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After Surgery in Germany, I Wanted Vicodin, Not Herbal Tea

nytimes.com

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Re: After Surgery in Germany, I Wanted Vicodin, Not Herbal Tea

#191

Post by syshum »

Karnickel wrote: post #64
syshum wrote: post #8

I always get in a arguments with my EU acquaintances over pain management topics. The idea that is a "good" to suffer with pain instead of taking pain killers is abhorrent to me.

Not sure how you manage to come up with such a comment after reading this particular article. Clearly she did not have the pain she feared she would have. She said she took two Ibuprofen - that she did not need ! So why would you think she would have been better off taking drugs against pain that she didn't have? Real pain is treated here in Germany - of course! But taking pills for mere fear of pain that isn't even…

>>So why would you think she would have been better off taking drugs against pain that she didn't have?

Never said she should have or would have been better off. I am making the claim that choice should have been hers and hers alone after getting advice from professionals.

Doctors could have told her "You do not need them, here are the reasons why" that is fine. the legal prohibition is what I have a problem with

>Real pain is treated here in Germany

That is not my understanding and I have known a couple people that have come to the US for pain management because they were unable to get it in the EU, I dont know if they were in Germany or not however. My understanding is that many EU nations have very strict and subject definition as to what "real pain" is. This is evidenced by the personal stories being told here how people "went through X and did not need pain meds" that is fine for them, people have different tolerance levels for different types of pain, and a tooth extraction may be a minor pain for some people and excruciatingly painful for others, yet most of these nations treat pain based on the average response by type of procedure not in individualized reactions.

Re: After Surgery in Germany, I Wanted Vicodin, Not Herbal Tea

#193

Post by rahkiin »

woolvalley wrote: post #168
nosickdays wrote: post #97

Earlier quoted context omitted.

This is a rather salient point. In the Netherlands, if I needed (in consultation with my doctor, of course) to stay out of work for a year to recuperate from illness or injury, I can do that and continue to receive my full salary. The second year would be at 70% salary. My job would await my return - only after 2 years would I be separated from my employer and have access to other long-term disability benefits. In th…

Who is paying for that 1 years salary?

The company that employes the employee.

And companies have insurance for these kind of things.

Re: After Surgery in Germany, I Wanted Vicodin, Not Herbal Tea

#194

Post by sneak »

majormajor wrote: post #158

There's something deeply concerning to me about claiming overall universal insights in pain management based on laparoscopic surgery. Good for her that she was fine, but I've had the opposite experience with more serious stuff. Moaning in bed unable to sleep due to the pain being worse than anticipated is no fun, and that was in a hospital with the nurses aware but waiting on the proper overnight staff to have time t…

I had a partner once that had to fly back to the US from Germany in a rush after not sleeping for most of a week due to pain following a broken bone.

This article should have condemned overly rigid, dogmatic practices like this, yet it ends up endorsing them. It’s ridiculous.

Re: After Surgery in Germany, I Wanted Vicodin, Not Herbal Tea

#195

Post by rangibaby »

trhway wrote: post #175
dpflan wrote: post #67

This passage feels like it is premise of the article; the author eventually comes to terms with her tea-sipping and resting as recovery, and this doctor explains the reasoning behind the medical decision-making which is very clear (and mindful/thoughtful) I think. “To paraphrase him [German anesthesiologist], he said: ‘Pain is a part of life. We cannot eliminate it nor do we want to. The pain will guide you. You will…

A similar reasoning of a (military) Russian dentist refusing to apply even local anesthetic that a friend seen once - "I prefer to not lose contact with the patient"

I had a tooth taken out without any anesthetic before. It was bad but the pain was so severe I barely remembered it even later that day. It’s almost like I remember it happening to someone else, not me.

Re: After Surgery in Germany, I Wanted Vicodin, Not Herbal Tea

#196

Post by wirrbel »

Karnickel wrote: post #113
adventured wrote: post #56

Earlier quoted context omitted.

You mean, $30,000 to $40,000, the median cost in the US, nearly all of which would be covered by insurance. No sense in fabricating magical numbers, like a multi-million dollar bill, everyone knows the flaws in the US system as is. It costs about 1/3 to 1/2 as much in Germany, paid for by other tax payers.

It's not paid by taxes but by health insurance. We have both a private and a semi-public system (managed by "Krankenkassen", independent insurance entities, that compete for members; it's... complicated, but less so than in the US, and it does not depend on the employer). Some might say it's like a tax, it gets deducted from your paycheck, but then that's the same everywhere, including the US. Difference is that it's…

I don't know if I would understand the German "insurance" system from that explanation. Maybe to complement your explanation another try at it:

Germany has two insurance-like systems to pay for medical treatments:

(1) insurances, with fees aligned with damage risk associated with the policy holder. (2) a system of "funds" that provide insurance benefits for insurants, however, are not organized like an insurance.

The system (2) is quite old (dating back to the 19th century) and has a few peculiarities:

* fees vary by income of the member of the fund (principle of solidarity, basically people with well paying jobs subsidise others). * half of the fee for a member is payed by the employer, half by the employee, deducted from the paycheck. * family members can be insured, too, without increasing fees. * fees are not dependent on your risk, i.e. they do not increase with age, preexisting conditions, etc.

The alternative to this fund are insurances that work on a risk-based pricing scheme - item (1) in the list:

* in order to be able to sign up for them, you need to have a certain steady income above a threshold (above 50000 EUR I believe). * pricing is per insurant, i.e. extra insurance contributions for kids and family members if they are on the same plan, etc. * for young adults these plans are usually cheaper than for older people, which means you can get "trapped" in a contract that is more expensive than the public funds I wrote about above.

For both systems, treatment prices are kind of fixed (as a rule of thumb, doctors can charge the insurance a bit more than the public funds, by a constant factor of 2-3, but I heard from doctors that this depends on the treatment).

Re: After Surgery in Germany, I Wanted Vicodin, Not Herbal Tea

#197

Post by mantas »

serf wrote: post #177
freyir wrote: post #117

Earlier quoted context omitted.

> the only thing worse than overprescribing necessary medications is underprescribing them. There are only three categories: overprescribing, underpresribing, and prescribing the correct amount. In the case of opioid-based painkillers, overprescribing leads to unnecessary addiction, in turn leading to heroin or fentaynl abuse, breakup of families, overdose, etc. If you’re underprescribed opioid painkillers, you just…

>If you’re underprescribed opioid painkillers, you just feel temporary pain (or not, since non-opioid painkillers exist). Without taking a political stance on regulated pain killers, I'd like to point out that the concept of 'temporary pain' is largely a myth. There has been much work done (mostly with chronic pain sufferers) to show that pain (and more generally over-excitation of nerves) can cause permanent nervous…

Is temporary pain, while stronger painkillers are given, on the level of chronic pain?

Re: After Surgery in Germany, I Wanted Vicodin, Not Herbal Tea

#198

Post by danieltillett »

eropple wrote: post #165
danieltillett wrote: post #161

Earlier quoted context omitted.

This study is so bad I don't know where to start. Apart from its small size, the other major things is there was no ibuprofen control or ibuprofen with codeine control. There is a vast difference in the effectiveness of ibuprofen over acetaminophen. It is studies like this that have caused us Australians to lose access to OTC codeine this week.

Is there a compelling reason for codeine to be OTC in the first place? It's an addictive opiate.

Codeine at the dose available over the counter is not very addictive. On top of this the pharmacists record your details so that anyone addicted is picked up and helped. As far as I can determine there has not been a problem with OTC codeine in Australia.

As for why to not make it prescription only is we have universal healthcare in Australia. Shifting low dose codeine to prescription only will cause a massive increase in doctor visits at a huge increase in the cost to the Australian tax payer. I use OTC codeine to treat and catch my migraines before they become major. I maybe take codeine once a month and never visit the doctor. I will now have to visit at least once or twice a year for no reason other than to get a script for something I have been buying over the counter for the last 30 years.

Re: After Surgery in Germany, I Wanted Vicodin, Not Herbal Tea

#199

Post by maxxxxx »

_agcx wrote: post #126
maxxxxx wrote: post #11

"I took two ibuprofens that first day. In hindsight, I didn’t need them, but I felt like I should take something" I have noticed the need to "take something" with a lot of American friends when they have problem. It's almost like a reflex.

I have noticed how the vast majority of my American friends do not express any reactive need to unnecessarily take pharmaceuticals (especially painkillers, in the case of pain) when they have a medical problem. Does my single anecdotal datapoint negate your single anecdotal datapoint?

I guess we need a third anecdote to make a final determination.

Re: After Surgery in Germany, I Wanted Vicodin, Not Herbal Tea

#200

Post by mantas »

serf wrote: post #178
madez wrote: post #92

I must applaud the doctors, as they did the right thing, and even gave explicit and detailed explanation. Pain is indeed important. It is a feature, not a bug. If you don't know what resting after a surgery means, then you are in need of more pain, not less, as pain is exactly what effectively teaches you what to do and what not to do. Also, Ibuprofen is really bad for your kidneys. If you take it, then make sure to…

>Pain is indeed important. It is a feature, not a bug. Indeed, but features have a cost.[0] [0]: https://med.stanford.edu/news/all-news/2014/07/study-reveals...

But some pain after surgery is far cry from chronic pain.

From my experience, there's very clear difference to be in pain for a quick moment, few hours, day or two, a couple weeks.. Fortunately I didn't have to experience it longer than that.

But I feel pretty confident to say it grows at geometrical progression. Short, even very strong, pain is nothing compared to week-long, even much lesser, pain. Post-surgery pain for a day or two is a joke compared to chronic lifelong pain.

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