Home > About Clifford Hospital > Our Featured Methodology

  • About Clifford Hospital
  •   Our Featured Methodology
     
      Case Study
      Case Study One: When It Comes to Surgery, Age Is Only Half a Story
     
      A heated discussion is going on among our doctors from multi-disciplinary fields.
       
     

    Who is a suitable candidate for surgery: a fit 84-year-old lady who takes a 1000-meter walk every day, or a 50-year-old couch potato man who has high blood pressure, heart disease and diabetes and is on five different medications?

    It all dates back to 2011 when the 82-year-old lady Ding was found to have rectal lesions and some polyps of the descending colon. The biopsy showed mucosal chronic inflammation, CEA 23ng/ml. Further checkups were recommended, but were rejected by Ding’s family members due to her old age and her untreated coronary heart disease since 2009. Ding was not known of hepatitis, tuberculosis, hypertension, or diabetes.

    On January 28th, 2013, Ding was warded into Clifford Hospital with various symptoms including partial intestinal obstruction, vomiting, weight loss, aphagia and severe abdominal pain.

    Obviously Ding’s tumors had progressed, and her family members finally agreed to let her do further checkups and receive treatments. A pelvic contract CT indicates rectosigmoid carcinoma with lymph node metastases. She is also suffering from increased bowel movements, stool bleeding, stool change, tenesmus and prominent anal pain. The doctors could feel the tumors during a physical checkup.

    On February 5th, 2013, a joint case consultation was held at Clifford Hospital for Ding,below are the opinions from different specialists.

     
       
       
     

    Professor Dr. Pang, a well-know specialist in integrative medicine, is more concerned about the patient’s nutritional status and immunity. “We have to look at the patient’s overall conditions especially her nutritional status and immunity. If her immunity is still strong and there is no serious chronic illnesses that could complicate surgery, surgery should be an option, and should be carried out as soon as possible," Professor Pang said. “Still, I’m worried if the patient has already had liver and lung metastases. PET/CT is necessary to find out the detailed tumor condition. If the case is too advanced, a surgery treatment's effect will be limited.”

     
     

    Having been engaging in clinical work for nearly 30 years, Dr. Zhang, a specialist in traditional Chinese medicine, is very professional in treating various difficult diseases such as chronic headache, singultus, insomnia, constipation, hypertension, depression, endocrine disorder, malignant tumor and postoperative complications. Dr. Zhang is also very concerned about Ding’s old age. “We have to look at Ding’s overall general condition and whether she has chronic illnesses that could complicate surgery," "We have to assess her social, functional, and emotional needs and help her plan for a speedy recovery after the surgery." Dr. Zhang further points out.

     
     

    Dr. Lu who is the head of Hyperthermia Center has been devoted himself to clinical work for 20 years, and he is particularly experienced in emergency resuscitation and pain management. Dr. Lu often advises senior patients and their families - as well as their surgeons - on how to optimize the care of patients who are planning to undergo an operation.

    “It is indeed highly risky for an 84-year-old patient to undergo surgery. It is vitally important to have a comprehensive assessment of all elements of risk before proceeding with surgery, as we all know senior patients have aging cardiac and respiratory systems and surgery causes them special concerns. Postoperative emergency care from the cardiovascular specialists is especially essential.” says Dr. Lu.

     
     

    Studying in Britain and working in several large British hospitals has allowed Dr. Ou to gain extensive experience in nutrition counseling and nutrition therapy. She is more interested in postoperative nutrition support. She believes parenteral nutrition is still needed before the patient’s partial intestinal obstruction could be resolved. Additionally, Dr. Ou says she will prescribe some juice made of fresh vegetables once the patient restores her gastrointestinal function.

     
     

    Dr. Li who is a TCM expert (in the corner of the left side) highly recommends surgery. He seems frustrated over the fact that no surgery has been given since 2011 when the patient was found to have rectal lesions and some polyps of the descending colon. “Age is not the most risky factor for poor outcomes. The presence of chronic illness and low physical functional abilities would place patients at higher risk, regardless of their age. Therefore, it is important to take all of these factors into consideration when discussing surgical plans. We had once given a successful surgery to a 101-year-old colon cancer patient. As we gain more experience, and along with the surgical advancements such as smaller incisions and lighter anesthesia, we would be able to give invasive surgery to patient at older age” said Dr. Li.

     
     

    10 years experience in working with cancer patients has rendered Dr. Zhao (an oncologist) more acute to cancer patients’ emotional needs. Considering that the patient’s family members are already blaming each other for their wrong decision made in two years ago when they unanimously rejected any surgery for the patient, today it would be ever harder for them to accept the fact that the patient is probably going to need a colostomy. Dr. Zhao believes it is equally essential to have a thorough discussion with the patient and her family members regarding the risks and benefits of the surgery.

    After a heated discussion, all the specialists agreed to the treatment plan consisting of surgery, colostomy, nutrition support and emergency support from on-call cardiovascular specialists.

    On February 12, 2013, the 84-year-old patient Ms Ding received a successful surgery. Now, she is recovering well at Clifford Hospital.

     
     
      粤ICP备12082684号 Copyright © 2013 by Clifford Hospital-A JCI Accredited Hospital, China’s A-Class Hospital, All Rights Reserved.
    3 Hongfu Road, Panyu, Guangzhou, Guangdong Province, P. R. China.
    Postcode: 511495.   Tel: (8620)-8471 8123.    Email: customer@clifford-hospital.org.cn