Wednesday, July 10, 2013

Pre-op Appt, Heart Valve replacement surgery. A few pics (Bay Beach, 4th)

For all reading this, obviously I already had the pre-op Appt today but no-less please consider any suggestions I should still ask? I have (had) the Cardiothoracic Pre-op at FMLH (Froedtert) on Weds, any suggestions or things you think I should specifically ask/remind them of? - I did request copies of UW's Anesthesia records (just the last 6 mo) and Dr.Bragg advised me to remind Dr.Mitchell on the day of surgery that when placing the chest tubes they need to be weary of the Thoracic shunt catheter as it runs down/over the same area chest tubes are typically placed. I know Dr.Maas has also faxed over her Endocrine-Cortisol recommendations and though she is on vacation that week advised one of her partners of my case if a consult where requested. I am not to sure what else I might be forgetting if anything?

Some of the things I kind of knew and which  l learned today include that surgery is expected to take anywhere from 4-8 hours with arrival (as of now) at 5am and surgery itself scheduled at 8:30am. My Surgeon did not think he would have to remove the Port-a-Cath but also said it was dependent on surgery and what all they end up doing (apparently) and in my Cardiologist's last clinic note he mentioned his recommendation would be to remove it at the time of surgery to minimize infection risk. The NP today thought it would be ok and would be able to be used once surgery itself was completed. Tests done today at pre-op where pretty standard including EKG, Chest Xray, 7 vials (!) of blood and meeting w the NP. A test to look at the arteries in the heart was done previously and was fine. Bactroban a type of infection preventive is used intra-nasally beginning 3 days pre-op as well as the more standard hibiclens the night before and morning of surgery.  A trans-esophageal Echo is done before the valve replacement and then again to check it's function post-replacement. All lines (arterial line, a direct line (in the neck) into the carotid artery, temporary pacemaker lines, chest tubes, and breathing tube) are all placed once anesthesia is commenced and I am fully asleep. These all generally stay in place for 3-4 days post-op minus the breathing tube which may be pulled as soon as 3-4 hours post-op once stable in the ICU.  They also have the cortisol dosing recommendations per my Neuro-Endocrine dr and the NP planned to share these w whoever the Anesthesiologist will be as well as she was able to pull up my records from UW's Anesthesia (Dr.Bragg's surgeries) and will share those. I emphasized multiple times how important it was that the Anesthesia team at FMLH no matter who is assigned to my case be made aware of my airway issues and be made to review UW's records. Anesthesia has not often went well at FMLH in the past so I am pretty uncertain about this aspect. =/

The things to be sorted out yet include as mentioned above Anesthesia, making sure they follow the same plan that UW's team has put together and used over the past 2 years with Dr.Bragg's many shunt surgeries. In addition the other big thing is I see my Pain Mngmt dr tomorrow and putting together  a post-op pain care plan with her and having her talk to my Surgeon/team about her recommendations. The NP today said they could utilize the FMLH Pain Mngmt team but I definitely pushed that I want my own PM dr involved in decisions! I also need to remind the Surgeon and team on the day of surgery, per Dr.Bragg that they absolutely need to be careful of the Thoracic shunt as the lines they place for chest tubes go in to the same general area on the one side as where the Thoracic shunt lies. The programmable aspect of the VP and TP shunts should be ok during and post-surgery. I do see Dr.Bragg Friday for post-op fup and hoping she can remove the dissolvable stitches from the Thoracic shunt surgery 2 weeks ago as these are incredibly ITCHY. I am not to sure if she will suggest or we will decide to move down either of the 2 shunts settings, on one hand I think we should and on another hand I think maybe we shouldn't? I guess i'll talk to her then, the reason  I tentatively think not to is what if it was to low, then i'd have to call them back and have the shunt(s) re-adjusted again which I super don't want to have to do. I'll see what she (Dr.Bragg) thinks, in all reality I really think the reality of us having to turn the shunt setting back up if we did turn it back down is pretty slim as long as we only did one setting change which is what Dr.Bragg pretty much always does. It really is up to her anyways.

Otherwise the only other new thing is the Hand surgery recovery has been well; I finally got to take the splint/case off for good last week and the only real issue is that the area around the scar is SUPER sensitive and so I definitely hope OT has some suggestions for this. I don't remember this much sensitivity w other surgeries but there may have been.

Alissa and Quinn (niece and nephew) came last week after I picked Lis up on Weds and Quinn up on Thurs which though incredibly tiring was also a lot of fun. Friday we as a family all went up to Bay Beach, the amusement park by Green Bay and then after taking the kids swimming Sat. afternoon we celebrated Quinn's 11th Bday party on Sat night and they all went to the races while my other nephew Zander spent the night at my Apt. Very fun. :)
                            I don't have many of the pics from any of those days on my computer desktop.

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