Thin Blood - Am I suitable for surgery?

[Colorado Kid]

Hello,

I recently had a consultation with a Dr. in my area.  I brought attention to the fact that I've experienced thin blood within the last year or so.  I believe this to  be attributed to the use of vitamins and herbal supplements, but I've never consulted a general practitioner about this.  The Dr. felt confident that it was due to the vitamins and told me to quit taking them two weeks prior to surgery.  He also stated that I should not have any alcoholic beverages 2-3 days preceding surgery.  This evening, after reading through several sites, I read that a particular doctor requires a "CBC" prior to surgery, and a "PT/PTT" may be requested in addition if the patient had been using aspirin containing medications or vitamins/supplements.  Do you feel this is necessary in all circumstances?  And, should I be concerned that my Dr. had not asked for these items?

In addition, I have not seen a general practitioner  for several years.  I am 27 years old and in seemingly good health.  I also found it to be strange that I need not have a physical/check up prior to surgery.  What is your opinion of this?  Do you require this of your patients prior to surgery?

This particular Dr. has many, many years of experience.  I've done extensive research on this Dr. and noticed he is certified through 2 boards, has never had his license restricted/revoked, and is free of state or federal disciplinary  actions, however, I did find that he has settled 3 malpractice cases in his career.  Should I be concerned about this? 

I truly appreciate any input you may have.  I'm trying to make the most educated decision possible. 

Best Regards,

Kolorado 

[DrBermant]

Hello,

I recently had a consultation with a Dr. in my area.  I brought attention to the fact that I've experienced thin blood within the last year or so.  I believe this to  be attributed to the use of vitamins and herbal supplements, but I've never consulted a general practitioner about this.  The Dr. felt confident that it was due to the vitamins and told me to quit taking them two weeks prior to surgery.  He also stated that I should not have any alcoholic beverages 2-3 days preceding surgery.  This evening, after reading through several sites, I read that a particular doctor requires a "CBC" prior to surgery, and a "PT/PTT" may be requested in addition if the patient had been using aspirin containing medications or vitamins/supplements.  Do you feel this is necessary in all circumstances?  And, should I be concerned that my Dr. had not asked for these items?

When a patient has a history of bruisibility or bleeding issues I ask for clearance from a Hematologist a specialist of the blood. While a single baby aspirin 2 weeks before or after surgery can increase bleeding risks during surgery, aspirin has no effect on PT/PTT and instead reflects on template bleeding time or other platelet function tests like PFA. The PT/PTT testing does not reflect function of platelets at all.  What testing is indicated depends on many factors starting with a thorough history and examination. Depending on age and other medical history, basic lab testing for all gynecomastia surgery is not warranted in my opinion and has left the standard of care many years ago as an unnecessary excessive cost and waste of resources.

Like aspirin, here are many other medications and over the counter substances that can interfere with clotting ability. Many of these blood thinners are not regulated and get into many innocuous products, drinks, and supplements. Never the less, they can wreck havoc on elective surgery causing unnecessary bleeding, bruising, and complications.

In addition, I have not seen a general practitioner  for several years.  I am 27 years old and in seemingly good health.  I also found it to be strange that I need not have a physical/check up prior to surgery.  What is your opinion of this?  Do you require this of your patients prior to surgery?

Basic general practitioner screening for all elective surgery is also not standard of care unless there are other factors. When a patient has medical problems that are being treated but have not been evaluated for quite some time, a check up is a smart move. One such example would be a patient who is on thyroid medication, has not been evaluated for a long time, and now has thyroid symptoms. Surgery without clearance is risky.  However, again, I prefer a specialist like an Endocrinologist for thyroid problems.

This particular Dr. has many, many years of experience.  I've done extensive research on this Dr. and noticed he is certified through 2 boards, has never had his license restricted/revoked, and is free of state or federal disciplinary  actions, however, I did find that he has settled 3 malpractice cases in his career.  Should I be concerned about this?  

I truly appreciate any input you may have.  I'm trying to make the most educated decision possible.  

Best Regards,

Kolorado  

Malpractice cases that have been settled are a possible sign of doctor issues. Learning about what was done, can be revealing. For some of the disasters I have seen from other doctors, when I looked up that doctor, I sometimes find a trail of malpractice cases, censures, loss of license, discipline, lack of Boards in Plastic Surgery, and other factors that a thorough check up by a patient should have raised concerns about choice of that doctor.

I have posted a section on picking your gynecomastia surgeon here:

http://www.gynecomastia.org/smf/index.php?topic=16474.0

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction

[Dr. Elliot Jacobs]

What do you mean and how do you know that you have "thin blood?"  That is not a medical term.

If indeed you have evidence of easy bruising or prolonged bleeding, this should definitely be worked up by a physician.  If your blood is thin because you are anemic, then this too requires a thorough work-up.

Many young men in their teens and 20's feel invulnerable and do not see a doctor for routine blood screening and a physical exam at least once a year.  And while major disease is much more rare in younger people, it does occur.

Would therefore suggest you get a thorough workup with your general care doctor -- and if any irregularities occur in your blood tests, then further workup by a specialist would be indicated.

Your gyne surgery is elective -- it can be done at any time.  But it should be done when you are in the best shape possible.

Good luck!

Dr Jacobs

[Colorado Kid]

Thanks, I appreciate the input.  Just to be on the safe side I will schedule an appointment for an examination pre surgery.

Regards,

Kolorado

[George Pope, M.D.]

This particular Dr. has many, many years of experience.  I've done extensive research on this Dr. and noticed he is certified through 2 boards, has never had his license restricted/revoked, and is free of state or federal disciplinary  actions, however, I did find that he has settled 3 malpractice cases in his career.  Should I be concerned about this? 

I truly appreciate any input you may have.  I'm trying to make the most educated decision possible. 

Best Regards,

Kolorado 

Settling a malpractice case does not always mean that a doctor or surgeon is at fault.  In many cases the surgeon's malpractice insurance company can force a settlement, because that is cheaper than going to trial.  It sounds crazy, but it's all about the bottom line to insurance companies.  In addition, going to trial is risky, even when a surgeon has done nothing wrong and feels confident that he or she can win.  All it takes for a doctor to lose a case is a jury sympathetic to the plaintiff, even if the facts of the case don't support the jury's decision.

Here in Florida there's a crazy law: "Three strikes, you're out".  If a doctor loses 3 malpractice cases, he/she will lose his/her license.  Because of that, many docs will settle a case they're likely to win, in order to avoid the hassle/expense of a trial, as well as the risk of losing for the reason I mentioned above.

In other words, there are many reasons a malpractice case may have been settled; doesn't mean the doctor did anything wrong.  That sounds crazy, but the med malpractice climate here in Florida is like nowhere else, so that's reality.

I suggest you actually ask your surgeon about the 3 settlements, if you're concerned.  You probably won't be the first patient who has asked.

Dr. Pope, M.D.

[Colorado Kid]

Update:

I went in for blood work and everything came back within normal range.  Better to be safe I suppose.

Thanks for the input.

Kolorado