Sizing Up Surgery
The Value of a Second Opinion -- Is Surgery Necessary? continued...
"A certified pathologist can generally identify 85 percent of regular tumors," Roscher says, "but if there is a glandular difference, tumors are difficult to diagnose and often require second and sometimes third opinions." He adds that even with the small number of unrecognizable tissue growths, specialists need the availability of additional resources to confirm or dispute their findings and recommendations, such as through the California Tumor Tissue Registry, a network of qualified professionals that was created for such specialized second opinions.
There are, however, instances when emergency surgery is necessary in order to sustain life, such as when the diagnosis of acute appendicitis is firmly made. In this case, surgery must be done quickly and efficiently, and would not warrant a second opinion.
The practice of ordering routine laboratory tests before admission for surgery is commonplace in most hospitals. Many doctors believe that urinalysis, chest x-rays, or complete blood counts, for example, can identify potential problems that might complicate the surgery if not detected and treated early. Some tests commonly performed before surgery and the symptoms that prompt doctors to order them are:
-- shortness of breath, chest pain, cough, fever without other source, abnormal sounds
-- chest pain, palpitations, arrhythmia, murmur, distant heart sound
-- frequency, hesitancy, discharge, side pain, kidney disease, diabetes, use of drugs known to cause kidney disease
white blood count
-- fever, suspicion of infection, use of drugs known to affect white blood cell counts
-- blood loss, easy bruising, alcoholism, use of drugs known to affect platelet count
-- excessive sweating with tremor or anxiety, muscle weakness, diabetes, pancreatitis, cystic fibrosis, altered mental status, alcoholism
-- vomiting, diarrhea, congestive heart failure, kidney failure, muscle weakness, tissue damage, hypertension, diabetes, use of drugs known to affect potassium levels
-- vomiting, diarrhea, excessive sweating, thirst or fluid intake, pulmonary disease, central nervous system disease, congestive heart failure, cirrhosis.
Patients facing surgery need to discuss with their doctors the necessity of having certain tests performed prior to surgery, says Mary Pat Couig, R.N., Associate Director for Nursing Affairs at the Food and Drug Administration.