How much can one control a reflex action? Is it possible at all?
The last twice I've needed an injection, I've felt the very sharp prick of the needle quite strongly and somewhat painfully. I think that my jerk away is a reflex action and not controllable, but I'm told what I'm doing is very dangerous and I need to hold still and don't seem to be heard when I say it's a reflex action.
Each time I've been told I'm being given the stronger anaesthetic. The last time, last Friday (a little leaking has restarted 4 months after my last Eylea injection), I at first felt just some pressure, but then suddenly the pain. Does this mean it had not been left long enough to have acted deeper into the cornea?
In December, it was sorer than usual after the injection, but this time it was about as sore as on my worst previous occasion. The administrator of the injection had had ophthalmologists check my eye before I left the clinic, but they claimed not to see anything too serious. No prescription painkillers, of course.
So what is the full range of anaesthetics available to them? How long should they be left?
I said to them about clamping my head, but I think that might just result in an even more dangerous movement of the eyeball.
Does anyone have any knowledge of how this problem can be handled by patient and clinic? Of course, the experience in itself every time only makes matters worse for the future.
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ironbrain
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I understand your comment about "reflex" reactions to the shot.
I've had it happen just once to me in one year of injections.
I try use a focused relaxation like in yoga, or meditation - sort of like what they teach in childbirth classes, too. I breathe in from the nose, counting a slow 1-2-3 in my mind......then I slowly exhale softly through gently parted lips....internally counting 1-2-3-4. I start this as the doctor does the final prep before the injection. That one time I did the reflexive jerk, I had not done my usual breathing technique, as I had been distracted by something. Now I make it even a more focused technique - it works wonderfully for me to avoid all that mental and physical body tension before the injection and possible jerk with the injection.
I'm sorry to hear of your injection problem. Perhaps I can relate my own experiences. I've had 30 injections so far and expect to have them until I die (maybe it won't be that long - I'm 87). Each injection - the actual piercing of the eye with the needle - has been (briefly) agony. I've tried everything and nowadays this is what I do: (1) I do not focus on the injection until just before going into the clean room; (2) I always ask for lots of anaesthetic, reminding them of the pain; (3) I take two paracetamol and one codeine phosphate - prescribed by my GP - one hour before the injection, remembering to be seated after taking the codeine because the doc said it's rather strong. It's also a good idea to make sure you're not allergic to the iodine used. Afterwards I usually go shopping, groping my way round the supermarket with a magnifying glass. Then the two-hour journey home.
Most folk seem not to have a painful injection but some have bad after-effects, which I don't. I've spoken to the clinic about the pain a few times, and spoken to the Macular Society and the conclusion seems to be that I am one of the relatively few physically sensitive cases. Our clinic nurses are very kind and I have a good relationship with them all. So...that's how it is. The advice about deep breathing is very useful and I always try that too. I wouldn't fancy having my head clamped so it might be worth trying relaxation exercises of whatever kind suits you, as well as training your mind and keeping a sense of proportion. (I still can't help giving a yelp, though, when the needle goes in.) All the very best for next time.
I also take two paracetamol an hour before and do the breathing/ counting thing with a quiet " grunt" on an outbreath at the time of impact to attempt to dissipate the tension. They usually say when the inj is coming and I immediately press my head into the pillow so any reaction movement is limited as much as possible.
I also squeeze the nurse' hand firmly, imagining the ( left) eye pain travelling down my arm, at the same time tensing/moving my right foot.
I think distraction is the best one can hope for. I had quite a few painful inj and my doc said some people just have more sensitive eyes. Good luck working out something that works for you.
I may well have a sensitivity problem – I have a skin reaction to some soaps, Pears and coal tar particularly, causing a sort of slightly scabby permanent goose-flesh effect (I was in my thirties before I discovered it was soap causing it, so I doubt it's anything serious). Of course, that's something I have to relate to them every time they ask if I have any allergies. But in such cases mightn't it be that one reacts more (beneficially) to the anaesthetic than otherwise.
Sometimes I wonder if they don't just dupe me telling me they're using the stronger stuff, avoiding actually doing so because of the higher risk of cornea damage with it.
In the waiting room, I don't really get butterflies or start churning – I'm in for an injection and that's it. I do get tense in the chair and that situation is going to sky rocket if things don't improve.
I think they can make it painless (just some pressure). I'm just wondering what the full range of anaesthetics is and how long they might need to be left to work right though the cornea. If they are using a stronger one on me (tetracaine?), might they be trying to get the injection done and my eyes rinsed off of it as soon as possible?
Oh, interesting ironbrain: I did not know there was potential damage to the cornea from the anesthetic drops. In fact I was assured that since the excess drops leave the eye, you cannot overdose. that COULD explain why my vision decreased so dramatically after an injection in which I was given 2 washings with drops because an emergency came up after my first dose and I had too wait too long before my injection. And the technician used copious amounts!
The retinal specialist (later) did not find anything different with my eye when I returned with complain of increased faded/fuzzy vision. Just the same mild cataract. But something seems wrong that my vision would be so much worse AFTER an injection.
I'm so sorry for you difficulties. I don't mean to make you wary of anesthesia, but you seem to have more information than I. I will ask the name of the anesthesia for you next time, because it does numb enough that i only feel a prick.
(If you get; "This article requires a subscription ...", try copy/pasting the title into Google and going to the page from there. Somehow that way I got more information.)
Corneal toxicity with damage to the epithelium has also been reported to occur with abuse of anesthetics which is rare since patients are normally not prescribed these drops for self-administration.
I can well understand your concerns but don’t have much idea of a solution. Most clinics have at least 2 different anaesthetics however, it sounds as if they have tried the stronger one.
According to the manufacturers a single drop should suffice but my clinic uses several over a period of 4-5 minutes. If I say that I have even the slightest sensation when they drip Betadine into the eye then they administer more.
All I can suggest is to ask if the injections can be given in a different quadrant of the eye. I know of an American patient who has painful injections but her doc had minimised the problem by mapping the quadrants and only injecting in the area of least discomfort.
Is it the same person who injects? I have found that individual technique can play a part. I had a lovely SA doctor who even gave me a steroid implant without my feelinh anything. The needle for that is much bigger than the usual one.
Hi ironbrain, I too jumped during an injection and was told off as if I had control over the jump. Other times it’s been fine. I think it depends on the amount of anaesthetic put into the eye, so I now always ask for plenty and explain that I jumped x
In Clinic J at MREH, they seem to have two rooms for these injections, a theatre type room and a more standard type room. The more senior surgeon (or whoever) has the theatre-type room, and I think on average (but not invariably) I've fared better in the theatre-type room. (I'm not complaining about less experienced personnel here – I marvel at the fact that there's people who can get up every day and do the job.)
The anaesthetic I've had has been administered by drops in the corners of the eye and along the eye, two lots a couple of minutes apart. I've been reading that tetracaine can take 5 minutes or more to become fully effective, so possibly things would be better if I don't have a "get things dome and get home" attitude about me. I don't think it was left 5 minutes, the second application anyway.
I've just been reading that anaesthesia by subconjunctival injection is possible. I can't say I fancy one of those either, but it looks like it might lessen the chance of feeling the intravitreal one and resulting "dangerous" reflex jerk.
I've also spotted a New Zealand study that showed allowing patients tetracaine for multiple applications at home for corneal abrasion did not show any corneal problems. So, where are we ...
Sorry to hear you have this problem, Ironbrain. I do not know if this would help to control your reflex reaction, but what I do an hour before each injection is chew up a Valium pill (prescribed by my GP for this purpose) to relax my muscles and calm my nerves. Since I receive an injection every 8 to 9 weeks, and this is the only occasion on which I take the drug, I have no worries about habituation. I must say it does help me very much to relax and stay calm.
I take 5mg the evening before of diazepam. With that and some zopiclone is the only way I can get some sleep and not arrive at the clinic after a white night. It's difficult getting them from my GP, though like you the four tablets I get are only for nights before eye injections and dental appointments. I was told that up to 10mg could be given me at the eye clinic, but so far it has not been. The trouble is it's not going to lessen the pain much or stop a reflex action for me which is the root problem.
I don't know what medication would be useful to control a reflex action, but it might be helpful to experiment a bit with your usual meds for sleeping the night before. I say this because I understand that there can be a bit of a bit of an anxiety rebound in the morning after taking zopiclone, and agitation/irritability can be experienced the morning after when using diazepam for sleep. I'm sure you have done some experimentation in the past in this regard. But I do not know what else to suggest. What you are consciously feeling at the time of the injection, your mood, mind-set, etc., may or may not be related to the reflex action of your autonomic reflex response. I do realize that. Good luck with controlling it. For me, an attitude of resignation with a very low degree of anger (rather than fear) seems to keep me steady.
I agree with Rannatk, that the person doing the injection plays a big part in the comfort of injections. For the past 2 years, I have had, almost exclusively, the same nurse, who has been amazing. Prior to that it seemed to be someone different nearly every time, not a good experience! Unfortunately, it looks as if our Bath hospital has changed the routine of having the injection on the same day as the scan and review. Now we have to make a separate appointment for the treatment. I have an appointment on Wednesday, this week and have been told it will be one of the doctors doing the injections. All my previous fears have returned. I will see on Wednesday whether I have been worrying unnecessarily - fingers crossed!!
It sounds to me like your not being numbed enough rather than a reflex action. Every time I've had the injection done I've felt a pressure but definitely no prick or pain til after the injection and the drops have wore off.
Do you have dry eyes? Sometimes having dry eyes can make them even more sensitive than usual I find putting plenty of eye lubrication drops before my eye appointment to help. Just make sure not to put them in too close to having your injection done otherwise they may wash the numbing drops away.
Do they build your numbing drops up? I used to have about 2-3 drops waiting then more when I would go into the injection room.
Mmm, I think it's not strong enough anaesthetic or not leaving it long enough.
I put some lubricating drops in in the waiting room before I see anyone at all.
Last time I had two applications of seemingly copious amounts of the anaesthetic drops while sitting in the injection room. I think not leaving them long enough is the most probable answer, unless I've already built up a resistance to them.
Yeah maybe it's not being left long enough then! So it hasn't kicked in fully. Like I said when I've had it done usually I have a few drops in the waiting room right before I go into the injection room then a few more once I'm in so theres a longer time for it to kick in. When I've had pressure tests on my eye lot of the time they put the drops in then touch your eye straight away and usually you can still feel it abit and then seems to feel very numb a little while after haha (obviously this isn't painful like a needle and the drops may not be as strong) but maybe ask for them to spread your drops out abit more and see if it helps at all?
With me the test seems to have become gently trying with the syringe needle – I don't know what they used before. The trouble is that last time, when she started inserting the syringe needle, I felt nothing but pressure, so I thought all's well, and began to relax. A hundred milliseconds or so later, I felt a very sharp, somewhat painful prick. Obviously, besides the reflex action, I was somewhat startled – my head went back and my upper torso arched above the chair.
Really, I think I must investigate how, and in what time scale, the anaesthetic delivers its effect deeper into the cornea.
Usually in my experience they test the numbness with a marker of sorts? So they would put a dot where the needle will be going in and if I can't feel the ink (or whatever it is) stinging then I'm good to go.
Ahh so it's almost as if the surface of your eye is numb but not underneath? I would definitely look into the time scale thing then! Maybe your just not having enough time before the procedure to get properly numb.
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