colonoscopyWhy would you want to be doped up and knocked out during a colonoscopy?    For that matter, why would you want to have a colonoscopy at all?   As to the latter, you pretty much don’t have a choice after turning 50.   Intestinal tract cancer rates are growing and they are very serious ailments.   The survival rates for such cancers are low — and late treated cancers result in almost sure, and painful, deaths.   The same is true for bowel and colon cancers.    53% of peopole who undergo a colonoscopy are less likely to die from intestinal cancers.  But another way:  if every person age 50 and older had a colonoscopy, 64% of people with colorectal cancer would have never developed the disease.  In light of the 6% risk of developing intestinal cancers, the risk far outweighs the inconvenience of a colonoscopy , which generally is a relatively common and safe procedure. However, the procedure gets a bit more complicated when sedatives or anesthesia are used.    And here’s the interesting part — in other countries, sedation is not used for colonoscopies.   In Europe, less than half of all colonoscopies use sedation. Yet, in the U.S.,  it is almost universally used.    This author recommends that when you have your colonoscopy, you should seriously consider going drug-free.

In the U.S., doctors frequently use a “conscious sedation” which is a brew of drugs that relax you while also blocking pain.   Patients are semi-conscious during the procedure but have little, if any, memory of what transpired.  Recovery from conscious sedation takes between 30 minutes to a few hours, although the effects of the sedation can take up to a few days to wear off fully.    Increasingly, MDs are using full anesthesia for the procedure — Propofol is the sedative of choice — arguably because conscious sedation doesn’t work well on patients who are obese or use painkillers.   However, there are a number of reasons for the use of sedation, including the fact that insurers reimburse for it,  doctors have more control over the process and because patients fear that the procedure is painful and they don’t want to experience pain.  The dirty little secret is that it is not a painful procedure; there are few nerves in the intestinal tract so one feels only pressure, not pain.

The dangers of sedation are not in your imagination;  there are definite risks involved with sedation.  In fact, it is probably the highest risk of complication during the procedure, according to the Weill Cornell Medical College, New York-Presbyterian Hospital.  Risks include an allergic reaction or respiratory problems.  There’s also a correlation of anesthesia with loss of memory later in life.   Actually, here’s how the Society of Gastroenterology Nurses and Associates describe it:

“A retrospective review, by Sharma VK et al, of 324,737 endoscopic procedures performed under conscious sedation was accomplished using the Clinical Outcomes Research Initiative (CORI) database.  Several factors related to cardiopulmonary unplanned events (CUE) during GI endoscopy were identified including chest pain; arrhythmia; bradycardia; tachycardia; wheezing; hypotension; hypertension; transient hypoxia; prolonged hypoxia; respiratory distress; pulmonary edema; vasovagal reaction; tracheal compression; death; and O2 saturation less than 95%.”

This is pretty serious stuff and it is entirely unnecessary.  Colonoscopies can be performed safely and with almost no pain.  But you’ve got to request it. American doctors do not offer sedation-free colonoscopies routinely.  The procedure is beautifully described by David Holzman in a blog;  it is mandatory reading if you plan to go sedation-free.  He describes the discomfort as minimal — hitting maybe 3-max out of 10 on the pain-meter for seconds at a time here and there, and otherwise never going beyond 2 out of 10, comparable, perhaps, to a very mild cramp. And added plus:  he could drive himself to and from the hospital, and he’d be able to work when he got home. Another knowledgeable blogger, Laura Johannes, offered a similar experience to that of Holzman.

IMG_20141229_074225My sedation-free colonoscopy was performed on December 29, 2014.  I’ll continue the tradition of Holzman and Johannes by offering details of my experience.  This was a 30-minute long procedure in which I had a number of small polyps removed.   The staff at Sharp Rees-Stealy in San Diego were very familiar with non-sedation colonoscopies, reporting that many health professionals and patients with high-level security clearances request them.  Essentially, they were not uncommon and were the preferred method among those in the business who understood the colonoscopy process.  Moreover, most all of the staff with whom I spoke actually preferred the drug-free patients because the process was less complicated and had they had very brief recovery periods.   The staff viewed sedation as a convenience to their patients, not due to medical necessity.  (By the way, the Sharp staff that conducted this procedure couldn’t have been nicer folks.  Pleasant and very competent.)

My procedure was somewhat long  (average ones last 15-20 minutes), yet there was minimal discomfort; largely just gas pains from the air pushed into the colon by the scope.   At no point did I feel any pain at all, even when the doctor was removing the polyps.  Recovery took less than five minutes — just the time needed to remove the monitoring equipment and IV tube used to keep me hydrated.   The doctor was skillful, but seemed to feel that the lack of sedation did not make her task any more difficult.  We chatted about her findings throughout the procedure and were able to discuss the polyp removal and evaluation process during the brief “recovery”.

My experience appears to be a fairly common one; no pain, minimal discomfort, no recovery needed.  I drove home after it was completed.But anecdotal evidence aside, please understand that you are taking unnecessary risks and substantial post-procedure discomfort when you rely upon sedatives to help you through a thoroughly non-traumatic procedure.  Think twice before using sedation — it just isn’t needed!

Some additional tips about preparing for a colonoscopy
  •  Many people think that they can drink the prep one to two days before the procedure and then drink nothing but clear fluids (such as Gatorade, apple juice or water) until the day of the colonoscopy. But even during the prep, the small intestine (the section of bowel after the stomach and before the colon) continues to produce chyme, a thick, mucousy secretion that sticks to the walls of the ascending colon—so that seven to eight hours after drinking the prep the colon is no longer completely clean.   Many doctors recommend a split prep, with half the prep ingested the day before the procedure and half ingested four to five hours before (the middle of the night when the colonoscopy is scheduled for the morning…or the morning when the colonoscopy is scheduled for the afternoon).
  • Chill the prep liquid and then use a straw to drink it, followed by a swallow of  ginger ale or another better-tasting clear liquid. Suck on a clear menthol lozenge after you drink the prep. And if you throw up the prep, wait 30 minutes (until you feel less nauseated) and then continue drinking the prep as instructed—it can still work.  Studies have found that eating a fiber-free diet all or part of the day prior to colonoscopy also allows for better cleansing of the colon.