Treatment for Bladder Spasms

Most surgical patients end up with a catheter placed into the bladder to drain urine (Foley catheter) some time during their stay. One bothersome side effect of these catheters can be painful and recurring bladder spasms. The best treatment is to remove the catheter of course. If the catheter can not be removed, often B and O (belladona and opium) suppositories are prescribed. However, this is also unpleasant for the patient.

One trick that urologists and urology nurses usually try before the b and o suppository is simply moving the Foley bag from its usual position on the floor or hooked onto the railing to placing it flat on the bed. This puts the catheter, tubing, and bag close to the level of the bladder and removes the pressure that the catheter exerts on the sensitive lower part of the inside bladder. This maneuver is often enough to stop the spasms but still allows the urine to drain.

Copyright 2006 Insidesurgery.com

The Glasgow Score in Head Trauma

Head trauma is unfortunately very common in the United States and is a leading cause of death in the young adult age group. Diagnosing the severity of a head injury is an inexact science but one common scoring system used widely is called the Glasgow Coma Scale. Patients are assigned points in three categories: eye opening (1-4); best verbal response (1-5); and best motor response (1-6). The lowest score is 3 which is a coma and the highest score is 15 which is minimal injury. The category that surgeons look at most closely is the best motor response.

Copyright 2006 Insidesurgery.com

Biopsy Technique for Moles

Almost universally surgeons recommend that an excisional biopsy be used when removing moles that are worrisome for melanoma. This type of biopsy removes the entire mole and the surrounding skin down to the the level of fat. If the biopsy does come back as a melanoma this type of biopsy allows the pathologist to determine how deeply into the skin the melanoma has penetrated (the Breslow level). This is important in determining the aggressiveness that is needed for the next operation and also in determining the prognosis.

Unlike surgeons, many dermatologists prefer to do a shave biopsy on moles. This is done by using a tiny, sharp, spoon-like device to shave off the top of the mole. It is easier and faster to perform and usually does not require stitches. But, if the biopsy comes back as a melanoma the opportunity to tell how deep the melanoma is has been lost.

Allergy to Surgical Staples

Surgical staples that are used to close skin incisions contain a significant amount of nickel. About 60% of Caucasians are allergic to nickel. This causes a mostly harmless red area around each individual staple (it may make the incision slightly more noticeable when fully healed). Some patients and inexperienced practitioners can mistake this localized reaction for an infection.

Stopping Glucophage

Almost all doctors recommend stopping metformin (a pill taken to control blood sugar in diabetes) at least 24 hours before any surgical procedure, endoscopy, or CT scan or other radiology study that uses certain contrast dyes. This is to lessen the risk of developing a rare but often fatal condition called lactic acidosis, which is the build up in the body of lactate. One of the brand names that metformin is sold under is Glucophage.