The purpose of this article is to help people with Multiple Chemical Sensitivities/Environmental Sensitivities (MCS/ES) prepare for surgery. The content has been derived from research and personal experience. Even though this information is based on knowledge I have acquired from various physicians, pharmacists etc., I am not an MD and this article is not meant to substitute for the advice of a medical professional.
The following suggestions may be helpful for Surgeries and Hospitalization if you have sensitivities. The first and most important point is to avoid a gas anesthetic. The reason for this is that anesthetic gasses are neurotoxic and can cause serious problems especially for people with sensitivities. An alternative to Gas is a continuous IV infusion of a short acting anesthetic by injection or a continuous flow pump. This can be done with Diprivan or Sodium Phenothal usually induced with Fentanyl (narcotic). These drugs are used at the Environmental Health Center (EHC) in Dallas and I have used Diprivan and Fentanyl in Canada with this type of pump for the Diprivan myself. (This is not to be confused with a PCA pump discussed below.)
If a paralizing agent is needed Dr. Rea has found succinylcholine chloride (Anectine) acceptable as per his article "Guide for Hospital Staff in Caring for Persons with Allergies/Sensitivites - Discussion Draft Sept, 1997" http://www.chebucto.ns.ca/~cares/CSEMguide.html
This may be required for example in abdominal surgery where the bowel cannot be moving. Anesthetic's will slow but not stop certain functions.
There is a very short web article by Paul R Cheney, M.D., Ph.D., 1992 which mentions gasses and Diprivan as well as has some additional information about intracellular magnesium and potassium depletion in patients with compromised livers. He offers some solutions for this problem at his site. [Note: the old cfidsfoundation.org site no longer belongs to Dr. Cheney, but his article is in several places, including: http://www.cfs.inform.dk/Behandling/anesthesia.html.[note: link does not work]]
He does advise Diprivan with nitrous oxide, which of all the gasses is considered the safest, but which should be avoided by those with MCS. Diprivan can be used alone as discussed above. This could theoretically be done either way. His specialty, however, is CFS not MCS and doctors specializing in MCS advise the avoidance of all gasses. In addition to the above you may need a small amount of Diazamuls, a preservative-free Valium emulsion, for long surgeries where the possibility of "awareness" is a concern. This can be explained by your anesthesiologist and avoided if necessary. This drug can also be used pre and post-operatively for sedation, and for cramping in certain types of procedures (valium in combination with narcotics discussed later).
Testing should be done for these anesthetics if possible and any other drugs that may be required. If you are extremely drug sensitive you could consider having your doctor contact Dr. Rea at the EHC for advice on your particular case. He is a cardiovascular surgeon and became disabled by operating room gasses like Halothane (214-373-5100).
Avoid using the rubber mask for oxygen as it is reused and has absorbed disinfectants. Using a disposable plastic one instead is the lesser of two evils as a ceramic mask will not fit the O.R. equipment or be allowed. A consult with your surgeon and your anesthesiologist is very important to insure you are well informed about the procedure and therefore able to find solutions for all your concerns and get confirmation that he/she will make every attempt to follow your agreed upon plan.
Then test drugs to be used, if possible, unless previously used, and make sure they do not contain preservatives or alcohol. Watch for inappropriate combinations of medications. This can be an individual sensitivity or a known phenomenon. For example, in my experience, mixing large doses of benzodiazepines and narcotics can cause post operative nausea while the use of either one alone or low doses with the anesthetic were tolerated.
Aspirin should not be used for several days prior to surgery and your doctor should be consulted about this or any other blood thinners you may be taking because the risk of excessive bleeding exists. Ask for the special warming apparatus which is put around your shoulders during a long surgery to keep your body temperature at a safe level. Borderline hypothermia is common for people with sensitivities and death due to hypothermia has been reported in routine surgical procedures. Hypothermia is also a possible surgical risk reported in some patients with CFS, a fact that you should make your doctor aware of.
If you are sensitive to Betadine (Providone Iodine) or topical alcohol bring your own bottle of Benzalkonium Chloride if tolerated. A preparation of 1:750 liquid can be purchased or compounded by a pharmacy. This product is also known as Zehran. Latex allergies can be dealt with by using sterile non-latex gloves.
Notify staff that you need oxygen at 5 liters pre and post-operatively and that you should not be exposed to perfume or scents at any time before, during, or after your surgery.
Various pain medications and ways of administering them exist. Alcohol is present in most injectable Morphine but can be avoided by using epidural morphine (which cannot contain preservatives) in a PCA (Personal Control Application) pump. In Canada, single dose vials of hydromorphone (Dilaudid), or Fentanyl do not contain preservatives or alcohol. Hydromorphone and Fentanyl are high potency synthetic morphine like drugs which simply need titration (reduced dosage) and I personally find them as tolerable or better than morphine when used in injectable form. They are not like Demerol which has toxic metabolites and should be avoided for any prolonged use. By mouth Morphine is definitely kinder to the stomach than any of the other alternatives I know of. If drugs you have no knowledge of or experience with are necessary, like paralyzing agents for example, make sure you investigate and test them and consult Dr. Rea at the Environmental Health Center if necessary. Anything else you can think of that is a problem for you at home make sure you are not exposed to it in the hospital.
Request a private room, cleaned with baking soda and water, scent-free nurses, and remove any furniture, drapery and anything that may be offgassing chemicals. Cover the soap dispenser (if scented) and use your own products if necessary. Anything you cannot remove may be covered with mylar (survival blanket) to keep the odor contained. The mattress is a good example of something that should be covered with mylar and I always do this by taping the mylar sheets together and to the underside of the bed. Hospital mattresses are usually plastic and tend to absorb cleaning products and be moldy. Mylar will stain sheets black but this washes out easily. I also bring my own bedding and pillow.
In transport to and from the O.R. and other places in the hospital, request that O2 be available to you using your own tubing. Use the O2 from the wall while you are waiting for surgery and ask that you be hooked up to the wall in recovery so that the tank for transport does not empty.
It is important to follow most of these guidelines for oral surgeries. These are suggestions from my own experience. You must consider your own sensitivities and ask questions to make sure you are aware of and have evaluated everything being administered and have taken all possible precautions to avoid exposures.
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