Yuval Patel
@yuvalpatelMD
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GI Liver doc @BorlandGroover / Alumni @DukeU and @HopkinsMedicine / Trained @OslerResidency and @Duke_GI_ / first gen to college
Joined June 2020
Referral for ⬆️ liver tests, male ~40. Labs: iron% low, low nl ferritin, mildly low hgb. No bleeding. Offer egd/colon (liver inflam ⬆️ ferritin). 3.5 cm bleeding sigmoid polyp, EMR neg margins, tva w/ hgd!. Don’t put blinders at the reason for referral!. #MedTwitter #GITwitter.
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An overwhelmingly satisfying outcome in clinic for me is seeing a decompensated alcohol associated cirrhosis patient “recompensate” clinically. It’s glorious and never gets old.
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Superb episode. Master class on how to think through these disease states and nuances in management. Gideon is a rare breed where every word is chosen with intent and logic , a fantastic explainer.
The Arts and science of Psc and Autoimmune hepatitis with the one and only Gideon Hirschfield🇬🇧🇨🇦. We talk. #diagnosis.#treatment.#UC.#psc.#UDCA.#ourbiggestfan. And much more… you don’t wanna miss this one.
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In a parallel universe she declines colonoscopy. She goes with cologuard and has a ~50% percent chance of a negative result . 😳 . #gitwitter #medtwitter.
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50 yo F referred for MetALD. In convo, discuss colon cancer screen. States due for next cologuard now and will obtain with PCP. Convinced her for colonoscopy. 2 cm flat polyp in cecum, adenoma HGD on path 🤯. 1/n
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Seen this about 5-10x in my inpt gi/liver experience. Young, no PMH.High cyclical fever.Hepatosplenomegaly.high ferritin. Ddx stills disease, HLH, lymphoma (diffuse large B, hepatosplenic T). Have yet to see it be an obscure infection. #MedTwitter #GITwitter #livertwitter.
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New cologuard “plus” 🙄. Great for detecting existing colon cancer. Poor for detecting advanced polyps (polyps most likely to turn into cancer if not removed). It’s what makes colonoscopy the superior test— because the goal is to prevent cancer!. #GITwitter #medtwitter
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Year ago screening colon no polyps, had “fair prep,” prior gi doc from another state said repeat in 5 years 🤨. Offered two day prep, colon with large flat polyp near AO. En bloc resection TA with HGD!. What’s your practice for fair prep? 5 years is absurd. #Gitwitter #MedTwitter
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Lot of hate out there towards Americans of Indian descent and Indian immigrants. For what it’s worth, the impact of this small portion of the US population objectively is a net benefit to the country. So even though you hate us, we typically make your life better.
Indian-Americans make up 1.5% of the population and pay 6% of all US tax. That's 4x their representation. This must-read 31-page report by BCG outlines the impact the Indian diaspora has had on the US.
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Excellent post in light of recent chatter.
A media blitz has been going on to demonize Doctor salaries. It's obviously funded by the Healthcare-Pharma Complex, to deflect blame onto Doctors for high Healthcare costs. It is the worst kind of gaslighting against doctors, because the exact opposite situation is true.
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Diagnostic colon 30 yo M, no fam hx colon cancer, has small TA. What age should his first degree relatives be screened?. @samirguptaGI @DougRobertsonMD @AasmaShaukatMD @JasonDominitz . Any quality data on this?. #GITwitter #MedTwitter.
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I’ve tried OCP for refractory gave 3 times in my career and the third times a charm. Pt w/ 5+ endoscopies with banding/apc/rfa for gave over the last half year, sees hematology on epo, iron iv etc. Amazing when something works so well. #livertwitter #gitwitter #MedTwitter.
🩸 An impressive review by Patrick Kamath on the treatment of portal hypertensive gastropathy and GAVE. The perfect blend of science, experience, and a touch of frustration that often comes from the limited response in some patients. #EASLCongress #LiverTwitter #WeShareEASL
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For patients w cirrhosis + ckd, with volume mgt by lvp, any data in restricting vol with lvp+giving iv alb even w low vol?Most do both. What about for pts admit w aki on ckd?. Role of hemodynamics?. @KavishPatidar11 @JoeCullaro @ebtapper . #livertwitter #GITwitter #MedTwitter.
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An important cause , and a no-brainer. Let’s get toxic chemicals that are outlawed accross the world also removed from the foods our kids eat in the US.
Amazing. I will not be buying any @KelloggsUS products, until they address this.
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Unfortunately, a tale far too common. Normal liver tests are falsely reassuring in masld/NAFLD in particular . Use fib4!. #GITwitter #MedTwitter #livertwitter.#PrimaryCare . 2/n.
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New ascites in pt w/ insulin dep dm. Ct w/ cirrhosis, splenomegaly, varices. Norm ast, alt, tbili, aphos 8 yrs!. But plts & alb trend clear 📉. “Why do I have cirrhosis my liver labs are normal?”. 1/n.
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RT @DGlaucomflecken: Let physicians own hospitals. Put ownership of healthcare back in the hands of people actually doing health care.
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I really truly hope she learns that people in healthcare should not be ageist + feel inclined to withhold care for people because they are an arbitrary age. Context matters. Nobody should advocate for futile care, obviously. That said, age is just a number; biases matter.
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This is spot on.
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You can’t hide from stress. At some point it’ll be there. Better to learn to cope with it, strategize to deal with it. The answer is not get rid of anything that causes stress for students, it’s to teach students how to deal with it.
‘Grades are major stressors for students,” writes one sociologist, so “instructors may … wish to consider alternatives to traditional grading, such as ungrading … a technique in which students assign their own grades.” Such practices “may not only have pedagogical benefit but.
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