Intro: Riverside Healthcare puts the health and wellness information you need well within reach.

Helen Dandurand (Host): Welcome back to the Well Within Reach podcast, brought to you by Riverside Healthcare. I'm your host, Helen Dandurand. And joining me today is Liz Deck, a Riverside internal medicine nurse practitioner, who is here to talk about digestive symptoms that you shouldn't brush off. Thanks for joining us today, Liz.

Liz Deck: Thank you for having me.

Host: Of course. So, you've been on the podcast before, but to give everyone like a refresh, could you tell us a little about yourself and your background?

Liz Deck: Certainly. I am a native kin Kankakee County person. I have practiced internal medicine as a nurse practitioner a little over 20 years now. And I'm located in Bourbonnais Internal Medicine.

Host: Great. Great. So, lots of experience and a great person to talk about the topic. So, we're talking about, like I said, digestive symptoms you shouldn't ignore. And they're really common. So, how do people know what's normal versus what's something they maybe shouldn't ignore.

Liz Deck: We always want to think about digestion, what did we just eat that maybe interfered with our digestion of going down or staying down, such as a burning sensation in the chest. And did the pain go away or was it caused by some spicy food? Are there already medications that should be consumed or taken to help prevent the symptoms? We always want to have a food history as well as a medication history. And does the pain radiate over the shoulder or does it go to the back? Does the patient still have a gallbladder? So, there's a lot of situations that we have to consider here when we look at the patient's pain. Is the pain in the center of the chest and is the patient thinking there should be heart problems that should be investigated? So, we're concerned about that and want to make sure, is there any type of heart history and to make sure it is not the heart, but truly a digestive issue.

Host: Yeah. When I thought of this topic when we were talking about it, I don't know that I even thought about heart issues. So, we're already learning something new. What are some of the specific symptoms that you hear maybe a patient casually mentioned to you that actually make you want to dig a little deeper?

Liz Deck: It depends on where that pain is. We are certainly looking at the abdomen. People describe stomach pretty generally. They don't say abdominal pain, they'll say stomach pain. Or if they don't say stomach pain, they'll say abdominal pain. We have to differentiate what are they concerned about and where? So, this is where a good physical assessment comes in. The abdomen is divided into nine quadrants or sections. And depending upon where they see their pain to be is to where we have to go after the answer. We're all built a little bit differently. So where a patient might think they are having pain in the right upper quadrant, we might think it's in the middle quadrant, again, depending upon how they are built.

The right lower quadrant, we would be concerned for appendix. Sometimes the appendix is in the back, sometimes it's on the left side. So again, is that the issue? And then, there are actual physical exam techniques to determine where we need to go next. A left lower quadrant pain, we would be concerned for diverticulosis. Has that already been diagnosed for the patient? Have they had a colonoscopy to find the diverticulosis and diverticulosis is a big word for saying outpouching of the colon. So if we have to look at an infection in the gut, that's another physical assessment to look at left lower quadrant pain. And it's not just for those patients who are above 45 who may have already had a colonoscopy, we have found diverticulitis or an infection in the colon of those little outpouching in the 20 to 30-year-old group. So, we've got to do that physical assessment and look at the proper diagnostic testing.

Host: Yeah. How is that treated?

Liz Deck: A diverticulitis is often treated with an antibiotic of what we consider to address a couple different types of organisms, both gram-positive and gram-negative organisms, which can grow in the gut.

Host: Okay, cool. And if. somebody gets that, does that mean they're kind of prone to that? Like that might spike again, that kind of thing?

Liz Deck: Yes. Yes. That can happen again. It can happen numerous times And what we want to do is certainly get that so it doesn't reoccur, and get them to digestive disease consultants to make sure they are okay and that gut hasn't flared again or what are the reasons that that's happening and do they have a family history related to digestive issues?

Host: Okay. Okay. So then, there are some symptoms like bloating, heartburn, like we just did talk about stomach pain a little bit, but like the bloating, especially in heartburn, a lot of people tend to brush them off and why would you say that people brush them off for so long?

Liz Deck: People don't want to have anything wrong with them. And that's true. We want to be pain-free, but sometimes that just doesn't happen. And we have to figure out why is that going on? Is it the type of food contributing to the bloating or is it really a problem with digestion? We have to look at our assessments of their pain, such as their position of the pain. Is there anything that provokes the pain? What's going to make it better? The quality of the pain, is it sharp pain? Is it mild pain? Is it dull pain? Where's the region? Does it radiate? Or how severe is it? Some people have tremendous pain tolerance and others have a very low pain tolerance, and it's often difficult to find that happy medium of saying, yes, you should be concerned about this pain. We have to look at the timing of the pain, the mode of onset. When did it start? When did it stop? Did it progress? And have there been previous episodes of that pain?

Host: Sounds good. So when we are talking about these things, I don't think we've really talked much yet about these issues, but constipation, diarrhea, those type of things, also happy things that go along with digestive symptoms, when do they cross the line then from annoying to, "Oh, this is a concern"?

Liz Deck: Great question. We have a lot of issues to differentiate that pain. Is it upper quadrants, middle quadrant, lower quadrants? Is it bloating? Is it heartburn? Is it stomach pain? Like you asked, where does it cross the line to be concerning? Our good history is going to help us. A big problem for many that can contribute to bloating, heartburn, stomach pain is constipation. And that is something that cannot be ignored. Many people don't understand what constipation is, so we say when you move your bowels, when you go number two, what's going to help them understand what we're talking about? That is huge. And what can contribute to that? Is it something they ate? Is it the fact that they've been constipated for more than 48 hours? Basically, we should have an elimination every 24 hours, 48 hours maybe at the most. Some people share with me, "It's been three to five days since they have gone." That is not good. These are waste products that have to be eliminated from the body. It should be a natural progression. If it doesn't happen that way, then how can we help them with that elimination so that they're not laxative dependent? Are there probiotics, prebiotics, extra vegetables, fruits that they can consume? Are they not consuming enough water?

One of the situations we pose to almost every patient is, are they drinking enough fluids? Forty-six to 60 ounces of fluid per day. We would prefer water, but we know it might be consumed of juice and milk and electrolyte fluids and coffee and tea, and many other types of liquids, and that's fine. But to make sure that is a minimum consumed, and we know we're safe for projecting that number because those are heart failure guidelines. Many people are not in heart failure to say the least. And we know that those are safe guidelines and the people who don't have those issues can certainly consume more. But that is just an unnecessary item for all of us. Our body's biggest component is fluid, and we've got to keep replenishing that.

Host: Yeah. That's why I always carry around a massive water bottle.

Liz Deck: It's a good thing to do.

Host: Yeah. All ight. We're going to take a quick break to talk about primary care at Riverside.

At Riverside, our primary care providers are right here in your community, offering personalized care for you and your family. Close to home and connected to the specialists and services you may need. Having a primary care provider means having someone who knows you, listens to you, and helps you stay well through every stage of life, from annual checkups and preventative screenings to managing everyday concerns when they pop up. Because remarkable care should never be out of reach. Remarkable care right where you live.

To find a primary care provider who's right for you and your family, visit myrhc.net/acceptingnew.

All right. And we are back. So, are there any digestive red flags that would prompt someone to call their provider immediately, like, "Oh, this might be an emergency?"

Liz Deck: Yes. Certainly, a time you would need to consult your provider immediately. is when you don't feel good enough to conduct activities of daily living. Basically not being able to stand up, sit down, lie down. Is the pain continuous? Is there a family history of a digestive issue, of a bowel disease, of something going on, chronic symptoms, pain that does not go away is a time to seek out that advice.

We ask that patients not wait until their annual exam, which might be scheduled three months from now. But certainly, make it apparent to your primary care provider. Is it a MyChart message? Is it a phone call to the office? What do you need to give to your provider to say, "I would really like to be seen. I'm having problems."

Host: Okay. How are digestive symptoms connected to things like stress, diet, sleep, and like mental health?

Liz Deck: We have more receptors in our gut than we have in our brain for anxiety and depression and stress. And that can certainly contribute to pain in any quadrant or area of the abdomen of the stomach pain. So certainly, our lives can get in the way of our digestion. And that is an important thing to understand. We also want to have previous medical history reminders that of diabetes, depression, all the medications that anybody takes has to be listed, whether they're prescription or over-the-counter. Is there a thyroid disorder going on? Any type of spinal function issues, anemia, past history of urinary tract infections, shingles, pleurisy. And pleurisy is between the lungs and the space they are in is a lack of fluid making that area a little bit noisy. It sounds like crackling newspaper. So, we want to make sure that we have ruled out many other issues related to digestive problems.

Host: Okay. So when a patient comes in bringing forward some digestive concerns for their primary care provider, what can they kind of expect from that visit?

Liz Deck: They can expect to be physically examined and if at all possible to sit on the exam table for the primary care provider to examine all their quadrants or sections for the quickest diagnosis, the most accurate. And we want to either be able to do an ultrasound if necessary, or prescribe the right medication to help alleviate the problem or to order a CAT scan if need be, and to get to the quickest diagnosis and most accurate diagnosis in the shortest amount of time to help really alleviate that problem.

Host: So if someone here is listening and they're saying, "This kind of sounds like me," what would your advice be for taking the first step, starting that conversation?

Liz Deck: We would like them to contact their primary care provider. What I have found is that many patients will Google their symptoms and they're absolutely terrified with what they find. So, we don't want them terrified, we don't want them scared. We don't want them to make their symptoms worse by finding scary things to read. So, we would like them to contact their primary care provider and, if at all possible, get in. There's the immediate care arena also locally that many patients utilize and help us out tremendously. But we really want those symptoms taken care of quickly and not be delayed, hoping to prevent further problems.

Host: Great. Well, I feel like this is a lot of good information about different digestive symptoms and diseases and things that could happen and also, you know, how to get in touch with your primary care provider and all of that. So, I feel like this has been really great. Thank you so much for being here today, Liz.

Liz Deck: Thanks for having me.

Host: Yeah, of course. And thank you listeners for tuning into the Well Within Reach podcast. Be sure to like and subscribe to well within Reach on Apple, Spotify, or wherever you get your podcasts. To learn more about services at Riverside Healthcare, go to riversidehealthcare.org.