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Get your own blood back.

We alert Post readers to the availability of equipment for transfusion of their own blood lost during surgery. The bothersome blood is suctioned away from the surgeon's scalpel and given back by infusion within five minutes after automatic filtering and cleaning. There is no risk involved.

This equipment is underutilized. It can be substituted for more than 50 percent of homologous blood transfusions now being given. (Homologous is the term used for someone else's blood.) There are good reasons for avoiding someone else's blood, especially if you don't know whose blood you're being given.

The only positive result of the AIDS epidemic might be the increased awareness of dangerous transmissible agents in blood transfusions and blood products. These include HIV (which causes AIDS); hepatitis, the more prevalent transfusion-associated illness; HTLV-1; CMV (cytomegalovirus); syphilis; EBV (Epstein-Barr virus); HTLV-IV; and HTLV-V.

Even though blood-screening tests have reduced the risk of contracting HIV, hepatitis B, or syphilis, no screening test is yet available at the blood banks to eliminate non-A non-B hepatitis or HTLV-1, the virus that causes T-cell leukemia or lymphoma many years later. There is a screening test for HTLV-1, but the test hasn't yet been approved by the FDA.

Autologous Intraoperative Transfusion-we'll call it AIT-is costeffective and is paid for by insurance carriers. The average cost of a unit of blood is $135. However, the AIT machine can process blood for about $1 a unit. A patient with a ruptured aneurysm may lose 15 pints of blood or more. AIT is particularly valuable for surgeries involving high blood loss, such as open-heart and orthopedic operations. There can also be large blood loss in the case of an ectopic pregnancy or a ruptured liver or spleen. AIT isn't used for open-bowel surgeries, and to date it hasn't been used for cancer surgeries, but all other surgeries can utilize this technique.

Dr. Charles Huggins, Director of Transfusion Services at Massachusetts General Hospital, has reported that such intraoperative autologous transfusions, were they to be more widely utilized, could make "the majority" of donor transfusions unnecessary.

The blood lost during surgery is suctioned directly from the patient into a Cell Savers(R) System, where an anticoagulant is added to prevent clotting. Then the blood goes to a reservoir, where debris is filtered out. Next, a centrifuge captures the red blood cells while the rest flows to the waste bag. Then sterile salt water washes the cells, and they are reinfused into the patient's bloodstream.

AIT has been used successfully for more than 12 years. New automated equipment has made it easier and less expensive. The newly automated hospital equipment for AIT costs from $17,000 to $30,000.

In trauma cases it takes less time to set up the AIT equipment than to type and cross-match for blood donors. Soon ambulances may be equipped with the Cell Savers. Haemonetics Corporation, manufacturer of this equipment, has recently been given a large order from the United States Armed Forces for use in the military. For civilians, the portable equipment could be equally valuable in preventing deaths from automobile carnage on the highways.

AIT prevents not only the transmission of disease but also hemolytic reactions from errors in cross-matching. Autologous transfusions decrease the demand on the blood supply, thus allowing blood bankers to be more strict about refusing to accept blood from any donors who might transmit diseases.

We believe patients should be made aware of the possibility of AIT as part of informed consent before surgery.

Sleepiness from Food Allergies?

Dear Dr. SerVaas:

Regarding your response to Nancy L. Sells [Apr. '88 Post] about her sister's narcolepsy-like problems, you stressed every medical condition except the one that could be the solution to her problem-food allergies. For years I suffered from similar narcolepsy-like symptoms but have been free of them for the last 20 years since finding on my own that they were caused by wheat. Even a very small amount of wheat will still cause the symptoms to recur.

Mention of this to various physicians over the years has elicited the normal nod and smile that suggests patient hyprochondria. My experience suggests most physicians do not recognize narcolepsy-like symptoms as serious or possibly food related.

Recently I read an article about a woman with tomatocaused symptoms similar to mine and those of Nancy Sells' sister. I hope her sister finds that rare physician who will at least try to find if her problem is food related, or try on her own if that is what It takes.

Another problem I suffered from for years as a young person was frequent bloodshot, irritated eyes. No help was gained from several physicians. I did not realize the problem was gone untU I read a medical book on gout and found gout could cause the symptoms. I had been under treatment for gout for three or four years and the symptoms had gradually disappeared. Neither the physician treating me for gout nor my ophthalmologist had recognized the problem was gout related, though each admitted knowing gout could cause the symptoms. Had my earlier physicians been more Wert, my treatment for gout could have been started many years earlier.

The above suggests better methods of diagnosis are needed. Perhaps the new computer-related systems will help physicians sort out the cause of patients' symptoms and they will give earlier and better treatment for rarely seen conditions.

Robert G. Dickinson Lakewood, Colorado

Can Anyone Help?

Dear Dr. SerVaas:

Do you have any brochures on hives? I have them about every two year. This time the doctor's treatment doesn't seem to work. They came in a "mosquito-like bump." Please help if you can.

Velma Sansom Austin, Texas

We haven't any brochures on hives. They can be due to foods people eat at certain times of the year. Shellfish, eggs, nuts, or an overindulgence in strawberries can cause hives. They can come as a result of a drug allergy, insect stings, or bites. Hives can also be the first symptom of viral infections, which can include hepatitis, infectious mononucleosis, and rubella.

Cholesterol Concern

Dear Dr. SerVaas:

My concern relates to my husband, who is 52 years of age. He is physically quite active, interested in good health. However, he has a history of heart- and cancer-related illnesses and deaths in his immediate family. I like to be conservative and cautious. Toward the end of November, we discovered that his cholesterol level was 319.

Following some advice given in a book entided The Eight Week Cholesterol Cure by Robert E. Kowalski, in roughly three weeks we got it down to 288. The measures we took were: oat-bran muffins three times a day, Nicobid tablets, and a high-fiber diet. We do have a couple of cocktails before dinner. Because of the side effects of the Nicobid, my husband stopped taking it, but we continued the other two measures. A week ago, he had the cholesterol tested again, and it is now up to 355.

Our doctor does not seem to be as concerned as I think he should be about the situation. He feels that my husband is genetically prone to a high level and that, with continued exercise, high-fiber intake, low-fat diet, and a prescription for Lopid (two capsules twice daily), ,he should be O.K.

Janet B. Hannis Woodstock, New York

Levels of cholesterol above 300 mg per deciliter frequently are due to familial hypercholesterolemia (genetically determined). Usually about half of the first-degree members of the family also have very high levels of cholesterol.

It is very important to lower the level of cholesterol as much as possible. This is accomplished by diet, exercise, and medicine. We believe the ideal level of cholesterol is 150 mg per deciliter, and below 200 mg per deciliter would be acceptable. We wish you success as you continue to work toward this level with your physician.

Don't Fiddle with This Spider

Dear Dr. SerVaas:

Have you ever considered doing an article on the brown recluse spider? In November 1987 my brother was bitten on the foot by this spider and is still recuperating. By the time it was recognized as being the bite of the brown recluse, he had to have surgery on the foot, was hospitalized about ten days, had to be off his foot for weeks, and eventually had to have skin grafting. He suffered much excruciating pain during the whole time. I wonder how much is known about this very poisonous spider. 1 have not been able to find much information about it.

I think it would be doing a great favor to farmer, and anyone eke whose work kept them in the out-of-doors a lot, to have more information about the spider.

In years past, we never heard of it in these areas-only in California or Florida.

Mrs. Herbert J. Young

Frankfort, Indiana

Brown recluse spiders are common inhabitants of the central and southern United States; however, serious bites from these spiders have been reported from almost all states. The spiders can be identified by their violin-shaped marking-hence the name "fiddleback." They are light tan to brown.

This nocturnal spider prefers a warm, dry area. It doesn't spin a web and is not aggressive. One patient we knew was sliding his arm into his coat, where a brown recluse spider was waiting for him. The victim spent several days in the hospital as a result. The bite is painless at first, and victims often do not know they have been bitten. Pain usually starts 6 to 12 hours after the bite. A red patch that may be two to ten inches in diameter then appears.

Help for a Rare Disease

Dear Dr. SerVaas:

I am writing in response to a letter in your March issue of The Saturday Evening Post from Mrs. Jean Meyer, Deltons, Florids, concerning her husband having Wegener's granulomatosis.

My brother-in-law has had this disease for over two years. It has damaged his lungs and liver. He also is very weak.

I wanted to tell Mrs. Meyer that there is a Dr. Harold Israel who knows Dr. Wegener. He is at Jefferson Hospital in Philadelphia, Pennsylvania. He has treated a few cases of Wegener's. She could also receive information from the Nadoncts Institutes of Health, Bethesda, Maryland.

The patient has taken Cytoxan, prednisone, and Bactrim at times. He is presently on Proloprim.

I tried to telephone Mrs. Meyer, but the operator could not tell me which Meyer of the six listed there. Please pass this information on to her or send me her address.

Jack Often Elmer, New Jersey Prevent Lung-Cancer Deaths

Your medical sleuths at the Post are working on an article about "lung Pap smears" for an upcoming issue. If you care about heavy smokers in your family, don't wait for our article to suggest that they consider having their sputum checked for telltale atypical cells. Our early investigations indicate that there is good reason for heavy smokers to act aggressively to catch an early lung cancer while it can be successfully removed with surgery. We went to St. Mary's Hospital in Grand Junction, Colorado, to meet with Dr. Geno Saccomanno, the godfather of the lung-Pap-smear movement. He uses an adaptation of the stain Dr. Papanicolaou developed for monitoring precancerous cells in the cervix (Pap smear).

Those wishing to have their sputum checked can do so by sending morning samples to the St. Mary's Hospital. Dr. Saccomanno prefers to read cells that have been sent in a special preservative prepared at the hospital. Anyone wishing more information about lung Pap smears for heavy smokers may write to St. Mary's Hospital, Grand Junction, Colorado.

Those who have severely atypical cells in repeated exams can have a bronchoscopic examination of the lungs. We were impressed with cases of long-term survival after early discovery and dissection of very tiny lung cancers.

Hurrah for Northwest Airlines

Let your thanks be heard in the form of ticket purchases. Take a "clean air" trip on a Northwest flight.

We predict that studies will show flight attendants and pilots will have more emphysema and lung cancer as they age. Working or frequent flying in smoke-filled cabins will be exposed as a health hazard. When lawsuits citing bad air in a working environment are lost by the airlines, we'll all win with more clean-air nights.

Alopecia Support

Dear Dr. SerVaas:

My hair is redly coming out and I'm beginning to wonder if I'll lose all of it. Do you know of a vitamin that I should take that will encourage it to grow back? I'll appreciate your help.

Mrs. H. C. Byne

Griffin, Georgia

We don't know of any vitamin deficiency that causes hair loss.

Alopecia means baldness, a partial or complete loss of hair. It may result from any of several factors, for which the cause is not usually known. These can be genetic factors, aging, or diseases affecting the hair.

Thinning of hair following a stressful illness is not the same as alopecia. It is possible that a stressful illness could trigger alopecia, however. If it is just thinning alone it is important, if possible, to remove the stress or at least minimize it and also have good nutrition. Your physician will want to check you for iron or zinc deficiency. He will also check your thyroid production.

There is a support group for alopecia. The address is:

National Alopecia Areata Foundation

71"C" Street, Suite 202

San Rafael, CA 94901

(415) 456-4644
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Title Annotation:blood is cleaned, filtered, returned during surgery
Author:SerVaas, Cory
Publication:Saturday Evening Post
Date:May 1, 1988
Previous Article:Michigan's Little Bavaria.
Next Article:Cholesterol: be aware of your ratio!

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