FIT or fecal immunochemical test is a test where you collect a stool sample at home and mail it to a lab to check for blood in it (colorectal cancers bleed).
The ease of doing it and relatively low cost make it suitable for doing yearly.
A positive result indicates a follow up colonoscopy.
I’m in a Medicare Advantage plan and my every-five-year colonoscopies have all been covered. I did have adenomas at my first two, though. So I guess I’m deemed “high risk.”
Ok, that’s what I thought it was. I did that a few times in the past, with zero issues.
Well, it’s that time again, five years after the last time. Something strange though, I told the nurse during my pre appt that the last time, they gave me propofol, and my heart rate went down below 40, so they discontinued it and I was awake for much of the procedure. She looked into my records, and said no, they gave you fentanyl the last two colonoscopies, and bradycardia (low heart rate) is sometimes a side effect of that. Tachycardia (high heart rate) would be the side effect of propofol. She said that this time, she put in my notes (and I should tell them) to give me propofol.
It surprises me that I was ever given fentanyl, especially since I always have low blood pressure and a low heart rate, and I mention it to them. I thought they gave people propofol. It kind of freaks me out.
To add, now I am reading studies that say propofol can give you bradycardia. So now I’m seriously confused! I’m hoping the anesthesiologists know what they’re doing.
The good thing about propofol is that it has a very short half life. Just by stopping the infusion, the patient begins to wake up. It clears very quickly and they always have emergency meds at the bedside to address any bradycardia or hypotension.
Most likely the anesthesiologists know exactly what they are doing. You are probably going to be in very good hands.
That makes me wonder if I actually did get propofol like I originally thought. I was sure I had that, and then they woke me up in the procedure, and I was completely alert and not groggy afterwards. I am going to a different place this time, and they are just reading the notes from the last place, so I want to make sure they have the right information. I think I will contact the last organization and ask them, because I don’t want to tell them the wrong thing. Regardless, maybe they will just give me a lesser amount of whatever.
Is propofol what they usually give you, or is fentanyl a thing? Thanks!
my insurance BCBS stopped covering anesthesia for colonoscopy this year. So, no more propofol, just fent and versed. and thus no nurse anesthetist. 
At the facility where I worked, they usually used Propofol. Some people were used to old school, so they might request conscious sedation vs. anesthesia, and so they would get Fentanyl and Versed. As noted above, I, as a Registered Nurse, can give conscious sedation. Propofol requires an anesthesiologist or CRNA. Our facility used CRNAs, and they gave excellent care. We never had an anesthesia incident that could be attributed to substandard care in the 10 years I worked there.
I also have BCBS, so I’m annoyed to hear they stopped covering Propofol.
That is weird that they’ve stopped covering Propofol. I wonder why.
bc it’s expensive; the staff not so much the Rx. It adds a full anesthesia charge.
You need a supervising MD, and CRNA.
If just fent and versed you the actual GI doing the case is also incharge of those meds, that he tells his in room GI RN to push.
It’s how they did it for years before prop, but the turnaround was much longer. They can see more pts/day when they use prop. faster recovery, etc.
I had conscious sedation with my colonoscopy. It was fine and prompt return to full functioning. I had an anesthesiologist as always because I am high risk due to my low lung function. It was totally uneventful.
I read that Massachusetts BCBS decided not to change their policy at this time.
One Blue Cross is just one Blue Cross. There are different BCs in each state.
Seems that at least one gastroenterologist disagrees with the limitation to a clear liquid diet before a colonoscopy, claiming that a low residue diet works just as well for the laxative clean out:
Well, here’s something scary.
There’s a woman in my town who publishes an on-line news source for things happening in our small city. She posted yesterday that in spite of a clean colonoscopy last July, she now has Stage 4 colon cancer.
Can someone explain how that is possible?? I’m assuming her doc last July had his eyes open.
I have never heard of such a thing. Either she has an extremely aggressive tumor, or her last colonoscopy missed something (which, though not common, certainly happens).
It must be extremely aggressive. This is what she posted:
I had a colonoscopy in mid-July which came back “clean.” But as weeks went by I developed anemia, which drained me badly. Eventually, a second colonoscopy was done and a CAT Scan.
The images were pretty damn scary, but doctors expressed confidence that we can beat this thanks to new treatments. My cancer is missing a protein and therefore Keytruda is effective immunotherapy.
But I went downhill. How could stage 4 colon cancer get worse? By inspiring foes: an abdominal infection, and sepsis.
I had surprise surgery, which revealed the reason behind my sudden painful call to 911, the abdominal infection.
Cancer treatment stopped. I was in Norwalk Hospital for four weeks. Now I’m in rehab.
I have an army of doctors!
I also have an army of helpers. They bring me gifts and keep me company. My son is very helpful, too.
This, sadly, does happen. Sometimes called "interval’ cancer; inbetween the intervals of regular screenings. It is so common, but doing a good colonoscopy is actually really hard despite these docs doing +/- 15/day.
AMR (adenoma/pre-cancer miss rate) is a real thing. docs miss adenomas all the time. Many measure their performance with ADR (adenoma detection rate); which can vary greatly!!! Some docs are around 20%, many others are over 60%. The higher the better. Only about 10% of cases are done with new AI tools, help the docs find polyps/adenoma. These AI systems reduce AMR, increase ADR…
Def ask if your doc has an ADR, and if they use AI/GI Genius for polyp detection.
I know docs miss adenomas, but I had always assumed the ones they missed were small, and that’s why they missed them. I don’t understand how it’s possible to go from a clean colonoscopy to Stage 4 colon cancer in seven months.
It makes me worry that the colonoscopy I had in August – also “clean” – doesn’t count for anything.
Could be that flattish polyps or cancers are harder to detect, meaning that a colonoscopy may not notice a cancer or a polyp on the verge of becoming dangerous.
If concerned about interval cancers, you may want to do FIT each non-colonoscopy year if you are using colonoscopy as primary screening.