Vas­cu­lar ser­vice alive and well in Syd­ney

Cape Breton Post - - Editorial -

I write in the hopes of clar­i­fy­ing what I have ob­served to be in­cor­rect or in­com­plete in­for­ma­tion pub­lished in the Cape Bre­ton Post and also aired on CBC re­cently, re­gard­ing the spe­cialty of vas­cu­lar surgery in Cape Bre­ton.

I have been a spe­cial­ist and en­gaged in vas­cu­lar surgery on this Is­land for 38 years. De­spite re­marks to the con­trary I am not re­tired. I con­tinue to op­er­ate one day per week and see many pa­tients in our vas­cu­lar clinic, and do all the an­gioac­cess pro­ce­dures for dial­y­sis pa­tients.

Also, part of vas­cu­lar surgery is the op­er­a­tion of a non-in­va­sive vas­cu­lar lab. I es­tab­lished this lab 35 years ago and we see about 3,000 pa­tients a year and re­ports go the pro­vin­cial Im­pax di­ag­nos­tic imag­ing record, avail­able to any physi­cian.

In ad­di­tion, in co­op­er­a­tion with the Vas­cu­lar ser­vice at the QE 2 in Hal­i­fax, we have been for­tu­nate to re­cruit a tal­ented young vas­cu­lar sur­geon to the pro­vin­cial depart­ment – Dr. Matt Smith. Although based in Hal­i­fax, Matt has a ma­jor re­spon­si­bil­ity for Cape Bre­ton pa­tients, to see and at­tend in­pa­tients and out­pa­tients in Syd­ney, and do some surgical pro­ce­dures. He has strong ties to Syd­ney, hav­ing at­tended Riverview High Sschool, and hav­ing his par­ents live here.

With the de­par­ture of a pre­vi­ous vas­cu­lar sur­geon, the ad­min­is­tra­tion, lo­cally and provin­cially, sup­ported the de­vel­op­ment of a hos­pi­tal based vas­cu­lar clinic, now in the Health Park. It op­er­ates to days a week ev­ery week. I al­ter­nate with Dr. Smith. All physi­cians have twice been sent con­tact in­for­ma­tion for re­fer­rals to these clin­ics.

We both see in-hos­pi­tal con­sults, as re­quired.

We sup­port the in­ter­ven­tional vas­cu­lar ra­di­ol­o­gists who on re­fer­ral con­tinue to revas­cu­lar­ize limbs in Syd­ney.

In ad­di­tion, there is a weekly re­nal ac­cess clinic run by vas­cu­lar surgery and all the ac­cess surgery re­quired by any pa­tient in the en­tire Eastern Zone is done here, ei­ther at the North­side Hos­pi­tal or CBRH. There are large num­ber of these. Many are com­plex pro­ce­dures re­quir­ing grafts and aneurysm re­sec­tions.

Dr. Naqvi is also still work­ing and is also on the reg­is­ter as a vas­cu­lar sur­geon. Many of the pa­tients he sees in the wound clinic have un­der­ly­ing vas­cu­lar dis­ease re­quir­ing in­ter­ven­tion. On some days there could be as many as three cer­ti­fied vas­cu­lar sur­geons avail­able for con­sul­ta­tion in Syd­ney.

For emer­gen­cies there is a call sched­ule pub­lished on the hos­pi­tal in­tranet. All of the vas­cu­lar sur­geons in Hal­i­fax have my con­tact info and even if I am not on call I ar­range to see sta­ble pa­tients and prevent un­nec­es­sary travel.

There­fore, I fail to see how it can be said that cur­rently there is no vas­cu­lar ser­vice in Syd­ney. Ob­vi­ously, there will come a time when I will re­tire, and my surgical con­tri­bu­tion will cease. The public and physi­cian pop­u­la­tion should be made aware that the province rec­og­nizes the need for a per­ma­nent po­si­tion based in Syd­ney. This will be a 0.6 FTE., and some­one will fill that when needed. Right now it is me.

I would like to men­tion two is­sues that those giving su­per­fi­cial at­ten­tion to the mat­ter may not have con­sid­ered.

Firstly, vas­cu­lar surgery and the train­ing for it have changed dra­mat­i­cally over 30 years. Where it once was part of gen­eral surgical train­ing, it now will be su­per spe­cial­ized and of­fered in a five-year pro­gram with no gen­eral train­ing. If you want the best, you need one of these folks and they are not go­ing to work alone, and be con­tin­u­ously on call for post op pa­tients.

Se­condly, our pop­u­la­tion at­ro­phy is killing us. Since I came to Syd­ney there are 35,000 less peo­ple on the Is­land. On that ba­sis alone, you need to re­assess ser­vices from time to time.

Fi­nally, I would dis­pute any sug­ges­tion that vas­cu­lar ser­vices have de­te­ri­o­rated over the past two years. Surely the goals of care should be to de­liver timely high qual­ity care as close to home as pos­si­ble. I be­lieve that with the help of the Vas­cu­lar ser­vice in Hal­i­fax, and with NSHA sup­port, we are de­vel­op­ing such a sys­tem. Of course there will be pa­tients re­quir­ing com­plex revas­cu­lar­iza­tion who will need re­fer­ral. How­ever, all their preop workup and most of their postop care can and is be­ing car­ried out here. Those re­quir­ing a sim­ple opin­ion are be­ing as­sessed here and never need to go to Hal­i­fax.

I am acutely aware that there are many other con­cerns re­gard­ing loss of ser­vices and re­cruit­ment dif­fi­cul­ties that con­cern our doc­tors, my­self in­cluded. Vas­cu­lar surgery should not be one of them.

Dr. Rex Dunn Syd­ney River

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