Surgery in 10 Days: still not sure what my surgery entails

[Graysonlaw]

I am not a happy camper Yesterday I mailed a note to the Dr. expressing my frustration. I still don't know what type of surgery I'm having and I am only about 10 days out. I've left messages with the surgical nurse and have received NO response.

I've reviewed all my notes, including the pre-op notes from the surgeon's office and they all reference the "Gill procedure." When I research that procedure, I get all kinds of stuff -- some with and some without fusion. I am relatively certain that fusion is part of my operation, but I want details on how they intend to do this. My research leads me to believe the "Gill" is shorthand for an open fusion, i.e. a single 5-7 inch incision. I would much prefer a PLIF or other minimally invasive procedure, but if I can't talk to the doctor or the nurse, I guess I don't have a vote here??? That just sounds wrong. I'd at least like to hear why they would do this rather than PLIF, so I can make an informed decision.

At this point I do not want to postpone surgery or look for another surgeon. I just want to move forward. I hope that my letter will register and I will get a quick and apologetic call. Of course, I suppose the doc could say that he doesn't want to deal with a "whiner" patient, but that is the risk I knew when I sent the letter. If he were to act that way, I don't think I'd want him to do the surgery anyway. Interestingly, both nurses I dealt with in my pre-pe were glowing about how lucky I was to have Dr. Davis. AHHH!

Short of showing up unannounced and demanding to see the Dr, any advice???

[KBear]

I am not a happy camper Yesterday I mailed a note to the Dr. expressing my frustration. I still don't know what type of surgery I'm having and I am only about 10 days out. I've left messages with the surgical nurse and have received NO response.

I've reviewed all my notes, including the pre-op notes from the surgeon's office and they all reference the "Gill procedure." When I research that procedure, I get all kinds of stuff -- some with and some without fusion. I am relatively certain that fusion is part of my operation, but I want details on how they intend to do this. My research leads me to believe the "Gill" is shorthand for an open fusion, i.e. a single 5-7 inch incision. I would much prefer a PLIF or other minimally invasive procedure, but if I can't talk to the doctor or the nurse, I guess I don't have a vote here??? That just sounds wrong. I'd at least like to hear why they would do this rather than PLIF, so I can make an informed decision.

At this point I do not want to postpone surgery or look for another surgeon. I just want to move forward. I hope that my letter will register and I will get a quick and apologetic call. Of course, I suppose the doc could say that he doesn't want to deal with a "whiner" patient, but that is the risk I knew when I sent the letter. If he were to act that way, I don't think I'd want him to do the surgery anyway. Interestingly, both nurses I dealt with in my pre-pe were glowing about how lucky I was to have Dr. Davis. AHHH!

Short of showing up unannounced and demanding to see the Dr, any advice???

It sounds to me like the doctor is not communicating well with you, which is necessary. I would NOT go through with a surgery that I did not fully understand and had researched. You may do research and come to the exact same decision as the doctor and decide on this surgery; but it needs to be your choice. You can not take back a surgery and a revision is a very serious operation. Do your research, if the doctor doesn't call you back, then I would postpone surgery and go get some more opinions (which is good to do anyway, I would say at least 3 opinions before surgery). I am not trying to scare you; but you need to be in on the decision for surgery, to understand the surgery and make an informed decison. Whether the doctor is the best in the world, I would not blindly trust their judgement. Good Luck!

[Justin]

Short of showing up unannounced and demanding to see the Dr, any advice???

Hi Pete,

I can understand your frustration, especially so close to your surgery date. Instead of showing up unannounced, is there a way you can call his office on Monday and set up an appointment with him?

As a patient, you have patient rights which include Informed Consent. This means that if you need a treatment, your health care provider should give you the information you need to make a decision (see below).
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Informed Consent

More and more, patients and their families are becoming responsible partners in their health care. When you go for medical care, you usually talk with the doctor to get his or her recommendations about the next step in your treatment. Most people follow these recommendations, but they are not required to do that. If you are an adult and you are able to make your own decisions, you are the only person who can choose which course of action to take.

All medical care requires the consent of the patient (or someone who is authorized to consent for the patient) before the care plan is carried out. In some cases, you approve the doctor's plan by simply getting a prescription filled, allowing blood to be drawn for lab tests, or seeing a specialist. This is called simple consent, and is OK for treatments that carry little risk for you.

What is informed consent and what does it involve?

In cases where there are larger possible risks, you may be asked to agree in writing to the doctor's plan for your care. Informed consent recognizes your need to know about a procedure, surgery, or treatment, before you decide to have it.

After your first talk with your doctor, you may have only a general idea of your doctor's treatment plan for you. You will likely want to know more so that you can think about the ways this plan may affect your health and your life. In order to freely decide whether the risks are worth the benefits you expect to get from the treatment plan, you must understand the risks and drawbacks of the plan. Most people find that they need to get some questions answered before they can decide on a treatment plan that carries some risk for them.

Informed consent is a process that includes all of these steps:

• you are told (or get information in some other way) about the possible risks and benefits of the treatment
• you are informed of the risks and benefits of other options, including not getting treatment
• you have the chance to ask questions and get them answered to your satisfaction
• you have had time (if needed) to discuss the plan with family or advisors
• you are able to use the information to help make a decision that you think is in your own best interest
• you communicate that decision to your doctor or treatment team

Here's a link to comprehensive information regarding Informed Consent on the American Cancer Society Website --> Click Here..

Copyright 2009 © American Cancer Society, Inc.

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Below is from the attached PDF "The Patient Care Partnership: Understanding Expectations, Rights and Responsibilities" from the American Hospital Association.

You and your doctor often make decisions about your care before you go to the hospital. Other times, especially in emergencies, those decisions are made during your hospital stay.

To make informed decisions with your doctor, you need to understand:

• The benefits and risks of each treatment.
• Whether your treatment is experimental or part of a research study.
• What you can reasonably expect from your treatment and any long-term effects it might have on your quality of life.
• What you and your family will need to do after you leave the hospital.
• The financial consequences of using uncovered services or out-of-network providers.

Please tell your caregivers if you need more information about treatment choices.

©2006-2009 by the American Hospital Association. All rights reserved.

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Here's a cut and paste from another thread that helps explain the Gill procedure:

Treatment of patients with symptomatic spondylolytic spondylolisthesis consists of nonsurgical management or surgery whereby surgery yields better outcome [1]. Surgical management comprises primary reconstruction of the pars interarticularis defect, decompression of the nerve root without fusion, decompression with (instrumented) spondylodesis, or a combination. Transpedicular fixation with interbody fusion is the most frequently advocated surgical technique [2-9].

A less invasive approach, in which nerve root decompression is performed without fusion, has been described by Gill [10]. The operation according to Gill consists of removing the loose lamina and excising the fibrocartilaginous tissue in order to decompress the nerve root. Various studies have reported satisfactory results [11-13]. Recently, we have presented the long-term results of 42 patients treated with bilateral nerve root decompression according to Gill or unilateral decompression; i.e. hemi-Gill. At 11 years after surgery improvement of leg pain was reported in 88%, and 71% documented good result in terms of patient satisfaction [14].

Although most surgeons perform nerve root decompression with instrumented fusion in the treatment of spondylolytic spondylolisthesis, scientific proof justifying instrumented spondylodesis over simple decompression is lacking. The clinical results of instrumented and noninstrumented spondylodesis seem comparable with decompression according to Gill; 60 to 90% of the patients have good results [4,6,15-20]. The main arguments that favour intercorporal instrumented fusion are enlargement of the neuroforamen to relieve nerve root compression, and prevention of progressive slippage. Instrumented spondylodesis, on the other hand, constitutes major surgery with considerable blood loss, longer operation time, and significant complication rates which correlate with the extent of fusion [19,21,22].

Gill's procedure is a less invasive alternative technique to instrumented fusion. The operation time is shorter and the paraspinal muscle injury is less extensive. Patients may have less surgery-related low back pain and mobilise quickly, indicating short hospitalisation, fast recovery and early resumption to work. In addition, costs and complications related to instrumented surgery are avoided. However, secondary instrumented surgery might be necessary in patients with recurrent or persisting leg pain due to foraminal nerve root compression [14].

The controversy in the treatment of low grade spondylolytic spondylolisthesis justifies a randomised controlled trial comparing instrumented spondylodesis with nerve root decompression alone. The purpose of our study, the Sciatica-Gill trial, is to assess the clinical outcome and cost effectiveness of both surgical strategies on the short term (12 weeks) and long term (2 years). There will be a trade-off between persisting or recurrent leg pain in the Gill group and higher complication rates and costs in the spondylodesis group. Secondly, various subgroups of patients will be identified who may benefit primarily from one of the allocated surgical treatments.

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I hope this helps and good luck!

[Graysonlaw]

Do your research, if the doctor doesn't call you back, then I would postpone surgery and go get some more opinions (which is good to do anyway, I would say at least 3 opinions before surgery).

I have had 4 opinions. Three said that surgery (fusion) was necessary to stabilize my spine, but we never discussed details of the surgery. The third (my current surgeon) talked about the Gill procedure, but at that time I had not found this group, so didn't know how to talk the lingo. If I do not hear from anyone from his office in the next week, I will definitely cancel.

That said, if I talk to the surgeon and he explains that the Gill is an open (as opposed to minimally invasive) surgery, I guess I'll have to mull his reasoning before going forward. I'll be certain to let you folks help me consider my options!

Thanks!
Pete

[Dave]

That said, if I talk to the surgeon and he explains that the Gill is an open (as opposed to minimally invasive) surgery, I guess I'll have to mull his reasoning before going forward. I'll be certain to let you folks help me consider my options!

Thanks!
Pete

Pete,

Ultimately the decision on which procedure is best for you is yours. IMHO you need more information as to what your surgeon plans on doing. I do not think that you should go into any surgery unless you fully understand what is being done, what are the expected outcomes, what are the potential pitfalls and what are the alternatives. If your surgeon has issues with this, then they might not be the right choice. Doctor/patient relationship must be built on trust and knowledge.

This is a major surgery you are facing. You are the patient and as Justin stated above, you have the right to know everything.

Good luck and Peace be with you.

[Terry Newton]

I have met my share of arrogant surgeons in my time. Unfortunately many of them forgot that they work for us in the process. We are also paying them which means we have a right to know what we are paying for. This surgeon is acting like he is God and that you need to trust that he is selling you this car, sight unseen, because he is the best car salesperson around, in all these parts.

I have always treated my doctor/patient relationships like a partnership. I expect that I will be a part of my health care decisions, I research things for myself, I ask a lot of questions, I treat the physician and their staff, with courtesy and respect and, expect the same treatment in-kind, I reserve the right to get second and third opinions if I deem it appropriate for my care.

You are the consumer, your money talks, you have rights that need to be met. I support you in getting answers from him or going elsewhere. If something goes wrong you will be the ultimate victim.

Good-luck in whatever you choose.

[runagain]

Pete,

IMHO, I'd be very careful. I read an interesting book recently, written by an MD, about why doctors make mistakes and what patients should know.
One point particularly sticks out: doctors were asked what they would do if a MD did not communicate well with them, the answer was get another doctor.

In the book, a lot was made about how important it was to have good communication with your physician.
It is your body. You have rights.
You are not being treated right.
Any surgery is major and you have a right to informed consent.
That also means if you have questions, you have a right to have them answered.

[Gilbert P]

Hi Pete

I understand your frustration, been there done that, I also looked up the Gill procedure and was overwhelmed with all the information.

Please get all the information you can and communication with your Dr.

I wish you all the best,

take Care

Gil

[Graysonlaw]

Still NADA. I was able to confirm that my surgery is still scheduled for Wednesday, but I have not heard from the Dr. or the surgical nurse regarding my multiple questions. I went so far as to send a letter a week ago and left another message for the nurse yesterday.

I did get a letter from the surgeon's office yesterday that tells me all the things I should have known several weeks ago (i.e. what I need for pre-op) and it also confirmed the date and time. As for procedure, it simply says "Lumbar laminectomy fusion with instrumentation." I take that to mean an open procedure rather than minimally invasive.

My problem remains that I've got a host of questions. I do trust the surgeon. Not only is he highly respected in the Baltimore area, but two nurses I saw (not affiliated with the hospital) gushed at how "lucky" I was to get him. Based upon this I am extremely reluctant to cancel. Also have family coming from out of town to assist. So, I feel a little stuck and makes me want to scream!

This just adds to the stress one feels before embarking on such a significant and scary life experience. Thanks to all of you for listening! No one else will . . . .

Pete

[ajj1001]

So, I feel a little stuck and makes me want to scream!

This just adds to the stress one feels before embarking on such a significant and scary life experience. Thanks to all of you for listening! No one else will . . . .

Pete

What a nightmare, I'd just keep calling to say that you need to have a few questions cleared before surgery as you have concerns. I researched what I was having done and it still took a couple of sessions with a spinal nurse and an anaesthetist to clear up stuff pre op so can't imagine what you are going through.

Never heard of laminectomy fusion with instrumentation but then I had never heard of a posterolateral gutter fusion before I was told t I was gong to have one. Did think that a laminectomy and a fusion were different things? I can understand why you need questions answering.