At what point does surgery become necessary?

I am confused and not sure how to ask this because I can not think of the words I want to explain, but without a syrinx what signifies when surgery is necessary? At my appointment with Dr Tew he said he does not want to do surgery just yet, but wants me to have a sleep study done, which I did (no results yet, but tech said I only slept maybe two hours), get with a nutritionist and work on a plant based diet as well as get with a personal trainer to help loose some weight. Neither of which, with no income, I can afford to do. I am not that far overweight, but could stand to loose a few more pounds(currently 154 and dropping) My CINE showed partial blockage with pistoning of the herniation with every heartbeat. My symptoms are many, including no gag reflex bilaterally, irregular heartbeat, hyperactive reflexes, but no pathologic reflexes.

I'm totally new to this so it's just my opinion... From what I hear, if your symptoms are getting worse, that's when you should get surgery. If you're feeling fine and the things you're doing are working to keep your life liveable... Then you should hold off on surgery. That's just what I'm reading from these boards, medical websites, etc.

Good luck!
Katrina W.