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Information for Those Who Live Far Away
by Christopher Chang, MD • Last Modified 9/14/2008

In the last 6 months, patients from Florida, Pennsylvannia, and NY have come to have this procedure done by Dr. Chang. Though you don't have to live in another state, if you live at least >2 hours drive away and would like to travel to Warrenton, VA to have Dr. Chang treat your Zenker's Diverticulum using the mininimally invasive ESD procedure, here are the steps to take. These steps also prevent patients who are not surgical candidates from wasting their time traveling to see Dr. Chang. Please note that from first contact to having the surgery peformed may take a few weeks.

STEP 1:

  • Contact your insurance company to make sure you are able to go out-of-network for your care (if you have Medicare, you are covered). This is YOUR responsibility. Not ours.
  • Email/Call Dr. Chang with your interest.
  • Mail a CD to Dr. Chang's attention containing the actual images of the barium swallow showing the Zenker's Diverticulum. Make sure an official report is also contained. A CD can be created for you if you request it from the radiology department where you had the exam performed.
  • Email/Mail to Dr. Chang the following digital pictures of your head, neck, and shoulders:
    • Front Face View: Mouth as wide open as possible (to make sure it is large enough to accomodate the instruments needed to perform procedure endoscopically)
    • Side Profile: Bend head forward as far as possible (chin to your chest).
    • Side Profile: Bend head as far back as possible (like looking up at the ceiling).

Once Dr. Chang feels you have the appropriate physique and the Zenker's Diverticulum is amenable to ESD, he will contact you confirming candidacy. The next few steps should be than taken:

STEP 2:

  • Fax (540-347-5224) your complete health insurance information to the office as soon as possible (front and back of all your health insurance cards).
  • A complete history and physical within the last 30 days from your medical doctor for preoperative clearance faxed to our office as soon as possible. Be sure that a list of all your medications is included. PLEASE NOTE that you must be off all blood thinners (plavix, coumadin, aspirin, ibuprofen & other NSAIDS, etc) for 5 days prior to and for 1 day after surgery. If you are on these medications, please have your physician state both pre and post-operative recommendations.
  • The following studies WITHIN the last 30 days and reports faxed to our office: EKG, CBC, Chem7, PT, PTT, and chest X-ray (PA/lateral).
  • Download, complete, and fax our office forms to us.

Once the office receives all this information, both Fauquier Hospital and our office will obtain preauthorization from your health insurance company. Depending on your health insurance company, your primary care doctor may need to write a letter of medical necessity as to why you are going out-of-network for your treatment. The following steps will occur as well.

STEP 3:

  • Call (540-347-0505) and ask to speak to Carrie Soaper to schedule your appointment and surgery.
  • Appointment to see Dr. Chang (the day before surgery which would be a Tuesday or Thursday is OK if the appointment is ideally before noon). Make sure you bring the hardcopy films and official reports of the Barium Swallow and Chest X-ray with you.
  • Preferred surgical date on a Wednesday (Dr. Chang operates only on Monday, Wednesday, and first Friday of each month).
  • If you aren't already, START taking prilosec (over-the-counter) or equivalent (ie, Nexium, protonix, aciphex, etc) one week before the procedure. You will need to continue taking this medication for a total of 3 months. This medication has been found to reduce the risk of the Zenker's Diverticulum recurring after the procedure.
  • Depending on how the operation goes, you may spend one night in the hospital or be discharged after a few hours.

Please note that Dr. Chang reserves the right to have you see any necessary physicians locally in Warrenton, VA (pulmonologist, cardiologist, internist, radiology, etc) before your surgery to make sure you are optimized medically (will occur same day as appointment or immediately before surgery).

It would be worthwhile to carefully read the informed consent for the ESD procedure which goes over risks and call Dr. Chang with any questions you may have.

Lastly, though you may have committed the time and expense to come to have the ESD procedure done, if there are any medical concerns that you may not tolerate the procedure or the general anesthesia to undergo the procedure, Dr. Chang reserves the right to delay or even cancel the surgery.

STEP 4:

Once your surgery is scheduled, we will have our hospital concierge, Lisa Spitzer, contact you to make your time here as smooth as possible. If you would like to utilize her services which I strongly encourage, she will meet you in my office when you arrive for your initial appointment and make sure you are able to get from place to place without getting lost. She can also make all hotel arrangements for you at significant discounts prior to your visit.

Hotels nearby where you can stay.