10 ms·

Frail Older Patients Struggle After Even Minor Operations

88 points by vo2maxer 7y ago

dr_ 7y ago
Ironically, some of the newer value based initiatives, such as BPCI, along with changes to the post acute skilled nursing reimbursement, is actually decreasing the amount of time and care some of these elderly could benefit from post operatively to enhance their recovery. If we allowed our elderly Medicare patients to go into a rehab unit for the amount of days they need, without requiring a 3 night hospital stay first, I wonder the impact this would have on morbidity and mortality, especially after minor operations.
taxicabjesus 7y ago
It seems to me that there's something wrong with medicine, but I haven't quite figured it out yet. My recent submission [0] was about how the system defaults to expensive treatments that are marginally effective, and that doctors frequently have no ability to provide what patients actually need. My one grandfather died soon after his pacemaker was replaced - the wounds from his IVs became infected. I like to say that when he heard the doctor ask him if wanted his pacemaker replaced, he said to himself "this is my chance": If not for the surgery he certainly would have lived many more months while the battery gave out... [0] https://news.ycombinator.com/item?id=21728864 https://news.ycombinator.com/item?id=21728864
- trevyn 7y ago
  A thread to pull on: How does medicine work outside of developed countries?
  - BurningFrog 7y ago
    Yeah, there are many alternative medical systems in the world today, but Americans usually know nothing of them.
  - hycaria 7y ago
    Yep I'm always astonished at how these things are taken for granted.
- throwaway5752 7y ago
  I hate to be short with someone, but did you bother to read this? I mention it because of, Moreover, living longer is not older people’s only concern, or even their primary one, Dr. Rosenthal pointed out. “We don’t ask patients often enough, ‘What’s important to you?’” The primary though should be understanding what the patient wants. The patient might accept risk of death for quality of remaining life. That is a classical dilemma for a pacemaker in the eldery. And it is simply a calculated, rational risk. The problem is when patients are not given the all their options and realistic risk for each (including the risk of no action). edit: and I take this for granted, but a pacemaker can improve quality of life substantially. When it corrects a heartbeat it can prevent vertigo, falls, broken bones, and any other number of incidental effects of irregular rhythm. It is not a defibrillator.
- tyri_kai_psomi 7y ago
  What if this is medicine working as intended? "Frail older patients" wasn't even a word in anyone's vernacular 50 years ago, you just died if you were in that state. This is a result of us pushing the boundaries of what current modern medicine is capable of doing. Now there are more people living longer that, quite frankly, wouldn't have in earlier environments. In a way we are bypassing selection for "strong older people"
alexpetralia 7y ago
Non-paywalled: http://archive.is/i9UUp http://archive.is/i9UUp
- mirimir 7y ago
  PSA: In Firefox, enabling reader view, as soon as the page has loaded, avoids the paywall. And not just for NY Times. Add-ons like DOM delete can also help.
- paulcole 7y ago
  This works, too: https://www.nytimes.com/subscription https://www.nytimes.com/subscription
  - mirimir 7y ago
    I bet that they don't accept Bitcoin, Monero, etc. Or even cash by mail.
    - onetimemanytime 7y ago
      Yeah, that is stopping 99.99% of people from subscribing /supporting great journalism.
      - mirimir 7y ago
        I subscribed once, in meatspace. It took over a year to get rid of them, after they kept jacking up the price. I will never again give them a card number.
hanoz 7y ago
I once overheard a doctor say something which has always stayed with me, along the lines that after a certain age then once you're off your feet for any length of time, then that in itself puts you in big trouble.
- JshWright 7y ago
  This is why hip fractures are often "the beginning of the end". When someone over the age of 65 breaks their hip, there is a ~50% chance they'll be dead within a year.
  - peeters 7y ago
    Do you have a source for that number by chance (assuming it wasn't just off the cuff)? I understand and don't argue the idea, but 65 isn't passing my smell test, that seems absurdly young.
    - luu 7y ago
      This study claims 28% mortality, 46% moderate-severe disability, 26% able to live independently after one year. https://www.ncbi.nlm.nih.gov/pubmed/31810636 https://www.ncbi.nlm.nih.gov/pubmed/31810636 METHODS: Older adults aged ≥65 years were included if they had an isolated hip fracture, were admitted to hospital between July 2009 and June 2016, inclusive, and were registered to the Victorian Orthopaedic Trauma Outcomes Registry. Mortality up to 12 months (365 days) post-injury, and functional outcomes (Glasgow Outcome Scale-Extended; GOS-E) at 12 months post-injury were examined. Multivariable Cox proportional hazards regression was used to estimate adjusted hazard ratios (aHRs), and multivariable logistic regression was used to identify predictors of living independently compared with severe disability or death on the GOS-E. RESULTS: 4,912 patients were included, of whom 28% died, 46% had moderate-severe disability, and 26% were living independently 12 months post-injury. Mortality rates were lower in women (aHR=0.56, 95%CI: 0.50, 0.63), and in people injured in a high fall vs low fall (aHR=0.47, 95%CI: 0.31, 0.72). Mortality rates were higher in people in the older age groups (75-84 years: aHR=1.53, 95%CI: 1.21, 1.93; 95+ years: aHR=3.58, 95%CI: 2.68, 4.77), living in areas with the highest level of socioeconomic disadvantage (aHR=1.25, 95%CI: 1.01, 1.55), with a Charlson Comorbidity Index weighting of one (aHR=1.60, 95%CI: 1.36, 1.88) or more than one (aHR=2.21, 95%CI: 1.94, 2.53), whose injury occurred in a residential institution versus at home (aHR=2.63, 95%CI: 1.97, 3.52), that resulted in intensive care unit admission (aHR=1.68, 95%CI: 1.21, 2.32), and in people who did not have surgery versus people who had internal fixation (aHR=1.65, 95%CI: 1.33, 2.04). Independent living was inversely associated with most of the same characteristics; however, people also had lower odds of living independently if they were from metropolitan residential areas versus rural areas (aOR=0.77, 95%CI: 0.62, 0.96), or had mild to moderate (aOR=0.33, 95%CI: 0.27, 0.39) or marked to severe (aOR=0.13, 95%CI: 0.09, 0.20) preinjury disability vs no preinjury disability. Relatedly, this study from the same institution claims 5% mortality rate after a year for people under 65: https://www.ncbi.nlm.nih.gov/pubmed/27527378 https://www.ncbi.nlm.nih.gov/pubmed/27527378
mrtweetyhack 7y ago
Shocking!
throwaway5752 7y ago
This is one of the key benefits of the all the new generation of health care sensors, particularly as they mature and hit clinical/FDA approved levels. Obviously, you heal worse as you get older. But as noted in another comment, just being bedbound can be deadly. But further, hospital acquired infections are a huge problem. Getting people back into their homes and routines will benefit patients in a number of ways beyond those described in this article.
craz8 7y ago
2 years ago, I had major abdominal surgery. I’d had a similar one in the 80s They really wanted me out of bed to walk a bit within 12 hours. That first walk, I made it half way to the door of the room. They focused on getting me out of bed and walking regularly (with a frame for support), no matter how short, and breathing into a device to measure lung capacity (which is almost zero with big hole in your side) It sucked! A lot! But this was a key part of the recovery process. Being vertical is important for many bodily functions, and the less you can be vertical, the longer the recovery will be I can’t imagine having to do this in another 30 years
- larnmar 7y ago
  Hopefully in another 30 years, a machine/robot will gently raise you to a standing position in a way that’s optimal for recovery.
cameronh90 7y ago
The way we care for the elderly in hospitals is not working and cannot continue as the population ages. Issues like the one raised are just the surface. We are spending an ever increasing fortune to keep elderly patients alive for just weeks or months, often with poor quality of life. What this and the article is pointing towards, is that we need to get better at assessing when it's time to move from curative medicine to palliative care. This is not just about advancing medicine, but about our culture and attitude towards the (current) inevitability of death.
- randycupertino 7y ago
  I did a rotation at a wealthy Bay Area hospital where they routinely put stents in patients in their 80s. Thought of reporting them to medicaid for overbilling but most of the pts were private pay. Hospital has over $4 million dollars worth of art on the walls and a $500k koi pond in the lobby.
  - cameronh90 7y ago
    I live in the UK, so my experience is in NHS hospitals, which are rather more frugal in their decor.... however over-treating patients in their 80s is little different on this side of the Atlantic. It's not done for a profit motive in general here, but more that nobody loses their medical license, and no NHS trusts get smeared in the gutter press, for trying to "save" a life against all hope (see the controversy surrounding the Liverpool Care Pathway). The lack of any legal route to assisted dying is also a problem. Even if that was introduced here, it would probably only cover people with a specific terminal diagnosis, not the more common scenario in the elderly of repeat curable problems.
    - hydrox24 7y ago
      > The lack of any legal route to assisted dying is also a problem. Euthenasia is a contentious topic, rightly so in my opinion, and is a seperate issue to regaining a balanced view of how and if we should treat the seriously ill when the treatment may harm them as much as the illness.
alleycat5000 7y ago
If this article interests you, I'd highly recommend the book Being Mortal by Atul Gawande: https://en.m.wikipedia.org/wiki/Being_Mortal https://en.m.wikipedia.org/wiki/Being_Mortal I found it to be thought provoking, moreso as I've gotten older.
mirimir 7y ago
Now that I'm over 70, I won't be having prostate surgery. Or surgery for anything else that won't likely kill me within a few years. Edit: If you would, in my circumstances, please share why.
- melling 7y ago
  Fortunately, people are working on less invasive solutions for prostate cancer: https://news.ycombinator.com/item?id=21762242 https://news.ycombinator.com/item?id=21762242
  - mirimir 7y ago
    Good stuff there. Thanks. I do get ~annual PSA tests. And if I tested positive, I'd have a biopsy. And if it was low-grade, I'd just get tested more often. And then there's this study, which I have taken to heart: "Ejaculation Frequency and Risk of Prostate Cancer: Updated Results with an Additional Decade of Follow-up".[0] > Patient summary: We evaluated whether ejaculation frequency throughout adulthood is related to prostate cancer risk in a large US-based study. We found that men reporting higher compared to lower ejaculatory frequency in adulthood were less likely to be subsequently diagnosed with prostate cancer. 0) https://sci-hub.se/https://doi.org/10.1016/j.eururo.2016.03.027 https://sci-hub.se/https://doi.org/10.1016/j.eururo.2016.03....
    - tonyedgecombe 7y ago
      I seem to remember there is also a strong association between the more deadly forms of prostate cancer and STD's.
      - mirimir 7y ago
        Yes, trichomoniasis.[0] From Medscape:[1] > Trichomoniasis is one of the most common STIs in the United States, with a prevalence estimated at 8 million cases annually; however, exact numbers are difficult to obtain because the infection is not nationally reportable and many infections are asymptomatic. ... Prevalence is also thought to be underestimated owing to the low sensitivity of the commonly used wet mount technique. Yet another reason for safe sex. Or no sex, which is safer. 0) https://www.webmd.com/sexual-conditions/guide/trichomoniasis https://www.webmd.com/sexual-conditions/guide/trichomoniasis 1) https://emedicine.medscape.com/article/230617-overview https://emedicine.medscape.com/article/230617-overview
jdkee 7y ago
To surgeons, surgery is the solution regardless of patient outcomes. That is why you should always get a second opinion to hear about non-surgical options.
- onetimemanytime 7y ago
  https://en.wikipedia.org/wiki/Law_of_the_instrument https://en.wikipedia.org/wiki/Law_of_the_instrument "I suppose it is tempting, if the only tool you have is a hammer, to treat everything as if it were a nail." Then, there's the financial side: they have bills to pay so, so, at least, they lean on side of surgery.
onetimemanytime 7y ago
I guess it's easier said than done, but at some point we gotta understand that we don't have "x disease or ailment," we just have old age. And accept that. Things start to break down
jacquesm 7y ago
There really is no such thing as a minor operation. And anything requiring general anesthesia is a serious whack to the system. When you're older this is a much larger factor than when you are younger. Just breaking a hip, arm or leg, a fall or a minor infection can easily be fatal to an older person because of the reduced efficiency of the immune system, and their general lack of resilience.
- arethuza 7y ago
  I remember when I was in my 20s and rather fit I had some surgery planned that was made up of 4 separate procedures and originally the surgeon suggested doing the work in 2 operations - for some reason I talked him round to doing everything at the same time even though he did warn me that I would feel like I had been "hit by a bus" (his exact words). I did indeed feel pretty awful after - was off work for six weeks. Now I am a good bit older I'd be pretty reluctant to undergo surgery requiring general anaesthesia unless it was really required.
- specialist 7y ago
  I've had many surgeries. I've been asking my anesthesiologists how many IQ points I'm losing every time I get general. Shrugs. Then I ask 1 point? 2 points? More? Ya, maybe. -- Also, there's another subthread about falling, hip surgeries, etc. My current understanding is that maintaining lean muscle mass and balance are crucial to preventing future falls. To keep this short: I now believe everyone 40+ should get regular physical therapy assessments and tuneups. Then do all those core strengthening and balance exercises. (I was actively running, jogging, lifting, and pretty trim. I was shocked to learn how much function I had lost. Like balancing on one foot to put on a sock.) Dr. Peter Attia (The Drive podcast) is giving similar (complimentary) advice for people who want to pace themselves to live to 100. -- PS- I will now suggest to my care providers to begin tracking both IQ and balance. I'm surveyed and tested yearly for so many other things. I don't know why this has never occurred to me before. Duh.
simonsarris 7y ago
> "If you want to change communications, you probably have to work on the surgeons" more than the patients, Dr. Schwarze concluded. I find it harder and harder to believe that Insurance is the Bad Guy in US healthcare, as insurance companies make fairly normal level insurance industry margins (like, less than car insurance). The magnitude of total spend is the real problem, and that's a provider-side problem, not a payer side problem, but its hard to talk about doctors and pharmacy benefit managers being the potentially evil ones. People can't stomach the thought that its not a faceless insurance company, and that it might be doctors, in aggregate, over-prescribing and over-practicing well beyond actual need. (And proponents of EU style healthcare costs never mention EU style doctor salaries, and the difference w.r.t. those and the USA). It sure would be terrible if tons and tons of these interventions done on frail people had no real medical use, and hundreds of them were found to be ineffective (not budging mortality, etc), and surgeons just wanted to get paid. Totally terrible if journals had meta-analyses of that. https://elifesciences.org/for-the-press/94d42de3/almost-400-medical-practices-found-ineffective-in-analysis-of-3-000-studies https://elifesciences.org/for-the-press/94d42de3/almost-400-...

88 points by vo2maxer 7y ago

dr_ 7y ago

Ironically, some of the newer value based initiatives, such as BPCI, along with changes to the post acute skilled nursing reimbursement, is actually decreasing the amount of time and care some of these elderly could benefit from post operatively to enhance their recovery. If we allowed our elderly Medicare patients to go into a rehab unit for the amount of days they need, without requiring a 3 night hospital stay first, I wonder the impact this would have on morbidity and mortality, especially after minor operations.

taxicabjesus 7y ago

It seems to me that there's something wrong with medicine, but I haven't quite figured it out yet. My recent submission [0] was about how the system defaults to expensive treatments that are marginally effective, and that doctors frequently have no ability to provide what patients actually need. My one grandfather died soon after his pacemaker was replaced - the wounds from his IVs became infected. I like to say that when he heard the doctor ask him if wanted his pacemaker replaced, he said to himself "this is my chance": If not for the surgery he certainly would have lived many more months while the battery gave out... [0] https://news.ycombinator.com/item?id=21728864 https://news.ycombinator.com/item?id=21728864

trevyn 7y ago
A thread to pull on: How does medicine work outside of developed countries?
- BurningFrog 7y ago
  Yeah, there are many alternative medical systems in the world today, but Americans usually know nothing of them.
- hycaria 7y ago
  Yep I'm always astonished at how these things are taken for granted.
throwaway5752 7y ago
I hate to be short with someone, but did you bother to read this? I mention it because of, Moreover, living longer is not older people’s only concern, or even their primary one, Dr. Rosenthal pointed out. “We don’t ask patients often enough, ‘What’s important to you?’” The primary though should be understanding what the patient wants. The patient might accept risk of death for quality of remaining life. That is a classical dilemma for a pacemaker in the eldery. And it is simply a calculated, rational risk. The problem is when patients are not given the all their options and realistic risk for each (including the risk of no action). edit: and I take this for granted, but a pacemaker can improve quality of life substantially. When it corrects a heartbeat it can prevent vertigo, falls, broken bones, and any other number of incidental effects of irregular rhythm. It is not a defibrillator.
tyri_kai_psomi 7y ago
What if this is medicine working as intended? "Frail older patients" wasn't even a word in anyone's vernacular 50 years ago, you just died if you were in that state. This is a result of us pushing the boundaries of what current modern medicine is capable of doing. Now there are more people living longer that, quite frankly, wouldn't have in earlier environments. In a way we are bypassing selection for "strong older people"

alexpetralia 7y ago

Non-paywalled: http://archive.is/i9UUp http://archive.is/i9UUp

mirimir 7y ago
PSA: In Firefox, enabling reader view, as soon as the page has loaded, avoids the paywall. And not just for NY Times. Add-ons like DOM delete can also help.
paulcole 7y ago
This works, too: https://www.nytimes.com/subscription https://www.nytimes.com/subscription
- mirimir 7y ago
  I bet that they don't accept Bitcoin, Monero, etc. Or even cash by mail.
  - onetimemanytime 7y ago
    Yeah, that is stopping 99.99% of people from subscribing /supporting great journalism.
    - mirimir 7y ago
      I subscribed once, in meatspace. It took over a year to get rid of them, after they kept jacking up the price. I will never again give them a card number.

hanoz 7y ago

I once overheard a doctor say something which has always stayed with me, along the lines that after a certain age then once you're off your feet for any length of time, then that in itself puts you in big trouble.

JshWright 7y ago
This is why hip fractures are often "the beginning of the end". When someone over the age of 65 breaks their hip, there is a ~50% chance they'll be dead within a year.
- peeters 7y ago
  Do you have a source for that number by chance (assuming it wasn't just off the cuff)? I understand and don't argue the idea, but 65 isn't passing my smell test, that seems absurdly young.
  - luu 7y ago
    This study claims 28% mortality, 46% moderate-severe disability, 26% able to live independently after one year. https://www.ncbi.nlm.nih.gov/pubmed/31810636 https://www.ncbi.nlm.nih.gov/pubmed/31810636 METHODS: Older adults aged ≥65 years were included if they had an isolated hip fracture, were admitted to hospital between July 2009 and June 2016, inclusive, and were registered to the Victorian Orthopaedic Trauma Outcomes Registry. Mortality up to 12 months (365 days) post-injury, and functional outcomes (Glasgow Outcome Scale-Extended; GOS-E) at 12 months post-injury were examined. Multivariable Cox proportional hazards regression was used to estimate adjusted hazard ratios (aHRs), and multivariable logistic regression was used to identify predictors of living independently compared with severe disability or death on the GOS-E. RESULTS: 4,912 patients were included, of whom 28% died, 46% had moderate-severe disability, and 26% were living independently 12 months post-injury. Mortality rates were lower in women (aHR=0.56, 95%CI: 0.50, 0.63), and in people injured in a high fall vs low fall (aHR=0.47, 95%CI: 0.31, 0.72). Mortality rates were higher in people in the older age groups (75-84 years: aHR=1.53, 95%CI: 1.21, 1.93; 95+ years: aHR=3.58, 95%CI: 2.68, 4.77), living in areas with the highest level of socioeconomic disadvantage (aHR=1.25, 95%CI: 1.01, 1.55), with a Charlson Comorbidity Index weighting of one (aHR=1.60, 95%CI: 1.36, 1.88) or more than one (aHR=2.21, 95%CI: 1.94, 2.53), whose injury occurred in a residential institution versus at home (aHR=2.63, 95%CI: 1.97, 3.52), that resulted in intensive care unit admission (aHR=1.68, 95%CI: 1.21, 2.32), and in people who did not have surgery versus people who had internal fixation (aHR=1.65, 95%CI: 1.33, 2.04). Independent living was inversely associated with most of the same characteristics; however, people also had lower odds of living independently if they were from metropolitan residential areas versus rural areas (aOR=0.77, 95%CI: 0.62, 0.96), or had mild to moderate (aOR=0.33, 95%CI: 0.27, 0.39) or marked to severe (aOR=0.13, 95%CI: 0.09, 0.20) preinjury disability vs no preinjury disability. Relatedly, this study from the same institution claims 5% mortality rate after a year for people under 65: https://www.ncbi.nlm.nih.gov/pubmed/27527378 https://www.ncbi.nlm.nih.gov/pubmed/27527378

mrtweetyhack 7y ago

Shocking!

throwaway5752 7y ago

This is one of the key benefits of the all the new generation of health care sensors, particularly as they mature and hit clinical/FDA approved levels. Obviously, you heal worse as you get older. But as noted in another comment, just being bedbound can be deadly. But further, hospital acquired infections are a huge problem. Getting people back into their homes and routines will benefit patients in a number of ways beyond those described in this article.

craz8 7y ago

2 years ago, I had major abdominal surgery. I’d had a similar one in the 80s They really wanted me out of bed to walk a bit within 12 hours. That first walk, I made it half way to the door of the room. They focused on getting me out of bed and walking regularly (with a frame for support), no matter how short, and breathing into a device to measure lung capacity (which is almost zero with big hole in your side) It sucked! A lot! But this was a key part of the recovery process. Being vertical is important for many bodily functions, and the less you can be vertical, the longer the recovery will be I can’t imagine having to do this in another 30 years

larnmar 7y ago
Hopefully in another 30 years, a machine/robot will gently raise you to a standing position in a way that’s optimal for recovery.

cameronh90 7y ago

The way we care for the elderly in hospitals is not working and cannot continue as the population ages. Issues like the one raised are just the surface. We are spending an ever increasing fortune to keep elderly patients alive for just weeks or months, often with poor quality of life. What this and the article is pointing towards, is that we need to get better at assessing when it's time to move from curative medicine to palliative care. This is not just about advancing medicine, but about our culture and attitude towards the (current) inevitability of death.

randycupertino 7y ago
I did a rotation at a wealthy Bay Area hospital where they routinely put stents in patients in their 80s. Thought of reporting them to medicaid for overbilling but most of the pts were private pay. Hospital has over $4 million dollars worth of art on the walls and a $500k koi pond in the lobby.
- cameronh90 7y ago
  I live in the UK, so my experience is in NHS hospitals, which are rather more frugal in their decor.... however over-treating patients in their 80s is little different on this side of the Atlantic. It's not done for a profit motive in general here, but more that nobody loses their medical license, and no NHS trusts get smeared in the gutter press, for trying to "save" a life against all hope (see the controversy surrounding the Liverpool Care Pathway). The lack of any legal route to assisted dying is also a problem. Even if that was introduced here, it would probably only cover people with a specific terminal diagnosis, not the more common scenario in the elderly of repeat curable problems.
  - hydrox24 7y ago
    > The lack of any legal route to assisted dying is also a problem. Euthenasia is a contentious topic, rightly so in my opinion, and is a seperate issue to regaining a balanced view of how and if we should treat the seriously ill when the treatment may harm them as much as the illness.

alleycat5000 7y ago

If this article interests you, I'd highly recommend the book Being Mortal by Atul Gawande: https://en.m.wikipedia.org/wiki/Being_Mortal https://en.m.wikipedia.org/wiki/Being_Mortal I found it to be thought provoking, moreso as I've gotten older.

mirimir 7y ago

Now that I'm over 70, I won't be having prostate surgery. Or surgery for anything else that won't likely kill me within a few years. Edit: If you would, in my circumstances, please share why.

melling 7y ago
Fortunately, people are working on less invasive solutions for prostate cancer: https://news.ycombinator.com/item?id=21762242 https://news.ycombinator.com/item?id=21762242
- mirimir 7y ago
  Good stuff there. Thanks. I do get ~annual PSA tests. And if I tested positive, I'd have a biopsy. And if it was low-grade, I'd just get tested more often. And then there's this study, which I have taken to heart: "Ejaculation Frequency and Risk of Prostate Cancer: Updated Results with an Additional Decade of Follow-up".[0] > Patient summary: We evaluated whether ejaculation frequency throughout adulthood is related to prostate cancer risk in a large US-based study. We found that men reporting higher compared to lower ejaculatory frequency in adulthood were less likely to be subsequently diagnosed with prostate cancer. 0) https://sci-hub.se/https://doi.org/10.1016/j.eururo.2016.03.027 https://sci-hub.se/https://doi.org/10.1016/j.eururo.2016.03....
  - tonyedgecombe 7y ago
    I seem to remember there is also a strong association between the more deadly forms of prostate cancer and STD's.
    - mirimir 7y ago
      Yes, trichomoniasis.[0] From Medscape:[1] > Trichomoniasis is one of the most common STIs in the United States, with a prevalence estimated at 8 million cases annually; however, exact numbers are difficult to obtain because the infection is not nationally reportable and many infections are asymptomatic. ... Prevalence is also thought to be underestimated owing to the low sensitivity of the commonly used wet mount technique. Yet another reason for safe sex. Or no sex, which is safer. 0) https://www.webmd.com/sexual-conditions/guide/trichomoniasis https://www.webmd.com/sexual-conditions/guide/trichomoniasis 1) https://emedicine.medscape.com/article/230617-overview https://emedicine.medscape.com/article/230617-overview

jdkee 7y ago

To surgeons, surgery is the solution regardless of patient outcomes. That is why you should always get a second opinion to hear about non-surgical options.

onetimemanytime 7y ago
https://en.wikipedia.org/wiki/Law_of_the_instrument https://en.wikipedia.org/wiki/Law_of_the_instrument "I suppose it is tempting, if the only tool you have is a hammer, to treat everything as if it were a nail." Then, there's the financial side: they have bills to pay so, so, at least, they lean on side of surgery.

onetimemanytime 7y ago

I guess it's easier said than done, but at some point we gotta understand that we don't have "x disease or ailment," we just have old age. And accept that. Things start to break down

jacquesm 7y ago

There really is no such thing as a minor operation. And anything requiring general anesthesia is a serious whack to the system. When you're older this is a much larger factor than when you are younger. Just breaking a hip, arm or leg, a fall or a minor infection can easily be fatal to an older person because of the reduced efficiency of the immune system, and their general lack of resilience.

arethuza 7y ago
I remember when I was in my 20s and rather fit I had some surgery planned that was made up of 4 separate procedures and originally the surgeon suggested doing the work in 2 operations - for some reason I talked him round to doing everything at the same time even though he did warn me that I would feel like I had been "hit by a bus" (his exact words). I did indeed feel pretty awful after - was off work for six weeks. Now I am a good bit older I'd be pretty reluctant to undergo surgery requiring general anaesthesia unless it was really required.
specialist 7y ago
I've had many surgeries. I've been asking my anesthesiologists how many IQ points I'm losing every time I get general. Shrugs. Then I ask 1 point? 2 points? More? Ya, maybe. -- Also, there's another subthread about falling, hip surgeries, etc. My current understanding is that maintaining lean muscle mass and balance are crucial to preventing future falls. To keep this short: I now believe everyone 40+ should get regular physical therapy assessments and tuneups. Then do all those core strengthening and balance exercises. (I was actively running, jogging, lifting, and pretty trim. I was shocked to learn how much function I had lost. Like balancing on one foot to put on a sock.) Dr. Peter Attia (The Drive podcast) is giving similar (complimentary) advice for people who want to pace themselves to live to 100. -- PS- I will now suggest to my care providers to begin tracking both IQ and balance. I'm surveyed and tested yearly for so many other things. I don't know why this has never occurred to me before. Duh.

simonsarris 7y ago

> "If you want to change communications, you probably have to work on the surgeons" more than the patients, Dr. Schwarze concluded. I find it harder and harder to believe that Insurance is the Bad Guy in US healthcare, as insurance companies make fairly normal level insurance industry margins (like, less than car insurance). The magnitude of total spend is the real problem, and that's a provider-side problem, not a payer side problem, but its hard to talk about doctors and pharmacy benefit managers being the potentially evil ones. People can't stomach the thought that its not a faceless insurance company, and that it might be doctors, in aggregate, over-prescribing and over-practicing well beyond actual need. (And proponents of EU style healthcare costs never mention EU style doctor salaries, and the difference w.r.t. those and the USA). It sure would be terrible if tons and tons of these interventions done on frail people had no real medical use, and hundreds of them were found to be ineffective (not budging mortality, etc), and surgeons just wanted to get paid. Totally terrible if journals had meta-analyses of that. https://elifesciences.org/for-the-press/94d42de3/almost-400-medical-practices-found-ineffective-in-analysis-of-3-000-studies https://elifesciences.org/for-the-press/94d42de3/almost-400-...