"In the end, Dr. Oakland didn't make much progress." Zheng Ren said.
"No, I remember she did experiments on mice and cut off the nerves on one side. The other side also became necrotic after a few weeks." Su Yun retorted.
"I think this is a special incident and has no universal significance." Zheng Rendao, "Clinically, Canadian doctors conducted a large-scale sample survey on kidney stones and found that mirror pain exists.
But in terms of probability, I observed it at Haicheng City No. 1 Hospital, and the so-called 0.48% incidence rate seems a bit high. "
"Oh?" Su Yun didn't expect that his boss had already started studying mirror pain in his humble place in Haicheng.
"Canadian data shows that there were 3 cases of mirror pain among more than 600 patients," Zheng Rendao said. "The data I observed were more than 400 patients with urinary tract stones, and none of them had mirror pain. Clinically, this patient is the one I encountered. The first case to arrive.”
This is the case with clinical research. Whether it is 600 or 400 cases, it is a small sample, and deviations are normal.
But from the observation of boss Zheng Renzheng, mirror pain should be considered a very rare disease in China.
"What about admission to the hospital? Then what?" Mr. Yu was a little confused.
"Admission, lithotripsy. If your director doesn't agree with the mirror pain, you can do an intravenous pyelogram." Zheng Ren pointed his finger at the X-ray standing film inserted on the reader and said: "This should be the body's Some kind of stress change. Once the stone is broken and eliminated from the body, and the pain is no longer there, things should get better here."
"Boss Zheng, can you be more detailed?" Mr. Yu didn't have any good ideas. He couldn't say that when reporting the medical history to the director.
"Hmm... then you just report it to the director." Zheng Ren looked at the film and said: "The pressure on the right renal collecting duct increases due to hydronephrosis, and then the nerve endings of the lamina propria extend, and the smooth muscles spasm and contract, trying to remove the stone. move Place."
"Lactate production increases, stimulating the mucosa and activating chemoreceptors. After the afferent nerve reaches the spinal cord, it connects with the spinal cord at the T11-L1 level and is subsequently transmitted to the central nervous system, creating the illusion of contralateral pain."
"..." Mr. Yu was silent and speechless.
If I tell the director like this, I'm afraid I'll be the chief resident for another year.
But seeing that although Boss Zheng gave a diagnosis, he couldn't come up with a particularly convincing point of view, so he could only nod his head.
"As for the image of the left ureter near the lumbar 2-3 vertebrae, intravenous pyelography can be used to rule it out. Regardless of whether it is mirror pain or not, right urinary tract stones must be treated later." After Zheng Ren finished speaking, he Take off the film, put it in a bag and give it to Mr. Yu.
Next, the two residents became busy.
It is a relatively huge project to persuade patients who have previously firmly refused to be admitted to the hospital for diagnosis and treatment.
But after all, the two had rich clinical experience, and the patient was in severe pain. They had a relatively reasonable but fantasy explanation, and he reluctantly accepted it.
The pain of kidney stones is really painful, and it feels like the end of the world. Even if there is a mountain of swords and a sea of fire in front of you, you still have to go through it.
Su Yun took advantage of this time to order breakfast.
Zhou Litao finished his work and breakfast had just been delivered.
"Boss Zheng, Brother Yun, the patient has been sent to the hospital." Zhou Litao reported the finishing work.
"Well, gravel will do. If it can't be broken, the urology department has many solutions." Su Yun said while eating steamed buns.
"This is also the first time I have encountered mirror pain in the urinary tract." Zhou Litao is still very interested in this. "I have encountered a few cases of contralateral pain in patients with orthopedic amputation, but I think it is hysteria."
"It's not hysteria, it's just that the scientific principles haven't been found yet." Zheng Ren smiled, "The existing science has no clear explanation for the diagnosis and treatment of many diseases."
"I think this problem can be solved by using central nervous system remodeling." Su Yundao said, "Unfortunately, I don't do research in this area, so I don't have a clue at the moment."
"There is no need to do it. When encountering similar patients, it is enough to know that there is such a possibility and not to misdiagnose." Zheng Ren has positioned himself very accurately and has always been a clinician.
Dr. Charles had previously persuaded him to engage in theoretical research, but Zheng Ren had already thought clearly the moment he decided to give up.
While the three of them were having breakfast, they chatted about some speculations about mirror pain.
Zhou Litao felt a little emotional. No wonder Boss Zheng is so prosperous now. When he was the general resident of the emergency department in Haicheng, he knew something about such unorthodox things.
There is no such thing as a pie in the sky.
Regarding Boss Zheng's guess, Zhou Litao was wrong from the beginning.
It was only after Zheng Ren met the patient with mirror pain this morning that he began to reflect and recall similar patients he had encountered in his medical career.
Therefore, the thinking of cheating is different from other people's. When Zhou Litao thinks about Boss Zheng with normal people's thinking, he can only go further and further down the wrong road.
Boss Zheng never... rarely makes forward deductions. He always makes backward deductions after knowing the answer. Reverse reasoning is very worry-free, but it is also based on Zheng Ren's strong memory.
"By the way, why has Mr. Cui been away from work lately?" Zheng Ren asked casually after finishing his meal.
Zhou Litao sighed and said, "It's been more than half a month since Mr. Cui got sick last time. He has been getting better and worse over and over again. I came to the hospital to check and found nothing serious."
Zheng Ren was startled for a moment, knowing that Mr. Cui was old, and some things could not be solved by human power.
"Where is Cui's hometown? I'll go take a look when I have time." Zheng Ren said.
"Tomorrow is my day off, and I'm going to take a look at Cui's hometown." Zhou Litao said, "Boss Zheng, if you have time, can we go together?"
"Okay, tomorrow... in the afternoon." Zheng Ren said, "There are more things in the morning."
Speaking of Mr. Cui's illness, the atmosphere in the duty room was a bit depressing.
But after all, I am almost 80 years old, so some minor problems are normal.
Not to mention the nearly 80-year-old Mr. Cui, Zheng Ren saw the doctor's system panel in every doctor's office, which was somewhat red.
This is the law of nature. Zheng Ren wanted to go once. First, he missed Mr. Cui a little. The second is to take a look at the system panel and see that Mr. Cui has other problems that were misdiagnosed.
Although the latter was unlikely, Zheng Ren still thought it would be more appropriate to take a look.
After breakfast, Zheng Ren and Su Yun left the emergency department and returned to the interventional department to prepare for their early shift.
Lin Yuan was still sitting in front of the computer, busy writing medical records. Chang Yue chatted with the patient's family in the ward. Everything in the department looked as usual.
Plain and simple, yet rich and colorful.
…
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Note: I wrote about mirror pain. When I was searching for information, I recalled that there was a patient who had undergone amputation in the outpatient emergency department. He kept complaining about pain at the location of the amputation and the contralateral side. I keep telling people behind my back that they are pretending to be sick... I feel a little ashamed. This is the first time I know about mirror pain.