Chapter 752: Solving the mystery
This round of ward rounds looks no different from the previous ones.
It's nothing more than asking about nails.
What can this suggest?
Xu Qiu gave the final conclusion: "This is not the proxy Munchausen syndrome."
"It's not!"
"All the symptoms are consistent, I didn't expect it to be not!"
When Xu Qiu's guess came out, although everyone doubted it in their hearts, they obviously believed in each other's judgment more.
"Nails..." Wang Ping in the crowd touched his chin, thinking about Xu Qiu's previous behavior and the nails he mentioned.
He suddenly thought of the patient's blood routine. At that time, Xiang Kai had an abnormality of low hemoglobin, but it didn't attract much attention. Now it's linked together... Is it a nutritional disorder?
Wang Ping immediately expressed his thoughts.
Xu Qiu nodded, then shook his head... Yes, but not completely.
"It can be understood as a nutritional disorder, but the essence should be a disorder of vascular motor nerve function."
Xu Qiu's explanation made everyone a little confused.
He didn't say much, and when the results came out, they would naturally understand.
"Do a sympathetic nerve block experiment." Xu Qiu ordered.
…
More than ten minutes later, Lv Ruping rushed to the ward and saw Xiang Kai who was about to be taken for examination.
“Didn’t Doctor Xu say it’s not agency syndrome?” She was happy and sad.
She was happy that her son did not lie, he was really sick, and with Xu Qiu’s attention, the disease would definitely not be delayed.
She was also sad about this.
She would rather be too controlling and have agency syndrome than see Xiang Kai suffer.
The two contradictory emotions intertwined, making her heart suffer.
Shi Lian comforted: “Don’t worry, Doctor Xu already has an idea. If there is no problem, it will be diagnosed in the next two days.”
Lv Ruping didn’t know what expression to make, but just nodded and repeated: “Thank you, Doctor Xu, thank you, thank you!”
She watched Xiang Kai enter the examination room, and when she could no longer see him, Lv Ruping retracted her gaze. At this moment, she finally realized that two lines of tears had flowed down her face.
…
Sympathetic nerve block is usually used clinically to diagnose and treat sympathetic nerve-mediated neuropathic pain.
The so-called block is actually the application of anesthetic drugs, injected around the sympathetic nerves, thereby changing related functions.
Therapeutic block is repeated local anesthesia injection, gradually reducing the spontaneous discharge of active neurons, blocking the sympathetic ganglia in the pain area, reducing the activity of sympathetic nerves, and ultimately achieving the effect of reducing pain.
What Xiang Kai wants to do is to conduct an inspection experiment.
The process is not difficult. After the block is successful, skin temperature monitoring, pulse oximeter volume volumography, etc. are used to observe the clinical signs after the sympathetic nerve is blocked.
However, traditional inspection methods have significant shortcomings.
For example, skin temperature monitoring has many confounding variables, such as ambient temperature, autologous vascular diseases, and the use of vasoactive drugs, which may cause the skin temperature results before and after the block to be inconsistent with the actual results.
Fortunately, Lin Yi has money and uses a more advanced skin conductance detector.
The principle is simple: the sympathetic nerve activity of normal skin stimulates muscarinic receptors, which then stimulate sweat glands to secrete sweat filled with sodium and other electrolytes. The electrolytes in these sweats increase conductivity and reduce skin resistance...
The skin conductance detector detects these indicators through a non-invasive motor attached to the skin, which is almost unaffected by the external environment and has extremely high accuracy.
Soon, the experimental results came out.
The doctor in the laboratory looked up and saw that the patient complained of pain relief, and the tested area changed from sweating, dampness, and coolness to a comfortable warm feeling, and sweating decreased...
The skin conductance detector also accurately displayed the relevant data, confirming this result.
"Dr. Xu's guess was correct, it was a positive diagnostic sympathetic block!"
...
When the test results came out, many people were dumbfounded.
Xu Qiu also had some feelings.
Everyone was misled...
Before, they all assumed that the patient was "extremely sensitive". In fact, Xiang Kai did not have severe pain because of his sensitive nerves, but only showed an abnormal reaction to pain!
There is an essential difference between the two.
The former is highly sensitive to factors such as temperature, touch, sound, light, electricity, and water.
But Xiang Kai is just more prone to pain.
He is just sensitive to pain.
"So... what is the disease?" Many doctors in the clinical medical group asked questions.
This time Xu Qiu did not keep it a secret, he listed Xiang Kai's condition.
1: Ankle sprain two months ago.
2: Severe pain of unknown origin.
3: Vascular motor dysfunction and nutritional changes in the limbs.
And the fourth point, the diagnostic sympathetic nerve block test is positive...
Just after the analysis, Director Zhu of the neurosurgery department blurted out: "Complex Regional Pain Syndrome!"
Xu Qiu gave a look of approval, which was the final diagnosis.
...
Complex Regional Pain Syndrome.
Although it is also a rare disease, it is much more common than the proxy syndrome.
However, because the latter has a too fierce reputation, the popularity and attention of complex regional pain syndrome are not as good as the proxy syndrome.
This is a pathological pain secondary to local injury. It usually persists beyond the normal healing process of the wound. After a long period of incurable disease, it gradually develops into a significant motor function decline and shows a trend of progressive development.
It has many clinical manifestations, but the main one is pain, including spontaneous pain and induced pain, and the most critical one is the induced pain.
Induced pain just includes hyperalgesia!
And this is exactly the manifestation that was misdiagnosed as "extreme nerve sensitivity" by thirteen hospitals.
He is not too sensitive, but has an abnormal reaction to pain!
…
"It turned out to be like this!"
"I can only say that Dr. Xu is awesome!"
"This mother is also amazing. If it weren't for her persistence and her unconditional belief in her child, she would not have insisted on coming to Dr. Xu for diagnosis. Maybe it would really be misdiagnosed!"
"Yes, if it continues to drag on, the patient may face more severe muscle atrophy and even loss of motor function!"
The patient is an eleven-year-old child, who is in the golden period of bone development and motor ability improvement. If this period is missed, no one can save the situation.
Abnormal vascular motor function of the injured leg will also cause the growth of the leg on that side to lag behind the other side. Every day of delay will make his foot slope worse. By the time everyone realizes that it is not the proxy syndrome, it may have lost the meaning of treatment.
"Get ready for treatment." After the diagnosis, Xu Qiu felt much more relaxed.
The treatment plan is clearer.
In Xiang Kai's case, the most suitable one is TENS therapy.
——
Remember to vote for love power!
