Drugs and cervix
October 15, 2011 3:35 AM Subscribe
I was advised to take 100 mils of ibuprofen before I go in for a colposcopy and possible cervical biopsy Monday morning. Should I take my last half of a klonopin, or my last ativan, and will these drugs necessitate me asking someone to drive me?
The nice scheduler who called from Planned Parenthood today said they saw two different kinds of abnormal cells in a Pap smear I took last week, and the second kind is such that they want me to come in ASAP.
She said, "Take 100 mils of ibuprofen." I asked, "Is this the time to take an ativan?" She said yes.
[I'm kinda freaked out by this. I have no insurance, no job, no financial werewithal. A bad outcome will be really bad. For extra awfulness, every GYN I've ever seen has joked about how difficult my cervix is to find.]
Is an ativan the right drug to take before I go? The pill is four years old. Or should I take the half of a klonopin, which script was filled in 2010 (for dental phobia)? And should I ask someone to drive me if I take these drugs? And should I take the 100 mils ibuprofen too?
The nice scheduler who called from Planned Parenthood today said they saw two different kinds of abnormal cells in a Pap smear I took last week, and the second kind is such that they want me to come in ASAP.
She said, "Take 100 mils of ibuprofen." I asked, "Is this the time to take an ativan?" She said yes.
[I'm kinda freaked out by this. I have no insurance, no job, no financial werewithal. A bad outcome will be really bad. For extra awfulness, every GYN I've ever seen has joked about how difficult my cervix is to find.]
Is an ativan the right drug to take before I go? The pill is four years old. Or should I take the half of a klonopin, which script was filled in 2010 (for dental phobia)? And should I ask someone to drive me if I take these drugs? And should I take the 100 mils ibuprofen too?
I cannot speak for the cervical exam part, but I would take the Ibuprofin (NOT aspirin) and I would take whichever of the two benzos that had more milligram bang for the buck left. 4 years may have reduced the efficacy a little, but it is still good to go. Or, ask your GYN to prescribe 1 or 2 more pills. She should have no issue doing so and 2 pills of a generic will not cost much at all. I had two prescribed for an MRI and two for a colonoscopy. They should help with any anxiety you may be having.
As for getting someone to drive you home, it can't hurt, but depending on when you take the benzo and how long the procedure is, it might be overkill.
posted by JohnnyGunn at 5:17 AM on October 15, 2011
As for getting someone to drive you home, it can't hurt, but depending on when you take the benzo and how long the procedure is, it might be overkill.
posted by JohnnyGunn at 5:17 AM on October 15, 2011
YES, get someone to drive you if you take Ativan or klonopin. You should also check on the dose of Ibuprofen that you've been advised to take.
In fact there are a ton of flags that are going up for me with regards to the advise you've been given.
1. You were given medical advise by a scheduler - usually schedulers have no medical background - maybe this is different at the place that you are going but 100mls of Ibuprofen is a strange dose - normally it would be 200 or 400 mls.
2. Health care institutions have an obligation to give you written and verbal information on your role in safe care which includes pre and post procedure instructions. They should also provide you with information on who/where to call if you have any questions or concerns.
3. Does the clinic/health care facility know that you have ativan that you are planning on taking. Have they talked to you ahead of time about your list of home medications and what their medication plan is? This is commonly called medication reconciliation. A list of your home meds is gathered and then the physician reviews this before considering any needed changes.
4. IF you are planning on taking a benzo you should make sure the person/people who will be present at your procedure know this - it may alter your level of consciousness and have an impact the normal flow of the procedure. Your health care providers need to have this information in the event that you have an adverse event such as depression in your respiration, fainting etc etc
You should phone back and ask to speak to a nurse or physician to get clarification and WRITTEN instructions.
posted by YukonQuirm at 5:20 AM on October 15, 2011 [6 favorites]
In fact there are a ton of flags that are going up for me with regards to the advise you've been given.
1. You were given medical advise by a scheduler - usually schedulers have no medical background - maybe this is different at the place that you are going but 100mls of Ibuprofen is a strange dose - normally it would be 200 or 400 mls.
2. Health care institutions have an obligation to give you written and verbal information on your role in safe care which includes pre and post procedure instructions. They should also provide you with information on who/where to call if you have any questions or concerns.
3. Does the clinic/health care facility know that you have ativan that you are planning on taking. Have they talked to you ahead of time about your list of home medications and what their medication plan is? This is commonly called medication reconciliation. A list of your home meds is gathered and then the physician reviews this before considering any needed changes.
4. IF you are planning on taking a benzo you should make sure the person/people who will be present at your procedure know this - it may alter your level of consciousness and have an impact the normal flow of the procedure. Your health care providers need to have this information in the event that you have an adverse event such as depression in your respiration, fainting etc etc
You should phone back and ask to speak to a nurse or physician to get clarification and WRITTEN instructions.
posted by YukonQuirm at 5:20 AM on October 15, 2011 [6 favorites]
Sorry, one more point - though medication expiry dates vary, they are often less than one year from manufacture. You need to check all the expiry dates on your medications and throw out medications that have expired. I can not imagine any antivan tablet that is 4 years old would be suitable to take. I am not a pharmacist so you should consult with a physician or pharmacist to be sure.
posted by YukonQuirm at 5:27 AM on October 15, 2011
posted by YukonQuirm at 5:27 AM on October 15, 2011
If you're unsure, you can call a pharmacy and ask to speak to a pharmacist. Doesn't even have to be your own pharmacy. Just call up your local Walgreens. They'll be able to give you the answers you're looking for, and you shouldn't need to ask a physician (which can be tricky without insurance).
posted by phunniemee at 5:36 AM on October 15, 2011 [1 favorite]
posted by phunniemee at 5:36 AM on October 15, 2011 [1 favorite]
As a data point, I had this procedure done in college (also at Planned Parenthood). Of course everyone is different, but it wasn't too bad. It was more uncomfortable than painful, with some spotting for a few days after. I took 3 or 4 regular ibuprofen and nothing else. (I do agree the 100 mils sounds like a strange number.) Good luck! I know it isn't particularly pleasant, but I don't think it will be as bad as you might imagine.
posted by Glinn at 6:54 AM on October 15, 2011
posted by Glinn at 6:54 AM on October 15, 2011
100 mg of Ibuprofen is a "junior strength" dose. It's like something you would take before going to get your legs waxed, just to take the edge off of things. (IANAD, but I personally would also feel comfortable substituting with one normal strength Ibuprofen--usually 200 mg--if that was all I had sitting around the house.)
posted by anaelith at 6:55 AM on October 15, 2011
posted by anaelith at 6:55 AM on October 15, 2011
I also had a colposcopy and cervical biopsy in college. The colposcopy itself was not a big deal compared to a regular pelvic exam. The cervical biopsy, however, was unpleasant, but not entirely for pain reasons - mostly because my doctor (for whatever reason) had not mentioned the possibility of a biopsy at all before the visit, so I was freaking out mid-exam. In terms of sensation, it felt like someone had taken a tiny hole punch to my cervix, followed by what felt like series of spasms through my innards. The spasms were the worst part - but again, because they were unexpected. I had a little bit of soreness for an hour or two after the procedure and some spotting, but I think that was it.
If I had to do it over again, I would most certainly take benzos. But I would get someone to drive you if you don't know how the medication is going to affect you - better safe than sorry.
posted by the littlest brussels sprout at 7:30 AM on October 15, 2011
If I had to do it over again, I would most certainly take benzos. But I would get someone to drive you if you don't know how the medication is going to affect you - better safe than sorry.
posted by the littlest brussels sprout at 7:30 AM on October 15, 2011
If you need to take something for anxiety, why not wait until you get to the clinic? If your wait time is anything like the ones I usually have at the doc office, it will have plenty of time to kick in.
Take deep breaths. If you have the time, get yourself into a quiet place and imagine a beautiful light moving slowly from your toes to the top of your head (yes, I know this sounds incredibly hokey. But my shrink walked me through this visualization before I had a scary surgery, and it really soothed me. I was able to remember it while waiting to be wheeled into the OR and it was really helpful. That and the xanax.)
I really hope you have a good outcome.
posted by bunderful at 7:32 AM on October 15, 2011
Take deep breaths. If you have the time, get yourself into a quiet place and imagine a beautiful light moving slowly from your toes to the top of your head (yes, I know this sounds incredibly hokey. But my shrink walked me through this visualization before I had a scary surgery, and it really soothed me. I was able to remember it while waiting to be wheeled into the OR and it was really helpful. That and the xanax.)
I really hope you have a good outcome.
posted by bunderful at 7:32 AM on October 15, 2011
Yes, call them. Where I used to work, it was 800 mg of ibu, with food, an hour before you came in for your colp. It seems like there may have been some miscommunication somewhere.
posted by verbyournouns at 8:05 AM on October 15, 2011
posted by verbyournouns at 8:05 AM on October 15, 2011
1) Ask your doctor this.
2) I'd strongly bet, despite the expiration date, the pill will still work just fine.
3) Ativan and Klonopin are really similar. If you want to know which to take...I think the bigger issue is the dosage of both. You could be taking half a 0.5mg Klonopin or a 2mg ativan. In other words, one is 4 times as strong as the other. Depends how relaxed you want to be...
posted by User7 at 8:30 AM on October 15, 2011
2) I'd strongly bet, despite the expiration date, the pill will still work just fine.
3) Ativan and Klonopin are really similar. If you want to know which to take...I think the bigger issue is the dosage of both. You could be taking half a 0.5mg Klonopin or a 2mg ativan. In other words, one is 4 times as strong as the other. Depends how relaxed you want to be...
posted by User7 at 8:30 AM on October 15, 2011
Er, sorry, that would be 8x stronger in the above example!
posted by User7 at 8:32 AM on October 15, 2011
posted by User7 at 8:32 AM on October 15, 2011
I just had an endometrial biopsy, and despite being assured that two Tylenol would be enough, I found the (admittedly, short) procedure very very painful. I really don't understand why we women don't insist on a little lidocaine or some other deadening agent before biopsy. I was especially angry afterward, when the doctor basically mocked me for crying out in pain. If I had known, I would have taken the strongest pain medication I had at home, or been more insistent on help with pain management from the clinic.
posted by Malla at 8:57 AM on October 15, 2011
posted by Malla at 8:57 AM on October 15, 2011
Best answer: Malla, I don't know about endometrial biopsy, but for a cervical biopsy lidocaine will skew the results.
I've had the cervical biopsy and colp, with 4 ibuprofen. It was pinchy and achy, and exhausting from the stress, but I'd compare the pain to a fairly minor kitchen accident. Later that night I was really crampy and really tired and super fussy, but again not actually suffering dramatically.
Your ativan question was a little leading. What the person on the phone heard was, "I'm a person with a current prescription for Ativan. Should I take one for this occasion?" and she said yes because it would be kind of dumb to tell someone with a current active prescription for anxiety medication to *not* take it for white-coat procedures. Also, if that is the person who also told you to take half an ibuprofen instead of four, I'm not sure she's a reliable source. You need to call back for clarification.
The nerves in your cervix are not like the nerves in your mouth. You will feel the procedure and it will not be your favorite thing, but it's not like having a tooth or toenail removed without anesthetic. If you feel you need anxiety mitigation, ask PP for a scrip for something not expired and linty, and get someone to drive.
posted by Lyn Never at 10:07 AM on October 15, 2011
I've had the cervical biopsy and colp, with 4 ibuprofen. It was pinchy and achy, and exhausting from the stress, but I'd compare the pain to a fairly minor kitchen accident. Later that night I was really crampy and really tired and super fussy, but again not actually suffering dramatically.
Your ativan question was a little leading. What the person on the phone heard was, "I'm a person with a current prescription for Ativan. Should I take one for this occasion?" and she said yes because it would be kind of dumb to tell someone with a current active prescription for anxiety medication to *not* take it for white-coat procedures. Also, if that is the person who also told you to take half an ibuprofen instead of four, I'm not sure she's a reliable source. You need to call back for clarification.
The nerves in your cervix are not like the nerves in your mouth. You will feel the procedure and it will not be your favorite thing, but it's not like having a tooth or toenail removed without anesthetic. If you feel you need anxiety mitigation, ask PP for a scrip for something not expired and linty, and get someone to drive.
posted by Lyn Never at 10:07 AM on October 15, 2011
A point I meant to add: the ibuprofen is for swelling as much as pain (in part because swelling will make you a lot more sore later, and will slow your healing time) and you need to take it as correctly prescribed regardless of whatever else you get from them to take.
posted by Lyn Never at 10:09 AM on October 15, 2011
posted by Lyn Never at 10:09 AM on October 15, 2011
I just had the colposcopy/biopsy combo pack last month. Just sent you memail. Anti-anxiety medication was absolutely OK, including with ibuprofen. (Just don't take aspirin, as somebody mentioned above; it promotes bleeding.) Tell the doctor you're on it, just so he knows. Don't take the pill that "expired," unless it's a relatively high dose for that brand; waiting around to find out how well it works is just going to be more stressful. (Note that .5 mg of one type of drug might be weaker than .5 mg of another type, even though they're in the same family.)
Can't answer the driving question for you, but if getting a ride is a problem and the bus isn't a good option, can you take enough time off to get there a little early, just to give the pill time to kick in (20 minutes for me, YMMV, I took it in the car on the way over), and then get some coffee or something for an hour or so afterwards? You're not going to have an especially clear head for work for the first couple of hours anyway.
posted by Adventurer at 12:37 PM on October 15, 2011
Can't answer the driving question for you, but if getting a ride is a problem and the bus isn't a good option, can you take enough time off to get there a little early, just to give the pill time to kick in (20 minutes for me, YMMV, I took it in the car on the way over), and then get some coffee or something for an hour or so afterwards? You're not going to have an especially clear head for work for the first couple of hours anyway.
posted by Adventurer at 12:37 PM on October 15, 2011
I had a colposcopy/biopsy, and I did take an NSAID. However, with or without anxiety pills (talk to your doctor!), it might be worthwhile to have an understanding friend with you. I felt so violated after the biopsy. It was painful, and I had a bad experience overall. YMMV, but it can't hurt. I could have used a hug and a shoulder to cry on.
posted by two lights above the sea at 3:24 PM on October 15, 2011
posted by two lights above the sea at 3:24 PM on October 15, 2011
I also had this procedure done in college. I drove myself to and from the clinic, and I dearly wish I would have had someone with me at the time. As others have noted, it is not so much painful as profoundly uncomfortable in both the physical and emotional sense. (The pain for me was like especially sharp menstrual cramps; a few intense pinches during and a duller low-grade crampiness after.)
If there's no medical reason not to, I would take both Ativan and some Aleve or ibuprofen. Being as chill as possible is the best thing you can do. I am not a doctor!
It will be fine!
posted by sideofwry at 3:52 PM on October 15, 2011
If there's no medical reason not to, I would take both Ativan and some Aleve or ibuprofen. Being as chill as possible is the best thing you can do. I am not a doctor!
It will be fine!
posted by sideofwry at 3:52 PM on October 15, 2011
I had this same procedure two years ago and I asked for local anesthetic. My doctor was really nice and agreed that it would be okay. The needle was very long (which scared me quite a bit), since it had to reach my cervix and it pinched a bit. The shot took longer than the actual biopsy. I would say if you are really scared ask your doctor about a little local anesthetic.
posted by estronaut at 4:24 PM on October 15, 2011
posted by estronaut at 4:24 PM on October 15, 2011
For future reference, rather than hanging on to a 4-year-old pill, if you are extremely nervous about a procedure, talk to your doctor. They might be willing to prescribe you a one-time dose of ativan/klonopin/whatever for the procedure. A friend of mine who was very nervous about her oral surgery got some benzos from her dentist for the night before and day of.
posted by IndigoRain at 5:10 PM on October 15, 2011
posted by IndigoRain at 5:10 PM on October 15, 2011
Sorry, one more point - though medication expiry dates vary, they are often less than one year from manufacture
The expiration dates are generally one year because the manufacturers don't test them for longer than that. They're not required to, and it's not in their interest.
The US Department of Defense, which would rather not buy new drugs if they still work, found many meds, under good storage conditions, to be effective well after the supposed expiration date.
posted by zippy at 11:49 PM on October 15, 2011
The expiration dates are generally one year because the manufacturers don't test them for longer than that. They're not required to, and it's not in their interest.
The US Department of Defense, which would rather not buy new drugs if they still work, found many meds, under good storage conditions, to be effective well after the supposed expiration date.
posted by zippy at 11:49 PM on October 15, 2011
Gosh, these answers aren't doing much to put your mind at ease! I get that you are mostly worried about the outcome of test, but it doesn't help to have people piling on to tell you their horror stories about the pain. I just wanted to chime in and say that I've had this procedure and it was not that bad. I'm not discounting others' experiences, but please don't assume that your experience will be the same. I would describe my experience as mildly uncomfortable, a momentary sting with the biopsy, and some cramping like a menstrual cramp, with a bit of spotting later. It did not take more than about 5 minutes to do the actual procedure.
The mostly likely outcome, if there are lesions, will be cryotherapy (which I had) or LEEP or laser treatment to remove any lesion(s), and that will be it. These are all procedures that happen in the doctor's office, and are relatively inexpensive (so not a huge financial worry to be treated). And FWIW, at the worst case, cervical cancer is very treatable. Please try not to spend a lot of time worrying about the outcomes, as the chances are very likely that you will be just fine. I'm not going to weigh in on the Klonopin vs. Ativan, but just wanted to reassure you about the big picture here. It's a simple, quick procedure, and "bad outcomes" are fairly remote.
posted by amusebuche at 3:37 AM on October 16, 2011
The mostly likely outcome, if there are lesions, will be cryotherapy (which I had) or LEEP or laser treatment to remove any lesion(s), and that will be it. These are all procedures that happen in the doctor's office, and are relatively inexpensive (so not a huge financial worry to be treated). And FWIW, at the worst case, cervical cancer is very treatable. Please try not to spend a lot of time worrying about the outcomes, as the chances are very likely that you will be just fine. I'm not going to weigh in on the Klonopin vs. Ativan, but just wanted to reassure you about the big picture here. It's a simple, quick procedure, and "bad outcomes" are fairly remote.
posted by amusebuche at 3:37 AM on October 16, 2011
You've already gotten your answer, but I am writing to correct a misconception in one of the comments above.
There are comments above suggesting that 2mg of Ativan is either 4 or 8 times as strong as 0.5mg Klonopin. Actually, 2mg of Ativan is twice as strong as 0.5mg Klonopin, according to the benzodiazepine equivalency charts. It's not a simple math question - you can't look at the number of milligrams of two different medications and compare their strengths, even if they are in the same family. People often make the mistake of thinking "oh, the number of milligrams is small, that means this medication is weak" - applying this logic to narcotics, 1mg of fentanyl might be thought to be much 'weaker' than 10mg of morphine. In fact, it's ten times stronger (1mg fentanyl = 100mg morphine)! So fentanyl is usually dosed in micrograms (mcg). Which is another important point when asking med questions - you've got to watch your units. You're asking about "100 mls" of ibuprofen, but mls are milliliters, a liquid measure. Usually ibuprofen in liquid form is for infants or children, and you would never give a 100ml dose because that's the entire bottle.... as others pointed out, even 100 mg (milligrams) of ibuprofen doesn't make sense because it comes standardized in 200mg tablets, and people typically take more than one at a time.
And since you're asking, I say take ibuprofen only. As a healthcare provider it kind of bugs me that people feel taking sedatives and narcotics should be standards prior to minor procedures. I see a lot of dependence and addiction out there, and I fear it's in part because we are so willing to give our strongest medications for anything that might hurt or make a patient upset. Unless you have anxiety or pain sensitivity that is extreme, I think dealing with the situation in other ways will actually be healthier for you in the end (and I do speak as a woman who has had a number of quite uncomfortable feminine-type procedures!).
posted by treehorn+bunny at 12:38 AM on October 17, 2011
There are comments above suggesting that 2mg of Ativan is either 4 or 8 times as strong as 0.5mg Klonopin. Actually, 2mg of Ativan is twice as strong as 0.5mg Klonopin, according to the benzodiazepine equivalency charts. It's not a simple math question - you can't look at the number of milligrams of two different medications and compare their strengths, even if they are in the same family. People often make the mistake of thinking "oh, the number of milligrams is small, that means this medication is weak" - applying this logic to narcotics, 1mg of fentanyl might be thought to be much 'weaker' than 10mg of morphine. In fact, it's ten times stronger (1mg fentanyl = 100mg morphine)! So fentanyl is usually dosed in micrograms (mcg). Which is another important point when asking med questions - you've got to watch your units. You're asking about "100 mls" of ibuprofen, but mls are milliliters, a liquid measure. Usually ibuprofen in liquid form is for infants or children, and you would never give a 100ml dose because that's the entire bottle.... as others pointed out, even 100 mg (milligrams) of ibuprofen doesn't make sense because it comes standardized in 200mg tablets, and people typically take more than one at a time.
And since you're asking, I say take ibuprofen only. As a healthcare provider it kind of bugs me that people feel taking sedatives and narcotics should be standards prior to minor procedures. I see a lot of dependence and addiction out there, and I fear it's in part because we are so willing to give our strongest medications for anything that might hurt or make a patient upset. Unless you have anxiety or pain sensitivity that is extreme, I think dealing with the situation in other ways will actually be healthier for you in the end (and I do speak as a woman who has had a number of quite uncomfortable feminine-type procedures!).
posted by treehorn+bunny at 12:38 AM on October 17, 2011
Response by poster: Thank you all for your input. I took the four-yr-old ativan and 2 200 mg capsules of ibuprofen. The clinician was exactly the right kind to set me at ease: gave her name, shook my hand, explained why the tests were indicated, and then, during the procedure (which did include a biopsy - odd to hear a person refer to the cervical points of interests as "6, 10, and 11"), told me exactly what she was doing. I of course told her about the ativan and the ibuprofen. The procedure was uncomfortable at worst. No pain then, and none in the several hours since.
So now I await my results! I appreciate all of your responses, and hope I won't have to ask more about this.
posted by goofyfoot at 4:27 PM on October 17, 2011 [1 favorite]
So now I await my results! I appreciate all of your responses, and hope I won't have to ask more about this.
posted by goofyfoot at 4:27 PM on October 17, 2011 [1 favorite]
So glad to hear the procedure went smoothly and that you had a good clinician, goofyfoot. Good luck on the results, and whatever might need taking care of. It sounds like you are in good hands.
posted by amusebuche at 3:20 PM on October 18, 2011
posted by amusebuche at 3:20 PM on October 18, 2011
Response by poster: I received my results: I'm fine.
Thank you all for your input. I hope this thread can be as useful to someone else as it was to me.
posted by goofyfoot at 3:29 AM on November 3, 2011 [2 favorites]
Thank you all for your input. I hope this thread can be as useful to someone else as it was to me.
posted by goofyfoot at 3:29 AM on November 3, 2011 [2 favorites]
This thread is closed to new comments.
Pill packets should have 'use by' dates on them, which will tell you if the pills are still good. If you don't have the packets then unfortunately I don't know the shelf-life of those drugs - hopefully someone else might.
Ibuprofen is a painkiller and anti-inflammatory, which are totally different effects to the other drugs. You're totally fine to take ibuprofen with a benzodiazepine.
Summary: take the ibuprofen. If either your ativan or klonopin are not out of date, take one (but not both), and get someone else to drive you there.
posted by Coobeastie at 4:12 AM on October 15, 2011 [2 favorites]