L EGAL I S SUE S
24-48 hours to relieve the pressure on the nerves. Surgery must be performed quickly to prevent permanent damage to the nerves which can result in loss of bowel and bladder control, paralysis of the legs, loss of sexual functions and neuropathic pain. Failure to diagnose, and correctly treat cauda equina syndrome, can result in harmful and often long-term health problems. Even when appropriate treatment is given, not all patients recover full function as this depends on the amount of damage and the speed in which surgery was performed.
In my role at Moore Barlow, I have come across many cases in which clients have suffered the life-altering effects of cauda equina syndrome as a consequence of a failure to promptly diagnose and provide effective treatment. In some cases, a less than 24-hour delay can make all the difference between recovery and life-long dependence on the support of carers. Not only is the condition devastating for the individual concerned but, as a result of their care needs, they then become a long-term health burden for the NHS.
The urgency of a fast diagnosis can be seen in one of my cases. The patient had
Prompt recognition and diagnosis of cauda equina syndrome is dependent upon clinical assessment, including a thorough history and description of the symptoms along with imaging, usually an MRI scan. If left undiagnosed for just 24-48 hours, the condition can have life changing effects.
a long history of episodic back pain over many years and underwent an MRI scan at a hospital Trust which showed a significant worsening of the prolapse of the L4/L5 disc since a previous scan. A delay of two weeks to review the scan, and a lack of awareness of the urgency of his condition among the Trust’s consultants, left the patients with serious physical consequences including bladder, bowel and sexual dysfunction. There are a number of simple adjustments that can be made to the way cauda equina syndrome cases are approached that could go a long way to reducing the number of costly errors made, and improve health outcomes for patients.
Diagnosis
Cauda equina settlements are often substantial as the effects on individuals are usually quite extensive. As well as damage to bladder, bowel and sexual function, there can be restrictions on mobility and ongoing pain, often leading to an inability to work and the need for extensive help with everyday living. Frequently clinicians, especially when patients enter into acute emergency care settings, miss key ‘red-flag’ symptoms as patients are often in pain and do not have the appropriate language to discuss their intimate symptoms. Therefore, misdiagnosis of cauda equina syndrome is often the result of problems with communication; since cauda equina syndrome involves incontinence and sexual dysfunction, patients may not feel comfortable in disclosing this information unless asked in the right way. They may also avoid talking about these problems in great detail or not even know themselves what the symptoms are, due to other pressing pain. The extremely time-sensitive nature of cauda equina syndrome treatment means that the language used must be specific and succinct, and this means reducing the stigma around discussing intimate symptoms.
Improving communication Unfortunately, there is no ‘silver bullet’ when it comes to fixing communication problems between clinicians and patients. With the embarrassment that cauda equina syndrome symptoms can bring, very often patients struggle to describe what they are experiencing due to the taboo nature of their symptoms. It is not easy to describe to a stranger the details of sexual, bladder and bowel dysfunction, especially when you are already in a rather vulnerable and painful position. This understandably complicates a clinician’s job, and they may be feeling around in the dark for a diagnosis based on sparse descriptions. Equally the healthcare professional may not be asking the patient the right questions in order to elicit the detailed symptoms they need to understand to make a diagnosis. Patients may also be unsure exactly what their symptoms are
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