Chapter 1873

"Sex change surgery, is the condition stimulated by estrogen?" Lin Ge felt somewhat bored, so he casually asked.

"Estrogen not only promotes and maintains female SZ organs and secondary sexual characteristics, but also clearly affects the endocrine, cardiovascular, metabolic systems, bone growth and maturation, skin, etc." Su Yun didn't mind giving Lin Ge a detailed explanation of the effects of estrogen on the body after sex reassignment surgery.

Lin Ge does things decisively; Su Yun still appreciates that, just treating it as casual chat.

"Doctor Su, you said heart failure is related to estrogen?" Lin Ge asked.

Clinically commonly used estrogen drugs are mostly synthetic derivatives with estradiol as the base, such as estradiol benzoate, estradiol valerate, ethinyl estradiol, ethinyl estradiol ether, pregnant mare estrogen, etc. These drugs have a significant impact on the heart; patients develop heart failure, and if it continues to deteriorate, it is estimated to be related to estrogen injection.

Alas, this cost is still quite large, Lin Ge thought.

However, as an individual human, how one chooses their gender, Lin Ge felt others have no right to comment.

Just figure it out for yourself; be happy, why bother with others' gossip?

Just that this cost is a bit high, lifelong use of estrogen, plus so many side effects.

Long-term high-dose application of estrogen may increase the risk of breast cancer, may also increase the risk of endometrial cancer, and may increase the risk of cerebrovascular disease and venous thrombosis.

Su Yun sighed; it seems that regarding the patient's own choice of gender, his and Lin Ge's attitudes are the same.

For this elderly patient, Su Yun also felt some regret.

Being able to bravely choose one's gender, and it seems there is even a vampire who has always loved her, life is quite satisfying.

Just that decades later, all kinds of diseases came knocking.

Whether it's heart failure or cerebral infarction, both are related to estrogen injection.

In Su Yun's view, this case has no significance for consultation. Her body, as the drug metabolizes, triggers a series of reactions; now it should be untreatable.

After 5 minutes, Zheng Ren took off his glasses.

"Boss, any opinions?" Su Yun asked.

"Yes." Zheng Ren said clearly: "Director Lin, please go first."

"..." Lin Ge was stunned.

Just a case of a transsexual person, why avoid speaking in front of oneself?

What does Zheng Lao Ban mean……

Su Yun also felt somewhat surprised, looking at Zheng Ren, his eyes full of countless questions.

"Director Lin, sorry, it involves a confidential mission." Zheng Ren said apologetically.

After he finished looking at the medical record, combining Su Yun's statement of the medical history, he discovered a minor issue.

Just that this involves a mission, so it's not something Lin Ge can listen to.

"Then I'll go back to sleep first; you two are busy." Lin Ge also didn't mind, got up smiling and walked away.

After working long hours, whenever the word 'mission' is mentioned, any strange behavior is normal.

Not inquiring, not asking, the farther the better—this is Lin Ge's principle.

"Then I won't see you off." Zheng Ren stood up and said politely.

"You focus on your side first, rest early, take care of your health." Lin Ge said: "I'll head back first. When on a mission, don't think about family affairs; with Director Kong and me, there should be no problems."

"Thanks."

Seeing Lin Ge off, Zheng Ren returned to the small demonstration classroom.

"Boss, what's going on being all mysterious?" Su Yun asked.

"The patient had tea-colored urine four days ago; did you deliberately omit it?" Zheng Ren asked.

"Yes." Su Yun directly replied: "On the RV, you also saw Thus term: Thus term: Kelisidian should have drunk whole blood, absorbing hemoglobin via the gastrointestinal tract."

"There's hardly any research on this." Zheng Ren pondered: "We can't arbitrarily lump tea-colored urine together with drinking whole blood."

"It's just that long-term estrogen use has caused cerebrovascular disease." Su Yun said: "Tsk tsk, Boss, this is love."

Zheng Ren glanced at him; Su Yun's worldview is not right, has it really come to this?

Just looking at a consultation case, one can drag it onto love.

Zheng Ren has no opinion on sex change surgery either; it's just that this case still has some aspects he can't figure out.

"Estrogen has been stopped for two years; logically there should be no progressive myasthenia or chronic cerebral infarction." Zheng Ren said.

"35 years! You absolutely cannot ignore this issue." Su Yun said: "No matter what drug is used for 35 years, the accumulation in the body is an astronomical amount!"

Zheng Ren pursed his lips; although Su Yun's reasoning makes sense, he still feels there's something problematic.

"The lab tests show nothing special, except serum creatine kinase elevated to 20793 U/L; other indicators including inflammation markers such as erythrocyte sedimentation rate, C-reactive protein, etc., show no abnormality." Su Yun said: "And the rise in serum creatine kinase precisely confirms..."

"No." Zheng Ren said: "High accumulated estrogen levels in the body indeed can trigger cerebrovascular disease onset. But compared to previous medical records, don't you think this value is too high?"

"Meaningless." Su Yun waved his hand: "I think only an increase in serum creatine kinase has no clinical diagnostic significance."

"That's true." Zheng Ren was still thinking.

"No thymus CT was done, but looking at the chest CT, the thymus seems fine, not like myasthenia gravis." Su Yun said.

"Hmm, no." Zheng Ren was still thinking about several suspicious signs, "Let me think again, after seeing the patient I'll understand what's going on."

Su Yun narrowed her eyes, staring at Zheng Ren.

"How?"

"What do you mean by 'seeing the patient and knowing what's going on'?" Su Yun asked.

"Physical exam!" Zheng Ren said in a low voice: "You don't do a physical exam?"

"Tch, you knock on a watermelon before buying it because others do, is that how it is?" Su Yun said disdainfully.

"No." Zheng Ren answered firmly: "It's possible the doctors in Massachusetts missed some special symptom; I must see the patient, personally conduct a physical exam and take a history to find the cause."

Su Yun didn't think Zheng Ren personally doing all that would yield any answers; the various examinations, physical exams, and medical history at Massachusetts General Hospital were already very thorough.

"Boss, do you think there might be an issue between porphyria and estrogen?"

"No, if there were a problem, it wouldn't have lasted 35 years." Zheng Ren said: "Most likely, long-term estrogen use has led to cerebrovascular disease. What we need to do now is rule out low-probability diseases."

……

At the same time.

In the Gu castle that never sees daylight year-round, doctors and nurses in White Coats were busy.

「In the past 24 hours, urine output has nearly dried up; Ms. Vandi's condition is not optimistic, she may have only 48-72 hours left to live. 」 said a doctor.