Chapter 46

None of them had heard of this disease, including Song Zimo and Dr. Jin.

Dr. Jin looked at him in surprise, thinking, this kid reads more books than I, Old Jin, do. He had thought of him as a surgical craftsman, but he didn’t expect his theory to be so solid. On a day without any social engagements, he basically reads books in his spare time, books in Chinese or English, he has read all the orthopedic specialized works, and his papers are updated daily. He tracks international trends and has never heard of this disease.

He mulled over Yang Ping’s words and found some sense in them. Those with metal implants will release metal ions to some extent. These ions are taken to various joints by the blood circulation. If the synovial membrane is allergic to them, it can easily cause an inflammatory response. Theoretically, it is entirely possible.

Song Zimo gently nudged Yang Ping next to him with his elbow: “Senior Brother really is Senior Brother, to think of such an extraordinary disease, how did you learn about this disease?”

“I forgot, I heard it from someone.” Yang Ping said dismissively.

Director Han nodded, “Hmm, being able to propose this diagnosis shows that you have a wide range of reading and learning in your daily life, talk more specifically about it.”

Yang Ping said, “The patient underwent a fracture surgery of the lunate bone 4 years ago, during which two micro metal screws were used. These two screws were never removed. The onset locations are consistent with the inference; first, it was the left wrist joint and then other joints. The inflammation of the synovial membrane in the left wrist joint is thought to be directly caused by the release of metal ions, so it occurred earlier. The other joints were affected by the spread of metal ions through the bloodstream, so naturally, it happened later. Additionally, the timing also aligns with the hypothesis. The swelling pain in multiple joints appeared after this surgery. For now, I am just speculating and there is not enough evidence. We can try to remove the two screws and see if the symptoms will gradually diminish.”

“As for Dr. Yang’s opinion, I agree, let’s remove the two screws. Even if that’s not the cause, it won’t bring any adverse effects on the patient.” Tian Yuan’s opinion was moderate.

“How is it that none of you young men are speaking up?” Director Han said.

Usually, the discussion starts from doctors with less seniority and gradually escalates, with Director Han summarizing in the end. But today, this case was so rare that someone had to diagnose it as “difficult and complicated disease”. This diagnosis is reserved for cases where all doctors nationwide are stunned.

Just now, everyone was silent and it was like their mouths were sealed shut. But after what Yang Ping said, everyone’s mind was opened. Even though no one had heard of this disease, if Senior Brother Yang said it was the case, then it was. The rest is just about verifying the conjecture.

“Hmm, I agree with senior brother, no, Dr. Yang’s point of view.” Fang Yan said.

Little Five nodded too, “I agree with this opinion, it seems nothing else comes to mind.”

Zhang Lin raised his hand and spoke in a deliberately deep tone: “I have an immature idea. It is too slow to let these metal ions metabolize on their own. Can we use a chelating agent for metal ions and hasten the clearance of these ions, that way the symptoms can be relieved quickly.”

Director Han praised Zhang Lin: “Very thoughtful, let’s hear everyone’s ideas. Make bold assumptions and verify carefully.”

Zhang Lin perked up immediately after being praised, as if he’d suddenly grown taller.

Song Zimo said: “We can perform a joint puncture and draw joint fluid to test for metal ions to see if they can be detected. If metal ions can be detected, we will see if they are consistent with the composition of the implanted screws.”

Song Zimo is still Song Zimo. Although Yang Ping has boldly taken over the position of the eldest senior brother, it seems that no one can shake the position of second senior brother.

“Hmm, this is a good idea, drawing joint fluid for metal ion detection. This wouldn’t be hard for the laboratory. If necessary, we could ask the medical school’s laboratory to do it.” Dr. Jin agreed. He has always had a high opinion of Song Zimo.

“Even if metal ions are found, it doesn’t necessarily prove they are the cause.” Tian Yuan said.

The discussion started to escalate, Director Ouyang said, “In clinical practice, we should first address practical issues. By removing the screw and monitoring subsequent symptoms, we might gradually find relief. Such diagnostic measures are permissible in clinical practice, and besides, they pose no harm but offer potential benefit to the patient. As for other factors, they can be studied slowly. This is indeed a rare case and can be researched as a new topic.”

Director Ouyang, quite handsome, had an upright posture reminiscent of a soldier in stance. His salt-and-pepper hair added to his unique charm. Dr. Jin was of the same lean type. His group contrasted markedly with that of Director Bai.

Director Bai, weighing 180 pounds, pressed heavily on his chair. If it were not for the good build quality of the chairs in the department, the chair might have collapsed under his weight. His attending physician too was of substantial size. The two of them sitting together looked rather odd.

“Currently, many people are studying the effect of metal ions that enter the bloodstream due to the friction of metal-on-metal artificial hip joints on the human body. But few study the ions released by metal implants, because the amount of ions released can almost be ignored.” Director Bai spoke with vigor.

Director Ouyang chimed in: “I have searched for many documents and haven’t found any relevant papers. A few years ago, one of my classmates who was a visiting scholar in Europe mentioned that some European doctors were studying this, but I don’t remember the specifics. I also haven’t seen any related papers published about it.”

Everyone was very engaged in the conversation. They weren’t speaking carelessly but rather with certain thought. Rigorous clinical thinking is very important. In fact, it requires logical reasoning capabilities. A brilliant physician diagnoses diseases like peeling off layers of an onion, with clear logic and rigorous methodology.

The group’s combined views provided a clearer perspective to the case. Director Han said, “Why did we discuss this case? I only want to say two words, seriously. We need to take any issue seriously. Don’t think it’s just about joint pain? There are many cases where the cause is elusive, they receive routine treatment and then are discharged. Why does Peking Union Medical College Hospital remain the top hospital in the medical field? It is because of its rigor, this tradition has been followed till today.

The first AIDS case in our country was diagnosed by Peking Union Medical College Hospital. The process of it could be written as a fascinating book. At that time, nobody had seen such a disease and could only learn about it through literature reports. There were no mature biological reagents for diagnosis, it all depended on the doctors themselves to combine resources and break new grounds. There are countless such examples.

A patient with hyperthyroidism caused a loss of bone calcium throughout the body and was diagnosed with advanced bone cancer in several hospitals. The patient was not willing to give up and went to the outpatient department of Peking Union Medical College Hospital with difficulties. The professor examined him for a long time and then said, ‘I have insufficient experience in this area and cannot make a conclusion yet. I need to look up some references. You don’t need to make an appointment in a week, just come directly to the outpatient department to find me.’

The patient was furious at the time, waiting for several months just to hear him say he didn’t know? He almost blew up on the spot. He angrily left saying Peking Union Medical College Hospital was merely so-so. However, a week later, the patient thought it over and still decided to go find the professor.

At that time, the research on hyperthyroidism-induced bone mineral disease was just starting worldwide and many people were not familiar with the disease. The professor tried his best to find relevant literature and consulted with colleagues at home and abroad by telephone after getting off work. A week later, he made the diagnosis: it was hyperthyroidism, not bone cancer.

From then on, whatever the disease, the patient always went to Peking Union Medical College Hospital for examination. Even if he had to wait for months, he would still opt to go to Peking Union Medical College Hospital.

Previously, when the secretary of the World Health Organization Children’s Fund visited our country, he mentioned he was born in Peking Union Medical College Hospital in the 1930s. As a result, Peking Union Medical College Hospital found his birth medical record. The footprint from his birth was perfectly preserved, and the record of his mother’s several breastfeeding times a day was also clear. This type of rigor truly impresses mensen.”

Director Han, speaking earnestly added somewhat more, “I thought with this case, everyone would find it boring and feel it had no value for discussion. However, everyone spoke actively and enthusiastically today, showing that they are seriously considering it. Indeed, this is a rare case. An Austrian doctor researched it and published a paper on it, but it was in German and in an obscure medical college journal. Therefore, it might be challenging for everyone to access.”

When he mentioned the German paper, everyone’s eyes was directed towards him, wondering if this person could read German papers, surely not.

“Xiao Yang, where did you find this German paper?” Director Han asked.

“I heard a professor talk about it before, so I remembered it.” Yang Ping chuckled.

“No matter how you obtained it, if you can remember such obscure information and apply it when necessary, it is worth praising. You can proceed with this patient according to the procedure discussed just now. Conduct puncture of the joint fluid to find metal ions, and remove the screw surgically. Make sure to explain this clearly to the patient.” Director Han concluded in the end.

Could two screws cause severe synovitis of the limbs over three years? Is that really the case?

Everyone was impatient to know.