Learning about Celiac

Celiac disease is an immune reaction to gluten, a protein found in wheat, barley, and rye.  The protein gluten can trigger an immune response in your small intestine damaging the lining.  With the loss of proper small intestinal lining,  this can cause symptoms such as diarrhea, fatigue, weight loss, bloating, and anemia.

Why does Celiac disease happen? The actual cause is unclear, but is seems to occur due to genetic and environmental factors.  If you have a first degree relative with Celiac disease, the risk of other family members to have Celiac disease is as high as 10 to 40%.  One percent of Americans have Celiac disease and 95% remain undiagnosed.

How is Celiac diagnosed? There are blood work and genetic tests that can be done to make the diagnosis. But the gold standard for diagnosis is an upper endoscopy in which a biopsy of small intestine is obtained for examination.  For an accurate diagnosis, the patient must be eating gluten for at least two weeks, otherwise the test results may be falsely negative. This is because, with a strict gluten free diet, the lining of the small intestine repairs and will appear normal.

What are the complications of Celiac disease? If one does not maintain a strict gluten free diet, the intestinal lining will remain damaged and absorption of nutrients will be affected.  Iron deficiency is something to look out for. With iron deficiency, one can become anemic.  Calcium and vitamin D malabsorption can lead to osteoporosis, as well as infertility and increased risk of miscarriage.  Damage to the lining can also affect the absorption of sugars, such as fructose, lactose, and sucrose.  People can have a greater risk of developing intestinal lymphoma and small bowel cancer.  Although rare, some people may develop disease of nerves to hands and feet.  One can also develop a rash and a blistering skin disease.

How to treat Celiac disease?
There is no cure for Celiac disease. Maintaining a strict gluten free diet is key to the management.  Common foods that contain gluten include: flour, breads, crackers, muffins, pasta, cereal, baking mixes, sauces, spices, condiments, salad dressings, some medications and vitamin supplements. Wheat additives are the most common additives in American food, thus making it very important to reading all labels and taking extra caution.  After remaining gluten free, one will notice improvement in symptoms within days or weeks. However it can also take up to two years for intestinal healing. Some patients may need medications for treatment of this condition.

Learn more about Celiac at https://celiac.org

Sports physicals: Schedule and score

The drone of a lawn mower, the warmth of the noonday sun, the smell of sunscreen and fresh cut grass – summer is here and now is the best time to schedule your child’s sports physical.  Completing the exam early in the summer allows plenty of time to follow up with a specialist, if needed, or complete any additional tests. It also prevents the rushed sensation that comes with putting off the sports physical until the day before tryouts or the first practice.

Whether you’re a seasoned veteran or a rookie, everyone can benefit from a refresher on what a sports physical includes and why they are mandatory.  A preparticipation physical evaluation, or PPE, is a great way to maximize safe participation in a sport as it can identify life-threatening medical complications as well as old injuries and conditions that may interfere with performance.

The medical history form is the most important part of a PPE.  Personal and family history and review of symptoms detect approximately 75% of conditions that restrict participation or require further evaluation.

The physical exam will include a height and weight measurement, vital signs, vision test, musculoskeletal exam and cardiac screening. Make sure your children bring their glasses or contacts for the vision portion of the exam. If any joint pain or issues arise on the physical exam, having a sports physical early in the summer allows time to formulate a plan of care emphasizing rehabilitation and injury prevention.

In addition to the PPE, parents are encouraged to schedule their student athletes for baseline ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) and Sway tests.  Done before the season begins, these tests offer baseline information which will assist practitioners in making decisions about return to play in the event of a concussion. These two tests are not covered by insurance.

Please remember, a sports physical is not a substitute for an annual exam.  It is very important to have an established relationship with a health care provider who will oversee your child’s care throughout the year.

Rush Convenient Care locations offer school and sports physicals. No appointment needed. Learn more at rushcopley.com/convenientcare.

Concussing Testing
Deepak Patel, MD, Rush Copley Medical Group family and sports medicine physician, offers ImPACT and Sway tests in Aurora and Yorkville.  The cost is $25 per test. To schedule an appointment call 630-236-4270.

Diet Therapy for IBS

Irritable bowel syndrome (IBS) is a chronic and complex disease that occurs in patients with recurring abdominal pain and changes in bowel habits. The disease can be debilitating on a person’s quality of life. We still do not understand the root cause of the disease, but I believe there are many factors. Common treatments of IBS include pharmacologic, psychologic and dietary therapies. It is important to discuss these options with your physician before embarking on a targeted therapy or combination therapies.

Some patients are interested in using diet alone to treat their illness. Aversion to pharmacologic agents and avoidance to see a psychiatrist or psychologist play a major part of this. Ingestion of food triggers may induce symptoms in more than half of patients with IBS. It has been suggested that dietary therapy may regulate the “gut-brain” signaling. Therefore, in my opinion, it is reasonable to start with dietary therapy to reduce this driving cause.  Clinical studies suggest that low FODMAP diet may improve symptoms of IBS. FODMAP stands for Fermentable Oligosaccharies, Disaccharides, Monosaccharides and Polyols. They are carbohydrates found in the diet: fructose (fruits, honey, high fructose corn syrup, etc), lactose (cow’s milk, yogurt, pudding, custard, etc), fructans (grains, onion, garlic, inulin, etc.), galactans (beans, lentils, soy products, broccoli, etc.) and polyols (sweeteners containing sorbitol, mannitol, xylitol, maltitol and fruits such as avocado, apricots, cherries, nectarines, peaches, plums, etc). FODMAPs can swell the intestine and produce gas. If one is sensitive to the effects of FODMAP, symptoms of discomfort, cramping, gas, bloating or diarrhea may occur. Low FODMAP diet may help improve pain, bowel satisfaction and quality of life. There are apps available on smart phones to help guide which foods are high or low in FODMAPs.

Some patients without Celiac disease may report a possible diagnosis of gluten sensitivity due to improvement of their symptoms while on gluten-free diet. The diagnosis of gluten sensitivity is quite challenging. The reason being is that there is no measurable indicator available to diagnose the disorder. Although there is good symptom response self-reported by patients, who are undergoing a gluten-free diet, researchers have suggested that this is likely due to reduction of fructans and other FODMAPs that may co-exist with gluten in wheat, barley, and rye. Therefore, evidence does not support a role for gluten-free as first line dietary therapy. More studies are needed to define the role of gluten-free diet in IBS and other gastrointestinal disorders.

It is also common for patients with IBS to embark on a restrictive diet to improve their symptoms. I also see this commonly done in patients with Inflammatory Bowel Disease or Functional Dyspepsia. A major concern for this is that restrictive diet may lead to nutritional deficiencies and/or weight loss that can result into worse health outcomes. Therefore, I do not recommend this dietary approach without a proper discussion and guidance with a dietitian.

A low FODMAP diet, supported by growing body of evidence, is effective in IBS but should be delivered by healthcare professionals with expertise in diet management. Further studies are also needed to prove the effectiveness of a gluten-free diet, lactose restriction or probiotics in the treatment of IBS.

Learn more about Dr. Pacana’s approach to caring for patients and schedule an appointment at www.rushcopley.com/pacana

Colonoscopy: Have No Fear

Colonoscopy is a test use to examine the lining of large bowel or colon. The instrument has a light source, and a lens attached to a video monitor. The test is used for colon cancer screening and for diagnosis of various other diseases involving the colon in patients who may have bowel symptoms like bleeding or diarrhea.

Is the test as bad as it sounds? The answer is no. Fears and misconceptions persist like “will I be able to drink the prep”, or “it may hurt”, “complication may occur”, “I am not the one who will get colon cancer.” The fact is, colonoscopy is one of the safest procedures performed by a gastroenterologist.

Each year, 150,000 new cases of colon cancer are diagnosed and 50,000 people die from it. 60% of these lives can be saved by increasing awareness for screening of colon cancer. Colonoscopy not only helps detect precancerous growths called polyps but also gives the ability to remove them there and then. This prevents colon cancer in future.

Colonoscopy may be inconvenient but it’s not painful. It takes less than 45 minutes and you are sedated during this time. Colon prep these days are split into two halves, first half is taken the night before the procedure and the other half in the morning of the procedure, making it tolerable. In fact, lower volume prep solutions are also available these days.

Chances of someone having colon cancer over their lifetime is 1 in 20 which is high. This can be prevented by timely screening. Bottom line is, do not skip out on screening. Although colonoscopy is one of the most accurate test for colon cancer screening, there are other stool based tests which you may qualify for. So, talk to your doctor and get screened today.

Snow Much Fun: Shovel Safe

This winter has been a long one for Midwesterners. Between the ice, snow, and bitter cold it seems to be never ending. But at last February is here although, it doesn’t look like the snow is over yet. Here are some things to remember before heading out to shovel this winter.

Warm up properly

Shoveling is a very physical activity. It takes a lot of lower body and core strength. Just like you warm up and stretch before you work out you should do the same for shoveling. Make sure to stretch out your legs, hips, shoulders, and back before you head out to shovel.

Dress warm/wear proper footwear

Make sure before you head out to shovel you are dressed in layers. Covering your face and hands is very important.  Wear proper shoes or boot with good treads. Having snow or ice spikes/boot grips can improve your traction and more importantly prevent a fall or injury. 

Dr. Deepak Patel shovels this driveway this winter.

Proper technique

First, make sure you pick a shovel that is the correct, weight, height, and shape. When you shovel, focus on lifting with your legs and not your back. Hold your core tight to protect your back when you are lifting the shovel. Square up your shoulders and hips to the area you are shoveling. Pivot your entire body to the move the snow instead of twisting your upper body. Shovel small amount of snow at a time to decrease the weight of the shovel. Take breaks when need to avoid fatigue causing poor form.