
After Surgery in Germany, I Wanted Vicodin, Not Herbal Tea - mpweiher
https://www.nytimes.com/2018/01/27/opinion/sunday/surgery-germany-vicodin.html
======
dpflan
This passage feels like it is premise of the article; the author eventually
comes to terms with her tea-sipping and resting as recovery, and this doctor
explains the reasoning behind the medical decision-making which is very clear
(and mindful/thoughtful) I think.

“To paraphrase him [German anesthesiologist], he said: ‘Pain is a part of
life. We cannot eliminate it nor do we want to. The pain will guide you. You
will know when to rest more; you will know when you are healing. If I give you
Vicodin, you will no longer feel the pain, yes, but you will no longer know
what your body is telling you. You might overexert yourself because you are no
longer feeling the pain signals. All you need is rest. And please be careful
with ibuprofen. It’s not good for your kidneys. Only take it if you must. Your
body will heal itself with rest.”’

~~~
jjeaff
I wonder if that doctor has ever had major surgery himself and been told not
to use painkillers?

Even if that is the case, pain seems to vary greatly in how it affects people.
I would be very hesitant to tell someone that they should just let the pain
"guide" them, because I have no idea what it is like for them.

~~~
clwk
I have a very relevant anecdote:

My grandfather was an open-heart surgeon. In the days following surgery, he
would always insist that his patients get up and take a short walk. They would
not want to, but he insisted that this was an important and valuable part of
recovery (in several dimension) and that they needed to push past resistance
and force themselves to do it.

Later in life, he underwent a surgery requiring general anesthesia and found
himself in the same position. He said, "If I had known it was like that, I
would not have made them do it."

So I think the surgeon's personal experience of the situation is -- in fact --
highly relevant in practice, even if not in theory.

~~~
hvidgaard
I'm not sure we should forgo pain management after major surgeries, but the
benefit of getting up and walk even just 50m a few times a day is well
documented. So no, it isn't fun, but it is a highly beneficial thing to do.

------
maxxxxx
"I took two ibuprofens that first day. In hindsight, I didn’t need them, but I
felt like I should take something"

I have noticed the need to "take something" with a lot of American friends
when they have problem. It's almost like a reflex.

~~~
raverbashing
For migraine sufferers, not taking something as it starts to unfold will
result in a very unpleasant experience that will take longer to resolve

~~~
iforgotpassword
I had all four wisdom teeth removed at once and all I needed was one ibuprofen
the first night, but a fucking migraine and I need at least one, sometimes
two.

~~~
znpy
I had a wisdom teeth removed and was given basically nothing, besides the
anesthetic injection needed for me not to feel pain during the procedure.

Please note that my wisdom tooth was about 80-90% developed and outside the
gum, so no "surgery" was required, just some lever movement to pull it out.
Also, no stitches were needed.

I was sent home with just an advice to eat non-solid, cold stuff "using the
other side of the mouth".

Quite frankly, everything went okay. It was weird feeling that hole in my
mouth, but it eventually filled itself.

~~~
Doxin
I can second that experience. I'm still quite baffled by how little force is
required to remove a tooth. The dentist barely wriggled his wrist and it
popped out.

All I got sent home with was a wad of bandage to bite down on for the first 10
minutes. All in all probably the least painful experience I've ever had at the
dentist. (Novacaine doesn't quite work properly on me it seems)

~~~
iforgotpassword
Well one of mine was tilted 90°, it had to be cut into pieces first and then
cut from the bone. The others were quite OK though, not just a wiggle but no
crazy stuff involved.

------
cal5k
I had jaw surgery recently... while I wouldn't describe it as incredibly
"painful", particularly since everything was numb (they have to slice through
nerves for this procedure), it was really uncomfortable and stressful for a
couple of days afterwards.

I wasn't at all ashamed to take percocet after the surgery. Could I have lived
without them? Sure. Did they turn me into an instant addict? Of course not.

This story isn't about the crackdown on opioids since it sounds like it's more
just a cultural thing in parts of Germany, but it does strike me that people
experiencing legitimate pain are becoming casualties of our crackdown on
"inappropriate" prescribing.

~~~
problems
Yeah, I question the idea that it's beneficial to experience pain - why should
I? Especially if it's going to cost me days of my life that I could do
something with. Maybe not go out, but at least be able to catch up on some of
the more passive content... seems like a needless waste of life.

~~~
eropple
The experience of pain (and I'm separating this from the dopamine-release
thing for people who groove on that sort of thing) is, for my money, a useful
training facility for willpower and restraint. Separate from the pain-as-
warning-signs noted by 'lukeschlather, few things hurt _that much_ and the
fact that you are not the master of even yourself is a valuable reminder.

The experience of being uncomfortable is not a bad one to have, nor a bad one
to make peace with. Pain and discomfort are a part of humanity: when they
don't exist, we invent ways to have both. And there certainly exists a line
where chronic pain makes it humane to blunt it--but most folks _don 't have
that problem at all_.

And "content" is what you are left with when the soul is leached out of
creativity by people who lack it. It is a soul-suckingly awful construct in
the twenty-first century and decent people should reject it. Please don't
promulgate its notions.

~~~
throwaway34241
People talking positively about pain (and especially immediate post-surgical
pain as in the article) makes me uneasy. Sure, some level of pain is useful as
a warning sign. And wanting painkillers primarily to avoid resting is
unreasonable.

But, if there is too much pain, it will cause extreme stress during the day
and they will probably be unable to sleep at night - it is hard to imagine
this being beneficial for recovery.

Also, if the pain is too great, people will avoid future treatment, even if it
is medically advisable.

I think there have been problems with anesthesia in the past, where people
woke up during surgery (although still unable to move), and I think it led to
negative outcomes even though it is only pain - although I admit, I am
reluctant to look up the details.

At the very least, I think it is good to give enough pain medication so that
the patient does not want to die, although I understand it may be unavoidable
when the level / duration is high enough.

It looks like in the article, the level of pain and recovery for this
procedure is not very bad (probably because it's laparoscopic), and the
doctors know this, so their recommendations were appropriate and the patient
was worried over nothing. But, I don't think this means that the same is true
for all procedures, and suggesting that people just make peace with it or
whatever without knowing what the level is seems wrong. Especially in the case
of surgical recovery where the first day or two is usually the worst, and the
risks of medication over such a short period are low.

I wouldn't wish for a more serious level of pain on my worst enemy. I do not
think it is useful or possible to make peace with, unless you are Buddha
himself.

~~~
eropple
_> I don't think this means that the same is true for all procedures, and
suggesting that people just make peace with it or whatever without knowing
what the level is seems wrong_

It's like I literally expressed that? Maybe I made it trickier to parse by
referring primarily to chronic pain--if you want to lump extreme, trauma-
induced pain into that? Sure. When lives are on the line, whatever, do what
needs to be done; we have doctors to make educated decisions based on the
information available.

But I will contend most Americans--and my observations are largely limited to
us--mostly harm themselves in the effort to avoid what we have largely decided
is pain and is in many ways merely _discomfort_. And I tend to think that
_that_ ramps up into greater problems along the way.

~~~
throwaway34241
I see that makes more sense now, I think that line did throw me off somehow.

I haven't seen any close friends or family just pop a Tylenol for every day
aches and pains, but it certainly seems to be a thing, so I'm open to the idea
that I'm living in some kind of bubble in that regard. I've always thought of
pain medication as for bringing severe pain down to a lower (but non-zero)
level, so for example it might not be taken at all if you break a toe, but
would be more than reasonable for the jaw surgery in the first post in the
thread.

It's interesting, chronic back pain is one of the most common chronic pain
causes, and a doctor was talking to me recently about it (in general, luckily
I don't have it). Apparently once it gets started it can have its own self
reinforcing process, and there are measurable biological changes to how nerves
fire etc. that are independent of any initial underlying injury. Probably
there's some people faking or overstating it, but I could easily imagine such
a process getting pretty severe. Unfortunately, the outlook is pretty bad I
think once you've had it for a set amount of time.

So concerning chronic pain / opioid use I can't figure out if Americans are
less willing to deal with pain, or actually have more pain, or some
combination of both. If back pain just needs an initial injury to set it off,
then escalates from there, the unhealthy lifestyles and ever increasing
obesity levels here would do a lot to explain why it is becoming an increasing
problem.

------
woodpanel
Two words: German Romanticism.

Although the article‘s premise seems reasonable (given the author‘s origin,
the USA, being renown as prone to prescribe pain killers and psychotropics for
the most menial things[1]) - a similar bias must be outlined when trying to
understand the German perspective: That we are still romanticists.

Many German doctors will send you off with „some rest“ and „tea“. Some will
prescribe homeopathics, which are to some extend even covered by our universal
healthcare, which makes „sense“ since a large part of the electorate believes
in it. Even in IT you will regularly hear: „i feel like I’m getting a cold -
better take my homeopathics quick or it will definitely evolve into one!“

Alternative healthcare is a big market here, many individuals spending 100s -
1000s € a year for the most obscure things. Which doesn’t sound much per se,
but for Romanticism Germans who regularity castigate Pharma- and Medical
industries as capitalistic, to throw money so willingly away kind of beats the
purpose of coming across as mindful.

Anyone remembers the the Mitchell and Webb sketch about the „homeopathic ER“?
Well fun fact: the Nazis did try to make this happen. In order to get rid off
the evil, jewish (science based) medicine. They wanted to make homeopathy the
official medicine of the Reich - including the Wehrmacht, which for better or
worse, the Generals intervened against.

[1] I have no proofs for this being actually true, just the representation
that the US medical system gets by German media - and many Americans

~~~
Derbasti
This is not true. Doctors do not and must not prescribe Homeopathic stuff in
Germany. If it is payed for by the government/healthcare, it has to be proven
effective.

~~~
woodpanel
It is. There are many doctors openly advertising being open to alternative
medicine. Nowhere did I say „they must“. They can though, and often will since
patients who believe in Homeopathy will often choose another doctor if theirs
isn‘t „into“ it.

------
stevebmark
> I didn’t mention that I use ibuprofen like candy

Never, _ever_ become like this person. Do _not_ make a habit out of taking
ibuprofen and assuming it's benign. If you have to take painkillers every day
to function then something else is wrong and you need to address that. NSAIDs
alter chemical production in your body and over the long term can cause
permanent damage.

~~~
iforgotpassword
Can't really tell if this part was sarcasm, especially the children's cough
sirup that makes sleepy. Is this a thing!?

~~~
dpark
Lots of cough/cold medicine will make the user drowsy. The typical cough
suppressant dextromethorphan can cause drowsiness on it’s own. First
generation antihistamines such as doxylamine are also often included in “cough
and cold” medicines and can cause significant drowsiness.

Near as I can tell, doxylamine has literally no purpose in these medications
except to cause drowsiness. It doesn’t do anything for the cough or for a
runny/stuffy nose caused by an infection. You’ll find this combo in NyQuil.

So yes, it’s really a thing, though it probably shouldn’t be (the doxylamine
part at least).

------
majormajor
There's something deeply concerning to me about claiming overall universal
insights in pain management based on laparoscopic surgery.

Good for her that she was fine, but I've had the opposite experience with more
serious stuff. Moaning in bed unable to sleep due to the pain being worse than
anticipated is no fun, and that was in a hospital with the nurses aware but
waiting on the proper overnight staff to have time to check in to decide if
something stronger was justified.

Being uncomfortable is expected and fine, I don't want to be so numbed I hurt
myself from overexertion, being unable to rest due to the pain is not.

But mainly, let's get rid of the stupid numbered pain scale. I don't know what
the fuck a 5 vs a 10 is, but being told "you said it was at a 4, so we try to
keep it under 5, so we didn't think you needed more at first" is annoying when
I'm just basing my numbers off of some "I imagine getting shot in the knee
could still hurt quite a bit worse" standard.

~~~
kuschku
The 1-10 scale is very clearly defined:

0 Pain free

1 Very minor annoyance-occasional minor twinges

2 Minor annoyance-occasional

3 Annoying enough to be distracting

4 Can be ignored if you are really involved in your work, but still
distracting,

5 Can’t be ignored for more than 30 minutes.

6 Can’t be ignored for any length of time, but you can still go to work and
participate in social activities.

7 Make it difficult to concentrate, interferes with sleep, you can still
function with effort

8 Physical activity severely limited. You can read and converse with effort.
Nausea and dizziness may occur.

9 Unable to speak, crying out or moaning uncontrollable- pain makes you pass
out

10 Unconscious. Pain makes you pass out.

------
menacingly
My wife was adamant that she not receive opiates after both c-sections. At the
first hospital, the nurses were outwardly hostile toward her decision. "Why
wouldn't you want medicine? I don't think you understand. You've had
_abdominal surgery_. Do you understand that?"

She asked for NSAIDs and they refused, saying they would have to speak to her
doctor in the morning. She waited it out and the doctor came to visit. He was
not aware of the request, and was as appalled by the exchange as I think any
reasonable person would be.

It's not just that they're handing drugs out, they're actively scaring people
who refuse them.

As to the outcome, I don't think of my wife as a particularly "tough" person,
but she felt fine with NSAIDs and recommends them to other women having the
surgery.

------
ddebernardy
Heroin was initially marketed as a non-addictive version of morphine. It was
challenged by experts on the spot. But Bayer promoted it in ads as a remedy
against cough and cold for children regardless. [1] In some sense they weren't
first to come up with the idea - TIL ancient Egyptians used opium to stop
children crying. [2]

Anyway, IMO the real wtf is drug companies being allowed to advertise
prescription drugs in the US. A few lines into the article I eventually
assumed Vicodin was an opioid-based painkiller; whereas I'd gather many a NYT
reader would be familiar with the name. I find it unfortunate that the author
doesn't connect the dots and spell out the conditioning of consumers through
pharmaceutical ads.

[1]:
[http://www.cbgnetwork.org/4148.html](http://www.cbgnetwork.org/4148.html)
[2]: [https://www.theguardian.com/us-news/2018/jan/28/opioids-
the-...](https://www.theguardian.com/us-news/2018/jan/28/opioids-the-search-
for-the-perfect-painkiller-tens-of-thousands-us-deaths-g-protein-coupled-
receptor)

~~~
curiousgal
I am always reminded of this TV ad[0] where the side effects take up more than
90% of the ad time.

0.[https://www.youtube.com/watch?v=3hp_y0wDFz0](https://www.youtube.com/watch?v=3hp_y0wDFz0)

------
Johnny555
Related: some studies have found that opioids are no better than
ibuprofen+acetaminophen:

[https://arstechnica.com/science/2017/11/as-epidemic-rages-
er...](https://arstechnica.com/science/2017/11/as-epidemic-rages-er-study-
finds-opioids-no-better-than-advil-and-tylenol/)

And I believe it.

My wife had somewhat involved oral surgery (1 regular extraction plus removal
of 2 impacted molars embedded in her jaw - it was difficult enough that they
said a broken jaw during the procedure was a possible complication. The doctor
prescribed a week of hydrocodone, and said that she absolutely will need that
bottle, and may want a refill.

She didn't want to use the opioids so went with the alternating
ibuprofen+acetaminophen route, and though the first couple hours after the
Novocain wore off were a little painful, she was pretty comfortable after
that.

~~~
tomohawk
Not to put a fine point on it, but you don't know what you're talking about.
Have you ever seen someone who is in so much pain that they're projectile
vomiting just because of the pain? I have.

There is pain, and there is PAIN. If you can get by with some NSAIDS, then
you're just in mild pain. This is not likely to interfere with healing. This
is the kind of pain the person is talking about in the article. It's scary for
most people because they're not experienced with pain.

I was with a loved one who underwent a very serious surgery. This person has a
very high pain theshold and thought that they would ignore the doctor's advise
and take something a lot less strong than what was provided.

They ended up back in the hospital on a morphine drip to recover from their
pigheadedness. Not taking the prescribed opioids had let their pain get out of
control. Severe pain is very serious and can greatly interfere with the
healing process.

By way of comparison, this same person had a minor surgery (a couple of years
after the very painful one) and the doctor was shocked at how they didn't seem
to really be any pain, because their pain threshold was much higher than
before.

~~~
Johnny555
My point is that the doctor said she she not only needed a week's worth of
vicodin to manage the pain for recovery, but she'd likely need more.

Yet she really only needed zero vicodin. Just like the person in the NYTimes
article.

But thanks for your illuminating anecdote of someone who had some procedure
and ignored some medical advice and took something else than the something
that was prescribed.

~~~
refurb
Why does it surprise you? The doctor is probably basing his/her advice off
what they most commonly see.

Are you saying your doctor should have known in advance your wife was an edge
case with high pain tolerance?

~~~
Johnny555
Well no, I think her doctor is basing his/her advice on what he typically
does, and what patients expect (see the original NYTimes article where the
author was adamant that she needed stronger painkillers, but turns out she
didn't).

The dangers of opioids are well known, and it turns out that the evidence for
opioids being the best option to be routinely diagnosed is shaky. From the
article I linked to:

 _The authors of the new trial, led by Andrew Chang of Albany Medical College
in New York, note that common medical practice and guidelines, including those
championed by the World Health Organization, suggest that opioids are simply
more effective at treating acute pain than non-opioid medications—or
combinations of them. Yet, the data backing that is shaky._

So maybe, more discretion on when and how many opioids are prescribed would be
better for everyone.

------
madez
I must applaud the doctors, as they did the right thing, and even gave
explicit and detailed explanation. Pain is indeed important. It is a feature,
not a bug. If you don't know what resting after a surgery means, then you are
in need of more pain, not less, as pain is exactly what effectively teaches
you what to do and what not to do.

Also, Ibuprofen is really bad for your kidneys. If you take it, then make sure
to drink sufficient water. And don't give Ibuprofen to old people without
doctorial advise.

~~~
serf
>Pain is indeed important. It is a feature, not a bug.

Indeed, but features have a cost.[0]

[0]:[https://med.stanford.edu/news/all-news/2014/07/study-
reveals...](https://med.stanford.edu/news/all-news/2014/07/study-reveals-
brain-mechanism-behind-chronic-pains-sapping-of-mo.html)

~~~
mantas
But some pain after surgery is far cry from chronic pain.

From my experience, there's very clear difference to be in pain for a quick
moment, few hours, day or two, a couple weeks.. Fortunately I didn't have to
experience it longer than that.

But I feel pretty confident to say it grows at geometrical progression. Short,
even very strong, pain is nothing compared to week-long, even much lesser,
pain. Post-surgery pain for a day or two is a joke compared to chronic
lifelong pain.

------
refurb
_" Time is a flat circle. Everything we have done or will do we will do over
and over and over again- forever."_

For those of you who were around in the late 80's early 90's. Today's moral
panic about opioids will give you a chuckle.

Back in the 1980's opioids were the devil and many patients, even in hospice,
had undertreated pain due to fear of addiction.

In the 1990's it dawned on doctors that maybe they should be a little more
aggressive in treating pain. It made sense. Pain can slow recovery as it can
leave patients immobile. In addition, it's criminal to have someone suffer in
pain when you can prevent it.

So doctor's prescribed more and things worked out fine. Then they went to far
and prescribed heavy narcotics where they weren't really needed. In addition,
the public mood shifted towards opioids (as it had shifted towards cocaine in
the 1980's). Who needs to buy heroin when you can do a doc to write you a
script for 100 80mg Oxycotin?

So the crackdown begins. We have hospitals stating they won't give out
anything more than Tylenol or Ibuprofen.

I predict in the next decade we'll start the whole process all over again.
Patients in desperate pain won't be adequately treated. There will be a public
outcry and opioids will become "tools that can be appropriately use for all
types of pain."

~~~
hn_throwaway_99
I think calling current thoughts around opioids a "moral panic" is ridiculous.

Much of today's response to opioids is an _actual_ panic given that there is a
real, ongoing epidemic of opioid abuse that is killing tens of thousands of
people. The number of deaths by opioids more than _doubled_ in 2016 compared
to 2015.

I was around in the 80s, and this isn't just some "cyclical response". Take a
look at any of graphs of opioid deaths or overdoses - there is no cycle, just
something that is shooting up and up and up.

~~~
refurb
Sorry, it's a moral panic.

When I read comments like "just one Vicodin and you're addicted for life!",
"nobody should take opioids" and "opioids are destroying our country" it's
moral panic.

As for the number of overdose deaths, take a look at other countries that
never saw the massive overprescribing of opioids like Canada. The deaths are
due to synthetic opioids mostly coming from China.

------
sulam
The title of this article is misrepresenting the content to the point of
distortion. Her doctors never "prescribed" herbal tea (at most they mentioned
coffee in the context of stool softeners).

The author sounds a lot like my wife, actually. My wife cannot stand to do
"nothing". To me, a day doing "nothing" is like a gift from the universe. I
might nap, read a little, noodle around online, learn more of a new language
-- all without any particular goal in mind. Heaven! Or Hell, for some people!

------
wendyjreichert
I have no doubt that pills are overused, and Europe is a rather ahead of
America in terms of natural remedies and a less pill-pushing approach. That
said, doctors should take care: the only thing worse than overprescribing
necessary medications is underprescribing them.

~~~
freyir
> _the only thing worse than overprescribing necessary medications is
> underprescribing them._

There are only three categories: overprescribing, underpresribing, and
prescribing the correct amount.

In the case of opioid-based painkillers, overprescribing leads to unnecessary
addiction, in turn leading to heroin or fentaynl abuse, breakup of families,
overdose, etc.

If you’re underprescribed opioid painkillers, you just feel temporary pain (or
not, since non-opioid painkillers exist).

So, they’re not even really close in terms of long term consequences.

~~~
serf
>If you’re underprescribed opioid painkillers, you just feel temporary pain
(or not, since non-opioid painkillers exist).

Without taking a political stance on regulated pain killers, I'd like to point
out that the concept of 'temporary pain' is largely a myth. There has been
much work done (mostly with chronic pain sufferers) to show that pain (and
more generally over-excitation of nerves) can cause permanent nervous system
damage, brain chemistry changes, and CNS rewiring/plasticity-like changes.

Much of this research originated from the correlation between chronic pain
sufferers and un-treatable (or difficult to treat) depression.

~~~
pantalaimon
> Much of this research originated from the correlation between chronic pain
> sufferers and un-treatable (or difficult to treat) depression.

How do you conclude from results involving _chronic pain_ to the effects of
_temporary pain_?

I think there is a pretty obvious difference.

------
mnm1
Well, I suppose in Germany they also have a week of vacation, sick leave, or
disability to take off while feeling this pain and drinking tea. When that's
the case in the U.S., let's revisit this. Till then, let's hold off on the
moral judgements when the reality is some of us literally have to go back the
same day to work as the surgery. I've only taken pain killers once for a bad
dental abscess that my dentist was too dumb to see on an x-ray a couple of
hours before I could no longer chew. That was on a Friday and if I hadn't had
pain killers from previous surgeries, I'd have been in agony. I don't think
it's up to any prissy ass doctor to tell me, or anyone else, when I should
feel pain or not and whether I will need pain killers or not. As the very
least, I think we've established that people have different pain thresholds
and a doctor should know this before even entering medical school.

~~~
stormking
> Well, I suppose in Germany they also have a week of vacation, sick leave, or
> disability to take off while feeling this pain and drinking tea.

No, we don't have "a week of vacation, sick leave, or disability". We have as
many days or weeks as it takes. In many companies, you don't even need a
doctor's notice for the first three days.

------
curiousgal
> _This, however, is not a story about the benefits of universal health care_

Despite this phrase and the title (" _wanted_ " as opposed to " _needed_ ")
being technically accurate, you'd think the article is going to be the
disadvantages of a universal healthcare system but it's not.

It's about nothing.

Just an entitled patient bugging her doctors to prescribe her Vicodin before
her surgery even began and them not doing so because, as it tuned out, her
biggest hurdle after the surgery was boredom and not pain.

~~~
dpkonofa
I think the article tells the opposite story. She's not necessarily entitled,
just misinformed and mistaught. She's been taught to rely on pain meds instead
of using them as a supplement to understanding the pain. I think it's more of
a piece on education related to pain and meds rather than a study on boredom.

------
crystaln
I appreciate that this article tells a story and let's the reader think about
the meaning and impact, coming to their own conclusion.

It's almost like the author is mocking American media for spoon feeding
opinions.

~~~
nothis
I like the headline...

------
linuxhansl
I am German living the US, and I can absolutely second this.

Neither view-point in inherently better or worse, just different.

Note that Germany does have two class system now. The public class, and the
private class. When you're in the public system you often sit in different
waiting rooms for hours while those with private insurance get priority
treatment, choice of Dr., better rooms in hospitals, etc. Many Germans now
follow a hybrid, basic coverage through public insurance, with private add-
ons.

It sounds like the poster had private care.

Most vividly I remember the birth of my son some years ago in the US. We had
to practically force the doctors to stop looking at monitors and machines and
actually look at the mother. They wanted to control the whole process like a
machine, instead of letting nature do its thing, unless and until something
goes wrong. Afterwards the bill was $32k (for a no frill, no complications
birth) $24k charged to his mother, $8 charged to my son (at age of the few
days, his first official mail). The insurance covered it all, still the cost
seemed staggering.

However, _would_ something have happened, I felt extremely confident that we
would receive the best care and treatment that current technology could
deliver.

It's also often different from Dr. to Dr. and region to region. I have not
come across a chamomile sipping Dr. in Germany, yet. :)

I do subscribe to reducing "fixing" things with pills. Often that's the
instant-gratifying, cheap way out. Health requires thought, time, and "work".
And of course I would not try to cure cancer with herbal tea.

~~~
aeriklawson
As for the cost part, do German hospitals behave like American ones? i.e.
overcharging for everything on the expectation that insurance will cover it?

------
bambax
> _Stool softeners_

Never heard of those. What are they exactly? Orange juice?

I had a minor operation last year, also via laparoscopy. Didn't take any
painkillers afterwards, and all was fine.

I think pain has a lot to do with fear: if we don't expect it and we don't
know why it's there, it's horrible, but if we know where it comes from and how
it's supposed to evolve it's a lot more bearable (within limits of course).

~~~
imtringued
>Never heard of those. What are they exactly?

Anecdote: Dried plums work pretty well for me.

~~~
ddebernardy
Further anecdote: (Diluted) plum juice works wonders for babies.

------
jimjimjim
Something that seems more important than the pills is rest. A lot of countries
have, by law, a certain number of sick days, annual leave days, and a attitude
that if you arn't functioning well then don't be at work or you'll make
mistakes and cause more work.

why does the US have a 'play though the pain'/'your letting the team down'
attitude towards people taking care of themselves?

------
BLKNSLVR
The article abruptly ended without its appropriate summation commentary on the
cultural dependence on drugs inherent, normalised, and seemingly encouraged,
in the US.

Admitting taking ibuprofen like candy? Even as a joke, it would only be funny
where such behaviour isn't too far from normal. No wonder your pain threshold
is low.

~~~
cyborgx7
It told you a story and let you draw your own conclusion. Why do you need
someone else to tell you what to think?

------
carlhjerpe
A story about a self medicating American living in Germany trying to get
prescription drugs from the doctor.

------
sologoub
Just spent two weeks on the other side of the border from Munich, in Austria.
The article is very accurate on over the counter meds - you can’t get what you
are used to in US.

I caught a really nasty flu the first few days there and by end of the week
was searching for something to ease the cough. The cough syrup I was able to
buy tasted like rubber and did not contain the active ingredients you normally
find in US. It sort of worked - better then nothing, but certainly did not
really help the situation. Cough drops I was given plain did nothing for me.
All was purchased in a local Apotheke and dispensed by a pharmacist.

Upon return to the US, I continued to struggle with the cough and finally gave
up and when to a doctor. Sinus infection and antibiotics... so much for the
non-drug way of healing.

~~~
austrianguy
There is certainly a difference between 'just' a flu and something worse
(sinus infection, and so on).

The body notices when there is something more to it than just a flu.

That's the point were you get yourself a nice appointment at your 'Hausarzt'
(family doctor, sounds wrong tbh) and let yourself check thoroughly. If
somethings wrong, you'll get your medicine. If not, well just get yourself
some rest. Our social systems and working rights give you the freedom to be
ill for a long time and not needing to worry about losing your job.

Maybe in the US you are so used to getting your painkillers and hardcore
medicine for a simple flu (, and so on) that you cannot withstand some pain.

Most dentists don't prescribe you painkillers or even antibiotics after a
wisdom tooth removal, even if it was a operation and not just pulling it out.
Yes it hurts as hell, but just stay at home for 3-5 days, get some rest and
live happily ever after.

------
raverbashing
I'm going to be very honest, the author comes across as entitled and someone
that buys every medicine ad that comes out of tv

Take what's prescribed and if there's an issue do complain (or a previously
known issue, not "I think just Ibuprofen won't work")

~~~
ams6110
I think that was deliberate. The author was trying to illustrate her
preconceptions about medication and pain and eventually discovering a
different point of view.

------
pseingatl
Would you rather live in a country where medication is freely available over
the counter, or one in which you need a prescription for everything? Having
lived in both, I'd choose the former. What is a problem in the latter is
trivial in the former. Does requiring medical intervention lessen drug abuse?
Not entirely. But the vast majority of medications purchased are not drugs of
abuse. When was the last time you heard of patients abusing blood pressure
medication? Or heart medication? Sure, there are idiots who will eat Tide
pods. An adult can purchase a semi-automatic rifle in my country, but .375
milligram aspirin? God forbid.

~~~
boobsbr
I'd choose the former as well. After moving to Belgium I discovered that I
need a prescription for almost every medication. Even metamizole, topical
minoxidil and contraceptive pills need prescription.

But Tylenol is freely available, so I guess you can give yourself liver
poisoning an die, but you can't treat alopecia without going to a doctor.

------
MindTooth
After surgery in December I used some mix of antibiotics and anti-inflammatory
for five days. Occasionally some painkillers if needed.

As a Norwegian though, I expect to get well, and only take painkillers when
needed. I never pop painkillers when I have a headache, minor pains, etc.

I am a also a firm believer that when the time comes, I have a lesser
tolerance and the painkillers will work better.

Regarding pain, if you feel it, you can work to resolve it. If you do not, how
can you?

------
shams93
There have been times I needed opiate painkillers, I melted all the skin off
my right hand in an accident, needed a major skin graft. I did become
physically addicted but the experience was so harsh any time anyone offered me
opiates outside a medical context I was like hell no. I don't consider that
pushing opiates because the level of pain when growing back nerve endings is
off the charts.

------
Quzani-Berlin
Hi, I read your article and many of your experiences are - sadly - the normal
behaviour with pain and pain killers in Germany. In the south of Germany even
more than up in the north (from my experiences). But there is hope... I would
recommand that you search for a new doctor - in the best case a young doctor
fresh out of the university. The reason is simple. Pain management have only
recently become a major topic in the professional training and myths and wrong
behaviour are strong. younger doctors understand more and more that pain means
stress and stress make sick and is a negative influence to the healing
process. I hope that more and more doctors in Germany understand, that feeling
pain is not a guide - it's a burden that nobody should carry. Wish you the
best. Quazni (I hope my english is not as bad as I think it is.)

~~~
izacus
I think you completely failed to read between the lines - the article is a
criticism of rapidly increasing number of people addicted to pain pills in US
and their excessive consumption across the country.

~~~
throwaway2016a
I don't think you even have to read between the lines. The article is pretty
clear about it.

Not just pain killers but also things like cold medicine.

But he did say his English was poor so i can see how that might get lost in
translation.

~~~
eshyong
I'm pretty sure the author is a woman... the article says she got a
hysterectomy, which is surgery to remove a uterus. (She also mentions her
husband in the opening paragraph)

~~~
nothrabannosir
They were talking about the HN parent comment, Quzani.

------
sidcool
What is more worrying about US healthcare and the big pharma, is that they are
trying to impose the same modus operandi in other countries. I hope none of
the other developed Nations take this threat lightly.

------
xingu22
Somewhat tangential to the article, but interesting to note: various studies
have indicated that ibuprofen and acetaminophen are as effective as opioids at
treating acute pain:

[https://arstechnica.com/science/2017/11/as-epidemic-rages-
er...](https://arstechnica.com/science/2017/11/as-epidemic-rages-er-study-
finds-opioids-no-better-than-advil-and-tylenol/)

------
DoofusOfDeath
There was a study at Mass General Hospital studying if pre-surgery carb
loading reduced the need for post-op narcotics. (Not sure what the outcome
was.)

~~~
criddell
Aren't they worried about the patient vomiting and choking? I had a dental
implant done at the end of last year and I wasn't supposed to eat anything
before surgery.

~~~
rscho
Clear liquids such as sugared water can be safely ingested until 2 hours
before surgery.

~~~
criddell
That's interesting. I was told to eat and drink nothing except enough water to
swallow the pills I needed to take beforehand (pain killers and an
antibiotic).

------
g09980
Friend in the US had a benign type of surgery. The procedure carries minimal
pain after the first 24 hours other than maybe aching (and my friend really
had a pretty boring recovery). She was still given a bottle of probably 20+
pills of Oxycodone that fortunately went unused (later disposed.)

While my friend was responsible in her recovery, I wonder how many people
medicate themselves just because.

------
gok
Fascinating to hear so much anti-drug commenting here. Sounds a lot like the
comments for stories praising DEA raids of medicinal marijuana facilities
(“Americans just use too many drugs! Doctors prescribing drugs just to ease
the pain of patients are enabling a gateway to addiction”)

------
agumonkey
I really wonder how much psychological trick one can play on it's post
surgical pain. You know if you're in a blissful happy environment and not a
post-butchery waiting room it might change your day from dread to "ok".

~~~
Someone
It ,ay be hard or impossible to do, but the potential certainly is there.
[http://theconversation.com/emotions-affect-how-pain-feels-
as...](http://theconversation.com/emotions-affect-how-pain-feels-as-soldiers-
know-only-too-well-25889):

 _”Beecher initially wondered whether these war-wounded men were generally
insensitive – for chemical or hormonal reasons, for instance. However, this
turned out to be untrue since even badly wounded patients who claimed not to
be in pain cursed medics who were rough when giving them an injection. Instead
Beecher concluded that the best explanation for the men’s lack of pain
involved their emotional state. They were not suffering because their wounds
represented an escape “from an exceedingly dangerous environment, one filled
with fatigue, discomfort, anxiety, fear and real danger of death,” but because
they provided them with “a ticket to the safety of the hospital”.”_

Simplifying the explanation, it seems optimism (?or delusion?) (“things will
get better” or, maybe, “the pain prevents me from doing things that will do
more harm”) helps decrease suffering.

~~~
agumonkey
I also think of how one person sees a sensation of mild pain. As a kid, most
falls, even harsh at times, don't last in your mind. I remember nasty crash on
mountain bikes where we would dust ourselves off, laugh and go. The thrill of
the action made the pain very secondary. Even the day after, when the injury
would hurt a bit more we wouldn't really complain. Because it's part of the
pleasure of trying, achieving.

After a certain point, the brain shifts, we're not in growth, we're in
maintenance mode and every problems is void of side value, it's just this, a
problem.

Maybe it's also because these are self or externally inflicted sensations,
compared to surgery for an internal disease.

------
vondur
My wife took only ibuprofen after the C-section birth of our son. She was ok
with it. The nurses had her walking around the next day to help with the
healing.

------
PhasmaFelis
I hope they're not just knee-jerk going "pain is a part of life" for
everything. I had surgery to set a broken ankle last year, and the first night
I was nearly in agony _after_ taking a prescribed Vicodin. I can't imagine how
bad it would have been if they'd tried to fob me off with ibuprofen.

------
readhn
i had a surgical procedure years ago. one of the most painful experiences
(during recovery), i felt like putting dynamite into my mouth and exploding
it.. this is when i first tried Vicodin. it was a total life saver. and no i
did not become addicted from taking 3-4 pills to manage extreme pain. this is
the only time i took such strong pain killer. im glad these pain killers are
readily available option in USA(filled in 20min at local CVS).

------
brandonmenc
Cue the anti-drug (really, anti-medicine) comments from all the people who
have never encountered chronic debilitating pain, either personally or in a
loved one.

~~~
BLKNSLVR
This article isn't about chronic debilitating pain. It's about the fear of
pain and the culturally normalised behaviour of pre-over-medicating.

------
ajaimk
The title and the tone of the article seem to be very contradictory. OP might
just need to add a conclusion to this.

~~~
perlgeek
Often the editors will pick a title, not the author of the article. Which
might explain the disconnect.

------
jk2323
Pain is definitely undertreated in Germany (e.g. dentist).

It is overtreated in the US. I had two Surgeries in the US and was given stuff
like Vicodin to take home. Never took it. Would have rated the pain 0 out of
10. But I am very pain tolerant.

------
bebna
Tja.

------
syshum
I always get in a arguments with my EU acquaintances over pain management
topics.

The idea that is a "good" to suffer with pain instead of taking pain killers
is abhorrent to me.

~~~
fatjokes
It's one thing to suffer with pain needlessly, it's another if the treatment
of pain could have long term harmful effects, e.g., addition to opioids.

I had impacted wisdom teeth and needed dental surgery. The dentist gave me a
couple of codeines to take home but I never took them. The day after the local
anesthesia wore off was miserable, but it became easily manageable after that.
I found a lot of times the fear of the pain was worse than the pain itself.

~~~
syshum
This is why my individualism, and Self Ownership come it to play as I feel
that should be my choice if I want to take the risk, it should be up to me if
the pain is server enough to warrant opioids or not as I am the one
experiencing the pain.

Every person reacts differently to procedures and to pain, some people having
their wisdom teeth removed may not be painful, others it might be terrible
pain. It should be up to the individual as a adult to make those choices for
themselves

I am sure that will be an unpopular opinion given the state of society is that
no one should be treated as adults and that governments or "others" should
tell people have to live ...

At multiple times in my life I have been given hydrocodone, I have almost
never used the entire prescription, but when I needed them I would glad to
have them. The idea that a 3rd party can tell me "ohh your pain is not that
bad just live with it" when there is a easy solution to allow me not to live
it it, well I find that morally reprehensible

~~~
fastball
If you're paying for it, I agree with you.

But that's not the case in Germany, as they have a single payer healthcare
system. That "easy solution" costs _other people_ money.

~~~
tpush
Slight correction: Germany does not have single-payer healthcare.

~~~
germanier
But the public health insurance system (which covers 90% of the population)
makes joint decisions (through broad guidelines) on what is covered. An
economic assessment is always part of the decision. Representatives of doctors
are heavily involved in the process as well. _Gemeinsamer Bundesausschuss_ is
the name of that body.

------
zython
> "After my surgery, I had to pay 25€ for the taxi ride home"

I'll take that over the multi-million US-american hospital bill, any time.

~~~
adventured
You mean, $30,000 to $40,000, the median cost in the US, nearly all of which
would be covered by insurance. No sense in fabricating magical numbers, like a
multi-million dollar bill, everyone knows the flaws in the US system as is.

It costs about 1/3 to 1/2 as much in Germany, paid for by other tax payers.

~~~
Karnickel
It's not paid by taxes but by health insurance. We have both a private and a
semi-public system (managed by "Krankenkassen", independent insurance
entities, that compete for members; it's... complicated, but less so than in
the US, and it does not depend on the employer).

Some might say it's like a tax, it gets deducted from your paycheck, but then
that's the same everywhere, including the US. Difference is that it's managed
by independent entities and not the government, and they even compete. The
private insurances are quite significant in Germany too. You are allowed to
leave the government-mandated "Krankenkassen" if you earn over a certain
amount of money per year, then you have to get private insurance - which is
less expensive if you are young, but unlike the Krankenkasse family members
(e.g. non.working spouse, children) are not included and it may become much
more expensive when you get older, it's hard to predict because it depends on
many factors including if you picked the right insurance company (that didn't
lose as much money and now has to raise prices).

~~~
wirrbel
I don't know if I would understand the German "insurance" system from that
explanation. Maybe to complement your explanation another try at it:

Germany has two insurance-like systems to pay for medical treatments:

(1) insurances, with fees aligned with damage risk associated with the policy
holder. (2) a system of "funds" that provide insurance benefits for insurants,
however, are not organized like an insurance.

The system (2) is quite old (dating back to the 19th century) and has a few
peculiarities:

* fees vary by income of the member of the fund (principle of solidarity, basically people with well paying jobs subsidise others). * half of the fee for a member is payed by the employer, half by the employee, deducted from the paycheck. * family members can be insured, too, without increasing fees. * fees are not dependent on your risk, i.e. they do not increase with age, preexisting conditions, etc.

The alternative to this fund are insurances that work on a risk-based pricing
scheme - item (1) in the list:

* in order to be able to sign up for them, you need to have a certain steady income above a threshold (above 50000 EUR I believe). * pricing is per insurant, i.e. extra insurance contributions for kids and family members if they are on the same plan, etc. * for young adults these plans are usually cheaper than for older people, which means you can get "trapped" in a contract that is more expensive than the public funds I wrote about above.

For both systems, treatment prices are kind of fixed (as a rule of thumb,
doctors can charge the insurance a bit more than the public funds, by a
constant factor of 2-3, but I heard from doctors that this depends on the
treatment).

------
spraak
Very sad to remove the uterus, it's the center of the universe in its way.
Life comes forth from there, having originated from spiritual realm.

~~~
spraak
If anyone is still reading this, I'm very curious why this would be downvoted.

