Chapter 265: Things often develop in the worst direction, the real culprit of diarrhea is found
After seeing Wei Fang off, Zhou Can was full of expectations for the effects of this medicine.
Whether it is really effective is hard to say at this point.
After Hu Wei took it, he had to wait for about 72 hours to know whether it was effective. The recipe was learned from Director Wen of the Department of Neurosurgery.
At that time, Director Wen was just excited and mentioned this prescription to Zhou Can. Moreover, this prescription was not developed by Director Wen, but was passed to Director Wen by his mentor before his death, asking him to continue researching.
The speaker may not mean it, but the listener may take it seriously.
Zhou Can thought it was magical, so he wrote down the recipe. After learning it, he has not yet conducted any clinical trials.
It’s not a bad idea to use Hu Wei as a free drug tester.
…
The next day, around ten o'clock in the morning, the patient with diarrhea and diabetes insipidus queued up to undergo an abdominal B-ultrasound examination.
Director Zheng had already explained that he would be performing two important endoscopic surgeries in the operating room that morning, and the patients could go directly to the inpatient department to find Zhou Can after getting the test results.
This is a difficult case that most people cannot handle.
The patient's mother found Zhou Can with the test results.
Unexpectedly, after Zhou Can took the B-ultrasound results and looked at them, he remained silent for a long time.
"Doctor Zhou, can you find out the cause of my son's illness ? Is his illness serious?"
The family members may also be a little panicked.
This is the love a mother has for her son. She raised her son all by herself, which was not easy.
Her son is her life and her hope for survival.
Zhou Can could clearly feel her anxiety and nervousness.
"From the results of the B-ultrasound examination, the situation is not good. The B-ultrasound shows that there are multiple space-occupying lesions in the liver. This means that the patient is likely to have a pancreatic endocrine tumor."
Before doing the B-ultrasound examination, Zhou Can hoped that the patient was not seriously ill.
But now it has developed in the direction he least wants to see.
Pancreatic endocrine tumors can be divided into functional and non-functional tumors.
Non-functional tumors do not produce neuroendocrine substances and do not cause special clinical symptoms in patients.
Obviously, the patient's diarrhea is so severe that it must be a functional tumor.
It is not clear what type of tumor it is.
Insulinoma, gastrinoma, glucagonoma, vasoactive intestinal polypeptide-secreting tumor, somatostatinoma, etc. may all occur.
Pancreatic cancer is worthy of being called the king of cancer because it has its own terrifying aspects.
"Tumor..." The patient's mother heard this with a look of fear and pain on her face. She then held her forehead and temples with her hands, and her body began to shake, as if she could no longer stand.
"Don't get excited. Don't get excited. We are only suspecting that it might be a pancreatic endocrine tumor. This is not the final result yet."
Zhou Can could only say some words against his will to appease the family members.
In fact, he knew very well that the B-ultrasound results had basically confirmed that the patient had a pancreatic endocrine tumor, and it was very likely that it had spread.
At least it's mid-term.
This means that once a patient is diagnosed, they may not even have the chance to undergo surgery.
What the king of cancer is best at is not giving patients a chance to survive.
Don't give doctors any chance to rescue.
Not even a chance to control its growth is given.
Zhou Can quickly stood up and helped the woman sit down in the doctor's office chair.
Then he walked to the door and waved to the nurse station, "Xiao Li, if you're not busy, come and help me."
The nurses in the Department of Gastroenterology came to Zhou Can for help more and more often, and Zhou Can became very familiar with them.
In addition, Zhou Can was young and rich, and he was generous. From time to time, he would treat all the nurses to milk tea and barbecue after get off work.
I have to explain that he invited the nurses to have a barbecue after get off work, but he himself would not go.
Instead, he instructs a leader to pay and he will reimburse the next day.
Although these female nurses in the Department of Gastroenterology are all beautiful and well-educated, it does not affect their desire to take advantage of others.
Every time we heard that Zhou Can was treating us, even if we were not at work, we would form a team and rush over to have barbecue.
However, their quality is still quite high. Although they like to take advantage of small things, they are not greedy. After eating Zhou Can's food, they will also give back. In addition to paying special attention to Zhou Can's work, sometimes they will also return the favor in their own way.
For example, stuffing two biscuits into Zhou Can's pocket, or putting a bag of snacks in his pocket.
This really made him laugh and cry.
In the minds of girls, secretly eating snacks at work is very enjoyable. But for Zhou Can, he usually eats some fruits and almost never eats snacks.
On the one hand, work and study are very busy, on the other hand, there is a big difference between men and women in this regard.
The nurse named Xiaoli ran over and asked, "Brother Zhou, what do you want me to do?"
"Look, the female family member inside almost fainted after learning that her son might have a pancreatic tumor. Please help hold him up. In case he falls or gets hurt, it will be hard to explain later."
It's really difficult for Zhou Can, a man, to help others.
Although the female family member is already fifty years old, he must pay attention to the impact.
What people say is scary.
These days, a distorted photo can easily ruin a doctor's career.
For example, the incident of a nurse playing with her cell phone during the rescue of a patient that caused a lot of controversy a while ago. Anyone with a little bit of common sense would know that in such an urgent situation of rescuing a patient, which doctor or nurse would dare not take the patient's life seriously and sit by and play with their cell phone?
It was later found out that the nurse was not playing with her mobile phone, but was trying to contact doctors in related fields to come for rescue, and was using her mobile phone to coordinate rescue supplies.
However, the family members were angry at the female nurse because of the patient's death, and took photos to expose her on the Internet.
It eventually caused an uproar.
Fortunately, the truth was later found out and the female nurse was cleared of all charges.
In reality, there are too many things that make doctors and nurses sweat and cry.
The female nurse was very good at comforting people. With Xiaoli's comfort, the family member's emotions gradually stabilized. However, the sadness between his eyebrows could not be wiped away.
This patient is under the care of Director Zheng. Now that there has been significant progress in the diagnosis, Zhou Can feels it is necessary to report to Director Zheng in a timely manner.
Even if Director Zheng might be performing surgery on a patient, there is nothing we can do.
Zhou Can decisively dialed Director Zheng’s cell phone.
"Doctor Zhou, has the result of the patient with diarrhea and diabetes insipidus been found out?"
"The specific cause of the disease is still unclear. However, the patient's abdominal ultrasound has shown multiple space-occupying lesions in the liver!"
Zhou Can reported on the patient's condition.
“This is really fatal!”
After hearing this, Director Zheng was silent for a few seconds, then he sighed deeply in a heavy voice.
Medical prognostics can sometimes be as accurate as scientific predictions.
The higher the level of the doctors involved in the diagnosis, the more accurate the predicted results will be.
Before the B-ultrasound was done, Zhou Can predicted that the patient's disease was likely to be a malignant tumor. In the end, it turned out to be true.
"It is indeed very distressing. Do you think it is still necessary to do a plasma hormone level test? Although the ultrasound results are not very good, there are still two or three steps to the final diagnosis."
Zhou Can asked Director Zheng about the next treatment plan.
"Do it! After you're done, we can determine the type of pancreatic tumor."
Director Zheng readily agreed.
"I don't think there's much suspense about the results of the plasma hormone level test. There's still a glimmer of hope. We can further use imaging tests to see if the tumor has metastasized. If it hasn't metastasized, or if it has only metastasized to the surrounding lymph nodes, there may still be a chance for surgery. I suggest doing another CT scan, focusing on the chest, abdomen, and neck."
If pancreatic tumors metastasize, the neck area of the human body is the most abundant in lymph nodes and is the focus of screening.
The organs in the chest cavity are also very susceptible to involvement.
This is like when your neighbor's house catches fire, the surrounding houses can easily be affected as well.
When a tumor occurs in a certain organ or tissue, the first organs or tissues to be affected are often the adjacent organs or tissues.
"Okay! I'll ask Huang Liang to issue the medical examination application form and send it over right away. I'll trouble you to communicate with the family members."
This patient has almost always been diagnosed by Zhou Can and Director Zheng, and they are the only two who know the patient's condition best.
It's okay for Huang Liang to run errands and deliver an examination application form, but it's too difficult for him to communicate with the family members.
The inspection application was issued very quickly.
Zhou Can’s communication with the family members was also very smooth.
When the results of plasma hormone level tests came out, Zhou Can found that the patient's plasma VIP and SST were significantly elevated.
The VIP value, or vasoactive intestinal peptide value, reached an astonishing 300-890. You should know that the normal value for a normal person is only around 60. The VIP value of this patient was more than ten times higher than the normal level.
The SST value is commonly known as somatostatin, reaching a terrifying 600-2500ng/L, while the normal value is only around 25. It is a full 100 times higher than the standard.
When seeing this result, Zhou Can's heart sank to the bottom.
If only I could find him sooner.
However, if we had found him earlier, he might not have reached the current diagnostic level at that time and would not have been able to diagnose the cause of the patient's illness.
Now it is basically possible to determine whether a patient has a mixed tumor that secretes VIP and SST based on plasma hormone levels.
Now I finally understand why the patient's secretory diarrhea continues.
Vasoactive intestinal peptide is widely present in the nervous tissue and pancreatic endocrine cells of the digestive tract system.
It has many physiological effects, including relaxation of smooth muscles, stimulation of bile secretion, and stimulation of intestinal secretion of water and electrolytes.
The patient's elevated vasoactive intestinal polypeptide was the main cause of his secretory diarrhea.
As for somatostatin, it is mainly distributed in the thalamus, pancreatic D cells and small intestine.
Its main function is to inhibit the secretion of the digestive system.
The patient's SST value exceeded the standard by 100 times, which would cause steatorrhea. However, this patient also had secretory diarrhea, which could offset part of the secretory diarrhea.
Now the real causes of the patients' diarrhea and diabetes insipidus have been found.
The truth has finally come to light.
The only thing we pray for is that the tumor has not metastasized significantly in the next CT scan.
Contrary to expectations, the CT results were quickly delivered to Zhou Can.
The patient had a space-occupying lesion in the pancreatic body and metastatic lesions in the liver. Clinical evidence-based practice proved that the middle segment of the patient's main pancreatic duct was completely obstructed.
Abnormalities were also found in the supraclavicular lymph nodes.
Without doing a pathological biopsy, Zhou Can was sure that the patient's tumor had metastasized to the liver and supraclavicular lymph nodes.
After examination, it was confirmed to be a metastatic neuroendocrine tumor.
Seeing such a bad test result, Zhou Can's heart was already half cold. However, he still held on to the last ray of hope and proposed to perform an exploratory surgery on the patient to see if there was still a chance to remove the pancreatic tumor?
Cure is impossible.
At least it can prolong the patient's life.
After surgical exploration, it was found that the patient's pancreatic body and neck were several times larger than normal size. The tumor had invaded the surrounding tissues and had metastasized to the liver. The patient completely lost the opportunity for surgery.
When the patient was pushed out of the operating room, his mother was already waiting anxiously outside the operating room.
Came to meet him immediately.
"Doctor Zhou, how is my son's surgery going?"
In fact, she already had a bad feeling in her heart. When she asked the question, her face was pale and her hands were shaking uncontrollably. Just like a 90-year-old man, her body was out of control.
Zhou Can had already told her before the exploratory surgery.
If it is confirmed that there is still a chance for surgery, she will be asked to sign a new consent form for surgery and the tumor will be directly removed.
If there is no chance for surgery, we can only find a way to make the patient spend the last moments of his life as less painfully as possible.
The operation was over so quickly, and no one asked her to sign the consent form again. She could already foresee the result.
"Please push the patient back to the ward first. I will talk to the family about the patient's condition."
Zhou Can said to the nurse and Dr. Huang Liang.
This patient was originally under the care of Zheng Hongtao. Out of responsibility and morality, Zhou Can has been working hard for the patient.
Unfortunately, in the end we can only do our best and cannot defy fate.
Faced with this patient with advanced neuroendocrine tumor, Zhou Can was helpless, and so was Tuya Hospital.
The current medical level in the world is not able to cure patients with advanced cancer.
Even extending the life of patients is difficult.
Considering the patient's family situation, any doctor with a conscience would not ask the family to sell their house and empty their savings to pay for the patient's treatment, because this is no longer something that money can buy.
The final result will be that both people and money will be lost, there will be absolutely no hope.
When a patient is diagnosed with cancer, doctors generally do not tell the patient directly, and may even intentionally avoid telling the patient. As for whether the family members tell the patient or not, that is up to the family members.
Zhou Can led the family members to sit on the chairs in the aisle.
" After surgical exploration, your son's tumor has metastasized to multiple locations, and it has reached the advanced stage of cancer, which means he has lost the opportunity for surgery. All our hospital can do is to alleviate his pain as much as possible."
After hearing this, the family member grasped the edge of the chair with one hand, closed his eyes, and had an expression of great pain.
Sobs came from the depths of her throat and tears flowed out like beads that had broken off the string, continuously sliding down her slightly rough cheeks.
It can be seen that at the age of fifty, her face already has many wrinkles.
If a woman takes good care of herself, lives a carefree life, has a healthy lifestyle, and actively exercises and keeps fit, she may look like a woman in her thirties.
The woman's face has aged and she looks so haggard. She must have had a very hard life.
Now, she will fall into greater pain because her son has cancer.
It's really distressing to watch.
"Doctor Zhou, how long can my son live?"
She tried hard to wipe away her tears, but she couldn't.
As soon as I wiped it off, it came out again.
"If nothing unexpected happens, he should be able to live for about three months. In the late stages of cancer, cancer cells invade various tissues and organs of the body, causing great pain to the patient. You should try to make sure he eats and drinks well! I personally do not recommend selling everything you have for various expensive treatments."
Zhou Can would not make money by doing something unscrupulous, and I cannot guarantee that other hospitals or other doctors would not do the same.
Some private hospitals in particular will not stop until they have squeezed every last drop of blood pressure from the patient's family.
For a terminally ill cancer patient, the cost of treating him is millions.
The hospital does not belong to a certain person, but a collective. As long as the family members are willing to pay, the hospital will never oppose the doctor's behavior. Instead, it will approve and acquiesce.
After all, any hospital needs to make money, and only by making money can it operate stably.
The performance of a department is also closely related to the income of doctors.
There is no doctor or nurse who doesn't want to live a good life.
"I only have... three months to live..."
After hearing this, the patient's mother almost fainted on the spot.
It took a long time for her to catch her breath, then she covered her face and burst into tears, sobbing.
Zhou Can dared to handle any difficult case, but faced with the crying and despair of the family members, he seemed a little helpless.
The woman's crying also attracted the attention of many people.
Zhou Can felt even more uncomfortable sitting here.
Next time I talk to my family about this kind of thing, I have to do it in the office. Otherwise, it would be too embarrassing.
Fortunately, he was popular, and a nurse walked over quickly.
"Doctor Zhou, what's going on with her?"
"She learned that her son has advanced cancer and only has three months to live, and she had a mental breakdown. Please help comfort her."
Zhou Can felt like he had grabbed a life-saving straw.
The usual milk tea and barbecue were finally not in vain.
