When the Doctor Uses A Hack

Only by discovering this key point can one truly diagnose the disease.

This is what modern medicine refers to as: the gold standard of diagnosis!

For instance, diagnosing tuberculosis might involve finding the tuberculosis bacillus in sputum cultures, or diagnosing cancer involves finding cancer cells in the tissue, and so on and so forth…

But!

Many diseases do not have a gold standard.

This calls for finding a main clue that can help diagnose the disease!

Once this is found, by following clues, one can help diagnose the disease.

Chen Cang took a deep breath and his gaze upon the elder was filled with reverence.

Chen Cang nodded slightly to signal his gratitude.

The elderly man only smiled faintly, nodded, and said nothing.

…

…

What made the elderly man formidable lay right here.

But the most formidable aspect wasn’t just here.

It also lay in his philosophy of interacting with people.

He knew that Wu Yushu had a problem, perhaps a serious one, but he wouldn’t say it outright.

He understood this was a hospital, where the doctor’s word prevailed.

Even though the elder was a renowned doctor, no matter how skilled, he would not overstep his bounds or gratuitously instruct Chen Cang on what to do.

However, as a doctor, seeing a patient’s diagnosis running into issues, his conscience wouldn’t allow him to stand idly by.

At this moment, suggesting that Chen Cang “take the blood pressure” was a move of high emotional intelligence.

If the elder had asked Chen Cang to take a chest X-ray, do an ECG, or even a cardiac ultrasound, that would be one thing, but would the patient be willing?

What would the patient think?

“Your doctor can’t make a diagnosis without someone else’s help?”

Would the patient think the doctor was incompetent?

They might even refuse to follow the recommendation for further testing.

But taking blood pressure is starting from the patient’s perspective. Think about it: taking blood pressure is such a simple thing—it doesn’t cost money, just a straightforward checkup.

Firstly, the patient doesn’t have any psychological resistance and follows the advice.

Secondly, the doctor can obtain many useful clues from it.

It could be said that the problem was resolved effortlessly, which is quite impressive.

Never underestimate the sphygmomanometer; it may seem simple.

Yet, this blood pressure detection can reveal many things.

This is where the sophistication lies.

Pulsus paradoxus is the phenomenon where the pulse weakens significantly or even disappears during inhalation and reappears or returns to normal during exhalation. Observing this with a sphygmomanometer is more direct and evident than with manual palpation.

An experienced doctor can feel a lot just by a simple touch.

The occurrence of pulsus paradoxus is due to an increase in intrapericardial pressure, which limits ventricular diastolic filling. With inhalation, systemic venous return is restricted, reducing the volume of blood the right ventricle pumps into pulmonary circulation. Pulmonary circulation is influenced by respiratory negative pressure, causing pulmonary vessels to dilate, which decreases the volume of blood flowing from the pulmonary veins into the left heart, reducing left heart output and causing the pulse to weaken or even disappear.

Pulsus paradoxus is commonly seen in right heart failure, pericardial effusion, and constrictive pericarditis, as well as severe asthma and other diseases.

With this diagnosis, what Chen Cang needed to do next became clear and straightforward.

Combining the cardiac auscultation sounds from before with the current pulsus paradoxus, Chen Cang now had a substantial understanding of Wu Yushu’s condition.

It was almost certainly constrictive pericarditis!

However, to confirm the diagnosis, there must be evidence. Thinking this, Chen Cang began to observe carefully. With Wu Yushu’s breathing, the bulging jugular veins in his neck could be faintly seen, but due to being somewhat overweight, they weren’t very pronounced.

Chen Cang remembered Wu Yushu saying that he had come with symptoms of abdominal distension, indigestion, and poor appetite.

He said, “Let me feel your abdomen.”

Wu Yushu cooperatively raised his leg.

After Chen Cang performed an abdominal percussion, he fell silent for a moment. There might be fluid accumulation in the abdominal cavity, accompanied by an enlarged liver.

At this point, Chen Cang had already made a rough diagnosis.

Thinking this, Chen Cang asked in detail about the patient’s medical history and precipitating factors.

Afterward, Chen Cang looked at Wu Yushu, “Based on your symptoms and my examination just now, I feel you’re more likely suffering from constrictive pericarditis.”

Upon hearing this, Wu Yushu’s eyelid twitched reflexively, startled by the medical term.

He had heard of pneumonia and rhinitis, but this was the first time he had heard of pericarditis!

With this thought, Wu Yushu’s complexion changed, “What is pericarditis? What does it mean?”

Chen Cang explained, “Constrictive pericarditis is a disease caused by chronic inflammation of the pericardium. Over the long term, it leads to thickening, adhesion, and even calcification of the pericardium, restricting the expansion and contraction of the heart, resulting in reduced heart function and causing systemic blood circulation disorders.”

“Your difficulty breathing, chest pain, including abdominal distention, are all directly related to this!”

Truth be told, Wu Yushu was quite frightened when he heard this.

He could not afford to be ill…

That was crucial.

The heavy burden was on him; how could he dare to fall ill?

He didn’t even dare to rest, let alone get sick.

Thinking this, Wu Yushu quickly asked, “Doctor, is my condition serious?”

Whether it was serious or not was hard to say, but seeing Wu Yushu’s condition, Chen Cang had to speak the truth:

“To be honest, it’s not a simple disease. If it continues to develop over the long term, it will not only affect the cardiovascular system but may also involve the liver, lungs, and other systemic diseases.”

Wu Yushu felt a jolt in his heart, “Does this require hospitalization? Or can I just take some anti-inflammatory medication?”

In Wu Yushu’s mind, inflammation should be treated with anti-inflammatory medicine, right?

But inflammation of the heart… that made him feel unsure.

Having heard Chen Cang’s explanation, which seemed quite serious, Wu Yushu became scared.

Chen Cang couldn’t help shaking his head, “With constrictive pericarditis, the main treatment is surgery, supported by medication. The earlier, the better. And the fluid in your abdominal cavity needs to be drained. My suggestion is to arrange for hospitalization as soon as possible.”

“After you’re admitted to the hospital, complete the relevant examinations, and then we can devise a specific treatment.”

Chen Cang had said all that needed to be said.

He could see that Wu Yushu seemed somewhat resistant to the examinations, probably for one of two reasons: either financial pressure or the loss of time.

But when the disease comes, treatment still needs to be carried out.

However, the examinations could be done after hospitalization.

That way, insurance could cover a large part of the costs of the examinations.

This was the best Chen Cang could do.

Therefore, Chen Cang did not insist on Wu Yushu having the examination done in the outpatient clinic immediately; he hoped that Wu Yushu could be admitted to the hospital as soon as possible, for the same reasoning.

Upon hearing Chen Cang’s words, Wu Yushu fell silent, sitting there, saying nothing for a long time.

At this time, Chen Cang saw the next patient, an elderly person.

Seeing the elderly person, Chen Cang didn’t know what to say. After thinking, he instead offered, “Elderly sir, how may I assist you?”

The old man passed over the emergency room registration, “I need an ECG, I’m feeling a bit of palpitations.”

Once Chen Cang saw the old man’s name, his eyes narrowed!

That name might not mean much to most people.

But in the medical field of Dongyang Province, or rather, in the field of traditional Chinese medicine, the significance was too different.

Chen Cang had come across this name by chance, and never expected to meet such a luminary!

National Medical Master: Zheng Sanshui!

ps: Hehe, this is the third update for now, actually

The extraordinary vessels, they are truly quite interesting, something I have indeed encountered before.

Lastly… shamelessly asking for your votes, cough cough!