Transcription:
How do You Decide If You Really Need Surgery?

Melanie Cole (Host): It may seem like a daunting task, deciding whether to go ahead with surgery, but with your doctor's help and a few well-asked questions, you can take some simple steps that can make it easier to decide. My guest today is Dr. Kamran Parsa. He's a neurosurgeon and a member of the medical staff at Palmdale Regional Medical Center. Dr. Parsa, what is the first thing you tell patients when they come to you, they've got back problems, or some other issue, a neck issue, and they're considering surgery? What do you tell them?

Dr. Kamran Parsa, DO (Guest): Good morning, Melanie. So the first most important thing to know about back surgery is that you want to keep it as a complete last resort. Never jump into surgery. Make sure you exhaust all conservative measures, unless the only stipulation is if you have red flags present, which we can talk about as well a little bit.

Melanie: So then let's get into the red flags first, because then I want to talk to you about questions that you want them to ask. But what are some of those red flags, Dr. Parsa, that people should be concerned about and say, "Okay, this is enough now. I really have to look at this."

Dr. Parsa: The way I like to break it down is to say there are three red flags. The first one being bowel or bladder incontinence. If you know that you have stenosis or pressure on your spinal cord or your nerves, and you develop onset of bladder retention or difficulty going, with loss of control down the line, these are red flags that should not be ignored, and should be attended to immediately. So that's the first red flag.

The second red flag is if the nerves being impinged are causing functional deficit where the numbness or the pain that is in the arm is also leading to weakness, and due to the weakness, you cannot perform your occupation, or you cannot go on about your daily life. That is when you have to really consider surgery in order to take pressure off the nerve as soon as possible to regain the function of the muscle, and prevent it from worsening. So that's the second red flag.

The third red flag is pretty much along the same lines as the bowel and bladder incontinence, are signs and symptoms of spinal cord compression, which is different from your nerves, and this would lead to problems with balance, ambulating, problems with your handwriting, typing, basically small daily tasks of buttoning your shirt. These are subtle signs that can be a symptom of an impending spinal cord damage, and that is when you also need to really address having the pressure taken off the spinal cord. So these are my three red flags.

I sometimes add what I would say a pseudo red flag in there in that if the pain from the nerve is so bad that you constantly have to go to the emergency room to control the pain, that sort of falls in my eyes under that functional status red flag where you really can't go about your daily life because of this constant pain, and that's when it's also a good indication to really intervene surgically as opposed to non-surgically.

Melanie: Well that was so well put, Dr. Parsa, and really important red flags. One of the more important ones being about your quality of life, and the intensity of your pain. When you tell people these red flags, and some of them resonate with them, what questions do you want them to ask you when somebody is getting ready for this and they're questioning back surgery? What questions do you want to hear them ask about the upcoming surgery?

Dr. Parsa: Well the first- before that, I try my best to educate my patient in regard to conservative management. So if a patient asks me, "Okay I'm here sitting in your office, what are the non-surgical treatments that I can do to prevent surgery?" That's actually the most important question in my mind. And there's a lot of options at our disposal, and much of it is very effective and it helps you prevent surgery. So that's number one.

Number two is if you are to undergo surgery, I think the next important question is, "What are my surgical options?" Now there are so many different approaches to the spine surgically, everything from minimally invasive to different directions. You can approach the spine from the front, from the side, from the back, so that's also a very good question to ask. "How would I plan on intervening to treat their pain symptoms, and what are the other potential ways to do it as well?" So they can- so my patient can be educated and knowledgeable, and to being involved in not only the decision of proceeding with surgery, but what type of surgery to have.

Other questions which are routine but important to ask include, "What is my recovery like for each of these different types of surgeries or options available?" "What is my expected outcome?" "How would I get back to the quality of life that I'm used to? And would I get back to it? And what would be my short-term and long-term restriction?" And finally, "How long would this benefit last?"

One of the reasons we try to prolong surgery is that it is effective, very effective, but a lot of times it has an expiry date per se, where the rest of your spine starts to break down depending on the type of surgery performed, and you may need another surgery on your spine. So it's important to be knowledgeable. I take my time going through the entire physiology and anatomy of the spine with my patients. One thing important that I always point out is there's multiple segments in your spine. It's broken down into three areas; your thoracic, cervical, and lumbar. So if they opt- if someone has surgery on their lumbar spine, that doesn't prevent them from needing surgery on their cervical spine down the line.

So there's many, many of these types of questions, and the more my patients ask these questions, the more appropriate understanding they have of what's going on with their body, and generally they have a much better outcome because there are no real surprises good or bad for them.

Melanie: What do you ask them about their support systems, work leave, returning to activity, what kind of activity they want to return to? Are there certain things, Dr. Parsa, that you make sure of when you're making this decision with a patient?

Dr. Parsa: Absolutely. Absolutely. I mean there's many times I sit down and have a deep conversation with my patient, ask them about their livelihood, what are they involved in, and what kind of occupation. If they work in construction, and they're involved in lifting heavy objects, it's important to know the different surgical options available, and which of those would get them back to the type of- back into construction, not only as soon as possible, but also to keep them in there as long as possible.

Sometimes doing the most minimally invasive surgery doesn't strengthen your spine to a point where you can go back to a heavy duty job, and vice versa. So it really- to me, I try to personalize my approach on the care to every one of my patients as to what their livelihood is, what the expectations are, how old they are. An eighty-five year old person does not need to have the same expectation or same amount of activity in their daily life- physical activity as a twenty-five year old, and therefore different surgical options are available for each of those individual patients. It's very important to me to really get to know my patients, what they want to achieve, and then I would- fortunately I've been trained enough to have all the options at my disposal to accommodate what my patients' needs are.

Melanie: And Dr. Parsa, I'd like you to wrap it up for us with your best advice about when to keep surgery as a last resort, and when not to do so, and when you think a patient should seek a second opinion.

Dr. Parsa: So I'll go backwards a little bit. I think when it comes to your neurological system, whether it's brain surgery, spine surgery, really you always need to have a second opinion. It's a very, very important structure. The wrong surgery, the wrong approach can have detrimental effects on your quality of life, and permanent detrimental effects.

So it's very important to get a second opinion, or even a third opinion is what I always advocate to even individuals who come to me to see me the first time. We talk about all these things, and I say- I give them an option of different physicians in the community that they can also seek a second opinion for.

To wrap up what we're talking about, I always advocate keep surgery- the first three options for surgery is no surgery. So avoid surgery, avoid surgery, avoid surgery always unless red flags are present, which we spoke of earlier. And then the next options are, "Okay what are non-surgical treatments?" And this can range from physical therapy all the way to acupuncture to yoga to- I mean you name it, there's a lot of different options available, and spending that- as long as you don't have red flags present, spending that extra time and effort to undergo the conservative measures, you are potentially saving yourself from surgery, which is a big deal. So I always, always, always advocate for that to my patients, and many times they do very, very well, and they come back, and they're some of my most thankful patients who come back and say they were better with physical therapy and we can avoid surgery for however long, and that's really rewarding.

Melanie: What a great ending. Thank you so much, Dr. Parsa, for sharing your expertise in this difficult topic. People do not always know what to ask or whether they should get a second opinion, so thank you for sharing that great information today. You're listening to Palmdale Regional Radio with Palmdale Regional Medical Center. For more information, please visit www.PalmdaleRegional.com. That's www.PalmdaleRegional.com. Physicians are independent practitioners who are not employees or agents of Palmdale Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole, thanks so much for listening.