Gastroenterology

The surprising risks of long-term proton pump inhibitor use

Meds
June 18, 2023

A lot of my patients take proton pump inhibitors (PPIs). They generally work pretty well for their intended use. By limiting the secretion of gastric acid from the stomach, they can effectively blunt uncomfortable symptoms of erosive gastritis, gastroesophageal reflux disease, H. pylori infection, and peptic ulcers. However, without further evaluation, these medications are not designed to be prescribed indefinitely, or for more than a two-month period. When patients experience …

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A unique method for managing chronic bowel conditions, treating fecal impaction, and preparing for colonoscopy procedures

Conditions
May 20, 2023

Fecal impaction and severe chronic constipation can have significant consequences on patients’ mortality, morbidity, psychosocial well-being, and health care costs. It is especially prevalent among the elderly and individuals with neurogenic bowel disorders. The condition can lead to life-threatening complications like bowel obstruction, intestinal perforation, fecal incontinence, and urinary retention.

Traditional treatments for fecal impaction and severe constipation include lifestyle changes, fiber supplementation, laxatives, suppositories, enemas, and digital stimulation. However, …

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How healthism and moralizing health are costing us too much [PODCAST]

Podcast
May 6, 2023
YouTube video

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In this episode, we will be joined by Kristen L. Cole, an assistant professor of communication studies. Kristen shares her personal journey with Crohn’s disease and how the pressure to control her health led her to accumulate …

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Why poor diets are contributing to a surge in colorectal cancer cases among young people

Conditions
April 26, 2023

An alarming trend has emerged in my medical practice in recent years: I’m seeing more and more young adults with colorectal cancer.

When I began practicing as a family physician 21 years ago, I never saw patients in their 40s and 50s with the disease, much less ones in their 30s. Now, I diagnose two to three people in those age groups every year.

On the heels of National Colorectal Cancer Awareness …

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Why skipping your colonoscopy could be a deadly mistake

Conditions
January 31, 2023

I have to respond to and correct the recent article and podcast about a doctor having his first colonoscopy in his late 60s without anesthesia. There were multiple factual errors and misstatements by the doctor author, which may well dissuade doctors and laypeople from colonoscopies in the future.

First, he notes the reason he’s thus far not had a colonoscopy: he has no family history, and he’s athletic and overall …

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A physician’s remedy for stress, anxiety, depression, and burnout [PODCAST]

Podcast
November 28, 2022
YouTube video

Subscribe to The Podcast by KevinMD. Catch up on old episodes!

“My own burnout episode forced me into some heavy-duty soul-searching and serious reflection. I got lost in the world of seeing as many patients as possible, battling for more operating room time, and keeping up procedure volumes, …

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How the mind-gut connection affects total health

Conditions
October 7, 2022

As a colorectal surgeon, I address complex intestinal issues with state-of-the-art interventions. Fortunately for most people, the key to a healthy digestive system isn’t that complicated. A proper diet, regular exercise, and stress reduction all help create a healthier and happier gut.

The “mind-gut connection” influences how you think and feel. Imagine a marathon runner nervous at the start of a race who runs to the bathroom first. Or how a …

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I’m a doctor who just had his first colonoscopy in my 60s — without anesthesia

Conditions
September 23, 2022

Well, I am that family physician and geriatrician who is now almost 70 years old. And I cannot believe it because, in some ways, I am still like 27 years old!

First of all, I’m very healthy, and I’m lucky that nobody in my family had colon cancer or any cancer. Most of my relatives lived into the late 80s, and my grandmother and my grand grandfather lived to the ripe …

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Drawing the line on unnecessary medical tests

Physician
September 2, 2022

How much medical uncertainty can you tolerate? Most patients have not given much thought to this consequential issue, but it hovers over them in their doctors’ offices. This is also an issue for medical professionals. Indeed, how both sides in the doctor-patient relationship navigate this will be instrumental in choosing the path forward.

Medicine is not mathematics. It’s a murky discipline with incomplete data and moving targets. Many of your symptoms …

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Why are women leaving medicine? Gaslighting.

Physician
July 22, 2022

Not a week goes by that I don’t have a conversation with an amazingly successful women physician who states: “I’m thinking of quitting.” They are succeeding in all their goals: leadership, family, practice improvement, the highest level of patient care, contributing meaningful research and/or teaching, and even getting some homemade muffins or a bottle of cherry wine from patients on occasion.

Why would someone in this situation feel so dissatisfied to …

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Are you guilty of anchoring bias?

Physician
June 30, 2022

As doctors, we have all been guilty of anchoring bias, which means we put too much weight on the first complaint. When a patient presents to the clinic with a complaint that sounds vaguely like a headache due to a sinus infection, we whip out the script pad and write a script for Augmentin. We tell them to return if they are not better in two days. That latter statement …

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The epidemic of work dread

Physician
June 17, 2022

Work dread.  Even if you didn’t know it had a name, you know the feeling.  It is that sensation in the pit of your stomach when you realize that the start of your workday or workweek is fast approaching, and you don’t want it to come.  Sometimes it begins on Sunday afternoon when you want to be enjoying time with your family.  Other times, you might find yourself sitting in …

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A call to action for my medical colleagues

Conditions
May 10, 2022

Modern medicine, a system originally designed to fix acute health care problems, now creates more chronic health care problems than helping to solve them. I see the dangers of over-testing and over-prescribing taking place each day in my day-to-day pediatric clinical practice.

It scares me to see how many doctors reflexively prescribe pills designed to merely mask symptoms rather than take time to understand the underlying cause or that most chronic …

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10 colorectal pearls for Colorectal Cancer Awareness Month

Conditions
March 18, 2022

March is Colorectal Cancer Awareness Month. Share these gems with your family, friends, and patients. Take the time to reflect on your personal history and encourage yourself and others to get screened when appropriate.

1. The large intestine or the large bowel consists of the colon, rectum, and anus. The colon and rectum have a cumulative length of 150 cm or 4.9 feet.

2. Gastrointestinal contents are received from the small bowel …

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It’s time for physicians to stop taking patient calls at night

Physician
January 28, 2022

The calls started during dinner.

“I forgot to get my med refilled, and now I’m out. Can you call it in?”

“I’m reading these colonoscopy prep instructions, and I see I was supposed to stop eating seeds a week ago. Should I still take the prep?”

“I haven’t had a bowel movement in three days. What should I do?”

The calls continued during the night. As usual, there were a lot of bowel prep …

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Innovation in a rural gastroenterology practice using a farm

Physician
December 9, 2021

The cost of health care in the United States continues to rise, totaling over $3.8 trillion per year.  Gastrointestinal diseases contribute significantly to health care costs and were recently estimated to be $135.9 billion annually. Innovation in gastroenterology has traditionally focused on expensive pharmaceuticals, devices, and new procedures.  Many of the conditions and …

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How did we let insurers run health care?

Meds
November 15, 2021

How did we Americans allow health insurers to dictate how physicians practice good medicine? The hypocritic oath says, “Do no harm.” We should not allow insurance company profits to prevent proper care for patients.

Our insurer is now telling our young adult son, a Crohn’s patient (Crohn’s is not yet a curable disease), who has been in remission since he began taking Remicade over 11 years ago to switch to a …

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The pancreas of the future?

Tech
August 5, 2021

Hidden in the epigastric region of the abdomen concealed by a curtain of peritoneum is a moody, often forgettable little organ. Of course, the term organ is a somewhat generous description for this rather overqualified gland. The pancreas has its own set of rules as it mischievously lurks behind the stomach waiting for its cue for chaos.

In a moment of theatrical exaggeration, it can go from completely forgettable to a …

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