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Aug 6 • 52 tweets • 15 min read
'Do you know what he loves most?'
his wife asks me
What is it?
'When school re-opens, & children buy colorful stickers from his shop, the smile on their faces', she says,
'when he gives them some free.'
'Will he be able to do that at least?'
& my heart race.
In 2014, Ajith suffered from alcohol use disorder
He used to consume almost a liter of alcohol every day and come back home on all fours
Until one day, when he started developing memory loss, could not identify his wife & children & went into a state of confusion
Jul 31 • 46 tweets • 16 min read
Middle aged man, James is brought for admission
Deeply jaundiced, confused, incomprehensible
His wife is desperate
Docs elsewhere gave him 3 more months of life
What did they say he has? I ask her
Alcoholic hepatitis, she says
& I think to myself - 'docs were right'
James has been using alcohol daily since last 8 years
Since last 2 years, he started drinking excessively & alone
He wakes up only to start drinking more than a liter per day
His last alcohol use was 3 days prior to current jaundice onset
He was obese and without...
Jul 30 • 6 tweets • 2 min read
Recently diagnosed alcohol related cirrhosis, name Rakesh
Brought to my OPD for evaluation and management
Middle aged man, one child, young daughter
Wife is a clerical assistant in a Govt office, name Sindhu
Rakesh has been a heavy drinker
Has had 2 episodes of jaundice+
in the recent past
Both times mild alcohol associated hepatitis, resolved in few weeks, got back to drinking again
Consumes close to 800ml daily
Hard liquor, rum, whisky and gun
Early morning drink (eye opener)
Absolutely no insight into disease
Sold off shop to partner+
Jul 29 • 12 tweets • 3 min read
Sadhguru's ELEVEN scientific quotes that challenged my scientific temper and changed my life
Jul 28 • 5 tweets • 1 min read
This 30's something woman comes to the OPD with her jaundiced husband
They have two kids, 8y son and 4y daughter
The husband drinks close to 1 liter of alcohol every day. His last drink was this morning before coming to meet me
He has severe alcohol hepatitis
Chances of him...
dying is close to 70% at six months without a transplant
He developed jaundice five days back, but continued drinking. Some days He drank and slept on the porch
Wife called the neighbors and all of them forcefully put him inside a car and got him to the hospital
Jul 22 • 45 tweets • 12 min read
1/ I walk up to the middle-aged woman who is terribly worried
This is the third time her husband is in the ICU
Each time, worse than the previous
This time, he is in a coma, and the reasons for him going into recurrent altered behavior remain elusive
Only one clue - cirrhosis 2/ Shankar, her husband has diagnosed with cirrhosis just a two months ago
At the time, he had swelling of both feet and an evaluation revealed low platelets and features of cirrhosis on imaging
Absolutely no complications of cirrhosis
Complications of cirrhosis come in stages
Jul 12 • 19 tweets • 7 min read
Here is the master thread of my #tweetorial mega threads on real-life clinical mysteries, difficult diagnoses, tough-as-nuts patient management and every patient case that made me and my treating unit sweat it out.
#MedTwitter#FOAMed1. A young girl with mysterious liver failure and her father who wants to avoid a liver transplant.
1/ 'There is a referred case for you', the ER doc tells me.
'How bad is it?' I ask him
'Pretty bad,' he says
'But nothing a good clinical history cant crack eh?',
I tell him confidently
'That's the problem', he shoots back, ' the patient cant speak. He's on he ventilator'. 2/ Elsewhere, the patient, Navin (name changed), a 48-year-old school teacher did not give doctors time to figure out what was going wrong
He presented with fatigue for 1 week, lacked interest in food and then, one fine day, became disoriented and the next day, landed on the..
Jul 3 • 52 tweets • 20 min read
1/ 'There's a self referred patient for you', ER doc tells me
'Yes, husband getting her discharged from multiple hospitals looking for a diagnosis'
Self referrals are nerve-racking, I thought, as I walked in, looking at the deeply jaundiced, disoriented woman 2/ The husband, Raj is by side of her bed
He is worried sick
Elsewhere, they were advised liver transplant
Docs weren't sure what was causing liver failure,
killing his wife, Meera
All he knew was that it was acute liver failure(ALF)
ALF is a terrifying, flummoxing disease
Jun 26 • 54 tweets • 13 min read
I ask the ER doc
‘Not sure doc’, he replies
‘Severe pancreatitis, but something is off.’
I think your Unit needs to look at it
‘Liver looks coarse & thers fluid in abdomen’
& we prepare ourselves for a confrontation so sinister, we did not know we'd lose...
39y old, healthy mother of 2 children
10y pretty girl, 5y little boy
Husband works as an office staff for a large MNC
Loss of appetite was first symptom, followed by abdominal discomfort
These went on for 1mo
An ultrasound done at the time revealed coarse fatty liver...
Jun 21 • 5 tweets • 3 min read
I think India should be proud about the most glorious stretching it has gifted to the world
But glorifying it using sick kids inhospital is kind of begging for credibility for a pseudoscientific practice that has pseudo-modernized through the ages
Many will be surprised to see the term pseudoscience associated with Yoga. Thats bcoz u dont really know principles behind Yoga which is at best, contorted stretches to improve flexibility, nothing more
Im lukin at the middle-aged man
His eyes deeply jaundiced
I was sure he saw everythin yellow
Diagnosed with severe alcohol-hepatitis (AH), docs elsewer went up to third line therapy
without any success
So here he was with me
Both of us battling an enemy hiding in plain sight...
6 wks back he started complaining of loss of appetite and fatigue
No fever, joint pains, skin rash
Tests for Covid were negative
As were other viral diseases
In a wks time, he saw his eyes turn yellow
and his urine a dark orange
He admitted to binge drinking...
Jun 16 • 13 tweets • 6 min read
EVERYONE PLZ see this theory question
asked for Final Year Bachelor's in Ayurveda degree
Question is write short essay on
"Woman as an Aphrodisiac item"
In the next tweets, I will show the textbook which students of Ayurveda are made to study and the answer to this question...
...this is the answer that students are studying in their Bachelor's degree, instead of progressive, scientific facts that are to be useful for community and humanity
Chapter teaches how to objectify women into aphrodisiac 'items' and 'baby making factories'
Jun 16 • 5 tweets • 5 min read
Assistant Commisioner of Police Traffic West, Kochi, has blocked entire public road for his morning walk
Morning school buses are unable to pick children from respective apartments
Children are forced to cross road between cars coming from both sides on the opposite road
Parents spoke to Officer, but doesnt budge, wants to continue his 'kingly' routine
Queens Walkway Kochi has separate jogging track & service road
But this man blocked entire public road for his morning routine, endangering kids 2/3
As Indian medical education system is headed towards "Integrated Medical Care" which means, scientific medicine will work along side Ayurveda and such alternative practices,
I would like to point out why this is a marvelous idea and one that will strengthen public health....
Middle aged man is diagnosed with reactivation of chronic hepatitis B virus infection
He was seen in 2010 with flare of hepatitis B and that settled spontaneously. An integrated medicine practitioner treated at that time.
No antivirals given, patient did well...
Jun 13 • 6 tweets • 3 min read
I wish I had this Homeopath confidence
2.PCOS can't be 'cured'.Probably u misdiagnosed PCO vs PCOS😑
3.Infertility due to? Infertility is not a diagnosis🙄
4.All r self limiting🥲
5.ALL pediatric issue? Hav U cured Tetrology of Fallot?
And think of "The Mother" as some nature-based philosophical ingredient and not give attention to it
Bcoz the ingredient on main label mentions only 500mg Apple Cider Vinegar
- that's OK right?
Thats part misleading..
Jun 3 • 33 tweets • 9 min read
Middle-aged woman enters OPD
Diagnosed wit depression since 6mo
On multiple anti-depressants/anxiolytics
Her problems do not seem to go away
But I am a Hepatologist, I tell her
– I do not treat depression
I was told ur Unit can diagnose me
Can u please atleast evaluate me?...
I ask her about her family
Married with 2 children, both working
A loving husband, steady job and the couple has been social
Except since last year, she’s been feeling the blues
Does not feel like meeting people, being home helps
Home is where her heart was...
Jun 2 • 4 tweets • 3 min read
A stable cirrhosis patient, 2 months on these herbal dietary supplements
Out of the blue, his liver cancer test is off the roof
Do herbal components stimulate and promote cancers in at risk patients?
Yes, most implicated is Aloe Vera which has ability to promote cancer...
These little "sippy" blend of multiple fruits and herbs foodsupplementshop.in/product/on-on-… is rich in potential cancer causing plant chemicals and Aloe Vera too.