Our physicians are the experts at what they do, but new information often changes their approach. My purpose wasn't to impugn the surgeons in this case, however I know from many years experience that our job as bloodless pros is to be brave and ask the tough questions. We must resist the current standard of care rut. We must admit that some surgeons "think bloodless" better than others. I still experience the old "if they won't take blood there is nothing we can do" syndrome. Don't you? When we challenge that we are not questioning the physician's judgment we are simply doing our job, which includes bringing a new perspective to difficult cases.

Have you heard of the "luck of the draw" principle? In one setting or practice the premise "we need to raise her crit before we can operate" might be focal, however in another setting or practice the premise might be "she won't get better laying in bed so lets offer her the option of surgery. After all, no surgery means a long, lingering demise as a medical patient".

__________________
Mr. Jan B. Wade
Blood Management Consultant
Enhance Outcomes - Control Cost
For Information Call - 360 296-1807
Email

Our physicians are the experts at what they do, but new information often changes their approach. My purpose wasn't to impugn the surgeons in this case, however I know from many years experience that our job as bloodless pros is to be brave and ask the tough questions. We must resist the current standard of care rut. We must admit that some surgeons "think bloodless" better than others. I still experience the old "if they won't take blood there is nothing we can do" syndrome. Don't you? When we challenge that we are not questioning the physician's judgment we are simply doing our job, which includes bringing a new perspective to difficult cases.

Have you experienced the "luck of the draw" principle? If Aunt Mabel goes to physician or hospital A she receives no treatment because her crit is two grams below normal and she is called 'anemic' (BTW. when will we change that pesky scale?). If she goes to physician or hospital B she receives treatment. It's a matter of personal judgment. The A group says "we usually use blood in these cases. Because we can't, we won't take the risk. After all she is anemic". The B group says "if she becomes a medical patient she faces a long slow demise, we should offer to share the risk with her even though she won't take blood".

__________________
Mr. Jan B. Wade
Blood Management Consultant
Enhance Outcomes - Control Cost
For Information Call - 360 296-1807
Email

14 March 2004

Being an anesthesiologist, I would like to find out how bad the liver cirrhosis is. As it was mentioned earlier, no update on liver enzymes is available. I would ask re prothrombin time and activated plasma thromboplastin time as these are monitors of the coagulation profile. How low are the patient's serum proteins, particularly albumin? The liver problem especially if coagulation profile is not optimum will pose a big problem.

Medical management would be an option. I just talked to Brother Dan Kuizon, a cardiologist at the Philippine Heart Center for Asia and asked him if it would be alright to bring his thoughts/advice on this case to the forum.He asked what valves are to be replaced. You may email him at dankui@hotmail.com

Sister Angie Gapay

Angelina A. Gapay, MD
Department of Anesthesia
Divine Word Hospital
Tacloban City
Philippines

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Angelina A. Gapay, MD

ap: Could you fax a copy of darbopoeitin info to me as well? 719-487-0184. Jan Grossberg