Tuesday, June 05, 2007

How do they do that?

The Survivor's Guide to Surgical Menopause has tipped us to two interesting pages that give operative procedure details on:

DO NOT GO TO THERE IF YOU ARE SQUEAMISH. While there are no illustrations or photos, the terminology is medical and describes, layer by layer, each step involved.

It's also important that you understand that these are for "open" procedures. That means that they are the conventional, make-an-incision surgeries and that laparoscopic or vaginal procedures involve other steps. Other procedure variations don't seem to be posted to the site yet. And, of course, if you're having extra work done, like a recto/cystocele repair or endo removal, that will also change the exact method used.

Still, if you're wondering "how do they do that?" or why it takes some time to heal, this might help fill in those blanks.

The Survivor's Guide bookmark account has other useful and interesting stuff about surgeries, too--go check out tags like "surgery" and "hysterectomy."

Thursday, March 01, 2007

Transfusions as a potential blood clotting risk for women

We give a lot of attention to some forms of blood supply risk when we consent to a transfusion, but a newly-released study contains an additional factor we may want to discuss with our surgeons when we are talking about having a transfusion either before or after we have a hysterectomy.

In this study, researchers found that

Transfusion was associated with an increase in the odds of developing VTE in women (odds ratio, 1.8; 95% confidence interval, 1.2-2.6) but not in men (odds ratio, 0.9; 95% confidence interval, 0.5-1.9). In the absence of transfusion, female compared with male sex was not associated with an increased risk of VTE (odds ratio, 1.2; 95% confidence interval, 0.8-1.7).

What does this mean for us? We already know that a hyst (or any abdominal surgery) raises our risk of developing a postop blood clot, and that's why our doctors usually prescribe elastic stockings and/or pneumatic hose as well as anticoagulant therapy as a regular part of our immediate postop care.

But it could be that women who have a transfusion before surgery, perhaps to correct anemia from excessive bleeding, as well as those who require transfusion to compensate for blood lost during the operation, may be incurring an extra risk factor. And since blood clots are a very serious health threat as well as a reason why future HRT use may be forbidden, this is something to take into account when making the decision to permit a transfusion.

It's not necessarily a reason to turn one down, of course: sometimes blood loss can be life-threatening and there may be few other options for dealing with the situation. If a doctor knows that this elevated risk exists, there may well be specific measures to do with both detection and prevention that can be put in place that help reduce this added risk exposure. It's not a simple or straightforward decision, so it needs to result from a discussion with your own surgeon or doctor. But this new information is definitely something to be sure they've heard of and are taking into account in how they manage your overall treatment.

If you want to share the content of this study, it is:
Association Between Venous Thromboembolism and Perioperative Allogeneic Transfusion
Kent R. Nilsson, MD, MA; Sean M. Berenholtz, MD, MHS; Elizabeth Garrett-Mayer, PhD; Todd Dorman, MD; Michael J. Klag, MD, MPH; Peter J. Pronovost, MD, PhD
Arch Surg. 2007;142:126-132.