Patient review and her medical history
Dr. Kaiser is experienced and well versed in his field. He is passionate about his work, professional, approachable, and empathetic. He is down to earth, encourages the patient to express their concerns, actively listens, asks relevant questions, is thorough in covering all bases, and perseveres until he arrives at the root cause of the problem. His diagnosis is accurate, and he only prescribes procedures and medication that are needed. He makes the time to clearly explain the diagnosis, the challenges, the possible scenarios, and prepares and shares a clear treatment plan. Dr. Kaiser doesn’t hesitate to go the extra mile; navigating the system, reaching out to colleagues, finding quality specialists for associated medical issues, undertaking additional research-whatever is required. He is present and supportive all through the treatment. He is invested in and committed to the care, recovery, and well-being of his patients. Dr. Kaiser is not ruled by the rampant commercialism of the medical system present in todays’ world which dishonours the integrity and principles of the profession. This is rare. What is also very rare, and comforting, is his accessibility-despite his busy schedule, he always puts in the time and effort to answer any questions or concerns his patients might have. This level of support gives one hope and strength at a time when one could be afraid and feel they have none-it also plays a huge part in being able to manage the illness and recovery, knowing you are in safe hands under his care. Would strongly recommend.
Medical History of the Patient
She was a 50 year old healthy lady. She presented one year ago to another hospital with sudden onset jaundice and abdominal distension. Her liver tests were markedly deranged with high bilirubin values (15 mg/dL), high transaminases (AST and ALT 1000 IU/L) and prolonged coagulation (INR 2.5). Imaging was suggestive of liver cirrhosis. She was diagnosed as possible autoimmune hepatitis and was started on steroids and referred to India for urgent evaluation for liver transplantation. Apparently with the steroids she started improving and eventually she did not need a transplant. She returned back to Dubai after three months and was on immunosuppressant therapy for presumed autoimmune hepatitis. While her jaundice completely resolved, she continued to have mild ascites and coagulopathy and therefore a liver biopsy was not done.
She came for a second opinion and further follow-up. We noticed that her haemoglobin level was unusually high for a lady (15-17 g/dL). But what was more striking was a typical mosaic appearance of her liver on her previous CT scan. This type of pattern is usually seen with hepatic venous outflow obstruction or what is also known as Budd Chiari Syndrome. This was subsequently proven on a MR venogram done at our hospital. Haematological evaluation showed that she had a myeloproliferative disorder that explained her high haemoglobin and hypercoagulable state.
Retrospectively analysing her case, her initial clinical presentation with jaundice and ascites was likely due to hepatic venous thrombosis that fortunately resolved without anticoagulation. The use of steroids and the apparent response was only coincidental and was a red herring.
The patient was started on long term anticoagulation. She also needed phlebotomy to keep the haematocrit below 45 percent which would prevent further thrombosis. With this there was complete resolution of her symptoms and normalization of liver function tests. In the end it was a gratifying diagnosis to make which completely changed the management that she would need for the rest of her life.[/vc_column_text] https://goo.gl/maps/iDtKHX3rMCDAhse38 [/vc_column][/vc_row]
