Unnecessary surgeries

[spotty_dog]

http://www.consumerreports.org/mg/free- ... geries.htm

This is a fairly recent list from Consumer Reports of 12 surgeries that are overperformed. Whaddya think?

[Sheherezade]

Is this article recent? (I should have checked. ) DH just did his OB/Gyn oral boards and was pretty clear that the thinking on vaginal birth after C section had changed. He was taught in residency to try for vaginal birth, but when studying for the boards ACOG has clearly changed that position. They are now against trying for vaginal birth post C-section. The article claims the opposite. Maybe the decision is more complex than I'm thinking. Anyway.....that bit has me doubting the article's background research. I know the C-section rate is very high now. My impression is that it has risen due to the out of control liability in OB.

I've heard the bit about the ortho knee surgeries. I would be interested in what the ortho counter argument is - if they haven't changed the practice.

[spotty_dog]

It's dated 11/30/05. So pretty recent.

Are you saying that the current standard of care is to "forbid" VBAC? Weird.

[Sheherezade]

Not forbid I'm certain, but they have backed away from the VBAC strongly since my husband's chief year (4 years ago). He had to explain cases then in light of the thinking at the time. I bet someone with more OB now might have a clearer understanding. DH doesn't do deliveries anymore.

[spotty_dog]

Hm. A quick look-see indicates that maybe the decline in VBAC trials is because of ACOG guidelines that require that the OB be immediately available during such a trial of labor, in case of rare complications.

Liability in OB is certainly a huge can of worms.

[PrincessFiona]

I was encouraged to try a vbac in europe with Amanda...and then when pg with Alex here in the US was encouraged again...though I was offered a repeat section each time. With Alex, I hemmorhaged at my scar and needed emergency surgery....so I did kind of start rethinking the whole vback thing. Bad things can happen.

[Gwendolyn]

I guess I was expecting a list of surgeries that I would be suprised by. Aren't most of these commonly known as mostly elective?

[mommax3]

I *think* DH (who finished residency at the same time as Angie's husband if I am not mistaken) is very pro-VBAC, but would stay in-house if he had a patient attempting a VBAC. By the same token though, due to events that took place during our time in the military and some soul searching on DH's part regarding "academic standard of care" vs. "community standard of care", he is not going to try real hard to talk someone into a VBAC. It is sad but true that OBs don't get sued for doing sections, only for NOT doing them. (whether they were indicated at the time or not......)

Sally

[DCJenn]

We ended up not having Nikolai circumsized and my husband feels pretty strongly that they're really not warranted. (that and we didn't think "Hi, welcome to your new country. We're you're parents and we'd like to operate on your penis." would help in the adjustment...)

I'm quite glad that I'll never have to deal with the whole childbirth thing...

jenn

[PrincessFiona]

"Hi, welcome to your new country. We're you're parents and we'd like to operate on your penis."

[Vanquisher]

I've heard the bit about the ortho knee surgeries. I would be interested in what the ortho counter argument is - if they haven't changed the practice.

I didn't see this part. Am I blind?

Further, I completely disagree with the weight loss surgery one. Death rate is 1/200 for gastric bypass, but much lower for lap-band. However, without surgery, in 10 years, the number of people in the morbid obesity population who die is so much greater than the population who diw of those who do have it. Is it a risky surgery? Yes. But really, it isn't that much riskier than any other major surgery. The risks go up when a patient is morbidly obese as they are heavier, and have co-morbidities. These same mortality rates can be applied to other major surgeries in this population.

I take offense to the idea that it is an easy decision to have the surgery. Most people who have this surgery do it as a last resort to save their lives. Anyone who gains weight for the surgery, usually only gains a very few pounds and only does this because of the strict guidelines of insurance companies for payment of these procedures. If anything, this should be a decision for a surgeon and their patient to decide on and not for insurance companies to decide.

[Sheherezade]

The knee surgery study was in the intro ... not one of the procedures they discuss. I remember when the studies came out I was amused. I think they put the real and sham surgery patients through PT and ended up concluding that the PT had been giving the positive result all along, not the surgery. (I love ha-ha-you-think-you-know-so-much scientific findings.....)

I was reassured by the wisdom tooth thing. I have all mine, except one refuses to come all the way out. I keep expecting it to cause some major issue since I refused to have the things removed preventatively in college. Every now and then it shifts and I'm teething for a month. Luckily, I get to use cognac-soaked cotton balls instead of a frozen washcloth. This has been going on for 15-20 years, so maybe I'll never have an issue.

[PrincessFiona]

Further, I completely disagree with the weight loss surgery one. Death rate is 1/200 for gastric bypass, but much lower for lap-band. However, without surgery, in 10 years, the number of people in the morbid obesity population who die is so much greater than the population who diw of those who do have it. Is it a risky surgery? Yes. But really, it isn't that much riskier than any other major surgery. The risks go up when a patient is morbidly obese as they are heavier, and have co-morbidities. These same mortality rates can be applied to other major surgeries in this population.

I take offense to the idea that it is an easy decision to have the surgery. Most people who have this surgery do it as a last resort to save their lives. Anyone who gains weight for the surgery, usually only gains a very few pounds and only does this because of the strict guidelines of insurance companies for payment of these procedures. If anything, this should be a decision for a surgeon and their patient to decide on and not for insurance companies to decide.

Heidi...the death rate is 1/200 but the complications that people get form the bariatric surgery are really...really..really... bad too...I guess I'm biased because I get my 'news' from Thomas...but since he does ID he sees all of the surgeries 'gone wrong' and has awful stories to tell...he doesn't ever NOT have at least one bariatric surgery patient....and many, he says, go on to have problems with nutrition (absorption issues) and diarrhea.

One of our previous neighbors had the procedure done. She didn't have any infections as complications, but has lost 170 pounds in 7 months. Problem now? They can't keep her from losing too fast...and she has chronic diarrhea and has to constantly drink water...everywhere she goes she has a water bottle. She will have this diarrhea for the rest of her life...as well as the nutritional problems. She's so thrilled though because she thin...but she is less healthy now than she was before.

Lap-band is less successful in terms of weight loss...at least based on all I've read (which...unfortunately, since you know I struggle with my own weight issues...has been a lot of reading).

At the end of the day (I'll say it then run for the hills) I don't think that a problem of brain chemistry (which I truly believe is at the heart of a lot of obesity/overeating) should be fixed with surgery that is irreversible. Lap band is of course reversible...but not as effective in the long run.

If only...I could wish hard enough and just be thin again...I promise I would never get fat again.



kris

[Rapunzel]

Of the surgeries on the list the only one any member of my family (including extended family) has had was wisdom tooth extraction. I had it done because my teeth were seriously impacted AND if they did emerge my mouth is literally not big enough to hold them* (I don't really have room in my rather small mouth for the teeth I already have - braces were a problem). My brother and three bils had theirs removed because it is required by our church prior to entering the missionfield.




*(I'll bet none of you would've guessed I actually have a small mouth! )

[Vanquisher]

Kris, I get that there are problems, I really, really do, but being alive with diarrhea is better than being dead. It should be a surgery of last resort. Absolutely last resort, but it does save lives.

I myself am trying to get my insurance company to pay for LAP-BAND for me. It is not easy to get most insurance companies to pay for this (been working on mine for months, and I meet the criteria) surgery or gastric bypass, but I honestly think it saves lives, and I do not consider it to be an unnecessary procedure.