ArcaMax

DEAR DR. ROACH: Next month, I am scheduled for cataract surgery. The procedure has been approved by my cardiologist and my primary doctor. I am pretty healthy, feel like I'm doing OK, and have been told so by my medical providers.

My problem is that no one seems to be listening to me. I have repeatedly said that I have a problem with anesthesia (fentanyl and midazolam). I have numerous allergies, one of which is narcotics. Nobody seems to be taking me seriously. Is there a different anesthetic I can request? -- S.S.

ANSWER: The term "narcotic" derives from the Greek word meaning numbness or stupor. The term isn't used medically now, since it has a negative connotation due its connection with illegal drugs. So, "opiates" is used specifically for natural derivatives of the poppy plant (such as morphine), while "opioids" are synthetic drugs (such as fentanyl) that work on the same receptor. The term "opioids" is used for the entire class.

Allergies to opioids are rare, but it is common to have an adverse reaction to them. Nausea or vomiting, constipation, dry mouth, confusion, and itching without a rash are common adverse effects of opioids, but they aren't usually allergic. True allergies commonly involve a rash, wheezing or swelling. It's estimated that 90% of people with a medically documented allergy to opioids have a nonallergic reaction.

What your anesthesiologist will do is get a careful history of what drug you had and what the reaction was. There are several chemically different classes of opioids, so if you are one of the rare people with a true allergy, you can get a chemically unrelated alternative.

Midazolam, by the way, is part of a chemically unrelated family of sedatives called benzodiazepines. These are used during surgery to keep people calm and relaxed.

DEAR DR. ROACH: I am a 76-year-old female who had a total hysterectomy along with the removal of one ovary approximately 40 years ago. The second ovary was removed some time later. Since then, I have had a Pap smear every two years. I questioned my doctors as to whether the Pap smear is necessary due to my past surgery, and I have been getting conflicting answers. What is your medical opinion.? -- C.A.

ANSWER: The consensus of medical opinions is that if you had the hysterectomy for cancer, whether it was for endometrial or cervical cancer, you should continue to get a Pap smear for the rest of your life. There is always a small chance that a few cells might have been left during surgery. In the unusual case that cervical cancer does come back, a few cases are caught early because of the Pap smear.

If the hysterectomy was done for a reason other than cancer, such as fibroids, then no further Pap smears are needed, assuming that you had a total hysterectomy -- not a supracervical hysterectomy where the cervix is left in place.

I have seen many cases where a woman has been unsure or even mistaken about which surgical procedure she's had, so it is absolutely essential that a woman understand exactly what the surgery was. In your case, I suspect you had a total hysterectomy with a unilateral salpingo-oophorectomy, which is the removal of the entire uterus and cervix along with one ovary and Fallopian tube. It would be ideal to have the surgical records from 40 years ago for your new doctors.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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