You vs. Surgery
5 questions you should ask your surgeon before going under the knife.
I have had 3 surgeries in my lifetime - an appendix removal and 2 knee surgeries. Each time, I was given a clear picture of what the surgery itself would look like, as well as the recovery timeline. I thought this was the norm. Until I became a PT and started hearing things like,
Post back surgery patient - "I don't really know what the surgeon did, he just fixed it"
Post ankle surgery patient - "He tied some tendons together in there and said I'm good to go" (in case you were wondering, this is not something that is actually done
Post knee replacement patient, previously very active running, working as a pilot "doc says it is an easy surgery, and in 2-4 weeks I'll be good as new" (this is more like 6 months-18 months recovery)
Sub 40 year old with arthroscopic knee scars "yea I had a knee replacement." Me - "are you sure it was a knee replacement" Pt - "yea he replaced my knee. Or maybe replaced a ligament. Or maybe cleaned it out, I don't know"
Patient with a multi-level neck fusion "I don't know, I just feel like I don't have full mobility, I'm a bit limited." Me, estimating she has 80% of normal range of motion, "ok, well what were the doctor's expectations they told you for recovery, they did fuse some vertebrae together, so some range of motion loss is inevitable" Patient, honestly shocked "WHAT?!?! I WAS TOLD EVERYTHING WOULD BE NORMAL!"
Now, what does this tell you? First, that I have likely run into some apathetic and uninformed patients. Some patients go to the doctor, say fix me, and are uninterested in the process. However, from some of these situations as well as my personal experience shadowing surgeons, some of this comes from a lack of communication.
Yet, we can't place all of the blame or all of these burdens on surgeons. From their perspective, the surgery IS easy. They've done it a thousand times. They can do it in their sleep. The outcomes of a little missing range here, a little strength deficit there? well they are normal, all of the research papers say so. Several weeks after surgery you will likely walk into their office with no brace, no sling, no crutches. They will ask how you are doing. You may say, well I'm doing good. Still a little tight, still a little pain. They will say here's a new PT script, here's some more meds, and be on their way. This is the same as a teenager getting in the car after school and the conversation going - how is school? It's fine, math is hard. Well you have to study harder. Ok. Ok.
Well I am here to help you break that communication barrier. No, not the one between teenagers and parents, that would take some dark magic but the one between you and your surgeon to get everyone on the same page. Here are the 5 questions I think are absolutely imperative to get the answer to before agreeing to go under the knife.
What are all of my options to treat this injury and the risks and benefits?
When a new treatment technique is proposed, it is often put up against a current treatment option in a research study. Outcomes are usually measured based on a variety of factors. Many times, the new technique may outperform the old technique in some factors, and be outperformed in others. So lets say that there are 5 factors measured and one treatment technique outperforms the other on 3 of these factors. The conclusion of the study will be that that treatment technique is better. Surgeons, then, staying updated on the research will know that that technique is better. But who is it better for? The demographic that was studied on 3/5 factors. Does that mean that you match that demographic? Are those the factors that are important to you?
For example, surgical ACL reconstruction has a much higher return to sport percentage than non surgical. But if you aren't an athlete? Non surgical approach may be right for you. Knowing all your options and making informed decisions is important.
2. What is the full recovery time until I am back to my current (or goal) lifestyle.
Many people will ask prior to a surgery "what is the recovery time?" But this question is a bit broad. We'll go back to the ACL scenario. Even surgically, the recovery time for an ACL reconstruction on a sedentary desk worker who drives to work and plays video games on the weekend is probably going to be somewhere around 3 months. For a football player who wants to get back to the top of his game? 9-12 (maybe even 18) months. Narrowing down what you consider to be "recovered" can help the surgeon give you an accurate estimate.
3. Will I have long term limitations to this are of my body?
We'll go back to the example at the top of a multilevel spinal fusion patient being surprised that they may have limited range of motion. That is the whole purpose of the surgery. I know that, the surgeon knows that, but unless that information clearly gets passed along to the patient, they may have no idea!
Setting and knowing expectations and realistic goals for range of motion, strength and function after surgery can help avoid surprises at that 6 or 12 week follow up.
4. Will the procedure done on this area of my body affect another part of my body?
Similar to the last question, but not exactly the same. Going back to the last example of spinal fusion surgery, almost 50% of patients who have one level spinal fusion undergo a fusion of an adjacent level in the following years. When we think about it from a mechanical point of view, fusing one level means the adjacent levels have to take over the work, and will break down quickly. But sometimes that is not so apparent at the time, and other surgeries have more complex long term impacts on other body parts. Again, having this expectations before hand can help make an informed decision and an understanding of the long term implications of a procedure.
5. What exactly are you going to do in there?
Prior to doing any surgical procedure, except in the case of an emergency or unconscious patient, a medical professional needs to obtain what is known as "informed consent." This means that the individual to undergo the procedure understands the procedure, and the risks and benefits. Well, as is evidenced by some of the examples above, I don't think this is always done completely. Even if you do not have a medical degree, having a basic understanding of what will be done during the procedure can help you understand recovery time, outcomes and risks. Also, down the road if you ever have trouble with that area it is helpful to know exactly what type of surgery you had.
Some people that know me think I am "anti-surgery." That is not at all the case. Physical Therapy cannot fix all issues. However, I am "anti unnecessary surgery" and "anti-uniformed surgery." Therefore, asking these questions can help better prepare you for surgery.
If you or someone you know has or will undergo a surgery and wants help preparing questions to ask, etc, email me at firstname.lastname@example.org and we can chat.