Friday, 7 June 2013

Appendicitis


The most common operation I perform (by far) is an appendectomy.  I make a 1 cm (that's less than 1/2 inch - ok, that's the absolute last metric conversion I'm doing!) incision at the umbilicus (that's the belly button for the 99% of you illiterate in Latin), another tiny 1 cm incision on the left side of the abdomen, and a 0.5 cm incision on the lower abdomen.  A camera goes through the first incision, instruments go through the other two, and the appendix comes out in a nice clean plastic bag about 8-10 minutes later.  Most patients go straight home from the recovery room, and those that don't typically go home the next day.  It's a very satisfying little operation, mainly because patients feel so much better so quickly.   It's a beautiful operation, but one that I hate doing at 2 AM.

I think that most everyone has heard of this disease, since not a single patient of mine has asked me "What's appendicitis?" when I've told them they have it.  But I'm constantly amazed that more people don't ask what the appendix is for.  Come on, people!  I'm removing a piece of you!  Granted it's a little piece (about the size of your little finger), but aren't you the least bit curious to know what the thing does and what's going to happen to you when you don't have it anymore?

If you're really curious...well, tough.  The truth is that no one really knows.  There are several theories out there, and most of them sound like complete and utter rubbish.  Some researchers a few years ago announced that they believe the appendix acts like a "safe haven" for good bacteria which can then recolonise the colon after an infection, essentially "rebooting" the colon.  That sounds like a very nice theory, doesn't it?  That's wonderful!  The human colon has a reset button!  It's great, except for one problem - it doesn't.  The bacterial flora of the appendix is exactly the same as the rest of the colon.  This theory sounds like a bunch of shit to me.  Pun intended.

Other researchers believe that it has some immune function, especially in fetuses.  This theory is at least partially true - there is some immune tissue in the appendix, but when you look at all the other immune tissue you have, it's a tiny fraction, so it certainly doesn't contribute a whole lot.  It's like peeing into a pond.  Sure, you might be adding more water, but it's undetectable.

Most people believe the appendix is a vestigial organ - one that used to serve an important function but doesn't anymore due to evolution (THAT'S RIGHT!  EVOLUTION!  COME AT ME, CREATIONISTS!  Please?  Pretty please?).  It may have contributed to digestion in some manner back when cavemen ate roots and leaves, but it doesn't need to do a whole lot with the burgers and pizza that we stuff into our faces these days.

So the bottom line is that we don't know.  Regardless, that doesn't excuse the fact that most people don't even ask.  For those rare few who do ask me, I have my own theory, one that I think very few general surgeons would refute:

The sole purpose of the appendix is to keep general surgeons busy and awake in the middle of the night.  Fuck you, appendix.  Fuck you.

16 comments:

  1. I hope that metric conversion thing was a joke. Otherwise I'll need to learn how many pounds in a kilogram and whatnot.

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    Replies
    1. Congrats! You will soon be moving on to a more logical and cleaner world.

      Delete
    2. Roughly 2.2 pounds per Kilogram. If you're using Windows XP/7 (I can't confirm for 8, I don't use it), the Windows Calculator has a unit conversion mode you'll find quite nice.

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    3. I actually use an iPhone for all my docbastard needs. I'm sure there's an app for that though. :)

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  2. I'm inclined to go with the vestigial theory. They once suspected appendicitis in me, but it turned out I wasn't even born with one. So it can't be that important.

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  3. Hey SkyGuy32, I just read your profile and realized that I, at 14 years old, am not the youngest reader of this blog (you might be). I am currently in an unspecified location in Texas, and I like to play flight simulators in my free time. By the way, you should upgrade to Microsoft Flight (it's free) and try out Orbiter Spaceflight Simulator.

    ReplyDelete
    Replies
    1. I heard that MS flight was bad, and I'm happy with the ATC and flight dynamics of FSX. The trailer didn't make it seem like they focused on realism as much as action. I think I'm also going to get Kerbal Space Program, but I'll check out Orbital Spaceflight Simulator.

      As for being the youngest reader, I doubt I am. I might be the youngest commenter though.

      Delete
  4. OK, here are some pretty accurate metric conversions:
    0.62 mi=1 km
    1ft 3.37 in=1 m
    0.39 in=1 cm
    2.2 lbs=1 kg
    4.23 cu=1 L
    2.24 mph=1 m/s
    The similarity between the mph-m/s and kg/lbs ratios is a coincidence.

    ReplyDelete
    Replies
    1. Shouldn't the ft/m be 3 ft 3.37 in = 1 m?

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  5. This comment has been removed by the author.

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  6. Had suspected appendicitis last Thursday. Worst pain ever. I was loaded with tramadol, but I was on agony with each deep breath or move. Suprise suprise the pain went& I flee the ER. I have mild pain in my RLQ radiating to the back on and off, but it is nothing compared to the previous pain. Still no clue what it is. I bet the surgeon who came to see me, had the same explanation, that or he enjoy torturing people.

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  7. I think maybe the reason people don't ask is that they already know it basically does nothing. I remember learning very early in school that the appendix is a vestigial organ, it's what they use as an example of a vestigial organ when you learn that term.

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  8. I had my appendix removed when I was 8 years old & even by then I knew that it didn't really do anything overly important.
    "Funny" side part to this story... My Mom thought I was faking a stomach ache to get out of cleaning my room & it took nearly 3 hours of agony, rolling around on the bathroom floor, for her to take me at my word & bring me in.
    The surgery I had was different than the one you mentioned, though, Doc... My incision was over 3 inches long & I was placed on a morphine push for 2 days afterward (AT AGE 8! I still have trouble believing that). I wasn't allowed to leave for nearly a week. I remember a high fever & some kind of tube coming out of the incision for the first day or so. The memories are a bit fuzzy. Maybe there were complications that they didn't explain to 8-year-old me? If so, do you know what they might have been?

    ReplyDelete
    Replies
    1. You had yours done open (rather than laparoscopic), and it sounds like your appendix ruptured and/or you had an abscess.

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  9. I had my appendix removed two months after my daughter was born, and after a party for my dad's birthday. I had eaten all the leftover cake when I started experiencing some wicked bad pain in the lower right quadrant. I was a single mom so before I could see the doctor, I had to struggle to the store, doubled over in pain, for milk and diapers and money for the babysitter.

    By the time I got to the Dr's office, he took one look and called an ambulance. I was thisclose to rupturing when they got me into surgery and it was pretty touch and go for a few days - I was in hospital for 5 days. It was also one of the few times I really regretted being a single Mom with two kids 15 months apart in age. Thank God I had people to help take care of us while I recovered!

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