Vascular service alive and well in Sydney

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