Right sort of sedation ? Confused, worried, exasperated

[sitroenn]

Some of you might recognise my story. This saga has been going on for over a year.

I need to have two wisdom teeth extracted. I have M.E. and low blood sugar and have to eat every one-two hours. I also have very bad recation to valium/diazepam

A year ago I was due for extraction with Conscious Sedation at the dentists but she only told me that I had to fast for 4 hours the day before. At that point I was in a relapse with my M.E. (barely able to get out of bed) and couldn't possibly fast at all so the dentist referred me to the hospital.

I went for my two pre-op assessments and at the first one I was told that at the second assessment I would be able to ask about how they would manage the need to fast and my problems with fasting because of the hypoglycaemia. In the event no one was availble to speak with me about that issue and I was told to phone the surgeon's secretary. I did this and she really couldn't help me (she is lovely but after all she's an expert in admin not surgery) and she suggested I wrote a letter outlining my situation and concerns..which I did.

The original letter from the hospital said I must not eat anything after 7.30 a.m. and surgery round would begin at 1.30.p.m and I was third on the list...so probably I wouldn't be seen until at least 3 p.m.: 7 hours without food.

Two weeks later the secretary phoned and said 'The Consultant says you can fast for 4 hours or have a local..it's up to you' I said I couldn't face such an extraction with a local (though I have had two that way recently) and if I could fast for 4 hours (which would be difficult but maybe not impossible) how late would I be able to eat -- given that it's unclear when I'd be seen for the extraction. She said she'd ask and phoned the following week, apologised for the muddle and then said ' They said you can fast for 4 hours but probably that means you shouldn't eat after 9.30 (5 hours or possible longer without food) or you can have oral sedation'

'Would that be diazepam then? because you know it says in my notes that I do not tolerate that well.'
'I don't know' she said. 'I'll ask and phone you back'

She phoned back and said 'They said they'll see you on the day and work something out'


This doesn't settle my mind at all. I had asked on tis forum about fasting times and IV sedation and been told by one of the dentists that he never asks people to fast. Now I wonder if I'd be better off cancelling the hospital and going back to the dentist (who is sick of me already ) and asking for Conscious Sedation for extraction because the dentist's fasting time was 4 hours and I'd know exactly what time I'd be seen.

I'm so confused and exasperated. In the end I just want these damned teeth out and my various difficulties to be addressed properly so I know what I'm up against. Am I being wimp ? Unreasonabel ? A pain in the neck ? When I had the last extraction (last lower molar before wisdom) with a local I was terrified and nearly couldn't do it. I asked the dentist to stop just before she gave me the injection and said 'I'm not sure I can do this' but really I was just needing a moment to compose myself. The dentist said 'Nobody else makes such a fuss. You'll just have to get on with it' ...so I did. The afterwards she complained about the amount of blood !

Many apologies for such a long post.

Any suggetsions/ advice ??

 

[RP]

First of all, if a dentist talked to me like that, I'd be gone in a flash. Sorry no excuse.

If you have IV sedation, make sure the IV has dextrose in it, so you will have some sugar on board during the surgery. Also try eating a meal high in complex carbohydrate like those in wholegrain form such as wholegrain breads, oats, pasta, potatoes and brown rice. Complex carbs are broken down into glucose more slowly than simple carbohydrates and thus provide a gradual steady stream of energy throughout the day. I'd also ask if you could suck on a hard candy or two if you get hypoglycemic while waiting.

Being anxious is going to speed up your metabolism. You may also want a pre-sedation like Ativan or Halcion to keep you calm until surgery.

Good luck

rp

 

[sitroenn]

Hi RP Thanks for responding. I'll ask about the dextrose in the IV. I am planning to have some eggs for protein and complex carbs in the morning though I'm still not sure how that's going to last from <7.30 til after 2.

I've been told I cannot have ANYTHING after 7.30 a.m. --- not even candy/sweets so don;t knwo what to do about that.


I've actually been considering having the extractions with a local just to get round all the probs with fasting and sedation. I don't know....

Thanks for getting back anyway. Still confused about best route