Chapter 622 Patients with metal allergies
Before the morning shift, August showed up at the doctor's office. He had returned from personal leave.
To August, the air in China was so sweet and fresh, with a strange luxury.
The people here are smart and well-spoken.
There are all kinds of things to eat outside, and after three months of training, you don’t have to eat the same thing every day.
August's return made Robert no longer so lonely. At least he had someone to talk to in the dormitory, otherwise it would be unpleasant to watch TV all the time.
Although this guy always likes to put a spinal model on the coffee table, and then talk to himself ecstatically, and sometimes blocks Robert's view of watching TV, but it is still better than eating spicy strips and watching TV alone.
August divided the vacation gift he brought into two parts, one to the nurse's station and one to the doctor's office.
The gift package contains a lot of German snacks, such as chocolates, gummy bears, and various biscuits. In fact, when it comes to food, no other country has as much food as we do in China. Any province can provide a lot of it, and Germany is famous for it. So few, such as dark beer, it is impossible to bring a few pieces of dark beer on a plane, so I can only bring some candies and cookies.
In addition to candies and cookies, there are also some small gifts.
This guy still has some brains and brought several bottles of Daisy hand cream to the head nurse and the nurses. The old man actually still has the mentality of a warm man. Nurses wash their hands frequently, especially in winter, which can easily cause dry skin, so hand cream is a necessity.
The old man was also very generous in giving gifts to several doctors in the department, including a Montblanc pen for each person. It is estimated that when he got off the plane and went out of customs, the customs would think that he was bringing goods to the online store.
In fact, I am used to using simple gel pens and rollers, but I am not used to pens. However, in order to show off, everyone silently pinned the pens in the pockets of their white coats. Some people who only wore hand-washing clothes also pinned the pens to the pockets of their white coats. pocket.
Sometimes you still have to pay attention to the cool stuff.
"Can most people recognize this brand? There is a six-pointed star on it."
Zhang Lin put on his pen and straightened his chest, feeling that he had risen a few levels.
Xiaowu’s words were a bit shocking: “If most people pay attention to your pen, even if they do, they won’t recognize the brand.”
Doctors and nurses are so busy all day, who cares what brand of pen you use.
In order to verify Xiao Wu's words, Zhang Lin took off his pen and ran to the nurse's station.
"Do you recognize this amount?"
Zhang Lin grabbed a nurse and asked, but no one knew him. Zhang Lin was very disappointed, so he came up with a plan. He found a small infusion patch, wrote the word Montblanc on it, and then circled the end of the pen cap and posted it. down, and hang the bag back on the chest.
"Can you see this word?" Zhang Lin straightened his chest and asked Xiao Wu.
Xiaowu looked left and right: "Yes!"
"Is it clear?"
"Clear!"
Zhang Lin was finally satisfied.
"Has the pediatrician invited us for consultation today?"
"Yes, one with amniotic band syndrome."
"Leave this consultation to me."
Zhang Lin went to the whiteboard to look for consultation sheets, picked out the list for pediatrics, and then looked at the pen on his chest - Montblanc, so exciting.
Among the stack of lists, one of the consultation sheets named Yang Ping. Zhang Lin took the consultation sheet and asked: "Is this for the professor?"
"Professor knows, come over after the operation in the afternoon." Song Zimo took the consultation form.
Yang Ping came in. Everyone was eating August's snacks, especially Fatty Liang, who was eating gummy bears. Others were eating them one by one, but he tore open the bag, raised his head and poured the whole bag into his mouth. Yang Ping saw that Peace of mind.
The doctors in the department all used the same pen. Yang Ping noticed this detail and found it strange.
Song Zimo stepped forward and put a pen in Yang Ping's pocket: "Today, we will all change our clothes. Yours is a limited edition."
"I don't use a pen!"
Yang Ping didn’t know that this was August’s gift.
Song Zimo put on the pen and arranged Yang Ping's white coat: "I didn't tell you to use it, just hang it up. It's just the logo of the department."
——
There was a tight schedule of surgeries throughout the day. After the surgery in the afternoon, Yang Ping went for consultation.
Song Zimo, Xu Zhiliang, Dr. Luo and Dr. Ao all followed Yang Ping. During work hours, these guys followed Yang Ping like shadows.
Judging from the consultation sheet, an old man in his seventies has severe osteoarthritis on both knees. The treatment plan for joint surgery is bilateral artificial knee joint replacement. However, this old man is allergic to many metals. The joint surgery plan is to I was cautious and did allergy tests to titanium, chromium, cobalt, nickel, molybdenum and other metals. All of them were allergic, so I had to give up the artificial joint replacement.
However, the children were very filial, so the doctor had to find a way. They wanted the old man to go out for a walk in his later years and see the great places of the motherland. Director Chang of the Joint Surgery Department asked the subordinate doctor to ask Yang Ping of the General Surgery Department.
When Yang Ping arrived, Director Chang of the Joint Surgery Department happened to have already performed the operation and was still in the department.
"Professor Yang will conduct consultation in person?"
Director Chang shook hands.
This is no nonsense. I was named on the consultation sheet for consultation, but you also consulted me in person?
"Must! Watch the X-ray first." Yang Ping smiled.
Surgeons are very direct and do not waste time. Director Chang arranged for Yang Ping to sit down, and the doctor in charge of the bed immediately ran over to help adjust the X-ray.
The electronic screen for professional reading is a vertical rectangular screen. The patient's X-ray appears on the screen very clearly. The bilateral knee joints have become varus deformed, the medial joint space has significantly narrowed, the intercondylar ridge has hyperplasia, and there are obvious bones around the joints. hyperplasia, which is typical of bilateral knee osteoarthritis.
Knee osteoarthritis is a knee joint disease characterized by knee cartilage degeneration and secondary bone hyperplasia.
The main symptom is knee joint pain, which worsens when standing and walking, and can be relieved to a certain extent by resting.
There are two types of knee osteoarthritis, one is secondary and the other is primary.
Secondary cases generally have clear causes, such as intra-articular fractures. After the fracture malunion heals, the joint surface is uneven, leading to premature wear and degeneration of articular cartilage.
Primary disease is a common disease in the elderly. It can be understood that as age increases, the cartilage of the knee joint will wear out like a car tire. Once the cartilage wears out, it will cause a series of symptoms. In this disease, knee joint pain is usually caused by cartilage degeneration, while bone hyperplasia generally rarely causes pain unless the hyperplasia of bone causes impact during joint movement.
Certain advertisements on TV often use bone hyperplasia as a threat, and there are a myriad of drugs for treating bone hyperplasia.
Because no matter who the elderly are, as long as they take X-rays, bone hyperplasia will be found in the lumbar spine and knee joints, making all elderly people the target of intimidation.
Nowadays, when the elderly see a doctor, they all know: Doctor, I have bone hyperplasia, which causes low back pain and knee joint pain. Please prescribe some medicine to treat bone hyperplasia.
The obsession with bone hyperplasia is entirely due to the propaganda and brainwashing by doctors in the media.
In fact, most bone hyperplasia does not require treatment at all. It is a manifestation of degeneration. For example, most knee joint pain is not caused by bone hyperplasia, but by cartilage degeneration.
If bone hyperplasia really causes compression of the lumbar nerves or impact of the knee joint, it cannot be solved by a few pills, and surgical intervention is required.
The contributions of “doctors” who make medical advertisements on TV will definitely put doctors from all over the world to shame.
If you pay a little attention, you will find that many medical problems in the world have been overcome by them, but they hide it from the people and disdain worldly things such as the Nobel Prize. If they care about this, I am afraid that all the Nobel Prizes in medicine in the world will be lost. fell into the hands of this group.
Of course, although they are not interested in the Nobel Prize, they are also interested in something, which is the money in the pockets of their middle-aged and elderly friends.
"The patient is allergic to titanium, chromium, cobalt, nickel, molybdenum and other metals. I'm afraid artificial joint replacement cannot be done. Let's see if there is any good method." Director Chang was in a dilemma.
The artificial knee joints on the market today definitely contain these metal components. Even if the artificial joint is customized, it cannot escape these metal components. However, there is an option. All-ceramic knee prostheses are also available, but the technology is immature and has few applications. .
In fact, there are procedures for how to treat this kind of disease. Director Chang asked Yang Ping for consultation, which fulfilled the family's wish and did not think there was any new method.
"Both ankle joints also hurt?" Yang Ping noticed the record in the medical record.
Then he called up X-rays of both ankle joints, which also showed signs of osteoarthritis, but the symptoms were not very serious.
"The original plan was to replace the ankle joint?" Yang Ping asked.
Director Chang nodded: "The original plan was to adopt conservative treatment for the ankle joint."
Ankle artificial joint replacement is currently immature. Mature artificial joint replacements are hip and knee replacements. Therefore, the postoperative effects of ankle joint replacement, especially the long-term effects, are poor.
"Let's go see the patient?"
Let's all go to the ward to see the patients.
The patient is a seventy-four-year-old male with a kind face, lean body, dark skin, and muscles, giving him a healthy feeling.
There were several family members nearby, all children. When they saw the doctor coming, they all greeted him politely.
The patient's vision and hearing were very good, but he spoke Chongqing dialect and could not understand Mandarin. Yang Ping had to use the help of his children to complete the medical history inquiry.
The old man used to be in good health and had no chronic diseases such as high blood pressure. He only had joint pain, pain in both knees and ankles, but the pain in the knee joints was more obvious, and the symptoms in the ankle joints were much milder than those in the knee joints.
He has a history of carrying heavy objects for decades and works as a "bangbang" in Chongqing. He is strong and has good stamina. He can carry more things than others and walk faster. He can carry all three children with just one pole. Send to college.
After these children graduated one after another, some became civil servants in Shanghai, some worked as teachers in G City, and some worked at Tencent, a large Internet company, which were all pretty good.
These children are very sensible and filial to the elderly. They take turns taking the elderly to live in big cities. They travel with their father every year so that he can enjoy his old age in peace.
However, the old man suffered from osteoarthritis in these four large joints and has been unable to walk for a year. When he could walk before, he had to endure the pain.
Several children discussed and asked around, and heard that joint replacement treatment was possible. It happened that their daughter lived near Sanbo Hospital, so they sent the old man to the hospital for treatment.
After Yang Ping asked about the medical history, he checked both knee joints. There was obvious friction sound when moving, and there was obvious tenderness at the medial condyle, indicating that the pain mainly came from the cartilage defect of the medial condyle. At this severe stage, there is no other effective method except artificial joint replacement. method.
Then check the muscle and nerve function. There is muscle atrophy, but it can be recovered through exercise. This is not a big problem. There is no problem with the skin. Apart from the loss of muscle strength caused by atrophy of each muscle, there are no neurological problems.
Auxiliary examination showed that there was a herniated disc in the lumbar spine, but there were currently no obvious neurological symptoms in the lower limbs.
This shows that the effect of artificial knee replacement for this patient will be very good.
"How is it? Professor Yang?" asked the patient's daughter.
The patient has two sons and a daughter. The daughter graduated from graduate school and was admitted to the high school affiliated to G City Normal University as a teacher. Her son-in-law is also a teacher in the same unit.
The doctor in charge of the bed had communicated with the family beforehand and asked Professor Yang from the Department of General Surgery to come over and take a look.
Yang Ping did not make a clear statement for the time being: "Because the elderly are allergic to many metals, we have to consider the treatment plan."
"Yes, many hospitals recommend conservative treatment for this reason, but I have tried all methods of conservative treatment, but it has no effect. There is nothing we can do. We bought more than 10,000 yuan for the capsule on the TV, but it has no use." The patient's daughter is a teacher, relatively talkative, and speaks very standard Mandarin.
Yang Ping frowned. In this case, conservative treatment has no effect because the medial condylar cartilage has been severely worn, the medial joint space is severely narrowed, and the alignment of the lower limbs has also changed.
The old man watched the conversation between the doctor and his daughter and just smiled.
"How did you find out that the old man was allergic to metal?" Yang Ping asked.
The patient's daughter said: "I fell down once and suffered a comminuted fracture of the distal end of the right radius. The doctor said that the joint surface collapsed and required surgery. Later, a steel plate was installed. However, the area around the surgical incision was red and swollen after the operation, and it never healed and leaked fluid. At that time, Thinking that there was an infection, the doctor took some liquid and cultured bacteria. After culturing for several times, the bacteria were gone. Then they took X-rays and found that the bone around the screws was resorbed, but they couldn't find the cause. Later, they said that they were considering metal allergies and needed to take out the steel plate. After taking it out, The doctor said that the nail holes and the soft tissue around the steel plate were black. I still have pictures.”
The patient's daughter flipped through photos on her phone.
Yang Ping looked at the photo, and combined with his previous medical history, it was indeed consistent with metal allergies, but he didn't expect to be allergic to so many metals, including titanium.
However, some problems in clinical practice are all kinds of strange. For things like allergies, allergens are even more strange.
For example, there is a woman who is allergic to her boyfriend's sperm. There is nothing she can do about it. It is very difficult to become a couple. If the allergy is mild, she will develop urticaria afterwards. If the allergy is serious, one love session may cause laryngeal edema, causing difficulty in breathing, which is life-threatening.
There are also allergies to electromagnetic radiation, such as allergies to WIFI.
Some people are allergic to coins, some are allergic to banknotes, etc. Dermatologists who specialize in allergies know this well.
"We will discuss it before replying to you." Yang Ping replied to the patient's daughter.
(End of chapter)