Come on, Dr. Wu

Chapter 378 Analgesia
The three people were also a little surprised at this time, because if it was the right kidney, the position of the patient's right kidney was obviously lower, and the lower pole was already below the pelvis.

"This should be the swelling I felt before."

Tumor!

The three of them were even more surprised, which meant that the smooth and movable lump that Wu Xiaofu had touched before was the kidney!

“Can you feel the kidneys?”

Several of us have been interning for a while and we often do physical examinations, especially in hepatobiliary surgery. The most common examination is abdominal examination, but we have never seen a patient whose kidneys can be felt.

Thinking of this, several people hurriedly took pictures, "Boss, the clinic is over today, we have to go over and take a look."

If you come across something rare, you should try to see it so that you can have more material when writing articles in the future.

"It is indeed rare, but it is possible to feel it. This patient has a thin body and very little subcutaneous fat and intra-abdominal fat, so it is easy to feel the smooth kidney."

Body shape!

A skinny girl appeared in Jiang Bei and the others' minds. Don't worry, if that were the case, it would really be possible to touch her.

"Okay, go back to your seat and ask the patient to come in."

Jiang Bei and the others hurried back to their seats. Liu Lin pressed the number-calling button, and the first patient pushed the door open almost at the moment his number was called.

The patient was a middle-aged man who was supported by a woman of similar age. They should be a couple.

The patient was holding his stomach, his face pale, probably in pain. Wu Xiaofu could even see beads of sweat on his forehead.

"Come on, sit down."

When Cheng Shi saw this situation, he quickly stood up and asked the patient to sit down.

"In the future, if you have this kind of situation, either go to the emergency room or remind the doctor in the clinic to see him first. Don't just sit there and wait, as that can easily lead to problems."

This patient was obviously in extreme pain, but he was also very strong-willed. His face turned pale, his facial muscles twitched, and beads of sweat were pouring down his face, but he gritted his teeth and didn't say a word.

"It didn't hurt that much when I started waiting, but it suddenly got worse and worse. Doctor, what happened to him? Actually, it started hurting yesterday, but it got better after a short rest. I thought it might be something I ate that was bad, so it shouldn't be a big problem.

But this morning, it suddenly got worse. It was better when I was on the road in the car, but now it's not working anymore."

Listening to what the patient's family said, Wu Xiaofu frowned and asked a few more questions, and found that there was really no triggering cause.

But precisely because there is no inducement, this problem appears serious, because the patient's pain is located in the middle abdomen, slightly to the left.

"Come, lie down here."

Wu Xiaofu asked the patient to lie on the treatment bed.

"pain!"

When Wu Xiaofu was palpating the patient, he finally couldn't help crying out. His abdomen was relatively flat and soft, without any bulge or muscle tension, but there was positive tenderness in the left upper abdomen. Moreover, upon closer touch, he actually felt the spleen.

The spleen, which is within reach, is obviously enlarged, and it is not just an ordinary enlargement, but can be considered severely enlarged.

Splenomegaly is also graded. Generally, when palpating, the first thing that is touched is the lower edge of the spleen. If the lower edge of the spleen exceeds the horizontal line of the umbilicus, or the apex of the spleen exceeds the anterior midline to the right, it means that the spleen is already severely enlarged.

It is not common for the spleen to be enlarged to this extent.

Infection! Heart failure! Blood disease! Cirrhosis! Tumor! Connective tissue disease!
Anyway, no matter which one it is, the patient's condition will not be good. Although splenomegaly will cause discomfort, it is rare to suffer such pain. In Wu Xiaofu's judgment, there is only one situation now.

"It may be a ruptured spleen. You Zhiyi, take the patient to get a CT scan urgently. Liu Lin, tell Peng Xia to notify Director Chen to prepare for surgery."

"it is good."

You Zhiyi and the others were also shocked when they heard Wu Xiaofu's words. It was not the first day they had been doctors, so how could they not know the seriousness of spleen rupture? Any delay could be fatal. Although they had not yet conducted an examination, in their opinion, Wu Xiaofu's diagnosis was more standard than an examination.

The patient and his family members also panicked when they heard this.

"Ruptured spleen? Surgery? Doctor, is it that serious?"

"Well, it should be correct. We will do a check-up later. If the spleen is really ruptured, emergency surgery is definitely required. Otherwise, it could be fatal at any time. In addition, the patient has an enlarged spleen and may have underlying diseases, so we need to pay more attention.

So, I'll let Doctor You take you for the checkup. You Zhiyi, on the way, tell them what needs to be explained before the operation, and talk to the patient and his family first."

"Okay boss."

Seeing how serious Wu Xiaofu's words were, the patient's family members did not dare to be careless and quickly nodded in agreement.

There was a wheelchair in the ward, and You Zhiyi pushed the patient out directly. The people outside the clinic were stunned when they saw this. How could he walk in and come out sitting?

The second patient walked in panic.

He was also a middle-aged patient, who came in accompanied by his wife. He also had abdominal pain and came in holding his stomach.

"Director Wu, who was that big brother just now?"

You know, when they were waiting together just now, the two of them exchanged a few words. They both had stomachaches, were in the same group, and were about the same age. They looked like fellow sufferers at that time, but who could have thought that the eldest brother came out in a wheelchair not long after he walked in.

The doctor was accompanying him, so how could he not panic?

He wouldn't be like that, would he? It was obvious that the elder brother was seriously ill.

Wu Xiaofu looked at the patient and smiled. "It's okay. You shouldn't be that sick. Tell me where you feel uncomfortable."

The patient was still skeptical until Wu Xiaofu asked him questions and examined him and told him that he just had bile duct stones. Only then did he feel relieved.

Admit them to the hospital and have elective surgery. I saw every patient, ate a little at noon, and then started again. I could never finish seeing them.

The first patient in the afternoon made Cheng Shi and others feel that it was worth learning from.

The patient is an elderly male, over 70 years old, who has been diagnosed with intrahepatic cholangiocarcinoma and right colon cancer for more than 3 years. The main reason he came here this time was because he had unbearable pain in his lower back, back and right shoulder joints for 2 months.

Um, cancer pain management.

This is also an important topic in oncology. Although Wu Xiaofu is a surgeon and mostly performs surgeries, he also often has to deal with cancer pain, because many of the patients in his outpatient clinic and wards are cancer patients. As long as they are cancer patients, cancer pain is an unavoidable word.

Because even after radical surgery, the tumor does not mean that it will not recur. Once it recurs, the patient will suffer from the pain while his life is counting down. Since the patient's life cannot be saved, the patient must have a better quality of life in the last moments of his life.

Pain is undoubtedly the thing that most affects a person's quality of life.

Therefore, controlling cancer pain is also a test for doctors like them.

The patient suffered from abdominal discomfort 3 years ago, and examination revealed tumors in the colon and liver. He was treated at the First Affiliated Hospital at that time. However, when the disease was discovered, it was already in the late stage. Fortunately, it had not metastasized to the brain and bones, so there was still a chance for surgery.

So after two courses of preoperative chemotherapy, he underwent left hepatectomy + right hemicolectomy + ileostomy under general anesthesia in the operating room. The operation was relatively successful. The reason for two courses of preoperative chemotherapy was that the patient's tumor area was not small at the time. If the operation was performed according to this, the area to be removed would be too large, especially the liver, and liver transplantation would be almost the only option.

After chemotherapy, the patient's tumor area was reduced and left hepatectomy was sufficient.

The same goes for the colon.

Only two courses of chemotherapy are required because if more than two courses are given, the patient's body will suffer a lot of damage. At this time, if the patient undergoes surgery, the risks will increase too much. Moreover, the range of the tumor at that time is not so standard, and the chance of recurrence after resection is too high.

Therefore, preoperative chemotherapy can be performed, but generally only two courses are given.

The patient's postoperative pathological report was sarcomatoid intrahepatic cholangiocarcinoma, villous adenoma of the right colon, high-grade, cancerous, and moderately differentiated adenocarcinoma.

To be honest, this result is neither good nor bad.

The patient's recovery after the operation was actually quite good, and he continued with 4 cycles of chemotherapy.

Unfortunately, during the follow-up examination, retroperitoneal lymph node metastasis was discovered soon after. There was no choice but to continue with the combination of radiotherapy and chemotherapy to suppress the disease.

However, the longer the chemotherapy and radiotherapy last, the worse the patient's health will be. Two months ago, the patient developed low back pain and right shoulder joint pain without any obvious cause. Oral analgesics were not effective.

The worst pain in the world is cancer pain.

Oral medications are not effective, and it is impossible to get painkillers every day. There is no choice but to undergo celiac plexus destruction. The reflex arc we learned in high school, celiac plexus destruction, is equivalent to destroying both the afferent and efferent nerves of the pain reflex, which can naturally reduce the pain caused by the intra-abdominal tumor.

However, this effect is not permanent. As time goes by, you will eventually feel the pain in another way, and your nerves will slowly recover. At this time, you will need to undergo another celiac plexus destruction surgery.

The patient came to Wu Xiaofu because he wanted Wu Xiaofu to help him see if he could undergo celiac plexus destruction surgery or if there were other methods of pain relief.

"Director Wu, can my father still undergo that pain relief surgery?"

Wu Xiaofu shook his head when he heard this. "Have you ever thought about why the patient has shoulder pain?"

This!
The patient hasn't had a full-body check-up for a long time. The tumor has recurred to this extent. The patient and his family are ready to give up. Now the patient has basically stopped even radiotherapy and chemotherapy, and except for painkillers, the family basically doesn't take other medicines. Their purpose is very clear, which is to live the last stage of life well without pain.

"Director Wu, what do you mean?"

"It is highly likely that the patient has bone metastasis, which is why he has shoulder pain. If bone metastasis occurs, performing a plexus block may puncture the mass, which may lead to risks such as abdominal bleeding, infection, and tumor spread. Therefore, I do not recommend celiac plexus destruction. The risk is too high. Let's go get a check-up first to see what the situation is and then decide based on the situation."

The patient had a malignant liver tumor that was adjacent to the diaphragm and phrenic nerve, so when a signal to stimulate the nervous system occurred, the signal was then transmitted back to the nerve origin in the spinal nerve C3-C5 region, causing pain symptoms.

The C3 to C5 region covers the upper limbs, especially the shoulder area, so stimulation of the diaphragm and phrenic nerve in liver cancer patients can cause shoulder pain.

Upon hearing this, the patient's family members quickly agreed.

After the results came out, the thoracic spine MRI showed a mass in the front of the patient's spine, which partially invaded the body of the 12th thoracic vertebra.

"Director Wu, what should we do? My dad is in so much pain every day that he can't sleep. We feel so bad for him. Is there no other way?"

Once it reaches this point, it is not only the patients who are in pain, but also their family members who are taking care of them.

If the pain still cannot be relieved, the patient's family members dare not imagine what life will be like in the future, and their own father may actually die from the pain.

"I recommend that the patient undergo a neuraxial analgesia device."

Intraneural analgesia device placement!

The patient's family obviously had never heard of this method.

In modern medicine, analgesia plans for cancer pain have been continuously optimized, and the status of intrathecal drug analgesia has evolved. The intrathecal analgesic device implantation mentioned by Wu Xiaofu is a type of intrathecal drug analgesia. In the past, experts and scholars believed that intrathecal analgesia was the last remedial measure after other conservative treatments failed.

However, more and more literature now confirms that compared with the systemic use of opioids, intrathecal administration is significantly safer, with lower complications and mortality, less possibility of changing treatment plans, and more cost-effective. Therefore, many doctors now recommend this method of analgesia to patients in clinical practice.

Even now, Wu Xiaofu has regarded it as one of the preferred treatment options for intractable pain.

If the patient had come to see Wu Xiaofu last time, perhaps what he had undergone was not abdominal plexus destruction surgery, but intrathecal analgesia device insertion. The principle is very simple. It is to put such a thing into the spinal canal and then inject analgesics, which directly reach the nerves and have significant effects.

Upon hearing this, the patient's family naturally would not be picky about anything. For them, as long as it can relieve the pain, anything is fine.

"Okay, let's do the surgery. Director Wu, when can we do it? You've seen my dad's condition."

Wu Xiaofu nodded and asked Cheng Shikai to be admitted to the hospital. Relevant examinations were also required for this operation. After all, it was a procedure to place something inside the spinal canal, so the risk was quite high and everything had to be done safely.

The patient's family was even happier when they heard that he could be hospitalized.

You know, at this stage, the patient is already at the point where the hospital is unwilling to admit him. Otherwise, since the medical insurance can cover the expenses, the patient's family would be eager to keep the patient in the hospital.

(End of this chapter)