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“If you did not have a colonoscopy, I would still recommend that you do it in a conventional way and get that IV sedation. But if you are an adventurer as I am, I would highly recommend that you do a colonoscopy the same way I did without anesthesia. I heard there might be only one patient out of 1,000 who is doing colonoscopy without anesthesia as I did. So in a way, that’s some kind of crazy record, and I will tell that one day to my grandchildren. I am already bragging about that. God bless, and remember that we never have enough time and love and do a colonoscopy sooner than I did.”
Mike Neskovic is a family physician.
He shares his story and discusses his KevinMD article, “I’m a doctor who just had his first colonoscopy in my 60s — without anesthesia.”
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Transcript
Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/podcast. Today on the show we have Mike Neskovic. He’s a family physician, and he wrote the KevinMD article titled “I’m a doctor who just had his first colonoscopy in my 60s, without anesthesia.” Mike, welcome to the show.
Mike Neskovic: Thank you, Kevin. I know we have only 15 minutes, so let me get into it. We are both primary care physicians, and I think that’s the best profession ever. Actually, I think real doctors are born into that profession. I think I was three or four years old, a kid, and I was thinking about becoming a doctor in some way, and it kept shaping in a better and better way. Thank God, I became a physician at age 24.
Actually, I should be a farmer now, because of my dad’s dream. My great-grandfather was a farmer, my grandfather, my father, and I broke that tradition because I really love being a family doctor. I’ve been a family physician for the last 33 years here in California.
Kevin Pho: Oh, that’s so wonderful to hear. As my listeners know, I’m in internal medicine; I do primary care myself. Right now there are just so many obstacles to primary care. You have the electronic medical records, you have all these bureaucratic regulations, and we have to do so much in shorter and shorter time. So after 33 years, tell me about some of the joys that you get practicing primary care.
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Mike Neskovic: Yeah. First of all, there is a saying: We never have enough time and love. So my joy is my family. Thank God, I’ve been happily married for 32 years, I have two boys, and I have extended family in Serbia. Everybody is welcome in my office.
Of course, as a physician, I took the Hippocratic oath on January 28, 1977, so you can see I’ve been a doctor for more than 45 years. But I don’t know about other doctors. In a way, my life is like I’m still 27 years old, and I love a healthy lifestyle, and I want to do things my way. And yes, I’m board-certified in family medicine and geriatric medicine, but half of that is wrong, in my opinion. I believe in a holistic approach, and of course, it’s always better to treat any disease without any medicine.
Kevin Pho: Now, for those medical students who listen to the show, give them one reason why they should consider primary care as a career.
Mike Neskovic: First of all, we are like honeybees. Maybe some people just have that nature to give, that they have compassion, that they like to help people. My father told me, “Son, don’t deal with sick people, number one. It’s better to be a farmer.” I said, “But I like it.” I said, “Dad, I want to be a geriatrician.” He said, “What does it mean?” I said, “That means helping old people.” He said, “No, especially don’t do that. They smell terrible. Old people are deaf and stuff.”
I like old people, believe me. Yesterday I saw a 97-year-old and a 94-year-old, my last two patients yesterday, and my mom is still alive, 93, thank God. It’s not my decision to decide how long somebody will live, but I’m trying to relieve their pain and suffering, to help families, and to help caregivers for seniors. Sometimes a small thing and a small lead can help our patients and caregivers provide better care for our patients. We cannot make an old person younger again, but we can always do something to help with pain.
Kevin Pho: So let’s talk about your KevinMD article that you wrote. It’s titled “I’m a doctor who just had his first colonoscopy in my 60s, without anesthesia.” Now, for those who get a chance to read your article, just share that story with my audience.
Mike Neskovic: Yeah. First of all, I would never have a colonoscopy. Why? Because I’m like a cat, or like those animals that know exactly if something is going wrong. I know I have a negative family history of colon cancer, I’m eating very healthy, and my body is functioning. I’m going to be 70 in a few months, and I’m functioning like I’m 27. I’ve conquered many mountains, like Mount Kilimanjaro, Mount Rainier, and many other mountains. I just knew I was not going to do it, but my family was on my case, and I said, “OK, I’ll do the colonoscopy, but you do something for me.” So my boys and my wife promised.
I went to my colleague, a gastroenterologist, and I thought there would be resistance. I said, “You know what, man? I’ll do this colonoscopy under one condition: no anesthesia.” He said, “Sure, no problem.” I said, “Wait a minute. I was thinking I was going to quarrel with you and stop.” He said, “No, we’ll do it.” And we decided. The advantages are that I can drive myself, I can drive back home, and there is no anesthesia. I don’t like needles, so I said, “Let me avoid the needles.”
And maybe I’m a little bit crazy. Five or six years ago, I was running Los Angeles marathons. Man, I did 31 Los Angeles marathons. A few years ago, I noticed a bulge in my right inguinal area, a typical inguinal hernia. So I was running one year; the next year, I needed to hold this thing because it was painful and bulging; the third year, I said, “Let me do it.” So my colleague did a laparoscopic hernia repair, and again, at 10 a.m., I didn’t want to take any pill. He said, “Let me sign that against medical advice.” We are free beings, and I didn’t take one pill after hernia surgery. Nothing with the colonoscopy.
I think it’s worthwhile. Actually, I heard from a few of my friends. One veterinarian lady said, “You know what? I had three children with no anesthesia, a natural birth, and women have been delivering naturally for thousands of years.” And I said, “So you and me, we are similar: natural colonoscopy, natural childbirth.” And a few other patients told me, “I’m not going to just take pills and IV.” It’s rare, but sometimes people choose to do a colonoscopy without anesthesia, and I think it’s worthwhile for some of you who are brave. Of course, for one person out of thousands, something wrong can happen. Nothing happened to me.
And the ladies, they said, “Sit here in a corner and wait.” They didn’t know I didn’t have anesthesia. I said, “Listen, how about going home?” They said, “Oh no, you need to wait for somebody to pick you up.” I said, “No, how about I sign that thing?” So it was worthwhile.
And maybe it’s a reminder for listeners and for doctors: We should be giving a personal example to people, right? The colonoscopy is really the gold standard. And you can see, it’s very cool. I saw the inside of my colon. Those two flexures are very painful. I was telling him, “Please slow down,” at the splenic one, and the pain got relieved. Again, at the hepatic flexure, I said, “Man, slow, slow down,” badly, drawing that back. And he said three times, “You have a colon like a 20-year-old person.” So it’s cool.
Kevin Pho: So let me just be clear: You didn’t have any medication? You didn’t have any Versed? You didn’t have any Demerol? Was it completely zero medication?
Mike Neskovic: Anyway, I’ll tell you, I highly recommend it. Pills are terrible. I believe, of course, we need antibiotics and occasional stuff, but all of these pills, including Tylenol and Advil, are terrible. But I must tell you, I’m like my professor of acupuncture. She said, “I’m my own experimental animal.” I said, “What did you do?” She said, “I have some herbs that are for constipation.” She was healthy, like me. She said, “Let me experiment.” She tried the regular dose, and nothing happened. A double dose, and nothing happened. She put in five times more medicine, and she said, “I got such bad diarrhea, it was terrible.” So these herbs really work and can help with constipation.
In my case, I did marathons without any pills, and many colleagues around me take Advil, Aleve, or whatever. Once I had a problem with knee strain, pain, or whatever. I said, “Let me try to take this damn Advil,” and I took two Advil. Believe me, that damn thing relieved my pain a little bit, and I finished the marathon. So I see this devil pill works. There is a saying: Nobody can give you anything, and nobody can take anything from you. I regret it. I shouldn’t have taken those two pills. I would have finished my marathon anyway. And anyway, I’m recommending it to you, Kevin. How about you, man? How many marathons did you finish?
Kevin Pho: I haven’t done any marathons, but I’ve actually had three colonoscopies myself. I’ve had one with conscious sedation, with Versed and Demerol, and then I’ve had two with propofol, where you’re just completely out for the colonoscopy, and then you just wake up and it’s already done. But take us into the endoscopy suite. For my audience who’s considering going without anesthesia, just walk me through that process. Tell me what you were feeling, and tell me about the actual procedure. What did that feel like for you?
Mike Neskovic: Yeah. First of all, I thought, “I’m a doctor.” I said, “Bang, they will do it.” They made me wait a whole hour. So the doctor doesn’t give a damn; he has his system. So I’m waiting, and they check my blood pressure: 150 over 90. I said, “Oh my God, I never had 150 over 90.” So we are human beings: anticipation, anxiety. I’m waiting there, and I said, “Let me meditate.” I like yoga and meditation, and it came down to 140, but still, I always have 120 over 80. So still, we are humans, and you’re in that medical environment.
And at one moment, two big guys are taking me out. I said, “What the heck? Maybe they are going to hold me,” or whatever. This doctor didn’t make a big deal at all. He just quietly spoke, and he was telling me what he was doing. Only, I had to fight with him. I said, “Man, slow down, man, slow down.” And he did slow down a little bit. Eventually, I saw the cecum, and I saw my appendix site, and it’s like the bile is working a little bit; you see that there. But it’s beautiful inside. I’m more handsome inside, man, than outside. So it’s just fantastic to see your body inside.
And actually, really, you have many different types of pain. Maybe when I hit my finger with a hammer, it’s a different kind of outside pain. This is inside pain, because it’s stretching the colon and those nerves are activated. It’s a kind of weird pain. But drawing the colonoscope back is so beautiful, and he turns around to see there are no hemorrhoids, and it’s nice and clean.
And they put in so much air, and the guy said, “Don’t be shy, just let it go.” I said, “Man, I’m a shy guy,” and those two big guys were next to me, holding me by the shoulders. I said, “Listen, I wish those two guys would go out.” It took maybe 10-15 minutes, and I was done. But after that, this gas thing was coming out. I was talking to my son, and the gas was coming out, and then I said, “Son, I have to quit. I need to be alone now to clean myself.”
And the body is amazing, man. From this clean colon, in 12 hours everything starts working perfectly. I would recommend it: If you’re a little bit brave, why not? And that’s a good life experience. That’s called a point of reference. Many people, even for a little bit, take pills, so they never experience pain. Pain is our lecture, our best friend, and we should be looking at pain differently.
And yes, I’m going to do it next time, if I need it, hopefully never again. But again, a colonoscopy without anesthesia, and now I will know better. I’ll tell the guy, “Listen, when I tell you stop, you stop, man, because you are pushing that damn thing.” But he’s my colleague, and maybe he was backed up; he had 10 colonoscopies. He was doing it as fast as if I were asleep, which is not good for a guy like me. You slow down a little bit.
Kevin Pho: Now, when you talk about the pain that you were feeling while you were having the colonoscopy, how severe was that? On a scale of 1 to 10, what kind of intensity are you talking about?
Mike Neskovic: First of all, when he puts the colonoscope right there, it’s discomfort, maybe 1, 2, 3. And when you go up the descending colon, to the splenic flexure, it goes to 8, 9, 10. So actually, tears started coming to my eyes, and I was moaning, 10 over 10. Now he’s going through the transverse colon; it’s 7 over 10, or 6, variable. Now again, at the other one, the hepatic flexure, it’s 10 over 10. I’m moaning, and it’s almost unbearable. I’m telling you, those two flexures are very hard, but it’s lasting maybe 30 seconds and 30 seconds, so one minute is very hard. After that, it’s just a little bit of discomfort, and maybe that gas; they put lots of gas in to open up the colon inside. And overall, it’s quick, and I would say go ahead, do it.
Kevin Pho: He’s a family physician. He wrote the KevinMD article “I’m a doctor who just had his first colonoscopy in my 60s, without anesthesia.” Mike, what kind of questions should one be asking themselves if they want to consider having a colonoscopy with or without anesthesia?
Mike Neskovic: First of all, if the doctor recommends a colonoscopy, go ahead and do it. If there is a doubt, don’t leave any stone unturned. Many people don’t know that there are colonic polyps. If that small polyp is growing, at one point it can become cancerous, or it can be precancerous. So it’s really important to remove that colon polyp, and that’s the gold standard. Anybody 50 years or older should have it, especially if people have a positive family history. If anybody had colon cancer, definitely they should have it. If you have any bleeding or change in bowel habits, you know, you have constipation, later on diarrhea, that should be done.
And when you look at the business, our gastroenterologists make more money than us family doctors. He does one colonoscopy and can go have a whole weekend, and we need to work day in, day out. But we love our job better, and we contribute our way, and they contribute their way. So yes, colonoscopy is the gold standard, and I would recommend that the majority of people do propofol, like Michael Jackson, so you know nothing, or conscious sedation. But you need to suffer the IV, to put some needle here, and that’s not good, and you cannot drive home. That’s a disadvantage. Yeah, I drove home.
Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?
Mike Neskovic: Yeah, my take-home message is that it’s said that, of human beings, 9 out of 10, 99 percent of people, don’t live their life; they are not fulfilling their destiny. I hope, Kevin, you and me, we are doing something we love to do. And I think we should be active. I will never stop hiking and doing marathons. I’m kidding. Like, I married once, and I never stop doing my marathons. So I did 31. God willing, when I’m 100, I will count until 100; after that, no counting. And I’d like to live to 126. You too, right?
Kevin Pho: I’m going to try. Mike, thank you so much for sharing your story, time, and insight. Thanks again for being on the show.
Mike Neskovic: Thank you, Kevin. It was my pleasure. Have a good day.
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