Someone took this picture of me while I was naked...

[AJMD429]

.


...and they didn't even pay me...!!!

...in fact, the whole photoshoot probably cost $20,000 or so... Plus I even had to take off work to get it done and now I won't get paid a dime...

7116~2.jpeg

Gangrenous gallbladder. No symptoms to max pain in less than three hours.

...but it might explain how I found out what a 10 out of 10 might be on the 'pain scale'...although I'd say it was more a '8' because to me the max would be the person running and on fire who isn't even able to respond to commands to drop and roll, followed by the one who at least can obey the command but not respond verbally, followed by the person who is writhing uncontrollably and unable not to shout out, but can communicate a bit (that was me). However conventional nomenclature excludes those first two categories, I guess because they can't even answer the question.

It was enough pain that even if in a life or death fight at one point I'd have quit. Even during the two days thinking I'd likely die when I had CoVid, it just made me MAD, and all the more determined to fight, but this was awful.

The good news is that thanks to a technologically excellent, albeit administratively horrible, healthcare system, less than 60 hours after symptom onset I'm at home with only mild incisional pain.
Had an omelette and oatmeal and yogurt for breakfast and sandwich for lunch. I just try to avoid sneezing or coughing or moving certain ways...

Moral of story...if it hurts get it checked out...!!!

[piller]

Good grief! Take care of yourself, Doc! What would you tell a patient who let it go to that point? Remember, as we age, we heal slower.

[Sixgun]

Wow! Great Doc!....at first, before I read the script I thought you were getting a circumcision!....

I have no idea how you can explain a life threatening surgery with laughter and optimism......I'd be in my bubble for a week.

20 big ones huh?....heck, for a grand I would've done it for you.....get ya all alcoholed up and you could walk me through it.....

Very happy your OK.....for real....----Sixer

Im curious...what would have happened if say.....your way away from civilization when it happened?

[wecsoger]

ewwwwwww!

I did *not* clip on the image to zoom in...

Did the gall bladder divorce a decade or so ago. Still have the "trophy size" stone somewhere. Dr. was extremely impressed.

Laparoscopic surgery is awesome! Couple small incisions, good to go. Much better than old school slicing across a major muscle group.

Got to try morphine for the first time (highly recommend it, as needed), and the low point was trying to take a leak thereafter. Nurse putting and taking out catheter didn't do too well.

No great issue to not having one, other than making sure of bathroom access if you have a big meal of fatty foods on an empty stomach. (grin)

Glad to hear it was fixed, post haste. You'll be up and about in no time.

[piller]

Morphine and Fentanyl both failed to give me any relief the one time I was given them. First time being given a narcotic and it was morphine. Nothing. Absolutely nothing. They gave me 25 micrograms of Fentanyl. Nothing. That should have made me stop breathing. No reaction at all.
I get enough relief from Ranger Candy to use it after dental implants.

Doc, you should know about taking care of yourself. Be a little bit careful.

[jeepnik]

Gee, Doc, don't scare us like that. Glad you are feeling better. Sounds like the pain is up there with passing a kidney stone. That's a nine on my scale. The burning thing is truely a ten.

[CowboyTutt]

Holy Cow Doc!!!!

I hope you heal up soon!!!

-Andy

[AJMD429]

.
I feel pretty good now just 24 hours after surgery, other than the incision pain when I move wrong or cough, but that's not a big deal compared to how I felt 60 hours ago when it onset.

What surprised me is that I had no symptoms when I woke up at 4:30, and I left the house at 5:15 with just a vague stomach discomfort that barely got my attention. It takes me 35 minutes or so to get to work and by the time I got there I could barely make it from the car to inside the office. I tried laying on the floor and various positions to get comfortable and the pain got more intense so I tried pulling a couple chairs over with my feet to try to raise my legs or something to get comfortable but nothing worked. So it wasn't like I really ignored any symptoms, although the condition had obviously been going on quite some time.

The good news about that is that it might potentially make me feel better overall because maybe it was causing some sort of vague malaise that I was unaware of.

Sixer.... I would have sent that picture but they had to use an extreme wide-angle lens and I couldn't downsize the photograph enough to load without crashing the internet.

Piller..... Not practicing in-hospital medicine for the last 20 years I haven't actually prescribed it, but I understand that intravenous acetaminophen is quite the thing as far as severe pain treatment in some countries, and I know a couple physicians and surgeons who use it here. They say it is often more effective than narcotics for many patients, and it certainly a primary option to consider if the patient doesn't tolerate or respond to narcotics. I've only used it orally for mild pain or as an adjunct to multiply the effect of narcotic pain medicines.

Another thing that sometimes helps non-responders, other than the obvious tactic of trying a higher dose if the problem is not an adverse reaction, is the addition of guaifenesin. I believe the mechanism has something to do with blockade of ion channels in the cell or something of that sort. I think it's mostly applicable to people who have been on it and developed tolerance.

What you could do is research the literature for some articles on intravenous acetaminophen and keep them handy to give to any physician who might be trying to treat you for pain. From what I was told by The physicians here who use it it's readily available but the pharmacies in the hospitals don't make enough money off of it versus the other alternatives to want to prepare it because they would have to make it up as an IV. You could even make sure that someplace nearby has the powder to make it from on hand so that it could be made if and when you need it.

[gcs]

Sounded like you had an interesting time...
What the heck caused that, and no symptoms?, crazy!!!

[Oldncrusty]

Ouch! That hurts just looking. Glad you're recovering swiftly.

[piller]

Acetaminophen needs the 2C19 gene to deacetylate it. I totally lack that gene. I am not sure why narcotics are ineffective on me.
Despite my kidney damage from metformin, I will stick with Ranger Candy when in pain. Other NSAIDs work almost as well.

Omelets are just chicken that started in a semi-liquid state.

[Sixgun]

"Wide angle lens". ......your too white to have that issue.

Happy for you Doc.......the board wouldn't be the same without you...----006 aka Sixer

[gamekeeper]

Glad to know you're on the mend Doc...

[AJMD429]

"Wide angle lens". ......your too white to have that issue.

I guess that means the 'news' media won't leave out my skin color if I am witnessed committing a crime...

[Tycer]

Heal well friend!

[rossim92]

Ouuuuccccchhhh!

[Drawdown]

Glad you got your clothes back on, and on the healing side of it, especially as far as pain, take care!
I've been thru a few bad ones myself. I woke in recovery after surgery to fuse a broken neck, literally my eyes just opened wide, like someone snapped their fingers to wake me, into literally screaming in pain, couldn't breath! I actually thought I was laying on what felt like a hatchet buried in back my neck. The surgery entrance was in the back. They grabbed me held me, put the oxygen and morphine to me! Worse feeling of my life!
Glad you're on the good side of a bad time!

[Blaine]

Pleased that you're still with us.

[piller]

Doc, may I suggest pineapple or papaya as a snack on a daily basis. They both seem to help prevent gallbladder issues, and after the gallbladder is removed, they help digestion. There are pills with the enzymes in them, but it is tastier to eat the fruit.

[Griff]

Glad you finally tripped to the fact you were having some sort of episode! And sought help! The board would not be the same without you!

[ollogger]

Jeepers Doc. i was just looking at the photo with out reading and i thought you took a load of fine shot
glad that wasnt the case & your doing well




Brad

[Nath]

ouchee...
Best wishes sir.

[Bill in Oregon]

Sorry you had to endure that pain, Doc. Glad they knew what to do about it.

[AJMD429]

.
Shot a friend’s 308 Ruger Hawkeye or whatever the M77 is called these days. 10 shot detachable magazine and threaded muzzle.

Really nice all-around gun.

Me Rugers...!

Thanks for the thought on pineapple and papaya; both good things I like so have an excuse to eat more of now.

[AmBraCol]

Doc, may I suggest pineapple or papaya as a snack on a daily basis. They both seem to help prevent gallbladder issues, and after the gallbladder is removed, they help digestion. There are pills with the enzymes in them, but it is tastier to eat the fruit.

Nice tip there. We just bought a couple fresh pineapples yesterday. Papaya are also fairly common here.

[AmBraCol]

That's a pretty graphic explanation of the top end of the pain scale. Sure am glad you got it taken care of. It's amazing what all they can do through a small hole in your abdomen instead of splitting you stem to stern like they used to do.

[KWK]

Lovely photo.

Fine one evening. Rolling on the floor in agony in the morning. It’s no wonder the ancients believed in evil magic.

Good to hear you’ll still be with us.

[RIHMFIRE]

GEEEEEZE DOC!!!
HOPE YOU R FEELING BETTER NOW

[AJMD429]

.
Cut two wheelbarrow loads of 8" and less firewood yesterday without issues. Went slowly. Didn't do big stuff cuz I shouldn't lift much and NO WAY I'm gonna yank that splitter starting cord.

Tube out soon.

[Blaine]

.
Cut two wheelbarrow loads of 8" and less firewood yesterday without issues. Went slowly. Didn't do big stuff cuz I shouldn't lift much and NO WAY I'm gonna yank that splitter starting cord.

Tube out soon.

And...once again...Doctors are the worst patients.

[AJMD429]

.
Cut two wheelbarrow loads of 8" and less firewood yesterday without issues. Went slowly. Didn't do big stuff cuz I shouldn't lift much and NO WAY I'm gonna yank that splitter starting cord.

Tube out soon.

And...once again...Doctors are the worst patients.

Hey...at least I didn't try to start the splitter....!

[CowboyTutt]

Blaine is right, yes, you need to get about walking as they do all the time now mostly, but PLEASE don't overdo Doc!!! -Tutt

[AJMD429]

.
Grandkid came out and we went on a long (500 yard) high-altitude (peaked 40 ft above starting altitude) hike and that was just about right...

Sat in the garden to rest and started to read a good book...

7491.jpeg

[CowboyTutt]

Doc, I hope in some way this applies to you and not Ukraine and not you. I am first generation Ukrainian American. I don't want to hijack your thread, but just wanted to say. I wish you well.
-Tutt

[AJMD429]

Doc, I hope in some way this applies to you and not Ukraine and not you. I am first generation Ukrainian American. I don't want to hijack your thread, but just wanted to say. I wish you well.
-Tutt

The book is interesting - all about how 'experts' in life are good within the bell curve of things, but it is the crisis and the innovator that typically determine the course of history more than the status quo.

I've had some interesting conversations with my Ukrainian patients, and if you're ever so inclined, ,it would be interesting to hear your thoughts on what is going on over there. Back 25 years ago I used to listen to shortwave to find broadcasters in trouble zones, but even then you are only getting a handful of information and it is still often infused with bias or propaganda.

[piller]

In my profession, there are a bunch who are competent within the bell curve for normal patients. When we start to see those few with unusual situations, symptoms, reactions, conditions, or whatever it is that is unusual, then most of them fall back on the big group situations and fail the patient.

My first time of having a patient with unusual symptoms was in Manhattan, Kansas about a year after graduation. An elderly female customer was chronically on an antidiarrheal medicine. I was the first one to ask her about it. She didn't really seem to know. Then one day she and her husband had eaten at the McDonald's in that Walmart. She came up to the counter and was in severe distress. The McDonald's had not cleaned the grill as she asked, and a tiny amount of leftover cheese had got on her burger. I gave her the antidiarrheal medicine right out of the stock bottle. A few minutes later, she came back. Then she told me that her mother had died in childbirth, and she had never been given milk as an infant or toddler. She was severely lactose intolerant. I immediately called her Doctor to get her medicines changed so that we were not giving her anything with lactose in it. Doctor Borgendale laughed at me and said that he would go along with it to teach me to mind my business. 6 months later he called me and asked why his patient had gained 10 pounds and had not requested a refill on her antidiarrheal. She was in better health than she had been in years. In 30 years of her taking antidiarrheals, I was the only Pharmacist to try to help. Her lactose intolerance was unusually strong, and everyone else just went bact to the norms.

That was my first time of proving that there are people who are outside of the bell curve.

Doc, you know the difference between soreness and pain. Keep up the healing.

[AJMD429]

.
Impossible I tried to cultivate relationships with pharmacists that are bidirectional because we should be part of a team. That's difficult with the chain stores, but pretty easy with the compounding pharmacies or the few remaining mom and pop operations.

I have found out that there are quite a few medicines with lactose as a filler, and even in trace amounts some people really have trouble with it. There is definitely a majority of patients who simply don't tolerate large amounts, but if you who have horrible symptoms from the tiniest amount. Same with gluten, and probably lots of other things.

[piller]

The rare Pharmacist and Doctor who work together are the best combination. Eddie Murphy described most Pharmacists in Beverly Hills Cop when he was chewing out the two Cops tailing him. You got your guns and your badges and you are on the job and don't know nothing about nothing. A little effort outside of just putting up numbers and you can help patients. I get yelled at all the time for wasting time on things other than just filling bottles with pills. Independent stores sometimes have Pharmacists who will spend time on things that are not just putting pills in a bottle. My Endocrinologist spent the time to look up my condition. One Doctor who had trained under Dr. DeBakey had told me that I just wanted to be difficult.

[CowboyTutt]

Doc AJ and Pillar, I really thank you and commend you both for what you have done for your patients. I am now alerted to intolerances in medication and will keep that in mind.

Doc, I have friends in Ukraine and I know your super busy but if you have time to talk, what are your days off? Hopefully Saturday or Sunday? It is Pascha in Ukraine this coming Sunday. The Patriarch of the Ukrainian Orthodox Church has warned his people not to congregate as they fear a missile strike on the churches in Kyiv. The evil of the Russian Federation knows no bounds... I don't want to hijack the thread but will tell you more about it if we can talk.

-Tutt

P.S. PM sent Doc.

[AJMD429]

Cool. Maybe Saturday!

[CowboyTutt]

Doc, hope so, sent you all my contact information! Saturday good, Sunday afternoon which is probably evening your time might also work! -Tutt