A co-worker of mine heard a national news report that Aetna will no longer cover the cost of anaesthesia (sp?) for colonoscopies! Yikes! Can a SDoper confirm if this is true (hopefully not by personal experience)? Have others heard this report? If this is true, all I can say is BYOB! 
Bonus Question: When will Aetna stop paying for the cost of the lubrication? :eek: Gadzukes! Talk about really sticking it to the customer! 
It appears to concern one drug. .
I don’t like the opening this creates. Slippery slope and all that. 
Runner, yeah…this post is loaded for bare (sic)! Also, I think I heard they’re going to start using more Exlax, instead of lube, as I recall…keeps ya running to the doctor, ya know!
Weren’t they just saying that a CAT scan, or MRI or something is just as good as a colonoscopy?
That’s on my list of new technologies I want to see in the world. I want something to replace the colonoscopy to be invented before I turn 40.
[QUOTE=riker1384]
Weren’t they just saying that a CAT scan, or MRI or something is just as good as a colonoscopy?
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No, it’s not. Certainly, there are people trying to make such a thing true, but we’re not there yet.
Keep in mind, too, that a CAT scan exposes you to radiation. MRI’s can be quite expensive.
On a more personal note, last January when I couldn’t even keep water down and the docs were trying to figure out what the hell was wrong with me I got BOTH a CAT scan and a colonoscopy - because the two technologies provide different information, I suppose.
And I had versed as my “sedation”. I really didn’t remember the procedure at all, and certainly felt no discomfort, much less pain.
The colonoscopy isn’t bad at all - it’s the prep for it the day before that can get bad. They want you to clean out your insides prior to the test, so you receive medication that basically flushes you out completely. I recommend lots of toilet paper and some good reading material close at hand as you will be spending a LOT of time in the toilet voiding your bowels.
And that’s ANOTHER problem - most people I know who’ve been through this say they have no problem taking the day off to get the colonoscopy – but great resistance to taking off the day before. Hey, I just don’t see how you can be expected to work - seriously, multiple craps per hour for like 12-16 hours. What are we supposed to do, sit on top of a bucket instead of a chair?
Geez, and if you think people complain about people doing that sort of thing in public bathrooms, just wait until someone has to do it at their desk…
Agreed, Broomstick. I had to get one the same weekend as I had to write a final exam research paper for one of my Spanish classes. This special anesthetic does not strike me as medically necessary. Once you have survived the day before, the actual procedure itself feels like wrapping yourself in a blanket made of kittens and sunshine.
I must not be understanding colonoscopies. Why the need for anesthesia, or especially, sedation? Unless the scope is on the order of centimeters thick, or spiked or barbed, I don’t see why it’s necessary
chaoticbear, who has never had one
[QUOTE=chaoticbear]
I must not be understanding colonoscopies. Why the need for anesthesia, or especially, sedation? Unless the scope is on the order of centimeters thick, or spiked or barbed, I don’t see why it’s necessary
chaoticbear, who has never had one
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I’ve had a sigmoidoscopy and two colonoscopies. The was no anesthesia w/ the sigmoidoscopy and it was very uncomfortable. As I understand it there is air pressure injected in the intestine, to expand the walls and faciltate the Dr’s. view. This causes the discomfort (to put it mildly) and the anesthesia masks this pain.
[QUOTE=chaoticbear]
I must not be understanding colonoscopies. Why the need for anesthesia, or especially, sedation? Unless the scope is on the order of centimeters thick, or spiked or barbed, I don’t see why it’s necessary
chaoticbear, who has never had one
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Speaking as someone who has … to visualize the colon the intestine must be inflated with air. This stretches the gut wall and, believe you me, is quite painful.
Having said that, pain killers and sedation was more than adequate. Not sure that is classified as anesthesia.
[QUOTE=Broomstick]
No, it’s not. Certainly, there are people trying to make such a thing true, but we’re not there yet.
Keep in mind, too, that a CAT scan exposes you to radiation. MRI’s can be quite expensive.
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I think that’s an overly broad and perhaps outdates statement. It’s a rather vigorous debate at this point. If you’d like my somewhat considered opinion on the topic, the radiation threat for the patient population and dose used in virtual colonoscopy (colonoscopy done with a CT scan as opposed to an optical, done with a tube colonoscopy) is negligible. On an immediate basis, it’s safer than optical colonoscopy because it has a lower rate of bowel-perforation.
https://content.nejm.org/cgi/content/abstract/349/23/2191
http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&uid=16473802&cmd=showdetailview&indexed=google
I’d be happy to provide some more cites or information if you’d like.
Just had one done on Thursday. The anisthesia included a morphine derivative that has the side effect of relaxing the bowel by stopping peristalsis (sp?).
Oh! Air! Consider my ignorance fought.
[QUOTE=Long Time First Time]
Having said that, pain killers and sedation was more than adequate.
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Or not, depending on your personal experience. I woke up in the middle of my colonoscopy, and recall the most intense gas pains i had ever experienced. I groaned out load, then they must have hit me with more sedation, because I went back out again.
[QUOTE=Broomstick]
And I had versed as my “sedation”. I really didn’t remember the procedure at all, and certainly felt no discomfort, much less pain.
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If you don’t remember the procedure, how can you be sure you didn’t feel any pain?
When I was being wheeled into the OR for emergency surgery to correct a botched appendectomy, I demanded that they not insert a catheter, because the last time I had a catheter it hurt an astonishing amount. Of course, they said “Okay, okay, okay,” and reassured me, but when I woke up in the recovery room, sure enough, I had a catheter inserted. When the surgeon came to see me, I told her “I guess you had to put a catheter in after all. But thanks for waiting until I was unconscious.” She said “You don’t remember what happened?” and I said “Uh, I remember going into the OR and having Dr. Smith [the anesthesiologist] tell me to start counting backwards. That’s all until I woke up here.” And the doctor said “Well, we put the catheter in pretty soon after Dr. Smith sedated you, but when we started putting it in you woke up and started screaming and fighting us. We had to pretty much hold you down and you were moaning and wiggling the whole time and making it difficult, so finally Dr. Smith went ahead and gave you the general anesthesia so we could finish.”
So apparently I was in agony, but I don’t remember any of it.
[QUOTE=threemae]
I think that’s an overly broad and perhaps outdates statement. It’s a rather vigorous debate at this point. If you’d like my somewhat considered opinion on the topic, the radiation threat for the patient population and dose used in virtual colonoscopy (colonoscopy done with a CT scan as opposed to an optical, done with a tube colonoscopy) is negligible. On an immediate basis, it’s safer than optical colonoscopy because it has a lower rate of bowel-perforation.
https://content.nejm.org/cgi/content/abstract/349/23/2191
http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&uid=16473802&cmd=showdetailview&indexed=google
I’d be happy to provide some more cites or information if you’d like.
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I base my statement on a research radiologist who was paid to evaluate such risks. The problem isn’t so much a one-time CAT scan, but the number of such scans a person is likely to get in a given time period.
I had ALREADY had an abdominal CAT scan less that three weeks before. People with gastrointestinal problems often get multiple CAT scans in a short time frame in our medical environment, and THAT’S the problem, not the dose of the individual scan.
Between the researcher I was working with as part of my job, and with consultation with the doctors treating me, I just didn’t see getting more radiation when there was an alternative test without it with little risk available. Also, as part of the medical testing I was undergoing, they also biopsied a small portion of my intestine which you can NOT do with a CAT scan. Which is another thing - if they do find something on a “virtual scan” then you are subject to yet another procedure if biopsies or polyp removal is required, whereas with a “tube” colonoscopy such sampling can be done at the same time as the colonoscopy.
Yes, CAT scans are wonderful - it sure as hell beat exploratory surgery - but they are not the be all and end all of medical testing/imaging. I am already familiar with your cites, as well as many others, but since I no longer have that job as of November I’m not in a position to go back and list all of them that I am aware of in a proper manner.
[QUOTE=chorpler]
If you don’t remember the procedure, how can you be sure you didn’t feel any pain?
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Well, to some extent, if I don’t remember it don’t matter. Certainly, no one indicated to me that I had shown and evidence of pain and since it was sedation, not anesthesia, it wasn’t a matter of being paralyzed and unable to react.
[QUOTE=Long Time First Time]
Having said that, pain killers and sedation was more than adequate. Not sure that is classified as anesthesia.
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Well, when I had it done the sedation was administered by a nurse-anesthetist. Probably doesn’t hurt to have someone specifically trained in anesthesia doing this, and it may even be required.
Another advantage to an actual colonoscopy as opposed to the “virtual colonoscopy” advertised is that in the former, if a polyp is found, it can simply be removed right then and there. My gastroenterologist told me that while not all polyps progress to cancer, just about all colon cancer starts as a polyp. So if one is found during a “virtual” exam, you need to have a second procedure to actually remove it.
The phrase “a bunch of mindless jerks who’ll be the first up against the wall when the revolution comes” springs to mind, for some reason.
[QUOTE=Broomstick]
I base my statement on a research radiologist who was paid to evaluate such risks. The problem isn’t so much a one-time CAT scan, but the number of such scans a person is likely to get in a given time period.
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Broomstick, I am certainly not trying to argue about the appropriateness of an optical colonoscopy for you as an individual, especially given what you have since shared. I was simply disagreeing with your statement, “No, it’s not. Certainly, there are people trying to make such a thing true, but we’re not there yet.”
I think it’s obvious that there is still a place for optical colonoscopy, but to say that virtual colonoscopy is simply not an option as a screening tool in 2007 just isn’t true. Perhaps not for you, but for the general population, it is. It is very similar in sensitivity, specificity, tolerability, and safety. I would argue that it exceeds optical colonoscopy in some of these criteria and will likely improve much faster than optical colonoscopy.
Again, the debate is vigorous, there are advantages to either, but virtual colonoscopy has safety advantages in some respects over optical colonoscopy, and it has cancer risks that optical colonoscopy doesn’t have.
For anyone that is interested, I’ve found this article from to be an exceptional review of the issue of radiation exposure in CT scans. It’s not alarmist, but it does make a fairly convincing arguement that some CT use should be more carefully considered, particularly in pediatric patients and especially when other daignostic modalities are available.
http://content.nejm.org/cgi/reprint/357/22/2277.pdf
For context, optical colonoscopy has a bowel perforation risk of around 1-2 per 1,000 per procedure.