Podcasts about endoscopist

Endoscopist-related factors, rather than biology, are more likely to account for interval cancers in the proximal colon. New data suggest that Crohn's patients have greater risk of high-risk HPV infection and thus may benefit from anal cancer screening. New study on the factors associated with response to placebo in IBD patients has implications for clinical trial design. Research finds an association between the grade of acute on chronic liver failure and response to terlipressin and albumin in hepatorenal syndrome.

Meet the doctors, Arjun and Shobha Rayapudi! Doctors who are passionate about truth and healing. This amazing couple is an inspiration not only to their community in Newfoundland, Canada but to me as well. This is an incredible story of grit and sacrifice that has these two saving the lives of patients. You do not want to miss this and learn about what they are doing. Dr. Arjun Rayapudi is a general surgeon and a plant-based community nutritionist. He is certified by American Board of Surgery and is a Fellow of Royal College of Physicians and Surgeons of Canada. He did his surgical residency training at University of Florida and University of Illinois at Peoria after obtaining the medical degree from Rangaraya Medical College. He is working as a General Surgeon and Endoscopist at Burin Peninsula Health Care Center, located in beautiful rural Newfoundland, Canada. Dr. Shobha Rayapudi is a physician, epidemiologist, researcher, and a clinical trialist. Besides the medical degree from Rangaraya Medical College, she holds a Masters of Science degree in Epidemiology (Clinical trials and evidence synthesis) from Johns Hopkins Bloomberg School of Public Health. Working as a clinical trialist at the Johns Hopkins Center for Clinical Trials, her principle scientific interests have been on effects of nutrition in preventing and reversing chronic diseases. Along with her rocking husband, beautiful son, and veggie-loving dog, she resides in beautiful rural Newfoundland as well. You must check out their website at http://giftofhealth.org and Facebook here https://www.facebook.com/Giftofhealth.org/ I was so honored to meet and interview these two, I hope you will also enjoy this conversation. Please share this podcast with at least one person and together we can change the world. Check out my website for more help and resources http://howtohealth.org

Nadine spent 17 years working as a nurse in the ER. She holds a membership in the Emergency Nurses Association, as well as a Certified Emergency Nurse certification. During the course of her career, Nadine obtained ACLS, PALS, NALS, ENPC and TNCC certifications, honing her skills in advanced cardiac life support, neonatal advanced life support, pediatric advanced life support, and trauma. Despite this impressive background and experience, she had never been educated about celiac disease, and didn’t know what to look for until she was diagnosed herself. Nurses are in a unique position to recognize potential celiac patients and act appropriately. Though most nurses don’t have the authority to diagnose, they do have an obligation to act as patient advocates. Because celiac disease is the most underdiagnosed and misdiagnosed autoimmune disease in the world, it is important that nurses get educated about the fundamentals of celiac disease, the wide array of symptoms an undiagnosed patient may present, and how to keep celiac patients safe in and out of the hospital. Today on the podcast, the Gluten Free RN addresses nurses, explaining how celiac disease damages the GI tract, the consequences of a ravaged immune system, and the neurological nature of the disease. She also reviews the genes that indicate a predisposition to celiac disease, the best available tests for gluten sensitivity, and the need for a worldwide mass screening. This is a must-listen for medical professionals, offering an overview of the most current celiac studies and an explanation of how to approach doing research on your own. Celiac disease is on the rise and it doesn’t discriminate, so it is crucial that the nursing community get educated – STAT. What’s Discussed:  Why nurses need to employ a high index of suspicion regarding celiac disease Most undiagnosed and misdiagnosed autoimmune disease in world  The lack of training around celiac disease in the medical community Nadine was nurse for 17 years Didn’t know symptoms of celiac disease Diagnosed ‘by accident’  The celiac symptoms Nadine thought to be ‘normal’ Canker sores Intermittent constipation, diarrhea Eczema on hands Difficult time gaining weight Whole family had gas  What nurses need to know about celiac disease What it is, what it entails Symptoms may present with How to keep patients safe (in and out of hospital) How to request testing How to interpret lab results  How long it takes to receive celiac diagnosis in US 9-15 years  The restrictions of being a nurse Can’t diagnose (can recognize, treat appropriately) Can’t perform surgery Can’t prescribe meds, take patient off medication  Nadine’s experience leading up to her celiac diagnosis  Nadine’s celiac diagnosis Dermatologist diagnosed Blood test, skin biopsy negative HLA-DQ2.5 gene carrier (super-celiac category)  Why a negative blood test, skin biopsy doesn’t rule out celiac disease  Nadine’s current health  Why Nadine stopped working as an ER nurse Celiac diagnosis was life-changing Started own businesses RN On Call, Inc The Gluten Free RN Celiac Nurse Consulting  The increased prevalence of mortality in undiagnosed celiac patients Undiagnosed celiac disease associated with 4-fold increased risk of death (45 years of follow-up) Prevalence of undiagnosed celiac disease has increased dramatically in US over last 50 years  The grains that contain gluten Wheat Barley Rye Oats (cross-contamination)  The products that may contain gluten Medication Food Personal care products  The search terms to use when doing celiac research Gluten-related disorders Both spellings (celiac, coeliac)  Why celiac disease is primarily a neurological disorder Involves enteric nervous system (in intestines) Vagus nerve (superhighway of information from intestines to brain)  Why celiac disease is not an allergy Allergy is IgE-mediated antibody response Celiac tends to be IgA, IgG-mediated antibody responses  The genes that indicate a predisposition to celiac disease HLA-DQ2 HLA-DQ8  Why Nadine advocates for a world-wide mass celiac screening  The relationship between celiac disease and infertility People with infertility issues, difficulty maintaining pregnancy should be tested  The chronic nature of celiac disease Never goes away Gluten is neurotoxin Must be 100% gluten-free for life  How gluten exposure presents for Nadine Blisters in mouth within 10 minutes  How gluten can cause damage along entire length of GI tract 28 to 32 feet in length Person-to-person variability  How damage to GI tract presents Canker sores Difficulty swallowing, dysphasia GERD Eosinophilic esophagitis Gas, bloating Diarrhea constipation Crohn’s disease Atypical diseases Idiopathic diseases Ulcerative colitis Diverticulitis Diverticulosis Rectal cancer Bowel cancer Hemorrhoids  How constipation can be a neurological issue Gluten as neurotoxin can paralyze nervous system, intestines Stool cannot get pushed through Can result in colon cancer, megacolon  Disorders that may be caused by undiagnosed celiac disease Diabetes Heart problems Sudden cardiac deaths Strokes Bowel, rectal cancer (recent increase in young people)  Why a biopsy is no longer considered the gold standard of celiac testing Positive anti-tissue transglutaminase and positive EMA indicates damage to intestines Endoscopist should take six to 15 samples in duodenum, jejunum (damage can be patchy)  The stages of intestinal damage caused by celiac disease Marsh 1 – microvilli destroyed Marsh 2, 3 – villi themselves fall over, blunt or atrophy Marsh 4 – looks like hot, inflamed sponge and immune system compromised  The consequences of a damaged immune system Hypo-responsive (doesn’t respond) Hyper-responsive (reacts to everything)  The importance of including a total IgA and IgG in the celiac antibody panel Ensure patient is not IgA deficient  How the US has gone backwards in the last 70 years Times article from 1950 declares ‘cures certain in 90% of cases’ and ‘deaths rare’ Celiac disease has gone unrecognized since then  The testing for celiac disease Celiac antibody test (baseline) Small intestinal biopsy Nutritional panel (D3, B6, B12, magnesium RBC, zinc, ferritin) Follow-up to track healing, ability to absorb nutrients  The difficulty with the celiac antibody test 70% false negative  The best available celiac testing EnteroLab Gluten Sensitivity Stool Test Cyrex Laboratories Array 3  Factors that might interfere with accurate celiac testing IgA deficiency Benicar (blood pressure med) known to cause villous atrophy in absence of celiac disease Lab-to-lab variability Only tests for anti-tissue transglutaminase 2  How to carry out a clinical trial for celiac disease or gluten sensitivity Adopt gluten-, dairy-free diet for at least three months It takes six months to a year for intestines to heal Recommended for patients with genetic predisposition, regardless of negative blood test  The Paleo diet Nadine suggests for celiac and gluten-sensitive patients Whole food Meat, fish and eggs Nuts and seeds Fruits and vegetables  The findings of a celiac study published in the Journal of Insurance Medicine Atypical, non-diarrheal presentations now most frequent Celiac disease is grossly underdiagnosed in US Average delay in diagnosis for adult patients ranges from four to 11 years Diagnosis and treatment with gluten-free diet leads to improved quality of life Medical costs in celiac cohort were 31% lower over three-year period  Why celiac disease should be on every primary care physician’s differential diagnosis  The rise of celiac disease 1:501 in 1974 1:219 in 1989 1:100 is current estimate Doubles every 15 years (according to Mayo Clinic)  Why Celiac disease is a worldwide issue Affects every ethnicity Frequency of tTGA in Mexico City study was 1:37 Increasing diagnoses in North Africa, Middle East and Northern India  How celiac disease can lead to obesity Patient cannot absorb nutrients (malnourished) Body responds by storing fat for cheap energy  How the risk of cancer increases exponentially in undiagnosed celiac patients  Why nurses must be patient advocates  Nadine’s advice around research and celiac disease for nurses Not taught in nursing programs Do your own research to keep up with current info Resources: Snarky Nurses  on Instagram National Nurses in Business Association “Increased Prevalence and Mortality in Undiagnosed Celiac Disease” in Gastroenterology PubMed Cyrex Laboratories EnteroLab New York Times Article, May 1950 “Economic Benefits of Increased Diagnosis of Celiac Disease in a National Managed Care Population in the United States” in the Journal of Insurance Medicine “Celiac Disease Could be a Frequent Disease in Mexico: Prevalence of Tissue Transglutaminase Antibody in Healthy Blood Donors” in the Journal of Clinical Gastroenterology “Celiac Disease in African-Americans” in Digestive Diseases and Sciences “Coeliac Disease” in The Lancet Connect with Nadine:  Instagram Facebook Contact via Email ‘Your Skin on Gluten’ on YouTube Melodies of the Danube Gluten-Free Cruise with Nadine Books by Nadine: Dough Nation: A Nurse's Memoir of Celiac Disease from Missed Diagnosis to Food and Health Activism