Have To Go Get My Wisdom Teeth Out.

[sprintz]

I tried to put it off, but I can't anymore.

I haven't had any experience with anesthetics or the such since I was diagnosed.

What similar experiences have you guys had and what precautions should I take due to dysautonomia?

[NMPotsie]

There is an article about dental treatment for POTS patients here: http://www.cfids-cab.org/rc/Brooks.pdf

My doctor told me to avoid anesthesia as much as humanly possible, and if necessary to tell the doctors to make sure and carefully monitor bp and heartrate, avoid epinephrine (I was also told to avoid lidocaine, but not everyone is), and have the treatment in a location that makes it easy to get to a hospital should I have problems. Additionally, I was told to carefully salt and fluid load in the days before and days after a procedure, and to avoid issues that would require my meds being held for long (so, easy on the painkillers in my case because they worsen my bradycardia w/the beta blockers but if I can't take the propranolol I am a tachy mess).

It seems like the big issues were the epinephrine and making sure my doctors are fully aware of potential complications so that they are paying careful attention.

[sprintz]

Jeez, that worries me. I guess I'm in for a treat huh? I do remember getting epinephrine fillings done when I was first diagnosed and nothing abnormal happened, so is that of any significance?

[NMPotsie]

I don't know enough about it to give a definitive answer, but I was told that because dysautonomia is so unpredictable it's not safe to assume that because you did not react poorly last time you will be okay for the next. I have had fillings that were not an issue, and then I suddenly had a very bad reaction to lidocaine that was just out of the blue. What I did was to provide the article above to the doctor and then discuss my specific issues with him because we are all so different.

I have high adrenaline levels, so in my case it was important to avoid epinephrine and carefully monitor the bp both during and after procedures. I haven't had to have surgery, but an oral surgeon will be educated in the effects of anesthea and, while perhaps not experienced with POTS, will understand patients who have heart problems (and thus cannot tolerate novacaine or its ilk). There are plenty of alternatives. I would try and stay awake if it were me; if they're not impacted, many people get them done with a local and are fine. If they are, then I would talk to the doc.

[peregrine]

My dentist asked me to talk with my neurologist about any contraindications for treatment (good dentist!). Neuro hasn't said anything about avoiding epinephrine, and I had it after the spaciness started but before I noticed the tachycardia. I did get some epinephrine for an IV placement after the POTS started and very nearly passed out, but it was hard to disentangle that from needle-induced syncope stuff. Definitely a conversation to have with both your neuro/cardio/whomever and your dentist, and especially for something major like this, a good call to put them in touch together. In the past I've had dentists call my psychiatrist to make sure that the Seroquel (which can trigger long QT issues) wasn't a contraindication for lidocaine, so they should be willing to do it.