What to expect at first Mayo consult for C4-5

Posted by admgrn @admgrn, Aug 3, 2021

I have been granted an appointment with the neurosurgery team in Rochester for a consult on a herniation at C4-5.

I’ve never been to Mayo, so I’m excited to have the opportunity to be evaluated by a expert team. I do have some questions though about what happens after my first consult.

My surgical consult is with a neurosurgery resident. Is this who I’ve been paired with and will perform the surgery? Or do the residents vet patients for the non-resident surgeons?

If Mayo recommends what others have, I’m likely looking at either:
Posterior foraminotomy and discectomy
Cervical artificial disc replacement

Has anyone had either of these, and will either require staying overnight?

Anything I didn’t specifically ask that I should know as someone traveling to Mayo from out of state?

Interested in more discussions like this? Go to the Spine Health group.

@admgrn Hello and welcome to Connect. You must feel good for being offered a consult. Like you, my admission to Mayo Clinic was for cervical spine surgery 5 years ago. It is a teaching medical center and I was seen first by a non-resident neurosurgeon and later followup appointments were also attended by resident neurosurgeons. Perhaps Mayo is still trying to catch up from the backlog of surgical cases because of the shutdowns during the pandemic when they stopped performing elective surgeries and that is why you are scheduled with a resident. You will need to ask at Mayo who will perform the surgery. I did ask that question, and the non-resident surgeon (with a profile on the website) performed my surgery, and the resident surgeons closed the incision with sutures, and also prescribed the pain medications, and were the on call staff for questions after surgery. They give you a paper after surgery with a number to call with 24 hour access and the resident will call you back. My surgery was a fusion at C5/C6 with anterior approach. Per the insurance requirements, they arranged for a one night hospital stay, but usually release patients in the afternoon the same day after morning surgery after they confirm that your pain is controlled, you can eat and swallow liquids, and are able to void your bladder. The nurses will also make sure you are able to walk around and not at risk of falling. I was nauseated by the pain medicine and worried about falling, so I stayed overnight in the hospital and I think I had to leave by 2:00 in the afternoon so as not to be charged for an extra day. It's a good idea to stay at the hotel for a day or 2 after surgery in case there are complications. You might not feel like traveling yet.

My consult was arranged that I saw a neurologist first who was chosen by the neurosurgeon. I would not see the surgeon until the 2nd day so they could have tests completed for him. The neurologist ordered testing based on his exam, and there was blood work, some MRIs so we had imaging of the complete spine, and nerve conduction tests with EMG. (muscle function test) that were done by other neurologists and there were some residents assisting in that test. I was also sent to a consult with a vascular thoracic surgeon because I also have thoracic outlet syndrome that causes an overlap of symptoms common with a spine issue because they wanted to confirm what was the main problem and to understand where pain was being generated.

Because you have been given an appointment, they have already vetted you as a patient and determined that they can help. You may want to ask questions about what are the different procedures that can address your problem, and of course the benefits and risks of each. Anterior vs. posterior (which is a more painful recovery per my surgeon). With an anterior surgical path, there is a risk of loosing your voice so that your voice would be like a whisper because it can paralyze a vocal cord. It's not a huge risk, but it can happen. My surgeon told me about that risk and that if that happened, there is a surgical procedure at Mayo to restore the voice by placing an implant so the vocal cords can meet again. I didn't want hardware on my spine, and my surgeon offered a fusion with only a bone graft if I stayed in a hard collar for 3 months. I am glad I did that and the 3 months went by sooner than I thought.

I drive from out of state to go to Mayo, and we stay at a hotel with a kitchen in the room so we can fix our own meals and stay in the room. Many hotels have rooms like that. I stayed across the street from St. Mary's Hospital so I could walk to the early morning call for surgery. I had to be there at 6 AM. The night before surgery you will have a number to call for an automated answer of when to report because they don't know until the end of the prior day, how the operating rooms will be scheduled. We always packed our groceries from home, but you can go to the stores in Rochester if you have a car and navigation system to get there, but that will take extra time and you might be too tired or later than you expected when you arrive.

You will like Mayo. It is a very healing atmosphere with lots of art everywhere, and music when people play the pianos in the atrium of the buildings. They are very organized about scheduling anything you need medically and giving you printed instructions. There are many people who will help you find your way to your appointments. Write down a list of questions you want to ask at your consult.

Will you be flying to Rochester or driving?

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@jenniferhunter Thanks for the great, thorough answer.

I would be flying to Rochester from Tennessee.

I asked that my first appointment be virtual so that I can have the more preliminary conversations without having to travel multiple times pre-surgery.

They have me scheduled for two virtual appointments, one with a nurse practitioner and then the following day the resident surgeon.

Perhaps this is a bad idea to start with virtual appointments? Should I come in person instead?

How many appointments/trips should I expect to have to make before the surgery?

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@admgrn

@jenniferhunter Thanks for the great, thorough answer.

I would be flying to Rochester from Tennessee.

I asked that my first appointment be virtual so that I can have the more preliminary conversations without having to travel multiple times pre-surgery.

They have me scheduled for two virtual appointments, one with a nurse practitioner and then the following day the resident surgeon.

Perhaps this is a bad idea to start with virtual appointments? Should I come in person instead?

How many appointments/trips should I expect to have to make before the surgery?

Jump to this post

@admgrn I had one consult at Mayo (including the multiple appointments and testing) that were completed in a week. I was offered surgery at the first meeting with the neurosurgeon on my 2nd day there. He already had all the information he needed because they are so organized and efficient, so it was easy. I waited about 5 weeks for my surgery to get on his schedule. I could have had a 2 week wait, but I was still trying to get ready at home for my long recovery. I had follow ups and returned to Mayo in person at 6 weeks post op, 3 months post op and 1 year post op. Some of those followups could have been done remotely, but I preferred to go back to Mayo. They used dissolving sutures, so I didn't have to return to have any removed. They can sent orders for X-rays to be done where you live and then the disc is mailed back to Mayo because they do try to make it easier for commuter patients. You could ask about virtual follow ups. Perhaps that is preferable now that there is the pandemic to worry about and public exposure while traveling. There is real concern about another wave with the delta variant and we don't know what will happen with it.

I don't think it is a bad idea to have virtual appointments. You have to do what you are comfortable with and to get all your questions answered and it saves travel expense. You have to be completely comfortable and thrust the surgeon. I need to meet someone in person to do that, but maybe you don't need that. Ask about that too at your virtual appointment. Maybe that is why you have a couple appointments instead of one like I had as in person at Mayo. Maybe you can have all the pre-op appointments as virtual, but you need to decide what works best for you. They are very accommodating as the motto is the needs of the patient come first. If you need a virtual appointment with the surgeon who will be doing the surgery, ask for it. You might be able to get all your questions answered before that and that could be a short meeting because the surgeons are very very busy. You can also send messages on the patient portal. Sometimes a nurse calls you back with answers if the list gets long. I just contacted Mayo about following up with my surgeon on some new symptoms and he is already booked out more than 3 months with a wait list. I talk about him a lot on here by name, so perhaps I have sent him a lot of patients.

I had a plan in mind when I returned at my 6 week follow up.
Here is the story. https://sharing.mayoclinic.org/2019/01/09/using-the-art-of-medicine-to-overcome-fear-of-surgery/

This link has lots of information on planning and packing for travel to Mayo Clinic.
https://www.mayoclinic.org/patient-visitor-guide/preparing-for-your-visit
Mayo Clinic in Rochester also has Concierge Services to help make your trip go smoothly. They provide information about travel, lodging, Mayo Clinic and community resources to plan your visit. And it’s free.

Now with the Live Chat service, concierge services provide preliminary trip planning for all 3 Mayo Clinic campuses in AZ, FL and MN.

Here are Five Ways to Contact Mayo Concierge Services

Phone: 507-538-8438
Live Chat: https://www.mayoclinic.org/patient-visitor-guide
Email: concierge@mayo.edu
Web form: https://www.mayoclinic.org/patient-visitor-guide/minnesota/becoming-a-patient/concierge-travel-services
In-person in Rochester MN: Lobby hours are 8:00-5:00 Monday through Friday. Offices are located in the International Center in the Mayo Mathew’s Lobby, Executive Lounge on Mayo 5, Radiation Oncology Lobby – Desk R

So are you excited now?

REPLY

@jenniferhunter Thanks for all the detail. I did have my consult and both the nurse practitioner and the chief resident surgeon seemed very knowledgeable and made me feel comfortable.

The only thing I forgot to ask is who would be assisting with the surgery.

I read somewhere that Mayo is unique in that their chief residents run their own clinic and perform surgeries somewhat autonomously.

I’m just curious if they are assisted by a surgical tech, another resident, or an attending surgeon.

I’ll need to send a follow-up question via the portal to find out.

The surgeon is gathering some information for me on which artificial disc is recommend for my particular situation. That’s the only area where there wasn’t a clear answer and I preferred to have a better idea of what device they will use.

REPLY
@admgrn

@jenniferhunter Thanks for all the detail. I did have my consult and both the nurse practitioner and the chief resident surgeon seemed very knowledgeable and made me feel comfortable.

The only thing I forgot to ask is who would be assisting with the surgery.

I read somewhere that Mayo is unique in that their chief residents run their own clinic and perform surgeries somewhat autonomously.

I’m just curious if they are assisted by a surgical tech, another resident, or an attending surgeon.

I’ll need to send a follow-up question via the portal to find out.

The surgeon is gathering some information for me on which artificial disc is recommend for my particular situation. That’s the only area where there wasn’t a clear answer and I preferred to have a better idea of what device they will use.

Jump to this post

@admgrn I'm glad I could help! It sounds like you did great job getting onboard and asking questions. That is how you be a good patient and have a great recovery by embracing the situation. In my spine surgery, the neurosurgeon (not a resident) did my surgery, and the resident surgeons closed the incision and did the follow up for discharge and writing prescriptions. I know that the neurosurgery program at Mayo is 7 years and my surgeon teaches in it. I also had surgery on my ankle last year at Mayo with an orthopedic trauma surgeon, and there were 3 assistants in the operating room. I know one was a surgical resident and I met her at my appointment when I met the surgeon 2 days before the procedure.

I'm sure they will have you arrive a couple days early for Covid testing before your surgery. Also make sure you get everything done and organized at home to make your recovery easier. Do you have a surgery date scheduled?

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