The Enhanced Doctor-Chapter 695: Blood on the Gums

"Old Peng, any thoughts?" Liu Banxia asked after they arrived at the Neurology Department office.

Peng Bo shook his head. "I’ve admitted him and conducted a preliminary physical examination and questioning. However, at this stage, I can’t determine the cause of the encephalitis."

"The child hasn’t had a cold recently and has generally been in good health. So I can’t figure out why his immune system would be compromised enough to cause encephalitis."

"Even with some mosquitoes around these days, families are generally very careful. I asked the patient; he hasn’t been bitten anywhere, neither at home nor at school."

"So I’m wondering if this could be an intracranial infection with an undetermined cause, rather than simple encephalitis. But the CT scan was negative. Do you have any ideas?"

Liu Banxia’s brow furrowed as well. This was indeed a puzzling situation.

The child had no obvious external injuries and hadn’t recently suffered from illnesses like a cold that could lower his immunity. So, what could have led to encephalitis? 𝒻𝓇𝑒𝘦𝘸𝑒𝒷𝓃ℴ𝑣𝘦𝑙.𝒸ℴ𝘮

Intracranial infection is a general term that includes encephalitis, as well as other conditions like cerebral abscess and cerebral cysticercosis. However, those would typically show up on a CT scan.

Another point is that encephalitis is usually accompanied by a high fever. The child has had headaches for quite some time now; that should have marked the onset of the illness. By now, his temperature should theoretically be quite high.

After a moment of thought, Liu Banxia asked, "Brother Peng, do you think it could be an infection in the nasal cavity or ear canal that led to the intracranial infection?"

"Excluding external transmission and a compromised immune system, I believe only an infection near the cerebral ventricles could affect them, right?"

Peng Bo nodded. "That’s a plausible direction. We have to wait for the culture results anyway. Why don’t we perform a detailed examination of his nasal cavity and ear canal in the meantime?"

"If we find any lesions, we can take samples directly. This might help us identify the pathogen even faster than the cerebrospinal fluid culture, saving a lot of time."

"Okay, I’ll talk to the child’s parents about this," Liu Banxia said. "If the examination of the nasal cavity and ear canal doesn’t reveal anything, then you can suggest the next diagnostic imaging."

"Then I won’t stand on ceremony; you take the first shot on this," Peng Bo said.

It shouldn’t be assumed that just because such examinations are for the patient’s benefit, the family members will readily agree. They were still in the exploratory stage, and every diagnostic test needed careful consideration.

Liu Banxia took this responsibility upon himself. If there truly was no issue found, his subsequent recommendations for other diagnostic tests would be less likely to provoke excessive reluctance from the child’s family.

Because even if they wanted to complain, they would direct their complaints towards Liu Banxia.

"Dr. Liu, please, you have to see how Jiajia’s illness should be treated," the child’s mother said anxiously as soon as Liu Banxia entered the hospital room.

"I apologize," Liu Banxia said. "I was just attending to a matter in another department. I only just learned about the preliminary results of the cerebrospinal fluid test."

"We just discussed it. Based on the child’s current condition, we suspect a possible intracranial infection caused by an infection in his nasal cavity or ear canal."

"Please try to recall carefully: after the headaches started, did Jiajia mention any other areas of discomfort?"

The couple shook their heads. They usually paid very close attention to their child’s health. They had assumed the headaches were just from study fatigue. The only other thing was that he seemed a bit listless, which they had already mentioned to the doctor.

"The reason we are considering this examination is because the nasal cavity and ear canal are located very close to the brain," Liu Banxia explained patiently.

"Moreover, this examination is non-invasive; we’ll use an endoscope to observe the areas. We’ve considered many potential causes for your son’s current condition. What we need to do now is to rule them out one by one."

"Dr. Liu, can’t we just give him anti-inflammatory drugs?" the child’s mother asked.

Liu Banxia shook his head. "Many pathogens develop a certain degree of resistance to anti-inflammatory drugs. After we culture the pathogen, we also need to perform a drug susceptibility test to see which medication will have the best effect."

"If we were to administer medication indiscriminately, it would be irresponsible towards your child. Currently, his vital signs are stable, which gives us some time to clearly identify the cause."

"Alright, Dr. Liu, please issue the order. We’ll go get the tests done now," the child’s father said.

"Okay," Liu Banxia said. "Let me call an ENT specialist first. I’ll find someone highly skilled."

Their swift agreement stemmed from the parents’ trust in him. He had to live up to that trust. In his mind, Du Fancheng was the best person for this.

"President Liu, what’s the matter?" Du Fancheng asked as soon as he answered the phone.

"Are you busy right now? If not, I have a patient here who needs an endoscopic examination of the nasal cavity and ear canal. We need to see if an infection there might have caused an intracranial infection," Liu Banxia said.

"Okay, bring him over. We don’t have many patients today," Du Fancheng said and then hung up.

After hanging up, Liu Banxia looked at the couple and said, "Alright, let’s go for the examination now."

"Try not to worry excessively. Your son’s symptoms are somewhat complex at the moment. Considering he’s also a bit anemic, has he experienced any symptoms like dizziness, tinnitus, or insomnia recently?"

"No, Jiajia has always been perfectly fine," the child’s mother said. "He eats well, plays well. If we hadn’t come to the hospital this time, we wouldn’t even have known he was anemic. He eats everything; he’s not lacking any nutrition."

"We are currently investigating the cause of his anemia. We’ll inform you as soon as the test results are available. Anemia can have many causes, and the results should be out soon," Liu Banxia comforted them.

"Sigh... Dr. Liu, we’re entrusting Jiajia’s situation to you," the child’s father said.

"Please rest assured. Even though I’m the one here with you, Doctor Peng from the Neurology Department is also back in his office researching the case. We take our responsibility for every patient who comes to our hospital very seriously," Liu Banxia said reassuringly.

"Alright, let me introduce you. This is Doctor Du from the ENT Department. He will be examining Jiajia shortly to see if we can find anything."

"Old Du, the patient underwent a lumbar puncture, and the cerebrospinal fluid analysis revealed an intracranial infection. The child hasn’t had a cold recently, and his body temperature isn’t in the high fever range. Could you take a look?" Liu Banxia said.

"Okay, don’t be nervous," Du Fancheng said. "The examination of the nasal cavity and ear canal is very quick. Have you had any symptoms like a runny nose or hearing impairment recently?"

"I don’t think so... Jiajia, have you?" the child’s mother asked.

"I... I don’t know," Jiajia said.

"I haven’t had a runny nose, but I have sneezed. Does that count? Hearing... I don’t know if my hearing has been affected. Lately, I’ve had some trouble concentrating, and sometimes I really can’t hear what people are saying clearly."

"Don’t be so nervous," Du Fancheng said with a smile. "There are many reasons for sneezing; it doesn’t necessarily mean you have a cold. Just now, when we were talking, our voices weren’t loud, and you could hear us clearly. This also proves your hearing is fine."

"Come, let’s examine your ear canal first. Don’t be nervous; it doesn’t hurt at all. Just try not to move. Yes... that’s it, hold still."

"A preliminary look shows no major issues, just some impacted cerumen in your left ear. It’s not serious; I can remove it for you in a bit."

Hearing Du Fancheng’s words, the child’s mother tensed up immediately. "Dr. Liu, is this impacted cerumen what caused Jiajia’s brain condition?"

Liu Banxia shook his head. "Impacted cerumen is essentially what we commonly call ’earwax.’ Normally, it detaches and comes out of the ear canal on its own with jaw movements from chewing or talking."

"Severe cerumen impaction can block the entire ear canal and might lead to otitis media. However, as Doctor Du just said, Jiajia’s isn’t very serious, and it can be treated directly."

"Looking at the left ear now, apart from a bit of cerumen buildup, I don’t see any other problems. I’ll remove this first, and then I’ll check the right ear," Du Fancheng said.

"Doctor, thank you," the child’s father said gratefully.

"You don’t need to be so polite with me," Du Fancheng said as he removed the cerumen and then carefully inspected the ear canal again. "We’re here to examine him, and if there’s an issue, it needs to be addressed. Besides, this isn’t a difficult thing. Look, it’s just this little bit."

"President Liu, the left ear is completely fine. Even the area where the cerumen had accumulated is very clean, and the middle ear shows no signs of inflammation."

After that, Du Fancheng began to examine the right ear canal. Similarly, there were no problems; in fact, the right ear canal didn’t even have any accumulated cerumen.

"Next, we need to do the nasal endoscopy. This might cause a little discomfort, but it’s nothing serious. Many children can manage it, so you’ll definitely be fine," Du Fancheng comforted the patient again.

"Then... should I wipe my nose first? What if I have boogers?" the patient asked, a bit embarrassed.

"Don’t worry," Du Fancheng said while trimming the young patient’s nasal hairs. "As doctors, we’ve seen all sorts of things. Don’t try to clean it now. If you pick your nose, you might damage the nasal mucosa, and that would prevent us from making an accurate assessment."

"Alright, I’m starting the examination now, so I won’t be talking. Just listen to what we say. I need to examine you thoroughly to see exactly where the problem might be."

As Du Fancheng proceeded with the examination, Liu Banxia’s mind was racing. So far, at least, he couldn’t see any problems on the monitor. If this examination of the ear canals and nasal cavity still reveals nothing, what tests should be done next? And how could he reassure these parents and prevent them from becoming overly anxious?

Just as he was thinking this, Liu Banxia’s brow furrowed. The child, perhaps feeling some discomfort, had opened his mouth slightly.

And Liu Banxia saw a trace of blood on the child’s gums. Although it wasn’t much, it caught his attention.