Tips To Avoid Ulcers with Dr. Nina Nandy - Transcript

[00:00:30] John Salak: With all the problems in the world, why would someone want to worry about ulcers? After all, since anyone can remember, we've been told that stress itself can lead to ulcers. So why do anything to increase the chances of developing them? Well, there are a few answers.

First off, stress doesn't really create ulcers. It may make them worse, but it doesn't actually cause them. More importantly, however, is that if we don't think about ulcers, and how best to avoid them, chances are a lot of us are going to get one. The number could already actually be increasing, and running past the 1 in 10 Americans that is now used as an ulcer yardstick.

Left untreated, these stomach and intestinal lesions can cause all sorts of nasty and potentially serious symptoms and dangers. Unfortunately, It's easy to overlook ulcers, or perhaps suffer through them. So how do we deal with preventing, identifying, and treating ulcers? Fortunately, we've identified an expert on this unpleasant problem, who is more than ready to open up on the ulcer issue, its causes, symptoms, treatments, and more.

So relax, and keep listening.

All right, so welcome to really the most important section of our podcast is when we get to speak with someone who knows a heck of a lot more about the subject we're talking about than I ever do. And today, obviously, we're focused on ulcers and what they are, why they're being brought about, how dangerous are, how many people get them.

And we have a wonderful guest to help explain this and give us some insights on exactly what this means for you on a health wise. And that is Dr. Nina Nandy. She is with the AGA, which she will pronounce later because I have a tough time pronouncing the full name of the association. So Dr. Nandy, welcome to our broadcast.

[00:02:22] Guest - Nina Nandy: Hey, thanks so much for having me. I appreciate it.

[00:02:24] John Salak: Okay. And do you want to just tell everybody what AGA stands for? Cause we

[00:02:28] Guest - Nina Nandy: Yeah, so I am an active member of the American Gastroenterological Association, or AGA, as well as some other GI societies, and I am a practicing gastroenterologist currently in Austin, Texas.

[00:02:42] John Salak: Before we dive into specifically the topic of ulcers, tell us what a gastroenterologist is or what their focus is.

Because it's probably wider than what we're assuming.

[00:02:52] Guest - Nina Nandy: a gastroenterologist is basically a doctor of digestive diseases. So, first we do our training in internal medicine, then we do a special fellowship and GI for three to four years. And we focus on anything from acid reflux to ulcers to, rectal bleeding, diarrhea, constipation, all that good stuff.

So not only do we deal with all the digestive health issues, we do procedures as well. Like your regular routine, screening colonoscopy, but also more advanced things like taking out gallstones or, common bile duct stones or doing feeding tubes and dilations and whatnot.

[00:03:27] John Salak: Okay, that covers a lot of really interesting stuff. And we won't get into what we discussed earlier as to why you got into this specific profession. But we do want to focus today on ulcers. Everyone has heard of ulcers. I'm not sure everyone knows what an ulcer is, why it may be dangerous, how widespread these problems are. So could you start with just telling us exactly what an ulcer is and are there different types?

[00:03:50] Guest - Nina Nandy: absolutely. So I think this is a great topic first of all, because it's so widely prevalent. It's something I talk about almost every day. So an ulcer at the most basic sense of the word, it's a sore or a lesion that can form. Usually in the lining of the digestive tract, typically in the stomach, we call those gastric ulcers or in the upper part of the small intestine, and we call those duodenal ulcers, but you know, you've probably heard of people with diabetic foot ulcers and things like that. So it's really, not limited to the GI tract. They usually happen when the protective lining of the GI tract is damaged in some way or eroded, which allows all the stomach acid and juice to irritate the sensitive tissues.

[00:04:28] John Salak: Okay. And they're in different locations, obviously, as you mentioned. Most of the time we think of them as internal in the digestive tract. are ulcers different or are they basically all the same thing but they just happen to appear in different areas? Are there different types of

[00:04:41] Guest - Nina Nandy: There's definitely different types of ulcers caused by different reasons. I think today we're mainly focusing on the GI type of ulcers. But yes, you can get ulcers, on your mouth, like aphthous ulcers, cold sores are types of ulcers. Diabetic ulcers, of course, are different types of ulcers.

[00:04:56] John Salak: So, the next obvious question is, what causes an ulcer and is stress a big driver? I know there are other reasons, but because for years it's almost been a joke you're going to stress yourself out, you're going to cause an ulcer. So what causes ulcers and is stress a contributor?

[00:05:12] Guest - Nina Nandy: This is an awesome question. The most common causes of GI ulcers, and since we're talking about GI, is H. pylori or Helicobacter pylori. That's a bacteria that infects the lining of the stomach and the small intestine, and that causes inflammation and weakening of the protective mucous layer. That's something we always test for. And the other more common Another common cause of ulcers is NSAIDs, or non steroidal anti inflammatory drugs. And those are things like aspirin, ibuprofen, naproxen, that can irritate the lining too. There are other causes like smoking and lots of alcohol, genetic factors.

There are some medical conditions that make you more prone to developing ulcers like Crohn's disease, Zollinger Ellison syndrome, other inflammatory bowel. And, that brings us back to the very. important and interesting concept of stress. So stress doesn't directly cause ulcers, but it makes behaviors and people who already have contribute to making them worse.

And it also contributes to unhealthy behaviors because when you're stressed, you might smoke or drink more or, have poor eating habits and that can certainly contribute to ulcer risk.

[00:06:22] John Salak: what about, I'm sorry, what about uncontrolled acid reflux? That's an issue that people have said relates to ulcers, and if it does or doesn't, part of this is clarifying what people need to think about, at least in this area.

[00:06:36] Guest - Nina Nandy: and I think that's a great question, too, because reflux, or GERD, as we call it, gastroesophageal reflux disease, is something I talk about every single day. It's and it doesn't directly lead to ulcers, but it can contribute to their development, lot of important ways. So first of all what is GERD? GERD acid reflux is when the stomach acid flows back up into the esophagus maybe because the lower esophageal sphincter or that flap we have that muscle is loose or other reasons can cause it and that irritates the lining of the esophagus and so over time anytime you have chronic irritation that weakens the protective barrier of the esophagus and makes it more susceptible to damage. So You know, sometimes chronic or severe cases can lead to ulceration in the esophagus. We call that erosive esophagitis. And sometimes it can lead to you maybe have heard of a condition called Barrett's esophagus, which are some precancerous changes in the lining of the stomach. Basically the cells and they start to look more like stomach cells because they can protect themselves against acid, but the esophagus wasn't meant to do that. But, Chronic exposure can sometimes cause these all sort of changes. Acid reflux, itself doesn't directly cause ulcers, but it exacerbates, it makes conditions worse that lead to ulcer formation, especially in people who are susceptible which we'll probably talk about a little bit, like, you know, who's prone to this.

[00:07:56] John Salak: Yeah, exactly. Let's just circle back a little bit to the causes. You mentioned genetics can be a cause, certainly medication or aspirin, ibuprofen I believe can be a cause. Beyond genetics, and not that isn't important, but that's almost something you can't control if you're predisposed to it.

What are the causes that can lead people to develop ulcers?

[00:08:15] Guest - Nina Nandy: So certainly anything that's going to, erode the protective lining of the stomach, any behavior that does that, which would be using NSAIDs, excessive smoking, excessive drinking. And we said medications and genetic things, but behavioral things like, uncontrolled acid reflux by eating certain foods, that are known to make, the symptoms worse. Things that can make acid reflux worse are, you know, spicy, acidic, greasy foods, that kind of thing. But that's not the same for every person, but certainly some of these behaviors, especially smoking and drinking can contribute.

[00:08:46] John Salak: there certain groups that are more at risk for developing ulcers?

[00:08:50] Guest - Nina Nandy: Yeah, so you know, that's an So there are some studies that used to show that men were maybe more at risk of developing ulcers than women. And we thought maybe estrogen was protective in some ways of, inhibiting a chronic stress response. But there are new studies that came out that, I just read one where the incidence of ulcers in women to men was three to two, and that the risk goes up as we age, because maybe we're losing some of these protective barriers in the GI tract. And historically, I think they were more in men because there were more higher rates of smoking in men, and then maybe men were more using NSAID drugs like anti inflammatory drugs for arthritis and joint pain and stuff like that.

But I think that's changed a lot.

[00:09:28] John Salak: okay. And do we know roughly how many people, and we're talking about gastro or intestinal ulcers. I don't want to screw up the terminology. How many people are suffering from ulcers?

[00:09:38] Guest - Nina Nandy: Yeah, that's a great question. So the prevalence of It's hard to say. So I would say in the United States, it's estimated that about 10 percent of people will develop some kind of gastric peptic ulcer at some point in their lives, which is a lot. And so that figure depends on, age, gender, other health conditions as well.

And sometimes a lot of this is under reported. People don't get it, sorted out, their symptoms or they don't get it. I don't really get medical attention, but it's is very common around the entire world.

[00:10:06] John Salak: Do you think Think the percentage is rising or lowering.

And I mean, you mentioned smoking as a factor. I think that's declining in the States, but rising in the third world and elsewhere um, you know, do you think that's growing, getting better or worse in terms of percentage? Or prevalence,

[00:10:21] Guest - Nina Nandy: I think it's increasing because we are more able to detect what's going on, So I think, you know, in the general population, I think probably we're seeing more of it because we have more advanced techniques to find them. Whereas in the past, maybe people only kind of went into the doctor if they had a complication of an ulcer, like bleeding and other things that we'll get into. But I think. It may not be a true increased prevalence, but I think we're seeing more and more of it because we know what to look for.

[00:10:46] John Salak: Okay, that's that's, yeah, that's interesting. And we come across that with a lot of the issues we cover, is that the diagnostic abilities are greater or more advanced. So we're picking more of that up, which is a

[00:10:57] Guest - Nina Nandy: And now we also have the wonders of the internet. So people are like, Oh, what are my symptoms? Could it be an ulcer?

[00:11:01] John Salak: Well,

[00:11:02] Guest - Nina Nandy: to the doctor about

[00:11:03] John Salak: there you go. And that was, and there we go. And that was my, thank you for leading into my very next question. So you're sitting there I'm, I'm sitting here drinking black coffee, my third cup of the day and talking to you. And I'm not, nervous in any way or stressed out, but what are some of the symptoms

so we know, this may be more than just. You know, as, As Oh, forget it. Whoever the guy was in the the Christmas pageant, a bad piece of pork, no, it's not a bad piece of pork. Well, how do I know I may have an ulcer?

[00:11:31] Guest - Nina Nandy: Yeah, so ulcers cause a variety of symptoms and it depends on the location and the severity, but the most common things you'll see with ulcers are abdominal pain. And usually it's like a burning or a gnawing sensation that occurs between like the breastbone and the navel. Sometimes it's intermittent, sometimes it's persistent, depending on the location of the It can be worse when you eat or sometimes people feel better when they eat And then you get indigestion.

And so sometimes, like bloating or belching feeling full Like a fullness in your upper stomach nausea vomiting sometimes loss of appetite or unintentional weight loss those are the more common things and then things that are less common, but are also very important for us to check out is if the ulcers are causing heartburn, if you're getting black sticky poops, sorry, this is a GI talk. but you know, if you have any blood, in your stool, we got to get that checked out because bleeding ulcer is a big deal. And then chronic blood loss, which you may not see, you can get very tired. So an ulcer can cause fatigue. And then also there are some ulcers that don't have symptoms. And so, you don't necessarily have to have any symptoms.

[00:12:36] John Salak: And I know it's going to vary by person, but. How long would these symptoms go on for? I mean, it sounds like any of this you should have checked out, but I suspect people think, Oh, it's a bad day or I'm stressed out. I feel better today. So there's no problem when there may be a problem.

So what's a good gauge for them to say, Hey, I really need to have this checked out. And I know everybody should have all of those symptoms checked out, but is it persistent for a day, a week?

[00:12:59] Guest - Nina Nandy: So that's that's a good question. And like, in medicine, there's always so many different factors, right? So I think, for example, if a person has certain risk factors, they're a young, healthy person, but they just had surgery. So they're on a bunch of Motrin, then they have pain. That might not be a long time thing that might be pain for a week or a month, but they have a real reason. And then some people kind of have chronic issues that go on for months and they don't get it checked out until, there's blood one day. Or they have really bad pain. So, I mean, it's hard to say how long these have been going on, but when we, actually take a look at the ulcers, we can kind of get an idea of how chronic it's been, based on size and how deep it is and how big it is, because, sometimes those take a long time to form. Yeah, I think some of the issues are just not really thinking about the symptoms or pushing it off to the side. It'll get better, or it's just, something I ate.

[00:13:47] John Salak: And you don't see it. That's another thing. I mean, a lesion on your foot or something like that, you're going to see

and you can say, Oh my gosh, that's, that's, that's terrible. And people go in for their annual checkups.

What? in And hopefully you're spending some time with your doctor and we've read studies that a doctor's visit is down now to 11 or 12 minutes

sometimes,

[00:14:05] Guest - Nina Nandy: Ooh, don't get me started

[00:14:06] John Salak: be disgusted. You will have you for another part on that.

So, they're

going, Oh,

so, our GP, I mean, I'm not bashing GPS, but are you're a primary care physician? Are they likely to investigate whether you have an ulcer unless you look like somebody who, Either has a symptom or an age factor.

How do we proactively check for that? I guess is what I'm saying.

[00:14:31] Guest - Nina Nandy: I mean, a lot of times they'll just send them to me, but, but, they're doing their best. They're trying their hardest, and they have, a lot of factors that they have to, deal with on their checklist, their blood pressure and lipids cholesterol, that kind of thing.

But I do think, they do a pretty good job of, investigating the. If somebody has bad heartburn or bad reflux or this gnawing pain or weight loss, they will refer to GI or a lot of them might do like an initial test, like a non invasive test, like checking for that bacteria I talked about, H.

pylori. There's a breath test and there's also, a poop test, that they can sometimes check for.

[00:15:03] John Salak: . at a certain age, should you ask your doctor to check for these things? Should people be asking when they hit 60, 65 to do some sort of.

[00:15:11] Guest - Nina Nandy: I think people should ask. People should ask about any symptom at any age, We have seen a lot of unfortunately things happen in younger younger people and a lot of times people Have been written off because you're young and healthy like that's nothing and then I'm of the firm belief that if anything's going on You're the one who deals with your body every day.

Please. Tell us let us know And we're not gonna know it unless you tell us or unless there's a concern and just say hey, you know Could it be you know? this or that. I'm concerned about this. And a lot of times if you have a good relationship with your physician, it's just a conversation and say, you know what, let's get this test and rule it out and give you peace of mind.

I'm really of the school of thought that just get it checked out.

[00:15:47] John Salak: It begs a certain question too, and I know we talked about the symptoms and who's, may be more likely to develop ulcers. Are they appearing more in younger people? Short of our ability to diagnose them and identify them, do you suspect younger people are getting more ulcers or ulcers are appearing in younger people more often?

[00:16:05] Guest - Nina Nandy: Well, you know, the risk factors of developing ulcers are generally come with age and especially because of the protective lining of the stomach. gets eroded. But I do see a lot of ulcers in younger people. I don't know if it's becoming more and more just because we're more aware of it, but certainly, you know, if you're a person who plays a lot of sports, have sports injuries, you're taking those drugs, those NSAIDs, you've had surgery, that kind of thing. I think with the appropriate risk factors, we see it more. and more. But I don't know if, just a young person without any of those risk factors would be more at risk of developing that. I think there has to

[00:16:37] John Salak: Okay.

[00:16:37] Guest - Nina Nandy: know, some reason. Some reason.

[00:16:38] John Salak: All right. What are the risks of an untreated ulcer or what can ulcers lead to other than the discomfort and the pain and the bleeding, which is all significant,

[00:16:47] Guest - Nina Nandy: Yes. Yes.

Yeah.

[00:16:48] John Salak: to other problems?

[00:16:49] Guest - Nina Nandy: Oh yeah. Yeah. Yeah. I think, ulcers can pose a variety of risks if they're not treated. And so, it's important to get this looked at. So one thing is, what is the cause of the ulcer? If the cause of the ulcer is H. pylori, that bacteria we talked about, which is very common, right?

Yeah. That bacteria is actually, considered a carcinogen. It can cause a very rare type of lymphoma in the GI tract. So we have to treat it. And not only do you want to get that treated, you have to check for eradication, meaning, six, six to eight weeks after you're done with antibiotics, get a test to make sure that bug is gone. we want to make sure you don't have it. So it doesn't lead to that risk. And then of course, bleeding, is common with ulcers because the more erodes a blood vessel can poke through. And some of those can be really bad. They require, clipping and banding and injecting and all, and sometimes surgery.

The other thing that's really bad is a perforation or a tear. So basically, if an ulcer gets deep enough, it can kind of. Eat away and go through the lining of the stomach and then. that can cause stomach acid and digestive juice to spill into the abdominal cavity. And that can be life threatening, cause peritonitis and often require surgery. Also another bad thing ulcers can do is cause obstruction or blockage. So let's say you've got a big ulcer in the stomach located in the area where stomach goes into the small intestine. That's called the pylorus. You can get what's called a gastric outlet obstruction. So , anything you eat is not going through.

So, you're gonna get nauseous, feel bloated, feel awful. You can have persistent vomiting due to that weight loss,

[00:18:16] John Salak: Wow.

[00:18:17] Guest - Nina Nandy: Yeah,

[00:18:18] John Salak: So they're dangerous enough is it make your life miserable. The bacteria you mentioned how is that being brought about? Is that just happenstance that you may get that bacteria? Is that something that, that, you're more likely to cause it or bring it into your system?

[00:18:31] Guest - Nina Nandy: so H. pylori is actually pretty common around the world and certain parts of the world are more prone It's just what we call endemic. It just lives in that area. So if you

travel you might pick it up It's also kind of a hygiene thing So if you're around people that have it and you don't wash your hands or they're preparing your food you can get that so some sometimes if I have a patient who has it You just want to make sure everybody else in the household gets checked, too

[00:18:51] John Salak: You have an ulcer, and again, there are different areas of ulcers and, I guess, different severities. How do we begin to treat it?

[00:18:59] Guest - Nina Nandy: So at this point, I guess we've already diagnosed the fact that a person has an ulcer, right? Like we've done an endoscopy. I'm assuming, we took a scope, we took a look. Cause it's important to take a look and I'll tell you why, because you have to know the location of the ulcer. That makes a difference. How many, how big is their blood vessels, that are involved. for Example the treatment depends on. what causes it. So if H. pylori bacteria caused it, and sometimes, we find H. pylori because we always biopsy the stomach, even though you don't have an ulcer, you want to treat with antibiotics.

So it's usually a three or four drug regimen, for two weeks. And then we test again in six to eight weeks to make sure the bug is gone. If the cause of the ulcer is taking those medications, like NSAIDs, And there are other medications, that can cause ulcers too, besides NSAIDs. then you want to, stop them if you can. And treat with medications that protect the lining of the stomach. Like, Meprazole, Nexium, your PPIs, or H2 blockers like like Zantac. But PPIs are generally a little bit better to treat ulcers. And then of course, if you have a bleeding ulcer, we go in there and put a clip on it or inject it, put hemo spray.

There's lots of other things we can do while we're doing the procedure itself. We can do it all together. and so, the treatment kind of depends on, what causes it, and whether there's complications.

[00:20:13] John Salak: So, so basically we're talking about stopping whatever's causing the ulcer, if it's bacteria or an infection is that correct? And then repairing or allowing the

[00:20:21] Guest - Nina Nandy: know.

[00:20:22] John Salak: To, to repair the stomach lining.

[00:20:25] Guest - Nina Nandy: Yes. And I will tell you something that's important that I want, all the listeners to know in our GI guidelines and like I said, medicine, is a art and a science. So there's guidelines that exist for reasons, but specific. Individuals, depending on their risks or different, but usually ulcers that are in the stomach, or bad ones in the esophagus, we re scope, so we look again after, a period of eight weeks or so, to make sure that has healed.

Small intestine, not so much, but stomach ulcers in particular, even after the treatment, you want to make sure that ulcer is gone, because in some cases, a chronic ulcer that doesn't heal could be an early gastric cancer. So we just want to make sure that it's gone. Yeah. Cause gastric cancer is, is no joke and, it's something we want to make sure we can prevent. I mean, unfortunately a lot of times you can't prevent it, but, we want to make sure that ulcer is healed.

[00:21:15] John Salak: We sort of touched on this earlier, but how do you maintain a healthy stomach lining short of whether you have an ulcer or not, but it's just good health? Is it gut health? Obviously if you're smoking is never good for anyone.

I recognize that, but are there other things you should be doing?

Are there certain foods that promote, better stomach lining? There are things that we should all be doing just to stomach lining is in better shape.

[00:21:39] Guest - Nina Nandy: Yeah. So, you know, it's kind of the very simple things. In terms of eating whole grains, fruits, vegetables, lean proteins that can promote good digestive health. So you want to avoid eating, heavy meals, that are processed, that can sit, anything that sits in the stomach for a long time, like fried stuff.

that just, makes it harder for the stomach to empty. So the longer it's sitting in there, the more acid and stomach acids trying to break it down. And then that can lead to, destruction of the lining. So anything that's a process, even nitrates, then certain countries, more smoked fish, for example, is popular smoked and cured meats, have been known to destroy the lining of the stomach or promote stomach cancer in large amounts.

But, those are

[00:22:20] John Salak: hmm. Right.

[00:22:20] Guest - Nina Nandy: Be aware of.

[00:22:22] John Salak: So it's really like every, almost everything else is a healthy nutritional diet

is really going to protect so many different, yeah that's really important. So given that you're from Texas, this means you never eat barbecue or anything like that, anything

[00:22:35] Guest - Nina Nandy: I am not a

barbecue person. I'm from the East Coast originally, but I've been in Texas for a couple years, but yes.

[00:22:41] John Salak: Okay.

[00:22:42] Guest - Nina Nandy: I know I'm probably gonna get canceled by my, everyone in Texas by saying that our here is

[00:22:47] John Salak: Okay.

Oh,

I understand that. And when you're on the East coast, you're not eating clam fried clam strips then or at least

not regularly.

[00:22:55] Guest - Nina Nandy: I never said that. . Well, I think Moderation

right?

Moderation is key. I try to do plant-based when I'm at home, but when I travel, it's sort of, anything goes

[00:23:06] John Salak: Okay, that sounds good. All right. So we've covered a lot of ground, and I know there's a lot more that we can talk about. Well, to sort of wrap it up, what are the biggest misconceptions people have about ulcers, and how is that affecting them?

[00:23:19] Guest - Nina Nandy: Misconception is that, Oh, like your mom always says, you stress yourself out. You're going to give yourself an ulcer. Right. so, So the biggest misconception is that it's only caused by stress and, or spicy food. And yeah, I mean, that can make ulcer symptoms worse in susceptible people.

Of course, there's some truth to it, but it's not the primary cause. So the primary cause, like I said, is usually H pylori bacteria or those drugs like NSAIDs. And so that's important to, get that sorted out. And then, the other sort of misconception is that ulcers are always painful.

No, that's not true. You can have other symptoms. There can be silent ulcers depending on where they are located. And then, there was this whole thing where avoiding spicy foods or eating a lot of dairy helps you feel better. Like, oh, have some yogurt or have some milk. Mm, you know, milk can also be, irritating to the gut lining, so that's not necessarily true. And, sometimes people say, ulcers are always treated by surgery, and that's not true either, because usually surgery is pretty rare to treat an ulcer unless it has, torn, perforated, or there's a horrible bleed that we can't control endoscopically. So those are like the biggest misconceptions I hear. My whole thing, if I could give listeners one piece of advice, if there's anything that's bothering you, please tell us. I rather know more than less. And there's something that's really on your mind, we'll let you know if it seems like, it doesn't make sense to treat for that.

But a lot of times, it's good to have peace of mind as well.

[00:24:43] John Salak: one thing that did want to clarify, you had mentioned the various drugs people take that may exacerbate or cause ulcers. Why would you be taking those drugs?

[00:24:54] Guest - Nina Nandy: Oh, yes, yes, yes. That's very important. So, , like I said, NSAIDs are non steroidal anti inflammatory drugs like Motrin, Aspirin, and Naproxen. They're the most common reasons, people, Generally take it for joint pain, arthritis or post surgery, migraine headaches, that sort of thing. So they're the most common because, they're over the counter.

And it does depend on how much and how frequently, or you're more at risk, obviously, if you're taking it every day for a long time. But there are other drugs, like, drugs for chemotherapy or steroids like prednisone that can irritate the gut lining, so, so we always want to make sure, someone's on long term prednisone has something to protect their gut. and certain things that we use for osteoporosis, like bisphosphonates can cause damage to the esophagus. So, always good thing to go over your med list and tell us if there's

[00:25:41] John Salak: Sure.

[00:25:41] Guest - Nina Nandy: taking or yeah.

taking or

[00:25:43] John Salak: And usually we can, we, doctors, medical profession can find alternatives or some counter reacting drugs or

[00:25:52] Guest - Nina Nandy: Yeah, you know, for medications for, for sure. Yeah. So I always say, try to take the lowest therapeutic dose that gives you the desired effect. And and also, don't say take something if you don't need it. But you know, I have patients who are chronic arthritis and like the only thing that helps, for example, is naproxen. and if that's the case, and you can't take anything else tramadol or whatnot, Tylenol, if that doesn't help, then, Maybe you need to be on a medication to protect your gut lining while you're taking that medication. Maybe you need to be on some, H2 blocker, like a rinitidine, famotidine, that's like Zantac, Pepsi. Or you need to be on something like a Nexium. So, there are ways to either, change therapy to something else, or do something to lessen your risk.

[00:26:30] John Salak: Okay. And ultimately, the biggest thing is talk to your, your doctor, your primary care physician, if you think you have a symptom or you just want to be checked out.

[00:26:37] Guest - Nina Nandy: Find someone that you trust that is open to having this sort of discussion and communication with you. I really stress that the relationship between doctor and patient is very important. And if you feel like someone's not listening to you, or, you you're not getting what you what need to out of the conversation, it's okay to ask for another opinion or, sit down with uh, whoever, you feel is a good fit.

[00:26:58] John Salak: We hear that so many times from so many experts is to make sure your relationship is strong with so it's it's common and it's important because you have to be able to talk to

people and they have

[00:27:07] Guest - Nina Nandy: You have to feel comfortable. And, I know I have a lot of patients that are like, I don't want to say anything when I go to the doctor, but here's your chance to tell me. So, if you want to bring a threat, if you want to bring a friend or a family and, oh, I I don't want to, Say that all guys are like this, but I don't know how many times I find out from the wives or the girlfriends or the daughters or whoever, the son and I'm like, well, that's not true.

Why are you telling them? Everything's great. You're having all these problems. We couldn't travel. You can't play golf. So I need to know.

[00:27:34] John Salak: right. Exactly. Well, I can attest to that I can and my wife were sitting here She could have tested that as well. So in my case, so

[00:27:40] Guest - Nina Nandy: So, so I like

[00:27:41] John Salak: doctor

[00:27:41] Guest - Nina Nandy: a friend.

[00:27:43] John Salak: Okay. All right. Bring a friend. That's, that's another podcast. Bring a friend

To your appointment. Dr. Dr. Nandy,

thank you so much.

There you go. That's okay. We're going to start. We will work with the AGA to to create a day like that.

So, all right. Dr. Nandy, thank you very much for everything and

all your insights on

[00:28:03] Guest - Nina Nandy: Hey, thank you so much for having me. This was fun. I hope you guys learned something awesome.

[00:28:08] John Salak: Before we move on, we wanted to again encourage listeners to take advantage of the hundreds of exclusive discounts WellWell offers on a range of health and wellness products and services. These cover everything from fitness and athletic equipment to dietary supplements, personal care products, organic foods and beverages, and more.

Signing up is easy and free. Just visit us at WellWellUSA. com, go to Milton's Discounts in the top menu bar, and the sign up form will appear. Signing up will take just seconds, but the benefits can last for years. Okay, so by now it's clear that ulcers are serious business that can lead to serious consequences, which is why it is extremely important to speak to your doctor if you're having any related symptoms.

Of course, not all ulcers give off symptoms, so having periodic IG checks or scopes is also a smart move, especially for older or at risk individuals. There is good news in all of this, however. Diagnostics are improving all the time, making it easier to identify problems. What's more, the earlier a problem is identified, the easier and less invasive the treatment.

Early treatment also lessens the risk of other more severe complications from arising. Finally, a lot, if not most, treatments usually require just antibiotics or other medicines. Ultimately, the best advice we can give, don't overlook or dismiss ulcers. You'll wind up giving yourself one. Well, that's it for this episode of What the Health.

We'd like to thank Dr. Nina Nandy. with the AGA for her time and insights. If you'd like more information on the AGA's work, please visit gastro. org. That's gastro. org. That brings us to the end of this episode of What the Health. Thanks for listening in, and we hope you'll join us again.