Ouch! Colonoscopy.

[Pruitt]

Next week, I'm having my brown cherry broken.

I have never been put under a general anesthetic, so just a touch nervous. Any Stories to put a guy's mind - and colon - at ease?

[A_B]

Sad to day I've been put under many times, but most of mine are form teh other side of the digestive system. If you have a good anesthesiologist (which are hard to find in these parts ((the swamp)) at least) then you are golden.

Worst part is the shit you have to drink the night before.

[Sabo]

I've had two colonoscopies, and it really isn't that bad of a procedure. As AB said, the worst part about the procedure is the day before. You have to follow a clear liquid diet for the day, and you have to drink a gallon of a water and laxative solution. It will cause you to shit your guts out. Just be sure you're near a bathroom at all times and there's plenty of toilet paper and you'll be fine.

The day of the procedure is very straightforward. I'll tell you about my most recent procedure, which was about five months ago. I checked in, and they took me and my wife into the back holding area. You get undressed and lie on a gurney. A very attractive woman came up and introduced herself as my anesthesiologist. She described the procedure, and I think she gave me a pill to take. After 15-20 minutes, I was wheeled back to the exam room, which was mostly dark. I was instructed to lay on my side. The anesthesiologist then injected a drug into my IV line. After a few seconds, I looked at her and said "Hey, I think I'm starting to feel it", and then I passed out. The next thing I knew, I was back in the holding area with my wife.

I felt no pain whatsoever at any time during the procedure. You're groggy for a couple of hours afterwards, but otherwise I felt perfectly fine.

I did read (and maybe Howard confirmed this too) that the anesthesia drugs given for colonoscopies changed recently. I remember about a five minute sequence from my first colonoscopy, but that's it. Apparently the anesthesia drugs used could cause some amnesia. But in both cases, I felt no pain as a result of the procedure.

[Nonlinear FC]

What Sabo said. Just be mindful of your diet a few days before they want you to set up shop on the toilet for the evening. Also, flushable wipes might be in order.

[sancarlos]

I had an entertaining experience with that procedure. I detailed it, here.

[The Sybian]

I had an entertaining experience with that procedure. I detailed it, here.

Hey Bronto, what happened with your old man and the mental fogginess?

[howard]

I have never been put under a general anesthetic, so just a touch nervous.

To begin, you will not be put under a general anesthetic. You will be unconscious, in order to render the experience painless. But you will be much less deeply unconscious than you would for a general anesthetic.

The difference is safety. Under the deep unconsciousness of a general anesthetic, your breathing and circulatory functions are drastically affected; under the light unconsciousness of sedation for a colonoscopy, you breath on your own without assistance other than some supplemental oxygen. Your blood pressure and other cardiac functions are mildly altered. A skilled anesthesiologist (good luck finding one of those*) will be closely monitoring these and other functions while administering the sedative medications.

General anesthesia is extremely safe. Sedation for colonoscopy is an order of magnitude safer, for all comers. Relatively healthy, relatively young people such as yourself, even greater odds of a safe outcome. For my patients, the most dangerous part of their day is the taxi ride to the clinic.

The preparation process, drinking the laxative and cleaning out your colon the night before, is the most unpleasant part of the process. Not my fault.

*Yesterday I happened to send this note to a friend:

Anesthesiologists tend to be pretty consistent in the way we practice. Our training and the board certification process is pretty specific and standardized, it is easier to do in our specialty compared to most of the others (radiologists tend to be consistent as well.)

Even the anesthesiologists who are lacking in personality or bedside manner tend to be pretty good at their work. The few bad ones stick out like sore thumbs, and I have not encountered very many. Compared to the many bad docs in other fields. I used to think I was being chauvinistic about my own field, but it is the quality of training and high standards of the field.

[mister d]

General anesthesia is extremely safe. Sedation for colonoscopy is an order of magnitude safer, for all comers.

Is there any way to ensure you do?

[howard]

Not with Obamacare. You need really good insurance.

[DC47]

I saw the 72 virgins. Things were great! They said it was a battle to get me to come back.

[Johnnie]

The latest How Stuff Works podcast is about anesthesia.

[howard]

Should be a short cast. "We don't know."

But there are some fascinating theories, and snippets of discoveries about some of the drugs and neuron receptors. I'll check it out.

[howard]

Listened to it. For two guys who didn't know what they were talking about, they did an ok job. Had they spent an hour speaking with an actual anesthesia doc, they could've avoided all of their mistakes. Overall ok, but their stuff about awareness under anesthesia was some dangerous misinformation, they got seriously wrong. A five-minute conversation could've set them straight.

Granted, I have spent my entire professional life explaining anesthesia to lay people, so I am kinda good at it.

It is interesting to me when intelligent, generally knowledgeable people investigate a new topic, then must use that new-found knowledge, how well or poorly they do. Like journalists, and lawyers frequently do in the course of their work.

[The Sybian]

Had they spent an hour speaking with an actual anesthesia doc, he would have put them to sleep

Ha!

[DC47]

It is interesting to me when intelligent, generally knowledgeable people investigate a new topic, then must use that new-found knowledge, how well or poorly they do. Like journalists, and lawyers frequently do in the course of their work.

One of my favorite topics, as I'm an expert in a few things and also a terrified newcomer struggling to make important decisions based on my understanding in several areas where I have no prior background.

I find anything having to do with research, in any field, to ring alarm bells. So many smart newcomers have a sweet, innocent faith in 1) individual scientists/experts; 2) elite universities; 3) refereed journals; and 4) statistical significance.

Any savvy person with experience in even a single research-based field does not share this view.

1) They know that many individual scientists and experts are kooks or criminals, or both.

2) Elite universities routinely employ many people who are self-interested or buffoons or both, and exercise no meaningful quality control after tenure is granted.

3) Refereed journals employ these flawed people as editors and reviewers. Further, reviews are often far too casual. It's an empirically proven fact (in refereed journals!) that journal reviewers go very light on the research design and especially statistical analysis.

4a) Statistical significance means far less than people think. For example, with a big enough sample and enough variables, you -- voila! -- have a significant result. Perhaps on a post-hoc hypothesis, but what the hell, there's a bit of theory to support it.

4b) You can get to significance in small studies by dropping just a few, selected cases due to some 'irregularity' (dramatically boosting P value if the case doesn't support the hypothesis) or in apparent minutae as to how you conduct the research. For example, the 'success' of control group subjects makes it notoriously hard for psychiatric drugs to show that they are superior. Solution: do something to prevent the control group from having warm, caring interactions with doctors, which is a source of some of that non-medicated success.

Three simple facts about science should be painted in big letters everywhere, especially over the entrances to buildings where it is conducted.

1) In many fields, there is no replication. There is never even an attempt to replicate key findings. Or the findings fail to be replicated, even after several attempts by different investigators. So for example, many academic studies that find drugs to be effective fail to replicate when pharma firms subject them to clinical trials.

2) In almost all fields, there is a bias towards publishing positive results. That's because negative results don't get published. They don't 'advance the field' by producing something new. And see 3).

3) Research that might attack the underpinnings of any field does not get conducted That's due to the inter-personal politics of the field, rejection of threatening or low-probability-of-success-but-potentially-high-impact research grants, and the scientists' own need to do work that is highly-likely to succeed in order to advance careers.

Failure to deeply understand much of the above greatly limits how any newcomer to any field can really interpret that field. Very smart people who have little research background have great confidence (after all, they are very smart about other things) that they can parachute in, read the highlights, and skip ahead to sophisticated conclusions. Well, no.

One of my greatest fears at parties is a smart friend who approaches me saying "I read a great book/article/paper on Subject X and now I know that ...." if I know a lot about X. The more I know, the more painful this is. There is no way out for me. I can either be nice and nod my head, which is deceptive. Or attempt to point out the flaws in this necessarily limited perspective, which leads to conflict. Mostly I just ask a couple questions that might lead to deeper thought ('Did he test that across several economic cycles?' 'Will that effect be arbitraged away in the future?' 'Do you think that result could be to other variables that were correlated with the presumed causal factor?' 'Was Keith really a junkie at that point?').

Then, as soon as is polite, I change the topic to something where I've got no great knowledge. Like: 'Hey, what the hell do you think is up with your wife and kids?' That can serve to change the conversation.

[howard]

Because of the factors you beautifully describe, in addition to the simple factor of literal tens of billions in annual profits to pharma and insurance companies, medical research and literature is thoroughly corrupted. Corrupt to the point of being useless. This is a slightly different topic, but I'm gonna rant for a minute.

Drugs that are taken by millions of americans daily are literal poisons. The latest scandal is the statin anti-cholesterol drugs that cause diabetes and actually cause heart damage. While the drug companies commit fraud, abetted by the FDA and the whole medical system that preaches 'don't eat meat and fats, eat carbs instead'.

This is truly a dark era for lies, fraud and manipulation in the service of profits, resulting in the wealthiest society in the history of mankind also being incredibly unhealthy. Because making you sick makes some people big money.

Don't even get me started on psychiatric medications.

So called medical research is but one of the essential tools feeding this corrupt machine. I had developed good habits in school and residency, regularly hitting the library and reading in depth the latest science in my specialty and in medicine generally. As long as 15-20 years ago this had become a complete waste of time, for reasons dc lists, because of the corruption of direct funding sources, and for other factors as well.

We had a good thing going, a wonderful medical research system that was far from perfect, was building man's medical knowledge exponentially, improving the general health and unlocking mysteries. We've completely destroyed that, as well as the health of 350 million americans. Just look at what we eat. And the handfuls of pills we take, many to counteract the poisonous effects of what we eat.

[DC47]

I agree with all you say. I imagine that you could easily list ten or twenty additional specific causes of the dysfunction of research in just the medical subfields alone.

It's big news when a major player is caught painting mice. But everyone assumes that this is all there is, and that due to the scandal no one else will dare do that now. Wrong. They will do this (but with better paint in most cases) and the equivalent, because the reward system promotes it. But more important are the hundred other types of slightly more subtle dysfunctions.

I'm curious about statins because I take them. It's my understanding that atorvastatin at least has positive benefits on disorders even beyond the cardiovascular. According to real, scientific research! Do I have the wrong idea? Which type were you referring to above?

[rass]

The Swamp:
Where the butthole jokes devolve into reasoned discussions of the dissembling nature of the dissemination of knowledge.

[howard]

I don't know many specifics about the various statins. When I had cholesterol numbers to indicate treatment, I was still a true believer. This was in 2002.

However, I thought I would try diet and exercise first. And I did Atkins. I ate more red meat, cheese and butter than I ever had before. I tripled my dietary intake of cholesterol. And a funny thing happened. My cholesterol went down. Because I cut my carbs by 90%. Increased calories, increased fat and cholesterol, yet I lost 30 lbs, and 30 points on my 'bad' cholesterol.

My thinking began to change. Specifically my thinking about what my industry was pushing, and how.

The specifics of the statins has come out in recent years. The fraud in suppressing clinical trial data, and the links to diabetes. My thinking was more general - don't counteract a bad unhealthy diet by a pill.

Even if I had more specific knowledge about atorvastin, I wouldn't pretend to know in your whole situation (weight, diet, lifestyle and possibilities of changing those, past history of heart disease, family history of health disease.)

If after I had dropped weight, established great diet and exercise habits, still had sky high LDL, had two parents and three uncles who dropped dead in their 50s from heart attacks, maybe I would take them. Sadly, very few doctors are going to take the time to help you make such a consideration.

But they sell $40 billion of these things a year. I sure as fuck will not take them just because some NIH or AHA guidelines say I should.

[DC47]

On the world wide web it just takes an average of three interactions before people start citing Thomas Kuhn. Then some fool breaks out the Wittgenstein, and all hope is lost.

[Pruitt]

Thank you all for putting my mind at ease. I am sure that I'll be a bit nervous leading up to it, but I'll make sure I have plenty of three ply and magazines to get me through a day on the toilet.

[The Sybian]

The Swamp:
Where the butthole jokes devolve into reasoned discussions of the dissembling nature of the dissemination of knowledge.

Happy?

[Shirley]

4a) Statistical significance means far less than people think. For example, with a big enough sample and enough variables, you -- voila! -- have a significant result. Perhaps on a post-hoc hypothesis, but what the hell, there's a bit of theory to support it.

4b) You can get to significance in small studies by dropping just a few, selected cases due to some 'irregularity' (dramatically boosting P value if the case doesn't support the hypothesis) or in apparent minutae as to how you conduct the research. For example, the 'success' of control group subjects makes it notoriously hard for psychiatric drugs to show that they are superior. Solution: do something to prevent the control group from having warm, caring interactions with doctors, which is a source of some of that non-medicated success.

Here I come to defend the numbers.

Statistical significance means a lot. It is critical to an understanding of the results of any sort of study. As Rasheed Wallace might say, Numbers Don't Lie. The math is what it is.

Where it all falls apart is in the interpretation. The statistical formulas are very accurate for the numbers they are fed. And that's the key. Where they the right numbers? I don't just mean accurate, but right. Do they really mean what people think they mean? That's the hard part. What was truly measured?

And if you really know what was truly measured, can you then accurately interpret what the statistical analysis says about those numbers?

And if yes to both of those - proper interpretation of both inputs and outputs - can you accurately and clearly describe what you found? That's really fucking hard. Numbers and analysis very precisely describe one specific thing and not the zillion other very similar sounding things that people might think you meant. I think it's this last part - both in the writing and the reading of analysis - where most of this falls down.

(And I'm gonna assume DC meant "dramatically lowering P value," right?)

[DC47]

Here I come to defend the numbers.

Statistical significance means a lot. It is critical to an understanding of the results of any sort of study. As Rasheed Wallace might say, Numbers Don't Lie. The math is what it is.

If Rasheed was a scientist, he would insist that they do. In any practical sense of these words, you undercut this point with what you say below. Statistical significance doesn't just sit thereon a page. It jumps off, it is used for important purposes. And it is typically used by people outside of the field in question (and my many inside the field) in a manner that is even worse than what you say.

I think that your statement that "It is critical to an understanding of the results ..." is true in a limited, literal sense. But a more true statement would be "It is one of several things that are critical to an understanding of the results, and standing alone it is often misleading."

Where it all falls apart is in the interpretation. The statistical formulas are very accurate for the numbers they are fed. And that's the key. Where they the right numbers? I don't just mean accurate, but right. Do they really mean what people think they mean? That's the hard part. What was truly measured?

And if you really know what was truly measured, can you then accurately interpret what the statistical analysis says about those numbers?

And if yes to both of those - proper interpretation of both inputs and outputs - can you accurately and clearly describe what you found? That's really fucking hard. Numbers and analysis very precisely describe one specific thing and not the zillion other very similar sounding things that people might think you meant. I think it's this last part - both in the writing and the reading of analysis - where most of this falls down.

A few additional qualms about statistical significance.

1. Statistical significance is based on a variety of assumptions, depending on the type of analysis. For example, one can be that the true underlying population distribution of a variable is in the shape of the so-called 'normal curve.' This is typically false to varying degrees. No doubt large ones in many cases. But in most this isn't even knowable as we only have access to a sample from the whole population. And this is just one of many assumptions that savvy researchers know are routinely violated in major ways. The statistical results are mathematically inaccurate to the (often unknown) degree that this is true.

2. The conventional levels of .01 and .05 significance levels were pretty much made up out of thin air by Ronald Fisher in the '20s. They are fixations of modern science. For example, it is common for hypotheses to be said to be 'unsupported' when .051 levels are achieved, but the opposite for .049 levels. But Fisher knew that these levels were just his off-the-cuff (though he was one of those quirky rejected-by-university-professors English geniuses, to be played by Cumberbatch some day, so he had terrific cuffs) estimates of what should count as strong support for hypotheses, based on his take on the science he knew at the time (sub-fields of biology). And he explicitly disavowed the notion that there should be any particular levels of significance that were employed universally.

Note that I'm not saying statistical significance is a worthless tool. I am saying that anyone who applies it as a religious artifact is. And I have met oh-so-many with PhDs. I am saying that it is used with significant ignorance even by most scientists, and especially by people who are trying to interpret science without possessing a deep scientific background. For a variety of reasons, going far beyond what has been laid out here, and which include issues of math, measurement, and various aspects of research design, statistical significance is much less firm as an indicator of 'what is true' than is widely assumed. Put another way, a smart scientist could come to the conclusion that a study which resulted in a significance level of only 1/10 of that of another study (that is, much higher P value and much less statistical significance) on the identical topic actually provides much more support for the hypothesis in question. Or no support at all. It would depend on many other factors.

(And I'm gonna assume DC meant "dramatically lowering P value," right?)

Proper usage about statistical significance is tricky. I actually wrote "dramatically boosting P value." By "boosting" I meant improving the significance level, as I take it you understood from the context. With P values this means lowering the number, as you state. Scientists colloquially talk about "boosting" or "cranking up" P values; in context this is clear to all involved.

[Brontoburglar]

I had an entertaining experience with that procedure. I detailed it, here.

Hey Bronto, what happened with your old man and the mental fogginess?

Whoa, callback.

I honestly think it might have been the drugs. He had that surgery in late July I believe, so he would have been on good drugs for 3ish months after that? He just had his second knee replacement at the end of January, and I haven't noticed anything abnormal. There have been no noticeable things to make me go "hmm..." this time around. Granted, I'm not living at home any longer, but I do see/talk to him probably once a day at least.

[DC47]

Nice to hear that. The death of a parent is not kind to a child, not at any age. But there is something far more cruel of a parent slipping away mentally and emotionally.

The first is a tragedy. The second is terror, long and drawn out.

[Pruitt]

Man, I haven't eaten in 34 hours and my stomach is making some of the most bizarre noises ever heard. Luckily I had a stack of good magazines in the washroom last night...

4 hours until the search for the Chilean miners begins.

[Pruitt]

That was my first experience with anesthetic and I must say, I am very impressed.

All is well in there, all the found was a single small polyp that is currently on the way to the lab. Doctor says he is not concerned at all.

[rass]

Good job! /gentle smack on the ass

[sancarlos]

Glad to hear it went well.

[Pruitt]

Glad to hear it went well.

And now for a nice wife-sanctioned nap!

Life is good.