Expert: Ronald Levy, M.D. - 8/9/2008

Question
I have a bad history of colon cancer in y family as well as polyps, so I get frequent colonoscopies.  Not my favorite way to spend 15 minutes, but certianly not exactly torture.  The first one that I had was with Versed and  I really had a freaky "paradoxical" reaction anad vowed never to agree to it again; I still have nightmares about that experience; it was not the procedure, it was the drug.  So, I had the next 3 without it, no problems, erally crampy for a few minutes, but certianly better that that terrible drug.  My GI doc had no problem with this and respected my wishes.  Two years ago, I moved, got a new GI doc, relate thhte story and he agreed that I did well with no drugs.  So I schedule the exam, do the prep, etc and first they try to convince me to get another sedating agent from anesthesia (propofol); which I refused (why risk it, if I did well with nothing?). The new doc sort of went back on his word and said "but it's so much "better" sedated......so he finally agreed "again"..then they shove a "sedation consent"in front of me and ask me to sign agreeing to "sedation!!!!!!! So I wrote on the form "I do not agree to sedation",the doc reluctantly agreed...A nurse suggested that I have the doc cosign the form also, but by this time everyone was giving me a hard time.  My dad dies of colon cancer, I just want the exam withut drugs and I have done it before.  From what I have read, a LOT of prople have issues eith the "conscious sedation" with colonoscopy. My question is:  what do I have to do next time, after the doc promises no sedation, just refuse to sign or make them revise the form  and have him sign it also?   I guess that I have to look for a new GI doc, I'm having symptoms and will obviously have to look for a GI doc that I could trust.

Answer
You are certainly free to do what you want but Propofol is different from Versed and it might be worth your while to give it a try. If you insist on no sedation, then tell your doc that it is your way or the highway (Obviously not in those words :D) and if he doesn't agree, then find one who will. They cannot force you to have sedation but they can refuse to do you if you don't. So you need to find a doc who is willing to do the procedure without sedation.

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston