Richard has to add diagnosis as another factor to this theoretica study
protocol :)
anecdotally, i have experience exponentially lower vasovagal responses
since leaving the world of retina.
hearing a dx of wet amd vs. cancer tends to put people in slightly
different mindsets when it comes to invasive testing.
Akorn only lists that "Rare cases of death due to anaphylaxis have been
reported."
(was it yanuzzi that reported 1 in 245,000? about 30,000,000 IVFAs ago?)
Akorn also says that reducing a dose from 500 mg to 200 mg "may be
appropriate...when a highly sensitive imaging system...is used."
In terms of actual allergies, i know if i eat one mussel, i may get a bit
of an itchy mouth. If i eat a dozen, my throat closes.
I would hypothesize that exposure levels of an allergen would directly
relate to the severity of the reaction - that is why, say, micro-dosing of
peanuts has been shown to cure peanut allergies in a growing number of
reported studies.
-sandor
On Fri, Mar 10, 2017 at 12:32 PM, Marshall Tyler <marshalletyler@xxxxxxxxx>
wrote:
I always preferred the smaller volume to 25% as there may be some
anecdotal evidence that smaller volumes yield less nausea. Remember the
days of 10cc of 5%? Well,... I do. There seemed to be a large drop of
nausea when I went to the smaller, and smaller volumes. Richard Hackel
proposed a study of the temperature of the dye. Room temp v. body temp. I
was not done since we had such a low nausea rate that it would be very hard
to show a significant difference. Also, protocols were a pain to get
approved and patient consent would slow the clinic flow.
So, fast injections consistent with the ability to have a good, easy,
injection site. P.S., I started with 19gu butterflys but was then, due to
staffing preference, downgraded to 21gu.
Thank you,
*Marshall*
Marshall E Tyler, BS, FOPS, X-CRA
On Fri, Mar 10, 2017 at 10:57 AM, Hector Mendez Caratini <
dmarc-noreply@xxxxxxxxxxxxx> wrote:
Stuart:
Ok. I understand your point about “the highest level testing results”. We
all do.
But, for the record, I have been performing Fluorescein Angiographies for
the past 44 years. That is close to 100,000 FAs during my professional
career. In that period of time, I've had the mishap of beating the odds
(the manufacturer’s published data that comes along the printed literature
that accompanies the pharmaceutical product). That means that two deaths
have occurred during an FA procedure. I am certain that other ophthalmic
photographers have had that happen to them too. Therefore, I would not like
that to happen again to me, nor to anyone else in the profession. That is
why I have implemented those injection rate changes that I would like to
address.
I am aware that death is a subject matter that practically no one would
like to publicly address, due to the risks of the legal implications. But,
Optimal and OPS should be concerned with patient safety first, versus high
quality images. Any one out there willing to express their opinions on this
important matter?
Regards to all.
Hector Mendez Caratini, CRA
On Friday, March 10, 2017 11:10 AM, Hector Mendez Caratini <
dmarc-noreply@xxxxxxxxxxxxx> wrote:
Dear Coy and fellow ophthalmic photographers:
I would like to address a new safety concern topic:
It is not comfortable for the patient to rapidly inject (in less than 2
to 3 seconds) a bolus of 5cc 10% fluorescein dye and have him /or her vomit
on you past the 30 seconds mark. It happens too frequently. More than you
would like it to happen.
With the newer acquisition equipment (and old ones too, such as Topcon
TRC 50’s), which are much more sensitive, I have been using the following
technique.
To reduce the possibilities of adverse reactions (nausea, vomiting,
urticaria, cardiac arrest and even death!), what I have been doing is
injecting half the dose that comes inside the vial (it doesn’t matter if it
is 10% or 25%, light or dark). It has worked very well for me. With
practically NO allergic reactions a year, versus a lot monthly ones. You
still can get an excellent Early Phase and Mid Phase fluorescein transit.
Where you can easily identify the leaking pathology. Sometimes, the Late
Phase (past seven minutes) images look a bit washed out. But, if you’re
taking into consideration patient comfort and safety, it’s very well worth
the dose.
Another positive side to this equation is that you’re reducing the
monetary costs of the study. That is one vial for two patients. It is nice
to obtain high quality exhibition grade images. But, please remember that
patient safety should always be our main concern. Put yourself (or your
dear family member) inside the patient’s shoes.
Hector Mendez Caratini, CRA
Puerto Rico
On Friday, March 10, 2017 9:47 AM, "Egnatz, Thomas" <tegnatz@xxxxxxxxx>
wrote:
I am posting this for Coy. Sorry about the delay, I have been off
Optimal for a month (new computer).
Tom
*From:* Cobb, Coy, VHACIN
*Sent:* Thursday, February 16, 2017 9:22 AM
*To:* 'optimal@xxxxxxxxxxxxx'
*Subject:* 10% vs 25% Fluorescein
Morning all
Would anyone know of any studies comparing 5cc’s of 10%, verses 3
cc’s of 25% fluorescein ?
Specifically, I’m looking for anything that addresses adverse reactions.
Coy Cobb COT CRA
