FAQs

  1. Aortic Aneurysms

    What causes Aortic Aneurysms?

    Aortic aneurysms are most often caused by damage to the artery’s wall due to atherosclerosis, commonly known as hardening of the arteries. Atherosclerosis is caused by a buildup of cholesterol and other fatty deposits in the arteries and hypertension (high blood pressure). Other causes of aortic aneurysms may include: -Congenital weakness of the artery wall (something you are born with) -Weakening of the artery wall from smoking or high blood pressure -Dissection or tearing of the artery wall -Trauma (usually falls or motor vehicle accidents) -Sometimes the cause of an aneurysm is not clear. Aneurysms may be hereditary.

    What are the symptoms of Aortic Aneurysms?

    Most aortic aneurysms have no symptoms. In fact, most are diagnosed on a chest X-ray or computerized tomography (CT) scan performed for evaluation of another condition, such as lung disease, or during routine exams. Symptoms may occur, however, due to the aneurysm pressing on nearby organs or tissue, or if the aneurysm leads to dissection. Symptoms of dissection include severe tearing pain in the chest or back, stroke, cold or numb extremities, or abdominal pain.

    How are Aortic Aneurysms treated?

    Treatment for an aneurysm depends on its size and location and your general health. If the aneurysm is small and you have no symptoms, your physician may suggest a “watch-and-wait” approach with regularly scheduled images of the aneurysm to check the size. However, if your aneurysm is large enough, or if the aneurysm is growing more than 1 centimeter (cm) per year, surgery may be your best option. Your health-care provider will work with you to evalulate the risks of rupture and the risks of surgery.
     

    Medical Treatment of Aortic Dissections

    Open abdominal or open chest surgery The accepted standard treatment for aneurysm once it meets the indications for surgery is replacement of that portion of the aorta with an artificial graft. Typically a graft is made from DacronTM, a material that will not wear out. The graft is sewn in place with a permanent suture material.

    Endovascular surgery

    In recent years, a treatment has been developed to repair an aneurysm without major surgery. Many surgeons have been using less invasive endovascular surgery on abdominal aortic aneurysms. The procedure results in less blood loss, less trauma to the aorta, and fewer (or no) days in intensive care. Because results with endovascular repair of abdominal aortic aneurysms have been encouraging, similar techniques are being developed for the treatment of thoracic aortic aneurysms as well.

    What is the prognosis for an aortic aneurysm?

    The risk of death with medical treatment of descending thoracic aortic dissection is about 10 percent. If surgery is required, the risk is higher, however, at about 30 percent. Every effort is therefore made to treat these patients with medication.

  2. Appendectomy

    What happens on the day of surgery?

    You will report to a pre-operative nursing unit, where you will change into a hospital gown. A nurse will review your chart and confirm that all paperwork is in order. You will be taken to a pre-operative nursing unit where an anesthesiologist will start an IV. Before any medications are administered, your surgeon will verify your name and the type of procedure you are having. You will then be taken to the operating room. After the appropriate form of anesthesia is administered, surgery will be performed.

    What type of anesthesia will be used?

    You will have a pre-operative interview with an anesthesiologist who will ask you questions regarding your medical history. An appendectomy is performed under general anesthesia, which will keep you asleep during your surgery.

    What happens during the surgery, and how is it performed?

    If your surgery is performed laparoscopically, your surgeon will make three to four small incisions, and insert tube-like instruments through them. The abdomen will be filled with gas to help the surgeon view the abdominal cavity. A camera will be inserted through one of the tubes that will display images on a monitor in the operating room. In this manner, your surgeon will be able to work inside your abdomen without making a larger incision. Once inside, your surgeon will cut out and remove the appendix. If the appendix has ruptured, the abdomen area will be flushed with warm saline, and the incision may not be closed completely but left open with packing to help prevent infection.

    How long will I be in the hospital?

    Most patients are in the hospital from seven to ten days with an open appendectomy and four to five days after a laparoscopic appendectomy. You may need a ride home when discharged from the hospital.

    What are the risks associated with an appendectomy?

    As with any surgery, there are risks such as bleeding, infection, or an adverse reaction to anesthesia. Your surgeon will inform you of the risks prior to surgery. The risk of leaving appendicitis untreated is significantly greater than the surgical risk associated with the procedure.

    Will there be scar(s)?

    If the procedure is performed laparoscopically the incisions should heal well, leaving small discrete scars. If the open method is used, a larger scar will be present.

    When can I expect to return to work and/or resume normal activities?

    Light activity at home is encouraged after surgery. You can expect to return to normal activities, such as showering, driving, walking up stairs, light lifting, and work within a few days. If you are taking narcotic medications for pain, you should not drive

  3. Dialysis Access

    Post Treatment

    Immediately following the operation, the patient should
    ¬ Keep the arm raised above the heart to reduce swelling and discomfort;
    ¬ Keep the incision dry for at least two days; and
    ¬ Avoid scrubbing the incision until the sutures are removed.
    The site of the incision may be sore, but over-the-counter painkillers should suffice for the pain.To care for the access site in the weeks following surgery:
    ¬ Avoid heavy lifting or rigorous activity;
    ¬ Report any worsening pain, swelling, or bleeding to the physician;
    ¬ Alert the physician in the event of fever higher than 101 degrees F.
    Possible ComplicationsAbout one-third of all new accesses fail, typically because of clotting (thrombosis). In the event of clotting, the fistula or graft is surgically fixed in a procedure called a thrombectomy, a procedure where the graft or fistula is opened and the clots are removed with a special kind of catheter. When the clots cannot be removed, a new graft or fistula is needed. Infection is another complication, which may be treated with antibiotics.

    Lifestyle Adjustments

    Protecting the portal site is crucial for someone on dialysis. To maintain a clean a safe access site, physicians recommend that patients:
    ¬Check the site several times a day to ensure that the access is functioning.
    ¬Do not carry heavy items with the arm that has the access.
    ¬Do not sleep on the arm with the access site.
    ¬Do not wear any clothing or jewelry that binds that arm.
    ¬Do not let anyone draw blood from that arm.
    ¬Do not allow injections to be given into the fistula or graft.
    ¬Do not permit anyone to measure blood pressure in that arm.
    ¬Keep the site of the fistula or graft clean using an antibacterial soap.
    ¬Observe the site after dialysis for swelling, bleeding, or infection.
    ¬Do not use any creams and lotions over the site of the fistula or graft.

  4. Breast Procedures

    What do I need to do before surgery?

    Please contact your insurance company to verify the coverage and determine whether a referral is required. You will be asked to pre-register with the appropriate hospital and provide demographic and insurance information. This must be completed at least five to ten days before the date of surgery. Your surgeon will give you specific instructions on how to prepare for your surgery.

    What happens on the day of surgery?

    You will report to a pre-operative nursing unit where you will change into a hospital gown. A nurse will review your chart and confirm that all the paperwork is in order. You will be taken to a pre-operative holding area, where the anesthesiologist will start an IV. Before any medications are administered, your surgeon will verify your name and the type of procedure you are having. You will then be taken to the operating room. After the appropriate form of anesthesia is administered, surgery will be performed.

    What happens during surgery, and how is the surgery performed?

    Your surgeon will make an incision and separate the tissue between the skin and the chest wall. Your surgeon may request a frozen section of the breast tissue. This lab test is performed to identify the area of the tumor. It may take several days to completely identify the tumor. If you have elected to have an immediate breast reconstruction, the plastic surgeon will then perform the reconstruction.

    How long will I be in the hospital?

    Your length of stay will depend on the type of mastectomy. Usually, this ranges from two to ten days.

    When can I expect to return to work and/or normal activities?

    You can expect to return to normal activities such as showering, driving, walking up stairs, light lifting, and work, within a few days. Heavy lifting is discouraged until the pain and swelling have diminished. If you are taking narcotic medications for pain, you should not drive.
     

  5. Carotld Endarterectomy

    When is the Procedure Indicated?

    Common indications for carotid endarterectomy include:
    ¬Persons who have had a TIA or mild or moderate stroke within the past six month and have carotid artery stenosis (blockage) between 50 and 69 percent; or
    ¬The presence of severe degrees of blockage even without any warning symptoms.

    Endarterectomy may be inappropriate for people for whom surgery poses a significantly increased risk, such as:

    ¬People of very advanced age or who have a serious disease, such as uncontrolled cancer;
    ¬People with problems with other blood vessels in the head, such as cerebral aneurysm.

    Pre Treatment Prior to the endarterectomy, a physician may order the following tests to assess the plaque buildup inside the arteries:

    ¬Duplex Ultrasound
    ¬Angiography
    ¬Magnetic Resonance Arteriography.

    The procedure typically takes about two hours.

    Post Treatment Guidelines
    Following the procedure, the patient may spend one or two days in the hospital. During this stay, the physician will monitor the patient to ensure normal brain functioning, maintain blood pressure, and watch for any sign of bleeding from the neck area.
    After discharge, physicians recommend that the patient:
    ¬Limit physical activity for several weeks;
    ¬Avoid driving a car; and
    ¬Report any change in brain function, severe headaches, or swelling in the neck.
    The patient is usually able to resume normal activity several weeks following the operation.

    Restenosis, or re-blockage of the carotid artery, occurs in approximately six percent of patients. To help prevent restenosis, the physician recommends lifestyle changes, which include:

    ¬Maintaining an ideal weight;
    ¬Exercising regularly; and
    ¬Avoiding foods that are high in cholesterol and saturated fat.

    Possible Complications

    Although carotid endarterectomy is effective in reducing the likelihood of future strokes, there is a risk of serious complications such as stroke during the procedure. This risk can range between one and three percent.
    Factors that increase the risk of complications include:
    ¬Extensive arterial blockage in other blood vessels;
    ¬Poorly controlled hypertension;
    ¬Prior stroke on either side of the brain; and/or
    ¬Diabetes.

  6. Colon Resection
    Please contact your insurance company to verify the coverage and determine whether a referral is required. You will be asked to pre-register with the appropriate hospital and provide demographic and insurance information. This must be completed at least five to ten days before the surgery date. Your surgeon will give you specific instructions on how to prepare for the procedure.
    Before surgery, your colon will need to be emptied. Your physician will give you directions on how to do this. You may be put on a liquid diet and instructed to drink a solution that will induce diarrhea. You may also be instructed to give yourself an enema.

    What happens on the day of surgery?

    you will report to a pre-operative nursing unit, where you will change into a hospital gown. A nurse will review your chart and confirm that all paperwork is in order. You will be taken to a pre-operative nursing unit where an anesthesiologist will start an IV. Before any medications are administered, your surgeon will verify your name and the type of procedure you are having. You will then be taken to the operating room. After the appropriate form of anesthesia is administered, surgery will be performed.

    What happens after the surgery?

    Once the surgery is completed, you will be taken to a post-operative or recovery unit, where a nurse will monitor your progress. It is important that your bandages be kept clean and dry. Mild discomfort may occur at the incision site, so your surgeon may prescribe pain medication. You will be scheduled for a follow-up appointment within two weeks after your surgery.

    How long will I be in the hospital?

    Most patients are in the hospital from five to seven days with an open colon resection and three to five days with a laparoscopic colon resection. You may need a ride home when discharged from the hospital.

    What are the risks associated with a colon resection?

    As with any surgery, there are risks such as bleeding, infection, or an adverse reaction to anesthesia. Other risks include injury to the ureter, bowel, or spleen, and anastomotic dehiscence, which is the separation or leaking of the sutured colon. Your physician will inform you of the risks prior to surgery.

    Will there be scar(s)?

    If the procedure is performed laparoscopically the incisions should heal well, leaving small discrete scars. If the open method is used, a larger scar will be present.
    When can I expect to return to work and/or resume normal activities?
    This can vary from patient to patient. There are no restrictions after laparoscopic colon resection. You will be encouraged to return to normal activities such as showering, driving, walking up stairs, light lifting, and work as soon as you feel comfortable. Some patients can return to work in a few weeks while others prefer to wait longer. You should not perform heavy lifting or straining for six to eight weeks after open surgery. If you are taking narcotic medications for pain, you should not drive

  7. Gall Bladder Removal

    What do I need to do before surgery?

    Please contact your insurance company to verify the coverage and determine whether a referral is required. You will be asked to pre-register with the appropriate hospital and provide demographic and insurance information. This must be completed at least one to ten days before the surgery date. Your surgeon will give you specific instructions on how to prepare for the procedure.

    What happens on the day of surgery?

    You will report to a pre-operative nursing unit, where you will change into a hospital gown. A nurse will review your chart and confirm that all the paperwork is in order. You will be taken to a pre-operative holding area, where the anesthesiologist will start an IV. Before any medications are administered, your surgeon will verify your name and the type of procedure you are having. You will then be taken to the operating room. After the appropriate form of anesthesia is administered, surgery will be performed.

    What happens after the surgery?

    Once the surgery is completed, you will be taken to a post-operative or recovery unit where a nurse will monitor your recovery. It is important to keep your bandages clean and dry. Your physician may prescribe medication for pain, nausea and vomiting which are not uncommon with this procedure. You will be scheduled for a follow-up appointment within two weeks after your surgery.

    How long will I be in the hospital?

    Although some patients may stay overnight, most go home the same day.

    What are the risks associated with gallbladder removal?

    As with any surgery, there are risks such as bleeding, infection, or an adverse reaction to anesthesia. Other risks include bile duct or bowel injury. Your surgeon will inform you of the risks prior to surgery.

    Will there be scar(s)?

    If the procedure is performed laparoscopically the incisions should heal well, leaving small discrete scars. If the open method is used, a larger scar will be present.

    When can I expect to return to work and/or resume normal activities?

    This varies among patients. There are no restrictions after laparoscopic gallbladder removal. You will be encouraged to return to normal activities such as showering, driving, walking up stairs, light lifting, and work as soon as you feel comfortable. Some patients can return to work in a few days, while others prefer to wait longer. You should not engage in heavy lifting or straining for six to eight weeks after open surgery. If you are taking narcotic medications for pain, you should not drive.

  8. Ventral Hernia

    HOW IS A HERNIA REPAIRED?

    Surgery involves return of the abdominal contents back into their normal position and repair of the area of weakness. A plastic screen or mesh (made from non-reactive material) is used to safely reinforce the area in repairing the overwhelming majority of hernias (both primary and
    recurrent hernias). The mesh patch becomes part of the body, giving strength and support to the abdominal wall. The mesh patch reduces, but does not eliminate, the chance of the hernia coming back.

    WHAT HAPPENS AFTER THE OPERATION?

    After surgery, you will be active and able to walk, and offered a light snack. Patients with straightforward small or moderate sized hernia repairs are discharged on the day of surgery safely and comfortably. You should take panadol and nurofen regularly for pain. For the first
    week or two, you may need something stronger in addition, so a prescription for narcotic pain medication will be provided.

    WHAT IF I DON’T HAVE THE HERNIA REPAIRED?

    While hernias in babies sometimes heal, hernias in adults will never get better without surgery. In fact, they tend to enlarge and get worse over time. Many patients ask about a truss (externalhernia support.) A truss may support the weak area and provide some comfort, but is generally ineffective and can cause pressure sores. Hernias can be aggravated by chronic cough, constipation, or heavy lifting. Contents of the hernia, like intestine, may occasionally become trapped within the hernia leading to intestinal blockage or damage ( incarceration orstrangulation), creating an emergency surgical situation.

    Incision

    Your incision is covered with a waterproof protective dressing. You can shower and wash your hair as usual, but do not soak or scrub the dressing. After showering, pat dry. Your dressing will be removed at your first post-operative visit. If you experience itching once the dressing is off, you may apply lotion to the scar. You might notice bruising around your incision or down into your genital area. In addition, the scar may become pink and hard. This hardening will peak at about 3 weeks and may result in some tightness, which will disappear over the next 3 to 4 months. You will also notice some numbness of the skin over the area. This is normal.

  9. Hiatal Hernia
    Hiatal hernia is a condition in which a portion of the stomach protrudes upward into the chest, through an opening in the diaphragm. The diaphragm is the sheet of muscle that separates the chest from the abdomen. It is used in breathing. The cause is unknown, but hiatal hernias may be the result of a weakening of the supporting tissue. Increasing age, obesity, and smoking are known risk factors in adults. Children with this condition are usually born with it (congenital). It is often associated with gastroesophageal reflux (GERD) in infants.
    Hiatal hernias are very common, especially in people over 50 years old. This condition may cause reflux (backflow) of gastric acid from the stomach into the esophagus.
    Most usual symptom is burning sensation behind the breastbone. Sometimes it can be very mild, sometime it can become so painful that it could be hard to concentrate on anything else but the pain. Another one is burping, belching and other unpleasant things. There are certain kinds of foods which guaranteed to give you this (like soft drinks).
    Sour taste in your throat usually occurs in the morning. If you experiencing this symptom every morning and taste is really sour it is time to do something about your heartburn. Nightime heartburn in a very bad stage you must work hard to put it under control.
    Sore throat is tricky, since it is very easy to confuse it with cold. Swallowing difficulties is pretty scary. If your heartburn is causing you swallowing problems run to the doctor now. This symptom could be a sign of something serious. Usually based on this symptom your family doctor will refer you to gastroenterologist who will perform an endoscopy. Chest pain, a very confusing one. But if you have this symptom it does makes sense to consult with your doctor. It is better to make sure that it is not a problem with your heart than have unpleasant surprises later.
  10. Parathyroids
    The parathyroids are four tiny glands in your neck, two on each side of your thyroid gland. They make parathyroid hormone (PTH) which controls the level of calcium in the blood. Calcium is very important for the normal functioning of muscles, nerves, and bones. It is absorbed through the intestines and stored in the bones. Parathyroid hormone raises blood levels of calcium by increasing intestinal absorption of calcium, and by dissolving calcium from the bone into the bloodstream.

    What is hyperparathyroidism?

    Some people make too much parathyroid hormone, a condition called hyperparathyroidism. This condition is most common in middle-aged women, but can occur in men or women at any age and can run in families. In 9 of 10 patients with hyperparathyroidism, the cause is a single benign tumour. In one
    of 10, all four parathyroids are enlarged. Cancer is exceedingly rare.

    What are the symptoms of hyperparathyroidism?

    The body does not like having blood calcium levels too high, and tells you in a number of ways.
    Hyperparathyroidism can cause
    ¬ weak bones, called osteoporosis, which can lead to fractures
    ¬ kidney stones, renal impairment
    ¬ high blood pressure
    ¬ abdominal pain
    ¬ increased frequency of urination
    ¬ constipation
    ¬ stomach ulcers and pancreatitis
    ¬ psychiatric problems
    ¬ arrythmias and heart disease
    ¬ difficult to control blood sugar if you are diabetic

  11. Peripheral Arterial Bypass Surgery

    What is Peripheral Vascular Disease?

    Your arteries are normally smooth and unobstructed on the inside but they can become blocked through a process called atherosclerosis, which means hardening of the arteries. As you age, a sticky substance called plaque can build up in the walls of your arteries. Cholesterol, calcium, and fibrous tissue make up the plaque. As more plaque builds up, your arteries can narrow and stiffen. Eventually, as the process progresses, your blood vessels can no longer supply the oxygen demands of your organs or muscles and symptoms may develop.

    What is surgical bypass?

    Surgical bypass treats your narrowed arteries by creating a bypass around a section of the artery that is blocked. During a bypass, your vascular surgeon creates a new pathway for blood flow using a graft. A graft is a portion of one of your veins or a man-made synthetic tube that your surgeon connects above and below a blockage to allow blood to pass around it. You may be familiar with bypass surgery on heart arteries, but vascular surgeons also use bypasses to treat peripheral arterial disease (PAD). Surgeons use bypasses most commonly to treat leg artery disease, which is hardening of the arteries in the leg. Surgeons also use bypass to treat arm artery disease.

  12. Thyroidectomy

    What is the thyroid gland?

    The thyroid gland is shield-like organ located just below the larynx or Adam’s apple. It is a small gland that wraps around the trachea or windpipe. The gland converts iodine from the diet into the thyroid hormone, thyroxine. The levels of this hormone control most of your body’s metabolic functions including temperature, heart rate and growth.

    What are the indications for thyroid surgery?

    Thyroid surgery (thyroidectomy) may be required if there is:
    -A lump that could be a malignant tumour (thyroid cancer). This is usually determined by a fine needle biopsy of the lump.
    -A goitre (enlargement of the thyroid) causing pressure on surrounding organs resulting in symptoms such as difficulty swallowing, difficulty breathing or a persistent cough.
    -Growth of your thyroid down into the chest cavity (a retrosternal goitre)
    -Excessive activity of the thyroid (hyperthyroidism or thyrotoxicosis)

    Thyroidectomy

    A thyroidectomy is the procedure performed to remove all or part of the thyroid gland. Located in the front of the neck, the thyroid is a butterfly-shaped gland, consisting of two lobes connected by an isthmus. The gland is responsible for regulating metabolism by secreting hormones. When diseases affect the thyroid, its size or activity may become abnormal. These diseases include thyroid cancer, goiter, and hyperthyroidism. Thyroid problems can often be treated medically, but in some cases, the thyroid needs to be removed. The extent of thyroid removal depends on the patient’s condition.

  13. Esophagogastrectomy
    An Esophagogastrectomy is a surgery to remove the esophagus and part of the stomach. The esophagus is then replaced in one of two ways: by moving the remaining portion of the stomach upwards, or by replacing it with a section of the large bowel (colonic reconstruction). Lymph nodes near the esophagus may also need to be removed. Your doctor will discuss with you what procedure is most likely to be needed for your situation. This surgery is typically done for people with esophageal cancer or people with Barretts .
    Esophagitis, is for those who are at high risk for developing esophageal cancer. This operation removes the diseased portion of the esophagus.
    Swallowing problems or dysphagia are common in people with esophageal cancer. Often times these swallowing problems cause people to have a difficult time eating. Surgery should help reduce swallowing problems.
    You should get a good understanding of the purpose of this surgery when you discuss this with your doctor. It may be to remove all of the cancer, or the diseased area. Or, it may be to help lessen your symptoms. Please always ask questions that you have. Our care team will try to give you the information you need.
  14. Ultrasound Guided Thyroid Fine Needle Aspiration
    Ultrasound Guided Thyroid Fine Needle Aspiration

    What are Thyroid Nodules?

    Simply put, thyroid nodules are lumps that commonly arise within an otherwise normal thyroid gland. Often these abnormal growths of thyroid tissue are located at the edge of the thyroid gland, so they can be felt as a lump in the throat. When they are large or when they occur in very thin individuals, they can even sometimes be seen as a lump in the front of the neck.
    Once a thyroid nodule has been detected (or suspected), there are a few things that the physician will want to know before any recommendations can be made regarding treatment. Remember, the vast majority of thyroid nodules are benign and nothing to worry about, so the focus is on determining which ones have any reasonable chance of being cancerous.

    How can I know if I have a thyroid nodule?

    One of the first tests that is routinely performed is the ultrasound.This simple test uses sound waves to image the thyroid. The sound waves are emitted from a small hand-held transducer that is passed over the thyroid. A lubricant jelly is placed on the skin so that the sound waves transmit more easily through the skin and into the thyroid and surrounding structures. This test is quick, accurate, cheap, painless, and completely safe. It usually takes only about 10 minutes and the results can be known almost immediately. Not all nodules need this test, but it is almost routine.

    How do I know if I should have surgery?

    Certain characteristics of thyroid nodules seen on an ultrasound are more worrisome than others. Keep in mind, however, that an ultrasound alone cannot make the diagnosis of cancer. The FNA will usually (but not always) tell if a nodule is benign or malignant. This is often the only test needed. This test will usually help determine that the nodule has a low chance of being cancerous (has characteristics of a benign nodule), or that it has some characteristics of a cancerous nodule, and therefore a biopsy is indicated.