by NeuropathicGuy » 26 May 2011, 23:11
RedCharger, I have to be honest here: when I read that you were going to have LIS without being sedated, I thought that was nuts. I really wanted to say something yesterday, but decided not to because I didn't want to risk putting you in a negative mindset before the procedure.
But now that things are where they are, I'm going to come clean here: IMO you absolutely need to be given more than simple local for LIS. Not having either (A) conscious sedation; (B) general or MAC anesthesia; or (C) spinal anesthesia for this procedure is -- in my humble opinion -- TOTALLY F'ING CRAZY. Straight up.
I'm sure it can be done. Heck, in Asia it's not rare to have colonoscopies and upper endoscopies done without sedation. But if there's a better option to save the patient some pain, then why not use it? It makes zero sense to me. Medical science invented painkillers and sedatives for a reason, and that reason isn't to sit idly by while patients suffer unnecessarily. If the doctor doesn't want you conked out during the procedure for whatever reason (and really I can't think of a good one when it comes to LIS aside from the standard risks that come with all surgical anesthetics), an anesthesiologist can give you spinal anesthesia so that you're fully awake and lucid, but just can't feel anything from the point of the nerve block downward. It's still technically local, but like an epidural given during childbirth.
BTW, here's why I'm so against the "local only" approach: after I had LIS, I developed an abscess. It was very close to the anal verge so per my (misguided) request, my surgeon tried to slice and drain it in the office using just local. She insisted that this should not be done using local only, but I wanted a quick fix and asked that she try. Note that this is a less invasive cut compared to LIS. Well, she was right, and I was wrong... As soon as she put considerable pressure on the scalpel, I knew there was no way in hell I'd be able to tolerate it. So I ended up getting it done properly in the operating room under MAC/general again.
I just don't see how anyone can tolerate cutting there with an active fissure without something stronger. It's ridiculous that anesthesia wasn't even an option. Totally, completely bogus. It should be the patient's call. If you asked for local only, then that's a different matter. But if it wasn't even an option, then what this surgeon is practicing is not medicine, it's barbarism. If this jackass has no concern for the patient's preferences, then screw him and find someone else. You'll be better off for it, especially since you'll need to see your surgeon again for follow up care.
Hopetoheal, I didn't get a chance to read up on your post-LIS thread, but saw here that you had LIS with local only. My hat's off to you. Well, my hat, shoes, glasses, socks, ummm shirt, jacket, and might as well include pants too!!! My goodness. I don't know how you did it, but I think you're my new hero for having gone through with it and for managing to maintain your sanity.
P.S. For what it's worth, I've been having some stomach problems and need to have an upper endoscopy done soon. My GI doctor normally does this under conscious sedation (fentanyl + midazolam) only. However, I am a Valium addict (unfortunate collateral damage from my battle with my fissure) and thus have very high tolerance to benzodiazepines, which account for most widely used sedatives. During a colonoscopy back when I was in fissure hell, the doctor gave me 5x more sedatives and painkillers than he typically gives (and I'm a small guy at only 120 lbs on a good day), and I still wound up waking up during the procedure, which resulted in it being aborted midway through. I explained this past experience to my GI doctor and he immediately agreed to have an anesthesiologist put me under MAC/general using propofol for the upper endoscopy. No questions asked, no rebuttals, no "that's not how we do things here." Just a simple "I understand and it's your call." That's the way it should be. You will find a doctor who has his head screwed on straight. Just be patient. I know in Canada it can take a bit more time to get in to see a new doctor than here in the States, but believe me, it will be worth it in the long run. This last guy you had the misfortune to deal with shouldn't be operating on people's asses. In fact he sounds like he needs an operation just to get his head out of his own ass! I'm sorry to hear you had to go through all that crap and look forward to hearing when you find someone else who isn't an arrogant moron.