Chapter 2136: with translation of chapter title

Zheng Lao Ban, a few days ago I was thinking to come see you." Zhang Weiyu said, "But Director Wei said we should still do the examinations first, otherwise it would take too much of your time."

"Hmm." Zheng Ren nodded, Director Wei was right.

The patient is a young worker at the main store of my Maoyangdian, in Feng County, quite far away.

"Huh? The main store? Isn't this place the main store?" Su Yun exclaimed.

Normally, the main store is set up in first-tier cities like Di Du and Modu, with branches spreading nationwide—that's the normal business model.

But this Maoyangdian, its main store is actually in Feng County.

Since ancient times, the land has been divided into nine provinces, and Xu Zhou is one of them. Feng County is also an ancient city, with quite a few historical legends.

"It's an old shop, family-run; my grandfather refuses to move the shop to Di Du no matter what." Zhang Weiyu said, "The old man treasures that century-old sign more than his life. I've said it twice, and almost got kicked out of the house."

That's imaginable; Zheng Ren nodded. That's what tradition is.

"A distant relative of mine had a cerebral hemorrhage last autumn; after surgery he recovered okay, but the kid didn't want to go to school, so he came to work at the shop." Zhang Weiyu said, "After surgery he took medicine to control his blood pressure; at first it was fine, but a few months later his blood pressure kept rising."

The patient is an 18-year-old boy who, half a year ago, suddenly developed headache and impaired consciousness; he visited the local hospital, where a head CT revealed left basal ganglia–lateral ventricle periventricular intracerebral hemorrhage.

Upon admission, his blood pressure was 220/110 mmHg; considering intracranial hypertension, they immediately performed intracranial hematoma evacuation.

Postoperatively, he took oral enalapril maleate 10 mg once daily.

Initially, he took antihypertensive medication for blood pressure control, keeping it at 110–120/70–80 mmHg, which was fairly good. But as time went on, his blood pressure rose higher and higher.

But after all, he's a young guy, so his attention to his health isn't high enough. Being able to take his medicine on time every day is already pretty good; as for measuring his blood pressure daily, he only stuck with it for about a month before stopping.

A few days ago he again felt uncomfortable, measured his blood pressure, and got 180/120 mmHg. As for the process in between, the patient himself couldn't describe it clearly.

This scared him badly, so he rushed around looking for help and ended up finding Zhang Weiyu in Di Du.

That's the whole story.

The medical history isn't complicated; the patient's family has a history of hypertension, but everyone else just takes one antihypertensive drug and keeps their blood pressure under control.

There's no such thing as his kind of stubborn, uncontrollable hypertension.

Because of the family history, Zheng Ren ruled out many hereditary diseases.

"Director Wei took me to see Director Zhang; at the time, Director Zhang suspected an adrenal issue and ordered the relevant tests." Zhang Weiyu said.

Director Zhang said: "Later the patient switched medications and increased the dose, taking amlodipine besylate 5 mg twice daily and terazosin hydrochloride 4 mg at night; his blood pressure was controlled for a few days, then it went back up."

"I thought it might be an adrenal issue, but they did an adrenal Nuclear Magnetic Resonance and renal angiography, and everything was normal."

This examination was quite detailed, almost ruling out the possibility of renal hypertension.

Hypertension is mainly divided into primary and secondary types, each with many branches. Director Zhang's consideration was thorough, her inclination fairly clear, leaning toward secondary hypertension.

The most common causes of secondary hypertension are renal hypertension, endocrine hypertension, and other very rare triggering factors.

"How tall and how heavy is the patient?" Zheng Ren asked.

"1.8 meters, over 230 catties." Zhang Weiyu said.

His build is somewhat on the heavy side; Zheng Ren thought for a moment and asked, "Is his snoring severe?"

"It's bad; nobody dares to sleep with him—the snoring shakes the bed." Zhang Weiyu laughed, "When he was hospitalized, he had a private room, but his snoring drove everyone else out of the ward."

"Do you suspect obstructive sleep apnea hypopnea syndrome?" Su Yun asked.

"Stubborn hypertension can be considered due to this issue." Zheng Ren said.

"Hmm, I also suspect obstructive sleep apnea hypopnea syndrome." Director Zhang said, "We've already had the patient undergo an enhanced renal Nuclear Magnetic Resonance, but that hospital is unfamiliar with OSAHS testing and doesn't perform it."

This is normal; although obstructive sleep apnea hypopnea syndrome is fairly common, in daily life we encounter many people whose snoring comes and goes all night, with uneven rhythm, like singing opera.

However, hypertension triggered by such factors can basically be controlled with proper medication; the cases that are hard to control are still relatively rare.

"Boss Zhang, tell me about his snoring." Zheng Ren is now more interested in the patient's snoring.

"Don't mention it, Zheng Lao Ban." Zhang Weiyu sighed and said, "I went home for the New Year, stayed only two days before rushing back, all because of his snoring."

"During the New Year, the shop does good business and stays open; neighbors who don't feel like cooking come over as guests. I had originally planned to go home, drink and chat with family, but I could hear his snoring through the wall."

Zheng Ren listened quietly.

"His snoring makes the walls shake." Zhang Weiyu complained, "Besides that, while he's snoring, it sometimes seems like he runs out of breath. Once I listened to his snoring; there was no sound at all in the middle, and it stopped for a full fifty seconds… about a minute."

From Zhang Weiyu's account, Zheng Ren basically had a clear picture of the patient's condition.

"I was afraid he'd have another cerebral hemorrhage and no one would notice if he died in bed, so I got up intending to check. When I reached the door, the snoring started again, and that's when I went back to sleep."

"You say the snoring isn't enough, but being scared like that in the middle of the night—who could stand it? I stayed home for two days over the New Year and then rushed back."

When a roommate or bed partner notices the patient has stopped breathing, they often worry the breathing won't resume and shake the patient awake; such pauses usually end with gasping, choking awake, or loud snoring.

This situation is called apnea, a manifestation of sleep apnea hypopnea syndrome.

Most people who snore can start breathing again on their own due to lack of oxygen, but this guy's breath-holding time is too long.

Since we can't do a physical exam, Zheng Ren can only speculate; whether it's correct or not is hard to say.

"Boss Zhang, is the old store in Feng County still busy at this hour?" Su Yun suddenly asked.

"It's a small county town; shops close early, and there's hardly any nightlife." Zhang Weiyu didn't know why the conversation turned this way, but he just said whatever came to mind.

The young master beside Zheng Lao Ban must not be neglected either. Even if one neglects Zheng Lao Ban, the adults are magnanimous and won't get angry. But this young master is hard to serve; who knows, he might cause some trouble.