Gou is practicing medicine in the clinic

Chapter 416: Bodhisattva’s heart is empty, choose one of the two
"But this patient has no symptoms such as fever!"

Zhong Hu felt a little incredible when he heard that the patient had bone cancer, and that the tumors in the bones and joints had metastasized from the lungs.

When lung disease occurs, fever symptoms are most likely to occur.

Such as pneumonia.

"Also, there is no enlargement of the patient's superficial lymph nodes. No abnormalities were found in the heart or abdomen. How could this become lung cancer?"

"Whether it's lung cancer or not, I don't have to say. Just take a film for the patient and it will become clear."

Li Jingsheng said confidently.

He knew that Zhong Hu might still first suspect that the patient's disease was osteoarthritis.

In fact, this can directly rule out the possibility of osteoarthritis.

When he felt the patient's bones just now, he found that there was obvious calcification in the soft tissue near the knuckles of the index finger, middle finger, and thumb of the patient's right hand.

Osteoarthritis is a degenerative disease of the joints.

Most common in older people.

Moreover, the symptoms of joint pain are extremely obvious, especially when the joints of both knees have an attack, the pain will be excruciating.It is most obvious on cloudy and rainy days, or when the weather is about to change.

"We have taken films of both knee joints of the patient. You see, you can see obvious osteophytes, and the bone hyperplasia is almost clear at a glance. Based on my clinical experience, I think the patient is more likely to have osteoarthritis."

Zhong Hu is also an old chief physician of orthopedics, with good level and experience.

He is more likely to diagnose the patient with osteoarthritis, which naturally makes sense.

"But this patient's joint lesions are mainly concentrated in the wrist joints and finger joints of both hands. Also, the patient's erythrocyte sedimentation test results show that the patient's erythrocyte sedimentation rate is significantly increased. For osteoarthritis, this data test will not increase. One more thing, have you ever seen any osteoarthritis patient’s hands and feet grow at the same time?”

Li Jingsheng felt that the diagnosis of this case was not as difficult as imagined.

What I fear most is that the doctor will get involved in it.

When doctors diagnose diseases, it is easy for doctors to fall into a trap because they have too rich clinical experience and grasp some symptoms and characteristics that are consistent with the intention of initial diagnosis.

"Okay, let me talk to the patient first. Family members and patients are very reluctant to undergo examinations. The current treatment is bone and joint hyperplasia of the limbs. If they are asked to do chest imaging examinations, they may not agree."

Out of his trust in Li Jingsheng, Zhong Hu decided to take a chest X-ray for the patient.

It’s just that some patients are difficult to speak.

It is easy to get scolded if you prescribe some tests that cause headaches and feet.

"Then I'll go back to the outpatient clinic to work first. If the test results are different, I'll come back after work to help you with your consultation."

Li Jingsheng left in a hurry.

It was around four o'clock in the afternoon when Zhong Hu called.

"Xiao Li, just now our nurse got through the patient's thinking and took the most economical chest X-ray for the patient. It showed that there is a patchy shadow in the right lower lung."

Zhong Hu said excitedly.

"There has been another major breakthrough in the diagnosis of this disease. But I still don't think it is cancer. Instead, I suspect it may be a rare pulmonary osteoarthropathy."

Zhong Hu usually has a serious face in front of the doctors, and even dares to fight with Professor Wu if he disagrees.

Unexpectedly, he was as honest as a cat in front of patients.

It was just a check-up, but it was delayed until four o'clock in the afternoon to clear the patient's mind.

And the check was a chest X-ray.

It's cheap, but the results that can be found are very limited.

you get what you pay for.

Chest X-ray has its limitations.

For a patient like this, it is actually possible to get a chest CT directly in one go.

"I still insist that the patient's disease is cancer. Lung cancer plus bone cancer."

Li Jingsheng was very determined.

Bone palpation has always been very accurate, especially now that the level has improved.

He touched a dead wood and bone elephant, which was 99% likely to be cancer.

Pulmonary osteoarthropathy is a paraneoplastic syndrome.

It is caused by tumor tissue secreting biologically active proteins or peptide hormones, causing local or systemic non-specific clinical manifestations.

The most common symptom of pulmonary osteoarthropathy is periosteal hyperplasia and new bone formation.

But the most common site for this disease is the distal end of the long bone.

Finger clubbing and hypertrophic osteoarthropathy often occur.

The patient's joints are clearly swollen, not hypertrophic.

This is one of the doubts.

Director Zhong Hu is so sure that the patient has pulmonary osteoarthrosis because the patient has a long history of smoking.

Often, the disease is associated with a history of smoking.

However, no research institution, doctor, or team dares to say that this disease is related to smoking.

"Director Zhong, why don't we further perform a chest CT on the patient?"

Li Jingsheng asked.

Facts speak louder than words.

A hundred words or a thousand words are not as reliable as a chest CT film.

"Oh, I want to get him right once and for all, but the patient and family members don't agree, so there's nothing I can do!"

Zhong Hu was helpless.

……

Six days passed in a row, and Li Jingsheng worked as usual every day and was still very busy.

The patient with the abnormally long limbs ultimately refused to consent to further testing.

When encountering such patients, doctors and nurses are helpless.

Doctors and nurses all have a bodhisattva heart, but if the patient does not cooperate, there is nothing anyone can do.

Zhong Hu treats patients according to pulmonary osteoarthrosis.Mainly anti-infective treatment.

It seems that it has been almost a week since the treatment, but the patient's condition has not improved significantly.

The family members questioned the hospital's diagnosis and treatment standards and forcibly discharged the patient with him.

This situation often occurs in hospitals and is called voluntary discharge.

The patient does not follow the normal procedures and is discharged from the hospital privately without the permission of doctors and nurses.

Some patients voluntarily leave the hospital because they owe the hospital treatment fees, have no money to pay, or are unwilling to pay, so they choose to leave the hospital voluntarily.

At noon, Li Jingsheng went to the orthopedic surgery office as usual to help his future wife handle difficult cases.

The second group she was in had poor performance. If she didn't help, if the second group was really cancelled, Ou Qinglan might have no choice but to join another group.

If you love her, you must respect her choice.

Since she wants to stay in the second group, that's her wish.

Li Jingsheng was helping her diagnose and analyze a bone injury case when a doctor under Director Zhong Hu hurried into the office.

"Doctor Li, Dr. Li, the patient is back again. Director Zhong asks you to go to the office immediately."

"Which patient?"

Talking without beginning or end.

Li Jingsheng was a little confused.

"That's the patient with bone hyperplasia in his limbs who voluntarily left the hospital this morning!"

"It's him. He came back with the same result."

Li Jingsheng didn't have any good solutions for this case.

Lung cancer, and bone metastasis occurs, to be honest, it is a matter of how long it takes.

If nothing unexpected happens, the patient will reach the end of his life soon.

Li Jingsheng came to Zhong Hu's office.

There are three people in the small office at the moment.

The patient with bone hyperplasia in his limbs, his wife, and his son.

The patient's wife had tears in her eyes.

The son should be born when he is 30 years old, about the same age as Li Jingsheng.

When the old man fell ill and was hospitalized, Li Jingsheng did not see the patient's son.Only the patient's wife stayed by the bedside.

Young couples come to accompany each other when they grow old.

Sometimes, it is necessary to be nice to your other half.

When either spouse falls ill and is sent to the hospital for emergency treatment, the person with the power to sign and make the decision is often the spouse.

Brothers and sisters are not considered first relatives under normal circumstances.

They don't have the power to make decisions.

Unless the patient has no spouse, or the first relative is absent, and there is no other way, brothers and sisters only have the power to sign and make decisions.

If he treats his wife badly, he will beat her and scold her at every turn.

Or when a wife treats her husband badly, is disgusted with her in various ways, and is inconsiderate in various ways, and is really sick and needs to pay for life-saving treatment.The other half has every right to choose to forego treatment.

Then he really has no choice but to die.

"Doctor Li is here!"

When Zhong Hu saw Li Jingsheng walking into the office, he quickly stood up to greet him and reminded the patients and their families.

"Dr. Li, I really regret that I didn't listen to you and Director Zhong. This morning, my husband went to Qiaobang Hospital for a check-up. He had a chest CT and it was found that he might have a malignant tumor."

The woman spoke of this with regret.

In her opinion, it was because she was reluctant to part with the hundreds of dollars and refused to do a chest CT scan for her husband, which delayed his condition.

The patient's mood is also very low.

Generally speaking, when a malignant disease is diagnosed, the patient is often not told.

They obviously didn't hide anything from the patients.

This is a family matter, so Li Jingsheng will naturally not care about it.

"What are you thinking now?"

Li Jingsheng asked his family members.

"I definitely want to treat my dad! Director Zhong told us that you had already diagnosed my dad's disease seven days ago. But medicine needs to pay attention to evidence. Since we refused to do the chest CT, we have been There’s no way to diagnose it.”

The patient's son looked at Li Jingsheng with a complicated expression.

He may be a little older than Li Jingsheng, but Li Jingsheng is already an expert in the medical field.

This made him very admired and envious.

"Director Zhong, how do you think this disease should be treated?"

Li Jingsheng looked at Zhong Hu.

He couldn't make the decision on his own, so it would be better to let Zhong Hu handle it.

"I respect the opinions of family members and patients. If family members want to hear your opinion, you should talk about it first!"

Zhong Hu gave the right to speak to Li Jingsheng again.

"Since you trust me, then I'll tell you! As for my uncle's disease, it was discovered relatively late, and it is likely that it has metastasized in many places. With the current medical level, if treated, the life expectancy may be only one or two more. months. And in the later stages, many complications will occur, and the patient will be particularly painful.

Also, after undergoing radiotherapy and chemotherapy, the patient may have difficulty getting out of bed and needs someone to take care of him.

Furthermore, the cost of treatment may be as high as hundreds of thousands.

Such a large amount of money is a huge sum for many families.

If you choose conservative treatment, our hospital will find ways to reduce the patient's pain and try to improve the patient's quality of life.The cost will also be relatively low, it depends on what you choose. "

(End of this chapter)