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Gastroenterologist Reveals 3 Ways to Make a Colonoscopy Much Easier · The Gastro Truth with Dr. Mel Ona

• 0:00
  SPEAKER_00: Why is it that two people can get the exact same colonoscopy and one of them spends the whole evening cramping and bloated while the other one is back to feeling normal by lunchtime?
• 0:09
  SPEAKER_00: It comes down to three decisions, and normally your gastroenterologist makes all three of them for you before you ever walk in.
• 0:16
  SPEAKER_00: These are three decisions I always think about for my patients because they can lead to a much easier experience and recovery.
• 0:23
  SPEAKER_00: And not every gastroenterologist or endoscopy center does things the same way.
• 0:28
  SPEAKER_00: So let me show you all three.
• 0:29
  SPEAKER_00: That way you know exactly what to ask about before you book.
• 0:33
  SPEAKER_00: And I'll tell you why I'm so sure about it, because I've been on that table twice with no sedation at all.
• 0:39
  SPEAKER_00: And I filmed both times live.
• 0:42
  SPEAKER_00: I'm Dr.
• 0:42
  SPEAKER_00: Mel Ona.
• 0:43
  SPEAKER_00: I'm a gastroenterologist in Hawaii and I've done thousands of scopes.
• 0:46
  SPEAKER_00: Now I actually stayed awake from my own colonoscopies.
• 0:50
  SPEAKER_00: The reason I stayed awake is that I kept hearing the same thing in clinic.
• 0:54
  SPEAKER_00: People weren't necessarily scared of what we might find.
• 0:57
  SPEAKER_00: They were scared of the table and the scope and being sedated in a room full of people they'd just met or never met.
• 1:04
  SPEAKER_00: So they'd put it off.
• 1:06
  SPEAKER_00: A year, five years, sometimes a lot longer than that.
• 1:10
  SPEAKER_00: I wanted to be able to tell them what it actually feels like from the inside instead of just saying, you'll be fine.
• 1:16
  SPEAKER_00: Okay, so let's start with the easiest one to ask for.
• 1:19
  SPEAKER_00: It's also one that can make a big difference in how you feel afterward.
• 1:23
  SPEAKER_00: So ask number one, what they inflate you with.
• 1:26
  SPEAKER_00: To see the wall of your colon, we have to inflate it.
• 1:30
  SPEAKER_00: Otherwise, it's collapsed on itself and we'd miss things.
• 1:33
  SPEAKER_00: So that part isn't optional.
• 1:35
  SPEAKER_00: What is optional is what we inflate it with.
• 1:38
  SPEAKER_00: Some places still use room air.
• 1:40
  SPEAKER_00: And room air isn't absorbed very quickly.
• 1:43
  SPEAKER_00: Your body has to work it out the slow way over time.
• 1:46
  SPEAKER_00: That can contribute to the cramping and bloating people describe afterward.
• 1:50
  SPEAKER_00: The other option is carbon dioxide, or CO2.
• 1:53
  SPEAKER_00: The gut absorbs the CO2 much more rapidly.
• 1:56
  SPEAKER_00: It enters your bloodstream and you breathe it out through your lungs.
• 2:00
  SPEAKER_00: So it generally clears much faster than room air.
• 2:03
  SPEAKER_00: Same procedure, same scope, potentially a very different recovery.
• 2:07
  SPEAKER_00: Now you might be thinking, if it's that simple, why hasn't anyone mentioned it to me?
• 2:11
  SPEAKER_00: Plenty of centers do use CO2, but it requires separate equipment and it's just not the kind of thing that usually comes up on a two-minute scheduling call.
• 2:20
  SPEAKER_00: So you bring it up.
• 2:21
  SPEAKER_00: When you call to book, ask them this do you use carbon dioxide or CO2 instead of room air?
• 2:27
  SPEAKER_00: That's the whole ask.
• 2:28
  SPEAKER_00: The technical term is CO2 insufflation, but you don't need to remember that.
• 2:33
  SPEAKER_00: Just ask about CO2, carbon dioxide.
• 2:35
  SPEAKER_00: And whichever answer you get, you walk in knowing a little more about how your procedure is going to be done.
• 2:41
  SPEAKER_00: Quick thing before the next one.
• 2:43
  SPEAKER_00: If you're here in Hawaii and you'd rather go through all of this with me in person instead of on a scheduling call, my practice information is down in the description.
• 2:52
  SPEAKER_00: Okay, let's talk about the second one.
• 2:54
  SPEAKER_00: Ask number two, water instead of air.
• 2:56
  SPEAKER_00: The first ask was about how you may feel afterward.
• 2:59
  SPEAKER_00: Now this one's about the 20 or 30 minutes you're actually in there.
• 3:03
  SPEAKER_00: Now there's another way to insert the scope, and it uses water instead of relying on gas or air to open the colon.
• 3:10
  SPEAKER_00: Now it sounds strange the first time you hear it.
• 3:12
  SPEAKER_00: What the water can do is help us advance the scope while minimizing how much the colon gets stretched and distended along the way.
• 3:20
  SPEAKER_00: And that's important.
• 3:21
  SPEAKER_00: A lot of the discomfort people experience during a colonoscopy comes from stretching, especially as the scope moves around the turns and bends of the colon.
• 3:30
  SPEAKER_00: So if there's less stretching, there may be a lot less to feel.
• 3:33
  SPEAKER_00: Now hold on to that one, because how much sedation you need can depend in part on how much discomfort you're actually experiencing.
• 3:41
  SPEAKER_00: So water immersion, that's the phrase.
• 3:44
  SPEAKER_00: Just ask them if they use it.
• 3:45
  SPEAKER_00: Ask number three, sedation you decide on.
• 3:48
  SPEAKER_00: So here's the one that can change your whole day.
• 3:51
  SPEAKER_00: When you book your colonoscopy, ask what kind of sedation the facility offers.
• 3:56
  SPEAKER_00: Because sedation doesn't mean the same thing everywhere.
• 4:00
  SPEAKER_00: One common option is called conscious or moderate sedation.
• 4:04
  SPEAKER_00: And that's usually a combination of medications like midazolam, or known as versed, and fentanyl.
• 4:10
  SPEAKER_00: You're relaxed and sleepy, and you may remember very little, but you're generally still breathing on your own and can respond to instructions.
• 4:17
  SPEAKER_00: The other common option is deep sedation, most often with propofol.
• 4:21
  SPEAKER_00: And that's what many centers, including ours, use.
• 4:24
  SPEAKER_00: With propofol, you're typically deeply asleep and unaware of the procedure, and it usually wears off quickly once the medication is stopped.
• 4:32
  SPEAKER_00: Now both approaches can work very well.
• 4:34
  SPEAKER_00: The difference is mainly how deeply you're sedated, how the medication is given and monitored, and what the recovery feels like afterward.
• 4:42
  SPEAKER_00: And then there's a third option people don't always realize exists.
• 4:45
  SPEAKER_00: Little or even no sedation at all.
• 4:48
  SPEAKER_00: Now that's what I chose for both of my colonoscopies.
• 4:51
  SPEAKER_00: Why?
• 4:52
  SPEAKER_00: It was to give people some information about how safe and comfortable the procedure can be, even without sedation.
• 5:00
  SPEAKER_00: And the videos can describe that as you can see in the YouTube videos.
• 5:04
  SPEAKER_00: But let me be very clear because this isn't for everybody.
• 5:07
  SPEAKER_00: Now, if you've had abdominal surgery, if you've had a difficult colonoscopy before, if you know your anxiety is going to be running hot in that room, take the sedation, please.
• 5:17
  SPEAKER_00: There's nothing brave about white knuckling a colonoscopy.
• 5:20
  SPEAKER_00: And if you're tense and uncomfortable, it can actually make the examination more difficult.
• 5:25
  SPEAKER_00: So the point isn't to have the least sedation possible.
• 5:28
  SPEAKER_00: Now the majority of our patients undergo prophal sedation and they feel rested and comfortable during and after the procedures.
• 5:35
  SPEAKER_00: The point is to ask what your options are.
• 5:37
  SPEAKER_00: Understand the differences and decide with your medical team what's appropriate for you.
• 5:42
  SPEAKER_00: What's it actually like being awake for it?
• 5:44
  SPEAKER_00: Now, for me, most of the procedure was absolutely fine.
• 5:48
  SPEAKER_00: Now, one of my best friends, who's a very good gastroenterologist, did the procedure.
• 5:52
  SPEAKER_00: So I felt mostly pressure, and the spots I really felt cramping were at corners where the colon turns.
• 5:58
  SPEAKER_00: So a few seconds each, and then it passes.
• 6:01
  SPEAKER_00: That was my experience.
• 6:02
  SPEAKER_00: And I'll tell you what actually was the hard part because I don't want to oversell this.
• 6:07
  SPEAKER_00: It's the bowel prep.
• 6:08
  SPEAKER_00: The day before, the bathroom, the morning up, and emptying yourself out.
• 6:13
  SPEAKER_00: The scope itself was about 20 minutes and can last, you know, up to 30 minutes or maybe more, depending on what's found.
• 6:18
  SPEAKER_00: And I watched the whole thing on the screen in front of me.
• 6:21
  SPEAKER_00: But one important difference if you're considering this.
• 6:24
  SPEAKER_00: Now, if you receive sedation, you will need someone to take you home afterward.
• 6:29
  SPEAKER_00: And there are restrictions for the rest of the day.
• 6:32
  SPEAKER_00: With no sedation, those medication-related restrictions may not apply, although you still need to follow the specific instructions of your doctor and facility.
• 6:40
  SPEAKER_00: So what if they say no?
• 6:42
  SPEAKER_00: So let's say you ask all three and you get three no's.
• 6:45
  SPEAKER_00: First, it's fair to ask why not, and it's fair to put the same question to whoever referred you.
• 6:51
  SPEAKER_00: You're always allowed to ask questions about your own procedure.
• 6:54
  SPEAKER_00: And even a no is worth having because you walk in knowing what the day is going to be like instead of finding out during it.
• 7:01
  SPEAKER_00: So second, and this is important, if you're already booked somewhere and they don't offer these options, go anyway.
• 7:08
  SPEAKER_00: These things may make the experience or recovery easier, but none of them is more important than actually getting the colonoscopy when you need one.
• 7:17
  SPEAKER_00: I had a patient, a woman executive running a demanding job, who pushed her colonoscopy off for close to 10 years because she felt fine.
• 7:25
  SPEAKER_00: When she finally came in, we found an advanced tumor.
• 7:28
  SPEAKER_00: She got through it and she's been clear for a few years now.
• 7:32
  SPEAKER_00: But we were treating cancer instead of removing a precancerous polyp.
• 7:36
  SPEAKER_00: And that difference is the whole reason I'm standing here.
• 7:40
  SPEAKER_00: The only version you should never choose is the one where you don't go.
• 7:44
  SPEAKER_00: One more thing.
• 7:45
  SPEAKER_00: If you're being sent for this because of gut symptoms that have been going on for months, there's a video on this channel about what should get ruled out before anybody settles on a diagnosis for you.
• 7:55
  SPEAKER_00: This one was about getting through the day.
• 7:57
  SPEAKER_00: And that one's about making sure they're looking for the right thing in the first place.
• 8:01
  SPEAKER_00: Go watch it next.
• 8:03
  SPEAKER_00: You don't have to be brave about this.
• 8:05
  SPEAKER_00: You just have to know what to ask.
• 8:07
  SPEAKER_00: Three questions before your colonoscopy or endoscopy.
• 8:10
  SPEAKER_00: And the thing you've been dreading may turn out to be a lot easier than you imagined.
• 8:14
  SPEAKER_00: I would do one of these every week.
• 8:16
  SPEAKER_00: The stuff you'd only find out if you had a gastroenterologist in the family.
• 8:19
  SPEAKER_00: Hit subscribe so you don't have to be related to one.
• 8:22
  SPEAKER_00: I'll see you in the next one.