Dawn Kuruvilla Profile picture
Apr 15, 2023 16 tweets 6 min read Read on X
How my half day work ✂️ on a Saturday is progressing…😄

1. Young lady with 🫀 disease referred by ENT doc with epistaxis 👃 ImageImageImage
Pounding heart 💓 with loud P2 & PSM at the lower left sternal area

I got the mother and she said since 6 months she is blue 🔵

Centralcyanosis➕Clubbing➕VSD➕PulmHTN
There was Hx of recurrent LRTIs in childhood. Image
I sent her 🏠 to get old records 🔖 and our suspicion of cyanotic CHD with incd 🫁 blood flow due to TOGV was right 🫵🏽 Image
Her CBC proved why she’s having epistaxis 🩸

She’s having secondary polycythemia with erythrocytosis causing hyperviscosity symptoms ☄️ Image
Sadly nothing could be done for her 😓now that she has developed Eisenmenger syndrome 🌒 and her heart disease is so progressed to offer her any corrective surgery at this age😧
2. Just when I am abt to leave for lunch 🥗, a man came in ED with history of falling from his 🚲 and refused admission in 2 hospitals coz of no BP & pulse 😪

Told my staff to do ECG and that made sure I am in for the long exciting day 😬 Image
64 yr old 👳‍♂️ with no DM or HTN or 🚬 or 🍺 history , but chews tobacco had a syncope with severe cardiogenic shock ⚡️

ECG showed ST elevation 📈 in inferior leads.

We loaded the STK 💉 & as we were giving loading doses of DAPT➕ high intensity statins, he had this 👇
This is ST elevation inferior wall MI with complete heart block 🚫

This is bad 👎 and confers bad prognosis for the MI 😑

We gave him one shot of Atropine 🩼 and started Dopamine infusion

We gave plenty of iv fluids 💦 and monitored his urine output 🚰
With the thrombolysis and other Rx, rhythm normalised 🤗 and he is symptomatically better 👍

His repeat ECG also reassured us 👇 with less ST elevation and SR of 80 rate 😇

Jesus has been kind to our efforts 🙏 Image
3. Just when I was taking a breather, my JMO said one 18 yr old👦 who’s pale like a ⚪️ paper has come ☹️

Seeing his hemolytic face,feeling his big spleen & hearing from his father that his sister 👧 has a blood disease for which many 🩸 transfusions have been given,I knew this…
… is Sickle Cell Anemia

On asking more, he has been havg painful episodes in his 🦵➕chest for which many 🥼 have given him analgesic 💉

Nobody bothered to make the connection with his sister’s sickle cell disease 😧

No wonder SCA is a neglected disease and remains so 😰
His CBC showed severe anemia, thrombocytopenia ➕ hemolytic markers were ⬆️—LDH 673, retics 6%, IB 2.5

Maybe he’s thalassemia trait with HbS heterozygous state as it’s a microcytic hypochromic anemia which never required transfusion 😯 Image
He was administered Tramadol and Diclofenac injection for his pain and blood was mobilised

I convinced his 👨 to send HPLC & get his daughter’s treatment reports📄

I was amazed by the way BHU, Varanasi has treated her and followed her up so far 🫡
Kudos 👏 Image
As I walk back to my 🏡 for a late lunch, I am grateful to God for the opportunities we have as a mission 🏥 to treat these precious patients 🤗

Life of a peripheral hospital physician 👨‍⚕️ is never boring and has immense potential to serve a suffering population 🎭
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More from @dawnkuruvilla04

Mar 22
Sharing with y'all an interestg experience I’d in my mission hosp🏥

It all startd with me getting a📞 from my opthal frnd, when I was abt to finish my clinic and head back home for Holi weekend 🎭

She wantd me to see a young man with cataract but with some systemic complaints
She told me it’s a young chap who has been complaining of fever 🤒 for a couple of months and has plenty of 🩸 reports in his hand from many hospitals

She said its unusual that the guy developed cataract 👁️ so early

She wanted me, the physician to have a look 🧐 and figure
The guy came with his sister👇

from the look of him i thought he’s def sick as he was puffy+bloated🫃

But as i spoke with him the story unfolded really strangely 😐

And I’m glad I listend to his complaints after refusing his sister’s attempts to show me the blood reports 📃 Images shared with patient permission
Read 20 tweets
Nov 17, 2023
In the eve of National epilepsy day🟣celebrated on Nov17, my heart goes out to the few precious young lives I’ve had the privilege to manage with seizure disorder 🥹

I think epilepsy is a great suffering in 🇮🇳 & as a parent I can’t imagine the pain of taking ur child thru this
Most of my epilepsy patients have been young & mostly girls in their teens 👧
It was Cassidy Megan-an 8yr old from Canada who started the purple wave of epilepsy awareness in 2008.
She chose purple to raise awareness and to let people with epilepsy know that they are not alone Image
As a father to a newborn daughter 👼 who’s presence in my 🏡 has given me a new resolve to protect and serve, I can feel the agony of the parents who in the same night 2 days back brought to our mission hospital 🏥 2 teenage girls with status epilepticus in unconscious state
Read 20 tweets
Apr 23, 2023
In the era of giving more voice to women 🔉and greater honour 🎖️to ladies, I bring you a sad tale of neglect and poor care 😰to this beautiful lady 🧕who allowed me to share her story of suffering and our mission 🏥 ‘s attempt at giving her some solace and relief ❤️‍🩹
She came to me holding her 👵 who works as a maid 🧹 in a nearby village

👀 bulged out,neck pulsating with a evident thyroid mass & head covered with her dupatta hiding her sparse hair 🧕she had a pounding 💓 beating at 140/min🥺

She told me reluctantly that she has…
.. not had her cycles for 4 months 😥
She wasn’t married

But that was only the beginning of many maladies this poor soul was suffering for the past 2 years or more 😢

She said her sisters will complain that her entire body is shaking while 😴 and hence refuse to share the 🛌
Read 19 tweets
Mar 24, 2023
My experiences on the challenges and hopeful aspects of tackling TB in a rural secondary 🏥 on 🌎 TB day.

I see TB Rx not detached from overall well-being of a patient 🔄 and unless ground level realities of poverty, malnutrition & easy access to healthcare is made possible…
..the theme of this year’s campaign- 'Yes! We can end TB!' won’t bear fruit 🍎

Structural changes shud happen in the way people with TB live and survive in this hard world.
They need wholesome 🥘, ventilated 🏠 and easy access to 🏥facility
I recently had a 30 yr old mother of 2 come to me with an episode of hemoptysis, all 😟 and 😱

On digging more, she has been coughing for 1 month and had been told to have typhoid for her fever in Jan and Feb 😏

There wasn’t much on auscn & PhysicalEx
I ordered a 🩻,CBC,ESR
Read 24 tweets
Mar 14, 2023
Working in a resource poor setting 🏥, it’s only once in a while I get to diagnose some of the neurological diseases 🧠 for which I have strong clinical suspicion for.

Today I had such a day 😎
65 yr poor old lady, diabetic and hypertensive, came with droopy eye lid on the right side 👁️.

She said it’s worsening by the duration of the day being alright in the morning 🌅
Eye dept had sent to me for evaluation of Bell’s palsy 😑🙃
On asking more qs in my clinic, she said both eyes are droopping, R>>L and vision+ face are normal ☹️.

Her pupils were normal,direct+ indirect light reflex tests + with no RAPD & full EOMs 🤓

No limb weakness or other systemic symptoms/signs.

Now, what do we have with us…🤔
Read 21 tweets
Dec 26, 2022
Second story of today is of a middle aged poor man who was in a nearby big district hospital for 3 days and referred to a big city for treatment.
He came to us hearing we have a good set up and having no money to even travel to Varanasi BHU.
He was emaciated and breathing hard 😮‍💨.
My 🩺 told me has a big pleural effusion and on asking history I was convinced he probably has TB with effusion.
His CXR showed this 👇 Image
Read 31 tweets

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