Expert: Dr Ian Jackson - please note UK based - 5/17/2010

Question
QUESTION: In April 2010 I had TL surgery and general anaesthesia was used. About a 1/2 hour after leaving surgery, in the recovery room, I began to shake/jolt/siesure?? I had been asking questions already and talking with my husband ... when this incident occured I was not able to speak...I could partially hear the nurse and some of my husband's voice but could not respond, my arms pulled up close to my body and my hands pulled in toward my arms and I shook sort of jolt like for a good fifteen or twenty minutes. The nurse went off to get an adavan pill for anxiety --I had never had one before by the time she came back with it autherised...my husband by touching my neck and talking reassuringly to me... it slowly subsided and when I was able to speak again - - I told them I didn't want it. What was this?? They assured me it wasn't a seisure but that's what it looked and felt like from my perspective. Also...the 2nd night after surgery I ended up going to emergency because my fingers and arms went numb...strange tingling and numbness all through my forearms...the emerg doc. hypothesized it might be carpal tunul sydrom that was unmasked by the surgery...that it may be something that would have shown up in the next few years as a problem? Is this a reaction to anaesthesia? Could it be related to the strange shaking incident post surgery? Now three weeks post surgery I'm experiencing alot of difficulty with my joints?/tendons....my wrists and forearms are not painful to the touch but movement is causing me great difficulties....anything that turns my wrists/hands is painful my tendons through my forearms hurt when I write or carry my kids. My ankles and knees are clicking...my knees feel weak and "old" my elbows ache. It almost feels like my bones hurt in my arms.
(They use carbon dioxide in Canada with a Tubal ligation surgery - could this be a cause...or is it an anaesthesia reaction?)
I would like to understand what happened in the hospital post surgery...I can send more details if it would be helpful. Thank you so much for your time and consideration.

ANSWER: Hi there
I am sorry to hear about the problem you experienced. I suspect that no one can categorically tell you what happened as it is an unusual occurrence and we can only make suggestions about the mechanism. The commonest cause of shaking/shivering following surgery is caused by dirsturbance of temperature control following anaesthesia. This can be very marked and severe but still does not sound like your experience.
The description you give sounds like an 'occurrence' (for want of a better word as it is not a recognised condition) we have seen in our hospital a 3-4 times over the past decade. This means it is fairly rare as we perform 20,000 procedures per year. Each time the patient has had uneventful surgery and then while waking up appears to have a 'seizure' but it isn't a seizure as they can hear what we are saying and respond to a degree. It appears to last for a variable amount of time usually 20-40 minutes though one was considerably longer.
Now as to what is happening and what is the cause - we don't really know and it would be wrong for me to suggest otherwise. We do however think there is some relationship with the anaesthetic induction agent called propofol.
Now as to your current problems 3 weeks later I would suggest that this is probably a result of the muscle spasms you had. Imagine how you would feel having run a half marathon with no training. Your joints, ligaments and muscles would be sore. I suspect (but can't state categorically) this is what is happening with you and it should settle over the next few weeks.
Simple analgesics eg ibuprofen may well help.
I hope the above is of some help but I can only end as I began - I doubt that anyone can tell you exactly what happened. As to future anaesthesia?
We don't know the answer but if you presented to me with your story then I would probably choose to avoid giving you propofol (just in case).
Kind regards
Dr Ian Jackson  

---------- FOLLOW-UP ----------

QUESTION: Thank you so much for your prompt answer.Here's some other details...here in Canada there is a surge of people connecting to an ADHD diagnosis (a great documentary was shown on local TV last Sept. and is supposed to come available for purchase in June 2010.) I received my diagnosis 2 years ago - - and I am so thankful for it.
-Have ADD
-Had quite high anxiety /trama going into surgery
-Had my period return for 2 months (I had my fourth and last child in Aug 2009...by this body...we haven't ruled out adoption or fostering) with very bad PMS (my husband says I usually have bad PMS... we've been married 12 years but this was especially bad, and I feel odd that I didn't recognise a consistant pattern...
-Tried an SSRI, Ciprolex to balance the PMS stuff had HORRIBLE side affects, only lasted 5 days trying to take it and then 5 days of bad withdrawal from it: found out I am likely an "ultra slow metabolizer" (my liver that is)
-Five days before surgery we began Plan B to handle the PMS stuff...taking the birth control pill, I had never taken the pill before...when we were first married I had had "the shot that starts with a "D"" for only a brief period of time ....then had used only condoms between my pregnancies.
-To "cope" I had studied carefully the "What Will Happen Sheet" they provided and fully expected to be able to ask some last minute questions to the surgeon and anaesetisiolgist as the sheet indidcated...was told I was receiving "oxygen"...and only when I finally interuppted the staff did they rustle to grab the surgeon who popped her head in front of my face ...I barely could form one of my less important questions which were fuzzy to recall because of their "oxygen"... to her and I was out ...pre -surgery ended up being quite tramatic.
-So I have ADD, afew weeks pior to my surgery (because the dexedrine I use to treat the ADD acts as a appetite supressant in my case) I had lost a good 25 lbs which put me at 5"7, 140lbs ... this caused my dexedrine dose to be too high...the triad of ADD, OCD & Tics disorder was "agrivated/further activated"...I started blinking tics (I am the first in my family to receive the ADD diagnosis - but since I've now researched tics abit there are 2 others who were displaying tics over the years which we didn't know were tics whom I had strongly suspected also have negetive life interfearing ADD but they're my brothers so I've hesitated as their ADD looks different than mine.
I also seemed to be overfixating...compulsively searching for answers to the point where it was interferring with me caring for my family...we didn't realize until hindsight that it was too much dexedrine.
-I had researched tubal liagation surgery and read via internet that some women believe something called tubal liagation syndrome exists - a very adverse reaction to "messing" with the falopian tubes...if there is the presence of "hormonal upset" earlier - puts these patients at a higher risk of being affected...I was concerned about this and it did add stress, so far I seem to be OK post op.
I read in a book B6 can be used to combat carpo tunnel instead of expensive surgery. Years ago a naturopath I saw said my body was very deprived of B vitamins and also seemed to be doing something that hindered my body from receiving the B's even if I did try to boost intake. I also read B12 is important for neuron "stuff" and that ADD is related to neuron "stuff" so perhaps all my B12 is getting used up fighting my ADD.
-No one saw my ADD...I searched for years...7 experts who told me I was fine...could perhaps benefit from more positive thinking (CBT)...apparently women are often misdiagnosed with anxiety or depression (which are symptoms) of the underlying root cause...ADD. I still have a heavy lonelyness and sadness and desire to isolate and find everything so "difficult" my dexedrine made me 100%plus better, yet I still don't feel well...some pieces are still missing. I thank God - for keeping me alive all these years and even through these days as in gr. 11 over procrastinating over a school paper that I really cared about but struggled to complete I first felt sure I should take my life - God intervened and has carried me from that point on through all these years - I know He guides me even now...so I thank you for your encouragment by trying to give me an answer based on your experience...I am strengthened that God will use my pain to help others with their pain - as you can tell he did not create me shy to speak or share with others. What ever clarity or thoughts you can offer are so greatly appreciated.
I feel relief not only with getting "whys" answered but even in the opportunity to process by asking...care to comment on any of this stuff? Do you see anything interesting or connecting about my issues.

Answer
Wow!
Sorry but that is completely out of my areas of experience and so I cannot comment. I ahve given the best ideas I can about what you are experiencing following your anaesthetic but it may well be that your 'anxiety' and ADHD contributed to your sensitivity to this issue.
I wish you well
Dr Ian Jackson