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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

#141

Post by diminoten »

SEJeff wrote: post #123
da02 wrote: post #96

Earlier quoted context omitted.

Can you give more details of "technically died"? Any after-life experience?

Technically died likely means cardiopulmonary arrest aka a heartrate of zero. Medical personnel refer to this as "a code" or "code blue" I drowned as a kid in a friend's pool when I was 7 or 8. I was "technically dead" as well. No afterlife experience, but as I was thrashing underwater, my entire body felt like you feel when your leg goes to sleep, and before I went "to sleep" I got really calm and everything was pea…

You're crazy lucky, CPR isn't supposed to bring you back from anything or flush water out of your lungs, it's supposed to keep your blood flowing to your brain until paramedics can get to you.

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

#142

Post by Nasrudith »

0xcafecafe wrote: post #67

I wonder if this would eventually be extended to wisdom teeth, something dentists are too trigger happy to remove.

Probably not unless people start losing more teeth to make room. They are a chronic source of some nasty problems unlike appendicitis which can just go away with antibiotics.

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

#143

Post by mapt »

odyssey7 wrote: post #72
bookofjoe wrote: post #71

Earlier quoted context omitted.

A recent example: Drs. Barry Marshall and Robin Warren, who discovered that gastritis, gastric ulcers, and stomach cancer are caused by the bacteria H. pylori. "In 1983 they submitted their findings so far to the Gastroenterological Society of Australia, but the reviewers turned their paper down, rating it in the bottom 10% of those they received in 1983."—Wikipedia. Marshall and Warren were awarded the Nobel Prize i…

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 what we're looking for.

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

#144

Post by mmsimanga »

tinus_hn wrote: post #57
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…

You’d be surprised to learn what happened to the person who suggested it is better if the surgeons wash their hands between patients (Ignaz Semmelweis)

Side note, my daughter was born at Semmelweis hospital in Vienna. My wife was studying in Vienna at the time. That's when I heard of Semmelweis and read up all about him.

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

#145

Post by hospes »

christinamltn wrote: post #81
krylon wrote: 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.

>> Gave up the serious pain meds the next day since the side effects (zero attention span) were more annoying than the bit of pain.

Next time you can try Ibuprofen + Tylenol, to avoid mentioned side effects.

Ibuprofen Plus Acetaminophen Equals Opioid Plus Acetaminophen for Acute Severe Extremity Pain: https://www.aafp.org/afp/2018/0301/p348.html

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

#146

Post by hellofunk »

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.

A ruptured appendix would not likely be resolved with antibiotics, I'd think. But catching appendicitis before it ruptures would be a less critical issue.

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

#147

Post by da02 »

fredsanford wrote: post #140
da02 wrote: post #96

Earlier quoted context omitted.

Can you give more details of "technically died"? Any after-life experience?

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?

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

#148

Post by smaddox »

jawns wrote: post #98
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."

About 10 years ago, one study set forth an interesting hypothesis: The appendix is a place where "good" bacteria can safely hide during infection. I'm not sure if there's been any work since then to confirm the hypothesis, but it sure is an interesting idea. Source: https://www.nytimes.com/2008/06/17/health/research/17appe.ht...

I think I remember reading at some point that another hypothesis is that it acts as a repository for bad bacteria, so that your immune system doesn't forget how to make antibodies for those bacteria. I think I remember the sinuses being posited as serving the same role.

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

#149

Post by nkrumm »

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?

Clinical history, some labs, and imaging are typically used to diagnose. In adults, CT scan has the highest sensitivity and specificity (0.96 and 0.96); better than ultrasound. The difference is not as pronounced in children (smaller abdomen-- easier to visualize using ultrasound), so that is commonly used to save exposure to radiation (though note that an abdominal CT scan is actually a very low dose).

Source: https://effectivehealthcare.ahrq.gov/topics/appendicitis/res...

"The estimated effective radiation dose of abdominopelvic CT is 8 to 10 mSv with standard dose and 2 to 4 mSv with low dose techniques [40]. To put these numbers into context, the effective dose from annual background radiation is 3.1 mSv and from plain abdominal radiography is 0.7 mSv." (from https://www.uptodate.com/contents/acute-appendicitis-in-adul...)

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

#150

Post by paavoova »

gwbas1c wrote: post #87
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.

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

It is life-threatening, but it most certainly doesn't have to come out for full recovery. In some cases, it's impossible to remove due to the infection (inflammation, abscess) obfuscating its location. The treatment is aggressive intravenous antibiotics for a period of time, then oral antibiotics. The statics for recurrence after recovery I've had quoted as between 1/4 and 1/3 lifetime chance, and patients are advised on proactive surgery to remove what remains of the appendix.

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