I guess that I should consider myself fortunate that I have a job and am still able to work. Apparently the 'failing health club', to which I'm now a probationary member has little say on when appointments are scheduled. So far, each appointment starts with "Doctor So and So will see you on....". I've not heard "When is a good time for you?" I guess when you're dealing with specialists their time is more valuable - to both them and their patients. So I'm at the whim of the scheduler when it comes to appointments.
During the last few days of Massachusetts' Governor Patrick, an informal session passed legislation that would be enacted in 90 days from being signed into law. One of these bills that happened to squeak by was the windshield wiper law. Basically, in Massachusetts if you have your windshield wipers on, you must now have your lights on. Obviously a safety measure forcing drivers to 'be seen' during bad weather. The intent of the law makes sense, but the application and enforcement does make one raise their eyebrow (if not their ire). For example, if your vehicle has day running lights (DRL), that doesn't count. If the wipers are on, then the lights must be on. We all know that turning on the lights dims the dashboard display (for most cars). Of course if it were night time, you wouldn't want the glare distracting your view of the road and traffic. But dimming the dash during the day only makes it very difficult to see how fast you are going or what song was playing on Sirius XM. Also, this is primary enforcement. Unlike seat belt 'lack of use' which is secondary - meaning they can't pull you over for just that, you could be pulled over, ticketed and surcharged (for six years plus the current year) if you did not have your headlights blazing while wipers are engaged. [Live Free or Die residents can laugh here].
[Post script: Do I have to turn on the lights when I spritz the bugs away?]
My appointment was scheduled for mid day. I figured that traffic during that time getting to Brighton might not be too horrible. HA! As fate would have it, it was lightly raining. Not only do drivers forget how to drive when there's any precipitation, but this new law - taking effect that day would be put to the test.
I gave myself two and a half hours figuring I'd have time to get lost, find parking and meander through a vacuous hospital complex. Good thing. Besides seeing four sets of vehicles pulled to the side of the road due to accidents, pot holes, etc., the cops were out in full force. Yes, there were many electronic signs about the law, but they are distracting because by the time the whole message is displayed - you've passed it, unless traffic comes to a crawl as it does often.
I took no chances and turned on the lights and hoped I knew all the songs I was hearing on Deep Tracks.
It took almost two hours to get to St Elizabeth's Medical Center [although it wasn't playing, I could hear St Elsewhere theme in my head]. I was able to snag a spot on the top floor of the parking deck and walked to the first entrance I saw. Walking in I saw an information desk. I asked for directions to the Cardinal Cushing Pavillion. I was given a look like I had three heads. "Who are you here to see?' Dr Kansal. [The look of confusion, then some shuffling of papers.] "Oh he's in the Cardinal Cushing Pavillion." [Good to know DAH]. I got the 'can't get there from here' line but they gave complex directions which I followed - but got lost. Using the trail of breadcrumbs I left behind, I made it back and said that I couldn't find elevator G. "Oh, there's no sign for that. Just go past the ATM and it's on your right." [ Was this Hotel California?]
I made it to elevator G, then to the eight floor with 15 minutes to spare. Of course just enough time to fill out paperwork. I purposely left an answer blank and was never called on it. [Was that being passive aggressive?]
Met a professional to take my vitals then another who came in reviewed my answers. Nope, they never asked for that missing answer. I was instructed to disrobe and put on a one-size-fits-all "MC Hammer" shorts.
I was examined by a Physician's Assistant, Bill. Then asked to wait for Dr. Kansal.
Shortly after Dr. Kansal came in, introduced himself and began confirming information from his folder. He said that he reviewed the CT scan and reported that the aneurysm was 4.9 cm. Generally repair is needed when it gets closer to 5.5 cm. He said we could monitor it with an ultrasound and subsequent CT scan every few months, but said that it should definitely be addressed. As I already knew from my research, he spoke of the 'open' surgery which is the old standard and effective but had varying levels of risk. A small percentage die on the table, up to 30% die within 30 days, but after that the risk dramatically drops off. If people die after that it's due to other causes. This is major surgery with a recovery period of 3-5 months. He did not recommend this treatment. [Good. I don't either].
He spoke of EVAR (endo vascular aneurysm repair) where a 'stint-like' graft is fed through the femor arteries in the groin and attached to the aneurysm sac. The risks were lower compared to open surgery initially, but there are often subsequent procedures needed for endoleaks and/or migration (movement) of the graft. My research confirmed this. Although not the optimal result, it was better than the alternatives:
- waiting it out and hoping it doesn't get bigger (ticking time bomb approach);
- having open surgery with high risk of immediate death or complications/death within the first 30 days.
I wasn't thrilled with any of this at this point, but he did continue by saying that I was an excellent candidate to a third option - Nellix.
Nellix is an investigational EndoVascular Aneurysm Sealing (EVAS) system designed for the treatment of abdominal aortic aneurysm (AAA). It's the next generation of AAA therapy intended to treat more anatomies than currently approved endovascular stent graft devices, and is the only technology whose operating principle is centered around sealing the aneurysm sac.
Nellix was designed to address unmet clinical needs, and potentially reduce the need for secondary interventions following endovascular AAA repair. In initial clinical trial experience involving 34 patients outside of the United States 100% implant success was observed. In a two year follow-up, no aneurysm rupture, conversion to open surgery or stent graft migration has been observed. One secondary procedure for distal Type I endoleak had been performed. Physician feedback has been positive, particularly as it relates to ease of use and versatility to treat both standard and more challenging aneurysm anatomies.
This is cutting edge and an FDA approved clinical trial offered in only six locations in the US - Massachusetts - St Elizabeth's being one.
I've done much research on this (online), watched you tube videos on all three types of procedures and read all the white papers I could find of the European trials. (It's now standard in Europe).
EVAR requires a more invasive approach requiring exposing the femor arteries and subsequent pain/healing peiod. EVAS has reduced this with insertion points that may not even need a band aid. Dr Kansal said that the procedure would require an overnight stay and a day or two rest up, then limited activity for about a week. After that all restrictions are lifted. He said that patients often ask after surgery when will the surgery take place because there has been no impact. [Videos and white papers support this.]
I'm leaning to this. But I do need more information. Of course every decision has dependencies.
Dr Kansal recommends that I take care of the cancer first. Heal up, then come back to him for an ultra sound and CT scan. After the results are reviewed, I would go in for pre-op then have the surgery. There would be a some follow-ups and ultra sounds to ensure things went according to plans. This plan would affect the order of precedence. The reconstruction/reduction surgery would need to be done last. I'm not sure what that means to the other surgeons and of course the insurance company.
I have follow-ups with Dr. Moore, Dr. Rees, Dr. Mehta and a consultation with a second vascular surgeon.
Good Article Dr G V Praveen Kumar is one of eminent Surgeons from KIMS treats diseases related to blood vessels, arteries and veins at Vascular Care Center.He had performed many Surgery services like AV Access, Radio Frequency Ablation, Endo Venous Laser Ablation, Varicose Veins, Diabetic Foot, Endo Vascular interventions. Vascular Diseases are treated efficiently by skilled Surgeons and if needed Surgeries are done at Vascular Care Center.
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