Surgery

If the need for surgery or diagnostic procedure is not urgent, Marshall Protocol (MP) patients should request that it be postponed until more inflammation is resolved. MP patients who are to receive a local injected anesthetic, such as is given for dental procedures, should request that it not contain any epinephrine (also known as adrenaline). MP patients should also avoid having nitrous oxide used as a sedative.

If the need for surgery or diagnostic procedure is not urgent, Marshall Protocol (MP) patients should request that it be postponed until more inflammation is resolved. Some Th1 patients do not recover easily from surgery because their compromised immune systems hamper recovery. Also, the presence of high levels of angiotensin in Th1 inflammatory disease can cause poor wound healing. Keep in mind that surgeons tend to focus on the procedure more than the recovery process.

MP patients who must receive a non-MP antibiotic before, during or after surgery or a diagnostic procedure should discontinue all MP antibiotics and Benicar.

Continuing MP medications along with most other antibiotics administered in conjunction with surgery may result in a strong immune system reaction. MP patients may not want to combine the suffering after a procedure with immunopathology.

It is preferable to consult with hospital staff and negotiate use of compatible ABx if at all possible in order to improve surgical outcome. Continuing Olmesartan reduces surgical risk

So if a patient must take an antibiotic, Ceftin, Biaxin or fluoroquinolones are recommended, as they minimize the possibility of unstable immunopathology. Use of these does not preclude an MP patient from continuing with olmesartan.

MP patients who do not discontinue MP medications before surgery should use their knowledge of what adjustment of MP medications works for them to dampen immune system reactions prior to, and during recovery from the procedure.

After my recent presentation in Perth (Western Australia), an anesthetist commented to me that he had been having trouble with patients who were taking ARBs for blood pressure. You see, when he gives them the IV antibiotics prior to the surgery (as a precaution against infection) it seems some of them get quite ill.

If you are going to keep taking Benicar, I think you need to have a talk with the surgeon and anesthetist and make sure there are no surprises.

Trevor Marshall, PhD

MP patients undergoing surgery who need a general anesthetic or sedating medication via IV, should inform the anesthesiologist of the MP medications that they are taking. There are no known contraindications to continuing MP medications because of the need for general anesthesia or sedating medication.

MP patients who are to receive a local injected anesthetic, such as is given for dental procedures, should request that it not contain any epinephrine (also known as adrenaline).

MP patients should avoid having nitrous oxide used as a sedative.

I might tend to avoid nitrous oxide as an induction. It seemed to disagree with me many years ago and has been reported to be problematic for some folks with CFS. It is important to talk with your anesthetist or anesthesiologist about your concerns and inform them you may need a lower than normal dose and that you may take longer to come up. Depending on the specific type of procedure being done, a spinal or epidural may be a possibility with a propofol or similar drip to keep you sedated. I don't know so much about immune effects of nitrous oxide, but I would relate to it in terms of speed of recovery and the rate of detoxification and elimination of the medications used.

P. Bear