Friday, December 30, 2011
Unbelievably, I just got off the phone with an outfit in my town who specializes in digestive disease. I asked the perky girl who answered the phone if they had a problem doing unsedated colonoscopies. I was expecting the runaround, obfuscation, shock, dismay or platitudes. What I got was "of course we do unsedated colonoscopies." She went on "lots of doctors (did you get that?) have unsedated colonoscopies. I could never do it (unsedated) but we have plenty of people who get their colonoscopy without any sedation. Just tell us when we schedule that you are going with the option of no sedation and we will schedule you with our doctor who does them that way."
There is hope! We don't have to accept Midazolam or die of cancer! Isn't that great? Now to figure out the risks of the bowel cleansing and see if there might be one that won't throw my electrolites out of whack. I'd rather eat vegetable shortening for a week. I wonder if that would work? LOL As you can tell I'm delighted to find that unsedated colonoscopies are perfectly acceptable in my city. Thanks also to my excellent primary care physician who also believes that if I want unsedated, then that's what I'll get.
If anybody wishes to know what city is offering these unsedated colonoscopies, e-mail me at firstname.lastname@example.org and I'll tell you. I don't want them mad at me for putting their name up on an edgy blog like this, even though it's favorable. For my many friends from this blog (you know who you are) you can fly in, I'll pick you up at the airport, take you to the medical center, stay with you if you want and then you can stay at my house until your flight out. It's all within about a 10 mile radius.
P.S. Unsedated means no Propofol either. Just so we are perfectly clear about what NO SEDATION means! I might want a tiny bit of Fentanyl, or not. My choice.
Thursday, December 29, 2011
I have reproduced the article from Dr. Kevin's blog here as well. There are some pertinant statements that I want to point out, so I am going to put those in bold! Any comments I might make as I read through this will be in purple and (parenthesis.) We are starting to be heard by the medical community! Happy reading!
Reduce sedation in critically ill patients
I sit here today, in this small, windowless call room with its low twin bed that is covered in untouched hospital blankets and sheets. Tonight is one of my last nights on a 30-hour call shift in the medical intensive care unit. Yet another mile-marker on this long journey of residency. My day began at the break of dawn, when I and another resident passed each other in the parking lot at 7am – the only souls trudging to our cars at such an ungodly hour on a Sunday morning. But this is the life we chose.
The day passed as many days have passed in the intensive care unit – extubating one patient, intubating another, placing one or two central lines, and being present with families in a time of crisis and even in the face of death. It is a charged atmosphere. At one point, our hospital raised the Donate Life flag in honor of a young gentleman who had died and donated his organs to patients in need across the country. At another point, we gathered round in a patient’s room with family and chaplain to offer the only piece of caring we still could offer her – empathy, compassion, and prayers.
The families and patients in this unit have reminded me, over the past few weeks, of the primary reason I chose to become a doctor: to care for my patients. Patients roll into this unit on stretchers, many with breathing tubes in place, many so confused or sedated that their memories of this visit will merely be a vague sense – blurred brush strokes across canvas, lacking definition or purpose. But perhaps it is better that they do not remember – it serves as a survival mechanism, if they ever make it out of here.
(Here is where the medical people take a detour. It is NOT better to have amnesia. Patient after patient is telling the workers this. Why are we having so much trouble convincing these medical people that WE KNOW WHAT'S BEST FOR OURSELVES and it isn't Versed? Medical workers can't help but be aware that their precious Versed is causing sever problems and even death in people. Why would they smugly claim that it's for the patients' when it really is all about the ease of staff? It's not like there is any shortage of medical personnel in these places! They are NOT being worked to death, so why the sedation?)
All too soon, however, reality will hit. Some of these patients will be paralyzed for the rest of their lives. Others will never be able to eat or lie flat again, because they are at such a high risk for aspiration . Still others may never speak again because of malignant masses occluding their vocal cords. Hard to imagine, really, but it happens here every day.
Even with these tragedies, though, some patients will make it out of the ICU in good health, at least in a medical sense. But even they must struggle to overcome the effects of their prolonged hospital stay – weakness, anxiety, fear. Many of them will need rehabilitation, both mental and physical, for extended periods of time.
In an attempt to prevent this, there is a new movement in critical care units to sedate patients less, to exercise them more, and to allow them to return functioning, mobilizing human beings as quickly as possible and even in the setting of the grave illnesses which brought them here. An article in the New York Times published in 2009, Get Patients Up, introduces some of the new and relatively radical approaches that physicians are using at Johns Hopkins, including mobilizing patients on ventilators. The idea is to allow patients to maintain their strength, to minimize muscle wasting, and to prevent long-term neuromuscular weakness that ultimately requires patients to participate in months of physical therapy to return to their baseline.
An article from Vanderbilt University in Chest describes an “ABCDE bundle” which is a strategy to minimize delirium and weakness in critically ill patients. It includes awakening patients daily, allowing them to breathe on their own without ventilator assistance for brief periods every day, coordinating their breathing and awakening, closely monitoring their delirium using consistent guidelines, mobilizing them early, and initiating physical and cognitive therapy. The goal of this bundle approach is to reduce the devastating effects of delirium and weakness which patients commonly struggle with after their ICU stays.
Although these ideas push the bounds of conventional ICU medicine, which include deep sedation and bed rest, they mark the beginning of a new and perhaps even more humane approach to care for the critically ill. Even more interestingly, these new techniques recall the age-old wisdom of Hippocrates. Primum non nocere. First, do no harm.By sedating patients with high doses of medications to treat their pain and agitation, by paralyzing patients to minimize the use of their respiratory muscles, and by restraining them to strict bed rest, we are in some cases harming them more than we are helping them. So let us take a fresh look at critical care medicine and remind ourselves that, at least for some of our patients, less is more.
(I can't tell you how happy I am that the grave disservice of "sedating" patients with drugs which cause delirium and a host of other complaints is hopefully going to be phased out. I have opined that trying to give people amnesia, preventing them from having their needs met by drugging them into immobility is cruel and unusual punishment. Thank about it! A person is trapped inside that body and they may or may not have amnesia. They are living through every single minute of the pain and torture. Whether they remember later or not is still not an excuse to subject us to this kind of treatment. Destroying people's brains and causing possible life long mental problems for the sake of staff convenience is not only an affront to human dignity, it's against the law! The sheer boredom of being forced to lie in a bed with only the sounds of the room for hour after hour is enough to make anybody crazy to start with. With Versed you are CONSCIOUS of all of this the whole time! How nasty is that? No wonder we have people with POCD and PTSD after hospital interventions! Thank God that the medical profession is starting to take notice of this... Less IS more! The anonymous author of this piece is absolutely correct!)
This anonymous medical resident blogs at A Medical Resident’s Journey.
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Wednesday, December 21, 2011
Tuesday, December 20, 2011
anonymous has left a new comment on the post "Introduction":
I spent the last hour or so reading the posts starting from the very beginning. I stopped half-way through 2007 when I realized that I could not finish the whole thing in one sitting. But the little that I did read has reinforced what I believe to be true. I want to briefly report my wife's experience. She had a colonoscopy two weeks ago and was given 7 mg of Versed and 125 ug of fentanyl. Prior to the surgery, she was an active, intelligent, independent, strong-willed, and outgoing mother and wife. You name any positive human attribute and I know that it could be applied to my wife. However, in the two weeks since the surgery, she has been an absolute basketcase. She is prone to daily panic attacks, mood swings, and cannot perform simple day-to-day tasks. Never has she behaved like this, and I have know her for 28 years. I am a medical professional and have read a good deal of the scientific and anecdotal literature on Versed. I understand the neurochemisty of the drug at the molecular level and how it can alter brain functioning. Indeed, it is this basic scientific understanding that helps me to cope with my wife and provide her the emotional support she needs. I also understand that Versed only impacts a small proportion of the population who use it. However, for those whom it does impact, the effects can be terrifying. My wife and I are getting through this one day a time. We have resources such as family and friends who will get us through this. However, I did want to post my thoughts to relieve some of my own anxiety and also to reassure others who have similar symptoms that they are not "crazy" and are certainly are not alone. Thank you.
This is not a crazy person! This person correctly identifies Versed as the culprit in the decimation of his wife's mental health. It is absolutely unbelievable that a drug like this is used so indiscriminately in the medical field. It galls me that medical "professionals" continue to deny that this poison has side effects and in particular, these side effects as described by the above poster! This attitude amongst those who have knowledge of the myriad side effects of a whole host of drugs causes them to deride us because we report that Versed is unsafe.
Anybody who watches the minimum of television will see all kinds of drugs advertised. Each of these drugs has a list of side effects which almost always include mental problems occurring as a result of using the drug. Do medical people find it amusing that drugs touted as alleviating depression and such are also implicated in WORSE mental disorders than the problem they are meant to treat? Doesn't it follow that an "anti anxiety" drug such as Versed could CAUSE the very thing that it is allegedly used to "treat?" Any drug like Versed with such SEVERE AND PROFOUND EFFECTS ON THE BRAIN can absolutely cause problems. To deny this can happen from Versed injections, is a mental disorder of the highest magnitude. Only a mentally compromised moron would deny the horrible side effects of Versed!
Having some anxiety about medical people and their job of cutting you open or some other intrusive and painful procedure is NORMAL! Why are these same highly educated medical people deciding that normal and justifiable anxiety is a mental disorder that must be "medicated" with a monstrous drug such as Versed is beyond me.
I'll make a bet with you! If you go in for surgery and DO NOT exhibit any anxiety at all, I bet that your medical employees will write something in your chart about your "affect." If they don't remark on your lack of affect, then they will still ROUTINELY WRITE "ANXIETY" ON YOUR CHART! If you are not anxious, you are "crazy" and if you are anxious, (perfectly normal) then you need Versed intervention. You can't win with these people. They could care less about people such as the above poster's wife who react badly to their drug of choice. Medical people are wrapped in a cocoon with others of their ilk and will not or cannot relate to anything or anybody other than themselves. (Nor will they tolerate ANY criticism whatsoever! Not for themselves and not for their precious Versed.)
Tuesday, December 13, 2011
Suppose that I irradiate my perfectly normal breasts for a screening procedure, even though I have no problems and nobody on either side of my family has ever had breast cancer. Does this sound like a plan? The very performance of this test could cause problems/changes in delicate breast tissue can't it? There is no use telling me that the amount of radiation is negligible. I have read all the studies. There is a lack of due diligence being used to ensure that the machine doing the irradiating is within boundaries isn't there? My feeling is that I should not be taking risks with my health for no apparent reason.
The next problem, and this goes for both the mammogram and the pap smear, is what then shall I do if there is some minor problem detected? It would be minor as I am asymptomatic. Nobody in my family on either side has experienced any kind of cancer... Won't the medical workers want to continue with more intrusive tests? Biopsies and exploratory surgery etc. (keep in mind that nearly EVERYTHING is "pre-cancerous") Won't that involve a (heated) debate about that brain poison Versed? You bet it will. You can't have a biopsy or surgery without an IV. Once the IV line is established, who can GUARANTEE that I won't be injected with "Vitamin V" again? Nobody can. Given the vitriol from health care workers that I have experienced by suggesting that Versed can be a very bad drug for lots of people, why would anybody in the medical field listen to me? Hell they might want to deliberately shoot me up with it to show me who is boss. It happened before, it can happen again. It happened to my sister too.
On to colonoscopy. It may surprise some people that Versed itself is causing major problems in re colonoscopy. I personally speak to many, MANY people who have been sedated for colonoscopy who are experiencing severe and long lasting mental problems subsequent to the Versed injection. The problem starts with devious medical people, intent on doing as little patient care as is humanly possible, who either LIE about the effects of Versed as in "something to RELAX you" or they simply don't mention this nasty little drug at all. (Screw patient rights law!) Too late once they get it into your veins. There's horror story after horror story pertaining to this all over the web. I have collected a lot of them here on this very blog. People are being tortured all over this country by having Versed slammed into their brain and the ASSUMPTION by medical people that a) it's fine to subject patients to torture, and b) it doesn't matter because they fried your synapses with Versed. What's left out is the 10% that don't get amnesia. What about them? The prevailing attitude from our sympathetic (cough) health care workers is "Too damn bad for you!" Not to mention the perforation issue which is ameliorated by omitting the "sedation" for colonoscopies.
There's also another issue with colonoscopy that nobody seems to talk about and that's the prep itself. You are subjecting your body to extreme stress and distress by using the bowel cleansing regimen. My body isn't giving me any trouble at all. Why would I deliberately set out to throw it all off balance with the "bowel cleansing?" So I have to risk sending my system off kilter, frying my brain again, perforations etc. for a test that isn't medically indicated? This can't be real.
So now I'm in a quandary. I truly do not want to defy my doctor! I really like him. I selected him with deliberation and am pleased with my choice. I don't want him to dismiss me as a patient, but I'm totally unwilling to risk my mental and physical health when there is no underlying reason to do these tests. (no lumps, bumps, blood, pain or family history, everything working as it should) Medical checkups shouldn't involve this kind of anxiety...