godfather of surgery

Chapter 622 Patients with Metal Allergy

Before the early shift, August showed up at the doctor's office. He had returned from his personal leave.

To August, the air in China was so sweet and fresh, so strangely luxurious.

The people here are smart and well-spoken.

There are all kinds of things to eat outside, and you can study for three months, and you don’t have to repeat the same food every day.

August's return to the team made Robert less lonely. At least there was someone in the dormitory to talk to, otherwise it wouldn't be a good feeling to watch TV all the time.

Although this guy always likes to put a spine model on the coffee table, and then mutter to himself, and sometimes block Robert's view of watching TV, it's better than watching TV alone eating spicy sticks.

August divided the vacation gift he brought into two parts, one was sent to the nurse's station and the other was placed in the doctor's office.

There are many German snacks in the gift pack, such as chocolate, gummy bears, and various biscuits. In fact, when it comes to food, other countries are not as rich as ours in China. You can take out a lot in any province, and Germany is famous. So a few, such as dark beer, it is impossible to bring a few pieces of dark beer on the plane, so I can only bring some candies and biscuits.

In addition to candy cookies, there are some small gifts.

This guy is still a bit smart, and brought a few bottles of daisy hand cream to the head nurse and the nurses. The old man actually has a warm-hearted thinking. Nurses wash their hands frequently, especially in winter, which can easily cause dry skin, and hand cream is a necessity.

The old man was also very generous as a gift to several doctors in the department. Each of them had a Montblanc pen. It is estimated that when he got off the plane and left the customs, the customs would think that he was bringing goods to the online store.

In fact, the practical and simple gel pen signature pen is used to it, but the fountain pen is not used to it, but in order to force the style, everyone silently pins the pen in the pocket of the white coat, and some people who only wear hand washing clothes also pin the pen in the hand washing clothes pocket.

Compelling this thing, sometimes you still need to pay attention.

"Ordinary people can recognize this brand, right? There are six-pointed stars on it."

Zhang Lin fastened his pen and straightened his chest, feeling that he had stepped up a few grades.

Xiao Wu's words are a bit shocking: "Ordinary people who pay attention to your pen, even if they pay attention, will not recognize the brand."

Doctors and nurses are dizzy all day long, who cares what brand of pen you use.

In order to verify Xiao Wu's words, Zhang Lin took off the pen and ran to the nurse's station.

"Do you know this one?"

Zhang Lin grabbed a nurse and asked, but no one knew him. Zhang Lin was very disappointed, so he thought of a plan, find a small infusion sticker with the word Montblanc written on it, and then wrap it around the end of the pen cap. Down, hang it back to the chest bag.

"Can you see this word?" Zhang Lin puffed up his chest and asked Xiao Wu.

Xiao Wu looked left and right: "Yes!"

"Is it clear?"

"Clear!"

Zhang Lin was finally satisfied.

"Did the pediatrics invite us for a consultation today?"

"Yes, an amniotic band syndrome."

"Leave this consultation to me."

Zhang Lin went to the whiteboard to find the consultation list, picked out the pediatric list, and then looked at the pen on his chest——Montblanc, really exciting.

In the stack of lists, one of the consultation sheets called Yang Ping by name, and Zhang Lin held the consultation sheet: "Is this for the professor?"

"The professor knows. I'll go there after the operation in the afternoon." Song Zimo took the consultation form.

When Yang Ping came in, everyone was eating August's snacks, especially Fatty Liang, who was eating gummy bears. Others ate them one by one, but he tore open the bag and poured the whole bag into his mouth. Feel free to respond.

The doctors in the department all changed to the same type of pens. Yang Ping noticed this detail and found it strange.

Song Zimo stepped forward and hung a pen in Yang Ping's pocket: "Today we will change all our clothes, and yours is a limited edition."

"I don't use a pen!"

Yang Ping didn't know it was a gift from August.

Song Zimo fixed the pen and tidied up the white coat for Yang Ping: "I didn't tell you to use it, just hang it up, it's just the logo of the department."
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The operation schedule was relatively dense all day long, and Yang Ping went to the consultation after the operation in the afternoon.

Song Zimo, Xu Zhiliang, Doctor Luo and Doctor Ao all followed Yang Ping. During working hours, these guys followed Yang Ping like shadows.

According to the consultation form, an old man in his 70s has severe bilateral knee osteoarthritis. The treatment plan of the joint surgery is to perform bilateral artificial knee replacement. However, this old man is allergic to many metals. The joint surgery is cautious. , I did allergy tests for metals such as titanium, chromium, cobalt, nickel, molybdenum, etc., and I was all allergic, so I had to give up artificial joint replacement.

But the children are very filial, and they must think of a way for the doctor. They want the elderly to go out for a walk in their later years and see the great rivers and mountains of the motherland. Director Chang of the Joint Surgery Department asked the subordinate doctor to hire Yang Ping from the General Surgery Department.

When Yang Ping arrived, Director Chang of the Department of Joint Surgery happened to have undergone surgery and was still in the department.

"Professor Yang consulted in person?"

Director Chang shakes hands.

This is no nonsense, the consultation list asked me to consult by name, and also consulted in person?
"Must! Look at the X-ray first." Yang Ping smiled.

Surgeons are straightforward and don't 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-rays.

The electronic screen for professional film reading is a vertical rectangular screen. The patient’s X-ray film appears on the screen, which is very clear. The bilateral knee joints have been varus deformed, the medial joint space is obviously narrowed, the intercondylar ridge hyperplasia, and the bones around the joints are obvious. 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 is aggravated when standing and walking, and can be relieved to a certain extent by rest.

There are two types of knee osteoarthritis, one is secondary and the other is primary.

Secondary generally has a clear reason, such as intra-articular fractures, after fracture malunion, it leads to uneven articular surface, leading to premature wear and degeneration of articular cartilage.

The primary disease is a common disease of the elderly. It can be understood that as the 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, the pain of the knee joint is generally caused by the degeneration of cartilage, while hyperosteogeny rarely causes pain, unless the proliferating bone mass causes impact during joint activities.

Some advertisements on TV often use hyperosteogeny as a tool for intimidation, and there are so many drugs for treating hyperosteogeny.

Because no matter who the old people are, as long as they take X-rays, they will find bone hyperplasia in the lumbar spine and knee joints, so all the old people become targets of intimidation.

Now when the elderly see a doctor, they all know: doctor, I have hyperosteogeny, which is why I have low back pain and knee joint pain. Please help me to prescribe some medicine to treat hyperosteogeny.

The obsession with bone hyperplasia is completely brainwashed by media doctors.

In fact, most bone hyperplasia does not need treatment at all, it is a manifestation of degeneration, such as knee joint pain is mostly not caused by bone hyperplasia, but by cartilage degeneration.

If bone hyperplasia really causes compression of lumbar nerves or knee joint impingement, it cannot be solved by those few pills at this time, and surgical intervention is required at this time.

The "doctor" who advertises medicine on TV, his contribution to medicine will definitely put doctors 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 secular things like the Nobel Prize. If they care about this, I am afraid that all the Nobel Prizes in medicine in the world will be into the hands of this group.

Of course, although they are not interested in the Nobel Prize, they also have something they are interested in, which is the money in the pockets of the majority of middle-aged and elderly friends.

"The patient is allergic to various metals such as titanium, chromium, cobalt, nickel, and molybdenum. I am afraid that artificial joint replacement cannot be done. Let me see if there is any good way." Director Chang is quite embarrassed.

The artificial knee joints currently on the market must contain these metal components. Even if the artificial joints are customized, they cannot escape these metal components. However, there is an option, the all-ceramic knee joint prosthesis is also available, but the technology is immature and the application is seldom .

In fact, there is a formula for how to treat this kind of disease. Director Chang asked Yang Ping for consultation, which is also the wish of the family members, and he will not think there is any new method.

"Both ankles also hurt?" Yang Ping noticed the record in the medical record.

Then I called up the X-rays of the bilateral ankle joints, which also showed the performance of osteoarthritis, but the performance was not very serious.

"Original plan to replace the ankle joint?" Yang Ping asked.

Director Chang looked away: "The original plan was to use conservative treatment for the ankle joint."

Ankle joint replacement is currently immature, and mature artificial joint replacement is hip and knee replacement, so the postoperative effect of ankle joint replacement, especially the long-term effect, is poor.

"Shall we see the patient?"

Let's all go to the ward to see the patient.

The patient is male, 74 years old, with a kind face, lean body, dark skin, and a sense of muscle, giving people a healthy feeling.

There are several family members next to me, all of whom are children. When they saw the doctor coming, they all greeted him politely.

The patient's eyesight and hearing are very good, but he speaks Chongqing dialect and cannot understand Mandarin, so Yang Ping had to rely on the help of his children to complete the medical history inquiry.

The old man used to be in good health, without any chronic diseases such as high blood pressure, but joint pain, both knee joints and ankle joints were painful, but the knee joint pain was more obvious, and the symptoms of the ankle joint were much milder than those of the knee joint.

He has decades of long-term history of lifting heavy objects. He was a "bang bang" in Chongqing. He has great strength and good physical strength. He lifts more than others and walks fast. Send it to college.

After these children graduated one after another, some were admitted as civil servants in Shanghai, some became teachers in City G, and some worked in Tencent, a large Internet company.

These children are very sensible and filial to the elderly. They take turns to pick up the elderly to live in big cities, and accompany their father to travel every year, so that he can enjoy his old age peacefully.

However, the old man is troubled by osteoarthritis in these four major joints, and has been unable to walk for a year. When he was able to walk before, he endured the pain by force.

Several children discussed and asked around, and heard that joint replacement could be used for treatment. It happened that the daughter lived near Sanbo Hospital, so the old man was sent to the hospital to seek treatment.

After asking about the medical history, Yang Ping checked the knee joints on both sides. There was obvious friction sound when moving, and the tenderness in the medial condyle was obvious, indicating that the pain mainly came from the cartilage defect of the medial condyle. In this severe stage, there is no other effective treatment except for artificial joint replacement. method.

Then check the muscle and nerve function, muscle atrophy, but it can be recovered through exercise, this is not a big problem, and there is no problem with the skin feeling, except for the loss of muscle strength caused by atrophy, there is no neurological problem in each muscle.

There is intervertebral disc herniation in the lumbar spine in the auxiliary examination, but there are no obvious neurological symptoms in the lower extremities.

It shows that the effect of artificial knee replacement on this patient will be very good.

"How is it? Professor Yang?" the patient's daughter asked.

The patient has two sons and one daughter. The daughter graduated from graduate school and was admitted to the middle school attached to the G City Normal University as a teacher. The son-in-law is also a teacher in the same unit.

The doctor in charge of the bed had communicated with the family members in advance, and asked Professor Yang from General Surgery to come and have a look.

Yang Ping has not made a clear statement yet: "Because the elderly are allergic to various metals, we have to consider the treatment plan."

"Yes, many hospitals recommend conservative treatment for this reason, but conservative treatment methods have been tried, but they have no effect. There is no way. We bought more than 1 yuan for the capsule on the TV, and it didn't work." The patient's daughter is a teacher, she is more talkative, and her Mandarin is very standard.

Yang Ping frowned. In this case, conservative treatment has no effect, because the cartilage of the medial condyle has been severely worn out, 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 laughed.

"How did you find out that the old man is allergic to metal?" Yang Ping asked.

The patient's daughter said: "One time, I fell and suffered a comminuted fracture of the right distal radius. The doctor said that the articular surface collapsed and surgery was required. Later, a steel plate was installed, but the area around the surgical incision was red and swollen, and it did not heal and leaked. Thinking it was an infection, the doctor took the liquid to incubate the bacteria. After several times of incubation, there were no bacteria. Then they took X-rays and found that the bone around the screw had absorbed, but they couldn’t find the reason. Later, they said that they were considering metal allergies and had to take out the steel plate. After taking it out, The doctor said that the soft tissue around the nail hole and the steel plate was black, and I still have photos.”

The patient's daughter flips through the photos on her phone.

Yang Ping looked at the photo, combined with his previous medical history, it was indeed a metal allergy, but he did not expect to be allergic to so many metals, but he was also allergic to titanium.

However, some problems in clinical practice are all kinds of strange things, such as allergies, allergens are even more strange.

For example, if a woman is allergic to her boyfriend’s sperm, there’s nothing she can do about it. It’s very difficult to become a husband and wife. If it’s mild, you’ll get hives afterwards. If the allergy is severe, just one love affair may cause throat edema, breathing difficulties, and life-threatening.

There are also allergies to electromagnetic radiation, such as allergies to WIFI.

Some are allergic to coins, some are allergic to banknotes, etc. Doctors who specialize in allergies in dermatology have a deep understanding.

"We'll discuss it before we reply." Yang Ping replied to the patient's daughter.

(End of this chapter)