Patient.
Long-term gastric disease, stomach pain has increased in the past 2 years, once had blood in the stool, stomach pain slightly relieved after taking gastric medicine, the patient has long-standing diabetes, hypertension and other problems, old and weak, would like to ask Dr. Ma for advice on a more secure treatment plan, whether the patient can withstand total gastrectomy surgery, whether chemotherapy is needed after stage II gastric cancer surgery
Dr. Ma Enling, Department of Basic Surgery, Peking Union Medical College Hospital
Gastroscopy and biopsy were done Esophagus: mucous membrane was clear and peristalsis was normal. Cardia: dentate line is clear, lamellar mucosal rupture is seen in the sub-curvature of cardia, the range is about 2.0*3.0cm, the surface is uneven, ulcer and nodule-like hyperplasia are visible, the texture of biopsy is brittle and easy to bleed. Gastric fundus: mucus lake was clear in color and small amount. The folds were cerebral gyrus-like, and no blood vessels were seen. Gastric body and sinus: mucosa was white and rough, submucosal vascularity was seen. Peristalsis was normal. Gastric angle: arched bridge-shaped. Pylorus: round, good opening and closing. Duodenum: no abnormalities were seen in the bulb and descending part. HP: negative Endoscopic diagnosis: subcardia ulcer type carcinoma (stage II) Chronic atrophic gastritis
Ma Enling, Department of Basic Surgery, Peking Union Medical College Hospital.
Hello! Also need to know details as follows: How high is the maximum blood sugar? How much can be controlled with insulin? What is the highest blood pressure when no antihypertensive medication is used? How old are you? How many flights of stairs can you go up in one breath? Whether chemotherapy is needed after surgery depends on the postoperative pathology report.
Patient.
Dr. Ma, thank you very much for responding to questions at this late hour. The kindness of the doctor is touching! He is 71 years old and has a recent preprandial glucose of 10.3 and postprandial glucose of 11. He has been controlled by medication and has not yet taken insulin. By the way, how long does it take for insulin to bring down the blood sugar? My blood pressure is 140/85 after using antihypertensive medication, and 160/96 without antihypertensive medication (not taking any medication for a day). Please let me know if you need any more information. Thanks again!
Ma Enling, Department of Basic Surgery, Peking Union Medical College Hospital.
Hello! The endocrinology department of our hospital is the best in the country, and we are still very experienced in operating on diabetic patients, so the risk is not too big in our hospital. The other general conditions mentioned above are mostly tolerable for total gastrectomy at least in our hospital. If you want to come to my hospital for surgery, you can leave your cell phone number and I will contact you.
Patient.
Dr. Ma, thank you! We haven’t told the old man the truth yet, so I don’t know if the surgery has to be done right away? Also, in the current situation, how long is the approximate wait for a bed?
Ma Enling, Basic Surgery Department, Peking Union Medical College Hospital.
The surgery should be done as soon as possible. If you decide to operate, you can be hospitalized in about a week or so.
Patient.
Dr. Ma, what you just said about the patient basically being able to tolerate the total resection has reassured me a lot. In addition, I would like to ask you, as a doctor, whether it is better to tell the patient the truth about this disease or to conceal it for better treatment? We are struggling because the old man just went through a painful event and it would be a big blow to him if we tell him the truth, but if we don’t tell him the truth, he will always put off the surgery (we are now telling him that he needs surgery for his stomach ulcer). I look forward to your reply.
Ma Enling, Basic Surgery Department, Peking Union Medical College Hospital.
The old man can be told: the doctor at the Peking Union Medical College says that sooner or later the ulcer in the stomach is going to become cancerous, and the current gastroscopy does not exclude that a small part of it has already become cancerous. If the cancer has just turned into cancer or if the cancer is small, early surgery may even cure it, but if it is delayed and becomes advanced, then the surgery will not be effective even if it is done well.
A total gastrectomy is not terrible, I have used the small intestine to make a small stomach instead. If the old man can agree, he should be operated as soon as possible, the more delayed the smaller the chance.
Patient.
Dr. Ma, thank you so much! We’ll do it your way!
Peking Union Medical College Hospital Basic Surgery Department Ma Enling: Okay.
Patient.
Dr. Ma, can you arrange for hospitalization as soon as possible? Is it possible for us to visit you on Thursday before your appointment to discuss more detailed surgical arrangements? I have already left a phone number in front of me, so I hope you can give us a call. Thank you very much.
Ma Enling, Department of Basic Surgery, Peking Union Medical College Hospital: Did the old man agree to the surgery? He can arrive in Beijing on Wednesday, and will be hospitalized on Thursday (21st) morning after the clinic (one patient can be discharged at 10:00 that day). Please send me a text message with the patient’s name, gender, age, place of origin, and type of cancer in the pathology report. Bring all the tests with you.