My Medical Skills Give Me Experience Points

Chapter 1343: Chapter 531: Diagnosing Carotid Artery Lesions by Palpation, Tissue Necrosis Stage (Part 2)

However, Zhou Can did not do it.

Since the patient had come specifically to seek his diagnosis, even if the patient was just being polite with words, Zhou Can believed he needed to give his best effort.

The reputation of Cardiothoracic Surgery needs continuous accumulation.

Zhou Can is very interested in this kind of complex case.

He continued to listen to the patient’s abdomen, but did not hear any obvious abnormal bowel sounds. He tried palpating by hand, and the abdomen was soft and flat, with no significant tenderness reaction or masses found. There was no percussion pain in the liver and kidney areas.

After failing to find much in the chest and abdomen, he deliberately checked the patient’s spine and found no deformity.

Nor did he find obvious lumbar disc herniation or similar issues.

Considering that the patient started to experience excessive walking, leg numbness, coldness, and other symptoms at a young age, Zhou Can did not rule out the possibility of spinal lesions compressing nerves, causing the aforementioned symptoms.

After Zhou Can’s pathological diagnosis advanced to Level 6, he gained a deeper understanding and insight into the nine systems and three circulations of the human body.

He previously thought that blood circulation was directly related only to blood vessels.

Now, with his increased expertise, he realized how shallow his previous understanding was. Nerves can also affect blood flow, along with many other factors.

For example, heart failure, premature beats, etc.

After examining the upper body, Zhou Can focused again on the patient’s right leg.

The fourth digit of the right foot was blackened and showed signs of gangrene, and the skin temperature of the right calf was, upon comparison, significantly colder than that of the left calf.

This indicated that there might be problems with the blood circulation in the patient’s right foot.

"I need to check the nerve reflexes of both your feet to determine the cause of the issue. Just stay naturally relaxed; it won’t cause any harm to your body."

Zhou Can said to the patient.

"Well, finally, a different examination from the other doctors."

The patient felt quite happy upon hearing that.

After so many doctors examined and treated him without success, his mental stress was undoubtedly enormous.

Almost despairing, a doctor suddenly brings a new approach, giving him a glimmer of hope. So he was quite pleased.

"Come, sit down, just naturally bend your legs perpendicularly."

Zhou Can had the patient sit properly and signaled the family to support the patient to prevent accidental falls.

The reflex hammer hit the patient’s left knee.

Bam!

The left leg showed a clear knee jerk reflex. Trying the right leg, the knee jerk reflex was similarly normal.

Although it was slightly weaker than the reflex of the left foot.

This was related to the disease in the right leg.

Subsequently, he performed physiological nerve reflex tests on both feet of the patient. Including the right foot, there were nerve reflexes present.

At this point, the possibility of nerve-caused blood circulation problems was basically ruled out.

Zhou Can once again targeted the blood vessels in the right leg.

The femoral arteries on both sides of the patient were palpable, and the pulse strength seemed normal.

Continuing downward, the left popliteal artery was present and normal. But the right popliteal artery showed no signs of pulsation.

The problem became more clear, and this was another significant discovery.

Continuing palpation, he found the left dorsalis pedis artery present, but the right dorsalis pedis artery also had no pulsation.

This is a typical indication of chronic arterial ischemia.

According to the patient’s condition, the chronic arterial ischemia in the right foot was at least at stage two, and possibly advancing to stage three.

In chronic arterial ischemia, the first stage mainly presents as numbness, coldness, fear of cold, sourness, and fatigue in the affected limb. If it occurs in the foot, the patient might even experience claudication.

Especially, the symptoms are more pronounced after the patient walks a longer distance.

The calf or foot muscles may ache and spasm.

If this condition persists and walking continues, the pain will further intensify.

At this point, as long as the patient rests timely, the pain can be relieved immediately.

The symptoms experienced by the elderly official in his youth correspond highly to the first stage of chronic arterial ischemia.

Zhou Can also became more convinced that the elderly official suffered from this disease.

Once the cause is found, there’s a way to resolve it.

"If this illness had been treated promptly in your youth, maybe it wouldn’t have progressed to the current extent!"

Zhou Can sighed lightly.

Many illnesses begin as minor issues and are dragged into becoming major, severe problems.

"The medical standards were poor when I was young, and doctors couldn’t find out what was wrong. I didn’t have time for inpatient treatment, so I just took some arbitrary pills. Young man, you know? The big opportunities in a person’s life may come just once. If you miss them, they’re gone forever. Of the six people who entered the agency with me, only I seized the opportunity to climb up."

Talking about his life experiences, the elderly official seemed somewhat proud.

He actively shared some success stories with Zhou Can.

The other five did not seize the opportunity; they probably retired only as clerks at best. At most, as section chiefs.

The elderly official holding a high position is undoubtedly very successful compared to them.

"Thank you for sharing these valuable life experiences with me."

Zhou Can sincerely appreciated the elderly official.

Communication between doctors and patients can sometimes be very enjoyable, allowing one to learn valuable and useful experiences from patients.

"Seeing a young man like you who works diligently, I can’t help but offer a few pointers. Back then, I also craved success and worked hard to advance, just like you. During the examination just now, I felt that you were very thorough, and this conscientious approach to work is excellent."

The elderly official, used to being a leader, spoke somewhat like a leader mentoring a subordinate.

Zhou Can responded humbly with a smile and continued examining the elderly official.

In this disease’s second stage, known as the nutritional disorder stage, the affected limb will exhibit numbness, coldness, fear of cold, and increased sourness, while the walking distance decreases significantly. It takes a long rest to relieve these symptoms. Even at rest, persistent pain occurs.

This resting pain is very tormenting, especially at night, when the pain becomes more intense.

It can make the patient unable to sleep, enduring great suffering.

Additionally, the affected limb will display noticeable skin pallor, even appearing purple, red, and the skin becomes particularly dry, with hair directly falling off.

Some patients may also experience nail thickening and deformation and muscle atrophy.

If it occurs in the hands, nail thickening and deformation are more obvious, and when muscle atrophy occurs, it resembles ALS patients.

This disease and ALS are not easy to distinguish, and there is a possibility of misdiagnosis.

The elderly official has already experienced the second stage, unfortunately still without timely and proper treatment.

When it reached the second stage, the patient himself, due to the prolonged course of disease for over a decade, was already used to it. Even though by this time he had some status and could access quality medical services, he only underwent anti-infection treatment at the local hospital.

It wasn’t until the recent necrosis and blackening of his toe that he realized the seriousness of the issue and went to the large hospital in the provincial capital seeking treatment.

He first went to the Provincial People’s Hospital for treatment, and it was unclear if it was his own decision to have doctors perform anti-infection therapy or what.

At the Provincial People’s Hospital, it turned out that only anti-infection treatment was administered.

No further treatment measures were taken.

Honestly, this seemed somewhat abnormal to the professional Zhou Can.

It made him secretly wary, wondering if this elderly official or his family might be troublesome.

Many patients, upon initial contact, seem very amiable and pleasant.

But as soon as any inadequacy in treatment occurs, or if the treatment results are not obvious, they immediately change their attitude. Various curses, complaints, or even demands for explanations from hospital leaders.

When encountering such patients, most people choose to keep their distance.

When there is really no alternative, the only option is defensive practice.

Under such circumstances, failing to find ways to protect oneself would genuinely make doctors and nurses seem naive.

Chronic arterial ischemia in the third stage is also called the tissue necrosis stage.

Unfortunately, the elderly official has already advanced to this stage. Currently, it should only be in the beginning. As it develops to the later stages, the entire right leg will become necrotic, which is terrifying.

The most evident symptom of the necrosis stage is intensified pain, ice-cold affected limb, starting from the toes showing signs of blackening and necrosis.

Moreover, the skin on the foot will lose its glow, directly turning dull like the color of a corpse.

This is a manifestation of the loss of vitality and vigor.

"Dr. Zhou, have you figured out what disease my father-in-law has?"

The patient’s daughter-in-law had remained silent.

At this moment, seeing Zhou Can’s furrowed brows and serious expression, she asked.

"It seems like chronic arterial ischemia in the legs, and the disease stage is very advanced. To identify the exact cause of ischemia requires further diagnosis. Clinically, the most common method is to establish collateral circulation to improve local blood supply. Symptoms are often significantly alleviated, and the condition can markedly improve."

Zhou Can was confident enough to say this.

The exact surgical approach will need further examination of the arterial situation in the legs to decide.