I compiled this list of questions for my surgeons before my all-in-one surgery in August 2011: mandibulectomy, fibulectomy and mandibular reconstruction.
You can read my wonderful surgeon’s comprehensive answers in three parts:
- Could I have another consultation before surgery? I’m scared and don’t feel like I have all the information I’ll need.
- When will you be able to to tell us how the surgery has gone? If you can’t see me, can you phone or meet with my husband?
- Will you do follow up checks with me in hospital? Will other doctors do follow up checks? For what and how often?
- How large is my tumour?
- What has been destroyed other than the bone? Do you often see ameloblastomas this destructive of mandible etc?
- Do you often see ameloblastomas that have infiltrated the soft tissue? What does the infiltration of the soft tissue mean? Will it affect the surgery or prognosis?
- What does the pathologist in the second biopsy mean by: “a suggestion of basal palisading certainly prompts consideration of a residuum of an ameloblastomatous process”?
- The pathologist in the second biopsy wrote that the tumour has “a somewhat basaloid appearance, apoptotic cells are seen and scattered mitoses”. What does this mean? Is this the same as the pathologist in the first biopsy saying my tumour “exhibits basaloid features with evidence of apoptosis and occasional mitoses”?
- The pathologist in the second biopsy wrote, “Overall the radiology had a somewhat aggressive appearance which could fit for a large ameloblastoma.” However, they also said, that the tumour’s appearance is an “unusual finding in a straightforward benign ameloblastoma”. What other diagnoses could the tumour’s appearance fit with?
- The pathologist in the first biopsy said “unequivocal malignant features are not observed”. The pathologist in the second biopsy did not see “frank malignant features”. What would these features have been? How would they have differed from what the pathologists did see?
- The pathologist who undertook the first biopsy said had “done progesterone receptor on the tissue and found it to be strongly positive, raising the possibility of some degree of hormonal effect on this tumour”. What does this mean? Does the possible hormone effect suggest another or concurrent diagnosis?
- In my notes, I wrote “if the biopsy results do not come back as clearly benign, I’ll likely have a CT PET scan”. Will I still have a CT PET scan?
- Is there anything else I can get done to ensure I don’t have other tumours?
- When will you get the results of the pathology on the removed tumour and mandible? What will you do if you find malignancy? What will you do if the tumour is not clearly benign?
- Will I need more tests or scans before admission to hospital?
- When will the blood tests, chest x-ray and ECG noted in my hospital admission paperwork take place? Before or after surgery?
- Is there anyone else on my medical team that I could/should meet before my surgery?
- Is there anything else I should be doing to prepare for surgery?
- How will my surgery be affected if I lose too much more weight?
- I haven’t received any doctors’ invoices yet? Whom should I expect invoices from that I’ll need to pay up front?
- Will there be other doctors’ invoices to pay after the surgery?
- What other in-hospital services will I have to pay for after the surgery? When? Can I get an estimate?
- Who will be involved in the surgery other than Dr P and Dr A? What is their role? Do I pay for them in addition?
- Who does the tracheostomy?
Fibulectomy and fibula flap
- What do you learn from my doppler ultrasounds on the artery and vein in my legs?
- Do you take the whole fibula? What happens to the joints or bone parts that remain? Do you take muscle with the fibula?
- How will you know if the fibula flap is failing?
- How much will I be able to move with my jaw wired?
- How will you know if you have removed all the tumour?
- What will you do if you can’t remove all the tumour?
- How much of my soft tissue will you remove? What will be the effect on my face?
- Can I meet the dietitian who’ll be looking after my NG tube etc before my surgery? I am concerned about my weight loss already.
- Will there be a clinical nurse specialist assigned to me in hospital? Can I ask her questions beforehand?
- When will I be able to get out of bed?
In-hospital recovery milestones
- What will you look for to determine I am able to move from ICU to my own hospital room?
- What will you look for to determine I can have the tracheostomy removed? How long is it usually left in?
- What will you look for to determine I can have the nasal feeding tube removed? How long is it usually left in?
- What will you look for to determine I am able to be discharged from hospital?
In-hospital tests / procedures / tubes
- What tubes etc will I wake up with? Are there any I might not be aware of?
- What blood tests will I need after surgery? What is their purpose? How often?
- I have a needle phobia. A PICC line was suggested. What are the pros and cons? What would I need to do to organise?
- How is the tracheostomy removed?
- How is the NG tube removed?
- When will I have follow up consultations with my surgeons? When? What will they be looking for?
- Will I have follow up tests? Which tests? When? What will they be looking for?