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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18663
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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My mum is due to have part if her aorta repaired and a cabg.

Resolved Question:

My mum is due to have part if her aorta repaired and a cabg. I want her to have an mri first to mitigate risk as she has leg and feet swelling since October 2013 post a lumpectomy. They still haven't got to the bottom of the "mystery" condition.
Submitted: 3 years ago.
Category: Medical
Expert:  Dr. D. Love replied 3 years ago.
It is unclear what question you are asking.
How can we be of assistance?

Customer: replied 3 years ago.
How do I insist on am mri? I am surprised it hast been done when my mum is anyway high risk for surgery. But not surprised at nhs bureaucracy
Expert:  Dr. D. Love replied 3 years ago.
What evaluation has she had to this point?

Customer: replied 3 years ago.
The consultant wanted a scan to rule out thrombus as there was a concern there was one between liver and heart. From the blood work they are 99.99% sure there isn't one so radiology cancelled it. I want an mri of her heart lungs liver and kidney. I suspect our previous local hospital are guilty of negligence and should have done this earlier. No condition is a mystery, it requires further testing. Do we have the right to insist on an mri?
Expert:  Dr. D. Love replied 3 years ago.
An MRI would be appropriate if it is clinically indicated, but there is no right to insist on any study that is not clinically indicated. That is why I am trying to understand what evaluation has been done.
Did the consultant not have the blood tests when the scan was ordered?
Who ordered the blood tests?
Has she been seen again by the consultant?
Did he agree that the test should have been cancelled?

Customer: replied 3 years ago.
The consultant requested both. That she has mystery swollen that has not been diagnosed is a huge concern before planning ohs. I guess I will have to pay privately? I am sure the scan was cancelled due cost. Clinically the risk of thrombus now is enough of a reason for an mri
Customer: replied 3 years ago.
I believe to consultant is now aware. But hospital politics may get in the way of him challenging a fellow consultant....
Expert:  Dr. D. Love replied 3 years ago.
Is she scheduled to see the consultant again before the surgery is scheduled?
Is this consultant the physician that will be doing the surgery?

Customer: replied 3 years ago.
I have left a message that I want to speak to him. The heart consultant will perform her surgery. Hopefully me insisting will make it easier to bypass politics. What do you think re surgery when there is an unexplained condition?
Expert:  Dr. D. Love replied 3 years ago.
There are several issues to consider in this situation.

Generally speaking, when the blood test looking for evidence of clotting is negative, the only reason to consider further evaluation would be if there is a high clinical suspicion that a clot is present. Without being able to examine her, I cannot make that determination, but the consultant that ordered the test would be able to say that. It is still unclear what was seen by the consultant that raised suspicion about a clot between the liver and the heart, but if the situation is a high clinical suspicion, then it would be appropriate to pursue an MRI. It is important to note that swelling can be due to a blood clot, but it is rarely between the liver and heart, so concern that there is a clot between the liver and heart is usually not based on the fact that there is swelling of the foot or leg. Therefore, it would be appropriate to discuss with the consultant what amount of clinical suspicion is present.

It is true that there always is a certain amount of bureaucracy for any medical delivery system, but the first issue when trying to overcome that bureaucracy is documentation that there is a clinical indication for whatever test is being discussed. If the consultant's assessment is that there is a high clinical suspicion, then there would be an argument that can be made against the bureaucracy. In that situation, the consultant will be the best advocate for support that the MRI should be done.

As for whether surgery should be considered if there are unexplained symptoms, it would depend upon what surgery is needed and what unexplained symptoms are present. There are certain surgeries that need to be done immediately, and we frequently are not concerned about unexplained symptoms. If the unexplained symptoms do not pose a significant risk to the surgery or the postoperative period, then further evaluation of the unexplained symptom can be done after the surgery. There are other surgeries that are less urgent, and the surgeon will prefer to perform a proper evaluation of unexplained symptoms. Specifically for when there is swelling of the legs, surgery is frequently done based on a negative blood test looking for clot.

If you have any further questions or need clarification, please let me know.

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