Help me relax about my sigmoidoscopy

January 11, 2009 8:15 AM

Help me relax about my medical procedure (sigmoidoscopy)

I'm scheduled for a flexible sigmoidoscopy early this week. And I'm starting to stress out.

This is the **fourth time** I've had one. I am not stressed out over the unknown.

However, the first time I ever had one, my Crohn's Disease was really causing a ton of problems and the flexible sigmoidoscopy hurt like I couldn't believe. (Inflating my already very inflamed instestinal tract and inserting tubs into my very hurty bottom was really a bad idea.) The prep and the scope were awful, awful, awful. And the GI and nurse were awful. I changed GIs.

Enter my current GI. He is kind, sweet and one of the best in the country. When he did my next two sigmoidoscopies, he sedated me, because he was concerned that my first experience had scarred me for life. (He said it sounded terribly cruel to go without sedation, given my physical state.)

But that was a few years ago. Now I need another sigmoidoscopy. Because I am breastfeeding and my bottom is not in shreds, my GI prefers that we go without sedation (as is the norm). And I agreed.

But that was a few days ago. Now I'm starting to freak out a bit. I am trying not to focus on it and I know it will only be five minutes or so. I've given birth twice, suffered from Crohn's, had a terrible abscess, gone through life traumas...and had minor procedures like colonoscopies (with sedation!) and several surgeries...I can handle this. I don't want to waste Canadian health care dollars. I don't want to have to pump and dump for my baby. And I want to be alert for my kids and get on with my day.

But I'm worried that I'm going to knot up over fears about what happened the very first time. In fact, when I think about the procedure, I worry that it might be like that again or that I'll be stressed and get myself into a state where it will be like that, simply due to anxiety.

What can I do to relax about this?

(Note: this is happening in a couple of days. I can't go see a therapist before then and I'm not quite THAT freaked out or I would have called my GI and begged for sedation. I just want to relax so that I don't actually cause myself pain from stress during the procedure. And, yes, I will be telling the nurse how I'm feeling.)

posted by anonymous to health & fitness (11 comments total)

Have you considered asking the GI for Valium or a drug like it? Then you wouldn't be sedated, per se, but you would also be a lot calmer. I had a dentist who prescribed Valium like candy for patients to take before they were sedated. I would think it would help even if the sedation wasn't going to happen. Of course, I have no idea how that would affect breastfeeding.
posted by aetg at 8:30 AM on January 11

But I'm worried that I'm going to knot up over fears about what happened the very first time.

You're worried that you'll worry? That seems a bit...unhelpful. Try your best to keep distracted until the day of. Bake some cookies, wash the car, do some pre-spring-cleaning cleaning, do some goofy baby stuff. Just try not to think about you-know-what. And try not to think about not thinking about it. Just keep your mind occupied with other things. Anything where you have to read and follow instructions works best.

You know it's going to suck. But it's the same awful procedure with a better doctor, right? And now you know what to expect, so there won't be the element of surprise compounding the pain. And if you're in better condition, that'll help too. It all adds up to a better (or at least not quite as terrible) experience.

Dread it, sure. But don't worry. It's going to happen, it's going to suck (but not as much), and that's that. Worrying helps nothing. DISTRACTION IS YOUR FRIEND. Keep busy.
posted by Sys Rq at 8:50 AM on January 11

Check out Dr. Hale on fentanyl and versed. Dr. Hale is the author of the book Medications and Mother's Milk, which is the definitive reference on breastfeeding and pharmacology. Looking inside that book, I see fentanyl is lactation risk category L2, which is pretty low risk. I would refer your doc to this source and ask for sedation. Hale is the expert in this field.
posted by crazycanuck at 8:56 AM on January 11

PS, looked up alprazolam (Xanax) which I am prescribed for dental hysteria. Lactation category L3. "The benzodiazepine family, as a rule, are not ideal for breastfeeding mothers due to relatively long half-lives and the development of dependence. However, it is apparent that the shorter acting benzodiazepines [ed: Xanax has shorter half-life than Valium, IIRC] are safest to use during lactation provided their use is short-term or intermittent, low dose, and after the first week of life."

I would say then that Xanax pre-procedure might also be a good option.
posted by crazycanuck at 9:06 AM on January 11

I was diagnosed with cervical cancer last year and had a handful of unpleasant and moderately invasive procedures/tests. To my surprise I found that breathing deeply and focusing on the in/out of my breath really helped. Before I had this experience I would have thought that "focus on your breath" was a bunch of hippie bullshit, but it really was astonishing how relaxed and calm I could be, even with a doctor using a low-voltage wire to remove abnormal cells in my Lady Business.

It might also help if there is a nurse or attendant who can hold your hand. It sounds a little silly but being able to squeeze someone's hand can be a great comfort.

Good luck!
posted by kate blank at 9:12 AM on January 11

Useful: Dr Jack Newman on drugs and breastfeeding, Lactmed, and Motherisk. The latter are very nice over the phone and can advise your doctors as well.
posted by kmennie at 9:36 AM on January 11

Schedule something interesting/exciting/distracting to happen soon after the procedure. Try to focus on that event after the procedure to remind yourself that even if it hurts like hell during the procedure, it will be over soon, then you can get on with life. Maybe that's weak tea for the kind of anxiety you're experiencing, but it might help.
posted by Salvor Hardin at 10:24 AM on January 11

Why don't you use a breast pump, store some breastmilk, and get sedated?
posted by KokuRyu at 11:36 AM on January 11

How old is your child? I was given Halcion (Triazolam) when I was getting a lot of dental work done (conscious sedation is a wonderful, wonderful thing.) According to LactMed, "Triazolam has a relatively short half-life, so occasional use while breastfeeding an older infant should pose little risk to the infant, but monitor the infant for excessive drowsiness." Wouldn't hurt to ask you GI.
posted by cgg at 2:53 PM on January 11

I second storing some milk, just in case. Call your doctor tomorrow morning, and explain how stressed you are. You may end up with meds, more reassurance, or some other thing that your doc may suggest.
posted by theora55 at 3:23 PM on January 11

Having endured probably a dozen flex sigmoidoscopies, most with no sedation, I have a few tricks:
- if the prep is too harsh for you, just do what you can and don't worry about completing it all. Sometimes I just fasted instead, and they never had any problems seeing what they needed to see
- immerse yourself in a novel beforehand so you can focus on the plot instead of your anxiety. Keep reading for as long as possible - right into the examining room.
- it'll be over FAST. Seriously, they say it'll take five minutes, it usually was much less.
- focus on your breathing, or my favourite go to ritual: counting up by sevens.
- bargain with yourself: if you feel you can't stand the pain any longer, tell yourself you'll insist they stop, but after you first count to seven. Hopefully they'll be done, or the pain will lessen before you get there.
- think about the delicious foods you will eat afterward
posted by raxast at 7:54 PM on January 11