70% of Americans are confident in the
accuracy of their doctor’s advice and don’t feel the
need to get a second opinion, a new study finds.
medications to manage your cholesterol? “The reality is that 20 percent
of patients who undergo this [cath-eterization with stents] do not have
any symptoms, 30 to 50 percent have
not had a stress test, and 30 percent
are not treated with medical therapy
first,” says Kaul. If plaque is forming in
your arteries, this is a systemic disease;
a stent won’t keep even a full inch of
your arteries clear. You’ll still need
aggressive medical therapy to prevent
future problems.
With spinal fusion,
a surgeon places
bone grafts that
“weld” two or
more vertebrae
together to prevent
motion and stop
pain. The proce-
dure is often used to treat back pain
from spinal stenosis, which occurs
when the soft tissues between the ver-
tebrae flatten out, creating pressure
on the spinal cord or nerves that go to
the back, arms, neck, shoulders, and
legs. There is little consensus on how
best to relieve pain from stenosis,
so doctors tend to develop their own
preferences, says Richard Deyo, M.D.,
professor of medicine at Oregon
Health and Science University.
Their top treatment choice increasingly seems to be fusion. Deyo
recently studied the records of more
than 30,000 Medicare patients who
underwent surgery for stenosis of the
lower back and found that complex
fusion procedures (in which surgeons
place bone grafts between multiple
vertebrae) had increased an astounding 1,400 percent between 2002 and
2007. The risks are significant: Those
who underwent complex fusion were
nearly three times more likely to suffer life-threatening complications
than those who underwent less invasive surgery. Previous studies have
Complex
Spinal Fusion
for Stenosis
also found that most fusion patients
experience no more relief from their
chronic back pain than those who
had physical and behavioral therapy.
“There is even some evidence that
[complex fusion surgery] is worse
than other surgeries,” says Floyd J.
Fowler Jr., Ph.D., senior scientific advisor for the Foundation for Informed
Medical Decision Making (FIMDM).
“The vertebrae right above and below
the fusion have to do a lot more bending, and it puts stress on your back
above and below.”
ALTERNATIVES TO SURGERY Before
considering any type of back surgery,
make sure you have exhausted more
conservative measures, including
physical therapy, cortisone injections,
acupuncture, and medications. “
Probably less than 5 percent of all back pain
requires surgery,” says Arnold Weil,
M.D., clinical assistant professor of
rehabilitation medicine at Emory University School of Medicine in Atlanta.
menopause. These patients also face
a higher risk of heart disease and lung
cancer, says William Parker, M.D.,
author of A Gynecologist’s Second
Opinion and lead investigator of a 2009
study on the long-term health consequences of hysterectomy.
ALTERNATIVES TO SURGERY If you
suffer from uterine fibroids, ask your
doctor about other options, including
uterine-artery embolization, in which
the arteries leading to the uterus are
blocked, causing the fibroids to stop
growing. You might also consider a
new procedure, focused ultrasound,
which shrinks fibroids via ultrasound
waves. “It’s kind of amazing that we’ve
had all these alternative procedures
for many years and they haven’t gained
a lot of traction,” says Parker.
Each year approxi-
mately 600,000
American women
have hysterecto-
mies, or removal
of the uterus, and
studies show that
the vast majority
are unnecessary. A hysterectomy is
critical when the patient has cancer
(which is the case for about 10 percent
of those women). But most patients
undergo the procedure for quality-of-
life concerns such as heavy bleeding
or pain caused by uterine fibroids—
benign growths in the uterine wall.
Complications are common. Women who undergo a hysterectomy
have a 60 percent increased risk of
incontinence by age 60, a University
of California, San Francisco study
found. A hysterectomy that includes
removal of the ovaries—an oophorectomy—throws the patient into instant
Hysterectomy
for Uterine
Fibroids
With this proce-
dure a surgeon
places a tiny
camera in the
knee, then inserts
small instruments
through other
incisions to repair
torn or aging cartilage. Studies show
the operation works well when pa-
tients have in fact torn their meniscal
tissue, but it is no more successful
than noninvasive remedies in treating
osteoarthritis of the knee. In a 2008
study, 178 patients with osteoarthritis
received either physical and medical
therapy without surgery, or therapy
plus surgery. After two years the two
groups had nearly identical outcomes,
reporting less pain and stiffness and
more mobility.
ALTERNATIVES TO SURGERY If you
have knee pain, “start with the least
harmful and invasive treatment and
work your way up the ladder,” says
Colin Nelson, a senior research associate at FIMDM. This includes lifestyle
changes such as exercise, as well as
medication and cortisone injections. ;
Knee
Arthroscopy
for
Osteoarthritis
