George Smallfield

Associate Professor focused on esophagus, Barrett’s and cancer. Opinions are my own. No one should follow medical advice from twitter - especially mine

[Keith Siau @drkeithsiau]

Composition of regularly used IV fluids 💧 #MedEd

[XKCD Comic @xkcdComic]

Epistemic Uncertainty https://t.co/5dpFtlMNw9 https://t.co/UZtkVB0HJC

[George Smallfield @realSmallfield]

@sentigastro I always like suction as soon as you cross the hepatic flexure. Pull back until you are about to fall back - suck again and then try to push for the first time. Then if stuck prone and lots of sweating.

[George Smallfield @realSmallfield]

While not as cool as Population One, @Medtronic has a really cool setup to show #ESD retraction in VR. The super spy shipping case takes it up a notch.

[George Smallfield @realSmallfield]

@doctornikkid Nice. Joe has the good idea to use the scope to push down and inflate gastric balloon w endo visualization in lieu of X-ray during acute scenarios. Glad to have him here - wish we could capture north of the James

[George Smallfield @realSmallfield]

@KidneyWars @VCU_IMRes @liverprof @tabdelfattahmd @KasparMatt Somehow that seems scarier to me

[George Smallfield @realSmallfield]

Ritual lactulose shots. Learning first hand what we hand out. @VCU_IMRes @liverprof @tabdelfattahmd @KasparMatt

[Thaer Abdelfattah MD,MPH @tabdelfattahmd]

Happy #NationalWomanPhysicianDay

To all the amazing mentors, colleagues, educators and innovators who push the limit and raise the bar for all of us!!!

@VCU_IMRes @AmCollegeGastro @ASGEendoscopy @AASLDtweets @AmerGastroAssn

[George Smallfield @realSmallfield]

@tabdelfattahmd @VCU_IMRes I was expecting it to be horrible, but actually tastes good taking it just once. I could use as a topping on pancakes or waffles. As for the result - that is less pleasant.

[Thaer Abdelfattah MD,MPH @tabdelfattahmd]

The Digestive Health Service residents at @VCU_IMRes
and @realSmallfield wanted to try lactulose, I was kind of “bullied” into it, anyways some of us had a sip and some had the full dose!

Didn’t actually taste as bad as I thought!

What song was playing in the background?!?

[Thaer Abdelfattah MD,MPH @tabdelfattahmd]

Had the chance to watch the @AmCollegeGastro with the Digestive Health Team at @VCU_IMRes @realSmallfield

HRS nomenclature is changing⬇️

[George Smallfield @realSmallfield]

@docdai @drkeithsiau Me too!

[XKCD Comic @xkcdComic]

First Thing https://t.co/WAtLI0sHFX https://t.co/2pkqe5EU34

[George Smallfield @realSmallfield]

@drkeithsiau @doctornikkid Probably as low as feasible without causing pain (above dentate). I’m more Barrett’s and GERD, so open to feedback. I find in retroflexed position you tend to anchor proximal mucosa and the distal mucosa rolls into the cap. I anchor at the top of the vessel for safety

[George Smallfield @realSmallfield]

@doctornikkid @drkeithsiau Sure thing. Not hard to do - just have to be ready to roll off with a finger or remove endoscopically if too low. I prefer the Cook bander to the Boston we are made to use, but for cost savings there always is a Stiegmann-Goff single shot bander too.

[George Smallfield @realSmallfield]

@HamzeSaraireh Yea. It was the one with bleeding, right?

[George Smallfield @realSmallfield]

@michellebr00ks Good luck! I really liked NEJM knowledge+ we have the residents do. App was nice while waiting at the food store or in elevators. Level of questions was spot on - MKSAP harder than the boards. Explanations were detailed with links too

[George Smallfield @realSmallfield]

@liverprof Worse is our celiac panel that sends costly and useless anti Gliadin, EMA IgG and IgA, beyond only test needed - TTG IgA. Not only is the testing wasteful, the patient with IBS-D. positive only for anti-gliadin IgG will usually end up with EGD further wasting $

[George Smallfield @realSmallfield]

@VCURadRes Yup. Took a lot of extension of the neck to get everything lined up

[George Smallfield @realSmallfield]

@doctornikkid @AmCollegeGastro And Provation has a great template for EoE