【My medical skills can add experience points】【】
A common cold, unexpectedly brought great disaster to this young and beautiful girl.
It made her sick for two years.
With modern medical standards, even a bad cold is not a big deal. Just buy a box of medicine at the pharmacy on the side of the road, and you will be cured soon after taking it.
But this girl has been ill since she was seventeen years old.
The age of seventeen or eighteen is the age when the body's resistance is strongest, with vigorous body functions and full of vitality.
Zhou Can realized that the girl's body must have suffered from immune decline or immunodeficiency, so a small cold overwhelmed the body's defense system.
Almost all intractable diseases have a common feature, the patient is still not getting better after being treated in many hospitals.
Many difficult cases appear as minor ailments at the beginning, and they are good at disguising enough to make patients relax their vigilance. For example, low-grade fever, mild pain, or some mild symptoms of discomfort and so on.
They are like endless weeds, more and more will be cut, and finally become a disaster, completely crushing the patient's body and taking the patient's life.
Although the disease that was critically ill from the beginning was terrifying, it was easier to diagnose because of the obvious lesions.
At most, it is difficult to treat.
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 fate of the disease, and maybe a box of medicine for a few cents can cure the disease.
Many patients who have signed up for the special needs expert account believe that they have a deep understanding. They found a general doctor, went through various examinations, and took a basketful of expensive medicines, but their condition did not improve.
Then I listened to someone's introduction and hung up the number of an expert.
Hey, the expert didn't ask for any other tests, and after some diagnosis, he prescribed a box of medicine for fifty cents.
The patient was bewildered, is this expert reliable?
Could it be the brick house?
I went home and tried to take the medicine as prescribed by the doctor. A week later, something incredible happened.
The body feels significantly better.
Continuing to take the medicine, half a month later, the incurable disease was cured. Since then, this patient has said that it is really nice to be an expert.
I only regret that I didn't call the expert at the first time when I got sick.
So much so that I took a lot of expensive and useless medicines, and did a lot of unnecessary examinations. It was really wronged by those ordinary doctors to use them as guinea pigs for practice.
This patient was undoubtedly lucky.
He met specialists who happened to be good at treating his disease.
Otherwise, it is hard to say what the final result will be.
There are not a few unlucky patients who have been treated from mild to severe.
It is unbelievable to say that this female patient has a small cold that has not been cured for two years.
Zhou Can took the patient's examination information and checked it carefully.
The superior doctors are very happy that these young doctors are eager to learn and make progress.
Patient's erythrocyte sedimentation rate 39mm\\/first hour. Glutamate aminotransferase 170u\\/l, aspartate aminotransferase 137u\\/l, alkaline phosphatase reached 320u\\/l...
After reading the checklist, Zhou Can immediately suspected that there was something wrong with the patient's lymphatic system.
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【My medical skills can add experience points】【】
The patient used roxithromycin anti-infection treatment in the first hospital, and the effect was very poor.
Later, bone marrow puncture and B-ultrasound examination were supplemented in an outer hospital.
Now that these examinations were done in the outer hospital, Du Leng asked the patient to do a bone piercing again. The family members have not scolded their mothers, it is really good self-cultivation.
Bone puncture results showed active hyperplasia.
Abdominal b-ultrasound suggested that there were polyps in the gallbladder.
splenomegaly.
Hilar lymph nodes are enlarged.
Sure enough, as Zhou Can predicted, there was a problem with the lymphatic system.
He continued to check the patient's examination in another hospital.
Later, after the hilar lymph nodes were found to be swollen, the experts from the other hospital asked the girl to have a B-ultrasound of the lymph nodes.
The results indicated that there were enlarged lymph nodes in the bilateral neck, armpits, and groin.
Enlarged lymph nodes in so many parts indicate that it is likely to be a systemic lesion.
The problem is more serious than expected.
If you just get angry, it is more common to have bilateral cervical lymph node enlargement.
Cold is divided into wind-cold and wind-heat.
Wind-heat is getting angry and wind-evil invasion, which is a double syndrome.
The experts from the outer hospital were not vegetarians, so they performed a biopsy of the patient's inguinal lymph nodes following the clue of enlarged lymph nodes.
The result was reactive hyperplasia, and immunohistochemistry showed hyperplasia in t, b, and histiocytes.
This can basically be locked into 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. It's a pity that the good times didn't last long. Less than ten days later, the patient had a fever again, and the fever was above 40 degrees, and he developed a cough.
The family members urgently sent the patient to the hospital again for treatment, and they still found the same expert.
Because the last treatment had a certain effect, the family members have a high degree of trust in that expert.
After receiving the consultation, the expert immediately issued an application for blood routine examination to the patient.
After the blood test RT, it was found that the proportion of lymphocytes increased to 47%, and no abnormalities were found in the bone marrow puncture. The ast was checked, 43u\\/is aspartate aminotransferase.
If you check it, you will definitely check alp, that is, alkaline phosphatase, which has reached 141u/l.
Immediately afterwards, the patient was checked for blood and sputum cultures. It is estimated that the expert still suspected that the patient was infected with a virus or bacteria.
After not gaining much, the experts from the outer hospital were a little confused, and decided to apply for an abdominal CT for the patient.
It is estimated that the expert only checked an abdominal ultrasound last time, and felt that there were certain limitations.
The description of the examination of the lesion site is not clear enough.
So this time a ct was done.
The results indicated that the patient's liver was enlarged, fatty liver appeared, the spleen was still enlarged, and there was a low-density lesion in the left adnexal area.
Seeing this result, Zhou Can secretly sighed in his heart. If the experts were separated from the many high-tech medical examination instruments, they might be directly beaten back to the level of diagnosis and treatment in the primitive society.
Take this female patient as an example, the experts only did abdominal B-ultrasound last time, and found no fatty liver and ovarian lesions in the patient.
The ct results indicated that the low-density foci in the left adnexal area were actually ovarian tumors or cysts.
This time, experts from other hospitals were afraid of being slapped in the face, so they performed a liver biopsy on the patient and sent it for pathological examination.
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【My medical skills can add experience points】【】
The examination results showed that the liver cells were mildly turbid and swollen, with small focal fatty degeneration and scattered focal necrosis.
The portal area was slightly dilated, and more lymphocytes infiltrated.
Mild disruption of the leaflet perimeter plate.
Lymphocyte infiltration was also found in the hepatic sinusoid.
The final diagnostic opinions given by experts from other hospitals were chronic hepatitis, fatty liver, and gallbladder polyps.
The patient was given liver protection treatment and anti-infection treatment again.
The patient was hospitalized in the hospital for nearly four months and was discharged after his condition improved.
During this period, the patient's fever has not been cured.
From high fever to low fever, until discharged from the hospital is still a low fever state.
After discharge from the hospital, hepatoprotective treatment was continued.
After the patient went home, he often had a fever at night, even reaching 38 degrees or more.
In this way, after another half a year, the patient had red eyes for no reason, blurred vision, buzzing in the right ear, and severe hearing loss. stuffy nose.
The girl's mother saw that her daughter's condition has not been cured, and now the symptoms are much worse than the initial symptoms.
She was worried that there would be more serious problems if she went to that specialist for treatment again, so she changed to another hospital this time.
Unexpectedly, the doctors in that hospital failed to find out the cause of the disease after three days of investigation.
So the girl's mother had no choice but to find the expert from the outer courtyard again.
This time, the experts from the outer hospital spoke very tactfully after receiving the consultation. It means that he has practiced medicine for decades and has never encountered such a difficult disease. In view of the fact that the girl's condition has deteriorated, it is recommended that the family members go to Tuya Hospital or other large hospitals.
The expert had exhausted all his life's knowledge, but he still couldn't cure the girl's disease. If it continues to be cured, lives will be spread, and signboards will be smashed for sure.
Therefore, the expert from the outer hospital suggested that the family members take the patient to the experts from other hospitals in 'Huo Huo'.
Many doctors have done this.
The girl's mother originally wanted to go to Tuya Hospital to register for an expert account, but it was very difficult to obtain an expert account.
Just this time, I heard that there will be a large number of experts from Tuya Hospital coming to Xinxiang Maternity and Children's Hospital, so I hurried over with my child.
At first, the mother felt quite happy when she saw Professor Zhang Bihua from the Department of Obstetrics and Gynecology, and a doctoral student who graduated from a prestigious overseas university. I thought it was finally right.
Unexpectedly, Du Leng prescribed multiple examinations for her daughter, and obtained a lot of professional medical knowledge about various diseases.
In the end, I found out that this returnee doctor is a silver-like wax gun head.
The theoretical knowledge is great, but the actual diagnostic ability is terrible.
"Director Zhang, can my daughter's disease be cured?"
The girl's mother had also heard of Zhang Bihua's name, and at this moment, she was almost desperate for her daughter's illness.
"Don't worry, no matter how difficult the disease is, as long as you find the real cause, you can get rid of it with the right medicine. We have so many experts here, and we have the strong medical strength of Tuya Hospital behind us. Even if we are here today If the experts can't find out the cause of the disease, they will also ask the relevant experts of the General Hospital to conduct a special consultation and try their best to cure your daughter."
Zhang Bihua gently comforted the mother who was on the verge of collapse.
"Yang Chan, give the patient a physical examination."
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【My medical skills can add experience points】【】
Considering that the patient is a young woman, it is best for her to be examined by a female doctor.
Yang Chan gave the patient a physical examination.
Body temperature 38 degrees, obvious fever. The pulse was 115/min, the blood pressure was 110/80mmhg, and a soft lymph node was palpable in the right groin, which was movable. The bulbar conjunctiva of both eyes was slightly congested, the conjunctiva of the eyelids was not congested and edema, the sclera was normal, and there was no jaundice.
The pharynx was mildly congested, the left tonsil was enlarged, there was pus moss on it, and there was gag reflex.
The patient suffered from weakness in both lower limbs, instability in standing, and pain on both sides and soles of the feet.
In addition, the patient has certain hearing impairment.
"Considering that your daughter has symptoms such as unsteady standing and lower limb weakness, it is necessary to perform an electromyography for her to check the peripheral nerves of the upper and lower limbs, auditory and sympathetic nerves of the upper and lower limbs. In terms of ear and throat, Dr. Du has already prescribed sinus CT Examination showed that the right ethmoid sinus and bilateral maxillary sinus were inflamed. Head MRI showed thick mucous membranes in both maxillary sinuses and ethmoid sinus, and bilateral otitis media..."
Director Zhang had read all the examination materials, and asked Yang Chan to perform a comprehensive physical examination on the patient before giving further diagnostic opinions.
In fact, Du Leng basically asked the patient to do all the examinations that should be done.
Including sinus CT, head MRI and so on.
After Director Zhang finished speaking, he looked at the other two experts.
"Director Jiang, Director Shi, do you have anything to add?"
Because the patient's condition has lasted for more than two years, it has caused many lesions in the body, and the condition has become extremely complicated.
Zhou Can couldn't help sighing, if it was an ordinary family, I'm afraid they would have stayed at home and taken some traditional Chinese medicine and adopted conservative treatment.
Because many families can hardly afford the heavy medical expenses.
After the treatment in a large hospital is ineffective, they will think that the treatment in other hospitals will have the same result.
So I choose to resign myself to fate.
Both chief physicians Jiang and Shi shook their heads.
This case is too complicated and tricky, and they are really daunting at their level, and there is no way to give any constructive advice.
"Doctor Zhou, what about you? Do you have any good advice?"
Because of Zhou Can's outstanding performance in two consecutive cases, Zhang Bihua attached great importance to his opinion.
"Can I touch her neck?"
Zhou Can made a request that did not answer the question.
When Yang Chan was doing the physical examination for the patient just now, he had been watching from the side.
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 there was a misunderstanding.
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"It's ok, you don't hide your illness from the doctor! Doctor Zhou just checks my daughter."
When the family members were diagnosed at Du Leng's side just now, they actually secretly observed the situation at Director Zhang's side.
Zhou Can performed extremely well in the diagnosis of the obese woman, and his diagnostic opinions were even better than those of several experts. This made the female family members have a particularly deep impression on Zhou Can.
I have a high degree of trust in Zhou Can in my heart.
"Thank you for your trust and understanding!"
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【My medical skills can add experience points】【】
Zhou Can walked up to the female patient with a slightly serious expression on his face.
"If it hurts when I touch it, you can tell me right away."
He said to the female patient.
"OK!"
The voice of the female patient was very delicate, and her Qi was obviously insufficient.
After exhorting, Zhou Can stretched out his hand to touch her slender neck. The skin is very delicate, which is more conducive for Zhou Can to feel whether there is any swelling under the skin.
He felt from the side of the neck to the throat and surrounding area.
"Ah... it hurts, it hurts..."
The female patient suddenly let out a cry of pain.
Zhou Can nodded, as if he had expected it.
"Hold on a little bit, I'll try to be as gentle as possible. I want to see how big the tumor is and if there's still tumor around."
What I touched just now was actually the pharynx.
After some exploration, he didn't touch other tumors or make other new discoveries.
"Doctor Zhou suspects that she has a tumor in her pharynx?"
Director Zhang asked in surprise.
The female patient and her mother had a little more admiration for the young doctor's medical skills.
"There should be a tumor in her throat, and the size may not be large. I suggest that after further investigation, the tissue of the tumor should be taken for pathological examination. I feel that the lymphoma may be very large."
Zhou Can said in a rather determined tone.
Some lymphomas are extremely hidden and very difficult to detect. Especially in lymphangioma, the smallest lymphatic vessel may not even have a diameter of 1 mm. Even an MRI may not be able to detect it.
Director Zhang looked at the family members.
"Do you think it's okay to do another pharyngeal tumor examination?"
"Yes, yes. This doctor Zhou is really good. He didn't even need any equipment to know that there may be a tumor in my daughter's throat."
The family members praised Zhou Can.
For her, as long as she can find out the cause of her daughter, it doesn't matter how many tests she does.
Families with a good economy are never worried about how much medical expenses are spent, but whether the disease can be cured.
In fact, the richer people are, the stronger their risk awareness~ www.mtlnovel.com~ They buy a full range of commercial insurance.
In the event of a serious illness, after being reimbursed by medical insurance and commercial insurance, I can't spend much money.
On the contrary, it is the poor people who need to support their families in Hukou with a meager salary every month. It is normal to be stretched. There is really no extra money to buy commercial insurance that is not cheap.
When a serious illness occurs, they often face the end of selling their house and car to see a doctor.
Returning to poverty due to illness is not uncommon.
The patient went for a checkup.
"Dr. Zhou's clinical experience and clinical diagnosis ability are very good!"
Gao Jian said to Zhou Can full of bitterness.
Needless to say, in the diagnosis of these difficult cases, he failed miserably.
Zhou Can made meritorious service one after another, and had major diagnostic achievements. As a talented student of Imperial Medical University, even though he had been trained in Tuya's internal medicine department for nearly two years, he didn't even have a chance to speak.
It's not that he doesn't want to say it, but that he has limited ability and can't give any constructive opinions at all.
"Doctor Gao, don't praise me so hard. I have no other weakness, but I don't praise myself." Zhou Can's self-deprecating response made everyone smile.
"Xiao Gao, let's go. Doctor Zhou's strength is strong, and that's what he has learned. Let me tell you, diagnosing patients is the best way to learn."
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【My medical skills can add experience points】【】
Director Jiang said to Gao Jian.
After he finished speaking, he also pointedly glanced at Du Leng's table not far away, which had changed from bustling to deserted.