Thursday, July 12, 2012

Reconstruction: surgical opinion #2

Today I met Dr. G in Be'er Sheva.

I wound up alone at this visit, too, but not through lack of planning.

My genuinely loving husband actually forgot about the appointment this morning. I hadn't reminded him. I tried calling him multiple times in the morning, but, it turns out he left his phone on 'vibrate' after morning prayers, by accident. In the end I had to call a cab and solo flight... again. Made me very anxious, indeed. It was too late to get someone to drop what they are doing and come with be me now. I would feel bad about that, mostly because I have the kind of friends who would do that in a heartbeat, if they at all could. I can't take advantage of that good nature toward me... I don't like asking for favors. Especially because these are the very same people who *have* helped out so much each time I am out of commission. I don't want to overstay my welcome, you know?

Anyway, here I am at consult #2, solo.

I had met him before, actually, this Dr. G. It was at Soroka, when I was there five years ago, while he was in his last year of residency in plastic surgery. I remembered him from then as being really nice. (still is.)

I walked into his [private] office, and he said "you look familiar to me". Uh, yeah, that may be because I was a famous person on the ward back then. :) I reminded him a bit about the NF, and he immediately remembered.


After the small talk about the _seven_ surgeries, and the orthopedic and nerve issues I have gone through in five years, then discussing in depth about the types of pain I live with, we got down to the exam.

He looked... he said "oh yeah, I totally remember this graft".
That is the second plastic surgeon in one week who told me that. I gotta get away from this small town gossip.
Next opinion in Tel Aviv...

Main news is that he decidedly stated that he would *not* use skin expanders.

I already liked the sound of this. Of course he had to pull-and-pinch-and-separate-and-pull some more on poor gapey. Hurt like hell, but the difference this time is that he was gentle verbally, apologized before a particularly sensitive stretchy pull: "sorry Sarah, but this will hurt... I need just a few seconds with this...". Still hurt, but I didn't feel beat-up afterward. We like that.

To do the surgery without skin expanders is a bit more sensitive, and will take more surgeries to accomplish the goal.

To backtrack a bit- the reconstruction plan with the expanders would be two surgeries. One to implant the expanders and one to do the reconstruction; the actual closure. *But*, I'd have to come to the hospital every week to two weeks for six months until the skin is stretched enough to close gapey. During that time I'd have painful balloons protruding from under my upper thigh skin, hip skin, and lower belly. (Yeah, *that* would be comfortable and promote mobility!) Then, after that, would be surgery #2.

Dr. G was saying that he'd need at least three surgeries to accomplish a good result, possibly four. He felt pretty confident it'd be three, though.

Each surgery would be six * months * apart.

(warning: gets a little bit oogy, like grisly here...)
At each surgery, he'd take a bit of my natural skin, and using it's natural elasticity to bring it over gapey, he'd be, at the same time, taking off a strip of the graft, the exact size of the stretch of skin. The graft would be removed in stages, over the three [or four] surgeries, not all at once.

End result would be gapey covered with my own skin, same end result as balloon surgery. *But*, the balloon surgery said that in the end, everything on my belly would be symmetrical. With the non-balloon surgery the doctor said that my puppik ('belly button' for those of you not well-versed in Yiddish) would be off center-- by an inch- to inch & a half. That would be **so weird**. I mean, gapey's nature is ^all about^ asymmetry, but I want the surgery to help me look (and feel) normal. Dr. G said he'd be able to surgically straighten out my puppik a while thereafter should I choose (after the stretched skin would accept more stretching). Hmmmm.....

Time-wise under the knife is about the same. Dr. 'No-bedside-manner', from Sunday, said the actual reconstruction surgery would take 10 to 12 hours. Dr. G, today, said that each surgery would take around four hours. End result- also 12 hours, but not all at once.
Anyone have an opinion about which is better from that point of view?
(I'd love an opinion especially from my wise sister-in-law RK, if you want to weigh-in!)

Here is one **really interesting point** that I never thought of. (although Robert said he had thought of this very thing. Wise man)

While I asked him if this procedure is, in his eyes, purely cosmetic (as Dr. 'No-bedside-manner' implied), he immediately said "absolutely not!". "It is purely medical, 100%. You *need* this thing closed. Especially because you have orthopedic problems with your hip."
Turns out that if, in the future, I ever need a hip replacement (not too far-fetched to imagine), it would be impossible to do with this huge skin graft in the way. An 'open' procedure cannot be done. Until now, all my hip surgeries have been arthroscopic-- three or four holes in the skin with a camera and surgical knives inside showing the surgeons where to cut. Professor Meller even said himself that it would be potentially extremely damaging to do my PVNS surgery in an open procedure. He said he'd be wary of never being able to close the joint, with no skin and fat to close up around it.

A hip replacement, however, needs to be done in an open procedure. If I needed that, I'd have to wait at least a year, maybe two, before I could get a new hip, because I'd first need to do the plastic surgery.

Also there is the issue of this procedure ("procedures" is more accurate) potentially being beneficial to relieving some pain, and therefore reducing pain medicine, making me healthier in the not-so-long-run.

Yes, he did say that it would help *some* nerve pain, but not the major stuff I have. The nerve pain it would help (or solve, but he can't say that, of course) would be the gapey pain, and the immediate vicinity. This includes the pain I suffer from the mesh placement.

The major nerve pain I have- all the way down my thigh- Dr. G said grimly, that he would not hope on ever fixing, or hope that those nerves will grow back. He said that they are irreplaceable, having been decimated by the NF. There is a "road block" there (yes, Hebrew speakers, he used the word מחסום.) Dashed my hopes, but such is life. Looks like nerve pain will remain in my life, but hopefully a lower dose of maintenance medicine.


Yes, it is definitively a medical, necessary (elective) procedure. That bodes well for full insurance coverage. Thank Gd we took out extra insurance a long time ago. We have the breathe-easy choice of going completely private, including a private hospital of course, completely covered (to the tune of 75,000 shekels + mom (VAT), which comes to roughly $20,000 [American].
In our free-medical care nation, which in general I really *love*, in this case I'd actually have MUCH fewer options. Coverage is very tight, of course.
I also went private when I had the mesh put in-- private surgeon, hospital, the whole thing (with Wi-fi and a computer for each bed, attached above you, ready to be pulled down!). Completely covered.

I learned a lot at this visit.
I am glad I have this blog space to keep it all straight, so I can cough it all up for future reference.

We may go with Dr. G, but I am very, very curious to hear what the plastic surgeon Dr. Gur in Ichilov, has to say. That would not be considered private, sine it is a national hospital. Dr. Gur is very up with all the new techniques around. He has a cool website (with not-so-modest pictures, so I am not including it here. You can Google it.). The decision may be riding on that, but I also believe, with all my heart, that:

it won't be me picking the surgeon, it will be the hand of God. 
It will be done by the surgeon He chooses, I just have to do the footwork,
then wait to see what will happen.

This same hand of God scooped me up a good few times from grave situations?
If I reach out and actively connect my hand with His, and we work together,
this will all be Good.
Pure good.

My Rebbetzin today at my weekly shiur said something 
that hit me at the right moment as quite profound.

It is- that while the world was created by God,
 everything He creates is inherently GOOD.
Everything has been tailor made for my (all mankind's) good.

While the world is inherently good,
there are things that are simply not befitting/ congruous/ convenient 
(י(מתאים  for... .


  1. you are so strong, I don't know how you've been thru what you've been thru and still sound so positive! keep it up

  2. I know some really, bad ass dudes. Guys I would have gone into the jungle with, and I don't believe any of them are stronger than you.

  3. Good luck with the decision-making. And nice running into you today.

    1. yes, it was nice! I like your short hair- so cute on you. :)

  4. Wow sweetie - that is major stuff you went through today.
    I am so glad the dr was kind. We like that, too :-).

    And - what's better? I wish I'd know. I have to think, maybe an answer will come up.
    I'll get back to you on that one.

    I love you,

  5. despite wanting the best- because you have all kinds of connected problems and no operation will be a 'one-time whammy' and it's need someone you can be in continual contact with...not sure you want to get too far from home! Good luck.

    1. you're right, Tzippi - that is definitely a big consideration. It gives this guy (the one in this blog) a big point on his side. I still want the opinion of the Ichilov guy, tho, just to see if there is a technique of doing this that we don't know about. Also, a hospital doctor (Ichilov guy) is not as available as a private one, as far as O.R. availability (when can we start this process), and phone calling availability. Big point for this one.