It’s been pretty quiet on this blog lately.
Have you heard the saying that flying consists of hours and hours of boredom interrupted by moments of sheer terror?
Well, let me tell you about the time I was waiting for anesthesia prior to surgery, but I developed an allergic reaction and the surgery was cancelled…
[Image of allergic contact dermatitis from Google Images]
So far I’ve had two surgeries, both of which were Tricare referrals to civilian facilities. This was to be my first surgery at a VA hospital.
The contrast between civilian and VA facilities and experiences was interesting, but I’ll save that for another post.
I will say, though, that the military “hurry up and wait” dynamic is alive and well at this VA facility. That may have saved my life.
Every stage of the process at the VA hospital felt slow and inefficient. There was a whole lot of waiting. And communications could have been better as far as what would happen during each stage of the process.
One thing that was well communicated, however, was the pre-surgery cleansing process.
I was given a nifty hospital gown and robe, a pair of no-slip hospital socks, and some antiseptic body wipes, and was escorted to the bathroom. Once there, I was directed to follow the cleansing protocol on the wall chart using the antiseptic wipes and I was left to accomplish the task.
There were three packages, each of which contained two wipes. The wall chart showed a body with six defined zones and directed me to use one wipe for each zone, in a prescribed sequence. Excluding the head and genitals, I was to start at the neck and wipe my entire body with the antiseptic wipes. The chart spelled it all out: use the first wipe to clean the neck, shoulders, and chest; use the second wipe to clean the arms and hands; etc. When I had completed wiping down my body with the antiseptic wipes, I let it air dry as directed. (The antiseptic was supposed to remain on my body, rather than being rinsed off.)
After having completed the pre-surgery cleansing protocol as directed on the wall chart and donning my nifty gown, robe, and socks, I returned to my hospital bed and waited. And waited. I could feel the residue from the wipes on my body – it felt tacky. I remember commenting that I hadn’t had to do this cleaning procedure for either of my previous surgeries. We assumed the VA was being ultra-cautious about infections.
Eventually I was taken back to some kind of a surgical staging area. The nurse anesthetist put in an IV line, and I had pre-surgery conversations with a nurse, the nurse anesthetist, the anesthesiologist, and my surgeon. Again there was more waiting around than I had experienced prior to previous surgeries.
The nurse anesthetist returned and said it was time to remove my robe. As she assisted me in getting the robe off of my shoulders (while I was propped up in the hospital bed), she exclaimed, “Your back is really red and splotchy!” This got the attention of the nearest nurse, who came over, looked at my back, and agreed it didn’t look normal.
They asked me questions: “Do you have a history of eczema?” [No]. “Do you have a history of hives?” [I don’t think so]. “Is it spreading?” I could feel that my face and neck were getting more and more flushed. I could tell when the hives spread up my neck, although I couldn’t see them.
They started looking at the rest of my body, asking questions while they looked under my gown and folded back my blanket: “Is it on your chest?” [Yes]. “Is it on your abdomen?” [Yes]. “Is it on your arms?” [A bit]. “Is it on your legs?” [Not yet].
Once they determined that I was probably having an allergic reaction, they started asking lots of questions: “Does it itch?” [No]. “Does your tongue feel swollen?” [No]. “Stick out your tongue and let me look at it.” “Are you having any trouble breathing?” [No]. Other medical staff came and went, looking at the situation and asking questions.
At some point the nurse anesthetist went and got Benadryl (an antihistamine) and started administering it through my IV. Then they started trying to determine the cause of my allergic reaction.
It was pretty clear to me that it must be the antiseptic wipes. But the pre-surgery cleansing protocol had apparently been instituted fairly recently, and not many people in the pre-surgery staging area seemed to know about it. I explained it to person after person.
Finally one or two people who were aware of the new cleansing protocol got involved. A consensus was reached that I was having an allergic reaction, as evidenced by allergic contact dermatitis and hives (urticaria), and that it was caused by the antiseptic wipes.
A decision was made to delay my surgery while they monitored my condition. The nurse anesthetist was prepared to administer steroids if necessary. The patient who was scheduled after me was moved up to my surgical time slot. I started to feel light-headed and buzzed from the Benadryl. A nurse told me that my blood pressure was “slightly high.” When I asked her “How slightly?”, she responded “185/99.”
I was informed that the hospital was tracking adverse patient reactions to the new protocol. Someone sent for the Chief Surgeon, who came and looked at me, asked me a few questions, proclaimed that I was manifesting a classic dermatologic allergic reaction, and told me he was sorry I was having this negative reaction and that it would be logged.
I was also informed that this allergy would be added immediately to my VA medical records. The substance to which I reacted is Chlorhexidine. In the wipes, it was a 2% Chlorhexidine Gluconate solution. I was told that Chlorhexidine reactions were rare, but could be severe.
The anesthesiologist suggested that I have a shower to wash off the antiseptic. No one responded to his suggestion, although a nurse went and got a wet wash cloth and proceeded to wipe down my back and part of my neck.
The rash/dermatitis/hives seemed to stop spreading in response to the Benadryl. My blood pressure also started coming down. My surgeon, who had been monitoring my situation, returned and informed me that he had decided to cancel my surgery and re-schedule it for another day.
Initially I was disappointed by this decision, since I wanted to get the condition I needed surgery for dealt with, and because I would have to go through the surgical preparation logistics all over again.
But after I got home and started feeling better, I researched Chlorhexidine reactions and found multiple medical journal articles describing patients with Chlorhexidine reactions having anaphylactic reactions* under anesthesia, either in pre-op or during surgery. Then I was very grateful for my surgeon’s caution.
(And for the inefficiency of the hospital staff. Had my surgery started on time, I might have been under anesthesia when my allergic reaction manifested.)
Additionally, I was warned that my symptoms could return (presumably after the Benadryl wore off). It would not have been good for my symptoms to get worse or to return while I was under anesthesia.
After monitoring, and the return of my blood pressure to an acceptable level, I was permitted to go home, with the caution to continue to monitor my symptoms and to get help if the symptoms returned/got worse and I started to have trouble breathing.
[I insisted on a shower before leaving the hospital, to remove the offending substance from my skin, however no shower was available, so I was given wash cloths and towels, and escorted to a bathroom to clean up in the sink. I washed myself as best as I could, and took a complete shower after I got home.]
I did have symptoms again at home the next day, which I treated with an OTC antihistamine and an NSAID. Had my symptoms gotten worse, I would have called 911 or driven to the emergency room.
I am still waiting to re-schedule the surgery…
BOTTOM LINE: The VA has a new (as of April 2016) pre-surgery cleansing procedure which consists of using 2% Chlorhexidine Gluconate body wipes. Some people, like me, are allergic to Chlorhexidine. Chlorhexidine is also used in hospitals in catheters, antimicrobial skin dressings, and antimicrobial surgical mesh, among other things. It is also used sometimes to sterilize medical equipment. If you are allergic to Chlorhexidine, be VERY, VERY cautious in a medical setting and make sure all of your healthcare providers know.
Chlorhexidine is also used in dentistry, in certain mouthwashes and rinses and in certain dental procedures, so be cautious there as well.
WARNING: If you are allergic to Chlorhexidine, you should be aware that it is an ingredient in many products besides pre-surgery antiseptics. Please see this website for other products (including everyday household products) which may contain Chlorhexidine.
NOTE: Prior to this incident, I was aware that my skin was sensitive to some laundry detergents (they make my skin itch) but I had never had an allergic reaction, nor had I been diagnosed with any allergies. I had no idea I would have an allergic reaction to the antiseptic wipes.
*NOTE: An anaphylactic reaction/response is a severe allergic reaction. The most dangerous anaphylactic reaction is one in which the airway is compromised due to swelling of the mouth, tongue, throat, and/or lungs. For more information on anaphylaxis, see this Mayo Clinic website.