Speaker 1: (00:00)
Hey everybody, what's going on? Doctor Chad Woolner here hand Dr Buddy Alan. And this is episode six of the Health Fundamentals podcast. On today's episode, we're going to be discussing the question, do you actually need knee surgery? So let's get started.

Speaker 2: (00:14)
You're listening to the health fundamentals podcast. I'm Dr Chad Woolner and I'm Dr Buddy Alan. And this show is about giving you the simple but powerful cutting edge tools you need to change your health and your life. So sit back and enjoy the show as we show you the path to your best life down to a science.

Speaker 1: (00:33)
So, hey everybody, welcome to the episode on today's episode. We wanted to kind of dive in and talk about a pretty important subject in general. Um, specifically we're going to be talking about knee surgery today. Um, but, uh, I think we can apply this to a lot of procedures even beyond just surgery. You know, I think there's some pretty, uh, pretty important implications that patients need to consider, uh, when they're making a decision as life altering, uh, as surgery, right? As permanent as surgery. Yeah. And I think the first place to start, to be honest, um, we want to preface this by saying, by no way, shape, or form are we trying to imply, uh, that you shouldn't ever receive surgery if it's recommended to you, that you shouldn't ever, uh, not listen to the recommendations of trusted healthcare professionals. Uh, but I think it's important to understand that gone are the days where, uh, you know, it used to be almost like, it almost reminds me of like the old and times where, you know, back in, in the dark ages, you know, there were certain people who held all the power in terms of the knowledge and the understanding.

Speaker 1: (01:46)
And throughout time what we've seen is this dramatic democratization of information, you know, the Internet, uh, for good and for bad. You know, and then we talked about this I think in episode one in terms of that. Yeah, there's so much information now. How do you make sense of all right. Yeah. And so, um, to, to start this off, uh, you know, there was a study that was published. I'm just going to talk a little bit about this study here. Um, it was published in the New England Journal of Medicine in this kind of caught my attention years ago, trying to see this back in 2013, December of 2013 and basically what the, what the study did was it compared arthroscopic partial meniscectomy versus sham surgery. So basically from meniscus tear of the medial meniscus, they went in and they compare. They actually went in and repaired it and then the other group and they blinded it and they didn't know who the patients didn't know who got what a, they literally just poked a hole in the knee and didn't do anything else.

Speaker 1: (02:47)
Just kind of pretended to do this. It was a sham surgery. Right. And, and listen to these results or listen to the conclusion in this trial involving patients without knee osteoarthritis, but with symptoms of a degenerative medial meniscus tear, the outcomes after arthroscopic partial meniscectomy, we're no better than those after a sham surgical procedure. Scary. Yeah, that is scary. You know, and granted, we understand there's some pretty specific criteria here that they're talking about. Um, and so we, we don't want to like paint everything with one bro. So that means if you've got a meniscus tear and you don't ever do knee surgery, we don't ever need knee surgery. You know, we see patients all the time and, and as much as we would love to say, you know, we can always, uh, prevent patients from, from getting or needing surgery, that just isn't reality.

Speaker 1: (03:35)
You know, sometimes it is, uh, the appropriate course of action. Right. So, um, so what are your thoughts on this? So the thought on this really comes down to the fact we've got studies that show, and I promise you there's thousands of these surgeries done regularly. Still to this day. There are, they're still doing these surgeries. Okay. And, um, so the scary part of this is how many times, or maybe you yourself were told by a doctor that said, hey, you need surgery. And you were like, Dang it. And you go through with the surgery and without any sort of second opinion, you don't think twice about it. You know, I've, I mean, I would have years ago I would have done that in a second, you know, um, fortunately because of education and reading and research and, and just more knowledge and understanding and really frankly learning a lot from patients and things that they have had done.

Speaker 1: (04:26)
Um, my eyes have been kind of more open to, again, not just say no, I'm not just saying throw it out because it's garbage. Everything's garbage. Cause that's not true. But there is, there is always reason now to like, am I sure is that exactly what I need? Because the problem with surgery is while in some cases it can be very, um, incredibly helpful. It can also not be, it can also be very, um, basically it's something you live in with the rest of your life and there's no going back. No, there's no second chances with that. Your life will completely be changed from that point on. You know, we've, unfortunately, we've seen many, many patients and this is especially the case. You really need to, I think be especially, um, conscientious, I guess. And, and judicious, I guess the best word I could come up with a thoughtful, if back surgery is in question, uh, back surgery in general.

Speaker 1: (05:22)
Most of the back surgeries out there have notoriously poor, um, outcomes. Um, you look at so many of the studies, I mean that's precisely why there is such a, an actual diagnosis called failed back syndrome. Um, it's basically saying you've tried multiple back surgeries and it's just to a point where it's irreparable. Um, and we've seen patients like this. In fact, one patient comes to mind, uh, the poor guy, he's, he's just living his life, uh, on a cocktail of pain meds the rest of his life. My father, my father was your father. Yeah, he had multiple low back surgery. And, and what's interesting is initially the symptoms would abate, whether that be numbness or other things that the symptoms would improve for a short time. But generally within a year or two years at most, usually all of those symptoms started coming back. And to every bit is severe degree and you know, and it's like there was less and less you could do to help bomb it's short term gain if you want to call it that very, very long term permanent loss.

Speaker 1: (06:21)
You know, and the interesting thing for me personally, you know, talking about your dad, um, you know, I come from a very unique perspective in that my father was a registered nurse, um, incredibly, uh, skilled and extremely competent, knowledgeable, I mean, brilliant. Um, and so from that side of the lens of that medical model, I grew up, you know, with a father in that, in that role. But then also my mother and my aunt, um, and actually my, both of my brothers, uh, my mother and my aunt are heart transplant recipients and they're alive today as a result of sure, incredibly skilled physicians. I'm super grateful for that. That type of surgery, you know, has, has given me more time with my mother, which is incredible. My, both my brothers, uh, as a result of, um, uh, a, a genetic condition, hypertrophic cardiomyopathy. Um, both of them have had a interventions as a result of that.

Speaker 1: (07:20)
And so, um, again, this just saying we don't want to make some sort of a blanket statement. All surgery is bad. I think the punchline we're trying to get out of it, I think that the truth we're trying to highlight here is that it's not always the most appropriate course of action. And so if it's not always the appropriate course of action, then how do we, how do we go about, what would you recommend to patients who are contemplating this? You know, what, what would be the, what would be the appropriate course of action? We kind of have to take a little bit of a step back because we've kind of been conditioned to, um, many of us when you've had pain that's been there for long periods of time and you're like, oh, I've, I went to PT four times and it didn't do anything and I have been adjusted a couple of times or a handful of times or maybe even a bunch of times and it didn't make it all go away.

Speaker 1: (08:04)
And so we think that there is that, that's the last thing we can do. Right. That's it. Um, the reality is, and a lot of these times it's, we have to take a little bit more, um, I guess put a little more energy into it is what I'm trying to say. Take personal responsibility and ownership. That is it. We literally have to dive in and understand like, look at this is on me because guess what, the doc who does your surgery and if it, if it works, wonderful. If it fails, that doesn't hurt him at all. All right. He doesn't have to live with that the rest of his life. So I would say the biggest thing with even this question in, in the beginning here of do you need a knee surgery, do actually need knee surgery is it's think about like where you're at.

Speaker 1: (08:49)
Take that, that introspective look and just say, what do I need to do to make myself healthier? Yeah. The best thing all of us can do as far as getting healthy and, and, and taking care of ourselves is put the energy in, you know, put the energy into yourself, put the time in, try, you know, like I would try, I would say to, um, really important kind of critical questions you can ask yourself is, number one, have I truly exhausted all conservative options? Have I done that? Okay. And, and if you really truly can say, Yep, I've, I've exhausted. And I would say in most instances people haven't done that. They haven't exhausted all conservative options. And then number two, the other question is, is it really urgent? You know, cause in some instances, like for instance, let's say a patient has a disc herniation and it's getting to the point where it's starting to create deficits, you know, in terms of their, uh, function.

Speaker 1: (09:47)
Um, that's not something you want to fool around with. You know? And so we, there have been several cases I know you've had and I've had where we've seen patients where it's like, Yep, unfortunately you're at a point where we can't fool around with this. You definitely need to get in and consult with an orthopedic specialist. Um, and so, so, but, but there are also on the flip side times when, uh, you know, when you've experienced this as well, where there have been, unfortunately some doctors who have blatantly, I don't want to say blatantly, maybe intentionally or unintentionally, they have not been straightforward with patients. Uh, using fear as a means of getting patients to make decisions. Uh, hastily, we'll say, you know, so I would take those two questions. Number one, have you exhausted all your options, conservative options? And then number two, is it urgent?

Speaker 1: (10:35)
Do you need to, do you need, do you really need to make that decision as quick as the doctors perhaps recommending, you know, and, and, and, and I think, um, in most instances you're going to find that you have ample time to really consider that, you know, and, and we're not talking that you need to sit and wait on it. Months and months and years, but enough time to at least do a little bit of a investigation for yourself. Get a second, third or fourth opinion if necessary and a, and really think about it. You know, I think most people don't, don't really look at the longterm perspective of what could this do. Yeah. Short term. It might make me make the pain go away. Right. Um, longterm. What does this mean? Yeah. All right. You know, cause especially when it comes to joint replacements, two fusions to things like that.

Speaker 1: (11:21)
Yeah. Those always have other things that you have to deal with down the road. Longterm ramifications were really bad as human beings, just in general at forecasting into the future. You know, we always think, you know, there have been numerous studies that have been done, psychological studies. I, I quote this, uh, when I ever I do, we do a variety of trainings for other healthcare professionals. And one of the, the pages that I quote from a book, it's a great book called the willpower instinct by Kelly mcgonigal and she quotes this study. Uh, you can read it on page 95, but that's how, that's how many times I've read this to people. Um, in terms of a study that was done to see how people perceive their futures. And the, the, the punchline of it is that everybody perceives that their future is going to be amazing.

Speaker 1: (12:10)
Like we're going to have more time in the future. We're going to be more motivated, we're going to have more energy, we're going to have more resources. Things will always be better in the future when in reality, what we have to understand is that your future, not that we, not that we can't improve our future. I'm not trying to paint this know, gleam, bleak picture, but we have to understand that our future is going to have the same constraints as the presence. We're going to still be bound by the same 24 hours that we all get a lot of to us each and every day. You're going to be still, uh, have the constraints of, of the, you have a certain finite level of energy and attention and motivation. Um, you know, so, so there will definitely be the same constraints in the future that are here and the presence.

Speaker 1: (12:51)
So we sometimes we'll remove those and paint this beautiful, overly optimistic, blissful, perfect future when that's just not the case. And so when, when contemplating something like surgery, uh, we really got to think about the future implications, like you said, you know, are there going to be longterm lasting ramifications as a result of that decision? And, and an almost always there will, you know, and so sometimes it's just a matter of really truly getting a clear picture of cost versus benefits. So anything else you want to add? Uh, not so much. I'm really just be smart about this is your body. Yeah. Again, anyone else treating you and trying to help you. Um, especially when it comes to more invasive things, it's like, look, they don't have to live with the body. You do. Yup. Absolutely. It's so, so take it seriously. You know, the, the, you are what you eat and the, and you know, it's like you're going to pay a lot less now than you will in the future, you know, as far as what you put into yourself, whether it be for fitness, whether it be for what you're eating and, and all these different, even what you put into your mind, the things you're reading.

Speaker 1: (13:54)
Absolutely. All of these things make a big difference on who we are and what we will be in the future. And hopefully with those optimistic projections of our future are things that we can, that we actually make happen because that's, we all want to feel like we are getting better as we get older and smarter and um, just make sure we don't make those hasty decisions because we're inpatient now when more often than not, if we give our body time and do the right things like we talk about with our five fundam fundamentals of health, if we do the right thing in the right order for the right amount of time, there are very few things that we can't fix. Yeah. Very naturally a great things will happen when you follow that. So. Absolutely. Absolutely. So hopefully this has been valuable. Hopefully this has given you some food for thought and uh, maybe given you, um, open the door to some options that you may not necessarily have felt were available to you. So, uh, thanks for listening and uh, we'll talk to you guys the next episode.

Speaker 2: (14:53)
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