Although Liu Baoguo claimed that he was choking on water to cough so badly, the state of "lung infection" above his head did not tell a completely different story.

Patients are reluctant to cooperate and do not tell the truth. This makes Sun Lien, a doctor, very puzzling - if you don't plan to listen to the doctor, then what are you doing in the hospital?

Sun Lien turned his head and saw Shen Qingmei standing at the door, and then sighed, this Mr. Liu probably came to the hospital because of Shen Qingmei's insistence.

The patient's cooperation is limited, but the diagnosis that should be made still needs to be made. Sun Lien shook his head helplessly, and began to continue to examine Liu Baoguo - since you don't want to say it, then I'll check it little by little. Physical changes don't always show up just because you don't want to cooperate.

Getting started for a physical examination, Sun Lien quickly found some problems. The most direct thing is that when Liu Baoguo was subjected to spinal percussion, he showed obvious percussion pain.

The area of pain, but not just the status bar indicates the L5-S1 segment with a herniated lumbar disc. Rather, it is the L3-L5 lumbar vertebrae. This area was scanned by CT and Brother Luo from the imaging department saw several hardening spots with increased density from the L4-L5 segment.

Wait...... Sun Lien took two steps back and began to be silent, cancer shows low-grade fever more commonly, and it is generally low-grade fever for a long time - will bone cancer show intermittent fever?

After pondering for a while, Sun Lien decided to confirm his thoughts, "Xiao Guo, draw a blood for Mr. Liu." He doesn't plan to tell the patient directly about the specific examination items. If you say "I suspect you have cancer" to a patient who doesn't want to cooperate with the doctor at all, the other person will not be in a hurry.

Although Liu Baoguo had some reservations in the process of answering the medical history, he was quite cooperative when the doctor conducted an examination. After being drawn a full twenty milliliters of blood, Liu Baoguo asked helplessly, "Still smoking?"

"That's pretty much it. Sun Lien replied with a smile, he planned to use this blood sample to toss the laboratory department. In addition to tumor markers, Sun also plans to complete all other tests such as liver function infectious diseases.

"Next, there is a little quiz for you to cooperate with. Sun Lien asked Liu Baoguo to get off the bed and stand on the ground, and then put the pen in his pocket on the ground. "Can you help me pick this pen up?"

Liu Baoguo glanced at Sun Lien with some confusion, then slowly walked to the floor where the pen was placed, supported the knee of his left leg with one hand, and slowly squatted down, then straightened his waist and reached out to pick up the gel pen that did not have much ink.

Bending the knees and hips without bending over, positive reaction. Sun Lien frowned slightly, this is not the result of a herniated lumbar disc - unless Liu Baoguo's lumbar disc herniation has developed to the stage of prolapse.

"That's how you usually pick up things?" Before Sun Lien spoke, a female voice suddenly came from behind him. When I looked back at the voice, it was Lin Yanan. Instead of a lab coat, she wore a running tracksuit — a young woman who had just finished a night run rather than a doctor. "Do you have to put your hands on your knees?"

"This is Dr. Lin, the orthopaedic talent of our hospital. Sun Lien hurriedly introduced, and looked behind Lin Yanan by the way, "Doctor Yuan didn't come with you?"

"I told him to eat slowly. Lin Yanan smiled, "Usually I eat too fast and I don't have a fixed time, and I am prone to stomach problems after a long time." As she spoke, she took out her work ID from her pocket and hung it around her neck, and turned to Liu Baoguo, "You haven't answered my question yet." ”

"Ah...... Right. Liu Baoguo was stunned, then nodded and replied, "My waist has always been uncomfortable, so it's easier to squat like this." ”

Once this kind of thing happens, it's when everyone gets together. Brother Luo from the imaging department also appeared outside the ward, holding two developed CT films in his hands, "Yo, where are they?"

Of course, Brother Luo came to send the CT examination results, and he didn't talk nonsense, so he directly handed the film to Sun Lien and Lin Yanan, "I watched it a few times, and the nature of the density increase point of L4-L5 is not clear, but there is no sign of blurring or erosion, at least it should not be...... Bad. ”

The word "bad" can refer to many things, and in the mouth of a radiologist, this mainly refers to the area of the lesion that is "suspected to be cancerous".

Imaging to determine the nature of the tumor is generally carried out by whether the boundary of the lesion area is clear, and whether the lesion area invades adjacent structures. In general, the more blurred the boundaries and the more tissue is invaded, the more likely the lesion is to be malignant tissue.

Of course, there are many methods and schemes used to judge the nature of the tumor, and the boundary of the lesion area and whether other tissues are involved cannot be used as a complete basis. The final decisive judgment still has to rely on pathological testing.

"There's a lot of TB. Lin Yanan and her husband have already communicated the basic situation of the patient, and she made her own judgment after watching the film, "It may be tuberculous spondylitis, although intermittent high fever is relatively rare, but it cannot be completely ruled out." ”

"If bloody TB spreads, it can leave traces in other parts of the body. As a radiologist, Luo Ge certainly understands how difficult it is to diagnose tuberculosis, "You can consider getting a PET scan for a checkup." ”

"Or take the spinal fluid and do a PCR to see. Regardless of whether the bacteria are detected or not, at least the direction can be clarified. Lin Yanan continued, "The treatment plan is ready-made, as long as the diagnosis is confirmed. ”

It is not routine for doctors to discuss diagnosis and treatment options in patient rooms, at least Mr. Liu looks nervous. "I've never been in contact with anyone with TB. ”

Shen Qingmei also frowned and said, "Mr. Liu has basically lived on the farm all these years, and he has very little contact with outsiders. Tuberculosis is a disease...... Doesn't it take contact with other TB patients to spread it?"

"Not necessarily. Sun Lien replied, "Tuberculosis is a zoonotic disease, dogs, pigs, cattle and other animals can be infected with tuberculosis, especially after cattle are infected with Divergent tuberculosis bacillus, and even have the ability to spread to humans." ”

"But I don't have cattle on my farm...... I don't have dogs, and I don't have pigs. Liu Baoguo was puzzled, and the doctors' words were already very clear, he was very likely to be infected with tuberculosis. But where he was infected from, Liu Baoguo really couldn't figure it out. "I have some goats, mainly to eat the weeds in the mountains. ”

"Sheep don't seem to have the ability to be infected with tuberculosis, right?" Brother Luo is not professional in this regard, and Lin Yanan doesn't know much about it. The two of them exchanged ideas and suggested to Sun Lien, "Why don't you ask the doctors from the infectious disease department to come for a consultation?"

Sun Lien stood there and thought for a while, then looked up and asked, "Mr. Liu, what animals do you have on your farm?"

"Animals?" Liu Baoguo counted with his fingers, "There are sheep, rabbits, chickens and ducks, and geese...... Oh yes, and I dug two ponds with silver carp and grass carp, and maybe some small trash fish and tilapia washed down from the mountain springs. He looked up at Sun Lien, "Other animals...... At most, there are voles and feral cats. ”

"Have you had any direct contact with these animals in the past year?" Sun Lien continued to ask, if according to Liu Baoguo, he has had very little contact with outsiders over the years, then the possibility of being infected by other people is indeed very low. In comparison, animals are more likely to spread diseases," I mean the experience of grabbing these animals with their hands. ”

"Yes. Liu Baoguo nodded honestly, he really felt a little scared, "At the end of last year, I killed chickens and caught a few fish...... Oh yes, at the beginning of the year, there were a lot of lambs in the flock, and I got a veterinarian to vaccinate the sheep. Later, I saw that people were too busy, and I also vaccinated the lambs. ”

Sun Lien's eyes widened, and he suddenly thought of a possibility that had been ignored. He looked at Lin Yanan and asked with some uncertainty, "Could it be...... Brucellosis?"