41–49 of 49 posts
There was a study where knee surgeons just made an incision in the skin and told the patient the procedure was done. The result was about the same rate of success, and a lot less risk of complications. I can't find a date on this article but it's at least from 2010 if not older. http://abcnews.go.com/Health/story?id=116879&page=1
Earlier quoted context omitted.
This is a pretty stupid example imo, it isn't really workable in practice. You can die from a ruptured appendix and the surgery isn't terribly involved. Whereas people come in constantly with elevated WBCs; it'd require a high index of suspicion to treat for appendicitis with antibiotics in every circumstance. You would probably end up doing more harm than good that way because antibiotics are not benign drugs.
The WBC count would only be some evidence. I presume some sort of ultrasound could localize the infection in the appendix. I imagine there are some people for whom surgery isn't an option. I'm not sure what that condition might be given the routine nature of the procedure, but they might be out there.
Basically my point is that most people where you could diagnose appendicitis from elevated WBCs followed by ultrasound will probably not be in the hospital or clinic or ED in the first place. The reason this is a surgical emergency is because the symptoms are of rapid onset. Thus, elevated WBCs are of limited utility. Furthermore, because appendicitis is an emergency, ultrasound is not the preferred imaging modality–CT scans are used instead, which are relatively more expensive and expose patients to ionizing radiation.
You can choose to treat patients with antibiotics (and they've done studies), but generally over 50% of patients managed initially with antibiotics will ultimately require surgery anyway within 48 hours, and of the From my reading of Uptodate, experts in the field feel similarly; after performing a cost/benefit analysis, initial management with antibiotics is indicated only for patients who cannot undergo surgery.
Not my worst experiences, but two similar injuries left me with very differing experiences, as comparative examples. In the first one, the doctor wanted to get me into (arthroscopic, fortunately) surgery right away, without even doing an MRI. In the second, a different doctor said that, even if surgery were eventually warranted/needed, the condition had left me too weak to be a good surgical candidate. So, see a PT and work and strength-building, and see how I tolerated it.
The first doctor racked up a big bill and produced no positive effect. The second doctor saw me for one visit, got me to a good PT / rehab program, and helped me make a full recovery.
Anecdote, sure. But, combined with some other singular, not positive experiences: I'll go under the knife only when I have no other choice.
Appendectomy: The possibility of dying from a ruptured appendix is enough for surgeons to recommend this procedure but several studies have shown that antibiotics alone are also effective. The recurrence rate is higher with antibiotics, but the surgical complications are lower. I can think of a reason why the recurrence rate for appendectomy is lower than for antibiotics. ;-)
I was with the article until this statement... Appendicitis is a medical emergency and suggesting you can just take antibiotics and it'll go away, or that antibiotics (a group of medicines with their own problems) are preferable to an established and very effective treatment feels irresponsible to me. Even if that's true, if you are experiencing appendicitis you NEED to talk to a doctor and you likely NEED to conside…
What a lot of people seem to overlook is that, in the developed world, you have a 1% chance of death every time you go under general anesthesia.
citation? This to me sounds incredibly high.
It's worth noting that their data contains zero observed deaths in ASA Physical Status I Patients, which are basically healthy adults.
I would assume things have either stayed the same or improved: Sevoflurane was just starting to be used around the time that the data were taken for that paper.
A couple of years ago I slipped (herniated) two lumbar disks. Both of the surgeons I consulted begged me NOT to get surgery (one with tears in his eyes). I'm ever so grateful that there are surgeons out there who will push back. Contrast that with when I went to an orthopedic specialist about knee pain from running. In less than two minutes of consultation he told me he wanted to snip my tight IT bands. My jaw was on…
Acupuncture, there has been so much FUD spread about alternative medicine that I have no idea what to trust anymore. It isn't even covered by most insurance. What is real, who to trust.
Western medicine has some amazing things to offer for serious conditions. Its really silly how most other ailments are covered by crap in the drug store. I say crap because after my wife started treating the family with essential oils, and my acupuncturist's herbal remedies I'm sick less often and recover faster. I even avoided having to have my gallbladder removed. On fucking herbs ¯\_(ツ)_/¯ Do I know why all these organic compounds and odd treatments work? Does that mean they don't? Does it mean it's all psychosomatic? sigh Maybe, just maybe people in the east figured out a system for treating many ailments. Maybe western medicine needs to zoom out from the molecule and start looking at the whole patient.
You want a lesson in the limits of western medicine? Watch your child die slowly of cancer. Losing my daughter disabused me of any fantasies of cures just around the corner. Meanwhile top doctors kept saying "we've never seen this before". Western medicine doesn't have answers for half of what people think it does. This isn't CSI. Humble out. If some herbs and acupuncture can heal people then deal with it.
Earlier quoted context omitted.
Acupuncture, there has been so much FUD spread about alternative medicine that I have no idea what to trust anymore. It isn't even covered by most insurance. What is real, who to trust.
Acupuncture is a very effective placebo (because you can really feel it working). There's a whole complex theory about points all over the body which affect ailments in different parts of the body, also based on personality type, but (of course!) none of it matters. Carefully poke someone with needles anywhere (and pretend there's some meaning behind the placement) and the effect is the same. The big give-away that a…
Citation needed.
Earlier quoted context omitted.
Acupuncture, there has been so much FUD spread about alternative medicine that I have no idea what to trust anymore. It isn't even covered by most insurance. What is real, who to trust.
I tried accupuncture last, I should have tried it first. I love how western medicine calls any mechanism it doesn't understand "placebo" (reference to child comment) or "psychosomatic". Acupuncture worked for me after I exhausted everything western medicine had to offer (short of surgery). I had serious injuries (MRI showed this). I had verified radiating nerve pain, tests showed the nerves were innervated (activated…
Earlier quoted context omitted.
Acupuncture is a very effective placebo (because you can really feel it working). There's a whole complex theory about points all over the body which affect ailments in different parts of the body, also based on personality type, but (of course!) none of it matters. Carefully poke someone with needles anywhere (and pretend there's some meaning behind the placement) and the effect is the same. The big give-away that a…
> Carefully poke someone with needles anywhere (and pretend there's some meaning behind the placement) and the effect is the same. Citation needed.
"Sham acupuncture may be as efficacious as true acupuncture: a systematic review of clinical trials"