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Reply to "Pouchoscopy While Awake Review!!! FAQ (Frequently Asked Questions!!!!"

@CTBarrister posted:


Insurance covers sedation in the USA as well. However patients are often asked to choose between Propofol (the retail cost of which is 20 times more expensive than conscious sedation) and no sedation and they believe they have no other choice. It's completely false to believe this. Conscious sedation is both cheap and covered. However hospitals and busy medical offices push the more expensive propofol for a reason: they can do and bill for more procedures because Propofol reduces recovery times and enables them to push patients out the door. I once confronted a doctor I know who owns a facility that performs numerous endoscopies every day and he laughed and admitted it was true. That's exactly why it's policy. I get conscious sedation and have someone drive, it's cheap and more effective for the patient unless they need to go back to work or drive themselves from the facility.

I don't know what is used in Canada but the standard conscious sedation cocktail used in the USA is fentanyl and versed.  They have and will vary dosages on request. My GI uses a comical scale, "twilight", "medium", and "smoked", or something like that. I go medium rare, or medium twilight. I also one year had 50 mg fentanyl and no versed (versed causes short term amnesia) so that I could recall the procedure. Can you tell me what is the standard cocktail in Canada?

There have been a zillion other threads on this topic and in reading them and in also speaking to patients in real life I find that most people are remarkably uninformed on what their options are, what the insurance coverage and cost issues are, the propofol vs. conscious sedation cost analysis, and how it benefits the provider far more than the patient (especially when they don't tell you the impact of the payouts on your next year's insurance premium, which they don't). The result is that many patients make uninformed choices that are of more benefit to the doctor than it is to them.

I have also had the procedure done with no sedation. I can tolerate it, but don't prefer it. I find that J Pouch and Ileum being pumped full of air is uncomfortable both physically and mentally. I just don't see any need to deal with it when I don't need to. There is no need to have a hero complex on medical procedures.

Wow!!! I don't have a pouch yet but had a flex. sig yesterday and had a horrible experience. They forced me to use "MAC" anaesthesia (it's propofol), which I had a terrible reaction to last November. They knew of this reaction and my GI told me they could not give me twilight sedation or else they would need to make me wait in the hospital for 4 hours before letting me leave, despite me having a driver waiting there! They lied to me because i've had twilight done 7 other times with different doctors and never once had to wait very long at all. I called and asked their endoscopy center about this today and she told me, no, you only have to wait 1 hour with twilight/conscious sedation. So I am waiting for a call back from their office manager, because both my GI AND the anaesthesiologist nurse both came in separately and told me the same reason why I HAD to do MAC and not twilight. The MAC makes me extremely depressed and suicidal after it wears off for the rest of the night, I was sobbing uncontrollably and had zero appetite. Same exact thing happened in November. Now I'm wondering if they just wanted more money!!!

My entire scope was pointless anyway. I just finished a round of prednisone so all it showed was mild inflammation and instead of realizing this was from the pred, my doctor tells me I have to stay on Stelara and change my mesalamine from Delzicol to Lialda. I haven't been able to get off steroids for years and he thinks a mesalamine switch is now the answer?!

Sorry to hijack this thread. Thank you all for the pouchoscopy information.

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