[Music] symptoms of GI health issues can range from Annoying to causing discomfort we're talking nausea burping bloating frequent heartburn and more in this episode of being well I'll sit down with Carl's Alicia Sledge to talk about ways to focus in on your digestive health and get it back in check when sarra Bush Lincoln opened in 1977 it was with the promise to serve the community's health care needs it has grown into a two hospital system with nearly 60 clinics that provide trusted Compassionate Care for over 50 years Horizon Health has been keeping you and your family healthy and although some things have changed Horizon Health's commitment to meet the Ever Changing needs of our community has remained the same Horizon Health 50 years strong Carl is redefining Health Care around you innovating new Solutions and offering all levels of care when and where you need it investing in technology and research to optimize Healthcare Carl with health Lions is always at the Forefront to help you thrive [Music] thank you for joining us for another episode of being well I'm your host Lacy Spence and today we are covering a topic that we covered a little bit earlier in the season but we thought it was so important we should talk about it twice we were talking about gut health and to help us further this Con this discussion we are welcoming in from Carl we've got nurse practitioner Alisha Sledge here with us welcome to being well hi thank you thank you for having of course so before we dive into this topic uh can you give us a little bit of background how did you end up in medicine so I um originally whenever I had my daughter I actually had a phenomenal nurse she was great um it made me really wanted to get into nursing so when I went in I had intentions of becoming a midwife but after doing my rotations I realized that that was not for me um I became a nurse on a med surge floor and from there transferred to digestive health and that has been my home since 2010 there you go yeah we uh we're talking about uh Midwifery this season as well very interesting field um but definitely takes a special person to do it a special person to also be doing what you're doing so as we talk about GI Health um I think maybe an okay place to start would be um when it comes to colonoscopies I think people maybe kind of Psych themselves out about it um the prep the being put under so when it comes to colonoscopy what are you looking for so what whenever we do the colonoscopy itself we're looking for any irritation so looking for any redness pops any ulcerations um a lot of people whenever they wake up after the colonoscopy they do seem to be alarmed that they've had biopsies taken so one of the things that we really want to let people know is it's common it's common biopsies are painless um it's pretty routine okay and so with that you're taking a a sample of something that maybe looked a little interesting or worrisome yeah so pops actually look um almost like uh skin tags okay yeah so anytime we see those we remove them and what are the what are the pops doing like are they obstructing flow or no so um not always I mean unless they're quite large which are concerning but most of the time they're very small um but each pop carries um kind of a different risk for progressing into liver or not liver cancer sorry colon cancer depending on the number of polyps and the type of pop that will determine when you're due for a repeat colonoscopy gotcha so what if I have a history of colon cancer in my family does that change when I should be getting a first colonoscopy or absolutely so um what we typically do is age of onset in a first-degree relative so first degree is of course your parents or siblings so or child any of those diagnosed with colon cancer you look at the age of diagnosis and Rewind 10 years so if your family member was diagnosed at 45 you need to get screened at 35 okay um if I have no family history then what's that first AG well no family history and no symptoms so no symptoms is important um if you're if you're at a um if you're able to complete a colon guard then we actually order that test it's actually shipped to your home it's a stool sample so you can actually um complete that in the privacy of your home and mail it back in and at what age should I be looking into this kind of so now all screening is actually start at 45 um there's actually some evidence out there to suggest that we're going to start screening earlier possibly 40 very soon oh gotcha so definitely keep an eye out for that absolutely um moving on to gird G Rd what's it stand for and what is it so gastrosoph reflux disease that encompasses things like heartburn um regurgitation um you know most people have that typical pain in their chest but some sorry some uh women actually have atypical symptoms they don't often experience that sometimes it could be trouble swallowing or sometimes a little less frequent um episodes of heartburn in women mhm so how common is gird um actually it's estimated that over 20% of the population has gir wow that's a lot um are there certain risk factors for that or is it diet related what causes it a lot of times it's diet related but sometimes it could be a medication side effect sometimes meds increase your heartburn um obesity is a is a big one your diet you know if you eat a lot of tomato based foods it's going to definitely increase and who should be seen for gird um anyone with chronic gird you've had it for a long time um been on a PPI medication for a long time we want to see you and so this is more than just your routine I have heartburn every now and again this is absolutely yes what would you consider chronic um if you've had it for years several years and you've been on the medication some individuals are actually on medications but they still have breakthrough heartburns symptoms we want to see you um and then there's alarm symptoms so if you're having food stick in your esophagus or you're having any pain when you're swallowing we want you to come in O how would I know if I have food sticking well whenever you swallow you typically feel food stick most of the time people feel it here um so as it passes it can get lodged goodness okay so definitely a lot to be watching out for here um earlier in the season we did talk about um barretts esophagus but for folks who maybe miss the episode can you you kind of explain to people what is that so any individual who's had chronic reflux for a number of years um average person is a white male around the age of 50 um typically it is a change in the lining of the lower esophagus and so anytime you have Barett esophagus we want to scream you it is a precancerous condition from Damage Done from chronic reflux gotcha we've got a lot of things to cover here um if I want to have a colonoscopy or EGD but I fear anesthesia yeah so that is one good thing about Carl um Carl actually offers um no sedation okay so if you you have that fear or perhaps you're just curious and you want to watch on the screen and you want to see what's going on you have that opportunity okay well hey I mean Different Strokes for different folks uh there's me who's like I I prefer to be super knocked out but that's that's okay a there is a lot of uh very cool science there that I'm sure people do appreciate um moving on to fatty liver disease what is that so um fatty liver disease is simply that it is an accumulation of fat around the liver um people who typically have midw or fatty liver are those from the Midwest because we are on that Midwestern diet right so we eat things like red meat potatoes and corn and it's just not healthy for our liver so most of us do have some degree of fatty liver what we really want to get out to the community though is the fact that fatty liver can actually progress and lead to liver curosis okay so let's talk about that a little bit so um if I'm developing liver ceros how does that kind of present what am I watching out for because I feel like fatty liver isn't something that you know I'm going to be able to look into a mirror and even notice that I have in the first place so most of the time what we see is um individuals who are referred to us with these mild elevations in their liver um enzymes or perhaps they have fatty liver that was accidentally seen on an Ultra sound that's where we see it the most there's not really any symptoms of liver disease or liver therosis until you're at a decompensated state and so we really want to catch this early so if you have the risk factors um you've had an ultrasound what we really encourage is we're going to we are going to try to treat you as early as possible so if you've had that ultrasound in the past any abdominal Imaging you have fatty liver we want you to come and see us when do you typically catch it like like is it I always think ultrasound is like I know it's not just pregnancy but like do you catch it in pregnant women more or sometimes with fatty liver um patients can develop a mild abdominal ache in that right upper region of their abdomen so sometimes they have those kind of issues um what we really look for in screening if you have a history of diabetes family history of diabetes um elevated cholesterol blood pressure or if you're carrying your weight in your abdomen you likely have fat liver okay so as you're talking about scanning and testing for this um I have in my notes a fibos scan is that the kind of test you're talking about or is that something different no so a fibos scan um unfortunately I do see patients in matune and I do have to have them drive to Urbana to have this test done the test itself is uh very quick I often tell patients it's going to take five minutes but then I've had patients come back 3 minutes later and they're done very quick um you lay down on an exam Table and there is a wand with a small probe at the end and it Taps your liver 10 times and that's it very quick painless and I'm so sorry what are you testing for so what we're looking for is the amount of fat on the liver um fat is scored as mild moderate to severe it's able to tell us that measure but more importantly it's able to tell us the amount of scarring scarring is scored 0 to four four is estimated liver ceros so of course everybody wants a zero but if that Test shows a three or a four we will recommend a liver biopsy okay so with that um you said it's very quick very quick uh do you ever have people who are I guess maybe nervous to get it or nervous of their results absolutely so we try to get their results as quick as possible to them um as far as the test itself I tell them especially if they're going to make that drive from like Kohl's County to Champagne go find something fun to do um preparation for it is fasting for 4 hours so go shop go eat make it a fun day don't make it something you know traumatic it's a very quick test with great results so we do encourage everyone to get one done if they have fatty liver and so as you're talking about um diet playing a factor in it if I'm somebody who's maybe got a healthier diet and maybe not carrying weight around my midsection can I still have fatty liver absolutely so we're actually seeing more and more individuals who are of healthy weight who do have fatty liver and a lot of that we attribute to diet really so do you have any more insight on that as far as what in the diet if um is there is there a way to eat for a better fatty liver well and so we typically recommend um General GI we recommend Mediterranean diet and I feel that most people in the community sometimes when they say well it's very expensive to eat healthy we actually looked up not very long ago and it costs about $10 for a medium-sized meal from McDonald's you can actually buy an eight pack of chicken breast two heads of broccoli and a 2B bag of rice for under $20 that's a meal for an entire week so it's doable you you can do this you can eat healthy on a budget yeah well and to save people a Google if they're not familiar with uh the Mediterranean diet what does that typically look like what we want to see with that is it's limiting your red meat um we want to see those lean proteins chicken fish um you know none of the fried food processed food um High fats high sodium um we want vegetables and fruit there's not a lot of secret to it um shop in the outside aisles stay away from the inner aisles um the Mediterranean diet is healthy overall it's very low sodium it's good for most of the of the um of the of your body systems not just GI yeah uh limiting the processed food I'm sure helps as well yes absolutely absolutely gotcha so moving on to Advanced liver disease is that different than the liver curosis so that is Advanced liver liver disease is liver curosis but once you have liver curosis there's two um compensated and decompensated if you're compensated your body has done a great job of you know battling the fact that your liver is scarred and so you you kind of look at the liver like it's a filter so it's clogged but you don't have those symptoms there's no signs so your body is doing well we our goal is to keep you at that compensated State and prevent you from decompensating and then the other type was the therosis then nope the decompensated liosis that's where you'll see those signs and symptoms so you'll typically see things like yellowing of the skin arise um dark urin that looks like Coca-Cola bow movements that are clay colored light colored um abdominal fullness from fluid that accumulates um sometimes confusion swelling in the legs things like that mhm and I know that we've been talking about Di a little bit um but I also feel like a lot of people associate Liver Health with alcohol consumption can you speak to that at all I I the biggest thing that I see that we really want to push to the community is letting people know you do not have to be an alcoholic to have liver curosis okay um fatty liver itself progresses and so often times I have these these sweet patients who come in and I have to give them the UN unfortunate news that they have liver therosis and they say how did this happen to me I've never drank alcohol I've never done any drugs and then they tell their church congregation or their friends and family and they say oh I didn't know you I didn't know you had an alcohol problem so that is a big one we really want to push that you do not have to drink alcohol MH and uh as a side note as well even if you are happening to consume this and you're having liver issues please don't be afraid to reach out because of that absolutely absolutely um you know it's kind of the same as as smoking um individuals who smoke cigarettes daily that doesn't mean you're going to get lung cancer if you drink alcohol the daily that doesn't mean you're going to have liver curosis MH um moving on we've got Nash and mash what are those so um Nash is non-alcoholic Stato hepatitis that um when we say the word hepatitis we're not meaning chronic he hepatitis like he B hepsy we're meaning inflammation of the liver that's it so the Stato portion of that word just just means fat so fatty liver that has caused inflammation that is the more Progressive form that is the type that we often see progress and Lead deliver curosis We Now call it mash for metabolic Associated dysfunction um stattle hepatitis and so how do we treat mash um it is very simple unfortunately there are medications in the works that we're trying to get um FDA approval for but as of right now we don't have any medications to treat it it's lifestyle it's the Mediterranean diet um we want to see exercise um exercising 5 days a week um 30 minutes a day no two days off in a row we want to see that weight loss and does that have to be intense exercise can it just be as simple as walking not at all yep simple as walking just getting moving doing things um there was actually a study done at a point in time that had um several patients that were diagnosed with Nash um and they biopsied them at the beginning of diagnosis and biopsied them one year later in those patients that had lost 5% of their overall body weight we actually saw a significant reduction in fatty liver but no change in scarring um in those patients that lost 10% there was a big reduction in not only the fat but also the scarring so what we recommend we want to see that 10% not quick usually within the first 6 months and then maybe another 10% 6 months later mhm um with that Mediterranean diet is that kind of teaming it up with maybe a caloric deficit or maybe oh yes absolutely so we do want to see those calories go down I often challenge people to go and write out their normal diet um what they typically spend what they typically eat and then bring that in we can always take a look at it and see where they need to make those changes and so when you come across patients um have they typically seen their primary care doctor first they do um the issue sometimes though is that they've been told years ago that they had fatty liver but they just didn't think anything of it they thought this is very common and so no real followup is done but when they were first told often we say oh you got to work on diet and exercise there's no treatment we are seeing these diagnosis of non-alcoholic curosis patients increasing so it's very important right now to really get the word out that fatty liver can progress and lead to curosis so in your time in uh this field this Lane um are there any cases that come to mind where you've seen some maybe radical lifestyle changes that had a lasting impact can you talk about it well um so some of these patients what we tell them anything before liver curosis you um you can reverse it so un you know most of the time people say scarring can't change that is not the case with the liver it's actually able to regenerate cells so let's say you're at a stage three and you you know you work hard and you you follow the diet and we shouldn't really say it's a diet anymore right it's just healthy eating and daily exercise so if you're doing those things we see that 10% weight loss we can often rescan you with a fibos scan sometimes rebiopsy and we have seen a lot of patients get rid of that scarred tissue very nice uh is there ever an instance where part of my liver maybe needs to be removed um can you well once you have liver ceros no unfortunately we don't want you to have a liver bio or a liver transplant what we want is to preserve what liver function you have so by you know if your liver ceros was caused by alcohol you know of course stopping it is going to be important if it's fatty liver changing your diet and lifestyle is going to be important so if we can get you to make those changes that's what that's where we want to see you at but unfortunately some patients will turn into decompensated liver ceros and the only treatment for that is a transplant gotcha um I assume that's probably a very lengthy and strenuous process it is and unfortunately a lot of patients you know you have to be referred to an outside facility so we're looking at IU in Indianapolis Northwestern or maybe Barnes um but we do have the luxury of having a physician from Northwestern that actually comes down the first week of most months and sees patients at Carl so instead of driving all the way to Chicago to meet with them you can get established at Carl so only an hour away gotcha that would be very nice to save some time on the road for sure um in our last several minutes here uh I have to ask what do you most commonly have come through your doors we see a variety of everything um I do see a lot of liver patients but we also see pancreas so most people don't really realize that we do see pancreas patients pancreatitis um pancreatic lesions and then all forms of General GI so any swallowing issues colitis anything like that we see mhm well since we have a moment are you able to talk about either of those conditions whether it be pancreatitis or colitis or both um so a lot of the colitis it depends on what's causing it so is this inflammatory bowel disease which we actually have um nurse practitioners that are specialized in inflammatory bowel disease like ulcer of colitis or Crohn's so often when those referrals roll through we make sure to set you up with them because that's how you're going to get the best care um pancreas issues um there's a few of us other providers that are specialized in the pancreas and we have a few wonderful Physicians that are um trained in the more advanced endoscopies and that's who you're going to be established with as us um typically pancreatitis is caused by either chronic alcohol use or gall stones are the two most common causes MH um with gall stones aren't those painful not always a lot of us have them you just don't know it oh yeah how do you usually discover those is that incidentally unless um one of them happens to fall out and becomes trapped in the bod duct then you typically have pain um symptoms you may turn um a little yellow or your eyes turn yellow but most of the time um fever chills pain in that right upper quadrant things like that and we've been talking an awful lot about uh ailments that are impacting adults do some of these conditions also impact children um so we do see a lot of children with these issues um Carl actually has pediatric gastroenterologist too so in my group we see 18 and older but in anyone under the age of 18 we get the you established with pediatric GI mhm uh before we wrap up is there anything about the topic or about what you do that I didn't ask about that you think is important for the viewers to know I think the main thing is if you have those risk factors or you're having symptoms um unexplained weight loss change in bowel habits um any of the blood in the stool come and get screened get your colonoscopies completed if you don't have the risk factors complete the cola guard if you have fatty liver we want to screen you see where you're at on that scar score um and if you've had untreated um heartburn reflux for years or you are treated and you're still having symptoms we want to get you scoped and again if I'm wanting to get screened or get the col guard I'm supposed to go through you or my primary both both can handle that y gotcha um some final some final thoughts uh as your time in this field is there any uh big changes that you've seen in how people are treated advancements maybe um well as far as our patients go we have seen some big changes like even the um Colonoscopy prep um when I first got into this patients were actually having to drink a gallon and so now you're only having to put away 64 ounces so it's a lot easier um we keep making improvements all the time when we started you know screening ages of colonoscopies was 50 now we're 45 I won't be surprised at all when we reduce it much lower mhm do you think you could see it go even lower like early 30s probably is that due to the diet then or more family history or genetics genetics play a strong role and of course our environmental factors so our our diet our lifestyle things like that can play a role and of the conditions that we spoke about what's maybe the most rare That You Don't See quite as often well so there are other causes of liver curosis um as aside from alcohol and fatty liver we do see a variety of other possible causes um without going into the long term anology of it this could be due from um too much iron too much copper protein deficiencies and autoimmune causes where the body is either attacking the liver the plumbing around the liver I didn't even know that too much iron was a thing I I wish I had that problem being on the the more anemic side of things um but nurse practitioner alicious ledge thank you so much for coming and filling Us in on everything in the in the GI region we sure appreciate it abely thank you for having me of course and we want to thank our viewers for joining us for this episode of being well and we hope to see you next time Carl is redefining Healthcare around you innovating new Solutions and offering all levels of care when and where you need it investing in technology and research to optimize Healthcare Carl with Health Alliance is always at the Forefront to help you thrive for over 50 years years Horizon Health has been keeping you and your family healthy and although some things have changed Horizon Health's commitment to meet the everchanging needs of our community has remained the same Horizon Health 50 years strong when Sarah Bush Lincoln opened in 1977 it was with the promise to serve the community's health care needs it has grown into a two hospital system with nearly 60 clinics that provide trusted Compassionate Care [Music]