Epidural steroid injection - severe reactions?

Recently, I almost died from a severe reaction from a routine epidural steroid injection to my lower back (L4-L5). The treatment was on Friday afternoon. The next day, Saturday, I had a sudden and very severe reaction. I could NOT get enough breath. I thought I was dying. I was wracked with pain everywhere, I was shaking all over, and I was sweating profusely. The ambulance medic could not get an I-V going, because my body was swollen.

To make a long story short, I was treated with I-V Benadryl, morphine, and valium. It was the Benadryl that saved me. They did a bunch of other tests, but nothing showed up. Within about 5 hours I was all better and released. It was as if nothing had happened. They told me to take some high doses of over-the-counter Benadryl and that I would be fine. NOT!

On Sunday afternoon, I had another attack. We called "911" again - same set of symptoms; same treatments; same results. This time they admitted me to the hospital. I was there until Tuesday. All tests were negative.

The thing that is bothering me is that the doctor, and others in the group, all told me that it was not possible for this to be a reaction to steroids. Well, I know this is a lie. I have had 3 of these treatments. There was no reaction to the first treatment, but I did have an event with the second treatment. It was again the day-after. That time, my face turned red and hot - very unpleasant. I went to the doctor's office on my way home from work. The doctor's nurse looked at me and said, "You are having a reaction." She went on to say that it happens to some people, and that I should just take some Benadryl. I was never as bad as I was with the third treatment. That one cost me 2 trips by ambulance and 2 days in the hospital.

It bothers me that the doctors lied to me. They are obviously afraid of something. So, I am trying to find other people that had similar experiences.

Have you heard of this kind of thing happening before?

Thank you,

Chuck

Chuck - certainly THANKFUL that you are here posting, and picking my jaw off the floor!

We found out my wife and son were allergic to sulpha based meds and luckily found out before it escalated to the extent of your reaction.

My Grandfather had a shop injury (sawed his thumb off) and when they used the "gas" on him - he went into malignant hyperthermia shock caused by the gas (I think that's what it's called - can be passed down to successive generations and my boys and I have not been tested). He died from that.

Hope you get some further details to address this. Sorry I don't have any information to contribute, but again...GLAD you are here with us!!

Glad your ok, sounds like you've had a rough time over the past few months.

Not sure if this is any help:

Epidural cortisone injections are very safe and usually have no side effects. There are however certain potential risks about which you should be familiar. Some patients experience a mild ache in their back several hours after the procedure when the local anesthetic has worn off. This usually resolves rapidly and can be treated with an ice pack for 15 - 20 minutes and/or Tylenol. Allergic reaction to either cortisone, contrast agent ( iodine), or local anesthetic (xylocaine) is very rare. If you think you may be allergic to any of these medications you must notify you doctor. The most common side effect following the injection is a small drop in your blood pressure if you sit up too soon after the injection. This passes in a few minutes. Less common side effects include transient headache, nausea, facial flushing, insomnia and low grade fever.

Complication from placement of the needle are rare. A small leak of spinal fluid can occur as the needle is placed into the epidural space. Usually the leak stops spontaneously and does not cause any problems. It can on occasion cause a headache which worsens when you sit up. Most often this can be treated at home with bed rest and fluids. On rare occasions more prolonged rest in the hospital or a procedure to stop the fluid leak is needed. Infection, bleeding and nerve damage have been reported but are very, very, rare.

Epidural cortisone injection should not be performed if you have active infection at the site of injection, a bleeding disorder, or uncontrolled diabetes or congestive heart failure.

From this web page


Wishing you good health for the future /ubbthreads/images/graemlins/smile.gif

Sigman:
Thank you for your concern. I lost a friend to sulpha allergy. Some people don't get a second chance. I am so glad that you were able to catch things before they got out of hand for your wife and son. I guess the "gas" you were speaking of was the old-time "ether" that they used to use.

xray:
Thanks for finding that article for me. I have found other articles similar to that too. You know, the doctor said something like, "Well, we would write a paper about your case, but it is too rare, and it is impossible." Then, they went on to imply that I was just too nervous. In other words, if something like this happens to a patient, no one will ever hear about it, because it can't happen. Geez! /ubbthreads/images/graemlins/jpshakehead.gif Why don't doctors "listen" to their patients?

I am going to get pi$$ed again. /ubbthreads/images/graemlins/mad.gif

Chuck

It is actually very unlikely that the reaction was due to steroids. They are potent ANTI-INFLAMATORY drugs, and allergic reactions to steroids are almost unheard of. HOwever such reactions are often seen as a result of allergies to preservatives and solubilizing agents in the solution, or in some cases latex used either in the syringer, or the 'plug' in the vial.

As a result, may drugs intended for use in and around the spine are now preservative free, which means single vial use.

MHT is an anesthesiologists nightmare, and in general suceptability is genetic. Prior to development of Dantrolene in 1979 MHT was probably 99.9% fatal. Even today, survival depends upon early recognition, and extremely agressive treatment. When recognized and treated appropriately, deaths from MHT are rare.

When in doubt, or if there is a family history, anesthesiologists will stay well clear of agents thought likely to trigger MHT, and use dantrolene prophalaxis.

The first doctor I went to was almost casual about the injections. I'm on several blood treatment drugs due to clogged arteries. The doc but said if my other doctors said it was OK, he'd do the injections. My neurologist said it was OK if I could stay on only one of the meds.

I sought a second opinion, and was told by the second guy that an epidural was really bad news if you have any drugs that enhance bleeding. It can cause un-noticed bleeding into the spinal column and paralysis. I verified that was true online.

OH.

I'm still awaiting treatment.

I'm glad you are OK and hope it gets better. If you have established an alergy you need to make sure it's listed on your records.

Daniel

Lightchucker, glad you're o.k.
I've had the injections in two seperate courses of three (two different pile-ups). I found the skill of anesthesiologist who does the work is a big part. One was kind of rough, the other older guy was very good and made all the difference. One did it while I was sitting up, lights nearly went out that time. After one injection I got the killer headache. Apparently you can get something for that (unknown to me at the time). I have penicillin and sulfa alergies and wear dog tags stating that (my last set from from dog tags online, good service, cheap insurance).

get better soon chuck .i wish i knew more what to say and had advice on the injections

Any medical info you get from me is third hand, but nobody I know has ever heard of an even remotely severe reaction to steroids like that.

I'm interested in what matheww50 had to say about allergic reaction to some other component of the drug, or latex or something like that. Can they find out brand names of the drug you got the first time when it didn't do anything bad vs the last 2 when it started? Did they switch to a new kind of LP kit?

While it's entirely possible that you're the first case that any doc at that hospital or anywhere has seen with that kind of reaction, it's much more likely that you're reacting severely to something known to cause it that they just aren't thinking of. So be sure to spread your detective work beyond trying to find what the docs are hiding from you to what they did to you and what they did it with as well /ubbthreads/images/graemlins/wink.gif

Nothing to add medically, but I'm glad you're OK Chuck.

Ditto here, Chuck, but I'm sure glad that you came through it ok! Phew! /ubbthreads/images/graemlins/mpr.gif

And the attitude of the medical folks seems worrying. If they're trying to either dismiss you or brush it off, something's not right. Thankfully I didn't have to go through a life threatening situation to learn that, but it's still not a good sign.

Can't offer any advice (my 'patients' are electronic in nature, not living) but I can offer you my best wishes and hopes that you will get better as soon as possible. Now would be good, yesterday would be even better /ubbthreads/images/graemlins/grin.gif

I, too, have been going through this treatment now for a number of years. I've never experienced a reaction such as yours. I suspect that what you had was not JUST a steroid injection. I know that what I'm being given is referred to as a "steroid injection", but the doctor who performed it said it is more of a "cocktail". In other words, they used Lidocain, novacain, the steroid and an anti-inflamatory agent. My suspicion is that if you actually had the "cocktail" you may have reacted to one of the other additives. Good luck..I hope you can resolve this.

Like Matthew, my suspicion is (barring any other medical issue) that you may have had a reaction to a carrier or diluent.
It could be that something was contaminated--a frightening thought. The MD's might consider checking the serial/mfg numbers, if possible, for bulletins/problems/recalls.

True "reactions" to these injections are incredibly rare. We usually see "sensitivity" rather than a true "reaction". Sensitivities are much less severe, and easy to manage.

The primary concerns with epidural injections are infection, spinal leak, spinal injection (you do NOT want those meds going spinal) and nerve ablation/damage. A true spinal injection can have severe effects--but I doubt this happened to you, because you should have had an immediate response.

Anyway, glad you are OK!

Bob

[ QUOTE ]
gadget_lover said:
The first doctor I went to was almost casual about the injections. I'm on several blood treatment drugs due to clogged arteries. The doc but said if my other doctors said it was OK, he'd do the injections. My neurologist said it was OK if I could stay on only one of the meds.

I sought a second opinion, and was told by the second guy that an epidural was really bad news if you have any drugs that enhance bleeding. It can cause un-noticed bleeding into the spinal column and paralysis. I verified that was true online.

OH.

I'm still awaiting treatment.

I'm glad you are OK and hope it gets better. If you have established an alergy you need to make sure it's listed on your records.

Daniel

[/ QUOTE ]

YIKES! I had to respond to this one.
I make my living managing epidurals, intrathecals, intrapleurals and a bunch of other neuraxial pain control techniques. I also train pain fellows in these techniques.

Epidural placement/injection is a NO GO with an anticoagulated (or any coagulopathy!) patient. Some of the anticoagulants reverse easily to allow the techniques, but some (Plavix for example) reverse very slowly, and/or are difficult to measure. There is an increased risk of epidural hematoma, which could infarct the cord resulting in paralysis.
I won't go into all the details, but there are specific guidelines from ASRA.

DO NOT allow a "fly by night" doc to stick needles into you unless you are positive they know what they are doing. An anesthesiologist/MD that has served a pain rotation is the minimum. Someone that has completed a fellowship is even better. ASRA guidelines should be followed!

Oops...sorry for the rant, but it frightens me to know that there are some docs that practice having minimal knowledge.

Bob

I have had back injuries from my chosen line of work(truck mechanic) and was being treated for a supposed ruptured disc. The pain management Dr. gave me an epidural inj without informing me of the makeup. (I am a diabetic) and started having vision problems before getting home from the Drs office. My medical records showed I was diabetic but apparently the Drs failed to actually read the rather important notation. Even diabetes that is well controlled can be seriously compromised by steroidal injections. Now I demand to know the contents of any meds I am given, before application.

I am also diabetic and have had 3 series of ESI shots (9 total) and now one of Facet Medial shots. Thankfully no adverse reactions to them. However, I have had 3 allergic reactions to something I ate (don't know what) and went to the ER after the second attack. The attending doctor also mentioned that I could take benadry but it would not take effect immediately. I now carry and have used an Epi-pen plus a Glucagon kit.

Bob, the rant's perfectly fine, especially if it helps someone.

I'm lucky in that I can manage to avoid any major pain through the simple trick of not sitting down much. I'm further lucky that I'm not working at the moment, so I can lay down when I need to and don't have to drive anywhere. The MRI shows a definite bulging disk (6mm).

Interestingly, the second doctor said that a microdiscectomy would be safer than the ESI in my case, since he would be able to see and stop any bleeders. That makes sense to me. I'm still not anxious.

You know you are getting old when your daily meds include a combination of asprin, plavix, mobic and aggrenox. You know you have the wrong doctor if he doesn't question that combination. /ubbthreads/images/graemlins/smile.gif I've since dropped the mobic.

Thanks for kicking it there, Bob.

Daniel

pedalinbob:

You obviously know something about this. I tried to be as brief as possible in my description (hate to bore people).

I do take Warfarin (Coumadin) because of blood clots that can form due to atrial fibrillation. Depending on the doctor and the procedure I am going to have, I stop taking the Warfarin for 3-5 days (5 days for this doctor), but then I take Lovenox injections until the day before the procedure. The day before I had this epidural, I had an INR of 1.0, which is supposed to be normal.

It is apparent to me that these reactions are directly related to the epidural in some way. I never accused this guy of doing anything wrong. He just seemed to be trying to get me to think it was all in my head...yeh, right, and his brain is up his @@s. (Sorry, but it really makes me angry to think he was trying to get me to doubt my own sanity.) He should have been saying things like you said. "Well maybe we have something wrong with the juice we are using." Don't blame the patient!

It angers me that I cannot risk having this treatment again. I am pretty sure that I would die this time. After all, the second treatment gave me a flushed, burning (red) face and body. The third treatment almost killed me and cost me 2 ambulance rides, 2 days in E/R, and 2 more days in the hospital. It doesn't take a board certified genius to figure that it would be ill-advised to give it another go.

What should I ask this doctor?

What should I listen for?

Thanks so much to everyone for your help and concern!

Chuck

[ QUOTE ]
What should I ask this doctor?

[/ QUOTE ]

A recommendation for someone to get a second opinion from. Given his lack of any brain storms explaining, or even any ideas on whats causing the problem. You need to talk to another doc. He should be happy to recommend someone locally to you and that person should be happy to review your info and see if they can point you towards any other info.

Good Luck Chuck!