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After century of removing appendixes, doctors find antibiotics can be enough

arstechnica.com

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Re: After century of removing appendixes, doctors find antibiotics can be enough

#81

Post by christinamltn »

krylon wrote: post #47
bookofjoe wrote: post #32

Somewhat OT but interesting: "When [Kurt] Semm introduced laparoscopic surgery at the University of Kiel, he had to undergo a brain scan at the request of coworkers as 'only a person with brain damage would perform such laparoscopic surgery.' On September 13, 1980, Semm performed the first laparoscopic appendectomy, opening up the path for a much wider application of minimally invasive surgery. At first, his operatio…

It's weird in retrospect. When my grandfather had his gall bladder removed (late 1960s, I think), he spent about 4-6 weeks in hospital and another couple of weeks at home recovering; last year, I had my gall bladder removed, they sent me home after three days. Now that's progress!

My gallbladder removal 5 years ago was outpatient surgery. I went in around 7am and was home on the couch by mid afternoon. Gave up the serious pain meds the next day since the side effects (zero attention span) were more annoying than the bit of pain. It's amazing how far we've come for some medical treatments.

Re: After century of removing appendixes, doctors find antibiotics can be enough

#82

Post by zaphod12 »

MaysonL wrote: post #33
bookofjoe wrote: post #32

Somewhat OT but interesting: "When [Kurt] Semm introduced laparoscopic surgery at the University of Kiel, he had to undergo a brain scan at the request of coworkers as 'only a person with brain damage would perform such laparoscopic surgery.' On September 13, 1980, Semm performed the first laparoscopic appendectomy, opening up the path for a much wider application of minimally invasive surgery. At first, his operatio…

The "Semmelweiss reflex" https://en.wikipedia.org/wiki/Semmelweis_reflex

An aspect of this that is seldom remembered is that Semmelweiss was a HUGE jerk, which didn't help adoption. Instead of telling or showing other doctors how things could be better, he called them barbarian murderers for not washing their hands. It was a decade before he'd even have a civil conversation about it, or publish for peer review.

There's a lesson in that...sometimes being right isn't enough on it's own.

Re: After century of removing appendixes, doctors find antibiotics can be enough

#83

Post by seszett »

fulafel wrote: post #76
seszett wrote: post #74

Earlier quoted context omitted.

It's only possible in some places, for example Kerguelen island has no airstrip, the closest airstrip being on Réunion island 3000km away (Davis station on the Antarctic continent is closer, 2000km, but does not have a permanent airstrip). No helicopter in the world has such a range, so the only means of evacuating is by ship, with the fastest ships in the area taking minimum 3 days to make the trip. If a navy ship i…

Could you parachute fuel down for helicopter refuelings along the way? Edit: it seems that aetial refueling for helicopters is a thing as well.

There is only the ocean along the way though, I don't think it would be possible to drop resupply fuel that way.

Aerial refueling though I guess could work, although I suspect that no suitable tanker airplane is to be found within range anyway most of the time (and no suitable helicopter either) as the military base on Réunion is not a major air force base and there is no other country than France with decent forces in the area. Australia has tankers but they're on the wrong side of their country, nowhere near Perth.

I think we're getting beyond very, very expensive here and into the territory of things no country would do outside of extraordinary circumstances, the kind of circumstances in which the country operating the base would not matter anyway as most others would cooperate in any way they could.

Re: After century of removing appendixes, doctors find antibiotics can be enough

#84

Post by bookofjoe »

mr_overalls wrote: post #73
bookofjoe wrote: post #32

Somewhat OT but interesting: "When [Kurt] Semm introduced laparoscopic surgery at the University of Kiel, he had to undergo a brain scan at the request of coworkers as 'only a person with brain damage would perform such laparoscopic surgery.' On September 13, 1980, Semm performed the first laparoscopic appendectomy, opening up the path for a much wider application of minimally invasive surgery. At first, his operatio…

Are there examples of other fields being so staunchly/abusively conservative? I'm struggling to imagine a physicist, engineer, or attorney being forced to undergo a mental examination for suggesting a radical new theory or procedure.

"I hold that space cannot be curved, for the simple reason that it can have no properties. It might as well be said that God has properties. He has not, but only attributes and these are of our own making. Of properties we can only speak when dealing with matter filling the space. To say that in the presence of large bodies space becomes curved, is equivalent to stating that something can act upon nothing. I for one, refuse to subscribe to such a view."—Nikola Tesla

Re: After century of removing appendixes, doctors find antibiotics can be enough

#85

Post by odyssey7 »

nielsole wrote: post #77
odyssey7 wrote: post #72

Earlier quoted context omitted.

Hey! We must read similar things. https://news.ycombinator.com/item?id=17952107 Looking back I could have talked about Zika here. How many childhood viruses are we sure don't cause down-the-road issues like cancer? Most of the time when you get a random virus, the doctor has no clue which one it is and doesn't test to find out. I can remember being told by nurses at the school "there's a virus going around," and that…

I really look forward when the premise of Theranos becomes technically viable. Cheap continuous medical tests. So much in medical diagnosis is just a very coarse decision tree and it is uneconomical to investigate every sickness. Imagine doctors having more time per patient. Imagine many diseases detected before there are symptoms. I got carried away here, but medicine looks so much more promising then CS sometimes.

There is huge room for medicine to be improved, but actually the reason for that is there is a lot of resistance to changing things in major ways despite all the things that could be done. A lot of software companies know that their key to staying on top is to improve things fast enough that a group of founders in a co-working space won't put them out of business. Hospitals don't have this pressure at all; they just have to keep providing the acceptable services that they always have, and people will still go there. I've been pressured into unnecessary procedures and even given (multiple!) sales pitches for surgeries that I haven't needed or wanted, because the hospital makes huge amounts of money from it, and consumers aren't savvy enough to know when their doctor is just trying to pad his profitability figures.

Plus, when you write software that disrupts an industry, your employees are still software developers who work and function like software developers. If you want to change healthcare, you need to change how the doctors operate.

Re: After century of removing appendixes, doctors find antibiotics can be enough

#87

Post by gwbas1c »

crazygringo wrote: post #80

I'm so confused. From Wikipedia: > Appendicitis is caused by a blockage of the hollow portion of the appendix. This is most commonly due to a calcified "stone" made of feces. Inflamed lymphoid tissue from a viral infection, parasites, gallstone, or tumors may also cause the blockage... The combination of inflammation, reduced blood flow to the appendix and distention of the appendix causes tissue injury and tissue de…

> Or are the antibiotics for dealing with an actual ruptured appendix

If your appendix ruptures, it is life threatening and has to come out.

Most appendix removals happen before the appendix ruptures. The conclusion of the study is that high doses of antibiotics is an effective way to prevent the appendix from rupturing without surgery.

Re: After century of removing appendixes, doctors find antibiotics can be enough

#88

Post by zaphod12 »

sonnyblarney wrote: post #56
jazoom wrote: post #44

Earlier quoted context omitted.

In Australia, where public hospitals provide a free service, antibiotics are first line for uncomplicated appendicitis. Most people recover just fine. It's amazing how things are different when a surgeon doesn't want to do a procedure since it means more work for them, compared to where a surgeon wants to do a procedure since that's how they get paid. Obviously, it's much better for the patients if they avoid unneces…

Even in socialized medicine systems, doctors who do more stuff get paid more. 'Single Payer' usually means the government runs insurance not the doctors office. So the doctor bills more in both cases. Both of those inscentives are maligned though - the doctor should do 'what's right'. What's also nutbars is that there isn't a standard playbook for this stuff. There should be specific procedural research on all of thi…

These standards of care do exist for a lot of things. (see NCCN treatment guidelines for ones related to oncology). Oftentimes a doctor will not be reimbursed by insurance if they give treatments that are outside of approved standards. There is leeway given, though, because its just damn hard in many cases. Patients can present with 4/7 key symptoms and may report other unrelated issues. Or ailments can act differently in different people. Or maybe you have never been able to sleep well and don't even notice that, and it's a key issue related for a diagnosis.

1 really interesting point about it, though: They vary WILDLY by nation. You wouldn't think it would make a difference, but because of the varied regulatory bodies, and even culture, it does. (This was an issue that Watson for Oncology ran into after being trained by US doctors. In Japan, even on the occasion is gave a reasonable answer - it was watson after all - it often was not how the Japanese doctors would act in that circumstance).

Re: After century of removing appendixes, doctors find antibiotics can be enough

#89

Post by lightbyte »

bitexploder wrote: post #59
ransom1538 wrote: post #45

I found this conversation unnerving at 13 years old: Doctor: "Does all this make sense? We need to remove your appendix.. now." Me: "Doctor, ok, so you need to remove my appendix cause if you don't I could get really sick. " Doctor: "Yes." Me: "What does the appendix do?" Doctor: "We don't know."

Doctor: in your case, kills you in about 24-48 hours. I had mine out as well. I was 19. My dad drove me to the hospital. Doc slipped his finger up my bum, said, “you have appendicitis. You need surgery. Now.” I was being operated on quickly after that. It had ruptured. So it goes.

>Doc slipped his finger up my bum

Is this a standard way to diagnose appendicitis?

Re: After century of removing appendixes, doctors find antibiotics can be enough

#90

Post by bitexploder »

lightbyte wrote: post #89
bitexploder wrote: post #59

Earlier quoted context omitted.

Doctor: in your case, kills you in about 24-48 hours. I had mine out as well. I was 19. My dad drove me to the hospital. Doc slipped his finger up my bum, said, “you have appendicitis. You need surgery. Now.” I was being operated on quickly after that. It had ruptured. So it goes.

>Doc slipped his finger up my bum Is this a standard way to diagnose appendicitis?

Heh, yeah. It is traditional. And ineffective (of course). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071072/

I was kind of out of it. Maybe there was a lot of pain, but my memory of it was just so much discomfort, what is something minor like that?

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