Yesterday my patient on the operating table bled buckets. He wasn't on blood thinners-no explanations.🤷♂️
After surgery he told me he was taking a herbal concoction of Ginger, Garlic, Turmeric & Asafoetida thrice daily to prevent covid.
Need to change my Pre-op instructions. 🤦♂️
Since many are asking.
Pre op bloods were done 3 weeks back. BT, CT, PT, aPTT, INR were all within normal limits. Considering no co-morbidities the blood work wasn't repeated just before surgery. Hadn't considered this history.
It is not often that an eye surgeon is able to awe a room full of medical students and residents in a busy Ophthalmology clinic.
👀.
So I'll take this opportunity to write a thread 🧵 about this extra-ordinary accomplishment. 🤩 1/
An 18yr old male patient was referred to me. He came in with complaints of a swelling on his left eyebrow since last 3 mts. He had gone to several doctors of different specialties before me & had several differentials ranging from “Sebaceous Cyst” to “Dermoid cyst”! 🤷 2/
At first look it did seem one of those differentials was right. On examining though, texture appeared like classical "bag of worms" sign. I asked for history including leading questions of specific signs which would confirm what I suspected. All negative! 3/
There is no difference between getting a cab or getting a cataract surgery done.
Agregator start ups are reaching every nook and corner now.
It is high time there is regulation and laws governing these type of businesses especially concerning healthcare.
These agregators do not take of any risks of surgeries and costs of running hospitals but take a lion's share of the revenues (read "Comission"), exponentially increase valuations & sell off the business at high profits to the highest bidder.
Finally, the patients lose out & further dip in patient-physician trust. Few are perturbed by this poisonous, unethical and illegal businesses as govts ought to have kept watch before these agregators start shop but unfortunately doctors are left to alert the populace.
This NEET counselling fiasco is what happens when you make laws without debate and without considering the stakeholders into account.
Those affected by the laws will take any of the legal recourses available to them to challenge- courts and protests. 1/
Don't paint the disaffected as the cause of the pain like the govt is doing now. It is on the govt's duty to plan for laws being in effect and to protect those fall between the cracks because of it. 2/
Reform is very difficult for any country but reform is not brought in by stealth. It brought by consensus. Even those which will benefit them in the long run needs the trust of the citizens for them to bear the pain of reform. 3/
The only controllable factor in the prevention of #Mucormycosis is the close monitoring of blood sugars during & post COVID-19 and it's appropriate control
The extra-ordinary focus on steroid usage in #COVID19 and the use of O2 delivery mechanisms is diluting a simple message. 1
We are seeing Mucormycosis even in home quarantined patients who had mild disease and even in those who had no history of hospitalisation, steroids or other immunomodulatory drugs.
Steroids, equipment non-sterility and diabetes might be contributory but not the main cause. 2/
There is of course overuse of steroids in covid-19 like every other drug in India for every disease. Both the medical establishment and the public is prone to poly-pharmacy in India. The easy availability of drugs OTC has contributed to this.
This wave, I've already seen 5 in the last week. 4/5 were still positive for virus.
Patient profile:
Younger patients, more aggressive disease. I do think that covid itself is responsible for disease not just immuno-supression as a 2/5 patients were not even diabetic in 20s.
Mucor is not a novel fungus. It is all around us.
I do blame poly-pharmacy for some of this. Humans are destined to go extinct due to emergence of super-bacteria and super fungi