Gou is practicing medicine in the clinic

Chapter 376: Changes in blood vessels must have reasons, one-step inspection

"no!"

The family members shook their heads.

Li Jingsheng's original intention was to check the initial inspection data, and then compare it with the recent inspection data to look for some clues of changes.

The family did not retain the original examination data, so he could only look for other ways to make a breakthrough.

If there were imaging examinations such as brain CT and MRI when the disease first developed, it would be able to provide a good comparison.

Even just a head color ultrasound is of great diagnostic significance.

However, even 11 years ago, the total cost was more than 300 yuan, including examinations and medicines. The possibility of a brain CT scan was very slim.

At that time, the conditions in many hospitals were quite primitive.

Just like Li Jingsheng's clinic, it gets better and better by adding new equipment little by little.

At that time, many hospitals only had X-ray and B-ultrasound imaging equipment.

If you look through the medical teaching cases from 20 years ago, you will find that the biochemical and imaging examinations at that time were very simple.

Li Jingsheng decided to check the information and compare it after lunch.

"Uncle, please go back to the car and rest first. I will check the relevant information later. I took a look at the recent examination information you brought. There is an MRI of the brain and a CT examination of the head. Have you done any MRI scans? On the basis of the examination, have you ever done an MRI angiography examination?”

MRI scans are extremely accurate.

Moreover, it can image some deep cavity lesions, and the imaging effect is stronger than CT.

Even today, large hospitals still regard it as a bottom-line imaging examination.

Most people have only heard of MRI examinations, and few patients know about magnetic resonance imaging, and there is also an MRA examination method that specializes in checking blood vessels.

It mainly displays blood vessels and the tissues surrounding them, which allows doctors to observe the condition of blood vessels well.

It is often used especially in the examination of intracranial blood vessels.

"Never did."

The old man shook his head.

Getting an MRI scan is not cheap.

No one will do this test again.

"Okay, you guys go and have a rest first! I will check the information first at noon, and then find a way to find other doctors to make a diagnosis together. It is not easy for you to come all the way from other provinces. If you have any difficulties, you can report them to me at any time. As long as you are here Within my capabilities, I will try my best to find ways to help you solve it."

After Li Jingsheng persuaded the patient to leave, he continued to sit for consultation.

Fortunately, after two troublesome patients came in early in the morning, no one was particularly difficult to diagnose and treat.

During lunch, he deliberately looked up the anatomy of intracranial blood vessels on the Internet.

Because this is a standardized teaching diagram, it has less reference significance.

He was going to ask the teacher who taught general education at the school.

At this time, Li Jingsheng was already a teacher himself.

He worked as a teaching assistant for Professor Di of Orthopedic Medicine at the Affiliated Hospital of Jiangli Medical University.

Ye Hui and others are considered his students.

However, he is currently only a temporary employee at this medical school and has basically never attended classes there.I am not familiar with the personnel of the college.

Therefore, he was going to ask a teacher from his alma mater to help him.

Li Jingsheng rarely speaks among his classmates.

Because since his classmates knew that he was doing well now, they started to get close to each other and build relationships, which made him very annoyed.

As long as he shows up in the group, there will always be a few guys who come out to flatter him and please him.

He opened his address book and searched for a while before finding the phone number of Teacher Yu, who was in charge of teaching general classes.

Try calling.

"Hello, who is it?"

A slightly cold voice came from the other end of the phone.

"Hello, Teacher Yu, I am Li Jingsheng from Class 3117!"

"Oh, it's you! I heard that you have opened your own clinic now. How are you doing?"

The teachers are quite well informed.

However, they usually only focus on students with whom they have frequent contact, and students who do particularly well.

There is no doubt that Li Jingsheng is a model of counterattack.

He struggled to climb out of the mud and became a successful person envied by his classmates.

"Thank you for your concern. Apart from being busy at work, everything else is going well for me now. I am bothering you today because I want to ask you for some anatomy diagrams of intracranial blood vessels in adults. I met a young man who came from other provinces. Female patient…”

Li Jingsheng briefly explained the patient's condition and what happened.

After hearing this, Teacher Yu did not refuse.

"In this case, you add my WeChat account and I will find some pictures of the real thing to take pictures for you."

"Thank you!"

Li Jingsheng feels that most teachers are very respectable beings.

He deserves the title of human soul engineer.

"Teacher Yu, are you feeling well?"

Li Jingsheng asked.

"Except for some problems with the lumbar and cervical spine, everything else is fine. As you know, these are occupational diseases and there is no way to avoid them."

"If you have time, you can come to my clinic and let me give you a massage. As long as the lesions are not particularly serious, significant results can generally be achieved."

Li Jingsheng said sincerely.

When Teacher Yu first taught him, he was only 45 years old and in his prime.

He must be in his late fifties now.

I haven't seen him for many years, and I don't know if this teacher has changed.

Listening to the sound, it is still so sonorous and powerful.

"Well, when I have the opportunity, I will go find you. I saw in the news a few days ago that you have learned bone-setting techniques, and your level is very good. I find it unbelievable. Your instructor and several other people in the department The teachers are all discussing this matter and think you are special and have brought glory to your alma mater."

This evaluation is very high.

Li Jingsheng really doesn't think his achievements are anything special.

At least it's not a very high level now, just barely reaching the director level.

Even the self-proclaimed experts blush.

He said a few words of humility and ended the call with Teacher Yu.

After the two parties became WeChat friends, it didn’t take long for Teacher Yu to send him more than a dozen cross-section pictures of blood vessels in the human head.

When preparing specimens, blood vessels are usually stained.

Veins are stained blue, arteries are stained red, and nerves are stained yellow.Ligaments are usually not stained.

When medical students first learn anatomy, they must endure their inner fear and discomfort and carefully observe the distribution of blood vessels, as well as the structure of muscles and nerves.

More complex blood vessels and nerves are often distributed in a tree shape.

Even if you remember their distribution firmly, when you get to the operating table and dissect the patient, your brain is basically a mess.

For example, Li Jingsheng has been trained many times to be calm and well-informed.

He looked at the physical pictures sent by Teacher Yu and carefully analyzed the direction and distribution of blood vessels.

Teacher Yu was very considerate and even sent a special picture of blood vessel specimens.

That is, all other tissues in the patient's body have been melted away, leaving only blood vessels.Even the capillaries can be seen clearly.

They are like tree roots, densely distributed throughout the human body.

The head is also extremely rich in blood vessels.

Li Jingsheng quickly brought the female patient's head imaging report.

Even if MRI and CT are done, they can still only distinguish the main tissues and blood vessels.

After all, what you are watching now is not dynamic.If you really want to check, doing an MRA or CTA are both good options.

In contrast, he found that the blood vessels in the head of female patients were indeed richer than those of normal people.

Could it be that too many blood vessels can cause head lesions?

Never heard of it.

But the blood vessel network formed in the patient's head is obviously different from ordinary people. How to explain this?

He decided to ask Director Luo, director of the Department of Neurology of the Second Hospital, for advice.

Although I don't like Director Luo's personality, only Director Luo in the Second Hospital has a higher level in this regard.

As for neurosurgery, it is a cold and arrogant department, even more arrogant than general surgery.

Li Jingsheng has had little contact with neurosurgery doctors so far.

Cardiac surgery and neurosurgery are both so-called high-precision surgical departments.

The doctors in these two departments are generally a bit arrogant.

There is indeed the capital of Niu B.

The call was quickly connected.

"Hello, Director Luo, I am Li Jingsheng from the Orthopedic Surgery Department!"

"I have saved Dr. Li's phone number. I know even if you don't tell me where you are. Is there something wrong?"

Director Luo seemed very friendly.

"I have a case that I would like to ask you about..."

Li Jingsheng explained the patient's condition.

"Uh... this problem - I have less contact with it. But I think the blood vessels have become more abundant than normal people. If the blood vessels in the whole body are not like this, it means that the patient's head blood vessels have some pathological changes. The self of blood vessels The ability to change is very strong. For example, when a thick artery is blocked, as long as the blockage does not occur suddenly, the surrounding blood vessels will definitely react.

They will slowly replace the blocked blood vessel.

The vascular network on both sides of the brain has become richer. I think we can check for angiography.If conditions permit, you can also go to their People's Hospital or Qiao Bang to check for an MRA, or even do a further DSA test. "

Director Luo is never lenient in diagnosing patients.

As long as he thinks it is necessary, he will prescribe it to the patient.

"Okay, thank you for your advice! I'll ask the patient to do an MRA examination."

"If we want to do it, it's best to check another DSA. I think even if we can't find any problems, we can at least make some discoveries."

Director Luo emphasized.

"Okay, I'll communicate with the family."

Li Jingsheng feels that if a patient applies for these two examinations at the same time, his family may not agree.

And his small clinic can't do it, so he can only send patients to People's Hospital or Qiaobang Hospital.

Typically, both of these tests require an appointment and may even require hospitalization.

While he still had some time, he talked to the family members.

Unexpectedly, his family trusted him very much and readily agreed to take their daughter for these two examinations.

Considering that the patient's family came from other provinces and were not familiar with the place, and that they had food and accommodation in the car and had to take care of their daughter who was unable to move, Li Jingsheng decided to find a relationship.

There are no acquaintances there in Qiao Bang.

The People's Hospital has a lot of acquaintances.

This time I didn’t find Lian Tao, but Professor Wang Weiwei.

The cry of Lao Wang cannot be in vain. If something happens, you must ask Lao Wang for help.

In terms of status, connections, and familiarity with hospital personnel and various rules and regulations, Professor Wang Weiwei is obviously better than Lian Tao.It would be easier to let Professor Wang Weiwei handle this matter.

Li Jingsheng called Wang Weiwei to talk about the matter.

"Jingsheng, although this patient's situation is not an area I am familiar with. But after listening to your ideas, I suggested that you either do DSA directly. The family has a high degree of trust in you and is willing to cooperate. This is a good foundation.

MRA examination and DSA actually overlap. In terms of accuracy, MRA is much lower than DSA.

The gold standard for cerebral vascular disease, currently everyone only recognizes DSA test results.

Although the cost of MRA head examination is not particularly high, it still costs more than 800.And you have to make a reservation and queue up.It's better to go straight to the point and check the DSA.But you have to do a good job of communicating and explaining to your family members.

This examination is invasive and very expensive.

At least nearly 9000 yuan is required. "

To perform DSA, it is generally necessary to puncture the femoral artery and inject contrast agent.

Its accuracy is very high.

It’s just that many patients are unwilling to inject contrast media and are afraid of invasive examinations.

In this case, the only option is MRA examination.

"Okay, I'll talk to the family first. I believe they will understand our goodwill. When the negotiation is completed, I will call you."

Li Jingsheng felt that what Professor Wang said was very reasonable.

The patient has already had an MRI done in another hospital, and the estimated results of another MRA may not be satisfactory.

It's better to go straight to the point and check the DSA.

Doctors sometimes prescribe routine imaging tests for patients first, and then order more advanced tests if they feel further testing is necessary.This is just a matter of procedure.

Under the condition of high mutual trust between doctors and patients, and it is already known that there is likely to be a problem with the blood vessels in the patient's head and a more precise examination is needed, there is no need to take those detours.

After communicating with the family members, they still had the same trust in Li Jingsheng as before.

This old couple took their daughter around to seek medical treatment, and they must know how to deal with doctors.

If you do not cooperate with the doctor, it is easy to cause a lot of unnecessary trouble.

……

The next day, under the arrangement of Professor Wang, the patient underwent DSA examination at the People's Hospital.

Li Jingsheng specifically asked for two hours of leave from the hospital to settle the matter of purchasing the clinic yard.

Signing a contract, various procedures, paying a deposit, etc.

It took more than an hour of work to get it done.He didn't breathe a sigh of relief until everything was completed successfully.

Although the guy who handed over the blackmail letter failed to succeed, he still caused a lot of psychological pressure on Li Jingsheng.I'm afraid of losing my chain at the critical moment.

Fortunately, everything went very smoothly.

After completing the step of paying the deposit, the next thing to do is to make money quickly and hand over the full amount on the next payment date.

The total amount of nearly 840 million yuan is still quite difficult for him.

Fortunately, the clinic's online drug sales business, offline drug sales business, and diagnosis and treatment business are all developing well.

Especially online drug sales gave him a lot of surprises.

The convenient drug purchase business in the same city is not as good as expected.

After so many days, although the number of people buying medicines continues to increase, the benefits are far lower than expected.

Moreover, a person is required to be on duty at night to dispense medicine.

Increased operating costs.

However, everything has two sides, and you cannot just look at the benefits.

The development of intra-city drug purchase business has greatly facilitated some patients who are inconvenient to go out to purchase medicines.A green channel for self-rescue has even been opened for some acutely ill patients.

If a child has a high fever at night, it will be difficult to buy medicine after [-]pm.

At this time, you can only take your child to the hospital.

Sometimes it's just a minor illness like a cold or a fever.

If the mother is the only one with the child at home, it is very inconvenient to take the child to the hospital for medical treatment late at night.

If there are two children at home, it will be even more troublesome.

Leaving another child at home will definitely make a parent feel uneasy.

Therefore, the intra-city drug purchase business is a truly convenient and beneficial measure.Able to earn reputation and support for Sunshine Clinic.

(End of this chapter)