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question about botox-please share your experiences w/me!

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  • question about botox-please share your experiences w/me!

    yikes!! I'm considering a botox injection, and have read about it being done as a simple procedure in the doctor's office or in the hospital under general anesthesia, and everything in between. who has had this done, and under what kind of circumstances??
    "courage is fear that has said its prayers"

  • #2
    Botox for what? Your bladder? Skeletal muscles (for spasticity)? Cosmetic? You need to be a little more specific.

    (KLD)
    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.

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    • #3
      bladder
      "courage is fear that has said its prayers"

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      • #4
        So what you've read is correct. I gather most people (including most SCI, but definitely all non neurogenic folks) have general anesthesia.

        For myself personally, which you should in no way base your decisions on, I have been able to convince three different urologists/anesthesiologist combinations with varying success to let me go without anesthesia. I am quite sure that I have a very complete spinal cord injury, no glimmer or hint of a partial injury and I have an MRI that shows my spinal cord pretty clearly ending around T10 or so on the scans. I don't need anesthesia. Every urologist has been on board with this, and one agreed to do it in the office without an anesthesiologist present (though we were in a large 800 bed hospital that had plenty of resources should I start to freak out and feel pain... how wonderful that would be...). Most urologists have insisted that an anesthesiologist be present, though I have been able to talk my way out of any sort of general anesthesia, though if an anesthesiologist or nurse anesthetist is there they are going to insist on having a boat load of drugs ready to go at a moments notice.

        If you have any sensation whatsoever below your injury level you probably need general anesthesia. If you have a higher injiury (T6 or above) and are at risk for autonomic dysreflexia you need general anesthesia. Basically the odds are pretty low that you can get away with what I got away with, and I had to do a lot of convincing of healthcare providers to get the lack of intervention (I am a healthcare provider myself, but that only partially helped).

        Essentially a urologist is going to jam a big, thick metal rod up your urethra into your bladder and make 10 or 20 injections into the muscle of your bladder (I forget how many they actually do). If you have any sensation, you do not want to feel that. If what should be pain at levels below your injury manifest as anything (pain, sweating, increased heart rate, etc) you DO NOT want to experience that while conscious.

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        • #5
          I had the procedure done by two different urologists. Neither balked at skipping the anestesia. In fact, it was never even discussed. We all just assumed it was unnecessary. I don't like it when doctors get all procedure happy for no reason other than protocol. Of course, I understand their liability issue. But if you have been a patient for a while, they should know better because they should know YOU better.

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          • #6
            Originally posted by August West View Post
            I had the procedure done by two different urologists. Neither balked at skipping the anestesia. In fact, it was never even discussed. We all just assumed it was unnecessary. I don't like it when doctors get all procedure happy for no reason other than protocol. Of course, I understand their liability issue. But if you have been a patient for a while, they should know better because they should know YOU better.

            As someone who is all for skipping anesthesia when it's not necessary, I'd gamble that the majority... if not the vast majority of SCIers need it for an invasive procedure like this. Impossible for either of us to judge since Jennypenny didn't fill out her profile with level of injury, but it's reckless to assume it's unnecessary.

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            • #7
              Originally posted by funklab View Post
              Impossible for either of us to judge since Jennypenny didn't fill out her profile with level of injury, but it's reckless to assume it's unnecessary.
              Her profile is complete, and indicates she has a C5 injury. For those subject to autonomic dysreflexia (most people with injuries at T7 or above) either general or spinal anesthesia may be needed for any cystoscopic procedure, including botox injections.

              (KLD)
              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.

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              • #8
                Originally posted by funklab View Post
                As someone who is all for skipping anesthesia when it's not necessary, I'd gamble that the majority... if not the vast majority of SCIers need it for an invasive procedure like this. Impossible for either of us to judge since Jennypenny didn't fill out her profile with level of injury, but it's reckless to assume it's unnecessary.
                My whole point is that if the doctor knows you well, then it's not an assumption. It's a fact that was already established beforehand.

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                • #9
                  I've had it done nine times and it was always under general anesthesia
                  T4 complete since 30 April 2012

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                  • #10
                    T6 complete, never had anesthesia with botox ONLY because I've never had AD.

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                    • #11
                      I've had the same Uro since my sci, so he knows me well, having done scoping on me numerous times and I never had any reactions.(I'm incomplete)

                      I've always just had it done in his office w/o any anesthesia, well they do inject some Lidocaine for a few minutes beforehand, and it has always been painless. Watching it on the monitor, it is a pretty hardcore bunch of injections being jabbed in there, so you do want to be careful. He was one of the Uro's that did the Trial to get Botox approved with Medicare, so he does a lot of them. Next time I'll have to ask him what his ratio of patients is who need anesthesia.
                      "a T10, who'd Rather be ridin'; than rollin'"

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                      • #12
                        Just have your uro mix some lidocaine with saline and inject into your bladder in order to "splash" the bladder walls. It will numb the walls, so that when they inject the botox, you won't get a large AD response.

                        I've had it done twice. The first time lasted a while, and then I did it again, but perhaps too soon. I've read that in some cases, one can build resistance to the botox. So, I figured I would "save" the next couple of botox treatments for later years. In any case, you probably want to separate the treatments (get the botox, but then don't get the next one until the first is completely out of your system, which could take as long as a year or more). Obviously, this is my experience and YMMV.
                        No one ever became unsuccessful by helping others out

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                        • #13
                          quadriplegics who might go in to AD need general. Many urologist do in their office.
                          We usually have general or spinal or something-at a VA. and same as surgery work up. urine must be totally clean so antibiotics before hand. So it depends on your surgeon, your SCI etc... Especially first time.
                          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.

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                          • #14
                            I've had this procedure done going back almost 10 years when I was a participant in the clinical trials leading up to FDA approval. I am a T4 complete and the cystoscopy (with a metal, not flexible scope) is a certain AD trigger for me. Is the AD so serious that could not survive the procedure without anesthesia and not stroke out, maybe. But why take the risk?

                            Funklab: I don't understand why you mentioned where your cord ends as relevant to the decision to receive anesthesia. It's the lesion level that's relevant. Common SCI knowledge is that SCIs at the T6 level and higher are susceptible to AD. Were you trying to make a different point? Learn me.
                            stephen@bike-on.com

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                            • #15
                              Originally posted by stephen212 View Post
                              Funklab: I don't understand why you mentioned where your cord ends as relevant to the decision to receive anesthesia. It's the lesion level that's relevant. Common SCI knowledge is that SCIs at the T6 level and higher are susceptible to AD. Were you trying to make a different point? Learn me.
                              My only point was that there's radiologic evidence that it is complete (which the first urologist had access too). Doctors are trusting and all, but few would take a patient's word that their injury is complete. If you risk being sue for millions if your patient has AD and dies on the table, there's ample reason to assume the worst and treat defensively (in this case with general anesthesia). We do live in America after all. If the radiologic evidence shows that there is no cord past where my fracture is at T11, my urologist can be pretty certain he's not going to start shoving tubes up my urethra and poking holes in my bladder and suddenly find some preserved sacral nerve function that I didn't know about or tell him about that sends me off into a fatal case of AD and then my tearful loved ones sue him for all his malpractice insurance is worth.

                              Consider yourself learnt!

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