Adrenal Insufficiency Support Group

Gah, stressed about having to have a sigmoidoscopy tomorrow! (this was talked down from a full colonoscopy, but I have a family history of colon cancer, so that's in my future). The preparation is rigorous, something I hadn't even realized. I thought my biggest fear/problem was the sedation (which I was going to go without, though I'm not so sure). But the prep is magnesium citrate and going without food starting at 6pm. At MINIMUM, I have reactive hypoglycemia, so hunger combined with no exogenous source of glucose, which starts at midnight when I'm not supposed to even have FLUIDS of any kind, is going to be a HUGE problem!!! I'm not even sure I'll be able to make it through the night, let alone the morning prep stuff (stressors, to say the least!).

I called to ask if they could recommend something in place of sedation, and they said NO, there is no alternative (wtf? Can't they recommend a painkiller at least, for comfort?!) Propofol doesn't sound compatible with seizure disorder history. And to top it off, the anesthesiologist was unconcerned with the fact that I have a horrible reaction to epinephrine (the dentist, after that episode, told me to avoid epinephrine; the anesh said that's not true): she said that's how they treat adrenal crises, and people do have reactions to it, no big deal. Well, I KNOW "most people" don't react to the epinephrine in dental shots like I do, because I know how I react now versus how I used to NOT react to it before I had a seizure disorder (um, head pressure and afraid to move because I felt like I was about to have a seizure.....seriously, I wanted to go to the ER....versus, well, NO effect when I was younger and healthier).

I hate getting old and having health problems....... (I also rejected the endoscopy that they wanted me to have because I didn't want full sedation. Hate hate hate)

Footprints:

I would give the gastroenterology office a call and talk through your concerns.

A sigmoidoscopy is less invasive and taxing than a full colonscopy. If that can ease some of your concerns. The scope passes about 8-10 inches. They do use some carbon dioxide gas to inflate the air - which can be discomforting.

As to your concerns about needing to have fluids/nutrients to avoid hypoglycemia . . . again, call the office for their recommendations. I would think that you could sip clear liquids (apple juice, broth). As they are not doing a full scope of the large intestine the need for a "sparkle clean" intestine is less.

People with diabetes have colonscopies and I imagine that they have needs similar to yours as regards glucose and fluid maintenance. I would imagine that the gastroenterology office has at least some experience with this.

Best wishes with the exam and for a clear scope,

- Karen -

Tried replying and it didn't take.... Thanks Button! I heard back from the GI doc, who said it would probably be okay to simply do the, er, pretreatments in the morning instead of going without all fluids (even water) from midnight on and all the other stuff. He also said they'd hook me up to an IV just in case. No pain medication to ease discomfort, though, which I think is odd.....

Anyway, I also left a message for my Cleveland clinic endo (whom I liked), to ask about up-dosing. I don't know when to do that (for SAI), and certainly don't want to experiment now, so am looking for guidance.

Yes, fingers crossed. The doc thinks there's maybe an immune problem going on, with cause to be determined later if confirmed.

I hope it goes well! Let us know.

Footprints:

I am glad to hear that you got some degree of reprieve from the GI clinic regarding the sigmodoscopy prep and fluid/glucose restrictions.

I take 30 mg of HC a day as my maintenance/baseline dosing in 3-4 divided doses. When I have a dental hygiene appointment I need to up-dose. Here is what my endocrinologist and I have come up with as the optimal strategy for me: When I up dose for a dental hygiene appointment I take 5 mg of additional HC the morning of the appointment. If troubling or moderate low cortisol symptoms emerge after the appointment, I take an additional 5 mg of HC.

Steroid dosing is individualist. But I offer my up dosing strategy as a consideration for you in case you do not hear back from your endocrinologist and experience low cortisol symptoms from your procedure.

Best wishes to you in the procedure. I hope that your sigmoid colon is sparkling and healthy. I have an ileostomy and so can empathize and related to all-things colon. Humor intended. :- ).

- Karen -

Post edited by: ButtonButton, at: 03/13/2012 09:09 PM

OK - Slow deep breaths. In, out, in, out. OK. Are you ready? First of all. You don't need a pain pill for this - they upset your stomach, and then you'd throw up, and then they'd cancel it - what a mess. Second, if you get propofol - well good for you! Just make sure there is a qualified individual (such as myself no less)LOL. Propofol is not contraindicated in individuals with seizure disorders - use it all the time. Hopefully they will be kind and give you some versed and fentanyl (now that one is an IV form for pain). The IV will be any easy way to give you some dextrose if needed.

Diabetics are actually a bit easier that hypoglycemics because they just take less insulin the night before and none in AM of surgery - they come in with high glucose, not low.

As for the epi - oh, if I could tell you how many people come in saying they had an epi reaction at the dentist - I could retire! I'm not sure what your story is BUT this is what usually happens. Someone was getting numbed up, then all of a sudden they either had a massive BP increase, get shaky all over, or have their heart rate take off. The dentist tells them that they had a reaction to the epi. What happened is that the numbing medication, which also contains epi, was injected very close to, or directly into. a blood vessel. Well, we all know what happens with an epi surge, now imagine it even more concentrated in a medication form, directly into a vessel. When the anesthesiologist was saying that they would treat an adrenal crisis with adrenalin, they were really being a bit condescending because we would first treat it with steroids. However, if the BP was in a life threatening state then epi is a potential drug that may be used. There are a lot of steps that should be taken before it gets to that point though! There are times though that epi is truly a life saving drug. It is a naturally occurring chemical in our bodies as well so please remember that - you may be more sensitive to it - a little goes a long way - but some day it may save your life.

Good luck. I hope you get a good nights sleep and that all goes well tomorrow!

Post edited by: hypomama, at: 03/13/2012 09:32 PM

Thanks for the words of support! I survived it, and did it without going under. Not that bad, after all. I think I was more stressed about it than during it! I only had a brief time afterward, when waiting in line for food, that I experienced any kind of after-effects. I started experiencing "extra gravity", which is something that I feel sometimes when my head is acting up neurologically. It's a weird sensory thing. Food helped a LOT! I was exhausted yesterday night and this morning (and my coffee pot went kaput after 1/2 cup output-talk about awful timing!!!), but am feeling better today so, really, only a minimal blip.

Hypomama, thank you for taking the time to explain the dental experience! It makes a lot of sense. The reason I think it's related to my overall health is that I've experienced similar problems, where I over-respond to adrenaline (with tachycardia and body shakes). When the dentist explained that epinephrine was in the shot, it was like an "ah-ha". So....putting your comments together with my own experience, I would propose that maybe I won't respond negatively to normal dental anesthesia (containing epi) if injected correctly, but still could potentially over-react to epi injected directly into me. I read in some simplistic description of the stress response (so not with a bibliography) that cortisol counters the response to adrenaline so that the body does not go out of control (like slowing down a started horse that sprints out of the gate); I want to research this to see if this is true, as it would explain some things to me.

Hi Laura

You obviously need a failsafe & redundant coffee system...! One on the bedside table and two spares under the bed!

<grin>

I'm so glad it went well!

I'm curious about the "extra gravity" feeling, as I sometimes have the feeling that my body is a tootsie roll - it feels as if I have become more dense and very heavy. Is that similar to your feeling?

Footprints:

So GLAD to read that the sigmoidoscopy was tolerable and that you are A-OK. Now you have that procedure behind you.

(: Karen