The Enhanced Doctor-Chapter 642: Did the patient not tell the truth?

Arriving downstairs, Wang Xiaoyan and two young women walked in after less than ten minutes.

"What's the situation? You all look fine," Liu Banxia said as he approached them.

"It's Liu Lu. She fainted suddenly during class today, but then she seemed fine. I'm a bit worried," Wang Xiaoyan said.

"Teacher Yanzi, I'm really okay. Could it be because I rushed this morning and forgot to eat breakfast?" Liu Lu asked.

"Oh dear, now that you're here, let Dr. Liu check you out. He's my good friend Qiaoqiao's husband—a very capable doctor," Wang Xiaoyan said.

"Why hype me up like that? You make me sound like some miracle doctor," Liu Banxia said with a laugh.

"But fainting suddenly definitely means something is wrong with your body, so a check-up is a good idea. Go register first, and then I'll see you. Xu Yino, come and help with the physical examination later."

Liu Lu nodded. Since I'm here anyway, and he's Teacher Yanzi's acquaintance, I might as well get examined, she thought.

"Yanzi, your classes start so early?" Liu Banxia asked.

"What else can I do? I'm not like you and Qiaoqiao, who are practically rolling in money. I have to work hard; I still have so much of my mortgage to repay," Wang Xiaoyan said.

"Ouch, that stings. Wait a couple of days until I have time off, and I'll come work for you again. It didn't work out last time, so we definitely have to make up for it," Liu Banxia said.

"Really? Don't tease me. I'll treat you to dinner then," Wang Xiaoyan said, delighted.

"No, I should treat you. Just come hang out with Qiaoqiao more often. She's even started targeting my interns lately," Liu Banxia said.

"Sigh... I'm just worried about making money. Otherwise, I wouldn't have added a morning class. I get tired too, you know," Wang Xiaoyan said.

"What are Liu Lu's specific symptoms? I'd like to understand her situation beforehand. She seems a bit thin; has she always been like this?" Liu Banxia asked.

"She's one of my students. She started before the New Year, but I don't think she's thin," Wang Xiaoyan said.

"Aren't all young women like that these days? I, on the other hand, feel a bit overweight. I got lazy over the New Year and didn't watch what I ate."

"You can't compare everyone to Qiaoqiao. I was actually planning to urge her to do yoga with me again. Didn't you tell her she looks good even if she's a bit chubby?"

"Er... she told you that too? Actually, I do think so. You all are too focused on being thin. It should be about what's healthy and proportionate for your body," Liu Banxia said, a bit sheepishly.

The other student standing nearby chuckled. She also knew Qiaoqiao and often went over to hang out. However, Qiaoqiao was never serious when doing yoga and had been labeled a "bad example" by Teacher Yanzi.

Just then, Liu Lu walked over. "Dr. Liu, I've registered."

"Come over to the examination bed. Have you felt anything else unusual recently?" Liu Banxia asked.

"Not really. I can eat and drink normally. Could it be low blood sugar or something?" Liu Lu asked.

"What about your three meals a day? Do you often replace dinner with fruit?" Liu Banxia continued.

"Oh, no, I eat and drink normally. As long as I get enough exercise, it's fine. I do yoga with Teacher Yanzi in the morning, go to the gym in the afternoon, and my evenings are pretty flexible," Liu Lu said with a smile.

Liu Banxia nodded. "Xu Yino, do a basic physical exam."

"Okay," Xu Yino replied and began the auscultation.

"Don't forget what you promised! You absolutely have to come over next time you have a day off," Wang Xiaoyan reminded him again.

"Absolutely, positively. Something unexpected came up last time, but it shouldn't happen again," Liu Banxia said with a smile.

"You earn so much money, you should enjoy life too! I don't have a choice right now; since I've taken on this work, I have to see it through."

"Every day when I open my eyes, all I see is that huge mortgage. Don't I have to pay it back?" Wang Xiaoyan said.

Liu Banxia shook his head helplessly. This girl is really something else, he thought. She's so driven. Don't assume she's struggling just because she's always complaining about her large mortgage payments; it's because she owns multiple properties.

She's a bona fide landlady, raking in a hefty sum from rent each month. Add to that the money from her yoga classes, and most people really can't compare.

At this moment, Xu Yino reported, "Teacher Liu, the basic physical exam didn't reveal any issues."

"See? I told you. It was probably just because I didn't have time for breakfast this morning... OOF..." Liu Lu said. As she started to get up, she suddenly swayed and sat back down on the examination bed. "My leg felt weak for a moment."

"How do you feel now?" Liu Banxia asked quickly.

"Um... I feel a bit flustered, kind of like when I'm extremely hungry. Am I just hungry? I usually eat a lot for breakfast," Liu Lu said.

"Xu Yino, listen to her heart sounds again," Liu Banxia instructed.

Xu Yino, who was already prepared nearby, quickly auscultated her heart again.

"Teacher Liu, this time I heard a faint click," Xu Yino reported after listening.

Liu Banxia frowned. "Let's do a muscle test as well. It seems like she has some mild muscle weakness."

Xu Yino quickly performed the test and then nodded at Liu Banxia.

"I was about to let you go, but it looks like that's not an option now," Liu Banxia said.

"Dr. Liu, do I have a heart condition?" Liu Lu asked, growing anxious.

"It's hard to say for sure right now. I'll order a complete blood count and a blood chemistry panel for you, and then we'll do an echocardiogram to see exactly what's going on," Liu Banxia said.

"There were some abnormalities in your heart sounds, and an echocardiogram will give us a clear diagnosis. You also seem to have some muscle weakness, which, although not severe, could be a symptom of an underlying condition."

"The main thing is, I also feel you're underweight. But don't worry, once these tests are done, we should have a much better idea of what's happening."

Hearing this, Liu Lu's expression became more worried.

"Don't worry. It might also be related to you skipping breakfast. In fact, that makes it a good time to do the blood chemistry panel and check your electrolyte levels," Liu Banxia said.

"Xu Yino, please write up the orders. Since she's Yanzi's referral, you can draw her blood personally. After the blood draw, she can have some warm milk and then go for the echocardiogram."

There's something not quite right about this patient, Liu Banxia thought. I can't quite put my finger on it. Maybe it's because I just diagnosed a patient with rapid weight loss, so I'm overly sensitive to thinner patients now.

No point in overthinking it. Better to wait for the test results.

"Old Liu, is she really okay?" Wang Xiaoyan asked, moving closer to Liu Banxia.

"I can't say for sure yet. Let's see what the test results show. But don't you think she's a bit too thin to be completely without problems?" Liu Banxia countered.

"That's true... but she usually eats and drinks well. We've eaten together. Could it be some other serious illness?" Wang Xiaoyan pressed.

"That's why we need to do the tests, to find out exactly what's going on," Liu Banxia said.

"While I'm pretty good, I'm not a miracle worker. I still need to rely on diagnostic tools. Don't overthink it; it's probably nothing too serious."

"She doesn't have any other discomfort elsewhere in her body. It might just be a digestive system issue. Let's look at her electrolytes; that should give us some clues."

Wang Xiaoyan nodded. Worrying now is pointless, she thought. She also felt a surge of relief and gratitude that she had brought Liu Lu to Liu Banxia; otherwise, this might have been overlooked.

The blood tests would take some time, but the echocardiogram was quick.

Xu Yino hurried back with the ultrasound report. "Teacher Liu, there's some mitral valve prolapse. A left ventriculography is recommended."

"Let me see," Liu Banxia said, taking the report from her.

"Dr. Liu, is it very serious?" Liu Lu asked, her voice even more anxious.

"From the ultrasound, it doesn't look extremely severe. But we need to determine if it's primary or secondary. Have you taken any medications recently?" Liu Banxia asked.

Liu Lu shook her head. "I haven't taken any medication... Hmm, do birth control pills count?"

"Those don't count," Liu Banxia said, shaking his head. "Do you have any other discomfort anywhere else in your body?"

"No, nothing else. Just the fainting spell today, and I do feel tired occasionally," Liu Lu replied.

"Try not to worry for now. Once the rest of the test results are out, I'll consult with a cardiologist," Liu Banxia said.

"Your symptoms aren't very severe. As I said, we need to determine if it's primary or secondary. Primary means it's congenital, something you're born with. Secondary means it's caused by some other factor that developed later."

"For example, certain genetic conditions, rheumatic diseases, myocardial diseases, Wolff-Parkinson-White syndrome, and so on. We need to rule all of these out."

"Otherwise, even if we treat the current mitral valve prolapse with medication, it won't address the root cause. If it's primary, based on my experience, it's usually not a major issue and doesn't require surgical intervention."

"Huh? I might need surgery?" Liu Lu exclaimed, startled again.

"Even if surgery were necessary, it's a very common procedure nowadays. But first, we need to determine the cause," Liu Banxia said.

"Teacher Liu, I'll go check on the blood test results," Xu Yino said.

Liu Banxia nodded.

The patient's fainting episode was likely caused by the mitral valve prolapse, he mused. Perhaps doing a yoga pose at that moment placed some kind of strain on her heart.

Even her fatigue could be related to this mitral valve prolapse.

"Teacher Liu, the blood test results are here!" Xu Yino announced, rushing back in.

Liu Banxia took the report from her, and his brow furrowed.

The patient's blood urea nitrogen and sodium ion levels were somewhat high, while her potassium ion levels were a bit low.

What could be causing this?

Could it be that the patient wasn't telling the whole truth?