The Enhanced Doctor-Chapter 608 Gaoxie disease?

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"Dr. Liu, this isn’t a big deal, right?" Seeing Liu Banxia frown, the patient became somewhat unsettled.

"Hmm... I’m still considering. It’s unclear if there’s any related significance," Liu Banxia said with a smile. "You rest for a while. All of today’s tests are done anyway. Even if we need to do more, we’ll have to wait until tomorrow. I’ll ponder over it more when I get back."

The patient nodded, feeling somewhat relieved after hearing Liu Banxia’s words.

"Could these be related symptoms? Developing plaques is also quite common, right?" Xu Yino said.

"It’s hard to judge right now. A lot about this patient is ambiguous. Wow, look at all these intoxicated patients coming in! Can you help out for a while too?" Liu Banxia said.

"Alright, I’ll go over there too. Don’t waste your brainpower here; you keep thinking," Wei Yuan glanced over and chimed in.

This wave was quite large; about ten people had come in. Three of them were carried in, and the rest weren’t in particularly good condition either.

Liu Banxia nodded. With Wei Yuan going over, he could fully manage the situation.

Once seated, Liu Banxia carefully pondered the patient’s condition again, picking up a pen and writing on paper.

He first listed some known conditions, such as a slightly enlarged spleen and mild anemia, then added clumsiness, mild ichthyosis-like skin, and mild macules. These were some of the symptoms detected so far.

Then he put a question mark next to all items except mild anemia and clumsiness, and even underlined the word "mild."

The question mark signified his uncertainty about whether this was a manifestation of a disease, as he currently couldn’t find a correlation. "Mild" was also noteworthy, as all of the patient’s manifestations were mild.

This was the hardest part. Without a correlation, you couldn’t provide a directional judgment.

For instance, the ichthyosis-like skin changes might be an external manifestation of the disease, or they could be due to skin allergies or dry skin; it was truly difficult to determine.

In his heart, he was inclined to think the patient didn’t actually have a disease. These didn’t really count as true symptoms; they were all ambiguous conditions, and he could find a separate explanation for each one.

"Macules, ichthyosis-like skin, anemia, enlarged spleen, clumsiness," Liu Banxia murmured, the pen in his hand starting to circle each item.

Clumsiness might be due to anemia. Anemia can affect the body, but since hers is mild, there are no obvious symptoms like head discomfort.

Tumor marker screening is still negative, and routine blood tests and normal blood biochemistry are also fine. It’s either a genuine illness or no illness at all.

If it’s a genuine illness, organic disease can likely be ruled out. After the lumbar puncture results are negative tomorrow, we’ll need to consult neurologists for ideas or proceed with a comprehensive examination.

Hmm... Is there another possibility? Could it be endocrine-related? Are these mild symptoms caused by an endocrine disorder?

That can’t be right either. The patient is very cheerful and doesn’t have palpitations or excessive sweating, so it’s unlikely menopause has started this early. Then what could it be?

An enlarged spleen... is it a sign of disease or not? What if it’s like that patient with IgG4-related disease? But her spleen wasn’t the issue in that case, and her liver function is normal.

If it’s a progressive condition, perhaps because the symptoms are so mild, it hasn’t affected the liver yet? Then, where in the body is the problem originating? What has caused all these symptoms? Are they all external manifestations of a single underlying illness?

"Hmm... Huh?"

Reaching this thought, Liu Banxia shot up from his seat. His sudden movement caused the chair to make a harsh scraping noise.

Seeing him like this, Wei Yuan, who had just finished treating the intoxicated patients, hurried over. "Banxia, have you figured something out?"

"Hold on, let me think carefully," Liu Banxia said with a frown. "Brother Wei, how likely do you think it is that all these symptoms are manifestations of a single disease? Hmm... I think I might actually have a clue."

"Is it possible? You’re considering everything as a whole? That seems unlikely, right? The ichthyosis-like skin and macules are symptoms too?" Wei Yuan asked with a frown.

"Actually, we all forgot to consider a rare disease. Under normal circumstances, it really shouldn’t be occurring in our country now," Liu Banxia said after some thought. "For example, Gaucher disease. Three of these conditions are among the manifestations of Gaucher disease. But she doesn’t exhibit the common symptoms of osteoporosis and easy fractures; instead, she has this clumsiness."

Could it be a misleading manifestation? Is it because the bone marrow cavity is in an expansion phase that it’s having this effect, rather than an effect caused by anemia?

"If we count that, it makes four, right? So, next, we just need to do two more tests? Take an X-ray to see if the bone marrow cavities in both legs are enlarged. And then do a beta-glucocerebrosidase activity assay. That’s not too complicated, is it?"

The more Liu Banxia spoke, the brighter his eyes became. Although Gaucher disease was rare nowadays, this patient’s current condition truly bore some resemblance.

Wei Yuan thought for a moment and nodded. Without any definite leads, Liu Banxia’s guess seemed quite plausible.

"Dr. Liu, you’re not going to do more tests, are you?" seeing Liu Banxia and Wei Yuan approach again, the patient asked, unsure whether to laugh or cry.

Liu Banxia nodded seriously. "We need to do two tests. Don’t worry, we won’t draw blood again. The first is an X-ray of both your legs to look at your bone marrow cavities. We can get the results today."

"The second is a beta-glucocerebrosidase activity assay. The fastest way to do this is a bone marrow puncture, but that’s quite invasive, so we’ll opt for a skin fibroblast culture instead."

"Wait, Dr. Liu, are you saying I might have diabetes?" the patient asked, confused.

"Uh... it’s not related to diabetes. This beta-glucocerebrosidase is an enzyme secreted in the body. If the level of this enzyme is too low, it could very well be causing your current symptoms," Liu Banxia explained.

The patient frowned, feeling that what Liu Banxia was saying sounded very strange.

"Dr. Liu, this isn’t an incurable disease, is it?" the patient asked after considering for a moment.

"Right now, it’s just my speculation, so we need to do these tests. This disease also has many types. If I tell you now and I’m wrong, it would be pointless. After all, it could still be many other similar conditions," Liu Banxia said. "Actually, I’m also making a wild guess, since we haven’t been able to reach a diagnosis despite all these tests. I also don’t want to just pass you on to the neurology department for them to run even more tests."

The patient nodded; she could only go along with it now. Despite what Liu Banxia said, she felt he was being very honest and was considering her well-being.

"If it’s confirmed, have you thought about how you’ll explain it to the patient?" Wei Yuan asked while the patient went for the X-ray.

Liu Banxia shook his head. "That’s why I didn’t say much. The X-ray is merely supporting evidence. The beta-glucocerebrosidase activity assay result is the gold standard. However, I suspect Type I is more likely."

Actually, that was just a wild guess. There was nothing concrete to base it on; it was merely something he was hoping for.

"By the way, what was that commotion with that group earlier?" Liu Banxia asked.

"They probably drank counterfeit alcohol. Standard treatment, though they’ll suffer a bit," Wei Yuan said. "One of them found some so-called ’original unblended liquor’ from somewhere, the kind in a plastic jug. They were all enjoying it, but before they even finished their meal, they started reacting."

"It’s a good thing they had some common sense. If they had just gone to sleep, a stomach pump and laxatives wouldn’t have been enough. They could have lost their sight, or even their lives."

Liu Banxia shook his head; alcohol was truly something he couldn’t comment much on.

If it were merely blended liquor, it wouldn’t be so bad, as it would at least be within safety limits. But many unscrupulous merchants don’t care about such things; as long as it tastes good, sells well, and makes money, that’s all that matters to them. Who knows if, during one of those blending processes, they added too much methanol or industrial alcohol? That certainly wouldn’t end well.

Actually, much of it is simple common sense: you get what you pay for. If these so-called "original unblended liquors" were truly brewed from grain, could they be that cheap?

And another harm such inferior alcohol inflicts on the human body is a high incidence of esophageal and stomach cancer; it truly harms people deeply.

It wasn’t very common in big cities yet, mainly concentrated in smaller cities and rural areas. Actually, his father used to drink it before Liu Banxia forcibly made him stop.

His dad didn’t drink it to save money back then, but because people passed it around by word of mouth, claiming this "original unblended liquor" was genuine grain alcohol and tasted good.

As for whether it was truly good or not, Liu Banxia was instinctively skeptical of such products.

"Oh my god, I’m exhausted. Finally, all done," Xu Yino said, walking over at that moment.

"You’ve worked hard," Liu Banxia said.

"Not at all, Teacher Liu. Did you make a discovery? I noticed the patient isn’t here," Xu Yino asked.

"I have a suspicion, so we need to do another screening. When the patient comes back, take a sample from her ichthyosis-like skin, collect skin fibroblasts, and culture them to measure the beta-glucocerebrosidase level."

Xu Yino frowned. "Ah, Gaucher disease?"

"Eh? Little Xu, you noticed that too?" Wei Yuan asked in surprise.

Xu Yino shook her head embarrassedly. "No, I just happened to flip through a catalog of rare diseases a while ago, saw this one, and just glanced at it."

Wei Yuan chuckled. "Well, that’s still pretty good. If you had paid a bit more attention, the credit for diagnosing this patient might have gone to you."

"No way. I don’t have as much energy as Teacher Liu," Xu Yino immediately surrendered.

She couldn’t even handle some of the regular cases yet; these rare diseases would have to wait their turn.