“Oh yeah, and one more thing,” mum continues.

The immunologist looks at her.

“Why is Brenda getting hairier? Look at her arms! The hair is getting longer! Is this caused by the medicine too?”

The immunologist looks at me. I simply shrugged and give him my usual ‘mum’s worrying too much again‘ look like I always do when she goes about her usual habit of bombarding him with endless questions every visit.

“Well, yeah. It is caused by the medicine,” the immunologist says. “But, is it any cause of concern to you, Brenda?”

“Well, no!” says I.

“I like being hairy. It keeps me nice, warm and fluffy.”

The expression on my immunologist’s face at that moment was epic. From that moment, I think he’s quite convinced that he’s dealing with a loon instead of a patient with autoimmune problems.

And no, I wasn’t being sarcastic. That’s actually 50% truth. I quite like being hairy … definitely not for the ‘nice and fluffy’ part, but well … it does keep me warmer than usual.

Cyclosphorine
Cyclosporine belongs to the group of medicines known as immunosuppressive agents. It is used to reduce the body’s natural immunity in patients who receive organ (for example, kidney, liver, and heart) transplants.

When a patient receives an organ transplant, the body’s white blood cells will try to get rid of (reject) the transplanted organ. Cyclosporine works by preventing the white blood cells from doing this.

(Adapted from MayoClinic.)

It’s a pretty darn strong medication, commonly used to suppress the immune system of transplant patients to prevent organ rejection. I initially had my reservations about it, because of its multitude of side-effects, but eventually took the plunge because otherwise, the illness would just get worse. (And I’ve stopped responding to even the strongest H1 and H2-blockers out there.)

Well, it’s taking its toll – numb fingers and toes, the constant feeling of fatigue and weakness and the occasional nausea. And recently, low-grade fever. All part and parcel of being on Cyclosphorine but side-effects aside, it’s doing a pretty good job and preventing my flare-ups … so far.

I also need regular blood tests to ensure my white cells don’t fall too low, or that my kidneys don’t fail.

Above all, I’m also glad I’ve (finally) managed to find an awesome allergist/rheumatologist to take care of me. He’s one of the very few here in Singapore, so I’m mightily glad.

The doctor, a couple of friends and this forum (contributed to by a host of other people around the world with the same medical condition) has been a great source of support so far.

So, if you know me in real life and have been wondering why hadn’t I called you out in aeons for shopping/lunch/dinner/just bumming around, now you know why. I’ve been basically devoid of energy for quite a while. Please be patient with me, though – I’ll be back to my old self once I assimilate to Cyclosphorine!

Until then, please pardon me while I conk back off to sleep in bed. G’nitey.

Not many folks are aware that they can opt for IV sedation on top of local anaesthasia for minor surgical procedures, or for dental procedures. At least, not in Singapore. Based on some of the overseas forums I’ve read, IV sedation is more commonly practiced in the U.S. or U.K. Whereas, it is comparatively rarer here.

IV sedation involves the administration of a mixture anti-anxiety drugs and a sedative directly into the bloodstream via an IV line usually inserted at the back of the hand. The drugs put the patient into a state of light sleep, thus rendering him/her unaware of the procedure being carried out, but will not bring about a complete loss of unconsciousness. (Note: Not to be confused with General Anaesthasia.)

IV sedation helps a lot when dealing with procedural anxiety. I get generally apprehensive when it comes to medical procedures. That’s common, so does everyone else. However, nothing scares the shit out of me more than getting a dental procedure done.

I didn’t opt for IV sedation to cope with the fear though. I felt it was a better option for me because of my background heart condition. Heart condition plus procedural anxiety do not get along. The last thing I wanted was to end up in atrial tachycardia or explode into one of my epic heart flutter attacks in the midst of getting such a procedure done – which is why I chose to be sedated.

I spent about a week researching intensively on IV sedation and its pros and cons, and eventually decided that it was the best choice for me. My decision was met with a fair amount of resistance though, which held me back a little – but I stood firm with my decision and went ahead with it eventually.

I wasn’t at all surprised by the resistance expressed though. IV sedation is not as commonly practiced here, hence the reduced exposure to such cases (leading to the “huh?! Is it even necessary?!” mentality), and the general lack of awareness about it. One of my doctors even mixed up IV sedation with General Anaesthasia (the latter of which is much, much riskier).

General Anaesthasia induces deep unconsciousness and requires intensive monitoring of the patient’s vital signs. GA also takes much longer to recover from, with a higher risk of complications as it greatly suppresses the cardiovascular and respiratory systems. Patients under GA are always intensively monitored with the whole horde of menacing beeping machines you see in the Critical Care Units.

That is not to say that IV sedation is completely risk-free, though. There are very, very rare incidences of patients requiring artificial resuscitation as they were too deeply sedated. But every medical procedure has its fair share of risks. Even the root-canal procedure I went through had a risk level of complications far higher than the actual sedation itself (because mine unfortunately, also involved a deep infection of the bone).

IV sedation on the other hand, acts on the central nervous system which in turn, suppresses the cardiovascular and respiratory systems, but only slightly. The patient is unaware of what is going on due to the amnesia-inducing properties of the drug, but will not be completely unconscious which makes it much easier for the anaesthetist to manage.

I recovered really quickly post-sedation – “coming to” within 15 minutes after drug administration was stopped, and could even walk (albeit a little wobbly) almost immediately. I was monitored throughout the time I was “out” – but only with an pulse oxymeter and a blood pressure cuff … because that is only about what was needed.

It really helped me in the sense that it slowed down my usually rapid heart rate. And because I was “out”, there wasn’t any anxiety experienced that could potentially bring on a full fledged attack. The only minus about it was the involvement of an IV butterfly needle (which didn’t bode well with my general fear of needles). But better that, than to remain in a state of extreme stress for two hours with a potential atrial tachycardia attack lying in the background.

There are some inconveniences that accompany IV sedation though, such as the need to remain rested for the remaining day, and slight nausea. However, if you have background medical conditions that can potentially complicate a procedure, or severe procedural anxiety, IV sedation benefits more than anything else.

Of course, there are the sceptics that claim that “IV sedation is for pussies”, “You aren’t man enough if you need IV sedation”, or “IV sedation is only an easy way from anxiety.”

Forget all that, because all those are simply noise interfering with the patient’s personal decision based on his/her own background.

Ultimately, I believe it is about what’s best for you, and your comfort level.

If you’re curious and want to read up more, here are some links to help you.

Dental Fear Central: IV (Intravenous) Sedation
IV Sedation versus General Anaesthesia
Wikipedia: Twilight Anaesthesia
IV Sedation – Is it safe?
Dental Relaxation: IV Sedation

And yeah, the whole purpose of this post is to let you guys know that when it comes to stuff like these, you have options to choose from. Don’t let fear stop you from undergoing any procedure you have to go for because recovery (or the prevention of further complications and infection) matters more than anything else.

And also to the folks with underlying medical conditions (like me) that could cause complications in conjunction with anxiety – look, choices!

Meanwhile, wish me the best of luck for this coming Thursday – it’s Round 2 of my Root Canal procedure (yes folks, with IV sedation) and I am going to have to contend with a swollen left cheek, various aches and pains, and potential light fever for two days after that. Whoopie.