Chapter 821: Medical Genius Chapter 818: Etiology and Treatment!

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Protagonist:

Fang Ziye

Upon hearing this, Hu Qingyuan had a sudden realization.

With his excellent memory, he immediately said: "So that's how it is. Neuropathic arthropathy — the core mechanism is nerve damage leading to loss of joint proprioception and pain sensation."

"Patients often cannot perceive joint damage or overuse, and repeated microtrauma triggers inflammation, bone destruction, and joint structural collapse. Diabetes is the main etiology; long-term hyperglycemia damages peripheral nerves!"

"Why did I only think of diabetes and overlook the core mechanism?" Hu Qingyuan was somewhat annoyed.

He was just a hair's breadth away, already extremely close to the correct answer.

The patient wasn't very old — just early middle age, roughly thirty-six or seven — and at this moment she looked a bit bewildered.

"What is Charcot joint? Is it very troublesome?" She froze for a moment, then asked Fang Ziye.

Fang Ziye explained: "My student just said it — this is a type of neuropathic arthropathy, a local functional overload following reduced sensory function."

"It's commonly seen in diabetes, but spinal cord injury can also cause reduced sensory function; any disease affecting nerve function can lead to Charcot joint disease."

"You might have had spinal cord discomfort before but didn't pay attention."

"Is it from carrying a child too much?" Fang Ziye asked with a smile.

At this age, it's the peak period for second children.

Many mothers at this age easily develop chronic lateral epicondylitis of the humerus.

"I'm not married yet." The middle-aged woman's expression flickered slightly, her tone firm.

Fang Ziye listened, and couldn't help but be stunned for a moment.

He observed her carefully again; the woman didn't look thirty-six or seven — after dressing up, she looked about thirty.

Her figure was attractive, leaning toward prosperous.

No children at this age? Could she be DINK? Or infertile?

"What kind of work do you usually do?" Fang Ziye asked casually, seeing that Hu Qingyuan had already confirmed reduced sensation on his end.

"I work in a prefecture-level city. Just ordinary sales." The woman replied seriously.

"Alright, for your situation we need to draw blood for tests, and then do an MRI to confirm whether you have spinal cord injury."

"There are many types of etiologies affecting nerve function... your current symptoms should be relatively severe..." Fang Ziye said.

"Okay, Doctor, you're the expert, I'll listen to you." The middle-aged woman replied politely.

Hu Qingyuan finished the physical examination on his side, and also looked at the patient's local hospital X-rays and CT.

"Master, no signs of fracture, but there is joint surface roughness — it is indeed Charcot joint disease." Hu Qingyuan said.

"Mm, I've already ordered the tests for you. The guide slip is here; just scan the QR code to pay, then go to the location marked above."

"Qingyuan, write up the medical record..." Fang Ziye instructed.

Hu Qingyuan's theoretical reserve is becoming more and more solid.

Being able to recall Charcot joint disease — this rare disease type — and its common etiologies proves Hu Qingyuan's memory is indeed exceptional.

Hearing this, Hu Qingyuan approached the computer and, based on the tests Fang Ziye ordered, wrote the medical record.

Besides writing the physical examination and imaging review content, the medical record must also include diagnosis, examinations, and treatment recommendations.

One item caught Hu Qingyuan's attention.

Pre-transfusion four-item test!

Also called epidemiological screening.

Hu Qingyuan glanced at it, froze slightly, then thought of the important etiology of Charcot joint disease — anything affecting nerve function can cause Charcot joint disease.

Syphilis seems like it could too?

Could it be that Master suspects...?

Hu Qingyuan is a normal man; of course he has learned from Japanese teachers, and some strange positions are very damaging to the elbow joint...

However, the visitor is a patient; her occupation isn't that important.

After politely seeing off the first patient, Hu Qingyuan didn't curiously ask Fang Ziye what he was considering.

Some things, even with suspicion, are only suspicion.

The second patient — Hu Qingyuan no longer delayed time, handed everything over to Fang Ziye; he only did history-taking and physical examination, while Fang Ziye was responsible for recording the physical examination content, writing the electronic medical record, and issuing medical orders...

Roughly eleven twenty in the morning, the first middle-aged woman returned for follow-up.

The blood test results Fang Ziye ordered came out very quickly, and the MRI at the new hospital area didn't require queuing for an appointment either.

Seeing the results, Fang Ziye said very calmly: "Madam, you've seen your own blood test results, haven't you?"

"You also heard the chat between me and my student earlier — Charcot joint disease is a local symptomatic diagnosis; any factor that can affect nerves can lead to Charcot joint disease."

"The important etiology of this symptom is also very direct: sensory dysfunction leads to joint overuse, causing local repetitive injury, triggering joint destruction, deformity, and functional impairment."

"That thing you tested positive for can also cause damage."

"This is your personal privacy, but there's one thing you must do properly: if you have a boyfriend or other fixed sexual partner, you must tell him and have him get tested too."

"Otherwise, it's an illegal act."

"Syphilis isn't hard to treat; what you need to do now is go to dermatology, register, and get the syphilis treated first."

"Then consider the local problem."

The middle-aged woman was somewhat panicked, yet didn't seem that anxious: "Doctor, if that infection is cured, can the pain here disappear?"

Fang Ziye did not doubt why the local hospital didn't do the 'epidemiological screening'!

This isn't a routine examination for non-surgical cases; when she was hospitalized at the local hospital, infection was considered more.

But if there's an infection without infection indicators, nonspecific inflammation is considered more.

Fang Ziye shook his head: "At the beginning, if it could be corrected, it could be alleviated."

"But there's no opportunity anymore."

"The deformity and arthritis that have already formed won't rehabilitate back to how they were before."

"If your infection is treated well, come back to me and I can perform surgery on you; you still need joint functional reconstruction."

"Don't take any other medicine either; they're useless, but you can continue taking some medicine for nourishing the nerves."

"Did you hear clearly?"

"You must go to Dermatology now!" Fang Ziye said.

After the middle-aged woman's complexion changed uncertainly for a while, she left dejectedly.

After the middle-aged woman left, Hu Qingyuan took the opportunity to ask in a low voice: "Master, is she cheating or what?"

Is she cheating or oh oh oh!

"How would I know? I'm just a doctor, not a fortune teller, and I don't have the Heavenly Eye."

"I'm only responsible for treating illness."

"Hmm, you can carefully consider this patient; some diagnoses are local symptomatic diagnoses."

"Some diagnoses are direct diagnoses, so besides determining the local diagnosis, we must infer the cause based on the local diagnosis."

"Anything the patient says could become the basis supporting his diagnosis, although most of it is useless."

"But we need to be cautious and careful."

"You can consider cystinuria; your knowledge base is still decent." Fang Ziye praised.

If Feng Junfeng and Liu Yao were answering, they probably wouldn't think of this rare disease, cystinuria.

"Master, don't praise me; a missed correct answer is also a wrong answer."

"Sigh, studying medicine is too hard." Hu Qingyuan said.

Fang Ziye suggested with a smile: "How about you change supervisors? That way, you might feel more accomplished."

Hu Qingyuan immediately shook his head: "No way, Master?"

"Even an idiot wouldn't choose that; am I supposed to be an idiot above four?"

What's more idiotic than an idiot is an idiot above four.

The disease types here at Fang Ziye's place are indeed difficult, but high difficulty makes challenges interesting.

Dealing with fractures all your life, just doing incisions and sutures; when encountering something tricky, you say let's go, go to the senior hospital.

What's the point of that; might as well go livestream yourself.

"Master, I'm going to call the next patient..." Hu Qingyuan happily trotted out.

Hu Qingyuan was very clear that he wasn't too poor, but the cases his master encountered were too high-level.

There's a saying: at my master's place, I'm worth nothing, and even my teacher called me very poor, calling me Teletubbies.

But once you step out of my teacher's door, even back in the department, what should you call me?

Speak!

Call me Genius!

Hu Qingyuan was very confident that even Senior Brother Lan Tianluo would have to give a thumbs up and call him Genius for his professional operational talent!

Doing math, my Master's Uncle is the professional.

Doing medical studies, doing surgery, my Master and I are the professionals; Master's Uncle, you're just a bit older... If Lan Tianluo knew Hu Qingyuan said he Lan Tianluo was just a bit older, he would definitely explode and hit him...

At one thirty-seven, Fang Ziye started his lunch break and went out to get a meal.

The previous patient was still at the doorway: "Professor Fang, Professor Fang, please, add a number for me; I came from Lichuan City, it's really not easy!"

"I ran too far."

Fang Ziye heard this and nodded: "I know, are you hungry?"

The patient shook his head: "I just bought a boxed meal from over there and just finished eating. I'm not hungry, I don't need lunch."

Hu Qingyuan thought this was just a stupid asshole.

Fang Ziye replied: "I'm hungry; since I came over in the morning, I've only drunk half a belly of water; I've been working all along; now I'm so hungry my chest is sticking to my belly."

"I have to see patients at two o'clock sharp, then I can finish today's outpatient numbers; now it's already one thirty-seven, oh no, thirty-eight." Fang Ziye took out his mobile phone to show him.

"I beg you; I'm also my parents' child; can you let me eat a meal?"

In one morning, thirty-five numbers, plus follow-up numbers.

Anyone who sees outpatients like this knows how sour and refreshing it is!

Fang Ziye's statement was reasonable and well-founded; the new guide nurse couldn't stand it anymore: "Big Brother, stop begging; Professor Fang's outpatient numbers are really overloaded."

"Everyone also saw that Professor Fang has no leisure time; he's been working all along; eating a meal is common human emotion."

"He started work at eight o'clock; who doesn't eat lunch?"

Hearing this, the middle-aged person's face was full of struggle: "Professor Fang, but it's really not easy for me to make one trip; if I have to wait, I'll have to wait until next week."

"I said, go see other professors first! ~"

"Our department has other professors' numbers you can register for; if they can't figure it out, they'll refer it to me. Is what I said not clear enough?"

"Those who registered my number have formed a medical relationship with me; I must be responsible for them!!!"

Another patient understood and suddenly realized: "Professor Fang, can we register for anyone's number in your department?"

"They'll also push cases they don't understand to you?"

"Then I waited so long before for nothing?"

"We're a big department, a team; internal coordination is very normal, right?" Fang Ziye said.

The elder sister immediately shook her head and said: "No, no, no, when I was treated at other hospitals before, it wasn't like that; they definitely weren't responsible for recommendations."

"Disease types not belonging to their specialty are all refused, and they directly tell us to go refund our patient numbers."

Regarding other brother hospitals, Fang Ziye found it hard to comment: "Our hospital doesn't have many patients, so we help each other; after all, our hospital isn't a top-tier hospital, so we might not be as busy as those big hospitals."

"And even if you've seen the outpatient clinic and obtained an admission certificate, you still need to queue for a long time."

"I have to go eat... I also need to use the toilet later, so I might be a few minutes late."

"Xiaomo, explain things to the other patients later; thanks for your hard work." Fang Ziye said to Guide Nurse Cao Xiaomo.

The guide nurses at the hospital weren't on the establishment quota, and turnover was high, so Fang Ziye wasn't surprised that the previous guide nurse had left.

Everyone has their own life and choices.

"Okay, Professor Fang." Cao Xiaomo nodded seriously; although this was her first time working a shift with Fang Ziye, she also thought Fang Ziye was super handsome and super cool.

It's just that he's a bit older, and he's already married...

Afternoon, three o'clock.

What Fang Ziye didn't expect was that the middle-aged woman who had come for a consultation in the morning actually came back with a follow-up patient number.

After the follow-up number was registered, they were seen in the order of one outpatient visit per one follow-up number.

"Professor Fang, Doctor Chen from Dermatology said my illness isn't difficult to treat, and I can be hospitalized and treated at the same time."

"The orthopedics ward at our hospital is hard to book; let me get an admission certificate first, or listen to your suggestion." The middle-aged woman said.

This request was reasonable.

Fang Ziye said: "If you choose surgical treatment, I can issue the admission certificate for you first, but after you go to the ward, tell the patients that you're in Professor Wang Zongkai's group."

"I'll perform the surgery for you then; our group has too many booked patients, and your situation would be too troublesome to queue for."

"If you queue for Professor Wang's group, you can be hospitalized in about a week, but if you're in our group, you'll have to wait until September or October."

The middle-aged woman asked: "Doctor, my treatment might take about a month."

"A week later, I might not be able to come for hospitalization."

"Professor Fang, do I really need surgery?" She knew Fang Ziye's time was tight, and she asked two questions in a row.

Fang Ziye shook his head: "Surgical treatment would be better, and your future activities will also be more convenient."

"You can also choose not to have surgical treatment, as long as you can accept your current joint deformity and pain."

"As for booking a bed, you can book it first; it's not that you must come to be hospitalized immediately."

"You can keep it first, maintain the sequence continuously, tell the nurses clearly, and they'll make a phone remark for you."

First to queue, first to be hospitalized, there's an order.

Her situation was special, and the department wouldn't be so unfeeling.

"Then let's do surgery..." The woman said.

Fang Ziye didn't ask why!

Hu Qingyuan's side had already written the admission certificate information, explaining in detail: "You go to the Orthopedics Ward, hand the admission certificate to the Nurse Station, and tell them you want to book this professor's bed."

"If they ask you, just say Professor Fang said it personally; this is Professor Fang's signature, which they recognize."

"Others can't imitate it!"

There had been clever people who imitated Fang Ziye's signature on admission certificates, but they were found out...

"Okay, thank you Professor Fang." The middle-aged woman left, her back view somewhat desolate.

Only then did Fang Ziye and Hu Qingyuan begin their normal consultations.

At six ten in the afternoon, Fang Ziye and the other finally finished a day of consultations.

After leaving the outpatient clinic, the two immediately rushed to the parking lot.

There was a particularly important task in the laboratory today, requiring Fang Ziye to rush there personally.

It concerned the optimization of the bridging electrode, and this step had to be personally operated by Fang Ziye to be done.

But as they passed the parking lot, Fang Ziye and Hu Qingyuan heard a somewhat familiar conversation: "I don't care if you don't want to get married; anyway, things are just like this right now."

"I must have surgical treatment first; even if you don't give me money, I'll still have the surgery."

Hu Qingyuan was especially stunned upon hearing this.

They looked at each other with Fang Ziye.

Fang Ziye touched his nose: "Don't mind other people's privacy."

"Let me tell you, don't have designs on Little Peach; she's my niece; if you dare touch a single hair of her, I'll fight you and your whole family to the death."

"My brother and sister-in-law passed away early, and my parents divorced and don't care about us; you can bully me, but if you have the slightest improper thought about Little Peach, I'll immediately expose all your embarrassing stories."

"Anyway, I don't expect anything anymore. You're just a rotten person! ~"

"I'll figure out a way for Little Peach's subsequent treatment costs myself. Don't you worry about it; I'm just a common person, but I'm not a rotten person..."

Fang Ziye and Hu Qingyuan walked a bit further away, but they could still hear the middle-aged woman's conversation.

Sometimes, a person's prejudices are a great mountain.

Once formed, they're very hard to change.

But occasionally, one might also feel slightly guilty because of one's own prejudices.

"Master, I was wrong; I shouldn't have guessed randomly." Hu Qingyuan said with his head down.

"Let's go; everyone has times for gossip and idle talk; when we gossip and talk idly about others, we should calmly accept others' gossip and idle talk about us."

"Our task isn't guilt, but to go to the laboratory and complete the final step of the bridging electrode."

"Then officially start putting the bridging electrode into clinical trials next month, officially announcing the routine treatment of spinal cord injury."

Fang Ziye said this, then added: "Actually, my own social experience is also quite shallow; I've had doubts too."

"It's just that the other party appeared even more calm than us; this is a spotless heart."

Hu Qingyuan nodded: "Master, sneaking a bit of gossip isn't too unforgivable, right?"

"Mm, tonight I've already reserved time with Elder Brother Song Yi to discuss basic theory together, Master, no need to wait for me for a while..."

"Okay! ~" Fang Ziye nodded. (Chapter End)