Bloodless Surgery: A Brief Insight

Unsurprisingly, I never thought I'd actually learn anything from watching "Grey's Anatomy" apart from the odd tiny fact. Like most TV shows I watch it is purely for entertainment purposes and, at this stage, mostly because I want to know how the story ends. But whilst watching episode 13 of Season 9 I actually learnt something: Jehovah's Witnesses don't believe in blood transfusions.

Typically I avoid any discussion of religion or politics because it tends to lead to awkward situations or arguments, but I thought I would write about this revelation because it genuinely intrigues me, as did the thought of bloodless surgery that was mentioned in the episode. Enough so that I went and looked it up to see whether it was true, which it is.

So, to start with, I just want to say that not accepting blood transfusions seems rather strange to me, but each to their own. Apparently the Jehovah's Witness interpretation of Bible verses which prohibit ingestion of blood encompasses such acts as blood transfusions. They believe this to include whole blood and its major components (red cells, white cells, platelets and plasma), however will allow certain procedures which use their own blood (e.g. dialysis), blood substitutes and blood fractions (e.g. albumin, haemoglobin, clotting factors).

As I mentioned above, the episode of Grey's Anatomy I watched mentioned bloodless surgery and this is mostly what I wanted to read about. It's rather a strange concept when you first think about it, but after doing a little bit of reading it doesn't actually seem that much of a stretch. Especially when you realise that the term "bloodless surgery" doesn't actually mean there's absolutely no blood involved. What the term actually means is that it is surgery performed without the use of allogeneic blood donation, i.e. no whole blood transfusions of blood from someone other than the patient. There are a myriad of procedures and techniques that the term bloodless surgery encompasses, one of the main ones being autologous blood donation - use of the patient's own blood collected pre-surgery or cycled through a machine and then back into the patient during surgery.

Turns out that "bloodless surgery" as term started appearing around the 1880s, supposedly when orthopaedic surgeon Adolf Lorenz started using non-invasive techniques to treat patients due to his own allergy to materials used in operating theatres at the time.

In modern times bloodless surgery has been developed for a number of reasons, beginning in the 1960s and 1970s at the impetus of patients who rejected blood products for religious reasons or for fear of blood contamination and blood borne diseases. Denton Cooley was a surgeon who is now known as the modern father of bloodless surgery. He performed the first bloodless open-heart surgery in 1962, and in 1977 published his study of/report on 542 open-heart surgeries that he had performed without allogeneic blood transfusions. It's a little bit incredible when you think about it.

Recently bloodless surgery has garnered more interest due to the fact that it can be less costly and there is a reduced risk of post-operative infection or disease without an allogeneic blood transfusion. Also, without transfusions there are apparently fewer complications and faster recoveries according to the research. Not only that, but it is also thought if we can reduce the dependency on blood donation and blood banks then even better because it is never guaranteed. Nor are blood transfusions always the best course of treatment, and thus bloodless surgery should be available as an option if it is better for the patient.

Recent hallmarks for bloodless surgery:

• 2008: The WA Government was the first in the world to implement Patient Blood Management (PBM) as a policy
• 2010: The World Health Organization officially recognised and adopted the principles of PBM
• 2010: US Department of Defence granted approximately US$4.7 million towards training military and civilian physicians and health care providers

Further information / where I went to read (I know there's not many 'sources' here, but this is not uni, I didn't read extensively, just enough to gain an understanding, and they're not all listed here. I did also venture to Wikipedia and even the Jehovah's Witness website, but the below are very interesting/informative):

• Nathaniel I. Usoro (2012). Bloodless Medicine and Surgery, Blood Transfusion in Clinical Practice, Dr. Puneet Kochar (Ed) - chapter 11: http://cdn.intechopen.com/pdfs/32731/InTech-Bloodless_medicine_and_surgery.pdf
• The Wall Street Journal article "Bloodless Pressure: More Surgery Without Transfusions": http://online.wsj.com/article/SB10001424127887323494504578340962879110432.html
• WA Government's PBM: http://www.health.wa.gov.au/bloodmanagement/home/about.cfm

So, there you go, you learn something new every day!

Peanut Butter Chocolates, of all things...

This might seem like a crazy topic to start with after letting my blog lapse for 2 years, but it's not such a bad thing. I love chocolate and I love peanut butter, but for some reason have never really tried peanut butter chocolates much.

What typically springs to mind when thinking about peanut butter chocolates is Reece's Pieces or Reece's Peanut Butter Cups. I don't really remember when I first tried the Pieces, but I know the Peanut Butter Cups made a definite impression when I first tried them whilst spending the weekend at a friend's place in 2012. They're seriously addictive is the best way to describe what I remember about them (and my response to them).

Head to head - which wins?!

I was recently talking to a friend at work about some random stuff and was surprised to hear that there is such a thing as Peanut Butter M&M's. Said friend then gifted me 2 things, a packet of Reece's Pieces and a packet of Peanut Butter M&M's. Having never tried the M&M's variety before I was given this awesome gift with the intention of being able to try both and compare them. This then challenged me to pick a favourite of course.

I semi-seriously taste tested, if you're going to make a running joke of something you might as well finish it properly, right? Initially the jury was still out on my preference. I think that may have had something to do with the Indian I ate for dinner before trying each of them, so I saved some and tried them again on two different nights a few days later.

Turns out I prefer the M&M's. Factors considered included size, coating, filling and overall taste. At first I thought their overall flavour was letting them down, but I reserved final judgement until a total of three taste tests were completed. The second two tests swung the vote in the M&M's favour.

As my friend also points out, the colour variety in an M&M's packets lets you be selectively OCD about what colours you eat first and save for last. Like all good children do of course!

Although, when you think about it, technically the Reece's Pieces are Peanut Butter Candy... no matter!

It's been a while...

So, I was traipsing my way through all my online accounts to check what I still had when I came across my blog. Poor, discarded, bereft thing that it is I seriously considered just deleting it entirely. But then I thought perhaps it could give me something to do when I'm bored.

Let's face it, it's very easy to watch way too much TV, read a lot, and do not much else with my time other than go to work. So I figure maybe I can branch out a bit and give some new life to this blog by chronicling the occasional adventure or reviewing books, TV shows and the like. Probably a bit too late to finish blogging my Europe trip (from 2 years ago!!) so I won't be doing that!
We'll see how it goes. No definite plans as of yet, just an intention to try :-)

European Experience Roadmap

I've been a bit slack since I started this blog. I don't update everyday, but I need something to do with my time and I now have home internet (of sorts) so I'm going to endeavour to update more regularly! I thought the first step in the right direction was to actually update, so here I am!

A continuation of my European adventures sounded like a good idea so I thought I'd provide a brief overview of everywhere I went before actually creating some more posts about it. It's a bit of a roadmap of sorts I guess.

After my time in London on my own, which has already been discussed (although I could go on), I joined a Contiki tour called the European Experience. It was an interesting way to see Europe for the first time. I kind of went in to it thinking of it as a 'taster of Europe' for me. There's so many places that I had wanted to go to and the easiest way was to join a tour which went to a lot of them. My tour visited the following:

• Paris, France
• Beaujolais Wine Region, France
• French Riviera (Antibes & Monaco)
• Florence, Italy
• Rome, Italy (& the Vatican City)
• Venice, Italy
• Hopfgarten, Austrian Tyrol
• Dachau, Germany
• Munich, Germany
• Vaduz, Liechtenstein
• Lucerne, Switzerland
• Lauterbrunnen, Switzerland
• Rhine Valley (St. Goar), Germany
• Heidelberg, Germany
• Amsterdam, The Netherlands

I don't know that I would do a Contiki tour again. It wasn't bad but there were elements of it which weren't as nice as travelling at your own pace. I would've preferred to spend some more time in some of the places I visited to see a few more things, but as a taster trip of Europe it was pretty good.

So the basic information: I spent 20 days travelling around Europe with 39 other Australians, an American, a Swiss, a Scottish bus driver and a tour manager from Basque. In such close quarters I can say that anyone thinking about a tour should take note: you will get sick. It's not a question of will I or won't I. It's a question of how sick and for how long. I ended up being sick for three and a half weeks of my four week holiday despite the fact that I was taking antibiotics and looking after myself. I think I drew the short straw on that front!

Having said that though you take the bad with the good and my holiday ended up being pretty fantastic I would say. I took 1260 photos over four weeks, spent a fair chunk of money (although not as much as I expected!) and have many great memories. I don't think I'll ever enjoy the song "Papa Americano" again, but I will always love "I'm Glad You Came" by The Wanted and Contiki will be to blame. Or, more accurately, Gari (my tour manager) is to blame since he chose both our wake-up song and our day song.

So, the foreseeable future of this blog includes lots of talk of Europe, and that's why!

Other London Exploits

So, I mentioned that I had been to the Wallace Collection, the Museum of Childhood and Regent's Park in an earlier post. I won't bore you with too many details but I thought I'd share some of my finds.

The Wallace Collection is a really good place to go if you want to see some fantastic 15th to 19th Century examples of artwork, furniture, porcelain, etc. It is best known for the collection of 18th Century French works. Their armoury is pretty darn cool too, just so you know. I'd highly recommend a visit, and it's free so why wouldn't you? The collection was built up by the four Marquesses of Hertford, most of it gathered by the 4th Marquess Richard Seymour-Conway, who then left the collection to his son, Sir Richard Wallace. Sir Richard's widow, Lady Wallace, is responsible for establishing the museum, since she left the whole darn lot to the nation on condition that no item ever leave the collection. Quite nice of her I would say, and a fair deal for the nation.

I headed from the Wallace Collection over to the Museum of Childhood at Bethnal Green. Now this place also houses a few treasures, mostly sentimental value, since I recognised some stuff from when I was a kid. And I'm fairly certain my parents recognised objects that they'd had as kids as well when I showed them the photos. You have to deal with lots of children (it is a Museum of Childhood afterall) but if you can cope with that then I would go here too, it's kind of fun to regress for a little while and reminisce about toys and stuff. Also, there are some incredible examples of clothes and childhood items from other eras too, not just toys.

Regent's Park was my last afternoon in London before I started a tour round Europe. I'd been told that it was a nice place for a wander so I headed there after I got bored with the Camden Markets. It's a beautiful garden, lots of lovely roses. I think I was probably there for about two hours, not quite sure.

The weather was gorgeous, so sunny that I ended up taking my cardigan off, and just enough of a breeze that I didn't feel like I was burning in the sun. Took a few photos of the roses since there were so many, and wandered through most of the park. Turns out there was also a concert at the open air stage, which, although I didn't go to the concert I could hear the music of from quite a distance. Made a lovely accompaniment to my stroll in the park.

Disclaimer: All photos taken by me.

A jaunt to the West End via Bar NightJar

One of my aims while I was in London was to go see a show of some sort on the West End. Who wouldn't want to do that?! I managed to convince myself that it was worth it to line up and try to get a lottery ticket to see 'Much Ado About Nothing' starring David Tennant and Catherine Tate.

I'm a bit of a Doctor Who fan so I've seen them in the TV show together and thought it might be nice to see them in a live stage show. Also, I've never seen Much Ado live before so I was attempting to kill two birds with one stone if you will. When I asked my hotel concierge if it was possible to still get tickets to Much Ado (which was in its closing week) I thought I had buckley's chance, but he informed me of the lottery. Apparently if you turn up to Wyndham's Theatre sometime between 10 and 10:30am they'd give you a raffle ticket and then at 10:30 they'd draw 20 of them and the people with those tickets are able to buy some of the best seats in the house for just £10. I decided that I might as well go along and see how it went, nothing ventured nothing gained and all that.

I would like to be able to say that I'd managed to get a winning ticket. Unfortunately that wasn't the case, I was one number off! :-( But, then I lined up to buy a returns ticket - one which someone had bought at full price and had to return for some reason. It wasn't cheap but it still wasn't full price, so I ended up getting one for the performance that night.

Decided to make a decent night of it and head to a bar that a friend had recommended before seeing the show. Had to catch the Piccadilly Line to King's Cross St. Pancras station and then switch to the Northern Line to get to Old Street station, and it took me a little longer than I was expecting to find the place, but once I got there it was one of the best bars I've ever been too. I've been noted by a friend as someone who it's hard to make a drink for, as according to him I'm a bit of a "fussy one" - his words, not mine (you can read them here on his blog in a post about Motel Bar, an amazing place in Wellington).
If you believe the whole fussy drinker thing then it might surprise you to hear that this place in London managed to make me two incredible drinks in a very short half hour time period.

Where was I? At a place called Bar Nightjar on City Road. (Go check out their website)
Service at Nightjar was brilliant. I walked in, without a booking and was immediately greeted by a hostess who was quite happy to sit me at the bar. Admittedly, it was quite early in the evening on a Wednesday night for it to be too much of a problem, but having mentioned that someone I knew had been raving about the place she actually knew who I was talking about right away once I said where I'm from, which I found quite surprising since my friend has only ever been there once!



The bartender was great. He let me peruse the menu for a little while, then talked to me about what sort of drinks I normally like and made a couple of recommendations. I ended up going with a Scoff Law and a 24 Volt Cobbler. The Scoff Law was at the recommendation of the bartender, something which I'd been eyeing off in the menu but couldn't decide if I would drink or not. I'm glad I took him up on the suggestion, it was a very enjoyable drink and I only wish that I'd had some more time to savour it. I probably could have drunk it a little slower, but the 24 Volt Cobbler had caught my eye before the Scoff Law, and I just had to try it.

Here's why:

24 Volt Cobbler - side view



Mozart dry chocolate eau de vie

Fresh cranberries

Maple syrup

Fresh squeezed lime

Nightjar electric bitters

Mixed berries liqueur

Red wine

(all credit to Nightjar's website menu)



24 Volt Cobbler - top view



Firstly, who wouldn't want to try something called Electric Bitters? But, aside from that, it sounded delicious to me before I even saw it. And then I was presented with the cocktail itself. Absolutely incredible! That's all I've got to say. I'm not one for reviewing a drink so I've not got the appropriate repertoire of words to describe what I was tasting, and I didn't really make any notes about it's flavours, but wow! Probably one of the best drinks I've ever had in my life, that's really all I need to say I think. I would go back to Nightjar in a heartbeat if I'm in London again. It's unfortunate that I couldn't spend the evening there. I should've gone earlier in my trip when I could actually take the time to enjoy the drinks as they should be enjoyed, but that's life.



David Tennant



Had to make my way back to Wyndham's Theatre very quickly, since Much Ado was due to start at 7:30pm. I took my seat, which turned out to be quite a nice one. Royal Circle B15, pretty much smack bang in the middle of the second row on the first floor. Had a brilliant view of the stage so I didn't miss anything, which was good because it was a great show. There was some tension in the audience to start, since David Tennant had been sick for the last two performances and not been on stage, but the curtain lifted and the play started straight off without any announcement of the sort, so it was no surprise to me when he appeared on stage. He did get a massive round of applause though, since we were all pretty stoked to see that he was in it.



Catherine Tate



It was a brilliant show! Moments I don't think I'll forget include seeing David Tennant in a denim mini-skirt and Catherine Tate dangling in mid-air and flailing about. And I ended up getting some autographs and photographs out of it all, so I'd say my trip to the West End was a success if you ask me.

Disclaimer: All photo's taken by myself; 24 Volt Cobbler recipe from Bar Nightjar - please see their website

European Reflections

So, as I mentioned in my first post this blog is going to be a mixture of many things. I thought I might start with some reflections of a recent trip to Europe.
First thing to note is that I really don't sleep much on planes. I learnt this lesson a long time ago but it was reinforced this trip. By the time I got back to Australia I'd seen 14 movies, 7 on the way over and 7 on the way back. A plane trip provides me with an excuse for a movie marathon it seems, since there's not really much else to do. Also, they feed you a tonne of food on Emirates flights. Not that I'm complaining, but wow!

Stained glass ceiling in Harrods Foodhall 

Anyway, London was my first port of call. It's an amazing city, I've been before but this time I could explore some other stuff. Ended up meeting some 'locals' while in the Victoria & Albert museum who showed me around Harrods and Hyde Park. Did you know that Harrods has a Pet Kingdom? I did not. They have the cutest Bengal Kittens (or they did while I was there)! Well we explored Harrods for a while and then decided to grab some food from the Foodhall to eat in Hyde Park. The Foodhall of Harrods is fantastic. There's some brilliant stained glass and blown glass lights, and it smells delicious down there. I ended up buying some elderflower bubbly, to try something new, and some kind of bacon and cheese bread twist. I can attest to the fact that their bakery goods not only smell wonderful but taste it too!

It's kind of fun to meet nice randoms in new cities and have them show you around, I quite enjoyed it as it meant I wasn't all alone on my first day in London. Did I forget to mention that this was the afternoon I'd landed in London that I did this? I thought it would be a good way to stay awake if I ventured out of my hotel to explore a museum, and bumping into Jen and Vi with the help of a lovely German/American woman on my tour of the museum was an even better way, since it at least meant I got to see a few places and didn't go back to my hotel until after 7pm.

Outside British Museum

Managed to find my way back to the British Museum the next day, because what's a trip to London without stopping there? Was slightly disappointed to find that one of the rotating exhibits was "Australian Season", full of paintings and sketches by Australian artists like Sidney Nolan. I've seen enough of those in Australia, I was going overseas to see new stuff! I guess I can look at the positive side of it though, it meant there was less I had to rush about to see :-)
Amusingly enough I bumped into the German/American woman and her family again, after also having seen them in Harrods the previous evening. Had a lovely chat once again, very amused by the whole thing. But I guess if you're tourists in London there's a few set places you're likely to go, so it's not so surprising that I kept bumping into Bridgit and Stephanie (her daughter).

Foyer of the British Museum

I mastered the Tube/Underground, whatever you like to call it. I was expecting it to be terrible but it was mostly on time and not too bad. Crowded at times, but that's to be expected on any form of public transport, not just London's.
Other London exploits included a jaunt to the West End for a show via Bar NightJar (an amazing place!), a visit to Regent's Park and some time at the Wallace Collection and the Museum of Childhood - more to come on these!

Disclaimer: All photos posted were taken by me.