R/O Urolithiasis

顯微鏡下面草酸鈣的結晶

R/O Urolithiasis


週六中午被送到台大急診處，折騰了一天，晚上九點多回到家裡，遵照醫囑服用了兩顆口服藥，沖個涼澡，就上床睡覺了。

隔天上午，敏圓長老打電話過來，關心我身體的情形，同時告訴我，他與正吉執事可以開車來接我們一起去華神。感謝他們的愛心，下午十二點二十分我們就到了華神六樓。這是和平教會為了教堂重建，第一次到境外禮拜。我覺得身體還有點虛虛的，只能到處走走看看，也不能幫忙搬什麼東西。

感謝晶晶牧師，在週六中午得知我被送急診的情況，就一口答應要替我講道，而且他是照我所寫好的講道大綱準備講道內容與投影片。我想他週六應該是忙到沒有睡覺，真是感謝他的幫忙，主日崇拜的講道才沒有開天窗。在參加禮拜的時候，我的後背與左下腹又開始發生類似週六上午的疼痛。我又開始覺得坐立不安，心裡想，是否又須要被再送一次急診了。感謝主的恩典，這次的疼痛，程度比較輕微，時間也比較短暫。我忍了約十分鐘，它就消失無蹤了。因此，我決定參加完第二堂華語的主日崇拜，有許多兄姐前來表示關心與慰問。雅琇長老過來問我，是否願意試試喝五筋草熬的湯，有利尿的作用，我說，好啊！不久，正吉兄與敏圓姐又開車送我們回家了。

主日晚上，我接到我的家庭醫師蕭亦裕執事的電話，在電話中他詳細詢問的發病的經過，以及在台大急診處醫師處理的情況。他認為，除了尿路結石之外，還須要考慮幾種其他的可能狀況。 當天晚上一點四十一分，我收到蕭醫師送過來的電函，經過蕭醫師的同意之後，我將其內容，分享於下：

Dear Pastor,

Review of the clinical course & present laboratory evidences makes me raise my impression of left urolithiasis to 85%.

10 RBC/HPF in urinalysis still signified something wrong & could not be denied, although it was not as high as we expected. Dilution of urine may account for this low count of RBC in U/A. Sudden fast infusion of large amount of intravenous fluid diluted the blood clot in wound of scratched, by spiky stone, wall of ureter. A reasonal pathophysiological explanation for the attack is as follows. Given that urolithiasis usually occurs in people with some unidentified specific renal environment & you do not have past history of it, this episode might be the consequences of dehydration contributed by hot temperature of summer & inadequate water intake in recent busy days of move of church.

The shift of locations of pain from back to LLQ in Saturday morning was the result of passage of stone from left kidney to the lower end of ureter. The stone might break into pieces during the course. The question concerned now is whether the stone or stone pieces has/have passed the distal end of urethra or been trapped in narrow distal end of left ureter. Only IVP can answer this question probably. My opinion is it is unavoidable to make accurate diagnosis & rule out other important abnomralities such as HIVD & compression fracture of lumbar spines.

Fortunately its risk is low & avoidable. Anaphylactic shock to contrast medium is prevented by using new kind of agent, but it might be charged 1500 to 2000 NTD depending on the regulations of examination hospitals.

Many people might jump to an immediate conclusion that this illness signfies spiritual warning. I am more inclined to accept it is purely a medical thing which still can be used by God to convey some important message to us. We have tried very hard not to be misguided by paradoxical thinking all the time, haven’t we? Because misinterpretation costs us dear. It is time to change our life bit by bit. Drinking more than 2000 cc ( 4 500-cc cups) per day, 3000 cc being better, is a good start. To be continued.

週一上午，太太陪我搭公車前往台大醫院，到舊院區二樓泌尿科門診，我掛的是25號，等了一下子，就輪到我看病了。我的同班同學陳世乾醫師看到我，非常親切的問診，並且將週六的驗尿報告 (我的尿液裡面有十到十五個紅血球、+++ 潛血、草酸鈣的結晶) 以及X光片 (KUB並沒有石頭的影像) 都調出來，詳細讓我看。請我躺到診療床上，幫我做身體檢查。

世乾兄告訴我，就這些病程、檢驗、以及身體檢查的情形看來，最大的可能，還是尿道結石。在腰部X光片看不到任何石頭的影子，只有在超音波上面，看到一些可能是小小的石頭影子。因此，他在我的病歷上寫下 R/O Urolithiasis. 翻譯成中文，是 “排除尿道結石”，意思是在考慮可能引起我上週六被送到台大醫院急診室的疾病當中，最優先要考慮的，是尿道結石。在排除了尿道結石的可能之後，才會考慮其他的可能。他建議我立刻再去做一次小便追蹤檢驗，同時安排我在八月底 [台大醫院要安排超音波檢查，可要排相當長的時間] 再前往台大做追蹤超音波檢查。他認為我暫時不必再吃什麼藥物，只須要多喝開水就好了。

週二下午，明基兄就拿了三大寶特瓶到我們家，裡面裝著他與雅琇長老前往台大校園到處幫我找的車前草，拔回家後整棵用水洗乾淨，就用慢火熬了三個小時，才熬出來的湯。我喝了之後，果然尿液就增加許多了。實在感謝他們夫婦的愛心。

車前草 [又稱為五筋草]