Asthma – Tailoring Treatment To Your Symptom Severity

The National Heart, Lung, and Blood Institute created recommendations for the treatments that are best for different levels of asthma severity. These recommendations also address the changes you and your health care professional should be considering.

Keep in mind that your particular treatment plan is designed to fit the symptoms you have before you start treatment. As your symptoms improve, you and your health-care provider will reassess how you feel and make any changes if needed. Please — make changes only with the advice of your doctor.

The National Heart, Lung, and Blood Institute’s recommendations are as follows:

If you have mild asthma symptoms that occur once or twice a week.

You may need to use only a reliever, such as an albuterol inhaler, on the days you are having symptoms. If you know the trigger of your asthma and if the trigger is unavoidable, you may want to use your inhaler before an exposure that you can predict. Or if you have exercise-induced asthma, you should consider taking the prescribed number of puffs before exercising.

If you have mild asthma symptoms that occur daily. 

You may need to use a reliever every day, even on good days. You may also want to use a controller every day because this can make your asthma less active and can limit how often you need to use the reliever.

If you have moderate asthma symptoms. 

You should be using an inhaled corticosteroid controller every day. This inhaled drug is the best available for reducing inflammation and controlling asthma symptoms. You also will use a reliever to help treat symptoms when they appear. Some people need a second controller, such as a long-acting airway opener, which is especially helpful for nighttime symptoms. Examples of long-acting airway opening medicines are salmeterol (Serevent), formoterol (Foradil), and the combination inhaler that pairs salmeterol with a corticosteroid (Advair). Doctors are cautious about the use of these long-acting airway openers because of a public health advisory warning that the US Food and Drug Administration issued. These inhalers may put some people at risk for having more severe or even fatal asthma flares, even though they appear to reduce the frequency of flares for most people who use them. Because problems have been rare and because the medications provide valuable symptom relief for many people, lung specialists continue to recommend these medicines to many patients, although the drugs are used with more caution.

A new type of controller, Omalizumab immunotherapy, blocks a part of your allergy response. This controller might be added if other treatments are not working for allergic asthma. Your health care professional may suggest that you try different combinations of controllers and relievers to find the medicines that work best for you. You can test these combinations by trying one for a month or so and seeing how you feel.

If you have severe asthma symptoms. 

You’ll need an intense drug regimen to improve your breathing enough so asthma doesn’t limit your activities. Be aware that your asthma is severe enough that a flare-up could put you in the hospital or threaten your life. Taking daily corticosteroid pills is the best way to control inflammation. You will probably also need to use a long-acting airway opener that acts in concert with the pills. Omalizumab immunotherapy (see above) is a treatment for allergic asthma that may be helpful. Also, you’ll be advised to use your reliever, as needed, to control symptoms.

In any of the cases, you may also try acupuncture, this alternative medicine therapy has been proven to help reduce asthma and allergy symptoms, visit AB Acupuncture to know more about how acupuncture may help you.

Alleviating Arthritis Pain With Herbs Part II

Modern medicine’s answer to arthritis relief is currently a double-edged sword. There are scores of medications to choose from, several of which have been designed for convenient once-daily dosing. These medications also have the backing of the Food and Drug Administration (FDA) which oversees years of medical research before they can be released to the general public.

The medical risks of taking these medications, unfortunately, can be serious. No prescription-based medication can claim to be free of these risks. Stomach ulcers, kidney damage, and bleeding complications are among the most commonly seen.

When looking into the possibility of taking an herbal remedy for arthritis relief, the big question should be, are these a safer alternative to modern medications? Is the effectiveness comparable?

Before we get into that, we also recommend looking into the benefits of acupuncture treatment for alleviating arthritis pain. You can learn more about this when you contact AB Acupuncture. Regular acupuncture treatment in addition to these herbal remedies could have positive effects in addressing your pain.

Now, let’s look at three different herbal remedies with both safety and effectiveness in mind.

Healers practicing Ayurvedic medicine have long used Boswellia serrata, also called Indian Frankincense, to relieve arthritic symptoms. The gummy resin collected from the Boswellia tree contains Boswellia acids which have proven anti-inflammatory properties. In comparative studies against conventional nonsteroidal anti-inflammatory drugs (NSAIDs), Boswellia was found to be safer with equal effectiveness.

Boswellia acts differently than conventional NSAIDs in that it inhibits the production of leukotrienes which are mediators in the chemical pathway that leads to inflamed joints. This means that it isn’t hard on the stomach like aspirin or NSAIDs.

The recommended dose of Boswellia is 450 milligrams of boswellic acids daily (usually 150 mg three times daily). Note, however, that the extract you buy might give the milligram strength of the whole extract, only a percentage of which will be Boswellia acids. You will need to get out your calculator to figure out how much boswellic acid you’re really getting. Why DO they always do that?!?

Personally, I think Boswellia is an excellent choice for arthritis pain relief.

Another Indian herb used for arthritis relief is turmeric, one of the main ingredients in curry powder. Ayurvedic medicine has multiple uses. As it applies to arthritic relief, turmeric is believed to inhibit prostaglandins, much in the same way as NSAIDs do. Unfortunately, the risk of stomach ulcers exists as well. The recommended dose is 500-1000 milligrams several times per day. My advice: it wouldn’t be my first choice because of the risk of stomach ulcers.

Cayenne pepper is a perfect example of an herbal product that was “rediscovered” by modern medicine and subsequently found itself on pharmacy shelves as a “modern arthritic cure”. Healthcare providers call it “capsaicin” and I’m sure it sold for a premium price when it was first released as a prescription-only product.

Capsaicin comes as a cream and fortunately a prescription is no longer needed to purchase it. The strength of the cream is 0.025% or 0.075%. It is applied 3-4 times daily to the painful joint itself.

How does it work? Well, have you ever eaten an extremely hot pepper and noticed that, after the burning subsided, your tongue was numb? The same process works in joints. For the first few days after you start the cream, the joint is supposed to burn a little and there won’t be any pain relief at all. That’s because the cayenne pepper is releasing and subsequently using up Substance P, a chemical essential to the ability to sense pain by the nerves. Once all the Substance P is depleted, the nerve is “numbed” and remains so as long as you keep applying the cream.

I like capsaicin cream. It has no side effects and can be used in combination with medications taken internally. Patience, though, is the key to its success.

Once you reach a reasonable improvement in arthritic pain, stick with the treatment and begin a gentle but persistent exercise program like water-walking, bicycling, or just plain walking. Your joints will actually feel better and you will be less likely to suffer the long-term complications of arthritis. Keep moving and good luck!

Chinese herbs


Chinese herbal medicine is one of the great herbal systems of the world and has an unbroken tradition going back to the 3rd century BC. Together with acupuncture, massage (Tuina), exercise (Tai Qi, Qi Gong), and dietary therapy it forms part of Traditional Chinese Medicine. All these treatments share the same theory and the same aim, not just to treat symptoms but to deal with underlying imbalances and to strengthen the person’s Qi to prevent a recurrence of the disease.

Chinese herbal medicine is extensively practiced throughout clinics and hospitals in China for the treatment of a very wide range of conditions. Because of its systematic approach and clinical effectiveness it has for centuries had a very big influence on the theory and practice of medicine throughout the Far East.

During its two-thousand-year history, great doctors have contributed to its store of knowledge and wisdom, and in the past few decades, a great deal of research has been done in China into every aspect of its use. The result is a subtle, powerful and flexible system.


The range of conditions that can be treated with Chinese herbs is wide, but the following may be singled out:

  • Skin problems, including eczema, psoriasis, acne, urticaria
  • Digestive disorders, including diarrhea, constipation, irritable bowel syndrome
  • Gynecological problems, including menstrual problems and pre-menstrual syndrome
  • Chronic fatigue, including ME or ‘post-viral syndrome’
  • Asthma, coughs, bronchitis
  • Hay fever, sinusitis, rhinitis
  • Urinary problems, including chronic cystitis


Chinese herbal medicine uses several hundred substances, mostly of plant origin (roots, seeds, flowers, twigs, and barks). These are hardly ever prescribed singly. They are combined into a formula that usually contains between 8 and 12 ingredients. The exact combination is adjusted to suit the patient’s individual condition and is likely to be altered as the treatment progresses to take account of changes that have occurred. It is therefore a very flexible system that can be closely tailored to the needs of the individual.

The prescribed mixture of herbs is usually prepared by the patient as a decoction (boiled and then simmered in water) and taken twice a day. Consultations will be on average once a fortnight, and you will be given enough herbs to last till the next appointment. In some cases, the herbs may be given in powder form or as pills (these are not as strong as decoctions but are more suitable in those cases where longer-term treatment is indicated). In addition, external treatments (ointments, washes, soaks) may be prescribed for skin problems.


The length of treatment will vary depending on the severity of the condition and how long you have had it. In some cases (especially with younger children) you can expect a good response in 2 to 3 weeks. For severe chronic problems, you may need to take the decoctions for 8 to 12 weeks. In certain cases, treatment may be even shorter or longer than these figures suggest. You may also consider using it in conjunction with other forms of Eastern medicine such as acupuncture.


There have been some recent concerns about the safety of certain Chinese herbal medicines. These have arisen from the inclusion of illegal ingredients by some suppliers, either banned toxic materials or ingredients such as steroids which by law can only be supplied by doctors. A good Chinese herbal medicine supplier observes the highest standards of safety and quality and is supplied exclusively by companies with a proven commitment to those standards. In addition, it can also have blood-testing facilities which will be used when appropriate as a further safety measure. Finally, a good sign is if they fully support worldwide conservation programs, and no endangered species of animal or plant is used.

Self Psychology

Self-psychology is a psychoanalytic orientation developed by the psychiatrist Heinz Kohut at the beginning of the ’60s that brings a breath of fresh air to the often inflexible and much too anchored in theories field of psychoanalysis.

Short overview:

According to Kohut, people’s problems appear when essential needs that individuals have during childhood are not being fulfilled, needs that are related to their self and not to innate sexual drives. With having such an idea, Kohut proposes a psychoanalytical system that places the patient at the core of the healing process, orienting it according to his/her needs as opposed to theories that must be applied at any cost. Self-psychology is very popular today as it continues to emphasize empathy in the therapeutic relationship as well as exploring and crediting the subjective self of those that partake in the therapeutic process.

Main concepts:

  • Self: Unlike Freud who spoke of psychic instances of the individual in terms of id, ego, and superego, Kohut proposes a new perspective over the personality of individuals. According to him, people develop 4 instances of the self or, simplified, 4 types of self: the nuclear, virtual, cohesive, and grandiose selves. They develop since the youngest of ages, interaction with others being an element that helps in shaping these selves.
  • Empathy: Being a psychoanalyst himself, Kohut saw the source of all the problems of individuals in defective childhood experiences. Most often, a lack of empathy from the part of the parents prevents the child from developing the 4 types of self and in this way accounts as the cause of pathologies that may plague adult life (Nersessian & Kopff, 1996). In therapy, individuals seek to obtain the psychoanalyst’s empathy, which helps them understand and overcome their childhood conflicts because the therapist is not only meant for a clinical approach of exploring an infantile past bombarded with sexual fantasies.
  • Selfobject: Exterior objects that children do not perceive as different from them. Examples can go from parents that are in the care of the child up to a certain toy belonging to the child or even to a specific part of the maternal body (the breast, for example). These self-objects have the purpose of assuring the child’s continuity and security, which are absolutely necessary in order for him/her to know the world and interact with it from early ages (Kohut, 2009).
  • Optimal frustration: According to Kohut, in order to develop, individuals need to have an optimal frustration level (one that is too great could become traumatic, a too-small one may not be perceived as an obstacle). The relationship with the mother has to offer optimal frustration doses from very early ages precisely for the reason to help the individual build a solid basis of the self.


Just like classical psychoanalysis, self psychotherapy continues to be in very high demand in our day. Unlike the classical psychoanalytical approaches, therapists trained in self-psychology prefer to rather “empathize” than “analyze”. A great deal of emphasis is placed on sustaining and analyzing the client from his/her point of view, which is also subjective. The therapist tries to understand how they experiment with the problems they are facing, as opposed to giving verdicts only by looking for answers in their past. If you would like to go the more traditional route, you can book an appointment at Estadt Psychological Services today.

Even though childhood remains the source of problems that lead the patient into therapy, it is interpreted in a flexible and personal manner. The applications for Kohut’s theories are useful both in resolving individual problems as well as those of couples. For the latter case, the accent falls on the way in which different instances of somebody’s self have developed and on the way in which the interaction between the selves of individuals that form a couple leads to the apparition of various problems. In the same time, the application of Kohut’s theories can be made on a cultural level, interpreting a number of works of art (books, films) as well as the relations cultivated between notorious historical figures, such as the relation between Jung and Freud (Homans, 1979).


Ulcerative Colitis

What Is It?

A number of infections and other conditions can cause the rectum to become irritated and inflamed, but few of them cause lasting symptoms. Ulcerative colitis, however, is a lifelong condition that begins with rectal inflammation and can worsen to involve much or all of the large intestine. Ulcerative colitis most often begins to cause symptoms between the ages of 15 and 40.

Research suggests that ulcerative colitis is genetic (inherited). The illness may begin with a breakdown in the lining of the intestine. Normally, the lining of the intestines keeps bacteria that normally live in the colon carefully sealed within the digestive “pipeline.” As long as the bacteria are perfectly contained, it remains invisible to your immune cells and does not provoke a reaction. When the intestine’s lining fails, bacteria that usually are harmless can activate your immune system. Ulcerative colitis is an autoimmune disease, meaning that the immune system attacks part of the body. In ulcerative colitis, cells from the immune system collect in the bowel wall and cause inflammation, injuring the bowel. Once the bowel inflammation has started, it can continue, even if the immune system stops being exposed to the bowel bacteria.

Ulcerative colitis affects the inner lining of the rectum and colon, causing it to wear away in spots (leaving ulcers), and to bleed or to ooze cloudy mucus or pus. Sometimes, other parts of the body are affected by the inflammation, including the eyes, skin, liver, back, and joints. One serious concern about ulcerative colitis is that it substantially increases the risk of colon cancer.

The disease is not contagious, even within families, so contact with another person cannot spread the disease.


The symptoms of ulcerative colitis vary. Some people with the disease have a burst of symptoms every few months. Others have symptoms either all the time or very rarely.

Typical symptoms include:

  • Cramping abdominal pain, especially in the lower abdomen
  • Bloody diarrhea, often containing pus or mucus
  • A feeling that you have little warning before you need to have a bowel movement
  • The need to wake from sleep to have bowel movements

Ulcerative colitis also may cause fever, fatigue, decreased appetite, and weight loss. It also can lead to dehydration by causing you to lose fluids.


To confirm a diagnosis of ulcerative colitis, most patients will need to have either flexible sigmoidoscopy or colonoscopy. Both procedures involve the use of a small movable camera and a light to view the insides of your large intestine. During either procedure, a biopsy may be done. In a biopsy, small samples of tissue are clipped from the lining of the intestine so that they can be examined under a microscope for signs of inflammation.

Because many temporary conditions, such as infections, cause the same symptoms as ulcerative colitis, your doctor will want to test your stool for other conditions that could explain your symptoms or make your symptoms worse. Tests for parasites and for bacterial infections will be done. Blood tests will be done to check for a low blood count or low iron levels, which can occur in ulcerative colitis. Blood tests also can help to detect inflammation. Blood tests should be done to check on your liver because inflammation of the liver ducts (called sclerosing cholangitis) occurs in some people with ulcerative colitis.

If you would like to undergo a medical assessment and figure out whether you have ulcerative colitis, contact IES Medical Group to know what options are available to you.

Expected Duration

Ulcerative colitis is a lifelong condition unless the large intestine is removed by surgery. Most people with ulcerative colitis do not choose to have their colon removed, because their symptoms can be controlled with medication or because they only have symptoms once in a while. In ulcerative colitis, the inflammation is not always active, so there can be long breaks between symptoms. Each time ulcerative colitis acts up, symptoms can occur for weeks or months. Often these flare-ups are separated by months or years of good health with no symptoms. Some people are able to identify triggers that aggravate their symptoms. By managing their diet, these people can increase the time between flare-ups.


There is no way to prevent ulcerative colitis. However, some people are able to decrease the frequency of symptoms by avoiding certain foods, such as spicy foods or milk products. If you have ulcerative colitis, you can decrease the toll the condition takes on your body by eating a well-balanced, nutritious diet. By storing up vitamins and nutrients, even between episodes of symptoms, you can decrease complications from malnutrition, such as weight loss or a low blood count.

It’s important to know that ulcerative colitis increases your risk of colon cancer. People with extensive inflammation in the whole colon have the highest risk. When the entire colon is involved, the risk of cancer can be as much as 32 times normal. About 5% of people with ulcerative colitis will develop cancer in the colon. Because of the higher cancer risk, it is important to have your colon checked frequently for early signs of cancer. If you have had ulcerative colitis affecting the entire colon for eight years or more, or if you have had just the bottom half of the colon affected for 15 years, you should start being screened regularly for cancer. One good strategy is to have a colonoscopy every one to two years.

Poor nutrition or the effect of colitis medicines can lead to osteoporosis, a disease that weakens bones and can cause bones to break. Osteoporosis can be prevented with specific medicines, as well as adequate exercise, calcium, and vitamin D. If you have ulcerative colitis, you should discuss this issue with your doctor.



Medications are very effective at improving the symptoms of ulcerative colitis. Most of the medications that are used work by preventing inflammation in the intestine.

The medicines that commonly are tried first are a group of anti-inflammatory medicines called aminosalicylates. These medicines are chemically related to aspirin, and they suppress inflammation in the gut and in joints. They are given either by mouth or directly into the rectum, as a suppository (a waxy capsule that is inserted into the rectum) or an enema (liquid that is squeezed from a bag or bottle into the rectum). Some medicines in this group include sulfasalazine (Azulfidine), mesalamine (Asacol, Pentasa, Rowasa) and olsalazine (Dipentum). These medicines clear up symptoms in most people, but you may need to be treated for three to six weeks before you are free of symptoms.

Other, more powerful anti-inflammatory medicines are helpful, but they suppress the immune system, which causes an increased risk of infections. For this reason, they are used less often for long-term treatment. These medicines include prednisone (sold under several brand names), methylprednisolone (Medrol), budesonide (Entocort), azathioprine (Imuran), mercaptopurine (Purinethol), infliximab (Remicade), and cyclosporine (Neoral, Sandimmune).

You may also be given medicines that make symptoms less painful by decreasing spasms of the colon. One example is hyoscyamine (Levsin, NuLev).

When symptoms are severe or when diarrhea causes dehydration, you may need to be admitted to the hospital to get fluids and, sometimes, nutrition intravenously (through a vein) while the colon recovers.


Surgery is used in people who have severe symptoms that are not controlled by medicines, who have unacceptable side effects from medicines, or who have a very high risk of colon cancer because of extensive inflammation in the whole colon. One of several surgeries may be used to treat ulcerative colitis, depending on the amount of colon that is affected. Either part of the colon or the entire colon can be removed. After some surgeries, bowel movements will have to leave the body through an opening called a stoma in the abdominal wall. The stoma replaces the function of the rectum and may be connected to a drainage bag. It may be used temporarily or permanently. Newer surgical techniques allow many patients to keep the layer of the rectum that contains its muscles, even though the lining of the rectum needs to be removed. This type of surgery (called ileoanal anastomosis, or pull-through surgery) has a cosmetic advantage, and it allows bowel movements to pass through the rectum and to be near normal, except that bowel movements are more frequent (usually five to six times per day) and contain more liquid.

When To Call A Professional

New or changing symptoms often mean that additional treatment is needed to keep ulcerative colitis under control. For this reason, people who have ulcerative colitis should be in frequent contact with their physicians. Common symptoms that require a doctor’s immediate attention are fever, which could indicate infection or a ruptured intestine, and heavy bleeding from the rectum. A serious, but uncommon, complication, called megacolon, results when the colon inflammation is so severe that it stops the colon’s motion. Megacolon causes the abdomen to swell, which can cause vomiting or severe abdominal pain and bloating. Megacolon requires emergency treatment.


Ulcerative colitis can affect people very differently. Many people have only mild symptoms and do not require continuous treatment with medicines. Others might require multiple medicines or surgery. Unless it is treated with surgery, this disease is a lifelong condition. Ulcerative colitis requires people to pay special attention to their health needs and to seek frequent medical care, but it does not prevent most people from having normal jobs and productive lives. As is the case for any chronic illness, it can be helpful for a person newly diagnosed with ulcerative colitis to seek advice from a support group of other people with the disease.

Management and Treatment of Acid Reflux Disease

Definition of Gastroesophageal Reflux (GERD)

Gastroesophageal reflux disease (GERD) is a digestive disorder that affects the lower esophageal sphincter – LES, (where the muscle connects the esophagus with the stomach) – causing the stomach’s contents to back-up into the esophagus.

Description of Gastroesophageal Reflux (GERD)

The esophagus is the tubelike structure that connects the mouth to the stomach. When you swallow, food and beverages are moved down the esophagus by wavelike involuntary muscle contractions to the stomach’s entrance. At that point, the muscle of the LES relaxes (opens) to let the food pass into the stomach and quickly closes again.

The backwash of stomach contents into the esophagus, commonly called reflux, occurs when the LES muscle is very weak or, more commonly, when it inappropriately relaxes causing heartburn. Heartburn is the burning sensation in the throat or chest caused by the backwash of the stomach contents (usually acidic).

GERD is extremely common, with 20 percent of all adults reporting at least weekly episodes of heartburn. Up to 10 percent of all adults complain of daily symptoms. Most patients have mild disease and few develop esophageal mucosal damage (reflux esophagitis) or more severe problems.

Causes and Risk Factors of Gastroesophageal Reflux (GERD)

Some doctors believe that a hiatal hernia may weaken the LES and cause reflux. A hiatal hernia is a defect in the diaphragm that permits a portion of the stomach to pass through the diaphragm’s opening into the chest.

Dietary and lifestyle choices may also contribute to GERD. Certain foods and beverages, including chocolate, peppermint, fried or fatty foods, and coffee or alcoholic beverages, may weaken the LES, causing reflux. Additionally, studies have shown that cigarette smoking, obesity, pregnancy, and asthma may also be associated with GERD.

Symptoms of Gastroesophageal Reflux (GERD)

The most common symptom of GERD is heartburn. Heartburn most often occurs 30 to 60 minutes after meals. The heartburn is usually intensified by eating, lying down, bending over or exercising. Patients often report relief from taking antacids or baking soda.

Additional, atypical symptoms may include regurgitation of acidic materials, chest pain, asthma, chronic cough, chronic bronchitis, chronic sore throat, morning hoarseness, swallowing difficulty, bloating, belching, nausea, and weight loss. Some patients with severe esophagitis may be almost asymptomatic.

Diagnosis of Gastroesophageal Reflux (GERD)

Medical history is most important because physical examination and laboratory tests are often normal in uncomplicated GERD. Further investigation may include upper endoscopy with biopsy (viewing the esophagus and stomach through a narrow tube and sampling a small piece of tissue) and rarely, barium studies or pH monitoring (to document abnormal acid exposure in the esophagus).

Treatment of Gastroesophageal Reflux (GERD)

Non-Surgical Treatment

For patients with mild GERD, doctors recommend simple lifestyle changes, such as quitting smoking or losing weight, dietary changes, and taking over-the-counter (OTC) antacids.

Physicians suggest eating smaller meals and avoiding acidic foods (such as tomato products, citrus fruits, spices, and coffee), fatty foods, peppermint, chocolate, and alcohol. Most importantly, it is recommended to avoid eating three (3) hours prior to bedtime or to lie down.

Elevating the head of the bed on 6-inch blocks may reduce heartburn by allowing the effect of gravity to minimize reflux of stomach contents into the esophagus at night.

Quitting smoking may also reduce the symptoms of GERD. Additionally, refrain from wearing tight clothes that put pressure on the abdomen.

Antacids may help neutralize the stomach acid and stop heartburn. Antacids have long been a mainstay of treatment of gastroesophageal reflux. These agents not only buffer acidic gastric contents but may also lower esophageal sphincter pressure by stimulating gastrin release in response to alkalization in the stomach. Alginate antacid (Gaviscon Liquid), Maalox TC, Mylanta II, and other medications, may provide relief of occasional heartburn.

When patients with mild to moderate symptoms of GERD fail to improve with lifestyle changes and antacids, the next step is to try other medications. Doctors may suggest a Histamine2 (H2) receptor antagonist, such as cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid), or nizatidine (Axid), each if which has a moderate ability to suppress acid.

Another option is to prescribe prokinetic drugs, such as cisapride (Propulsid), that helps in contracting the LES, clearing the esophagus, and enhancing gastric emptying.

If GERD is considered severe, the doctor may prescribe proton pump inhibitors, such as omeprazole and lansoprazole.

If these behavior modifications and drug therapies do not work, the doctor may recommend further testing and ultimately, surgery.

Surgical Treatment

Surgery may be warranted in patients whose medical therapy has failed, who have experienced complications or side effects with the drug treatment(s), who have had relapses of GERD, or who have been diagnosed with Barrett’s esophagus, esophageal stricture, esophageal ulcers, esophageal bleeding or a hiatal hernia.

There are two types of anti-reflux surgeries: open and laparoscopic. Laparoscopic surgery (done via tiny incisions in the abdomen) is the procedure of choice due to the reduced post-surgical recovery time. The most common laparoscopic anti-reflux surgery is called laparoscopic Nissen fundoplication. In this procedure, surgeons rebuild the upper end of the stomach into a high-pressure zone, strong enough to prevent acid juices from rising into the esophagus, but not so strong that food cannot enter the stomach.

You can also opt for a minimally invasive procedure such as esophyx transoral incisionless fundoplication, which is a 30-45 minute procedure wherein the body’s anti-reflux barrier is reconstructed in order to treat chronic acid reflux and GERD.

Questions To Ask Your Doctor About Gastroesophageal Reflux (GERD)

  • What tests need to be done to diagnose the condition?
  • How are these tests performed?
  • What is the cause of the reflux?
  • Will you be prescribing any medications?
  • What are the side effects?
  • What antacids do you recommend?
  • How often can the antacids be taken?
  • Any dietary suggestions?
  • Are there any complications to reflux?
  • Could an ulcer develop?
  • Do some herbal remedies relieve or prevent heartburn?
  • Will secondhand smoke make the condition worse?
  • Does stress increase reflux?

Insulin Reaction: What You Should Know

Insulin is used to reduce the amount of sugar in your blood. However, if your sugar level drops too low, you’ll develop the symptoms of hypoglycemia, a potentially serious condition that is most common among insulin-dependent diabetics. The problem is often called an insulin reaction. Fortunately, prompt treatment will cure it.


You can drive down your blood sugar too far by missing a meal, eating too little, eating late, or exercising more vigorously than usual without eating extra food. Hypoglycemia can also be triggered by an infection, excessive doses of insulin, alcohol, and certain medicines.


Mild signs include headache, hunger, sweating, nervousness, problems staying focused, mood changes, and weakness. Moderate signs Include heavy sweating, increasing weakness, heart palpitations, memory loss, double vision, problems walking, and numbness in the area of the mouth and (possibly) the fingers. Severe signs include Seizures, fainting, muscle twitching, and passing urine unexpectedly.


For mild hypoglycemia, you should drink a small glass of fruit juice, eat hard candy, or take a sugar tablet. A severe attack is an emergency. Make sure your family and friends know the signs and will get you to an emergency room if an attack occurs. They should call 911 or 0 (operator) for help.

If you’re at risk of hypoglycemia as a result of being diabetic, consider booking an appointment for an Endoscopic Sleeve Gastroplasty (ESG), a procedure developed to help diabetics and those who are obese eat better and lose weight. Click here to learn more.

What You Should Do

  • If you have been treated at a hospital or doctor’s office, a friend or relative will need to drive you home.
  • In the future, check your blood sugar before driving.
  • Make sure to keep your blood sugar at the level recommended by your doctor. If your blood sugar drops below this level, you must eat immediately. Call your doctor if you need more information on monitoring your blood sugar at home.
  • Take orange or apple juice, sugar, or candies if you have any symptoms of low blood sugar. If you have time, check your blood sugar first.
  • Keep sugar (such as candies) and glucagon in your car and home.
  • Warn friends and family not to make you swallow anything if you pass out.
  • Check with your doctor before you resume exercise.
  • Eat regular meals and snacks using the diet suggested by your doctor.
  • Do not drink alcohol. Alcohol may lower your blood sugar.

Call Your Doctor If…

  • Your symptoms are not relieved by eating.
  • You have repeated attacks of low blood sugar.

Seek Care Immediately If…

  1. You cannot get something to eat and you feel you are going to pass out. THIS IS AN EMERGENCY!

Patient Education: Inflammatory Bowel Disease

Inflammatory Bowel Disease (IBD) is a broader term for a group of chronic diseases that cause inflammation of the digestive tract.  The most common types of IBD are Crohn’s Disease and Ulcerative Colitis, which affect approximately 1.4 million Americans.  It is estimated that 7 out of 100,000 people in the U.S. develop Crohn’s disease, and 10 to 15 people out of 100,000 develop Ulcerative Colitis.  As many as 4 million people worldwide suffer from IBD.  There are still many unanswered questions about IBD, which is why the Northwestern IBD Center is dedicated to laboratory and clinical research studies into the causes and treatments of Crohn’s and Ulcerative Colitis. 

What causes IBD?

The exact causes of IBD are unknown.  The most recent research suggests that IBD may be caused by a problem with the body’s immune system which causes it to attack parts of the digestive tract as it would a virus or bacteria.  It also appears that there is a genetic component to IBD and that certain environmental factors may increase a person’s risk for developing Crohn’s or Ulcerative Colitis.  It’s likely that a combination of genetics and environmental triggers is what causes the immune system to malfunction in IBD.

How is IBD diagnosed?

Many times the diagnosis of IBD is difficult and time-consuming.  Making an accurate diagnosis is crucial so that a person can receive the most effective treatments.  A variety of tests are used to diagnose IBD.  These include colonoscopy, flexible sigmoidoscopy, barium x-rays, capsule endoscopy, and blood tests.  

A colonoscopy is the most definitive way to diagnose IBD.  This test is conducted at our GI Laboratory.  During this test, your doctor inserts a thin, flexible tube through the rectum to examine the tissue lining the colon.  The tube is long enough to view your entire colon, from the anus to the last part of the small intestines.  Colonoscopy allows your doctor to see any inflammation, ulcers, or other problems that may indicate IBD.  During this procedure, your doctor may also take tissue biopsies from inside the colon to test in the laboratory for certain types of cells called granulomas.  Granulomas are present in Crohn’s Disease but not Ulcerative Colitis.  This is an important way for your doctor to distinguish which form of IBD is present.

A flexible sigmoidoscopy is similar to a colonoscopy, except your doctor only views the last 2 feet of your colon and can be done in our clinic versus the GI Laboratory.  This procedure is useful for diagnosing disease in the lowest portion of the colon but does not allow your doctor to see any problems that may be higher in the colon or small intestine. 

X-rays used to diagnose IBD include a barium enema and small bowel follow-through.  These tests use barium, which is a safe dye that gives clearer x-ray images of the digestive tract.  During a barium enema, barium is placed in the colon which coats the lining and creates a silhouette of the entire large intestine.  A small bowel follow-through, or barium swallow, involves drinking a glass of barium which coats the stomach and small intestine so that parts of the digestive tract that cannot be viewed with a barium enema can be examined for any abnormalities.

Capsule Endoscopy is a newer technique used to examine the small intestines.  For this procedure, you swallow a small camera enclosed in a pill-like casing.  During the day, you wear a belt with a receiver that will capture pictures from the camera as it passes through your digestive tract.  The capsule endoscopy produces thousands of pictures that your gastroenterologist can review for ulcers, inflammation, or other abnormalities that would indicate that Crohn’s Disease is present.

Several blood tests may be used to help with diagnosing IBD.  These include checking for anemia, elevations in white blood cell counts, and changes in inflammatory markers in the body such as C-Reactive Protein (CRP) and Sedimentation Rate (ESR).  There are also specific blood tests for IBD, which look for certain antibodies in the blood that are specific to Crohn’s Disease or Ulcerative Colitis.  These tests are helpful but are not 100% accurate in diagnosing IBD.

Crohn’s Disease

Crohn’s Disease (CD) can affect anywhere from the mouth to the anus but most commonly affects the small intestine and/or colon.  It causes inflammation, deep ulcers, and scarring to the wall of the intestine and often occurs in patches.  The main symptoms are pain in the abdomen, urgent diarrhea, general tiredness, and loss of weight.  Crohn’s is sometimes associated with other inflammatory conditions affecting the joints, skin, and eyes.

The severity of symptoms fluctuates unpredictably over time.  Patients are likely to experience flare-ups in between intervals of remission or reduced symptoms.  The cause or causes of Crohn’s Disease have not yet been identified, but both genetic factors and environmental triggers are likely to be involved.

Ulcerative Colitis

Ulcerative Colitis (UC) affects the rectum and sometimes the colon (large intestine).  Inflammation and many tiny ulcers develop on the inside lining of the colon resulting in urgent and bloody diarrhea, pain, and continual tiredness.  The condition varies as to how much of the colon is affected.  In addition, Ulcerative Colitis can cause inflammation in the eyes, skin, and joints.  If the inflammation is only in the rectum, it is known as proctitis.

Like Crohn’s disease, the severity of symptoms fluctuates unpredictably over time.  Patients are likely to experience flare-ups in between intervals of remission or reduced symptoms.  The cause or causes of Crohn’s Disease have not yet been identified, but both genetic factors and environmental triggers are likely to be involved.

Microscopic Colitis

Microscopic colitis (MC) is the third type of IBD.  There are two types of microscopic colitis: collagenous colitis and lymphocytic colitis, both of which can be treated with medications. Common symptoms of MC are abdominal pain and diarrhea, but visualization of the colon via colonoscopy shows no abnormal changes or inflammation.  The physician takes biopsies of the colon, which are used to make the diagnosis of microscopic colitis.   It is thought that MC may be associated with Celiac Sprue (gluten-sensitive enteropathy).

How is IBD treated?

For both Crohn’s Disease and Ulcerative Colitis medication is the recommended form of treatment. Currently, there is no medication that can cure IBD.  The goal of medical treatment is to reduce the abnormal inflammatory response in the intestines and allow tissues to heal.  Once active symptoms such as diarrhea and pain are controlled, medications are used to reduce the frequency of flare-ups and maintain remission. In more advanced disease, surgery is often necessary. The type of operation performed and the prognosis are specific to each disease. 

The most commonly prescribed drugs for inflammatory bowel disease are:

  • Aminosalicylates (mesalamine, balsalazide, sufasalazine, osalazine). These are often used as first-line treatment in early disease.  These drugs work similarly to aspirin to reduce inflammation in the intestines. 
  • Corticosteroids (prednisone, methyloprednisone, and budesonide ). Steroids are powerful drugs that reduce inflammation in the intestines and can aid in the treatment of fistulas.  
  • Immunomodulators (6-mercaptopurine, azathiopri ne, methotrexate, tacrolimus, thalidomide). These drugs control the immune response and can help maintain remission and reduce the dose of corticosteroids.
  • Antibiotics (metronidazole and ciproflaxin). Antibiotics are helpful in patients with fissures or abscesses, particularly in disease involving the rectum or anus.
  • Anti-TNF Medication (infliximab, adalimumab).  Infliximab is a medication that suppresses a certain part of the immune system (Tumor Necrosis Factor-Alpha) and can help induce and maintain remission.  It can also aid in the treatment of fistulas.  Adalimumab is another anti-TNF medication currently being used for off-label treatment of Crohn’s Disease.

Depending on the form of IBD you are experiencing, another option is endoscopic treatment. Visit IES Medical Group to learn more about the kinds of conditions they treat and what procedures are available to you.

Other Ways to Manage IBD

Psychosocial Therapy

Patients with IBD often have psychosocial concerns directly or indirectly associated with their disease. Coping with a chronic, unpredictable disease can be extremely difficult for patients and their loved ones. People who are newly diagnosed with an IBD often feel overwhelmed with the treatment decisions they have to make and the effects the disease may have on their lifestyle. Patients who have had an IBD for a long period of time may continue to struggle with the impact the disease has on their relationships, employment, and educational goals. Addressing these issues with a health psychologist is often helpful.

Similarly, because the gastrointestinal system is highly susceptible to the consequences of stress, patients with IBD often have to be more proactive than the average person in adequately managing their day-to-day stress. Stress management techniques such as cognitive-behavioral therapy and hypnotherapy can be useful in disease management, potentially reducing one’s risk for relapse or reducing the need for certain medications.

Because we firmly believe in the importance of addressing psychosocial concerns as part of optimal IBD management, our Center employs a GI-health psychologist, Dr. Laurie Keefer, to assist with our patient’s educational & emotional needs.

Dietary Therapy

Diet and nutrition is an important aspect of living with IBD.  While it may be common to believe that the disease is either caused or cured by certain diets, data do not exist to support this idea.  It is likely, however, that diet affects symptoms and plays a small role in the underlying inflammatory process. 

IBD can interfere with digestion and the absorption of nutrients by the body, making proper nutrition important.  There is no single diet that will work for every person, so you should discuss an individual dietary plan with your physician who may recommend you see a licensed nutritionist.  A first step to identifying foods that may either help or worsen your symptoms is to keep a food diary.  A food diary can also help identify if you are receiving an adequate supply of nutrients from what you are eating.  This should include the proper intake of calories, proteins, vitamins, and other nutrients.  The most common vitamin deficiencies are vitamin B12, Folic Acid, Vitamin D, Vitamin A, Vitamin E, Vitamin K, and Calcium.  These may be affected by the disease itself or certain medications taken to treat IBD.

Nutrition is critical for IBD patients, who may become malnourished from loss of appetite, the bodily stress of chronic disease, and poor digestion of protein, fats, carbohydrates, water, and other vitamins and minerals.  Maintaining good nutrition is pivotal in the management of IBD.  Being well-nourished leads to better effects from medication and fewer growth problems, among other benefits.  Because cramping and pain may occur after eating during disease flares, there are some techniques you can use to reduce these effects:

  • Eat five small meals every 3 to 4 hours.
  • Limit your consumption of milk or dairy products if you are lactose intolerant.
  • Reduce the amount of greasy or fatty foods in your diet.
  • Reduce certain high fiber foods, such as nuts, seeds, popcorn, and some vegetables.
  • The CCFA website has a list of IBD friendly recipes that you may find helpful in planning your diet.

Some patients require nutritional support, known as enteral or total parenteral nutrition (TPN).  Enteral feedings are given via a nasogastric (NG) tube or gastrostomy tube (G-tube).  The nutrient-rich liquid formula is delivered directly into the stomach via these methods and is typically given at night while you sleep.  You are then free to eat normally if you can throughout the day knowing that the proper nutrition you require was already provided. 

TPN is used when the bowel needs to rest and not digest any food, even formula.  During TPN, a catheter is placed into a large blood vessel (usually in the chest).  TPN is more complex nutritional support than enteral nutrition and requires the supervision of a physician who is specially trained in this area.



Bariatric surgery is intended for people who are 100 pounds or more overweight (with a Body Mass Index of 40 or greater) and who have not had success with other, less risky weight loss therapies such as diet, exercise, medications, etc. In some cases, a person with a Body Mass Index (BMI) of 35 or greater and one or more co-morbid conditions may be considered for bariatric surgery.

If you’re seeking a surgical procedure done with the state-of-the-art technology with highly experienced staff, visit IES Medical Group.

Important Considerations

Bariatric surgery should not be considered until you and a doctor have looked at all other options. The best approach to bariatric surgery calls for discussion of the following with your doctor:

  1. Bariatric surgery is not cosmetic surgery and should not be thought of in any way as cosmetic surgery.
  2. Bariatric surgery does not involve the removal of adipose tissue (fat) by suction or surgical removal.
  3. The patient and doctor should discuss the benefits and risks together.
  4. The patient must commit to long-term lifestyle changes, including diet and exercise, which are key to the success of bariatric surgery.
  5. Problems after surgery may require more operations to correct them.

Complications of Bariatric Surgery

As with any surgery, there are immediate and long-term complications and risks. Your healthcare team can speak with you further about the benefits and risks. Possible risks can include, but are not limited to:

  • Bleeding*
  • Complications due to anesthesia and medications
  • Deep vein thrombosis
  • Dehiscence (separation of areas that are stitched or stapled together)
  • Infections
  • Leaks from staple lines
  • Marginal ulcers
  • Pulmonary problems
  • Spleen injury*
  • Stenosis (narrowing of a passage, such as a valve)
  • Death

* To control operative bleeding, removal of the spleen may be necessary.

According to the American Society for Bariatric Surgery 2004 Consensus Statement, the operative morbidity (complications) associated with Roux-en-Y gastric bypass in the hands of a skilled surgeon is roughly 5 percent and the operative mortality (death) is roughly 0.5 percent.26 For Laparoscopic Adjustable Gastric Banding the same consensus statement reported that in the hands of skilled surgeons, the operative morbidity is approximately 5 percent and operative mortality is approximately 0.1 percent.26

Risks and Possible Side Effects

  • Vomiting
  • Dumping syndrome
  • Nutritional deficiencies
  • Gallstones
  • Need to avoid pregnancy temporarily
  • Nausea, vomiting, bloating, diarrhea, excessive sweating, increased gas, and dizziness

Why Would I Have an Open Procedure?

In some patients, the laparoscopic or minimally invasive approach to surgery cannot be used. Here are reasons why you may have an open procedure, or that may lead your surgeon to switch during the procedure from laparoscopic to open:

  • Prior abdominal surgery that has caused dense scar tissue
  • Inability to see organs
  • Bleeding problems during the operation

The decision to perform the open procedure is a judgment call made by your surgeon either before or during the actual operation and is based on patient safety.

Easy Ways to Maintain Healthy Lifestyle


Healthy living means having a good physical health with good mental thinking and peaceful living. These days many peoples are there who face health problems which could be avoided by some healthy living. Some people have physical problem while others face mental problems. You must have heard about healthy living, but must be wondering what does it mean? Generally it means healthy weight, healthy foods and proper exercise. Doesn’t it sound simple? So making small changes in your life and taking more steps toward healthy living can be beneficial.


Proper exercise plays an imperative role

One of the biggest problems of today’s life is lack of physical activity. It is well known that physical activity is good for health but due to hectic working schedule it is ignored. Ignorance of physical activity can lead to many health problems, so it is advised to exercise regularly. It is a truth that the more you exercise the healthier you’ll be.

Even some moderate activities can make a difference in your life, so chores, walking and gardening can be good option. By just adding little movement to your life you can avoid many health problems like can reduce heart disease risk and diabetes, improve joint stability, improve range of movement, control bone mass, prevent fractures and osteoporosis, and enhance self-esteem. So if you make small changes in your daily routine it can help you to lead a healthy lifestyle.



Simple tips to move your body and eat healthy

To loss weight you can add little more activities to your life. If you cannot go for a physical structure program then start with some small things as every little bit is countable because it helps to burn calories.

Turn off the TV: Once a week turn of the TV and do some physical activities with your family which you enjoy and can add as exercise. Like play games, go for walk, or go for swimming anything could be more active then just sitting on couch.


Walk: You should walk more as walking is beneficial for health. So you can take your dog out each day, after meal talk a walk in your garden, if your office is nearby then walk to your office. These all small thing can act as good physical activity and helps your nutrition facts to maintain healthy lifestyle.

Do chores: Making your garden proper, raking leaves and sweeping floor are not vigorous exercise but can help you move while getting your house in order.


Pace while talking: While talking with your friend on phone you can pace around or do cleaning. It is a good way to keep your body moving while doing something you enjoy.


Eat more veggies: Add more veggies to your food like while eating sandwich add tomato to it, you can mix extra veggies to your pasta and so on.


Add more fruits to diet: You should consume more foods so while having your breakfast, lunch or dinner eat more fruits because they are good for healthy lifestyle.


Eat low fat foods: Switch to skim milk and eat fat free yoghurt as it is a simple way to eat fewer calories.

So here are some basic ways to maintain a healthy living. Healthy diet and proper exercise can lead to healthy life which is beneficial from every point of view like in professional life, and in personal life.

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