"Hello two, I'm Zhou Qiao!" As soon as Zhou Qiao came over, he smiled and greeted the other party.

In any case, in a foreign country, it is still very affectionate to see compatriots. Maybe some people will deliberately trick their own people. However, if you look unkind, can you get it?

Zhou Qiao always felt that most people are ordinary people, and the necessary vigilance is to have it, and the heart of guarding against others is indispensable, but when he sees his compatriots, he rejects people for thousands of miles, just like preventing thieves, it is really unnecessary. Except for northern Myanmar.

In addition, he runs a clinic, and if he really wants to cheat, he will also cheat others.

Fortunately, the reputation of the iris clinic has always been good, and it is basically not cheating. For example, he never sent anyone sky-high bills. There are expensive expenses, and it is also necessary to make it clear to the other party before incurring expenses.

If the other party is unwilling, then there is no next step.

Secret medicine is so profitable, it has never been used by the poor, and it is the rich who come to make an appointment for medical beauty.

Rachel told Sister Ying's condition again, including some major symptoms, Sister Ying's husband thought about it and added another sentence, saying that Sister Ying still had frequent urination and urgency during this time.

Sister Ying immediately glared at him angrily, and said in her heart Are you lacking heart, why do you say anything, is it a shame?!

Zhou Qiao smiled slightly and said approvingly: "This is also a very important information. ”

Sister Ying just gave up, because she was in an outside clinic, she didn't get mad. If you change at home, the Hedong Lion's Roar will come immediately!

Even so, her husband shuddered, regretting that he shouldn't have talked too much. However, he always felt that not explaining the symptoms comprehensively was more or less a hidden danger, which was not conducive to the doctor's diagnosis.

In fact, it is true that many patients feel that the symptoms that are okay are very valuable in the eyes of doctors!

Zhou Qiao pondered for a moment, glanced at Sister Ying's neck, and said, "You sit here, I'll check it for you." ”

Liu Ying sat down, after all, she used to be a teacher, and her posture was very upright.

Zhou Qiao stood behind her, gently pinched her neck with both hands, placed the thumbs of both hands on the back of the neck, and placed the middle fingers of the index fingers on both sides of the trachea under the cricoid cartilage, and palpated the thyroid isthmus and the left and right lobes respectively.

"Don't be nervous, relax, head forward slightly." Zhou Qiao said.

"Swallow saliva...... Well, one more time! ”

When the patient makes this swallowing action, his thyroid gland moves up and down with swallowing, and Zhou Qiao can feel his condition more clearly.

Zhou Qiao continued: "Turn your head slightly to the left...... Nice, turn right again......"

When the head is slightly turned to the left, the left lobe of the thyroid gland is examined, Zhou Qiao's left thumb is placed on the posterior edge of the left sternocleidomastoid muscle and gently pushed forward, the index finger and middle finger touch the left lobe, and the index finger and middle finger of the right hand are pushed to the opposite side of the thyroid gland.

At this time, Zhou Qiao's right thumb is placed on the posterior edge of the patient's right sternocleidomastoid muscle and gently pushed forward, the index finger and middle finger touch the right lobe, and the left index finger and middle finger push the thyroid gland to the opposite side.

"Does it hurt?" Zhou Qiao asked while pinching.

"It hurts a little bit, and it's very uncomfortable. cough~, cough~"

Although Zhou Qiao had tried to be as gentle as possible during the examination, Sister Ying still couldn't stop coughing.

Zhou Qiao let go.

"Doctor, how's it going? Is there something wrong with the neck? Sister Ying's husband asked worriedly.

Zhou Qiao nodded and said, "Yes,......"

Before he finished speaking, he was interrupted by Sister Ying!

Sister Ying frowned and shouted very anxiously: "Isn't it just that you have eaten too much and have stomach pain, diarrhea and fever?" Why is it still pulling on the neck? ”

The heart said that this Dr. Zhou looks very famous, how can he be more unreliable than that white aunt? Also, so young, I don't know if it's okay? Shouldn't the fame be blown out?

Zhou Qiao smiled slightly, spread his hands, and said, "Look, you are so short-tempered, this is hyperthyroidism!" A little thing, you will blush and have a thick neck, you must be less angry in the future, people should be cheerful, and smile for ten years! ”

"Huh? Hyperthyroidism? Sister Ying was stunned!

Heart, I've been grumpy lately, and I've been in the U.S. since I came to the United States. But I really didn't expect it to be hyperthyroidism, I just thought there were too many things that didn't go well. Also, forehead lines have really increased!

Zhou Qiao advised: "In addition to being less angry, you should eat less seafood in the future, don't eat iodized salt, buy non-iodized salt, and eat less spicy, don't drink strong tea, coffee and other stimulating drinks, as well as cola, sprite and other gas-producing drinks." Don't stay up late, get enough sleep! ”

"Eat less seafood? Am I caused by eating seafood? Sister Ying asked suspiciously. After she came to the United States, she did eat a lot of seafood because San Francisco was close to the sea.

Zhou Qiao shook his head and said, "Eating seafood is just an inducement, it will aggravate the condition, and in rare cases, it will be the real cause." ”

Because there are many causes of hyperthyroidism, diffuse toxic goiter with hyperthyroidism (Graves' disease, GD) is the most common, accounting for about 85% of all patients with hyperthyroidism, followed by nodular goiter with hyperthyroidism and subacute thyroiditis with hyperthyroidism. Other less common causes include iodine hyperthyroidism and pituitary hyperthyroidism (TSH tumor).

The specific cause requires further investigation.

Zhou Qiao continued: "I just palpated, but I have already felt the thyroid enlargement, and there are several small nodules, if you want to confirm further, you need to do thyroid B ultrasound, serum thyroid hormone, thyroid-stimulating hormone, thyroid autoantibody and other tests, if you agree, I will arrange it." ”

Sister Ying: "......" just wanted to be anxious, thinking of Zhou Qiao's words, she couldn't help but take a deep breath, and secretly silently thought, don't be angry, don't be angry, can't be in a hurry!

"You can arrange it!"

She was really scared. Okay, why do you have hyperthyroidism?

Her husband frowned as well.

However, the facts are in front of us, and I have to believe it. Xindao, this Doctor Zhou is still very capable, much more powerful than that white aunt!

Actually, it's not that Rachel is not at the level, Rachel is just an internist, not very good at surgery. And the thyroid gland is examined, which is a surgical method.

There may be some experienced doctors, both inside and outside the department, who can quickly associate thyroid problems, but Rachel is almost meaningless.

Rachel was originally positioned as a more basic doctor, used to meet the daily needs of ordinary patients. Compared with medical seeds like Murphy and Stephanie, Zhou Qiao does not have high requirements for her.

Incurable diseases, more complicated, if Zhou Qiao is here, Zhou Qiao will come, if Zhou Qiao is not there, Murphy can't handle it, just refer it directly. Anyway, in primary care clinics in the U.S., referrals are the most common thing.

There is no shame.

On the contrary, a clinic like Iris-de-lis, which is a grassroots clinic, has repeatedly carried out difficult surgeries, can be regarded as an outlier! I can't find a few in the whole of America.

Rachel's job is simple, but the volume is large.

Rachel sees more patients than aesthetic patients, and is one of the main businesses of the clinic.

Next, Zhou Qiao arranged a series of relevant examinations for Sister Ying, and the results came out, and sure enough, Sister Ying's thyroid hormone was so high that it could not be detected, and the procalcitonin index was much higher than the normal value.

This indicator shows that the infection has spread to the bloodstream, combined with high fever, diarrhea, vomiting, frequent urination, urgency and other symptoms, and finally, Zhou Qiao was diagnosed with hyperthyroid crisis combined with sepsis.

"Hyperthyroidism is hyperthyroidism, why is there still sepsis?" Sister Ying was stunned and anxious.

Zhou Qiao told her to relax, as long as the cause was found out, and it was not an incurable disease, the medication could be controlled quickly, so that she could be at ease.

Of course, this disease is actually quite serious, if it is not detected early, delayed for a while, or treated improperly, there is a certain chance of death, about 20%-50%.

The risk of death is quite large, and the standard for issuing a serious illness notice has been met!

Zhou Qiao analyzed the risk and cause of the couple.

"If we compare the human thyroid gland to a thyroid hormone synthesis machine, other people's machines are producing thyroid hormones needed by the human body on demand, and Sister Ying's machine is like a model worker, in a state of excitement for a long time, synthesizing and releasing excessive thyroid hormones."

"Too much thyroid hormone will cause hypermetabolism and sympathetic nervous excitement in the human body, causing heart palpitations, sweating, increased eating and bowel movements, and weight loss."

Sister Ying said: "Yes, yes, I have indeed lost a lot of weight, and at first I thought it was a successful weight loss!" ”

I ate so much seafood and cooked so many leftovers every day without getting fat! I was glad that I couldn't eat fat, but now I realize that it's ignorance!

"Generally speaking, hyperthyroid crisis is more common in patients with hyperthyroidism who have not controlled thyroid hormone levels for a long time or patients with untreated hyperthyroidism, and signs of extreme hypermetabolism due to infection, surgery, trauma, mental stimulation, stress and other triggers, often accompanied by decompensation of one or more organ functions."

"As for the cause of your illness, when I asked about your symptoms before, your husband mentioned that you have frequent urination and urgency, and I speculate that your hyperthyroid crisis is likely to be caused by a urinary tract infection."

As soon as these words came out, Sister Ying's husband immediately raised his eyebrows, and said in his heart that it was right to listen to me, how could he hide his symptoms because he was embarrassed? Doesn't that just work?

Sister Ying sweated.

Zhou Qiao: "After the human body is infected with a certain bacteria, the immune system will automatically turn on the security work, and for severe patients with hyperthyroidism with high thyroid hormone levels, their hormone levels will be chaotic or even riotous with the opening of the immune system. ”

"In this case, when a high concentration of thyroid hormone enters the bloodstream, the body 'collapses', and if it is not diagnosed and treated in time, there will be a life-threatening situation of multi-organ failure."

Sister Ying: "......"

Sister Ying's husband: "......"

They felt very lucky, fortunately they came to Zhou Qiao's place, if they went to other places, they might be delayed by misdiagnosis. And then Karma!

Zhou Qiao admitted Sister Ying to the hospital and arranged her in a ward on the second floor, and then selected antibiotics for anti-infection treatment and high-dose drugs to control hyperthyroidism, and soon, Sister Ying's symptoms were alleviated, and thyroid hormone levels also stabilized.

It can be called a cure for the disease!

The reason why it didn't work before was that the medication was wrong.

Of course, in the case of Sister Ying, further treatment will be required in the future, as well as regular follow-up, and they decided to come to Zhou Qiao's side in the future. The old customers of the iris clinic have added another one.

Although Sister Ying and her husband work very hard, their income is still good, if they save a few more years, when their children graduate from college, they will return to China to support the elderly, and their lives will be very nourishing.

After all, saving dollars to go back to China for consumption is indeed taking advantage.

However, people who generally come out rarely go back.

Zhou Qiao is still young and has not yet thought about the future arrangements, but there is a high probability that he will still choose to return to China. Not for anything else, wealth does not return to the hometown, such as a night walk in brocade! As for the little red heart, that's the basic literacy.

A family like Sister Ying is not really rich.

Of course, Zhou Qiao is not really rich now, tens of millions of dollars are still small in the United States, and the road ahead is still very long!

Veronica's fifth stage surgery was timed, coincidentally, on May 20.

However, several of his women are all foreign girls, so it's not this festival.

520, although it is a very romantic festival in China, there is no such atmosphere in the United States.

Mainly, 520, 521, is a homophonic terrier of Chinese, foreigners do not speak Chinese!

Because the clinic was too busy, Zhou Qiao didn't bring anyone this time, and went over alone.

Last time, Veronica transferred to San Francisco in order to have surgery as soon as possible, but after the operation, after playing for about half a month, she got tired and went back.

So this time, Zhou Qiao is still going to Los Angeles.

Originally, Zhou Qiao divided the operation into six phases, and there were still the fifth and sixth phases left, and the reason why it was originally divided like this was mainly because the points were not enough, and he couldn't redeem so many secret medicines at one time.

But now, the "secret medicine" has been mass-produced in East Africa, and this problem does not exist.

Zhou Qiao called Governor Hulk to tell him that the remaining two stages of surgery would be done at one time this time.

When Governor Hulk heard about it, he hurriedly shared the good news with Veronica, who was overjoyed! She can't wait to call her friends and get ready to head out to sea and enjoy the beach, sun and bikini on the island!

When he stepped on the plane, Zhou Qiao was still feeling that he was too "miserable" to be alone, and it was time for the clinic to recruit people again, so he called Elena and asked her to continue to contact the headhunting company, or ask Rachel, Park Xiuzhu, Stephanie and others to recommend familiar and reliable friends.

For each senior doctor who is hired and has been employed for 6 months, a reward of $4,000 will be awarded, and for each senior nurse who is referred, if hired and has been employed for 6 months, a reward of $2,000 will be awarded.

After all, it's really hard to recruit the right people.

With the reward, they will also be more motivated to reach out to some of their former colleagues.

The current recruitment plan is one doctor for medicine and one for surgery, and two nurses.

No, as soon as the news came out, Rachel and Park so-joo immediately began to rummage through the address book to see who else could be poached.

Even Stephanie began to wonder if there were any friends who could be poached from Johns Hopkins Hospital.

Their efforts were fruitful, and Park so-joo contacted a nurse named Kim Hee-jin, a Korean girl, gentle and careful, 26 years old, who had been in another clinic in the Bay Area before, and was not married anyway, and had no fixed residence, so she happened to be dissatisfied with the original working environment, so she came over.

Elena, Ava and Murphy interviewed Kim Ji Zhen together, and they were quite satisfied, and after asking Zhou Qiao, they went through the entry procedures for her.

Jin Ji is really not beautiful, she looks honest, virtuous and diligent, and the third daughter is not worried that she will become a threat.

Rachel also contacted a doctor, who was also a white aunt like her, who had worked in the grassroots clinic for many years and was experienced enough to handle most of the daily cases, but the doctor's interview needed to be conducted by Zhou Qiao himself, so it was about a week later.

As for Stephanie, the environment in which she worked before was so good that her colleagues at Johns Hopkins Hospital didn't want to come over. When Stephanie called to inquire, they laughed at her and left a hospital as big as Johns Hopkins Hospital to run to a small clinic. You think I'm as stupid as you are?

Of course, that's not what I said, but that's what it means.

Moreover, a colleague also regretted that he mentioned the incident of the surgery competition, saying that Stephanie missed the opportunity and lost the opportunity to soar to fame, and expressed great sympathy for this.

Stephanie pursed her lips and hung up angrily, feeling that she was really bored.

"Is Johns Hopkins Hospital really that good? Why do I feel so happy at Iris Clinic now? Cut~, if you don't come, you'll regret it later! Stephanie snorted.

Thanks to the "Book Friends 160601130111263" for the tip.

(End of chapter)