No treatment options from consultant.

[BlueSilverCats]

OH has PAD . He was referred for an MRI looking at getting an angioplasty done after the results.

He saw the consultant today who said there are no treatment options, that the other doctor who mentioned angioplasty was on another planet and all he can do is to stop smoking. I read the letter so this is not coming just from OH. It even mentions that if it gets worse or his leg is at risk, there still isn't much they can do.

They won't even attempt an angioplasty or a stent or a bypass. Nothing they can do and they won't see him again either, just get referred again if things get worse/anything changes.

It literally says in the letter that his recovery is entirely up to OH . Stop smoking, exercise more and that's it. He will stop smoking, so that isn't an issue.

AIBU to think this can't be it?

I want OH to get a second opinion at the very least.Might even look at private, but I have no idea where to start.

You are free to ask for a second opinion.
Who was the doctor who suggested angioplasty? The letter suggests it was not a consultant who can do the procedure so doesn't know all the finer detail.

Hard to comment. May just have microvascular disease (so the tiny vessels not the big chunky ones) so not amenable to intervention (but the 1st person wasnt aware of that as spoke pre-scan.) Always have the right to ask for a 2nd opinion

When did the other doctor mention angioplasty?

Was he also a consultant, and before or after the MRI?

Always always get a second option.

Never trust a word they tell you until you get it independently verified.

Maybe it's too dangerous because of his other health conditions to give him a general anaesthetic and that's why he's to stop smoking and lose weight?

If those things will help surely that's the place to start?

Yes also a consultant. He had a doppler first, then saw that consultant who said it's going to be an angioplasty and wait for an MRI appt to gauge exact location and get an appt for it.

Different one today who said nothing can be done. Well, they will try a bypass if his foot dies, to ask for a new referral is that happens and no need to see them again.

No risks were discussed , just that nothing can be done and that the other consultant was wrong.

Lifestyle changes will happen regardless, but the thing is , that is the only "treatment ". Nothing else planned, no review, no checkups , no options, no alternatives if the lifestyle changes don't actually help.

It depends on where the disease is and how bad it is, if is generalised throughout the leg then specific treatments may not be appropriate. Stopping smoking is a must as is controlling other risk factors such as diabetes, high blood pressure, getting exercise, seeing if medications such as statins are needed to control the cholesterol level. Sadly having PAD in the leg means being more at risk of atherosclerotic diseases in other arteries throughout the body so lifestyle things are incredibly important!!

has he given up smoking already, if so how long ago? They may be more likely to try Angio if he’s already demonstrated sustained cessation.

No point if he's still smoking .

So there is a point where the arteries are so diseased nothing can indeed be done? This doesn't help my worry, but if it's true , then I guess a second opinion is not needed?

Yes , he will quit smoking. Ironically, he was referred to a stop smoking clinic and that consultant wrote to the GP to prescribe meds to help, but they refused. He has cut down, but after today it's stopping.

He has quite an active lifestyle (manual work, mostly outdoors) and not overweight.

He is on statins.

Definitely get a second opinion. We have a neighbour who had a heart attack last year. Was in hospital, in induced coma, and wife and children told that he wasn’t going to make it and nothing could be done. His wife sent his notes to a leading consultant at Papworth, who said he could help. He had an op there, and returned home where he still is. Only 50 yrs old. Always worth getting a second opinion.

What are his symptoms?
This will probably be the main determining factor. If he is claudicating (gets pain on walking) then the risk of treating some types of disease will far outweigh the possible benefits and the national guidance is to be on a graded exercise programme first and smoking cessation (largely because continuing to smoke makes any treatment highly likely to fail).
If he has a critical limb (tissue loss, pain at rest and at night) most centres would offer something. However there will be some circumstances where angioplasty is highly likely not to work (long length blockages into the below knee vessels, no obvious target in the foot to aim for) and therefore it might not be offered in this situation.
Angioplasties are usually done under local anaesthetic so this shouldn’t affect things. They are usually performed by interventional radiologists but do get performed by vascular surgeons in some parts of the country which might explain why there was a bit of a disagreement about management (? Saw a vascular surgeon first who doesn’t do)

should really be on an anti platelet (aspirin or clopidogrel) as well as a statin

@BlueSilverCats op, here is the link to the NICE guidelines https://www.nice.org.uk/guidance/cg147. And to the NHS website guidance www.nhs.uk/conditions/peripheral-arterial-disease-pad/. I think anyone should be entitled to a second opinion but I would suggest you first ask the consultant to explain their reasoning and to set out more clearly what steps he needs to take and under what circumstances to go back to seek help. It may be that the specific areas of atherosclerosis causing his symptoms are not suitable for surgical measures. Lifestyle modification is usually the first line of intervention ,alongside exercise progression and diet change and the elephant in the room is your husbands smoking habits.

I’m sorry to hear this. I would definitely get a second opinion and if this is going to take a long time, try to go private if you can. Something is not adding up with the 2 different consultant opinions. And as the consequences for your OP could be severe I would have thought he’d want to be sure what the options are. Nothing stopping lifestyle changes alongside getting another opinion. Quite possibly not in this case, but I am aware that some Drs “fob off” people when the don’t have a great understanding of the illness or just want to get the patient off their list.

Very unlikely. Vascular patients are one of the most crumbly frail people we anaesthetise for (often with little choice when ischaemic limbs become infected or such and its life saving). We consent that they could be very high risk for not surviving but can't say ever not gone ahead unless imminently dying anyway which surgery wouldn't change the prognosis. We can do a lot of lower limb stuff under spinal anaesthetic and the surgeons are used to doing a lot under LA due to the nature of their patient group (if their leg vasculature is furred up the same will be said for their heart/brain/kidneys etc

They can often try if it's limb saving ie.acutely ischaemic but often unsuccessful as often the vessels they're trying to graft onto the inital problem are just as awful. It's super stressful when they're trying to do emergency cases

I'm an anaesthetist not vascular surgeon though, I'd def ask for a 2nd opinion

That's mad they've refused to prescribe, can he book in with the nurse for smoking cessation.appts - most gps won't prescribe outside of a treatment programme as there's a lot of evidence now that drugs alone aren't enough they need the ongoing support too (my mums been refused meds as didn't want to attend the classes/appts

Thank you I did read through it , but honestly, my head is a mess so I couldn't make much sense of it, especially what goes with the severity of his occlusion . From the sounds of it, it's really bad.

Yes, the smoking is a non negotiable now. He has cut down, and made other lifestyle changes when this whole nightmare started last year but obviously not good enough.

I can post the exact wording of the letter with the exact issues if anyone with experience is willing to have a look. I just fear that indeed there is nothing else to be done, which is not what I want to hear, but I'm willing to accept it.

You seem very confident that he'll be able to make the necessary lifestyle changes @BlueSilverCats . Are you prepared for the idea that he may not. He hasn't so far and they're very difficult things to do.

If he doesn't, then it's his own damn fault, especially if it's the ONLY solution. Maybe that's why I'm hoping there is/should be a plan B. Just in case. He is adamant he'll do it, he's absolutely terrified too,but then again, that's easy to say on day 1.

He's looking atm at getting the stop smoking meds privately. I did tell him to try gp again in light of this latest development as they might change their mind, but he said there's no point. He's probably not fully rational either , given it's him actually with the condition.

Apologies for rambling, hope some of this makes sense.

Post the letter -
It may be clearer

What's wrong with his foot?
Does he have diabetes ?

very good advice on here

possibly copy the letter wording here? may be more understandable

He doesn't have diabetes. Due to PDA , pain when walking (managed with painkillers) , numbness, very cold to the touch, very low pulse . Basically he's getting extremely low blood flow to it.