Dr. Procedural Questions

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RTR
Regular Member


Date Joined Oct 2007
Total Posts : 29
   Posted 12/3/2007 5:46 PM (GMT -7)   
I'm just curious as to how much interaction folks have had with their surgeon.  Here is my experience:
 
I met my surgeon once prior to surgery
I saw him and his 2 residents the evening of the surgery
Resident discharged me from hospital on 2nd day.
 
On the one occassion I've needed the dr office the nurse practioner called us back.
 
I know the nurse practioner will remove the catheter but wife got the impression nurse practioner will also go over pathology results.
 
All of the above is ok with me with the exception of discussion of the pathology report.  I'll be a little dissapointed if it works out this way.  I'm not stressing over this just curious about other experiences.
 
 
 
 
 
 
 
 
 
 
 
 

Diagnosed 9/07
Gleason 6  3+3
First PSA 4.1
2nd PSA 3.6
stage T1C
age 46
daVinci performed 11/28/07
@ Univ of Ala Bham (UAB)


Cedar Chopper
Regular Member


Date Joined Mar 2007
Total Posts : 432
   Posted 12/3/2007 7:22 PM (GMT -7)   
RTR,

The more the surgeons are in surgery getting their stats and experience level up, the more they rely on their nurses for routine questions and the common/simpler problems.
If you "transfer in" from another physician that did the biopsy and helped you through the decison process, this also limits contact as you the P.C. patient shouldn't wait more than necessary.

Even when you make an appointment for a consultation with the surgeon (as you rightfully wish for the pathology report)  - even with the best intentions to give you all the time you need, the nature of their business is that things come up unexpectedly.
I had an appointment cancelled as I arrived when my surgical team was suddenly called to E.R. for some nephrology procedure on a teenager.

That being said, after you are respectful of these demands on the physician,
  you must be firm to get the answers you want from the physician.
I'd bring my spouse or close relative/friend and bring something to read for both of you in case you have to wait a bit - unexpectedly.
Bring a list of your questions and politely make it clear you need to talk with the Surgeon about each question.

I wouldn't try to pin her/him down on things like "Exactly how long until I'm continent?" or
"Exactly when will I overcome E.D?" , etc.
Besides the fact no one knows the exact answer on many topics for each patient,
  physicians are cautious about either building up expectations or feeding pessimism.
Surgeons can be "gun-shy."
Disappointment can lead to at worst mis-guided litigation or at the least "bad press,"
   - while unbridaled pessimism can seriously retard recovery.

Hold on to the "best-case scenario" and deal with the tough issues and decisions only as they come up.  Worry never helps.

I hold out the best for you from the highest source I can imagine,
  - that indominateable Light you can hear, smell, feel, & touch 
    - with your eyes closed.....

Your Friend,

CCedar
ICTHUS!


Gordy
Veteran Member


Date Joined Jun 2005
Total Posts : 528
   Posted 12/3/2007 7:28 PM (GMT -7)   
Personally, I would have found another surgeon.

-Les
1/2005 Dx PSA 26.5 Gleason 7 (4+3) @Age 61
1/2005 Start Casodex and Zoladex
PSA drops to <0.01 AND REMAINS THERE TO THIS DAY
7/2005-8/2005 5 weeks of IMRT and then HDR brachy
1/2007 Rad Oncologist orders CT scan of pelvis
because of complaints of pain in both thighs
MRI confirms pain not caused by cancer BUT
1/2007 CT scan of pelvis picks up a nodule at bottom of left lung
5/2007 CT scan of lungs shows 1/2007 nodule has grown and
there are numerous nodules on both lungs.
6/2007 Thoracic surgeon removes wedge of left lung for biopsy
6/2007 Path report says 95% chance of metastatic PCa, but she's
never seen cells like this before.
7/2007 2nd opinion at M.D. Anderson in Houston.
They confirm: mutated PCa, very rare, but seen there 2 or
3 times. Recommendation: have CT scans every 6 weeks
and watch for change. At that point start chemo and will
survive for 22 - 24 months thereafter.
PSA STILL UNDETECTABLE


PianoMan
Regular Member


Date Joined Feb 2007
Total Posts : 365
   Posted 12/3/2007 7:32 PM (GMT -7)   
My experience was like yours. I was thrilled to get the surgeon I did -- I had a 1/2-hour consultation with him by phone, then an in-person consultation the day prior to surgery.
The next time I saw him was just before I was wheeled into the operating room and the next day he came to the hospital (on a Saturday) to see how things were going. Five days later, I got the post-op pathology report from his nurse, which was fine with me. If I had needed to talk to him personally at that time, he would have been acessible. (He was available to me long after surgery by phone.)
So it sounds like you're on the same track I was.
Best to ya...

D.O.B - 8/9/52

PSA: First ever was 9.8 in late Oct. ‘06, two weeks later, 10.1

DRE: Negative

Biopsy results 11/22/06.  Both lobes involved.  Six out of eight cores positive - from 100 percent to 90, to 60, to 50, two 20s and two zeros.

Gleason 3+3 = 6

Da Vinci Robotic RP surgery, City of Hope, Jan 12, 2007

Post surgery pathology – Organ confined, Gleason still 6, margins clear.  Volume of tumor much less than biopsy suggested.  12 percent overall.

First post-surgery PSA -- Undetectable, 2/20/07

Second post-surgery PSA -- Undetectable, 9/11/07


IdahoSurvivor
Veteran Member


Date Joined Aug 2007
Total Posts : 1015
   Posted 12/3/2007 8:15 PM (GMT -7)   

My experience to date...

 

Even though she has a physician's assistant, I saw my surgeon for every pre-op and post-op appointment.  She visited me both days in the hospital.  She took out my drain personally in the hospital.  There have been times that her nursing staff has been involved, but she has been there every step of the way.  She also took out the cath.  There has only been one time when I was offered to see the PA, but that was when I was late for an appointment and my surgeon could not see me that day.  As I talked about my surgeon's approach with a nurse who used to work in the office, it seems that she pays special attention to her cancer patients.  I'm satisfied thus far.

 

All the best,

 

Barry


"Idaho" ~ Barry

 

Da Vinci Surgery July 31, 2007… 54 on surgery day
PSA 4.3  Gleason 3+3=6  T2a  Confined to Prostate

1st PSA 0.04 (undetectable) 9/11/2007

My web site: http://pca-info.blogspot.com


ldoun
New Member


Date Joined Jun 2007
Total Posts : 19
   Posted 12/4/2007 7:35 PM (GMT -7)   
JTR,

Your "contact time" with your surgeon was better than mine, but I am not complaining. I got the best surgeon and hospital available within 300 miles. My results and experience were very good. I did refer myself to Duke after a LOT of research on what to do, where to go and what to ask. I read several Journal articles written by the Surgeon and his Symposium lectures and was familiar with the surgery.

Initial meeting at Duke: I met with the "Resident Fellow" for about 45 minutes and the Surgeon for about 10 minutes.
The day of surgery: I never saw the Surgeon or Resident but there were a lot of people in the OR as best I remember. The Resident reported to my wife that all went well.
Day after surgery: I saw the Surgeons Nurse Practitioner who released me and told me that the Surgeon had been with her when they started round but was call for emergency surgery.
She called me with pathology reports and sent the all the hospital, surgical and pathology reports a few days later. (I got all that because of the self-referral). The catheter was removed by my local GP without problems. I had and have had no complications.
6 week followup: I saw the Surgeon for about 10 minutes, was given RX for Cialis/Pump and told to come back in 6 months. PSA was checked after I saw him--<0.1.

The surgeons written report and pathology report had pretty well explained everything and I had few if any substantive questions.

I have no complaints, I felt confident in his ability and experience and my results have been very good so far. I got outstanding care while at the hospital and saw several Residents who checked on me in the few hours I was there. I would have liked to have seen him more but he has a lot of demands on his time and expertise beyond holding my hand. I still feel I can contact and speak to him if I need to--to date I haven't needed to.

I will comment that with all "teaching Hospitals", the Residents are there in training and do participate in all aspects of the surgery as was true in my case. My surgeon was at the Patient side for part and at the Robot for part, but he was there and guiding my operation throughout.

Jim
Age 64
5'8" 145#
PSA pre-op 5.2 (12% free)
Gleason 3+4=7
Robotic RP 4/24/07 Dr. Albala, Duke
Post-op- Organ confined Gleason 7
6/18/07 PSA <0.1
10 wk: 0-1 mini pad per day
ED Cialis and VED prescribed


uncledan
Regular Member


Date Joined Aug 2007
Total Posts : 120
   Posted 12/4/2007 8:46 PM (GMT -7)   
I think Cedar Chopper has the answer. We all want a surgeon who has unlimited procedures under his belt, but we want him to spend his time with us. Sorry you can't eat the cake and take it home too. I was somewhat fortunate to see my surgeon for about 45 minutes in my first consultation, then about 10 minutes before the surgery. He came to the waiting room and meet with my wife and brothers and spent several minutes with them. I did see him twice more before leaving the hospital and talked long distance with him the second day after release. I have had three meeting with him after release from the hospital. Unless I have something come up that needs attention I won't be seeing him again. So in four + months, I spent less than 2 hours with him. Since most doctors are paying off loans to get where they are, not to mention the malpractice insurance premium each year, I can see why they are not available to chit chat. They are in the operating room making money. Just keep a positive attitude and with good luck and God's blessings yooou are home free. Uncle Dan
Age 67
No symptoms, DRE negative, 10 - 06 PSA 5.44, 01 - 07 PSA 6.47
5 - 07 CT and Bone scans negative, 05 - 07 Biopsies, 2 of 6 positive
Gleason Score (3+4) 7 Stage T1c
08 - 14 Dr. Dasari - Baptist Hospital, Nashville da Vinci RAP, five hours surgery
Some right nerve and all left nerve removed,
Hospital discharged 8 - 16
Pathology report Negative margins, Encapsulated, 50% left side
Lymph nodes 2 R & 1 L - Negative, R & L seminal vesicles - Negative
Gleason changed (4+3) 7 closer to 8 than 6
9 - 26 Great PSA 0.000, 9 - 27 Starting on meds for ED
10 15 Dry most of the time, occasional leak (dribble )
10-27 Received pump started use on 10-29 can see resulted, enlargement.
11-22 Viagra, Lavitra no help yet, Pump still not producing usable results either.
11-28 2nd PSA since surgery 00.00

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