When the Best Treatment is No Treatment
What do you consider to be one of the major health hazards today?
I think it is being a patient in the modern health care system. Don't get me wrong - modern medicine has much to offer today, and millions of people benefit from improved quality of life, increased length of life and decreased illnesses.
However, modern medical strategies may also create problems because of the goal to "fix". Consider David's story.
This past week David, a patient of mine, came to me with his MRI. We looked at it and saw where his disc was protruding (herniated), putting pressure on a nerve. He asked me for a referral to an orthopedic surgeon to remove the disc protrusion, because "If I get rid of the protrusion, the pain will go away."
Before I answered his question, I asked, "What is your daily level of pain?"
He replied, "About a 3 out of 10."
Here is what I told him.
"David, I know you have chronic pain and that is annoying and frustrating, it's uncomfortable. However, I am wondering whether this is a level of pain that you can live with? I ask you that for a number of reasons. The first is that disc surgery is invasive and brings a host of risks including infection, and the possibility of increased pain. Secondly, the fact that a disc is shown to protrude in an MRI does not mean it is a new injury, nor does it guarantee that the protrusion is causing the pain."
As a rule, I only recommend surgery when a person is experiencing pain daily that is greater than 8 out of 10. In this case, Joan Rivers the comedian said it best, "If it ain’t broke don't fix it."
It is prudent to very carefully consider a surgical option for disc issues. Consider whether your quality of life is seriously affected by the issue. And remember that with disc related issues, just because we see something on imaging, it doesn't mean it is a new issue or that it is the root of your pain. You can read more about this in my article on "medical imaging technology."