My endoscopy today failed — became agitated. How do I fix this?
August 10, 2022 6:10 PM Subscribe
Everything worked out with the "ride" and ASL interpreter for the endoscopy today (yay!). However, they had to stop the endoscopy halfway through because according to the doctor's notes, I became agitated and repeatedly pulled out the endoscope, so they had to stop. How do I fix this situation?
I'm really frustrated, disappointed, and down about this, because my stomach issues were recurring and it was hard to book this appointment. Then there was the whole hubba with needing a ride/escort, but that worked out. Unfortunately, after I was given anesthesia, things went downhill. The interpreter wasn't present in the actual room where the procedure happened, and I honestly don't remember anything; I kept going in and out of consciousness, but according to the doctor, they had to reschedule because I became agitated. I do not remember this agitation at all. Not to mention, to add insult to injury, they were a bit rude, rushing me out because another patient had the room. I was out of it, shocked and confused, and not really registering everything properly. It took me a good couple of hours or so to get myself together. I do not even remember getting dressed. I was told when I called to reschedule, to ask for a MAC (monitored anesthesia care). Frankly, the whole situation made me feel like I was a bit crazy/weird.
I was told to call the scheduling line to reschedule. When I did, I was told the next available date was in early October, which is a ways away. I don't mean to sound like a special entitled snowflake, but honestly, this is so frustrating. It was already stressful for me to get everything coordinated for this, not to mention the "wasted" sick leave hours I put in from work, being Deaf, and having to deal with finding a ride.
Questions:
1) Is what happened with me (getting agitated/not remembering much, etc) normal? I was told this happens to a lot of patients, but I don't understand how it happened. I don't remember. I'm normally very cooperative and "docile" and not the kind to become visibly agitated.
2) Is there any way I can have Kaiser mark my rescheduled appointment as a follow-up, so I wouldn't have to pay the co-pay again? While the interpreter was present for most of the time, I do feel that maybe if she was present in the procedure room right before the actual procedure itself, things might have went smoother. I feel it's unfair that I'd have to pay the co-pay again.
3) Segueing into this from #2, October is a bit far away, and I've already waited since May to get today's test, only for things to go sideway after all the hassle. Is there a way I can try and have Kaiser move my test up earlier? It's not an emergency situation per se, but considering the circumstances, I feel it might be easier and better. I'm sick of this on/off stomach pain and want it to be finished.
4) If #3 isn't possible, is there a way that Kaiser can send me to an out-of-network provider to get the endoscopy done with, then treat/bill it as in-network (ie, charging me only the co-pay, or even $0, if #2 is possible); that way, I can get the procedure done with earlier? I'm on a HMO plan and Kaiser can be very bureaucratic, but figured I'd ask if it's possible.
5) Seems a bit minor, and I've no aches so far, but I'm a bit worried that when I became agitated, I could have potentially bit down firmly on the mouthpiece that was put between my teeth. Should I be worried about any damage to my teeth?
Thanks! This was such a foreign and new process to me, and incredibly disappointing.
I'm really frustrated, disappointed, and down about this, because my stomach issues were recurring and it was hard to book this appointment. Then there was the whole hubba with needing a ride/escort, but that worked out. Unfortunately, after I was given anesthesia, things went downhill. The interpreter wasn't present in the actual room where the procedure happened, and I honestly don't remember anything; I kept going in and out of consciousness, but according to the doctor, they had to reschedule because I became agitated. I do not remember this agitation at all. Not to mention, to add insult to injury, they were a bit rude, rushing me out because another patient had the room. I was out of it, shocked and confused, and not really registering everything properly. It took me a good couple of hours or so to get myself together. I do not even remember getting dressed. I was told when I called to reschedule, to ask for a MAC (monitored anesthesia care). Frankly, the whole situation made me feel like I was a bit crazy/weird.
I was told to call the scheduling line to reschedule. When I did, I was told the next available date was in early October, which is a ways away. I don't mean to sound like a special entitled snowflake, but honestly, this is so frustrating. It was already stressful for me to get everything coordinated for this, not to mention the "wasted" sick leave hours I put in from work, being Deaf, and having to deal with finding a ride.
Questions:
1) Is what happened with me (getting agitated/not remembering much, etc) normal? I was told this happens to a lot of patients, but I don't understand how it happened. I don't remember. I'm normally very cooperative and "docile" and not the kind to become visibly agitated.
2) Is there any way I can have Kaiser mark my rescheduled appointment as a follow-up, so I wouldn't have to pay the co-pay again? While the interpreter was present for most of the time, I do feel that maybe if she was present in the procedure room right before the actual procedure itself, things might have went smoother. I feel it's unfair that I'd have to pay the co-pay again.
3) Segueing into this from #2, October is a bit far away, and I've already waited since May to get today's test, only for things to go sideway after all the hassle. Is there a way I can try and have Kaiser move my test up earlier? It's not an emergency situation per se, but considering the circumstances, I feel it might be easier and better. I'm sick of this on/off stomach pain and want it to be finished.
4) If #3 isn't possible, is there a way that Kaiser can send me to an out-of-network provider to get the endoscopy done with, then treat/bill it as in-network (ie, charging me only the co-pay, or even $0, if #2 is possible); that way, I can get the procedure done with earlier? I'm on a HMO plan and Kaiser can be very bureaucratic, but figured I'd ask if it's possible.
5) Seems a bit minor, and I've no aches so far, but I'm a bit worried that when I became agitated, I could have potentially bit down firmly on the mouthpiece that was put between my teeth. Should I be worried about any damage to my teeth?
Thanks! This was such a foreign and new process to me, and incredibly disappointing.
By a weird coincidence I just had an upper endoscopy today myself!
2-4 are all questions for Kaiser/your doctor. As for 5, I think it's unlikely you damaged your teeth on the mouthpiece. The mouthpiece I had today was very solid but not rigid, and I suspect it was specifically designed to prevent dental damage.
For your next attempt, I'd assume there's some way to secure your hands. I'm kind of surprised they didn't have a way to do that today. I only had twilight sedation but I still feel kind of loopy and off, so don't be surprised if you're not quite yourself for a day or so.
posted by Ursula Hitler at 6:40 PM on August 10, 2022 [1 favorite]
2-4 are all questions for Kaiser/your doctor. As for 5, I think it's unlikely you damaged your teeth on the mouthpiece. The mouthpiece I had today was very solid but not rigid, and I suspect it was specifically designed to prevent dental damage.
For your next attempt, I'd assume there's some way to secure your hands. I'm kind of surprised they didn't have a way to do that today. I only had twilight sedation but I still feel kind of loopy and off, so don't be surprised if you're not quite yourself for a day or so.
posted by Ursula Hitler at 6:40 PM on August 10, 2022 [1 favorite]
You aren't crazy and it's definitely not your fault - as flug said, some people react poorly to certain types of anesthesia. I would be super frustrated too in your case.
I can't speak to the bureaucratic particulars of your insurance situation (except to say that I have family members who have Kaiser and from what they tell me Kaiser is very, very finicky with their rules). But I can say that if you're not feeling any aches or pains in your teeth, your teeth are fine, so hopefully that will eliminate a source of concern for you.
And yeah I agree with Ursula too - they should have secured your hands today, and I'm surprised they didn't. Seems like it was a poorly managed situation all around and I'm sorry they were rude to you on top of that.
Talk to your doctor about seeing if you can get the next try moved up earlier. There might be a way. No harm in asking.
I hope you get to the root of your GI issues soon.
posted by nayantara at 6:44 PM on August 10, 2022
I can't speak to the bureaucratic particulars of your insurance situation (except to say that I have family members who have Kaiser and from what they tell me Kaiser is very, very finicky with their rules). But I can say that if you're not feeling any aches or pains in your teeth, your teeth are fine, so hopefully that will eliminate a source of concern for you.
And yeah I agree with Ursula too - they should have secured your hands today, and I'm surprised they didn't. Seems like it was a poorly managed situation all around and I'm sorry they were rude to you on top of that.
Talk to your doctor about seeing if you can get the next try moved up earlier. There might be a way. No harm in asking.
I hope you get to the root of your GI issues soon.
posted by nayantara at 6:44 PM on August 10, 2022
Response by poster: Sorry if it appears I'm thread sitting, but I just reviewed the notes again, and it appears I was given "Midazolam" for the anesthesia, if that makes any difference? It kind of felt a bit akin to being extremely buzzed/drunk (going in and out, and forgetting stuff).
Yes, #2-4 are questions I plan to ask Kaiser. I guess what I meant was, would my chances be good? And how do I best advocate for myself in this situation? As stated, Kaiser is very bureaucratic, so I need help in how to navigate this situation and get what I want/need, because Kaiser tends to be good at saying no or following policies rigidly. I want to be able to get around this situation, but I am not sure how to ask in a way that will help Kaiser to say yes, if that makes sense.
Minor correction to my OP: "another patient had the room" should have read as "another patient needed the room."
posted by dubious_dude at 6:46 PM on August 10, 2022
Yes, #2-4 are questions I plan to ask Kaiser. I guess what I meant was, would my chances be good? And how do I best advocate for myself in this situation? As stated, Kaiser is very bureaucratic, so I need help in how to navigate this situation and get what I want/need, because Kaiser tends to be good at saying no or following policies rigidly. I want to be able to get around this situation, but I am not sure how to ask in a way that will help Kaiser to say yes, if that makes sense.
Minor correction to my OP: "another patient had the room" should have read as "another patient needed the room."
posted by dubious_dude at 6:46 PM on August 10, 2022
it appears I was given Midazolam for the anesthesia
I am not a doctor. I am just a rando on the internet who knows how to Google.
I Googled "Can midazolam cause agitation" and found a research paper that points out that the side effects of midazolam can include agitation and aggression. (The paper's authors refer to it as "a paradoxical reaction," which is what happens when a person experiences the opposite of what a drug was intended to do.) Another drug, called flumazenil, apparently can reverse this paradoxical reaction.
Good luck. I hope that this information is helpful and you are able to go through with the endoscopy.
posted by virago at 7:09 PM on August 10, 2022 [2 favorites]
I am not a doctor. I am just a rando on the internet who knows how to Google.
I Googled "Can midazolam cause agitation" and found a research paper that points out that the side effects of midazolam can include agitation and aggression. (The paper's authors refer to it as "a paradoxical reaction," which is what happens when a person experiences the opposite of what a drug was intended to do.) Another drug, called flumazenil, apparently can reverse this paradoxical reaction.
Good luck. I hope that this information is helpful and you are able to go through with the endoscopy.
posted by virago at 7:09 PM on August 10, 2022 [2 favorites]
No, midazolam doesn’t make a difference. (I am a doctor, not yours.) As said above, people react different ways to anesthetics, and that can include agitation. It’s well known in medicine that some people who take benzos—midazolam is one—can have what is called a “paradoxical reaction”—they become agitated, aggressive w, disinhibited etc. This is not at all something to be embarrassed about—it’s just your brain doing weird stuff and your medical team is correct it is somewhat common. (And flumazenil is NOT used to treat this for several reasons.)
I understand your frustration with staff canceling, but it was done for your safety and staff’s safety. I’d try to keep that in mind going forward. And just make note of this for future physicians, medical stuff, procedures, etc.
posted by namemeansgazelle at 7:14 PM on August 10, 2022 [13 favorites]
I understand your frustration with staff canceling, but it was done for your safety and staff’s safety. I’d try to keep that in mind going forward. And just make note of this for future physicians, medical stuff, procedures, etc.
posted by namemeansgazelle at 7:14 PM on August 10, 2022 [13 favorites]
Flumazenil is NOT used to treat this for several reasons
I appreciate your pointing that out. (I apologize if I mistakenly created the impression that I endorsed the validity of the aforementioned research paper's conclusions.)
posted by virago at 7:32 PM on August 10, 2022 [3 favorites]
I appreciate your pointing that out. (I apologize if I mistakenly created the impression that I endorsed the validity of the aforementioned research paper's conclusions.)
posted by virago at 7:32 PM on August 10, 2022 [3 favorites]
To this non medical person, it does sounds like your reaction to anesthesia was unlucky, but no one's fault.
You could ask if you can be put on the "cancellation list."
It may also be worth asking if a different kaiser location could accommodate you sooner.
posted by oceano at 7:48 PM on August 10, 2022 [2 favorites]
You could ask if you can be put on the "cancellation list."
It may also be worth asking if a different kaiser location could accommodate you sooner.
posted by oceano at 7:48 PM on August 10, 2022 [2 favorites]
Is your doctor aware that October was the next spot? When I received really long wait for a similar procedure, I called and asked his staff if this delay was ok from his perspective of my need for treatment and miraculously an appointment opened up sooner (which means I was given one of the spots being held for emergencies).
However it still wasn't as soon as absolutely possible because, like you, I needed a certain level of staffing/anesthesiologist which means coordinating multiple schedules.
posted by beaning at 9:14 PM on August 10, 2022 [7 favorites]
However it still wasn't as soon as absolutely possible because, like you, I needed a certain level of staffing/anesthesiologist which means coordinating multiple schedules.
posted by beaning at 9:14 PM on August 10, 2022 [7 favorites]
If it's any consolation, I also get agitated with some kinds of anesthesia. I once tried to pick a fight with a nurse as I woke up from an Endoscopy, because we weren't in Barcelona. (We were in Seattle).
If there's any possible upside to this? You can record the date/time/location/doctor of the procedure that you had, and your bad reaction to it during/after the procedure. Preferably in an easy to get document. Then, the next time you have any sort of procedure that requires anesthesia? You can send them this document, or convey the info another way, so that they can better anesthesize you in the future.
(For my most recent Endoscopy, I told them of the agitation, and they were able to use a different med. I didn't react badly to that one at all.)
posted by spinifex23 at 9:38 PM on August 10, 2022 [3 favorites]
If there's any possible upside to this? You can record the date/time/location/doctor of the procedure that you had, and your bad reaction to it during/after the procedure. Preferably in an easy to get document. Then, the next time you have any sort of procedure that requires anesthesia? You can send them this document, or convey the info another way, so that they can better anesthesize you in the future.
(For my most recent Endoscopy, I told them of the agitation, and they were able to use a different med. I didn't react badly to that one at all.)
posted by spinifex23 at 9:38 PM on August 10, 2022 [3 favorites]
There is no shame in having a weird emotional reaction to meds any more than there would be to getting a rash or feeling queasy. Not remembering much is a feature of sedation, not a bug. (Some sedation meds make me weepy and do odd things to my vocabulary for about a day--the last time I had it, I needed to call the doctor's office the next day and tell them that they had used a Latin-root word I was familiar with but not in a medical context, but that I had no idea what the word *was*, and the doc laughed at the specificity of the memory hole but was completely unsurprised that she needed to review her findings with me.)
Ask to be put on the cancellation list to increase the chances of being seen sooner.
Mouthpieces are designed to be bit on by half-conscious people without causing lasting damage.
posted by tchemgrrl at 4:39 AM on August 11, 2022 [1 favorite]
Ask to be put on the cancellation list to increase the chances of being seen sooner.
Mouthpieces are designed to be bit on by half-conscious people without causing lasting damage.
posted by tchemgrrl at 4:39 AM on August 11, 2022 [1 favorite]
I'm sorry they were brusque with you! It can take several hours to recover from sedation, as you did, and it's normal that they would move on if it turned out the procedures and tools they had planned for wouldn't work (trying to do a simpler anesthesia procedure, maybe, without the time or personnel on hand to change. That would be why they told you to ask for a different type of anesthesia care next time.)
I think of it almost more like a flight getting cancelled: it's not about you, and the choice makes sense in terms of the resources they had and the best way to optimize future success (stop trying now, get you on a different "plane" later, get the next flight onto the runway), but it's disruptive and hard for you and it sucks that no one involved was more compassionate about it to take the time to explain
posted by Lady Li at 5:52 AM on August 11, 2022 [2 favorites]
I think of it almost more like a flight getting cancelled: it's not about you, and the choice makes sense in terms of the resources they had and the best way to optimize future success (stop trying now, get you on a different "plane" later, get the next flight onto the runway), but it's disruptive and hard for you and it sucks that no one involved was more compassionate about it to take the time to explain
posted by Lady Li at 5:52 AM on August 11, 2022 [2 favorites]
This thread is closed to new comments.
I think it is purely a matter of, some people react to that particular anesthetic in that way, and (by the pure luck of the draw) you happen to be one of them.
The only "solution" or thing to do differently next time, is to use a different type of anesthetic, which is exactly what they have suggested to you.
I'm sorry they didn't handle the situation better and explain it to you better. This is literally 0% your fault and it is completely understandable that you are frustrated.
posted by flug at 6:24 PM on August 10, 2022 [21 favorites]