Chapter 280: This disease scares even the experts. The real medical skills must be learned from the patients.
Unexpectedly, a common cold brought such a huge disaster to this young and beautiful girl.
She was ill for two years.
With modern medical technology, even a severe cold is no big deal. You can just buy a box of medicine at a roadside pharmacy and recover quickly after taking it.
But this girl has been ill since she was seventeen years old.
Seventeen or eighteen years old is the age when the body's resistance is the strongest, the body functions are vigorous and the energy is full.
Zhou Can realized that the girl must have immune decline or immune deficiency, which is why her body's defense system was overwhelmed by a minor cold.
Almost all difficult diseases have one common feature: patients do not get better after being treated in multiple hospitals.
Many difficult cases first appear as minor illnesses, which are good at disguising themselves as something that can make patients relax their vigilance, such as low-grade fever, slight pain, or some mild physical discomfort.
They are like weeds that can never be cut off. The more you cut them, the more they grow. Finally, they become a disaster, completely destroying the patient's body and taking his life.
Although a disease that is critical from the beginning is scary, it is actually easier to diagnose because the lesions are obvious.
The most difficult thing is treatment.
The difficulty of this kind of difficult case lies in the fact that the real cause of the disease cannot be found. Once the cause is found, it is equivalent to finding the key to the disease, and the disease may be cured with a box of medicine worth a few cents.
Many patients who have made appointments with special specialists believe that they have experienced this: they go to an ordinary doctor, do all kinds of tests, and take a lot of expensive medicines, but their condition does not improve.
Then I listened to the introduction and made an appointment with an expert.
Hey, this specialist didn't order any other tests, and after a diagnosis he prescribed a box of fifty-cent medicine.
The patient kept wondering in his heart, is this expert reliable?
Could it be an expert?
I went home and tried to take the medicine as prescribed by the doctor. A week later, something incredible happened.
I feel noticeably better.
He continued to take the medicine, and after half a month, his long-standing illness was cured. From then on, the patient told everyone he met that it was great to see a specialist.
I only regret that I didn't make an appointment with that specialist as soon as I fell ill.
As a result, I took a lot of expensive and useless medicines and did a lot of unnecessary tests. I was used as a guinea pig by those ordinary doctors. It was really unfair.
This patient is undoubtedly lucky.
He met a specialist who happened to specialize in treating his disease.
Otherwise, it is hard to say what the final result will be.
There are quite a few unfortunate patients whose mild illnesses are treated as severe ones.
It's hard to believe that this female patient had been treated for a minor cold for two years but it still couldn't be cured.
Zhou Can took the patient's examination records and looked at them carefully.
Senior doctors are very happy that these young doctors are eager to learn and make progress.
The patient's erythrocyte sedimentation rate was 39 mm/hour. Glutamate aminotransferase was 170 U/L, aspartate aminotransferase was 137 U/L, and alkaline phosphatase was 320 U/L...
After reading the examination list, Zhou Can immediately suspected that there was something wrong with the patient's lymphatic system.
The patient was treated with erythromycin for infection at the first hospital, but the effect was very poor.
Later, he underwent bone marrow puncture and B-ultrasound examination in another hospital.
Since these examinations were done in other hospitals, Du Leng asked the patient to do another bone marrow puncture. The family members were very well-mannered and did not curse.
Bone marrow biopsy results showed active proliferation.
Abdominal B-ultrasound showed that there were polyps in the gallbladder.
splenomegaly.
Enlarged lymph nodes in the hilar region.
Just as Zhou Can predicted, there was something wrong with the lymphatic system.
He continued to review the examinations the patient had undergone in other hospitals.
Later , after finding that the hilar lymph nodes were swollen, experts from another hospital asked the girl to undergo another B-ultrasound examination of the lymph nodes.
The results showed that lymph nodes were enlarged in the bilateral neck, axilla, and groin.
The enlargement of lymph nodes in so many parts of the body indicates that it is likely a systemic disease.
The problem is more serious than expected.
If it is just a case of heat, bilateral cervical lymph node enlargement is often more common.
Colds are divided into wind-cold and wind-heat.
Wind-heat is a combination of internal heat and the invasion of wind evil, which is a double symptom.
The experts from the other hospital were not pushovers. Following the clue of swollen lymph nodes, they performed an inguinal lymph node biopsy on the patient.
The result was reactive hyperplasia, and immunohistochemistry showed hyperplasia of T, B and histiocytes.
This basically locks down the possibility of virus infection.
Experts from other hospitals gave the patient liver protection and antiviral treatment.
This is symptomatic treatment and is common in medicine.
The patient's condition improved after receiving treatment. Unfortunately, the good times did not last long. Less than ten days later, the patient had a fever again, with a high fever of over 40 degrees, and developed a cough.
The family members rushed the patient back to the hospital for treatment and consulted the same expert.
Because the last treatment had some effect, the family had a high degree of trust in the expert.
After the expert saw the patient, he immediately requested a routine blood test.
After checking blood Rt, it was found that the lymphocyte ratio increased to 47%. No abnormalities were found in bone marrow puncture. AST was checked, 43U/L. AST is aspartate aminotransferase.
If you check it, you will definitely also check ALP, which is alkaline phosphatase, and it should reach 141U/L.
The patient was then given blood and sputum cultures, and the expert probably still suspected that the patient had a viral or bacterial infection.
After not getting much results, the expert from the other hospital was a little confused, so he made up his mind and requested an abdominal CT scan for the patient.
I guess this expert only did an abdominal B-ultrasound last time and felt that it had certain limitations.
The description of the examination of the lesion site is not clear enough.
So I had a CT scan done again this time.
The results showed that the patient had an enlarged liver, fatty liver, an enlarged spleen, and a low-density lesion in the left adnexal area.
Seeing this result, Zhou Can sighed inwardly. If the experts were separated from the numerous high-tech medical examination instruments, they would probably be pushed back to the diagnosis and treatment level of primitive society.
Take this female patient for example. The expert only performed an abdominal B-ultrasound last time and did not find that the patient had fatty liver and ovarian disease.
The CT results showed a low-density lesion in the left adnexal area, which was actually an ovarian tumor or cyst.
This time, the experts from the other hospital were afraid of being slapped in the face, so they performed a liver biopsy on the patient and sent it for pathological examination.
The examination results showed mild turbid swelling of liver cells, small foci of fatty degeneration and scattered focal necrosis.
The portal area was slightly dilated and infiltrated with more lymphocytes.
There was slight destruction of the leaflet boundary plate.
Lymphocytic infiltration was also found in the hepatic sinusoids.
The final diagnosis given by experts from other hospitals was chronic hepatitis, fatty liver, and gallbladder polyps.
The patient was given liver protection and anti-infection treatment again.
The patient was hospitalized for nearly four months and was discharged after his condition improved.
During this period, the patient's fever had not been cured.
The fever turned from high to low and remained at a low level until discharge from the hospital.
After discharge, continue liver protection treatment.
After returning home, the patient often had a fever at night, even reaching over 38 degrees.
Just like that, about half a year later, the patient suddenly developed red eyes, blurred vision, buzzing in the right ear, and severe hearing loss. Nasal congestion.
The girl's mother saw that her daughter's condition had not been cured and that the symptoms were even worse than at the beginning.
She was worried that if she went to the same specialist for treatment again, there would be more serious problems, so she changed hospitals this time.
Unexpectedly, the doctors at that hospital couldn't find the cause of the disease after three days of examination.
So the girl's mother had to go to the outside hospital expert again.
This time, the specialist from the other hospital spoke very politely after seeing the girl. He meant that he had been practicing medicine for decades and had never encountered such a difficult disease. As the girl's condition had worsened, he suggested that the family go to Tuya Hospital or other large hospitals.
This routine is so similar to the Golden Foot Bath in Dabing Qizi.
The expert has used all his life's knowledge, but still can't cure the girl's disease. If he continues to treat her, she will die and his reputation will be ruined.
Therefore, the expert from another hospital suggested that the family take the patient to consult experts from other hospitals.
Many doctors have done this.
The girl's mother originally wanted to go to Tuya Hospital to make an appointment with a specialist, but she found that it was very difficult to get an appointment.
It just so happened that I heard that a large number of experts from Tuya Hospital would come to Xinxiang Women's and Children's Hospital for consultation, so I hurried over with my child.
At first, the mother was very happy to see Professor Zhang Bihua of the Department of Obstetrics and Gynecology and doctoral students who graduated from famous overseas universities. She thought she had finally come to the right place.
Unexpectedly, Du Leng prescribed a number of tests for her daughter and gave her a long lecture on professional medical knowledge on various diseases.
Finally, I found out that this overseas returnee PhD was just a piece of cake.
Theoretical knowledge is great, but actual diagnostic ability is terrible.
"Director Zhang, can my daughter's disease be cured?"
The girl's mother had heard of Zhang Bihua's name. At this moment, she was almost in despair about her daughter's illness.
"Don't worry. No matter how serious the disease is, as long as the real cause is found, the disease can be cured with the right medicine. We have so many experts here, and we have the strong medical strength of Tuya Hospital behind us. Even if the experts present today cannot find the cause, we will ask the relevant experts of the General Hospital to conduct a special consultation and do our best to cure your daughter."
Zhang Bihua gently comforted the mother who was on the verge of collapse.
"Yang Chan, please give the patient a physical examination."
Considering that the patient is a young woman, it would be best if she had a female doctor perform the physical examination.
Yang Chan performed a physical examination on the patient.
The body temperature was 38 degrees, with obvious fever. The pulse was 115 beats/min, the blood pressure was 110/80 mmHg, and a soft lymph node could be felt in the right groin, which was movable. The conjunctiva of both eyes was slightly congested, the palpebral conjunctiva was not congested or edematous, and the sclera was normal without yellowing.
The pharynx is mildly congested, the left tonsil is enlarged with pus on it, and the pharyngeal reflex is present.
The patient experienced weakness in both lower limbs, unsteady standing, and pain on both sides and soles of both feet.
In addition, the patient has certain hearing impairment.
"Considering your daughter's unstable standing and lower limb weakness, you need to do an electromyogram to check the peripheral nerves of the upper and lower limbs, hearing, and sympathetic nerves of the upper and lower limbs. In terms of ear and throat, Dr. Du has already ordered a sinus CT scan, and the results showed inflammation of the right ethmoid sinus and bilateral maxillary sinuses. The head MRI showed thick mucosa of both maxillary and ethmoid sinuses, and bilateral middle ear mastoiditis..."
Director Zhang looked at all the examination data and asked Yang Chan to conduct a comprehensive physical examination on the patient before giving further diagnostic advice.
In fact, Du Leng basically had the patient undergo all the necessary examinations.
Including sinus CT, head MRI, etc.
After Director Zhang finished speaking , he looked at the other two experts.
"Director Jiang, Director Shi, do you have anything else to add?"
Because this patient's illness has lasted for more than two years, it has caused lesions in many parts of the body and the condition has become extremely complicated.
Zhou Can couldn't help but sigh. If it were an ordinary family, they would probably have stayed at home and taken some Chinese medicine or something and adopted conservative treatment.
Because many families find it difficult to afford the heavy medical expenses.
When treatment at a large hospital fails, they think that the same result will occur if they go to another hospital for treatment.
So I choose to leave it to fate.
Chief Physicians Jiang and Shi both shook their heads.
This case was too complicated and difficult, and it was really daunting for them given their level, so they were simply unable to give any constructive advice.
"Doctor Zhou, what about you? Do you have any good suggestions?"
Because Zhou Can performed exceptionally well in two consecutive cases, Zhang Bihua attached great importance to his opinion.
"Can I touch her neck?"
Zhou Can made a request that was irrelevant to the question.
Just now, when Yang Chan was doing a physical examination on the patient, he was watching.
In this case, even if he wanted to touch the patient's neck, he had to consider the difference between men and women. It would be bad if it caused misunderstanding.
"Sure, it's okay to see a doctor! Doctor Zhou, just check up on my daughter."
When the family members were diagnosing the patient with Du Leng, they were actually secretly observing the situation on Director Zhang's side.
Zhou Can performed extremely well in diagnosing the obese woman, and his diagnosis was even better than that of several experts, which made the female family member have a particularly deep impression of Zhou Can.
I have a high level of trust in Zhou Can.
"Thank you for your trust and understanding!"
Zhou Can walked to the female patient with a slightly serious expression.
"If it hurts when I touch you, you can tell me right away."
He said to the female patient.
"OK!"
The female patient's voice was very delicate and her breath was obviously lacking.
After giving the instructions, Zhou Can reached out and touched her slender neck. The skin was very delicate, which made it easier for Zhou Can to feel whether there was any swelling under the skin.
He felt from the side of the neck toward the throat and surrounding area.
“Ah…it hurts, it hurts…”
The female patient suddenly cried out in pain.
Zhou Can nodded, as if he had expected it.
"Just bear with me for a moment. I'll try to be gentle. I want to see the size of the tumor and whether there are any other tumors around it."
What I just touched was actually the pharynx.
After some exploration, he did not touch any other tumors or make any new discoveries.
"Doctor Zhou suspects she has a tumor in her pharynx?"
Director Zhang asked in surprise.
The female patient and her mother had more admiration for the young doctor's medical skills.
" There should be a tumor in her throat, but it may not be very large. I suggest that we take tissue from the tumor for pathological examination after further investigation. I think it is very likely to be lymphoma."
Zhou Can said in a rather firm tone.
Some lymphomas are extremely hidden and difficult to detect. This is especially true for lymphangioma, where the smallest lymphatic vessels may be less than 1 mm in diameter. Even MRI may not be able to detect them.
Director Zhang looked at the family members.
"Can you do another check for a swelling in the pharynx?"
"Yes, yes. Dr. Zhou is really amazing. He can tell that there may be a tumor in my daughter's throat without using any instruments."
The family praised Zhou Can.
For her, as long as the cause of her daughter's illness can be found, it doesn't matter how many tests are done.
Families with good financial conditions never worry about how much medical expenses will cost, but only about whether the disease can be cured.
In fact, the richer people are, the stronger their risk awareness is, and they buy a full range of commercial insurances.
If a serious illness really occurs, after reimbursement from medical insurance and commercial insurance, you won’t have to spend much money.
On the contrary, poor people, who have to support their families with a meager salary every month, are often short of money. They really don't have extra money to buy those not-so-cheap commercial insurance.
When serious illness occurs, they often face the outcome of selling their houses and cars to pay for medical treatment.
Many people fall back into poverty due to illness.
The patient went for a check-up.
"Dr. Zhou's clinical experience and clinical diagnostic ability are amazing!"
Gao Jian said to Zhou Can with bitterness.
Needless to say, he failed miserably in diagnosing these difficult cases.
Zhou Can had made many contributions and achieved important diagnostic results, but as a top student at the Imperial Capital Medical University, he didn't even have a chance to speak even after nearly two years of regular training in Tuya's Department of Internal Medicine.
It’s not that he doesn’t want to speak, but his ability is limited and he can’t give any constructive suggestions.
"Doctor Gao, please don't praise me so hard. I don't have any other weaknesses, and I just can't stand being praised." Zhou Can's self-deprecating response made everyone laugh.
"Xiao Gao, let's go. Doctor Zhou's strength is the result of practice. I tell you, diagnosing patients is the best way to learn."
Director Jiang said to Gao Jian.
After saying this, he glanced meaningfully at Du Leng's table not far away, which had gone from lively to deserted.
