Your Health

Like Sherlock Holmes, doctors need to be good detectives

W. Gifford-Jones MD & Diana Gifford-Jones

February 28, 2021

BY W. GIFFORD- JONES MD & DIANA GIFFORD-JONES

A 57-year-old woman, receiving physiotherapy for an injured ankle, suddenly suffered a seizure, became unconscious, and was rushed to Emergency. The obvious diagnosis; a sudden stroke, but as Sir Arthur Conan Doyle, the English doctor and writer who created the fictional private detective, Sherlock Holmes, wrote, “There is nothing more deceptive than an obvious fact.”

A report in the Canadian Medical Association Journal shows that Doyle was right. Doctors must sometimes think like Sherlock Holmes. The ultimate diagnosis was not a stroke. Rather, a complication from the triple A disease, abdominal aortic aneurysm (AAA).

It’s a problem that doesn’t receive much press. But it killed Albert Einstein, the famous scientist, Lucille Ball, the TV star, and the actor George C Scott. Unless diagnosed early, before it ruptures, AAA is an efficient assassin.

The aorta is the main artery that delivers blood from the heart to the entire body. It’s about the size of a garden hose and after leaving the heart; it extends to the neck a short distance, then down the back of the abdomen.

During the last 60 years, the risk of AAA has tripled. This is in part due to improved diagnostic methods and an aging population. It’s also more common in males than females, and about 5% of men over age 65 have some degree of aortic aneurysm.

Increased blood pressure is a major risk factor for AAA. It’s also more likely to develop in smokers and those suffering from chronic lung disease. But AAA can result from atherosclerosis (hardening of arteries) that gradually weakens the arterial wall and is a major cause of heart attack which ends the lives of so many North Americans.

An aortic aneurysm may be without symptoms until rupture occurs in which case the hemorrhage is so sudden and severe that death is speedy. But today many aneurysms are diagnosed during other diagnostic abdominal procedures. This provides significant time to decide how these herniations are best treated, particularly since the majority of aneurysms expand at a very slow rate.

Since major surgery is involved to remove an aneurysm, it’s prudent to monitor them every six to twelve months by abdominal ultrasound, CT scans, and MRIs to detect changes in dimensions.

In the final analysis, the decision depends on the size of the aneurysm. Surgery is normally advised when the aneurysm measures 5 to 5.5 centimeters as this is when they’re more likely to rupture. In some cases, a surgical stent is placed inside the aneurysm to decrease the risk of rupturing. Rather than using an abdominal incision, the stent is inserted through the femoral artery in the groin and then guided up and into the weakened aortic wall.

This operation is more serious than having an appendix removal so surgical expertise is vital. It’s the old story that practice makes perfect, whether a plumber or a surgeon.

For instance, in one study for aneurysms repaired by a vascular surgeon in a university hospital, the mortality rate was 2.2%. But in hospitals where surgeons were performing fewer cases and were less experienced, the mortality rate was 5.5%.

Remember the common Gifford-Jones recommendation. If you are told surgeon X is the best for the operation and that surgeon has the personality of Dracula, don’t look elsewhere. It’s the hands that do the surgery, not the personality.

The story of the patient with the injured ankle had a happy ending. She was discharged in nine days. It reminds doctors that 30% of AAA has neurological signs, not pain or other symptoms. Like Sherlock Holmes, doctors need to be good detectives.

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Written By W. Gifford-Jones MD & Diana Gifford-Jones

Dr. W. Gifford-Jones, MD is a graduate of the University of Toronto and the Harvard Medical School. He trained in general surgery at Strong Memorial Hospital, University of Rochester, Montreal General Hospital, McGill University and in Gynecology at Harvard. His storied medical career began as a general practitioner, ship’s surgeon, and hotel doctor. For more than 40 years, he specialized in gynecology, devoting his practice to the formative issues of women’s health. In 1975, he launched his weekly medical column that has been published by national and local Canadian and U.S. newspapers. Today, the readership remains over seven million. His advice contains a solid dose of common sense and he never sits on the fence with controversial issues. He is the author of nine books including, “The Healthy Barmaid”, his autobiography “You’re Going To Do What?”, “What I Learned as a Medical Journalist”, and “90+ How I Got There!” Many years ago, he was successful in a fight to legalize heroin to help ease the pain of terminal cancer patients. His foundation at that time donated $500,000 to establish the Gifford-Jones Professorship in Pain Control and Palliative Care at the University of Toronto Medical School. At 93 years of age he rappelled from the top of Toronto’s City Hall (30 stories) to raise funds for children with a life-threatening disease through the Make-a-Wish Foundation. Diana Gifford-Jones, the daughter of W. Gifford-Jones, MD, Diana has extensive global experience in health and healthcare policy. Diana is Special Advisor with The Aga Khan University, which operates 2 quaternary care hospitals and numerous secondary hospitals, medical centres, pharmacies, and laboratories in South Asia and Africa. She worked for ten years in the Human Development sectors at the World Bank, including health policy and economics, nutrition, and population health. For over a decade at The Conference Board of Canada, she managed four health-related executive networks, including the Roundtable on Socio-Economic Determinants of Health, the Centre for Chronic Disease Prevention and Management, the Canadian Centre for Environmental Health, and the Centre for Health System Design and Management. Her master’s degree in public policy at Harvard University’s Kennedy School of Government included coursework at Harvard Medical School. She is also a graduate of Wellesley College. She has extensive experience with Canadian universities, including at Carleton University, where she was the Executive Director of the Global Academy. She lived and worked in Japan for four years and speaks Japanese fluently. Diana has the designation as a certified Chartered Director from The Directors College, a joint venture of The Conference Board of Canada and McMaster University. She has recently published a book on the natural health philosophy of W. Gifford-Jones, called No Nonsense Health – Naturally!

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