Is epinephrine such an extreme trigger that an episodic runs serious risk of being kicked out of remission?

[Bejeeber]

As I search 'epinephrine' here and on f-book I see practically all of the most respected CH advisors warning of what a major trigger it can be, and I'd really be a fool not to take those warnings very seriously!

With some impending sinus surgery (just an outpatient deal, something I think of as being no big deal), the only real concern I have is the epinephrine factor. I'm inspired to ask if many other episodic CH'ers in remission have had the lidocaine/epinephrine stuff injected without being set off CH-wise?

Apparently epinephrine is favored for its ability to discourage too much bleeding with procedures around the head area with all it's vascular pressure and fondness for shooting streams of blood out as if propelled from a device such as a Super Soaker™ squirt gun. 

 

[Bejeeber]

Like, if you're in a remission place where your ordinarily major trigger alcohol doesn't set you off, would epinephrine potentially be that much more still of a trigger than alcohol?

[jon019]

2 hours ago, Bejeeber said:

Apparently epinephrine is favored for its ability to discourage too much bleeding with procedures around the head area with all it's vascular pressure and fondness for shooting streams of blood ...

...well...that explains why the arrogant prick anesthesiologist blew me off when i PLEADED with him to forgo the epi for my own "head" surgery...he at least coulda told me the above....

.....good news/bad news from this clusterhead if ya can't talk 'em out of it: did NOT trigger a cluster cycle...did wake up to a one-off  6 hr kip 8+ hit ...you know it's bad when you are scaring ICU nurses.....drained the hospital O2 to no avail and they wouldn't give me triptans....

....if i was yu i'd keister a Zomig....

Edited June 1, 2021 by jon019

[Bejeeber]

Thank you for that highly pertinent report from the trenches Mr. jon!

If I could knock out an epinephrine induced one off hit with a triptan while not triggering a cycle, I'd consider that a big win. 

It sounds like in your scenario that when you came to, the attack may have been well underway though, with no chance to catch it near onset.....

[xBoss]

I got kicked out of remission when I had a tooth extracted and blame the epi.

[jon019]

2 hours ago, Bejeeber said:

It sounds like in your scenario that when you came to, the attack may have been well underway though, with no chance to catch it near onset.....

.....affirmative....

[Bejeeber]

Yikes you guys, udderly nightmarish on both accounts. 

@xBoss, when you got kicked out of remission, would this have been at a point in the cycle where alcohol consumption was still safe enough, but (confirming worst fears ) the epi packed that much more of a trigger punch?

[CHfather]

Jeebs,
My recollection is that my daughter's first bad cycle followed a tooth extraction, when she had only had occasional "bad headaches" before that time.  The extraction itself was difficult, and for a long time we were blaming the dentist for having caused her CH (which at that time (and for much too long thereafter) was diagnosed as trigeminal neuralgia).  I don't remember specifically whether she was having those "headaches" at the time of the extraction, so I'm not fully answering your question, but the shift in severity was very large.

14 hours ago, jon019 said:

....if i was yu i'd keister a Zomig....

Edited June 1, 2021 by CHfather

[Bejeeber]

So it sounds as if there's the chance with some of these dentist visit induced horrors that the dentist actually poked a trigeminal branch or something, but epi is generally the  most likely suspect for pointing fingers of blame at.

And I think it may just now be dawning on me what "keister a Zomig" implies. 

[CHfather]

1 hour ago, Bejeeber said:

And I think it may just now be dawning on me what "keister a Zomig" implies.

A new expression to me, too, but worth remembering, although I'll have to work hard to fabricate an occasion when I'll get to use it. 

[Ricardo]

@BejeeberI'm not so sure about triggering a cycle or not, but pretty much everything that dentistry has and does triggers a serious cluster for me.  

But something that might be looking into as an option is nitrous oxide.  I have been getting nitrous at the dentist for the past 4 or 5 years and never once had a cluster break though.  

It has been successful enough as an abortive that I got a whipped cream maker so I could take nitrous at home and it has been unbelievably helpful.  I know a couple times it has kept me out of the ER.

 

-Brendan (AKA Ricardo  )

 

[jon019]

3 hours ago, Bejeeber said:

And I think it may just now be dawning on me what "keister a Zomig" implies. 

...'twarnt no "implication"...they wouldn't give me pants, they don't put pockets in those shorty gowns, and my ass was hanging out...

....sorry if we're scaring you bejeeber, but note that for me, out of hundreds of cycles, a weirdly triggered hit (e.g. epi, zinc welding) has never started a new one...

Edited June 1, 2021 by jon019

[xBoss]

10 hours ago, Bejeeber said:

Yikes you guys, udderly nightmarish on both accounts. 

@xBoss, when you got kicked out of remission, would this have been at a point in the cycle where alcohol consumption was still safe enough, but (confirming worst fears ) the epi packed that much more of a trigger punch?

Yeah, I was drinking beers and way out of cycle and I got hit hard after a dentist visit then busted it and got hit hard again after the next visit five weeks later. They were both extractions of molars and had tons of drugs put into my jaw. I now ask for low epi since they love the stuff for blood control and don't really want to go without it.

[Bejeeber]

Thank you for the cautionary tales @xBoss- that is some seriously messed up dentistry provoked hell. 

And @Ricardo, WOW, somehow I had missed or forgotten along the way the thing about laughing gas being an abortive???!!!

I recall being given nitrous oxide as a grade school kid while getting some baby teeth molars removed, and man I was partying! I think it ended up being a serious inspiration for seeking out the party smokes when I could get access a couple years later. 

 

[xBoss]

I love nitrous. Going to grab some whippets today and see if they can abort an attack. Probably have not done one since before I had CH which was 22 years ago!

 

[spiny]

Jeebs, the Epi proved to be a provoker of Hell for me. Repeatedly! 

I cut my thumb with Machete cutting corn. It was sewed up no problem. But the 'hand specialist' was an idiot and it took 4 surgeries to fix the mess that he made. Anyhoo, I woke from surgery and was fine. No biggie actually. But, he pumped me full of epi. The hospital was 2 hours from home and they gave me no meds as it was supposed to stay numb for 4-12 hours post surgery. That was not true for me. It came alive in less than an hour and I had no pain meds and a lot of pain. I had 10 hits in the following 24 hours. My personal record. It was hell night. No cycle started though. It was summer and I was not in my normal cycle time just yet. The next trip to that place and they were told that it would be a general and NO epi ever again. I had no hits.

When I had the great colonoscopy done, I told that one that I might need O2 post even though it was just sedation. She asked how I wanted it? 15LPM and a non-rebreather for 5 minutes and then 5 minutes at 5LPM. Well, they sedated me and I got a hit. So, they did full anesthesia at that point as I was thrashing allover according to them. I hit the recovery room, woke immediately and sat up - her cue on the O2! Cleared it right up and no more issue with that one. They were very shocked that I woke immediately. They had just told my husband that it would be over to an hour. Nope, she made a bat turn and let him know that I was up and almost ready to go. Now, when I go the THAT hospital, we have a procedure in place and my chart is noted for NO EPI. They also have O2 waiting when I wake. I can see the tank!! I made a believer out of that doctor.  When the gallbladder came out, the O2 was right there for me. But, no epi, so no hit! 

I refuse to have dental work done during my 'normal' cycle months! My dentist won't work without epi. Yes, it shrinks the blood vessels to reduce the bleeding. It also provides better deadening of the area, so the dentist is happy with that and won't work without it. Were it possible, I would change dentists to get nitrous!! That would be the bomb!!!

[Bejeeber]

Wow, @spiny, clearly you've been through the epi ringer too, and have some seriously convincing evidence after those various procedures that points right at the epi being the culprit. 

I actually had the beloved colonoscopy without any sort of sedation or nothin', in order to avoid provoking any CH. Painful? Yes, but of course a relative walk in the park compared to Mr. You-Know-Beasty-Who. 

[Ricardo]

@Bejeeber Admittedly, there have been very few clusterheads that have tried nitrous as an abortive so as far as working for other people we really don't know yet.  But it works damn well for me  

[jon019]

.....seems countintuitive ...N20 described as a "potent cerbral vasoldilator" which is just the opposite of what we want. would seem similar to nitroglycerine which can be used diagnostically to precipitate a CH hit....

...on the other hand....thc is discussed on every CH board i've ever been on.... and while it too is a potent vasodilator, there are folks who swear by its use. though i do not recall as an abortive (yikes, smoking tobacco for me during a hit was damn near suicide)...

....can only wildly speculate that vasodilation throughout body might reduce the pressure on the trigeminal nerve....but this is way beyond my knowing....

 

[Bejeeber]

Ah, searching the forum now and seeing how individuals such as our reality checking uber expert @CHfather have been keeping an eye on the nitrous and how one CH'ers abortive may be another's trigger with it.

 

[xBoss]

2 hours ago, jon019 said:

.....seems countintuitive ...N20 described as a "potent cerbral vasoldilator" which is just the opposite of what we want. would seem similar to nitroglycerine which can be used diagnostically to precipitate a CH hit....

...on the other hand....thc is discussed on every CH board i've ever been on.... and while it too is a potent vasodilator, there are folks who swear by its use. though i do not recall as an abortive (yikes, smoking tobacco for me during a hit was damn near suicide)...

....can only wildly speculate that vasodilation throughout body might reduce the pressure on the trigeminal nerve....but this is way beyond my knowing....

 

Yeah, cigs are horrible, they magnify the pain so much. weed doesn't help me much but it usually doesn't make it worse, sometimes maybe a little bit.  O2 never worked for me but I never got it flowing enough. N2O is such a good temp pain killer that it has me wondering. Time to make some whipped cream. :p

[jon019]

48 minutes ago, xBoss said:

 N2O is such a good temp pain killer that it has me wondering. 

....ok, starting to make sense...pain killer!....was probably going down the wrong road with vasodilation/constriction speculation. unlike opiates, could be n20 is hitting the right pain pathways irespective of blood vessels situation?  perhaps weed similar...

.....decades of this shit and "i'm still no bloody good at it" (to quote aussiebrian)...sticking around to learn, i wish more folks did...ya never know when the beast gonna morph and different weapons needed....

Edited June 3, 2021 by jon019