What is the most pain you have ever felt

[Captain Ketamine]

U docs have knowledge or opinions on prostate cancer treatment HIFU ?

Not my area of expertise, need to get an unbiased urological opinion.

 

[veni vidi vici]

Not my area of expertise, need to get an unbiased urological opinion.

I was wondering if you were familiar with it as a treatment option for PC.

 

[hasher]

I was wondering if you were familiar with it as a treatment option for PC.

You are a pain in this ass. Fortunately you are are a tiny member.

 

[Captain Ketamine]

Agreed... love me a ketamine infusion; often set that and a vec drip so that a longish case is on autopilot. A bolus of dilaudid and cruising altitude achieved.

I've had mixed results with dexmet, but many swear by it. Long MAC dental? oh yeah

Ive used clonidine for years, which has been very helpful for emergence especially with aggressive young males (wild beast anaesthetic). Dexmedetomidine is something I’m slowly getting to terms with as now cheaper and off patent. Knowing when to turn it off in the longer case is the challenge.
Unfortunately we don’t have atipamezole like the vets use to reverse it, as would be useful especially with ICU cases. I would have thought it could be marketed in humans by now.
When I started we used a range of IT local anaesthetic for spinal depending on the case duration but after the lignocaine issue we only have bupivicaine available, a pity.

 

[Point Break]

Well……lotsa theories but when it’s “near term” certain it’s less theoretical and more……..troubling to put a fine point on it. No one wants to linger in misery but it rarely happens quite that rapidly and the benchmarks are less obvious. I know almost certainly what the process will be for me…..it’s less certain exactly when it might become intolerable, and not just for me but for my wonderful wife who will bear the brunt of caring for me and watching my suffering. I did that for my late wife over two years…..it was soul crushing.

 

[Glenn McCarthy]

Getting kicked in the nads is the worst. Worse than childbirth right? 3 months after getting kicked in the nads no dude says, "I'd like to get kicked in the nads again," however, 3 months after giving birth a woman will say, "I'd like to have another child!"

 

[130lights]

Getting kicked in the nads is the worst. Worse that childbirth right? 3 months after getting kicked in the nads no dude says, "I'd like to get kicked in the nads again," however, 3 months after giving birth a woman will say, "I'd like to have another child!"

3 months… no.

“The American College of Obstetricians and Gynecologists recommends waiting at least six months between pregnancies—although 18 months or longer is preferred.”

 

[Steam Flyer]

Getting kicked in the nads is the worst. Worse that childbirth right? 3 months after getting kicked in the nads no dude says, "I'd like to get kicked in the nads again," however, 3 months after giving birth a woman will say, "I'd like to have another child!"
...

There is some truth there; but I'm not sure it proves that getting kicked in the 'nads hurts worse.

But to quote the late great Betty White, "When people want you to toughen up, they say 'Grow some balls.' That's totally wrong. Balls are actually very sensitive and vulnerable. When people want you to toughen up, they should say 'Grow a vagina' because those things can really take a pounding!"

 

[ShortForBob]

Getting kicked in the nads is the worst. Worse that childbirth right? 3 months after getting kicked in the nads no dude says, "I'd like to get kicked in the nads again," however, 3 months after giving birth a woman will say, "I'd like to have another child!"

We're tougher than you are.

Seriously though, childbirth obviously must hurt a lot, but I seriously don't remember any pain at all. A common experience I'm told.

 

[130lights]

There is some truth there; but I'm not sure it proves that getting kicked in the 'nads hurts worse.

But to quote the late great Betty White, "When people want you to toughen up, they say 'Grow some balls.' That's totally wrong. Balls are actually very sensitive and vulnerable. When people want you to toughen up, they should say 'Grow a vagina' because those things can really take a pounding!"

I know zero women that wanted to be pregnant again 3 months later.

 

[boomer]

Subjectivity of pain is so true.

I’m one of those crazy people that drove myself to the hospital having a heart attack. Based on family history, I was sure that’s what it was, so I took ASA and packed a suitcase. (And I worked at the hospital). I knew the cardio chief was excellent so made sure he was called. But as time went on and he got to know me well, he learned that I’m not a complainer. So if I ever mention chest pain, he does a cath. Gold standard.

That started 19 years ago.

Every two years for 40+ years had to take the first aid refresher. Medical science pivoted a few times as I recall. The Heimlich maneuver went back and forth a few times with repeated blows on the back. Burns went from covering with dry cloths to wet cotton and back to dry cotton or gauze; using water went to, no water, cold water or ice water, to covering burn with a clean towel or sheet and head directly to the ER.

Asprin/ASA for heart attack and stroke as far back as I recall has been helpful and NSAIDs like ibuprofen not helpful, then not long before I retired the first time about 2005, warning that NSAIDs like ibuprofen increase the chance of heart attack or stroke.

One trick for pain relief back in the service, that I learned from a Builder 1st Class named Gary Ray, who said his grandmother taught him - if we had no other means of pain relief, was taking a strong cup of coffee with a couple asprin. It became one of the best quick pain relievers I ever learned. Asking the first aid instructors over the years about this, non knew of the grandma advice for pain relief. - these days, one sees it come up occasionally on the web.

 

[Goodvibes]

Treatment of aortic dissection has undergone a paradigm shift during my career.

When I started out, operations took 5-10 hours, were bloody, huge and ran the risk of causing paralysis because the graft would seal off the artery of Ademkowitz which supplies the anterior portion of the spine.

Big belly incisions, students and assistants holding retractors for hours.

Many units of RBCs, platelets and weeks in the ICU, hospital, rehab. Emergencies were very often fatal.

Now, with endovascular techniques it’s practically an outpatient procedure, can be done under sedation in the right circumstances.

Kinda mind blowing.

That changes my view about the date when "First, do no harm." actually worked from. Some claim it was WW1, but I'm not convinced.

 

[Goodvibes]

I know zero women that wanted to be pregnant again 3 months later.

Reminds me of the old male chauvanist joke.

"Congratulations Mark well done mate, gunna have the first one hey? So when are you going to have the next one?
"Well that depends."
"Depends on what?"
"Whether she delivers in a public or private ward!"

 

[Goodvibes]

We're tougher than you are.

Seriously though, childbirth obviously must hurt a lot, but I seriously don't remember any pain at all. A common experience I'm told.

Men don't recall it either, but sure spend a lot of time trying to remember.

 

[Ed Lada]

Damn!
38 years old
I have no idea how I have made it this long with what I’ve put my body through.
You said you had taught and knew what to do, why did you not go straight to the hospital?

Because one of the symptoms of having a heart attack is denial!

 

[Ed Lada]

Well……lotsa theories but when it’s “near term” certain it’s less theoretical and more……..troubling to put a fine point on it. No one wants to linger in misery but it rarely happens quite that rapidly and the benchmarks are less obvious. I know almost certainly what the process will be for me…..it’s less certain exactly when it might become intolerable, and not just for me but for my wonderful wife who will bear the brunt of caring for me and watching my suffering. I did that for my late wife over two years…..it was soul crushing.

Taking care of a loved one through their final years, months, days, is probably one of the most difficult things a person can ever do. It drains the body physically and it drains the mind emotionally. It requires a delicate balance of care for the loved one and care for oneself. Outside help, family, friends, hospice, etc. eases the physical burden but not the emotional one. When the end comes, the crisis is over and eventually the memories of the event fade somewhat but they never go away.

We can take comfort that we did the best we could in a terrible situation. We can remember the good times and try to forget the horror of the bad times. We can remember our loved one for what they were in our life and not what they became at the end. At least we can have that satisfaction although it seems completely inadequate at times. On that happy day when we make the vow to have and to hold from this day forward, for better, for worse, for richer, for poorer, in sickness and in health, to love and to cherish, until parted by death, we aren't thinking about the bad things, we want to believe it will all be good, and our love one will pass gently and quickly in their sleep. And the lucky ones do. But we never know what can happen and there is no way to prepare for it whether it s quick and peaceful or long, drawn out and a living nightmare. All we can do is the best we can and when it's over we try to pick up the pieces and live our lives as best we can. And we can draw our strength from the happy memories and not let the bad ones bring us down for too long or too far.

It is wonderful PB that you could find happiness again after losing your 1st wife. It speaks highly of your character and your inner strength and will. Now that you are facing your own demise, I'm sure you will do everything you can to make it as easy as possible for your wife.

I understand your pain. I went through 6 months of hell when my mother passed away from a malignant brain tumor. I've endured many painful trials and travails of life in my 67 years but nothing was even close to as bad as that experience. 37 years later I still think about it. I can still hear her screaming and see her body thrashing in her bed as the tumor slowly destroyed the brain of a wonderful, compassionate, loving, very intelligent woman. But I remember the 30 years of love and happiness my mother gave me and I cherish those memories. I think about her often and I remember her beautiful smile and the warmth of her love for me.

In the not so distant future I will take measures to pass peacefully and not put anybody through the painful ordeal of taking care of a useless lump of meat that used to be me. I am fortunate enough that I can do this without any trouble. I will do it for myself and for the people that care about me. Losing someone close to you is painful but I want to minimize that pain as much as I can.

It is reprehensible that for many reasons very few places in the world allow assisted suicide. What rational, empathetic person believes it is better to prolong human suffering because of some religious, moral, philosophical, or political reason. What right does any other person have to tell another person that they have no control of the only one thing we as individuals have complete control over, our very personal decision to end our own life when we believe it is untenable. Why should people who are already suffering have to have the anxiety of trying to chose a method of dying that ensures success. The anxiety of worrying that they didn't do it correctly and end up in an even worse condition and placing that burden on those around them. The anxiety of possibly suffering terrible pain as they take their last breath, The anxiety of breaking some law or causing some kind of trouble for themselves and others. That makes a difficult situation worse and it's just inhumane. States take many measures to kill criminals in a humane way out of vengeance. Yet they don't allow the same consideration to terminally ill individuals. I am the only one that thinks that is just completely irrational and sick?

I spent a number of years helping people in some kind of mental health crisis. I helped people to decide to live rather than impulsively end their life for a situation that had a reasonable alternative action that could be taken. There is great satisfaction in saving a human life. But there are times when ending ones own life is a reasonable, rational and appropriate decision. And in my mind, that should be an inalienable right. What kind of society do we live in where we allow our animals a pain free, quick and peaceful death to end their suffering and we don't allow our fellow humans to have the same dignified and peaceful death when it's appropriate. It is the right thing to do for the individual and for their loved ones.

 

[Captain Ketamine]

That changes my view about the date when "First, do no harm." actually worked from. Some claim it was WW1, but I'm not convinced.

Primum non nocere…first do no harm… is a mantra that has been around for a very long time (?Hippocrate).
My colleague was mentioning repair of an aortic aneurysm or ruptured AAA. This is a condition more common in men that have smoked and above the age of 65. But anyone with atherosclerotic disease can get it.
It starts as a dilation of the aortic artery. If found and small it may just be monitored. If large then discussion with patient on management (Stent vs open surgery).
The concern is spontaneous rupture. If rapid, this causes a very rapid death. If slow it may present as abdominal or back or testicular pains. It can be a little tricky to diagnose initially, so high index of suspicion is required. The feeder vessel to the spinal cord can vary quite significantly from person to person. It may already be tenuous because of the atherosclerotic disease the patient will invariably have, it might be right in the way of where you need to clamp it to stop the patient bleeding out in front of you, it may be difficult to see or get access to because the belly is full of blood and dying gut. Or the dynamics of flow may mean that although patent the flow of blood to the cord may be impaired During the cross clamp of the aorta.
How we approach the management of these patients depends on many factors. The end result is to have a patient alive and obviously in reasonable condition.
But if the patient is already in crap condition before you start, then it may be more appropriate to allow the patient to be comfortable with a morphine infusion, and die that way. This is big surgery in the emergency situation with higher mortality rates. In those in poor condition. The use of endovascular approaches to stent the inside of the vessel with bespoke stents has revolutionised treatment of this condition. With patientS previously cons inoperable able to be treated. But they may still have aberrant feeder vessels. They may still have poor renal function from diabetes or whatever that complicates the process. Their lungs may be crap their heart may be crap they may have poor cerebral vascularity. Each patient will have their own issues.
Ruptured thoracic aneurysm are an extra level of crap as it may dissect up to the heart, you may need a valve replacement at the same time. It’s long laborious surgery requiring heart lung machine.

we are all too well aware of Primum Non Nocere.

 

[Goodvibes]

What kind of society do we live in where we allow our animals a pain free, quick and peaceful death to end their suffering and we don't allow our fellow humans to have the same dignified and peaceful death when it's appropriate. It is the right thing to do for the individual and for their loved ones.

Had large animals, lot's of horses and cows, dogs there too of course. Last time we had an old horse put down (last year), the young vet after giving the second green needle, stood there with us as we cried and watched the last twitches fade.

Trying to placate us he said : "It's a great way for them to die, I wouldn't say no it when the time comes."

He was right. But I also realised why we have a high suicide rate amongst vets. Besides the obvious downer no matter how you try to spin it, his female student assistant was over at their vehicle, busy tidying up, pretending not to cry.

Did I say it above already (shit, just notice what thread this was, thought it your other one Ed)? The best thing we leave our family is alleviate the fear of death dying, however that can happen. My father, either deliberately or not, did that for me, happens to be the best for all concerned.

 

[ShortForBob]

I know zero women that wanted to be pregnant again 3 months later.

Me either.

 

[veni vidi vici]

.