This doctor has a system

Chapter 525 588. Acupuncture Base is Actually Better
Gong Fanshun has been very busy recently, so he is very angry.

The laboratory needed to recruit a group of high-end talents. He contacted several senior and junior students he was familiar with in school, but none of them were willing to come.

"The treatment is very good, the boss always gives money!"

"Is it Shabi or throwing money?" Some people don't believe it.

Some people think the treatment is good, but they are still unwilling to come.

It has been so many years since we graduated, and many people have already bought houses, got married and had children. Unless there are special circumstances, they still don’t want to change jobs.

People are like this. After staying in a familiar and comfortable environment for a long time, they are unwilling to make changes. It is nothing more than boiling a frog in warm water.

In the end, only one person was willing to come here to take a look.

"Brother Deheng!" Gong Fanshun happily hugged him, "You look much older, your hair has become thinner."

"I'm losing my hair." Zong Deheng said with a smile, "You still look the same, your hair hasn't decreased."

After graduation, he worked in a research institute in Tianjin and would occasionally contact Gong Fanshun.

"I haven't seen you for a few years. You look a lot fatter now." Gong Fanshun patted Zong Deheng's beer belly and said, "You are a senior executive now, right?"

Zong Deheng said nothing.

"Middle management is also good, it's easier." Gong Fanshun.

Zong Deheng said nothing.

"It is actually better to work at the grassroots level with acupuncture, where you can directly display your talent instead of letting it go to waste," said Gong Fanshun.

Zong Deheng sighed.

"Seeing you reminds me of our school days." Gong Fanshun quickly changed the subject, "How is sister-in-law? I haven't seen you posting on WeChat Moments recently."

Zong Deheng's wife is from the same class as Gong Fanshun, so the two are familiar with each other.

However, Gong Fanshun didn't like her very much. She was the kind of person who was self-centered and had a bad temper. She would often give others the cold shoulder.

"I think it was deleted for you." Zong Deheng said, "We are divorced."

"Why?"

"Oh, his father went to jail the year we got married." Zong Deheng felt a pain in his balls whenever he mentioned this. His ex-father-in-law was the head of a research institute, so naturally, as a son-in-law, he had a smooth start.

But things don't always go as planned. My ex-father-in-law was reported by someone, perhaps because he stood on the wrong side or something.

Everyone looks clean when they put on clothes, but once they take off their pants, their butts are full of shit.

"I was sentenced to 12 years." Zong Deheng said in a heavy tone, "This is not the most uncomfortable thing."

The most distressing thing is that all the money earned was recovered.

"What do you think he was thinking? Keeping so much cash at home!"

"Damn, they usually don't even let us spend a little. Now we have become nature's porters."

He didn't gain any advantage, and his work was greatly affected because of this. Now his position in the workplace is somewhat awkward.

Since then, his wife's mentality has been unbalanced and she would quarrel with him at every turn. After a fierce quarrel some time ago, the two completely parted ways.

"The child stays with me, and the property belongs to her."

Zong Deheng felt a little uncomfortable when talking about this. It was quite uncomfortable that he finally saw the true face of the person beside him after so many years.

"Where is the child now?"

"With my parents." Zong Deheng smiled, "I have been relying on them for a while now."

He was depressed for a long time, but recently he realized that he had to continue working hard even for the sake of his children.

"Come to our company and let's work together." Gong Fanshun said to him.

Even if Zong Deheng's level is still at the level when he was in school, it is enough for him to enter Fengxin Technology.

However, the other party's performance did not disappoint Gong Fanshun's expectations. After walking around the laboratory, he knew that the orb was not covered in dust.

This is also the reason why Zong Deheng was still able to work at the company even though his former father-in-law had already gone to work operating a sewing machine.

At that time, his direct supervisor wanted him to leave, but others disagreed.

"Xiao Zong is gone. Who will do the work of their department? Who will be responsible for contacting us?"

"That's right, do you count on your relatives who can only talk nonsense?"

"What era is this? Are you still using collective punishment?"

The direct supervisor reported the situation to his superiors, but the new supervisor felt that there was no need to do so. The person was not a relative of his, and since he was capable, why not just let him continue to work there?

I have lost my position and can only stay firmly rooted at the grassroots level.

"You should adapt here for two days first." Gong Fanshun reported Zong Deheng's specific situation to Hu Jiaran, and the latter was very happy.

"If it's really as you said, then the company has gained a new talent!"

"Wait for a while, and then let him lead a team."

With a PhD and so much work experience, he would have been the company's treasure if he had come before. But now the company has more people, more rules and regulations, and the feelings of the elderly must also be considered.
-
Gao Feng is looking at a patient's medical record. There are many people in this world, and there are also many diseases.

Some people are eccentric and even their illnesses are different from others. This is not a good thing.

Patient, female, 77 years old.

Chief complaint: paroxysmal chest tightness and wheezing for 7 days

Seven days ago, the patient had repeated chest tightness and shortness of breath symptoms without obvious cause. The symptoms worsened after activity and lasted for a long time, accompanied by palpitations, headaches, occasional dizziness, and occasional transient amaurosis.

The bowel movements are normal and the urine volume is about 4500-5000ml/day.

The normal urine volume of most people is about 1500-2000ml/day, so this patient obviously has a problem.

No fever, chills, chest pain, cough, sputum, abdominal pain, diarrhea, foamy urine, hair loss, photophobia, dry mouth, dry eyes, oral or perineal ulcers, skin lesions, Raynaud's phenomenon, etc.

He has a history of "hypertension, hyperlipidemia, type 2 diabetes, diabetes insipidus, bilateral hydronephrosis, old cerebral infarction, rheumatoid arthritis, osteoarthritis" and so on.

There was nothing special about the marriage history, menstrual history and personal history.

Both parents have passed away. The father had a history of "hypertension". The mother had a history of "breast cancer". There is one brother and one sister. The brother suffers from "hypertension" and the sister is healthy.

The patient was pushed to the hospital by her two daughters-in-law. She lived near the Provincial Hospital and was an ordinary retired cadre.

Thanks to the careful care of his family and proper maintenance when he was young, the patient looks much younger than his actual age.

Physical examination: coarse breath sounds in both lungs, low breath sounds in both lower lungs, and a small amount of moist rales can be heard. The heart border is enlarged, the heart rate is 108 beats/min, the rhythm is regular, the heart sounds are low and dull, and no murmurs are heard. Mild pitting edema in both lower limbs. Abdomen and nervous system physical examination (-).
For patients with sudden chest tightness, cardiopulmonary causes must be ruled out first.

主管医生给她完善了检查，结果发现心衰标志物BNP：421pg/ml(0-100)。电解质血钠：168 mmol/L(137-147)，血氯：131 mmol/L(99-110)。

Renal function test showed that creatinine was slightly elevated: 113 umol/L (35-80), and the white blood cell count was also above the normal value.

Cardiac ultrasound showed: large amount of pericardial effusion.

The CT examination revealed even more problems: bilateral pleural effusion; large pericardial effusion; multiple calcifications in both breasts; intrahepatic calcifications and liver cysts; abnormal density of the right posterior lobe of the liver; left renal cyst; abnormal density of both kidneys, considering hydronephrosis; increased density of the abdominal fat space and thickening of the mesangium and omentum; and considering uterine fibroids.

Pleural effusion is actually not a big deal, it is not too much, but a large amount of pericardial effusion needs to be treated in time.

The normal pericardium is a double-layer sac structure consisting of a serous layer and a fibrous layer.

The serosa layer is divided into two parts: the parietal layer and the visceral layer. The parietal pericardium is composed of the serosa layer, the parietal layer and the fibrous layer. The visceral pericardium is the visceral layer of the serosa layer. The gap between the parietal layer and the visceral pericardium is the pericardial cavity.

There is 15 to 50 ml of serous fluid in the pericardial cavity, which usually serves as a lubricant.

If heart disease or other diseases cause the pericardium to secrete excessive fluid, it will cause obvious discomfort symptoms, such as difficulty breathing, chest tightness, and pale complexion. In severe cases, it may cause pericardial tamponade, causing the patient to collapse.

When the amount of fluid accumulation is small, medication can be used for treatment. When the amount is large, surgery is required.

The patient was very afraid of pericardiocentesis and requested conservative treatment.

"Don't use a knife right away!" The family members also had this opinion.

Bu Zhengyang was helpless and could only explain patiently.

"She has too much. It's definitely not okay to be conservative."

"Besides, she's so sullen right now, draining the accumulated fluid will also alleviate the symptoms."

"How much fluid do I have?" asked the old lady.

"This can hold at least two cups." Bu Zhengyang said, pointing to a 2ml large cup on the bedside.

The old lady finally agreed to the drainage tube placement. It was not because Bu Zhengyang’s advice was right, but because she could not bear her anger any longer.

As the pericardial effusion was continuously drained, the patient's chest tightness symptoms improved significantly, but Bu Zhengyang soon felt something was wrong.

Why isn't this over yet?

You can play it every day, and there is no end to it!

In general, the patients had polyserosal effusion with large pericardial effusion as the main feature, and also had multi-system diseases such as diabetes insipidus, hydronephrosis, osteoarthritis, and thickening of abdominal fat tissue and mesangium.

However, the pericardial effusion was sent for testing several times, but no problems were found, which gave Bu Zhengyang a headache.

He asked for a consultation with the cardiothoracic surgery department, who was a little puzzled by the stubborn pericardial effusion and suggested a pericardial window + pericardial biopsy + partial pericardectomy with the assistance of thoracoscopic surgery.

"This way, we can explore the pericardium during surgery to see what's going on. Another thing is that we can remove a part of it and send it to pathology."

The patient rejected the cardiothoracic surgeon's suggestion on the spot, and her family members were also hesitant. The old lady was not young anymore, and the risks of the operation would definitely be high.

"I don't want to have the surgery!" The old lady was very determined and she had a reservation about the surgery.

20 years ago, the patient's husband underwent a heart bypass surgery in a Beijing hospital due to severe coronary artery blockage, but the result was regrettable and he ultimately died on the operating table.

This incident was a great blow to the patient, and from then on, she had a fear of surgery.

"The surgical method nowadays is different from before. We use thoracoscopy, which has a relatively low risk," explained the cardiothoracic surgeon.

But there are definitely risks. As I said, there will always be patients who die inexplicably.

what reason?
do not know.

(End of this chapter)