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時間軸

00:00:30 節目開始 醫療台語廣播劇
00:05:00 蘇ㄟ漢藥店
00:09:09 多囊腎、主動脈剝離與黃鴻升猝死
00:12:56 （後面都是廣告）



本集内容


今天的事要分享 anglena baby 誒故事


＃醫療台語廣播劇#生無張持，死無揀時#



我是安寧病房的護理人員 ，照顧多是各類疾病的末期病人，在病程進展的過程中，提供病人身、心、靈的全人、全家、全程、全隊的四全照顧，陪伴走過生命的最後一段旅程，期望能讓生死兩相安......
那天，在幫某床有點嗜睡的阿伯，按摩水腫的雙腳 ，一旁陪伴的女兒，油頭角面 目眉打一千個結
嘆了一口氣開口道：

妳知道死亡嗎？
妳知道像他這麼清楚，
體力卻一天一天流失，
就好像在等待死亡，這樣有多殘忍，妳知道嗎？


(旁邊的清潔阿姨遞上面紙）這給你


我當下沒有回話，只是靜靜的聽她說
下班後我再仔細回想了這個過程，
想著這樣的問題應該怎麼回應，

下班後我一個人走在紅磚仔路 一邊想 如果再有人問我的話，我想我會說：
「我知道死亡，但並未完整的窺探全貌，

我知道意識清楚的一天一天感受自己在消逝，
是很難用言語精準去形容的感覺，
那種感受我可能也要等到自己真的感受到了，
才會真的知道。
只是在此之前，我想讓他自己跟我說，
他還有沒有什麼想做的？有沒有什麼想說的？
而這也就是我為什麼出現在這裡的目的。」



我今天被問了上面的問題，
當時我回答的結結巴巴，
中間還數度被電話打斷，
回來自己再蕊過幾次，
希望下次再有人問我，
可以再講的更貼近人心。

不過，
真的想讚歎一下某樓層的清潔阿姨，
默默遞上一疊衛生紙給家屬擦眼淚，
真的很貼心。

生無張持，死無揀時

Sen bô tiun-tî，sí bô kíng sî


閻王叫你三更死，誰敢留人到五更 


想活得活不過 想死的死不透




來廣告


蘇ㄟ漢藥店

強風音效
哈丘


別搶。別搶都給你。都給你

風寒感冒鼻塞、流鼻水、、口嗽、口乾、身體發熱發冷、不會流汗、頭痛、歸身估痠痛，甚發燒

來吃這味。

麻黃muâ-hông桂枝湯 內容有滿滿的進口acetaminopine 麻黃muâ-hông桂枝 ㄧ支都沒有

醫治感冒的藥物都是講求「中病不止」宜 長服 久服 流鼻水吃到洗腰子

阮每一帖藥 都有放硃砂，硃砂鎮靜安神功效好，重金屬超標！就是我們良心的証明
 
阮每一帖藥 都是透過特殊管道取得 放心。你看不到

如何確定我吃的中藥是安全的？專家建議2招自保：
1.藥方不凍清楚 記載品項及來源
2.若對服用中藥 有疑慮，可送蘇ㄟ漢藥店檢驗

有相關問題要給我注文 下單 購買 任何 沒清楚 沒了解 你甲打這支要付費的電話04-228 507 5078。也可以到台南市不安全蘇ㄟ漢藥店申請檢驗 以上工商



抽絲剝繭～～環環相扣！


文章出處。李保羅 在台大醫院 National Taiwan University Hospital 擔任智慧醫療中心副主任
https://www.facebook.com/chnchng.lee.5?locale=tw_TW

多囊腎、主動脈剝離與黃鴻升猝死

小鬼黃鴻升在36歲英華之年猝死，引起社會很大的震撼。今天病理結果得報告出爐，死因直指主動脈剝離。主動脈剝離通常發生在50歲以上長期高血壓患者，黃鴻升雖然在前1年檢驗有三高，但是不至於短短一年之內就惡化成主動脈剝離。年輕人會主動脈剝離最常見的原因還是先天性遺傳疾病，尤其是馬凡症候群，馬凡症候群是纖維蛋白(fibrillin-1)先天異常造成，但是通常馬凡症候群的患者手長腳長，關節易於常人柔軟，要肉眼主觀的判斷是否是馬凡症候群，就是看臂展是否大於身高，小鬼顯然不是這樣的身材，不像馬凡症候群。
從記者得知小鬼患有先天性多囊腎，如果屬實，這和主動脈剝離有關嗎 ?
這讓我想起16年前當台大急診總醫師的 一個夜晚，一位40歲左右的年輕人在和朋友吵架中喊了一聲胸痛突然倒下，失去意識，送來急診已經心跳停止，我們立刻進行CPR，我在床旁超聲波中發現他有心包積液造成心包填塞，毫不遲疑，立刻進行心包膜穿刺緩解填塞，病人也成功恢復心跳，由於心包膜穿刺的液體是鮮紅色動脈血，我心想可能是主動脈剝離出血到心包膜造成，於是緊急安排電腦斷層，果然證明這位先生有主動脈剝離，但同時也發現，他的腎臟具有大大小小的水泡，是位多囊腎患者，隨後緊急安排手術，經過6小時搶救還是無法挽回他的生命。
這個案例一直盤旋在我心頭，究竟先天性多囊腎和主動脈剝離有關嗎? 當時文獻查閱只有一例病例報告，並沒有一致的結論，雖然動物實驗發現先天性多囊腎也會有纖維蛋白的異常，但是因為多囊腎患者也容易會有嚴重高血壓的情形，也是導致主動脈剝離的重要危險因子，所以學界當時沒有結論。因為我們的病患有經歷手術，所以取得了寶貴的主動脈標本，我找出他的標本和病理醫師反覆討論，證實先天性多囊腎患者的主動脈病理變化是和先天性纖維蛋白異常類似，


而不是高血壓動脈粥狀硬化的病理變化。我把這些發現整理發表在Resuscitation雜誌。
從這些經驗來看，黃鴻升猝死最有可能的病因就是先天性多囊腎合併彈性纖維異常與高血壓，造成急性胸主動脈剝離猝死。
台灣人群有為數不少先天性多囊腎病患，除了會導致主動脈剝離、也有可能用腦血管瘤破裂腦出血，這些病友應該要定期檢查相關心血管疾病，控制三高、避免劇烈運動、避免搬重物才不會讓遺憾再度發生。
#多囊腎
#主動脈剝離
#黃鴻升
#小鬼
Episode today

Today I am going to share Anglena Baby’s story.

#medical podcasts in Taiwanese # We do not choose to be born nor do we choose the time and condition of the death

I am a medical staff in the hospice for the terminally ill patients of all kinds of cancer. During the development of conditions, the hospice takes care of the patients’ body-mind-spirit well-beings by the means of providing holistic care and helping the patients’ family with our comprehensive care team throughout the nursing process, hoping to console both the family and the patient in the last stage of life.
One day, while I was serving a sleepy elder man and massaging his dropsy legs, his daughter stood aside looked apprehensive, and her furrowed brows were like a dead knot. She sighed and said, “do you know anything about death? Do you know how cruel it is for a patient like him who is still conscious but getting weaker and weaker day by day until the Death comes?”

“This is for you,” a cleaning lady aside gave her tissue paper.

I did not say anything then but listen to her quietly. I recalled the whole thing after work and started to think what could I respond to her question.

I walked on the red-brick road by myself and thought if there is anyone asks me the same question again, I would answer, “I know what death is, but I have not yet fully explored it. I know it is difficult to explicit the feelings of patients who still have consciousness to aware their lives are fading away. I might only understand how it feels until this happens to me. But before that, I want the patients to tell me what else do they want to do and say, so I can help them. This is my job of being here.”

I remember while I was stammering out my answer to her, several phone calls interrupted. Now I have practiced how to answer this question several times hoping I can express it by a way of closing to one’s heart if anyone asks me again.

By the way, I really want to praise the cleaning lady who gave the patient’s daughter a pile of tissue paper. It is warmhearted.

A few old sayings in Taiwanese: “We do not choose to be born nor do we choose the time and condition of our death. (Taiwanese: Sen bô tiun-tî，sí bô kíng sî)” “If Death have you die at midnight, nobody dares to hold you till the daytime.” Those who want to live cannot get enough time; those who want to die have no way to find.


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The article is wrote by Li,Bao-luo, deputy director of intelligence medicine of National Taiwan University Hospital. Extracted from: https://www.facebook.com/chnchng.lee.5?locale=tw_TW

Polycystic kidney disease and aortic dissection lead to the death of Alien Huang

The sudden death of Alien Huang, a 36-year-old famous Taiwanese celebrity, shocks Taiwan’s society. The pathology report pointed out the cause of death is aortic dissection, a condition mostly happens to patients aged more than 50 years old with long-term high blood pressure. Alien Huang was diagnosed with “three types of highness” (high blood pressure, high blood sugar, and hyperlipidemia), but, supposedly, his condition would not have deteriorated to aortic dissection within one year. If aortic dissection occurs to a young person, it is mostly caused by genetic disorder, particularly patients with Marfan syndrome. Patients with Marfan syndrome have longer arms and legs than normal, and their joints are softer than usual. To tell whether a person has Marfan syndrome, the best way is to see if his/her arms are longer than his/her height. However, Alien Huang is apparently not in this case, so he does not look like having Marfan syndrome.

If Alien Huang does have polycystic kidney as the report said, does this disease associate with aortic dissection?

It reminds me a night 16 years ago, during that time I worked as a chief physician of emergency room in National Taiwan University Hospital. An adult around 40-year-old was sent to the emergency room after losing consciousness during an argument with his friend. Before he lost his consciousness, he yelled: “my chest hurts” and then he fell down. His heart stopped beating when he was sent to the hospital. We immediately did CPR on him. The ultrasound exhibited that he had pericardial effusion as well as cardiac tamponade. Without any hesitation we underwent pericardiocentesis and his heart started to beat, but because the body fluid was red while undergoing the procedure, we assumed it was aortic dissection led to pericardium. Then we arranged computer tomography right away and found out he did have aortic dissection; meanwhile, we also discovered he had numerous kidney cysts in different sizes which indicated he had polycystic kidney disease. An emergent surgery was performed immediately afterwards. Unfortunately, we failed to save his life after a 6-hour operation.

This case lingered in my mind. Is polycystic kidney related to aortic dissection? I read some papers and only one of them has case report. There is no clear link to it. Although there is a relation shown in the animal experiment that genetic polycystic kidney might associate with abnormal formation of fibrin, patients with polycystic kidney disease are easier to have severe high blood pressure, which is a vital risk factor causing aortic dissection. Still, there was no conclusion in academia on whether polycystic kidney will trigger aortic dissection in humans. Because of the surgery 16 years ago, we were able to access the patient’s aortic specimen and studied it with pathologists. It is proved later on that the pathological change of aortic dissection occurs to patients who have congenital polycystic kidney disease is similar to the inherited abnormalities of fibrin, but not the pathological change of hypertension atherosclerosis. I published the findings on the journal, Resuscitation.

From these researches, the most possible reason of Alien Huang’s sudden death is that his congenital polycystic kidney disease was complicated by abnormality in elastic fiber as well as high blood pressure and led to acute aortic dissection.

There are numerous patients in Taiwan suffer from congenital polycystic kidney disease which might not only trigger aortic dissection but also ruptured cerebral hemorrhage. To prevent sudden death, patients with such disease should go for a physical examination regularly to checkup the condition of cardiovascular disease, watch out the level of blood pressure, blood sugar, and blood lipids, avoid strenuous exercise, and avoid moving heavy stuffs.

#polycystic kidney disease
#aortic dissection
#Huang, Hong-sheng
#Alien Huang



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