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Medical Forum / General / General / June 2006about having cystoscopy
Hi. I had a brief 30-hour episode of blood in urine a week ago. The urologist wants to do a cystoscopy. He wanted to do it in his office yesterday and I panicked. I plan to do it as an o/p procedure early next week. My insurance sucks and I'll have to pay for most of this myself. If I do it in the office is it excruciating? I'm a baby about pain and procedures. What would you do? Thanks for your comments. Jane > Hi. I had a brief 30-hour episode of blood in urine a week ago. The > urologist wants to do a cystoscopy. He wanted to do it in his office [quoted text clipped - 7 lines] > > Jane Jane...I am a male and it hurts us worse than you, since we have more plumbing to go through. I am sure your uro will use a flexible scope and it shouldn't be too bad. I would recommend you go for it in the office, especially if you have to pay for it w/o insurance. Good luck and let us know how you do :-) ...Pete Jane Cohen wrote: > Hi. I had a brief 30-hour episode of blood in urine a week ago. The > urologist wants to do a cystoscopy. He wanted to do it in his office [quoted text clipped - 7 lines] > > Jane Jane...I am a male and it hurts us worse than you, since we have more plumbing to go through. I am sure your uro will use a flexible scope and it shouldn't be too bad. I would recommend you go for it in the office, especially if you have to pay for it w/o insurance. Good luck and let us know how you do :-) ...Pete This message is for the original poster: I also had blood in my urine and my urol. decided to handle the problem a different way. He plans to check three separate urine samples under a microscope for blood cells. The samples will be collected on three separate days--the second urine of the day. He said if he does NOT find any blood cells in any of those samples, he will NOT do any more tests such as the cystoscopy. You may want to ask your urol. to do the same thing since it may prevent the pain and also save you money--if no blood is found in those urine samples. Jason > Jane Cohen wrote: > > Hi. I had a brief 30-hour episode of blood in urine a week ago. The [quoted text clipped - 5 lines] > > procedures. What would you do? > > > This message is for the original poster: > I also had blood in my urine and my urol. decided to handle the problem a [quoted text clipped - 6 lines] > is found in those urine samples. > Jason Thanks for your thoughts, Jason. Here's what happened with me: First I went to my internist last week because I panicked at all the blood I saw. They sent a specimen out for analysis and there was blood but no infection. In the uro's office, they spun a specimen right then and there was no blood. When the uro said he wanted to do the procedure, I said, so let's wait until it happens again. He said, The most likely cause of painless hematuria is bladder cancer. He said, What if it doesn't happen again for 6 mos or 1 year, and at that point it's cancer and not treatable, and we could have found it now. That makes sense to me. I can't wait around for a year to see if it happens again. I need to know now what's wrong. Jane >>Hi. I had a brief 30-hour episode of blood in urine a week ago. The >>urologist wants to do a cystoscopy. He wanted to do it in his office [quoted text clipped - 14 lines] > > Good luck and let us know how you do :-) ...Pete Thanks for your comments, Pete. I know it seems crazy to make such a big deal of this but I've been doing a lot of reading on the internet and it sounds hideous. I can barely stand getting a pap smear. Did I say I'm a bad patient? The whole thing took me by surprise and I didn't get all the details from the uro, like does he have anesthesia in his office. He didn't offer anything to make me comfortable, though. He said it's not so bad. He said it's like a colonoscopy. Well, I'd never be awake for that! Anyway, Pete, thanks for your opinion. > Thanks for your comments, Pete. I know it seems crazy to make such a big > deal of this but I've been doing a lot of reading on the internet and it [quoted text clipped - 7 lines] > > Anyway, Pete, thanks for your opinion. I have never had a cystoscopy, but my husband had a colonoscopy once, and they gave him something to sedate him. He says he doesn't recall it being terribly uncomfortable, but wouldn't want to have it done wide awake. It sounds like you discussed your concerns with your doctor, and he tried to reassure you, but didn't offer any specific solutions to your problem? It may be his clinical experience that most patients tolerate the cystoscopy with minimal discomfort, without needing sedation. But you're an individual, and if your fear is that strong, you deserve to have it addressed. You might consider calling his office and asking if he can prescribe something or administer something to help you relax during the procedure. If you can't (or don't want to) talk directly with the doctor, try enlisting the help of one of his nurses (they can be great allies). Reemphasize your fear, and don't be shy about it. Axiety can make anything physical less comfortable, which can, in turn, increase your anxiety. If you have a negative experience now, you may be less likely to pursue needed testing in the future. That's not a good outcome. FWIW, it sounds like you've found a thorough and competent doctor, and I would definitely follow his advice about having the test. But be proactive about getting your fears addressed beforehand, however. And don't feel bad about having them--I'm a total weenie about needles and have difficulty going in for a simple blood test, so you're not alone. >> Thanks for your comments, Pete. I know it seems crazy to make such a big >> deal of this but I've been doing a lot of reading on the internet and it [quoted text clipped - 35 lines] > don't feel bad about having them--I'm a total weenie about needles and > have difficulty going in for a simple blood test, so you're not alone. Flexible cystosopy is most usually an office-based procedure. The urethra is topically anesthetized. It tends to be less uncomfortable for women in men because women have a much shorter urethra. It tends to be not very painful, I'm told by patients, but that is indeed an individualized perception. Certainly it can be done with sedation, but that would be very unusual to be done in the office - sedation requires a substantial amount of monitoring equipment and trained personnel that are well beyond the scope of the *typical* urologist's office. The OP should check with her own urologist. Every doctor is different, but generally speaking, most surgeons would consider "calling his office and asking if he can prescribe something" to be a bad idea and refuse, instead recommending that it be done in the hospital under intravenous conscious sedation if the patient's anxiety was that bad. Be aware that that would be more expensive, and that some insurance policies may not cover the added expense of doing what they consider an office-based procedure in a surgical facility. Colonoscopy is almost always done with intravenous conscious sedation because it *does* tend to be uncomfortable. It has nothing to do with cystoscopy, and cannot be used in any sort of comparison to that procedure. HMc > > I have never had a cystoscopy, but my husband had a colonoscopy once, > > and they gave him something to sedate him. He says he doesn't recall it [quoted text clipped - 46 lines] > > HMc I only used the comparison because that is apparently the one her doctor used. You may still consider this bad advice, but let me be clearer about what I meant. I was thinking maybe he could prescribe something like 5 mg of Valium that she could take shortly before the procedure to help her relax. I definitely wasn't talking about general anesthesia. I hope it will comfort the OP to know a topical anesthic is used, and maybe that, alone, will reduce her fear. It doesn't sound like she was aware of that; I certainly wasn't. What would be your response to a patient wanting 2 or 5 mg of Valium for relaxation? If someone is incredibly anxious about a procedure, would you still consider that to be an unreasonable request? And Jane, Howard doesn't go around announcing it, but he is a general surgeon who specializes in minimally invasive procedures. So if you're going to listen to anyone in this thread, it should be him. > I only used the comparison because that is apparently the one her > doctor used. [quoted text clipped - 15 lines] > surgeon who specializes in minimally invasive procedures. So if you're > going to listen to anyone in this thread, it should be him. I wouldn't (don't) do it. The doseage of sedative-hypnotic medications is variable from person to person. If 5 mg isn't enough and the patient's anxiety level is still too high to proceed, now we have an office scheduling issue and we either reschedule, or give some more oral Valium and wait. And even then we risk a very dissatisfied patient, as well as more dissatisfied patients out in the waiting room who now must wait longer to see that particular urologist. My opinion. Others may do it differently, and I do suggest that the OP call the urologist's office and find out HIS opinion... HMc > > I only used the comparison because that is apparently the one her > > doctor used. [quoted text clipped - 28 lines] > > HMc Thanks for the feedback. I'll leave medication suggestions out of my advice in the future, and stick to the pragmagtic and emotional stuff. Having one person to clean up after is enough, I'm sure. ;) marcia, MD (medical dilettante) Howard McCollister wrote: > > I only used the comparison because that is apparently the one her > > doctor used. [quoted text clipped - 28 lines] > > HMc Thanks for the feedback. I'll leave medication suggestions out of my advice in the future, and stick to the pragmagtic and emotional stuff. Having one person to clean up after is enough, I'm sure. ;) marcia, MD (medical dilettante) marcia, I love reading your posts. You are doing a great job--much better than I am doing. Howard does a great job cleaning up after all of us. Jason > Howard McCollister wrote: > > "marcia" <design1@insight.rr.com> wrote in message [quoted text clipped - 23 lines] > am doing. Howard does a great job cleaning up after all of us. > Jason Don't beat yourself up too much, Jason. I think you're doing much better with your posts, and I know I do better when I stick to the stuff I genuinely understand. Suggesting that she ask for meds seemed innocent to me, but Howard's reality check just highlights how bad a seemingly innocent idea can be. Yes, he does a great job cleaning up after us... I agree... right now he's probably sitting at his computer saying, "Oh, G-d, now there's *two* of them." lol. ;) Jason Johnson wrote: > Howard McCollister wrote: > > "marcia" <design1@insight.rr.com> wrote in message [quoted text clipped - 23 lines] > am doing. Howard does a great job cleaning up after all of us. > Jason Don't beat yourself up too much, Jason. I think you're doing much better with your posts, and I know I do better when I stick to the stuff I genuinely understand. Suggesting that she ask for meds seemed innocent to me, but Howard's reality check just highlights how bad a seemingly innocent idea can be. Yes, he does a great job cleaning up after us... I agree... right now he's probably sitting at his computer saying, "Oh, G-d, now there's *two* of them." lol. ;) Marcia, You are probably correct. I am glad that Howard makes use of his medical knowledge to help people. I was a member of a medical newsgroup that had a person that worked in a lab in a hospital and was an expert related to blood and urine tests. Instead of making use of his medical knowledge to help people, he would wait for anyone that was not a doctor to provide advice and would use his medical knowledge to make us appear to be stupid. I once waited three days for anyone to help one person that requested some advice. I decided to check my 1000 page medical book and copied an exact quotation from the book related to that disease. Within the next hour, he told me all of the reasons my advice was stupid. I could not help but wonder why he failed to provide advice to that person during those three days. I call such people "net cops". I don't believe that Howard is a net cop since I have seen posts where he provided excellent medical advice to people that requested advice. I have a great amount of respect for doctors and medical experts that use their knowledge to help people. However, I have NO respect for doctors and medical experts that NEVER help people but instead use their expert medical knowledge to attack those of us that do try to help people. The net cops have caused several medical newsgroups to get NO posts or almost NO posts since most people never post more than one time since they were attacked by a net cop. I don't let net cops bother me. I will help people despite the efforts of net cops. You will note that I don't provide advice to all of the people that have medical problems that I have not researched. A good example is the person that had a problem with really high levels of blood sugar. I did not know nothing about that subject so I did not post. I was glad when other people provided advice for that person. I hope that you don't allow the net cops to prevent you from posting. Jason > Marcia, > You are probably correct. I am glad that Howard makes use of his medical [quoted text clipped - 25 lines] > to prevent you from posting. > Jason I don't think Howard qualifies as a "net cop," either. He's been very gracious in sharing his expertise, doesn't come across as arrogant (which makes me wonder if he's really a surgeon...;)), and doesn't get defensive when questioned. That makes him a great resource, imo. Then there's Robert who, I think, has said he's a medical technologist, who also seems to be knowledgeable and helpful, as well as a few other characters of variable usefulness who pop up from time to time. I didn't respond to the blood sugar message until after Robert did because I didn't have any knowledge that would help the poster, either. However, when he returned after Robert told him his blood sugar was dangerously high, I didn't feel under-qualified in pushing him toward the hospital when he seemed reluctant to go. Imo, you can usually say, "see a doctor, see a doctor, see a doctor," with impunity, because that's often the obvious appropriate action. And if someone's symptoms sound alarming (one side of my face is paralyzed; my blood sugar is still 550, etc.,) there's little harm in saying, "go to the ER." It seems people sometimes post here hoping to avoid doctors and hospitals, so empathy and encouragement is usually a safe response, as well. I think the trick lies in figuring out what you can responsibly say to a poster given your specific knowledge of a condition or situation. I know I'm not qualified for much more than hand-holding, so when I step over that line, I can handle the criticism. I really appreciate that Howard took the time to educate me about my error--that's not "net cop" behavior, but more like mentoring. I think if you can look at it that way, it makes the interaction less threatening. So far, I haven't encountered any of those "net cops" you mentioned, but I'll definitely be on the lookout. If I were you, I'd go back and attack that lab tech's manhood. ;) > > Marcia, > > You are probably correct. I am glad that Howard makes use of his medical [quoted text clipped - 59 lines] > but I'll definitely be on the lookout. If I were you, I'd go back and > attack that lab tech's manhood. ;) And Howard, I hope you're reading and enjoying these posts, because we expect serious brownie points for all the praise we've heaped upon you. ;) >>> Marcia, >>> You are probably correct. I am glad that Howard makes use of his [quoted text clipped - 76 lines] > expect serious brownie points for all the praise we've heaped upon > you. ;) Marcia...be aware that I tried to praise Howard at various times and he told me that "he didn't need my praises". He can be arrogant and stubborn at times, but I think he is a tremendous benefit to this ng (and the heartburn ng), and I certainly appreciate him volunteering his time and have said my heart goes out to a doctor that will do that (far and few between - very rare). But he told me he didn't need my praise - oh well. Sorry Howard, I like you, but I have to call them the way I see them. If you want to start attacking me, be aware that I have all of our previous messages on my hard drive :-) ...Pete > Marcia...be aware that I tried to praise Howard at various times and he told > me that "he didn't need my praises". He can be arrogant and stubborn at [quoted text clipped - 5 lines] > attacking me, be aware that I have all of our previous messages on my hard > drive :-) ...Pete Oh! If he can be arrogant and stubborn, then I guess he really *is* a surgeon. ;) I haven't read the posts you're referring to, so it's hard for me to know what was going on or to guess why he said that, but I'm sure he *doesn't* actually need anyone's praise or gratitude or whatever to prop up his ego. Tough, I say. If he's done something nice for you or someone else and you appreciate it, you're free to pay him a compliment, and he'd better be man enough to handle it. :) I guess he appeals to me because my favorite uncle is a cardiologist, and he has always taken an instructive approach with me, and I respond to that. I practically lived with my aunt and uncle when he was in med school, and anyone who makes me think of him gets a more-than-generous appraisal in my book. It's the same way with my GP who taught at the local med school and has been a preceptor in private practice for number of years. So if I come off a little too effusive, it has more to do with my own psychology than anything else. Try not to take what he said to you too much to heart. You seem to me a very kind and sensitive person, which is rare. People who are a little less sensitive sometimes don't realize the impact their words may have on others, and may make comments that mean little to them and much to the person they're talking to. For now, I'm giving him the benefit of the doubt. And if he turns out to be the evil troll who lives under the bridge, well... I'll cross that bridge when I come to it. :) Pete wrote: > Marcia...be aware that I tried to praise Howard at various times and he told > me that "he didn't need my praises". He can be arrogant and stubborn at [quoted text clipped - 5 lines] > attacking me, be aware that I have all of our previous messages on my hard > drive :-) ...Pete Oh! If he can be arrogant and stubborn, then I guess he really *is* a surgeon. ;) I haven't read the posts you're referring to, so it's hard for me to know what was going on or to guess why he said that, but I'm sure he *doesn't* actually need anyone's praise or gratitude or whatever to prop up his ego. Tough, I say. If he's done something nice for you or someone else and you appreciate it, you're free to pay him a compliment, and he'd better be man enough to handle it. :) I guess he appeals to me because my favorite uncle is a cardiologist, and he has always taken an instructive approach with me, and I respond to that. I practically lived with my aunt and uncle when he was in med school, and anyone who makes me think of him gets a more-than-generous appraisal in my book. It's the same way with my GP who taught at the local med school and has been a preceptor in private practice for number of years. So if I come off a little too effusive, it has more to do with my own psychology than anything else. Try not to take what he said to you too much to heart. You seem to me a very kind and sensitive person, which is rare. People who are a little less sensitive sometimes don't realize the impact their words may have on others, and may make comments that mean little to them and much to the person they're talking to. For now, I'm giving him the benefit of the doubt. And if he turns out to be the evil troll who lives under the bridge, well... I'll cross that bridge when I come to it. :) I took some psychology classes and no longer remember all of those terms we had to memorize to pass the tests. It my guess that "net cops" have a really low self esteem. Their self esteem is raised when they put someone down. In other words, they build UP their self esteem by putting other people DOWN. If they get a complement when they put someone down--their self esteem is raised even higher. It's kind of like a cocaine high--it's only a temporary high. Therefore, they have to do it at least once or more per day to build up their self esteem. If they are not able to do it where they work, they do it at home with their wives and children. Many of them abuse their wives and children--either mentally or physically. Perhaps newsgroups are a great place for them since they can become net cops. If it prevents the abuse of wives and children--perhaps becoming a net cop would be a great thing. My brother-in-law was such a person--very low self esteem--I recall watching him deal with his children. During the entire evening, he criticized them and put them down. I don't recall him saying one positive thing to them the entire evening. It's really sad to watch someone with a low self esteem trying to build it up by putting people down. Jason >> Marcia...be aware that I tried to praise Howard at various times and >> he told me that "he didn't need my praises". He can be arrogant and [quoted text clipped - 37 lines] > to be the evil troll who lives under the bridge, well... I'll cross > that bridge when I come to it. :) Thank you for your nice comments Marcia, I like you. I do consider myself a kind and caring person, and will admit that I am sensitive, and I have been to hell and back with doctors in my life. I can also be a son of a bitch, but I like to think it is in a reactionary mode :-) . You have a very nice and understanding way about you and handle yourself well in the ng. Remember I don't like doctors in general, so every once in a while you may see me inject some negativity about my many bad experiences with them. There is a urologist from Spain who volunteers his time in the BPH ng, who is truly awesome, and the best I have ever seen, and I have praised him to the hilt, and he is a true kind and caring person, and boy do I wish he was my urologist. Howard is a tremendous benefit (to this and the heartburn ng - like I have said), but he can be a little abrupt sometimes. I look for his posts all the time, always trying to expand my medical knowledge, and learn as much as I can. I have even caught him at a couple minor faux pas, which he graciously acknowledged, but I consider him extremely knowledgeable, and do indeed appreciate his efforts [sorry Howard, I just praised you again :-)]. Take care. I believe you are a good person :-) ...Pete Jason Johnson wrote: > Marcia, > You are probably correct. I am glad that Howard makes use of his medical [quoted text clipped - 25 lines] > to prevent you from posting. > Jason I don't think Howard qualifies as a "net cop," either. He's been very gracious in sharing his expertise, doesn't come across as arrogant (which makes me wonder if he's really a surgeon...;)), and doesn't get defensive when questioned. That makes him a great resource, imo. Then there's Robert who, I think, has said he's a medical technologist, who also seems to be knowledgeable and helpful, as well as a few other characters of variable usefulness who pop up from time to time. I didn't respond to the blood sugar message until after Robert did because I didn't have any knowledge that would help the poster, either. However, when he returned after Robert told him his blood sugar was dangerously high, I didn't feel under-qualified in pushing him toward the hospital when he seemed reluctant to go. Imo, you can usually say, "see a doctor, see a doctor, see a doctor," with impunity, because that's often the obvious appropriate action. And if someone's symptoms sound alarming (one side of my face is paralyzed; my blood sugar is still 550, etc.,) there's little harm in saying, "go to the ER." It seems people sometimes post here hoping to avoid doctors and hospitals, so empathy and encouragement is usually a safe response, as well. I think the trick lies in figuring out what you can responsibly say to a poster given your specific knowledge of a condition or situation. I know I'm not qualified for much more than hand-holding, so when I step over that line, I can handle the criticism. I really appreciate that Howard took the time to educate me about my error--that's not "net cop" behavior, but more like mentoring. I think if you can look at it that way, it makes the interaction less threatening. So far, I haven't encountered any of those "net cops" you mentioned, but I'll definitely be on the lookout. If I were you, I'd go back and attack that lab tech's manhood. ;) Marcia, You made lots of great points. I hope that you never have to deal with net cops. I believe the net cops have some serious psychologcal problems. It's kind of like those people that enjoy criticizing fellow employees when the boss is in the room. When the boss agrees with them about that criticism--it makes them act like a little child when you give him candy. They get a feeling of joy when they criticize someone--esp. when a fellow net cop posts a message agreeing with their criticism. Two net cops in one newsgroup can close it down since they feed off each other's posts. They take turns patting each other on the back. I have noticed that only men play the role of net cops--so it could be a manhood issue. I once had to work with someone that treated me great when we were working together but would criticize me when there was a group of people around him. I requested a transfer to a different department to get away from that nut case--no one wanted to work with him since he treated them the same way that he treated me. He was later assigned to a job where he only had to work with supervisors. They close down newsgroups because no one wants to become their victims. Jason > Marcia, > You made lots of great points. I hope that you never have to deal with [quoted text clipped - 14 lines] > They close down newsgroups because no one wants to become their victims. > Jason Oh, I know the type you're talking about. I just had a fun encounter with a couple of hyenas ("net cops") on another NG. I agree, like most bullies they've got major issues. Also, like most bullies, they have weakness and can be overcome if you build up a thick enough skin and have a talent for sarcasm. I think you made a good choice by leaving those groups. People like that are toxic, and if you spend too much time around them, or try to play their games, you'll only end up feeling sick inside. Not surprisingly, they tend to gravitate to the internet and land smack in the middle of usenet, probably because no one will tolerate them in the real world. They are arrogant, obnoxious, rarely as smart as they think they are, and tend to get involved in online feuds that last for years. I don't know what their specific psychological diagnosis might be, but my guess is terms like "paranoid" and "personality disorder" figures heavily into it. I don't mean to drop you in the middle of a conversation, but I just found out my kids are making s'mores over an open flame on stove, so I'd better go supervise before they turn into crispy critters. Later. M :) Quickly... Pete and Jason, you can email me. I'm sure the group doesn't want to read all this. Marcia > I didn't respond to the blood sugar message until after Robert did > because I didn't have any knowledge that would help the poster, either. > However, when he returned after Robert told him his blood sugar was > dangerously high, I didn't feel under-qualified in pushing him toward > the hospital when he seemed reluctant to go. Don't really know if that was a bogus post or not but if it wasn't then I hope he is OK. I have trouble posting to people here who will say something like I have a blood on the side of my head after I had a car accident and made it home and wants to know what to do or what could it be. > Imo, you can usually say, "see a doctor, see a doctor, see a doctor," > with impunity, because that's often the obvious appropriate action. And [quoted text clipped - 7 lines] > but I'll definitely be on the lookout. If I were you, I'd go back and > attack that lab tech's manhood. ;) There is a difference when I post here and when I am at work. I have received many phone calls from outside the hospital asking specific questions. I have seen patients coming out of doctors offices and they have asked me very specific questions about their care or understanding of their condition. I have seen very angry patients wanting and demanding their lab results and when given those results want to know what they mean. They assume the lab results are stated in plain English as to "you have this or that". I can not say one single word about interpretation or meaning. When a doctor calls and wants help then we have more room for interaction. This is not a medical setting and it's pretty much a free for all and anyone can voice an opinion and the buyer beware on who they believe. It is very difficult as a medical professional to remain silent when things are posted that one knows is wrong. That is the area of contention here. I think everybody needs to know that people with a wide background will comment here and the net is the great equalizer on opinion. If the person wanted solely a medical opinion then he would go to a doctor and he wouldn't be here asking questions. I think people want a patient advocate or info in which to evaluate the medical opinion. Again I say that one needs a strong doctor to patient relationship based on trust but verify. Get second opinions or third. Not a net cop here but do voice an opinion like everyone here. > > I didn't respond to the blood sugar message until after Robert did > > because I didn't have any knowledge that would help the poster, either. [quoted text clipped - 4 lines] > Don't really know if that was a bogus post or not but if it wasn't then > I hope he is OK. Good question. I pulled his profile this morning and noticed there was about an 11-hour gap between his last post (which was right around the same time as his last post here) and his next post, so hopefully that means he got treatment if he was telling the truth. He was definitely still alive and posting on alt.hard.drugs (hmmm) about 16 hours ago. > I have trouble posting to people here who will say something like I > have a blood on the side of my head after I had a car accident and made > it home and wants to know what to do or what could it be. Understandable. Since I don't have a medical background, it's especially hard for me to tell who's making things up, who has a legitimate concern, and who is just uncommonly stupid. I would tend to want to err on the side of caution, but you're under no obligation to respond to any of them, so your own judgment is your best guide. FWIW, people with "Munchausen by Internet" (which is really just factitious disorder) tend to present very dramatic symptoms with the hope of engaging you in care-taking behavior. They're trying to get basic needs for nuturing met, and probably gravitate more toward support groups than places like this (although I'm sure they pop up here on occasion, too). If you ignore them, answer their questions in clinical way, or point them toward a doctor or hospital, they're unlikely to stick around because you're not meeting their true, unstated need. I'm no psychiatrist, but my degrees are in psychology and sociology, and I have a special interest in Munchausen, factitious, and somatoform disorders, so I'm on a little safer ground with this one. > > Imo, you can usually say, "see a doctor, see a doctor, see a doctor," > > with impunity, because that's often the obvious appropriate action. And [quoted text clipped - 17 lines] > as to "you have this or that". I can not say one single word about > interpretation or meaning. Understood. I can recall the frustration I felt watching watching the ultrasound tech's face while reading the screen when I went into early labor with my first child. I could tell she was concerned about something, and I badgered her unmercilessly, but she wasn't allowed to tell me anything, either. (Placenta previa; everthing turned out fine). It does amaze me that people leave their doctors' offices with questions unanswered because, I suspect, they went unasked. Maybe that does speak to the quality of the doctor-patient relationship, although I think the patient bears a responsibility for developing that, too. It's not a relationship unless both parties participate. > When a doctor calls and wants help then we have more room for > interaction. [quoted text clipped - 11 lines] > that one needs a strong doctor to patient relationship based on trust > but verify. Get second opinions or third. I'm not sure everyone *does* understand that caveat emptor applies on the internet, or perhaps most strongly on the internet. Some people may come to this NG expecting an expert opinion, and may be inclined to believe anything they read. That's a little scary. And you're right, there are no restrictions on who can participate or to what extent... any given post could be answered by an expert, a well-meaning but misguided lay person, or a total kook. >From the perspective of someone not working in the medical field, I can say there are a lot of people out here who are reluctant to see a doctor when they need one, or first need to be thoroughly convinced they have a problem they can't solve themselves (I'm guilty of this one, myself), especially if they feel there's something embarassing about their situation. People who are comfortable seeing doctors don't need to ask for confirmation because they're already sitting in someone's waiting room. They may post later, asking for clarification or further information on something. That's my take on it, subject to revision as I learn. :) I agree with you about the need for a strong doctor-patient relationship, and I also understand why you might post to correct misinformation. That's responsibile behavior, imo, and not something you need apologize for. > Not a net cop here but do voice an opinion like everyone here. Never suspected you of being a net cop. My observation has been that you respond to what you know about, refrain from undue speculation, and correct misinformation in a way that allows the ...er... "misinformer" to save face. I've never seen you deliberately humiliate anyone, which I believe is the concern of the person talking about net cops. Some people are more sensitive to criticism than others and it's hard to tell how any given person will respond to (or feel about) being corrected. Personally, I don't mind being criticized, but am mortified by my mistakes. lol. > Good question. I pulled his profile this morning and noticed there was > about an 11-hour gap between his last post (which was right around the > same time as his last post here) and his next post, so hopefully that > means he got treatment if he was telling the truth. He was definitely > still alive and posting on alt.hard.drugs (hmmm) about 16 hours ago. We have a critical value call on anybody with a greater than 500 mg/dl glucose. It's ironic that my last one was a few days earlier at the clinic and the doctor was waiting for my call even though it was after hours and hoping they would answer the call. > FWIW, people with "Munchausen by Internet" (which is really just > factitious disorder) tend to present very dramatic symptoms with the [quoted text clipped - 5 lines] > unlikely to stick around because you're not meeting their true, > unstated need. I actually think some people look at the responses to medical situations in order to gain info on how to present or what to say to doctors in order to sound legit. There are certain signs and symptoms that can cause a doctor to act. These are the true Munchausen people. > I'm no psychiatrist, but my degrees are in psychology and sociology, > and I have a special interest in Munchausen, factitious, and somatoform > disorders, so I'm on a little safer ground with this one. We are all victims to own own psyche and the mind can do tricks especially when one mentions do you have a sharp pain radiating to the back (pancreatitis), well now that you mention it yes. There's ways to gain information such as open ended questions which don't really apply here. The lines of communication are distorted here. > It does amaze me that people leave their doctors' offices with > questions unanswered because, I suspect, they went unasked. Maybe that > does speak to the quality of the doctor-patient relationship, although > I think the patient bears a responsibility for developing that, too. > It's not a relationship unless both parties participate. They are scared of the doctor or don't want to bother him. Those also post here and the answer is to fix the relationship or find another doctor. > I'm not sure everyone *does* understand that caveat emptor applies on > the internet, or perhaps most strongly on the internet. Some people may [quoted text clipped - 3 lines] > any given post could be answered by an expert, a well-meaning but > misguided lay person, or a total kook. Jason's complaint is very rare as most professionals are hounded and run off by the kooks who want to control the NG. I hate it when posters start out with I don't trust my doctor blah, blah. I have had the same doctor for twenty years. I trust him but that doesn't stop me from getting second opinions. > >From the perspective of someone not working in the medical field, I can > say there are a lot of people out here who are reluctant to see a [quoted text clipped - 6 lines] > or further information on something. That's my take on it, subject to > revision as I learn. :) That's true and that's why it helps greatly to have a good doctor patient relationship and like any relationship over time that reluctance or embarassment is gone. That's the biggest mistake that people make is all of a sudden they need a doctor and they don't know anybody. That never works to their satisfaction and it can be dangerous. > I agree with you about the need for a strong doctor-patient > relationship, and I also understand why you might post to correct [quoted text clipped - 13 lines] > person will respond to (or feel about) being corrected. Personally, I > don't mind being criticized, but am mortified by my mistakes. lol. I've had my moments, lol. You have a fair balanced and stabilizing influence here and you are welcome. > > FWIW, people with "Munchausen by Internet" (which is really just > > factitious disorder) tend to present very dramatic symptoms with the [quoted text clipped - 10 lines] > doctors in order to sound legit. There are certain signs and symptoms > that can cause a doctor to act. These are the true Munchausen people. Good insight. I hadn't considered it from the perspective of their being here to do research, but I think you've made a valid point. I'm going to start watching those posts more carefully to see what I can learn. What piqued my interest about Munchausen and factitious patients was having had a friend who turned out to have this/these disorder(s)--I was only able to get her to admit to the factitious part, but I suspect most of her medical emergencies were manufactured as well. She was a frequent flier at most of the hospitals in her city, and also made the rounds on a few hospitals in *my* city when she came to visit. I understand why medical professionals find them frustrating and annoying to deal with, but they're fascinating to watch from the sidelines. For awhile, anyway. :) What do you see out in the real world WRT Munchausen patients? The literature suggests it's relatively rare and--in hospital patients--more often seen in men (not counting Munchausen by Proxy, which is mainly women), but I wonder if the line between Munchausen and factitious disorders isn't a little blurrier than the literature suggests, and if there aren't *at least* as many women as men perpetrating it? > We are all victims to own own psyche and the mind can do tricks > especially when one mentions do you have a sharp pain radiating to the > back (pancreatitis), well now that you mention it yes. There's ways to > gain information such as open ended questions which don't really apply > here. The lines of communication are distorted here. That's true. Conversations on the internet aren't really interactive, so it would be difficult to ask or get a valid and revealing answer to an open-ended question. Then you have the added difficulty of not being able to read a person's facial expressions or body language, which might otherwise inform your choice of follow-up questions. > > It does amaze me that people leave their doctors' offices with > > questions unanswered because, I suspect, they went unasked. Maybe that [quoted text clipped - 5 lines] > post here and the answer is to fix the relationship or find another > doctor. I'll bet they also withhold vital information from their doctors. > I've had my moments, lol. You have a fair balanced and stabilizing > influence here and you are welcome. Thanks. :) I'll grant you leniency for your "moments," if you'll grant leniency for mine. I'm not always fair, balanced, stable or even polite, as the anti-vacc'ers will gladly tell you. ;) > Understood. I can recall the frustration I felt watching watching the > ultrasound tech's face while reading the screen when I went into early > labor with my first child. I could tell she was concerned about > something, and I badgered her unmercilessly, but she wasn't allowed to > tell me anything, either. (Placenta previa; everthing turned out fine). That is unnerving! So glad it was all okay. > It does amaze me that people leave their doctors' offices with > questions unanswered because, I suspect, they went unasked. Maybe that > does speak to the quality of the doctor-patient relationship, although > I think the patient bears a responsibility for developing that, too. > It's not a relationship unless both parties participate. Well, sometimes when you're alone in the doctor's office and get hit with unexpected bad news, you get pretty shook up. I always take a list of questions to a planned office visit, but this was topic was new to me and I wasn't prepared for an invasive procedure. Obviously I didn't ask the right questions, but I don't always think fast on my feet. It's all worked out though, and I have apoligized profusely to the scheduling nurse for being a pest. Jane > > It does amaze me that people leave their doctors' offices with > > questions unanswered because, I suspect, they went unasked. Maybe that [quoted text clipped - 11 lines] > > Jane Oh, of course--that's always an exception. If a doctor told me the most common cause of something I presented with was cancer, I'm sure nothing he said afterward register. I returned to one of your earlier posts and saw where you mentioned you'd had questions after leaving the office, so I can understand why you might think I/we were referring to you, but by that message we had digressed a bit, and I was actually thinking of my frustration with my father and his diabetes and (apparently now) heart condition. Sorry; I know that wasn't clear. Conversations frequently digress around here, sometimes to the point where messages later in a thread have very little to do with the original's poster's question. Sad but true. :) I have no criticism at all for the way you've handled this. I think you've approached your concerns in a reasonable way; not everyone is as proactive as you've been about addressing your fears by educating yourself. I'm glad you called your doctors office and arrived at a solution you're comfortable with. I hope you'll return afterward to tell us everything went well. Now, I'm off to find that long post you alluded to that seems to be lost. ;) marcia >>>It does amaze me that people leave their doctors' offices with >>>questions unanswered because, I suspect, they went unasked. Maybe that [quoted text clipped - 38 lines] > > marcia Well, it *is* hard to be a good patient all the time. Don't I know it. Anyway, thanks again. :-) >>>I have never had a cystoscopy, but my husband had a colonoscopy once, >>>and they gave him something to sedate him. He says he doesn't recall it [quoted text clipped - 66 lines] > surgeon who specializes in minimally invasive procedures. So if you're > going to listen to anyone in this thread, it should be him. Hi, Marcia. Thanks for this interesting contribution! I didn't see Howard's posts show up in the NG but appreciate a point of view from a surgeon. No, the doc didn't tell me he would use a topical anesthetic, which seems like the obvious thing to say, so I have to wonder about that. I believe I would have gone ahead right then if he'd mentioned it. I was indeed planning to call his office tomorrow (after my CAT scan ) and ask exactly that, if he would give me something to make me more comfortable. Not sure why that's such a bad idea ... I understand Howard's comment about office scheduling in the next post, but I can take my own valium at home an hour prior to the appt. The very idea of local anesthesia helps cut my anxiety. However, then Howard ends up saying "Others may do it differently, and I do suggest that the OP call the urologist's office and find out HIS opinion... " so I'm not sure exactly what he says I should or shouldn't call about. Man I still don't know what to do ... But thanks for all the comments folks!! > I understand Howard's comment about office scheduling in the next post, > but I can take my own valium at home an hour prior to the appt. The very [quoted text clipped - 5 lines] > Man I still don't know what to do ... But thanks for all the comments > folks!! Concerning taking the valium, if one is doing their own driving to the office then they would not allow it because of legal concerns accidents etc. They don't want to be in a position of telling you it's OK to take a valium and drive. If they give you the valium there then driving home is out of the question. They won't let you. Topical anesthetics are used in males normally and I don't know about females. >>I understand Howard's comment about office scheduling in the next post, >>but I can take my own valium at home an hour prior to the appt. The very [quoted text clipped - 9 lines] > is out of the question. They won't let you. Topical anesthetics are > used in males normally and I don't know about females. No, no! My husband would drive me and wait and take me home. I won't drive myself. When I read 'topical anesthetic' I understood 'local anesthetic'. 'Topical' doesn't seem very strong. Jane > No, no! My husband would drive me and wait and take me home. I won't > drive myself. [quoted text clipped - 3 lines] > > Jane You know what I wonder? How does a cytoscope compare in size to a Foley catheter? If you've ever been catheterized during a hospital stay you know that, while it's not something you'd do for fun on a rainy weekend, having one inserted isn't really all that horrible. If there's any kind of valid comparison there (if Howard doesn't answer, you can ask when you call your doctor's office), then I think this procedure may be less traumatic than it sounds. >> No, no! My husband would drive me and wait and take me home. I won't >> drive myself. [quoted text clipped - 13 lines] > call your doctor's office), then I think this procedure may be less > traumatic than it sounds. The pain of injecting a local anesthetic would be substantially greater than the pain of a cystoscopy. Topical anesthesia is especially effective when applied to mucous membranes such as the urethra. Local injection would add nothing except more pain. A typical flexible cystoscope is 3-4 mm in diameter, smaller than a typical foley catheter which is 5-6 mm in diameter. HMc >>>No, no! My husband would drive me and wait and take me home. I won't >>>drive myself. [quoted text clipped - 23 lines] > > HMc Interesting, thanks! I get it about the anesthesia. Jane >>No, no! My husband would drive me and wait and take me home. I won't >>drive myself. [quoted text clipped - 13 lines] > call your doctor's office), then I think this procedure may be less > traumatic than it sounds. Hi, Marcia. I was only catheterized once and it was after surgery when I was still under. I don't remember the insertion part and I don't remember how long I had it in, so it couldn't have been too scarring to my psyche. ;-) Howard did say it's clearly smaller than a cath and the office does use the xylocaine jelly. I hope your assessment is correct that the procedure is less traumatic in fact than it sounds! Jane > Hi, Marcia. I was only catheterized once and it was after surgery when I > was still under. I don't remember the insertion part and I don't > remember how long I had it in, so it couldn't have been too scarring to > my psyche. ;-) The least they could have done was wake you up, so you'd have the experience as a point-of-reference later! > Howard did say it's clearly smaller than a cath and the office does use > the xylocaine jelly. I hope your assessment is correct that the > procedure is less traumatic in fact than it sounds! > > Jane I hope it is, too. FWIW, I can remember being catheterized, and I wouldn't call it more than briefly uncomfortable. Once the catheter's all the way in, it's barely even that. I think between the xylocaine jelly and the small diameter of the scope, things are looking very positive (or as positive as anything like that can be). Jane Cohen wrote: >> Howard did say it's clearly smaller than a cath and the office does use >> the xylocaine jelly. I hope your assessment is correct that the >> procedure is less traumatic in fact than it sounds! Well, to be clear, MOST flexible cystoscopes are smaller than MOST urinary catheters. Now, I was a little surprised to hear that your urologist uses a rigid cystoscope. I don't know what the diameter of that might be, there are several different arrangements. HMc > Jane Cohen wrote: > [quoted text clipped - 8 lines] > > HMc Uh oh ... there goes that anxiety level ... No, I think this will be ok. Thanks again for your help, Howard. Jane >> Jane Cohen wrote: >> [quoted text clipped - 14 lines] > > Jane Yeah, sorry about that. However, it's unlikely that your urologist would want you to be in pain, and if he didn't have a system for office cystoscopy that his patients were OK with, he'd change the system. HMc >>> Jane Cohen wrote: >>> [quoted text clipped - 20 lines] > > HMc Or, he's one of those older docs that still do things the old ways ... LOL He did say that if his patients were all screaming and yelling in great pain, he would have an empty waiting room. I guess that's true. Jane >>>> Jane Cohen wrote: >>>> [quoted text clipped - 22 lines] > Or, he's one of those older docs that still do things the old ways ... > LOL Jane...I didn't want to tell you about the rigid scope I had in 1995 from one of the old time docs you mentioned [they do like to stay with their original equipment :-)]. I have had flexible scopes since, and they are not quite as bad (but remember I am a male, and the rigid will definitely hurt a male more). It sounds like you have one of the older uro's. I don't understand why he hasn't switched to a flex scope. It would certainly let him get a better look at the bladder also. I still think you will be all right and do just fine. Try not to worry so much :-) ...Pete > He did say that if his patients were all screaming and yelling in > great pain, he would have an empty waiting room. I guess that's true. > > Jane > Jane...I didn't want to tell you about the rigid scope I had in 1995 from > one of the old time docs you mentioned [they do like to stay with their > original equipment :-)]. NO please don't!! I can't take any more! ;-) > I have had flexible scopes since, and they are not > quite as bad (but remember I am a male, and the rigid will definitely hurt a [quoted text clipped - 4 lines] > look at the bladder also. I still think you will be all right and do just > fine. Try not to worry so much :-) ...Pete I asked all the nurses at the hospital (I saw a lot of nurses when I was there for the pre-op testing and the CT scan) and they all said his practice is the best around here. The nurses know who's good and who slides by. I felt like I had a rapport with the nurses b/c they all understood my panic and couldn't have been more comforting, and I am quite sure they would have indicated in some way (nudge nudge wink wink) if they thought I should find another doc. I'm gonna give this a try in the office. Now I'm gonna stop thinking about all this until Monday! I'll report back if I live to tell the tale. Jane >>Hi, Marcia. I was only catheterized once and it was after surgery when I >>was still under. I don't remember the insertion part and I don't [quoted text clipped - 15 lines] > jelly and the small diameter of the scope, things are looking very > positive (or as positive as anything like that can be). Yes I think so too. Thanks for your support. First I'll say what I did, then I'll go back and answer some of the individual posts. I called the uro's office this morning, followed the telephone prompts and left a message for his nurse. Then I went for my CT scan. I drank all the stuff ok at home. I walked into a full waiting room and was quite pleased when I was taken promptly at my appt time. That was fine. I also had a scrip for a chest xray from my internist and they squeezed me in for that also. Now I have lower back pain around my kidney ;-) Around noon the nurse called me but I lost the call on my cell phone. It took another hour to make contact again. She was very pleasant. She said some people do have difficulty handling the procedure, but most people tolerate it fine. Most of their patients do it in the office. She said it really only is about one minute of discomfort. They do use the xylocaine jelly. She said she thought I should try it and if I freak out they will reschedule the hospital. She said it was not a problem to cancel the hosp appt. The only bad thing is they don't use a flexible scope on women, only men. Except for that, it all seemed very reasonable so I agreed to try it. (Ok I just went to look for an anatomy chart on the internet and I see that women basically do have nice short straight urethras LOL) That's my story. The new appt is scheduled for Mon June 12. I had trouble squeezing it in with all my other doctor appts. I feel like I'm in training to be an old person ;-) Thanks everyone who commented! I feel better now about this decision. > First I'll say what I did, then I'll go back and answer some of the > individual posts. [quoted text clipped - 27 lines] > > Thanks everyone who commented! I feel better now about this decision. Sounds like things are moving right along. You had a good experience this morning, other than the lower back pain and slight hiccup of finding out the scope's not flexible. The nurse was able to offer you some options you can live with, and your cell phone carrier only dropped you once. All in all, not a bad outcome so far. ;) You really are sounding a lot less fearful, more upbeat, more confident. I hope everything continues going well for you, and that your health concerns turn out to be small and manageable. Please come back and let us know how you're doing. :) marcia >>First I'll say what I did, then I'll go back and answer some of the >>individual posts. [quoted text clipped - 40 lines] > > marcia Thanks. I will report back. > I was indeed planning to call his office tomorrow (after my CAT scan ) and > ask exactly that, if he would give me something to make me more [quoted text clipped - 9 lines] > Man I still don't know what to do ... But thanks for all the comments > folks!! My suggestion is that you call the urologist's office and tell them that you're anxious about the procedure. They may tell you to take your own prescription Valium, or they may have a protocol where they give you some type of sedative/hypnotic before the procedure. Different surgeons do these things differently. I'm only suggesting you call YOUR doctor's office and find out how he does it. HMc > > I was indeed planning to call his office tomorrow (after my CAT scan ) and > > ask exactly that, if he would give me something to make me more [quoted text clipped - 16 lines] > things differently. I'm only suggesting you call YOUR doctor's office and > find out how he does it. ANECDOTE AHEAD - proceed with caution: I recently had a cystoscopy. I was told that local anesthesia was not used in female patients as the female urethra is too short for the topical anesthesia to do any good. According to the papers I found on the topic on PubMed, this does seem to be the the current prevailing opinion, though personally, I'd wish they'd at least try it. The procedure itself takes less than 15 minutes; when I called to tell them I have the paradoxical reaction to Versed (and was scared crapless about having it done), I was told it was not used due to the brevity of the procedure. Again, this is anecdotal; different urologists may do things differently. That said, the procedure was unpleasant, but not *nearly* as unpleasant as I had feared. My prior urologic adventure had been surgery to remove a stone from deep within my kidney, so my fear level very, very high.  Signature"Did Father shoot him? I will eat Grandfather for dinner." - Helen Keller, on learning of the death of her grandfather > ANECDOTE AHEAD - proceed with caution: I recently had a cystoscopy. I > was told that local anesthesia was not used in female patients as the [quoted text clipped - 6 lines] > used due to the brevity of the procedure. Again, this is anecdotal; > different urologists may do things differently. Just this very moment, one of my partners walked by. She is a Urogynecologist and does many, many flexible cystoscopies on any given day. She tells me that she and her partners ALL use a topical anesthetic for cystoscopy on females (xylocaine jelly). It is gently applied to the urethra externally, and applied to the cystoscope. HMc > > ANECDOTE AHEAD - proceed with caution: I recently had a cystoscopy. I > > was told that local anesthesia was not used in female patients as the [quoted text clipped - 12 lines] > cystoscopy on females (xylocaine jelly). It is gently applied to the urethra > externally, and applied to the cystoscope. That could be the difference - my urologist's suites are decorated exclusively with diagrams of the male urinary tract and other male-anatomy-based posters to point that the first time I was seen there, I wasn't sure I had gone to the right place. There may be other women patients there - I've just never seen them. I did mention my information was anecdotal; nonetheless, not even trying to numb the area seemed a little brutal so I did look it up on PubMed to see how far this deviated from the norm. I did request xylocaine jelly be used during my procedure, but that request was refused. Signature"Did Father shoot him? I will eat Grandfather for dinner." - Helen Keller, on learning of the death of her grandfather >>>ANECDOTE AHEAD - proceed with caution: I recently had a cystoscopy. I >>>was told that local anesthesia was not used in female patients as the [quoted text clipped - 23 lines] > see how far this deviated from the norm. I did request xylocaine jelly > be used during my procedure, but that request was refused. My uro's office also features diagrams of males. I read that only 20% of a uro's practice is female. Howard mentioned a urogynie - sounds brilliant but I'm sure we don't have any in this area. My uro will use the xylocaine so that's reassuring. By the way, after the procedure, were you fine to go out or did you go home to sleep? I have this appt scheduled for 11 am and another dr appt scheduled for 1:40 pm. And I plan to be zonked from valium ;-) Jane > By the way, after the procedure, were you fine to go out or did you go > home to sleep? I have this appt scheduled for 11 am and another dr appt > scheduled for 1:40 pm. And I plan to be zonked from valium ;-) I had mine around 10 am and was out by 10:40 (there was a lot of waiting and re-setting for my latex allergy). I was able to do what I normally do, but I was in some pain. Keep in mind that mine was done because I have a chronic kidney infection which itself is quite painful and I had passed a stone a few days before as well. Your mileage could vary considerably! Most doctors give a drug like Prosed/Urised or another urinary tract analgesic afterward; it isn't sedating but is supposed to help with the urethral spasms (mine didn't prescribe anything - but you won't be seeing him!) Signature"Did Father shoot him? I will eat Grandfather for dinner." - Helen Keller, on learning of the death of her grandfather >>By the way, after the procedure, were you fine to go out or did you go >>home to sleep? I have this appt scheduled for 11 am and another dr appt [quoted text clipped - 9 lines] > help with the urethral spasms (mine didn't prescribe anything - but you > won't be seeing him!) Hi, REP. Thanks for the comments and the tip about the post-procedure meds. I'll be sure to ask for something. > Just this very moment, one of my partners walked by. She is a > Urogynecologist and does many, many flexible cystoscopies on any given day. [quoted text clipped - 3 lines] > > HMc My uro will use the xylocaine jelly (good) but not the flexible cystoscope (bad). But I'll give it a go. Jane > ANECDOTE AHEAD - proceed with caution: I recently had a cystoscopy. I > was told that local anesthesia was not used in female patients as the [quoted text clipped - 10 lines] > as I had feared. My prior urologic adventure had been surgery to remove > a stone from deep within my kidney, so my fear level very, very high. Hi, REP. Hope you are fully recovered from the paradoxical reaction to Versed. Your story is actually encouraging, as you say it was not nearly as bad as you expected. And this uro does use xylocaine jelly. Jane > > ANECDOTE AHEAD - proceed with caution: I recently had a cystoscopy. I > > was told that local anesthesia was not used in female patients as the [quoted text clipped - 13 lines] > Hi, REP. Hope you are fully recovered from the paradoxical reaction to > Versed. There is nothing to recover from - the paradoxical reaction is that it doesn't work at all (or rather, wakes me up and keeps me up). I've had Versed for a number of procedures, including a kidney biopsy, whch means I had them done completely wide awake. I was telling them about this reaction so they could have another sedative on board - which was unnecessary, since they didn't even give a Valium! >Your story is actually encouraging, as you say it was not nearly > as bad as you expected. And this uro does use xylocaine jelly. Much less terrible than I expected (and mine was with a rigid scope, too). Not at all fun ... but far better than I expected (and it took less time, too). Signature"Did Father shoot him? I will eat Grandfather for dinner." - Helen Keller, on learning of the death of her grandfather >>>ANECDOTE AHEAD - proceed with caution: I recently had a cystoscopy. I >>>was told that local anesthesia was not used in female patients as the [quoted text clipped - 27 lines] > too). Not at all fun ... but far better than I expected (and it took > less time, too). Thanks for the clarifications. I guess that's all I'm hoping for -- that it's better than I expect. And now I'd better stop dwelling on this and think happy thoughts for the next week! Jane > > Much less terrible than I expected (and mine was with a rigid scope, > > too). Not at all fun ... but far better than I expected (and it took [quoted text clipped - 3 lines] > it's better than I expect. And now I'd better stop dwelling on this and > think happy thoughts for the next week! I'm glad I could be of some help. I agree - the anticipation was by far the worst thing about it! You have my best wishes for a quick, easy procedure with great news at the end of it. Signature"Did Father shoot him? I will eat Grandfather for dinner." - Helen Keller, on learning of the death of her grandfather >>Thanks for the clarifications. I guess that's all I'm hoping for -- that >>it's better than I expect. And now I'd better stop dwelling on this and [quoted text clipped - 3 lines] > the worst thing about it! You have my best wishes for a quick, easy > procedure with great news at the end of it. Thanks much, REP. I'll report back Monday night. Hi, all. I know you’ve been waiting with bated breath for my cystoscopy report. :-) As you know, I had tremendous anxiety over the pain of the procedure and considered going to the hospital for an outpatient procedure. After I spoke to his nurse last week, I decided to take the risk and try it in the office. After I made that decision, I have been free of anxiety and worry almost the whole week, until yesterday. I actually took a valium last night before bedtime, and took 2 this morning about 90 minutes before the appt time. My husband drove me and they took me promptly. The ‘medieval torture chair’ was not what it seemed. I was imagining a Gyne table with stirrups. The ‘stirrup’ part was actually for my knees, padded, and quite comfortable. (This was a woman’s examining room – the rooms for men are somehow different.) The nurse injected xylocaine jelly and there was a tiny pinch at insertion. They made me wait a few minutes, not long, and the doc came in. My valium must have been working because I was pretty relaxed, able to keep breathing, and not tense. Again, there was a tiny pinch at insertion but … that was it. Then I asked for a urinary tract analgesic (as I learned to do here) and he gave me a look. He didn’t exactly roll his eyes, but it felt like he did. He said, you don’t need it. I said, what about the pain and blood? He said, there will be very little pain and no blood. He was right ;-) So the procedure was nothing! How about the outcome? Well, there is a small 7-mm tumor that he wants to remove and he believes it is malignant. 1/4 inch doesn’t seem that small to me. But on the whole, to me it’s good news. I have a friend my age who felt fine and looked great, and was diagnosed in January with Stage 4 brain cancer, also lung cancer, also lymph node involvement. She felt great, went to the doc about a persistent cough, and found out she is riddled with cancer. That’s what I was most afraid of. One little tumor – the prognosis seems favorable. Of course I’ll have to go for frequent follow ups. No prob. I got the results of the CT scan. “Most results were unremarkable. … There are multiple less than 5-mm diameter low attenuation foci in the liver, may be related to tiny liver cysts. Note is made of a somewhat more prominent 7-mm low attenuation focus adjacent to the fissure of the ligament tere. Followup imaging suggested to assess stability.” Not sure what that all means. Doc pointed it out but basically glossed over it. Problem? Also had a chest x-ray and my lungs are hyperinflated. Long time smoker, quit almost 10 years ago. Problem? Well, that's my story. Appreciate the help and support from the group here. :-) Jane > My suggestion is that you call the urologist's office and tell them that > you're anxious about the procedure. They may tell you to take your own [quoted text clipped - 4 lines] > > HMc Thanks very much. That's exactly what I did and just explained in a long post to all. The nurse was very nice, encouraged me to try it in the office, and said it wasn't a problem to cancel the hospital now and reschedule everything if it's necessary. Because I know I can go to the hospital if I really freak out, I feel comfortable trying it in the office first. I'll take plenty of relaxant first and my husband will drive me. Jane >Flexible cystosopy is most usually an office-based procedure. The urethra is >topically anesthetized. It tends to be less uncomfortable for women in men >because women have a much shorter urethra. It tends to be not very painful, >I'm told by patients, but that is indeed an individualized perception. >Certainly it can be done with sedation, but that would be very unusual to be >done in the office - sedation requires a substantial amount of monitoring >equipment and trained personnel that are well beyond the scope of the >*typical* urologist's office. The OP should check with her own urologist. We've had this question arise before. Are you suggesting that the *typical* oral surgeon -- the guy who extracts teeth or puts in implants -- is more advanced anesthesia-wise than the urologist? My oral surgeon offers local, local with anxiety-reduction (I suppose nitrous oxide), or totally out-of-it anesthesia for extractions at the patient's option and at no additional charge and all done in the office. I've only ever had an extraction so I can't say about the procedure for implants. Are dentists more responsive to the needs of patients than other medical/surgical disciplines? >>Flexible cystosopy is most usually an office-based procedure. The urethra >>is [quoted text clipped - 17 lines] > office. I've only ever had an extraction so I can't say about the > procedure for implants. Yes. Dentists tend to be much more advanced in their application of anesthesia and sedative technique, and especially oral surgeons. They are trained in it, have a sophisticated array of delivery devices and monitoring equipment, and their personnel are trained and experienced in its use. Dentists, and oral surgeons in particular, tend to do things in the off that are far more painful than urologists. The need for anesthetic technique in most surgeons' offices is quite low, as a rule. Comparing a cystoscopy to an oral surgical procedure from a pain standpoint, even an anxiety standpoint, isn't valid. > Are dentists more responsive to the needs of patients than other > medical/surgical disciplines? A practicioner's office is set up based on the needs of the patients they see. HMc >>>Flexible cystosopy is most usually an office-based procedure. The urethra >>>is >>>topically anesthetized. It tends to be less uncomfortable for women in men >>>because women have a much shorter urethra. It tends to be not very >>>painful, >>>I'm told by patients, but that is indeed an individualized perception. >>>Certainly it can be done with sedation, but that would be very unusual to >>>be >>>done in the office - sedation requires a substantial amount of monitoring >>>equipment and trained personnel that are well beyond the scope of the >>>*typical* urologist's office. The OP should check with her own urologist. >> We've had this question arise before. Are you suggesting that the >> *typical* oral surgeon -- the guy who extracts teeth or puts in [quoted text clipped - 4 lines] >> office. I've only ever had an extraction so I can't say about the >> procedure for implants. >Yes. Dentists tend to be much more advanced in their application of >anesthesia and sedative technique, and especially oral surgeons. They are [quoted text clipped - 5 lines] >oral surgical procedure from a pain standpoint, even an anxiety standpoint, >isn't valid. And just how do you come to this conclusion (the degree of pain)? Is there some sort of blood test that can say how high the level is for any particular patient. Or is this just your guess? And regardless of some objective standard (if there is one) why should the patient have to undergo any? I've never had either a cystoscopy or a colonoscopy (that's what you specialize in, isn't it?) but my anxiety level after having read your posts for the last few years and seen your indifference to the pain you might be causing is so freaking high that I doubt even a couple of valium could bring me down from just writing this post, let alone actually volunteering to undergo either procedure. OTOH I have no particular anxiety in going to the dentist even though I know he's going to do some drilling, nor in even having a root canal. The difference, in part, is due to the dental procedure being curative; the medical procedure is only diagnostic. But that of course is no excuse for the lack of painless urology (like painless dentistry). As to whether your assertion about lack of pain (reading between the lines) is correct there's conflicting reports. Some of those in sci.med.prostate.bph report agonizing pain and the infuriating indifference of the provider. Others on some B&D sites assert no pain using sounds far bigger than your cystoscope. The latter say that if there's pain, it's due to lack of adequate lubrication. Impossible to know who to believe. >> Are dentists more responsive to the needs of patients than other >> medical/surgical disciplines? >A practicioner's office is set up based on the needs of the patients they >see. Based on the assumptions and convenience of the practitioner, more likely. >> Hi. I had a brief 30-hour episode of blood in urine a week ago. The >> urologist wants to do a cystoscopy. He wanted to do it in his office [quoted text clipped - 14 lines] > > Good luck and let us know how you do :-) ...Pete Jane...I am sorry, but I have to yawn a little bit after reading all the extensive posting below, based on all my vast experiences with endoscopies, including the uro cystoscopy, which is the only one I have while awake. I don't think the local (xylocaine or lidocaine) is worth a sh.t (pertaining to me as a male). But as long as your uro uses a flexible scope, I believe the local should be just fine. I am not a female, so I cannot say what the pain level is for females. But like I said, I believe it should be less painful for females because males have more plumbing to get through. I think you may be worrying a little too much. You can take a valium if you think that will help and have your husband drive you. I think you will be okay unless you are totally allergic to pain of any kind :-) . Actually, it may be better to be awake so the uro can get a feedback from you as he/she is instilling water in your bladder (which I assume they will do). Take care :-) ...Pete > Jane...I am a male and it hurts us worse than you, since we have more > plumbing to go through. I am sure your uro will use a flexible scope and it > shouldn't be too bad. I would recommend you go for it in the office, > especially if you have to pay for it w/o insurance. > > Good luck and let us know how you do :-) ...Pete Well, Pete, as I said just above, he does *not* use a flexible scope but he *does* use the xylocaine jelly. I'll give it a try. Thanks for your support, Jane |
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