FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

surprising truism: AMNESIA CAN be a part of good health care!

Question: I recently had a minor procedure, a colonoscopy, that was done as an outpatient at the hospital. My wife claims I had a conversation with her and my doctor afterwards, but I don't remember a bit of this. Is she teasing me, or did my doctor actually give me something that would let me carry on a conversation -- not just say a few words, but a whole conversation -- and not be able to remember any of it?

Answer: We doctors often need to do things that are unpleasant. Colonoscopy, the procedure you had, is a common procedure that belongs on a list of unpleasant things. Colonoscopy, for those of you who don't know about this test, is an examination of the entire colon. That is the source of the "colon" part of "colonoscopy." The "oscopy" portion of the word refers to the use of a "scope," an instrument used to look inside the colon. The typical instrument is a high-tech marvel that allows the doctor to steer the lighted tip along the four-foot length of the colon as it twists and turns. Pictures of the inside of the colon are constantly displayed on a television for the doctor to see.

As you have probably assumed, the process of passing the colonoscope inside the colon produces abdominal cramping and pain. It can be done without the benefit of medicine, but it certainly isn't a pleasant experience. Consequently, most doctors administer a medicine to alleviate the pain. The most commonly used one is Versed.

Versed is in the family of medicines called benzodiazepines that also includes Librium, Valium, Ativan and other brand name and generic equivalent products. Versed, which has the generic name of midazolam, is only used in an IV formula, where other benzodiazepines may be available for oral or IV use. The administration of Versed by IV produces an immediate high level of the drug in the blood, and shortly thereafter the drug reaches the brain where it does its work of producing relaxation, sleepiness and decreased pain perception. Wow! Just what the doctor ordered for someone undergoing a painful procedure. Versed produces sleepiness, but it is not an anesthetic. You weren't "out" during the colonoscopy, although you may have fallen asleep.

The body eliminates Versed over the next several hours. Typically the level drops to one-half of the original within two hours. In that period of time most individuals become sufficiently awake that they will subsequently remember what they say and do. But as your wife and doctor will attest, you were awake enough to carry on a conversation before then. You see, amnesia isn't just a soap opera phenomenon. You experienced a drug-induced version of it.

The drug-induced amnesia that Versed causes is a desirable side effect that occurs in 90 percent of individuals getting the drug. Although you may feel funny about talking to your wife without knowing what you said (is that a guilty conscience talking?), you also don't remember an uncomfortable procedure. I'd say that is a reasonable trade.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701. Past columns are available online at http://www.FamilyMedicineNews.org.