Surgeons fail to make the cut
‘I started with my son’s Doc Martens, last worn when riding his motorbike 30 years ago’
It may not be a lot of fun being taken to hospital in the middle of the night with appendicitis, but there should be some consolation in knowing one is at least contributing to the training of tomorrow’s consultant surgeons.
Every aspirant surgeon has to start somewhere, and where better than removing an inflamed appendix? A small incision above the groin, separate out the overlying muscle, fish out the inflamed organ, tie it off with a ligature, a few stitches and the job is done.
There is, however, a problem. For several years now, the incidence of acute appendicitis has been in steep decline, with young surgeons now being lucky to have the chance to remove one appendix a month. “How can today’s surgical trainees ever begin to learn their craft?” The
Lancet lamented in an editorial. Appendicitis is, perhaps surprisingly, a relatively “new” affliction – none of the great physicians of ancient times, Hippocrates, Galen or Maimonides, mentions it. Indeed, it was not until 1886 that an American surgeon, Reginald Fitz, first described the characteristic presenting symptoms of abdominal pain, starting around the umbilicus and moving towards the right groin. Appendicitis would subsequently become the most common of all surgical emergencies, peaking in frequency in the mid-Fifties. This dramatic rise and fall in incidence has prompted much controversy, though neither of the two contending theories for the changes – dietary and infection – are particularly persuasive.
Recently, the diminishing opportunity for trainee surgeons to refine their skills has been further
compounded by the unexpected discovery that most of those with straightforward appendicitis do not require an operation at all: a trial published in the Journal of the
American Medical Association last year revealed that for 75 per cent of patients, a three-day course of oncedaily antibiotics is just as effective.
The result, researchers say, is that sufferers can now make a choice “between being treated with either antibiotics or surgery”.
Nothing to sneeze at
The curious corollary of the recurrent medical enthusiasm for polypharmacy is the frustration experienced by those whose doctors are reluctant to prescribe medicines that have dramatically relieved their symptoms in the past. This is a particular issue for sufferers of hay fever, which, as reported last week, is anticipated to be very troublesome this year because of the unusually high grass and birch tree pollen count.
The standard combination of an antihistamine and a steroid nasal spray is usually sufficient to control the misery of sore itchy eyes, sneezing, aching sinuses and wheezy cough. But for some, this is insufficient and their only hope of appreciating the joys of summer lies in a single intramuscular injection of the long-acting steroid Kenalog.
No longer – for, as several readers despairingly attest, their request for the jab is now declined on the grounds that it can cause severe side effects. As, indeed, like all steroids, it can, if given at high doses repeatedly for treatment of a severe inflammatory disorder. This is scarcely the situation here, and there does not appear to be a single case report to suggest otherwise.
This leaves the sufferer with no option other than to “go private” – a costly business that can entail a £90 consultation fee and a further £75 for the injection itself.
Booting out arthritis
Finally, my thanks to a reader for passing on a surprisingly simple solution for the crippling arthritis of his ankles following repeated sprain injuries.
His orthopaedic consultant advised a bone fusion operation to relieve the pain, though this would obviously compromise their flexibility. He opted, instead, “as a last resort”, to try high lace-up boots: “I started with my son’s Doc Martens, last worn when riding his motorbike 30 years ago.”
These certainly helped – but, better still, his wife found on the internet a pair of Mueller lace-up ankle braces, much favoured by professional footballers, which have dramatically improved his mobility.