“Doctor, how soon will I be able to have sex after my spine surgery?” was the first question an elderly Parsi gentleman asked me after I advised an operation for the pain in his lower back that had been radiating down both legs over several months. All of 6 feet, he sat in the chair in front of me hunching awkwardly off to one side, a posture that gave him some relief, as I gave him all the ‘gyaan’ I could on the risks and benefits of surgery, something doctors routinely do to obtain informed consent from the patient. People usually ask me questions like how long before they can get back to work, are they any postures they should avoid, what are the chances of this happening again, or was there a possibility that this could lead to paralysis. I guess, in our community, the priorities are slightly different, or rather just plain and simple.
I am a neurosurgeon, a doctor who operates on the brain and spine but owing to the sheer volume of neck and back pain in society today, both literally and metaphorically, most surgeons in this specialty tend to see more of that. Thankfully, I’m blessed that I do an equal amount of both. Often, people are confused as to whom they should consult for spinal issues: an orthopaedic surgeon or a neurosurgeon? To which my answer is obviously the latter. There is always this friendly banter that goes on amongst us, but the honest truth is that one should turn to someone who operates on and treats conditions of the spine daily; there are some extremely talented and skilled orthopaedic spine surgeons – I just won’t name them.
Most spine ailments originate from poor posture, lack of exercise, paucity of sunlight, unhealthy diets, and probably a genetic disposition to degeneration. “To feel ‘fit as a fiddle’, you must tone down your middle!” my grandfather used to say. Many people suffer from poor heath not because of what they eat but what is eating them. But the good news is that more often than not, you can rid yourself of neck and back pain without surgery: a combination of some pain relief and nerve soothing medication along with guided physiotherapy can work wonders. Surgery should be considered when these options fail, and when even surgery doesn’t work, which is less often the case, we can always blame the next level of spinal degeneration taking place above or below in the spine. Thankfully, for the 33 vertebrae in our spine, there 33 spinal surgeons in 5 hospitals around me. So, my mantra is, when it comes to spine surgery, like everything else in life, less is more.
I treat a large number of patients from other countries. The most confusing patients I get are Arabs with back pain who come to me from the Middle East. Those who don’t need surgery want it, and those who really need surgery flatly refuse it. What makes it more perplexing is that they often belong to the same large family: they could be two wives of the same husband or two brothers from another mother. And if both ever decide to get admitted at the same time, one needs to check a thousand times as they have four names in common, and you don’t want to end up operating on the wrong one. Actually, to think about it, that wouldn’t be a bad idea because that’s probably the one who needed surgery in the first place.
Patients from Africa, on the other hand, are delightful to take care of. They are warm, trusting, and forever filled with gratitude. They accept, after a little bit of explanation, what you propose to do for them, and I think they have the best post-surgical outcomes as well. I don’t expect any patient to blindly trust their doctor but having reasonable faith in him/her is what I personally believe impacts recovery positively. If you accept and believe that your doctor is likely to treat you like he would his own family, something that has been my guiding philosophy, there is no reason to suppose that you are being misguided. The rest is in the hands of khodaiji.
The thing about treating conditions affecting the spine is that there are so many options and so many fears among patients. Five surgeons will give five different opinions based on their understanding, skill, and experience. However, gone are the days when spine surgery meant being bedridden for life or a few months, or even having to be in bed for longer than a few hours a day, as a matter of fact. Today we have mastered minimally invasive techniques that cause less adjacent tissue damage, negligible blood loss, and faster recovery with almost complete relief from their symptoms. Patients can go home the same day or the next depending on their overall condition. Now these, truly, are medical achievements to be proud of.
In young patients, the aim of surgery is to get them to do everything they want to in the long lives they have left. In the elderly, on the other hand, it’s not about having them run a marathon or climb Everest, but to get them to the point they were before the pain became crippling. I recently attended a wedding of the brother of a close friend. Colaba agiari was packed to the hilt and festively lit up, with the DJ belting out one latest Bollywood hit after another in full throttle while Generation Next in sexy ensembles grooved like their spines were made of rubber. The fervour of youth was profound. The same evening, I also made it to the 50th wedding anniversary of my close friends of my mom in the ballroom of a 5-star hotel. The crowd, some with lumbar braces and walking sticks, some with shoulder splints and kneecaps, was waltzing gingerly to a live band of two and crooning to retro music, enjoying themselves just as much as the younger ones I had seen earlier, or, who knows, perhaps even more. Spine surgery is like that: you need to know the least you need to do to make your patient happier: the goalposts vary with age, religion, socioeconomic status, and sex – both the gender as well as how often you’d like to indulge in it.
This Navroze, may your back be as good as your front.
Dr. Mazda K. Turel is a minimally invasive brain and spine surgeon. He is a consultant at Wockhardt Hospital, Mumbai Central, and also an Honorary at Sir J.J. Hospital. He can be reached on mazdaturel@gmail.com or +91 993.017.4567. To know more about him, visit www.mazdaturel.com.
