Archive for November 2014

Heartburn: A Common Problem

Heartburn: A Common Problem

Heartburn: A Common Problem

Jeffrey Michalak, DO, Gastroenterologist
Midlands Clinic, PC

Have you suffered from repeated bouts of heartburn and sour tasting fluid in your throat?  These are classic symptoms of a common health problem called gastroesophageal reflux disease or GERD. This is a condition in which the esophagus becomes irritated because of acid flowing back from the stomach.

Your Anatomy

The esophagus is the tube connecting the throat to the stomach. When food is swallowed, it travels down the esophagus, past a sphincter that joins the esophagus to the stomach, and into the stomach. Smoking, caffeine, and alcohol all increase the level of acid in your stomach, which can make your symptoms worse. Eating certain foods or medicines can also add to the problem. 

Symptoms of GERD

  • A burning sensation in the chest (heartburn)
  • A bitter or sour taste in the back of your mouth
  • Burping
  • Pain in the lower chest/upper abdomen
  • Chronic cough and hoarseness
  • Worsening of the above symptoms when bending over or lying down flat

Causes of GERD

The exact cause of GERD is unknown. The following are contributing factors that may weaken the lower esophageal sphincter, resulting in reflux:

  • Lifestyle: Use of alcohol or cigarettes, obesity, poor posture (slouching)
  • Medications: Calcium channel blockers, theophylline (Tedral, Hydrophed, Marax, Bronchial, Quibron), nitrates, antihistamines
  • Diet: Fatty and fried foods, chocolate, garlic and onions, drinks with caffeine, acidic foods such as citrus fruits and tomatoes, spicy foods, mint flavorings
  • Eating habits: Eating large meals, eating quickly or soon before bedtime
  • Other medical conditions:  Hiatal hernia, pregnancy, diabetes, rapid weight gain

When to Seek Medical Care

Many people experience the signs and symptoms of GERD on occasion.  When the signs and symptoms occur at least twice a week, or interfere with daily activities, it is time to call your doctor. It is advised to try and relieve GERD symptoms by changing habits, diet, and lifestyle, prior to consulting a health-care professional.

  • Call your doctor when symptoms of GERD occur frequently, disrupt your sleep, interfere with work or other activities, or are not relieved by lifestyle change or over the counter medications. 
  • Inform your doctor of your lifestyle changes and  if you are using over the counter medications so that it can assessed as to how well these changes are working for you. 

If you have any of the following, go immediately to the emergency department:

  • Severe chest pain or pressure, especially if it radiates to your arm, neck, or back
  • Vomiting followed by severe chest pain
  • Vomiting blood
  • Dark, tarry stools
  • Difficulty swallowing
  • Shortness of breath

Your Medical Evaluation

The goals of treatment are reducing reflux, relieving symptoms, and preventing damage to the esophagus.  This can be done a number of ways.  The first thing your doctor will do is a thorough physical exam and request diagnostic tests.  These tests may be performed by a gastroenterologist, or GI doctor.  A gastroenterologist specializes in treating digestive problems.  The following are tests that may be performed to identify what is causing your GERD discomfort:

  • Barium Upper GI- a series of xrays to evaluate how your digestive tract works.
  • Esophageal endoscopy- allows the doctor to see inside your esophagus through a tiny flexible tube.
  • Esophageal manometry- measures the muscle tone in the sphincter between your esophagus and stomach as well as the muscle tone of the esophagus.
  • pH monitoring- test that monitors the acid in your esophagus for 24-72 hours
  • Ruling out gall bladder problems through ultrasound

Life After Treatment

GERD can often be managed through a combination of lifestyle changes, medication and sometimes surgery.  Your doctor can help you find the option that is right for you.  With the appropriate treatment, you can return to living a full and healthy life, eating the foods and doing the activities you enjoyed before your heartburn started.

Dr. Jeffrey Michalak, Gastroenterologist at Midlands Clinic, PC, sees patients for GERD and other digestive disorders.  To make an appointment with Dr. Michalak, please call 605-217-5500.

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Midlands Clinic doctors implement ERAS protocol

Midlands Clinic doctors implement ERAS protocol

This article was originally published in the Sioux City Journal.

For the past year, Drs. Lawrence Volz and Robert Anderson at Midlands Clinic in Dakota Dunes have been implementing a new protocol that significantly improves outcomes for patients undergoing colon surgery.

The protocol, Enhanced Recovery After Surgery (ERAS), is a multi-step program that starts several days before the operation and helps prepare patients for surgery. ERAS also involves multiple changes in the way these patients are managed from the operating room to the nursing unit after surgery until they are seen in follow-up in the surgeon’s office.

ERAS protocols are designed to achieve early recovery after surgical procedures by maintaining preoperative organ function and reducing the profound stress response following surgery. The key elements of ERAS protocols include preoperative counseling, optimization of nutrition, minimizing narcotics pain medication, early feeding and mobilization.

“These protocols have been going on in Europe for 10 years or longer,” said Dr. Lawrence Volz, a general surgeon at Midlands Clinic since June 2006. “By following the protocol, surgeons there found that patients experienced less complications, mortality is less, the length of stay in the hospital is less, and patient satisfaction is better. All outcomes are improved, saving hospitals money and improving the outcomes for patients.”

Click here to read the rest of the story.

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