Do You Need This Surgery?
- From: Ablang <ron916@xxxxxxxxx>
- Date: Sat, 31 May 2008 08:32:05 -0700 (PDT)
Do You Need This Surgery?
Millions of Americans are having operations on their knees, backs and
sinuses...
Do You Need This Surgery?
By Dr. Ranit Mishori
Published: May 25, 2008
http://www.parade.com/articles/editions/2008/edition_05-25-2008/1Do_You_Need_This_Surgery
More than 70 million Americans face surgical procedures every year.
Are they all necessary?
Probably not. Even the simplest operation is a serious undertaking.
“No surgery is minor,”
says Dr. Thomas Russell, executive director of the American College of
Surgeons. There is
always a possibility that something can go wrong when someone sticks a
sharp blade in your
body.
Sometimes surgery is the only available treatment. In other cases,
however, less-invasive
options should be tried first. Whether or not you go under the knife
may even depend on
where you live. “There’s evidence that in some parts of the country,
certain procedures are
overdone,” says Dr. Russell. “But other communities take a
conservative approach and require
you to go through hoops and hurdles before you have surgery.”
Clearly, there should be no delay when surgery is the only recognized
treatment or you’re in
a life-threatening situation. But doctors agree that patients
considering elective
procedures should proceed cautiously.
Here is some vital information to consider about three of the most
popular forms of elective
surgery.
Knee Surgery More than 13 million Americans suffer from
osteoarthritis of the knee. In
plain language, their knee joints have worn out. Most doctors will try
conservative
treatments first, including medication for pain and inflammation,
physical therapy or joint
injections. “To have knee surgery just because you have arthritis is
not the solution,”
cautions Dr. Jim King, president of the American Academy of Family
Physicians.
When the conservative approach fails, however, about one in four
people with osteoarthritis
of the knee eventually becomes a candidate for total knee-replacement
surgery.
About a half-million Americans a year undergo this procedure, known as
knee arthroplasty, in
which metal, plastic or ceramic replaces all or most of the worn-out
joint. It is one of the
most successful and established surgical procedures in the U.S. More
than 90% of people who
get new knees experience significant pain relief, improved mobility
and a better overall
quality of life. Recovery can be slow and painful, though, requiring
months of therapy.
On the other hand, a recommendation for knee arthroscopy—a less-
invasive and increasingly
popular procedure selected by 650,000 patients in the U.S. last year—
should be looked at
skeptically. The theory behind the procedure is that arthritis causes
loss of tissue at the
surfaces of the bones, which painfully chafe against each other and
produce debris. The
surgeon—guided by a camera inserted at the knee joint—cleans the bone
and smooths the
surfaces. Unfortunately, several studies have concluded that this
procedure is not very
effective, particularly against advanced arthritis. In fact, one study
found that “sham”
surgery—where only a cut was made, though the patient believed a full
procedure had been
performed—provides as much relief as arthroscopy.
If your doctor recommends arthroscopic surgery, be sure to ask why he
thinks it’s necessary
and what other options he recommends. If you’re not satisfied with the
answers, get a second
opinion.
Back Surgery The spine is made up of 25 bones called vertebrae. Soft
disks filled with a
jellylike substance sit between them to cushion and keep the vertebrae
in place. If a disk
bulges or ruptures—a “slipped” or “herniated” disk—you experience a
great deal of pain.
Slipped disks are not unusual. Most adults will suffer at least one at
some point in their
lives.
Many surgeons agree that up to 90% of slipped-disk sufferers will get
better simply with
time. It may take six to 12 months of rest and medication, but full
recovery almost always
occurs without surgery. For the 10% who don’t improve or who develop
other worrisome
symptoms—such as numbness in the legs, problems with walking or
incontinence—surgery may be
necessary.
The surgery for a herniated disk, a diskectomy, removes all or part of
the disk. The
procedure is very effective in quickly alleviating pain. The risks
today are minimal, and
techniques are being developed to make incisions even smaller.
Another common condition, especially in older patients, is spinal
stenosis, in which the
nerves of the spinal cord become squeezed. It can also be quite
painful.
While waiting is usually the best option for a slipped disk, surgery
is the standard
treatment for spinal stenosis. The procedure, called a laminectomy,
removes some bone and
soft tissue from around the nerves in the spinal cord. Most doctors
consider it a risk for
stenosis sufferers not to have this operation. The inability to walk
puts people of any age
at risk for obesity, cardiovascular disease, osteoporosis, anxiety and
depression. A recent
study showed significant relief from pain and disability within six
weeks of surgery.
Less-invasive techniques are being explored—for example, inserting a
titanium spacer between
parts of the spine to decompress them. But because no long-term
studies have assessed the
safety or effectiveness of this new procedure, prompt surgery remains
the best treatment for
now.
Sinus Surgery Sinusitis affects 30 million Americans. It hits,
literally, right in the face,
inflaming the air pockets behind the cheeks and brows, causing
inflammation or filling them
with mucus. The result: congestion, facial pain and headaches.
Surgery for chronic sinusitis is controversial—many experts say it
provides no cure. The
first line of treatment should be medical: nasal steroids, antibiotics
and saline washes.
If symptoms persist for at least 12 weeks, surgery should be
considered. In the most common
surgical procedure—called FESS, for Functional Endoscopic Sinus Surgery
—a surgeon inserts a
fiber-optic tube and instruments through the nose to open the sinuses
and remove abnormal
tissue. More than 500,000 Americans undergo this procedure annually.
“It gives you more
breathing room and more ventilation so that the sinuses work even when
you are swollen,”
says Dr. Jordan Josephson, a sinus specialist at New York’s Lenox Hill
Hospital.
He urges patients to “manage their expectations.” Surgery won’t
resolve causes of chronic
sinusitis, such as allergies. It just makes them more tolerable.
Because your eyes and brain are so close to your sinuses, the
surgeon’s experience is
critical. Complications such as loss of vision or brain damage may
occur in 1% of cases.
“But in qualified hands, the
surgery is relatively safe,” says Dr. Josephson.
Ultimately, elective surgery is about making you feel better. And it’s
you, the patient, who
must decide the right course of action for your needs, carefully
choosing the time, the
place and the doctor. Educate yourself about any procedure and ask
questions. You must be
convinced that the benefits of what may be a short-term solution to
your problem outweigh
the risks.
Questions To Ask
About the surgery
• What are the risks and benefits?
• What are the latest techniques and surgical options?
• Is there evidence that this surgery is effective?
• How many people achieve full recovery?
• How long is the recovery?
• What can go wrong?
About the timing
• Do I need the surgery right now?
• Do I have other options?
• What happens if I wait a while?
• Can I wait too long?
Resources and information you need to find the right surgeon:
• U.S. Health and Human Services (and Medicare)
• American Medical Association
• WebMD
.
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