[HSF] Intimal Tears

[Ani Anyanwu]

Ed
 
Not really. Surgery is my job and I would just do my job whatever it is. Whether what I do or what we do is the 'right' thing is another question which is what I raised in the earlier discussion. LVAD therapy is no different from any other and we still weigh the risks and benefits of each case and sometimes say no, as I did to a 71 year old in post infarct cardiogenic shock last week with a logistic euroSCORE of 98. Also all patients having VADs and high risk valve operations are sick, very sick and symptomatic. We (doctors) do not go looking for them - they look for us. Screen triggered disease and VOMIT is different because you are operating on people who never complained about whatever it is you say they need fixing. I am operating on one such patient this week, incidental coronary disease in a patient needing kidney transplant and I still feel uneasy about whether I am doing the right thing. Dr Frater put it very well - we should be prepared to hold conflicting views on what we do in our heads at the same time. My views have little to do with my practice as a surgeon or as a doctor. I just don't like brain washing whether I am at the giving end or receiving end.
 
Ani
 
 



> Date: Mon, 4 Feb 2008 18:13:23 -0600> Subject: Re: [HSF] Intimal Tears> From: ebender001 at charter.net> To: OpenHeart-L at lists.hsforum.com> CC: > > I don't mean to "pile on" Ani with this question, but ever since our> discussions about carotid artery surgery Ani's responses about avoidance of> medical personnel and "VOMIT" have been bothering me. Ani, I gather from> your missives that you have the difficult job of performing a lot of> desperate operations on desperate patients. Naturally, a lot of the> outcomes are predictably fatal, with the successes being all that much> sweeter. Do you think that your aversion to aggressive diagnosis and> intervention has anything to do with the arena in which you perform? I bet> that if I had to go through what you go through, I would be averse to> "looking for trouble" also. I remember Tom Starzl commenting that he found> the renal transplant work enjoyable, and the research was challenging, but> when he started in on liver transplants, that was when the torture really> began for him.> > Ed Bender, MD> > > On 2/4/08 5:28 PM, "Tea Acuff" <tacuff at swbell.net> wrote:> > > Of course the problem with logic and prospective complications is that one can> > argue either way retrospectively. Some are stronger arguments (as in Ani's> > calculations), but none are clear.> > > > tea> > > > > > ----- Original Message ----> > From: Prasanna Simha M <prasannasimha at gmail.com>> > To: OpenHeart-L at lists.hsforum.com> > Sent: Monday, February 4, 2008 10:45:19 AM> > Subject: Re: [HSF] Intimal Tears> > > > Playing Ani's ethics game - is it ethical to postpone surgery to> > demonstrate liabilities (which may not ever occur or if occurs may not> > change outcomes and is in no way concerned with patient outcome ) versus> > going ahead with surgery (whose outcomes also may not change.> > Prasanna> > > > On Feb 4, 2008 5:19 PM, Ani Anyanwu <anianyanwu at hotmail.com> wrote:> > > >>> and close the rent with a purse string. The last option is remove the>> >> dilator , compress and cancel the case for 24 hours.> >> > >> Prasanna> >> > >> This last option has two advantages - 1) It will differentiate a carotid> >> puncture related stroke from a surgeon related stroke - you never know what> >> the anesthesiologist has done and if any drugs have been given. We recently> >> had a patient stroke after direct administration of norepinephrine and> >> propofol into the carotid artery (this was in an ICU patient with the line> >> placed by a surgeon). 2) Avoids a neck incision.> >> > >> We had a similar case to yours in a child when I was at Harefield, where> >> we could not get the ACT to rise despite boluses and boluses of heparin. In> >> the end doing it the old fashioned way worked (directly injecting into the> >> RA). At some point in the surgery the right pleura was opened to reveal> >> white fluid (propofol) - all the medication had been going straight into the> >> pleural cavity where the tip of the line resided.> >> > >> Ani> >> > >> > >> > >> > >> > >>> > > > > > > > _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------
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