Dr. Suskind is a gastroenterologist at Seattle Children’s where he sees patients in the Inflammatory Bowel Disease (IBD) Center and Aerodigestive Program. He is the director of quality improvement and co-chair of the Nutrition Subcommittee.

A new comic book produced by Dr. Suskind at Seattle Children’s teaches kids about inflammatory bowel disease (IBD) by following the adventures of Professor Nimbal as he takes two curious students on a microscopic journey through the gut.

See also: A Comic Book Hero Explains Inflammatory Bowel Disease – On the Pulse (seattlechildrens.org)

Q: What was the impetus for creating a comic book about IBD?

One of the things that we know in medicine is that when patients are educated, when they know what they’re doing and why they’re doing it, there is a much higher compliance, much better quality of life and outcomes. Education equals better outcomes — 100%.

As a GI doctor, naturally I think the gut and microbiome are fascinating. But for my young patients with IBD, it can be really challenging to understand this very complex diagnosis. When I sit down in the clinic with a family for 30 or 45 minutes to tell them about it, it is very likely they will have a huge amount of concern and stress. Absorbing all that information in such a short amount of time and retaining it can be hard. Very hard. I wanted to find a better way to deliver the information in a fun, eye-catching way that would also reduce some of the significant embarrassment and stigma people often feel about bowel issues. So I basically took everything I say at my first clinic appointment and put it into the comic book.

Q: How did you actually make the book?

I’m lucky to have Seattle Children’s support. After I came up with the concept I spent two days scouring the Internet for an illustrator who I felt had the vibe I wanted, which is how I found Jason Piperberg.  We spent about a year developing the characters and scenes.

I printed hard copies that I can mail to providers to give their IBD patients, plus the comic is available for free online to download or print ( www.nimbal.org/professor-nimbal-thank-you). I’ve sent it to every GI doctor in the United States as well.

Q: Who is reading it?

Kids here in the United States and around the globe! When I put out a call to my international GI colleagues offering to make the comic book accessible in their language, with their help, I got a great response. It’s now available in 10 languages: English, Spanish, Portuguese, Hebrew, Urdu, Hungarian, Romanian, Dutch, French and Arabic. These are all available for free online. The biggest problem with translation was humor. For example, in the English version, there’s an intestine-traveling vehicle nicknamed the  P.O.O.P. (for People Operated Omniverse Projectile), but for Arabic, we ended up giving it a name that translates to a “magical flying toilet bowl,” which I’m assured is quite funny and culturally appropriate.

Q: What has been the response from patients and parents?

Very positive, both here and overseas. I’ve enjoyed hearing from colleagues from Pakistan, Brazil and many other countries about the difference it’s made for patients.

Q: Can the comic also help kids with IBS or other GI conditions?

The comic book emphasizes nutrition and the interplay of food and the microbiome within IBD, but it’s really for anyone. It teaches the reader why things occur in our gut and how to manage IBD.

Q: How did diet become such a big focus for you in treating IBD?

Years ago, when diet was believed to be irrelevant to IBD, a patient of mine came up to me and told me about a special diet that worked for him. At first, I was skeptical. I began looking into it, at first with small retrospective studies. After further evidence, I became convinced that diet has a major impact and wanted to push the research forward.

The idea was, if you will, “poopoo’d” at first, since IBD was believed to be an immune dysregulation, not necessarily focused on the intestinal microbiome, in which diet would have an impact. But over time, our growing body of research at Seattle Children’s has shown that diet is not only relevant to IBD but integral to its management. (For more information, see Treating Inflammatory Bowel Disease Through Diet). Today our clinical program using dietary therapy in IBD is the largest in the country.

Q: Is the idea of using diet to manage IBD catching on?

Yes. At one point literally no other center did dietary therapy. But because of our research and the support Seattle Children’s provides to other centers, we’ve opened this intervention to children’s hospitals across the United States. Providers visit us to see how we do our dietary intervention.

I should note that there have been huge advances in the last 5 to 10 years not just in understanding diet’s role in IBD but also in advancing the available medical therapies, which means we are able to treat IBD more effectively than in the past

Q: Is there information you can share that would help PCPs spot IBD in patients and refer them in sooner?

First, I’d like to emphasize that we are diagnosing and getting IBD patients into GI departments much more quickly than 10 or 20 years ago. PCPs are doing a phenomenal job. Being aware of IBD symptoms and ordering standard laboratory studies for kids with chronic abdominal pain has been key.

The main symptoms for IBD are chronic abdominal pain, diarrhea, poor weight gain, a decreased height velocity (sometimes even before symptoms come on) and blood in the stool. We advise getting standard bloodwork — which would be CRP, sed rate, CBC, and albumin — and stool studies to rule out infection, as well as a stool calprotectin, an inflammatory marker in stool.

IBD and celiac sometimes can look similar, so if you have a concern for chronic diarrhea and weight loss, celiac disease should be evaluated as well. The vast majority of patients coming to PCPs and even to GI physicians don’t have these disorders, but we definitely don’t want to miss them.

Q: How is access to the IBD program?

It’s good. When kids are referred to us with high suspicion of IBD, we view it as urgent and try to see them within a week. Then they are regularly followed by our team. Many times, they can have their appointment by telehealth and avoid the commute, which has been great.

Mainly by encouraging patients to maintain a healthy diet, stay up to date on vaccinations and continue their IBD medicines. It’s important for them to stay connected and follow up on a regular basis. Also to assure that patients feel comfortable reaching out if concerns arise. We believe in a team approach to care, and having the PCPs involved is central. Currently, Seattle Children’s sees about 800 IBD patients a year. It takes a team to assure that all patients do well.

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