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From time to time, our patients like us to share their stories with you. Read more about Mr Kapp.

Between October 2017 and July 2018 my vision was impaired in one or both eyes on four separate occasions. I wrongly put the first of these down to being a ‘silent migraine’ which I’d experienced 20 years earlier. My vision was back to normal after 3 days, so I took no action. When I mentioned this five months later to my optician she said that was no migraine. It sounded more like I ‘d had a ‘transient ischemic attack’ (TIA). TIAs should be treated as medical emergencies requiring swift diagnosis and treatment since they indicate the patient is at high risk of a damaging, potentially fatal, stroke. She advised I have it diagnosed urgently and referred me to my GP who arranged admission to my local hospital’s TIA Clinic for review.

There I had my history and blood pressure taken, a blood test, CT scan of my head, and an ultrasound and a CT scan of my carotid arteries. I was also booked in for an MRI scan of my brain next day. The consultant advised my left carotid artery was 90% blocked. He explained they’d normally operate immediately to clear the blockage but in my case they’d wait to see if the problem reoccurred, and to call an ambulance if it did.

Over the next 12 weeks I suffered three further bouts of impaired vision. Two were - rightly or wrongly - diagnosed as migraines. The third featured intense headache and impaired vision which persisted. I saw my GP about this who referred me to my optician for an eye test which revealed damage to my retina in my left eye. My GP referred me back to my hospital who checked my eye and booked me in to St Georges Hospital for urgent surgery.

After completing their diagnostic tests and reviewing my history, the vascular consultants at St Georges decided not to operate since the blockage in my artery was high up in my neck, hence difficult to access, I’d had heart surgery and was being treated for atrial fibrillation which increased risk of surgery. Thus they wished to wait and see if there was further reoccurrence. I was not impressed by their treatment plan since I was physically strong, had had general anaesthetics without bother since my heart operation and had already suffered loss of vision in one eye. I could not see how suffering further damage would aid diagnosis. I therefore decided to gain a second opinion I could trust.

My goal was to find the vascular consultant near me who had the greatest experience at clearing blockages in carotid arteries (such operations are called carotid endarterectomies). I used the Vascular Society’s web site to examine the records of consultants based in London and identified the one most experienced with carotid endarterectomies. With my GP I reviewed those that came to the fore. He and I agreed Mr Domenico Valenti sounded ideal and my GP arranged for me to see him quickly.

On first meeting Mr Valenti I ran through my distrust of my recent treatment plan, and the reasons for it. He heard me out and said he could handle the issues involved. Mr Valenti struck me as someone who had a passion about doing the right operation well, which is what I was looking for; I was impressed by his steadiness and evident experience; and believed all he told me. Thus we agreed to proceed with his diagnosis and treatment plan.

In line with this, I had a blood test, a duplex carotid ultrasound and CT scan of my heart the next day. Mr Valenti directed the ultrasound personally to obtain the clearest possible view of blood flow past the blockage. I was impressed by how he ‘went the extra mile’ on this diagnostic test to be sure of his treatment plan.

Over the next week, he resolved other fears cited by St George’s vascular team, by arranging a heart stress test (‘Dobutamine stress echo test’), overseen by Prof Monaghan at Kings College Hospital. My heart’s capacity to handle an operation was reviewed by Prof MacCarthy. Professors Monaghan and MacCarthy both gave me the thumbs up for an operation. This resolved fears St George’s had expressed about my capacity to survive an operation.

I had my left carotid artery successfully unblocked by Mr Valenti on 23rd August at Kings College Hospital. The operation normally lasts two hours. Mr Valenti said mine lasted twice as long as he took advantage of a cancelled theatre booking to take his time with me. The blockage he removed turned out to be ‘fissured’, which allowed the restricted blood flowing past it at high speed to wash out bits from inside it. Such bits had damaged my eye, and possibly caused some small blood clots in my brain revealed by the MRI arranged on my first visit to the TIA clinic. Such bits could at any time have more serious consequences.

Before the operation. he oversaw a repeat of my duplex carotid ultrasound scan, and explained he’d cancel the operation if it showed zero blood flow past the blockage. This is in line with best practice. As a patient, I would have been disappointed if it had been so cancelled, but his meticulous approach to diagnoses and good practice meant I’d have accepted his decision.

After the operation, I recovered overnight in King’s outstanding intensive care unit, I was kept in hospital for a further 24 hours. There Mr Valenti inspected my wound and gave me clear and crisp advice on my recovery (no driving for 6 weeks, no heavy lilting for six months).

These were pretty restrictive – but I stuck by them due to the confidence I had in Mr Valenti’s judgement.

The operation involved a lot of cutting around nerves and arteries and the wound takes weeks to heal. I saw Mr Valenti at my request a couple of times about issues which troubled me (wound seepage, swelling, nerve pain). He put my mind at rest both times. I was free of discomfort by end December. Now swelling has gone and scarring is virtually invisible. Mr Valenti checked me out six months later in May 2019b and confirmed I’d made a complete recovery.

I’ve had no further visual disturbances since the op, and I’m back to shifting 100kg balks of timber in my garden without issue.

In my opinion, My Valenti is a model of what a surgeon should be. He is highly-skilled, approachable, courteous, crisp, clear, brave and meticulous. I saw no signs of pomposity, vanity or arrogance – his focus seems entirely on diagnosing a patient’s problem precisely, managing risk and fixing the problem to the highest standard. A great man, and a great surgeon. I’d him recommend to anyone.

M. Kapp

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