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Doctors' Answers to "Frequently Asked Questions" - Surgery



These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Should Medications Be Stopped Before Surgery [posted 11/17/98]
Question:
I have fibromyalgia, myofascial pain syndrome, osteoarthritis, restless legs syndrome and environmental allergies. For these various conditions, I take Flonase, Claritin, Guaifed, Serzone, Ambien, and Arthrotec. I am scheduled for a rotator cuff repair in five weeks and know I can't take the Arthrotec for a couple of weeks before the surgery. Of the other meds I take, are there any others that should be discontinued? I had read that Serzone should be discontinued as early as "clinically feasible" prior to elective surgery because there was no experience with possible interactions between Serzone and general anesthesia. My internist (who prescribed these meds), orthopedist, rheumatologist, and physiatrist are all sort of at odds with each other over the issue. I'd prefer not to discontinue the Serzone if possible not being able to take the Arthrotec will make my pain levels go up considerably and all the stress of getting ready for the surgery and leaving work for six weeks will only make things worse. I'm concerned that my ability to cope and function pre-op will go down considerably if I must also discontinue the Serzone.  Do you have any experience or opinion with this med and surgery?

Answer:  Usually not a big deal. Some worry about seizures on Serzone, and you might cut it back the week before the surgery. But, I wouldn't be concerned especially.

Possible Surgical Complications
Question: I had a 7 hour surgery last October, ever since, which may be coincidental, I am unable to take medications. If I take sinus medication, I have pounding in my ears. If I take pain medication, hormone medication, my hands become tingly and have a numbing sensation. In December, an ERCP was performed with surgical procedures on my liver and pancreatic ducts, and in April I had my appendix removed. Now, I am told there is a bowel stricture that is possibly from the first surgery. I am terrified of another surgery, since I have had so many bad reactions to any medications. Is all this from too many surgeries in a short period of time, or should I be looking for another cause. After the first surgery, I had several incidents of both arms and hands becoming numb, like they were asleep. I hope you have an answer, as I have asked my Doctor and he can not tell me a cause.

Answer: I can't figure any connection unless there was damage to your liver during surgery.

Orthopedic Surgery
Question: What is the hardest orthopedic surgery you have ever done?

Answer:  I'm not an orthopedic surgeon, but I have assisted while a medical student with a limited experience. My colleagues tell me that trauma, particularly motorcycle accidents are the most difficult to perform due to the types of fractures and the dirt and foreign bodies in open wounds.

Heart Surgery
Question: Have you ever done heart surgery? If so, how long did it take?

Answer: I have assisted while a medical student and the surgery from the surgeons point of view took about 3 1/2 hours.

Exploratory laparoscopy
Question: Is a complete small bowel obstruction (2 in. stitch closed), incisional and ventral hernias common complications of an exploratory laparoscopy?

Answer: I'm not sure what your question is. Any surgical opening can result in a subsequent hernia. The size varies by the pressure of the abdominal contents and the ability of the abdominal wall to heal. Small bowel obstructions are also sequelae of any abdominal procedure-- about 5-10% of patients will eventually develop adhesions and some bowel obstructions due to surgical procedures.

Eye Surgery
Question: What surgery is available and where is it available with reference to a damaged optic nerve?

Answer: This depends completely on the cause of damage to the optic nerve (trauma, inflammation, etc.) and the amount of penetration and avenue of approach to the nerve of trauma.

Rectal Surgery Healing
Question: I had surgery and was hospitalized for 6 days for the most painful condition I've ever experienced. I had a perianal abscess. A mass of tissue "the size of an egg" was removed from between my rectum and my tail bone. I was treated at home with home health care for another two weeks. Unfortunately, a fistula developed, and I had surgery again one month later. The surgeon said all went well. I have been healing now what seems like forever. After initially taking hot baths in my whirlpool 3 times per day from returning home after the initial surgery until three months from now. I now take only two per day, before work and immediately after coming home. I am extremely careful in keeping the area clean, (my surgeon said I'm about the best he's seen), carefully cleaning with baby wipes after each BM, and powdering with Mexsana and Ammons medicated powder, and using gauze pads for drainage. When is this thing going to heal? I still have drainage, although significantly reduced. Since it has been over 4 months since the last surgery (fistula), I thought I would be healing up. One month ago, my surgeon did an internal look into the colon, and stated that of the 3-inch incision about 2 inches had healed, leaving one inch yet to heal. Is there anything I can do to speed the process, or anything I can avoid doing that might impede the healing process?

Answer: This wound sounds like it is healing by granulation. This is a very slow process. It will ensure complete healing, but it takes a long time. Maintaining good calorie intake, avoiding secondary infection, and keeping the area clean are the best methods to maximize the rate of wound healing.

Surgery
Question: Could you tell me if abdominal surgery (cesarean) crosswise or lengthwise is preferred? A student told me that a family member had a “U” shaped scar on the right side.

Answer: The skin incision is usually left to the right to aid in healing and avoid scars for swim suits, etc. The actual incision in the uterus can vary and usually has nothing to do with the external scar. Consequently, top to bottom, or left to right, the incision in the uterus is the same. The choice of skin approach is individual and of little consequence.

Surgery
Question: Will a 17 cm pseudocyst of the pancreas subside over time if a low fat diet is maintained and all other indications are okay, or should it be surgically removed? What is the danger of the pseudocyst bursting?

Answer: Diet doesn’t seem to have a lot to do with pseudocysts with the exception of alcohol. Usually pseudocysts are removed if they do not spontaneously resolve over 4-6 months. The cyst will not burst, however, it will cause chronic discomfort and increase the risk for pancreatitis.

First Major Surgery
Question:What was it like the first time that you performed a major surgery?

Answer: Going into surgery is kind of an interesting experience. One doesn't perform a major surgery on ones own until late in surgical residencies. However, first experiences in the Operating Room are lasting emotionally. Going into the OR is a lot different than the rest of the hospital. There are a lot of rules about scrubbing your hands, putting on scrubs, gloves, etc. The nurses in the OR are very particular about sterilization and any deviation from established routine is a major sin. As a consequence, there is a lot of criticism and observation of young physicians as they enter the OR to ensure that they don't break any of these "rules''. This also involves a certain amount of indirect hazing to prove that you belong. For example, "you didn't wash your hands sufficiently" or "you broke sterilization -you'll have to leave and regown". Being in masks and gloves is a little dehumanizing at first. It is also hot! The high intensity lights and the gowns teem up to a real broiler. In any case, once you have bested the nurses, scrubbed, gowned-now you enter the realm of the surgeons. Surgeons by nature are probably the most structured and heirarchal branch of medicine. The chief surgeon does most of the delicate or difficult surgery, the senior residents assist, the junior residents fight over any small procedure-like the sutures or closing- and the medical students hold retractors and try to stand around the edges and look over shoulders to see what is going on. This can be very difficult in a four to five inch cavity of the body. It is impossible in neurosurgery. The patient is drapped and really it is difficult to see them as human-part of the draping process I'm sure. The atmosphere-if everything is going well-is pretty light. Music picked by the chief surgeon, jokes, medical student hazing. The atmosphere in ER is pretty accurate-if you ever watch this show. However, if problems arise it gets deadly silent-and everyone gets progressively nervous. Putting your hands inside a living human during surgery is really an emotional experience. Seeing a heart beat before your eyes or repairing a kidney or appendix is one of the special experiences that makes being a physician such a unique job.



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