Dr James Le Fanu: 28 March

Why coronary bypass surgery is riskier if performed in an emergency; a solution to bladder problems and a warning about home remedies
Several years ago, the eminent American heart surgeon Michael DeBakey had the unusual experience of having his life saved by an operation of his own devising. Back in 1956 he pioneered a method – utilising a Dacron graft – for repairing a rupture in the major artery, the aorta, which till then had been universally fatal. He subsequently went on to perform the ­ first coronary bypass operation and devise an arti­ficial heart to tide patients over until a transplant became available. Along the way he operated on an estimated 20,000 patients including the Shah of Persia, the Duke of Windsor, Marlene Dietrich and Boris Yeltsin – as well as being medical advisor to presidents Lyndon Johnson and Richard Nixon.

Then, aged 97, while preparing a lecture in his study, he felt a sharp pain ripping through his upper chest, which he promptly diagnosed as being due to a tear in the internal lining of the aorta, warranting the Dacron repair procedure he had devised four decades earlier. The surgeons at the hospital were initially reluctant because of his age but DeBakey insisted. The operation lasted four hours and following a ‘stormy’ post-operative course, he lived on for another two years before eventually dying of ‘natural causes’.

No doubt DeBakey’s operation, like his life, stretched the limits of the possible but as surgeon Saroj Das of London’s Hillingdon Hospital has observed in the Journal Of The Royal Society Of Medicine, the age boundaries of surgery continue to lengthen – with, for example, 95 per cent of those aged 75 or over surviving major cardiac surgery.


This encouraging situation, however, applies only to planned ‘elective’ operations. The same procedure, when performed as an emergency, carries a disproportionately high risk with the mortality rate for coronary bypass surgery in octogenarians leaping tenfold to 33 per cent in such circumstances. In surgery, more literally than in life, ‘a stitch in time saves nine’.

This week’s medical query comes courtesy of a 63-year old lady from Bristol troubled by a distressing problem for the past few years. She has in general very good bladder control but every few months she suddenly wakes in the night to ­ find she has voided completely. ‘It is so random, I have not been able to ­ find a trigger,’ she writes. ‘This problem is causing me such distress I am worried to go on holiday, stay with friends and almost to fall asleep.’

The random episodic nature of this nocturnal enuresis (as it is known) without any other urinary symptoms is likely to be due to the spontaneous contraction of the detrusor muscle that empties the bladder – probably related to the altered state of consciousness and brain activity when asleep. The fact that this occurs only every few months would rule out any preventive drug treatment, so the only option would seem to be to wear some sort of waterproof pants when visiting friends or on holiday.


It is natural to assume that home remedies, being simple and straightforward, do not give rise to side e˜ ects in the same way as the potent drugs produced by the pharmaceutical industry. But no remedy can ever be guaranteed to be completely safe.

Thus topical application of an ice cube has several uses in the treatment of acute muscular injury, piles, cold sores and so on. There are, however, several accounts describing how excess exposure can result in cold injury or frostbite to the a˜ffected tissue. Hence, when sensitive areas are being treated, ice cubes should be insulated within a couple of dishcloths and not be applied for more than an hour at a time.

Email drjames@lady.co.uk