questions, questions, and more questions

[Bryan B]

Hi everyone,

I have some more questions as they keep popping up as I start my journey towards surgery.

1.) I live in TN but have decided to have my surgery in in NC since all of my family still lives there. I lived there for 30 years and moved to TN in June, 02. My entire family live within an hour's drive from Duke and I can get the post-op care I need much easier if I have it done there. I saw a cardio and CV surgeon in Nashville last week and they both agreed I need surgery. Can anyone give me any advice on how to go about selecting a cardio and surgeon at Duke? My provider (United Healthcare) lists severl surgeons on staff at Duke and 50+ cardios. Should I ask my local cardio and/or CV surgeon here in TN for a referral?

2.) My Mom was talking to a gentleman from their church who just had bypass and AVR at Duke and highly recommended his surgeon, but he's not on my list of network surgeons at Duke. How hard is it to work with the surgeon and insurance company if I wanted to use a surgeon outside of my PPO network? This gentleman also said that instead of wiring his sternum shut they "glued" it together (that's how he explained it to my Mom anyway). He said he had almost no post-op pain and was able to sleep in bed within a few days of coming home. I googlized it and didn't have any luck finding any info on this. Has anyone heard of this method being used instead of wires for sternum closure?

I took my first baby steps towards getting the ball rolling. The surgeon I spoke with here suggested I get some dental work done pre-op and I had my first appointment today. Got my teeth x-rayed and cleaned. I need 2 crowns and a couple of old fillings replaced, so I'm looking at 3 more appointments minimum. I don't like to go to the dentist, but I'm finding that all of a sudden the prospect of getting the dental work no big deal considering what lies ahead of me.

Thanks for letting me babble. I just want to get the dental work done, get a date set, and get this over with ASAP.

 

[ALCapshaw2]

Bryan,

Several on this board have had their surgeries at DUKE so I'm sure you will be getting some recommendations from them. DUKE is and EXCELLENT Heart Hospital (rated #5 if I remember correctly).

You did NOT mention PRE-Medicating with an antibiotic before having your teeth cleaned. Did you do that? If not, call your dentist or PCP or Cardiologist ASAP and ask if you should be put on an antibiotic to prevent Bacterial Endocarditis which can settle in (and damage) Heart Valves.

You need tp be premedicated with an appropriate antibiotic one or two hours before EVERY Dental Procedure, typically 2000 mg of Amoxicillin. If you have a problem with any form of Penecillin, there are other antibiotics such as Azithromycin (Z-Pak) that can be used. The American Heart Association has a Premedication Guideline Pamphlet that your Cardiologist should be familiar with.

You may want to call the 'on call' cardiologist TONIGHT to pose this question so that you can get an RX ASAP if needed. Several of our (younger) valve surgery survivors came to 'our world' because they developed Bacterial Endocarditis following Dental Procedures without premedicating.

'AL'

 

[Bryan B]

Al,

Thanks for the response. I did pre-medicate with 2Gm Amoxicillin 1hr before the procedure. I've had to do this all my life so I guess I didn't even think to mention it. Since I just got over IE, I was a bit paranoid as the dentist was scraping and I could taste a little blood. I guess I will just have to trust that the Amoxicillin will do it's job.

I noticed that several people have mentioned Dr. Glower (I think) from Duke. Of course he's not on my provider list.

Three that are on my list from Duke are:

Carmelo Milano
Robert Messier, Jr.
Robert Anderson

If anyone has heard of these surgeons and have any info on them I would love to hear from them. I searched them on the Duke site and they all have great credentials, but I know little else about them. I used to date a girl who worked in the CTSU at Duke but lost touch with her over the years. She is married now and I don't know her last name.

Thanks!

 

[medtronic of borg]

care

care

!. Dr referals are great from one facility to another. Because when someone has a succeful surgery they tend to automatically assume he is the greast thing on earth and skills may very well be only marginal at best.

2. I have had both wires and glue. I strongly suggest if they give you a choice use the glue.

3. the pre dental work, well what can I say ditto on the others comments.

Med

 

[Bryan B]

Thanks for the reply Med, and I agree about the pre-med. I have done this before every dentist appointment in my life due to my VSD and have never had an infection from dental work . I asked my doctor/dentist if I needed special consideration in my dosing regimen since I just got over endocarditis, but they said the 2Gm dosing was sufficient. The origin of my IE was unknown, but I had a lengthy bout of bronchitis in June & July and chronic prostatitis in August & September. Those are the two main suspects, but there is no proof that they didn't develop as a result of having IE for months without knowing it.

Med, how did you go about choosing your surgeon? My family doc referred me to a cardio that I met for the first time Tuesday. He referred me to a CV surgeon I met the same day. Now that I have decided to have the surgery in a different state that puts a whole new twist on finding the right cardio and surgeon for me. I want to keep moving forward with this...I'm usually a basket case when it comes to "waiting rooms".

 

[LUVMyBirman]

Hi Bryan,

Wanted to wish you well. I lived in the Memphis area for 4 years. Had my surgery there as well. Noticed you are in TN. If you need a few good docs for aftercare....let me know

 

[epstns]

Hi Bryan,

You've already met some of the more experienced folks around here, so the technical info they can give is far beyond my limited abilities (I'm still pre-surgery for aortic stenosis, with some "years" to wait). I will, however, welcome you to The Waiting Room, the virtual waiting room for soon-to-be valvers. This is one where you don't need to be a basket case, as we are frequently visited by the best group of experienced valve replacement patients in the world (IMHO). Ask all the questions you forgot to ask your docs, as well as the ones you thought were too silly to bring up -- people here have been through it all, I'm sure.

Glad to have you -- stay well and be careful until you get it done.

 

[KimC]

Ditto from the man who runs our waiting room. Ask any questions you may have. This is the place in cyberspace to do it.

Keep taking those deep breaths and focusing on base camp on the other side.

Best,

 

[maxximom]

Hi Bryan..and welcome to a most wonderful site.
I had my surgery at Duke in September of 2001. I had a Aortic Valve Replacement AND a Triple Bypass (I do things up big time) my Surgeon was Dr. Donald Glower. Dr Glower specializes in Valve problems and also does Minumally Invasive Surgery (when possible) He is easy to talk to and actually listens to what you have to say. I live just outside of Raleigh in Wake Forest and if I can be of any help please feel free to email me and I will send you my home phone number. There are other people here who have had surgery at Duke..and if I recall all have used Dr. Glower as their Surgeons..I am sure that they will chime in. Please contact me if you wish..it is NOT a impossition at all
[email protected]
Good Luck!
Joan

 

[Bryan B]

Thanks Joan and everyone else too!

I lived in Cary for 30 years before moving to Nashville. I also used to work for a company that was doing beta-testing on some new pharmacy dispensing technology at the VA right across the street from Duke (ate lunch at Duke often). My parents still live in Cary and my sister lives in Greensboro, so having surgery at Duke will allow me to be close to those who will be supporting me through this journey (before and after).

I have noticed that several posters have mentioned Dr. Glower. Dr. Jaggers from Duke has also been recommended, and he does the Ross procedure (which is my first instinct to have done if I'm a compatible candidate). I guess I need to do some research on the "cost factor" if I want to use an out of network surgeon.

I was able talk to my cardio's nurse today. She thought that one of his partners may have some connections at Duke. She is going to get back with me in the next day or two. Hopefully they can help me with the process of contacting someone at Duke.

 

[maxximom]

Byran

there a quite a few Ross proceedure people here on the forum.. I'm sure that now that you have mentioned it, you will be hearing from them soon.I'm sorry that I can't help you out with other surgeons names..as the only one I am familier with is Dr. Glower.
There are so many Cardio-thorasic Surgeons at Duke..each with there own field of expertise.. I am sure that you will find the "right" one for you. Again..feel free to call me if you wish to.
Joan
AVR,Triple Bypass
9/25/01
St Judes Toronto Stentless Porcine Valve
Duke Medical Center
Dr Donald Glower

 

[Blanche]

Bryan:

You want to be careful if you use a non-network provider. The costs can be enormous. Our son was airlifted to a hospital for emergency surgery after a vehicle accident. He had no choice of providers. The surgeon and two other doctors were not in his plan. He had to pay a larger deductible, separate from the deductible for his network providers, and a copayment of 50% as well as the amounts over the reasonable and customary charges that his plan allowed. The total maximum out-of-pocket costs were also higher. He took out a loan for $5,000, and that did not cover the total deductibles and copayments. And, all he had was his spleen removed.

My plan has a $400. deductible, a 40% copayment of reasonable and customary charges (and, that's where they get you) and an out-of-pocket maximum for non-network providers of $5,000.
For network providers the deductible is $0, the copayment is 20%, and the out-of-pocket maximum is $2,500. Big difference.

Best of luck in whatever you choose.

Blanche