As time goes on, we continue to find out in medicine that sometimes not doing something is better than doing something.  I think this is a very difficult fact for many Americans to swallow as we have all (myself included) become accustomed to fixing anything that is not “normal.”  However, more studies continue to be released suggesting that maybe the power of medication is more powerful than surgery.  For instance, I blogged on a study which discovered that Arthroscopic Knee Surgery is not better than Physical Therapy (https://ausfamp.wpengine.com/blog/torn-meniscus-of-the-knee/).  A few years ago, another study came out suggesting that we should not open clogged coronary arteries that surround the heart unless they are causing symptoms or threatening heart attack.  The study showed that being treated with optimal medications (statins, ACE inhibitors, aspirin) did better than opening the arteries with stents!  We are also discovering that mammograms may be harming more people than helping them (https://ausfamp.wpengine.com/blog/mammography-is-a-mammogram-safe/). There are books written on this topic of Over-Treating and Over-Testing America.

The study that I saw this morning is quite shocking to me.  The study compared two different groups revolving around AVMs (Arterio-Venous Malformations).  AVMs are blood vessel abnormalities that can occur anywhere in the body.  A high-pressured artery usually links to a capillary which then drains into a low-pressure vein that carries blood back to the heart.  In an AVM, a high-pressured artery links directly to a low-pressured vein, this link causes distortion and increased likelihood of stroke.  If you imagine hooking your main water line from the street to a water hose on your house, you can imagine what happens with an AVM – it bleeds.  When an artery bleeds in the brain, it causes a hemorrhagic stroke.

The Study:  This particular study focused on AVMs in the brain which are rare, but they have the ability to cause strokes, seizures, and headaches.  Half of the patients underwent medical therapy which means their blood pressure was controlled, they were told to avoid blood thinners, and they were started on any medications that would alleviate symptoms (headaches, seizures, etc) of the AVM.  The other half underwent surgical closure of the AVM.  The researchers watched to see which set of patients had strokes or died from either the AVM or surgery.

Moral of the Story:  The results were profound.  In fact, the results were shocking enough that they had to terminate the study early because it was unethical to continue allowing people to undergo surgery.  Terminating a study early is very rare – this means that the results were shocking.  The patients that underwent surgery did much worse, and they were having more strokes and dying more often.

Before I end my blog today, I want to encourage all of my patients – or anyone who reads this – to think twice before undergoing a procedure.  Ask your physician specific questions about your outcome.  How much will I improve with this procedure? What are my alternatives?  What are my chances of getting better without this procedure?  Is there anything else I can try before having the procedure performed?

You may be shocked to find out what your physicians tell you.  For instance, sinus surgery for recurrent sinus infections, anosmia (inability to smell), or recurrent headaches is only 50% effective.  Wow!  This statistic always surprises me.  This means that you will undergo anesthesia and severe sinus discomfort for days after the surgery for a procedure that has a coin-flip chance of helping you in the long run.  Not to mention the deductible that you will have to pay.  Maybe trying other medications before going through surgery is not such a bad idea after all.

LESS >>> MORE.  That is my opinion.  What is yours?

#Surgery #Procedure #AVM

http://www.essentialevidenceplus.com/infopoems/dailyInfoPOEM.cfm?view=141290