Colonoscopies and anesthesia

Reader warning: this blog has strong anal and colonic content.

OK, I'm kind of pissed off. This article says that due to the popularity of the colonoscopy and possibly because of the large profit to me made from administering it, some surgeons are rushing through the process, fairly often taking only around two minutes for the whole thing. As a result, there have now been an unreasonable number of colon cancers found after one or even two normal colonoscopies.

Because my brother actually had colon cancer, I was judged to be at increased risk, and so I started having colonoscopies earlier than many people. I've now had three and am coming up on number four. So far, they've all been normal, but that article makes me doubt the third and most recent one.

Why just that one?

Well, because for the first two I was, at my request, conscious during the entire procedure.

(Apparently some people don't take any anesthesia at all during the procedure, but that would be hard for me, especially if it lasted 20 minutes. It feels like an extremely crampy session of major flatulence, but with no possibility of a relieving fart.)

What they did was to give me an analgesic, probably morphine, to "dull" the pain (most of the pain is from the air they use to inflate the colon so that they can inspect the surface better). I was able to look at the monitor during the procedure, and even listen to the doctor and ask questions to a limited degree. I found the whole process very interesting. During the second one, the doctor even gave me a copy of a photo they took showing a slightly inflamed region (which turned out after biopsy to be normal). I genuinely appreciated being awake and to a limited degree made a part of the process.

Number three was different. I made the request to the doctor, who was some guy with an office 30 miles away from where I live who I'd never met before. He basically said, well, ok, I'll "try", but I prefer the patients to be fully under. In the actual procedure, the very first time I said it was painful, wham!, I was out and don't remember a single thing after that. I was P.O.ed at the time, but since I just put it down to a concern that I might move or something if I were conscious, I basically let it go, although I was determined to make a bigger issue of it next time.

Well, now that I've seen the above-mentioned article, there is a new theory on the table for why colonoscopists prefer to have their patients unconscious: so that they won't go back and tell their primary care docs that the damn colonoscopy only took two minutes!

And not only that, the trust that medical people put in colonoscopies is impressive: I've talked to many doctors about them, and it is universally believed that if you have a normal colon after a colonoscopy, then you aren't going to get colon cancer for at least 5 years. After two, they say that it's 10 years (one surgeon I spoke to recommended 2-3 years, but he was a krufty old geezer who probably knew things that even most docs don't know about the interaction between medical practice and everyday human greed, laziness, and incompetence).

OK, here's the "bottom" line: If you can stand it, pressure your colonoscopist to allow you to remain conscious during the procedure and look at the monitor screen. Interact with him. If you see something that you think he may have overlooked, tell him. Yes, it may annoy him, but colon cancer is pretty annoying too, and according to the NY Times article, you're probably paying about $2000 for the test. And it's pretty interesting to observe the procedure. You're actually going to see the inside of your large intestine in detail. Let's not forget that the word doctor comes from Old French docere to teach, and that the cognate noun meant "educated person" or "teacher". Let's let the docs teach us something about what's going on in our own colons!

You could also ask for the start (insertion of the colonoscope sensor) and end (final removal of the sensor) times, but here again, if you're unconscious, then it would be difficult to distinguish between a "transcription error" and a fraudulent report.