Colonoscopy and Canabis interaction with Propofol

Tests and investigations
1

Hello there,

I'm a 46 yrs old male, health with no underlying health conditions. This will be my second Colonoscopy only that this time the Anasthesia part is done by Propofol. 

I am a Canabis user. I smoke every evening - this was the only "drug free" solution I found that can help my insomnia. 

My procedure is scheduled in 5 days and today I started panicking... Is the combination of the two (Propofol and Canabis in my system) dangourus? Should I postpone surgury and "clean" myself for a month prior? Couldn't find much info - maybe you guys can route me?

Thanks,

R 

2

I don't have any personal experience about the drug interaction but just wondering why you need anaethesia for the colonoscopy? It isn't a painful procedure.

If you google "cannabis and propofol" you do find some scholarly articles, one saying that, in tests, if cannabis is present the system, then higher doses of propofol are required in order to be effective. This sounds like it's relatively safe to combine the two but would probably lengthen your recovery time. Best advice would be to call the endoscopy department to see what they advise.

3

I am not any kind of doctor and/or an anaesthetist but there are some studies suggesting that more propofal may be required when the patient is a regular cannabis user so this may not be the best agent if you are a moderate to heavy cannabis smoker. I may be completely wrong or it may be a study on using propofal in a completely different situation but you should certainly raise it with your consultant. If you type in propofal and cannabis interaction you will see the articles. It seems to be research in its early stages and it may be to do with inducing general anaesthesia. As I say, anything to do with drug interactions is for the experts so the thing to do is check with them.

4

Sorry, Limeleaf 2 said it all in much shorter form than I - I should have checked to see if there were any replies before I wrote! Anyway, that's two of us who found the same thing.

5

How can you say it isn't a painful experience? For many it is a traumatic, excrutiating experience. Me being one of them. Perhaps it wasn't painful for you but to tell people it is painless is not being completely honest because it is different for everyone.

6

Well, all I can do is speak of my own experiences of painless procedures and mention that many other people have posted in these forums to say that it is not painful. I think it's important to do so as many first timers look in these forums for advice They post that they have heard bad things and are so terrified that they think they can''t go through with the procedure. Someone could be so scared by what they read here that they could end up not having a diagnostic procedure that could end up saving their life.

A colonoscopy should not be painful. What I would like to read here is people explaining why their procedure was painful. For example, did you talk to the endoscopist about why you experienced such pain? Perhaps you have a particular medical condition that would make it so. I just don't think it's helpful to scare people.

7

I agree about the scaremongering but people should be able to go knowing full facts and that is, for some people it can be extremely painfull. I wish I had known the first time I went as it was totally unexpected and I thought they had come across an obstruction. The second time I went I was pleasantly surprised that it was bearable but uncomfortable, the third time they aborted the procedure as it was just unbearable. People need to know the truth and make an informed decision as to whether to go for sedation or not. Some it's a breeze others it's not hence the name of the forum. 

8

I hear what you say but you didn't answer the question. Did you ask why it was painful on those occasions? Thousands of these procedures are carried out every day and sedation is optional. If a procedure carried a high probability of pain then endoscopists would insist on sedation and they don't.

I have always opted not to have sedation as I live alone and don't want to have to go through the rigmarole of arranging for someone to be with me overnight, a requirement if you have sedation. I can be in and out of the hospital in an hour if I don't have sedation rather than having to have someone drive me around and watch over me.

The OP is considering delaying the procedure for a month to clean cannabis out of his system and that month could make a big difference if there is something wrong that requires treatment.

Anyway, it may all be academic if he talks to the endoscopy department and finds that propofol had no contraindications in combination with cannabis.

9

Mixing Profofol and Canaboids can be dangerous.  Sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures can increase sleepiness or slow your breathing more with Propofol.   I know egg and soy allergy is a contraindication so I didn't have it for my Colonoscopy.   Notify your anesthetist about your use of Canaboids and he may be able to adjust the dosage or rebalance the sedative drugs to compenate for the reduced use of Propofol.   I am curious why this colonoscopy you have a need to use Propofol when your previous one did not.   If it was a problem of remembering the colonoscopy, meaning you remembered it when you didn't want to, there are other drugs that induce amnesia other than Propofol.  In the states they love to use Versed, a Benzo that can induce amnesia.   I can't tell you want any of that is like since I had my colonoscopy sans drugs.

10

I find it TOTALLY DISINGENUOUS when an individual states that a colonoscopy is "painless," and ESPECIALLY DISINGENUOUS when the medical community states a colonoscopy is "not painful" because different people have different experiences as not all people have the exact same colon design. 

Yes, I don't think scaring people is the proper, but being dishonest about this procedure may result in people undegoing a colonoscopy under the assumption that it will be nothing.  Unfortunately, for some that is TOTALLY  not the result. 

For me, personally that means that I do NOT trust the medical community whatsoever, especially in the US where I live, because it the medical-industrial complex is driven so much more by revenue; as in doctors, hospitals and clinics saying whatever just to get the most money for the least effort, regardless of the true benefit (muchless true comfort level) to the public that relies on the honest intent of the medical field.

Yes, and I feel some shame as I did work decades in the health care field myself.  It has always been driven sharply by $$$, but it has become even worse since my retirement.

11

I really do object to being accused of dishonesty and now disingenuity - just another word for dishonesty.

I have had several totally painless colonoscopies all without sedation. I have ulcerative colitis so the first was to detect the disease and subsequent ones to monitor the disease. I can only report honestly on my own experiences but many others in these forums have said the same.

Hysteria over colonoscopies only serves to make people nervous and possibly cancel their procedures.

12

I have a very high pain threshold so I had a recent colonoscopy "without" sedation but it was still uncomfortable and i could see how it could be untolerable for some.  Both the doctor performing the procedure and my GP doctor were surprised at my decision.  My GP thought I was nuts.  I did a lot of research before making the decision and I did not find anyone who said the procedure without sedation was completely painless.  I think it is different for everyone.  I think the person saying it is completely painless is either not being truthful or was sedated and does not remember.  The best person to  ask about the combination of Propofol and Canabis is your doctor.  Good Luck.

13

And to address the question as to why it was painful.  The discomformt is just part fo the normal process.  It involves forcing air into your colon to allow for proper visual.  This can cause cramping.  The amount of discomfort could depend upon a lot of factors.  Giving the benefit of the doubt to the person that says it is painless without sedation, it is possible that there are some exceptions but it is not the norm and I would recommend not  assuming that everyone will have the same experience.

14

Everyone has his or her own opinion.

Your recent note to me says, " I can only report honestly on my own experiences but many others in these forums have said the same."   OK, I can understand that.

Before that previous notations by you said, " It isn't a painful procedure" and " I think it's important to do so as many first timers look in these forums for advice They post that they have heard bad things and are so terrified that they think they can''t go through with the procedure. Someone could be so scared by what they read here that they could end up not having a diagnostic procedure that could end up saving their life."  That second comment "hints" that calling what some regard as pain as only slight "discomfort" helps to prompt some to go through a procedure on a "hopeful" note that it will be OK. I have read a number of blogs that relate very distaste experiences from the procedure itself  to the prep to adverse and paradoxical (meaning some people would have a totally opposite reaction to a medication, in the case of versed, meaning instead of being sedated, would become overly excited and perhaps even combative) reactions to versed or other sedatives.  NIH studies (National Institute of Health in the US) have clinical studies that quantify that significant numbers of people have suffered pain during colonoscopies.  I can understand that painting a rosy picture of this procedure will encourage greater use of this test for first time patients, but that followup visits are severely curtailed because  distrust of the medical field results from dismissal of painful experiences.

Stating your personal esperience I DO find genuine, but to say that your experience will mean that someone undergoing the procedure for the first time will have the same experience as you,  that is what I interpret as disingenuous.

I have NOT had a colonoscopy, but I did have a sigmoidoscopy, and I was NOT apprehensive at all going in.  In fact, I felt exactly as you stated, that "Thousands of these procedures are carried out every day and sedation is optional. If a procedure carried a high probability of pain then endoscopists would insist on sedation and they don't."  But after I suffered a great deal of pain, and recall the nurse telling me after a sigmoidoscopy that "You should have been sedated for that procedure," I had my own first hand proof that we all experience pain and discomfort differently.

Because of that experience, I genuinely do NOT trust health care in the US.  Health care is reimbursed on a fee-for-service basis in the US, so there is no incentive to really tell the truth about necessity of procedures or the comfort levels of them.  The more procedures are done, the more money is made, just just getting patients in and out serves the doctor's financial incentive. Doctors have the financial  incentive to do as many procedures as possible, all under the guise of using a risk/benefit model that "knowing more test results" is good, regardless of possible adverse risks to the patients.

Since I have no family history of colon cancer, and none of the other risks of smoking, sedentary lifetstyle, obesity and on, it is my personal choice to take my own chances, which stands at 5%.  Since a sigmoidoscopy is a colonoscopy "lite," I refuse to undergo a colonoscopy with my previous first hand experience.  I view the colonoscopy as having its place, and is very useful, but with its significant risks, I strongly feel everyone is entitled to make decisions based on their own acceptance of risks and benefits.  The medical industrial complex (which consumes 17% of the American GDP, compared to 9.5 - 11.5% of the respective GDPs of other "first world" countries) is constantly stirring up a fear frenzy on commercial TV in the US for every new medication, and every procedure, and I honestly question how much is truly needed, and how much is only out of control capitalism. 

So, I also object to being accused of hysteria.  I worked in health care for several decades, in addition to having a Masters in Public Health, so I have a a rational basis for my viewpoints. I do not want wish to discourage anyone from having a procedure that they need .... only that everyone be informed appropriately about the which screening tests would be personally appropriate.

15

I have noted many comments about the "discomfort" caused by the use forcing of air into the colon.  Another cause is "looping" which means the tip of the colonoscopy device can "catch" the walls of the colon, and in that manner, cause it to get overly stretched out (hopefully not get punctured, which does occur about 1/1000 cases in studies in the US).  Looping seems to be an occurance that happens more when the practitioners are less experienced, or trying to rush through cases too quickly.  If you google colonoscopy and Looping, you can learn more about it, if you dare.

And of course, many experience discomfort (Pain, for some) when the colonoscope is going through the curves of the sigmoid colon, or around the tight turns at the splenic and hepatic flexures..

16

Yes limeleaf. I did ask why the procedure was aborted and was told it was so painful I had started to vomit., so it shows how sedated I was not to even know that I was vomiting. I remember hearing someone scream and afterwards realised it was me. The consultant told me I may have a more twisted bowel than normal( the second procedure I had wasn't too bad) also it could have been part of the bowel may have been a bit irritable or diverticulitis .. In other words he didn't know but offered me a CT scan instead. I have had two children, no gas and air and though painful as expected I feel I would prefer to have another baby than go through that procedure again. ( would be a miracle as I'm 63)  having said all this my mother in law has had 2 colonoscopies and said she felt nothing but slight discomfort. I am not calling you dishonest as I believe that you are one of the lucky ones as is my mother in law but I think it's important for people to realise before they go in for one to take whatever sedation is offered just in case they are one of the unlucky ones. I've had one sigmoid VERY painful, the first colonoscopy and removal of polyp, uncomfortable and the follow up colonoscopy excrutiating and traumatic. So not only is everyone different, every procedure is different. I don't know why and I don't think the doctors know why either

17

I truly empathize with your painful experiences, and agree that even the "same" experiences can differ on the same person.  Practitioner differences can very widely.

I worked in health care (as an ICU nurse in the US) for some two decades, and recall just too many times that a doctor during various treatments would say "you're going to feel a little pressure," which seems to be secret code for "you're going to hurt like hell."  After a while, I wondered if doctors said that to make a patient feel better, or just to make themselves feel better while inflicting a little "discomfort."

Again, I am really not one to stir up a fear frenzy, but believe that honest information helps to enhance a sense of trust with the medical field.  I fear that is too late for gaining my trust at this point.

18

I agree with you and furthermore, I don't think anyone needs to go through pain or discomfort just for the sake of not getting medications. During my first Colonoscopy I was put to sleep with Versed, felt nothing, remembered nothing, overall the experience was almost soothing... 

I concur that different people have different levels of tollerance to pain, personally I want to sleep when that happens. My only fear is from the combination of my Canabis habbit and Propofol. 

19

No two people experience pain the same way. For me, sedation makes it painless except for pressure (and it was just that for me) when the tube moved from the sigmoid to the lateral section. It was very brief. I find the 3 minute preliminary exam with my consultant a week or two before murder to be honest although he is hardly going up at all. So the body is a strange thing. And nature ain't fair. I improve the chances by not having s holiday the year I have it and pay privately. That way I can choose a hospital and a consultant with a proven track record. If the air they use is carbon dioxide I get little bloating. But everyone's gut is different. Which is why people with IBS suffer so differently. But isn't the big question: why am I having it done? If it is to try and cure a bad bowel condition or protect against bowel cancer then you have to measure the risk against possible pain or discomfort of the procedure. I had a friend die of vowel cancer. The pain isn't just for twenty minutes and it isn't a choice. Statistically most people can tolerate colonoscopy. I think we all have to be very careful about scaring people who have never had it. If they find it very painful they will have to weigh up risk with reward just like in any medical procedure. I'm not Mr Strongman. I've had kidney stones and never felt pain like it for hours and hours and hours, whatever they tried to give me. As I said, nature is a lot of things but it ain't fair. Before anaesthesia people were operated on and had to recover without much useful pain relief. I think we just have to think about it calmly and carefully. There are some options to colonoscopy now such as virtual ones etc, but ultimately the truth is that for the vast majority with sedation (and some without) it is near painless, for a minority there is actual pain and a lot of discomfort and for a smaller minority it is intolerable. In which case don't have it. All of us can have one bad time. I have to have stomach endoscopies very regularly. 99 per cent have been fine; 1 was very unpleasant. Same (and very good) consultant. It's life, folks. But just as with anything some people are better endiscopists than others. Finally, at least we have the option. In my lifetime it did not always exist and if you had something going on, surgical exploration was the only way. Colonoscopies aren't perfect but they are a whole lot better than what existed, or rather did not exist, before.

20

Sorry, bowel cancer not a vowel cancer!