"Can this be used as a vascular stent? The expert diagnosis of the Provincial People's Hospital is the same as yours, saying that it is chronic arterial ischemia. I went to a very professional medical website to check the treatment of this disease, if the blood is not smooth due to narrowing or blockage of blood vessels, you can do a very small minimally invasive surgery, and put a stent in the blood vessel to open it. ”

As soon as the old cadre's daughter-in-law said this, Zhou Can finally understood why the Provincial People's Hospital did not operate on the patient.

Even Zhou Can was instructed by his family on how to treat his illness, and he was very disgusted when he heard it, the experts of the Provincial People's Hospital, which one is not a well-known figure in the medical field? was directed by a family member who thought he knew very well, looked up a little information on the Internet, and blindly commanded.

Experts are unable to refute this woman's identity in person.

The best thing to do is to deal with it softly.

Continue to treat the veteran cadres according to the treatment methods that have been tried in the previous hospital and proved to be ineffective.

The old cadres looked at it, ah, they thought that the experts of the Provincial People's Hospital were so powerful, and they were no different from the doctors of the prefecture-level city hospitals! Or anti-infective therapy, will that work?

As long as the old cadres are not stupid, they promise to change hospitals obediently.

If the experts from the Provincial People's Hospital mention it in a more serious tone, we can't be sure of your disease, so you can amputate it first.

It is guaranteed that the old cadres will be frightened overnight and ask for a transfer overnight.

Sometimes, patients and their families feel that the level of a certain specialist is poor, maybe they are not really bad, but they are deliberately 'messing' to make you think that he is poor.

"This kind of stent is generally rare. I recommend doing an angiogram first. Because your father-in-law is older and has no history of smoking, the possibility of arteriosclerotic occlusion may be considered. ”

Zhou Can glanced at the woman lightly, and patiently explained.

Unlike myocardial infarction, this kind of chronic arterial ischemia of the limb is usually caused by a large plaque in the blood vessel that blocks the blood vessel.

Hardening of the arteries causes the lining of blood vessels to shrink and eventually become completely blocked.

"We agree that if the problem is found, we still hope to avoid large-scale surgery as much as possible, and hope to use the treatment plan given by experts after online consultation, with minimally invasive interventional surgery and stent placement to solve the problem."

The female is quite stubborn.

In fact, it is common to encounter such family members or patients in clinical practice, who only believe in the conclusions obtained by acquaintances, online 'experts', and Baidu searches. They don't want to trust the doctors who treat them.

What's even more terrifying is that the attending doctor told them that they couldn't trust the Internet and that they would treat them according to the method I said, but the family not only didn't listen, but thought that the doctor was trying to cheat him for money.

The only way to meet such family members and patients is to ask them to go to that acquaintance for treatment.

Zhou Can stood up and glanced at Director Xueyan.

The latter winked at him with a vague wry smile.

If it weren't for the presence of her family and patients, she would probably have shrugged her shoulders and showed a helpless expression.

"Then you guys think about it again, and if you agree, you can do an angiogram first. The patient's condition is progressing every day, and the early treatment and early benefit. After a long delay, amputation should be the last option. ”

Zhou Can can only talk about this.

If the family and the patient don't listen, he can't do anything.

Doctors can only give the treatment plan that they think is most beneficial to the patient, and the patient can only choose what to do in the end.

"Dr. Zhou is right, my disease cannot be postponed any longer. Listen to you, I'm willing to listen to you, can you arrange for an angiogram now? You can rest assured, you don't have to think about money, as long as it can cure the disease, I don't care how much it costs. ”

In the end, veteran cadres are people who have been in officialdom for a long time and have rich experience.

He had already sensed a hint from the expressions of Zhou Can and Director Xueyan, and when he heard that he was going to have his leg amputated after a long time, this statement was exactly the same as the statement of the experts of the Provincial People's Hospital.

His heart was filled with fear.

There must be a law for a man with a large mouth, and there must be a law for a woman with a large mouth.

This daughter-in-law's filial piety is filial piety, but she is a little too strong.

It is normal for doctors to be disgusted if they have to let the hospital treat her according to her requirements.

If you say, what happened at the Provincial People's Hospital is a bit weird.

So at this moment, when they go to Tuya Hospital, if they can't change some of their concepts on their own, they are likely to encounter 'quacks' again.

"Dad, don't worry. A friend of mine who is a doctor told me that doctors like to make things worse. If you can't cure it, it's because the patient's condition is too serious, and the doctor has done his best. ”

The woman leaned into the old cadre's ear and whispered.

"Listen to me, let's discuss the treatment plan with the doctor."

She has a caring face that she is worried that her father-in-law is old, does not understand the sinister society, and is easy to be deceived.

After hearing this, the old cadre raised his head and said to Zhou Can and Director Xueyan, "It's okay, please arrange it for me as soon as possible, the sooner the better." After saying that, he turned to look at his son and daughter-in-law.

"It's not too early, go back! There's a nurse to take care of it anyway. When the time comes, the operation will be signed, and I will look for you again. ”

"Ah Fen, then let's go back first!"

The son of the old cadre said to his daughter-in-law.

"Dad, if the test results come out, you must tell us in time! When the time comes, you will wait for us. ”

The daughter-in-law was still full of unease.

"I have a sense of proportion, go back! Take care of your mom. ”

The old cadre waved at his son and daughter-in-law.

It's almost like rushing the two of them home.

Zhou Can saw all this in his eyes, and secretly said in his heart that big people are really different from ordinary people. After all, he relied on his own efforts to climb up step by step, and his reaction ability was quite strong.

Judging from the performance of this veteran cadre, most of them have already realized what the problem is.

Since this person was a key patient personally explained by Dean Zhu, an angiogram was arranged for him overnight.

Unlike cerebral angiography and cardiovascular angiography, angiography of the extremities is relatively less risky. It's also easier to implement.

However, the necessary preparations must not be missing.

In the office, Zhou Can shook his head, "Sister Yan, should we first give this old cadre a plain X-ray examination, and then do an arterial angiogram?" ”

This allows for more targeting.

X-rays may detect plaque calcification in the arteries.

Eventually, though, an arteriography will definitely be needed.

This is because angiography can determine the location and extent of the blockage of the artery.

For example, are the arteries twisted? Diffuse irregular narrowing of the lumen, or segmental occlusion.

Only by ascertaining the specific conditions inside the blood vessels can the most favorable surgical plan be formulated.

This case is not complicated.

It's the patient's daughter-in-law who gets really tricky.

There are too many things to do, and it is inevitable that doctors have great concerns.

Originally, plain X-ray examination should have been done in the Provincial People's Hospital, but people were stunned that this examination was not done.

Even one more test can create an extra income for the hospital.

But other doctors would rather not make this money.

Doctors are paid, and when they encounter a lot of patients, they really don't care about treating one more or one less.

In order to treat one more patient, but the family and the patient complained, and even violently went to court, all kinds of personal threats, it is better to have one less thing.

Director Xue Yan had no objection to Zhou Can's inspection plan.

Happily nodded in agreement.

"This patient is still very good, but the daughter-in-law has too many things. His wife is even more of a sentence with 800 hearts. I was sick at the time. Fortunately, his wife has high blood pressure and heart disease, so she is not suitable for staying in the hospital for a long time, so she went back. ”

After hearing this, Zhou Can couldn't help but shudder.

The daughter-in-law of an old cadre alone is enough to make people unbearable, and if the patient's wife is even more severe, this disease is really not under the law.

"At that time, the family will need to sign before the operation, so how to get it? If you don't have a soft knife to persuade the patient to transfer to the hospital, forget it. Cardiothoracic surgery is very busy right now, and it is not possible to occupy too many medical resources because of such a large number of patients. ”

Zhou Can proposed.

"Let's see what happens! When the time comes, it will be impossible to find a way to transfer the patient to the hospital. ”

Director Xueyan was still soft-hearted after all.

Women, soft-heartedness is a common problem.

Encountering a vicious woman with a ruthless heart is a nightmare for all men.

……

By the time Zhou Can came out after two surgeries in the cardiothoracic surgery, it was already twelve o'clock in the evening.

Nowadays, the major surgeries I receive are super difficult, and the operation time is often three or four hours, or even longer.

Zhou Can felt more and more that time was running out.

There are too many high-precision surgeries in cardiothoracic surgery, and many of them are big projects.

Sometimes, extreme care is required to anastomosmoses a blood vessel, or to cut out a tumor, or to repair a mitral valve. And do a lot of auxiliary work for the smooth implementation of the operation.

In order to remove a tumor, it is necessary not only to open the chest, but also to remove the pericardium, and even establish cardiopulmonary bypass, and the heart stops beating.

These preparations are indispensable.

And every step is walking on the tip of a knife, so you have to be extra careful.

After dragging his tired body out of the operating room, Zhou Can now just wants to go home and take a shower and sleep.

I was thinking that I would be able to leave work early and go home to write my thesis.

I can't do anything now.

After surviving this period of time, he will definitely think of some ways to squeeze out time for studying, improving his academic qualifications and academic level as much as possible.

Because many old-timers have used the lessons of blood to tell him that academic qualifications are too important.

"Zhou Can, the two inspection results of that old cadre have come out. I know you're a busy man, why don't you help him read the test results before leaving? After Director Xueyan took the examination report from the doctor in charge of the bed, he stopped Zhou Can.

If you don't ask Zhou Can to help the staff now, I'm afraid you will have to wait until after seven o'clock in the afternoon tomorrow.

"Okay!"

Zhou Can did not refuse.

After receiving the inspection report, he stared at the dim light of the corridor and looked at it carefully.

"Hey, I did one more color ultrasound check, which is good!"

Zhou Can found that in addition to plain X-ray examination and arterial angiography, color ultrasound examination was also done.

"At that time, after the results of the examination came out, I looked at it and found that the patient's popliteal artery and iliac artery were stenosis, so I took it upon myself to apply for a color ultrasound examination."

The doctor in charge is a young doctor in his thirties, and he is currently at the attending level.

Most of the newly recruited doctors in the Department of Cardiothoracic Surgery have doctoral degrees, and some are even postdoctoral fellows.

These people have a very big advantage, working for a year and being promoted directly to the director.

In terms of rank promotion, compared with doctors with ordinary academic qualifications, they are simply riding rockets.

"It's good, you should be flexible."

Zhou Can nodded, appreciating the self-assertion of the bed-managing doctor.

In clinical diagnosis and treatment, the patient's situation is ever-changing, and the doctor needs to adapt to the situation. If you are the kind of dull doctor, you are actually not suitable for clinical front-line work.

It is a good choice to work in an administrative position or in a medical and technical department.

Of course, there is a possibility that many more will eventually be forced to change careers.

After Zhou Can carefully reviewed the patient's three examination reports, he already had a bottom in his heart.

Color Doppler ultrasound showed that the patient's abdominal aorta, iliac artery, and popliteal artery all showed significant stenosis. Among them, the abdominal aorta is also narrow, which Zhou Can did not expect.

This also shows that his diagnostic skills are far from being at the top.

Of course, even the world's top experts cannot diagnose some hidden lesions in patients by palpation and some simple auxiliary tests.

Zhou Can can detect the presence of lesions in the patient's popliteal artery and even the iliac artery only through palpation, which is already very powerful.

The ultrasound results also showed that there was no blood flow signal below the superficial femoral artery on the patient's right side.

No wonder the pulsation of the popliteal artery and dorsalis pedis artery is not felt in the right foot.

Then look at the patient's imaging results.

Extensive irregular stenosis of the abdominal aorta and bilateral iliac arteries, with the right common femoral artery visible but not the superficial femoral artery.

The imaging results were basically consistent with the results of color ultrasound.

"Judging from the examination results, the patient's right superficial femoral artery sclerotic occlusion can be basically confirmed."

After reading the inspection report, Zhou Can gave a diagnostic opinion.

In fact, the doctors present can basically give a diagnosis based on these examinations.

What Director Xueyan and the doctor in charge of the bed are really looking forward to is that Zhou Can will give a treatment plan.

"Zhou Can, can you give me a surgical plan now? Or you can go home with the test results and give me a surgery plan tomorrow morning. ”

Director Xue Yan did not hide it in front of other doctors and nurses in the department, and she liked to listen to Zhou Can's opinions on the surgical plans of some key patients.

"I'd better give it now! The examination materials are kept in the department, which can also be used as a reference for other doctors. ”

Zhou Can felt that the patient's condition was not particularly complicated.

The surgical plan is also not particularly difficult.

"The patient's imaging results showed contrast in the right deep femoral artery and the right popliteal artery above the knee joint, indicating that there is still a blood outflow channel in the arteries of the lower extremities. The presence of crackles on auscultation of the patient's lungs indicates that there may be a lung infection, and if surgery is desired, it may be necessary to control the patient's lung infection with medication before surgery. As for the surgical option, I think that bypassing the right common femoral artery with the popliteal artery will help the patient to regain blood circulation in the right leg. ”

There are many factors that need to be considered for surgery.

Lung infections, especially in such elderly patients, will definitely need to be controlled before surgery.

(End of chapter)