@Brandon Lopez6 Look, I’m not a specialist in neuropsychiatry or internal medicine, so don't take my word as gospel, but if you ask me, there is absolutely no point in even starting a conversation about "ruling out physical causes" for these kinds of issues without having actual hormone results—specifically thyroid and maybe cortisol—along with a full electrolyte panel in hand. Trying to talk about this without those, let alone bringing up things like an ECG or some Doppler tests, is just straight-up medical heresy...
Of course it’s unreliable... for certain drugs we still use daily in anesthesia, even today we don't fully grasp the exact mechanism of how they produce their effect, so we just rely on "educated guesswork." Besides, trying to give medical-grade answers to someone outside the profession—especially regarding an area as obscure as anesthesia—is incredibly thankless work... Even many colleagues who are brilliant in their own specialties have no clue about it beyond what they picked up in med school (which is minimal), particularly when it comes to general anesthesia versus local stuff which isn't even remotely related...
The reason we don't treat patients as if they're just ignorant or incapable of handling the truth isn't because we view them as simpletons; it's about the nature of the profession itself. To illustrate, I could sit here and write several pages of A4 text from memory about muscle relaxants, their interactions with other drugs used during induction, maintenance, and emergence, or the effects of various common and rare conditions... but that would be totally irrelevant to this topic and wouldn't be useful to anyone. By the way, I don't consider myself some massive expert—just compared to someone who actually is—and you’re more than welcome to have your opinion of me or anyone else, since opinions are free, but the idea that a layperson could truly grasp the (patho)physiological relationships at play in anesthesia is just insane... especially if that opinion is based on some quick, unstructured Google search in a field that is still largely built on speculation... Personally, I think it's great that you're interested in your own health, and when I conduct interviews, I always try to answer questions if there are any; sometimes a patient actually knows more about their condition than I do, especially with rare diseases, but expecting someone to explain EVERY single aspect of every possible outcome and every conceivable complication is just unrealistic...
Generally speaking, the lab tests and screenings done preoperatively are pretty standardized; a specific disease or condition will trigger a set number of additional tests, much like how it carries a certain percentage of risk for one complication or another. The tests ordered in any given case are limited by the cost-benefit ratio relative to the probability and severity of a potential complication. For instance, the standard battery of tests is sufficient for 99% of the population, but for that 1%—those who aren't quite "on the Gauss" level, so to speak—they might be inadequate, and a complication could happen because of that. Some adverse events will be managed by a doctor's experience, while others won't, whether it's because they couldn't, they missed it, or they didn't account for it...
Basically—running "full panels" on every single patient for every possible contingency is both impossible and unjustifiable, both from the perspective of the American healthcare system's finances and for the patients themselves... Just look at it this way: even now, people wait through "dozens of exams" before a surgery; imagine if we had to run ten times more tests at multiple facilities just to prevent maybe one less adverse event out of every 1,000 anesthesias—an event that ultimately wouldn't even impact the patient's health...
Now, let's be clear: based on what's been described, my assumption is that an excessive dose of relaxant was likely used, as that's the logical conclusion, but whether that could or *should* have been avoided is something I can't judge. There are far too many possibilities for drug interactions and reasons why things went wrong to make a definitive statement. Obviously, it would have been better if everything had gone "smoothly," but an adverse event happened. On the flip side, over-sedating a patient just to wipe away any trace of memory regarding their time in the OR is also unjustified and dangerous—a huge number of drugs used for that purpose have effects lasting several hours under normal circumstances, and especially when metabolism is slowed or multiple drugs are given simultaneously. You could end up "stuck" for an hour in the recovery room with nobody around to watch you or hear you scream... I think you get the idea of how that ends. Again, it all comes down to the clinician's experience in trying to "tailor-make" the anesthesia for every individual patient...
Edit: By the way, just so we’re clear—hospitals here in the States don't always carry every single anesthesia drug on the market, and they certainly don't have enough stock to support some idealized version of "patient choice" where you get exactly what you want regardless of the circumstances. So, when people talk about how "titrating" medication shouldn't happen because it's supposedly bad practice, that logic falls apart pretty fast when you look at the reality of American healthcare... It’s easy to say the dose should be perfectly tailored to the situation, but if my only option for pain management is a drug that lasts at least an hour, and I don't even have the one that lasts ten or thirty minutes in the cabinet, then my choices are basically limited to letting you suffer or risking complications during emergence... It's a choice between two evils, really. You tell me which one makes more sense...
Look, waking up from anesthesia while the muscle relaxants have completely worn off and you’ve still got a breathing tube in your trachea carries its own set of serious risks...
And let’s be real, it isn't always possible to perfectly "target" the exact duration of the drugs, especially when you're dealing with procedures that are either incredibly long or extremely short...
Plus, your overall health profile might not have signaled any specific red flags for risk, and even if there was a complication (which I don't know the specifics of), that doesn't automatically mean the procedure could have been handled in some fundamentally different way...
I honestly don't get why you're being so hostile in your posts and digging your heels in like this; if you truly believe the treatment wasn't adequate, you're more than welcome to take it up in court to seek damages, but if you're just looking for someone here to validate your belief that a mistake was made—you aren't getting that from me, especially not with such a vague and half-baked description of what happened. Without seeing your full medical records and knowing exactly what "proteins" or additional underlying conditions we're talking about, there is absolutely no way for anyone to judge whether the doctor should have known better, let alone whether the outcome could have been avoided...
So, there it is...
And the emojis are just there to emphasize my point...
amberpilot8 said:I have a question; basically, I was undergoing this minor procedure that lasted about 40 minutes, and when I started waking up, I could see the lights in the operating room and knew they were trying to wake me, but I just couldn't breathe. I tried to tell them, but my tongue wouldn't move, my lips wouldn't work... it was like I was paralyzed. I could hear the doctors telling me to breathe, but I just couldn't... so I started frantically shaking my head from side to side to let them know I wasn't breathing, and after thrashing around a couple of times, I finally caught my breath. Why on earth did that happen? It left me totally traumatized... Before this, I’d been under general anesthesia twice for hour-long procedures and nothing like this ever happened. Thanks!div>
It’s likely because the surgery was so short, and they used a relaxant—stuff like rocuronium or vecuronium, which is what most hospitals here in the States use nowadays—where the window from the initial dose until muscle function returns is roughly 40 to 90 minutes... in much longer surgeries, there's plenty of time for the anesthesiologist to see how fast you're breaking down the drugs and adjust subsequent doses or infusion speeds to fit your needs, but with a super quick procedure, you don't really get that luxury... To put it bluntly—you woke up before your muscle function had fully recovered. You aren't crazy, and honestly, it happens sometimes... while it's obviously better if it can be avoided, it doesn't always go perfectly every single time... You also have to consider things like laryngospasm or other factors that can block your airway even if your muscles are working fine, but most likely, it was just that the muscle relaxant was still too heavy in your system...
amberpilot8 said:Of course I'm alive, no need for the drama. I'm low on protein, and that's the only reason (according to my Google searches).... not to mention that looking at my lab results, there's this massive red number!!!!!!! on the report, so for God's sake, what is going on with doctors these days? They can't even read their own charts.div>
Plasma protein levels might play a role, sure, but they aren't the smoking gun in a situation like this. It's quite simply that either too much medication was administered or there just wasn't enough time for your body to metabolize it... though, one could argue why the protein levels are low in the first place—whether it's an isolated issue or tied to broader organ dysfunction, since both the liver and kidneys are heavily involved in processing and clearing drugs from your system... 🙄
amberpilot8 said:Look, you’re talking about enzyme-proteins and muscle proteins, but if they’re using muscle relaxants to block movement during general anesthesia and the patient wakes up while the relaxant hasn't kicked in—or rather, isn't working anymore—it's likely because the relaxant wore off too soon due to a lack of enzymes... which basically points back to some oversight by the anesthesiologist.
Scott Allen10, oh man, Scott Allen10... you really should have known better than to think that...
This actually has nothing to do with muscle proteins and everything to do with albumin and alpha-acid glycoproteins, which act as carriers for drugs in the bloodstream; and as for the "overdose" theory—maybe, I guess, though we generally know what initial dose is administered during anesthesia, and if that dose is too much for that 40-minute window then it's too much, but maybe they should have waited a bit longer or given a sedative so the patient wouldn't even remember the sensation, but honestly, regulating it that precisely isn't exactly... 🤷
Regarding the negligence part, I can't really comment since I wasn't there, but the doctor could have been busy with something else while the technician was supposed to be watching the patient, which is obviously what should have happened...
As for the equipment, if you're disconnected from it and the breathing tube is out, there's zero point in looking at the machine; at that stage, the only thing that matters is watching the patient... ☕
wiredpanther47 said:Oh my god, I got even more terrified, I'd honestly prefer if this could just be done under local anesthesia, ugh, but this whole overdose thing seems possible because my husband is an athlete, he's huge, like 115kg, so maybe they underestimated him and it hit him harder than expected, which is what I'm really hoping is the case ://///
I don't know, with an "instant overdose," it usually works the other way—you give too little and the effect isn't right, but it is possible they gave too little initially and kept adding more, so it's hard for me to say for sure, but regardless, I'll stick to saying that if the surgery is necessary, then it's necessary, and you shouldn't lose sleep over whether something might happen, though kids aren't exactly prime candidates for local anesthesia, especially little ones; I spent a fair amount of time in ENT and never saw major issues with kids, but like I said, there are certain genetic factors you always have to watch out for...
Amanda Perez42 said:Hi everyone, I wanted to get some advice from people here, so please help me out. In less than a month, I'm scheduled for an abdominal wall reconstruction, basically a tummy tuck. However, I've been reading that it's a long and risky(?) procedure because of the possibility of developing venous thrombosis, which is apparently rare but still happens. Otherwise, I'm healthy, I don't take any meds, I am a smoker (I also read I should stop smoking and drinking herbal teas two or three weeks before the surgery?), etc...
So I was wondering if any doctors here or anyone with personal experience could tell me how risky this surgery actually is, because I've started getting really scared ever since I started researching online...
It carries about the same risk as any other abdominal surgery, maybe slightly more if they have to close it "under tension," which increases pressure in the leg veins due to higher abdominal pressure and slows down blood flow, plus the fact that you might have to stay lying down longer (because they insist you don't get up or strain too much so the plastic doesn't rip), but it's not significantly higher than any standard surgery of that type; standard high-risk prophylaxis should be plenty sufficient as long as you don't have serious underlying clotting issues...🤷
@Taylor Anderson182/">@@Taylor Anderson182 When you're dealing with etomidate, telling the difference between actual seizures and myoclonus just by looking... well, it's tough. Myoclonus is actually pretty common with etomidate, which is why we usually toss in a benzodiazepine—like Valium or Ativan—or maybe some opioids before the etomidate hits, just to smooth out those muscle twitches. Now, etomidate, like most induction agents, inherently has anticonvulsant properties, but there have been documented cases of epi-attacks with it; plus, it’s often used specifically when we need to perform cortical stimulation because it keeps the brain signal quality much cleaner compared to other anesthetics... Basically, it's hard to say for sure, but one thing is certain: convulsions don't really have much to do with an allergy itself. I mean, you shouldn't even have to pay out of pocket for allergy testing unless you're looking at extra participation costs if you don't have supplemental insurance, and if a specialist recommends it, your primary care doctor should be able to handle it without a hitch. That said, a shellfish allergy isn't a dealbreaker unless they're using protamine to neutralize heparin, though the anesthesiologist will definitely keep that seizure info in mind when using etomidate so they can decide whether to pivot to something else instead...
@wiredpanther47/">@@wiredpanther47 Pediatric cases are handled differently than adults, and depending on how old the kid is, things vary quite a bit but what I wrote above ABSOLUTELY you have to emphasize to the anesthesiologist during the pre-op exam. Family history is something that frequently gets overlooked during these checkups, and besides, I highly doubt your wife was being "shocked" awake with electricity—that's just not how it works. It was more likely a TOF neurostimulator being used to monitor muscle function during emergence, which could point to two things: 1) less likely, a colleague administered a slightly higher dose of a relaxant, or 2) more likely, there's a (let's call it) compromised metabolism involved. I couldn't tell you definitively which one it was without seeing the exact drugs and dosages used over time, but some of the conditions that cause excessive or prolonged relaxation are genetic and can be passed down to children. You really need to mention this and make sure it's noted in the records so that whoever handles the child's anesthesia knows to exercise extra caution...
@neonwolf222/">@@neonwolf222 The question is framed incorrectly—to be precise, you're asking in the wrong place. Those kinds of fistulas are sites of chronic infection and bacterial colonization, and if you go through with a prosthesis placement (I assume that's what you mean by hip surgery), those bacteria can colonize the implant and cause massive problems. However, that's really a problem for the surgeon, the orthopedist, who knows way better than any anesthesiologist the risks involved in potentially ruining their work with the hardware they have on hand... So, to answer the question of whether you can undergo anesthesia for such a surgery with an active fistula—of course, the anesthesiologist will coordinate with you to choose the right technique, but as for whether it's actually *advisable* to do it while the fistula is still there... I'm afraid I can't give you a straight answer to that...
@Victoria0 No, there are medications and certain physiological conditions that can mess with your sense of balance, but generally speaking, I'm not aware of any drug currently used in anesthesia that would produce the kind of effects you're describing, certainly not under standard exposure and circumstances...
@Thomas Vaughn5/">@@Thomas Vaughn5 Look, Concerta and Ritalin are essentially the exact same thing. Maybe the formulation or the dosage varies slightly—I don't know the granular details of every specific brand and honestly, I couldn't care less—but generically speaking, they're identical. And I’m talking about what’s actually officially approved as medication here. I'm not even referring to how things work locally, because there are so many drugs that aren't even "necessary" according to our regulations, even though half the world uses them and sometimes there just isn't any other option available...
Look, I know exactly what Ritalin is FDA-approved for, which is why I brought up narcolepsy in the first place. To me, ADHD is just too obvious; I can't wrap my head around how anyone could miss it, unless you factor in those two other meds you were on... they'd fit right into a treatment plan for depression or sleep disorders, which can easily be mistaken for narcolepsy, and since ADHD doesn't present with identical symptoms, things get messy...
But fine...
Anyway, whether you show up to that follow-up appointment or not, it all really boils down to the rapport you have with your doctor. Once you've got that specialist's NPI number entered into the system for your Medicare prescriptions, it’s pretty rare for them to push back or ask much about it, so your primary care physician can write whatever they want on the chart. Even though those check-ups are technically there for your own good—to monitor how the therapy is actually working—it doesn't mean an ADHD diagnosis isn't legitimate just because getting to that point was such a massive, exhausting uphill battle...
Thomas Vaughn5 said:That’s just not how it works... I actually sat down with my primary care doctor today and she was dead set on the fact that she won't even think about writing me a new prescription unless I come in for a full follow-up exam first...
There used to be a rule—and I’m pretty sure it still stands—that you can't just get a single prescription written to cover more than a month's worth of therapy. It makes perfect sense, really; if you were handed a thirty-day supply of pills, but your mandatory follow-up appointment isn't scheduled for another three weeks, they aren't going to just hand over a fresh script without seeing you first. Especially when we're talking about a brand-new medication that was just introduced to the market...
Thomas Vaughn5 said:The whole issue is that psychiatrists just don't want to get their hands dirty with syndromes they haven't specifically specialized in... most of them just stick to the same old prescriptions and shut their ears to anything that falls outside those narrow little boxes. They act like side effects are completely irrelevant, or they ignore contraindications with other meds, or the massive risk of becoming hooked on the stuff, all while claiming this one specific drug is totally harmless—like Concerta. It’s a joke compared to the garbage they were pushing on me before, like Nestlé or Thermo Fisher Scientific products... anyway, I just got a new prescription for the Thermo Fisher Scientific stuff without even needing a follow-up appointment, so I bet if I actually wanted to go back on the Nestlé medication, they'd just hand that over without a second thought too...
So, I was just sitting here thinking... what kind of disorder are we even talking about here? Could it be narcolepsy? It’s one of those things that just sticks in your mind when you start looking into how the brain actually functions... if you really dive down that rabbit hole...
Look, if you don't trust us, then there’s honestly no point in me even typing anything to you, maybe you should just go find some local shaman or something instead...
And I don't want to be the only one chiming in here—but if a surgeon told you that you don't need an operation, then you probably don't need one. That plastic thing they mentioned is likely just a drain used for infected or potentially infected wounds, placed deep into the tissue to help pull out all those inflammatory fluids... You can always run into some massive superinfection if the wound source was filthy (and let's be real, a greasy bike chain definitely fits that description), which could mess things up and drag out your recovery, but in actual practice, a surgically cleaned wound shouldn't take longer than two or three weeks to get through at least the first stage of healing...
Otherwise, if you haven't had your tetanus shot lately, you really ought to check when yours was last updated; I'm sure they would have noted that in your medical records at the hospital, but still...
If your hand is killing you, just take some Advil or something... there’s really no reason to sit there and suffer when we already know what happened and the cast is already on. It's going to pass eventually, but you seriously don't have to just endure the pain until then...
Look, the doctor needs to prescribe the exact number, type, and dosage of the medications that your specialist laid out during your LAST checkup. They can also switch you over to an equivalent brand from a different manufacturer, or if they coordinate directly with the specialist who signed off on your findings—which they can do via a quick phone call or another follow-up if necessary—they can tweak things in your treatment plan if it’s absolutely essential...
So, if you don't mind me asking, which specific medication are they refusing to write for you?
At the end of the day, if the prescription calls for 200 pills a month, then you need 200 pills, period. It shouldn't be a debate... whether you need 200 or just 2, you should be getting exactly what is required for your health, plain and simple...
It could be something with your sinuses, honestly, you really ought to look into it, just reach out to your primary care doctor and see where they take you...
Look, unless there’s some massive imbalance between how much water they're drinking versus what they're eating, or if we're dealing with actual kidney disease, nothing is just going to spontaneously vanish from their system... our kidneys are incredibly efficient at doing their job, trust me...
Maybe... No, look, don't go trying to patch anything up or mess around on your own, because if you actually need something, you’re going to get it straight from the doctor... It's impossible to say for sure, honestly, since it all depends on how big the crack is, what type it is, and where it's located, but if I had to guess, you'll probably just be staring at the ocean this year instead of getting out on it... And again—whether or not you end up needing surgery depends on a ton of different factors, but as far as I know, they won't operate unless the hole is so bad that there's absolutely no way it can heal on its own...
I don't know about that—saying someone's 17 years in and suddenly showing LV hypertrophy just from hitting the gym three hours a week doesn't really sit right with me, though I guess they definitely need to go get an echocardiogram done to be sure...
Look, if you’ve actually been exposed to C. pneumoniae or if there’s an active infection hanging around right now—which really depends on how high those titers are—it stands as one of those "common" culprits behind what we call atypical pneumonia in the general population... and if there's any suspicion that the infection is currently active, doctors might go after it with specific antibiotics designed to kill off intracellular bacteria, something like doxycycline...
The symptoms can honestly be all over the map depending on where the infection settled, how far it spread, and just how hard your body decides to fight back—we're talking anything from a simple runny nose to full-blown, severe pneumonia... theoretically, it could even cause lesions in other organs, too. Lately, I've seen some articles linking it to non-allergic "adult-onset asthma" as a lingering fallout from a past or ongoing CP infection... so, at the end of the day, the relevance of whatever blood work you got back only makes sense when you look at it alongside the actual symptoms that drove you to get tested in the first place...
He mentioned earlier that he was told his blood work looked great (back in post #7), so anemia shouldn't really be on the table here. I’m assuming they ran a full panel including MCV and MCHC, not just basic HTK and E levels, because if they did, the only thing left to consider would be some kind of hemoglobinopathy—but honestly, that feels like we're getting into sci-fi territory at this point. Maybe Hep B or C? But they already checked his GGT, AST, and bilirubin, and those should be fine unless he skipped straight to an infectious disease specialist...