I had one. They gave me a Valium, that’s it. I think they dabbed a touch of some local on the anus, along with the lube, maybe.
There was no pain at all, and watching my colon on TV was sort of entertaining. Mildly.
I did not say it wasn’t an option, the statement I responded to was as follows:
No, it’s not just as good as - not as a blanket statement for all people. My own example was to provide a situation where it was not just as good as but arguably inferior to the old fashioned way of doing it. MLS also touched on a more general example.
And, as you pointed out, there is yet some debate on the various methods used. Perhaps I am more conservative when it comes to medical innovations, but I don’t accept automatically that newer and/or more expensive is necessarily better. I do not object to virtual colonoscopy when appropriate but I too often encounter the notion that it is somehow going to entirely replace sticking a tube up one’s backside and that just ain’t so. I suspect part of the issue is that, particularly in US, there is cultural indoctrination against shoving things up the backside for any reason which, in my opinion, is a significant factor in why people who should get a colonoscopy don’t always do so.
Once again, I don’t have any objection to CAT scans or MRI’s when appropriate but they will not replace everything else. For situations where interventions are likely to be needed - biopsies, polyp removal, etc - imaging will simply not be able to replace “tube” methods until we develop a means to magically teleport the tissue out of the intestine. Those situations are a significant fraction of the reasons colonoscopies are done in the first place. For healthy people for whom this test is purely a screening test for asymptomatic issues yes, the technology is starting to mature but that’s not the only reason this procedure is done. I applaud the development of technology that is safer and less intrusive to the patient, but new technology must be proven and not simply accepted.
I guess we’re arguing over semantics then. I certainly never claimed that virtual colonoscopy was superior to optical colonoscopy in every aspect for every patient population. I was simply trying to provide some Straight Dope that virtual colonoscopy is not some distant, imagined potential future technology. It’s a very real, clinically available technology that is appropriate for some people.
I still feel that your statement was overly broad but was probably true 10 years ago.
I agree completely with this part of your post, especially given that virtual colonoscopy still involves a very real, “tube up one’s backside,” to inflate and visualize the colon. This can be done with a patient-controlled pump with less pressure in virtual colonoscopy than in optical colonoscopy.
For more general information for people that are curious about how virtual colonoscopy works:
http://www.radiologyinfo.org/en/info.cfm?pg=ct_colo&bhcp=1
I’m not exactly sure how virtual colonscopy would be better in this particular instance, as it is significantly more expensive that the conventional type and would require the services of a radiologist as well as the gastroenterologist or colo-rectal surgeon. Since the Propofol was struck out because it required a second doctor (anaesthetist) I’m not sure if the virtual colonoscopy would be approved by the insurance people on the grounds of cost.
As long as the insurance company is still willing to pay for Midazolam, Lorazepam or Diazepam, I don’t think anyone will be enduring colonoscopies without some sort of sedation.
Propofol is just one drug, it’s not the only one, or indeed a commonly used one where I work (we usually give people some IV Midazolam).
From that link:
“Significant pain is uncommon, occurring in fewer than 5 percent of patients. A muscle-relaxing drug may be injected intravenously to lessen discomfort, but this is seldom necessary.”
I’d love to know how the authors define “significant pain”. Is that more than “discomfort” (my least favorite medical code word for pain)? Maybe they’ll give you a “muscle-relaxing drug” if you howl loud enough, but it appears that actual intravenous sedation is out.
Which is why I’m not looking forward to the day when insurance companies refuse to cover traditional colonoscopies in favor of the cheaper “virtual” kind. Your comfort will be secondary to monetary savings.
As to the OP, I am concerned that physicians and some of their patients will now have to fight to get the more expensive drug, in disputes with Aetna and other insurers who will claim that certain patients don’t fit criteria for more anesthesia. The result will be more hassles and unnecessary pain for some patients.
I’ve had two endoscopy procedures and they were painless. The prep beforehand wasn’t so bad either. On the other hand, I know of patients who experienced considerable pain during colonoscopy (including a family member who apparently didn’t get adequate anesthesia beforehand).
Jackmannii, M.D.
Aetna can be a pain in the ass.
I’ve been putting off having this procedure done for several years now, not because of the actual procedure itself but because of the prep the day before. I was with my mom when she struggled to swallow that gallon of horrid tasting stuff the day before (she ended up throwing up most of it). I can accept that I’ll be on the toilet most of the day. I can accept that my colon is going to be probed. What I can’t get past is being forced to drink massive quantities of vile liquid.
And now it looks like some insurance companies are looking for ways to cut their payouts by limiting sedation. Oh, yeah. This is really going to encourage me to have this done. :rolleyes:
I didn’t have to drink GoLYTELY. All I took was a Fleet’s Phospho-soda laxative, and Dulcolax, in addition to a 24-hour fast. Check with your doctor.
Take it from me, it’s not so bad. You can drink the liquid concoction (there are various kinds BTW) over time and it does clear out your colon before the procedure. The colonoscopy procedure is nothing, over and done with before you know it, and its diagnostic value is worth it. The best part is you only have to do it every 5 years or so. So a day’s worth of discomfort every 5 years for some knowledge that you’re not going to get colon cancer is a no-brainer for me.
I think it was Dennis Wolfberg who used to say in his stand up act that telling a patient who was about to undergo a colonoscopy that he might experience “discomfort” was like telling people in the path of an oncoming tsunami that they might experience “moisture.” 
Full disclosure: I work in the insurance industry, although I have never worked for Aetna. I have no intention of standing up for, or speaking for, Aetna. But, reading the article, it looks like Aetna stopped covering this drug in most cases. Many of the top gastroenterologists quoted in the article (for whom patient satisfaction should be an important consideration) agree with Aetna’s take on this, while the anaesthesiologists, who stand to gain from the drug’s use, are (surprise!) against Aetna’s policy.
If an insurance company were to cover all the expensive drugs and procedures that their competitors restrict, that company would have to charge far higher premiums and would quickly go out of business. (This is not only because of the relative cost difference of the drugs and procedures, but becuse such a company would quickly attract all of the most expensive patients in the market. This phenomenon is called “adverse selection”.) Purchasers of health insurance - often employers - base their decisions primarily on cost, with service, reputation, provider networks and other considerations of somewhat lesser importance. (This is rational behavior - if all consumers valued service over cost, then there would be a Nordstrom’s on every corner and no Wal-Marts anywhere.)
The point I want to make here is that medical inflation remains hideous, and situations such as this are a big reason why. Many of we American consumers are still in need of having our Ignorance Fought regarding what this stuff really costs. If a new drug comes along that, to pick a number, is more beneficial for 5% of the patients, but costs 500% more money (not an exaggeration), it is not unreasonable to cover it for those 5% while questioning whether it is worth prescribing without restriction for the other 95% of the patients. We Americans complain bitterly about the tremendous cost of insurance, yet want unfettered access to every expensive drug and procedure that comes along. Just like schools, public infrastructure, etc., we want everything, as long as someone else pays for it.
There are reasonable arguments on all sides of the current debate regarding the American health care “system”, which isn’t really a system at all. I’m not going to get into that here - that’s been a topic in GD for years.
For an average-risk patient without signs or symptoms or significant family or personal history, there’s still no real great evidence that colonoscopic screening provides for better outcomes (in terms of survival) than checking multiple stool samples annually for the presence of blood.
Ask your doctor about what screening test is right for you, and when.
Question: A gastroenterologist told me that a clean colonoscopy was practically a guarantee of no colon cancer for 5 - 10 years, since it would take at least that long for a single non-cancerous polyp to start to become cancerous. Is that borne out by medical statistics? For me, if that’s true, I’d rather endure one colonoscopy per decade than several doctor visits for stool samples every year.
Basically true, but you don’t need to see the doc that often to give stool samples. Just get a kit to take samples over a series of days (a tiny speck not much bigger than the tip of a pen is sufficent) and mail it in. Repeat yearly after the age of 50.
BTW, in case anyone wants evidence-based conclusions about screening for colon cancer in low risk populations, go here: Clinical Guidelines and Recommendations | Agency for Healthcare Research and Quality
The summary goes on to talk at length about when different modalities, including CT and ‘virtual’ colonoscopy may be preferable. Or not.
Qadgop’s link highlights the relatively low sensitivity of standard fecal occult blood tests (the kind using cards you mail in to the doc’s office). The article cites less than half of cancers being detected by annual testing. There is a brush test that is reportedly quite a bit more sensitive than the typical Hemoccult card test, though I haven’t heard of it being recommended for general use or as a substitute for colonoscopic screening, particularly in people with a family history of colon cancer.
Thanks for the reassurances, Fear Itself and nivlac. I’m going to have to stop being a baby about it and just have it done, considering my mom had colon cancer and ended up with an illiostomy (sp?). Her surgeon showed us pictures of her colon after he’d removed it. It wouldn’t have been very much longer until she was completely blocked by tumors (though it was Alzheimer’s that she eventually died from). I just hope that when I have the procedure done, my insurance will cover at least a major portion of it. But I’m not holding my breath.
This is pretty much exactly what happened to me, without the special anesthesia. And it still wasn’t really that bad. It was pain, but when I woke up it didn’t even seem like a real experience.
Repeated from 12-19-2006, 06:30 PM #14
"My first colonoscopy procedure, following bloody stools and a quick sigmoidoscopy, was painless and they fortunately snipped and removed two precancerous polyps. I was conscious enough at the end of it to watch the 'scope’s view of the last couple of feet of my colon on the wall monitor. It looked just like Katie Couric’s, BTW. They even gave me color photos of the two polyps, pre-removal.
But when I went home and went to bed that night, I awoke to the most painful abdomen that I had ever had. I could not even bend to get off the bed to go to the bathroom, but I did, eventually, make that move…
Prior to the second one, I told the (different) proctologist about that (pain) and he felt that that had probably been caused by the air that is blown into the colon to expand it. No pain or polyps resulted from the second or third oscopies. The last one, though, involved a self-administered enema as part of the purging. That was interesting, never having had one before that I remember.
I’ll have no problem about having future scopings when the need or schedule arises. The first one probably saved my life 11 years ago."
The prep for the first one, with the gallon of GoLightly, was no fun. The others, with a laxative in a sports drink, was better, except for the enema.
I had Versed in each one, I believe.
Interesting. My husband had a colonoscopy recently and he just mentioned he got a bill for the anesthesia; it wasn’t covered by our carrier (Cigna). I was about to write them a terse letter asking who the bleep is going to undergo a procedure like this without sedation/anesthesia, but after reading this thread and the folks who say they did it without drugs and it was fine, I’m thinking I’m a big wuss.
Just kidding, I know I’m a big wuss. But hey, if you’re going to ram something with that size bore up my rear end AND charge me $10K for it, I’m gonna need something more than lidocaine. Really.
Every five years? $10K? No drugs? There’s gotta be a better way.