Allison Kickel

[Allison Kickel @AllisonKickel]

@TK_HelpDesk Must be on my end. Appreciate your help.

[Emre Yekedüz @yekeduz_emre]

@TumorBoardTues @DrYukselUrun @BonumCe 👴🏼 72 y.o. male with hematuria 🩸 ECOG PS:1

🔖 Comorbidities: T2DM,🫀CAD, 💧CKD (eGFR:38 mL/min)

‼️TUR-BT: Urothelial carcinoma with m.propria invasion

🩻TAP-CT: cT2, no lymph node and distant met ❌

[Emre Yekedüz @yekeduz_emre]

What is your preference for this patient’s treatment?

@drenriquegrande @shilpaonc @MattGalsky @apolo_andrea @PGrivasMDPhD @OncoBellmunt @AndreaNecchi @XinanSheng @tompowles1 @OncBrothers @realbowtiedoc @nataliagandur @bavilima @neerajaiims @PBarataMD @FaltasLab @HemOncFellows @MichvdHeijden @y_loriot
@ERPlimackMD @DrKarineTawagi @ravikanesvaran @DrRosenbergMSK @koshkin85 @DrChoueiri @FabioSchutz78 @sonpavde @MikeSerzanMD @NazliDizman @DrYukselUrun

[Yüksel Ürün @DrYukselUrun]

@yekeduz_emre @TumorBoardTues @BonumCe @drenriquegrande @shilpaonc @MattGalsky @apolo_andrea @PGrivasMDPhD @OncoBellmunt @AndreaNecchi @XinanSheng @tompowles1 @OncBrothers @realbowtiedoc @nataliagandur @bavilima @neerajaiims @PBarataMD @FaltasLab No easy answer here.
Each choice is a crossroad for the patient, not just a number in a chart.
What would you do, and why?
Share your real-world experience, let’s learn together. #TumorBoardTuesday

[Jason Hou @JasonHouMD]

@MondayNightIBD @DCharabaty @abbvie @JanssenUS @TakedaPharma @sabpeds @JosephHabibi_MD @ibdtweets @andrewbgrossman @DignassAxel @BettenworthDb @fgomollon @berkeleydoc @dunleavy_katie @halesj126 40M with ileocolonic #Crohns in clinical remission on UST, endo healing on last CLN 2 yrs ago. He says he feels fine.

🧪labs: Hb 10 g/dl, Ferritin 60 ng/ml

#MondayNightIBD What would you at that visit?

[Allison Kickel @AllisonKickel]

@turbosterno Thanks ☺️ @turbosterno
#MasterClass in the list of things NOT to say in presentations 🤫

[Allison Kickel @AllisonKickel]

@MedCaseWriter Ahh early mgmt experience stories! We all have them. Those that can’t get behind the #dearintern movement; you are a worker bot 🤖 and we don’t want to hear from them anyways.

[Allison Kickel @AllisonKickel]

#dearintern I once sent an email to my company finance team bad mouthing a client who regularly paid late. When populating the email address for the client (so fiancé could follow-up w them) I failed to remove them from the CC line. Yup sent it directly to the client Pres.

[Allison Kickel @AllisonKickel]

@Dr_RShatsky Ants go marching sloooooooowly. I get tired and forget the lyrics to most things but this gem requires zero mental load. The slower you go, the quicker they drift off.

[Yara Sarkis, MD @yaransarkis]

@MondayNightIBD 1/Differential of Non-infectious Non -IBD colitis:
🔆 Drug-induced
🔆 Common Variable Immunodeficiency
🔆 Behcet disease
🔆 Segmental Colitis Associated w/ Diverticulosis
🔆 Ischemic Colitis
🔆 Radiation Colitis
🔆 Malignancy

🤔Can you think of other dx?
#MondayNightIBD

[Yara Sarkis, MD @yaransarkis]

@MondayNightIBD 2/Immune Checkpoint Inhibitor Enterocolitis
📌ICI = monoclonal antibodies that reactivate immune response to tumor cells
📌Activation of T‐cells can cross‐react with host antigens
📌Enterocolitis ⬆️anti‐CTLA‐4 > anti‐PD‐1/PD‐L1 agents
📌Diarrhea
⬆️risk perforation if unrecognized

[Yara Sarkis, MD @yaransarkis]

@MondayNightIBD @SanjeevaniTomar @halesj126 @JosephHabibi_MD @RomyChamoun @MarcelYibirin @ifrahfatima @GroverDheera @dunleavy_katie @drsophiadar @Spencerkelley7 3/ICI + Diarrhea:
📐R/o infection
🔦C-Scope: appearance of IBD; but mucosa can look normal -> always biopsy; consider EGD +Bx
🔬Path can have chronic IBD changes, crypt apoptosis
💊Depends on severity: budesonide -> IV steroids-> Biologic
✅#IBDAlgorithm👇
https://t.co/TQ8D3KlIAr

[Yara Sarkis, MD @yaransarkis]

@MondayNightIBD @SanjeevaniTomar @halesj126 @JosephHabibi_MD @RomyChamoun @MarcelYibirin @ifrahfatima @GroverDheera @dunleavy_katie @drsophiadar @Spencerkelley7 @DCharabaty @BassiMehak @TabibianMDPhD @EugeneYenMD @DivyaBhattMD @DevikaGandhiMD @DrJessicaA @AstinWordenMD @drmonrezapour @KReddyMD 4/Capecitabine (oral 5-FU) induced colitis
🎯Diarrhea in up to 50%
🎯Rarely ileitis, severe watery or bloody diarrhea, Protein-losing enteropathy
🎯Bx: severe inflammatory changes, necrosis
🎯Pathophysiol: Ischemia?
📌💊Rx: stop capecitabine, IVF

[Yara Sarkis, MD @yaransarkis]

@MondayNightIBD @SanjeevaniTomar @halesj126 @JosephHabibi_MD @RomyChamoun @MarcelYibirin @ifrahfatima @GroverDheera @dunleavy_katie @drsophiadar @Spencerkelley7 @DCharabaty @BassiMehak @TabibianMDPhD @EugeneYenMD @DivyaBhattMD @DevikaGandhiMD @DrJessicaA @AstinWordenMD @drmonrezapour @KReddyMD @HolmerMd @MPrasadMD @AsmeenBhattMD @cfritzMD @shifaumarMD @maysaazoghbi @wabillin @MichelleKimMD @MItaniMD 5/#NSAIDs:
📌Affect distal small bowel and colon.
📌Erosions, ulcers
📌Diaphragm-like strictures: pathognomonic of NSAID injury

[Yara Sarkis, MD @yaransarkis]

@MondayNightIBD @SanjeevaniTomar @halesj126 @JosephHabibi_MD @RomyChamoun @MarcelYibirin @ifrahfatima @GroverDheera @dunleavy_katie @drsophiadar @Spencerkelley7 @DCharabaty @BassiMehak @TabibianMDPhD @EugeneYenMD @DivyaBhattMD @DevikaGandhiMD @DrJessicaA @AstinWordenMD @drmonrezapour @KReddyMD @HolmerMd @MPrasadMD @AsmeenBhattMD @cfritzMD @shifaumarMD @maysaazoghbi @wabillin @MichelleKimMD @MItaniMD @ValerieHeronMD @MichaelOssoCEO @fcaprioli76 @DrNancyFu @SamZullowMD @mattie_md @David_LeimanMD @alan_barkun @PascalJuillerat 6/Chronic Variable Immune Disease Enteropathy #CVID
📌Loss of B-cell function with ↓ serum IgG level & serum IgA or IgM
📌↑ GI infections: Giardia, Campylobacter, Salmonella, Norovirus
📌Diarrhea; protein-losing enteropathy, SIBO
🚨↑risk of NH B-cell lymphoma , gastric CA
#B2B

[Yara Sarkis, MD @yaransarkis]

@MondayNightIBD @SanjeevaniTomar @halesj126 @JosephHabibi_MD @RomyChamoun @MarcelYibirin @ifrahfatima @GroverDheera @dunleavy_katie @drsophiadar @Spencerkelley7 @DCharabaty @BassiMehak @TabibianMDPhD @EugeneYenMD @DivyaBhattMD @DevikaGandhiMD @DrJessicaA @AstinWordenMD @drmonrezapour @KReddyMD @HolmerMd @MPrasadMD @AsmeenBhattMD @cfritzMD @shifaumarMD @maysaazoghbi @wabillin @MichelleKimMD @MItaniMD @ValerieHeronMD @MichaelOssoCEO @fcaprioli76 @DrNancyFu @SamZullowMD @mattie_md @David_LeimanMD @alan_barkun @PascalJuillerat 7/CVID Dx: EGD/C-scope
📌Biopsy even if mucosa is normal
🔬Villous atrophy, ↑IEL; IHC: CD8+ T cell
🔬lack/absence of plasma cells (differentiate from celiac disease)
💊Rx: budesonide; case reports AZA, TNFi

[Yara Sarkis, MD @yaransarkis]

@MondayNightIBD @SanjeevaniTomar @halesj126 @JosephHabibi_MD @RomyChamoun @MarcelYibirin @ifrahfatima @GroverDheera @dunleavy_katie @drsophiadar @Spencerkelley7 @DCharabaty @BassiMehak @TabibianMDPhD @EugeneYenMD @DivyaBhattMD @DevikaGandhiMD @DrJessicaA @AstinWordenMD @drmonrezapour @KReddyMD @HolmerMd @MPrasadMD @AsmeenBhattMD @cfritzMD @shifaumarMD @maysaazoghbi @wabillin @MichelleKimMD @MItaniMD @ValerieHeronMD @MichaelOssoCEO @fcaprioli76 @DrNancyFu @SamZullowMD @mattie_md @David_LeimanMD @alan_barkun @PascalJuillerat @amelia_kellar @FeenaliePatel @mahmoudrahal @MKaur_MD @mspibddoc @dababneh_yara @JPandolfinoMD @a_livanos @MatthieuAllez 8/#Behcet disease:
🎯Intestinal BD in 3-60% of pts
🎯⬆️GI involvement w BD in East Asian countries (Korea, Japan) vs Western or Middle Eastern countries
🔦C-scope: GI ulcers; 🌋volcano shaped ulcer in ileocecum
🚨Rarely intestinal perforation
🤔of BD in pt w oral/genital ulcers

[Yara Sarkis, MD @yaransarkis]

@MondayNightIBD @SanjeevaniTomar @halesj126 @JosephHabibi_MD @RomyChamoun @MarcelYibirin @ifrahfatima @GroverDheera @dunleavy_katie @drsophiadar @Spencerkelley7 @DCharabaty @BassiMehak @TabibianMDPhD @EugeneYenMD @DivyaBhattMD @DevikaGandhiMD @DrJessicaA @AstinWordenMD @drmonrezapour @KReddyMD @HolmerMd @MPrasadMD @AsmeenBhattMD @cfritzMD @shifaumarMD @maysaazoghbi @wabillin @MichelleKimMD @MItaniMD @ValerieHeronMD @MichaelOssoCEO @fcaprioli76 @DrNancyFu @SamZullowMD @mattie_md @David_LeimanMD @alan_barkun @PascalJuillerat @amelia_kellar @FeenaliePatel @mahmoudrahal @MKaur_MD @mspibddoc @dababneh_yara @JPandolfinoMD @a_livanos @MatthieuAllez @KDeFelice_IBD @PriSantiagoMD 9/Segmental Colitis Associated with diverticulosis (SCAD)
🔹Men>60
🔹BRBPR, Diarrhea
🔹🔥 spares diverticular orifices & rectum
🔹Bx: Architecture distortion
🔹Self-limited, course of 5-ASA, abx, budesonide
🔹If chronic: Biologic➡️Surgery
✅#IBDAlgorithm👇
https://t.co/Qgn2lDOMXy