This week our contributing writer Doctor Gifford-Jones talks about questioning the necessity of surgery when alternative, safer options can work.
Is it better sometimes to run for the woods rather than submit to surgery? The decision is easy when the diagnosis is acute appendicitis or a strangulated hernia. But there are times when a sojourn in the woods makes sense. Time is often the best healer.
Several weeks ago the gods were unkind to me during the night. When arising from bed I suddenly experienced a pain from hell. Like a tire that blows out, two inter-vertebral disks had suddenly exploded with a vengeance, and I was on my hands and knees in agony.
My MRI report was not good and the neurosurgeon gave me two choices. A operation which might be successful to ease the pain. Or painkillers, anti-inflammatory drugs and tincture of time. I elected time.
Five weeks of rest were required along with considerable pain before the disks decreased in size and relieved the pressure on nerve. Unfortunately, injury to the sciatic nerve left me with a weakened quadriceps muscle in the leg. I considered that a small price to pay compared to the potentially serious complication of major spinal surgery. I considered the risk/benefit ratio and won!
It’s been said that if you give a carpenter a hammer, he wants to use it. This is natural and the same maxim applies to surgeons as well. Give them a new device or technique and they want to use it. Most do so in a responsible way. But the necessity for balanced judgment remains.
Today hundreds of thousands of angiograms are performed in North America. Dye is injected into coronary arteries to detect a blockage. If an obstruction is found doctors snake a tiny balloon into the artery and crush the mass. Or they may insert a tiny cylinder called a stent to keep the artery open.
Some authorities claim that too many of these procedures are being done. They argue doctors resort to angiograms before they’ve done an exercise stress test. And stent and bypass surgery is performed when the blockage is insignificant and the patients symptoms minimal. Or surgically fail to suggest that lifestyle changes and medication are safer and may be equally effective.
Women should think twice when hysterectomy is prescribed for fibroids, pelvic pain and abnormal bleeding. Techniques such as hysteroscopy, in which a lighted instrument is inserted into the uterus, can remove fibroids leaving the uterus intact. Another procedure, endometrial ablation can destroy the uterine lining and decrease troublesome bleeding. Oral contraceptives are also often successful in controlling bleeding and painful periods.
For males a big decision is whether an enlarged benign prostate gland should be removed by surgery. But before resorting to surgery frequent sex and the use of saw palmetto (320 milligrams a day) may be effective. Medication such as Proscar may shrink the gland. Others may be helped by drugs such as Hytrin and Flomax which relax muscles around the urinary tube making voiding easier.
Men should also ask their doctor whether the use of lasers or microwaves are an option to destroy prostate tissue. These procedures are less likely to result in complications. And if a malignancy is present and you’re in the 70’s watchful waiting may be the prudent course. Surgery usually results in a 15 per cent or more chance of urinary incontinence. No one wants to end their life in diapers.
One operation, currently in vogue to treat obesity, is to either shrink the stomach or re-route food around it. This major surgery carries a one in 250 risk of dying. Some fear the operation is now used before patients seriously try to eat less and exercise more. Another procedure to cut out heartburn by laparoscopy is questionable when good drugs are available for this condition.
I often say to patients who are thinking of hip or knee replacement, “How much is the problem really bothering you?” Particularly, if they walk into the office with relative ease. Each of us has our pain tolerance level. But today it’s my impression that too many people undergo surgery long before that level is reached. Unfortunately, some of these patients get more than they bargained for when complications occur.
A second opinion can help to solve these problems.