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So today at work, something was brought to my attention, and it's really intriguing to me.
It's the premise that women with lower back tattoos (tramp stamps) may not be able to get epidurals in Canada because the ink gets into the spinal cord/tissue, and due to the lack of medical research, anaethesiologists are reluctant to perform them. According to the report from the Canadian Journal of Anesthesia, they're not really sure either, although some cases of neuropathy and other conditions have been reported.
They intend to research this more since more and more women have these lower lumbar tattoos, and in the meantime, it's up to the anaesthesiologist to whether they want to give the epidural, not give them, or cut a section of skin out before giving them.
I'd totally count this as a major con when choosing a tattoo site.
It's the premise that women with lower back tattoos (tramp stamps) may not be able to get epidurals in Canada because the ink gets into the spinal cord/tissue, and due to the lack of medical research, anaethesiologists are reluctant to perform them. According to the report from the Canadian Journal of Anesthesia, they're not really sure either, although some cases of neuropathy and other conditions have been reported.
They intend to research this more since more and more women have these lower lumbar tattoos, and in the meantime, it's up to the anaesthesiologist to whether they want to give the epidural, not give them, or cut a section of skin out before giving them.
I'd totally count this as a major con when choosing a tattoo site.
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From:
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The article has some writing flaws in it that confuse the issue of problems arising from infected tattoos not related to epidurals, and issues arising from the ink compounds affecting the epidural.
I know BME lists this as an urban myth, but when it actually affects how doctors give medical care, how much of a myth is it?
From:
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I read the article;
"Conclusions: There is no information in the literature about possible risks from inserting needles through tattoos during the performance of neuraxial anesthesia. This report discusses the possible implications. "
In two of the three examples they were able to find pigment free skin. What’s the statistical validity of a study of three people, two of which don’t even fit the criteria.
But it even get's better. They then go on to say that coring from just skin itself can cause tumours. Hell, by that regard NO ONE should get an epidural...
"Coring
Hollow needles, with or without a stylet, entrap tissue fragments (cores) in their bore as they pass to deeper structures. Injection through these needles may then result in this entrapped tissue being deposited in the deeper site. In 1956 Choremis et al. reported on five children who developed iatrogenic epidermoid tumours in the epidural and subarachnoid spaces following multiple spinal injections of antibiotics.3 The authors postulated that during lumbar puncture a "core" of tissue containing epidermal elements was picked up as the nonstyletted needle passed through the skin and was subsequently injected into the subarachnoid or epidural space. The cells of the core then grew into an epidermoid tumour. Since that time numerous other cases have been reported including some in adults4? and one involving spinal anesthesia in a parturient. This latter case had two lumbar punctures as a child and a third at age 33 for "diagnostic purposes". She then had a fourth for spinal anesthesia for childbirth and subsequently developed an epidermoid tumour. "
Interestingly, What I had read is that the needle for a epidural is quite tiny. But they try to account for that:
"Although nonstyletted needles have been implicated in "coring", the newer styletted spinal needles also cause coring. Campbell et al. microscopically examined the needle tips of 25-gauge Quincke and Whitacre needles for evidence of coring after failed attempts to identify the subarachnoid space.9 Tissue cores were found in 80% of the Quincke needles and 41% of the Whitacre needles. Most of the tissue was blood clot or fat. No epidermal tissue was found."
So no epidermal tissue was found. But yah, there was coring. In normal non tattood situations.
they go on to explain complications due to normal tattooing, that I guess they are implying could be exacerbated by a epidural. But who really knows, since they don't connect the two, except having them in the same report.
And then they conclude..
"Will nicking the skin prior to inserting an epidural or spinal needle as done by Campbell et al. avoid picking up tissue cores containing pigment? It would seem reasonable. Obviously the size of the nick has to be larger than the needle being inserted and should penetrate through the dermis. Whether these precautions provide adequate protection is unknown.
To date, there are no reports of complications from inserting a needle through a tattoo."
But then, it's risky, due to the normal risks associated with tissue coring..
"However, the lack of reported complications could reflect the fact that in the past fewer patients (pregnant and non-pregnant) had tattoos involving the midline of their lower back. The number of patients having neuraxial anesthesia through a pigmented tattoo would have been correspondingly small. Additionally, epidermoid tumours and arachnoiditis do not occur immediately but develop over time. It may be too early to see any long-term consequences."
con't
From:
no subject
"Based on the limited information available it is possible that inserting an epidural or spinal needle through a tattoo could cause long-term problems such as arachnoiditis or a neuropathy secondary to an inflammatory reaction, but we don’t know."
You know what's funny, I see so many parallels to my sisters surgery, where they said standard procedure is to take all of the colon. She had to search, but she found a doctor willing to do a local laposcopic surgery, and she's fine now. But she went through 3 surgeons and two GP's before she found someone who knew more than the usual out of the book advise.
In fact, it's laughable that a doctor would refuse to give one based on this report. The report is just bad science.
Interestingly the web sites i visited said something along the lines of "find a doctor who is willing"
It scared the crap out of my friend who was trying to decide if she wanted to get one, and i said "do the research" cause she had just heard on CTV News that it was risky. And they said about as much as "some doctors won't perform it, so beware if yer afraid of the pain of childbirth"
it's just such a bizarre way to look at things. Knowing the risk.
From:
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it's just, to summarize
"doctor's --> BAH!"
From:
no subject
I mean, my background is in Biology, so I find this article in particular to be like a frickin' train wreck. I'm glad someone else is reading critically (it's part of the reason I posted this article in particular).
It intrigues me because despite the utter lack of information (plural of anecdote does not make data), doctors seem to be legitimately concerned about this.
Have I ever mentioned how screwed the medical system is with regard to women? Possibly men too, but especially women. It took the medical profession like 20 years to clue in that general anaesthesia does not affect women the same way it affects men, and women revive from the same dose about 20% faster than men. You can figure out how they discovered this right?
Hell, I still want to meet my new doctor and ask him junk like "Fibromyalgia is a real disease: True or False?"
From:
no subject
it never occured to me that women exhibit totally different symptoms for heart attack until my mom had one, and she's a research HOUND when it comes to debunking medical sacred cows...
but shit, yah, i think we're on the same page...
So, how did they discover it? having women come OUT of anaesthesia in the middle of surgery?
It DOES appear some Doctor's would be hesitant to perform epidural's, but i still maintain it's likely a cultural bias...
Did i ever tell you about the time two summers ago i had strep and the doctor asked me if i had been sucking cock lately? Purely because the walk in clinic i went to was Church and Bloor.
Or the time i had the m ups and the Walk in doc did a full battery of tests for sexual disseases? I found out because the doctor i went to get the results was younger and he mentioned that the doctor did all these other tests with my blood "cause you look questionable". He had put it right in the notes. I DID look like a long haired greasy garage mechanic back in my 20's but...
From:
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I could sort of see the question from the doctor since a gonorhea infection in the throat has similar symptoms to strep... but holy god, use some tact. As much as we would love our doctors to be unbiased... they're not... they're human and hopfully doing the best they can without burning out.
Indeed, women were coming out of anaesthesia in the middle of surgery—a lot—and then they thought...maybe there is something to this . Hell I've come out of anaesthesia in the middle of surgery (I was displeased).
Almost all new medications are tested on men aged 18-35. Hello? We're still trying to get past the premise that women are not men with ovaries, and children are not little adults. I was prescribed a medication for my stomach when I was 19 called Cytotec, and it does a great job protecting the stomach... but it's also called RU-486 in Britain and no one thought to mention this to a young woman.
From:
no subject
yup, so i asked what the difference would be, and he said he'd proscribe the same thing. Penecillin. So actually, he just wanted to ask me...
"I was prescribed a medication for my stomach when I was 19 called Cytotec, and it does a great job protecting the stomach... but it's also called RU-486 in Britain and no one thought to mention this to a young woman."
JEEBUS!!!
and.. i look fine now, almost gentlemanly ;)
From:
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From:
no subject
heh
;)