Gastro Health Magazine - Fall 2013 Issue by Gastro Health

HELICOBACTER PYLORI TESTING

INTRODUCING OUR NEW

PATIENT PORTAL

PROBIOTICS IN HEALTH & DISEASE

AMY BRENNEMAN’S

CALMER, HEALTHIER, HAPPIER SELF

FATTY LIVER

CLOSTRIDIUM DIFFICILE

DEBBIE’S DREAM

FOUNDATION

CURING STOMACH CANCER

FALL 2013 ISSUE

Eat Easy. YOU’LL NEVER LOOK AT A FOOD ITEM AS “TROUBLE” AGAIN. At Aventura Hospital and Medical Center, Kendall Regional Medical Center and Mercy Hospital we’re all about providing proactive solutions to digestive disorders. If you’re experiencing abdominal pain, gastrointestinal bleeding, diarrhea, constipation, vomiting, nausea or any other gastrointestinal symptoms—it’s time to give the discomfort a rest. We offer a full suite of treatments to diagnose, manage and treat gastrointestinal disorders of all kinds—simple and complex. Our expert teams of gastroenterologists, physicians and highly trained staff provide top quality care for digestive diseases and conditions. Say no to discomfort and say yes to your favorite foods starting today. For more information on our services or to receive a free physician referral call 305.480.6666.

www.aventurahospital.com

www.kendallmed.com

www.mercymiami.com

Knowing exactly what’s being treated can make all the difference. Just ask Carol. Carol’s tumor was found using the SpyGlass® Direct Visualization System. Thanks to the early and definitive diagnosis, her medical team could be more aggressive in her treatment and removing her tumor. Today, Carol is continuing to make the most of her life, creating quilts for her family, friends and for patients in local pediatric wards. For more than 30 years, Boston Scientific has been developing innovative and less-invasive medical technologies used to diagnose and treat gastrointestinal (GI) diseases. Many of our devices are designed to remove polyps and stones, biopsy tissue to help diagnose cancers, keep the GI tract open, provide nutritional support and stop internal bleeding.

To learn more, ask your doctor about Boston Scientific or visit www.BostonScientific.com/gi-patients.

© 2012 by Boston Scientific Corporation or its affiliates. All rights reserved. SpyGlass® is an unregistered or registered trademark of Boston Scientific Corporation or its affiliates. CAUTION: The law, including Federal (USA) law, restricts this device to sale by or on the order of a physician.Indications, contraindications, warnings and instructions for use can be found in the product labeling supplied with each device.

ENDO-51310-AA March 2012

Why Choose Gastro Health?

06 Gastro Health was formed in 2006 through the merger of several groups. Today, we have grown into the largest gastroenterology group in Miami-Dade County, with 20 locations throughout South Florida. Our physicians specialize in all aspects of digestive medicine and surgery. The group is composed of over 50 healthcare providers that include leading physicians, board certified in gastroenterology and hepatology for adults and children, and specializing in colorectal surgery, pathology and radiology. In addition, our group also comprises nurse practitioners, physician assistants, nurse anesthetists, nutritionists and radiology technicians.

Our Mission To provide outstanding medical care and an exceptional healthcare experience. Guiding Principle We will treat each patient as a valued member of our immediate family. Our physicians maintain the highest levels of accreditation and constantly pursue ongoing education to stay current in the knowledge required to meet your needs. All our doctors are board certified in their specialty fields. Many of them have also received specialized training in advanced endoscopic and invasive procedures. We are involved in clinical research and medical education, allowing us to provide patients with the latest techniques and treatments all under one medical group. Using performance and outcome measurements, we strive to demonstrate quality and improvement in the delivery of patient care.

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The physicians at Gastro Health, along with our skilled support team, take great pride in improving patients’ quality of care and ensuring an exceptional healthcare experience. We have made quality patient care our highest priority. We work closely with our referring primary care physicians and engage in a constant communication with them about your health, diagnosis, treatment and recommendations to keep them informed about your care. In addition to our specialized training and experience, we believe that we achieve high quality care in other ways too. One of our main goals is to work in partnership with our patients and their primary care physicians, as they strive to enhance and maintain their quality of life.

We thank you for the confidence you have placed with us by giving us the opportunity to serve you and your primary care provider.

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Caring for You and Those You Love

Inside this issue

Amy Brenneman’s Calmer, Healthier, Happier Self Do You Know What a Mid-Level Provider Is? Health Starts Here Gastro Health Physician Directory The HALO System Probiotics In Health And Disease Introducing Our New Patient Portal Have You Had Your Flu Shot? Investigative Overview: Clostridium Difficile Helicobacter Pylori Testing Debbie’s Dream Foundation: Curing Stomach Cancer Don’t Scratch Your Bottom Could I Have a Fatty Liver? Gastro Health Foundation AliveAndKickn – Dave’s Story Designed and Published by:

Alejandro Fernandez, MBA, CMPE Chief Executive Officer

11900 Biscayne Boulevard, Suite 100

9500 South Dadeland Boulevard, Suite 802

Miami, FL 33181

Miami, FL 33156

T. 305.820.0690

T. 305.468.4180 www.gastrohealth.com

Caring for you and those you love.

Mission To provide outstanding medical care and an exceptional healthcare experience.

GuidinG PrinciPle We will treat each patient as a valued member of our immediate family.

core Values Care and Compassion Provide competent, individualized care in a professional, respectful and caring way. Teamwork Recognize each other as valuable members of our healthcare team by treating one another with loyalty, respect, and dignity. Responsibility Provide excellent and efficient administrative, accounting, personnel, and business management services. Value and Excellence Develop valuable ancillary services that improve our patientsâ&#x20AC;&#x2122; quality of care and customer experience.

Honesty and Integrity Communicate openly and honestly, build trust and conduct ourselves according to the highest ethical standards. Stewardship Attract and retain great talent and the finest gastroenterologists by actively promoting a professionally satisfying work environment. Accountability Maintain mutually beneficial relationships with top referring physicians, payers, employers, and health systems using performance, outcome, as well as satisfaction measurements to demonstrate accountability and improvement in our care delivery.

Gastro Health

AMY BRENNEMAN’S

CALMER, HEALTHIER, HAPPIER SELF

By: Kate Hahn

Find out how the actress overcame a life-altering illness while juggling family, friends, and her new show, Private Practice – in this interview with Prevention Magazine. LIFE-CHANGING HEALTH CRISIS Earlier this year, you took several weeks off from Private Practice because of an illness. What was going on? I had ulcerative colitis that just did not get better. I couldn’t hold on to food. I was depleted, and I didn’t produce enough red blood cells, so I was also anemic. I got diagnosed in my second pregnancy. I used all sorts of medication during those five years: Colazal, 6-MP, Humira--to name a few. Because colitis is an autoimmune disorder, most of these medications are immunosuppressors--tr ying to get the immune system to calm down. I also used alternative medications--acupuncture, herbs, supplements--as well as dietary restrictions of wheat, dairy, raw food. I tried it all! Everything I did had some small benefit, but nothing really solved the problem. I remember thinking, This is just taking up too much of my space. My main symptom was constant diarrhea. Over time, I became chronically dehydrated, malnourished, and anemic. I did not stay in bed all day but powered through everything on diminished energy. I’m not necessarily proud of that, but as a working mother, what are you going to do? So my entire colon was taken out. The follow-up surgery involved the removal of the ileostomy bag--which I’d had attached for about three months by that point. That second operation reconnected my insides again so that I no longer needed it.

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GASTRO HEALTH MAGAZINE • FALL 2013

What was the recovery like? I was out for about six weeks. I came back and finished the season. I had the second, more minor surgery as soon as we wrapped. I’ve been healthy ever since.

SURGERY OF LAST RESORT Why did you wait five years before trying surgery? I was being New Agey about it--like, surgery, grrr. With all our understanding of the mind/

Gastro Health

body connection, there’s a point at which you can use that idea to abuse yourself: If I could only find the right technique or I’m too stressed. You’re blaming the victim, who is you. Years ago, my doctor told me there was a surgical solution, but I thought, I will never do that, you know? But surgery ended up being what healed me. I’m so grateful to Western medicine. Now I eat basically everything. THE SWEETS POLICE What are your guilty pleasure foods? I never really had a sweet tooth until I had kids. Now I eat cakes, brownies, cookies. But I try not to keep that stuff in the house. Like, if the kids want dessert, it’s Tofutti Cuties. And I always joke that my husband’s almost like a dog--if you give him a bowl of kibble, he’s fine. [Laughs affectionately] He has very simple tastes. DOING THE “SQUEEZE” How did you get back into exercise after surgery? I’m a distance runner, and I thought Pilates was for sissies. Then I wandered into this place called Pilates Sports Center that’s right near here and I was like, Wow! They’re all serious ex-dancers or ex-Rockettes. I said to the trainer, “Okay, work me out. Can’t use my core. Good luck.” But we worked around it, and it was awesome how specific we could get. And I hear you do the Tracy Effinger Squeeze routine? [Nods] She came out with a DVD...I always felt like exercising to videos was kind of depressing, like something suburban ladies do--which I am now! [Laughs] But I have a little gym room in my house with a TV in it, and I don’t even do the whole routine, just thirty to forty minutes. Her technique is really a sustained squeeze of various body parts with two-pound weights; in the beginning you’re thinking it’s not hard, but by the end, you’re shaking. It’s awesome. Do you encourage your kids to get a lot of exercise too? We’re outside all the time. In our neighborhood, we don’t have sidewalks, which is a drag, but

GASTRO HEALTH MAGAZINE • FALL 2013

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Gastro Health

we live on a gated property. So I open the doors and say, “Get lost--I don’t want to see you for four hours.” It’s that old-fashioned thing. LEARNING TO UNPLUG Many people say that today’s kids lead overstructured lives, with too many lessons and too much computer time. Do you ever just unplug? For us type A’s, before you know it, even relaxation is a little too structured. Sometimes I have to turn my iPhone off. I don’t do video games. For me, it’s really about finding ease and letting go. I cut out a lot of stuff that was crowding out my own voice. It’s the art of chilling out. I’m such an adrenalized person, and we live in an adrenalized culture, and yet slowing down is the underbelly of good mental health. HER GIRL TRIBE You mentioned your “girl tribe” on one of your tweets [Amy’s Twitter address: TheAmyBrenneman]. What’s up with that? My girl tribe is all women, and we are ten in all. We meet four times a year, during the two solstices and two equinoxes. We like to mark the passage of the seasons. We generally meet about seven in the evening at someone’s house--sometimes inside, sometimes out. Always there’s food! We go around the circle, and everyone has a chance to check in. If it’s a big group, we set a timer for fifteen minutes. If it’s a small group, we don’t. There’s absolutely no restriction on what’s okay to talk about, although we generally don’t indulge in “crosstalk.” That is, we let one person at a time speak without interruption. That way, it feels more sacred, less like everyday conversation. People speak from their hearts, often sharing things they don’t talk about anywhere else. That group has become the cornerstone of my life, in many ways. So do you have a tribe BFF? Actually my best friend is probably a guy: Chris. I’ve known him since I was eighteen, and we see the world the same way. He makes me laugh till I pee and holds me when I weep. Now we’re both raising children at the same time. So often I feel inadequate as a mother and judge myself too harshly. Chris blesses me, accepts

me, and keeps me company. Unfortunately, he and his family moved to Oregon, so we see each other much more infrequently than we used to. But when we do manage to get together for a reunion, it’s like coming home. KEEPING FACE In youth-obsessed Hollywood, do you ever feel pressure to use Botox or injectables or have plastic surgery? I’ve experimented. Fillers are fine, but Botox kind of freaked me out because I couldn’t move my face. I was like, “Isn’t it my job to make facial expressions?” This is just me, but when people really change how they look, it’s weird. I get a little spooked about that, like, “Ah, but nobody else looks like you and now you’re gone. Now you’ve got the nose that that girl has!” Is there a part of your body you wish you could change? After I had my kids, my boobs started to deflate, but now they’re sort of pumping up again. [Laughs] I have so many different needs and sides to myself--I can imagine getting a boob job and changing my mind the next week. It’s why I don’t have tattoos! What’s your go-to beauty product? Kate Walsh turned me on to Kate Somerville facial products which are delish. Her moisturizers are yummy. Kiehl’s Silk Groom Serum for hair--I have fuzzy hair, so everything needs constant quenching. WHAT MAKES HER HOLIDAYS SPECIAL The holidays are right around the corner; what will you be doing? We’ll go to our house in Massachusetts. It’s dark and dank, which I love. [Laughs] I don’t think I’ve ever had a warm-weather Christmas. My brother lives in Boston, so he comes in with his family, and the cousins are nearby too. What I love about the holidays is having a buffet and sitting down at the table together. And then you just lounge and nosh some more. I remember two years ago, there was this beautiful snowfall on New Year’s Eve, and when we went outside in the morning, it was like something out of a movie.

As the year ends, what are you reflecting on? This illness was a huge teacher for me. Would I wish it on anybody? No. Did it open up lessons? Yes. It’s not about leading with your strength or trying to be perfect. And what’s next for you? Honestly, I plan to have more space-out time. Just to let my little inner spirit be. HER BUCKET LIST Dreams for the Future This is Amy’s list. What’s yours? • Dancing with shamans in Brazil • Living in Bali with my family • Performing on Broadway • Writing a book • Dancing with the Alvin Ailey American • Dance Theater • Being friends with Michelle Obama • Traveling in Africa • Traveling in southern India • Travel, Travel, Travel!

GASTRO HEALTH MAGAZINE • FALL 2013

Gastro Health

DO YOU KNOW What a Mid-Level Provider Is?

id-level providers, such as Nurse Practitioners (NPs) and Physician Assistants (PAs) are an integral part of the medical team, working autonomously under the supervision of physicians to diagnose, manage, and treat a variety of medical conditions in settings such as primary care, surgery, and various subspecialties including gastroenterology. At Gastro Health, PAs and NPs diagnose and treat a wide range of digestive and liver diseases. As highly trained licensed medical providers, NPs and PAs evaluate patients in both office and hospital settings. They perform physical exams and also order and interpret tests that

Sabrina Kaplan, M.M.S, PA-C Physician Assistant

include necessary labs, imaging, and procedures. They also prescribe medications to treat various medical conditions. Mid-level providers are fundamental in educating patients on their illnesses, as well as counseling patients on the importance of screening tests such as colonoscopies. In the upcoming years, medical institutions will certainly see an increasing number of patients due to a growing population and the implementation of the Affordable Care Act. This will create an even greater demand on quality health care providers. With the expansion of health care, PAs and NPs will continue to play a key role as part of the health care team. Through preventative care, mid-level providers can focus on promoting health in a cost-effective way, while continuing to provide exceptional health care to patients alongside their physician counterparts.

“With the expansion of health care, PAs and NPs will continue to play a key role as part of the health care team.”

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Health Starts Here By Erika Chavez Healthy Eating & Green Mission Specialist | Whole Foods Market

Health Starts Here is the Whole Foods Market healthy eating initiative, which puts into action our commitment to offering health-promoting education and recipes.

astrointestinal health doesn’t just start when you visit your doctor or schedule your next colonoscopy. It begins the minute you wake up in the morning on any given day. To ensure the wellbeing and strength of your digestive system, you want to put into practice healthy eating habits, from breakfast to dinner. As the Healthy Eating Specialist at Whole Foods Market in North Miami, I teach our customers about the Four Pillars of Healthy Eating, which are “whole foods”, “plant strong”, “healthy fats”, and “nutrient dense.” What do these pillars mean? When I stress eating whole foods, I mean that the majority of your plate should be made up of unprocessed ingredients that are in their most natural state, like vegetables and whole grains. To be considered plant strong, you need to eat a diet made up of mostly plant-based foods, like beans and fruits. Why? Because nothing promotes a healthier digestive system than tons of fiber! Healthy fats should come from whole plant sources, so no extracted olive oil here. We’re talking about avocados, nuts, and seeds. You should always want to get the most nutrients for your caloric buck, so look for nutrient dense foods that are low in calorie and high in vitamins. Why should you eat for colon health? We all rather prevent a problem from arising rather than having to go under treatments to fix ourselves. By eating foods high in fiber and micronutrients, you may be promoting a healthier digestive system, which could aid in keeping colon problems at bay.

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• Eat a rainbow. By ensuring that your plate is filled with many different colors, like red from tomatoes or orange from carrots, you can guarantee that your body is absorbing as many different vitamins and micronutrients as possible.

Ready to cook?

Try the Health Starts Here Pineapple-Ginger Rice with Edamame! Pineapple and ginger are both amazing digestive aids that aren’t just good for you, but make for a delicious meal.

Other helpful dietary changes to optimize colon health:

Pineapple-Ginger Rice with Edamame

• Avoid dairy products. Dairy can be hard to digest and may cause inflammation throughout the digestive system. • Cut out processed foods. Remember the “whole foods” pillar? It’s especially important to cut out processed foods, like white bread and artificial sugars, because of the lack of fiber and introduction of additives, which may cause irritation.

• I¾ cup low-sodium vegetable broth • 1 tablespoon finely grated fresh ginger • 2 tablespoons brown rice miso or light yellow miso • 4 cups cooked brown rice • 2 cups shelled edamame • 1½ cups chopped fresh pineapple • ¼ cup chopped fresh cilantro

GASTRO HEALTH MAGAZINE • FALL 2013

In a large, deep skillet, bring broth and ginger to a simmer over medium-high heat; simmer for 2 minutes. Remove skillet from heat and whisk in miso. Return to heat, add rice, edamame and pineapple. Toss gently and cook until liquid is absorbed and rice is hot throughout, 3 to 5 minutes more. Stir in cilantro, serve, and enjoy.

Gastro Health

C onvenient &C ompassionate Galloway Endoscopy Center is an accredited surgical facility offering diagnostic and therapeutic gastrointestinal procedures in a comfortable and convenient outpatient setting. Our compassionate, bilingual staff provides top-quality care while assisting our experienced and highly skilled doctors. Best of all, because of advances in medical technology, endoscopic procedures can be safely performed outside the hospital, so you can return to the comfort of your home the same day as your procedure. You have a choice in healthcare. Isn’t it time you got treated better?

A division of Baptist Surgery and Endoscopy Centers

7500 SW 87 Avenue, Suite 101 • Miami • GallowayEndoscopy.com • 305-595-9511 A not-for-profit organization committed to our faith-based charitable mission of medical excellence GASTRO HEALTH MAGAZINE • FALL 2013

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Caring for You and Those You Love

PHYSICIAN DIRECTORY Gastro Health is a medical group made up of the finest physicians and allied health professionals in South Florida specializing in the treatment of gastrointestinal disorders, nutrition, and digestive health. Our team of board-certified physicians, physician assistants, nurse practitioners, nutritionists and technicians combine their clinical expertise and experience to provide patients with quality medical and preventive care in the field of Gastroenterology. With numerous office locations, endoscopy centers, diagnostic imaging, pathology laboratory, in-office infusion therapy, and affiliations with South Floridaâ&#x20AC;&#x2122;s premier hospitals â&#x20AC;&#x201C; Gastro Health continues to achieve excellence in medical care.

PHYSICIAN DIRECTORY

Gastro Health

Francisco J. Baigorri, MD * Gastroenterologist Care Center 1

Simon Behar, MD * Gastroenterologist Care Center 3

Barry E. Brand, MD Gastroenterologist Care Center 2

Gustavo Calleja, MD * Gastroenterologist Care Center 1

Marc S. Carp, MD Gastroenterologist Care Center 6

John P. Christie, MD Colorectal Surgeon Retired

Lewis R. Felder, MD Gastroenterologist Care Center 7

Edward Feller, MD Gastroenterologist Care Center 15

Jose P. Ferrer, Jr., MD * Gastroenterologist Care Center 3

Jose P. Ferrer, Sr., MD * Gastroenterologist Care Center 3

Mark S. Friedman, MD Gastroenterologist Care Center 8

Nelson Garcia Jr. MD * Gastroenterologist Care Center 8

Pamela L. Garjian, MD* Gastroenterologist Care Center 16

Daniel Gelrud, MD * Gastroenterologist Care Center 1

Harris I. Goldberg, MD Gastroenterologist Care Center 1

Ruben Gonzalez-Vallina, MD * Pediatric Gastroenterologist Care Center 12

Pedro J. Greer Jr., MD * Gastroenterologist Care Center 11

Eugenio J. Hernandez, MD * Gastroenterologist Care Center 3

Mitchell Gregg, MD Radiologist

Guillermo P. Gubbins, MD * Gastroenterologist Care Center 10

Alfredo J. Hernandez, MD * Gastroenterologist Care Center 11

Enrique HernandezSanchez, MD* Pediatric Gastroenterologist Care Center 14

Moises E. Hernandez, MD * Gastroenterologist Care Center 3

Richard E. Hernandez, MD * Gastroenterologist Care Center 5

Raghad Koutouby, MD Pediatric Gastroenterologist Care Center 13

Eduardo Krajewski, MD * Colorectal Surgeon Care Center 9

* Habla EspaĂąol

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GASTRO HEALTH MAGAZINE â&#x20AC;˘ FALL 2013

Gastro Health

Robert C. Lanoff, MD * Gastroenterologist Care Center 2

Jose A. Lavergne, MD * Gastroenterologist Care Center 7

James S. Leavitt, MD Gastroenterologist Care Center 1

Marc Lederhandler, MD Gastroenterologist Care Center 1

Oscar Loret de Mola, MD* Pediatric Gastroenterologist Care Center 17

Jerry Martel, MD, MPH * Gastroenterologist Care Center 8

Antonio Martinez, MD * Pathologist Pathology Medical Director

Flavia D. Mendes, MD * Gastroenterologist Care Center 1

Pedro Morales, MD * Gastroenterologist Care Center 8

Brett R. Neustater, MD Gastroenterologist Care Center 7

Javier L. Parra, MD * Gastroenterologist Care Center 1

Alfredo Rabassa, MD * Gastroenterologist Care Center 1

Andres I. Roig, MD * Gastroenterologist Care Center 3

Ricardo J. Roman, MD * Gastroenterologist Care Center 7

Seth D. Rosen, MD Gastroenterologist Care Center 2

Neil E. Rosenkranz, MD Gastroenterologist Care Center 2

S. Lawrence Rothman, MD Gastroenterologist Care Center 1

Eduardo Ruan, MD * Gastroenterologist Care Center 1

Andrew I. Sable, MD Gastroenterologist Care Center 2

George A. Sanchez, MD * Gastroenterologist Care Center 1

Somal S. Shah, MD * Gastroenterologist Care Center 11

Arie Slomianski, MD * Gastroenterologist Care Center 1

David A. Sommer, MD Gastroenterologist Care Center 2

Marcos Szomstein, MD * Colorectal Surgeon Care Center 9

Howard I. Schwartz, MD Gastroenterologist Care Center 1

Stefania L. Vernace, MD Gastroenterologist Care Center 1

* Habla EspaĂąol GASTRO HEALTH MAGAZINE â&#x20AC;˘ FALL 2013

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Allied Healthcare Staff

Claudia Acosta, PA-C*

Darlene Boytell-Perez, ARNP *

Jessica Jairala, PA-C*

Sabrina Kaplan, M.M.S, PA-C

Rebecca Karousatos, MS, RD, LDN

Ellen Matas-Sosa, PA-C

Hernando Mispireta, ARNP *

Ronal R. Ricano, PA

Hengameh Shahidpoor, ARNP

Kayce Tugg, MSN, RN

Care Centers Care Center 1 Main Office 7500 SW 87 Avenue, Suite 200 Miami, FL 33173 305-913-0666

Care Center 7 Satellite Office #1 5803 NW 151 Street, Suite 105 Miami Lakes, FL 33014 305-770-0062

Care Center 1 Satellite Office 6141 Sunset Drive, Suite 301 Miami, FL 33143 305-913-0666

Care Center 7 Satellite Office #2 21110 Biscayne Boulevard, Suite 206 Aventura, FL 33180 305-770-0062

Care Center 2 9555 N. Kendall Drive, Suite 100 Miami, FL 33176 305-273-7319

Care Center 8 8200 SW 117 Avenue, Suite 110 Miami, FL 33183 305-274-5500

Care Center 3 8950 N. Kendall Drive, Suite 306-W Miami, FL 33176 305-596-9966

Care Center 9 7765 SW 87 Avenue, Suite 212 Miami, FL 33173 305-596-3080

Care Center 4 15955 SW 96 Street, Suite 205 Miami, FL 33196 305-468-4191

Care Center 10 475 Biltmore Way, Suite 207-A Coral Gables, FL 33134 305-662-6170

Care Center 5 7765 SW 87 Avenue, Suite 105 Miami, FL 33173 305-274-0808

Care Center 11 3661 S. Miami Avenue, Suite 805 Miami, FL 33133 305-856-7333

Care Center 6 1400 NE Miami Gardens Drive, Suite 221 North Miami Beach, FL 33179 305-949-2020

Care Center 11 Satellite Office Florida International University 885 SW 109 Avenue, Suite 131 Miami, FL 33199 305-856-7333

Care Center 7 Main Office 16855 NE 2nd Avenue, Suite 202 North Miami Beach, FL 33162 305-770-0062

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* Habla Español

GASTRO HEALTH MAGAZINE • FALL 2013

Care Center 12 8940 N. Kendall Drive, Suite 603-E Miami, FL 33176 305-512-3345

Insurances AARP Medicare Complete American Heritage Life Insurance American Medical Security AvMed Care Center 14 Baptist Executive Health 9980 Central Park N. Boulevard, Suite 316 Beechstreet Boca Raton, FL 33428 561-206-6064 Blue Cross Blue Shield Cigna Care Center 15 Coventry Health Care 8353 SW 124 Street, Suite 203 Miami, FL 33156 Dimensions Health 305-259-8720 First Health Network HealthSun Health Plans Care Center 16 8353 SW 124 Street, Suite 108 Humana Miami, FL 33156 Humana Champus Tricare 305-669-1115 JMH Health Plan Care Center 17 Mail Handlers Benefit Plans 7775 SW 87 Avenue, Suite 120 Medica Health Plan Miami, FL 33173 305 274-8243 Medicare Part B MultiPlan Imaging Center Neighborhood Health Plan 7500 SW 87 Avenue, Suite 200-A Miami, FL 33173 OneSource 305-468-4190 Preferred Care Partners Simply Healthcare Pathology Laboratory 9000 SW 87 Court, Suite 110 United Healthcare Miami, FL 33176 VISTA Health Plans 305-468-4194 Care Center 13 9260 SW 72 Avenue, Suite 217 Miami, FL 33173 305-271-7330

The HALOSystem:

Removing the Risk of Barrett’s Esophagus

Gastro Health

Andrew I. Sable, MD Gastroenterologist

arrett’s esophagus is a condition in which the cells that normally line the lower portion of the esophagus are replaced by tissue that is usually found lower in the intestine. This process, called metaplasia, is believed in some part to occur as a result of chronic reflux of stomach acid back into the esophagus (gastroesophageal reflux disease, or GERD). Overtime, this chronic regurgitation causes damage to the normal esophageal lining. In the body’s attempt to heal and protect, it grows different cells thus leading to Barrett’s esophagus. Barrett’s esophagus itself usually causes no symptoms. It is diagnosed when a gastroenterologist performs an endoscopy on a patient to further evaluate symptoms such as chronic reflux, heartburn, or even difficulty swallowing. If your healthcare provider identifies tissue that appears abnormal, he or she will take samples to help determine if Barrett’s esophagus is present. The significance of having Barrett’s is that it is associated with a much higher risk of developing esophageal adenocarcinoma. Fortunately, even those who have Barrett’s esophagus have a very low risk (less than 0.5% of patients per year) of developing esophageal cancer. Unfortunately, at the present time, there is no reliable way to determine which patients with Barrett’s esophagus may go on to develop esophageal cancer. It is fairly typical for a healthcare provider to recommend those who have Barrett’s to undergo surveillance of this condition with endoscopy at regular intervals. This may help to identify tissue that is dysplastic (pre-malignant). Although commonly recommended to patients with Barrett’s esophagus, the use of antacids has not been shown to prevent the development of cancer. Treatment for people with Barrett’s esophagus and dysplasia is individualized and can vary from surgery or endoscopic resection to using photosensitizers (PDT) and radiofrequency ablation (RFA).

In 2005, the HALO System was approved for use by the FDA for the ablation of Barrett’s esophagus in those select patients who have developed dysplasia. This system uses radiofrequency to destroy Barrett’s tissue that has been previously identified during endoscopy. Even though radiofrequency has been used for many years for the treatment of Barrett’s, there has been no reliable method that was safe, effective and easy for both patients and their physicians until the development of the HALO System.

tissue with minimal risk. It has been studied extensively in both the United States and Europe and has been shown in some studies to be over 98% effective in eliminating dysplastic tissue (pre-malignant cells). Recent studies estimate that well over 3 million Americans over 50 years of age suffer from Barrett’s esophagus. If you have Barrett’s esophagus, speak to your Gastro Health physician to see if you may be a good candidate for the HALO System.

In an outpatient setting, the HALO System is used during endoscopy to destroy the Barrett’s

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Gastro Health

Probiotics

in Health and Disease

Guillermo P. Gubbins, MD Gastroenterologist

eople are ecosystems. A healthy adult can harbor about 100 trillion bacteria in his gut alone, which is 10 times as many as the number of cells in his body. In exchange for raw materials and shelter, the body’s commensal bacteria or “microbiome” feed and protect their hosts. The “normal” microbiome digests dietary fiber, generating short fatty acids that serve as fuel for certain cells’ metabolic needs, or are also stored as fat. In addition to Irritable Bowel Syndrome (IBS), Inflammatory Bowel Disease (IBD), Antibiotic-Associated Diarrhea, and Infectious Diarrhea, an altered microbiome has also been associated to Atherosclerotic Heart Disease, Obesity, Diabetes, Metabolic Syndrome, Non-Alcoholic Steato-Hepatitis and various presumably “auto-immune” diseases such as Type 1 Diabetes, Eczema, Multiple Sclerosis and even Autism. Modifying microbiomes with antibiotics in specially bred mice predisposed to hardening of the arteries significantly reduces their Atherosclerosis. In Multiple Sclerosis, researchers have shown in mice that gut bacteria trigger the reaction that causes the immune system to turn against certain nerve cells and strip away their insulation in precisely the way that leads to multiple sclerosis. If gut bacteria are making you ill, can swapping them make you healthy? The yogurt industry has been answering this question for many years. Indeed probiotics – which are live micro-organisms that when administered in adequate amounts, confer a health benefit to the host – are found in yogurt. Although it is commonly recommended as a source of probiotics, not all of the live cultures contained in yogurt survive well in an acidic environment, nor do they colonize the microbiome efficiently. Some yogurt preparations in the United States are pasteurized, which kills the bacteria. Furthermore, the residual lactose contained in yogurt can increase symptoms in patients with lactose intolerance, including those that develop secondary lactose intolerance following an episode of acute gastroenteritis. Since yogurts are limited in the range and amount of bacteria they can transmit, different concentrated probiotic formulations have been developed and studied scientifically. Some of the most commonly available include: VSL#3, Align, Culturelle, DanActive, Mutaflor and Florastor. Unfortunately, very few studies have hinted that probiotic pills may improve your health, and scientists claim that there is not enough proof and more research is needed. Hence, these pills should not be taken unless recommended by your physician. However, there is no harm in eating yogurt products that have “active cultures” which have probiotics in them. A low-fat yogurt can always be part of a healthy diet. The downside is that probiotics are not regulated

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GASTRO HEALTH MAGAZINE • FALL 2013

by the FDA and therefore the manufacturers do not have to prove that the ingredients listed on the label are actually in the bottle. Furthermore, probiotics are expensive and not covered by insurance (except for VSL#3 DS in “pouchitis”) and there is a small chance that they can cause infections in people with weak immune systems.

“Although it is commonly recommended as a source of probiotics, not all of the live cultures contained in yogurt survive well in an acidic environment, nor do they colonize the microbiome efficiently.”

Gastro Health

Member of Alliance Benefit Group

GASTRO HEALTH MAGAZINE • FALL 2013

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Gastro Health

Introducing Our New Patient Portal

astro Health has under taken an ambi tious program to improve customer service and streamline business processes using state-ofthe-art technology. We are happy to announce the release of our patient portal. Our patient portal looks much like a website, but the similarities end there. A website offers a static user experience while our webbased patient portal, intimately connected to our electronic health record, is an important gateway into our medical practice for our patients. Our portal provides a secure, HIPAA compliant, two-way communication channel between our patients and us, their health care providers. Unlike our practice’s office operations, the portal provides convenient, 24-hour self-service options. It allows patients to handle business and clinical interactions with our practice at their convenience and allows our staff to respond in an appropriate non-urgent manner.

While the features of portals may vary, the options typically allow patients to complete, manage, or communicate with their provider regarding: • • • • • • • • •

Registration Financial clearance Medical history Appointment scheduling requests and confirmations Appointment recalls for preventive and other recommended care Test results notification and tracking Patient - health care provider communication Online bill payment Prescription renewal

We believe that an interactive web portal can help answer a number of commonly asked questions, and also allows our staff to work on more productive endeavors such as patient

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GASTRO HEALTH MAGAZINE • FALL 2013

James S. Leavitt, MD Gastroenterologist

education, patient services, collections, and insurance follow-ups. It provides enhanced services to the patients 24 hours a day, 7 days a week and improves our patients’ experience with Gastro Health. Regardless of the specific functionalities, patients find value in a well-designed and functional patient portal because they feel like they are participating in their care process and have been given a greater menu of choices. A 2008 survey by the Commonwealth Fund found that 94 percent of consumers rated easy access to their own medical records as either “important” or “very important” to them. Gastro Health’s patient portal will streamline access to our practice by offering patients self-serve access to many of the functions and information that they most value from health care providers. A recent survey by the Deloitte Center for Health Solutions found that nearly 80 percent of healthcare consumers were interested in gaining access, through their physicians, to an integrated medical record containing their test results, physician visits and other information. Three out of four surveyed wanted their physicians to provide online services to schedule appointments, get test results, access medical records and exchange E-mail. Confirming the at titude of consumers to embrace portals, Intuit Health concluded that 72 percent of consumers would use a tool to help them pay their medical bills, easily communicate with physicians, make appointments, and obtain lab results online. Portals can meet all of these patients’ needs – and more.

Portal Benefits A patient portal creates a single, customizable point of access to applications and information thereby providing tremendous value to our patients and our practice by strengthening physician-patient relationships, securely

sharing information, improving practice operations and cost savings, improving accuracy, and increasing access while decreasing waiting times. As patients are given more responsibility for their own health care costs, we at Gastro Health, feel that we must provide both quality and cost efficiencies in order to compete. Portals offer the transparency expected by a new breed of health care consumers who demand value and access. Forester Research analyst Elizabeth Boehm, who researches the role of online services in health care, concludes: “You wouldn’t consider not having a phone system, and the generations that are coming up are going to think it’s ridiculous not to be able to communicate via computer.” So, we ask that you enroll in our patient portal. Go to our website www.GASTROHEALTH.com, visit our offices, or call us so you can create your username and password TODAY.

Start taking an active role in your healthcare!

Gastro Health

INTRODUCING OUR NEW PATIENT PORTAL ON GASTROHEALTH.COM DESIGNED SPECIALLY FOR YOU

WITH OUR PATIENT PORTAL YOU CAN:

Request appointments Fill out patient forms before your visit Check your test results Send a message to your physician Update your personal and medical records Log in 24/7 with access anywhere

CREATE YOUR USER ID AND PASSWORD TODAY AND START TAKING AN ACTIVE ROLE IN YOUR HEALTHCARE!

HOW TO REGISTER: Step 1: You will receive an invitation email from Gastro Health with a link and unique ID that will take you through the registration process.

Step 2: Click on the link in the invitation email to create a unique user ID and password.

Step 3: Once registered, complete your medical, family and social history.

Step 4: Click “Submit” to send your information directly to our office. GASTRO HEALTH MAGAZINE • FALL 2013

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Gastro Health

HAVE YOU HAD YOUR FLU SHOT?

Jose P. Ferrer, Sr., MD Gastroenterologist

Gastro Health recommends that patients with Crohn’s Disease or Ulcerative Colitis who are taking “immunosuppressant medications” receive a yearly flu vaccination and the pneumonia vaccine every five years.

Immunosuppressant medications include the following: • Prednisone • Azathioprine (Imuran, Azasan) • 6-Mercaptopurine (6-MP, Purinethol) • Methotrexate (Rheumatrex) • Infliximab (Remicade); Adalimumab (Humira); Certolizumab Pegol (Cimzia) • Natalizumab (Tysabri) The inactivated influenza vaccine given by an intramuscular shot, as well as the pneumonia vaccine, are both safe for patients taking immunosuppressant medications. However, live vaccinations are not safe if you are taking immunosuppressant medications.

Live vaccinations include: • Chickenpox (Varicella Zoster Infection) • Measles, Mumps and Rubella (MMR) • Yellow Fever • Intranasal Flu Vaccine (this is different from the one given by an Intramuscular injection)

If you have ANY questions or concerns, please consult your Gastro Health physician.

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GASTRO HEALTH MAGAZINE • FALL 2013

Gastro Health

INVESTIGATIVE OVERVIEW: CLOSTRIDIUM DIFFICILE

Jose P. Ferrer, Jr., MD Gastroenterologist

Also, as mentioned previously, the major risk factors for this illness are antibiotic use and admission to a hospital. Germs can spread easily in hospitals and can persist on many surfaces, facilitating transmission. Adequate cleaning of surfaces and hand washing is imperative, as traditional alcohol gels are not as effective against the bacteria. Also, the quantity of antibiotics one takes and the lengths of time in which they are taken also increase risk of infection. Medications which lower stomach acid, particularly proton pump inhibitors (PPI) have also been associated with higher incidence of infection. Other factors include older age, recent surgery, inflammatory bowel disease (IBD) and patients undergoing chemotherapy.

ntibiotic-associated diarrhea (AAD) is a diarrhea that develops in patients who are taking or have taken antibiotics. One of the most severe causes is being infected with the bacterium Clostridium difficile (C. difficile). Infected individuals tend to be older adults, particularly if hospitalized and exposed to antibiotics. There has been a rising trend of infections in younger adults from the community setting, even in the absence of antibiotics. This rise in infections has also been accompanied by more “virulent” strains which are more difficult to treat.

Symptoms There are millions of “good” bacteria in our colons which protect us from infection. By taking antibiotics, many of these defenses are killed and opportunity arises for C. difficile. If this bacteria flourishes, it can potentially lead to severe diarrhea. These symptoms are the result of a toxin produced which injures the intestine. Symptoms can vary in intensity from very mild illness to severe life threatening conditions. These include loose stools and mild abdominal cramps to profuse diarrhea and severe abdominal pain. Other symptoms include fever, nausea and vomiting and poor appetite. Diarrhea can also include blood.

Complications C. difficile can lead to several complications. Profuse diarrhea may predispose to dehydration and even kidney injury. With severe infection, the large intestine can become very lazy and unable to move air and stools. This scenario can lead to over distention of the colon (Toxic mega-colon) and possibly even rupture (perforation). The most severe complication can include death if not treated appropriately.

Diagnosis The most common way to diagnose the bacteria is by stool tests. These lab tests identify the presence of the toxin produced by the bacteria. Usually, a colonoscopy is not needed to make the diagnosis; however, in rare cases there may be a need to look at the colon for signs of inflammation, described as “pseudo membranes.”

Treatment

Cause

The treatment of C. difficile usually involves 10 to 14 days of antibiotics. The common antibiotics include metronidazole (Flagyl), vancomycin and more recently fidaxomicin (Dificid). Severe illness not responding to medical treatment may require surgery, which includes removal of the colon. Unfortunately, the risk of re-infection is quite high, approaching one in five patients. Studies have suggested that certain probiotics may have a role in preventing recurrence.

The cause of the colitis, C. difficile, is found in many parts of our ecosystem. These include soil, water and animal waste. Sometimes, we can even “carry” the bacteria in our colon without any symptoms. Highest places of infections are health care settings and facilities. Transmission is usually due to poor hand washing.

The take home point is to avoid antibiotics if they are not absolutely indicated, as well as adequate hand washing in health care facilities. If diarrhea develops in association with antibiotic use, alert your physician as an early diagnosis. Appropriate treatment is paramount.

GASTRO HEALTH MAGAZINE • FALL 2013

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JF 3/7/13

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To learn more, scan this code with your smartphone, or go to www.prepopik.com.

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BE PREPARED…

Gastro Health

HELICOBACTER

PYLORI TESTING

s previously discussed in our Fall 2012 issue, Helicobacter pylori (H. pylori) is a bacteria found in the stomach that can cause a variety of intestinal disorders such as peptic ulcers and gastritis. This bacterium is also a very common cause for dyspepsia, a syndrome consisting of epigastric discomfort, feelings of early fullness after eating, and bloating. For patients who do not have “alarm” symptoms such as weight loss or vomiting which require a more thorough evaluation, non-invasive testing for H. pylori can easily and effectively diagnose the presence of this bacterium. One such test that is commonly available now is a urea breath test. This test can be used to both diagnose Helicobacter pylori and confirm its eradication. The test requires a patient to provide a sample of their breath about 20 minutes after ingesting a compound. This is based on the fact that H. pylori can covert a compound called urea to both carbon dioxide and ammonia.

but not completely eliminate the presence of H. pylori in the stomach. In order to eliminate this risk, a patient must not use antibiotics for four weeks and PPIs for two weeks prior to undergoing the test. Another option in terms of non-invasive evaluation is the use of an H. pylori stool antigen test. The antigen is essentially a marker for the presence of active bacteria. This test offers a similar accuracy as compared to urea breath testing in detecting the bacteria. However, it has a slightly higher chance of a false positive result in comparison to the urea breath test,

Somal S. Shah, MD Gastroenterologist

and a similar chance of a false negative result. The main advantage of stool antigen testing is that it is slightly less costly as compared to the breath test. The urea breath test is an increasingly common way for physicians to safely and accurately diagnose the presence of H. pylori in the most cost effective way possible. The increasing use of this test will undoubtedly lead to this bacterium to be more easily identified and thereby allow more and more patients to reap the benefits of treatment.

During this test, a patient will ingest a detectable type of carbon called an isotope. If H. pylori is present, this isotope will incorporate into carbon dioxide and will then be detectable in the patient’s breath. There are two commercially available tests, and the only difference between these tests is the use of a radioactive isotope in one of the tests. It should be noted that the amount of radiation used in the test is essentially equal to the normal radiation a person is exposed in their daily life. The urea breath test has a reported sensitivity and specificity of 95%, meaning the chance of a false positive test is very low. False negative tests can also occur, especially if a patient is being prescribed certain medications. The two classes of medications that can cause false negative results include antibiotics and proton pump inhibitors (PPIs) such as Nexium or Prilosec. These medications will suppress

“For patients who do not have “alarm” symptoms such as weight loss or vomiting which require a more thorough evaluation, non-invasive testing for H. pylori can easily and effectively diagnose the presence of this bacterium.”

GASTRO HEALTH MAGAZINE • FALL 2013

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Gastro Health

DEBBIE’S DREAM FOUNDATION:

Curing Stomach Cancer For the person diagnosed with stomach cancer, there is an urgency to get the best treatment immediately.

STOMACH CANCER: THE FACTS

• Stomach cancer, also known as gastric cancer, is one of the leading • • • •

•

causes of cancer death worldwide - second in men and fourth in women. Each year nearly 930,000 people worldwide are diagnosed with stomach cancer, and approximately 700,000 die. According to the American Cancer Society, approximately 22,000 Americans are diagnosed with stomach cancer each year, and more than 10,000 will die within the first year. Currently, more than 64,000 Americans are living with stomach cancer, and studies have shown that the incidence of stomach cancer is rising in young people. Per cancer death, gastric cancer receives the least amount of federal funding and there is little research being conducted on stomach cancer for a variety of reasons, including lack of funding and few physicians specializing in this disease. There are few sources of dependable information about this disease.

DDF STRATEGIC INITIATIVES

• Raise awareness through educational programs and events about • • • • •

stomach cancer and the toll it takes on patients and their families Inform stomach cancer patients, families, caregivers, and healthcare professionals through educational materials and symposia Provide no-cost support and objective, reliable information about treatment options, ongoing research, and clinical trials Serve as the primary resource for health care professionals to refer their patients Fund research directly and through focused public policy efforts to increase federal funding Encourage collaboration and information sharing among medical professionals, researchers, scientists, pharmaceutical companies, public agencies, and patients.

DDF MILESTONES

Debbie’s Dream Foundation: Curing Stomach Cancer (DDF) held the first ever Stomach Cancer Education Symposium in 2011 and has repeated the event each year featuring lectures by renowned doctors from leading cancer centers; it was viewed internationally via webcast. Lectures are available on www.DebbiesDream.org. DDF launched its Patient Resource Education Program (PREP) to provide education, resources, and support internationally for stomach cancer patients, families, caregivers, and health care providers. The foundation hosts events nationwide, helps patients all over the world, funds stomach cancer research grants, and is developing chapters internationally.

ABOUT THE FOUNDER

Debbie Zelman is a rare individual who turned personal misfortune into an opportunity to make a difference in the world. In April 2008 she was diagnosed with advanced, incurable stomach cancer. In the course of searching for treatment options, she quickly learned how difficult this disease is to detect and treat. In April 2009, to fulfill her dream of a world free of stomach cancer, she founded Debbie’s Dream Foundation: Curing Stomach Cancer which has emerged as the international leader for this underrecognized and under-funded disease. Debbie’s Dream Foundation: Curing Stomach Cancer is a 501(c)(3) nonprofit organization dedicated to raising awareness about stomach cancer, advancing funding for research, and providing education and suppor t internationally to patients, families, and caregivers. DDF seeks as its ultimate goal to make the cure for stomach cancer a reality.

JOIN US AND TOGETHER WE CAN MAKE DEBBIE’S DREAM OF CURING STOMACH CANCER A REALITY! For more information, lectures, numerous resources and related links visit: www.DebbiesDream.org (954) 475-1200 | Toll-Free (855) 475-1200 | Info@DebbiesDream.org | 9110 West State Road 84, Davie, FL 33324

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GASTRO HEALTH MAGAZINE • FALL 2013

Don’t Scratch Your Bottom

tching around the anal area is called Pruritus Ani. This condition is an unpleasant skin sensation that produces the desire to scratch.

Marcos Szomstein, MD Colorectal Surgeon

Lack of cleanliness is rarely the primary cause. Once the patient develops this condition, they have the tendency of washing the area vigorously with soap and a washcloth. This is usually counterproductive due to damage to the perianal skin and washing away protective natural oils.

Why does this happen? There are a number of possible reasons. Some of them are moisture due to perspiration, a small amount of residual stool around the anus, hemorrhoids, fissures, fistulas, certain foods, smoking and drinking. Foods and beverages that are associated with Pruritus Ani include coffee, tea, carbonated beverages, milk products, cheese, chocolate, nuts, and spicy food. Rare anal malignancies can cause itching.

Perianal dermatitis, anal warts and hypertrophic skin are other causes for this condition.Parasites that cause anal itching are very rare in the United States.

What can be done to make the itching go away? A careful examination by a specialist can identify a definite cause for the itching. At least half of these patients never identify the reason for their problem, but they are still treated for their symptoms. A biopsy is rarely needed in the work up of this condition. The goal should be to achieve clean, dry and intact skin.

Some general recommendations include: 1. Avoid certain foods that cause this condition. Gradually reintroduce the offending foods; this helps identify which group is responsible and threshold for tolerance. 2. Avoid moisture in the anal area. 3. Avoid further trauma to the affected area. Anal hygiene is important. Use baby wipes or wet toilet paper to clean the area. Pat it dry. Never rub. 4. Do not scrub the anal area with regular toilet paper. 5. Minimize the use of soap in the anal area. 6. Try not to scratch the itchy area. Scratching produces more damage to the skin, which in turn makes the itching worse. 7. Use only medications prescribed by your physician. 8. If symptoms persist after 6 weeks, make another appointment with your physician.

“Foods and beverages that are associated with Pruritus Ani include coffee, tea, carbonated beverages, milk products, cheese, chocolate, nuts, and spicy food..”

Gastro Health

COULD I HAVE A FATTY LIVER? Flavia D. Mendes, MD Gastroenterologist

Nonalcoholic Fatty Liver Disease (NAFLD) is the term used for the buildup of extra fat within liver cells in individuals who consume little or no alcohol. This buildup of fat can cause inflammation and fibrosis (scarring) of the liver. NAFLD is ex tremely common, and it is recognized as the most common liver disorder in western countries, including in adolescents and preadolescents. It affects about 1 in 25 adults in the United States (3 to10 times more common than Hepatitis C). NAFLD is diagnosed in approximately 8 out of 10 patients who are evaluated for abnormal liver tests.

What Causes Fatty Liver? The exact cause is not known, but the main risk factors include obesity or overweight; diabetes; high cholesterol and/or triglycerides; and high blood pressure. Rapid weight loss and poor eating habits, as well as medications, may also cause fatty liver even in patients without those risk factors. Most of the time, NAFLD does not cause any serious liver problems and most people with fatty liver will live as long as those without it; however, the disease can progress, leading to inflammation of the liver tissue, which is also called Nonalcoholic Steatohepatitis (NASH). The persistent inflammation can cause scarring, which ultimately can lead to cirrhosis of the liver. Patients with cirrhosis may develop complications such as liver cancer and liver failure, and may need liver transplantation. It is difficult to predict the course of this disease, but we know that patients who are older, diabetics and/or obese are the ones at higher risk for worse disease.

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Why Should You Ask Your Doctor About Fatty Liver? Fatty liver is usually silent; it causes no signs or symptoms until it is very advanced. It is commonly first noted by the finding of abnormal liver tests on routine blood work. If diagnosed early, liver damage can be prevented. If your doctor suspects that you may have fatty liver, you will need blood tests to help exclude other causes of liver disease. Imaging studies (such as ultrasound) will likely be ordered and they may show fat accumulation in the liver. In some cases, a liver biopsy may be needed to confirm the diagnosis and/or to determine the severity of the disease.

Is There a Cure? NAFLD cannot be cured, but it can be controlled, and prevented. There is no medication proven to effectively treat fatty liver disease. The treatment/prevention is focused on diet and exercise, aiming gradual weight loss and tight control of the associated conditions, such as diabetes, high blood pressure and high cholesterol/triglycerides. If you have been diagnosed with fatty liver, you should strive to maintain a healthy weight with balanced diet and exercise; limit alcohol intake; only take medicines that you need and follow dosing recommendations; see your doctor regularly and consider a consultation with a liver specialist.

Gastro Health

THE MISSION OF THE GASTRO HEALTH FOUNDATION IS TO PROMOTE AWARENESS, EDUCATION, AND IMPROVE THE QUALITY OF LIFE OF CHILDREN AND ADULTS AFFECTED BY DIGESTIVE DISEASES. GASTRO HEALTH FOUNDATION SPONSORS RESEARCH, PROMOTES EDUCATION, AND SUPPORTS SERVICES AND FUNDRAISING INITIATIVES FOR: • • • • • • •

The awareness of Colon Cancer screening in South Florida The awareness of Hepatitis C screening to baby boomers in South Florida Annual gastroenterology clinical updates for primary care physicians and gastroenterologists Annual Crohn’s and Colitis Educational Seminar for children and their families Support groups in English and Spanish for patients with inflammatory bowel disease in South Florida Support groups for parents and children with inflammatory bowel disease in South Florida Other foundations with similar missions: • American Cancer Society • Crohn’s and Colitis Foundation of America

This active organization also offers a wide range of educational programs for patients and health care professionals, while providing supportive services to help people cope with these chronic gastrointestinal diseases. These programs are supported solely through donors, grants, and fundraising efforts. For more information about the GASTRO HEALTH FOUNDATION, visit www.gastrohealthfoundation.com.

GASTRO HEALTH MAGAZINE • FALL 2013

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Gastro Health

AliveAndKickn

David Dubin Founder

DAVE’S STORY

n 1997, I began experiencing cramps and bleeding at age 29 and despite my family history, it didn’t occur to me that it could be cancer. My grandfather had colon cancer in his sixties and my father had colon cancer in his forties. My symptoms had mistakenly been chalked up to stress from the recent marriage, new house, firstborn child, etc. Surgery number one was the toughest. Foot long scar, buckled over abdominal pain, and six months of chemotherapy since it had spread to the Lymph nodes. My weekly schedule included chemo day on Fridays; rest day on Saturdays; and Sunday remained my soccer day. It wasn’t pretty, and my teammates had no sympathy, but I was resilient nonetheless. Once declared cancer-free, the bad dream for me was over, or so I thought. In 2007, as if turning forty wasn’t bad enough, my colon cancer returned. This time, I actually had no symptoms. As a blood donor, you’re allowed to donate once considered “cancer-free” for five years. So when I went to donate, it was discovered that my iron count had dropped severely. My GI doctor confirmed another colon tumor. That is when I started my blog, AliveAndKickn. It felt like an apt name, given my medical and soccer history. After successful surgery, genetic testing confirmed that I had Lynch syndrome (HNPCC or Hereditary non-polyposis colorectal cancer). By now, my wife and I had three kids – all boys, and colon cancer hasn’t missed a Dubin male in three generations. Some people inherit money. I started seeing an oncologist that specialized in genetic cancers. Since Lynch has other tendencies besides colon cancer, I started having other parts checked. I had my prostate checked, started getting mammograms, and also CT scans of chest, abdomen, and pelvis. The CT scans discovered a very small tumor on my right kidney. Surgery number three was scheduled for February 2009; I was 42. I’ve been cancer-free since 2010, although every routine scan, probe and scope brings about its own share of anxiety. I call them my quarterly annuals, as I try to spread the tests out. I still coach and play soccer and manage a full workload. I’ve been featured in the “Colondar” – the calendar of colorectal cancer survivors diagnosed before age 50; I was Mr. January 2012. My wife and I turned AliveAndKickn, the blog, into AliveAndKickn, the not-for-profit foundation. Besides writing, speaking, signing Colondars, and making appearances, we have our AliveAndKickathon soccer fundraising events. I’m pretty sure we’re unique in using soccer as a way of reaching out to the community, but we wanted to reach people under 50, women, and multiple ethnicities. Our newest endeavor has been in the documentary world. AliveAndKickn has a 25-minute documentary that has been entered into a number of national film festivals. So far, we’ve been accepted into a few, with a dozen more pending.

For more information about our not-for-profit foundation, please visit WWW.ALIVEANDKICKN.ORG

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GASTRO HEALTH MAGAZINE • FALL 2013

My oldest son is now eighteen and is preparing for college applications. He has not been tested yet, but he does know what symptoms to look for. He will be tested before his nineteenth birthday. My middle son is now fourteen, and my youngest son is nine. They too know about AliveAndKickn, why we do what we do, and the story. They will be tested eventually as well. I think they like me still. For some reason, my wife still likes me as well. She deserves bet ter. Till death do us par t means one thing when you’re get ting married at 27; and it means something much different now. I’m very fond of saying that I don’t know what the future holds. Regardless, I want you to remember me as you’ve seen me – AliveAndKickn!

Colon cancer is the second-deadliest form of cancer in the U.S., yet it doesn’t have to be. Did you know that it’s 90 percent preventable? Screening is the key. Colon cancer stops with you This simple procedure – called a colonoscopy – can actively prevent colon cancer. Do it for you and your loved ones. If you are at-risk, get screened, and get on with your life! Who should get screened? Anyone 50 and older People who have a family history of polyps or colon or rectal cancer African-Americans who are 45 and older Other minority groups where the disease is more prevalent

Simon Behar, M.D. Jose P. Ferrer, Sr., M.D. Jose P. Ferrer, Jr., M.D. Nelson Garcia, Jr., M.D. Alfredo Hernandez, M.D. Eugenio J. Hernandez, M.D. Moises E. Hernandez, M.D. Jerry Martel, M.D., M.P.H. Seth D. Rosen, M.D. Andrew Sable, M.D. Galloway Surgery Center 7600 SW 87th Ave., Suite 100 Miami, FL 33173 Phone: 786-245-6100 www.gallowaysurgerycenter.com

To schedule your colon cancer screening, please call 786-245-6100

Do you or someone you care about suffer from heartburn? Can you read the signs correctly to determine if your heartburn is just that, and nothing more serious? Difficulty swallowing. Heartburn. Sore throat. Regurgitation. Acid reflux. Chronic coughing. GERD. All of these are consistent with Barrett’s esophagus – a condition that is often a precursor to the most rapidly rising form of cancer in the U.S. The good news is that it is easily diagnosed and, if found early enough, treatments are easy, non-invasive and relatively painless. Take control of your health and ask your Doctor about your risk for developing Barrett’s esophagus and treatment options. to progress to cancer. To learn more, visit curebarretts.com.