WEBVTT - Ep 160 Appendicitis: Don’t know what you’ve got til it’s gone? 0:00:00.440 --> 0:00:03.239 Hi. My name is Molly, and in March of twenty fifteen, 0:00:03.320 --> 0:00:05.720 I was thirty six weeks pregnant with my first child. 0:00:06.120 --> 0:00:08.840 For the most part, my pregnancy had been uneventful, except 0:00:08.880 --> 0:00:11.960 for a visit to labor and Delivery in mid February 0:00:12.320 --> 0:00:14.080 with some pain that they determined at the time to 0:00:14.120 --> 0:00:17.120 be just gas. So on the afternoon of March sixteenth, 0:00:17.160 --> 0:00:19.479 when I started to feel similar pain again, I just 0:00:19.480 --> 0:00:21.200 put it off as being gased and did all the 0:00:21.200 --> 0:00:24.160 recommended things to treat the pain, but over the course 0:00:24.160 --> 0:00:27.080 of a few hours, the pain got progressively worse. At 0:00:27.120 --> 0:00:29.880 around six pm on the evening of March sixteenth, I 0:00:29.920 --> 0:00:31.479 decided I would take a bath to see if warm 0:00:31.520 --> 0:00:33.440 water would help, and once I got out, I could 0:00:33.440 --> 0:00:35.800 barely walk, and I then decided that this was definitely 0:00:35.880 --> 0:00:38.680 not gas pain. When I got to the hospital, because 0:00:38.680 --> 0:00:41.320 I was thirty six weeks pregnant, they really just focused 0:00:41.320 --> 0:00:43.839 on me being in pre term labor, but the biggest 0:00:43.880 --> 0:00:45.920 issue being that the pain I was having was getting 0:00:45.920 --> 0:00:50.520 progressively worse and was constant, which contractions aren't. At about 0:00:50.520 --> 0:00:52.720 two hours in, a doctor mentioned that what I was 0:00:52.760 --> 0:00:55.880 experiencing might be round ligaman pain and they were probably 0:00:55.880 --> 0:00:58.120 going to send me home with some exercises. Thank god 0:00:58.160 --> 0:01:00.680 they didn't. To the span of a few hours, I 0:01:00.720 --> 0:01:03.120 had an ultrasound done as well as an MRI. Is 0:01:03.160 --> 0:01:06.319 a doctor's thought I could possibly have appendicitis, but when 0:01:06.319 --> 0:01:09.240 you're pregnant, the appendix is often hidden because of your baby, 0:01:09.280 --> 0:01:11.679 so standard tests don't allow you to see the appendix. 0:01:12.480 --> 0:01:15.400 Prior to going into the MRI machine. They gave me morphine, 0:01:15.400 --> 0:01:18.039 which still didn't touch the pain, and having to lay 0:01:18.160 --> 0:01:20.640 in the MRI machine for over forty minutes not being 0:01:20.640 --> 0:01:22.920 able to move was one of the worst things I've 0:01:22.959 --> 0:01:28.839 ever experienced. Unsurprisingly, the MRI and ultrasound didn't show anything. Finally, 0:01:28.880 --> 0:01:31.839 after six hours, around midnight on the seventeenth of March, 0:01:32.120 --> 0:01:34.440 they decided to admit me to the hospital, still not 0:01:34.520 --> 0:01:37.240 knowing what was going on. As the hours went on, 0:01:37.319 --> 0:01:40.600 my white blood cell count continued to rise, I developed 0:01:40.600 --> 0:01:44.240 a fever, and I was losing amniotic fluid. So finally, 0:01:44.280 --> 0:01:47.520 after sixteen hours of being an excruciating pain, they decided 0:01:47.520 --> 0:01:49.640 that they had to do an emergency C section to 0:01:49.680 --> 0:01:52.840 figure out what was going on. I remember getting the 0:01:52.880 --> 0:01:55.400 epidural and it being the greatest thing. Ever, because I 0:01:55.440 --> 0:01:58.440 could no longer feel the pain in my stomach as 0:01:58.440 --> 0:02:01.080 they cut me open. The one thing I can remember 0:02:01.160 --> 0:02:03.440 is that I'm saying, there's puss and her stomach called 0:02:03.440 --> 0:02:07.800 the other surgical team. Minutes later, they delivered my daughter, Madeline, 0:02:07.840 --> 0:02:11.320 at twelve thirty four on Saint Patrick's Day. After they 0:02:11.360 --> 0:02:13.840 delivered my daughter, the ob team swapped out with a 0:02:13.880 --> 0:02:16.840 general surgical team, and for a brief moment, they considered 0:02:16.919 --> 0:02:19.720 keeping me awake since I had an epidural, but thankfully 0:02:19.760 --> 0:02:22.080 my husband stepped in and said, put her under now. 0:02:22.880 --> 0:02:24.800 Once they put me under, it was found that my 0:02:24.840 --> 0:02:28.040 appendix had ruptured and I had peratinitis in my intestines. 0:02:28.560 --> 0:02:31.160 For the next three days, I was on ivy antibiotics, 0:02:31.160 --> 0:02:33.680 but my white blood cell count was continuing to rise 0:02:33.720 --> 0:02:37.679 and I was still running a fever and it looked awful. Thankfully, 0:02:37.800 --> 0:02:40.680 after three days, my white blood cell count finally dropped. 0:02:41.360 --> 0:02:44.760 At this point, my doctors confessed to me how concerned 0:02:44.800 --> 0:02:47.440 they were getting about me. I stayed almost a week 0:02:47.480 --> 0:02:50.360 in the hospital recovering from appendicitis in my c section, 0:02:50.520 --> 0:02:52.680 and I was very popular on the floor because most 0:02:52.720 --> 0:02:54.440 of the doctors had never seen a case like this. 0:02:55.440 --> 0:02:57.400 It took me weeks to fully recover, and I was 0:02:57.440 --> 0:02:59.720 seeing a doctor twice a week for over a month 0:02:59.760 --> 0:03:03.000 because of constant issues I was having. My daughter spent 0:03:03.040 --> 0:03:05.919 two days in the special care unit receiving IVY antibiotics, 0:03:05.960 --> 0:03:09.360 but overall was really healthy considering what she had been through. 0:03:10.120 --> 0:03:12.600 While this was all going on, I was so focused 0:03:12.600 --> 0:03:14.720 on my pain, recovering and my daughter that I really 0:03:14.760 --> 0:03:17.280 didn't think about the implications of what had happened to 0:03:17.320 --> 0:03:20.160 me until I started your research and realized how dangerous 0:03:20.200 --> 0:03:22.840 the situation was and how it could have ended so 0:03:23.400 --> 0:03:26.560 differently for both me and my daughter. Thankfully, we were 0:03:26.600 --> 0:03:30.799 both okay afterwards and having discussions with my doctor, they 0:03:30.840 --> 0:03:33.120 think that my appendix started to be inflamed when I 0:03:33.160 --> 0:03:36.120 went to labor and delivery in February of twenty fifteen. 0:03:36.400 --> 0:03:38.520 They also had a theory that my daughter was kicking 0:03:38.520 --> 0:03:40.560 my appendix and that may have caused it to become 0:03:40.680 --> 0:03:45.800 inflamed in rupture. Lastly, during those agonizing sixteen hours prior 0:03:45.840 --> 0:03:48.800 to having my daughter, we had an amazing nurse who 0:03:48.880 --> 0:03:51.400 knew what I was experiencing wasn't labor pain or around 0:03:51.480 --> 0:03:54.880 ligament pain. And advocated for me and stay with us 0:03:54.920 --> 0:03:57.400 the entire time, even when she was off her shift, 0:03:57.440 --> 0:03:59.520 to make sure that we were okay. I will never 0:03:59.520 --> 0:04:01.560 forget her and the other nurses he took care of me. 0:04:02.000 --> 0:04:39.080 Thank you. 0:04:48.720 --> 0:04:55.760 Oh my gosh, that sounds terrifying, absolutely awful. I can't. Oh, 0:04:55.800 --> 0:04:59.880 I can't imagine. Yeah, thank you so much for be 0:05:00.000 --> 0:05:03.240 being willing to relive that experience and share that with 0:05:03.440 --> 0:05:06.800 all of us that I can't. Yeah, I don't have words. 0:05:07.080 --> 0:05:09.200 No, Yeah, thank you, thank you. It must have been 0:05:09.360 --> 0:05:12.120 really terrifying, So thank you for sharing. 0:05:13.040 --> 0:05:16.280 Hi. I'm Aaron Welsh and I'm Erin Alman Updike, and 0:05:16.360 --> 0:05:18.160 this is this podcast Will Kill You. 0:05:18.360 --> 0:05:22.040 And today we're talking appendicitis. Yeah, yeah, this. 0:05:22.040 --> 0:05:24.800 Is kind of an oddball one for us. I feel like. 0:05:24.920 --> 0:05:28.839 It isn't It isn't I feel yeah, you're right, don't know. 0:05:29.200 --> 0:05:31.320 I feel like that about a lot of our episodes recently, 0:05:31.320 --> 0:05:33.040 where I'm like, are there rules anymore? 0:05:33.080 --> 0:05:35.320 I don't think so, No, we make the rules are 0:05:35.360 --> 0:05:36.640 and this is our podcast? 0:05:37.080 --> 0:05:40.880 True, but kind of I think there's I'm excited to 0:05:40.960 --> 0:05:47.279 learn history things don't know it, and there's pathology there 0:05:47.320 --> 0:05:48.120 for sure, So. 0:05:49.040 --> 0:05:51.960 I mean, one of my biggest touch points is Madeline. 0:05:52.120 --> 0:05:58.200 I think I talk about Matline that was always drawn 0:05:58.240 --> 0:06:00.839 to that for some reason. Probably I was a spooky 0:06:00.839 --> 0:06:03.600 little kid. But yeah, doesn't. 0:06:03.320 --> 0:06:06.279 Everyone love Madeline like it's it's a classic? 0:06:06.600 --> 0:06:06.840 Yeah? 0:06:06.839 --> 0:06:07.039 I know? 0:06:07.240 --> 0:06:11.680 But okay, were there multiple Madeline books or just Madeline? 0:06:11.760 --> 0:06:13.760 I only know Madeline, but I don't know. 0:06:14.120 --> 0:06:16.320 Oh my gosh, Okay. For the longest time, I thought 0:06:16.360 --> 0:06:18.760 it was all I don't know. I thought that was 0:06:18.800 --> 0:06:21.839 just like story number one in a Madeline series. 0:06:22.240 --> 0:06:24.800 I don't know. I've only read that one. Matt me too. 0:06:25.080 --> 0:06:29.320 Yeah, okay, so I guess it feels like there must be. 0:06:29.360 --> 0:06:30.960 We are gonna have to google it after. 0:06:30.800 --> 0:06:33.679 This, someone is going to reach out and be like, wow, Wow, 0:06:33.720 --> 0:06:39.279 your Madeline knowledge is really poor, very poor. One out 0:06:39.279 --> 0:06:40.120 of five stars. 0:06:40.200 --> 0:06:43.320 Thank you, dear. You know what. It's good though, it is. 0:06:43.520 --> 0:06:46.080 It's going to be a great episode. But before we 0:06:46.120 --> 0:06:48.480 get into any of it, it's quarantiny time. 0:06:48.800 --> 0:06:51.920 It is, Aaron, what are we drinking this week? 0:06:52.279 --> 0:06:56.159 We're drinking waiting for the rupture, not the rapture. 0:06:57.520 --> 0:07:00.640 Gosha. I'm pleased with myself on this song should. 0:07:00.360 --> 0:07:03.320 Be It's a good one. I would hope that we 0:07:03.360 --> 0:07:05.960 don't ever actually wait for the rupture. But it's a 0:07:05.960 --> 0:07:06.920 good quarantini name. 0:07:07.040 --> 0:07:11.080 No, it's a great name, if I do say so myself. 0:07:11.240 --> 0:07:14.200 And it's a great quarantine as well. It's got some 0:07:14.320 --> 0:07:18.400 delicious ingredients. Essentially, what you've got here is a French 0:07:18.400 --> 0:07:21.840 seventy five, which is gin and champagne. Subtract the champagne, 0:07:21.880 --> 0:07:24.000 add some sparkling cider for a little bit of a 0:07:24.040 --> 0:07:30.200 fall winter vibes, some iced lemon spices, you know, delish. 0:07:30.720 --> 0:07:33.080 We'll post the full recipe if you need it on 0:07:33.240 --> 0:07:37.040 our website, this podcast okay dot com and our social 0:07:37.080 --> 0:07:40.160 media for both the Quarantini and the non alcoholic plus 0:07:40.200 --> 0:07:40.760 sy parita. 0:07:41.120 --> 0:07:46.400 They're there. They're there website. We've got some great stuff 0:07:46.600 --> 0:07:49.000 on that website. You know, we just revamped it, well 0:07:49.200 --> 0:07:52.160 just now it's been months, because two and a half 0:07:52.200 --> 0:07:53.840 months ago we revamped. 0:07:53.360 --> 0:07:57.360 It by the time this comes out, but it's great. 0:07:57.440 --> 0:07:57.960 Check it out. 0:07:58.080 --> 0:08:01.480 It is great. It's got things like transcripts. It's got 0:08:01.520 --> 0:08:04.800 links to our bookshop dot org affiliate account, our Goodreads list, 0:08:04.840 --> 0:08:08.240 it's got links to merch some pretty sweet stuff going 0:08:08.280 --> 0:08:12.160 on there. It's got links to our Patreon. It's got 0:08:12.240 --> 0:08:17.640 links to oh music by Bloodmobile. It has got sources 0:08:17.640 --> 0:08:19.800 for each and every one of our episodes, have a 0:08:19.840 --> 0:08:23.040 little section about the errands. There's a submit your first 0:08:23.040 --> 0:08:26.440 hand account form. 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You can find it there. 0:08:51.200 --> 0:08:54.120 And you know, we're just gonna shout it out again. 0:08:54.640 --> 0:08:57.839 If you like the show, please rate, review, subscribe, make 0:08:57.840 --> 0:09:00.720 sure that you're subscribed on whatever podcast or you use. 0:09:01.440 --> 0:09:04.120 It really helps us out a lot, So it does. 0:09:04.400 --> 0:09:04.960 Yeah, thank you. 0:09:05.040 --> 0:09:05.520 Thanks. 0:09:06.080 --> 0:09:07.439 Well, should we get started. 0:09:08.000 --> 0:09:10.480 Let's do it. Let's take a quick break and then begin. 0:09:34.640 --> 0:09:38.520 There is this kind of very textbook description of appendicitis, 0:09:38.920 --> 0:09:41.640 and I'm going to tell you how it goes. It 0:09:41.760 --> 0:09:46.360 starts with usually kind of a vague pain and abdominal 0:09:46.400 --> 0:09:49.080 pain around the belly button, kind of like in the 0:09:49.160 --> 0:09:52.120 center of the belly, around your belly button, and it 0:09:52.160 --> 0:09:54.840 tends to go along with like, I'm not really feeling 0:09:54.960 --> 0:09:57.800 hungry because my stomach doesn't feel good. I don't want 0:09:57.840 --> 0:10:01.080 to eat anything, and then it might press to feeling 0:10:01.120 --> 0:10:04.560 actually nauseous, like feeling like you're gonna throw up, and 0:10:04.600 --> 0:10:08.559 then maybe some vomiting, and then that pain will start 0:10:08.600 --> 0:10:11.680 to move and it moves from around the belly button 0:10:11.760 --> 0:10:15.000 down into the right lower quadrant kind of mirror your 0:10:15.080 --> 0:10:18.320 right hip bone, like the part that sticks out, and 0:10:18.400 --> 0:10:21.679 then you'll get a fever. And this tends to kind 0:10:21.720 --> 0:10:25.080 of progress usually over about like a twenty four hour period, 0:10:25.160 --> 0:10:27.600 Like it's not a super sudden onset, but it's not 0:10:27.800 --> 0:10:35.000 like prolonged. That's the classic description. And this classic description 0:10:35.920 --> 0:10:39.640 is not the only way that appendicitis can present by 0:10:39.960 --> 0:10:44.400 any means, but it is the classic description because it 0:10:44.600 --> 0:10:48.120 does happen, and it happens pretty frequently. It's very common 0:10:48.160 --> 0:10:52.439 that this kind of series of events is how appendicitis 0:10:52.520 --> 0:10:56.760 starts and presents. I can very vividly remember having a 0:10:56.880 --> 0:11:00.439 patient describe their like course of symptoms that brought them 0:11:00.440 --> 0:11:03.839 to the emergency room exactly liked this, and I looked 0:11:03.880 --> 0:11:06.240 at them and I was like, well, you described the 0:11:06.280 --> 0:11:09.040 textbook description of a pendicitis. 0:11:09.440 --> 0:11:12.120 Are you an actor right here? Like this? 0:11:12.559 --> 0:11:16.960 Is this a real patient encounter? And then when you're 0:11:17.000 --> 0:11:20.720 in the emergency room and the person examining you starts 0:11:20.760 --> 0:11:24.800 to do their exam and they touch your stomach. Sure enough, 0:11:25.120 --> 0:11:28.480 very often people have pain in this kind of text 0:11:28.520 --> 0:11:32.160 book area. And that point. There's a point, it's called 0:11:32.280 --> 0:11:36.160 mcburney's point. It's like two thirds of the way between 0:11:36.160 --> 0:11:39.440 your belly button and that sticky, oudy part of your 0:11:39.520 --> 0:11:42.760 hip bone, which is called your anterior superior iliac crest. 0:11:43.120 --> 0:11:44.719 So it's like a little bit closer to your hip 0:11:44.720 --> 0:11:47.280 bone than your belly button. Along this like diagonal line 0:11:47.280 --> 0:11:50.240 between your belly button and that hip bone, you can 0:11:50.280 --> 0:11:53.120 put your finger there, and that tends to be the 0:11:53.160 --> 0:11:56.120 most tender spot. It hurts really bad if you smush 0:11:56.160 --> 0:12:00.120 down there. There's a few other signs that you can see. 0:12:00.280 --> 0:12:02.920 Maybe someone doesn't have pain exactly right there, but they 0:12:03.000 --> 0:12:05.800 might If you smush down on the left side of 0:12:05.840 --> 0:12:09.040 their belly, it might hurt on that right side. That's 0:12:09.040 --> 0:12:11.440 a sign that there might be appendicitis, and then there 0:12:11.440 --> 0:12:13.200 are a lot of other things, like the way that 0:12:13.280 --> 0:12:16.440 you move somebody's hip or leg that might tell you 0:12:16.559 --> 0:12:20.160 how far down into the pelvis, how extensive that infection 0:12:20.280 --> 0:12:24.240 might be. So when somebody comes into the hospital, to 0:12:24.320 --> 0:12:27.720 the emergency room or even an urgent care reading that 0:12:28.080 --> 0:12:32.760 textbook description, almost certainly, like over ninety percent of the 0:12:32.840 --> 0:12:38.840 time people get diagnosed correctly with appendicitis. And it's possible 0:12:39.360 --> 0:12:43.040 based on those textbook descriptions that diagnosis can happen with 0:12:43.280 --> 0:12:48.160 just that story alone. But today, because it's available at 0:12:48.240 --> 0:12:50.400 least in most of the high income countries in the world, 0:12:50.600 --> 0:12:54.000 we have access to technology to confirm this diagnosis. So 0:12:54.160 --> 0:12:56.360 most of the time when people come in with symptoms 0:12:56.400 --> 0:12:59.040 like this, there's going to be some kind of imaging 0:12:59.360 --> 0:13:03.600 that's either a CT scan or an ultrasound if you 0:13:03.640 --> 0:13:06.520 need to avoid radiation, to make totally sure that what 0:13:06.600 --> 0:13:11.640 we see is actually appendicitis. And that becomes even more 0:13:11.679 --> 0:13:16.040 important when people don't read the textbooks, aka, when your 0:13:16.040 --> 0:13:21.120 bodies present with appendicitis differently than what that classic description is, right. 0:13:21.559 --> 0:13:23.880 And what are some of the ways that it doesn't 0:13:23.880 --> 0:13:25.560 present with that classic description. 0:13:25.960 --> 0:13:28.320 One of the ways that it gets missed the most 0:13:28.400 --> 0:13:32.319 is when somebody is having constipation, and so they're maybe 0:13:32.400 --> 0:13:35.680 not having because sometimes you get diarrhea with appendicitis. When 0:13:35.679 --> 0:13:39.160 people are having constipation and appendicitis, it's more likely to 0:13:39.200 --> 0:13:42.960 get missed for one reason or another. You might not 0:13:43.160 --> 0:13:46.439 have a fever. You might not have a fever yet 0:13:46.840 --> 0:13:50.200 you might have pain, but it's a little bit more nonspecific. 0:13:50.920 --> 0:13:54.360 Someone might think, and this is where things get very subjective, 0:13:54.520 --> 0:13:57.360 and we'll talk more about this later, but people might think, well, 0:13:57.400 --> 0:14:01.960 your pain doesn't seem that severe. So there's a lot 0:14:02.000 --> 0:14:03.760 of different ways you may or may not have that 0:14:03.880 --> 0:14:06.040 nausea or vomiting. You might have a lot of vomiting, 0:14:06.040 --> 0:14:07.960 you might have no vomiting. So like, there is a 0:14:08.040 --> 0:14:12.000 huge range. But so when those symptoms might not exactly 0:14:12.080 --> 0:14:15.360 match what we think of as appendicitis, maybe the point 0:14:15.400 --> 0:14:17.800 where you have pain seems to be a little off 0:14:17.920 --> 0:14:21.280 from what I expect for appendicitis, whatever it is, then 0:14:21.400 --> 0:14:24.800 these kinds of imaging studies become even more important. And 0:14:24.840 --> 0:14:26.520 the truth is that there's also a lot of other 0:14:26.560 --> 0:14:29.920 pathologies that can mimic appendicitis, even if it seems like 0:14:30.040 --> 0:14:34.480 a textbook description right, something like an ovary intrsion, a 0:14:34.600 --> 0:14:39.880 cyst rupture, an ectopic pregnancy. There's something called mesenteric lymphatinitis 0:14:40.040 --> 0:14:44.560 that looks almost identical to appendicitis clinically, but then on 0:14:44.640 --> 0:14:47.320 imaging is going to look really different, So there's other 0:14:47.360 --> 0:14:49.960 stuff that it could be. So imaging and then blood 0:14:50.000 --> 0:14:52.840 work are going to kind of help the overall picture 0:14:52.920 --> 0:14:56.280 of making sure that we're correctly diagnosing somebody with appendicitis. 0:14:56.720 --> 0:14:57.960 What do you see in the blood? 0:14:58.680 --> 0:15:02.080 You might see an elevated whye blood cell count because 0:15:02.080 --> 0:15:04.840 you have an infection going on, and then you would 0:15:04.880 --> 0:15:08.800 expect usually not to see other things like your liver 0:15:09.000 --> 0:15:10.840 being out of whack, because that might make you think 0:15:10.840 --> 0:15:13.720 it's something else that's going on. You always have to 0:15:13.800 --> 0:15:15.720 check if somebody has a uterus to make sure that 0:15:15.760 --> 0:15:18.320 there's not a pregnancy, because a then it could be 0:15:18.320 --> 0:15:21.280 an ectopic pregnancy, and b then you might change the 0:15:21.320 --> 0:15:23.720 type of imaging that you're going to do to avoid radiation. 0:15:24.360 --> 0:15:26.000 So that's the kinds of things that you're looking for 0:15:26.040 --> 0:15:28.160 in blood work. There's not anything that's like, ooh, this 0:15:28.200 --> 0:15:31.960 blood work means appendicitis. There's no like specific blood work 0:15:32.520 --> 0:15:35.400 and Arin, I think you'll talk. I'm sure about how 0:15:35.400 --> 0:15:38.200 people used to deal with appendicitis back in the day. 0:15:39.160 --> 0:15:43.080 I can't wait, but a little spoiler for most people, 0:15:43.560 --> 0:15:47.040 because it wasn't that long ago that the standard of 0:15:47.120 --> 0:15:49.960 care was to cut somebody open with a big old 0:15:49.960 --> 0:15:53.360 incision and then cut that appendix out and then stitch 0:15:53.360 --> 0:15:56.800 you back up. And that is called an open appendectomy. 0:15:56.880 --> 0:16:00.280 And that is what Madeline had. Ah, that's why she 0:16:00.320 --> 0:16:02.080 had a big old scar, and everyone was like, I 0:16:02.240 --> 0:16:04.200 want my appendix out too. 0:16:04.560 --> 0:16:09.760 Yep, I did as well. Yeah, before I knew more appendixes. 0:16:10.320 --> 0:16:12.880 So open appendectomy was the standard of care for a 0:16:12.920 --> 0:16:17.720 long time until the advent of what's called laparoscopic appendectomy, 0:16:18.080 --> 0:16:21.880 which is instead of one giant cut, they use really 0:16:21.960 --> 0:16:24.600 a couple of really really small cuts, and then these 0:16:24.600 --> 0:16:27.280 instruments on long sticks and a camera that they can 0:16:27.280 --> 0:16:30.080 put inside of your belly to look at your appendix 0:16:30.120 --> 0:16:32.960 and all of your other organs, and then if needed, 0:16:33.080 --> 0:16:36.240 take the appendix out through these teeny tiny holes. And 0:16:36.320 --> 0:16:39.280 this is a lot better because it's a faster recovery, 0:16:39.320 --> 0:16:42.160 there's less trauma to the muscles of the abdominal wall, 0:16:42.200 --> 0:16:45.960 there's less pain, postoperatively. It's like, everything is better if 0:16:46.000 --> 0:16:51.160 you can do a laparoscopic procedure. But it's still surgery, right, 0:16:51.200 --> 0:16:55.120 It's still cut this thing out because it's causing problems. Today, 0:16:55.280 --> 0:16:57.480 in the year twenty twenty four, people are starting to 0:16:57.480 --> 0:16:59.920 come around to this wild idea. And I say start 0:17:00.200 --> 0:17:02.640 because the literature goes back quite a ways. 0:17:02.920 --> 0:17:04.640 Yeah, to like the fifties at least. 0:17:04.680 --> 0:17:07.520 I think, Oh, that's even further than I realized I 0:17:07.600 --> 0:17:12.119 knew of it, like to the early two thousand, but 0:17:12.280 --> 0:17:15.399 like it's been an accepted practice I think since like 0:17:15.440 --> 0:17:19.120 the mid two thousands, but still is not that common 0:17:19.680 --> 0:17:22.320 that you maybe don't have to cut it out and 0:17:22.400 --> 0:17:25.280 maybe can just use antibiotics to treat it. 0:17:26.080 --> 0:17:29.399 But is there there's like a higher relapse rate or 0:17:29.440 --> 0:17:32.200 whatever it would be called, like a higher recurrence rate 0:17:32.240 --> 0:17:33.280 of appendicitis? Right? 0:17:33.320 --> 0:17:36.840 There is there a lot. Let's talk about it. Okay, okay, 0:17:36.880 --> 0:17:40.120 So let's talk first about what is actually going on 0:17:40.720 --> 0:17:44.600 in your appendix. What is appendicitis really like? Now we 0:17:44.640 --> 0:17:46.200 know what it looks like and most of the time 0:17:46.200 --> 0:17:48.199 you're going to need surgery to get it out. So 0:17:48.240 --> 0:17:51.680 what's going on? And that might tell us when it 0:17:51.760 --> 0:17:53.879 might be a good idea to not do surgery or 0:17:53.920 --> 0:17:56.399 do surgery based on what's going on. 0:17:56.600 --> 0:17:58.000 Oh it, it's good. 0:17:59.320 --> 0:18:02.840 So in humans, Aaron, I remember you asking me this 0:18:02.880 --> 0:18:04.760 while we were before we recorded, and I was like, 0:18:04.840 --> 0:18:07.359 had to look all this up because why are there 0:18:07.400 --> 0:18:10.760 so many different names for the appendix. Yeah, in humans 0:18:10.800 --> 0:18:14.000 it's called the vermiform appendix because it looks like a 0:18:14.000 --> 0:18:17.760 little worm vermous like a worm. Yeah, it's a little 0:18:17.760 --> 0:18:20.760 out pouching. Basically, your appendix is this little like out pouching, 0:18:20.800 --> 0:18:24.320 this little like finger of tissue that comes off of 0:18:24.359 --> 0:18:27.199 the very first part of your colum or your secum, 0:18:27.359 --> 0:18:29.240 or your large intestine. It has a lot of names. 0:18:30.240 --> 0:18:32.520 And I don't remember, Aaron, which episode it was relatively 0:18:32.520 --> 0:18:34.160 recently that you were like, can you tell me all 0:18:34.160 --> 0:18:36.440 the parts of your intestines? Do you remember that? 0:18:36.520 --> 0:18:37.919 I think it was neurovirus. 0:18:37.960 --> 0:18:43.040 Neurovirus, Okay, So as a refresher, your small intestine is 0:18:43.040 --> 0:18:45.800 what's connected to your stomach, and that is what wriggles 0:18:45.840 --> 0:18:48.000 its way back and forth in the center of your abdomen, 0:18:48.320 --> 0:18:52.119 and it ends in the right lower quadrant of your belly, 0:18:52.720 --> 0:18:55.320 and there's a valve that connects your small intestine to 0:18:55.400 --> 0:18:58.720 your large intestine, and right next to just kind of 0:18:58.800 --> 0:19:03.320 right underneath, like down south, closer to your feet. I 0:19:03.359 --> 0:19:07.200 guess of where your small intestine connects to your large intestine. 0:19:07.440 --> 0:19:10.040 That is where this little extra bit sticks out that 0:19:10.119 --> 0:19:14.639 looks like an anemone tentacle. It's very small. It's like 0:19:14.800 --> 0:19:18.560 one to three millimeters in internal diameter, so really small, 0:19:18.640 --> 0:19:21.560 smaller than your pinky finger, and it sticks off of 0:19:21.560 --> 0:19:24.439 the bottom of your large intestine. Your poop is going 0:19:24.520 --> 0:19:28.000 to go through your small intestine and then swoosh up 0:19:28.080 --> 0:19:30.760 your large intestine and then eventually all the way out 0:19:31.240 --> 0:19:35.160 until you poop it out. Okay, So this little finger 0:19:35.320 --> 0:19:39.480 of an appendix can get clogged, and there's a few 0:19:39.520 --> 0:19:43.399 different ways that it can get clogged. Sometimes it gets 0:19:43.560 --> 0:19:46.639 clogged with poop, and when it gets clogged with a 0:19:46.680 --> 0:19:50.359 chunk of poop, that chunk is called an appendico lith 0:19:50.760 --> 0:19:55.440 or a FeCO lith, a little hard poopball. But sometimes 0:19:55.480 --> 0:19:57.720 it can get clogged with other stuff. It could get 0:19:57.760 --> 0:20:00.560 clogged with a tumor, either a benign two or a 0:20:00.600 --> 0:20:05.199 cancerous tumor. It can get clogged with an overgrowth of 0:20:05.600 --> 0:20:09.880 lymphoid tissue that is like our immune tissue, which there's 0:20:09.920 --> 0:20:13.280 a lot of in our appendix, that can kind of overgrow. 0:20:13.359 --> 0:20:16.560 And that can happen just on its own because you 0:20:16.680 --> 0:20:21.040 just have immune tissue growing, or it can happen because 0:20:21.160 --> 0:20:26.560 that tissue is responding to an infection, or sometimes it 0:20:26.560 --> 0:20:28.720 can get clogged with other things like just a little 0:20:28.800 --> 0:20:32.760 chunk of calcium, whatever it is. Anytime in our bodies, 0:20:33.240 --> 0:20:37.200 a small tube that's connected to a bigger tube gets clogged, 0:20:38.400 --> 0:20:42.520 you have stagnation of stuff, and that is a perfect 0:20:42.560 --> 0:20:44.920 medium for bacteria to grow and. 0:20:44.880 --> 0:20:46.879 Thrive like a stagnant pond. 0:20:47.200 --> 0:20:50.199 Exactly like a stagnant pond. And so that is what 0:20:50.359 --> 0:20:53.879 happens in our appendix. When you get appendicitis you have 0:20:54.040 --> 0:20:57.639 something that causes this tube that should be like open 0:20:57.720 --> 0:21:01.560 to communicate with your large intestine get clogged and blocked off, 0:21:02.240 --> 0:21:06.480 and then bacteria start to grow and multiply. As that happens, 0:21:06.520 --> 0:21:10.560 it triggers inflammation, because that's what a bacterial infection does. 0:21:10.640 --> 0:21:15.520 It triggers inflammation, and that inflammation causes swelling, and when 0:21:15.520 --> 0:21:18.720 you have swelling in a really small space, that ends 0:21:18.800 --> 0:21:21.800 up cutting off the blood supply. To the walls of 0:21:21.840 --> 0:21:26.800 that appendix, like to the tissue, and then eventually, because 0:21:26.840 --> 0:21:29.199 the blood supply is cut off, the tissue of the 0:21:29.240 --> 0:21:32.200 walls of the appendix starts to die and then it's 0:21:32.240 --> 0:21:35.280 weak because it's dead tissue, so then it can perforate, 0:21:35.920 --> 0:21:39.200 and that's what causes a perforated appendix. And then all 0:21:39.240 --> 0:21:43.000 that infected stuff, the bacteria, the inflammation, the white blood cells, 0:21:43.040 --> 0:21:47.480 the pus, it explodes out of your appendix, and a 0:21:47.480 --> 0:21:50.639 couple of things can happen. If that happens, If just 0:21:50.680 --> 0:21:53.480 a little part of the wall gets a hole in it, 0:21:53.560 --> 0:21:56.720 like a small hole, then the fluid might come out 0:21:56.760 --> 0:22:01.159 and get trapped, and that is what forms an absce Okay, 0:22:01.240 --> 0:22:04.640 or sometimes the whole appendix can rupture and then it's 0:22:04.680 --> 0:22:07.560 not contained and then all of that infected fluid can 0:22:07.640 --> 0:22:10.760 kind of go throughout your whole abdomen. And that's what's 0:22:10.800 --> 0:22:14.520 called peritonitis, which is very serious. That's definitely an emergency. 0:22:15.359 --> 0:22:18.160 Does that make sense, I mean, that's essentially appendicitis. That's 0:22:18.359 --> 0:22:19.320 that is what causes it. 0:22:36.080 --> 0:22:40.120 Okay, So at what point, like what's happening when your 0:22:40.119 --> 0:22:42.720 belly button hurts versus when that pain moves to the 0:22:42.760 --> 0:22:47.520 lower right quadrant, and then like when does surgery? When 0:22:47.560 --> 0:22:50.639