Saturday, January 16, 2016

On Female Physicians, Colonoscopies and Propofol

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It was 23 years ago - after we'd moved to the U.S. from Barbados -that I was directed to take an "entry physical" for qualification to the Columbia Medical Plan (in Columbia, MD). I didn't know what to expect, only that the exam would be "thorough"  and administered by a "Dr. Ruth Penn"  Up until then the idea of a female physician was about as alien to me as the notion of a female soldier. Acculturated from early to accept defined gender roles, I was biased toward believing that females went into kindergarten or grade school teaching, or nursing and secretarial work - but never as fully qualified M.D.s

Suffice it to say that after that exam I had radically altered my perceptions.  The woman who administered it was professional, no-nonsense and attendant to every detail one could imagine - even to the point of (my) mild embarrassment-  but with the aplomb (and sensitivity)  to put a patient at ease.

The professional, detailed mindset of the physician led me from that time to select female physicians over male ones - who (as wifey also learned to her detriment) were less attentive to critical details, almost always in a rush, and seldom possessing the instincts or insights of their female counterparts. But don't just take my word, Google "advantages of having a female physician"

This is important to note as now nearly 50 percent of M.D.s are female. The world has "tilted" off its axis metaphorically and culturally from where it had been 50 or 60 years ago.

Flash forward now to my first colonoscopy nearly 20 years ago. I didn't know what to expect only that the HMO had advised it owing to my age (50). I was administered the drug versed to attain a "conscious sedation" but was still alert enough to recall seeing the screening monitor and most of the procedure. Even hearing one nurse yelp: "Doctor! You almost perforated his colon!"   Evidently, the guy had been tripping through with his 'scope" not appreciating I had moderate to severe diverticulosis and nearly punctured the intestinal wall. (Something that usually occurs about 1 in 1200 times in which case you likely have to have an emergency surgery and be fitted with a colostomy bag.)

The other thing I recall is that despite the versed (which had many adverse effects on my mental state and temper) the pain was unreal, and the complications - lots more bleeding than expected - unacceptable.  My conclusion is the guy was in too much of a rush and I nearly paid for it.

Flash forward another ten years after our move to Colorado, to find a house, and it was time for another colonoscopy (10 -year interval). Our female primary care physician recommended a gastroenterologist named Dr. Sue Mitchell . I related my previous experience, but
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she allayed those worries saying Dr. Mitchell was eminently qualified and made the appointment. Not wishing to have a repeat of my versed experience, Dr. Mitchell only used a mild pain killer (fentanyl) and I was able to observe the entire procedure, which found and removed two polyps, one of them - pre-cancerous (adenomatous).

I had no adverse effects, or pain, as in the previous time and only the amount of bleeding one could expect from having a minor surgery. (About a 'tablespoon' of blood). Moreover, Dr. Mitchell was detail-oriented, observant and did methodical notes - which she gave to me - as well as calling up a day later to see how I was doing.

Three years later - since I had two polyps - it was time for another colonoscopy and she repeated though this time without pain killers or anything else - but with an intravenous drip in case I was unable to handle it. As it turned out she was right. Having to slowly move the scope through small crevices and corners - arising from the diverticulosis - there were spots she hit that required the administration of measured doses of fentanyl. Despite the desire to go without anything, any sedation or pain killers- it was not possible with this diverticulosis.  The good news is that only one polyp was found (hyperplastic) and it was removed. I didn't have to do it again for five years.

Fast forward to this year and the time was overdue for a colonoscopy for me as well as my wife. Originally, I'd planned to forego it entirely and just do the non-invasive F.I.T. test advocated by Dr. Deborah Fisher of Duke University, see e.g.

http://brane-space.blogspot.com/2015/01/not-thrilled-by-getting-colonocopies.html

But my primary care doctor advised against it especially because of my polyp history. She said it was better to get it done, and  - if NO polyps showed up - I could get the F.I.T. done next time (when I'd be at least 74).

We scheduled our procedures this past Thursday, both with Dr. Mitchell. We both had forgotten how brutal the prep was - especially hard for Janice who just couldn't manage to gulp down 64 ounces of Gatorade (mixed with Miralax powder) in the short time. She was feeling nauseous so had to stop after 50 oz.  I just took the damned bottle and swigged it all down in an hour. Needless to say, the "mission" for clean out had begun.

The other hard part is you're only allowed to drink clear liquids for the day - coke, tea, gelatin (not red!), but you can have Ensure up until noon or so.

The last batch of 64 oz. with the Miralax had to be taken at 2 a.m. and again I just chugged it all down within an hour or so while Janice struggled. It took her over two hours. I also ended up drinking lots of water (at least eight full glasses) because there was no water to be had after 5 a.m.

We took a cab to arrive at Pike's Peak Endoscopy by 7:30 a.m. and within 15 minutes were each allocated separate rooms to get ready.  I then went to visit Janice, who was in tears - after being told they couldn't give her the propofol she had wanted, on account of her having a cold. They warned doing so could have the same outcome as occurred with Joan Rivers - whose windpipe swelled up so much during her endoscopy she couldn't breathe and died.  SO, Janice settled for the conscious sedation instead and besides she didn't have the adverse reactions to versed like I did.

As for me, I really really want to go 'lowball' with the meds, and I hated the idea of conscious sedation with versed. But Dr. Mitchell calmly reminded me how difficult it was for me the last time, and though given small doses of fentanyl she had to add more because I was writhing from the pain - not good when you have this device in your intestines.

She suggested using propofol but all I could recall about it is that it was the drug administered to Michael Jackson and which he'd OD'd on. She assured me, however, it would be given at the smallest dose. Also, I would have my full mental faculties back almost immediately after as opposed to the grogginess that accompanies sedation.

To cut to the chase, the procedure went well, and I was out like a light until I was awakened in the recovery room There I was given four glasses of water, a latte and a couple of cookies. Dr. Mitchell came to visit me and said things had gone superbly and no polyps were found, not one.  As for wifey, they alas had to abort her procedure because the prep had not worked the way it ought to have on her. She was upset and still mulling over whether to have it again, but reminded of the brutal prep - she may not. (She's never ever had polyps like I've had).

Both of us have to commend Dr. Mitchell for attending to us during a difficult morning, and also following up for both of us.  She is definitely the gastroenterologist one would want if and when they have to get a colonoscopy!  As for propofol, you may wish to read more about it here:


(If unable to access, Google: "Consumer Reports, propofol"

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