What Doesn’t Make You Stronger Can Kill You

Bit of self promotion here:  I’ve got a piece in today’s Boston Globe, on one of the hidden consequences of failing to deal with the antibiotic crisis.  In it, I focus on the use of antibiotics as prophylactics in surgery. Nowadays, it’s standard procedure for a wide range of operations to dose the patient with antibiotics shortly before she or he goes under the knife; doing so has been shown to signficantly reduce the risk of post-surgical infections.

I took off from a study that modeled the consequences of increased microbial resistance for ten common procedures, mostly surgeries, along with chemotherapy for a particular set of cancers.

The results of that study were predictable:  more resistance leads to more post-op infections and to more deaths.  If the situation gets really dire, if common causes of infection associated with surgery become increasingly untreatable then the calculation behind all kinds of medical interventions will change:

That’s what scares Dr. James Maguire, an infectious disease specialist at Brigham and Women’s Hospital. “I think some of the worst feelings we have are when we have a problem with a patient and there’s nothing we can do.” Infections following joint replacements are bad enough. They are, Maguire says, “catastrophic in terms of what happens to the patient.” Were the risk of infection to go up enough, he adds, “having seen what an infected joint replacement is all about I would think twice.”

That’s a response to an operation that may be vitally needed to reduce pain and increase mobility — but, as Maguire went on…

…while someone contemplating a joint replacement can choose to forgo the risk, if they need a new heart valve or a ventricular assist device, “that’s potentially life and death.” In such circumstances, “if your life depending on having the device, even with great risk you’d do it. But more would die.”

Behind such specific possible horror stories, this is for me a deeply cautionary tale about the way choices our society — our politics — makes have much deeper effects than our usual debate admits.  Antibiotics are not just responses to disease; their use penetrates medical practice, to the point that basic expectations we may have about what how we can move through the stages of our life can be dashed, without our ever really grasping why.

That is:  joint replacements are part of our medical and mental landscape now.  There are over 330,000 hip replacements performed each year in the US.  We know (some of us, venerable as we are, more than others) that our knees, elbows, shoulders and so on won’t always work as well as they do today.  We know, most of us I’m sure, folks who’ve had the op and are now playing tennis again or whatever, and we have in the back of our minds (those of us fortunate enough to believe we’ll still have adequate health care available over time) that if and when that bit falls apart in our own bodies, we can look for the same outcome.

Except, of course, if the risks of surgery shift significantly in the meantime.

The last point I make in the piece, somewhat more gently than here, is that should the way we age, the way we give birth and so on deteriorates because of unchecked microbial resistance, that will be a more-or-less hidden consequence of political failure.

That’s because dealing with the antibiotic crisis boils down to doing two things:  regulating economic activity and funding research.  The GOP doesn’t want to do either.  And, as usual, people will die as a result.

So, on that note of cheer, a link, again, to the piece.

Oh…and open thread too.

Image: Follower of Jan Sanders van Hemessen, An Operation for a Stone in the Head, date unknown (to me).

55 replies
  1. 1
    SiubhanDuinne says:

    Tom, I mentioned this and linked to your piece in one of yesterday’s threads. Was hoping you’d front-page it, and I’m glad you did.

    Congratulations, as always, for getting wide exposure for your clear and elegant writing.

  2. 2
    rikyrah says:

    Just spent the morning cleaning up a storage room. Still not finished. I am a pack rat. I don’t like de-cluttering.

  3. 3
    MobiusKlein says:

    Typo alert:

    cheap compounds could quash amortal threat

    should be

    a mortal threat

  4. 4
    TaMara (HFG) says:

    Hmmm, where have I read this before. ;-)

  5. 5
    smintheus says:

    I have an eye condition that could be treated surgically, but my ophthalmologist warns me strongly against ever having eye surgery unless it gets vastly worse because of the danger of infection.

  6. 6

    I have a question.

    So the tax bill as currently written (we think) says that a whole bunch of unspecified cuts need to take place next year, and we’re figuring they’re going to try and take that money from Medicare, Social Security et al. But they can’t do that with reconciliation, right? This was their reconciliation bill for next year.

  7. 7
    Wapiti says:

    William Gibson’s latest, The Peripheral, had some subtext of this; the suggestion that in a short while medical procedures are likely to be more risky for the reasons you discuss.

    eta: It’s a minor part of the book, but I found it daunting when I read it. Gibson’s writing has moved from science fiction to speculation about current technologies and trends.

  8. 8
    Wag says:

    An excellent piece, and a notice about a potential (for now, at least) major disaster. Some of this can be dealt with through tightening restrictions of use of antibiotics for human use, but the use of low level antibiotics for growth promotion in the agricultural world is another major factor in the development of antibiotic resistance.

  9. 9
    sukabi says:

    @MobiusKlein: yes well, our amoral politicians pose a moral threat

  10. 10
    Ruckus says:

    Tom, I have direct experience.
    Have been through a few procedures in the last 3 yrs and was pre-dosed with antibiotics 3 of those times. Twice I came down with bad e-coli infections after the procedures, once it was really nasty. ER nasty. Not quite ambulance/ER nasty, but only maybe a day away from that. And of course the treatment is massive antibiotic dosage. Somehow it seems……. barbaric, like “We don’t really know what we are doing but here, take this,” barbaric.

  11. 11
    HeleninEire says:

    I’m such a Luddite. Went into a phone store today and asked for “an external battery” and the lovely 24 year old boy, who has never not had a mobile phone in his life said “you mean an external power source?” And he topped it off with “Ma’am”

    I am 100 years old.

    The end.

  12. 12

    @Wapiti: I liked Pattern Recognition. His first sci-fi book set in the present!

  13. 13
    Ruckus says:

    That sounds a bit melodramatic?
    People have eye surgery regularly, do they really get infected a lot? I know a number of people with cataracts (including me) that do or will require surgery to be able to see. I’ve had laser eye surgery (over 20 yrs ago) with no issues. It would seem that laser eye surgery would pose little risk, there is almost no contact with any instruments or hands. And the laser actually burns away tissue, can the bacteria live through that?

  14. 14
    Ruckus says:

    I get sired upon occasion. Maybe not quite the same thing?

  15. 15
    HeleninEire says:

    @Ruckus: In my mind yes. Sir means respect. Ma’am means old. But maybe that’s just me being paranoid. And old.

  16. 16
    trollhattan says:

    Never once got sir’d until well into the 40s. Also don’t live in the South, so don’t experience those social norms either.

  17. 17
    Mnemosyne says:


    Well, that’s a cheery thought. Maybe I don’t need to get my ACL and meniscus surgically repaired after all.

  18. 18
    debbie says:

    When did this pre-surgical dosing begin? I never had to do that.

  19. 19
    Yutsano says:

    @Major Major Major Major: I still want to know how they got half this shit got past the Parliamentarian. It’s like a third of the amendments are either not budget related or are cutswhich shouldn’t be able to go through reconciliation. And reconciliation is law not just a Senatorial norm. There is a possibility someone could sue over the tax bill.

  20. 20
    debbie says:


    My Southern grandmother trained me to use “ma’am,” but now that it’s directed at me, I wish I could go back and apologize.

  21. 21
    debbie says:

    @Major Major Major Major:

    Good question. I’m hoping they’ll need 60+ votes for the slash-and-burn portion of tax reform.

  22. 22
    smintheus says:

    @Ruckus: This would be physical surgery to the back of the retina. Really no comparison to the minor danger posed by marginally intrusive cataract surgery. My ophthalmologist warned me at length against allowing myself to be talked into surgery (which he himself does perform).

  23. 23

    I had LASIK eye surgery maybe 20 years ago, and at the time, I asked ahead if it would interfere with eventual cataract surgery. The eye doc said no problem. Well, haha, the jokes on me because my current eye doc says it is indeed a problem.

  24. 24

    @debbie: I mean, this is literally their reconciliation bill for the current fiscal year, which ends next September.

    Do they get another one in the lame duck session?

  25. 25
    Snarki, child of Loki says:

    Humans have ALWAYS been at war with microbes. We fight them every hour of every day, in the most intimate battlefields imaginable.

    And when we lose, they EAT us.

    Those GOPers are species-traitors and need to be disinfected from the body politic.

  26. 26
    Ruckus says:

    I think you are correct, for at least some of the time. But sir was not always used with respect in the military and I’ve only been getting that since my beard has turned a lot closer to all white. OTOH I call men I don’t know sir, no matter their age, as exactly that, a sign of respect.
    But alas I think that ma’am is used on women of a somewhat advanced age. I try to only use if on women a lot older than me for the same reason you don’t like it. For some reason while sir seems normal, ma’am seems wrong. Maybe it’s the military thing. Except there a woman officer would be ma’am because sir would be far more awkward. And wrong.

  27. 27
    debbie says:

    @Major Major Major Major:

    Oh, heaven forfend.

  28. 28
    J R in WV says:


    Off topic:

    I read on Lawfare.org that much of this “tax reform” bill directly contradicts other tax law that has been on the books for many years, and also is directly opposed by many legal decisions by courts at all levels. So there are many avenues forward to opposing the implementation of much if not all of this bill.

    On topic: I have had both shoulder joints replaced, the cartilage was all gone so the two bones comprising the joint were in direct contact, grinding each other. It was agony. The surgery was also agonizing, but I had good pain meds for that post operative pain.

    Something that may have been (or not, I don’t recall!) mentioned prior to arranging for the surgery is that going forward, any minor medical procedure (like the dental tech cleaning my teeth) requires prophylactic antibiotics to prevent a blood born infection from settling into that artificial joint, where there is no blood flow carrying our built-in infection fighters.

    As mentioned by several people in Professor Levinson’s article an infection in an artificial joint is a nightmare that starts with removal of the joint, leaving me with useless arms. Or my wife with useless legs, as she had her knees done right after I was fully recovered from my second shoulder replacement. It basically took each of us nearly a year to have both surgeries and to recover.

    Now we can travel and enjoy retirement… if those prophylactic antibiotics still work and are tolerable. My last dental appointment was OK, but it took me several days to recover from the antibiotics. I have Irritable Bowel Syndrome, it appears to run in my mother’s family.

    So having a major upset in my bowel flora and fauna caused by antibiotics is beginning to have it’s own negative impact. Until this most recent antibiotic dose, which is a big but brief dose rather than a constant dosage for a week or 10 days, I never had much of a reaction to antibiotics, other than recovering from whatever infection I had acquired.

    I will also eventually need cataract work. I was exposed to lots of UV growing up, and then still more in the Navy. As a kid UV was used industrially at the family business. I never had a serious reaction, but it was there. And then in the shipyard arc welding was everywhere. Plus radar equipment on smaller ships sweeping the top of the bigger ship I was on.

    So much bad news!!

  29. 29
    Ruckus says:

    The worst response was the first time the procedure was done. I had the same procedure twice more, because while the after effect was not good, not having the procedure quite possibly could have made me dead. I like sick over dead or even bed/wheelchair ridden. I know 3 people who live in wheelchairs, it isn’t as much fun as it sounds. And while the risk has risen and not just a blip, it is still a rather small risk. Also I’ve had two other procedures/operations in the same facility and no problems/infections.
    Life is risky but as someone pointed out once, we live at the pinnacle of human knowledge. Medicine is no different. Now politically/religiously some are trying to reverse that, but fuck the Luddites, continue to move forward.

  30. 30
    Ruckus says:

    OK that is different. There is always a balance between risk and reward. You have to use the best info you have and make a call. And that call has to work for you. See my comment at #29.

  31. 31
    Ruckus says:

    @Dorothy A. Winsor (formerly Iowa Old Lady):
    I see an ophthalmologist every year at the VA because I have vision issues and will absolutely require surgery at some point. And it’s always a different one. They all tell me the same, the laser surgery made/makes no difference.

  32. 32
  33. 33
    J R in WV says:


    As I got to know the staff at the wine and cheese shop, we would chat, and they would can me Mr. WV, rather than JR, which has always made me uncomfortable.

    I am not comfortable with displays of my superiority like being called sir or Mr WV. But for many years my full beard has been getting lighter in color, and now it’s nearly white. That seems to prompt Sir and Mr. from many people.

    As a kid, I never used my first name, because I shared my whole name with an uncle. I got along with Uncle J just fine, we had a lot in common. But even in a small town (perhaps especially in a small town) I felt awkward about that. And Mr. WV always makes me look around for my dad, even though he has been gone for 12+ years now.

    So I asked the young staff at the wine and cheese shop, where I shop once or twice a week as it’s just a few doors from the bakery, to just use my nickname, and I hope they can get into it. I suspect some patrons at a wine shop are somewhat full of themselves, and would take offense at a young “clerk” calling them JoAnn or Tom.

  34. 34
    Yutsano says:

    @J R in WV: I will laugh if thy forgot to put a severance clause in this monstrosity.

  35. 35
    Stan says:


    Sir means respect. Ma’am means old

    Anyone who has been in the military has been taught that “m’am” is exactly equivalent to “sir”. No age-ism implied. And they will use that term a lot ;)

  36. 36
    Ruckus says:

    I enlisted in the military. Had lots of fun. Sir and ma’am were not always used with respect by a lot of people I served with. And not just the younger guys in because of the draft. Often they were spoken with enough contempt that it could be seen dripping off the words as they were uttered. And as I said, I learned sir was respect, ma’am was older woman. Now different parts of the country used to be different in this respect. When stationed in the south I heard ma’am a lot more than other parts of the country. But it is in no way universal, military or not.

  37. 37
    sharl says:

    Thanks Tom; a good (though sobering) piece. Even the handful of comments over there were a cut above the usual comment forum; there were two or three woo-woo–type comments that commonly show up in medical/health pieces, but also some links to more detailed articles from the scientific community.

    The importance of solid and well supported institutional structures to support research was noted in both your article and in the comments. The politics of that is always a challenge in these years decades beyond the U.S.’s post-Sputnik panic response. Research rarely offers immediate payouts in the form of market-ready products, so the representatives of the research community have to walk a fine line in seeking funding, by promising as much as they can without over-promising. (I’m sure those folks sometimes dangle a few toes over that line during project/proposal pitches; as long as they don’t do a running broad jump over the line, there’s probably no major harm done.)

    A long time ago – I’m pretty sure in the Clinton years – the NIH Director (Harold Varmus I think) was testifying before a (sub)committee of one of the houses of Congress, who (along with Clinton) wanted to give NIH a HUGE increase in his budget to achieve new medical advances. Varmus was appreciative, but ever-so-gently noted that the advances the politicians wanted would not happen overnight, and would not come from one scientific discipline alone (biology or whatever; I have forgotten the details).

    So many non-scientists, whether politicians or not, seem to thing the process works like a meat grinder: shove a pound of beef into the inlet, turn the crank or push the button, and voilà, nearly a pound of ground beef comes out the other end within a minute or two. It can become quite problematic when people with power over budgets realize that instant gratification ain’t gonna happen. But gotta forge on as best as we can…

  38. 38
    Mnemosyne says:

    @J R in WV:

    If antibiotics cause digestive issues, you need to start a course of probiotics a couple of days beforehand and keep taking them for at least a week after you stop taking the antibiotics. That will keep the balance in your gut a little better.

    Also, consider going on a low-FODMAP diet for at least a few days before and after so you don’t irritate your gut even more. Google “Monash University FODMAP” for the most official scoop.

  39. 39
    lowtechcyclist says:

    My mother-in-law died in September from an infection that wouldn’t go away in the wake of a very minor surgery (putting in a new dialysis port). As the kids say, this shit is real.

    Thanks, Tom, for a very clear and well-written piece on the subject.

  40. 40
    Mnemosyne says:


    The last time I had my ACL replaced (and it was the same one I damaged this time), the big scandal about infected tissue transplants broke in the media a couple of days after my surgery. People were getting botulism from transplanted ligaments and tendons. Fortunately, I was not one of those unlucky people and the tissue I got had been harvested and stored properly.

  41. 41
    sharl says:

    By the way, Tom, here’s a recent interaction I had on Twitter that has pretty much nothing to do with your piece – the only common feature is bacteriology – but which you may find interesting. It concerns the misuse of political power, (ir)responsible media practice, and (maybe) the horrible bind professionals and experts can find themselves in when they get tangled up in bad politics and media misbehavior.

    Among stuff that has long riled me are some of the ways our then-leadership ginned up public support for our Glorious Iraq Adventure. The manner by which the relevant (classified) National Intelligence Estimate was deceptively edited to produce the unclassified NIE summary we all saw at the time is one thing. The other thing that has long bugged me was the lie that Saddam was behind the October 2001 anthrax attacks in the U.S. So I’ve occasionally ranted on twitter about why investigative journalist Brian Ross of ABC News has never outed the government source who lied to him, and why he bought the story in the first place.

    Brian Ross’ recent screw-up with the Michael Flynn story – reporting that Flynn contacted the Russians during the campaign, rather than during the post-election period prior to the Inauguration – got conservatives all riled up, and ultimately earned Ross a 4-week suspension by ABC News. (Hmm, that certainly didn’t happen after the anthrax thing; liberal media my pasty white ass!)

    Recently I noted two or three conservatives (from their twitter bios/timelines) retweeting my old anthrax-related Brian Ross grumblings about Ross, I assume due to the recent Flynn-related Ross rage among the conservatives. But then I got this:

    Three sources used Brian Ross as patsy for fake anthrax story (one from Office of the Vice President, one from USAMRIID, and one from UNSCOM).— Richard H. Ebright (@R_H_Ebright) December 3, 2017

    Although it doesn’t name names, I’ve never seen this kind of detail. And this guy is no twitter rando either (~I’m~ the rando in this exchange). He is a prominent senior faculty member at Rutgers, and a specialist in microbiology and infectious diseases, and it turns out he got tangled up in the anthrax investigation in its earliest days, since Rutgers is near the place from which the anthrax-containing letters were mailed, and to a criminal investigation team his laboratory would look like a plausible candidate as a source for the spores. He and his laboratory were apparently quickly cleared – I don’t think his lab or group ever worked with that pathogen – and he went on to be used occasionally by media as an expert on anthrax and the October 2011 attacks.

    In a twitter reply I asked him if there was a public report of any sort on what he had just told me. He said no. So I’m hoping he’s not putting himself at any risk; he hasn’t (yet) deleted the tweets, and in fact went on to ‘fav’ several my my other old tweets griping about Brian Ross. The only thing I can figure is that, like me, he remains pissed about that fake Saddam-anthrax connection. He certainly has far better reasons than me to be pissed! I’m just a rando who can’t get over a lot of dead, maimed, and displaced Iraqis, along with the dead and maimed U.S. troops who went based on a widely propagated lie.

    Why did Prof. Ebright tweet out this information at all? I surmise he felt safer in doing so after seeing the following from former White House (Dubya) spox Ari Fleischer:

    Mr. Lima – You should correct the last sentence of this story. Brian Ross was told he was wrong BEFORE he aired his story about Saddam being behind the anthrax attack. Your story says he was told that after. I’m the person who told ABC not to air it. cc:@TerryMoran https://t.co/TzmdPqA29F— Ari Fleischer (@AriFleischer) December 2, 2017

    Fleisher has a long tradition of being a self-serving, lying shitweasel, so had a seen only this tweet, I would have considered it for a second, then said to myself it’s fucking Ari Fleischer, ignore this and move on. But the fact that Prof. Ebright responded to Fleischer’s tweet with a “Me too” might have prompted Ebright to open up on this topic. ¯_(ツ)_/¯

    Apologies for the great length of this, but I see several important issues at play here, with people behaving horribly being let off the hook, on the selling of the Iraq War, on the events leading up to our 2008 economic crash, on people losing their homes over mortgage robo-signing, and on and on and on. When I see pissed off youngsters on social media – and boy, are they fired up (again) after this recent Senate action! – this is one of the big things that riles them (crushing student debt that cannot be discharged via bankruptcy probably leads the list). Hard to sell them on the value of traditional institutions – government, religious, and otherwise –
    and their supporting functions (political parties and campaigns and whatnot) when so many sociopaths and amoral types have gotten away with so much without so much as a slap on the wrist.

  42. 42
    sharl says:

    @sharl: Tom, a very, very long comment I left for you is in moderation (I’m guessing due to too many links rather than excessive verbosity). Just FYI. It’s not related to your post, but maybe is relevant to your general interests (media, science, & politics). I thought you would be interested in the content, which may or may not be newsworthy.

  43. 43
    TriassicSands says:

    @Snarki, child of Loki:

    We’re not just at war with microbes; we depend on them to live. It may be a cliche, but it’s true that we are made up of more bacterial cells than human cells.

    Read “Missing Microbes” by Dr. Martin Blaser (2014). It’s more about the good bacteria our overuse of anti-biotics have killed, than the bad bacteria that our increasingly ineffective anti-biotics fail to kill. The implications of anti-biotic overuse are scary, but this isn’t a new awareness. In 1994, Laurie Garrett wrote about misuse and overuse of anti-biotics in her book “The Coming Plague.” Sadly, it wasn’t a newly recognized problem 23 years ago. It goes back much further, but we’ve lacked the will to address the problem.

  44. 44
    Greenergood says:

    That is: joint replacements are part of our medical and mental landscape now. There are over 330,000 hip replacements performed each year in the US. We know (some of us, venerable as we are, more than others) that our knees, elbows, shoulders and so on won’t always work as well as they do today. We know, most of us I’m sure, folks who’ve had the op and are now playing tennis again or whatever, and we have in the back of our minds (those of us fortunate enough to believe we’ll still have adequate health care available over time) that if and when that bit falls apart in our own bodies, we can look for the same outcome.

    ‘joint replacements are part of our medical and mental landscape now’. – not any more! Unless you’re rich, you can kiss these procedures goodbye! Playing tennis? Hah! After Friday’s horrific vote, I despair.

  45. 45
    J R in WV says:


    Jeeze, Sharl, that’s longer than MY posts, which are all really long…

    But it’s all really good stuff, so keep up the good work!!!

  46. 46
    sharl says:

    @J R in WV: Haha, thanks. On my War-and-Peace–length comments I usually start feeling bad about the fourth paragraph in, but it somehow never stops me. And – of course – the odds of something resulting in me getting snagged by FYWP increase as a function of the length, so there’s that too.

    If I were really committed to my comments, I would first compose them in a word processing app before posting, so my commitment still isn’t 100%, contrary to appearance.

  47. 47
    TriassicSands says:

    To show how complicated our microbial world is — H. pylori, well known for causing stomach ulcers, stomach infections, and increasing the risk of non-cardia gastric cancer is also associated with a decreased incidence of esophageal adenocarcinoma. If we’re in a war with microbes, it’s one we’ll probably never win. An uneasy truce may be the best we can hope for when the same bacteria may be both friend and foe.

  48. 48
    caphilldcne says:

    @Major Major Major Major: This was their reconciliation bill for FY 2018. (ACA Repeal and Replace that failed was the reconciliation bill for FY 2017). So they will have one more shot at a reconciliation bill for FY 2019.

  49. 49
    caphilldcne says:

    BTW – the reconciliation process basically is where they would handle cuts to entitlement programs (e.g. Medicaid/Medicare/VA) and possibly establish a sequestration for defense and non-defense discretionary spending which would create required cuts in the the appropriations process. This will get very ugly in coming years.

  50. 50
    sharl says:

    @sharl: P.S. I just went to Prof. Ebright’s twitter feed to see if anything new has cropped up there. The tweet I cited above is still there, plus he has since retweeting something from Glenn Greenwald, who responded to the Ari Fleischer tweet I cited above:

    In late 2001, ABC put Ross on every program for a full week claiming government tests found a link between anthrax attacks & Saddam. It was incredibly damaging. But to date, ABC refuses to reveal which government officials told this lie to Ross. https://t.co/t9e9788Er7— Glenn Greenwald (@ggreenwald) December 3, 2017

    Greenwald is problematic – even for me – but his media criticisms are often detailed and spot-on, though probably not of the quality they used to be (especially where Russian interference in U.S. politics is concerned, which he continually minimizes or outright dismisses). Here’s a link for Greenwald’s April 2007 Salon piece on Brian Ross’ very very wrong story on the Saddam-anthrax connection, which of course didn’t exist. NOTE: the Salon site these days is really shitty, and I had something autoplaying over there recently that I never could track down to shut off.

  51. 51
    MikeS says:

    The thread may be dead, But I wanted to add a story for Tom. The husband of a friend of mine had a post-operative infection after a knee replacement. They talked about removing the prosthetic, doing antibiotic treatments and then waiting months before redoing it. Instead they did a rather drastic antibiotic treatment. They did twice daily, high-dose intravenous antibiotics for a long time, I think 6 or 8 weeks! It worked and he is fine and didn’t need to have the metal joint removed and he is fine now two years later, but it was very stressful (and expensive for their insurance provider I assume, but probably cheaper than multiple surgeries. Their son is an RN so they had professional help available for doing this.

  52. 52
    efgoldman says:

    Tom, I read your (excellent and frightening) story this morning but didn’t get to the blog until now. As usual, it is compelling and coherent for those who WANT to pay attention. Homo ecenomicus primus being who and what we are, lots of people won’t.

  53. 53
    Ruckus says:

    As I said up thread, my infections were fought with high dose antibiotics. There really was no other choice for me. They were one time injections and a ten day regimen of an oral. These completely clean out most of your digestive bacteria so eating is fun for a few days. But that’s OK you really don’t want to eat much in any event. I’ve been nasty sick a few times in my life but nothing is like what I went through. At first you just feel a little down, but as time goes on the world just shuts down for you. And you don’t even realize that it’s happening until it’s almost too late. There was no pain, no symptoms other than just general malaise until as I said above, it’s almost too late. Fun times.

  54. 54
    StringOnAStick says:

    @J R in WV: You should talk to your surgeon about the antibiotics before your dental hygiene appointments. The current ADA and AHA recommendation is to do so for 2 years post joint replacement surgery, longer if there are co-morbidities. Tell your surgeon about how it is making your IBS worse and go from there.

  55. 55
    J R in WV says:


    My cousin, the first member of my family and my generation to die, had esophageal adenocarcinoma. He seemed to be in fairly good shape when my only local cousin and I tooled up to see him that last time. about 90 days from diagnosis to death, we saw him a couple of weeks before he died. He was still at home. He told us:

    I don’t regret anything I’ve done. I regret the things I haven’t done!

    What I took away from that advice was to get busy on the bucket list. I retired asap.


    Thanks so much for that advice. I have probably one more time in 5 months or so, and will make an appointment to talk about it.

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