Transcript: Stomach Disorders | Mar 19, 2001

(music plays)
The opening sequence shows a wooden table with a small lit candle as several words fly by: Nutrition, medicine, prevention, treatment, health.
Fast clips show different sets of hands performing activities on the table such as pulling petals from a daisy, drawing a big red heart, tuning a violin, flipping through the pages of a book, cooking, and pouring a glass of red wine.
In animation, the title appears inside the shape of a house: “More to life.”

Maureen Taylor sits in a studio with printed brown walls and a small chart in the background, which reads “More to life.”

Maureen is in her late thirties, with wavy brown hair in a bob. She’s wearing a black blazer over a pink blouse.

She says
HI, AND WELCOME
TO “MORE TO LIFE” I'M
MAUREEN TAYLOR.
I READ A QUOTE RECENTLY FROM
A DOCTOR WHO SAID NOTHING IS
SO OVER RATED AS SEX AND
UNDERRATED AS A GOOD BOWEL
MOVEMENT.
AMEN.
TODAY ON “MORE TO LIFE.”
WE'RE GOING TO GET THE SCOOP
ON POOP IS OTHER
GASTROINTESTINAL ISSUES.
DOCTOR DAVID BARON IS A
GASTROENTEROLOGIST.
HE'S HERE TO TAKE YOUR CALLS
ON IRRITABLE BOWEL
SYNDROME, CROHN'S AND COLON
CANCER SO GIVE US A CALL.

David appears on screen. He’s in his forties. He has short black hair in a neat cut and is clean-shaven. He wears a black suit, blue shirt and a matching dark silk tie.

A caption appears on screen showing two phone numbers.

Maureen continues IN TORONTO DIAL 416-484-2727.
CALL LONG DISTANCE TO 1-888-411-1234.
AND YOU CAN e-mail YOUR
QUESTION FOR DOCTOR BARON TO
moretolife@tvo.org
WELCOME BACK,
NICE TO SEE YOU.

David says GOOD TO SEE YOU AGAIN.

Maureen says SO DELICATELY
NOW, WHAT CONSTITUTES A
GOOD BOWEL MOVEMENT.

The caption changes to ¨Doctor David Baron. Gastroenterologist.¨

David says A GOOD BOWEL MOVE S WHAT
YOU'RE COMFORTABLE WITH.
IF YOU DEFINE NORMALITY,
WHICH MEANS 90 PERCENT OF THE
POPULATION FITS INTO
NORMALITY, IT MEANS ANYWHERE
FROM THREE BOWEL MOVEMENTS A
DAY TO THREE BOWEL MOVEMENTS
A WEEK AND FOR SOME PEOPLE
THOSE BOWEL MOVEMENTS MAY BE
NORMAL, IN QUOTATION MARKS,
SOLID, FORMED, MAYBE A
LITTLE LOOSE, MUSHY IS
OTHERS THAT MAY BE A LITTLE
HARD BUT IT'S WHAT YOU'RE
COMFORTABLE WITH.

Maureen says HOW WOULD YOU
KNOW IF YOU'RE NOT COMFORTABLE.

David says
I HAVE LOT OF PEOPLE
WALKING INTO MY OFFICE
ASKING THAT EXACT QUESTION.
IF YOU'RE NOT COMFORTABLE
WITH HOW THINGS ARE WORKING
FOR YOU.
IF YOU'RE HAVING MORE THAN
THREE BOWEL MOVEMENTS A DAY,
THAT'S NOT NORMAL, LESS THAN
THREE BOWEL MOVEMENTS PER
WEEK, THAT'S NOT NORMAL.
IF YOU'RE STOOLS ARE LIKE
WATER BEING THAT'S NOT
NORMAL AND IF YOUR STOOLS
ARE EXTREMELY HARD THAT'S
NOT NORMAL.
AND THERE ARE WAYS TO FIX
THAT EASILY, MOSTLY BY
ALTERNATING DIET.

Maureen says SO THE THREE
THING, CONSTIPATION AND
DIARRHEA, CHANGE IN DIET
WOULD HELP EITHER OF THOSE.

David says PROBABLY.
REMEMBER, DIARRHEA IS NOT
ONLY THE FREQUENCY, IT'S THE
LIQUIDITY OR CONSISTENCY AND
THE COMBINATION OF THOSE TWO
PEOPLE CALL DIARRHEA, AND IN
FACT MANY PEOPLE SAY I HAD
DIARRHEA, BUT WHEN YOU
REALLY GO INTO IT THEY HAVE
PERFECTLY NORMAL BOWEL
MOVEMENTS.

Maureen says I SEE.
WHAT ARE THE THINGS WE NEED
TO INGEST IN ORDER TO MAKE
OURSELVES SORT OF REGULAR
AND HEALTHY?

David says I'M A
FIRM BELIEVER IN WHAT WE
CALL A HIGH FIBRE DIET AND
THAT MEANS LOTS OF BRAN.
I SUGGEST TO ALMOST ALL OF
MY PATIENT TO HAVE AT LEAST
THREE TABLESPOONS OF MET
MUSIL OR THREE TABLESPOONS
OF PRODIEM A DAY AND THAT
WILL KEEP YOU REGULAR.
IT'S INTERESTING, PEOPLE WHO
SAY THEY HAVE DIARRHEA AND
YOU SAY I WANT YOU TO TAKE
METAMUCIL, AND THEY LOOK AT
YOU LIKE YOUR OUT OF YOUR
MIND, BECAUSE WHY WOULD YOU
HAVE ME TAKE A LAXATIVE, BUT
IT'S A REGULATOR.
IF YOU HAVE DIARRHEA, IT
FIRMS THINGS UP BIT.

Maureen says THE FLUID IS
IMPORTANT, TOO, ISN'T IT?

David says
ABSOLUTELY.
IF YOU TAKE THE METAMUCIL OR
THE PRODIEM OR OTHER FIBRE
AND DON'T DRINK ENOUGH WATER,
IT TURNS INTO CONCRETE.
SO YOU WANT TO MAKE SURE YOU
GET AT LEAST EIGHT GLASS OF
WATER A DAY.

Maureen says WHAT ROLE DOES
EXERCISE PLAY IN THIS
PROCESS?

David says I'M A FIRM BELIEVER
EXERCISE IS VERY IMPORTANT.
KEEPS YOU MOVING, GETS YOUR
BOWELS MOVING REGULARLY.

Maureen says WHAT DO YOU MEAN
TO EXERCISE?L YOUR PATIENTS--
WHAT ARE YOU TALKING ABOUT?

David says THREE TO FOUR TIMES A
WEEK.
YOU KNOW, PROBABLY AT LEAST
HALF AN HOUR TO 45 MINUTES
OF GOOD EXERCISE.
FOR SOME PEEP TELL MAY BE
JUST GETTING OUT FOR A WALK
BECAUSE THEY'RE NOT USED TO
DO ANY EXERCISE.
I DO A LOT, AND FOR PIECE
IT'S AN HOUR AND A HALF
WORKOUT AT GETTING MY
HEART RATE AT 80 PERCENT MAX SO IT'S
DIFFERENT FOR DIFFERENT
PEOPLE.

Maureen says OKAY.
WHAT ARE THE MOST COMMON
GASTRIC PROBLEM US SEE IN
YOUR OFFICE THESE DAYS?

David says IN MY OFFICE?
I WOULD SAY NUMBER SOMEONE
SCREENING FOR COLON CANCER
SO IN FACT IT'S NO SYMPTOMS,
BUT RATHER PEOPLE WORRIED
ABOUT COLON CANCER,
APPROPRIATELY SO, BECAUSE IT
IS A PREVENTABLE CANCER.
NUMBER TWO IS PROBABLY UPPER
G.I. SYMPTOMS LIKE HEARTBURN,
ACID DISEASE, ULCERS,
ALTHOUGH ULCER DISEASE SEEMS
TO BE A DYING ILLNESS.
BECAUSE OF THE ADVENT OR THE
FINDING THAT H.-PYLORI,
WHICH IS A BACTERIA THAT
CAUSES ULTER IS, WE'RE NOW
ABLE TO TREAT THE BACTERIA
AND IN FACT CURE ULCER
DISEASE.

Maureen says YOU TREAT IT
WITH ANTIBIOTICS.

David says ANTIBIOTICS.

Maureen says BECAUSE IT'S A
BACTERIA.
AND WE ONLY FOUND THAT OUT
WHEN?

David says
GUY MARSHALL FROM TRAIL I
CAN'T HAVE INGESTED H-PYLORI
FOUND THIS OUT ABOUT 1987 SO
ABOUT 14 YEARS NOW BUT IT'S
BEEN MAINSTREAM ABOUT EIGHT
YEARS.

Maureen says LET'S GO BACK TO
COLON CANCER.
THEREOF IS NO SCREENING TEST
FOR IT NOW.
I MEAN THERE'S A TEST BUT
IT'S NOT LIKE MAMMOGRAMS AND
THINGS IN ONTARIO.

David says THERE'S ABSOLUTELY
SCREENING TESTS FOR COLON
CANCER.
THERE ARE THREE POSSIBLE
TWICE SCREEN FOR COLON
CANCER.
ONE IS TO DO FECAL OCCULT
BLOOD TESTING WHERE YOU TEST
YOUR SCHOOLS -- STOOLS EVERY
YEAR FOR BLOOD.
THAT'S BEEN SHOWN IN
RANDOMIZED CONTROL TRIALS TO
IN FACT DECREASE THE RISK OF
CANCER AND DECREASE
MORTALITY.
THE OTHER WAYS ARE A
FLEXIBLE SIGNIFICANT MADEOSCOPY,
THREE TO FIVE YEARS WHERE WE
STAKE TUBE UP PEOPLE HE IS
BACK SIDE AND GO A THIRD OF
THE WAY UP THE COLON AND
WHAT I CALL THE GOLD
STANDARD IS A COLONOSCOPY,
WHERE WE GO ALL THE WAY
AROUND THE COLON, AND WE'RE
LOOKING FOR NOT CANCER BUT
POLYPS BECAUSE WE KNOW
POLYPS ARE THE PRECURSORS OR
WHAT COMES BEFORE CANCER AND
TAKING THESE OUT YOU CAN
DECREASE THE RISK OF
DEVELOPING CANCER BY OVER
90 PERCENT.

Maureen says SO AT WHAT AGE
SHOULD PEOPLE START TO HAVE
THESE TESTS?

David says IT DEPENDS ON THEIR
FAMILY HISTORY.
SO FOR EXAMPLE, SOMEONE WHO
HAS NO FAMILY HISTORY, I
WOULD SUGGEST AT THE AGE OF
50 THEY SHOULD START TO BE
SCREENED.
SOMEONE WHO HAS A VERY
STRONG FAMILY HISTORY, IT
DEPENDS ON THE TYPE OF
FAMILY HISTORY.
IF THEY HAVE ONE FIRST
DEGREE RELATIVE, EITHER
MOTHER, FATHER OR BROTHER,
THEY SHOULD START TO BE
SCREENED ABOUT TEN YEARS
BEFORE THE AGE OF ONSET, THE
FIRST RELATIVE TO DEVELOPED
CANCER.
IN OTHER WORDS IF YOUR MOM
DEVELOPED AT 50, YOU SHOULD
STAT AT 40.
IF YOU HAVE TWO OR MORE
FIRST DEGREE RELATIVES WHO
DEVELOPED IT WE START AT A
YOUNGER AGE, 40.
IF YOU HAVE SOMETHING CALLED
F.A.P. OR FAMILIAL ADENOMATOUS
POLYPOSIS, GENETICALLY
INHERITED CANCER THAT SHOULD
STARTED IN THEIR TEENS.

Maureen says AND HOW OFTEN?

David says IT DEPENDS ON THE FAMILY
HISTORY.
SOMEONE WHO HAS NO FAMILY
HISTORY AND WE DON'T FIND
POLYPS, I WOULD SUGGEST
DOING COLONOSCOPY EVERY FIVE
TO SEVEN YEARS, IF THEY HAVE
A STRONG FAMILY HISTORY AND
THEY FALL INTO THESE F.A.P.
CATEGORIES OR SOMETHING
CALLED HEREDITARY NON-POLYPOSIS
COLON CANCER SYNDROME, THEY
SHOULD BE HAVING EVERY YEAR
TO TWO.
SO IT REALLY DEPENDS.

Maureen says NOW WHEN I SAID
WE DON'T HAVE SCREENING --
ARE THOSE PAID FOR BY OHIP,
ALL OF THOSE THINGS?

David says THOSE ARE PAID FOR BY
OHIP BUT THERE'S NO
SCREENING PROGRAMME.
AND IN FACT I'M A MEMBER
OF -- I'M ON THE BOARD OF
DIRECTORS AT THE ONTARIO
ASSOCIATION OF GASTROENT
ROLL GEE, AND ALONG WITH
CANCER CARE, ONTARIO, WE'VE
BEEN TRYING TO PUSH FORWARD
A SCREENING PROGRAMME
UNFORTUNATELY THE GOVERNMENT
HASN'T UNDERSTANDED YET.
IT'S COMING BUT IT'S NOT
HERE YET AND WE'VE BEEN
TRYING TO PUSH FORWARD
BECAUSE WE THINK THIS IS A
PREVENTABLE CANADA SEMPLE
IT'S MORE PREVENTABLE THAN
BREAST CANCER BECAUSE WE'RE
NOT LOOKING FOR CANCER,
WE'RE LOOKING FOR BEFORE
CANCER.

Maureen says WE'RE TAKE
QUESTIONS THIS AFTERNOON FOR
DOCTOR DAVID BARON, A
GASTROENTEROLOGIST SO GIVE
US A CALL WITH YOUR
QUESTIONS ABOUT STOMACH AND
BOWL.
HELLO, NATASHA.

Natasha says HELLO.
I'VE HAD PROBLEMS SIMILAR TO
WHAT YOU'VE BEEN TALKING
ABOUT LATELY, UP TO EIGHT
TIMES A DAY WHERE I'VE HAD
THE DIARRHEA.
I'VE HAD THE COLONOSCOPY
DONE, X-RACE DONE THE LOWER
INTESTINE, AND ALSO STOOL
SAMPLES TAKEN, AND I'M NOT
SURE WHERE TO GO FROM HERE.
BECAUSE THEY'RE FINDING
NOTHING WRONG.

David says OKAY, NATASHA HOW OLD
ARE YOU?

Natasha says I'M TWENTY-ONE.

David says FIRST OF ALL, ANY
RESPONSE I GIVE TODAY, WHY
REALLY ANSWER YOUR QUESTIONS
PER SE, BECAUSE I'M NOT THE
PHYSICIAN TAKING CARE OF YOU,
SO I'M JUST GOING TO
PREDICATE EVERYTHING I SAY
WITH THAT HOWEVER IF I SAW A
21 YEAR OLD GIRL IN THE
OFFICE WITH SYMPTOMS SIM
WLAR TO YOURS, THE ODDS ARE
THIS IS PROBABLY DIETARY
RELATED.
IF YOUR PHYSICIAN AND
GASTROENTEROLOGIST HAVE
LOOKED AT YOUR BOWEL,
ESPECIALLY YOUR ILEUM, AND
THIS IS BEEN GOING A SHORT
TIME WHERE WE THINK OF
INFECTION.
IF SOMEONE HAS IT FOR LESS
THAN THREE WEEKS WE THINK OF
AN INFECTION AND I ALWAYS
LAUGH WITH RES DENS WHEN I
ASK THEM WHAT ARE THE CAUSES
OF DIARRHEA THAT ARE GOING
ON FOR LESS THAN THREE WEEKS
AND THEY'LL ALWAYS SAY
INFECTION THE FIRST ONE AND
I'LL SAY WHAT'S SECOND AND
THEN THEY'LL BE STUMPED AND
I'LL SAY INFECTION AND
WHAT'S THIRD, INFECTION
WHAT'S THE FOURTH,
INFECTION.
SO DIARRHEA LESS THAN THREE
OR FOUR WEEKS IS ALWAYS
INFECTION.
FOR MONDAY THAT THAT YOU
HAVE TO START THINKING ABOUT
DISEASE PROCESSES AND YOU
HAVE TO START THINKING ABOUT
DIET.
CERTAINLY SOMEONE YOUR AGE,
WE OFTEN SEE LACTOSE
INTOLERANCE.
I DON'T KNOW WHAT YOUR MILK
INTAKE, IS BUT OFTEN -- I
KNOW WHEN I TURNED 19 I
DEVELOPED LACTOSE
INTOLERANCE AND I NEVER HAD
A PROBLEM BEFORE THAT AND
ALL OF A SUDDEN I COULDN'T
TOLERATE MILK.
AND BELIEVE IT OR NOT
THERE'S MILL INCOME
EVERYTHING SO YOU REALLY
HAVE TO READ YOUR LABELS
PROPERLY.
THE OTHER DIETARY FACTOR IS
THE.
A FIBRE YOU'RE TAKING IN IN
YOUR DIET.
YOU SPLAY TO INCREASE THE
AMOUNT THAT YOU TAKE.
THOSE SO THOSE ARE THE
THINGS I WOULD LOOK AT
INITIALLY BEFORE SUGGESTING
ANY OTHER TEST.
AND I'M ASSUMING -- THERE
ARE OTHER TESTS JUST ASIDE
FROM IMAGING THE BOWLS.
WE WANT TO MAKE SURE THE
BLOOD COUNTS ARE OKAY, THE
STOOL TESTS THAT WERE DONE
WERE OKAY, THERE'S NO
EVIDENCE THAT SHE'S LOSING
PROTEIN OR BLOOD OR
HEMOGLOBIN THAT WOULD
SUGGEST A MORE SINISTER
DISEASE PROCESS.

Maureen says OKAY, THANKS
NATASHA.
KERRY IS IN INNISVILLE.
HELLO, KERRY.

Kerry says OH, HI.

Maureen says HI.
GO AHEAD.

Kerry continues I HAVE A QUESTION
ABOUT MY THREE-YEAR-OLD
NIECE HAS EXTREME
CONSTIPATION.
SHE CAN GO FOR ABOUT TEN
DAYS WITHOUT HAVING A BOWEL
MOVEMENT.
PAIN EVERYDAY IN THE STOMACH.
SHE'S ON LACTULOSE, WHICH
SHE TAKES QUITE A LOT, THE
DOCTOR SAYS SHE SHOULD BE ON
THE TOILET ALL THE TIME, AND
SHE HAS BLEEDING WITH IT AND
NOBODY SEEMS TO -- EVERYBODY
SAYS WELL, THAT'S JUST THE
WAY SHE IS.

David says WELL FIRST OF ALL, I
DON'T TREAT KIDS, SO -- AND
ANY ADVICE I GAVE -- SORRY,
ANY ADVICE YOU GAVE YOU
ABOUT KIDS WOULDN'T REALLY
BE VALID, I'M GOING TO HAVE
TO PASS ON THAT QUESTION.
WHAT I WOULD SUGGEST,
HOWEVER, IS THAT IF THIS IS
CONCERNING TO YOU, THAT YOU
HAVE YOUR PEDIATRICIAN
CONSULT A
GASTROENTEROLOGIST, WHICH
THERE ARE MORE AND MORE NOW
IN THE PROVINCE WILLING TO
SEE THESE TYPE OF PATIENTS.

Maureen says WE'VE HAD THESE
QUESTIONS WHEN WE HAD
DOCTOR DIANE SACHS ON WITH KIDS
WHO WILL HOLD FOREVER IN
ORDER NOT TO GO AND I KNOW
THEY CAN BE QUITE STUBBORN
ABOUT IT BUT THE WAY YOU
DESCRIBE IT IT DOES SOUND
LIKE IT'S SERIOUS.
SO YEAH, WE'LL HAVE TO --
ARE THERE ANY
GASTROENTEROLOGISTS OUT
THERE?

David says THE NUMBERS ARE
INCREASING.
I KNOW THERE'S AT LEAST SIX
OR SEVEN AT HOSPITAL FOR
SICK CHILDREN.
AT MY HOSPITAL THERE'S ONE,
BUT THEY'RE GRADUATING ABOUT
ONE A YEAR SO THERE IS AN
INCREASED NUMBER.

Maureen says OKAY.
SO CAN WE TALK A LITTLE BIT
ABOUT -- YOU SAID THERE WAS
A FAMILIAL TYPE OF
GASTRO PROBLEM, BUT ARE OTHER
THINGS -- DO THEY RUN A
FAMILY?
I KNOW A FAMILY WHERE
CROHN'S IS AFFECTING FOUR
OUT OF FIVE PEOPLE IN ONE
FAMILY.

David says SURE, IT'S A PARTIALLY
GENETIC DISEASE.
WE HAVEN'T ISOLATED ONE GENE
THAT SAYS IF YOU HAVE THIS
GENE YOU WILL GET CROHN'S
DISEASE BUT SEVERAL CENTERS
AROUND THE WORLD, INCLUDING
Mt. SINAI DOWN THE ROAD THAT
ARE DOING GENETIC TESTING
FOR CROHN'S AND ALL OF THEM
HAVE ISOLATED DIFFERENT
GENES ACCOUNTING FOR THE
DISEASE.
SO IT'S PROBABLY MULTI
GENETIC, THERE ARE PROBABLY
MANY GENES THAT ACCOUNT FOR
THE DISEASE.
WHAT'S VERY DRAG ABOUT THE
GENETICS IS THAT WE'RE
FINDING THAT THERE ARE
CERTAIN PEOPLE THAT HAVE
CERTAIN GENES THAT ARE
PREDISPOSED TO CERTAIN TYPES
OF CROHN'S DISEASE THAT ARE
PREDISPOSED TO RESPOND TO
CERTAIN MEDICATIONS THAT
OTHERS DON'T RESPOND TO IF
THEY CARRY THAT GENE.
SO THAT'S THE REALLY
INTERESTING PART ABOUT THIS,
IS THAT WE MAY BE ABLE TO
TAILOR OUR THERAPY FOR
CROHN'S DISEASE BY A
PATIENT'S GENETIC PROFILE
AND SAY OKAY, WHO DRUG X
WILL WORK ON THIS PERSON,
BUT DRUG Y WILL NOT.

Maureen says
WE'RE STILL A FEW YEARS
AWAY FROM THAT THOUGH?

David says AT LEAST
FIVE TO TEN YEARS AWAY FROM
THAT.

Maureen says FOR THE PEOPLE
THOUGH WHO DO SUFFER FROM
CROHN'S IT SEEMS AS IF SOME
ARE GOING ALONG FINE AND
DON'T HAVE FLAIR-UPS AND ALL
OF A SUDDEN BANG.
DO WE KNOW WHY THAT HAPPENS?

David says ANYTHING CAN CAUSE A
PATIENT WITH CROHN'S DISEASE
TO FLAIR.
THE MOST COMMON ONE IS
INFECTION AND THE MOST
CLASSIC, SOMEONE'S GONE TO
THE CARIBBEAN, GOTTEN
INFECTIOUS DIARRHEA, WHERE
IN YOU AND I IT WOULD JUST
DISAPPEAR AND THEY GO ON TO
HAVE A FLAIR AND IT'S
PROBLEM PROBABLY
REINSTITUTING THE WHOLE
INFLAMMATORY PROCESS THAT
BEGAN IT AGAIN.

Maureen says AND STRESS?

David continues
IT DOES NOT CAUSE IT, BUT
IT CAN CERTAINLY FLAIR THE
DISEASE.
I SEE MANY PATIENTS COME IN
WHO SAY “I WAS DOING FINE,
THEN I HAD THIS STRESSFUL
PERIOD, I WENT THROUGH THE
STRESSFUL PERIOD, IT WAS
FINE AND OVER AND THEN I GOT
MY FLARE.”
AND THAT'S NOT UNCOMMON
EITHER AND THE OTHER SUN
MEDICATION.
ALWAYS ASK YOUR PATIENTS
WHAT MEDICATION YOU'RE
TAKING BECAUSE EVEN DRUGS AS
SIMPLE AS ASPIRIN CAN FLARE
CROHN'S DISEASE.

Maureen says OKAY.
MIKE IS NEXT IN LONDON.
HI MIKE.

Mike says HI.

Maureen says HI.
WHAT'S UP?

Mike says OKAY WELL MY
GRANDFATHER HAD COLON
CANCER.
MY MOTHER HAD POLYPS AND
UNCLE HAD DIVERTICULOSIS AND
I'VE HAD DIVERTICULOSIS.
I USED TO TREAT THIS WITH A
FAIRLY HIGH FIBRE DIET AND
IT ACTUALLY DIDN'T TAKE MUCH
FIBRE TO KEEP ME SORT OF
REGULAR.
BUT SINCE I HAD BOWEL
SURGERY A COUPLE OF YEARS
AGO, A PORTION OF BOWEL WAS
TAKEN OUT IN '98 AND EVER
SINCE THEN, IF I STICK TO
THE HIGH FIBRE DIET, I GET
DIARRHEA.
SO I'M WONDERING, IS THE
HIGH FIBRE DIET REALLY
NECESSARY FOR ME?
THAT'S ONE QUESTION.

David says RIGHT.
YOUR BOWEL -- PART OF YOUR
BOWEL WAS REMOVED BECAUSE OF
DIVERTICULOSIS?

Mike says
WELL I HAD AN ABSCESS AND
CONSTANT PAIN.

David says OKAY, SO
I'M JUST GOING TO TRY TO
EXPLAIN TO THE AUDIENCE,
DIVERTICULOSI AND
DIVERTICULITIS.
IT'S VERY COMPLICATED AS YOU
GET OLDER, THE INCIDENTS OF
DIVERTICULOSIS INCREASES AND
WHAT THAT MEANS IS IT IS
JUST TINY POCKETS OR
OUTPOUCHINGS FROM THE BOWEL
AND WHEN YOU'RE 50 YEARS OLD,
ABOUT 50 PERCENT OF THE POPULATION
HAS IT, WHEN YOU'RE 70,
ABOUT 70 PERCENT, AND 80, 80 PERCENT.
IT JUST GOES UP AS THE AGE
GOES UP.
AND IN GENERAL, THESE CAUSE
ABSOLUTELY NO PROBLEMS AND
NO SYMPTOMS.
HOWEVER WHEN THEY DEVELOP A
COMPLICATION, THAT'S WHEN
PEOPLE RUN INTO PROBLEMS AND
THINGS LIKE DIVERTICULITIS
WHICH IS INFLAMMATION OF ONE
OF THESE DIVERTICULITIS, THAT'S
WHEN YOU RUN INTO THE
PROBLEM AND ONE OF THE
COMPLICATIONS IS AN ABSCESS
LIKE THIS GENTLEMEN HAD AND
THE TREATMENT IS USUALLY
ANTIBIOTICS AND SOMETIMES
SURGERY.
IF SOMEONE HAS RECURRENT
ATTACKS OF DIVERTICULITIS,
THEY WILL OFTEN NEED SURGERY
TO FIX IT.

Maureen says OKAY.

David continues SO AS
FAR AS WHY IN YOUR
PARTICULAR CASE FIBRE CAUSES
YOU TO HAVE DIARRHEA, I'M
NOT SURE.
YOU MAY BE -- YOU MAY BE
HAVING TOO MUCH FIBRE, YOU
MAY NOT BE HAVING ENOUGH
FIBRE.
A LIQUID YOU TAKE IN YOUR
DIET IS ALSO IMPORTANT, AND
AGAIN THINK OF OTHER THINGS
THAT ARE CAUSING THE PROBLEM
LIKE LACTOSE.
SEE IF THAT'S CAUSING YOU TO
HAVE SOME LOOSE BOWL
MOVEMENTS.

Maureen says SO WOULD A
DOCTOR BE ABLE TO SIT DOWN
AND TELL HIM WHETHER THIS IS
TOO MUCH OR TOO LITTLE
FIBRE?

David confirms I WOULD THINK SO.

Maureen says OKAY,
DIVERTICULITIS THEN, HOW
WOULD YOU KNOW YOU HAVE IT?

David says
DIVERTICULITIS, PEOPLE
PRESENT WITH PAIN AND IT'S
MOSTLY LEFT-SIDED PAIN.

Maureen says WHERE?

David continues
LEFT LOWER QUADRANT,
ABDOMEN, DOWN LOW ON THE
LEFT SIDE, FEVER, BECAUSE
IT'S AN INFECTION, AND WHEN
THE, WHEN THE PHYSICIAN
FEELS YOUR BELLY, IT'S VERY
TENDER AND OFTEN WHEN WE DO
A WHITE COUNT OR A BLOOD
COUNT, YOUR WHITE COUNT IS
ELEVATED INDICATING
INFLAMMATION OR INFECTION.

Maureen says OKAY.
MIKE, THANKS VERY MUCH.
CHRIS IS NEXT.
HI CHRIS.

Chris says YEAH.

Maureen says HI.

David says GOOD
AFTERNOON.

Chris says I HAD COLON
CANCER YEARS AGO, COLON
RECTAL SECTION, AND EVERY
THIRD DAY I HAVE TO RUN TO
THE BATHROOM AND I'LL BE IN
THE BATHROOM FIVE, SIX,
SEVEN TIMES THAT DAY SO I
CAN'T LEAVE THE HOUSE VERY
MUCH.
AND ALSO, I HAVE GAS THAT
BUILDS UP, LIKE I COULDN'T
BE LEFT IN A ROOM.
I COULD CLEAR OUT A SPORTS
CENTRE.
IT'S JUST AWFUL.
MY DOCTOR SAYS THAT IT'S
NORMAL, BUT I DON'T KNOW.
I GUESS I'M ASKING YOU IF IT
IS NORMAL OR IS THERE
ANYTHING THAT I CAN DO ABOUT
IT?

David says SURE.

Chris continues
HE DOESN'T WANT TO PUT ME
ON A MEDICATION.

David says OKAY.
FIRST OF ALL, SIR, HOW MUCH
OF YOUR COLON WAS REMOVED?

Chris says I THINK ABOUT
SEVEN OR EIGHT INCHES.

David says OKAY SO
A SMALL AMOUNT.

Chris continues YES IT WASN'T
VERY MUCH AND IT WAS COLON
RECTAL AND IT WAS A TERRIFIC
SUCCESS.

David says RIGHT.
I'M GOING TRY TO ANSWER YOUR
SECOND QUESTION FIRST WHICH
IS THE GAS PROBLEM.
THIS IS A VERY FREQUENT
PROBLEM THAT PEOPLE COME
INTO MY OFFICE AND SAY I'VE
THIS TERRIBLE GAS WHAT CAN I
DO ABOUT IT?
IT'S EXTREMELY COMMON AND IT
REALLY IS DEPENDENT ON WHAT
YOU EAT.
I CAN PROMISE YOU THAT IF
THIS GENTLEMEN WENT ON A
STARVATION DIET FOR THREE
DAYS HE WOULD HAVE
ABSOLUTELY NO GAS AT ALL.

Maureen says SO IT'S NOT
RELATE TO THE TREATMENT FOR
THE COLON CANCER.

David says ABSOLUTELY NOT.
IT'S RELATED TO WHAT WE EAT.
AND THERE'S CERTAIN FOODS
THAT PRODUCE GAS.
AGAIN SOMEONE WHO'S LACTOSE
INTOLERANT, I KNOW I KEEP
HARPING ON THIS LACTOSE, BUT
LACTOSE INTOLERANT SO WHEN
WE ALWAYS TAKE A HISTORY WE
ASK ABOUT LACTAID PROBLEM.
POP, YOU'RE HAVING TWO,
THREE, FOUR CANS OF POP A
DAY.
THAT'S AIR YOU'RE TAKING IN.
IT'S GOT TO GO SOMEWHERE AND
IT'S GOT TO COME OUT THE
BACKSIDE.
CARBONATED WATER, EVEN
MINERAL WATER THAT'S CARBON
NATURED.
CHEWING GUM THAT HAS A
TREMENDOUS.
A SORBITO FLMD IT AND
ASPARTAME, AND THE BACTERIA
IN YOUR COLON LOVE AND EAT
IT UP AND WHAT THEY PRODUCE
AS A BYPRODUCT IS AIR AND
THE AIR THEY PRODUCE
SOMETIMES IS FOUL SMELLING.
AND THE BIG ONE IS
VEGETABLES.
CAULIFLOWER, BROCCOLI, PEAS,
BEANS, CABBAGE, THOSE
PRODUCE A TREMENDOUS AMOUNT
OF GAS.
AND THAT'S BECAUSE WE'RE NOT
COWS.
WE CAN'T BREAK DOWN THE
VEGETABLES SO IT'S BROKEN
DOWN IN THE COLON BY THE
BACTERIA AND THEY PRODUCE A
BYPRODUCT OF GAS AND SO GAS
CAN BE FOUL SMELLING.

Maureen says BUT THOSE
VEGETABLES ARE GOOD FOR US
TO EAT.

David says
ABSOLUTELY BUT EVERYTHING
IN MODERATION, AND YOU KNOW,
YOU HAVE TO BE WILLING TO
SAY -- THERE'S NOTHING WRONG
WITH PASSING GAS.
IT'S MORE OF A SOCIAL
PROBLEM THAN --

Maureen giggles and says
THAT'S WHAT I
TELL MY HUSBAND.
THERE'S NOTHING WRONG.

David says IT'S MORE OF A SOCIAL
PROBLEM THAN IT IS A MEDICAL
PROBLEM.
IT BUGS YOU OR BUGS THE
PEOPLE AROUND YOU.

Maureen says BUT HE SOUNDS
LIKE HE'S ALMOST A PRISONER
IN HIS HOME THOUGH EVERY FEW
DAYS.

David says RIGHT,
AND AGAIN TINKERING WITH HIS
DIET WOULD PROBABLY BE
HELPFUL.
YOU KNOW, REMOVING EIGHT
INCHES OF YOUR COLON SHOULD
NOT ALTER YOUR BOWEL
MOVEMENTS THAT MUCH.
IT DEPENDS HOW LOW THEY
ACTUALLY WENT, HOW LOW THE
ANASTOMOSIS OR WHERE THEY
HOOKED HIM BACK UP IS THAT
MAY BE PLAYING A ROLE IN HOW
FREQUENT HIS BOWEL MOVEMENTS
ARE.

Maureen says THANK YOU VERY
MUCH, CHRIS.
RENÉE IS IN TORONTO.
HI RENÉE?

Renée says HI.
BASICALLY WHAT I'M WONDERING
IS THROUGHOUT MY LIFE,
STARTING FROM CHILDHOOD I'VE
ALWAYS HAD IRREGULAR BOWEL
PROBLEMS.
I'VE BEEN THROUGH TESTS AND
EVERYTHING AS A CHILD.
EVERYTHING CAME BACK NORMAL.
SINCE I'VE GIVEN BIRTH
THINGS HAVE JUST WORSENED.
ONCE EVERY TEN DAYS
POSSIBLY, AND WHEN I DO IT'S
JUST REALLY PAINFUL, AND
IT'S THROUGHOUT THE DAY.
BASICALLY, IS THERE
SOMETHING THAT I HAVE TO
WORRY ABOUT?
IS IT COMPARABLE TO WHEN I
WAS A CHILD AND ALSO BOTH MY
MOTHER AND MY GRANDMOTHER
DIED OF GASTRO-RELATED
CANCER.
NOW SHOULD I BE A BIT
WORRIED OR IS IT JUST
SOMETHING I SHOULD SAY IS
THE SAME THING AS CHILDHOOD.

David says
FIRST OF ALL HOW OLD ARE
YOU.

Renée says TWENTY-NINE.

David says
AND HOW OLD WAS YOUR MOM
WHEN SHE PASSED AWAY?

Renée says FIFTY-FOR YOU.

David says
AND HOW OLD WAS YOUR
GRANDMOTHER?

Renée says IN HER 50s AS WELL.

David says AGAIN IN GENERAL, SOMEONE
WHO HAS THAT STRONG A FAMILY
HISTORY OF COLON CANCER AND
ARE WHO HAS HAD A CHANGE IN
HER BOWEL MOVEMENTS, EVEN
THOUGH IT WAS RELATED TO A
LIFE EVENT IN PREGNANCY,
WHAT I WOULD SUGGEST IS THAT
SHE DOES HAVE A COLON -- SHE
SHOULD HAVE A COLONOSCOPY
FROM A SCREENING POINT OF
VIEW.
WITH THIS FAMILY HISTORY,
NORMALLY, IF SHE DIDN'T HAVE
SYMPTOMS, I WOULD PROBABLY
START SCREENING HER BETWEEN
35 AND 40, SO SHE'S GETTING
TO THAT AGE, BUT SINCE SHE
IS HAVING SYMPTOMS, AT LEAST
ONE LOOK NOW WOULD PROBABLY
BE WORTHWHILE.
CERTAINLY IN SOMEONE THIS
YOUNG YOU DON'T WANT TO MISS
CANCER OR A POTENTIALLY
CURABLE LEAGUES.
I'M NOT SAYING THIS WOMAN
HAS CANCER IN ANY WAY SHAPE
OR FORM AND I DON'T WANT HER
TO WALK AWAY FROM THIS
THINKING THAT THAT'S WHAT
I'M TELLING HER.
WHAT I'M SAYING IS THAT AT
HER AGE WITH A CHANGE IN HER
BOWEL MOVEMENTS, AGAIN, EVEN
THOUGH IT'S RELATED TO A
LIFE EVENT, AND GIVEN HER
VERY STRONG FAMILY HISTORY,
I WOULD HAVE THIS WOMAN
SCREEND.

Maureen says WHAT ARE THE
SYMPTOMS OF COLON CANCER?

David says MOST OF
THE TIME THERE ARE NO
SYMPTOMS.
THE MOST COMMON SYMPTOM IS
NO SYMPTOMS DEPENDING WHERE
THE CANCER IS.
IF IT'S ON THE RIGHT SIDE,
DOWN LOW ON THE RIGHT SIDE
IN THE RIGHT COLON, THEY
WILL PRESENT TO MY OFFICE
WITH ANAEMIA.
THEIR IRON LEVELS WILL BE
LOW AND ANAEMIC AND A LITTLE
TIRED AND THINGS AREN'T
QUITE AS NORMAL AS THEY USED
TO BE.
IF IT'S ON THE LEFT SIDE
OVER HERE, THEY'LL PRESENT
WITH SOME BLEEDING, THAT'S
THE MOST COMMON ONE, OR
INCREASING CONSTIPATION OR A
CHANGE IN THEIR BOWEL
MOVEMENTS WHERE THEY BECOME
SOMEWHAT THIVOLET HAVING SAID
THAT YOU KNOW, I GET
REFERRED TO ME PATIENTS WHO
HAVE THIN BOWEL MOVEMENTS
AND CHANGES IN BOWEL MOVE
WANTS ALL THE TIME AND
ALMOST NEVER TURNS OUT THEY
HAVE ANYTHING.
SO I DON'T WANT EVERYBODY TO
RUSH OUT BECAUSE THEIR BOWEL
MOVEMENTS WERE A LITTLE BIT
THIN TODAY TO GET, YOU KNOW,
INVESTIGATED.
BUT YOU KNOW, IF THEIR BOWEL
MOVEMENTS ARE CONSISTENTLY
CHANGED THAT'S CONCERNING.
OFTEN PEOPLE COME TO ME, YOU
KNOW, I'VE NOTICED THAT --
ONCE A WEEK MY BOWEL
MOVEMENTS ARE THIN, BUT THE
REST OF THE TIME THEY'RE
NORMAL.
WELL THAT MEANS THAT THEY'RE
NORMAL.

Maureen says YEAH.
YEAH.

David says SO I'M NOT AS CONCERNED
ABOUT IT AND DEPENDING ON
THEIR AGES, I WOULD SUGGEST
A COLONOSCOPY OR NOT.

Maureen says WHERE WOULD THE
SIDE MAKE A DIFFERENCE LIKE
IT?
IS IT BECAUSE OF THE WHERE
THE INTESTINAL TRACT IS?


David says THE LUMEN OF THE
DIAMETER ON THE LEFT SIDE IS
VERY SMALL, AND SO THAT'S
WHY THEY'LL PRESENT WITH
BLEEDING OR A CHANGE IN
THEIR BOWEL MOVEMENTS AND ON
THE RIGHT SIDE IT'S QUITE
LARGE SO EVEN IF THERE'S A
LARGE LESION SITTING THERE
IT WON'T CAUSE NARROW STOOLS
AND ANY BLEEDING THAT WILL
OCCUR WILL BE DISSIPATED AS
IT GOES AROUND BECAUSE IT
HAS TWICE TRAVEL.

Maureen says OKAY.
ALL RIGHT.
GOOD LUCK.
THANK YOU VERY MUCH FOR THE
CALL.
HERE'S AN E-MAIL.
I'VE BEEN DIAGNOSED WITH IBS,
IRRITABLE BOWEL SYNDROME
ABOUT FOUR YEARS AGO.
I'D LIKE TO ASK DOCTOR BARE IF
IT IS A NORMAL SYMPTOM
DURING AN EPISODE THAT I GET
EXTREMELY NAUSEATED AND EVEN
HAVE VOMITED ON VARIOUS
OCCASIONS.
I GET SO WEAK I'M UNABLE TO
STAND ON MY FEET AND I'VE
EVEN PASSED OUT A FEW TIMES.
I AM ON -- ALSO HAS TERRIBLE
ABDOMINAL PAIN.
I'M ON MODULON AND
RANITIDINE BUT SEEMS LIKE NO
MATTER WHAT THE PROBLEM
OCCURS.
SOMETIMES I HAVE NO BOWEL
MOVEMENT FOR 45 DAYS AND
THEN EIGHT TO TEN.

David says
FROM THE AUDIENCE POINT
OF VIEW, ZANT.
AC IS WHAT WE CALL AN H-2
RECEPTOR ANTAGONIST AND
BLOCKS ACID PRODUCTION IN
THE STOMACH GIVE IT TO
PATIENTS WHO HAVE HEARTBURN
OR BELLY PAIN ABOVE THE
BELLYBUTTON.
MODULON IS A DRUG WE USE TO
TREAT IRRITABLE BOWEL SYNDROME
AND IT'S AN ANTI-SPAS MOD
DICK THAT WORKS ON THE
OPIATE RECEPTORS IN THE
GUCHT ABOUT 45 TO 50 PERCENT OF
PATIENTS WHO HAVE IRRITABLE
BOWEL SYMPTOMS ALSO HAVE
UPPER G.I. SYMPTOMS.
NAUSEA, VOMITING, HEARTBURN,
VAGUE ABDOMINAL DISCOMFORT
ABOVE THE BELLYBUTTON, FEEL
FULL AFTER EATING, BELLY
PAIN SO IT'S NOT UNUSUAL TO
HAVE BOTH SYMPTOMS AT THE
SAME TIME OR EVEN AT
DIFFERENT TIMES BUT THEY MAY
HAVE BOTH SETS OF SYMPTOMS.
IT'S NOT UNUSUAL TO SEE
THAT.
AND OFTEN WE HAVE TO TREAT
BOTH THE UPPER AND THE
LOWER.
WE BELIEVE THAT THE UPPER
SYMPTOMS ARE MOTOR TILT
RELATED, AND IN FACT WE
THINK, ALTHOUGH WE'RE NOT
REALLY SURE THAT EITHER TABL
BOWEL SYNDROME IS ALSO A
MOTILITY PROBLEM SO IT
WOULDN'T BE SURPRISE
PHYSICAL PART OF YOUR GUTS
AREN'T WORKING PROPERLY THE
UPPER PART WOULDN'T BE WORK
AS WELL TO CAUSE THESE
SYMPTOMS.
AND IT'S NOT INFREQUENT, YOU
CAN BE CONSTABLE STATED AND
NOT GO FOR SEVERAL DIES A
WEEK, AND THEN YOU CHANGE
OVER TO DIARRHEA.
THAT'S CLASSIC FOR IRRITABLE
BOWEL SYNDROME.

Maureen says DOES IT MEAN
THAT THE MEDICATIONS AREN'T
WORKING FOR HER THOUGH?

David says AGAIN,
YOU HAVE TO THINK OF WHAT
THE MEDICATIONS ARE USED
FOR.
THE RANITIDINE IS USED TO
PREVENT ACID PRODUCTION AND
THE MODULON IS USED TO
DECREASE SPASM AND SORT OF
IMPROVE BOWEL MOVEMENTS.
THEY MIGHT NOT BE, BUT --

Maureen says SO IT MAY BE
TIME TO RE-EVALUATE THAT.

David says YEAH.
BUT THEY ARE GOOD
MEDICATIONS WHEN THEY'RE
USED, IT'S JUST THEY HAVE TO
BE USED IN THE PROPER
SETTING.

Maureen says ALRIGHTY.
MARY IS IN SOUTH RIVER.
HI MARY.

Mary says HI.
I WAS DIAGNOSED WITH AN
IRRITABLE BOWEL SYNDROME AT
THE AGE OF 13, AND I'M 26
NOW, AND I'VE BEEN ON WHAT
YOU CALL A BRACHT DIET FOR
ABOUT TWO YEARS.
NOW I WAS LISTENING TO THE
E-MAIL YOU WERE READING AND
I HAVE ALMOST LIKE THE SAME
SYMPTOMS.
I VOMIT, I GET WEAK AND I
DON'T HAVE A BOWEL MOVEMENT
FOR ABOUT FOUR WEEKS.
IS THAT NORMAL?

David says
FIRST OF ALL THE BRANCH DIET IS

- EXPLAIN THAT
FOR THE AUDIENCE?

Mary says PARDON ME?

Maureen says WHAT IS THE
BRACHT DIET?

Mary explains
DRIED RICE, APPLE SAUCE,
DRY BREAD AND THAT'S
BASICALLY IT.
AND I'VE EATEN IT FOR LIKE
THREE WEEKS STRAIGHT.

David says WELL, I MEAN -- IF THAT'S
ALL YOU'RE EATING, CERTAINLY
THAT IS NOT A BALD OR
HEALTHY DIET, AND THE FIRST
THING I TELL ALL MY PATIENTS
IS YOU HAVE TO EAT A
WELL-BALANCED DIET IF YOU
WANT TO HAVE -- JUST FOR
YOUR HEALTH, NEVER MIND FOR
YOUR BOWEL MOVEMENTS, IT
DOESN'T SOUND LIKE THERE'S
CERTAINLY ENOUGH FIBRE IN
THAT.
RICE IS CONSTIPATING,
BANANAS ARE CONSTIPATING SO
YOU WANT TO INCREASE THE
FIBRE IN YOUR DIET TO HELP
YOU HAVE MORE FREQUENT BOWEL
MOVEMENTS.

Maureen says SO IS -- I JUST
TO WANT GO BACK TO MARY.
DID A DOCTOR RECOMMEND THAT
DIET TO YOU?

Mary confirms YES, WHEN I WAS
13.

Maureen says A REGULAR
DOCTOR?

Mary says YES.

David says
WHEN YOU WERE 13, BUT I
DON'T THINK HE TOLD TO YOU
CONTINUE IT FOR 13 YEARS.

Mary says NO, I STOPPED ON
MY OWN, BASICALLY, I STARTED
DRINKING COFFEE AND NOW THAT
I'VE BEEN DRINKING COFFEE,
IT SEEMS TO MAKE MY BOWLS
MOVE BUT I STILL DO GET --

David says COFFEE'S A GOOD
LACKSTIVE.
COFFEE AND MILK HAVE VERY
GOOD LAXATIVES, BUT AGAIN
FIBRE IS SO IMPORTANT AND
I DON'T KNOW IF
YOU'RE DRINKING EIGHT
GLASSES A DAY BUT IT'S VERY
IMPORTANT.

Maureen says WHAT ABOUT THE
IRRITABLE BOWEL SYNDROME?
WHAT ARE YOU DOING ABOUT
THAT?

Mary says I EXERCISE DAILY
AND I HAVE A LITTLE FELLOW
THAT HAS A BOWEL PROBLEM AS
WELL BECAUSE I'M ALL
CONFUSED.
WHAT I WANTED TO KNOW IS AN
IRRITABLE BOWEL SYNDROME
INHERITED?

David says NO, IT'S
NOT.
I'M SAYING THAT LIKE IT'S A
DEFINITELY.
NOT THAT WE KNOW OF.
I MEAN, THERE ARE PEOPLE IN
THIS WORLD WHO BELIEVE THAT
EVERY DISEASE IS GOING TO
HAVE A GENETIC
PREDISPOSITION.
HAVING SAID THAT
IRRITABLE BOWEL SYNDROME
IS NOT A DISEASE.
IT'S A SINNED DROP.
IT'S A CONSTELLATION OF
SYMPTOMS THAT INCLUDE
ABDOMINAL PAINS, DIARRHEA,
CONSTIPATION, ALTERNATING
DIARRHEA, PAIN WITH DEAF
INDICATION OR PAIN RELIEF BY
DEAF INDICATION, ABDOMINAL
BLOATING OR GAS SO IT'S
REALLY A CONSTABLE -- A
GROUP OF SYMPTOMS.
WHEN YOU DO BLOOD WORK IT'S
NORMAL, X-RACE ARE ALL
NORMAL, THERE'S NOTHING WE
CAN HANG OUR HAT ON OTHER
THAN SAY IT'S A
CONSTELLATION OF SYMPTOMS.

Maureen says I DIDN'T IS WHY
SOME HEALTH PROFESSIONALS
PUT IT IN A CATEGORY WITH
CHRONIC FATIGUE SYNDROME AND
FIBROMYALGIA AND TEND TO BE
DISMISSIVE OF IT.

David says I
WOULDN'T BE DISMISSIVE OF
IT.
CLEAR LEAF PEOPLE HAVE THESE
SYMPTOMS.
FIBROMYAL GENTLEMAN, THERE
ARE SOME SUBTLE BLOOD
CHANGES THAT CAN OCCUR AND I
HAVE TO TELL YOU IT'S VERY
COMMON IN PATIENTS WITH
FIBROMYALGIA TO PRESENT WITH
IRRITABLE BOWEL SYNDROME AND
THERE'S A CLOSE ASSOCIATION
WITH THE TWO --

Maureen says DOESN'T IT MAKE
IT DIFFICULT TO TREAT THAT
IT'S A CONSTELLATION OF
SYMPTOMS AND NOT A DISEASE.

David says
THE HARDEST THING I TREAT
IS IRRITABLE BOWEL
SYNDROME WITHOUT A DOUBT
BECAUSE A LOT OF IT IS DIET
MANIPULATION WHICH IS HARD
TO DO FOR PATIENTS.
A LOT OF IT IS STRESS
RELATED AND THERE'S A VERY
STRONG GUT-BRAIN
INTERACTION.
THE SECOND MOST COMMON.
A NERVES IN THE BODY ARE IN
THE GUTS AND THERE'S A
STRONG ASSOCIATION BETWEEN
THE BRAIN AND GUTS SO OFTEN
IF WE CAN MODIFY WHAT'S
GOING ON UP HERE, WE CAN
MODIFY WHAT'S GOING TONIGHT
IN BELLY.

Maureen says WOULD YOU EVER
RECOMMEND TO PATIENTS THEY
SEEK TREATMENT FOR STRESS OR
TOQUE A PSYCHOLOGIST ONCE IN
A WHILE?

David says ABSOLUTELY.
I'VE OVER HAD PATIENTS GO ON
ANTIDEPRESSANTS AND GET
MIRACULOUSLY BETTER.
I'M NOT SUGGESTING THAT FOR
EVERYBODY BUT THERE'S A SUB
SET OF PATIENTS WHO WILL
BENEFIT FRF PSYCHOLOGICAL
INTERVENTION.

Maureen says WE'RE TALKING
ABOUT THE STOMACH, ABOVE AND
BELOW THE BELLYBUTTON THIS
AFTERNOON WITH DOCTOR DAVID
BARON, A GASTROENTEROLOGIST
SO GIVE US A CALL WITH YOUR
QUESTIONS FOR HIM.
PLANK

Maureen says AND JUST BEFORE
WE GO ONTO THE NEXT CALL,
THERE IS A CONNECTION
BETWEEN I.B.S. AND CANCER
ISN'T THERE?

David says
ABSOLUTELY NO CONNECTION
BETWEEN IRRITABLE BOWEL
SYNDROME AND COLON CANCER.

Maureen says AND HAVE THEY
LOOKED FOR THIS?

David says YES.
AS FAR AS I'M AWARE THERE IS
NO ASSOCIATION.
YOU HAVE TO REMEMBER, COLON
CANCER IS COMMON.
7 TO 8 PERCENT OF THE POPULATION
WILL DEVELOP COLON CANCER IN
THEIR LIFE SOMETIME.
IRRITABLE BOWEL SYNDROME CAN
OCCUR IN UP TO 30 PERCENT OF WOMEN
AND PROBABLY UP TO 10 PERCENT OF
MEN SO IT'S VERY COMMON AS
WELL SO IT WOULD NOT BE
UNUSUAL TO HAVE BOTH OF
THEM.

Maureen says OKAY.
ALL RIGHT, GOOD.
A QUESTION HERE ABOUT CALL
LIGHT TIS.
I HAVE GRANDPARENT WITH CALL
LIGHT TIS AND AN AUNT ON THE
OTHER SIDE OF THE FAMILY
WITH CROHN'S.
I'VE RECENTLY BEEN INFECTED
WITH THE GIARDIA PARASITE
FOR TEN WEEKS.
CAN THIS INCREASE MY CHANCES
OF DEVELOPING CROHN'S OR
CALL LIGHT TIS.

David says THIS IS USUALLY A WATER
BORNE TYPE OF INFECTION,
USUALLY OFTEN IN THE
MOUNTAINS YOU'LL GET IT
SOMETIMES IF YOU'RE
TRAVELLING DOWN SOUTH YOU'LL
GET IT.
IT'S USUALLY EASILY
TREATABLE WITH AN
ANTIBIOTIC.
THE QUESTION IS A GOOD ONE.
DO INFECTIONS CAUSE CROHN'S
DISEASE AND WE DON'T KNOW
THE ANSWER TO THAT.
THERE ARE CERTAIN PEOPLE OUT
THERE WHO BELIEVE THAT
CERTAIN INFECTIONS CAN
INITIATE THE WHOLE PROCESS
IN A GENETICALLY
PREDETERMINED PERSON TO
DEVELOP CROHN'S DISEASE IS
GIARDIA ONE OF THEM?
NOT AS FAR AS QUESTION KNOW
BUT YOU KNOW, ANY BUG CAN DO
ANYTHING TO THE BOW WELLS SO
IN HER CASE I CAN'T SAY
CATEGORICALLY NO, BUT IT'LL
BE UNLIKELY.

Maureen says
THEY HAVE SUCCESSFULLY
TREATED SOME TYPES OF CROHN'S
WITH ANTIBIOTICS, IS THAT
RIGHT?

David says
ABSOLUTELY.
PART OF OUR ARMAMENTARIUM
FOR CROHN'S DISEASE IS USING
ANTIBIOTICS AND SOMEHOW
WITH THE FLORA AND THE
ANTIBIOTICS WE'RE ABLE
TO ALERT A DISEASE
PROFILE.
WE'RE NOT ABLE TO CURE IT.
IN FACT IF YOU DO A
COLONOSCOPY BEFORE AND
AFTER THERAPY, EVEN THOUGH
SYMPTOMS ARE GONE, ENDOSCOPICALLY
THE BOWEL LOOKS THE SAME.
OUR GOAL IN TREATING CROHN'S
DISEASE IN THE YEAR 2001 IS
TO CONTROL SYMPTOMS.

Maureen says NOT TO CURE YET.

David says NOT YET.

Maureen continues WE OFTEN HEAR
CROHN'S AND CALL LIGHT TIS
IN THE SAME SENTENCE.
MAYBE YOU SHOULD TEAM US HOW
THEY PRESENT.

David says COLITIS
JUST MEANS AN INFLAMMATION IN
THE COLON.
YOU CAN HAVE INFECTIOUS
COLITIS CAUSED BY AN
INFECTIOUS BACTERIA,
ISCHEMIC COLITIS WHERE LOW
BLOOD FLOW CAN CAUSE DAMAGE,
OR YOU WILL VERY ACTIVE
COLITIS, WHICH IS IDIOPATHIC
DISEASE, WHEN PEOPLE THINK
OF COLITIS THAT'S WHAT THEY
THINK OF AND IT CAUSES
INFLAMMATION IN THE RECTUM
GOING BACKWARDS TO THE CRON
OR YOU COULD HAVE CROHN'S
COLITIS OR CROHN'S INVOLVING
THE SMALL BOWEL, WHERE IT'S
CALLED SMALL CROHN'S DISEASE.
COLITIS JUST MEANS INFLAMMATION
OF THE COLON WITHOUT
SAYING ANYTHING ABOUT THE
IDEOLOGY.
ONE THING I HAVE TO SAY,
PEOPLE TALK ABOUT SPASTIC
COLITIS THAT'S A MISNOMER.
IT'S ANOTHER WORD FOR
IRRITABLE BOWEL SYNDROME AND
WHEN YOU LOOK INSIDE WITH AN
ENDOSCOPE, THERE IS NO
INFLAMMATION WHATEVER.

Maureen says ALL RIGHT.
LISA IS IN LONDON.

Lisa says HELLO? THANKS FOR
TAKING MY CALL.

Maureen says YOU'RE WELCOME.

Lisa continues MY QUESTION IS I
HAVE ULCERATIVE COLITIS,
I'VE HAD IT THREE AND A HALF
YEARS NOW, WORSE THAN THE
CONSTANT TRIPS TO THE
BATHROOM AND BLEEDING AND
CRAMPING WHAT I'VE FOUND
MORE DEBILITATING THAN THAT
IS THE JOINT PAIN WHICH IS
NOT SOMETHING THAT I
EXPECTED WHEN HE TOLD ME
THAT I HAD THIS, WAS TO HAVE
THIS INCREDIBLY DEBILITATING
JOINT PAIN IS THAT SOMETHING
THAT'S COMMON WITH PEOPLE
WITH ULCERATIVE COLITI
SCOMPMD HOW ARE YOU TREATING
IT?

David says IT'S
VERY COMMON FOR PATIENTS WHO
HAVE IT IS TO DEVELOP JOIN
PAIN.
IT'S ONE OF THE EXTRA
IN INTESTINAL MANIFESTATIONS
OF INFLAMMATORY BOWEL
DISEASE THAT INCLUDES
INFLAMMATION OF THE JOINTS,
THE MOUTH, OF THE EYES, RED
PAINFUL SWOLLEN EYES OR BACK
PAIN OR THEY CAN DEVELOP
RASHES MOSTLY ON THEIR LEGS,
SAMES BUT TO BEING.
THERE ARE SOME CLASSIC
RASHES THAT OCCUR WITH THIS
DISEASE AND ALMOST ALWAYS
RELATED TO THE ACTIVITY THE
BOWEL ITSELF AND IF YOU CAN
BRING THE BOWEL INTO
REMISSION, YOU'LL BE ABLE TO
GET THE JOINT SYMPTOMS INTO
REMISSION.
OFTEN ONCE YOU MELT THE
BOWEL SYMPTOMS AWAY THE
JOINT PAIN WILL GO AWAY.
AGAIN I CAN'T REALLY COMMENT
ON LISA'S EXACT CASE BUT
SOMEONE HAVING ONGOING
SYMPTOMS AND JOINT PAIN
CLEARLY NEEDS MORE POTENT
MEDICATION THAN THEY'RE
GETTING AND THERE ARE OTHER
ALTERNATIVES.

Maureen says WHAT ARE THE
COMMON MEDICATIONS FOR GSZ
COLITIS.

David says
THE COMMON ONCE WE USE
ARE DRUGS LIKE SALAZOPYRIN
GIVE ORALLY, THE FIVE ASA
PRODUCTS, THEY'RE NOT
ASPIRIN PRODUCTS, THEY'RE AN
ANTI-INFLAMMATORY TREE
PRODUCT THAT ARE TAKEN
ORALLY.
THERE'S SUPPOSITORY FORM OF
THE FIVE ASA, THERE'S ENMA
FORM, WHERE THE PATIENTS
ACTUALLY GIVE THEMSELVES
ENMA OF THIS 5 ASA TO
DECREASE THE INFLAMMATION
BUT THAT ONLY WILL HEAL THE
LEFT COLON AND THEN THERE
ARE MORE POTENT DRUGS THAT
CAN BE GIVEN RECTALLY, LIKE
A STEROID DRUG OR SOMETHING
CALLED BUDESONIDE, A
STEROID DRUG, METABOLIZED
QUICKLY BY THE LIVER SO YOU
DON'T GET THE SIDE EFFECTS,
AND FINALLY THERE'S STEROIDS
WHICH HAVE MANY SIDE
EFFECTS.
CERTAINLY YOU NEED TO
DISCUSS THESE AT LENGTH AND
IN DETAIL WITH YOUR
GASTROENTEROLOGIST, BUT
STARTING STEROIDS AND WHAT
ALL THE SIDE EFFECTS ARE,
BECAUSE THERE ARE MANY WITH
STEROIDS.
AND FINALLY, ULTIMATELY
THERE IS A CURE FOR
ULCERATIVE-COLITIS

Maureen says SURGERY.

David confirms and continues
EXACTLY.
THE CURE IS SURGERY, AND
ONCE YOU TAKE THE COLON OUT,
THEY WILL NO LONGER GET COLE
LIGHT TIS BECAUSE --

Maureen says THERE'S NO
COLON.
BUT OFF COLONOSCOPY?

David says WELL IT DEPENDS ON YOUR
AGE.
USUALLY WE'RE ABLE TO DO A
POUCH PROCEDURE, WE'RE ABLE
TO HOOK UP THE SMALL BOWL TO
THE a.m. NUS ITSELF AND
PRODUCE AN INTERNAL POUCH.
PRODUCELY BETWEEN THE AGES
OF 50, 60, IT'S HARDER TO DO
BECAUSE OF INCREASED RISK OF
INCONTINENCE DOING THIS.
CERTAINLY UNDER THE AGE OF
50, MANY PATIENTS ARE
ELIGIBLE TO HAVE THIS DONE.
USUALLY OVER THE AGE OF 60,
ALTHOUGH SOME PEOPLE ARE
STILL DOING THAT, WE USUALLY
LEAVE PEOPLE WITH A
COLOSTOMY.


Maureen says OKAY.
ALL RIGHT, THANKS VERY MUCH
FOR YOUR CALL, LISA.
GRANT IS NEXT IN TORONTO.
HI GRANT.

Grant says HI.
YES I'VE BEEN EXPERIENCING
UPPER G.I. PROBLEMS FOR THE
PAST FOUR WEEKS.
BURPING, SOME HEARTBURN, AND
AFTER I'VE EATEN, IT FEEL
LIKE THERE'S SOMETHING STUCK
JUST UNDER MY BREAST BONE,
AND I'VE BEEN -- DOCTOR PUT
ME ON -- I STARTED OFF WITH
PREVASET FOR A COUPLE OF
WEEKS AND IT SEEMED TO HELP
BUT THEN MY DOCTOR PUT ME ON
LOSAK AND IT'S HELPING A BIT
MORE BUT I'M STILL GETTING
THIS CONSTANT BURPING AFTER
I'VE EATEN.

David says OKAY,
HE'S DESCRIBING SYMPTOMS
THAT I THINK ARE COMPATIBLE
WITH WHAT WE CALL
GASTROESOPHAGEAL REFLUX
DISEASE.
THIS IS VERY COMMON.
ABOUT A THIRD OF THE
POPULATION HAS REFLUX
DISEASE AND PROBABLY 16 PERCENT OF
THE POPULATION HAS REFLUX AT
LEAST ONCE A WEEK WHERE THEY
GET IT THAT SIGNIFICANTLY.

Maureen says WHY DOES HE GET
IT ALL OF A SUDDEN?

David says THAT'S A
GOOD QUESTION.
THE FIRST QUESTION HE HAVE
TO ASK HIM IS HIS AGE
BECAUSE THERE ARE CERTAIN
ALARM SYMPTOMS WE WORRY
ABOUT IN PATIENTS THAT
PRESENT WITH NEW ONSET HEART
BURN.
PATIENTS IN A 20-YEAR-OLD WE
DON'T REALLY WITH HE ABOUT
IT IN A 50 OR 60-YEAR-OLD,
AND THEY'VE NEVER HAD THIS
BEFORE IT NEEDS TO BE
INVESTIGATED.
IF SOMEONE'S HAVING TROUBLE
SWALLOWING, WHERE IT'S
GETTING STUCK AS IT'S GOING
DOWN, THAT SHOULD BE
INVESTIGATING.
IF SOMEONE IS ANAEMIC, BLOOD
COUNT IS LOW, THAT SHOULD BE
INVESTIGATING.
IF THEY HAVE MALITA, WHICH
IS BLACK BOWEL MOVEMENTS,
THAT SHOULD ALSO BE
INVESTIGATED.
SO ANYBODY WHO HAS THOSE
ALARM SYMPTOMS SHOULD BE
INVESTIGATED.
ONE WHO'S BEEN ON A PRO TON
PUMP INHIBITOR, LIKE OUR
CALLER, AND WHAT A PROTON
PUMP INHIBITOR, THESE ARE
DRUGS THAT TOTALLY SUPPRESS
ACID.
UNLIKE THE H-2 RECEPTOR
ANTAGONISTS WE TALKED ABOUT
BEFORE, THIS TOTALLY UP
EXPRESSES ACID AND IF YOU'RE
NOT BETTER IN TWO TO THREE
WEEKS THAT SHOULD BE
INVESTIGATED SO FAILURE TO
RESPOND TO MEDICATION SHOULD
ALSO BE INVESTIGATED.
AND USUALLY THE WAY WE
INVESTIGATE THIS IS WITH A
GASTROSCOPY.

Maureen says
WHAT DOES THAT INVOLVE.

David says IT'S ACTUALLY A VERY
SIMPLE TEST.
I'VE HAD IT DONE.
YOU'RE GIVING ME THIS LOOK.

Maureen says YEAH WHAT ABOUT
THE COLONOSCOPY.

David continues
I'VE HAD THAT DONE, TOO.
GASTROSCOPY INVOLVES
SPRAYING THE BACK OF THE
THROAT, MOST OF MY PATIENTS
I GAVE SEDATION TO MAKE THEM
SLEEPY.
MINE, I HAD NOTHING.
MOSTLY BUSINESSMEN OR
PEOPLE WHO HAVE TO GET ON
WITH THEIR LIVES DON'T TAKE
SEDATION BECAUSE THEY HAVE
THINGS TO DO.
WILL -- WHAT HAPPENS IS YOU,
YOU TAKE SEDATION, GO TO
SLEEP AND THEN WE PASS A
TUBE ABOUT THE THICKNESS OF
MY BABY FINGER, PASS IT DOWN
INTO THE STOMACH, TAKES
ABOUT FIVE MINUTES TO DO.

Maureen says THROUGH THE
THROAT?

David confirms
THROUGH THE THROAT.

Maureen says ALL RIGHT AND
YOU HAVE HAVE LOOK AROUND IN
THERE?

David says HAVE A LOOK AROUND.
ACTUALLY THE TECHNOLOGY IS
AMAZING, WHAT WE'RE ABLE TO
SEE, EVEN COMPARED TO TEN
YEARS AGO.
IT'S ALL ON VIDEO, WE ALL
LOOK AT BIG TV SCREENS AND
WE'RE ABLE TO GET TREMENDOUS
PICTURES OF THE STOMACH.

Maureen says OKAY
THANK YOU VERY MUCH, GRANT.
I THINK I HAVE AN E-MAIL
HERE ABOUT REFLUX THAT YOU
MENTIONED.
MY 17-YEAR-OLD DAUGHTER HAS
BEEN REGURGITATING AFTER
EVERY MEAL FOR THE LAST 17
MONTHS.
A SPECIALIST IN LONDON
DIAGNOSED HER WITH
GASTROINTESTINAL REFLUX
CAUSED BY A WEAK VALVE.
SHE'S CURRENTLY TEK TAKING
TWO DRUGS, AND A DRUG TO
INCREASE THE HE WANT TEAGUE
OF THE STOMACH.
CAN THIS VALVE STRENGTHEN IN
TIME OR IS SURGERY THE ONLY
OPTION?

David says LOTON BLOW
PUMP INHIBITOR, TOTALLY
SUPPRESSES ACID AND IN
PATIENTS WITH REFLUX DISEASE
IT GETS RID OF THE SYMPTOMS
95 TO 98 PERCENT OF THE TIME.
THE PROBLEM IS YOU HAVE TO
STAY ON IT.
ABOUT HALF OF THOSE PATIENTS
WILL STAY ON THIS DRUG FOR
LIFE.
THE OTHER DRUG CALLED
METOCLOPRAMIDE WHICH I'M NOT
A BIG FAN OF, IT'S A DRUG
THAT DRIVES EVERYTHING
FORWARD SO RATHER THAN
REGURGE STRAIGHT, IT'S
DRIVING THE STOMACH CONTENTS
DOWN.
IT'S A GOOD DRUG THAT WORKS
BUT IT HAS A LOT OF SIDE
EFFECT.
LIKE PARKINSONIAN SIDE
EFFECTS, LIKE TREMORS, YOU
HAVE TO BE AWARE.
GETTING BACK IN GENERAL TO
REFLUX DISEASE, WHEN DO YOU
CONSIDER SURGERY.
I THINK PATIENTS WHO DON'T
WANT TO TAKE A DRUG FOREVER.

Maureen says AND SHE'S ONLY
17.

David continues RIGHT, AND IT MAY MEAN
HER BEING ON A DRUG FOR THE
NEXT 60, 70, 80, 90 YEARS,
THAT'S A LOT OF TIME TO TAKE
A DRUG.
ALSO YOU DON'T WANT TO TAKE
THIS DRUG MAXERAN FOR A LONG
TIME BECAUSE OF THE SIDE
EFFECTS AND AS YOU GET OLDER
THE SIDE EFFECTS BECOME MORE
PROFOUND.
BUFFER EVEN CONSIDER SURGERY,
YOU NEED TO DO A LOT OF
INVESTIGATIONS TO MAKE SURE
YOU'RE A GOOD CANDIDATE FOR
SURGERY.
WITH THE ADVENT OF
LAPAROSCOPIC SURGERY, WHERE
YOU WILL ACTUALLY DO KEYHOLE
SURGERY TO FIX A HIATUS
HERNIA, EVERYBODY SAYS OH
WE SHOULD GET THIS DONE BUT
PEOPLE HAVE TO REMEMBER THAT
YOU NEED TO BE GOOD
CANDIDATE AND YOU NEED TO BE
A PERSON WHO'S GOING TO DO
WELL WITH THIS, WHETHER YOU
HAVE IT OPEN, HIATUS
HERNIA, LIKE IN THE OLDEN
DAYS, OR A CLOSED OR
LATCH SCOPIC HIATUS HERNIA.
AND I DON'T SPEND ANYBODY TO
SURGERY UNLESS THEY'VE HAD A
GASTROSCOPY, A HERNIA
X-RAY.
THESE PATIENTS, YOU WANT TO
KNOW WHAT THEIR VALVE
PRESSURE IS, YOU WANT TO DO
A MOTILITY TEST AND AGAIN
I'M SURE IN LONDON SHE HAD
THIS DONE.
YOU WANT AN UPPER G.I.
SERIES, A BARIUM X-RAY TO
MAKE YOU ARE THE ESOPHAGUS
IS NOT SHORT, THAT WOULDN'T
BE A GOOD CANDIDATE AND YOU
WANT TO HAVE A 24 HOUR P.H.
MONITOR, LEAVING A PROBE IN
THE ESOPHAGUS TO MEASURE
THE.
A ACID TO MAKE SURE THAT'S
THE ACTUAL DISEASE PROCESS
THAT'S GOING ON.

Maureen says THAT DOESN'T
SOUND PLEASANT.

David says IT'S NOT BAD.
IT'S VERY THIN TUBE, IT'S
LEFT IN WE WANT PEOPLE TO GO
ABOUT THEIR BUSINESS.
WE WANT TO SEE WHETHER THEY
DEVELOP REFLUX AND WHETHER
THE REFLUX IS CORRELATED
WITH THEIR SYMPTOMS.

Maureen says WE'LL GO TO
JEANIE NOW IN TORONTO.
HI JEANIE?

Jeanie says HI.
I HAVE A QUESTION
ABOUT GASTROPARESIS.
I WAS DIAGNOSED WITH
DIABETES ELEVEN YEARS AGO
AND ABOUT SIX YEARS AGO TOLD
ME I HAD GASTROPARESIS,
VOMITING FITS I GO THROUGH,
COULD LAST FROM THREE
DAYS -- THIS LAST PERIOD
LASTED ABOUT A MONTH AND A
HALF AND IT'S JUST CONSTANT
VOMITING.
DO YOU HAVE ANY INFORMATION
FOR ME?

David says SURE.
GASTROPARESIS MEANS THE
STOMACH ISN'T MOVING.
DAST ASTRO, STOMACH, PARESIS,
PARALYSIS.
DIABETICS ARE PARTICULARLY
PRONE TO THIS BECAUSE
OVERTIME TIME, UNFORTUNATELY
DIABETICS GET DAMAGE TO
THEIR NERVES AND NOT ONLY
DAMAGE THEIR NERVES IN FEET,
AND THESE PATIENTS WILL
COMPLAIN IN NUMBNESS AND
TINGLING IN HANDS AND FEET,
THEY CAN DAMAGE THE NERVES
TO THE STOMACH SO THE
STOMACH DOESN'T WORK PRO
PROPERLY AND AS A
GASTROENTEROLOGIST I SEE
THIS FREQUENTLY.
AS AN ENDOCRINOLOGIST YOU
WOULD SEE THIS NOT
UNCOMMONLY BUT NOT AS
COMMONLY AS I SEE IT AND AS
A FAMILY PHYSICIAN YOU WOULD
PROBABLY SEE THIS RARELY.
IT DOES OCCUR, IT DEPENDS
WHO YOU SPEAK TO AS TO HOW
COMMON IT DOES OCCUR.
THE QUESTION IS HOW DO YOU
TREAT IT.
UNFORTUNATELY THE BEST DRUG
FOR THIS IS A DRUG CALLED
CISAPRIDE.
WHY AM I SAYING
UNFORTUNATELY?
BECAUSE IT'S NOW OFF THE
MARKET.

Maureen says WHY?

David continues
THERE HAVE BEEN REPORTS
IN THE STATES OF CARDIAC
PROBLEMS WITH THIS DRUG, AND
IT'S BEEN TAKEN OFF THE
MARKET -- TAKEN OFF THE
MARKET IN THE LAST YEAR,
BOTH HERE AND IN THE STATES.
SO IT'S NOT AVAILABLE.

Maureen says THAT'S NOT THE
DRUG THAT'S UNDER A
CORONER'S' INQUEST RIGHT NOW,
IS IT?

David says NOT THAT
I'M AWARE OF.
SO THAT'S GONE AND THAT
HAPPENED TO BE IT THE BEST
DRUG.
THERE WERE A LOT OF GOOD
TRIALS TO STHAI IT WORKED
VERY WITH.
THE DRUG THAT WE MOSTLY USE
IN THESE PATIENTS IS A DRUG
CALLED DON PARODONT OR MOTOR
TRILLIUM, MADE BY THE SAME
COMPANY AS CISAPRIDE.
ORTHO-JANZEN.
IT WORKS TO EMPTY THE
STOMACH, QUITE WELL BUT NOT
AS WELL IN THAT IT ONLY
EFFECTS THE UPPER GUT AND
NOT THE WHOLE GUT.
AND WE KNOW DIB BET
DIABETICS IT'S THE WHOLE GUT
THAT'S THE PROBLEM, IN THE
JUST THE STOMACH AND IF YOU
WERE TO GO INTO MORE DETAIL
WITH THIS WOMAN WHO CALLED
SHE PROBABLY HAD A LITTLE
FECAL INCONTINENCE OR
CONSTIPATION OR BLOATING IT
MAY WORK FORRER UPPER G.I.
SYMPTOMS BUT NOT LOWER G.I.
SYMPTOMS IF SHE HAS ANY AND
THAT'S A DRUG THAT WOULD BE
CERTAINLY RECOMMENDED IF SHE
WENT TO SEE A
GASTROENTEROLOGIST TO TRY.
THE OTHER DRUG IS MAXERAN
THAT WORKS VERY WELL BUT
AGAIN THERE ARE A LOT OF
SIDE EFFECTS SO I'M
RELUCTANT TO USE IT.
THERE'S BEEN DATA A DRUG
CALLED ERYTHROMYCIN, AN
ANTIBIOTIC MAY INCREASE
INTESTINAL EMPTYING BUT IT
CAUSES A LOT OF G.I. UPSET.
AND THERE'S NEW WORK WITH A
HORMONE CALLED MODEL IN WHICH
SOUNDS LIKE MOTILITY, ITS A
HORMONE PRODUCED IN THE GUTS
THAT ACTUALLY IMPROVES
EMPTYING OF THE STOMACH AND
THE GUTS.
AND THERE'S NEW WORK ON
THAT.
CERTAINLY IT'S NOT READY FOR
PRIMETIME YET.
BUT THERE'S -- COMING DOWN
THE PIPELINE THAT MAYBE
SOMETHING THAT SOMEONE LIKE
OUR CALL ARE MAY BENEFIT
FROM.

Maureen says SO UNLESS
SHE'S -- SHE'S GOT TO TRY
ALL THESE DIFFERENT DRUGS
THAT YOU'VE MENTIONED BEFORE
YOU CAN --
DOESN'T SOUND LIKE THERE'S A
MAGIC BULLET.

David continues SHE HAS
TO SEE A GASTROENTEROLOGIST
WHO HAS A CERTAIN EXPERTISE
NECH DEALING WITH THIS TO
TRY THESE DIFFERENT
MEDICATIONS.
THERE'S DOSING MANIPULATION.
YOU KNOW, THE PATHOS WILL
SAY YOU CAN GO UP TO DOSE-X
BUT OFTEN IN OUR EXPERIENCE
WE'VE HAD TO DOUBLE OR EVEN
TRIPLE THAT UPPER LIMIT
DOSE.

Maureen says GOOD LUCK,
JEANIE.
THANK YOU.
JOHN IS IN SUDBURY.
HELLO, JOHN.

John says HELLO.

Maureen says HI.
GO AHEAD, JOHN.

John says OH, OKAY.
THE DOCTOR SORT OF -- I
GUESS HE'S ANSWERED PART OF
MY QUESTION, BUT I'VE HAD
ULCERATIVE COLITIS FOR NINE
YEARS, AND I'M JUST WAITING
NOW ON AN OPERATION, THEY'RE
GOING REMOVE MY LARGE BOWL
APPARENTLY THIS MONTH
SOMETIME AND I'VE JUST BEEN
KIND OF CURIOUS -- HERE IN
SUDBURY, THEY CAN ONLY DO
THE OUTSIDE POUCH.
AND I WAS JUST WONDERING IF
YOU COULD GIVE ME ANY
ADVICE.
IS THAT THE BEST WAY TO GO?
I'M 55 YEARS OLD NOW.
LIKE, THE PREDNISONE KEEPS
ME SORT OF GOING, BUT IF --
I CAN'T TAKE IT FOREVER, I
REALIZE THAT.
I JUST WONDERED WHAT
SUGGESTIONS HE HAD.

David says WELL AGAIN, IF YOU'VE
BEEN ON PREDNISONE FOR
LONGER THAN SIX MONTHS AND
YOU'RE ON FAIRLY HIGH DOSES,
MANY OF US WOULD SUGGEST AN
OPERATION BECAUSE THE SIDE
EFFECTS FROM PREDNISONE ARE
SO SEVERE IN THE END YOU'LL
BE WORSE OFF, EVEN THOUGH
THEY HAVE THEIR COLON IN
TACT.
SO SIX MONTHS, SEVEN MONTHS,
EIGHT MONTHS, BUT ANYTHING
MORE THAN THAT ALREADY, WE
START WORRYING ABOUT THE
SIDE EFFECT PROFILE AND WE
OFTEN DO SUGGEST SURGERY.
NOW THE QUESTION, IN SOMEONE
55, WHETHER THEY SHOULD HAVE
AN ILEO-ANAL POUCH OR A
REGULAR COLOSTOMY, I HAVE TO
TELL YOU, THE COLOSTOMY IS
THE EASIER APPROACH.
YOU GET IT DONE, YOU FEEL
GREAT, YOU'RE OFF THE
PREDNISONE AND YOU DON'T
HAVE ANY PROBLEMS.
AND YOU KNOW, WHEN YOU'RE 55
OR 60, THE VANITY ISSUE, IT
USUALLY ISN'T AS STRONG.
WHEN YOU'RE DEALING WITH A
21-YEAR-OLD GIRL WHO WANTS
TO WEAR A BIKINI, IT'S A
MAJOR ISSUE.
AND THAT PLAYS A BIG ROLE.
BUT DOING THE ILEO POUCH, IN
ABOUT 10 OR 15 PERCENT OF PATIENTS
THEY DO HAVE PROBLEMS WITH
INCONTINENCE OR RECURRENT
BLEEDING OR DIARRHEA, SO
IT'S NOT A PANACEA OPERATION,
IT'S A VERY GOOD OPERATION,
BUT SOME PATIENTS DO RUN
INTO SOME PROBLEMS WITH IT.
AND AT 55 IT REALLY DEPENDS
ON A PERSON'S ANAL TONE, AS
TO WHETHER THEY WOULD
TOLERATE AN ILEO-ANAL POUCH
OR WHETHER THEY WOULD BE
INCONTINENT.
THE LAST THING YOU WOULD
WANT TO DO IS HOOK SOMEBODY
UP AND THEN FIND OUT THEY'RE
INCONTINENT AND NOT
TOLERATING THIS AND THEN
HAVING TO REVERSE THE POUCH
AGAIN.

Maureen says AND THAT'S A
RISK 10 TO 15 PERCENT OF THE TIME.

David continues NO, 10
TO 15 PERCENT OF THE TIME IS
PROBABLY THE AMOUNT OF PEEP
WHO HAVE PROBLEMS WITH
RECURRENT DIARRHEA,
POUCHITIS, THE INFLAMMATION
OF THE POUCH, BLEEDING BUT
85 TO 90 PERCENT HAVE A TREMENDOUS
RESULT WITH IT.

Maureen says OKAY, BUT HE
CAN'T GET THIS DONE IN
SUDBURY.
IS IT NOT AVAILABLE
THROUGHOUT THE PROVINCE?

David says IT DEPENDS ON THE
SURGEON.
I'M NOT SURE WHO'S AVAILABLE
UP IN SUDBURY, BUT IT
DEPENDS ON THE SURGEON, WHO
DOES THIS WHETHER IT'S
COMFORTABLE DOING ILEO-ANAL
PUMPS.
THIS SURGEON THAT HE WENT TO
MAY BE ABSOLUTELY
COMFORTABLE DOING IT BUT
FIGURED IN A 55-YEAR-OLD IT
WASN'T APPROPRIATE OR ON
RECTAL EXAMINATION HE FOUND
HIS TONE TO BE NOT AS STRONG
AS IT SHOULD BE, THAT HE
DIDN'T THINK HE WOULD DO
WELL WITH A POUCH.
BECAUSE THE POUCH PROCEDURE
INVOLVES THE OPERATION TO
TAKE OUT THE COLON, THEY
FASHION USUALLY THE POUCH AT
THE SAME TIME.
THEN YOU HAVE TO COME BACK
FOR A SECOND OPERATION.
SO THE OPERATION IS BIGGER,
THE FIRST ONE, YOU COME BACK
FOR A SECOND OPERATION, AND
IF YOU HAVE PROBLEMS, AND WE
KNOW THERE ARE MORE PROBLEMS
AS YOU GET OLDER, YOU MAY
NEED A THIRD OR A FOURTH
OPERATION.

Maureen says OKAY.
YEAH, IT'S COMPLICATED.

David confirms and continues IT'S
VERY COMPLICATED AND EVERY
PERSON IS A INDIVIDUAL AND I
CAN'T SAY THAT EVERYONE
NEEDS A POUCH OR THAT
EVERYONE SHOULD HAVE A
COLOSTOMY.
YOU REALLY NEED TO SIT DOWN
WITH YOUR GASTROENTEROLOGIST
AND YOUR SURGE ANDON YOU AND
DISCUSS WHAT YOU WANT OUT OF
THIS.

Maureen says OKAY, JOHN, GOOD
LUCK.
THANKS VERY MUCH.
SHEILA WOULD LIKE TO YOU
ADDRESS CELIAC DISEASE AND
ITS FREQUENT MISDIAGNOSIS AS
IRRITABLE BOWEL SYNDROME.
MANY OF YOUR CALLERS MAY
BENEFIT FROM AN SPEND OSCOPY
AND DIAGNOSIS.

David says IT'S INTERESTING HOW
CELIAC DISEASE HAS CHANGED
OVERTIME.
WHEN I WENT TO MEDICAL
SCHOOL, THE PATIENTS
PRESENTED WITH WEIGHT LOSS,
DIARRHEA, THEY LOOKED LIKE
CONCENTRATION CAMP VICTIMS.
THEY WERE MALNOURISHED,
THEY LOOKED AWFUL AND THEY
COULD WALK THROUGH THE DOOR
AND YOU COULD MAKE A
DIAGNOSIS, THEY LOOKED THAT
BAD.
IN THE YEAR 2000,2001, WE
DON'T SEE THOSE PATIENTS
ANYMORE.
WE JUST DON'T SEE THEM.
THE WAY THESE PATIENTS ARE
PRESENTING ARE USUALLY WITH
IRON DEFICIENCY, FOLATE
DEFICIENCY.
THEY'RE ABSORBING ONE OR TWO
DIFFERENT TYPES OF VITAMINS.
OCCASIONAL THEY GET
DIARRHEA, OCCASIONAL THEY
GET PAIN, ABDOMINAL PAIN SO
IN FACT IT'S VERY RARE TO
GET CLASSICTIC EITHER TAL
BOWEL-LIKE SYNDROMES WITH
CELIAC DISEASE AND USUALLY
DON'T PRESENT THAT WAY
ANYMORE.
THE FIRST TIME WE SEE IRON
DEFICIENCY OR HEMOGLOBIN IS
OFF, THEY START GOING FOR
THE TESTS AND EVENTUALLY WE
MAKE THE DIAGNOSIS.
IT'S NOW CLEAR, BECAUSE
WE'RE ABLE FROM A GENE POINT
OF VIEW AND SEROLOGY POINT
OF VIEW THAT THE INCIDENTS
IS ACTUALLY QUITE HIGH.
IT'S PROBABLY ONE IN 300
HERE IN CANADA.

Maureen says OF CELIAC?

David says
YEAH, AND MOST OF THE
TIME IT'S A SYMPTOM MAGMATIC
AND THAT'S WHY IT'S
MISDIAGNOSED BECAUSE PEOPLE
DON'T HAVE SYMPTOMS.
THE WAY TO DIAGNOSE IT IS TO
DO A BIOPSY OF THE SMALL
BOWL AND WE DO A GASTROSCOPY
AS WE DISCUSSED BEFORE AND
TAKE A PIECE OF THE SMALL
BOWEL AND THE PATHOLOGIST
LOOKS FOR A FLAT MUCOSA.
NORMALLY THE LINING OF THE
SMALL BOWEL HAS THESE VILLI,
WHICH ARE KIND OF RIDGES
UNDER DER THE MICROSCOPE IN
CELIAC DISEASE IT'S FLAT.
RATHER THAN A HILLY PLAIN IT
LOOKS LIKE A FLAT AREA AND
THAT WILL LEAD US ONTO THE
CLUE THAT THEY HAVE SELIAK
DISEASE AND WE'RE ABLE TO DO
A BLOOD TEST NOW TO CONFIRM
THAT THAT'S WHAT THEY HAVE.

Maureen says AND THEN YOU
KNOW TO TREAT THAT AS --

David says DIET.
THEY GO ON A GLUTEN-FREE
DIET.
THIS IS NOT AN EASY DIET,
AND I WILL NEVER DIAGNOSE
CELIAC DISEASE WITHOUT A
BIOPSY AND SEROLOGY TESTING
BECAUSE THE DIET IS
DIFFICULT.
THEY HAVE TO GO ON A
GLUTEN-FREE DIET LIFELONG
AND BE OFF WHEAT, RYE,
BARLEY AND THERE'S SOME
PEOPLE WHO THINK OATS AS
WELL ALTHOUGH THERE'S A
RECENT STUDY TO SAY OATS MAY
NOT BE AS IMPORTANT.
AND YOU KNOW, IF YOU GO INTO
ANY STORE AND ANY PACKAGED
GOOD HAS GLUTEN IN IT.
McDONALD'S, IT HAS GLUTEN IN
IT.
IT'S A VERY DIFFICULT DIET
TO FOLLOW.
IF I'M GOING TO SUBJECT A
PATIENT TO THAT DI, I WANT
TO BE SURE THAT THAT'S WHAT
THEY HAVE.

Maureen says OKAY.
JUST IN THE LAST MINUTE WE
HAVE PEPTO BISMOL.
I SEE PEOPLE TAKING THAT OR
HEARTBURN PILLS ALMOST ON A
DAILY BASIS IS THAT BAD?

David says
NO, PEPTO BISMOL IS AN
OVER THE COUNTER DRUG THAT
TREATS HEARTBURN, ACID
INDIGESTION, SOME PEOPLE
TAKE IT FOR DIARRHEA, AND
ALL IT REALLY DOES IS COAT
THE STOMACH.
IT DOES HAVE SOME ANTI-H
PYLORIA AFFECT AS WELL.
SO IT MAY BE HELPFUL IN THAT
WAY AS WELL.
BUT THE ONE -- THE ONE THING
I HAVE TO WORN.

Maureen says CAN'T HURT YOU?

David says CAN'T HURT YOU.
ONE THING I HAVE TO WARN
CALLERS IS IT TURNS YOUR
STOOLS BLACK.
I'VE HAD PATIENTS COMING TO
ME ALL THE TIME SAYING I
HAVE BLACK STOOLS, I'M
THEREFORE BLEEDING.
THE FIRST QUESTION IS ARE
YOU TAKING PEPTO BISMOL?
YES.
WELL YOU'RE NOT BLEEDING.

Maureen says THANK YOU VERY
MUCH FOR DOING THIS.
DOCTOR DAVID BARON IS A
GASTROENTEROLOGIST AND CHIEF
OF MEDICINE AT NORTH YORK
JEAN ROLL HOSPITAL.
IF YOU'D LIKE MORE
INFORMATION ON THIS TOPIC
VISIT--

A slate appears on screen. It reads “Canadian Association of Gastroenterology. www.cag-acg.org.¨ followed by a new one that reads ¨Crohn’s and Colitis Foundation of Canada. www.ccfc.ca.¨

Maureen concludes AND THAT'S
IT FOR THIS EDITION OF
MORE TO LIFE.
JOIN US MONDAY THROUGH
FRIDAY FROM 1:00 TO 2:00.

A closing slate reads “The advice given in the preceding program is of a general nature only. Viewers should consult their own medical professional for medical advice specific to their circumstances.”

Watch: Stomach Disorders