Chapter 531: Touching the neck can identify venous and arterial lesions and tissue necrosis
"I heard that you cured a disease that even the top hospitals in the capital couldn't cure. We came here specifically to see you." The old cadre's son also said.
These people are well-informed and naturally learned about Zhou Can's legendary story from some channels.
Especially for such powerful families, those who want to curry favor with them will try every means to find a world-famous doctor for them.
"Thank you for your trust and kindness, but I'm not that great. I'm just an ordinary doctor. Let me examine you first!"
Zhou Can is not used to being praised in this kind of occasion.
He is a down-to-earth person who likes to concentrate on studying medicine or treating patients.
The patient's biochemical test results, including urine routine and stool routine, were all normal.
Because the patient had pain in his lower limbs, black toes, and gangrene, and was worried about kidney problems, such as uremia, he was given a kidney function test.
The patient's renal function was found to be normal.
Later, we were worried that the patient had diabetes, so we checked his fasting blood sugar, which was still normal.
Even the existence of liver function problems was suspected.
Unfortunately, after checking liver function, it was still normal.
Diabetes, uremia and hepatitis, which are likely to cause this type of lower limb gangrene, have basically been ruled out.
The diagnosis has basically reached a deadlock here.
Zhou Can also took this into consideration and asked to come and see the patient's actual situation. Physical examination is a general examination. It seems that everyone's examination content is similar. In fact, a highly skilled doctor can find many clues from the physical examination, which is of great help in diagnosis.
It's totally fine to at least provide some food for thought.
The patient and his family were very cooperative and were happy for him to help with the physical examination.
He first lifted the quilt to check the patient's right foot.
Some disinfection and other treatments have been done above, mainly to prevent local necrosis of the foot, severe decay and further infection.
Gangrene refers to special morphological changes such as necrosis and blackening of local tissues.
It is mostly caused by blood circulation disorders due to diseases, trauma and other factors.
It causes large-area ischemia and necrosis of local tissue and secondary infection by putrefactive bacteria.
Gangrene can be divided into dry and wet. Dry gangrene is manifested by blackening, dryness, and necrosis of the limbs. Wet gangrene is not to be mentioned, but pus oozes, ulcers, rots, and stinks.
In general, dry gangrene is slightly better.
But this is not absolute.
For some patients, wet gangrene may look very scary, but it may be easier to treat.
The main thing is to find the cause of the disease, improve local blood circulation, fight infection, etc.
Through observation, Zhou Can found that the fourth toe of the patient's right foot had turned black and was obviously gangrenous.
And there is no obvious boundary with normal tissue.
This means that gangrene can continue to progress and spread upwards.
No wonder the doctors at the previous hospitals all said they had to amputate to save the patient's life.
After Zhou Can looked at it, he began to examine the patient's neck.
Because of lower limb pain and gangrene, after excluding common causes such as diabetes and uremia, there are basically only two possibilities: either bacterial or viral infection, or blood vessel problems.
The patient received anti-infection treatment in the first two hospitals, but the effect was not obvious.
It failed to stop the progression of the disease.
This suggests that viral or bacterial infection is less likely.
Moreover, the patient's biochemical examination was basically normal. There were no problems with liver and kidney functions, and the most likely problem was with the blood vessels.
The veins in the lower limbs are most likely to have problems.
If the injury is caused by a car accident, you need to be particularly alert to damage to the femoral artery. Especially crushing injuries can easily cause the femoral artery to rupture and cause heavy bleeding.
This old cadre is obviously more likely to have venous lesions.
Zhou Can did not touch the patient's right foot, but touched the patient's neck. What happened?
First of all, some of the veins in the lower limbs are deep veins, which cannot be felt or seen. When he observed the patient's right foot just now, he had already checked the superficial veins on the patient's right foot.
No obvious abnormalities were found.
So this headed straight for the largest vein that could be felt on the body's surface, the jugular vein.
The origin of human blood is the heart. Both arteries and veins originate from the heart.
However, when doctors examine patients, they cannot open the patient's chest to check whether the veins are normal. The most common and effective method is to feel the jugular vein.
Of course, this requires the doctor to have rich diagnostic experience.
Zhou Can found no distended jugular veins or abnormal pulsation in the carotid artery. The trachea was in the middle and was also normal.
There was no enlargement of the cervical lymph nodes or thyroid gland.
There was no stiffness in the neck.
After checking the neck, he put on a stethoscope and began to examine the patient's chest and abdomen.
The patient's chest and respiratory movements were symmetrical and normal. The bilateral vocal fremitus was symmetrical and the breath sounds in both lungs were slightly coarse, but normal. The patient was probably a little nervous when he was examined.
He heard mild crackles in the patient's right lower lung.
Sometimes there is, sometimes not.
This was a new discovery. Zhou Can's expression changed slightly and he continued the examination.
When auscultating the patient's heart, no pathological murmurs or pericardial friction sounds were heard in the valve auscultation areas.
The heart should be normal.
Logically speaking, after this stage of investigation, the patient can basically be transferred to other departments.
But Zhou Can did not do so.
People come to him specifically for treatment, so even if they are just being polite, he will still do his best.
To enhance the reputation of cardiothoracic surgery, continuous accumulation is required.
Zhou Can was also very interested in this difficult case.
He then auscultated the patient's abdomen and heard no obvious abnormal bowel sounds. He tried to palpate the abdomen with his hands and found it was flat and soft, with no obvious tenderness in the whole abdomen and no masses. There was no percussion pain in the liver and kidney areas.
After checking the chest and abdomen and finding nothing significant, he also specifically checked the patient's spine and found no deformity.
No obvious lumbar disc herniation was found.
Because the patient had walked too much when he was young and had symptoms such as leg numbness and coldness, he did not rule out the possibility that the patient's spinal lesions had compressed the nerves and caused the above symptoms.
After Zhou Can’s pathological diagnosis was promoted to level six , he had a deeper understanding and enlightenment of the nine systems and three circulations of the human body.
It was previously believed that the body's blood circulation was directly related only to blood vessels.
Now that his level has improved, he realized that his previous understanding was too superficial. Nerves can also affect blood circulation, and there are many other factors that can affect blood circulation.
Such as heart failure, premature beats and so on.
After checking the upper body, Zhou Can focused again on the patient's right leg.
The fourth toe of the right foot was black and showed gangrenous changes. The skin temperature of the right calf was obviously much cooler when touched than that of the left calf.
This means that the patient is likely to have problems with blood circulation in his right foot.
"I need to check the nerve reflexes of your feet to determine the cause of the disease. Just stay relaxed and natural. It will not cause any harm to your body."
Zhou Can said to the patient.
"That's good. I finally encountered an examination item that is different from other doctors."
The patient felt very happy after hearing this.
So many doctors examined and treated him, but to no avail. He must have been under a lot of pressure.
When he was almost in despair, a doctor suddenly came up with a new idea, which gave him a glimmer of new hope. So he was actually quite happy.
"Come, sit down with your legs bent naturally and vertically."
After Zhou Can asked the patient to sit down, he signaled to the family to hold the patient to prevent him from falling and causing accidents.
The percussion hammer hits the patient's left knee.
Bang!
The left leg showed obvious knee jerk reflex. Then I tried the right leg, and the knee jerk reflex was also normal.
However, the reflex is slightly weaker than that of the left foot.
This is related to the lesion in the right leg.
Then, the patient's feet were tested for physiological nerve reflexes, and nerve reflexes were found in all of the patient's right feet.
At this point, the possibility that the nerves are causing poor blood circulation has been basically ruled out.
Zhou Can once again targeted the blood vessels in his right leg.
The femoral arteries on both sides of the patient were palpable and the pulsations were normal.
Then, the left popliteal artery was found to be present and normal, but no pulsation was felt in the right popliteal artery.
The problem is becoming clearer and clearer, and this is another major discovery.
Continuing palpation, he found that the patient's left dorsalis pedis artery was present and the right dorsalis pedis artery was also absent.
This is a typical manifestation of chronic arterial ischemia.
According to the patient's condition, the patient's right foot chronic arterial ischemia is at least in the second stage, and may even have progressed to the third stage.
Chronic arterial ischemia, in the first stage, is mainly manifested by numbness, coldness, fear of cold, soreness, and fatigue in the affected limb. If it occurs in the foot, the patient may even limp.
The symptoms are particularly obvious after the patient walks a long distance.
There may be swelling, pain, and cramping in the calf or foot muscles.
If you continue walking after this happens, the pain will get worse.
At this time, as long as you rest in time, the pain will be relieved immediately.
The symptoms the old cadre experienced when he was young were highly consistent with the first stage of chronic arterial ischemia.
Zhou Can was also more certain that the old cadre had this disease.
As long as we find the cause of the disease, we can find a way to solve it.
"If your disease had been treated in time when you were young, it might not have developed to the current extent!"
Zhou Can sighed slightly.
Many diseases start as minor illnesses but are left untreated until they become major or serious illnesses.
"When I was young, the medical level was poor and the doctors couldn't find any illness. I didn't have time to be hospitalized for treatment, so I could only take some random medicine. Young man, do you know? The great opportunities in a person's life may only come once. If you don't seize them, you will lose them forever. There were six people who entered the agency with me, and I was the only one who seized the opportunity and climbed up."
Talking about his life experience, the old cadre was somewhat proud.
He even took the initiative to share some successful experiences .
The other five people failed to seize the opportunity and may only be clerks when they retire. At best, they may be section chiefs.
Compared with them, the veteran cadres must be very successful as they are able to hold high positions.
“Thank you for being willing to teach me these valuable life lessons.”
Zhou Can was truly grateful to this veteran cadre.
The communication between doctors and patients can sometimes be very pleasant, and we can even learn a lot of useful and valuable experience from patients.
"Seeing a down-to-earth young man like you, I can't help but want to give you some advice. Back then, I was just like you, eager to succeed and working hard to make progress. When you examined me just now, I could feel that you checked very carefully. This serious attitude towards work is very good."
The old cadres have been used to being leaders, and now their words have a certain flavor of leaders promoting subordinates.
Zhou Can responded with a humble smile and continued to examine the old cadre.
The second stage of this disease is called the nutritional disorder stage.
The affected limb will become numb, cold, afraid of cold, and more sore and swollen, and the walking distance will be significantly shortened. It takes a long time to rest to relieve. At the same time, even in a resting state, the pain will still continue.
This resting pain is very torturous, especially at night, when the pain is more obvious.
It will make patients unable to sleep at night and suffer.
In addition, the patient's affected limbs will show obvious pale skin, even purple spots and redness. The skin will also be extremely dry and the hair will fall off directly.
Some patients may also experience thickening and deformation of toenails and muscle atrophy.
If it occurs on the hands, the nails will become thicker and deformed more obviously, and muscle atrophy will occur, just like in patients with ALS.
This disease is not so easy to distinguish from ALS, and there is a certain possibility of misdiagnosis.
The old cadre has already gone through the second stage, but unfortunately he still has not received timely and correct treatment.
By the time the disease develops to the second stage, the patient has become accustomed to it because the disease has lasted for more than ten years. Even if he has a certain status and can enjoy high-quality medical services, he still only receives anti-infection treatment in the local hospital.
It was not until recently that his toes began to become necrotic and blackened that he realized the seriousness of the situation and rushed to a large hospital in the provincial capital for treatment.
He first went to the Provincial People's Hospital for medical treatment. It is not known whether he suggested that the doctor give him anti-infection treatment or what happened.
At the Provincial People's Hospital, I only received anti-infection treatment.
No further treatment was given.
To be honest, this seems somewhat abnormal to Zhou Can, a professional.
It also made him secretly alert, wondering if this old cadre or his family members might be causing trouble.
There are many patients who are smiling and very friendly when you first meet them.
If there is any inadequacy in the treatment or the effect is not obvious after the treatment, they will immediately turn against us, abuse us, complain, and even ask the hospital leaders for an explanation.
When encountering this type of patient, everyone basically stays away from them.
If there is really no other option, then defensive medical treatment is the only option.
In this situation, if you still don't think of a way to protect yourself, do you really think the doctors and nurses are fools?
The third stage of chronic arterial ischemia is also known as the tissue necrosis stage.
Unfortunately, this old cadre has already progressed to this stage. It should be just the beginning. In the later stage, the whole right leg will be necrotic, which is terrible.
The most obvious symptoms of the necrosis stage are increased pain, coldness of the affected limb, and signs of necrosis and blackening starting from the toe tip.
Moreover, the skin of the feet will lose its luster and become dull, like the color of a corpse.
This is a sign of loss of vitality and vigor.
"Doctor Zhou, have you found out what's wrong with my father-in-law?"
The patient's daughter-in-law remained silent.
Seeing Zhou Can's frown and serious expression at this moment, she asked.
"It's a bit like chronic arterial ischemia in the legs, and the disease is already in a very late stage. The specific cause of the ischemia needs further diagnosis. In clinical practice, the most commonly used method is to establish collateral circulation and improve local blood supply. Symptoms can often be significantly relieved and the condition can be significantly improved."
Zhou Can dared to say this only because he was basically 90% sure of it.
The specific surgery to be performed requires further examination of the leg arteries and blood vessels.
