Dr. Bex
speaker
498 appearances
7 recordings
1 series
first heard Nov 2024
last heard Jun 2025
Dr. Bex’s voice in public audio — every appearance, attributed to the second.
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The problem is anytime you have blood vessels, nerves, ligaments, organs, all in one place, there's a chance that one will impinge on the other and cause problems kind of in very general terms. And at times of, let's say, rapid weight gain, rapid weight loss, there are times where things may shift.
The argument is made that if you have Ehlers-Danlos, so you do have that laxity, that things may kind of shift or move maybe more than in other people. And again, it's all kind of a perfect storm, meaning some of these things, most of these things that I just mentioned, at any given point in a person's life, they may have one of these, but your body overcompensates.
And again, you may just incidentally find out that you had one of these things. Now, in this case, it's a ligament. So part of the diaphragm, which is what helps you breathe. And it compresses what is called the celiac artery that gives blood flow, I guess, to your intestinal tract.
The idea is if that band or that ligament is kind of pushing on the artery, it would decrease blood flow to your intestines and potentially cause pain or symptoms. So the idea is if you do this, what is called a celiac plexus block, you are going to block those nerves, potentially the pain goes away. So...
it can be one way to quote unquote diagnose this is if you do this block and your pain goes away, it kind of indicates that maybe that was the cause. It's kind of, if I numb that area and it feels better, maybe that is the cause. Now what's interesting to me is, a neurosurgeon doing this was, is, I mean, I've had, I know a pain management doctor who does it, GI doctors who do it.
And I know this was like a multidisciplinary team in New York, but it sounds like this was Dr. Bolognese who did it. That was just an interesting piece because to me, this is more of like a GI diagnosis. But so this was one where he did the treatment, proved it worked, and therefore kind of said she probably had it. Interestingly, there are some studies that show 25% of people
if you did scans would have this compression with no symptoms at all. So asymptomatic people. That's interesting.
We have to think about, unfortunately, in the
I was going to say something because neurosurgery is at the top and pediatrics is actually near the bottom, which is interesting. That was interesting.
It's not a fault of an OB-GYN every time there's something that happens. It's the circle of life. It's everything that goes into what a pregnancy means. And so I agree with that. I think neurosurgery, it makes sense. Like I said, this is your brain and your spinal cord. It controls everything else. So again, outcomes, it is a high risk, but a high reward
Also, when things go right because of what you may regain, but there's also what may come after. And I think thoracic surgery is another one. That's heart, major blood vessels, again, make sense, lungs, and then OB-GYN. The least are psychiatry, pediatrics. Pediatrics is interesting to me.
It makes me think, I think there's, I don't know if there's shorter stories or like there's a longer, like adults, if you think about it, they come in with a lot more comorbidities and a lot more other things that may put them at higher risk of outcomes happening versus a child who hopefully when you're coming into this has a pretty clean slate or like there's not so many other factors playing in.
But I would think the pediatric suits that are there, at least from what are much more devastating because it is a child that is potentially, harmed slash, you know, had something bad happen.
Yep. I was going to say that the word experimental, just so I think people kind of understand, it goes back to what we were saying about These ideas not being maybe validated, meaning they're newer procedures, which does happen anytime a new procedure comes out. There may not be those bigger trials to say, but that probably means that most of them are not what you would consider standard of care.
And what happens is that also means that insurers are not going to be potentially paying for these because if an insurer sees there are alternatives to treatment and this is an experimental procedure, it may not be covered. And so experimental is not always a bad thing. It's how medicine happens sometimes, meaning you have to go through a stage.
The other thing is whether you're kind of disclosing that this is something experimental when you're doing it. But I think just to be clear, like these American Association of Neurological Surgeons, all of them, there are guidelines on the things that are done the most frequently. There are places where they don't have guidelines yet, but there's still that consensus among neurosurgeons.
And then there's the experimental, and that can be for many reasons, but that it does, that word experimental does come up a couple of times, at least in these cases.
And that's important in medicine of all branches, all fields, but specifically surgical. I mean, I mean, informed consent is very established. The idea that you are disclosing the facts, you're telling them why you're doing it, you're telling them the benefits, you're telling them risks, and you're telling them the alternatives.
And to me, that piece of this is experimental should be part of that, saying the words, there may be risks we don't even yet understand.
know about right when you're talking about it if only so many have been done we want to make sure that the parent or the patient is voluntarily agreeing so that at the end when they're signing consent it's not because they feel like they have to or like their hand is being forced
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