More Than Just a Cooperative Surgeon Is Needed
A complete Bloodless Program requires more than just a cooperative surgeon
More than just a cooperative surgeon is involved in treating a Bloodless Patient. Before the surgeon performs the operation special preparation of the Bloodless Patient is needed.
Pre-surgical preparation involves highly skilled nurses educated in the special care of a Bloodless Patient. Special techniques like microsampling, pulse oximetry, the administration and oversight of iron therapy or other drugs require specialized know-how. In particular, Erythropoieten (EPO) may be administered prior to surgery to stimulate red blood cell production. Training seminars teach nurses these unique Bloodless Medicine skills.
Complementary and alternative medicines that may at may act as blood thinners or interfere with blood clotting medicines or enhance blood thinning medicines may be discontinued to reduce or eliminate excessive bleeding.
A special diet may be implemented prior to surgery to promote red blood cell growth.
Alterations in the diet may be needed prior to and following surgery. Hundreds of foods contain the same blood thinning compound as aspirin. A cooperative surgeon is generally not a dietician – more than a cooperative surgeon is needed for the best outcome in Bloodless Surgery.
During surgery special techniques such as hypotensive anesthesia, hyperoxic ventilation, cell salvage, hypothermia, hemodilution, proper patient positioning, and special agents such as tissue adhesives and gels may be involved. Knowledge of these procedures and techniques are all typically part of a successful Bloodless Program.
The role of another doctor – the anesthesiologist
All fluids administered during surgery, including homologous blood, are given by the anesthesiologist - not the surgeon. It is not your Bloodless Surgeon that makes the decision whether or not a blood transfusion will be administered. So, while you may have an earnest, well intentioned and cooperative surgeon who agrees to perform Bloodless Surgery – he does not have total control in the operating room.
Post operative recovery
Bloodless Patients need special attention to recover and specialists are involved. In traditional hospitals a high percentage of blood transfusions are given after surgery; in bloodless surgery for the elderly most transfusions are given in ICU following surgery. ICU personnel must receive special training to care for the Bloodless Patient, whether old or young. A cooperative surgeon is essential but much more is needed.
Nurses will continue to monitor your recovery and need more than the typical training given in order to help the Bloodless Patient recover.
Other doctors, beside your surgeon, will also participate in your treatment post surgically and they may make decisions affecting your wishes while your surgeon is not present – your recovery is a twenty-four hour job and your surgeon will not be in the hospital at all hours of the day. You need more than just a cooperative surgeon to care for you; ideally, you need an entire surgical department that is both cooperative and well trained in Bloodless Surgery.
As an example of a recently developed tool being used in Bloodless Surgery is the CardioPAT™ Surgical Blood Salvage System. It travels from surgery to recovery right with the patient.
“The transition from intra-operative to post-operative intensive care is simplified with the CardioPAT system. With this device, ICU staff have greater opportunity to enhance patient care by providing the system perioperatively. I believe the system is more convenient than the present post-operative management of blood loss." Dr. Andrew Owens, Clinical Director of Cardiothoracic Surgery at The James Cook University Hospital.
Many hospitals do not have this device but a modern Bloodless Hospital will find it helpful in enhancing care for the Bloodless Patient.
A full blown Bloodless Surgery and Medicine Program brings all these elements together to successfully treat the Bloodless Patient.
Administrators institute special protocols to ensure the safe and specialized care needed to make a Bloodless Program work well. This may include special forms, legal notices, even simple things like No Blood bracelets and signs to identify Bloodless Patients.
Successful Bloodless Medicine and Surgery Programs have much, much more than just a cooperative surgeon they have an entire department of professionals on staff that are specially trained in their respective fields – or perhaps we should say retrained in order to adapt their skills in order to completely treat the Bloodless Patient from the moment he walks in the hospital door until he is checked out.
In reality a successful BMSP involves much more than training – it goes far beyond. It involves a proper mindset.
In the decades of the 80’s and 90’s patients who wanted surgery without blood transfusions were generally looked at as fanatical oddballs that demanded the impossible. They could sometimes find a cooperative surgeon, such as Ron Lapin or Denton Cooley but they ran into other nearly insurmountable obstacles – administrators, department heads and anesthesiologists that were not cooperative.
In over 230 hospitals worldwide that has changed. These institutions have full blown Bloodless Programs – not just cooperative surgeons. Their mindset is not to view the Bloodless Patient as a problem or even as a challenge. They welcome the Bloodless Patient as a pro-active patient that wants leading edge Bloodless Care.
A cooperative surgeon is only the beginning
A cooperative surgeon may be easy to find but a comprehensive Bloodless Program may not be. Some BMSPs have been functioning for many years. Some are new. Twelve programs just opened in the United States in 2008. More are on the way. Experienced cooperative surgeons are not as common as cooperative surgeons. Don’t simply look for a cooperative surgeon but a surgeon that you can have confidence in, and find a program that will treat you as an individual. Your confidence is part of your well being. A holistic approach to your recovery may require that you have an experienced cooperative surgeon.
On the other hand, many young Bloodless Surgeons are highly skilled, trained by experts like Dr. Denton Cooley and other well known Bloodless Surgeons or they have participated in experienced Bloodless Programs. Age is not always the determining factor when looking for a cooperative surgeon and a solid BMSP.
You may have found a cooperative, well trained surgeon. You may have found a hospital that says they will collaborate with him. You may have been given assurances by hospital staff and administrators that they will respect your wishes as a Bloodless Patient. But be sure that all these promises are backed by realities – a program that is complete, experienced, functional and staffed with highly skilled personal. It starts with a cooperative surgeon but it does not end there.
When a cooperative surgeon is all there is
However, not everything in life is perfect. What about areas that do not have a Bloodless Hospital and all that can be found is a sympathetic cooperative surgeon? Or, what about countries or regions of a country that do not have a hospital with a Bloodless Program? What can be done in these situations?
"Treating anemia is the best way to avoid blood transfusions." -Mary Ann Rouch, Blood Conservation Program Coordinator, Presbyterian Hospital of Plano
First: treat anemia if it exists. Treat the anemia and the odds of avoiding a blood transfusion are greatly reduced. Learn more about anemia; click here.
Second: build up your red blood cell count; click here. When a patient cooperates and prepares himself through diet and supplements, the need for a transfusion can be eliminated. Click here.
Third: always have a medical directive ready and signed.
Fourth: look for a sympathetic and cooperative surgeon and review the simple surgical methods that can reduce excessive bleeding, or blood loss. Click here to learn more. Much can be done even by a surgeon who is not a trained Bloodless Surgeon. If he is a cooperative and reasonable doctor he may work together with your wishes and respect your rights as a Bloodless Patient.
To find a cooperative bloodless surgeon click here.
"Diagnostic testing is an important cause of blood loss in critically ill patients. Blood samples for diagnostic testing are commonly taken up to 24 times per day depending on patient illness acuity, ease of sampling and institutional practice. The reduction of blood loss associated with diagnostic testing seems a logical, proximate intervention and may reduce the burden of anemia among critically ill patients."
"Bloodless surgery is separating surgeons from the old school of thought, -- on the necessity of an actual blood transfusion. All types of surgery can and is being performed successfully without blood transfusions. This includes open-heart operations, brain surgery, amputation of limbs and the total removal of cancerous organs."
Listen to what the experts say about blood
"The case [of] Raymond Talbert: He was able to leave the hospital four days after his heart surgery. Northeast Baptist says other patients who received the same procedure with blood transfusions spent 15 to 22 days in the hospital." -woai.com
"Based on data from 9,218 Michigan bypass patients… women are 3.4 times as likely as men to receive blood." -ScienceDaily.com
"Reports from Europe, the USA and elsewhere on evidence–based practice in the field of blood transfusion stress that inadequate training of nurses is a key determinant of poor transfusion-related knowledge and practice of transfusion safety procedures." -Council of Europe
"Blood conservation programs offer a solution to the multiple problems that surround blood use." -American Journal of Health-System Pharmacy Abstract Volume 62(18) September
"Let the patient decide, because it is the patient who must live with the consequences." -J. Mervyn Thomas, MB, Nanaimo Regional General Hospital Nanaimo, BC