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Botox shot in bladder without anesthesia?? Terrified about AD!!

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    Botox shot in bladder without anesthesia?? Terrified about AD!!

    Hi guys, I just came back from a visit with a new urologist.

    He claims to have performed botox shots on bladders of SCI without using any kind of anesthesia. He told me that if any AD arises, he uses hypotensive medications to maintain blood pressure under control.

    This seemed extremely weird for me so I need to know if any of you guys have ever heard about this.

    The only time I got botox shots I was under anesthesia and I still got AD, so the doctor had to increase the anesthesia.

    It'd be great to have botox shots without the complications of anesthesia, but I definitely don't want to have a stroke because of an AD.

    THANKS!

    #2
    I am a complete quadriplegic at c-6/7. I had 4 or 5 courses of bladder Botox and all were done without general anesthesia. I was given 10-20 mg of Valium. A local anesthetic gel was inserted into the urethra and the scope was lubricated with anesthetic gel. Once the scope was in place the urologist injected a local anesthetic in several places in the bladder wall. After that, he began the Botox injections.

    The entire time, I was hooked up to a blood pressure monitor that measured pressure every five minutes. Blood pressure lowering medication was on hand in case of autonomia. In addition to this monitoring, I was able to tell the doctor when I was having other symptoms. The rescue medication was not needed.

    My procedures were done at a major teaching hospital with a renowned neurourology department in Northern California.

    All the best,
    GJ

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      #3
      Quick response: find a new doctor. I've had several Botox procedures and I ABSOLUTELY required anesthesia to contain a considerable AD spike in BP.
      Last edited by stephen212; 7 Sep 2012, 1:26 PM. Reason: Cell phone meddling with my spelling!
      stephen@bike-on.com

      Comment


        #4
        Will anesthesia be there or someone else monitoring and controlling your blood pressure or is going to try and do both?
        CWO
        The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

        Comment


          #5
          I'm going to have the botox shot in the bladder soon too. Anything I should be concerned with?
          Hopefully the botox will calm my bladder, which gives me lots of extra spasms & pain.

          ---------
          c4/5, incomplete, powerchair user, lotsa pain
          C4/5 incomplete, 17 years since injury

          "The trick is in what one emphasizes. We either make ourselves miserable, or we make ourselves happy. The amount of work is the same.” - Carlos Castaneda

          "We live not alone but chained to a creature of a different kingdom: our body." - Marcel Proust

          Comment


            #6
            So you are already on an anticholinergic? The bladder shrinks with an indwelling tube in also so we put everyone on low dose "Oxybutynin and increase if issues to Oxybutynin 10 q 8 hours.
            New med coming out also.
            But Botox good for most- -other than usual infection and bleeding and make sure they know about AD if you have it.
            Kicks in about 1-2 weeks.
            More are doing it without anesthesia, they do all kinds of things outpatient now a days or in the clinic and I am sure some are just fine that way- with monitoring.
            Monitor the blood pressure- remember AD usually starts with the slow elevation- without symptoms- and 20 mmHg is the beginning so know your baseline.
            Some doing it under moderate ( used to be called conscious sedation) but always have a pain medicine on hand ( even though you may be complete and not "feel it" your nervous system is sending that AD signal. And if you are having AD post botox then take something mild and go from there. Also use lidocaine to cath even though you might not usually! Sometimes there is blood and they leave the indwelling in for a week or so- keep it irrigated and draining.
            AD makes people feel "yucky"and of course can be life threatening and if you can prevent it with a little pain pill for a day or two might be better than the up and down effects and feeling of the blood pressure.
            CWO
            The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

            Comment


              #7
              If your doctor does not offer 2-4 Cipro tablets to take for a couple days after the Botox procedure, ask him about it. Out of the 4 or 5 times I had Botox injections, I had one infection even though I took a couple of days of Cipro, prophylactically.

              I had Botox injections when I managed my bladder with intermittent catheterization. I have been able to manage bladder spasms with a minimal dose of Oxybutynin now that I have a suprapubic catheter.

              I found ever decreasing effects of Botox with every course of injections that I had. After I had the last course of Botox, there was no response to the drug at all. It was about that time anyway that urodynamic studies suggested that intermittent catheterization was no longer a reasonable way for me to manage the bladder. When Botox became ineffective and maximum doses of anticholinergics left my mouth as so dry I couldn't take it any longer, and I was cathing every two hours around the clock, I decided to take steps to manage my bladder differently. After exploring all of the possibilities, I opted for the most simple procedure and had a suprapubic placed.

              All the best,
              GJ

              Comment


                #8
                Originally posted by gjnl View Post
                If your doctor does not offer 2-4 Cipro tablets to take for a couple days after the Botox procedure, ask him about it. Out of the 4 or 5 times I had Botox injections, I had one infection even though I took a couple of days of Cipro, prophylactically.

                I had Botox injections when I managed my bladder with intermittent catheterization. I have been able to manage bladder spasms with a minimal dose of Oxybutynin now that I have a suprapubic catheter.

                I found ever decreasing effects of Botox with every course of injections that I had. After I had the last course of Botox, there was no response to the drug at all. It was about that time anyway that urodynamic studies suggested that intermittent catheterization was no longer a reasonable way for me to manage the bladder. When Botox became ineffective and maximum doses of anticholinergics left my mouth as so dry I couldn't take it any longer, and I was cathing every two hours around the clock, I decided to take steps to manage my bladder differently. After exploring all of the possibilities, I opted for the most simple procedure and had a suprapubic placed.

                All the best,
                GJ
                I have always been instructed to take 7 days of antibiotics starting 3 days prior to the procedure. I have had 3 procedures thus far through Allergan's Dignity Study (now closed), receiving 300 units of Botox each time, with results lasting between 9 and 18 months. My next procedure is scheduled in two weeks, 11 months after my last one. I am still not leaking, though I'm feeling sensations of fullness at lower volumes.

                From what I've been told, there is no expectation nor scientific basis that would predict that repeated treatments will be progressively less effective. I certainly hope that's the case because Botox has proven wonderfully effective for me. There have been people who've experienced no benefit whatsoever from Botox treatment, so clearly results will vary across the population.
                stephen@bike-on.com

                Comment


                  #9
                  I have had Botox done probably six times. One time was done in an office without IV mild sedation. It was one of the worst decisions I ever made allowing this to be done and in retrospect, was even more unconscionable that a physician would do this. Even if you are monitored for BP, you would need to have an anesthesiologist right there, with the line already started, to save you if you develop stroke level dysreflexia. The reason why they will avoid using the anesthesiologist is to avoid the additional cost. If they're going to be there, with the line started, you might as well be on the safe side and be mildly sedated.

                  When I had it done in the office without sedation, I started getting symptoms of AD far in excess of what I ever experienced before. Not only that, the physician was not even monitoring my BP. I was truly frightened that I was very close to popping a brain blood vessel and winding up with impaired speech, facial paralysis, and loss of half of my already quadriplegic upper extremity. It would've been way too late to avoid this once the process went beyond the point of no return.

                  I would never have it done without anesthesia. My urologist would never give it without anesthesia.

                  Comment


                    #10
                    x2
                    What crags said.
                    stephen@bike-on.com

                    Comment


                      #11
                      My first course of Botox was in August of 2006. Two hundred units were administered each time I had Botox treatments. Lately, I have read where doctors are administering 300 units per treatment. I took 2 days course of prophylactic Cipro. I have read about longer courses of Cipro being administered and it makes good sense to me to take a longer course.

                      Six years is a long time ago in the learning curve of medicine, and it is not surprising to see different modalities of treatment evolving in the intervening years.

                      That said, I did not experience the difficult autonomia without anesthesia that has been described here. As a c 6/7 complete, I am not a stranger to bouts of autonomia. Truth told, I had worse autonomia during urodynamics studies than I did with any of the Botox treatments.

                      The original poster, C5C6 should voice his concerns and have a frank discussion with his urologist and ask him how many times he has administered Botox, and about his track record on dealing with severe autonomia brought on by the procedure.

                      All the best,
                      GJ

                      Comment


                        #12
                        the urologist told me the procedure is done with a cardiologist present at all times and ready to administer the hypotensive medication.

                        I think the question is as basic as: is it safe to treat AD only with hypotensive medication while not stopping what's causing the AD? what are nthe risks?

                        Let me repeat this: I already had a botox shot with anesthesia, and still got AD. Without anesthesia, it is for sure that I WILL get AD again.

                        Comment


                          #13
                          Originally posted by C5C6 View Post
                          the urologist told me the procedure is done with a cardiologist present at all times and ready to administer the hypotensive medication.

                          I think the question is as basic as: is it safe to treat AD only with hypotensive medication while not stopping what's causing the AD? what are nthe risks?

                          Let me repeat this: I already had a botox shot with anesthesia, and still got AD. Without anesthesia, it is for sure that I WILL get AD again.
                          While the protocol for treatment should not necessarily vary by country, perhaps it does. It would be odd to find a cardiologist present to administer hypotensive meds during a urological procedure here in the US. My urologist is more than capable of doing this himself in an office setting. I also find it odd that the the anesthesiologist could not prevent an occurrence of AD during the procedure. Granted not every anesthesiologist has experience treating AD and may responsibly decline participating in a procedure for which they feel inadequately trained. But there are anesthesiologists who DO have this training. If possible, I would suggest searching for an anesthesiologist who's skilled with treating AD. This search may prove difficult, though, if your urologist only teams up with a limited group of specialists.

                          My Botox procedures are done in the hospital because I require sedation and BP monitoring to prevent AD, which must be done by an anesthesiologist.
                          Last edited by stephen212; 9 Sep 2012, 10:37 PM.
                          stephen@bike-on.com

                          Comment


                            #14
                            Originally posted by SCI-Nurse View Post
                            Will anesthesia be there or someone else monitoring and controlling your blood pressure or is going to try and do both?
                            CWO
                            There would be either an anesthesiologist or a cardiologist constantly monitoring my blood pressure and ready to apply a hypotensive medication

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                              #15
                              ok so bottomline, I should do anaesthesia... it would be too risky not to do it...

                              does anyone have access to a paper regarding this?

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