Wellness

[depglass]

I've had a pacemaker since I was 37.  My last colonoscopy was inpatient and anesthetized.  But I didn't have to stay over.  The only thing I've ever stayed over for was a knee replacement.  Quite frankly its only been lately they've mentioned the pacemaker as a reason for inpatient.  No problem with Medicare or Sup. Ins.

[bellarosa1]

The issue actually is the pacemaker not the anticoagulant. Most outpatient endoscopy centers are not equipped with the proper equipment if the pacemaker should malfunction. As anesthesia providers we “class “ patients based on their medical history.
PS (physical status) 1 is a perfectly healthy individual. PS 2 could be a smoker, or mild hypertension( treated) or diabetes. These are only examples. PS 3 could be a BMI over 40, more severe COPD, kidney disease. You get the picture. Free standing outpatient centers cannot do some PS 3 or higher for accreditation.. Plus it is at the discretion of the anesthesia providers based on the patient’s history whether anesthesia can be safely given as there is no backup like in a hospital. Our backup is calling 911 to be taken to a hospital.

Also saw this comment as well. Most polyps earn a colonoscopy every 3 years. Depends on diagnosis hyperplastic may be the exception but benign polyps have the capacity to became cancerous.

[hckynutjohn]

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@bellarosa1 wrote:
The issue actually is the pacemaker not the anticoagulant. Most outpatient endoscopy centers are not equipped with the proper equipment if the pacemaker should malfunction. As anesthesia providers we “class “ patients based on their medical history.
PS (physical status) 1 is a perfectly healthy individual. PS 2 could be a smoker, or mild hypertension( treated) or diabetes. These are only examples. PS 3 could be a BMI over 40, more severe COPD, kidney disease. You get the picture. Free standing outpatient centers cannot do some PS 3 or higher for accreditation.. Plus it is at the discretion of the anesthesia providers based on the patient’s history whether anesthesia can be safely given as there is no backup like in a hospital. Our backup is calling 911 to be taken to a hospital.

Also saw this comment as well. Most polyps earn a colonoscopy every 3 years. Depends on diagnosis hyperplastic may be the exception but benign polyps have the capacity to became cancerous.

@bellarosa1 

Not much, if anything, I agree with in your post. I do not have a pacemaker, but have experienced PE on 2 different occasions, and have had a 12.9/ 13.0 INR reading. From reading your post, you understand what that number means.

I have had more Colonoscopies than most 10 people my age. Throw in my 1 upper and 4 lower Double  Balloon Enteroscopies! I have had twice as many Endoscopies as Colonoscopies. Lots of experience with these procedures.

My nephew is also an Anesthesiologist, so I am pretty familiar with what type of anesthesia is used for which procedures.

In my opinion, any Gastroenterologist,  that does a Colonoscopy outside a hospital, on a patient that is on a blood thinner like Coumadin/Warfarin or Plavix? They are running an unnecessary risk on their patient.

I can't comment on your "P" listings, because I know nothing about them. I am familiar with BMI and COPD. BMI is nothing but a better guess at ones body composition. COPD? I attended 12 Pulmonary Rehab Classes after my Aspiration Pneumonia during my 1st heart attack.

As far as an Anesthesiologist knowing a patient's full medical history? Some are not even sure which patients they will be monitoring until maybe 20 minutes before the procedure. No way they would know my history in that short amount of time.

In my most recent procedure, a Heart Catheterization, my Anesthesiologist didn't even know the location my Cardiologist was going to enter my Arteries. The doctor decided while I was lying on the table waiting to get it done.

hckynut(john)🥅🏒 🇺🇸

[AuntG]

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@bellarosa1 wrote:
The issue actually is the pacemaker not the anticoagulant. Most outpatient endoscopy centers are not equipped with the proper equipment if the pacemaker should malfunction. As anesthesia providers we “class “ patients based on their medical history.
PS (physical status) 1 is a perfectly healthy individual. PS 2 could be a smoker, or mild hypertension( treated) or diabetes. These are only examples. PS 3 could be a BMI over 40, more severe COPD, kidney disease. You get the picture. Free standing outpatient centers cannot do some PS 3 or higher for accreditation.. Plus it is at the discretion of the anesthesia providers based on the patient’s history whether anesthesia can be safely given as there is no backup like in a hospital. Our backup is calling 911 to be taken to a hospital.

Also saw this comment as well. Most polyps earn a colonoscopy every 3 years. Depends on diagnosis hyperplastic may be the exception but benign polyps have the capacity to became cancerous.

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Very informational @bellarosa1 . I don't understand why the previous poster is disagreeing since you are stating how the process is handled in your profession. 

[hckynutjohn]

@AuntG 

Are you referencing me as the previous poster? If so, what is it you don't understand? I would be more than happy to clarify everything I said. 

hckynut 🇺🇸

[bellarosa1]

John…. a couple of points to your response. I was generalizing about the anticoagulants. Most not all of the patients we see are on them because they have atrial fibrillation. They see their cardiologist and they tell the patients when to restart and the doses etc. All patients on anticoagulants have blood work in the morning. Your personal history is much different. That’s why we treat every patient as an individual.
I respect your opinion and understand you know a lot about medical issues but you are not an anesthesia provider and are not aware of everything we do. I don’t tell my husband many of the things we do so I’m sure your nephew doesn’t share everything as well. Everything we do is for the patients safety. Yes, I might not know the patient until a few minutes before but someone probably has either seen them or reviewed their history. In an endoscopy center, we have lists of the patients with a basic history and physical and flag patients that may not be candidates and follow up.
There are many issues that are more important to us (anesthesia) and not anyone else. Airway is of utmost importance and that’s where the BMI comes into consideration. Many people with increased weight may have difficult airways which is why there are cutoffs in free standings centers. No, we do not intubate normally in an endo center but if we have airway issues it is always a possibility.
There’s more but I’ll just say we may have concerns that are not obvious to the general population.

[hckynutjohn]

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@bellarosa1 wrote:
John…. a couple of points to your response. I was generalizing about the anticoagulants. Most not all of the patients we see are on them because they have atrial fibrillation. They see their cardiologist and they tell the patients when to restart and the doses etc. All patients on anticoagulants have blood work in the morning. Your personal history is much different. That’s why we treat every patient as an individual.
I respect your opinion and understand you know a lot about medical issues but you are not an anesthesia provider and are not aware of everything we do. I don’t tell my husband many of the things we do so I’m sure your nephew doesn’t share everything as well. Everything we do is for the patients safety. Yes, I might not know the patient until a few minutes before but someone probably has either seen them or reviewed their history. In an endoscopy center, we have lists of the patients with a basic history and physical and flag patients that may not be candidates and follow up.
There are many issues that are more important to us (anesthesia) and not anyone else. Airway is of utmost importance and that’s where the BMI comes into consideration. Many people with increased weight may have difficult airways which is why there are cutoffs in free standings centers. No, we do not intubate normally in an endo center but if we have airway issues it is always a possibility.
There’s more but I’ll just say we may have concerns that are not obvious to the general population.

bellarosa1,

I must have missed your post mentioning that you are a Doctor and Anesthesiologist. 

As far as blood thinners(anticoagulants), in my many weeks on the Heart Floor with only heart patients and 72 Cardiac Rehabilitation Sessions! Most of the patients, that I spoke with that were on blood thinners, were not because of Afib. 

They were on them post open heart surgery, and most were never diagnosed with either Afib or Vfib. Their Cardiologists wanted them on thinners for at least 6 months post surgery. For those like myself, with CHF, their thinner regimens varied.

As far as BMI? While I have done Submersion Body Composition Tests several times, there has never been any of my many doctors even mention my BMI. I would think an Anesthesiologist would be more concerned with a patient diagnosed with Sleep Apnea, than an arbitrary body composition guess like a BMI.

Anyways. 

hckynut(john)🥅🏒 🇺🇸

[bellarosa1]

John… you are a special man with a special set of ailments. The people you talked to on the heart floor have specific issues. I was being more general as in the patient who comes to a hospital or endo who happens to be on anticoagulants for past history of DVT or AF and won’t see a heart floor. You and your friends on the heart floor have very specific needs.

I appreciate you telling me how to give anesthesia and what my concerns should be. However, if I had listened to you, I would have failed my boards. As I said earlier, anesthesia providers have concerns that other specialties other than maybe ENT surgeons or critical care. Yes, obstructive sleep apnea is a big concern. The larger concern is being able to put a breathing tube in someone with speed and ease. The larger the person is, the faster their oxygen saturation goes down so speed is important. People with high BMI’s often have very large necks with lots of extra tissue making intubation challenging. The only medical providers that usually care about this are the ones who intubate on a regular basis. Again anesthesia, ER , ENT and probably critical care. Other doctors/providers call anesthesia if there are airway issues.

No where did I say I was a doctor. I said anesthesia provider which I am a CRNA( certified registered nurse anesthesiologist) and I have been giving anesthesia for about 35 years in all types of settings and procedures. The settings include major teaching hospitals, city / town general hospitals, ambulatory centers and endoscopy centers as well as teaching.

Hope you stay well. When our department needs another chief physician anesthesiologist maybe we can make you an honorary one!

[Trailrun23]

After many phone calls and research, we have figured out that Medicare is what is complicating DH being required to get a colonoscopy done at a hospital rather than a free-standing facility. He has not had his pacer longer than 9 months and is on Eliquis. These are the two criteria that require the hospital setting but Aetna and Medicare will still only pay the customary amount regardless of the setting. His cardiac electrophysiologist ( I finally got the title right) has sent a petition letter saying he must have the procedure in a hospital, it is not his choice, so it should be covered as a hospital procedure, since that is what it will be. We are waiting on a response, but they have changed the date now so far away it isn't even something I expect an answer to anytime soon.  The only bright spot so far is he found out the prep for this now is not the gross liquid you have to choke down....it is 21 pills you take over a period of hours prior to the procedure. The prep is the worst part of the whole thing, so if now you can use pills instead....that is progress indeed! Thanks for all the feedback...it's clear that how things like this are done really varies around different areas of the country.

[bellarosa1]

Thank you for the update. Yes, some things vary depending on what part of the country you’re in. On thing that doesn’t really change is the insurance companies bottom line is money and the lack of concern for their clients health…. unfortunately. People make life and sometimes death decisions that are clueless.
Hope everything works out!!