Outpatient colonoscopy

[frankva]

My pcp wants me to have a fun giant dildo colonoscopy since I have now hit the big 50. So, I went to the local outpatient facility for a consult. The gi doc says that most hiv patients, including me, have to go to the hospital and use an anethesthesiologist & surgery room because of medication interactions w/ the standard outpatient sedative. I ain't too happy about this because the outpatient facility is about a 1500 cost whereas the hospital/anethesiologist procedure will be several thousand. My co-pays will be substantially more. Also it's a lot more of a headache to go to the huge hospital. Does anyone know about this? MY meds are crixivan, viread and epivir.

[pozniceguy]

I had it done as outpatient in Dr's well equipped office...nothing was said about meds   problems..Dr knew about HIV  since that was part of reason I was referred to him...now go back every two yrs...next one coming up in Oct...

[Matty the Damned]

Hey Frank,

I recently had a general anesthetic and yes they can interact with HIV medications. Particularly atazanavir (Reyetaz), but also others perhaps. You could try our nifty drug interaction tool but I suspect you need to know the name of the specific anesthetic(s) being used.

My feeling would be that if the medicos say you're going to need an inpatient anesthetic because of your meds, then the outpatient form of colonoscopy is not a goer in your case.

Best regards,

MtD

[thunter34]

i still think it is probably a good idea to suck it up about the copay and have the test done.

[penguin]

frankva -

the sedatives usually used for this procedure in an outpatient setting (things like versed & halcion) can have quite a serious interaction with PI's and sustiva. the blood levels of the sedative are raised and the rate at which they are cleared decreased, which makes heavier sedation/respiratory depression etc more likely

if you're having concerns, could you discuss this more with your consultant, or ask to speak with one of the anaesthetists?

kate

[whizzer]

Versed, which is commonly used as the sedative/hypnotic drug during conscious sedation procedures, is metabolized by the cytochrome P-450 system in the liver.  Norvir is a P-450 inhibitor.  This makes it much easier to overdose a patient on Versed (and Halcion, among others).  So it all depends on your GI doc doing the procedure.  If he's not comfortable sedating you, then he's going to want an anesthesiologist to do it.   And that usually means the hospital, at greater cost, and with the anesthesiologist's fee on top of everything else.

[AlanBama]

I've had four in total, I believe.   Prep for the last two was the same:  drink one bottle of Fleet's phospho soda, beginning the afternoon before the day of your procedure.    In previous ones, I have been required to do more 'extensive' prep.   I once had an upper and lower G.I. (with barium enemas) series, as well as an endoscopy and colonoscopy.   They had me go on a liquid diet three days before (broth, popsicles, hard candy, water, gatorade [but not red or purple])

As soon as I was strong enough to walk to the car, I made my friend drive me to the nearest Steak and Ale.......never felt so 'empty' in my life.

My last two, in 2002 and 2005 were done in this small town hospital, as an outpatient, but I was put competely under, which is the way I prefer it   The little cute nurse says "sir don't you want to watch it on the screen?   Hell no, I have to see what comes out of that factory each day....I have no desire to see the 'works' of it)

[dbmathews]

I had an outpatient colonoscopy done earlier this summer due to a positive result of an anal pap smear.  My doctor (surgeon) is completely aware of my HIV status and the meds I am on, and I heard nothing about any interaction or concern regarding meds.  His only issue was my CD4 count which is still wonderful (knocking on wood).

Just checked my pulse and confirmed I do have a pulse and am still here...  not a ghost writer. 

Don't you just love to hear about risks and issues...  after the fact!!!  I have to go through this once a year now so hopefully I will remember to ask this question next summer.

Take care and big hugs folks.

[Lou-ah-vull]

I had my colonoscopy this year also and ran into this issue.  At the time i was on Atripla and there is definitely a problem with Atripla and either versed or halcion.  I had trouble getting the outpatient staff to understand that I was unwilling to use either sedative.  So, it was general anesthesia for me.  As it turned out, general was much better for my system.  There were no lingering after-effects (God knows you already get that in spades from the sustiva.)  In my case with my insurance, I only was out the co-insurance and co-pay for the anesthesia (about $100 after all was said and done.)  Well worth it to avoid the risk of versed or halcion.

Gary

[boylikertampa]

Since becoming positive 7 yrs ago, I have had 2 colonoscopies and will have another one soon.  All were outpatient.  My GI doctor (I have Crohn's also) wants me to have one every 2 yrs or so since I had a cancerous tumor in my sweat glands a few yrs ago -- I'm glad he wants to continue to look for cancer.  No mention of problems with meds.