在美国看急诊看专科--看肾结石小记 (w English)

2019-03-12 23:03

好些年前，一天夜里边上有个朋友胆结石发作，疼痛难忍送急诊，从急诊住院最后手术割掉胆囊，取出很大块的结实。后来我去他家时，他还拿出结石给我看过，好几颗，而他描述当时送急诊时的疼痛时，用了"上窜下跳"这四个字。

二月二十四，周日晚9:30左右，我突然间感觉到左下腹疼痛难忍，接着又是翻江倒海地呕吐，最后只得急匆匆赶去急诊室。当CT最后发现是一颗六毫米大的肾结石在作怪时，我心底略略松了一口气，庆幸只是一颗石子，并无其他大碍。那晚挂了点滴，打了止痛片，凌晨二点回到家昏昏睡去。

不料，就是这小小六毫米大的结石，在体内歇了两天，周三上午2月27号11点多又开始发作，疼得浑身冒汗，连车也开不了，只好叫某人来接我回家。回到家中，才发现家里普通止痛片根本不起作用，某人拿着急诊医生开的高强止痛片，手忙脚乱的，去药房拿，等拿到已经下午两点。一颗止痛药下去，疼痛没有抑制住，一个半小时后又开始狂吐。我躺在床上打家庭医生电话，打专科预约，那时候等待的每一分钟都是煎熬。四点多家庭医生与专科医生的意见反馈过来，鉴于疼痛和呕吐情况，建议再去急诊。

周三五点的急诊室人不少，这次的我没有那么幸运被马上送进病房，而是被晾在一边。我在大厅角落里哼哼唧唧的，没人理，又让某人把自己推坐在医务人员进出的口上，接着哼哼唧唧，还是没人理睬。估计不是什么高危病人了，没有生命危险，服务人员见怪不怪。等了两个小时，终于被推进入内。这次用药参照上一次，只是没有做ct，只做了x光、血和尿检。晚上10点20左右被放行回家。

两次的剧痛，让我对此心存几分恐惧。周四上午一上班，我就开始打电话约专科医生，心想马上又到周末了，可不要三进ER。一通电话，一通保险公司确认，终于约到了周五一位专科医生。放下电话，上网一查，发现这医生很年轻， 2018年才开始行医的。不过事已至此也管不了那么多了，病急还真是乱投医呢。

话说这六毫米的结石是个临界状态的石头，说小不小，说大不大。当2月24晚查出是六毫米结石时，某人掏出手机上网查，当时网上的信息是70%的可能性会自动掉落。当2月27号再次进'ER，我问医生，自动排出的可能性是多少时，医生的回答是百分之五十。到3月1号再看专科医生时，同样的问题，答案是40%到60%的可能会自动排出。

从2月24到3月1号整整五天时间，我对结石自动排出的希望也随着医生的信息、时间的流逝而变得渺茫起来。周五看专科时，医生给了一个白色的漏斗，如果结石排出了，希望能接住做个化验分析。整个周末，我除了睡觉午休，不停地喝水，每次上厕所手拿漏斗，满怀希望，希望看到纯白的漏斗里出现一块小石头，这种期盼不亚于当年淘金者大浪淘沙，希望从过滤的江河水里看到金子的影子。无奈，整整两天，不见一点踪影。

周末很快过去，迎来了新的一周。周一上班后的第一件事又是打电话给家庭医生，希望refer到另外一位专科医生，寻求second opinion。我隐约觉得周五看的这位医生太年轻 ,态度也一般，她匆匆看了急诊的报告后，就准备安排手术时间。而我总觉得手术是最后一张牌，不得已而为之。

在网上看了网评后，我要求家庭医生refer一位第一次急诊时医生推荐的专科医生。一番电话恳求，终于约到第二天上午的一个appointment。

于此同时，周一上午在公司，自己又是拼命喝水，还在水里加了很多新鲜柠檬。午饭前上完厕所，发现toilet里有一颗褐色的小东西沉淀在那里，就在我片刻犹豫想定睛再细看时，一声自动冲水系统的哗啦声，把水中物体冲得无影无踪。我半信半疑地回到座位，脑子里一直在纠结，我看到的是结石吗？

周二上午十点多，我开车去了一个车程二三十分钟远的诊所，见到一位中等年纪中等身材的男医生。医生说了这样一句话，CT上测出的6mm很可能实际上只有4-5mm，这个信息很关键，因为前面讲到6mm是临界状态，小于6mm，结石掉下来的可能性急剧增加。而随后几天的无症状让我越来越相信体内的石头已经在一天前排出了。我心上的石头也随之一天天滑落。虽然最后的确诊需要再做一次CT(Xray都无法查出)，我已经不把它当回事，也不准备再做一次CT了。

据网上的统计数据说，十个女性中会有一位得结石，而男性得结石的比例比女性大一倍。写下这些流水账，希望给网友们一些借鉴。虽然造成结石的原因众说纷纭，成因不明，有可能是家族史，有可能是饮食，也有可能是某些人的体质就是容易得结石。虽说结石很多情况下是钙化的结果，医生并不建议减少钙质食物。另外，我个人对网上建议的、饮食上控制某类食物，比如，控制鱼、肉(poultry)、深绿色蔬菜、巧克力等等，心存疑问，尤其是说到柚子(grapefruit)和富含维生素C的蔬菜水果会导致结石更是疑问重重---为什么柠檬可以帮助排出结石，而柚子则在黑名单上? 但是，有一点我坚信不疑，那就是多喝水，少进盐，少进糖。脱水（dehydration) 是结石的第一凶手，网上资料说到在极度恶劣环境下的士兵因为脱水会患结石，让我联想到马拉松运动員等其实是需要及时补充水分的。

一直以来有种感觉，美国医生的水平和素质是良莠不齐的。拿这次看病来说，一个急诊医生会告诉你每6小时服用止痛片，24小时不间断，服用五天。而另一个专科医生会告诉你，止痛片需要时才服用。又比如，四个医生中，只有最后一位医生告诉你，CT上的六毫米结石实际有可能只有4-5毫米这样关键的信息。

随着网络的发展、信息的普及和交流，人们对疾病了解的渠道越来越广。除去需要CT, MRI这样高端仪器的诊断，人们在很多情况下对自我疾病的了解和用心观察，会让自己成为最好的医生。

最后，借此感谢众网友的关心，你们的问候和意见(例如可以用声波击碎，柠檬有助结石排出，茶叶不利于结石排出等)都让我感动，给了我温暖和信心。让我们一起健康，远离疾病苦痛!

"You’ve tricked me.” The nice young ER doctor said smilingly. “It is a kidney stone that travels like this in your body to the current UV junction.” The doctor gestured a diagonal line from a kidney to the left lower abdomen.

I felt a bit relieved at the conclusion from the CT scan, that it was a 6mm stone dropping from the left kidney that caused the acute pain and the vomit. Pain was gone by the time the high dosage pain-killer had been inside the body for an hour or so. Tired and dazed with sleep, I was home 2 am in the morning of 02/25/2019.

However, my second ER experience on 02/27/2019 wasn’t that lucky. Wednesday evening’s ER was much more crowded. Though nobody looked as painful as I did, I was left unattended in the check-in lounge groaning for almost two hours before being admitted. Then a nonchalant young doctor saw me, without much enthusiasm, without much advice, a bit inexperienced to me too. He followed the first ER doctor’s medication, and instead of another CT scan, which was unnecessary, I had an X-ray. But the X-ray could not detect the stone. I was released around 10:20 pm at the night, being told that I would have to take the pain-killer Toradol every six hours around the clock for the next five days.

When Thursday came, the first thing I did in the morning was to call and make an appointment with a urologist, but the referred urologist wouldn’t be available until March 8. Worrying about the coming weekend, I decided to go with any doctor available in the group. So, Friday morning I found myself talking to a very young specialist who started practicing since 2018. She suggested surgery and had it scheduled in advance if by the time the stone still would not pass on by itself. She dismissed the ER doctor’s around-the-clock pain killer advice, but to take it as needed. A white-color strainer was given to me upon my leave.

I started to drink water like a cow in the weekend and hoped that the stone would pass on. However, much to my disappointment, large quantity of water resulted in frequent pees, with no anticipated small stone filtered out in the strainer.

Then came Monday. I called my family doctor, asking specifically for a urologist in the network, who was referred by the first ER doctor, for a second opinion. Then I frequented the company kitchen for more water, squeezing fresh lemon to it as suggested online and a friend who left a comment in my blog. Then something happened. A brownish small stone was spotted at the bottom of a toilet when I went to restroom. Before I could take a closer look, it was flushed away automatically. I stared at the clean toilet, empty and void of anything. Within minutes, I started to question myself. Was it really a kidney stone I saw?

The doctor I saw the very next day on Tuesday obviously looked more experienced and confident. By the time I saw him, I did so much homework by myself that I know a 6mm kidney stone has about fifty percentage chance of passing on by itself. Stones smaller than 5-6mm have much higher possibility. What I didn't know or what the three doctors did not tell me is that a 6mm kidney stone diagnosed by a CT scan could be 4-5mm in reality. Hearing this from the last doctor I saw, who said with an affirmative expression, I was led to believe that the little stone I saw the day before must be it, as pain did not afflict me again ever since.

戳这里 Claim your page

来源: 文学城-暖冬cool夏