many people will die from this article because they wil not believe their doctor and go to another one with a broken appendix that kills you in a few days from septic shock.
After century of removing appendixes, doctors find antibiotics can be enough
161–170 of 212 posts
Re: After century of removing appendixes, doctors find antibiotics can be enough
#162Somewhat 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!
But also - how much of that is medical progress, and how much of that is ballooning costs coupled with insurance companies refusing to cover more than the absolute minimum (and in some cases much less than what really should be the minimum for the sake of safe recovery)?
Re: After century of removing appendixes, doctors find antibiotics can be enough
#163Earlier quoted context omitted.
And nothing to do with the pile of research that’s been done in the past few decades identifying exactly which medications actually provide mortality benefit in cardiac disease and which don’t, of course.
Well, that's precisely my point. Yes, new drugs help, but often less so than the "dogma of the year" lets you hope at first. The point is that MDs are usually identified as scientists because many people think they actually had an important part to play in the development of new useful technology, and don't see that most of the time those new things come directly from the lab and clinicians just test drive them to fi…
> To follow up on your cardiology example, I'd say that pills certainly helped, but the game changers really are the new toys of the interventional cardiologist.
Balloon caths re-stenosed 30% of the time. Balloon caths with bare metal stents re-stenosed about 15% of the time. Balloon caths with stents and dual-platelet drugs re-stenose about 3% of the time. I think this is one of those "drugs help ... but less so" situations where drugs get less credit than they're worth, and the physician scientists that did the endless slogging to figure out how to optimize interventional cardio's toys deserve real credit.
But, yes, I agree: most MD's aren't scientists. Quite a lot of MDs are only barely science-literate. They're engineers: they're taught a body of science and its application, with the expectation that they apply it usefully.
Re: After century of removing appendixes, doctors find antibiotics can be enough
#164A friend (in UK) had a similar condition called diverticulitis wherein the intestine makes a new pouch and it gets infected. They were treated only with IV antibiotics (and pain killers) but spent almost a week in hospital vs people attending for surgeries who were out again in a couple of days. I imagine _if_ it requires a longer hospital stay that will override the medical necessity. Perhaps samples could be taken,…
There's also some evidence that the bacteria in your stool is even less well-correlated to the bacteria further up your intestines than we thought (and we already thought it wasn't great). [1]
[1] - https://www.theguardian.com/science/2018/sep/06/probiotics-n...
Re: After century of removing appendixes, doctors find antibiotics can be enough
#165I'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.
> The conclusion of the study is that high doses of antibiotics is an effective way to prevent the appendix from rupturing without surgery.
I've been through a few million dollar surgeries and I had my appendix out as well. When you get a blocked appendix (appendicitis induced), you create scar tissue from the inevitably distended bile duct. Now you have an increased chance of it occurring again, and a weaker duct (scar tissue is generally weaker). This snowballs. Removal is the safe course after the first onset. This study assumes 2 things. First, that no major damage is done over the course of appendicitis attack(s). Second, the patient is compliant with a dietary restriction and an antibiotic course. Yes, you don't NEED to have your appendix out after the first attack if you eat right. The chances that a patient is compliant is less than 50% This is just a medical reality. People who take blood thinners have to be monitored, more for compliance than anything else, and there's a whole industry to the more dangerous conditions than appendicitis.
Re: After century of removing appendixes, doctors find antibiotics can be enough
#166Earlier quoted context omitted.
The doctor told me that there was no heartbeat and no breathing for approximately 3 minutes. Since I'm still here... :) I called it technically dead. As for afterlife... I don't remember anything from surgery until I woke up 9 days later in the ICU.
Any permanent damage? Or did you make a full recovery?
I had/have a few issues now. My kidneys were damaged and there have been slight memory issues. Both eased over time.
The weirdest thing was, I started craving BBQ ribs. I was indifferent to them before.
Re: After century of removing appendixes, doctors find antibiotics can be enough
#167Earlier quoted context omitted.
Appendicitis will kill you! And the surgery in most cases will save you. :) At least in my case. I technically died from a ruptured appendix and spent 9 days in ICU. The doctors delayed surgery to see if the antibiotics would work. This was ~10 or so years ago.
They delayed surgery before or after the rupture? Was it already ruptured when you arrived?
Before :) -- They were looking for the antibiotics to possibly save me from the surgery, which was my request when I was told what the treatment approaches could be.
The thinking there is likely part of what saved my life. They put a thing in the huge vein in my neck at the point I opted to attempt to avoid surgery that was used to directly deliver the antibiotics to the brain.
Re: After century of removing appendixes, doctors find antibiotics can be enough
#168This reminds me of when tonsils were removed at the first sign of trouble. When I was in my early 20s, in the 1970s, I went to my doctor about a bad sore throat. He advised me to see an ENT who barely bothered to look down my throat for more than a second and automatically declared I needed mine removed. That bothered me but I very much respected my personal doctor who said he respected this ENT. When I mention this…
Growing up, I felt like getting tonsils removed was as common as changing teeth, it must've happened to a third or so of my classmates at the time. It seemed harmless enough from a distance, they pull out some stuff from your throat and you get ice cream.
They tell you you can have all the ice cream you want to eat, but neglect to mention that you'll be in too much pain and too nauseous to actually want to eat any. :P
Believe me, all the ice cream in the world isn't worth that experience. You're not missing anything.
Re: After century of removing appendixes, doctors find antibiotics can be enough
#169Earlier quoted context omitted.
Growing up, I felt like getting tonsils removed was as common as changing teeth, it must've happened to a third or so of my classmates at the time. It seemed harmless enough from a distance, they pull out some stuff from your throat and you get ice cream.
I had mine out as an adult and it was a pretty painful week of recovery.
Yes but Allison visited me in the hospital! TIL: Alisson liked me!!
Re: After century of removing appendixes, doctors find antibiotics can be enough
#170Finally a thread where I can contribute!
I was part in the Finnish APPAC trial (published on JAMA/2015).
In April 2012 I was in an out of the hospital for four or five times with intensive stomach pains, but as they weren't localised in the mcburney area and my white cell counts weren't elevated, I just got sent home with painkillers.
The last time my white cell counts were slightly elevated (around 36 when under 14 is considered to be normal) and the stomach pains were worsening while jumping and the pain localising in the lower right of my stomach I was personally sure about what I had. Doctors still disagreed.
I was then told that there's an experimental trial and if I sign up for it, they'll do a CT scan (I had begged for this the previous visits). Lo and behold, the scan showed inflammation not caused by a stone.
I got ertapenem intravenously for three days and 7 days of metronidazole and levofloxacin. For about a year everything was fine, but I started to get occasional localised pains again, but they came and went and never really worsened. I think between 2013 and 2017 I've been to the hospital about 6 or 7 times because of the pains but they've always resolved by itself.
Two months ago it came back again and it was worse than the first time I got diagnosed. Spent two nights in the ER waiting for surgery. Again, ct scanned and blood levels show inflammation. I get sent home with pain killers and metronidazole and floxacin. ER nurses and surgery doctors were baffled by the case, said they've never seen an inflammated appendix been put on the non-urgent surgery waiting list.
Got told today that it's going to be removed this year, lol. After six years and asking every time to have it removed.
Approximately 80% of the appendicitis cases are not at risk of bursting anytime soon so an immediate surgery is not necessary. The rest are complicated and need urgent surgery.
I've been told that about 74% are fine after the antibiotics for the first year but a majority in the trial have ended up with it removed within a 5 year window. So, while having an appendix would be ideal and it's cheaper to throw a ct and some medicine at the patient, a surgery is still almost always needed.
In my personal experience, I have a strong gut feeling that a low carb diet might've affected how many times my appendix has shown slight signs of inflammation. Up until 2016 I was in ketosis for a four years and that was when I had issues most often (although the latest has been the worst overall). The sample size of this idea is just n=1 so take it with a grain of salt.
Oh, a sidenote, latest hospital ordeal put me in bed rest for almost a month because metronidazole did not play nicely with my ankles and I lost my job during that time so I'm also going through talks with my lawyer about a suit for unlawful termination. Fun times.
Please do ask questions if I can clarify anything or you want to hear about something specific!