Surgery Godfather
Chapter 507 - 463: Can Monkeys Get a Herniated Disc?

Chapter 507: Chapter 463: Can Monkeys Get a Herniated Disc?

"Help him out?"

Zhang Lin worried the intern might collapse again.

If there were any mishaps, no one would be willing to take responsibility. It is better to prevent complications.

The intern stubbornly shook his head, insisting on staying in the operating room. As a future surgeon, he would have to face even more stimulating scenes; this was a hurdle he must overcome.

Song Zimo seemed to see a reflection of his own past when he was leaning against the wall of Mo Sixth emergency center, swaying and dizziness.

He understood the intern’s psychology best at this time. Afraid of been expelled from the specialty of surgery, he needed to appear unaffected even if he was experiencing inner turmoil, telling everyone: I can do it!

"Let him stay. Be careful and speak up if you feel unwell. In fact, it’s not a big deal. You’ll get used to it over time." Song Zimo encouraged the intern and told Zhang Lin not to kick him out.

Naturally, Zhang Lin did not dare to go against Song Zimo’s words. Song Zimo’s status as the second brother in the department was unshakable.

Zhang Lin and Little Five used to dream of competing for the position of the third brother. But since Xu Zhiliang joined, they gave up the idea completely.

This stutterer was not only incredibly hardworking, but also very intelligent. Zhang Lin even suspected that the reason why the man’s mouth couldn’t keep up with his mind was causing his stutter.

The removal of gout nodules is no different from the removal of surface tumors. It’s a basic surgery.

However, maintaining normal healing of the surgical incision post-surgery is challenging. Every detail needs to be attended to with utmost precision. The bleeding needs to be thoroughly stopped, and layers of stitches need to be dense, with no leaks.

If there’s a leak, tissue fluids mixed with urinary crystals keep seeping out from the gaps in the surgical wound, causing the wound to never heal properly.

"Lime" cannot be completely cleared. It is almost ubiquitous, having soaked into cartilage, synovia, joint capsule, ligament, and tendon. Almost all tissues around the joint have been eroded by it, and there’s no limit to this erosion.

As long as the chunk of "lime" is removed, it’s good enough. The area is continuously rinsed with a large amount of saline and the white turbid "lime" water, which flows from the aspirator to the suction tube and into the collection bottle.

Excess skin and fascia are trimmed, and the incision becomes fusiform. Some areas with large gout nodules are also left with negative-pressure drainage.

After efforts, over forty gout nodules all over the body were gradually removed, and the surgery ended.

The patient regained a normal appearance, no longer looking disgustingly monstrous. The lower limbs were amputated from the knees, a result of many years of giving free reign to gout.

In the future, if he can consistently take medication and control uric acid within the range of 180-300 μmol/L, he can hope to live a normal life. Some of the uric acid crystals deposited within his body will also gradually dissolve.

The intern managed to suppress his discomfort and stabilize himself. Although his face looked terrible, he didn’t collapse. Pretending to be at ease in the operating room, he declared that he could become a surgeon.

"Fatty, it’s been a long time since your gout acted up, hasn’t it?"

Zhang Lin asked Liang Fatty while he had some free time.

"I haven’t had a gout attack for a year, I take allopurinol once a day, on time, just like brushing my teeth and washing my face. Now, my uric acid is stably controlled around 200."

"My father-in-law also has gout. Do you have any good suggestions regarding medication?" Zhang Lin got to the point, and Little Five also listened attentively.

The lecture time was short, and a lot of things were not fully understood.

"Conduct HLA-B*5801 gene screening. If it turns out negative, Allopurinol is highly recommended. Don’t think it’s ineffective just because it’s cheap. If there’s no other contraindications and HLA-B*5801 gene is found to be negative, Allopurinol is definitely the best option in terms of efficacy and safety. The latest gout guideline from the American College of Rheumatology recommends Allopurinol as the first-line drug. Although it is not a first-line recommendation in China because the prevalence of HLA-B*5801 gene positivity is relatively high in Han population, if HLA-B*5801 gene is confirmed to be negative, Allopurinol is the best choice." Liang Fatty spoke clearly, he had thoroughly studied these medications.

"Makes sense. Elderly people generally have some high blood pressure or similar issues, so it’s better to be cautious with Febuxostat. I will have him do a HLA-B*5801 gene test when he’s free, it only costs a few hundred yuan, right? If it’s negative, I’ll have him switch to Allopurinol." Zhang Lin was reassured after getting a clear answer.

Little Five also noted this down, hoping that his father-in-law’s HLA-B*5801 gene test result would be negative.

"Move the bed!" Xu Zhiliang, Zhang Lin’s superior, threw his gloves into the yellow collection box and gave the order with authority.

On hearing the superior’s call, Zhang Lin immediately perked up. Along with the standardized training student and the intern, he lifted the patient, moving him from the operating bed to the Pingche.

The amputated limbs were bagged, labeled, and handed over to the cleaner in the operating room who then took the amputated limbs to the pathology department.

"It would be best to spend three months in the pathology department. Stand by the sampling table in the gross laboratory, and eat meat buns while watching teachers dissect things like liver, stomach, and intestines. When you can do this, then you can consider having passed the test." Song Zimo patted the intern’s shoulder.

The intern felt nauseated. Merely listening to this scenario made him nauseous, let alone eating buns while watching. That would require a high degree of cultivation.

At this moment, Yang Ping was taking a phone call in the corner. The call was from Huang Jiacai in Shanghai.

"The spinal external fixators have been sent to the laboratory in Guilin. We need to make time to go there. Forty monkey surgeries will probably take two days. Fatty, you should go too. Any issues with the monkey anesthesia, Little Five? You arrange the travel." After hanging up the phone, Yang Ping arranged the task to Guilin.

"Shall we go this Friday after work? Song and I will go with you. Old Xu and Zhang Lin will stay in the ward. We’ll switch next time. Depart after work on Friday and return on Sunday night. I will get them to prepare the skin a day in advance." Little Five was in charge of external liaison, including research activities.

Preparing the skin involves removing hair from the surgical area and cleaning the skin.

Monkeys have much denser body hair than humans, so preparing the skin is a laborious process. For forty monkeys, all the hair on their backs had to be removed with electric razors.

"The anesthesia equipment and drugs are available there. I’d shown you the list of equipment and drugs. Any issues?" Little Five asked Liang Fatty.

It was the first time they would be anesthetizing forty monkeys at once.

The quantity of anesthesia could only be referenced from humans and adjusted based on the monkeys’ weight. Liang Fatty had also consulted his mentor at Huaxi in advance. The mentor was researching a new type of local anesthetic and was currently in the animal experiment stage. He had vast experience with post-experimental anesthesia.

Scientific research is gruelling, especially in basic research. It is both hard and tiring, and without pay, naturally no one wants to do it.

However, basic research is vital. Like the foundation of a building, without a solid foundation, no matter how beautiful the building is, it would be futile.

After the surgeries on the forty monkeys, the external fixators needed to be adjusted daily. Which screws to rotate, how many times, and how many degrees each rotation needs to be precise.

In addition, regular X-rays, MRIs, and CT scans were required for the monkeys. Analyzing these imaging data, taking some tissue for microscopic analysis, studying the firmness levels of the fixators, and recording any issues that arose during the process.

The PhDs dispatched from Xiehe Hospital were to complete these tasks. They had excellent research qualifications.

When the patient woke up from the anesthesia and returned to the ward, although his entire body was bandaged, those lumps beneath the gauze were no longer there.

If all goes well, he could start walking with prostheses after fourteen days.

Back in the ward, Yang Ping had nothing to do and called up the monkey imaging photos from Guilin for review. Xiehe’s lab in Guilin had complete equipment, and the quality of these imaging photos was very high. Full spinal X-rays, 3D reconstructed CTs, and various sections of MRIs were very standardized.

In order to get the best imaging photos, the laboratory staff came up with many solutions. They designed an X-ray permeable stand to fix the monkeys for the inspection.

These little guys wouldn’t let you examine them compliantly. Even when fixed on the stand, some images had to be shot many times to obtain.

"Don’t you find this monkey’s X-ray picture looks a lot like a child’s?"

"Didn’t Darwin say humans evolved from apes."

"You can see, the physiological curves are not very prominent?"

"Yeah, why aren’t the physiological curves very prominent."

Zhang Lin and Little Five also looked on from the side.

"The imaging data here not only includes our experiment of 40 monkeys but also many of their past experimental monkey data. The physiological curve of the spine was formed after humans started to walk upright. Monkeys can stand upright briefly, but they mostly walk on all fours, so their spine doesn’t have the typical physiological curve of humans." Yang Ping explained to them.

Orthopedic expert Professor Qin Sihe once wrote a paper analyzing the formation and correction of deformities from an evolutionary perspective.

"You think monkeys might have lumbar disc protrusion?" Zhang Lin asked Little Five.

Xu Zhiliang was surprised by Zhang Lin’s question: "Did you hit the mark by a fluke today with such a profound question?"

Why didn’t he stutter when he was giving lectures to the wall every day, but now he does?

Zhang Lin was too angry to retort.

"Look, these are the MRIs of old monkeys’ spines. The three lowest intervertebral discs in humans degenerate the fastest. By old age, they would surely have dehydrated, presenting a low signal, but monkeys seem not to have this problem." Yang Ping pulled up some data for him to see.

"So, your question, if it wasn’t hit the mark by a fluke, I might have to call you Teacher Zhang." Xu Zhiliang genuinely thought this question was profound.

"Why don’t we study the difference in lumbar disc degeneration between monkeys and humans for our next topic after finishing the current one?" Little Five suggested.

"Actually, from an evolutionary perspective, the human intervertebral disc is inferior. It hasn’t evolved well yet to adapt to humans’ upright posture, so it’s prone to issues." Song Zimo was also contemplating this issue.

Yang Ping partly agreed with this view: "Degeneration is inevitable. The degeneration of the human motor system always starts from stress concentration areas, such as the lower lumbar vertebrae and knee joints. Anatomy adapts to function, but ironically these areas are not anatomically reinforced."

To solve clinical issues in medicine, one must start thinking from the basics.