Barry Newman

A "perforated appendicitis" ( s opposed to an "appendix burst") will almost always put you in the hospital. However, your appendix does not walk around and suddenly decide to "burst" on you. Usually, in fact almost always, you develop a perforated appendix after the slow development of appendicitis which gets worse and worse and then after the inflammation moves through the wall of the appendix, contents are released into the abdomen with resulting worsening infection, fever, abdominal pain (getting worse), and signs of peritonitis. Even then, as the infection has developed slowly in most cases, the inflammation has walled itself off limiting the extent of the infection. Whether treated with antibiotics to calm the infection or having surgery to remove the appendix, there is usually a hospital stay required for treatment with antibiotics until the infection has improved enough to allow return to some normal function.

General anesthesia can be scary for anyone, especially children. That does not mean it has to be. there are a lot of ways that is can be made less scary. With a patient anesthesiologist who has experience with children, it can be made into a game. With adequate explanations, especially if the interventions are done in an age-appropriate manner, most children will do fine. Also, with the use of premedications that minimize anxiety, often children do not even remember much of the experience. Finally, with a good child life program that incorporates much of the above, and does pre-op teaching, perhaps a tour of the operating room, sometimes may allow parents to be present for the induction in a controlled manner so as to minimize anxiety for the parent or for the child, a lot of the "scariness" may be minimized or eradicated.

You can feel the pain of a herniated disc when it is pressing on a nerve. However the disc is deep inside not only your body, but inside the bones of your spinal column. The likelihood you could feel something small and squishy (yes, a medical term) that deep inside is almost zero. If you can feel a discrepancy in the spine itself, such as a dislocated spinal bone, that might be possible, however that would be so very dangerous that you would need to be seen immediately to ensure that your spine does not get compressed by the slipped bones. Most likely what he is feeling are the facets between the spinal bones which is where the bones come in contact with each other, and can by themselves create a lot of discomfort, and even enough inflammation to cause compression of the spinal nerves as well.

The issues of timing and decision-making for surgery in ulcerative colitis are difficult and very personal. The typical general reasons for doing surgery would be persistent bleeding, persistent pain, malnutrition, or failure to thrive (grow) either from nutrition or from the use of medications like steroids, the development of complications from medications, or even just the desire to improve quality of life. Since the surgery for ulcerative colitis is rather major, including substantial risks, needs for anesthesia, long term effects, possible alterations in quality of life, not to mention cost, and hospital stays, everything needs to be discussed and the pros and cons of surgery vs no surgery carefully balanced. So the quick answer is that there is no quick answer. What is serious bleeding to one patient or one doctor may be rather different from another person, or another doctor. Thus it is best to discuss your son’s particular situation with his doctors, and if surgery is believed to be needed, or preferred, then it would be time to meet with a surgeon and to discuss the options further. Good luck to you and to him. BN