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Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4087_Библиотеки_им_академика_М_И_Перельмана

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thepresentandtakealookatwhathappensinthehospitalifyoushouldrequireanoperationtotreatyourveins.
YourStayinHospital
Formanypatients,comingintohospitalforvaricoseveinsurgeryisanewandpossibly,ratherfrighteningandanunpleasantexperience.Thissectionsetsoutto
alleviatesomeofthosefearsandtogiveyousomeideaofwhatyoumightexpectduringyourstay.Wemustpointoutthatsurgeonsandhospitalsdo,ofcourse,vary
fromcountrytocountry,andtheycanalsovarywidelyintheirroutinesfromareatoareawithinacountry.Sodonotbetoosurprisedifthingsprovenottobeexactly
asstatedhere.
Thefactisthatdoctorsareindividualists,andthisparticularlyappliestosurgeons.Everyexperiencedsurgeonworksouttheroutinethatgivesthebestresultsinhis
hands,justasanyothertechnicianwoulddo.Surgeonsthereforedifferinthetypeofstitchestheyuse,howlongtheykeepthemin,thebrandofskinantisepticthey
liketoemploy,themakeofbandageorstockingtheyutilize,thenumberofdaystheyrecommendyoutostayinhospital,andinmanyotherrespects.However,your
surgeon,hishousesurgeon,orthewardsisterwillexplaintoyouwhichparticularroutinetheyemploy.Theywillalsoinformyouabouthowlongyouaregoingtobein
hospital,whenthestitchesorclipsareduetobetakenout,howlongyouneedtobeoffwork,andsoon.
Hereisabasiclistofthethingsyoushouldtakewithyouforyourshortstayinthehospital:
1.nightclothesandadressinggown;
2.slippers;
3.toiletries;
4.boxofsoftpapertissues;
5.plentyoflightreading;
6.writingmaterialandapen;
7.abottleoffruitjuiceorcordial;and
8.somesmallchange—butdon'ttakeanyvaluablesifyoucanpossiblyhelpit.
Mosthospitalsprovideearphoneslinkeduptothehospitalradiosystem,butifyouwanttotakeyourowntransistorradiowithyou,do
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makesurethishasanearpiece;otherpeoplemaywanttosleepormaynotwanttolistentoyourparticulartypeofentertainment.
Manyhospitalsadmitpatientsforoperationsofintermediateseverity(andthisincludesvaricoseveins)adaybeforesurgery.Thisenablesthesurgicalstafftocheck
youoverthoroughlyandtogiveyouafullmedicalexamination.Thetimewillalsogiveyoutheopportunityofmeetingthewardsisterandhernurses(youwillsoonfind
outtheyarejustasimportantasthedoctors),learnsomethingaboutthewardroutineandenableyoutofindyourwayabout.Somehospitalswillarrangeanearly
morningadmissionforanafternoonoperation,especiallyifthisistobedoneunderalocalanaesthetic.
WhysomanyChecks?
Whenyougetintohospitalyouwillquicklyrealisehowapttheword`patient'is—youcertainlyhavetobe!Itseemsasifeveryoneisaskingyouyourname,age,
address,nameandaddressofyourdoctor,nextofkin,andsoon.Thiscarefulroutinedocumentationensuresthatyourrecordswillbeaccuratelyfiled;thatyour
doctorwillgetareporton
Ofthemanyhospitalchecksyouwillhavebeforeyourvaricoseveinsoperation,
themostimportantwillbemadebytheHouseSurgeon.
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yourstay;andaboveallthatyouwillhavethecorrectoperationperformed!Inveryrareinstancespeoplehavegotmixedupinhospital.Notsurprising,perhaps,when
yourealisethathospitaltheatresmaybecarryingout20ormoreoperationsadayandperhapstherearetwoorthree`JohnBrowns'andacoupleof`MarySmiths'
onthelist.
Nowadays,though,thisisalmostimpossible,aseachpatientiscarefullylabelledwithaplasticnametag,usuallyaroundthewrist,onadmission.Theexactsiteofthe
operationisindicatedonthepatientwithanindeliblemarkingpencil(so,inthecaseofavaricoseveinoperation,thesemarkswillbeplacedontheaffectedlegand
perhapsovertheparticularveinsthatthesurgeonwishestodealwith).Theanaesthetistwillcarefullycheckyournameanddetailsalloveragainjustbeforethe
operation,whileyouarestillawakeintheanaestheticroom;howevertiresomeitmayseemtothepatient,itisasafeguardwethoroughlyapproveof.
Havingbeendocumented,youwillnextbeseenbythehousesurgeon,whosejobitistogiveyouthecompletecheckovermentionedabove.Youwillbeaskedalot
ofquestionsaboutyourgeneralhealthandyouwillbeexaminedfromtoptotoe.Perhapsyouwillfindthisrathersurprising,possiblyevenalittleembarrassing,when
afterallyouareonlybotheredaboutsomeveinsonyourleg.Nevertheless,thisissomethingyoushouldwelcome.Chapter8describessomeofthethingsthatcan
imitatethefeaturesofvaricoseveinsandtheircomplications,anditisjustaswelltobeabsolutelycertainbeforesurgerythatitisyourveins,andonlyyourveins,that
arethetrouble.Inaddition,itisobviouslyvitallyimportantthatasimpleoperationforvaricoseveins,whichiscertainlynotessentialtolife,shouldbecarriedout
withoutanyriskwhatsoever.Thatiswhythehousesurgeonislookingforanyevidenceofrecentchestinfectionoracold,raisedbloodpressure,undiagnosed
diabetes,andsoon,allofwhichmightintroducesomeelementofhazardintotheanaestheticandtheoperation.
YoumayhavehadyourchestXrayedatyouroutpatientvisit;ifnot,itmaybedoneatthisstage.Abloodtestisalsousuallyroutineinmosthospitals.Manypeople
haveafearofinjections,possiblyahangoverfromchildhoodwhenbothsyringesandneedlesseemedsohuge!Butmodernneedlesareveryfine(andverysharp)and
thehousesurgeonorthelaboratorytechnicianisveryskilledincarryingoutthetestwiththeminimumofdiscomfort.
Aspecimenofyoururineisalwaystakenbyoneofthenursesanditistestedforsugar,bloodandproteinlevels.Again,thisisaverysensi
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bleprecaution,andonewhichoccasionallypicksupthingssuchasunsuspecteddiabetes.
Ifyouareadmittedtoateachinghospitalyouwillalmostcertainlyhaveamedicalstudentassignedtoyou.Heorshewillhavealreadyspent23yearsinmedical
school,willbekeen,intelligent,enthusiasticanddedicated—andnottheleastlikesomeofthecharactersyouseeinthevarioustelevisionseries!Theywillcheckyou
overandwillbesomeonetotalkto,aswellassomeonetotakeagreatinterestandcareinyourcase.
Therestofthedayisyourown,timetogettoknowthenursesandtheotherpatientsontheward,andthisiswhereyourbooksandmagazineswillcomeinhandy.
PreparingfortheOperation
Eitherthatday,ormoreusuallyonthemorningoftheoperation,theareathatistobeoperatedonwillhavetobecompletelyshavedofhair.Thismeans,inmost
varicoseveinsoperations,thewholeoftheleg(orlegs)andthepubicarea.Howeverthisisusuallyperformedintheatre,asithasbeenshownthatthisisassociated
withalowerchanceofdevelopinganinfectionafteryouroperationthanifitisperformedonthewardbeforehand.
Shavingisnecessarysothatthesurgeoncandisinfecttheskinproperly,stitchupthewoundwithoutgettingbitsofhairintoit,andgetthedressingssafelystuckdown
ontotheskin.Asthehairsgrowback,theareadoesoftenfeelalittleuncomfortableanditchy,butthereisnowayofavoidingthis.
Sleepinginastrangebedthenightbeforeanoperationisnoteasy,sodonottorefusethesleepingpillthatisprescribed;youwillbenefitfromagoodnight'ssleep.
Onthemorningofyouroperationyouwillhavetodowithoutyourbreakfast.Indeed,ifyouarescheduledforearlymorningsurgeryyouwillbestarvedofallfoodand
drinkfrommidnightbeforehand.Ifyouareontheafternoonoperationlistyouwillbeallowedanearlymorningcupofteaorcoffee.Keepingyouwithoutfoodisa
vitalprecautiontoensurethatyourstomachiswellandtrulyemptiedbythetimeyoucometohaveyouranaesthetic.Thiscutsouttheriskofvomitingduringthe
introductionoftheanaestheticandmeansthatalthoughyoumayfeelalittlenauseatedandqueazyafterwards,youareveryunlikelyactuallytobesick.Youmaybe
worriedthatyouaregoingtobesick,perhapsasaresultofanunpleasantexperiencemany
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yearsago,butwithmodernanaesthetictechniquesitisunusualafterthistypeofsurgery.
TheAnaesthetic
About90minutesbeforeyouroperationyouwillreceiveyourpremedicationinjection(abbreviatedbythehospitalstaffasthe`premed').Thisusuallyisgivenintothe
tissuesofyourbuttock,whicharerelativelyinsensitiveandaverysafesiteforinjections.Thepremedicationhastwoeffects;itmakesyoufeelpleasantlydrowsyand
freefromanxiety(youmayevengocompletelyofftosleep),anditmakesyourmouthfeelverydrybutthedryingupyoursecretionsisanadditionalhelptowardsa
safeanaesthetic.Ifyouhavedenturestheseareremoved,sincetheycouldbeverydangerousifleftinplacewhileyouareunconscious.
Whileyouareinthispleasantlydozystate,youwillbecollectedandtakentotheoperatingtheatreonatrolley.InnearlyallhospitalsinBritaintheoperatingtheatre
hasanannex,knownastheanaestheticroom,wherethepatientisputtosleepbeforebeingtakenintothetheatreproper.Othercountrieshavedifferentroutines,of
course;intheUnitedStates,forinstance,thepatientisusuallywheeleddirectlyintotheoperatingroomandputtosleepthere.Britishsurgeonsandanaesthetiststhink
thatanaestheticroomsareagreatadvantagetothepatients,andtheyarealwaysadmiredbyAmericansurgeons.However,forsomereasonoranother,wecannot
seemtopersuadethepowersthatbetointroducethemintohospitalsintheUnitedStates.
Theolddaysofhavingamaskputoveryourfacetoputyoutosleeparelongpast.Analmostpainlessinjectionintoyourarmattheelboworintothebackofyour
handsendsyouoffintoadreamlesssleepwithinafewseconds.
Onwakingafteryourvaricoseveinsoperationyouwillfindyourselfbackintherecoveryannexoftheoperatingtheatreortuckedupinyourownbedontheward.
Thewoundwillcertainlyfeeluncomfortable(manypatientsdescribeitashavingbeenkickedontheleg)butthiscanberelievedquiteeasilybyapostoperative,pain
relievinginjection.Youmayfeelveryslightlynauseatedbutusuallywithinafewhoursyouareabletositupinbedandenjoyadrink.
Insomecases(somesurgeonsdothisasaroutine)theoperationiscarriedoutunderalocalanaestheticandwehaveusedthisformofanaesthesiaforvaricosevein
operationsonmanyoccasions.Thepatientmaybefrightenedofgoingtosleep(justasothersarefrightenedof
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stayingawake!)ormayhavesomeslightproblemthatmakesalocalanaestheticpreferableandsafer.Inthesecircumstances,thepreoperativepreparationsarevery
muchthesameasalreadydescribed,rightuptoandincludingthepremedicationinjection.Insteadofbeingputtosleepintheanaestheticroom,however,youare
takenstraightintotheoperatingtheatreandfeelonlyoneortwopricksintheskinatthesitesoftheoperation.Afterthisyouaresimplyawarethatthesurgeonis
workingonyourlegusuallyit'snothingmorethanalittlediscomfortandindeedmanypatientsdozeoffandsleepthroughitall.Althoughsomesurgeonsmightlike
anaudience,weprefertoputupascreensothepatientcannotwatchus.
WhenyougetHome
Itisrarelynecessaryforpatientstostayinhospitalmorethanadayorsoaftertheusualvaricoseveinsoperation.Indeed,inmostcentrestheoperationsarecarried
outasadaycaseandthepatientreturnshomeontheeveningofsurgery.Hereareafewdo'sanddon'tsforyouwhenyoureachhome.
Dressings
Usuallythesurgeonwilladviseyoutoleavethedressingshehasputonuntouched.Thiscouldvaryfrom5to10daysaccordingtothetypeofoperation,thetypeof
stitchusedandtheparticularpreferenceofyoursurgeon.Thehospitalwillarrangeforyourowndoctorornursevisitortoremoveanynon
absorbablesuturesforyou,
eitherathomeoratthedoctor'ssurgery.
Somehospitalsprovideanemergencydressingincasetheoneyouhavebecomeslooseorwet.Ifyoudohaveanykindofproblemwiththedressingyoushouldlet
thesurgicalstaff,thewardsisteroryourowndoctorknowatonce.Also,ifyounoticeaslightoozeofbloodfromthewoundoraminordischarge,thistooshouldbe
reported.
Bathing
Whenyourleghasdressingsonitandisbandaged,bathingwillbeaproblem.Trytokeepthewholeareadry,particularlythegroinarea.Thealternative,ifyouhavea
showeravailable,istowrapthewholeofyourlegandgroininabigplasticbag,screwingituptightabovethedressing,andthentakingaquickshower.Most
surgeons,however,will
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''WernerBokelberg/theImageBank,©1999"
Walkingisalwaysgoodforvaricoseveins.Butafter
injectiontreatmentorsurgeryabriskdailywalk
insupportstockingsisessentialtopreventtheriskof
stagnantbloodclottingintheleg.
applywaterproofdressingstoyourleg,whichwillwithstandaquickshowerafter48hours.Donotsoakinabathforlongperiodsuntilthedressingsareduetobe
removed.
Exercise
Walkingwiththelegwellsupportedbyanelasticstocking,overthebandagesatfirst,theruleisthemorewalkingyoucandothebetter!Aimat3miles(5kilometre)a
day,startingassoonasyougethome,butwhenyou'resittingdownorlying,propyourlegupintheair.
Sleeping
Propyourleg(orlegs)uponpillowssothattheheelontheoperatedsideisabovethekneeandthekneeabovethehip.Thisishelpedifyouhavethefootofyour
bedraisedonafirmpieceofwood,somebricksorapileoftelephonedirectories.Elevatingyourlegwillputit
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inthemostcomfortablepositionforthenightaswellashelpingtodrainanyfluidthatmightotherwisecauseswellinginyourlegwhenyouarestanding.
Driving
IfyouliveinthemiddleoftheAustralianbush,andthereisnooneelseforhundredsofmilesaround,thereisnoreasonatallwhyyoushouldnotdriveyourcaralmost
atonce,aslongasyouarefreeofpain.Accidentshavebeencausedbypatientshavingtobrakequicklythennotdoingsoastheyexperiencepainparticularlyinthe
groin.Also,ifyouliveinruralpartsoftheUnitedStatesorBritainyoushouldbeabletodriveassoonasyoufeelable.Unfortunately,mostofusdonotliveinsuch
idyllicsurroundings.Anyonelivinginornearcrowdedcitieswillhaveexperiencedotherdriversontheroadcrossingoverontheredlights,pedestrianssteppingoff
pavementsdirectlyinfrontofacarandmotorcyclistsdrivingthewrongwaydownonewaystreets.Allthesecircumstancesmean,ofcourse,thatyoumayhaveto
stamponthebrakesandyoucanjustimaginehowdifficultthatisgoingtobewitha
Improvisingamethodofkeepingyourlegraisedaboveyourhips
atworkhereachievedwithadeskwillreducethepressureinyourlegveins
andaidswiftrecoveryaftersurgicaltreatment.
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ratheruncomfortableincisioninthegroinandyourlegwrappedinbandages.Forthisreasonouradviceisnottodriveyourcarincitiesortownsuntilthewoundis
nicelyhealed,thestitchesareoutandthelegisquitecomfortable.Usuallythisisabouttwoweeksaftertheoperation.
Work
Thisdependsalmostentirelyonwhatyourworkhappenstobe.Ifyoucanworksittingatadeskandthereissomeonetogetyoutoyourjobandhomeagain,youcan
bebackatworkwithinafewdays(butremembertotryandkeepyourlegraisedasmuchasyoucanwhilesittingatthedesk,tableorwork
bench).Attheotherend
ofthescale,ifyouareengagedinheavymanualwork,afarmerforexample,youwillwanttohaveyourlegcompletelyhealedbeforegettingbacktofullactivity.
Againthisisgoingtobe23weeksfromthetimeofsurgery.Thesamerestrictionappliesbeforeyoucantakeupveryactivesports.
Noneoftheserestrictionsshouldbeveryarduous.Mostlyyouwillbeonlytoopleasedtoberidofthetroublesomeorunsightlyveinstoriskanythinggoingwrongat
thislatestage.Unfortunatelythereisagroupofpatientswhowillhavetoputinalotofhardworkbeforetheycanevenbegintreatment:these,theseriously
overweight,weshallconsiderinChapter7.
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Chapter7—
LosingWeighttoHelpyourVaricoseVeins
Obesitymakesitdifficultforyourdoctortotreatyourvaricoseveins.Here,wegointowhatcanbedoneaboutthisproblem.
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