TheLiverDoc

TheLiverDoc

19-05-2022

17:04

My staff ushers in a man & his mother cradling a 5y old boy into OPD I luk at my list & ask, Mr Ram? But the staff tells me, Ram is next on list But this boy looked very sick & was given priority One look at the boy & I knew what this was A race against my worst enemy Time..

The boy's name is Dheeraj which in Sanskrit means 'patience' - but this was not a time to be patient becoz "If we lose time, we lose the little patient" Dheeraj was diagnosed with a dreaded liver condition a few weeks after birth called biliary atresia...

Biliary atresia is a blockage in the tubes (ducts) that carry bile from the liver to the gallbladder This congenital condition occurs when the bile ducts inside or outside the liver do not develop normally The bile formed stagnates within the liver, leading to inflammation...

and damage to liver cells, scarring and rapid onset cirrhosis in children In fact most common reason for a pediatric liver transplant is biliary atresia, which is a rare disease affecting 1 in 8,000 to 1 in 18,000 live births worldwide The need is to let the bile flow...

so that the liver cells do not get damaged by the stagnant bile and inflammation (called cholestatic liver disease) To get the bile going, the surgery performed is called Kasai Procedure, named so, after the Japanese pediatric surgeon, Morio Kasai who developed it in 1950...

Dheeraj received a Kasai procedure when he was 42 days old Everything seemed fine Until the infections started Cholangitis (infection within bile ducts) is a dreaded complication and when it occurs repeatedly, the surgery fails Even after 6 mo after Kasai, the jaundice...

Did not resolved and hence the doctors advised a liver transplantation if the infections kept recurring OR when the liver became cirrhotic and with portal hypertension (high liver pressure) complications or in case of liver failure with advent of brain failure/encephalopathy...

But the family was distraught They had spend good amount of money for the Kasai and the repeated infection related admissions and now, there was no way they could afford a transplant and the doctors were ONLY discussing about transplant So they took the next best option...

One that was Safe Natural Without side effects One that comes as a savior when modern medicine fails The great hope that flows through social media, by word of mouth, relatives and friends vouch for it, the Government promotes it Ayurveda...

The Ayurvedic practitioner takes one look at the child and says - this is not biliary atresia - but problems with Kamala and Pandu - a term used in Ayurveda to describe a diseases which "resembles" Jaundice And so intense herbal treatments, massages, dietary therapies start...

The boy is given a bunch of herbal meds, some labelled and some unlabeled over a period of 3 years for the jaundice and Kamala disease He is put on a strict diet where proteins are restricted, nutrition is heavily curbed As with all failed Kasai surgeries, the boy does well...

for few years after Kasai surgery when the disease plateau But then, once it starts progressing, with the advent of malnutrition and repeated infections then it is a rapid decline When the family saw that after start of Ayurvedic treatments, the boy was 'stabilized'...

they lost all hope in modern medical treatments WITHOUT realizing that as the boy was aging He was not growing His bones were getting brittle His liver disease was progressing more rapidly in presence of herbal drugs He was extremely malnourished and stunted When I saw him...

in my OPD, he was slipping into a liver coma in arms of his grand mother Was 5 years old, but looked and weighed like a 1 year old and he was very sick I knew that the failed Kasai and years of herbal drugs and Ayurvedic malnutrition was killing his liver & there was no time...

Rushing him into the pediatric ICU was the next step where along with team of excellent residents and doctors, the boy was quickly evaluated for Nutrient deficiencies Managed for high ammonia and encephalopathy Infections screened for and treated The nutrition was the...

Toughest part since we had to prevent 'refeeding syndrome' Which is the potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients receiving proper nutritious refeeding Bcoz the tiny body is not used to proper nutrition, direct feeding...

can make it go haywire and sometimes leading to life threatening events that can kill the child But we did it slow and steady and then came the next part We wanted to know how soon this child required a transplant - and the way to do it was to see the liver itself and so...

A liver biopsy for called for But with liver failure and there was no way we could go for a direct liver biopsy due to high risk of complications - so we get the experts @SRajesh_IR to do it another way Access the liver through a vein in the neck and get a small tissue out...

called transjugular liver biopsy - easily done in adults, but very difficult and mind numbing when done in children bcoz of small veins and high risk... But with a special set of tools and technique, after the little guy was first sedated, the biopsy was performed masterly...

and the reports revealed that the biliary atresia had progressed towards cirrhosis, the liver cells were extensively damaged due to stagnant bile as well as the multiple herbal drugs that were given over the years This meant, two insults were happening at a time and the...

need for a liver transplant was PRIORITY Living related-donor liver transplantation was the best option here since chances of getting a cadaver liver during the pandemic was almost zero So family starts looking for donors The mother had just given birth to a baby girl and...

so she was ticked off the list. Father's blood group did not match Theirs was a small family and there were NO RELATED DONORS This meant that no cure could be offered & best supportive care had to be continued until the child died of natural causes due to the liver disease...

Unable to bear devastating news, 61y old grand mother, who has been the boys pillar of strength volunteers to be the liver donor. Her blood group was a match But she was a frail lady, elderly with other health issues We tell her its a risk worth taking. But its still a risk...

that could kill both her and the child But she was sure and seeing her courage, love and strength, the transplant team gathers the confidence to evaluate her & miraculously, she passes all the strict donor screening steps & ultimately is chosen as the liver donor to Dheeraj...

Meanwhile Dheeraj is now fully stabilized after weeks of hardships His nutritional status improved He was more active And he was ready to receive a part of his grandmothers liver, with love... (the below image is the actual part of healthy liver given to Dheeraj)

And aftr wks of Hard-work frm physicians Expertise frm interventional radiology Help of pathology Extreme dedication frm transplant surgery @drjohnsmathew & unending love from family Dheeraj went home to hug his grandmother, Carrying inside him, a part of her, for life.



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