75 yo with oesophageal cancer
- AF – CHADS-VASC 4
- Binge drinker
- Epilepsy – absence seizures
- BP in clinic – 192/70
- Discussed at CPET group – not taking medications as has no regular GP
- Spirometry: Mild airflow obstruction, post BD change 28%. Consistent with asthma.
- CPET – Peak VO2 low at 15.2ml/kg, AT 7.7ml/kg/min. T depression inferolaterally towards peak exercise.
- Maximal stress test: HRmax – 85% predicted. This patient reached 82% predicted, RER – 1.15. This patient – 1.12. RER (VCO2/VO2)
- Ventilatory reserve – MVV=FEV1x35, should have at least 20% reserve. Patient has encroached on his ventilatory reserve. HR also raised at this time which could suggest SV limitation. Note patient has not been taking bronchodilators.
- NAC – surgery planned for 8 weeks post NAC. Concern that patient will significantly decompensate with chemo
- Borderline – alcohol intake – unwilling to cut-down. Weight loss, non-compliant with medications
- Social issues – no car, may not be able to participate in prehab, from isolated area
- Prehab – multiple options. Dr Jen Mackney co-ordinates via CPET MDT and periop clinic. This patient would be better suited to a supervised program.
- Restart antihypertensives and bronchodilators
- Formal stress imaging
- Prehab and re-test preoperatively before deciding if fit for surgery.