Doctor: It's reasonable to perform surgery on yourself.

The old man in the vest lit a new cigarette, took a deep puff, and slowly exhaled. The smoke covered his old eyes, and said, "Yesterday or the day before yesterday, he started vomiting. I didn't take it seriously, thinking that he had eaten something bad, so I gave him a few oxytetracycline pills. As a result, he suddenly became like this tonight."

Old man Lin glanced at the old man in the vest and said in a deep voice, "Smoke less, you cough so much, and drink less, that's how you got your stomach disease."

The old man in the vest smiled, "Okay."

Old man Lin didn't say anything more, and turned to check Xiaojie's condition.

Touching his neck, the neck muscles were stiff, dragging the back of his head forward, Xiaojie immediately showed a painful expression and showed strong resistance.

This is... neck stiffness.

A very bad sign, meningitis, meningeal cancer and various cerebrovascular diseases may cause this symptom.

Considering Xiaojie's age and the local situation, Old Man Lin looked at the old man in the vest with some anger and asked, "Did you cook snails for him?"

Old Man Ouyang shook his beard and said, "No, didn't you give us a lecture before, saying that the snails in the field can't be eaten, saying that there are some nematodes, we have never eaten them!"

Old Man Lin emphasized, "That's called Angiostrongylus, which is the most common parasite in golden apple snails."

After that, he looked at Xiaojie in confusion and muttered, "No, Xiaojie's situation is very similar to being infected with Angiostrongylus... Did he cook for himself when you were away?"

"That's impossible. We all have vegetables left at home. His grandmother and I would leave a hundred yuan at home before going out to work. He would definitely not be hungry."

At this point, the old man in the vest had a much lower voice and said, "But this child never spends money recklessly. Every time he comes back, the money is still there, and he cooks noodles for himself."

"Very sensible." Old Man Lin felt very distressed.

He checked the time and took out the thermometer, and immediately felt something was wrong.

The temperature was 37.9 degrees, a low-grade fever.

The old man in the vest took a look and said, "It's not serious. Last time, the grandson of Old Yang in the village had a fever of 41 degrees, and he was fine in the end. He only had 37 degrees."

Is 37.9 degrees also 37 degrees... Old man Lin was too lazy to argue with the old man in the vest, and counted on his fingers and said, "Stiff neck, low temperature, vomiting... If I'm not mistaken, he should have headaches from time to time these days, and he can't eat anything, right?"

The old man in the vest was stunned for a moment, and suddenly remembered some details, and asked hurriedly, "Usually he can eat two bowls of rice. These two days when I came back, he stuffed a few mouthfuls and said he was full, and he always pressed his head... Do these count?"

Old man Lin's expression became more serious. He pointed to his forehead and asked, "Are you pressing here?"

"Yes, yes - he didn't say it hurt, and he didn't make a fuss. If he hadn't vomited, how would I know he was sick!"

Of course you don't know... This child is so sensible that it makes people feel distressed... Old man Lin felt a little sad and got up to get the key.

The old man in the vest was stunned for a moment: "Brother Lin, what are you doing..."

"Hurry up, go to the county hospital, if it's any later he will die!" Old man Lin's voice was full of unquestionable urging.

Angiostrongylus infection, and also caused severe meningitis.

No one knows how Xiaojie was infected, when he ate the golden apple snail, but old man Lin has basically confirmed that it is a parasitic disease. If it goes on, even the gods can't save it!

I just hope it can be controlled... Old man Lin prayed silently.

Soon, old man Lin locked the door and put Xiaojie on the back of his tricycle.

For the convenience of transportation, the back seat of the tricycle was transformed into a soft cushion. This is a "rural ambulance" specially built by old man Lin. It is no problem to transport two or three patients.

"Let's go. "After saying this, Old Man Lin stepped on the accelerator and pierced into the heavy dusk like a gust of wind.

…

The county hospital urgently carried out an inspection. Old Man Lin put his hands on his waist and directed the young doctor in the emergency department of the county hospital to do the inspection.

He was a famous old doctor. Although he did not have a medical qualification certificate, he had a high reputation. In addition, he came to the county hospital many times. Everyone knew that he was capable, so they were happy to listen to his instructions.

The next morning, the results of various examinations finally came out.

Xiao Jie's hemoglobin was only 67, while the standard value for normal children was around 110~150.

In addition to hemoglobin, other indicators of blood routine were also abnormal.

The number of eosinophils increased, accounting for 12%;

The cytological classification gave a more specific proportion, with 60% eosinophils and 34% neutrophils; 4% lymphocytes and 2% monocytes...

The lumbar puncture examination showed that the pressure reached 340mmH20, the number of nucleated cells was 230/mm3, and the CSF protein was 0.81g... indicating increased intracranial pressure.

In addition, Chaddock’s sign positive, neck resistance...

Chaddock’s sign is the most important sign of pyramidal tract damage. The examination method is that the patient lies flat with both lower limbs straight, and a sharp object is used to gently scratch the skin on the outer side of the dorsum of the foot from back to front. If the big toe dorsiflexes, it is positive.

The bad news is that the hospital did not find the pathogen in the patient's cerebrospinal fluid, and the proportions of sugar and chloride in the cerebrospinal fluid are normal.

This is also in line with the clinical conclusion. The gold standard for judging whether a patient is infected with angiostrongylus is to find the larvae or adults of angiostrongylus in the cerebrospinal fluid or eyes. However, the actual detection rate is less than 5%, and most patients are diagnosed by other detection methods.

Even without the gold standard, symptoms such as headache, vomiting, and stiff neck can confirm that angiostrongylus is infected after eating incompletely cooked golden apple snails...

"First prescribe albendazole for insecticide, and then combine it with levamisole?" The young doctor at the county hospital asked for opinions.

Although it is a township hospital, with the popularization of medicine and health by the country, even rural children know that golden apple snails cannot be eaten, and in recent years, there have been few cases of infection with angiostrongylus.

They can only learn a few treatment guidelines from textbooks:

"In the early stage of angiostrongylus infection, albendazole, mebendazole, etc. need to be used for insecticide treatment in time, and levamisole has a strong killing effect on larvae."

Hearing this combined therapy, the corners of Lin's mouth twitched.

Sure enough... Medicine is still an empirical discipline, and optical theoretical knowledge is not very useful. Only by experiencing different patients and encountering various situations of the same disease can one slowly grow into an excellent doctor.

"No?" The young doctor at the county hospital was puzzled.

"Of course not." Old Man Lin shook his head firmly.

He looked at the boy on the bed. At this time, Xiao Jie was awake and his mind had returned to normal, but he still had a splitting headache and couldn't stop vomiting, which made the boy's face extremely ugly, and his lips were as white as if he had crawled out of the morgue freezer.

"Then what treatment should be used now?" Seeing Xiao Jie's appearance, the young doctor was extremely anxious, fearing that the patient would die in the hospital.

Old Man Lin clenched his fists and said, "On the contrary, no insecticide measures can be taken now..."

——

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