5 Surgeries to Avoid

Maybe Im the wrong ex-patient to be apprisal you this: Experimental operating theatr erased stage III colon cancer from my shell-shocked trunk six years ago. Just straight Ive got to admit that all is not well in Americas operative suite. Please dont get me wrong. Id go back under the scalpel in a minute if I had a gastro-tumor recurrence (like EXEC bid officer Tony Snow did) or some whole orthogonal, unforeseen orthopedic pinch (a knee harm, for instance). But at to the lowest degree 12,000 Americans conk p.a. from unnecessary surgery, according to a Daybook of the American Learned profession Connexion (JAMA) report. And tens of thousands more suffer complications.

The fact is, regardless how talented the operating surgeon, the body doesnt much care about the docs credentials. Surgery is a trauma, and the body responds American Samoa such—with John Major stemma exit and swelling, and every last manner of nerve and pain signals that can stay put sometimes for months.

Those are but few reasons to try to minimize elective surgery. And I found even more later on talk with more than than 25 experts involved in several aspects of surgery and surgical care, and after reviewing a fractional-dozen political and health chec think tank reports on surgery in the United States. Here, what you need to know about five surgeries that are overused, and newer, sometimes less-invasive procedures and solutions that English hawthorn be worth a look.

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Surgical proces to Annul No. 1: Hysterectomy
Theres long been a concern, at least among many women, about the high rates of hysterectomy (a procedure to remove the uterus) in the Coalesced States. American women have twice as many hysterectomies per capita as British women and four times every bit many Eastern Samoa Swedish women.

The operating room—either longstanding open (bear-sized incision) or laparoscopic (small slit) — is commonly used to treat persistent vaginal bleeding Beaver State to remove benign fibroids and painful endometriosis tissue. And if both the uterus and ovaries are removed, it takes by your sources of estrogen and testosterone. Without these hormones, your danger of heart disease and osteoporosis rises markedly. There are also potentiality side effects, from newfound pelvic problems to lower sexual desire and slashed pleasure. Hysterectomies got more negative press afterward a watershed 2005 University of California, Los Angeles (UCLA), study revealed that, unless a woman is at very high jeopardy of ovarian malignant neoplastic disease, removing her ovaries during hysterectomy actually raised her health risks.

So why are doctors ease performing the double-hex surgery? "Our profession is entrenched in price of doing hysterectomies," says Max Ernst Bartsich, Medic, a gynecological operating surgeon at Weill-Cornell Medical Center in New House of York. "Im non proud of that. It may be an acceptable procedure, but it isnt necessary in so many cases." In fact, he adds, of the 617,000 hysterectomies performed annually, "from 76 to 85 percent" may follow unnecessary.

Although hysterectomy should be considered for uterine cancer, some 90 percent of procedures in the United States government nowadays are performed for reasons other than treating cancer, accordant to William H. Parker, MD, medical institution professor of gynecology at UCLA and author of the 05 study. The bottom argumentation, he says: If a hysterectomy is recommended, amaze a second opinion and conceive the alternatives.

What to do instead
Go knife-free. Endometrial ablation, a nonsurgical procedure that targets the uterine lining, is some other fix for persistent duct bleeding.

Focus on fibroids. Fibroids are a problem for 20 to 25 percent of women, but there are several specific routes to relief that arent nearly as drastic as hysterectomy. For example, myomectomy, which removes just the fibroids and not the uterus, is seemly increasingly democratic. And thither are other less-invasive treatments out at that place, too.

In France in the early 1990s, a fix who was prepping women for fibroid surgery—by block, or embolizing, the arteries that supplied blood to the fibroids in the uterus—noticed a number of the benign tumors either soon shrank or disappeared, and, voila, Jacques Ravina, MD, had discovered female internal reproductive organ fibroid embolization (UFE). Since past, interventional radiologists in the United States have enlarged their use of UFE (typically a one- to three-hour routine), using injectable pellets that shrink and "starve" fibroids into entry. Supported research from David Siegel, MD, chief of vascular and interventional radiology at Long Island Jewish Medical Center, Recent Hyde Park, Newfound York, some 15,000 to 18,000 UFEs are performed here to each one year, and up to 80 pct of women with fibroids are candidates for it.

Another untested fibroid treatment is last-intensity focused echography, or HIFU. This even less fast-growing, more forgiving newfangled function treats and shrinks fibroids. Its whats called a no-scalpel surgery that combines MRI (an imaging machine) mapping followed by powerful sound-moving ridge "shaving" of tumor tissue.

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Surgery to Avoid No. 2: Episiotomy
It can sound so simple and efficient when an OB-GYN lays out all the reasons wherefore she performs episiotomy ahead delivery. After all, its logical that cutting or extending the vaginal opening along the perineum (betwixt the vagina and anus) would reduce the jeopardy of girdle-tissue tears and relieve vaginal birth. Just studies register that severing muscles in and around the get down vaginal wall (its to a higher degree just skin) causes American Samoa many or much problems than it prevents. Pain, irritation, muscle tears, and incontinency are all common aftereffects of episiotomy.

Unlikely year the Terra firma College of Obstetricians and Gynecologists (ACOG) discharged new guidelines, which same that episiotomy should nobelium longer cost performed habitually—and the numbers have dropped. Many doctors now reserve episiotomy for cases when the baby is in distress. But the rates (nigh 25 percent in the United States) are still much besides high, experts say, and some headache that its because women arent aware that they lav decline the surgery.

"We asked women whod delivered vaginally with episiotomy in 2005 whether they had a choice," says Eugene Declercq, PhD, main author of the leading national survey of vaginal birth in America, "Listening to Mothers II," and professor of enatic and minor health at the Boston University School of World Health. "We recovered that only 18 percent said they had a choice, while 73 percent aforesaid they didnt." Put differently, about three of four women in childbirth were not asked about the surgery they would soon face in an urgent state of affairs. "Women often were told, 'I can experience the baby out quicker," Declercq says, as opposed to doctors really asking them, 'Would you like an episiotomy?"

What to DO instead
Communicate. The time to prevent an unnecessary episiotomy is well before labor, experts agree. When choosing an OB-GYN practice, invite its value of episiotomy. And when you flummox pregnant, have your druthers to avoid the surgery written on your chart.

Get ready with Kegels. Employed with a nurse or mid-wife may reduce the chance of such surgery, experts read; she can teach Kegel exercises for stronger vaginal muscles, OR execute perineal and pelvic-dump knead before and during labor.

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Surgical procedure to Avoid No. 3: Angioplasty
Every year in the United States, surgeons perform 1.2 meg 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 bypass, which is open-heart surgery. The problem: A groundbreaking study of more than 2,000 core patients, just discharged this year at a cardiology group discussion and in The Unweathered England Journal of Medicine, indicated that a whole nonsurgical method—essence medication—was even as salutary Eastern Samoa angioplasty and stents in keeping arteries open in many patients. The bottom line: Angioplasty did non appear to keep heart attacks or save lives among nonemergency nub subjects in the study.

What to do instead
Take the right meds. If the study is mighty, medications may cost as strong as steel. "If you experience chest pain and are stable, you can take medicines that do the job of angioplasty," says William Boden, MD, of the University of Bison bison School of Medicine, American bison, New York, and an author of the report. Medicines old in the study included aspirin, and blood pressure and cholesterol drugs—and they were taken on with exercise and diet changes.

"If those dont work, past you can have angioplasty," Boden says. "Now we can unequivocally say that."

Naturally, whats 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 forbearing to treat a docs life style recommendations—diet and exercise guidelines—but as earnestly as if they were prescription drug medicines.

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Surgery to Avoid No. 4: Pyrosis Operation
A walloping 60 million Americans experience heartburn at least once a month; more or less 16 zillion deal with it daily. Indeed its nobelium wonder that after suffering nasty symptoms (intense stomach-acid backup or near-moment burning in the throat and chest after just a a couple of bites), patients naughtily want to believe surgical operation prat provide a quick pickle. And, for some, it does.

A procedure called nissen fundoplication can assistance 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 dont ever go away subsequently the popular procedure, which involves swathe a split up of the stomach around the weak part of the esophagus.

"That may be because surgery doesnt directly sham healing capacity or dietary or lifestyle choices, which in turn can contribute to recurrence in a hurry," he says.

The surgery can come undone, and side effects English hawthorn include bloating and trouble swallowing. Remes-Troche believes its best for precise serious cases of long-standing gastroesophageal reflux disease (GERD) operating room for those at risk of Barretts esophagus, a disease of the top digestive tube that follows years of heartburn affliction and can be a precursor to esophageal cancer.

What to do rather
Make lifestyle changes. A combination of diet, employment, and acid-reducing medication may help sufferers beat the burn without going under the knife. But its a treatment that requires perseverance.

"It took me four years of appointments, diets, drugs, sleeping happening slant beds—and even yoga—to keep my pyrosis directed," says Debbie Bunten, 44, a Silicon Valley clientele-evolution manager for a software system steadfast, who was overeager to avoid surgery. "But I did it, and am glad I did."

Put for a picture. Another technological growing can make a heartburn diagnosing easier to swallow—a tiny photographic camera pill that beams pictures of your gullet (14 shots per secondment) through your neck to a receiver operating theatre computer in the doctors office; it passes harmlessly out of your system four to six hours subsequent. The $450 Pillcam (a similar camera capsule from Olympus is awaiting Food and Drug Administration approval) can be used instead of standard endoscopy to screen chronic-heartburn sufferers for various esophageal complaints, including GERD, which can develop into the possibly precancerous Barretts esophagus. Unlike an endoscopy, in which youre insensible and a lighted tube is snaked down your throat, a capsule camera leaves you wide awake and is smooth within 20 minutes, says Pillcam guru David Fleischer, MD, a staff physician in gastroenterology and hepatology, and professor of medicine at Mayo Clinic College of Medicine. If anaesthesia makes you sick, the capsule camera may comprise for you.

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Surgery to Avoid No. 5: Lower-Back Operating theatr
Since the 1980s, operations for depress-back pain and sciatica get increased approximately 50 percent, from approximately 200,000 to much 300,000 surgeries annually in the United States. That rise is largely owing to minimally invasive advances that include endoscopic keyhole tools used tandem with magnified video output.

To its citation, OR (endoscopic or the traditional lumbar-disc compensate) does relieve lower-back pain in 85 to 90 percent of cases, docs pronounce. "Yet the embossment is sometimes temporary," says Christopher Centeno, MD, director of the brand new Centeno-Schultz Pain Clinic come near Denver. And that adds up to tens of thousands of unsuccessful patients who find the promise of surgery was overwrought or snub-lived.

What to do instead
Try painkillers and exercise. Despite the persistent nature of lower-back pain, the most joint cause is a comparatively minor problem—muscle strain—not disc irritation, disc rupture, or even a bone problem, experts say. Despite its severity, this type of acantha nuisance most often subsides inside a month or two. Thats why operating room, or any other invasive test operating theatre treatment beyond light exercise or painkillers, is rarely even inside the early month of a complaint. Even pain caused by a bulging operating theatre slipped disc "resolves along its own inside a year in around 60 percent of cases," orthopedists claim.

"Seventy to eighty percent of the clock time we can get to a factual diagnosis, feel a way to manage pain, and get patients turned the drugs without surgery," Centeno says. "Or, more fittingly, never set off the drugs."

"We wont to prescribe 30 days bed rest for patients with herniated discs, but that was 15 to 20 long time agone," says Venu Akuthota, MD, medical exam director of the Spikele Nub at University of CO Infirmary and associate prof of medicine at the University of Colorado School of Medicine. "Actually, movement is very helpful for treating back conditions. Nowadays, we dictate fair, deficient-impact exercise, like walking, or functional out on an elliptical flight simulator surgery salt mine."

Learn nearly stem cells. Ive seen the future of cover operating room firtshand. And information technology looked to me, from behind my surgical mask, as if a womans empty behind was doing much of the crop. Upbound close, crouched inside the Centeno-Schultz Pain Center, I joined a squad of MDs, a PhD, and two nurses to witness orthopedic account in vivo: an adult fore cell (ASC) transplant to help bones and joints grow anew.

In the midst of the huddle together, Centeno, the back- and neck-pain specialist, is plunging a acerate leaf that looks big plenty to use on a horse deep into the hip bone of a 54-twelvemonth-old weekend athlete and skier whos been affected to the sidelines by harm and foresighted-term lower-back pain. The longanimous is drooping of pain sensation pills just wary of major surgery. Rather shes undergoing ane of the first ASC orthopedic transplants in the nation.

The harvested stem cells will be used to grow millions of new ones that will be implanted in her back to spur and regenerate much youthful, able-bodied juncture tissue—if all goes as planned in this part of an ongoing study approved aside a medical inquiry institutionalized look back board, that is. Heretofore, leastwise, information technology has. Early MRI pictures of related procedures suffer shown fulgurous growth of regenerative tissue paper. And theres even better news: By exploitation the patients own stem cells, the surgical team avoids the ethical debate over using embryonic tissue for research purposes.