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Sweet sleep By BILL KETTLER Mail Tribune They saved the best part of Bob Powell's colonoscopy for last. Not that the rest of the exam was bad - the retired FBI agent slept through it under a sedative. The best part came when the drug wore off. Powell woke up alert and refreshed - no nausea, no grogginess, no fuzzy thinking - barely three minutes after the procedure ended. "We have some juice for you, Bob," Dr. John Walker said as Powell floated up to consciousness. "What kind of juice would you like?" "No juice," said Powell, 76. "Water. Scotch and water." Powell was alert enough to crack a joke minutes after his colonoscopy because Walker uses a sedative that wears off quickly and leaves patients clear-headed and mindful without the typical side effects of traditional sedatives. Walker's sedative of choice is propofol, a drug that's been used for years in conjunction with other sedatives, but rarely on its own. With propofol, "people get their heads back so quickly they can usually remember what we tell them within four or five minutes," he said. Doctors who have studied Walker's ground-breaking technique say it could change the way people think about colonoscopy because it eliminates the aggravating side effects that have come to be associated with the examination. "I think within five years we're going to see it take off," said Dr. Doug Rex, an Indiana gastroenterologist who came to Medford to study Walker's technique. "A lot of people are going to start catching on." Side effects of sedation are one of the excuses people have used to dodge colonoscopy, an examination that greatly reduces the risk of death from cancer of the colon. Colon cancers develop from tiny polyps that arise in the colon, but the polyps typically take years to turn into fast-spreading cancers. Doctors use a flexible endoscope to see the inside of the colon and remove the polyps long before they become life-threatening. "There's fair evidence we can basically prevent colon cancer," Walker said, by giving people over 50 a colonoscopy every 10 years. Sedation spares patient discomfort during the exam, but the most commonly used sedatives (Demerol and Versed) often leave patients feeling queasy and fuzzy-headed for hours. "Many people are zombied-out for a whole day" under traditional sedation, Walker said. With propofol, it's common for patients to wake up after a colonoscopy sedation and tell their spouse, "Honey, you're next because I love you and there's no excuse not to because it's so easy." Walker has talked about his work at national medical meetings, but other gastroenterologists have been slow to convert to propofol sedation. "I know what happens," he said. "People get excited when they hear me talk. But then when they go home (and try to implement something new), they get shot down in committees." Doctors' resistance to change has hindered Walker's efforts to spread the technique, said Rex, the Indiana doctor, who has treated more than 4,000 patients using propofol since he learned the technique in Medford. "Anesthesiologists across the country have control of (propofol)," he said, "and they've been reluctant to let anybody use it." Physicians rarely have used propofol (trade-named Diprivan) alone because it produces relatively light sedation and wears off quickly. Walker said those attributes make propofol especially useful for endoscopic examinations, where light sedation is enough. He and colleagues at Medford's Gastroenterology Consultants pioneered propofol sedation for colonoscopy five years ago with Dr. Robert McIntyre, a Medford anesthesiologist who served as medical director at the newly opened Surgery Center of Southern Oregon. They realized that traditional sedatives did not work well for some colonoscopy patients, such as those who had experienced painful procedures in the past, or had a history of post-traumatic stress disorder, or heavy drug use. McIntyre tried sedating those patients with an initial dose of propofol and following up with small doses every few minutes for the duration of the examination. The patients always went to sleep easily and woke up minutes after the procedure ended, with none of the side effects associated with Demerol and Versed. Walker observed that McIntyre's medicine always worked with problem patients, so he decided to try it on other people, too. The cost of having an anesthesiologist involved made the procedure too expensive, so McIntyre and Walker trained several nurses to administer the sedative under Walker's supervision. Nurses monitor each patient's breathing and heart functions and administer small doses of propofol when a patient's body movements suggest more sedation is required. Five years and 8,800 patients later, Walker's records show no patients with complications attributed to sedation and plenty of satisfied customers. Eighty-four percent of patients surveyed rated their propofol sedation better than their last experience with traditional sedation. One former patient who had moved to Kentucky even traveled back to Medford for an exam because she couldn't find anyone locally who used propofol. "I just cannot speak highly enough of it," said Shirley Sawyer of Lexington. "In a little while after it's over you come to, and they give you orange juice and the doctor comes in and talks to you and you can go home. I've had several surgeries and this was a very pleasant experience." Walker said propofol also seems to induce pleasant dreams. Patients don't dream under most sedatives, but many people who have been under propofol have talked about dreams of fishing, or playing with puppies, or drinking a milk shake, or going on a spree with a no-limit credit card. Walker would like to think gastroenterologists across the United States will pick up the technique soon, but experience has taught him change happens slowly. He's fond of quoting Hofstadter's law: "Change takes place more slowly than you expect, even if you take into effect Hofstadter's law." Reach reporter Bill Kettler at 776-4492, or e-mail [email protected] Mail Tribune Home | Ottaway Newspapers, Inc. | Dow Jones & Co., Inc. | Privacy | Contact Us Copyright � 2001 Mail Tribune, Inc.