crazy scalpel

"You are not only sick, but I'm afraid the treatment is a bit complicated." Seeing that Zhong Liangquan was a little uneasy, Xie Ke comforted him: "But as long as you actively cooperate, I believe we can still cure this disease. But Don't forget what I just said. Communication is very important. Whether it is your illness, symptoms, or your true thoughts, I hope you can talk to me. Of course, I will also share all my I will tell you what I know, and not hide it.”

Zhong Liangquan: "Oh, ok. I'll tell you everything."

Xie Ke smiled at him: "Don't be nervous. It's really not easy to treat cervical spondylosis, and you often don't get good results, but it doesn't directly threaten your life after all. We can take it slowly, and the ultimate goal is to improve your health. quality of life."

Zhong Liangquan: "Then, Xiao Xie, you said that my spine didn't press the nerve in the left arm, so what's the matter with the pain in my left arm?"

"All the nerves responsible for feeling pain on the body surface and internal organs are transmitted through the spinal cord," Xie Ke pointed to his head, "The brain is only responsible for receiving signals. So there are often misunderstandings due to various reasons. This There are two kinds of misunderstandings. One is a mistake in the signal transmission process, for example, if your left arm hurts, it may be a heart problem.”

Zhong Liangquan agreed. When he came to see a doctor, the radiologist had done a heart examination for him.

This kind of pain felt in a place other than the source of pain is called associated pain in medicine.In addition to the left arm related to the heart, indigestion may cause chest pain, kidney stones may cause stomach pain, bladder accident may cause pain in the collarbone, and appendicitis may also manifest as lower abdominal pain.

"But according to your examination, your heart is very good." Xie Ke continued, "There is a second situation, that is, your brain was deceived by you."

"?" Zhong Liangquan learned to be smart this time, and didn't ask any more questions, but waited for Xie Ke to speak.

Sure enough, Xie Ke continued on his own: "Let's use an analogy. Do you know how thieves steal things?"

Zhong Liangquan thought about it cooperatively: "Sneak? Sprint? Feint? Open the lock?"

"..." Xie Ke was dizzy, why did the patients he encountered either read Goosebumps or play games?He coughed, "I mean in reality, thieves carry out stealing strategies. They usually commit crimes with two people. One is responsible for touching you in front to attract your attention, and the other is responsible for taking advantage of your attention away from the back." time to strike."

"That's right," Zhong Liangquan said, "That's how my wife's cell phone was stolen."

Xie Ke nodded with satisfaction: "The principle is that when the person who is responsible for attracting your attention touches you, the receptors in your body responsible for feeling will send a signal to your nervous system, and your nervous system will Respond to it first, and its sense of its surroundings will be weakened. And your scoliosis bulges towards the right arm nerve, but your right arm does not feel discomfort, this is probably because of your Too much attention was drawn to the left arm."

Zhong Liangquan: "So, if my left arm stops hurting, my right arm will start to hurt?"

"It's not impossible, but the problem with your left arm may be your heart." Xie Ke said while pointing to his head again: "It's not the heart, but the psychology. All psychological problems, It's all about the brain."

Whether it is the East or the West, in the earliest recorded history, people initially regarded the heart as an organ to control human mind.It wasn't until the development of anatomy that people had to admit that in fact, whether it is the place where the commands to the various organs of the body or the place where the so-called mind and thoughts are produced, it is the brain in the most tightly protected skull of the entire human body.

"Psychological problem?" Zhong Liang didn't believe it at all: "How is it possible?"

Xie Ke: "It's really very possible. That's why I repeatedly emphasized to you that you must communicate. My guess is that because of the recurrence of your intervertebral disc herniation after the first operation, you have to undergo the second operation. At this time, you have already begun to have doubts about Dr. Zhao Hua's treatment plan. But you did not express your worries. After the second operation, you saw this scoliosis from the cervical spine film. At this time, you must be very uncomfortable, because there was no such side curvature before the operation, so you must think that the surgeon who performed the operation is not skilled enough to cause this situation. I said, right? "

Zhong Liang didn't refute at all.

Xie Ke: "After you plant this seed of doubt in your heart, if one day you occasionally have pain in your arm, your feeling will be amplified. You will be more and more inclined to believe that the pain is caused by a failed operation. Caused."

Zhong Liang didn't speak at all, but he obviously didn't believe what Xie Ke said.After all, this kind of analysis is completely guesswork.Since Zhong Liangquan chooses Western medicine and surgery, it shows that he still has a lot of trust in scientific things.If it was just such a guess, it would be impossible for Xie Ke to convince him.

And Shayk understood this, so he said, "Okay, we've summed up the psychological factors that may affect you, including," He stretched out his palm, clenched it into a fist, and then raised his thumb first. , "One, your anxiety and depression about your condition and the pain itself."

Xie Ke raised his index finger again, "Second, the gap between your expectations for the surgery and your actual satisfaction."

Then the middle finger was also stretched out, "Three, pressure from society, such as the money paid, your wife's attitude, etc."

Xie Ke gave Zhong Liang Quan a three-pointed gesture, "Now, I also want to tell you the theoretical basis. I have explained to you just now that the transmission of pain signals is through the central nervous system. To be precise, the When tissue is injured, cyclooxygenase converts a fatty acid called arachidonic acid into prostaglandins, which trigger inflammation and pain."

Cyclooxygenase has two isozymes, cox-1 and cox-2.

Among them, cox-1 is an inherent enzyme in all cells, while cox-2 is an immediate early gene that is expressed after injury.

However, unlike cells from other tissues, both coxs are expressed in the spinal cord.

Cox-2 is rapidly upregulated in neurons in the spinal cord after receiving a signal from a noxious stimulus, producing large amounts of prostaglandins.Prostaglandins increase the sensitivity of nociceptors to noxious stimuli, leading to increased pain perception and responses to normally innocuous stimuli.

This is the reason for "no disease" but "pain".

There may indeed be pain at the beginning, but with Zhong Liangquan’s psychological factors, after amplifying the pain, this feeling deceived his brain, causing the pain signal to increase excessively, and causing the receiver to sensitive.

It's like when someone pokes you, but you feel like you've been stabbed by a knife.Overreact.

This persistent noxious stimulus changes the function, chemistry, and even structure of the neurons responsible for nociception.This is called neuroplasticity.

Xie Ke: "After a series of reactions, it will finally affect the central regulation of sensory signals, causing the intermediary inhibitory neurons to lose their function and apoptosis. To put it bluntly, it will cause the brain cells responsible for this area to die. It will be transmitted to the brain Increased nociceptive signaling in your brain amplifies your perception of pain, which is called central sensitization."

Zhong Liangquan opened his mouth, but did not make a sound. He really didn't expect that mental activities could affect the cells in the body.

Xie Ke: "Central sensitization will not only make your pain worse, but also turn your pain into long-term chronic pain, which is very painful. So we have to start from all aspects, and let you be abused by cox-2. The old neurons are remodeled."

Zhong Liangquan: "Then what should I do?"

Xie Ke continued to look at his various examination results, and suddenly asked: "Why didn't you do an electromyography after the second operation?"

Zhong Liangquan said: "Oh, isn't the intervertebral disc herniated? After cutting it out, I still need to do it? It is said that it can be done or not, so I didn't do it."

Xie Ke asked Zhong Liangquan to stand up, then took his left hand, and gently pulled it down, Zhong Liangquan immediately bared his lips.Xie Ke helped him lift it up gently, and asked him, "How about this?"

Zhong Liangquan: "This is much better."

Shayk: "Have you ever hurt your shoulder?"

Zhong Liangquan: "No."

Xie Ke: "You take off your clothes."

"Ah?" Zhong Liangquan: "What are you doing?"

Xie Ke: "Let me see your muscles and touch them."

Zhong Liangquan had no choice but to take off his shirt, exposing his collarbone and shoulders.Xie Ke looked at his bulging and full shoulder muscles, compared them left and right, and said, "Go for an electromyography, it may be a strong rib."

After sending Zhong Liangquan away, Xie Ke rubbed his forehead and sat back in his chair. This patient is really troublesome.

The intervertebral disc herniated and two pieces were removed.

Failed spine surgery syndrome, postoperative scoliosis.Zhao Hua's operation was indeed not good, but he also had problems with his psychological endurance.

Coupled with the strong ribs, there are three diseases just by counting.

And they were all in the same position, so it was hard to tell which was the cause of his pain.Or, which one has the most reasons.

However, Zhong Liangquan was Xie's father's former colleague after all, and Xie Ke would do his best no matter what.

That being the case, it can't be said that there is only another operation.Correct the bad things done before, and then cut off all the sources that may cause the pain.

Xie Ke casually drew a sketch of the surgical approach on the draft paper, made an incision above the collarbone, first relieved the compression of the nerves and blood vessels caused by the ribs, and then in order to completely solve the poor intervertebral discectomy performed by Zhao Hua, He was planning to go straight to a spinal fusion to fix those three levels together.

Xie Ke was immersed in the analysis of Zhong Liangquan's condition, thinking while walking, until he returned to the door of the house, he found a pile of old sofas, old tables and chairs in the yard.They looked familiar, as if they were all from the brother's study.

There was also a note posted on it, "Whoever wants it, take it."