This doctor has a system

Chapter 395 460. You always know Stephen Hawking, right?

"I don't think the doctor will talk nonsense." My daughter thought for a moment and said, "He is so handsome."

"He's so handsome that he can't be eaten as a meal." The patient curled his lips to express his disapproval.

"You can't say that." The patient's daughter replied, "Don't you say that my dad is ugly all day long, which affects your appetite?"

patient.

However, out of respect for the elderly, the patient's daughter deliberately registered another number.

"It's hard to say." Director Zhou Feng of the Department of Respiratory Medicine at Xie Xie said while holding his glasses, "I think he still needs to be hospitalized for a detailed examination."

"There is still a possibility of malignancy." He considered it and said.

"Huh?" The patient was frightened now.

People are like this. When I go to the hospital to see a doctor, my thoughts are very complicated. When the doctor says that I am not sick, I will inevitably have doubts. Could it be that the doctor's skills are too low and he missed the diagnosis for me?
But when the doctor really says that you have a big problem, you will be worried. Is it because the doctor is too low-level and misdiagnosed me?
"But a doctor just said I was fat."

"You are most likely suffering from amyotrophic lateral sclerosis." Director Wang Chaofan said, "Of course, we still need further examination."

She eats.

Then this is very strange. There is no problem with the heart and lungs, so why do you have difficulty breathing?

"Is amyotrophic sclerosis easy to treat?" the patient asked, "A hospital as big as yours must have treated many patients like me."

"Well, you may have a neurological disease." Gao Feng said, "Well, you can go to the neurology department and have a look."

"No." Director Zhou Feng said. If you wait, you might not be able to wait. "I'll just ask the patient to come to you with the film."

The disease often manifests as progressively aggravated muscle weakness, muscle atrophy, fasciculations, etc. caused by combined damage to upper and lower motor neurons.

The patient's symptoms quickly reminded him of a chronic, progressive neurodegenerative disease: amyotrophic lateral sclerosis.

The patient had some concerns, but did not ask any more questions and went out with the note.

"Come, lie down and I'll check your private parts." Gao Feng said.

"Show this to the doctor," he instructed.

"It's not easy to treat." Director Wang Chaofan said euphemistically, "Do you know about ALS?"

It was obvious that he did not realize the seriousness of the matter.

It is a chronic, progressive degenerative disease that affects upper and lower motor neurons and the muscles of the trunk, limbs, and head and face they innervate.

Soon, Director Wang Chaofan of the Department of Neurology saw the note. He asked carefully about the medical history, and soon his face became serious.

"Morgani's hernia?" Director Zhou Feng hesitated.

He wrote a note and handed it to the patient. It said in English letters: ALS, which is the English abbreviation of amyotrophic lateral sclerosis.

Her father specially raised a golden retriever to solve the problem of leftovers. As a result, when the dog grew up, there was not enough to eat. My mother was used to thrifting and felt that the leftovers were all good things and it would be a pity to let the dogs eat them.

Accompanied by her daughter, the patient came to the imaging department anxiously, and the bald Director Bian received her.

"I'm busy." Director Bian of the Imaging Department replied, "Can you wait for a while?"

patient

Speaking of amyotrophic lateral sclerosis, you may have never heard of it, but you must be familiar with its other name: ALS.

"Yes, the doctor also said it was called Morgani's hernia." The patient's daughter still had a good memory.

The patient lay on the examination bed again.

"It's not a tumor, it's probably Morgani's hernia." Director Bian looked at it carefully and said, "Sometimes it's easy to be confused with a tumor."

"Am I fat?" the patient said angrily to her daughter, "Sanni next door is 10 pounds heavier than me, and no one calls her fat!"

“I always feel weak,” the patient explained.

"It's a bit much." Her daughter was not afraid of her at all, "Don't eat leftovers anymore. If you have a dog at home, let the dog eat it."

"Old Bian, I have a movie here that I need you to watch."

Therefore, she is fat and dancing in the square every day does not help.

In the afternoon, the patient who complained of coughing and dyspnea for more than 10 days came back with the film. Gao Feng took it and looked at it. Both the CT and ECG showed normal.

"Aunt Sanni is 173cm tall and you are 155cm tall." My daughter said, "I think you are a little fat."

Gao Feng conducted a systematic physical examination on him, and soon made suspicious findings. The patient's upper limbs had low muscle tone, but tendon reflexes were hyperactive, and Hoffmann's sign was positive. His lower limbs had high muscle tone, tendon reflexes were hyperactive, and Babinski's sign was positive. .

"You are fat."

"Do you think I eat too much?" The patient was furious.

He pushed his glasses up again and looked at it again, feeling that he was still not sure.

So he picked up the phone and decided to call someone.

The patient lay down on the examination bed obediently, and Gao Feng noticed that he was struggling a little bit when he sat on it.

The patient was stunned for a moment.

Could it be a neurological disease?

A small number of cases are genetic, but in most cases the cause is unknown.

"I think I've heard of it, but I can't remember it for a while," he said.

"You always know Stephen Hawking, right?" Director Wang Chaofan said, "He's the one in the wheelchair."

"He also wrote a book called A Brief History of Time."

The patient reacted for a while, and when his legs became weak, he was about to collapse on the ground. The student behind Director Wang quickly ran over to support him.

"Don't be too pessimistic." Director Wang consoled him, "It's possible that we made a mistake."

The patient soon had a glimmer of hope in his eyes after hearing his words, but the result was destined to disappoint him. After further examination, he was eventually diagnosed with amyotrophic lateral sclerosis (ALS).

This means that the patient's life has entered a countdown. There is no specific treatment for this disease. The progression of the disease can only be delayed but cannot be avoided. The prognosis is very poor. Most patients die of respiratory muscle paralysis or lung infection within 3 to 5 years.

Gao Feng didn't want to talk to the patient in the clinic mainly for this reason. He didn't want to see the patient look desperate.

"Professor Gao, where are you now?" The caller asked was Director Fan Enfu of the Department of Endocrinology of Peking Union Medical College. "I heard that you came to our place again. Why didn't you come to the rare disease clinic?"

"I'm staying in the Respiratory Department now." Gao Feng said with a smile, "I'll talk to you after the ward rounds."

Director Fan Enfu attends the rare disease clinic four days a week, and his work focus has shifted from the endocrinology department to here.

"There are still a lot of patients," he said to Gao Feng, "but most of them are not rare diseases."

To be precise, they are all difficult and complicated diseases, which are quite different from rare diseases.

Yes, we are all ordinary people, so where do so many rare diseases come from?

But now the female patient in the clinic feels that she is extraordinary. She feels that she must be suffering from some strange disease.

"I've been catching a cold every week for more than two months." The 2-year-old patient complained to Director Fan Enfu, "I don't know what's wrong!"

The duration of each cold was about 5 days, and the catarrhal symptoms such as nasal congestion and runny nose were finally relieved, but she felt something was wrong as soon as she went out.

"It's the kind of thing that when the wind blows on me, I know something bad is going to happen." The patient was so depressed that he almost vomited blood. "I started to have a fever when I got home. When I got to the hospital, the doctor said I had a cold."

"Too often!"

"Just give me two days off every week, just like going to work!"

The patient couldn't help swearing, and the family member next to him smiled apologetically at the doctor.

It’s no wonder that the patient is like this. She used to be a national-level long-distance runner and has been working in a public institution after retiring. Although the frequency of physical exercise is not as high as before, it is definitely much higher than that of ordinary people.

The patient's husband didn't get sick even though he was at home all day long. On the contrary, she, a former athlete, caught colds all the time. How unbecoming!

"Have you had a detailed examination at the hospital?" Director Fan Enfu asked, "Is there a problem with your immunity?"

"I've been admitted to the hospital twice. I took X-rays and other things and said there was no problem, but the doctor did say that my immunity is a little weak." The patient took out the examination sheet and showed it to Director Fan. "He also asked me to take some medicine for a while after I go back. This drug.”

The drug the patient mentioned is called thymosin tablets, which are small molecule polypeptides with non-specific immune effects discovered and purified from calf thymus. It can induce the differentiation and maturation of T cells, enhance the production of cytokines and enhance the antibody response of B cells, thereby enhancing immunity.

It is mainly used in various diseases with low cellular immune function (such as viral hepatitis, prevention of respiratory tract infections, stubborn oral ulcers, etc.).

Of course, the effect of this drug is not very precise, and some patients report that the effect is not very good after taking it orally.

"I heard that you have opened a rare disease clinic, so I thought of coming over today to have a look." The patient is a native of the capital and his home is not far from here.

Gao Feng looked at the patient's test results and found that one of the five immunity indicators was indeed slightly low. Others, such as liver and kidney function, cardiac enzymes, electrolytes, and infectious diseases, were normal.

"By the way, her gastrointestinal condition has been bad recently and she always suffers from diarrhea." The patient's lover added.

"Director Fan, what is this?" Gao Feng pointed at the chest CT and said.

"I really can't say this." Director Fan said. He is an expert with a background in endocrinology. His ability in chest CT can only be said to be average. He can definitely see the obvious things, but he is a bit blinded by others.

"It doesn't feel like normal tissue." Gao Feng said, "But the film didn't work well. We need to make a new one. It's best to just plain scan and enhance it."

Many patients don't understand why the doctor who admitted me to a new hospital still asked me to take X-rays after I had already taken them.

In fact, a very important reason is that there is too little information obtained from the film.

If you had the examination at our hospital, the doctor could see nearly a thousand images on the computer, but there would only be a few dozen on the film you brought with you.

Therefore, if it is convenient, it is a good idea to spend tens of dollars to go to the imaging department where the film was taken to carve a disk and bring it to the new hospital.

The patient was very enthusiastic about the examination, and it was obvious that she was very anxious about her condition.

"Director Fan, what do you think is the problem with this patient?" Gao Feng asked after the patient left.

"There is a high probability that there is something wrong with the immune system." Director Fan thought about it and said, "But it's still strange, because the patient's physical fitness was very good before, but now his immunity suddenly drops?"

It seems a little unreasonable.

Speaking of immunodeficiency diseases, many people will immediately think of AIDS. The HIV virus mainly invades the human body's immune system, eventually leading to defects in human cellular immune function.

As a result, patients are easily susceptible to infections such as bacteria (including tuberculosis), viruses, fungi, and parasites. Due to the lack of immune resistance, the infection will be more difficult to cure and may lead to death of the patient.

This patient had repeated upper respiratory tract infections, which led people to suspect that there was a problem with her immune system. However, the patient's infectious disease results were negative, and AIDS could basically be ruled out.

"By the way, you just said there was something wrong with the chest CT?" Director Fan mentioned this, "I really didn't see it at all."

"It looks like a thymoma, but I'm not sure." Gao Feng said, "Let's take a look together later."

Thymomas are tumors that differentiate from thymic epithelium and mostly occur in the anterior mediastinum. Thymomas seen with the naked eye are generally round or oval in shape, with varying volumes. The tumors are soft in texture and mostly dark brown or gray-red in color. The tumor may present a leaf-like outline with obvious gray-white fibrous tissue intervals in between.

It may be asymptomatic in the early stage, and is often found during physical examination. Clinically, it often presents with symptoms such as dull chest pain, shortness of breath, and cough. Thymoma can invade locally or metastasize to distant places, and there is a possibility of recurrence after complete resection.

But the better thing is that thymoma is a tumor with relatively low malignancy in biological behavior. If patients are treated early, they can achieve better therapeutic effects.

"Immune deficiency, thymoma?" Director Fan was stunned.

"What's wrong?" Gao Feng saw something wrong with his expression and asked casually.

"Could it be Goods syndrome?" Director Fan sat up straight. "No, the patient should not be so unlucky." He said with a smile.

Goods syndrome is a rare autoimmune deficiency disease, which is mainly characterized by thymoma and hypogammaglobulinemia. The incidence rate is only 1.5/100 million. Due to the rarity and insidiousness of the disease, misdiagnosis and missed diagnosis are often easy to occur. The patient eventually died from a severe infection.

"I have been attending a rare disease outpatient clinic recently, so I always refer to rare diseases when diagnosing patients." He said to Gao Feng, "The main reason is that I have read too many books on this subject, and my mind is full of rare diseases."

After speaking, Director Fan laughed happily.

Gao Feng also laughed along with him. This is indeed the case at work. No matter what industry you work in, you are accustomed to looking at problems from the perspective of your own industry.

The female patient came back soon with a chest CT film in her hand.

Director Fan quickly turned on the computer, and the two of them studied it carefully.

(End of this chapter)