[HSF] Too scared to touch.....

[Ani Anyanwu]

Actually in this case Michael you do know the other devil. Easy to work out likely scenario if you did operate. How obese is obese here anyway?

Ani
  ----- Original Message ----- 
  From: Michael Firstenberg<mailto:msfirst at gmail.com> 
  To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com> 
  Sent: Saturday, April 28, 2007 11:01 AM
  Subject: Re: [HSF] Too scared to touch.....


  That is a major part of our argument not to operate.
  She came in with a RCA/RV problem - and that was taken care of.
  Everyone is just "scared" of the LAD/Cx disease (not that bad though)  
  and thinks that CABG will save everything......


      resisting the oculo-graft reflex  (i.e see blockage - needs graft)

  the devil you know vs the devil you dont.

  she needs medical management (I dont even think she came in on beta- 
  blockers/statin/etc)


  -michael



  On Apr 28, 2007, at 10:51 AM, Ani Anyanwu wrote:

  > Michael,
  >
  > What would be the indication for surgery at the present time?
  >
  > Ani
  >   ----- Original Message -----
  >   From: Michael Firstenberg<mailto:msfirst at gmail.com<mailto:msfirst at gmail.com>>
  >   To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart<mailto:OpenHeart-L at lists.hsforum.com%3Cmailto:OpenHeart>- 
  > L at lists.hsforum.com<mailto:L at lists.hsforum.com>>
  >   Sent: Saturday, April 28, 2007 10:36 AM
  >   Subject: [HSF] Too scared to touch.....
  >
  >
  >   Would anyone do anything different?
  >
  >   52 year/old, multiple medical problems (poorly controlled diabetes,
  >   hypertension, high lipids of course - and dont forget obese).  Known
  >   brain AVM, cryptogenic cirrhosis with history of varices/bleeding/
  >   blakemore tube (the works, but nothing recent and LFTs/proteins not
  >   too bad) - treated with mesocaval shunt for portal vein  
  > thrombosis in
  >   1999.  Splenic embolization also.  Chronic anemia and renal
  >   insufficiency.  CT scan of abdomen "suggests carcinomatosis" -
  >   slightly worse over past "couple of years" - but no primary (CA125
  >   elevated  to ~60 baseline in our hospital 0-40, already had TAH-BSO
  >   years ago).  About six months ago, fell and got a "hairline"  
  > fracture
  >   of left hip - no intervention, but developed a DVT in right leg.
  >   Recently, fell again (may have been near syncope) and broke right
  >   ankle in several places.  Admitted to outside hospital after fall,
  >   hypotensive, found to have a troponin of ~20 with a moderate RV
  >   infarct.  Taken to cath lab for PCI (BMS to occluded right -
  >   interesting as she was on coumadin) - opened up,  but also has
  >   significant LAD/Cx disease.  Good targets.  Cardiology asking for  
  > off-
  >   pump LIMA-LAD and they will do a protected left main stent.
  >   Anesthesia and Ortho doesnt want to fix her ankle until her heart is
  >   taken care of.
  >
  >   Would anyone operate?
  >
  >   Cardiology somewhat understanding of our reluctance to "take the  
  > high
  >   potential operative mortality hit" and in fact they are not sure  
  > they
  >   even want to "take the PCI hit".  To be honest, we all want to try
  >   and help (not sure of the long term benefit as no one has any  
  > idea of
  >   her long-term prognosis), but no one wants to have a potential CABG
  >   mortality.
  >
  >   Hal - can I send her to you?
  >
  >
  >   -michael
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