Pre-surgery consultation - list of questions

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Lauren's_Dad

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Hello:

I just returned from my visit with Dr. Balkhy, my surgeon for my upcoming 8/26 aortic valve replacement surgery. As many members have wisely suggested, I compiled a list of questions to bring to this meeting. In case anyone is looking for a list of this type as a starting point, here are the questions I brought to the meeting (also attached as a .pdf file, many of these questions came from similar threads on this topic):

Questions about the surgery itself:
1. How high risk is this surgery?
2. What are the specific risks?
3. How long will my heart last if I don?t do the surgery soon?
4. Will you be available for complications after the operation? For how many days? If you?re not around, who is the backup?
5. How long does the surgery usually take?
6. Will someone update my family during surgery? How often and how detailed? Will there be WiFi access available to update non-attending friends and family?
7. How long will I be in the hospital if all goes well?
8. What kind of follow-up is expected in the days/weeks after the procedure?
9. What type of long-term follow-up does one need in the years after surgery (i.e. Doctor visits, echos, EKGs, etc.)?
10. What are my options regarding blood (DDAVP and recombitant factor)? How is this being managed during the surgery? What precautions are being taken to ensure no risk of bleeding? Of blood clots forming?
11. Describe the role of the anesthesiologist. Who will it be, and what are his credentials? Does he understand the effect of bleeding disorders on anesthesia?
12. Describe your vision of the surgery ? in addition to the valve replacement, is the aorta being repaired or removed? How much?
13. How long will I be on the heart-lung machine?
14. Will I be getting a body shave before the surgery? To what extent? Why exactly do you do this? (Note: The answer is yes, I am receiving a full body shave from chin to toe, and they do this for sanitary reasons - don't want hair to fall into the surgical area. Not sure why I find this interesting, but I do...

Questions about the surgeon & rate of success:
1. How many valve replacements have you done?
2. What has been your success rate? Your long-term success rates?
3. Have you had much/how much experience with bleeding disorders?
4. What is your mortality rate?
5. What is the risk of stroke? Paralysis?
6. Do I have the opportunity for a minimally invasive procedure? Robotics?

Other Questions Regarding Pre-Op and Post-Op Care
1. Can my family stay with me or be allowed in when they wants?
2. What is 'Plan B' if the surgery cannot be performed as planned for some reason?
3. What would have to happen for you to revert to 'Plan B'?
4. What effect will my bleeding disorder have on my ability to medicate?
5. What type of materials are you going to use (valve type)?
6. What will be used if the aorta needs replacement?
7. What will be used to hold the sternum together?

Other Questions Regarding Insurance
1. How do I ensure that all medical costs will be paid? Does this surgery require pre-approval? If so, when will this be done? By whom?
-------------------------------------------------------------
As for my visit, I had hoped that my dilated ascending aorta would not be replaced, but it's likely that my hope will not come true - looks like some of the aorta will need to be replaced with a Dacron graft. Also learned that I will need to be at the hospital at 5am the morning of the surgery, and the surgery will take 3.5 to 5 hours (depending on the amount of work needed on the aorta).

All in all, good information to have, but a bit overwhelming right now. Need to take a day to digest everything - may have a few questions for the group. I think a few hours of mindless TV would be a good idea - luckily Olympic synchronized diving is currently on...

Have a good night everyone,
Jason
 

BackDoc

Well-known member
Joined
Jul 11, 2006
Messages
203
Location
Palm Beach County Florida
"Other Questions Regarding Insurance
1. How do I ensure that all medical costs will be paid? Does this surgery require pre-approval? If so, when will this be done? By whom?"


you can't assure that all costs will be paid. However, you can and should make sure that the hospital and all the doctors who will be attending to you are participating with your specific health plan. otherwise you may be stuck with a bill for an "out of network" service. If they are "participating providers" with your specific insurance plan, they are contracted with a fee schedule. You will still be personally responsible for any applicable deductible payments and or co-payments. Know what your deductible is, and if it has been meet for the current year. The "deducitible" is the portion that you must pay before the insurance pays their portion. The co-pay is what you will pay after the insurance pays their portion up to the contracted fee if your doctors and hospital are participating with your specific plan.

As to exact fee's--you can't tell. You can get a ballpark figure, but everyone is different going into this type of procedure. Drugs, Blood, time in ICU, complications, etc.

Also; and I can't stress this enough. Any insurance plan is a contract between you (the insured) and the insurance company. Not between the doctor and your insurance company. Please take it upon yourself to know as much about your policy as possible. Call your own insurance company and ask if a "pre-approval" necessary. Make sure you know in advance if the answer is yes/no. Don't rely on someone else to answer this question for you.

if the answer is yes, then your doctors insurance relations staff will handle the pre-approval process. They are the only one's who can get this "pre-approval".

Perhaps the biggest cause of misunderstandings and problems are that patients do not understand their own insurance plans. Take the time to read yours. You should have a hard copy of the SPD, or Summary Plan Description. If you don't have a copy, request one.
 
P

Phyllis

Guest
That's a great list Jason and I hope Ross will make it a sticky in the pre-surgery thread!
 

emc07

Well-known member
Joined
Jun 21, 2008
Messages
56
Location
Kalamazoo, MI
Good Questions!

Good Questions!

Hello:

I just returned from my visit with Dr. Balkhy, my surgeon for my upcoming 8/26 aortic valve replacement surgery. As many members have wisely suggested, I compiled a list of questions to bring to this meeting. In case anyone is looking for a list of this type as a starting point, here are the questions I brought to the meeting (also attached as a .pdf file, many of these questions came from similar threads on this topic):

Questions about the surgery itself:
1. How high risk is this surgery?
2. What are the specific risks?
3. How long will my heart last if I don?t do the surgery soon?
4. Will you be available for complications after the operation? For how many days? If you?re not around, who is the backup?
5. How long does the surgery usually take?
6. Will someone update my family during surgery? How often and how detailed? Will there be WiFi access available to update non-attending friends and family?
7. How long will I be in the hospital if all goes well?
8. What kind of follow-up is expected in the days/weeks after the procedure?
9. What type of long-term follow-up does one need in the years after surgery (i.e. Doctor visits, echos, EKGs, etc.)?
10. What are my options regarding blood (DDAVP and recombitant factor)? How is this being managed during the surgery? What precautions are being taken to ensure no risk of bleeding? Of blood clots forming?
11. Describe the role of the anesthesiologist. Who will it be, and what are his credentials? Does he understand the effect of bleeding disorders on anesthesia?
12. Describe your vision of the surgery ? in addition to the valve replacement, is the aorta being repaired or removed? How much?
13. How long will I be on the heart-lung machine?
14. Will I be getting a body shave before the surgery? To what extent? Why exactly do you do this? (Note: The answer is yes, I am receiving a full body shave from chin to toe, and they do this for sanitary reasons - don't want hair to fall into the surgical area. Not sure why I find this interesting, but I do...

Questions about the surgeon & rate of success:
1. How many valve replacements have you done?
2. What has been your success rate? Your long-term success rates?
3. Have you had much/how much experience with bleeding disorders?
4. What is your mortality rate?
5. What is the risk of stroke? Paralysis?
6. Do I have the opportunity for a minimally invasive procedure? Robotics?

Other Questions Regarding Pre-Op and Post-Op Care
1. Can my family stay with me or be allowed in when they wants?
2. What is 'Plan B' if the surgery cannot be performed as planned for some reason?
3. What would have to happen for you to revert to 'Plan B'?
4. What effect will my bleeding disorder have on my ability to medicate?
5. What type of materials are you going to use (valve type)?
6. What will be used if the aorta needs replacement?
7. What will be used to hold the sternum together?

Other Questions Regarding Insurance
1. How do I ensure that all medical costs will be paid? Does this surgery require pre-approval? If so, when will this be done? By whom?
-------------------------------------------------------------
As for my visit, I had hoped that my dilated ascending aorta would not be replaced, but it's likely that my hope will not come true - looks like some of the aorta will need to be replaced with a Dacron graft. Also learned that I will need to be at the hospital at 5am the morning of the surgery, and the surgery will take 3.5 to 5 hours (depending on the amount of work needed on the aorta).

All in all, good information to have, but a bit overwhelming right now. Need to take a day to digest everything - may have a few questions for the group. I think a few hours of mindless TV would be a good idea - luckily Olympic synchronized diving is currently on...

Have a good night everyone,
Jason
Hi Jason,
Those are great questions.

For some of the Family staying in the hospital/updates type questions, the nurses at the hospital should know the answers to these questions, and they are easier to reach usually. I called a nurse and asked all types of questions: ie. Can I shower, can my husband stay with me? What clothes can I wear etc. I felt better once I got those questions answered as well. They are not as important as the medical ones, but something that I wanted to know at least. Good luck with surgery & the recovery. Hopefully it will be over before we know it!
 

pamela

Well-known member
Joined
Sep 23, 2007
Messages
644
Location
Cold Lake, Alberta, Canada.
Zipper and I discussed her list of questions and I see a couple that I know I should have asked are missing.

Although it may sound vain or frivolous, who is cutting and sewing, the surgeon or a less practiced intern or resident?

I don't absorb stitches, in particular the knots, very quickly or at all. Is there a method or a material that can be used to lessen the likelihood of festering rejection, even though it means I may require additional visits to have the stitches removed?
 

ccummins

Well-known member
Joined
Feb 2, 2009
Messages
172
Location
Chicago, IL
I think that it is important to distinguish the questions that should go to the surgeon and the ones that go to the nurses. The surgeon should certainly be open to all questions ... related to surgery. I think it is a good idea to hold off other questions for the nurses. As others have mentioned, they (nurses) really understand these things better. No need to bother your surgeon with the details about your post op room for instance. These things are very important to us as patients and friends and family. They should and need to be addressed; we just need to recognize by whom.
 

Eva

Miracle Believer
Joined
Aug 8, 2008
Messages
4,066
Location
Redondo Beach, CA
One may ask about the experience of the surgeon and how many he has done, but I would like to ask the surgeon:

1 - who will work on the heart?! the surgeon only? or residents/PN and while the surgeon is watching?!

2 - if getting a mechanical valve in general, which model and why in particular that model?!

3 - if it is in the mitral position and one of St. Judes: Is it designed to leak after the surgery to wash away blood precipitation?!! After all we go through, we need not to freak again if an echo would show a leak and we do not know that this leak is essential!!

4 - who is going to do every step all the way from opening to closing the sternum.
 

bugchucker

Well-known member
Joined
Jan 16, 2009
Messages
170
Location
Reno, NV USA
A friendly resource if needed

A friendly resource if needed

Hi Jason-
I am 14 days post op and feeling better than I have in years, though in hind sight there are many things I would have done differently. Sounds like you are in good hands and well prepared. I had several folks reach out to me but I only communicated with them via email. Now I wish I would have spoken to them live, which is why I'm posting my phone number (scary!). Feel free to call me any time if you want to discuss my experiences...I'm a 37 year old male, just had AVR and ARR. My recovery has been better than textbook, yet there were surprises for me and my family.

Wishing you the best!

Phil, Removed phone number for members own safety-Ross
 

sharad

Active member
Joined
Apr 16, 2009
Messages
35
Location
Nashik, Maharashtra, India.
Questions to Doctor about Heart-lung machine

Questions to Doctor about Heart-lung machine

Dear All,

The following questions related to the heart-lung machine may be helpful:

1. Will a heart-lung machine be used during my surgery?

2. How common is the use of a heart-lung machine with my type of surgery?

3.What are my risks with the heart-lung machine?

4.How long will I be on the heart-lung machine?

5.What will happen if my heart does not function when they remove me from the bypass machine?

6.What specialists will be used during my surgery?

7.Are there any other alternatives available to me?

8.Will by recovery be any more or less difficult if a heart-lung machine is used?

9.Do I need any special preparations for surgery using a heart-lung machine?

10.Will I need to change my medications prior to my surgery?

11.How long will it take me to recover from the surgery?

12.Could a heart-lung machine affect my pregnancy in any way?
 

Star54

Well-known member
Joined
Jun 22, 2009
Messages
376
Location
Brooklyn, NY
God Bless you. I had very little questions, I left the operation in God's hands. Afterwards I was so lucky to be alive, I think my only question was my butt showing......and I read so much on here....for me to much is just too much.
Godspeed and Goodluck!
 

ALCapshaw2

Well-known member
Joined
Mar 20, 2003
Messages
6,910
Location
North Alabama
Good Questions, but TOO MANY for the Surgeon.

Try to get as many answers as you can from his staff
(office manager, Nurse, Physicians Assistant, etc.)

Nationally, risks for first time OHS are 1% morbidity, 1% mortality versus almost certain demise if left untreated.

How long will you last without surgery?
Some patients had their valves literally disintegrate inthe surgeons hands. Less severe cases *may* last 2 or 3 years with declining health / endurance / quality of life (or something to that effect based on something I read somewhere.... who knows who wrote that)

'AL Capshaw'
 

normofthenorth

Well-known member
Joined
Nov 1, 2010
Messages
857
Location
Toronto, ON, Canada
Not exactly on-topic, but relevant, I think:
Now that I'm 4 months post-AVR and in cardio rehab and returning to some earlier "normal" activities (like bicycling and downhill skiing), I'm wishing that I had established a pre-op, pre-symptoms "baseline", esp. for my heart rate. I've got three inexpensive gizmos that tell me my heart rate (wrist BP cuff, watch, and chest-strap-plus-watch), but I never used any of them a year ago, when I was doing those same activities while still feeling fine.

I knew I was heading for the OHS (I'm a congenital BAVer), but I didn't know the HALF of the long rehab and recovery I was headed for. (Funny how the cardios and surgeons don't emphasize that part!) I had plenty of time to buy, and strap on, a chest-strap HR monitor (like the one I wear now while skiing), but nobody told me that I should. I think I, and "they", should have. . .

So, take it from me, a few months from now, you may well be curious about how much your HR USED to rise while you power-walk a mile or two, or bike, or do anything else that you'll be gradually returning to post-op.
 

Jason

Well-known member
Joined
Mar 30, 2011
Messages
370
Location
Mackay, Queensland, Australia
I didn't see it in the thread here anywhere, but another important question if you are still differentiating between surgeons would be what their infection rate is. I wanted to know that A) my surgeon was experienced at my particular surgery and B) that they, their staff, and the hospital do everything they can to keep me infection free, post operation. I also agree with Norm, in that if I had thought to do so I would have paid much more attention to my pre-surgery heart rate, etc. I do rememeber (I think!) what my resting heart rate was in general as well as after working hard on an elliptical, etc. but it is merely a guess as I didn't write it down.
 

Gloria

New member
Joined
Nov 22, 2013
Messages
1
Great Questions, thanks to all of you. I'm having an aortic valve replacement on December 10th 2013, at Columbia Presbyterian Hospital in Manhattan. My surgeon is Dr. Matthew Williams, from what I have ben told he is one of the top cardiac surgeons. My concerns are port-operative. I live alone and wold like to go to inpatient cardiac rehab at CPH for as long as I can, so that I can come home with a little more strength. Has anyone had experience with inpatient cardiac rehab? Has anyone had a valve replacement and an abdominal aortic aneurysm repair at the same time? One more question for the ladies, I have been told to purchase sports bras. Any suggestions as to brand and or type? thanks and blessings to all. Wonderful to meet all of you in spite of our circumstances. I feel blessed that they found my problems and there are solutions and good professionals to help us.
 


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