Surgery
The Perils of Being a Patient
What is one of the major health hazards today? It’s being a patient. Because there are so many pitfalls, and it’s easy to fall into them. Modern medicine has much more to offer today which makes life better for millions of people. But it can also create problems, unless you know where the traps are and how to avoid them. I’ve never forgotten an incident that happened years ago. I’d completed a successful surgical procedure and returned to the recovery room to check on my patient. But I noticed several doctors crowded around one bed, which is never a good sign. A male patient had undergone a gallbladder operation and was experiencing difficult, labored breathing. His surgeon and anesthetist were concerned. They...Read More
Surgery
Minor Surgery That Ends In Disaster
There is one fundamental rule in surgery, “If it ain’t broke, don’t fix it.” Why? Because as one of Harvard’s great neurosurgeons once remarked, “There is no such thing as minor surgery, but there are a lot of minor surgeons.” He could have added that minor surgery can also result in needless tragic deaths. And that one major operation can be avoided. The best adult example is Joan Rivers, the comedian, who allegedly had undergone several cosmetic facelifts and joked about it. But she had one too many and died of cardiac arrest during the operation. The youngest tragedy is the newborn baby who recently suffered a circumcision, apparently unwanted by his parents. He died from hemorrhage. For some families the decision for...Read More
Pain, Surgery
Wrong Site, Wrong Procedure, Wrong Patient Surgery
Are you scheduled for surgery? If so, there are ways to circumvent horrendous surgical errors. We’ve all heard stories about surgeons amputating the wrong leg. Or fixing a hernia on the side that didn’t need it. If you think this is past history, you had better think again as it happens every year in North America. During a 10 year period in Canada, wrong-site surgery happened 106 times. Each year, 6.3 cases involved a lower extremity and in 4.3 cases, an upper limb. The most common error was the use of arthroscopy (looking into the joint with an optical instrument) on the wrong joint. This misfortune happened to 24 patients. And in one case a total knee replacement was performed on...Read More
Eyes, Ears, Nose & Throat, Nutrition, Surgery, Vitamins
Do I Need Cataract Surgery?
Do I get a lot of E-mail? Yes, tons of it. Do I get letters? Practically never, particularly those without a return address. So I was surprised by a recent one. All I know is the writer lives in Lethbridge, Alberta, and is elderly. She has written that she wants to be an informed patient, so is asking for my stand on cataract surgery. “Ms. X” simply believed she needed reading glasses, but was told by an optometrist that she required cataract surgery. She remarks, “I hesitated, so he sent me to an ophthalmologist for a second opinion. He also agreed that surgery was needed, suggested I simply sign on the dotted line, then called, “Next patient, please”. But the writer asked...Read More
Cardiovascular, Surgery
Surgery for Swinging-Door Heart Valves
Mitral valve surgery can best be described by comparison to the swinging saloon door in old western movies. It demonstrates what can go wrong with the heart’s valves. And what surgical procedure is needed to correct mitral valve prolapse (MVP). To get a first-hand view of this procedure, I watched Dr. Tirone David, one the world’s great cardiac surgeons, perform the operation at Toronto General Hospital. The mitral valve separates the two left chambers of the heart. Each time the heart beats the valves swing open, like the doors of a western saloon. But after opening they close firmly again while the heart pumps blood to the body. The problem is that swinging doors of saloons often develop loose rusty hinges that...Read More
Surgery
Why Surgeons Need Cockpit Training
Would you buy an airplane ticket if the pilot refused to check his instrument panel before taking off? You’d probably would run for the woods, choose another airline or decide it’s safer to go by train. But a recent study shows that some surgeons are not following proven surgical guidelines for a potentially fatal operation. What’s needed? A big dose of pilot discipline. A study done at the University of Alberta reviewed carotid endarterectomies done in four western provinces. This study revealed that one in ten of these procedures should not have been performed, and 47 percent were done for dubious reasons. The conclusion? Surgeons needed “cockpit management”. Endarterectomy is a common operation performed to prevent stroke in patients who have partial...Read More
Infection, Pain, Surgery
Appendicitis: It Strikes Kings and Us Mortals
Today, surgery for appendicitis takes a back seat to bypass surgery, knee and hip replacement. But every day in North America at least one person dies due to an attack of appendicitis. This week, an unusual case of appendicitis. And how did England nearly lose a King? A report in the Canadian Medical Association Journal tells the story of a 15 year old Philippine boy who immigrated to Canada at age 11. For four months he suffered every week from abdominal pain. Eventually, due to increased discomfort he was seen in emergency. Physical examination and blood studies were suggestive of acute appendicitis, and ultrasound revealed the organ was swollen. Laparoscopic surgery was performed, the ruptured appendix removed and the abscess drained. The...Read More
Infection, Surgery
How to Stay Safe in Hospital
Luckily, I've only been admitted to hospital for surgery on two occasions. But when it happened I had serious concerns. The big one was, will I develop a complication during my hospital stay that I didn't have on arrival? So, what can be done to prevent this from occurring? First, I choose my surgeon like porcupines make love, very, very carefully. This choice can have a major impact on outcome. I realize the best of surgeons can encounter a problem that is largely "an act of God". But chances are slim that an unforeseen event will occur with a first class technical surgeon. So the surgery is the least of my worries. I know some may say, "Yes, but you have the...Read More
Surgery
Robotic-Surgery Still Requires Skilled Human Hands
Dr. Harvey Cushing, one of Harvard's great neurosurgeons, once remarked, "There is no such thing as minor surgery, but there are a lot of minor surgeons". He wanted to drive home the point that you should always be careful about who does your operation. But when Cushing made this remark, he had never heard of Robotic-Surgery. So what would he say now? A report in the Journal for Healthcare Quality analyzes complications that occurred during one type of robotic-surgery between the years 2000 and 2012. During that time there were 174 injuries and 71 deaths. Another study at Johns Hopkins University revealed what has long been suspected, that surgical complications are not always reported...Read More
Surgery
Pros and Cons of Keyhole Surgery
What's the most advanced surgery of recent years? I believe most surgeons would quickly respond, "laparoscopic surgery", often referred to as keyhole surgery. But never let the word "keyhole" lead you astray. In 1991 Dr. Joacques Perissat at the University of Bordeau, in France, announced at the World Congress of Surgeons that he had removed a gallbladder (cholecystectomy) using optical instruments through small incisions. Now, a number of more complicated operations are performed by this method. Laparoscopic surgery has been a great boon for patients. Without a large incision there's less pain, speedier healing and shorter hospital stay. But as in any type of surgery there are unexpected pitfalls. One problem is that the term "keyhole surgery" leaves the impression that tiny incisions...Read More
Surgery
Appendicitis: It Nearly Killed King Edward VII
How would you like to be the young surgeon in 1902 who was asked to see Prince Edward who was to be crowned King of England in two days? His Mother, Queen Victoria, had reigned so long that Edward had become the playboy prince. Now he was obese, old, flatulent and a terrible operative risk. Young Dr. Treves diagnosed a ruptured appendix and recommended surgery, much to the consternation of other doctors. While Treves operated, officials were preparing for the king's funeral. But Treves got lucky. His decision proved prudent. He simply drained an abscess and left the appendix alone. No doubt Treves also lifted more than one prayer to the Almighty. Luckily, Edward survived and was later crowned King...Read More
Dental, Surgery
Antibiotics for Cleaning Teeth after Hip Replacement?
What should you do if a dentist or dental hygienist says, "I won't clean your teeth unless you agree to take antibiotics following surgical hip or knee replacement?" Today, over one million hip and knee replacements are done every year in North America. It's estimated that by the year 2030 this number will escalate to four million annually. But should dentists paint every joint implant patient with the same brush? The American Academy of Orthopedic Surgeons (ACOS) is adamant about this question. They claim that during the last 20 years the number of post-operative hip and knee infections has markedly decreased due to the use of antibiotics during surgery and the immediate post-operative period. Anyone scheduled for these procedures can shout "hallelujah"...Read More
Cancer, Genitourinary, Surgery
Cooking the Prostate Gland
How many angels can dance on the head of a pin? No one knows. Nor has anyone, to this point, found the answer to treating prostate cancer. Now, a treatment called high-intensity focused ultrasound (HIFU) is available. So could this procedure be the ultimate way to cure prostate malignancy? In North America, every three minutes, a man is diagnosed with prostate cancer and every 15 minutes a man dies from it. The major problem has always been, which men should be treated, and when should doctors follow a wait-and-see policy? Waiting to see what will happen has never been a logical move anytime cancer is diagnosed. The result is normally the spreading of the malignancy and eventually death. But prostate malignancy, unlike...Read More
Surgery
I Could Hear The Sawing and Hammering!
When does a doctor fully realize the nature of a disease? Sir William Osler, distinguished Professor of Medicine at McGill, Johns Hopkins and Oxford University, remarked that a doctor only fully understood a disease when he suffered from it himself. Having just recovered from a hip replacement operation, I couldn’t agree more with Osler. So what did I learn and what did I fear? W. C. Fields, the comedian, when asked what he wanted inscribed on his tombstone, replied, “I’d rather be in Philadelphia”. I felt the same way as I was wheeled into the operating room. But at least I had the satisfaction of knowing I had first used every medical therapy I knew to prevent this from happening. Nine...Read More
Miscellaneous, Surgery
The Best Time to Have an Operation
A report in the Canadian Medical Association Journal says it’s much safer to time your sickness. If not, there is a good risk of ending up with inferior medical care. So when should you get ill? And what is the prime time to have an operation? Jesse Gruman, president of the Washington, DC. based non-profit Center for Advancing Health, says, “Anybody who’s been in hospital knows that it’s a kind of banker’s hours after six o’clock. You feel really vulnerable if something happens at night because of the sparseness and responsiveness of the night staff.” But is this also a problem in Canada? Dr. David Wilson, president of the Canadian Society of Hospital Medicine, isn’t reassuring. He says, “In comparison with...Read More
Surgery
Israeli Research Gives Hope For Spinal Cord Injuries
What’s the most catastrophic illness that can befall us? To me it’s a spinal cord injury (SCI) that results in total paralysis. During a recent visit to Israel I interviewed Dr. Shimon Rochkind, world-renowned neurosurgeon at the Tel Aviv University Sourasky Medical Center, an expert on SCI. Every year 12,000 North Americans sustain spinal cord injury. The people involved are usually under the age of 30 and 80 percent are males. Some, like Christopher Reeves of Superman fame, fall from a horse. Others dive into shallow water or are involved in car accidents. Dr. Rochkind has spent his life trying to accomplish what’s said to be impossible. Time and time again we’ve been told...Read More
Miscellaneous, Surgery
Surgery Minus Complications
Would you jump at the chance of back surgery that has zero risk of post-operative complications, is free of pain and provides relief of all your symptoms? Or would you choose a back operation that provides none of these guarantees? The first choice may sound like being sold swamp land in Florida. But a recent study shows this is not science fiction. Dr. Rachelle Buchbinder is a researcher at Monash University in Malvern, Australia. She recently reported in The New England Journal of Medicine about an operation called vertebroplasty. During this surgery medical “cement” was injected into a fractured spinal bone to provide extra strength to it. The surgeons hoped that this approach would relieve back pain because compression fractures...Read More
Surgery
Is your parent healthy enough for surgery?
Warren Buffett, believed to be the world's greatest investor says, "Risk comes from not knowing what you're doing." Risk in surgery also comes from not knowing what you're doing. But in this case, rather than losing money, you can lose a life. A report from Johns Hopkins University says that "50% of people over 65 will undergo surgery." It's a forgone conclusion that aging parents and their children will therefore be asking, "Do you believe he or she is well enough to undergo an operation?" Sometimes the answer is as easy as falling off a log. The parent simply does not need surgery. After all, why submit a 70 year old, who has only mild discomfort that's not life-threatening, to a major...Read More
Lifestyle, Surgery
I Should Have Locked Up the Shotgun
Why was it so hard for me to have a good night’s sleep? It wasn’t the continuing uncertain state of the economy. Rather, every time I rolled over in bed my shoulder reminded me it wasn’t happy. This wouldn’t have happened if I’d been smarter and taken my own advice about prevention. But luckily Low Intensive Laser Therapy (LILT) has saved me from surgery a second time. Several years ago I became involved with trap shooting. I enjoyed the eye-to-hand coordination that’s required, but one day I got careless and shot too many rounds. That’s when the excessive recoil of the gun caused a rotator cuff tear (RCT) in my shoulder. I would have told anyone...Read More
Surgery
Shock Therapy to Treat Fractured Bones
“How one error can have such a devastating effect on your life!” a friend said to me. She had spent summers in the same cottage for years and knew well the step from living room to kitchen. But one evening she forgot, fell, and sustained a severe fracture of the leg. I wrote several weeks ago that she had been taken to the local hospital and remained there for three days without treatment. Whether she will be in a wheel chair the rest of her life depends on a new way to heal broken bones. Dr. Rob Gordon is an orthopedic surgeon at the University Health Network in Toronto and an early pioneer in the use of shock wave therapy....Read More
Surgery
Head Injuries Sustained In Sports
"Do you know of anyone who could help my child?" a long-standing friend of mine recently asked me" Their young child had sustained a head injury while playing hockey had been left with severe headaches and various medications had failed to relieve his suffering. Today, head injuries can occur in a variety of sporting activities. So what should about even minor blows to the head? Earlier this year actress Natasha Richardson fell and struck her head while skiing on a beginners slope at Mont Tremblant in Quebec. She walked away apparently without injury. But what shocked the world was the headline news 24 hours later that she had died from this trivial injury. After all, she was not racing down a...Read More
Infection, Surgery
Surgery Without Any Complications
Would jump at the chance of back surgery that has zero risk of post-operative complications, is free of pain and provides relief of all your symptoms? Or do you choose a back operation that provides the same result, but has none of these guarantees? This first choice may sound like being sold swamp land in Florida. But a recent study shows this is not science fiction. Dr. Rachelle Buchbinder of Monash University in Malvern, Australia, recently reported in The New England Journal of Medicine an operation called vertebroplasty. During this surgery medical "cement" was injected into a fractured spinal bone to provide extra strength to it. The surgeons hoped that this approach would relieve back pain as compression fractures of the...Read More
Orthopedics, Surgery
What You Should Know About Ankle Replacement
"Should I have surgery to replace my painful ankle?" a friend recently asked me. He added, "I now wear an ankle support to play tennis and I want to get rid of it." Today, we all know friends who have had surgery to replace a worn out hip or knee. But an increasing number of people are also getting new ankles. What should my friend and others know before they make this decision? The majority of ankle replacements are due to osteoarthritis, the wear-and-tear type that occurs with aging. But, an arthritic ankle can also develop following injury to the joint many years earlier. Cartilage between bones deteriorates and finally bones grind on bones. Replacing an ankle is not minor surgery. Surgeons...Read More
Gastroenterology, Surgery
Napoleon Didn’t Have a Choice For Treating Hemorrhoids
Would Woodrow Wilson have negotiated a more lasting peace treaty following World War I if he had not complained about tight-fitting shoes? Would Napoleon have won the Battle of Waterloo if he had not been suffering from hemorrhoids (piles) while directing the battle on his horse? Small annoyances might have changed history? But unlike Napoleon patients today no longer have to endure the pain of hemorrhoids. Piles affect 90 percent of the population at some time in their life. And in spite of being a common condition little research has been done on this problem. After all, cancer and cardiovascular research is well respected, but what doctor wants to tell people he's a pile expert. It was due to this lack of...Read More
Eyes, Ears, Nose & Throat, Surgery
LASIK Eye Surgery, Suppose the Parachute Fails To Open?
"Would you take the risk of jumping out of a plane with a parachute?" I asked the patient. She had just asked me if she should toss away her eye glasses and have her vision corrected by LASIK surgery. Millions of North Americans have had this procedure done and are happy with the result. But now the FDA (Federal Drug Administration) in the US wants stronger warnings of complications on patient information material. The problem is that just as some parachutes fail to open, there can be devastating surgical complications. LASIK surgery permanently changes the shape of the cornea, the clear covering at the front of the eyeball. A laser device is used to cut a flap in the cornea leaving...Read More
