LIVER PATIENTS

Prof (Dr.) Subhash Gupta, Chairman – Centre for Liver & Biliary Sciences, Max Super Speciality Hospital, Saket

Of course, everyone needs to follow a set of standard precautionary steps such as – staying at home, no physical contact, using hand sanitiser multiple times a day, not undertaking non-essential tasks, ample rest and so on. However, liver patients need to a be a little more conscious with an already compromised immunity system.

• Liver Transplant Patients – Transplant patients need to be more cautious as they are given medicines as a part of their immunosuppression regimen to prevent rejection. Therefore, making them all the more susceptible to Coronavirus. They should ideally get a blood test and get on a call with their clinician to check if the dosage of medicines can be reduced for a temporary period of time. In addition, they should stay at home, wash their hands frequently, not meet new people, follow social distancing strictly, eat freshly cooked food and have plenty of water.
• Liver Disease Patients – This set of patients should be extremely wary of the nuances of the disease as their level of immunity is also low. They should strictly avoid alcohol and diabetic patients need to keep control of their blood sugar levels. They should also speak to their doctor to check if their liver disease is stable or unstable. They should stay at home and follow all precautionary steps such as not undertake tasks which might cause infection, have lots of water, watch their weight, prevent constipation and completely avoid using medicines such as Dulcoflex or Diclofenac which involve risk of bleeding.
• Dialysis Patients – Those getting regular dialysis done, should continue with their treatment, however, they should visit the hospital wearing a mask and avoid contact. We have suggested decrease in the number of attendants and only hospital workers to pick and drop the patient till the dialysis centre to avoid the usage of public transform and hence ensure decreased chances of infection. The patients should also maintain proper distance when they reach the dialysis centre.

If a liver patient comes in contact with someone who has a disease, he/she should immediately inform the authorities and carry out respective tests. They have to call the available helpline  numbers provided by the government. With a surge in Covid-19 cases, there’s a high possibility that the number of places where people can get tested will also increase similar to Korea. Long queue outside testing centers are also extremely dangerous as it might infect one who does not even have the virus.  People who are down with fever and dry cough, should get tested. However, ones with runny nose and cold, should not rush to the hospital. Instead, go for literature-led medicines such as paracetamol and crocin. Liver patients should also avoid Ibuprofen as it involves risk of bleeding. Efforts are being made that it doesn’t become community-acquired but only basis direct contact.

CANCER PATIENTS

Dr. Harit Chaturvedi, Chairman – Max Institute of Cancer Care, Max Super Speciality Hospital, Saket

Everyone needs to follow the standard precautionary steps such as – Social Distancing (staying at home, no physical contact), using hand wash / sanitiser multiple times a day, not undertaking non-essential tasks, ample rest and so on. Since Cancer is a semi emergency, we assure our patients for continuum in care, based on national and international guidelines.

• Follow-up patients – We are encouraging patients who have completed their treatment to not visit hospitals for routine check-ups for the time being. Instead they should stay at home and go for online consultations though various social media platforms such as Tele consult, WhatsApp, Skype, Facebook and even Instagram.
• New patients and those undergoing treatment – There is need for personalised decision making for each patient, through engagement of the multidisciplinary clinical teams. These teams have tele conference to bring best recommendations for each situation. We are working closely with national and international bodies to bring latest recommendations in ‘Corona times’ into practice. For each patient depending on tumour type and stage the team takes a decision to ensure best practices are put forth.
• Patients on Chemotherapy – The chemotherapy of patients on curative intent is being continued. However, treatment of those on palliative intent, is restricted and applied with lot of caution, as they are more prone to serious infections. The healthcare providers at Daycare are fully equipped with universal precautions and PPE.
• Patients on Radiation therapy – All radical, adjuvant/ neo adjuvant treatments must be carried forward with caution. The experts tailor the treatment to cut down hospital visits and weigh the benefits of treatment now or could this be delayed by 2-3 weeks.
• Surgery – All curative intent surgery is carried on with caution. The special considerations for case selection is the tumour biology, stage and the condition of the patient. We have to weigh the benefits of this surgery and the risk for the patient and staff. The staff is provided full protective gear and support to ensure safety.

We join arms with our patients and their families to COMBAT Cancer in the Corona times. Here COMBAT stands for:

C: continuum in Cancer Care.
O: only unavoidable visits to the hospital.
M: medical records to be digitalised to ensure 100% information transfer.
B: beware of fake advise, don’t act without confirmation from your oncologist.
A: adherence to guidelines for treatment. This applies for all times, more so for difficult times, to ensure, we use our resources where we get maximum impact.
T: tele consult. We ensure continuum in care by leveraging IT & Technology and remain accessible for consultations.

For patients at home, we are currently providing e-consultation through numerous social media apps to ensure easy access and stand by our patients and their families.