some memories from liver clinic that make me happy when I think about them in this challenging year

#livertwitter
"I'm me again!"
- A text from a patient after I prescribed lactulose
My patient getting married in a ceremony officiated by the hospitalist when admitted
A picture from my patient wearing a bow-tie at wal-mart to rep Tapper style
A patient being late to my palliative care visit with him because "he is out chopping wood."
getting to say goodbye and how much I cared about him face to face to a patient who passed from sepsis a couple hours later
A butt-dial from a patient's spouse 9-months after they passed. But I picked up and they are doing great, about to go to the beach with their daughter
"That pickle juice saved my life"
- A participant in my muscle cramps trial
patient who was on home hospice 5 years ago coming to clinic looking like a million dollars with examples of their recent wood working
patient who was bedbound with a bili of 30 6-months ago coming to clinic straight from the gym and I had to confirm it was the right person
MRI report saying "steatosis and nodularity has resolved" - patient tells me they lost 30 lbs
patient who I did not expect to ever be able to go hiking "wants to re-schedule, they are going hiking"

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More from @ebtapper

9 Dec 21
1/
Tomorrow is the last meeting of the @AASLDtweets Practice Metrics Committee (PMC) chaired by @AsraniSumeet

He is the kindest, most committed collaborator and has done so much to shape and support the future of #cirrhosis quality

#livertwitter @serperm
2/
Sumeet was chair of this committee after Michael Volk and @KanwalFasiha. Under their leadership, we:

1. Defined the key PROs in #cirrhosis: pubmed.ncbi.nlm.nih.gov/29272043/
2. Developed quality metrics for #cirrhosis that included the patient voice: pubmed.ncbi.nlm.nih.gov/30586188/
and
3/
3. Developed quality metrics for liver cancer diagnosis and management: pubmed.ncbi.nlm.nih.gov/34778999/

Soon you will hear from the committee on PROs in liver cancer, metrics for liver transplant, and metrics for the management of #cirrhosis coagulopathy
Read 4 tweets
15 Oct 21
The hepatitis B vaccine is amazing.

It also has a wild backstory
Want to hear it?

A #tweetorial

1/

#livertwitter #MedTwitter Image
First:

Hepatitis B sucks
1⃣About 3-4 in every 100 people have it
2⃣It causes liver cancer, #cirrhosis

But the vaccine rocks!
1⃣Prevents liver cancer!
2⃣Was first recombinant vaccine!

So let's get into it

2/ ImageImageImage
Did you know that the discovery of hepatitis B was recognized with the 1976 @NobelPrize for Dr. Baruch Blumberg?

His studies over the course of 5 years 1964-1969 changed the world.

Let's take a look

3/ Image
Read 19 tweets
3 Jul 21
I don’t get the vitamin k thing. There is no known benefit (pubmed.ncbi.nlm.nih.gov/23080365/). And the harm is that It sends mixed signals. It undoes the teaching about the #cirrhosis coagulopathy. Because iv vit k is special and novel, it’s a consult rec that sticks. Needs reconsidering
For my #livertwitter friends replying about vit K deficiency in malnutrition, I am not mad at ya, I have nothing but love for you! I see - and address - malnutrition in every patient I meet! I am pro-food, pro-vitamin! I am happy we can still talk this out
Read 4 tweets
29 Jun 21
1/

WHY are steroids used for alcoholic hepatitis?
SHOULD we?
WHAT is the deal with prednisolone vs prednisone?
WHERE did the discriminant function come from?
ARE you ready for a #tweetorial

#livertwitter #medtwitter #meded #cirrhosis
2/

Alcoholic hepatitis is a life-threatening acute liver injury featuring a liver full of necrotic cells, "Mallory bodies" of cellular junk, & severe inflammation (neutrophils)

Fig1: Mallory's original description
Fig2: Alc hep Mortality in 1966 according to bilirubin
3/

Where did we get the idea for steroids in alc hep?

Everyone in 1950's France was using steroids to treat #cirrhosis. As in the examples below, Prednisone/prednisolone were said to resolve ascites, edema, jaundice, and fevers. They made patients hungry and happy too
Read 17 tweets
17 Jun 21
1/
Why do we use NAC (n-acetylcysteine) for tylenol overdose?

A #tweetorial

tylenol is also known as paracetamol, acetaminophen, APAP
#livertwitter #meded #medtwitter
2/

Every year in the US alone, >50,000 acetaminophen overdoses are reported to poison centers, causing >110 deaths. Overdose can be intentional, though often accidental, always tragic.

There's an antidote: NAC. It saves lives.

Want to know how it was discovered?
3/

In the 1970's, Drs. Laurie Prescott & Roger Williams showed people were dying of APAP overdose in the UK
Then Mitchell et al released 6 papers showing why & what to do. Their 1st paper confirmed APAP dosing was key & showed that liver injury was due to p450 metabolism
Read 18 tweets
1 Jun 21
We wanted to⬆️engagement with @JHepatology research
🤔Hypothesis: people are ⬆️ likely to connect with the people behind the research than the research itself
🧐Plan: Randomize papers to personal story tweets or graphical abstracts
🧐Primary Outcome: paper downloads
#livertwitter
We found that story tweets garnered more downloads and tweet impressions

We conclude that showcasing the authors and their motivations in paired tweets is an effective strategy for research engagement

journal-of-hepatology.eu/article/S0168-…
There is still more work to be done in optimizing the way a journal's account presents its research on twitter. We hope you enjoy our contribution. @kidney_boy @tony_breu @LizzieAbyMD @rrosenblattmd
Read 4 tweets

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