Alright, let me walk you through this step by step...
"Riječanka1" basically vanished into the digital void when Reddit migrated to a new server—I just couldn't get back into my old account no matter what I tried, so I had no choice but to start fresh with this handle. Honestly, when it comes to usernames, whether here or anywhere else, I’m pretty much a one-name kind of person 😂—this is really the only nickname I use.
brisknomad6 was asking about what laparoscopy actually is and how the experience feels. So, basically, laparoscopy is a method (it can be used for diagnosis, treatment, or both at once) where doctors access the abdominal cavity minimally invasively—meaning they use the smallest incision possible. Whether they are checking out organs in the digestive system (like the stomach, intestines, liver, or bile ducts) or the urogenital organs (ovaries, uterus, and to a lesser extent, the abdominal wall or bladder), they use a tiny incision, usually about half an inch, just above the belly button to slide in a telescope camera. During the actual procedure, they "inflate" the abdomen with CO2 to create some working room. Besides that main camera port, they make two or three other tiny little nicks, all under an inch, just below the ribcage on both sides, to get the surgical instruments in there. The big upside to this approach is that because the cuts are so small, they heal way faster than a traditional open surgery (what they call a laparotomy). You get back on your feet sooner, which means less time off work—which is huge—and there's a much lower risk of ending up with a post-op hernia.
Scott Allen10—man, he’s definitely an anesthesiologist... (you know, people always joke that anesthesiologists are our sworn enemies 😬)... though, my best friend is actually an anesthesiologist, so I know firsthand that isn't always the case...
Jose Miller3, look, it’s totally up to you if you want to open up. Honestly though, with the way things are going lately and how people act around here, admitting you’re a doctor can feel pretty ungrateful—maybe even a little risky for your own peace of mind 🙂 . The vibe right now is just... off. It feels like everyone points the finger at us (and okay, maybe we aren't always blameless, but it’s definitely not as much as people love to claim) as the reason the healthcare system is such a mess. I actually write about all this stuff on my blog quite a bit (the link is in my profile, so I won't clutter this post by dropping it again), specifically regarding the medical field. If you're curious, check out my recent post called Healthcare—is it a dying profession? . Whenever I have a spare moment on here, I try to jump in and reply to people... so one of these days, I'll 😬 get around to answering your question about the issues surrounding terminal patients.
And as for the whole "egotrip" thing—man, I feel like if I actually tried to convince anyone that I'm not constantly on an ego trip, nobody would believe me anyway 🙂 .
Sophia Martinez65 - honestly, resetting fractures and dislocations isn't actually that brutal—it’s all about technique. Take a radius fracture, for example. You aren't fighting against nature here. If you're dealing with an impacted radius fracture with dorsal displacement of the distal fragment (which is pretty much the standard textbook case), you just do two things while someone else provides counter-traction by stabilizing the elbow. You hold the hand gently and pull in a longitudinal direction to regain length (the patient usually stops hurting right then), then you pull dorsally to decompress the impact, and finally set it into volar flexion while using your other thumb to "align" the fragments. The trick is you aren't using more than maybe 2-3 kg of force. It's the same deal with shoulder dislocations... first, you perform extension in semi-abduction. You grab the forearm with both hands and, kind of like when you're sailing, you lean back like you're tightening a spinnaker. You use your body weight to "pop" the humeral head out of the axilla, and then it just spontaneously reduces itself (though I might add a little bit of magic via IV, too). Those are just some tips to make life easier—because, let's be real, not every surgeon is some hulking brute. For me personally, the toughest thing was working on partial hip prostheses for femoral neck fractures. When you're implanting the prosthesis, you cut through the neck with an electric saw, and then you have to yank the head out of the acetabulum using a sort of punch, almost like popping a cork out of a bottle. And get this: the ligamentum teres is the strongest ligament in the whole body—you actually have to tear it away from the fovea capitis using luxation movements. And you can't call anyone for help! You have to do it yourself; it's a matter of pride. Though, I'll admit I take shortcuts now and then—like how I occasionally handle lower or upper leg amputations for diabetic gangrene. Some patients have extremely petrous, brittle long bones, so I have to use a regular saw because a vibrating one would just shatter them. Sometimes the instruments even jam on the bone because they see me sweating so much—basically, their mechanics just can't handle how slowly I'm sawing. 😬
Nobody even asks if you're okay—honestly, everyone was just waiting for me to go running to the Chief crying, saying I couldn't do it or that it wasn't for me... You know how people say here: "Don't bother asking for help!" 😈 Well, I didn't ask.
Sorry, moderators, getting off-topic again, and I promised I wouldn't. 🙂
Kimberly Thomas4... you’ve gone and completely offended the entire medical community here in Washington, D.C.... This stuff falling from the sky isn't even rain; it's just the tears of my fellow D.C. doctors flowing in endless streams.... 😈
They need a serious reality check 😬 Or, honestly, just like during peak rush hour at a busy Walmart, having them write it out a hundred times: "I am going to learn how to communicate like a civilized adult on this forum, without the hysterical outbursts and those immature 'suggestions'." 🙂 Look, we don't all have to see eye to eye, but there’s no reason to lose your mind over it, right? 😍
Sophia Martinez65 said:Look, Kimberly Thomas4, I don't see the issue here. If there’s actually a medical reason for it, they'll just go into the hospital, have the mole removed, and Medicare will pick up the tab—so everyone stays happy. 😬 If there isn't a clear indication and you're short on cash, just leave the mole alone and keep an eye on it yourself. Just remember the ABCDEF criteria: A- asymmetry B- border C- color D- diameter E- elevation in the center F- funny looking lesions Plus, doctors usually recommend taking it out if it's constantly getting irritated or if it's sitting in a spot that gets tons of sun exposure.
By the way, regarding what you called a "minor procedure"—aside from all the years a surgeon puts into their education and everything Susan Martin24 mentioned, they still have to administer anesthesia, sterilize the area, and use sutures that aren't exactly cheap. So, really, think about it.
If I got anything wrong, please Susan Martin24, set me straight. It's been a while since I studied dermatology (okay, maybe not *that* long ago 🙂), so I'm writing this mostly from memory. I hope my brain is still holding up okay 🙂. I definitely wouldn't want to give out bad info. 🙂
Sophia Martinez65, your memory is clearly selective, and honestly, so is your answer—everything seems fine to me. 👍 Just a few more minor little notes to add: - Generally, if a mole's diameter is larger than a standard pencil—say, over 7-8 mm—it's definitely worth talking to a doctor about removal. - Discoloration matters too; it's not just about it being darker, but also how unevenly the pigment is spread out. - Borders—if they aren't smooth and sharp, but look kind of "smudged" or blurry. - The presence of "satellites," which are those tiny little clusters of pigment a few millimeters away from the main mole or right along its edge. That's a big red flag because it raises concerns about melanoma.
Basically, any mole should be monitored by a dermatologist (yet another specialist whose private visit starts at $100 and goes up from there—can you believe the nerve? 😬), who is ultimately the one to decide if surgery is necessary...
One thing I really don't get—everyone complains about how doctors "rip them off," yet nobody wants to wait two months on a referral for a procedure that, in 99.999% of cases, isn't an emergency and can easily wait a bit longer. I guess if it's free, it's not good enough, and if it costs what it actually costs to provide the service, then it's too expensive. 🙂 Man, we really are a piece of work. 🤮 (Wait, where did Rigo go?!?) 🙂
I’m going to have to disagree with Chloe Gray12 on one pretty simple point: healthcare is a market-driven industry in plenty of ways, but that’s not really what we’re debating here. My whole argument was specifically about the price list of a private plastic surgeon—someone running their own legitimate practice, paying their taxes, and operating entirely outside of the Medicare system. They aren't taking referrals from government insurance, which means they have total freedom to set their own rates based on the actual value of their expertise. They're players in the market too, and they know exactly what their skills are worth. 😈
And as for Kimberly Thomas4, who's being incredibly "generous" by suggesting that both me and Chloe Gray12 should just take our opinions elsewhere and stop cluttering up this thread: hey, moderators, are you seeing this? Is this forum some kind of private club owned by Kimberly Thomas4, or is it actually a public space for discussion?
Sorry for going off-topic here, but I really had to weigh in on this:
Scott Allen10 said:.... Honestly, reading that makes me think you might not have actually escaped far enough....😈 ....
I get that feeling sometimes too.😬 I mean, abdominal surgery is basically the heavyweight champion of the surgical world... kind of like how track and field is to athletics.😍 Still, when I look back at my old crew—grinding away and pulling all-nighters at age 16 while I’m out enjoying coffee on the Promenade every Saturday and actually having my weekends free—I don't regret trading in the Formula 1 lifestyle for a reliable tractor.😍 There are real perks to P&R surgery. I recently did some training at Mayo Clinic regarding skin malignancies, and man, you see everything from BCC and SCC to those weird non-ectodermal ones like Ewingo... plus all sorts of benign tumors, like tendon sheath growths in places you wouldn't believe.😁
And let's be real, it’s physically exhausting. Liposuction is a serious workout—honestly, it feels as intense as digging up a whole garden, and don't even get me started on dermabrasion, which is basically like carving wood.😉 My shoulder has been killing me lately.😛 My blood pressure has been running high, too.😈 You're always living with that underlying dread, wondering if a patient will suffer an embolism—which, sadly, has happened to a few of my melanoma patients post-op, since melanoma is incredibly thrombogenic—or if some other complication will pop up.
Scott Allen10, our priorities shift as we get older—when you're young, you just want to chase whatever your heart tells you to... but later on, certain things just hit you out of nowhere. But honestly, everything changed when they started calling me Mme Trousseau at the clinic. 😍
As I’m sure you know, Trousseau's sign—which is basically migratory thrombophlebitis of the abdominal wall—is a dead giveaway for tumor invasion in the retroperitoneum (where a mass compresses the vertebral vein drainage system), making it one of those classic "red flags" for pancreatic cancer. About 30 years after Trousseau first described this phenomenon, he actually ended up dying from pancreatic cancer himself...
A few years after I really started diving deep into pancreatic research—I'd published several papers, defended my Master's, and was right on the verge of finishing my PhD—everything flipped overnight. I turned yellow and completely crashed... obstructive jaundice followed by pancreatitis. Even though I already knew I had cholelithiasis, during an ERCP, they found some major issues with the Vater papilla. They prepped me for surgery and did an intraoperative biopsy that showed chronic inflammation... then they opened up my bile duct to clear it all out and inserted a drain, which caused a stricture. It felt like nothing would work naturally... long story short, I spent a month stuck in a hospital bed in my own department, and for a whole year, my pancreatic and liver enzyme levels were all over the place. I also dealt with several episodes of ascending cholangitis (thankfully, I didn't develop biliary cirrhosis) and high blood sugar for quite a while (which is ironic, since one of the big "innovations" in my doctoral research was tracking glucose dynamics as a pre-morbid indicator for pancreatic cancer...). Eventually, I just got tired of the whole ordeal. 😈
These days, I'm much more relaxed. I work less for more money, and no more grueling on-call shifts... but, I have a new "love": melanoma. 🙂 Don't worry though, it doesn't pose any bigger threat to me than it does to anyone else—I don't have a single mole on my body. 😬
Like the old folks say, sometimes you need to be a little wary of bad omens and warnings, rather than just ignoring them. 😂
Casey Cook10 said:The OP is basically saying the same thing... you either pay the full premium or you grab a referral from your doctor and just hope for the best with whoever you end up seeing. Just pay the specialist $133 and bring your insurance referral, and you shouldn't have any issues at all. 😁 😁
That approach doesn't fly with me. Maybe some of my colleagues might let it slide if you show up with a referral plus a nice bottle of wine from $13.... People always say everyone has a price, but honestly, my price is way higher than that. 😈 At the end of the day, you're selling your reputation and your integrity.
Scott Allen10, I really think we’re past the days when a surgeon would just toss a patient onto the table by the neck and start hacking away at their insides immediately. 😈 Getting thorough with pre-op workups and prep is everything. It lets us map out a procedure that actually helps the patient long-term, especially when dealing with hepatobiliary tumors. Like you were saying, the symptoms usually don't even show up until the disease has already spread, and by then, we're often looking at palliative care just to keep them comfortable. We might need to do a bile duct diversion to prevent cholestasis—you know, that jaundice that causes unbearable itching and bilirubin encephalopathy, not to mention how much it stresses out an already exhausted liver fighting metastases. Or we have to perform a gastrojejunostomy (GEA), because those inoperable tumors eventually grow large enough to block the stomach outlet, basically starving the patient. In those cases, we loop a bit of the small intestine to the stomach so food can bypass the duodenum. So, if the common bile duct is still passable—meaning the tumor isn't right on top of it yet or hasn't squeezed it shut—we can just place a metal stent to keep things moving. That kind of procedure is quicker and requires less anesthesia time, which is huge for someone who’s already physically drained from being sick. Of course, sometimes we unfortunately have to go the route of a percutaneous bile duct drainage... basically threading a catheter into the common bile duct under X-ray guidance without full anesthesia...
Jose Miller3, that is such a solid question! 😍 Especially nowadays, when the public is constantly breathing down our necks. It feels like people think nobody is allowed to die in a hospital anymore—just look at that case involving those two women at Mount Sinai. One passed away from a thromboembolism after surgery (even though we followed full prophylaxis protocols) and the other just succumbed to the nature of her illness, yet the journalists have already tried to spin it into some massive scandal. Because of that pressure, a lot of our colleagues end up overtreating. They operate and medicate (and spend money, obviously, even if it's senseless) everything under the sun, mostly out of fear of being dragged through the mud by the local news or TV stations. And our patients? Look, feel free to throw stones at me, but most of them act like sheep. Hardly anyone actually tries to learn anything about their own condition; most don't even bother asking the doctors a single question, with very few exceptions! So, it’s pretty obvious why they don't make their own decisions. If I were talking about someone close to me, like my mother, for example, I would make the following choices in the hypothetical situation you described: NO to radical surgery (assuming the tumor is inoperable; otherwise, the survival odds might be higher), YES to adjuvant chemotherapy, YES to palliative procedures when the time comes, YES to any alternative therapies that don't clash with official treatment, and YES to proper pain management—including accepting the fact that the person will likely become heavily dependent during the terminal phase, which is something most uninformed family members try to avoid at all costs. This topic is so huge I could honestly write about it for days.... I know several patients who made similar choices in similar situations, and I can tell you firsthand that they lived out the rest of their lives with much higher quality than those who were overtreated....
But, as I said, so many people who claim to be devout Christians don't really get that biblical principle: "Knock, and the door shall be opened to you." In this context, let's paraphrase it: Ask, and you will be given an explanation... and for heaven's sake, do some reading too. 😈
Casey Cook10 said:My bad, I guess for a patient with such an advanced case (and since an angiography was mentioned... so I'd say it's pretty widespread locally), figuring out whether the process originates from the pancreatic head or the tail is more of an academic distinction than anything else.]
I have to respectfully disagree there—the difference in prognosis and overall survival rates is actually massive. The angiography is huge because it shows how much the portal vein system is involved, which is absolutely critical when you're planning the surgery. For instance, if the splenic vein is wrapped up in the tumor, it means the invasion has hit the body or the tail of the pancreas. In that scenario, you can basically kiss a Whipple procedure goodbye. You won't be able to mobilize the tail or find enough healthy pancreatic duct to pull off a pancreaticojejunostomy. Not to mention, that kind of involvement often leads to portal hypertension, which is a major contraindication for the surgery itself...
Sorry, I know this is getting a little too technical for a forum discussion... but I'm sure Casey Cook10 gets where I'm coming from. 😍
Look, if you think it’s such a waste of money, why don't you just do it yourself?
Honestly, I feel the same way about getting my hair cut or colored—it feels like a total rip-off—but I still end up dropping $300 easily $133 just because I said the word "cheap" 😬
But seriously, that "useless" surgeon you're talking about isn't just some random guy. They're a specialist or even a sub-specialist who spent at least 24 years in school just to perform what you call a "pointless" procedure. And that’s not even counting the cost of the nursing staff, the medical equipment, the disposable supplies, or that "unnecessary" pathology report used to tell the difference between a harmless mole and melanoma. That lab work is done by *another* highly specialized pathologist who's also apparently "useless" according to you...
Who knows, maybe it won't go wrong... better watch out so it doesn't! 🙂
Since I’m a surgeon and my entire master’s and doctoral research focused on the head of the pancreas—plus the fact that I actually went through obstructive jaundice myself and had an ERCP performed—I wanted to drop a few thoughts for my colleagues here:
1. Sophia Martinez65 - Just so we're clear, ERCP isn't done under general anesthesia; honestly, that’s one of its biggest perks. Usually, the patient just gets lightly sedated before the procedure (using something like IM diazepam or Dormicum), and we spray the throat with lidocaine before sliding the gastroscope in. The exam itself is definitely uncomfortable because the manipulation triggers that gag reflex, but it's not excruciatingly painful unless they have to perform an intervention during the process. In my case, they tried a papillotomy and attempted to extract a stone using Dormicum—which failed, obviously—but I was right there experiencing it live, and I survived...
2. Trebor - I wouldn't go so far as to call ERCP a totally futile procedure. It provides incredibly valuable data regarding the obstruction of the common bile duct, whether it's due to endoluminal metastatic masses or biliary sludge. Plus, when a tumor mass is compressing the duct from the outside, it’s often possible to place a stent during the ERCP, providing a minimally invasive palliative solution.
Naturally, this is the gold standard when we suspect a neoplasm at the Vater area or the common bile duct itself. It’s absolutely essential for differentiating between a carcinoma originating from the papilla versus one coming from the head of the pancreas. It feels a bit strange to hear about these delays—I know plenty of outpatient patients make it to places like Brooklyn without any issues, sometimes even before those in San Francisco... And I really can't get behind the idea that a surgeon is just trying to "brush off" a patient, as someone else put it a little more politely earlier.
But here’s what I truly don't understand, and frankly, it drives me crazy: people, seriously, do you all have those famous "family doctors" you've picked out? You pay them through your insurance, they get a steady paycheck—so when a specialist requests or orders a specific test, your Primary Care Physician has a LEGAL OBLIGATION to ensure it actually happens. That means picking up the phone, calling, and getting the patient scheduled for that ERCP!!! Don't tell me it's impossible, because I know for a fact it isn't. The issue is that most of you who are unhappy with us specialists (yeah, yeah... we're just greedy and want to kick you out the door as fast as possible if we can't fix you...) don't bother asking "your doctor" for anything at all. 🙂
jadesailor14 said:all they need to do is post a picture of themselves next😍
u zagrljaj nobelovac😂 😂 😂
(That’s why they're being so secretive about what they actually do for a living—learned from experience in a past life on this forum. Not even the sweet scent of a Herbalife pitch can throw us off the scent 😈 ...)
Justin Fox said:Look, a nurse could just brush you off, give you the wrong injection, or even hit you with a Samarin shot and nobody would ever know...
Yeah, I get it—healthcare workers aren't going to love the idea of being held accountable for everything they do, but they really should be ready to stand by their actions. ..
Something like this would actually protect the vulnerable—people who don't have the strength to fight for their own rights. ...
It would also be great if they’d just hire more doctors and nurses so everyone could work shorter shifts. Instead of those grueling 8-hour stretches, maybe try 6 hours? That way they can actually focus on what matters—the patient's well-being—and it wouldn't be so draining for them either. Just because factory workers pull 8-hour shifts doesn't mean that's the perfect setup for everyone.
Like I've said a few times now: please, for your own sake, go get some help! Like, right now!!! Maybe head over to psychiatry, of course.... Honestly, these posts of yours aren't even funny anymore... they're just sad. 🤮
Those first two paranoid quotes speak volumes on their own, the third one screams Messiah complex, and that fourth one is basically your prognosis: since you've completely lost touch with reality, I'm afraid there's no saving you. 🙂
Justin Fox, the reason I ask is because we've already seen plenty of construction workers on this Reddit thread acting like self-proclaimed nutrition experts. And since you seem to be even "better" and "stronger" than those guys, I’m guessing you’re a plumber 😂 😂 😂
With that massive urge of yours to play Big Brother, that Orwellian type 😈
Justin Fox, I’ve actually asked you this before on another thread here in the "Health" section, but you conveniently went totally silent 😎 , so come on, let us know: WHAT DO YOU ACTUALLY DO FOR A LIVING? WHAT'S YOUR PROFESSION AND YOUR FIELD? I'm genuinely curious. 👍