To go for surgery, or not to go for surgery

This is the moment of truth! Sometimes there is simply no choice and the only thing to do is try to manage the process so that your recovery can be the best that it can be (do talk about scar tissue with your surgeon!). But I have talked with people who have said that it is much harder when the case for surgery is not so clear cut, and the diagnosis or outcomes are less certain.

With the informed consent rules, it can be very difficult to get any definitive advice from the surgeon on what the likely probabilities are for different outcomes, and whether in their expert opinion it is likely to help or not.

You can feel very alone, in pain and probably having been suffering for a long time and feel that you have lost out on a lot of things. What should you do?

Many athletes have surgery and regret it

Many athletes end up saying that if they had known what it would be like in the years after surgery, they would not have had it. Don’t let that be you.

Some of the reasons may be that:

  • We are positive and believe that we can simply ‘will’ ourselves better, so when we listen to the range of outcomes and timings, we always believe that we will be in the best and fastest group – and maybe even tell ourselves that we can beat those odds too! This rarely happens. So brief the person who comes with you to listen carefully to all of the range of outcomes and probabilities.
  • We place high demands on our body, so even a slight level of dysfunction is noticeable and impacts our lives. We need to remind ourselves that almost everything has a workaround solution – you only need to watch the Paralympians to remind yourself of the power of this.
  • We may subscribe to the ‘instant-fix’ mentality of today’s modern world and forget that there is a lot of healing that takes a very long time. We are not like a bike or a machine, and will not be ready to go as soon as the mechanics are fixed – because there is too much soft tissue recovery, body trauma and system re-patterning to do.
  • We think that because we will be out of hospital in a few days, it will not take long. This is not at all true – whilst you will be home very quickly (and by the way you should plan ahead to ensure that you can cope in that difficult post-operative stage), the time for the body to heal is long. They will often cut through 9 different layers of tissue (even with keyhole) and each of these need to heal. Those with less blood supply heal slower, as they only get what they need more slowly. Whilst there are things that you can do that will make it go slower, there is little that you can do to make it go faster!

So what if you are facing the decision?

You have to find your own true-north on the right path forward… And all at a time when (for sure) your judgement is impaired as a consequence of the pain and frustration of your injury.

 Some tips that might help could be:

  • Take someone with you to the appointment to ensure that you get a well-balanced view of the probabilities of the range of outcomes. Having two of you helps to ask more questions and also listen and take notes in the appointment.
  • Ask about the surgery itself and understand the impact of the incisions and the consequences for the healing process. Often the scar tissue can be as much a factor as the ‘fix’ itself. And talking this through and understanding it can help with the decision (and indeed if you go ahead, with the choices around the exact surgical approach – for more on this read my blog on scar tissue)
  • Would you want to watch the surgery on YouTube?  Many people think that this is seriously squeamish and scary. But for others seeing it and understanding the different aspects enables an understanding of the level of trauma and recovery. And some watch it before going to see the surgeon, as it prompts different questions that they had not previously thought of. You need to think it through for yourself.
  • What is the sentiment on the internet about recovery from this surgery?  Obviously every patient is different and the internet will not tell you the answer for you. But if the prevailing sentiment is that it is a very long recovery, and not a full recovery – what are the common themes? And are there questions that you want to ask your Doctor about the specifics (without referring to the internet, as that is always how to upset Doctors!!)

What if you are not sure?

It is completely normal to come out of an appointment with the surgeon and to be really unsure of whether you want to go ahead with surgery.

If you wrote two lists on the same piece of paper – reasons, why to have the surgery and reasons why not – what would the balance of opinion suggest is the right answer? Is there any more information that would help to make it clearer? Is there anyone that you can talk over the list with to add more insight?

There are a couple of challenges to be aware of:

  • You can feel a sense of momentum that means that you feel pressure to go ahead (whether coming from the medical process, or from family & friends, or your own need to move forward). Resist it! This is a big decision and it is your body. So you need to be happy with the decision.
  • You may feel that there are no other options. This is never true.

So what are the other options?

There are a number of other options – some of which are below. Which one you go for probably depends on (i) how confident you are of the initial diagnosis of the issue, (ii) the level of improvement that you have seen (or not seen) through the current work of rehabilitating it and (iii) the levels of risk and length of predicted rehabilitation from the surgery.

  1. Get another opinion from another surgeon. You are absolutely entitled to this, and no-one should make you feel bad for asking this question.
  2. Continue rehabilitation with another physiotherapist (or whatever rehabilitation specialist you are seeing). There is a huge variation in the approaches that different people in the same profession take. And I would say that if you have been seeing them for more than a couple of months and are not making progress, then a change would be a good thing.
  3. Try a different approach. There are a lot of different therapy approaches, and when you spend a lot of time with clinicians you realise the levels of uncertainty – lots of intelligent guessing because they cannot see inside your body, and the level of variation in people. So for all that many can be very sniffy about ‘alternative’ therapies – these may be what your body will respond to.
  4. Give it some time.  This is a hard one – but can often work. So setting a time limit and truly resting and nurturing the injury by keeping away from activities that trigger it.

Good luck!

Only you can make this decision for your body – take your time and make sure that you feel  that you have explored the details and the options fully. It would be really sad to be a year or two down the line and regretting this decision.

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