Estimates of blood loss are not always accurate

DEAR DR. ROACH: Here’s something I’ve wondered about for a long time: Years ago, I was told that I lost 5 pints of blood in childbirth. How did they come up with that number? Obviously, they weren’t scooping up blood off the floor to measure it! — L.K.
         ANSWER: During surgery, there is always some blood loss, but 5 pints of blood is a great deal of blood loss, being about half the amount of total blood volume of an adult.
         Way back when I was a third-year student, anesthesiologists and surgeons both estimated blood loss during surgery, based on the amount of blood removed from the body by suctioning (which is measured) as well as on the sponges used in surgery (hopefully the blood doesn’t actually get on the floor during most surgeries, but it can certainly happen during childbirth). Unfortunately, the estimates are not accurate. Surgeons in particular tend to underestimate blood loss. Blood levels can be measured before and after surgery, and so in hindsight the blood loss can be estimated reasonably well. During surgery with high amounts of blood loss, blood tests are taken frequently (and often tested in the operating room) to determine whether, and how much, blood needs to be transfused.
         In your case, you may have required blood transfusions to keep your level near normal, or they may have noticed the drop in your blood hemoglobin level.
         DEAR DR. ROACH: My wife has to have a CAT scan. She dreads having to drink the two bottles of fluid before the scan. Can I doctor up the fluid (syrup, ice cream, etc.)? — J.N.
         ANSWER: There are several types of oral contrast given for CT scans, and the type of scan determines the best choice of contrast, which will then be ordered by the radiologist. Barium-based contrast (Readi-Cat) is viscous and chalky. Diatrizoate (gastrografin) tastes bitter. Iohexol (Omnipaque) has a less unpleasant taste than the others and is generally preferred by those who must drink them. All of these agents can have flavorings added.
         Traditional ways of adding flavor include unsweetened Kool-Aid mix, Crystal Light and water flavoring drops (such as MiO and Dasani). I don’t recommend ice cream. I do recommend drinking the fluid cold.
         There are some companies now marketing oral CT contrast solutions that are much easier to get down than the traditional agents.
         DEAR DR. ROACH: Who decides what surgery is an elective? I have been on a waiting list since August and am scheduled for February. I need a hip replacement, and after five years of injections that are no longer effective, my doctor agreed to surgery. I’m using pain pills and lidocaine patches, but still feel a lot of pain. — M.G.
         ANSWER: The term “elective” is used to describe any surgery that is scheduled and not performed immediately due to a medical emergency. The term “semi-elective” sometimes is used to describe a necessary procedure to save life or limb but that does not need to be done emergently.
         The surgeon is generally the person who decides if a surgery is appropriate, and it seems that this is the real issue in your case. Deciding when to perform a joint-replacement surgery is a mutual decision between patient and physician. A six-month wait for surgery, when patient and surgeon have decided it is appropriate, is outside my experience, and I am frankly unable to guess why you have had to wait so long.
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         Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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