Turned away
Hi,
So this week presented an interesting case…a patient on our Cardio placement has a thoracic aortic aneurysm but after having been in hospital for a few days to prepare for surgery, this patient’s blood pressure was a bit high on the day before her planned surgery. I can’t remember the exact size of the aneurysm but I think it was about 5cm. The patient is quite an overweight/maybe obese individual and would therefore present other risk factors for undergoing a general anaesthetic, but the outcome was that the anaesthetist did not want to anesthetize the patient and therefore she could not have the surgery. She instead was given some medications to assist in controlling the blood pressure issue before she was discharged a few days later to a rural hospital and told to lose some weight before she could have the surgery.
So my problem with this is two-fold. One, if that was me, I would be very anxious about trying to exercise knowing that I had an aneurysm that could potentially rupture at any unknown time-therefore how should I then loose enough weight to be able to have the surgery without risking my life in the meantime? And my second issue is that if this patient had previously tried to loose weight and had been unsuccessful, she would possibly present for lap-band surgery in which an anaesthetist would put her under to do that surgery so how is this any different?
So I suppose there are a few things that puzzle me with this case and who knows if we’ll find out the answers!!
posted by Lauren @ 5:59 PM
1 Comments:
Lauren
Unfortunately I don't have the training or knowledge to make judgement on surgeon decisions regarding suitability for surgical procedures. I remember one instance where I thought a surgeon was making a poor surgical choice for an obese patient and the patient subsequently spent several days in ICU and then a high dependancy unit. Different surgeons do have different strengths and varying risk management profiles.
On a personal note, a close friend of mine has had three cerebral aneurisms. He has a successful, professional career, family and had led an active lifestyle. He asked the surgeon what to do after his third event. The response was, there are not too many people like you still walking so continue to live life fully. He has subsequently swum the English Channel.
As much as we do know, there are so many unknowns. Is an exercise program likely to cause a major event, given your patient's history? Moderate exercise combined with sound nutrition would seem sensible. I am not sure that lap-band procedures would be considered for this patient.
Regards
John
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