♪ DR. STOVER: GOOD EVENING AND WELCOME TO DOCTORS ON CALL.

I'M DR. SANDY STOVER, FACULTY MEMBER AT THE UNIVERSITY OF MINNESOTA MEDICAL SCHOOL, DULUTH CAMPUS, AND I AM YOUR HOST FOR OUR PROGRAM TONIGHT ON UPPER GI PROBLEMS, HEARTBURN, ULCERS AND GALLSTONES.

THE SUCCESS OF THIS PROGRAM IS VERY DEPENDENT ON OUR VIEWERS.

PLEASE CALL OR EMAIL YOUR QUESTIONS AND WE WILL DO OUR BEST TO ADDRESS THEM.

THE TELEPHONE NUMBERS AND EMAIL ADDRESS CAN BE FOUND AT THE BOTTOM OF YOUR SCREEN.

OUR PANELISTS THIS EVENING INCLUDE DR. ROBERT ERICKSON, A GASTROINTESTINAL SPECIALIST WITH ESSENTIA HEALTH, AND DR. STEVEN VOPAT, A GENERAL SURGEON WITH COMMUNITY MEMORIAL HOSPITAL IN CLOQUET.

VOLUNTEERS FOR THE "GREAT GARDENING" SHOW ARE ANSWERING OUR PHONES.

AND NOW ON TO TONIGHT'S PROGRAM.

IT IS GOOD TO SEE BOTH OF YOU.

THANK YOU FOR COMING.

THIS IS AN INTERESTING SUBJECT FOR THE SHOW.

I AM WONDERING IF WE CAN PUT UP OUR GRAPHIC AND WALK THROUGH THE AREA WE WILL TALK ABOUT TONIGHT.

DR. ERICKSON: WE START WITH THE GI.

IT CONSISTS OF ORGANS FROM THE MOUTH TO DIRAND RECTUM.

THE MUSCULAR STOMACH, THE SMALL INTESTINE, WHICH WE CAN'T LIVE WITHOUT.

IT HELPS TO ABSORB NUTRIENTS.

IN THE COLON, WHICH HELPS TO MAINTAIN HYDRATION.

THE TWO GLANDULAR ORGANS LIKE THE LIVER, CREATING BILE, AND THE PANCREAS TO BREAK DOWN FOOD AND INSULIN PRODUCTION.

DR. VOPAT: YOU HIT THE HIGH POINTS.

THE GALLBLADDER, A COMMON QUESTION I GET IS WHAT DOES A GALLBLADDER DO AND HOW CAN I GET ALONG WITHOUT MINE?

IT IS A RESERVOIR FOR THE BIO THE LIVER PRODUCES, AND IT MIXES IN WITH FOOD, AND IT GIVES YOU A LITTLE EXTRA BILE, BREAKING DOWN FATTY FOODS SO WE CAN DIGEST AND ABSORB THEM.

IF WE TAKE THE GALLBLADDER OUT, THE LIVER IS THERE, THE BILE DUCTS, AND PLENTY OF BIO.

-- BILE.

THE ORGAN DOES HAVE A FUNCTION, BUT ALSO AN ORGAN WE CAN THE WITHOUT.

DR. STOVER: WE WERE TALKING ABOUT THE GALLBLADDER NOT BEHAVING CORRECTLY.

WHAT SYMPTOMS MIGHT PEOPLE NOTICE?

DR. VOPAT: THE CLASSICAL SYMPTOMS ARE FATTY FOOD INTOLERANCE.

IT IS MANIFESTED BY PAIN AFTER EATING.

USUALLY THEY ARE MORE LIKELY TO CAUSE TROUBLE FROM BECAUSE THEY STIMULATE THE GALLBLADDER TO EMPTY.

THE PAIN EXISTS IN THE RIGHT UPPER ABDOMEN UNDER THE RING GAUGE -- RIB CAGE.

IT CAN RADIATE BETWEEN THE SHOULDER BLADES.

THE CLASSIC GALLBLADDER SYMPTOM IS YOU EAT A HAMBURGER AND FRENCH FRIES, AND 30 MINUTES LATER, PAIN, NAUSEA, VOMITING.

THERE IS A SPECTRUM OF SYMPTOMS PEOPLE CAN PRESENT, SOMETIMES MILD NAUSEA OR PAIN BETWEEN THE SHOULDER BLADES, BUT THE CLASSIC GALLBLADDER ATTACK IS PAIN AND NAUSEA.

DR. STOVER: I CAN PICTURE THAT BEING FATTY, BUT ARE THERE OTHER FOODS?

DR. VOPAT: ANY FOOD CAN DO IT.

FAT IS IN PLACES WE WOULD NOT EXPECT IT.

A GOOD SHARE OF PROCESSED FOODS AND FAST FOODS.

SALADS ARE FINE.

A LOT OF THAT STUFF, IT IS IN PLACES WHERE WE DON'T EXPECT IT, BUT IF YOU HAVE IN THIS BEHAVING GALLBLADDER, SOMETIMES MANY TYPES OF FOOD CAN CAUSE PAIN.

DR. STOVER: IS THERE A PROBLEM SOMETIMES THE COULD BECOME AN EMERGENCY -- THAT IT COULD BECOME AN EMERGENCY?

DR. VOPAT: YES.

OFTEN PEOPLE HAVE INTERMITTENT SYMPTOMS.

BY THE TIME PEOPLE COME IN AND SEE THEIR FAMILY DOCTOR AND GET THEIR ULTRASOUND AND GET THERE GALLSTONES DIAGNOSED AND SEE ME, THEY THINK BACK, I HAVE HAD SEVERAL SIMILAR EPISODES, BUT IT GOT BETTER, THEN DIDN'T BOTHER ME FOR SIX MONTHS.

I DID NOT GIVE IT ANOTHER THOUGHT.

OFTEN THAT IS THE CASE.

SOMETIMES THE FIRST ATTACK LANDS YOU IN THE EMERGENCY ROOM BECAUSE THE PAIN IS SO SEVERE, AND IT CAN BE IN THE CHEST AREA AND YOU'RE NOT SURE YOU ARE HAVING A HEART ATTACK.

YOU CALL 911, GO IN BY THE AMBULANCE, EKG AND ENZYMES ARE FINE, THEN THEY GET THE ALTER SOUND AND FIND THE GALLBLADDER IS INFECTED.

IN THOSE SITUATIONS, OFTEN THE PAIN DOES NOT GO AWAY UNTIL WE REMOVE THE GALLBLADDER, AND THEY CAN GO ON AND IN SEVERE CASES THEY CAN ABSCESS AND RUPTURE LIKE ABOUT APPENDIX.

DR. STOVER: WITH GALLBLADDER PROBLEMS, THE LIVER CAN BE AFFECTED.

WHAT KIND OF PROMISE CAN THE LIVER HAVE?

DR. ERICKSON: SOMETIMES WE TAKE ELEVATED LIVER TESTS, AND THEY ARE SO HIGH WE EXPECT A STONE HAS PASSED FROM THE GALLBLADDER INTO THE BILE DUCT, THEN WE PERFORM A PROCEDURE WHERE THEY CAN GO DOWN AND SEE THE STONE, REMOVE THE STONE, AND THEN THEY CAN TAKE OUT THE GALLBLADDER.

IT IS OFTEN A TEAM APPROACH.

DR. STOVER: WE HAVE A QUESTION FROM DONNA FROM DULUTH WONDERING ABOUT GALLSTONES.

IF YOU HAVE SMALL GALLSTONES, DOES THE GALLBLADDER HAVE TO BE REMOVED?

DR. VOPAT: SIZE DOES NOT MATTER.

IN FACT, SMALL ONES ARE LIKELY TO GET INTO THE BILE DUCT AND CAUSE BLOCKAGES DOWNSTREAM.

WHAT REALLY MATTERS IS PRESENCE OR ABSENCE OF SYMPTOMS.

OCCASIONALLY WE FIND GALLSTONES WHEN WE ARE LOOKING FOR SOMETHING ELSE, AND OCCASIONALLY I SEE THOSE PEOPLE IN THE OFFICE , AND I LIKE TAKING OUT GALLBLADDERS, BUT IF THEY'RE HAVING TROUBLE AND NO PAIN, I WARNED HIM ABOUT THE POTENTIAL SYMPTOMS.

IT IS FINE TO OBSERVE THEM.

ONCE PEOPLE HAVE PAIN, THE NATURAL HISTORY IS THAT USUALLY BECOME MORE SEVERE AND MORE FREQUENT.

ONCE THEY CAUSE TROUBLE, IT IS A GOOD TIME TO HAVE THE GALLBLADDER REMOVED.

DR. STOVER: WE HAVE ANOTHER QUESTION ABOUT THE LIVER.

AFTER THE GALLBLADDER IS REMOVED , CAN THE LIVER HAVE PROBLEMS?

DR. ERICKSON: THE LIVER FUNCTIONS FINE.

THE ONE ISSUE THAT CAN OCCUR SOMETIMES IS DIARRHEA, SO EXCESSIVE BILE, BUT THAT CAN BE TREATED.

THE LIVER DOES A PRETTY GOOD JOB.

DR. STOVER: ONE OTHER THINGS THAT ARE IN THAT SAME AREA ARE ULCERS IN THE STOMACH.

SOME REFER TO THAT AS HEARTBURN IS A BIG CAN YOU TALK ABOUT HOW AND ALSO IS FORMED IN THE STOMACH?

DR. ERICKSON: THERE ARE TWO GENERAL CAUSES OF ULCERS IN THE STOMACH.

ONE IS FROM A BACTERIA.

IT RESIDES IN THE MUCUS LAYER AND CREATES ENZYMES AND HELPS TO DIGEST THE MUCOSA OF THE SMALL INTESTINE, AND THE SECOND ONE THING IS THINGS SUCH AS ASPIRIN AND IBUPROFEN.

THOSE ARE TWO MAJOR CAUSES OF ULCERS IN THE STOMACH.

DR. STOVER: I KNOW YOU HAVE DONE DIAGNOSTIC THINGS FOR ULCERS, BUT CAN YOU DESCRIBE WHAT IT IS LIKE TO LOOK FOR AN ULCER?

DR. VOPAT: WE BOTH DO THESE PROCEDURES, AND BASICALLY WHAT IT IS IS A DAY SURGERY PROCEDURE .

THE ONLY PREPARATION IS TO HAVE AN EMPTY STOMACH, SO WE HAVE YOU NOT EAT BEFORE HAND.

WE START AN IV.

WE HAVE MONITORING EQUIPMENT TO WATCH THE HEART RATE, BLOOD PRESSURE, OXYGEN, THEN WE GIVE MEDICINE TO THE IV THAT STATES THEM.

WE CAN USE THE ENDOSCOPE, AND THERE IS A MONITOR THAT WE CAN SEE THE INNER WORKINGS, AND ONCE FOLKS ARE ASLEEP, WE LOOK AT THINGS, GET BIOPSIES, DO TESTS FOR BACTERIA.

IN THE EVENT OF A BLEEDING ULCER OR SOMETHING, OFTEN WE CAN INTERVENE AND CAUTERIZE THE BLEEDING VESSEL OR SOMETHING LIKE THAT, BUT FROM THE PATIENT 'S STANDPOINT, WE ARE GENEROUS WITH THE SEDATING MEDICATIONS, AND OFTEN THEY FALL RIGHT ASLEEP, AND THE NEXT THING THEY KNOW THEY ARE WAKING UP.

THE ELECTIVE PROCEDURES IS WHEN WE ARE DOING IT PRETTY QUICK, GENERALLY 10 MINUTES OR SO.

DR. STOVER: THERE IS A GOOD QUESTION ABOUT THE ESOPHAGUS.

AS YOU ARE LOOKING, YOU'RE LOOKING AT THE ESOPHAGUS AS WELL.

WHAT WOULD CAUSE A BLOCKAGE IN THE ESOPHAGUS WOULD MAKE IT DIFFICULT FOR PEOPLE TO SWALLOW?

DR. ERICKSON: YOU SLEEP ACID REFLUX FROM THE STOMACH -- USUALLY ACID REFLUX FROM THE STOMACH.

IT CAN DAMAGE THE MUCOSA OF THE ESOPHAGUS AND CAUSE ALSO RATIONS -- ALSO RATIONS THAT ULCERRATIO NS AND HAVE OTHER PROBLEMS.

ESOPHAGUS CANCER CAN CAUSE PROBLEMS.

IF YOU HAVE HEARTBURN OR PROBLEMS SWALLOWING, IT'S PROBABLY HEARTBURN, BUT BEWARE BECAUSE THERE ARE THINGS THAT CAN CAUSE OTHER PROBLEMS.

DR. STOVER: ANOTHER QUESTION ABOUT AFTER EATING AND SWALLOWING, PEOPLE COUGH UP PHLEGM.

IS THAT SERIOUS?

DR. VOPAT: OFTEN THAT IS ACID REFLUX.

IT CAN BE A REFLEX RELATED WHERE THE SECRETIONS PILEUP.

SOMETIMES IT IS A PROBLEM RELATED TO SWALLOWING IN THE THROAT, PEOPLE WHO HAVE HAD STROKES AND THINGS LIKE THAT WHO HAVE DIFFICULTY COORDINATING THEIR MUSCLES IN THE THROAT, SO WE OFTEN NEED TO DIFFERENTIATE FROM PROBLEMS IN THE THROAT THE PROBLEMS IN THE ESOPHAGUS.

THOSE OF THE TWO MAJOR AREAS WE THINK ABOUT WHEN SOMEONE COMES IN LIKE THAT.

DR. STOVER: ONE PERSON WAS WONDERING IF HICCUPS WOULD BE INVOLVED IN THE MUSCLES AS WELL?

DR. VOPAT: HICCUPS IS AN INVOLUNTARY CONTRACTION OF YOUR DIAPHRAGM.

THE NUMBER ONE CAUSE IS THE ACID REFLUX, SO OFTEN WE WILL TREAT ACID REFLUX AT THE HICCUPS GO AWAY.

DR. STOVER: WHAT KIND OF TREATMENT DO YOU START WITH WHEN YOU HAVE SOMEONE WITH REFLUX OR OTHER STOMACH PROBLEMS?

DR. ERICKSON: THE FIRST ARE SIMPLE THINGS.

WE WILL LOOK AT THEIR DIET, WATCHING THE SPICY, GRIESE FOOD.

-- GREEASY FOOD.

IT IS IMPORTANT NOT TO EAT THREE TO FOUR HOURS BEFORE YOU GO TO SLEEP, THEN ONE OF THE MAINSTAYS IS REDUCING THE AMOUNT OF ACID OR THE PRODUCT THAT IRRITATES THE ESOPHAGUS, SO WE WOULD TREATED WITH LOCKERS AND INHIBITORS.

THOSE ARE MEDICATIONS THAT REDUCE THE ACID AND HELP PEOPLE.

DR. STOVER: THERE IS ANOTHER QUESTION FROM WISCONSIN.

THEY ARE WONDERING HOW SERIOUS IS IT TO BE DIAGNOSED WITH A FATTY LIVER?

DR. ERICKSON: WE ARE SEEING AN INCREASE IN THAT, INCREASING WAIST SIZE.

15% OF THE TIME IT CAN TURN INTO A SCARRED LIVER, BUT IT IS OFTEN A HARBINGER OF OUR LIFESTYLE, AND ASSOCIATED WITH HYPERTENSION , STROKE RISK, SLEEP APNEA, SO IT IS OFTEN RELATED TO OBESITY, SO WE WILL OFTEN WORK ON A PATIENT'S WEIGHT, AND THEY CAN SEE A REDUCTION IN INCREASE IN THEIR LIFE SPAN BY REDUCING CARDIOVASCULAR RISK FACTORS IN DIABETES, SO IT IS ALL PART OF THE METABOLIC SYNDROME.

DR. STOVER: IT SOUNDS LIKE THE LIVER CAN REPAIR ITSELF IF THERE IS A BETTER DIET.

DR. ERICKSON: IT CAN TAKE A LOT OF HITS.

WE CAN HELP QUITE A BIT.

DR. STOVER: YOU MADE A COMMENT ABOUT THE DISCOMFORT WITH THE GALLBLADDER, AND JANE HAD A QUESTION ABOUT WHAT KIND OF SYMPTOMS ARE YOU THINKING THAT MIGHT MAKE PEOPLE WORRIED ABOUT THAT MIGHT BE GALLBLADDER?

DR. VOPAT: SOMETIMES IT IS DIFFICULT TO TELL.

THE TWO DISEASES CAN MIMIC ONE ANOTHER.

IF YOU'RE HAVING AN ACUTE ONSET OF PAIN, PARTICULARLY IN THE CHEST OR UPPER ABDOMEN, IF IT IS A PRESSURE-TYPE PAIN OR CRUSHING PAIN, ASSOCIATED WITH SPREADING, PAIN RADIATING INTO THE LEFT ARM, SHORTNESS OF BREATH, PARTICULARLY WITH RISK FACTORS LIKE A FAMILY HISTORY OF HEART DISEASE OR YOU ARE A SMOKER OR SOMETHING, ALL OF THOSE THINGS DESERVE A CALL TO 911 AND A TRIP TO THE EMERGENCY ROOM.

IF IT TURNS OUT THAT YOU WERE JUST HAVING A BAD GALLBLADDER ATTACK, THAT IS FINE.

YOU WILL BE OK, BUT YOU SHOULD GET AN EKG AND STUFF FIRST.

IF IT IS A MILD PAIN THAT OCCURS 30 MINUTES AFTER EATING AND IT IS NOT RELATED TO EXERTION OR ASSOCIATED WITH SHORTNESS OF BREATH, MORE NAUSEA, MORE LOCATED TO THE RIGHT UPPER ABDOMEN, IT CAN PROBABLY BE MORE REASSURING THAT THAT IS LIKELY A GALLBLADDER THING.

IF IT PASSES FAIRLY QUICKLY, YOU CAN SEE YOUR DOCTOR IN A FEW DAYS TO GET AN ULTRASOUND.

IF IN DOUBT, IT NEVER HURTS TO GO TO THE EMERGENCY ROOM.

SOMETIMES IT IS HARD TO TELL THE DIFFERENCE WITHOUT RUNNING TESTS.

DR. STOVER: I THINK THE ULTRASOUND IS ANOTHER TEST THAT MORE PEOPLE MAY KNOW ABOUT THAT IN ENDOSCOPY.

IT IS COMMON IN EMERGENCY ROOMS AND ALSO OFFICES.

THERE IS A QUESTION FROM JAN FROM DULUTH ABOUT THE ESOPHAGUS, AND WHAT CAN ONE DO WITH THAT.

DR. ERICKSON: IT IS GENERALLY ASSOCIATED WITH ACID REFLUX, MANY YEARS OF ACID IRRITATING THE LOWER ESOPHAGUS.

THE BODY REPLACES IT WITH INTESTINAL TISSUE.

IT HAS A HIGHER INCIDENCE OF CANCER, HIGHER THAN THE GENERAL POPULATION, SO WHEN WE FIND IT IN PATIENTS, THEY WILL UNDERGO SURVEILLANCE EVERY THREE YEARS TO CATCH IT EARLY WITH VARIOUS TECHNIQUES.

IF WE FIND CANCER, THEN WE CAN INTERVENE, BECAUSE THE ESOPHAGUS IS THEN, AND YOU WANT TO CATCH ANY CHANGES EARLY FROM SO THAT IS WHY YOU SURVEY THEM FOR ESOPHAGUS CANCER.

DR. STOVER: THE SYMPTOMS WOULD BE SIMILAR TO REFLUX?

DR. ERICKSON: USUALLY ACID REFLUX.

SOMETIMES THEY HAVE NO SYMPTOMS BECAUSE IT DOES NOT HAVE THE SENSATION THE NEW XHOSA DOES, BUT IT IS USUALLY AFTER YEARS OF REFLUX -- THAT NEW XHOSA DOES COME -- MUCOSA DOES.

GENERALLY MIDDLE-AGED MALES WITH LARGE WAIST WILL REQUIRE IT IF THEY'VE HAD MANY YEARS OF REFLUX.

DR. STOVER: HAVE YOU SEEN KIDS WITH ANY ISSUES RELATED TO GALLSTONES OR ESOPHAGUS OR STOMACH PROBLEMS?

DR. ERICKSON: I DON'T PRACTICE PEDIATRIC GASTROENTEROLOGY, BUT CERTAINLY CHILDREN GET G.I.

DISORDERS.

DR. STOVER: WE ARE TALKING ABOUT PREVENTION FOR SOME OF THESE THINGS AND YOU SPOKE ABOUT DIET.

COFFEE, SODA POP, OR THINGS MORE ACIDIC, THOSE KINDS OF THINGS?

DR. ERICKSON: IT IS NOT JUST HEALTHY.

WE ARE SEEING FATTY LIVER'S AND CHILDREN -- LIVERS IN CHILDREN, SO IT IS IMPORTANT TO BEGIN GOOD DIETARY HABITS EARLY AND AVOID THOSE THINGS, BECAUSE LONG-STANDING OBESITY CAN BE A REAL BURDEN ON THE BODY.

DR. STOVER: HOW ABOUT TOBACCO USE?

IS THERE AN INFLUENCE WITH TOBACCO USE?

DR. ERICKSON: IF YOU HAVE AN ULCER AND SMOKE, IT DOESN'T HEAL AS WELL.

TOBACCO USE IS NOT GOOD FOR MANY ORGANS.

THERE IS A HIGHER CANCER RISK, EVEN IN THE COOLER, NOT ONLY THE LONG, BUT THE COOL, SO ANY TYPE OF TOBACCO USE IS NOT GOOD, AND STARTING YOUNG IS NOT A GOOD IDEA.

DR. STOVER: I WILL THROW THIS ONE IN.

EXERCISE, HAS IT HELPED OUT IN TERMS OF WHAT WE ARE TALKING ABOUT?

DR. ERICKSON: EXERCISE IS ALWAYS GOOD.

IT IS REDUCTION OF THE WEIGHT.

GOOD FOR YOUR MIND.

AGAIN, HEALTHY LIVING.

DR. STOVER: MY DAD HAD A LOT OF TROUBLES WITH REFLUX, SOME PROBLEMS WITH WHERE THE ESOPHAGUS GOES INTO THE STOMACH, AND SOME PEOPLE TALK ABOUT A HIATAL HERNIA IN THAT AREA.

CAN YOU DISCUSS WHAT THAT MIGHT BE?

DR. ERICKSON: IT IS A PORTION OF THE STOMACH THAT COMES INTO THE CHEST.

THE HIGH-PRESSURE AREA WORKS WITH THE DIAPHRAGM, SPECIAL FIBERS IN THE LOWER ESOPHAGUS, BUT WHEN THAT GETS DISPLACED UP, THOSE TWO AREAS CAN WORK TOGETHER, SO THERE IS A HIGHER PROPENSITY FOR ACID COMING UP, SO THOSE PEOPLE WHO HAVE THOSE HERNIAS IN REFLUX GENERALLY HAVE IT WORSE.

DR. STOVER: WE HAVE A QUESTION ABOUT LISA STICK LIVER DISEASE -- POLY-CYSTIC LIVER DISEASE.

IS THERE SOMETHING THEY CAN TAKE?

DR. VOPAT: THAT IS A DETAILED TOPIC, BUT THERE IS NO SPECIFIC THERAPY.

DR. STOVER: THIS IS A GOOD QUESTION ABOUT OTHER MEDICATIONS THAT CAN AFFECT THE LIVER, OTHER MEDICATIONS YOU SEE THAT IF YOU USE TOO MUCH IT CAN BE HARD ON THE LIVER?

DR. VOPAT: I WOULD LIKE TO MAKE A POINT THAT WE GENERALLY SEE EVEN SOME LIVER FAILURE WITH SUPPLEMENTS AT TIMES, SO EVEN THOUGH SUPPLEMENTS ARE NATURAL MEDICATIONS, I THINK PATIENTS NEED TO BE AWARE AND CONSUMERS NEED TO BE AWARE WHAT THEY ARE BUYING AND WHAT THEY ARE TAKING, BECAUSE THE NUMBER ONE CAUSE OF ACUTE LIVER FAILURE ARE SUPPLEMENTS AND MEDICATIONS, SO YOU NEED TO BE REAL CAREFUL.

DR. STOVER: YOU HAVE SEEN PEOPLE WITH DIFFERENT MEDICATIONS THAT THEY USE FOR REASONS PRESCRIBED, AND SOMETIMES SUPPLEMENTS.

HAVE YOU HAD ANY COMBINATIONS THAT YOU HAVE NOTICED HAVE BEEN PROBLEMATIC FOR GALLBLADDER OR STOMACHS?

DR. VOPAT: I GUESS ONE OF THINGS IS ACETAMINOPHEN OR TYLENOL, A COMMON MEDICATION, AND AS LONG AS YOU TAKE IT IN MODERATION, IT IS FINE, BUT IT CAN BE DANGEROUS IF YOU OVERDOSED ON IT.

ONE OF THE THINGS THE LIVER DOES IS IT METABOLIZES A GOOD SHARE OF THE MEDICATIONS WE INGEST AND CONVERTS THEM INTO THE ACTIVE FORMS, SO A LOT OF THOSE MEDICATIONS CAN BE TOXIC, BUT I CAN'T THINK OF ANYTHING SPECIFIC I SEE OFTEN IN MY PRACTICE.

DR. STOVER: WE HAVE A QUESTION FROM JOHN FROM DULUTH WONDERING ABOUT ACID IN THE STOMACH WE NEED.

HOW MUCH IS THE RIGHT AMOUNT OF ACID?

HOW DOES THAT PLAY A ROLE IN ILLING MICROBES AND OTHER THINGS WE MIGHT SWALLOW?

DR. VOPAT: WE DON'T SPECIFICALLY MEASURE THE AMOUNT OF ACID IN THE STOMACH.

WE KNOW THAT TAKING SUPPRESSIVE MEDICATIONS CAN THEORETICALLY REDUCE B-12 AND IRON ABSORPTION.

CERTAINLY ACID IS IMPORTANT, AND IN MANY CAPACITIES, BUT WE DON'T MEASURE THE TOTAL AMOUNT OF ACID.

IT IS A GOOD QUESTION.

IN SOME OF RESEARCH SETTINGS, MAYBE, BUT NOT CLINICAL.

DR. STOVER: ONE THING WE HAVE NOT TALKED ABOUT AS MUCH IS THE PANCREAS.

THERE WAS A QUESTION ABOUT A BLOCK DUCT IMPACTING THE PANCREAS.

CAN YOU SPEAK TO HOW THAT MIGHT HAPPEN?

DR. ERICKSON: WE COMMONLY SEE GALLSTONES.

WHEN THE PANCREAS IS HAVING PROBLEMS, GENERALLY IT IS INFLAMED AND WE CALL IT PANCREATITIS.

ONE OF THE MAJOR JOBS OF THE PANCREAS IS TO SECRETE DIGESTIVE ENZYMES WHICH ARE GOOD FOR US IF THEY ARE IN OUR INTESTINES DIGESTING FOOD, BAD FOR US IF THEY ARE LEAKING OUT OF THE PANCREAS, SO OCCASIONALLY THE COMMON CAUSES FOR THAT ARE GALLSTONES, ALCOHOLISM IS A COMMON ONE, ELEVATED BLOOD LIPIDS IN SOME CASES, THEN WE SEE A CERTAIN CASE THE DOCTORS CALL IDIOPATHIC, WHERE WE CAN FIGURE OUT EXACTLY WHY, AND IT CAN RUN A SPECTRUM FROM RELATIVELY MILD DISEASE THAT WAS SETTLED ON ITS OWN, TO VERY SEVERE DISEASE THAT REQUIRES SURGERY OR AN ENDOSCOPIC PROCEDURE TO PUT A STENT IN IT.

DR. STOVER: YOU MENTIONED ALCOHOL.

DOES THAT IMPACT THE STOMACH AS WELL?

DR. ERICKSON: IT WILL CAUSE GASTRITIS OR INFLAMMATION OF THE STOMACH AND THEN BACK TO THE PANCREAS, SO EVERY WEEK WE HAVE PATIENTS IN THE HOSPITAL, HEPATITIS, THINGS AFFECTING THE LIVER, SOME MODERATION OF ALCOHOL IS VERY IMPORTANT FOR YOUR G.I.

TRACT.

OR ABSTINENCE.

DR. STOVER: MODERATION IN ALL THINGS, FATTY FOODS, ALCOHOL.

AS WE ARE THINKING ABOUT OVERALL HEALTH, IS THERE ANY OTHER THINGS YOU MIGHT WANT TO ADD?

GOOD FOOD, GOOD EXERCISE?

AND MEDICATIONS?

THE BALANCE OF EVERYTHING YOU TAKE, SUPPLEMENTS AS WELL.

DR. ERICKSON: BE GOOD TO YOUR BODY.

DR. STOVER: THAT IS GOOD.

THIS HAS BEEN FUN TALKING TO YOU.

AND REMEMBERING HOW THE WHOLE SYSTEM WORKS TOGETHER.

IT IS A COMPLEX SYSTEM.

I DO APPRECIATE IT.

DR. ERICKSON: LIKEWISE.

DR. STOVER: I WANT TO THANK YOU GUYS, DR. ROBERT ERICKSON AND DR. STEVEN VOPAT, AND OUR PHONE VOLUNTEERS FROM THE "GREAT GARDENING" SHOW.

PLEASE JOIN DR. RYAN HARDEN NEXT WEEK FOR A PROGRAM ON LYME DISEASE, RASHES, AND ACNE WHEN HIS PANELISTS WILL BE DR. HILARY REICH AND DR. PAUL SANFORD.

THANK YOU FOR WATCHING.

GOOD NIGHT.

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