Please be aware that instead does not work for everyone in every location. I am in one of those places where I took beginning sign as an evening course from the local community two different times and made NO contacts to actually use it! I have forgotten 99% because of disuse. It has also been years since I saw anyone use it in public (such as in a store). Also, some of us have other reasons to live where sign is not in general use.my advice to not take surgery, learn American Sign Language instead.