How do you choose a surgeon?

[Guest]

Is it true that laparoscopic surgery is easier on bigger patients? A surgeon on Quora said that while anesthesia might be more challenging, the extra space helps with instrument placement. I had hoped that being smaller might help.

No, being bigger doesn't help. They put air in the abdomen to make things visible. Being big makes it both more difficult to put the air in, and more difficulty to maneuver the trochars. Experience is the most important thing to look for. You're looking for a surgeon whose practice involves mostly doing your type of surgery, especially if your surgery is unusual. Ask both your primary physician and others in his field (but who aren't competitive with him). When it comes to picking a surgeon for an unusual procedure, I would avoid Yelp reviews or focusing on personality. You don't want a jerk, but the main goal is surgical success. I personally wouldn't prefer a surgeon over 65. Hand/eye dexterity do deteriorate over time.

[+ FreshFluff]

The problem is that almost every surgeon used the robot for surgery because it’s a lot easier than the backbreaking work of removing benign masses for hours of end. I’m not a fan of robotic; it means more and larger incisions and studies say it causes more problems.

I’d far prefer conventional laparoscopy done by hand but so few surgeons in the U.S. do it for this procedure.

 

After reading the research, the best surgical teams out there are in Taiwan and South Korea. But it would be crazy to go there if I don’t speak the language, right? The doctors there publish in English FWIW.

Edited March 8, 2019 by FreshFluff

[Guest]

Well, the doctors who publish in English probably have staff translating. The hospital staff may not speak English. I'm not sure what you mean by "cause more problems." Do you have statistics from comparative studies about complication rates? I hope you're not just talking about incision sizes and cosmetic issues. Where will you be getting your follow-up care? Would you be coordinating this between specialists there and here?

[+ sniper]

if you're concerned about scarring is it am option to have a plastic surgeon on hand to close? I'm jut spitballing here. also if a foreign country is sufficiently cheaper perhaps hiring a bilingual provate-duty nurse is an option.

[+ Gar1eth]

I just read this thread. I don't have any suggestions. But I wanted @FreshFluff to know I'm sorry about her having to have surgery. And I wish her only the best!!

 

Gman

[+ FreshFluff]

Well, the doctors who publish in English probably have staff translating. The hospital staff may not speak English. I'm not sure what you mean by "cause more problems." Do you have statistics from comparative studies about complication rates? I hope you're not just talking about incision sizes and cosmetic issues. Where will you be getting your follow-up care? Would you be coordinating this between specialists there and here?

 

This was a head to head study between robotic and conventional lap teams at one hospital. The robotic team had far more experience but still had higher average blood loss. The FDA has also warned the company about malfunctions, such as arcing, which can burn the patient.

 

The hospital staff was my concern too. I hadn’t really thought about the details since I’m bot yet seriously considering it. I guess I’d stay there for a couple weeks then get follow up care here.

Edited March 8, 2019 by FreshFluff

[+ FreshFluff]

if you're concerned about scarring is it am option to have a plastic surgeon on hand to close? I'm jut spitballing here. also if a foreign country is sufficiently cheaper perhaps hiring a bilingual provate-duty nurse is an option.

 

I could try, but my guess is that the main surgeon would be offended and tell me to go elsewhere. A few surgeons use closure techniques similar to those of PSs while others use barbed sutures.

 

I like the bilingual nurse idea. I keep thinking of all that could go wrong abroad though, esp if I have complications

 

@Gar1eth Thank you. I really appreciate it. TBH, it’s a relativelycommon issue.

[+ Gar1eth]

One thing to consider-if you have surgery outside where you normally reside-surgeons really don't like taking care of other doctor's surgery patients except in emergencies. If you did go outside the country, check and see whether they might have an affiliation with someone stateside.

 

Gman

[+ FreshFluff]

Over four years after the first strange symptoms showed up, I’m finally having surgery this morning. I chose my doctor without regard to location. after two consults and a preop, I think I made the best choice I could. Still barely slept though.

 

It would have been easier and the result better had I done it 4 years ago, but what can you do?

 

Thanks for the support, everyone.

[BaronArtz]

Best of luck, FF. I will be thinking of you …

 

And please keep us posted.

[+ Gar1eth]

I too wish you all the luck in the world. We'll be looking for your posts once you are recovered.

 

Gman

[+ Just966]

Well Friday came and I’m now 4 stents richer and feeling great. Answered prayer really.

Glad things went well @g56whiz !! You are very correct though tat you dont always get to choose your heart attack location and when it happens you just want it fixed as soon as possible! I had mine while biking in europe and had a stent placed in a hospital where only one physician spoke english and he was a young resident. The process was very efficient though as was brought in admitted, prepped in their ICU and was in radiology being stented all within the hour. After 3 days in hopsital was discharged and continued on with the holiday; although no biking, and felt great. I knew I required an addition stent and had that done when I arrived back home as they would only do 1 at a time in Europe. Hope things continue to go well and you hit the gym regularly now as studies on cardiac rehab (gym work and cardio training) are very positive compared to results on those who do not get into a cardiac rehab program.

[Epigonos]

The City of Hope is the number 1 cancer treatment and research facility/hospital in the state of California and number 11 in the nation. My sister is under the care of the head of their Department of Pulmonary Oncology. The man has a national reputations as one of the top two or three doctors in his field. Besides being an outstanding physician he has an incredible bedside manner. He is one of the kindness more caring doctors I have ever met.

The other day we were discussing what to look for in finding a new doctor. His stated belief is that you look for the best technical physician you can find in your area of need. If the doctor you find has a good bedside manner well and good. If, however, his bedside manner isn't all that great but he is recognized as any outstanding doctor in his field that is who you go for. He couldn't emphasis strongly enough that expertise in his field should be the number one determiner. Bedside manner is nice but it isn't a determiner of successful treatment.

Edited September 17, 2019 by Epigonos

[+ Just966]

The City of Hope is the number 1 cancer treatment and research facility/hospital in the state of California and number 11 in the nation. My sister is under the care of the head of their Department of Pulmonary Oncology. The man has a national reputations as one of the top two or three doctors in his field. Besides being an outstanding physician he has an incredible bedside manner. He is one of the kindness more caring doctors I have ever met.

The other day we discussing what to look for in finding a new doctor. His stated belief is that you look for the best technical physician you can find in your area of need. If the doctor you find has a good bedside manner well and good. If, however, his bedside manner isn't all that great but he is recognized as any outstanding doctor in his field that is who you go for. He couldn't emphasis strongly enough that expertise in his field should be the number one determiner. Bedside manner is nice but it isn't a determiner of successful treatment.

Very true and when you manage to get both in an individual you've hit the jackpot! Physicians as a whole have had a bad rep over the years as a group with bad bedside manners and is a fact in a number of cases. However having worked with many physicians closely throughout my career, it is also true thatthere are a great many outstanding physicians who are also very openminded and have great bedside manners. Unfortunately we tend to hear less about this group as thet are overshadowed by the closed minded minority of physicians who see themselves above all others, in my experience.

[Rudynate]

Very true and when you manage to get both in an individual you've hit the jackpot! Physicians as a whole have had a bad rep over the years as a group with bad bedside manners and is a fact in a number of cases. However having worked with many physicians closely throughout my career, it is also true thatthere are a great many outstanding physicians who are also very openminded and have great bedside manners. Unfortunately we tend to hear less about this group as thet are overshadowed by the closed minded minority of physicians who see themselves above all others, in my experience.

 

 

Doctors are different now. Maybe they teach communication skills in medical school. Or maybe healthcare institutions realized that they had to humanize doctors. By and large, doctors these days are friendly approachable people that are a pleasure to deal with. My first job after I got out of the military was as an orderly in a VA hospital. There was something extremely dehumanizing about medical education back then. The residents and attending physicians were complete bastards. They were like that to the patients, to staff, everyone. The process hadn't worked yet on the medical students and they were nice normal people. But you could witness the transformation from normal person into flaming asshole with no social skills as they proceeded through their training.

[+ g56whiz]

Glad things went well @g56whiz !! You are very correct though tat you dont always get to choose your heart attack location and when it happens you just want it fixed as soon as possible! I had mine while biking in europe and had a stent placed in a hospital where only one physician spoke english and he was a young resident. The process was very efficient though as was brought in admitted, prepped in their ICU and was in radiology being stented all within the hour. After 3 days in hopsital was discharged and continued on with the holiday; although no biking, and felt great. I knew I required an addition stent and had that done when I arrived back home as they would only do 1 at a time in Europe. Hope things continue to go well and you hit the gym regularly now as studies on cardiac rehab (gym work and cardio training) are very positive compared to results on those who do not get into a cardiac rehab program.

Well . . .

Thanks @Just966 but the saga hasn’t yet ended. Recovering from a 4 stent procedure wasn’t as easy as from one. Getting that many stents at once was apparently undertaken suspecting that my platelet problem was merely in remission. That was true. I’ve had multiple extended hospitalizations sometimes with no discernible platelets at all. When I suffered an AFib problem closer to home, a new hematologist was called in who rethought my case. He figured out that H.pylori is common in this area and can cause my platelet problem. Sure enough I tested positive for H.pylori and my platelet problem was cured with 14 days of common inexpensive antibiotics. All the while my aortic stenosis has become critical. I’ve been evaluated for a valve replacement and am waiting for the procedure. Meanwhile I AM getting to the gym 3x a week but keeping my heart rate at 100 or less per my cardiologist’s request.

[+ Just966]

Well . . .

Thanks @Just966 but the saga hasn’t yet ended. Recovering from a 4 stent procedure wasn’t as easy as from one. Getting that many stents at once was apparently undertaken suspecting that my platelet problem was merely in remission. That was true. I’ve had multiple extended hospitalizations sometimes with no discernible platelets at all. When I suffered an AFib problem closer to home, a new hematologist was called in who rethought my case. He figured out that H.pylori is common in this area and can cause my platelet problem. Sure enough I tested positive for H.pylori and my platelet problem was cured with 14 days of common inexpensive antibiotics. All the while my aortic stenosis has become critical. I’ve been evaluated for a valve replacement and am waiting for the procedure. Meanwhile I AM getting to the gym 3x a week but keeping my heart rate at 100 or less per my cardiologist’s request.

Well sounds like they are getting to the bottom of things which is good. Hopefully will not have to wait too long for a valve replacement so that you can move forward. Good that you are getting to the gym in the meantime. Are you on medication to keep your heart rate down, find that weird when you work out hard and rate never goes above 100! Take care!

[+ FreshFluff]

i felt totally fine when I was in bed. But because I had some post-anesthesia issues and then almost fainted when getting up, I'm in the PACU/observation overnight. But it went fine. My organs remain in place and are clear.

 

As for searching out the leaders in the field, that's surprisingly challenging. I looked at published outcome data, even though that criterion effectively discriminates against non-academic physicians who don’t publish. Referrals tend to be hyper-local though my own GP asked for advice from an out of town colleague I also had a list of questions for consults, and I added new questions as I learned. I looked not only at the answer but at the way the surgeon thought about various issues. Bedside manner tends to affect that last criterion. Anyway, I'm confident that I did the best due diligence I could.

 

I knew this was coming, but the pain right now is a bitch.

Edited September 18, 2019 by FreshFluff

[mike carey]

I’m finally having surgery this morning.

Hope it all went well.

[+ honcho]

I'm glad you checked in FF; you have my wishes for a speedy recovery and the best possible outcome.

[rvwnsd]

Thanks for checking in @FreshFluff . How are you doing now? Better, I hope.

[+ FreshFluff]

Thanks, @rvwnsd and @honcho . I feel better can only get out of bed with a lot of help. .I can't even switch off the bedside light. That’s the norm for this procedure though. Between being in hospital and pre-procedure jitters, I've slept a total of nine hours in 3:days.

 

My hotel has no bedtop food trays so it's hard to eat.

Edited September 19, 2019 by FreshFluff

[geoffk]

you pick the one that takes your insurance.

[+ g56whiz]

Thanks, @rvwnsd and @honcho . I feel better can only get out of bed with a lot of help. .I can't even switch off the bedside light. That’s the norm for this procedure though. Between being in hospital and pre-procedure jitters, I've slept a total of nine hours in 3:days.

 

My hotel has no bedtop food trays so it's hard to eat.

Well @FreshFluff I too am pulling for your speedy and full recovery. A word of caution from my own experience. Beware of post opioid constipation. I went 10 painful days with it and clinicians tend to treat it first - if at all - with the mildest over the counter remedies that often don't work. Sometimes you just have to be aggressive. If you're having this problem and get it fixed your sleeping may also improve. Stay strong

[Guest]

Well @FreshFluff I too am pulling for your speedy and full recovery. A word of caution from my own experience. Beware of post opioid constipation. I went 10 painful days with it and clinicians tend to treat it first - if at all - with the mildest over the counter remedies that often don't work. Sometimes you just have to be aggressive. If you're having this problem and get it fixed your sleeping may also improve. Stay strong

If stool softeners and prunes don't work, a Dulcolax suppository will usually work.