ST: Cowboys All-Pro left tackle Tyron Smith lands on injury report

[DallasDW00ds0n]

It’s invasive, and therefore brings extra risk to the injury, including scarring, hemorrhage, nerve damage, infection, and even death.

Right, so with surgery is more risk even with results? Scarring, hemorrhage, nerve damage, and infection are all effects that could happen. Going back to my point, this is why doctors would not suggest surgery first. There is potential Smiths back may never be the same if he does.

 

[Doc50]

Right, so with surgery is more risk even with results? Scarring, hemorrhage, nerve damage, and infection are all effects that could happen. Going back to my point, this is why doctors would not suggest surgery first. There is potential Smiths back may never be the same if he does.

Again, every procedure we do has risk. Before deciding to take the additional risk, all other modalities should be tried first, and the patient of course must have an anatomical issue which is proven to reparable. The benefits need to far outweigh the risks, and as I pointed out earlier regarding a 90% success rate of microdiscectomy in athletes, that small risk is likely deemed by patient and surgeon to be worth taking.

We do not ever go into elective surgery with a poor risk vs benefit ratio. If there's very little chance of fixing the problem, and a significant chance of causing harm, no reputable surgeon would take such a an elective case.

So, a premise that surgeons routinely elect to perform back surgery on cases that are likely to have bad outcomes is false.
Having permanent post-surgical deficits greater than pre-surgical will eventually put the surgeon out of work.

 

[diefree666]

They miss Leary too. Free wasn't the bum he was made out to be either.

by the end of last season Free was a bum. Third most QB pressures and sack of ALL TACKLES in the NFL. He was done.

 

[DallasDW00ds0n]

Again, every procedure we do has risk. Before deciding to take the additional risk, all other modalities should be tried first, and the patient of course must have an anatomical issue which is proven to reparable. The benefits need to far outweigh the risks, and as I pointed out earlier regarding a 90% success rate of microdiscectomy in athletes, that small risk is likely deemed by patient and surgeon to be worth taking.

We do not ever go into elective surgery with a poor risk vs benefit ratio. If there's very little chance of fixing the problem, and a significant chance of causing harm, no reputable surgeon would take such a an elective case.

So, a premise that surgeons routinely elect to perform back surgery on cases that are likely to have bad outcomes is false.
Having permanent post-surgical deficits greater than pre-surgical will eventually put the surgeon out of work.

Obviously I would never assume coming out of surgery the results would be worse than the injury itself. But you can not guarantee 100% back to normal with surgery; if we're at surgery with Smith, it's likely he'll never be at the level he was preinjury.

 

[TheHerd]

Again, every procedure we do has risk. Before deciding to take the additional risk, all other modalities should be tried first, and the patient of course must have an anatomical issue which is proven to reparable. The benefits need to far outweigh the risks, and as I pointed out earlier regarding a 90% success rate of microdiscectomy in athletes, that small risk is likely deemed by patient and surgeon to be worth taking.

We do not ever go into elective surgery with a poor risk vs benefit ratio. If there's very little chance of fixing the problem, and a significant chance of causing harm, no reputable surgeon would take such a an elective case.

So, a premise that surgeons routinely elect to perform back surgery on cases that are likely to have bad outcomes is false.
Having permanent post-surgical deficits greater than pre-surgical will eventually put the surgeon out of work.

I'm not being a jerk, but really interested in if you deal with elite level athletes.

The surgeon who rebuilt my shoulder a few years back after a nasty cycling accident is on the Patriots surgical team and we have had some interesting conversations about the different approaches between dealing with professional athletes and people like me. I compete in triathlon at a fairly competitive level for old guys, but certainly not on the professional stage. There is certainly a different level of risk acceptable at different levels, and of course the recuperative capabilities of young world class athletes is on another level.

 

[perrykemp]

by the end of last season Free was a bum. Third most QB pressures and sack of ALL TACKLES in the NFL. He was done.

He still was above average in the run game.

 

[Doc50]

I'm not being a jerk, but really interested in if you deal with elite level athletes.

The surgeon who rebuilt my shoulder a few years back after a nasty cycling accident is on the Patriots surgical team and we have had some interesting conversations about the different approaches between dealing with professional athletes and people like me. I compete in triathlon at a fairly competitive level for old guys, but certainly not on the professional stage. There is certainly a different level of risk acceptable at different levels, and of course the recuperative capabilities of young world class athletes is on another level.

I'm simply quoting statistics of outcomes in athletes; individual cases are simply anecdotal evidence that may not represent the norm.

It's true that any injury which is debilitating may be better off with a partial fix than left alone; expected outcomes are thoroughly discussed before surgery and it can be obviously prudent to accept a less than perfect repair rather than live with a current debility. Athletes (especially young ones) are generally more likely to have excellent outcomes regarding return to normal function. However, they will require function at an elite level which may be difficult to achieve depending on the location and nature of the injury.

I posted extensively on this a while back, in discussion of microfracture surgery for osteochondritis dissecans of the knee.

 

[Doc50]

Obviously I would never assume coming out of surgery the results would be worse than the injury itself. But you can not guarantee 100% back to normal with surgery; if we're at surgery with Smith, it's likely he'll never be at the level he was preinjury.

Well, the problem is neither you nor I know the exact nature of his dysfunction.
There may not be a surgical solution to his back pain, or there may be a minor nerve root impingement that can be resolved through arthroscopy, and he may have complete resolution.

Not enough info at this point, certainly not enough to say that any procedure will leave him at less than 100% for his career.

 

[TheHerd]

I'm simply quoting statistics of outcomes in athletes; individual cases are simply anecdotal evidence that may not represent the norm.

It's true that any injury which is debilitating may be better off with a partial fix than left alone; expected outcomes are thoroughly discussed before surgery and it can be obviously prudent to accept a less than perfect repair rather than live with a current debility. Athletes (especially young ones) are generally more likely to have excellent outcomes regarding return to normal function. However, they will require function at an elite level which may be difficult to achieve depending on the location and nature of the injury.

I posted extensively on this a while back, in discussion of microfracture surgery for osteochondritis dissecans of the knee.

I was really just interested if you had worked with these types of guys. It's a fascinating sub-culture to me. It's sometime hard for us lay people to remember these are just people in the end, and damn young people at that. Thanks for sharing your professional expertise.

 

[Doc50]

I was really just interested if you had worked with these types of guys. It's a fascinating sub-culture to me. It's sometime hard for us lay people to remember these are just people in the end, and damn young people at that. Thanks for sharing your professional expertise.

I don't do any surgery -- I see some in follow up and long-term management. Unfortunately, my contribution may include chronic pain management.

 

[LocimusPrime]

This line was better with Leary and free. I guess they had better teamwork

 

[Melonfeud]

It's very rare that a person returns to their former self after disk surgery. This is very concerning for sure. Tyron could still be a beast even not as his former self, but probably not the best in the league.

But I ask the question again, is back tightness a symptom of the bulging disk, or is this something else which can be worked around with PT/yoga/acupuncture/whatever?

It would stand to reason the term 'bulging disc' with Tyron would have been revealed with an MRI.
The only cure (I'm aware of) for a bulging disc is 1) stop doing what aggravates it to alleviate pain to a lesser degree
And 2) invasive surgery, shimming the lumbar vertebrae thusly realignment of the spinal casing-liner that's causing pressure on the spinal cord,,,you'd think they'd have some type of injectable compound that could be placed in there with a short recovery turnaround timeline, but with our FDA good luck with that, I know our spec-ops guys are fielding freeze dried blood plasma that takes 6 minutes to reconstitute, perfected and procured from France who have no FDA like ours

 

[Melonfeud]

by the end of last season Free was a bum. Third most QB pressures and sack of ALL TACKLES in the NFL. He was done.

I believe I've read that 'statistic' posted here on the Zone, 666.

 

[CCBoy]

Again, every procedure we do has risk. Before deciding to take the additional risk, all other modalities should be tried first, and the patient of course must have an anatomical issue which is proven to reparable. The benefits need to far outweigh the risks, and as I pointed out earlier regarding a 90% success rate of microdiscectomy in athletes, that small risk is likely deemed by patient and surgeon to be worth taking.

We do not ever go into elective surgery with a poor risk vs benefit ratio. If there's very little chance of fixing the problem, and a significant chance of causing harm, no reputable surgeon would take such a an elective case.

So, a premise that surgeons routinely elect to perform back surgery on cases that are likely to have bad outcomes is false.
Having permanent post-surgical deficits greater than pre-surgical will eventually put the surgeon out of work.

If a patient wants multiple plastic surgeries, for eye appeal...would you require a psychologist to voice an opinion first?

 

[Doc50]

If a patient wants multiple plastic surgeries, for eye appeal...would you require a psychologist to voice an opinion first?

Good question.

Most people that are obsessed with their vanity have a dysmorphic disorder as well as OCD.

But cutters wanna cut, so a patient like that can always find someone who will do these cash-only vanity procedures, of course after the obligatory hold-harmless paperwork is signed.
Many such cases have terrible outcomes, so the patients just keep getting more surgery.

While legitimate plastic surgery for things such as trauma or congenital defects has merit, cosmetic surgery is not main stream medicine, and such a psycologic profile as you suggested should disqualify a patient from these procedures which simply play into their dysfunction.

For a little insight, watch episodes of “Botched”.
It’s 2 excellent plastic surgeons tackling cases with previous bad outcomes; some patients they see will simply never be happy, and they refuse to do those cases.

BTW, reduction mammoplasty for pathological enlargement is legitimate. There’s significant back pain and postural difficulties associated with this anomaly.
Bigger is not always better.
(Careful, Zoners — this a family site which includes ladies).

 

[CCBoy]

Good question.

Most people that are obsessed with their vanity have a dysmorphic disorder as well as OCD.

But cutters wanna cut, so a patient like that can always find someone who will do these cash-only vanity procedures, of course after the obligatory hold-harmless paperwork is signed.
Many such cases have terrible outcomes, so the patients just keep getting more surgery.

While legitimate plastic surgery for things such as trauma or congenital defects has merit, cosmetic surgery is not main stream medicine, and such a psycologic profile as you suggested should disqualify a patient from these procedures which simply play into their dysfunction.

For a little insight, watch episodes of “Botched”.
It’s 2 excellent plastic surgeons tackling cases with previous bad outcomes; some patients they see will simply never be happy, and they refuse to do those cases.

BTW, reduction mammoplasty for pathological enlargement is legitimate. There’s significant back pain and postural difficulties associated with this anomaly.
Bigger is not always better.
(Careful, Zoners — this a family site which includes ladies).

Thanks for the share, Doc. As always...

 

[TheHerd]

Good question.

Most people that are obsessed with their vanity have a dysmorphic disorder as well as OCD.

But cutters wanna cut, so a patient like that can always find someone who will do these cash-only vanity procedures, of course after the obligatory hold-harmless paperwork is signed.
Many such cases have terrible outcomes, so the patients just keep getting more surgery.

While legitimate plastic surgery for things such as trauma or congenital defects has merit, cosmetic surgery is not main stream medicine, and such a psycologic profile as you suggested should disqualify a patient from these procedures which simply play into their dysfunction.

For a little insight, watch episodes of “Botched”.
It’s 2 excellent plastic surgeons tackling cases with previous bad outcomes; some patients they see will simply never be happy, and they refuse to do those cases.

BTW, reduction mammoplasty for pathological enlargement is legitimate. There’s significant back pain and postural difficulties associated with this anomaly.
Bigger is not always better.
(Careful, Zoners — this a family site which includes ladies).

I see some Star Bellied Sneetches lessons in there.