OFF TO SURGERY ON MONDAY....Cleveland Clinic

Cleveland Clinic Complex

Inside Surgical Center

I will be having surgery on Monday at Cleveland Clinic for my appendix.  Therefore, after I post today, I will not be posting until I get back and feel like sitting here.  Some of you may ask why am I sharing my experience so openly.  Well, it may be helpful.  Not so many people let you in their mind and since mine is so empty it will not be too complex for you to follow me.  Just joking.

I have chosen Cleveland Clinic as my provider for health care.  I am not one that cares a lot about the touchy feely of delivery.  I want the best staff I can have.  I rate the technical expertise and outcomes top on my list.  If they relate to me in some great way that is a plus, but not required.  I have researched both the clinic and my physician.

My experience at Cleveland Clinic has been so positive so far.  Maybe because it is very much, if not  identical to Duke.  I am very familiar with a hundred people asking the same questions, the multiple roles of nurses, and all the hustle and bustle.  Leah will be with me until they let me be on my own.  We are thinking that 24 hours after I have had the procedure, I will be good to go.  To back up just a little...I have been having bowel problems for quite a while, mostly controlled.  I told my primary care, Ann Tann, MD, after thanksgiving at a regular appointment.  She ordered a CAT and it showed a 2 cm, very small, lesion at the site of my appendix.  I was referred to one surgeon who chose to send me to another one who is very skilled in appendix work.  No kidding.

Dr. Chilikonda

The most critical step for me was to choose the best surgeon I could find.  I choose Sricharan Chilikonda, MD.  This may be a bit of a surprise to most of you who know I have a bias.  He is listed as Surgical Oncology, Minimally Invasive and Robotic Surgery...that is what is on his card. He is part of the Digestive Disease Institute.  His interests are: biliary and pancreatic surgery, gastrointestinal surgery, general surgery, hepatobiliary and pancreatic surgery, hepatobiliary surgery, Hepatocellular Carcinoma, laparoscopic liver surgery, laparoscopy, liver, Liver surgery, Metastatic Cancers, Surgical Oncology. I guess he has the abdomen covered. .  He will be repairing a hernia at my belly button, so as part of the Hernia Institute, guess this is also a match.  He was recruited from University of Pittsburgh.  He was on staff in the Division of Surgical Oncology at the University of Pittsburgh where he served as Director of Robotic Surgery. He is currently in the Department of Hepatobiliary and Transplant surgery and is Director of the General Surgery Robotics program at the Cleveland Clinic.  OK so I think I have it covered.  I cannot choose my anesthesiologist.  The most important thing I wanted to know was how it actually worked in the OR.  The anesthesiologist, the MD, supervises anesthetists during procedures.  In this case the supervision ratio is 1:3 with additional backup when needed.  I feel comfortable with this.  Normally, the nurse anesthetist is so skilled that he/she does not need the MD.  However, when they need them they really need them.  It is a good question to ask, although the staff will think you are a little crazy , but do not be afraid.  There are some hospitals in this country that do not have a MD on site. 

I will be having general anesthesia.  I have had it so many times in the past four years, that it is almost routine for me. Today's induction is so improved as is the recovery.














I am having moments of pure panic.  Most of the time I talk myself into knowing that this is such a little thing.  The report from the CAT scan was: DIFFUSELY DILATED APPENDIX, THIS IS MOST LIKELY MUCOCELE OF THE APPENDIX   THOUGH APPENDICEAL CARCINOMA CANNOT BE EXCLUDED.  One of the most exciting things about Duke and Cleveland Clinic is that they have a chart that is available to patients.  Everything is open and known to the patient.  This is the goal of all systems in the future.  Many times physicians will take it upon themselves to tell you what they want you to know.  These times are getting fewer.  Unfortunately, in my opinion, the most incompetent of the physicians use lack of information to avoid letting their patients know of their incompetency.  Information is not withheld in any form.  .Some of you would prefer not to know details.  I shall never forget, setting up one of the first patient education committees in the country at Barnes in St. Louis.  We brought the doctors to the table, yelling and screaming.  They wanted nothing written.  My preoperative information came in a personalized booklet of over fifty pages.  Quite an advancement.  I really hate it when patients do not take advantage of the improvements.  I am hoping that every reads every word of the things they get, researches on the Internet and talks to professional friends that they may have.

Back to being scared.  Of course I am.  My closed mouth but wonderful grandmother, would be shocked to know that I was letting even casual friends know how I am feeling.  My family will relate.  Coping with the next few days will be a challenge.  Especially since I am in a different place and have not developed any friends and am not yet active in my church.  My sister has been a constant support to me in the last twenty years, and she is no longer close by.  That saddens me so much. Leah has been with me on brief occasions, but never for the long haul.  Lots of waiting.  She will be so helpful.  My strategy is to keep busy.  Today I am cooking corned beef for the family...cleaning house, and getting my things in order.

Another thing to do, I have to make sure my health care power of attorney is in order.  In the past the person I trust most, my friend Jane, has held that. I really do not feel that close family should be put in a position of having to make the decisions.  It still reads that way but I have to rewrite it.  I know that my daughter will use her as a resource if it is needed and will listen to her sage advice. Making sure your financial and healthcare poa is in order is a must.  The other document that really needs to be in order is the DNR document.  I know that this is a real low risk procedure, but variables exist...so lets be prepared and make it easier for the people who have to make the decisions and take care of you.  So many people ignore the preparation of these documents as well as a will.
        I will re read all my instructions this afternoon.  I have to do only clear liquids on Sunday and not eat anything after midnight.  So some hearty meals are in order...but not too much.  Although they told me that there would be no bowel prep, thank goodness, I was still worried.  that prompted an additional call to the nurse practitioner in the surgeons' practice.  She said it was great I raised the question.  We all know our bodies better than anyone.  So we agreed that I would do a simple laxative, and only have clear liquids on Sunday.  I hope every patient in the world compares their body with the general knowledge and asks and asks and asks.  What if he does need to use and incision rather than the laproscope that is planned?  The cleaner the better.  If I had complete evacuation every day, this would not be a concern.  I do not.  So lets get that bowel as clean as possible.  Thank goodness it will not be a Go Lightly thing. 
I don't need to carry anything much but my documents and iPhone.  The hospital has clothing.  I am not interested in pretty, so that gown is very comfortable and utilitarian.  I will not be wearing makeup--most of you will want at least a little lipstick, but not me, just something else to keep up with.  I will have my glasses and iPhone:  they have comb and brush, dental care items so I will leave those at home. My daughter will carry a little bag for me. Forget the book, I have a regular book and a audio book ready to go on my phone.  The hospital will have stuff to support walking and other movements. No special pillow, Most hospitals will not allow this, thank goodness because of the bed bug problem and general inability to know cleanliness of individuals.  So get over personal preferences.  No jewelry, lock it up.  Prepare to amuse yourself with people watching, resting, and whatever TV might be available.  And my iPhone.  I will have another bag, if a longer stay is required, but still will take very little.

The most important thing to me, is to have an open and inclusive conversation with my daughter.  This is above all the most important thing.  Now, this conversation is assuming that this is a simple 12 hour procedure.  But, it must  include all alternatives.  This will be so hard for me, but harder for her.  Taking enough time to take care of this business is worrying me more than anything.  Talking to my other family and friends is important, even critical.... although this is a minor major surgical thing. 

Well you are in my mind.  I know that there are so many other things to say, but for now this is enough.  I will be back with you when my experience is over.  Love my Blogging and will be back soon

Til next time.....