Pain during laryngoscopy
November 18, 2009 7:18 PM   Subscribe

Did my doctor miss a crucial step or am I just a wuss?

Today I went to my primary care physician. I've been waking up choking lately, and besides just generally be terrifying, it's causing me to lose a lot of sleep. My doctor suspected GERD, but he wanted to be sure, so he sent me to an ENT, who was willing to see me the same afternoon.

I made an appointment for 2:00. I waiting in the exam room for about 45 minutes, and was just about to leave when he came in. He seemed like a nice enough guy. He told me he would be inserting a scope up my nose and down my throat to take a look. He said it might "tickle". Then he proceeded, and it was one of the most painful things I've ever felt. I started crying. He pulled it out and said he needed to do it one more time while I was lying down. Just as bad.

So I was telling this to my husband, who has had this procedure before, and he said, "He didn't give you a numbing spray!?!" So... is the anesthesia considered optional by most doctors? I generally have a high tolerance for pain.
posted by Evangeline to Health & Fitness (28 answers total) 2 users marked this as a favorite
I can only speak from my own experience, but when I had that done I got the numbing spray.
posted by amro at 7:19 PM on November 18, 2009

I've had this done several times by two different doctors. Both used numbing spray.
posted by kimdog at 7:25 PM on November 18, 2009

I've had it both ways from the same ENT no less. I didn't find it super painful the time without, but it was quite uncomfortable and I told him that next time we were using the spray.
posted by canine epigram at 7:28 PM on November 18, 2009

Um, I do this a lot. Two different sprays, the end result is numbness. If he's just looking at my sinuses, he can do it pretty much right away. If he's looking all the way into my tonsil/throat, he lets it drip and we wait a while.

I find it unpleasant anyway, but with no anesthetic...ick. I'm sorry you had to go through that. I definitely wouldn't see him again.

Even if he just forgot, what's he going to forget next time? Forget to clean something? Re-use a tongue depressor?

If your doctor thinks you have GERD bad enough to be choking, you need to see a good gastroenterologist ASAP. They will probably do tests to see what the problem is and check for esophageal and stomach damage.
posted by kathrineg at 7:31 PM on November 18, 2009

I've had it both ways by the same doctor. First with, then without, then with from there on as I insisted.
posted by Pollomacho at 7:32 PM on November 18, 2009

Also...did your doctor send you to the ENT to diagnose GERD, or to rule out something else?
posted by kathrineg at 7:33 PM on November 18, 2009

I've had it with the same warning and with no numbing spray or anything. Fairly unpleasant, for sure.
posted by sulaine at 7:34 PM on November 18, 2009

You know, I misspoke when I said "GERD". My doctor didn't leap to that conclusion. He did think it was probably acid reflux, but that's not necessarily the same, is it? I've also been regurgitating bile into my mouth. No heartburn though, strangely.

During an upper endoscopy several years ago, a different doctor discovered I had a hiatal hernia. It wasn't giving me any symptoms at the time, but he said there was a good chance I'd have problems with acid reflux later.
posted by Evangeline at 7:38 PM on November 18, 2009

Is it possible your ENT thought that a nurse had administered a numbing spray while you waited? (I mean, obviously he should have double checked--especially once you started crying--but that was the first thing I thought of.)
posted by Meg_Murry at 7:49 PM on November 18, 2009

I just had this done recently (twice actually), and there was numbing spray both times, but I felt like there wasn't enough or the doc didn't give it enough time to take effect. It was fairly unpleasant. Not excruciating, but definitely uncomfortable and with some pain. That said, I can't imagine a doctor not using any type of anesthetic at all. So sorry that happened to you.
posted by katemcd at 7:53 PM on November 18, 2009

I've had this done twice. The first time, like you, I had one of the most horribly painful experiences of my life (I honestly can't remember whether a spray was used, because I didn't know what to expect and have blanked the whole thing out, but either it wasn't used or it was misapplied). The second time, a different doctor used a spray, and I was shaking with apprehension, because of the last time, but then never felt a thing. "When are you going to put it all the way down?" I asked the doctor, who considered this hilarious because he had already done so, and removed it, and was examining the photograph.

It was reflux. I stopped eating big dinners just before going to bed, and started sleeping on three pillows so that my body was on a slope, and it went away.
posted by game warden to the events rhino at 7:55 PM on November 18, 2009

Meg, I don't think that's the case. He listened to my symptoms before doing the scope thing, but then he never left the room. I'd be surprised if he ordered the nurse to administer a numbing spray without even talking to me. Then again...
posted by Evangeline at 8:03 PM on November 18, 2009

It's cool if you're not sure exactly what it is, but any kind of acid problem that leaves you waking up/choking means you probably want to see a gastroenterologist, especially if your insurance will cover it.

A hiatial hernia can definitely give you reflux issues (my father-in-law has one). Even if that's what's going on, you probably need someone to check you again out to see if you have ulcers or any other problems down there, as well as prescribe you meds.

Scare tactic: My partner has had reflux for a while, he left it untreated for a few years because his general practitioner didn't think it was a big deal. Until he had to get emergency surgery because scar tissue had built up in his esophagus and a hunk of food was stuck there. He couldn't eat or drink for a day and a half. A year after that, he had to have another surgery on his esophagus.

Take care of yourself, and no, you're definitely not a wimp. Anytime a doctor does something that makes someone cry (!) he should be aware of that and actively work to comfort and reassure you.
posted by kathrineg at 8:06 PM on November 18, 2009

My airway is very restricted when I lie down, apparently. There are a host of other congenital issues that he thinks are contributing to the problem (wide tongue, huge tonsils, high palate). He thinks that the acid reflux is actually a result of the obstruction, and that when I wake up, I'm waking up because I'm not breathing, and the deep breath I'm taking is actually forcing the acid up. Just poking around the web, it seems that most doctors agree there's a relationship between acid reflux and sleep apnea, but it's kind of a "chicken and egg" debate.
posted by Evangeline at 8:06 PM on November 18, 2009

Thanks guys.
posted by Evangeline at 8:07 PM on November 18, 2009

Lawrence Cohen (on the UES) is my husband's gastroenterologist. First doctor who treated his reflux effectively. Love him.

If you need an ENT, I recommend Steven Sacks. Very kind, very thorough. He's on the UES too.
posted by kathrineg at 8:17 PM on November 18, 2009 [1 favorite]

It hurts a lot to get anything weird into your sinuses. Ever gotten pool water up there? Definitely not fun.

I have had the experience of sleeping (fitfully) with a tube going through my sinuses. I'm pretty sure I wasn't given anything when it was put in, and I remember that it hurt going in, but I kind of got used to it once it was there. It's probably one of those things that varies by doctor, just like some dentists are willing to put you under for everything and some won't give more than Novocaine for anything.

If you get it done again, just ask for the numbing stuff!
posted by that girl at 9:46 PM on November 18, 2009

You might wanna try raising the head of the bed a couple inches, up on bricks or books until this is sorted out- get gravity on your side to keep the refluxate down. Probably can't hurt, but might help?
posted by twistofrhyme at 12:05 AM on November 19, 2009

My husband had this done a few years ago and the doctor didn't use any numbing spray. He hated it, and he's the kind of guy who likes to watch the needles go in.
posted by defreckled at 3:53 AM on November 19, 2009

What I don't understand is why, if numbing spray is an option, a doctor wouldn't just offer it to you. Is there a good reason NOT to use it?
posted by Evangeline at 4:15 AM on November 19, 2009

I wrote in briefly above to describe my several experiences with and without the spray. The spray has its issues too. Namely, it numbs and dries out your sinuses sometimes for several hours. It also prevents you from feeling pain that could signal something wrong with your sinuses, like for instance the scope pressing in the wrong place. The spray also only numbs your sinuses, NOT your throat and it does not stop that gag reflex.

As to why I had the scopes done in the first place, I too have GERD. I also have a hiatal hernia that may have been compounded by the reflux. I was sent to the ENT from my GI because I was also aspirating acid during the night, which was eroding my larnyx. This in turn was causing restricted breathing (due to swelling and irritation) and laryngeal polyps which had to be surgically removed. Again, all of this was due to the GERD. So don't let folks question the necessity for a laryngoscopy in relation to GERD.
posted by Pollomacho at 5:21 AM on November 19, 2009

I have only had scopes done in the hospital when I am knocked out with Versed, and the painkiller is Demerol. I have never had any doc suggest to do it in their office, I suppose I am naive about this, but it sounds horrible.
posted by chocolatetiara at 7:30 AM on November 19, 2009

i have had this done many times, by different docs. they *knew* they were going to scope you before you even got there, and it was the nurse's job to squirt spray up your nose when she brought you back to the room. i've never had the doc do it. (they're too good for that.) so he assumed the nurse did it, and she forgot. or didn't look at the chart, or whatever.

some docs have a better hand with the scope than others.

i don't think the numbing spray is all that helpful, and it just gives me nosebleeds anyway.

it's just one of those things that feels weird and unpleasant but is done in less than 30 seconds.
posted by misanthropicsarah at 9:56 AM on November 19, 2009

it's just one of those things that feels weird and unpleasant but is done in less than 30 seconds.

I gotta tell ya, this was a lot worse than "weird and unpleasant." I expected weird and unpleasant and instead got something that felt like an ice pick going through my sinus cavities. Seriously, I'm a pretty tough gal when it comes to stuff like this. I really had no apprehension at all going in.
posted by Evangeline at 10:12 AM on November 19, 2009

I don't think anyone is casting aspersions, just relating their own experiences.

I'm wondering if these congenital issues you mention upthread made it much more unpleasant than it might have been otherwise. Either way, insist he use spray next time. I'm sorry this happened to you.
posted by canine epigram at 10:42 AM on November 19, 2009

Oh, I'm sorry if I seemed defensive. I'm really not. It's weird how people experience pain. I don't have any problems with shots, unless they're in my lower face. Then I pass out. Most procedures give me no problem at all, but I either faint or almost faint when I have blood drawn. A mammogram this past year had me crying, while for other women it's no big deal.

At any rate, in the last few years I've developed a lot more compassion for people who complain about procedures that I wouldn't consider a big deal.
posted by Evangeline at 10:47 AM on November 19, 2009

Just to throw this in, I've had this done twice- the second time, they gave me a painkiller and then thoroughly numbed my throat. The first time, the doctor walked into the room, told me to hold still, and literally just shoved the thing down there. And yeah, "uncomfortable" is not the word for how horrible that felt. Regardless of any underlying conditions that you might have, it is an intensely uncomfortable and painful thing to do. And both times it was a doctor, not a nurse- so I guess it just comes down to bedside manner. If possible, going forward with whatever treatment you need, get a different doc- it would have been so easy for them to minimize your discomfort and if they didn't bother, you don't want to have to deal with them.
posted by Dormant Gorilla at 11:45 AM on November 19, 2009

What I don't understand is why, if numbing spray is an option, a doctor wouldn't just offer it to you. Is there a good reason NOT to use it?
posted by Evangeline

Um, I do this a lot. Two different sprays, the end result is numbness. If he's just looking at my sinuses, he can do it pretty much right away. If he's looking all the way into my tonsil/throat, he lets it drip and we wait a while. [my emphasis]

Katherineg gives what I think is the answer: this Doc squeezed you in on the same afternoon you made the appointment and made you wait for 45 minutes; he knew just how uncomfortable it was going to be, but he didn't have time to wait for you to get numb if he had used the spray.

Borderline malpractice, I think (because of his negligence you could end up with a fear of having an endoscopy in the future, delay needed care, and develop a life-threatening illness that would have been trivial if you had gotten timely treatment).

Tell your doctor not to refer anyone else to that guy!
posted by jamjam at 11:41 PM on March 6, 2010

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