Chapter 466: A High-Stakes Diagnosis

“Well, if Director Tang says so, then I guess I’ve got nothing to worry about.”

With that, Zhou Can finally relaxed and took a seat.

Male and female colleagues meeting alone to discuss work is pretty normal in big corporations. Like when a subordinate reports to their boss, or—just like now—Zhou Can coming over for a consultation.

“Haha, as long as we’ve got nothing to hide, we’ve got nothing to fear! Anyway, let’s get to business. Here’s the child’s medical record. We’ve run nearly every test already. He’s been treated at other hospitals for a long time, but nothing’s really worked. I called in experts from our department, even some from Gastroenterology, but we still haven’t figured out the real cause.”

Dr. Tang Fei handed Zhou Can the child’s medical records to review.

In medicine, patients under 14 are typically considered children. This patient is a boy and he just turned 14. He first came in complaining of more than six months of leg swelling and abdominal bloating.

When he was admitted, he also reported nausea and vomiting.

“This kid’s parents sure have nerves of steel. His legs have been swollen for over half a year, and yet they never thought to take him to a hospital…”

After reading the case history, Zhou Can shook his head and sighed.

A lot of intractable diseases start out as minor issues that get dragged on and on. It’s like raising a tiger only to become its prey.

“Although, to be fair, I can’t really blame his parents entirely. The boy’s father is a government official. His mom’s a CEO at a major company. The family’s got wealth and power, and he’s their only son—they treat him like a treasure. I heard they hired several tutors for him, plus a personal nanny. The only thing lacking is that both parents are super busy, so they rarely spend time with him.”

No wonder Dr. Tang Fei is taking this case so seriously.

Every country on earth runs on relationships; it’s always been that way. Whether in ancient times under feudal rule or modern legal societies, personal connections have always been the unspoken rules that shape society.

Back in the day, let’s say an aristocrat’s kid or a government official’s family member messed up or even committed a crime—would the magistrate dare actually arrest them?

Even if public outrage forced the magistrate’s hand, they’d struggle to survive the pressure coming from all directions and probably have to let the person go in secret.

Chances are, the magistrate didn’t even know the guilty young lord or his family. So why risk violating the law to cut him loose?

Because that rich kid’s uncle is a prefect with much more power than the county magistrate.

That’s reason enough right there to set the boy free.

The uncle would get the message, quietly slip the magistrate some silver, and offer support in the future. Any official with sense would ‘happily’ accept.

Chasing favor and avoiding conflict has become a basic instinct for humans after thousands of years living in society.

It’s kind of like keeping out of trouble, but more intricate and developed.

This child’s parents have probably already connected with Director Tang Fei, maybe even the hospital director or other leaders. With pressure like that, Director Tang Fei has even more reason to be proactive in the child’s treatment.

If he gets better, that’s a huge win.

Even if they can’t cure him, she’ll still need to show extra effort.

Zhou Can nodded and continued examining the medical history.

After the kid started having nausea and vomiting, the nanny got nervous and let his parents know. That’s when they finally rushed him to the hospital.

Their first stop was the Provincial Children’s Hospital, and they booked an appointment with a specialist.

Just look at the difference—wealthy kids get treatment worthy of aristocrats.

In ancient times, if a prince or royal got sick, they’d send for an imperial physician and use the best doctors and medicine available.

Today, the children of the elite go straight to the top hospitals and see the best specialists in the province.

The specialist ordered all three major routine tests: blood, stool, urine, plus an abdominal ultrasound.

Blood work showed a WBC of 3.3×10^9 per liter.

Platelets were at 189×10^9 per liter; stool and urine tests were normal.

Ultrasound revealed an enlarged spleen.

The boy complained of fatigue. His abdomen was soft without tenderness or rebound pain; no enlarged liver was felt. The spleen was enlarged about 3 cm below the ribcage, soft in texture, and shifting dullness was noted.

He also had mild swelling in both legs, but it wasn’t severe.

During the exam, the doctor didn’t palpate the liver—maybe worried about scaring the kid or causing resistance, maybe something else.

Either way, you could tell from the tests—they were being extra by-the-book.

Very conservative, in fact.

That alone suggests the specialist at the Provincial Children’s Hospital felt some pressure dealing with this patient.

Maybe the child’s parents are tough to deal with?

After all, with the dad in government and the mom a company president, tons of wealth and power, and only one son, they’re bound to be anxious after hearing he’s sick.

It wouldn’t be surprising if their tone or attitude made the doctor uncomfortable.

In the end, the specialist only ordered the most basic tests and didn’t dare ask for any extra.

As for treatment, things got even more interesting: he ordered the boy to fast for two days.

No targeted medicine at all—just two days with no food. And then, like magic, the boy’s symptoms improved.

You’ve got to admit, that’s some specialist-level skill.

No drugs needed—just fasting for two days, and the kid got better.

But the good times didn’t last. Less than two weeks later, he relapsed. They went back to the same doctor, who now suspected a duodenal ulcer. The expert recommended another two days of fasting.

Seriously, this specialist is a miracle worker.

Sure enough, after two more days of fasting, the symptoms improved again.

Reading up to this point, Zhou Can felt his head ache. It had been a long time since he’d seen a case this bizarre. His gut told him this was a hell-level, rare disease.

No wonder Dr. Tang Fei called in so many experts with no results.

Even the Provincial Children’s Hospital expert tried the fasting trick twice and still couldn’t cure the boy. Every time the kid fasted, he’d improve—then relapse again.

Zhou Can started to wonder: could something be wrong with the boy’s diet?

Rich families tend to go all out on food—delicacies, seafood, meat, supplements galore.

Could the boy’s illness be a type of food accumulation disorder?

Reading on, by the fourth relapse, the family probably lost confidence in the first specialist and switched to another doctor—but still at the same hospital. Under pressure, the new expert started using medication.

The meds and treatment all followed the standard protocol for duodenal ulcers.

But after all that, there was no obvious improvement.

Now this was really getting interesting.

He gets better with just fasting and no meds. Now, with proper medication, nothing is working.

The new specialist probably cursed his luck—this was way too weird.

Why could the last expert get results with just fasting, but when I carefully prescribe the right medication, there’s no effect?

While cursing his fate, the new doctor ordered more tests.

Still, just the usual stuff.

This time, blood showed the WBC had gone up to 5.62×10^9 per liter. Lymphocytes about 51 percent, hemoglobin around 104g/L.

Given the ongoing mild leg edema…

And the fact that the illness hadn’t improved after treatment, kidney problems became a new suspicion.

Normally, at 14, a boy’s kidneys are at their best—no sex life, maybe not even their first wet dream yet.

The kidneys should be clean and perfectly healthy.

A 24-hour urine protein test came back normal. Remember, this was a 24-hour protein quantification.

That meant his kidney function was fine.

Since nausea and vomiting were still present, they ran another stool test.

This time, they found something new—intermittent positive occult blood in the stool.

What did that mean?

Occult blood means hidden blood in the stool. ‘Intermittent positive’ means that sometimes there was blood, sometimes not.

There are many reasons for this—mainly gastrointestinal bleeding.

And it was most likely intermittent bleeding.

The new doctor was thrilled at this lead. Finally, some progress.

With this, they ran a Sudan staining of his stool. The result? Negative.

Seeing the negative result, the specialist probably breathed a sigh of relief.

A positive Sudan stain can mean cancer.

For healthy people, Sudan stain results are negative.

If excess neutral fat is excreted, Sudan III staining becomes positive. This often signals liver decompensation, pancreatic pathology, acute diarrhea, or fatty dysentery.

This can happen with acute or chronic pancreatitis, pancreatic head cancer, malabsorption syndromes, small intestine absorption issues, or childhood diarrhea.

With the clue of positive occult blood, the doctor zeroed in on the digestive tract.

They ordered a full gastrointestinal contrast study.

Zhou Can could guess that the new expert felt determined—‘I’m going to crack this case and land a big win soon!’

The contrast test wasn’t in vain. It showed a thickening of the duodenal mucosa.

For someone so young, right in their prime, thickened duodenal mucosa suggested the illness had been going on for a long time.

It’s like developing calluses. If you only do hard labor for a day or two, there’s no way you’ll get thick calluses.

But if you do heavy work for a long time, they’ll gradually build up.

The more calluses, the longer you’ve been hard at it.

So rough, thickened duodenal mucosa usually points to chronic inflammation and long-term bad habits—poor diet, not enough exercise.

But honestly, Zhou Can didn’t think this was a huge problem.

If it were just thickened duodenal mucosa and nothing else, there’d be no need for treatment—just monitor and review regularly.

If possible, keep up with gentle exercise and stick to a light, easy-to-digest diet.

Congee, noodles, lotus root powder, milk, soy milk, oranges… as long as you stick to regular meals and a routine, there shouldn’t be any major issues.

And things should improve quickly.

Still, after all that work, having only this to show must have been incredibly frustrating for the specialist.

It’s like staring at a giant fish pond, convinced it’s full of fish because you see them jump.

You think, “I’ll catch thousands of pounds of fish here—at least a few hundred for sure.”

But when you finally drain the pond, after all that effort, all you get are a few buckets of minnows and shrimp.

That’s what happened here: aiming for a big ‘catch,’ only to come up with scraps. Anyone would be disappointed.

Sometimes, that’s just how medicine is. You’re so sure you’ve found the target, only to come up empty after all your effort.

Not getting answers left the specialist frustrated, unable to explain anything to the family.

So, he moved on to the next test.

What now?

A gastroscopy.

Intermittent occult blood in the stool meant there had to be a bleeding site somewhere.

Zhou Can once dealt with a similar case—a patient with gastrointestinal bleeding and no clear cause. After much persistence, Zhou Can finally discovered a rare parasitic infection.

He even co-authored a paper on it with Dr. Shi from Critical Care, published first in a leading national medical journal.

Eventually, it made it into an SCI-indexed journal.

Dr. Shi even earned a promotion to associate chief physician thanks to it.

Zhou Can benefited too. Given his credentials, he never dreamed his first paper would be such a success. It greatly improved his prospects.

Later, when he started consulting at Xinxiang Maternity and Child Hospital, that SCI paper helped him get selected as a reserve member of the Elite Doctor’s Hall.

Since its invention, the gastroscope has allowed doctors to precisely find countless upper digestive tract diseases.

CT, ultrasound, even MRI can sometimes miss lesions—gastroscopy can find them.

After performing a gastroscopy, the specialist actually made a breakthrough.

The boy had atrophic gastritis and duodenal mucosal edema.

It looked a bit like gyral brain swelling.

During the gastroscopy, they casually took a duodenal biopsy for pathology.

Honestly, at this stage, cancer was definitely on the radar.

So a pathology test was totally necessary.

Earlier treatment targeted duodenal ulcer directly, but with no effect.

Based on clinical experience, if there are obvious findings but targeted treatment fails, the result usually isn’t good.

The pathology came back: the boy had severe acute and chronic inflammation—along with villous atrophy.

That’s when a diagnosis popped into Zhou Can’s mind: celiac disease.

Celiac disease, also known as gluten-sensitive enteropathy or nontropical sprue, is pretty common in developed Western countries, but extremely rare in China.

What came to Zhou Can’s mind was: even the rich have their troubles—like so-called ‘diseases of affluence.’