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

  1. #1
    Senior Member
    Join Date
    Apr 2005
    Location
    Argentina
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    147

    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. #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

  3. #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; 09-07-2012 at 01:26 PM. Reason: Cell phone meddling with my spelling!

  4. #4
    Will anesthesia be there or someone else monitoring and controlling your blood pressure or is going to try and do both?
    CWO

  5. #5
    Senior Member
    Join Date
    Jun 2008
    Location
    Waterford,NY
    Posts
    476
    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

  6. #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

  7. #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

  8. #8
    Quote 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.

  9. #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.

  10. #10
    x2
    What crags said.

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