Colonoscopy topic, revisited

[catwoman]

Had a visit with my gastroenterologist today to set up a colonoscopy. Don't have an appointment for that nice little procedure yet.

He started out by saying I would have to go off warfarin for 4 days before the procedure.
I said nope.
He then said I could go off warfarin for 4 days and go on Lovenox.
I said no deal.
He cited the increased risk of bleeding fully anticoagulated (like there isn't any with Lovenox???).
I said, "You do cauterize when you remove polyps, don't you?" He said, well, yes, but there's still an increased risk of bleeding.

He cited a "very low" risk of stroke associated with going off warfarin. Mentioned about getting my INR down to 1.5.

I reminded him my St. Jude is in the mitral position, with higher risk of clots.
Told him I have my own INR machine, adjust my dosage myself. My INR yesterday was 3.0. Told him what my INRs have been. That I could bring it down just a little, but certainly not to 1.5.

Told him I knew of mechanical valvers who had suffered strokes as a result of going off warfarin before a colonoscopy and I wouldn't let myself be subject to that.

He agreed to do the colonoscopy with me fully anticoagulated, that he "could" remove very small polyps without a problem, but if there was a big one, I'd get a return visit.

He said the chance of needing to do anything further would be very very slight.

He said I seemed to be very well educated on anticoagulation therapy.

I'm sticking to my guns.

 

[Ross]

Bravo! Message to short.

 

[csutherland]

I love that. In light of Jerry's recent experience with Lovenox (14 x $60) when he needed a bronchoscopy/biopsy I applaud your grit. It has taken many trips to the coumadin clinic to get his INR back in range.

We've always fudged on the dental procedures and one previous colonoscopy & he's never had a problem with bleeding. Since he had one small polyp removed at that time (4 yrs ago) he's supposed to have a colonoscopy done every 3 yrs. We didn't get notified it was due and forgot it ourselves last year, but I got a phone call a few wks ago setting him up for Dec. I haven't had the nerve to even tell him about it yet. He's had so many medical/dental procedures done in the recent past he's pretty sick of it all.

 

[dtread]

Virtual Colonoscopy

Virtual Colonoscopy

There's no good reason why they can't do a Virtual Colonoscopy. Does not require you to change your anticoagulation at all.

INSIST on Virtual Colonoscopy!

Anybody on Warfarin should get Virtual Colonoscopy. If that identifies polyps, then go back a second time with bridging.

 

[lance]

Well done

Well done

Marsha, good for you. Doctor was co-operative as well.

 

[catwoman]

There's no good reason why they can't do a Virtual Colonoscopy. Does not require you to change your anticoagulation at all.

INSIST on Virtual Colonoscopy!

Anybody on Warfarin should get Virtual Colonoscopy. If that identifies polyps, then go back a second time with bridging.

Dan:
Several folks here have had traditional colonoscopies while fully anticoagulated, even having polyps removed in the same procedure.

Some insurance policies will not cover a virtual colonoscopy. I have e-mailed Aetna to see if my coverage includes the CT colonoscopy.

For people at higher risk of colon cancer, due to familial history, a traditional colonoscopy is probably the preferred procedure since it can detect polyps at a smaller size that the CT colonoscopy.
I am in that grouping. (And I would rather go through a colonoscopy procedure just once, to avoid expense and prep for a 2nd procedure.)

Latest articles on CT colonoscoy -- which are very promising:
http://www.cancer.org/docroot/NWS/c...creening_Option_for_Average-Risk_Patients.asp

http://www.webmd.com/colorectal-cancer/news/20080917/virtual-colonoscopy-real-accuracy

 

[terryj]

Marsha, my husband has an appt. next Friday to discuss his colonoscopy. I know they will want him to go off his coumadin because I already had a discussion about this with his nurse. The nurse said we could try and get the doctor to do it while he was on the coumadin but she knows he won't. I am printing out your post and using it for ammunition. Thanks for revisiting this subject right now. Good luck with your procedure

 

[dtread]

Yes, I can see why some folks that are on anticoagulation would still prefer the traditional colonoscopy; particularly if they are at higher risk of polyps, have a history of polyps themselves (or in their family), and/or don't want to have the potential of having to mess around with the prep twice. Also, as you pointed out I see little reason to reduce anticoagulation levels for traditional colonoscopy. However, if no polyps are found with the virtual then only one prep is needed.

The virtual does have the advantages of being less invasive and not requiring sedation, which means a quicker return to normal activities. And definitely no change in anticoagulation. Also, the virtual is less expensive so I would think that the insurance companies would be embracing it. But that does not seem to be the case (at least for Kaiser), as the initial answer that I've gotten from Kaiser Mid-Atlantic is that they don't have the capability. But they have not provided me with a good reason why not, other than they say they just don't have the capability. Which I do not believe, because if none of their current service providers have the capability then they could certainly contract with a facility that has the capability.

The prep is a "pain in the butt" but I don't think its all that bad. Besides, a lot of folks could stand to lose some weight. At any rate I feel the virtual colonoscopy should certainly be considered as an option by folks on anticoagulation. I've seen the guidelines for virtuals as every three years, and more recently as five years (in the article you cited). The time frame for traditional colonoscopies seems to be ten years, so that could be a consideration also.

 

[bvdr]

Good for you, Marsha. I agree wholeheartedly.

 

[njean]

Everytime I see my PCP he tells me that I need to have a colonoscopy but he too says that I need to get off the coumadin for at least 4 days prior.

I just keep telling him that I don't want to have to come off coumadin for the procedure especially due to my double valves & the fact that the mechanical mitral is already in a stressed state! Last time I saw him (PCP) he finally said that unless I start experiencing problems best thing is, to leave things alone. So, I just keep praying that nothing else goes wrong!

 

[terryj]

I called our Blue Cross/Blue Shield office to see if they would pay for a virtual colonoscopy. They said only if he could not come off his coumadin for the test for some medical reason. How about a clot and he could die? Nope not for that. I asked if they would cover the lovenox shots since they wouldn't cover them when he came home from his valve replacement. No they won't cover those either. We pay 300.00 a month for insurance through our jobs. We may skip the colonoscopy.

 

[catwoman]

Norma:

In that case, why not ask about a CT colonoscopy? If something is found, go into the hospital on a heparin drip or go on lovenox.

My father-in-law -- who had had 2 MVR surgeries (2nd time with AVR + quad CABG) -- disliked doctors and procedures. So he avoided going to doctors and ignored signs of ill health.
When he began losing a lot of weight, my brother-in-law made an Dr. appt for my FIL.
It was colon cancer and the doctors gave him 2-3 months; he lasted 7-8 months, opted to forgo treatment.

R.C. had warning signs but chose to ignore them. Sometime warning signs are so subtle they can be overlooked. My mother's colon cancer was diagnosed when she had an upper GI in preparation for a hernia repair.

 

[sue943]

I have haemorroids which bled the other week. My GP is insisting that I have an investigation ' just in case' despite my arguments. I have just received my appointment for CT colonography, he thought it would be better for me than having a more traditional colonoscopy. Presumably if they find anything suspicious we can then take it from there for further investigation.

I am dreading having to take the medication to prepare my colon, really dreading it.

 

[njean]

Norma:

In that case, why not ask about a CT colonoscopy? If something is found, go into the hospital on a heparin drip or go on lovenox.

My father-in-law -- who had had 2 MVR surgeries (2nd time with AVR + quad CABG) -- disliked doctors and procedures. So he avoided going to doctors and ignored signs of ill health.
When he began losing a lot of weight, my brother-in-law made an Dr. appt for my FIL.
It was colon cancer and the doctors gave him 2-3 months; he lasted 7-8 months, opted to forgo treatment.

R.C. had warning signs but chose to ignore them. Sometime warning signs are so subtle they can be overlooked. My mother's colon cancer was diagnosed when she had an upper GI in preparation for a hernia repair.

Thanks Marsha --- I will bring this up to my doctor next time I see him which is in 3 weeks. I know these type of exams are essential especially for folks in our age group but sometimes things can get so complicated!

 

[ALCapshaw2]

Congratulations Marsha!

That's one more Doctor educated in the risks / trade-offs for anti-coagulated patients.

Hopefully more will 'see the light' and be willing to do at-least routine diagnostic Colonoscopies while anti-coagulated.

 

[Marty]

Marsha, you should send the good doctor a bill for one hour CME!

 

[Marty]

Marsha, you should send the good doctor a bill for one hour CME!

 

[Karlynn]

When I was dealing with my stomach issues and was looking into scheduling a colonoscopy and endoscopy, the GI dr. said I would not need to stop ACT. He can do a biopsy while on ACT and remove a few small polyps if necessary. If the procedures are for screening - it's like a dentist wanting you to do off ACT for tooth cleaning.

But I will ask about the colonography when I do end up scheduling.

 

[ALCapshaw2]

When I was dealing with my stomach issues and was looking into scheduling a colonoscopy and endoscopy, the GI dr. said I would not need to stop ACT. He can do a biopsy while on ACT and remove a few small polyps if necessary. If the procedures are for screening - it's like a dentist wanting you to do off ACT for tooth cleaning.

But I will ask about the colonography when I do end up scheduling.

VERY INTERESTING Karlynn.

Mine would not agree to doing the same for the same procedures.
When it's time for a followup, I'll have to raise that issue again.

 

[catwoman]

Update -- Dec. 1's the date

Update -- Dec. 1's the date

Will have my fun c-scope on Monday, Dec. 1.
Scheduler called today to set it up & I told her that I am on warfarin & why. Said I would not go off it. She said my gastroenterologist had already noted as such.

I asked her about premedicating with antibiotics and whether I would have an IV of antibiotics for the procedure. She said she didn't know and was e-mailing the doctor while we were on the phone.

Anyone know about antibiotics before a colonoscopy?