Preparing for your cosmetic surgical procedure may include Blood Work / Mammogram / EKG Information, or other diagnostic testing, depending on your heath and your procedure. The purpose of a preoperative evaluation is to determine if you are healthy enough to undergo the planned procedure, and to maximize your safety when you are treated surgically. Surgery is really nothing more that a controlled injury, and your body responds to surgery just as it would to any other stress. You will find that you may feel slightly frightened or anxious both before and after surgery. This is your body’s fight or flight response in action. After surgery, you will also find that you retain fluids, and your weight may increase several pounds rapidly. This is simply another manifestation of your body’s response to stress and will resolve as your recovery progresses.
Other organs are involved in the stress response as well, and it is for this reason that much of the testing is done. It is important to know that the function of your heart, lungs, liver, and kidneys are adequate. If not, you may need to have some medical “tuning up” prior to your surgery. It is not uncommon for someone who goes in to see the doctor for foot pain to wind up being treated for diabetes or even having an open-heart operation. If you have seen your doctor regularly, things like this probably won’t happen to you, but there are many people who only see their physicians after problems become unbearable. These people often find that they are harboring more than the problem that brought them in to see their doctor.
You should expect to have your blood drawn on more than one occasion while preparing for surgery. It is likely that your primary care physician has drawn blood from you to determine what is causing the problem that brought you into the office. Once you are referred to a surgeon, you will probably have more blood drawn for tests that are more specific to the problem diagnosed. Beyond those tests, you will be given a battery of tests that assess the function of your vital organs.
Blood will be drawn to determine the number of oxygen-carrying red blood cells (RBCs) that you have. This same test can also determine the number of infection-fighting white blood cells (WBCs) you have, as well as the number of clot-forming cells called platelets. You will probably hear your doctor talk about your hemoglobin (the amount of iron in your red blood cells), your hematocrit (the volume of RBCs in your blood), and your white count (the number of WBCs in your blood).
Unusual values in these numbers may require a postponement of your surgery until it can be determined why you have abnormal results. In most otherwise healthy people, this test comes back normal. The next test is called a coagulation profile, sometimes referred to as a PT and PTT. This test is designed to determine if your blood clots in the normal fashion. As you can imagine, performing surgery on a patient whose blood does not clot normally can be quite a challenge. Medications can be administered to temporarily correct abnormal blood clotting; however, if you are scheduled for elective surgery and you have a disorder of coagulation, your surgeon will want to know where the problem lies and will try to correct the problem prior to your operation. At a minimum, you will also have blood drawn to determine your kidney (also called renal) function. These two tests measure the amount of protein breakdown products circulating in your blood, namely blood urea nitrogen (BUN) and creatinine; again, it is important to have normal kidney function prior to surgery. If your test shows abnormalities in this regard, you will probably be asked to see a nephrologist (kidney doctor) prior to surgery. Other common tests prior to surgery include a glucose level to determine if you have diabetes, and one to measure electrolyte levels.
The preoperative chest x-ray (CXR) is not done on all patients, but it is fairly routine for those patients over the age of 50 or patients who have a history of smoking or lung disease. If you fall into one of these three categories and you have not had a CXR in more than three months, you will probably need to have one prior to surgery. In obtaining this test, your surgeon is looking for a number of things, including the presence of an infection, the indication of lung disease, or the presence of a lung mass. Additionally, chest x-rays let physicians look at the size of your heart and whether any fluid is accumulating in your lungs (a condition known as congestive heart failure). Abnormalities on the chest x-ray may mandate a trip to a pulmonologist (lung specialist) or cardiologist (heart specialist) prior to elective surgery.
Smokers or patients with known lung disease will need additional testing prior to surgery. If your CXR is abnormal or if you are going to have a lung resection, your surgeon may want you to have pulmonary function tests (PFTs). This series of tests determines how well you move fresh air in and out of your lungs. It also allows your surgeon to tell how well you absorb the oxygen that you inspire. Patients who have a mass in their lung will need a chest CT (or cat scan), which provides very high resolution images that will aid your surgeon in determining which procedure to perform. In some parts of the country, an MRI will also be performed in the preoperative period. Finally, your doctor may order an arterial blood gas (ABG) prior to surgery. This test requires that a needle be inserted into one of your arteries (usually in your wrist or groin), and determines the amount of oxygen and carbon dioxide in your blood, it also determines the pH. (or acidity) of your blood. This information is important in determining whether you are able to withstand an operation, and is also necessary for your postoperative care.
Obtaining an EKG prior to surgery is an important part of the preoperative work-up. As mentioned before, surgery causes tremendous stress on the body, and one of the organs most important in the stress response is the heart. Just remember back to the last time you were frightened or upset, and think about the pounding feeling you had in your chest. This is the effect that the stress hormone epinephrine (adrenaline) has on your heart. In response to stress, your heart not only beats faster, but it also beats more forcefully. If you have a normal heart, this is no problem, but if your heart has a poor blood supply (as you see in patients with coronary artery disease), this added work can cause serious problems. The EKG is not a forward-looking test, in that it can not predict what will happen to your heart in the future. People with normal EKGs have heart attacks every day. What the EKG can do is look at the electrical activity generated by your heart. The pattern of the heart’s electrical activity can tell your doctor if you have ever had a heart attack in the past (which you may not even have known about). It also shows if your heart is in a normal rhythm, how well the conduction system of the heart works, and if any of the chambers of the heart are working too hard (a condition call hypertrophy).
An abnormal EKG will usually trigger a series of other tests, including echocardiography and stress testing. In severe cases, you may be asked to have a cardiac catheterization immediately. An echocardiogram is a noninvasive (i.e., non-painful, requiring no needles) test which uses sonar waves (similar to those on submarines) to create an image of the heart. Using this test, a well-trained cardiologist can determine the heart’s size, the function of its valves, any abnormal thickening of its walls, and the pressures inside the chambers of your heart. A stress test does what its name implies, it puts your heart under stress either by exercise or by injection of drugs, which in turn alters the heart’s perfusion (blood supply). The heart’s response to this stress is then measured by EKG or by radioisotope scanning. This will let your doctor know if any area of your heart has a poor blood supply, and if you are at risk of having a heart attack during, or immediately after, your surgery. Please note again that a normal stress test or echocardiogram does not rule out the possibility of a heart attack, but normal results suggest that your heart is in good enough condition that a heart attack is unlikely.
A mammogram is an x-ray examination of the breasts, used to detect and diagnose breast diseases. Screening mammography is used as a preventive measure for women who have no symptoms of breast disease. This painless procedure does not squeeze or damage the implant as it uses computers and specially designed digital detectors to produce an image that can be displayed on a high-resolution computer monitor, and transmitted and stored just like computer files.
Breast implants can also impede accurate mammogram readings because both silicone and saline implants are not transparent on x-rays and can block a clear view of the tissues behind them, especially if the implant has been placed in front of, rather than beneath, the chest muscles. Experienced technologists and radiologists know how to carefully compress the breasts to improve the view without rupturing the implant.
From a patient´s point of view, having a digital mammogram is very much like having a conventional screen-film mammogram. Both film-based and digital mammography use compression and x-rays to create clear images of the inside of the breast. During all mammography exams, the technologist positions the patient to image the breast from different angles and compresses the breast with a paddle to obtain optimal image quality.
Unlike film-based mammography, digital mammograms produce images that appear on the technologists monitor in a matter of seconds. There is no waiting for film to develop, which can mean a shorter time spent in the breast imaging suite.
“Pre Operative screening tests may or may not alert you and your doctor to serious medical problems and are not intended to be a substitute for a physician’s exam.”