Expert: Ronald Levy, M.D. - 2/28/2008

Question
How can I find a gastroenterologist who will listen and respect my wishes for no sedation for a colonoscopy?  I recently went through contacting each of the practices in the area where I live and there was no interest in seeing the patient to discuss options in pharmaceutical care prior to being on the table, after the prep and then not listening.  I finally found a gastroenterologist two hours away from me who stated he was willing to discuss my concerns.  However, at the outpatient session, it was far more of a "this is how it will be done" session.  When I informed him that I have had allergic/adverse reactions to certain medications (ones that are routinely used in colonoscopy either as a part of conscious sedation or MAC) he aced as though he did not believe me, but acquiesced, agreeing to only give me something to relax me, which he said would be needed.  I thought the Versed was just to relax me.  I have only vague, sketchy memories of the process, no explanation of what was going on.  It produced an amnestic quatilty of which I was not forwarned.  In addition, he promised that the sedation would wear off the same day and would not be uncomfortable.  First, it has felt like an awful hang over lasting about 36+ hours after the procedure.  In addition, my job involves significant concentration and impacts the lives of others.  Based on the physician's insistence that I would be fine, I had a conference call with an attorney on a case that we share 24 hours after the procedure.  I was a space Kadet and hope that I do not loose my livelihood as a result of the discrepancy between what I was told and what happened.  How/where can I find a competent caregiver who can do my next colonoscopy?  It was recommended that I have a repeat examine in 5 years.  If it has to be as this doctor insisted, I will never again have a colonoscopy!  Surely, there has to be a better way.

Answer
Most people would find colonoscopy without any medication extremely unplesant. But if that is what you want, I would suggest going to a teaching hospital where they would be more likely to listen to your concerns. Regarding Versed, One of the features of Versed is that it causes amnesia. This is generally a good thing because people do not like to remember these experiences. While the effects generlly wear off within 4-12 hours, we usually tell people not to make important decisions for 24-48 hours after a procedure. Most colonoscopies are done with Versed and Fentanyl (a narcotic) and occasionally Propofol. Allergies to these medications is rare. My suggestion is to explain to the gatroenterologist your concerns and see if they would be willing to comply. I would still say not to make important decisions for 12-24 hours post procedure.

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston