Post Operative Complications

Joel
Joined: 18 Dec 2008, 23:57

08 Mar 2003, 01:18 #11

I think Kim's story below adds some valuable perspective to this issue.
One Year Ago, I Started 2 Journeys.....
Last edited by Joel on 19 Sep 2009, 15:44, edited 1 time in total.
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ladygrace
Joined: 07 Jan 2009, 19:05

05 Apr 2003, 02:18 #12

Hey Joel, the health effects go way past post surgery complications. I recently had to go on a course of estrogen for some "female problems". The Doc told me if I was still smoking there would be no way any health pro would let me take it--fear of blood clots, etc. I have to tell you, it's the first real encounter I've had about how quitting truly affects my health. I can't begin to tell you how pleased I am to be part of the "I quit" crowd. Thanks for all your help.

Ladygrace...3mos, 1wk, 1 day.....smoke free and living it.
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Joel
Joined: 18 Dec 2008, 23:57

05 Apr 2003, 03:58 #13

Hello LG:
I am lifting the following from our Smoking and Pregnancy . The information about the use of oral contraceptives and smoking is particularly chilling.
FACT SHEET NO. 7

July 2001

SMOKING, SEX & REPRODUCTION

Introduction

Cigarette smoking can affect women's fertility; men's fertility; sexual function in men; pregnant women's health; the health of an unborn child; and the health of young children.

Fertility

Women who smoke may have reduced fertility. One study found that 38% of non-smokers conceived in their first cycle compared with 28% of smokers. Smokers were 3.4 times more likely than non-smokers to have taken more than one year to conceive. It was estimated that the fertility of smoking women was 72% that of non-smokers.[1] A recent British study found that both active and passive smoking was associated with delayed conception.[2] Cigarette smoking may also affect male fertility: spermatozoa from smokers has been found to be decreased in density and motility compared with that of non-smokers.[3]

Male sexual impotence

Impotence, or penile erectile dysfuntion, is the repeated inability to have or maintain an erection. One US study of men between the ages of 31 and 49 showed a 50% increase in the risk of impotence among smokers compared with men who had never smoked.[4] Another US study, of patients attending an impotence clinic, found that the number of current and ex-smokers (81%) was significantly higher than would be expected in the general population (58%).[5]

Overall smoking increases the risk of impotence by around 50% for men in their 30s and 40s. ASH and the British Medical Association have calculated that around 120,000 UK men in this age group are needlessly impotent as a result of smoking.[6]

Smoking and oral contraceptives

For younger women, smoking and the use of oral contraceptives increases the risk of a heart attack, stroke or other cardiovascular disease by tenfold. This effect is even more marked in women over 45.[7] It is therefore important that all women who take the contraceptive pill be advised not to smoke.

Smoking and pregnancy

Approximately one-quarter of pregnant women in the UK smoke. Women who smoke in pregnancy are more likely to be younger, single, of lower educational achievement and in unskilled occupations. The male partner is more likely to smoke. Only one in four women who smoke succeed in stopping at some time during pregnancy. Almost two-thirds of women who succeed in stopping smoking in pregnancy restart again after the birth of their baby.[8] In December 1998, the Government set a target to reduce the percentage of women who smoked during pregnancy from 23% to 15% by the year 2010, with a fall to 18% by 2005.[9] This will mean approximately 55,000 fewer women in England who smoke during pregnancy.

Foetal growth and birth weight

Babies born to women who smoke are on average 200 grams (8 ozs) lighter than babies born to comparable non-smoking mothers. Furthermore, the more cigarettes a woman smokes during pregnancy, the greater the probable reduction in birth weight. Low birth weight is associated with higher risks of death and disease in infancy and early childhood. The adverse effects of smoking in pregnancy are due mainly to smoking in the second and third trimesters. Therefore, if a woman stops smoking within the first three months of pregnancy, her risk of having a low‑weight baby will be similar to that of a non-smoker. 8

Spontaneous abortion

The rate of spontaneous abortion (miscarriage) is substantially higher in women who smoke. This is the case even when other factors have been taken into account.8

Other complications of pregnancy

On average, smokers have more complications of pregnancy and labour which can include bleeding during pregnancy, premature detachment of the placenta and premature rupture of the membranes.[10] Some studies have also revealed a link between smoking and ectopic pregnancy 10 and congenital defects in the offspring of smokers.[11]

Perinatal mortality

Perinatal mortality (defined as still‑birth or death of an infant within the first week of life) is increased by about one-third in babies of smokers. This is equivalent to approximately 420 deaths per year in England and Wales. The increased perinatal mortality in smoking mothers occurs particularly among manual socio-economic groups and in groups that are already at high risk of perinatal death, such as older mothers or those who have had a previous perinatal death. More than one-quarter of the risk of death due to Sudden Infant Death Syndrome (cot death) is attributable to maternal smoking (equivalent to 365 deaths per year in England and Wales).8

Passive smoking and pregnancy

Exposure by the mother to passive smoking has also been associated with lower birth weight, a higher risk of perinatal mortality and spontaneous abortion.[12]

Breast feeding

Research has shown that smoking cigarettes may contribute to inadequate breast milk production. In one study, fat concentrations were found to be lower in the milk from mothers who smoked and milk volumes were lower.[13]

Health and long‑term growth

Infants of parents who smoke are twice as likely to suffer from serious respiratory infection than the children of non-smokers. (See also Fact Sheet No. 8, Passive Smoking.) Smoking in pregnancy may also have implications for the long term physical growth and intellectual development of the child. It has been associated with a reduced height of children of smoking mothers as compared with non-smoking mothers, with lower attainments in reading and mathematics up to age 16 and even with the highest qualification achieved by the age of 23.[14] One study has demonstrated a link between maternal smoking during pregnancy and adult male crime.[15] There is also evidence that smoking interferes with women's hormonal balance during pregnancy and that this may have long-term consequences on the reproductive organs of her children.[16]

Smoking and cervical cancer

Epidemiological studies have found that women who smoke have up to four times higher risk of developing cervical cancer than non-smokers and that the risk increases with duration of smoking. Studies have demonstrated biochemical evidence that smoking is a causal factor in cervical cancer.[17][18]

Smoking and the menopause

The natural menopause occurs up to two years earlier in smokers. The likelihood of an earlier menopause is related to the number of cigarettes smoked, with those smoking more than ten cigarettes a day having an increased risk of an early menopause.[19] New research suggests that polycyclic aromatic hydrocarbons found in tobacco smoke can trigger premature egg cell death which may in turn lead to earlier menopause. [20]
Last edited by Joel on 19 Sep 2009, 15:52, edited 1 time in total.
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Joel
Joined: 18 Dec 2008, 23:57

12 Apr 2003, 01:59 #14

Butt out or no surgery, smokers told
Doctor won't operate unless they quit

Addiction too powerful, critics say
From the Toronto Star
4/11/03


LESLIE PAPP
FEATURE WRITER

Fed up with patients who won't quit tobacco, a Northern Ontario surgeon is refusing to operate on smokers - even if it could save their lives.


And other doctors in the province have the right to do the same thing, says Ontario's medical watchdog, the College of Physicians and Surgeons.

Ethicists label such refusals unfair. Smoking, they point out, is an addiction, and many in its grip don't have the power to quit. They warn that targeting smokers is discriminatory, since lifestyle choices such as eating fatty food play a big role in other diseases, from heart problems to diabetes.

But Dr. Claudio de la Rocha, a chest surgeon who does all lung cancer operations in Timmins, has taken a stand. "Nobody goes under the knife without having quit smoking," he says, tapping his desk with a forefinger.

It's not known how many doctors reject tobacco users. A Winnipeg family physician, Dr. Frederick Ross, made headlines last year when he gave his patients three months to stop smoking or find another doctor.

And surgeons in Melbourne, Australia, have refused to give smokers heart or lung transplants, or life-saving bypass surgery, citing medical and moral grounds.

De la Rocha says that about one in five smokers coming to him are denied surgery; they're unwilling, or unable, to give up tobacco.

Some are outraged by the very suggestion that they butt out. De la Rocha says angry patients have answered him with a one-finger salute and slammed his door so hard, the diplomas on his wall rattled.

"I've had people where I thought, `My God, is this guy going to jump across the desk?'"

Others quietly leave his office, promising to try quitting, and they don't come back.

De la Rocha requires smokers to abandon their habit three to six weeks before a procedure, and he cites sound medical reasons for that.

Studies show that smokers don't do as well as non-smokers on the operating table. Tobacco users are prone to risky complications, such as lung infections and blood clots, resulting in heart attack or stroke.

Smokers also consume valuable health-care resources, de la Rocha says. If society is going to spend thousands of dollars to treat them, it's only fair to ask that they "take the first step" and quit their risky habit.

And there's worry that bad outcomes, aggravated by smoking, could tarnish a surgeon's reputation, de la Rocha says. In the United States, there's extensive monitoring of surgeons' performance, with "report cards" separating the profession's stars from its ****-ups. A trend toward increased accountability is building here, too, making smokers less desirable to have as patients.

Performance report cards "are coming down the pipe," de la Rocha says, elaborating on why he has rejected smokers. "If my reputation is on the line, it stands to reason I would take that step."

According to the Ontario Medical Association, he is well within his rights.

The stop-smoking ultimatum "could be a reasonable thing to say," says Dr. Ted Boadway, executive director of health policy for the OMA and a family physician for 13 years. "You have to look at the risks involved, and every surgeon has to make a decision."

Boadway says he isn't aware of other Ontario doctors refusing to treat smokers, but he has personally dropped patients because they were addicted to drugs or alcohol.

Their problems were "insoluble as long as they continued their behaviour," he says. "You put a huge amount of effort into these folks. And every doctor has their breaking point."

Doctors are free to drop smokers from their patient list as long as they steer them toward appropriate care from some other source, says Dr. Graeme Cunningham, head of the College of Physicians and Surgeons of Ontario.

Doctors ending their relationship with a patient need to give the departing person "a menu of choices," he says. This could be as simple as a list of other doctors expert in treating a patient's particular disease, or hospitals where help is available.

There's no requirement to actually find another doctor for a patient who is sent away, and no policy on whether smokers should be denied treatment because of their addiction.

"We wouldn't take a specific position around smoking and smoking cessation, and people needing lung or heart operations," Cunningham says.

But ethicist Margaret Sommerville says refusing to treat smokers solely because of their addiction unfairly targets this population. It amounts to discrimination, "to the extent that an addiction is a physical and mental disability."

De la Rocha's reply: "I'd like to see that ethicist taking care of a patient in respiratory failure following surgery. That's all."

Doctors are clearly justified in refusing to do a procedure if they feel the risks of an operation outweigh the benefits. But undergoing surgery as a smoker doesn't appear to be riskier than being denied treatment.

"There's a risk in not getting the operation," says Sommerville, founding director of the McGill Centre for Medicine, Ethics and Law in Montreal.

"As well, the physician must make sure that the refusal to treat would be a last-ditch option, that all other ways of solving this situation - such as offering support and addiction treatment - have been explored."

De la Rocha says he tries to be flexible. He relies on family physicians to provide smoking-cessation services and to refer patients to other specialists. An emergency case is always treated. And sometimes, when a patient is a particularly heavy smoker and is desperately trying but unable to stop, he settles for a big drop in cigarette use - something like a 75 per cent reduction.

"That's a good chunk."

Those who fail to quit, or refuse, must find another surgeon. And that means going to Sudbury or Toronto.

"Can they find someone?" de la Rocha muses. "I have no idea. I don't follow them up."

Other doctors say they've been tempted to drop smokers.

"I have considered it," admits Dr. Gail Darling, a chest surgeon at Toronto General Hospital who has operated on more than 1,000 lung cancer patients. But she has decided to continue treating tobacco users even if they don't quit.

"Smoking is an addiction (and) addiction is a disease," she says. "It's a terrible thing."

Dr. Jon Irish, chief of surgical oncology at Toronto's University Health Network and Mount Sinai Hospital, says he has heard anecdotes about Ontario physicians refusing to treat smokers, adding he might have been sympathetic to such a policy early in his career.

Now, after years spent watching smokers suffer from their habit, he says denying care "is a pretty harsh line to take."

Irish specializes in cutting out head and neck cancers - diseases mainly caused by tobacco use.

About 90 per cent of his patients are smokers and Irish is "very adamant" in pushing them to quit. Almost 60 per cent of them do, he says, citing his own study, soon to be published in a medical journal.

But Irish doesn't deny treatment to patients who don't butt out. That would amount to punishing them for an addiction over which they have little control, he says. And they're being punished enough.

"If you have a cancer and I'm going to take out your tongue or take out your lung or take out your bladder, that's a pretty high price to pay," Irish says.

"That's a pretty good incentive to stop smoking. If you continue to smoke, that, to me, signifies addiction."






Reply  Message 35 of 35 in Discussion From: Joel      Sent: 4/11/2003 12:53 PM

Since I put up the article above on doctors refusing to treat smokers, I thought I had better attach this post again from a couple of years back.



From: Joel.               Sent: 2/9/2001 8:07 AM This thread touches on another aspect of the denial of treatment string. I do realize it is a sensitve issue and I understand the line that it straddles and seems to cross to some people. But often the physician has the best interest of the patient in mind when taking such a hard line approach. I recognize it because it is not all that dissimilar to the hard line approach we take here at Freedom, and for the same reason, we recognize that success or failure in quitting is a life and death issue. Unless viewed that way a smoker is likely to push his or her luck, smoking till the very last moment, sometimes his or her actual last moment. When refusing treatments, physicians and dentists may not only be trying to minimize their liability, improve their statistics or accomplish any other self-serving goal, they are sometimes just trying to save the person's life in the best way they know how, influencing the smoker to quit and then letting them repair what damage they can.

I think the people who responded to this string months ago recognized this issue. I was at my dentist yesterday who coincidently brought up this same topic. He was saying how periodontists often refuse procedures on smokers, one for the chemical irritation that smoking will do to the surgery and the other reason for the sucking motion on a cigarette causing problems with the sutures needed for procedures. He also brought up some issues specific to women and estrogen and smoking that apparently is playing havoc in some periodontal diseases. I am going to look into the issues when I get a chance.

Also when I was leaving the dental office, one of the office staff stopped me because her daughter had just left her a message on how she was going crazy after two days without smoking. I actually ended up in a 15 or 20 minute phone conversation with the daughter. Ended up missing my lunch but it was worth it if it gets her through that all critical third day mark.

I think it is important for everyone here to recognize that you all have been getting an education and an understanding of the nicotine addiction and its treatment that is helping you to stay nicotine free. But that understanding will not only be beneficial for you but for many around you. Most people don't know this information, even some of your medical professionals. Share with them your success and your knowledge.

You would be amazed at just how many people you may touch. When you are at your doctor or dentist, let them know you quit and how you did it and how you feel now that you quit. Don't assume this is uninteresting information, or something they have heard a thousand times before. It may have been told to them by others but they may not have actually heard it or assimilated the material. The most important message you can get across to them is your understanding of nicotine addiction.

Again, being medical professionals they may understand the danger or smoking but they often don't understand and have never been trained on the issue of the nicotine addiction. Share that information. The most important message you can share with them is your understanding of how you stay smoke free and how all their other patients can accomplish the same goal, if they simply understand the importance of remembering to never take another puff!


Joel
Last edited by Joel on 16 Feb 2011, 19:14, edited 1 time in total.
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Joel
Joined: 18 Dec 2008, 23:57

21 May 2003, 01:19 #15

Image By not smoking you are enhancing your chances of overcoming potentially life threatening diseases and conditions.
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CanadaBobGold
Joined: 07 Jan 2009, 19:46

14 Jun 2003, 15:03 #16

Haven't been around much lately, especially not posting as I'm laid out flat recovering from the first (left leg) of two femoral artery bypass operations. The surgeon is certain that we've got a winner... as long as I never, ever take another puff.

He's warned me that if I ever start smoking again, he'll refuse to do any more surgery on me and the bypasses will most likely fail. The next step would be a life of even more limited mobility than the totally blocked arteries caused by 37+ years of heavy smoking.

Better late than never? From where I'm sitting, YES.

5 months, 13 days, 1 hour of not smoking
5396 cigarettes not smoked
$2319.79 CDN saved
18 days, 17 hours of my new life saved
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John (Gold)
Joined: 18 Dec 2008, 23:57

10 Jul 2003, 10:46 #17

Ann Surg. 2003 Jul;238(1):1-5.

Abstinence from smoking reduces incisional wound infection: a randomized controlled trial.
Sorensen LT, Karlsmark T, Gottrup F.
*Copenhagen Wound Healing Center and the dagger Department of Surgical Gastroenterology, Bispebjerg University Hospital, Copenhagen Hospital Corporation, Denmark.
OBJECTIVE Clinical studies show that the incidence of postoperative wound complications is higher in smokers than nonsmokers. In this study, we evaluated the effect of abstinence from smoking on incisional wound infection.
METHODS Seventy-eight healthy subjects (48 smokers and 30 never-smokers) were included in the study and followed for 15 weeks. In the first week of the study, the smokers smoked 20 cigarettes per day. Subsequently, they were randomized to continuous smoking, abstinence with transdermal nicotine patch (25 mg per day), or abstinence with placebo patch. At the end of the first week and 4, 8, and 12 weeks after randomization, incisional wounds were made lateral to the sacrum to excise punch biopsy wounds. At the same time identical wounds were made in 6 never-smokers. In 24 never-smokers a wound was made once. All wounds were followed for 2 weeks for development of wound complications.
RESULTS A total of 228 wounds were evaluated. In smokers the wound infection rate was 12% (11 of 93 wounds) compared with 2% (1 of 48 wounds) in never-smokers (P <0.05). Wound infections were significantly fewer in abstinent smokers compared with continuous smokers after 4, 8, and 12 weeks after randomization. No difference between transdermal nicotine patch and placebo was found.
CONCLUSIONS Smokers have a higher wound infection rate than never-smokers and 4 weeks of abstinence from smoking reduces the incidence of wound infections.
PMID: 12832959
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Toast (GOLD )
Joined: 18 Dec 2008, 23:57

27 Jul 2003, 01:13 #18

Well, yesterday morning I had arthroscopic knee surgery - in the big scheme of things, not a major surgery, but still a big deal! Seems I tore some cartilidge in my knee practicing my kung fu kicks a little to enthusiastically last fall. Image Image

Everything went incredibly smoothly! I was home in under 3 hours. I have had NO pain - it's been amazing. I mean, of course my knee is sore, but not enough to even consider taking any medication. I feel great!

I am so grateful to not even worry about smoking during all this. Not wishing I could sneak out and smoke while I waited in pre-op for an hour, not having to light up first thing out the door and chainsmoke all the way home. Not have to hobble up every 30 minutes or more to go out & smoke all day yesterday when I needed to be w/my knee up & iced. And all that is really minor and incidental when I consider the whammy smoking does on the whole body, slowing healing, complicating meds, etc.

Thank you Freedom!

Image Melissa
26 months
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jdinkcmoGOLD
Joined: 19 Dec 2008, 00:02

21 Sep 2003, 01:24 #19

Hello Joel,

I feel compelled to add my story to this string just in the hope it will help someone else lurking out there. When my lumbar vertabrae failed some 2+ years ago, the back surgeon operated using screws, rods and hip bone implants. This was done on 10/01 and I was an active addict at the time. All seemed to go well EXCEPT the bone grafts did not heal and by spring of 2003, X-rays revealed one of the four 3" long titanium screws had totally broken in two. Why didn't I heal? Nicotine, plain and simple. The surgeon had warned me but we addicts don't always hear.

OK, I quit smoking in early January this year, so by the time my surgeon was ready to operate this time, I was a confirmed quitter. The back problem had grown way worse in this length of time, so I had to undergo TWO surgeries (June and August) just to repair the damage, yet again. Do I look back with regret that I didn't give it up in 2001? You bet I do, because 2 more back surgeries is not a day in the park, believe me. When I was at the doc's recently, I told him about whyquit & freedom and suggested he NEVER operate on a smoker and to tell them about me. If my story helps just one smoker to quit, it'll have been worth it. JD

Judy is SILVER and has been nic free for: 8M 4D 10h 12m and has NOT smoked 11179 smelly cigs, for a grand $$$ savings of $1,872.50 plus life of Freedom extended by: 1M 1W 19h 35m.
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CandidCandiSilver
Joined: 18 Dec 2008, 23:58

17 Nov 2003, 06:38 #20

Thanks, Joel, for bringing up this thread this morning. Helps to reinforce my quit as surgery looms this Thursday! Loved reading the posts from some of the "regulars" I've come to know in the last three weeks. Wish I'd stuck with my August quit, but, alas, I didn't know about Freedom and I didn't know a lot of things about nicotine addiction . . . . . . . or as a friend often says "I had Compound Ignorance . . . . . I didn't know I didn't know!"

I can't say enough about this group . . . . thank you, thank you . . .

Candi
I have been quit for 3 Weeks, 3 Days, 18 hours and 58 minutes (24 days). I have saved $90.23 by not smoking 694 cigarettes. I have added 2 Days, 9 hours and 50 minutes to my life.
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