To Colonoscopy or Not Colonoscopy

That is my question.

I am due for a colonoscopy. It's been 3 years and I am due since they found and removed 3 polyps the last time.

My problem is the device rep. I had a procedure (not heart related) 4 months ago and the rep did not want to do his job. He wanted to use a magnet instead of programming my device into the safety modes. So my concern is I am going to get this same rep again for this procedure. If I do, I am walking out and I don't want to waist the Doctors time but I can't trust this guy with my heart and don't want another confrontation with him right before a procedure like last time.

I am trying to figure out how to handle this. I don't want to involve the Doctors, it's not their problem, it's mine. Short of skipping it.....any other ideas??

Grateful Heart

13 Comments

Me too!

by Many Blessings - 2013-07-21 01:07:14

Hi Grateful Heart,

I'm actually going through the exact same issue right now. The only issue for me is the cauterizing, nothing else about the colonoscopy.

Since I'm 100% dependent (AV Node ablation) and my escape rate is below 20, my EP doc and others do not want me to have it done, even though I need one. I also called my CRT-P manufacturer and they suggested not doing it unless it is absolutely necessary and there are no other options.

They did say there is a 5/10 cauterizing "rule" your doctor can follow if it's absolutely necessary. It's where they cauterize for 5 seconds, wait 10 seconds, cauterize 5 wait 10, until it's complete. They said this is "less" risky, but still not "safe" in certain situations, and suggested I not do this either.

Also, because I am on Coumadin (even if I stopped it for a few days prior) the 5/10 "rule" doesn't always work in stopping the bleeding. This might be a problem for you as well if you're on anticoagulants.

Another option is, there is a certain type of CT scan that is "almost" as good as a colonoscopy, and shows the upper and lower areas. I can't remember what it's called but I think it has a number following the "CT". I can find out exactly what it's called for you if you want, and no one else answers first. That is what they've suggested doing for me, so that's what I'll be doing! I think we still have to do the "pleasant" pre-cleansing routine prior, so don't get too excited! LOL!

I hope this helps!





Me too (Part II)

by Many Blessings - 2013-07-21 01:07:59

I forgot to mention....

With doing the 5/10 "rule" thing, your PM tech might be more comfortable using the safe mode versus the magnet, but I'm guessing not. It might be worth asking, just in case.

With the CT, the PM wouldn't even be an issue, so you could totally keep your PM tech out of picture. If they do see more polyps, then you might want to see if they'll give the 5/10 thing a shot putting you in "safe mode".

Let me know what you decide to do.

What if they won't do it?

by Many Blessings - 2013-07-21 02:07:11

Not sure of Grateful Heart's case, but what if they won't do it. If the gastro docs (we've asked 2) won't do it because the cardio & EP docs are saying no and the PM manufacturer suggests not to do it because it's not worth the risk, where do you turn?

Common sense says to go to the nearest big city for treatment, but my EP doc (who is saying no) is at a major hospital in the biggest city in the state, so I can't go there either. Everyone wants an okay from all of my docs, which they won't give PM or Coumadin wise. They don't want to stop my Coumadin for more than 3 days because of my stroke & TIA history, and because of bleeding problems during & after my PM (I stopped Coumadin 3 days prior).

I was all for doing it (PM & Coumadin wise), until it wasn't an option any longer. I agree the colonoscopy/sigmoidoscopy would show even more, and if there is a problem, they can take care of it right then and there, but what if they refuse to do it because of risk factors in an individual's case?

Grateful Heart might be in the same situation if she can't find another PM rep to help her out. Does anyone have any suggestions that might help us?

Thanks!

Thank you All

by Grateful Heart - 2013-07-21 02:07:40

I had no idea there could be so many issues for this procedure. Thanks for all the information.

Tammy, the CT scan definitely sounds like an option. At least we could go that route and take it from there. If they saw something in your case, I think at that point they would have to consider the next step (colonoscopy) for you.....wouldn't they? Maybe if you present it to them that way, they would give you the option....I don't know.

Inga, I hope everything works out well for you in September. Thanks for sharing guys.
Fortunately, I am not on any anticoagulants.

Sara, glad it all worked out for you.....way to go.

Jean and Don, I spoke to someone at the MFGR comp. about this rep. They kinda said they cannot guarantee he won't show up if he is the only one available. They said they sometimes do not have that many reps for certain areas.

I guess if I need it, I will speak with the Surgeon before hand like Don said and just let them know, if he shows up.....I'm out. They shouldn't be upset with me if I let them know upfront.....right? (Probably wrong).

So, I guess the heart really is connected to everything!

Grateful Heart

Do IT!!!!!!!!!

by donr - 2013-07-21 02:07:44

ME: a colonoscopy is critical for your future. Statistics says you need it, based on past history.

You need to get the colo-rectal operator of the Mt Palomar 200 inch telescope in on this - he has a stake in it. It is unfair to him/her to leave them out of the situation.

Now - this is about as far from your PM as you can get, short of working on your big toe, so you do not have the same problems of the ground plane they stick to you being even close to the ICD. Surely the surgeon can figure out how to stick it on a thigh, well out of his way. Normally they roll you up on your left side for the procedure, so the left thigh should be good. MOF, it might be good to have a sit down w/ your surgeon, explain your history & ask him/her point blank if they use RF electro cautery. They may well just use a steel loop & pas a DC current through it to heat the wire & burn the polyp off. If that is the case, your body will not be involved in the electric conductivity.

Your cardio is the place to start w/ the story & your concerns that you told us about. He should be able to make everything clear to the MFGR that you do not want that rep. Start NOW, don't wait for the procedure date to get close.

The only alternative that is ruled out is the "Do Nothing Alternative."

Good luck sorting this one out.

Don

No issues

by golden_snitch - 2013-07-21 03:07:16

Hi!

I have had a coloscopy with removal of a big and ugly polyp in January. Because of the cauterization the pacemaker had to be checked afterwards, but apart from that the pacemaker was no issue at all. It doesn't need to be programmed into a different mode or something like that. They couldn't check my pacemaker right after the procedure, because they didn't have the device for this manufacturer, so I had it checked two days later - no problem at all, it was working fine. I need to go in again in September, because the polyp they found in January already had some high grade dysplasia.

By the way, I had SA and AV node ablated (100% paced in the atria and ventricles), and was on Coumadin, too. I stopped Coumadin a week before, and had to continue on Heparin injections for another week after the procedure due to the polyp removal. They also put in five little clips where they removed the polyp to stop the bleeding.

Go for it, the pacemaker isn't really an issue when you have this procedure.

Best wishes
Inga

Sparrow-That's what I was told

by Many Blessings - 2013-07-21 08:07:30

When I was asked my cardio doc & PM manufacturer why so many others out here didn't have an issue when they needed a procedure done that required cauterizing, I was told there are many different situations, and it just depends on the patient's current condition(s), type of device(s), number of lead(s), single or bi-v PM, placement of the lead(s), medications, dependent or semi-dependent, and the patients full cardiac history (there were more things but I couldn't write them down fast enough).

They said some patients are considered "normal" cases, that can be done with minimal cautionary guidelines and do fine, while there are many others that are "unique", "uncommon" or "extremely unusual" cases and should not be done unless absolutely medically necessary. They said there just isn't an easy answer, because what is safe for some, may be life threatening for others.

Guess there really isn't an easy answer for any of us and we all need to do what we feel is best for us. If you feel comfortable and can find someone to do the procedure, great. But, if you can't find anyone to do it, or assist with your PM during the procedure, then the choice has been made for us. LOL!

I'm interested to see what others have been told when they ran into this issue.


Me too - no problem

by SaraTB - 2013-07-21 11:07:27

I'm 100% paced, and have had a colonoscopy. The hospital was briefed, and they did the procedure in the same building as the cardiology lab, so that the PM could be checked later if they had to do cauterisation, instead of their usual facility, but otherwise no problem at all. My EP was fully informed and had no concerns about the procedure.
Luckily for me, no cauterization was required.

My situation

by Grateful Heart - 2013-07-21 11:07:38

Thank you all. I just want to be clear about my situation. I have a Bi-Ventricular ICD and heart wise, I am doing great! So much improvement from 5 years ago, thank God.

Aside from the electro cautery concerns, which I understand, my main concern is this rep.

I've had some problems in the past with my settings after a procedure and another time, the rep was running late and they wanted to use a magnet. I told them no and we talked about it long enough for the rep to show up. Both times this was not the rep in question.

But last time, this rep didn't want to do his job at all. Honestly, I don't know why he showed up. He knew why he was there, he knew there were issues in the past and still he was just going to use the magnet because "it's the easiest way".....his words.

I know in the scheme of things I am just the patient. I do speak up when necessary, which is what happened with this last rep. I explained I had problems with the settings, etc. in the past and I was not trying to be difficult. He claimed it was the Hospital's policy and he did not make the decisions. I turned to the Anesthesiologist right in front of him and asked her if this was policy and she looked at him and said "No". Then she told him to use the programming. So she's a keeper!!

I just don't want to have to go through that again if he shows up, so I will leave.

A weary but.......Grateful Heart

hmmmm

by jeanlancour - 2013-07-21 12:07:40

Could you call your device co, and request a different rep? I would explain why, and tell them you just don't trust him. After all they are paying him, but you are the one hosting their device..and able to call attention to their reliablety, if they would not listen and step up to stand behind their product and personal. Just a thought. Good luck, Jean

Motivation to prepare...

by donr - 2013-07-22 02:07:40

....Gratefull: The greatest motivation I can think of to solve this problem PRE OP is the BOWEL PREP you have to go through!!!!! Do you REALLY want to get up & walk out after going through having that hand run up inside you, grabbing you by the top of your stomach, turning you inside out & scrubbing down the guts w/ a wire brush? I stuck around in a hosp for two days on a liquid diet just to avoid having to do that again pre op for my colon surgery.

GO out & FIGHT!!!!! Or I'll send Dana up to counsel you & remember - she looks on CHESS as a contact sport!

Don

Well... since you put it like that

by Grateful Heart - 2013-07-22 05:07:26

Ok, I will definitely talk to the Surgeon about it.

Don, your way with words is ..................well, I have no words!!

Tell Dana she can stand down. :)

Grateful Heart

Russian Roulette

by Jax - 2013-07-22 12:07:27

That's the game you would be playing if you don't get a colonoscopy....

I really don't care if anyone considers me difficult....you are not JUST the patient....you are the most important person at your procedure. Without you it doesn't go on....I have walked out of various things...when I don't like things being said...too bad for them.

If that rep comes walking in...you should be walking out...maybe then they will get the idea.

P.S. I have to take a colonoscopy myself. Really looking forward to it...NOT.

You know you're wired when...

You have a dymo-powered bike.

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