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Should I get a second opinion about surgery?
Aortic Aneurysms | Last Active: Jul 19 9:33am | Replies (43)Comment receiving replies
Ta da! Update on my 2nd opinion at Stanford heart clinic on July 2... yes, I actually got myself up to Stanford and DID this... thanks to encouragement from kind folks in this group! It's about a 2 hr drive, not too far really, but I'm a homebody so it was a major effort.
First, I had an echocardiogram and then the next day I met with the cardiothoracic surgeon/aorta specialist, Dr Fischbein. Echo showed my aneurysm "measures 5.2cm extending to arch which measures 4.3 @ proximal portion. Aortic root is borderline and measures 4cm." Dr Fischbein is recommending "ascending and Zone 2 total arch replacement to remove all aneurysmal tissue". He stated, "I recommend a Zone 2 arch since the bovine trunk is so large". (Apparently the structure of my arch is a variant from the norm). During actual surgery, he will decide whether or not to replace aortic root with "bioroot". He is also recommending a PET scan prior to surgery to make sure there is no inflammation in the aorta (due to my diagnosis of giant cell arteritis which has been recently treated with course of prednisone). He said stitching the aorta graft into inflamed tissue could increase my risk of infection.
Whew! It was alot to process and I felt a bit dazed and overwhelmed in the moment (still do). I liked the surgeon though, and I felt comfortable with him. But it wasn't until days later, that I realized how much I don't understand. His recommendation is very different from the recommendation I got from my local cardiothoracic surgeon who discussed doing a "straightforward" surgery, just cutting out the aneurysm and replacing it with graft. She never mentioned the arch or root, although she did mention they were both "mildly dilated". It seems Dr Fischbein's recommendation is for more extensive and complex surgery including arch and root.
My big, obvious question is, which surgeon do I choose?
I don't feel at all mentally equipped to make this huge decision. I've read that better patient outcomes are associated with higher volume hospitals and I'm certainly trusting Dr Fischbein's opinion about my needing the more complex surgery. However, getting surgery at my local hospital is vastly more convenient and especially comforting if I should have post-surgery complications, and also for getting support from friends (I have no family). I'm 75 yrs old, live alone. Logistics of surgery and arranging for support during recovery seems daunting enough, let alone managing all of it while being away from home.
Anyone care to weigh in on how I can calmly and logically make this decision? Ha! Or perhaps bury my head in the sand and postpone surgery indefinitely? (my knee jerk choice)
Replies to "Ta da! Update on my 2nd opinion at Stanford heart clinic on July 2... yes, I..."
I would choose Dr Fishbein at Stanford. He appears to be conversant with all possible issues. Going local could be a disaster - we have had a patient advocacy business for 35 years and have done site visits at all these major hospitals. From a systems viewpoint, most community hospitals cannot compare to these major academic hospitals.
You should speak with the social work dept at Stanford. They can provide you with information about the post op protocol and process. I suspect you would be referred to a skilled rehab facility for at least six weeks.
In our previous experience with other services (primarily transplant patients at Stanford) Stanford had “tentacles” to resources outside the Palo Alto area. Patients are referred to them from all over California, the US and even Internationally.
Write down your needs and your questions and present them to a social worker. I suspect Stanford Cardiovascular surgery also has Patient Navigators who could be helpful about the operative process, etc..
The giant cell arteritis is a risk factor for rupture. What is the status of your GCA?
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You certainly have a lot on your plate. Did you discuss what the first surgeon recommended with Dr. Fischbein? I wonder if it would be possible for them to discuss your case together and come to a conclusion? I know these surgeons usually work in teams. It's hard to know what to do when you're facing such a difficult decision and have no idea yourself what's best. My gut feeling would be to investigate Stanford further. What's the hospital like? Is it clean and pleasant? (I know hospitals are clean but is it really clean?) Does the staff look happy or harassed? Is there a rehab facility nearby where you could go to recover and have nursing care? Do you have a friend who might go with you and/or stay for a few days? I live in NC and my best friend has offered to go with me to Cleveland Clinic or Mayo or wherever. Or I may just stay in NC, if I ever need surgery. You won't want many, if any, visitors, at least at first, I imagine. I think you'll feel better once you make a plan, feel good about it, get all your ducks in a row, then trust the gods or fate or karma or the good will of the universe. This group, as you say, is a life-saver.