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Jan 30 • 42 tweets • 15 min read
Guest - @theliverdr Dr Abby Phillips, hepatologist, ie, a liver doctor.

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The space is in English.
Why liver health is important?
What does the liver do?

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Liver is the original detox, and it's like a traffic policeman.

The name comes from Old English "lifer." Formerly believed to be the body's blood-producing organ; in medieval times it rivaled the heart as the supposed seat of love and passion.

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Drug-induced liver injury.

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Drug-induced liver injury is a diagnosis of exclusion. The hepatologist has to do some detective work to rule out all the more common causes of liver injury - which basically presents as jaundice - then come to the drugs that the patient is taking.

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ATT - anti-tuberculosis therapy is the commonest cause of drug-induced liver injury in 🇮🇳

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Herbal medicines, including medicines that are made from herbs and traditional herbal medicines - and how to test how they affect the liver.

To put it very shortly, it's a very complex and difficult issue.

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We, ie, the medical fraternity in 🇮🇳 is taking things for granted and not taking responsibility for banning drugs that are proven to be toxic.

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India does not have a science watchdog. 💯

It is NOT the IMA.

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"Among hundreds (more than 600) of my patients with cirrhosis, ie, damaged livers, I have not found a single case of COVID vaccine induced problems." - Dr Abby.

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What is faecal microbial transplant, ie, stool transplant?

Dr Abby's focus of research.

Started in traditional Chinese medicine.

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Clostridium difficile infections in ICU setting, and how faecal transplant was found to be useful for that

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Healthy donor stool transplant can reduce complications of alcoholic liver disease, especially hepatic encephalopathy, and reduce repetitive bacterial infections.

Fighting bacteria with bacteria, like, fire with fire.

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Grade 1 (or mild) fatty liver. What is the significance?

A very relevant question, especially from a radiologist's point of view.

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Fibroscan, shear-wave elastography - that measures liver stiffness in NASH - non-alcoholic steatohepatitis (fatty liver).

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MR elastography is more sensitive and specific than ultrasound elastography. But costlier, and more time consuming.

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Chemophobia. Confusing actual disease progression and adverse effects of medicines.

Prime example. I've been taking insulin for 15 years for diabetes, and because of that my kidneys are damaged.

Actually long-standing diabetes has damaged the kidneys.

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Ultrasound elastography screening for fatty liver is quite prevalent in TamilNadu, both in govt and pvt sector hospitals. - @sylvitweets

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How effective is keelanelli (கீழாநெல்லி) - @sylvitweets

@vetriyoga TN govt service Siddha physician replying.

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Clinical conundrum - @mercedezlad - is asking a specific doubt.

Using this forum as a sounding board 😜

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Dr Abby is explaining about keelanelli

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If you have jaundice, is it a medical cause or a surgical cause?

If medical, have you identified the cause properly before treating.

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Smoking + alcohol. How does that affect the liver?

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Global liver disease burden vs alcohol consumption.

Moderate alcohol consumption, about 8 units per week - reduces heart attack risk, but it increases overall risk for cancers in multiple organs.

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Alcoholic liver disease is dependent also on your genetic risk of getting the disease, not just quantity and duration of alcohol consumption.

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Now talking about - liver transplantation

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Reasons for transplant:
Acute liver failure one important reason. Patient has to fit some criteria.
Cirrhosis - based on stage of the disease.

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MELD score for chronic liver disease, to stratify patients for transplant.

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Organ donation.

National systems of cadaver donation. We have a pretty good system in TamilNadu.

But we don't have a national, centralised system.

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OOOH. Controversy.

Malayalam movies being attacked. 😜

But, seriously. This is actually busting myths and rumours about organ donations, especially liver donation.

In Kerala they do only living donation.

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Cadaver donation programme in #Tamilnadu - the main man behind it, @AmalJos95950131 - speaking now.

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The importance of living liver donors.

The liver is one of the few organs that can regenerate throughout your life. So if you donate (part of) your liver, you don't lose anything. You are saving a life.

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apologies for the lapse in live-tweeting. connectivity issues. sorry.
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Giving excessive paracetamol in kids with high fever is dangerous.

Paracetamol actually disguises fever pattern and may impede diagnosis.

Paracetamol does not cause long-lasting liver injury. It is ONLY temporary damage, and only when it is abused.

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OMG!!

I'm trying to live-tweet this #medtwitter #TwitterSpaces and I'm now confused if I'm covering a medical conference.

Dr Abby @theliverdr is adipozhi hitting sixers out of the ground scientifically.

Lay people who are listening, please excuse. 😜
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I don't know who names these drugs.

The bleddy names of the newer MABs.

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There is no role for vitamin supplementation in COVID.

There's a video in English in @theliverdr's timeline that explains this.

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The Indian population is the best to start any kind of nonsense business in. Our people are the most gullible.

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I'm assuming this is Dr Abby @theliverdr's video explaining the uselessness of vitamin supplements for COVID
I have a big problem with proton pump inhibitors - pantoprazole, omeprazole, rabiprazole, etc.

Please consult a hepatologist.

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Ok. We're concluding with @sylvitweets, medical gastroenterologist's comments.

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On a personal note, this was one of the best medical spaces that I've attended after #TwitterSpaces began.

Kudos @drnaveenpc for the effort. Many thanks Dr Abby @theliverdr for your time and expert opinion.

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Vijay Profile picture
Jan 18, 2021
#CovishieldVaccine Dose 1 done. At Salem, Kumarasamipatti Urban PHC.

All #healthcareworkers in #TamilNadu are eligible to get vaccinated in this phase. Go to the nearest vaccination centre with a hospital ID & a govt ID: DL/PAN/Voter ID. Aadhaar not encouraged.
Got a follow-up call from Salem corporation asking if I was fine and had any side-effects after yesterday's vaccination.
I'm more than a little troubled by news of low attendance at vaccination centres all over the country. There are news reports of big hospitals in Delhi where only a handful of #healthcareworkers have turned up for vaccination.
Read 8 tweets
Vijay Profile picture
Jul 13, 2020
@Gautaamm @aparanjape @ngkabra @anandesh @ksprashant @Girbane @neeran @MCCIA_Pune I'll reply from the perspective of being a co-founder who's been involved in building, deploying & developing an EHR for outpatient medical practice (@slashdr) for the last 5+ yrs.

When we started back in 2014-15, we were well aware that dentistry was primed for such a product.
@Gautaamm @aparanjape @ngkabra @anandesh @ksprashant @Girbane @neeran @MCCIA_Pune @slashdr We chose to stick to the medical OP side because the co-founders had the most experience in that side.

Knowing how our product has evolved, we are well aware now that we can deploy this to outpatient dental practices after building in the necessary features.
@Gautaamm @aparanjape @ngkabra @anandesh @ksprashant @Girbane @neeran @MCCIA_Pune @slashdr Coming to the points that you raised, when we initially started approaching doctors, one of the most important points of resistance that we met was similar to the one that you mentioned in your first few tweets. That of a software vendor selling out to big corporate chains.
Read 13 tweets
Vijay Profile picture
Apr 19, 2020
Listen to the most recent episode of our podcast: LTH E3 – Telemedicine anchor.fm/letstalkhealth…
I'm sharing a partial transcript of this LTH podcast episode of as a thread here.

1. During the ongoing COVID epidemic & nationwide lockdown, many doctors are doing Teleconsultation. Is it legal?
Yes. MCI/BOG has approved & given specific guidelines for practising telemedicine.
2. What are the modes of teleconsultation allowed?

Phone calls, email, text messaging, WhatsApp and other similar platforms, video call etc with different level of permissions for each mode.
Read 13 tweets
Vijay Profile picture
Apr 16, 2020
If there's one thing that I wish will change after this #Covid19India #lockdown, I hope it's the Indian tradition of visiting a patient admitted in a hospital. This has, over the years, become a specific kind of social norm, at least in our part of the country.
Patients, and, more often, the patient's immediate family members, are offended if all the relatives that they consider are "close," do not visit in the hospital when they are admitted - for whatever reason.
This "visiting a sick relative in the hospital" is a ritual that has acquired a definite social standing.
There are some compulsory steps that have to be followed:
1) You most often have to fight with the hospital security people to violate visiting hours.
2) Bring some fruits.
Read 18 tweets
Vijay Profile picture
Apr 15, 2020
There are many in the media and social media who are questioning #TamilNadu government's response to #Covid19India, especially with respect to the low numbers of testing for #coronavirus. There are unfavourable comparisons to other states who have performed more tests.
There is an opinion expressed by knowledgeable public health experts that since the percentage of positive cases identified by the states doing extensive community-level testing is not very big, there may be no big benefit in doing such extensive and expensive testing nationwide.
I work in a private sector multispeciality hospital. We are one of the hospitals that our district health authorities had designated in the city to be prepared with isolation ward for potential #COVID19 patients very early in the epidemic when our state had single-digit numbers.
Read 9 tweets
Vijay Profile picture
Jan 31, 2020
படங்களில் இருக்கும் இரண்டு உரையாடல்களை வைத்துப் பேசறேன்.

எழுதத் தொடங்கினப்புறம் ரொம்ப நீளமாயிருச்சு விருப்பமிருந்தா படிங்க. 😄🙏🏽
இது எல்லோருக்கும் பொருந்தும்ன்னு சொல்லலை, ஆனா அண்ணன்மார் @AmmU_MaanU @akaasi மற்றும் என்னைப் போன்ற படித்த நகர்ப்புற பெற்றோருக்கும் @Rasanai போன்ற வெளிநாட்டில் வசிக்கும் வசதியான இந்திய பெற்றோருக்கும் கண்டிப்பாகப் பொருந்தும்.
பொறுப்பான இந்தியப் பெற்றோர்ன்னா பிள்ளைகளை எப்பாடு பட்டாவது நல்லா படிக்க வைக்கணும் டாக்டர் / என்ஜினீயர் ஆக்கிடணும்ங்கற மனப்பான்மையோடவே வளர்ந்துட்டோம். இந்த ரெண்டு துறை இல்லாட்டியும் குறைந்தபட்சம் நல்ல வேலைவாய்ப்பு கிடைக்கும் அளவுக்கு படிக்கவைக்க பாடுபடுவோம்.
Read 21 tweets

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