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DTMark

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HOLA441
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HOLA442

I'd be wanting to know why they can't operate.

So would I. But that's the sort of question where I'd expect quack to know best, and to tell you honestly.

An operation is a shock to the system, and as such could cause something catastrophic. If the patient has other conditions, even something as simple as high blood pressure, they might think the risk outweighs the benefits. But they should be able to discuss it with the patient.

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HOLA443

So would I. But that's the sort of question where I'd expect quack to know best, and to tell you honestly.

An operation is a shock to the system, and as such could cause something catastrophic. If the patient has other conditions, even something as simple as high blood pressure, they might think the risk outweighs the benefits. But they should be able to discuss it with the patient.

As an IT consultant, I often make what I'd call best judgements on the best course of action for my clients. To some extent it depends on the client and the project, but I'll generally explain the options and why I recommend a particular one.

Those are not, however, life-threatening scenarios. It is entirely natural in such situations to want to be absolutely certain that every option has been explored and maybe even to be cynical and wonder whether cost plays a part.

Actually, I suspect that I may not want to hear the answer and that it is related to the stage of the disease. That said, MRI scans did not reveal secondary tumours anywhere else. But, I do think it worth pursuing a second opinion - but then I would, wouldn't I.

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HOLA444

Very sorry to hear about your father, DTMark.

NHS healthcare is a lottery. In London, I couldn't even find a GP to take me on - never mind get an appointment. I had to use the walk-in centres/A&E. In West Yorkshire, I could pretty much guarantee same day appointment - if I rang them up at 7am, and was willing to go in straight away. My parents in Dorset will wait weeks for an appointment. Where I live in North Wales usually takes a few days - although if you ring at 8am, you can usually get an appointment for the next day.

West Yorkshire was also superb for treatment of more serious conditions, as was London too. The missus had cancer. Took the best part of two years to get a referral to hospital to get a diagnosis (but this was partly down to bad luck on the missus' part in moving around a lot, and having symptoms which could have been a bunch of less serious things - and her notes taking ages to transfer from one surgery to another). Once the diagnosis came through though - she was in surgery in a week, monthly monitoring/follow up afterwards, including further surgery and then chemo. They were very very good. She has had the all clear for more than a decade.

If you can, DTMark - try to make time to go the appointments with your Dad and ask these questions/take notes etc. Often the patient is overwhelmed by the situation and forgets or worries about the possible answers. Macmillan Cancer Nurses are also extremely supportive and very knowledgeable. Do have a chat with them about any questions you might have.

I'd take it as a positive sign they are recommending chemo, and think they have a chance of nailing it.

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HOLA445

I've had various private healthcare plans over the years. In my view all they are is the equivalent of the queue buster passes you get in theme parks. It avoids the gp running through their standard flow chart for getting rid of you on your first appointment. The logic for such appears to be as follows:

If patient complains of pain, suggest rest and ibruprofen and a follow up in 6 weeks. If pain is gone, everyone's a winner. If not then who cares? The patient gets another go.

Apart from that it nearly killed a friend of mine who had a infection in his shin bone. Failed totally by the first line he was eventually taken to hospital in an ambulance where he stayed for a month where they discussed amputation.

Don't bother complaining either. Patients are never right Drs always are.

Oops kind of derailed my reply. As far as I can gather "I've got private cover" basically gives the gp comfort that they don't have to apply whatever stupid policy the NHS have foisted upon them. It grants quicker access to all sorts of diagnostics. If repeats are required, its not an issue. Appointment times are exactly that, not the infuriating NHS version which is:

Give 40 people an appointment time of 10am and then work through those that bother to turn up thus maximising your efficiency. The patients however get to play the great time management lottery. A "10am" appointment may lead to a 2pm slot with the doctor. If you have any sort of job this is a massive **** pain.

Finally and this is not a defence of the NHS but a wider observation based partly on the experience of losing my father to cancer. People have unrealistic expectations regarding medicine (modern or alternative). Humans are frail and the human body is phenomenally complex. It is not a machine and cannot be treated as such. Diagnosis is not an exact science. In fact its more like an arcane art. Two practioners can arrive at widely different conclusions upon which massively different treatments might be used. 20/20 hindsight and a desire for different outcomes does allow for a degree of "if only something different had been done the outcome would have been different" maybe, maybe not. Also people want good outcomes.that's not always possible. People get sick and die even if all the "right" decisions are made.

Good luck with your father. My only advice would be if you're not happy with an spent of care, challenge it. Assertively but not aggressively, the latter in the NHS is a virtual excuse for them not to engage. As others have noted. There are systemic issue in the NHS such as repeat postponements. Even a degree of challenge can ensure a better outcome for your father. Yes it'll be at expense of someone else, but for me that's what the veneer of the NHS attempts to hide. Its every man for himself.

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HOLA446
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HOLA447

Sorry to hear about your Dad.

The main differences between private healthcare and NHS in the UK, at least as I seen them are:

Private healthcare tends to have lower utilisation of resources, whereas the NHS tends to run at maximal capacity at all times.

Private healthcare makes it easier to have long appointments for detailed consultations

Private has more flexibility in treatment options, particularly for new treatments where the NHS may not be prepared to fund it.

Here's a little anecdote to illustrate the first point: I was recently approached by a private outfit looking for consultant. I went along to see what this was all about. They had an MRI scanner - it does 8 scans per week. My NHS hospital does 120 scans per week with the same model of scanner, and is typically booked-solid for 3 weeks. As you might imagine, the private facility can do most MRI scans the same day as the request.

Because there is a chronic problem of maximally booked clinics in the NHS, there is a lot of pressure on doctors to try to discharge patients at the earliest possible opportunity. As a result, there is a tendency to under-investigate. In the private sector where doctors are paid per consultation, incentives are opposite.

Obviously, there are "short-cuts" in the NHS designed to fast-track serious conditions - so, if a GP suspects cancer, then, at least in England, then if the correct box is ticked on the diagnostics form, the patient must get their diagnostics completed within 2 weeks of the GP's appointment. The problem is that this mechanism has been politically distorted towards cancer - so anything that is a type of cancer, gets this priority (but it also means that a very mild, and slow progressing leukaemia in an 80 year old for which treatment is neither required nor available, will necessarily take priority over the potentially life-or-limb threatening blood disorder in a 20 year old). Another problem is that even though these targets exist, due to the capacity at which NHS services are operated, it is not always possible to meet them. Postponements are not uncommon, and while they shouldn't be offered for cases of suspected cancer, they do still happen, sometimes repeatedly.

Ultimately, the NHS is not a single monolithic entity, and it has different effectiveness in different regions. Some areas seem to be managing pretty well, some areas are imploding with waiting times going parabolic (e.g. North Wales).

Most private healthcare in the UK is set up to do high-throughput, low-complexity tasks, where the NHS has long waits. So, diagnostics, minor surgery, or cosmetic surgery which the NHS will not fund. In general, private healthcare facilities tend to be less well set up for provide complex or high-risk treatments, and that would typically mean NHS care (this can be privately funded, and some NHS hospitals do have dedicated private wards specifically in order to take advantage of their facilities). Of course, that is not universally the case, there is private healthcare available which has extensive capabilities, but there are few facilities that can offer it (mainly in central London). Just bear in mind that these facilities charge tend to be higher than most insurers are willing to pay on a standard policy.

What private healthcare is not set up to do is deal with chronic conditions. Things like kidney failure, pain for which a definitive treatment is not possible, mental health problems, certain infectious diseases (e.g. HIV), etc. are basically not covered by any health insurer in the UK - meaning that there is essentially no private market for these conditions.

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HOLA448

I'm an NHS hospital doctor. In my view most people don't love the NHS, but they do fear being without it.

To the OP: sorry to hear to hear about your father.

Private healthcare in the UK is completely different from the US. The UK private healthcare model focuses on offering treatments that are relatively cheap to provide, such as day-surgery hernia repairs, and tends to leave coverage of more expensive long-term conditions to the NHS. Also private healthcare tends to leave the NHS to pick up the pieces when things go wrong.

Also, if you're being treated in a private hospital, they don't always have the medical cover immediately available at night and weekends, when you might have to wait for the consultant to drive in from home, as opposed to the on site, on-call training grade doctors.

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HOLA449

Thanks for all the responses.

That line doesn't really do it justice, as people have spent quite some time typing out really detailed and useful replies.

My partner lost his father three years ago to a heart attack, the loss was very sudden.

Following that, we have, in the last year, lost both of our adopted cats to cancer and on both occasions had to make the decision to put them to sleep. I confess that I am still emotionally numb to the last one, our female, who we lost at age 12. I know I haven't dealt with that fully yet.

If I have been in what you might call a "bad mood" lately - these are the reasons why. If you have been on the receiving end of one of my apologies, that doesn't justify it. It only explains it. I am experiencing emotions the depth of which have no parallel.

I have some reading to do here, and you have all made some prescient, superb points.

My father and I have something of a journey ahead of us.

Thank you again.

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HOLA4410
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HOLA4411

Just to add (at an admittedly late stage in the thread so maybe of limited use) a good friend of mine's wife has recently been treated for breast cancer by BUPA.

According to him the biggest benefit, and one which made it worth the money was that BUPA will do chemo at home.

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HOLA4412

The appointment in Euston is actually next Tuesday (my error), so we'll know more then. However more is emerging:

His lymph nodes appear swollen (ironically, this is where the tumours in our female cat Maddy were) and the MRI is unable to penetrate sufficiently to give an accurate picture.

The biopsy session will also involve an ultrasound applied directly from within the lung to have a look at that. The results of which would presumably determine possible courses of action as regards surgery.

I am just on the point of getting over a dreadful cold. I visited him in hospital but felt it unwise to get too close or touch just in case I transmitted it. I'm going to see him at home as soon as I can.

I'm really struggling with something. Can I ask for opinions:

I'm very cynical as a person. I have my father's personality to a large degree. We are both quite fiercely independent, slightly head-strong, maybe a little impetuous, this probably comes across in my posts. I thank my father for my intellect and my mother for my empathy.

We're a family that others would regard as not especially "close" but then given our character types, we don't "need" to sit down to Sunday lunch every week. Has never been like that. We are not "distant" as such, but I feel I know him very well, perhaps vice-versa.

Unless surgery is an option, and I am realistic here, time is limited.

This then leads me to think "What would you really like to do? If money were no option? What have you always wanted? What can I make happen for you?"

If I ask that question, then I am pre-judging the outcome and where this is going.

I know that he will also be realistic.

I don't feel that I can simply "smile and put on a brave face and exude optimism". He'll see through that.

How the conversation goes is going to have to be a little spontaneous depending on what he says to me.

I know that this is a big question:

How would you deal with this? What would you say?

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HOLA4413

His lymph nodes appear swollen (ironically, this is where the tumours in our female cat Maddy were) and the MRI is unable to penetrate sufficiently to give an accurate picture.

Oh, right.

That was something they had to test with my late relative. I don't recollect for certain, but I think swollen lymph nodes would indeed have been a likely blocker to that operation.

Sounds like you may be headed for a dark place. I was there a year ago: the last few months of my relative's life after hope was extinguished were worse than nothing, but I'm too much of a coward to put her down (and she'd have been appalled at my giving up years of my life to our thoroughly evil "criminal justice" process, even if they didn't convict in the end).

There comes a time when even Switzerland isn't an option, 'cos the patient is simply too weak to travel. Last time I took my relative out I hired a wheelchair for the day only to find she was too weak to cope with the ten minutes to a nice spot she should have enjoyed.

Your dad may need to anticipate a time when he descends to a sad wraith, whose continued existence mocks the memory of the man he was. The irony is, that's precisely when the NHS goes into no-expense-spared overdrive to deny him release.

Sorry, I was going to be more helpful, but I'm getting myself into too much of a state now. And most of what I might say doesn't belong on a public forum.

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HOLA4414

Just wondering if someone could please explain the advantage of Denplan...partner pays about £300 per year plus treatment. That compares to the worst year I have had...£202 for a crown. Otherwise about £17.50 per year for a check up or £35 where I get two visits in. It's really up to me as to how quickly I respond to reminders.

So there we have it.....about £300 a decade or £300 a year...seems a bit of a no brainer.

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HOLA4415

I got a GP appointment in just three or four days earlier this year.

That's a huge improvement on the one time in my life I've had a truly urgent need, and it was going to be more than two weeks. That was autumn 2007, before anyone was talking "austerity".

Our GP has pulled its finger out recently. Doctors sited in all the 'spare rooms' they have with paper labels. Have seen Dr 'Moss from the IT crowd' three times now and he's going to refer me to ENT for my dizziness.

How would you deal with this? What would you say?

I don't know. Sit and bite the inside of your mouth to stop yourself howling with fear and sadness.

Ask stupid questions that no one knows the answer to.

Cry.

Be there for him even if it's only to make him a cup of tea.

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HOLA4416

I know that this is a big question:

How would you deal with this? What would you say?

Cancer is not a homogeneous disease so your Dad's experience will likely (hopefully?) differ from my Dad's.

All I can say is that you will never regret spending time with him.

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HOLA4417

Oh, right.

That was something they had to test with my late relative. I don't recollect for certain, but I think swollen lymph nodes would indeed have been a likely blocker to that operation.

Sounds like you may be headed for a dark place. I was there a year ago: the last few months of my relative's life after hope was extinguished were worse than nothing, but I'm too much of a coward to put her down (and she'd have been appalled at my giving up years of my life to our thoroughly evil "criminal justice" process, even if they didn't convict in the end).

There comes a time when even Switzerland isn't an option, 'cos the patient is simply too weak to travel. Last time I took my relative out I hired a wheelchair for the day only to find she was too weak to cope with the ten minutes to a nice spot she should have enjoyed.

Your dad may need to anticipate a time when he descends to a sad wraith, whose continued existence mocks the memory of the man he was. The irony is, that's precisely when the NHS goes into no-expense-spared overdrive to deny him release.

Sorry, I was going to be more helpful, but I'm getting myself into too much of a state now. And most of what I might say doesn't belong on a public forum.

I'm so sorry to hear this and DTMark I wish you and yours well

I can agree with Porca M that it is a dark place indeed. I had to nurse my mother through it and it nearly took me with her. I had a nervous breakdown; the only thing that saved me was the Marie Curie hospice - truly a saintly organisation - who took her in for her final 8 weeks.

If it is terminal DTMark, look to getting him out of a hospital environment that as Porca says does everything to keep people alive and into a hospice where they do not resus

I still feel terrible guilt that I prayed "make it quick and painless" when we got the diagnosis as terminal, but compared to some of the prolonged horrors that people can go through it was a relatively short illness

please PLEASE read this link http://www.zocalopublicsquare.org/2011/11/30/how-doctors-die/ideas/nexus/

sorry to be so grim, I hope you're lucky

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HOLA4418
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HOLA4419

I think I might frame it like this.

Whatever the outcome, it sounds like you'd like to do some cool stuff with your Dad sooner rather than later. If that's the case, and he's up for it - then do it.

A few years back, when my Dad was turning 70 and noticeably slowing up - I decided to make a change with my folks. I still can't get to see them more than once or twice a year, and they certainly can't travel up here. But I chat to him for at least an hour every week, and whenever I find an excuse (e.g. a significant milestone) I bung them enough cash to have a decent holiday if they want to (they'd never take "charity"). I don't think they have done a big holiday (Mum's not really well enough), but they've done a few days out, and knowing that they can if they want and having a bit of a buffer against unforeseen expenses - is a bit of a comfort I think. Especially as they've always struggled for money previously.

Give him your time and love. I doubt he wants anything else - and you can start as soon as you like.

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HOLA4420

When my old man phoned me 10 years ago to announce he had inoperable lung cancer it wasn't that much of a shock, considering that he already had just about everything else that can go wrong with lungs, and I had been steeling myself since my teens for him to pop off at any moment.

For the next 6 months, I stalked him with a camera trying to get something to remember him by, as he was something of a raconteur, and ended up with some pictures and videos that are very precious to me.

He had a grotty last month, in and out of hospital, contracting MRSA courtesy of the NHS, but when the end came it was at home and mercifully sudden, although hard on my mum.

His was the first close death that really affected me in my 46 years.

I wish I had more video of him telling his stories.

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HOLA4421

This is one of those moments where I feel I should take the time to re-quote comments and thank each person on a personal basis.

But I hope that, when I say thank you, each of you will feel that it is addressed to your personally, because it is.

For the care you have shown, and the messages that I have received - a genuine thank you.

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HOLA4422

We're a family that others would regard as not especially "close" but then given our character types, we don't "need" to sit down to Sunday lunch every week. Has never been like that. We are not "distant" as such, but I feel I know him very well, perhaps vice-versa.

Unless surgery is an option, and I am realistic here, time is limited.

This then leads me to think "What would you really like to do? If money were no option? What have you always wanted? What can I make happen for you?"

If I ask that question, then I am pre-judging the outcome and where this is going.

I know that he will also be realistic.

I don't feel that I can simply "smile and put on a brave face and exude optimism". He'll see through that.

How the conversation goes is going to have to be a little spontaneous depending on what he says to me.

I know that this is a big question:

How would you deal with this? What would you say?

Obviously the situation is different for everybody, but if it helps in any small way im happy to pass on my experience.

My family is also not close, Other than to occasionally moan at each other I never had any kind of relationship with my father, we didnt really argue we just didnt speak much, however 6 weeks ago he became very ill, 4 days later we found out he had cancer, he passed away on the 6th feb (2 weeks from the day i took him to A&E) and his funeral was this monday, so I have this all pretty fresh in my head.

So, as to how I would deal with it, I can only tell you what i/we did and hope it helps.

We had conversations we have never had before, I got to understand the hows and whys of his words and actions and moved from a place of frustration with him to a feeling of respect as it turns out he had been doing the best he felt he could do all along for a variety of reasons. I made sure I never lied to him while he was in hospital but I will admit when I was told some particularly scary stuff I then didnt feel the need to pass it on unless he asked (which he didnt).

If you can offer him your time, i'd say do it in a heartbeat, the biggest thing for me was when i stood at his bedside upset and he asked my mum "why is he crying?, I didnt think he cared" and she was able to tell him of course I cared I just wasnt very good at telling him, and he nodded and I think that gave him some peace.

I genuinly hope this works out as well as it can for you, its a very tough time

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HOLA4423

Obviously the situation is different for everybody, but if it helps in any small way im happy to pass on my experience.

My family is also not close, Other than to occasionally moan at each other I never had any kind of relationship with my father, we didnt really argue we just didnt speak much, however 6 weeks ago he became very ill, 4 days later we found out he had cancer, he passed away on the 6th feb (2 weeks from the day i took him to A&E) and his funeral was this monday, so I have this all pretty fresh in my head.

So, as to how I would deal with it, I can only tell you what i/we did and hope it helps.

We had conversations we have never had before, I got to understand the hows and whys of his words and actions and moved from a place of frustration with him to a feeling of respect as it turns out he had been doing the best he felt he could do all along for a variety of reasons. I made sure I never lied to him while he was in hospital but I will admit when I was told some particularly scary stuff I then didnt feel the need to pass it on unless he asked (which he didnt).

If you can offer him your time, i'd say do it in a heartbeat, the biggest thing for me was when i stood at his bedside upset and he asked my mum "why is he crying?, I didnt think he cared" and she was able to tell him of course I cared I just wasnt very good at telling him, and he nodded and I think that gave him some peace.

I genuinly hope this works out as well as it can for you, its a very tough time

I can empathise with that, greatly.

You can't tell people how they should deal with things (not that your are). Each to their own.

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HOLA4424

My last read of this thread for the morning. I have to go out and tbh I will look like I've been crying.

I have a tiny clip of my dad pulling a face taken at the start of the week he was diagnosed. I was showing him my new video camera. I wish I'd left it with him so he could have maybe made us some films to watch.

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HOLA4425
Guest TheBlueCat

Also private healthcare tends to leave the NHS to pick up the pieces when things go wrong.

I have some experience of that with a family member. I personally had a good experience with private medical insurance which allowed me to get treated more quickly and in greater comfort than would otherwise have been the case. The huge caveat is that I chose a private ward in an NHS teaching hospital with a proper crash team and full ICU instead of a fully private hospital. There's no way I'd go for anything that required a GA in most small private hospitals (somewhere like the Wellington in London would OK I guess).

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