What questions to ask the surgeon?

[maras1]

AlCapshaw2 said in another thread:

"If a patient is interested in the latest developments in valves (all types) or procedures, or they are High Risk patients, they need to learn what questions to ask and how to find surgeons who offer those alternatives, preferably with experiece with the needed / desired procedure / prosthesis."

I am meeting with a surgeon for the first time on Tuesday. He is who my cardiologist recommended. There are few surgeons in the area and they all work for the same practice.

What should I ask and how do I know, or find out if he is the right guy?

Mark

 

[maras1]

Yes, I am to have AVR. It's a little disturbing to me that it's possible that a surgeon may only offer valves from the sales rep he likes the best rather than what is the best for the patient. With all the experience in this forum, I think you all know what I need to ask to get the best advise.
Mark

 

[Bina]

I had had the same cardio for years and when the time came, he recommended my surgeon, who is the chief of CT surgery at a major hospital in Montreal. When I went for the first meeting, I had a really good feeling about this middle aged meticulous man with the great hands. He was very experienced, open to discuss anything, and included my husband in the process.

 

[Phyllis]

AlCapshaw2 said in another thread:

"If a patient is interested in the latest developments in valves (all types) or procedures, or they are High Risk patients, they need to learn what questions to ask and how to find surgeons who offer those alternatives, preferably with experiece with the needed / desired procedure / prosthesis."

I am meeting with a surgeon for the first time on Tuesday. He is who my cardiologist recommended. There are few surgeons in the area and they all work for the same practice.

What should I ask and how do I know, or find out if he is the right guy?

Mark

This thread might help with the questions: http://valvereplacement.com/forums/showthread.php?t=17988&highlight=questions+surgeon

 

[ALCapshaw2]

After checking your profile, I see that you have a Bicuspid Aortic Valve.

For starters, I recommend that you look over the Bicuspid Aorta Valve and Connective Tissue Disorder Forum.

Recent studies show a high correlation between BAV and Connective Tissue Disorders which can result in Aneurisms in the Aorta. Note that the Standard Echocardiogram does not image the full aorta. The best methods to check for Aortic Aneurisms are either a CT of the Chest or an MRI. Ask your Cardio or Surgeon about checking for aneurisms and connective tissue issues BEFORE surgery.

IF you have an aneurism or they suspect you may have a connective tissue disorder, then you will definitely want a Surgeon who specializes in Surgery of the Aorta. This type of surgery can go way beyond the 'comfort zone' of the average Heart surgeon, especially if the Aortic Arch is involved.

I do not know about Aortic Specialists in Florida.
Perhaps Arliss or Oaktree can give you some names if needed. You might want to call Cleveland Clinic of Florida if you are not comfortable with your local surgeons.

'AL Capshaw'

 

[Leah]

It's a little disturbing to me that it's possible that a surgeon may only offer valves from the sales rep he likes the best rather than what is the best for the patient.

Y'know, I'm concerned about whether this is a truly accurate depiction, and also that seeing it this way could lead to a lot of unnecessary angst, IMNSHO. I can see many reasons that major surgery centers and centers of excellence would select a limited number of valves. While you wouldn't expect cost to be a non-issue, if you're talking about an outstanding facility with a great medical track record you have to assume that the starting point is quality.

I know that there are vr.com members who have the interest and ability to study up on surgical details that include comparative valve technology and hemodynamics. I don't denigrate the value of doing that for those that wish to do it. But I think it's also important to remember that if I, as an educated, intelligent lay person, do the homework necessary to choose an expert - a top notch surgeon with an outstanding success rate - it doesn't exactly make sense to assume that he or she (almost always "he" in this field) is an idiot or ignoramus about the technology that's essential to his chosen profession, or that he or she isn't motivated by a desire to give people the best possible chance at life. As you consult each surgeon, ask him hard questions and see what his answers are concerning the valves he prefers. His opinions may vary from the next surgeon's, but you'll probably find that he has intelligent, thoughtful, quality-driven reasons for his opinions. (This, at least, has been my experience.) If he doesn't, of course, then he may not be the person for the job.

It also doesn't make sense to assume that other educated lay people - including those on this site who have done phenomenally diligent and thoughtful research - know more than whichever outstanding surgeon you or I might choose. Think about it. You can research the track record of the BI, Mass General, Brigham and Women's, Stanford, Cleveland Clinic, etc. You have absolutely no stats on how accurate any VR.com member's judgment is about valves, surgical interventions, etc. This is in part a wisecrack, but I hope, also, not an un-wise crack.

I think that sometimes we try too hard to control some of these details because the whole proposition of needing and having open heart surgery bespeaks a huge lack of control - just the nature of existence, which we're experiencing in a particularly stark way. I know this is the case for me. Again, I don't fault anyone for trying to drill down deeply on these issues - but I think the process goes astray when we start thinking we're being cheated if we can't control or even understand any particular detail.

Good luck in all your choices! At minimum, this is a wonderful place to start getting inspired to ask questions.

Leah

 

[Leah]

And I didn't really respond to your question about "what questions." Oaktree's are a great starting point. Also, how does he/she see your situation, including timing of surgery, and why. What valve or valves does he/she recommend and why, including how he sees the tissue/mechanical trade-offs. (Even though the trade-offs are well known, it's helpful to see how the particular surgeon scopes it out.) Anything he can tell you about that hospital's and his own stats on mortality/morbidity. You may have questions about the particular hospital and practice, e.g., how the surgeons and cardios interact as a team, etc.

But really what I've found most helpful, over a number of consults, was sitting down in advance and reflecting on what I really wanted to know for myself. What was really on my mind, going into the consult, that I wanted to understand more about. Some of the questions I or others might recommend may not really be issues you care about. You may have other things on your mind that we didn't think of, but these are things about which you are concerned or worried or confused.

It's also worth asking about contradictions, if the surgeon says one thing and it's different from what you've read or heard, or different from what another doctor has told you. This can give you a sense of how the guy thinks. But be careful that you don't assume, just because you read it here, that the surgeon is wrong if he or she has an intelligent explanation for a different view and takes your question seriously.

Also, not everyone likes to ask a million questions or feels the need to do this type of process. You might prefer to ask a few key questions and sit back and see what the surgeon has to say for himself or herself. And as you listen to what the surgeon is saying you will find questions emerging during the conversation. I tend to generate a large number of questions, but that's how I process any important decision. For some people, too much detail can get in the way.

BTW, are you limited to your local community? I know that Cleveland Clinic has a Florida hospital and some VR.com members have gone there. It is good to know, going in to the consult, whether this is "the guy" or whether you have other options.

You may also develop a strong gut feeling, as other members have said, that you trust a particular person to cut you open. That's very important.

Good luck! I am coming to the very end of this journey too, and know how important it is to feel we've made a decision we are comfortable with.

 

[Leah]

Good posts, Leah. Thank you.

You're welcome. Boy are we ever all in this together!

 

[pamela]

One concern you may want to address in respect to valve choice is to be certain you have a realistic understanding of your lifestyle. You may say you're active and eat healthy, be sure that's really who you are. Don't lie to yourself that you can stick with an exercise and diet plan post-operatively if you've never had any practice before hand. It's also not a time to have false expectations of your own will.

We all do what we have to do, but most of the time, that's not always what we want to do.

So, after answering the typical questions you need to ask yourself, tell your surgeon and then, ask him if he were in the same circumstance, which choice would he make.

Take heart,
Pamela.

 

[maras1]

Date and decision made

Date and decision made

My surgery date was set today. My visit to the surgeon was kind of uneventful because of the knowledge I have picked up from everyone at this site. Thanks to you all.

September 4th is the big day. I was hoping for the first week of Oct. but he thought that was way too far down the road and wanted to do it much sooner. I decided on a tissue valve and he said it would probably be an Edwards valve. The hospital is just now ordering their first order of St Jude valves and I may be the first SJ installed there.

Once again, thanks to everyone who contributes to this site. I will now move onto the Pre and Post Op forums more to help prepare for this. I hope to get my wife on the spouse forum soon. She's not very computer savvy but I think it will help her.

Mark