Friday, July 16, 2010

This morning I attended King's College Hospital for pre-operative assessment in advance of the surgery on Monday to deal with my 'abdominal aortic aneurysm (AAA). MRSA swabs were taken, five blood samples in different coloured tubes, chest x-ray, blood pressure (124/54) height (170 cm) and weight (60 kg with clothes on, though I was actually 57.8 on our scales this morning without clothes). So my Body Mass Index (Mass in kg/ Height in metres squared) is 20.0, towards the lower end of the normal range of 18.5 - 24.9. These measurements plus an interview with D, the nurse, about my previous medical history, took 2 1/2 hours, an improvement on the 3-4 hours allowed for in the appointment letter. Clearly the bottom line is that I'm fit to undergo the surgery on Monday, and the 'bed manager' will call some time on Sunday to tell me to what ward I'm to report.

Letter from Mr R, July 8, after we had discussed th options for the AAA:

I saw this gentleman today in my clinic. I have been through his CT scan with him and his wife and I have explained to him about the pathology (the infrarenal abdominal aortic aneurysm). We had quite a long discussion about treatment options including no intervention. EVAR and open surgery. In view that he had a major laparotomy in the past following a ruptured colon with a colostomy and reversal of the colostomy, his abdomen is quite hostile which puts an open repair at a higher risk of complications. He is fully aware that with the EVAR repair there is less mortality risk as well as a significantly lower hospital stay, but continuous follow-up in the future will be required.

After a long discussion. Lord Avebury has decided to go for the EVAR repair which we are planning to do on 19th July. I have discussed his case with Dr W who will be ordering his stent. We have also agreed that he is not going to need any renal artery angioplasty prior to the procedure.

He is fully aware of the risks including about 3% mortality as well as the follow ups for his EVAR.

I have added to Lord Avebury's treatment Aspirin 75 once a day. since his platelet count is above 500 which increases the risk of Ml during the procedure.

Late afternoon Sujit called to say there had been some unruliness at the Bangladesh meeting I was to have chaired at the LSE. The BNP speaker who came first was heard peacefully, but as soon as the Awami League spokesman began his presentation there were interruptions, and this further degenerated into physical violence. BNP supporters started throwing chairs, and Pola Uddin, who had kindly agreed to chair the meeting in my absence, called the police. The meeting was being filmed by Bangla TV, and its possible that whoever committed the violence could be identified and criminal charges brought.

It has to be acknowledged, that if we can't have an orderly meeting between supporters of the government and opposition at the LSE, there isn't much hope of the parties sitting down together to see what common ground there might be between them in Dhaka. The BNP has boycotted the Parliament and stages 'hartals' - mass demonstrations on the streets - rather than engaging in a rational discussion of policy. They are aggrieved by the AL government's court proceedings to evict the leader of the opposition, Khaleda Zia, from her grace and favour residence, and the renaming of the airport which was given the name of her late husband when he was President. But in the meanwhile, the country faces huge problems including the constant threat of terrorism; the violence perpetrated by the student body the Chhatra League; the trials of the war criminals of 1971; the promise by the government to implement the Chittagong Hill Tracts Peace Accord of 1997, and looming ahead, the displacement of tens of millions of people from coastal areas as the sea level rises due to global warming. These and other threats require united action by the people of Bangladesh, and it will be a tragedy if the parties can't respond coherently.

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