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A

ALCapshaw

AARGH !

I'm still trying to get comfortable with the prospect of my second heart surgery. After so many invasive procedures, multiple catheterizations, angioplasties, CABG, TEE's, I find myself wondering how many home runs I can hit in a row.

The hospital I've selected is highly rated as is the surgeon, but I know so little about him still. I'd really like him to 'sell me' on why he is so good, how many similar procedures he has performed, and his success rate. I'd like more details about exactly how he plans to repair my Mitral Valve, replace my Aortic Valve, and what he means about 'fixing' the thickening he referred to in our first meeting. Is this asking too much? I don't mean to be confrontational, but I'd sure like to know more about him and his surgical plan for ME.

I've tentatively scheduled for May 21 since he will be out of the office for a few days in each of the first two weeks of May and then be on vacation for the first two weeks of June. That also makes me concerned. What if I have complications and he is gone?

How many times did you meet with your surgeon?
For how long? Did he explain everything he was going to do?

I KNOW I need this repair / replacement, but I'm having a hard time getting comfortable about the specifics !

'AL'
 
Hi!

I can hjust HEAR the anxiety........gosh, my heart goes out to you.
My husband and I met with his surgeon just once, prior to going in to have the work done. He was with us for almost two hours. When we left his office, his waiting room was full, but frankly, he acted as if he didn't care. He said "Don't worry, they'll wait." He was right. If we were the ones in the waiting room, we would have waited as well.

The second meeting we had with him was the day before the surgery. That was only about 15 minutes, at the hospital, but it sure felt good to see him again.

There were a number of calls made between those two pre-op visits, and he was so great about calling back, even if it was at odd hours. We just loved knowing he cared so much.

I am confident, if your surgeon has the reputation you say he does, that any question you have, or concern, he will be happy to address. It sounds like you've chosen well.

Be confident. God has shone a light on you on your travels thus far, so there is no reason to believe that He is not holding your hand now. Peace be with you.

Marybeth
 
I met my surgeon only once - immediately after angio - he came in, said you need surgery - bypass. I was in such schock at such news I only said - Oh, ok. Now I know better, even tho I had a great success, he was an excellent surgeon, gave me wonderful aftercare and couldn't ask for a better heart staff team. They had all their ducks in a row and we patients were sort of like an assembly line every day, tho they gave us as much attention as we needed. As for your questions, why don't you write them down and try to make a phone connection with your surgeon, if you can't get a regular appointment. Ask him the questions you have. If you get answers pre-surgery, you won't have to run around the internet afterward hunting those answers - as I did. But it did bring me to this great site God bless
 
Hi Al

I know how you feel. I had my first heart surgery in 99.
I am now on the waiting list again for my aortic valve.
I have met with my surgeon just the one time. The next
time I see him it will be in Sugery. I do have to go for
a preop visit to have all the tests done before surgery.
I am still waiting for my call.

:) Judy
 
I'm in the same position as you and I still have the jitters galore.

I sometimes wonder if I'll ever be satisfied with any of the answers that I do get. I think my mind is preprogrammed to doubt. Doubt can be a good thing or it can also be bad.

I've met with a surgeon once so far, and he spent a reasonable amount of time answering questions. Unfortunately, I was so dumbfounded at the moment, that I forgot alot of the questions that I wanted to ask. I even had a paper with the questions on it that I forgot to get out of my pocket. Was I nervous? You betcha!

http://www.bestdoctors.com/en/default.htm
 
Getting more comfortable

Getting more comfortable

Hi Al,

I met with my surgeon for about 20 minutes and then I had a 3 minute telephone conversation with him about a week or so later. That's all the actual time I spent talking with him prior to the surgery.

However, I was pretty comfortable with him even before I met him. I have a great cardiologist, who I respect and trust enormously, that recommended this surgeon for me. That recommendation meant a lot to me.

Then I checked out the surgeon's credentials on the hospital's web site. He had gone to some of the very best schools and practiced in excellent hospitals and was now the chief surgeon on the transplant team in addition to his regular surgery practice in Philadelphia.

I was also fortunate enough to meet two of this surgeon's former patients and talk with them about their views. (Actually one was the wife of one of his patients.) The both raved about the quality of care they received from him and from the hospital. I later learned of another patient in this area that had used this surgeon and liked him very much. All three cases were success stories.

When I finally got to met with the surgeon, he was professional and friendly, but was a little rushed because he had been doing an emergancy operation that morning and as a result, his regular schedule was backed up. He covered the areas that I was most concerned about like the type of valves available, the pros and cons of each, their longevity, etc. He talked about what he planned to do, what alternatives he would use if he couldn't repair the leaky mitral valve, and we discussed a possible date. That's where we ended. However, he did say that if I had any further questions, to give his office a call and he'd get back to me. I called a week of so later and talked with his secretary, who gave him the message when he was free, and he got back to me within an hour or two. It was during that convesation that we confirmed that he would be my surgeon and set the date of surgery.

Now I'm 6 weeks post-op and feeling great! I have no restrictions except limiting my lifting to 40-50 lbs. The only meds I take are toprol and enalapril. I'm in a cardio-rehab program 3 times a week, I walk at least 2 miles almost every day, and I have no complaints.:)

At this point I can finally say that I feel 100% confident about my choices.

I hope some of this is helpful to you and you will follow up with your surgeon to get the information you need to feel more comfortable.

Ron K
 
Al - I understand your questions and need to know. I actually never met my surgeon. I can't say I was comfortable with that and wished I had more contact. I was hoping he knew all about my case which was Aortic replacement (homograph) and Mitral repair. I went in not knowing. I think we all have the right to have our questions answered prior to surgery, so we have confidence they know our case. These surgeons are so busy, it is difficult. Good luck getting the confidence you need, your competant surgeon will do a good job regardless.
 
Oh Al, you've got lots and lots of home runs in 'ya. Joe's had 5 major thoracic surgeries, a pacemaker implanted, a trigger finger fixed, a lens implant, inhospital oral surgery, a mastoidectomy, an appendectomy and he's having some more surgery May 3 for gallbladder, and a couple of hernias. He's 70 years old and still vertical. I was teasing him this morning and said that he has a blank space on his chest without any scars, and that's the real reason he's going for more surgery.:p

His surgeons spoke with him one maybe two times prior to surgery. It's usually a good idea to have a list prepared to get all your questions in because their time is so limited. Most of them start operating around 7AM and go all day long, taking inbetween time for patient visits inhospital and at the office. A lot of them work long after other doctors have gone home for the night because they also have to study the cases and then there are the emergencies that might happen. Lots of times Joe's visit was conducted with the doctor in hospital scrubs. If you've heard good things about this surgeon from people you respect, he must be a good man.

Most surgeons will be glad to answer your questions on the phone, if you don't mind being called at different times. Some of them have Physician's Assistants who can field minor calls. I think you should get your questions answered for peace of mind, so give him a buzz.

I wish you all the best with your coming surgery, you need it and you'll feel much better afterwards. Here's to a much healthier life.

Take care,
 
I understand all the questions you need to ask.
I asked them of my first surgeon since I had time before my surgery(6 wks). But, for my 2nd avr, I met the surgeon only for about 15 minutes a few hours before my surgery. I came in from ER, and it was more than a month before my consult appoint. with him. My surgery was to be after that. Oh well, I relied on all the great things I had been told about him and his expertise in the field of valve replacements. Also, he had terrific bed side manners, and was very confident. Only after my surgery when I had my follow up appointment with him, did he tell me I was one sick lady and was at deaths door when he met me for the 1st time.
He did a great job, even videotaping my procedure for me. I just knew I was in good hands when I talked to him that first time.
Hope this helps,
Gail
 
hi al!
i know how you must be feeling right now, nervous, unsure....it will all be fine.
our case was very similar to marybeth's. we went surgeon shopping and met with two different surgeons. one we found (who was proficient at the ross procedure, which was one of joey's options) ourselves and the second one who came very highly recommended by joey's cardiologist. the first one (who ended up doing the surgery) met with us for almost 2 hours, drawing diagrams and explaining things. we followed up that visit with numerous calls to his office(one almost every other day) to ask questions we had forgotten to ask. he, or his assistant, always returned our calls.
when we met the second surgeon_ and he is supposed to be brilliant_ we did not care for him at all. he hardly gave us the time of day, insisted that he do the easiest and least complicated valve, even if it meant going back for re-op in fewer yrs. joey felt like he was running an assembly line.
i've heard from many on this site that even surgeons who aren't as well known as others can do a wonderful job. you have to feel comfortable with the person.
i wish you all the best in your decisions. please keep us posted as to what happens.
be well,
sylvia
 
Re: Getting more comfortable

Re: Getting more comfortable

Ron K said:
Hi Al,

I met with my surgeon for about 20 minutes and then I had a 3 minute telephone conversation with him about a week or so later. That's all the actual time I spent talking with him prior to the surgery.

However, I was pretty comfortable with him even before I met him. I have a great cardiologist, who I respect and trust enormously, that recommended this surgeon for me. That recommendation meant a lot to me.

Then I checked out the surgeon's credentials on the hospital's web site. He had gone to some of the very best schools and practiced in excellent hospitals and was now the chief surgeon on the transplant team in addition to his regular surgery practice in Philadelphia.

I was also fortunate enough to meet two of this surgeon's former patients and talk with them about their views. (Actually one was the wife of one of his patients.) The both raved about the quality of care they received from him and from the hospital. I later learned of another patient in this area that had used this surgeon and liked him very much. All three cases were success stories.

When I finally got to met with the surgeon, he was professional and friendly, but was a little rushed because he had been doing an emergancy operation that morning and as a result, his regular schedule was backed up. He covered the areas that I was most concerned about like the type of valves available, the pros and cons of each, their longevity, etc. He talked about what he planned to do, what alternatives he would use if he couldn't repair the leaky mitral valve, and we discussed a possible date. That's where we ended. However, he did say that if I had any further questions, to give his office a call and he'd get back to me. I called a week of so later and talked with his secretary, who gave him the message when he was free, and he got back to me within an hour or two. It was during that convesation that we confirmed that he would be my surgeon and set the date of surgery.

Now I'm 6 weeks post-op and feeling great! I have no restrictions except limiting my lifting to 40-50 lbs. The only meds I take are toprol and enalapril. I'm in a cardio-rehab program 3 times a week, I walk at least 2 miles almost every day, and I have no complaints.:)

At this point I can finally say that I feel 100% confident about my choices.

I hope some of this is helpful to you and you will follow up with your surgeon to get the information you need to feel more comfortable.

Ron K
Click to expand...
 
Hey Al... unfortunately due to postponments, I met with my surgeon many times! But this also gave me time to talk with his other patients.... not that I really needed to... his reputation preceded him.

I still stop in and visit them.... and whenever I am in the hospital there I usually run into him and we chat.

Call him back... voice your concerns... ask your questions! It is your life here!

Take care,
Zazzy
 
Surgeons

Surgeons

Hi Al, because I traveled to the Cleveland Clinic for my surgery, I didn't meet my surgeon until the day before my surgery. The cardiologist at the Clinic who handled my case sheparded me through the tests and catheritization. He was great too. My surgeon had an emergency when I was to have seen him, but he met with me later that night and we talked. He had been so highly recommended for the homograft surgery by both my home cardio and the one at the clinic. In fact I guess that was why the clinic hired him was for his research on homografts. There were three of us the day of my surgery...I was second, but the guy ahead of me who was having a by-pass had problems and I didn't get to surgery until about 7 pm. I was so hungry! I think the hunger kept me from worrying at that point. He came to see me several times the first day (I think it was the next day) and at least once ever other day I was there. I think you need to be comfortable with your surgeon. See if you can hook up with him again and ask your questions.
 
Sorry for the long delayed reply. I wrote a LONG response using quotes from Ron's post since he covered most of my concerns, only to have NONE of my inputs appear! Hank determined there is a problem with the QUOTE function and is working on a fix.

Thanks to MABerge, Hensylee, JBriau, Ross, Ron, Bill, Nancy, Hensylee, Gail, Sylvia, Zazzy, and Jean for your thoughts and suggestions. I've read each of your inputs 3 times now.

Last Thursday, we drove down to Birmingham, AL to tour the UAB hospital and check out the area and the efficiency apartments near the hospital. The rooms in the cardiac unit are spacious with nice hardwood floors and modern shower facilities. On the 9th floor there is a unit that looks more like a 5 star hotel with space for family members to stay and of course, nurses. While these nurses care for cardiac patients, I decided I'd rather be on the cardiac floor, close to the nurses who specialize in cardiac care.

I also met the Nurse Practicioneers who supervise nursing care for my recommended surgeon. They gave me the UAB Cardiac Surgery Booklet to take home for review. Personally, I think these should be given to the patients after the FIRST visit with the surgeon so that patients have time to absorb all the information, instead of waiting until check-in, which is the standard procedure.

NO ONE wanted to answer my question of who they would choose if they needed an Aortic Valve Replacement. There are three senior surgeons and several support? surgeons. One of the floor nurses suggested that the top guys ALL 'walked on water' but the most senior surgeon, Dr. Pacifico, 'walked a little higher off the water'. I appreciated her candor. He is known for his efficiency and speed in surgery and is considered the best for bypass surgery. He works with a team. His assistants do the opening and closing, then he comes in, connects the lines for the heart-lung machine, stops the heart, does his surgery (bypass or valve, etc), restarts the heart, and moves on the the next patient.

My recommended surgeon, Dr. James Kirklin, specializes in transplants and pediatric cases. I'm not sure if he does the actual opening and closing, but he does stay in the O.R. for the entire operation and has a reputation for being very meticulous. He said he has placed 'hundreds' of Bovine Pericardial Valves. He expected my surgery would involve 80 to 90 minutes on the H/L machine which is not excessive. His receptionist suggested that I write down my questions and send or fax them to the office and then he would call me at home some evening next week. That sounds good to me.

I had to stop to catch my breath a few times with all the walking. I expect the 'Turning Point' in our attitude comes when we are more afraid NOT to proceed with the surgery than we are to proceed :)

Thanks again for all of your understanding and support.

'AL'
-----------------
Severe Aortic Stenosis
Mild Mitral Regurgitation
 
Hey Al,

I've heard good things about Dr. Pacifico, primarily from the Ross Procedure Listserve, he seems to be the surgeon of choice for those seeking a Ross Procedure in your area. Sounds like having those skills would be advantagous in any surgery.

I got a Bovine Pericardial Valve on 3/15. I was on the Heart/Lung machine for 56 minutes. Your milage may vary. :)

Chris.
 
VERY INTERESTING Chris...

I have also asked for a Bovine Pericardial Valve.
In addition, there will be a Mitral Valve Repair
and removal of some "thickening" but I forgot
where. I 'think' he said 5 to 10 minutes for
each of those extra procedures.

Your praise for Dr. Pacifico is also interesting.
There is LOTS of good press for Dr. Pacifico.
I was referred to another surgeon but I have
not found anything like the press and praise
for Dr. Pacifico. I wonder if I should interview
Dr. Pacifico...

'AL'
 
Hi Al,

I was reading through the posts to your question, then can to the last one, a repsonse back from you. It seems that the nurse there already provided you with the information I was going to suggest, which is to write down your questions and fax them to your doctor. I still do this today with my doctors prior to meeting with them. That way, they have a chance to think about your concerns and provide you with answers as soon as you meet with them. I keep an on-going word document in my PC that I just write down my questions and concerns through out the year. When my doctor appointment s come up, I just reveiw the list, and send the ones that I still need answers to the doctor.

Hope you have a favorable response to your concerns from your doctor. It sure works for me.

Rob
 
Hi Al,

It sounds like you got all the information you were looking for during your visit to UAB last Thursday. If fact, you got so much information that now you have to get more. (I'm referring to the info about the two surgeons.) If I were in your shoes, I think I'd talk with Dr. Pacifico before making any final decisions.

However, I'm sure either surgeon would be able to do an excellent job. It's just that you would probably have a little more confidence in Pacifico, given the recommendation of the staff person and his reputation.

However, you ought to finalize your plans soon. The problems is not going to go away, and as you are beginning to notice, it will gradually get worse. When you start having serious symptoms, you're running the risk of damaging the heart muscle. The valve can be repaired; the muscle can't .

By the way, my time on the bypass machine was 77 minutes, which is close to the estimate that your were given to have your bovine valve installed.

Al, you've got most of the information you need. Get the rest as soon as possible, set a date, and get this behind you. Waiting doesn't make it any easier and will cause you more stress than moving ahead.

I'll be watching for the post that talks about the final decision on the surgeon and the setting of the date for the operation.

Ron K
 
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