Diff in surgical opinion

[dixitworld]

Hi

wow, you sure have some bad examples of surgeon bedside manners there.



"him" is who?

so far I lean towards Dr Svenssons opinion

What I meant is Miller told me that he is expert so no more discussion.
guys I really don’t understand what discussion going on but definitely see no agreements.

To me it seems to just believe that CC is better hospital and Svensson must be doing more re do surgeries and I should go to him. I am scared too much without any sleep and I hope that I should survive this surgery.

thanks all for their responses.

 

[Agian]

What I meant is Miller told me that he is expert so no more discussion.

I think we have a winner

 

[Agian]

Hey Dixit, you'll be OK.

 

[Superman]

.....guys I really don’t understand what discussion going on but definitely see no agreements.

thanks all for their responses.

If you’re referring to the side banter, I’m guilty of just messing around a bit when this is s serious topic for you. Apologies.

The consensus here here appears to me to agree that Dr Miller has terrible bedside manner. Nobody seems to think he’s a bad Dr. Just rude. Beyond that, with a lot of these situations, the only real “wrong” answer is to do nothing.

I agree with Agian. You will be okay. I went through the same thing 9 years ago. 2nd operation. Valve and graft. I’m in the best shape I’ve been in in years. Work two jobs. Have five great kids. Travel a bit. Really can’t complain.

Both recommendations will will get you where you need to be. Time to choose the Dr you’re most comfortable with doing the procedure that makes the most sense to you

 

[cldlhd]

Yes I am also not happy with wordings Dr. Miller used for another opinion. Regarding taking these info to the surgeons both are stubborn wiTh their recommendation.
Dr Svensson at CC will not meet anyone more than 1 time before surgery nor he will personally answer more questions

Dr Miller on the other hand has told him that he is the expert so no more argument on the decision

Only once prior to surgery? That seems pretty harsh. I met with my surgeon, Dr. Bavaria, twice. On the 2nd consult get said either we do it now or I'll see you in a year

 

[dixitworld]

I talked to multiple other surgeons back in India over phone including my previous surgeon , everyone said the decision should be taken during surgery , in case valve and the ring of valve is good enough then no need to replace valve , else if there is any calcification on valve or ring then only it need to be replaced.

So this is contradicting the Dr Svensson opinion who is still of the opinion whatever the situation of valve is , he want to put composite graft replacing the original valve.

Dr Miller 73 yrs age continue to give me goosebumps if i think of selecting him as surgeon.

I dont have much option locally here near san francisco , i can go to other surgeons in Stanford who are comparatively younger but dont have much reviews either including Dr. Joseph WOO (Current head of Stanford cardiac surgery) or Michael Fischbein.

Totally confused not sure what to do.

 

[jyg]

dixitworld,

I am in San Francisco as well. Almost 4 years out from AVR and replace of my proximal arch and some of the innominate artery with Dacron. This was done by the head of thoracic at CPMC, Dr. Vincent Gaudiani. He's very, very confident and a real mensch, but clearly compassionate. He's very busy, but always took time before surgery to answer any questions. He answered every email I sent. He enjoyed my enthusiasm (er, fear) in learning all I could about my condition and would go into detail with me that he said he rarely did with other patients simply because I wanted to know. I never felt belittled or that my layman's concerns and fears were an irritation to him. And he did a bang up job. No complications. Cardio says everything is still working great. My stay at CPMC was really good. Their cardio-rehab team is _excellent_.

I would recommend giving Gaudiani a call. You'd get to recover close to home.

 

[Warrick]

I certainly agree with this. 2.5-3.5 has been my range since the introduction of the INR system in the 1980s with absolutely no issues.........plus it is very easy for me to stay within those limits without really tryi

Oops....didn't mean to hijack thread. This issue will always cause uncertainty if the diagnoses and/or remedies don't agree. I'd probably have to get a third opinion unless I was very comfortable with one of the proposed remedies

Curious how was your INR/PT managed/measured before the introduction of INR measurement?

 

[pellicle]

Curious how was your INR/PT managed/measured before the introduction of INR measurement?

using similar methods, but the move to INR meant that instead of trying to wrestle with a number like 28.3 seconds the INR made it an averaged standardised ratio and thus easier to conceptualise

 

[pellicle]

Also Warrick , I dunno if this helps but:

International normalized ratio

The result (in seconds) for a prothrombin time performed on a normal individual will vary according to the type of analytical system employed. This is due to the variations between different types and batches of manufacturer's tissue factor used in the reagent to perform the test. The INR was devised to standardize the results. Each manufacturer assigns an ISI value (International Sensitivity Index) for any tissue factor they manufacture. The ISI value indicates how a particular batch of tissue factor compares to an international reference tissue factor. The ISI is usually between 0.94 and 1.4 for more sensitive and 2.0-3.0 for less sensitive thromboplastins.[3][4][5]

The INR is the ratio of a patient's prothrombin time to a normal (control) sample, raised to the power of the ISI value for the analytical system being used.

 

[Warrick]

using similar methods, but the move to INR meant that instead of trying to wrestle with a number like 28.3 seconds the INR made it an averaged standardised ratio and thus easier to conceptualise

Thanks, I did look it up after wards and it looked very hit and miss for a while there, found this interesting

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1365-2141.2008.07119.x

I've read abit lately people having bleeding issues with the other meds such as Pradaxa and Eliquis on other sites

 

[dixitworld]

I did had phone consultation with Dr Alberto Puchittino at Mayo. He also told that when root need to be replaced , he will need to replace the valve also as thats the best way to remove all diseased tissues.But he end up saying that my case is borderline case for surgery with current 5.2 cm.

Young age asks for early intervention while redo surgery asks for delay in intervention and third factor is growth (which he cant predict in my case with no previous CT Scans availabke) , although my echo showed 4.7 cm in Oct 2015 and 5.2 in Dec 2017.

Risks he told me upto 2 % for young age patients. Its really tough to decide if i should go ahead or wait.
Although mentally its challenging to wait also , but fear of surgery is also a big thing.