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Dr. Minocha's Series on Digestive Myths & Healthy Realities       Continued .........

 

By Dr. A. Minocha,   author of  "How To Stop Heartburn: Simple Ways to Heal Heartburn and Acid Reflux" and "Natural Stomach Care: Treating and Preventing Digestive Disorders with Best of Eastern and Western Therapies"

 

DAY NO. 98 ...

Bright red blood with stools is due to hemorrhoids...

Bleeding from hemorrhoids is typically seen as streaks of blood on the side of the stools especially when straining during defecation. However, all blood with stools is not hemorrhoids. Bleeding from other anorectic conditions like anal fissure as well as bleeding from inflamed colon/rectum or cancer may mimic hemorrhoidal bleeding. Never be too sure of the source. Talk to your doctor!

 

DAY NO. 99 ...

Stress causes stomach ulcers...

IsnĂt this what most of you were always told and believed? In fact, psycotherapy used to be very popular for the treatment of ulcers in the middle of this century. However, we now understand that most ulcers are associated with stomach infection and drugs. Routine stress, if at all, plays a very minor role and that too in otherwise predisposed individual. This however needs to be distinguished from the extreme physical stress. By very sick, I mean sick enough to be requiring admission to the intensive care unit after head injury, severe burns or requiring help of respirator machines to help you with breathing etc. Under these extreme circumstances, ulcers can develop in the stomach and even cause significant problems like severe bleeding.

 

DAY NO. 100 ...

Acid in esophagus leads to problems related to food pipe only...

While heartburn is a well known symptom of abnormal acid reflux, this acid may affect parts of body other than the digestive system. It is well recognized that asthma may be caused or exacerbated by acid reflux. This may occur via the nerves connecting esophagus and breathing tubes or by aspiration of refluxing acid into the lungs. Similarly, there may be chest pain or pressure that may act and feel like angina of the heart. Frequently even the most astute physician or the patient may be unable to identify the source. Chronic cough and hoarseness is not uncommon. Polyps may be formed in the voice box (larynx).

 

DAY NO. 101 ...

All polyps go on to become cancer...

If the polyp is benign, the risk of transformation to cancer varies with its microscopic structure. In the colon, the adenoma type of polyps are considered to have malignant potential. Only a fraction of all adenoma polyps or adenomas eventually change to cancer. The risk of cancerous change depends on the size as well as sub-type of adenoma. At the time cancer is detected at one site in colon, polyps may be detected at other sites in the same colon. In general, a colon that is predisposed to developing polyps is also predisposed to development of cancer of the colon. Having said all this, there are other common types of polyps in the colon e.g. hyperplastic type. These hyperplastic polyps although very common do not increase the risk for colon cancer. It also follows from this discussion that the patients with colon adenomas may need regular follow-up colonoscopic exams for surveillance while those with hyperplastic polyps do not.

 

DAY NO. 102 ...

Barium enema is similar and equal to colonoscopy ...

Barium enema involves an x ray of colon after putting barium into the colon. On the other hand, colonoscopy is direct visualization of the inside lining of the wall of the colon. To equate these two tests is like saying a shadow of an object is equally good as seeing the actual object. Barium enema is less sensitive in detecting abnormalities especially small ones and those located in the lower most part of colon (sigmoid colon) and the rectum. In contrast to barium enema, colonoscopy also allows for an opportunity to execute diagnostic maneuvers like taking biopsy as well as perform therapeutic modalities like removal of polyps.

 

DAY NO. 103 ...

It is better if I am put to sleep during endoscopy...

Most endoscopies are performed under ˘conscious sedation÷ and are well tolerated. During such state, the patient is responsive but sedated and breaths on his own. Putting to sleep or general anesthesia is much more cumbersome, expensive and risky modality. Risk for complications outweigh any benefits of doing endoscopy under general anesthesia in most instances. Sedatives also have risk for complications like problems with heart rhythm, blood pressure and breathing etc. In fact, some experts recommend doing some types of endoscopies without any sedation at all. Many patients after conscious sedation do not have any memory of the procedure. This is related to the amnestic action of some sedatives.

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DAY NO. 104 ...

Removal of gall bladder causes cancer...

Attempts to link the removal of gall bladder (cholecystectomy) to the development of cancers in other parts of body especially colon have failed to provide any convincing linkage.

 

DAY NO. 105 ...

Alcohol intake usually leads to liver cirrhosis...

While hepatitis due to alcohol is a very common phenomenon in drinkers, the progression to chronic liver cirrhosis is relatively uncommon. Less than 20% of people who drink over 80 g of alcohol (8 oz of 86 proof whiskey) per day for periods exceeding five years develop cirrhosis of the liver. However, the amount of alcohol may vary since some women may develop cirrhosis after ingestion of only 20-40 g of alcohol per day. Other factors that influence the development of cirrhosis include deficiencies in nutrition, simultaneous intake of other drugs that may be toxic to liver and concurrent liver problems due to infections like viral hepatitis.

 

DAY NO. 106 ...

Medicines to suppress stomach acid should not be taken when drinking alcohol...

The basis for this statement has been the fact that one of the acid blockers (tagamet) has been shown to slow down the detoxification of alcohol thus giving rise to higher levels of blood alcohol for a given amount of alcohol ingested. This interaction is not true for other acid blockers. Even for tagamet, the increase in levels is so small that it is clinically insignificant. In any case, you should not be drinking and driving at the same time, whether or not you are taking acid blockers. Capish!

 

DAY NO. 107 ...

Output of loose stools excludes constipation...

In general, constipation leads to fewer stools that may be hard. Sometimes, the stools are so backed up in the colon, that a part of the hardened stool blocking the passage opens up and liquid stool may squirt around this impaction caused by hardened block of stool. Treatment involves disimpaction.

 

DAY NO. 108 ...

Aspirin like drugs (NSAIDs) cause ulcers in stomach only...

Of course, we all know that aspirin like medications or NSAIDs (non-steroidal antiinflammatory drugs) can cause ulcers in the stomach. Less appreciated is the fact that these drugs may cause ulcers in the esophagus, small intestine, colon as well as the rectum and anal canal. The ulceration by these drugs in the intestine, colon, rectum or anal canal followed by healing of the ulcers may lead to strictures or narrowing of the diameter of the lumen of the gut. On occasions, this narrowing can become significant enough to impede the movement of bowel contents downstream and require some type of therapeutic intervention. Acetaminophen (tylenol) is not included in this category of drugs.

 

DAY NO. 109 ...

I cannot take any milk products since I have lactose intolerance...

Lactose intolerance is a relative deficiency of the enzyme lactase which digests lactose present in dairy products. The degree of deficiency varies from person to person and so does the amount of dairy product he/she can tolerate. A cup of milk a day can be tolerated by most people. However, each person has to judge for himself/herself how much is tolerated. Yogurt although a dairy product is well tolerated even by lactose intolerant subjects. Frozen yogurt is less well tolerated although it is better tolerated than milk.

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.DAY NO. 110 ...

Endoscopy and liver biopsy are safe procedures...

Like someone said, ˘Surgery is only minor so long as it is performed on someone else÷. Same is true for these procedures of endoscopy and liver biopsy. I have been involved with literally thousands of these procedures. In general, it is true that these are safe procedures. But safety is a relative term. Several complications are associated with these procedures and on rare occasions may even cause death..

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DAY NO. 111 ...

Polyps in familial disorders are seen in children and young folks only...

While the familial polyp conditions are more commonly identified in children, the diagnosis may sometimes not be made until the thirties or forties. This is because some of these cases occur sporadically by mutation of the gene involved rather than inheriting a mutated gene. Oldest patient identified to have familial polyposis was diagnosed in his seventies.

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DAY NO. 112 ...

Diarrhea means loose stools...

Diarrhea is a very imprecise term and means different things to different people. Most precisely, it is defined in terms of weight of the stool. If the 24 hour stool output exceeds 200 g, person is said to have diarrhea. Others include in the definition an increase in fluidity, frequency and volume of stool output. Some patients refer to diarrhea as urgency to defecate as well as stool incontinence etc.

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DAY NO. 113 ...

Perforation (hole) of the bowel always requires surgery...

Perforation of the bowel may occur at any site of the digestive tract. It may occur due to a variety of conditions include ulcers, severe inflammation or as a result of endoscopy. Surgery is frequently required although, some patients with small perforations that seal off soon after occurrence may be managed medically.

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DAY NO. 114 ...

I can distinguish between chest pain arising in my esophagus from that of angina of my heart...

Heart and the esophagus (upper food pipe) are similar in location and have similar nerve supply. Both can be a source of chest pain. Contrary to popular belief, even among some health care professionals, it can sometimes be almost impossible for even the most astute patient or the physician to distinguish between the source of the pain. In one study of patients with longstanding angina of the heart, acid was infused into the esophagus via a catheter leading to production of chest pain. Over half the patients who developed pain thought they were having their usual anginal chest pain. This of course has tremendous medical implications especially in patients with concomitantly two sources of chest pain, both the heart and the esophagus. On top of that, it has been shown that acid reflux may via some unknown mechanisms produce reduction in blood flow to the heart, further complicating the matter.

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DAY NO. 115 ...

All patients with H. pylori infection in stomach get ulcers...

Helicobacter pylori is the type of infection of the stomach that is associated with ulcers in stomach and duodenum (first part of small bowel). However, only a minority of people who have this infection develop ulcers. Most are just walking around fine and dandy. The reasons for this are not clear. One factor that can increase your chances of ulcer associated with this infection are if you have a family history of ulcers. The knowledge about mechanisms involving H. Pylori and ulcer formation is still in its infancy but growing fast.

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DAY NO. 116 ...

I am too young (40) to get cancer...

It is true that your risk for cancer is higher as you grow older. Thus folks below 40 have much lower prevalence of colon cancer than those above 40. It therefore follows that age is not a barrier to getting cancer, only that the chances are less. I personally have seen colon cancer develop in 20 year olds. Therefore, if the warning signs of cancer are there, you must see your doctor!

 

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DAY NO. 117 ...

Diverticulitis and diverticulosis are same...

Diverticulosis means presence of diverticulae or outpouching or pockets in the wall of the bowel, usually the colon. A single outpouching is called diverticulum. If multiple, they are known as diverticula. The presence of diverticulum or diverticula is called diverticulosis. Approximately 10% of people have it by the age of 40, 30% at 60 years and the number may rise to 50-80% by the age of 80. It is rare in Asia and Africa and is called the disease of the modern civilization. The presence of these diverticula in the colon usually does not cause symptoms in as many as 90% of the patients. Occasionally, the diverticulum becomes inflamed by impaction of solid concretions of stool. This results in inflammation of the area and is known as diverticulitis. The weak bowel wall of the diverticulum may give away and result in a small perforation or a hole causing leakage of fecal material outside of bowel wall. Patients may develop pain, fever and other signs of abdominal infection. Medical treatment is effective but sometimes patients may need to go to surgery. Diverticulosis may occur less commonly in other parts of the digestive tract.

 

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DAY NO. 118 ...

Diverticulitis causes bleeding from colon...

While diverticulosis is a well known cause of massive painless bleeding, bleeding from an inflamed diverticulum or diverticulitis is rare. Recurrent bleeding due to diverticulosis may occur in 25% of cases. Occult bleeding is very rare. Thus, when a slow, intermittent and small amounts of blood loss is suspected, it is less likely to be due to diverticulosis.

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DAY NO. 119 ...

Everyone going abroad should be on antibiotics for traveler’s diarrhea...

TravellerĂs diarrhea is generally caused by bowel bacteria. It is usually a result of breakdown in sanitation techniques. The major component of prevention is dietary discretion which not only protects against travelerĂs diarrhea but also other illnesses like hepatitis. Antibacterial agents are effective for prevention but not routinely recommended. The exceptions would be the travelers going abroad on important educational or business meetings. However, this criteria is hard to justify. What is important lies in the eyes of the beholder. To me, my hard earned vacation time is the most important. Many antibacterial agents can be used for prophylaxis. The most popular is peptobismol two 300 mg tablets four times a day every day during the travel. This reduces the risk of travellerĂs diarrhea by about half. However, the use of prophylactic antibiotics can lead to a false sense of security and the traveller may not observe the required dietary precautions. Complacency can lead to acquiring infections like viral hepatitis which are not protected by prophylactic antibiotics.

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DAY NO. 120 ...

Travelers from developing countries do not develop traveler’s diarrhea when visiting the U.S...

The risk for developing travelerĂs diarrhea depends on the country of origin of the traveller and the region being visited. Thus, westerners visiting the developing countries have almost a 50% chance of developing diarrhea. The risk of travellerĂs diarrhea among visitors from developing countries to the western countries although low, does exist and may be as high as five percent.

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DAY NO. 121 ...

Traveler’s diarrhea does not occur once you arrive back home...

TravelerĂs diarrhea develops about 3 to 7 days after arrival in the host country. Thus, the symptoms may start or persist as many as 7-10 days after return from the travel. The timing of the start of illness depends upon the incubation period of the bug responsible for travelerĂs diarrhea.

                   

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DAY NO. 122 ...

Diagnosis of cancer means death sentence...

The diagnosis of cancer while scary is not uniformly bad. It depends on the location, the type of cancer and the stage in which it is detected. In fact, some cancers may be detected at a completely curable stage while others are may be so advanced as to preclude any meaningful attempts at treatment. It is for this reason that screening procedures have been recommended, e.g. screening for colon polyps and cancer.

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DAY NO. 123 ...

Polyps are always benign...

Polyp merely means a protuberance on the lining of the bowel wall. The benign or cancerous nature can only be determined by its structure as examined under the microscope. Thus the polyp may be benign or contain cancer. Similarly, some kinds of benign polyps may have a high predilection to go on to cancer in future and thus are called premalignant.

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DAY NO. 124 ...

Ischemic colitis usually requires surgery...

Ischemic colitis is inflammation of the colon as a result of reduction of blood flow to a particular segment of the colon. It is analogous to heart attack. In most cases, it is mild and resolves on conservative treatment without any sequelae. In a minority of patients, the inflammation may become life threatening and may require surgical intervention.

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DAY NO. 125 ...

Once affected, ischemic colitis keeps coming back...

Ischemic colitis occurs due to a disease process causing a reduction of blood supply to colon. It therefore seems reasonable that the attacks of ischemic colitis should keep recurring. However, what makes sense is not necessarily always true. In most cases, the attacks of ischemic colitis do not recur.

 

So folks, what do you think after having read all of the fact and fiction regarding our digestive health. Although we do not understand our digestive system completely, our understanding is much better than it used to be. There is lot of information that we know to be true and a lot more not to be so. The digestive system provides us with pleasures for the palate as well as source of nutrition to sustain life. Once it goes amuck on a chronic basis, it can be difficult to fix it. We can do a lot to protect it, service it and maintain it for a life long work. The key is learning about it and doing things that are right. In addition, if things do go wrong, it is important to make educated decisions about our digestive health care so as to minimize the problems from our technologically advanced but financially strapped and error prone health care system. Remember, knowledge is power! 

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