Surgery and MS

[Veronica]

I ended up really messing up my right shoulder and am having rotator cuff surgery in early March. Feeling as if I am preparing to climb Mount Everest in preparing for life in a sling for six long weeks. Both my PTs ( Herb and my ortho PT Adam) and my neurologist and now my surgeon ( who I just met on Friday...) agree with my wanting to be admitted overnight ( this is arthroscopic/outpatient surgery) and then getting into a good Re Hab facility for maybe all of a week. I had alot of concerns of being able to come home directly from the surgery to deal with the loss of use of my dominant arm, my issues with MS....and living alone. I won't go on and on here about all that I am getting set up for....it is like a full time job preparing for this, organizing all that I will need and getting friends ready to be helping out. One thing that I would love to hear about from others is what your experiences were with surgery and the anesthesia and if/how it affected the MS. Both PTs have concerns about the anesthesia, but my neurologist said his only concern is that it may affect the bladder: it may take me longer to have that first pee after the surgery, and of course, I may be weaker with not being able to exercise as I had been. And I JUST got back to baseline!! Grrrr..... Any advice or stories of your experiences would be appreciated!! And you know I will keep you all in the loop as to how it goes.....thank goodness I love telling good stories......I am looking at this as just new material......or at least trying to!! (Think I will be using that icon alot here...)

[Marinadca]

I am sorry to hear that!

My only experience with surgery and MS was having a tooth pulled/implant placed.

To be honest with you, my MS acted up pretty badly after the surgery, which happened in Late June. So there is no way to know if the relapse I had was a result of the anesthesia/surgery or just in the cards for me anyhow. There really is no way to know. It did suck for a bit but eventually was back in action and better then new. MS seems to be a constant cycling of starting over. :/

Please do not take my experience and think you are definitely going to have a bad time - that is not true at all. We are all different and you are ready for any challenge, I know it

[ActiveMSers]

Veronica! Sorry to hear about your impending surgery. I went under anesthesia six years ago no problem (for my central line in my chest). There is always a risk, but for me I just woke up and felt fine, not even groggy after a few minutes. No effect on my MS.

I'm not sure I want to know how you messed up your shoulder. Hope it wasn't doing something silly. But if it was, it will make a good story even better (well, at least funnier maybe, when you look back on it years down the road).

[Suebee]

Hi Veronica , sorry to hear about your shoulder. As I've posted in other threads, surgery had a big impact on me and MS. This is just my experience. With re to actual surgery, I made the anthesiologist tell me exactly how they would treat my me differently because of my ms. The dr explained that they would give me slightly less muscle relaxants during surgery. 2nd, I had to keep insisting before and after surgery to not put heat/warm blankets on me. The heat bothered my symptoms. I found on Internet a small study showing better recovery from surgery by MS patients if heat/warm blankets not applied. So discuss with surgeon and nurses ahead of time.
After surgery, I think I had a flare 3 wks post surgery but I made mistake of waiting it out rather than getting steroids. I lost a lot of endurance and strength. I did 3 mo of out patient PT 2x wk. Although I improved, I am no where near baseline before surgery, now almost 1 yr ago. I share this with you, but remember, this is my experience, and I think the fact that you plan to go to rehab and can focus on endurance you will do so much Better. Best of luck!!!

[Veronica]

Thank you for this input Marina, Suebee and Dave.....really helps....
Suebee....never thought of the muscle relaxant affect...already emailed the nurse practioner (who is like my casemanager) that I want to talk to the anesthesiologist about this, too...

I'll work on making the cause of this an interesting story Dave, but it'll be difficult! Fell last Feb. when I was turning my head too much to the side to talk to someone, rehabbed it and it felt great, then little bits of bursitis triggered in twice, and then the night I came back from my neurologist, my better foot caught the edge of a very secure rug ( the relapse factored in...) and I landed on the elbow of this poor shoulder...That's where I think I did all this major damage.... very boring, huh?

[Suebee]

Veronica, best of luck with your shoulder. I felt with my own surgery that since I had no other option, I just accepted the risk. And Doing so really took away the worry. There was no need to worry about my MS flaring because I wasn't going change my decision for surgery. I hope that's helpful.
With re to warm blankets, I couldn't find the study I referenced above but I did find this link that mentions why a rise in temp post op is not good for MS patients. Interestingly , there is a lot of protocols listed on line which mention preventing hypothermia (obviously important ) during surgery and after with warming blankets. I found the warming blankets made me feel incredibly weak and I had to call nurses to get them off of me before surgery and after. I'd be interested if anyone in medical profession can offer info on Controling temperature of MS patient Here is link I found that references heat problem in surgical MS patients http://m.ceaccp.oxfordjournals.org/c...cp.mkr019.full

[Suebee]

Article states:

Anaesthetic considerations [for MS]. Local anaesthetics may exacerbate symptoms due to the increased sensitivity of demyelinated axons to local anaesthetic toxicity.
Non-depolarizing neuromuscular blocking agents may be used in normal doses. Caution should be exercised when using depolarizing neuromuscular blocking agents if the patient is debilitated. Temperature maintenance is important as symptoms can deteriorate with an increase in temperature, as demyelinated axons are also more sensitive to heat.

[Veronica]

Thanks Suebee. I will be going in to see the anethesiologist sometime this week to have a little chat.... and I will mention the muscle relaxants, and heat blankets....I know that when I had PCL repair back in 2001, I awoke shivering with my teeth chattering uncontrollably, and the blankets helped. But that was before the diagnosis and my subsequent increased intolerance to heat.... All these are part of why I am pushing for the overnight ( which they have already said is a Done Deal)...and the short ReHab stay...still in the works...

Thanks for the reminder to be kind to myself after this and not over do it. Gotta keep the movement going, but gotta let my body heal...

[teena marie]

Hi Veronica,

Wishing you good luck. This whole thread has been interesting. Dental appointments are often very difficult so I will discuss the anesthetic issue before I go in April.

Take good care,

Teena Marie

[Suebee]

TM, I'll chime I again about anthesisa. I had very old fillings and my dentist wAnted to replace 3 on back molars. It required locals for all 3 areas, several shots for each. Ahead of time I learned that The general consensus is that locals are no problem for MS patients. But I found out that's not accurate. It's controversial whether a local can trigger a relapse. And it needs to be carefully done if you have facial weakness or in swallowing. I was reclined and left alone as the local numbed my mouth. I felt by swallowing/ breathing was slightly impaired and needed to yell for nurse to raise the back of chair. For the fillings, I had to ask for a special prop to keep my mouth open, and prompt assistant to suction my mouth a lot. I also had to negotiate with dentist to raise the chair back the max Amt he could tolerate to do the work. I think it was the amount of local administered that caused these problems and my particular deficits. Subsequently, My ms symptoms were also exaggerated for a few weeks. I will do Any future dental work in small increments and hopefully have a better result. I found this article that mentions controversy surrounding locals on 2nd to last page. https://www.aana.com/newsandjournal/...s/p217-224.pdf

[Suebee]

C-section and MS

Since we are discussing surgery issues, I thought I would also add what I did for a scheduled c-section. I brought medical journal articles that showed it was acceptable and possibly preferable standard of care to have epideral instead of spinal for MS patients. This is controversial. But I had done my homework and was able to get anthesiologist to agree at a major teaching Hosp. There is a potential that demylenated areas are are more at risk for injury with a spinal and one of my lesions was in a vital area. The risk with epideral is that it doesn't completely numb you. If it doesn't, a general, which is even less preferable, can
Be administered. And I did have a tiny spot on my abdomen that didn't numb, and that $&&)/-. But i don't regret my decision. I did not have a flare or worsening of my MS afterwards. Whatever you decide for childbirth, read up on risks and benefits of different approaches. Takedown MS.

[AMFADVENTURES]

Veronica, it looks to me like you've really done a stellar job getting ready for this. I can say, from personal experience, that rehabbing from shoulder surgery is critical to a quicker and fuller recovery and that it hurts like hell for at least the first couple of weeks. But this is the first I've heard of adverse effects from anesthesia. I'm interested to see others responses too.

Good luck, I'm looking forward to seeing you on the slopes next winter.

I'll be thinking of you,
Larry

[Veronica]

Okay so I am six days post-surgery, and I thought I'd share with you my pre-surgery conversations with the anesthesiologist and my surgeon. I have to say I am very impressed with them both.. The anesthesiologist told me that the nerve block that they were putting in my shoulder would not trigger a relapse. And no general anesthesia would be used. She said the sedation that they would use on me was going to be one that I would come out of quickly after surgery, as she wanted me to have what I needed for the surgery, but didn't want it lingering in my body. She also said that she would put a little steroid in the IV to ward off an exacerbation . After the anesthesiologist left, my surgeon came back in and said that instead of a nerve block that lasts 12 hours she would use one that only lasts 6 hours. Again she said this was to lessen the total time that anesthesia would be in my body. Pretty impressive as far as I was concerned in their thoughtfulness in, and knowledge of, working with a person with MS.

And the result? Well, I'm still in some pain from the surgery and am having bouts of fatigue, but this all seems to be standard post-surgery experiences and not due to increased MS activity. I've started to increase my physical activity, and feel that I'm in good shape with balance and in walking. Just need to start building up endurance. Very nice feeling that I didn't end up taking major steps backwards from the surgery. Thanks for all the input.... helped me to formulate questions for my Medical team that they obviously took seriously. Now on to recovery!!

[Marinadca]

Glad all went well I hope you have a good and full recovery!

[Suebee]

So glad things went well and the doctors took good care of you. Wishing you a speedy recovery ! Suebee