Whitney Gray

nurse practitioner in pediatric #IBD @ChildrensPGH, working toward #zerowaste, and finding 🌞

[Whitney Gray @whimorgra]

@hilarykmichel @PedsGIChat @SCKimCHP @tkazmers @xtzhang No info collected, maybe resource sheet would have been the better word choice :).I think having this information attached to the discharge paperwork routinely can let patients know that these are topics we are happy to discuss with them when they are ready

[Whitney Gray @whimorgra]

@PedsGIChat @SCKimCHP @hilarykmichel @tkazmers Our team has been working on an information sheet on women’s health in IBD that can be incorporated into the EMR (Thank you Dr. Zhang @xtzhang!)

[Whitney Gray @whimorgra]

@PedsGIChat @SCKimCHP @hilarykmichel @tkazmers Most participants want their GI provider to initiate discussions around SRH as it relates to their IBD. When you practice in a subspecialty, it is sometimes a grey area about who the care should be provided by (PCP vs. Peds GI vs. Gyn in this case)

[Whitney Gray @whimorgra]

@RossMaltz @PedsGIChat @SCKimCHP @hilarykmichel @tkazmers Great question! Sulfasalazine reversibly causes oligospermia and therefore recommended to be discontinued 3-4 months before attempting conception (with alternative therapy plan established) There is some question of this for methotrexate as well, but data is limited.

[Whitney Gray @whimorgra]

@hilarykmichel @PedsGIChat @SCKimCHP @tkazmers The mother did today as her son asked her about it. It is more common that they bring it up, which I am always happy to talk about further so they have that information and not find something incorrect online

[Whitney Gray @whimorgra]

@PedsGIChat @SCKimCHP @hilarykmichel @tkazmers Most of the time, when patients and their families hear it is less than 10%, they feel reassured by this. I also discuss that there is currently no way to predict as the cause of IBD is multifactorial so it should not weigh heavily on your decision

[Whitney Gray @whimorgra]

@PedsGIChat @SCKimCHP @hilarykmichel @tkazmers I actually talked about this today with a family of a patient who was just diagnosed. It is less than 10% if one parent has IBD but can be higher ~1/3 chance if both parents have IBD.

[Whitney Gray @whimorgra]

@Gastro4Kids @PedsGIChat @SCKimCHP @hilarykmichel @tkazmers It is also helpful if your patient has another diagnosis besides IBD to be able to quickly discuss recommendations taking both into consideration.

[Whitney Gray @whimorgra]

@Gastro4Kids @PedsGIChat @SCKimCHP @hilarykmichel @tkazmers Exactly! Theoretical risk based on those factors. . Therefore, we generally recommend progesterone only options. I really like the U.S. Medical Eligibility Chart for Contraceptive Use from the CDC for a quick reference (there is an app too!) https://t.co/lGwbFWRKES

[Whitney Gray @whimorgra]

@temarahajjat @hilarykmichel @PedsGIChat @SCKimCHP @tkazmers @tkazmers shared with me the suggestion of asking "do you ever want to get pregnant" and that has opened the door for the conversation in older teens/young adults. This link is a great resource about having the conversation: https://t.co/1S6dWArOtm (also courtesy of @tkazmers )

[Whitney Gray @whimorgra]

@PedsGIChat @SCKimCHP @hilarykmichel @tkazmers Of course, it is always best to minimize steroid use. Methotrexate is an absolute contraindication and should be discontinued 3-6 months prior to trying to conceive. However, there should be clear plans on alternative therapy to keep disease under good control.

[Whitney Gray @whimorgra]

@PedsGIChat @SCKimCHP @hilarykmichel @tkazmers Biologics are safe as well as thiopurines (We learned this from the PIANO study. Mesalamines are safe. Corticosteroids increase risk for complications such as birth defects, GDM, preterm birth but are not an absolute contraindication.

[Whitney Gray @whimorgra]

Agree! When there are different EHR systems that do not communicate the collaboration can be difficult #TweetNLearn

[Erin Colvin @erincrnpbaker]

@CHP_APP A3: I think collaborative care is a must! But I also see how hard that can be unless services are integrated into the same practice. #tweetnlearn

[Whitney Gray @whimorgra]

@CHP_APP @HMorganPedsPCPA Hi everyone! I am Whitney Gray, CRNP with GI