Chapter 104: Turning hostility into friendship
"Let's have a good chat with this patient." Yang Ping felt that the time was ripe.
Director Zeng was very sincere: "Well, I'll get the patient's information."
There are many bulging bags of patient's films. From Nanqiao People's Hospital, to Shipo People's Hospital, to hospitals in provincial capitals, every hospital has made a complete set.
Yang Ping simply classified these films into three parts:
Otherwise, there are a bunch of films and it’s hard to figure out which one was taken when and where.
The two people faced the reading lamp, hung up the films one by one, looked at one film and then changed it to another.
Yang Ping pointed to the recent magnetic resonance film and said: "Look at the left femoral shaft. The local signal here is still different from the signal in other parts. Let's look at the CT."
He took out the CT scan from the same period, verified the date, and hung it up: "Similarly, the density of this part is different from other parts. You can see that there is slight sequestrum formation and local hyperplasia here, but there is no such thing in other places." The phenomenon is just an uneven decrease in bone tissue density, causing bumps and bumps. ”
Then hang up the X-ray: "The trabeculae are unevenly reduced, and there are no gaps in the cortex for the time being."
Having said so much, Director Zeng didn't understand what Yang Ping wanted to express?
Yang Ping also saw his confusion and said: "I suspect that this patient is not infected with the entire femur, but only with a local infection here!"
Director Zeng was attracted by his novel ideas. Why was this patient so difficult and why the provincial hospital was unwilling to operate on him? They thought the entire femur was infected and there was no way to operate.
"This patient had been hospitalized in the Provincial People's Hospital. He originally planned to have the infected bone segment resection and bone lengthening surgery, but both ends were also infected. It was impossible to cut off the entire femur. How could it be extended after all was cut off? So the doctor The surgery was abandoned and it was recommended to go back to the local hospital for anti-infective treatment.”
The so-called return to the local hospital for anti-infective treatment was just an excuse, and they were unwilling to take over.
Yang Ping said: "If the judgment is correct and there is only focal osteomyelitis, it will be much easier to handle. The infected bone tissue can be completely removed, filled with calcium sulfate containing antibiotics, and then a myocutaneous flap can be made to cover the defective part. , the problem is solved.
Bone lengthening technology, also called bone transport technology, uses the distraction osteogenesis technology of Dr. Ilizalov of the former Soviet Union to lengthen bone tissue.
There was a time when this technology was very popular, and many hospitals used it to perform height-increasing surgeries. Yes, it was the augmentation of Lei Guan'er's broken bones.
Broken bone heightening led to the abuse of technology and many accidents occurred. Later, the Ministry of Health issued an order prohibiting the use of this technology for heightening, and it was only used to treat diseases and correct deformities.
"Director Yang, if it is focal osteomyelitis, how can we explain the image changes in other parts of the body, such as bumps and bumps?"
Director Zeng was very interested in following Yang Ping's ideas, not only in solving problems, but also in the fun and sense of accomplishment brought by this rigorous logical reasoning.
You can still be a doctor! I feel like discussing with Yang Ping like this has improved my clinical thinking by several levels.
Yang Ping went straight to the point: "The changes in other parts are caused by hyperthyroid bone mineral disease. This disease overlaps with osteomyelitis, which makes people think without thinking that the entire femur is infected and there is no way to save it."
Thyroid examinations are not routine in-hospital examinations. When orthopedic patients are hospitalized, thyroid hormones are generally not checked unless there are special circumstances, unless there are symptoms, such as thyroid enlargement.
"Then what should we do?" Director Zeng decided to be more frank and straightforward.
The knowledge is a bit beyond the scope, and it burns your brain!
Yang Ping said: "I just speculate that further tests are needed at present, including blood tests to check thyroid hormones, and more bone punctures to collect bone tissue for bacterial culture."
Medicine is a rigorous science, and you must not make decisions based on your feelings. This will not only fail to cure the disease, but may also cause harm to the patient.
"We will perform multiple puncture points, do bacterial culture, and look at the results. If bacteria are cultured at every puncture point, it means that the femur is widely infected. If bacteria are cultured only at this point and no bacteria are found at other points, then support me. Once the diagnosis is made, we perform surgery to remove the infected bone tissue and make a myocutaneous flap to cover the defect," Yang Ping explained in detail.
Director Zeng said: "Should I make arrangements now to draw his blood on an empty stomach tomorrow morning?"
"We will draw blood on an empty stomach tomorrow morning, and now we will do a bedside bone biopsy to collect bone tissue to culture bacteria." Yang Ping agreed.
It’s not too late, think it over carefully and take action early. Two weeks of procrastination and nothing could be accomplished.
Director Zeng immediately went to the doctor's office, picked up a doctor at random, and prescribed a medical order. Tomorrow morning, he would draw blood on an empty stomach, check thyroid hormones, and do a color ultrasound to see if there were any thyroid nodules or the like.
In the eyes of Director Zeng, Yang Ping is now a great immortal, and he should take advantage of the two weeks he is here to quickly move away the two mountains in Core.
It's not easy to be the head of the department. Every day when I sit in the office and take a sip of tea, I have to see if Teacher Yan is here.
You have to take detours when commuting to and from get off work for fear of being blocked. Although he does not threaten your personal safety, it is annoying. If a person keeps pestering you, you will never have a good life.
This patient has osteomyelitis of the femoral shaft. Although the surgery was not performed here and the family members are polite, they will ask you every now and then: "How is it going? Is the infection under control? Are there any other options?"
I was so overwhelmed with questions that I could only respond perfunctorily: "I'll change the medicine in a few days and see."
But I have to change the dressing every day, and I feel helpless and uncomfortable! Without delay, Director Zeng asked a doctor to prepare a bone puncture kit for bedside bone puncture.
"Shall we go see Teacher Yan again?" Yang Ping thought of going to see him again.
Although we have full confidence, we still need to pay close attention. The human body is complex and medicine itself is not perfect and cannot cope with all changes. This is the uncertainty of treatment.
After general anesthesia, no food or drink was allowed for six hours. Teacher Yan’s son sat beside the bed and moistened his lips with a cotton swab.
"Dad, Director Yang and Director Zeng are here to see you." the old man's son said.
Teacher Yan was sleeping on his side, facing inward, to avoid pressing the surgical site. When he heard Yang Ping coming, he said, "Director Yang, there is no pain at all now, and my whole body is relaxed. Thank you very much."
He fumbled under the pillow with his backhand and took out his notebook: "Give me a pen. Wait a minute. I'll write it down. What time will it be? Director Yang comes in to check the ward. I want to write a letter to thank you. I met you earlier, so I don't have to." After all this trouble, you have pulled out the root of the disease for more than ten years, and I feel so relieved that it is indescribable.”
"Director Yang, which hospital are you from, can you tell me?" Teacher Yan asked.
"Sanbo Hospital in the provincial capital." Yang Ping told him.
"I have written it down. I want to write a letter of praise to your hospital. He is young and promising, and is a pillar of the country." Teacher Yan closed the notebook, and his son took it and stuffed it under the pillow.
After watching Teacher Yan, the bone puncture bag is also ready. This kind of bone puncture is best performed under CT guidance to accurately penetrate the center of the lesion.
But now femoral lesions are diffuse and can be seen everywhere. As long as the puncture reaches the femur, it is considered successful, and the bone tissue suspected of infection happens to be exposed, so look directly at the puncture.
Therefore, this does not require CT guidance and can be punctured directly at the bedside under local anesthesia.
The doctor in charge of the bed communicates well with the patient and signs the informed consent form.
Yang Ping operates it himself, and the entire process is strictly sterile to prevent inaccurate results due to contamination.
Bacterial culture takes several days. After the bone puncture is done, all we have to do is wait for the results.
Zhang Lin was checking the doctors' medical records and instructing them on how to write an excellent medical record. He put a dressing patch on his fingers, and the skin was broken by rubbing his fingers while washing clothes.
The hospital originally bought a washing machine for everyone to use, but many of the doctors were a little germophobic, and more than a dozen batches of people who went to the countryside shared the washing machine. Many of them did not dare to use it, so they washed it by themselves. Anyway, it only lasted two weeks.
"Medical records are the most important test of a doctor's ability!" Zhang Lin spoke in a cadenced manner, with a full teacher's style.
The doctors listening around him were very attentive.
"Look, brother, your medical record is very well written. It has written abnormalities that are difficult for others to find. You are a talented person!" Zhang Lin pointed at the medical record.
Everyone looked closely at the medical records. The brother who was praised was very long-faced.
"Man, the history of menstruation is written so clearly. It's not simple. It took a lot of effort." Zhang Lin tapped his fingers on the table.
Everyone wanted to laugh but didn't dare.
Song Zimo took Xiaowu to have an operation. He had a severed finger replanted. He originally planned to just let go of the finger and just sew it up. He called the operating room and found out that there were microsurgical instruments, needles and threads, and an old microscope, so he decided to do it. The severed finger was replanted.
At noon, I met Director Tian in the canteen. Director Tian said that the weather was nice these days and everyone wanted to go into the mountains to provide free medical services to the villagers.
Before leaving get off work, Yang Ping went to see Teacher Yan again, but there was still no pain.
The biggest fear is rebound. This kind of rebound sometimes lasts for several days. Ordinary patients can just explain a few words, but once this patient rebounds, it is easy to cause misunderstandings.
The system didn't announce the results immediately after the surgery as usual. He was probably waiting for the results. The system was fickle and it wasn't easy to get points from it.
"Director Yang!" Teacher Yan said in a high voice.
"Say!" Yang Ping said.
Teacher Yan said: "I am thinking about writing a thank-you poem!"
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(End of chapter)