Vas­cu­lar surgery woes over­stated, says Syd­ney physi­cian

‘This is not a prob­lem area, com­pared to some of the oth­ers’

Cape Breton Post - - Cape Breton - BY NANCY KING nk­ing@cb­post.com

A doc­tor in Syd­ney says there are le­git­i­mate con­cerns about the cur­rent state of health care in Cape Bre­ton but ac­cess to vas­cu­lar surgery isn’t as poor as it’s been pre­sented re­cently.

In an in­ter­view Tues­day, Dr. Rex Dunn said a vas­cu­lar sur­geon did leave the re­gion but that doesn’t mean there is no vas­cu­lar ser­vice avail­able. Dunn noted that he him­self has not re­tired and still ded­i­cates about four days a month to surg­eries, sees pa­tients in the vas­cu­lar clinic and per­forms ser­vices for dial­y­sis pa­tients. There is a 0.6 full-time equiv­a­lent po­si­tion based in Cape Bre­ton, which he cur­rently fills.

There is also a visiting vas­cu­lar sur­geon who trav­els reg­u­larly to Cape Bre­ton from Hal­i­fax.

“Let­ters have been sent out to ex­plain what the ser­vice will be and now has be­come,” he said. “You should be re­as­sured that there is a way for timely con­sul­ta­tions, timely surgery, what­ever surg­eries are ap­pro­pri­ate to do here, we will con­tinue to do them.

“This is not a prob­lem area, com­pared to some of the oth­ers.”

Dunn ac­knowl­edged most of the pro­ce­dures he does are con­sid­ered to be on the more mi­nor end of the scale, but they are still nec­es­sary, and he would also re­spond if called to a vas­cu­lar emer­gency.

He added he is acutely aware of the dif­fi­cul­ties the re­gion is fac­ing in re­cruit­ing in cer­tain spe­cial­ties and the con­cerns of doc­tors that their voices are not bring heard.

In a let­ter to the Cape Bre­ton Post, Dunn noted that with the de­par­ture of the pre­vi­ous vas­cu­lar sur­geon, ad­min­is­tra­tion both lo­cally and provin­cially sup­ported the de­vel­op­ment of a hos­pi­tal-based vas­cu­lar clinic, lo­cated in the Health Park. It op­er­ates two days each week. There, Dunn al­ter­nates with the visiting vas­cu­lar sur­geon and lo­cal doc­tors have been sent con­tact in­for­ma­tion for re­fer­rals to the clinic.

The ap­proach to more com­pli­cated vas­cu­lar surg­eries has changed, Dunn said.

“This is a tremen­dously changed spe­cialty over the past 30 years,” Dunn said. “A lot of this work is done in vas­cu­lar suites that are highly tech­ni­cal and com­bined with some surgical pro­ce­dures, so if you want your pa­tients to have the best they should have ac­cess to that.”

Dunn said the is­sue here is look­ing at what is prac­ti­cal ver­sus what is rea­son­able.

“If you are go­ing to get a re­cently trained vas­cu­lar sur­geon at the top of their game, they would end up work­ing alone. there’s no cross-cov­er­age for them here so you would be on call 365 days a year, it’s just not sus­tain­able,” he said.

He said Prince Ed­ward Is­land went through a sim­i­lar sit­u­a­tion and the sin­gle vas­cu­lar sur­geon there es­sen­tially “col­lapsed un­der the strain,” and in­stead moved to a model sim­i­lar to that which now serves Cape Bre­ton.

“You need some­thing that will be sus­tain­able for a long time,” Dunn said.

Dr. Mah­mood Naqvi is a for­mer med­i­cal direc­tor of the Cape Bre­ton District Health Author­ity. It’s his opin­ion that the level of vas­cu­lar surgery cur­rently avail­able in Cape Bre­ton is not ad­e­quate. He has ar­gued that due to the cur­rent lack of a full-time vas­cu­lar sur­geon there are pa­tients who are be­ing trans­ported to Hal­i­fax and end­ing up with am­pu­ta­tions or worse.

“Only con­sul­ta­tion ser­vice is avail­able at this time by a con­sul­tant vas­cu­lar sur­geon visiting surgery on a reg­u­lar ba­sis,” Naqvi said. “There has to be a full-time vas­cu­lar sur­geon prac­tis­ing from Syd­ney, not from Hal­i­fax.”

The less com­pli­cated vas­cu­lar surg­eries, in­clud­ing am­pu­ta­tions, can be per­formed by other sur­geons, Naqvi said. He said the visiting sur­geon doesn’t per­form oper­a­tions in Cape Bre­ton, in­stead those pa­tients are trans­ported to Hal­i­fax.

“Vas­cu­lar surgery is presently very lim­ited in Syd­ney and we need to have a full-time vas­cu­lar sur­geon,” he said.

Dunn said he has the great­est re­spect for Naqvi, but he dis­agrees that the vas­cu­lar ser­vice lo­cally has de­te­ri­o­rated. He added he’s not aware of any de­lays re­sult­ing in in­creased am­pu­ta­tions.

It’s been about 18 months since there was a full-time vas­cu­lar sur­geon based in Syd­ney, Naqvi said.

“Peo­ple should know that we’ve been los­ing so much health care from this area that in the com­ing gen­er­a­tion it will be very dif­fi­cult to im­prove health-care ser­vices,” Naqvi said. “If you live in Cape Bre­ton Is­land, your chances of liv­ing is two years shorter than if you lived in main­land Nova Sco­tia.”

CAPE BRE­TON POST PHOTO

Dr. Rex Dunn says that while a vas­cu­lar sur­geon has left the re­gion, that doesn’t mean there is no vas­cu­lar ser­vice avail­able on the is­land.

SUB­MIT­TED PHOTO

Dr. Mah­mood Naqvi be­lieves the level of vas­cu­lar surgery cur­rently avail­able in Cape Bre­ton is not ad­e­quate.

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