prostate cancer and “killing a fly with a shot gun when a slingshot would have been fine” or ” a doctor prescribes the bark of the quinquinna when the patient would be be obliged to eat the whole tree.”


life breaks everyone at some point....some heal stronger where they've been broken

 This story makes a strong point and one that is not lost on any surgeon who has had a patient not do well and ultimately die after an operation. Particularly in prostate cancer this is a concern because of some prostate cancers being “low risk, slow-growing, die with it not of it type” kind of cancer. I.E why treat something with a shotgun when all you need is a slingshot.

Robotic surgery is still surgery and I suppose in the story below the “hernias” were attributable to the laparoscopic port sites which I would think unusual. All in all the author of the story and the coroner trace the heart condition back to the robotic prostatectomy.

Now everyone will go back and see if he had any antecedent heart conditions, what was his PSA, his Gleason’s score, the volume of the disease..i.e. ” Did this man really need to have the prostate removed in the first place.”
“Would this have happened if he’d had radiation?” Etc, etc.

When I mention the dirty little secret about surgeons, a little bit of it is about this. That is surgeons are “risk averse” as a rule. We don’t want to operate on anyone that is has a higher likelihood of have post operative problems . That is why we don’t operate on “all” newly diagnosed prostate cancer patients. I imagine about 35 -40% of the patients who are diagnosed ultimately have surgery.  Some don’t want it, some are not candidates, and yes some are told by their urologist that despite their wanting surgery, the urologist thinks it better to do something “less risky.” Happens every week in my practice.

The real deal here is that he had more hearth disease than he or his caregivers knew or that was clinically apparent. Maybe just bad luck….but what if someone, maybe a family member, a friend, or the patient himself pushed for something other than surgery. What if?

 

Stress of operations led to man’s death

June 07, 2011

A Woodley man diagnosed with prostate cancer died at home following complications after an operation, an inquest heard.

Peter Young, of Crockhamwell Road, was diagnosed with prostate cancer on November 18 last year, and chose to have robotic surgery to remove his prostate.

Following an operation at Royal Berkshire Hospital he suffered two hernias and underwent further operations to correct complications caused by the initial surgery, before he died at home on January 5.

At Mr Young’s inquest at Windsor Guildhall on Thursday, May 26, surgeon Adam Jones said: “I did think his operation went well. We didn’t see any trouble and it wasn’t an operation we were particularly worried about.”

The coroner heard Mr Young continued to feel unwell in the few days after his surgery on December 9 and suffered a hernia on his right side.

The 67-year-old underwent an operation to repair the hernia on December 12 and on December 14 he complained of chest pain.

An ECG showed another hernia on Mr Young’s left side and Mr Jones said it was “strange” to have suffered two.

A CT scan took place before the second hernia was treated and revealed further injuries Mr Young had suffered during his prostate operation.

Mr Jones said: “We were misled by the hernias. If we hadn’t seen a hernia on day three after the operation we possibly would have had a CT scan at that point to see what was going on.”

Mr Young was discharged from hospital on December 31 and died on January 5 from a cardiac arrhythmia.

Coroner Peter Bedford recorded a narrative verdict, saying “the stress of the operations contributed to his heart attack”.

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