After saying that, Teng Guihua realized that something was wrong with her and immediately covered it up: "I'll just ask, ask."
The subtle joy on her face was caught by Yang Ping. Perhaps the physical examination training in the system space made his observation skills stronger than ordinary people.
You read that right, my daughter's condition is getting worse, shouldn't she be anxious, even crying? Why is she still a little happy?
"I'll do it!" Teng Guihua also squeezed to the bedside to help Fang Xiaoyun massage her legs.
Fang Xiaoyun's colleague Chang Juan stepped aside a little and showed a disgusted expression. The weasel was sending New Year greetings to the rooster, which was not a good intention.
But she is Fang Xiaoyun’s mother anyway. She didn’t force money this time, she just came to see her daughter. As a colleague, it’s hard to say anything.
This mom is quite fashionably dressed, has heavy lipstick, and has a pungent perfume that can be smelled through the mask.
There are many rings and bracelets on her hands and necklaces on her neck.
After reading Fang Xiaoyun, Professor Zhang told Yang Ping to observe closely. He also wanted to go to the outpatient clinic. He said that a patient's test results came out and he was very anxious. He had been waiting for him and he would explain it to the patient.
It was already after get off work time, but the old man still went to explain the condition to the patient, which was really tiring.
The old man is eighty and still has no time to spare. The hospital arranged for him to go to the clinic one day a week, but he refused and insisted on going out five days a week.
After Professor Zhang left, Yang Ping retrieved all the case data of Fang Xiaoyun for research.
Any abnormality must have an explanation, otherwise there will be a knot in your heart and you will feel unhappy.
This kind of abnormality would be fine in the eyes of others, but Yang Ping was not willing to let it go easily.
"What? You're not off work yet?" Xiao Su put her bag next to the computer, sat down to accompany Yang Ping, and massaged Yang Ping's shoulders.
The two made an appointment to have dinner together, take a walk after dinner, and play tennis for a while.
"This patient's spinal cord edema continues to not subside, and the peak period lasts too long, which is very abnormal-" Yang Ping explained to Xiao Su.
"Look slowly, I'll accompany you." Xiao Su sat next to her, leaning against her, and kneading Yang Ping's shoulders with her hands.
Doctor, it is very important to have an understanding partner.
Otherwise, a few days of consecutive emergency surgeries can turn the family into a mess.
"Watch the movie carefully and don't worry about me. My father is a doctor and my mother is a nurse. I have been used to it since I was a child." Xiao Su smiled slightly.
Yang Ping looked at each piece one by one, not missing any clues, and carefully inspecting every part.
It doesn't matter if you sacrifice some rest time. It's better if you don't find the problem. If you find the problem, you can deal with it in time. If it is delayed, it will affect the patient's life.
"The spinal cord compression has been completely relieved, there are no signs of embolism in the arteries supplying blood, and the dural veins are slightly thicker than normal."
While Yang Ping was watching, he told Xiao Su that Xiao Su was very interested and he liked to listen to Yang Ping talk about his condition.
The dural veins are slightly thickened. This is Yang Ping's intuitive feeling after watching too many images in the system space.
If blood vessels are slightly thicker or thinner, nothing can be found at all, and even a slight difference cannot explain the problem.
Yang Ping compared the MRI and CT films before surgery, on the first day after surgery, and one week after surgery.
The dural veins in the same part became thicker every time. Although this change was very subtle, Yang Ping still caught it.
Moreover, changes in spinal dural veins are positively correlated with spinal cord edema. The thicker the veins, the more severe the spinal cord edema.
If it weren't for my devilish training in the system space, how could I have seen such an almost negligible change?
Spinal dural arteriovenous fistula?
No way, there are less than 300 cases reported in the world. For such a rare disease to occur at the same time as spinal tuberculosis complicated by paraplegia, and superimposed together, this is the probability of a lightning strike.
However, the more Yang Ping looked at it, the more he pointed to this disease, which was almost certain.
If so, spinal arteriography must be performed as soon as possible. The angiography time is very long and takes several hours.
There are many blood vessels in the spinal cord, and their distribution is very complex. There are bilateral vertebral arteries, common carotid arteries, thyrocervical trunks, costocervical trunks, and 12 pairs of 24 intercostal arteries. These blood vessels may be the site of fistula formation.
During angiography, the X-ray exposure time is long, which is a great test for both the patient and the surgeon.
The most troublesome thing is that because the structure of blood vessels around the spinal cord is complex, perhaps because of inadequate techniques, even if all the above blood vessels are angiographed, the problematic blood vessels cannot be found.
Contrast media also increases the risk of spinal artery embolism, especially the anterior spinal artery that was anastomized in the previous surgery. The condition is complex and multiple conflicting risks are intertwined.
Without the patient's full understanding and cooperation, in this case, the next step of examination and treatment cannot be carried out.
"Dural arteriovenous fistula? Emergency DSA digital subtraction angiography should be arranged immediately." Yang Ping told Xiao Su.
I couldn't eat dinner in the evening, and my walks and tennis were useless.
"What are you eating? Let's order takeout!" Xiao Su was not dissatisfied.
Looking at Yang Ping's attitude, if DSA is diagnosed and emergency surgery is needed, it would be great to do the surgery together!
There was no need to explain, the two of them had a tacit understanding, and Xiao Su immediately went to arrange takeout for dinner.
Everyone was preparing to pack up and get off work. Song Zimo and Tang Fei said hello to Yang Ping and said it was time to get off work.
"Well, after the diagnosis is confirmed, perform surgery immediately and contact the interventional operating room, which should be able to do hybrid surgery."
Yang Ping took the water brought by Xiao Su, and Xiao Su said with a smile: "It seems that everyone can't get off work. I have ordered all the takeaways."
Song Zimo and Tang Fei immediately gave up get off work. Song Zimo handed the backpack to Tang Fei: "Put it away for me. I'll call Fatty Zhang Lin, Xiaowu, and others over. We have work to do tonight. There are less than 300 cases in the world. We stepped on it, is it true or not?"
"Ninety percent of it is true, prepare for DSA and surgery." Yang Ping stood up.
If the two diseases are superimposed and occur at the same time, both can cause spinal cord edema and paraplegia. One disease can mask the other. What a low probability.
Zhang Lin, Xiaowu and Fatty saw that Yang Ping hadn't gotten off work yet, so they didn't dare to get off work on time for fear of being asked to do something.
Several people were "having a meeting" in the duty room. After receiving a call from Song Zimo, they all came out without any delay.
They have no idea about spinal dural arteriovenous fistula and have never heard of it.
At this time, Professor Zhang called with a hurried tone: "Xiao Yang, where are you? I'm going to do a DSA of the spinal arteries on Fang Xiaoyun in the emergency department. It's very likely that there's a spinal dural arteriovenous fistula!"
"I'm making arrangements!"
"I'll be in Corey right away!"
The phone was not hung up in time, and the old lady's voice came from inside: "Hey - I just came back, the food is all ready, go have a bite to eat before you go, maybe take two or three bites to fill your stomach -"
Professor Zhang has rich experience, and he also thought of this rare possibility.
Song Zimo is contacting the interventional operating room. There are several operating rooms that can perform hybrid surgery.
But at night, I don’t know if there are enough people to help do DSA. I need the help of an interventional doctor with very good skills.
Everyone split up. Xiao Su and Zhou Can needed to get the right instruments, prepare microscopes, and determine the interventional surgery room, and send them all there.
After DSA is performed, the diagnosis is confirmed, and the operation is performed directly in the interventional operating room. Sometimes angiography is required during the operation to find vascular fistulas, and post-operative angiography is required to confirm whether the arteriovenous fistulas have been properly treated.
Yang Ping reported to Director Han, and Director Han also said that he would come immediately. He was not worried about Yang Ping's skills, but was giving Yang Ping a platform and taking risks. After all, Yang Ping was the attending physician.
After checking Zhang Lin's informed consent form, making slight modifications, and printing it out, Yang Ping took Zhang Lin to talk to Fang Xiaoyun to obtain her understanding and cooperation.
Teng Guihua is in the ward, and Fang Xiaoyun's colleague Chang Juan is also there. She may be worried that this mother will do something unfavorable to Fang Xiaoyun.
Yang Ping thinks Fang Xiaoyun is fine. This mother may be the biggest obstacle to communication. Fang Xiaoyun is an adult. In order to save trouble, Yang Ping decided to bypass this weird mother.
"I want to talk to the patient now. You go out, Zhang Lin, call the nurse in and take them out." Yang Ping's words are unquestionable.
"I am her mother, there is nothing you can discuss in front of me." Teng Guihua noticed something unusual.
Yang Ping waved his hand: "Go out, didn't you hear clearly? I don't want to waste time. Fang Xiaoyun is an adult and has the ability to act independently. You don't need to be present."
Although these words are crude and direct, it is a waste of time to argue with her at this time.
Chang Juan is more aggressive: "Go out as soon as the doctor says. There is so much nonsense. Xiaoyun, let's go out and listen to the doctor in everything. Don't think too much."
A colleague pushed her mother out, and when the nurse came in, Zhang Lin closed the door and examined the female patient, or if he wanted to talk alone behind the closed door, a third party such as a nurse or female doctor must be present to avoid unnecessary disputes.
"Dr. Yang, what happened?" Fang Xiaoyun asked a little scared.
Yang Ping said calmly: "Fang Xiaoyun, it has been a week since your operation, and the strength of your legs is getting weaker and weaker. This is not normal. We suspect that in addition to spinal tuberculosis, you also have a dural arteriovenous basket. This is a rare condition.
There are currently less than 300 cases of this disease reported in the world. It is very likely that it occurred just after the surgery and became the reason for the worsening paralysis of your lower limbs. I am not 100% sure, but I am 90% sure. Now I need to do a spinal arteriography
, look for each blood vessel one by one, you may find it, or you may not find it. If you find it, operate immediately to take care of it. This time, the operation will be done from behind. Are you willing to believe us and cooperate with us? If so
If this disease is not discovered and treated in time, and time is wasted, it will cause permanent paralysis."
This disease is acute, has a poor prognosis, and causes venous blood stasis, which can cause unrelieved spinal edema and subsequently cause extensive arterial embolism.
"Don't be afraid. You can decide your own affairs. Your body is your own. You don't need to consider other factors." Yang Ping added, his tone was firm but gentle, and he spoke clearly.
Fang Xiaoyun is an ordinary rural girl. Before she graduated from junior high school, she was scolded by her mother to work. She worked as a general worker in a factory. Later, after being introduced by others, she went to a foot bath shop to do foot massage and acupoint massage.
All her money over the years has been used to support her family, and all she bought were cheap clothes. She was reluctant to replace a Redmi mobile phone after using it for several years.
But at the critical moment, the girl had a very clear idea. She thought for a while and nodded: "Dr. Yang, I will listen to you in everything. Thank you for your hard work. I need to check and perform the surgery."
"Just say this. We will make arrangements immediately. I will tell you the details of the operation——."
After speaking and signing, Yang Ping stood up and the nurse opened the door.
I thought it would take a lot of effort to convince Fang Xiaoyun, but I didn't expect it to be easy. This girl understands things very well.
