Chapter 467: Unraveling the Mystery of the Illness

Getting this far counted as real progress, but the cause of the illness still remained undiagnosed.

Celiac disease was just a suspicion at this point.

Besides, this condition is strongly tied to genetic and immune deficiencies.

Studies have shown a close connection between gluten-induced enteropathy and eating wheat-based foods; gluten might be the trigger behind it. The illness tends to show up as a result of genetic factors, immune issues, and gluten in the diet interacting together.

Wealthy families pay particular attention to their diets—though what they think is healthy might not always be genuinely good for them.

This mainly refers to those with deep roots in wealth, not those who just recently got rich.

It’s said it takes three generations to really know how to dress and eat well.

In other words, only after wealth has lasted three generations do people truly understand what quality clothes are, what foods are actually good for their health, and how to savor the best flavors.

Even if this child does have celiac disease, you can’t confirm the diagnosis with just an endoscopy and duodenal mucosal biopsy.

The child reported bloating and lower-leg edema, which does match up with celiac disease symptoms.

Some patients suffering from this condition will get obvious bloating, nausea, vomiting, weight loss, tiredness, wasting, fatigue, and swelling.

Zhou Can was now deeply suspicious that the child really did have celiac disease. Although there was no diarrhea—only bloating—diagnostic criteria shouldn’t be dogmatic. You can’t just copy textbook knowledge word for word.

The same illness can look a bit different for each person.

That depends on individual immunity, constitution, tolerance, severity of illness, and where the disease is located.

With a strong constitution, someone might just feel nauseous and not even reach the point of vomiting.

But others might end up with the full set: nausea, vomiting, diarrhea—the works.

This child comes from a very well-off family and probably doesn’t want for anything. Judging by his weight and height, his constitution should be robust.

That’s exactly why, despite six or seven months of leg swelling, it was only now that nausea and vomiting showed up.

So sometimes being too healthy has its downsides too.

Minor ailments barely make a ripple for people like this, maybe not even entering their system. When major diseases strike, progress can be much slower as well.

If it were cancer, of course, the sooner it’s caught, the better.

But with robust health, symptoms might be mild and cancer cells grow slowly. By the time anyone notices, the most frightening prospect is that those cells may have already spread.

Still, all things considered, stronger health is always better.

In theory, the stronger your constitution, the lower the risk of serious illness or malignant cancers.

Even though Zhou Can already had a good idea of the cause, he held back and kept digging.

After discovering a second major clue, the specialist ran a full colonoscopy on the child.

You could sense how eager and invested the specialist was—he wanted answers, fast.

He was determined to nail down the cause of the illness.

The results from the full colonoscopy came back normal.

Reaching this point, the second specialist seemed a bit lost again. If the colonoscopy was normal but the child still had intermittent fecal occult blood, how could that be explained?

Since the patient had already done a full digestive tract scan, plus endoscopy and colonoscopy, any more intestinal exams seemed unnecessary.

It’s likely that the family put considerable pressure on the specialist too.

In the end, he prescribed medicine to treat the child for enteritis.

That left Zhou Can baffled. Who knows what the second specialist was thinking to prescribe an enteritis treatment here. Maybe it made sense because the duodenal biopsy showed severe acute and chronic inflammation.

And just because Zhou Can suspected celiac disease doesn’t mean other specialists would come to the same conclusion—or even follow the same diagnostic path.

After all, the most classic celiac disease symptom is chronic diarrhea.

And iron-deficiency anemia.

For severe cases, diarrhea can strike dozens of times a day.

If you’ve watched historical dramas, you’ll know there are two legendary pills in the martial world: the first is knockout powder, which makes you faint and at your enemy’s mercy. Black inns use it to rob or harm travelers.

The second is croton seeds—a medicine used to cause diarrhea, perfect for punishing rivals.

Martial artists are all about settling scores swiftly.

If you’re outmatched in power or rank and someone crosses you, grinding croton into a powder and sneaking it into their food is a time-honored way to get even.

People rarely resort to outright murder or poisoning.

Even back then, the law held fearsome sway over the public.

Causing your opponent to collapse from diarrhea wouldn’t normally attract the authorities. Hardly anyone reported it, so the risk was low.

For celiac patients, though, things are a lot worse than a dose of croton.

With croton, a person just suffers a day or two and then recovers.

But without treatment, a celiac patient lives with constant, worsening diarrhea—possibly spending eight or nine hours a day in the bathroom.

This child’s case was particularly tricky. The specialists were careful and deliberate, and their thinking was quite different from Zhou Can’s.

Treating him as if he had enteritis had predictable results.

When days of treatment didn’t work, the child’s family began to doubt the standards at the Provincial Children’s Hospital and brought him to the Pediatrics Department at Tuyu Hospital.

Chances are, if Tuyu can’t find the cause or show real improvement, they’ll head for a major hospital in the Imperial Capital or Magic City.

The big hospitals in those cities have more advanced medical equipment.

And it’s not just about a single cutting-edge scanner or surgical tool—their advantage is across the board.

They’re packed with stronger teams of experts. Sometimes different departments will work together, seamlessly coordinating. Many previously untreatable or undiagnosable conditions finally get solved exactly because these hospitals have so many top-tier specialists.

In the field of medicine, specialists in the capital have even more focused areas of expertise.

Just in gastroenterology, you might find nearly twenty subfields, with different experts for each.

Take digestive enzymes, for example. That’s a tiny subfield in gastroenterology, easy to overlook.

Yet top hospitals in the capital have doctors who focus entirely on digestive enzymes.

By comparison, Tuyu Hospital is already a leading provincial hospital. Whether it’s the Department of Gastroenterology or Surgery, they rarely split up stomach and intestines. Their top doctors tend to be experts in both these subfields.

Just within the intestines, you have subdivisions: small intestine, appendix, cecum, ascending colon, transverse colon, descending colon, sigmoid colon, rectum, pylorus, duodenum, and so on.

It’s the old saying—a jack of all trades is master of none. Tuyu’s experts spread their focus across numerous areas of the stomach and intestines. But the capital’s top specialists might spend their entire careers on a single organ—say, the cecum—digging deeply into everything related to it.

As you might guess, there’s a real gap between Tuyu’s experts and those in the capital.

“After the child was transferred to our hospital, did you mainly check on his protein levels?”

After reviewing all the information, Zhou Can was even more certain the child likely had celiac disease.

This kind of diagnostic ability could almost be called a talent.

That’s not to say other specialists aren’t as skilled overall—they just might not have Zhou Can’s sensitivity or ability to synthesize findings for cases like this.

Even Zhou Can has misdiagnosed cases before.

Whether or not this child really has celiac disease is still up in the air.

“We checked for protein loss isotopes and found abnormally high yet diffuse blood flow in the abdomen, but saw no clear signs of protein loss. Blood plasma electrophoresis revealed M protein. Blood immunoelectrophoresis showed an increase in LGcK monoclonal protein, with LGM and lambda reduced…”

LGM is one type of immunoglobulin.

After discussing the case, Tuyu’s experts found the child had low plasma protein levels, and it was chronic.

He was also fairly thin for his age, with an enlarged spleen, leg edema, and occasional abdominal bloating.

So they shifted their focus to the severe hypoalbuminemia and increase in blood monoclonal immunoglobulins.

Their consultation notes all circled around explaining the cause of the decreased serum albumin.

Everyone had different views and came up with many theories and analyses.

First theory was malabsorption of serum albumin. The child had occasional bloating and vomiting after meals, plus weight loss. Combined with a decreased D-xylose test—even though no fecal fat was found—they still considered malabsorption syndrome in the small intestine likely.

Second theory was inadequate intake, which nearly everyone ruled out. Both the child and his family, as well as the housekeeper, confirmed he ate enough. With nutrition, there were no concerns at all.

In families like this, if you want it, you eat it.

The third theory involved impaired synthesis. But liver function looked normal, major liver virus markers were negative, so synthesis disorder was basically ruled out.

Fourth theory: protein loss from the body. The main ways to lose albumin are via the kidneys or gastrointestinal tract. They’d checked his urine long ago and found nothing, so kidney loss was eliminated.

Loss via the digestive tract could also be excluded, since protein loss isotope scans showed no obvious problem.

By this point in the discussion, the experts could pretty much lock in the small intestine as the problem.

Especially the duodenum.

After making a long detour, Tuyu’s experts found themselves right where the Provincial Children’s Hospital specialists had ended up.

The experts at the Provincial Hospital had already tried treating for duodenal ulcers and enteritis, with zero effect.

If Tuyu’s experts tried those same treatments, even if the family didn’t call them out to their faces, they’d definitely criticize them behind their backs.

“The root of the problem is probably in the small intestine!”

Zhou Can always spoke cautiously. Instead of naming a specific disease, he started with what he could confirm.

“Everyone in our discussion also agreed that the child’s small intestine is likely the issue.”

Dr. Tang Fei narrowed her phoenix eyes slightly, just watching Zhou Can.

Knowing him as she did, she suspected there was more to come from Zhou Can.

“Are the child’s family really hard to deal with?”

That was the next thing out of Zhou Can’s mouth.

She couldn’t help but laugh, pressing a hand to her forehead. “One family member is a government official with a high rank. The other is a CEO worth over ten billion yuan. It’s safe to say they’re strong-willed. But after talking with both parents, I’d say they’re pretty reasonable overall!”

Having a net worth of over a billion and over ten billion are worlds apart.

Once you’ve reached ten billion, you’re mid-level in the business elite. A hundred billion makes you top-tier in the country.

Maybe she thought her evaluation was still too vague and worried Zhou Can might hesitate during diagnosis.

“Their child was always cared for by a nanny. When the leg swelling lasted more than half a year, it wasn’t until he ate lots of meatballs and threw up that the nanny finally called the parents about the child’s condition. Even then, they didn’t blame her for not noticing the swelling sooner. The child stayed nearly two months at the Provincial Children’s Hospital and they always cooperated with doctors. When results lagged, they just transferred hospitals, never once blaming the doctors.”

“They never said anything bad about the Provincial Hospital’s specialists when talking with me. They admitted their child might have a rare condition and asked us to do our best, but said if we couldn’t solve it, they’d just seek treatment in the capital. After transferring to us, they agreed to all tests and cooperated fully.”

Dr. Tang Fei had only good things to say about the family.

Zhou Can’s worries faded a lot.

“Director Tang, since it’s just us, I’ll be blunt. I strongly suspect the child has celiac disease. Even though the symptoms aren’t textbook, taking everything into account, it’s still highly likely.”

When she heard his answer, Dr. Tang Fei froze for a moment, her eyes showing a flicker of disappointment.

She’d had high hopes for Zhou Can, thinking bringing him in might uncover the child’s true diagnosis.

His conclusion of celiac disease had genuinely caught her off-guard.

“I’ve discussed that possibility with the other experts. But some of the symptoms don’t quite fit. All we really have is duodenal inflammation and severe hypoalbuminemia to go on.”

During their earlier discussions, they’d already dismissed celiac disease.

No need to doubt these specialists’ skills—especially not after a group consultation like this. It’s rare for them to slip up.

“True, the child doesn’t have the classic symptom of diarrhea. But I reviewed his records—the first time he had nausea and vomiting was after a huge serving of meatballs. That’s a lot of meat in one go, which triggered vomiting. Usually, he eats a balanced diet, mixing meat with wheat products. Celiac is mainly triggered by eating wheat on top of a pre-existing immune deficiency.”

Zhou Can shared the reasoning behind his diagnosis.

“If he used to eat wheat products before, why didn’t he ever get sick?”

Dr. Tang Fei cut straight to the point with her question.

“Just because he didn’t get sick before doesn’t mean he was healthy. This is a chronic disease, and his strong constitution delayed the onset. There’s one other way to confirm the diagnosis.”

Zhou Can’s eyes were clear and full of conviction.

When it came to diagnostics, he had a talent that left others in the dust.

He’d shown it even as an intern.

As for his surgical skills, that was more thanks to the experience system in his medical training. Of course, he wasn’t lacking in raw talent either.

“What’s the method?”

Dr. Tang Fei pressed for specifics.

“The child should undergo more blood tests and imaging. Let’s check for anti-gluten antibodies, anti-endomysium antibodies, and anti-reticulin antibodies.”

Zhou Can rattled off all three antibody tests in one breath.

It’s the fastest way to confirm the diagnosis.”