Search for tag: "procedures"

Interviewer: So maybe you're considering getting a cosmetic or a reconstructive procedure done. We've all seen the before and after photos, but it's there's sometimes a journey in between those two points, and to kind of talk us through this is Dr. Courtney Crombie. She's an Assistant Professor and plastic surgeon with University of Utah Health.

Now, Dr. Crombie, what are some of these, you know, you see in magazines, you see on advertisements, you know, the before and the after. But, you know, there's a lot more involved with the recovery, regardless of what your procedure is. Why don't you walk me through some of the things that you as a surgeon really want your patients to understand when they're first thinking about these kinds of procedures.

Dr. Crombie: So most of the time, you know, our patients come and meet with us. They'll have at least one, and sometimes multiple meetings with us prior to a given procedure. And then on the day of the procedure, once again, we meet in the morning. They'll meet their anesthesiologists, and then they'll meet with us, and usually, depending on what the procedure is, we'll do our markings and our consent forms and then off to surgery.

After the procedure, we usually see them within the first week for their first follow-up appointment, and it'll either be with the surgeon, or someone on our team to check in and make sure that they're doing okay with their pain medicines and that our surgical sites are doing okay, if there is drains involved, you know, a drain check and just to see overall how they're doing.

On my service, I usually end up seeing patients probably every one to two weeks after their procedure until the kind of the final product of our procedure is done, which may be anywhere up to six weeks later. All our checkups were following drain outputs and removing drains, checking on wounds, removing Steri-Strips, and when it is time to start doing massages on massaging of scars, we will talk you through that portion, talk about sun exposure to scar, and get you through everything to the end product.

Interviewer: So beyond say scar care, wound care, pain management, what are some other things that they also should be keeping in mind? I would assume that, you know, they're going to be out for a while, they're not going to be able to, you know, lift anything, run around with the kids. What are some of those other kind of, you know, social and psychosocial aspects of all this?

Dr. Crombie: We discuss with you your daily activities of what we start allowing you to do, from walking the dog to, you know, carrying your children, playing with your kids, riding a bike. Whatever the activities are, we're usually discussing what those things are that we think is okay to do based on what wounds you have, what muscles are lying under those wounds. So we're very involved with everything because we want you to have the very best outcome for the things that we're helping you through.

Interviewer: So a patient who, you know, they hear that it's going to be a process, right? They hear maybe they're going to hurt for a while, they might have to, you know, work through one thing or another, what is something you tell them to kind of reassure them, if this is something they really want to do?

Dr. Crombie: I remind them that there are going to be good days and bad days, and on your good days, you really need to sort of tone it down so that your bad day, you don't totally crash. And I ask them about their support system, and I encourage their significant others to help them through on, you know, to be their cheerleader, and to help them through on their bad days, and hopefully they have a good support system. We want our patients to do well. It's a reflection of us, of course, and, you know, we want the best for our patients. We want good outcomes for them. And that's why we're here.

Interviewer: We're here with Dr. Barbu Gociman, a craniofacial surgeon and the Medical Director of the Cleft Center here at the University of Utah. Dr. Gociman, when does a parent usually find out that their child might have a cleft lip or a cleft palate?

Dr. Gociman: Here in the United States, most cleft lip patients are diagnosed with their condition during pregnancy. So the parents will know that the baby is going to be born with a cleft. By contrast, when the babies have only a cleft palate, usually the diagnosis is not obvious on ultrasound and is not made prior to birth. So the diagnosis is made in the first day of birth.

Interviewer: So what are some of the things that a parent needs to be doing those first few months with their child to make sure that . . . how early are they getting surgeries? What do they need to be doing the first couple months?

Dr. Gociman: Considering what the problems are, as we said, the lip, the gum, the hard and soft palate are involved. One of those structures or all of them, you can imagine the baby will have difficulty with feeding, with suckling. If a cleft lip is present, they cannot create a seal around the nipple. If there is a clefting of the palate, the babies will have a very hard time developing suction. Specialized devices are needed to provide adequate caloric intake, meaning adequate amount of milk or formula to keep with the needs of the newborns.

Interviewer: When does the first surgery usually take place?

Dr. Gociman: For a cleft lip patient, if we assure adequate nutrition, there are no other anomalies associated with the condition, and the baby grows normally, the timing is approximately three months of age. And the reason for that is the baby has grown sufficiently enough to withstand the anesthesia without any additional risk, and all the structures that are involved in the cleft are bigger and stronger, and the operation is performed easier, with less risk of things breaking down or having other complications during the surgical procedure.

Interviewer: What happens during those first three months while you're waiting for the child to get stronger? Who should they be visiting?

Dr. Gociman: Here at the University of Utah, we have an excellent system in place to assure that all the needs of cleft patients are met. For a cleft lip patient, the diagnosis is most of the time made prenatally, so the parents already had a prenatal visit with the nurse coordinator, with the physician assistant in charge of the cleft team, and with the craniofacial surgeon that will perform the repair. So they already have a good idea of what is coming.

Once the baby is born, especially if it's born here, close, at the university hospital, or even at a hospital in close proximity, a cleft surgeon will visit with the family, evaluate the exact anatomy of the cleft, and start with the process of treatment. And this involves two major elements in the first three months of life. One is assuring adequate feeding, and, as I said, there are different modalities through which this is achieved with specialized nipples, specialized bottles, specialized techniques of holding the baby to prevent regurgitation.

And the second thing that is as important is what we called molding. We are trying to achieve normal anatomy. Due to the lack of continuity in the muscles of the lip and the palate, the elements that compose those structures can migrate apart, and the anatomy becomes very difficult to recreate. So in those first three months of life, we attempt to bring all those structures together. We try to reshape the nose, the lip, the alveolus, and the palatal shelves.

Interviewer: Seems like the treatment of cleft lip and cleft palate has more than just the surgical components and just the restructuring. There's also speech. There's also feeding. There's also socialization. What sort of resources are available to a new parent here with the cleft team?

Dr. Gociman: We have a comprehensive cleft team. First, we see the patient right after birth to assure adequate feeding and the molding has been started. And at the same time, we schedule a clinic visit with the cleft team so the family gets a chance to visit with all the members of the team. And each member has an important role in cleft care. So the team is made up of a cleft craniofacial surgeon, an ENT surgeon, pediatric orthodontist, a speech therapist, feeding specialist, and a social worker. So the reason for that is to assure that all the problems encountered in cleft are addressed from the beginning and the family has a complete understanding on all the steps and all the elements that need to be addressed.

As such, the cleft surgeon will talk about a cleft repair, the sequence of different operations based on the particular anatomy of the patient.

The ENT surgeon will talk about hearing. Most cleft babies have a hard time with draining the ears and have significant infections of the middle ears and require tubes early on. Also, they have to assure later on that the speech is adequate, possibly perform speech correction surgeries down the road.

The orthodontist, as I said before, initially will have a very significant role in performing the molding and then, later on, in assuring eruption of the teeth, orthodontic work, and help with any orthodontic operations.

The speech therapist will be there, initially, to help with feeding, assure that the method that is most effective is used, and then, later on, as the speech starts developing, address any problems, involve the patient in speech therapy, and so forth.

Finally, the social worker is there at all steps of cleft care just to address any social problems that may arise, and we have quite a long number of issues that arise in our cleft patients. So it's a very useful component of the team.

Interviewer: So I understand that cleft care can be a long process. It's years and years of treatments and procedures. But it seems like this type of team can really help set a child and their family on the right path and get them started and give them a step up.

Dr. Gociman: It has been shown over and over again that having a cleft team and having a professional cleft team makes all the difference. This is a standard across the United States. We are proud to have the largest, oldest, dare I say, the best team in Utah and in surrounding states. So we are getting patients from all the states around us. We pride ourself with our results, with innovation. We publish a lot. We are actively involved in research. And we are always trying to improve our technique and our results. We are very critical with our results, and we are trying to achieve perfect outcomes every time.

Announcer: Health information from experts supported by research. From University of Utah Health, this is thescoperadio.com.

Interviewer: A vasectomy is one of the most effective forms of birth control available. But there can naturally be some apprehension about a procedure that's been nicknamed "getting snipped." Joining us is urologist and male fertility specialist, Dr. Alex Pastuszak from University of Utah Health. And in order to help make this a little less scarier procedure, Doctor, I'd like you to give us an overview from preparation to procedure what to expect during and what recovery looks like. But first of all, let's talk about the procedure itself first. So where does it happen? Where does it all start?

Dr. Pastuszak: Yeah, great question, Scott. So a vasectomy is one of the easiest procedures that anybody can undergo. We either do it in the clinic or in an operating room as a day surgery. So it's very simple.

Interviewer: All right, a very simple operation, which is fantastic. What exactly happens? Now, again, there's that getting snipped thing, which brings up visuals that I don't want to talk about. But it's nothing like that actually. It's very non-invasive.

Dr. Pastuszak: No, exactly. I mean, we make one or two very small holes in your scrotal skin, and we just pluck your vas up. We'll clip it. We'll cut it, make sure the two ends don't come back together, and then we'll put it right back. All of that takes anywhere from 15 to 40 minutes.

Interviewer: So actually, probably preparing for and recovering from it takes a lot longer than the surgery. I mean . . .

Dr. Pastuszak: That's right.

Interviewer: You'll probably spend more time in the waiting room than you will actually getting the procedure done.

Dr. Pastuszak: Absolutely. I actually tell guys to budget about an hour, an hour and a half. And as I just told you, a minority of that is actually spent doing the procedure.

Interviewer: A lot of guys think it's kind of painful. So it does use local anesthetic, which is another advantage, right? You're not completely going under. It's just in the area, like if you went to the dentist, for example, and had a tooth extracted.

Dr. Pastuszak: That's right, and that's part of what makes it really safe. And a lot of guys come in very anxious about it. But we give them some medication to relax ahead of time. And like you already said, they get some local anesthetic. At the end of it, most of them ask me, "Why was I so anxious? I shouldn't have."

Interviewer: Yeah, I got you. And so I guess I'm a little anxious about the fact I'd be awake during this procedure, right? So should I be concerned about that, or how do you kind of alleviate, you know, that stress?

Dr. Pastuszak: Not at all. Well, usually, guys are actually pretty relaxed by that point.

Interviewer: From the medication. Okay.

Dr. Pastuszak: From the medication. But if they're not, please bring your iPad, bring your iPod, bring your iPhone or your Android, listen to some music. And, you know, you should expect to have very professional, courteous staff. They'll help laugh you up during the procedure, too, if you're anxious. We're good at that.

Interviewer: Okay. So the actual procedure, pretty painless. How do you prepare for the operation? So, you know, it only takes 15 minutes there. But what do I need to do before I come in?

Dr. Pastuszak: Well, so you should bring some tight-fitting underwear or a jockstrap because you're going to leave with your scrotum supported and you're going to want to have that for the following week just to sort of prevent your boys from jumping up and down and causing any undue discomfort. You should come in with a clean genital area. We don't necessarily require that you shave. But if you'd like to, you can do that the day of, and we'll do any sort of trimming that we need to in the clinic. And you definitely need to bring someone to drive you home because, like I said, these relaxing medications will basically be like drinking two or three martinis.

Interviewer: Okay. So I got you. What about any sort of medications or anything like that? Do I need to worry about that before surgery?

Dr. Pastuszak: Yeah. We don't want you to be on any anticoagulants. So if you take aspirin regularly, I would stay off of it for about a week. If you take any other prescription medications that would thin your blood, you should also make sure that the doctor who prescribed that is okay that you're off that. But I would be off that for a week. And also fish oil. A lot of guys don't realize that fish oil is an anticoagulant. So I would not take that for at least a few days to a week before the procedure.

Interviewer: What about after the procedure?

Dr. Pastuszak: So these are going to be the best couple of days of your life because . . .

Interviewer: That's what I hear. Pick something to binge-watch.

Dr. Pastuszak: Exactly. No, we don't want you being a complete couch potato, but you kind of have, hopefully, free reign in the house depending your partner. We do want you to rest. No real strenuous activity for three to five days. It's a great idea to buy a bag of frozen peas. In fact, some of my colleagues have branded ones that you put on your scrotum and keep them there not enough to freeze your boys, but just enough to kind of keep the discomfort at bay.

It really only takes a few days to heal from this. The discomfort is transitory. It'll be there for a few days to a week, but it's very minor, and you'll be back up and running before you know it. Point of note, you do want to get up and walk around while you're resting. You don't want to be a complete couch potato because you don't want blood clots in your legs. But sack out for a little bit.

Interviewer: All right. And how long until I'm back to work? So I get the procedure. I go home on, like, say, a Monday. When can I expect to go back to work?

Dr. Pastuszak: Yeah, that's a great question. So, basically, we don't want you lifting anything heavy for three to five days. So depending on what you do, just be aware of that, you know. If you're a guy at a factory who lifts 50-pound boxes every day, desk duty for a few days.

Interviewer: Got you.

Dr. Pastuszak: If you're, you know, a corporate executive, lawyer, doctor who just kind of pushes pencils or stands and does surgery, a day or two should be fine.

Interviewer: All right. And when will the patient know that the procedure was actually effective because it's not immediate?

Dr. Pastuszak: Right. So it takes your body three months to make sperm. So we only know that that tube is occluded with no sperm coming out three or more months after your vasectomy. Also, keep in mind that you need to ejaculate 10 to 20 times to clear the pipes between when you have your vasectomy and when you go in three or more months later to get your semen analysis.

Interviewer: All right, and the great thing about that is this is one of the . . . it might be the only birth control procedure you can test for effectiveness, that's not somebody getting pregnant.

Dr. Pastuszak: That's right. That's right. And, you know, just talking about birth control, you should use a second form of birth control while you're waiting for that three-month period to be over.

Interviewer: Got you. Are there any risks I should be aware of?

Dr. Pastuszak: Yeah. So any procedure comes with risks, but the risks for vasectomy are very minor. And the three main risks include infection, bleeding, and pain in the testicles that is present after the vasectomy itself, or develops weeks to months after the vasectomy itself. All of those risks are less than 1% to 2% of all patients who have a vasectomy.

Interviewer: Wow. So that is about as safe as it gets when you're talking about a surgical procedure, it sounds like.

Dr. Pastuszak: Absolutely. If you want to have a great sex life without worrying about getting your partner pregnant, vasectomy is the way to go.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at thescoperadio.com.

Interviewer: How can you prepare for surgery so you have a better recovery? That's next on The Scope.

Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Interviewer: For a long time the responsibility of the outcome of a surgery was kind of placed on the surgeon's shoulders. But more and more, we are learning that the things you do or that you don't do as a patient can significantly impact the outcome of surgical procedures. Dr. Thomas Varghese is head of the section of general thoracic surgery at the University of Utah Health. What do you tell your patients that they can do to prepare for upcoming elective surgeries?

Dr. Varghese: The reality is that patients have much more power in determining the outcome of the surgery. It's not just the surgical technique.

Interviewer: The skill of the surgeon or the facility you go to, which are important . . .

Dr. Varghese: And don't get me wrong. Absolutely, there is a lot of data out there saying that going to an experienced surgeon, going to an experienced center really makes a difference. But there's also specific aspects where the patient health really makes a difference. So let me give you some examples.

One thing is nutritional status. We know there's over 40 years of literature in the surgical field where if a patient is malnourished coming into the surgical intervention, they are starving, they've had unexpected weight loss, their protein levels are abnormally low, those will lead to higher morbidity and mortality and complications, you know such as after G.I. surgery where there is a hookup or osmosis in the leak, those complications go up significantly after surgery.

We know in the area of blood sugar control that the best way of framing it is not just for diabetics but in patients who respond poorly to the stress of surgery and have abnormal blood sugar levels. If you have higher blood sugar levels around the time of surgery before, during and after, those patients have increased levels or increased incidents of infections after surgery as well.

Smoking is another area. We know that there's so much evidence that it's not just respiratory complications that smokers are at risk for. It's also increased risk of strokes, increased risk of heart attacks, increased risk of death after surgery. And so getting smokers to stop smoking before their elective surgery makes a huge difference.

And probably the final area where there's a lot of evidence that has emerged is also a direct correlation with medication. There are certain medications and supplements which increase the risk of bleeding after surgery. And getting those patients to understand what those medications are, what those supplements are and getting them to stop before surgery really makes a difference.

Interviewer: And how far in advance would someone have to start kind of optimizing these before their surgery for it to really make a difference?

Dr. Varghese: Historically, people mistakenly thought that these type of interventions took months before surgery. But the reality is that a lot of these things may take even as little as a couple of weeks, two to three weeks. Probably the longest time period is for smoking cessation. If you look at the recent literature, for example, in 2011 there was a meta-analysis in the Archives of Internal Medicine, where they really said that three weeks of smoking cessation.

And really, smoking cessation is an all or none phenomenon. You really have to work with patients and get them completely off smoking. Three weeks prior to the intervention was enough time period to make sure that they had enough better outcomes.

Nutritional interventions, probably a couple of weeks before surgery. Medication optimization especially with the supplements that lead to increased bleeding, again a couple of weeks before surgery is plenty. And then blood sugar control, the data is a little bit varied in terms of the time period, but again one to two weeks before the surgery. So we are not really talking about long period of time in terms of getting optimized prior to your surgery.

Interviewer: We're talking about elective surgeries where you actually do have the ability to control some of those things beforehand. And there've been times I've heard stories of somebody who has been in an accident and they go through surgery and then they recover and somebody might say, "It was because you were in such great shape that you recovered as well." So all of these things would contribute to that. What about physical exercise as well?

Dr. Varghese: Great question. Physical exercise has been a little bit messy in terms of the literature, and I think that there are a couple of different factors for that. Some of the clinical trials that have been conducted historically have been unrealistic. You know, they've been asking patients to report back every single day and use very, very expensive equipment with a physical therapist monitoring every single step of the way. This is not really pragmatic in the real world.

The general recommendations for the population at large is that we should be doing five days a week of moderate-level exercise, you know, 30 minutes of moderate-level exercise to improve your health. At the time of surgery what we do as a general recommendation, something as simple as starting a daily walking program where we say you set aside some time, morning noon, or night, you go for a walk, and the goal being you add on a couple of miles per day of walking in addition to what your normal level baseline level of activity is. Something as simple as that has been shown in the literature to make a huge difference in terms of your outcomes.

Interviewer: So I think the takeaway is to know if you are going in for an optional surgery that there are things you can do. Your nutrition, your smoking, your blood sugar and your medications that can really impact the outcomes. So be honest with yourself, be honest with your physician. If somebody is in a place where this isn't being . . . is this pretty commonly practiced with physicians?

Dr. Varghese: I think the honest answer is that there is increasing recognition. Unfortunately, there is still widespread variation in terms of the amount that people are doing. What we are hoping to do is not only getting more physicians involved in this movement, but the people who are the most powerful, who can really truly make a difference are the patients.

We are hardwired in all our aspects of our lives to be prepared before we embark on our journey. Why wouldn't you do the same thing for big time surgery as well? You know that if you are about to have elective surgery, you know when the surgery date is, why not empower yourself? Why not get engaged? Why not try to get into the best possible shape going into that elective surgery?

You will truly make a huge difference in your outcomes in terms of your recovery, the safe passageway through the surgery, as well as your ability to resume your normal activities. And I think that patients have the ultimate power and the more engaged your patient is coming into their elective surgery, the better that they'll do.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: May 29, 2019
originally published: August 2, 2017