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
4
Now patient is still coughing his lungs out. It's actually worsening. So they go a long specialist. A #Pulmonologist
He says looks like obstructive lung disease. Let's check. So pulmonary function tests, blowing thru tubes and pipes etc follow. Result. Obstructive lung disease
5
Everyone is happy. He puts him on inhaled steroids plus short course oral steroids and nebulizer, inhalers the full package. After 2 wks the patient developed severe breathing difficulty he comes back and gets admitted under pulmonary guy
He nw says. Mayb it's heart.
6
Enter the #Cardiologist. Now this patient has night time breathing issues. Cardiologist says, paroxysmal nocturnal dyspnea. Classical #Heart failure. But patient says no I have it in morning also. Doc says very bad heart failure. So echocardio heart scan is on. Scan is normal.
7
But cardiologist wants a trial. So he puts patient on diuretics to lower stress on heart and some blood pressure medicines even though he has normal blood pressure. But he tolerates it. After discharge, 10 d later, he comes back coughing. Pulmo and cardiologist says Wil refer..
8
..Patient is happy. So they go to a hi fi private center. The first day, after clinical check up, CT #scan of chest (finally!!!) done. It shows both lungs infective changes. The Specialist says. Need to rule out tuberculosis. So they do bronchoscopy washes and send for test..
9
..Bronchoscopy test normal
The lung washings showed some cells of infection. No TB bacteria.
He says no TB. Puts him back on inhalers and stuff. Goes on for 2 months. Patient has his good days and bad days. But 6 mo after initial chest symptom nw comes low grade fever.
10
Patient is now tired
So he goes to a #naturopathy guy
He says nature will cure.
So he eats leaves and plants and berries and does yoga all the while coughing for 2 more months
Then he stops
Hears about new chest specialty hospital. Goes there. The specialist sees him, examine
11
Doc goes thru all tests. Says too any tests done. I don't want want repeat any of this. I want to repeat only 2 tests. Patient says ok. One more CT chest - radiologist says looks like TB. Specialist says need to confirm. So they post patient for VIDEO ASSISSTED THORACOSCOPY!
12
After VATS PROCEDURE, new specialist says, we have biopsied the lung. Now patient goes double crazy. Did all the other stupids miss my cancer???!! He's going bonkers. The biopsy came back as Bronchiectasis. Non specific, a long term effect of smoking. Doc says it's fine.
13
So patient is put back on same inhalers, breathing exercise and what not. He's inhaling steam more than a pressure cooker is making steam. No use. So down and out, he discuss with neighbors. Neighbors son is doing MBBS trianing. He says let my prof take a look. So he goes ther
14
Old prof examines, does ultrasound of chest and abdomen. He finds something and takes a step back. He tells the #MBBS neighbor. Take this guy to a liver doctor
Looks like #Cancer of liver spread 2 lung. Patient comes 2 our unit.
Aftr 1yr.
Ready for #palliation
#livertwitter
15
We review all records.
Low grade fever, chronic non expectorant cough, severe wasting, loss of weight, loss of appetite. One proper contrast CT of abdomen and chest.
Voila. Radiologist says. It's TB. I say he's evaluated multiple times over 1 yr for that. He says TB.
16
And the nodule of the liver, it was just focal fat. Normal finding.CT chest was terrible. Lots of changes associated TB chest infection. We discuss the findings and our concern with patient. He now hears everything we had to say. We reassure him. He will live long
17
Tuberculosis treatment started. Few weeks down, patients cough is reduced. His disability is low. He's not using inhalers. His chest Xray has cleared. He feels better. Appetite is good. From a referral for #Liver cancer, we finally make a diagnosis of tuberculosis 1yr later.
18
Tests nt always confirmation. Disease confirmation comes frm treating doctor. 4 tat, 1 must B open 2 giving THE PATIENT, BENEFIT OF DOUBT
Do U kno wat TB was called in Olden Days?
Consumption
A gud term wen investigative #medicine & not #clinical medicine is practiced
End

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More from @drabbyphilips

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/
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
Read 7 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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