1/
Y promoting, supporting, advertising, sympathizing or simply ignoring, being neutral abt #Ayurveda, #Siddha or #Unani is dangerous 2 #publichealth. #MedTwitter #livertwitter
Middle aged man with BCLC-B liver #cancer (survival >30 mo) was advised a chemoembolization procedure Image
2/
Chemoembolization or TACE is relatively safe and adverse event free option in selected patients
It also improves survival
But
This patient luked 4 othr options. He was scared of TACE. Physician failed to gain his confidence bcoz he was busy moving 2 seeing many othr patients
3/
Physician gave the patient an appointment 4 procedure and left it at that. The patient, relatively stable man, went around asking for other options. Landed in arms of a traditional #ayurvedic healer, who advised him a cocktail of herbs and cow urine which he tuk for 3-4 mo Image
4/
Now came actual issues.
Patient developed ascites (fluid in abdomen), itching and jaundice.
He was scared to review wit first physician so went to another physician who saw that, in 4 months, BCLC Stage B cancer was nw BCLC stage D.
He put him on palliative care.
But
5/
Patient was nw ready 4 TACE, surgery, transplant anything.
He was beyond all that. I presume he wud hav died by now as he was at a palliative center nearby home, out of State. When discussing #cancer treatments, put urself in patient's shoes
See the world differently.
#MedEd
6/
The ONLY reason patients who visit a modern medicine facility, and THEN go for #AYUSH treatments is bcoz the physician is not communicating well. Spend time with the patient (esp 1st visit and 2nd opinions). Show them a doctor cares. No fear mongering. Follow evidence trail.
7/
Voice UR concerns over alternative, traditional treatments for diseases 4 wich ther R effective treatments.
If majority of docs in #India did that, then, alternative medicine will die an inward death
Learn frm #ayush practitioners on communication skills.
They're damn gud

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More from @drabbyphilips

16 Mar
1
Listen to this story of #tuberculosis
Real, not fiction. Even though may sound like super fiction. Of a patient now admitted under me.

56 yr man. Prior #smoker No #alcohol use, no #DRUGS. Family guy. Starts havin cough. Nagging no sputum
Keeps him awake at night
#MedTwitter
2
He goes 2 a GP. Clinical examination and blood tests done. Says some chest infection. Puts him on antibiotics for a week. Asks for review. 1wk later some change in symptoms, but not fully ok. GP extends antibiotic course 7 more days. C, no fever and no signs of infection yet.
3
After 14d course, no change. Patient chucks the GP. Goes for a senior GP. Senior GP does clinical exam,blood tests AND chest X ray. X ray comes back as "not looking normal" 🙄 But no diagnosis. So he says. Let's try a short course of #antibiotics AND antifungal. Again 14 days
Read 18 tweets
16 Mar
1/
A real story of #modern medicine & #Ayush

Sad wen the former messes things up

24 yr male - overweight by 11kg. Routine check up - fatty liver/advised by GP 2 stop eating - yes he said stop eating, eat when hungry or he'll develop cirrhosis +
#MedTwitter #livertwitter
2/
So the guy gets food phobia - loses 2 much weight in 2 months - close to 12 kg - rechecks liver test - AST and ALT enzymes are higher than before - fellow is sure its 2 late and he is going to develop cirrhosis - so he goes 2 a Gastroenterologist at a suburban clinic +
#ethics
3/
Gastro doc does his ultrasound liver - sees grade 3 fatty liver frm prev Grade 1 - says its bad (on radiological assessment). Liver tests show AST 200 ALT 102. Patient repeatedly asks if he had developed cirrhosis
No answer (a silent doctor is either a fool or thinking one) +
Read 14 tweets
15 Mar
1/
My comments:
#quackery is diff frm #pseudoscience
Former may hav secular/political or religious attributes while the latter does hav regional differencs wit respect 2 political/religious practices
Some eg, discuss:
Traditional Chinese Med
Japanese Kampo
Homeopathy
Ayurveda
2/
"A quack is a "fraudulent or ignorant pretender to medical skill" or "a person who pretends, professionally or publicly, to have skill, knowledge, qualification or credentials they do not possess; a charlatan or snake oil salesman".
3/
"Pseudoscience consists of statements, beliefs, or practices that claim to be both scientific and factual but are incompatible with the scientific method".
#pseudoscience may or may not lead to quackery
Eg
i-red.in
zyropathy.com
Read 6 tweets
15 Mar
1/
Don't look at it as a JOB

See it as one's DUTY.

A patient is a doctor's extended #family

The art of #medicine goes well beyond the realm of a 'work-shift'

There is no current proven role of #herbal medicines in #cancer even though a lot of basic #science work is ongoing +
2/
Oral cancer is treatable condition. Please C Indian Clinical Practice Guidelines for oral cavity cancer bit.ly/3vnJoWJ

Ther R guidlines formulated for management in low resource areas too onlinelibrary.wiley.com/doi/full/10.10…

None of these feature #herbal drugs or #Ayurveda +
3/
The professor mite B right in his own terms, but not scientifically

A student must B able to rise to the occasion & correct/question his/her teacher if need B - this is truly success of practical education

Neither the professor, nor the patient, knws abt effect of herbals
Read 6 tweets
14 Mar
1/
You said, " no #ayurvedic #drug has any adverse effects". This is classical “Like a frog in a well” phenomenon.
Let me clear ur doubts. But Im sure u wil choose 2 remain in the well. Ur wish, but don't drag others into ur well of ignorance
#MedTwitter #livertwitter

A thread
2/
Clinical outcomes, histopathological patterns, and chemical analysis of Ayurveda and herbal medicine associated with severe liver injury-A single-center experience from southern India

pubmed.ncbi.nlm.nih.gov/29476406/
3/
Outcomes and Toxicology of Herbal Drugs in Alcoholic Hepatitis - A Single Center Experience from India

pubmed.ncbi.nlm.nih.gov/31915602/
Read 17 tweets
13 Mar
1/ Cirrhosis patient with new onset fluid in abdomen (ascites) due to excessive salt use in daily foods. Moderate ascites, was advised needle drainage of fluid 4 relief. Heard frm neighbor that once removal starts, then it's transplant. So didnt agree to it. Went 4 #homeopathy 👇
2/
Few wks of #homeopathy, patient very lethargic. No advise 2restrict salt. On the other hand, patient told 2 consume water, #homeo every 2 hours. Came back in few wks in brain failure bcoz sodium level was 114. Admitted. Na corrected.Fluid removed. Stabilizing.
#MedTwitter
3/
#Homeopathy mayb subtle 2 cos any effect, adverse event/ this is what proponents wud say, that its mayb no effect, no side effect, but simple fact is that, it deters patients frm real treatment, that's the real danger.
#worldhomeopathyday,10th April say no to #Homeopathy
Read 4 tweets

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