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En español | The four operations discussed on the following pages are often overperformed. Some are moneymakers for doctors and hospitals; others are expedient and still others seem to work, at least in the short term. But evidence shows that all have questionable long-term outcomes for treating certain conditions, and some may even cause harm. Consider these alternatives.
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Stents are tiny mesh tubes that surgeons use to prop open arteries carrying blood to the heart. If a patient is having a heart attack, a stent can be a lifesaver. But for heart disease patients with stable angina — chest pain brought on by exertion or stress — a stent is not better at preventing a heart attack or prolonging survival than lifestyle changes.
If your doctor orders a heart catheterization to explore your blood vessels, ask that he or she wait to perform any treatment such as stenting in a separate procedure. Even before submitting to a heart cath, make sure you’ve explored other alternatives. Do you adhere to a strict diet, exercise or take medications to manage your cholesterol? If plaque is forming in your arteries, this is a systemic disease, and a stent won’t keep even a full inch of your arteries clear.
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With spinal fusion, a surgeon places bone grafts that “weld” two or more vertebrae together to prevent motion and stop pain. The procedure is often used to treat back pain from spinal stenosis, which occurs when the soft tissues between the vertebrae flatten out, creating pressure on the spinal cord or nerves that go to the back, arms, neck, shoulders and legs.
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Before considering any type of back surgery, make sure you have exhausted more conservative measures, including physical therapy, cortisone injections, acupuncture and medications. “Probably less than 5 percent of all back pain requires surgery,” says orthopedist Arnold Weil, CEO of Non-Surgical Orthopaedics in Marietta, Ga.
Each year more than 400,000 American women have a hysterectomy, or removal of the uterus, and studies show that the vast majority of surgeries are unnecessary. A hysterectomy may be critical when the patient has cancer, but most patients undergo the procedure for quality-of-life concerns such as heavy bleeding or pain caused by uterine fibroids — benign growths in the uterine wall.
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If you suffer from uterine fibroids, ask your doctor about other options, including uterine-artery embolization, in which the arteries leading to the uterus are blocked, causing the fibroids to stop growing. You might also consider a procedure known as focused ultrasound, which shrinks fibroids via ultrasound waves.
With this procedure, a surgeon places a tiny camera in the knee, then inserts small instruments through other incisions to repair torn or aging cartilage. Studies show the operation works well when patients have in fact torn their meniscus, but it is no more successful than noninvasive remedies in treating osteoarthritis of the knee.
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If you have knee pain, “start with the least harmful and invasive treatment and work your way up the ladder,” says Colin Nelson, a senior research associate at the Informed Medical Decisions Foundation. This includes lifestyle changes such as exercise, as well as medication and cortisone injections.
This article originally appeared in the July/August 2011 issue of The Magazine.
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