Tag Archives: gratitude

Three responses to infant surgery

Infant surgery does different things to different people.

This post introduces readers to three men whose infant surgery recently prompted them to go public, each in his own way.

yay1Dave Outred went online to express his joy and gratitude for his full and satisfying life, apparently unaffected by the rather messy start to life he had.  After developing pyloric stenosis (“PS”), he was operated on twice in a London hospital in 1955 to remedy this rather common condition when he was about 6 weeks old: when it became clear that the first “procedure” had not dealt with his stomach blockage, it was repeated a day or two later, leaving him with two rather large and untidy scars.

But, he wrote on Facebook (to a “closed” Group) –

I say, be proud of your scars because you are a survivor!  I have had a great life: played sports for my town as a school boy, enjoyed camping and an outdoor life with the scouts, been married twice [currently 31 years], followed my football [soccer] team through good years and bad, semi-retired at 48 after many years of working 6 and 7 day weeks.  Lots of friends and a full life.  Recovery from P.S. is the start of a life you may never have had.

ButchBee02aJay Jacobs’ infant surgery was to deal with volvulus, a twisting of the bowels that like PS blocks the passage of food but can also quickly cut off the blood supply, causing gangrene and death of the affected intestines.  Perhaps because he was not expected to live, perhaps because cosmetic concerns rated rather lowly in 1957, perhaps because of his earlier weight problem, he has also been left with a very large and sunken scar.

Jay Jacobs found it harder than Dave Outred to feel accepting and confident about his disfiguring scar and count his blessings… until he found his niche.  Jay Jacobs always had a weight problem but in his later adult years he succeeded in beating this: he found diets and fitness programs that worked for him, participated in the Biggest Loser program on TV, and developed and promoted his discoveries, weight-loss and new-found wellness to become a successful entrepreneur!

Quite likely because of his accomplishments, he was also persuaded to rise above his negativity about his abdominal scar.  He appeared “topless” on TV and online, and wrote about his former “shame” and new-found confidence about his torso and story.

In mid-2019 the national free-to-air TV broadcaster in Australia aired a short video created by Alexander, a young man who was born with mild pectus excavatum, a “pigeon chest”. He was troubled in his adolescence by being singled out for comment, sometimes cruel, but also reports that growing up he was determined and able to rise above this, helped by his parents and closer friends, so that he can now accept his body as different but “OK”.

Henry Fox like Dave Outred also had PS and early surgery to remedy it.

Genes baby1It left him with a lifelong passion for the importance of medical research.  Many PSers realise that up to about a century ago, the diagnosis of infant PS was almost always a death sentence: the surgical remedies then on offer were so crude and horrific and so rarely successful that most parents preferred to see their little one simply expire.

Henry Fox knew this and also that there are still many conditions of infancy that although less common than PS need research funds and workers.  He wrote –

Owing to the type of research now carried out by Action Medical Research, I was able to undergo a small operation to rectify this and am now able to make the most of my ability to digest properly…!
Since then, Action Medical Research together with its most famous sponsor, Paddington Bear, have stayed very close to my heart.  I spent several days as a young child attending Action Medical Research’s Paddington Bear tea parties, over-indulging in a fair few marmalade sandwiches to help raise funds for their life-saving research!!  This association has stayed with me and it is rumoured that (aged 27) I may still possess a Paddington Bear duvet cover.

 Henry is seeking sponsorship for his running in the 2016 London Marathon (24 miles or 40 km on 24 April) to raise funds for medical research.

Nerdy MD2For many years now I have been reading and writing about the many issues around infant PS, and seeking greater recognition of the turbulence that affects a fair number of those affected by this rather common ailment.

I have been intrigued by the unity among parents affected by PS: those who write report as one that it was their most traumatic experience ever – and that all too often it left them feeling cheated in one way or another.

On the other hand, those who themselves have had PS respond and reflect on it in many different ways, and the reports above are typical but only samples of many very different responses.

Reflecting on my 70th

Birthdays and anniversaries are times for celebration, and reaching “three-score years and ten” years is certainly worth a big three cheers! But they are important for reflection as well.

150926-25 sml

Renmark Reunion September 2015

Gratitude to God and to the most important people in my life over these 70 years are features I’d like to be emblematic of me.  I am still surrounded with so many loving and kind people, I have enjoyed wonderful peace and excellent health, and my contribution in several circles is still wanted and apparently appreciated.

Ten days ago Helen and I gathered to celebrate my 70th birthday with our 4 children, their spouses and our 11 beautiful grandchildren.  A wonderful 5 days . . .

October 6th is ten days after my birth-day and  marks the 70th anniversary of the life-saving surgery I had in the Netherlands.  I would not be writing this but for that day in my life!

Together with the country of my birth and background, my weary and expecting parents were struggling to emerge from the ordeal of World War 2.  And then I arrived, their long-awaited first child, but soon clearly defective: scary, uncontrollable and life-endangering vomiting (infant pyloric stenosis – “PS”).  And these were times when medical science was pretty rough and ready by today’s standards and when people didn’t dwell on what they’d rather forget.

Pic 12

Mother with me – October 1945

So October 6th marks what I now realise was the gift of a new and wonderful second start in life, but also the beginning of a life-shaping journey of exploration and discovery – outside of me and within.

Outside, my parents were unwilling or unable to answer my reasonable questions about the 10 cm scar on my belly, and this drove me to look for information elsewhere.  But until the advent of the web, this search yielded only cold textbook medical data about PS and the then 33 year old surgical fix for the condition.  And explanations of my deeper issues were nowhere to be found: there were no pointers to where these might be unearthed and no ways of identifying people who could help me to realise (as I do now) that my pain was by no means wacky.

Book coverWithin, I was tormented with private pain from the dawn of my self-consciousness until recent years.  Even now I am still working to piece my private pain-puzzle together, although the web has given me access to much information, clarification and to networking with fellow-survivors, all of which has enabled me to receive and share much healing.  Since 2012 I have blogged about my journey, and in 2014 a pediatric surgeon friend and I published a small book, in which he explained what many still regard as the elusive cause of PS and I outlined my personal experience of this condition. It so happens (in Australia at least) that October 6 falls in “Mental Health Week” – and my own story has certainly helped me to feel a sense of identity with people challenged by mental health issues.

Time changes things!  The past 70 years have taught us the value of openness in the home, the importance of both listening and speaking for healing, of collaboration in achieving goals, and (by no means least) we have learnt much about trauma.

70 years have also brought huge changes to surgical technique and to holistic care in the hospital and home.  Time seems to have done less to change the unhelpful attitudes of some in the medical profession – but that’s due to human nature being far from perfect.

What do these changes (and their lack in some respects) mean?

120327-07-WgHcThe kind of trauma symptoms I struggled with is rare among more recent PS survivors.  Their surgical scars are sometimes almost indiscernible, usually tidy and very rarely as gnarly.  Affected children’s and their parents’ questions are typically answered much more fully and sympathetically, and the children are helped to understand, “own” and even feel pride about their story.

As I see it, I have discerned this is the growth in myself.  I am indeed a survivor from a bygone era of medical practice and parenting, and my scar is an exhibit of mid-20th century surgery.  I know it’s not socially correct for a cultured older gentleman like me to proudly show off his scar as an 8 year old lad might… but I’m catching up on lost joys and enjoying it!

End-of-year reflection

This post was born between Christmas and a new year, surely a time of celebration, thanksgiving and reflection for all our readers, and amplified for many people like me by our Christian faith and values.

Being an infant pyloric stenosis (“PS”) survivor also adds to this time of the year: life-saving surgery leaves people like me with much more than the typical parent tales of the cute things we did when we were very young.  PS survivors of anywhere like my vintage (1945) usually have an ugly scar and were perhaps psychologically affected.  However, our scar also reminds many of us at least daily that our life was saved and greatly extended thanks to the admittedly crude surgery and long before we were conscious of it!

For me that happened more than 69 years ago, and the passing years make me increasingly grateful for a rich and happy life.

Song writer Robert Thompson supports Sheffield Children's Hospital.

Song writer Robert Thompson supports Sheffield Children’s Hospital.

Early this month I came across a weblink to a British newspaper article that reminded me that being a PS survivor affects many people this way.  A local songwriter penned a Christmas song (Would you believe Father Christmas has a twin?) and created a CD around it to raise funds for kidney research at Sheffield Children’s Hospital.

Reading this also reminded me how many PS people who mention their survival story online also express their gratitude for being a survivor, despite their often strong feelings about a disfiguring and embarrassing scar and ongoing trouble with what are suspected as being long-term effects of the condition or the operation.

We all agree that our world is far from perfect, and that the same is true of our bodies and emotions, even without having had infant surgery.  But life can be pretty good despite this!

Thank you also to my readers for your interest, encouragement and responses.  Best wishes for 2015!

The possible effects of infant pyloric stenosis

Doctor01The most common mistake and the biggest lie told about infant pyloric stenosis (“PS”) and the surgery to remedy it are the simplistic notion that neither has after-effects:  “After the quick little operation you’ll have a new baby, and you and your child will never think about PS again!”

Sadly, that mantra is all-too-often “too good to be true”.  All-too-often it just adds disappointment, insult and feelings of betrayal to the nightmare: of many parents in the weeks, months and often years after their child’s surgery, and of survivors every time they are told that their chronic troubles cannot be explained but have nothing to do with the scar on their belly.

The prevalence of this rather too promising assurance is why in 2012 I devoted a lengthy post about this on this blogsite.  It has been the 2nd most read post on this site.  I will revisit this subject more briefly here, and urge interested readers to use the link to read what I wrote there, and to use the Categories and Search/Tags boxes at the upper left of this page to find related material.

Because PS is relatively common (between one and five babies in 1,000 will suffer with it in developed countries – that is a lot of people!), we must conclude that the widespread belief about there being no ongoing or side effects although false and misleading is nevertheless generally true. I suspect that if (say) half the millions of PS survivors had troublesome adhesions, obvious PTSD or chronic reflux, we would know about it.

It is also true that some of the reported ongoing effects of PS and the surgery to deal with it cannot be linked with the condition with any certainty.

Obesity02For example, obesity or minimal body mass in later life are common complaints among survivors and could indeed be the result of the pylorus’ being slit and behaving somewhat differently – and some small studies have recognised this.  Yet from my self-knowledge and interaction with others affected it seems to me that our genes and eating choices are mainly responsible for how we process our food intake.  As an uncle used to tell my parents, “Every pound passes through the mouth”.

The vexed matter of GERD, GORD, or reflux is another common complaint that is often suspect but hard to pin on PS or its surgery.  I have written about the challenge that chronic abdominal pain is for many people: patients, parents, and physicians.  Long-ago abdominal surgery is all-too-often on the list of suspects for persistent undiagnosed pain, but a PS link is far from always established, although this may be because so many busy doctors fail to “engage” with patients who consult them about a list of hard-to-diagnose abdominal complaints.  If a quick prescription or a referral to a surgeon will help you, fine, but otherwise…

Having noted all this, it is sad but true that PS and its operation cause much, much more grief than the medical world seems willing or able to recognize, if the thousands of medical articles and personal stories available online are considered.  Again: the problems listed below will not affect everyone after PS and surgery for it, but they affect many.

Here is an incomplete and dot-point list; it summarises many other posts to this blogsite.

Some immediate and ongoing after-effects of PS (regardless of surgery)

  • Malnutrition of the brain (incl. lasting effects on memory, coordination and motor development)
  • Hernia formation
  • Risk of children inheriting PS
  • Increased risk of later gastric ulcers

Some effects of medical or “watch and wait” treatment of mild PS

  • Need for surgical treatment in infancy or later life

Some immediate after-effects of Pyloromyotomy (PS surgery)

  • Complications of surgery – a list incl. breach of the pyloric passage, incomplete pyloromyotomy, infection, bleeding, wound rupture, anesthetic problems, hernia formation
  • Disturbance of gastric function (continued although milder vomiting, GERD/reflux, slower or faster processing)
  • Emotional effects of surgical trauma and maternal separation

Some long-term after-effects of Pyloromyotomy

  • Disturbance of gastric function (abnormal vomiting, GERD/reflux, irritable bowel syndrome, slower or faster processing)
  • Abdominal adhesions
  • Post Traumatic Stress Disorder – various results of retained somatic (body) memories and transfer of parental trauma
  • Significant discomfort for women during pregnancy
  • Scar disfigurement – self-image
a PS baby showing malnourishment

a PS baby showing malnourishment

Against all the above possible causes of PS puzzles and problems, ranging from minor irritants to significant and life-affecting afflictions (all-too-often dismissed by the family doctor), we must remember one thing.  Whereas PS a century ago meant the terrible death of almost every affected baby, today it is a negligible cause of infant mortality, thanks to the steady progress of Western medical science during the past 125 or so years, when Dr Harold Hirschsprung first described PS in detail.

This blogsite is committed to seeing a better integration of the science and the humanity of managing PS.  In several areas there remains some room for improvement.

100 years of Pyloric Stenosis surgery – an academic’s review

In October 2012 I posted a tribute and three reflective articles on the centenary of the publication of the German Dr Conrad Ramstedt’s surgical technique to relieve pyloric stenosis (“PS”).

This operation saved my life less than two weeks after my birth in 1945, and it has become the most used treatment of this condition and the most common non-elective infant surgery.  However, debate continues on issues such as –

  • Can PS be more promptly diagnosed more often so that more treatment options are available?
  • Should medical (rather than surgical) treatment be tried on more PS babies, with surgery as a later option?
  • How important is it to choose a surgical technique that reduces scarring in later life?
  • Can the symptoms reported by PS surgery survivors (PTSD and a long list of immediately or later evident abdominal complaints) be linked with PS or its treatment, and perhaps avoided?
  • Do the medical journal articles on PS and pyloromyotomy (PLM) deal with great repetition on just a small number of the related issues and avoid other significant matters?

Last year I found only one or two medical journal articles prompted by the centenary of Ramstedt’s pyloromyotomy: these were available only upon what would be for many a costly subscription, and the Abstract (supplied by only one publisher) gave nothing significant away.

Raveenthiran Prof Dr V 2012.bmpHowever, I am very thankful that during the past week, the Indian Prof. Venkatachalam Raveenthiran published an online review of the past 100 years of PS surgery which he generously made available to anyone interested.  There is also a ‘pdf version available on the web.

So once again I’d like to report on a medical journal report:  to summarise it, highlight the main points, and where necessary “translate” it and sometimes comment on it for general reading.

I have found that some of Prof. Raveenthiran’s observations are of real interest to one who has learnt to be thankful for the discovery of this surgery – despite the many years of my struggle with some of its after-effects.

  • The discovery of a surgical technique that brought to an end the very high mortality rate of PS babies has not reduced the interest in the condition.  In fact, in recent years the number of research reports about PS and PLM published annually has increased, and several of the formerly accepted data have been contradicted or rejected.
    However, I (Fred) am not alone in having observed that much of this output is very repetitive and sometimes even trite (stating what is already established).
  • US measures PLM01-1Dr Raveenthiran observes and discusses the growing reliance on diagnosing PS by ultrasound (U/S) technology rather than by simply palpating “the olive” (feeling for the swollen pylorus).  Others and I have reported this also.  The Professor reviews some of the current rather rigid diagnostic criteria, their failings, and their nature which show the need for more research if U/S is to be a more reliable and effective tool.
  • Another current “discovery” is questioned and analysed by the doctor: the widely quoted Danish study that claimed that bottle-fed babies had 4.6 times as much risk of developing PS as breast-fed infants.  This research report also contradicts the “established belief” of earlier years, and Dr Raveenthiran asks some pertinent questions.
  • Plm Lap single port01During the last 20 years circumbilical (around the umbilicus or navel) and Minimal Access Surgery (MAS, also laparoscopic) techniques and equipment have been increasingly applied to infant surgery, including PLM.  In recent years, as this website page shows, MAS using miniaturised equipment (still leaving three but smaller scars) and single-incision laparoscopy (SILS) through the umbilicus have come into use, for both adult and infant patients, and most reports state that after a learning process is completed, the results with the new techniques show no major disadvantages plus the benefit of an improved cosmetic outcome.
    Prof. Raveenthiran expresses bemusement at this string of claimed improvements, questions the practicality of SILS, and mentions yet another new technique, endoscopic PLM (removing the blockage from inside the gastric canal) which has not yet been used on human subjects.
    At this point I (Fred again) recalled reading a recent report that found most pediatric surgeons who had graduated more than 20 years ago were still using open incisions for their PLMs.  As they say,  It’s hard to teach an ol’ dog a new trick.
    As one of the countless PS survivors whose main after-effect has been our struggle to come to terms with an eye-catching and ugly scar, I say (as strongly as I can):  Hey! Please! Yes!  All other considerations being equal, bring on more cosmetically-considered infant surgery!
    Note: See also Dr Raveenthiran’s comment below.
  • In his final paragraph, Prof. Raveenthiran castigates the common attitude that “PS doesn’t have any after effects”.  My comment on this: Hear! Hear!
    He mentions something else I and others have often pointed out: the almost total lack of long-term follow-up of PLM patients, and of research into the long-term effects of PS and PLM.  He touches on some of the problems that have been discovered (but largely ignored and unknown): significantly lower cognitive, receptive language and motor scores, irritable bowel syndrome, and chronic functional dyspepsia and functional abdominal pain at a later age.  He calls for much more long-term study of these problems.

On a personal level, I was once again gratified and reassured as I found that almost everything Prof. Raveenthiran chose to mention and highlight in his essay was a matter that I have also raised, discussed and advocated for in these blogs – albeit without the benefit of medical training and without supposed academic status.  Isn’t it wonderful that the web allows any and all of us to dig out information for our own and others’ help and healing?

Another new year has dawned… Here’s to the victory of truth!

Thanksgiving – a time to count blessings

Many around the world are covetous of the United States’ Thanksgiving Day tradition.  I’m writing this on the fourth Thursday in November, when Americans at home and abroad gather to enjoy a celebratory meal followed by a long weekend.  They’re giving thanks for a number of particular reasons, flowing from the founding of their nation as marked by the arrival of the Pilgrim Fathers at Plymouth Rock late in 1620, these settlers’ first harvest a year later, and the breaking of a serious drought in 1623.  The original thanksgiving occasions took the form of grateful Christian worship meetings rather than a high-calorie meal!

The Netherlands is my country of origin and Australia my adopted country: sadly, neither has anything like Thanksgiving… nor do many other countries (other than Canada) to my knowledge.

In this post I would like to register some of my thanks at a personal level and in regard to my writing these posts, which are a modest part of the centenary of infant pyloric stenosis (“PS”) surgery.  I regard God (as I’ve come to know God through Jesus Christ) as the ultimate maker and giver of everything that is good, and so I honour and thank God  –

  • For the gift of life which most of us today in the developed world take for granted, but which my PS scar keeps reminding me is always a tenuous gift.
  • That PS is so readily treatable by a course of medication or by surgery.  Although I have hated my scar and still have mixed feelings about it (as I do about my other personal inadequacies and battlefields), I have come to realise that without prompt surgery I might not be writing this today.  And of all the abdominal conditions of infancy, PS is not only by far the most common, but also the one that is the most easily corrected and with the least “collateral damage”.
  • For my parents who, even though as people of their time they were ill-equipped to help me understand and “own” the trauma and pain my PS surgery caused me, nevertheless suffered much and loved me through what was for them too a horrendous experience.
    More generally, I am grateful for strong women who can become assertive and even pushy mums.  The web is littered with stories of mothers who stood their ground when they are put down by a condescending doctor who belittled their prior experience of PS, their parental research, and their motherly instinct that something was seriously wrong with their baby.
  • For the hospital staff who nursed me during those first weeks of life in such a way that despite the rough-and-ready way infant surgery that was done at the time, I wasn’t added to the medical morbidity (complications) and mortality statistics.  (The psychological/ emotional after-effects were another story, but unknown at the time.)
  • That medical science, researchers and writers have during the past 100 years added unimaginably much to our understanding and skills in treating life-threatening and life-affecting medical conditions.  Whether it’s the risk factors of a relatively obvious abnormality like PS or the mapping of the brain or genes, we are far from in control, but we do feel increasingly empowered.
    More generally again, I give special thanks for doctors with good diagnostic skills which allow PS babies to start treatment before they are near death, to surgeons who know their stuff and have a deep respect for their tiny patient’s emotional and cosmetic well-being, and to parents, pediatric specialists and hospital sections with the courage and kindness to advise and try medical treatment of PS rather than letting the surgeon set the agneda.
  • That support communities and forum interaction are so common and easily formed and developed today!  As one who was deeply affected at the personal level by my PS experience, I know what it was like to live in isolation from information, explanations and others with the same nagging questions and deep aches.
  • That my two years of weekly posting at this address has met with such a strong and positive response.  Although comments have been fairly infrequent apart from those of my faithful co-blogger, they have been invariably positive, appreciative, and in harmony with my passion here.  Often they have been a complete surprise and most heartening.  And the number of visits far, far outnumbers the comments.
  • For the fact that none of my children and grandkids have developed PS.  Infant PS is known to result from any of several factors, and it seems more likely that my stressed out mother was involved in my first problem than my genetic code.
  • Generally again, I thank God that in the developed countries at least, babies today rarely die of PS.  Until some 50 years ago, there were some terrible mortality rates due to delayed diagnosis, the unavailability of suitable treatment, and surgical and post-operative complications.  Times have certainly changed!

Pyloric stenosis surgery makes a century! (2) – the difference Dr Ramstedt made

German Dr Conrad Ramstedt’s surgical remedy for infant pyloric stenosis was announced to the world at a medical conference and publication exactly 100 years ago last week.

This anniversary was of course rather significant for someone who underwent that surgery 33 years later to save his life just 10 days after his mother gave him birth.  And because pyloric stenosis (“PS”) affects between 3 and 5 babies in every thousand born in developed countries, and most of these are treated surgically, there are many people alive today because of Ramstedt’s discovery.

Dr Conrad Ramstedt operating

However, one only has to research the history of this condition and its treatment to realise that whilst the German doctor realised he had made a significant discovery, he was also the unwitting cause of trauma in at least some and perhaps many PS babies and their parents.  Let me explain…

In 1912, the medical treatment of babies with PS was general but very risky, and almost half the infants died despite it.  Several surgical techniques were then being offered as an alternative for PS babies, but these were so drastic and severe on a tiny, malnourished and dehydrated baby that the great majority died of surgical shock, infection, and other related causes.  Most parents took their chances with the available medicines… and prayed.

Dr Conrad Ramstedt’s accidental discovery in 1911 and published in October 1912 represented a major breakthrough: see my previous post and an earlier one.  The Ramstedt pyloromyotomy was rapidly adopted as the remedy of choice in all countries around the world, and in four decades after 1912, deaths from PS fell to almost nil in most countries.  However, even in the 1940s, some countries (including Great Britain) continued to report their PS mortality was still at 25%.  I have been shocked by how many mentions there are on the web of relatives dying of PS.  Despite all this, Ramstedt’s technique and better health standards in hospitals have done much to make death from PS most uncommon today.

How did the Ramstedt pyloromyotomy contribute to this?

It made treating PS relatively easy and simple for surgeons, hospital staff and parents. For surgeons the technique requires practice and care, but is essentially one of the simplest surgical procedures on the OR list.  The surgery usually ends the violent and deadly vomiting; although some continued vomiting and reflux occur quite often, it is fairly rare that an incomplete myotomy (division of the pyloric muscle) or its redevelopment requires a repeat of the surgery.  So: anxious parents are greatly relieved, the surgeon immediately becomes a successful warrior, and the baby quickly starts to make up for weight lost: I gather that my post-op photo is quite typical!

Apart from the great relief of all concerned, the Ramstedt pyloromyotomy saves pediatric ward staff and the bay’s parents having to manage (or endure) weeks (and often two months) of medical treatment, with each of the sick baby’s feeds requiring medication be administered beforehand to a rigid schedule, milk having to be given slowly and carefully, daily weighing, and regular consultations with the hospital clinic or paediatrician.  Why put yourself through all that when surrendering your baby for just an hour or so to the gowned and skilled surgical staff produces what often seems like an instant fix?

Some babies are best treated surgically, and of the babies treated medically, up to 20% will not respond sufficiently well to escape surgery.

On the other hand, almost all Ramstedt pyloromyotomies seem to be fully effective, certainly in the immediate sense.  And although the worldwide web includes many hundreds of complaints and stories of a long list of troublesome ongoing effects from their PS or its surgery, it is just as clear that the vast majority of survivors are satisfied enough not to air their troubles.  The possible effects of the surgery are many and real, and sometimes severe, but many PS survivors report little or no gastric or abdominal discomfort, few or no problems with their scar or adhesions, and no trauma.  And this silence of the vast majority of PS patients has enabled most of the medical world to assure anxious and worried parents that “PS and its surgery will have no after-effects on your dear child”.

What I have written so far gives me some cause for concern, however.

Ramstedt’s discovery at once saved my life (and I’ve had more than 65 very good years so far), and it has also been responsible for the trauma I and not a few others have had to deal with (often chiefly in private) for most of our lives.

It was quite unintentional, but it is nevertheless true that Ramstedt’s surgical solution for PS effectively and inexorably moved the medical community’s interest away from perfecting the already (and still today) quite effective treatment of PS with cheap and simple medication and careful maternal nursing.  The Ramstedt pyloromyotomy is (as stated above) in itself what many surgeons call “elegant”: it is easy, quick and usually effective.  But until quite recently the surgery and what came with it could be very severe and traumatic on the baby and also on the parents, and it was associated with more (and more severe) risk factors than the medical alternative.

Thus the Ramstedt pyloromyotomy helped fuel the ascendancy of the power and prestige of the surgeon with which some of us are all too familiar today!  We must remember that specialist and high technology medical science has been very largely responsible for our rising health standards and life expectancies, but in fact PS is one of the maladies that can in most cases be brought under control by medical means and with surgery kept as a last resort.  In some countries, PS continues to be managed in this manner.

So Ramstedt’s operation short-circuited interest in understanding and managing the causes, pathogenesis (biochemical development such as proposed by Dr Ian M Rogers) and even prevention of PS.

Whilst I am deeply grateful for the operation that saved my life and realise that in my case surgery may well have been the only responsible remedy, I have often wished that I could have been treated more gently, without a disfiguring scar, and without inflicting life-long trauma on my parents and me.

And in this wish I am not alone.