Sunday, May 29, 2011
I also want to point out that this person thinks that an "anesthesiologist" (misspelled in the post as you will see.) performed his sedation. Correct me if I'm wrong, but do anesthesiologists do the sedation for a simple colonoscopy? Maybe this guy was an ASA3 or something? He doesn't state WHY he is so special that he rated a Dr. instead of a nurse... (CRNA)
Here's the post, reproduced from http://www.askapatient.com/; (FYI askapatient removed the last 2 sentences of this post from their web page on 5/30/11 because it was offensive. (italicized and bold below) I am leaving the statement alone here, as it was written. I want people to see the depth of hatred and rage that Versed invokes in some people. Over-the-top emotional responses are part and parcel of being "sedated" with Versed. This man exemplifies this bizarre side effect of Versed.)
"Went in for a colonoscopy. (incomplete sentence; WHO or WHAT went in for a colonoscopy?) I was given Versed and fentanyl (proper name should be capitalized) in my I.V. The anestegiologist (sp) told me that I would feel relaxed and sleepy and that was it. Woke up in post-op 40 minutes later and walked out of the hospital 45 minutes after that. (incomplete sentence again; who or what 'woke up...'?) I resumed normal activity later that afternoon. (What might that be? Bar room brawling?) No memory of the procedure and absolutely no side effects. I would recommend this to anyone who is considering an outpatient procedure. All the comments you read on this site from the sensitive "cry babies" is a bunch of garbage. These people are the same pain in the asses that everyone hates and should be dismissed." (From a 49 year old male. Emphasis mine.)
Wow! Can we say "hostile?" I can't help myself from correcting rants, so here's another one; It's not "pain in the asses" it's "pains in the ass." We don't have "pain in our asses" we have "pains in our ass." Can you grasp the subtle difference?
"Sensitive "cry babies?"" What about he himself being an "insensitive boor?" I can denigrate people with the best of them, which isn't this poster! "Everyone hates?" Says who? This poster is also an egotistical mind reader apparently. What he finds infuriating, so must everybody else. What "a bunch of garbage" he is spouting!
We who have had severe and long lasting side effects from this nasty little potion Versed "should be dismissed." The medical community would like to "dismiss" our concerns about Versed. In fact they are doing a really good job of just that. That's because Versed is only for the ease and convenience (and MONEY, don't forget that!) of the medical personnel, not the patient.
I am really glad that this poster feels he suffered no ill effects from the Versed. (I personally hope that it is the Versed which caused this person's anger and rage, and that it isn't a personality flaw of his! Anybody who reads this blog knows I feel that Versed affects bright people most, ergo, if my hypothesis is correct, this guy has the IQ of a gnat. Angry and stupid isn't a good combination... I'm just sayin'!) I cannot understand why there is such animosity towards people who dislike this particular drug. No other drug has this effect on people. Think about it, can you name one single drug other than Versed, that if the patient doesn't like it, the patient is vilified? It's insane.
This is what Dr. Douglass has to say on this subject;
The business of modern medicine
You have to spend money to make money. That's an accepted fact in the business world. What a lot of people AREN'T ready to accept is that mainstream medicine is one of the biggest businesses out there -- which means that all of those same business rules apply.
So when your doctor spends big bucks on diagnostic imagining equipment, you know good and well who's REALLY footing the bill.
That's why it came as no surprise to me when a recent study found that docs who buy or lease MRI machines have much higher rates of screenings -- and ultimately, surgeries.
Researchers looked at Medicare claims for low back pain filed between 1998 and 2005 by primary care doctors and orthopedists, then isolated numbers on docs who bought or leased MRI machines in that time.
They found a 32 percent increase among primary care docs in the months immediately afterwards. Orthopedists had a smaller increase -- just 13 percent. But that's because the machines helped keep them busy in other ways: That 13 percent boost in MRIs led to a 34 percent increase in surgery rates, according to the study in Health Services Research.
If the surgeries were beneficial, I wouldn't have much of a problem with it. But for patients with back pain, neither the screening nor the surgeries that result from them are necessary.
As I told you recently during a similar exposé on X-rays for back pain, nearly everyone ends up with disc "problems" like slips and bulges. (Read more here.)
But most people never feel a thing -- proving that these disc issues are not the real cause of pain, just a convincing excuse to operate.
And that's why most people who go through back surgery end up in as much pain as they were before, if not more -- because now they’re recovering from an invasive procedure to boot.
So if your doc wants an MRI for something like back pain, find out if he owns the machine – and if he does, go get a second opinion.
Get it? Your relationship with the medical community is based on the money to be extracted from you and your insurer. It is necessarily an adversarial one in a lot of cases. (most?) Be an informed patient! Protect your interests, your money and your most valuable asset, yourself.
All these colonoscopies? I think most of the time they are a waste of time and money. The risks out weigh the benefits unless you are already having a problem. That's my opinion. PTSD from sedation, perforation, infection all for a "simple" diagnostic tool. Not to mention the huge expense of this simple procedure which CAN be done without these risks. No sedation=no mental disorder and no perforations. It also means no MONEY for the CRNA, the nursing "levels of care" charges, the drug manufacturers and the Doc can't do as many per day. He/she will have to SLOW DOWN! Which leads me to this from Dr. Douglass's "Daily Dose"
Colon docs poop out
Most people would lose their jobs if they mentally clocked out hours before the end of the workday.
Imagine an accountant who always screws up numbers after lunch!
Yet it's perfectly acceptable in the world of medicine -- especially when it comes to the single most important cancer screening: the colonoscopy.
A new study confirms that docs get worse at this procedure as the clock winds down toward quittin' time – with some docs only half as good at the last procedure of the day as they are for the first.
Researchers tracked 28 endoscopists for four months, checking not only how many polyps they found per patient but how those numbers changed throughout the day.
They found that for each hour that passed, docs detected 4 percent fewer polyps.
But the clock isn't the only thing you need to watch -- you also need to look at your place in line, because researchers say docs detected 5 percent fewer polyps in each successive patient.
Docs that performed 12 procedures a day found only half the polyps in the last patients of the day as they did in the first, according to the study in the American Journal of Gastroenterology.
To make matters worse, this is a problem we've known about for years, but clearly no one is taking any steps to correct the problem.
Back in 2009, I told you about a study showing that docs who worked early in the morning found 27 percent more polyps than docs who performed the procedures after 8:30 a.m.
What's changed since then?
Not much, according to the new study.
Look, it's crazy that the time of your appointment could actually make a life-or-death difference, but the numbers don’t lie.
Since that's the reality, recognize it -- and in addition to making sure you pick an experienced and well-recommended doctor with a good track record, always schedule your appointment before breakfast.
Your rear guard,
William Campbell Douglass II, M.D
Friday, May 27, 2011
Everybody reacts differently, I’ve learned, to the challenges that come with a multiple myeloma diagnosis.
What I might dislike or find annoying may not be so troublesome to someone else. Similarly, things that may not bother me much, if at all, can be hugely vexing to others.
Sometimes, as patients, we can be drawn into situations by our disease where we aren’t sure exactly what to expect. Most of us, I think, take these things in stride, and grin and bear it. Well, maybe not always grin, but as most cancer patients will tell you, you’ve just got to accept the fact that those treating you are going to do things to you that you aren’t going to like.
For my part, for example, since my diagnosis, I have had experiences that in my pre-myeloma life would have made me cringe. An open-lung biopsy in 2006 comes to mind, although that’s but one of several instances. Yet, when the cringe-inducing procedure is happening to you, and the purpose is to keep you alive, it becomes much easier to shrug it off and think, “Well, that’s just one more thing I have to put up with.” We can be pretty resilient when we have to be.
So I thought it might be helpful from time to time to give a bit of a head’s up about what one can expect over the course of myeloma treatment – from my perspective, of course.
In particular, I’d like to tell you about one of the drugs you are sure to come across. The drug is Versed (midazolam), but I refer to it as the “forget drug.” It’s used commonly in surgical procedures these days, especially ones where they’d like you to be somewhat conscious and responsive during the goings-on. It’s a sedative and relaxant, so it helps you get through the discomfort that a procedure may cause. If you’ve had a colonoscopy, you’ve had Versed, for example.
The big side effect of Versed, however, is amnesia, and I think that’s why the medical profession likes it. (emphasis mine. I have been saying for years that Versed is for the comfort and convenience of the STAFF, not the patient.) While the drug is intended to lessen your pain and anxiety by helping you relax, the drug is also going to erase your memories of the procedure, including those of any discomfort you experienced.
I’ve had a few encounters with the “forget drug,” one of which was for the insertion of an apheresis catheter prior to stem cell harvesting and transplant. I remember absolutely nothing about this procedure and for some time afterward, although I apparently was fully conscious for the duration.
It took me a while to figure out that I had never really been put under anesthesia.
I “came to” in recovery and Linda, my wife, was sitting there (hospitals don’t like you to come in for procedures alone, but especially when they are giving you the forget drug), and it seemed pretty much like I’d just came out of sedation. That’s what I thought anyway.
About an hour or so later, after we’d left the hospital, my head cleared enough for me to reflect back. I realized that when I rejoined the real world in recovery, I was sitting up and engaged in conversation. In fact, I may have come to in mid-sentence. (emphasis mine. This happened to me as well, see prior posts) I said as much to Linda.
She said something like, “Oh yeah, you were awake and talking when I came over to the operating room waiting area before they brought you to recovery.” (Oh HORRORS!)
For some 20 minutes in recovery, I apparently sat around awake and talking.
But, of course, thanks to Versed, I don’t remember.
There’s about an hour of my life – where I was otherwise aware and lucid, I’m told – during which I have no idea what transpired.
That’s what the forget drug does to you.
This doesn’t bother most of the people I talk with. They say they’d rather not recall surgical procedures anyway. Most seem to think it’s odd that I find this even the slightest bit troublesome. That includes my doctors, I suspect. ( I find it odd that this DOESN'T trouble them.)
For my part, I just don’t like to have my memories stolen, good ones or bad ones. (Tim over at versedbusters says this very same thing!)
The other thing is, there is no question that sometimes Versed procedures are going to be uncomfortable.
For example, there was an instance where I went into a procedure – a colonoscopy – with the intent of fighting as best I could the amnesia aspect of Versed. I was partly successful, and I can still recall various things that happened. Not everything, of course, but in every previous encounter with the forget drug, I had remembered nothing.
At one point, I experienced a fair amount of pain, and I turned my head to the doctor and said, “Hey, can you be a bit more careful? That hurts.”
The stunned look on his face when he got called out by a patient like that was priceless. It made me laugh, and I went back to watching my colonoscopy on the little television monitor they give you.
And to think – that treasured little moment could have been erased.
My conclusion is that a forget drug is an imperfect solution.
In the best of all worlds, we’d find a way to eliminate pain and discomfort during procedures where you remain conscious, rather than dealing with them by having you forget they ever happened. (emphasis mine. These are my sentiments exactly. Fentanyl comes really close to being able to do this for patients. Unfortunately, this is NOT desirable to the staff. They do NOT want this solution. Funny how all these medical people want Versed and yet we patients are saying we don't like it or want it. So who is this med for? Us, or the staff?)
Tuesday, May 24, 2011
Here's the text from the link. I am adding my own thoughts in a different color and any bold or italicized text is also mine.
Expert: Ronald Levy, M.D. - 6/17/2009
Dr. Levy, in your response to a recent question entitled "Colon scope without versed" (asked on 6/15/2009), you indicated that you agree with the asker's GI doctor's statement that "most [...] Versed horror stories are untrue." You then went on to say that "[t]he majority of Versed complaints have to do with the amnestic effect of the drug. A lot of patients don't like the feeling of not remembering what happened. The fact is, this is an expected (AND desirable) effect of the drug." Having read this response of yours, I have two related questions for you. First, on what basis did you form your opinion that most Versed "horror stories" are untrue? I think if anything smacks of "untrue," it is the peculiar and seemingly reflexive (and, by the way, weak) defense, routinely issued by medical practitioners like yourself, of a drug that many people clearly abhor and that has caused intense, ongoing suffering in many patients. My second question is, exactly how can you characterize as "fact," the idea that amnesia is a "desirable" effect of Versed? You said yourself (see above quote) that "many patients don't like the feeling of not remembering what happened." Well, if that is indeed how "many" patients feel, then how could you possibly characterize the very thing they "don't like" as being "desirable" in any way? Could you instead mean, for example, that the inducement of amnesia in patients is "desirable" to YOU as the anesthesiologist? Alternately stated, to whom is amnesia desirable? Your very own words indicated that many patients don't like it. How, then, is it desirable? Please clarify.
Get the answer below
Let me start with the second question first. When Versed was developed, it was designed to relieve anxiety, be shorter acting than Valium and to cause amnesia. (emphasis mine)(Isn't it interesting that the amnesia isn't mentioned to the patient? And the drug was NOT designed to cause amnesia! If you will look around the web, this amnesia was a shock to anesthesia providers when Versed was first released. It was a "bug" not a design trait.) To use an analogy, one of the desired effects of roller coasters is to give an adrenalin rush to the rider. Because many people don't like that feeling, does that mean that we shouldn't make roller coasters?? (People who don't like an adrenalin rush can CHOOSE not to ride a roller coaster can't they? What a lame analogy! Or are you trying to say that anesthesia is a fun ride, just like at an amusement park? This sounds like drug seeking behavior if that is what you are saying. Isn't that something that physicians et al are very concerned with? People who look upon mind melting drugs as a fun ride, like a roller coaster?) Or to reverse what you're saying, Just because some people don't like the amnestic effects of Versed, should we withdraw the drug from those patients (the majority) (Majority? Says who?) who do want that effect? The fact of the matter is that Versed is given 10s of thousands of times every day (overuse and abuse of Versed) and perhaps less than 1% of patients don't like the effects. (Show me the scientific studies which prove that it's only 1%!) As an anesthesiologist, it is not desirable to ME for the patient to be amnestic other than as benefits the patient. (Balderdash! If this statement were true, this Dr. wouldn't be so absolutely DETERMINED to marginalize people who hate Versed.) Our role is to make the procedure as pleasant for the patient as possible, and for most people who have a fear of pain, fear of surgery and fear of bad outcome, not remembering their time in the OR is desirable. (Assumes facts not in evidence) As to the first question, it follows from my first answer. The only "horror" stories I've heard are related to amnesia which, as I said, occurs in less than 1%. ( The first part of this statement is a bald faced LIE! I myself wrote to this Dr. YEARS AGO complaining about Versed. I DIDN'T GET AMNESIA! He is either lying or selectively remembering, when he says that the only horror stories he has heard are about the amnesia. As for the second part, again, show me the PROOF that it's only 1% of patients. If you look around the web, it's a whole lot more than 1% who object to this drug. So the second part of this statement is also a fabrication.) You quote that many people have "intense, ongoing suffering"...what is the evidence for this statement. ( I am the evidence for this statement along with many, many others like me. Show me evidence to the contrary.) What exactly is the "ongoing" suffering?? (It's called PTSD, along with a myriad of other drug induced anxiety reactions stemming from the amygdalla. Insomnia, depression, anxiety, obsession, irritability, continuing memory issues etc. Don't act stupid Dr.) People may not (MAY not?) (We are telling you that we DO not like it! Besides, isn't this just what you say that 99% of patients desperately want? I'm confused, must be the Versed I was poisoned with!) like the feeling of lost memory, (exactly what you say we do like???) but I don't know of any reports in the literature discussing long term psychological effects from Versed administration. (That's because MEDICAL STAFF love this drug. There won't be any studies until we patients make enough noise to FORCE the medical community to seriously look at the side effects of their very favorite drug!)
So in summary, if you are one of those people that wants to remember all the fine details of your procedure, tell your anesthesiologist not to use an amnestic (and they won't), (Yes Dr. they will use an amnestic regardless of patient instructions. Many people report having this drug forced on them, to include myself, my sister, and many others.) but don't deny to people who don't want to remember, the right to have Versed. (This last statement is nothing but hyperbole. We are not trying "to deny to people who don't want to remember, the right to have Versed!" Don't try to obfuscate the true issue which is; We patients have a right NOT TO HAVE THIS DRUG VERSED. This is the crux of the matter. Patients are getting this drug whether they want it or not and without informed consent. It is causing them HARM! We want this ABUSE OF PATIENTS TO STOP!)
Hope this clarifies the situation,
Ronald Levy, MD
Professor of Anesthesiology