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The advantage with elective surgery is that you have time to think, prepare and get your body ready for the procedure – whether it’s cosmetic or health-crucial.
What a misnomer! The term elective surgery sounds like an operation a patient chooses rather than being medically necessary, which is often not the case – as anyone who has undergone a scheduled angioplasty will testify.
Basically, any surgery that can be planned in advance falls into the elective-surgery category. That includes cosmetic procedures like face-lifts and tummy tucks, as well as surgeries most folks wouldn’t consider optional. Think non-acute cholecystectomies (gallbladder removal). Think masectomies. Think hip replacement.
Unlike the patient who shows up at the emergency room with a perforated appendix, elective-surgery candidates are often afforded time to do homework and make decisions. They can pick out surgeons, select the optimal dates for the operations, and get their bodies and minds in the best possible shape.
“It allows you to get your ducks in a row,” says Dr. Charles Daniel, a urologist with Jefferson Surgical Clinic.
Selecting a surgeon
The best place to find your surgeon may be at the office water cooler.
“The way it works for most patients, and I find in Roanoke this is very true, is that it’s really by word of mouth,” says Dr. James Farmer, an orthopedist with LewisGale Medical Center. “You talk to your friends.”
After gathering recommendations, patients will still want to study the doctors’ resumes, paying careful attention to whether or not they have been certified through the American Board of Medical Specialties, according to plastic surgeon Dr. Enrique Silberblatt.
“Whenever you’re having any service performed you want to pick a provider who’s trained to provide that service,” says Silberblatt. “If you want some electrical work done in your home, you’re not going to call the plumber.”
Younger surgeons may have less experience performing a specific operation, but they shouldn’t be dismissed out of hand.
“Oftentimes they’re more up to date on the newer and more advanced procedures,” says Dr. Patrice Weiss, chair of obstetrics and gynecology at Carilion Clinic.
Patients will want to steer clear of physicians who seem too eager to perform a surgery on a patient who hasn’t yet undergone less invasive treatments, advises Dr. Paul Lenkowski Jr., an ear, nose and throat doctor with Jefferson Surgical Clinic.
“If someone offers you surgery for your sinuses the first time they see you, you may want to go after another opinion,” he says.
“Your surgeon is somebody that gives you information. Not a salesman,” Silberblatt agrees. “If you go in and they’re a little too anxious to get you on the books and they start suggesting procedures that never crossed your mind then the little red flags should go up.”
Setting a date
Since by definition elective surgeries are not urgent, life-or-death situations, how does a patient decide when to go under the knife?
Often, they listen to their bodies.
For instance, people who love to read or people who frequently drive at night may be ready for cataract surgery sooner than their counterparts who don’t rely on their eyesight as heavily. “It has a lot to do with what your activities are and what you want your daily functioning to be,” says Dr. David Kinsler, an ophthalmologist with Vistar Eye Center.
Farmer engages candidates for orthopedic surgeries into discussions about how long they’ve suffered from the injury, the intensity of their pain and the attempts they’ve made at getting better.
“Once we get to that point, the picture is really clear and you very rarely need to convince somebody,” he says.
Patients also need to take their mental health into account when scheduling surgery. Women going through divorces often come in for consultations with Silberblatt in the hopes of freshening up their appearance. Silberblatt explains that they’d be better suited to wait to have surgery when they’re at a happier place.
“Surgery is a stress in life,” Silberblatt says. “You want to do it at a point where you don’t have any other associated stressors.”
Once patients decide to go through with surgery, they have to set a date. More than one web site offers astrological charts designed to assist in selecting the optimal time for surgery, but none of the doctors interviewed for this story was aware of any patients consulting with celestial bodies. Rather, says Daniel, they tend to time the procedures so that they fit with work, school and vacation schedules.
That’s why Daniel performs the majority of vasectomies on Fridays. “A lot of guys will knock off work an hour early, come over here 3:30 or 4 p.m., get a vasectomy, go home, take it easy over the weekend and then return to life,” Daniel says.
Dr. Steven Goldstein, a cardiologist with LewisGale Medical Center, says a regimen of exercise and eating well in the days prior to an angioplasty isn’t likely to make the operation go any more smoothly.
“I think it’s more of a long-term plan of eating well and exercising,” he says. “I mean you don’t want to eat badly or anything.”
For elective surgeries that can be postponed weeks or months, though, patients may have more time to make improvements to their lifestyles, which, according to Weiss, can reduce their risk of acquiring nasty things like post-op blood clots and pneumonia.
“Major changes within a couple of weeks are usually hard,” Weiss says. “But we know that patients who smoke, patients who are obese, patients who are diabetic, patients who are malnourished do not recover and heal as well as their counterparts who are nonsmokers, nonobese, not diabetic.”
Some doctors stress getting unrelated medical conditions like high blood pressure under control before undergoing some elective surgeries like repairing a torn ACL. For other operations, that’s less crucial. Kinsler only asks patients with a multitude of health problems to pay a visit to their internist before undergoing cataract surgery.
“For your everyday person who has hypertension or diabetes, that’s not necessary,” he says.
Farmer’s patients frequently work with physical therapists to strengthen muscles and improve joint function before undergoing surgery.
“All that really helps them get better on the back end faster,” he says.
Patients might also be well served to work on improving their attitudes before an operation. Sunny dispositions can help patients to heal more quickly, Weiss and Farmer agree.
“The more positive your outlook and the more active you are to begin with usually you do better post operatively,” Farmer says.
A HEAD-TO-TOE LOOK AT ELECTIVE SURGERIES
Cataract Surgery: As we age, areas of our eyes’ lenses turn cloudy. Cataract surgery replaces that opaque natural lens for a clear artificial one. In the past, people used to talk about cataracts as being at various stages of ‘ripeness’ by how cloudy the lens had become.
Dr. David Kinsler, an ophthalmologist with Vistar Eye Center, regards this notion as old-fashioned. “You’re not a watermelon or a cantaloupe,” he says.
Instead, Kinsler stresses that patients know it’s time for cataract surgery when “they can’t see well enough to do the things they want to do.”
LASIK Eye Surgery: During this operation, ophthalmologists change the shape of a patients corneas in hopes of eliminating the patients’ need for glasses. Kinsler says he performs fewer LASIK procedures these days due to the lackluster economy.
“This is all out of pocket,” he says of LASIK. “It’s like going out and buying a new car or a TV or something.”
Rhinoplasty: Nose jobs ranked as the sixth most popular cosmetic surgical procedure in 2010 according to the American Society for Aesthetic Plastic Surgery. While the operation can make a dramatic change in a person’s appearance (think Jennifer Grey from “Dirty Dancing”), Roanoke plastic surgeon Dr. Enrique Silberblatt cautions that it takes a year for minimal residual swelling in the nose to disappear completely.
“That doesn’t mean you’re running around looking like Bozo for a year,” he says. “Most of the big swelling goes away in three or four weeks.”
Balloon Sinuplasty: In this relatively new operation that’s akin to angioplasty, doctors place a balloon into the nose. It’s gradually inflated to open the blocked nasal passage.
“You’re not really removing stuff,” explains Dr. Paul Lenkowski, Jr., an ear, nose and throat doctor with Jefferson Surgical Clinic. “You’re just making things bigger and making them function better.”
Here’s something you probably didn’t know: doctors sometimes use cocaine to relieve nasal congestion and as an anesthetic before this surgery. “It’s a really good decongestant and then afterward it helps to control the pain,” says Lenkowski, Jr.
Tonsillectomies: In the first half of the 20th century, most kids had their tonsils surgically removed as a measure to ward off recurrent strep throats. Today, tonsillectomies continue to be the second most common surgery performed on children. In January, the American Academy of Otolaryngology issued new tonsillectomy guidelines recommending that doctors perform the operation only when children have recurrent sore throats (more than seven in a year) or sleep apnea. The new guidelines delight Dr. Tu Tran, an ear, nose and throat doctor for LewisGale Medical Center.
Before, Tran would sometimes face parents of a child with a sore throat who insisted that the child’s tonsils be removed. Tran would refuse, and the parents would take the child to another doctor, who might have a different criteria for removing tonsils.
Tran says that tonsillectomies can improve life for kids who meet the guidelines, but he’s not one for sugar coating.
“It is a big deal operation,” he says. “The reason is that it’s very painful. No matter what. It’s very painful.”
Ear Tubes: In this most common pediatric operation, doctors insert tiny tubes designed to drain fluid in the ears of kids who get recurrent ear infections. Without this surgery, Dr. Vivian Mao, an ear, nose and throat doctor for Carilion Clinic, worries she’d have to prescribe more antibiotics to clear up ear infections. That, in turn, will lead to antibiotic-resistant bacteria. “Luckily, ear tubes are pretty simple solutions,” Mao says.
Angioplasty: Doctors use a balloon to widen clogged heart arteries in this common procedure. While non-urgent angioplasty is considered elective surgery, patients don’t face it casually, according to Dr. Steven Goldstein, a cardiologist with Lewis-Gale Medical Center.
“I think people do have an understanding of how serious it is and how risky it is,” Goldstein says. “Anything that involves the heart, they kind of get their tail up.”
The operation has a success rate of over 95 percent, with less than one percent of patients dying during surgery, according to Goldstein. “It’s under one percent, but it’s a hundred percent for those people,” he says.
Liposuction: The second most popular cosmetic surgical procedure involves a doctor removing fat from specific areas of the body. Silberblatt warns that patients shouldn’t see this procedure as a substitution for weight loss. At most, he will remove 10 pounds of fat. What the procedure can do, however, is to remove fat from specific areas.
“You should be at the weight you’re going to be at,” Silberblatt says. “Then you can recontour at that weight.”
Bariatric Surgery: About 220,000 morbidly obese people in the U.S. had surgeries designed to limit their food intake in 2009, according to the American Society for the Metabolic and Bariatric Surgery. Carilion Clinic currently averages about two dozen bariatric surgeries each month, according to Dr. T.A. Lucktong, medical director of bariatric surgery at the facility.
Lucktong has found that his patients on average manage to keep off between 40 and 60 percent of the weight they initially lose following the operation.
“Some patients can regain the weight lost,” he says. “Most patients who regain weight regain a small portion of the weight loss. Some patients do not regain weight and continue to maintain initial weight loss long term.”
Hysterectomy: Removing a woman’s uterus is still one of the most common gynecological surgeries, according to Dr. Patrice Weiss, chair of obstetrics and gynecology at Carilion Clinic.
“However, there appears to be fewer performed nationally,” she says, “because there are newer and less invasive procedures which may be able to correct the problem before a woman requires a hysterectomy.”
One of those newer procedures is an endometrial ablation, a procedure that destroys the lining of the uterus. “It is a procedure much less invasive than a hysterectomy, designed to treat women with abnormal uterine bleeding,” says Weiss.
Women who do eventually decide to have a hysterectomy will find that the surgery can now be performed laparoscopically. “Women can wake up and have three or four band-aids and go home the next day, as opposed to several years ago where people were having big skin incisions and had a much prolonged healing course,” Weiss explains.
Carpal Tunnel Surgery: Carpal tunnel syndrome occurs when patients compress nerves in their wrists, usually by engaging in repetitive motions, whether that’s typing numbers into a spreadsheet or dealing out tarot cards. Patients usually come to see Dr. James Farmer, an orthopedist with LewisGale Medical Center when symptoms of numbness, tingling and pain keep them from sleeping at night.
Doctors may complete carpal tunnel surgery using traditional surgery, a mini-open approach that involves a smaller, one-inch incision or endoscopy. “There are lots of ways to skin a cat,” explains Farmer, an orthopedist with LewisGale Medical Center.
No matter the surgical approach, though, the end result is the same: the carpal ligament is cut. “It’s like opening a can of biscuits to relieve the pressure,” he says.
Hip Bursectomy: A bursa is a fluid-filled pouch that serves as a cushion between a bone and a muscle or a tendon. When the bursa get inflamed it’s called bursitis and it really hurts. Usually the pain can be eased through less invasive methods like cortisone injections or anti-inflammatory medications, but severe cases may require surgery. The procedure involves making two to three small incisions and inserting a camera to use as a guide. Then, Farmer says, “we get in there and clean out the bursa.”
Patients undergoing hip bursectomies tend to be in their fifth decade of life or older, according to Farmer. “It’s a degenerative thing,” he says.
ACL Reconstruction: This surgery repairs a tear in the anterior cruciate ligament in the knee. Farmer has a particular affection toward this surgery because many of the patients who need the operation are athletic and want to continue being active.
“You fix the mechanical problem and nine times out of 10 they’re going to return to the same level of activity they were at before,” he says. “That isn’t the case with a lot of other surgeries.”
Bunionectomy: The name pretty much explains this one. Doctors use this procedure to exorcise a bunion, an often painful enlargement of bone or tissues at the base of the big toe which are frequently caused by wearing shoes that are too tight and narrow. Doctors go in through a small incision with a (gulp) saw to remove the bump. Sometimes doctors will also realign the bones in the big toe using pins to keep things in place.