Practicing Medical Skills in a Small Clinic novel Chapter 538

Chapter 538: Chapter 247: Lyme Disease, Making Plans

"No, no, after you talked to him, his attitude has improved a lot. Now when I go to the bathroom or do other things, he doesn’t follow me anymore. Also, he’s cooperating more in his daughter’s treatment."

Dr. Shao Bing expressed his admiration and gratitude to Li Jingsheng when mentioning this matter.

"Not long after you left, the patient’s mother actively approached me and agreed to do the CSF test. Then I contacted someone I knew at Qiaobang Hospital. Since it was after hours, I waited a long time before they sent someone to do the lumbar puncture and then sent it for testing overnight. The results just came out, and as you expected, there was a major discovery."

Li Jingsheng was relieved to hear that the family agreed to the CSF test.

It seems that this difficult case can be figured out before tomorrow.

"What are the results? Send them to me to see."

"Sure! I’ve already sent it over. Eosinophils are greater than 5%, Cryptococcus, acid-fast bacillus, CSF bacterial smear culture are all negative. The possibility of acute meningitis is very high."

Dr. Shao Bing said excitedly.

"Let me look at the test results first, let’s chat on WeChat."

"Okay, okay! Thank you so much today, I’ll remember it for a lifetime."

Shao Bing said, his voice somewhat choked up.

It seemed his emotions were a bit out of control.

He quickly hung up the phone.

In recent days, first, the clinic was violently vandalized by family members, then he was forced to take the child everywhere for treatment.

He went to Qiaobang Hospital where he had worked before, only to witness the coldness of human society.

There was no progress in the child’s diagnosis either.

He expended money and effort, but the family was ungrateful, threatening him in various ways, and monitoring him twenty-four hours a day. The grievances and heartaches within, no one can truly understand.

At Dr. Shao Bing’s most desperate moment, Li Jingsheng, a doctor he had never met before, took a taxi in the middle of the night to help consult and achieved significant breakthroughs and progress. He even helped change the family’s attitude before leaving.

In Shao Bing’s mind, Li Jingsheng had long been considered a benefactor.

At this moment, with new breakthroughs and discoveries in the test results, he couldn’t help but be overwhelmed with joy and excitement.

It’s unimaginable how much grief and fear he must have suffered these days to make a nearly sixty-year-old man choke with emotion.

The family was exceedingly unreasonable.

Li Jingsheng carefully examined the CSF test results.

The tests from major hospitals are really detailed. Some results might have been repeated more than once.

From the test results, it supports the diagnosis of acute meningitis.

He pondered: bacterial meningitis? That can be directly ruled out.

Because the bacterial smear is negative, and bacterial meningitis usually has an acute onset with rapid progression. Severe meningeal irritation and lesions often occur within twenty-four hours, leading directly to mental confusion.

In earlier times when medical science wasn’t advanced, people might go mad in a day, and were thought to be possessed.

It could only be said that life wasn’t valued then.

With these difficult diseases, if they couldn’t be identified, they typically worsened with treatment, ending in death.

Viral meningitis? Protein is slightly elevated, sugar and chloride are normal, CSF bacterium is negative, seeming to align with the disease. But eosinophils are high, along with migratory erythema, and the patient had a bite a month ago.

Li Jingsheng believes it cannot be this disease.

Tuberculous meningitis has many similarities with this disease, but the elevated eosinophils can rule it out.

And the CSF didn’t show any purulent changes.

This further rules out tuberculous meningitis.

The remaining cryptococcal meningitis, the test results do not support.

That leaves only the last one, neuroborreliosis.

This is a rare infectious disease, usually occurring after a tick bite, leading to Lyme disease.

This disease was once prevalent in some remote areas.

For example, the region where Ou Qinglan’s hometown is located saw an outbreak in the fifties and sixties. Medicine was quite backward then and couldn’t identify it.

Until close to the eighties, around 1975, a superpower abroad first discovered the disease.

Later, as the technology spread, people began to know this disease, which is highly similar to meningitis, called Lyme disease.

With today’s level of medical technology, diagnosing this disease is easy; both serum and CSF tests can confirm it.

"I believe it’s possible it is Lyme disease!"

Li Jingsheng sent a message.

"Ah..."

Shao Bing seemed very surprised; he should be trying hard to diagnose which type of meningitis it is.

He didn’t expect Li Jingsheng to have a diagnostic conclusion so quickly.

And it’s a rare infectious disease.

"Let me explain my diagnostic approach and basis: the patient has migratory erythema, was bitten by a mosquito-like creature a month ago, developing a red bump. Then nausea, vomiting, neck stiffness, facial paralysis, delirium, lymphadenopathy, mild fever—these symptoms all align with this disease. The slow onset also matches."

Li Jingsheng laid out his diagnostic basis.

Actually, it is already quite sufficient.

"It seems to really be the disease you diagnosed, but it can be treated with ceftriaxone. Why didn’t I see any effect when I used it?"

Shao Bing’s reaction was swift.

His solid medical foundation was evident.

Once he heard of this disease, he immediately thought of the corresponding medication plan.

"There are three possibilities: first, you are using counterfeit or expired drugs."

Li Jingsheng began analyzing the reasons for him.

If unfamiliar, one generally wouldn’t dare say this, fearing a backlash.

They all run clinics, so naturally understand that when sourcing drugs, unreliable pharmaceutical companies might provide counterfeit ones.

For instance, Litong Pharmaceutical he cooperated with before sold many small factory imitations of big brands.

Some were about to expire as well.

Litong Pharmaceutical, at least, counts as an official pharmaceutical company; selling counterfeit drugs boldly hasn’t happened over there.

Whether Dr. Shao Bing’s drugs are counterfeit is unclear.

"Second, short treatment duration. You just used it once and changed medication the next day. In theory, when treating this disease with ceftriaxone, the second day should show some effect. But you likely panicked at the time, not noticing the changes in the patient."

Li Jingsheng provided the second possibility in his analysis.

This could indeed be possible.

"Third, the patient has a unique physique that poorly absorbs this drug."

This situation exists but is rare.

Major hospitals encountering such patients would usually try changing medication or combining medications.

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