For this gout patient, should he have surgery or not? If so, what kind of surgery should he choose?
The doctors in the department are very conflicted. The gout has reached this stage and is at the end of its rope. No one can come up with any good solutions.
The patient visited many hospitals. Huge gouty nodules ruptured on both ankle joints, and "lime"-like substances continued to be discharged. The wounds became larger and deeper, mixed with various drug-resistant bacteria, and could not be cured after a long period of treatment.
The distal end of the tibia and fibula, talus, and calcaneus on the side have been exposed and partially necrotic, forming chronic osteomyelitis.
This kind of wound has almost no chance of healing.
In fact, this is also the case. These wounds have been through the efforts of many hospitals, including debridement, negative pressure suction, etc., and various surgeries, but to no avail.
The doctors in each hospital just shook their heads: the only solution was amputation! And they suggested going to a better hospital for surgery.
Where is the better hospital? The patients’ families don’t know.
Because the patient's bilateral lower limbs are already filled with uric acid crystals, after amputation, the stump faces a very high risk of non-healing. Once it does not heal, new chronic wounds will form.
Money has been spent, the disease has not been cured, and both legs are missing. If the family members do not understand and struggle, the doctor will be trapped in a quagmire, overwhelmed and unable to extricate himself.
Therefore, the best way is---don't touch it!
Don’t touch, just walk around!
Nothing happens like this. Over the years, doctors have become less courageous. "Besides amputation, is there any other way?" Song Zimo broke the silence.
Yang Ping shook his head: "Amputation is the best way for him."
Cut off both lower limbs above the ulcerated wound and at the level of the calf.
Although the stump may not heal, that is only a possibility, and now, the chronic wounds of the bilateral ankle joints have no chance of healing at all.
"Don't be so depressed, everyone. For many patients, amputation is a constructive surgery, not a destructive surgery. Amputation can bring patients from darkness to light!"
Because, after amputation, if the stump heals well, a prosthesis can be installed to restore normal walking function, so that the patient can return to society.
Because lower limb prostheses are very developed, modern medicine has revolutionized the concept of lower limb amputation.
Amputation---sometimes it is a constructive operation that brings hope, light and light.
Some serious lower limb injuries require long-term treatment and repeated operations, which consume a lot of time, energy and money. The function of the finally saved limbs is very poor and cannot be compared with prostheses.
Such limb salvage is a kind of devastation to the patient and an ineffective treatment plan; at this time, amputation is a reconstructive surgery, amputating the useless limb, installing a prosthetic limb, restoring normal walking function, and helping the patient quickly run towards the goal.
A normal sunny life.
"I agree! Chronic osteomyelitis has formed in the bilateral ankle joints. Continuing treatment will only waste time and money. Amputate both lower limbs at the lower third of the calf. If the stumps do not heal, continue to raise the amputation level again.
Amputation, until healing, other gouty nodules can be carefully removed. For the patient, the goal is to return to a normal life. If a prosthesis can end the current bad life and allow him to become a normal person again, why is amputation so important?
Horrible." Song Zimo agreed very much with Yang Ping's opinion.
Especially what Yang Ping said: Sometimes, amputation is a constructive surgery, not a destructive surgery. Amputation can bring the patient from darkness to light!
Others seem to have no better method. The disease has reached the end of the road and there are not many methods to choose from.
The treatment plan was decided in this way. When the patient's daughter heard the news in the consultation room, she was very disappointed.
She thought that when she came here, there would be a better way, a different way.
"The method that is most beneficial to him is the best method. This method is not necessarily the latest or the most expensive. Most treatment methods are ordinary methods!" Yang Ping saw her disappointment and asked her
Explain patiently.
"Amputation, if successful, can end his current dark life. With prosthetic limbs installed, he can walk normally as before."
Yang Ping said with confidence.
The patient's daughter was tempted, and other hospitals also told her, but the doctors were unwilling to undertake the operation.
Yang Ping actually saw the problem. The patient's daughter had taken care of her father for too long, and she also knew some knowledge about her father's condition, so she repeatedly questioned the doctor's treatment details and even questioned every medication.
This can easily give the doctor the impression that she doesn't trust the doctor.
Since there is no trust, the doctor is certainly not willing to take risks and does not perform this operation. No matter from the legal or moral perspective, the doctor does not have to bear any responsibility. On the contrary, if it is performed, if it fails, the doctor may face endless troubles.
"Is the success rate of surgery high?"
The patient’s daughter’s biggest concern.
"It is difficult to say the specific success rate. His condition is special and there are no similar statistics. If we have to say the success rate, it is 50% to 50%. If it fails, the amputation stump will not heal and form a new difficult-to-heal wound. Let's try again.
Amputate once and raise the plane." Yang Ping explained the remedy plan for failed surgery.
The patient's daughter was very embarrassed: "How many times do you have to do this? Don't you have some confidence?"
The implication is, are doctors unsure of what they do?
"No one is sure, no one is sure! His current condition and condition have determined that this is an uncertain operation, not because the doctor is not technically sure, or because his body has reached a point where he is not sure about healing. This outcome is
His body determines whether he succeeds or not. The initiative is not with me, but with him. I can only do my best to do what I do." Yang Ping said matter-of-factly.
Although these words don’t sound good, they are true and candid.
The patient's daughter's face was filled with anxiety and hesitation. She thought for a moment and said: "If the operation fails, will there be a charge for the failed operation? Is it free?"
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I didn’t expect patients to ask such questions.
Yang Ping said seriously: "Every operation, regardless of success or failure, will be charged."
"It's unreasonable to charge for a failed surgery. I go to the store to buy something. If it's broken and can't be used, I can return it for a refund or exchange it for a new one. Likewise, I paid for the medical expenses, but no
If the expected purpose is achieved, why are there still charges? That is, if the thing is not completed, the money will still be collected?" The patient's daughter mustered up the courage to speak out.
Yang Ping was not angry either: "Treating diseases and saving people cannot be compared with commodity trading. You have used the wrong metaphor. If you follow this logic and you think this is a commodity transaction, I refuse to provide you with medical services now, which means I refuse to sell."
This product, for you, I want to remove this product from the shelves, is that okay?"
The patient's daughter's face turned red and white, and she was speechless for a while.
"The human body is very complex. All treatment effects are statistical and cannot be guaranteed to be 100%. This is the characteristic of medicine. If you follow your logic, I will tell you very frankly - no doctor is willing to operate on your father.
, including me!" Yang Ping must tell him this truth.
There are some things that must be sorted out before surgery, otherwise it is easy to get into a quagmire after surgery.
"To be honest, Dr. Yang, although my father has medical insurance, the long-term treatment has put a heavy financial burden on us. Several elderly people in the family are overwhelmed." The patient's daughter told the truth.
Yang Ping was also helpless: "I sympathize with you, but I am just a doctor. We really can't help you financially. We can only try our best to help you save hospitalization expenses. If you are indeed a poor household, we will help you fight for it."
Some charitable relief. If you are willing to bear the risk of surgery with me, I will do my best. If you are unwilling to bear the risk, or think that all risks must be borne by the doctor, then it can only be a pity that I cannot bear all."
In the face of risks, doctors can only act rationally. If patients and their families insist on not wanting to take risks, no one can force others to make a choice.
The choice lies with the patient, and the doctor can only help him make the choice.
"Let me think about it. Is there any other way? More conservative?" The patient's daughter was still hesitant.
Yang Ping shook his head: "There are only two options at present, either to maintain the status quo, or to amputate, challenge risks, and pursue a normal life."
Many times, money affects decisions!
Money is not everything, but nothing can be done without money.
If this patient's daughter didn't think about money, she wouldn't have so many worries and wouldn't ask questions that are difficult for the doctor to understand.
Her biggest worry was that the operation failed and she had to undergo multiple operations. In the end, the money was spent, the disease was not cured, and her leg was lost.
Every family has its own scriptures that are difficult to recite. The patient’s daughter began to call her husband in front of Yang Ping to ask for his opinions.
The other party was silent for a moment, with a sleepy tone, and answered briefly: "It's just a cure, what else can I do---"
The tone seemed helpless and helpless.
After calling her husband, the patient's daughter thought for a while and scrolled on her phone as if searching her address book. It seemed that there was no one with whom she could discuss.
Both the couple are only children, who should they consult with? No one can discuss it, and they have to bear everything themselves.
The woman's phone rang again, and it was her husband's: "Honey, don't worry, just follow the doctor's plan. Do you want me to come over now? There are risks in everything you do, and there is a risk of choking when eating. If you can't do it anymore, then
Cut it once, and if it doesn’t work, cut it again. Anyway, it’s not a problem now. The worst is still bad, how bad can it be.”
"That, that---" The woman was worried about money, but she couldn't express it.
The man on the other end of the phone understood very well and said with a smile: "I will go to the company to advance next month's salary, and the surgery will be arranged first."
Not long ago, an old man at home suffered a stroke and spent a lot of money on hospitalization. He was just discharged from the hospital and now another one is hospitalized.
"Isn't next month's payment already paid in advance?"
Women have good memories.
She found that she was still in the interview room, and greeted Yang Ping with a smile, intending to go out and make a call: "Dr. Yang, I'm sorry, let's discuss it and decide."
Yang Ping nodded.
"Oh, I haven't finished the advance yet, you can still make an advance!"
The husband on the other end of the phone hesitated.
