Surgery isn’t (necessarily) the answer
I find it incredibly interesting how some cultures tend to think of surgery as their first option while others think of it as their last option. In my work at ROOTS, 85% of my patients are non-Mexican and 30-40% of that bunch are American. I’ve had over 30 different countries represented among my patients (I’ve counted). To some degree each individual person is different, but there do seem to be some trends.
Americans more than any other sub population, have been the group that consistently brings up surgeries to me. They suggest them, and early at that.
Often times I barely make it through my description of what I understand is going on and before I can clarify the recommended treatment plan - “what if we get in there and just fix it?”
But, surgeries don’t just…fix things. The purpose of surgeries is to change some thing(s) anatomically (that you will have to rehabilitate) to improve your chances of a certain goal.
None of that is a guarantee. Even if there’s a pretty good chance that all your goals would be met successfully; there’s always a chance that they won’t.
When it comes to statistics, if a surgery has an 95% success rate that doesn’t mean people rehabilitate 95% and on average continue to struggle 5%. It means 5% of people didn’t experience a successful surgery. That can include death and anything else on the list of potential risks - the least of which is “no improvement”.
Your medical team (perhaps your surgeon and myself) are responsible for informing you of all the options, risks, and benefits. It’s NOT our job to make a decision; your body your choice.
Each person has their own goals and individual relationship with risk tolerance. You accept the potential risks for the potential benefits in order to meet your goals. And you entrust your medical team to help you get there.
I didn’t really understand any of this until I started navigating medical decision making both personally and professionally. Continue reading for some nuanced personal examples.
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When I broke my forearm in a bike accident, I had a plate and screws put in surgically to change the position of the bone fragments in order to improve healing time, improve healing outcomes, and prevent future dysfunction and arthritis of my wrist joint. It was a simple procedure with a big outcome.
Seemed like a pretty good bet to me so I went for it. And lucky me, everything went well.
Note: I have a current patient who had the same surgery and is now on her 2nd revision surgery and a complex rehabilitative journey because she wasn’t so lucky. It’s not a guarantee.
On the other side…About 15 months ago, I tore through most of what remained of my left ACL, meniscus, MCL and another little but very important ligament called the MPFL. My knee was torn up with bone growths (osteophytes), cysts, and a bunch of other things that when they showed up on MRI prompted a moment of awkward, pregnant silence from multiple orthopedists.
So like, obviously I should get a surgery, right?
For something that challenges me every single day (and has for more than half my short life), I’m still going with no.
A surgery would be 1) a more or less make-it-up-as-you-go surgical plan, 2) a lets-see-how-it-goes recovery plan, and compared to what I have right now, 3) not-sure-what-else-it’ll-get-you potential outcome.
Either way, I won’t be picking up skiing as a primary sport and can do most of what I want. I’m guaranteed to have arthritis either way so we can’t really avoid that (especially not with additional assault to the joint surfaces via surgery). I don’t personally feel very risk tolerant after 3 other surgeries on my knees where 2 of them have failed.
So…then what?
I accept the level of pain and dysfunction I have (with continued conservative treatment) with the hope that things will continue to improve because I do not believe the potential benefits outweigh the potential risks.
At some point my knees will likely get worse, the arthritis will likely settle in, and then I’ll likely consider a full or partial knee replacement. At that point, the benefits will likely outweigh the risks. And if not, I’ll just keep chugging along. Because surgery isn’t (necessarily) the answer.
