Dr. Bicer Saved My Life | Aborted Transplant | Why a High Degree of Doctor Involvement is Extremely Important

[Rawkerboi]

Eugenix always does a small test of local anesthesia before the procedure. Now i realized why it's so important. 

 

[JoeD]

13 hours ago, Stines said:

 

 

 

Well this thread is taking a turn. From the symptoms you guys posted (and what I was able to gather from my own research), I agree with you all that my reaction seemed to be much closer to what we'd expect from lidocaine toxicity rather than anaphylaxis. I am still concerned why Dr. Bicer did not mention lidocaine toxicity at all to me; she only described my reaction as "anaphylaxis" and an "allergic reaction." I will reach out to her soon to see what she has to say.

@JoeD you mentioned earlier that lidocaine toxicity is caused by the technician inadvertently injecting lidocaine into a blood vessel or artery. Can lidocaine toxicity be caused by anything other than technician error? If not I will have to demand my deposit back from the clinic.

 

Edited December 26, 2023 by JoeD
Agree with Melvin, I decided to delete

[shiba1985]

We are all just playing arm chair quarterbacks here. No one was with you so we dont know. It would be very very rare for lidocaine toxicity to come at the start of surgery. Usually it happens more closer to the end. Unless someone made an error.  LIdocaine toxicity and injecting lidocaine into a blood vessel is not the same. The later happens frequently in small doses and clears up on its own. 

There is a reason in USA and Europe a technician is not allowed to do anesthesia and only a physician can. 

 

Having said that whether toxicity or allergic reaction, has to be determined by the physician on site. So all our opinions dont matter. 

[diegoyrenny]

Is there any other type of numbing medication available?

[Melvin- Admin]

Unless the posters here are medical professionals that were present, id be very careful listening to second hand medical advice from anonymous users on a forum. 

Let’s please refrain from providing medical advice here. It’s not what this community does, if you have specific questions concerning your condition. My advice is to speak with a medical doctor in your area, not a hair loss forum.

[Stines]

Hey everyone. Dr. Bicer has reached out to me and told me she will be making a detailed post soon. Hopefully that clears things up. Thanks.

[Dr. Ozlem Bicer Clinic]

As Dr. Özlem Biçer, who followed and managed the patient throughout the whole process, I will try to explain both the process and the differences between anaphylactoid reaction, which is a type of acute severe allergic reaction, and intoxication in a language that non-doctors can understand. In both cases, some symptoms are common, some are different, and therefore doctors have to make a diagnosis with some differential diagnosis and indication criteria.  
 
The correct diagnosis is lifesaving not only during acute treatment but also in the long term, as it has to be taken into account in the medical treatments that the patient will receive throughout his/her life.
Patient who has been diagnosed with Jetocaine anaphylaxis should never, ever be injected with Jetocaine for the second time, because if the patient is given Jetocaine for the second time, the possibility of repetition of anaphylaxis reaction is very high.

But if you misdiagnose a patient with Jetocaine anaphylaxis and say that this is a Jetocaine intoxication, you bring up the possibility of giving this patient a second chance of anesthesia, in which case the patient's life is in danger with the risk of an anaphylactic reaction that may develop in the patient. This is my reason for sharing this post as a doctor. 

(The diagnose of this patient is an anaphylactoid reaction, which is a type of rapidly developing severge Type 1 allergic reaction. Because of this diagnose, this patient cannot be given Jetocaine anymore. 

Jetocain intoxication is a discussion self-displayed by over dosage or intraarterial administration, or by involvement of the central nervous system and cardiovascular system due to perfusion.

1. Although numbness around the mouth is the most well-known and the first thing that comes to mind in intoxication, it is also seen in anaphylactic reactions. Therefore, not all numbness around the mouth is intoxication.

2. Tremor in the hands and feet is a sign of allergic reaction, it is not a sign of central nerve system involvement, it is not epileptic seizure, it is not considered as an intoxication attack.  Central nervous system is not involved in this patient. So, it is not considered as intoxication.

3. Hypotensive and hypertensive episodes may occur in anaphylaxis, but bradycardia (i.e. low heart rate) is essential in intoxication. Bradycardia accompanies hypotension in the differential diagnosis.  There is no cardiac involvement in this patient. No bradycardia treatment has been used in any way. i.e. the cardiac system is not involved. i.e. intoxication is not considered.

4. Skin rash is very common in anaphylaxis. Allergic skin lesions are not expected in intoxication.  

5. This case was brought under control very quickly by applying allergic and anaphylaxis protocol. In case of intoxication, anti-allergy treatment would not have worked, the process would have been uncontrolled, and the progress would have dramatically deteriorated to respiratory arrest.

6. Anaphylaxis is a dose-independent process. Intoxication is a dose-dependent process.
The amount of anesthesia used in this patient is half of the daily dose limit that the patient can receive, even after taking into account the patient's weight (on average over 70kg). There was no overdose in this patient.  The reaction started before hairline anesthesia was administered. So even the total planned daily dose was not used. So, there is no overdose and intoxication are unthinkable.

In the specific case of this patient, needle-free anesthesia was administered by a licensed anesthesia technician. Needle-free anesthesia works on the principle of delivering anesthesia into the skin through pressure, without a needle. Due to the settings of the device, the amount given and the level at which it is given intradermal. There is no artery and vein in this level. 

For the intoxication, deep plan injection is required to enter the artery and vein network. It is not possible for this device to inject drugs at this depth. In addition, due to the settings of the device, each pulse dose is not enough to cause intoxication. All nurses and anesthesia technicians working in our clinic are postgraduate graduates. And all of them have intensive care experience. They are fully authorized and professional in the technique of administering an injection.  

7. If it was intoxication, the patient would have had to be followed up for at least 24 hours at the university hospital, drug absorption would have been rapidly decreased with IV lipophilic solution and a completely different treatment protocol would have been defined. Our patient's condition was not accepted as intoxication in all examinations performed at the university hospital (blood gas, liver enzymes and all intoxication tests), it was accepted as a rapidly developing type 1 allergic reaction (anaphylactoid reaction, considering that all anti-allergic interventions were correct and appropriate, and the patient's symptoms passed very quickly, the process was evaluated as anaphylactoid reaction and our full report was approved. In addition, the reason for transporting the patient by ambulance was to ensure that the patient was safer in intensive care conditions in case of angioedema due to anaphylaxis, and the university hospital confirmed that all the treatment performed in our clinic was correct and satisfactory.

8. ANAPHYLAXIS IS DOSE INDEPENDENT. The anaphylactic reaction may also occur at the test dose. Allergy testing is not performed to eliminate the risk of anaphylaxis. Allergy testing is a test performed on patients with multiple drug allergies in order to select the appropriate drug. It should be performed in immunology clinics. There is no such concept as prophylactic Jetocain allergy test in hair transplantation.   So, the answer to the question of whether it could have been prevented if the test had been done: NO.  There is no chance to prevent the patient from any anaphylaxis with allergy tests. If the test was done, anaphylactic shock would have occurred during the test also.

ANAPHYLAXIS AGAINST ANY DRUG CAN COME TO EVERY PATIENT, EVERY DOCTOR (WITH OR WITHOUT TESTING)
Anaphylaxis is therefore a manageable process, not a preventable one.   

Although there are many more differential diagnosis criteria that can be written, I think this is enlightening enough.
As a 26-year physician and 33-year member of the medical community, I am experienced enough to distinguish between anaphylactic reaction and intoxication. I and my entire team are technologically and scientifically equipped for all kinds of emergencies that may occur before and after the hair transplant procedure. The fact that the patient was diagnosed very quickly, and the process was managed correctly is the biggest proof of this.

Hair Restoration Network is one of the most reliable and ethical forums that I respect the most. What they do to inform patients correctly is admirable. I am eternally grateful to Melvin and all members for this.  As always, I respect everyone's support, criticism and comments on the forum.
However, we would like to emphasize that while even no doctor can diagnose the patient without knowing the patient's clinic, without seeing the process, without evaluating the vital signs, without examining the patient in all details, misleading the patient with shortcut research from Google can cost the patient's life. I invite all members to sensitivity in this regard,

If anyone has more questions, they can forward to Mrs. Ozen and contact to  me directly.
 
Best Regards,
Ozlem Bicer, MD

Edited December 29, 2023 by Dr. Ozlem Bicer Clinic

[BobbyBoucher]

Wow that is interesting reading.

Dr Bicer from my own experience has a great team and the original post seems to tell the story of procedures and knowledge in place to deal with such situations.  I wonder if the knowledge exists in cheap hair mills?

Glad You are ok after all this @Stines.

I was going the SMP route and booked with Jay at Elixir SMP just outside London, before I had really bad reaction to head shaving and later booked to go to Dr Bicer. Elixer is one of the best around in many peoples eyes.

 

Edited December 27, 2023 by BobbyBoucher

[Stines]

On 12/27/2023 at 2:54 PM, Dr. Ozlem Bicer Clinic said:

As Dr. Özlem Biçer, who followed and managed the patient throughout the whole process, I will try to explain both the process and the differences between anaphylactoid reaction, which is a type of acute severe allergic reaction, and intoxication in a language that non-doctors can understand. In both cases, some symptoms are common, some are different, and therefore doctors have to make a diagnosis with some differential diagnosis and indication criteria.  
 
The correct diagnosis is lifesaving not only during acute treatment but also in the long term, as it has to be taken into account in the medical treatments that the patient will receive throughout his/her life.
Patient who has been diagnosed with Jetocaine anaphylaxis should never, ever be injected with Jetocaine for the second time, because if the patient is given Jetocaine for the second time, the possibility of repetition of anaphylaxis reaction is very high.

But if you misdiagnose a patient with Jetocaine anaphylaxis and say that this is a Jetocaine intoxication, you bring up the possibility of giving this patient a second chance of anesthesia, in which case the patient's life is in danger with the risk of an anaphylactic reaction that may develop in the patient. This is my reason for sharing this post as a doctor. 

(The diagnose of this patient is an anaphylactoid reaction, which is a type of rapidly developing severge Type 1 allergic reaction. Because of this diagnose, this patient cannot be given Jetocaine anymore. 

Jetocain intoxication is a discussion self-displayed by over dosage or intraarterial administration, or by involvement of the central nervous system and cardiovascular system due to perfusion.

1. Although numbness around the mouth is the most well-known and the first thing that comes to mind in intoxication, it is also seen in anaphylactic reactions. Therefore, not all numbness around the mouth is intoxication.

2. Tremor in the hands and feet is a sign of allergic reaction, it is not a sign of central nerve system involvement, it is not epileptic seizure, it is not considered as an intoxication attack.  Central nervous system is not involved in this patient. So, it is not considered as intoxication.

3. Hypotensive and hypertensive episodes may occur in anaphylaxis, but bradycardia (i.e. low heart rate) is essential in intoxication. Bradycardia accompanies hypotension in the differential diagnosis.  There is no cardiac involvement in this patient. No bradycardia treatment has been used in any way. i.e. the cardiac system is not involved. i.e. intoxication is not considered.

4. Skin rash is very common in anaphylaxis. Allergic skin lesions are not expected in intoxication.  

5. This case was brought under control very quickly by applying allergic and anaphylaxis protocol. In case of intoxication, anti-allergy treatment would not have worked, the process would have been uncontrolled, and the progress would have dramatically deteriorated to respiratory arrest.

6. Anaphylaxis is a dose-independent process. Intoxication is a dose-dependent process.
The amount of anesthesia used in this patient is half of the daily dose limit that the patient can receive, even after taking into account the patient's weight (on average over 70kg). There was no overdose in this patient.  The reaction started before hairline anesthesia was administered. So even the total planned daily dose was not used. So, there is no overdose and intoxication are unthinkable.

In the specific case of this patient, needle-free anesthesia was administered by a licensed anesthesia technician. Needle-free anesthesia works on the principle of delivering anesthesia into the skin through pressure, without a needle. Due to the settings of the device, the amount given and the level at which it is given intradermal. There is no artery and vein in this level. 

For the intoxication, deep plan injection is required to enter the artery and vein network. It is not possible for this device to inject drugs at this depth. In addition, due to the settings of the device, each pulse dose is not enough to cause intoxication. All nurses and anesthesia technicians working in our clinic are postgraduate graduates. And all of them have intensive care experience. They are fully authorized and professional in the technique of administering an injection.  

7. If it was intoxication, the patient would have had to be followed up for at least 24 hours at the university hospital, drug absorption would have been rapidly decreased with IV lipophilic solution and a completely different treatment protocol would have been defined. Our patient's condition was not accepted as intoxication in all examinations performed at the university hospital (blood gas, liver enzymes and all intoxication tests), it was accepted as a rapidly developing type 1 allergic reaction (anaphylactoid reaction, considering that all anti-allergic interventions were correct and appropriate, and the patient's symptoms passed very quickly, the process was evaluated as anaphylactoid reaction and our full report was approved. In addition, the reason for transporting the patient by ambulance was to ensure that the patient was safer in intensive care conditions in case of angioedema due to anaphylaxis, and the university hospital confirmed that all the treatment performed in our clinic was correct and satisfactory.

8. ANAPHYLAXIS IS DOSE INDEPENDENT. The anaphylactic reaction may also occur at the test dose. Allergy testing is not performed to eliminate the risk of anaphylaxis. Allergy testing is a test performed on patients with multiple drug allergies in order to select the appropriate drug. It should be performed in immunology clinics. There is no such concept as prophylactic Jetocain allergy test in hair transplantation.   So, the answer to the question of whether it could have been prevented if the test had been done: NO.  There is no chance to prevent the patient from any anaphylaxis with allergy tests. If the test was done, anaphylactic shock would have occurred during the test also.

ANAPHYLAXIS AGAINST ANY DRUG CAN COME TO EVERY PATIENT, EVERY DOCTOR (WITH OR WITHOUT TESTING)
Anaphylaxis is therefore a manageable process, not a preventable one.   

Although there are many more differential diagnosis criteria that can be written, I think this is enlightening enough.
As a 26-year physician and 33-year member of the medical community, I am experienced enough to distinguish between anaphylactic reaction and intoxication. I and my entire team are technologically and scientifically equipped for all kinds of emergencies that may occur before and after the hair transplant procedure. The fact that the patient was diagnosed very quickly, and the process was managed correctly is the biggest proof of this.

Hair Restoration Network is one of the most reliable and ethical forums that I respect the most. What they do to inform patients correctly is admirable. I am eternally grateful to Melvin and all members for this.  As always, I respect everyone's support, criticism and comments on the forum.
However, we would like to emphasize that while even no doctor can diagnose the patient without knowing the patient's clinic, without seeing the process, without evaluating the vital signs, without examining the patient in all details, misleading the patient with shortcut research from Google can cost the patient's life. I invite all members to sensitivity in this regard,

If anyone has more questions, they can forward to Mrs. Ozen and contact to  me directly.
 
Best Regards,
Ozlem Bicer, MD

Thank you for the post Doctor. It was very informative and cleared up my concerns.

[Gatsby]

I wouldn't expect anything less from Dr Bicer's professionalism.