Chatting with our doctor

Alright, look, Susan Martin24, give it to me straight—just try to break this down for me in plain English:

When you're looking at a 70-year-old patient who—according to the stats—only has a 10% chance of making it through the year, is it actually better to go through with surgery, or should we just let nature take its course?

Maybe I’m being harsh, but honestly, I’m not even trying to make excuses here... what is the actual, tangible benefit of such an invasive procedure for the patient themselves?

And what about the people around them? How much does a surgery like that actually help their family or support system?

BTW, since you're a surgeon: when you're deciding whether to operate or not, does the family or the patient's home environment play any role in that call at all?

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. 😈

Totally off topic here...

I was just wondering how you, Susan Martin24, ended up in plastic surgery when you had an actual specialist and a top-tier surgeon for hardcore abdominal work on your case. I mean, shit happens, right? Maybe it was just fate or some other weird cosmic coincidence...😬 ...?

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. 😂

It’s honestly like...😱 ...you stepped straight out of the Twilight Zone...it feels like...🙂 ....

Every abdominal surgeon's absolute worst nightmare...honestly, reading through this makes me think you might not have run far enough away from all that trouble in the first place...😈 ....

"Miss Trousseau"...hehehe...how "charming"...😂 ...Personally, if I had to pick a "Miss Disaster" from the world of medical conditions, I’d put pancreatic disease at the very top—I'm talking both CA and necrotizing pancreatitis, both surgically treated—it's brutal! You honestly can't even tell where the drains should go or where everything is flushing out; the patient looks jaundiced and pale, and their blood pressure is basically hitting rock bottom...

And regarding that whole thing with the new "love"...to me, comparing plastic surgery to an abdomen is like stepping down from an F-16 to fly a crop duster—except the price tag is just as high, if not higher.

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.

Anyway, end of tangent, hopefully.👍

Offtopic:

Susan Martin24, was it a struggle for you having to set fractures and deal with dislocations? You mentioned starting out in abdominal surgery before moving over to plastics. But surely you had to pull some shifts in the ER during your residency? It’s not that I’m weak—I just don't have the strength to haul a 330lb guy's leg around by myself. Did you have to call for backup, or were you expected to handle that solo? And did they even ask how you'd manage stuff like that when you were applying for the residency?

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. 🙂

Awesome! 👍

Can I jump in first with a real question? 😉

Is that okay? Thanks! 🙂

Man, I just love knowing everything about everything... partly because I'm super curious, but mostly just so I don't freak out. 😁 So, here it is

What exactly is laparoscopy, and how does it actually work? Like, do they knock you out completely or just give you a little something? And how long does it usually take before I can get back to my normal life?
Also, do dermoid cysts have a tendency to come back?

Feel free to DM me too 🙂

thx

brisknomad said:... do they knock you out completely or just a little bit? ....

I can weigh in on this, though I’m sure a Woman from Rijeka would be way better at handling the actual surgical specifics....

If you're looking at laparoscopic surgery, the prep work before you go under is pretty much identical to what you'd go through for traditional open surgery. It basically comes down to the fact that surgeons always need to be ready to pivot mid-procedure and switch to a standard open incision if things get tricky.

Because of that, the anesthesia setup is usually the same as a classic procedure—using general endotracheal anesthesia along with muscle relaxants to keep everything smooth.

Now, some specific laparoscopic procedures, like certain gynecological or urological surgeries in the lower abdomen, can sometimes be done using spinal or epidural anesthesia, where they inject the anesthetic right into the spine, as people usually say.

At the end of the day, the anesthesiologist—who really calls the shots here—will decide which method is best based on your overall health, your pre-op tests, and the specific type of surgery being performed.

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...

Susan Martin24 said:and yeah, proper treatment hurts. It also means facing the fact that by the time they hit the terminal stage, that person is gonna be a heavy addict—something a bunch of uninformed family members try to dodge at all costs.

So what exactly is being given in that therapy, and why are these clueless family members avoiding it?
lame answer🙂

thanks so much 👍 i finally got the picture 🙂

honestly josh, the only thing I actually care about is the extraterrestrial stuff 😁

When we're managing pain for patients at the end of life, it’s pretty standard to use opioids alongside NSAIDs—basically prostaglandin synthase inhibitors. The idea is to tackle the pain from two different angles: hitting those opioid receptors while simultaneously blocking the prostaglandins that trigger the sensation of pain in the first place.
The thing about pain in terminal cancer patients is that it's progressive. It just keeps ramping up because you've got metastases spreading, the tumor itself undergoing necrosis, and the physical pressure of the mass pushing against surrounding tissue. Plus, since the body builds up a tolerance to opioids, you're constantly having to bump up the dosage. This means these poor souls are almost perpetually under the influence—they're often foggy, drifting in and out of sleep, or feeling extra irritable. If they don't get their next dose right on schedule, they start showing classic withdrawal symptoms...
But honestly? They aren't feeling the pain anymore. The pain becomes manageable, and at the end of the day, that's really the only thing that matters.
Unfortunately, I see a lot of family members who are absolutely terrified of this. They don't want their father—who is dying, and let's face it, usually isn't even being asked what he wants anyway—to pass away looking like an addict. 🤮
It’s honestly heartbreaking how little people whose loved ones are facing an incurable illness actually know about what's coming. And what's even worse is that many of their doctors do nothing to prepare them. Some doctors even seem to pray that nobody asks them anything; they stay silent out of a sort of misplaced sense of pity or just pure awkwardness, avoiding the conversation where they have to say, "Look, your father likely only has a month or two left, you should probably get ready..."
So yeah, the whole situation is just one big, messy gray area. 😢

brisknomad6, you aren't talking about that extraterrestrial scent by Thierry Mughler, are you? 😬
I actually have a bottle myself, but honestly, it’s nothing to write home about. It’s pretty heavy and punchy—lots of sandalwood and other woody notes that give it this masculine vibe... but it isn't exactly unpleasant 🙂

😂

so, this extraterrestrial thing is a Dermoid and I’m kinda wondering... does it actually come back or am I gonna be immune? 😬

A Dermoid, or what we call a dermoid cyst (usually found on the ovary), is basically part of a group called hamartomas—think of them as little "glitches" in nature. During embryonic development, a specific cell division from the ectoderm—which is the foundation for epithelial tissues and everything derived from them, like skin, hair, sweat glands, sebaceous glands, nails, teeth, and even neural tissue—basically gets misplaced. It ends up settling on a different organ, most often the ovary, and just grows there on its own.
Most of the time, a Dermoid is benign and won't come back once it’s been surgically removed. That said, it's pretty common to see multiple cysts at once; if they found and took out one, there might be others lurking nearby.
By the way, you can also find dermoid cysts on the scalp or face. They look almost identical to an atheroma, but when a doctor opens them up, you'll find much more than just sebum inside.
Honestly, your little extraterrestrial is more like a peaceful house pet—totally harmless... nothing to be scared of. 😉
The real clinical importance here is in the differential diagnosis of ovarian cysts. Every single cyst needs to be monitored, especially if it isn't just a simple follicular (ovulatory) cyst, because until proven otherwise, doctors have to rule out ovarian cancer.
And let me tell you, ovarian cancer, much like pancreatic cancer, is one of the nastiest malignancies out there because it doesn't really show symptoms until it's already reached an inoperable stage.
But it is highly preventable—ladies, regular gynecological checkups are an absolute MUST!!!

brisknomad6 said:Great! 👍

What exactly does laparoscopic surgery entail—how is it actually performed? Is it full general anesthesia or just some light sedation? And how long before I can get back to my usual routine?

Thanks.

To help ease those nerves...

http://www.mayoclinic.org/tests-procedures/laparoscopy/about/acp-2038513

Best of luck!

Susan Martin24 said:ovarian cancer.
And that one—along with pancreatic cancer—is honestly one of the nastiest, most unfair malignancies out there... it just doesn't show anything until it's already reached an inoperable stage.

ugh, we absolutely loathe that thing...

but look, I have to get something off my chest (and I hate being that person who talks trash about doctors, but let's face it, there are some total parasites in the profession, so sometimes you just have to say it): what do you guys think about a gynecologist who refers a patient to a psychiatrist—claiming she's "just making up symptoms"—only for that same patient to end up needing surgery for Stage III ovarian cancer three months later?

Shouldn't she be hit with a baseball bat or something? lol

PS: I've moved past the phase of pure, white-hot rage toward that doctor, but man... I really wish there was a way to make sure she never gets near another sick woman. I know, sadly, there isn't...