@intercst how are you? How was your leg surgery on Thursday?
Wendy
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I had an angioplasty done on Tuesday which restored 90% of the blood flow to my right foot. My foot feels better, but I’m sore from my left groin to my right shin where they shoved the 6 foot long wire and necessary tools into my femoral artery and beyond. That discomfort should subside over the next week or so. In the days just prior to the angioplasty, I was only able to walk 200 ft before I had to return home to elevate the limb to drain the blood out of my foot. Now I can walk about 600 ft at a normal gait, pain free, and I assume that distance will increase with time.
Now we have to decide what to do with the fossilized aneurysm. There are risks to removing it in an open leg surgery, and risks to leaving the 25-year-old fossil in there. (Leg surgeries on the elderly – even on otherwise healthy folks like myself – tend to be high risk operations that do more harm than good.
They also want to do a scan of my left leg to see if anything is going on in there. To date, my left leg has been fine, but apparently these leg aneurysms are a rare complication of lupus – if you have one, there could be others.
I go back to the vascular specialist on June 10th to decide the next steps.
intercst
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What is a fossilized aneurysm?
Wendy
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Wow, @intercst …I didn’t realise your exercise tolerance had dropped so much (it was my mum’s inability to walk even 200yds that finally took her to the doctor in her early 60s) Is this why you made the initial appointment with the PA, or did you get a sudden, rapid decline pre op.
Looks like you’re a bona fide, card carrying member of The Outliers Club…folk who’ve gotten a sudden belated heads-up on serious conditions that folk who should’ve known better ignored before they became serious. I’ll be interested to know what your vascular bloke has to say. I finally got mine to admit that “someone should’ve said something sooner” WRT my iteration of ASCVD.
On a different medical condition but similar principle of benign neglect, Peter Attia sent me this today…out of the goodness of his heart.
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Sounds like it’s something really, really old people get.
Calcified, meaning that the walls of the aneurysm have hardened?
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@eldemonio Ahem…@intercst is years younger than I am…and I’m not “really, really old” (age 71).
Wendy
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My bad, it was a poor attempt at a joke.
Well, I thought it was cute. Folks, fossilized. Get it? In case you don’t, I’ll explain: fossils tend to be really, really old.
Pete
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No problem, I was teasing also.
Wendy
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Not that lame @eldemonio …really. However, it’s good to realise that a good many of these “associated with the elderly” conditions are the late stage phenomena of departures from healthy homeostasis that started at a much earlier age (quite possibly in childhood for those of us with a strong genetic predisposition)
In a discussion on early intervention WRT ASCVD a while back, some genius posted that not everyone is as old as you (meaning me) Didn’t need to make a comment to that example of ignorance…it advertised itself…but it really does behoove us all to wonder at every stage of our Chronological Enrichment just what might be going pear shaped with our bodies and what we can do about it NOW! Even those of us who’re long time Good Custodians of the old chassis…actually, especially those of us who’re Good Custodians because those who ought to know better are likely to be leaving our problems to fester while they take care of the folk with the bad habits!
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Not really. I’ll be 70 in February,
intercst
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A “fossilized aneurysm” isn’t a standard medical term. However, the phrase likely refers to an aneurysm that has been calcified, meaning the aneurysm wall has become hardened with calcium deposits. Calcification is a common finding in aneurysms, and it can sometimes be detected on imaging scans like CT or MRI. [1, 1, 2, 2, 3, 3, 4]
Here’s a more detailed explanation:
- Aneurysm: An aneurysm is a bulge or weakness in a blood vessel wall, often due to long-term damage or degeneration of the vessel. [5, 5, 6, 6, 7, 8]
- Calcification: Calcification occurs when calcium deposits build up in the aneurysm wall, making it thicker and harder. [1, 1, 2, 2, 9, 10, 11]
- Clinical Significance: Calcification can be a sign of an aneurysm that has been present for a long time and is undergoing remodeling. It can also indicate a stable aneurysm, as the calcification may provide some structural support to the wall. However, calcification can also be associated with areas of weakness in the wall, increasing the risk of rupture. [1, 1, 2, 2]
That’s apparently the concern in my case. Doctors would prefer to just leave it in there, since doing an open leg surgery carries risks. More imaging may be needed to make the decision.
intercst
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When I went to my doc-in-the box PA at Zoom Care in late March, I was able to walk about 1500 ft, down from 6-8 miles in the months previous. The angioplasty procedure wasn’t scheduled until May 20. They said I could wait as long as I was able to still drain the blood out of my foot by elevating the limb. Once the blood draining stopped providing relief, I was instructed to immediately go to the ER.
Over that 2 month wait, I declined from 1500 ft to a 200 foot walking distance.
Apparently the vascular specialists are very busy and I wasn’t an urgent case. More than half the patients in the waiting room were in wheelchairs.
He did ask me if anyone ever did a CAT scan of the leg back in 2000 when I first had an acute episode that left me sitting at home with my leg elevated for about 6 weeks, I told him. "Everything but, 2 ultrasound scans that my doctor had the Chairman of Radiology at Methodist Hospital in Houston review because she didn’t believe that there was no blood clot, an MRI that showed a normal leg with edema (we didn’t need an MRI to tell it was swollen) and a referral to an orthopedic surgeon where I never saw the doctor, but the Physician Assistant asked if this was a Workman’s Comp or auto accident injury and did I want Physical Therapy (to run up the bill.) {{ LOL }}
Apparently endovascular procedures for PAD were just starting in the late 1990’s and 2000’s. But you’d expect a world renowned academic Cardiac Care Hospital like Houston Methodist to be at the forefront of this technology. So yeah, I think they missed something not referring me to a vascular specialist at the time.
intercst
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I’ve started to think that next time some sort of screening test I have has my physician giving me a reassuring “clean bill of health”, I’m going to ask for a secong opinion. Certainly when it’s some sort of population based risk assessment…like the formula for ASCVD events based on lipid profile!
Here’s an article with some interesting insights (especially if you’re motivated to read through the references) on using available technology to visualise what’s going on under the hood on an individual patient basis vs relying on the “might be” of population based formula based risk assessment (or hope and guesswork, depending on your point of view)
Seems to me it’s not much different from being aware of available tools and using them to know exactly what’s in your own wallet, bank account, retirement portfolio etc. to predict if your money is going to last for as long as you need it rather than waiting until checks bounce or credit cards get declined.
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