What happens when we need emergency surgery?

Good morning to everyone. I was wondering what the general picture is across the UK. If, for example, a person needs to have emergency surgery to have a bowel blockage fixed, (or other surgical procedure) do they get sent to their local hospital or a specialist cancer centre? Also, if it's the local hospital (not where their oncologist works), does the general and/or gynaecological surgeon at the general hospital remove any growths that happen to be there and are easily removed? If they don't, would an oncological surgeon have been a more suitable person to be operated on by. I'm saying this in the setting of emergency care. I think the fact that many people who have abdominal cancers are being shunted around the system and not getting specialist care in times of crises like this is an issue which needs to be addressed. That's the picture I have but it may not be the case for everyone. I just wanted to know whether my experience is unusual. Just to let you know that this post is not just viewable by members here. Love Tina x x

[Whippit]

Dear Tina, This is a good question. It's our support group next week so I'll ask round to see if anyone has any experience of this or has any feedback of other patients who've been through emergency surgery. I'll let you know if we have any feedback from SE Wales. xx love Annie

[Hidden in reply to Whippit]

Good morning Annie .. I'd really appreciate that. Love Tina x x

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I'd like to add that I know many general hospitals have an oncologist from the network who attend their MDTs. Do any hospitals have visiting surgical oncologists who will operate with the local surgeons in emergency cases? I mention this because my trials nurse told me yesterday that they might if they happen to be there but I read the Annual Report of my local Cancer Network and it specifically says that visits from oncologists to local hospitals are non surgical. Love Tina x x

[Hidden]

Having experienced the need for emergency treatment, it tends to be a 999 call. We are fortunate that when the paramedics arrived I had a choice between North Staffs or Macclesfield A+E. We chose Macclesfield because they have a close affiliation to Christies. Some of the Christie conultants do clinics at Macc but not OC. We were also advised by the Christie that any surgical needs we can contact the Christie and be admitted there but it would,nt be an emergency situation. So depending on time constraints we can pick and choose. Also bearing in mind Christie is foremost a chemo treatment centre, their surgical skills are limited. They dont handle emergencies like A+E.

[vipervictoria]

I've been in this situation too - in my case, when I got to A&E I was monitored and the problem - a blockage in the ureter - passed. This wasn't cancer related.

You have a summary care record, which you can see by asking your GP. That should have ovarian cancer right at the top, along with your current status - I know you are trying to get onto a drug trial, so if & when that starts, that should also be on your summary care record.

Assuming that the ambulance personnel have your name and date of birth, they will then alert A&E intake that you are on the way. (They almost always go to the nearest one, but as Paul points out, sometimes you are given an option.) A&E will then start to prepare, and the first thing they do is check your NHS SCR. (Thing is, although this almost certainly wouldn't apply in your case, emergency ambulances sometimes pick up someone who has had an accident in the street and may be unconscious - they then along with the police do all they can to find out who the person is…)

Now, we all gripe about the NHS, but the fact is that with a few exceptions A&E departments are generally extremely efficient, full of staff who love what they do. (I say this because there are so many news stories going around about people left on trolleys for hours, etc..) See e.g. the series on Channel 4 about A&E at Kings College Hospital.

When you reach A&E, they will ask some questions, probably talk to you about your cancer treatment, and then go ahead and deal with whatever the problem is.

It sounds complicated, but it's actually quite simple. It almost always works very well. My mother had lots of bowel problems (not cancer related), she had a couple of blockages, a perforation, and several severe GI bleeds. She actually never had surgery, because the medical treatment always worked - this usually is I/V fluids along with very regular monitoring and bed rest.

Hope this helps, and also that you won't need to be admitted to hospital this way. Vxxx

[Hidden in reply to vipervictoria]

Hi Vicky and Paul

I was asking the question because I was admitted via the 1111 route recently .. a saga in itself. Anyway, I was operated on in an emergency setting on a Sunday night in my local hospital. I had a necrotic nodule removed and then other nodules and lesions were noted consistent with a recurrence. I get the impression that in this setting, the general surgeon or whoever it is, will put whatever is causing the acute episode right if they can and get the patient out. The problem is that as far as I can tell, they won't do any more work than is necessary. For example, they didn't remove nodules from my small bowel mesentery which is a crucial area for small bowel function as it's the passage for veins and arteries to that area from the heart. I'm now healed so I asked my nurse about this and she said the question needed to go to my oncologist who will consult with the surgical oncologist. If the nodules could have been removed by the general surgeon (who specialise in the bowel area) at the same time, this is complete madness. To expect that it's normal to go through two laparotomies because of protocol is almost inhumane. It'd be interesting to know whether nodules are ever removed from the small bowel mesentery. Love Tina x x

[vipervictoria in reply to Hidden]

Well done for getting thru' 111! That is a huge achievement in itself. I too have had to call 111 recently - my GP has told me he is not calling them again! He was furious to find himself being told by a call handler - a non clinician - that he couldn't do what he was trying to do, which was to get some urgent drugs to a patient with the help of a district nurse…

And this is a health reform? I think it is a way of using NHS money to give funds that are supposed to help patients to private enterprise…

I am sorry about your surgery, but I think that's more or less what would happen at any local district hospital - it's only the bigger hospitals that have a surgical oncologist on call, and even that varies, depending which area you are in. You are absolutely right in what you say - it is inhuman and also a serious waste of money - the cost of one laparotomy by a surgical oncologist versus the cost of two, one done by a general surgeon and one by a cancer specialist.

Again, I hope you are OK over the weekend, and also rest and relax a bit - I am off to a charity sale in the village hall. Vxxx

[Hidden in reply to vipervictoria]

The wound's healed now Vicky. Thanks for your support and thoughts. Love Tina x x

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Hi Millie .. Thanks for getting back. It's reassuring that you'll know they'll do that, isn't it. Love Tina x x

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Hummmmm good question love x G x

Ps. it isn't only surgery that there is a problem with going to A&E but any condition that might be unrelated or related to cancer.. ( see Babs post about ascites)

[Hidden in reply to Hidden]

Thanks Gwyn .. I'll look for it. Love Tina x x

[Hidden in reply to Hidden]

I looked Gwyn .. and had mentioned my experience of getting to A and E using 111. Since then, my oncologist has told me to present at A and E and I'll be triaged which I'm going to do next time. However, it does lead to a battery of tests before drainage as Babs has pointed out and the nil by mouth regime. I think there is a need for a facility to go in to have ascites removed as soon as patients are uncomfortable. My local hospital runs a nurse led drainage clinic for those who have ascites due to liver disease but not one for women with ascites due to Ovarian because the Ovarian patients are treated by cancer specialists who don't have emergency facilities. Absolute madness. Love Tina x x

[HumbleD]

I totally agree that this is a good question. I had a blocked bowel five days after debaulking surgery for OC in Christmas 2010 and a day after being discharged from where I was initially treated. My husband drove me to our local A and E on instruction from NHS direct. That was two days before Christmas, I was faced with bowel surgery on Christmas Day, if it did not unblock, by a surgeon at local hospital. I am just glad that it unblocked after two days and I was sent home on Boxing Day. In the perfect world would have wanted the surgeon who did my original operation to have done any further work. However, in life and death situation this had to be the best option at that time. I remember doing the most weird exercises on my hospital bed after being given a drip of omprezole and morphine for the pain, to unblock my bowel. Does this help?

Love Wendy x

[Hidden in reply to HumbleD]

Hi Wendy .. It does help. I'm getting the feeling that this is usual. I'm ok about going to my general hospital because there are good surgeons everywhere. I have disease throughout my abdomen and in the lung so I know it's inoperable but I was concerned that nodules weren't taken out of a crucial area like the small bowel mesentery because these weren't causing an acute problem at that particular time though they are growing albeit slowly. I'm not even sure if surgery is possible if the nodules aren't too close to the blood vessels. Thanks for your thoughts ... Love Tina x x

[vipervictoria in reply to Hidden]

Tina, never give up. The new drug you are trying to get might be so good that the disease shrinks everywhere to virtually nothing - this happens sometimes, according to my oncologist. One of my best friends, who I met on an ovarian cancer site 4 years ago, has survived for more than 7 years after being given a prognosis of 3 - 6 months!!! There are new drugs and treatments, trials etc., starting all the time.

It can be done. Vicky xxx

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You're right Vicky ... it can be done. ..and thanks ... I really believe it'll not be too long now before major breakthroughs are at the pharmacies .. Love Tina x x

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I've only needed emergency treatment when temp is raised during chemo. Most times I have gone to the local cancer centre where I'm treated, once I had to go to the local hospital which is state of the art brand new and they were worse than useless. I had the impression they would rather I'd gone somewhere else. On the last occasion I was staying at my caravan in West Wales and went to the out of hours Dr. He admitted me and to be honest I don't think it was necessary but can't complain about caution. They were fantastic and very thorough. Fortunately I've never needed surgery but the hospitals I would be taken to in this area have oncologist surgeons, it would just depend whether he was on call at the time I was admitted.

Glad you are recovering

Love Chris xxx

[Hidden in reply to Hidden]

Thanks Chris ..

I suppose the upside of not having large centres in Wales, is the specalst surgeons are in general hospitals which has its upsides. It's still not a guarantee of being operated on by a surgical gynaeoncologist so maybe the situation in practice isn't so different in England as regards emergency surgery. Hope you're keeping well Chris. Love Tina x x