Overlooked Risks (part 3 of 3): Anesthesia & Fluoroquinolone Antibiotic Toxicity:

It's totally understandable that people with FQAD (Fluoroquinolone Associated Disability) are hesitant about taking more medications, especially when it comes to anesthesia. Research has shown that fluoroquinolone antibiotics can interfere with mitochondrial function, which is very concerning since mitochondria are the powerhouse of your cells and play a huge role in overall systemic health.

Most anesthesia guidelines for mitochondrial safety are specified for primary mitochondrial disease (PMD) - a genetic condition, though they might be helpful for those dealing with FQAD.  The three types of anesthesia are general, local and regional, and due to the amount of information, the following information is geared just toward major surgeries requiring general anesthesia.

What to Know:

For individuals with mitochondrial issues, anesthesia isn’t always straightforward, and here’s why:

> Heightened drug sensitivity may prolong sedation or muscle weakness because the body struggles to metabolize anesthetic drugs efficiently. 

> Anesthesia can push an already struggling energy system into overdrive, sometimes leading to the inability to clear lactic acid properly, which can be made worse by supporting medication used during surgery. 

> Certain muscle relaxants sometimes used, such as succinylcholine, may cause extended paralysis in patients with compromised mitochondrial function, making post-surgical recovery more challenging. 

> Some anesthetics can increase oxidative stress, potentially worsening brain fog, neuropathy, and other neurological symptoms.

When it comes to mitochondrial issues, some anesthesia agents are generally considered more favorable than others, though opinions vary within the scientific and medical community. The choice of anesthesia depends on several factors, including the patient's specific condition, the type and length of surgery, and which drugs will be used to induce and maintain anesthesia. Total intravenous anesthesia (TIVA) is often preferred over inhaled anesthetics. Propofol, while commonly used in surgeries, should be approached with caution due to its multiple effects on mitochondrial function - it's recommended for induction rather than continuous infusion because of this. Patients with mitochondrial dysfunction are likely at higher risk to develop propofol infusion syndrome. Ketamine is another intravenous option, often combined with dexmedetomidine, a drug which provides sedation with minimal respiratory depression and has a more favorable profile for those with mitochondrial dysfunction. This combination allows for lower doses of ketamine, thus reducing potential risks. Anesthesiologists may also tailor their approach by mixing different agents to balance effectiveness and safety. 

Avoiding Issues:

To mitigate possible issues, there’s some things you can do before surgery such as: 

- Select a reputable University or hospital where you can choose your anesthesiologist as opposed to those that are subcontracted and show just before surgery;

- It is vital you have a conversation with the anesthesiologist well in advance of the surgery date; 

- Schedule your surgery for the first morning slot to minimize fasting time and reduce stress on your body and energy levels for a better outcome. 

Conclusion:

Unfortunately, direct human data is lacking when it comes to anesthesia and mitochondrial response and remains variable to interpretation and debate.  It is important to remember that the absence of published reports of adverse effects with an agent does not mean that the agent is safe, it more likely reflects a possible publication bias. To protect your health, always research in advance and ask detailed questions about all medications, IVs being used, as well as potential side effects based on your medical history. Finally, ensure you have proper notation in your medical file about possible mitochondrial damage due to fluoroquinolones in case you must have emergency surgery at some point. 

Disclaimer

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Note: 

Anesthesia types - General, Regional, Local

Common inhaled anesthetics - Sevoflurane, Isoflurane, Desflurane 

Common intravenous (IV) anesthetics – Propofol, Ketamine, Etomidate

References:  

Fluoroquinolone-induced serious, persistent, multisymptom adverse effects

https://pmc.ncbi.nlm.nih.gov/articles/PMC4600819/

Propofol Is Mitochondrion-Toxic and May Unmask a Mitochondrial Disorder

https://pubmed.ncbi.nlm.nih.gov/27488955/

Mitochondrial Disease and Anesthesia

https://med.stanford.edu/content/dam/sm/pedsanesthesia/documents/mitochondrial-disease.pdf

Propofol Infusion Syndrome in Adults: A Clinical Review.

https://pmc.ncbi.nlm.nih.gov/articles/PMC9671386/

Anesthetic Considerations in Patients with Mitochondrial Defects

https://pmc.ncbi.nlm.nih.gov/articles/PMC3711963/

General anesthetics cause mitochondrial dysfunction and reduction of intracellular ATP levels

https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0190213

Anesthetic hypersensitivity in a case-controlled series of patients with mitochondrial disease

https://pmc.ncbi.nlm.nih.gov/articles/PMC8280249/

Patient care standards for primary mitochondrial disease: a consensus statement from the Mitochondrial Medicine Society

https://www.nature.com/articles/gim2017107?mibextid=Zxz2cZ

Contrast dyes, like those with gadolinium or iodine, help improve MRI and CT scans, but they might pose issues for people experiencing adverse effects from fluoroquinolones (FQ’s). These types of antibiotics have been linked to mitochondrial issues, which can cause oxidative stress and sometimes impaired kidney function, the organ responsible for excretion of substances.  The following are just two of many contrast agents.

Gadolinium-based contrast agents (GBCAs):

Recent studies show Gadolinium can possibly accumulate not only in the kidneys but also in other organs, even in people with normal kidney function, more typically after repeated exposures. Health issues can also increase with higher contrast concentrations and with particular brands of contrast agents. The amount of contrast used in an MRI depends on the specific imaging needs and the area being examined, so this is useful to find out in advance.  There are two types of gadolinium-based contrast agents based on their chemical structures - linear and macrocyclic, with the linear contrast agent resulting in more retention within the body for a longer duration [see brands in Table 1 FDA reference].  In review of the research, it appears that any consequences of residual GBCAs (deemed to be variable) have not been greatly investigated.

Iodine Based Contrast:

This contrast is used for X-rays and CT scanning, methods cautioned in Part 1 of this series.  Considered relatively low harm, though still with a chance of severe adverse effects in some, patients with pre-existing cardiovascular, respiratory issues or damage to their blood brain barrier should be aware. Unfortunately, lack of contemporary studies and ongoing research aiming to clarify the true risks, to include those of kidney and thyroid issues, remain unclear. Reactions can be dependent on contrast volume as well as the route of administration.

Non-Contrast Imaging Alternatives:

• MRI without contrast & Ultrasound

• CT Scans without Contrast (see Part 1 in this series for warnings) 

• Functional MRI (fMRI): This specialized type of MRI detects changes in blood flow and brain activity

• Non-Contrast MRA: This is an advanced technique to image blood vessels

Alternative Contrast Agents:

• Vegetable-based dyes are sometimes used in gastrointestinal and eye imaging 

• Microbubble Ultrasound Contrast

• Iron-based MRI Contrast Agents: use iron oxide nanoparticles and availability is limited. Note: Iron ions trigger Fenton reactions resulting in oxidative damage and cellular stress - already issues in many FQ damaged patients

If Contrast is Necessary: If an MRI with gadolinium is necessary, you may consider discussing with a functional medicine doctor or nephrologist: 

- A preliminary kidney function test and kidney monitoring 

- Exploring macrocyclic type contrast agents and their potential side effect differences

- Precautions to be taken before and after imaging 

As with any drug or medical procedure, arm yourself with knowledge by reading the references under “Reviews” which will provide more overall detail.

Disclaimer

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References:

See Contrast Brands’ Chart:

https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-warns-gadolinium-based-contrast-agents-gbcas-are-retained-body

Reviews:

Toxicity Mechanisms of Gadolinium and Gadolinium-Based Contrast Agents—A Review

https://pmc.ncbi.nlm.nih.gov/articles/PMC11012457/

Pathophysiology of Contrast-Induced Neurotoxicity: A Narrative Review of Possible Mechanisms

https://karger.com/ene/article/87/1/26/879615/Pathophysiology-of-Contrast-Induced-Neurotoxicity

Mitochondrial dysfunction is underlying fluoroquinolone toxicity: an integrated mitochondrial toxicity assessment

https://link.springer.com/article/10.1007/s13273-022-00263-9

Contrast-induced nephropathy and oxidative stress: mechanistic insights for better interventional approaches

https://translational-medicine.biomedcentral.com/.../s129...

Gadolinium-free contrast agents for magnetic resonance imaging of the central nervous system https://pubmed.ncbi.nlm.nih.gov/29431424/

Iron oxide nanoparticles induce ferroptosis under mild oxidative stress in vitro

https://www.nature.com/articles/s41598-024-82917-3?utm_source=chatgpt.com

Side Effects of Radiographic Contrast Media: Pathogenesis, Risk Factors, and Prevention

https://onlinelibrary.wiley.com/doi/10.1155/2014/741018

Microbubble contrast agents: a new era in ultrasound

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1120332/

Non-contrast MRA provides safe diagnostic alternative for patients with kidney disease

https://medicalxpress.com/.../2016-09-non-contrast-mra...

Medical imaging -  CAT (CT) scans, MRIs, and X-rays, play a crucial role in modern diagnostics. But for individuals suffering from Fluoroquinolone-Associated Disability (FQAD), particularly those with mitochondrial dysfunction, these seemingly routine procedures may pose hidden risks. It’s time to shed light on how medical imaging can exacerbate symptoms in people already grappling with fluoroquinolone-induced toxicity.

Understanding the Risks - 

Fluoroquinolone antibiotics, such as ciprofloxacin (Cipro) and levofloxacin, are known to cause mitochondrial damage, compromising the cell’s energy production and making them more vulnerable to external stressors. When an individual with FQAD undergoes medical imaging, especially those involving ionizing radiation, their already fragile mitochondria can suffer further harm.

Ionizing Radiation and Mitochondrial Vulnerability - 

1. Generation of Reactive Oxygen Species (ROS):

Ionizing radiation from CT scans, X-rays, and nuclear medicine imaging (PET and SPECT) generate ROS—unstable molecules that cause oxidative stress. In healthy cells, mitochondria can often handle this stress, but in FQAD patients, the already-damaged mitochondria are overwhelmed, leading to increased cell damage and dysfunction (Smith et al., 2017).

2. Mitochondrial DNA (mtDNA) Damage:

Unlike nuclear DNA, mtDNA lacks protective histone proteins and efficient repair mechanisms, making it particularly vulnerable to radiation-induced damage. Studies have shown that mtDNA mutations accumulate more readily in cells exposed to ionizing radiation (Wallace, 2013), which may further impair energy production and trigger apoptosis - programmed cell death.

3. Cumulative Effects of Radiation:

The damage isn’t just immediate - it builds over time. For example, a simple CT scan of the sinuses exposes the body to about 0.371 millisieverts (mSv) of radiation, nearly four times more than a standard X-ray (Radiological Society of North America, 2020). Multiple scans over time can cumulatively exacerbate oxidative stress and mitochondrial dysfunction.

Implications for FQAD Patients - 

For those with FQAD and related conditions like MCAS, the effects of medical imaging can manifest as worsening fatigue, neuropathy, muscle weakness, and even cardiac complications. Given the delicate state of their mitochondria, even low doses of radiation can tip the balance, leading to a cascade of symptoms that may take weeks or months to resolve.

What Can Patients Do?

While medical imaging is often essential, there are steps FQAD patients can take to reduce risk:

1. Minimize Unnecessary Scans:

Always discuss with healthcare providers whether imaging is absolutely necessary and explore alternative diagnostic methods or low-dosage CT.

2. Opt for Non-Ionizing Imaging:

MRI (magnetic energy and radio waves)  and ultrasound (sound waves) do not use ionizing radiation and are generally safer for those with mitochondrial vulnerabilities (World Health Organization, 2018).

3. Space Out Imaging Procedures:

Allow time between scans to enable the body to recover from any oxidative stress induced by radiation.

4. Use Antioxidant Support:

While more research is needed, some studies suggest that antioxidant supplementation may help mitigate radiation-induced oxidative damage (Ghosh et al., 2014).

5. Refer to the dosage comparison charts for specific body areas in below reference list or ask your doctor.  

Conclusion:

Tissues with high energy demands, such as the brain, heart, liver and muscles, can be more vulnerable to mitochondrial damage from radiation, which can potentially worsen symptoms like fatigue, neuropathy, or cardiac dysfunction. Imaging outcomes may vary between individuals depending on factors such as:

- what body part is being imaged (duration/dosage of treatment varies with body area)

- your size, age, weight, and the sensitivity of the tissue being targeted

- type of machine used

&

- possibly the extent of FQ toxicity, stage of FQ toxicity, prior health conditions

See Disclaimer

________________________________

References:

Radiation Dosage Charts - Multiple Areas of the Body:

FW Radiology

https://fwradiology.com/radiation-dose/

NeuroLogica

https://www.neurologica.com/blog/ct-scan-radiation-dose

• Ghosh, S., Das, N., & Chattopadhyay, D. (2014). Radiation-induced oxidative stress: A review. Journal of Clinical Biochemistry and Nutrition, 55(1), 1–7.

• Radiological Society of North America. (2020). Radiation dose in X-ray and CT exams. Retrieved from RSNA.org

• Smith, R. A., Murphy, M. P., & Dragunow, M. (2017). Mitochondrial dysfunction and reactive oxygen species in aging and disease. Free Radical Biology and Medicine, 112, 9–17.

• Wallace, D. C. (2013). Mitochondrial DNA mutations in disease and aging. Environmental and Molecular Mutagenesis, 54(7), 533–545.

• World Health Organization. (2018). Ionizing radiation, health effects and protective measures. Retrieved from WHO.int

· McLaughlin, P. D., Chawke, L., Twomey, M., Murphy, K. P., O'Neill, S. B., McWilliams, S. R., et al. (2018). Body composition determinants of radiation dose during abdominopelvic CT. Insights into Imaging, 9(1), 9–16. 

· Effective dose (radiation). (n.d.). In Wikipedia. Retrieved from https://en.wikipedia.org/wiki/Effective_dose_(radiation)

Fluoroquinolone antibiotics are often overlooked in discussions about surgeries and their associated possible risks. However, patients experiencing serious adverse long-term effects from these antibiotics should be informed and encouraged to discuss concerns with their doctors or dentists beforehand. 

In surgeries, fluoroquinolones can be present in or associated with the following:

Antibiotic-Impregnated Sutures: Some surgical sutures may be coated with fluoroquinolones to prevent infection at the surgical site.

Topical Antibiotic Solutions: These are used during surgery to irrigate wounds or surgical sites and can sometimes contain fluoroquinolones.

Antibiotic-Impregnated Sponges or Meshes: Used in surgical wounds or implant sites to reduce infection risk, these may be impregnated with fluoroquinolones.

Implants and Prosthetics: Metal implants, screws, or prosthetics may be coated with antibiotics, including fluoroquinolones, to prevent post-surgical infections.

Post-Surgical Wound Dressings: Some dressings used after surgery are treated with antibiotics like fluoroquinolones to help prevent infections.

PLEASE NOTE: Fluoroquinolones may also be given as a prophylactic during surgery in IV form

See Disclaimer

________________________________

References:

In Vitro Antibacterial Efficacy of Sutures Coated With Aloe vera and Ciprofloxacin: A Comparative Evaluation https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6555338/...

​Temperature-sensitive liposomal ciprofloxacin for the treatment of biofilm on infected metal implants using alternating magnetic fields. https://europepmc.org/article/PMC/6034688...

Ciprofloxacin-Collagen-Based Materials with Potential Oral Surgical Applications

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7563124/...

The FDA has specifically provided warnings that these medications cause peripheral neuropathy.  Multiple systemic adverse effects may stem from nervous system dysfunction, and the following is just a simplified outline that aims to provide some insight into what you might be experiencing:

Peripheral Nervous System (PNS)

The PNS consists of all the nerves outside the brain and spinal cord. It has two main components: the somatic nervous system and the autonomic nervous system.

1. Somatic Nervous System:

• Voluntary Control:  Controls voluntary movements by innervating skeletal muscles. For example, moving your arms or legs.
• Sensory Input: Transmits sensory information from the body to the central nervous system (CNS), such as touch, pain, temperature, and proprioception (sense of body position).

2.  Autonomic Nervous System (ANS): 

The ANS controls involuntary body functions and is further divided into three branches: the sympathetic, parasympathetic, and enteric nervous systems:

a. Sympathetic Nervous System:

"Fight or Flight" Response: Prepares the body for stressful or emergency situations. This includes increasing heart rate, dilating pupils, dilating airways, and inhibiting digestion.

Energy Mobilization: Mobilizes energy stores to provide quick energy.

b. Parasympathetic Nervous System:

"Rest and Digest" Response: Promotes relaxation and recovery. It slows the heart rate, constricts pupils, stimulates digestion, and conserves energy.

Homeostasis: Maintains regular bodily functions and conserves energy.

c. Enteric Nervous System:

Gastrointestinal Control: Regulates the functions of the gastrointestinal tract, including peristalsis (movement of food), secretion of digestive enzymes, and blood flow to the gut.

Autonomous Functioning: Often referred to as the "second brain," it can operate independently of the CNS but also communicates with it.

Functions Controlled by PNS and ANS

PNS:

• Voluntary movements (walking, typing, etc.)
• Sensory perception (touch, temperature, pain)
• Reflexes (knee-jerk reaction)

ANS:

• Heart rate and blood pressure regulation
• Respiratory rate and airway constriction/dilation
• Digestion 
• Gastrointestinal motility
• Pupillary response and eye accommodation
• Sweating and thermo-regulation
• Urination and sexual function

The PNS and ANS work together to ensure that the body can respond to both voluntary actions and involuntary needs, maintaining overall balance and homeostasis.

 Fluoroquinolones have been shown in studies to cause mitochondrial dysfunction, impacting the energy production essential for cellular function.  Given the high energy demands of neurons within the ANS, mitochondrial dysfunction can have several effects detailed below:

1. Cardiovascular Issues: Mitochondrial dysfunction can possibly impair the autonomic regulation of heart rate and blood pressure, potentially leading to conditions like orthostatic hypotension (a drop in blood pressure upon standing) and arrhythmias.

2. Gastrointestinal Problems: The ANS controls various functions of the digestive system, including motility, secretion, and blood flow. Mitochondrial dysfunction can lead to gastrointestinal issues such as gastroparesis (delayed stomach emptying) and constipation.

3. Respiratory Difficulties: The autonomic regulation of breathing can be affected, potentially causing issues like sleep apnea or other respiratory irregularities.

4. Thermoregulation: The ANS helps maintain body temperature. Mitochondrial dysfunction can impair this regulation, leading to problems with maintaining an appropriate body temperature.

5. Sweating Abnormalities: Mitochondrial dysfunction can possibly affect sweat gland function, leading to excessive sweating (hyperhidrosis) or reduced sweating (anhidrosis), which can impact thermoregulation and skin health.

Overall, the proper functioning of the nervous system is crucial for maintaining homeostasis in the body, and mitochondrial dysfunction can significantly disrupt these vital processes. For more information about nerve damage in those affected by fluoroquinolones, please view Part 2 of our series with Dr. Stefan Pieper, who treats “floxed” patients in his practice in Germany: https://www.youtube.com/watch?v=slxWylnNzQ8

* For a list of drugs in the fluoroquinolone class

**2013 FDA Warnings: Due to concerns about nerve damage, the U.S. Food and Drug Administration (FDA) issued a Black Box warning about fluoroquinolones and the risk of peripheral neuropathy. 

See Disclaimer

_________________________________

References: 

Autonomic Nervous System

https://my.clevelandclinic.org/health/body/23273-autonomic-nervous-system

Peripheral Neuropathy Associated with Fluoroquinolones

https://www.academia.edu/11210092/Peripheral_neuropathy_associated_with_fluoroquinolones

Fluoroquinolone-induced serious, persistent, multisymptom adverse effects

https://escholarship.org/uc/item/44d5r44g

Ciprofloxacin impairs mitochondrial DNA replication initiation through inhibition of Topoisomerase 2

https://pdfs.semanticscholar.org/6d82/ae7622517a5731eab55ff3fa63ad73085078.pdf

The exact mechanism by which fluoroquinolone antibiotics can cause inner ear damage is not fully understood and has only been analyzed in animal research, but there are several mechanisms that could possibly result in such issues:

- Disruption of Mitochondrial Function: Fluoroquinolones have been shown to interfere with mitochondrial function in cells. Mitochondria are the energy-producing structures within cells, and their dysfunction can lead to cell death. The delicate hair cells of the inner ear, responsible for transmitting sound signals to the brain, are particularly vulnerable to mitochondrial damage.

- Formation of Reactive Oxygen Species (ROS): Fluoroquinolones can increase the production of reactive oxygen species (ROS) within cells. ROS are highly reactive molecules that can cause oxidative stress, inflammation and damage cellular structures, including those in the inner ear (choclea). 

- Inhibition of Ion Channels: Fluoroquinolones may interfere with ion channels in the cochlea, disrupting the normal flow of ions required for proper hearing function.

- Tendon and Connective Tissue Effects: These antibiotics are known for their potential to damage connective tissues, including tendons. Similar effects might extend to the delicate structures in the ear, such as the ossicles(small bones in the middle ear) and tympanic membrane (eardrum).

- Neuropathy:  Fluoroquinolones can cause peripheral neuropathy, which involves damage to nerves. If the auditory nerve (cranial nerve VIII) or vestibular nerve is affected, it can lead to symptoms like: Hearing changes or loss, Dizziness, Balance problems

Tinnitus:

Tinnitus is a frequently discussed concern within the FQ-affected community. You can explore more about others' experiences and insights in the support group linked below. Per the Mayo Clinic, here are some other conditions that can cause tinnitus:

• Meniere's disease. Tinnitus can be an early indicator of Meniere's disease, an  inner ear disorder that may be caused by abnormal inner ear fluid pressure.
• Eustachian tube dysfunction. In this condition, the tube in your ear connecting the middle ear to your upper throat remains expanded all the time, which can make your ear feel full.
• Earbone changes. Stiffening of the bones in your middle ear      (otosclerosis) may affect your hearing and cause tinnitus. This condition, caused by abnormal bone growth, tends to run in families.
• Muscle spasms in the inner ear. Muscles in the inner ear can tense up (spasm), which can result in tinnitus, hearing loss and a feeling of fullness in the ear. This sometimes happens for no explainable reason, but can also be caused by neurologic diseases, including multiple sclerosis.
• Temporomandibular joint (TMJ) disorders. Problems with the TMJ, the joint on each side of your head in front of your ears, where your lower jawbone meets your skull, can cause tinnitus.
• Blood vessel disorders. Conditions that affect your blood vessels — such as atherosclerosis, high blood pressure, or kinked or malformed blood vessels  — can cause blood to move through your veins and arteries with more force.  These blood flow changes can cause tinnitus or make tinnitus more      noticeable.
• Other  chronic conditions. Conditions including diabetes, thyroid problems, migraines, anemia, and autoimmune disorders such as rheumatoid arthritis and lupus have all been associated with tinnitus.

Please see the excellent Mayo Clinic article link below for much more detail on tinnitus and what to try to mitigate the issue. Not everyone who takes fluoroquinolone antibiotics will experience inner ear issues or damage, and the severity and duration of the ototoxic effects seems to vary among individuals. 

Good to know: NSAIDs, such as aspirin, ibuprofen, and naproxen, can alter blood flow to the cochlea (part of the inner ear critical for hearing). Reduced blood flow may temporarily affect auditory nerve function, leading to tinnitus.

See Disclaimer

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References:

Tinnitus (Mayo Clinic)  Nov. 30, 2022 

https://www.mayoclinic.org/diseases-conditions/tinnitus/diagnosis-treatment/drc-20350162

Pharmacological drugs inducing ototoxicity, vestibular symptoms and tinnitus: a reasoned and updated guide

https://www.europeanreview.org/wp/wp-content/uploads/956.pdf

Ophthalmotoxicity and ototoxicity of the new quinolone antibacterial agent levofloxacin in Long Evans rats.

https://europepmc.org/article/med/1622440

Ototoxicity of Topical Moxifloxacin in a Chinchilla Animal Model

https://onlinelibrary.wiley.com/.../MLG.0b013e318148b275

Ciprofloxacin impairs mitochondrial DNA replication initiation through inhibition of Topoisomerase 2. 

https://academic.oup.com/nar/article/46/18/9625/5088042

Types of Medication That Can Cause Tinnitus 

https://www.healthline.com/health/medications-that-cause-tinnitus?utm_source=chatgpt.com

It’s that time of year when some will travel by plane to another destination for the holidays.  Those that had their lives greatly impacted by the adverse effects of this antibiotic class may experience issues that could make them more susceptible to low oxygen levels and physical side effects not to be ignored, particularly during flying. 

FQAD encompasses a range of long-term side effects from fluoroquinolone antibiotics, including damage to mitochondria, which play a crucial role in energy production and oxygen utilization in cells.

Why FQAD Could Affect Oxygen Levels:

1. Mitochondrial Dysfunction:

* Mitochondria are essential for cellular respiration, the process that generates energy from oxygen. In individuals with FQAD, mitochondrial damage can impair this process, making cells less efficient at using oxygen.
* This may cause a heightened sensitivity to low-oxygen environments, such as during flights, where cabin pressure reduces oxygen availability.

2. Nervous System Effects:

* Fluoroquinolone toxicity can cause autonomic nervous system dysfunction (dysautonomia), leading to poor regulation of breathing, circulation, and oxygen delivery to tissues.
* Symptoms like shortness of breath, palpitations, or poor oxygenation may become more noticeable during flight.

3. Cardiac and Pulmonary Issues:

* Some people with FQAD report heart-related symptoms (e.g., arrhythmias) and respiratory issues, which can further compromise oxygen delivery.
* Reduced physical activity due to chronic pain or tendon damage can weaken the respiratory muscles over time, exacerbating oxygenation problems.

4. Inflammatory or Vascular Effects:

* FQAD is often associated with systemic inflammation and sometimes possible vascular damage, potentially reducing blood flow and oxygen delivery to tissues.

5. Altitude Sensitivity:

* At cruising altitude, the air pressure inside an aircraft cabin is equivalent to 6,000-8,000 feet above sea level, where oxygen levels are lower. Individuals with compromised oxygen utilization or mitochondrial function may feel the effects more acutely.

Symptoms of Low Oxygen in FQAD Individuals During Flying:
• Shortness of breath or difficulty breathing
• Fatigue and weakness
• Dizziness or lightheadedness
• Increased heart rate (tachycardia)
• Cognitive difficulties ("brain fog")
• Tingling or numbness in extremities

Precautions for FQAD Individuals When Flying:

Consult a Doctor: Discuss any experienced air travel problematic symptoms. They might recommend supplemental oxygen during a flight or other options.

Use Supplemental Oxygen: Some airlines allow passengers to bring FAA-approved portable oxygen concentrators or may provide oxygen upon request (@$300?).

Hydration and Movement: Stay hydrated and move around during the flight to promote circulation and oxygenation.

Compression Socks: If circulation is compromised, these can reduce the risk of blood clots and improve blood flow.

Avoid Stressors: Minimize additional stress on the body by avoiding alcohol, caffeine, or other dehydrating substances.

Monitor Symptoms: Carry a pulse oximeter to monitor oxygen saturation levels during the flight, if possible.

If symptoms of low oxygen (e.g., confusion, severe shortness of breath, or chest pain) occur during or after flying, seek immediate medical attention. A personalized approach is needed in treating FQAD patients, with consideration to patient’s unique symptoms, medical history, severity level, and metabolic requirements.

See Disclaimer

_________________________________

References:

   Fluoroquinolones-Associated Disability: It Is Not All in Your Head
https://www.mdpi.com/2673-4087/2/3/17?utm_source=chatgpt.com
   Fluoroquinolone-related neuropsychiatric and mitochondrial toxicity: a collaborative investigation by scientists and members of a social network https://www.mdpi.com/2673-4087/2/3/17
     Medical Advice for Commercial Air Travel https://www.aafp.org/pubs/afp/issues/2021/1000/p403.html...
   

   Evaluation of patients for supplemental oxygen during air travel
https://www.uptodate.com/.../evaluation-of-patients-for...
   Mitochondrial dysfunction is underlying fluoroquinolone toxicity: an update on mechanisms and implications https://link.springer.com/.../10.1007/s13273-022-00263-9...
    How Airplane Travel Affects Your Body https://health.clevelandclinic.org/dehydration-exhaustion...
    Air Travel - Air Travel - Merck Manual Professional Edition
https://www.merckmanuals.com/.../medical.../air-travel...