Health Features

Addressing Discomfort

When we’re in pain, it’s all we can think of. It impacts our work, our relationships and our entire outlook. That’s why it’s so important to deal with discomfort immediately, to get to the bottom of what’s wrong and make it right.

Doctors know irritable bowel syndrome is a very common disease. What they don’t know is why. The uncomfortable and inconvenient symptoms are believed to affect 10 to 20 percent of the population.

ibs rollercoaster
“People with irritable bowel syndrome have abdominal pain and a change in bowel habits. We don’t know the reasons exactly,” says Dr. Elizabeth Marsicano, a SLUCare gastroenterologist and assistant professor at Saint Louis University School of Medicine. It’s a ‘spectrum disease,’ meaning it presents a range of symptoms. “Some people are never seen in a doctor’s office or diagnosed because it doesn’t hinder their quality of life,” Marsicano says. “We see others who are unable to go to work, cannot go out with friends or family, and are afraid of going on vacation.”

Irritable bowel syndrome can present varying symptoms within the same patient, too. “People can have a change in the frequency and consistency of bowel habits, either constipation or diarrhea, or sometimes both,” she says.

is it genetic? 
“Science is alwyas trying to learn more,” Marsicano says. “Like a lot of diseases, the prevailing thought is that there is a genetic predisposition and then something else happens. Sometimes a viral illness throws people off. Sometimes it is an environmental exposure. There is no defining cause. The causes are different for every person.” The environmental exposures triggering IBS flare-ups often are food intolerances, says F. Afua Bromley, an acupuncturist at Acupuncture Saint Louis. “When people come in reporting the symptoms of irritable bowel syndrome, we have to delve deeper to figure out if it is simply a food intolerance or if the symptoms are indicative of something more significant, such as Crohn’s disease or ulcerative colitis,” Bromley says. “In Chinese medicine we do a lengthy intake and look at the patterns when symptoms are worse.”

Dairy and wheat products are the leading causes of food intolerance issues, she says. “The vast majority of people on the planet do not tolerate dairy well. It is common to have some spectrum of dairy intolerance.”

gut check
“The over-arching view of irritable bowel syndrome is as a hypersensitivity of the gut,” Marsicano says. “I explain it with a sunburn analogy. When you get into the shower, the warm water usually feels good. When you have a sunburn, the water feels painful because the skin is sensitive. We believe that is what is happening in the gut; the nerves are perceiving pain from stimuli that normally would not feel painful.”

Getting to the bottom of a particular patient’s problem takes some deductive reasoning. “We go through all the symptoms and what patients think may be their triggers,” Marsicano says. “Some people feel foods are triggers, others think it’s stress.” The SLUCare gastroenterology clinic includes nutritionists who can work on dietary issues with patients, Marsicano adds.

Additionally, the role of gut bacteria is being researched. “We know certain probiotics are good for the gut and certain bacteria can be bad,” she says. “That is something that could help us treat IBS in the future.”

the role of stress
“Stress can be a factor in IBS, but not with everyone,” Marsicano says. “Certainly there is interplay between the brain and the gut. Anxiety and depression also can affect bowel habits.” These IBS patients may benefit from psychiatric care and techniques that will reduce anxiety. “People may be prescribed medications or directed to yoga. We offer gut-directed hypnotherapy and have had very good results with that,” Marsicano says.

[mouth maladies]
Dental health is about a lot more than pretty teeth. As Dr. Robert P. Rothenberg notes: “Keeping the mouth healthy can be a very great benefit to providing general health.” Studies have linked poor oral health to heart, digestive and respiratory problems.

lip service
The keys to oral health are what you have heard since you were a child: “brush, floss and get those checkups,” says Dr. Robert W. Boyle of Clarkson Dental Group. Everything from neglect to soda beverages can wreak destruction beyond the lips. “There is a lot going on in the mouth. People take it for granted,” says Robert P. Rothenberg, who practices in West County.

The simplest necessity of daily living—eating —is one of the greatest threats to mouth health. “You have a days’ worth of food debris on your teeth, so brushing before bedtime is critical,” Boyle says. “Brush your teeth thoroughly at least twice a day. Three times is better, but the two most important are the morning, ideally after breakfast because there potentially is a lot of sugar in breakfast foods, and at night.”

While the guidelines for dental hygiene haven’t changed for decades, the techniques have. “Electric toothbrushes have been proven to be more effective than regular brushes,” Boyle says. Also, he stresses, floss daily. “You’ve heard it before: Flossing reduces the chance of cavities between the teeth and helps keep your gums, and the bone underneath that supports your teeth, healthy.”

the usual suspects
There are two things that can cause discomfort to the mouth, Rothenberg says. “One is a disease process, which can be decay of the hard tissue of the teeth, or gum disease, which affects the soft tissue. Systemic disease also could have effects on the mouth due to hormone changes or changes in physical health.”

Another issue many suffer from is drug side effects, Rothenberg points out. “Medications required to treat those medical conditions could have an effect on the mouth, such as slowing saliva flow and making the mouth dry, therefore making it more susceptible to gum disease and decay.” Further complicating mouth pain are sinus issues, which can imitate a toothache. “If the sinus is irritated, that can stimulate the nerves of the teeth and cause the patient to feel like they have a tooth problem,” Rothenberg says.

our vices
“Tobacco, either smoked or stuffed into the cheek, can have a very detrimental effect on the mouth,” Rothenberg says. “As for what you drink, I don’t think coffee is a real problem, except it might stain the teeth. But if you put sugar or cream in, those feed the biofilm and bacteria in the mouth that cause decay and gum disease.”

Today’s scourges are “the various energy drinks and sodas. Those are very acidic and they just tear up the teeth,” Rothenberg cautions. “There are constant chemical reactions going on in your mouth. The bacteria in there create acid that will soften and demineralize the enamel structure of the teeth and the gum. The saliva, if you are healthy, has various minerals that constantly restore the mineral deposits in the enamel. But if you drink or eat something that is very acidic, it will leach out the minerals from the enamel very quickly, and the saliva has a harder time of redepositing those minerals.”

health-guy[neck pain, back pain]
The neck and back consist of 24 vertebrae connected by discs, ligaments and tendons that support the weight of your body and protect the spinal cord, which is connected to the body through 31 pairs of delicate nerve roots that pass through the spinal bones. No wonder we are often stiff and sore!

what the @+)%$#!
Half of all working Americans have back pain symptoms each year, according to the American Chiropractic Association (ACA). “People don’t take care of themselves the way they should,” says Dr. Robert Elder of Metro Chiropractic in west St. Louis County. “They get in car accidents and they fall. They sit all day, and sitting is very bad for the spine—it deconditions the muscular structure that helps to support it.”

Low back pain is the single leading cause of disability worldwide, according to the ACA. It is one of the most common reasons for missed work and the second most common reason for visits to the doctor’s office (after upper respiratory infections). Spinal pain causes $50 billion in health care expenditures each year.

take care!
“When someone has neck or back pain, most of the time it is biomechanical in nature,” Elder says. “We analyze the biomechanical function, then adjust the spine to create better function. With better biomechanics the pain will be alleviated.” Injuries are the leading culprit for putting the back out of alignment. “The most common thing is trauma to the spine. I do a lot of car accident work. In a car accident, the spine is thrust forward and backward at a high rate of speed,” he explains. “The g-forces tear ligaments, disrupt soft tissue and sometimes herniate or bulge a disc.”

it’s complicated
The spine must work in unison with its associated anatomy to perform trouble-free service, Elder says. “It is a moving structure with a lot of moving parts, just like your car. It includes your nervous system, which controls and coordinates every function of your body. When we adjust the spine, we are not just adjusting the bones but actually changing the physiology.”

Interestingly, all the body’s systems work more smoothly when they are free of pain. “Research has shown that your endocrine system and heart function improve, and the oxygenation of tissues improves when you are more balanced and the spine is more relaxed. The brain and body can communicate better,” he explains.

back maintenance
Restoring the neck and back to proper order may require multiple professional adjustments, as well as effort from the patient. The treatments may include massage therapy and homework in the form of regular strengthening exercises.

One good exercise for back health is the yoga ‘fish’ pose, Elder says, especially for counterbalancing the effects of sitting at a desk all day. “Lie on your back then push your elbows and head into the mattress. Lift up your back. Arch your chest and keep the buttocks and legs flat. Maintain the position as long as you can. Try to increase the time a little bit every day until you get to the point that you can hold it for minutes at a time.”


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