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Rissa
Member
03-20-2006
| Thursday, November 02, 2006 - 3:33 pm
Thanks Twinkie and Kitt. We haven't gotten any answers yet. He is hallucinating on/off (presumably because his blood volume is so low and its your blood that transports oxygen to the brain) so they put him in a locked ward after his 2 days in emergency. Emergency told us that they can't give him a blood transfusion in the ER, that he would have to wait until properly admitted. Now we are on day 3 of being admitted and what the treatment seems to consist on is TAKING copious amounts of blood for further tests. If it wasn't so serious, it would be laughable. They are going to do a gastroscopic procedure to see if he is bleeding internally. Seems to me that that should have been done day one in the ER, but what do I know? Not only didn't they do it ASAP but they are so far behind that if he IS bleeding internally he will have to hold on until Saturday to find out. (sigh) I think I will just be relieved if its anything but cancer at this point. Wonder if Hugh Laurie is available for a consultation? Thanks again, will go check into that article now.
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Twinkie
Member
09-24-2002
| Thursday, November 02, 2006 - 3:56 pm
They should have him on oxygen.
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Herckleperckle
Member
11-20-2003
| Thursday, November 02, 2006 - 4:14 pm
Rissa, though this article is about blood transfusion techniques, it has a couple of references about why people have a low blood count. I bolded and used red on those for you. Hope your dad improves, hon. Source: Ivanhoe.com Reported November 8, 2004 Blood Substitute In-Depth Doctor's Interview Fred Cushner, M.D., explains the benefit of erythropoietin injections vs. patients donating blood to themselves before surgery. Ivanhoe Broadcast News Transcript with Fred Cushner, M.D., Orthopedic Surgeon, Beth Israel Medical Center, New York, New York, TOPIC: Blood Substitute What is erythropoietin? Dr. Cushner: Erythropoietin is actually a hormone that the body makes when your body has a low blood count. The body signals your kidneys to produce erythropoietin. Erythropoietin then goes to the bone marrow, which signals the production of red blood cells. Erythropoietin kind of allows you to be your own blood bank. If you have a low blood count, then you take erythropoietin, also known as Procrit, and it makes you produce more red blood cells. How did the idea come about to use erythropoietin for this purpose? Dr. Cushner: When we began studying blood loss over 10 years ago, in one of our initial studies we looked at the people that got transfused and looked at what factors led to those blood transfusions. Then we compared those to others that did not get a transfusion. Initially, we thought the patients that lost more blood were the group that had the transfusions, but that was not the case. The people who got transfused and the people that did not get transfused lost about the same amount of blood, but the difference was where they started from. So people who have high counts are probably not going to get a transfusion, but if your blood count is lower and you lose the same amount of blood, then you would probably have a transfusion. So that was our first paper, and since then we have been building on that body of knowledge. What we found is that donating your blood for later use rather than building you up before surgery actually increases your risk to need someone else's blood for a transfusion. What are the results of your most recent study? Dr. Cushner: Our most recent study documented the negative effect of patients donating blood to themselves before surgery. We demonstrated that those who donated their blood never regained that blood count that they were prior to the donations. We compared this group to another group that received the injections of erythropoietin rather than donating their own blood. This group came in before the surgery, received three injections, and rather then dropping their blood count, they built up their blood count. So there is a significant difference between the two groups by the time of surgery. These lower blood counts are really orthopedic-induced anemia. By the patients donating the blood we made them more anemic than had we just left them alone or had we given them the injections. So, certainly it convinced all of us to come up with a protocol where basically we check a patient's blood count before surgery. If the patient has a high blood count, then we do not do anything; we leave them alone. If the patient has a low blood count, we give him or her the Procrit injections and let the body be its own blood bank. That way the patient can avoid getting a transfusion of somebody else’s blood. How do blood donations create the need for more blood in patients getting surgery? Dr. Cushner: We used to think that if you donated your blood before surgery that your body would rebuild by the time the surgical event occurred. Well, that is not the case. A recent study we completed showed that even though we tell patients to donate blood four weeks in advance of surgery, it is really about two and a half weeks by the time the blood bank makes the appointment. For the patient that is just not enough time to rebuild the blood count. Also, we know that by donating one unit of blood, it is not enough loss to make your blood count go down so your body does not get that feedback mechanism that I described. You do not have a low oxygen count so your own erythropoietin does not kick in to stimulate your red blood cells to form. Basically you are donating the blood, and the body does not have enough time to recover by the time of the surgery. Hence, the increased risk of a transfusion. Is it true that donated blood is not as fresh at the point that it is needed by the patient after surgery? Dr. Cushner: Yes. Blood in your body is better then blood that has been stored for a month. So if you donate your blood, it does lose some of its properties and make it a less valuable resource for helping recovery after surgery. What would be the advantage of erythropoietin over blood donation? Dr. Cushner: Well, several advantages. Number one is we make generalized rules that you take one unit of blood from every patient, and everybody is different. You have some people with very high blood counts, so if you took one unit of blood from those patients it would just be wasted. About 75 percent of the patients fall into the category that will never need the blood they donated, so why subject them to it? If the patient is getting a knee replacement or a hip replacement because they are having problems walking, having them go to the blood bank and donate the blood is just another chore, and may be difficult for them. For the 25 percent that does have a low blood count, you are making the blood count even lower. By lowering the blood count, you are exposing them to not only a chance of getting a transfusion, but also making them feel worse. It has been well demonstrated that the higher blood count, the better you feel and the quicker you return to normal activities after an operation. So, there really is no benefit to donating the blood. There is also a chance of a clerical error so that if you do not get the right blood back. This is also an important new protocol because all patients are not the same. We do not treat people who have bad hip arthritis the same way as people who have mild hip arthritis. We treat people with bad knees that curve out differently then people with bad knees that curve in. So we should treat patients that have different blood counts differently. We should not make a generalized rule, like let’s take one unit of blood from everybody getting joint surgery. We should check a blood count. If they are low, let’s do something to help them. Let’s build them back up with injections. If they are high, let’s leave them alone and not make them any worse. What surgeries does erythropoietin work for? Dr. Cushner: It has been shown to work in any major orthopedic procedure. This medicine has been around for a long time. Kidney-dialysis patients who have low blood counts from their kidney not working have been using this medication for years. So whether you are a anticipating a large blood loss from spine surgery, hip surgery, or knee surgery this would be beneficial. What is the transfusion rate at Beth Israel Medical Center? The national average? Dr. Cushner: If you look at the national average, it varies in more than just the transfusion rate. It is also important to know what the blood count was before the operation. For instance, if you do not transfuse people who are relatively low, then your transfusion rate may be very low, but that does not mean that your patients are going home with high blood counts. Certainly, in some cases patients, because of medical reasons, cannot tolerate a low blood count and do need to get a transfusion, but now that we came out with this protocol the transfusion rate is less than 2 percent at our most recent study. How widespread is the practice of administering Procrit to manage blood loss before surgery? Dr. Cushner: It is interesting. It has been a slow evolution. It takes a long time sometimes to change doctors' practice patterns. As you go to more meetings, there are more and more surgeons that pull me aside and ask me, "Well, how do you do this?" It is really just a pragmatic issue at this point. I do not think anyone will argue that this is not the right way to go in regards to raising the blood counts and preventing the transfusions. It is more about how you make the arrangements to have the patients get the injections in expeditious fashion before the surgery. The problem with joint surgery is that 70 percent of operations are done by people that do less then 15 a year, so I am not sure that all of those physicians that are not doing a lot of surgeries are going to the extent of setting up an erythropoietin injection protocol. But, I probably would say about 25 percent of institutions are starting to use erythropoietin. We recently completed a survey with all of the members of the Hip and Knee Society, and we are tallying the data. So, hopefully I will have a specific answer for you in the near future. Have you had any reactions from people who are glad that this is here because they have religious or personal issues with blood donation, for example a Jehovah’s Witness? Dr. Cushner: Most certainly. Some patients are referred in because they hear we practice bloodless surgery protocols. That category of people is certainly a large amount of patients that come to see us, but an even larger group is those who just do not want to risk getting somebody else’s blood. There are some studies that show there is an increased risk of infection post-operatively if you get somebody else’s blood, including immunosuppression. Are there any adverse effects from getting injections of Procrit? Any complications with it? Dr. Cushner: Erythropoietin is probably one of the safest medicines that we can give. We have looked to see if it increases the blood pressure or the rate of blood clots, and it just does not happen. This is one of the safer medicines out there. You will probably see less reactions to erythropoietin then you will for a simple aspirin or Tylenol. How long have you been using erythropoietin before surgery? Dr. Cushner: We have been using it going on seven to eight years now. How does this affect the patients? Dr. Cushner: They don't have to give a transfusion, and they can leave the hospital with a high blood count, which means that they are feeling good. They leave the hospital ready to start therapy and don't have to sit there and spend the first two weeks in bed because they get dizzy when they stand up. END OF INTERVIEW This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc., or any medical professional interviewed. Ivanhoe Broadcast News, Inc., assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors in different ways; always consult your physician on medical matters. If you would like more information, please contact: Pam Trester Office Manager for Dr. Cushner Beth Israel Medical Center (212) 870-7979
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Herckleperckle
Member
11-20-2003
| Thursday, November 02, 2006 - 5:29 pm
Rissa, also see the info I posted today under For Heart Patients. Turns out Mitral Valve Prolapse can also cause low blood volume.
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Kitt
Member
09-06-2000
| Thursday, November 02, 2006 - 6:40 pm
Yeah, I really hope you get some answers soon and that your dad improves.
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Rissa
Member
03-20-2006
| Saturday, November 04, 2006 - 2:43 pm
Thanks Heckle. I am a medical information junkie so I have really enjoyed reading these articles. They have finally gotten around to some more indepth tests. The camara down the throat to the stomach, a colonoscopy as well as kidney and heart function tests. He had a triple bypass ten years ago btw Heckle, so your article did hit home. So far all the tests have come back with no answers. They have ruled out internal bleeding, cancer, bleeding ulcers, kidney failure, heart issues. I am starting to think he was being poisoned by the massive amount of prescription drugs he was on. The first day in emergency they took him off almost HALF, so that he is down to 8 different drugs instead of 13 every day with the reasoning that they will be able to monitor him 24/7. Every day that has gone by his mind is clearer for longer periods and he is sleeping better. His blood volume hasn't gone up at all but maybe that will follow too. He weight is still going down though, he has lost about 6 pounds in the one week he has been in the hospital... could be water retention issues clearing up though. If it is a drug related issue, his family physician better run and hide. LOL I had a very LOUD conversation with him a few years back about how unimpressed I was with his standard of care.
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Hukdonreality
Member
09-29-2003
| Saturday, November 04, 2006 - 3:37 pm
Rissa, I haven't been in this thread in some time, and just now saw your postings. If your father has low blood volume, rather than low blood counts, it is quite different. The medical term for low blood VOLUME is hypovolemia. I did run across a number of sites while looking for "causes of hypovolemia" that seemed to point at drug interactions. You might very well be on to something with those thoughts. I wish you well in your search for answers. I didn't find anything particular that I felt would be important to post here. I hope the doctors get with it and find out WHY he has low volume. Best wishes to you and your family.
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Cndeariso
Member
06-28-2004
| Saturday, November 04, 2006 - 5:09 pm
acne, why did i get in in my teens and never got rid of it? i'm 47 and i've had acne now for 35 years. i don't wear makeup and i don't put anything on my face after i bathe. i have it across my back down to the bottom of my shoulder blades too. it's not a lot, not huge stuff, mostly black heads that fester and some whiteheads too. i am clean but not exceedingly so. so, i don't get it.
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Christina
Member
08-07-2005
| Tuesday, November 07, 2006 - 6:38 am
Wish I could help you...but I can give you some ideas. Phisoderm has a body wash, my son swears by. Microdermabrasion face scrubs(Mary Kay) sells it. Too much scrubbing can also irritate and cause blemishes. Try going to a salon where they will cleanse and extract black/white heads. They will have some suggestions for cleaning your body type. Hope this helps a little.
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Denecee
Member
09-05-2002
| Tuesday, November 07, 2006 - 9:55 am
Cndeariso, I got nodular acne in my late 20's and after suffering for years I went to a dermatoligist(sp). I did the Acutane treatment and have never had a problem since, but I drink at least 64 oz of water a day but more like 94 oz is what I usually drink. He told me that drinking lots of water is very important. It doesn't sound like you have nodular acne but if you can, you should try to see a dermatoligist.
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Rissa
Member
03-20-2006
| Wednesday, November 08, 2006 - 6:54 am
Cndeariso, my husband used Acutane in his late twenties as well. I don't think he had nodular acne so perhaps the drug works on different types of acne (or maybe his doctor just used a different name). If I recall, he took it for three months and is very happy with the results. He did have to have either his liver or kidney function monitored with a simple blood test but I understand not all doctors do that. There is so much a dermatologist can do nowadays, please don't live with the problem if you dont need to. On another note: My dad is getting a whole lot of attention at long last. Mostly because they cannot figure out whats wrong with him. Pretty much every hospital department has visited and run tests. The ony thing they seem to be accomplishing is that his hemoblobin is now down to 78 because they keep taking out so much blood to find out why he has so little blood. Three doctors came together last night and told him he was officially a medical mystery and he has them stymied as to what to even test for. They took him off of EVERY drug even insulin. He takes heart medication, blood thinners, pain killers, diabetic meds, cholesterol, blood pressure, etc. Now he is taking a daily low-dose aspirin and the nurses are testing his blood hourly and giving insulin only as needed. Docs said they will be back on Friday so he is very depressed now, wanted to go home by Wed. They also had pysch talk to him and they report that he is clear on 'most things', still can't recall how he got to the hospital and when asked he said he had been there about 3 days (its almost 2 weeks). Anyway, as long as he is in the hospital they are at least ruling out a whole lot of issues we had been worrying about.. heart, kidney, cancer, etc.
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Cndeariso
Member
06-28-2004
| Tuesday, November 14, 2006 - 10:24 am
thanks for the info! i appreciate the advice.
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Colordeagua
Member
10-25-2003
| Saturday, November 18, 2006 - 8:32 pm
I've had pierced ears for many years. And it's been a lotta lotta years since I've had an infection in them. Well, bought a pair of earrings sometime ago. Wore them some with no problem. Then started getting an infection when I wore them (both ears, but the left much more than the right). Went the rubbing alcohol route. Didn't wear those earrings for a while. Any that I did, I dipped in alcohol first. Swabbed piercings with alcohol too. Ears healed. But any time I put that one pair in, they're infected again. Those earrings have been dipped in alcohol often enough. Anyone have any suggestions? The earrings (posts) are favorites of course.
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Shadoe
Member
11-04-2004
| Sunday, November 19, 2006 - 11:00 am
I would toss them. If you really want to keep them, you better get them put onto new posts. Maybe you could see about a coating for the posts. Something in the metal/material of the post is not agreeing with you and likely never will. I don't see the point in wearing something that you know is going to react badly with your body.
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Colordeagua
Member
10-25-2003
| Sunday, November 19, 2006 - 11:34 am
Thanks, Shadoe. I guess I do remember hearing at sometime that some metals (or whatever in / on earrings) just might not agree with an individual's body chemistry.
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Mameblanche
Member
08-24-2002
| Sunday, November 19, 2006 - 1:56 pm
Colour, due to allergies, I can only wear gold, or hypo-allergenic jewelery. DH teases that I have expensive allergies. But gold-plated or 10k gold is fine with me, I'm not a princess. LOL. Only thing is that gold-plating eventually wears off, so I have to have those redipped occasionally. Hope this helps. 
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Shadoe
Member
11-04-2004
| Sunday, November 19, 2006 - 1:57 pm
Also, doesn't that chemistry change through your life? I used to be able to wear jewellry but now, I can wear very very little metals of any kind. Even the metals on a watch clasp. I have 3 rings that do not irritate my skin, and all my earrings (plugs) are natural materials like bone, ebony, and some other non metal materials. So, if you really like the stone or a part of the set, you should just go to a jeweller and see about getting a good setting.
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Colordeagua
Member
10-25-2003
| Sunday, November 19, 2006 - 2:46 pm
The earrings are sterling silver (or at least any part that comes into contact with skin) like most of my earrings. Have a few that are white gold or rhodium plated yellow gold. I don't wear yellow gold jewelry. I'll wait a few weeks and then try them once more -- maybe with different backs. I have plenty of earrings, but of course this particular pair is one of my favorites. They're Judith Jacks.
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Shadoe
Member
11-04-2004
| Sunday, November 19, 2006 - 6:45 pm
Speaking of trying different backs, you might want to try the flat plastic disk backs - if the posts are long, see if you can put the plastic on the post and then put the earring in the hole, then put another plastic disk on back. That way, only the metal of the post will be touching your skin. If you still get an infection, you will know it's the posts that are the problem.
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Rissa
Member
03-20-2006
| Monday, February 19, 2007 - 9:21 am
Has anyone here had experience (personal or with a child) with having the veins/arteries in their nose cauterized? My 17 year old has finally had it with the nosebleeds and set up an appt for this week to get the procedure done. Is it painfull? What is the recovery like?
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Colordeagua
Member
10-25-2003
| Wednesday, February 21, 2007 - 5:49 pm
Can't exactly help, Rissa. As a child I suffered nosebleeds. Start for reasons -- or no reason at all. In the middle of the night while I was sleeping -- nosebleed. I always caught it. (Wake up and grab nose. Not a drop on the pillow.) Strange?! Couldn't tumble in PE class in school. That would start it. I broke my nose in a car accident at age 17. That cured it. Never had another one.
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Rissa
Member
03-20-2006
| Wednesday, February 21, 2007 - 6:04 pm
Thanks for the response CD. SHe actually had the procedure this afternoon so now I have the answer. LOL It's basically putting a fireplace match in your nose and rubbing it over the exposed vein. The chemicals in the *match* cause the vein to be cauterized. It all went very fast, less then 30 seconds for both sides. Her nose felt bruised for about an hour or so then she went to work. Got a call an hour ago that she had another nosebleed. {sigh} Sorry to hear that you had to break your nose to cure your nosebleeds.
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Luvmom
Member
10-17-2000
| Sunday, February 25, 2007 - 9:28 pm
Well,I feel like a fool looking for advice on something so trivial but,I just broke my pinkie toe tonight.I stubbed it on my couch.I've been icing it on and off for the last 2 hours.I'm just looking for advice on what will help and what to do with it next.Doctors won't do anything for a broken toe.
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Mak1
Member
08-12-2002
| Monday, February 26, 2007 - 4:03 am
Sorry, Luvmom. I know it hurts like the dickens because I did the same thing one time. After the icing phase, all I did was tape it to the toe beside it. I don't know if there's anything else you can do. It was quite swollen for a while and hurt for a long time.
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Luvmom
Member
10-17-2000
| Monday, February 26, 2007 - 12:31 pm
Thanks Mak.I figured it was going to hurt for a while.I can't miss work either and I'm a Pizza Hut Prep Cook.We have no one to fill my place.This is not going to be fun!!
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