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From: Thistle
Date: 02/21/02
Time: 03:47:28 PM
I post these pre-surgery questions to help those of you who are considering a fundo and who are assessing a surgeon to do so with more confidence. Iassume up front that you already have references on your surgeon and that you have had ALL the tests -- that you haven't allowed someone to tell you that short-cuts during the diagnostic period were OK, that a manometry test, say, isn't important because it's obvious you're refluxing. (Run for your life if you are ever told this type of thing. You want to know ahead of time that you'll still be able to swallow.)
BACKGROUND COMMENTS -------------------
The point of these questions is that the answers are individual. (If they weren't, we wouldn't need to ask!) What my surgeon told ME about my situation doesn't matter. Thus, I am not sharing the answers I got when I asked these questions.
The answers depend on all sorts of stuff, such as why you might need a fundo, what your surgeon's skills and experience are, how the hospital you'll be in works, your other medical issues, etc. They are questions that I think should be asked, even if you are positive you already know what the answers will be. Never assume that you're on the same wave length as your surgeon, in other words. Be sure you are, so you aren't surprised.
If you don't understand an answer, say so. Or ask, "Why is that?" Or, "Can you explain the thing you stick down my throat again?" You don't have to admit you didn't "get" it, in other words, if your ego is like mine!
I treated my surgeon the same way I treat all my doctors. The first time we met, I explained right off the bat that I'm the sort who likes to ask a lot of questions -- was she comfortable with that? I would then mention this at each appointment until I was sure that it wasn't necessary. I asked the questions below over the course of several visits. I always gave her a copy of my questions. (I consider this a courtesy, and I'm told doctors appreciate this.) She was fine with giving me the time to write down the answers when I needed to do that. (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.)
THE LIST --------
What is your background? How many fundos do you do in a month? Open or lap?
What interested you about this type of surgery? What other kinds of surgery do you do?
Can you please explain why you believe I should have a fundo? (Then break this into several follow-up questions, such as, Can you explain why my diaphragm needs repairing during the fundo. How will you do X?)
As part of the conversation about why you should have a fundo, ask the surgeon to discuss the results of each and every test with you (I'm assuming here that you've kept track of the tests you've had!). And ask questions as you go along (example: if you look at your barium x-ray: "Is that my LES?") even if you already know the answer. (You want to be SURE that he/she has actually reviewed your test results, in other words.)
Will you do a whole wrap (lap Nissen) or half wrap (lap Toupet)? Why?
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 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? ("Oh, it's not at all difficult," is NOT something you should hear.)
What might cause my fundo to fail? What are the chances that this could happen?
How often have YOU (not all surgeons) had this <failure> happen? (Hope that 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? 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? (Especially important if you'll be in a teaching hospital. You want to make sure that your surgeon does not let a student do the actual work. 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 one was REALLY important to me!)
How long until I'll be able to drive? use stairs? pick up my toddler? roller blade? sky dive? jog? swim? kick box? (Ask about whatever activity is important to YOU.)
What medications do I need to stop taking? When? (At this point I whipped out a dated spreadsheet showing everything I took, from daily vitamin to PPI with doses, frequency, and reason for using. I left a copy behind, for my file.)
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? How far in advance should I schedule these visits?
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 now so that you can then ask who will be available for back-up and what their credentials are. Or so that you can move your surgery date back, if you'd prefer that.
Ask questions about how this surgery might affect related health issues you have -- from epilepsy to a bum knee and the abuse it might take during this, or whatever. You don't want to emerge from this experience in worse shape on another front! (In my case, another health care provider prepared a two-page "report" for my surgical file, so that the surgeon and the anesthesiologist would have a quick summary of another problem I was being treated for and so that they would not do anything to thwart my progress with that problem. This technique worked really well, and I got through everything without backsliding on that front. Yay! I also went over the details verbally with the surgeon and the anesthesiologist.)
Ask at EVERY visit: 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.
Finally: Should I have more questions before surgery, how can I contact you? (If the surgeon is NOT receptive to this, and has shown signs that you don't need to know all this stuff anyway, you've very likely got the wrong person!)