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  • Questions to Ask Your Surgeon (Thistle's List)

    (Following is a list of questions that Thistle asked her surgeon before she had her lap Nissen. (Thanks Thistle!!)

    Please note that my case was pretty straightforward, no hiatal hernia or gall bladder issues. If you have these, you'll have to add questions about them to your mix, of course. (And if you've got good questions of your own, please post them so we all benefit!)

    Here's how I handled this: I told the surgeon right off the bat that I'm the sort who likes to ask a lot of questions -- was she comfortable with that? (Yes.) I would mention that at every appointment. When the day came that we had "the" appointment, where we went over everything, I gave her a copy of my list of questions. I also always wrote down the answers, and she was always fine with giving me the time to do so. (One of the reasons I'd asked her if she was OK with questions. I would NOT have been able to use a surgeon who did not grant me this courtesy. Your own mileage may vary on this point.)

    Here's the list (not all asked at the same appointment, some asked at EVERY appointement):

    What is your background? How many fundos do you do in a month? Open or lap?

    What interested you about this type of surgery?

    Can you please explain why you believe I need a fundo. (Break this into several questions, if need be, such as, Can you please explain why you think my diaphragm needs repairing during the fundo.)

    Will you do a whole wrap (lap Nissen) or half wrap (lap Toupet)? Why?

    What muscles will be affected? How will that affect my mobility afterward? And for how long?

    What is the biggest risk I'll take in having this surgery?

    What is the hardest part of the surgery, for you?

    What might cause my fundo to fail? What are the chances that this will happen?

    How often do you have this (whatever the failure is) happen? (HOPE the response to this is a tiny fraction of the whole, "because I do a good job of assessing up front whether this is an appropriate solution.")

    Do I need any other tests before the operation? (Often you'll need a chest x-ray and blood test right before.)

    When will I meet the anesthesiologist? (And who will he/she be?)

    What drugs will I receive? (This should include pain meds, not just whatever your anesthesiologist gives you.)

    Who else will be in the OR? (VERY important if you'll be in a teaching hospital. Also, it's good to know what sort of nursing crew they allow.)

    What other doctors will see me at the hospital, besides you and the anesthesiologist? (Again, especially important if you'll be in a teaching hospital.)

    How long does the surgery take? About how long will I be in the recovery room?

    Can you give me post-op diet guidelines?

    When will I be able to sleep on a level bed? (This was REALLY important to me!)

    What medications do I need to stap taken? When? (At this point I whipped out a spreadsheet showing everything I took, from daily vitamin to PPI with doses, frequency, and reason for using)

    When can I resume taking the meds (assuming you're told to stop them, of course)? Be SURE you are clear that you should stop using your PPI! It should NOT be needed post-fundo.

    When will I need to return for follow-up appointments after surgery? Can I schedule them now?

    What might cause you to give me an open, even though we're planning on a lap?

    Show me where the incisions will be (both for lap and open).

    How many stitches will you put in my diaphragm? (Even if you don't have a hiatal hernia, you might get some, so it's worth asking.)

    What should I do if I have problems after I'm released from the hospital? (Try to get a fix on what is urgent and what is not and whether you can reach your surgeon easily, especially outside of office hours.)

    Check whether your surgeon will be at work for the 4-6 weeks following your surgery. If vacation or holiday time-off is coming up, you need to know that so that you can then ask who will be available for back-up and what their credentials are.

    Is there anything else I should know that I've not already asked about? (This is an attempt to be sure that your surgeon isn't "forgetting" to mention something to you. Not to brag, but in my case, my surgeon said, "Gosh, I've never had a patient who asked such good questions! You are really thorough," when I asked this one.

    If I have more questions, how can I contact you? (If the surgeon is NOT receptive to this, you've got the wrong person!)

    Finally, include questions re: related health issues you might have -- from a bum knee and the abuse it might take during this to diabetes or whatever. You don't want to emerge from this experience in worse shape on another front!

  • #2
    Is it too late?

    My Nissen is scheduled for tomorrow. I do NOT feel ready. Everyone says that its normal to be nervous, and that i'm in really good hands but....

    I've only met the surgeon once. He was okay but not as personable as I would like. At the time, I didn't realize that it would be the only time I'd talk to him before surgery so I didn't ask a lot of questions. I have since called back and spoken with the receptionist. She had answers to most of my questions but still I wanted to talk to "the man"

    Should I ask these questions tomorrow when I see the surgeon before surgery? Would it be possible to cancel if I get an answer I don't like? Or should I just forget the questions and go thru with it?

    I've been to two GI specialists and the pulmonologist I've seen for years, and all three think the surgery is a good idea. All have said my surgeon is "The One" to do it. So, why ask questions, right?

    Have had GERD for 16 years. Its controlled with PPIs (except during pregnancy) but the problem is that i don't take the PPIs as I'm supposed to. As soon as the heartburn goes away, I forget about it. Am afraid I'm damaging my esophagus this way. Does that make sense?

    Lately, the burning hasn't been an issue. Have had nausea and burping (those are symptoms, arent' they?). I wonder if I'll feel worse after surgery?

    Would appreciate any advice/thoughts/ shared experiences.

    Thank you,
    Goldee

    Comment


    • #3
      Hawk, nice list ;O)

      Goldee as for your op, dont worry about it too much, the only thing that i would have asked before the op would have been what the after effects of the lap, i.e i cant be sick and i have developed other problems, such as ulcers... You really need to be sure that your having this op BECAUSE U NEED TO HAVE IT... I wouldnt allow anyone to pressurize me into something that i didnt feel good about... As i said, i am sure u will be fine and we all have doubts about operations, but i think your biggest problem MIGHT be after the operation.

      Take Care, hope it goes well

      Comment


      • #4
        Need Hawk's Help

        Hi Hawk,

        I would really appreciate if you could help me track this person down on your site. It was posted 2002, I just had the operation undone and would love to speka with her. Please let me know how I can get her email address. Thanks allot.

        Heartburn-help Buy Tummy Tamer® Online!!! <--- Click Here
        [ Home | Contents | Search | Next | Previous | Up ]


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

        NISSEN FUNDOPLICATION I HAD A TAKE DOWN
        From: SUZANNE
        Remote Name: 24.106.23.23
        Date: 10/10/02
        Time: 08:09:20 AM


        Comments
        I HAD THE NISSEN FUNDOPLICATION, 2 1/2 WEEKS THERE AFTER HAD IT REVISED BECAUSE I COULDN'T SWALLOW ANYTHING. SINCE MY GALLBLADDER ALSO HAD TO BE TAKEN OUT. I SUFFERED WITH MANY SERIOUS PROBLEMS WHICH LET TO MALNUTRITION/ANOREXIA AND A HEART RATE OF ONLY 32 AND AND MUCH TIME SPENT IN THE HOSPITAL. I HAD A FEEDING TUBE PUT INTO MY SMALL INTESTINES FOR NUTRITION.I HAVE SINCE HAD A TAKE DOWN OF THE WRAP, WHICH I WAS TOLD BY MANY SURGEONS THAT IT WAS NEARLY IMPOSSIBLE TO DO AND IF IT COULD BE DOWN IT HAD TO BE OPEN PROCEDURE AND THERE WAS NO GUARANTEE IT WOULD HELP, IN FACT I COULD BE WORSE OFF. I WENT AHEAD AND HAD IT DONE. NOT ONLY DO I FEEL BETTER MY SURGEON WAS ABLE TO DO THE WHOLE PROCEDURE LAPROSCOPICALLY. HE IS AN EXCELLENT SURGEON WHO CARES VERY MUCH ABOUT HIS PATIENTS, HE SAVED ME FROM DYING OF STARVATION. I AM NOT SAYING IT IS A PERFECT SCIENCE, I STILL HAVE SOME PROBLEMS BUT NOTHING NEARLY AS BAD AS IT WAS PRIOR. IT WAS A RECENT SURGERY SO I AM STILL RECOVERING BUT HAVE NO REGRETES, BUT HOW COULD I, IT WAS EITHER THIS OR DIE.

        SUZANNE

        Comment


        • #5
          David,

          Unfortunately, the message that you copied is from the old message board. Due to the construction of the old boards we were not able to store any contact information on the users. I check the web for any other message boards that Suzanne may have posted on and did not find anything.

          We will leave this thread on the forum and hopefully Suzanne still visits here every now and then and will contact me..

          Hawk

          Comment


          • #6
            More Questions for Your Surgeon

            I made good use of the questions listed during my surgical consult, and came up with a few more that might help others...

            How much typical weight loss occurs after the procedure? Also, what happens if weight loss continues (e.g. will it affect a succesful outcome)? Will weight gain affect the procedure's effecacy?

            What other procedures might be done in the hospital? (Ask so that you know whether a foley catheter, NG Tube, etc. may be used.)

            What will be the implations of this procedure (could the wrap tear, etc.) if I get pregnant and carry the baby to term.

            What will your fees be? What will the hospital's fees be?

            What is the chance I might need blood? Should I consider designated donation (where you donate your own blood ahead of time).?

            How long does the surgery take? What medications will be used?

            Who will be rsponsible for my care if there are non-surgical complcations (e.g. pneumonia)? Should my PCP be notified that I am going in for this procedure?

            If I do need a revision, when will that decision be made and on what criteria will it be based?

            Are any follow-up monitoring tests suggested (e.g. annual EGD)?

            Comment


            • #7
              Nissen Sugery

              Originally posted by goldee
              My Nissen is scheduled for tomorrow. I do NOT feel ready. Everyone says that its normal to be nervous, and that i'm in really good hands but....

              I've only met the surgeon once. He was okay but not as personable as I would like. At the time, I didn't realize that it would be the only time I'd talk to him before surgery so I didn't ask a lot of questions. I have since called back and spoken with the receptionist. She had answers to most of my questions but still I wanted to talk to "the man"

              Should I ask these questions tomorrow when I see the surgeon before surgery? Would it be possible to cancel if I get an answer I don't like? Or should I just forget the questions and go thru with it?

              I've been to two GI specialists and the pulmonologist I've seen for years, and all three think the surgery is a good idea. All have said my surgeon is "The One" to do it. So, why ask questions, right?

              Have had GERD for 16 years. Its controlled with PPIs (except during pregnancy) but the problem is that i don't take the PPIs as I'm supposed to. As soon as the heartburn goes away, I forget about it. Am afraid I'm damaging my esophagus this way. Does that make sense?

              Lately, the burning hasn't been an issue. Have had nausea and burping (those are symptoms, arent' they?). I wonder if I'll feel worse after surgery?

              Would appreciate any advice/thoughts/ shared experiences.

              Thank you,
              Goldee
              Hi Goldi

              I am brand new to this site, I have Barrett's Esofagus, mild one ( first stage )
              The Doctor who did the Bravo test one me said " I am a good candidate for Nissen surgery " this ofcourse happend last year, I did not go for the surgery then, now my internal Doctor also recommends that, I should think more serious about that, could you please give some feedback from your experience? I do appriciate that.
              Thanks
              Moe V.

              Comment


              • #8
                These two sites with general information about preparing for surgery (but not specific to GI surgery) might help when you are in the planning stages:

                What You Need to Know: [url]http://ahrq.gov/consumer/surgery/surgery.htm[/url]
                Quick Tips—When Planning for Surgery: [url]http://ahrq.gov/consumer/quicktips/tipsurgery.htm[/url]

                Comment


                • #9
                  Here's a blog that explains how important it is that patients are proactive and direct when they are in the hospital. I think the examples of how to word questions you ask is especially helpful. Link is [url]http://newsblogs.chicagotribune.com/triage/2008/06/tips-on-speakin.html[/url] (don't know how long this remains active).


                  TRIAGE (name of blog)
                  Making Sense of Health Care
                  Chicago Tribune
                  June 10, 2008

                  Tips on speaking up in the hospital

                  No one likes to feel criticized by someone they’re trying to help.

                  So, if you’re a hospital patient who’s spotted something that disturbs you, think about what you’ll say to your doctor or nurse and how you’ll say it.

                  A positive response is more likely if you’re direct but not confrontational.

                  “Don’t wait for (medical providers) to breach protocol and then pounce,” advises Julia Hallisy, who authored “The Empowered Patient” after her daughter endured an ultimately fatal cancer.

                  “Be diplomatic, so they think of you as a partner, not an adversary.”

                  I interviewed Hallisy for my article in today’s paper about hospital programs that encourage patients to speak up when they have a concern instead of remaining silent.

                  Although this San Francisco dentist thinks the idea makes sense in principle, in practice she believes patients need more guidance than most programs offer.

                  “It really puts people behind the eight ball, asking them to catch their doctor or nurse doing something they don’t like and then complain,” Hallisy said.

                  After watching providers repeatedly fail to wash their hands before dealing with her daughter, Hallisy decided a proactive approach was more productive.

                  “I’d say something like, ‘I know infections are a big problem in hospitals and I just don’t feel comfortable unless I see everybody wash their hands and put on a new set of gloves, ' " she remembered.

                  Another expert I consulted for today’s article is Virginia Gill, an associate professor of sociology and anthropology at Illinois State University who studies how doctors and patients communicate.

                  She’s what’s known as a “conversation analyst,” and her works involves videotaping interactions in medical clinics.

                  Time and again, she finds that patients think they’re asking doctors for something directly when in fact they’re being quite indirect. “Patients have a hard time asking straightforward questions,” Gill said.

                  For instance, instead of asking a physician straight out about a diagnostic test, a patient will often say something like: “Do you do this test here?” or “I had a doctor who used to do that test for me and it would relieve my mind.”

                  A much clearer approach would be to ask “Would this test be appropriate for me, given my circumstances?”

                  Also, Gill finds that patients often speculate out loud about their illness and what treatments might be available instead of asking a doctor directly for recommendations.

                  It’s like a teenage boy who tells a girl “Hey, I heard there’s a basketball game on Saturday” instead of “Do you want to go on a date with me on Saturday,” she said.

                  What really worries patients is that if they speak their mind, then maybe a doctor or a nurse will get mad and “then maybe they won’t do everything they could for me,” Gill speculated.

                  The best approach is to be “assertive, calm and straightforward” rather than “demanding, aggressive and unreasonable,” she said. If this is just too hard, have a family, friend or adult child come in and speak on your behalf.

                  “Everyone needs someone who’s willing to be an advocate for them in the hospital,” Gill explained. “Just have them try to ask for help in ways that compel a response.”

                  And don’t back down even if things become a little tense, these two experts agree. Stand your ground, politely but firmly. After all, it’s your health that’s at stake.

                  Comment


                  • #10
                    Guidelines for getting discharged from hospital

                    Robert Wood Johnson Foundation has various toolkits posted, including a checklist for making sure you know everything you should know when you're discharged:

                    http://www.rwjf.org/content/dam/farm/toolkits/toolkits/2013/rwjf404048

                    In some cases, you might want to review some of these items with your surgeon before your surgery.

                    Comment

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