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Hypersensitive to epinephrine: What gene causes this?

Discussion in 'Post-Exertional Malaise, Fatigue, and Crashes' started by Wendi C, Oct 12, 2014.

  1. Wendi C

    Wendi C

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    I'm getting a wide excision for atypical mole I had biopsied, this Friday. After a call to my primary MD (super holistic minded to boot), I reminded him of how badly I react to lidocaine with epinephrine. He warned me that this procedure uses A LOT of lidocaine and to please call my Derm beforehand and see if she'll lessen or can do it without epi. I do not get it even at the dentist. My heart rate shoots up, I get severe anxiety. It's the usual too much adrenaline feeling and just the thought of it causes anxiety!

    What mutation causes this?
     
  2. Kati

    Kati Patient in training

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    Hi @Wendi C

    I don't know what gene is related to that, but I don't think it matters too much. I am also one who doesn't do epinephrin very well, to the point that when faced to having a basal cell removed last year, i opted to get injected with sterile water because the dermatologist didn't have the 'no epinephrine' option.

    i am not exactly sure how a mole removal vs a basal cell removal differs in terms of needing a lot of anesthesia, but if I were you, I'd check ahead of time with the dr whether he carries the plain lidocaime, and if not whether they could get a vial for you.

    Best, Kati
     
  3. alex3619

    alex3619 Senior Member

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    In my case I cannot tolerate it. Its not a mutation. Its orthostatic intolerance. Any drug that messes with vascular tone can trigger OI reactions. Whether OI is due to one or more genes is another question ... and a complicated one.

    The question is this: how soon is the negative reaction? An immediate reaction may not be OI.
     
    Last edited: Oct 13, 2014
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  4. Wendi C

    Wendi C

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    Thanks @alex3619. The reaction takes somewhere between 5-10 minutes to happen. I was reading somewhere, and now cannot find it, that one of the MAO or COMT genes (or lack of one) causes you to process out the epi up to 4X longer than others.

    @Kati - Yep.. I'm going to call her today. I'm praying they don't give me grief. Pregnant women can't have epi so I have to think they must do this to preggos once in a while without it. And I'm SURE I'm not the only one in their practice with this issue. I'm glad, though, that you didn't need the lidocaine. What I'm getting is called a wide excision where they take 5 cm from each side of the mole and I'll have a 3-4 in scar. I couldn't understand why they called it surgery (the Derm said) when they only take more then a shave (her words). Then I watched a You Tube video of it being done. Gave me the heebie-jeebies just watching! But I'm a wimp so...
     
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  5. Kati

    Kati Patient in training

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    @Wendi C I also had a muscle biopsy using plain lidocaine. The surgeon was not too keen on this because epinephrine helps the lido working better and she argued that epinephrine at the dentist and using epinephrine in the tissue were different beasts, but I wanted none of that, and thankfully she used the plain one.

    It can be done.

    The last time Epinephrine was used at the dentist, not only did i feel horrible on the dentist chair, i relapsed for a good 2 weeks, it was horrible, and if it can be avoided, i am all for that.

    Physicians and dentists don't seem to understand. My dentist thankfully has been very understanding though, and I know it's a pain because he has to re-freeze every 30 minutes, so procedures take a bit longer.
     
  6. Wendi C

    Wendi C

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    @Kati - I'm SO relieved!!!!! I called, already geared for a fight. I talked to the nurse who will actually be numbing me up and she acted as if it was no big deal. She just lightly said, "oh! Just remind me right before I numb you that you have a problem with epi". So, I'm guessing they've heard this before. And your surgeon is full of it. No offense, but it all gets sucked into our blood and liver the same way whether through the gums or through the skin elsewhere.

    I had 3 moles shaved off last month and very little anesthetic was used and I felt the effects just like at the dentist, but more mild due to the smaller amount. I didn't even think about it until after I got up to get dressed and started to feel funny.

    Anyway - crisis AVERTED! Whew.. So relieved!
     
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  7. sueami

    sueami Senior Member

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    I want to say COMT and MAO A also. I have both and also started reacting to epi at the dentist about six years ago.

    If it makes you feel better, I had a squamous cell carcinoma removed in a rather large surgical procedure (skin about the size of a quarter of a graham cracker was relocated in an in situ graft and stitched up) in Feb with many shots to numb it up. A dozen, maybe.

    I told my dermo about my intolerance to epinepherine and he said that it's effective (at reducing bleeding) at much lower levels than is often put into a shot. He diluted by I believe 75 percent for me, on my leg, and I noticed no reaction to it. That was likely in part to it being on my lower leg and not being metabolised/carried throughout my system well from there, and partly from the dilution.

    So even if you have a dermo who wants to use it to minimize bleeding in a distal limb, you can ask them to dilute it significantly.
     
  8. Kati

    Kati Patient in training

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    Very glad for you Wendi!
    Best wishes for a good post-procedure recovery.
     
  9. IreneF

    IreneF Senior Member

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    Last time the dentist forgot to use the straight lidocaine, I reacted within moments. It seemed like it took forever to pass. I don't know if that is true if the stuff is injected into your skin. It was a fairly miserable experience, and my jaw ached for weeks. He said, "That's not supposed to happen," as if it was somehow my fault.
     
  10. Wendi C

    Wendi C

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    I'm sorry that happened to you Irene. :confused:I'm sure in the future you'll remind them. People who don't have our issues have little understanding or sympathy and don't care to. I can't imagine what I'd think of me if I didn't have this. :nervous:
     
  11. IreneF

    IreneF Senior Member

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    Thanks for your sympathy. I might ask for gas. Or a muscle relaxer so I can keep my mouth open. And I will take Vicodin before things start to ache. I discovered that taking painkillers before the pain gets bad is better than the wait-and-see-if-I-need-it approach.
     
  12. Wendi C

    Wendi C

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    Be careful with the gas @IreneF. I have adverse reactions to it as well as many others with MTHFR; mostly it takes forever to clear my blood and they make me stay longer on oxygen because I'm always white as a ghost and light-headed too long afterward. But yes, I'm a huge fan of staying on top of the pain beforehand. I had a root canal done this year (my first) and it was painfull to keep the mouth open. I took 800mg of Ibuprofen beforehand and then took tiny bits of codeine afterward, as I can't hardly handle full doses. It made a huge difference. I plan to do the same this week with my surgery.
     
  13. CFS_for_19_years

    CFS_for_19_years Hoarder of biscuits

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    I have problems keeping my mouth open for any type of dental work so I always ask for a block that goes inside the mouth to prop the jaw open. I don't know if you're familiar with this but most dentists have them available.

    I understand that when having dental work that goes on for more than an hour the jaw is going to ache no matter what, but the block takes the strain off your muscles. I have fibro and my muscles gave up a long time ago!

    After a long dental visit, my dentist stuck his gloved finger in my mouth and found the muscle that was in spasm and pressed on it for a minute. He taught me how to find it so that I could do it on my own.
     
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  14. Peyt

    Peyt Senior Member

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    Hello, I know it's been over a month since you put up this thread, but the gene that causes excess ephrine is COMT. I came acorss your post looking for answers on how to help COMT++ which i have myself. I get bad headaches all the time .... Especially when I want to take other supplements such as Methylfolate and B12 and many others.... Another sign of excess ephrine is a racing heart which I have also. Please post any info you might have as far as treating it... It seems like most Genetic Doctors are well versed on MTFHR but I have not found any solid answers on COMT++ and what supplements helps it.
     
    Wendi C likes this.
  15. Wendi C

    Wendi C

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    Hi @Peyt - I don't personally know how to treat this snp either other than food. For me at least, I very strict clean diet of low carb veggies and meats helps the adrenals and racing heart.
     

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