meeting the surgeon

[Gribur]

well going in the morning to meet the surgeon and the anethetist. Am going to write down the list of questions from the thread and hope that will let me know what i need. cheers guys. any last minute info please let me know

 

[Bina]

Hopefully the visit went well and you had a good "gut feeling".

 

[jpattillo]

How many surgeons did you interview?

 

[Jkm7]

Hope you left your meeting with the surgeon feeling confident you are in good hands. Faith in our surgeon is critical IMO I could not submit to a surgery without feeling strongly this person will take the best possible care of me and be responsive to my DH's questions and need for info.

 

[Greg a]

Larry, I hope allwent well and you are feeling more confident about L.H.S. and your Doctor if not ask for a referal to another maybe at Cardiac in Kitchener or Toronto .....Queensway campus of Trillium Health care is doing great things as well

 

[Gribur]

Hey everyone, ty for the well wishes. I met with Doctor Guo today and he seemed like a decent guy. I need to first off give everyone here a huge thumbs up as my knowledge of my condition and treatment options blew away the hospital staff today and they were thrilled I even knew the terminology, treatment options etc. Dr Guo told me that I am not in immediate risk, he said I could probably go up to a year before the surgery. My wife and I both made a decision which is scary but I am hoping it was the right one, we decided it would be best to nip it in the bud and opted for early treatment , within the month. I am expecting a call tomorrow with the date. The surgeon (DR.Guo) asked what i would like to do and what amount of risk I am willing to accept. I told him I am not willing to raise the risk level any more then needed and that I never want to have it done again. He asked what I thought about the Ross and I said I am not willing to sacrifice my good pulmonary valve in any way. He also asked me what my thought was on tissue. I opted for a mechanical valve. He asked if i was into rock climbing, hockey, etc to rule out those risk factors i guess. They use the ST.Jude and since he told me it has been around since 1968 I am reassured it works well. He told me that he will perform a modified Bentall, replacing the aortic valve and replacing the aortic arch. I am hoping this is the best option. I used the questions on this forum and he answered all of them. I am interested to hear everyones comments on the above info, good or bad please. I wanted to make it personal so I printed the pic that I have posted of my wedding so he could see my children and what is most important to me, I really think it worked to personalize the meeting. It was a 7 hour appointment/pre op and met with everyone involved and recieved way too much info too fast lol. The one nurse we met was excited about me knowing of the On-x and was going to speak with my surgeon regarding a study and to see if the On-X is able to be used in the modified bentall, I did some reading and am pretty sure it is not. Sorry I am all over with this post, just want to get it down before i forget. Dr Guo does approx 70 aortic valves per year and has been doing it for a long time, not quite sure how long but he has been practicing for over 20 years. He is in the operating room every day but monday and performs 2 surgeries per day, transplants, other valves, bypasses etc. just curious as to whether 70 per year is a good figure , let me know what ya think. There is more but I am tired and need to process the info. If anybody has any info or questions in regards to responses he gave me or the meeting in general please ask or inform me. talk soon
Larry

 

[jpattillo]

I made the same decision you did to go ahead and do the surgery asap even though I could have waited months to years potentially. I went with the Medtronic Open Pivot mechanical valve. Taking coumadin is not as big of a deal as some may indicate. I'm still able to do everything I want to do from a career and recreation standpoint. I had my surgery 3 weeks ago and I'm doing great. Since you are having a modified Bentall you will have a little more involved procedure than me but I bet you will do great!

 

[Mentu]

Glad to hear your meeting with your surgeon went well. With respect to your question about the number of valve replacements your surgeon performs.....I would be concerned if he performed 70 surgeries a year but 70 valve replacements in addition to many other heart surgeries is a very different thing. Many if not most of our surgeons perform other types of heart surgery. My surgeon said that repairing different types of heart problems gives him a far broader experience than if he only performed valve replacements; he thinks it makes him much better at his job. I certainly have no complaints.

Now as you prepare for the AVR you might also begin planning for your recovery. Let us know how we can help. Best Wishes.

Larry

 

[Bill B]

Glad your visit to the surgeon went well. I'm not sure why he was so confident you could put this off for a year based on what you reported in your first posts here.
http://www.valvereplacement.org/for...Help-me-please&p=521066&highlight=#post521066
Personally, I think you are going to right way to push this forward. You seem to be well in-charge of the situation. The only precaution I would like to put forth about being "in-charge" is that you do you darndest to just relax after surgery and let the staff take care of you. I was so much in-charge, I fussed about everything they did during my recovery and could not just take it easy. I was a mess during that first week post-op until one of the nurses had a long talk with me and got me to relax and trust them.

 

[Gribur]

LOL Bill, I am the kind of guy who really doesn,t like anybody doing things for me. I never stop moving and usually sit for more then 10min the first time during the day at around 9pm. I really can,t tell how good the surgeon is, but I do know that university hospital is on the leading edge of pretty much all things medical so I am going to assume that he was hired for a good reason. I really don,t know about feeling the "faith" but I am confident that he knows his way around a ticker. I am at a point right now that everything feels very surreal. On one hand I can see myself waking from the surgery and starting the recovery, on the other I can see myself with a sleeping bag, a backpack full of canned chili and taking up residence in a nice secluded cave. I have decided to not prepare myself for the worse, I had even planned on leaving a little video for the family just in case, but I have come to think of that as setting myself up for failure, which is not an option. I went with the st jude as it is tried tested and tru and i guess the On-X doesnt come with the graft for the surgery i need. The surgeon also said it was the valve they use, I assume some kind of contract??? I wouldn,t mind shopping around for surgeons but this guy was picked by chief of cardiology for the city of London to work on me so I also need to believe that it may be for a reason. Also if anyone knows, how much harder is the modified bentall then just a AVR? I guess the way for me to look at it is that he will be replacing pretty much everything that could malfunction later on. Cheers guys and please keep the input/suggestions coming, it helps to feel the bond with everyone on here.

 

[Bill B]

On-X has a grafted valve, but I know nothing about its suitability for your surgery. I can tell you I went with the St. Jude's based on my surgeon's recommendation and my personal review of all the available On-X literature.

As to "preparing for the worst", I think I went about it the same way you did. I expected to come back and did not do much if anything in terms of settling my affairs. Once you get started on that, where do you stop? The risk from AVR and ascending aorta repair is very low. However, I did not appreciate at the time that the risk from the surgery I had is several times higher. Still quite low, but I'm glad I didn't know the real numbers. I was rather calm prior to surgery, rather resigned that this had to be done. That said, it was VERY surreal, primarily because I had no noticeable symptoms. It felt like perhaps I was being "punked" and Kucher might jump out just before the surgeon started to cut on me. No such luck. Over all it went very well, especially since I never had any pain. My biggest problem, a result of thinking I knew more about at least some things than my doctors and nurses, was relaxing and not focusing on all the new and ultimately minor sensations and issues. I didn't sleep for days post-op and finally got a few doses of lorazepam and got some well-needed sleep.

 

[Bryan B]

On one hand I can see myself waking from the surgery and starting the recovery, on the other I can see myself with a sleeping bag, a backpack full of canned chili and taking up residence in a nice secluded cave.

My imagination wasn't quite as vivid as yours, but I did think about whether or not I would get to the hospital doors and make a run for it at the last second. :biggrin2:

But when the time came a calm came over me and when I went through the doors I felt at that point it was out of my control. Once I got into pre-op and they gave me a "feel good shot" (a term used by a beloved former member Bonnie) I really didn't have a care in the world.

 

[Gribur]

same surgery?

same surgery?

On-X has a grafted valve, but I know nothing about its suitability for your surgery. I can tell you I went with the St. Jude's based on my surgeon's recommendation and my personal review of all the available On-X literature.

As to "preparing for the worst", I think I went about it the same way you did. I expected to come back and did not do much if anything in terms of settling my affairs. Once you get started on that, where do you stop? The risk from AVR and ascending aorta repair is very low. However, I did not appreciate at the time that the risk from the surgery I had is several times higher. Still quite low, but I'm glad I didn't know the real numbers. I was rather calm prior to surgery, rather resigned that this had to be done. That said, it was VERY surreal, primarily because I had no noticeable symptoms. It felt like perhaps I was being "punked" and Kucher might jump out just before the surgeon started to cut on me. No such luck. Over all it went very well, especially since I never had any pain. My biggest problem, a result of thinking I knew more about at least some things than my doctors and nurses, was relaxing and not focusing on all the new and ultimately minor sensations and issues. I didn't sleep for days post-op and finally got a few doses of lorazepam and got some well-needed sleep.

I am still new to all the jargen but it looks like maybe you had the same kind of surgery i am in for. Your kinda freaking me out when you say "risk factors several times higher" If i am looking at the same surgery what numbers are we talking?

 

[Gail in Ca]

Oh my, don't even go there, referring to risk factors! I am very glad I didn't know the real risk factors for my 3rd surgery, which I later read on this site.

 

[Bill B]

I am still new to all the jargen but it looks like maybe you had the same kind of surgery i am in for. Your kinda freaking me out when you say "risk factors several times higher" If i am looking at the same surgery what numbers are we talking?

Notice that in addition to the root and ascending aorta, I had a good part of my aortic arch replaced. The grafted valve took care of the first two parts of the aorta and is very routine, The arch is a rather hairy procedure that adds to the risk. Everything else is relatively insignificant. You will do fine.

 

[Gribur]

not too sure

not too sure

Notice that in addition to the root and ascending aorta, I had a good part of my aortic arch replaced. The grafted valve took care of the first two parts of the aorta and is very routine, The arch is a rather hairy procedure that adds to the risk. Everything else is relatively insignificant. You will do fine.

I know it is the valve, root and part of the aorta, it looks like in the ct that the bulge is located just past the valve where blood has been forced through the valve and put pressure on that spot, as it was explained to me. I guess i would need to look at a labelled diagran to see what that part is called.

 

[Gribur]

Hey everyone, hope all is well. I was just thinking and wondering about my surgeon. I called my new cardiologist who is the chief of cardiology for London On and was formerly for Toronto and I asked his secretary to ask him why he picked this surgeon for me. The response was that he is a senior surgeon who is good at what he does and that he would never refer somebody to a surgeon that he wouldn't use for his own family. Sounds good, but this is the second time from 2 different people that i have heard the " I would have him work on one of my family members if it was needed". I am now wondering if this is written in the cardiology text books and is something used to calm nerves. I was also wondering if you guys feel that around 70 of the procedure I am having done per year is considered a good amount? how many did or does your surgeon perform? I really am not positive about what exactly the other surgeries he performs during each week are and am just worried that maybe he has not done this enough to have it to the point of basically doing it with his eyes closed. Please give me your thoughts on this, It just started to bug me a bit and am looking for some reassurance i guess. cheers all and ty for everything
Larry

 

[Bill B]

For an individual surgeon, this sounds like a very respectable number of valve replacements. After a certain number the skills are honed and it then just becomes repetitive. Let me also say that there are major advantages to staying fairly local and not travelling great distances unless you have a special case that takes special expertise. Continuity of care is better, particularly in the period immediately after discharge, should "something" happen. We had an example of this recently on this message board when a member who goes by oncnurse had surgery at a distant medical center, developed a wound infection after discharge and had a harrowing experience getting proper care for that.

 

[escargome]

Larry,
I don't think that people stating they would prefer is your surgeon took care of one of their family members is a line given to nervous patient's. I believe that they are stating complete confidence in your surgeon. These people I would suspect have nothing to gain if you use this surgeon or not, so they are stating an opinion of their own. I took a look at your surgeon and he seemed to have written or been part of many many cardio/thoracic journal papers. He seems to me to be very competent in his skills, so try to trust what people say, get your heart fixed and then enjoy your family and life after you recover.

 

[Bryan B]

Also remember that he performs 70 surgeries of the specific type of surgery you are having per year. I have read the bio you posted on him and it sounds like he does many different types of heart surgery so overall he most likely performs hundreds of surgeries per year. I know both of my surgeons have multiple specialties and perform hundreds of surgeries each year...many times 2 per day. My first surgeon did heart transplants, aortic valve replacements, and complex surgeries on children with multiple congenital heart defects. My second surgeon does aortic valve replacement, specializes in all types of surgery for both ascending and descending aortic disease, and is the surgeon that is leading the study of transcatheter valve replacement at Duke Medical Center where I had both of my surgeries.

While I think it is fine to research all of your options, just because this surgeon is close to you doesn't mean he isn't an excellent surgeon. I know it's easy to start second guessing such an important decision, but I relied heavily on the opinion of my cardiologists. I feel fortunate that Duke is one of the best heart surgery hospitals in the US and it's only 30 minutes away. It gave me a lot of comfort knowing that if I had any problems after surgery they were very close to me.