Month: July 2016

Definition.  Gastroephagheal reflux disease (GERD), also referred to as heartburn or acid indigestion, is a burning sensation that occurs in the chest.  Heartburn generally worsens when lying down or bending over.  In most cases, heartburn can be managed with simple lifestyle modifications and occasional use of over-the-counter medications.

Causes.  Heartburn occurs when stomach acid backs up into your esophagus, the muscular tube that connects the throat to the stomach.

Identifying triggers.  Certain foods that may trigger heartburn include alcohol, black pepper, chocolate, caffeine, fatty or fried foods, ketchup, mustard, onions, orange juice, carbonated/fizzy drinks, tomato sauce, peppermint, and vinegar.  If experiencing frequent heartburn, you may consider starting a food diary.  Begin keeping a log of the foods and beverages that you eat/drink, and document which food(s) cause acid reflux.  Then make an effort to decrease your intake of those foods and drinks.

Complications.  Potential complications of heartburn include chest pain, chronic cough, sore throat, laryngitis, and abnormal growths on the vocal cords.  Additionally, acid reflux may worsen pre-existing asthma in some patients.

When to see your doctor.  Severe heartburn that interferes with your daily activities warrants a visit to your doctor.  Examples include heartburn that occurs more than twice weekly; symptoms that persist despite using OTC medications; and experiencing difficulty swallowing.

Lifestyle modifications.  You can make small changes to find relief by:

• maintaining a health weight
• avoiding tight-fitting clothing
• avoiding foods that trigger heartburn
• eating smaller meals
• not lying down immediately after a meal
• elevating the head of your bed
• avoiding tobacco

OTC pharmacological treatment.

• Antacids.  Maalox, Mylanta, Rolaids, Tums, etc are antacids that neutralize stomach acid.  In general, antacids work quickly, but can only be used once heartburn is already occurring.  Additionally, they may not provide relief for long.
• H-2 receptor blockers.   Tagamet, Pepcid, Axid, and Zantac help to reduce acid production.  These medications don’t work as quickly as antacids, but do provide longer relief.  Stronger versions are also available by prescription.
• Proton pump inhibitors.  Nexium, Aciphex, Protonix, Prevacid and Prilosec block acid production, and allow time for damaged esophageal tissue to heal.  Though PPIs are used commonly, ideally they should be used for the shorted duration possible.  Chronic use may result in decreased calcium or magnesium levels,  certain infections including pneumonia, and bone fractures.

Definition. Flatulence is the accumulation of gas (air) in the GI tract.  Gas exits the body when people either burp or pass gas (fart).  Though sometimes embarrassing, everyone experiences gas at some point or another.

Cause.  Gas is generally caused by swallowing air, or when certain foods breakdown in the intestine.  Swallowing a small amount of air when you eat or drink is normal.  Activities such as eating or drinking too quickly, smoking, chewing gum, or drinking carbonated/fizzy drinks may cause you to swallow more air than usual.

Certain food groups may also cause someone to experience flatulence.  Foods that may cause gas include beans; vegetables such as broccoli and cabbage; fruits such as apples, pears, and peaches; whole grains; dairy products; and pre-packaged foods.

Symptoms.  The most common symptoms of gas include burping, passing gas, bloating, and abdominal or chest pain.

Identifying triggers.  The best way to find the cause of your gas is to keep a food diary.  Document what you eat and drink, and then how often you burp, pass gas, or have other symptoms afterwards.

Treatment.  The best way to treat your flatulence is to identify your food triggers and then avoid them.  Alpha-galactosidase (Beano) may help reduce gas when you eat beans, vegetables, and whole grains.  Simethicone (Gas-X) may relieve bloating and abdominal pain or discomfort caused by excess gas.  If you are lactose-intolerant, finding lactose-free dairy products should be beneficial.  Lactase tablets or liquid drops can help digest regular dairy products when lactose-free products aren’t available.

Everyone has different bowel movement patterns.  Only you know what “regular” means for you.  Some people may have a movement several times per day, while others experience them only a few times per week.

Definition.    Generally, constipation is defined as having (a) fewer than 3 bowel movements within a week or (b) bowel movements that are hard, dry, or small making them difficult to pass.  While uncomfortable, constipation is typically not dangerous, and only lasts for a few days.

Complications.  In the worst cases, constipation may lead to hemorrhoids (swollen and inflamed veins around the anus); anal fissures (small tears in the anus); rectal prolapse (when the rectum sticks out of the anus); or fecal impaction (tightly packed stools in the intestine and rectum).

Causes.  The most common causes of constipation are slow movement of the stool, delayed emptying of the colon, and GI diseases such as irritable bowel syndrome.  Constipation may worsen with a low fiber diet, lack of physical activity, certain medications (such as opioids), and/or ignoring the urge to have a bowel movement.

Treatment.  Some simple lifestyle modifications may help to improve your regularity.  Improve your eating habits by staying well hydrated, eating more fiber (22-34 grams/day), and increasing your intake of fruits and vegetables.  Avoid eating dairy and processed foods as these may worsen constipation.  Exercising regularly (150 minutes per week) should also be beneficial.

Medications. Over the counter medications may be helpful if you’ve implemented the lifestyle changes above and still aren’t able to maintain regularity .  There are several types of laxatives available on the market:

• Bulk-forming agents such as Citrucel, Fibercon, and Metamucil, absorb fluid into the intestine making the stool bulkier and easier to pass.  It is important to take these medications with water to avoid creating a blockage in the intestine.
• Osmotic agents such Milk of Magnesia, Miralax, and Sorbitol help the stool retain fluid.  This softens the stool and increase the frequency of bowel movements.  These medications are generally not the best choice for older patients, and those with heart or kidney failure.
• Stool softeners also work by mixing fluid into the stools, which softens them.  Examples of stool softeners include Colace and Doculax. Stool softeners are especially beneficial for people who should avoid straining while having a bowel movement, such as someone who has cardiac issues, or recently gave birth or had surgery.
• Lubricants such as Fleet and Zymenol work by coating the stool, which helps it hold more fluid and pass more easily.
• Stimulant laxatives should be reserved for severe constipation which lasts an extended time, or has failed other therapies.  As examples, Correctol and  Senekot cause the intestines to contract, which moves the stool through the digestive tract.

If you still are not able have a bowel movement within 2-3 days of starting OTC medications, you should see a physician.  Frequent constipation, or bouts of constipation that last several weeks at a time may be indicative of a more serious condition such as a bowel obstruction, irritable bowel syndrome, or colorectal cancer.

Definition.  Diarrhea occurs when someone passes loose/watery stools more than 3 times a day.  Generally, diarrhea passes on its own in a day or two.  Diarrhea lasting longer than that may be indicative of a more serious problem, such as a GI infection.  Diarrhea that lasts longer than 4 weeks, considered chronic diarrhea, may be a symptom of a chronic disease.

Though diarrhea occurs fairly commonly, it is important to manage severe or prolonged diarrhea because it may lead to dehydration.  Dehydration occurs when the body lacks enough fluids and electrolytes (i.e. sodium, potassium, and chloride) to function properly.

Causes.  Acute diarrhea is often caused by a bacterial, viral, or parasitic infection that gets into our bodies via contaminated food or water.  Food intolerances (i.e. lactose intolerance), certain medications (i.e. antibiotics), and Traveler’s diarrhea (which occurs after traveling to certain countries) may also cause acute diarrhea.  Chronic diarrhea is usually related to serious GI disorders/diseases such as irritable bowel syndrome (IBS), ulcerative colitis, Crohn’s disease and/or celiac disease.

Symptoms.  In addition to loose stools, someone experiencing diarrhea may also experience cramping, abdominal pain, nausea, and loss of bowel control.  If the diarrhea is caused by infection, fever, chills, and/or bloody stools may also occur.

Complications.  The most significant complication of diarrhea is dehydration, which may cause organ damage, shock, or coma in the most severe cases.  Signs of dehydration include thirst, decreased urination, dark-colored urine, dry skin, fatigue, and dizziness.

When to see a doctor.  If you are showing any of the signs of dehydration listed above, you should see a healthcare provider.  Your doctor may suggest drinking electrolyte-containing fluids such as fruit juices, sports drinks, and broths. Be careful to avoid drinks that are high in sugar, such as sodas, because this may further worsen your dehydration. Children may benefit from rehydration products such as Pedialyte.  Severe dehydration may require hospitalization and IV fluids.

It is also recommended that you see your doctor if you experience diarrhea lasting more than 2 days, severe abdominal pain, a fever >102 degrees, or stools that are black, tarry, and/or contain blood or pus.

Diagnostic tests.  Tests are usually only run to determine the cause of chronic diarrhea.  Tests may include a stool culture, blood tests, and/or a colonoscopy.

Treatment.  Generally, the best treatment for acute diarrhea is preventing dehydration by replacing lost fluids and electrolytes.  If the diarrhea is caused by an infection, it is usually best to avoid anti-diarrheal medications and use antibiotics to eradicate the offending organism instead.  If not due to infection, over-the-counter medications such as loperamide (Imodium) and bismuth subsalicylate (Pepto-Bismol) may be helpful.

Supportive Nutrition.  Avoid foods that are greasy, high in fiber, sugary, or high in caffeine as these may worsen diarrhea.  Yogurt, which contains live active bacterial cultures may be beneficial in regulating your digestive system.  Soft, bland foods such as bananas, plain rice, boiled potatoes, toast, crackers, cooked carrots, and skinless baked chicken may be added to the diet once symptoms begin to improve.

Protecting yourself from potentially cancer-causing ultraviolet (UV) sunrays is important year-round, but especially during the hot summer months.  And yes, practicing sun safety is important even for those of us with melanated skin.

Damage from UV radiation can occur in as little as 15 minutes, and over time can lead to eye damage, a weakened immune system, sun spots, wrinkles, and skin cancer in the worst cases.

You can practice sun safety by:

• Limiting your outdoor activities from 10:00am – 2:00pm, when UV radiation is the strongest.
• Wearing protective clothing like long-sleeved shirts, pants, and wide-brimmed hats to protect yourself from direct sunlight.  Generally, dark clothing provides better protection than light-colored clothes.
• Using sunscreen.  Use products with a sun protection factor (SPF) of 30+.  The higher the SPF, the better protected you will be.  Additionally, you’ll want to choose a “broad spectrum” product that offers both UVA & UVB protection.  Apply sunscreen 15 minutes before sun exposure, and reapply every 2 hours.  If swimming or sweating excessively, you’ll want to reapply more frequently after drying off.  If participating in water activities, you may also consider using a water-resistant sunscreen product.  Some cosmetics, such as lipsticks, foundations, and moisturizers offer UV protection as well.  Also be sure to check the expiration date of your sunscreen periodically to be sure it is still effective.
• Protecting your eyes from cataracts by wearing sunglasses that offer at least 99% UV protection.
• Taking advantage of shade provided by trees, umbrellas, or other shelter.
• Performing monthly skin exams.  Schedule an appointment with your provider if you notice any of the following: a sore that will not heal; a new or changing growth or mole; hyperpigmentation; or changes in the integrity of the skin such as bleeding, oozing, scaliness, etc