"I heard that even the top hospitals in the imperial capital couldn't cure the disease, but you cured it. We're here to see you this time. The old cadre's son also said beside him.

These people are well-informed, so they can naturally learn about Zhou Can's legendary story from some channels.

Especially in this kind of powerful family, those who want to pat their sycophants will try their best to find a famous doctor in the world for them.

"Thank you for your trust and kindness, but I'm not that good, I'm just a general doctor. I'll give you a check-up first! ”

Zhou Can is not very suitable for this kind of touted occasion.

He is a more down-to-earth person, and he likes to concentrate on studying medicine or treating patients.

The patient's biochemical examination results, urine routine and stool routine, were all normal.

Because taking into account the pain in the lower limbs of the patient, the toes are blackened, gangrene appears. I was worried about kidney function problems, such as uremia, and specially gave the patient a kidney function test.

The patient was found to have normal renal function.

Later, I was worried that the patient had diabetes, and I checked my fasting blood sugar, which was still normal.

Even liver function problems are suspected.

Unfortunately, after checking the liver function, it is still normal.

Diabetes, uremia, and hepatitis, which are prone to cause gangrene of the lower limbs, have basically been eliminated.

At this point, the diagnosis is basically deadlocked.

It was with this in mind that Zhou Can asked to come over to see the actual situation of the patient. The physical examination is a general examination, and it seems that everyone's examination content is similar, but in fact, high-level doctors can find many clues from the physical examination, which is of great help to the diagnosis.

At least provide some direction for thought, perfectly fine.

The patient and his family were very cooperative and were very happy to let him help with the medical examination.

He first lifted the covers to examine the patient's right foot.

Some disinfection and other treatments have been done above, mainly to prevent the foot from severe decay and further infection after local necrosis.

Gangrene refers to special morphological changes such as necrosis and blackening of local tissues.

It is mostly caused by blood circulation disorders caused by diseases, trauma and other factors.

It causes large-scale ischemia and necrosis of local tissues, and secondary putrefactive bacterial infection.

Gangrene can be divided into dry and wet, and dry gangrene is manifested as symptoms such as blackening, dryness, and necrosis of the limbs. Wet gangrene is not secreted, pus is broken, rotten and smelly.

In general, dry gangrene is slightly better.

But this is not absolute.

Some patients have wet gangrene, which looks very scary, but it may be easier to treat.

The main thing is to find the cause of the disease, improve local blood circulation, anti-infection and so on.

Through observation, Zhou Can found that the fourth toe of the patient's right foot had become blackened more severely. There was a noticeable phenomenon of gangrene.

And there is no obvious junction with normal tissue.

This means that gangrene can progress and spread upwards.

No wonder the doctors in the previous hospitals said that they would amputate their limbs to save their lives.

After Zhou Can saw it, he began to examine the patient's neck.

Because of the pain and gangrene in the lower limbs, after ruling out common causes such as diabetes and uremia, there are basically only two possibilities left. Either there is a bacterial and viral infection, or there is a problem with the blood vessels.

The patient received anti-infective therapy at the first two hospitals, but the effect was not significant.

It did not stop the progression of the disease.

This indicates that a viral or bacterial infection is less likely.

And the patient's biochemical examination is basically normal. There are no problems with liver and kidney functions, and blood vessels are most likely to have problems.

The most problematic areas in the lower extremities are the veins.

If it is a car accident injury, you need to be especially vigilant for femoral artery damage. In particular, crush injuries can easily cause rupture of the femoral artery and cause massive bleeding.

This old cadre is obviously more consistent with the lesion of the veins.

Zhou Can does not touch the patient's right foot, but touches the patient's neck, what is going on?

First of all, some of the veins in the lower limbs belong to deep veins, which cannot be felt or seen. When he looked at the patient's right foot, he had already looked at the superficial vein on the patient's right foot.

No significant anomalies were found.

That's why I went straight to the largest vein that could be felt on the surface of the body, the jugular vein.

The origin of human blood is the heart, whether it is arteries or veins, it originates from the heart.

However, when doctors examine the patient, there is no way to dissect the patient's chest cavity to see if the veins are normal. The most common effective way to do this is to feel the jugular vein.

Of course, this requires the doctor to have a lot of experience.

Through palpation, Zhou Can did not find that the patient's jugular vein was distended, and the carotid artery did not have abnormal pulsation. The trachea is in the middle and is also unremarkable.

There is no enlargement of the lymph nodes in the neck or thyroid gland.

There is also no stiffness in the neck.

After checking his neck, he put on a stethoscope and began to examine the patient's chest and abdomen.

The patient's thoracic cage and respiratory movements are symmetrical and unabnormal. The bilateral tremors are symmetrical, and the breath sounds in both lungs are slightly rough, which is quite normal. It may be that the patient is a little nervous when he or she is examined.

He heard a mild crackle in the patient's right lower lung.

Comes and goes.

This is a new discovery, Zhou Can's expression moved slightly, and then went down for examination.

On auscultation of the patient's heart, pathological murmurs and pericardial friction rubs are not heard in the auscultation areas of the valves.

The heart should be normal.

It stands to reason that when this step is found, the patient can basically be pushed to other departments.

But Zhou Can didn't do it.

People came to him specifically for diagnosis and treatment, even if the other party was just polite, he had to go all out.

The fame of cardiothoracic surgery needs to be accumulated.

Zhou Can is also very interested in this difficult case.

He then auscultated the patient's abdomen and did not hear any obvious abnormal bowel sounds. Palpation was tried, and the abdomen was flat and soft, with no obvious tenderness throughout the abdomen, and no mass was found. There was no percussion pain in the liver and kidney area.

After examining the chest and abdomen and finding nothing, he also deliberately examined the patient's spine and found no deformities.

No obvious lumbar disc herniation or the like was found.

Because considering that the patient had too much walking when he was young, he had symptoms such as numbness and coldness in the legs. This allowed him not to rule out that the patient had a lesion in the spine that compressed the nerves and caused the above symptoms.

After Zhou Can's pathological diagnosis was promoted to the sixth level, he had a deeper understanding and understanding of the nine systems and three major cycles of the human body.

Previously, it was thought that the body's blood vessels were only directly related to blood vessels.

Now that his level has improved, he realizes that he was too superficial before. Nerves can also affect blood vascularity, and there are many other factors that can affect blood vascularity.

Such as heart failure, premature beats, and so on.

After checking the upper body, Zhou Can focused on the patient's right leg again.

The fourth toe of the right foot is blackened and has gangrene, and the skin temperature of the right calf is much cooler than that of the left calf.

This means that the patient is likely to have a problem with blood circulation in the right foot.

"I need to check the nerve reflexes in both feet to determine the cause of the lesion and just keep it in a natural relaxed state. It will not cause any damage to your body. ”

Zhou Can said to the patient.

"It's good, I finally encountered a different examination item from other doctors."

The patient was very happy to hear this.

After so many doctors examined and treated him, it was ineffective. He must have been under a lot of pressure.

When he felt almost hopeless, a doctor suddenly played a new trick, which gave him a new glimmer of hope. So I'm happy.

"Come, you can sit and bend your legs vertically."

After Zhou Can asked the patient to sit down, he motioned to the family members to support the patient to avoid falling and causing accidents.

The percussion hammer is slammed into the patient's left knee.

Bang!

The left leg has a pronounced knee-jerk reflex. Try the right leg again, and the knee jerk reflex is also normal.

However, the reflex is slightly weaker than that of the left foot.

This is associated with a lesion in the right leg.

Next, the patient's feet were tested for physiological nerve reflexes. Nerve reflexes are present in all areas, including the patient's right foot.

At this point, the possibility of nerve-induced blood circulation is basically ruled out.

Zhou Can once again targeted the blood vessels in his right leg.

The femoral arteries are palpable on both sides of the patient, and the strength of the pulse is normal.

Subsequent examination shows that the left popliteal artery is present and normal. The right popliteal artery showed no palpation.

The problem is becoming clearer, and this is another major discovery.

Continuing to palpate, he found that the patient's left dorsal foot artery was present, and the right dorsal foot artery was also unpulsating.

This is typical of chronic arterial ischemia.

Depending on the patient's condition, the patient's right foot chronic arterial ischemia is at least stage 2 or even progresses to stage 3.

Chronic arterial ischemia, stage I, is mainly manifested by numbness, coldness, sensitivity to cold, soreness, and fatigue of the affected limb. If it is present on the feet, the patient may even have a claudication.

Symptoms are especially noticeable after patients have walked longer distances.

Muscle swelling and twitching in the calves or feet may occur.

If you continue to walk after this happens, the pain will get worse.

At this time, as long as you rest in time, the pain can be relieved immediately.

The symptoms of the old cadres when they were young were highly consistent with the first stage of chronic arterial ischemia.

Zhou Can is also more sure that the old cadres have this disease.

As long as the cause is found, a solution can be found.

"If you had been treated when you were young, it might not have progressed to the current level!"

Zhou Can sighed slightly.

Many diseases are from small illnesses to major illnesses and serious illnesses.

"When I was young, the level of medical care was poor, and the doctors couldn't detect anything wrong at all. I didn't have time to be hospitalized, so I had to prescribe some medicine and take it. Do you know, young man? The great opportunity of a person's life may be lost forever if he doesn't seize it. There were six people who entered the agency with me that year, and I was the only one who took the opportunity to climb up. ”

Speaking of the experience of this life, the old cadres are somewhat proud.

He also took the initiative to share some successful experiences with Zhou Can.

The other five people failed to seize the opportunity and may be just a section member when they retire. It's the head of the stock that is holding it up.

The old cadres were able to occupy high positions, and compared with them, they must have been very successful.

"Thank you for your willingness to teach me these valuable life lessons."

Zhou Can is sincerely grateful to this old cadre.

Doctor-patient communication can sometimes be pleasant. You can even learn a lot of useful and valuable lessons from the patients.

"Seeing a down-to-earth young man like you, I can't help but want to mention a few words. Back then, like you, I was eager to succeed and desperately motivated. You just checked on me, and I can feel that you are very careful and have a very good attitude towards doing things. ”

The old cadres are used to being leaders, and now they have the flavor of leaders promoting their subordinates.

Zhou Can responded with a humble smile and continued to check the old cadres.

The second stage of the disease is called the dystrophic phase.

The affected limb will be numb, cold, cold intolerance, soreness will increase, and the walking distance will be significantly shortened. It takes a long break to relieve. At the same time, even at rest, the pain continues.

This resting pain is very torturous, especially at night, when the pain is more pronounced.

It will keep the patient awake at night and tormented.

In addition, the affected limb will have obvious pale skin, even purple spots, flushing, the skin will be very dry, and the hair will fall off directly.

Some patients also have thickened and deformed toenails and muscle atrophy.

If it occurs on the hands, nail thickening and deformation is more pronounced, and muscle atrophy occurs as in ALS patients.

This disease is not so easy to distinguish from ALS, and there is a certain possibility of misdiagnosis.

The veteran cadres have already gone through the second phase, but unfortunately they still have not been able to receive correct treatment in time.

It is estimated that by the time the second stage progresses, the patient himself has been accustomed to the disease for more than ten years. Even though he had a certain status and could enjoy high-quality medical care at this time, he still only received anti-infection treatment at the local hospital.

It wasn't until recently that the toes were necrotic and blackened, and I felt that the situation was serious and ran to the big hospital in the provincial capital for medical treatment.

First, he went to the Provincial People's Hospital for medical treatment, but I don't know if he himself advocated that the doctor give him anti-infection treatment or what's going on.

In the Provincial People's Hospital, only anti-infection treatment was done.

There are no further treatments.

To be honest, in the eyes of Zhou Can, a professional, this is somewhat abnormal.

also made him secretly vigilant, this old cadre or his family, shouldn't it be a problem?

There are many patients who, when they first come into contact, are smiling and very amiable.

When the treatment is not in place, or the effect after the treatment is not obvious, they will immediately turn their faces and deny the person. All kinds of abuse, complaints, and even asking the hospital leaders for explanations.

When encountering such patients, everyone basically stays away.

If you really can't do it, then you can only have defensive medical care.

In this case, if you don't want to protect yourself, are you really a fool to be a doctor and a nurse?

Chronic arterial ischemia stage III, also known as tissue necrosis.

Unfortunately, this veteran cadre has progressed to this stage. It should be just the beginning. In the later stages of development, the entire right leg will die, which will be terrible.

The most obvious symptoms of the necrotic phase are increased pain, cold extremity, and blackening signs of necrosis from the end of the toe.

And the skin of the feet will lose its luster and become dull, like the color of a dead corpse.

This is a manifestation of a loss of vitality and vitality.

"Doctor Zhou, have you found out what my father-in-law's illness is?"

The patient's daughter-in-law did not speak.

Seeing Zhou Can's brows furrowed and her expression serious at this moment, she asked out loud.

"It's a bit like chronic arterial ischemia in the legs, and it's very late. The specific cause of ischemia requires further investigation. In clinical practice, the most commonly used method is to establish collateral circulation and improve local blood supply. Symptoms are often significantly relieved and the condition can improve significantly. ”

Zhou Can was basically nine out of ten before he dared to say so.

The specific surgery will be decided by further examination of the arteries and blood vessels in the legs.

(End of chapter)