Any doctors on here? Advice for Abdominal Aortic Aneurysm
Discussion
Abdominal Aortic Aneurysm
My 76 year old father in law has been suffering from a back pain for about 6 weeks now. He is very fit for his age. Initial GP consultation with Locum doctor sent him away with the usual painkillers.
A week later he went to see his actual GP who decided to send him for an XRay. They saw something on the XRay (no communication as to what) an referred him for an outpatient appointment to see a NHS vascular consultant. This consultant examined him and said that we suspect you have an abdominal aortic aneurysm and will book an ultrasound for you. When we asked if this was causing the Lower back pain (which is quite severe), he replied no, that is something completely different.
Now we were waiting for the ultrasound and I was doing some research into AAA and it seems it can be catastrophic if it bursts. So in the interests of saving time, I booked an ultrasound at a private hospital and they confirmed the AAA is over 5cm in size.
I tried to contact the NHS consultant via his secretary and she said that we can book an earlier appointment for this Monday and will look at the scans but he may not be happy with how the scan is done so he may want to do his own scan. He refused to allow us to email the scan results and the report to him etc. He also mentioned he is off for two weeks at Easter. (Initially we have a NHS scan booked for 17th March and an appointment booked with the consultant on 14h April).
Now my question is, how do I get the NHS to operate immediately. It looks like this could be a time bomb and now they have it confirmed, why will they not operate immediately? It's seems extremely risky to potentially wait another 4-6 weeks and his pain is getting worse and radiating down his leg. There seems to be no urgency or appreciation of the seriousness in their approach at all.
Any advice would be greatly appreciated.
My 76 year old father in law has been suffering from a back pain for about 6 weeks now. He is very fit for his age. Initial GP consultation with Locum doctor sent him away with the usual painkillers.
A week later he went to see his actual GP who decided to send him for an XRay. They saw something on the XRay (no communication as to what) an referred him for an outpatient appointment to see a NHS vascular consultant. This consultant examined him and said that we suspect you have an abdominal aortic aneurysm and will book an ultrasound for you. When we asked if this was causing the Lower back pain (which is quite severe), he replied no, that is something completely different.
Now we were waiting for the ultrasound and I was doing some research into AAA and it seems it can be catastrophic if it bursts. So in the interests of saving time, I booked an ultrasound at a private hospital and they confirmed the AAA is over 5cm in size.
I tried to contact the NHS consultant via his secretary and she said that we can book an earlier appointment for this Monday and will look at the scans but he may not be happy with how the scan is done so he may want to do his own scan. He refused to allow us to email the scan results and the report to him etc. He also mentioned he is off for two weeks at Easter. (Initially we have a NHS scan booked for 17th March and an appointment booked with the consultant on 14h April).
Now my question is, how do I get the NHS to operate immediately. It looks like this could be a time bomb and now they have it confirmed, why will they not operate immediately? It's seems extremely risky to potentially wait another 4-6 weeks and his pain is getting worse and radiating down his leg. There seems to be no urgency or appreciation of the seriousness in their approach at all.
Any advice would be greatly appreciated.
Edited by shopper150 on Saturday 12th March 08:06
this should be in health etc.
AAA is a major operation with possible serious issues, depending on where the AAA is located, and would require a stay on intensive care. A vascular surgeon would run thro all the risks, and these may also depend on other co-morbidities of the patient, age etc.
As the AAA gets bigger, the chances of it bursting is increased -then often RIP. So if a patient has a known AAA, the size would be monitored to see if is increasing. When it gets to a certain size, this is when they would operate usually.
I would go back to gP with information and ask for a urgent fast-track referral to a vascular surgeon.
HTH
AAA is a major operation with possible serious issues, depending on where the AAA is located, and would require a stay on intensive care. A vascular surgeon would run thro all the risks, and these may also depend on other co-morbidities of the patient, age etc.
As the AAA gets bigger, the chances of it bursting is increased -then often RIP. So if a patient has a known AAA, the size would be monitored to see if is increasing. When it gets to a certain size, this is when they would operate usually.
I would go back to gP with information and ask for a urgent fast-track referral to a vascular surgeon.
HTH
One of the things th NHS are not good at is communicating to patients when everything is ok, relatively speaking.
Although it's a potentially lethal condition you have to assume trust in the consultant that if he thought you were in imminent danger then they would get you in ASAP.
Getting a scan without the expertise behind it to manage the findings does nothing but cause worry really. Personally I'd go back to th gp and explain everything but be specific that you want your back looking at by a specialist MSK bod. The back pain could be entirely unrelated.
Although it's a potentially lethal condition you have to assume trust in the consultant that if he thought you were in imminent danger then they would get you in ASAP.
Getting a scan without the expertise behind it to manage the findings does nothing but cause worry really. Personally I'd go back to th gp and explain everything but be specific that you want your back looking at by a specialist MSK bod. The back pain could be entirely unrelated.
5cm is not an aneurysm at bursting point so there's no need to rush. The NHS will prioritise based on clinical urgency. To do that he will need to have the tests he needs and then they'll decide from there. If you want an EVAR more quickly than the NHS will provide then you'll need to pay for it yourself. Bear in mind the procedure comes with its own risks and the consultant will have to discuss the risk vs benefit with you before you go ahead. AAAs usually develop slowly over a number of years so it may be decided that screening the size of it every so often would be a better approach. Whilst understandable, I think what you've done (paid for private ultrasound and done your own research) has only caused you unnecessary worry.
The back pain and sciatica is probably a slipped disc pinching on a nerve or something. Nothing to do with the aorta.
The back pain and sciatica is probably a slipped disc pinching on a nerve or something. Nothing to do with the aorta.
Edited by zeDuffMan on Saturday 12th March 10:46
FYI:
NHS said:
Symptoms of an AAA
In most cases, an AAA causes no noticeable symptoms. However, if it becomes large, some people may develop a pain or a pulsating feeling in their abdomen (tummy) or persistent back pain.
http://www.nhs.uk/conditions/repairofabdominalaneurysm/pages/introduction.aspxIn most cases, an AAA causes no noticeable symptoms. However, if it becomes large, some people may develop a pain or a pulsating feeling in their abdomen (tummy) or persistent back pain.
Thank you for all your replies so far.
It's worrying knowing this is 5.4cm in size and he has had a very significant back pain for many weeks, but it looks like weeks, yet the consultant seems happy to take a slow train on the basis of a 30 second physical examination.
I understand that the consultant needs to weigh out the risk factors, but he is in no rush to get the information he needs to make that decision.
The back pain is clearly a symptom which is has written off (he actually stated, that's nothing to do with it, it's like coming to see a plumber for an electricians job).
It's worrying knowing this is 5.4cm in size and he has had a very significant back pain for many weeks, but it looks like weeks, yet the consultant seems happy to take a slow train on the basis of a 30 second physical examination.
I understand that the consultant needs to weigh out the risk factors, but he is in no rush to get the information he needs to make that decision.
The back pain is clearly a symptom which is has written off (he actually stated, that's nothing to do with it, it's like coming to see a plumber for an electricians job).
Im no expert but I can clearly sense your frustration however a quick Google suggests he will be observed only:
http://www.nhs.uk/Conditions/repairofabdominalaneu...
Whilst I have your attention let me tell you about my mates dad, he was a fit and healthy 70y old who had piles and because my mate has more money than sense insisted the docs did a CAT scan when he went to see them (privately) for his Chalfonts. I have no reason why he did this, he just did.
The CAT scan didnt show anything wrong with his guts but did show a small cancer somewhere else, really tiny and the kind of thing that would not be operated on just observed. You can guess the rest - mate urged his dad to have surgery, private surgeon obliged and my mates dad died shortly afterwards of a complication. My mate still has not got over this.
Everything has risk and consequence.
An aneurysm can kill you but so can the surgery.
I wouldnt have an aneurysm op unless I really had to.
Good luck
http://www.nhs.uk/Conditions/repairofabdominalaneu...
Whilst I have your attention let me tell you about my mates dad, he was a fit and healthy 70y old who had piles and because my mate has more money than sense insisted the docs did a CAT scan when he went to see them (privately) for his Chalfonts. I have no reason why he did this, he just did.
The CAT scan didnt show anything wrong with his guts but did show a small cancer somewhere else, really tiny and the kind of thing that would not be operated on just observed. You can guess the rest - mate urged his dad to have surgery, private surgeon obliged and my mates dad died shortly afterwards of a complication. My mate still has not got over this.
Everything has risk and consequence.
An aneurysm can kill you but so can the surgery.
I wouldnt have an aneurysm op unless I really had to.
Good luck
shopper150 said:
Thank you for all your replies so far.
It's worrying knowing this is 5.4cm in size and he has had a very significant back pain for many weeks, but it looks like weeks, yet the consultant seems happy to take a slow train on the basis of a 30 second physical examination.
I understand that the consultant needs to weigh out the risk factors, but he is in no rush to get the information he needs to make that decision.
The back pain is clearly a symptom which is has written off (he actually stated, that's nothing to do with it, it's like coming to see a plumber for an electricians job).
Where I worked they wouldnt actually consider operating on an any AAA under 6cm in size.It's worrying knowing this is 5.4cm in size and he has had a very significant back pain for many weeks, but it looks like weeks, yet the consultant seems happy to take a slow train on the basis of a 30 second physical examination.
I understand that the consultant needs to weigh out the risk factors, but he is in no rush to get the information he needs to make that decision.
The back pain is clearly a symptom which is has written off (he actually stated, that's nothing to do with it, it's like coming to see a plumber for an electricians job).
There are other options rather than the classical surgery route which your surgeon will discuss with you.
As others have said, there is a risk of rupture and a risk of surgery. When the risk of rupture outweighs the risk of surgery, your FIL will be offered the operation. The risk of rupture increases with the size of the aneurysm.
I'm a mere final year medical student but my understanding is that if an aneurysm ruptures, that's when you get acute onset back/flank pain.
I'm a mere final year medical student but my understanding is that if an aneurysm ruptures, that's when you get acute onset back/flank pain.
GOG440 said:
shopper150 said:
Thank you for all your replies so far.
It's worrying knowing this is 5.4cm in size and he has had a very significant back pain for many weeks, but it looks like weeks, yet the consultant seems happy to take a slow train on the basis of a 30 second physical examination.
I understand that the consultant needs to weigh out the risk factors, but he is in no rush to get the information he needs to make that decision.
The back pain is clearly a symptom which is has written off (he actually stated, that's nothing to do with it, it's like coming to see a plumber for an electricians job).
Where I worked they wouldnt actually consider operating on an any AAA under 6cm in size.It's worrying knowing this is 5.4cm in size and he has had a very significant back pain for many weeks, but it looks like weeks, yet the consultant seems happy to take a slow train on the basis of a 30 second physical examination.
I understand that the consultant needs to weigh out the risk factors, but he is in no rush to get the information he needs to make that decision.
The back pain is clearly a symptom which is has written off (he actually stated, that's nothing to do with it, it's like coming to see a plumber for an electricians job).
There are other options rather than the classical surgery route which your surgeon will discuss with you.
I think the cautionary tale from the previous poster about the incidental finding on the CT scan and the un-needed op and it's role i nthe demise of the patient is worth remembering ...
a normal abdominal aoarta is 2 -3 cm in diameter, over 3 cm is where an aneurysm can be diagnosed
around 5.5 cm is where it changes from watching to considering intervention
elective repair has a MORTALITY rate of around 2 % ...
mph1977 said:
this may be a little facetious; But the OP is obviously powerfully built and be-goatteed and becasue it's his dad what little powers of reasoning have gone out of the window ...
Yes a little unfair I think. As a grandad I did the best I could for my children and I would like to think that perhaps they would return the favour later. If the Consultant had provided even some of the useful information in this thread perhaps the OP's understandable panic could have been avoided. As usual a little knowledge is a dangerous thing.I was summoned for a U/S scan of the abdominal aorta when I was 65. Until then I had never heard of the abdominal aorta let alone that it was a point of potential weakness in men.
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