THE QUESTION: My father-in-law needs cervical decompression surgery. He's been told it will be 12 to 18 months and that the only way he will get the operation sooner is if he degrades further, potentially to the point of paralysis. Cancer patients, he's been told, have priority. What options do patients have or are they at the mercy of the system?
THE ANSWER: Waiting for paralysis does not sound like a good plan, and you are right to question the long wait, especially when no firm surgery date has been set. Patients sometimes mistakenly believe a long wait represents a safe one when that is not the case. It may simply reflect a backlog. You want to be a patient of the health care system, not a victim of it.
I'm sure you are aware the operation is not trivial. A cervical decompression is performed to relieve some if not most of the patient's pain symptoms, which are often due to a herniated or protruding disc. The procedure involves removing what is causing that compression of the nerve in the first place, be it a portion of the disc or a bony spur.
According to Hamilton Hall, author of the Back Doctor books, there are "windows of opportunity" for some spine operations. Surgery is not a last resort. "You don't operate on somebody because you have run out of good ideas," said Dr. Hall, executive director of the Canadian Spine Society.
In fact, your father-in-law is one of the few who actually has a condition that can be corrected by an operation: The vast majority of patients referred to spine surgeons cannot have their problems - as painful and disabling as they may be - surgically fixed.
When a surgeon sees a patient who needs an operation, "you'd like to do that the next day," said Albert Yee, a spine surgeon at Sunnybrook Health Sciences Centre in Toronto. He has seen patients so disabled by back pain they need wheelchairs to get around. Others who can walk are in so much pain they are "crying to me as they walk through the door."
Of your father-in-law's wait, he said: "Eighteen months is a bit tough to fathom for anybody."
Dr. Yee has suggestions on how to whittle down that wait time or at least make sure you don't fall through the health care cracks. Mention to the surgeon 18 months is a long time to wait and that as much as you would prefer that doctor, ask if there another physician he or she trusts that has a shorter queue.
If your father-in-law chooses to stay with that surgeon, recognize that spinal conditions can fluctuate so ask the surgeon when he needs to be reassessed. Check with the office to make sure you have all the right tests done before hand, such as MRI and CT scans, which may need to be repeated following a long wait.
If you choose to stay with that surgeon, increase your odds. Put yourself on the cancellation list; tell the office workers that you live close to the hospital (if that is the case) and are ready to go at any time. Sometimes, Dr. Yee said, patients are called at 7 or 8 in the morning, asked to come in for surgery that day, so long as they haven't eaten. Call the office periodically, be polite and ask where you are on the surgery or cancellation list.
The health care system with its long waits may seem paralyzed at times - but you shouldn't be.
The Patient Navigator is a column that answers reader questions on how to navigate our health-care system. Send your questions to firstname.lastname@example.org .
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