Sunday, December 28, 2014

Knee Replacement, Versed, and an Enlightened CRNA

My husband had to have a complete knee replacement recently.  He had injured it many years ago and finally it gave out.  That meant surgery.  Surgery that includes the dreaded SEDATION!  Sedation as defined by the medical field, not by normal people.  Naturally I freaked out!  My husband didn't want to remember the surgery and *I* was adamant that he not get Versed.  I reminded him of what he went through after my unqualified DISASTER of an experience with this drug.

I called the surgeon's office and requested an anesthesiologist that I personally have met.  How odd is it that patients can request which surgeon they want, but not the anesthesiologist?  I did not get the anesthesiologist *I* wanted.  My husband was nervous enough without me having one of my tantrums, so I let that one go.  The doctor was from the same group as the one I wanted and I'm pretty sure that she wouldn't have sent a bad one.  (I know this doctor peripherally through horses, so once again horses saved the day)  So we got an anesthesiologist whom we had never met and then got a crna.  I was getting anxious...and *I* wasn't even having surgery!  I just couldn't imagine caring for somebody as out of control as I was after my ORIF.  What if my husband responded like I did?  No way I could take care of him.

The anesthesiologist explained that the crna was NOT all on her own like Aaron, my crna was.  He told us how he would be doing the nerve block and that as soon as my husband was stable and comfortable with Propofol, he would turn the Propofol drip over to the crna.  He stressed that he would be immediately available if a problem arose and that he NEVER left his crna's on their own without oversight, like Aaron was.  He stated that he had no problem taking over from the crna at any time and that he tended to be possessive over his patients.  The crna did not seem in any way annoyed about any of this.  If you have read this blog you know that a lot of crna's have as much disdain for doctors as they do for patients.  This was NOT the case where my husband went.  Our crna was part of the team, not God incarnate.  I know that the two of them saw the glint in my eyes and they were very good about allaying my fears.

The crna is the person I want to talk about.  She was very kind.  When we said "NO VERSED" she was absolutely fine with it.  No argument.  She stated that she herself had been given Versed (she believed the lies?) and had a very bad experience with it.  She stated that she experienced partial amnesia for more than two weeks afterwards.  She had fuzzy mental processes.  Do we want mental agility in our crna's?  Yes.  Do we want the crna's to decide that our own mental processes are not as important as theirs?  No.  Do we want crna's that are so desperate to make their own job easier that they will use a bad drug for that sole purpose?  No.  I'm amazed that we got a crna who was sane.  I've had so many crna's come here and "attack" me for stating the obvious about Versed that it was SHOCKING to get one that absolutely agreed with me.  She not only agreed that Versed was bad, but she kept her promise not to use it.

Apparently we are making progress with crna's.  At least where *I* am at.  It helps that she had firsthand experience with the nasty Versed and hated it.  I still don't get why she allowed it in the first place, but at least it was a learning curve which she extrapolated from and applied to her own patients.  What a great nurse!  SHE didn't decide that Versed was bad for an exalted personage such as herself but just fine for everybody else.  I still can't believe it.

I just wanted to publicly praise one particular crna and the professional way she dealt with me.  (my husband is the opposite of confrontational)  She realized that *I* was an important part of the team as well.  I will allow this woman to be part of any team I may have in the future.  I still want my friend the anesthesiologist, not a substitute, but the crna will be welcomed by me.  The rest of the crna's like Aaron who tried to destroy my life by assaulting me with drugs I had declined and all of them who have posted their rants here, there and everywhere are still on my sh*t list.

There is hope for all of us who have had bad experiences with Versed.  For myself, I would have gone with the nerve block and zero sedation, but for those like my husband who are stressed out by the very idea of monitoring their own surgery, you can get what you need without Versed.

Sunday, December 7, 2014

Anesthesia in the Dental Office

A reader sent this to me and I have reproduced it here with his/her permission.

Today, at age 47, I had all four of my wisdom teeth extracted. The top two were fully erupted, the bottom right one was a partial bony impact and the bottom left one was a full bony impact. By my request, I was given a local anesthetic only, the procedure took about an hour, and was entirely painless. I was able to drive myself to and from the appointment, and treated myself to a movie on my way home before the anesthetic wore off.

From everything I've read or have been told, it is very rare in the United States to have impacted wisdom teeth removed with only a local anesthetic. Apparently, the standard of care is to provide IV sedation (usually Versed) for a procedure that is absolutely painless if the local anesthetic is administered properly. Before finding the dental surgeon who performed the extractions today, I was told by a nurse at a different dental surgeon's office that IV sedation is "better for everyone involved" when impacted teeth are removed. Of course it's better for the provider when an extra $400-$500 can be tacked onto the bill and the patient won't remember a damned thing about what was done, and the patient can't object to his treatment because he "lacks capacity" under sedation. What arrogance to assume sedation is always "best" for the patient! Unless the patient states a desire to not remember the procedure or is so anxious that the procedure can't be done any other way, there is absolutely NO benefit to the patient.

It wouldn't be so upsetting if this was an isolated comment by a very callous nurse. About three weeks ago, I had my teeth cleaned at a clinic at a technical college. At that point, I knew I was going to have my wisdom teeth removed, and informed the hygienist who was supervising the student working on me. She made some comment about making sure I had someone to drive me home and being careful until the sedative wore off, and I told her that I had absolutely no intention of being sedated. The hygienist replied that the pain would be too great for a local anesthetic, and that I would need to have IV sedation. When I told her I knew what Versed was, that it does absolutely nothing to block pain, and that I already scheduled the surgery without sedation, she stared at me wide-eyed and open-mouthed. She mumbled something about the "dental surgeon knowing what was best," and I left. I was so bothered by her comment that I called her the next morning to ask why she lied to me. She completely denied lying about Versed, and said she had told me only that my surgeon would know whether or not the pain could be controlled by a local anesthetic.

When I first read this blog about 6 months ago, I thought many of the entries were over-the-top in painting a picture of a conspiracy among medical and dental providers about dissembling the true purpose and use of Versed. From my own experience with an endoscopy clinic earlier this year and having my wisdom teeth removed today, I convinced that there is at least a culture, if not a conspiracy, around this drug. There is a big difference between being told "this drug will help you relax" and "this drug will cause you to not remember anything that happens to you, although you will be awake." If more patients understood what they were being given, and why, more would refuse Versed. I suppose that some providers can justify the lie if they believe that a number of patients might forgo important procedures if they became anxious about the notion of being given a drug that would allow them to be awake, yet rob them of their memory. And it may be true that some patients would not be treated, it is not up to a provider, or up to ANYONE, to decide what is right for a patient, except the patient!

I've also learned that there ARE providers who will work with you and respect your wishes about not being administered Versed (or Propofol, or other amnestics.) If this is what you want, just be firm and state your intentions clearly. Someone who thinks they know what's best for you, regardless of your wishes, is probably not someone you want providing your care. Be patient, and find the right provider. He or she is out there!