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[whitespace] Bloodless Surgery program reaches Jehovah Witnesses

Community Hospital offers it as option

Los Gatos--When Desmond Ramirez was wheeled into major surgery last year his blood level was perilously low, despite weeks of blood-building therapy.

"It was still low enough that any wrong move and I could have died," Ramirez, who asked that his real name not be used, says. Extra bags of blood were readily available, but for the 21-year-old Jehovah's Witness, taking blood was not an option. "It wasn't even a thought," he says. "I could have died either way."

But thanks to a Community Hospital of Los Gatos surgeon and cutting-edge blood-saving technology, Ramirez's ulcerated intestines were repaired, and the Sunnyvale retail clerk was out of the hospital a few weeks later.

Ramirez, as the majority of Jehovah's Witnesses, believes the Bible forbids ingesting blood. Citing passages from both the old and new testament that prohibit the "partaking of blood," Jehovah's Witnesses refuse transfusions. They believe that, since IV's are also used to deliver food to the sick, blood transfusions are akin to eating blood.

Unlike Christian Scientists who avoid medical care in favor of religious practitioners, Jehovah's Witnesses do seek out medical treatment. While the medical establishment may have taken a "take it or leave it" attitude toward methods of treatment in the past, places such as Community Hospital of Los Gatos have begun to redesign their surgical techniques to satisfy patients' beliefs.

"We're here basically because of the Jehovah's Witness community," Bloodless Program Coordinator Glenna Aitken says. "They want good medical treatment; they just don't want to use blood."

The Bloodless Program at Community Hospital is comprised of a handful of physicians and surgeons who, armed with the newest blood-saving technology, work with patients who would die before they would accept a blood transfusion. The program was started in 1997, after a hospital employee, who knew of a similar program in San Luis Obispo, brought the issue to the administrative team at the hospital. Aitken said the idea was presented to the hospital's doctors and surgeons, several of whom were interested. She now works with an average of 25 patients a month.

"You want to treat everyone to the best of your ability while staying consistent with their beliefs," says Dr. Michael Nails, a family practitioner and surgeon. "Jehovah's Witnesses shouldn't be looked on or treated any differently because they don't want to use blood products."

Nails, who lives in Campbell and practices in Los Gatos, is one of just two primary care physicians in the county that Aitken refers bloodless medicine patients to for treatment. He says Jehovah's Witnesses aren't that much different from any other patients, except that treatment decisions need to address beliefs from the beginning.

"Western surgery is very tight on blood loss," Nails says. "You just have to be a little more conscious of the fact that you're dealing with someone whose beliefs need to be taken into account." By doing so, he says, surgeons can reduce the chance of ending up in a situation where a transfusion might be necessary.

Dr. Richard Adrouny, a hematologist and oncologist, specializes in pre-operative consultation for bloodless medicine patients. Adrouny's patients use drugs, such as recombinant erythropoientin, to stimulate the production of red blood cells prior to surgery. While a number of Dr. Adrouny's patients come through referrals from Aitken, he says an increasing number of people are opting for bloodless medicine.

"You reduce the risk of exposure to contaminated blood, particularly hepatitis B and C, which can have lasting consequences," Adrouny says. He added that recent studies have shown blood-producing drugs to be more effective than donating one's own blood in advance, which Jehovah's Witnesses also prohibit.

Once on the operating table, surgeons use a variety of equipment and techniques to minimize blood loss. A device known as a cell saver recycles a patient's blood, while surgeons use harmonic scalpels and argon bean coagulators to coagulate blood vessels while operating.

Through the use of these techniques, Ramirez, who came into surgery with half as many red blood cells as a normal patient, was able to survive an operation that normally involves substantial blood loss. And while Ramirez may be an extreme case, other Jehovah's Witnesses have also benefited from the program.

San Jose resident Arlene Yowek doesn't even know exactly what doctors did during her surgery to prevent blood loss and the need for a transfusion, but she's thankful nonetheless. Her primary physician referred her to Community Hospital of Los Gatos, where she was put in contact with Aitken.

"When I went in to get registered [before surgery] they put a band around me saying 'no blood,'" she says. "I had absolutely no problems at all; they seem to be very knowledgeable about it."

Before going under the knife, Yowek said she signed a number of legal forms stating that she would not take blood under any circumstances. She and Ramirez both said that their families understood and supported their decision to risk death rather than violate their beliefs.

Doctors have no choice but to be equally understanding, according to Nails. The Hippocratic Oath states that doctors can "do no harm," but Nails says, it's not always up to the doctor to define what "harm" is. In the end, the release form patients sign is the last word. "It's a matter of respecting someone's beliefs," Nails says. "The only time it becomes a sticky wicket is when you're dealing with a child."

According to state law, doctors have the final say on the treatment of anyone under the age of 18. However, Nails says that he has to judge patients on a case by case basis. While an 8-year-old may have no real concept of religion, a 17-year-old most likely does. Nails says the best approach with children is to be proactive--even more than with adult Jehovah's Witnesses--to avoid being caught in a moral and ethical dilemma.

Doctors also have to accept that not every patient makes it, whether they elect for bloodless or traditional surgery. Niles says the point of the program is to allow the patient to be treated according to his or her beliefs, rather than the beliefs of the doctor. Just as a mechanic who fixes Hondas can't take the same approach with a Chevrolet, he says, doctors have to be willing to adjust to their patients.

"If a guy is fixing a Chevy," Nails says, "he should fix it with Chevy parts."
Nathan R. Huff

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