Surgery best option for appendicitis

Dear Dr. Roach: A coworker of mine recently had a ruptured appendix. The doctors did not remove it, but instead gave him heavy doses of antibiotics for three weeks. I thought they had to remove it. What is going on? — D.M.

Surgery remains the preferred therapy for acute appendicitis, the inflammation of the appendix of the large intestine. Nonoperative management can be used in people with uncomplicated appendicitis — which might be valuable for some, especially people with a history of surgical complications. However, 27 percent of people assigned to antibiotics needed surgery anyway.

DearDr. Roach: I’m aType 1diabeticwhowas diagnosed with common variable immunodeficiency. Canyoutell me about this, and whether it might be related tomy diabetes?— J.B.

Common variable immunodeficiency is, despite its name, not a common condition. It does indeed cause immune deficiency and increased susceptibility to infection and malignancies. Further, the condition may be so mild as to go unnoticed in some people, while others have recurrent infections. The hallmark of the syndrome is a very low level of immunoglobulins (antibodies) in the blood. Although usually present at birth, most are diagnosed between ages 20 and 45. Thus, there often is a long delay in diagnosis.

Because CVID is not one disease but many, there are many manifestations of this condition. However, recurring infections, especially pneumonias or sinus infections, should prompt a clinician to consider testing for this condition.

Often, the diabetes may be blamed for what is actually an immune-system disease. Treatment with intravenous immunoglobulin may be lifesaving in serious infections. I also have read that this treatment may make blood sugar sporadically drop in an unpredictable fashion.