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Why?: I did my pouchoscopy awake because I did not have a ride if I were to be sedated.

Was it uncomfortable when he put the scope in?: No, I did not really feel anything, it was great!

Was it painful?: Not at all! I did feel a lot of pressure at times but there was ZERO pain.

Did you feel the biopsies being taken?: I felt the pressure of it but I did not feel any pain of the biopsies being extracted.

Did the doctor use numbing cream?: Yes, he used Lidocaine.

Is the Lidocaine free?: It should be and it was I did not pay extra for Lidocaine

Was the procedure pretty quick?: Yes, it was way under 5 minutes.

Did you feel pain after everything was over?: Not at all.

Were you able to drive home without any problems?: Yes, I drove all the way home and did fine.

Was it cheaper doing it awake?: Yeah, I did a comparison and it was waaayyy cheaper doing it awake.

Were you nervous?: YEAH!!! I was really nervous it was going to hurt but it did not at all.

Were you able to talk to the doctor during the procedure?: Yeah, he even explained a lot of stuff and he answered all of my questions.

Was the screen big?: Yeah it was like a big tv lol.

Did the air pump feel uncomfortable while awake?: Yeah but its okay.

Did the water thingy feel weird while he was spraying inside of you?: A little but its totally fine lol.

Did he take pictures?: Yeah, I still have them.

Did you pass gas?: After everything was over,  I went to the bathroom and passed gas and pooped afterwards too.

Did they take your blood pressure throughout the procedure?: Yeah.

Did you wear a mask throughout the the entire thing?: Yeah.

Do all gastros do pouchoscopys awake?: No unfortunately. I had to call a bunch of gastro clinics and talk to the manager to send messages out to the doctors to ask them that question, it took a while to find one that would do it awake, but do not give up looking

Would you do it again?: YEAHHHH!!!! Its cheaper and you get more info and you can drive home, HEYYYY!

Do they still give you an IV?: Yeah.

What time do you recommend getting the procedure done?: As early as possible so you can eat and hydrate ASAP

My pouchoscopy was normal

**I hope I answered all of the FAQ, if you have anymore questions that I missed, write them down below or send me a message**

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I've had many decades worth of colonoscopies, and now pouchoscopies (also called an endoscopy) and I've always had them under sedation. No big deal for them to administer it. Insurance is different in Canada and sedation is covered. I know this is an advantage. I tell them in advance of the day and they have a dose ready. My sedation is always administered by the doctor performing the pouchoscopy so it isn't necessary for an anesthesiologist to be booked and paid. I think that is where the higher cost might be. Ask your doctor if he or she can administer.

I'm out for 20 minutes or so for the procedure. Maybe my checkup takes longer because it's also a cancer checkup - my reason for having a pouch. Another 30 - 40 minutes to wake up in the recovery room with the other groggy patients.

No pain, no uncomfortable feeling of pressure from the air they pump into my pouch, or the distressing sense that I'm going to poop while on the table. I don't really want to ask my surgeon any questions or chat with him or his team because I need him to focus entirely on the examination of my pouch. Anything I need to tell him, any concerns or changes I've experienced, I tell him before I go under. He leaves handwritten notes on any findings, and the nurse gives it to me when I wake, along with cookies and juice, water, to rehydrate and help the blood glucose. I book the first appointment of the day so I am done by mid morning and can eat lunch.

I would be too nervous to do this while awake, and they would not get a thorough examination if I were squirming or saying ouch the whole time. So, if you're the least bit anxious or nervous, please don't be afraid to ask for help. It's important to have your pouch checked. There is also a tiny pill called Ativan, by prescription, taken half an hour before the procedure and it doesn't quite knock you out, but relaxes you completely and you can drift. The pill will be less costly than sedation and it wears off very quickly when you wake.

I had my pouchoscopy with sedation in December and was home in a few hours. I got myself home without assistance and ate lunch, starving. Remember, after sedation, do not drive, or operate machinery, or sign any legal documents that day no matter how awake you feel.

Winterberry,

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.

Last edited by CTBarrister
@Winterberry posted:

I've had many decades worth of colonoscopies, and now pouchoscopies (also called an endoscopy) and I've always had them under sedation. No big deal for them to administer it. Insurance is different in Canada and sedation is covered. I know this is an advantage. I tell them in advance of the day and they have a dose ready. My sedation is always administered by the doctor performing the pouchoscopy so it isn't necessary for an anesthesiologist to be booked and paid. I think that is where the higher cost might be. Ask your doctor if he or she can administer.

I'm out for 20 minutes or so for the procedure. Maybe my checkup takes longer because it's also a cancer checkup - my reason for having a pouch. Another 30 - 40 minutes to wake up in the recovery room with the other groggy patients.

No pain, no uncomfortable feeling of pressure from the air they pump into my pouch, or the distressing sense that I'm going to poop while on the table. I don't really want to ask my surgeon any questions or chat with him or his team because I need him to focus entirely on the examination of my pouch. Anything I need to tell him, any concerns or changes I've experienced, I tell him before I go under. He leaves handwritten notes on any findings, and the nurse gives it to me when I wake, along with cookies and juice, water, to rehydrate and help the blood glucose. I book the first appointment of the day so I am done by mid morning and can eat lunch.

I would be too nervous to do this while awake, and they would not get a thorough examination if I were squirming or saying ouch the whole time. So, if you're the least bit anxious or nervous, please don't be afraid to ask for help. It's important to have your pouch checked. There is also a tiny pill called Ativan, by prescription, taken half an hour before the procedure and it doesn't quite knock you out, but relaxes you completely and you can drift. The pill will be less costly than sedation and it wears off very quickly when you wake.

I had my pouchoscopy with sedation in December and was home in a few hours. I got myself home without assistance and ate lunch, starving. Remember, after sedation, do not drive, or operate machinery, or sign any legal documents that day no matter how awake you feel.

You made excellent points! During the procedure, I never squirmed, I stayed still the whole time. I never said ouch once, There was ZERO pain, I promise. There was pressure at certain times but everything was ZERO Pain. I know it sounds too good to be true, I was skeptical myself before I got it done, but its totally fine. Maybe you should try it once and see how it goes. If you choose not to, that is okay too

@Winterberry posted:

I am sure my surgeon gives me Propofol. I remember asking at my recent pouchoscopy, just before I went under, and I am almost certain he said Propofol because the image of Micheal Jackson came to mind as I started to drift to sleep.

I'll ask my surgeon and if the answer is something else, I'll post.

If you are Canadian, the same things I said about cost considerations would not apply since the government is insuring you.  When you pay for private insurance premiums it is a whole different ball game.  The retail cost of Propofol in a routine pouchoscopy procedure is $2000 vs. maybe $150-$200 for conscious sedation.  The more that is billed, the more insurance pays, and what they pay determines your next year's premium payment.  The difference in cost is beyond ridiculous to anyone who can do the math, but like I said it benefits medical providers because the swifter recovery times from propofol mean more scopes, more patients and more money for them.  In the USA healthcare is something like 20% of GDP. So if you get scoped at hospitals, or big endoscopy centers, they will try and shove propofol down your throat.  BTW it MUST be administered by an anesthesiologist, whereas conscious sedation need not be.  This is because if you mess around with it, it can kill you, as Michael Jackson found out.  The bottom line is it's so expensive it should never be used in these procedures. It is used to drive profits, and for no other reason.

Last edited by CTBarrister
@scallop posted:

Main benefit to me -- able to ask questions after the procedure and remember responses!

Good doctors (like mine) set up a separate appointment to go over the scope results a couple weeks later, after the biopsy results come back. Since the questions and the answers are going to be the same at that time, and there will be new questions about the biopsy results which can't be asked during the procedure, this should not be a major consideration in deciding to have the procedure without sedation.  I also find it's easier to view photos on a TV monitor in my doctor's office than it is in a procedure room.  He puts them on the TV monitor, I have a much better view of them, and we can discuss them without either of us having distractions.  This does not need to happen at the time of the procedure, it can happen at any time that is convenient for the patient.

Last edited by CTBarrister

Hi, CTBarrister. I will ask my surgeon what he used to sedate me. I am almost certain he said Propofol. Perhaps sedation procedures are different in Canada?  My surgeon administers the drug into my IV.  I know there wasn't an anesthesiologist present because I would have been introduced to him/her. He always introduces his team, resident, nurse, aide, etc., since it would be considered rude to peer inside someone's bum without formal introductions!  Then they briefly discuss me while I'm in the room, my name, birthdate, procedure, and then I'm asked to sign something -- just to make sure someone else didn't volunteer to take the scoping for me, and for liability.

Before Covid lockdown, we always set a followup in the office to review my scope and CT scan results. Now I get results by email to save a trip to the hospital.

Definitely Propofol here in CT has to be administered by an anesthesiologist (and in NY).  I have never seen it administered by a nurse or other doctor in either State.  Usually they have a staff anesthesiologist at hospitals, or large endoscopy centers, or bigger doctor's offices, who are available to do it.

Canada is different than the USA on a lot of things, like what a prescription is required for.  There are lots of medicines that are prescription only in the USA that are over the counter in Canada.  One time I was in Montreal and I was really sick. I went to a pharmacy called Jean Coutu or something like that and was able to get a cough medicine which had codeine or something in it, which I did have to fill out some special papers for, but did not need a prescription.  That would not have happened in the USA.

I did have propofol a few times, always by an anesthesiologist.  I have no problems with it other than the obscene expense of it at retail to the patient.  The benefit of Propofol is you are out cold and when you come to you are 100% and not groggy like you are with conscious sedation.  It's because of that swift recovery that they can kick your ass out quickly, and then bring in the next person for their scope. Using propofol probably results in 25% more patients seen and procedures performed every day, meaning many more profits.  They are all about moving the bodies in and out.

Last edited by CTBarrister

CT, your cost analysis seems incomplete. Making an endoscopy center able to see more patients per hour makes it more efficient in many ways, since lots of the costs (staff, overhead, etc.) accrue by the hour. While you can certainly argue that they make more money for being efficient, that’s far from a completely bad thing. Wacky drug pricing and reimbursement skews this, of course, but there’s much more to it than the price of propofol. In any case I’ve never bothered with sedation for a pouchoscopy, so I (happily!) get out there quicker than the propofol recipients.

Scott the efficiency is not the bad thing.  The $2000 bill to your insurance company for the retail cost is the bad thing. That means an unnecessary payout by your insurer, and higher premiums next year when it's all added up.  I was simply pointing out why the facilities use propofol.  It increases efficiency and profits- but at the expense of the patient and his or her wallet.  It is MUCH cheaper to choose conscious sedation, which keeps insurance costs down. It's on the order of 1/10th to 1/15th the cost.

Last edited by CTBarrister

I go to the Cleveland Clinic and I've never even been asked if I wanted to be sedated.  I don't even think she used Lidocane.  It was uncomfortable, for sure, but really it wasn't bad.  I liked that she could tell me what she was seeing live and I could look at the screen, too, to see what she was talking about.  I don't think I'd ever be sedated for it after doing it 3 times with no real problems.  

Why does USA not have free healthcare for all as it's such a wealthy country.Its been very sad to see people struggling to afford ostomy bags or wearing them for 11 days and cleaning them out.

USA more like a 3rd world country with 80 year olds running it.your maternity leave and holidays need extending as well.

New Zealand

Free healthcare for all New Zealand residents.including all ostomy appliances.

52 weeks payed maternity leave.

20 days a year holiday pay not including public holidays.

40year old Prime Minister.

Last edited by Chook
@Disneynut posted:

I go to the Cleveland Clinic and I've never even been asked if I wanted to be sedated.  I don't even think she used Lidocane.  It was uncomfortable, for sure, but really it wasn't bad.  I liked that she could tell me what she was seeing live and I could look at the screen, too, to see what she was talking about.  I don't think I'd ever be sedated for it after doing it 3 times with no real problems.  

Wow! COOL!!! The doctor put Lidocaine cream in my butt so I did not even feel the scope at all. Thank-you for mentioning that you did fine without Lidocaine, Now I know its not bad without Lidocaine

The Lidocaine was free for me so I definitely did not complain

@Chook posted:

Why does USA not have free healthcare for all as it's such a wealthy country.Its been very sad to see people struggling to afford ostomy bags or wearing them for 11 days and cleaning them out.

USA more like a 3rd world country with 80 year olds running it.your maternity leave and holidays need extending as well.

New Zealand

Free healthcare for all New Zealand residents.including all ostomy appliances.

52 weeks payed maternity leave.

20 days a year holiday pay not including public holidays.

40year old Prime Minister.

Hopefully some day we will have free healthcare, I know that would be great! We do have great emergency healthcare though.

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