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I'm confused -who should do surgery? I'm confused -who should do surgery?

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Unread 10-29-2003, 08:17 AM
I'm confused -who should do surgery?

I had a LSH one year ago. Had a few hormonal challenges and was being seen regularly by my gyn. He was following some persistent ovarian cysts he found in June. I had some strange bowel and bladder habits that cropped up several months ago. He ran a ca125 and it was ever so slightly elevated at 37.1. He called me to schedule emergency laparoscopic BSO last week as he knows I have a heightened awareness of cancer. A family emergency prevented me from doing the surgery.

I am scheduled for a laparoscopic BSO on Nov.4 to be performed by my gyn with a gyn/onc "on call" in the event cancer is found. Is this a good plan? I've been doing some research. If there's a chance any cancer would be missed with a laparoscopic BSO, I really don't want that!!! My understanding is that ovarian cancer is often only cellular and not visible to the naked eye. It can only be detected microscopically. So, I wonder if it would be the better part of wisdom to have a gyn/oncologist do a laparotomy and full staging surgery.

There's some tension between dh and myself over all this. Dh thinks I am crazy to even be considering laparotomy when cancer "has not even been diagnosed". He can't understand that the surgery IS the diagnosing tool. I don't WANT a laparotomy. I can't seem to get him to understand why I am tenaciously pursuing everything. He hasn't read what I have. I know he believes there is no cancer. I want to believe that, too. He wants me to trust my gyn and go with whatever he recommends. I love my gyn. He is the best dr I've ever had. He's not an oncologist. I would love to do what he's recommending, but I need to do what's best for me. Not for anyone else. Not based on how anyone else feels.

If there's even a minute chance there's cancer in there, I want it to be found and fully detected now. Dh believes there's a strong possibility I don't have cancer. Of course I want to believe that, too. Yet what I really want is the best care for myself if I DO have it. Seems to be hard to get that point across.

How does one decide? I have asked my gyn to get an appt with a gyn/onc, but he might not be able to do that before surgery.
Am I going crazy? Does any of this make sense to anyone out there?

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Unread 10-29-2003, 09:05 AM
I'm confused -who should do surgery?

Im with you 100%. You do whats best for YOU!! You have to satisfy your own conscience and have your questions answered to your satisfaction. Then you need your issues settled whichever way is best for YOU!!

I am so much like you are. I dont like wondering about things. I want them laid out in front of me so I can make the decisions myself. My own personal choices are driven by how I can fix the problems and avoid any future problems, recurrances, or hidden issues. I need to know that I have done ALL I CAN do NOW the best way possible FOR ME. Have you asked your doctor about his recommendations and told him your concerns??

Bless your dear husbands heart, he means well and is really banking on the best scenario. It sounds like your doctor is doing the same. But I do understand your concerns with DEFINITIVE DIAGNOSIS to whether you have cancer or not.

Just let your doctor know you NEED TO KNOW DEFINITIVELY either way. Ask him how he plans to be able to do that for you with his current plan of action.

Hang in there!!! COMMUNICATE with the Doc!!!
Unread 10-29-2003, 01:57 PM
I'm confused -who should do surgery?

Why don't you talk to the on-call gyn onc? Perhaps s/he can review the ultrasounds and decide whether "on call" is good enough.

Personally, I don't like the "on call" routine. In some community hospitals a gyn onc attends surgeries done by regular gyns perhaps once or twice a month to supervise and instruct, but given that a hyst is usually only an hour or two in the OR, I'm not exactly sure what "on call" means.

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Unread 10-29-2003, 02:07 PM
I'm confused -who should do surgery?

Hi Dorrie
In my case I had a gyn onc on call and what it meant was that my gyn did the hyst then while I was still under anethesia they got pathology report if it was anything other than stage1A cancer the gyn onc was the one that would take out my pelvic lymph nodes and resume after care.
Unread 10-29-2003, 02:10 PM
I'm confused -who should do surgery?

Hi Texas Friend

You do need to do what is best for you. Try to see if you can talk with the gyn onc before, a week or two should not make a difference until you can get all the facts. Your gyn may very well be taking the correct route.
Unread 10-29-2003, 03:15 PM
I'm confused -who should do surgery?

s Texasfriend

Whenever an ovarian cancer is even slightly suspected, you need to have a consultation with a gyn oncology surgeon. They are the experts when performing surgery on ovarian cancer.
I, like Dorrie, have often wondered about this gyn/onc on call.
If a gyn/onc needs to be on call for the remote possibility, then the ob/gyn should have the gyn oncology surgeon performing the surgery from the start. It is too risky to believe that if needed, a gyn onc will be able to clear their schedule and step into the OR.
Although many patients seem to find comfort with a gyn onc on call, to me it sounds suspicious. And I would encourage any woman to avoid this situation. JMHO

Unread 10-29-2003, 03:22 PM
I'm confused -who should do surgery?

Hi Again
Each state and doctor are different so by all means check with the gyn onc. In my case the gyn onc had his scedule cleared and the surgery was arranged around his schedule. He was there they called it he was on standby. I do know he was there because the nurses were confused at first as to which one was doing the surgery. But my surgery was definately delayed by a few days because we had to coordinate with the gyn onc. Mine was not ovarian cancer but endometrial. At any rate gyn onc are the experts.
Unread 10-29-2003, 04:23 PM
I'm confused -who should do surgery?

Hi Texas.

I totally agree with Karenann...Gynocologist/oncologists are definately the way to go. When I was about to have my hysterectomy, my family doctor told me in no uncertain terms, "If you want your surgery done right the first time, even if there is the slightest inkling that cancer may be present, you go with the specialist because they know what to do and what to look for. He proceeded to say that any surgeon or gynocologist can do a hysterectomy BUT only an oncologist/gynocologist will definately do it right the first time!!

I took his advise to heart and together we found one of the top on Long Island. My surgery was perfect and I never had any problems at all.

Keep in touch.
Unread 10-29-2003, 05:09 PM
I'm confused -who should do surgery?

Depending on the situation, "on call" may be OK - BUT as a consumer of health care, I would want to know exactly what on call means, and what would happen if cancer was found.

Ovarian cancer surgery is somewhat different from other gyn cancers in that the cancer may be all over the abdomen and quite a bit of skill is required to remove it all - and even to know where to look. This is what is called "optimal debulking" and isn't such an issue with most other gyn cancers. Not all gyns are experienced in this type of surgery.

Texasfriend, there is a certain amount of anxiety in contemplating the possibility of cancer. Some of it you can't control. But you can find out all of the details about WHO is doing what to your body. My DH who happens to be an MD was equally skeptical of a laparotomy in my case. MY in-surgery pathology was normal - or not cancer anyway. My gyn-onc just didn't like the way the slides looked and proceeded to do a total hyst. DH and I were very grateful when 2 pathologists later, an ovarian cancer dx was made.

Unread 10-29-2003, 06:31 PM
I'm confused -who should do surgery?

I think you need to go with your instincts. I had a TAH on 10/9 and stage 1C ovarian cancer was found. All indications for me led everyone, including the gyn/onc to believe we were dealing with nothing more that fibroids and cysts. What was believed to be a simple 2 hour hysterectomy turned into a 6 hour stay in the OR for staging. My CA-125 was normal (33.4). The best decision my gyn made for me was to refer me to the best gyn/onc in San Francisco at UCSF Hospital. Good luck.

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