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Health & Senior Living
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Making Surgery Less Scary:
10 Questions to Ask Your Surgeon


Undergoing an operation, whether it is the first one or the fifth, can be a stressful time in one’s life. Millions of people undergo an operation each year and every single one of them has a different experience. Surgery provokes many feelings, most notably fear and anxiety. While it is understandable to have these qualms, preparing and educating oneself can go a long way to making the surgical experience an easier one. Most surgeons are experts in their field and strive to carry out the safest and least invasive procedures available for the specific disease being treated. While an emergency operation is essential and does not usually allow the luxury of time for the patient to learn more about the procedure, elective operations are a different thing altogether. Elective operations allow the patient to ask many questions, which should enable them to feel comfortable entering the operating room. So what are those questions you should ask? There are never too many questions to ask your surgeon. There are never stupid questions either. On the day of your appointment you should feel comfortable learning everything you need to know. Here are some of the basic questions that you should ask your surgeon.

  1. What operation are you recommending? Before you leave the office, your surgeon should have explained the surgical procedure in fairly good detail. If something is going to be repaired or removed, you should know why it is necessary. Sometimes pictures and drawings can help with the understanding and many surgeons will provide these. These drawings can explain the different steps in the procedure. Sometimes there are different ways to do the procedure and your surgeon will decide which is best and explain why this is. There can be more than one way to do the operation. One way may require more extensive surgery than another. Some operations that once needed large incisions or cuts in the body can now be done using much smaller incisions. This is called laparoscopic surgery. These small incisions let doctors insert a thin tube with a camera into the body to help them see. Then they use tiny tools to do the surgery. Your surgeon will decide whether this minimally invasive surgery is the safe option for you.
  2. Why do I need the operation? Surgery is the solution to many diseases that a person can obtain. Some operations are meant to reduce a specific symptom or improve a body function that is problematic. Some are done to decrease or prevent pain. In some instances, surgery is done only to diagnose a problem and maybe even fix that problem at the same time. Having an operation can be life saving as well. You should know how the operation will be used to treat your medical condition.
  3. Are there alternatives to surgery? Although you may be seeing a surgeon with the expectation that you will need an operation, sometimes this is not the only treatment option for your medical problem. Nonsurgical treatments or different medi­cations may help you even more than surgery. You should ask your surgeon about other options and the risks and benefits of these choices. An alternative to surgery may be watchful waiting. During this time the surgeon will periodically check to see if your problem has gotten better or worse. If worse, then surgery may need to be done sooner than later.
  4. What are the benefits of having the operation? Most operations have specific benefits associated with it. You should know how long the benefits will last. Usually the benefits will last for a long time, but in some instances a second operation may be needed at a later date to improve the outcome. For some procedures, the benefits will last a lifetime. You must also be realistic about your expectations from the surgery because at times patients can expect too much and are disappointed in the outcome. Your surgeon will usually tell you the published information about the outcomes of the specific procedure.
  5. What are the risks of having the procedure? Every procedure carries at least some risk. If an operation is recommended to you, then the surgeon has likely weighed the benefits of the procedure against the risks of complication or unwanted side effects. Some complications that can occur with any procedure are infection, significant bleeding, abnormal reaction to anesthesia, or even problems affecting the heart. If you have many current medical problems such as high blood pressure, diabetes, or problems with your heart, lung, or kidneys, you may be an increased risk for a complication during surgery. Your surgeon will discuss the possible complications of the surgery as well as the risks associated with it.
  6. How much experience do you (the surgeon) have in doing the operation? There will always be certain procedures that a surgeon is more comfortable with compared to others. While every operation can have surprises, an experienced surgeon should be able to handle most unusual circumstances. Surgeons that are not comfortable with a particular operation will typically refer to a specialist for that disease. Never be afraid to ask the surgeon about his/her experience with this procedure and its outcome. Some surgeons will be more experienced with the more minimally invasive techniques than others.
  7. Where will the operation be done? Many surgeons will do procedures either in an office or in a hospital operating room. There are special Surgery Centers designed for outpatient procedures as well. Until recently, most surgery was performed on an inpatient basis and the patient stayed in the hospital for more than one day. Nowadays, many operations are done on an outpatient basis, which will significantly reduce the cost of the hospital stay. If a doctor recommends a longer stay for a typically shorter stay procedure than you should ask why.
  8. What type of anesthesia will I be getting? Anesthesia is an integral part of the surgical experience. It is used so that surgery can be performed without unnecessary pain. Your surgeon should explain whether the operation will require local, regional or general anesthesia and why this particular form is the best choice for your particular operation. Local anesthesia numbs a small part of your body and only for a short period of time. This type is generally used for small short procedures such as removing a skin lesion. Regional anesthesia numbs a larger portion of your body for a longer period of time. Such procedures may include knee or ankle surgery. General anesthesia numbs your entire body and you will be asleep during the whole operation. This type is used for most major operations and all laparoscopic procedures. Anesthesia has come a long way over the years and is quite safe for most patients. Anesthesiologist or nurse anesthetists who are both specially trained to do this administer it typically. You will typically meet them the day of the procedure and they will answer all questions you may have.
  9. How long will it take me to recover? Your surgeon can tell you how you might feel immediately following the operation as well as what to expect the days to weeks after the procedure. You will be advised on what you should or should not do around the time of surgery. There may be restrictions for days, weeks, or even months after the procedure. Your doctor will tell you how long you should expect to stay in the hospital as well as how long before you can return to work or even get back to driving. Some procedures may require rehabilitation or physical therapy to allow you to get back on your feet. Your surgeon will let you know when you can start regular exercise and how much you should not lift after the surgery. You should carefully follow all advice given by your surgeon to help you recover as fast as possible.
  10. How much will the operation cost? Health insurance typically covers necessary operations but the coverages can vary widely among different insurance carriers. There may be some costs that you will be required to pay. You should ask what your surgeon’s fees are and what it exactly covers. Most fees will cover the visits in the hospital as well as several visits after the operation. The other costs of the operation may include the hospital stay as well as the treatment by the anesthesiologist and other care providers during your stay. You will usually be billed for these separately.

Being informed can greatly reduce or sometimes eliminate the fear and apprehension of surgery. It starts with asking the right questions of your physician. Ideally, together you and your physician will share in the decision that supports the best surgical outcome possible.

Submitted by Melvin D. Schursky, Jr. M.D., Board-Certified by American Board of Surgery. Dr. Schruskys’ practice is located on the Campus of Riverside Walter Reed Hospital, 7554 Hospital Drive Suite 303, Gloucester, Va. 23061. For more information or to schedule an appointment, call 804-693-3400.

No Pills, No Pain, No Scars: A Surgical Solution to GERD Without an Incision
By Reginald Mason, M.D., FACS

Many people approach having surgery with apprehension and thoughts of scalpels and blades and scars (oh my!). But what if, one day, you could have surgery without an incision? For individuals with chronic acid reflux, it seems that day has arrived.

The revolutionary Transoral Incisionless Fundoplication (TIF) procedure uses the groundbreaking technology of the EsophyX device to treat gastroesophageal reflux disease, or GERD, without an incision or visible scarring. According to the American College of Gastroenterology, GERD affects at least 5–7% of the world’s population. It is a painful, chronic disease that occurs when stomach acid flows back into the esophagus. This strong acid irritates the lining of the esophagus and causes heartburn and acid reflux. While individuals can have isolated episodes of heartburn or acid reflux treatable with over-the-counter medications and simple changes in lifestyle, GERD is diagnosed when these episodes occur more than twice a week and interfere with an individual’s daily life.

GERD is the result of a weakening or relaxing of the valve connecting the esophagus to the stomach. This valve is designed to relax to allow food from the esophagus into the stomach. However, when the valve weakens inappropriately, stomach acid is able to flow back into the esophagus, resulting in symptoms such as heartburn (a burning sensation in the chest or throat), chest pain, difficulty swallowing, dry cough, sore throat or hoarseness, regurgitation of food or sour liquid and the feeling of a lump in the throat. Long term consequences can include bleeding in the esophagus and breathing problems.

Traditional treatments for GERD— such as medication, lifestyle modifications and surgery—focus on symptom man­agement and include over-the-counter antacids, proton pump inhibitors and certain dietary guidelines. However, the typical treatment options for GERD often provide only temporary relief and can force individuals to give up popular foods and depend on medications indefinitely. Those suffering from GERD must accept the side effects and risks associated with medications and more invasive surgical techniques.

But now, the TIF procedure offers a safer, more permanent solution for treating GERD. The procedure restores the barrier between the esophagus and stomach. “The principles behind the TIF procedure have been used for years and are proven to treat GERD,” explains Dr. Reginald Mason. Dr. Reginald Mason and Dr. Michael Francis of Riverside Tappahannock Surgical and Gastroenterology Associates are the first providers in the area to offer the procedure. “The breakthrough of the TIF procedure is that we can perform this effective surgery by going through the patient’s mouth, without an incision.” Dr. Mason adds that incisionless surgery means decreased recovery time, reduced pain and no visible scar. Without an incision, there is also a reduced risk of complications compared to the traditional surgical procedures used to treat GERD.

Widely recognized as the next step in the evolution of minimally invasive techniques, the EsophyX device is introduced into the body, not through an incision, but through a “natural” body orifice, the mouth. The EsophyX device and the TIF procedure reduce hiatal hernia and create a valve between the stomach and the esophagus to restore the natural, physiological anatomy to reduce/prevent gastroesophageal reflux. Because the procedure is incisionless, there are no visible scars and the risk of adverse effects is reduced.

With millions of people suffering from GERD, this evolution in surgery will provide a welcome alternative to the typical treatment options. “The TIF procedure can allow patients to become less dependent on medications and many are able to start enjoying foods they’ve avoided for years,” says Dr. Mason. “This procedure can dramatically improve a patient’s quality of life.”

For more information about the TIF procedure, contact Riverside Tappahannock Surgery and Gastroenterology at (804) 443-6232.

 

Changing Your Thinking About Retirement Living: Amenity-rich, maintenance-free communities attracting younger residents

You could ask Nathalie “Dee” Perkins herself why she chose the retirement community lifestyle. But you’d have to catch her first. Most of her days begin at 4:30 a.m. feeding her two cats, Charlie Brown (“named after the song, not the cartoon,” she notes) and Lady. Then she’s either taking a swimming class or teaching one; she recently became a Certified Water Fitness Instructor. Depending on the day, Dee might be working away at her computer completing a proposal for her consulting business. Or she might be attending board meetings at her church and previous townhome community. She serves as treasurer on both committees.

Many people balk at the idea of a retirement community because they are still so active and independent. But these days—with retirement communities offering a complete resort-style, amenity-rich lifestyle—many healthy individuals and couples want to make the transition while they’re able to take advantage of all the amenities. Even more, the active, social living of retirement communities are shown to add seven healthier years to residents’ lives.

Dee was attracted to this lifestyle and, though she’s barely 70 and still works full time, she was unofficially researching retirement communities for several months. A knee injury prompted her to take the transition seriously. The stairs in her previous townhome were presenting a dangerous inconvenience: “The two-step I was doing to get up the stairs wasn’t working,” she admits jokingly.

Free to Be

A self proclaimed wanderer—she grew up in Richmond and has lived in Connecticut, Arkansas and South Carolina—Dee certainly wasn’t ready to sit back and “retire from life.” When she chose to move to an Independent Living apartment at the Warwick Forest Retirement Community in Newport News, she said she was honest from the start. “I walked in and said, ‘Let me explain, I don’t play bridge.’” While this warded off any potential bridge partner requests, Dee says that Warwick Forest never really seemed like a “normal” retirement community, at least not compared to her perception.

“The people are very active,” she adds. “I have the freedom to come and go as I please without worry.” Dee believes this freedom enhanced her already independent lifestyle. “[This community] keeps me young. It keeps me going.”
Susan Piland, who lives in a private cottage in the same community with her husband, Mike, agrees. “We can still do all the things we did before we moved,” she says. The Pilands don’t feel like they’ve sacrificed their independence to live in a continuing care retirement community. In fact, they say it’s just the opposite: they think of all the things they’ve gained. “The housekeeping, wellness, fitness center—these things enhance our quality of life.”

The freedom and independence to maintain her own schedule is Dee’s favorite part of living in her maintenance-free community. Well, that and the breakfast. After having nearly a full day before the rest of us wake up, Dee says by the time she heads to breakfast, she’s ravenous. “It’s my favorite meal of the day!” she says excitedly.

Bye-Bye Bingo
Today’s active retirement communities encourage residents to swap the hassle of home maintenance and piles of individual bills for resort and spa-style living for all-inclusive flat rates. In addition to delicious breakfasts, residents of many communities enjoy professionally decorated common areas, several casual and formal dining options, high quality fitness centers offering personal training and group exercise classes, game and hobby areas and indoor pools.
Guest speakers, day trips and special events fill up communities’ activities calendars. Indoor and exterior maintenance and housekeeping are often included in the fees, so residents will have even more time to enjoy all the perks.

When Dee isn’t consulting on government proposals, swimming laps or scolding Charlie Brown, she knows there will be plenty of other activities to keep her busy. “When I’m not working, there are 101 other things to do here,” she says.

Healthy Living for Today and Tomorrow
Perhaps the greatest benefit to the younger, healthier demographic choosing continuing care retirement communities is the peace of mind. By moving to a community that provides all levels of health services and explains all of your financial options upfront, residents eliminate many of the uncertainties of staying at home. The decision to move to a retirement community eases financial and emotional burdens for many families.

This peace of mind extends beyond residents. Adult children rarely express their concerns about caring for their parents, but these worries are not lost on residents of retirement communities. A major deciding factor for many individuals is knowing their children will not shoulder the responsibility for their parents’ care.

While Dee considered her options, she thought about moving closer to family in Northern Virginia.

Move Now, Sell Later
Real estate experts are not expecting much improvement in home appreciation over the next two to three years. This means little, if any, increase in equity. Today, adults who have owned their homes for awhile could be in the best position to make the move to a retirement community. “The long term appreciation is there, so homeowners aren’t losing money when they sell in this market,” says Sarah Conaway, Warwick Forest’s Director of Marketing. “And staying in a house that won’t appreciate is like keeping your money in a bank account at zero percent interest,” Sarah adds.

While the housing market slowly rebounds, retirement community fees will continue to increase each year. The next couple of years represent an unusual opportunity for new residents to take advantage of lower prices and get the
best value.

Continuing Care Retirement Communities are adding even more incentives, some surprisingly creative. One program from Riverside guarantees new residents that their home will sell in the first 15 months after their move to Warwick Forest. If it doesn’t, Riverside will buy it. Other communities are allowing delayed payments of entrance fees or allowing short-term rental options. But these special arrangements will likely be phased out as the housing market rebounds.

Decide Now, Move Later
Retirement communities understand that the transition from a previous home to a new one doesn’t happen overnight. For individuals and couples who have decided on the retirement community lifestyle, several options exist to help them plan their move.

Future Wait Lists, offered by most communities, enable prospective residents to make a refundable down payment (usually ranging $500-$1500), choose their desired floor plan and estimate the year they would like to move. Being on this priority list ensures that when an available home meets the criteria, members of the wait list are given first priority. Sometime wait list members are treated like extended family and are invited to use the community’s amenities before they even live there.

“If you are seriously considering moving to a retirement community, acting sooner rather than later makes all the difference,” Sarah says. “We usually have a waiting list at Warwick Forest of about one to three years for future residents to have their preferred homes.”

Residents like Dee Perkins and the Pilands prove that the faces of retirement communities are changing. And this new image might look a lot more inviting than you once thought. While the health care resources are steps away, Sarah explains that continuing care retirement communities do not bear a patient or health care provider mentality.

“These communities are designed for individuals and couples to move in as early as possible,” Sarah says. “Our first class services and amenities are not focused on caring for sick people; our passion is keeping healthy people active, independent and excited about their future.”

Travel tips for seniors looking for a hassle-free vacation
Statistics are proving that age 70 really is the new 50. According to the U.S. Travel Association, mature travelers ages 65 or older represented 21 percent of all leisure travelers in 2010. From taking a trip with their grandchildren across country, to living out dreams in far, exotic destinations, today’s seniors are choosing to enjoy their golden years traveling.

Staying safe and being prepared when traveling is more important than ever for this age group. Here are some special considerations for senior travelers looking for a hassle-free travel experience.

Pack Carefully
When packing for a trip, it’s important to be prepared. Some packing essentials include a comfortable pair of shoes, a hat and sunglasses to protect the face, clothing that you can wear in layers and any necessary personal items. Multi-purpose items, such as a scarf, which can also be used as a makeshift beach blanket, are always smart to pack and limit the weight of your suitcase. If you are taking an extended vacation, inquire about laundry options close to where you’ll be staying.

Visit Your Doctor
As a senior, your health is very important and no one ever wants to get sick or injured on vacation. Schedule a checkup with your doctor before any major trip to discuss the activities you plan to do, and get written prescriptions for any medications you may need. Keep your prescriptions in their original containers so that they can be identified properly. If you plan to travel out of the country, contact the Center for Disease Control and Prevention for required immunizations.

Get Protection
Whether traveling 50 miles or 5,000, prepare for the unexpected by purchasing a membership from a travel and medical assistance company like On Call International before you leave. Senior travelers ages 77 to 85 can purchase a special Mature Membership, which includes services like emergency medical transportation to the hospital of their choice, transportation home, worldwide physician referrals, a 24-hour nurse helpline and emergency travel assistance.

The membership also includes pre-travel destination and health information, lost-luggage assistance, worldwide legal assistance and even covers the cost of transporting grandchildren or a traveling companion home if you need to stay in the hospital.

Plan Carefully
When planning your trip, stay organized and compile any contact information and travel reservations to keep in a folder to ensure you don’t have any problems. You might also include emergency numbers and family contact information in this folder as well. Whether driving or flying, it’s smart to gather maps ahead of time so you don’t get lost. If you are traveling out of the country, make sure your passport is up to date several months ahead of time as getting a new passport takes time to process.

With a little planning, seniors can travel without worry and enjoy the best of their golden years exploring the world. For more information about safe travel and medical assistance memberships, visit www.oncallinternational.com.