Epidurals are a miracle technology
worksinprogress.co
worksinprogress.co
Will go for minimally invasive micro laminectomy next, tired of treating symptoms and not the root cause.
In that procedure surgeon will remove parts of lower vertebrae that is pinching the nerve bundle, nerves that progress down each leg.
Success rates of better than 70%, it's a gamble. But willing to accept that rather than end up on addictive pain pills for life.
3 to 6 months recovery period before active lifestyle again, cannot risk disturbing the "fix". Giving up flip turns in lap swimming for quite a while. Supplemental covers the other 20% that medicare won't pay.
Cash paying patients suffer $35k to $45 K for the procedure.
Medicare pony's up only about $6,500, which the surgeon must accept, no extra cash changes hands.
Supplemental covers the 20% that medicare will not pay.
Steve Kerr's advice after his own back surgery complications (albeit microdiscectomy, not a laminectomy) make me hesitant:
"If you're listening out there, if you have a back problem, stay away from surgery... Rehab, rehab, rehab. Don't let anybody get in there."
You acknowledge the parent commenter knows more than you, but you decide it's somehow helpful to post contradictory information anyway sourced from someone else who also likely knows more than you.
But if you have nerve problems caused by an issue with your spine, you probably want to address them before they become worse or irreversible, and back surgery may end up being the only option.
Don't get me wrong. I support state-sponsored health care, especially after moving from the US to Norway over a decade ago. Just the peace of mind not having to worry so much about financial ruin because of health issues relieves so much stress - even stress related to just keeping yourself healthy is less (If I get hurt while jogging, it isn't a big issue, for example) But fixing the US system is bigger than just payments or insurance for all. Gotta fix things like education costs, the burden of unpaid internships, and things like that, too. I wish it weren't such a complicated problem and I wish there were the political desire to do such a thing.
It’s kind of like our industry - the higher comp is a big reason behind how the US attracts talent from all over the world.
Not every country is in contention, as even if, for example, Hungary has the best medicine program, very few people are gonna learn Hungarian just to attend the university. The same argument applies for every country which requires a non-english language for admission.
US software devs also make 2x what their European colleagues do, but that never gets called out as bloat. Plus US software devs make that 2x pay without taking our additional loans for medical school at the rate of $75k per year or doing years of low pay residency where their salary doesn’t give them the means to pay off those loans.
(Not in the medical field at all)
Of course it does. And it gets acted on. Every major corporation in America has explored or implemented moving to European or other foreign developers to save costs.
Developers also don’t have the advantage of a trade group that prevents this practice, requires particular education or limits the number of people allowed to get that education.
Unpaid time off and possible job loss if you have medical issues that require you to be off work? They still worry about health insurance and things like that. Poor work/life balance, no promise of using vacation time, especially weeks at a time? The worry of lawsuits? Little to no job security?
Money isn't everything. Money can't really buy the quality of life that legal protections can - it is harder to lose legal protections.
in that case you should double check your math, because it doesn't work out like that
> If doctors cannot pay back their student loans, it doesn't matter.
this is plain dishonesty. there have been actual discussions on how a significant number of physicians in the USA retire or semi-retire in their 50s!
Don't completely trust any anesthesiologist (pain management) or neurosurgeon (for surgery) or chiropractor or random folks advice to do yoga/stretch. Spend quite a bit of time understanding the anatomy, read up on everything and maybe you will find the right set of exercises to help relieve pain. Troubleshooting disk/spine/nerve issues is very hard and most doctors don't have any time to investigate it deeply. They just look at MRI. There are lots of people with the same problems showing up on MRI, but they are pain free.
Sorry to hear about re-herniation. Thats what I am concerned about. I have multiple disc herniations, one with cauda equina. Multiple neurosurgeons have recommended surgery, but each is going to do a different procedure. I understood as they don't fully understand whats the root cause, everyone wants to do the procedure they are comfortable with and what they've been doing. One wants to cut the disc, another remove lamina, another fusion and something else. I decided its not worth taking the risk when they don't know what they are doing. There are so many reports of failed back syndrome, revision surgeries, cascading failures (because it increases pressure on adjacent discs).
> with the caveat that many physios don't seem to know what they're doing either
Yes, this is true of nearly any profession. We just have to spend significant time researching and troubleshooting with an engineering mindset.
But there are some good ones. I had one 15 years ago - a lady from Japan who was an absolute wizard. She changed my life completely - not by "doing" anything, but instead teaching me how the body actually works and helping me to awaken many dormant muscles. The closest I've found since then is moveu.com - weird guy, but he knows his stuff and has the right approach (that only we can fix ourselves, and he can only educate us on how to do so).
I have not requested serious pain pills, applying clove oil (eugenol) mixed with benzocaine all over the lower back and buttocks, (lidocaine 5% is useless) wait 10 to 15 min, then can arise in morning from bed for a day's work, yet nagging pain most of day. I refuse OTC NSAID's as they can damage the heart over time. My spinal X-ray looks like an F1 racetrack. Doc says scoliosis, yet no one in my family has this genetically. At some point it just get's so frustrating you start to realize that surgery may be the only way out. Spoke to an 80 year old once who said he had the procedure, they had him up and walking the hospital floors after he awoke from the anesthesia, let him go home next day (I guess his was uncomplicated and straightforward).
Check out moveu.com - it's cheap (and free to start if you want for their drip marketing to send you a coupon code) and full of excellent information, videos, community etc for fixing yourself. I have no affiliation - just a happy user.
Many people have been able to fix situations that the butchers (surgeons) assured them they could only treat with surgery. And there's many more who have had spinal surgery who say they're now stuck for life with a terrible situation.
I don't bring this up to say that actually Epidurals suck, just to bring attention to the fact that they can fail, and that the system has historically handled such failure really poorly, and that the system itself isn't very well aware of this issue. This isn't just opinion from some podcast, but also admitted by the professionals working within this field.
It's also something valuable to be aware of when you or your partner is planning to have an epidural, because there is real space (and even a need) for advocacy for the patient when an epidural fails and the woman giving birth is in excruciating pain.
> The result is unnecessary birth trauma.
Not trying to be snarky, but which is it? This is definitely a situation in which having a midwife there to advocate for you is an absolute plus.
The consensus seems to be shifting more towards converting to general anesthesia after epidural failure unless there are very clear reasons not to.
That sounds absolutely horrible for that little creature. Yet I am a man, so I really am not allowed to speak on the matter and I absolutely let my wife decide entirely on the matter by herself (we had absolutely no time for an epidural, my wife delivered both kids way too fast)
> Newborn oxytocin levels were higher in the umbilical artery vs. umbilical vein, and both were higher than maternal plasma levels, implying substantial fetal oxytocin production in labour. Newborn oxytocin levels were not further elevated following maternal intrapartum synthetic oxytocin, suggesting that synthetic oxytocin at clinical doses does not cross from mother to fetus.
In other words, the fetus makes its own oxytocin during labor. It does not come from the mother.
[1] https://link.springer.com/article/10.1186/s12884-022-05221-w
I have no clue, but that's a big relief.
disclaimer: I know nothing about this
[1] https://www.bbc.com/future/article/20260401-women-were-never...
The hospital only had two rooms suitably equipped for giving birth in a squatting position, so I was lucky to get one second time.
Seems to depend a lot on the hospital. We (partner is pregnant with a high risk pregnancy) were at a level 1 prenatal care center in Germany a few weeks ago where they very much insisted that in her and the child's condition, a c-section is pretty much her only option.
We're now in a different, also level 1, prenatal care center, also in Germany (though a different state), where the prevailing medical opinion is "natural birth should work perfectly fine for you. We're not ruling out a c-section in case things go sideways, but natural birth is very much our preferred option in your case."
The first center seems to be quite keen on using as many cases as possible for training their staff in c-sections, even where it's not strictly necessary/beneficial. At least that's what we've heard from other parents in similar situations.
The first place might have a strong surgical team and might be inclined to solve everything via surgery?
There were no complications at all, but both were as the doc put it "large" so my sister was given a choice.
Note that per Wikipedia [0], death by abdominal surgery in general in High-HDI countries is on the order of 100-1000/100k.
Obviously, I'm only a spectator, but the overall experience seemed way less traumatic and stressful for her with the natural child birth, working with midwives and nurses rather than doctors.
Also, it can be difficult for women to remember the finer details of the pain because the hormones after birth specifically function to cause a kind of amnesia. (The hormonal effect on memory isn't unique to pregnancy or women, it's just rarely so pronounced as at child birth.)
We've had two kids, the first my wife had an epidural (after rejecting it twice before expressly demanding one unprompted), the second without. The first birth lasted, IIRC, over 20 hours at the hospital (not counting initial time spent at home), and we had long conversations with various maternity nurses and our doula about women's experience with child birth. The hospital's nurses were on strike so our nurses were from around the country with experience with all different kinds of hospitals and populations.
So it would be interesting to see the elective vs crash ceasarian rate.
Because the statistics still include all those variations. The variations are also not that huge, and are also independently studied.
You might as well ask how we can talk about the risk/safety of general anesthesia, given that different hospitals and even different anesthesiologists use different drugs.
...do you think that same commitment might have shown up in other ways in her parenting? such as in the foods she fed her child, or the activities she encouraged that child to do?
man, I remember when I used to come to HN because the average intelligence level of the comments was higher than it was on reddit.
It made it emotionally difficult to get surgery again.
> These have indeed an appearance of wisdom in promoting rigour of devotion and self-abasement and severity to the body, but they are of no value in checking the indulgence of the flesh.
Meaning: sure, looks good, but doesn’t actually help if the suffering itself is your goal.
(Notwithstanding this, Acts 5:41. A lot, in such topics, depends on exactly how you present things.)
Compare this to cows or horses - where the baby is of sizeable size, but goes statistically smoothly.
first, childbirth is fucking dangerous. Its also unnecessarily painful. In terms of risk[1], the epidural is not the thing thats going to cause "morbidity", its the baby coming out breech or massive internal bleeding.
A non insignificant number of women literally tear themselves a new arsehole when delivering a baby. Yes elective caesarians can carry higher risks, but also might be required to actually deliver a live baby, or save the mother.
THe problem for the statisics is that there is a difference between elective caesarians and emergency once. If you group them together, then you're going to get a higher mortality/morbidity rate, because there’s a reason why it was an emergency
Personally I have no fucking clue why people wouldn't want an epidural. My wife didn't want one the second time because "she wanted to get home quicker" (by a fucking day) it turns out by her own words: "it was way way more painful without the epidural" bear in mind shes a fucking doctor, and a paediatric one at that.
[1] Women of African origin in the UK have worse outcomes in child birth, partly because of the lower uptake in pain relief.
This seems just plain wrong. It is not at all extremely biologically conserved.
Pregnancy and birth varies wildly across species. Not conserved. For primates, it's got problems; in humans, pregnancy is an absolute mess. The birth itself is historically one of the most dangerous things a woman can do, and remains not exactly a walk in the park even with the best of modern interventions.
Does the popularity of cancers as one ages mean we should just let people die because Nature Always Knows Best?