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Dr. R- new manual

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Hi Dr. Rutledge -

I read the new manual and I am very glad that you addressed some of

the controversial issues such as gastric cancer. Thank you. It's a

welcome addition. I did notice that you still need to change the

statement about the patient letter at the very beginning of the

manual so that it matches the new patient letter requirements. It

stillsays 5-10 pgs.

I also remember now seeing a news show on complications in surgery (I

think I remember it being bleeding) for patients who were taking St

's Wort as a supplement prior to surgery. You may want to look

into that to add to your aspirin list. I believe some patients have

come close to dying and they traced it back to the supplement

eventually. But since it is classified as a nutritional supplement,

patients do not think to tell a doctor they are taking it. It is

highly recommended for help with depression and weight loss, so your

patient population would be potential St. 's Wort users.

I am also going to take this opportunity again to ask you if I am at

any increased risk by continuing to take my Ultram ( up to 600 mg per

night) for my neuropathy pain. It is an opium derivitive from what

I have read. My surgery is 3 weeks away and I will need time to find

some alternatives.

Looking forward to meeting you -

Laurie from Ohio

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