“What the eye doesn't see and the mind doesn’t accept, DOES EXIST!”
👇 picture of the hands of Thomas Edison’s assistant. Later died from Cancer due exposure to the same ‘invisible’ X-Ray radiation
Why are we discussing this in 2020, during
#Covid_19
?
1/
I have been fortunate to be able to reach some of my academic and professional goals this year.
But, by far, this has been my biggest contribution to humanity.
Introducing Jonah Pereira to the world.
The love of our life; Karlyn and Natalie's best Christmas gift ever!
#dad
CUSPF-TIPS anyone?
Continuous UltraSound, Pulsed Fluoroscopy for TIPS
Great application in PV thrombus
✅ Single stick PV puncture
✅ Plan stent dimensions
✅ Deploy stent LIVE
The profound impact of feeling recognized as F.S.I.R (Fellow of Society of Interventional Radiology) at
#SIR24SLC
is undeniable
The strive to excellence in clinical care, teaching, research and EVERYTHING
#VIrad
will continue.
🅲🅰🅽🆃 🆂🆃🅾🅿 🆆🅾🅽🆃 🆂🆃🅾🅿
When IR comes to the OR, good things happen!
Intra-operative-Ultrasound-guided, Open and endovascular, Superior Mesenteric Venous thrombectomy.
#ClotOut
#VIrad
⚡️ Published
@JVIRmedia
⚡️, will hopefully help
#Irad
#InterventionalSpecialists
with patient care after
#UFE
"Intraprocedural Superior Hypogastric Nerve Block (
#SNHB
) is safe, effective, significantly reduces pain, need for opioids and allows same-day discharge
#UFE
"
Thread 👇
In 2023 a dedicated IR clinic should really be the Rule not the Exception for any clinical
#IRad
practice.
Started with 2 patients in my first clinic in 2016 and see where we are now 📈
#ClinicalIR
@SLU_VIR
From 'PubMed who?' in 2014, to TENURED- Associate Professor In Vascular Interventional Radiology in 2022, has been long and winding.
Clinical demands notwithstanding, i hope the research has helped fill gaps in knowledge and change the way
#IRad
in healthcare evolves.
#Humbled
Congratulations
@keithppereira
for your promotion. It is not easy getting progressing academically when there is overwhelming clinical work. Well deserved. Very proud of you!
@SLU_VIR
⚡️ Breaking ⚡️ for
#BPH
and
#PAE
RANDOMIZED clinical trial of
#PAE
vs SHAM (
#PAEvsSHAM
)
"Improvements in subjective and objective variables after
#PAE
are FAR SUPERIOR from those due to the placebo effect"
🙏 Late Dr Pisco
@TiagoBilhim
@nunovpc
Stepping up the
#IRad
game...
If the patient cannot come to us, we come to the ICU..
@SLU_VIR
Interventional specialists placing a bedside IVC filter
#IVCF
using Intravascular Ultrasound (IVUS) guidance without fluoroscopy.
Today's 8 am
#UFE
begging to leave hospital at 10.30 am....we found a middle ground 11 am
The secret 🤫:
#RadialFirst
and
#SHNB
#Tweetorial
on technique and troubleshooting....
🧵1/
#Gastroenterology
colleague: Cirrhosis,variceal bleeding and portal vein thrombosis. No good options right?
#IRad
:
Trans-splenic TIPS
Trans-TIPS large bore thrombectomy
Trans-TIPS Variceal embolization
Trans-ferred Home next day
#AllInADaysWork
This faithful IVC filter did it's job darn well, well passed its age, until it was forced into retirement!
Dual access and loop snare, laser assisted IVC filter removal after IVUS guided mechanical thrombectomy of dangling gnarly clot with proximal protection
#FilterOUT
#VIrad
Not a massive
#Clothaul
......
But just enough to treat this massive
#PE
, save a life and earn a little compliment from our amazing critical care physicians.
#IRad
My 5 yr old clinging to my legs on Monday morning as i was leaving to the hospital 💔 😪
I had barely seen her for a couple of hours over my busy call weekend 🤷♂️
I promised i would make up to her the next weekend 👨👧🤸♀️🤼♂️🚵♀️🏊♀️
#MedTwitter
#SoMeDocs
#PhysicianSacrifices
#IRadLife
I will no longer wear a mask inside MY business (operating room in hospital). Its has always been unconstitutional to enforce. Let's make this bullshit stop for now!
#Medtwitter
, Who's with me?
#MyMaskProtectsYou
Mic'd up and excited to go LIVE in a few minutes with
@MollyRoseTV
in
@stlmoms
segment on
@FOX2now
.
So what is this
#IRad
(Interventional Radiologist) going to speak about pertinent to Mom's?
Tune in soon 📺
Medical drama vs Reality
Drama 📺: The Resident
@ResidentFOX
(S 5 Ep 13; FOX,24:20) had a scene where a surgeon suggests they page Interventional Radiology for embolectomy (removal of clot)
He responds "You know those guys don't work over the weekend ".
Reality: 👇
#IRad
No
#Cancer
is Too Big or Too Small.....Interventional Radiology
#IRad
does it all!
Threw in the kitchen sink at this 9 cm
#LiverCancer
#HCC
with complete response at 9 months, AFP down from 1000 to 54 and possibly downstaged to transplant.......
Feels like scrolling through another Clot picture, until you step back and realize how Interventional Radiology has changed the face of modern medicine
Its 🤯 that in 2023 we can extract this 25-cm-long-dangling-clot from the IVC in 30 minutes, from a small pinhole
#IRadMagic
The advantage of a CTA for a GI bleed is that you can not only focus your area of search but you can also
#MakeItBleed
by doing a provocative angio after being subselective, fearlessly!
#Irad
#JustCoilIt
#StopTheBleed
I grew up in a 👨👩👧👦 family where 🙍♀️ daughters had an equal opportunity to education and empowerment.They became mothers AND highly successful professionals.
On the morning of
#InternationalWomensDay
, as a proud dad of two girls, i assured them this will continue.
#EachforEquality
2030:
#IRad
fellowship, wait what's that?
Today marks a historic day for our specialty. The last class of 'fellows' graduate.
Its now
#IRadRes
all the way baby...Interventional Radiology Residency- a 5 year program directly out of medical school!
Gloves OFF, but Pants ON!
'Practical Controversies in
#PAE
' to address all your unresolved clinical, technical and practice building questions.
🌎 Global pioneers in the field
💥
#SIR2020vIRtual
June 13, 3:45-5:15 p.m EST
Register:
'Altered' vascular anatomy from Liver transplant 20 years ago combined with a 'rock-hard' liver from recurrent PBC Cirrhosis?
No Es Un problema for
#IRad
#GunSight
🎯 to the rescue!
Interventional Image-Guided Modified Miller banding of fistula for severe Dialysis Access Steal Syndrome.
Don't we, as
#IRad
like to 'visualize' every step along the way?
#NoGuessing
An
#IRadTweetorial
1/
100
#PAE
and counting.....🎉🎊
SLU
#IRad
#InterventionalSpecialists
helping men with prostate enlargement (
#BPH
) pee better 🚹, since 2014.
A lot of colleagues to thanks and acknowledge...🙏
You know you've made it as a CLINICAL Interventional Radiologist (
#VIrad
) when clinical encounters,not procedures top your wRVU CPT heat map.
Embo's, Revasc, Thromb'mies n more: is
#IRad
THE more diverse specialty in modern day medicine?
@SIRspecialists
@VISLAMDSCAIP
He went in to get a scan for belly pain, walked out with a death sentence
18 mo later still alive, and cancer free
No stitches. No scars. No Surgery.
National
#WithoutaScalpelDay
commemorates the first
#Intervention
performed in 1964, by the pioneering Charles Dotter.
#IRad
#IRad
📞
#IRad
'I have a PE and would like to get catheter directed therapy'
'Sure, What's the patient's name and DOB?'
'I, am the patient'
Thank you Dr. Ilan Raoli for sharing your
#PulmonaryEmbolism
journey with us at
#MidwestPE23
. So glad you are back to normal life!
Trauma Surgery Colleagues: "IT IS TIME for change of attitude and nomenclature to reflect that Splenic Artery Embolization (
#SAE
) is its own distinct procedure, rather than being constrained as a faceless nonoperative adjunct"
👇 is why: 20 min, pinhole in wrist, Spleen saved
Genicular Nerve Ablation
#GNA
is rapidly evolving tool in the
#IRad
armamentarium to treat
#kneepain
due to osteoarthritis
#OA
✅️ Technically easy
✅️ Safe, No SAE
✅️ Effective
GNA >> sham (59% v 0% with ≥50% pain 📉)
GNA > steroids (74% v 16% with ≥50% pain 📉)
Will
#Covid_19
go down in history as a
#pandemic
that killed thousands of people, crashed the economy and then was globally eradicated with a 1.27 dollar 💵 drug treatment, extensively available in
#India
?
#Hydroxychloroquine
While
#Medtwitter
is flooded today with medical students relieved and excited to have matched in
#MatchDay2021
, a lot of Programs are also both relieved and excited to match and train the future physicians!
We
@SLU_VIR
matched
#IRadRes
!
Oh, when that 45 minute
#UFE
for
#fibroids
turns into a more interesting one...
⛔ Hypoplastic left radial
🚫 Hypoplastic bilateral Uterine
🎢 Ovarian arteries
⁉️ Difficult SHNB
#Irad
still sends patient home, same day, for lunch!
9 PERT activations this past week
@SLU_VIR
3 thrombectomy
3 CDT
3 conservative
How we choose one over another?
➡️ High vs Intermed High
➡️ Contraindication to tPa
What would we do if all things are equal ⁉️
Look forward to enrolling in PEERLESS, RCT thrombectomy vs CDT.
When the midnight-Budd-Chiari -bleeding-varices-on-two-pressors-situation turns out to be a SingleStick.USguided.LiverBiopsylike.Livesaving.DIPS.
CUSPF-DIPS anyone?
CUSPF-TIPS anyone?
Continuous UltraSound, Pulsed Fluoroscopy for TIPS
Great application in PV thrombus
✅ Single stick PV puncture
✅ Plan stent dimensions
✅ Deploy stent LIVE
Oh the sweet sound 📢 of an Arterialized Vein.
Our first home-made, technically successful, Deep Venous Arterialization (
#DVA
) in the books, folks!
#IRad
1/
Remember the time when good-ole-angiojet was the only option for pharmacomechanical thrombectomy?
It still works in 2021!
SMV thrombus causing bowel ischemia managed percutaneouly; pain and clot free at 1 month clinic FU
#IRad
To all our
#IRad
techs, nurses, PA, NP, Residents, fellows and physicians who support the
#FRONTLINE
during procedures and serve as the
#FrontLineHeroes
in ER's and ICU's during
#Covid_19
THANK YOU! 🙏
"Doc what would a patient like me do for this
#aneurysm
in the lung before the days of Interventional medicine?"
I said.."Well...just consider yourself lucky it didnt happen then!"
#IRad
#BetterMedicine
#WithoutAScalpel
Medical students are graduating early to join fight against
#Covid_19
A 5 yr old also graduated her K-class early to be a hair stylist, albeit under strict supervision of a toddler
#CovidTimes
#CoronavirusHaircut
When thrombus and need for
#IRad
thrombectomy strikes twice, in a couple of days, inspite of optimal anticoagulation, think Heparin Induced Thrombocytopenia
#HIT
?
A short 🧵....
No
#Bleed
is Too Big or Too Small.....Vascular & Interventional Radiology
#IRad
does it all!
Massive rectus sheath hematoma embolized not once but twice (inferior epigastric and lateral circumflex) with cessation of bleeding, off pressors....
A
#PandemicBirthday
🎈🎉 for my now 6-year-old who was exceptional through this quarantine....
And although she craved and missed socialization, she washed her hands, wore her mask, had a smile on her face and did not throw a single tantrum thru this tough time..
One of those days when you pull, then pull harder and then
@t_intheleadcoat
tells you to 'just pull everything out'.
I listen to him, the whole room gasps, i check vitals, break-out to change scrubs and then return to finish the case.
#IRad
#ClotOut
#ComprehensiveVascularCare
Step wise approach to a complex Esophageal and Gastric variceal bleeding situation:
EVL
⬇️
TIPS
⬇️
BRTO
⬇️
EVL if aggravates EV
⬇️
Trans Hepatic BATO of EV
⬇️
#WhenAllElseFails
⬇️
Trans SPLENIC BATO of EV
⬇️
🤷♂️🤷
My big
#PetPeeve
in medicine:
The oldest, sickest, weakest patients gets Interventional
#Irad
treatment, go home same day and are cancer free, organ saved
The youngest, healthiest, strongest get
#surgery
, anesthesia, hospital stay and lose their organ/part thereof
#MedTwitter
OSH Urology referral: TURP on 126 g prostate postponed 3× in 1 yr; COVID, didn't take preop antibiotics, then 'lack of OR time'.
Meanwhile poor man continued to suffer with a 20 Fr Foley in his penis
#PAE
➡️ Cath free in 5w➡️ 70 g prostate in 12w
🙏
#DoRightThing4UrPatients
Expertise in
#CLI
does not end in hi-fives in the control room after successful three vessel run off, but with longitudinal patient follow up, personalized wound care and multi-D collaboration, until complete wound healing is achieved and amputation is prevented.
#VIrad
#PAD