iiinova — where your digital self keeps evolving

David Wong, Hepatologist in Toronto. UHN/SMH. INTJ @torontoliver.bsky.social · 24/10/2025

Attending the Jenny Heathcote Hepatology Update today. ##liversky www.torontohepatologyupdate.com

Home | Hepatology Update 2025

David Wong, Hepatologist in Toronto. UHN/SMH. INTJ @torontoliver.bsky.social · 26/06/2025

Parents are pressured to give ... www.cbc.ca/news/canada/... It's very telling @cbc.bsky.social did not allow comments at the end of this article. I'm sure GenX would roast them. It implies that women in the workplace is a recent thing. Most of my friends' moms were working. Summers were glorious.

cbc.ca

Parents are pressured to give kids an '80s summer. Are we wearing nostalgia blinders? | CBC News

The internet is rife with articles and posts waxing nostalgic for the unscheduled summers of decades past. But the reality is all these posts urging parents to let kids be bored and free can make mode...

010

David Wong, Hepatologist in Toronto. UHN/SMH. INTJ @torontoliver.bsky.social · 06/06/2025

Who should see these patients? Endocrinology? Cardiology? Who is left to see liver failure, decomp cirrhosis?

010

David Wong, Hepatologist in Toronto. UHN/SMH. INTJ @torontoliver.bsky.social · 24/04/2025

People quote guidelines like they are gospel. In the end guidelibes are just opinions from those who have reviewed literature. There is no guarantee that the authors have actual clinical experience. Paid services like UpToDate are guilty of this as well.

192

David Wong, Hepatologist in Toronto. UHN/SMH. INTJ @torontoliver.bsky.social · 22/04/2025

I was taught to swim away from a sinking ship as you might get sucked down along with the ship. Trick for us is not to get sucked down.

020

Reposted by David Wong, Hepatologist in Toronto. UHN/SMH. INTJ

Terri Allan @tizzy47.bsky.social · 07/04/2025

Saturday’s Toronto Star (Canada)

Canadian newspaper, the Toronto Star, dated April 4, 2025 with the headline “Trump launches golden age of stupid”

334966

David Wong, Hepatologist in Toronto. UHN/SMH. INTJ @torontoliver.bsky.social · 05/04/2025

Do the Americans still have a constitution in anything but name? I thought the Supreme Court gave that away.

000

Reposted by David Wong, Hepatologist in Toronto. UHN/SMH. INTJ

Science Magazine @science.org · 08/01/2025

"[My adviser] told me that instead of focusing on finding a dream job, I should think about what I am good at and what makes me happy at least 80% of the time. This advice surprised me at first, but it ended up being exactly what I needed to hear." scim.ag/3DHtLCc

scim.ag

To choose a career, I needed to do more than ‘follow my dream’

Practical advice helped this international scientist figure out her post-Ph.D. direction

011624

David Wong, Hepatologist in Toronto. UHN/SMH. INTJ @torontoliver.bsky.social · 05/01/2025

The registry needs to have a purpose. However, it can be used to push boundaries. Examples: 1. Refractory ascites. Max age? 2. PreOp registry 3. Variceal bleed. When is too sick just too sick? I know we have pushed well past the age criteria of 65 and so far so good.

000

David Wong, Hepatologist in Toronto. UHN/SMH. INTJ @torontoliver.bsky.social · 05/01/2025

This is code for 1. Give fluids 2. Give enough 3. Don't give too much 4. Reassess frequently, more frequently the sicker they are

000

David Wong, Hepatologist in Toronto. UHN/SMH. INTJ @torontoliver.bsky.social · 05/01/2025

Something to bear in mind, that the successful studies we see published reflect not just the science but also the skill to do the non-science dance, whether that be writing grants or writing papers or networking to publicize the work. Those with good ideas but who are not as skilled are silenced.

000

David Wong, Hepatologist in Toronto. UHN/SMH. INTJ @torontoliver.bsky.social · 05/01/2025

The key may be in the selection. There are so many variables (types of surgery, types of decompensation) that it is impossible to address from a prospective study at this point in time. It may be worthwhile to have a registry to help glean what is futile versus what is possible.

121

David Wong, Hepatologist in Toronto. UHN/SMH. INTJ @torontoliver.bsky.social · 30/12/2024

Without recurrent or refractory ascites. Thank you for that caveat!! Due to referral bias I am seeing a lot of worsening ascites on carvedilol.

010

David Wong, Hepatologist in Toronto. UHN/SMH. INTJ @torontoliver.bsky.social · 16/12/2024

As a teacher, I hope my students learn when I teach them. However they seem to need a lot of repetition to get through the stages: 1. New concept 2. Heard before 3. Remember 4. Understand 5. Apply knowledge For some concepts most never get to 5

000

David Wong, Hepatologist in Toronto. UHN/SMH. INTJ @torontoliver.bsky.social · 15/12/2024

You mean vaccine discovery for Covid And HBV! But the current lesson is: Vaccines only work if you use them. Measles comes to mind. There is an emerging contrast between Asia and Africa for chronic HBV in young people

000

David Wong, Hepatologist in Toronto. UHN/SMH. INTJ @torontoliver.bsky.social · 14/12/2024

That part is true. I have seen guys in their 20s start crying when told they needed long term treatment with Tenofovir when I worked in Ethiopia. Need more effort with birth vaccination for Africa as it seems to be working in Asia.

010

David Wong, Hepatologist in Toronto. UHN/SMH. INTJ @torontoliver.bsky.social · 14/12/2024

Hi Ren. Song from 2022. Ever hear something that sounds interesting but when you listen to the words it blows you away. Self doubt, mental health. #MedSky youtu.be/s_nc1IVoMxc?...

youtu.be

Ren - Hi Ren (Official Music Video)

YouTube video by Ren

010

David Wong, Hepatologist in Toronto. UHN/SMH. INTJ @torontoliver.bsky.social · 14/12/2024

In the early 2000s Jenny Heathcote did a quality of life study comparing 3 groups. Turns out Hep C was least happy, followed by liver clinic staff. Hep B was the happiest. Hep B does not have to be catastrophic and full of stigma. People can and do live with hep B.

110

David Wong, Hepatologist in Toronto. UHN/SMH. INTJ @torontoliver.bsky.social · 13/12/2024

Liver Clinic Christmas party The one where the lab researchers go WILD

000

David Wong, Hepatologist in Toronto. UHN/SMH. INTJ @torontoliver.bsky.social · 09/12/2024

2015 HCV meds became available. I was made to feel envy because I was told that if a drug was approved by the FDA, laws mandated that it would be covered. The grass always seems greener elsewhere but sometimes it is just a mirage. HCV meds soon became readily available in Ontario Canada. #MedSky

110

David Wong, Hepatologist in Toronto. UHN/SMH. INTJ @torontoliver.bsky.social · 08/12/2024

Does mixed systems help or rob from the public system? Does the public benefit from a mixed system or does benefit only go to those of privilege? Do our politicians have the best interests of the public at heart or are they looking out for their rich buddies?

020

David Wong, Hepatologist in Toronto. UHN/SMH. INTJ @torontoliver.bsky.social · 07/12/2024

Telus clinic reboot in Toronto. Are they a silo again or will blood test results be visible in OLIS so that healthcare providers outside of Telus can see the whole picture when their patients get sick? MedCan and Cleveland clinic also silos @thestar.com www.thestar.com/business/a-h... @torstar

thestar.com

A high-tech medical clinic operated by a telecom giant has opened in Toronto — and it’s accepting up to 6,000 patients

Each of the seven examination rooms in the new Telus Health clinic is equipped with 'AI scribe' software that listens to appointments and sends notes to your phone.

000

David Wong, Hepatologist in Toronto. UHN/SMH. INTJ @torontoliver.bsky.social · 07/12/2024

For years I have heard the arguments for private healthcare from healthcare colleagues in Australia and USA. Why have we not heard more about the challenges from mainstream media? Have the Hollywood court dramas been more accurate all along?

000

David Wong, Hepatologist in Toronto. UHN/SMH. INTJ @torontoliver.bsky.social · 06/12/2024

First clinic done at St Mikes. Epic here is different from Epic at UHN. Things are mostly there but called something different and located elsewhere. Like going to live in the US. Looks the same but something is slightly off. #MedSky #Epic

010

David Wong, Hepatologist in Toronto. UHN/SMH. INTJ @torontoliver.bsky.social · 06/12/2024

Good job. Need to acknowledge the treatment decision is complex and that there are people level factors to consider. Those chosen for resection are not the same chosen for ablation. We have a weekly multidisciplinary meeting where someone who knows the patient presents and advocates on their behalf

120

David Wong, Hepatologist in Toronto. UHN/SMH. INTJ @torontoliver.bsky.social · 05/12/2024

7/30 lost HBsAg in the NUC + SiRNA + PegIFN group. Good start but •No NUC + PegIFN control group •Response only if HBsAg titer <1,000 •Grade 3 or 4 AE in 50%

001

David Wong, Hepatologist in Toronto. UHN/SMH. INTJ @torontoliver.bsky.social · 04/12/2024

Lol it wasn't me. It was the kids who do things at the very last minute. Adds to the drama of abstract submissions. They all got submitted. Kids got grey hairs. Brings back fond memories for me.

010

David Wong, Hepatologist in Toronto. UHN/SMH. INTJ @torontoliver.bsky.social · 03/12/2024

Stopping therapy. Many of my patients who lost HBsAg had stopped therapy years ago. Could this have resulted in an immune boost? Something to think about. We are in the process of looking at our data.

010

David Wong, Hepatologist in Toronto. UHN/SMH. INTJ @torontoliver.bsky.social · 03/12/2024

Natural history. Some do lose HBsAg on their own without antivirals. My patients tend to be older over 60. Could HBV specific immunity improve with age or has the virus given up the fight?

110

David Wong, Hepatologist in Toronto. UHN/SMH. INTJ @torontoliver.bsky.social · 03/12/2024

New agents like SiRNA, antisense oligos, checkpoint inhibitors only work in those with low HBsAg titers. They don't report the trend of HBsAg titer before treatment. If it was already falling before treatment, did treatment really do anything?

110

David Wong, Hepatologist in Toronto. UHN/SMH. INTJ @torontoliver.bsky.social · 03/12/2024

Interferon. What's old is new again. China loves interferon and they say side effects are mild. However, I lived through the interferon era and my patients HATE the interferon side effects. It also never really worked for us although HBsAg loss could happen years later

110

David Wong, Hepatologist in Toronto. UHN/SMH. INTJ @torontoliver.bsky.social · 03/12/2024

HBsAg can go negative after many years of therapy with rtPol inhibitors like Tenofovir and Entecavir. Problem is that this outcome is extremely rare in Asians and most of my patients are Asians

110

David Wong, Hepatologist in Toronto. UHN/SMH. INTJ @torontoliver.bsky.social · 03/12/2024

Thoughts on Functional Cure of chronic HBV infection. #LiverSky is this rare or are we just not checking? How many patients get annual HBsAg testing? Literature says best predictor of HBsAg loss is falling HBsAg titer. How else did they expect it to go negative??

132

David Wong, Hepatologist in Toronto. UHN/SMH. INTJ @torontoliver.bsky.social · 01/12/2024

Many lost HBsAg after stopping therapy. What level of ALT elevation would you consider a significant flare? Thinking 5xULN

000

David Wong, Hepatologist in Toronto. UHN/SMH. INTJ @torontoliver.bsky.social · 01/12/2024

I hope to retire in 4 years and 7 months, but who's counting? I have already started to warn my patients followed for chronic liver diseases.

020

David Wong, Hepatologist in Toronto. UHN/SMH. INTJ @torontoliver.bsky.social · 01/12/2024

A large part of the problem is demographics. Baby boomers are retiring. Also people now care more about work-life balance and are no longer willing to work the crazy hours.

010

David Wong, Hepatologist in Toronto. UHN/SMH. INTJ @torontoliver.bsky.social · 01/12/2024

Functional cure of chronic HBV infection. When someone with chronic HBV infection becomes HBsAg neg. Can happen without any of the newer experimental agents. What would you like to know about this? #LiverSky

132

Reposted by David Wong, Hepatologist in Toronto. UHN/SMH. INTJ

Canada Healthwatch 🍁 @canadahealthwatch.ca · 29/11/2024

Here's where the primary care crisis is hitting Ontario hardest www.thetrillium.ca/news/health/... @jackhauen.bsky.social Get weekly updates: CanadaHealthwatch.ca/newsletter 🍁

A map showing which parts of Ontario have the most people without regular primary care.Map: Jack Hauen and Jessica Smith Cross. Data: Inspire-PHC

3219

David Wong, Hepatologist in Toronto. UHN/SMH. INTJ @torontoliver.bsky.social · 30/11/2024

My interest is hepatitis B. There are many ICD-10 for HBV. I choose B18.19: HBV+ HDV? B18.1: HBV+, HDV- B18.10: HBV immune tolerant, HDV- Because I am interested in tracking HDV testing B17.1 for HBV+ HDV+

010

David Wong, Hepatologist in Toronto. UHN/SMH. INTJ @torontoliver.bsky.social · 30/11/2024

Everyone's Epic is different. Go to your SlicerDicer module and play around. What can and cannot be analyzed? You can document a diagnosis like cirrhosis in your note, as an entry in Problem List, Medical History, in the visit or in other ways? My SlicerDicer can only see Medical History

110

David Wong, Hepatologist in Toronto. UHN/SMH. INTJ @torontoliver.bsky.social · 30/11/2024

Clinical medicine is the scientific method applied. •Diagnosis is the hypothesis that implies natural history •Treatment is the intervention that changes natural history •Experiment is the observations over time. If it is different from what you expect you should consider rejecting your hypothesis.

021

David Wong, Hepatologist in Toronto. UHN/SMH. INTJ @torontoliver.bsky.social · 30/11/2024

FIB-4 is age, AST, ALT and platelets to predict liver fibrosis. Informative in stable chronic disease. Not infrequently misused in acute illness. Example: 62M with diabetes has flu. Blood tests show liver enzymes transiently acutely high. FIB-4 high, MASLD cirrhosis? This is a common referral.

000