Back in 2002 as a doctor

Thinking of this, Deng Ming's hands tightened, and he held the thermos cup firmly in his palm.

I seem to have achieved the ultimate, and I rarely smoke or drink, except for the occasional second-hand smoke from the boss.

It seems that people still need to pay attention to their own bodies. Director Miao is about the same age as himself, and they all have degeneration of the white matter of the brain.

Deng Ming didn't look at the film carefully, and the MRI film is indeed nothing to look at. A professional doctor can diagnose it at a glance.

He looked at Director Miao with some pity, and told himself in his heart that he must start going to bed early and getting up early from today, and strive to be like his boss, and live to be 80 and still be able to go to the operating table.

But the boss is a different kind. His work, rest and living habits are like ascetic monks. Deng Ming feels that if he becomes the boss, life seems meaningless.

Mr. Huang and Zhou Congwen watched the film for 5 minutes before Zhou Congwen picked up the EEG and handed it to the boss.

The same is true for EEG, Director Miao's description did not omit anything.

Zhou Congwen sighed inwardly, then picked up the test sheet and looked through it with the boss.

Suddenly Zhou Congwen's eyes lit up, and the test sheet stopped at the serum ion test.

"Xiao Miao, the normal value of calcium ions here is 2.15-2.55mmol/L?" Huang Lao suddenly asked.

"En." Director Miao nodded in a daze.

"The upper limit of normal value." Huang Lao said softly.

"The two-point endpoint method and the reports from the testing instrument Roche C2 are basically the same." Zhou Congwen said, "Boss, do you think it is used for B-ultrasound."

"Keep watching."

Huang Lao and Zhou Congwen talked in an inexplicable and weird way, talking nonsensically, not to mention Director Miao, even Deng Ming was a little confused.

2-point endpoint method, detection instrument Roche C501, is this wool?

Although it can be heard from the context before and after that it is the inspection method of the laboratory department, but no clinician will care about these.

Knowing the normal value of the test and what it means is already very good, how can you even know the details of the laboratory.

Besides, it doesn't make sense either.

Although that is what he said, both Zhou Congwen and Huang Lao knew the meaning of this passage.

Deng Ming squinted at Director Miao, recalling what Zhou Congwen said just now in his mind.

"Director Miao, have you been taking calcium supplements?" Deng Ming and Director Miao asked chattingly.

"Yeah." Director Miao nodded, "I was deficient in calcium during the unit's physical examination last year, so I have been taking calcium tablets orally for the past two years, and I also occasionally take calcium gluconate and take vitamin D2 regularly."

"It's a lot of calcium." Deng Ming habitually wanted to chat with Director Miao, but he saw Director Miao's trembling hands out of the corner of his eye, and swallowed all the rest of the words.

"Oh." Director Miao sighed deeply.

"Do a B-ultrasound and take a blood sample." Mr. Huang said after reading all the test sheets.

"Ah?" Director Miao was taken aback, "Old Huang, what else do you need to check?"

"There seems to be a problem with blood calcium, and I'm not sure." Huang Lao said, "Look at the parathyroid glands."

Parathyroid?

This matter is relatively remote, and general clinical doctors will not pay attention to it.

Director Miao is the same.

As the name suggests, the parathyroid glands are located on the back of the left and right thyroid glands, or buried in the middle and lower parts.It is about the size of soybeans and secretes parathyroid hormone.

"Insufficient secretion of parathyroid glands will gradually decrease blood calcium, while blood phosphorus will gradually increase, leading to hypocalcemic convulsions and even death. Supplementing parathyroid glands and calcium salts can temporarily relieve symptoms.

When the parathyroid glands are hyperactive and the parathyroid glands secrete too much, bone calcium will enter the blood, and the reabsorption of calcium by the kidneys will be strengthened. At the same time, vitamin D3 will be activated to become active D3, which will promote the absorption of calcium by the small intestine and cause hypercalcemia. High, and inhibit renal reabsorption of phosphate.

Promote the excretion of phosphorus in the urine, so that the blood phosphorus is too low, resulting in abnormal deposition of calcium salts in some tissues, pathological calcification of the tissues, and possible formation of kidney stones. "

Huang Lao explained simply.

"What's more, there are symptoms such as hand tremors."

"!!!"

Both Deng Ming and Director Miao were stunned for a moment, and a flame of hope rose in Director Miao's heart.

Not Parkinson?

But when he changed his mind, he smiled wryly.

Huang Lao just said very clearly, but he is not sure.It is estimated that I saw a test result of the upper limit of normal value, in order to check it.

The MRI film clearly shows that I have Parkinson's.

Director Miao lowered his head, feeling inexplicably sad.

Chapter 1509 Parathyroid glands

"Director Miao?" Zhou Congwen called softly.

"Ah?" Director Miao felt sad and immediately responded.

Although Zhou Congwen was young, Director Miao knew clearly that this person must be the Taishan Beidou-level existence in the future of cardiothoracic surgery, so he didn't dare to underestimate him at all, and looked at Zhou Congwen with eyes like those of his peers.

"The boss means to make an appointment for a B-ultrasound, and the boss will do it himself." Zhou Congwen said, "Then take a blood test and check the level of parathyroid hormone."

"Uh... good." Director Miao hesitated for a moment, but still nodded.

Even if he didn't agree with Huang Lao's statement, Director Miao still followed suit honestly.

"Xiao Miao, is there anything unusual about you recently?" Elder Huang asked.

"Uh..." Director Miao was a little puzzled.

"It's normal to ask about the medical history." Zhou Congwen explained.

"..." Director Miao was stunned for a moment, "Old Huang, I have had severe diarrhea recently. I checked the serum ions because I was worried about potassium deficiency, but the potassium ions are not bad."

"Oh, I see." Huang Lao suddenly smiled, "You go to contact, hurry up."

Seeing Director Miao staggering out of the office to contact and check, Deng Ming felt a little sad.

"Boss, I'm afraid Director Miao is really going to retire. You said he's only in his 50s, one year younger than me, so..." Deng Ming shook his head when he said this, and tightened his hands holding the thermos.

"Not necessarily." Zhou Congwen said with a slight smile.

"Huh?" Deng Ming was puzzled.

"Didn't the boss say that it might be a matter of the parathyroid glands?" Zhou Congwen said, "I need a B-ultrasound to check the situation. I hope there is a parathyroid adenoma. If that's the case, just have an operation."

"..." Deng Ming frowned at Zhou Congwen.

"Zhou Congwen, tell me what you think." Huang Lao sat on the chair in the director's office, closed his eyes and said slowly.

"Excessive synthesis and secretion of parathyroid hormone, which leads to calcium, phosphorus and bone metabolism disorders, is relatively rare, but not uncommon."

"That's right!" Zhou Congwen said, suddenly smiled, "I met a patient who broke his fibula while walking."

"..." Deng Ming was stunned for a moment, "Pathological fracture? Or something wrong with the parathyroid gland."

In fact, if it was normal, Deng Ming would definitely think it was caused by pathological fractures and tumor erosion.

But today the boss and Zhou Congwen are talking about parathyroid tumors, so Zhou Congwen probably wants to talk about a similar example.

Deng Ming looked at Zhou Congwen's face, feeling a little helpless.

Ordinarily, Zhou Congwen would never have such a wealth of clinical experience. There is a high probability that he made up the fact that he has ever met a patient.

But it is impossible for Deng Ming to accuse Zhou Congwen indiscriminately because of such a trivial matter.

Besides, my boss didn't speak, so I should hold back.

"At that time, we all thought it was a pathological fracture, which frightened the patient's family members. They were all transferred to the fibula, fearing that patients with advanced cancer would be hopeless." Zhou Congwen said with a smile, "but later the examination results found that it was parathyroid hormone. The fracture caused by abnormal secretion made everyone breathe a sigh of relief."

"And then?" Deng Ming asked.

"I did some research later." Zhou Congwen said, "Most patients have no symptoms and signs in the early stage, but when the disease develops to a certain extent, the clinical manifestations are diverse and lack specificity.

Osteoarthritis, urinary calculus, renal colic may occur, pathological fractures may occur in severe cases, gastrointestinal symptoms such as ulcer disease and pancreatitis may occur in a small number of patients, and nervous system symptoms may occur in individual patients. "

"Many patients with kidney stones also have parathyroid problems, and of course there are patients who are misdiagnosed as Parkinson's disease."

"..." Deng Ming concluded.

This is a disease of endocrinology or thyroid surgery, and Deng Ming doesn't know much about it.He looked at Zhou Congwen's confident expression, and turned his eyes to his boss suspiciously.

"In the diagnosis of Parkinson's disease, one thing is to rule out increased blood calcium. The possibility of Parkinson's disease is still very small at such a young age. Although blood calcium is only the upper limit of normal value, it needs to be checked."

As he spoke, Huang Lao's voice gradually dropped.

Deng Ming pricked up his ears, and vaguely heard the boss's murmur, "If only the problem of the parathyroid gland is fine, a minor operation can solve it. I hope... huh?"

This is also normal, Deng Ming thought to himself.Many family members of patients are like this, hoping that the patient's "terminal illness" is another disease that can be treated.

But the vast majority of cases will be disappointed.

There are so many rare diseases clinically.

"Old Huang, the B-ultrasound room has been contacted." Director Miao walked in with a cotton swab in his hand and pressed the blood vessels on his arm, and reported to Huang Laohui.

He had just finished taking blood, and the finger holding the cotton swab was still trembling.

In this state, let alone undergoing an operation, Zhou Congwen was afraid that Director Miao would not even be able to hold his job securely when he ate for a while.

Director Miao probably lost his job, whether it was the job in the hospital or the job at home.

Huang Lao stood up and walked out of Director Miao's office with his hands behind his back.Director Miao followed, his limbs were stiff, and his walk seemed to be even slower and slower than that of Mr. Huang.

Deng Ming saw Director Miao walking staggeringly, and felt a sense of the end of the hero in his heart.

I just wish I had this symptom a few years later.

He doesn't expect to be able to undergo surgery at an octogenarian age like his boss, and to study new surgical methods, but it is definitely best to hope that these geriatric diseases will last for a few years.

When he came to the B-ultrasound room, Mr. Huang sat down calmly and applied couplant on Director Miao's neck.

"Old Huang, what if it's not the case." Director Miao suddenly asked anxiously.

"No, that's a pity." Huang Lao said, "Now it seems that if it's not a parathyroid problem, it's Parkinson's. The research on Parkinson's disease in the world is not very deep, including the principle and treatment. very."

"..." Director Miao's hopes faded away.

"If not." The B-ultrasound probe in Mr. Huang's hand landed on Director Miao's neck, "You need to buy a crutch and wear a nameplate. If you get lost someday, I can send you home according to the address on the nameplate."

Director Miao almost cried when he heard what Huang Lao said.

Although I know all of this, Mr. Huang, don't say it so directly.

"Here." Mr. Huang held the B-ultrasound probe in his right hand and pressed it on Director Miao's neck. After less than 10 seconds, he suddenly paused, raised his left arm, and pointed at the screen with his left index finger, "Here."

"Old Huang, what did you see?!" Director Miao asked.

"Shut up, the probe has moved." Huang Lao said, "There is no need to prepare crutches and nameplates. You can find time for surgery."

Deng Ming was taken aback, and he followed his boss' finger to look over.

He is not a doctor in the imaging department and knows little about B-ultrasound, but abnormal hyperplasia can be vaguely seen on the B-ultrasound image.

It's a parathyroid problem!

Chapter 1510 Who is willing to be fooled by B-ultrasound

Huang Lao's voice was not loud, as gentle as ever.

But the gentle voice fell in Director Miao's ears, like thunder on the ground, roaring and continuous.

Director Miao was like a person about to drown grabbing a hand, and he didn't let go.

But before he could continue asking, Huang Lao's voice came again.

"Zhou Congwen, record."

"Okay boss, tell me." Zhou Congwen had already taken a pen and paper and waited for his boss.

"There is a parathyroid adenoma on the left side, the size is about 2×1cm, and it is recommended to be removed." Mr. Huang said while Zhou Congwen recorded.

What Huang Lao said was very simple, even a little sloppy.

Then Mr. Huang took the toilet paper and threw half of it on Director Miao's neck, "Wipe yourself."

"Boss, you sound like a scumbag." Zhou Congwen laughed.