Mens Health Blog. Medical Blog

Can you tell me about autologous blood transfusion in the lead-up to a hysterectomy?

Autologous blood transfusion is the transfusion of an individual’s own blood during a surgical procedure. The blood is collected prior to surgery, a procedure that can be organised through a blood transfusion service or a hospital.

Autologous blood transfusion is usually suggested if a radical hysterectomy is proposed. This means that the surgeon intends removing the entire uterus, both ovaries, the Fallopian tubes, nearby lymph nodes and the upper portion of the vagina. However some surgeons recommend it ‘just in case’ for less major versions of the procedure. The amount of blood collected depends on the patient’s weight and general health. If three units of blood is to be collected (a unit is 450 ml), this is done one unit at a time on three separate occasions, usually at weekly intervals. Iron supplements are usually advisable and will be prescribed by your doctor.

How much danger is involved in having a hysterectomy?

The risk to life is small — between one in 2000 and one in 5000 women who have a hysterectomy die as a result of it. The risk varies depending on the technique used, the skill of the surgical team and the reason for the hysterectomy. This is comparable to the risk of death for some other kinds of major surgery. Infection occurs after surgery in about one in twenty women, and about one in 300 sustains damage to the bladder, bowel or ureter. About one in ten women bleed after the operation. In most cases this is mild, but about one in 100 requires a blood transfusion and drainage of blood from the abdomen.

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Foetal Alcohol Syndrome

In its most extreme form, a mother’s alcohol consumption can cause Foetal Alcohol Syndrome (FAS). The characteristics of this syndrome include abnormalities of growth, craniofacial, musculoskeletal, cardiac, nervous system and neuro-developmental delay or mental deficiency, with an average IQ of 65. Babies born with Foetal Alcohol Syndrome will look visibly different from other babies. They may have reduced weight, length and head circumference compared to healthy babies and may be labeled as ‘failing to thrive’. The nasal bridge can be poorly formed and the baby may have large ears which are simply formed. They may also have a cleft palate. Limb defects are also common, including such problems as congenital hip dislocations. Congenital heart disease is also a concern. As with any drug, the newborn baby may display signs of withdrawal symptoms, such as restlessness, and being fretful and tremulous.

Foetal Alcohol Effects

It is now recognized that some children do not bear the severe physical characteristics of FAS but still have subtle mental or behavioural difficulties caused by being exposed to alcohol in the womb. These characteristics have been identified as Foetal Alcohol Effects. And they are produced merely by ‘social drinking’.

One study looked at the effect of consuming two or more drinks most days during the pregnancy or binge drinking (drinking five or more drinks in one go, at a party for example) before the mother realized she was pregnant. The babies born from these mothers were followed over seven years to see how they progressed. From the beginning, the babies had a lower than average birth weight and were more jittery. They had difficulty establishing a good sucking pattern and had disrupted sleep patterns. From eight months, their ñî-ordination was not good and they still had disrupted sleep patterns.

A follow-up study at seven years old showed that those children whose mothers had been drinking two or more drinks a day were seven points lower in their IQ scores than the average seven-year-old. Children of mothers who had been binge drinking before they realized they were pregnant were approximately one to three months behind in reading and arithmetic. Other tests from this study showed a poor attention span, problems with memory and negative behaviour patterns.

In fact, they had some of the classic symptoms of hyperactivity, now called attention deficit hyperactive disorder (ADHD). Cause and effect can be so difficult to pinpoint when results may be present seven years after the actual cause. But, instead of focusing attention on drugs such as Ritalin to control hyperactivity, maybe funding should be ploughed into preventative measures which could be as simple as asking women not to drink at all during pregnancy.

Alcohol is also a diuretic so it increases the urinary excretion of valuable vitamins and minerals. Zinc, a very important mineral during pregnancy, is depleted with alcohol consumption, and studies show that when zinc levels are reduced, low birth weight and foetal malformations can follow. Folic acid deficiency can also result from the diuretic effect of alcohol and this is the nutrient known to help prevent spina bifida.

Clearly, alcohol is a toxin and there is no limit below which it is safe. In this situation it is definitely not the case that ‘a little won’t harm’ and I cannot emphasize too strongly how important eliminating alcohol is to the health of your baby.

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Most, if not all of us, have confronted serious challenges and threats in our lives before being diagnosed with cancer. We did our best to address these situations, work through them, and then put them behind us as we moved on with our lives. In fact, this strategy is fully applicable to many kinds of cancer, since once the patient has passed the five-year mark, she can usually be pronounced cured. Unfortunately, the same cannot be said with certainty about breast cancer. While it is true that with every year that passes, it is more likely that breast cancer will be a part of our past, this is not always the case. The disease has been known to recur five, ten, fifteen, and even twenty years later. Thus, living with breast cancer becomes a particularly stressful challenge. Hester described the challenge well in a letter she wrote to the editor of our local newspaper. “All of life must be viewed through a double lens, that of possible future good health and that of possible future disaster.

Learning to live well after breast cancer is a lesson in hope.”

Once you get through this ordeal, each of you will find your own way of beginning the next part of your life, choosing your own path, marking your own priorities. One thing is certain, whatever decisions you may choose: You will make changes in your life. Having cancer forces you to assess and reassess what you want to do with the rest of your life. If there are projects-you have fantasized about but have pushed out of your consciousness, you may well decide to take the plunge and go ahead. This book is one of our projects.

The challenge is to learn how to live well, whatever that means to you personally. Although the terror you feel now, at the time of diagnosis, will subside and lose its intensity, it will remain a lifelong companion. Your awareness of it will, of course, fluctuate, and some days you will struggle not to be overwhelmed by it, while other days you will feel calmer and more in control. The overarching goal is to keep trying to achieve a balance in our lives between fear and hope. Whether healthy and well, or ill and unwell, we struggle to find level ground—a safe place where we feel the various competing attentions in our lives are in equilibrium.

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Several kinds of chemotherapy are frequently used to treat breast cancer. Your oncologist will speak to you about which drugs are most appropriate for your situation. Some of the common chemotherapy agents which have been used for years include Cytoxan, Adriamycin, Methotrexate, and 5-Fluorouracil (5-Fu). Others are being studied and used all the time, and it is likely that, over the next few years, standard chemotherapy combinations will be somewhat different than they are today. For example, Taxol or Taxotere are now sometimes added to adjuvant chemotherapy treatment. Usually the drugs are administered through an IV tube in your arm/hand and are not painful. It can be unsettling to realize that there is no standard treatment that is best for everyone, but you can be sure that your doctor is recommending what is best for you. Feel free to ask questions, and, if you wish, to get a second opinion.

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Occasionally, tissue expanders (temporary fillers to prepare your breast) are indicated; these are inserted during a series of procedures over several months. You will experience three stages of treatment. The first step will be the implanting of a tissue-expanding device that your surgeon will insert into your chest wall following the mastectomy itself. When you wake up from surgery, the device will already be in place. As the plastic surgeon will explain to you, s/he will expand your remaining tissue gradually over the next several months so as to accommodate an implant large enough to match the other side. This is accomplished by injecting saline solution through a porthole left exposed at the mastectomy site. After these expanding treatments are completed, s/he will schedule a time to both remove the expanding device and insert your permanent implant; this procedure will require that you return to the hospital.

Each of these reconstructive procedures involving tissue transfer is essentially a graft. You can expect to heal fairly rapidly after the first couple of days. The first twenty-four hours you will feel lousy; you have just had major surgery lasting several hours. You need time to recover from the effects of anesthesia as well as from the surgery itself. Try to cooperate with your nurse, who will urge you to turn, cough, and deep-breathe regularly, even though doing these things will hurt. Be aware that you will have odd-looking tubes hanging from your incisions; the tubes accumulate fluid (a mixture of blood and other body fluids) and will need to be emptied on a regular basis. When your surgeon determines that the drainage has slowed to an acceptable trickle, s/he will remove the tubes by exerting a steady, firm pressure at the site; the opening in the skin through which the tubes had been inserted will seal quickly (within one to two days).

You can expect to have some postoperative pain; however, you may be surprised that the mastectomy site itself is not the major source of discomfort. This is because the area is numb, following the severing of many nerves. The chest area will remain numb for weeks or months OR POSSIBLY FOREVER.

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Mothers may find it disturbing to discover that their children have told all their friends and classmates about the illness or its side effects. Children do not have the same sense of what is private that you do, and your calm management of the situation may enable them to share the news with everyone in a matter-of-fact way. The positive effect of this is likely to be that many people, even some whom you do not know well, will offer to help. Many elementary school classrooms organize dinners for a student’s mother undergoing chemotherapy. If you are lucky enough to have this come your way, say yes. Make sure your own child’s teacher and classmates know how much you appreciate their help and the efforts of their parents. Write (or draw, depending on the age of the children) a communal note that your child can help you create and might want to read out loud (if s/he feels comfortable doing this), or ask the teacher to do it on your behalf. Alternatively, you might ask your child’s teacher to pin your note of thanks up in the classroom or to transcribe it onto the blackboard.

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Many women facing cancer treatment are interested in complementary or alternative therapies. Traditional or Western treatments for breast cancer include surgery, radiation, chemotherapy, hormone therapy, and biologic therapy. All other treatments can be considered complementary. Since we feel strongly that there is far-reaching and impressive data to support the value of traditional medical treatments for breast cancer and no comparable set of data exists for complementary therapies, we implore you to use these other modalities in addition to, rather than in lieu of, standard medical care. This is the reason that we are referring to them as complementary rather than alternative treatments. Having said that, we recognize that many women are motivated to do everything possible to help themselves, and that some believe that non-Western health traditions have much to offer.

Frequently, this is also an area where friends may give advice. You may find yourself the recipient of many articles and books espousing one or another treatment, diet, or program to cure cancer. Of course you may find all this interesting “and welcome. If you do not, one strategy can be to ask someone to screen-your mail, setting aside all such literature. You can then look at it later if you wish.

There is often controversy about the value of these treatments. This is because alternative, or complementary, therapies often have not been subjected to carefully designed clinical trials. A clinical trial is a research study designed to evaluate the effectiveness or value of a particular treatment. In the context of treatment for early breast cancer, any option offered under a clinical trial would be considered to be at least as effective as the prevailing standard treatment for the same condition. On the other hand, most standard treatments for breast cancer have been subjected to such clinical trials and have therefore accrued substantial scientific data to support their value.

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In the 1930s, research was launched to find a hormonal treatment to alleviate menstrual pain. The search led to the invention of hormonal contraception. The first hormonal contraceptive was the Pill. It became available in 1960 and is now the most popular method of reversible contraception in the United States.

Thirty-one years later, American women were offered another hormonal option—implants inserted under the skin to provide five years of contraception. Two years after the introduction of implants, an injectable method that lasts 12 weeks became available.

Throughout history, millions of women dreamed that they might live their lives free from the burdens of unintended pregnancy. While there still remains a very real need for more and better contraceptive options, the introduction of hormonal contraception changed the lives of women forever by offering them safe and highly effective methods with which to control their fertility.

The Pill is a reversible method of birth control that is available only by prescription. It is a monthly series of pills taken once a day. The active ingredients are synthetic hormones like those produced by the body to regulate the menstrual cycle. Combined oral contraceptives contain both estrogen and progestin. Mini-pills contain progestin only.

How the Pill Works

Combined pills keep the ovaries from releasing eggs (ovulation). Mini-pills can also prevent ovulation. They also work by thickening the cervical mucus. This prevents the sperm from joining with the egg. Both types of pills can also prevent fertilized eggs from implanting in the uterus.

Effectiveness of the Pill

The Pill is one of the most effective reversible methods of birth control available to women in the United States. Of every 100 women who use the Pill, only three will become pregnant during the first year of typical use. Women who take the Pill correctly every day have less than a 1 percent chance of getting pregnant.

Birth control pills work best if taken at about the same time every day for the full monthly series. Pregnancy can happen if an error is made in using the Pill—especially if:

• pills are started too late in the cycle

• two or more pills are missed in a row

• pills are taken in the wrong order

The Pill may be less effective in preventing pregnancy if taken with other medicines such as those that control seizures or tuberculosis. Talk to your clinician about what to do.

The Pill provides no protection against sexually transmitted infections.

Advantages of Using the Pill

The Pill is convenient to use. Women who use the Pill have:

• more regular periods

• less menstrual flow

• less menstrual cramping

• less iron-deficiency anemia

• fewer ectopic (tubal) pregnancies

• less pelvic inflammatory disease (PID)

• less acne

• less premenstrual tension

• less rheumatoid arthritis

The Pill offers significant protection against:

• ovarian and endometrial cancers—risk reduction increases with each year of use, up to 80 percent

• noncancerous breast tumors and ovarian cysts

Who Can Use the Pill

Most women can take the Pill safely. You should not use the Pill if you are over 35 and smoke more than 15 cigarettes a day, especially if you are greatly overweight.

You shouldn’t use the Pill if you have unexplained vaginal bleeding or if you ever had:

• cancer of the breast or uterus

• blood clots in the veins or lungs

• skin cancer called malignant melanoma that spread to another part of the body

You may need special tests to see whether you should take the Pill if you have had certain medical conditions such as liver disease, diabetes (even if it only occurred during pregnancy), high blood pressure, high cholesterol levels, or if there is a history of blood clots in your family.

For all women, except those who smoke more than 15 cigarettes a day and are over 35, the newer low-dose pills have fewer side effects and complications than pregnancy and are much safer than pregnancy.

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