Zeldman
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That's good to hear..!!!
I did not have to pay on my last medical adventure. They shaved me like a porn star....
Colonoscopy prep
- Thread starter JOhnH
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That's good to hear..!!!
I did not have to pay on my last medical adventure. They shaved me like a porn star....
Rushie
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Rushie
That gives a clue about the REAL reason they want you sedated. So they can hurry it along without needing to skillfully work it with the least discomfort and I bet the least risk of damage. I wonder what the studies show for accidental damage with sedated vs not sedated? Or are you at higher risk if not sedated because of wriggling around if it hurts?
steingar
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I can attest that they were pretty brutal with my innards. Either that or they were careful as can be, and I'm just sensitive. But I've never been sensitive to anything else.
Sheet, Mark. What good is health if one can't afford to eat? I'm 77, and according to actuarial tables living on borrowed time. I do not intend to stretch my life span. I will take what the good lord gives me. Forgive me for being a pessimist but my greatest fear is being stuck in a nursing home and not being in control of my life. I would rather face death than being totally mentally incapacitated. I watched my eleven year older sister go through that. It wasn't pleasant.
Rushie
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I don't know if 77 is the exact age at which "they" recommend you no longer get them, but my mom was probably there if not only a little older. The way the doctor explained it, once you get elderly enough, the risk of the procedure itself gets pretty high, ie: falling and breaking a hip while trying to rush to the potty, dehydration, sedation complications, etc., and the benefit of catching a slow growing cancer early becomes less and less with time.
Rushie
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I had a "lower endoscopy" with no sedation or anything and it was indeed brutal. Hurt like the dickens. But the doctor went higher than he initially said he would and bragged that he got around the first bend and got to look at the top horizontal part. I don't think it's them poking you so much as your own intestine cramping up in protest to being invaded. I guess.
RJM62
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Geek on the Hill
I suspect that the $900.00 the private hospitals wanted to charge for ~ $15.00 worth of Propofol may have had something to do with their not wanting to do the procedure without sedation. Just a hunch, of course, based on the $450.00 worth of blood work and the $175.00 EKG they also wanted to do, despite both having just been done about two weeks prior during my annual physical. Anything to pad the bill.
The only comparative risk study I could find in my two minutes of searching suggests that deep sedation increases the risks associated with the procedure, especially when polypectomy is performed.
I will say this: Doing a colonoscopy without sedation requires a team that works well together. Mine was composed of a doctor and two nurses who obviously had done a lot of these procedures together. The nurses knew where to push and pull before the doctor even told them. The head nurse also narrated the journey as I watched it on the monitor. When I needed to be repositioned during the procedure, I did that myself with the nurses' guidance. I can't help but think that that's safer than being moved around while unconscious with a semi-rigid tube halfway up your colon.
The VA hospital did require me to get hooked up to an IV and all the monitoring machinery and to sign a consent to be sedated / anesthetized in the event of an emergency. They also told me I could change my mind and get sedated at any time during the procedure. But there was no need. There were only two brief periods of a few seconds each during which I experienced what I'd call "pain." They occurred when the doctor had to maneuver the scope around the bends, and she warned me in advance when that would be happening. During those few seconds, it felt like bad gas. The rest of the procedure felt like mild gas or no discomfort at all, depending on where on the journey we were.
Rich
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I respect your decision Norm. 77 ain't old though but I understand your reasoning.
Clark1961
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While those are good and valid points there are some very good reasons to at least get one look up the bung hole somewhere along the line. I know a guy who nearly bled to death because of a lower intestine problem at age 80. If he'd had it looked at when 60 could the resection been avoided? Dunno...
On the other hand I had a non-blood relative die without a rectum. I'm sure the last couple years of his existence were miserable.
It's a simple procedure, get the telescope shoved up yer butt and then move on.
Rushie
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Not that the Mayo Clinic is the be all and end all but their opinion is not necessary after age 75:
http://www.mayoclinic.org/diseases-...t-answers/colon-cancer-screening/faq-20057826
Of course that's colonoscopy and come to think of it my mom's doctor does have her do the fecal occult blood sample. That's fun. Getting Mom to poo in the bedside pot and then smearing it into the slide with a stick for 3 days in a row. And then cleaning out the pot. That tissue paper floating on the water in the regular toilet was a big Fail, I don't know how they think that's gonna work. "The stool will float on top of the tissue paper!" Uh, no it didn't.
Clark1961
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Note that age 75 is a limit for folks who have been getting regular screening and have had negative results from each screening.
I got a Milwaukee video inspection camera few years ago. On the box it says "THIS IS NOT A MEDICAL DEVICE. DO NOT USE TO INSPECT YOUR BODY." Of course, the first thing everybody does is point the thing in their mouth or their ear or something. I had it on my desk at the officer for a while (one of my coworkers borrowed it). I told people it was the new Textron Corporate Wellness program...DIY colonoscopy.
My last colonoscopy I was getting information from the office about how to get there. They gave me driving directions and told me to park behind the building and the door was there. Without thinking I say "Colonoscopy, Enter in the rear."
My last colonoscopy I was getting information from the office about how to get there. They gave me driving directions and told me to park behind the building and the door was there. Without thinking I say "Colonoscopy, Enter in the rear."
Rushie
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Well the Mayo recommendation does say for those with a clean history. So I agree, get it done a few times when younger. Depending on what they find will inform your decision about how long to keep doing it. There is a big difference between having an adenomatous polyp removed and having nothing, or just some hyperplastic bump. Like everything else, it should be case by case, not a blanket answer.
Rushie
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Yeah your post crossed with mine.
azure
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Yep. The fact that Miralax isn't so labeled doesn't prevent doctors from using it for that purpose, and in fact I once had a 'scopy where the only prep was indeed a full bottle of Miralax, dissolved in Gatorade.
Off-topic: I always thought that antifreeze was ethylene glycol, not POLYethylene glycol.
azure
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My doctors back in Michigan were adamant about using sedation, I tried to ask them to do it without but it was not negotiable. What was negotiable (surprisingly) was the anesthetic used. I've had Versed added to the mix and wound up unable to remember anything the doctor told me after the procedure. After that I absolutely refuse the stuff. Pure propofol for me, and they were quite willing to oblige.
I've never had any after-effects more than 30 minutes after waking up from propofol. But everyone is different.
RJM62
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Geek on the Hill
Everything is negotiable in some way or another. In my case, I just took my ass elsewhere -- literally.
Doctors are businesses. Patients are customers. If they want to keep me as a customer, ultimatums are not a good way to do so.
As for the specific anesthetic being negotiable, I suspect they really don't care as long as the reimbursement is the same.
Rich
Ethylene Glycol is the TOXIC antifreeze. Actually the non toxic stuff is Propylene Glycol. I had those confused.Yep. The fact that Miralax isn't so labeled doesn't prevent doctors from using it for that purpose, and in fact I once had a 'scopy where the only prep was indeed a full bottle of Miralax, dissolved in Gatorade.
Off-topic: I always thought that antifreeze was ethylene glycol, not POLYethylene glycol.
Propofol doesn't have too bad side effects, but versed which sometimes also used does
azure
Final Approach
In every other respect, my doctors were great... so you're right, I could have taken my business elsewhere, but it was not a critical enough reason to do so.
Perhaps more interesting is the reason they gave me for insisting on sedation - they want you completely motionless, mostly for your safety (and, of course, for liability reasons).
azure
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The main side effect of versed (as I found) is temporary amnesia. It's almost universal, from what I've been told. That's reason enough to forego it, as far as I'm concerned.
RJM62
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I know that's what they say. I suspect, however, that the real reason has more to do with being able to bill the insurance company $900.00 for a vial of propofol that costs less than twenty bucks. I had mine done while awake and aware, and they had to reposition me about half a dozen times during the course of the procedure. That leads me to the inescapable conclusion that the "must be perfectly still" argument is just nonsense to justify the profit padding.
Rich
JOhnH
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Rich,
Respectfully, I think your negativity of why good Doctors want to perform the procedure in the best way is frankly, unwarranted and misguided. My biggest complaints about clients in my veterinary business were the ones that kept complaining that "we are only in it for the money". And I know too many good human doctors to believe that about them.
RJM62
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Geek on the Hill
We're all entitled to our opinions. But for the record, I really don't dislike doctors. I do dislike hospitals, and all of the doctors I dealt with when I needed to have the colonoscopy worked for hospitals (in the case of Basset, as direct salaried employees). As such, they have to represent the hospital's position, which may or may not be in alignment with the patient's interests or preferences.
Hospitals, in my opinion, are a racket worthy of a RICO indictment. They're the only industry in America that I think the government couldn't possibly make any more corrupt than it already is. I mean, think about it. What other business can sell you services, with or without your express consent, without posting prices or telling you what they will be in advance, without telling you about additional services that may become necessary in the cost of providing the ones you agreed to, with absolutely no guarantee that the services will work nor even that they were the right services for your condition, and mark up products they use by a factor of tens of thousands of percent: And then compel you to pay for those products and services, whether or not you consented to them, and regardless of whether or not they were succesful?
Doctors tend to have high ideals and to want to serve humanity when they decide on their professions. Unfortunately, they are unavoidably bound up with hospitals, who run a racket that even the Mafia envies. But doctors need their hospitals more than they need any particular patient. Whose interests should I think they care about more?
Rich
I've never had a colonoscopy done in a hospital. The last one was done in the practices office and prior ones in an outpatient endoscopy center that was shared across a couple of local practices (and owned by them).
timwinters
Ejection Handle Pulled
I had to start having them done early, at 40, family history (youngest of 10 and polyps are common in my family, we're all azzholes, but none of us is a perfect azzhole).
And since I move a lot and/or work across a wide area, I've had them done in various locals and I've found that prices vary widely. In Springfield, MO they run less than $4k and that includes path (last week's price, I'm going down next month for one).
The last one I had done in Cape Girardeau, MO was freakin' $10,500 and I was clean!
Shop around friends, especially if you have a high deductible healthcare plan like I do.
And since I move a lot and/or work across a wide area, I've had them done in various locals and I've found that prices vary widely. In Springfield, MO they run less than $4k and that includes path (last week's price, I'm going down next month for one).
The last one I had done in Cape Girardeau, MO was freakin' $10,500 and I was clean!
Shop around friends, especially if you have a high deductible healthcare plan like I do.
RJM62
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Geek on the Hill
Those kind of places are hard to find around here, and even harder to get a referral to if your primary doctor happens to belong to one of the handful of hospital systems that dominate medical care around here. They try as hard as they can to keep everything under their own roofs. They're basically a cartel. There is a way around it, at least with BC/BS, but most people don't know about it. More on that later.
My primary care doctor at the time I came due for the colonoscopy worked for Basset, which is one of the bigger players in the medical cartel around here. Doctors at Basset are salaried employees of the company, and the company strongly discourages them from referring patients outside Basset's own system. So even if there were an independent, free-standing facility within a hundred miles or so, it's highly doubtful that I could have gotten a referral from Basset. I suspect the same is true for a lot of people whose primary care doctors work for or are exclusively affiliated with one particular hospital system.
I had the same problem years ago when I needed my gallbladder removed. My then-doctor in Queens was affiliated with, I believe, New York Presbyterian. The surgeon I wanted was affiliated with St. Francis. It was like pulling teeth to try to get the referral. Apparently the primary care doctor was under a lot of unofficial pressure to refer a certain amount of patients to New York Pres for specialty services to maintain his privileges.
The surgeon to which my PCP referred me spent the better part of the visit telling me about his work on the state ethics board and all of his many civic and charitable activities, none of which I gave a rat's ass about. I frankly didn't care if he'd just been released from the state prison that morning. I cared about how many gall bladder jobs he'd done and what his conversion rate was, not how many charities' boards he was on. So after listening to his ******** for 20 minutes, I paid him for the consult and called BC/BS to get set up with the guy I wanted. He was a client and friend of mine who pulled an average of five gall bags a day and had about a one percent conversion rate. That was what I cared about, not whether the surgeon coached Little League on the weekends.
Now here's the way to get around PCPs who only will refer you to their own hospitals' specialty clinics, at least if you have BC/BS. I don't know if it works with other insurers. What I've found over the years is that BC/BS only cares about the PCP referral for the treatment, not the particular physician or hospital to which the referral was made. They only care that the treatment is medically necessary and that the specialist is in their own network, not whether the specialist is affiliated with the same hospital as the PCP.
In other words, if the PCP makes a referral for a particular procedure, but the patient doesn't like the doctor or facility to which he or she was referred, all it takes is a phone call to BC/BS to get the specialist or hospital you want (assuming that they're in-network). BC/BS just modifies the referral and approves the change over the phone. It's all the same to them. They all get paid the same contracted rates, so it makes no difference to BC/BS which one you go to.
Doing it that way also gets the PCP off the hook if their hospital system complains, because the change was patient-initiated. The PCP tried their best to keep the business in the family. The rebellious patient took it elsewhere.
I am so disgusted with the politics and corruption of the private hospital industry that I'm tempted to list the doctor at the V.A. as my primary doctor with BC/BS (the V.A. is in the network) and just get all my care there, whether service-related or not. I hate to admit it, being of a strongly libertarian bent, but they just run a better outfit than any of the private hospital systems around here.
Rich
azure
Final Approach
I don't entirely disagree - though in situations like that, where the decision is (presumably) in the hands of the doctors rather than the company (i.e. the hospital), I suspect minimizing liability exposure has more to do with it than conscious profit padding.
But in the health system I'm in now, the profit padding is very evident. When I was in one of their rehab centers for an extended stay a couple of years ago, I was kept on a multivitamin since I had listed it as a "medication" I take. Several months after discharge I received a bill for $200 for those multivitamins. $ frakking 200?? I can buy a bottle of multivitamins containing 5 times as many as I was given in the facility for less than one-tenth the price.
Then there is the "active problem" list that I see on their patient portal page, which basically lists all the diagnosis codes they have used to get paid by my insurance company, written out in English. That list now contains some 30 conditions, most of which I've never been told that I have, and almost certainly don't have. Two or three would be very serious if I actually had them, and would require special issuances if I was flying on a 3rd class medical. I've discussed with all of my doctors the fact that I'm a pilot and that I need my visible medical record to reflect only those conditions I actually have been diagnosed with, and to contain no presumptive or tentative diagnoses.* I've asked them to take more than one of them off for that reason; I've been assured that the diagnoses would be removed, but it has NEVER HAPPENED. Apparently it is simply out of their control; the codes are entered by assistants and secretaries after reading the office note and contain anything that MIGHT be relevant to what was discussed during the visit, and that justifies a higher billing rate. I'm not a happy camper, even with Basic Med, since if I ever developed one of the Big Three conditions that require a one-time SI, I would basically have to disabuse a growing list of bogus diagnoses at my expense in order to fly. But there is apparently nothing that I, or my doctors, can do about it. I already had one diagnosis like that from 30 years ago that my specialists have long been convinced is bogus, but there is no way to convince the FAA of that. They caught it about 4 years ago and started once again requiring an annual imaging study for it that I would now have to pay for out of pocket, for absolutely no medical reason. It's one of the reasons I'm now flying on Basic Med.
*That's often an interesting discussion in itself, since many doctors seem to not understand that the diagnostic codes their offices put into the system are NOT private and that the Feds can easily see them. There is a lot of naivete about "patient privacy" out there in the profession.
Rushie
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Rushie
I don't entirely disagree - though in situations like that, where the decision is (presumably) in the hands of the doctors rather than the company (i.e. the hospital), I suspect minimizing liability exposure has more to do with it than conscious profit padding.
But in the health system I'm in now, the profit padding is very evident. When I was in one of their rehab centers for an extended stay a couple of years ago, I was kept on a multivitamin since I had listed it as a "medication" I take. Several months after discharge I received a bill for $200 for those multivitamins. $ frakking 200?? I can buy a bottle of multivitamins containing 5 times as many as I was given in the facility for less than one-tenth the price.
Then there is the "active problem" list that I see on their patient portal page, which basically lists all the diagnosis codes they have used to get paid by my insurance company, written out in English. That list now contains some 30 conditions, most of which I've never been told that I have, and almost certainly don't have. Two or three would be very serious if I actually had them, and would require special issuances if I was flying on a 3rd class medical. I've discussed with all of my doctors the fact that I'm a pilot and that I need my visible medical record to reflect only those conditions I actually have been diagnosed with, and to contain no presumptive or tentative diagnoses.* I've asked them to take more than one of them off for that reason; I've been assured that the diagnoses would be removed, but it has NEVER HAPPENED. Apparently it is simply out of their control; the codes are entered by assistants and secretaries after reading the office note and contain anything that MIGHT be relevant to what was discussed during the visit, and that justifies a higher billing rate. I'm not a happy camper, even with Basic Med, since if I ever developed one of the Big Three conditions that require a one-time SI, I would basically have to disabuse a growing list of bogus diagnoses at my expense in order to fly. But there is apparently nothing that I, or my doctors, can do about it. I already had one diagnosis like that from 30 years ago that my specialists have long been convinced is bogus, but there is no way to convince the FAA of that. They caught it about 4 years ago and started once again requiring an annual imaging study for it that I would now have to pay for out of pocket, for absolutely no medical reason. It's one of the reasons I'm now flying on Basic Med.
*That's often an interesting discussion in itself, since many doctors seem to not understand that the diagnostic codes their offices put into the system are NOT private and that the Feds can easily see them. There is a lot of naivete about "patient privacy" out there in the profession.
That exact thing happened to me. There's a string on the AOPA board about it. My doctor put "diabetes" in my record. I do not have diabetes, I have PRE diabetes and there is a big difference. She said she would get it removed and it was never removed. So I called the insurance company myself and got absolutely nowhere. Apparently you, the patient, have no power at all to correct your own records.
JOhnH
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Minimizing liability has something to do with it. Good, honest, conscientious doctors (which I think most of them are), are going to opt for the methods and procedures that provide for the best outcomes for the patient. Of course protecting themselves from law suits is also a powerful motivator to do things the right way instead of the cheap way.
Rushie
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I'm figuring there are three things that are the main determinants of the doctor's decision: profit, liability protection, and the best interest of the patient, not necessarily in that order.
None of them are wrong. The doctor has to profit or he finds another career. He is forced into needing to protect himself against liability by our sue-happy society, and presumably he has a huge moral imperative to do what's best for the patient. When these three things come into conflict with one another he must allocate weight (importance) to each. I'm guessing the proportion of importance allocated to each will vary a great deal depending on many factors.
We can all hope that the best interest of the patient will always rank first and outweigh the other two but that's probably not always the case. I have faith it still is most of the time. When making a difficult medical decision here is how I sort it out: I ask the doctor if this is what he would do if it were him(or his wife, or child) and then I watch his body language carefully as he says "yes" (because they always say yes).
CT4ME
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This Dave Barry article says it all... I love the part about the prep inducing Time Travel, where you begin to eliminate food you haven't even eaten yet.
http://www.miamiherald.com/living/liv-columns-blogs/dave-barry/article1928847.html
http://www.miamiherald.com/living/liv-columns-blogs/dave-barry/article1928847.html
sourdough44
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Instead of a new thread, I'll ask here. I have no known family history of problems 'down there', but I'm working up the thought of a 1st colonoscopy. The stats are, almost 55, yes a guy.
I keep hearing the prep is worse than the actual event. Is it almost unanimous to get one?
I keep hearing the prep is worse than the actual event. Is it almost unanimous to get one?
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The actual event for me was they knocked me out and I woke up later farting, and not knowing what happened.
Girlfriend was entertained, other than the farting. (which kept me entertained)
I'd recommend vaseline before and during prep. You'll use a lot of toilet paper.....
Girlfriend was entertained, other than the farting. (which kept me entertained)
I'd recommend vaseline before and during prep. You'll use a lot of toilet paper.....
Clark1961
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Yes, get one. The prep is an annoyance but a bit of planning minimizes the discomfort. Check with the insurance to see what they pay. It is considered preventative care.
Timbeck2
Final Approach
I'll add that whatever you choose to flavor the colon blow powder with, make it something you don't intend to drink for the rest of your life. I flavored mine with Crystal Light Margarita flavor. I haven't had a real margarita to this day and that was 4 years ago.
Timbeck2
Final Approach
For peace of mind if anything else - yes. Not all of us know our family history.
JOhnH
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No, it's not unanimous to get one. But consider this: I have personally known, or been very close to someone that knew three people that died of colon cancer. It is a terrible way to die. I am quite sure I would find a way to kill myself once the wasting away and the pain began.
All three of those people that died had decided against a colonoscopy because it was too inconvenient. Every one of them spent their final days encouraging others to have it done asap.
sourdough44
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I go to my regular flight Doc tomorrow. He said he would do the required 'recommendation' for the colonoscopy, hopefully that will be enough.
My insurance company is going for the poop tests these days except I'd already had a prior colonoscopy and found precancerous polyps so I'm on the regular schedule anyhow.
Most of the gastroenterologists around here have an "express" path into the colonoscopy. If you don't answer any questions YES on their screening questions and your insurance company is game, your first visit to them is the actual colonoscopy.
Most of the gastroenterologists around here have an "express" path into the colonoscopy. If you don't answer any questions YES on their screening questions and your insurance company is game, your first visit to them is the actual colonoscopy.