Another exam

Ouch_Ouch_Ouch said:

I've decided...

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.)

It's unbelievable to me that insurance companies would not cover anesthesia for colonoscopies!  Perhaps we have Katie Couric to thank for that!  I believe mine has always been covered and if I remember correctly, the charge was about $800 last year when I had my last scope.  Before my procedure, the anesthesiologist came in and asked me some questions and then gave the order for the dosage.  Once in the scope room, an anesthetist actually administered the anesthesia.  I think it's very important for an anesthesiologist (who is an M.D. as you know) to review the patient's history, look at their stats, including size, and determine the correct dose.  I would question how trained a CR surgeon or gastro doc is in that regard.  Perhaps they feel that since they do these scopes on a frequent and regular basis that they are qualified.  However, whenever a patient undergoes anesthesia, anything can happen.

I will have to check out the website you listed--sounds like good information.  Thanks for sharing!

mp327 said:

Ouch

It's unbelievable to me that insurance companies would not cover anesthesia for colonoscopies!  Perhaps we have Katie Couric to thank for that!  I believe mine has always been covered and if I remember correctly, the charge was about $800 last year when I had my last scope.  Before my procedure, the anesthesiologist came in and asked me some questions and then gave the order for the dosage.  Once in the scope room, an anesthetist actually administered the anesthesia.  I think it's very important for an anesthesiologist (who is an M.D. as you know) to review the patient's history, look at their stats, including size, and determine the correct dose.  I would question how trained a CR surgeon or gastro doc is in that regard.  Perhaps they feel that since they do these scopes on a frequent and regular basis that they are qualified.  However, whenever a patient undergoes anesthesia, anything can happen.

I will have to check out the website you listed--sounds like good information.  Thanks for sharing!

I think an anesthesiologist must be readily available when a patient is to receive IV sedation.

Nic

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...

Well, this latest exchange of experiences and information certainly has me a little confused.  I’ve had 2 colonoscopies in the last 14 years and will have another next summer, just because that’s my scheduled every 5 years time.  For each of those I had my gastroenterologist, a nurse and a nurse-anesthetist in the procedure room at outpatient surgery.  I was barely out as that is what I asked for.  Two years ago when I was sent to gastroenterology at the beginning of this hellish journey I had a flex sigmoidoscopy done by the gastro, at outpatient surgery not in the office, because she liked the equipment there better.  I had no anesthesia then.  I’ve had two EUAs post-treatment, complete with anesthesiologist, and in an operating room.  I don’t really understand the point of us have colonoscopies as a part of our follow-up care.  I do understand anoscopy and sigmoidoscopy because aren’t they just looking at the rectum and the lower colon?  And, btw, I don’t have a colo-rectal surgeon.  Our surgery department doesn’t have a colo-rectal specialist but my friends refer to my surgeon as the “butt doctor” as he does much of this kind of surgery as well as general surgery.

Janet

eihtak said:

janet....

It is confusing but just shows the varience in follow-up. I am only scheduled for a colonoscopy every 5yrs as well. (Although my situation is slightly different than some, as I have the ostomy). I do not have a colo-rectal doc and rely on my general surgeons advice. A while back there was a discussion on here about colo-rectal doctors and I felt I may be missing something so went out of my usual clinic and scheduled my anoscopy.....I was absolutely unimpressed with that doc and never went back but rather continue to rely on follow-up care from my general surgeon, onc, gyn, and PCP.

I think the big question was in regards to the administration of anesthesia and who should do so.

My general surgeon is a great "butt doctor" as well!

katheryn

The reason for me in particular getting a colonoscopy instead of sigmoidoscopy is because I've never had one before. I want to save a third trip to the hospital: 1st sigmoidoscopy-2nd colonoscopy instead of 1st sigmoidoscopy-2nd sigmoidoscopy-3rd colonoscopy.

Here's the article on the importance of employing an anesthesiologist even if your insurance won't pay for one: http://lacolon.com/blog/colonoscopy-the-anesthesiologist-your-best-friend

A point the doctor didn't specifically mention was one from a post above, that the surgeon pays attention to how the procedure is going and what the scope finds while the anest. pays attention to the patient and makes sure s/he comes through the proceedings unscathed.