Du Leng's theory is not weak, but the diagnostic ability may also belong to the bottom among many attending physicians. Completely out of place with his ultra-high theoretical level.

The reason for this is because Du Leng did not realize that the real medical skills are not learned from books, but need to be learned from patients in clinical practice.

It is necessary to comprehend it in clinical diagnosis by yourself.

The real ability is never taught by others, but needs to be understood and transformed by oneself in order to become one's own ability.

He has an enviable doctorate and graduated from a prestigious overseas university, and his knowledge is also extremely profound. It's a pity that after he entered Tuya Hospital, he has always been proud and has a very high self-esteem, and he never thought of being down-to-earth and learning from the most basic clinical practice.

Instead, he has been keen to participate in various director-level high-difficulty case consultations and various difficult major surgeries.

In the end, Du Leng appeared in the expert consultation this time.

Only when the sea recedes will you know who is swimming naked.

Du Leng was dragged to Xinxiang Women's and Children's Hospital this time for a real battle, which immediately made him appear in his original form.

At this moment, his face was pale and his expression was gloomy.

I guess it must be uncomfortable in my heart.

Thinking about it, he used to jump so high, and now he fell from a high place, which is naturally extremely miserable.

But it's not necessarily a bad thing for him.

As long as you find out your own problems, learn lessons, and return to Tuya Hospital, calm down and start exercising from the most basic clinical practice. With his foundation, I believe that he will become a doctor with real skills in a few years.

Gao Jian followed Director Jiang back to their consultation table.

Before leaving, Gao Jian glanced at Du Leng sympathetically. Compared with Du Leng, Gao Jian is very lucky.

At least Takami has been diligent and down-to-earth in the past two years of training. is not as ambitious as Du Leng, and it is all about face engineering.

"Xiao Zhou, I'm optimistic about you! In the future, you have to bring Yang Chan with you, aren't you classmates? We should help each other even more. ”

Director Zhang Bihua also took Yang Chan back to his desk.

There are many patients who come to see her, and although she is here for consultations, there is a long queue at her desk. The patients and their families, organized by the nurses, waited patiently in line.

This is the face of a top famous doctor.

Patients and families are willing to buy her account.

When Yang Chan followed Director Zhang away, she glanced at Zhou Can with a faint gaze, and quickly shrank back. For the first time, Zhou Can saw the difference on her face.

This is not like the heroic, domineering and arrogant 512 squad leader.

Defeated her three times in a row and conquered her?

Zhou Can would never dare to think so.

In his impression, Yang Chan was very proud in her heart and had never surrendered. She'll definitely find a way to win it back next time.

After Director Jiang and Director Zhang left, their desk was deserted again.

No way, the reality is so cruel. Patients and families will never entrust their lives to an unknown 'expert'.

Deputy Director Shi's reputation is still too small.

Time passes little by little in boredom.

This kind of idleness is what Zhou Can hates the most, and there is no one.

In his opinion, it is simply a waste of life.

It's just that on the occasion now, if he is holding his mobile phone and reading a book, the impact will be very bad.

Fortunately, it didn't take long for the super obese female patient to come back from the examination.

Although the family members have a very good impression of Zhou Can and have a certain foundation of trust, they did not take the test results to Zhou Can, but asked Director Zhang Bihua to continue the diagnosis.

Compared with the young Zhou Can, the family still trusts Director Zhang Bihua more.

"Doctor Zhou, Doctor Zhou, come and have a look. Ling's diagnosis was really accurate, and the patient's thyroid function was really problematic. Skeletal examination reveals osteoporosis. ”

After Zhang Bihua saw the patient's examination results, she waved to Zhou Can excitedly.

The results of both examinations were similar to Zhou Can's prediction.

This made Director Zhang Bihua more trusting of Zhou Can's diagnostic ability.

"Her sleep apnea syndrome should be diagnosed as endocrine and metabolic disease. The lesion is a thyroid lesion. ”

Zhou Can was also very happy to see the results come out.

"It's no wonder that the patient's symptoms are very similar to those of mixed SAS, but the real cause has not been found! Who would have thought that it would be caused by thyroid lesions! Now, symptomatic treatment should be able to cure the disease. ”

Director Zhang Bihua was also very happy.

When a difficult case is successfully diagnosed, every medical staff involved will feel a special sense of accomplishment.

"Dr. Zhou's surgical ability is very strong, and she has rich experience in the diagnosis and treatment of nail breasts, do you think she needs surgery?" Zhang Bihua is somewhat unconfident in the treatment plan she prescribes.

Because this patient has seen many doctors, including many famous doctors in related fields in the province, they have not been able to cure this patient.

Now that she only needs to prescribe a prescription to cure it, she feels a little unreal.

"You can use drug treatment to see the effect first, but it is really ineffective and then consider the surgical treatment option. However, any surgery will cause irreversible physical damage to the patient, so try not to do it if you can do it without surgery. ”

Zhou Can does not recommend surgery to patients.

Take the medicine for a while to see the effect.

……

Director Zhang prescribed medication to the patient and instructed the patient to pay attention to weight control. It's best to keep exercising every day to lose weight.

Obesity can easily cause a variety of diseases, and her thyroid function is degenerate, which is likely to be related to obesity as well.

From a medical point of view, there are four causes of hypothyroidism. The first, inflammatory infections, including bacterial infections and autoimmune diseases. The second, tumors. Thirdly, trauma, thyroidectomy and isotope radiotherapy, and even radiotherapy for nasopharyngeal carcinoma can cause thyroid damage, leading to hypothyroidism. The last is the well-known lack of iodine intake.

The iodization of salt is to solve the problem of insufficient sulfur intake and prevent the appearance of big neck disease.

This female patient's poor lifestyle and eating habits, coupled with excessive obesity, are also prone to insufficient iodine intake and absorption.

If she does not control her weight at a reasonable normal level, she will increase the load on the heart, lungs, liver and kidneys for a long time, which is very likely to cause a series of serious lesions.

Director Zhang's treatment plan for her was to gradually supplement thyroxine to correct the problem of hypothyroidism. The patient is then asked to lose weight.

All are proven treatments.

Zhou Canmu sent the obese patient away, hoping that after she took the medicine, sleep apnea could be cured.

Not long after, the patient who had a small cold and had not been cured for two years came back from a check-up.

Normally, pathological tests take three to seven days to produce results.

For example, tumor tissue needs immunohistochemical testing or molecular pathological level testing, which takes a week.

If it is only an intraoperative pathology, this can be quickly tested, and the result can be obtained in 30 minutes.

Intraoperative pathology usually refers to the rapid freezing of the excised diseased tissue in a frozen microtome, making sections, and processing them through staining, sealing and other links, and then pathologists conducting pathological examination and diagnosis under the microscope.

The young female patient was very unfortunate and was found to have a mass in her left pharynx.

Doctors from Xinxiang Women's and Children's Hospital took the upper and upper posterior parts of the pharyngeal lateral cord for pathological examination, and initially suspected non-Hodgkin lymphoma.

Seeing this result, Director Zhang's face became very solemn.

Although Zhou Can had expected it, he couldn't help but look gloomy, and lamented for the young female patient in his heart.

"Dr. Zhou, now that the test results are out, it is really a tumor in the larynx. And it's lymphoma, how can you get it? Director Zhang Bihua didn't know how to deal with it, but felt sorry for this female patient.

Based on her diagnosis and treatment experience, she is very worried that the female patient's tumor has metastasized and spread.

In fact, the spread of a tumour is usually divided into three ways.

The first is infiltration into adjacent tissues, which is the easiest to control. As long as it is found in time, all the affected tissues are removed, and then chemotherapy is used to consolidate the curative effect, and the satisfactory treatment effect can basically be achieved.

The second is the metastasis of tumor cells through the bloodstream. It's tricky, but one tumor cell has to take root elsewhere and multiply like crazy, growing into a tumor. This requires multiple immune protections from the body.

It's like a bandit running to a strange place and trying to develop into a force, the success rate is not high.

If you are not familiar with the place, you will be wiped out by the local official or local organization.

It takes time for the tumour cells to move through the bloodstream to a new place and successfully take root and then develop into a second tumor.

With modern medical examination methods and diagnosis by experienced clinicians, it is relatively easy to detect.

It is also possible to achieve a better treatment effect by removing all the primary lesions and metastatic lesions and then radiotherapy.

The third type of tumor metastasis spreads through the lymph. The lymphoid tissue of the human body is an important immune organ of the body, and after it is attacked by tumor cells, it is equivalent to the government being infiltrated by bandits and controlled.

One can imagine how serious this consequence is.

If I have to describe it, it is lawlessness.

Therefore, as long as lymphoma is found to be malignant, the prognosis is often not good.

The girl's mother learned that her daughter had lymphoma, and when she looked at the solemn expressions of the doctors, she almost collapsed, her hands clenched tightly on the edge of the table, and she was trembling slightly. Tears rolled in his eyes, his breath became short, and his face was pale.

"Doctor...... Please, save my daughter. Her father works hard outside in order to give his children a superior living environment. Now, if I learn such a result, how can I explain it to her father......"

The family's voices were choked, and they were already crying.

That is, pretending to be strong in front of his daughter, otherwise he was afraid that he would have broken down and cried.

"Don't worry, it's just the first diagnosis. First of all, lymphoma is not necessarily malignant. Secondly, even if it is malignant, it can be surgically removed. The key now is to further clarify the nature of the pathology, and then check whether there is spread. ”

Director Zhang Bihua comforted the family.

She looked at Zhou Can again, "Doctor Zhou, I know that you have done many surgeries in multiple departments of surgery, and you must be very experienced. Which areas do you think are the key targets for screening? ”

Director Zhang was not ashamed to ask because he had a specialization in the art industry.

She did a lot of obstetrics and gynecology surgeries, but she did little tumor surgery.

In the case of cancer patients, they are generally handed over to the corresponding specialists.

For example, breast tumors are usually treated by a doctor in the nail and breast surgeons. Cervical tumors, ovarian tumors, these are handled by the obstetrics and gynecology department themselves.

The Department of Obstetrics and Gynecology does the most surgery such as cesarean section, uterine curettage, and ligation.

She really doesn't see lymphoma in the throat.

There is also little relevant processing experience.

"The patient is now suffering from liver disease, hearing loss, and now that he has been diagnosed with lymphoma in the throat, I recommend a CT of both ears and a CT of the chest for further examination. Ear drums and lungs are the key areas to be investigated. In addition, it is best to do a lumbar puncture and check the cerebral effusion routine. ”

Zhou Can did not shirk this time, but seriously gave further inspection suggestions.

Director Zhang nodded slightly, looking at the family.

Without waiting for Director Zhang to speak, the family bit their lipes and nodded vigorously, "Yes, we will do all these examinations." ”

It can be seen that Zhou Can successfully diagnosed her daughter with a tumor in her throat last time, and now it has been confirmed after the examination that her trust in Zhou Can has risen to an extremely high level.

Zhou Can's inspection suggestions, she accepted all the orders.

After Director Zhang applied for the examination to the patient, she took her daughter to the examination and did not mention it.

After she left, Director Zhang sighed and said, "If only the cause of this girl's illness could be found out earlier." Now two years have passed, and the liver has been damaged, and there are many lesions all over the body, and the results of the examination may be very bad. ”

"She's really delayed by this illness."

Zhou Can is scolding in his heart, quacks hurt people!

Some quacks treat people, they are simply killing people.

This girl had just turned nineteen, the same age as a flower, and it would have been nice if she had been diagnosed with lymphoma in her throat two years ago!

Now it has affected multiple body tissues and organs, and there is a chance that it has spread and metastasized.

I'm afraid the only thing that can be done is chemoradiotherapy.

The prognosis will be very poor.

Like her, I am afraid that she will not survive the five-year survival period.

"Doctor Zhou, may I ask you, have you confirmed the three examination applications you prescribed to her, and have you determined which parts of the tumor have metastasized?" Yang Chan watched Zhou Can diagnose these difficult cases one after another, and all of them were verified.

His diagnosis was correct.

This made her secretly admire in her heart, and at the same time, she was also full of curiosity about the condition of this female patient.

With her current level, she naturally can't accurately judge whether the tumor has metastasized and which parts it has metastasized to like Zhou Can.

Driven by strong curiosity, she asked Zhou Can for advice.

Zhou Can's eyes looked at her, his mood was still a little heavy, so his expression was relatively serious.

"It's pretty much already certain. Hearing loss must be caused by tumour cells in the ear drum and lesions. There is also her liver disease, including fatty liver, which should be a symptom. When lymphoma metastasizes, it is easier to attack the lungs, so I asked her to do a chest CT. The liver is known as the most silent organ, it has no sense of pain, and its resistance is naturally stronger than that of other organs. ”

To put it bluntly, it is a thick defense.

According to Zhou Can's understanding, the liver is a warrior in heavy armor, attacking high and defending.

For example, the liver's ability to detoxify is incomparable to that of any organ.

This can be considered as high attack power.

"Then why do you need a lumbar puncture?"

"This is simple, mainly to check the cerebral effusion routine. Although the head is at the top of the body and is called the head of the six yangs, the primary lesion of the patient is located in the throat of the head and neck, so it is very easy to attack the patient's head. And some of her symptoms also suggest that the brain, cerebellum, and nerves of the head are likely to have been affected. ”

Zhou Can patiently explained to squad leader Yang.

In the past, when she was studying, she taught others. Because she is a proper female student.

Zhou Can did not go to graduate school because he couldn't pass the exam.

She is fully capable of going to graduate school, and even directly entrusts graduate school. She voluntarily gave up and insisted on entering social work after finishing her undergraduate studies, most likely because her family conditions did not allow it.

A lot of girls are very sensible.

They know that their family conditions are not good, and they are not only frugal in school, but also try to earn their own tuition fees and get various scholarships. Then it is clear that you can continue your studies, but you will choose to enter social work early.

Yang Chan is a girl with very strong self-esteem, and she has never said that her family is poor in front of her classmates or teachers.

Also, as far as Zhou Can knows, she has never applied for a poverty grant.

But seeing that she usually dresses very plainly, and the class holds some activities with high consumption, she, the class leader, never participates. There are also many small details, all of which make Zhou Can understand that her family background must belong to the very poor kind.

(End of chapter)