Pre-assessment for a hysteroscopy? Why?

[AuldJosey]

Apparently I've to have one of these Friday to see whether I'm fit to go through the hysteroscopy.
Can anyone tell me what that involves? BP? Bloods?

I just fail to see the reason for a bloomin test about a test!

Sounds about right.

Seriously, though, if you have low potassium (according to my mother, who did), it can affect your heart rhythm and, all other things being equal, you sort the potassium levels, you sort the issue making you too high a risk for surgery at present.

Same way if you were anaemic (common with gynae problems) - that increases the chances of heavy bleeding during procedures. It's why pregnant women are routinely tested and prescribed iron tablets early in pregnancy, as a normal labour with an anaemic patient can result in greater blood loss and transfusions becoming necessary.

I hope it's all sorted quickly so whatever is causing your gynae issues is investigated and dealt with soon.

All I need now is to be bloody referred to cardiology! I'm already under 3 specialists!

My local one is also a teaching hospital, but they still aren't able to provide non emergency procedures to higher risk patients, so it's not necessarily being unrealistic.

I wouldn't knock it - it's obviously better than the alternative of not having specialists giving you care!

That's what I don't get! At the consultant appointment, from recent bloods, he said, well you're not anaemic. Then the nurse at the end told me to go to my GP and ask for iron replacements. I asked her to write down whatever I needed to ask the GP, and what she actually wrote down was potassium! So I questioned whether it was my iron or potassium and then she said, 'well your iron isn't.......... don't worry, your GP will be able to see what we see here' And off I toddled! None the fucking wiser.

So how can 80 year olds undergo complex surgery, and I can't!!??

It's not as if it's open heart surgery for 8 hours! It's apparently a 15 minute procedure!

It would have to be a blooming bank holiday. I'm going to be stressing about this for days now!

Yikes.

The low potassium can definitely contribute to heart issues as it affects muscle action - and of course the heart is a muscle. 107 is not awful but still high (60-100 is the normal HR for a healthy adult).

When you go under a GA they put you under so deep that you actually stop breathing. (This is why they teach intubation by having paramedic and medical students spend a day in the OR - every patient undergoing GA needs to be intubated, and it's in a nice, controlled environment.) This increases your risk for complications. Any GA carries a risk of death. Usually they will mandate at least an ECG if you are over a certain age or have certain medical conditions, and they may require a chest X-ray as well.

Putting someone under anesthesia is always a question of risks and benefits. Yes, they do cardiac bypasses on OAPs - IF the patient is stable enough to undergo surgery and IF the benefits outweigh the risks. Sometimes they can't even bypass every blocked artery because they would need to put the patient on heart-lung bypass and that's too risky for the patient.

It sounds as if your procedure is more elective (i.e. not to treat something immediately life-threatening). This means they're even more careful about risk/benefit analysis.

Feel like just giving up on the whole thing to be honest!

Heart bypass surgery tends to be a 'we do this now or they die' situation. And lots of 80 year olds can be incredibly healthy (unlike me in my 40s).

The risk of dying is therefore with surgery = higher than normal, without surgery = certain and probably in a very short time, which makes them more likely to get it than somebody else who is less likely to die without immediate treatment, but is roughly a similar risk for anaesthesia.

Anyway, you have a nurse on the thread now - I hope it's all sorted soon, as whatever they want to investigate in the first place can't be pleasant for you.

I’m a Dr OP- pre-assessments are not a waste of time. I assume you are having a general anaesthetic? These are not without risk, even though for a short procedure like a hysteroscopu the risks are lower than a long and complicated operation. Surely you would rather those risks were minimised? Perhaps you would genuinely prefer convenience over safety though.

The pre-op assessments confirm you are fit to undergo an anaesthetic and, just as importantly, can identify patients who are probably fit for surgery but have some risks which need to be managed- either before surgery or steps needed to be taken during surgery e.g. help determine the type of anaesthetic/any special requirements you may need during the procedure. It improves safety and also reduces the risk that your procedure would need to be cancelled due to an unforeseen issue that comes to light on the day of admission.

The pre-assessment nurse will record past medical history, current medications and check that the recorded drug allergies are correct. They then check blood pressure, heart rate and oxygen levels and may do an ECG. They can also check various other things e.g. for restrictions on jaw opening which is important to know if you’re undergoing an anaesthetic, or other symptoms such as shortness of breath on exertion which may indicate an undiagnosed problem.

Pre-op assessments were brought in after near misses and lots of cancelled operations. Not just to inconvenience and annoy patients.

@jacks11 If you would read my posts from today, I'd be eternally grateful!

Well I've shed a few tears - does low potassium mean you're more prone to crying?
I know I come across as an ass - but I'm genuinely not really in real life.

No idea whatsoever! I didn’t have GA with mine, just a local. I was terrified after reading all sorts of horror stories on t’net, but it was absolutely fine. Little bit of pressure, lovely nurse talking to me all the way through about holidays (what else 😂) and they even found and removed a polyp while they were at it, didn’t feel a thing.
So no, don’t know why you’re having a pre-assessment (maybe just ask) but please, don’t waste a second’s worry about the actual procedure.

Langrish - thanks for your reply. The reason for the pre-assessment is the anaesthetic. And now I can't have it as I'm not fit to undergo an anaesthetic

It's easy to whack out words on a keyboard with the pleasure of having time to think, but when you're at the mercy of medics, and you've an albeit lovely kind nurse keeping me posted throughout - you don't have time to digest what you're being told, so the questions come after!

If I had thought of it at the time, I'd have asked to speak to one of these elusive doctors who were consulting each other (read that as talking about me ) but you're just sort of reassured that you're in the hands of professionals. Why does this always happen me on weekends!!!!!!!!!!

Do standard bloods check for having had a heart attack? Why were they repeatedly asking me whether I was having chest pains? They seemed convinced that I was!

Sorry to jump in on this OP, but I had a hysteroscopy 2 years ago with no anaesthetic at all, local or general. Is that not normal? It was fairly unpleasant but not painful. I didn't even know anaesthetic was an option!

Well I got copied on the letter from the consultant to the GP today (which I only bothered to open now as I presumed it was the letter about the now not proceeding procedure!).

That says: 'She was adamant she wanted to have it under general anaesthetic'.

He was a lovely consultant and what my medical history doesn't state is that I was violently raped - hence the adamance about the GA.

So no - It appears a GA isn't exactly typical. He never questioned my decision however or tried to persuade me otherwise.

Due to the type of surgery they probably don't like to ask too many questions .

It's not surgery though!

Just had a chat with my Dad, my sis and my friend and I'm talked down a little now. I would talk to my brother but I'm not talking to him (he's a doctor so might have proved useful - though going on previous, without him seeing the full bloods he'd say fuck all - rather annoying - it's not all its cracked up to be having a dr in the family....). I do pick the most inconvenient times to fall out with people!