Office handouts – Here it is incase you lose your copy!
SOME HELPFUL HINTS
Heartburn:
Avoid irritants such as tomato sauce, spicy and fatty foods, fried foods, citrus fruits, chocolates, alcohol, coffee, caffeine, and cigarettes. Eat small frequent meals. Do not lie down immediately after meals. Avoid tight fitting clothes. Medicines work best if taken 30 mins. before a meal.
Bloating:
Avoid milk, cheese, fruits, potatoes, broccoli, cabbage, asparagus, cauliflower, beans, potatoes and corn.
Avoid artificial sweeteners (like that present in sugar free candies, chewing gum) soda and high fructose corn syrup.
Avoid mouth breathing.
Soluble fibers like that present in oats, barley, legumes, etc can cause more bloating.
Peppermint Tablet (To be swallowed not sucked on – available at GNC stores)
Align or VSL #3 (probiotics)
Iberogast Iberogast 20 drops tid. It is available online from amazon and other web pages. This has been shown to be helpful by anecodatal reports and is not FDA approved. I have discussedthis with the patient. It has been helpful for bloating. The side effects of Iberogast include allergic reaction to Chamomile (including anaphylaxis) and side effects of Liquorice which includes myocardial infarction, water retention, pseudohypoaldosternoism, headaches, fatigue and hypertension. Moreover it contains some alcohol.
Side effect of medications used for GERD / Heartburn treatment.
This is far from complete. Please contact your pharmacist or physician for additional information.
PPI: The drugs included in this is Nexium, Prevacid (Lansoprazole), Prilosec, Omeprazole, Protonix, and Aciphex. The new concerns with these medications include: increased incidence of wrist and hip fractures from osteoporosis (thinning of the bone), increased chance of pneumonias, bowel infection called C-Diff and low magnesium levels. Anyone on the medication for more than one year should get their magnesium level checked. Please contact your primary care for evaluation of osteoporosis.
Diflucan: Do not take cholesterol lowering agents with this medicine. It can cause rare serious liver failure.
New Medication Ordered: All RX’s are faxed to the pharmacy of your choice after 4:30pm
X-Rays Ordered EGD Colonoscopy
Blood Test Ordered
Check us out on the web: www.mygastrodr.com. Facebook Us: GI Consultants Community
Reducing Your Risk of Colon Cancer:
Take multivitamin with Selenium. Eat a high fiber diet. Avoid red meats. Exercise and Aspirin is helpful as well.
Relieving Constipation:
Gradually increase the fiber in your diet to 20-30 grams daily. Fiber supplements such as Benefiber, Citrucel, or Metamucil can be used.
Miralax (Glycolax) We generally recommend taking it at 8 pm mixed with a drink or water of your choice. If you need the medicine more than once we recommend taking second dose 30 min later at 8:30 pm
MOM 30cc (2 tbsp.) as needed. Take MOM 2 tbsp on any day that you skip a BM. (This is in addition to miralax).
Bloating: Avoid milk, cheese, fruits, potatoes, broccoli, cabbage, asparagus, cauliflower, beans, potatoes and corn.
Avoid artificial sweeteners (like that present in sugar free candies, chewing gum) soda and high fructose corn syrup.
Avoid mouth breathing.
Soluble fibers like that present in oats, barley, legumes, etc can cause more bloating.
Peppermint Tablet (To be swallowed not sucked on – available at GNC stores)
Align or VSL #3 (probiotics)
Iberogast Iberogast 20 drops tid. It is available online from amazon and other web pages. This has been shown to be helpful by anecodatal reports and is not FDA approved. I have discussedthis with the patient. It has been helpful for bloating. The side effects of Iberogast include allergic reaction to Chamomile (including anaphylaxis) and side effects of Liquorice which includes myocardial infarction, water retention, pseudohypoaldosternoism, headaches, fatigue and hypertension. Moreover it contains some alcohol.
Diverticular disease: Eat more fiber. Chew your food carefully. Currently, seeds or nuts are NOT thought to cause complications like inflammation or diverticuli or bleeding. Diverticulitis is inflammation of the diverticuli and can lead to complications. Patients need antibiotics when it is inflamed. They may need surgery.
Diverticular disease (just having the pockets but there is no inflammation or complication) is common and generally requires no intervention unless infected or if it bleeds.
New Medication Ordered: All RX’s are faxed to the pharmacy of your choice after 4:30pm
X-Rays Ordered EGD Colonoscopy
Blood Test Ordered Check us out on the web: www.mygastrodr.com. Facebook Us: GI Consultants Community
Medication Side Effects
This is far from complete. Please contact your pharmacist or physician for additional information.
Cipro or Levaquin: Tendon rupture (Achilles tendon) and liver toxicity.
Pramine or Bentyl: Dry mouth, drowsiness, racing of the heart, urinary retention, and constipation.
Flagyl or Metronidazole: Do not drink alcohol with this medication. This includes alcohol from mouth wash rinses ect. Long term use can cause neuropathy.
Amitizia: Nausea. You can avoid this by taking it with food. Abortions. Patients are advised to use birth control pills or contraceptive measures prior to using it. Do not share this medication with anyone.
Food Serving Grams of fiber
|
Apple (with skin) 1 medium apple |
4.4 |
Baked beans, canned, no salt added 1 cup |
13.9 |
|
Banana 1 medium banana |
3.1 |
Kidney beans, canned 1 cup |
13.6 |
|
Oranges 1 orange |
3.1 |
Lima beans, canned 1 cup |
11.6 |
|
Prunes 1 cup, pitted |
12.4 |
Lentils, boiled 1 cup |
15.6 |
|
Apple, unsweetened, w/ added ascorbic acid 1 cup |
0.5 |
Bran muffins 1 medium muffin |
5.2 |
|
Grapefruit, white, canned, sweetened 1 cup |
0.2 |
Oatmeal, cooked 1 cup |
4.0 |
|
Grape, unsweetened, w/added ascorbic acid 1 cup |
0.5 |
White bread 1 slice |
0.6 |
|
Orange 1 cup |
0.7 |
Whole-wheat bread 1 slice |
1.9 |
|
Green beans 1 cup |
4.0 |
Macaroni 1 cup |
2.5 |
|
Carrots .5 cups sliced |
2.3 |
Rice, brown 1 cup |
3.5 |
|
Peas 1 cup |
8.8 |
Rice, white 1 cup |
0.6 |
|
Potato (baked, with skin) 1 medium potato |
3.8 |
Spaghetti (regular) 1 cup |
2.5 |
|
Cucumber (with peel) 1 cucumber |
1.5 |
Almonds 1 cup |
17.4 |
|
Lettuce 1 cup shredded |
0.5 |
Peanuts 1 cup12 |
12.4 |
|
Tomato 1 medium tomato |
1.5 |
Spinach 1 cup |
0.7 |
Crohns Disease or Ulcerative Colitis
This can often be a lifelong disease associated with multiple complications and may require surgery also. Side effects of the medications commonly used to treat it are listed here.
Remicade, Humira, Cimzia: Life threatening infections including fungal infections, TB, hepatitis B reactivation. Patients are advised to get a yearly PPD and immunized against hepatitis A and B. It can also cause life threatening cancers. Other side effects include CHF, anemia, skin rashes, serious neurological problems, sensitivity to the sun, worsening lupus, sarcoidosis. Moreover, it should be avoided during pregnancy and lactation.
While on these medications, we recommend
1) Yearly flu shot
2) Evaluation for hepatitis A and B. You should get immunized against both
3) Yearly PPD
4) Immunization against Pneumonia.
5) Call your physician IMMEDIATELY if you develop fever.
Mesalamine (like Lialda, Asacol, Apriso, colazal etc): Generally very safe. Some patients may develop inflammation of the liver, lungs, kidneys.
Imuran : This medication can cause life threatening drop in blood counts. You WILL NEED blood tests frequently – initially every week or other week to later on once every 2-3 months INDEFINATELY. Moreover it can cause liver problems, pancreatitis, fever, and a higher chance of cancers like lymphomas.
Prednisone: Anxiety, insomnia, irritability, cataracts or glaucoma , facial swelling, high blood sugar, increased risk of infections, changes in body fat distribution, skin changes (acne, stretch marks, slow healing), osteoporosis (weakened bones and possible fractures), avascular necrosis of joints, joint pain, muscle weakness, and weight gain.
Check us out on the web: www.mygastrodr.com. Facebook Us: GI Consultants Community
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