The Enhanced Doctor-Chapter 433 is AIP not VIP
(Thanks to a friend for their monthly ticket and encouragement!)
An "ugly daughter-in-law" has to meet the in-laws eventually. Despite the patient’s resistance, Liu Banxia and Wang Huan had to step up to the challenge. However, the ice-cold stare from the patient gave both of them a bit of a fright.
The patient, indifferent to threats or coaxing, wasn’t buying any of it. If the previous check-ups had shown any result, they could have used that as a launching pad.
"Miss, honestly, all the tests we’ve done so far haven’t revealed what’s causing your illness," Liu Banxia said.
"But you’ve been experiencing abdominal pain, so there’s certainly something we haven’t identified yet. Can we do a pelvic ultrasound to see if the pain is caused by something in your pelvic adnexa?"
"Sometimes, pain can be referred, not direct. Your boyfriend is so worried about you. Consider this scan a favor for him, okay?"
The girl merely glanced at him and then lowered her gaze to her own fingers.
Even though Liu Banxia considered himself a persuasive speaker, he found himself at a loss in the face of this "silent treatment" from the patient.
Having no other choice, he fetched a cup of water and handed it to her. To his surprise, she didn’t reject it and took it from him without hesitation.
This unexpected acceptance caused Liu Banxia to pause. Could patients with depressive tendencies accept things offered to them so smoothly?
"Well, if we can’t pinpoint what’s wrong, we can’t let you leave. Let’s chat. What are you feeling right now?" Liu Banxia pulled over a chair, sat down in front of the girl, and looked straight at her.
The girl frowned slightly. "It just hurts a bit, waves of pain now and then. Is the pelvic examination a scan of the uterus and ovaries?"
Without any discernible reaction, Liu Banxia nodded. "We’ve done a CT scan on your abdomen and ruled out some conditions. Your intestines were also checked via colonoscopy and found to be problem-free, not even a polyp."
"So, we suspect the pain might come from the pelvic region, possibly due to an underlying inflammation. Without this scan, neither your boyfriend nor we can comfortably let you leave."
"Just think of this as a way to get rid of us. We do the check, you’ll have peace of mind, and so will we. After all, you two have a life to live together, right?"
The girl’s brow furrowed, and silence fell over the examination room.
Wang Huan was on tenterhooks, hoping she would agree soon so he could rush out and bring in the ultrasound machine.
Just as the patient’s boyfriend was about to speak, Liu Banxia quickly shook his head to stop him.
The girl stared at the disposable paper cup in her hand for a long moment, then lifted it, took a sip, and finally nodded.
The oppressive atmosphere in the examination room vanished with her nod. Wang Huan was the first to dash out, followed closely by Liu Banxia.
"Brother Wang, did you notice that the girl’s behavior isn’t exactly one of strong resistance?" Liu Banxia remarked.
Wang Huan paused for a moment, then nodded. "It seems so. Are you saying her current presentation isn’t depression, but rather neurological symptoms?"
"I think that’s likely, and this influence seems to be variable, too," Liu Banxia replied.
"Let’s do the ultrasound first. It could also be an inflammation or abscess in the pelvic adnexa causing a carcinoid-like reaction. But since she has abdominal pain, I still think there’s an issue."
Wang Huan nodded, a flicker of excitement within him. At least now they had a clearer direction and had identified new symptoms in the patient.
This was a hard-won opportunity for an examination, so Wang Huan and Liu Banxia scrutinized the ultrasound images very carefully. However, to their frustration, the ultrasound also revealed no problems.
They had scanned not only the pelvic region but the entire abdominal cavity, examining it meticulously.
"I’m feeling a bit better now, not as much pain," the patient said while the two doctors hesitated.
"Not as much pain?" Liu Banxia repeated thoughtfully.
"Could it be that if I drink less water, it hurts, but if I drink more, it doesn’t?" The patient was surprisingly more talkative this time.
Liu Banxia wanted to tell her that was impossible, but he dared not say it. Even if the girl didn’t have depression, she now exhibited signs of a neurological condition, requiring him to choose his words carefully.
"Let me listen again with the stethoscope," Liu Banxia said, wiping off the couplant and placing his stethoscope on her abdomen.
After listening for a while, he pressed the stethoscope down and closed his eyes.
This auscultation was quite long, lasting over three minutes. Then, he extended his hand and lightly rolled it over the patient’s abdomen.
After that, he placed the stethoscope back on her abdomen and continued to listen.
Even Wang Huan didn’t know what he was doing, but he didn’t interrupt. Liu Banxia must have discovered something; otherwise, he wouldn’t be acting so peculiarly.
This time, the auscultation was even longer. Only when the girl frowned slightly did Liu Banxia remove the stethoscope.
"How about we perform a magic trick?" Liu Banxia asked the patient with a smile.
Seemingly annoyed by Liu Banxia now, the girl’s frown remained, and she ignored him.
Liu Banxia, as if he hadn’t noticed, took out his penlight and began flashing it intermittently at the girl’s face.
It was obvious that the girl’s expression was far from pleased; she turned her head away sharply.
"Let’s talk about that magic trick," Liu Banxia said, his smile widening.
"I can change the color of your urine, make it darker. You haven’t had a urinalysis yet, so go to the restroom and collect a sample. If I can’t diagnose your illness today, all your tests will be free. How about that?"
"Banxia, are you saying...?"
Hearing this, Wang Huan’s eyes lit up. There weren’t many conditions that could be diagnosed by directly observing urine, and Acute Intermittent Porphyria was the most notable example.
Moreover, it wasn’t an unfamiliar case for the emergency center; a child had presented with the same illness not long ago.
However, he was somewhat puzzled, as the symptoms didn’t quite add up.
Firstly, although the main symptom of this disease was abdominal pain, it was typically colicky, not a dull ache, so it was often confused with an acute abdomen.
Secondly, this disease usually involves significant photosensitivity. Although Liu Banxia had just shone the penlight at the patient’s eyes, her annoyance seemed to stem merely from the frequency of the flashing.
The lights in the examination room were very bright. If she were truly photosensitive, she couldn’t possibly have tolerated such a long examination without any reaction.
However, much to his surprise, while he thought the patient would ignore Liu Banxia’s seemingly unreasonable request, she agreed.
It wasn’t just him; even the patient’s boyfriend was startled. Even if Liu Banxia was a doctor, asking his girlfriend to participate in a "urine magic trick" seemed a bit off.
The subsequent test was simple. Two urine samples were collected: one was sent to the lab, and the other was given to the patient’s boyfriend to take outside and expose to sunlight.
About five minutes later, the patient’s boyfriend rushed back; the color of the urine sample had already changed.
DING! Complex Abdominal Pain Patient task completed.
Gained 200 experience points, 100 points to Diagnostics skill proficiency.
The task reward was meager, making Liu Banxia feel a bit disheartened. However, given the unique nature of this diagnostic process, the smaller reward was somewhat understandable.
"It really is AIP! How is that possible?" Wang Huan was visibly unsettled.
"Doctor, is AIP my illness?" the patient asked.
Liu Banxia nodded. "AIP is the abbreviation. The full name is Acute Intermittent Porphyria. It’s a dominant hereditary disease. Most cases are diagnosed between the ages of 20 and 40, and it’s more common in women."
"There are many triggers, such as changes in diet, emotional stress, or certain medications. In your case, it was medication. The use of sulfonamide drugs can easily induce this disease."
"Moreover, the way this disease manifested in you made the diagnosis more difficult. You have a high pain tolerance, so what should have been colicky pain felt like a dull ache to you."
"This might also be related to your neurological condition. The presentation of this disease can vary greatly, so one shouldn’t generalize."
"Doctor, can this acute... uh... VIP thing be treated?" the patient’s boyfriend asked anxiously.
"Hmm... it’s AIP. It can’t be cured, but it can be managed through lifestyle adjustments," Liu Banxia replied.
"Your episode was triggered by sulfonamide drugs. In the future, you should avoid medications like sulfonamides, barbiturates, griseofulvin, chloroquine, and estrogen."
"Furthermore, sugar intake in your diet will be crucial. You’ll need to consume more high-carbohydrate and high-protein foods. First, you should be admitted to the hospital. Have a glass of cola, eat a big chicken leg. We had a young patient who managed their condition well this way."
"Doctor, this... this... you’re not joking, are you?" the patient’s boyfriend asked with a forced smile.
He thought Liu Banxia was pulling his leg again. They came to the hospital for treatment, got diagnosed with some serious-sounding VIP disease, and the solution was to drink cola and eat chicken legs? They could have done that at home; why bother coming to the hospital?
Liu Banxia, however, nodded seriously. "If you’re worried about not spending enough, we can also prescribe chlorpromazine to stabilize her mood, put her on a few IV bags of glucose for calories, and adding some hematin would be even better.
"Silly boy, save money where you can. If eating and drinking can control it, why pump her body full of all those unnecessary drugs? The reason for admission is to monitor her physiological indicators.
"Rest assured, as long as her body recovers, there won’t be any lasting effects. If you follow medical advice and lead a normal life in the future, the recurrence rate is very low. It’s not as terrifying as you imagine."
Although Liu Banxia had chided him, the young man could only grin sheepishly; the doctor seemed to make a lot of sense.
