Dr. Roach: Redundant pre-op procedures may be avoidable

To Your Health
Keith Roach

Dear Dr. Roach: Many of our local doctors insist on pre-procedure office visits prior to one-morning outpatient procedures such as rotator cuff surgery, colonoscopy and endoscopy. Since I receive regular checkups from a superb internist, see my cardiologist every six months and tend to schedule my procedures shortly after such checkups, I consider this an exploitative waste of my time and money, and feel they have this requirement only because I have good insurance and they can collect fees by putting me through time-consuming and unnecessary visits. My primary-care physician agrees. Do you have any comments or suggestions on how to get around this growing trend?


Dear L.S.: As a primary-care physician, I also get frustrated by requests for pre-operative visits in patients who have recently been seen. Sometimes, a letter to the surgeon that a recent visit showed no medical concerns prior to the planned surgery will suffice. Other times, the surgeon requires that certain tests be done (even some tests that have repeatedly been recommended against by experts).

While I agree it’s often a waste of time, I don’t think it is the surgeons’ desire to increase health-care costs that perpetuates this behavior. Instead, I think it’s a genuine desire to ensure their patients are in the best possible medical condition for the surgery that makes the surgeons insist on a medical visit.

Telling your PCP or cardiologist about a planned upcoming surgery allows us to get the appropriate tests and write the note in such a way that you often can skip the preoperative visit, if the regular visit is scheduled soon before the operation (in my hospital, that’s usually within a month).

Dear Dr. Roach: Two separate days in the past month, I woke up in the middle of the night after being asleep for about four hours and realized that my heart was beating extremely fast. I waited a few minutes and, just as I was wondering if I should go to the emergency room, my pulse started to slow down. I had no other symptoms other than my heart racing. I am a 25-year-old female with no other health problems. My roommate said she thought it could have been caused by stress. I’m scared it will happen again. Should I go to the hospital if it does happen again? If it did happen because of anxiety, is there any way to reduce stress, other than medication or therapy?


Dear S.C.: Waking up with your heart racing can be due to anxiety, but that isn’t a common presentation for anxiety, which usually is in response to stressful situations (or anticipating one). Waking up with a racing heart is more likely to be due to a heart-rhythm disturbance, such as a reentrant AV nodal tachycardia. The most common reason for this is having two pathways from the top of the heart (the sinoatrial node) through the midpoint (the atrioventricular node), which then goes on to the ventricles. A circular pathway can get set up down the abnormal fast pathway and up the slow one (or vice versa) causing a very fast heart rate.

I would not wait for it to happen again, but would go see a doctor and maybe get connected to a Holter monitor or event monitor. Both track your heart rhythm for extended periods of time.

Once you have a diagnosis, you can be treated, with radio waves to destroy the abnormal fast pathway or with medication if it ends up being the condition I am concerned about.

Email questions to ToYourGoodHealth@med.cornell.edu.