nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
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Tuesday, June 29, 2010

Doctors Get Sick, Too - My Appendicitis Story

 
For thirty years, I managed to catch everything patients came to see me about.  Or so it seemed.  But appendicitis isn't contagious.

This is a lesson in how to make poor health care decisions.  You'd think that after all those years of education, I would know better, but one of the things they drummed into our heads is, "Never treat yourself or your family," because it's impossible to be objective...or, as objective as you need to be.

We'll get to that, but the most interesting part of all this was to watch and observe myself in all this.  It sounds weird, and I'm not saying it was an "out-of-body" experience, just that there was a part of my mind that was watching this unfold, and fascinated by the whole thing.

The saga began one evening, before bedtime.  Patients over the years have described the onset of serious illness as if there was a perception that "something" was happening or about to happen.  They say that they "ate something wrong", or "didn't feel quite right" or "worked out too hard" etc.  I think their perceptions are just a "hindsight" phenomenon:  we look to find reasons and portents for things, even when there aren't any.  Not for me.  There was almost a sudden onset of right-sided abdominal pain.  Not stabbing, just an ache that was not there one second, and there the next.

Side note:  I was 52 years old.  Most people who get appendicitis are in their 2d or 3d decade.  That's true, BUT, there is a blip in the curve in the 50's, where there's an increased risk.

It wasn't severe, and at first I thought little of it.  But it persisted, and got somewhat worse.  In an hour or two it became tender to push deeply over it. 

Side note 2:   the pain of appendicitis is not very specific--in the beginning.  Usually patients will describe a diffuse abdominal pain, and there may or may not be tenderness.  At first, it may be indistinguishable from your basic intestinal "flu"  (there's technically no such thing, that's just what everybody calls it, or "the crud", etc).  But not always.

But, I had a nagging suspicion that something wasn't typical.  I've had cruise-ship virus, stomach flu, gastritis, etc. multiple times over the years (thanks to those patients I mentioned...no matter how often you wash your hands, it's gonna get ya, eventually).  I've had 'em all, and this didn't feel like any of that.  It wasn't a colicky pain (rising and falling, like cramps--caused by stones, kidney or gall bladder).  It was steady.

So, here I am, its 10PM, and I think this may progress.  I'm already thinking "appendix."

Side note 3:  Many will experience nausea and vomiting...and a low grade fever.  But not always.  And not me.

It's decision time.  Go to the ER, or wait.   I knew the local ER, and expected that, at this time of night, I would be among a dozen belly pain patients who would wait for some hours while all the gunshot wounds, auto accidents, and heart attacks slowed down the care for the less urgent.   The place would clear out about 3 or 4 in the morning, and the staff would start going through the other patients waiting.

So, hurt there, or hurt here.  That was the choice.  I was getting more sure that this was appendicitis, but (in my arrogance) I knew it would take at least 12 hours to get really "hot."   And until that time, the chance of rupture was small.  If rupture occurred it would be bad, bad, bad...

So, I got the heating pad and some acetaminophen, and went to bed.  It was not a restful night, but bearable.

By early morning, the situation seemed clear.  I had point tenderness in the right lower quadrant with rebound (where it hurts more when you let go, than when you press in on the abdomen...a sign that inflammation has spread to the lining of the belly.)

So, I approached my spouse and said, "I have appendicitis and need to go to the ER."  After several minutes of "You dumbass", and "why didn't you tell me" etc, and so forth, it was time to go.  I checked my diagnosis by consulting a friend and he agreed. 

At the ER I had timed things perfectly:  a weekend morning when the place was empty...and before the weekend rash of miscellaneous stuff began to pour in.  It took 2 minutes to be taken to an examining room.  The surgery resident asked where it hurt and I pointed with one finger to McBurney's point.  He said, "Well, that's pretty specific."  (McBurney's is the focal point for pain when an appendix is fully hot...but not always.)

Side note 4:  Nobody likes to wait.  Years of ER duty had taught me how the ebb-and-flow of care worked.

From there, things happened fast.  Pre-op sedation 30 minutes later.  Next thing I know I'm in up on the floor, and the nurses are poking me, saying, "breath deeper."  Apparently the docs got a little heavy with the narcs, and my blood oxygen saturation would drop every time I nodded off.  But that wore off in a few hours.

Next day I was eating and went home.  Total hospital time 24 hours.  Fast, huh?   Here's the explanation:  I had my appendix taken out through a small incision in the belly button with a fiberoptic scope.  That way you don't upset the rest of the GI tract, which tends to shut down for a few days if you mess with it.

I had a wound infection several days later, but that was no biggie.  Things went well and I was eating and up and around almost immediately.  The surgeon told me later that I timed it narrowly; when he got the appendix out it was about to rupture.

There are some big lessons here.  AND IT'S NOT THAT YOU SHOULD SIT ON YOUR SYMPTOMS UNTIL YOU'RE SURE IT'S DEADLY. 

1.  Appendicitis is still one of the most difficult diagnoses to make.  Scans have made it easier, but all the rest, the symptoms and signs, can fool you big time (gall bladder, kidney stone, flu bug...a long list).  Note how many times I said, "But not always," above.
2.  There's a time when making your own decision about seeking care is reasonable.  There's a time when you need to give up control and seek help (as I failed to do...a couple of more hours and "pop" goes the appendix).  I've seen too many heart attack victims (usually me) who had been having warning pains for weeks.
3.  Many operations that used to require major incisions and long hospital stays are now done with minimally invasive techniques and recovery is much quicker.  The sooner you are up and around the less likely there will be complications.

So, did I learn my lesson?  Probably not, I'm still the same person.  And the story played out again last year when I needed back surgery:  I waited until I was absolutely sure there were no other alternatives and it was the right thing to do.

I am convinced our bodies are marvelously designed to do the job, and you shouldn't mess with it unless absolutely necessary.  I always undergo conservative therapy first, I get second opinions, I research the medical literature and learn the latest on my condition.

And so can you.

Doc D
 

2 comments:

Anonymous said...

Ahh, yes, Appendicitis! Have I got a near-horror story for you! When my older brother was 13 yrs old, he had horrible experience with this. Lucky for our family (mom, grandparents and the four of us kids), we all had the same doctor who happened to be one of the best diagnosticians of his time. Before the doctor went into family practice, he also was an OBGYN and delivered me - the last of my mother's four children.

Anyway, I digress! My brother woke up sick one morning, and if my memory serves me right, symptoms came on fast for him - nausea, severe pain in the "McBurney's Point," and a low-grade fever. So, Mom took my brother to the doctor, and the first thing he said after my brother told him his symptoms was "You have appendicitis, son!" So, off they went to the nearest ER after a call to a pediatric general surgeon.

Unfortunately, the surgeon decided to put my brother through those horrible examinations, especially that lovely barium enema. Needless to say, the surgeon couldn't decide for sure that my brother's symptoms pointed to appendicitis and sent him home! My mother and grandmother played "round robin" with the same pediatric surgeon for nearly a week saying the same thing - just the stomach flu!

So, by the time our family doctor saw my brother a second time, he called the surgeon and threatened to have his medical license pulled by the state if he didn't "get that boy into surgery .. NOW!" To make a long story short, my brother had surgery to remove a badly infected appendicitis which had just barely ruptured and caused peritonitis. My brother spent ten days in the hospital and three months at home recovering from the entire ordeal. Thankfully he survived! I don't know what happened to the surgeon, but my mother refused to pay the bill because of all the crap she had to endure.

What did we learn from that experience? Always due a professional background check on any doctor who refuses to listen to his patients. AND - ALWAYS get a second opinion!

Doc D said...

Your brother was lucky. There are cases where patients have symptoms for long periods before surgery (I once had a guy who "walked" in--hunched over--after 3 weeks of pain. At surgery, what a mess). More often they crash and burn quickly.

When I was in med school there weren't any scans or MRI, and appendicitis was considered one of the most difficult diagnoses to make with any certainty. If you took out a normal appendix about 15% of the time, that was about right in order to not miss a "hot" one.
D

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