Ira D. Fisch, MD

I take my patients from anywhere. I'm willing to help anyone seeking surgical help/advice whether they are from the Bethesda or DMV area or not.

As a rule, I work very hard with my patients to help them avoid surgery if possible. There are many techniques that can be used to effect a cure to a problem that is not surgical. Only when the patient has failed conservative therapy, do I recommend surgical intervention. There are, however, certain spinal conditions, which require immediate surgery, and then surgery is done emergently.

We treat patients from across the entire DMV area including DC Arlington and Bethesda Maryland.

We have all begun to use multiple medications that are not narcotics to help relieve postoperative pain. For example, a muscle relaxer, like Valium, can do wonders for pain relief and can help patients decrease their postoperative pain considerably by decreasing the degree of spasm that they are having. The lack of narcotics help prevent constipation, addiction, persistent pain, and the general feeling of malaise that goes along with narcotic use. This is proven to be very effective in diminishing the need for narcotics following surgery.

Recently, it has become very apparent across the United States that overuse of narcotics can lead to a very difficult situation for patients. We all, as physicians, understand the pain involved after surgery but then at the same time appreciate that overuse of narcotics can lead to not only addiction but also chronic pain situation. Therefore, whereas adequate pain medication is given to the immediate postop period, it is very important to wean off of the pain medications as quickly as possible.

Many spinal surgeries, particularly lumbar discectomies are presently performed on an outpatient basis. Lumbar fusions and cervical fusions can also be done on an outpatient basis but this needs to be considered on a patient-by-patient basis.

It is very important to discuss with your surgeon as well as well as your primary doctor what blood thinners you are taking prior to surgery. Continuing to take blood thinners prior to surgery can lead to catastrophic results in spinal surgery, and excessive blood loss in other forms of orthopedic surgery.

Spinal surgery is commonly done for arthritis. There is always the potential for ongoing discomfort after surgery, particularly if screws need to be placed in the spine. In addition, one must be conservative about how many levels in the spine to fuse, which can thereby leave some residual discomfort from the adjacent levels, which are not fused. You cannot fuse the entire spine; therefore, some degree of residual discomfort has to be expected, particularly after spinal fusion surgery.

Whereas some degree of rest is acceptable after surgery, simply getting up and walking is actually very beneficial for patients in the postoperative period. The patients who make a concerted effort to be mobile typically have less pain after surgery and rehabilitate more quickly. A long bed rest is actually deleterious to the short term and long term outcome of surgery. On the other hand, being too active is also something that must be avoided.

Without getting into specifics, which can only be discussed with the patient for each specific condition, there are certain neurologic complications, which can occur if surgery is withheld for too long a period of time. The surgeon must be kept apprised as to any new changes that are going on, particularly if there is any new neurologic dysfunction that was not there in the past.

While the risks of surgery has definitively diminished over the years, every patient is told that risks persist and they should not consider surgery unless they understand the risks involved. I would not propose surgery to anyone I feel has a high risk for recovery or for further deterioration of their condition. Overall, the benefits of surgery by far outweigh the risks involved in most cases, except when specifically noted.

I would not consider surgery on a patient whom I did not feel there was a very high degree of probability that there would be improvement with their quality of life. Each surgery has a different potential for outcome. By definition, my decision to go ahead with surgery is that I feel there is a significant chance for relief of symptoms if surgery is performed.