Good Vibrations: Leading-edge treatment for a life-limiting gastrointestinal (GI) disorder

Good Vibrations

Good Vibrations: Leading-edge treatment for a life-limiting gastrointestinal disorder

In 1992, while practicing in Memphis, Tennessee, Thomas Abell, MD, medical director at the Jewish Hospital GI Motility Clinic and professor of medicine at the University of Louisville, and his GI team developed a gastric electrical stimulation therapy, now called the Medtronic Enterra Therapy System. This innovative therapy is used to treat symptoms of gastroparesis, a stomach disorder affecting roughly 5 million Americans.

The condition results in slow digestion of food, which causes severe, chronic nausea and vomiting. The Food and Drug Administration (FDA) approved the therapy in 2000, eight years after the first system was implanted. Prior to the advent of the Enterra Therapy System, patients had limited and minimally effective treatment options, including dietary modifications, medications, tube feeding or surgery.

Electrifying Effects

Enterra Therapy works by emitting mild electrical pulses to stimulate the top portion of the stomach’s wall. Its high success rate offers new hope to patients suffering from gastroparesis symptoms.

“This device is a great option for patients who have tried other treatments but haven’t experienced improvement,” Dr. Abell said. “This new approach is highly effective — about 80 percent of patients experience a considerable improvement in their symptoms.”

To provide more cost-efficient care, the Jewish Hospital GI Motility Clinic first offers patients a temporary Enterra device, placed outside the abdomen in an outpatient endoscopy lab, to see if their bodies respond to therapy and symptoms improve.

Watch the video below to hear Dr. Abell discuss Enterra Therapy

“We can usually tell within a week if the therapy is going to work for a patient,” Dr. Abell said. “If they respond well to the treatment, we surgically place a permanent device, which is inserted under the skin over the abdomen.”

Because the permanent device requires a surgical procedure, patients need several weeks to recover from the surgery before the device is activated.

“This therapy has been evolving greatly over the last 16 years since it was first approved by the FDA, and it holds great promise for patients who suffer from these symptoms, which can significantly impact quality of life,” Dr. Abell said. “We continue to see great success with this therapy, and look forward to seeing even more improvement as we learn more about this condition and similar GI illnesses.”

This article originally appeared in the 2017 Winter edition of One Health magazine. For more stories like this one, subscribe to One Health today.

Painful Acid Reflux Disease Affects Many Americans

Painful Acid Reflux Disease Affects Many Americans

Painful Acid Reflux Disease Affects Many Americans
Acid reflux disease, also known as gastroesophageal reflux disease (GERD), is a chronic digestive disease that affects nearly 20 percent of Americans, including children and adults.

A painful disease in which stomach acid flows backwards into the esophagus, GERD causes irritation and other negative side effects. Acid reflux disease can eventually lead to esophageal cancer if left untreated, so it is important to understand the symptoms and when to seek treatment.

The stomach produces harsh acids after a meal that help with the digestion of food. In a healthy person, a ring of muscle at the bottom of the esophagus called the lower esophageal sphincter prevents the acid from backing up into the esophagus in a movement called reflux. In people with acid reflux disease, this muscle does not function properly, and the acid backs up, or refluxes, into the esophagus.

Cause and Effect

The stomach lining is tough and it’s made to handle acid, but the esophagus is not. It has much more delicate lining and doesn’t repair itself as well. As a result, refluxed acid can lead to burns, which are painful and can make people feel nauseated or make like they have to belch frequently. Other symptoms of acid reflux include heartburn, regurgitation of bitter acid into the throat, bitter taste in mouth, dry cough, hoarseness, feeling of tightness in the throat, and wheezing.

There are many factors that can contribute to acid reflux, including:

  • Lifestyle
  • Medications
  • Diet
  • Pregnancy
  • Rapid weight gain
  • Certain medical conditions

Tests to diagnose acid reflux disease include X-rays of the esophagus, stomach and upper part of the intestine, gastrointestinal endoscopy, esophageal manometry, and a 24-hour pH probe study, a test where a thin probe or tube is placed in the esophagus. A gastroenterologist will perform any number of these tests to determine if symptoms are being caused by acid reflux or another health issue.

Prolonged acid reflux disease can cause long-term damage, including a precancerous condition called Barrett’s esophagus, where normal tissue lining the esophagus changes to tissue that resembles the lining of the intestine. Those who have suffered from acid reflux for five years or longer may require additional testing to see if they are at risk for Barrett’s esophagus.

Watch Video About Barret’s Esophagus

 

Relief in Reach

There are a variety of ways to reduce or eliminate the symptoms of acid reflux. In some cases, patients may receive a prescription for acid-blocking medication, which helps stop the acid-producing cells in the stomach. That way, when stomach fluids come back up, they include less acid, and don’t irritate the tissue.

Acid reflux can sometimes be prevented by changing the habits that may cause reflux. This includes avoiding alcohol and smoking, limiting fatty foods and other food triggers, maintaining a healthy body weight, and avoiding large meals within three hours of bedtime.

This article originally appeared in the Winter 2017 edition of One Health magazine. For more stories like this one and additional health and wellness information, subscribe today.


Kathleen Martin, MDKathleen Martin, MD

Dr. Kathleen Martin is a gastroenterologist with KentuckyOne Health Gastroenterology Associates.

5 Ways to Nip Your Allergies in the Bud [Infographic]

5 Ways to Nip Your Allergies in the Bud

Five Ways to Nip Your Allergies in the Bud

The Asthma and Allergy Foundation of America (AAFA) estimates that nearly 50 million Americans each year suffer from nasal allergies.

Kentucky is commonly ranked among the worst places to live with spring allergies by AAFA. While there is no known cure for allergies, they can be managed through prevention and treatment.

Review the infographic below for tips on how to manage your seasonal allergies, often referred to as hay fever, as trees and flowers begin to bloom.

Five Ways to Nip Your Allergies in the Bud

 

Solving Structural Heart Problems

Read Solving Structural Heart Problems

Solving Structural Heart Problems
When the valves and chambers in your heart aren’t working correctly, a specialized heart team with experience can make the difference.

Structural heart disease describes any defect with the anatomy of your heart or chambers. Whether it’s the valves that control blood flow, the chambers that make up your heart or a problem with the aorta, structural heart disease can lower your quality of life and put you at increased risk for potentially life-threatening heart health concerns, such as heart failure or stroke.

Some common structural heart problems include:

  • Valve stenosis (narrowing). When blood flows from one area of the heart or body to another, it passes through a valve, which acts as a gateway in or out of the heart. The aortic valve controls blood flow from the heart to the rest of the body. The mitral valve controls blood flow between the two chambers on the left side of the heart. And the pulmonary valve controls blood flow out of the heart and into the lungs. All can have narrowing. Left untreated, valve stenosis can cause irregular heartbeat, stroke, heart failure or loss of life.
  • Mitral valve regurgitation. When the mitral valve does not close properly, it can allow blood to flow backward, leading to heart failure and arrhythmia. Degenerative mitral regurgitation (wear and tear) along with mitral valve regurgitation caused by other conditions, such as coronary artery disease or heart muscle problems, are common causes of mitral regurgitation. If severe enough, mitral valve regurgitation can cause heart failure.
  • Atrial septal defect (ASD). A wall of tissue separates the upper chambers of the heart. An ASD is a hole in the tissue that allows oxygen-rich blood to flow into the oxygen-poor part of the heart. Symptoms vary depending on the size of the hole.

Treatment Requires a Skilled Team

Although medications can sometimes be used to manage symptoms of structural heart problems, surgery or a minimally invasive procedure may be the best treatment option.

“This subset of heart disorders is very complex and requires a collaborative team approach to address effectively,” said Nezar Falluji, MD, MPH, FACC, FSCAI, board-certified interventional cardiologist with KentuckyOne Health Cardiology Associates–Lexington. “At KentuckyOne Health, we offer a comprehensive, multidisciplinary approach. We combine the skills of interventional cardiologists, who specialize in structural heart disease, with those of cardiovascular surgeons to provide the best evidence-based pharmacologic, minimally invasive and surgical intervention care.”

A Minimally Invasive Approach to Treating AVS

If you are dealing with aortic valve stenosis (AVS), you know how exhausting the condition can be. For patients with severe AVS who are not ideal candidates for surgical replacement, implanting a prosthetic aortic valve using a minimally invasive approach saves lives and improves quality of life. This approach is known as transcatheter aortic valve replacement (TAVR).

At Saint Joseph Hospital and Jewish Hospital, both part of KentuckyOne Health, physicians use a catheter to place the replacement valve within the old, damaged valve, almost like a stent. The new valve takes over, and normal blood flow is restored. At KentuckyOne Health, TAVR is performed under conscious sedation, which improves patients’ recoveries and decreases hospital length of stay.

“The quality of life prior to aortic valve replacement is poor, and patients with aortic valve stenosis can’t do any type of activity that requires exertion — climbing the stairs, walking more than a block or doing things they want to do become impossible,” said Michael Flaherty, MD, PhD, board-certified interventional cardiologist, associate professor of medicine and physiology at the University of Louisville and director of adult structural heart disease at Jewish Hospital.“Fixing the valve not only improves patients’ quality of life, but is lifesaving. All those limitations are gone. When we perform the replacement with a catheter and use conscious sedation, patients are up and walking around the day of the procedure and go home the next day.”

Fixing Blood Flow Without Surgery

Patients with mitral valve regurgitation also face exhaustion, extreme fatigue and shortness of breath. If you have severe leakage but are not a candidate for surgery, the MitraClip system can help.

Available at Saint Joseph Hospital and Jewish Hospital, this system uses a nonsurgical puncture and a catheter to place a clip on the mitral valve. MitraClip allows the valve to close more completely, reducing the backflow of blood.

This article originally appeared in the Winter 2017 edition of One Health magazine. For more stories like this one, subscribe to One Health today

Losing Weight for a Healthier Life

Losing Weight for a Healthier Life

Losing Weight for a Healthier Life

Did you know weight-loss surgery can help treat Type 2 diabetes?

Type 2 diabetes can be challenging to control. Adults with the condition must prick their fingers to check their blood sugar multiple times a day. Many also take one or more medications or use insulin injections to keep their glucose levels under control. Even with these treatments, some people have a difficult time managing their illness.

“Medications and insulin injections work to a point, but they’re like a bandage,” said Robert Farrell, MD, FACS, bariatric surgeon at KentuckyOne Health Weight Loss and Surgery Associates. “We’re now seeing a paradigm shift. Weight-loss surgery is becoming a prominent choice for some people with Type 2 diabetes who are overweight or obese.”

Available Options

Three weight-loss surgeries — Roux-en-Y gastric bypass, sleeve gastrectomy and gastric banding — were discussed at the 2nd Diabetes Surgery Summit as treatment options for Type 2 diabetes. All three are available at KentuckyOne Health and are performed laparoscopically, meaning surgeons operate through several small, key-hole-sized incisions instead of through one large incision. Laparoscopic surgery is usually less painful and gets patients back on their feet faster.

During a Roux-en-Y gastric bypass, surgeons create a small pouch from a portion of the stomach. This pouch is separated from the rest of the stomach and the two upper parts of the small intestine, which are known as the duodenum and jejunum. The pouch is then reconnected to the lower segment of the small intestine, forming a “Y” shape. The surgery limits the amount of food people can comfortably eat at one time and the number of calories and nutrients that are absorbed from food.

“Metabolic changes happen almost instantly when you bypass the duodenum, so people see diabetes improvement not long after surgery,” said Joshua Steiner, MD, FACS, bariatric surgeon at the Center for Weight Loss Surgery at Saint Joseph East, part of KentuckyOne Health. “Many of our patients go home needing very little of their diabetes medication.”

The American Society for Metabolic and Bariatric Surgery estimates that Roux-en-Y gastric bypass essentially cures Type 2 diabetes in 80 percent of cases. Roughly 85 to 90 percent of Dr. Steiner’s patients no longer have to worry about diabetes after surgery, and nearly 100 percent see improvement.
Dr. Farrell offers Roux-en-Y gastric bypass and sleeve gastrectomy, which was the most performed bariatric surgery in 2015, to patients looking to improve their Type 2 diabetes symptoms. During a sleeve gastrectomy, physicians remove roughly 80 to 85 percent of the stomach. More than 80 percent of his patients who have a sleeve gastrectomy notice Type 2 diabetes improvement or resolution.

“To see that there is an option that can treat diabetes and prevent serious complications fills people with hope,” Dr. Farrell said. “These surgeries are truly life changing.”

This article originally appeared in the Fall 2016 edition of One Health magazine. For more information about weight loss and nutrition, subscribe to One Health magazine today.

The Right Route to Recovery

The Right Route to Recovery

The Right Route to Recovery

All stroke rehabilitation is the same, right? Wrong. Here’s why.

A stroke doesn’t just come and go. The repercussions of the event can stay with a person both mentally and physically for a lifetime. Each year, roughly 800,000 Americans experience a stroke, and many of those must then begin the recovery process.

Darryl Kaelin, MD

“Stroke is one of the most common causes for disability in America and is certainly a leading reason for needing rehab,” said Darryl Kaelin, MD, medical director at Frazier Rehab Institute, part of KentuckyOne Health and associate professor of the division of physical medicine and rehabilitation at the University of Louisville. “After a stroke, survivors can lose a lot of physical and mental function and must work to get back what they can. That’s where rehab comes in.”

In or Out?

The primary mission of all rehabilitation facilities is to help patients improve their quality of life by working on:

  • Skills such as walking, talking and eating
  • Physical strength and flexibility
  • Living an independent lifestyle

“Stroke patients must carefully consider where they will seek rehab,” Dr. Kaelin said. “Not all hospitals and clinics offer the same services.”

Recently the American Stroke Association recommended stroke survivors utilize acute, inpatient rehab instead of skilled nursing facilities. This decision was based on several studies that revealed numerous advantages to inpatient rehabilitation programs compared with those in skilled nursing facilities.

Some of the most notable benefits of inpatient rehabilitation include:

  • Daily visits from a rehab doctor
  • Longer therapy sessions
  • Higher nurse-to-patient ratios

These added benefits can lead to quicker recovery times as well as longer life expectancy for those who participate in acute inpatient rehab.

This article originally appeared in the Fall 2016 edition of One Health Magazine. Want more health and rehabilitation news like this? Subscribe to One Health Magazine and receive the latest news straight to your inbox.

The Ten P’s: Tips for a Good Doctor Visit

Tips for a Good Doctor Visit

No matter how well-trained, motivated and compassionate your doctor is, you might not be getting as much out of your health visits as you can. The good news is that there are several things you can do to make the most of your office appointments.

Here are some helpful tips from a doctor about what you can do make your time together as meaningful as possible.

1. Prepare

Make sure you know the correct date, time and location of your appointment. If you have not been to that location before, look it up so you know where you’re going. Make sure to bring your identification, insurance card, and a list of your current medicines and allergies. If you are seeing a specialist, know the name of your primary care provider so the specialist can send a letter summarizing the visit. If the doctor might need to examine you, wear clothes that are easy to take off and put on.

2. Paperwork

If you are seeing a doctor for the first time, you might be told to expect new patient paperwork in the mail. Look for it. If you do not receive it, call the office. People in the office might be able to email it to you. Then fill it out. Do not try to decide what you think the doctor needs to know and withhold information. Humor the doctor by filling it out accurately and completely. Office personnel are accustomed to seeing information presented in a certain way, and may need to follow a sequence for computer entry of information.

3. Person

Consider bringing another person with you to your appointment to act as another set of eyes and ears. On the other hand if you have young, active children consider leaving them with a sitter so you can focus on your visit.

4. Punctual

Often you will be told both an appointment time and an arrival time. Take traffic and unfamiliar surroundings into consideration when planning travel time. You may have to sign more forms after you arrive, so if you arrive just before your appointment time you will be behind. If you are flustered because you are late, you will not be thinking clearly when it is your turn to see the doctor.

5. Play

It’s not fair and it shouldn’t be this way, but at times you will have to wait. Bring a book or another diversion to occupy yourself while you wait. You will be in a better mood when it’s your turn to see the doctor.

6. Phone

Your health demands focus. Turn off your phone when the doctor or nurse is in the room.

7. Purpose

This is one of the most important points. Think about the reason for your visit, and tell the doctor or nurse practitioner within the first few minutes. Do not tell a story to explain the background or build dramatic effect; these can come out with further discussion. Get right to the point. For example, “I am here to discuss my blood pressure medicine. My blood pressure has been high, and I am having strange sensations. I wonder whether they might be side effects of the medicine.”

8. Participate

Be there mentally and take part in your visit. Your doctor or nurse practitioner is making decisions based on your responses to questions, so answer questions as best you can. Do not say what you think they want to hear. For example if your physician prescribes a medication but you do not take it, say so. Or if your doctor explains the results of a test and asks whether you understand, do not say yes if you do not.

9. Pen and paper

If you do not have a scribe to help you, bring something to make notes about the topics you discussed. You might even ask the doctor to review what you wrote to ensure it is accurate. Keep your notes in a binder or notebook, and bring it with you to every appointment.

10. Plan

This is very important. Make sure you understand the plan before the visit ends. For example you might say, “So I am going to stop taking Toprol, and start Diovan. I am going to come back in 6 weeks for blood work and a recheck. Is that right?” You both should be clear about what should happen next.

Being an advocate for your own healthcare does not mean you have to be suspicious or confrontational, but it does require some thought. It will help you to think about your appointment before, during and after the visit. You will learn more about your health, be more satisfied with your experience, and position yourself for a longer, happier life.

Remember your P’s!


Dr. David LipskiDavid Lipski, MD

Dr. David Lipski practices venous and lymphatic medicine at KentuckyOne Health Vein Care Associates.

Six Steps to Beat the Blahs

Six Steps to Beat the Blahs
There are ways to overcome cloudy, gloomy days.

“The wintertime and holidays can be difficult for many people suffering from depression or grieving the loss of a loved one,” said Kelly Gillooly, MEd, LCADC, director of behavioral health outreach at Our Lady of Peace (OLOP), part of KentuckyOne Health. “For those who struggle with depression during the holiday months, it’s important to not dwell on what the holidays are supposed to be like or how you’re supposed to feel.”

 

One Foot Forward

 

  1. Accept help from others — whether it’s with cooking, shopping or decorating.
  2. Avoid alcohol and other substances used to self-medicate.
  3. Don’t put too much pressure on yourself to have the perfect holiday.
  4. Find someone you can turn to when you’re feeling stressed.
  5. Get some exercise. Physical activity can help relieve depression.
  6. Give yourself permission to grieve if you’re struggling with the loss of a loved one.

“If you’re feeling down or overwhelmed, don’t be afraid or embarrassed to ask for help. Everyone needs support from time to time in their lives,” Gillooly said.

 

Need help finding peace and hope during the holidays or colder months?

 

Please do not hesitate to call — day or night — Our Lady of Peace’s Assessment and Referral Center. Our Lady of Peace is open 24/7 and offers assessments at no charge.

This article originally appeared in the Fall 2016 edition of One Health Magazine. Want more behavioral health information like this? Subscribe to One Health Magazine to hear from experts.

 

Flipping the Health Care Switch

Flipping the Health Care Switch
The transition from high school to college isn’t the only change teens need to make as they enter adulthood.

Between the ages of 18 and 21, most young adults make the switch from their pediatrician to a primary care physician who focuses on adult care.

Ben Rambicure, MD, family medicine physician at KentuckyOne Health Primary Care Associates, recommends families start looking for a new provider early so everyone is prepared.

A 3-step Process

Age 12

Teach preteens how to discuss their health care. Adolescents should be familiar with their personal and family history, as well as any medications they take on a daily basis.

Age 17

Start the search for your teen’s adult primary care physician and help your teen understand health insurance coverage.

Ages 18-21

Make an appointment with the internal or family medicine physician for your teen.

“At this point, teenagers can call their pediatricians and say, ‘I’m scheduled to see this provider on this date at this time,’ and arrange for their medical records to be transferred,” Dr. Rambicure said. “Because everyone is on the same page regarding medical history, screenings, vaccinations and lab work, teens can expect a smooth transition.”

This article originally appeared in the Fall 2016 edition of One Health Magazine. Subscribe to One Health Magazine to learn more about Primary Care information from local experts.

The Rundown on Reviewing Your Insurance Plan

Read The Rundown on Reviewing Your Insurance Plan

The Rundown on Reviewing Your Insurance Plan
The new year is here – it’s time to get a handle on your insurance plan and understand what’s covered.

“The turn of the new year marks a good time to review your current coverage and available options,” said Sherrie Troutman, benefits manager at KentuckyOne Health. “Participants need to ensure they understand the specifics of their particular health plan.”

Troutman offers a few practices for maximizing your plan in 2017 and helping you select your 2018 coverage:

  • Boost your overall health by staying up to date with recommended immunizations and screenings. “Talk with your doctor or primary care provider about which screenings and immunizations you should get,” Troutman said. “Many recommended screenings and immunizations – like routine childhood immunizations, the flu shot, mammograms and Pap tests for women, and osteoporosis screenings for older adults – are typically covered in full by your insurance company.”
  • Understand the specific in-network and out-of-network coverage benefits of your plan. Using in-network providers leaves you with a smaller out-of-pocket cost.
  • Know your out-of-pocket balance. Look up the details of your plan to find out what your out-of-pocket limit is and what is remaining. You will not maximize your benefits until your deductible, out-of-pocket maximum and other plan requirements are met.
  • Keep track of the number of visits with your doctor you have in 2017 aside form annual wellness checkups and other preventive services. This can help you decide whether a traditional plan or high-deductible plan will better suit your future health care needs.
  • Take charge of your health and well-being by scheduling an annual wellness visit, or checkup, as well as other preventive screenings with your primary care provider each year. “These visits are the cornerstone of preventive care and are covered 100 percent,” Troutman said. “Preventive screenings are crucial for finding health problems before symptoms begin, when most conditions are easiest to treat.”

And, finally, don’t forget to investigate health and wellness programs and incentives offered through your workplace.

“Employee Assistance Plans provide a wealth of information and assistance, such as face-to-face counseling, legal and financial services, and online resources, to help manage stress and work-life balance as well as improve both mental and physical health,” Troutman said.

This article originally appeared in the Winter 2017 edition of One Health Magazine. Want more health and wellness information like this? Subscribe to One Health Magazine to hear from experts on how to take control of your health.