Earthguy69 t1_j23l3m6 wrote
Reply to comment by Fetlocks_Glistening in TIL of Dick Roth, a swimmer who was diagnosed with appendicitis shortly before the men’s 400m individual medley in the 1964 Tokyo Olympic Games. He refused an immediate operation and instead swam in the finals, winning a gold medal. by alexjpg
I mean a young guy with pain in his lower right stomach, there isn't much else that it can be.
In my hospital we wouldn't do an ultrasound, we would just operate if the blood samples also show some inflammation.
Fetlocks_Glistening t1_j23lvuk wrote
So no overlap with IBS, or excessive gas, or, I don't know, an ulcer in the right place? Or a sports injury, muscle/tendon stuff or hernia?
Earthguy69 t1_j23peth wrote
>So no overlap with IBS, or excessive gas
When you palpate the abdomen there is a big difference between gas and ibs. Also the history. In modern times you can also take blood samples. Ibs or gas doesn't cause a measurable inflammation in the blood.
>, or, I don't know, an ulcer in the right place?
An ulcer the lower right abdomen (meaning large intestine distal part of the small bowel is extremely uncommon, especially in a previously healthy young male.
> Or a sports injury, muscle/tendon stuff
Again, when you palpate the abdomen an injury will be different from an appendicitis but again you can take blood samples.
> or hernia?
A hernia is something you would feel. It's also not something you get in your abdomen in that place. It's usually in other places. It's also not super common for a a young adult to suddenly develop it. If the hernia gets strangulated the pain is extreme and would warrant operation regardless.
Illustrious-Scar-526 t1_j24h4c8 wrote
So in your opinion, how much pain do you think dick was in? Sounds like it hurt but it wasn't full blown appendicitis hurt. I have never experienced it, but I have had people describe it to me so I can't imagine anyone would be able to move much. My friend told me he collapsed while trying to get out of a car when it happened, and he couldn't move and an ambulance was required.
Then again, some people are crazy and can just ignore pain like that when their goal is on the line, especially anyone who aspires to be an Olympian or professional athlete.
Prinzka t1_j25m8zc wrote
>Sounds like it hurt but it wasn't full blown appendicitis hurt. I have never experienced it, but I have had people describe it to me so I can't imagine anyone would be able to move much.
That's actually one of the things that made it difficult for the doctors to diagnose me.
They said normally with acute appendicitis people are in so much pay they're literally unable to move.
I traveled for several days even after it burst. So when I just walked in to a doctor's office they didn't think it could be that.
Prinzka t1_j246fnk wrote
>In my hospital we wouldn't do an ultrasound,
Really?
For me they did ultrasound and x-ray.
And my appendix turned out to already have been perforated.
Earthguy69 t1_j247omu wrote
If it's an uncomplicated appendicitis doing an xray is really unnecessary. It's lots of harmful radiation to a young person.
If the person has gone with it for days, have highly elevated inflammation markers or peritonitis, then yes doing an xray is indicated to see if there is any complications that could affect surgery.
ost123411 t1_j248duf wrote
I don't think the concern with doing a single xray for possible appendicitis is radiation exposure..
Earthguy69 t1_j25a0f0 wrote
It certainly is. You are doing a CT scan. 1/200 statistically get a cancer later in life that can be attributed to the scan.
ksdkjlf t1_j25d9u5 wrote
You're off by an order of magnitude. Per the FDA:
"A CT examination with an effective dose of 10 millisieverts [an abdominal CT averages 8] [...] may be associated with an increase in the possibility of fatal cancer of approximately 1 chance in 2000. This increase in the possibility of a fatal cancer from radiation can be compared to the natural incidence of fatal cancer in the U.S. population, about 1 chance in 5 (equal to 400 chances in 2000). [...] If you combine the natural risk of a fatal cancer and the estimated risk from a 10 mSv CT scan, the total risk may increase from 400 chances in 2000 to 401 chances in 2000."
400 in 2000 to 401 in 2000 is a change of 20% to 20.05%.
One abdominal CT is not "lots of harmful radiation".
ost123411 t1_j2932xo wrote
Much higher chance of dying during appendectomy than developing cancer from a single CT scan
Earthguy69 t1_j2978ji wrote
Not at all. You have a higher risk of dying driving to the hospital than doing the surgery
ost123411 t1_j297gkm wrote
You are drastically overestimating the level of risk involved with a single CT scan
Prinzka t1_j248jr0 wrote
My point is that your comment was like "oh you know immediately that it's appendicitis no need to check just start cutting".
And that's just not the case.
Both the x-ray and the ultrasound were to find out what the actual problem is.
Earthguy69 t1_j25aahg wrote
No, that is literally how it is.
An ultrasound can never say it's not appendicitis. Most often an ultrasound doesn't show it.
Doing a CT scan is just giving a young patient a lot of unnecessary radiation.
The medical legal climate in the US might be different but in most places they do not do a CT scan because the presentation is so obvious.
How long have you worked in the ED?
Prinzka t1_j25bz8i wrote
I know you're trying to argue from a position of authority so that you can go "hah see I've worked in X profession longer!".
I never said that I do this in a hospital.
I have no clue what an ultrasound can show in these cases.
What I'm saying is that after MY appendix perforated they did not know what it was.
All the tests they did included doing an ultrasound and an x-ray.
They didn't tell me what each test would specifically look for.
Just making the point that it's not an automatic cut and dry "oh that's acute appendicitis".
Especially if you've got someone with high pain tolerance.
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