Surgery
Shoulder Arthroplasty – I Couldn’t Even Wipe My Bottom
Today thousands of patients are having hip and knee replacement surgery that allows them return to a more active life and pain free life. But what happens to the hip and knee can also strike the shoulder. So why is it that people are more likely to shy away from shoulder surgery when it can be a crippling condition? One woman recently said to me with great hesitancy, "Doctor the pain in my shoulder has become so severe it's difficult to move my arm. I'm embarrassed to tell you, it's now even hard for me to wipe my bottom." If you don't believe this is a medical emergency you've never had this problem. But how does such an embarrassing situation happen? The...Read More
Surgery
Sacrifice Part of Your Stomach To Lose Weight?
"Desperate diseases require desperate cures", wrote the immortal bard, William Shakespeare. For grossly obese patients this means putting part of the stomach and small intestine out of commission (bariatric surgery). But this is not minor surgery and patients should know the risks before making this desperate decision. This year 150,000 bariatric operations will be done in North America. These patients usually weigh 300 or more pounds and the surgery seems like the answer to a maiden's prayer. Proponents of the operation say it causes weight loss, helps to cure or reverse diabetes, hypertension and the risk of other complications of obesity. For some patients it can be a life-saving procedure. Several surgical techniques are available to trim the stomach and intestine. One involves...Read More
Surgery
A Story of One Disaster After Another
Several weeks ago I wrote about needless, dangerous, delays due to flaws in our health care system that resulted in surgery after an appendix had ruptured. Since then I've received numerous letters from readers reporting similar happenings. This unbelievable story is a tribute to small town doctors, the backbone of our profession, who receive so little attention. How one helped to save the life of a desperately ill patient against great odds.. Charlie Godden, a 60 year old dairy farmer from Campbellford, Ontario suffered third degree burns to one third of his body, a life-threatening condition. His nightmare began when the 911 dispatcher could not determine the exact location of his farm. But finally the ambulance and fire department arrived at the...Read More
Surgery
Unexpected Consequences of Joint Replacement Surgery
An English proverb cautions that "It is the unexpected that always happens". No doubt people looking back on their life can recall several of those unexpected and unpleasant events. But how often do these unexpected events happen in surgery? Today an increasing number of people face hip and knee replacement operations. They're often concerned about the pain following surgery and long sessions of physiotherapy to recover joint mobility. But how many consider a coronary attack after the operation? Dr. Justin de Beer is an orthopedic surgeon at the Henderson site of Hamilton Health Services in Hamilton, Ontario. He and his colleagues recently reported to the Canadian Orthopedic Association that a worrying number of hip and knee replacement patients suffered a heart attack following...Read More
Surgery
How Would You Like To Be This Patient?
If such inefficiency of this medical kind happened in a corporation it would not survive this competitive world. Any business executive consultant would look at these needless delays and fire those responsible. A 40 year old man noted the onset of upper abdominal discomfort early in the morning. By late afternoon his pain had shifted to the lower right side of his abdomen and he complained of nausea. Since he had no family physician, he arrived at 6:00 pm at the hospital's emergency department. Due to abdominal pain he was seen quickly by the emergency doctor. The diagnosis was possible appendicitis. But in spite of a quick assessment by the doctor, this patient's luck for speedy treatment began to run out. A surgeon...Read More
Surgery
How To Prevent Unusual Hazards in 2007
Of course you all know how to keep healthy this year. Keep active, eat healthy foods, don't smoke, drink alcohol moderately, have regular medical, dental and eye checkups, buy a bathroom scale so there's no burying your head in the sand about obesity, etc, etc, etc. But here are some precautions you may not have considered. Are you scheduled for surgery in 2007? If so, there's a sure way to circumvent a horrendous surgical error. We've all heard stories about surgeons amputating the wrong leg. Or fixing a hernia on the side that didn't need it and neglecting the one that did. If you think this is past history, you had better think again. The Canadian Medical Protective Association (CMPA) says that...Read More
Surgery
Unfortunately, I Cannot Guarantee Your Survival
"What's the worst thing that can happen if I agree to surgery?" a patient recently asked me. Unfortunately, the only honest answer was that "some patients die". It's hardly the positive way to discuss surgical complications, but it does get quickly to the heart of the issue. Today, patients have every right to be informed about risk, but to do so effectively is easier said than done. For instance, it could be cynically said that the only truly informed patient would be a brain surgeon informing another brain surgeon about potential complications. There are no ifs, ands or buts in this case. In a similar vein I could talk to a nuclear physicist for days without ever understanding the complexities of his...Read More
Surgery
Is It Losing an Ear or Using Bloodsuckers?
It was August 16, 1985 and a horrendous way to start the day. Guy Condelli, a five year old boy in Medford, Massachusetts had his right ear bitten off by a dog. Dr. Joseph Upton, a reconstructive surgeon at Children's Hospital, Boston, reattached the ear during a tedious 12 hour operation. But three days later an ominous sign of impending disaster appeared. The ear had turned blue-black due to venous congestion. Blood thinners and lancing failed to restore normal blood supply. In desperation Upton telephoned Biopharm, an English company. It sent 30 leeches by air to Boston. These blood suckers were attached to the boy's swollen ear. Within minutes venous congestion diminished and normal circulation restored. The ear turned a healthy pink....Read More
Surgery
What’s The Best Day To Have Surgery?
Can you remain healthy during a hospital stay? It's not as easy as you think. This column is not intended to make you run for the woods, rather than seeking medical attention. But by being a well-informed patient you can decrease the risk of falling into hospital traps. Hospital statistics make your hair stand on end. Consumer Reports on Health states that in 1999 the Institute of Medicine (IOM) claimed that in the U.S. errors by hospital staff resulted in 100,000 deaths. In addition, 500,000 more patients were injured in hospital. Another study in 2004 of 37 million Medicare patients in the U.S claimed that hospital errors killed and hurt twice as many as found in the IOM report. Today contracting hospital...Read More
Surgery
Hernias – If it’s Partly Broken Should You Fix It?
Do you want to have a body free of imperfections? In an ideal world we would all say "Yes". But how important is it to be perfect?" A recent report shows that in some surgical operations it's prudent to live with a slight imperfection. Several months ago I watched one hernia after another being repaired at Shouldice Hospital in Toronto. This clinic has developed an international reputation for doing one thing very well. It's the old story that practice makes perfect whether you're a surgeon or a plumber. During the visit Dr. Casim Degani and his colleague Dr. Michael Alexander told me about a six million dollar study being conducted to determine if all hernias need to be repaired. This report, just...Read More
Surgery
Think Twice Before Agreeing to these Operations
Is it better sometimes to run for the woods rather than submit to surgery? The decision is easy when the diagnosis is acute appendicitis or a strangulated hernia. But there are times when a sojourn in the woods makes sense. Time is often the best healer. Several weeks ago the gods were unkind to me during the night. When arising from bed I suddenly experienced a pain from hell. Like a tire that blows out, two inter-vertebral disks had suddenly exploded with a vengeance, and I was on my hands and knees in agony. My MRI report was not good and the neurosurgeon gave me two choices. A operation which might be successful to ease the pain. Or painkillers, anti-inflammatory drugs and...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 surgeons are not following proven surgical guidelines for a potentially fatal operation. What's needed? A big dose of pilot discipline. Dr. Thomas Feasby, neurologist at The University of Alberta, reviewed carotid endarterectomies done in four western provinces. His study revealed that one in ten of these procedures should not have been performed and 47 percent were done for dubious reasons. His conclusion; surgeons needed "cockpit management". Endarterectomy is a common operation performed to prevent stroke in patients who have partial...Read More
Surgery
A Surgical Assembly Line to Repair Hernias
To ask what goes on at The Shouldice Hospital is like asking, "Is the Pope Catholic?" This hospital situated in Thornhill, near Toronto, is a world-famous center for the repair of hernias. But is its reputation as good as they say? If so, why? And why is it possible for surgeons to repair an obvious hernia and miss another one? To find the answers I observed Dr Casim Degani, chief of surgery at Shouldice, perform one hernia operation after another. A hernia is a protrusion of bowel through the abdominal wall. There are various types of hernias and 90 percent occur in men. The Shouldice success rate is outstanding, virtually 100 percent if there's been no previous surgery and 98 percent if...Read More
Surgery
The Benefits and Risk of Laparoscopic Cholecystectomy
In 1991 Dr. Joacques Perissat at the University of Bordeau, in France, announced to the World Congress of Surgeons that he had removed a gallbladder (cholecystectomy), using optical instruments inserted through a few small incisions. Now, 90 percent of of gallbladder operations are done by fiber-optics. What are the advantages and what is its most devastating complication? And the crematorium is the cure for some gallstones. An emergency cholecystectomy is required when a stone blocks the common bile duct (CBD) resulting in an acute inflammation of the gallbladder. To prevent this from happening, patients are often advised to have a cholecystectomy before this complication occurs. It's technically easier and safer to remove a gallbladder when the organ isn't inflamed. In the past it...Read More
Lungs, Surgery
Reduction Surgery to Treat Emphysema
"Damn those cigarettes," an angry Johnny Carson repeated over and over as he slowly died from emphysema. Unfortunately, Carson should have said "damn those cigarettes" years ago. The former star of the Tonight Show could have stopped destroying his lungs. But Carson, like so many others, failed to realize that once damage has occurred nothing can restore lung tissue. However, a new surgical operation, lung volume reduction surgery (LVRS), can help to improve the quality of life for some patients suffering from emphysema. Emphysema has always been frustrating to treat. Sir William Osler, one of North America's most famous physicians, was once asked how he treated emphysema. He facetiously replied, "I send them to Egypt." "For the climate?" a young doctor...Read More
Cancer, Eyes, Ears, Nose & Throat, Surgery
A Scotch and Soda And an Alarming Surgical Dilemma – Cancer of the Tongue
"Stick out your tongue", my dentist invariably requests during my regular dental checkup. I know that shortly he'll examine my teeth. But for the moment he's looking for any sign of cancer of either the tongue or the rest of the oral cavity. But what happens if your dentist or doctor detects a malignancy? What I learned over a scotch and soda should alarm all of us. Cancer of the tongue is one of the more common and serious types of mouth cancer. Every year 30,000 North Americans are diagnosed with this malignancy and it's curable in about 80 per cent of cases when diagnosed early. Malignancies of the tongue start as a small lump or a thick white patch. Over time...Read More
Archive, Surgery
“Critical Mass” Is The Name of the Game In Surgery
Suppose you need a radical cancer operation. Or angioplasty to remove a blockage in coronary arteries. Or a coronary bypass operation. Who should perform these procedures? Where should they be done? These are questions that patients and families of an aging population are asking more often. The answers may mean the difference between life and death. One component of the answer is "Critical Mass". Or, put another way, the old dictum is still true, "Practice makes perfect." Whether you're a plumber or a surgeon the more work you do the better the results. Dr. James Hollis, Assistant Professor of Medicine at Duke University in Durham, North Carolina, stressed this point at a meeting of the American Heart Association. Patients, he said, were more...Read More
