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本帖最后由 choi 于 6-29-2014 12:27 编辑
(1) Years ago, for a few years I read a handful of postings at www.mitbbs.com.com about diagnosis and treatment (frequently in bests hospitals) in China. In all those postings diagnosis and/or treatment made no sense--so I do not hold a high regard for medicine in China.
(2) This posting was originally posted as
倾心2007 (screen name), 一个硬币的另一面----美国看病记. 19楼 (name of the website), May 6, 2014 (杭州)
www.19lou.com/forum-1660-thread-4551399102990656-1-1.html
(3)
(a) There is indeed
Dean CHOU MD, Associate Professor of Neurological SurgeryAssociate Director, UCSF Spine Center, Department of Neurological Surgery, University of California San Francisco (UCSF), undated.
ucsf.edu/index.php/about_us_faculty_chou.html
(b) Alexander Gottschalk, PhD, MD, Director of Cyberknife Radiosurgery, UCSF Medical Center, undated.
www.ucsfhealth.org/alexander.gottschalk
, whose joint appointment is Assistant Professor, Department of Radiation Oncology, UCSF.
(c) International Services. UCSF Medical center, undated
www.ucsfhealth.org/services/international_services/
("Financial Requirements[:] Before you arrive at UCSF Medical Center, you'll receive an estimate of charges. You'll be asked to either make an advance payment or provide verification of authorization from an insurance plan accepted by UCSF")
(i) In Massachusetts I do not need to "make an advance payment," but then I am not an international patient.
(ii) The posting skipped the most critical part of going to a hospital: payment. It (posting) made it--the whole experience in UCSF--sound as "pay as you go" plan.
(iii) The following is what was written in the posting regarding International Services.:"罗伯特——UCSF国际中心专门负责接待我们的，所有的预约丶病历整理丶检查联络都由他负责。整个治疗期间我们没有排过一次队，所有都是他事先联系的，每次看诊，他基本都会陪同。来到神经外科，另一个华裔男子迎上来，他是国际中心指派的翻译。美国医院规定，对母语非英语的病人，看诊时都会提供专门的翻译，以防理解出错，耽误病情，而且这个服务是免费提供的哦。"
Translation is free. That happens in Massachusetts, too.
(d) Thomas G Martin, MD, Clinical Professor of Medicine, Adult Leukemia and Bone Marrow Transplantation Program, and Associate Director, Myeloma Program, UCSF, undated
cancer.ucsf.edu/people/profiles/martin_thomas.3387
The post described Dr Martin this way: "终于和DR Martin面对面了，他是个西班牙裔人，头发雪白." 头发雪白, it is true, but he is not Hispanic (or Latino), though he can speak Spanish.
(4) "老公是 5月7日检查出颈椎肿瘤的 [in Hanzhou]，5月30日，我们终于拿到了UCSF medical center（加州大学旧金山分院医疗中心）的预约单。"
Can it be so quick: obtaining visas, buying airline tickets? In US to get a discount for airline ticket, reservation has to be made at least two weeks in advance of flights. How about that in China?
(5) HOWEVER, the posting talked about diagnoses (plural form of diagnosis, as it is Latin (Greek spelled the same, but I am talking about plural form of a Latin word)), that is so extremely rare. That rare, perhaps not many have been reported in medical literature.
(a) You see, this is how the whole thing started: "3 年前，他 [老公] 时常觉得颈椎酸痛，开始没觉得异常，毕竟现代人十个里面有八个颈椎病。直到2012年春节，他的颈椎病越发厉害，有时候会觉得手指发麻。于是，催他去检查，在庆春东路的s医院骨科，拍了MRI." Paragraph 2.
(b) Then a couple of doctors made the diagnosis, simply on the strength of MRI, of "骨巨细胞瘤，属于脊椎肿瘤" (quoting F主任). Yet "giant cell tumor of the bone" (itself unusual) almost never afflicts the spine, much less the cervical spine. See
(i) giant-cell tumor of bone
en.wikipedia.org/wiki/Giant-cell_tumor_of_bone
(a relatively uncommon tumor of the bone; characterized by the presence of multinucleated giant cells (osteoclast-like cells) [photo of a pathological speciment, showing redder giant cells with multiple, purple nuclei])
(ii) Junming M et al, Giant Cell Tumor of the Cervical Spine: a Series of 22 cases and Outcomes. Spine, 33: 280-288 (1976)
www.ncbi.nlm.nih.gov/pubmed/18303460
("GCTs of bone are common, aggressive, or low-grade malignant tumors that occur infrequently in the spine above the sacrum, and their presence in the cervical vertebrae is even more exceptional")
Why would Chinese doctors diagnose GCT, without a biopsy? Biopsy is the first and natural course.
(c) It is INCREDIBLE that even Dr Chou mentioned GCT, too (quoting Dr Chou: "我研究了中国拍的MRI片子，觉得你最大的可能是骨髓瘤，如果是骨髓瘤不需要手术，放疗就可以。”一句话把我们打懵了。在中国跑了3丶4家医院，听了6丶7个专家的意见，从来没人和我们说过这种可能性。DR Chou 拿出一张纸，写下8个词分别是'骨髓瘤'丶'骨巨细胞瘤'丶'骨肉瘤'等，他告诉我们，颈椎这个位置的肿瘤，基本就是这8种可能性，每一种的治疗方法丶后续的防范和复发情况都不一样")
The truth is, when a MALE patient comes to see you with a tumor (biopsy not made when Dr Chou saw him for the first time), the most likely cause is metastasis--probably from lung cancer.
But I am unsure--even finish reading the posting--that the patient (her husband) had a tumor there. The symptoms of 颈椎酸痛 and 手指发麻 are vague--and can even be normal.
(6) "我们碰到的美国主诊医生都不穿白袍." This is true in Massachusetts, but some do (depending on individuals).
(7) Regarding biopsy. The posting states, "中国的活检，好像是住院时，由主管医生做的。美国非常重视病理报告，由专门的病理科医生亲自来做，保证提取样本的可靠性。" Come on, it is done, in US and Taiwan, by any doctor (including a physician, depending on what kind of biopsy)--except a pathologist. Because it was cervical spine, likely it was done by neurosurgeon.
(8) "抽骨髓的护士，就属于专科护士，在尾椎骨这里，扎针抽，做完问 '痛吗？' 回答 '没啥感觉。'”
But bone marrow biopsy (aspiration--drawing from bone marrow--is done prior to biopsy--a piece of bone marrow is cut out) is not done at 尾椎骨, but in the lower back. See
bone marrow examination
en.wikipedia.org/wiki/Bone_marrow_examination
("Bone marrow aspiration and trephine biopsy are usually performed on the back of the hipbone, or posterior iliac crest [photo]")
(9) PET-CT was done to make sure the disease was single--not multiple-sited, combining CT with PET (the latter does functional study: 往静脉注射一种糖代谢物用来标记肿瘤细胞).
(10) "两种药，总共5块多美金。和诊费比起来，简直可以忽略不计，难怪美国医生都不爱开药，医院甚至不设药房，靠卖药，他们早饿死啦。"
"医院甚至不设药房." I can not understand how they made the observation--so wrong!
(11) The posting continued, "焦急等待中，迎来了DR Chou助手的电话。她通知我们，活检结果确认是骨髓瘤，不需要手术。所以要帮我们转诊，转到放射科接受放疗，转到血液科接受检查 * * * 我们也开始了解骨髓瘤 [myeloma] 的情况。它其实是一种血液的恶性肿瘤，浆细胞 [plasma cells] 大量堆积，变异后，形成肿瘤，有单发 [solitary] 和多发 [multiple] 的区别。它会侵蚀骨骼，在脊椎和肋骨常见，但它的病症不明显，基本化验都查不出来，误诊率高达70%. * * * [quoting Dr Martin] '骨髓瘤，也叫浆细胞瘤 [plasmacytoma]，浆细胞会随着血液在体内四处流动。因此，单发的骨髓瘤只有百分之三，绝大多数是多发的。而且，骨髓瘤复发概率非常高，二年内复发概率超过70%，五年内复发概率超过50%，你们要做好准备。'"
(a) Interview with Dr Thomas Martin: New Treatments for Multiple Myeloma. UCSF Medical Center, undated
www.ucsfhealth.org/education/int ... r_multiple_myeloma/
("Hear Dr. Thomas Martin, a blood disorders specialist at UCSF Medical Center, discuss the latest therapies for multiple myeloma, the second most common cancer of the blood and one that's very difficult to treat")
The Web page (and discussion) is about multiple myeloma. But solitary is the same, in just about every aspect, except that it is single this time (can become multiple in the future).
(b) So it is incomprehensible that the coupe returned to Hanzhou happily. The road to recovery is just beginning! The patient will need a lot of treatment and examinations.
(12) "光阴如梭，8月底，我们又一次回到了UCSF，又一次回到了DR Chou的诊室。好吧，一切从他开始，到他结束。美国是主诊医生负责制，第一个接诊医生负全责，由他来判定治疗效果。DR Chou翻出两张MRI片子，一张是刚刚做的，一张是3个月前中国做的，他指着相应的位置示意我们：'肿瘤明显萎缩，说明放疗效果非常好，这个过程还会持续，直到肿瘤细胞完全失去活性，形成一个痂似的存在。'”
(a) Why see Dr Chou again? Incomprehensible. "美国是主诊医生负责制，第一个接诊医生负全责;" wrong.
(b) "肿瘤明显萎缩." Not completely gone yet?! And the patient departed for good!
(13) In case you want to know more about solitary myeloma.
Howard Chang, Solitary Bone Plasmacytoma – What Every Patient Should Know. The Myeloma Beacon, May 4, 2012.
www.myelomabeacon.com/news/2012/05/04/solitary-bone-plasmacytoma/
(a) In the disease, blood calcium level elevates, because tumor cells are eating the bone, releasing its component calcium.
(b) A plasma cell is a B lymphocyte that is activated by antigen. A plasma cell releases immunoglobulin or antibody. Because only a plasma cell underlies the myeloma (singular or multiple), the diseased cell is a clone secreting a single kind of antibody. So much antibody (of this kind) is made, it (the antibody) spills from blood to urine, despite the best effort of the kidney to recover it (losing it is losing nutrition). |
发表于 6-29-2014 12:15:04