Preop Appointment

[lucky401]

-------------------------------------------------------

Yesterday I had my pre op appointment for my surgery which is scheduled for 6/16. It really hit me yesterday that this is actually happening and of course the fear really started to set in.

The appointment went well and they covered more things that I didn't know. I knew that I needed an avr for a bicuspid stenotic valve and I opted for a tissue valve, that I am having an aortic aneurysm dacron graft if necessary or a repair to the aorta and that my mitral valve needs repair as well as the tricuspid valve. Well any way yesterday they said there is a chance that my tricuspid valve may need to be replaced and if that is the case they can only use a mechanical valve. Of course I didn't think this through too well at the surgeon's office but after I got home I realized I should have told them that if the tricuspid needs to be replaced with a mechanical valve then I would need blood thinners anyway and that the aortic valve should be replaced with a mechanical valve instead of a tissue one. Does this sound reasonable to you guys and should I call the surgeon's office and make sure they understand that if the tricuspid needs replacing then the aortic valve should be mechanical - if they can repair the tricuspid then I want a aortic tissue valve? Is this too much for them to remember? And should I ask them what type of mechanical valves they use and can I suggest the onyx valve I have been reading about here on the forum? Does this mean I have to ask for another appointment? I don't know if they do that sort of thing.

I am really getting nervous about this sudden uncertainty on things. I want to be sure the surgeon understands what I want. Is this reasonable or am I just panicking.

Thanks for all your help.

 

[Philip B]

Questions

Questions

Hey Lucky,

The questions you've discussed in your post sound like reasonable issues to discuss with your surgeon. OHS is a really big deal and it's often difficult to remember or even think of all of the questions you need and want to ask during the initial visit with your surgeon.

After my initial consultation I actually did a couple of additional visits with my surgeon for the sole purpose of asking questions and discussing procedures as well as options after my initial consultation. You might want to do the same thing. I was pretty straight with my surgeon; I made sure he knew how terrified I was.

One of the issues we discussed in detail was valve choice. He offered options and stated preferences. I questioned his preferences. Ultimately, my choice of valves became very clear.

It helped a lot to have a written list of questions and discussion topics when I did those additional visits with my surgeon. My wife accompanied me to listen, ask questions she had and take notes. These visits helped. While I was still terrified, down deep I think I had confidence I would do okay. These additional visits had an additional benefit as we became well acquainted with the folks who would be taking care of me in the ICCU following surgery.

-Philip

 

[perrypiratesdad]

Lucky... I second what Philip said, but would like to add one thing. You had asked if this is too much for your doctor to remember... gosh I hope not! If they can't remember that, then how is he going to remember how to do the surgery.

 

[Philip B]

Too Much

Too Much

I think operating rooms are set up so surgeons can watch "how to do it" videos as they operate.

-Philip

 

[Phyllis]

I really think this calls for another consultation with the surgeon- whether on the phone or in person- all your questions should be answered so that you can enter surgery confident in your decisions and your surgeon as well.

 

[lucky401]

Thanks for all your great advice. I called the nurse practitioner this morning. Well, it seems I got things wrong. If they have to replace the tricuspid valve they only use tissue valves so I would have a tissue valve for the aortic valve and for the tricuspid. She said that when they replace the mitral valve they only use mechanical because they feel the tissues valves are not as efficient as the mechanical for a mitral valve. The surgeon feels that he will be able to repair the mitral, in fact, he's hoping that when he fixes the aortic valve the mitral valve will then fix itself. Here's hoping.

Boy did I get things mixed up. Seems like I am getting bubbleheadedness already and I haven't been on the heart lung machine yet. Who knows what I'll be like after the surgery. In fact, I've noticed my memory has not been all that great lately. Could that be due to my heart not working right?

 

[Philip B]

Memory

Memory

Here's just a guess about the memory problems you mentioned...could it be less about your heart issues and more about the stress you are dealing with as you look at having those heart issues resolved? Often, stress tends to have an impact on thought processes and memory. That's why writing down your questions prior to consultations with your surgeon and taking notes during the consultations is a good idea. Your brain is probably on overload and it can only porcess a limited amount of information when it's overloaded.

With possible work on three valves and a potential aortic graft, you're looking at a major overhaul. Getting your questions addressed would be a good thing. I hope you've got a surgeon who does a bunch of these kinds of major overhaul jobs on a frequent basis.

I do find the information given to you by the NP about the types of valves your surgeon prefers using and the logic behind those preferences interesting. As noted in a previous post, I spent considerable time visiting with my surgeon about his valve preferences and recommendations. Tissue was an option we discussed for my AVR. I made the choice after weighing the pros and cons of the different types of valves he felt would effectively address my needs and concerns. I enjoyed exercising that choice.

-Philip

 

[lucky401]

Philip,

Thank you for your insights. I feel confident about my surgeon. I live in the Philadelphia area and will be having my surgery at the Hospital of the University of Pennsylvania. My surgeon is Dr. Joseph Bavaria and he specializes in the aorta and valves. I am a very small person, 4' 11" and the NP said the other day that it looks like Dr Bavaria is definitely going to do the aorta. The size of my anuerysm is about 4.5 but he feels that the size of the aneurysm is also relative to the size of the person. He is going to check the aorta when he gets in there but he is leaning towards putting in the dacron graft. I feel that I would like everything fixed at one time. I don't want to come back in 2 years time for more surgery to fix the aorta because it got bigger.

Thanks again for your thoughts. I am getting more and more nervous as the date gets closer.

 

[Philip B]

I'm glad you have confidence in your surgeon; it helps a lot. Others frequently comment here about getting all of the problems fixed on the first trip in rather than dealing with multiple trips.

Your surgeon's perspective regarding body size and aneurysm size is probably a good one. I'm 5'6" and my aortic aneurysm was 5.8 when it was repaired. My cardiologist and surgeon both figured I had been extremely lucky that it hadn't blown. It probably should've been way before I got around to it. Someone could and probably will take issue with this sort of speculation because how long an aneurysm will hold is such an individual thing; however, the old saying better safe than sorry easily applies to these kinds of situations.

Don't be afraid of approaching your surgeon with questions. Sometimes I think mine would've been happy if I'd simply adopted an "I trust you with everything and I'll stop worrying attitude", but that's not the way things are today. People tend to want to ask lots of questions and advocate for themselves and others.

I was terrified from the time I realized I had to have AVR surgery until I woke up in the ICCU. It's normal to be nervous. A step-by-step, day-by-day approach got me through. You'll make it. Just keep a positive attitude.

-Philip