The Enhanced Doctor-Chapter 521 Otolithiasis? Stroke?

(Thanks to zyj13 for the monthly ticket encouragement)

A day and a half of vacation seemed long when it first started. Now, it was time to go back to work. In Liu Banxia’s memory, it felt like he’d only slept twice, and then the break was over.

This time, he also brought a lot of snacks to work, carrying two large bags full, all prepared by Qiaoqiao. As for Qiaoqiao, she had driven off with Qing Kewa to have some fun.

"Teacher Liu, we really hope you can take vacations often. Just bring us some snacks each time," Xu Yino said with a smile.

"Naughty. Is it because no one is watching over you when I’m on vacation that you feel so relaxed? Don’t worry, the Lantern Festival is coming soon. Tsk, tsk. Good luck with that!" Liu Banxia said with a teasing smile.

The initially overjoyed interns suddenly looked glum. After the Lantern Festival, their rotations in the ICU and pediatrics would officially begin.

Was that even a life fit for humans? Their current days were already tough enough; rotating into those two departments would be sheer torture.

"Were there any issues yesterday?" Liu Banxia asked Shi Lei.

"No major issues. Two myocardial infarctions, one stroke. We might see an increase in similar patients soon; an alert has already been issued," Shi Lei said.

Liu Banxia nodded. This could be considered a "complication" of the holiday. Especially during long holidays like the New Year, people tended to overeat and drink excessively at home, significantly increasing the number of patients with potential risks for such diseases.

Not to mention anything else, alcohol itself wasn’t great. Many people thought they could hold their liquor and wouldn’t drink too much, but in reality, they often ended up drinking more than they intended.

Because by the time you felt you’d reached your limit, you were actually already over it. Alcohol could numb your central nervous system, dulling your senses.

"By the way, Teacher Liu, do you remember that young patient who was discharged before the New Year? The one with the superior mesenteric artery malformation? He was admitted today," Liu Yiqing said.

"Alright. Let him settle in for a day, and we’ll do his surgery tomorrow morning. That should also help his family feel more at ease. How’s his condition?" Liu Banxia asked.

"He’s doing alright. He’s been primarily on a liquid diet for the past few days, mainly to avoid aggravating the blood supply pressure to his stomach. Also, the thrombolytic drugs used initially are no longer causing any issues, which is excellent," Liu Yiqing replied.

"Okay, since you remember it so clearly, you can be in charge of monitoring the child’s preoperative preparations," Liu Banxia said.

Liu Yiqing smiled and nodded. This was nothing, just a very minor task.

"President Liu, there are quite a few patients in internal medicine today. Could you help out in the clinic next door?" Wang Huan called out.

"Sure thing!" Liu Banxia responded and jauntily hurried over.

Everyone burst out laughing. No matter how brilliant President Liu was, it didn’t spare him. His current role was essentially that of a pinch hitter; whenever a department was swamped with patients, he was needed to go and help.

The patient being attended to was helped in by his son. Liu Banxia took the registration slip and pulled up the patient’s information.

The record showed: 68 years old, history of otoconia disease, onset of current symptoms eight days ago.

"You’re not feeling well. Please help the gentleman lie down first; it’ll prevent vertigo from sitting up. Why didn’t you go to the ENT department?" Liu Banxia asked.

"There were too many people there; it got really crowded right after the New Year," the patient’s son said.

"I see a history of otoconia disease. How long has he had it?" Liu Banxia inquired.

"I’ve been feeling muddled since last year. I went to the hospital for a check-up, and they said my otoconia were dislodged," the old gentleman lying on the examination bed said.

"I came to my son’s place for the New Year, you see. I told him there was no need to go to all the trouble of going back to the county hospital. They just do a few maneuvers there, and it sets the ’stones’ right, then I wouldn’t feel muddled anymore."

"It costs so much to come to a big hospital, and it’s not easy for my son to earn money. But he insisted on coming. It’s totally unnecessary. Doctor, just let me go home."

Liu Banxia couldn’t help but be amused. This old gentleman was quite a character.

The patient’s son smiled, a bit embarrassed.

"I’d say it’s your good fortune that your son is so considerate of you. Since you’re already here, tell me about your symptoms this time. I also know how to do those maneuvers. Our fee is a bit higher than the county hospital’s, but not by much," Liu Banxia said.

"I arrived on the 28th and felt a bit carsick. My head has been a bit muddled since. I know, the ’stones’ must have shifted again," the old gentleman said.

"Miao Rui, take the gentleman’s blood pressure. Sir, do you have a history of diabetes or hypertension? I see your face looks a bit flushed," Liu Banxia said.

"Those are rich people’s diseases; I don’t have those. I can’t always eat rich food like lots of fish and meat; I can’t digest it well. Oh, here it comes again, here it comes again, it’s spinning," the old gentleman said, waving his hand.

"Doctor, can this otoconia disease recur frequently? Can’t the otoconia be fixed in place?" the patient’s son asked.

"Under normal circumstances, the otoconia are attached to the otolithic membrane. If they become dislodged due to certain conditions, these otoconia, which float and sink, will move with the fluid in response to head movements," Liu Banxia explained.

"This movement stimulates the hair cells in the semicircular canals, causing a sensation of vertigo. However, otoconia disease isn’t a major illness. As the gentleman mentioned, repositioning maneuvers usually resolve it."

"Teacher Liu, the patient’s blood pressure is a bit high: systolic 190, diastolic 120," Miao Rui, having finished taking the blood pressure, hurriedly reported.

Hearing these numbers, Liu Banxia was stunned. Although otoconia disease could cause some vertigo and affect blood pressure, it shouldn’t have elevated the gentleman’s blood pressure so much.

Liu Banxia took a small penlight from his pocket, checked the gentleman’s pupils, and his eyebrows furrowed. His eyes showed slight nystagmus and minor hyperemia. Were these caused by the vertigo?

"How long does your father’s vertigo last each time?" Liu Banxia asked the patient’s son.

"It varies. The vertigo only started a couple of days ago. Before that, he was just a bit muddled. The longest episode might have lasted seven or eight minutes, I think," the patient’s son replied after some thought.

That long...? Something’s not right. "Miao Rui, get a neurologist over here! I suspect the patient has had a stroke. Order an urgent brain CT!" Liu Banxia exclaimed suddenly.

Miao Rui was taken aback but quickly ran off to call the neurologist.

"Doctor, that can’t be, right? How could he have a stroke?" the patient’s son asked in panic.

"This is just my suspicion. Let’s get him to the CT scan first to check for any bleeding or infarction," Liu Banxia explained.

"President Liu, is this the patient?" Peng Bo from neurology asked, rushing over just as they were wheeling the gentleman out.

"He presented with otoconia disease, blood pressure is 190/120, flushed face, slight nystagmus, and conjunctival hyperemia. No other symptoms were observed," Liu Banxia quickly relayed.

"Alright, let’s get the CT scan first to see what’s going on. I’ll take over from here," Peng Bo said, then started pushing the gurney towards the CT room. 𝑓𝑟𝑒𝘦𝓌𝑒𝑏𝑛𝑜𝘷𝑒𝘭.𝒸𝘰𝑚

"Teacher Liu, I didn’t notice any other symptoms either. Shouldn’t a stroke have other manifestations, like localized numbness, facial asymmetry, drooling, or slurred speech?" Miao Rui asked curiously.

"You silly kid, who can say for sure with illnesses? Textbooks only state that such manifestations *may* occur; those are conclusions drawn from summarizing collected data," Liu Banxia replied.

"Carefully recall this patient’s situation and see if you can find anything else. Li Hao, come with me. There are still two patients here; I need to continue seeing them. You think about it and tell me later."

With that, Liu Banxia walked back into the examination room to see the next patient.

Miao Rui was troubled. Having studied under Liu Banxia for so long, he had developed almost blind faith in him. Even though the CT results weren’t back yet, he trusted Liu Banxia’s judgment. Still, what could he have missed? Based solely on high blood pressure, a flushed face, slight nystagmus, and ocular hyperemia, it seemed impossible to make such a diagnosis. This was like an assignment from Teacher Liu, and he had to figure it out. There had to be something he hadn’t noticed. But what was it? When Teacher Liu described the patient’s symptoms to Teacher Peng, he hadn’t mentioned anything else. It was unlikely he’d deliberately omit information just to test me. Besides, Teacher Peng hadn’t shown any signs of confusion either.

Miao Rui was really racking his brains over this impromptu assignment.

Unable to figure it out on his own, he started discussing it with his fellow interns. He described the patient’s condition, hoping they could brainstorm some ideas.

"Headache, vomiting, vertigo, unilateral limb and facial abnormalities, drooling, sudden visual and speech disturbances, impaired consciousness... these are the main manifestations of a stroke, aren’t they?" Xu Yino offered after some thought.

"The patient only presented with vertigo, and he has a history of otoconia disease. Could Teacher Liu have made the diagnosis based solely on high blood pressure?" Miao Rui asked with a wry smile.

"Given his advanced age, I think it’s quite possible for him to exhibit the symptoms he’s showing now when experiencing vertigo. But how could Teacher Liu diagnose it as a stroke just like that?"

"Ugh... My brain hurts from all this thinking. Should we ask Teacher Shi for help?" Liu Yiqing suggested.

"I don’t dare. Teacher Liu said he’d ask me for the answer later. I can discuss it with you guys, but I wouldn’t dare ask our teachers," Miao Rui replied with a grimace.

Everyone looked at him with sympathy. Poor kid.

Discussing it with his peers was a learning process; asking the attending doctors for the answer to this problem, however, would be cheating.

"Dr. Shi, what are this little group of youngsters huddled together discussing now?" Wang Chao approached Shi Lei and asked.

"Who knows? I guess Banxia is testing them again. A patient was just sent for a CT scan," Shi Lei replied.

"Tsk, tsk. Those poor kids. It’s a good thing I was born a few years earlier; otherwise, if I’d fallen into Banxia’s hands, I wouldn’t have had an easy time," Wang Chao exclaimed with feeling.

Shi Lei chuckled. "Haven’t you seen how quickly they’re progressing? You need to step up your game. Don’t let them surpass you. If there’s any surgery you want to scrub in on, just let me know."

"Hehe, thank you, Chief Shi! That’s exactly what I was thinking," Wang Chao responded with a grin.

"You! You’re picking up Banxia’s bad habits. Go eavesdrop on them and give them a hint. Wei Yuan and Qi Wentao are both off today, so it’s just the three of us on duty," Shi Lei suggested.

Wang Chao nodded and sauntered over to the group; actually, he was quite curious himself.