"I heard that even the top hospitals in the capital couldn’t cure the illness, yet you managed to do it. We’re here specially to have you look into the condition," said the son of the elderly cadre standing beside him.
People like them are well-informed, naturally able to learn about Zhou Can’s legendary story through various channels.
Especially families with significant influence like these, those looking to curry favor would go to great lengths to find renowned doctors.
"Thank you for your trust and admiration, but I’m really not that remarkable; I’m just a regular doctor. Let’s start with a physical examination."
Zhou Can wasn’t quite used to being in situations where he was flattered.
He’s a practical person, focused on studying medicine or treating patients.
The patient’s biochemical tests, urinalysis, and stool tests all came back normal.
Considering the patient’s lower limb pain, toe blackening, and occurrence of gangrene, there was concern about kidney problems like uremia, hence a special renal function test was conducted.
The results showed the patient’s kidney function is normal.
Then, concerned about Diabetes, a fasting blood glucose test was conducted, which was also normal.
Even liver function was suspected as an issue.
Unfortunately, after checking liver function, it remained normal.
Diseases that easily cause symptoms like lower limb gangrene, such as Diabetes, uremia, and hepatitis, have been largely ruled out.
The diagnosis reached a stalemate at this point.
Precisely because of this, Zhou Can requested to see the patient in person. Physical examination is part of the conventional assessment; while its ponents seem similar, a skilled doctor can glean many clues from it that greatly aid diagnosis.
At the very least, it offers directions for consideration without issue.
The patient and family were very cooperative and willing to let him assist with the examination.
He first pulled back the covers to inspect the patient’s right foot.
It had undergone some disinfection and similar procedures mainly to prevent severe rot and further infection after local necrosis.
Gangrene refers to local tissue death, discoloration, and other specific morphological changes.
It is often caused by disease or trauma leading to blood circulation disruption.
Causing significant ischemia and necrosis of local tissue, followed by infection from putrefactive bacteria.
Gangrene can be categorized into dry and wet types; dry gangrene manifests as symptoms of limb discoloration, shriveling, and necrosis. As for wet gangrene, it’s not necessary to describe—involves pus, rupture, rot, and stench.
Overall, dry gangrene is somewhat better.
Though there’s no absolute rule.
Some patients with wet gangrene appear terrifying, yet treatment might be simpler.
What’s crucial is identifying the cause, improving local blood flow, and fighting infection.
Through observation, Zhou Can noticed the patient’s fourth toe on the right foot was severely discolored with obvious signs of gangrene.
Furthermore, there’s no distinct boundary between affected and healthy tissue.
This implies the gangrene could progress upward endlessly.
No wonder doctors from previous hospitals advised amputation to save the patient’s life.
After observing, Zhou Can began examining the patient’s neck.
Given limb pain and gangrene, after ruling out mon causes like Diabetes, uremia, there’re essentially two possibilities left. Either it’s an infection by bacteria/virus, or vascular issues.
Antimicrobial therapy was undertaken at the first two hospitals, yet there was minimal effect.
Nor did it halt disease progression.
This indicates an unlikely bacterial or viral infection.
Moreover, the patient’s biochemical reports are generally normal; liver and kidney functions exhibit no issues, suggesting vascular problems are most probable.
The veins are most susceptible to issues in the limbs.
If the injury involves a car accident, particular caution should be exercised for femoral artery damage; crush injuries can easily cause rupturing and significant bleeding.
This elderly cadre seems to align more with vein disorders.
Zhou Can, instead of examining the right foot, touched the patient’s neck — what’s the rationale?
Firstly, some lower limb veins belong to deep veins, not palpable nor visibly identifiable. He inspected the patient’s superficial veins on the right foot earlier.
No apparent abnormalities were found.
Thus, he moved to the largest palpable vein on the surface, the jugular vein.
Blood originates from the heart in humans, whether through arteries or veins.
However, a doctor can’t possibly open a patient’s chest to examine vein normalcy. The mon efficient method is examining the jugular vein.
Of course, this demands prehensive diagnostic experience from the doctor.
Through palpation, Zhou Can didn’t detect jugular venous distension, nor abnormal carotid artery pulsation. The trachea remains centrally positioned, with no abnormalities noted.
No lymph node enlargement or thyroid swelling was observed in the neck.
No neck stiffness was present either.
After inspecting the neck, he donned a stethoscope for the thoracic and abdominal examination of the patient.
Visually, the patient’s thoracic shape and breathing movements were symmetrical, without disorders; bilateral vocal fremitus was symmetrical as well. Breath sounds in both lungs were slightly coarse, yet generally normal—likely induced by mild patient tension during tests.
A soft wet rale was detected occasionally in the patient’s lower right lung.
It’s a new finding; Zhou Can’s facial expression changed slightly, he continued the examination.
Upon cardiac auscultation, no abnormal murmurs or pericardial friction sounds were auscultated across valve areas.
The heart is presumably normal.
Technically, having reached this juncture, the patient could be referred to other departments.
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