Who would have imagined that a simple outpatient procedure would result in a potentially life-threatening experience?

At twelve years old, my son’s wisdom teeth had grown in sideways. The impacted teeth needed to be removed surgically to give more space in Barrett’s mouth and prevent crowding of his other teeth. The oral surgeon I chose for Barrett’s difficult dental extractions, Dr. Andrews (not his real name), had an excellent reputation. He had done consistently good work on the patients I had referred to him in the past for dental surgery.

After filling out all the paperwork on the clipboard, Barrett and I sat patiently in the waiting room. Dr. Andrews, a tall man with a look of confidence, walked into the room and greeted us warmly. He escorted Barrett down the hall toward the outpatient surgical suite. Before entering the surgical room, Dr. Andrews turned around and saw that I had tagged along. He let me know that friends and family members had to stay in the waiting room.

At that moment, intense and unexpected mother-bear feelings washed over me, causing me to become uncharacteristically assertive. In a firm voice, I said, “Dr. Andrews, I want to be in the room with my son. It’s important to me.”

Dr. Andrews looked surprised. He answered, “It’s against our policy. Dr. Elliott, you know the rules. Your son will be just fine. You don’t need to worry.”

My response surprised both of us. “Dr. Andrews, I want you to make an exception for me. I need to be in the room with my son. I can’t explain why.”

Reluctantly, Dr. Andrews allowed me to be in the surgical suite if I agreed to follow certain rules. I had to wear surgical coverings for my hair and clothing, and remain seated in a chair in the corner of the room, without speaking. I readily agreed.

The oral surgeon and his team prepared Barrett by covering his upper body with sterile drapes. Barrett received sedating medication intravenously, along with medication for pain because of the extreme impaction of his wisdom teeth.

I sat quietly in my chair in the corner of the room and looked out the window at a tall ponderosa pine tree framed by cobalt blue sky, letting my mind wander aimlessly while the surgeon dug out my son’s severely impacted teeth.

My reveries came to a sudden halt when I began gasping for air. I wondered for a second if I was having an atypical heart attack, but then knew that the danger was coming from Barrett and not from me. I jumped out of my chair and flew toward the operating table.

Dr. Andrews said sternly, with his hand outstretched as though stopping traffic, “STOP. Go back to your chair, Dr. Elliott.”

I kept walking and spoke with urgency in my voice, “Something is wrong with Barrett.” I came close enough to see that Barrett’s lips had a blue tinge. I yelled, “Barrett is not breathing.”

The nurse ran into the next room and came back with a syringe of naltrexone (Narcan), the medicine that blocks the opioid receptor sites in the brain and stops all effects of opiate pain medications instantaneously.

Dr. Andrews injected the blocking medicine into a port that had been placed in Barrett’s veins before the operation. Within seconds, Barrett gasped for air. Then came long sighs, followed at last by normal breaths and pinking up of his lips.

Dr. Andrews never discussed with me what happened, except to say that Barrett had been given the standard dose of Fentanyl, a synthetic opiate pain medication. He had an unusual reaction, one that Dr. Andrews had never encountered with any of his other patients.

After the dental surgery, Barrett showed no evidence of brain damage, suggesting that his respiratory arrest lasted less than six minutes, the estimated time it takes for the oxygen-starved brain to begin the dying process.

Fentanyl, one of the strongest opiate drugs on the market, has a rapid onset and a short duration of action—about 30-60 minutes—when given intravenously. The difference between a therapeutic dose and a deadly dose is very small. The opiate drugs (narcotics) can suppress the drive to breath and result in respiratory arrest and death when given in high doses.

Since Barrett was given a “standard dose” that had not caused problems in other patients, I suspected he might have a genetic mutation that made it more difficult for him to clear medications from his system. I assumed the genetic mutation came from me since I could not tolerate toxic chemicals, including pharmaceutical drugs. When drugs were necessary, I used pediatric doses due to the slow clearance of drugs through my liver.

Around the time of Barrett’s respiratory arrest, genetic testing had become available to the public; but these new tests cost hundreds of dollars, preventing routine testing of the general population. Given the importance of the data, I decided to overlook the exorbitant cost and get my genes tested, the ones specific for the detoxification pathways that clear medications and other toxic chemicals. I spit into a saliva-collection tube and waited a month for the results to come back.

The results filled me with an assortment of emotions. At last, I could see the science behind some of my unusual reactions to substances that other people enjoyed, such as the THC from recreational marijuana, alcohol, and illicit drugs. While in college, I was unable to get the same pleasure out of mind-altering substances. They felt like poisons to me.

On the long list of medications to avoid, Fentanyl jumped out at me as though it glowed in neon lights. It became clear as day why Barrett had a respiratory arrest on a “standard dose.”

Barrett received a crash course from me about genes and how they influence the detoxification pathways in the body. He understood the concept of genetic individuality and the dangers of “one-size-fits-all medicine.” Barrett and I are “outliers” and not under the Bell curve, which means we need to be careful about what is put into our bodies.

Sometimes all the knowledge in the world cannot protect you from danger. I experienced that vulnerability first-hand when I went to a university teaching hospital for a procedure that involved injecting dye into my brain in order to analyze the structural damage—an indirect consequence of a snowboarding accident.

As I sat on the bed in my dowdy hospital gown, the first-year anesthesia resident grilled me about my medical history. I made sure to tell the young doctor-in-training to make a note in my chart, as well as informing the attending physician, that my liver cannot clear Fentanyl normally from my body and not to use more than a pediatric dose for pain control. To emphasize my point, I said, “The regular adult dose of Fentanyl could kill me.”

The resident asked with disbelief, “How do you know you can’t clear Fentanyl normally?” I gave the young anesthesia resident a quick overview of genetics and the detoxification pathways in the liver. He took notes and asked for the name of the company that did my genetic testing. He assured me he would tell his supervising physician.

An orderly came into my room and wheeled me to the surgical suite. That’s the last thing I remember before I went unconscious. The next thing I knew I was back in my room, wide-awake, with a racing heart, shortness of breath, and a sense of terror that was beyond reason. Oh my god. I’m having a panic attack. So this is what it feels like for some of my patients with PTSD.

The young resident walked into my room and cheerily said, “How’re you doing, Dr. Elliott?”

“I’m not doing well. In fact I’m feeling terrible. What happened in the OR?” I asked.

“Nothing happened. The procedure went well.”

In disbelief, I responded, “I know something happened in the OR. Please tell me the truth, David. I won’t tell anyone you told me what happened because I know you could get in trouble. I have to know the truth or else I’ll wonder the rest of my life what happened. I went into the OR as the Erica I knew and came out a different person. I’m a total wreck right now. I’ve never felt anything like this in my life.”

He admitted, “You had a respiratory arrest. We had to resuscitate you. I told the attending physician what you said about Fentanyl. He said he had to follow standard protocol. I’m very sorry.”

I answered, “Thank you for telling me the truth.”

Months later when I asked for my medical records, there was no mention of a respiratory arrest in the chart. The summary stated, “Procedure uneventful.”

If you are an “outlier,” it might be worth your while to get the genetic testing done. The tests have become more affordable in the past decade. There are several companies that can test your DNA from your saliva. You simply spit into a tube and send it off. Often these companies have the ostensible purpose of checking your ancestry. After you discover if you’re really part Native American like you thought—or African or French—you can take your raw data and enter it into websites that interpret a slice of the raw data, the part that pertains to the detoxification pathways. The company 23andme has become a favorite for getting genetic information about one’s health.

Even after uploading the raw genetic data into websites like nutrahacker, it can still be difficult to know how to design a practical protocol to follow, including what foods to make sure you eat and which ones to avoid, what supplements to take, and what medications to avoid. Interpreting the results can be quite confusing because some gene mutations will require, for example, methylcobalamin, a special kind of vitamin B-12. Other genes will require that the methyl donors be avoided. In those cases, it’s best to take the methyl donors in moderation.

There are practitioners who are specially trained in gene mutation analysis, available for online consultations or in person, if you can locate a practitioner in your area trained in gene mutation analysis.

It turns out that the kinds of mutations I have in the detoxification pathway are very common, especially among the patients who come to me for help. If we lived before World War II, before the explosion of toxic chemicals on the market, the gene mutations would have played little or no role in our health. The mutated genes only get turned on in the presence of a trigger. Without the trigger, there is no problem. The study of this phenomenon is called epigenetics.

So, is genetic testing worth it? I think so. You can gain valuable tools for navigating the cards you were dealt and for potentially dodging some of the inevitable landmines that we all encounter in life. And you might gain some love and kindness toward yourself when you see what you’ve been up against.

One of my patients, a young woman from Chicago, cried as I discussed with her the results of her genetic testing. I asked her why she was crying. As she wiped away her tears, she said, “This is the first time I’ve felt compassion for myself. Ever since I was a young girl, I’ve been judging myself harshly for being different from my friends and having lots of problems. No matter how hard I tried, I could not meet my parents’ expectations—or even my own.”

Genetic testing offers an opportunity to gain a deeper understanding and appreciation of yourself.

Here’s to your good health!