Scary truths about surgery

Five operations you don’t want to get – and what to do instead?

Agreeing to a surgical procedure is an important decision which patients and their family members have to make. However, some people end up getting unnecessary surgery, just because they did not consult a few good surgeons before actually getting the surgical procedure. Due to this reason, tens and thousands of people suffer from complications post surgery in the US each year. However, in the case of an accident or emergency like an unforeseen orthopedic emergency or a knee injury for instance, there is no choice other than surgery.

Surgeries to avoid

So, as a patient, you need to understand that you have to be sure if you want to go for surgery or not. The fact is no matter how talented the surgeon is, the body doesn’t much care about the doc’s credentials. Surgery is a trauma and the body responds as such with major blood loss and swelling and all manner of nerve and pain signals that can stick around sometimes for months.

Those are but a few reasons to try to minimize elective surgery. Here is what you need to know about five surgeries that are overused and newer sometimes less invasive procedures and solutions that may be worth a look.

Hysterectomy

There’s long been a concern at least among many women about the high rates of hysterectomy (a procedure to remove the uterus) in the United States. American women undergo twice as many hysterectomies per capita as British women and four times as many as Swedish women.

The surgery either traditional open (large incision) or laparoscopic (small incision) is commonly used to treat persistent vaginal bleeding or to remove benign fibroids and painful endometriosis tissue. And if both the uterus and ovaries are removed it takes away your sources of estrogen and testosterone. Without these hormones your risk of heart disease and osteoporosis rises markedly.

There are also potential side effects from new found pelvic problems to lower sexual desire and reduced pleasure. Hysterectomies got more negative press after a landmark 2005 University of California, Los Angeles (UCLA) study revealed that unless a woman is at very high risk of ovarian cancer, removing her ovaries during hysterectomy actually raised her health risks.

According to Ernst Bartsich, MD, a gynecological surgeon at Weill Cornell Medical Centre in New York, of the 617000 hysterectomies performed annually, from 76 to 85 percent may be unnecessary.

Although hysterectomy should be considered for uterine cancer some 90 percent of procedures in the United States today are performed for reasons other than treating cancer, according to William H Parker, MD, clinical professional of gynecology at the UCLA. The bottom line he says: If a hysterectomy is recommended get a second opinion and consider the alternatives.

What to do instead

Go knife free. Endometrial ablation, a non surgical procedure that targets the uterine lining, is another fix for persistent vaginal bleeding.

Focus on fibroids. Fibroids are a problem for 20 to 25 percent of women, but there are several specific routes to relief that aren’t nearly as drastic as hysterectomy. For instance, myomectomy which removes just the fibroids and not the uterus, is becoming increasingly popular, and there are other less invasive treatments out there too.

Another new fibroid treatment is high intensity focused ultrasound or HIFU. This even less invasive more forgiving new procedure treats and shrinks fibroids. It’s what is called a no-scalpel surgery that combines MRI (an imaging machine) mapping followed by powerful sound wave “shaving” of tumor tissues.

Episiotomy

It can sound so simple and efficient when an OB-GYN lays out all the reasons why she performs episiotomy before delivery. After all, it’s logical that cutting or extending the vaginal opening along the perineum (between the vagina and anus) would reduce the risk of pelvic tissue tears and ease child birth. But studies show that severing muscles in and around the lower vaginal wall (its more than just skin) causes as many or more problems than it prevents. Pain, irritation, muscle tears and incontinence are all common aftereffects of episiotomy.

The American College of Obstetricians and Gynecologists (ACOG) released new guidelines which said that episiotomy should no longer be performed routinely and the numbers have dropped. Many doctors now reserve episiotomy for cases when the baby is in distress. But the rates (about 25percent in the United States) are still much too high, experts say, and some worry that it’s because women aren’t aware that they can decline the surgery.

What to do instead

Communicate. The time to prevent an unnecessary episiotomy is well before labor, experts agree. When choosing an OB-GYN practice, ask for its rate of episiotomy. And when you get pregnant, have your preference to avoid the surgery written on your chart.

Get ready with Kegels. Working with a nurse or mid wife may reduce the chance of such surgery, experts say she can teach Kegel exercises for stronger vaginal muscles or perform perineal and pelvic floor massage before and during labour.

Angioplasty

Every year in the United States, surgeons perform 1.2 million angioplasties, during which a cardiologist uses tiny balloons and implanted wire cages (stents) to unclog arteries. This Roto-Rooter type approach is less invasive and has a shorter recovery period than a bypass which is open heart surgery.

The problem: A ground breaking study of more than 2,000 heart patients indicated that a completely nonsurgical method, heart medication was just as beneficial as angioplasty and stents in keeping arteries open in many patients The bottom line; Angioplasty did not appear to prevent heart attacks or save lives among nonemergency heart subjects in the study.

What to do instead

Take the right meds. If the study is right, medications may be as strong as steel. “If you have chest pain and are stable, you can take medicines that do the job of angioplasty,” says William Boden MD of the University of Buffalo School of Medicine, Buffalo, New York and an author of the study. Medicines used in the study included aspirin, and blood pressure and cholesterol drugs and they were taken along with exercise and diet changes.

“If those don’t work then you can have angioplasty,” Boden says. “Now we can unequivocally say that”.

Of course what’s right for you depends on the severity of your atherosclerosis risks (blood pressure, cholesterol, triglycerides) along with any heart-related pain. The onus is also on the patient to treat a doc’s lifestyle recommendations – diet and exercise guidelines – just as seriously as if they were prescription medicines.

Heartburn surgery

A whopping 60 million Americans experience heartburn at least once a month; some 16million deal with it daily. So it is no wonder that after suffering nasty symptoms (intense stomach acid backup or near instant burning in the throat and chest after just a few bites) patients badly want to believe surgery can provide a quick fix. And for some it does.

A procedure called nissen fundoplication can help control acid reflux and its painful symptoms by restoring the open and close valve function of the esophagus. But Jose Remes Troche, MD of the Institute of Science Medicine and Nutrition in Mexico reported in The American Journal of Surgery that symptoms don’t always go away after the popular procedure which involves wrapping a part of the stomach around the weak part of the esophagus.

“That may be because surgery doesn’t directly affect healing capacity or dietary or lifestyle choices, which in turn can lead to recurrence in a hurry” he says.

The surgery can come undone and side effects may include bloating and trouble swallowing. Remes Troche believes its best for very serious cases of long standing gastroesophageal reflux disease (GERD) or for those at risk of Barrett’s esophagus, a disease of the upper gastrointestinal tract that follows years of heartburn affliction and can be a precursor to esophageal cancer.

What to do instead

Make lifestyle changes. A combination of diet, exercise and acid reducing medication may help sufferers beat the burn without going under the knife; but it’s a treatment that requires perseverance. “It took me four years of appointments, diets, drugs, sleeping on slant beds and even yoga to keep my heart burn manageable,” says Debbie Bunten 44, a Silicon Valley business development manager for a software firm, who was eager to avoid surgery. “But I did it, and I am glad I did”.

Lower back Surgery

Since the 1980′s, operations for lower back pain and sciatica have increased roughly 50 percent from approximately 200,000 to more than 300,000 surgeries annually in the United States. That rise is largely due to minimally invasive advances that include endoscopic keyhole tools used in tandem with magnified video output.

To its credit, surgery (endoscopic or the traditional lumbar disc repair) does relieve lower back pain in 85 to 90 percent of cases. “Yet the relief is sometimes temporary” says Christopher Centeno, MD director of the brand new Centeno Schultz Pain Clinic near Denver. And that adds up to tens of thousands of frustrated patients who find the promise of surgery was overwrought or short lived.

What to do instead

Try painkillers and exercise. Despite the relentless nature of lower back pain, the most common cause is a relatively minor problem muscle strain not disc irritation, disc rupture or even a bone problem, experts say. Despite its severity, this type of spine pain most often subsides within a month or two. That why surgery or any other invasive test or treatment beyond light exercise or painkillers is rarely justified within the first month of a complaint.

Even pain caused by a bulging or herniated disc “resolves on its own within a year in some 6 percent of cases”, orthopedists claim, “Seventy to eighty percent of the time we can get to a concrete diagnosis, find a way to manage pain, and get patients off the gruds without surgery,” Centeno says.

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