Aa
conflicting advice
Hi,
this is a bit long but would appreciate any thoughts or ideas.
I was diagnosed with severe cardiac artery disease about 8 months ago. The angiogram showed that my arteries are very small with extensive plaque and the decision was to keep me on maximum medication and see what happens. I was told that angioplasty was out of the question and that surgery will be very risky.
Well winter came and went and was not great. I can do stuff, have to take it very easy and spent quite a few hours on the sofa. It is a bit better at the moment and I keep active but its in slow motion always as any speed at all gets the angina going. Plus any tension, excitement - the usual stuff.
All the above happened in France - best in the world for healthcare and I have found it very impressive to date. However my sister arranged for me to see a cardiologist in England during a recent visit. I was keen to do this because, although my french is ok I really just wanted to talk through my condition in English and get a better understanding of what discomfort meant what. I sent the cardiologist all the reports and CD of the Angiogram. However the cardiologist, while agreeing that angioplasty would be very dangerous, thought that surgery was absolutely possible with minimal risk over the usual. He agreed that my arteries were 'developmentally' small but had seen worse. The surgeon, a professor of surgery, also thought that surgery was not a problem and now was a good time when age (60), a strong heart and good health were on my side. I am also very thin.
Back to France and met the surgeon there to discuss going forward for surgery to be told that it was very dangerous with a more than uncertain outcome because of the abnormal size of my arteries plus the fact that they go from small to threadlike on each side of the blockages. I will need surgery one day but the idea is to hold off as long as possible until there is no option. This is a highly renowned clinic majoring in cardiology carrying out over 5000 angiograms per year. Has anyone any ideas on why the advice should conflict to such an extent?
this is a bit long but would appreciate any thoughts or ideas.
I was diagnosed with severe cardiac artery disease about 8 months ago. The angiogram showed that my arteries are very small with extensive plaque and the decision was to keep me on maximum medication and see what happens. I was told that angioplasty was out of the question and that surgery will be very risky.
Well winter came and went and was not great. I can do stuff, have to take it very easy and spent quite a few hours on the sofa. It is a bit better at the moment and I keep active but its in slow motion always as any speed at all gets the angina going. Plus any tension, excitement - the usual stuff.
All the above happened in France - best in the world for healthcare and I have found it very impressive to date. However my sister arranged for me to see a cardiologist in England during a recent visit. I was keen to do this because, although my french is ok I really just wanted to talk through my condition in English and get a better understanding of what discomfort meant what. I sent the cardiologist all the reports and CD of the Angiogram. However the cardiologist, while agreeing that angioplasty would be very dangerous, thought that surgery was absolutely possible with minimal risk over the usual. He agreed that my arteries were 'developmentally' small but had seen worse. The surgeon, a professor of surgery, also thought that surgery was not a problem and now was a good time when age (60), a strong heart and good health were on my side. I am also very thin.
Back to France and met the surgeon there to discuss going forward for surgery to be told that it was very dangerous with a more than uncertain outcome because of the abnormal size of my arteries plus the fact that they go from small to threadlike on each side of the blockages. I will need surgery one day but the idea is to hold off as long as possible until there is no option. This is a highly renowned clinic majoring in cardiology carrying out over 5000 angiograms per year. Has anyone any ideas on why the advice should conflict to such an extent?
Best Answer
thanks and take care too
What about looking for another opinion, just to break the equality?
Jesus.
Jesus.
Hi Ed
That was helpful. My sister is pretty rich so it was the private Alexandra Hospital in Manchester but the surgeon involved was, I assume, at Manchester Royal Infirmary as well.
The Hospital in France is the Clinic St Martin which is pretty renowned.
I agree that now is actually better before any heart damage takes place and my one big advantage is that my heart is very strong. But the impression I get from the French clinicians is that I am just as likely to die as a result of surgery which is why they see it as a last resort. That makes it a pretty scary decision to make.
Actually if the situation did get worse it would be totally debilitating as 2 of my main arteries are over 90% Blocked - one 95% and the rest around 80/85%. But I can still garden, walk over to my Horses and spend a day in Paris so that is a pretty good quality of life
That was helpful. My sister is pretty rich so it was the private Alexandra Hospital in Manchester but the surgeon involved was, I assume, at Manchester Royal Infirmary as well.
The Hospital in France is the Clinic St Martin which is pretty renowned.
I agree that now is actually better before any heart damage takes place and my one big advantage is that my heart is very strong. But the impression I get from the French clinicians is that I am just as likely to die as a result of surgery which is why they see it as a last resort. That makes it a pretty scary decision to make.
Actually if the situation did get worse it would be totally debilitating as 2 of my main arteries are over 90% Blocked - one 95% and the rest around 80/85%. But I can still garden, walk over to my Horses and spend a day in Paris so that is a pretty good quality of life
It's basically all down to experience. I noticed this between different hospitals in the UK. If a hospital tends to have a policy where small arteries are not treated with anything other than medication until the time arrives where it is necessary (if at all), then they won't carry the same experience as those surgeons who do operate under such conditions to give a better quality of life. I know where you are coming from with the cold weather affecting you, it certainly makes angina a lot worse, whereas in the summer, the symptoms seem to virtually disappear. At the end of the day, you have two decisions. Do you wait to until things get so bad (and how much more difficult would it be to operate then), or do you have surgery now and improve your quality of life.
some things to keep in mind is that each time you get chest discomfort, the cells in your heart are in distress and likely being damaged. You have to have quite some time between discomforts for them to fully recover. Also, you have likely developed all possible collaterals if any by now, so your condition is not likely to improve. You could spend the next 20 years without getting worse so is your quality of life good enough for that prospect?
Which hospital did you go to in England? Was it St.Marys? Harefield? St. Thomas?
some things to keep in mind is that each time you get chest discomfort, the cells in your heart are in distress and likely being damaged. You have to have quite some time between discomforts for them to fully recover. Also, you have likely developed all possible collaterals if any by now, so your condition is not likely to improve. You could spend the next 20 years without getting worse so is your quality of life good enough for that prospect?
Which hospital did you go to in England? Was it St.Marys? Harefield? St. Thomas?
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I think if I was in your situation, I would remain as I am until needing the surgery. By, which time, perhaps angioplasty will have moved on with technology even further to deal with your issues. Even surgical techniques could advance in that time. I would make sure I carry a GTN spray at all times, which can be the difference between life and death. As your blockages worsen (if they do), you will notice this through your symptoms getting worse. I have always had this but Doctors have never listened. For example, at xmas just gone, I complained of growing symptoms to my cardiologist who said the scans (from one year ago), show no problems, just keep on the meds and you will be fine. Three weeks ago I had a heart attack. So you will have early warnings most times through symptoms increasing. You just have to convince Cardiologists that you know your body.
Take care