I run a clinic in the United States

Chapter 390 Luck in misfortune
Hereditary angioedema is a rare autosomal dominant disease characterized by episodic, self-limited, localized, nonpitting edema of the skin and mucous membranes.

The onset of the disease is unpredictable. Most have a family history and can occur at any age. It usually starts in childhood and worsens in adolescence. It is often accompanied by abdominal pain, nausea and vomiting, and skin swelling. However, because these symptoms are not specific, they are often dismissed. Treat as common gastroenteritis and allergies.

Patients with this type of disease mainly have facial subcutaneous edema, respiratory tract mucosal edema, gastrointestinal mucosal edema, or abdominal pain. The most fatal is upper respiratory tract mucosal edema, also known as "laryngeal edema", which can progress rapidly and cause The patient has difficulty breathing or suffocates, which is life-threatening.

Although Iris Tiantuan has locked in a general direction, it still needs to go through the necessary procedures, including improving the disease course information, ruling out other diseases, and conducting biochemical, immune, imaging, pathology and other related examinations.

Among them, the CT results are worth mentioning. The imaging report showed that the small intestine wall in the right lower abdominal part of Little Pamela was thickened, and the gastric wall, ileocecal area, ascending colon, hepatic flexure, and transverse colon were slightly thicker, and the serum complement also appeared. reduced situation.

In other words, the patient's hands and mouth are not only swollen, but now his intestines are also swollen, and his complement is abnormal. Basically, it's almost the same.

However, in order to further confirm the diagnosis, Iris Flower Tiantuan also arranged C1 inhibitor and genetic testing for little Pamela.

Because 90% of the currently reported patients with hereditary angioedema will show a decrease in serum C1 esterase inhibitor, therefore, adding a C1 inhibitor can provide good screening.

If the result is negative, it means that it may be other types, because there are three types of this disease, and the other two types only account for 10%, and the corresponding treatments are also different.

The results showed that the C1 inhibitor concentration of Little Pamela was 0.05g/L, which was lower than the normal value. It was among the 90% and belonged to type I. Gene sequencing results revealed that the c.1C>T heterozygous mutation occurred on SERPING1480, causing the synthesized related proteins to be unable to function correctly.

This hospital has grown into the best hospital in the area. There used to be a hospital that could keep pace, but now it can't keep up. That hospital doesn't have a boss as powerful as Zhou Qiao.

doctor:"……"

In the past, their family was treated in other places, and they went through a lot of troubles, no less examinations, and no less suffering.

All the data were combined, and after everyone discussed it, the patient was finally diagnosed as "hereditary angioedema type I".

"Yeah, isn't that blind treatment?"

After treatment at a clinic near her home, her condition worsened, and the clinic doctor hurriedly transferred Beatrice Grace to Sequoia Hospital without giving a clear diagnosis.

He is not allowed to report to the director, who will then report to the dean, and then pass it on to Dr. Zhou. Sometimes, additional reporting is required to Big Boss Luo Ya.

"what?"

There was silence for a moment.

The doctor hesitated for a moment and then told the truth: "Actually... we don't know what the disease is."

After clearing the clouds and seeing the sun, symptomatic treatment began. Although there is currently no cure for this rare disease, symptomatic treatment can well control the patient's condition, allowing the patient to return to normal school or work as soon as possible and become a normal person.

The family members are even more anxious.

In the intensive care unit, Beatrice Grace, a 21-year-old Texas girl, was lying on a hospital bed with a tracheal intubation, ventilator-assisted ventilation, and hemodialysis equipment next to her.

Sequoia Hospital, Texas.

But at this moment, Beatrice's family was in no mood to take into account the medical expenses. That will all happen after receiving the bill. Now, I want to see what the doctor says.

……

Beatrice's family members were as anxious as ants on a hot pot, talking all over the place.

The doctor said: "I will report to the director immediately." Xin said, how am I qualified to directly instruct Dr. Zhou?

"Then go and invite her quickly." Beatrice's family members urged.

"Doctor, you are talking, what kind of disease is it?" Beatrice's father asked angrily.

Just half a month ago, this girl was fine, and then she suddenly fell ill without any obvious trigger.

"Oh my God, I don't even know what the disease is, so how can I cure it?"

This drug does not require surgery. Chiba Nanako helped select a drug called lanariumab injection, which is very suitable for this disease.

Sequoia Hospital does not need to report some other minor matters, but if Dr. Zhou is to be used, even if it is out of etiquette, boss Luo Ya must be consulted.

And as the number of treatments increases, this "normal" time can get longer.

Doctor: "I just thought of it."

The doctor's eyes suddenly lit up and he quickly comforted him, saying: "Don't worry, don't worry, Beatrice's disease is very strange, probably a rare disease. The second boss of our Sequoia Hospital is one of the top doctors in North America. He A rare disease diagnosis and treatment center has just been opened, and we can invite him to come for consultation.”

Even before "collapse", there was only a slight fever and paroxysmal cough.

"Otherwise, it's better to transfer to the Houston Hospital as soon as possible."

"Poor little baby Beatrice, you are so pitiful. You just celebrated your 21st birthday."

terminally ill.

After arriving at Sequoia Hospital, the girl's condition progressed rapidly, with severe infection and respiratory failure, and she had to be transferred from the general ward to the ICU.

“Isn’t your Redwood Hospital known as the best hospital in Crystal Mills County?”

It can be said that this is the fastest they have ever encountered since seeing a doctor.

Beatrice's mother asked very worriedly: "Doctor, what disease does my daughter have? Can you cure it?"

With the help of Iris, little Pamela's abdominal pain, vomiting, edema and other symptoms were soon relieved, and the Simmons couple took her home happily.

In the United States, ICU is equally expensive. For ordinary families, getting decent medical care is no less than a mountain.

To put it simply, after symptomatic treatment with Iris Flower Tiantuan, although the root problem has not been eliminated, the condition that used to occur almost every month can now be managed safely for a year and a half.

If unfortunately it happens again next time, continue to come to Iris Clinic for follow-up consultation. Since it has been diagnosed before, you don’t even need to do various examinations. You can directly start symptomatic treatment, which will be faster and save money.

"Ah, that's great. Is it the young and promising Dr. Zhou? I've heard of it before, why didn't you tell me earlier?"

Moreover, early identification and timely intervention can help reduce the frequency of disease attacks, reduce the impact of the disease on patients' daily lives, and effectively prevent the occurrence of fatal laryngeal edema.

Soon, the doctor came back to share the good news. Dr. Zhou had started the telemedicine platform and summoned the backbone of various departments in the hospital to conduct remote consultations.

Beatrice's family was immediately disappointed.

Because, they thought they were talking about Dr. Zhou who rushed over from California immediately.

Unexpectedly, it was just a remote consultation.

Isn’t it reliable?
Will there be a misdiagnosis? After all, there is a big difference between diagnosing from videos and information and in person, right?

Beatrice's family members all questioned.

The doctor: "..."

"Actually, remote guidance is more time-sensitive. It's so far away. When Dr. Zhou comes over when he has time, the patient may... Don't worry, since Dr. Zhou has intervened, there must be no problem. There has never been a disease that Dr. Zhou couldn't diagnose. ." After some reassurance, everyone had no choice but to wait patiently.

Anyway, the consultation has already started. In a few hours, we should have the results, right?
Now that Beatrice is in the ICU, she can still survive for a few days, not less than a few hours. In addition, they are also worried that even if they go to Houston, what if the cause of the disease cannot be found and effective treatment cannot be achieved?
Moreover, if you go to Houston, you may not be able to use medical insurance. It is said that the big hospitals in Houston are more expensive, and you will go bankrupt by then.

In the conference room on the second floor of Iris Clinic, members of the Tiantuan Group gathered together again, turned on the large-screen projection, and conducted urgent multidisciplinary consultations with the team from Sequoia Hospital.

The Sequoia Hospital team was in a larger conference room with a big screen because there were more of them, more than thirty people.

Boss Zhou consulted in person, and everyone fought for the opportunity to come and participate. What you can learn is a little bit.

And when I tell people about it in the future, I also had a multidisciplinary consultation with Boss Zhou, which was very honorable.

The patient was admitted to the ICU because of persistent high fever, with a body temperature as high as 40.1°C, accompanied by thrombocytopenia, scattered rashes on the face and abdomen, and general edema. Conventional treatments were ineffective, leading to aggravation of infection and respiratory failure.

After Zhou Qiao and others understood the situation, considering that the patient had renal failure and thrombocytopenia, they instructed the Sequoia Hospital team to conduct clinical examinations on autoimmune indicators, thrombotic microangiopathy, renal biopsy pathology, and genetic testing. detection.

Due to the emergency, everything is an expedited service. Of course, the corresponding costs are also high.

Although Sequoia Hospital was built by Loya to win votes, it was not a loss-making business. Because the profits of medical treatment are too high.

Then, when the test results come out, they are immediately sent to Zhou Qiao's email.

Send items one by one as they come out, rather than waiting for them all to be sent out together.

It's almost like fighting.

Sequoia Hospital is constantly reporting data, while Zhou Qiao and the girl members are conducting in-depth analysis.

Due to overtime work, everyone did not go back at night and continued to work overtime in the clinic.

Elena and Ava are also here. Although they can't help much, Zhou Qiao works overtime and they have nothing to do when they go back.

Elena is very virtuous. She takes Ava with her to help prepare snacks and drinks for everyone, without any airs of a princess.

When you work overtime, it's always fun to eat and drink. Otherwise, it would be too hard, right?

Zhou Qiao joked: "The desserts made by the princess are even more delicious."

Elena leaned close to her ear and whispered: "Is it delicious for my sister and me?"

Zhou Qiao quickly whispered: "Of course it's not as delicious as yours, but... there are so many people, how can we not be so..."

"You're still pretending like this..." Elena pouted.

Zhou Qiao: "..."

On the other side, Stephanie's heart rippled: "Will Qiao eat us together tonight?"

God, six people together makes my body tremble just thinking about it.

After all, there are relatively few opportunities for these five beauties to work overtime together. This is the first time since they met.

Although she and Murphy are both pregnant, the early stages of pregnancy have passed and they can properly carry out exercise in that area. As long as the action isn't too intense, it's fine.

Although she and Murphy were not very harmonious, there was still Elena, Ava and Chiba Nanako at the scene to adjust the atmosphere, so there was no need to be embarrassed.

To be honest, Stephanie was quite looking forward to it.

Not only Stephanie had this idea, but even Chiba Nanako also had this shameful idea. Xin said, if it really happened, would she refuse? Or should you stay and join in?

I thought about it for a while, not knowing what to do.

It's a pity that they thought too much, and Zhou Qiao didn't have that thought. At least, he wouldn't have that leisurely time until the patient's condition was clear.

The other thing is that Zhou Qiao is not that destitute yet. Three people are already very exciting, but if there are a few more, it will be too much to balance.

Then, he was told by Elena that he was a bit prude. Six people, and they are in a clinic again. This...this...is really a bit embarrassing. I'm also afraid that one of the girls will be unhappy. If the other party doesn't accept it and ends up falling out, it won't be beautiful.

For example, Murphy...

Various data were sent urgently, including hemolysis indicators, complement-related indicators, etc. Finally, at dawn, Iris Tiantuan finally confirmed the diagnosis.

Beatrice suffered from a rare form of atypical hemolytic uremic syndrome (aHUS).

Something like a seven-in-a-million chance.

Of course, although this rare disease is rare and the "winning rate" is extremely low, compared with the disgusting lottery and double-color balls, the probability is actually quite high.

The former's chance of winning the jackpot is only one in 2142 million, while the latter's is one in 1772 million.

The most popular Mega Millions lottery in the United States has a probability of winning the jackpot of 1.75 in million, making it the most difficult lottery game in history.

Atypical hemolytic uremic syndrome (aHUS) is a syndrome characterized by the triad of microangiopathic hemolytic anemia, acute kidney injury, and thrombocytopenia. Nearly 50% of aHUS patients can develop end-stage renal disease. , the mortality rate reaches 25%.

Due to factors such as unspecific symptoms, complex causes, limited laboratory testing, and rarity, its diagnosis is very difficult. It requires careful evaluation of medical history, clinical manifestations, and laboratory test results, and the collaboration of multidisciplinary experts to make the correct diagnosis. diagnosis.

Any one of the doctors in the Iris Group is a famous general practitioner who is suppressing the party, so they can "detect the case" and find the "culprit" in a very timely and effective manner.

It is unfortunate for Beatrice to suffer from this rare disease, which is only 7 in 1 million. At the same time, she is lucky because she came to Sequoia Hospital and enjoyed the remote medical assistance of Iris Sky Group. Otherwise, ,The consequences could be disastrous.

Maybe, this time next year will be the anniversary of Beatrice’s death.

Fortunately, patients with "orphan diseases" usually face the huge challenge of not only facing difficulties in diagnosis, but also the lack of treatment drugs, which are extremely expensive. However, the aHUS disease that Beatrice suffered from can be treated with an injection called Seriferin.

This drug, also called eculizumab injection, is produced by the American company Alexion. It is one of the most expensive drugs in the world. It is also a recombinant human monoclonal antibody that inhibits terminal complement C5. The antibody has high affinity for C5, can block the formation of C5a and C5b-9, and protect mammalian cells from damage mediated by C5b-9, completely blocking complement-mediated destruction of blood cells.

This drug was originally not used to treat atypical hemolytic uremic syndrome (aHUS), but to treat paroxysmal nocturnal hemoglobinuria (PNH).

Like the previous "old drugs repurposed" project that Nanako Chiba participated in, clinical studies found that this drug also has very good effects on aHUS, so the U.S. Food and Drug Administration (FDA) approved it as a treatment for aHUS patients. of orphan drugs.

In addition, this drug can also be used to treat adult patients with generalized myasthenia gravis (gMG) who are anti-acetylcholine receptor (AChR) antibody-positive, and adult patients with neuromyelitis optica spectrum disorder (NMOSD) who are anti-AQP4 antibody-positive.

It can be said that one medicine has multiple uses.

This medicine is also available in China. It used to cost about 2 yuan a pill, and it was not covered by medical insurance. It was really hard for ordinary families to bear because one pill was not enough to cure the disease and many pills were needed. However, the good news is that starting from January 2024, 1, the new version of the National Medical Insurance Drug Directory will be officially implemented, and eculizumab injection has also been included.

After being reimbursed by medical insurance, the cost of each tube is about 1000 yuan. Perhaps it would be cheaper to add some other medical insurance.

Under the high-level guidance of the Iris Group and the careful treatment of the Sequoia Medical Team, Beatrice was transferred from the ICU to the general ward not long after, and no longer needed ventilator-assisted ventilation or hemodialysis. With supportive treatment, I believe you can be discharged from the hospital and return to your normal life soon.

The family couldn't be happier. Although the medical bills are high, they are nothing compared to precious lives.

After all, money is an external possession, and a person only lives in this world for seventy or eighty years. If you can live fifty or sixty years longer, what is money?
(End of this chapter)