Surgical clearance

After deciding to have surgery, I felt a sense of relief because I finally could put down all of my what-ifs and relax into the decision. Everything seemed to be falling into place. I looked forward to turning over a new leaf of feeling less intense about life and my illness.

Such lofty feelings gave way to stress and anxiety once I started to work on my pre-surgical clearance. I have had two surgeries (abdominal) in the past – all I had to do for these was show up for a pre-surgery appointment and remember not to eat anything after midnight the night before surgery; not so with neurosurgeries for people with a complex health picture.

Dr. Bolognese’s staff give you have a 30-day window to complete a lot of testing, culminating in a surgery sign-off from your GP or an appropriate specialist (e.g., cardiologist). The testing cannot be done 30 days before surgery, and it has to be completed four days before your scheduled date – leaving about 26-27 days to get everything done. That may seem like a lot of time, but it doesn’t leave much room for error.

At a minimum, the list includes an echocardiogram, ECG, extensive blood work (complete blood count with differential and platelet count, BUN, creatinine, electrolytes, random non-fasting blood sugar, albumin, total protein, cholesterol panel, PT and PTT, a MRSA swab, and a pregnancy test for all menstruating females. Most importantly, surgical clearance requires a physical and physician sign-off on various forms. Thankfully, I got to skip the rectal exam. Being a woman does have its advantages on occasion!

I had this list well before the 30-day window and figured that the echo and ECG would be the hardest to set up appointments for, especially the echo. I made sure to have these appointments lined up just as I entered the 30-day window. I even had a GP consultation scheduled within the 30-day window. I have an unusual situation in that one of my ME specialists also serves as my GP, an arrangement that hasn’t worked out very well because it is often impossible to get things done in a timely way.

My doctor seemed to be supportive of my surgery, but last week he threw up some hurdles. I had to make an additional four appointments. One to get a lab slip, another for a physical, another to get another lab slip for an item he left off (my bad, I should have double-checked before heading to the lab), and a final appointment to fill out and sign the surgical clearance form. This inefficient process has been tough with my increasing pain and decreasing mobility from tethered cord syndrome.

In hindsight, I should have made an appointment with him before I entered the 30 days. If I had done so, I would have requested a completed lab slip (and double-checked it for accuracy!). I own my part in all of this. And, finally, today, I went back to get the forms filled out. I had to manage the entire process and print my lab results at the office (they almost sent the wrong labs!) and make sure they faxed my records and clearance forms. My doctor’s MA was very helpful and even called Dr. Bolognese’s office to ensure they received everything. Yes, I am a control freak in these situations.

Stories like these always seem trivial in their retelling, but I had to develop multiple contingency plans because of the uncertainty about getting everything done in a timely way. I spend much of my time strategizing and predicting problems. This time involved getting my labs done at a local community hospital, where I could readily retrieve results from the portal (LabCorp does not provide records until my physician releases them). I made an appointment with a PA at my cardiologist’s office, figuring I could get a physical and surgery sign-off there. My third plan was to have my other ME practitioner do the exam, but that would have been a 4-hr drive and a $560 appointment. I am so relieved Plan A worked out and am grateful that my doctor and his staff came through for me. Sometimes I wonder why I don’t start with plan B.

Here are some lessons I learned

1. Line up all appointments – echo, ECG, bloods, urine, MRSA swab, and physical – to fall at the beginning of the 30-day window. Be aware that pent-up demand for imaging and testing during the pandemic could make it harder to get a timely appointment. This is especially true for the echo and ECG.
2. Get a completed lab slip *before* you enter the 30-day window – and double-check it has everything on it. Get the testing done on day one of the 30-day window.
3. Pro tip: labs, such as LabCorp, won’t swab you for MRSA, but will give you a throat swab. They will tell you that you need to return to your doctor to get it done, but I did it myself and dropped it off at the lab. Easy peasy.
4. Determine if you need any additional testing or sign-off from specialists, such as your cardiologist.
5. Insist on reviewing all records and forms filled out by your physician for accuracy and completeness before they are faxed (they almost sent the wrong blood test results). Consider asking to be present when they fax the records over and have them call for confirmation, as my doctor’s MA did for me today.
6. Be sure to get established with a supportive GP before you get to this point. I haven’t had a GP for four years since moving to Reno in 2017. I realized I need a dedicated GP and was fortunate to get an appointment with a physician I saw when I moved to Reno. I will get to see her before I head out to NY in less than two weeks. I figure it would be better to ask for help before surgery rather than showing up after surgery asking for suture removal and various drugs to help manage my recovery.
7. Consider contingency plans – who else, besides your GP, could sign off on the surgery clearance form? Consider making an appointment with them – you can always cancel.

After three weeks of high stress, I am happy to say that I have cleared this major hurdle. In hindsight, it seems silly I got so stressed, but then again, there is underlying angst about having surgery in the first place. I am more than ready for it, especially with escalating symptoms, but still, it is a matter of venturing into the unknown and all of its inherent uncertainty.