Carotid Artery Op

[Thisoldbird]

A very good friend in her 90s had this op 2 months ago..

Since then has only been able to whisper. Her voice is virtually non existent. 

I understand she was told it was normal and expected it to retun by about 6 weeks later.  

It's past that time and still no sign of her voice returning... It's very tiring, straining to make herself understood.  

The wound has healed beautifully. 

Does anyone have knowledge of this situation, please. 

[Peter Pedant]

it may be this operation - chapter by John Lumley

https://link.springer.com/chapter/10.1007/978-3-540-68816-7_1

and it says

nerve damage – this can cause a hoarse voice and weakness or numbness on the side of your face; it affects around 4% of people, but is usually temporary and disappears within a month.

I was Lumley houseman in 1975

it cd be carotid stenting  - the old girl is a bit old for all this - and I think the complications  are the same

[Peter Pedant]

technical question: technical answer

[naomi24]

Please advise your friend to consult her doctors.

[Peter Pedant]

very sensible advice if I might say so

[Thisoldbird]

Thank you all for your replies. 

I had Google and came up with similar time scale. 

I agree she was a bit old, but family agreed it could give her a few more years! Middle 90s now. 

I'm very sad for my friend as she has always been very active, indeed she is still active and out most days. It's the voice that's causing the problems. 

Family are involved so not sure I'll get the chance to make any suggestions.. just very sad.

Thanks again. 

[Peter Pedant]

Very technical area which changes - I saw John Lumley FRCS do three carotid endarterectomies every friday for six months ( 375). in !975 - audit was very young then I cannot find published results. Later Prof of vasc surgery

BUT the  complication rate was 2% ( stroke during procedure) and the saving from stroke was around 2% on one year follow up. - er dont these cancel out?

and so it is done much much much less now - does it mean it is in the category of " operation that doesnt work"

I was surprised to hear it was done in a 90 y old

[Peter Pedant]

Now - me n a few frenz were playing around with a super new neck ultrasound machine - and someone said - "SMith, one of your carotids isnt pulsating"

and did we all say - youre doomed !

I asked the vasc reg and he said " you do nothing - it clearly isnt today and so you watch and treat symptomatically."

OK. what about a carotid plaque which is causing TIAs, and he said " clearing it  may cause a biggo biggo TIA"

or

open-label trial in patients presenting with TIA or nondisabling ischemic stroke and severe intracranial atherosclerotic stenosis demonstrated that the addition of stenting to medical therapy, compared with medical therapy alone, resulted in no significant difference in the risk of

or... in AB speak, stenting for TIAs doesnt work

oo-er doctor

 

[Peter Pedant]

big med students lesson

you can do an operation but that doesnt mean it will /must benefit the patient

[barry1010]

Many medics know it does work and it is not an uncommon procedure for TIAs.

[Peter Pedant]

Nice indications for operation

https://www.nhs.uk/conditions/carotid-endarterectomy/why-its-done/#:~:text=When%20is%20surgery%20recommended%3F,your%20stroke%20or%20TIA%20symptoms.

bit of a read

[Peter Pedant]

results here - basically they havent changed for 50y

https://www.ahajournals.org/doi/10.1161/strokeaha.111.000513#:~:text=Results%E2%80%94,85%20years%20group%20(5.6%25).

[Peter Pedant]

Many medics know it does work 

yup. billion dollar industry in America.(*)

so much loolah, so many operations - the results should be obvious innit? - the longest series I can find is 4500 patients.

(*)well it is doing SomeOne a lot of Good !

[Peter Pedant]

I just as well put it here - altho the mods will squawk and cavil,

If you go to Mr X for operation Y and he says " yes I am your man" and you say "OK what are your results"

and he says: " I have done around 2000, so I am a well trained arteest. My hands are  healing hands and yet they learn too. I learn on every patient and yet every patient is different. I am still learning and changing. For both me and mankind, the theatres staff, and those on the ward"

and you say OK so what did you do. what happened and did your patients live?

" I cannot say - what I did last year is different to what I did 20 y ago and so my results are not comparable (within a time series). I have learnt and changed. I do much better now because I reflect and learn"

then you are dealing with a charlatan whose great signature operation - the one he is famous for - doesnt work. He cant print the results, as they will show terrible outcomes. He stops operating  and retires and no one does his operation. ( in America the insurance companies will pay or co-pay and that alone is the decider, not the outcome) 

This has to be said somewhere

When I had half my colon out in 1999, the surgeon said: "you have a fifty percent chance ( toss of a coin) of walking back into this office in five years". I took the chance.

or as my mother said in 1990 - "I dont care how rude he is: can he do the operation?"