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DrRussMD
DrRussMD, Board Certified Physician
Category: Medical
Satisfied Customers: 64048
Experience:  Internal Medicine--practice all of internal medicine, all ages, family, health, prevention, complementary medicine, etc.
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First off i am a 27y.o male snd difnt know what category to

Customer Question

First off i am a 27y.o male snd difnt know what category to put this question in. I went into the ER tonight to find out what i already knew, my discharge papers says external hemroid with blood clots. Duting my visit the doc also mentioned it was a rather large one. I had this same problem about two years ago. I also went to the ER and got a referral to a surgeon two years ago who gave my a couple shots of local annestia. I have always had problems with local annestia, especially with dental work. When i had my first hemroid removed i had a problem with the annestia and could feel cutting towards the end of the procedure. The doc at the time said that he had picked enough of the blood clots out that i could call it good if i wanted, and i did. But the thought of the feeling of the knife has haunted me ever since. So when i realized what i was in for this time my anxiety peaked and i had a little panic attack in the er tonight as the doc was getting ready to pick some of the blood clots out. I adked if he could put me under and give me an anistea that would knock me out for the short procedure, he said no that they dont do that for this kind of procedure. So i left the er without getting anything done and have been in aganizing pain ever since. I was given a prescription for a couple cresms snd light pain killer but it doesnt do much. I have to figure out a way to have this taken card of asap but am hoping to find somewhere that will help me out with my request of bring put under. The er wouldnt do it nor would the place i went to last time. Is there something i can say or do to garuntee i get put under for this opperation? I am starting work up again in the next week or two and need to get this taken care of.
Submitted: 1 year ago.
Category: Medical
Expert:  Dr. Norm S. replied 1 year ago.

Your concern is a common one in medicine, and most surgical centers commonly use something called conscious sedation or Monitored Anesthesia Care (MAC) to make surgical procedures more pleasant and less frightening for patients.

Under conscious sedation, you are given intravenous sedation before local anesthesia is used, such that you are not conscious and feel no pain, but do not require intubation or assisted breathing of general anesthesia. This is commonly performed in outpatient settings or in the hospital. It is generally performed by a nurse anesthetist under the supervision of an anesthesiologist.

I would recommend that you call some rectal surgeons and ask if they perform hemorrhoidal surgery under conscious sedation or MAC. You will be able to go through the procedure with no pain other than when the IV is inserted.

There is variation around the country as to when MAC is used, but it's very common.

Here is one reference http://www.yafferuden.com/hemorrhoid-surgery/when-is-hemorrhoid-surgery-necessary/ See under "Surgical Treatment". Best wishes.

Customer: replied 1 year ago.
there are no garuntees? You mentioned different parts on the country, fo you know if that apply to easyern iowa or how i can find this out. There was no other option last nightbof the surgery in the ER with just several locsl annestia shots are the snus, and fully awake. I had even asked for a different and easier way before he said no and i backed out and left. Also that was the case when i had this 2 years ago. Why wouldnt they have answered my plea ifvthis is do wifley used? It almost like they font believe on how i rould panick and anxiety if u cant at least get put to sleep? What kind of doctor should i look up to see if they would do a procedure like this? And i asked this in my past message that i sm a male and didnt know where suposse to categorise this, so please let ke knowvif it would help to telategorize the question
Expert:  Dr. Norm S. replied 1 year ago.

It can be difficult to get the best care in the ER, so if possible, it's best to seek care in a doctor's office.

I have practiced in the Minneapolis area, and I assume that care in Iowa is similar.

Either general surgeons or colorectal surgeons do hemorrhoidal surgery. You should be able to find the on line or in the yellow pages of your phone book.

There are never any guarantees. Any doctor can decide under what circumstances he/she wishes to perform surgery.

We don't have a category for general surgery or rectal surgery, so I don't think it would be helpful to seek another category.

Customer: replied 1 year ago.
Ok i will start my search. What is the name of your clubic in cass i cant fibd something? Being 1 state to tour south for me and my well being it would definitly be worth it. The place i got my first one taken taken out 2 years sgo said no just like the er doc did this time. It doesnt make senseThanks for your help,
Jon
Expert:  Dr. Norm S. replied 1 year ago.

I'm retired now, but I worked for many years at Park Nicollet Clinic in the Minneapolis area http://www.parknicollet.com

There are many offices. You can seek a surgeon under General or Colorectal Surgery. MAC anesthesia is commonly performed for a wide variety of surgical procedures.

Customer: replied 1 year ago.
I called the place with the link you sent. Called the colon and recnal surgery office. The lady i spoke to said she didnt think they did that but a nurse would call me back. I feel like im missing something on why nowhere will do this. I tried to places in my town, one place in iowa city and now waiting to hear back from the nurse
Expert:  Dr. Norm S. replied 1 year ago.

I could be wrong, but I suspect that the lady you spoke to didn't know what she was talking about. I'd wait to speak to the nurse.

Expert:  Camille-Mod replied 1 year ago.
Hello,
I received word that you are unhappy with your answer and I have opened your question to other Experts. Thank you
Camille- Moderator
Expert:  Dr. Phil, MD replied 1 year ago.

can I help?

Customer: replied 1 year ago.
appsolutley. I went to the ER the other day to confirm what i already know, i have a fairly large thrombosed hemroid with blood clots. I had this same thing about two years ago and got a referrel where the surgeon made an incision and removed the blood clots. I havnt had the best experiance with local anestia in the past (especially with dental work) its like my body has some kind of tolerance to it where i always have to request more then they would normally use. There has been a few times where i could feel some intense pain duribg a procedure using just local anitesia. When i had this hemroid operation almost two years ago, the same thing happen where i vouldnt even let the surgeon finish because after feeling a very sharp pain i could just lay there anymore. He said he had gotten most of it and let me go. This time around i am in a panic even thinking about it. Went i went to the ER two nights ago the doctor was going to perform the operation right there, but only with local anestia again. I asked about it and he said that is the only way these quick operation are prefomed. Right beford the annestia shot i had a panic attack and just couldnt go through with it. The doctor seemed a little irritated but i apolagized and just couldnt do it. I have made several calls to some hospitals and clinics and they are all saying the same thing. One nurse even said it eould cost thousands extra to use a different annestia anyways and if i wait to long with my hemroid they wont preform the surgey because it will start to go away. I have had this fir several days now and it is so painful and uncomfortable it is unreal. I basically have to lay on my stomach or side and do as little walking as possible. I sm starting back up work within the next week after being layed off for the winter, and i would not be able to perform in my labor intesive job under these conditions so i have to find a way to have this procedure done asap and get whatever recovery that is nessisaty started. Could you please tell me how i could attain the help im looking for with this procedure? Any specific hospitals/clinics in the midwest would be great!
Expert:  Dr. Phil, MD replied 1 year ago.

what state are you located in?

Customer: replied 1 year ago.
I live in Iowa during the winter and illinois the rest of the year. Both locations right by the illinois/iowa/wiscon border. I slways go to iowa hospitals for everythibg in the past but am willing to travel if they are willing to help make this possible for me
Expert:  Dr. Phil, MD replied 1 year ago.

I personally know of a doc that does these in the office.

It is in michigan though.

http://www.mpcenter.net/

Customer: replied 1 year ago.
Where you are sedated (asleep) during the procedure? Does he require referrels?
Expert:  Dr. Phil, MD replied 1 year ago.

You can be sedated if you like

No, not necessary

Customer: replied 1 year ago.
Wow thank you so much. I have two last wuick questions. I plan on making the long drive if i have to but would you happen to know any places closer that eould be worth my time calling and asking about? And doez the location you gave me require insurance?Thank you!
Expert:  Dr. Phil, MD replied 1 year ago.

I don't know of any closer places. I'm sorry.

Call their office.

His staff is very helpful

please don't forget a positive rating for me

Customer: replied 1 year ago.
I called and spoke with them. They said the doctors there would do the same thing as the doctors that i have talked to, regarding no sedation, fully awake with just local anestia. Thank you for your help but could you reopen this thread to other experts. Im just having a hard time believing no hospital will offer this service if requested fir comfort and anxiety. Thank you
Expert:  DrRussMD replied 1 year ago.

Hello;
We do not give personal referrals.

Any colorectal surgeon if doing hemorrhoidal surgery can have you using twilight sedation at least, as the first expert described.

Tell me exactly where you live. I will get you a list.

Customer: replied 1 year ago.
I live in Dubuque, iowa (eastern iowa) most of the year. I havent even heard of a hospital ive called yet offer that but would very much appreciate a list of places.
Its not just the anxiety but ive had a fes experiances in a couple procedures where i could feel very sharp pain before they add more local annestia. Im not sure if someone can have a tolerance for such a thing. Look forward to your help and thank you very much!
Expert:  DrRussMD replied 1 year ago.

You need to talk to the surgeons.

They are the only ones that say what they can offer, and any outpatient surgery center does this all the time, even for colonoscopies.

I can not take responsibility for your communications with hospitals, etc, and I can not talk to the surgeons for you.

Please also remember we are only paid per positive rating. I will need to see one.

Here is a reliable list.

As a matter of fact, general surgeons can do this, and some GI doctors have good methods.

Here is a general surgeon list

http://www.healthgrades.com/surgery-general-directory/ia-iowa/dubuque

Here is a list with a number of colorectal surgeons

http://doctor.webmd.com/find-a-doctor/specialty/colon-rectal-surgery/iowa/dubuque

And here are GI doctors.

I suggest you pic a surgeon and a GI doctor

Go see them each for a talk.

Do not try to get an agreement in advance, that is not going to work.

Any good doctor that uses outpatient surgery can easily handle this.

Now

please click a positive rating.

Find me anytime.

Customer: replied 1 year ago.
Thank you for your help.I am aware that you do not get paid until a positive rating is given. And you can not talk to the surgeons for me. Hince why i have dprnt days online and on the phone. You nedd to know that a positivd rating can not be given until i am satisfied with an answer. This idea is posted on your site and makes sense. You were much more informative then some of the others and i will more than happily give s positive rating when i find out the info ive been given is accurate. So you will most definitley see one when i am satisfied.Thank you
Expert:  DrRussMD replied 1 year ago.

The lists are accurate.

And, if you can't find a surgeon who can give you twilight sedation, or a GI doc, then you are not sitting down with them and explaining the situation.

They do this every day, as I said, even for colonoscopy.

I can not do that part for you.

Good luck and the best.

Please click a positive, that is the only way we can provide this service.

Good luck again.

Customer: replied 1 year ago.
I noticed you forgot the link to the GI doctors
Expert:  DrRussMD replied 1 year ago.

http://www.healthgrades.com/gastroenterology-directory/ia-iowa/dubuque

, please click a positive rating [hopefully excellent—that’s how we are paid, per rating]. If you forgot something, come back. I am here daily.