I was lucky enough of to receive another Botox treatment to correct, albeit temporarily, my urge incontinence. The procedure went pretty much as expected. It's early, so I don't know yet what the outcome will be. But, if it is anything like in the past, I should get good results.
While most people opt for general anesthesia, I always request spinal anesthesia without any sedation.
I have had this (and similar) procedure many times in the past, so, in regards to pre-procedure NPO requirements (the proverbial "nothing to eat or drink after midnight) I know what I can "get away with." I live over two hours from the hospital where the procedure is done, and I usually have to leave by about 6:00 in the morning. I have to have something to get me started, in this case a cup of coffee with a teaspoon of cream. Because I have spinal, as long as I "own up to it," it's never been a problem. This time, however, the anesthesiology resident fussed at me because of the teaspoon of creamer I had in my coffee! He even warned me that another anesthesiologist might cancel the procedure because of this! He even said he would have to consult with the anesthesiologist on call to "make sure it would be okay!" Please don't misunderstand: I'm not advocating ignoring pre-operative orders. It's just that, after several these, I know things will be okay.
For the first time, I did receive some fentanyl for sedation, but only because the CRNA (Certified Registered Nurse Anesthetist) in charge of my procedure insisted on it. I'm not sure why, because it's never been a problem before. I did itch quite a bit from it, which is a side-effect of fentanyl. So, I'm not sure that it did more "good than harm!"
I will have to say the anesthesiology resident (the one that chewed me out) did a very good job. He got the block on the first stick. The last time I had this done, an anesthesiologist did it, took him six sticks, and he had to get the CRNA to help him!
I've told my doctor many times that, as long as I knew it in advance, I was okay if she wanted a resident to do the procedure. This time she took me up on it, although I didn't know it before hand. However, she was in the OR, so I was okay with this. I could not see them, but I could hear her "coaching" him through the procedure.
The procedure was the same as in the past. I received 300 units in about 20 injections this time. When the procedure was over I asked to see the needle and the doctor showed it to me. It is about ½" long, and the size (I think) of a 20 gauge syringe needle. But, on the monitor, it looks as big as a broom stick! Of course, the image is magnified several times so the doctor can see. I had almost no discomfort this time. In the past, the irrigation fluid used to keep my bladder inflated and the surgical field clear would hyper-distend my bladder, causing some discomfort.
Another advantage of being awake and aware is I heard the doctor ask one of the nurses to bring her a size 16 Foley catheter. I begged them for a 14! For those of you that know, a 14 Foley is only 2 millimeters smaller than a 16, but trust me, because if where it goes, those two millimeters make a big difference! As usual, Foley went home with me.
The recovery nurse was also pretty strict. Normally after spinal, the patient is instructed to lie flat to lessen any side effects of the spinal. But, because I'm awake, they always raised my head a bit. She would not let me raise my head until the anesthesiologist (the resident who did my block) told her it was okay. It was his chance to "punish" me for the creamer, and he didn't take it! She did bring me coffee, so I guess it was okay.
Once I could wiggle my toes, move my legs and lift my bottom off the bed the hospital staff moved me to step down recovery. I (finally!) got something to eat (and more coffee). Because the nursing staff knows me fairly well, they left it to me to get Foley ready to go home. I didn't mind, as I have to take care of him anyways, and I know they are busy. After the number of procedures I've had, I know how to position the catheter clamp and the leg bag!
All in all, it went pretty well. And I know that the staff has my welfare at heart. So, I guess a little "chewing out" is to be expected!
Published On: August 03, 2009