WDSE WDSE WDSE ♪ >> GOOD EVENING AND WELCOME TO "DOCTORS ON CALL."

I'M DOCTOR MARY OWEN, ASSOCIATE DEAN OF NATIVE AMERICAN HEALTH AND DIRECTOR OF THE CENTER FOR AMERICAN INDIAN AND MINORITY HEALTH AT THE UNIVERSITY OF MINNESOTA MEDICAL SCHOOL.

I AM ALSO A FAMILY PHYSICIAN FOR THE FOND DU LAC BAND.

I AM YOUR HOST FOR OUR PROGRAM TONIGHT ON “UPPER GI PROBLEMS”.

THE SUCCESS OF THIS PROGRAM IS VERY DEPENDENT ON YOU, THE VIEWER, SO PLEASE CALL IN YOUR QUESTIONS TONIGHT.

THE TELEPHONE NUMBERS CAN BE FOUND AT THE BOTTOM OF YOUR SCREEN.

OUR PANELISTS THIS EVENING INCLUDE DOCTOR JONATHAN GAPP, A GASTROENTEROLOGIST WITH ESSENTIA HEALTH.

DOCTOR KRISA KEUTE, AN INTERNIST WITH ASPIRUS ST. LUKE'S AND FACULTY MEMBER AT THE MEDICAL SCHOOL DULUTH.

AND DOCTOR DYLAN WYATT, AN EMERGENCY MEDICINE PHYSICIAN AT ASPIRUS-ST. LUKE'S.

OUR MEDICAL STUDENTS ANSWERING THE PHONES TONIGHT ARE OLIVIA HOFF FROM RUSHFORD, MINNESOTA.

JOCELYN LARSON FROM LITCHFIELD, MINNESOTA.

AND ALISON PULST FROM ALEXANDRIA, MINNESOTA.

AND NOW ON TO TONIGHT'S PROGRAM, “UPPER GI PROBLEMS”.

>> THANK YOU FOR BEING HERE, EVERYONE.

UNTIL WE GET SOME QUESTIONS I WOULD LIKE TO ASK YOU SOME BASIC QUESTIONS THAT MAYBE NOT EVERYONE UNDERSTANDS.

WHAT DOES A GASTROENTEROLOGIST DO?

>> I SPLIT MY TIME BETWEEN CLINIC AND DOING PROCEDURES.

I DO COLONOSCOPIES.

AND I SEE PATIENTS IN MY CLINIC AS WELL AND TALK ABOUT DIGESTIVE PROBLEMS.

>> A LOT GOING ON WITH DIGESTIVE ISSUES IN THE LAST 10 YEARS.

YOU’RE PROBABLY GETTING A LOT OF QUESTIONS ON THAT THESE DAYS.

>> EVERYBODY WANTS TO KNOW WITH THE MICRO BIOME IS.

I FEEL LIKE THERE IS STILL A LOT TO LEARN ABOUT HOW WE CAN MANIPULATE IT AND KEEP IT HEALTHY.

IT HAS A BIG AFFECT ON HOW WE FEEL AND I THINK WE ARE STILL FIGURING OUT HOW MUCH OF OUR TOTAL HEALTH IT AFFECTS.

>> FASCINATING.

ALMOST LIKE IMMUNOLOGY WHEN WE WERE IN MEDICAL SCHOOL.

WIDE OPEN.

WHAT IS AN INTERNIST?

WHAT IS THIS ALL ABOUT?

>> THE INTERNAL MEDICINE PHYSICIAN TAKES CARE OF SICK ADULTS.

WE DO NOT TAKE CARE OF PREGNANT PEOPLE OR CHILDREN.

AN INTERN IS YOUR FIRST YEAR RESIDENT.

THEY ARE FRESH OUT OF MEDICAL SCHOOL.

IN INTERNAL MEDICINE, THERE ARE MANY DIFFERENT TYPES OF US.

SOME WORK IN THE CLINIC.

SOME WORK IN THE HOSPITAL.

SOME WERE JUST AT NIGHT.

THERE IS A LOT OF FUN VOCABULARY.

>> GREAT.

WE HAVE SEEN YOU A LOT HERE.

>> HAPPY TO BE HERE.

TELL US WHY YOU ARE HERE FOR GASTROENTEROLOGY.

>> I LIKE TO SAY THAT EMERGENCY MEDICINE DOES THE FIRST 10 MINUTES OF EVERY SPECIALTY.

AT THAT POINT IF WE SEE ANYTHING , WE CAN FOCUS IT ON WHAT IS CRITICAL.

WITH THE HELP OF SOME OF OUR COLLEAGUES, WE CAN STABILIZE FOLKS.

OFTEN TIMES STAY IN THAT WITH OUR COLLEAGUES.

>> WHEN YOU GET SOMEONE WHO HAS A G.I.

PROBLEM, THE FIRST THING YOU WILL DO IS CALL THE HOSPITALIST?

>> WE DO A LOT OF INDEPENDENT INTERPRETATION.

LAB STUDIES.

LOOKING AT THEIR HISTORIES.

WORKING WITH THE PATIENCE TO FIGURE OUT WHAT IS GOING ON.

THEY MAY NEED TO FOLLOW UP WITH SOME LIFESTYLE MODIFICATIONS OR MEDICATION OR A CLINIC OR MAYBE EVEN SAME HOSPITAL FOR SOME TIME.

>> THANK YOU.

ANYTHING YOU WANT TO ADD TO IT?

WE HAVE SOME QUESTIONS.

WHY MIGHT SOMEONE CONSTANTLY BE BELCHING AND HAVING TROUBLE KEEPING FOOD DOWN?

>> BELCHING IS FOR A LOT OF DIFFERENT REASONS.

ONE OF THE THINGS THAT IS KIND OF INTERESTING IS SOMETIMES PEOPLE WILL JUST BE BELCHING OUT THE AIR THAT THEY HAVE ACTUALLY SWALLOWED.

FOR SOME PEOPLE IT IS ALMOST AN ANXIOUS TAKE -- TIC.

THEY ARE SWALLOWING AIR MORE THAN THEY EXPECT.

THAT AIR HAS TO COME BACK OUT SO THEY WILL BELCH.

THAT IS ONE REASON.

SOMETIMES WE SEE PEOPLE BELCHING THAT CAN BE ASSOCIATED WITH AN INFECTION OF THE STOMACH.

A BACTERIA CAN LIVE IN THE LINING OF THE STOMACH.

SOMETIMES THAT IS A REASON.

OR IT COULD BE PART OF THE MICRO BIOME WE WERE TALKING ABOUT.

WHERE YOU HAVE BACTERIA IN YOUR GUT AND THEY TAKE THE NUTRIENTS THEY ARE EATING AND CREATE A GAS .

A LOT OF DIFFERENT REASONS.

>> THIS PATIENT ASKED ABOUT TROUBLE KEEPING FOOD DOWN.

>> I SUPPOSE.

IF BY KEEPING FOOD DOWN YOU MEAN SOMETHING LIKE VOMITING.

SOMETIMES IF YOU’RE GETTING A LOT OF FERMENTING, A LOT OF GAS BUILDUP IN YOUR SMALL INTESTINE OR YOUR STOMACH, THAT DISTENTION CAN MAKE YOU FEEL NAUSEOUS.

OR YOU COULD BE HAVING SOME REGURGITATION AS WELL.

ALMOST AN ACID REFLUX WHERE THE FLUID FROM THE STOMACH IS COMING UP.

>> ANYTHING TO ADD?

>> MAYBE WE SHOULD SAY THAT MOTILITY DISORDERS HAVE A TENDENCY TO MAKE ONE BELCH.

IF FOR EXAMPLE YOU ARE NOT MOVING, YOUR FOOD CONTENT IS NOT GOING THROUGH YOUR INTESTINE FAST ENOUGH.

IF YOU HAVE A PROBLEM WITH THE LITTLE MUSCLE THAT KEEPS YOUR FOOD FROM REGURGITATING.

THERE ARE SO MANY THINGS.

THAT IS WHAT MAKES MEDICINE FUN.

IT IS LIKE A PUZZLE EVERY TIME.

>> HOW CAN I PROTECT MYSELF FROM GETTING NOROVIRUS?

>> FIRST AND FOREMOST, WASH YOUR HANDS.

FOR A FULL AMOUNT OF TIME.

LONGER THAN YOU THINK YOU NEED TO.

IF YOU DO THAT FREQUENTLY, EVERY TIME YOU’RE OUT OR TOUCHING DOORKNOBS, YOU WILL REDUCE YOUR RISK SUBSTANTIALLY.

IF YOU HAVE DIARRHEA, PLEASE DO NOT GO OUT AND DO THINGS THAT INVOLVE TOUCHING FOOD OR INTERACTING WITH OTHERS BECAUSE YOU WILL BE A TYPHOID MARY AND SPREAD IT EVERYWHERE.

IT IS CARRIED INFECTIOUS.

A LOT OF HANDWASHING AND BEING MINDFUL.

>> THANK YOU.

CAN YOU TELL US WHAT SOME NON-BUT THIS LITTLE TREATMENTS FOR KIBS -- IBS MIGHT BE?

>> I THINK WE ALL CAN ANSWER AND CONTRIBUTE TO THIS ONE.

>> FIRST OF ALL, WHAT IS IT?

>> THAT IS THE OLD TERM, ACTUALLY.

WE LOVE TO CHANGE NAMES A LOT IN MEDICINE.

IT STANDS FOR IRRITABLE BOWEL SYNDROME.

NOW WE CALL IT FUNCTIONAL BOWEL SYNDROME.

YOU JUST WANT TO BE CAREFUL ABOUT LIMITING YOUR ALCOHOL INTAKE.

SOMETIMES YOUR CAFFEINE.

YOU CERTAINLY WANT TO EAT FRESH FOODS, COOK THEM THOROUGHLY.

IF A FOOD BOTHERS YOU, AVOID IT.

DRINK A LOT OF WATER.

I AM TRYING TO THINK.

>> THINGS LIKE FIBER CAN BE VERY HELPFUL IF IT IS THE RIGHT KIND OF FIBER.

PEOPLE SAY JUST TAKE MORE FIBER.

BUT UP -- NOT ALL FIBERS ARE CREATED EQUAL.

THERE ARE SOME THAT ARE MORE SOLUBLE.

SOME OF THOSE CAN BE REALLY HELPFUL.

IT IS SOLUBLE IN WATER.

IT DOES NOT FERMENT A BUNCH.

I CAN REALLY HELP SOME OF THE SYMPTOMS.

>> WHAT IS THE COMMON NAME FOR PSYLLIUM HUSK?

>> THEY ARE BRAND NAME’S.

>> THAT IS GOOD.

THANK YOU FOR NOT SAYING THE BRAND NAME.

HOW DO YOU TREAT, MANAGE, OR PREVENT PHANTOM GALLBLADDER PAINS?

THEY HAD IT TAKEN OUT SEVEN YEARS AGO.

IS THERE A WAY TO HELP WITH THAT PHANTOM PAIN?

>> SOMETIMES WHAT I HAVE FOUND IS THE PAIN THAT IS LEFT OVER CAN BE FROM SOME OF THE SCARRING OF THE SURGERY.

SOMETIMES MASSAGE OF THAT AREA.

IF YOU ARE HAVING CONTINUING PAIN AFTER A GALLBLADDER REMOVAL , IT CAN STILL BE A GOOD IDEA TO GET SOME WORK DONE.

YOU CAN SO GET GALLSTONES THAT WERE LEFT BEHIND.

THAT CAN CAUSE SOME PAIN.

THAT IS SOMETHING YOU WOULD WANT TO BRING UP WITH YOUR PRIMARY CARE DOCTOR.

YOU COULD AT LEAST GET AN ULTRASOUND TO MAKE SURE THERE IS STILL NOT ANYTHING LEFT OVER.

SOMETIMES THOSE GALLSTONES CAN REFORM.

>> THANK YOU.

THIS IS LOWERMGI BUT I THINK YOU CAN HANDLE IT.

WHAT ARE SOME EFFECTIVE TREATMENTS FOR MY CONSTIPATION?

>> NONPHARMACEUTICAL WAYS ARE A GREAT PLACE TO START.

A LOT OF CONSTIPATION FOR US AS AMERICANS, IT IS LIFESTYLE.

NOT ENOUGH OF CERTAIN TYPES OF FIBERS.

ACTIVITY LEVEL IS A BIG ONE.

WE DON’T GET ENOUGH AEROBIC ACTIVITY.

IT DOES NOT HAVE TO BE VERY INTENSE.

JUST DOING A GOOD JOB OF STIMULATING THE GET.

-- GUT.

GOOD HYDRATION IS ANOTHER ONE.

EAT A LOT OF FRUITS AND VEGETABLES.

A LOT OF CONSTIPATION WILL GO BY THE WAYSIDE.

>> ARE PEOPLE IN GENERAL EATING TOO MUCH JUNK FOOD?

[LAUGHTER] >> IS THAT A TRICK QUESTION?

>> MAYBE OUR MED STUDENTS ASKED THIS IN.

>> THAT IS A FAIR QUESTION.

>> IS A GOOD ONE.

.

>> IT DEPENDS ON THE PERSON.

SOME PEOPLE ARE VERY HEALTHY EATERS BUT THE REALITY IS WE DO NOT EAT VERY WELL.

WE ARE OFTEN ON THE RUN.

WE PUT OURSELVES LAST.

WHATEVER IT IS.

I HAVE LIVED A BUSY LIFESTYLE IS A HOCKEY MOM AND I CANNOT DENY THAT I HAVE GONE THROUGH A DRIVE THROUGH A TIMER TO.

WE COULD ALL DO BETTER.

PREPARING FOOD AHEAD OF TIME.

THINKING THROUGH THE PROCESS.

WHAT CAN I DO TO PREPARE MYSELF FOR THE DAY SO I CAN EAT WELL?

EAT THE RAINBOW.

INCLUDE A LOT OF VEGETABLES.

TRY TO GET FIVE IN A DAY.

AND FRUITS.

AND OTHER TYPES OF FIBER.

AND LAST WOULD BE MEETS, ESPECIALLY RED MEATS.

IF YOU CAN GO VEGETARIAN, THAT IS THE BEST WAY TO GO, BUT THAT IS NOT FOR EVERYONE.

I WOULD DEFINITELY SAY WE ARE NOT REAL GOOD EATERS.

>> I THINK WE NEED TO GIVE OURSELVES A BREAK.

PEOPLE WOULD GET DOWN ON THEMSELVES.

PEOPLE ARE VERY BUSY.

MY DAUGHTER THE OTHER DAY GREW UP IN AN INTEGRATING’S HOUSEHOLD.

WE DID NOT HAVE ENOUGH JUNK FOOD AROUND.

THAT IS ONE WAY TO THINK ABOUT IT, NOT HAVING THOSE FOODS AVAILABLE.

BUT WE ARE ALL BUSY.

>> TOMORROW IS ALWAYS A NEW DAY.

>> TOMORROW IS VALENTINE’S DAY, SO THAT IS ANOTHER STORY.

[LAUGHTER] THAT IS OK. CAN YOU EXPLAIN AUTOIMMUNE PANCREATITIS?

>> IT IS ESSENTIALLY THE BODY’S IMMUNE SYSTEM THAT IS ATTACKING THE TISSUE THAT MAKES OF THE PANCREAS.

THERE IS A LOT OF DIFFERENT TYPES OF PANCREATITIS.

YOU CAN GET IT FROM GALLSTONES, ALCOHOL.

THOSE OF THE MOST COMMON.

SOME MEDICATIONS CAN CAUSE IT.

ALL OF THESE ARE THINGS THAT CAUSE INFLAMMATION WITHIN THE TISSUE OF THE PANCREAS.

AS THAT TISSUE STARTS TO BREAK DOWN, SOME OF THE ENZYMES IN THE PANCREAS ACTIVATE THEMSELVES AND YOU GET THIS CASCADE OF INFORMATION.

FOUR AUTOIMMUNE, THE BODY’S IMMUNE SYSTEM IS STARTING THIS CASCADE OF INFLAMMATION.

THAT IS CREATING THE PANCREATITIS.

>> HOW IS IT TREATED?

>> NORMALLY WITH STEROIDS OR A WAY TO SUPPRESS THE IMMUNE SYSTEM.

>> THANK YOU.

WHAT IS A HIATAL HERNIA?

HOW CAN YOU MANAGE IT?

>> THEY ARE ESSENTIALLY THE DIAPHRAGM IS A BARRIER BETWEEN OUR THORACIC AREA AND THE ABDOMEN.

A HERNIA IS A SLIPPING OF SOME OF THE INTERNAL NONSENSE OF THE BODY THROUGH A LAYER OF MUSCLE.

IN THIS CASE THE MUSCLE IS THE DIAPHRAGM.

THE TISSUE GOING UP IS THE ESOPHAGUS OR THE STOMACH.

A LOT OF THEM ARE ASYMPTOMATIC.

SOMETIMES THERE IS THINGS LIKE REFLEX HAPPENING.

AND THERE CAN BE MORE SERIOUS ONES.

>> ANYTHING TO ADD?

>> IT IS OFTEN VERY COMMON TO SEE THESE.

A LOT OF PATIENTS GET CONCERNED.

THEY WILL SHOW ME THEIR REPORTS AND SAY I HAVE THIS DONE AND IT SHOWS THAT I HAVE A HERNIA.

A LOT OF PEOPLE ARE THINKING, CAN I SEE IT?

IS THERE A BULGE COMING OUT SOMEWHERE?

NO BUT IT CAN CAUSE SYMPTOMS OF REFLUX.

ONCE THEY GET TO A CERTAIN SIZE THEY CAN CAUSE OTHER SYMPTOMS BECAUSE THEY ARE UP NEAR YOUR LUNGS.

SOME PEOPLE START GETTING SHORTNESS OF BREATH.

WITH A PREVIOUS PROGRESS A CERTAIN AMOUNT, THAT IS WHEN WE CONSIDER SURGERY.

>> WHAT IS BARRETT’S ESOPHAGUS AND DOES ALWAYS LEAD TO CANCER?

>> HOPEFULLY NOT.

IT IS WHEN THE LIGHTING OF THE ESOPHAGUS CHANGES FROM THE NORMAL LIGHTING INTO A PRECANCEROUS LINING.

THAT CAN BE DIAGNOSED WITH YOUR FRIENDLY GASTROENTEROLOGIST.

USUALLY A BIOPSY IS PERFORMED TO LOOK AT THE TISSUE AND SEE IF IT IS NORMAL-LOOKING.

WHEN A PERSON HAS IT, WE CERTAINLY WANT TO MAKE SURE WE ARE DECREASING THEIR RISK OF THAT BECOMING CANCER.

WE WILL MINIMIZE THE ACID EXPOSURES SO WE WILL HAVE THEM ON ACID SUPPRESSING MEDICATIONS.

I WOULD RATHER NOT BE A PILL PUSHER IF I DO NOT HAVE TO BE.

WEIGHT LOSS IS SO IMPORTANT.

LOSING WEIGHT WOULD BE HELPFUL WITH THIS CONDITION.

SURVEYING THE SITUATION TO MAKE SURE THAT IT IS NOT PROGRESSING FOR SOMEONE WHO HAS A SEVERE CASE.

>> I ALWAYS MAKE SURE IF PARENTS HAVE THAT THAN THEY ARE NON-SMOKING.

SMOKING REALLY CONTRIBUTES TO THE PROGRESSION.

IF YOU CAN QUIT SMOKING, YOU WILL REALLY HELP YOUR CHANCES OF EVERYTHING.

>> THIS PERSON HAS A FOLLOW-UP QUESTION.

HOW OFTEN DO THEY HAVE TO GET CHECKED FOR THAT?

>> IT DEPENDS ON A LOT OF THINGS.

WE TALK ABOUT IT BEING A SHORT OR LONG SEGMENT.

NORMALLY WE HAVE YOU COMING BACK EVERY THREE YEARS.

AND WE ARE TAKING BIOPSIES.

THE QUESTION BECOMES MUCH CLOSER SURVEILLANCE.

MAYBE TALKING ABOUT TRYING TO CAUTERIZE IT.

>> THESE QUESTIONS HAVE TO DO WITH ACID REFLUX.

WHAT CAN YOU DO FOR IT?

CAN YOU EXPLAIN WHAT THOSE ARE?

>> I WILL TRY TO MAKE IT SIMPLE.

IT TAKES ACID AND NEUTRALIZES IT.

SIMPLY PUT.

THEY ARE USUALLY STRONGER MEDICATIONS THAT CAN BE USED FOR MORE SEVERE CASES.

MORE MILD CASES CAN USE THE H2 BLOCKERS.

WE SHOULD THINK ABOUT THE DIFFERENCES BECAUSE THEY ARE THINGS THAT HAPPEN WHEN YOU’RE ON THESE MEDICATIONS FOR THE LONG-TERM.

THAT IS SOMETHING I THINK ABOUT A LOT.

ESPECIALLY IF THEY HAVE LOST A LOT OF WEIGHT OR QUIT SMOKING.

WHATEVER IT IS.

MAYBE THERE REFLEX IS GONE.

>> THANK YOU FOR THAT.

WHAT WARRANTS AN ENDOSCOPY?

>> FROM MY SIDE OF THINGS, THERE CAN BE A NEED FOR AN EMERGENT ENDOSCOPY.

MAYBE THEY HAVE DARKER STOOLS.

WE CAN SOMETIMES SEE THAT.

THERE ARE MANY DIFFERENT REASONS.

>> ANYTHING TO ADD?

>> I WOULD AGREE.

THERE ARE A LOT OF REASONS TO DO ENDOSCOPY.

IT IS ALSO PART OF THE DIAGNOSIS FOR THINGS LIKE SCENIAK DISEASE.

-- CELIAC DISEASE.

YOU CAN ALSO TAKE A PICTURE WITH A CT SCAN.

PEOPLE WHO HAVE TROUBLE SWALLOWING, THAT IS WHAT I DO ENDOSCOPY’S FOR SOMETIMES.

A LOT OF TIMES IT CAN BE PEOPLE SWALLOWING.

>> ONE MORE, CAN NIGHTTIME REFLEX CAUSE A STICKY FILM IN YOUR MOUTH IN THE MORNING?

>> IT CAN.

PEOPLE CAN WAKE UP COUGHING OR HAVE A SOUR TASTE IN THEIR MOUTH.

I WOULD NOT SAY THAT IS DIAGNOSTIC.

I COULD SEE THAT BEING ONE OF THE SYMPTOMS.

>> WHAT ARE NONMEDICAL THINGS YOU CAN DO FOR ACID REFLUX?

>> YOU CAN MAKE YOUR BED A SLOPE.

YOU CAN QUIT SMOKING.

YOU CAN LOSE WEIGHT.

YOU CAN AVOID FOOD THAT CAUSES SYMPTOMS.

THAT WOULD BE THINGS THAT ARE NOT MEDICATION THAT YOU CAN DO.

WITHOUT EVEN GOING TO THE DOCTOR.

>> WE MIGHT RUN OUT OF TIME.

HOW CAN YOU DISTINGUISH BETWEEN REFLUX PAIN AND CHEST PAIN?

>> THAT IS CHALLENGING BECAUSE YOU CAN VERY SIMILAR SENSATIONS.

IF PAIN COMES FROM EXERTING YOURSELF, THAT IS USUALLY NOT THE STOMACH.

THAT IS A LITTLE MORE ALARMING.

>> ANYTHING ELSE TO ADD?

>> SOMETIMES YOU CAN RULE OUT OUR PROBLEMS.

ALWAYS THE HEART FIRST IS WHAT WE SAY.

HEART PROBLEMS ARE GOING TO HURT YOU.

>> YOU CAN RULE IT OUT.

WE CAN RULE OUT THAT YOU ARE NOT HAVING A HEART ATTACK.

>> TREATMENT FOR ACID REFLUX IN INFANTS?

>> WE DON’T HAVE A PEDIATRICIAN.

>> ONE THING I HAVE NOTICED IS YOU DON’T WANT TO MISS THAT DIAGNOSIS.

>> FREQUENT SMALLER FEEDS >> IS A BIG ONE THAT THEY MENTIONED.

THANK YOU.

I WANT TO THANK OUR PANELISTS, DOCTOR JONATHAN GAPP, DOCTOR KRISA KEUTE, AND DOCTOR DYLAN WYATT AND OUR MEDICAL STUDENT VOLUNTEERS: OLIVIA HOFF, JOCELYN LARSON AND ALISON PULST.

PLEASE JOIN DOCTOR RAY CHRISTENSEN NEXT WEEK FOR A PROGRAM ON “LOWER GI PROBLEMS” WHEN HIS PANELISTS WILL BE DOCTOR RYAN HARDEN, DOCTOR PAUL SANFORD AND DOCTOR SANDY STOVER.

THANK YOU FOR WATCHING.

GOOD NIGHT!

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