Questions to ask the Surgeon... How can we tell if they are good?

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Stockster
Regular Member


Date Joined Dec 2012
Total Posts : 54
   Posted 9/30/2013 5:56 PM (GMT -6)   
being checked by a surgeon.... Wondering what to ask to make sure they are potentially the right ones to do the procedure.

I live in Canada, and although we do have the luxury of Federal healthcare, the one limitation to this program is that they (Government and Dr's combined) do not like/tolerate a patient moving from one surgeon to another... the idea of getting a second opinion here is not in the patients best interest. Dr's are competitive and emotional here and often have a God complex. Now, this being said, we are blessed with some amazing Dr's. So...... my dilemma is, I have an appt with 'the best Dr' around the Toronto area that does Nissen surgery. But he is a general surgeon, who specializes in Laproscopic procedures.

When I asked him how many he's done, he said 'Oh so many'..... That's not a good answer!!

What questions did some of you more experienced people ask and demand before you decided to go with a specific surgeon? This Surgeon is supposed to be an innovator of the laproscopic robot/tool, and is 'widely renowned' for his talent. This is all from what the staff in the hospital say. The online reviews are mixed, but I have a hard time believing any of the posted reviews.

Any pointers would be great. I have a small sliding HH and GERD.

Thanks,

dencha
Forum Moderator


Date Joined Feb 2009
Total Posts : 7181
   Posted 9/30/2013 8:17 PM (GMT -6)   
Hi Stockster,
I sent a link to this thread to a friend from Toronto who used to participate in this forum.  Hopefully she'll be able to give you some specific information regarding the area in which you are living.
 
General non-invasive (laproscopic) surgeons are fine with the surgery as long as they are highly experienced.  I suspect you could call your surgeon's office and get a better estimate of how many he's done (that is more satisfying than "Oh, so many"). 
 
If, as you say, the surgeon you're seeing is the best Nissen surgeon in Toronto, I'm sure he has tons of experience and it's the right choice.
 
Have you had all the prerequisite testing?  If you've been referred to a surgeon I suspect you really need the surgery. 
 
You said that the reviews have been mixed...that may be because this surgeon, as renowned as he is, might not have the greatest beside manner.  If he is well known and is a skilled Nissen surgeon, you can live with some poor bedside manner. 
 
Be sure to stick around the forum if you have the surgery...we'll be here to support you through your recovery.
 
Best wishes with your appointment!  Let us know how it goes.
 
Best wishes,
Denise
 
PS...As far as questions, it's an individual thing.  A member from another forum came up with this list.  It's way too many to ask in one appointment, and you should sort through the questions and consider which ones suit your needs, but at least it's a start.
 
QUESTION IDEAS:
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 full wrap (lap Nissen) or partial wrap (lap Toupet)? Why?

What muscles will be affected? How will that affect my mobility afterward? And for how long?
 
When can I go back to work?
 
Will I be able to resume my workout routine and weight lifting?  When?

 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.  NOTE:  An experienced Nissen surgeon will want an endoscopy, barium swallow, manometry, 24 hour PH monitor, and sometimes a stomach emptying test)

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

What drugs will I receive? (This should include pain meds and anti-nausea drugs, 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.  NOTE:  I told my surgeon that I wanted HIM to do the surgery, not his resident.  He told me that his resident would have to be there and assist.  I said that was fine, as long has HE did the actual surgery.)

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? 

 What medications do I need to stop taking? When?  (Be prepared with a list of medications and supplements you take.)

 When can I resume taking the meds (assuming you're told to stop them, of course)? 

 When will I need to return for follow-up appointments after surgery? Can I schedule them now?
 
At what point post-op will my care be transferred back to my GI doctor?

 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? 

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.)

 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!
GERD/Heartburn Moderator
Nissen Fundoplication 2/09
Allergy/Asthma

"Whatever you fight, you strengthen, and what you resist, persists.”

“Worry pretends to be necessary but serves no useful purpose”

“Accept - then act. Whatever the present moment contains, accept it as if you had chosen it. Always work with it, not against it.”
Eckhart Tolle

Stockster
Regular Member


Date Joined Dec 2012
Total Posts : 54
   Posted 10/1/2013 1:18 PM (GMT -6)   
Thanks Denise,
 
You have read some of my previous posted questions and you, and all the other key moderators on the forum, are tuly amazing for responding.   So THANKS A MILLION for being here for us even though you have completed your journey(s) for now.
 
I'm not sure if I'm officially a qualified candidate fro Nissen, and I want to exhaust all the options before I have to go under the knife if it is the final option.  I definitely have pretty bad GERD and I am on Medication (Nexium 40 X 2 a day max, plus up to 2 X150 zantec) for life depending on the continual 'ups and downs' that come with this dissorder.   I have a number of test planned for December which will be the true indicator.  I had them all done before on the PPI's and they came black as low-normal, or that the PPIs are working to neutralize the acid.  I do often have acid irritation in my lungs, throat and vocal chords, have tremendous phlem build up and my voice has a continual rasp.  There is continual swelling and redness that is present in my vocal chords as I get them checked every 6 months at an ENT.
 
I will look into the Toronto contact you mentioned and see if she can shed any light on her search for reflux freedom!!
 
I do have a questions for you as I know you have seen them all.   My question is that I notice that there are a some people on this forum that seem to ELECT to have the surgery....   Is this common in the US, or is it becasue of the Private Healthcare system down there?   I have read many posts where people have NOT had the feeling of reflux, or regergitation of LPR symptoms and they are getting Nissen surgery?  I know that this would most likley not be an elected option up in Canada as the doctors would not do anything drastic unless all the issues were evident, present and truly chronic.
 
Thanks again for your email response.  I am on this forum a lot, and I can tell you from all the heath sites I have looked into, this GERD forum is at par with some of the Cancer sites I frequent since having Thyroid Cancer a few years ago.   You and your team of moderators are a true God send for all of us out here trying to get some honest, knowledgable feedback.  yeah     Thanks for 'Paying it forward!'
 
Chris
 

Cindy123
Regular Member


Date Joined May 2011
Total Posts : 175
   Posted 10/7/2013 8:19 AM (GMT -6)   
Hi Chris, I have asked Denise to give you my info so that you can contact me.  I live in Toronto (Scarborough) and I had the Nissen done at East York General Hospital.  Feel free to call me at any time.
 
Cindy

Stockster
Regular Member


Date Joined Dec 2012
Total Posts : 54
   Posted 10/7/2013 8:48 AM (GMT -6)   
Hi Cindy,

Thanks for your note. You can also send me a private message with your contact information and I will touch base. That's for you response and willingness to shed some light on this matter.

Chris

Stockster
Regular Member


Date Joined Dec 2012
Total Posts : 54
   Posted 10/7/2013 8:51 AM (GMT -6)   
I just noticed that there doesn't appear to be a private message options on this forum... So i guess I will wait for Denise's note.

Thanks, again!
C

dencha
Forum Moderator


Date Joined Feb 2009
Total Posts : 7181
   Posted 10/7/2013 9:54 AM (GMT -6)   
Hi Chris,
You can just click on the little envelope under my name to the left of this post.  You'll find my email there.  Just drop me a line, and I'll send you the phone number. 
Thanks Cindy123!
Take care,
Denise
GERD/Heartburn Moderator
Nissen Fundoplication 2/09
Allergy/Asthma

"Whatever you fight, you strengthen, and what you resist, persists.”

“Worry pretends to be necessary but serves no useful purpose”

“Accept - then act. Whatever the present moment contains, accept it as if you had chosen it. Always work with it, not against it.”
Eckhart Tolle

Cindy123
Regular Member


Date Joined May 2011
Total Posts : 175
   Posted 10/8/2013 8:43 AM (GMT -6)   
Hi Chris, I called you yesterday....did you get my message?

Cindy

Stockster
Regular Member


Date Joined Dec 2012
Total Posts : 54
   Posted 10/8/2013 12:54 PM (GMT -6)   
Hi Cindy.
 
Thanks for your message.  I missed your call yesterday as I was out for my birthday!   I will call you shortly
 
Thanks for reaching out.
 
Chris

Cindy123
Regular Member


Date Joined May 2011
Total Posts : 175
   Posted 10/8/2013 1:09 PM (GMT -6)   
Happy Birthday....hope you had a good time. I will call you after work...is that okay....it's a little hard to talk at my desk.

Cindy

Stockster
Regular Member


Date Joined Dec 2012
Total Posts : 54
   Posted 10/8/2013 1:10 PM (GMT -6)   
no problem. I'm free! Cheers.
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