Surgery

Are there any good surgical options to treat emphysema?

DEAR DOCTOR K: My mother has severe emphysema. Medication and oxygen therapy aren't helping much anymore. Are there any good surgical options?

DEAR READER: Emphysema is a long-term lung problem that makes it harder and harder to breathe as the disease progresses. It is often grouped together with chronic bronchitis under the label of chronic obstructive pulmonary disease (COPD).

Are cochlear implants a type of hearing aid?

DEAR DOCTOR K: I'm hard of hearing and want to learn more about cochlear implants. Are they a type of hearing aid?

DEAR READER: A cochlear implant involves several small electronic devices that are surgically implanted in the ear. It can provide sound to people who are severely hard of hearing or deaf. It is not a type of hearing aid. In fact, to be eligible for a cochlear implant, a person must have hearing loss in both ears that is so extreme that even the best hearing aid has little or no effect.

Should I have arthroscopic knee surgery?

DEAR DOCTOR K: I'm a lifelong runner with severe knee pain. I hate the thought of surgery, but hear it's not such a big deal these days, using arthroscopy. How do I know if I'm a good candidate for it?

DEAR READER: Arthroscopy is a technique used to diagnose problems in the knees and other joints. If a problem requiring surgery is identified, arthroscopic surgery can be performed. To appreciate how valuable arthroscopic surgery is, you have to understand what things were like back in the "old days" -- like when I was in medical school.

My toddler gets frequent ear infections. Should we consider surgery?

DEAR DOCTOR K: My toddler gets frequent ear infections. His doctor wants me to consider surgery, but that seems much too aggressive to me. Am I wrong?

DEAR READER: I'm not sure what kind of surgery your pediatrician is recommending, but I'll bet it involves putting in ear tubes. I'll explain that below. Ear infections are very common and can make children miserable. Most go away and don't cause problems, even without treatment. But a few can lead to complications, including more serious infections of the bone near the ear or even the brain.

What happens during a C-section?

DEAR DOCTOR K: My doctor says she is going to have to deliver my baby by C-section. What will happen during this procedure?

DEAR READER: A cesarean delivery, or C-section, is surgery to deliver a baby through the abdomen. It may be scheduled in advance when a woman cannot or should not deliver the baby through the vagina. A C-section may also be performed if continuing with labor or delivery becomes risky to the mother or baby. Finally, a cesarean may be done as an emergency procedure if there is immediate risk to a mother or baby.

Should I be worried about complications from a hip replacement?

DEAR DOCTOR K: My doctor says I need hip replacement surgery. She says it will help my pain. But I'm worried about complications. Should I be?

DEAR READER: I get a lot of questions about hip replacement surgery, and I'm in a good position to answer them: I had a hip replacement about a decade ago. Before I give a more detailed answer, let me cut to the chase: The benefits of hip replacement surgery greatly outweigh the risks.

Non-surgical treatments for fecal incontinence

DEAR READER: In yesterday's column I discussed non-surgical treatments for fecal incontinence. Today, I'll discuss surgical treatment options. When everything works properly, feces move from the colon into the rectum, which sits at the end of the digestive tract. The rectum has walls that stretch to hold the stool. Two circular muscles are present in the last inch of the rectum, or anal canal.

Do I have any say in the type of anesthesia the doctor uses for a minor surgical procedure?

DEAR DOCTOR K: I have a minor surgical procedure coming up. Will I have any say in the type of anesthesia the doctor uses?

DEAR READER: For some surgical procedures, more than one type of anesthesia may be appropriate. The doctor who will administer the anesthesia (the anesthesiologist) will talk to you about the options. I spoke to Dr. Kristin Schreiber, an anesthesiologist at Harvard-affiliated Brigham and Women's Hospital. She explained that anesthesia has four goals. The first is to make sure you have no pain; the second is to make you drowsy or unconscious. The third is to keep your body still during the procedure -- you don't want your surgeon to have to deal with a moving target. And finally, the fourth is to prevent bad memories of the procedure.

Can you have a bypass surgery and angioplasty at the same time?

DEAR DOCTOR K: My friend said he had bypass surgery and angioplasty at the same time. Isn't it usually one or the other?

DEAR READER: It is usually one or the other, but your friend may have been treated at one of a few select medical centers in the United States currently offering a new hybrid approach. If so, he may have had both bypass surgery and angioplasty during the same surgery. To answer your question, I need to explain both the traditional approach and then the new hybrid approach. The hybrid approach cannot be used in all patients. However, when it is used, the goal is to make the surgery less grueling, and the beneficial results of surgery more long-lasting.

Why do doctors remove the appendix when someone has appendicitis?

DEAR DOCTOR K: Why do doctors remove the appendix when someone has appendicitis? Don't we need this organ?

DEAR READER: Appendicitis is an inflammation of the appendix. This small, fingerlike tube hangs from the lower right side of the large intestine. It usually becomes inflamed because of an infection or blockage. The condition is quite common; it affects one in every 500 people in the United States each year. (I've put an illustration of an inflamed appendix below.)