What? No Propofol?
Dec 29th, 2007 by Terry
Not the best news for the New Year, but something that we all need to be aware of and get a little outraged over, just the same.
I have already written before about how Propofol is your friend and mine. Now, some insurance companies have determined that its use is medically unnecessary for colonoscopies. This is a bad and ill-informed decision on a number of counts.
Propofol is a drug with a quick onset and quick metabolism. What this means for YOU is that it will start working practically immediately, and last for the duration of your procedure, without any long-lasting after-effects. It causes no nausea or vomiting. It wears off quite fast. In small, titrated doses, it causes no respiratory depression.
Of course, colonoscopies can be done without Propofol; in fact, before the inception of this drug, colonoscopies were performed with various combinations of narcotics (think fentanyl, demerol) and benzodiazepines (think valium, versed), or without any sedation at all. They still are performed this way in many doctor offices and centers. My advice to all of you is to never opt for no sedation at all. As for the narcotic/benzo option, well, yes they work, but not without hitches.
Colons are long, tricky organs, with many twists and turns. Not so easy to navigate a 5 foot snake-like instrument through. A still, flaccid patient makes this a much easier endeavor for the colonoscopist and patient alike, and can often determine a successful or unsuccessful procedure. A comfortable patient has a relaxed abdomen. Narcs and benzos must also be given in incremental doses, like Propofol. Unlike Propofol, they do not wear off quickly, and narcs can cause nausea and vomiting (frequently) and respiratory depression. When narcs and benzos are combined, they pack a one-two punch, working synergistically together and often unpredictably. They also do not as reliably provide patient comfort like Propofol does.
Please give me Propofol for my colonoscopy.
Propofol needs to be administered by someone both very knowledgeable about how it works and very skilled in handling situations that may arise due to Propofol administration. Situations like airway and/or hemodynamic compromise. When an anesthesia provider gives you your drugs for your colonoscopy, YOUR heart, blood pressure, oxygen saturation, and breathing are constantly monitored for the duration of the procedure. Your anesthetist has no other responsibilities than watching over you to ensure a safe and effective anesthetic for the colonoscopy.
The insurance companies do not want to pay the anesthesia fee for these procedures. They would rather have YOU receive your sedation for this procedure by either the colonoscopist or one of his/her designated nurses (RNs) working with him. The same people who will be quite busy looking for any irregularities in your colon, biopsying lesions, removing polyps, filling out paperwork, applying abdominal pressure to assist in navigation of the large colon and otherwise involved in the procedure. All this, and administer incremental sedation while watching for and treating any side effects as a result of the drugs being given.
I’ve been involved in giving sedation for colonoscopies going the narcs/benzos route, and the Propofol route. The latter route has 100% reliable endpoints - namely, a sleeping, relaxed, comfortable patient. The former route is unpredictable and frequently provides inadequate, sub-par sedation.
Colon cancer is the our nation’s third largest cancer killer, after lung and protrate cancers. Getting people to have their colonoscopies for screening, let alone for symptoms, is Job One in both the prevention and treatment of this disease. Patients wake up after their colonoscopies with Propofol in disbelief that the procedure was even performed. Do you have any idea what kind of great PR this is for the person who may feel a wee bit scared of having a colonoscopy done?
Please give me Propofol for my colonoscopy. And don’t take away my anesthesia provider, either.
As an RN working in an ICU where we have done bedside colonoscopy’s and EGD’s with Narc’s and benzo’s, and seen how people come out of them, I could not agree with you more. Having Propofol as my anesthetic during my carpal tunnel release made all the difference to me. I’ve had versed before, I hated coming out of it. Insurance companies tick me off on a regular basis, but this is going too far. . .
That’s a very bad news indeed (maybe the insurance people should get colonoscopies…)! I don’t trust versed at all, it doesn’t work for me and having a colonoscope going through my inflammed and ulcerated bowel is not my idea of fun. I was so traumatized by a c-scope once (done under versed) that I’m now getting them under general anesthesia. I had a bone marrow biopsy w/o any sedation (not even a little something… that was 11 yrs ago) at the age of 10 and it hurt a lot, but I would have it again tomorrow morning instead of a scope with versed.
Mah, I had a bone marrow biopsy too. Without sedation. It was scary, but not all that bad, in the grand scheme of things. A colonoscopy without propofol would be akin to torture, IMO. I think that if more insurance companies start doing this, we are in a world of trouble.
You have me convinced! I admit I’ve had the luxury of not thinking about colonoscopies, but should I ever cross that bridge, I now know how it should be done–and sincerely hope that option is still available.
Boo hiss! Boo hiss!
It is not surprising that insurance companies would rather save a buck in one place and potentially lose it elsewhere if your anesthesia gets screwed up.
No, the insurance company gets out of the loop for the moment, but the docs and the nurses don’t. If something goes wrong, guess who the patient sues–everybody in the room, most likely. Funny how that HMO(or insert your favorite insurance company plan) is never in the room…
Somebody needs to call Katie Couric ASAP. All that work for promoting colon cancer awareness may go down the drain in one fell swoop, if people associate colonoscopies with horrible pain or reactions. Colon cancer is horrible enough. We’ve only known for YEARS that colonoscopy is worth the cost. Anyone remember a guy named Ronald Reagan and his colonoscopies?
If this becomes a national news story, people will nag their docs and their insurance companies and this practice will stop.
Love the Katie Couric angle,Rehab! Good idea.
the principle of the matter here is critically important for everyone. we cannot allow the insurance companies to dictate medical care. we cannot allow them to force doctors to fill out increasing amounts of complex and lengthy paperwork to get exceptions to allow good medical care to occur. i can’t tell you how many patients ‘wake up’ from versed/fentyanyl claiming that they had no anesthesia what so ever. plus with increasingly sick patients on multiple medications, the hypotension we see during procedures using versed is alarming. it is simply not true that the procedure can be done as well without versed virtually all the time. the success of the colonoscopy may be similar, but that does not mean at all that the procedure was the same.
grr.
SurgeXperiences 112…
Welcome to the 12th edition of the one and only surgical blog carnival. Your guide to brilliant surgical blogging around the web.
Being a non-surgeon I find it truly a privilege to be hosting the first edition of SurgeXperiences in 2008. Take some tim…
Grand Rounds at Path Talk…
Trent, over at PathTalk.org, hosted the first Grand Rounds of ‘08. There are a lot of good medical related articles. In my opinion, here are some of the best:
Med Journal Watch with “It ain’t necessarily helpful“
Eve…
Propofol freaking rocks! I had a miscarriage about 13 years ago, and the D&C was done under propofol. You wake up IMMEDIATELY and it is as if no time has passed. No dizziness, no nausea - amazing medication.
And now that I am looking for a GI doc for my first colonoscopy, I’ll start asking around for propofol!!!!
I will take neither Versed nor propofol.
There is some interesting material on unsedated colonoscopy.
There is a post or two regarding this on my blog.
Hi Tim. I’m so glad you stopped by here and shared your opinion and link to your experience.
I am also so sorry that you had such a negative experience with your anesthesia and anesthesia provider. I agree with you - it is of utmost importance that all of your questions always be answered truthfully and completely. It is also vital that you not be patronized or talked down to, as a patient. Unfortunately, this sometimes happens to patients, and it can have extremely negative sequelae for the patient. The advice on your blog should be most helpful to people.
I don’t know you, I have never met you, so it is quite difficult for me to address so many of the issues that you brought up in your blog. I HAVE been a patient, though, undergoing surgical procedures, on more than one occasion, as have many of my colleagues. While versed has left a terrible impression on you and those who have responded on your blog, I can assure you and my readers that the majority of patients not only fare excellently with this drug, but the majority DESIRE something to make them feel more relaxed, even forgetful. Myself included. But for those who do not want to feel that way, there is no reason why you should have to. I always tell my patients that I will tell them when I am starting to give them their sedation and when they will start to go to sleep. It’s all about establishing a trusting relationship. I think that they appreciate that. I have not received any negative feedback yet. I have taken care of a few patients who have wanted to be as awake as possible, and I respect that too.
I would also like to reassure people that date rape, personality changes, and I’m not quite sure what else you could be thinking of, Tim, but these kinds of unethical and violating behaviors absolutely DO NOT OCCUR in any OR or procedure area I have ever worked in or heard of. If it does happen, it is not only rare, but immoral, illegal, and probably career-ending for those who partake in it or witness it and don’t report it.
Finally, I would be very interested to read the material you may have about unsedated colonoscopy. I have given anesthesia (mainly propofol, but occasionally versed/fentanyl in the past) for literally hundreds if not thousands of these procedures, and I can assure you most wholeheartedly that these are very very uncomfortable, painful examinations, even in the most skilled of practitioners’ hands. I would not recommend going that route to any one I know, love, or care about. I would not recommend colonoscopy with no sedation to a complete stranger, for that matter.
Thanks for your reply. Many people act like I’m the anti-christ for downing their beloved drug.
I also do not gloss over the fact that propofol causes RETROGRADE amnesia. I find that objectionable too.
http://www.time.com/time/health/article/0,8599,1671492,00.html
Getting back to unsedated colonoscopy, here is an article I recently found:
http://www.medicinenet.com/script/main/art.asp?articlekey=569
There is a good post by “John” early in the comments of my blog:
Audit of sedated versus unsedated gastroscopy: Do patients notice a difference?
Jonathan Peter Watson, 1*MA, MBBCh, MRCP, PhD, FRACP, Carmel Goss, 2RN, Grant Phelps, 2MBBS, FRACP
Another article describing unsedated colonoscopy found here:
http://findarticles.com/p/articles/mi_m0BJI/is_3_31/ai_71632710
Just Google for “unsedated colonoscopy” or use the find feature to find a few mentions on my blog.
I just wanted to say that the amnesia part of Versed did not work, leaving me wide awake, yet unable to speak clearly or use my body as I saw fit, although I did (jerkily) obey the CRNA as if my life depended on it. I wondered at the time why the CRNA was allowed to make snide and humiliating comments about me and nobody said anything to him about it! Not my surgeon, the PA, the OR nurse, nobody made him stop. This would seem to be a problem unique to Versed, the disregard for the patient, their sensibilities, and/or their pain. Versed was worse than my worst nightmare and it was real. The amnesia is unreliable at best, the hypotension was the opposite with me, my blood pressure and heart rate were through the roof! Maybe as a result of being cognizent about what was happening and unable to respond. Anyway, I will forego any more elective surgery for fear that I might, once again, recieve Versed against my will. I realize that “most” people may find this drug to their liking, but for some of us it is worse than the condition that caused us to seek medical help in the first place.
Tim, nice hearing back from you. In reference to your first link, I consider it a breach of trust to administer the propofol (or anything else, for that matter) against the patient’s wishes. She was obviously more girded to experience either physical or psychic pain than to get “fuzzed,” and her wishes were totally not respected.
As to the prospect of an unsedated colonoscopy (or gastroscopy), all I can say is to each his own. If a person desires no sedation for either of these procedures, they should certainly be afforded the opportunity to have them done this way. The worst part of a gastroscopy is from stimulation of the gag reflex, which is continuous throughout the procedure, even with local topicalization. As for the colonoscopy, most people are not fond of the sensation of anything being inserted through their rectum, especially something the size of a garden hose. The colonoscope must make many turns during the examination, and often bows, causing sharp pain and intense cramping. That is not to say that the procedure cannot be done without anesthesia or sedation. But, like I said in the article, and hold fast to, make mine with propofol.
Jackie - I feel bad about the horribly negative experience that you had. I know nothing about you or your procedure or total anesthetic, but I do know that when you make this statement:
“This would seem to be a problem unique to Versed, the disregard for the patient, their sensibilities, and/or their pain.” - it sounds to me more like a problem unique to the individual who administered your drugs. Versed does not make caregivers show disregard to patients; rather, it sounds like you had poor anesthesia care. You could have quite possibly not had enough sedation (Versed is not the only drug that can be given for sedation. By combining several drugs, you can often get a more complete and relaxing sedative experience). You might have been undermedicated with Versed; you may have had what is known as a paradoxical reaction to Versed, ie - instead of getting more relaxed and sedate, you became more tense and hyperdynamic in your vital signs.
But it would be a callous individual, in my mind, who would laugh at your pain and strip you of your dignity. I hope that this bad experience will not deter you from seeking out necessary surgery, and please, do have a talk with your anesthesia provider before any procedure, explain what happened to you, and communicate all of your concerns and needs.
Thanks for sharing your story, and best of health to you.
I had to have a 2nd procedure to correct the first, in a different hospital, different surgeon etc. in order to avoid the problems! I recieved, per my request, nothing but a local (beir block) and Fentanyl for the pain that the tourniquet caused. This worked well for me and was exactly what I requested the first time. While the first CRNA et al said nothing to me, they had decided on a different course of action which included a GA, which I had specifically declined many times in preop. I allowed them to perform a dangerous nerve block to avoid the GA. The “conscious sedation” wasn’t discussed or it would have been flatly declined as well. I didn’t find out until well after what the “date rape” drug was. It was a stunning revelation to me and an unpleasant one at that! This disregard for me was explained that “they knew best” and since I wasn’t a medical person I had no right to tell them what was best for myself! Versed was used as a chemical coercion drug to keep me from stopping them from doing “what they knew best.” This is why I feel that Versed is used in a very disrespectful manner and breeds contempt for the patient as shown by the CRNA remarks. When you get away with allowing patients to scream in agony, grow accustomed to the patient having amnesia, and become used to the patient obeying you without demur, this can be a huge detriment to patient care. You seem different, but when Doctors and CRNA’s wield this much power over the patient the possibility for abuse grows exponentially. Thanks for letting me sound off and I hope I haven’t offended you!
Jackie, your experience at the first hospital smacks of not only unethical behavior but assault and battery. As an anesthesia provider, we are not allowed to administer any type of anesthesia without the patient’s informed consent. If you specifically discussed with them what it is you wanted and didn’t want, and they chose to ignore this, well, let’s just say that if it was me, I would be seeking out legal advice. If these folks didn’t feel that they could administer an anesthetic to your liking, then they probably should have advised you to go elsewhere rather than touch you at all.
No, lol, I am not offended. I have met a few people during the course of my career who do not feel comfortable getting sedated. My sister-in-law would rather feel the pain at the dentist than have novocaine. Everyone has a different response to stress, pain, and illness, and we all come with different issues. Fear of losing control is a very common one.
I do have to take issue with you about Versed breeding contempt for patients. Any anesthesia provider worth their stuff would not tolerate a patient screaming in agony. That is anathema to the very fiber of who we are as practitioners. If stuff like that is happening, I can assure you that it’s the exception and not the rule. I mean, after all, part our job is to relieve pain, not ignore it! Giving anesthesia is not about having the upper hand in some kind of power struggle; it’s more about trying to make you feel comfortable for an invasive procedure, of any kind. I cannot wrap myself around the whole disrespect aspect that you mention. I have always viewed my role, whether it’s giving general, spinal, or just versed anesthesia, as compassionate care. That would also include NO SEDATION AT ALL, or minimal. I treat you as I would want to be treated myself, or anyone I know or care about. And I am not in the minority.
Terry you almost restore my faith in anesthetists! You ARE a rare person. Thank you for your thoughts on this matter. I and others, am wondering where you practice, so we might go to you if we need any medical procedures.
Well, I practice in an inner city hospital in Philadelphia, but that’s about all the information I’d give out on the internet!
Philly is close enough. If I ever need a procedure again, if I can’t hire you, then perhaps you can recommend someone in my area who shares your ethics?
I was readin an account on a blog “trying to make sense of it all” and the author, Jubal, described an anesthesia technique used by Cedars-Sinai. According to him, cost drives the anesthesia. He says that this method uses lots of benzos, sub analgesic fluranes, a paralytic and zero opiods or other analgesics. The patient is paralyzed and (hopefully) amnestic and the pain of the operation keeps their blood pressure up. They also regain their baseline quickly afterwards. This is the kind of anecdotal evidence which points out the dangers of allowing amnestic drugs. As somebody on whom the amnesia drug didn’t work, I can’t even imagine the horror of being treated like this! I would like to verify this, but you know all the really GOOD information is sequestered away from patients. Have you heard of this Terry?
Could you please share the link to the article with me?
I’m not sure if this will come through…http://tryingforsense.blogspot.com/2007/12/welcome-to-party-pal-with-this-post-i.html#comments
Thanks for the link, it worked.
Where to begin?
I don’t know who this Jubal is - a physician? anesthesia provider? lawyer? And I certainly cannot speak to what he says is a technique used at Cedars-Sinai - I’ve never been there nor do I know anyone who has. If stuff like that is truly going on there, it is a medical scandal, IMO. It is unethical, amoral, and totally outrageous.
IV narcotics are some of the cheapest drugs available in the anesthesia arsenal today. Why someone withhold it and give a “cheap” anesthetic without using fentanyl and/or morphine wouldn’t even begin to make sense. Properly titrated, patients can attain both analgesia and the ability to breathe - it is done ALL THE TIME and the excuse that patients cannot breathe or maintain blood pressure, or it costs more to use narcotics, longer recovery and wake-ups - this is total misinformation and totally unreliable information. Do not believe this. Please.
Anyone who obtains consent for anesthesia must provide an informed consent. This means not only describing what will be provided to the patient, risks and benefits, but answering all questions and respecting all requests. If a request cannot be honored (ie - a patient does not want general anesthesia), then if no other alternative anesthetic can be arranged (and by this I mean in the patient’s best and safest interests), the anesthesia provider should then refer the patient to some other institution where maybe the patient’s request could possibly be honored.
This whole idea that anesthesia providers get their kicks out of taking advantage of patients who are sedated with midazolam is totally foreign to me and everyone I practice with. We are professionals, we do not work in a vacuum. There are patient safeguards built in everywhere - we are all the eyes and ears of the patients. Our concern is first to do no harm - and that includes psychic/mental/emotional as well as physical - and these allegations that versed makes general anesthesia easier to perform, that patients are entertaining to us, that we will have our way with patients under the influence of versed - I find totally offensive and, to tell you the truth, I feel like I am the one being baited and manipulated. There may be a rare unethical practitioner out there, but like I said before, no one works in a vacuum - we work with other people and stuff like what is described in that link just does not happen without SOMEONE noticing.
As a footnote, if Jubal heard of this weird and bizarre technique being utilized at Cedars, why didn’t he report it to someone? See, stuff like this is not informative; it’s misinformation.
It frightened me! I have had an obsession with Versed ever since I got it, and as you can see, it is never really far from my thoughts. I have been all over the internet trying to see if this reaction has happened to others and to try to put my experience into perspective. Any drug that causes this extreme amount of anxiety in otherwise normal people is very scary. I hope that you do not think I am baiting you, far from it. I am pathetically grateful to read your posts! What I experienced permeated the entire staff at the hospital where I was treated. I have never had this kind of thing happen to me before, EVER! If I told you some of the really bad and nasty things that were said to me when I was completely demoralized by my encounter with this particular hospital, you would go ballistic. I HEAR you say what should have happened to me, informed consent, explanations, defering to patients’ wishes, and it makes me want to cry some more, because it is diametrically opposite of what I recieved. I will never know why I was treated like I was. The hospital was cited for having no informed consent forms and other surgical consents in 10 of 11 patient charts that were looked at. That’s it, all I can do! What I wanted from the hospital was an apology, an assurance that this would NEVER happen to anybody else and the CRNA punished for violating my rights.
As far as patiet’s undergoing colonoscopy with the amnesia drug versed (and a little painkiller)…a significant numbr of patients sob, cry, beg for the doc to stop and often scream in pain…….I work in a clinical specialty where I often have my students observe colonoscopies (with the patient’s approval)…and let me tell you, many leave the GI suite white-faced over the agony that they see the patient under versed experience…expecially female patient’s…..and the Nurses keep saying: she won’t remember a thing…..and sure enough, the patient who was screaming during the procedure usually doesn’t remember doing so immediately afterwards…..they now that SOMETHING afwul happened, and lots of them develop partial recall over weeks and months…some become emotional wrecks. the main issue seems to do the exam quickly, with little regard to patient comfort and hope that they don’t remember a thing……The entire issue with versed is true informed consent..let potential patients hear someone screaming during the procedure then habe a smug GI nurse mention amnesia and they will NEVER consent to versed. I just lost another first-degree relative to colon-cancer and I will never get this exam with versed……either nothing (search the net, most people who have unsedated colonoscopies would do it again)…sedation is all about doing the exam quickly, poorly and for max profit, I’m afraid. If you want to be out, get Propofol; it’s the best of a bad series of drugs…….better yet, get a virtual colonoscopy
Just had a colonoscopy and had to argue to have it done awake and aware. I expressed my distaste for Versed, and my doc said that she uses it but would not want it herself…So she agreed to no sedation..long story short: on the day of the exam, in comes a CRNA telling me that she’s going to give me “better sedation” propofol, I guess, and I told her that I was doing it without sedation. She continues to argue with me until she shoved the consent in my face and I wrote on it that I did not consent to any sedation or CRNA/Anesthesia services of any kind nor would I authorise payment for any drugs not given by my colonoscopist….painkiller (fentanyl) is fine with me if needed, but the CRNA tried to convince me that she had to do it. NO, not true, I sent her packing. My doc did the test, it hurt in spots, but there was a syringe with 2ml of fentanyl handy if needed and the doc is certianly credentialled to give that if needed…the test was completed, got the results and I have lost any respect for CRNA’s if the one that I got was any example……….I now have to have extensive surgery and no CRNA will be part of the experience……I met with the chief anesthesia MD and he said that it’s my right to insist that the anesthesia be sone my a physician, not a nurse.
It’s simple: with colonoscopy and versed/fentanyl, most patients experience moderate pain and a LOT experience SEVERE pain. It’s a fact; the GI doc’s give it so the patient in agony won’t kick and scream and choke the doc; and hopefully have amnesia of the terrible event. This is what medical care (at least with colonoscopy) has degenerated to in the USA. The GI doc who did my first scope this way (I remember it all) was snide, and uncaring; we happen to share a financial adviser and go to an annual Christmass party together and I make sure that everyone who will listen hears about how I was treated and exactly why-so the doc can work faster and make a few bucks while the patient suffers…………
I wanted to respond to this post. I had a colonoscopy done 12/07. I had a horrific, paradoxical reaction to Versed back in 1991 that left me with permant memory loss, Severe Anxiety and Post Trumatic Stress Syndrome. When I heard that they use this drug to do a colonoscopy (which unfortunately I needed to have done due to unknown bleeding issues,) I freaked out. After looking for a while, I came upon a wonderful doctor in St Petersburg FL who agreed to do the procedure MY way. I told him if I can have two 9lb babies w/o drugs, and dental work w/o novocaine, I can do this procedure w/o drugs.
He warned me that it might be painful, and I told him that my pain tolerance is on par with Superman’s and not to worry. I promised to take a Xanex just in case anxiety got the better of me. When I got there after the IV was started and I wrote on every page of the consent form “Allergic to Versed” and “NO Sedation under ANY circumstances, Analgesics ok ONLY if absolutely necessary.” The two nurses in the room practically begged me to take pain medication and Versed, I finally had to get a little rude and tell them that my eyes would be on my IV and no one better go near it with any syringes!!
I was wide awake and talking to the Dr the entire time, even watched him remove a polyp (also painless.) The ENTIRE procedure except for one very mild cramp when he went around my transverse colon that lasted less than 2 seconds was painless!!! On a pain scale of 1-10 this procedure would be a 1. Medication for this is totally unnecessary. I was able to go home right afterwards and not have to spend hours in recovery, and I saved money by not taking any drugs that were offered. I guess people want to be drugged into oblivion because they hear wild stories that they’d be in alot of pain….NOT TRUE.
If you look on a search engine for Unsedated Colonoscopy you only hear GOOD things. People need to be less reliant on drugs, this is one procedure that it definately not needed.
I wanted to add a PS to my last post. When you have this procedure done, INSIST that the Dr use a Pediatric colonscope, especially if you’re a woman. My gastro Dr said that using an adult sized scope is very dangerous, they’re too big and not as flexible as a pediatric scope. Also the risk for perforation is alot greater when this large instrument is used. It also is so big that it often blocks the view of the Dr from finding small polyps.
I just had a totally unsedated colonoscopy. At a couple of points I was begging the doctor to stop. I can’t believe how painful it was. We tried 9 times to get an IV in, before we decided to go unsedated. But, I’ve got tiny veins and they just couldn’t get it. I thought they’d give me a shot or a pill or something, but they said if I could handle all these IV attempts, I could handle this. No, I really couldn’t. It was awful! It was just such intense pain and it didn’t stop until the scope was back below the curves. I know we had to do this, but it’s the next morning and I honestly feel like I’m bruised up on the inside of my colon. It still hurts. I’m looking for any information on recovery from this- is there anything I should be looking for? Is there anything that will make this hurt less? I’ve just been taking Advil and using a heating pad, but DANG! They said next time they’ll give me demoral. I know there’s a children’s hospital that has a vein viewer and I asked if we could try that, or if I could get the IV in the day before, when I’m hydrated enough to find my veins, but no on both counts. I’m only 4′9, so I think that may be part of why it hurt so much. If anyone has some advice for me, please write back. If any health professional is considering doing this on a small person, please, PLEASE, give them SOMETHING! And let us know what to watch for after the procedure. Thanks!