Severe attack of upper back pain - Forum

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Paranoid

Re: Severe attack of upper back pain - Ärzteforum

Post#21 »

There is a story about a consultant surgeon working in the NHS in England who had some PR bleeding typical of a CA. He got some old clothes, went to out-patients at St. Marks as a public patient, had sigmoidoscopy and biopsy of his rectal CA, and was admitted as an older man with no special affiliations. He AP resection was done by the senior registrar, he had a straightforward recovery, and left hospital in the usual time with no special fuss.

I'd go somewhere where they do the sort of surgery you think you need on a fairly routine basis. You shouldn't need to be in hospital all that long. My own preference would be for a pre-op ERCP, flush out stones or sphincterotomy, and lap chole a couple of days later.

I'm spoilt. My younger colleague has done almost a thousand ERCPs, lots of lap surgery, and is a neat unhurried surgeon. However my own biliary colic turned out instead to be mild ischaemia just off the circumflex branch, and responded to balloon angioplasty. I was getting exercise related biliary colic on the treadmill my wife bought me as a birthday present.


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Turkish surgeon

Re: Severe attack of upper back pain - Ärzteforum

Post#22 »

Why don't you post us on the lessons the rest of us should learn about how to look after our patients better? I think surgeons, and physicians and nurses in general, could contribute a lot to better patient care by noting what they found good and bad in some organised systematic way [like incident reporting and subsequent analysis].

Montag surgeon

Re: Severe attack of upper back pain - Ärzteforum

Post#23 »

I strongly feel that gastroenterologists number far too many, and that surgeons should be doing their own endo work generally. Perhaps the cutthroat competitive atmosphere in the Etats-Unis, the spirit that may have built the country, works against cooperative ventures such as ours. BTW, I have fellow resident pals in the States who do tell me of the relatively more intense level of intramural competition down there. I can understand your concern about a collection of Bozos doing a handful of procedures annually.

Paranoid

Re: Severe attack of upper back pain - Ärzteforum

Post#24 »

I'm really surprised at the number of you who feel cholangiograms are unnecessary. I have to admit that I was trained to do them and always did them with open cholecystectomy. I have continued to do so with lap choles largely because I feel that the a good operation should not be altered because it is done laparoscopically. I haven't reviewed my cases for a few years, but I have been surprised many times by CBD stone which were completely unsuspected - normal pre-of LFT's, amylase, and no history of jaundice or acholic stools. I'm usually able to clear the duct laparoscopically and if I can't, I send the patient for ERCP. I must admit that I don't like laparoscopic CBDE at all. It can be a thrash, and almost always ruins the day - but it can be done. My patients are grateful and I'm always amazed at how well they do post-op. Most go home the following morning feeling as well as the patients who did not undergo the extra hour-hour and a half of anes. time.

cocojambo

Re: Severe attack of upper back pain - Ärzteforum

Post#25 »

There's nothing that gets my dander up more than hearing gastroenterologists spout statistics about how many ERCP's you have to do before you are prepared to do a sphincterotomy. I traced the origin of that number and found a "study" where a gastroenterologist, with no training in ERCP, decided to seek such training. He used 100 cases as a goal, and after performing these cases in training, he started doing ES. His results were good. Based on this, he recommended that everybody should do 100 ERCPs. You call that a study? And it is often quoted.

I did about 10 ERCP's in my endoscopy fellowship with Jeff, and had to go to a small rural hospital to do my sphincterotomies, because my main hospital wouldn't let me do them (why should anybody be allowed to do an ERCP if they aren't allowed to do the sphincterotomy). Of course the main hospital eventually relented and granted my privileges.

I am sorry to say that I do less than 10 cases a year, yet I still feel very comfortable doing the procedure, and my results are very good. Although I admit that I am occasionally unable to cannulate, I have had no complications at all. Most of my cases are for CBD stones, and I can easily avoid over injecting the pancreatic duct (I have a good radiologist who can tell me what duct I am in before I even inject contrast).

I think that the bottom line is that everybody is different, and some of us can do something a few times and be good at it, and others can do it 1000 times and never get it right. We just have to figure out which category we fit into.

Gemcitabine

Re: Severe attack of upper back pain - Ärzteforum

Post#26 »

As an aside, my father-in-law had a lap GB last week by one of my partners and recuperated with us. Without question the worst part of the procedure was his post-op right sided chest and shoulder pain. Of course it resolved completely by 48 hours. Is anyone aware of any new data or inights as to the cause and control of this oftern severe, self-limited post-op complaint?

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Alalo

Re: Severe attack of upper back pain - Ärzteforum

Post#27 »

Most likely caused by inadequate release of the CO2 after GB removal. Once you are finished you must remove all of the CO2...It only takes a few seconds and it makes these complaints almost non-existant.

Pediatrician

Re: Severe attack of upper back pain - Ärzteforum

Post#28 »

The "no hernia incision" was LATERAL PARAMEDIAN incision placed one in the lateral section of the recus sheath . It's advocates (particularly the Leeds group) suggested that it avoids denervation of the muscle. It never became popular. The advent of the lap choleys created new problems.

Pediatrician

Re: Severe attack of upper back pain - Ärzteforum

Post#29 »

I do not have any scientific data but "people claim" that residual CO2 + blood irritates the diaphragm, causing the pain. Suck out everything before removing the ports.

Grandpa Phil

Re: Severe attack of upper back pain - Ärzteforum

Post#30 »

While not subjected to a scientific study, one of the surgeons in my home town swears that injecting 15-20cc of bupivicaine into the RUQ over the liver capsule decreases the incidence and severity of this complaint. The most important thing is to evacuate/irrigate all blood, bile and CO2.

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