Lisa posted on the general board but didn't get much response so I thought I'd try here. She is having surgery, to repair her arm, this Friday that will require general anesthesia. The last time she had anesthesia, she had 3 days of CH and a migraine. She also will probably need some kind of short term pain medicine. Any reccomendations?? I think I've figured percocet should be avoided and a limited amount of morphine may be best. She is going to call her nuerologist tomorrow morning to see if he has any thoughts but your experiences sometimes are more reliable.

Thanks for your help!

Charlotte

Sorry, but this is an area of such complexity that only the treating docs should be involved in making decisions.

I understand that you are only asking for personal experience but the potential interactions with anesthesia are too involved to not be fully clear with the docs about what we are using--and this includes supplemental products.

I second Bobs statements.

A conversation with the neuro and anesthesiologist ahead of schedule would be best.

I agree that you need to talk to the doctors involved, discuss it with ALL of the doctors, get their view on it, and their opinions.

Just so you know, you can also ask for them to hold her for observation afterwards. That way if it is very severe they can help her on the spot, and she won't be stuck at home suffering afterwards.

As far as [erspma; experiences... At the ER, I usually request Nubain, (it's injection only) it knocks the headache right outta the ballpark. They tried demoral on me, tried morphine on me, neither really worked. So far the only pain meds to offer me relief have been Stadol and Nubain, and I only use the stadol when the pain is to the point I want to kill myself.

Good luck with her surgery.

Not so fast. I conversed with my anesthesiologist right before a procedure I had back on Sept. 10. I specifically requested that there be pure O2 through a non-rebreather mask at 15 lpm available in the recovery room in case the anesthesia triggers a hit. He said, "Don't worry - you'll be on 100% O2 until you wake up."

It's like the words "non-rebreather" and "15 lpm" were completely foreign to him. I said that was fine, but I specifically wanted the high flow rate and NRB mask available if I needed it. He said he would make a note of it and tell the recovery nurses.

Please don't assume that we can't offer even the smallest constructive tidbit just because we're not doctors.

Charlotte - I took oxycodone for about a week (at tapering amounts and intervals) and have not had even an inkling of CH activity. But I am totally not in cycle right now. Not saying Lisa can or will, just what my experience was.

I have had 8 surgeries since I developed ch.  I have never had a ch hit after surgery but I have been on high doses of dilaudid after recovery so that may be why.  Because I take the fentanyl patch to prevent the ch I have a high tollerance to narcotics so I am really skrewed after surgieries.  Vicadin and percacet dont touch anything for me.  So for surgery pain I need the daulidid to recover on (They wont let me wear the patch during and briefly after surgery).  This may be something that will help you after surgery.  I get 4mg.  Talk to your anastesiologist and do what he recomends.  That is who I have had to talk to discuss my after surgery needs.

This has absolutely nothing to do with the other issue of what NEEDS to be discussed with all docs involved (and I fully agree, no matter how scary...), but regarding solely anesthesia, pain medication and hits.

My PERSONAL experience has been that through all surgeries I have had since onset of both New Daily Persistent Headache (chronic migraine, for me) and CCH, I have had 1-2 weeks post-op of no CH and significantly reduced migraine.  This was the case for EVERY SINGLE surgery except 2 sinus surgeries I had in 2005.  I am convinced in those cases that it was the intranasal cocaine used in sinus surgery that triggered me to have some of the severest of attacks I've ever experienced, despite literature that shows cocaine to have abortive effects.

I had my most recent surgery on 9/9, and I didn't start having CH's and severe migraine until 9/19.  10 days!  I was happy to have those 10 days because I had a lot of other stuff going on.  After I got the stim implanted, I had a good while too.  May have had more success after those surgeries than usual because they also use regional nerve blocks along with general anesthesia.  BUT if it were only the nerve blocks, then I wouldn't have also experienced relief after my bilateral knee surgery in 2005, which I did.  So it's a combination of things...

Jefferson tried using Propofol to abort intractable headaches back some years ago (2002-2003 maybe?) and eventually determined that there wasn't enough success.  HOWEVER, in light of my near-PF time post-op after all surgeries but the sinus, I had a recent discussion about this with one of the NPs and she again referenced the Propofol as a possibility.  It's a commonly used anesthetic.  I don't know if it was used during my surgeries, but I suspect it probably was.  Don't know if that's what is responsible for the near-PF time, but it may again have been a mixture of things.

In terms of post-op pain management, I have NEVER had worsening headaches from pain meds, although there are people here who will fight me tooth and nail over that statement, I know.  It has been discussed at conferences (not sure if in literature) that some people are not susceptible to rebound or increased frequency of attacks secondary to analgesics (including opioids, OTC meds, NSAIDS, triptans, and so on, so forth...)  After both stim implant and explant, I took Percocet (and at first, took 2 every 4 hours to get pain under control), and had no problems with headaches whatsoever.  Now I'm down to taking aleve and occasional percocet (took 2 yesterday d/t post-op visit for suture removal...), and I'm still fine in terms of them not causing more headaches than usual.  Am I back to having bad CH and bad migraine now that my post-op "heavenly near-PF phase" has worn off?  Yes, but nothing more than usual.

For my ortho surgery - I was on PCA in hospital for first day or so post-op.  Then due to side effects from the PCA, I was changed to oral percocet.  Was also given a longer-acting pain medication so that I didn't have to wake all night long and take shorter acting pain meds - as was my brother after every single one of his ortho surgeries.  I took the longer acting med (think it was oxycontin) for a week, then didn't need it any longer.  Took the percocet for a little longer than that, but this was also because I was traveling and both legs had been operated on simultaneously.  Nothing out of ordinary there, either.  No more intense hits from pain meds.  Never have.

So those are my PERSONAL experiences with head pain and anesthesia and pain meds.  She's at least gotta go into the surgery with the mindset that she'll wake up feeling better.  It doesn't help to fret over possibilities - but it DOES pay to be prepared.  Have docs have O2 ordered ahead of time.  After stim explant, neurosurgery resident ordered NRB mask and O2, and I ended up not needing it for entire stay bc of that post-op effect, but still I had it available to me.  They also even ordered that I could take my own Frova or Amerge if I needed for severe migraine or CH.  Those drugs weren't on formulary, but the pharmacy took them, examined them, and let me keep them in my room - on condition that I must tell RN if I needed to take it.  Neurosurgery NP wrote for those provisions upon my speaking up.  It pays to be proactive.

I will admit that I have had greater success when having neurologic surgery in terms of getting what I needed ordered.  ENT refused to listen to a thing I said, put me on IV morphine q2 hours as needed (which I had never taken in my entire life at that point!), called me drug  seeking because they offered me nothing else to relieve the pain, took me off all my headache meds because of the bleed I'd had, and after all that REFUSED to consult neurology.  But with all respect to them, after my 1st sinus surgery when I had a SEVERE CH, plus vomiting up blood post-op, they did learn about and prescribe a shot of DHE upon my request.

She's going to need to speak up about what she needs to have ready for her in the event that she does wake up and has a CH or migraine.  But she also needs (and you too!!) to have the mindset of hoping for the best, because it helps, even though it may not prevent the attacks from happening.  Don't be afraid - Be prepared!!

And I cannot emphasize enough the importance of telling everything to all doctors involved.  And honestly, nurses and pharmacists may even need to be kept in the loop as well.  They are often the gatekeepers.  Although patients themselves are the final gatekeeper of their own health, unfortunately.

I hope the surgery goes well and that she's feeling better soon!

Take care!
Carrie :)

They didn't do the cocaine for sinus surgery or post op care then because of getting complicated with drug testing with swimming/NCAA (dr decision, just to avoid any potential problems I guess!) so I was ok then..I was actually pretty good after my sinus surgery.
CH and asthma are both listed like 5 times on my paperwork for the surgery.  I'm calling Jefferson....oops today I think I was supposed to do it!
I think I'm a little extra nervous  because I don't like this hospital as much, they don't know me as well like this other one and it is the one that had bad nurses that yelled at me when I was real sick with asthma a few years ago.
ick.  
Thanks everyone.   :)

Here's my experience: local anesthesia can cause mild shadowing.

I had a small surgery this afternoon when 3 suspicious moles were removed and the doctor used some kind of anesthesia. Now I wish I had read this thread earlier, so I could have asked the doctor or the nurse more about the anesthesia they used.

Sanna

sandie99 wrote on Sep 23^rd, 2008 at 1:30pm:

Here's my experience: local anesthesia can cause mild shadowing. I had a small surgery this afternoon when 3 suspicious moles were removed and the doctor used some kind of anesthesia. Now I wish I had read this thread earlier, so I could have asked the doctor or the nurse more about the anesthesia they used. Sanna

General anesthesia (unconscious) or local anesthetic (numbing of the areas)?

The surgery went well. She now has a pin in her wrist that will stay in permanently. She came out of the anesthesia with no CH, just a bit of asthma issues. No pain yet but it's still numb. Hubby is out filling percocet for pain. Let's hope the weekend goes well! The hardest part now will be keeping her out of the water long enough for this to set and heal properly!

Thanks so much for everyones input!

Charlotte