CHAPTER 152: 152 CONSULTATIONS

Grandpa Cao was given special attention as a patient, and the results of his examination were out.

DING! Daily task completed (5/20)

Strange smell task completed

Experience gained: 100 points, proficiency in diagnostics: 200 points

Atherosclerosis was present in the lower extremities. There was an occlusion of the iliac and external iliac arteries on the right side with collateral circulation. The popliteal artery showed slight narrowing, leading to insufficient blood supply to the right lower limb. Additionally, there was a segmental occlusion of the right iliac artery with formation of peripheral collateral vessels. The thrombus was about 10 centimeters long.

There were three ulcerations on the right sole. A probe examination revealed the deepest sinus tract to be 0.7 cm and the shallowest one 0.5 cm. The bone was undamaged.

This meant that after débridement, if recovery went well, there was a good chance the foot could be saved.

The reason there was a good chance was because the foot is a major target organ for diabetics. Diabetic foot is one of the chronic complications that can lead to disability and death in diabetic patients, and it has a high recurrence rate.

Currently, Grandpa Cao’s three ulcers already contained pus, indicating a grade 3 ulcer depth, which could threaten the limb. If it progressed to grade 4 localized gangrene or grade 5 full-foot gangrene, the prognosis would be even worse.

Actually, in clinical settings, if a patient presents with symptoms such as cellulitis over an area larger than 2 cm, significant swelling, abscess formation, lymphangitis, or gangrene, these are considered signs of a limb-threatening infection.

Considering Grandpa Cao’s current condition, it wasn’t as simple as just a foot débridement surgery. Although the disease primarily manifested in his right foot, systemic treatment was necessary.

First, they had to improve Grandpa Cao’s overall health indicators and control his blood sugar, because high blood sugar could impede wound healing and lead to infections.

After preoperative preparations, a right-sided femoral artery incision for thrombectomy and an endarterectomy would be needed to address the thrombus. Then, a sharp débridement of Grandpa Cao’s sole would be performed, carefully avoiding active tissues.

This was the final plan decided upon after a joint consultation involving the endocrinology department, the orthopedics department, and Liu Banxia.

"Liu, you take care of the débridement of the sole. It shouldn’t be any more difficult than performing the débridement on the burns of that firefighter," Xu Peichen said with a smile.

Liu Banxia nodded, "Director Xu, I won’t hold back then. He’s someone I know. If I don’t do my part, it wouldn’t feel right."

"Alright, then let’s leave it at that for now. Later, I’ll administer the medication, and you all perform the tests on your end. If his body meets the criteria, you can proceed with the surgery," Ding Yuanhang said.

"Although the thrombus hasn’t caused a complete occlusion yet, it’s still quite dangerous. We’ll use thrombolytic drugs to manage it temporarily. The sooner the surgery can be performed, the better. I’ll head back first. If there’s any change in the patient’s condition, call me directly."

"Director Ding, I really can’t thank you enough," Liu Banxia said gratefully.

This was a significant favor. The "call" Ding Yuanhang referred to wasn’t to the endocrinology department’s general line, but to his personal mobile phone. This represented a form of acknowledgment—an acknowledgment of Liu Banxia’s abilities.

"Dr. Liu, I really can’t thank you enough," the eldest son of the Cao family said, grasping Liu Banxia’s hand after the two directors had left.

"Please, don’t be so formal. Grandpa Cao trusted my medical skills and came here; I’ll do my best to solve the problem," Liu Banxia replied.

"Even though the current examination results are quite optimistic, there are some things I need to clarify with you in advance. Any surgery carries inherent risks, especially considering Grandpa Cao’s diabetes, which significantly affects his prognosis."

"Two surgeries are required. One is to deal with the thrombus, for which I’ll ask a highly skilled general surgeon to assist. I’ll personally take charge of the débridement of his sole. I’ll do my utmost to remove all the necrotic tissue and preserve as much viable tissue as possible."

Liu Banxia spoke very sincerely, but hearing his words, the Cao brothers hesitated.

The primary reason was Liu Banxia’s youth. While he had astutely discovered Grandpa Cao’s diabetic foot through careful observation, his young age made them question his reliability when it came to performing surgery.

"You can rest assured, Dr. Liu is highly skilled at débridement," Liang Xiaolin interjected, seeing the brothers’ expressions, a hint of annoyance in her voice.

"A patient with necrotizing fasciitis whose fingers were affected, and a firefighter with severely burned hands—Dr. Liu performed débridement for both. Both patients are recovering very well. In fact, that firefighter is currently in the city hospital’s Burn Department."

Hearing Liang Xiaolin’s direct retort, the two brothers looked somewhat embarrassed.

"It’s understandable. I am quite young, and that can be misleading. However, débridement has been the main focus of my work for the past three years," Liu Banxia said with a reassuring smile.

"You should go to the ward now and spend some time talking with your father. His mood is very important for his condition. I’m making an exception for you today regarding visiting hours; just try not to be too noisy later tonight."

"Dr. Liu, thank you so much. Please don’t take our earlier hesitation to heart," said the eldest son of the Cao family.

Liu Banxia patted his arm and said nothing more.

"You’re just too good-natured. If it were me, I wouldn’t have bothered trying to convince them," Liang Xiaolin grumbled, still sulking.

"If they spent more time with their father, perhaps they wouldn’t have hesitated so much," Liu Banxia mused, then sighed. "Ah... I’m genuinely worried it might already be quite advanced. We have to get his blood sugar under control before we can even consider surgery."

"Hey now, keep your voice down, Xiaolin. Don’t be angry," Liu Banxia said, trying to placate her. "Go home and get a good night’s sleep. We should be able to operate by tomorrow, hopefully."

"Dr. Liu, are you two related? Is Doctor Liang your grandmother?" Qing Kewa, who had been watching the exchange, asked curiously.

"Haha, I certainly wouldn’t want such a grown-up... grandson!" Liang Xiaolin said, giggling, then playfully cleared her throat with an "Ahem!"

"You’re being cheeky. You need to be more professional in your attitude towards patients and their families. I’m putting you in charge of handling the surgical consent form, alright?" Liu Banxia said.

Liang Xiaolin wrinkled her nose. Would saying ’no’ even make a difference? This guy can be so stubborn; once he’s decided on something, there’s no changing his mind.

"I’m hungry," Qing Kewa announced at that moment.

Liu Banxia pulled out his phone to check the time. Good heavens, it was already almost seven o’clock! All the discussion back and forth had made him completely lose track of time.

"Alright, let’s go! We’ll head to the cafeteria. My treat—I’ll get you both a nice stir-fry," Liu Banxia announced with a magnanimous wave of his hand.

Since he was being so generous, Liang Xiaolin certainly wasn’t going to stand on ceremony. As for Qing Kewa? She was happy to tag along. Besides, she had already decided to diligently practice using chopsticks starting with dinner tonight.

Dr. Liu said that becoming proficient with chopsticks would make her fingers more nimble. He had to be right; Dr. Liu was amazing!

Watching the two girls huddled together, animatedly discussing what to order, Liu Banxia felt a sense of fond exasperation. They only met yesterday! How did they get so chummy so quickly?