THR AVN: Surgeon refuses THR unless all alcohol and tobacco use is ended

[ldk]

I have advanced Avascular Necrosis in both the left and right hips (much worse on the right). On the right, it feels like it can collapse any month.

My surgeon "fired" me this week, refusing to perform surgery, because he requires cessation of all alcohol and tobacco forever.

I only smoked cigars occasionally, and I can easily give them up, but I drink craft beer every day, and asking me to stop all alcohol is asking too much. I am heavily involved in the craft beer culture, being an Untappd moderator, brewery VIP/founder, etc. I've visited over 300 breweries.

(I understand not to drink alcohol right before or after surgery -- I would wait a month after surgery before drinking beer -- but this orthopedic surgeon requires complete alcohol abstinence FOREVER.)

I cannot switch surgeons easily, because all orthopedic surgeons within 40 miles are all affiliated with this one clinic, and the ban on smokers and drinkers is clinic-wide, and surgeons do not contradict each other, so if one surgeon refuses surgery because of alcohol, all other surgeons will read it in the notes and enforce it.

I am starting to look for orthopedic surgeons outside of my local area, such as 70-100 miles away.

Have you heard of surgeons refusing THR if the patient drinks or smokes at all?

It sounds like punishing the patient. "You did the necrosis to yourself and deserved it. Now you must repent and avoid all alcohol and tobacco, or you will be left to live with the consequences of your sins."

How likely am I to run into this when I go to another orthopedic surgeon?

Should I ask the orthopedic surgeon upfront whether they refuse THR on drinkers?

Should I lie about drinking, saying that I don't drink?

Is the AVN visible on a MRI direct evidence of alcohol-related damage, and is it likely to raise suspicions of alcohol use?

I'm not alcoholic. I rarely drink anything except craft beer, and it's 0-3 bottles/cans/glasses per day. I am also not obese (6 feet tall, 175 pounds).

 

[jakemedic]

Hello! Sorry you are going through this. Heck, I used to smoke with my primary care physician before my appointment and then he would come into the room and tell me I shouldn’t smoke. I quit smoking over 10 yrs ago now. Well, he died a few years ago. He was an army trained physician. The smartest, most down to earth doc I ever met.

I had AVN bilaterally in both hips. They didn’t say anything about drinking, but they did frown upon smoking. Mine was secondary to prednisone use for breathing issues, although smoking and alcohol use can also be a root cause. My advice, avoid cigars, quit drinking till after your surgery. Not drinking forever? Heck I haven’t seen the surgeon who installed my hips in nearly 16 years. My neuro surgeon who fused my L4 and L5 said nothing about it last summer. My ortho who installed my new knee 5 weeks ago didn’t say anything about it either. AVN is horrible, I wouldn’t wish it on my worst enemy. Do what you need to do to get through it and enjoy life again!

 

[mendogal]

Hi there.

Alcohol consumption over time in moderate doses is indeed one of the main non-traumatic causes of avascular necrosis, the other being (as @jakemedic notes) steroid use. It's not a correlation; the physiology is well established.

However in over 40+ years as a RN I haven't heard of a lifetime teetotaling expectation except in the case of liver transplants.

I am wondering what would happen if in a year the surgeon saw you drinking.... Would he remove the implants? It seems an interesting culture has taken root in your local medical center. We simply aren't supposed to be that judging.

I absolutely wouldn't condone lying to prospective surgeons. I also strongly urge you to consider that however central brewing and craft beer is to your life your situation is not unlike that of a diabetic who devotes their life to the making of French pastry and knowingly consumes a couple of mille-feuilles nightly.

I hope you are able to get the surgery you need. Regardless of what pans out, we will be here to support you.

 

[Kentpete]

@ldk I have avn and was told if I still smoked at the pre assessment he would cancel the THR there was no mention of alcohol though, I'm in UK

 

[Eman85]

Find an OS that drinks

 

[ldk]

Find an OS that drinks

Funny result: Search Untappd for Alaska Fracture Orthopedic Clinic.

(Might just be a glitch in the FourSquare Untappd venue map system, and inebriated check-ins choosing Alaska Fracture Orthopedic Clinic as the venue because it is the first match as they are typing -- the glass is Kassick's.)

 

[Jamie]

Smoking is a different story with surgeon recommendations. Most do not condone it and some won’t accept patients who smoke. This is for many more reasons than any possible correlation with the development of AVN. But I have never come across a surgeon who demanded patients completely stop drinking at moderate levels forever (0-3 beers a day would fall in that category). Perhaps the doctors believe that people who indicate they just drink a few drinks or beers a day are not telling the truth about their alcohol consumption.

If for no other reason than your peace of mind, I do hope you can get some additional opinions on your particular situation.

 

[ldk]

I'll go for three months without a sip of alcohol, but I am not willing to give up beer for life.

That's like asking a sommelier to stop drinking wine forever. I'm the cicerone equivalent.

 

[JennJon]

Just how does the surgeon go about “knowing” if you are drinking or not once the surgery is a success?….sorry, tell him what he needs to hear‍

 

[ldk]

I guess I have to lie to my next surgeon. Seems no other way. The medical-industrial complex is corrupt indeed.

 

[Freyagirl]

Before you change surgeons ask about why there is the restriction. If drinking will negatively affect the surgical outcome you probably want to know that. If the whole practice is against alcohol for all surgeries you clearly need to find another surgeon, but if the alcohol consumption means it is pointless to do the surgery you will have a big decision to make.

 

[ldk]

The surgeon has already cut off communication, and does not want to see me.

I have already made an appointment with another one.

I suspect it's a zero-tolerance rule against drinkers and smokers at this clinic.

I'll wait for months for the surgery to heal before drinking again. I won't bring it up with the new surgeon unless he asks. I don't smoke anymore.

 

[mendogal]

Best of luck with a different medical practice. Please let us know how it goes!

 

[ldk]

I drove 95 miles to another clinic, and the orthopedic surgeon looked at my MRI results, took X-rays, and immediately scheduled THR surgery for next month.

No questions or comments about alcohol or tobacco, other than the questionnaire questions you check off on a new patient form. To this surgeon, AVN "sometimes just happens", and there was no moralizing. He was much more concerned about my comfort than the bad orthopedic surgeon, who is maybe a surgeon first and a clinician second.

I have no idea why the only orthopedic clinic within 40 miles of me are teetotalers.

The bad clinic also requires my primary doctor to do a pre-op examination and "authorize" surgery, while this good clinic did not ask me to get surgery authorization from another doctor -- they just asked questions about medical history, surgical history, current medications, drug allergies, etc. and scheduled a surgery date on my first visit.

The orthopedic surgeon at the good clinic is also in his 60's and performs surgeries every day, while the orthopedic surgeon at the bad clinic is in his 30's (less experienced).

 

[djklaugh]

@ldk Bravo!!! I am delighted to hear you were able to find an experienced and compassionate surgeon! If you have a specific date for the surgery let us know and we will create a signature for you!

 

[mendogal]

Oh

 

[CricketHip]

Oh congratulations on getting a surgery date with another surgeon! What a relief and from the looks of your x-ray, this surgery is much needed.

We will add your surgery information to a signature for you after we get the date of the surgery.
Again, Congratulations!

 

[ldk]

Tentatively it's 04/17, but I don't want to commit to any date until it actually happens. I'll confirm it from my bed after it actually happens.

 

[ldk]

In case anyone is wondering: "How did he find out that you drink beer, and is he watching over you?"

It came up in a casual conversation. He asks something like "Do you drink alcohol?", which I guess was asked because of the association between alcohol and AVN. I answered honestly, something like "I drink beer". Then he immediately cuts off the discussion. "No more treatment unless you stop drinking beer. No compromises. You're finished. Unless you stop drinking all alcohol, I am done with you as a patient. End of discussion. You can request your records here."

An assistant of his called me, and said that because of the "code of honor" at this clinic, none of the other surgeons at this clinic would be willing to treat me either, because their "code of honor" prevents them from contradicting each other. If one of them refuses treatment because he finds out that you drink or smoke, then all of them will refuse treatment.

So I had to drive 95 miles to find a better clinic.

 

[Roy Gardiner]

There's something else going on there, I reckon. I think you're well rid of him.