I fear my heart’s too weak for surgery

MY HIP is causing me a lot of pain and trouble when walking, and my orthopaedic surgeon wants me to have a hip replacement soon. But as I have a heart condition — hypertrophic cardiomyopathy — my cardiologist is looking at doing a procedure called an alcohol ablation first.

I’m feeling nervous about all this, and hope you can reassure me about the use of anaesthetic and its downsides. Gillian Lovatt, Aldridge, West Midlands.

Ahip replacement will help ease the pain and stiffness of your hip and greatly improve your quality of life. however, it is major surgery and places a strain on the body, particularly if a patient has any pre- existing heart condition — which is why your cardiologist wants to treat yours beforehand.

For other readers, i should explain that hypertrophic cardiomyopathy is an inherited condition, where the heart muscle becomes thickened and scarred, making it harder for the heart to pump blood around the body.

The thickening typically affects the muscle wall of the left ventricle, the main pumping chamber, and starts in puberty, often remaining undetected until later in life. Some people have only minimal symptoms, while others experience breathlessness, chest pain or palpitations.

Medications can help, such as drugs to make the heart pump more efficiently. But people with severe symptoms or who do not improve with medication may be advised to have a procedure to reduce the excess muscle.

This can be done through an open-heart operation to cut away the thickened muscle, or by the non- surgical technique that you have mentioned: alcohol ablation.

ThiS is where the cardiologist inserts a catheter (a fine tube) into the femoral artery at the top of the leg and threads it up to the heart, into a branch of the artery that supplies the muscle. Alcohol is then injected through the catheter to destroy some of the muscle tissue.

Over the next few weeks, the enlarged muscle will shrivel, allowing blood to flow more easily through the left ventricle.

This procedure is successful in more than 80 per cent of cases, although there is a small risk of it causing heart block — where the heart beats more slowly, due to collateral damage to its electrical system. if this happens, then the patient will need to be fitted with a permanent pacemaker.

This must sound dramatic, and may be causing you some anxiety. But i can assure you that it is a routine procedure for the experts who carry it out.

i know you are nervous, too, about the anaesthetic, but all that is needed for this procedure is some local anaesthetic where the catheter is inserted.

As well as improving the function of your heart, the ablation should help protect you from any heart complications that could arise from your hip surgery (such as an abnormal heart rhythm) or during your subsequent recovery.

i should add that a hip replacement is not always carried out under general anaesthetic: some orthopaedic surgeons use local anaesthetic, such as an epidural.

Whichever option is recommended for you, though, it would be safest overall for you to first have the heart treatment that has been proposed. OUR son-in-law, who is 41, has been diagnosed with non-epileptic absence seizures. They started last year, when he collapsed at work. He was taken to hospital, but epilepsy was ruled out.

A consultant has suggested a childhood emotional trauma could have caused it, or a minor car accident or injury. It has been difficult for him, as he has been told he cannot drive or work, and the seizures can happen at any time without warning. He is waiting to see a neurologist, but this could take months. Can you help?

Name and address withheld. EvEry day, Gps see patients with symptoms that are difficult to understand or explain.

Sometimes, the symptoms can be quite troubling — such as the seizures experienced by your sonin-law. And yet, when tests are carried out, we can find no obvious sign of disease or abnormality, so it is difficult to reach a diagnosis and offer effective treatment.

i assume that your son-in-law was given an EEG (electroencephalogram, a recording of brainwave activity) and a brain scan (CT or Mri, to exclude a brain tumour or brain injury) and that both were negative. This would have ruled out epilepsy as the diagnosis.

When there is no medical explanation for such seizures, the conclusion may be that they are occurring for psychological reasons. This is not always easy for patients and their families to understand because they may feel it implies that the symptoms are made up.

it’s also a difficult issue for doctors to understand and explain, particularly as there is no straightforward way to ease the problem.

i would suggest that it is best to think of your son-in-law’s seizures as due to a functional disorder — a condition where a structure or organ looks normal in tests or under a microscope, but does not work as it should (irritable bowel syndrome is one such example).

in this case, it is the central nervous system that is prone to functioning abnormally.

YOur son-in-law’s seizures are real, beyond his control and disturbing his life considerably. But instead of being caused by a disease of the brain, they are driven by subconscious mechanisms.

Another term for this condition is dissociative seizures. One explanation is that they may be the body’s way of dealing with an emotionally upsetting experience from the past. The theory is that the seizure effectively stops a bad memory from being relived.

At the moment, there is no medication for this condition, and your relative’s care must become the province of a neurologist who specialises in this type of event, or a psychiatrist or psychologist. They may offer therapy to re-examine the exact history of a patient.

Over time, this may help unearth the events that triggered the problem, which are often so deeply buried in the pysche that even the patient is unaware of them. it takes a skilled professional to establish a secure, trusting environment, which is essential for this to happen.

in the meantime, do read the book by consultant neurologist Suzanne O’Sullivan, it’s All in your head. This specifically addresses the problem, and you will gain great insight — maybe that alone will enable you to inspire him and unlock the driving issues in his subconscious that have triggered these seizures.

i assure you, he can recover.

WRITE TO DR SCURR

TO CONTACT Dr Scurr with a health query, write to him at Good Health, Daily Mail, 2 Derry Street, London W8 5TT or email drmartin@dailymail.co.uk — including contact details. Dr Scurr cannot enter into personal correspondence. His replies cannot apply to individual cases and should be taken in a general context. Always consult your own GP with any health worries.