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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

#201

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After his comment I was curious, but still indifferent to bbq ribs. After yours, I too am craving bbq ribs. Some sort of ripple effect?

I read all three of these comments and I still dislike bbq ribs.

Funny guys :)

It was almost an obsession for several months to the point the family got sick of them... I'm glad that's over with.

I've asked a bunch of doctors about it and none of them had answers.

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

#202
post #47

Earlier quoted context omitted.

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)?

Good question. I think the medical progress is tremendous. My grandfather needed weeks before he could sit up again without serious pain, and he had a scar that went all across his abdomen. I had four small incisions (the largest was about 2cm long) and was on my legs and walking around without trouble the next day. I did not even need or get serious pain medication. As long as I stayed in the hospital, the doctor looked at the incisions every day to see if there was any sign of inflammation or infection. About the only serious discomfort I had was from the gas they used to inflate my abdominal cavity; but that was not so much painful as uncomfortable.

As far as I can tell, gall bladder removal is a fairly routine procedure by now, and the risks and possible complications are well enough understood that a competent surgeon can tell after three days if the procedure went well or if there are any problems. (Also, they told me to come back immediately if I experienced any pain or fever, or the incisions appeared not to heal properly.)

I Germany, hospitals usually get flat fee per case depending on the diagnosis, so there is an incentive to release patients as soon as possible. But all the doctors and nurses I have met so far take the health of their patients very seriously, and I do not believe they would release somebody who was still in need of medical care. Plus, ethical considerations aside, that might incur legal repercussions for the hospital and the doctor ordering the release, even in Germany.

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

#203
post #47

Earlier quoted context omitted.

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.

I was a little disappointed I did not get any opioid analgesics after the procedure, but on the plus side, I did not need it. I got Metamizole (https://en.wikipedia.org/wiki/Metamizole) on the first day and was told I could ask for more on the second day, but the pain was negligible, so I did not ask for more.

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

#204
post #54
post #47

Earlier quoted context omitted.

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!

It is indeed progress, all that time spend among the sick and not moving around is very hurtful to the human body. It is mainly that realization that causes the difference, and not better surgical techniques I think.

Mmmh, one large scar across your abdomen (~20cm, I think in case of my grandfather) vs. four incisions about 1cm each makes a huge difference.

Being able to get up and move around on the next day vs. having to lie in bed for weeks certainly makes a difference psychologically, but the laparoscopic procedure does put a much smaller burden on the body, too.

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

#205

Earlier quoted context omitted.

It definitely can, mine fully ruptured and I didn't find out till 4 days later. It requires very strong antibiotics, but did work good. My appendix came out 3 months later in a normal way.

Wow, I find that quite amazing.

Its not that surprising. You don't go removing your arm every time you get a cut.

Once the swelling that caused the rupture has stopped, it can heal. Assuming it wasn't too severe (you don't want to die of internal bleeding in the meantime)

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

#206

Earlier quoted context omitted.

Wow, I find that quite amazing.

Its not that surprising. You don't go removing your arm every time you get a cut. Once the swelling that caused the rupture has stopped, it can heal. Assuming it wasn't too severe (you don't want to die of internal bleeding in the meantime)

Perhaps I was confusing "ruptured" with "exploding".

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

#207

Earlier quoted context omitted.

A tl;dr summary... > A US Special Forces soldier bought fish antibiotics at a pet store to treat his sinusitis. It did not work out. -- I grew up in an area with 6 to 8 different military bases and it is fairly common knowledge in military areas that you can sometimes get away with using fish antibiotics to treat human infections. And in a lot of cases the pills are exactly the same. But sometimes not.

Article also states that aquarium antibiotics are more expensive than prescription antibiotics, while conveniently omitting the copay and time cost required for the doctor's office visit, which was needed to obtain the prescription. As such, it is also an uncommon practice to lie about symptoms during an office visit that was required for some other reason, to get a prescription for antibiotics that is not immediatel…

> As such, it is also an uncommon practice to lie about symptoms during an office visit that was required for some other reason, to get a prescription for antibiotics that is not immediately needed.

Wait, do doctors actually prescribe antibiotics given just invisible symptoms and no actual flora analysis? What's the point of the prescription system them? Isn't a doctor meant to find out what specific bacteria causes the problem and choose the right antibiotic to target these?

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

#208
post #110
post #101

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Waiting cures a wide range of problems, that don't end up killing you. It's really hard to separate 'doing a rain dance' and 'just waiting' when you have a sample size of 1.

And the ones who do die, don't post here to let us know how it turned out.

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

#209
post #143

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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…

We also assume that we only get a virus when we notice it. The reality is probably more like: You're exposed to millions of different viral antigens over the course of your lifetime; Many of them don't have a mechanism to really hurt you, and nearly all of them are dealt with efficiently by your immune system. Not only do they not cause symptoms, we don't even have a mechanism to identify them unless we already know…

"Ancient Viruses Are Buried in Your DNA":https://www.nytimes.com/2017/10/04/science/ancient-viruses-d...

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

#210

Earlier quoted context omitted.

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…

> 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. That's called Fee-For-Service (FFS) and is there is active effort to replace it with quality-based schemes. Provide…

I'm a retired neurosurgical anesthesiologist with 37 years of experience. Medications one day after their so-called expiration dates are just as effective as they were 24 hours earlier. Loss of potency and therapeutic efficacy over time varies tremendously depending on storage conditions: drugs kept refrigerated and in the dark will likely work just fine for YEARS after their expiration date. Pharmaceutical companies have noted that they are extremely conservative when it comes to expiration dates, much preferring to err on the side of caution. Dept. of eating your own dogfood: I had an anaphylactic/allergic reaction of unknown etiology in late 2015, my first ever; I had to go to the ER for IV steroids and Benadryl for treatment. No recurrence since. I immediately bought two Epi-Pens, one for my house and one for my car. Their expiration date was March 2017. I am completely comfortable not having purchased new ones, especially considering their now inflated prices even after all the bad publicity that focused on their markup. So I have bet my life on my belief that these "expired" epinephrine injectors will save my life should I ever have another anaphylactic/allergic reaction. However — if someone asked me for advice, I would tell them to get up-to-date ones; as a former practicing physician, this is one of those cases where what you advise is quite different from what you yourself would do.
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