Another exam

wishing you great results very soon !

Ouch_Ouch_Ouch said:

When does a colonoscopy take place?

I'm a little confused about sigmoidoscopy vs colonoscopy. They did a sigmoid when I was diagnosed and the oncologist mentioned a few visits ago that I would have to get a follow-up sigmoid. As long as I'm in the OR under anesthesia, why wouldn't they do a colonoscopy or will that require a third trip to the OR?

[I wish I could ask the oncologiast, but the visits are so rushed that I can't get through my list of questions and her nurse doesn't really seem to know a lot about cancer treatment. (My cardiologist's - actually electrophysiologist's - nurse knows more about cancer treatment than the oncologist's nurse does.) The oncologist's partner has been on maternity leave ever since I'm been under treatment, doubling the load, so it's nearly impossible to get timely appointments, impossible to get her on the telephone, and visits are rushed. Hopefully, her practise is more relaxed when her partner is also working.]

I did not initially have a colo-rectal doc.  The local hospital has two general surgeons and that's it.  I decided that I wanted to be followed by a colo-rectal doc and called one and made an appointment and am happy that I did.  He's only a half hour away.  I have seen him three times post treatment, at two month intervals.  I have had an anoscopy at each visit but I think at this last one, he did the sigmoidoscopy because he mentioned air going in there.  And it was very uncomfortable.  Not painful, just uncomfortable.  I've had these procedures done without any anesthesia.  Thankfully, I have anti-anxiety medicine and I'm not afraid to use it!  I asked about a colonoscopy and he said that since my colonoscopy was normal (it was routine, but the gastroenterologist found the cancer, lucky catch), he would not do another colonoscopy for a year.  I was happy to hear that though I don't know if it is the best approach.

Let's hope it is.

sandysp said:

You won't need OR

The signmoidoscopy is a very quick little test and not to me as uncomfortable as a pap smear. I think all of us could use a bit of anti anxiety medication when going for a procedure we are truly nervous about. It's easier on everyone. Deep breathing, a special prayer I memorized and meditation help me also. If I can't do that, I have learned that sometimes it just pays for me to draw a box in my imagination over and over. It helps unplug my brain which is of very little good to me when I am afraid and just have to go through something.

You are over the worst of it. It all will start to get easier. This is a way of life for me now. I am just glad I am feeling so well three years post last tx.

All the best and good luck,

Sandy

I saw the oncologist today and asked why a sigmoid and not a colonoscopy. She said that she "hadn't appreciated the fact that I never had one before" and therefore will reguest that instead. I want to go to the colo-rectal surgeon that saw me initially. After all, he is the only one who has ever laid eyes on that interior tumor. However, the oncologist told me that they rarely do colonoscopies and that a regular gastroenterologist would be better. I just don't understand her reasoning. Is not "colon" where colo-rectal surgeons get their specialty's name from, after all?

[From the American Society of Colon & Rectal Surgeons website, certification means expertise in [emphasis is mine]:

• Anorectal conditions
• Hemorrhoids
• Fissures
• Abscesses
• Fistulas
• Inflammatory bowel disease
• Chronic ulcerative colitis
• Crohn's disease
• Diverticulitis
• Colonic neoplasms
• Cancer
• Polyps
• Familial polyposis
• Endoscopy of the colon and rectum
• Rigid and flexible sigmoidoscopy
• Colonoscopy
• Endoscopic polypectomy
• Intestinal and anorectal physiology for management of
• Anal incontinence
• Constipation
• Diarrhea
• Rectal prolapse]

As for sedation vs anesthesia, the last time I was in way too much pain to be awake. I will have to have atropine via IV as I have rheumatic heart disease, with a resultant sick sinus syndrome and hypervagal tone, along with the biggest skin integrity-violation phobia you ever saw (needles, scalpels, spinters, anything sharp can make me pass out from a vaso-vagal response). The scope itself can instigate a vaso-vagal response as it pokes along. So, I don't know how this will pan out.

When I was previously sigmoided and diagnosed, my heart rate in the OR was a steady 38. For some reason, the anesthesiologist didn't want to give me atropine and snarkily said that they should be installing a pacemaker instead of doing a rectal scoping. He and the colo-rectal surgeon argued about it for a while, but eventually the anest. went along with him and then put me under. It wasn't even the anest. that examined me in the pre-op area, so seemed not to have a grasp of my history.

And there I was, suuronded by an OR team twiddling their thumbs, my butt sticking up in the air, literally freezing my tail off, wondering if this was going to happen or not!

Adventures in medicine...

Ouch_Ouch_Ouch said:

Procedure questions ---

I saw the oncologist today and asked why a sigmoid and not a colonoscopy. She said that she "hadn't appreciated the fact that I never had one before" and therefore will reguest that instead. I want to go to the colo-rectal surgeon that saw me initially. After all, he is the only one who has ever laid eyes on that interior tumor. However, the oncologist told me that they rarely do colonoscopies and that a regular gastroenterologist would be better. I just don't understand her reasoning. Is not "colon" where colo-rectal surgeons get their specialty's name from, after all?

[From the American Society of Colon & Rectal Surgeons website, certification means expertise in [emphasis is mine]:

• Anorectal conditions
• Hemorrhoids
• Fissures
• Abscesses
• Fistulas
• Inflammatory bowel disease
• Chronic ulcerative colitis
• Crohn's disease
• Diverticulitis
• Colonic neoplasms
• Cancer
• Polyps
• Familial polyposis
• Endoscopy of the colon and rectum
• Rigid and flexible sigmoidoscopy
• Colonoscopy
• Endoscopic polypectomy
• Intestinal and anorectal physiology for management of
• Anal incontinence
• Constipation
• Diarrhea
• Rectal prolapse]

As for sedation vs anesthesia, the last time I was in way too much pain to be awake. I will have to have atropine via IV as I have rheumatic heart disease, with a resultant sick sinus syndrome and hypervagal tone, along with the biggest skin integrity-violation phobia you ever saw (needles, scalpels, spinters, anything sharp can make me pass out from a vaso-vagal response). The scope itself can instigate a vaso-vagal response as it pokes along. So, I don't know how this will pan out.

When I was previously sigmoided and diagnosed, my heart rate in the OR was a steady 38. For some reason, the anesthesiologist didn't want to give me atropine and snarkily said that they should be installing a pacemaker instead of doing a rectal scoping. He and the colo-rectal surgeon argued about it for a while, but eventually the anest. went along with him and then put me under. It wasn't even the anest. that examined me in the pre-op area, so seemed not to have a grasp of my history.

And there I was, suuronded by an OR team twiddling their thumbs, my butt sticking up in the air, literally freezing my tail off, wondering if this was going to happen or not!

Adventures in medicine...

My colorectal surgeon is the only doctor who has done a colonoscopy on me.  It makes sense to me to have a CR doctor do this procedure, especially when one has a history of anal cancer, which I think would be out of the scope (no pun intended) of the specialty of a gastro doc.  However, my husband had his first and only colonoscopy a few years ago and his was done by a gastro.  As for anesthesia, I believe (but not 100% sure) that each time, I've received Propofol.  Before I am wheeled into the scope room, the anesthesiologist has always come in and asked me some questions, including how well I've come out of the anesthesia on previous scopes.  The last time I had a scope (October 2013), he asked me that question and after I told him that it can take me awhile to come out of it, he reduced the amount ordered.  It helped, as I actually remember my CR doc coming in and talking to me after the scope was done. 

As for the above list, I do not see anal cancer listed specifically.  I guess it would come under either "anorectal conditions" or "cancer," which takes in a lot.

eihtak said:

Procedure differences....

Once again it seems we have differences in follow-up procedures. I had a general surgeon do my biopsy, and ostomy surgery for anal cancer. (He later treated my breast cancer as well) About a year post treatment a gastro doc did my colonoscopy along with a separate scope of the anus. (I have a loop ostomy and although not in use still have my anus and rectum so require two separate looks). All came back good and was not scheduled for another colonoscopy for 5 yrs but saw a colo-rectal doctor for an anoscopy at approximately 2yrs post. Nothing more was scheduled along those lines but when having my last pelvic exam I questioned the need for another anascope and my gyn (who is a gyno-oncologist) did not think it was necessary. I have a CT scan in Dec so will probably just schedule a scope at the same time myself. I have never requested an exam or test that my doctors refused but have found the need to be pro-active and take the initiative occasionally. I trust them completely and feel I am closely watched, so anything I request is just for that added peace of mind.

Wouldn't it be nice if dx, treatment, and recovery follow-up could be "cookie-cutter" simple so we could all know we were being treated the same? But, since although we all share this horrific experience, we are still all different in our healing I guess its also good to asume our docs are treating our individual needs....I hope!

Be well.

katheryn

I'll call the colo-rectal surgeon's office and if he still takes my insurance, I'll ask to speak to his surgical-arrangements nurse and ask how frequently he does colonoscopy. If all sounds well, I'll schedule it for the end of October.

Meanwhile, I just read where insurance companies will cover "anesthesia", but not an anesthesiologist for colonoscopy. Those companies presume that the CR surgeon or gastroenterologist will wrangle the meds AND the procedure. Have any of you had a similar experience? What do anest. charge, on average?

By the way, this CR surgeon's site has a clear, concise article on anal cancer, as well as many other articles (including the one about anesthesiology and insurance companies): "Anal Cancer - Squamous Cell Carcinoma: A Curable Disease" - http://lacolon.com/patient-education/anal-cancer-squamous-cell-carcinoma-newsletter

ADDENDUM:  mp327 - I, too, was examined in the pre-op area by an anesthesiologist, but when I got to the OR, a completely different person showed up. Since I was originally scheduled for a hemorrhoidectory and sphinter resection for a large anal fissure, I was in an actual operating room, not an endoscopy room. There was even a huge sterile table covered with very scary-looking steel instruments! (I was in too mucn discomfort during the intial exam at the surgeon's for him to do a thorough digital rectal exam [DRE], forget an anoscope. He diagnosed me as best he could until I was under anesthesia and the true nature of my condition presented itself.)