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Question
Posted by: blindman | 2010/04/26

Surgery, rejection of material, aftercare and coxflam.

Hi there.

You may have gathered from the heading of my post that I have 4 questions to ask, but before getting down to the questions, let me mention by way of general introduction, that my wife and I are state patients because we cannot afford medical aid.

Now for my first question. I am due to have a hernia operation in June. I am diabetic and have reliably learnt the following things which will affect the decision whether to go ahead with the surgery or not.

1. The surgery is to be conducted at a secondary state medical facility. I have been reliably informed by a doctor friend that the surgeons at the facility are competent and that therefore, there is no need to be concerned about that matter.

2. I have also reliably learnt that the facility does not have a menu for diabetics. I have reliably learnt this information from another doctor, not the one I refer to later in this post. Diet is something that I can sort out though, as I can arrange for meals to be delivered to me privately. I have arranged for sugar testing to be done privately as well in case the staff are unable to cope. I have my own glucometer and strips and a private nurse related to me, who is prepared to do the tests for me at the facility.

However, if diabetic diets are not catered for at the secondary facility, my concern is that, post operatively, if I did run into complications resulting from diabetes, the ward staff may not be competent to deal with the issue. I am scared that if I did go hypo which does happen to me from time to time, due to the fact that there is quite a broad margin of fluctuation in my blood sugars, even though I control them well, that nothing may be done about the matter. I have fasting sugars of between 5 and 6 which can go up to the upper 7''s or even lower 8''s after breakfast, but which drop to the 4''s roundabout the afternoon and sometimes even drops lower than that, with the result that I go hypo. Notwithstanding the margins of fluctuation, my average sugars are somewhere between 5 and 6, readings seldomly going over 8 and less frequently, over 10 and if this does happen, which is about once in three months, it never goes higher than 11.

The question is what can I expect regarding blood sugars with a hernia operation?

Now for my second question. I am sensitive to foreign material being introduced to my body. I had a double enucleation operation some 25 years ago and some plastic prostheses were built into the socket to help my artificial eyes to move. My body rejected these plastic prostheses with the result that they had to be removed. My artificial eyes can still move quite normally without the prostheses. What are the chances of the material that will be inserted in the place where the hernia is, being rejected? The hernia I am seeking to have fixed, is an umbelical hernia, or rather, a double umbelical hernia.

My third question concerns post operative care. I have been informed by a source that I can take seriously, that the entire post operative care process is entirely up to the patient. If stitches or clamps have to be removed post operatively, the source informs me, this is not done at the facility and the surgeon does not get to see the patient to do a post operative assessment. I have been informed by this person, who does these kinds of operations privately, that it is up to the patient to get to see someone to have the clamps and stuff removed.

Someone has offered to get me to a private doctor who is a general practitioner to attend to the matter, should these statements be true, but I think that if a doctor has not operated on a patient, and he is expected to assess the work of another doctor and follow on from where the other one left off, that is, with the greatest respect, a very unreasonable ask, because he would not be aware of all of the peculiarities of the case that may have arisen during surgery.

What I would like to know is if it is true that at state facilities, the entire onus, as suggested by my friend, falls entirely on the patient to see to it that his/her post operative care? If this answer is true, would this not be rather hard and unreasonable to a person who is not medically qualified?

If the onus falls on the patient to organise his/her own care in hospital, what steps could the patient take to protect himself/herself against harm which could come about as a result of this rather impossible onus?

By the way, the persons who informed me of the matter of my concerns, will remain anonymous. I am not under any circumstances or for the payment of anything or the rendering of any favour, prepared to divulge those persons'' names as I do enjoy the trust and confidence of those persons. Suffice it to say that those persons gave me information on the strength of peculiar circumstances in which they find themselves.

My final question, as the heading to this post suggests, concerns Coxflam. My wife is a gout sufferer and is presently on Puricos and Coxflam. Unfortunately the Coxflam can apparently not be obtained from state hospital facilities. We do not want to mess around with her medication as it took one almighty job just to get the gout sorted out. I wondered if the doctor could tell me of any generics of Coxflam so that we can go back to the facility and ask for those generics, instead of Coxflam?

The doctor we saw at the primary facility, was decidedly disinterested in us. When I went to have my script renewed, he did not, despite the fact that it is written large as life on my file that I am diabetic, even do a blood sugar and a blood pressure test. I had to insist that he do these tests before writing my script and even then, I had to drag the results of the test out of him. He did not even examine me, something which is done as a matter of course when I visit my diabetologist, at the secondary facility, or even consider the circumstances which might have affected the reading, such as when last I ate, etc.

My wife did not fare much better. She was simply told that the hospital does not supply Coxflam and he left it at that. She did, however, get her Puricos from that facility.

I would appreciate it if we could get the names of generics so we can go back to the facility and insist that these medications be prescribed instead.

In the final analysis, therefore, I pose the general question: how safe is it to have surgery done at the secondary facility? The primary facility, for reasons I have already mentioned, and for reasons which I do not want to divulge here, is simply out of the question. Bear in mind that the surgery which I need to have done, is imperative, since there is more than just a reasonable chance that the hernia will strangulate.

Thanking you sincerely.

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Our expert says:
Expert ImageCyberDoc

Dear Blindman
Hypoglycemia is a risk post operatively due to the fact that you are kept nil per mouth and usually given insulin during the operation to keep blood sugar levels stable. It is very important that your blood sugar levels are very carefully monitored post operatively. The doctor that operates on you is responsible for your pre-operative, during operation and after operation care - whether blood sugar management, or follow up after the operation. What you as the patient will need to do is to ensure that you have a follow up appointment with him and keep the appointment at the clinic. If it is at an academic hospital, the after operation care may be left in the hands of a student doctor or junior doctor. However if you have someone that will monitor your sugar, he/she must ensure that the doctor responds to any calls to visit you if there are any problems. You should discuss with the doctor that will operate on you the kind of mesh they will be using to strengthen the area - and inform him of your rejection problems of the plastic prosthesis. They should maybe consider alternative operating techniques that may exclude the use of mesh. It is difficult to give an opinion on whether it is "safe" to have the operation done at this hospital, as the standards vary from province to province and hospital to hospital. But often the surgeons working at Public hospitals are private doctors doing public hospital sessions, and are very capable of doing the operations. Alternatives for Coxflam are Mobic, Adco-Meloxicam, Arthrocox, Flexocam, Loxiflam, M-cam, Melflam, Sandoz-Meloxicam and Zydus Meloxicam. It is an anti-inflammatory so maybe something like Voltaren or one of its generics may help if you can't get hold of the Coxflam.
Dr Bets

The information provided does not constitute a diagnosis of your condition. You should consult a medical practitioner or other appropriate health care professional for a physical exmanication, diagnosis and formal advice. Health24 and the expert accept no responsibility or liability for any damage or personal harm you may suffer resulting from making use of this content.

2
Our users say:
Posted by: Blindman | 2010/04/30

Hi there.

I want to take the opportunity of thanking you very much for the assistance I have received. This has addressed a number of concerns I have had concerning the procedure.

I have been able to also contact my diabetologist about the matter and he has assured me that one of the nursing staff at the diabetic clinic will also be checking up on me with regard to diabetic care. Once again, thank you very much.

Reply to Blindman
Posted by: cyberdoc | 2010/04/28

Dear Blindman
Hypoglycemia is a risk post operatively due to the fact that you are kept nil per mouth and usually given insulin during the operation to keep blood sugar levels stable. It is very important that your blood sugar levels are very carefully monitored post operatively. The doctor that operates on you is responsible for your pre-operative, during operation and after operation care - whether blood sugar management, or follow up after the operation. What you as the patient will need to do is to ensure that you have a follow up appointment with him and keep the appointment at the clinic. If it is at an academic hospital, the after operation care may be left in the hands of a student doctor or junior doctor. However if you have someone that will monitor your sugar, he/she must ensure that the doctor responds to any calls to visit you if there are any problems. You should discuss with the doctor that will operate on you the kind of mesh they will be using to strengthen the area - and inform him of your rejection problems of the plastic prosthesis. They should maybe consider alternative operating techniques that may exclude the use of mesh. It is difficult to give an opinion on whether it is "safe" to have the operation done at this hospital, as the standards vary from province to province and hospital to hospital. But often the surgeons working at Public hospitals are private doctors doing public hospital sessions, and are very capable of doing the operations. Alternatives for Coxflam are Mobic, Adco-Meloxicam, Arthrocox, Flexocam, Loxiflam, M-cam, Melflam, Sandoz-Meloxicam and Zydus Meloxicam. It is an anti-inflammatory so maybe something like Voltaren or one of its generics may help if you can't get hold of the Coxflam.
Dr Bets

Reply to cyberdoc

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