What Does It Mean To Do A Risk-Benefit Assessment For The Older Athlete With Health Challenges Such Aortic Surgery?

Hi folks! Thanks for stopping by!

The primary goal of this blog, and my recent e-book, is to assist people with the art and science, and I do mean art, of getting back on with their lives after a major health challenge, such as abdominal aortic aneurysm (AAA) surgery.

My e-book emphasizes the importance of undertaking your own personal risk-benefit analysis or assessment. This is the process whereby you determine the risks associated with doing or not doing what you are really passionate about, such as golf in the case of Alan who has an ascending aortic aneurysm or in my case Ironman training with an AAA stent graft.

But how do you undertake a risk-benefit assessment?

A friend of mine said recently, “Kevin, it’s easy for you with your veterinary medical and pathology training, but essentially impossible for the average person.” This is defeat before you start, and it will lead to you putting your life entirely in the hands of your doctor, which is not an approach I recommend. The trick is to generate reliable data about your condition and associated risks posed by your preferred activity, convert this information into knowledge, which takes a little worthwhile work on your part, leading you to develop the wisdom you will need to make your critical decisions (e.g. golf no golf?).

Interesting book with very valuable ideas about communicating with your doctor.

Doctors, as much as they can help us, are not only motivated by the desire to improve our health. Their decisions are also influenced by the potential for litigation, and a generally cautious approach to what you should and should not do.

As a physician, Philip Nye, whose thoughts I really appreciate, recently stated on our AAA Facebook Awareness page, “Nobody wants to be the person who said “go ahead” and then something bad happens, so it is far easier for them to play safe and say “better not”. Trying to ask questions about risk levels may be more fruitful than asking “can I do …” then you yourself can make a decision.”

Can you imagine your physician recommending sky diving as a hobby during your treatment for diabetes? Probably not! But such a hobby could motivate you to get in good shape in preparation for your first landing, and thus motivate you to live an active life. Doctors are great, but they maybe personally scared of sky diving, and it’s your life, not theirs, that is on the line! Remember that!

This is why I stress in my book the need to consider all aspects of your condition, list the risky activities, such as deep squats in the gym in my case, and find a way to eliminate them without abandoning your interest. Then list the risks associated with an inactive life, such as depression or poor health. This provides general background.

Use time, patience, introspection, all the data that you can find, including the opinions of as many skilled health professionals as you can find, advice on forums, and your relative desire to do whatever it is you love to do.

Then proceed by making a complete record of your condition, followed by asking questions of your health advisors, such as:

1. What is my surgery site like, how fragile is it, and when will it be fully recovered and stable?
2. Could you show me pictures or a video that would explain it fully for my level of medical training? 
   

   Click figure for link to remarkable video showing deployment of a Cook Zenith AAA stent graft, just like mine.
   

3. What kinds of movements would put stress on my surgery site? [excuse the misplaced number 3; it’s because WordPress sometimes does some weird stuff that I just cannot fix – otherwise it’s great, so thanks for everything WordPress staff].
4. Would you consider [insert activity] dangerous in my specific case? If they say yes, ask why, and request specific knowledge supporting their conclusion. A vague impression can provide misinformation so beware.
5. If you were in my situation would you do [insert activity]? If they say yes or no ask for supporting information, knowledge and examples.
6. Where can I find people to talk to who have been through this surgery and continue with an active life-style, especially if they pursue my favorite sport [insert activity]?
7. Are there forums where this situation is discussed? See my useful links tab for some examples.
8. What would you advise if your son/father/grandfather or daughter/mother/grandmother was dealing with this situation? Keep pushing for an opinion, and chase these opinions to a place where the advisor really knows what they are talking about (a rare thing indeed, I’m afraid), or don’t. Beware your health advisors ego as it can get in the way; I suggest you consider reading Love, Medicine and Miracles by Bernie Siegal, for clarification on this point.
9. Which health indicators should I monitor to ensure regular personal assessment of my health status in relation to my surgery, such as pulse rate and quality, blood pressure, and so forth?
   

   Example of blood pressure data that I used to work with my health professionals. This issue self-corrected about 18 months later, as I expected, permitting me to cease taking the medicine, along with the inevitable side-effects.

10. Any other questions that come into your mind – me, I searched the web, found papers indicating risks associated with rowing and other activities that induce dangerous pressure in the lower abdomen, and proceeded to avoid them. I also sought information on the nature of my stent with respect to risks of metal fatigue from cycling (I spin the pedals about 1,000,000 times per year), and built this knowledge into my training.

Keep asking questions of yourself and others, as this is a life-long situation. If in doubt drop me a line about the condition and maybe I can help you to solve the riddle, as I am attempting to do for Alan.

At the end of the day it is your call as to how you live your life.

-k @FitOldDog