Question about autonomic vs mast cell

[angelloz]

Good day all, Topics about mast cell have got me thinking about something. One doctor did diagnose me with MCAD but another doctor said not. Antihistamines make me feel worse not better. I was recently in the hosp for a recluse spider bite ( yep bad, scary several days ). For the burning pain they tried morphine. With only 2 milligrams of morphine my blood pressure tanked, I could take this way back when for severe migraines with no reaction like that. Sooo, can autonomic dysfunction cause this reaction in and of itself??. I have low blood volume, so could that be a factor? Any thoughts?

By the way, fever, chills, my entire back swelled beyond belief,  a systemic reaction to the bite. I am really surprised I survived this. Happy to be here and back asking questions :).

 

 

 

 

[Katybug]

Angelloz, 

I'm so sorry you were bitten. I have 3 friends who have been through brown recluse bites and they are nasty. 

I'm not sure I'm clear on the question,  but if your asking if autonomic dysfunction could cause you to have low bp in reaction to the morphine, I would take a guess at yes. Morphine, like any opiate, is a systemic depressant. So, it is a drug that would naturally suppress bp. Already having autonomic dysfunction would probably allow this effect to be intensified. This is strictly an educated guess. I have never seen any research specific to how opiates affect dysautonomia patients.

It would probably be a good question the next time you see your cardiologist or neurologist. If this was your reaction, it might be important information to give doctors in future situations, such as surgery or in an emergency (such as a brown recluse bite ?).

Hope you're feeling better!

Katie 

[Guest]

I don't really have an answer to your question, but I do have something to add.   6 years ago I had a series of major abdominal surgeries.  The surgical team had a very difficult time controlling my pain afterwards.  Apparently narcotics no longer have much of an effect on me (I did not have this problem when I was younger).  I was in recovery forever, because the meds had zero effect.  If I get a shot of morphine now, I feel the effects for about 30 seconds, then it is as though I haven't had an injection at all.  I'm sure it's linked to the dysautonomia.

[Katybug]

Draven, 

There is something g called pharmacogenetic testing. Some of us have gene mutations that cause meds to be metabolized too slowly or too quickly. For example, I am a rapid metabolize on one of the genes. That gene is associated with the metabolization of certain drugs. If I take those particular drugs, they have little to no effect on me, similar to what you describe about morphine.  The company that my doc ordered it through is YouScript by Genelex. Local anesthetic doesn't work on me at all and many pain meds don't either. 

[Guest]

That's really interesting Katie!  I'll have to see if I can access that testing in Canada.  

So, if someone has a rapid metabolize for something like morphine, do you know if the drug would work if that person gets a higher dose (or gets it multiple times in a short time frame), or is it something that simply won't work for that person any longer?   

[Katybug]

As far as I know,  the amount and frequency of the dosage won't make a difference. Each drug is metabolized through a certain drug pathway that is associated with a specific enzyme. There are several different pathways and some drugs have a primary pathway and a secondary pathway. The gene mutations somehow affect the enzymes but I'm not sure I can explain that part. The alterations to the enzymes is what changes the metabolism. There are normal, slow, and rapid metabolizers. Among the slow, there is also a really slow category, and, among the rapid, the is a really rapid category (my current POTS brain can't think of the actual language they use for the really slow and really rapid mutations. ) 

When they inject IV morphine in me, I literally feel nothing, like it didn't even happen. When I take certain oral narcotic pain meds, I never feel altered in any way and it may or may not take the edge off my pain but it only lasts a couple of hours, never a whole dose. Each drug is slightly different in how much effect it does or doesn't have. And only drugs metabolized by the specific pathway affected by my mutation are have an altered efficacy.