Expert: Ronald Levy, M.D. - 12/2/2009

Question
Hello!  My father has severe COPD, Asthma, is a smoker (don't get me started), diabetes and is suffering from urinary issues.  He has a 2-2 1/2" bladder stone.  The doctors in their insurance plan (don't get me started on that either heh) won't perform any procedure due to the risks of him dying from the anesthesia, and his heart function is down 15% from 2 years ago.  He is 73 and lives in Los Angeles (I do not) so am trying to help my family get as much accurate help as possible.

What sort of information do I need to present to a doctor for an accurate second opinion?

He is constantly urinating and has some blood from time to time.  First it was the prostate, then a second doctor found the stone, now it is not the prostate, come back in 6 months (this has been going on for 3 months) and my mother is at her wits end because Blue Shield won't pay for any other doctors then the doctors she has gotten 3 conflicting reports from in 3 months.

Thank you for any insight!

Steve

Answer
I can't help you with the diagnostic side of this but from the anesthetic side, there is no such thing as "too sick" for anesthesia. Certainly he is at increased risk and he should have a complete medical and cardiac workup prior to surgery but we can certainly give him a safe anesthetic. These cases are often done under spinal anesthetic. If he is at a community hospital, they might be more hesistant to do it because they might not have the appropriate post-op facilities. Have your dad seen at a large teaching hospital. I'm sure they would be happy (and well equipped) to manage this case.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston