Aspies and Surgery

[Jean in Newcastle]

Ds is having all 4 wisdom teeth out on Friday.  Anything I should know specific to ASD?  When he was little he was hyper-sensitive to any pain.  But now sometimes he seems the other way.  I don't even know what to ask. 

[Innisfree]

I know the sensory stuff is all highly variable. Dd has had all kinds of dental work done, including teeth out, without having any particular trouble. If anything, she seems unusually tolerant of procedures that they expect will be difficult. She is generally a sensory seeker.

 

I do remember when she was coming out from under anesthesia as a very small child she had a really awful time: screaming and thrashing around for ages. But I don't remember (if I ever knew) what anesthesia she had had, and more recently it hasn't been an issue.

 

Not sure if any of that helps you at all.

 

I generally try to make sure dd knows what will be happening a day or so ahead of time, but not long enough for her to work herself into major anxiety. A weekend of brooding does us no favors. YMMV. Hope it goes well!

[kbutton]

I have a harder time dealing with oral pain than other types of pain (wisdom teeth = awful; childbirth = no big deal). I'm not on the spectrum, but that may explain the sensitive as a kid, less so now--it could be very situation specific.

 

DH (who is the medical field) says that educating him respectfully on what to expect about the procedure is helpful (up to the point you think he can handle--as the PP said, not in a way that he'll be able to stew and stew). Then you are not dependent on doctor's office personnel being sensitive to his needs, particularly if he doesn't want to disclose his diagnosis. I don't know that he'd need to know the nitty gritty of what will happen while he's unaware (not sure how much sedation they do now), but knowing he'll wake up with packing in his mouth, he might have bloody saliva, whether he needs IV meds or not would be things my kiddo would want to know ahead. I would also need to go mama bear if a nurse isn't giving him a minute to psych himself up before doing something to him. Neither of my kids will get a shot at our doctor's office anymore because a nurse basically just jabbed them the minute she had the needle. By contrast, the local doctor in the box nurses will give them a minute to take a deep breath and stick out their arm when they are ready.

 

I know they do things differently than when I got mine out--I was out all the way for four impacted teeth, but I didn't have the meds that make you loopy on the front end or the back end. I would want to know if kids with autism sometimes metabolize those differently. There are anxiety meds out there just for this sort of thing, and some practices use them more liberally than others. 

 

Good luck!

[prairiewindmomma]

Our biggest struggle was coordinating the biting down on gauze to control bleeding after the surgery. His lack of body awareness was even greater post-anesthesia. Plan on lining his pillow with a towel and wearing an older t-shirt, iykwim.

 

We had talked through the procedure specifics the morning of. The oral Ativan before they placed the iV with the twilight mess helped. He honestly has almost no recollection of the event. Getting his toenail partially removed this summer has been a way more traumatic event.

[Lawyer&Mom]

It was really difficult and disorienting for me to come out of the old general anesthesia for oral surgery. I tend to be really sensitive to medication. The new twilight drugs? No problem.

[Pawz4me]

DS18 had his out last summer and did absolutely fantastic. But he's always been hypo-sensitive to pain. The gauze was the worst part, as he's always had sensory issues with certain things in his mouth and was diagnosed with oral/verbal apraxia as a child. It took him about twenty minutes after we left the dentist's office to become fully aware (he was talking/acting fine but later on told me he didn't remember anything until about that point). Being the rule follower type he followed the dentist's directions regarding pain control, rinsing with salt water, etc. to the letter. And I think that really helped his recovery. Don't forget the milkshake on the way home. :)

 

Crossing my fingers it goes well!

[wapiti]

I can't remember, have you done 23andme (and then run the data through genetic genie)?  Sorry if I'm remembering wrong; I though perhaps you have.  This probably isn't what you were asking LOL, but here's my two cents anyway:  if he has a MTHFR polymorphism, consider avoiding nitrous oxide (NO, laughing gas).  It is still controversial, but NO might result in an unacceptable rise in homocysteine (which is bad for reasons I can't even remember).  Post-surgical options for pain:  I like ibuprofen, if allowed, but for some surgeries, it is too much of a bleeding risk for some period of time (one or more days).  If he has polymorphisms related to the liver (detox) such as CYP2D6, etc., I would consider adding something to help clear anesthesia/oxycodone/tylenol (like broccomax or NAC or milk thistle).

[Jean in Newcastle]

I can't remember, have you done 23andme (and then run the data through genetic genie)? Sorry if I'm remembering wrong; I though perhaps you have. This probably isn't what you were asking LOL, but here's my two cents anyway: if he has a MTHFR polymorphism, consider avoiding nitrous oxide (NO, laughing gas). It is still controversial, but NO might result in an unacceptable rise in homocysteine (which is bad for reasons I can't even remember). Post-surgical options for pain: I like ibuprofen, if allowed, but for some surgeries, it is too much of a bleeding risk for some period of time (one or more days). If he has polymorphisms related to the liver (detox) such as CYP2D6, etc., I would consider adding something to help clear anesthesia/oxycodone/tylenol (like broccomax or NAC or milk thistle).

No. We haven't done 23andMe. But they aren't planning to do nitrous oxide anyway. That's interesting though because I had a bad reaction to nitrous many years ago.

[Renai]

Don't forget the milkshake on the way home!

But don't drink it through a straw!

[Heathermomster]

Good luck with the procedure!

Edited June 29, 2017 by Heathermomster

[Guest]

Good luck! Hope all goes smoothly!

[Jean in Newcastle]

Thanks, everyone.  He came through surgery just fine.  He was a bit nervous beforehand and was pacing the waiting room but since I was the only one in there, it wasn't an issue.  Afterwards he was dopey but compliant.  He's had moderate pain and the pain meds are working just fine for him.  The toughest thing for him was keeping gauze in his mouth for the first six hours.  It was a sensory thing and bothered him a lot but he managed to do it.  He slept ten hours last night (after a 4 hour pain med) and while he was sore and in a bit more pain when he woke up, it didn't seem too bad.  He's distracting himself on the computer.  The next hurdle will be tomorrow when he has to start stretching his jaw and getting back to normal foods. 

[Guest]

It sounds like he has gotten through it really well to this point! Looks like you have done a great job supporting him and teaching him perseverance :) Kudos to both of you!

Edited July 1, 2017 by Guest

[prairiewindmomma]

Yay!!!