After century of removing appendixes, doctors find antibiotics can be enough
arstechnica.com
arstechnica.com
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."
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.
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)
Is this a standard way to diagnose appendicitis?
Digital (as in finger) rectal examination is meant to help detect some of the atypical cases. It was part of my teaching, although I haven't read up much on it.
I'm a student doctor.
I was in there for a few days. The kid in the bed next to me was hard case. Nurse comes to check on him and he goes "yeah I managed to get all the grass out of my cut, and now it's heaps better"
He'd pulled all his stitches out.
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?
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...)
This wasn't in the game, but I presume it may also be necessary to do a pregnancy test (ectopic?), urinalysis for urinary tract infection, swabs for genital tract infection, blood draw for white blood cell count, and maybe look for other bowel conditions, kidney stones, gallstones, clots, torsions, cysts, or diverticula with the ultrasound.
It came in a bundle with Beyond the Black Hole, which came with 3D glasses that worked with CRT monitors. The feelies for L&D included a surgical mask. Maybe it came with Chessmaster, too?
Source: https://www.nytimes.com/2008/06/17/health/research/17appe.ht...
This is the great thing about HN -- there's a very good change somebody will come along and update my intuition.
Define "bad". Appendicitis patients invariably survive surgery and go on to live their normal, healthy lives. Until an objectively better solution comes along, we have no reason to not go with what Just Works™. And that's why medicine dislikes change.
It's amazing how medicine has advanced: We can now cure illnesses with very minimal amount of invasiveness required in most cases. Even before this news, open surgery was already mostly supplanted by laparoscopy, which involves only a few tiny cuts.
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.
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 peaceful. The only thing I could feel other than whole body numbness was a strong warmth. I took one last look up at the sun sparkling on the ripples of water above and closed my eyes.
A few minutes later, I awoke puking water and choking with my best friend shrieking hysterically as her mother frantically performed CPR on me. For some reason, my parents never ever let me swim in her pool again or go to her house unsupervised.
As for afterlife... I don't remember anything from surgery until I woke up 9 days later in the ICU.
The weirdest thing was, I started craving BBQ ribs. I was indifferent to them before.
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.
Example: https://www.pennlive.com/midstate/index.ssf/2015/03/union_co...
Another example: http://time.com/3897897/how-an-italian-boy-survived-42-minut...
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.
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 to doctors nowadays, most nod their heads that, today, it's not likely mine would have been removed.
It seemed harmless enough from a distance, they pull out some stuff from your throat and you get ice cream.
Believe me, all the ice cream in the world isn't worth that experience. You're not missing anything.
[1] https://www.buzzfeed.com/joeloliphint/is-empty-nose-syndrome...
In the modern day, a lot of people with a lot of education will scoff at anything that hasn't been produced by science, or even anything that simply wasn't taught to them in medical school. Meanwhile, the medical system is full of inefficiencies and outdated practices because of politics and resistance to accepting or learning newer scientific findings. Worthwhile questions about simple ways to improve things often go unanswered, because nobody has been able or willing to do a large, randomized trial about it.
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's all we knew: there was some virus, and everyone was getting it. We just assume that these things are harmless and irrelevant once you recover from them.
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.
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.
That's called Fee-For-Service (FFS) and is there is active effort to replace it with quality-based schemes. Providers still get paid for individual services but the rate depends on quality metrics of their overall population. (Source: worked in software for Population Health)
The inefficiencies you describe are less from the clinical side and more from the administrative side. Many of these admin-level people are doing what they can in an incredibly complex maze of processes, most of which started for a good reason. But they are process bees, and unable to make any changes: there's a huge barrier to change as of course nobody wants to be responsible for worse outcomes / deaths due to failure to respect process—yet they are immune from repercussions if poor outcomes are cause by said process.
More to the point, clinicians live in a constant grey zone: everything is a risk tradeoff and they do what they can to get the best outcome. The adminstrative folk see things in black and white. Here's a real example: outpatient office has slightly expired meds that are life-saving if a procedure goes bad, but new meds are not available because factory got damaged by hurricane. Common-sense is that a med does go from perfect to useless overnight and a few weeks is no big deal, especially when there is no alternative. Administrative view is the meds can't be used and must immediately be discarded because having them around the office will expose them to liability during audits... yet of course doesn't understand why that means all procedures of that type would get cancelled.
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.
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!
Still 4-6 weeks of recovery, but that's mostly due to them having to inflate the abdominal cavity to be able to see / work and a bit of bruising and shifting of stuff.
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
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.
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.
There's a lesson in that...sometimes being right isn't enough on it's own.
"Mob behavior found among primates and larval hominids on undeveloped planets, in which a discovery of important scientific fact is punished"
Maybe in a few years we'll lament that...
After all, we have physicists going around now (e.g. Nima) saying 'spacetime is doomed'
> 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 death. If this process is left untreated, the appendix may burst, releasing bacteria into the abdominal cavity, leading to increased complications... Acute appendicitis is typically managed by surgery. While antibiotics are safe and effective for treating uncomplicated appendicitis, 26% of people had a recurrence within a year and required an eventual appendectomy.
Given that bacteria are not even listed as a cause of appendicitis above, how do antibiotics help at all? Is there anything they can do to prevent "tissue death" in the appendix itself, and how? What about that "stone"?
Or are the antibiotics for dealing with an actual ruptured appendix (to kill leaking bacteria from the gut into the rest of the body), while the appendix presumably eventually resolves its blockage and heals itself on its own? Which sounds... scary, but of course I'm no MD.
Would love if anyone here knows how to explain what the article doesn't.
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.
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.
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.
It's also possible our previous understanding of appendicitis (as documented on Wikipedia) needs to be updated in light of this study.
The non invasive surgery only has you taking it easy for 7 days with no lifting anything over 10 pounds for a bit after that. They send you home from the hospital after 2 days. Most people resume work during the initial week.
Finland seems to be a special case; 10 days paid sick leave for a given incident, but in practice this is improved on by collective bargaining agreements in many trades.
Definitely surprising to hear about, but I'm glad we're still learning about these kinds of things. Imagine all the things we take for granted that are simply superstition when examined closely.
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 unnecessary surgery.
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 this stuff with the 'best practices' updated all the time.
There should be ongoing debate and churn around the practice, but once it's published, the doctors should all be in sync.
Doctors, like judges, have too much leeway. I think they feel that 'every case is special' and they are to some extent, however, I feel that they are playing against a statistical game and that their 'gut' is not right.
Just like airline pilots go through massive 'checklists' ... so should doctors.
I've been misdiagnosed for heart burn (doc thought it was heart palpitation) and for wound infection (was not infected, just a little red) - which is tragic because those are very common things.
Independents are paid more when they do more stuff, but employed doctors are usually paid a fixed salary depending on fixed work hours. Depending on the system, the practice either bills patients directly per consultation, or the social security organization, or gets a fixed income from social security or from the ministry of health that does not directly depend from how many patients they see. All three systems exist.
Best practices and procedures are usually handled at the hospital or... "medical house" (maison médicale or wijkgezondheidscentrum, the place where several non-independent doctors work as a team) level. It is indeed not something that really gets standardised at a higher level, although doctors also have a number of mandatory meetings that get conducted with attendees from different practices and that help with diffusing procedures, best practices and knowledge.
They don't all get in sync at the same time, but knowledges and best practices do diffuse through all doctors. Although independents usually try to attend the bare minimum because meetings directly translate to missed income for them.
I don't think the current model is wrong, although I think independent doctors are ill equipped to stay up to date, and not enough incentivised to do so.
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).
I see it more as a refinement of knowledge, just like Newtonian mechanics -> relativity. Or perhaps this is a bad example which should be the other way around because surgery works in all cases whereas the antibiotics work in most but not all cases. Ok, never mind :)
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, eg of stool, in order to select bacteria with which to reseed the intestine? I suppose that's quite labour intensive.
[1] - https://www.theguardian.com/science/2018/sep/06/probiotics-n...
I'm glad they are doing studies here. Please note the phrasing in the article concerning "uncomplicated" cases. I have plenty of criticisms of modern medicine, but let's not throw the baby out with the bathwater here.
When I was 34, appendicitid struck again. I new instantly that I had it, and this time I did not fear the hospital. This time, I wanted to avoid hospital because we were just a few weeks from moving to a new house. So I took antibiotics again, measured the fever, noted every measurement point in Excel but after 36 hours I found that it was not getting any better. So finally I took advantage of my wonderful German health insurance and got the appendix brilliantly removed...
Just want to state: there are times when antibiotics work and times when they do not.
It's anecdotal, but ever since I had my appendix out I've struggled with digestion issues. I've tried so many things: elimination diets to discover food allergies, probiotics, a switch to vegetarianism, tons of fiber supplements, no fiber supplements, intermittent fasting, acupuncture, traditional Chinese medicine. I tried out uBiome to see if I could discover anything with that. Nothing really has worked.
On top of that, the surgery cost $25k.
Certainly there are instances where the surgery is absolutely needed, as a rupture will kill you. I'd really like to see more research on the theory that the appendix holds a backup copy of good bacteria, because at this point I'm willing to believe the appendix isn't just vestigial and actually plays a role in intestinal health that we just don't understand.
there can still be scenarios where you developed acute appendicitis, it isn't treated in time (by either surgery or antibiotics), it perforates, possibly causing "infection of the lining of the abdominal cavity"
so i'd guess that removing the thing before there are any symptoms would still reduce risk, although maybe the cost-benefit tradeoff is a bit less clear.
The answer is no, however doctors who are wintering at Australian Antarctic stations are required to have their appendix removed. This is because there is usually only one doctor on station during winter, and evacuation back to medical care in Australia is impossible for at least part of the year. The requirement dates from the 1950s, when an Australian Antarctic doctor developed appendicitis on Heard Island and required a very challenging evacuation back to Australia.
In 1961 a Russian doctor successfully removed his own appendix at Novolazarevskaya station in Antarctica. With no outside help possible, he used local anaesthetic and had two expeditioners assist with surgical retractors and a mirror so that he could see what he was doing. The operation was a success and the doctor was back on duty within two weeks. It's not a situation that Australian Antarctic doctors would like to find themselves in!
As part of their overall medical review, all expeditioners are required to have a dental check before they depart for Antarctica within six months of their departure date. There is no requirement for expeditioners to have their wisdom teeth removed unless the dentist identifies that they may cause a problem over winter. The station doctor has eight days of training in emergency dentistry as part of their preparation, but this does not include wisdom teeth extraction.
http://www.antarctica.gov.au/about-antarctica/people-in-anta...
The Americans, of course, would just attempt surgery on site using remote assistance from stateside surgeons, do the horrendously expensive evacuation when it goes wrong, try to bill the patient for the entire multi-million dollar amount, and then base a screenplay or teleplay on the story.
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 is around, it could probably treat the emergency on board but most others will have to get back to Réunion first.
In the likely event that no ship from the French navy is around, the fastest means of evacuating will be requisitioning a nearby fishing ship but those will probably not make it to Réunion until at least one week.
Fortunately, the relative emergencies (but not life threatening) I have witnessed have always happened when a ship was already on its way for other reasons, but US or not there are real technical impossibilities in these places.
Edit: it seems that aetial refueling for helicopters is a thing as well.
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.
Apologies for the source, but I remember reading the same thing in a better source too.
With all the recent studies of the evolving antibiotic-resistant properties of bacteria and the importance of mantaining a healthy intestinal flora and how much the gut influences the brain, I am not sure that this treatment is necessarily preferable to modern appendix removal surgery. That said, if given the option, I'd probably prefer this than getting cut open (even if the incision with modern techniques is very very small).
https://en.wikipedia.org/wiki/Appendix_(anatomy)#Maintaining...
1) Europe has been doing abx before surgery for a while now. Unfortunately, their data has largely been lacking (thus the need for this trial), creating the impression that this was pushed by their national health services as a cost-saving measure rather than a patient-oriented one. The culture among surgeons in the US, regarding abx for appendicitis, is largely "we don't kill patients just to save a few bucks." The irony that the bucks being saved go directly into their pockets usually goes un-mentioned, but they are in earnest. It's just a win/win that their earnest desire to do the best for patients also pays their bills. It feels nice to get paid for doing the right thing. However, that creates a cultural bulwark against a change in expectations on appendicitis management.
2) There is often a feeling that "if we have to end up doing surgery anyway, we should just do the surgery. There's no value in making the patient go through two such episodes when we have definitive treatment." It's going to be highly subjective whether you think a 1/3 chance of two appendicitis episodes and inevitable surgery vs. a 2/3 chance of avoiding surgery means "it's obvious you should get abx" vs. "it's obvious you should get surgery." I think this study doesn't make anything obvious, but does pave the way to giving patients a reasonable alternative course of action.
3) This is not tantamount to saying "well, we've just been rash all these years in just going straight to appendectomy." Previous trials on this have been, methodologically, poor. Even this trial is a five-year follow-up to what was initially a one-year trial that wasn't adequately persuasive. The initial trial showed a 27% rate of return appendicitis. You can imagine that if the five-year results showed "80%" vs. "36/39%" we'd be having a different discussion. If it showed that having an appendicitis pop up a few years later had more adverse effects, we'd be having a different discussion. So this data was needed, and the fact that docs didn't jump on previously heavily flawed data is... well, docs doing what they're supposed to. You don't want your doc jumping after every poorly-supported shadow.
4) Appendicitis isn't diverticulitis. There's often a layman's shorthand that diverticulitis is just left-sided appendicitis, but it's not. The pathogenesis and appropriate treatments vary quite a bit: conservative treatment of a piece of normal anatomy is quite different from conservative treatment of a piece of herniated, pathologic anatomy. Don't confuse this study for meaning anything regarding the appropriate management of diverticulitis. That's not to say that abx management for diverticulitis is inappropriate, per se, but just saying these are different diseases and not to be confused here.
5) One shouldn't expect this to result in cultural change too quickly. There remains the fact that the primary protection against a malpractice suit is "local standard" - if all the local docs are doing the same thing, it's not malpractice to follow suit. The first doc to go out on a ledge with this is going to be minced meat the moment there's a bad outcome and someone sues. A study is beside the point - if you point to a new study during a suit, the plaintiff's attorney says, "Oh? You have a PhD in study design? No? Then what qualifies you to analyze this study better than every other doctor in your community?" This really won't go anywhere until an entire medical department agrees to go in on this simultaneously - most likely an emergency medicine department. Politically, though, they'd probably have to go to war with their hospital's surgery department to push it through, or otherwise have the surg folk on-side. It'll happen eventually, but it's not going to happen overnight.
(I know antibiotics are normally prescribed after an appendectomy anyway, but I presume that would be less than the dose needed to kill the primary infection outright.)
My wisdom tooth extraction was a shit show for that reason, but I've had all my 12 year molars removed since then, the last one a couple of weeks ago, and the recovery is pretty easy. (They wanted to root canal it and crown it... I was like bro just pull it because otherwise we're just gonna have this same conversation again in 10 years.)
Edit: Wait, you’ve had all your _second_ molars removed? That seems very unusual. I’m a little surprised the dentis was willing to do it, unless there was a big problem that couldn’t be dealt with otherwise.
A half sibling of Law (the other formal truth finding institution) and Science (the abstract unformalized institution).
Deaths attributable to heart disease in 1970 were just shy of 800k per annum. As of 2010, it was about 600k. A 25% drop in the leading cause of death, in less than a generation. Life expectancy was 70.8 years in 1970, and 78.7 in 2010 - an increase of more than 10% in a single generation.
Science isn't a process that moves along by weeks, months, or even years. It's something that moves generationally, and our society has made impressive strides.
You're welcome to be skeptical - science would die without that. But be the "loyal opposition," not a casual cynic: help the process improve, don't discard it as some political shell-game. Lives are in the balance.
I think you and arkades both have it right. It's a "politicized agenda-propelled random search" on a large enough scale and over a rich enough search space that it "has made impressive strides" despite its flaws and inefficiencies.
I have a friend who works as a Healer. People come to him and pay him good money and he gets results. He doesn't advertise, he gets referrals by word-of-mouth alone. My point is he gets results.[1] He can do things that are totally off the map of conventional medicine. However, he's uninterested in science and scientists (in general) are uninterested in him. "It's something that moves generationally" indeed, if paradigm shifts really require the dying out of the old guard.
If we think of inefficiencies in the search due to e.g. politics and superstition as a kind of malady, then it seems we are witnessing a phase of "Physician heal thyself", what with the advent of mass medical monitoring and big data correlation, eh?
[1] Have you heard the joke, "If alternative medicine works it's just called medicine."? Well, yes and no. Some things that work are too far outside the belief structures and will be ignored or ridiculed.
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.
And I would also add one of my favourite pseudo quotes: "science advances one funeral at a time." -- Max Planck
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.
> researchers led by Paulina Salminen randomly assigned 530 patients that showed up in the hospital with an acute, uncomplicated appendicitis to get either a standard, open surgery to remove their inflamed organ or a course of antibiotics. (By “uncomplicated,” the authors mean there weren’t other issues like perforation, abscess, or suspicion of a tumor.)
although if your appendix is already perforated then it's a bit late to try to prevent it from perforating by cutting it out, so fair enough.
And of course surgical clean-up of the abdomen must follow, along with a big pile of abx.
Ended up having an emergency appendectomy that night.
Although they told me afterwards, but the surgeons were extremely competent so I don't question their judgement.
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!
That kind of wrongful termination sounds like something that would happen in the States not Europe. Correct me if I'm wrong.
It's really hard to separate 'doing a rain dance' and 'just waiting' when you have a sample size of 1.
(I'm assuming you're in the US or somewhere like it where an appendix removal isn't free)
http://www.chicagotribune.com/news/ct-xpm-2002-09-01-0209010...
> A US Special Forces soldier bought fish antibiotics at a pet store to treat his sinusitis. It did not work out.
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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.
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. I don't actually know anyone who has done this, so it may be just rumor. I do know people who have used aquarium antibiotics, because their copay for a $150 office visit is $150 until their $8000 annual deductible is met. US health care is bananas.
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?