So sorry to hear you had trouble with the biopsy!  That's always scary and miserable!

It could have been a mast cell degranulation.  BP can be high or low during a degranulation.  Heart rate can be high.  You might want to ask which local anesthetic they used and if there was a preservative in it.  That can cause problems, too.  Did you pre-medicate before the biopsy?  The physical trauma of an invasive procedure can cause degranulation, as can the emotional stress from it.  So it could have been any of those things.

The Benadryl was a good choice of meds.  I find it works quicker if they give it in an injection, as long as it has no preservatives.  I react horribly to IV Benadryl, probably because it is preserved.

Hi Sasha!

I'm sorry you went through such a strong reaction!!   Yes, it's scary and very hard to handle when you don't see it coming and don't expect it!!!   Even for those of us who know what's going on, it's still a trial.  

I've been through a very similar experience and it wasn't very long ago.   Last October I went to Sao Paulo to join in on a study that includes masto patients.  The doctors I saw are part of the New Masto Reference Center we are starting here in Brazil.  The hematologist I consulted with did a 3 year fellowship at MD Anderson with Dr. Verstovsek, who is well know in the masto world, not as an authority, but as a well respected hematologist.  So, this doctor KNEW that masto patients are unpredictable with their reactions and that cautions must be taken.   Yet, sadly, there is a group of us who are more reactive than others amongst us.  The authorities don't know why, they just know we are.  

Anyway, part of the study was a skin biopsy.  I do not have lesions on my skin and they wanted healthy skin, no lesions.   I was not told to pre-medicate and I was not thinking that I would react and was not concerned at all!   So there I was, calmly watching the entire process.  He injected the lidocaine and after the area was numb went about doing a punch biopsy.  Then he began to sew me up.  He was about done with cleaning up everything when I began to feel odd.  It was about 10 minutes from the time of the injection and I began to feel my heartrate increase, palpitations, and I felt my stomach began to tighten up and to feel the brain fog comming over me.  I realized pretty quickly that I was beginning to react and asked for my purse and my meds and the doctor quickly saw that things weren't right and saw me take my meds.  I put the loratadine under my tongue so that it would take effect even quicker.  I sat there calmly, not allowing my emotions to get involved while the doctor kept his eyes on me.  After about 10 minutes the crises was already being turned about and the doctor finished his work.  He gave the okay for me to have a snack brought to me and then went his way as I ate my snack feeling normal again.  

I was about half way through my snack when suddenly and drastically everything began to change once again!  This time it was much, much stronger - brain fog, abdominal pain, tachycardia, dyspnea.  I again asked for my bag and this time took another loratadine and prednisone, which I always carry.  This time the nurse who had been in the room with me got a very concerned look on her case and asked me if I wanted to lie down, but I was so confused by trying to answer the question, thinking about if this was best and not being able to identify how to answer it that she just took me by the arm and led me away down the hall so that she could have me lie down.  In walking towards the recliner (I was in the area of the hospital where they do the blood testing and bone marrow biopsies, etc.), I was suddely surrounded by doctors and nurses, pulling at my arms, taking blood pressure, temperature, pulse.  I no sooner sat down then I began to lose consciousness.  I heard them call in the dermatologist and the hematologist who had been part of the group, who was aware I was a masto patient, began giving orders to the doctors.  Their comments were that of the hypertension and yet the intense flushing they were seeing.  By the time I'd lost consciousness and gone into a semi-conscious state, the other typical symptoms of anaphylaxis had disappeared and all they could see what that I had an intense flush and was "unconscious".   Yet, in truth I was semi-conscious and could hear and understand what they were saying, although I was totally, physically incapacitated and unable to respond!  They ordered a code red on me, began putting the stickers to hook me up to a heart monitor while the gurney was being brought in.  I heard the dermatologist give orders as to what meds to give me and they then removed me to the ER.  It was a matter of perhaps a little over 5 minutes after the 2nd biphasic reaction began.  

In the ER, the dermatologist gave instructions to put me on IV antihistamines and prednisone.  I had told him about having a hypertensive variant of masto and that I was known for severe reactions and that this was exactly how we had to deal with them!  I hadn't been sure he was listening while he was doing his procedure, but he obviously had been, thankfully!  The size of this reaction would have had me in syncope for HOURS on end had he not given me the IV antihistamines.  His listening as to how I had to be treated had me well enough to leave the hospital after only 2 hours!  Yahoo!!!


What was the trigger??   THE LIDOCAINE!!!!!


Sasha, stress is a MAJOR TRIGGER for us.   That means physical stress as well as emotional stress.   Some of us are more sensitive than others.  You've got to learn your body, do you react easily to anxiety and medical procedures?  Do you have severe reactions easily?  These are clues as to how reactive you are.   If you do, then you must premedicate prior to doing ANY medical procedures  - endoscopies, biopsies, scans, etc.   Any kind of procedure which might create extra vibrations like a CT without contrast, (contrast exams must always use pre-medication) or any kind of invasive activity.  In pre-medicating, the psychological and physical stress will not cause you to react while on the table.  

I was very honestly taken by surprise by this reaction and I have NO DOUBTS it was to the lidocaine.   I spoke with Dr. Escribano afterwards and we have no doubt that this was what was the trigger.   The timing has a lot to do with it.  There is very little anesthesia used in a skin biopsy.  Had this been caused by anxiety, the reaction would have come on much more quickly.  It takes time for the anesthetic to become systemic being that it's local, even though this is generally considered a "safe" anesthetic for us.   Some of us have been known to react anyway.  

However, had I been pre-medicated, none of this would have happened!  These protocols were used for a 9 hour major surgery and absolutely NO reacting ocurred during it.  So, I although I know it was the lidocaine, I have no doubts whatsoever as to the efficacy in those protocols of pre-medication!!!


Sasha, as long as you pre-medicate properly, as according to the REMA protocols, you will be safe.  

I hope this helps!


Lisa

Thank you everyone!  I started to wonder, after I came home, if I didn't have a reaction but an overdose of lidocaine.  I spoke with my allergy dr. and she thinks it is possible.  Given my weight and the amount given - they apparently gave me double the dosage that a person of my (low) weight should have gotten ... plus my symptoms.  I had dizziness followed by loss of sensation in my throat and my tongue and then a strange taste that tasted like strong bitter medicine.