Met my surgeon today

[Paleowoman]

I'm happy as could be expected with my surgeon when I met her today - Professor Marjan Jahangiri - at St Anthony's Hospital, Sutton (London). She will do a short sternotomy cut and she will use a bovine valve. But I'm not happy with the speed of all this. She wanted to do the operation before Christmas but has said that we can wait till early January instead when I said I wouldn't like to be discharged over Christmas when lots of doctors are on holiday and GP surgeries close over the holiday period in case I need help.

But early January is still tons earlier than I really wanted - I shall be so worried about my husband driving to and from the hospital in the snow and ice if we get bad weather like we often do that time of year - the UK cannot cope with adverse weather. I would have rather the op in March or spring time but the Professor didn't think I'd make it till then. She felt my valve was too narrowed and that, even though I feel well now, I could suddenly go into heart failure

Makes me now wonder what I'm supposed to do to stop my heart going into failure - take to my bed ? Not do so much walking ? I love walking. I have given up weight lifting but I am still walking several miles a day - does that put a strain on my heart ?

My pressure gradient is 68 mm/HG and my valve area size is 0.9 sq cm, but there's no sings of LV failure and my Ejection Fraction is a good 79% - surely it couldn't be so good if my heart was having trouble getting the blood through the valve ?

I also wasn't happy about the risk of osteoporotic fractures which I have heard can occur with this type of surgery - the Professor said she had done lots of ops on older people who would have had osteoporosis and they were fine, but to me it's a very big worry. I would want the surgical team to be very aware that I have osteoporosis and to lift me carefully...but I don't know how to get that across.

 

[maisiejane]

I'm happy as could be expected with my surgeon when I met her today - Professor Marjan Jahangiri - at St Anthony's Hospital, Sutton (London). She will do a short sternotomy cut and she will use a bovine valve. But I'm not happy with the speed of all this. She wanted to do the operation before Christmas but has said that we can wait till early January instead when I said I wouldn't like to be discharged over Christmas when lots of doctors are on holiday and GP surgeries close over the holiday period in case I need help.

But early January is still tons earlier than I really wanted - I shall be so worried about my husband driving to and from the hospital in the snow and ice if we get bad weather like we often do that time of year - the UK cannot cope with adverse weather. I would have rather the op in March or spring time but the Professor didn't think I'd make it till then. She felt my valve was too narrowed and that, even though I feel well now, I could suddenly go into heart failure

Makes me now wonder what I'm supposed to do to stop my heart going into failure - take to my bed ? Not do so much walking ? I love walking. I have given up weight lifting but I am still walking several miles a day - does that put a strain on my heart ?

My pressure gradient is 68 mm/HG and my valve area size is 0.9 sq cm, but there's no sings of LV failure and my Ejection Fraction is a good 79% - surely it couldn't be so good if my heart was having trouble getting the blood through the valve ?

I also wasn't happy about the risk of osteoporotic fractures which I have heard can occur with this type of surgery - the Professor said she had done lots of ops on older people who would have had osteoporosis and they were fine, but to me it's a very big worry. I would want the surgical team to be very aware that I have osteoporosis and to lift me carefully...but I don't know how to get that across.

Hi Anne,
Good news about the short sternotomy, Is that because she is female and is able to empathise ? Just take the bull by the horns and get it done and don't worry about the weather, I have known brilliant sunshine in the new year and thick snow in February, so if you are relying on the weather there will never be a good time, would your hubby have to drive a long distance to the hospital ?
Now that you have voiced your concerns regarding osteoporotic fractures, her surgical team can be more aware and take the precautions to protect you.
Reading your feed back of your consultation I am amazed at how much more information you have been given, my surgeon did not discuss the state of my heart or which tissue valve he would use, but then again he was annoyed that I didn't want mechanical, I think I would feel far more confident in the hands of your surgeon. Hopefully there are other members who can placate your fears regarding the fractures. Take care, Deb x

 

[Paleowoman]

Hi Deb !

I'm not sure why the surgeon is choosing the short sternotomy - I gpuess she's choosing it over thoractomy because she needs a better view of my aortic valve as I have a depressed sternum - she didn't really give a reason. She complimented me on how well I looked when we met - I think she was surprised I am 60 as I look younger (so my dh and ds tell me !) - so maybe she was thinking along those lines ? I don't mind a scar at all - it would be a trophy for all my stress and aggro about this !

She only told me it was a bovine valve because I asked her LOL At the start of the consultation she gave the usual little talk about surgery and what would happen and said I expect I'll be able to have answered your questions - well no, because I already knew about the surgery and had questions beyond the usual. So I asked whether she was going to use bovine or porcine valve and so got the answer bovine She didn't mind I was going with a tissue valve at all. She wasn't too happy that I asked how they cut the sternum - told me to leave the technical stuff to her........point against her there, but then I'm the kind of person that wants to know everything.

I don't feel too confident about the osteoporotic fractures bit. I'm going to ask my endocrinologist if he can refer me to a rheumatologist who can write to the surgeon. Hopefully my endocrinologist will also write giving advice about my diabetes. The same with the respiratory consultant.

How are you getting on yourself Deb ?

 

[maisiejane]

Hi Deb !

I'm not sure why the surgeon is choosing the short sternotomy - I gpuess she's choosing it over thoractomy because she needs a better view of my aortic valve as I have a depressed sternum - she didn't really give a reason. She complimented me on how well I looked when we met - I think she was surprised I am 60 as I look younger (so my dh and ds tell me !) - so maybe she was thinking along those lines ? I don't mind a scar at all - it would be a trophy for all my stress and aggro about this !

She only told me it was a bovine valve because I asked her LOL At the start of the consultation she gave the usual little talk about surgery and what would happen and said I expect I'll be able to have answered your questions - well no, because I already knew about the surgery and had questions beyond the usual. So I asked whether she was going to use bovine or porcine valve and so got the answer bovine She didn't mind I was going with a tissue valve at all. She wasn't too happy that I asked how they cut the sternum - told me to leave the technical stuff to her........point against her there, but then I'm the kind of person that wants to know everything.

I don't feel too confident about the osteoporotic fractures bit. I'm going to ask my endocrinologist if he can refer me to a rheumatologist who can write to the surgeon. Hopefully my endocrinologist will also write giving advice about my diabetes. The same with the respiratory consultant.

How are you getting on yourself Deb ?

I have just read your other post and I see you are good to go on 3rd January, that is my birthday so will definitely remember.
I am still waiting to hear, they have contacted me twice to go in but I wasn't available, so I go into panic every time my phone rings. you must be feeling mixed emotions, I am sorry that your surgeon has worried you, but I read the replies from others and it makes sense with what they are saying, the way I try and cope with it is by saying hopefully in 6 months time this will be over and we will be fighting fit again it helps short term.
Good idea about speaking to your endocrinologist re a referral, you have got to cover all bases and it may help ease your anxiety.
I should have asked more questions when I went for my consultation, but to be honest he p....d me off a little with his arrogance, but I will respect his skills as it is literately my life in his hands. Deb x

 

[Paleowoman]

I should have asked more questions when I went for my consultation, but to be honest he p....d me off a little with his arrogance, but I will respect his skills as it is literately my life in his hands. Deb x

Mine was arrogant too, and rather patronising.....it began to p** me off too because I had questions to ask but before I could ask them she said she'd explain about aortic valve surgery and "that should answer most of my questions". What arrogance ! Her little talk was five minutes of wasted consultation time as it was the basics that I knew years ago. My questions were in much more depth and I felt awkward asking them. I know that on paper she is the best surgeon and, quite frankly, the consultation would have been done better by paper/email ! I didn't really need to see her to ask my questions, and she only needed to see the echo done by the cardiologist to know whether or not I needed surgery...imho that is. I certainly shan't been fawning over her when surgery is over...assuming my bones are still intact and I haven't had a stroke !

I'm seeing my endocrinologist tomorrow, my cardiologist on Thursday, respiratory consultant on Monday. I will try and get a rheumatology appointment. Those consultants should all be able to have some say at the hospital and with my aftercare. Next week I and my husband are going to be shown round the caridac unit where we'll be able to ask questions of the nursing staff. That's all I can do...as I wrote elsewhere, lamb to the slaughter.

 

[maisiejane]

Mine was arrogant too, and rather patronising.....it began to p** me off too because I had questions to ask but before I could ask them she said she'd explain about aortic valve surgery and "that should answer most of my questions". What arrogance ! Her little talk was five minutes of wasted consultation time as it was the basics that I knew years ago. My questions were in much more depth and I felt awkward asking them. I know that on paper she is the best surgeon and, quite frankly, the consultation would have been done better by paper/email ! I didn't really need to see her to ask my questions, and she only needed to see the echo done by the cardiologist to know whether or not I needed surgery...imho that is. I certainly shan't been fawning over her when surgery is over...assuming my bones are still intact and I haven't had a stroke !

I'm seeing my endocrinologist tomorrow, my cardiologist on Thursday, respiratory consultant on Monday. I will try and get a rheumatology appointment. Those consultants should all be able to have some say at the hospital and with my aftercare. Next week I and my husband are going to be shown round the caridac unit where we'll be able to ask questions of the nursing staff. That's all I can do...as I wrote elsewhere, lamb to the slaughter.

Anne, You make me giggle, your views and thoughts are so similar to mine, we must be hell to live with eh? I saw my cardiologist last Friday, she was lovely she managed to placate some of my fears, but I guess we wont be completely stress free until we are on the other side looking back at a distant memory, when we do we should arrange to meet up and compare battle scars, something to look forward to LOL, Deb x

 

[Paleowoman]

Anne, You make me giggle, your views and thoughts are so similar to mine, we must be hell to live with eh? I saw my cardiologist last Friday, she was lovely she managed to placate some of my fears, but I guess we wont be completely stress free until we are on the other side looking back at a distant memory, when we do we should arrange to meet up and compare battle scars, something to look forward to LOL, Deb x

I think doctors who don't know me like don't like me very much ! They can't understand why I talk to them like an equal rather than a supplicant. Except my endocrinologist ! He loves it that I bring so much to the consultation. He tells me I'm the only patient who 'leads' the consultation and he likes that because it means we get down to business...and he gives me really long consultations too as we discuss so much ! Gosh, shouldn't consultations always be initially, at least, led by the patient. We're the customers and the doctors are who we are paying for help and advice - even if we see those doctors on the NHS we are paying for them with our taxes ! Of course there are loads of patients who don't take an interest in their health and conditions and just want to be told what to do so that's okay for them, but you and I, Deb, we're the new breed of patients who know about ourselves and go to a consultant to get what we need. Young doctors know this is happening in the world of medicine and they're okay with it - one of the GPs at my practice actually asks patients what they think they have ! And what they have found out on the internet...and then he takes it from there, it's a real partnership in modern health.
Love to meet up one day Deb !
Anne x

 

[maisiejane]

I think doctors who don't know me like don't like me very much ! They can't understand why I talk to them like an equal rather than a supplicant. Except my endocrinologist ! He loves it that I bring so much to the consultation. He tells me I'm the only patient who 'leads' the consultation and he likes that because it means we get down to business...and he gives me really long consultations too as we discuss so much ! Gosh, shouldn't consultations always be initially, at least, led by the patient. We're the customers and the doctors are who we are paying for help and advice - even if we see those doctors on the NHS we are paying for them with our taxes ! Of course there are loads of patients who don't take an interest in their health and conditions and just want to be told what to do so that's okay for them, but you and I, Deb, we're the new breed of patients who know about ourselves and go to a consultant to get what we need. Young doctors know this is happening in the world of medicine and they're okay with it - one of the GPs at my practice actually asks patients what they think they have ! And what they have found out on the internet...and then he takes it from there, it's a real partnership in modern health.
Love to meet up one day Deb !
Anne x

Anne,
Forget about being the proverbial lamb to the slaughter, you are not alone you are part of a flock. We will get through it xxx

 

[Paleowoman]

Forget about being the proverbial lamb to the slaughter, you are not alone you are part of a flock. We will get through it xxx

Yes we will xxx

 

[Gail in Ca]

Wow! I don't think I would even consider a surgeon that pissed me off! My surgeons have always been kind, so confident, and spent time with me, answering questions.
When he came into the waiting room to tell my husband my surgery went well, he even drew a picture of what he had done, for my husband to understand the procedure.
He has never made me feel inferior.
Is this what the future holds for American health care? I'm worried as many great surgeons will be retiring in the next few years.

 

[Paleowoman]

I thnk surgeons in the UK are not used to having to be particularly personable to patients - depends on their personality of course - but they don't need to be because they won't lose their patients to another surgeon. However, things are changing here as patients do have choice even under the NHS. But I have private healthcare in the UK and I can 'fire' any doctor who I don't like - I've done it. But there aren't websites in the UK where patients talk about their doctors or surgeons saying how great or how bad they are, so, you see, in the UK doctors are not so worried that they're going to lose patients. In America doctors almost advertise for patients in a sense, so they realise that the patientt is a customer, UK doctors are not at that stage yet. They will be as the NHS has become more accountable. Like with cardiac surgeons in the UK all their stats on operations and mortality are published for patients to see so you know, on paper at least, how good or bad your surgeon performs. That doesn't mean they're going to be nice people. I'm sure some of them are though.

 

[ski girl]

Someone once told me that a lot of surgeons have a god complex and can be haughty and arrogant when dealing with patients - but we're not seeing them for their bedside manner, we're seeing them to get some plumbing work done. And while they're doing that, I don't care how arrogant my surgeon is cos I'm asleep!

At first I thought my surgeon was quite stand-off-ish, then as I got to know him (I was on the bulk discount program, two OHS in one year) I realised he was absolutely hilarious, just very dry. You'll barely see your surgeon, as long as you trust their skills, put your faith in them. Remember, while OHS is a daunting prospect for all of us, it's fairly routine for them and hardly a tricky surgery.

If they seem disinterested, that's probably a good thing, if you've done something for 20 years day in, day out, you'd probably seem disinterested in the explanation too! Hope that helps.

 

[Paleowoman]

If they seem disinterested, that's probably a good thing, if you've done something for 20 years day in, day out, you'd probably seem disinterested in the explanation too! Hope that helps.

Yes It helps. Thanks

As long as I can make sure the medical staff involved in my aftercare know about my other health issues I will feel confident...until then I don't feel confident becasue it's no good having excellent surgery and then complications because no one cared to be careful regarding my osteoporosis or my cough or my diabetes.

 

[escargome]

Well Anne, I learned many years ago that the squeaky wheel gets the grease. So in order to keep my care givers on the same page, I explained to my cardiologist, my surgeon and all the nurses that were tasked with providing me with care, that "I have type2diabetes, I keep my blood glucose levels in tight control. So whenever they did a finger stick, I asked what my reading had been and how much insulin they intended to give to me. I also asked if I didn't know already what each pill they were giving me did. Just be firm in your request to be kept informed. All will be well. I shall keep you in my thoughts

 

[Paleowoman]

Thank you Chris ! I will do just that, and I'll take in my own meter. My endo has told me what numbers he wants me to have post operatively, he wants me quite low, preferably under 7 (120) at all times. He'll support me. I will try to be firm too !

Oh, my endo wants the cardiac surgeon to change the date of surgery to a few days later so that it will be after he and my other consultants get back from their Christmas holidays ! He wants to be around ! I'm so lucky in having some excellent doctors

 

[Gail in Ca]

Interestingly, even non-diabetics like me have been given insulin after OHS. Can't remember how many days I was given a shot, but I remember it because I thought it was something I hadn't had after my other surgeries, but maybe I was given it and the nurse just didn't tell me what it was, I don't know.

 

[ElectLive]

As long as I can make sure the medical staff involved in my aftercare know about my other health issues I will feel confident...until then I don't feel confident becasue it's no good having excellent surgery and then complications because no one cared to be careful regarding my osteoporosis or my cough or my diabetes.

You know, I made a point to ask my surgeon beforehand how prepared the entire medical team (surgical and recovery) would be to both monitor and treat my diabetes (Type 1). He quickly reminded me that diabetics are a fairly high percentage of those with heart problems, so as a result, generally any heart team should have lots of experience...over 1/3 of the cases in his particular group and team. All that being said, the point Chris makes is equally valid, and the sooner you can take charge...the better off you will likely be. Your endo is wise to emphasize tight control as it is important to help prevent complications, but just be aware that there's nothing like heart surgery to make it hard to stay in control at times! :rolleyes2:

But you will be fine, don't worry...it's like anything, just monitor and adjust as needed. Oh, and for reference, I started using my own meter as soon as I could, although it was "in tandem" at first since they wanted to continue following their own protocol, with their own readings, etc. But not long after, I was pretty quickly "released" to take over everything (all my insulin delivery)...basically at the point I was in active recovery mode (out of ICU, walking around, etc). Best wishes to you!

 

[Paleowoman]

Gail - apparently blood glucose levels rise very significantly after heart surgery even in non-diabetics due to the huge amount of stress hormones the body releases, that's why you would have had insulin, that's 'normal' apparently !

EL - My team is now getting together very well - I've corralled two in since yesterday evening and two more to go next week. They all want to be around when I have surgery so I've contacted the surgeon's secretary to change the date to when they're all back from holiday. I'm feeling very much more confident. I will leave the surgeon to do the mechanics. You know in the UK that surgeons, although fully qualified doctors, lose their Dr title once they become surgeons - I said to my cardiologist today that it's no wonder

 

[Jkm7]

Interestingly, even non-diabetics like me have been given insulin after OHS. Can't remember how many days I was given a shot, but I remember it because I thought it was something I hadn't had after my other surgeries, but maybe I was given it and the nurse just didn't tell me what it was, I don't know.

I am a non-diabetic who received one or two doses of insulin post op. They tested my glucose for the first few days after surgery and they said close glucose monitoring of diabetics and non-diabetics has proven effective in aiding in healing.

 

[Rachel]

Yup I too needed insulin for a few days right after surgery and I'am not diabetic....well I guess I was for a few days anyway.

Glad to hear you've got your med team together and that you're feeling a little better about all this - you're going to be just fine.