(Thank you to mochaX2 for the reward, as well as encouragement from Shadow Hands, Bus Brother, mochaX2, Sleepyhead, and Night Cat for their monthly tickets)
"Liu Lu, are you sure you haven't noticed anything unusual lately?" Liu Banxia asked.
Liu Lu shook her head in confusion.
"What about your diet?" Liu Banxia asked again.
Liu Lu still shook her head.
"Old Liu, what does it say on this?" Wang Xiaoyan asked, likely referring to a report.
"Based on the current examination, the levels of blood urea nitrogen and sodium ions are somewhat high, while the potassium ion level is a bit low," Liu Banxia replied.
"There are three main reasons for elevated blood urea nitrogen. First, organic kidney dysfunction, which means problems with the kidneys themselves. Second, pre-renal issues, such as dehydration, ascites, heart failure, or hepatorenal syndrome, among others."
"A third reason is excessive protein breakdown or intake. This can occur with certain acute infectious diseases, high fever, upper gastrointestinal bleeding, hyperthyroidism, or a high-protein diet."
"Considering your current physical condition, I suspect the cause might be a combination of mitral valve prolapse, upper gastrointestinal bleeding, and issues related to a high-protein diet."
"So, we'll also need to do a stool test shortly to check for occult blood. We need to take this matter very seriously at this point."
"Dr. Liu, I usually eat quite well, and I also have a large appetite," Liu Lu said.
"That could be one factor, because not only is your blood urea nitrogen level high, but your sodium ion level is also elevated," Liu Banxia said.
"This might be because you prefer strongly flavored food and consume a lot of salt. It could also be due to long-term use of corticosteroid medications. These steroids have a sodium-retaining, potassium-excreting effect, which aligns with your low potassium levels."
"Another possibility is hypertonic dehydration, which causes excessive water loss from the body, preventing the complete metabolism of sodium."
"Consider these three points and see if you can provide any relevant information, as these factors might also be contributing to your mitral valve prolapse."
"I don't eat salty food, and I haven't taken any other medications. Could it be hypertonic dehydration? I do frequently drink beer and other beverages," Liu Lu responded.
Liu Banxia nodded. "That could also be a reason, and it's plausible. If you frequently drink alcohol or other beverages instead of water over a long period, this is quite possible. However, your blood sugar isn't high."
"Now, let's talk about your low potassium levels. We've already ruled out drug-related causes. Generally, there are two possibilities: either insufficient intake or excessive excretion."
"Regarding intake, as long as one eats normally, there shouldn't be an issue. The potassium in food is sufficient for the body's needs. If your diet isn't the problem, then we must consider excessive excretion or issues with potassium ion transfer."
"Excretion can occur through the digestive system, such as with severe diarrhea or vomiting, though this is more common in children. Another route is through the kidneys, due to factors like long-term use of diuretics or certain kidney diseases."
"Another route of excretion is through the skin. This typically occurs during excessive exercise or in high temperatures, leading to significant sweating."
"Your situation might be related to this. Considering you practice yoga in the morning, exercise in the afternoon, and possibly take a sauna at night, sweating excessively, combined with potentially inadequate water intake, could also contribute to your first two symptoms."
"Other possibilities include alkalosis, barium poisoning, or excessive insulin, but I believe the chances of these affecting you are very slim."
"Given your current condition, I recommend a routine urinalysis, a kidney ultrasound, and a stool test. These should give us a clearer picture."
"Dr. Liu, what about my heart?" Liu Lu asked.
"We can address the heart later. As I said, we first need to determine the cause of your mitral valve prolapse before we can formulate an appropriate treatment plan," Liu Banxia responded.
"If it's not primary, and we can eliminate the underlying cause, and your prolapse isn't severe, we might not need to intervene at all."
"By the way, I've said a lot just now and explained the possible causes for these three lab values. Can you recall anything else that might give me a clue?"
Liu Lu shook her head. "I do eat a lot of meat, drink alcohol, sugary drinks, and milk tea... um... I don't drink much water."
"Ah... diet is very important. While your diet might be a factor, we still need to perform these tests," Liu Banxia said with a smile.
"Don't be embarrassed. These are just possible causes. We must be alert to conditions like upper gastrointestinal bleeding and also organic kidney disease. We need to investigate these thoroughly."
"If ignored, it might end up like in those TV dramas where someone suddenly coughs up a lot of blood. And I don't need to elaborate on kidney disease; if there's a problem, it's a major problem."
"I'm not trying to scare you; I'm being responsible for your health. Besides, these three tests are easy to do. Xu Yino, write up the orders directly. You can consider it giving me some business."
Hearing him say this, Liu Lu, who was initially hesitant, felt she couldn't really object and followed to pay the fees.
Liu Banxia rubbed his face, his expression becoming more serious.
"What's wrong? Is it a serious illness? Are her kidneys failing?" Wang Xiaoyan started to worry again.
She had understood his earlier explanation, which was quite basic. Now she suspected the problem might be kidney-related, stemming from her daily eating and drinking habits.
Liu Banxia, however, shook his head. "I just feel like she hasn't told me the whole truth. If she eats and drinks as much as she claims, how could she possibly stay so slim?"
"Even with a lot of exercise, it's unlikely she'd burn off all those calories. For her to be this thin, she'd either have to have a naturally fast metabolism or poor gastrointestinal absorption."
Wang Xiaoyan thought about it carefully. "That actually seems to be the case. She wasn't this thin when she first started learning from me. I just assumed it was the result of her intense exercise regimen."
"Exactly. That's why we need to investigate further. I won't be at ease until we figure it out, and it could be very dangerous for her," Liu Banxia said.
"I currently suspect an underlying disease is causing her symptoms, which we might have mistaken for side effects of excessive exercise."
"In any case, she needs a thorough examination. If we can't identify the underlying cause, her mitral valve prolapse will only worsen, and eventually, she'll likely need a mitral valve replacement."
"A replacement valve, however, is never as good as the original. And in her current situation, heart surgery should be avoided unless absolutely necessary."
Wang Xiaoyan nodded; it sounded plausible.
Anyway, Wang Xiaoyan now felt something was definitely abnormal. Combined with Liu Lu being quite thin, she was convinced there was an underlying illness.
"By the way, do you know what Qiaoqiao has been up to lately?" Liu Banxia asked.
Wang Xiaoyan rolled her eyes. "Bro, she's your wife! She's closer to you than to me. Why are you asking me?"
"Well, I've been working constantly lately. I only saw her briefly at lunchtime yesterday. We barely spoke; there was a pediatric patient in serious condition, and then she had to leave," Liu Banxia said helplessly.
"I was thinking if you had any inside information, I could prepare something in advance. You know, give her a surprise when I get some time off, make her happy."
"Oh my god, are you trying to rub it in our single faces?" Wang Xiaoyan grumbled.
"Not at all. Jiaojiao is working and has a boyfriend now," Liu Banxia said. "I just think you're closest to Qiaoqiao these days. After all, she was the first one to cook for *you*, and I was only the second."
"Alright, alright, I give up," Wang Xiaoyan said. "Once we're done here, I'll go over to her place tonight and try to find out."
"I only know she's probably busy preparing a whelping box for Tang Dou. By the way, how long is a dog's gestation period? I'll have to visit when the time comes."
"About two months," Liu Banxia said. "We'll let Tang Dou have just this one litter. Otherwise, with a bunch of huge Alaskan Malamutes, we wouldn't know how to walk them all."
"When you get here, don't rush off. I'll treat you to lunch in our cafeteria. You two can find a place to rest for a bit; I'll come get you when the test results are out."
"Alright, you go on with your work. I'm quite familiar with this place," Wang Xiaoyan nodded.
She knew Liu Banxia was busy, and appreciated his detailed explanation; it made her feel quite special. Next, she could spend time telling her friend just how amazing Qiaoqiao's husband was. That would help pass the time.
Returning to the side, Liu Banxia signed the necessary documents and continued to ponder the patient's case.
Based on his personal judgment, the patient definitely hadn't disclosed her full situation and was certainly hiding something. But he wasn't sure if what she was concealing was related to her medical condition. If it wasn't related to her condition, it would be wrong to pressure her into revealing it. However, if she didn't come clean, it could delay the diagnosis. His intuition was quite sharp now, and he'd pinpointed that odd feeling: the patient wasn't being entirely truthful; there was a degree of concealment. He could infer this from her demeanor and his previous experiences with patients. Normal patients are usually afraid of saying too little, but Liu Lu? Despite his detailed questioning, she had said very little. While consuming alcohol, meat, and sugary drinks could cause one or two of these symptoms, it wouldn't cause them all so thoroughly. That kind of intake would have to be far beyond a normal diet, like Qiu Mingyuan, who even developed kidney stones. One possibility he considered was illicit drugs. Certain drugs could indeed cause such manifestations.
DING! Task issued: Patient with strange mitral valve prolapse.
Open-ended task: The patient sought medical attention after fainting. Examination revealed a potential underlying illness, requiring the Host to conduct further diagnosis. Task reward will be issued based on the diagnostic results.
Looking at the popped-up task, Liu Banxia helplessly shook his head.