Should I go with the second opinion

@winproc - you could have been telling my story , as practically the same the same thing happened with me in June last year! Like you, I had a blocked LAD (@ over 90%) that meant a stent was impossible. I eventually had CABG surgery to bypass the problem on 25th February this year. I was in hospital for several beforehand, as they need to check that I was well enough for them to proceed with the surgery, as I have numerous health issues, including severe asthma which has affected my lungs badly. During surgery, apparently my left lung semi collapsed but, was rectified. However, post surgery and back at home, I had a couple of weeks off coughing almost continuously. Paramedics thought I may have had pulmonary embolism (I have a history of blood clots) and was admitted to hospital, where I was coughing up thick globules of green mucus - that obviously indicated a lung infection of some kind. Community acquired pneumonia was the next thought. Whatever it was, a CT scan showed that in fact it was pulmonary oedema in both lungs but more so in the left - remarkably, it also showed up a fracture in my T12 vertebrae - that hadn’t shown up in previous scans and x-rays, so osteoporosis is also considered 🙈. Because of my asthma, I’m using a lot of heavy duty meds that can actually help my lungs plus, I have been given a little gadget with a tube attached. The idea is that I suck on the tube numerations throughout the day, in an effort to get the lungs working properly to remove the fluid. Apart from all of that, I am still going about my life as I was before the surgery. As I have osteoarthritis and fibromyalgia, as well as bilateral replacement hips, my mobility isn’t that great but, on good days, I can get about with a rollator that has a firm seat - so I can stop and go at my leisure. On not so good days I have an electric scooter or a wheelchair to choose from. My amazing husband and our lovely family have all been incredibly supportive and helpful throughout. Would I have gone through the CABG surgery knowing all that was going to happen to afterwards. Most definitely - I wouldn’t hesitate. Because of the ‘hiccups’ along the way, it will take me a tad longer before everything is ‘A- Okay’ but, I’m happy to go with that - underneath, this little old lady is still tough and resilient 🇬🇧 😂🤣.

@winproc - out of interest, what U.K. hospital will you be attending please??

@dollydutchgirl1946 What can I but well done, you must be a tough cookie to go into the operation with the history listed here. I have had a few water works problems in the past now sorted on the wonderful NHS and one spell of pnumonia type lung problem when I was told by a nurse in A and E the phlegm being coughed up was caused by Heart Failure It appears this young lady was right all that time ago My heart problems and subsequent eventual investigations all stem from a long history of AF which I have had I t.hink, undignosed, for many years, since leaving over 30 years in the police service. Glad to hear you have the wonderful family and husband for support. I have the same from a loving wife I have no kids. Good news you are still able to get about with mobility aids. I am in a different situation and am doing lots of quite strenuous jobs around a house we are renovating in Cartagena Spain for 3 months. I keep taking the 5 pills AM and another 4 PM and if over do it fall asleep after lunch.

@dollydutchgirl1946 I have been very well treated and looked after for about 5 years by a Professor of Cardiology in the South Manchester area who prescribed my medication and I have had many scans, tests and a Cardiac MRI last year which first detected Breast Cancer possibility. Within a week I was at the Breast Cancer hospital for full treatment in one go. An examination by a consultant followed by a mamogram (which really hurt) and then an ultrasound and biopsy all in a morning. Eventually a nodule was removed by surgery and was Benighn. The MRI lead to the Angiogram for the stents which were not fitted. I was told by an aquintance of a bad experience they had wjth heart treatment with my Manchester team although as the Consultant said each visit You will not have a heart attack, I will look after you keep taking the pills..
After the 10 months since LAD diagnosis and being 80 in October I took the advice and his Cardiologist with a private appointmenat at Addenbrooks hospital in Cambridge in March I then came here to Spain and had a further telephone appointment from here, when he was a liitle agressive telling me he had retrieved all the scans ettc from Manchester all was in good order apart from the LAD. He has arranged for me to see the clinical lead surgeon at Royal Papworth Hospital, listed as the leading heart and lung centre for the UK.
I return at the beGinning of June for the appointme t to see if
he will ooperate on me.

@winproc - please take care not to overdo things in Cartagena (a very beautiful place). My CABG surgery was undertaken in Southampton and the team continue to take care of me. I have another CT scan scheduled towards the end of the month to see how the fluid in my lungs is doing and then I see my heart consultant again in early June to see how he feels things are proceeding. Hopefully, by then I will be able to start the heart rehabilitation classes. I was supposed to start them a couple of weeks ago but, because of the pulmonary oedema, the team wouldn’t let me start 🙈🤦🏼‍♀️.
I recently celebrated my 80th birthday together with my fabulous husband, our lovely daughter and her husband plus, our amazing, 17 year old grandson and his girlfriend together with our beautiful 26 year old granddaughter and her fiancé (who are getting married in September). Our Granddaughter twice a week - and says ‘Grandma- you know I love you to bits but, if you decide to cark it before our wedding, I’m going to be hopping mad - you do know that don’t you!! Then, we both burst out laughing - especially as last time my husband chimed in saying “You’ll be hopping mad, how do you I’ll feel - she’s already spent a fortune on a new dress, shoes and hat. That’s money I’ll never get back!!” 🤣😂
Please go into your surgery confident in the skills of your surgeon and his/her team, be prepared for a few days of post operative discomfort (you will be given pain killers to help) but, from then on things get better day by day. You will be amazed at how quickly the wound will heal. Wishing you and your wife every happiness during your time in Cartagena and every good wish possible for a perfect outcome to your surgery… 😊

I have had a further appointment yesterday with the Professor of Cardiology who has been treating me for a number of years with the medication. I told him I am 80 years old in a few months time. I was shown my beating heart and he pointed out the blocked LAD from the angiogram procedure. I told him of my second opinion cardiologist saying quite strongly to have the bye pass surgery now and the offer of the operation at the NO1 UK heart facility at Papworth Hospital.
He said I do not need it now, should not have it as it would not prolong my life and my quality of life with no angina pains would not improve. I should not subject my body to the risk when not essential now and advised to carry on with the medication.
I am due to see the surgeon at Papworth for a pre bye pass op appointment and I am now very confused. It was suggested yesterday by the Professor that this surgeon may see me and agree with him about his no need advice.
Have it now or not ??

@winproc I am not a physician. The medical establishment won't generally deal with a partially occluded major blood vessel until it is 70% blocked....BUT....they also take into account the presence....or absence...of objectionable and worrying symptoms. Much of modern cardiac care is palliative...they try to slow or stop the progression, but also to make you as symptom-free as possible. The thinking is that any surgical intervention is risky. 'First, do no harm!' is their oath, and if they become cowboys and want to dive in, and you die on the operating table or have a stroke the next day and are confined thereafter....of what use or benefit was the risky surgery, not to mention all the cost and materials that might have benefited someone with a better probability of recovery?

However, and this is just me: I know that delaying corrective surgery also imposes a risk, not to mention dealing with the greater urgency if suddenly nasty symptoms show that surgery last week was a smarter option. Also, just because there are no objectionable symptoms doesn't mean the body isn't under duress silently and that the system is not going short of oxygen and nutrition where and as it is needed. Some symptoms go unnoticed. In my dad's case, he later realized that his cognition was poor and that his vision had begun to close in on him, that his field of vision had been slowly narrowing. He needed a lot more light, for instance, to see anything. After his endarterectomy, his vision was noticeably better.

Aged people have falls. They fall because of poor vestibular response and...wait for it....poorer vision.

My preference would be to bear the risks and to hope for a good outcome that would ostensibly offer me improved quality of life and less risk of falls and other deteriorations that are sure to come if we do squat but to wait for the first real signs that something is wrong.

By all means, let the surgeon know of the advice of the professor. Ask him to help you to sort out the dichotomy presented, the contradiction between the two, and to give you a measured assessment of the risks of either continuing as you have been (professor's advice) or to attempt a remedial measure and what it might do for you if you do it sooner (surgeon's apparent position on the matter).

I am 81. Three years ago 3 stents were put in my LAD artery, which was only about 75% blocked at the time. My circumflex is almost totally blocked and actually ruptured when the cardiologist tried to "muscle" in a stent. A couple of observations: first, in cardiac rehab, I was the one considered high risk. There are several of us who meet every month for lunch. The ones who had bypass are doing the best. After seeing the same cardiologist for decades, starting because of sleep apnea, I switched to a UCLA doctor 4 months ago and the change has been, frankly, remarkable. She saw, on an echo and some blood work that my left ventricle ejection fraction was low, changed my medications, and almost eliminated my shortness of breath. My "old" cardiologist did not even concern himself with that echo and said "see you in 6 months," after a 3 minute appointment. I have had many EKGs and doctors listening to my heart, and even with the problems today, they say it sounds great. I have concluded those visits mean nothing. My new cardiologist, younger and state-of-the art, specializes in early detection and intervention. I wish my prior one had not blown me off with short appointments every 6 months, until I had an incident and referred to someone else and into the cath lab.

@gloaming Many thanks for your advice once more. I have initially delayed the surgeons appointment arranged for proposed immediate surgery. The two cardiologists with opposing advice are not surgeons and yesterday the Professor, who said stay on the pills at present, did say, When you go to see this surgeon in person, he could well also agree and not want to operate at this time. In view of this I am seeking yet another initial visit, direct to a surgeon in a different health area, to ask for a surgeons advice.(as you mention) Complicated, but a suggestion from my wife who is on the fence about which way to go. I am still capable of 45 minute uphill walks a couple of times a week with little effect but do get tired after a morning working in the garden . The proposed surgeon selected now is listed as operating the latest and robotic systems of treatment. Fortunately the Professor locally has posted his report on my web page and sorted a follow up appointment I did fear being struck off.

@bobtrAs I was told my angiogram was for stents and because of an MDT meeting during the procedure no stents were fitted and I learned my LAD was too severe for them. Good to hear that the alternative bye pass ops appeared more reliable and I am hoping to seek the opinion of a younger actual surgeon rather than the cardiologists who advise but do not shoulder any operational risk.