Confessions of a Sydney surgeon: why your operation may not work

<i>Appendectomy: The possibility of dying from a ruptured appendix is enough for surgeons to recommend this procedure but several studies have shown that antibiotics alone are also effective. The recurrence rate is higher with antibiotics, but the surgical complications are lower.</i><p>I can think of a reason why the recurrence rate for appendectomy is lower than for antibiotics. ;-)

There was a study where knee surgeons just made an incision in the skin and told the patient the procedure was done. The result was about the same rate of success, and a lot less risk of complications. I can&#x27;t find a date on this article but it&#x27;s at least from 2010 if not older. <a href="http:&#x2F;&#x2F;abcnews.go.com&#x2F;Health&#x2F;story?id=116879&amp;page=1" rel="nofollow">http:&#x2F;&#x2F;abcnews.go.com&#x2F;Health&#x2F;story?id=116879&amp;page=1</a>

A couple of years ago I slipped (herniated) two lumbar disks. Both of the surgeons I consulted begged me NOT to get surgery (one with tears in his eyes). I&#x27;m ever so grateful that there are surgeons out there who will push back. Contrast that with when I went to an orthopedic specialist about knee pain from running. In less than two minutes of consultation he told me he wanted to <i>snip</i> my tight IT bands. My jaw was on the floor. I was nothing but meat and a paycheck.<p>Thankfully acupuncture has given me back the ability to sit&#x2F;run&#x2F;lift&#x2F;stand. I&#x27;m so grateful I didn&#x27;t get surgery in either case.

This is no limited to Australia. I know a person in Russia who consulted 3 or 4 surgeons regarding her foot problem. The advise was always to perform a complex operation that would leave her with crutches for at least 3 months.<p>Finally somebody recommended another doctor. His advise was to make a hole in shoe insole around problematic area and see how things go. Then 9 months later she spent a month at sea and that mostly cured the problem.

&gt; &quot;But the decision to operate should be based on the best science, not on the worst-case scenario. If the best evidence tells us that a procedure is not effective, or that the benefits are outweighed by the risks for some patients, then it should not be done.&quot;<p>As long as patients can sue their doctor, no sane doctor will do less than what the patient wants if there is a remote chance the procedure is slightly more effective. A simple but prominent example is the prescription of a generic drug versus the &quot;original&quot;. Science tells us that there is absolute no difference. Now you tell the patient - the same patient who feels a very real, &quot;objective&quot; decrease in pain when being injected a saline solution instead of steroids.<p>And last but not least: the &quot;best science&quot; does not help us if doctors don&#x27;t know about it. And some treatments are so weird that a doctor won&#x27;t even consider it. Three anecdotes on that from my last 2 years:<p>1) British guy with pain in his knee. His doctor has been urging him to operate for years now. But he works in Nigeria on a oil drilling project in a good position and rather would prefer to wait the few years until he retires. The local &quot;joujou&quot;-man told him to rub python fat into his knee. It works for him! He told his doctor in the UK who dismissed that and told him that he might get into trouble for repeatedly rejecting sound medical advice. Shortly after I meet this guy in the Caribbean on his holiday, he tells me that story, I am skeptical and do some googling: 5 Minutes later I find a scientific study that proved that python fat is indeed a very good treatment for his condition. He mailed that to his doctor who read it and now leaves him alone. Snake oil, anyone?<p>2) Sahrawi ecologist with kidney stones but without the money to pay for the medical procedure to have them removed. He turns to local folk medicine, for a week he drinks a concoction that makes the stones break up and he can pass them naturally pretty much without pain. His doctor in Rabat speaks of a &quot;miracle&quot;.<p>3) Business man in Casablanca was told by his doctor that he either needs surgery on his knee or he should try the traditional desert treatment: Undress, get buried in hot sand, 30 minutes later get into a tent, firmly wrapped. Repeat for 3 days. When I met him he was on his way back from his 5th treatment - he says he does it every 2 years and thereby has avoided surgery for 10 years.

A few personal experiences, and the stories of many family and friends, have left me with the strong opinion that surgery is a very reluctant, last resort.<p>Not my worst experiences, but two similar injuries left me with very differing experiences, as comparative examples. In the first one, the doctor wanted to get me into (arthroscopic, fortunately) surgery right away, without even doing an MRI. In the second, a different doctor said that, even if surgery were eventually warranted&#x2F;needed, the condition had left me too weak to be a good surgical candidate. So, see a PT and work and strength-building, and see how I tolerated it.<p>The first doctor racked up a big bill and produced no positive effect. The second doctor saw me for one visit, got me to a good PT &#x2F; rehab program, and helped me make a full recovery.<p>Anecdote, sure. But, combined with some other singular, not positive experiences: I&#x27;ll go under the knife only when I have no other choice.

What a lot of people seem to overlook is that, in the developed world, you have a 1% chance of death every time you go under general anesthesia.

Caldwell Esselstyn has proven that it&#x27;s possible to cure heart disease such as angina with a low-fat, plant-based diet. He&#x27;s written a book about this 20 year study: Prevent and Reverse Heart Disease: The Revolutionary, Scientifically Proven, Nutrition-Based Cure.<p>I find it interesting that most doctors are continuing to recommend things like cardiac stenting. Maybe it&#x27;s money? I wonder if they even mention diet to their patients? Or is it the patients that are the problem - even if doctors mention diet, do many patients continue to eat unhealthy?