I’ve been stuck in a quandary for six months trying to figure out what is best — say yes to a complicated surgery or do nothing and hope that subsequent infections will not happen. Normally, it would be an easy decision: do the surgery and get it over with. But this is not just any surgery. My surgeon tells me there is a 30-50% chance that the surgery could fail, and I could possibly end up worse off than I am now — a scary dilemma. What do I do?
My surgeon thinks my age (78) and medical history (numerous skin breakdowns plus poor blood circulation) could complicate healing following a complicated urethro-scrotal operation, which would also include reconstructive flap surgery. Plus, there is one more potential complication: the location of the major incision — my perineum (center pelvic). Because both of my ischial tuberosities (sits bones) have been shaved down in previous operations, my perineum will bear most of my weight when I’m sitting.
The surgery itself, she says, is not the problem. I am the problem.
Why? My medical chart does classify me as a high-risk patient. That is how the surgeon arrived at her opinion. But is her view biased? Is her opinion negatively skewed by an overly complicated medical chart and her lack of knowledge about spinal cord injury and my everyday lifestyle? To her, I am a “paper patient,” as many of us are to our new doctors. Truth is, my surgeon just does not know me. She also knows next to nothing about the latest wheelchair cushions that can be custom designed and pressure-mapped, another important consideration.
So I challenged her. I asked if she had specific detailed imaging showing my blood flow in the area of my operation. No, she said, she was assuming that my history of coronary artery disease and peripheral artery disease meant that I would most likely have problems. Then why not, I asked, order some kind of imaging test that will show exactly what’s going on in that area — an angiogram or CT or something that shows the specific blood flow?