下午有個媽媽掛號，卻是問她當兵兒子的事情。本來幫她的兒子安排好我們這週開脊椎的手術，但是回到部隊裡面，長官說，要在軍醫院裡面開刀，開完刀之後才能驗退。
本來他們在一百公里外的大城裡問過，說脊椎手術要打釘子。我看了之後，建議病人既然這麼年
輕，可以不打釘子以免將來或多或少的後遺症。 他們覺得我的說法好，想在故鄉開刀，不在部隊所在開刀。可是現在卻變成有個驗退的權柄在軍醫院手裡。
我不勉強他們，照我意思開刀，結果不能早退伍，不就得在部隊裡受到長期病號的難堪待遇嗎？ 另一方面照著軍醫院的說法開刀，就要留個釘子在身體裡。 我已經覺得愛莫能助了，他們一家人恐怕更難抉擇吧！
13 則留言:
既然已經是面臨是否開刀的重症，應該是有達到一定的標準，可以給予提前停役後，自行治療吧吧！？
那阿兵哥可以反問醫官，我在軍醫院開刀之後的風險，你們軍醫願意承擔嗎？這樣做，是不是徒增醫病之間的對立關係呢？
Atlas,
你說話的語氣令我害怕呦，今天我令人受質疑，明天別人令我受質疑。
醫師的立場都是為病人好，不過彼此信念或許有些不同。 軍醫院的醫師，不是不好，他是我的大學同學。
我質疑的是只有在軍中手術才能驗退的制度，究竟是真還是假。
不久前電視報導有一個在金門服役的役男, 因為腰椎 HIVD 在當地手術, 不幸的是手術中竟然引發大出血, 術後經過多日的治療仍因器官衰竭死亡. 聽到這消息我覺得有點不可思議, 這應該是很平常的刀吧, 不知道他是不是在軍醫院開的. 至於要在軍醫院開刀才能驗退我覺得應該不是真的, 要不是病人家屬的推託之辭, 就是軍醫院在唬人. 這應該可以上軍醫相關網站查詢一下.
義務役的HIVD並不需要開過刀才能驗退 只要影像學檢查確認有壓迫神經根即可 有些需要動手術才能驗退的項目 只要手術醫師願意開立詳細的診斷證明亦可 並沒有只有在軍醫院手術才能驗退的規定 應該是軍中的長官怕麻煩才會這樣說
沒有地方貼，亂貼於此。醫師，閱後請刪除。
Damaged spine allows signals to brain
Tuesday, 15 November 2005
Brains of people with a spinal cord injury can respond to signals from their lower limbs during exercise, surprising new research suggests.
This finding, although preliminary, suggests that their spinal cords may not be as damaged as doctors think.
Alternatively, patients' brains could be responding to a change in blood flow while exercising.
Either way this world-first research suggests that rehabilitation could one day lead to improved function for people with injured spinal cords.
Australian neuroscientist Professor Ashley Craig of the University of Technology, Sydney and team, looked into activity-based therapy using Functional Electrical Stimulation (FES).
This involves helping people with spinal cord injury to exercise on a bike by electrically stimulating their legs.
Craig says this leads to the same brain patterns as those found in able-bodied people when exercising.
This suggests the brain is responding to signals from exercising muscles, a finding that he says may pave the way for better rehabilitation.
"We're not saying that we're going to regrow the spine," says Craig. "But it could improve their function which is something which has not really been possible until this activity-based therapy and FES came along."
Superman's tiny victory sparks research
Researchers became more interest in FES after the experience of Superman actor, Christopher Reeve.
He was paralysed from the neck down after a fall and needed assisted ventilation to breathe.
Five years later, when doctors predicted he would never get better, he started activity-based therapy using FES and began to improve.
"He had some degree of neurological recovery," says Associate Professor Glen Davis of the University of Sydney, who is working with Craig.
Reeve began to get some extra sensation in the top of his hands and could feel tingling and heat in the lower parts of his body, says Davis.
The actor was even able to move his fingers a little and his breathing improved, reducing his need for artificial ventilation.
"His breathing improvement was so profound that he was able to take the plane to Australia," says Davis.
The theory was that if Reeve had started the treatment earlier he might have got better results, says Davis. But researchers don't know much about how the exercise worked.
The first look at brain activity
The researchers set out to take the first look at the impact of FES-stimulated exercise on brain activity.
Using an electroencephalogram, they measured the brain activity of nine paraplegics cycling with the aid of electrical stimulation to their leg muscles, called active cycling.
They also measured the brain activity of nine able-bodied cyclists, matched for sex and age, and the brain activity of the same nine paraplegics while cycling on a machine that turned its own pedals, known as passive cycling.
Craig says the paraplegics who did passive cycling showed the brain activity of someone who was not exercising, but those who were doing the FES-stimulated exercise had the same brain activity as the able-bodied exercisers.
"It's unexpected because if the spine is broken, how are the signals getting back to allow the brain to activate in the way it does when the spine is not broken?" he says.
Mystery results
Craig says there are two possible explanations for the results.
First, the spinal cord may not be as damaged as suspected and signals are actually passing through it back to the brain.
Alternatively, he says, the brain could be getting feedback via the change in blood flow that happens during exercise.
While the heart rate of the passive cyclers did not increase, the heart rate of the active cyclers did.
"If the cardiovascular system is stimulated then you get feedback into the brain," says Craig.
He says whatever is happening, the fact that the brain is receiving feedback from muscles being exercised by FES, is exciting.
"When your cord is broken your brain changes," he says. "The part of the brain that runs the legs doesn't think the legs exist anymore so [brain cells] get redistributed to other things."
The feedback from the FES-stimulated activity could improve rehabilitation by helping to reorganise the brain, says Craig.
His colleague, Davis, will head a four-year trial, due to begin next year, to determine how much function the activity-based therapy can return.
曾經將此事詢問我的母親，
她所言假若是義務役他歸屬於國防部所管轄，
所以，他的全民健保似乎與他的家人(即一般人所保之全民健保)是不同的，所以他是一定需要在軍醫院內就醫。
但是，他若是替代役的話，他歸屬於內政部所管，所以他得以在軍醫院以外的院所就醫。
假若只是要驗退的話，我母親的說法似乎是只要到所謂的公立醫院開立詳細的診斷書，應可驗退。
就法規而言，兵役法第20條第一項第一款或第二款之規定都可以適用免役。但其附屬法規的第三條規定似乎可以在軍醫院做檢定，必要時得以由合格之地區級以上醫院作為診斷，但並不需要一定要在軍醫院裡面做治療，但其病人情況須符合脊隨病變造成肢體運動障礙的診斷就可以向軍醫院提出停役之要求。不知道這樣對於此事是否有所幫助？
故就法規的推論，或許醫師可以建議其母親帶著其所有相關脊隨壓迫造成肢體運動障礙的診斷，或者至軍醫院做出相關之診斷，而向國防部提出停役之要求。
假若停役之後，就沒有所謂強制一定要在軍醫院就醫的情況了！或許，這是一個解決之道吧！
謝謝Gush的意見，病人是椎弓斷裂，我幫他做了椎間盤攝影，證明合併上一節椎間盤破損。我的一件事先治療椎弓斷裂，所以，融合就好，說不定過一段時間椎間盤疼痛就減輕了。
如果要打釘子，就怕加重椎間盤負荷。 不過不打釘子，手術是小的，恢復卻是比較慢的，所以，要驗退，我沒有把握給他一定過，即使我有這個權力開診斷書。
Gush, 我開不了全世界的病人，這都是上帝的安排。
我了解，
我查了那些法規只是想要回覆您的質疑，
並不是在軍中手術才能驗退這樣的說法。
而是可以在軍醫院做出相關診斷，且向國防部申請停役。而不需要一定要在軍醫院手術才能驗退。
今天病人來報到，開完刀很順利。驗退一事， 且看看吧！
Sorry！在社會上真的沒必要處處樹立對立關係，我對醫療茫懂，大多遵照專業的建議，不過倘若軍醫有這樣的退役規定，我認為袋有一點唬人的意味在！
當兵時我也是因此症狀常跑軍醫，是當兵前的運動傷害造成，但我認為動手術能免則免的心態，一直拖著沒有就醫。服役時想說也可以順便做復建，還可以時常請假就醫，所以接受軍醫治療。不過你也知道，裝病報病號的也會有一點，我想軍醫師都會稍稍嚴格把關，避免阿兵哥渾水摸魚。
每個醫師的診斷都不相同，記得有一次一位年輕醫師就建議我直接開刀，有的給止痛藥和肌肉鬆弛劑，有的安排我進行復建，而我是在退伍前六個月複診要延長復建的療程時，一位資深醫師看了片子後，沒多說什麼就開立停役證明給我，反而讓我覺得莫名訝異。
以我的例子來說，要嘛選擇軍醫院治療，要不就停役後自行負責，我辦理停役時就有註明我之後不得要求國防部負責我的病情，等於宣告我的放棄部份權益。我認為上述的案例，應該也可以達到停役標準而能選擇自行治療才是。
atlas,
倒不知原來你才是真正有經驗的人。
今天早上家屬說明原委，他們去找了我的同學，同學當然還記得我，要他們把我們這裡的病例資料準備齊了，會幫病人辦停役。
這是一個皆大歡喜的結局，不是嗎？
終究有了一個圓滿的結果，
那種掛病號的日子我也待過，
那種感覺真的不是一個多好的滋味。
希望那位病患可以早日康復！
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