Monday, June 11, 2012

The Letter D Extruded: The effect of Anesthesia Drugs

It's odd, sometimes the answers are right in front of you, the ones that you can't see. Something that has bothered me as an anesthesiologist and psychic is the nearly united sentiment of the natural healing community that Conventional Medicine is Bad.  I have gotten into it online with several people, trying to inject some reality into childbirth, anesthesia drugs, and this perception that Conventional Medicine is Bad. And that Conventional Medicine is Designed to Make Someone Rich.

I see it as one way to address Common Human Suffering, through Disease. And the people who are from the granola-forces just refuse to see it.

Then it occurred to me: both are correct.

General Anesthesia uses very strong medicines, that produce severe side-effects. For some people, in their perception, the benefit is worth the price. And for others, the price is not worth the benefit.
What can be done to bridge the chasm between both points of view? Begin open discussion! Here are some of the side effects I experienced personally this past week. And here are some tips on how to avoid them. That way, anyone out there on whatever side can know the facts, and apply them to their benefit if the need for General Anesthesia should arise.

Anxiety Going under anesthesia and having surgery is frightening. You don't have to be aware of it. I asked, 'Please don't let me remember what the inside of the O.R. looks like; I have seen too much.' And my friend gave me anxiety medicine in my i.v. in PreOp Holding. What I remembered was patchy at best.

 Awareness Being awake in the O.R. CAN happen. If you are having cardiac surgery, conscious sedation without an anesthesiologist, OB anesthesia, emergency surgery you are at higher risk. (Your blood pressure is low and more anesthesia would only lower it) Obesity, female sex, and chronic use of prescription or non-prescription mood altering substances can increase the risk. Open discussion with your medical team and anesthesia provider can tip them off that 'you might need MORE' to stay 'out'. And if possible, BIS intraoperative monitoring can measure your level of consciousness while you sleep. For most people this sticker on the forehead is enough to ensure that appropriate levels of anesthesia are maintained. Then it is only if you have low blood pressure due to profound illness, that less anesthesia (which lowers the blood pressure) can be used, and that risk of awareness is present. 

 Muscle Relaxation For some surgery, it is important that you do not move (delicate, such as neurosurgery or cardiac surgery). For others, it is important that your muscles relax so that the surgeon can see inside (abdominal). For this strong muscle relaxing (paralyzing) agents are given. These are separate from pain medication and 'forget' (amnesia) medication. Although there is the chance you can 'wake up and not move', more often the case is that you will feel weak when you wake up. It will seem hard to take a breath, and your movements will be shorter and weaker.  Time will take care of this. Do not be afraid, for your oxygen is being monitored continuously and help will be given if your saturation is low. Five minutes or more and you will be normal again. Not to worry!

 Dryness of mouth Eating a cracker was miserable. I had no spit. It took glasses and glasses of water to get it to go down, and it stuck on my teeth. To reverse muscle relaxant, anticholinergic drugs are given. They dry up spit, and slow the gut. Sometimes you will feel the need to be thirsty for days following surgery. This is a normal side-effect of those drugs. It will pass. Note that the oxygen given is not always humidified too. It can be drying. 

 Dryness of eyes  tear production is decreased under general anesthesia. If dry eyes are a problem, ask for lubricant to be put in them while you are asleep. This worked wonders for me. Vision might be a little blurry when you wake up, but it is better than very dry eyes.

 Nausea and Vomiting Gut motility is slowed considerably by 1) surgery 2) anesthesia 3)pain medicine 4) reversal of muscle relaxant. I am on toast and tea for three days after surgery. Here is what to do--mention to everybody you have the problem and don't want to throw up. This justifies the expense of MORE medication. Get 1) a long-acting antiemetic (in pre-op) like scopolamine patch 1.5 mg transdermal or Emend (aprepritant) for three days of fighting nausea after 1 dose. 2) zofran round the clock 3) decadron round the clock 4) intraop benadryl 5) hydration at least 20 ml/kg intraop 6) avoid triggers (reversal, nitrous oxide).  Keep on supplemental oxygen and walk as much as possible to get the gut moving again. Until you pass gas from below, don't try to eat too much. Your gut is still asleep.

 Incisional Discomfort Take enough pain medicine so you can cough. I prefer non-steroidal anti-inflammatories (ibuprofen, toradol) for my pain. Sometimes in surgery these can affect bleeding and surgical outcome. So I took narcotics, which made me throw up.  It was a vicious circle--your options are to stop taking the narcotics and just hurt (I switched to ibuprofen except at night) or to take strong antiemetics. A good alternative is i.v. acetamenophen 1000 mg q 6 hours (Ofirmev).

 Itching  Itching was a serious problem from the narcotics. I scratched under my leg squeezers, on my back, on my arms and legs. There are scabs from clawing at myself. Benadryl usually is used in this situation, but it gives me nightmares so I opted to itch. Nubain also is excellent for stopping itching from narcotics.

 Constipation  Because the motility is slowed and the colon keeps absorbing water, constipation is a problem after most surgery, especially abdominal surgery. Keep on stool softener colace as long as narcotic pain killers are used. Walk. Increase fluids. Take psyllium. Mineral oil and prunes are also useful. Give yourself an entire day after surgery to get used to normal bowel function again. This is day two to day four. It is painful.

 Airway Obstruction  standard of care is to use a Masimo pulse oximeter on the patient post-op on the surgical ward. I have mild sleep apnea. I do not wear a mask. I was surprised at how often my oxygen saturation dipped below 93%. It would alarm at 90%. A few deep breaths would fix it. What happened is ATELECTASIS (drop in lung volume from shallow breathing after surgery) and NARCOTIC RESPIRATORY DEPRESSION (I would forget to breathe). Insist on a monitor on you or your loved one. It is the standard of care. And do incentive spirometry, breathing exercises, sitting out of bed in a chair, and walking to reverse the atelectasis process.

 Bleeding and Hypercoagulation Surgical trauma to tissue makes the patient hypercoagulable (more likely to clot). This is a risk for deep venous thrombosis and pulmonary embolus. Stockings, leg squeezers (sequential compression stockings), lovanox injections, subcutaneous heparin injections are for decreasing the risk. My surgeon was concerned about bleeding from my daily aspirin, and had me stop it. So I was sure to do  leg exercises and wear the compression hose. Take these same risk-reduction measures for long distance travel by car, train, or plane to reduce clotting risk. A friend of mine diagnosed a PE on himself mid-flight, and on landing had to be transported to a hospital for anticoagulation with a heparin drip.

 Risk of Falling/ Impaired Balance Getting up after surgery makes you light-headed. Have someone there. Hold on to an i.v. pole or a walker when walking at first. You will get your balance back again.

Urinary Retention Anesthesia and narcotics upset the cholinergic balance on the little muscles that tell your bladder sphincter to relax and let urine flow. For some with big prostates, the normal balance is lost for good, and medical intervention is necessary through a catheter or surgery to open the flow. If your first void or two after surgery is difficult, push as hard as you can, and know it will improve with time. Do not allow your bladder to overdistend, or else it will need bladder rest. Have your nurse help you with a quick in and out catheter first. Foley catheters tend to increase risk of infection, and need to be out by three days.

Sore Throat Your throat is likely to be VERY sore after any kind of surgery. My entire mouth burned. For days. Roof and tongue.  It is from intubation, laryngoscopy, and the bite block that is hard plastic that is used in the mouth. I lube my patient's endotracheal tubes and use soft cotton for a bite block, and they never get a sore throat unless intubation was difficult. Avoid citrus and you will get better.

 Nosebleed  My nose was full of dried blood. For days. I am not sure why. Perhaps a tube was passed through the nose to empty the stomach while I slept? I am still working on this one. You are not alone!

 Annoyance Everything bothers me! T.V. People talking. The way other people drive me in the car (they hit lots of painful bumps). Now it is post-op day five, and getting better. I have not experienced annoyance like this before, and am not sure where it comes from. Glad it is going away.

 Amotivation/passivity  My Life Force is weak. Daily Reiki is helping. And sunshine too. Eating to raise my vibration back to its natural state. Caring from friends, family, and coworkers helps with this one too.

 Chakra Imbalance  I have a sense for my chakras. Having surgery imbalanced them. But others chakras in the healing process are overcompensating. As I achieve balance, I am gentle with myself, as it is not going directly from imbalance to balance. Instead, it is going through many 'rebalancing' combinations that are uncomfortable along the way. I focus on my Heart Center. I listen for Guidance, which is quiet. And I Trust and Envision being back to normal for me again. Let me restate: I avoid low vibration, I am patient, I take in High Vibration whenever possible, and I wait. Sleep is one of the best things out there to heal the physical and non-physical alike.

 Miscommunication/being misunderstood Everyone working with you, be it professional, friend, or family, is going to see you through the distortion of how they see themselves. For me, the most extreme is my son, who is too young to understand the consequences of what I have been through. He cannot comprehend my being sick. I extend myself to a limit that I place on myself, for him. I protect my incisions with pillows against accidental harm (for example, he went to hit my arm at seeing an 'out of state' license plate, missed, and socked me square in the incision!). You are a perfect creature in illusion. It is all right to take steps to 'bend the illusion' somewhat in order to protect yourself. And have patience that everyone is doing the best they can, based on their individual state, to help you. Their intentions are good.

 Difference in Vibration/lack of Telepathy I went quiet. I missed it. The only thing I get is right before I wake up. It is coming back. There is only so much energy to go around. Be patient. And it will come back. Concentrate on Now, and know that everything is blessed and Right.

Healing is a lesson in itself. It is a powerful lesson. And when you see for yourself what surgery can do, and how you can bounce back, you will be inspired by the body's ability at reparation.

If you do not wish to undergo surgery, that is okay. But inform yourself so you can help others.

Imbalances that become physical are only lessons that have become harder to not notice.

Everyone has their lessons. As healers you shall experience them too.

One day all of this will seem antique. Better things are ahead. Until we get to them, add Reiki to the mix. And Namaste.

Reiki Doc

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