[HSF] Organ Donation: Jacob Lavee

Mon Mar 15 09:54:35 EDT 2010

Well I said " life" insurance. That of course is for others but the concept of insurance is not blurred by a "right" to what the insurance is about 
Tea

Sent from my iPhone

On Mar 15, 2010, at 9:34 AM, Michael Firstenberg <msfirst at gmail.com> wrote:

Tea -
actually the answer is: "why even buy it at all"?

-michael

On Sun, Mar 14, 2010 at 11:27 PM, Tea Acuff <tacuff at swbell.net> wrote:

Well apparently that idea is lost in the current "debate on healthcare". It
seems that insurance should equal for all. I should wait to buy life
instance until I need it.
Tea

Sent from my iPhone

On Mar 14, 2010, at 7:12 PM, John Schor <johnschor at mac.com> wrote:

Congratulations (Mazel Tov) to Dr Lavee for initiating a groundbreaking
"experiment" with regard to organ donation in Israel. If you sign a donor
card, you will "move up" on the recipient list.
Great Idea.
Please comment.

John
John Schor, MD
Thoracic and Cardiovascular Surgery
Heart and Vascular Center of
Northern Arizona
Flagstaff, Sedona, and
Cottonwood, AZ
Tel: 928-649-2584

On Mar 14, 2010, at 4:19 PM, Donald Ross wrote:

I hope you have invented a way of making the bleeding time meaningful,
Prasanna.
Now you need to correlate the result with operative blood loss or some such
end point.
With your present experience, would you postpone an operation till  the
fickle finger failed to force flooding?

tea, I am surprised you have not been able to distinguish between regular
sternal bleeding and platelet inhibited bleeding, the latter being
characterised by thin ill formed clots and repeated bleeding from the same
places after diathermy application. On rare occasions it is torrential after
sternotomy and recently we had a case of  OPCAB Lima to LAD in a patient who
was just on aspirin who had three take backs for bleeding and eventually
stopped after many platelet and blood product transfusions.
If he had been closed and put off for a week perhaps the operation would
eventually have been far  less invasive.
Don
On 15/03/2010, at 3:33 AM, Prasanna Simha M wrote:

In fact you know how I came up with the idea, traditionally  in Indian
Mythology Lord Krishna dies due to an arrow hitting his toe. He is
considered a clinical Tetralogy of Fallot based on mythological
description (and was presumably polycythemic and coagulopathic) and
after a particular bad bleeder it set me thinking and I poked the
bleeding patient with a needle and watched the time needed to stop
bleeding and after the basic bleeding stopped finger pressure made it
bleed for a very long time. When repeated with a non bleeder the clot
in that case stayed stuck without bleeding and after that I have used
it when taking a patient early with platelet poisons on.
Prasanna

2010/3/14 Prasanna Simha M <prasannasimha at gmail.com>:
Laugh at your will but there is a difference which I have noted.I have
noted that the patients who continue to bleed with finger pressure for a
longer period of time are the ones which are bloody on table. Maybe related
to stability of clot compared to just platelet plug formation.
Prasanna

On Sun, Mar 14, 2010 at 9:50 PM, Ani Anyanwu <anianyanwu at hotmail.com>
wrote:

No, the bleeding time they do and what I refer to are different. They
stop with spontaneous cessation whereas if you have a look at bleeding
stopping with pressure of the finger , you see a difference.
Prasanna

I do the same but I rub some garlic on before applying pressure - that way
I can tell if the clot formation is more likely intravascular or
extravascular :)

Ani

Date: Sun, 14 Mar 2010 17:14:34 +0530
Subject: Re: [HSF] clopidogrel loaded patients
From: prasannasimha at gmail.com
To: OpenHeart-L at lists.hsforum.com
CC:

No, the bleeding time they do and what I refer to are different. They
stop with spontaneous cessation whereas if you have a look at bleeding
stopping with pressure of the finger , you see a difference.
Prasanna

On Sun, Mar 14, 2010 at 4:52 PM, Donald Ross <donross at bigpond.com> wrote:
We used to do bleeding times and were informed by haematology that it was,
contrary to logic, meaningless.
Don
On 14/03/2010, at 7:14 PM, Prasanna Simha M wrote:

Why not prick their fingers instead of slicing their chests ? In doubt
I do that occasionally especially if they need to be done early. Some
guys just keep dripping even with a needle prick.
Prasanna

On Sun, Mar 14, 2010 at 10:43 AM, Donald Ross <donross at bigpond.com> wrote:

Judging from previous HSF discussions, members either wait 5 days if
possible or just go ahead anyway.
Those who don't wait, presumably, have not had seen extreme
coagulaopathic
problems with this approach.
There is no doubt, however,  that even with aspirin alone some patients
are
exquisitely responsive to anti-platelet medication  and can really have
dangerous bleeding even if the pump is avoided. Furthermore, there does
not
appear to be any reliable lab test for this condition. Perhaps the
"platelet
mapping" TEG offers some hope but I have not been impressed with it's
veracity.
To get around this dilemma I have been advising such patients of this
problem and warning them of the possibility that after opening the chest
the
operation might have to be postponed  for a week. In other words if
serious
coagulopathy is observed clinically then just close chest and wait for a
new
crop of clean platelets before operating on the heart.
This doesn't work for urgent surgery but avoids having so many stable
patients unnecessarily hanging around in hospital.
Barking mad?
Don
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