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Cat Forum / Cat Anecdotes / June 2005Question for medical professionals - OT
Since we have several medical professionals who post here, maybe one of you can answer my question. Here's the background: I recently had an upper endoscopy and colonoscopy. I have had both procedures before, and for the past several times I have always been put out, which I much prefer. The anesthetic used this time was Diprivan. Afterward, I remarked to the nurse that the anesthetic wears off much faster than the sedative they use when they don't put you out. She said that's because it is quickly metabolized and out of the system. That evening, I noticed itching on various parts of my body. The next day, there was much more itching, and a few areas had a small rash. By the third day, the itching was really getting to me, and I did two things I probably should have thought of sooner. I took an antihistamine, which helped considerably. When I realized that, I decided that the itching could be an allergy. I hadn't eaten anything unusual or changed detergents or bath soap, so the only new things I could think of that might have caused the itching were the Fleet Phosphate I had to drink to prepare for the procedure, and the anesthetic. I googled both. Fleet's didn't mention itching, but itching and rashes are side effects mentioned for Diprivan. My question is this: If the Diprivan is metabolized and out of my system quickly, could it have caused itching that lasted three days or more? It started getting better after that, but I still itch in a couple of spots. I realize that, if it is the probable culprit, I should notify my doctor and the facility where I had the procedures, because I'll no doubt be having them in the future. If it did cause the problem, is there another anesthetic that will have the same great results without the side effects? Joy DP says that your immune system may have had a delayed reaction. Sometimes it takes time for the body to recognize there is something new and respond to it. Ask your doctor and discuss pros and cons of trying something new. --Fil > DP says that your immune system may have had a delayed reaction. > Sometimes it takes time for the body to recognize there is something [quoted text clipped - 3 lines] > > --Fil Thanks. I'll do that. Joy > DP says that your immune system may have had a delayed reaction. > Sometimes it takes time for the body to recognize there is something [quoted text clipped - 3 lines] > > --Fil Good point. Delayed hypersensitivity reaction is an unusual but real allergic response, particularly important in asthma. For those who might be interested in such things, the inflammatory factors in delayed reaction are usually leukotrienes, as opposed to prostaglandins in prompt hypersensitivity. There's a fairly new class of asthma medications that blocks leukotrienes -- don't know if it's used in cats. > Since we have several medical professionals who post here, maybe one of > you [quoted text clipped - 28 lines] > My question is this: If the Diprivan is metabolized and out of my system > quickly, could it have caused itching that lasted three days or more? Yes. A slight bit of theory of allergic reactions: an antigen, in this case, stimulates the immune systemss (there's really more than one) to produce antibodies and other substances and cells. The itching may be caused by the chemicals produced by the subsequent immune reactions, not by the antigen itself. Do ask if they used any kind of contrast medium/dye during the procedures. Some of the iodine containing ones often produce immune reactions. >It > started getting better after that, but I still itch in a couple of spots. [quoted text clipped - 5 lines] > anesthetic that will have the same great results without the side > effects? Probably, although I have a hunch it may have been a dye reaction. It certainly would be wise to take an antihistamine before the procedure -- this is actually quite common in presurgical preparation, and generally thought required in any procedure when contrast media are injected into the blood. The usual would be 50-75 mg of diphenhydramine (US trade name Benadryl, Canadian is Gravol) perhaps 2 hours before the procedure. Thanks, Howard. I suspected contrast reaction first off but researched drug she named (its generic is what I researched online) and could find no reference in precautions re it containing any form of iodides. However, I did notice this drug is often used, for one reason or another, in *combination* w/many others - who knows what they contain? I raise big white itching hives, rash and sneezing from iodides! But I knew this, and was premedicated for both my cardiac caths - not one itch, sneeze, nor hive did I have neither time. Drunk-like, yes, but no allergy symptoms. I'd let her doc know of her distress post-procedure, so he can investigate. >> Since we have several medical professionals who post here, maybe one of >> you [quoted text clipped - 55 lines] > the blood. The usual would be 50-75 mg of diphenhydramine (US trade name > Benadryl, Canadian is Gravol) perhaps 2 hours before the procedure. > Thanks, Howard. I suspected contrast reaction first off but researched > drug > she named (its generic is what I researched online) and could find no > reference in precautions re it containing any form of iodides. While it's by no means my area of specialization, I've seen some recent reports where an iodine-based contrast agent is used, in gastrointestinal examinations, either before barium or instead of it. If there's any suspicion of an ulcer, there's usually an attempt to use direct viewing and X-ray techniques to rule it out, as barium getting out of the GI tract does nasty things. Of course, if there are any questions of vascular involvement, then iodine contrast agents would have been injected IV. Since she was out during the procedure, there's no way to tell if she had the telltale hot flash or taste. >However, I > did notice this drug is often used, for one reason or another, in [quoted text clipped - 5 lines] > sneeze, > nor hive did I have neither time. For mine, I agreed on the antihistamine, but didn't want any other sedation. If it was one of the research caths where they used pharmacologic stress and triggered angina, a little fentanyl or morphine into the IV handled things nicely. During angioplasty, I did need pain relief once or twice. (Score to date: 5 caths, 2 angioplasties, 1 bypass). In general, I preferred to watch the monitors and know what was happening. In another post, you pointed out correctly that things can get very confused based on a partial interpretation, based, for example, just on an X-ray film. With me, most of my physicians tend to agree that if I can follow the imagery, with no more than an occasional question for purposes of anatomical orientation, I might as well learn things at the same time they do. Laughing a bit at the way my diagnosis of diabetes was handled -- my cardiologist had just run several test batteries since I hadn't seen him in a while, and he was slightly concerned about thyroid abnormalities. Fritz said "you want the good news or the bad news first." "The good news" "Your thyroid is fine. Besides that..." and he handed me the chart, with the blood chemistries on top. I read the glucose, cursed slightly, and asked if he wanted to prescribe a sulfonylurea or if he wanted to send me to an endocrinologist. Only afterwards did I ask myself "was that a normal reaction?" :-) >Drunk-like, yes, but no allergy > symptoms. [quoted text clipped - 68 lines] > > Probably, although I have a hunch it may have been a dye reaction. It > > certainly would be wise to take an antihistamine before the procedure > > Thanks, Howard. I suspected contrast reaction first off but researched > > drug [quoted text clipped - 12 lines] > Since she was out during the procedure, there's no way to tell if she > had the telltale hot flash or taste. True, but I know I didn't have barium. Joy > > > Thanks, Howard. I suspected contrast reaction first off but > > > researched [quoted text clipped - 18 lines] > > Joy Iodine-based contrast agents have replaced barium for a number of applications. It's only been realized fairly recently how toxic barium is when it gets outside the GI tract. > Since she was out during the procedure, there's no way to tell if she > had the telltale hot flash or taste. Now that's interesting. I was injected with something before I went in the CAT scanner and was told I would feel a hot burning sensation throughout my body. I did, and it felt like I could track the stuff as it went round, so I'm glad they told me. They also said I might get a feeling like I had wet myself, although I wouldn't have done so. Fortunately, I didn't experience that, but a woman I was in hospital with - same symptoms, same everything as me, so same tests, did. She was convinced she had "had an accident." She hadn't. We compared tests and our operation all along the line and have formed a real friendship. She turned out to have a dermoid cyst, a benign one with hair and teeth in <shudder> We had both come in as emergencies a couple of weeks before so we knew each other before we were sent home to wait for our surgery therefore we were both thrilled to find out that we would come in and have our surgery on the same day, so we asked to be put in opposite beds. It's always nice to know someone on the ward that you get on with. One day after surgery: Me: Jayne? You alive? Jayne: No. Me: Nor am I. Jayne: Can you move? Me: No, are you glad you had it done? Jayne: F!!!! B!!! I wish I'd died.. Tweed > > Since she was out during the procedure, there's no way to tell if she > > had the telltale hot flash or taste. [quoted text clipped - 6 lines] > so > I'm glad they told me. My first cardiac cath was done by a cardiologist who knew me well, so all he needed to say (for both me and the assistants) was "shooting (dye)". He wasn't in the room, however, when I had my first angioplasty. The good news about that angioplasty was that it was being done by one of the two people who had done the most in the world -- they had been the students of the physician who invented the technique. Some of the team were very good at recognizing and speaking appropriately to a knowledgeable patient, but not everyone fell into that category. The first exception kept asking me to tell her exactly what I was feeling, especially when getting the first dye shots in the heart. When I started feeling the flush, and she asked me again, I broke out laughing and then gasped out something that I could say, for the first time in my life, with absolute accuracy: "heartburn". After an angioplasty, there is a period of 6-8 hours while your blood clotting returns to normal. During this period, a sandbag, often with a pressure clamp, goes over the puncture site in the upper thigh, in the groin. Without being unduly graphic, it was inhumane to have assigned to that duty the cardiac nurse who was also the rehab aerobics instructor. It is unfair to have someone like that inspecting one's groin every 15 minutes, with us both aware that a wrong move might make me bleed to death. :-( >> > Since she was out during the procedure, there's no way to tell if she >> > had the telltale hot flash or taste. [quoted text clipped - 36 lines] >minutes, with us both aware that a wrong move might make me bleed to >death. :-( I know what you are talking about. I had to go through such a procedure earlier this week. I went to the hospital last Thursday morning with angina. They performed a thallium stress test on Friday, which showed reduced blood flow in the front of my heart. They had to cut the stress test short as my heart rate unexpectedly dropped to only 30 beats a minute. Since it was too late in the day to schedule a Friday arteriogram, and they only do such on the weekend in life-and-death situations, I stayed in the hospital over the weekend and they did the arteriogram Monday morning. They had to implant a stent, my sixth. I came home from the hospital Tuesday afternoon, and received a royal welcoming from Cinders. One of my friends had come over Saturday to put out extra water and dry food for her, but she had hidden from him, so she had to go five days without any petting. I am now feeling well enough recovered that I worked a full day at the office on Wednesday and Thursday, although I will have to continue being careful of the puncture site for several more days to come.  SignatureJohn F. Eldredge -- john@jfeldredge.com PGP key available from http://pgp.mit.edu "Reserve your right to think, for even to think wrongly is better than not to think at all." -- Hypatia of Alexandria >>>> Since she was out during the procedure, there's no way to tell if she >>>> had the telltale hot flash or taste. [quoted text clipped - 57 lines] > office on Wednesday and Thursday, although I will have to continue > being careful of the puncture site for several more days to come. John! I'm so glad you are feeling better. Belated purrs. > I am now feeling well enough recovered that I worked a full day at the > office on Wednesday and Thursday, although I will have to continue > being careful of the puncture site for several more days to come. John, I'm glad you are feeling better. Hopefully this will be the last time you have to go through this. Healing purrs and doggie drool on the way. Diane > I am now feeling well enough recovered that I worked a full day at the > office on Wednesday and Thursday, although I will have to continue > being careful of the puncture site for several more days to come. Goodness! Glad you're back home and feeling better. Purrs for continued recovery. Give Cinders some scritches from me, just to make up for lost pettins. SignatureMarina, Frank and Miranda. In loving memory of Nikki. marina (dot) kurten (at) pp (dot) inet (dot) fi Pics at http://uk.pg.photos.yahoo.com/ph/frankiennikki/ and http://community.webshots.com/user/frankiennikki > >> > Since she was out during the procedure, there's no way to tell if she > >> > had the telltale hot flash or taste. [quoted text clipped - 57 lines] > office on Wednesday and Thursday, although I will have to continue > being careful of the puncture site for several more days to come. John, I'm so glad you're feeling better - belated purrs for what you went through and healing purrs coming for your continued health. Hugs, CatNipped Lots of purrs and best wishes for you, John, SignaturePolonca & Soncek > I know what you are talking about. I had to go through such a > procedure earlier this week. I went to the hospital last Thursday [quoted text clipped - 16 lines] > office on Wednesday and Thursday, although I will have to continue > being careful of the puncture site for several more days to come. Yes, I'll definitely let him know. Since the facility where the procedures were done has a file on me too, I'll cc them. SignatureJoy > Thanks, Howard. I suspected contrast reaction first off but researched drug > she named (its generic is what I researched online) and could find no [quoted text clipped - 66 lines] > > the blood. The usual would be 50-75 mg of diphenhydramine (US trade name > > Benadryl, Canadian is Gravol) perhaps 2 hours before the procedure. > > Since we have several medical professionals who post here, maybe one of > > you [quoted text clipped - 38 lines] > procedures. Some of the iodine containing ones often produce immune > reactions. Yep, I'm allergic to IVP dyes - but I just get hives, not anaphylactic shock, so when they had to give me an Iodine dye the last time I had a lithotripsy, they just loaded me up with Benadryl IV beforehand and I did fine. They might be able to do the same with you, but if there is another drug as effective that they could substitute they're probably go that route. Hugs, CatNipped > >It > > started getting better after that, but I still itch in a couple of spots. [quoted text clipped - 12 lines] > the blood. The usual would be 50-75 mg of diphenhydramine (US trade name > Benadryl, Canadian is Gravol) perhaps 2 hours before the procedure. > > Since we have several medical professionals who post here, maybe one of > > you [quoted text clipped - 55 lines] > the blood. The usual would be 50-75 mg of diphenhydramine (US trade name > Benadryl, Canadian is Gravol) perhaps 2 hours before the procedure. Thanks, Howard. I'll ask about the dye, but I don't think they gave me any. The doctor always gives me a copy of his complete report, including photos, before I leave the facility. Since it mentioned the anisthetic by name, I suspect it would also mention any possible dyes used. It's ironic - I'd been having rather bad hay fever attacks, and I use Benadryl for that. When the doctor's receptionist called the day before to remind me I was having the procedure, and what I had to do to prepare, I asked if it would be okay to take an antihistamine in the morning. She said only if I took it at 6 AM. It would have stopped working before the procedure, even if they'd started on time, so I didn't bother. As it turned out, my hay fever wasn't active that morning. Joy |
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