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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by gardenergirl on December 11, 2008, at 9:23:02
I see my pdoc today, and I definitely know what I need to talk about. I have to have outpatient surgery, so we'll have to figure out a plan for how to manage the anesthesia issue. Fortunately, he called me earlier in the week to verify my appt., so I was able to give him a head's up about this. Hopefully he read up on it if he didn't already have an answer.
I don't know if I'll have to go off of it temporarily. I know that it's not required but that it's often what's recommended. If that is what he recommends, I wonder if this might be a good opportunity to try staying off to see how I do. Just a thought.
A bit anxious about all of this but glad I am able to coordinate all the docs involved and the different issues. Looking forward to more information.
gg
Posted by SLS on December 11, 2008, at 12:12:01
In reply to Nardil and surgery, posted by gardenergirl on December 11, 2008, at 9:23:02
> I see my pdoc today, and I definitely know what I need to talk about. I have to have outpatient surgery, so we'll have to figure out a plan for how to manage the anesthesia issue. Fortunately, he called me earlier in the week to verify my appt., so I was able to give him a head's up about this. Hopefully he read up on it if he didn't already have an answer.
>
> I don't know if I'll have to go off of it temporarily. I know that it's not required but that it's often what's recommended. If that is what he recommends, I wonder if this might be a good opportunity to try staying off to see how I do. Just a thought.
>
> A bit anxious about all of this but glad I am able to coordinate all the docs involved and the different issues. Looking forward to more information.
>
> gg
Hi GG.I regret that I don't know enough about MAOIs and anesthesia in order to help you out. I really should. Maybe Larry Hoover will appear with some details.
Good luck on your health endeavours. Nothing serious, I hope.
I once went for a special surgery for depressive disorders known as an opthalrectomy. It's where they go in through your rear-end and all the way up to sever the optic nerve in order to get rid of that crappy outlook on life. It didn't work, but it was painless. Laughing gas, I think.
- Scott
Posted by Partlycloudy on December 11, 2008, at 12:27:40
In reply to Re: Nardil and surgery, posted by SLS on December 11, 2008, at 12:12:01
I guess I should pass on that procedure then...
pc
Posted by Phillipa on December 11, 2008, at 12:33:50
In reply to Re: Nardil and surgery » SLS, posted by Partlycloudy on December 11, 2008, at 12:27:40
Ummm me too that was a joke right as I'm dense enough to google the proceedure name. GG all I know is that I've read of others having surgery while on MAOI's . If you google the archieves I think there are threads on that very topic???? Love Phillipa
Posted by Phillipa on December 11, 2008, at 12:36:13
In reply to Re: Nardil and surgery, posted by SLS on December 11, 2008, at 12:12:01
Scott thought it was a joke as if severed optic nerve you'd be blind. Love Phillipa
Posted by Justherself54 on December 11, 2008, at 13:56:16
In reply to Re: Nardil and surgery, posted by SLS on December 11, 2008, at 12:12:01
I had major surgery over a year ago when I was on Parnate..I met with the anesthetist a month prior and he recommended I go off it. He said any surgery has risks without adding a MAOI into the mixture and he wanted it to be as safe as possible. My pdoc agreed with the anesthetist.
I know others have had surgery while on a MAOI. I guess it's a decision both you, your pdoc and your anesthetist have to be comfortable with. I have enough fear of surgery, let alone surgery on a MAOI that I agreed, went off parnate, had the surgery, and felt pretty good off meds for a while.
Hope your surgery goes well! Speedy healing!
Posted by Larry Hoover on December 11, 2008, at 15:07:55
In reply to Nardil and surgery, posted by gardenergirl on December 11, 2008, at 9:23:02
I haven't ever found a concise and direct list of dos and don'ts with respect to this issue. There is no one way to induce general anesthesia; anesthetists are artistes, somewhat.
I did find one review article, and a hospital document with a fair list of references. The latter list is more anecdotal/case report format, methinks.
I hope they prove useful. I hope everything goes well, GG.
http://www.springerlink.com/content/p0p715h58008r61r/fulltext.pdf
http://meds.queensu.ca/anesthesiology/assets/MAOI%20POLICY.pdfLar
Posted by Merge on December 12, 2008, at 17:54:54
In reply to Re: Nardil and surgery » gardenergirl, posted by Larry Hoover on December 11, 2008, at 15:07:55
I had emergency surgery when I was taking Nardil, so it certainly can be done with extra precautions. I also had scheduled surgery on 2 different occasions and the anesthesiologist wanted me to go off Nardil 2 weeks prior to surgery. It was, quite honestly, AWFUL. The withdrawal itself wasn't terrible but I got very depressed, very quickly - and then had to deal with having surgery and healing (both surgeries were inpatient) while being very depressed.
I understand that you need to weigh the benefits and the risks, but in my opinion, having surgery is stressful enough without being depressed. I was lucky enough to have people in my life who were able to remind me that those particular depressive episodes were because I had gone off my meds - which helped a little as I knew I could go back on the meds after surgery.
Hope it all works out for you.
Posted by gardenergirl on December 14, 2008, at 21:11:10
In reply to Re: Nardil and surgery, posted by SLS on December 11, 2008, at 12:12:01
Posted by gardenergirl on December 14, 2008, at 21:13:15
In reply to Re: Nardil and surgery, posted by Phillipa on December 11, 2008, at 12:33:50
Thanks Phillipa. I do recall that others have had it before, and that's reassuring.
gg
Posted by gardenergirl on December 14, 2008, at 21:20:16
In reply to Re: Nardil and surgery, posted by Justherself54 on December 11, 2008, at 13:56:16
Thanks justherself. I suspect that's what my anesthesiologist will say, also. How long did you have to taper Parnate to get off of it? I've asked my pdoc before about what to expect should I ever have to stop Nardil, and he always deflects the question. It feels as if he's intentionally withholding that info, and I don't know why. But it later occurred to me that maybe he doesn't know and would have to look it up?
At any rate, thanks for sharing your experience and your good wishes. This is fairly minor for surgery, but it's painful, thus why I have to be out.
gg
Posted by gardenergirl on December 14, 2008, at 21:23:22
In reply to Re: Nardil and surgery » gardenergirl, posted by Larry Hoover on December 11, 2008, at 15:07:55
Thanks Lar,
I think I'll bring that in for the discussion next week.Good to see you!
gg
Posted by gardenergirl on December 14, 2008, at 21:25:38
In reply to Re: Nardil and surgery, posted by Merge on December 12, 2008, at 17:54:54
Hi merge. Thanks for sharing your experience. I'm sorry that the times you had to go off were so bad. That's what I fear. It is helpful, I agree, when you can be reminded that the depression you're experiencing is due to the med change and that it's temporary. I hope when you went back on you didn't have any problems.
Thanks again,
gg
Posted by gardenergirl on December 14, 2008, at 21:33:16
In reply to Nardil and surgery, posted by gardenergirl on December 11, 2008, at 9:23:02
that said, "No Demoral."
Pardon my language, but, "No sh*t."
That's all he had to offer. It's up to the anesthesiologist, he said. I can understand that from a professional boundaries issue, and that he doesn't want anything on his behind when it's another doctor who will be administering a new med, and thus up to the new doc to manage the interactions. Still, wouldn't anyone expect a pdoc to be more knowledgeable about an MAOI, and at the very least, offer to consult? I said I wanted to sign a consent for release of information so that he'd have it in place if needed, and he didn't even seem to think that was necessary. He just wants me to let him know what the other doc says, and if I need to be off the Nardil, then he'd of course deal with that with me.
Bah. Mostly, all I want to know is what to expect as much as anyone can. Is that so much to ask?
gg
Posted by SLS on December 15, 2008, at 7:10:54
In reply to Went to pdoc and all I got was the lousy Tshirt, posted by gardenergirl on December 14, 2008, at 21:33:16
Is is possible that your doctor has very little idea what to expect?
With me, withdrawal from Nardil and Parnate are similar. If you taper too fast, you are bound to have rebound vivid dreams and begin to dream even before falling asleep. This is called hypnagogic hallucinations. Something similar can happen upon approaching wakefulness - hypnopompic hallucinations. These things are more likely to occur with Parnate than with Nardil.
You might experience "brain zaps" if the taper is too rapid. With Nardil, I think I experienced having my blood sugar become destabilized. I had to eat a granola bar every few hours to keep me going for the first few weeks. You can experience rebound depression or rebound mania, depending on your status of bipolar disorder.
The MAO system may take at least 2 weeks to recover from the time you discontinue Nardil completely. Recovery seems to take less time with Parnate.
On the whole, discontinuation of MAOIs can be uneventful if the taper is gradual enough. There are always exceptions, of course. I hope yours is easy.
- Scott
Posted by gardenergirl on December 15, 2008, at 7:36:32
In reply to Re: Went to pdoc and all I got was the lousy Tshirt » gardenergirl, posted by SLS on December 15, 2008, at 7:10:54
> Is is possible that your doctor has very little idea what to expect?
I think that's likely. I don't know that he's ever had anyone on an MAOI before. I first met him when he was a resident where I was doing a practicum. I was already on Nardil when I started seeing him a few years later.
>
> With me, withdrawal from Nardil and Parnate are similar. If you taper too fast, you are bound to have rebound vivid dreams and begin to dream even before falling asleep. This is called hypnagogic hallucinations. Something similar can happen upon approaching wakefulness - hypnopompic hallucinations. These things are more likely to occur with Parnate than with Nardil.I've had the rebound REM sleep and hypnagogic hallucinations when I've tried lowering the dose. I think it would be if I went down one tablet, 15 mg. It might have been less when I went down a half tab, 7.5 mg, but I can't remember for sure. I recall needing to sleep and sleep and sleep for a few days, which is also a symptom of depression for me, but I think this was rebound.
>
> You might experience "brain zaps" if the taper is too rapid. With Nardil, I think I experienced having my blood sugar become destabilized. I had to eat a granola bar every few hours to keep me going for the first few weeks. You can experience rebound depression or rebound mania, depending on your status of bipolar disorder.Never had brain zaps before. They don't sound like fun. I already have trouble with my blood sugar at certain times of the month, so I'll watch out for that if necessary, thanks. My diagnosis is atypical depression, so I would expect I'd be more likely to feel more depressed, and I believe that has happened with dose decreases in the past. It tends to even out in a week or two, though. The only time I've had any kind of manic-like episode was some mild hypomania when taking Biaxin XL. I never dreamed an antibiotic could have a psychotropic effect. Man, that was an uncomfortable feeling I wouldn't like to repeat.
>
> The MAO system may take at least 2 weeks to recover from the time you discontinue Nardil completely. Recovery seems to take less time with Parnate.
>
> On the whole, discontinuation of MAOIs can be uneventful if the taper is gradual enough. There are always exceptions, of course. I hope yours is easy.
>
>
> - ScottThanks, Scott. That's very reassuring. I hope, if I indeed have to go off temporarily, that it's smooth. Since the surgery likely has to take place during a five-day window in my menstrual cycle, I will probably have a fair amount of time to taper.
Thanks again.
gg
Posted by Justherself54 on December 15, 2008, at 11:00:31
In reply to Re: Nardil and surgery » Justherself54, posted by gardenergirl on December 14, 2008, at 21:20:16
At that time I was only at 20 mg. so it was a quick withdrawal, then the 14 day washout..for me, parnate was very easy to withdraw from..Nardil was worse for some reason...
Posted by gardenergirl on December 17, 2008, at 9:30:53
In reply to Re: Nardil and surgery » gardenergirl, posted by Justherself54 on December 15, 2008, at 11:00:31
Joy. sigh
Wish me luck. I go for the pre-op appt. today.
gg
Posted by jerrypharmstudent on December 19, 2008, at 15:46:14
In reply to Re: Nardil and surgery, posted by gardenergirl on December 17, 2008, at 9:30:53
This might be a bit late - but I had surgery to remove my VNS implant while on Nardil. My pdocs and surgeon said it was perfectly safe. I had no problems. Anyway, hope all goes well.
Jerry
Posted by gardenergirl on December 20, 2008, at 0:33:45
In reply to Re: Nardil and surgery » gardenergirl, posted by jerrypharmstudent on December 19, 2008, at 15:46:14
thanks so much Jerry. It's not too late, as I have an anethesia consult in about two weeks. Good to know it was ok for you, and very good to see you here.
gg
This is the end of the thread.
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