Q&A之手肘脫臼Dislocation篇
手肘脫臼Dislocation，如果沒有外傷的跡象，西醫認為應以物理治療為先與中醫看法一致，但如果保守方式無效的話，仍要以手術方法治療，原因是脫臼不是只簡單的小毛病，受傷後附在旁邊的血管，肌肉，肌腱，神經等都同時受到損傷，尤其是成人更不能忽視這看似簡單的傷痛。
除去物理治療外，談到中醫治療，醫囑中一定包括消腫藥等，如果也都沒效的話，我曾經為親人請教過三位專家會診。在我觀念中是學問、人品、經驗均是良醫者，不以批評西醫為前題的為上，而且應以審視西醫的方式挑選專業，甚至於請中西醫會診，我在行醫途中見過多位學問淵博，學者風度的良醫(中醫) 曾共同用整合方式關心病患。
任何手術都不是小手術(有笑話說:所謂"小手術"是別人的手術!)千萬不能忽略在手術前要準備的是手術後的恢復順利與否。準備工作完全不能忽略、除去花時間找良醫外有更多細節要關心:如果狀況需要以手術治療的話，應考慮及注意的項目應包括下列所述:1)你對一切有關你手術的細節都要儘量去熟悉、去瞭解、完全不能偷懶。 首先你就要請你的醫生把手術的過程講解清楚、一定要動手術的原因是? 當然你聽到怎樣把哪個地方切開、可能輸血、可能的副作用等愈聽愈心驚肉跳。 但是大部分病患都感覺到瞭解的愈多愈有信心、愈放鬆。
2)最要緊的是問清楚你手術的風險和好處、更重要的是拒絕手術後可能有的風險。雖然世界上最有名的外科也沒法給你100% 的保證、至少你徵求了不同醫生的意見後一定可以做個有智慧和有足夠常識的最有利於你的選擇的。
3)問清楚時間的安排、手術是不是馬上要做、還是可以安排到幾星期之後呢?例如: a.你有很棒的運動細胞、平常就以打球消遣週末的空時段、沒想到出意外、你的生殖器官被一個快球打個正中間、你的痛彷彿直奔下腹、胃、頭暈的沒法站穩、你用手輕輕的摸了摸看看是否兩邊的睪丸還在、發現左邊的已退回腹腔，或是你嘔吐、然後肚子疼、疼到右下腹。 突然血壓低、近休克……………這以上的三种都是急診、沒時間附合手術前準備。b.你的膝關節彷彿不聽使喚、喝咖啡坐的也不過兩三小時、站起來好像要抖幾下才行、上捷運還可以爬樓梯、下來的時候一步一痛、只能用自動升降梯。看了李主任名骨科、看了看x 光叫你準備排時間開刀。你準備半天的問題還沒張嘴就嚥下去了。回家想想、只要不坐太久、下樓不走樓梯等等決定再找第二意見、劉醫生問診較細心、安排了核磁共振原因是你屬於年青的銀髮族、健康情形不錯、劉醫生認為是膝關節半月板的磨損或者有個小裂痕、做個核磁共振好做準確的診斷、在檢察的這段時間囑咐你要節制不适當的運動等等。劉醫生沒有四五個助理、病人也不是五分鐘一個、下一次再來可以把你的問題都準備好來問清楚了。
4)如果可能的話、看醫生的時候帶個親人、朋友、都沒有帶個錄音机 (不是為了要告醫生而是你自已會太緊張、記不住醫生的叮囑 )、 特別是醫生無意之間用的很多術語。
5)手術前看醫生不能馬虎了事、這時候的準備要包括不只手術前的準備、主要 的是: 手術後的維護、重要的是手術後用的藥 、復健的安排、是否要租專用的床、輪椅、也別忘了準備敷傷紗布、繃帶。
6)手術的費用、是否健保完全給付、自己要負擔的部分是不是要準備賣房子!?美國對病人是最嚴酷的極刑就是醫療保險、我在「一定要看名醫嗎」書中提到醫療誤失之後、自己醫療保險反而拍屁股走人的事不勝枚舉。 醫生不計較也要付場地 (醫院、手術室、儀器、連消毒藥水、紗布:一定要數清楚、除去算錢外、怕留在病人傷口裡)。
7)手術後你的活動方式是不是要全部改觀:八圈麻將需要減到三圈嗎、每天三場國標舞行嗎、你每天看三診病人加起來兩百多人找誰代診、每週二的幼稚園義工能去嗎、不上班要休息多久、大概也要知道、除非你是名人、或有錢有權、否則好好準備于手術後的事吧。
8)別太省錢、盡能力找個幫忙清理買菜的臨時工、有小孩嗎、一定要找個看媽。要問醫生你能休息多久、這樣事先的妥善安排省心省時、你的恢愎期也快、如果我們都相信免疫系統的話、這樣的準備也可以增加免疫系統功能的、手術前手術後都需要增加免疫力不是嗎!
9)我堅持沒有小手術、小手術可能引發大出血、可能有生死交錯的細菌感染 、要踏實的妥善安排手術後的活動:燭光晚宴還可以、小攤子、速食店要少去、特別是消化系的手術。也不要整日不休的和親朋好友述說你手術中血淋淋的情與境、不但別人聽膩了、跟你絕交、你的手術後的休養才是最重要的。
10)最需要的是在麻醉師沒開始注射麻醉藥之前先自我介紹、告訴主刀的醫生你是左腿需婆要動手術、你的名字是……、你出生日期是……我的左腿需要動手術、也許手術室的醫生護士暗中笑你、但寧可如此也免得好腿無辜挨一刀!另加一項:有些手術前已經在你的左腿上畫上一個大 X、否則自已可以先畫上一個大 X。(當然這是在四肢的手術時才有用)。11)一定要告訴醫師你一直在吃的任何藥、中、西、補、瀉、丸散膏單、一點 都不可馬虎、劑量、你對任何藥的過敏。特別是糖尿病人更要注意、血糖的高或低在手術時都會有危險。
12)手術時最好有人在手術候診室陪你、這個人有多方面的功能、緊急通知、記錄手術後醫生的叮囑等。
13)雖然勤快也別自已作主張幫忙!例如你要動盲腸切除也不需要你自已先剃掉自己的右下腹的毛因是手術前是不用剃刀的去毛的、主要怕有微細的皮膚傷口會有嚴重的細菌感染。
14)也許醫療人員都會罵你、可是命是你的、請他她們一定要洗手、目前醫院最可怕的細菌感染、不幸也是死亡率最高的。
15)麻醉師、麻醉醫生是手術時另一位重要的人、手術前她會來看你、記得要告訴他你目前吃的藥、對藥的過敏更要告訴他。
16)在手術前有一些例行公事:心電圖、驗尿、驗血、放輸尿管、清洗局部、點眼藥水。如果這些該做的準備工作你有些關念的話減少對手術的恐懼感會減少。
17)可能的話、要求你的醫生安排你的手術在清晨第一臺、好處是你可以減短空腹等手術的時間、同時清晨第一臺是開刀房最清潔的時候、也更是手術團隊精神最好的時間。
18)手術後的 24小時儘量休息、中外習俗有異、中國病人只注重休息、進補、忌服用生冷。外國手術後積極催病人下床走路、喝冰水、吃冰塊、兩种習慣、我認為只要手術順利、沒有節外生枝、只要病人舒適都可以由病人自已決定。———以上摘錄自「看病的EQ一書」by 張之申
Thanks for your advice, I'll try not to use my right hand too much.
I scheduled an pre-admission test with my family doctor on Oct. 27, basically it's a routine test just like my annual check up test, receptionist said this test should be done about a week before surgery, the result will be more "fresh".
It's really nice to have the chance to talk to you, and get knowledge and comfort from you.
Mercy
I felt really bad for you that you have worked not only on the normal daily routines, but worked
tediously at jobs which required more than what is normal efforts! Please do your best to rest, remember what you must avoid is using your hands to do delicate jobs: playing the piano, guitar, sewing, art work, making Chinese dumplings (!). It requires much more intricate functions of your nerves and muscles in general. My second advice is more like common sense: Perhaps to have a family meeting to delegate daily routines, remember the family that helps you with house work loves you more than bringing you chocolates daily post surgery!
You general health must be maintained:
Our mental status is of utmost important to our recovery, and do remember, there is no "small surgical procedure", relax, plan for post surgical
activities, give yourself some pampering before surgery, a good book, a new CD, set your stage for
a peaceful recovery.
*****Lastly, limit your salt intake will reduce swelling eventually, a good habit to build starting now.
Trust your doctor, some of the presurgery tests are routine, some are more complex, all of them are necessary to make the procedures as smooth as possible. Do not worry, you will be just fine, keep me posted. Regards, Dr. Chang
令堂的年齡，經期，和許多其它病史及診斷中最重要的資料都缺，暫時在這兒無詳細問診的機會，很可惜，但無論如何體重遽減十公斤是一定不能忽視的。至於基本檢查，甚至於多項檢查而沒經醫生的關心問診，就亂石打鳥做檢查，
routine testing 對病的診斷毫無貢獻外，反而讓病患茫茫無助。
至於令親的建議不無道理，但請你不必太過緊張，就如你關心的鎖骨異狀應是正常，和甲狀腺位置有矩離。
我目前在台，如果母親的基本資料可以給我參攷的話，我可能會對她的問題多些瞭解和建議。
當然如果母親能找著一位良醫診療才是我最由衷的意見。
我將會把和 weight loss 可能有的起因列出供你參攷，別忘了，兒女的關心才是母親的 "良藥" !
Thanks for your participation and trust in me, take care, I will follow.
Dr. Chang
2008/10/10 Millicent 張醫生，您好:
我是從您的部落格而得知您的MAIL，
先謝謝張醫生願意提供一個管道讓醫病間多一溝通。
想請問的問題是:
家母最近兩三個月，體重遽減十公斤，
但除一直流汗外，並無其他異狀，
也於日前到縣立醫院做最基本的體檢，一切正常。
不過，有親戚推測家母可能有甲狀腺亢進的現象，
我仔細看了一下家母的脖子周圍，
也發現左邊鎖骨處明顯比右邊突出許多，
於是，我建議她再到醫院做相關的檢查，
但目前也只能等待檢查的結果，
想請問張醫生是否有其他建議？
謝謝!
祝 平安順心
丁同學
It feel so warm that someone celbrated my decision at a Starbuck.
Yesterday I went to NY Chinatown to join our Chinese school parade for celebrating double tenth. I was busy until tonight check your blog, your advice is "you must rest your hand prior to surger", oh, no, I was doing yard work, clean autumn leaves for 3 hours and painting the wall for 2 hours today.
Dr. H asks me to do pre-surgery test, I need to go to my family doctor to schedule this test.
Any other "You Must..." advice before or after surgery?
Mercy
Thank you for making my day!
Please remember, also, that you must rest your hand prior to surgery. Therefore, if I do not hear from you, I know you are on your way to recovery. Have complete confidence in Dr. H. and with warm regards.
I am celebrating your decision at a Starbuck in Taipei!
Do continue your comments and suggestions concerning my Blog after your splendid recovery.
Dr. Chang
Greetings from New Jersey.
Once again, thank you for your response. Actually I've been visited 3 hand surgeons already, I was hesitate and can't make up my mind. After I got your reply, make me sincerely consider about surgery. Thank you for your 18 tips - before surgery preparation. This is really a great help.
Today I called one of Dr. H's patients - who had right elbow surgery on January. (I got her umber thru Dr. H's secretary), she is very satisfied with her surgery, she said Dr. H is a great surgeon in this field. Just like you said, surgical procedures at the present have advanced so much. I was so worry about the incision and pain, she told me the incision are not that noticeable after recovery and regarding pain, they will provide pain killer, it wan't that bad.
Guess what? I schedule a surgery with Dr. H's secretary, the earliest available is Nov. 6. I hope I will have a splendid recovery just like you said.
Mercy
Thank you for your comment and support.
It is with readers like you and the enthusiasm you exude that encouraged me to continue my mission of
"Patient, educate yourself and stay healthy".
Thank you, regards from Taipei.
Dr. Chang
Greetings from Taipei.
I am very glad to see that you are taking great care of yourself. I agree with Dr. Houseman's advice, further more, you are only 52 and there are more than just 20 years of demand on your right hand. Surgical procedures at the present have advanced so much and microsurgery is definitely one of them. Should you still consider another opinion, you may consult another qualified surgeon. However, my advice is for you to make the decision soon. I have confidence in your own wisdom of choice and I foresee a rather splendid recovery.
I am presently in Taiwan, and I look forward to hearing you, do keep me posted.
With regards,
Dr. Chang
經一位骨科醫生介紹去見一位專門做微創手術的Dr. Michael Houseman at Mt. Sinai Hospital in NY, he said I need motivation to do it, if I can stand with it, then I don't need surgery. I am 52 now, if I will live another 20 years, may be I should have surgery? How do you think about microsurgery?