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Pivotal time for chronic hepatitis C treatment

February 10, 2014

An estimated 2.7-3.9 million people in the US are chronically infected with hepatitis C.* Patients are often diagnosed incidentally, when they donate blood, get life insurance or get a routine physical exam with blood tests showing normal or abnormal liver enzymes. They may have been diagnosed many years ago with non-A, non-B hepatitis, but forgot about it, never followed up, or did not mention it to their regular health care provider. In 2012, the Centers for Disease Control (CDC) issued additional recommendations to start screening “Baby Boomers,” those born between 1945-1965. Though Baby Boomers account for 3.25% of the US population, they account for 3/4 of the hepatitis C infections.*

Patients may have seen a health care provider in the past and told that there is no treatment, that treatments were not effective, or not worthwhile due to side effects. Patients have been reluctant to seek treatment because they have heard about the terrible side effects associated with treatment, including flu-like symptoms, fatigue, depression, muscle aches, rashes, etc, lasting up to a year.

Living with achalasia like Seahawk Malcolm Smith

February 06, 2014

On February 3, 2014, Yahoo Sports published an article regarding this years’ Super Bowl MVP, Malcolm Smith, as not only achieving recognition for his Super Bowl performance, but also dealing with a rare swallowing disorder known as achalasia.
 
Achalasia is a rare disorder with a prevalence of 10 cases per 100,000 individuals.  Men and women are equally affected and it is usually diagnosed between the ages of 25 to 60 years.  The disease often comes on slowly and is gradually progressive with problems swallowing solids and liquids, and movement of undigested food particles back up into the mouth unintentionally (bland regurgitation).  Patients also often complain of a burning chest sensation. Other symptoms include hiccups, difficulties belching, and sometimes weight loss.

The condition can be seen with radiology studies including a barium esophagram that shows a dilated, or larger than normal, cali...

Updates on LINX - GERD reflux management system

January 27, 2014

Since my initial LINX blog post 20 months ago, we have been engaged in a dialogue with patients from around the world who suffer from gastroesophageal reflux disease or GERD.  Despite my initial trepidation to “blogging”, this has been a rewarding experience to hear about patient’s problems, their concerns about the current treatments (PPI’s and Nissen fundoplication) and simply interacting with them.  I thank the patients who have taken time to share their thoughts on the blog.

 

When our social media manager asked me to provide an update on LINX, I realized that I have been simply responding to patient’s questions and I haven’t posted any of my thoughts or updates on what is happening with the LINX device.

There are some exc...

Troubles swallowing food or liquids - what does it mean?

January 13, 2014

Dysphagia refers to the sensation of food or liquid being delayed or hindered from the mouth to the stomach. This abnormality is increasingly recognized as an important concern that requires attention and study. There are many causes of impaired swallowing, which are categorized into two types, mechanical, a structural barrier to food bolus movement, and motility disorders, involving abnormal muscle movement. There are also two major anatomical sites, oropharyngeal and esophageal.

Oropharyngeal dysphagia is related to problems with the initiation of the swallows and clearing the food bolus from the mouth to the esophagus. This usually occurs within a second of swallowing and you may feel that you cannot initiate a swallow or food hangs up in the neck region. A test that is commonly used to evaluate this is a modified barium swallow or videofluoroscopic swallowing study. This study provides critical information on inability or excessive delay in initiation of swallowing, unintentional inhalation of food, unintentional expulsion of food from the nose or mouth, and/or abnormal retention of food in the back of the throat after swallowing. Most oropharyngeal dysphagia patients benefit from swallow rehabilitation programs.

Infants with Milk Allergy

January 10, 2014

A 4 week-old infant and his mother came to my office last week.  The mother had started seeing small flecks of blood and stringy mucous in the infant’s diapers a week prior.  The baby was fine in every other way, breast feeding normally, and looked quite healthy when I examined him.

I diagnosed the infant as having cow’s milk protein-induced proctocolitis, the term referring to allergic inflammation of the lower gastrointestinal tract from exposure to cow’s milk.

This is a diagnosis I make often. Here's what you should know about infants with milk allergies:

  1. It’s more common than you think. 2-3% of infants in the U.S. are allergic to cow’s milk protein. It is even more common in infants with eczema or who have parents or siblings with allergies.
  2. It’s seen in breast fed babies. Over 50% of infants with this condition are breast milk-fed infants.

Why you should care about fatty liver disease

December 23, 2013

The liver is a vital organ necessary for survival.  It performs crucial functions including protein synthesis and detoxification.  When excessive amounts of fat and lipids accumulate in the liver cells, this can lead to liver injury and cause a disease called fatty liver disease.  Fatty liver disease is a serious diagnosis that has become one of the most common causes of abnormal liver function tests in the United States.   Fatty liver disease is also referred to as Non Alcoholic Fatty Liver Disease or NAFLD.  NAFLD is associated with other diseases which influence fat metabolism, such as type 2 diabetes.

Why is fatty liver disease important?

NAFLD is a single disease seen in both alcoholics and non-alcoholics, especially in those who are overweight.  When a biopsy is taken of a fatty liver, features of liver injury and fat deposit in the liver may be seen.  These findings are of crucial importance as fat accumulation may cause ...

Technology can assist in diagnosis of heartburn, acid reflux and GERD

November 25, 2013

You may frequently interchange the terms heartburn, acid reflux and GERD, but it’s important to know if your heartburn is chronic and recurring.  Heartburn is a symptom we experience when acid from the stomach passes up through the esophageal sphincter into the esophagus, known as acid reflux.  For some people this can be acid that passes only a few inches up the esophagus or all the way to the mouth.  When acid from your stomach comes up as high as your mouth, you run the risk of aspiration (when fluids either going down to your stomach or coming up from your stomach enters your trachea and into your lungs). 

Gastroesophageal reflux disease (GERD) is described as severe or chronic acid reflux. Severe means that it happens when we have had a change in our body, like a pregnancy that causes pressure on our stomach forcing stomach content up into the esophagus. Chronic may mean there is a mechanical problem like a...

What causes constipation and how is it treated?

November 01, 2013

People often fear the worst about constipation.  Constipation is very common and only rarely signifies something serious.  Just because the average person has a bowel movement daily doesn’t mean you have to—if normal for you is every 3, 5, or 7 days that is okay so long as it’s not adversely affecting your life. In many cases, people with constipation struggle with it all their lives and are looking to be certain nothing more serious is going on and for a way to treat their symptoms.  Even in people with relatively new onset of constipation, there usually is a simple solution.  It is certainly reasonable to have your constipation assessed but in the absence of other warning signs for more serious disease, additional testing related to constipation is not always essential.

What are the causes of constipation?

Colonic inertia

  • Most cases of constipation are caused by colonic inertia, whic...

Is the FODMAP diet right for you?

October 21, 2013

FODMAPs is an acronym, coined by two Australian researchers, that refers to Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols. These are small chain sugars, fibers and sugar alcohols that are poorly digested by humans, but are easily digested by the bacteria in your intestine and colon. The FODMAP diet is used to alleviate the impact these types of foods have on your gastrointestinal tract.

Why dietary fiber reduces the risk of disease

October 11, 2013

Over the last couple of years, there has become more awareness surrounding the importance of dietary fiber and the prevention of disease.

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