U\It looks like my brother, Dennis C5/6, may have to have a colonscopy. He has had terrible AD with almost every bowel movement for the past two weeks. he had an impaction, that may not be gone.
He will see a GI r. tomorrow I think. What are the factors with someone with SCI during and after the procedure? He also have Leiden Factor 5 and is on 10mg of Coumadin per day.
02-16-2004, 08:40 PM
He may have to stop the anticoagulant prior to the coloscopy. This would be up to the GI physician.
Are you sure they are considering a coloscopy? If a fissure is the working diagnosis, then only a sigmoidoscopy is needed for this. This is much less of a prep, and much less of a procedure, although it can still cause AD. We use lidocaine jelly 2% as the lubricant for the sigmoidoscope, and monitor the patient constantly for blood pressure and AD symptoms. Anesthesia is usually not used for this test.
Coloscopy requires a full bowel clean out prior to the procedure. If he has an impaction, this test will have to be delayed until this is accomplished, usually with something like Golytely or oral Fleets. The prep is usually the worst part of this test, as it requires nothing but certain liquids by mouth for 24 hours, and the stool incontinence caused by the prep is a major problem at home. We try to admit our SCI patients for a 23 hour stay for this test. They come in the day before, have their prep in the hospital, stay overnight, and then go home the next day immediately after recovery from the test.
The test itself can cause major autonomic dysreflexia, so it is critical that the physician be very familiar with this condition, and know how to treat it if it should occur. Blood pressure monitoring should be constant during the procedure, and nifedipine or other fast acting ganglionic blocker must be available. Anesthesia (conscious sedation) is usually used for this, so the person is unable to report any symptoms during the test. The diagnosis of AD must be made completely by signs (high blood pressure, flushing of skin above the injury, sweating above the injury, etc.) without being able to rely on any reported symptoms by the patient.
I would delay either of these tests unless the physician is very experienced with handling SCI patients and their AD during these procedures, and either find a physician who is, or have this physician learn about AD from reading or speaking with an experienced SCI physician.
02-21-2004, 02:23 AM
I was amazed when my local county hospital did my colonoscopy KLD. I talked insurance into the overnight stay since I didn't have home health care and the AD thing. I was also given IV fluids during the "clean out" which may have helped with getting the overnight. But before I went into the OR room for the procedure the head of anesthiology stopped by with the 2 OR techs. She asked about any preferences in sedation and I explained why I vetoed an epidural immediately. She asked several questions about my history of AD and my average, high and low blood pressures that I remembered. She then went on to explain that if my BP went too high she would come in (otherwise the anestheology RN would handle it) and take me all the way under and I would wake up in the ICU. I had chosen twilight sedation for my procedure. She was the first doc I have met outside of rehab and neurology that didn't need me to explain what AD is. Said not to worry and the ICU would be precautionary until my BP was stable and then I'd go home just like normal although probably an hour or 2 later. The OR RN asked me about my idea of what high BP was for me too. When I told her mine was normally 90/60 but once hit 125/70 or so when I sprained my ankle so badly she said she'd call the doc in if I hit 130 over anything. I didn't have an impaction though to deal with just pain in my lower left side.
Now whether the gastroenterologist had a clue as to what AD was I don't know.
Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow."