Page 3 | No treatment options from consultant.

BlueSilverCats · 2025-01-22T18:09:29+00:00

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.

Member869894 · 23/01/2025 04:18

'The Easy Way to stop smoking' by Allen Carr helped me give up smoking. Good luck to you both op x

MissTrip82 · 23/01/2025 04:26

The absolute best possible use of time and energy here would be to seek whatever help you can afford to deal with his drug addiction. It is both limb and life-threatening.

DragonBalls · 23/01/2025 04:34

olympicsrock · 22/01/2025 23:17

I’m a vascular surgeon. I agree completely with the treatment plan discussed. It’s a really clear and reasonable letter.
The CT scan has shown a very long blockage not amenable to angioplasty ( sometimes thing progress between duplex and MRI/ CT) . Also a bypass is very unlikely to work in a man who continues to smoke and has also peroneal artery ‘run-off’ . For a bypass to work you have to have somewhere at the bottom for the blood to go. A bypass operation would put OH at significant risk and might lead to limb loss when the graft inevitably blocks . I discuss lots of cases like this at our multidisciplinary team meetings .
The recommendation would be to walk and develop collaterals and to stop smoking . Evidence shows that this can be just as effective as angioplasty with SFA disease and reduces the risk of limb loss in claudicants .

In our area there would be no monitoring either - we would safety.net patients by asking them to represent if the limb worsens. There are not the resources to monitor people and have the same conversations saying - still the same …. In general over 5 years from diagnosis with PAD as a claudicant , 1/3 will get better , 1/3 will stay the same , 1/3 will worsen to become critically ischaemic ie threatened.

OH really needs to wake up and stop smoking . He could use a nicotine vape or patches. I believe that Champix tablets have been discontinued in the UK perhaps why the smoking cessation person didn’t prescribe.

Love it when a specialist comes on. Magic of Mumsnet.

Champix still unavailable in Europe.

An alternative, bupropion (Zyban), also had supply issues for a long time in UK it is now available again. Maybe an option now??

Original poster

BlueSilverCats · 23/01/2025 06:58

olympicsrock · 22/01/2025 23:17

I’m a vascular surgeon. I agree completely with the treatment plan discussed. It’s a really clear and reasonable letter.
The CT scan has shown a very long blockage not amenable to angioplasty ( sometimes thing progress between duplex and MRI/ CT) . Also a bypass is very unlikely to work in a man who continues to smoke and has also peroneal artery ‘run-off’ . For a bypass to work you have to have somewhere at the bottom for the blood to go. A bypass operation would put OH at significant risk and might lead to limb loss when the graft inevitably blocks . I discuss lots of cases like this at our multidisciplinary team meetings .
The recommendation would be to walk and develop collaterals and to stop smoking . Evidence shows that this can be just as effective as angioplasty with SFA disease and reduces the risk of limb loss in claudicants .

In our area there would be no monitoring either - we would safety.net patients by asking them to represent if the limb worsens. There are not the resources to monitor people and have the same conversations saying - still the same …. In general over 5 years from diagnosis with PAD as a claudicant , 1/3 will get better , 1/3 will stay the same , 1/3 will worsen to become critically ischaemic ie threatened.

OH really needs to wake up and stop smoking . He could use a nicotine vape or patches. I believe that Champix tablets have been discontinued in the UK perhaps why the smoking cessation person didn’t prescribe.

Thank you so much for taking the time to explain it all . I really appreciate it. It's terrifying, but now , sadly , it does all make sense. I just didn’t want to "miss" something, if there was something to miss . Now I understand it all , all our focus can be following the advice about smoking and exercise and diet.

OP posts:

Destiny123 · 23/01/2025 07:05

BlueSilverCats · 22/01/2025 22:53

@pyjamarama and @Destiny123 thank you for explaining in a way that at least makes (even if brutal) sense to me.

I'm obviously no medical expert , and with all the medical advancements and treatments and things that can be done for so many illnesses/diseases it made no sense to me that nothing else is available. Or maybe I just didn't want it to make sense, because it's terrifying as fuck that it's all up to him.

Yep it's so awful to see working on vascular wards as patients often return and return for higher up amputations (and often many strokes and heart attacks as all the body's vessels will be in the same state). Its so depressing as I know my mum is heading the same way as just won't quit smoking but acknowledge there's nothing I can do if doesn't listen.

I'm sorry it's horrid

Destiny123 · 23/01/2025 07:21

BlueSilverCats · 22/01/2025 23:00

I don't know either. Probably part of why this is such a shock. Because it wasn't an let's see what the MR says , or we'll look at options, it was "you need an angioplasty, I'm sending you to get an MR done to see exact location and then we'll book it." That was after the Doppler. It was mentioned before too.

Then this appt came along with a different consultant and it was all wrong. Well, apparently he's right, but not what either of us expected to hear.

Show quote history

He must have just been optimistic that something would be bypass-able.

Sorry I'm not the best knowledge wise, I'm making educated guesses from similar pts I've anaesthetised for them

Destiny123 · 23/01/2025 07:22

Member869894 · 23/01/2025 04:18

'The Easy Way to stop smoking' by Allen Carr helped me give up smoking. Good luck to you both op x

Yea sooooo many pts have quit using this. The copy I bought my mum unfortunately remains on the bookshelf

Naillig222 · 23/01/2025 09:35

It's also worth noting that Champix have extremely severe side effects. There might be a reason they're not being prescribed by a GP who knows your husbands medical history.

Evenmoretired44 · 23/01/2025 13:17

sorry this is going on for him and for you - it is scary. What may help is a reframing of the communication. It isn’t that nothing can be done, it is that your DH is currently in charge of the care plan. So he doesn’t need to wait for an op or an outpatient appointment. He is in control to some extent of what happens next and you are as you can support him.
so he can swap to vaping, get nicotine replacement and meds if safe, and exercise. When he gets pain he needs to imagine the blood pushing open new collaterals and getting to his feet, to keep him going. When he thinks of having a cigarette, he needs to play the tape to the end ‘would I rather have a cigarette or my leg?’ Etc.
this plan he gets to do out of hospital, without needing to rely on anyone else. No it isn’t ideal but there are positives here and by focussing on them you both may feel better and more motivated, rather than hopeless about things.

Destiny123 · 23/01/2025 13:47

Naillig222 · 23/01/2025 09:35

It's also worth noting that Champix have extremely severe side effects. There might be a reason they're not being prescribed by a GP who knows your husbands medical history.

Champix has been totally banned in Europe since 2021 due to containing too high levels of a cancer causing substance

Zyban (bupropion is the only drug treatment now

lizzyBennet08 · 23/01/2025 14:45

Op
Think it might be no harm to get your oh to read this three so it might land better coming from lots of others than his 'nagging' wife.
I'm sorry that the news isn't what you both hoped for but in a way given that he has a manual job he can absolutley do the walking part , it's just the jmmediate smoking cessation that he needs to do and whiles it's hard at least it's something that is in his gift to do. Good luck

Original poster

BlueSilverCats · 23/01/2025 17:45

@Destiny123 yes, I think it was zyban he was supposed to get.

OP posts:

Original poster

BlueSilverCats · 23/01/2025 17:51

lizzyBennet08 · 23/01/2025 14:45

Op
Think it might be no harm to get your oh to read this three so it might land better coming from lots of others than his 'nagging' wife.
I'm sorry that the news isn't what you both hoped for but in a way given that he has a manual job he can absolutley do the walking part , it's just the jmmediate smoking cessation that he needs to do and whiles it's hard at least it's something that is in his gift to do. Good luck

Luckily he doesn't see me that way. Tbf , I kind of melted down a little bit yesterday, and I was rather stubborn and he gets it was just the shock and the doom and gloom of it all (and googling). I was up most of the night rereading the thread and processing it all so I'm in a much better place today and I apologise, he knows I'll support him in every way and it's about making a plan and sticking to it.

Can't say I'm feeling particularly optimistic (and still fucking terrified), but the fact that we /he are being proactive and there's something we CAN do about it is helping.

OP posts:

Kebabbky · 23/01/2025 17:59

I get how terrifying this must be for you but really this is on him now. He knows the risks, what the outcome will be if he doesn’t stop smoking and it’s up to him to decide how important quitting is for his health and his loved ones.