Surgery/Hospitalization Tips for E4s

[TheBrain]

Paul and Lily, I'm sorry to hear about your recent health issues. I'm sending healing energy your way.

Circular, I'm glad you don't need surgery, at least for now. If you start a topic on the thyroid, I'll participate.

Has anyone seen a connection between Demerol or other narcotics and APOE4 status? My younger sister (who doesn't know her status) had back surgery this week. She had general anesthesia (I don't know which one), but she evidently had a bad reaction to the Demerol. As she put it, "My oxygenation sucked and my blood pressure was low!" So she had to stay at the aftercare facility 3 hours longer than anticipated.

So she will never do Demerol again. One of my other sisters said she can't do Demerol either because of a previous bad reaction to it (she also doesn't know her APOE4 status). I had Demerol in my 20s for a cyst removal and didn't have a problem with it. In fact, I enjoyed it, but I hate shots, so I refused to use Demerol after the surgery because I didn't want a shot in my butt. Plus, my low pain level didn't really warrant it.

I also wanted to mention that over the past year, I had the sedative propofol for a colonoscopy and two endoscopies. I did fine with propofol, although my speech was slurred afterward, and my gastroenterologist had trouble understanding me as he communicated what he found. I gather from other posts that propofol is a good option, at least for some procedures.

[Wondering]

Does anyone have information about Versed? I have made a point of avoiding it (insisting that Anesthesiologists not use it with me) over the years because it is an amnesiac. (Here in the U.S., it is used routinely for virtually all surgeries - it's the main drug in "twilight anesthesia" and is the "anti-anxiety" drug infused first for most procedures. They were even going to give it to me for a Cesarean Section! I said absolutely not, as I wanted to remember my son's birth.)

But Propofol is an amnesiac, too, correct? I thought that avoiding amnesiacs would be a key point for us E4s...am I off base?

Thank you!

[Stavia]

Versed I see is midazolam. Its a very short acting benzodiazepine. It is out of your body in hours. Benzos used chronically are associated with a higher risk of AD. There is no evidence that a once off use at our age is a risk for future AD.
There is no such thing as an amnesiac class of drugs so one cannot generalise. Some drugs do cause amnesia, midazolam is one of them.
I am personally happy with extremely occasional use of a benzodiazepine. By this I mean one dose if a procedure is required and the drug is really really necessary. I had it a couple years ago pre knee surgery because I was terrified of the anaesthetic.

[Julie G]

Wonder if a model like this could eventually help us identify the safer forms of anesthesia?

Researchers create computer model that simulates anesthesia's impact on brain
http://phys.org/news/2015-09-simulates- ... brain.html

[Wondering]

Getting ready for surgery in a week and a half, and now prepping for my first "conversation" with the pre-surgery folks tomorrow. Was planning to push for the use of propofol, based on this thread. But then I found this:

http://eurekamag.com/research/012/994/012994331.php
"Molecular understanding of Alpha beta peptide interaction with isoflurane, propofol, and thiopental: NMR spectroscopic study"

If I am understanding correctly, this study says that both isoflurane and propofol are associated with scary brain changes that increase levels of A-Beta. Only thiopental did not show those same effects.

Comments? I'm still lobbying to avoid General Anesthesia if I can, but it's not looking hopeful. I want to know what to ask for if I need to have a general...

[Stavia]

Oh dear. Im going to need a quick GA for a Mirena possibly. Eeep. Looking for help too

[Wondering]

Just got off the phone with the Anesthesiologist in the pre-admission clinic. Not good news. Not good at all. Because my surgery will be done laproscopically, General Anesthesia is required. I know, it sounds backward, but the need to fill my abdomen with gas is the reason. There have been some studies showing better results with a spinal and light sedation for laproscopic surgery, but only outside of the U.S. The Anesthesiologist wouldn't even consider it. Bummer. [She was frustratingly difficult to talk to in general, and blew off my concerns about Alzheimer's risk as being trivial compared to the risk of cancer. Obviously, she doesn't have family members with AD, and isn't knowingly dealing with an E4 allele. She also works at a hospital that handles a lot of cancer patients.]

Then, I tried to talk about avoiding inhalation anesthetics. No dice. Though she did say that they typically use Sevoflurane, not Isoflurane (although she wouldn't even commit to that). Actually, now that I looked it up, Sevoflurane has identical effects to Isoflurane on us E4 folks - it's Desflurane that is different. ARGH! The alternative would be to use IV propofol, but it is not ideal for a longish surgery, as the effects are compounded the longer it is used, and it will take a lot longer to get out of my system. (And the research I found says it also has scary brain effects, especially at higher doses.) The Sevoflurane apparently clears out of a person's system very quickly (though, I am sure, slower for someone with an E4 allele). Apparently, I can ask not to have IV sedation ahead of time (in the U.S., that's typically the benzo Midazolam/Versed, which has amnesiatic effects, among other things). But that looks to be the only real influence I will have on the anesthesia protocol.

I meet with the surgeon tomorrow. I have a hunch she won't be any more flexible. We'll see. But I suspect I will end up in the tough position of deciding whether or not to go forward with this surgery, given the anesthesia risks to my brain. (It's preventative - scary big family cancer history combined with personal small cancer history.) Of course, the medical folks think I would be a fool to even consider not having it. (They wanted me to do it 6 years ago.) Friends from Europe (including one who's a doctor) say they wouldn't do this surgery preventatively - that it's a very U.S. culture thing to cut out healthy body parts to prevent some possible future risk.

Can you spell TERRIFIED? I don't know what I am going to do...

[Stavia]

Honey you have to pick which one you are the most scared of and prioritise that one and then don't look back. Stress is bad for us too.
Pick a side from your gut feeling. Surgery - yes or no?
Life is uncertain. We have to make decisions based on incomplete information.
But once you've chosen an action don't look back.

[Julie G]

(((Wondering))) I'm sorry that you're forced to make a difficult decision. Because I don't know the details of WHAT surgery you are considering (nor WHY), I want to qualify my comments by suggesting that only you (guided by your physicians) are qualified to decide what is right for you. I'm simply posting as your advocate and someone who's recently been in a similar position.

First, if you are at risk for dementia -and a woman- you are correct to be concerned about the effect GA can have. At this years AAIC, this topic was covered in some detail. (Be sure to scroll to the end)
WOMEN AT SIGNIFICANTLY HIGHER RISK FOR CONGITIVE AND FUNCTIONAL DECLINE AFTER SURGERY/GENERAL ANESTHESIA
https://www.alz.org/aaic/_downloads/tue ... n-risk.pdf

When I was making the tough decision you are, I was blessed to have both a surgeon and anesthesiologist who were willing to go outside of their comfort zones (business as usual) to protect my cognitive health. See the first post of this thread. I was the first patient at my semi-local hospital to have both a spinal and epidural with very light profofol while listening to guided imagery- all to protect my cognition. Clearly, the anesthesiologist you spoke with has little concern for yours. She's also wrong. Laparoscopic surgery can be done with many different types of anesthesia. GA may be preferential for your specific surgery, but there may be options. You deserve to have a conversation with an anesthesiologist who will take your concerns seriously and weigh out the pros and cons of different choices with you.
ANESTHESIA FOR LAPAROSCOPIC SURGERY
http://laparoscopy.blogs.com/prevention ... rgery.html

A wide variety of anesthetic techniques have been used for laparoscopic procedures. Although general anesthesia with endotracheal intubation is most routinely used and is considered to be the safest anesthetic technique, local and regional anesthesia have also been used safely for laparascopic surgeries.

Definitely discuss your concerns about how this could potentially affect your cognition with your surgeon. If she is also indifferent to your cognitive health, I would consider postponing the surgery until you can recruit a surgeon and anesthesiologist who will take your concerns seriously- especially given that the procedure is elective. I know it's hard to be assertive when you feel vulnerable, but you are worth it.

[giftsplash]

Can we have some consensus on what the best GENERAL ANESTHESIA to ask for if you have to have surgery and add it to our WIKI page.
Is it thiopental?