Take note: A matter of life or death
hen the significant findings of medical investigations are not acted on, they are described as having “got stuck in the notes” – a potent image that, unfortunately, proved fatal for Barnsley pensioner John Higgs. It was only after his death from a ruptured aortic aneurysm in 2015, as mentioned in this paper last week, that the CT scan report from four years earlier, of a golf ball-sized aneurysm, came to light.
There are few instances where the consequences of such an oversight can be literally “a matter of life or death” – as suggested by the memorable symmetry of the relevant statistics: 95 per cent of those whose aneurysm is detected early and repaired before it starts leaking will survive; 95 per cent of those in whom it bursts will succumb.
The operation itself was at one time an arduous procedure, as I recall from my time as a house surgeon in the 1970s, taking several hours followed by a stay in intensive care and a protracted convalescence.
Then, in 1986, Juan Parodi, an Argentinian physician, made a small incision in the groin and introduced an endovascular stent through the femoral artery up into the aorta that prevents the aneurysm from rupture – so now patients can return home the following day. This is now, by far, the procedure of choice, though 10 years on there is a small risk of late complications warranting long-term follow-up.
Gyp in the hip
The conundrum of the woman with the characteristic features of hip arthritis – pain on climbing stairs and waking her at night – but normal X-ray and MRI scans has prompted some interesting suggestions.
First, it would appear these radiological findings are not definitive, as for one reader who – when her pain was dramatically relieved with a local anaesthetic injection (confirming it was coming from the hip) – went on to have a hip replacement.
The operation was arduous, followed by intensive care and a protracted convalescence
At operation, she was found to have an area of eroded cartilage about the size of a penny piece that was obviously the cause of her symptoms – but was invisible on scans and X-ray.
Several readers describe how their hip pains were eventually found to be due to variously bursitis (inflammation of the fluid-filled sacs that act as a cushion between the tendons and bones, which can be relieved by a cortisone injection), fallen arches (improved by foot orthoses), tendonitis of the gluteus medius muscle (helped by hip flexor exercises), and a prolapsed disc, despite not having the usual symptoms of sciatica (pain-free since a discectomy).
Two further possibilities are first that these pains can be due to reduced blood flow to the hip from narrowing (or claudication) of the blood vessels supplying it from the femoral artery. “The pain is initiated by exercise and may occur at night when the blood pressure tends to be low,” writes Dr David Abell from Portsmouth.
Retired rheumatologist David Ellis advises measuring the iron and ferritin levels in the blood as unexplained arthritic pains can be an early sign of haemochromatosis, an inherited condition, in which iron levels in the body slowly build up over several years.
Gloomy days
This week’s medical query comes courtesy of Mrs AE from Chichester, for the past five years troubled by fluctuating low mood, which has been kept at bay by the antidepressant Sertraline. But, curiously, during her bad patches, though she wakes feeling awful and the gloominess persists throughout the day, around 6pm the sun comes out (as it were) and she is cheerful for the rest of the evening. Has anyone had a similar experience, she wonders, and how can she extend the good times?
Beta-blocker block
Finally, apologies to those who tried and failed to access the reference in last week’s column on the problems of the long-term use of beta-blockers. It can be downloaded at tinyurl.com/ beta blockers ross el lo, or by googling “Rossello cardiovascular drugs 2015”.