From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: sci.med
Subject: Re: Discectomy Question
Date: Sun, 11 May 2003 12:52:40 -0700
Message-ID: <b9m9m8$2e9$1@slb6.atl.mindspring.net>

"Robert A. Fink, M. D." <rafink@attglobal.net> wrote in
message news:igoqbvk4v5hvqatto9b0jc25b8ioqvhejs@4ax.com...
> <schw9883@bellsouth.net> wrote:
>
> Go see a neurosurgeon.  If the disc is truly "extruded" (has come out of
> the space), then it is very likely that surgery will be required.
> 
> Surgery, in good hands, has a 90% chance of improving or eliminating the
> leg symptoms (and neurological deficits), with a 5% chance of no
> improvement, and a 5% risk of worsening (more pain, paralysis of
> foot/leg, urinary, howel, or sexual dysfunction).

So?  If you carefully eliminate people who obviously can't
wait (foot drop, paralysis, agonizing pain) and manage
conservatively, after a year you have 80% resolution, 10%
continuing problems, and 10% who've dropped out and chosen
surgery.

In the only study I know of to actually randomized people
with herniated lumbar discs and pain-only to surgery vs.
conservative medical management, they couldn't get any long
term difference in outcome.

Which means an awful lot of people are going under the knife
to save themselves some short term pain, for a condition
which would do as as well with that favorite of medical
remedies, tincture-of-time.

Yeah, there are a lot of orthopods and neuro guys who do
discectomies who think they personally can beat the study
results. But they're over-confident SURGEONs for heaven's
sake. You have to factor that in.

SBH

Why lawyers make poor private pilots: they forget they're
arguing with God

Why surgeons make poor private pilots: they forget they're
not God

Why internists and pediatricians make poor private pilots:
you tend to fly like crap if you can't afford to fly often.

Why radiologists make poor private pilots: Well, actually,
radiologists are pretty good pilots...

From: "Howard McCollister" <nospam@nospam.net>
Newsgroups: sci.med
Subject: Re: Discectomy Question
Date: 11 May 2003 15:37:16 -0500
Message-ID: <3ebeb3fc$0$52145$45beb828@newscene.com>

"Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com> wrote in message
news:b9m9m8$2e9$1@slb6.atl.mindspring.net...


> Yeah, there are a lot of orthopods and neuro guys who do
> discectomies who think they personally can beat the study
> results. But they're over-confident SURGEONs for heaven's
> sake. You have to factor that in.
>
> SBH
>
> Why lawyers make poor private pilots: they forget they're
> arguing with God
>
> Why surgeons make poor private pilots: they forget they're
> not God
>
> Why internists and pediatricians make poor private pilots:
> you tend to fly like crap if you can't afford to fly often.
>
> Why radiologists make poor private pilots: Well, actually,
> radiologists are pretty good pilots...
>
>


Personally, I thought the reason internists make lousy pilots is that, at
some point during a flight, the pilot will have to make a decision...

But seriously folks, there must be hundreds of such jokes out there about
the personality differences between surgeons and internists (and some of the
other specialities). The fact is, however, there is usually at least a grain
of truth in a lot of such jokes, including the one Dr. Harris quoted above.

As to performing diskectomies, I'm kinda glad that there are people in the
world who DO try to beat the odds.

HMc

From: "Robert A. Fink, M. D." <rafink@attglobal.net>
Newsgroups: sci.med
Subject: Re: Discectomy Question
Date: Sun, 11 May 2003 15:06:28 -0700
Message-ID: <04itbvcgt2v6gmu2lrm84bktb50ik290jv@4ax.com>

"Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com> wrote:

>So?  If you carefully eliminate people who obviously can't
>wait (foot drop, paralysis, agonizing pain) and manage
>conservatively, after a year you have 80% resolution, 10%
>continuing problems, and 10% who've dropped out and chosen
>surgery.
>
>In the only study I know of to actually randomized people
>with herniated lumbar discs and pain-only to surgery vs.
>conservative medical management, they couldn't get any long
>term difference in outcome.
>
>Which means an awful lot of people are going under the knife
>to save themselves some short term pain, for a condition
>which would do as as well with that favorite of medical
>remedies, tincture-of-time.
>
>Yeah, there are a lot of orthopods and neuro guys who do
>discectomies who think they personally can beat the study
>results. But they're over-confident SURGEONs for heaven's
>sake. You have to factor that in.


I do not disagree with the above.  In fact, I would say that 85% (not
80%) of patients with bona fide herniated lumbar discs get better
without surgery on any given occurrence (figures from several large
series, one at the Mayo Clinic 20 years ago).  I would only consider
operating on the 15% who fail the conservative treatment program.

In the case of *extruded* (free fragment) disc, however; or in cases
of partial paralysis (foot drop) or bladder dysfunction, surgery is
often required acutely, otherwise serious residua are common.

Like most medical problems, clinical judgment is the most important
factor.


Best,

Bob


Robert A. Fink, M.D., FACS, P. C.
2500 Milvia Street   Suite 222
Berkeley, California  94704-2636  USA
Telephone:  510-849-2555
FAX:  510-849-2557
<http://www.rafink.com>

"Ex Tristitia Virtus"

From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: sci.med
Subject: Re: Discectomy Question
Date: Mon, 12 May 2003 11:00:09 -0700
Message-ID: <b9onf8$qgg$1@slb6.atl.mindspring.net>

"Howard McCollister" <nospam@nospam.net> wrote in message
news:3ebeb3fc$0$52145$45beb828@newscene.com...
> Personally, I thought the reason internists make lousy pilots is that,
> at some point during a flight, the pilot will have to make a decision...


<g>.  Yes. A system like the body that, with time and proper
metabolic support, very often fixes itself, can tend to
produce this mind-set.

The surgical answer may be to intervene (yes, make a
decision), but that's sometimes just one decision and
invasion before he loses interest and moves on. The patient
doesn't get candy the next day, no card, no flowers, no
phone calls.  :)

"Okay, I've reset the controls and it should land okay; now
on to the next airplane," says Mr. Surgeon, before bailing
out....

SBH