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>> HEARTBURN AND MORE, NEXT, "ON CALL WITH THE PRAIRIE DOC."
GOOD EVENING AND WELCOME TO ON CALL WITH THE PRAIRIE DOC.
TONIGHT WE'LL BE FOCUSING ON THE UPPER DIGESTIVE OR GASTROINTESTINAL
SYSTEM, ESSENTIALLY FROM YOUR MOUTH TO YOUR INTESTINES OR EVERYTHING IN-BETWEEN.
CONDITIONS AND DISEASES OF THE ESOPHAGUS, STOMACH, THE BEGINNING OF THE SMALL
INTESTINE CALLED THE DUODENUM CAN BE COMPLEX. THE DIAGNOSIS MAY REQUIRE
SPECIALIZED TESTING AND TREATMENT MAY EVEN REQUIRE MORE COMPLEX OPTIONS.
TO LEARN MORE, STAY TUNED. BUT FIRST, LET'S TAKE A LOOK AT THIS WEEK'S PRAIRIE DOC QUIZ QUESTION.
TONIGHT YOU HAVE TO CHOOSE THE BEST ANSWER. WHEN REFLUX OF STOMACH ACID UP
INTO THE LOWER PART OF THE ESOPHAGUS HAPPENS TOO OFTEN AND FOR TOO MANY YEARS, THE TISSUE
CHANGES IN THE ESOPHAGUS, RESULTING IN... MORE BURNING SYMPTOMS OR LESS BURNING SYMPTOMS.
CHOSE THE BEST ANSWER, MORE. OR LESS?
VIEWERS WHO CALL IN THE CORRECT ANSWER WILL BE ENTERED INTO A DRAWING TO WIN A SIGNED COPY OF
OUR BOOK, "THE PICTURE OF HEALTH." EACH OF MY ESSAYS, ORIGINALLY
WRITTEN FOR THIS SHOW, COMES WITH A WONDERFUL ACCOMPANYING PHOTOGRAPH BY DR. JUDITH PETERSON.
WE WILL ANNOUNCE THE ANSWER AND THE WINNER AT THE END OF THE SHOW.
REMEMBER, YOU ONLY HAVE 10 MINUTES TO GET YOUR ANSWER IN! BUT ANY TIME WE CAN ANSWER YOUR
MEDICAL QUESTIONS. WE ANSWER YOUR MEDICAL QUESTIONS ABOUT THE UPPER
DIGESTIVE SYSTEM AS THEY ARE CALLED IN OR SENT TO US VIA FACEBOOK OR EMAIL.
CALL IN QUESTIONS TO 1-888-376-6225. OR SEND US AN EMAIL TO THE ADDRESS ON THE SCREEN.
JOINING US TONIGHT FROM. THE USD-SANFORD SCHOOL OF MEDICINE IS DR. TIM RIDGWAY.
THANK YOU FOR JOINING US, TIM. >> THANK YOU FOR HAVING ME, RICK.
>> YOU'RE FROM THE BIG CITY OF WHAT NOW? >> I'M FROM AN OBSCURE LITTLE
TOWN CALLED RAVINIA, SOUTH DAKOTA. >> WHICH IS WHERE? >> BETWEEN WAGNER AND LAKE
ANDES, BY THE DAM IN PICKSTOWN -- >> A LITTLE TOWN SOUTH DAKOTA GUY.
>> A SMALL-TOWN SOUTH DAKOTA BOY. >> AND YOU DID MED SCHOOL --
>> I DID MY MEDICAL SCHOOL AT THE UNIVERSITY OF SOUTH DAKOTA, SCHOOL OF MEDICINE.
>> AND THEN YOU WENT TO -- >> I WENT TO MAYO CLINIC AND DID MY INTERNAL MEDICINE AND
GASTROENTEROLOGY TRAINING THERE. >> AND YOU CAME BACK TO SOUTH DAKOTA?
AND I HAD A FULL-TIME PRACTICE FOR A NUMBER OF YEARS AND THEN
ABOUT TEN YEARS AGO, THE MEDICAL SCHOOL OFFERED ME DID MY TRAINING THERE AND STILL DO
ENDOSCOPY THERE BUT I STILL ENJOY THE MEDICAL SCHOOL, FUNCTIONING AS AN EXECUTIVE
DEAN, DEAN OF FACULTY AFFAIRS, MEANING I OVERSEE ALL THE FACULTY ACTIVITIES BUT THE
FUNNEST PART IS STILL BEING INVOLVE WITH STUDENTS AT EVERY LEVEL AND IT'S VERY, VERY
REWARDING. >> AND AT THE SAME TIME, THIS YEAR YOU'RE THE PRESIDENT --
>> SOUTH DAKOTA STATE MEDICAL ASSOCIATION. >> TELL US ABOUT THAT.
>> IT'S BEEN A VERY, VERY BUSY YEAR BUT A WONDERFUL YEAR. AS I WAS TELLING SOME OF OUR
UNDERGRAD STUDENTS TONIGHT BEFORE THE SHOW THE FUNNEST PART HAS BEEN GOING AROUND THE STATE
AND TALKING TO THE DOCTORS AND YOU KNOW THIS AND I KNOW IT BUT I THINK OUR VIEWERS NEED TO KNOW IT.
WE HAVE SOME WONDERFUL PEOPLE IN THE STATE OF SOUTH DAKOTA TAKING CARE OF OUR CITIZENS AND
THEY CARE, THEY CARE ABOUT THEIR PATIENTS, THEY CARE ABOUT THEIR COMMUNITIES AND THEY'RE
WOULD YOU FEEL ROLE MODELS FOR OUR STUDENTS. >> WELL, WE THANK YOU FOR THIS.
WHEN WE TALKED ABOUT DOING THIS SHOW ABOUT A YEAR AGO OR SIX MONTHS AGO, WE WERE GOING TO
HAVE CHRISTINA HILL ON THE SHOW. SHE UNFORTUNATELY IS ON CALL, COULDN'T SWITCH IT SO WE'RE
JUST STUCK WITH JUST YOU. >> THEY'RE STUCK WITH US, YOU AND I.
[ Laughter ]
>> AND I MUST SAY THAT YOU'RE A HAND SOME GUY BUT CHRISTINA HILL-JENSEN KIND OF TAKES THE CAKE.
>> MY SON SAID THAT TO ME, HE SAID, YOU KNOW, NOT THAT I DON'T LIKE YOU, DAD, BUT
WHERE'S Dr. HILL-JENSEN. SHE IS A BEAUTIFUL LADY, INSIDE AND OUT, YOU KNOW WHAT I MEAN? >> ABSOLUTELY.
>> BUT WE'RE GOING TO TALK MOSTLY ABOUT THE UPPER SYSTEM. NOW, TELL US WHAT A NORMAL UPPER G.I. TRACT.
>> I THINK FOR OUR VIEWERS, IF WE GO TO THE TELESTRATOR AND WE CAN DESCRIBE HOW IT WORKS WHEN
YOU SWALLOW FOOD, I THINK THAT'S A GREAT EXAMPLE. >> YOU'VE GOT TEETH THERE.
>> YOU'VE GOT TEETH AND SO THE FOOD, BOLUS, WILL ENTER AND IT WILL HIT THE ESOPHAGUS HERE.
NOW, WHAT THE ESOPHAGUS IS DESIGNED TO DO IS SIMPLY TO PROPEL AND ALLOW THE FOOD, SO
IT RELAXES AND ALLOWS THE FOOT TO COME INTO THE STOMACH. THAT'S WHEN EVERYTHING STARTS TO HAPPEN.
WHEN FOOD CONTRACTS AND HITS THE STOMACH, YOU HAVE ACID PRODUCING CELLS THAT KICK IN
HUGE AMOUNTS OF GASTRIC ACID, WHICH AIDS IN THE DIGESTION OF FOOD.
THE STOMACH IS DESIGNED TO BASICALLY JUST MIX BACK AND FORTH, BACK AND FORTH.
IT JUST COMPLETELY GRINDS THIS FOOD INTO SMALL, TWO TO THREE-MILLIMETER PARTICLES
WHICH THEN EMPTY INTO THE DUODENUM, WHICH IS RIGHT HERE AND THE REST OF THE SMALL INTESTINE.
NOW, A KEY POINT AND WE'LL TALK ABOUT ACID REFLUX TONIGHT. ONCE THE FOOD HITS THE STOMACH,
YOU HAVE MUSCLES HERE, DIAPHRAGMS, AND YOU HAVE AN INTERNAL SPHINCTER MUSCLE
CALLED THE LOWER ESOPHAGEAL SPHINCTER. THIS MUSCLE IN NORMAL CONDITIONS TIGHTENS.
WHY? SO THAT ACID THAT IS PRODUCED IN LARGE QUANTITIES STAYS WHERE IT'S SUPPOSED TO.
ACID WAS NOT DESIGNED TO COME INTO THE ESOPHAGUS AND WHEN IT DOES, THAT'S WHAT CREATES A LOT
OF THE ISSUES THAT I SUSPECT WE'RE GOING TO BE TALKING ABOUT TONIGHT AND, FRANKLY, MAYBE OUR
VIEWERS HAVE QUESTIONS ABOUT. >> SO WHEN A PERSON SWALLOWS, THERE IS A COMBINATION OF
ACTION THAT HAPPENS WITH THE TONGUE AND SO ON. EXPLAIN THAT A LITTLE BIT.
>> IT'S VERY COMPLEX BUT THE TONGUE BASICALLY PROPELS FOOD AND ALLOWS THE FOOD TO ENTER
HERE, AND THEN THERE'S AN AIRWAY HERE. YOUR BREATHING TUBE IS HERE. >> YOU GOT TO PUSH --
>> SO THE BREATHING TUBE IS HERE, THIS IS A VALVE THAT HELPS TO CLOSE OFF THAT BREATHING TUBE.
>> THAT'S THE EPIGLOTTIS. [OVERLAPPING CONVERSATIONS] >> AND THAT MEANS FOOD CAN ONLY ENTER THE ESOPHAGUS.
>> SHOW US WHERE THE EPIGLOTTIS IS. >> RIGHT HERE. SO WHEN WE SWALLOW, IT CLOSES,
PROTECTS YOUR BREATHING TUBE SO FOOD CAN ONLY GO IN THE ESOPHAGUS.
BUT AS WE GET OLDER OR IF YOU'VE HAD A STROKE OR OTHER NEUROLOGIC CONDITIONS,
SOMETIMES THAT MECHANISM DOESN'T WORK WELL AND FOOD CAN ACCIDENTALLY ENTER THE
BREATHING TUBE AND THAT'S WHAT WE CALL ASPIRATION. IT DOESN'T LIKE IT AND WE
COUGH, WE SPUTTER, WE CHOKE, AND SOMETIMES IT CAN EVEN SET UP PNEUMONIAS, AS PEOPLE GO.
WE CHEW WITH OUR TEETH. THE TONGUE IS USED TO PROPEL THE FOOD TO THE BACK AND THEN
IT SENSES THE FOOD, THE AIRWAY SHUTS TIGHT AND THE FOOD ENTERS THE ESOPHAGUS WHERE THE
ESOPHAGUS THEN USES ITS RELAXATION CAPABILITIES TO ALLOW THE FOOD TO ENTER INTO THE STOMACH.
>> RIGHT, SO THIS ESOPHAGUS, THERE'S THREE DIFFERENT KINDS -- LEVELS OF ESOPHAGUS.
WHAT KINDS OF MUSCLES -- >> THAT'S CORRECT. YOU KNOW, WE HAVE SOMETHING WE
CALL SMOOTH MUSCLE WHICH IS IN THE LOWER PART OF THE ESOPHAGUS, AND THEN UP HIGH, WE
HAVE SOMETHING CALLED SKELETAL MUSCLE. NOW, THE DIFFERENCE IS, IF YOU'VE GOT A MUSCLE CONDITION,
CERTAIN MUSCLE CONDITIONS, ITS CAN AFFECT THE SKELETAL MUSCLE WHICH WILL GIVE YOU SWALLOWING PROBLEMS.
AND APPROPRIATELY TRAINED INDIVIDUALS CAN RECOGNIZE THAT. WHEREAS, THERE ARE OTHER
CONDITIONS THAT AFFECT THE SMOOTH MUSCLE OF THE ESOPHAGUS, A CLASSIC ONE IS SCLERODERMA.
>> THAT'S DOWN IN HERE. >> THAT'S DOWN IN THERE, AND THAT SMOOTH MUSCLE CAN - IT
JUST LAYS THERE, IT'S NOT PROPELLING FOOD. THIS MUSCLE WE TALKED ABOUT --
>> THIS LOWER ESOPHAGEAL SPHINCTER -- >> IS RELAXED, SO ACID IS ALLOWED TO GO FREELY UP INTO IT
IS ESOPHAGUS AND THE ESOPHAGUS CAN'T CLEAR IT BECAUSE IT HAS NO MOTOR FUNCTION AND THESE
PATIENTS GET HORRIBLE ULCERATIONS OF THEIR ESOPHAGUS, GET SCARRING AND STRICTURES OF THE ESOPHAGUS.
IT'S MISERABLE. >> OKAY. WHAT ABOUT THE PROPULSION OF FOOD DOWN? WHAT ABOUT THIS PROPULSION?
>> AS WE GET OLDER, SOMETIMES THAT MECHANISM GETS A BIT DYSFUNCTIONAL, AND IF YOU DID
AN EXTRACTION, WHAT YOU MIGHT SEE IS INSTEAD OF A STRAIGHT TUBE, YOU WOULD SEE THIS KIND
OF A PICTURE IN THE ESOPHAGUS, WHICH BASICALLY, IT'S JUST ISN'T COORDINATED WELL AND SO
SOMETIMES AS WE GET OLDER, IT CAN BE A LITTLE MORE DIFFICULT TO SWALLOW FOOD.
>> THAT CORKSCREWING OR -- IT HAS NOTHING TO DO WITH PRESBYTERIAN CHURCH BUT THEY
CALL IT PRESBY ESOPHAGUS, MEANING OLD, I THINK. >> CORRECT, CORRECT.
>> WE'VE GOT A QUESTION. THIS CAN LEAD INTO SYMPTOMATIC -- WOMAN FROM
ABERDEEN, AS FAR AS SYMPTOMS GO, DO YOU NEED TO HAVE INDIGESTION TO HAVE REFLUX?
>> THE ANSWER IS NO. THERE ARE CERTAIN INSTANCES WHERE PEOPLE WILL NOT HAVE
INDIGESTION, THEY WILL NOT DESCRIBE TO ME CLASSIC HEARTBURN AND, YET, THEY WILL
COME IN, SOMETIMES EVEN BLEEDING AND WE TAKE A LOOK INTO THEIR ESOPHAGUS AND IT'S
HORRIBLE, ULCERATED. WITH INDIGESTION, WHAT DO WE LOOK FOR, WELL, AS YOU SAW ON
THE SCREEN, GNAWING STOMACH PAIN, HEARTBURN WHICH IS A TERM THAT MEANS SOMETHING TO A LOT
OF DIFFERENT PEOPLE BUT IT'S BASICALLY A BURNING SENSATION ANYWHERE IN THE CHEST, WHERE
THE ESOPHAGUS LIES. UPSET STOMACH OR NAUSEA, BURPING CAN BE VERY, VERY
COMMON WHETHER PEOPLE HAVE REFLUX OR NOT, IT'S AN INDEPENDENT THING.
BUT THE PERSON FROM ABERDEEN SAID, DO YOU ALWAYS HAVE THIS BURNING SENSATION IF YOU HAVE
ACID REFLUX, THE ANSWER IS NO. PEOPLE HAVE DIFFERENT THRESHOLDS OF SENSITIVITY.
>> SO THEY CAN HAVE THE REFLUX AND NO SYMPTOMS AT ALL. SO THE INDIGESTION IS A BROAD WORD.
>> VERY BROAD, IT DOES NOT JUST MEAN ACID REFLUX. >> GALLBLADDER DISEASE.
>> ANYTHING IN THE UPPER INTESTINAL TRACT INCLUDING THE GALLBLADDER, THE PANCREAS,
THOSE ORGANS SO A VERY BROAD TERM AND NONSPECIFIC. WHEN WE GET QUESTIONS ABOUT
ACID INDIGESTION, I SAY TELL ME MORE, I TRY GET MORE SPECIFIC ANSWERS.
>> ONE OF THE BIG QUESTIONS BACK IN THE '70s WAS, I HAVE A HIATAL HERNIA, BUT I SAID DO
MANY PEOPLE WITH THAT HERNIA HAVE NO HEARTBURN, REFLUX, NO SYMPTOMS, NO PROBLEM AND THERE
ARE PEOPLE WHO HAVE NO HIATAL HERNIA THAT HAVE LOTS OF TROUBLE. EXPLAIN THAT.
>> HIATAL HERNIA IS VERY PREVALENT, YOU PROBABLY HAVE ONE, I MAY HAVE ONE.
IS THAT A BAD THING IS IN THE ANSWER IS NO, SO WHAT IS A HIATAL HERNIA.
>> YEAH, ERASE THAT AND... >> BASICALLY, WHEN WE BREATHE IN AND OUT, THE DIAPHRAGM MOVES OUR CHEST.
THEY SEPARATE THE CHEST FROM THE ESOPHAGUS. BUT IN A HIATAL HERNIA, WHAT
HAPPENS IS THAT PART OF THE STOMACH IS ABOVE THE DIAPHRAGM. SO WHAT CAN HAPPEN IS, YEAH,
SOMETIMES THAT LEAD TO A LOOSE MUSCLE AND MORE ACID CAN COME UP BUT MANY PEOPLE WILL HAVE
THIS DIAPHRAGMIC HERNIA, IT DOES NOT CAUSE ANY SYMPTOMS OR REFLUX, IT'S NORMAL AND I
ALWAYS TELL PATIENTS WHEN WE DIAGNOSE IT, THEY SAY DO I NEED TO DO SOMETHING ABOUT IT?
THE ANSWER IS MOST OFTEN NOT. >> NOW, IS THERE A -- LET'S SAY YOU HAD REFLUX WITH YOUR
HIATAL HERNIA, WOULD YOU EVER REPAIR IT BY BRINGING IT DOWN? >> I GET ASKED THAT QUESTION A LOT, TOO.
IN MOST INSTANCES, THE ANSWER WOULD BE NO, AND THE SIMPLE REASON IS WE CAN CONTROL THAT
ACID REFLUX WITH LIFESTYLE MODIFICATION AND MEDICATIONS WHICH ARE BY AND LARGE VERY SAFE.
IF YOU HAVE HORRIBLE REFLUX THAT CANNOT BE CONTROLLED ADEQUATELY WITH LIFESTYLE AND
WITH MEDICATIONS, THE ANSWER IS YES, YOU CAN DO A SURGICAL PROCEDURE WHERE THIS PART OF
THE STOMACH IS PULLED BACK DOWN BELOW THE DIAPHRAGMS AND THEN THE SURGEON WILL DO A WRAP, WE
CALL IT, A NISSAN WRAP IS THE MOST COMMON WHERE PART OF THE STOMACH IS WRAPPED AROUND THIS
AREA TO RESTORE THAT TIGHT MUSCLE. IT'S AN EFFECTIVE SURGERY IN APPROPRIATELY INDICATED
PATIENTS, BUT MOST PATIENTS DO NOT NEED IT, AND IT IS A BIG OPERATION. >> RIGHT.
AND I'VE HEARD ALSO THAT, YOU KNOW, WHEN YOU DO A GOOD WRAP AND YOU KEEP THE ACID REFLUX
FROM OCCURRING, 50% IN A YEAR ARE GOING TO HAVE REFLUX AGAIN ANYWAY AND STILL HAVE THEM --
>> ABSOLUTELY. THERE IS A WELL-DONE V.A. STUDY, WE LOOKED AT FIVE YEARS OUT AND OVER 70% WERE
BACK ON MEDICATIONS. SO I ALWAYS TELL PATIENT WE WANT TO BE VERY, VERY CAREFUL.
WE WANT TO HELP BUT WE DON'T WANT TO RUSH TO THIS AND THEN THEY COME BACK A YEAR LATER AND
SAY, DOC, I GOT THE SAME SYMPTOMS AGAIN, AND A LOT OF TIMES WE'LL SEE THAT THE WRAPS
HAVE SLIPPED AND THEY'RE BACK UP. BUT, ON THE OTHER HAND, I'VE HAD PATIENTS, THEY'RE
MISERABLE, ABSOLUTELY MISERABLE AND -- >> AND -- >> THEY FAILED EVERYTHING AND
THOSE ARE GOOD CANDIDATES FOR THIS OPERATION AND IT'S VERY SUCCESSFUL WHEN YOU DO IT IN
APPROPRIATELY SELECTED PEOPLE. >> ALL RIGHT. NOW, SOME PEOPLE ASK ABOUT
GERD, GASTRO REFLUX DISEASE, HOW IS THAT DIFFERENT, GERDES, FROM LET'S SAY HEARTBURN OR HOW
DO YOU DEFINE GERD? >> WELL, I ALWAYS TELL PATIENTS, THEY'LL COME IN AND TELL ME IT'S MY GERD.
THAT MEANS DIFFERENT THINGS TO DIFFERENT PEOPLE. BUT GASTROESOPHAGEAL REFLUX
BASICALLY MEANS THAT CONTENTS ARE REFLUXING FROM THE STOMACH INTO IT IS ESOPHAGUS.
IT CAN BE A STRUCTURAL PROBLEM SUCH AS A HIATAL HERNIA. IT'S MORE COMMON IN CITIES AND
DEVELOPED AREAS, BUT THAT CAN BE A CAUSE, AS WELL. YOU CAN ALSO HAVE NON-ACID GERD
WHERE STOMACH CONTENTS BASICALLY REFLUX INTO THE CONTENTS, THEY'RE NOT ACIDIC
BUT STILL GOING UP AND A LARGE AMOUNT AND THAT CAN CREATE TROUBLE FOR PEOPLE HAVE THE
>> IF THEY HAVE GERD WHEN THEY'RE LAYING DOWN AT NIGHT, THEY'LL INHERIT IT -- INHALE IT
AND END UP WITH LUNG PROBLEMS. >> YES, THEY CAN HAVE PNEUMONIAS, WE HAVE FOUND
PEOPLE COME IN WITH PNEUMONIA REPEATEDLY AND WE DON'T UNDERSTAND WHY AND PRETTY SOON
YOU HAVE TO START LOOKING AND DIGGING FOR A POSSIBLE GERD IDEOLOGY.
>> I'VE ALSO HEARD VOCAL CHORD AND THEY END UP WITH RASPY VOICES AND YOU LOOK AT THE
VOCAL CHORDS BECAUSE YOU WANT TO MAKE SURE THEY DON'T HAVE CANCER BUT WHEN THEY DON'T HAVE
CANCER, IT LOOKS LIKE IT'S BEEN BURNED BY STOMACH ACID, YOU TREATS THEM WITH OMEPRAZOLE OR --
>> USUALLY WHEN IT'S THAT TYPE, YOU HAVE TO USE A HIGHER DOSE BECAUSE WE'VE LEARNED THE
STANDARD DOSES DON'T CONTROL THAT. >> OKAY. >> WE CAN TALK ABOUT H. PYLORI
BUT ONE OF THE QUESTIONS HAD TO DO WITH PROBIOTICS. IF YOU LOOKED AT THE TREATMENTS
FOR GERD OR REFLUX, A LOT OF THEM IS IT'S GOING TO BE A H-2 BLOCKER, A MILDER, FASTER
TREATMENTS OR THE PROTON PUMP INHIBITORS LIKE PRILOSEC OR OMEPRAZOLE THAT ARE SLOWER BUT
MORE POWERFUL BUT IT TAKES AWAY THE ACIDITY IN THE STOMACH AND, THEREFORE, INFECTIONS CAN
OCCUR, RIGHT? PNEUMONIAS. WHAT'S THE PROBLEM WITH LONG-TERM USE OF THE ACID TREATMENT MEDS?
>> YOU KNOW, PROTON PUMP INHIBITORS WE'VE BEEN USING FOR YEARS AND I ALWAYS SAY THAT ANY
MEDICINE YOU START ON SOMEBODY, YOU HAVE TO WEIGH THE BENEFIT VERSUS THE RISK.
NOW IN PATIENTS THAT HAVE RIP-ROARING ULCERS AND ARE MASSIVELY SYMPTOMATIC, CLEARLY
THAT BENEFIT IS THERE. BUT WE'VE ALSO LEARNED THERE ARE SOME CONSEQUENCES TO PROTON
PUMP INHIBITOR USE. ONE OF THE MORE COMMON ONES WE'RE SEEING NOW, PARTICULARLY
IN LONG-LONG-TERM CARE FACILITY NURSING HOMES IS A BAD DIAHERRA.
AND WE ALSO MIGHT SEE THINNING OF THE BONES AS PEOPLE GET OLDER.
THERE'S BEEN REPORTS OF A BAD RASH THAT OCCURS THAT CAN BE VERY DIFFICULT TO DEAL WITH.
AND YOU CAN GET OVERGROWTH OF BACTERIA BECAUSE BY SUPPRESSING ACID IN THE STOMACH, IT
SOMETIMES CAN ALLOW FOR AN OVERGROWTH OF OTHER TYPES OF BACTERIA THAT CAN POTENTIALLY
CAUSE PROBLEMS. NOW, I DON'T WANT TO FRIGHTEN OUR VIEWERS AND SAY THEY HAVE
TO GET OFF THEIR PROTON PUMP INHIBITOR BECAUSE WE TALKED ABOUT THE SIDE EFFECTS.
THEY'RE RELATIVELY RARE BUT WE'RE FINDING THEM MORE AND MORE.
I THINK THE KEY POINT IS, MAKING CERTAIN YOU NEED THIS DRUG. WE'VE ESTIMATED THERE MAY BE UP
TO A THIRD OF PEOPLE IN THIS COUNTRY THAT HAVE BEEN ON THESE MEDICINES FOR SO LONG AND THEY
DON'T NEED THEM. >> AND IT'S ALSO VERY HARD TO GET OFF THEM. I MEAN, IT'S SORT OF LIKE --
LET'S USE THE WORD *** FOR -- IF YOU USE ***, YOU HAVE TO GO HIGHER AND HIGHER,
IF YOU STOP IT, YOU HAVE WITHDRAWAL AND I'VE HEARD IF YOU START A PERSON THAT DIDN'T
HAVE ANY PROBLEM WHATSOEVER ON PRILOSEC OR OMEPRAZOLE FOR A MONTH AND YOU STOPPED IT, THEY
WOULD HAVE WITHDRAWAL ACIDITY. >> THEY CAN HAVE A LITTLE BIT REBOUND EFFECT AND MORE ACIDITY
AND THEN THEY THINK THEY HAVE TO HAVE IT. >> I WOULD ENCOURAGE OUR VIEWERS, IF YOUR DOCTOR PUTS
YOU ON THE MEDICINE, GREAT, BUT ASK HOW LONG YOU NEED IT. DO I STILL NEED THIS.
SOMETIMES IT WILL BE LET'S TRY THIS AND IT'S STUCK. >> BUT THEY SAY YOU HAVE TO
TAPER OFF A -- WITH A THREE-MONTH PERIODS OF TIME SO IF YOU'RE -- AND YOUR DOCTOR
SAYS, OKAY, I WOULD SAY, YOU KNOW, SKIP EVERY THIRD DOSE FOR A MONTH, EVERY OTHER DOSE FOR A
MONTH, TAKE A THIRD DOZE -- >> EVERYBODY HAS THEIR OWN TAPER -- >> DO YOU TAPER FASTER?
>> I DO USUALLY BUT I ALSO TELL PEOPLE IF YOU GET SYMPTOMS BACK, THEN WE SLOW DOWN AND I
ALWAYS TRY TO EDUCATE AND WARN THEM AND SAY -- IF YOU GET BACK AND CALL IN AND SAY I NEED THIS
DRUG NOW, I HAVE PROBLEMS, NO, LET'S TAPER IT DOWN, LET'S GO SLOWER AND USUALLY YOU'RE
SUCCESSFUL. SO I THINK THE TAKE-HOME POINT HERE IS THESE ARE WONDERFUL MEDICINES, THEY HAVE
REVOLUTIONIZED HOW WE TREAT ACID REFLUX BUT HAVING SAID THAT, THERE ARE STILL PEOPLE
THAT FRANKLY DON'T NEED 'EM AND WE NEED TO BE SURE WE GET OFF 'EM IF YOU DON'T NEED 'EM
BECAUSE THERE ARE POTENTIAL RAMIFICATIONS. >> HUGE TAKE-HOME, IS IT BETTER TO TAKE H-2 BLOCKERS LIKE THE
PEPCID AND RANITIDINE AND -- >> IF YOU CAN RESPONDS TO THOSE, GREAT.
>> A LOT OF PEOPLE DON'T HANDLE THOSE AS WELL AS THE OMEPRAZOLE.
>> WE WANT TO TALK ABOUT H. PYLORI INFECTIONS, WE WANT TO TALK ABOUT INFECTIONS IN
GENERAL, THERE, AND THAT C-DIFF INFECTION WE TALKED ABOUT EARLIER. WE WANT TO TALK ABOUT DIFFERENT
KINDS OF MEDICINES AND THEN WE ALSO NEED TO SAY, BEFORE WE GO TO THE BREAK, WHAT IS THE
INDICATION FOR A E.G.D., ESOPHAGOGASTRODUODENOSCOPY. >> WHICH I'M SURE YOU'LL
EXPLAIN TO THE VIEWERS WHAT IT MEANS, MANY OF THEM HAVE PROBABLY HAD IT.
THIS IS SOMETHING THAT'S IMPORTANT, TOO, BECAUSE NOT EVERYBODY THAT COMES IN WITH
UPPER DIGESTIVE SYMPTOMS REQUIRES AN EGD. I LOOK FOR THINGS SUCH AS ALARM SYMPTOMS.
NOW, WHAT YOU SEE THERE ON THE SCREEN IS, YOU KNOW, IF YOU'VE GOT STANDARD HEARTBURN, AND
IT'S BEEN GOING ON FOR A WHILE, UNTREATED, THAT MIGHT BE AN INDICATION TO TAKE A LOOK.
IF THE SYMPTOMS LEAVE BUT THEN THEY KEEP COMING BACK, THAT'S A WAY TO LOOK.
BUT THE BIGGER THING I LOOK FOR ARE WHAT I CALL ALARM SYMPTOMS. ONE OF THEM IS AGE OVER 50, 55.
YOU KNOW, WORSE THINGS CAN HAPPEN AS WE GET OLDER. >> YOU'RE TALKING CANCER. >> TALKING CANCER.
TROUBLE SWALLOWING, IF FOOD IS STICKING ON YOU, THAT'S AN INDICATION TO TAKE A LOOK.
IF YOU'RE LOW ON BLOOD, IF YOU'RE ANEMIC, IF THE SYMPTOMS WAKE YOU UNAT NIGHT, I ALWAYS
TELL PATIENTS, YOU KNOW, THAT'S NOT NORMAL. IF SOMEBODY TELLS ME THESE ARE
WAKING ME UP, THAT'S REAL. IS THERE WEIGHT LOSS, IS THERE UNPLANNED WEIGHT LOSS?
SO THESE ALARM SYMPTOMS ARE WHAT ALARM ME AND I WILL TEND TO WANT TO LOOK AT SOMEBODY'S
UPPER G.I. TRACT SOONER THAN LATER IF I HEAR ANYTHING. >> IT'S LIKE FALLING OFF A
LONG, THEY USE MEDICINES THAT USE -- IT'S SO EASY YOU DON'T REMEMBER THE PROCEDURE AND
THERE'S NO PROBLEM AFTERWARDS. >> IT'S VERY SAFE AND -- BY AND LARGE, VERY SAFE.
YOU SEE SOMEONE THAT'S QUALIFIED TO DO IT AND, FRANKLY, SOMETIMES IT CAN BE VERY, VERY EFFECTIVE.
>> THERE WE GO. OF COURSE WE HAVE A NUMBER OF INDICATORS THAT AID IN THE
DIAGNOSIS, SOMETIMES IT'S JUST BEST TO GO IN AND SEE WHAT THINGS LOOK LIKE. >> AN EGD IS A
ESOPHAGOGASTRODUODENOSCOPY, ALSO KNOWN AS UPPER ENDOSCOPY. WHAT IT IS IS WE'RE LOOKING AT
THE ESOPHAGUS, THE STOMACH AND FIRST PORTION OF THE SMALL M TEST TINE.
THE REASON WE DO IT ARE FOR MULTIPLE DIFFERENT THINGS. ONE OF THEM WOULD BE DYSPHAGIA,
WHICH IS DIFFICULTY SWALLOWING, IF YOU FELT LIKE SOMETHING WAS GETTING STUCK IN THE ESOPHAGUS,
UP HERE OR DOWN LOWER THAT, WOULD BE A REASON TO DO IT. SOME PEOPLE WHO HAVE REFLUX,
REFLUX IS TRIED TO BE TREATED WITH MEDICATIONS BUT ISN'T GETTING CONTROLLED WELL, THAT
WOULD BE ANOTHER REASON, OR PAIN, PAIN IN THE UPPER ABDOMEN IS A REASON, PAIN IN THE
ESOPHAGUS, SOMETIMES WHEN PEOPLE SWALLOW, THEY HAVE PAIN.
WE CAN CHOOSE BETWEEN DOING RADIOLOGY STUDIES VERSUS THE EGD FOR THOSE TYPE OF THINGS.
SOMETIMES WE START WITH THE RADIOLOGY, SOMETIMES THE EGD, DEPENDING ON WHAT'S MORE
AVAILABLE. WHAT WE'RE LOOKING FOR IS ANY EVIDENCE OF INFLAMMATION, POLYPS OR THINGS LIKE THAT.
LOOKING FOR ULCERATIONS OR EROSIONS. THE REASON WE DO THE EGD IS THERE'S POSSIBLY GOING TO BE A
CHANGE IN MANAGEMENT OF WHAT WE'RE DOING WITH THE PATIENT SO WE MAY NEED TO ADJUST
MEDICATIONS, WE MAY NEED TO TRY A DIFFERENT MEDICATION OR ADD A DIFFERENT TYPE OF MEDICATION TO
THE PATIENT. THE PATIENT MAY ULTIMATELY NEED SURGERY DEPENDING ON WHAT WE ACTUALLY FIND.
IF THERE IS A MASS OR SOMETHING LIKE THAT. ANOTHER REASON WE WOULD DO IT
SOMETIMES IS IF A PERSON IS ANEMIC AND WE DON'T KNOW WHY, AND THEY HAVE A CULT BLOOD
THAT'S POSITIVE. DARK STOOLS. MELANA, ALSO KNOWN AS BLACK, TARRY STOOLS, THAT'S INDICATION
THAT THERE'S BLOOD THAT HAS BEEN DIGESTED AND SO WE WOULD DO AN EGD FOR THAT, AS WELL.
THIS IS A PRETTY EASY PROCEDURE TO RECOVER FROM. THE ONE THAT WE JUST DID WAS A
DIALOGUES, SHE HAS AN ESOPHAGEAL STRICTURE WHICH MAKES IT DIFFICULT FOR HER TO SWALLOW.
WE KNOW IT'S BENIGN SO WE WERE ABLE TO DILATE IT TODAY. SHE WON'T FEEL PAIN FROM THAT,
WE NEEDS TO KNOW THAT THERE WASN'T A PERFORATION WHICH IS ONE OF THE RISKS OF AN EGD,
THERE CAN BE A TEAR IN THE LINING OF THE ESOPHAGUS OR IN THE STOMACH OR IN THE SMALL
INTESTINE SO IF A PATIENT DOES HAVE PAIN, WE NEED TO FURTHER EVALUATION AT THAT POINT.
WHEN WE HAVE SOMEBODY WHO HAD SOMETHING STUCK IN THEIR ESOPHAGUS LIKE A FOREIGN BODY,
IF THEY HAVE A STRICTURE THEY DON'T KNOW ABOUT AND THEY EAT SOMETHING AND IT GETS LODGED
AND WE HAVE TO GET IT OUT, THE RISK FOR PERFORATION DOES GO UP A LOT AT THAT POINT BUT IT STILL IS PRETTY LOW.
[MUSIC]
>> THANK YOU FOR THAT. THE QUESTION I HAVE IS, WHAT IS THE MOST DANGEROUS OF FINDINGS
IN THAT EGD THAT YOU WOULD HAVE? >> WELL, OBVIOUSLY, THE WORST SCENARIO IS YOU FIND A CANCER
EITHER OF THE ESOPHAGUS, WE EVEN SEE IT IN THE STOMACH, ALTHOUGH NOT AS COMMONLY AND
THE DUODENUM IS RARE BUT THAT'S BAD. THE OTHER THING THAT WE'LL SEE IS ACTIVE BLEEDING.
USUALLY FROM AN ULCER IN THE STOMACH OR THE DUODENUM. AND THAT'S WHEN PATIENTS COME
IN VOMITING BLOOD OR THEY'LL BE PASSING BLOOD PER ***, ALTHOUGH NOT USUALLY BRIGHT
RED, IT'S BLACK AND TARRY LIKE, THAT IS AN EMERGENCY. THAT IS SOMETHING YOU DON'T
WAITS AROUND FOR, YOU COME THIS, YOU GET SEEN BUT WE'VE LEARNED THAT THE SOONER WE CAN
FIND THESE, WE HAVE ACTUAL TREATMENT THROUGH THE ENDOSCOPE, CLIPS, WE CAN BURN,
WE CAN INJECT MEDICINES THAT CAN SCAR THE VESSEL. WE'RE IN THE PATH, RICK,
REMEMBER THE EARLY DAYS, WE LEARNED ABOUT ULCER SURGERY.
[OVERLAPPING CONVERSATION]
>> IT'S ALMOST NONEXISTENT NOW AND IT'S PARTLY BECAUSE OF THE MEDICINES LIKE PROTON PUMP
INHIBITORS BUT WE CAN DO SOFTEN WITH THE ENDOSCOPE. >> LET'S DIVE INTO THE QUESTIONS.
73-YEAR-OLD MAN FROM MEDICINE HAS BEEN TAKING NEXIUM FOR SIX TO SEVEN MONTHS.
THAT NEXIUM IS ABOUT THE SAME AS OMEPRAZOLE. >> EXACTLY, RICK, THE SALES
PEOPLE AND THE COMMERCIALS WILL WANT TO MAKE YOU THINK THAT ONE OF THESE IS BETTER THAN ANOTHER
BUT WHEN APPROPRIATELY DOSED AND FOLLOWED CAREFULLY, NOT A WHOLE LOT OF DIFFERENT.
>> OMEPRAZOLE AND NEXIUM, AND THEN THERE'S >> THEY'RE ALL ABOUT THE SAME.
>> AND THIS PERSON WANTS TO KNOW, HE'S BEEN ON NEXIUM FOR SIX TO SEVEN MONTHS, WANTS TO
KNOW IF HE CAN DO SOMETHING TO GETS OFF IT. >> ABSOLUTELY. I THINK A LOT OF IT DEPENDS ON
WHY HE WAS PUT ON IT BUT WE DO KNOW THAT, FOR EXAMPLE, IF YOU HAD AN EGD AND THEY FOUND
ULCERS IN YOUR ESOPHAGUS, AND THEY PUT YOU ON A MEDICINE LIKE NEXIUM AND, OH, MY GOSH, THE
BEST THING IN THE WORLD, I AM FIXED, I FEEL GREAT. WE DO KNOW THAT IF YOU GET OFF
THE NEXIUM, THERE'S ABOUT A 90% CHANCE THOSE ULCERS WILL COME BACK. >> AND YOU'LL NEED TO STAY ON IT.
>> RIGHT. BUT ON THE OTHER HAND IF HE'S ON NEXIUM SIMPLY BECAUSE HE HAD
INDIGESTION, MILD HEARTBURN AND THE DOCTOR SAID LET'S GIVE THIS A TRY, WELL, FIRST OF ALL, IT'S
DIAGNOSTIC, RIGHT. IF YOU HAVE THE SYMPTOMS AND THEY RESPOND TO NEXIUM AND NONE
OF THE OTHER ALARM SYMPTOMS WE TALKED ABOUT, THAT'S A PRETTY GOOD SIGN THAT IT'S ACID REFLUX.
MY GOAL THEN IS TO, A, FIND OUT IF WE CAN GET HIM ON A LOWER DOSE OR, ALWAYS PUT THEM ON A
TRIAL OF GETTING THEM OFF. AND ONE OF TWO THINGS IS GOING TO HAPPEN.
WE TAPER, LIKE YOU SAID, AND SOME WILL DO GREAT. THEY MAY DO GREAT FOR A YEAR OR
TWO AND THEN MAYBE NEED IT BACK, GREAT, NO PROBLEM. YOU HAVE A HOLIDAY, YOU BOUGHT A YEAR.
SO MY ADVICE ON THE CALLER IS, TALK TO YOUR DOCTOR ABOUT YOUR MOTIVATION TO WANT TO GET OFF
IT AND WORK WITH YOUR DOCTOR TO SEE IF THAT CAN HAPPEN. IT MAY BE POSSIBLE BUT YOU MAY
LEARN THAT, NO, I NEED IT BUT THAT'S STILL HELPFUL, I THINK, IN THE LONG HAUL.
>> AND I LIKE THE IDEA OF SAYING THAT OMEPRAZOLE IS EQUAL TO NEXIUM.
NEXIUM TABLET IS BASICALLY 40 MILLIGRAMS OF OMEPRAZOLE AND IF YOU'VE TRIED 20 GRAMS OF
OMEPRAZOLE AND 40 MILLIGRAMS OF NEXIUM -- >> IT'S MUCH CHEAPER, BY THE WAY.
>> A WOMAN FROM LAKE NORTON, ANYTHING I CAN DO BESIDES SURGERY TO STOP MY ACID REFLUX.
>> THERE ARE A LOT OF THINGS YOU CAN DO. NON-MEDICINAL METHODS. I THINK WE UNDERPLAY LIFESTYLE
MODIFICATION, THINGS THAT YOU CAN DO THAT MIGHT HELP. FOR EXAMPLE, IF YOU HAVE A LOT
OF ACID REFLUX AT NIGHT, THEN PERHAPS LOOK AT WHEN YOU'RE EATING.
A LOT OF PEOPLE WILL HAVE A BEDTIME SNACK. REMEMBER EARLIER THAT I SAID
THE MINUTE FOOD HITS THE STOMACH, ACID IS PRODUCED, SO IF YOU HAVE A SNACK AT 8:00 AT
NIGHT AND YOU GO TO BEDS AT 9:00 OR 10:00, THAT IS THE PEAK TIME THAT ACID IS CHURNING IN
YOUR STOMACH AND THAT CAN REFLUX IN YOUR ESOPHAGUS. SO I TELL PEOPLE, TRY TO LIMIT
YOUR EVENING MEAL NO LATER THAN 6:00 AND DON'T GO TO BED FOR AT LEAST THREE TO FOUR HOURS
AFTERWARD, SMALL FREQUENT MEALS. THE LESS FOOD YOU PUT IN YOUR STOMACH, THE LESS STRESS, THE
LESS AMOUNT OF ACID PRODUCED, THAT CAN BE BENEFICIAL. STAYING UPRIGHT AFTER YOU EAT.
THAT'S A BIG ONE. WAS DO WE USUALLY DO AFTER WE'VE EATEN DINNER.
A LOT OF US GO IN, SIT ON THE CHAIR OR THE COUCH -- >> AND THEN RECLINE.
>> WATCH TV AND GUESS WHAT, THAT IS AN ABSOLUTE SET-UP. THINGS LIKE PEPPERMINT,
CHOCOLATE WILL RELAX THAT MUSCLE WE TALKED ABOUT, THIS MUSCLE THAT'S VERY ACTIVE RIGHT
HERE, FOODS LIKE PEPPERMINT AND CHOCOLATE WILL HELP RELAX THAT MUSCLE.
THERE ARE MEDICINES PEOPLE ARE TAKING THAT CAN RELAX THIS MUSCLE AND --
>> AND MAKE THE REFLUX WORSE. >> EXACTLY. SO, AGAIN, TO THE CALLER, I WOULD SAY, YOU KNOW, LOOK AT
ALL THE THINGS YOU'RE DOING, TALK TO YOUR DOCTOR, SEE IFTHERE'S ANY CHANGES YOU CAN MAKE.
NOW, HAVING SAID THAT, A LOT OF PEOPLE WILL SAY I'VE DONE ALL THAT, DOCTOR, I'M STILL HAVING
TROUBLE AND SO, YES, YOU CAN DO THE SURGERY WE TALKED ABOUT EARLIER BUT THERE'S ALSO SOME
NEWER METHODS COMING OUT, ONE WHERE YOU -- THE SURGEON WILL PUT A ROW OF MAGNETS IN AROUND
HERE TO HELP TIGHTEN THE MUSCLE. THE JURY IS STILL OUT ON IF THAT WILL BE EFFECTIVE OR HOW
LONG IT WILL BE EFFECTIVE. >> MAGNET. I LIKE THE IDEA OF ELEVATING
THE HEADS OF THE BED AND PUTTING FOUR OR FIVE INCHES, NOT A WEDGE BUT FOUR OR FIVE INCH, BOOKS --
>> TOO SIMPLE. [OVERLAPPING CONVERSATIONs] >> TIMING WE WANT TO THINK
THERE A HUGE MAGICAL TECHNOLOGY OUT THERE WHEN THE SIMPLE THING CAN MAKE THE REAL DIFFERENCE.
ALCOHOL, I FORGOT TO MESSENGER THAT, HAVING A DRINK AT NIGHT THAT, WILL RELAX THAT IF YOU HE
WILL AND REALLY -- >> BRING ON THE REFLUX. 68-YEAR-OLD WOMAN FROM VULGA
TAKING ACID REFLUX MEDICINE INCREASE THE RISK OF DEMENTIA? >> YOU KNOW WHAT, I THOUGHT WE
WOULD GET THAT QUESTION TONIGHT. THIS AN INFORMED CALLER. BECAUSE THIS JUST HIT THE NEWS
IN THE PAST COUPLE WEEK. THERE WAS A STUDY PERFORMED WHERE THEY LOOKED AT A LARGE
NUMBER OF ELDERLY PATIENTS ON ONE OF THESE PROTON INHIBITORS AND COMPARED TO THOSE WHO WERE
NOT AND SAID WE SAW A HIGHER INCIDENCE OF DEMENTIA IN THESE PEOPLE.
NOW, THE MEDICAL COMMUNITY HAS LOOKED AT THIS VERY CAREFULLY AND, YES, IT IS CLEARLY A
CAUTION BUT WE HAVE TO BE CAREFUL. WHEN YOU LOOK AT HOW THE STUDY
WAS DONE, THERE WAS A LOT OF CONFOUNDING FACTORS THAT COULD HAVE BEEN INVOLVED AND BY NO
MEANS CAN WE SAY AT THIS POINT YOU HAVE TO STOP YOUR PROTON PUMP INHIBITOR BECAUSE YOU'RE
GOING TO GET DEMENTIA. WE'RE GOING TO LOOK AT IT MORE BUT IT COMES BACK TO WHAT WE
TALKED ABOUT EARLIER, RICK, IF IT'S CLEARLY INDICATED, I STILL THINK THE ADVANTAGES OF THAT
MEDICINE OUTWEIGH THE RISK. >> I THINK IF YOU LET THE ACID GO UP THAT -- IT'S MUCH BETTER
TO TAKE THE MEDICINES IF YOU NEED THEM THAN NOT -- >> EXACTLY. >> DON'T LIVE WITH IT.
>> SO I THINK THE CALLER, EXCELLENT QUESTION AND ALL OF US RAISE OUR EYEBROWS AND WE'RE
LOOKING AT IT BUT RIGHT NOW, IT'S WAY TOO EARLY TO JUST RUN AWAY FROM SOMETHING THAT'S SO
EFFECTIVE. >> WHEN YOU HAVE DYSFUNCTIONAL BRAIN, THAT MIGHT BE THE CAUSE
OF DYSFUNCTION OF THE ESOPHAGUS AND, THEREFORE, IT'S DEMENTIA CAUSING ESOPHAGEAL PROBLEMS AND
THAT'S WHY YOU'RE ON OMEPRAZOLE OR ONE OF THOSE OTHER DRUGS SO WHO KNOWS WHICH IS THE CHICKEN
AND WHICH IS THE EGG. >> THAT'S CORRECT, AND WE DIDN'T LOOK AT THE BRAINS OF THESE PEOPLE.
WE KNOW THERE ARE CERTAIN ANATOMICAL CHANGES THAT CLEARLY TELL YOU DEMENTIA OR NOT.
THIS WAS WHAT WE CALL A POPULATION-BASED STUDY, LOOKED AT TWO GROUPS BUT SO MANY
CONFOUNDING FACTORS THAT COULD INTERFERE. SO I THINK BE CAUTIOUS BUT IF
YOU NEED THAT MEDICINE -- IF I NEEDED THAT MEDICINE, I WOULD NOT HESITATE KNOWING WHAT I
THEY TO CONTINUE IT RIGHT NOW. >> BUT I WOULD TRY THE NON-MEDICINAL -- >> ABSOLUTELY.
>> WOMAN FROM GLENN, SOUTH DAKOTA. >> GLEN, SOUTH DAKOTA DO YOU KNOW WHERE THAT IS?
>> THAT'S ANOTHER RAVINIA. >> WOMAN FROM GLEN, MY HUSBAND HAS LIMB GIRDLE MUSCULAR
DYSTROPHY AND WOULD THE ESOPHAGUS BE AFFECTED BY THAT? >> POSSIBLY.
>> THE SKELETAL MUSCLE -- >> WE TALKED EARLIER ABOUT THE SKELETAL MUSCLE AND LET'S ERASE HERE.
>> EXPLAIN THAT. SO UP HIGH, HERE IN THE ESOPHAGUS, IN THIS REGION, THE
UPPER THIRD IS WHAT WE USUALLY SAY. THIS HAS WHAT WE CALL SKELETAL MUSCLE AND THAT RESPONDS TO
DIRECT NERVE INNERVATION THERE AROUND THERE IS A COORDINATED EFFORT.
SO VARIOUS MUSCULAR DISEASES THAT AFFECT THE SKELETAL MUSCLE CAN AFFECT THE COORDINATION OF
THIS PART OF THE ESOPHAGUS AND SO, YES, WE SEE THIS IN DISEASES SUCH AS PARKINSON'S DISEASE --
>> A LOT OF THEM -- >> A LOT OF THEM -- SO THIS IS WHY IT'S SO IMPORTANT TO
UNDERSTAND THAT THE ESOPHAGUS DOES HAVE MUSCLE AND SO DIFFER DISORDERS THAT YOU WOULD THINK
HAVE ABSOLUTELY NOTHING TO DO WITH THE INTESTINAL TRACT CAN, PARTICULARLY IF THEY AFFECT
MUSCLES. >> WE HAVE A QUESTION FROM STURGIS, SOMEONE HAS CORKSCREW
ESOPHAGUS, SAME STORY THAT THE -- IT'S KIND OF LIKE A CORKSCREW AND IT'S RELATED TO
BEING OLDER, AND IT DOESN'T SQUEEZE IN THAT PERFECT WAY THAT YOU SQUEEZE YOUR TOOTHPASTE.
>> IT'S DISJOINTED, COULD ALL BE SQUEEZING AT THE SAME TIME AND THAT CAN GIVE RISE TO, BOY,
I JUST CAN'T GET FOOD DOWN AS WELL. SOMETIME I EVEN DRINK AND I HAVE TO GO SLOW OR I'LL BRING
IT BACK UP. >> WHAT DO YOU DO FOR IT? >> IT'S FRUSTRATING. IT'S -- THE FIRST THING I ALL
ADVISE BEFORE I JUMP TO ANY MEDICAL TRIALS IS SIMPLY THE WAY YOU EAT, AND RECOGNIZING
THAT YOU HAVE TO EAT SLOWER, YOU HAVE TO CHOOSE YOUR -- CHEW YOUR FOOD CAREFULLY AND I
ADVISE PEOPLE TO TAKE SIPS OF A BEVERAGE WHATEVER IT MAY BE TO HELP IT GO DOWN.
NOW, IF THAT DOESN'T WORK, WE DO HAVE MEDICATIONS THAT CAN RELAX THIS SMOOTH MUSCLE OF THE
ESOPHAGUS BUT I GOT TO BE HONEY WITH YOU, NOT A HUGE BENEFIT FROM THAT.
THERE ARE CERTAIN AMOUNTS OF PEOPLE THAT WILL. IF IT'S BAD ENOUGH, IF IT'S BAD
ENOUGH, SOMETIMES WHAT I WILL OFFER BUT THIS IS ONLY AFTER PATIENT SAY MY QUALITY OF LIFE
IS MISERABLE, WE CAN SOMETIMES WHEN WE DO AN EGD, WE'LL LEAVE A LITTLE GUIDE WIRE INTO THE
STOMACH AND I CAN TAKE A DILATOR TUBE AND IT HAS A HOLE IN THE MIDDLE OF IT AROUND IT
GOES OVER THIS WIRE AND THAT'S THERE BECAUSE I CAN ENSURE THAT THAT DILATOR GOES RIGHT WHERE
IT'S SUPPOSED TO AND DOESN'T GO POKING A HOLE IN THE ESOPHAGUS, BUT SOMETIMES DOING THIS
DILATION, STRETCHING ITS AND DOING THE DILATOR AND PULLING THE WIRE OUT, IN SELECTED
PATIENTS WE CAN GET RELIEF WITH THAT BUT I ONLY RESERVE THAT FOR THE ONES THAT ARE JUST
MISERABLE AND CAN'T SEEM TO GET BENEFIT. >> SO WE'VE NOT GOT MUCH TIME
AND A TON OF QUESTIONS, LET'S RUN THROUGH THEM. >> I'M TRY TO BE QUICK.
>> NISSAN SURGERY, WE DID TALK ABOUT -- >> BOTTOM LINE, THERE IS A STOMACH HERE.
THE PROBLEM IS THAT THIS MUSCLE IS TOO LOSS SO THEY TAKE -- THE SURGEON WILL TAKE THE STOMACH
AND WILL PULL IT AROUND AND FORM A BARRIER, KIND OF TIGHTENS THE ESOPHAGUS IN THIS
LOCATION AND WHAT THAT DOES IS IT PREVENTS ACID REFLUX FROM COMING BACK UP.
IN WELL-SELECTED PATIENTS AND THAT'S THE KEY, IN WELL-SELECTED PATIENTS, IT CAN
BE VERY EFFECTIVE. >> OKAY. SOMEONE FROM YANKTON, I'VE BEEN DIAGNOSED WITH SILENT REFLUX, I
HAVE I NO HEARTBURN BUT HAVE PHLEGM AND COUGH IN THE MORNING, ALSO LOST MY SINGING
VOICE AND WOULD LOVE TO BE ABLE TO SING AGAIN. CAN YOU TOUCH ON THIS SUBJECT,
AND I THINK -- I KNOW DOCTOR WOULD PUT HER RIGHT AWAY, BOOM, ON OMEPRAZOLE.
>> IF WE THINK -- IT CAN BE DUE TO REFLUX, LUNG CONDITIONS CAN DO THIS BUT THE BEST WAY THAT
WE'VE LEARNED TO UNDERSTAND IF THIS IS REFLUX OR NOT, YOU CAN DO AN EGD, BUT 90% OF THE TIME
IT WILL BE NORMAL. SO THE BEST WAY WE'VE LEARNED IS HIGH DOZE OMEPRAZOLE FOR
THREE MONTHS, 40 MILLIGRAMS TWICE A DAY, EVEN, FOR THREE MONTHS.
IF YOU REALLY WANT TO KNOW IF THIS IS DUE TO ACID REFLUX OR NOT.
>> THE VOICE SHOULD COME BACK. >> IF THOSE PATIENTS DON'T RESPOND IN THREE MONTE TIME,
IT'S HIGHLY UNLIKELY AND DO NOT WASTE YOUR TIME TAKING THE MEDICINES LONG TERM.
LOOK FOR OTHER THINGS. SOMETIMES WE CAN PUT A LITTLE PROBE IN THE ESOPHAGUS AND
MEASURE REFLUX CONTENTS TO SEE IF IT'S TRULY REFLUX OR NOT. BUT WE FOUND EVEN THAT'S
INVASIVE AND WHO WANTS A TUBE IN THEIR NOSE WHICH IS WHAT YOU HAVE TO DO.
>> FOR A DAY OR TWO. >> IF YOU THINK IT'S REFLUX, HIGH DOSE FOR THREE MONTHS,
IT'S SAFE FOR THREE MONTHS AND THEN YOU CAN DETERMINE IF IN LIKELIHOOD IT'S REFLUX OR NOT.
>> SO THIS CALLER SAID I HAVE A HERNIA WITH LEFT CHEST THAT FILLS MY LOWER LUNG CAPACITY,
I'M 85 AND SURGERY WON'T BE VIABLE OPTION. SHE SAID SHE HAS A BUECH DELECK HERNIA.
WHAT IS THAT? >> THE BOCH-DELUK, WHAT IS THAT? >> ANOTHER FORM OF A HERNIA
WHERE THERE CAN BE A BIG DEFECT IN THE DIAPHRAGM LIKE IN THIS AREA WHICH IS HER LEFT, SO THIS
PART OF THE STOMACH COMES UP LIKE SO. >> OH, OKAY. >> AND, YOU KNOW, 85 AND YOU'RE
RIGHT, SOMETIMES THE TREATMENT IS WORSE THAN THE UNDERLYING CONDITION. I WOULD LEAVE IT ALONE.
A LOT OF TIMES PATIENTS WILL LEARN WHAT THEY CAN AND CAN'T DO, I WISH I HAD A MAGIC ANSWER
FOR THAT ONE BUT I DON'T. >> THAT'S NOT PENETRATION OF THE DIAPHRAGM OR -- >> NO, A LITTLE DIFFERENT.
>> AND SHE -- SHE'S HAVING TROUBLE WITH BREATHING AND OXYGEN SO KIND OF HARD TO
ANSWER -- THAT'S A TOUGH QUESTION. >> THAT'S A ROCK AND A HARD PLACE, I'M SORRY.
>> DOES IT EVER CAUSE CONSTIPATION AND HOW WOULD YOU GO ABOUT WITH THAT? I DON'T KNOW ABOUT CONSTIPATION.
>> IN GENERAL, NO. WE HAVE SEEN OCCASIONAL PATIENTS THAT HAVE A NISSAN AND THEY'LL BECOME A LITTLE MORE
CONSTIPATED, WE THINK IT MIGHT BE THAT ONE OF THE NERVES THAT AFFECTS THE RELAXATION OF THE
STOMACH, THE VEGAS NERVES THAT COME DOWN DOESN'T HAVE QUITE AS MUCH STRETCH BUT USUALLY CONSTIPATION --
>> YOU JUST USE... >> 77-YEAR-OLD WOMAN HAS DYSPHAGIA AND HAD CRYOSURGERYRY
AND WANTS TO KNOW IF SURGEONS DO THIS IN SIOUX FALLS. LET'S TALK ABOUT CHRONIC REFLUX
AND THIS DISPLAGIA THAT CAN OCCUR AND WHAT IS THE COMMON WORD FOR THAT.
>> Dr. HOLM, YOU TALKED EARLIER IN THE SHOW WHEN PEOPLE HAVE LONGSTANDING ACID REFLUX
UP HERE, WHAT CAN HAPPEN IS OVER TIME THE CELLS THAT LINE THIS ESOPHAGUS CHANGE FROM THE
STANDARD LINING OF THE ESOPHAGUS, THE SAME LINING OF THE STOMACH COMES UP INTO HERE
AND THAT'S CALLED A BARRETT'S ESOPHAGUS. >> B-A-R-R--- >> E-T-T-S.
THE SIGNIFICANCE OF BARRETT'S ESOPHAGUS, PARTICULARLY WITH DISPLAGIA, WHAT SHE'S TALKING
ABOUT IS WE KNOW THAT PATIENTS WITH BARRETT'S HAVE A SLIGHT -- LESS THAN WE ORIGINALLY THOUGHT
BUT, NONETHELESS, REAL RISK OF CANCER OF THE ESOPHAGUS. MOST PATIENTS WITH BARRETT'S DO NOT GET CANCER.
BUT WHAT WE DO IS WE PERIODICALLY SURVEY THIS AREA AND THE ENDOSCOPIST WILL OBTAIN
BIOPSIES FROM THIS AREA OF BARRETT'S, AND THE PATHOLOGISTS LOOK AT THE.
IF YOU JUST SEE BARRETT'S ESOPHAGUS AND NOTHING ELSE, YOU'RE GOOD AND WE'LL FOLLOW UP
IN THREE TO FIVE YEARS. DISPLAGIA MEANS CELLS ARE STARTING TO CHANGE, STARTING TO
SHOW US A SIGN THEY'RE NOT HAPPY AND THAT POTENTIALLY CAN BE AN EARLY SIGN THAT CANCER
MIGHT BE BREWING. SO WHAT THE CALLER IS TALKING ABOUT IS CRYOSURGERY WAS A
FREEZING PROBE THAT YOU CAN GO DOWN AND LITERALLY ELIMINATE THE CELLS.
YOU KILL THEM OFF AND THEN THE THOUGHT IS THAT NORMAL ESOPHAGEAL CELLS WILL GROW IN
ITS PLACE. THE MORE COMMON TYPE OF THERAPY IS ENDOTHERAPY, RADIO FREQUENCY
ABLATION, WE CALL IT, A HIGH-FREQUENCY CURRENT THAT ALSO DOES THE SAME THING.
SO CRYO THERAPY IS ONE WAY TO TREAT IT, RFA OR RADIO FREQUENCY ABLATION IS MORE COMMON.
THAT'S DONE IN SIOUX FALLS QUITE A BIT. WITH CRYO SURGERY, I'M NOT SURE.
I HAVE DONE THAT BUT I'M NOT SURE IF ANYBODY ELSE IN SIOUX FALLS IS DOING IT.
>> HOW DOES REMOVE OF THE GALLBLADDER AFFECT DIGESTION? THIS IS FROM FLANDREAU.
>> ONE COULD ASK THE QUESTION, WE HAVE GALLBLADDERS FOR A REASON SO IF WE REMOVE THEM,
WHAT'S GOING TO HAPPEN. NOW, THE GOOD NEWS IS, MOST OF THE TIME, NOTHING.
WHAT THE GALLBLADDER DOES, WHEN WE EAT, THE LIVER STIMULATES THE PRODUCTION OF BILE AND THAT
BASICALLY HELPS US ABSORB FOOD, PARTICULARLY FAT. THE GALLBLADDER, THE BILE GOES INTO THE --
>> 20 SECONDS. >> IT GETS CONCENTRATED, WHEN YOU EITHER, IT PUSHES BILE INTO
THE INTESTINAL TRACT AND AIDS IN DIGESTION. THE MAJORITY OF PEOPLE WITH
GALLON GALLBLADDER OPERATIONS DO JUST FINE WITHOUT SYMPTOM. THE MOST COMMON SYMPTOM IS
DIARRHEA AFTERWARDS AND WE HAVE THINGS TO TREAT IT. IT CAN USUALLY WORK.
>> ALL RIGHT, SO WE'LL TALK MORE. WE'RE RIGHT UP TO THE WINNER OF TONIGHT'S PRAIRIE DOC QUIZ
QUESTION. TONIGHT YOU HAD TO CHOOSE THE BEST ANSWER. WHEN REFLUX OF STOMACH ACID UP
INTO THE LOWER PART OF THE ESOPHAGUS HAPPENS TOO OFTEN AND FOR TOO MANY YEARS, THE TISSUE
CHANGES IN THE ESOPHAGUS, CAUSING BARRETT'S ESOPHAGUS AND RESULTING IN...
MORE BURNING SYMPTOMS OR LESS BURNING SYMPTOMS. THE ANSWER IS, BELIEVE IT OR NOT, LESS!
IT WAS SUSAN SCHOENFELT TIER WHO ANSWERED THE QUESTION CORRECTLY.
THANK YOU, SUSAN, FOR PARTICIPATING AND A BOOK WILL BE IN THE MAIL TO YOU SOON.
THE FUNNY THING IS THAT THE STOMACH, WHICH IS PROTECTING AGAINST ACID THAT, TISSUE GROWS
UP INTO THE ESOPHAGUS AND SYMPTOMS GET BETTER. >> CORRECT. THE STOMACH IS DESIGNED TO
WITHSTAND ACID SO WHEN YOU GETS STOMACH LINING IN IN THE ESOPHAGUS, IT HELPS.
>> MY PROBLEM IS IT KEPT GOING AWAY BUT THE ANSWER IS, YOU MAY BE SETTING UP FOR CANCER.
DO YOU RECOMMEND THESE PEOPLE GET AN EGD? >> I THINK, AGAIN, IF THERE'S
ANY CONCERN, IF YOU'RE OLDER AND THERE ARE RISK FACTORS, THE PEOPLE MORE LIKELY TO GET
BARRETT'S ARE MALE, YOU AND I IN THAT CATEGORY, OVER AGE 50, WE'RE IN THAT CATEGORY.
OBESITY, USUALLY IF WE HAVE THE BIG ABDOMENS, THOSE PEOPLE ARE HIGHER RISK BUT --
>> AND SMOKERS. >> SMOKERS. THIS IS ONE OF THE RARE TIMES WHERE BEING A WOMAN, WOMEN
COMPLAIN OF ALL THE HEALTH ISSUES BUT IT'S RARE THAT WOMEN HAVE BARRETT'S ESOPHAGUS.
WE SEE IT PREDOMINANTLY IN MEN. THOSE ARE THE RISK FACTORS, IF YOU HAVE THOSE AND HAD AN EGD
AND THE HEARTBURN IS STARTING TO GET BETTER, ONE TIME, CHECK IT OUT, IF IT'S GONE, YOU NEVER
EVER TO LOOK AGAIN. >> WE'LL BE RIGHT BACK AFTER THIS. AS YOUR BABY GROWS, THERE ARE
NEW SURPRISES AND ADVENTURES EVERY DAY. WITH EACH NEW MILESTONE,
REMEMBER, IMMUNIZATIONS ARE SAFE AND ONE OF BEST WAYS TO PROTECT AGAINST SERIOUS
DISEASES, ESPECIALLY BETWEEN BIRTH AND AGE 5.
[TONE SOUND]
>> AND OUR GRANDDAUGHTER STELLA HAS ARRIVED, WE'RE MAKING SURE THEY STAY ON THEIR IMMUNIZATION SCHEDULES.
>> SCHEDULE YOUR CHILDREN EARS IMMUNIZATIONS TODAY FOR BABY'S SAKE. >> MR. H. CAME INTO THE OFFICE
BECAUSE HIS WIFE MADE HIM DO IT. THERE WAS A GUILTY MOVEMENT TO HIS EYES, ALTHOUGH HE HAD THE
TYPICAL NON-COMPLAINING, MODEST PRAIRIE-FARMER WAY ABOUT HIM. HE SAID HIS HEART BURN PROBLEM
WAS GETTING WORSE, PARTICULARLY AT NIGHT AND WHEN HE HAS A SECOND SERVING OF ICE CREAM
BEFORE THE 10:00 NEWS. HE ADMITTED HE HAD BEEN CHEWING A BOTTLE OR TWO OF TUMS A DAY
FOR SEVERAL YEARS, BUT THE PROBLEM STRANGELY GOT BETTER ABOUT A YEAR AGO, UNTIL RECENT
WEEKS. NOW SOLID FOOD LIKE CHICKEN BREAST WANTED TO CATCH ON THE WAY DOWN.
HE ADMITTED HE HAD WAITED UNTIL HE GOT THE HAY IN BEFORE COMING TO THE DOCTOR.
ABOUT 35% OF ALL PEOPLE HAVE SOME ACID REFLUX SYMPTOMS ON RARE OCCASIONS, LIKE ONCE A
YEAR, AND 20% OR ABOUT 50 MILLION PEOPLE IN THE U.S. SUFFER FROM RECURRING SYMPTOMS.
THEY DESCRIBE HALF-DIGESTED ACIDIC FOOD ROLLING UP FROM THE STOMACH, BURNING THE ESOPHAGUS,
AND INTO THE THROAT AND MOUTH. SYMPTOMS ARE GENERALLY MADE WORSE BY BIG-BELLY-OBESITY,
LATE IN THE EVENING FOOD IN THE GUT, CAFFEINE, SALT, AND ALCOHOL, CERTAIN ARTHRITIS AND
OSTEOPOROSIS MEDICINES, TOBACCO SMOKE, AND SOMETIMES BY A STOMACH INFECTION CALLED H. PYLORI.
AND REFLUX IS ONLY MADE WORSE, MORE PERMANENT, AND DESTRUCTIVE AS IT CONTINUES TO OCCUR.
THE MAINSTAY OF THERAPY STARTS WITH AVOIDANCE OF ALL THOSE ISSUES LISTED HERE, ESPECIALLY
LESS FOOD LATE IN THE DAY. ELEVATING THE HEAD OF THE BED WITH BOOKS UNDER THE BEDSTEAD
IS A POWERFUL AND UNDERUTILIZED TREATMENT. FORTUNATELY, THERE ARE MEDICINES THAT ALSO CAN HELP.
FOR OCCASIONAL REFLUX, OVER-THE-COUNTER MYLANTA OR MAALOX WORK, AND THESE DON'T
STIMULATE ACID-PRODUCTION LIKE TUMS, ROLAIDS, OR BAKING SODA. FAST ACTING, AS-NEEDED
HISTAMINE-2 BLOCKERS, LIKE RANITIDINE, THE GENERIC VERSION OF ZANTAC, ALSO GIVE QUICK RELIEF.
FOR PERSISTENT SYMPTOMS, SLOWER BUT MORE POWERFUL PROTON-PUMP-INHIBITORS, OR PPIS
LIKE OMEPRAZOLE, OR PRILOSEC, GIVE A MORE ENDURING RELIEF. BUT PLEASE REMEMBER, IF REFLUX
SYMPTOMS ARE SEVERE ENOUGH TO REQUIRE THE LONG-TERM USE OF ANY MEDICINE, TALK TO YOUR DOCTOR.
AN UNDERLYING INFECTION OR CANCER COULD BE THE CAUSE. I SCHEDULED MR. H. FOR AN EGD,
WHERE, UNDER ANESTHESIA, A SCOPE WAS PASSED DOWN THE THROAT, ESOPHAGUS, INTO THE
STOMACH AND DUODENUM. WE FOUND A CANCER IN THE LOWER ESOPHAGUS.
FOLLOWING SURGERY, RADIATION, AND SOME CHEMOTHERAPY, THE MALIGNANCY HAS NOT RETURNED,
AND THAT WAS YEARS AGO. NOWADAYS, WHEN I SEE HIM IN THE CLINIC, HE SEEMS HAPPY TO SEE
ME, BUT IT'S STILL ONLY AFTER THE FARM WORK IS DONE, AND ONLY BECAUSE HIS WIFE MADE HIM DO IT.
[MUSIC]
A BIG THANK YOU TO OUR GUEST DR. TIM RIDGWAY. IT IS AMAZING HOW THE DOCTORS OF THE STATE ARE SO WILLING TO
VOLUNTEER TO JOIN US EACH WEEK. IT IS SINCERELY APPRECIATED. >> THANK YOU FOR HAVING ME,
RICK. >> YOU BET. NOW ONTO OUR FINAL FLU SEASON UPDATE.
FLU VACCINE LIKELY INFLUENCED THE PRESENTATION OF THE FLU THIS YEAR.
GOOD JOB FOR THOSE OF YOU WHO HAD THE VACCINE. YOU PROTECTED NOT ONLY YOURSELF
BUT THOSE AROUND YOU WHO WERE SUSCEPTIBLE. NEW ZIKA INFO HERE.
THE CDC HAS RAISED THE LEVEL OF CONCERN ABOUT THE MOSQUITO-BORNE DISEASE AS WELL
AS THE STATES THAT MAY SEE INFESTATION. SO FAR, ALL OF THE CASES ARE IN
PEOPLE WHO HAVE TRAVELED OUT OF THE COUNTRY, BUT WE WILL PROBABLY SEE ISOLATED OUTBREAKS
AS THE MOSQUITO SEASON PROGRESSES. DO NOT FORGET TO USE PRECAUTIONS TO REDUCE YOUR
CHANCES OF BEING BITTEN BY A ZIKA-INFECTED MOSQUITO THIS SUMMER.
WE WILL BE POSTING SOME OF THE SUGGESTIONS ON OUR WEBSITE, WWW.PRAIRIEDOC.ORG.
THAT DOES IT FOR TONIGHT. FROM ALL OF US HERE AT "ON CALL WITH THE PRAIRIE DOC," UNTIL
NEXT TIME, STAY HEALTHY OUT THERE PEOPLE.