I Canceled My Colonoscopy

[Phyllis Jean]

After reading all of the bad experiences on this site regardomg colonoscopies, and the risks associated with it, I canceled my procedure today. I not only have a mechanical Aortic valve, I have diabetes requiring 2 insulin shots a day, plus high blood pressure. I don't feel confortable going ahead with this until I become better informed.

This is the part that bothers me: When I called to cancel my appointment, I told the person answering the phone the reasons I wanted to cancel. She said in a huffy voice "Just where have you been getting your information"? I said, "From off the internet, there is a wonderful site called valvereplacement.com. She said, "Hmmm, that is exactly what I thought".

Why did she respond in that manner? This is my body and I want the best possible care I can get. I don't want to blindly go into something that could cause me to have a stroke or excessive bleeding.

Your thoughts please.

 

[Karlynn]

Good for you! To not follow your instincts on this would be wrong. I'm glad you decided to wait in order to become better informed.

As to the response of the person you spoke with - some medical people are too arrogant to think they might not know it all and often the physicians attitudes are projected to the office personnel. Or the office personnel just have them on their own!

 

[Yaps]

My personal opinion? Some,not all.. drs and healthcare workers would rather you stay in the dark, to get info from them is pulling teeth. They have different agendas than you and I,different concerns. They sometimes feel informing one is too much bother, but I always start it out with..I hope you have a few minutes because.... they cant get out of it then..I canceled one med for my hubby(severe ph) as there was a lawsuit on the drug, John had been prescibed redux, kin to phen-fen, which is how he got ph..and he wasnt going to take another dangerous drug.. I was adamant... stick to your guns , find out the risks then go from there..love the pup...

 

[Ross]

Phyllis you should have said that you got your information from the American Society of Gastrointestinal Endoscopy-ASGE Policy and Procedure Guidelines for 2005-Referencing page, Volume 61, No. 2 : 2005 GASTROINTESTINAL ENDOSCOPY 191

"High-risk procedure. Discontinue warfarin 3 to 5
days before the procedure and concomitantly begin
administering LMWH. Consider using dose ranges as for
the treatment of patients with acute DVT (e.g., enoxaparin
1 mg/kg subcutaneously every 12 hours). Discontinue
LMWH for at least 8 hours before the therapeutic
endoscopy. The decision as to when to restart therapy
should be individualized."

If they can argue with their own fellows society guidelines, then they better go get some more schooling!!!!

I didn't want to do this to scare you, but dang it, you need to read it. PM warrenr for the story of his father!

I'm attaching the guide as a zip file for you to download and print out. It's 6 pages long. You can take it with you to your Doctor and bust his chops about not following the guidelines.

 

[Nancy]

I really hate to say this, but I believe that when doctors do not want to do bridging therapy, they are just plain lazy.

They know the risks, I'm quite sure, but just don't care and it does take time to consult with someone else in another field.

That's why everyone here, and their loved ones have to be vocal about getting it done the right way. If one guy or gal doesn't want to take the time, there are always others who will care more.

Insist on nothing but the best care that you can get for yourself. It is your life, protect it.

 

[Guest]

I think with your doctor's lack on interest in your safety and the attitude of the staff you did yourself a real favor.

When I worked on the Navajo Reservation the people were very respectful of physicians. I remeber one doctor saying, "I'd sure hate to go back to having billaganas (non Navajos) for patients again."

 

[Michaelena]

I really hate to say this, but I believe that when doctors do not want to do bridging therapy, they are just plain lazy.

They know the risks, I'm quite sure, but just don't care and it does take time to consult with someone else in another field.

That's why everyone here, and their loved ones have to be vocal about getting it done the right way. If one guy or gal doesn't want to take the time, there are always others who will care more.

Insist on nothing but the best care that you can get for yourself. It is your life, protect it.

Oh Nancy, how right you are! We must be proactive, in the end we are responsible for our care, we can't be victims.

Michaelena

 

[lance]

Good for you

Good for you

Phyllis Jean,

I think you made the right decision as confirmed by others on this board.

Just because your information came from the internet doesn't automatically relegate it to the trash can.

Following a few incidences I try and be my own best friend when it comes to medical matters and find out as much as I can.

By the way, could they go in once and take a look and then if they find anything (polyp) that needs removing go in again for the cutting or should a patient be bridged in order for them to just take a look?

 

[Marty]

Virtual ?

Virtual ?

I talked to a busy private practise gastroenterologist the other day. He said he never has had trouble "holding" for three days without a bridge and he has colonoscoped a lot of patients on warfarin for one thing or another over the years. However, he said he is also referring more older fragile patients for virtual colonoscopy and is happy with that.

 

[Guest]

I just got a e-mail from someone whose mother died 10 hours after he colonoscopy. I don't know why she was on warfarin but she was told to stop warfarin for one week before the colonoscopy.

 

[catwoman]

When I called to cancel my appointment, I told the person answering the phone the reasons I wanted to cancel. She said in a huffy voice "Just where have you been getting your information"? I said, "From off the internet, there is a wonderful site called valvereplacement.com. She said, "Hmmm, that is exactly what I thought".

Phyllis Jean:
I'll bet that person has never seen this website and may not have a high opinion about the internet.

I'm sure you can find another gastroenterologist on your insurance plan who agrees that you should be on bridge therapy. It may take some phone calls, but I'll bet there's one out there.

If you haven't read about Warrenr's dad, check out his posts about his dad's stroke the day of his colonoscopy. You can search for posts by member or by subject. I know of a woman here in the Fort Worth area who has a mechanical MV. Her daughter decided she needed a colonoscopy; gastroenterologist said go off warfarin, she did and 5 days later she suffered a massive stroke. This was in December 2004. She's in a nursing home bed in a retirement facility now. A friend whose dad is in the same facility told me about the woman after talking with the woman's son.

As we say, You can replace blood cells but you can't replace brain cells....

 

[Marty]

Virtual colonoscopy looking better

Virtual colonoscopy looking better

Marsha I'd like to know the details of the December 2004 case and about Al's when they become available. The busy gastroenterologist I referred to in my recent post when told about the Mead case said " that's the kind of disaster we all fear" . They are rare but colonoscopy is not risk free. We had a perforation in our clinic two months ago. He needed a diversion ileostomy and right hemicolectomy.He was not a warfarin patient but this complication would be tough on a warfarin patient bridged or unbridged. Complications are rare but when they happen to you they are 100%. Virtual is looking better all the time!

 

[catwoman]

Marty:
I'll see what I can find out.
The son is CFO or CEO of a business here, but I don't know the son's name. I did e-mail my friend about vr.com and Warrenr, and she passed those on to the son, who was interested.
Earlier this week, my friend had to suddenly move her dad to a geriatric psychiatric facility south of Dallas, about 50-60 miles away. He has dementia and his condition worsened overnight. She does not know when/if he will be moved back; she ran into the stroke victim's son when visiting her dad at the retirement facility in Fort Worth.

I would hazard a guess there are more of these stroke cases than believed Perhaps a warfarin patient has a stroke a couple of weeks after the colonoscopy and no connection is made between stopping warfarin and the stroke. The clot could have formed during the time the patient was off warfarin. Elderly people probably have a higher incidence of strokes anyway and some doctors might not even question/know/connect any incidents leading up to the stroke.

Perhaps a person who takes warfarin after a DVT doesn't have as high of a risk of suffering a stroke when suspending warfarin as mechanical valvers do. And how many mechanical valvers do you think the average gastroenterologist has for patients? Not as many of those as others who are on warfarin, is my guess.

My family has been told and given written orders that I am not to be taken off warfarin without bridging therapy. I'm uncomfortable even skipping 1 dose, unless my INR is extremely high.

 

[Guest]

People who have DVTs have little risk of stroke because the blood has to go through the lungs before it can get to the brain. The lungs are very efficient filters. However, PEs can kill. This is what probably killed my Dad. The doc stopped warfarin to scope his bladder and he had a PE and died. He lived just long enough to tell my Mom, "I don't feel good."

 

[Marty]

WOW! What a story.Al, I can see what stimulated your interest in hemostasis and thrombosis. We don't see as many pulmonary embolisms as we did years ago. I'm not sure of the reason ;but it is most likely due to better anticoagulation and the use of filters in the big vein in the abdomen which drains the legs ( inferior vena cava).

 

[warrenr]

Stopping anticoagulation for Colonoscopy

Stopping anticoagulation for Colonoscopy

I believe that I have mentioned this before. It seems very odd to me that Gastro's don't normally check a persons INR level before colonoscopy but will say they are worried about bleeding. If they are so worried about the bleeding if a patient is fully anticoagulated why not check the INR. I am not suggesting that a patient should just continue coumadin without informing the Gasto but I find it puzzling that they don't check INR level prior to procedure.

Just a note on my father's law suit. The Gastro is pointing the finger at dad's primary care physician and say's he was just there to perform the procedure. I guess in the Gastro's mind that means that he does'nt have to follow protocal.!!!!!!

 

[Guest]

If he does not accept responsibility for the outcome, then he should not have submitted a request for payment.

 

[perkicar]

Virtual Colonoscopy

Virtual Colonoscopy

Marsha I'd like to know the details of the December 2004 case and about Al's when they become available. The busy gastroenterologist I referred to in my recent post when told about the Mead case said " that's the kind of disaster we all fear" . They are rare but colonoscopy is not risk free. We had a perforation in our clinic two months ago. He needed a diversion ileostomy and right hemicolectomy.He was not a warfarin patient but this complication would be tough on a warfarin patient bridged or unbridged. Complications are rare but when they happen to you they are 100%. Virtual is looking better all the time!

I noticed Cleveland's website said something about doing virtuals--I'm going to ask my cardiologist there about it when I go in a few weeks. They want me to have a colonoscopy (my pcp here in Louisville) but quite frankly the whole stopping coumadin thing scares me.

 

[Marty]

Carolyn, You can not go wrong with a virtual done by Cleveland Clinic. If your exam is negative as over 90% are you are through. If they find something then you can use a Lovenox bridge and have a safe colonoscopy.
Warren, my gastro friend referred to in the above posts told me in no uncertain terms that warfarin mangement leading up to their procedure is the responsibility of the PCP. It surprised me that they can undertake an invasive procedure and do no preprocedure workup. As Ross says they do not seem to be acquainted with guidelines published by their own society.

 

[Guest]

One of the lawsuits that I consulted on involved a dentist whose patient had a stroke in the dental chair. I was defending the dentist, so I was able to get the dentist removed from the suit because it was the PCP who gave the directions as to what to do. This was a different matter because it was a dentist but you see what I mean.

I still think that the physician may claim that it is the PCPs responsibility but claiming that does not relieve all liability. This would be determined by the jury after hearing expert testimony.