The Enhanced Doctor

Chapter 1157: Chapter 1157: Choosing Between Two—How to Examine?

(Thanks to Se Zhong E Gui for the monthly ticket encouragement)

"Brother Xu, this is the situation with the patient, where do you think we should start?"

Liu Banxia came to Xu Hui’s office and asked.

"If it really is Huntington’s disease, it used to be judged based on family medical history and related symptoms." Xu Hui said.

"But your considerations also make sense. In the absence of relevant family medical history, if genetic testing is done and the result is negative, it can be troublesome for the patient to accept."

"Did you notice his fingers? I remember that in chorea, the fingers are most prominently affected, and then it slowly spreads, affecting the mouth and spreading throughout the body."

"I just paid attention too, and this is one reason I’m hesitant. The patient’s finger symptoms are not apparent; it’s more pronounced in the muscles of the legs and neck." Liu Banxia said.

"That’s why I initially leaned towards Wilson’s disease, but then I didn’t see the corneal K-F ring, so I was considering Huntington’s disease instead."

"It’s indeed quite complex, and if it’s Wilson’s disease, the brain CT should show something." Xu Hui said with a frown.

"However, muscle dystonia can also be caused by infection, perinatal injury or neuroleptic drugs, and the first two can be ruled out based on test results. As for medication?"

"The patient hasn’t taken any drugs, works every day, and is in good shape. It’s just that with the current muscle dystonia, goes home in the evening to drink a bit."

"When he talks about relaxation, he’s really just numbing his central nervous system. So, I personally still lean toward a hereditary disease, with these two being the most likely conditions."

"But there’s another special aspect, generally if it’s this disease, it manifests as developmental delay or symptoms in the mouth and jaw first."

"Then there’s really no choice but genetic testing. It’s best to test both Wilson’s disease and Huntington’s disease, even though one might be misdiagnosed, it’ll be more reassuring." Xu Hui said.

"It does involve spending more money, but it can save time. Given the current situation, family medical history seems to be the only reference point."

Liu Banxia nodded, "I just checked some information, the family medical histories of these two diseases are quite evident. If there’s none, I don’t know where to check next."

"However, I have another idea, because even now I tend to suspect Wilson’s disease, just without the corneal K-F ring and brain imaging indications."

"But from the data, although the corneal K-F ring is an important indicator, there is a very small number of patients who do not show it. And the brain imaging, do you think it might be there’s just initial symptoms, so it hasn’t shown up? What about an MRI instead?"

Xu Hui contemplated carefully, "Your thinking is correct, it is indeed very possible, albeit with a low probability. But you seem to have thought this through yourself, so what do you need me for?"

"Ai..., it’s the patient’s emotions, and the money is the other problem." Liu Banxia sighed.

Xu Hui nodded, but did not comment further on this.

Money is an eternal barrier in doctor-patient relationships that isn’t easy to overcome.

Why are tests conducted in a gradual manner, from low to high? Mainly it comes down to money.

He also listened to Liu Banxia describe some of the patient’s circumstances, including his complaints after regaining consciousness. If the patient’s family wasn’t financially constrained, or even averagely well-off, there wouldn’t be such strong negative emotions.

On this point, Xu Hui shared similar views with Xu Yino, feeling that Liu Banxia is truly meticulous and comprehensive in his considerations.

However, this thoroughness often leads to many concerns, putting him in a difficult position.

"Teacher Liu, the patient’s mother has arrived. The elderly lady is somewhat old, over seventy." At this moment, Xu Yino walked in.

Liu Banxia frowned, "Invite the elderly lady into this room."

Feeling a bit confused in his heart, the elderly lady has only this one son, but according to that era, there’s a large age difference between mother and son.

Unlike today, when many people marry in their forties.

"Doctor, I’m not senile, is it serious? What exactly is Guoliang’s illness? Just tell me directly, I can handle it." The elderly lady asked directly after coming in.

"Ma’am, please have a seat. I just want to learn more about your family’s medical history, but he can’t remember, so I need to trouble you to come by." Liu Banxia said.

Hearing his question, the elderly lady appeared a bit troubled.

Liu Banxia sighed inwardly, the elderly lady is indeed not confused, she’s already understood the situation.

"Doctor, Guoliang is the child I adopted when I was young." The elderly lady said.

"Aren’t you doctors? Don’t you have machines? Please examine Guoliang. Although our family isn’t wealthy, we can afford the cost of examination."

"Okay, if that’s the case, I know what’s going on." Liu Banxia smiled and nodded.

"Don’t worry, this matter won’t be talked about elsewhere. He just told me to keep things from you, he holds you in regard."

"Doctor, is Guoliang’s illness serious? How did a car accident happen? Did he hit his head?" The elderly lady asked.

"It’s still a bit difficult to determine at the moment. You can sit here and have some water while I go outside to continue examining him," Liu Banxia said.

"Doctor, please check thoroughly. Guoliang has suffered a lot. His family was poor before, and he didn’t even finish school," the elderly lady instructed.

"Alright, don’t worry," Liu Banxia nodded.

This result was unexpected for him, but the patient’s condition requires further examination; he couldn’t leave it ambiguous.

"Doctor, is my mom okay?" the patient asked anxiously upon seeing Liu Banxia coming out.

"Rest assured, I was just asking the elderly lady about any family medical history. However, she seems to have trouble remembering, so we can’t rely on it," Liu Banxia replied.

"Considering the current situation, I’ll present a testing plan for you. Based on the symptoms, they seem to lean towards two possible conditions."

"One is the originally suspected Wilson’s disease, and the other is Huntington’s disease. We’ll start the subsequent examinations from here."

The patient grimaced and said, "I’ve had such bad luck for generations, even to get diseases that are so uncommon."

"The best way to check these two conditions is through genetic testing, but the cost is a bit high," Liu Banxia continued.

"So, I’ve thought of a compromise: let’s do an MRI of your head. It can be more precise, and maybe it will detect problems missed by the CT scan."

"If the MRI results come back negative, then you’ll need to undergo genetic testing for Huntington’s disease. That’s the plan I have for now."

The patient hesitated, knowing the doctor mentioned the testing fees were quite expensive, suggesting it wouldn’t be cheap.

If genetic testing is the only way to confirm, then the money spent on the MRI might be wasted. But what if the MRI reveals something, saving the cost of genetic testing?

Genetic testing is high-tech and surely not cheap.

"Doctor, what if I am as I am now? I might not be able to drive, but I can still do manual labor, right?" the patient asked.

Liu Banxia shook his head, "One of these conditions can be treated, while the other cannot. So in any case, you need to get tested."

"Sigh... then let’s do the MRI first. If the MRI doesn’t show anything, it’s likely that the illness is untreatable, right? Does it even matter if it’s treatable or not?" the patient asked.

Liu Banxia hesitated a bit before nodding, "But my personal advice is to clarify it. At least we’ll all be aware."

The patient nodded, "Let’s go with the MRI then. Life and death are determined by fate, riches are by heaven, but I’m worried about my mom."

Liu Banxia patted his shoulder. After finishing the paperwork, they headed over to the MRI together.

This time he couldn’t wait for the report; he needed to see for himself and discuss directly with the radiology department.

"Doctor, do you think there’s a high chance I have a terminal illness?" the patient asked.

"Don’t think about that for now. We’ll just wait for the test results," Liu Banxia said.

"The worst result is Huntington’s disease, right? Even with that, you have about twenty years. In that time, you can still do a lot, can’t you?"

Xu Yino was startled; how could he just say it outright?

"Why aren’t you covering this up? Why are you telling me everything?"

The patient asked, somewhat amused and frustrated.

"I can’t exactly tell the elderly lady everything when she is my only relative, can I?" Liu Banxia said.

"Your filial piety is commendable. I believe you can endure this, especially since you have to care for the elderly lady and give her a proper send-off."

The patient nodded, "Actually, I know that I was adopted, so I hesitated when you asked about family medical history."

"I called the elderly lady in hopes of a possibility. If she knows about our family situation, it’s unpredictable. Once you spoke, I understood."

"Sometimes, there are things that should not be hidden. Is there a difference between birth and nurture? They raised and called her ’mom’ all our lives; she’s our mom," Liu Banxia said.

"Are you suggesting I should tell my elderly mom about this?" the patient asked.

"Sure enough, the elderly lady is your priority, even over your own illness," Liu Banxia looked at him.

"My thought is to talk about it. You two are mother and son; what harm in speaking about it? Otherwise, the elderly lady will keep this on her heart. Talk about it; I support you. Tell her after the test."

"Alright, I’ll follow your advice. Regardless, as long as it’s not an immediate life-threatening illness, I feel fulfilled in this life. I’ll take my elderly mom out for fun, work to enjoy life," the patient nodded firmly, finally smiling.

Xu Yino was still puzzled. She had no idea what the current situation was.

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