TheLiverDoc Profile picture
Jul 13, 2020 15 tweets 13 min read Read on X
#crazy Useless #patient

Middle-aged man, loves his #family, #farming, drives a cab, #happy. Son & wife at #home. Father-son relationship strong as rock. One #morning, son finds father mumbling to self. Mother says he hardly slept
Mumbling becomes angry ramblings. #Clinical LAENNEC WAS TAUGHT THE IMPO...
Has very little #breakfast. Walks excessively. Goes and lies down, only to get up and walk again. Family interactions little. Sleeps well for 2 hours from 12 to 2PM. Lunchtime. Groggy #father gets on the lunch table and defecates near plates and food. Son and mother aghast.
Father has gone mad. Calls the friendly neighbor, brings his car, rushes to #Medical specialty #clinic nearby. Father disoriented. Son gets the Fword from his own father multiple times, he is shocked! Then comes hurling of abuses after which they restrain him in the car.
In the clinic, #young duty-doc LOOKS at the patient, diagnoses #psychosis, advises observation and sedatives. After 2mg lorazepam, patient knocked out, later wakes up confused. Starts gibberish talk again. In between he identifies the wife, not son. This is devastating.
The young #Doctor is called again. He says this needs advanced #treatment. Psychosis is ‘refractory’ - he tells the #nurse – like a bloody crazy useless mad person (son overhears). Saddened by the fact that his father is driven to crazy for what reason?
So, they rush him in an ambulance to a bigger General #hospital nearby where an elderly #emergencymedicine doc sees the confused, groggy, occasionally abusive patient in restraints. He LOOKS attentively, but also #touch and #EXAMINE the patient.
Lesson 1: don’t #practice visual medicine. CLINICALLY EXAMINE the patient. The patient and family are gladdened by this. They get a sense that there is #care and #comfort is on the way if a doctor places her/his hands on the patient. Don’t be shy. #MedicalStudents The Doctor, 1891 painting b...
He finds a firm liver, enlarged spleen and spider angioma signs of cirrhosis. Son says father used alcohol heavily, stopped a year ago after #Blood vomiting after binge&retching. Doc says looks like he has cirrhosis and issues – needs gastro/liver doc. #Medical #examination
Our evaluation confirms #cirrhosis and portal hypertension (PHT; increase in liver pressure when liver shrinks). PHT is like a block in the highway. Cars get to take service roads and bypasses. These service roads/bypasses for #Portal venous blood are called #collaterals
Some collaterals are huge – called shunts, drawing blood away from liver, increasing #ammonia waste, resulting in brain failure – hepatic encephalopathy. In patient, blood ammonia levels were >300 and patient diagnosed with hepatic encephalopathy. #CT #Scans show large shunt
What was done? Lower ammonia. Look if patient candidate for liver #Transplant (using #MELD score and if not a transplant candidate, then block the shunts. How? Simple non-surgical #interventional #radiology procedure – shunt embolization by @SRajesh_IR
#irad #GITwitter
See what happens in the image below. Large shunts are taken care of. Ammonia reduction brings patient back to senses. Discharged a week later; CT scan done 3 months later showed shunts are gone. #Sedatives and #hypnotics worsen #encephalopathy in cirrhosis. Image
Do not forget to examine. Examine. Examine.
‘A good physician treats the disease but a great physician treats the patient who has the disease’
Not every cirrhosis patient is a goner at diagnosis.
“Diagnosis is not the end, but the beginning of practice”

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More from @theliverdr

Apr 20
Breaking: Our exhaustive paper on liver toxicity of various herbs/ plants used in Ayurveda, Naturopathy, Unani, Siddha and Homeopathy (Ayush) systems of alternative medicine is out now (free to read)
with @arifhussaintm

This paper was initially an invited paper by an Indian journal. The reviewers and Editorial board rejected the "invited" paper because they thought the paper was "too critical" of traditional, cultural and religious [unscientific] aspects of healthcare practice among Indian community and feared backlash from the alternative systems regulatory body (Ayush Ministry) and Ayurveda and Homeopathy practitioners & their organizations of they accepted their own "invited" paper.

The Indian medical science community is now hostage to it's unscientific past due to a deepening lack of scientific temperament among doctors, worrying knee-jerk response style assault from the alternative medicine industry/practitioners/regulators and general apathy towards patients & public health. It's disappointing.

Since they were spineless to publish our factual paper, we sent this to a neutral journal for peer review (which is got through) and paid open access publication fee, so that everyone could read it for free.

Please read and share this important paper which educates physicians on herbal liver toxicity from seemingly benign plant sources which they need to be aware of.

The subsequent posts also highlights infographics summary of various toxic Ayush-based botanicals that are increasingly reported to harm public and patients.

Thanks in advance, and I hope doctors in India start fearlessly respecting science rather than intentionally embracing ignorance & selfishly covering up themselves in a safety bubble, thereby endangering public health in the…Image
Continued: Summary on Tinospora cordifolia (Giloy) Image
Continued: Summary on Withania somnifera (Ashwagandha) Image
Read 7 tweets
Apr 13
The classical response from Ayurveda practitioners or Ayurveda sympathizers (and other alternative medicine practitioners) when debating the role of alternative medicine in healthcare is to "go and study Ayurveda or read Ayurveda" to understand it better. This is a logical fallacy, a kind of escapism. Dr. Kanojia here, has not read the Ayurvedic texts, which is why, he keeps fielding for Ayurveda.

India has a 5 year teaching course for students for Bachelors in Ayurvedic Medicine and Surgery called BAMS.

I have the complete syllabus collection of all curriculum approved text books of Ayurveda in my home library. I spent almost two years reading every single book taught in BAMS syllabus.

Classical Ayurvedic teaching material is rich in misogyny, nauseatingly magical thinking, extreme levels of animal cruelty and meat eating, primitive observations, primal herbal and interventional therapies and principles of practice based on obsolete humoral and elemental theories of disease formation and diagnosis.

For example:

For treatment of large tumors, honey was applied over the growth, flies are allowed to lay eggs on the tumor and the maggots are allowed to eat the tumor from within. The residual tumor is then burned off.

For women in obstructive labor, the hips, buttocks are beaten, the lady is made to inhale smoke from burned snake skin and feathers are used for tickling.

For the treatment of tuberculosis (there was no germ theory at the time, but descriptions of emaciation in tuberculosis was observed) the patient is fed herbs and made to drink alcohol (alcohol is in fact one of the risk factors for tuberculosis as we know now) and cure is achieved by massages from "beautiful ladies."

For treatment of seizures in children, demons were considered the cause (they still teach this in the BAMS curriculum) and such demonic possessions were slayed using prayers and chants.

For treatment of diabetes (there was no knowledge of actual diabetes, it was called Premeha and there were different types of Premeha based on diet/ activity, semen quality and based on "doshas". Ayurvedic texts describe some of the causes of "diabetes" to eating meat and drinking milk. There are nearly 20 types of diabetes described in Ayurveda - which of course, is nonsense.

For treatment of sexual disorders, testicles of various types of animals were boiled with herbs and the formulation applied or drank to increase sexual prowess and to "have sex with a 1000 women."

The bottom line is, if you actually read/study the Ayurvedic texts, you'll realize how completely absurd & pseudoscientific the whole system is and you'll never vouch for it again. I am sharing some excerpts from BAMS textbooks in the subsequent post.

Do not send your children to study BAMS and of course, do not read these texts. I did, so that you dont have to. It will take you to a dark place.
Proof 1:

Proof 2:

Read 4 tweets
Sep 20, 2023
1 of 45

"There is a place, but it is a long journey
If there is any hope for your jaundiced father, this place holds it"

"Where is it?" - the young man enquires

"A place called Kochi"

A son
A dying father
A terrifying battle
A terrible liver disease

From Telangana to Kerala Image
2 of 45

Few months ago, Deepak, a middle aged man started losing appetite

As days progressed, he felt lethargic and every small work became a chore

Hailing from a small town and with a small family in Telangana, he was taken to a local doctor...
3 of 45

Deepak's wife, a homemaker, looked after their family with love and motherly care

Deepak was the sole bread winner, with 2 children

His daughter started medical school on hefty fees, and the son was about to join an engineering college...
Read 45 tweets
Jun 29, 2023
Number of people dead from small pox from 1900 to 1980 - THREE HUNDRED MILLION.

Number of people dead due to small pox after 1980

Number of deaths in 1920's before introduction of vaccine, reported annually in the United States - 13,000 to 15,000.

Number of deaths reported from 1996 to 2018 in the United States - ONE.
Outbreak in 1916 - 2000 dead
Outbreak in 1952 - 3000 dead
Survivors - disabled for life.

Number of cases after 1994 in Western Hemisphere

Read 5 tweets
Jun 6, 2023
Ok some friends sent me private messages that I was harsh on Rachit. They feel that I have to correct Rachit's presumed "Busting" of my tweet content by "Busting" his tweet content on mine. So here goes. Stay for the real science friends. Image
Rachit says creatine is FOR ALL but gives no evidence to back his claims and goes on to copy paste biochemistry of creatine from a Google search.

International Society of Sports Nutrition position specifies creatine use in sports & athletics only...… Image
...and not in others. There is some inconclusive data in patients with muscular dystrophy and aging population, but they are not solid recommendations. In fact all recommendations are in training professionals only and not otherwise.…
Read 14 tweets
Jun 6, 2023
This is some real epic sh*t from Ankur Warikoo. So epic, that its worthy of immediate flushing.

➡️Whey protein for special populations - atheletes, sportspersons, bodybuilders, chronic liver and kidney disease ✅️

➡️Omega 3 supplements is only useful in people with high…… ImageImage
Collateral damage. Local creatine dealer feeling the heat. Image
A Gym-bro tries to debunk the factual details I have provided (he claims "everything busted") in the tweet but instead, lands head-on, in his own epic sh*t.

I cant even understand where these science-illiterates get the brains & guts (I know they have the balls, because their…… Image
Read 4 tweets

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