The Enhanced Doctor-Chapter 838: Athlete’s Foot in the Nose?
(Thanks to DRDER for the monthly ticket encouragement)
"Teacher Liu, are you busy right now?"
Miao Rui, who was attending the patients nearby, called out.
"Not busy, I'm coming over." Liu Banxia responded.
Even though the interns were helping with the arrangements, Huang Bo and Li Hao were also responsible for guiding them. There were quite a few patients at the moment, so Miao Rui and Su Wenhao were relatively busy.
"What symptoms?" Liu Banxia asked after approaching.
"The patient self-reports coming in for a cold, with a fever of 38.1 degrees, headache, and runny nose. I suspect it's an infection in the nasal cavity, as the nasal discharge is somewhat pus-like." Huang Bo quickly said.
Liu Banxia nodded, then put on the mask and gloves.
"How long has this symptom been lasting?" Liu Banxia asked.
"It's been over a month. Taking medicine helps a bit, then it recurs." the patient said.
"Tilt your head back, let me take a look at your nostrils first." Liu Banxia said.
"Doctor, it's just a cold, no need for a nasal endoscopy. It's just that my cold is a bit persistent, an IV should cure it." the patient said.
"Even so, we should take a look, colds come in many forms. Sometimes sinusitis can feel similar to a cold." Liu Banxia said.
"Headache, dizziness, tinnitus, runny nose, and general fatigue, sinusitis can cause these symptoms too. Think about it, what kind of cold lasts a month? With your physique, you should recover in about seven to eight days."
The patient thought for a moment and still tilted their head up. Liu Banxia took out a pupil pen to illuminate the patient's nostril. After seeing the inside of the nostril clearly, Liu Banxia frowned.
"You're lucky you came to the hospital. If you delayed further, your nasal cavity might have gotten worse. Do you have athlete's foot?" Liu Banxia asked.
The patient nodded blankly, puzzled how looking at the nose led to knowing about athlete's foot.
"There are some small blisters on the mucous membrane of your nostril, likely caused by a fungal infection." Liu Banxia said.
"Many times patients with athlete's foot after touching their feet don't wash their hands thoroughly, and habitually pick their nostrils. Unluckily, they can introduce fungi into the nostril."
"If you're even more unlucky, these fungi can take root and propagate extensively. Your nasal discharge is the pus from this fungal infection. Whether you want to or not, you'll have to undergo a nasal endoscopy."
"Doctor, that can't be right, how can the nose catch athlete's foot?" the patient was a bit stunned.
This situation hadn't been heard of before, athlete's foot is called that for a reason—it's on the foot. Although I have the habit of picking my nose, I wash my hands after washing my feet every time.
"Athlete's foot is a fungal infection because the feet are enclosed in shoes. The inside of shoes is relatively moist, making it more conducive for fungi to proliferate." Liu Banxia said with a smile.
"The conditions inside the nasal cavity are somewhat similar. Once the fungi take root, the moist environment creates an excellent home for them."
"Don't doubt my words, now your condition should be quite serious. You sometimes see some blood streaks when you blow your nose, right? And do you habitually use your right index finger to pick your nose?"
The patient nodded, slightly spooked. Is this a doctor or a fortuneteller?
"Get it checked out; if these fungi continue developing, who knows what might happen to your nasal cavity." Liu Banxia said.
"Miao Rui, write up the order. If there's an issue, it can be handled directly during the nasal endoscopy. It's lucky you came in today, otherwise it would have been truly dangerous."
Miao Rui looked at the patient, who hesitated slightly but still nodded.
"How did you know, Teacher Liu?" Miao Rui curiously asked after the patient went to pay. 𝓯𝓻𝓮𝙚𝙬𝓮𝙗𝒏𝙤𝒗𝙚𝙡.𝒄𝒐𝓶
"The pathways for fungal infections are generally limited, the most common being athlete's foot. But I was mostly guessing, sometimes there are environmental factors too." Liu Banxia said.
"Then how did you know they use their right index finger to pick their nose?" Miao Rui continued to ask.
"Silly, you didn't observe carefully. He left a tiny bit of a nail on his right index finger, while the other nails were neatly trimmed. Why would he keep that? Obviously for picking his nose." Liu Banxia said.
Miao Rui smiled and nodded, indeed he hadn't noticed that, focused as he was on discussing the illness with the patient.
"Actually, I also mentioned to the patient how awful sinusitis can be, but they refused to agree. Why did they agree as soon as you mentioned it?" Miao Rui asked again.
Liu Banxia scrutinized him, "It's a matter of composite factors. You called me 'Teacher Liu', and the patient heard it, so internally they believe I'm more skilled than you."
"Also, did you notice the amount of pens in my pocket? It gives an academic appearance. Other things also come into play; you should get a haircut and tidy yourself up a bit."
"During consultations, you also have to show some firmness. Even if we're providing the best service to patients, a lot of times you need to be assertive, otherwise it reduces the patient's confidence in you."
"Look at Su Wenhao, he rarely encounters this issue because he appears more composed. You, being slightly on the slimmer side, lack a certain presence."
Miao Rui took out his phone, using the camera to examine himself closely, then glanced at Liu Banxia and others, noticing a definite difference.
"Don't worry, it all takes time. Over time, that aura will emerge. How many years have I been in the hospital, yet there are still patients who think I'm young." Liu Banxia added.
"Sometimes, I wonder if I should get a pair of black-rimmed glasses. It seems more scholarly that way. Age may not be enough, so appearance comes to the rescue, and it'll get better over time."
Miao Rui nodded. This is indeed a secret trick. He had never considered this scenario before.
"I'll keep an eye on things here. You follow the patient to ENT for a look. I suspect it's a fungal infection; the blisters are evidence. There's no need to ask Yuanfang." Liu Banxia said.
Miao Rui glanced at him helplessly. Liu the Demon King must be in a good mood today; otherwise, he wouldn't be joking around like this.
He's quite curious too, as this is his first encounter with such a case.
Liu Banxia seemed pretty certain, regardless of whether it was transmitted from foot contact. A fungal infection seemed inevitable.
"Doctor, my stomach hurts."
A woman in her twenties walked up to Liu Banxia, clutching her stomach.
"Lie down on the examination bed. How long have you been in pain? Is it a dull pain or a cramping pain?" Liu Banxia asked.
"It's a kind of dragging pain. I suffer from menstrual pain, but this time it's different; my lower abdomen hurts," the patient said.
Liu Banxia frowned, "Are you still on your period? Any changes in diet?"
The patient nodded, "I haven't eaten much these past two days, but I'm not sure why it's so painful today."
"Hold on a moment. Xu Yino, come here, help me examine the patient," Liu Banxia said.
On the other side, Xu Yino quickly ran over.
"Lower abdominal pain, dragging sensation, history of menstrual pain," Liu Banxia said.
Xu Yino nodded, then began drawing the curtains and putting on gloves, while Liu Banxia stepped out.
If there wasn't a female doctor available, Liu Banxia would have done the examination himself. Given the patient's lower abdominal pain and menstrual symptoms, he wasn't sure if it was a pelvic or related issue.
Though it might not be the case, it's better for a female doctor to handle the examination.
After a while, Xu Yino came out, "Teacher Liu, considering the patient's condition, a pelvic CT scan might be necessary."
"How was the physical exam?" Liu Banxia asked.
"The abdomen and lower abdomen are both soft, and I listened to bowel sounds which were normal," Xu Yino said.
Liu Banxia nodded, "Alright, do it. We'll talk once we have the scans."
Xu Yino quickly went back in to explain to the patient.
The patient was indeed in a lot of pain, and after Xu Yino wrote up the order, she went to pay.
Liu Banxia initially thought of calling in a gynecologist for a look, but decided against it. A pelvic CT should be sufficient. If gynecological intervention is needed, there's still time to call someone.
There were still quite a few patients in the afternoon, mostly for wound cleaning and dressing changes. With so many people now, there's no need for Liu Banxia to personally get involved.
More than half an hour later, Miao Rui came bustling back.
"How did it go?" Liu Banxia asked.
"Teacher Liu, they found a sesame-sized fungal mass, fungal sinusitis," Miao Rui said.
Ding! Consultation task completed
Gained 30 experience points
"Tsk tsk, this guy, the fungus probably settled in his nasal cavity long before he realized he was sick," Liu Banxia remarked.
"According to Teacher Du, the treatment will take a long time, and the patient needs to be careful during treatment," Miao Rui said.
"It's already caused significant damage in the nasal cavity, with multiple necrotic areas. But since it was discovered early, we can try medication first; surgery may not be necessary."
"We actually have fewer cases like this in the north compared to the south. They have the monsoon season, which makes it too humid there," Liu Banxia said.
"But this guy probably kept a dirty nail. Even if you wash your hands, you can't clean under the nails completely."
"Maintaining good hygiene practices is very important, ideally coupled with some medical knowledge. His mucus had changed for a while, but he didn't notice."
"In many people's lives, even if they feel unwell, they choose to wait and see, right?" Miao Rui asked.
"Yeah, and they drag it out until it becomes a big issue. A lot of small problems become big ones by the time they come to us," Liu Banxia said with a smile.
"Don't forget to get a haircut tonight; looking sharp also gives patients confidence. You have to work hard and strive to become a formidable doctor."
Miao Rui nodded, feeling enlightened. Who knows, Liu the Demon King might use 'appearance' to tease him one day.
