pre operatiquestionon assessment

[Fundy]

I'm having a pre-operation assessment followed the next day by a dye test catheterization. I know what happens for the dye test but what generally goes on during the assessment.

All I know is that it should be 2-4 hours.

 

[Nancy jane]

When u find out please let me know. Am new to all this. Expecting avr feb 2012. & learning to navigate on this. Best of luck yo u ! Nancy Jane

 

[Jkm7]

It may vary but for me, I had chest x-ray, blood work, urine analysis, ekg, full physical/ neuro assessment ( in terms of alertness, memory and steadiness of walking), and met with anesthesiologist. It was tiring but none of it was a big deal.

 

[DanielB]

Hi Fundy,

I had my pre-surgery work done a few weeks ago ahead of my AVR surgery on 10/17 and mine consisted of a physical with the surgeon's assistant (I am told some surgeons in my group do thier own), meeting with the anethesiologist, chest x-ray, ekg, MERSA test, blood draw for lab work and a meeting with one of the surgical nurses to go over other details for the week and day of the surgery. They also gave me some antibiotic soap to shower with for the five days leading into my surgery to help in lowering chances of infection. All in all, pretty thorough and it seems to have worked - the surgery went well.

Dan

 

[Fundy]

Thanks, I was kind of wondering what would be happening. I googled MERSA test to see what it was. Is that the MRSA test for staph infection. What do they do to check for that, they wouldn't swab the entire body for it would they?

Is it usual to get a date set at the preassessment? Does the topic of valve choice get discussed then? When my cardiologist mentioned a few weeks ago that surgery would be happening in the next month or two, she also mentioned that the valve should last twenty years.

So I'm kind of wondering if the topic would be coming up at all during the assessment asking my thoughts on the choice. I recall quite often that many Canadians get a replacement not realizing they had input on the tissue vs mechanical choice.

 

[Lynlw]

Thanks, I was kind of wondering what would be happening. I googled MERSA test to see what it was. Is that the MRSA test for staph infection. What do they do to check for that, they wouldn't swab the entire body for it would they?

Is it usual to get a date set at the preassessment? Does the topic of valve choice get discussed then? When my cardiologist mentioned a few weeks ago that surgery would be happening in the next month or two, she also mentioned that the valve should last twenty years.

So I'm kind of wondering if the topic would be coming up at all during the assessment asking my thoughts on the choice. I recall quite often that many Canadians get a replacement not realizing they had input on the tissue vs mechanical choice.

Ok I think there might be a little misunderstanding, when you asked about the "pre-operation assessment" from most of the replies, it sounds like they thought (like I did) you were asking about the pre-op day AFTER you already know your having surgery and it a day or so, usually before the surgery which is why they do so many last min tests and you talk to several people which why it can last almost the whole day.. but now it sounds like you are asking about the first meeting with the surgeon, which is completely different. ( and sometimes depending its also when you decide who you will let operate on you if you get opinions from a couple surgeons.
Usually the appt when you are getting the surgeons opinion, they already have copies of your latest tests and pretty much they explain what they think you need done and why. They should explain any choices you have to or can make, like valve preference (usually just mech or tissue, but also can talk about certain brands) they will make their recomendations based on their experience. They usually will answer any questions as well as tell you things like how long your surgery should last, how long youll be in ICU and the floor ect. the ave hospital stay type things.
Depending on the hospital/country etc sometimes you might get the date at this appt, but uually this is when they say you will need surgery and put you on a list to get schedualled for surgery, sometimes you leave knowing the date but in many cases you'll get called when they are able to get you in.

ps the MRSA test is usually a nasal swab

 

[Fundy]

Lyn,

Yeah I already know I'm having surgery, I just don't know what day. all I know is that the cardiologist mentioned on the 7th of this month that I'd be doing a preassessment and a dye test before the surgery, which will be in 2 or three weeks(which is now in two or three days)...then the surgery will be after that in November. and that the valve should last twenty years. So I'm kind of thinking that the decision was already made. I believe in Canada or here in Nova Scotia anyway, the cardiologists and surgeons meet to discuss whether patient needs surgery. when they agree, they put things in motion.

It seems that certain Canadian's posting here felt like they were just led like cattle, while others knew what was going on and made some choices.

My guess is that at pre-assessment they plan on telling me the date then. But I don't know, its why I'm asking what happens at pre-assessment. I was kind of hoping the valve choice discussion would happen then, otherwise I really don't see any other discussion points, except for the following day in recovery after the dye test.

My understanding is that the surgery follows as soon as it can be scheduled amongst anyone else needing surgery. I don't think we actually have a 'meet the surgeon' appointment.

 

[Lynlw]

From different threads here it seems like how long the members from Canada, have to wait seems to change from center to center or where you live. I know some who knew they needed surgery ASAP and were frutrated wbout the time they waited even after their pre-op assement and they didnt get their dates then but waited for phone calls or letters with the date. maybe this thread will help since a few different people from Canada discussed their exerience http://www.valvereplacement.org/for...rovincial-health-care-system&highlight=canada or hopefully some of the Canadian members will see your thread, or maybe it would help to start a new thread with canada or nova scotia in the heading

As for what valve, I would just bring it up myself at your appt if I were you.

 

[Jkm7]

I agree that at any point you are with your surgeon and/or cardiologist, if you wish, it would be a good idea to initiate a conversation about your choice of valve. This is too important a decision for you to politely and patiently wait for someone else to mention. They may not realize you want input or that you have educated yourself about the choices. Almost every surgeon we have heard about here discusses this choice and unless there is a medical reason for one vs the other, most surgeons will implant the type valve you want. The sooner you have the conversation the less chance you miss the opportunity.

All best wishes to you.

 

[Fundy]

I found a fairly good but vague answer to most of my concerns via an online document. starting on page 10 of this pdf
http://maritimeheartcenter.ca/~mari2662/wp-content/uploads/2009/02/patient_booklet_0807.pdf

Except it starts out by going to a different floor than where I was told to go. And it's kind of hard to believe they can manage to have me meet with all those people in just 2-4 hours. Sometimes meeting with just one person seems to take that long. It would be more informative if they hadn't combined the pre-assessment with admission and next day surgery with the out patient pre admission and surgery not for days or weeks.

I'm kind of hoping for at least a week or so after. Kind of strange a booklet like this isn't handed out or offered before hand.

 

[piglet]

Hi Fundy,
I wish I could be of more help but I wanted to say hey anyway. All of my pre-surgery stuff happened in hospital so I'm afraid I can't advise you about what is to happen at your assesment, I'd give your cardiologist's office a call and see if they can shed some light for you. I would think if there was any special prep they wanted you to do prior to the appointment they would have told you about it by now. I would suggest if possible you take someone with you to take notes for you, two minds are better than one. I would also suggest you write any questions you have even if you don't know what's going to be happening or who you'll be seeing, it can't hurt and you'll be choked if you forget to ask the "one thing" you wanted answered the most. That's usually what happens to me.
Good luck and keep us posted

 

[Fundy]

Thanks Piglet,
My gf/wife has been going to most of cardiologist meetings with me in the city till now. This week we'll both be there for two days but she has regional manager meetings that day. The only real questions I have anyway is which valve and when will the surgery date be. I put off having a will and power of attorney done until this morning and they won't be ready for signing until early next week. So hopefully they haven't scheduled for early next week already.if so, I think I'd just have to say no.

The valve I was preferring was a mechanical and an On-X, but emails to On-X a year or so ago had them tell me not one surgeon in Halifax has done one; but three in St. John New Brunswick had. I'm not sure I'd want to deal with inter-province bureaucracy; especially at riskto me; is if my Province decided they would only cover a portion of the bill. Staying in province is better peace of mind,closer, and a lot simpler.

St. Jude's mechanical would have been OK with me. But cardiologist mentioned the valve they would be placing in me should last twenty years when she went over what was happening in brief for the rest of my life regarding this. I should have asked at that moment but I was thinking she must be low balling mechanical durability or high balling the tissue durability estimates. I guess why i didn't ask was because it was irrelevent at the time to me, as I was definitely going with mechanical anyway whenever I did talk with surgeon.

However, if an aortic tissue valve does have a good shot at lasting twenty years in a 45 year old; I'm thinking I definitely would prefer the reduced stroke risk and do another operation later. I mean there's no guarantee they won't have to reop with a mechanical valve if I eventually develop an anneurysm anyway. It just seems that from what I've been reading here is that others experience seems to last not much longer than 7-10 with a tissue valve.

But I recently realized I had no idea when if ever I would meet with surgeon pre-surgery. From what I'm gathering now I will or at least should get that opportunity sometime tomorrow. Golf seasons over now so they should have time to hang around on a Wednesday afternoon for a good chat.

Anyway, the preop assessment is tomorrow anyway, which is in hospital. Then catheritization dye test the next morning. I've heard from others that shaving myself may be a better idea, because they don't seem to be slow and careful. So that may be another concern. That's about it, other than just what do they plan on doing with me for four hours tomorrow just out of curiousity.

 

[Bina]

After being referred by my cardio, I met the surgeon of my choice in April 2005, he assessed me as moderate and
I went home to "get my head around" an upcoming surgery and organize my farm animals.

By late summer my condition was bad and I went for a stress echo and failed it.
Back to the surgeon in September 2005 and he ordered me back the next day for a heart cath with a surgery date
for 2 weeks later. No more fooling around for me, he was all business.

About one week before surgery was the Pre-Op visit and it did take a few hours of X-Ray, blood tests, GP consult,
anaesthesiologist consult, bacteria swabs, and discussion with a cardiac nurse.
My husband was right there to help me absorb info and make sure I didn't run away

 

[Bina]

Additional info: I had lived in Quebec all my life and had my cardio dude there, then I moved to Ontario just
3 years before my surgery, so I went back to Montreal, Quebec for the surgery. The night before operating,
they presented me with the "out of province" forms to sign and that was it. Cost=ZERO

And don't bother shaving for anything, they will shave the bits that they need access to.

 

[Fundy]

Bina, i remember you discussing this to me a year or two ago on here.I looked into this and from what I gather, there's no guarantee that the home province will guarantee to fully cover costs out of province, just fully cover what they themselves would pay if it happened here. So that could be all the costs uncovered for certain things not covered here, or if the billable item is covered they might only cover a portion. I'm not willing to gamble that some beauracrat tries to meet his budget by being stingy on my bill.

Either way, I'm now thinking I'd sooner go tissue anyway. I hate the thought of going back to a dentists office, even for a cleaning ; much more than having to do another operation.

But once again thanks. That info you gave me back then had me consider that scenario quite fully for over a year now. The decision was definitely ask about having an On-X here anyway, if not the St.Jude would be OK. However, I've since changed my thoughts on reoperation stance. The increased stroke risk seems to far outweigh the reop risk, and I don't think I'll mind the operation as much as dental procedures.

Does a tissue valve stand a 15-20 year durability shot now,most of the posters here seem to be experiencing 5-10; but maybe the valves are better now.

 

[Bina]

Do you have dental issues?
Any heart condition will require a person to keep up with good oral hygiene and regular dental checks, the mouth
is laden with bacteria that no amount of brushing or rinsing will totally remove. For me, it just isn't worth the risk.

Since I was age 46 at time of surgery, choosing a tissue valve would have only meant another surgery anyway,
so I took a lower risk in that area by choosing a mech. My INR has been a total non-issue.
I hope you do well with your operation, I knew that I would have a rough time.....

 

[Lynlw]

Additional info: I had lived in Quebec all my life and had my cardio dude there, then I moved to Ontario just
3 years before my surgery, so I went back to Montreal, Quebec for the surgery. The night before operating,
they presented me with the "out of province" forms to sign and that was it. Cost=ZERO

And don't bother shaving for anything, they will shave the bits that they need access to.

I agree with not shaving yourself, Beside the fact you wont know how much, or how little, (some hardly shave at all), your surgeon prefers, there are other reasons they probably prefer to do it themselves that morning

FWIW this forum is only about 11 years old, so most people who've had their valves last that long or longer would not be members,, usually it is the people whose valves dont last as long. and from my reading many of the people whose valves need replaced sooner than expected have the same type of tissue valve

 

[piglet]

I tell everyone, cut your toenails cause you won't be able to do it for a while after surgery