Chapter 201 The cause of the disease is found, crying is actually a good thing
The next thing is easier to handle. We need to find a way to arrange 24-hour EEG monitoring and bowel sound monitoring for the patient.
For this examination, the patient needs to stay in the hospital, but it does not count as inpatient treatment.
It's just a checkup item.
After a day of monitoring, the patient's 24-hour EEG data and bowel sound monitoring positioning have been completed.
Naturally, Zhou Can doesn't need to do this personally.
Director Jia temporarily arranged two interns to monitor the patient's bowel sounds and locate the patient.
Bowel sound monitoring does not need to be done 24 hours a day, but mainly concentrated before and half an hour after meals. However, the doctor who monitors the bowel sounds needs to draw an accurate positioning map.
This job requires strong professional knowledge.
At least you need to know clearly which intestinal segment the bowel sounds are occurring in.
Using two interns to do this task at the same time is also to ensure that there are no mistakes and to guarantee accuracy to the greatest extent possible.
In the digestive surgery consultation room, more than a dozen doctors were sitting together for consultation.
Several chief physicians from the Department of Digestive Surgery were present.
There are a total of five difficult cases and complex surgical plans, which require everyone to discuss and consult together with the wisdom of many people.
The first case to be discussed and consulted was this case of pseudoenteritis.
"This patient is 17 years old and has had diarrhea for more than two years. All symptoms are highly similar to those of enteritis."
Director Jia first introduced the patient's condition, and then put the patient's examination report and other information on the public screen.
"That's right , this is typical enteritis!"
A young deputy chief physician in his forties examined the case and made a conclusion.
"I know this case. More than half a month ago, the gastroenterology department invited me to join the consultation. We discussed it for a long time, but still couldn't find the real cause. It is basically certain that it is not ordinary enteritis. The patient has been treated in many large hospitals, but to no avail."
The speaker this time was Director Xiao of the Department of Digestive Surgery, who is 56 years old and also serves as the director of the Department of Digestive Surgery.
In terms of diagnosis and treatment level and surgical ability, he is second only to Director Jia.
The deputy chief physician who spoke first was immediately slapped in the face.
When you are young, you tend to express your opinions too impulsively and get slapped in the face easily.
"If it's not ordinary enteritis, then what could it be? Is it a difficult-to-cure chronic enteritis similar to Crohn's disease?" asked the deputy chief physician with a red face.
He is in his early forties, which is considered a 'young man' among doctors.
This deputy chief physician is quite aggressive and enterprising.
During the consultation, everyone spoke freely without any reservations.
If nothing else, the enthusiasm of this deputy chief physician is definitely worthy of encouragement.
"Crohn's disease can be ruled out, but the possibility of chronic enteritis cannot be ruled out."
Director Xiao replied.
"Dr. Zhou Can from our team believes that the patient has pseudoenteritis. Yesterday, we arranged for the patient to undergo 24-hour EEG monitoring and bowel sound monitoring. Now, please allow Dr. Zhou to introduce the diagnostic ideas to everyone!"
Director Jia is not arrogant at all.
Push Zhou Can out directly.
The whole audience was in an uproar, and all eyes were focused on Zhou Can.
Zhou Can stood up and introduced the diagnostic ideas to many senior doctors.
After the introduction, without waiting for him to sit down, Director Jia signaled to him, "Zhou Can, now the monitoring data you requested is out. Now let me introduce your diagnosis conclusion to everyone."
After listening to Zhou Can's diagnostic ideas, the consulting doctors couldn't help but think deeply.
Several chief physicians no longer regarded this intern who had made great contributions as a resident, but promoted him to an equal level.
"Through observation and comparison of brain wave data, I found that the patient's brain wave signals were basically the same as I predicted. Only when he fell asleep did his brain waves tend to be normal. At this time, bowel sounds no longer occurred. This shows that when the patient is awake during the day, his mind should always be in a highly tense state. This also further shows that the patient's long-term diarrhea is related to mental tension."
"Also, the bowel sounds after the patient eats can roughly infer that after the food is initially digested by the stomach and enters the duodenum, the intestinal peristalsis speed is much faster than normal. I have reason to suspect that after the food enters the intestine, it quickly passes through the intestinal peristalsis, is discharged into the rectum, and then is discharged from the body. The abnormal activity of the intestine is likely to be interfered with and controlled by abnormal nerve signals."
Zhou Can spoke eloquently, based on first-hand monitoring results.
The disease directly pointed out by the patient is neurotic digestive dysfunction.
"As we all know, gastrointestinal neurosis is actually a gastrointestinal dysfunction, functional dyspepsia, a general term for gastrointestinal syndrome. It is a disorder of higher nervous activity that leads to dysfunction of the autonomic nervous system."
It is mainly characterized by disorders of gastrointestinal motility and secretion, without histological organic pathological changes, and does not include gastrointestinal dysfunction caused by other systemic diseases.
"If you peel back some of the masking signs of this patient's condition, you'll find that it's highly similar to a neurotic digestive disorder."
After Zhou Can announced his diagnosis, the other doctors fell into deep thought again.
"Although your analysis is very reasonable and has certain supporting evidence, it is still impossible to confirm that it is this disease!" It was the "enterprising" deputy chief physician who first raised the question.
"It's not difficult to make a diagnosis. You can give the patient psychiatric drugs to relieve anxiety, and let the patient eat when his brain waves are stable. Then observe whether the patient's intestinal motility returns to normal."
Zhou Can had already thought of further testing methods.
If such a small problem could stump him, then the three months he spent in the intensive care unit would have been in vain.
Learning how the three major systems of the human body work and practicing them can give him a deep understanding of each system.
"I think this method is worth a try."
Director Xiao's eyes were extremely bright.
Zhou Can's diagnostic ideas and even experimental methods are unique.
"Prescribe the medicine to the patient immediately and see how effective the treatment is."
Director Jia wrote a prescription by hand and gave it to Qiuhong to execute.
…
When the consultation was about to end, Qiuhong ran back with an excited look on her face.
A smile on his face.
"Director Jia, after giving the patient the medicine, wait until the patient's brain waves are stable, and then let him eat. Forty minutes later, the patient's intestinal motility is still normal, and for the first time ever, he has no diarrhea. The family members are very happy and said that our hospital is worthy of being the most famous hospital in the province. They also praised you and Dr. Zhou for your superb medical skills and said that you are living miracle doctors!"
When Qiuhong talked about this, her face was full of pride.
After preliminary tests, it has been basically proven that the patient's enteritis is indeed related to high mental stress.
Now no one questioned Zhou Can's diagnosis.
When they looked at Zhou Can, their eyes were full of appreciation or admiration.
It’s not that shocking, because it’s not the first time that Zhou Can has made such a great achievement.
Zhou Can has "diagnosed and solved" many difficult and complicated diseases.
"I have little credit for this case, it's mainly Zhou Can's credit." Director Jia is a very down-to-earth person, and never competes with his doctors for credit. "Zhou Can, it has been basically confirmed that the patient's illness is indeed a mental illness. Tell me about your treatment plan! What I want to hear is a cure as much as possible, rather than relying on psychiatric drugs to control the disease for a long time."
Director Jia is half his teacher.
When making requests to him, the tone was completely that of an elder talking to a younger person.
Based on Director Jia's teaching and training of Zhou Can, he is indeed qualified.
Interpreted from another perspective, it can also be considered that Director Jia and Zhou Can have a close relationship.
"If you want to cure it, you must find the reason why the patient is so stressed. Based on the description of the family, I suspect that the patient's stress is related to the high school entrance exam. Because the patient fell ill in the second half of the third year of junior high school, close to the high school entrance exam. It is easier to find the cause of the high stress for children in this period. I want to talk to the family and the patient again, and then develop a corresponding treatment plan. Do you think it's okay?"
Zhou Can has been catching up on the basics of psychological medicine during this period.
It comes in handy now.
He suspected that the cause of the patient's high mental stress was most likely related to the high school entrance examination.
Even if this is not the reason, it should be relatively easy to troubleshoot.
For example, if there is a problem in the relationship of the parents, or the child is stimulated to fall in love prematurely, or the teacher criticizes the child harshly for something, all of these may cause the patient to be extremely nervous.
As long as the patient's mental knot is untied, the disease will heal itself without treatment.
"Go quickly, I'm looking forward to the final result!"
Director Jia asked Zhou Can to quickly find the patient and his family to communicate.
…
Zhou Can easily found the smiling family members outside the EEG monitoring room.
The cause of the child's illness was found, and the condition was initially under control after medication, which made the family very happy. The sadness on their faces had been swept away, replaced by a smile from the heart.
"Dr. Zhou, thank you for saving our son. You are our family's benefactor!"
When the family members saw Zhou Can coming over, they excitedly stepped forward and expressed their gratitude to Zhou Can repeatedly.
"I am only assisting in the diagnosis and treatment of your son's disease. The main credit goes to my instructor, Director Jia. I came here now to talk to you about the specific cause of your child's illness. I want to try to completely cure your child's disease instead of just using drugs to control the condition."
Zhou Can didn't choose a place, he just sat down on the bench outside and started chatting with the family members.
"Before your child became ill, did you put pressure on him regarding the high school entrance exam? For example, you wanted him to get into a good high school."
"Yes! When the high school entrance exam was approaching, the child's father emphasized more than once that he hoped the child could be admitted to the No. 1 middle school in the county. Because the child is the only child in the family and his academic performance is relatively good, my husband and I have high expectations for him. Could this also cause my son to get sick and have diarrhea?"
The family members did not question Zhou Can.
But I find it a little unbelievable.
No wonder they can't understand.
Without professional medical knowledge, who would have thought that putting some pressure on children for the high school entrance examination would actually cause diarrhea in children? In their view, diarrhea is only possible if one eats something unclean or is sick.
"I'm not 100% sure yet. Can your son communicate with you normally now?"
Zhou Can had asked the patient questions before in the outpatient clinic, but there was no way to communicate normally.
The patient has autistic tendencies.
At that time, it was thought that the patient had a serious illness, which led to autism.
Now I understand that he might have become autistic due to mental illness.
"Yes! When there are no outsiders around, I talk to my son and he responds to me relatively normally. It's just that our son has been introverted since he was young and doesn't like to talk much."
The patient's mother said.
"As long as someone can communicate with the child normally, it's a good thing. You can try to talk to the child and tell him that getting into a good high school is not that important. Try to untie his knot as much as possible and let him get out of the mental cage he has set for himself."
Zhou Can then gave the patient’s mother some specific instructions on how to give advice.
It is not difficult to provide patients with a private space that is as stress-free as possible. Simply draw the curtain above the monitoring bed to cover the entire bed.
Following Zhou Can's instructions, the child's mother went in and tried to persuade and enlighten the child.
If it really doesn't work, then we can only let them take the children to receive special psychological counseling.
Less than half an hour later, crying was heard from inside.
The child's father was anxiously waiting outside. When he heard his son crying inside, he immediately wanted to rush in to find out what was going on.
He was stopped by Zhou Can.
"It's actually a good thing that the child can cry. I'm just worried that he hides all the pressure deep in his heart and silently bears everything. Also, after you see the child, I hope you can take the initiative to tell him that he doesn't need to get into a good high school and stop putting pressure on him. Give him as much care as possible."
For a seventeen-year-old child, crying is the initial manifestation of having his psychological defenses torn apart and completely releasing emotions and stress.
This crying means that the child’s heart knot is collapsing.
It's a good thing.
Zhou Can is very busy and cannot stay here all the time.
After giving a few instructions, he went about his own business.
It was around one o'clock in the afternoon and he was writing medical records and looking up information in his office.
The child's father came.
As soon as you enter the door, you have to kneel on the ground.
Zhou Can was so scared that he quickly stood up and supported him. The other doctors also watched it in amazement.
"Dr. Zhou, thank you... My child ate half a bowl of rice and a lot of vegetables at noon. This was the first time in more than two years that he called me. Also, he didn't have diarrhea after eating. It was incredible. You saved my son, which is equivalent to saving our family. If my son died, my family would be ruined."
The man's voice choked several times.
For the vast majority of families, children are their hope and their lifeblood.
"Haha, that's great! It's the most gratifying thing for us doctors to see the patient's condition improve and recover. Your child is very thin due to long-term malnutrition. We can't expect to make him fat with just one or two meals. We need to do it step by step. Don't give him all kinds of nourishing food with big fish and meat right away. You must increase it gradually."
"In addition to gradual nutritional supplementation, we also need to help him increase his exercise. When he is able to stand up, take him to walk more and breathe more fresh air outdoors. When Director Jia comes, I will ask for you to see if he needs any medicine."
When Zhou Can heard the good news, he was happy from the bottom of his heart.
Finally, we successfully treated a patient with a difficult and complicated disease who was on the verge of death.
[Pathological diagnosis experience value +1. ]
[Congratulations on successfully diagnosing a very difficult case. You will be awarded +100 pathology diagnosis experience points. You will also be awarded +100 first aid experience points.]
Zhou Can received two big rewards at the same time.
[Congratulations on your emergency medical skills reaching the intermediate level. Your current experience value is 1/10000. When rescuing patients, your wisdom will be doubled, your mind will be highly calm, and your diagnostic thinking will be improved by 100%. ]
This special medical skill was successfully promoted to the intermediate level.
Zhou Can was very happy.
The use of special medical skills is different from that of ordinary medical skills. It is more like the spring rain that moistens everything silently.
It secretly and silently improved Zhou Can's diagnostic ability and helped him keep a calm mind. He was able to see the light and not be confused by the manifestations of some diseases.
The diagnostic thinking ability has been improved by 100%, which is equivalent to doubling.
According to his understanding, the diagnostic capability should be doubled when diagnosing critically ill patients.
Whether this is true or not, we need to find a patient to experiment on next time to find out.
