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ANNOUNCER:

MAJOR FUNDING

FOR "SECOND OPINION"

IS PROVIDED BY THE BlueCross

AND BlueShield ASSOCIATION,

AN ASSOCIATION OF INDEPENDENT, LOCALLY OPERATED,

AND COMMUNITY-BASED BLUE CROSS AND BLUE SHIELD COMPANIES.

FOR MORE THAN 80 YEARS,

BLUE CROSS AND BLUE SHIELD COMPANIES

HAVE OFFERED HEALTH CARE COVERAGE IN EVERY ZIP CODE

ACROSS THE COUNTRY

AND SUPPORTED PROGRAMS

THAT IMPROVE

THE HEALTH AND WELLNESS

OF INDIVIDUAL MEMBERS

AND THEIR COMMUNITIES.

THE BlueCross AND BlueShield ASSOCIATION'S MISSION IS

TO MAKE AFFORDABLE HEALTH CARE AVAILABLE TO ALL AMERICANS.

NEWS ABOUT OUR INNOVATIONS IS ONLINE AT BCBS.COM

AND ON TWITTER

@BCBSAssociation.

 

 

 

"SECOND OPINION" IS PRODUCED

IN ASSOCIATION WITH

THE UNIVERSITY OF ROCHESTER MEDICAL CENTER,

ROCHESTER, NEW YORK.

 

 

SALGO:

 

WELCOME TO "SECOND OPINION,"

WHERE YOU GET TO SEE,

FIRSTHAND, HOW SOME OF THE

COUNTRY'S LEADING HEALTH CARE

PROFESSIONALS TACKLE HEALTH

ISSUES THAT ARE IMPORTANT

TO YOU.

I'M YOUR HOST, DR. PETER SALGO,

AND TODAY I AM VERY HAPPY

TO WELCOME OUR "SECOND OPINION"

PRIMARY CARE PHYSICIAN,

DR. LISA HARRIS.

DR. DOUGLAS DROSSMAN FROM THE

UNIVERSITY OF NORTH CAROLINA

AND THE DROSSMAN CENTER.

DR. ASHOK SHAH FROM THE

UNIVERSITY OF ROCHESTER

MEDICAL CENTER.

AND ERIN SLATER, WHO IS HERE

TO SHARE HER PERSONAL STORY,

A STORY THAT OUR PANELISTS,

ALONG WITH YOU AT HOME, ARE

GOING TO BE HEARING FOR THE

VERY FIRST TIME.

SO LET'S GET RIGHT TO WORK.

ERIN, THANK YOU SO MUCH FOR

COMING.

 

 

SLATER:

 

THANKS.

 

 

SALGO:

 

YOUR STORY BEGINS

THE SUMMER BEFORE YOUR SENIOR

YEAR IN HIGH SCHOOL.

 

 

SLATER:

 

THAT'S RIGHT.

 

 

SALGO:

 

AND YOU WERE 17.

 

 

SLATER:

 

YEP.

 

 

SALGO:

 

AND YOU BECAME VERY ILL.

TELL US ABOUT THAT.

 

 

SLATER:

 

SO, BASICALLY, I HAD A LOT OF

FAMILY ISSUES UP TO THAT POINT,

AND IT JUST SEEMED LIKE, UM,

THIS ATTACK CAME ON ONE DAY OF

ABDOMINAL PAIN.

I WAS JUST KIND OF STUCK ON THE

COUCH, IN PAIN.

 

 

SALGO:

 

OKAY, AND YOU SAID SOME OTHER

FAMILY PROBLEMS?

 

 

SLATER:

 

RIGHT, SO MY MID- TO LATER

CHILDHOOD KIND OF WAS ROCKY, TO

SAY THE LEAST.

MY PARENTS DIVORCED WHEN I WAS

14, AND MY DAD ACTUALLY

COMMITTED SUICIDE WHEN I WAS 16.

AND IT HAPPENED -- THE PAIN

EPISODE, IT HAPPENED ACTUALLY ON

JULY 4th WEEKEND, AND HE HAD

DIED JULY 4th WEEKEND

THE YEAR BEFORE.

 

 

SALGO:

 

TO THE DAY?

 

 

SLATER:

 

TO THE DAY.

 

 

SALGO:

 

ALL RIGHT, SO NOW WE'VE

PAINTED A PICTURE.

IT'S YOUR TURN.

YOU CAN ASK ANYTHING YOU WANT.

 

 

SHAH:

 

CAN YOU DESCRIBE YOUR PAIN?

 

 

SLATER:

 

IT WAS JUST ALL-OVER

ABDOMINAL PAIN.

 

 

SHAH:

 

DID IT GO ANYWHERE?

 

 

SLATER:

 

UM, NO, JUST -- IT WAS LIKE A

BURNING, LIKE I HAD SWALLOWED

LEMON JUICE AND LIT IT ON FIRE.

 

 

SALGO:

 

WELL, THAT'S DESCRIPTIVE.

LISA?

 

 

HARRIS:

 

WAS IT CRAMPY? DULL? SHARP?

DID IT COME IN WAVES?

 

 

SLATER:

 

UM, I WOULD SAY CRAMPING.

CRAMPING, DEFINITELY.

AND IT JUST SEEMED LIKE -- IT

WASN'T REALLY COMING IN WAVES,

IT WAS JUST THERE.

IT HURT.

 

 

HARRIS:

 

AND NO FEVER, CHILLS?

 

 

SLATER:

 

NO.

 

 

HARRIS:

 

NAUSEA, VOMITING, DIARRHEA?

 

 

SLATER:

 

NOPE.

 

 

DROSSMAN:

 

WERE THERE ANY BOWEL

PROBLEMS?

 

 

SLATER:

 

UM, I HAD JUST PROBABLY ALL

MY LIFE HAD BATHROOM ISSUES --

MOSTLY CONSTIPATION.

 

 

SALGO:

 

THEN WHAT?

DID YOU GO TO THE DOCTOR?

 

 

SLATER:

 

A COUPLE OF WEEKS LATER, IT

KEPT HAPPENING.

IT WAS GOING -- IT WAS GOING ON

AND ON.

I WAS 17.

AND THERE WERE A LOT OF OTHER

THINGS THAT WERE HAPPENING AT

THE SAME TIME -- SO I WAS

GETTING MY FIRST JOB, I WAS

LEARNING HOW TO DRIVE A CAR,

I WAS PREPPING FOR COLLEGE

ESSAYS, AND I WENT TO MY PRIMARY

CARE DOCTOR WHO I HAD SEEN FOR A

NUMBER OF YEARS, AND SHE

BASICALLY SAID, "WELL, I THINK

IT'S STRESS."

 

 

SALGO:

 

OKAY.

THAT'S KIND OF A WASTEBASKET

DIAGNOSIS.

DO YOU THINK STRESS IS GOING TO

COVER THIS?

 

 

HARRIS:

 

WELL, I KIND OF WANT TO KNOW

WHAT SHE DID ON EXAM TO

DETERMINE THAT IT WAS STRESS.

DID SHE DO ANY LAB WORK OR

ANYTHING ELSE?

 

 

SLATER:

 

SHE DIDN'T DO ANY LAB WORK.

 

 

HARRIS:

 

OKAY.

 

 

SLATER:

 

OR, I MEAN, JUST THE REGULAR

PUSH YOUR BELLY, DIDN'T HURT, NO

MASSES.

 

 

HARRIS:

 

HAD YOU LOST ANY WEIGHT

IN THE COUPLE OF WEEKS FROM THE

TIME IT STARTED TO THE TIME THAT

YOU SAW YOUR DOCTOR?

 

 

SLATER:

 

NO.

 

 

HARRIS:

 

AND HOW WAS YOUR APPETITE?

WERE YOU ABLE TO EAT?

DID ANYTHING SEEM TO UPSET

YOUR STOMACH MORE?

 

 

SLATER:

 

NOT PARTICULARLY.

I WAS TRYING TO BE MORE CAREFUL

WITH FOOD.

 

 

SALGO:

 

WHY?

 

 

SLATER:

 

BECAUSE WHEN SOMETHING'S

WRONG WITH YOUR STOMACH, IT

SEEMS LIKE IT WOULD MAKE SENSE

THAT SOMETHING WAS -- I HAD

EATEN SOMETHING WRONG OR...

I SHOULD BE MORE CAREFUL WITH

JUNK FOOD AND THINGS LIKE THAT.

 

 

SALGO:

 

WELL, LET ME STOP YOU

HERE, AND I WANT TO ASK OUR

DISTINGUISHED PANEL.

IT SOUNDS LIKE SHE GOES TO HER

PRIMARY CARE, GOT SOME SORT OF

CURSORY EXAM, AND SAYS, "AH,

IT'S STRESS."

IS IT STRESS?

 

 

HARRIS:

 

WELL, WE DON'T KNOW YET.

 

 

SALGO:

 

IS IT FAIR, HOWEVER, TO JUST

LUMP IT INTO THAT STRESS BALL --

AND CALL IT, "THAT'S WHAT IT

IS.”

 

 

HARRIS:

 

ABSOLUTELY NOT.

 

 

SHAH:

 

HE SAID, "STRESS," BUT HE

DIDN'T SAY THAT WORD,

"IRRITABLE BOWEL SYNDROME," NO?

 

 

SLATER:

 

OH, NO, SHE DIDN'T SAY

ANYTHING LIKE THAT, SHE JUST

SAID, "STRESS," AND THEN WITH NO

FOLLOW-UP.

YOU KNOW, "IT MUST BE STRESS."

 

 

SALGO:

 

NO LAB TESTS, NO X-RAYS.

 

 

HARRIS:

NOTHING TO GIVE YOU TO

ALLEVIATE THE PAIN THAT YOU WERE

CONTINUING TO HAVE?

 

 

SLATER:

 

RIGHT, I WAS IN PAIN.

 

 

SALGO:

 

SO WHAT DID SHE DO

FOR THE PAIN?

 

 

SLATER:

 

NOTHING.

 

 

HARRIS:

 

YOU HAD MENTIONED

THAT YOU HAD HAD SOME BOWEL

PROBLEMS ALL OF YOUR LIFE.

NOW, HOW DID THAT CHANGE DURING

THIS PERIOD WHERE THIS SUDDEN

ONSET OF PAIN HAPPENED?

DID YOU HAVE MORE CONSTIPATION,

LESS CONSTIPATION?

WHAT DID YOUR BOWELS LOOK LIKE?

 

 

SLATER:

 

UM, IT WAS PRETTY MUCH THE

SAME.

 

 

HARRIS:

 

WHICH WERE WHAT?

HOW OFTEN DID YOU MOVE YOUR

BOWELS?

 

 

SLATER:

 

UM...PROBABLY

TWO OR THREE TIMES A WEEK.

 

 

HARRIS:

 

AND THEY WERE HARD, SOFT?

RUNNY?

 

 

SLATER:

 

 HARD.

 

 

HARRIS:

 

AND WERE THEY LITTLE BALLS,

OR THEY WERE --

 

 

SLATER:

 

LITTLE BALLS, YEAH.

 

 

DROSSMAN:

 

CAN I ASK YOU, THIS ISSUE

ABOUT STRESS, I MEAN, I THINK

THAT'S A COP-OUT.

NOTHING HAD BEEN DONE YET,

AS YOU SAID.

WHAT -- HOW DID YOU RESPOND WHEN

THEY SAID THAT?

WHAT WERE YOU THINKING WHEN THEY

SAID THAT?

 

 

SLATER:

 

I WANTED THE PAIN TO GO AWAY.

I IMMEDIATELY SAID, YOU KNOW,

"I'M NOT STRESSED," OF COURSE,

YOU KNOW, KIND OF A -- A FRONT

TO SAY, "YEAH, I AM STRESSED,

BUT SO?

MY STOMACH HURTS.

WHAT DOES THAT HAVE TO DO WITH

ONE ANOTHER?"

UM, AND SHE HAD NO FOLLOW-UP,

LIKE, "SEE SOMEBODY," OR,

"WE'LL DO THIS--" LIKE, THERE

WAS NO OTHER FOLLOW-UP, SO I

JUST --

 

 

SALGO:

 

YOU WENT HOME.

 

 

SLATER:

 

I WENT HOME.

 

 

SALGO::

 

NOW, DID THE PAIN

GO AWAY?

'CAUSE I'M SURE YOUR DOCTOR WAS

HOPING THIS IS A ONE-OFF,

YOU'LL GO HOME, YOU'LL FEEL

BETTER.

 

 

SLATER:

 

RIGHT.

 

 

SLAGO:

 

DID YOU FEEL BETTER?

 

 

SLATER:

 

NO, NO, THE -- I WOULD CALL

THEM EPISODES OR ATTACKS -- KEPT

HAPPENING.

A LOT OF TIMES IT WOULD BE AFTER

I ATE, BUT NOT ALL THE TIME.

 

 

SALGO:

 

WELL, DID YOU SEE

ANY OTHER DOCTORS?

 

 

SLATER:

 

YEAH. SO, UM,

IN ABOUT A MONTH OR TWO AFTER

THAT, IN AUGUST, SEPTEMBER,

I WENT TO MY FIRST

GASTROENTEROLOGIST.

 

 

SALGO:

 

AND WHAT DID THAT

DOCTOR DO, AND THEN WHAT DID THE

DOCTOR GIVE YOU TO HELP YOU WITH

YOUR PROBLEM?

 

 

SLATER:

 

EVENTUALLY HE PUT ME ON

PEPCID.

 

 

SALGO:

 

PEPCID. I WANT TO STOP

THERE FOR A SECOND, BUT I ALSO

WANT TO KNOW, DID THIS

GASTROENTEROLOGIST, THE SECOND

ONE YOU SAW, RUN ANY

TESTS AT ALL?

 

 

SLATER:

 

HE RAN A BARIUM SWALLOW.

 

 

SLAGO:

 

OKAY, THAT'S WHERE YOU

SWALLOW THIS CHALKY STUFF.

IT SHOWS UP ON X-RAY AND COATS

YOUR STOMACH, AND YOUR

INTESTINES TO SOME DEGREE.

AND THEY CAN LOOK TO SEE IF

THERE'S A PROBLEM.

 

 

SLATER:

 

EXACTLY.

THERE WAS NO PROBLEM.

SO HE KEPT TRYING NEW

MEDICATIONS OFF AND ON.

 

 

SALGO:

 

LET'S STOP

WITH PEPCID, 'CAUSE PEPCID IS AN

INTERESTING DRUG.

WHAT IS PEPCID?

 

 

SHAH:

 

PEPCID IS AN H2 BLOCKER.

IT BLOCKS THE ACID.

HISTAMINE IS BLOCKED AT THE

STOMACH LEVEL.

AND THE ACID IS CUT DOWN.

 

 

SALGO:

 

SO IT ACTUALLY STOPS

THE PRODUCTION OF ACID IN THE

STOMACH.

IT DOESN'T NEUTRALIZE IT.

IT TURNS IT OFF.

 

 

SHAH:

 

TURNS IT OFF.

 

 

SALGO:

 

GOOD IDEA, LISA?

 

 

HARRIS:

 

WELL, I -- I DON'T THINK SO.

 

 

SALGO:

 

WHY NOT?

 

 

HARRIS:

 

BECAUSE SHE HASN'T REALLY

GIVEN US A HISTORY THAT'S

PREDOMINANT FOR GERD.

SHE HAS SOME GERD SYMPTOMS --

 

 

SALGO:

 

GERD IS

GASTROESOPHAGEAL REFLUX DISEASE,

WHICH IS ACID

COMING UP THIS WAY.

AND IF YOU TURN THE ACID OFF,

PEPCID SHOULD WORK.

 

 

HARRIS:

 

BUT HER SYMPTOMS ARE

PREDOMINANTLY

WITH HER LARGE BOWEL.

I MEAN, SHE'S TELLING US THAT

SHE HAS PROBLEMS WITH STOOLING.

SHE'S HAD IT ALL THIS TIME, AND

NOW SHE'S HAVING SOME SHARP

ABDOMINAL PAIN, AND

IN THAT SETTING OF THE HISTORY

WITH THE STRESS, I MEAN, TO ME,

IT SEEMS PRETTY OBVIOUS THAT

THIS IS PROBABLY

IRRITABLE BOWEL SYNDROME.

THE ONE THING I PROBABLY WOULD

HAVE DONE WAS A PLAIN FILM, JUST

TO SEE IF THERE'S ANY

CONSTIPATION, IF THERE'S ANY

INTUSSUSCEPTION, WHERE THE

INTESTINES TELESCOPE --

 

 

SALGO:

 

OKAY, DID THE PEPCID

WORK?

 

 

SLATER:

 

IT WORKED FOR ABOUT

A WEEK OR TWO.

AND THEN THE PAIN CAME BACK.

HE GAVE ME LOTS OF MEDICATIONS,

AND EVENTUALLY IT LOOKED LIKE HE

WAS BASICALLY TRYING TO WORK

FROM TOP TO BOTTOM.

SO...I WENT TO ANOTHER DOCTOR.

AND HE ASKED, YOU KNOW, ALL THE

SAME BASIC QUESTIONS THAT I HAD

BEEN ASKED BEFORE, DID AN EXAM,

AND BASICALLY PRESCRIBED

HyoMax AT THAT POINT.

THEY HAD DONE -- HE DID DO A

COUPLE OF TESTS, ALSO, INCLUDING

AN ENDOSCOPY --

 

 

SALGO:

 

OKAY, THEY PUT A SCOPE

INTO YOUR STOMACH AND HAD

A LOOK?

 

 

SLATER:

 

YES, YEAH.

A ULTRASOUND, A C.T. --

 

 

HARRIS:

 

WOW.

 

 

SLATER:

 

A HIDA SCAN.

 

 

HARRIS:

 

WOW.

 

 

SALGO:

 

BLOOD TESTS?

 

 

SHAH:

 

BLOOD TESTS?

 

 

SLATER:

 

BLOOD TESTS FOR CELIAC AND

INFLAMMATORY BOWEL.

 

 

SALGO:

 

SO, AT THE END OF THE

DAY, DID THAT DOC GIVE YOU

A DIAGNOSIS?

 

 

SLATER:

 

UM, HE BASICALLY SAID,

YOU KNOW, "YOU PROBABLY HAVE

I.B.S."

 

 

SALGO: 

 

IBS IS IRRITABLE BOWEL

SYNDROME.

 

 

DROSSMAN:

 

IT'S AN INCREASED

SENSITIVITY OF THE BOWEL

TO VARIOUS KINDS OF THINGS.

IT COULD BE STRESS, COULD BE

FOOD, COULD BE PHYSICAL

ACTIVITY.

AND THE BOWEL REACTS IN MANY

DIFFERENT WAYS.

YOU CAN HAVE INCREASED MOTILITY,

CAUSING EITHER DIARRHEA OR

CONSTIPATION.

YOU CAN HAVE ABDOMINAL PAIN.

AND YOU CAN SOMETIMES HAVE OTHER

SYMPTOMS, LIKE BLOATING

AND THE LIKE.

 

 

SALGO:

 

ARE THERE DIFFERENT

KINDS OF I.B.S.?

 

 

DROSSMAN:

 

YES, YOU CAN SUBTYPE THEM

INTO THE MORE -- SHE SOUNDS LIKE

SHE'D BE MORE

CONSTIPATION-PREDOMINANT.

I THINK IT'S WORTH POINTING OUT,

AND I THINK THAT IT'S A

DIAGNOSIS YOU MAKE BY CRITERIA,

BY THE HISTORY, AND YOU DON'T

HAVE TO DO ALL THESE TESTS.

TESTS ONLY TELL YOU

WHAT'S NOT THERE.

 

 

HARRIS:

 

AND DID YOU HAVE ANY

BLOATING BEFORE, WHEN YOU WERE

HAVING THE ISSUES WITH

CONSTIPATION?

 

 

SLATER:

 

ABSOLUTELY, YEAH.

I LOOKED PREGNANT SOMETIMES.

 

 

HARRIS:

 

HER HISTORY, I

THINK THAT'S WHAT TIPPED IT.

IF SOMEBODY HAD TAKEN FIVE

MINUTES TO REALLY JUST SIT DOWN

AND TALK TO HER AND NOT FOCUS ON

THE ACUTE EPISODE, BUT HER

PREVIOUS HISTORY, SHE ALREADY

SAID THAT "SINCE I WAS YOUNG,

I'VE HAD BOWEL PROBLEMS."

AND HAD SHE SAID THAT TO ME,

THAT WOULD HAVE BEEN A TIP-OFF

TO START THINKING A LITTLE BIT

MORE ABOUT WHAT ELSE

IS GOING ON.

 

 

SALGO:

 

IS IT IN SOME WAYS A

DIAGNOSIS OF EXCLUSION?

 

 

DROSSMAN:

 

NO, I.B.S. IS A POSITIVE

DIAGNOSIS.

THERE ARE DEFINED CRITERIA.

THEY'RE CALLED

THE ROME CRITERIA.

THE CRITERIA ARE NOT THAT

COMPLICATED.

IT'S PAIN THAT'S ASSOCIATED WITH

A CHANGE IN THE FREQUENCY OF

THE BOWEL MOVEMENTS,

SUCH AS DIARRHEA OR

CONSTIPATION

OR THE CONSISTENCY OF THE STOOL.

AND THERE'S ALSO WHAT'S CALLED

RED FLAGS.

AND WHAT HAS BEEN DONE IS,

THERE'S BEEN RESEARCH TO

DETERMINE FIVE OR SIX ITEMS --

IF THEY'RE NOT PRESENT, THE

PREDICTABILITY OF HAVING I.B.S.

IS, LIKE, 98% TO 99%.

SO WHEN YOU SAY THEY'RE

 

 

SALGO:

 

NOT PRESENT, WHAT HAS TO BE

NOT PRESENT?

 

 

DROSSMAN:

 

BLOOD IN THE STOOL,

SIGNIFICANT WEIGHT LOSS,

FAMILY HISTORY OF CANCER OR

INFLAMMATORY BOWEL DISEASE --

 

 

SHAH:

 

ANEMIA.

 

 

DROSSMAN:

 

ANEMIA, AND ABNORMAL

PHYSICAL EXAM.

NOW, IF YOU DON'T HAVE ANY OF

THAT, YOU CAN JUST FOLLOW THE

PATIENT, BECAUSE DIAGNOSIS IS

SOMETHING YOU DO OVER TIME.

IF YOU KNOW THIS PERSON DOESN'T

HAVE TO GO TO THE EMERGENCY

ROOM, YOU KNOW WHAT'S GOING ON,

YOU TREAT IT, YOU SEE THEM BACK

IN THREE MONTHS, YOU CAN MAKE

DECISIONS DOWN THE LINE.

 

 

SALGO:

 

I WANT TO BE SURE WE

UNDERSTAND THAT, IN ADDITION TO

MAKING THE DIAGNOSIS, YOU DON'T

WANT TO MISS SOMETHING

WHICH COULD BE BAD.

SO WHAT ARE YOU RULING OUT

BEFORE YOU REALLY

NAIL THIS DOWN?

YOU'RE RULING OUT COLON CANCER.

WHAT ELSE?

 

 

DROSSMAN:

 

WELL, YOUR TESTS -- THE RED

FLAGS, YOU KNOW, IF YOU SEE

BLOOD IN THE STOOL,

CLEARLY KNOW WHERE TO GO.

 

 

SALGO:

 

THAT'S A RED FLAG

FOR CANCER.

 

 

DROSSMAN:

 

YEAH, YOU WOULD GO DOING A

COLONOSCOPY.

WELL, IN SOMEONE HER AGE,

PROBABLY MORE

INFLAMMATORY BOWEL DISEASE.

YOU DO WANT TO DO SOME

BLOOD WORK.

ONE OF THE THINGS WE THINK ABOUT

IS CELIAC DISEASE.

 

 

SALGO:

 

WHICH IS NOT I.B.S.

 

 

DROSSMAN:

 

IT'S NOT I.B.S., AND IT'S

TREATED DIFFERENTLY.

SO YOU TREAT THAT WITH

THE DIET.

 

 

SALGO:

 

OKAY, AND IF IT IS

I.B.S. -- NOT CELIAC DISEASE,

WHICH HAS CONSEQUENCES;

INFLAMMATORY BOWEL DISEASE,

WHICH HAS LONG-TERM

CONSEQUENCES -- WHAT ARE THE

LONG-TERM CONSEQUENCES OF

I.B.S.?

 

 

DROSSMAN:

 

WE DON'T HAVE ANY EVIDENCE

THAT IT DETERIORATES INTO

ANYTHING ELSE, BUT PEOPLE CAN

HAVE VARIATION IN THEIR SYMPTOMS

TO THE POINT -- SOME COULD --

THERE'S A WHOLE RANGE.

SOME COULD BE VERY --

PRACTICALLY DISABLED BY IT.

AND OTHERS HAVE OCCASIONAL

EPISODES ONCE OR TWICE A MONTH.

SO IT'S UNDERSTANDING HOW

SEVERE AND HOW PERMEATING THIS

CONDITION IS.

 

 

SALGO:

 

YOU WANT TO, IF I HEAR YOU

CORRECTLY -- I JUST WANT TO PUT

A BUTTON ON THIS.

YOU WANT TO RULE OUT THOSE

DISEASES THAT, IF LEFT

UNTREATED SPECIFICALLY WITH

SPECIFIC TREATMENTS FOR THEM,

CAN DO DAMAGE --

UP TO, AND INCLUDING KILL YOU.

I.B.S. IS A DISEASE WHICH

DOESN'T DO THAT, AND LONG-TERM

DAMAGE TO THE COLON IS

NEGLIGIBLE, WHATEVER THE DAMAGE

IS TO YOUR LIFESTYLE --

 

 

HARRIS:

 

YOU MAY FEEL LIKE YOU'RE

GOING TO DIE, BUT YOU'RE NOT.

 

 

SALGO:

 

ALL RIGHT, LET'S PAUSE FOR

A MINUTE.

I WANT TO SUM UP WHAT WE'VE BEEN

TALKING ABOUT BEFORE

WE LAUNCH AGAIN INTO THE FUTURE.

IRRITABLE BOWEL SYNDROME IS A

COMMON DISORDER.

IT AFFECTS THE LARGE INTESTINES,

AND THE CONDITION DOES NOT CAUSE

PERMANENT DAMAGE TO THE COLON.

IT'S IMPORTANT TO MAKE A

POSITIVE DIAGNOSIS OF I.B.S.

AND TO RULE OUT OTHER DISEASES.

ALL RIGHT, LET'S GET

BACK TO WORK.

WE'RE TALKING TO YOU NOW,

AND YOU HAVE I.B.S., ERIN.

SO YOU'VE HAD THIS DIAGNOSIS

NOW FOR QUITE SOME TIME.

ONCE YOU'D GOT IT, YOU WERE

TREATED WITH PEPCID, AND YOU

SAID THAT REALLY DIDN'T WORK

VERY WELL.

BUT WHAT HAPPENED NEXT?

 

 

SLATER:

 

I WAS TREATED WITH

HYOSCYAMINE AFTER -- AND I WAS

STILL 17, MAYBE 18 YEARS OLD

WHEN I SAW THAT SECOND

GASTROENTEROLOGIST, AND THAT'S

WHAT HE GAVE ME.

 

 

SALGO:

 

OKAY, WHAT'S

HYOSCYAMINE, BY THE WAY?

 

 

SHAH:

 

HYOSCYAMINE IS

AN ANTI-SPASMODIC.

 

 

SALGO:

 

OKAY, SO IT,

THEORETICALLY, AT LEAST, WOULD

KEEP THE COLON FROM GOING INTO

SPASM.

DID THAT WORK?

 

 

SLATER:

 

IT DID.

IT DID ACTUALLY WORK REALLY WELL

FOR PROBABLY ABOUT SIX MONTHS.

AND THEN I WENT OFF TO COLLEGE.

AND WHILE I WAS IN COLLEGE,

THAT'S ALL I USED -- THAT'S THE

ONLY MEDICATION THAT I WAS EVER

GIVEN, AND THAT'S THE MEDICATION

I USED --

 

 

SALGO:

 

AND DID IT WORK?

UM...IT WORKED FOR

A LITTLE WHILE --

I'D SAY FOR SIX MONTHS

TO A YEAR.

IT WOULD STOP THE SPASMING.

BUT THE PROBLEM IS, I'M

I.B.S.-C., SO IF YOU

STOP THE SPASMING --

 

 

HARRIS:

 

YOU GET MORE

CONSTIPATION.

 

 

SLATER:

 

YOU ALSO SHUT DOWN

THE BOWEL, YEAH.

 

 

SALGO:

 

SO THE ANSWER IS,

"NOT SO GOOD."

IT HELPED THE PAIN, BUT IT

WASN'T A GOOD --

HARRIS:

 

THAT WAS THE NEXT QUESTION I

WAS GOING TO ASK YOU…

 

 

SHAH:

 

DID THEY GIVE YOU ANY ADVICE

ON DIET?

 

 

SLATER:

 

NONE.

 

 

SHAH:

 

OR FIBER?

ANOTHER THING WHICH IS

VERY IMPORTANT IS LIFESTYLE

MODIFICATIONS.

 

 

SLATER:

 

NOTHING.

 

 

SHAH:

 

AND HOW TO EAT.

 

 

HARRIS:

 

EXERCISE AND WATER.

 

 

SHAH:

 

THESE ARE VERY FIRST THINGS.

 

 

SALGO:

 

SO THEY GAVE YOU SOME

PILLS, THEY DIDN'T REALLY GIVE

YOU A TREATMENT PLAN, DID THEY?

 

 

HARRIS:

 

I WOULDN'T EVEN HAVE STARTED

YOU WITH THAT AT ALL.

 

 

SALGO:WHAT WOULD YOU

HAVE DONE, LISA?

FIBER.

 

 

SALGO:

 

FIBER?

FIBER, FIBER, FIBER.

AND WATER, FOR DAYS.

AND THEN A DIET DIARY --

 

 

SHAH:

 

EXERCISE.

 

 

HARRIS:

 

TO FIND OUT HOW YOU EAT, WHEN

YOU EAT, WHAT YOU EAT.

AND EXERCISE, AS DR. SHAH SAID.

 

 

SALGO:

 

SO NOW YOU'RE IN

COLLEGE.

YOU STILL HAVE I.B.S.

 

 

SLATER:

 

I STILL HAVE I.B.S.

 

 

SALGO:

 

AND YOUR TREATMENT ISN'T

WORKING QUITE AS WELL

AS YOU'D LIKE.

TELL ME ABOUT THAT FIRST YEAR

IN COLLEGE.

WHAT WAS THAT LIKE?

 

 

SLATER:

 

IT WAS DIFFICULT.

LIVING IN A DORM,

IT WAS VERY DIFFICULT BECAUSE

I WAS EATING LESS AND LESS AND

LESS FOODS --

BECAUSE EVEN THOUGH NOBODY TOLD

ME TO MAKE A DIARY, YOU KNOW, I

BASICALLY DID THAT ON MY OWN.

EVERY TIME I'D HAVE PAIN, I

WOULD ASSOCIATE IT

WITH THE FOOD.

 

 

SALGO:

 

AND YOU'D CUT THAT

FOOD OUT?

 

 

SLATER:

 

AND THEN I WOULD CUT THAT

FOOD OUT.

 

 

SALGO:

 

AT THE END, WHAT WERE

YOU EATING?

 

 

SLATER:

 

SO, UM, IF WE FAST-FORWARD A

COUPLE OF YEARS, I WAS DOWN TO

ACTUALLY SIX FOODS

FOR ABOUT TWO YEARS.

BREAD, PEANUT BUTTER,

SOY CHEESE, PASTA, TOMATO SAUCE,

AND LACTAID MILK.

 

 

HARRIS:

 

OH, MY GOODNESS.

 

 

SALGO:

 

DR. DROSSMAN, I'M NOT EVEN

GOING TO JUMP IN HERE.

I'M GOING TO LET YOU

TACKLE THIS.

WHAT KIND OF A DIET IS THAT?

 

 

DROSSMAN:

 

WELL…BEFORE WE GET TO THE DIET, I

MEAN, SHE WAS NOT BEING FOLLOWED

BY ANYBODY.

BECAUSE PART OF THIS IS, YOU

COME -- I'M NOT GOING TO SAY

THIS IS TRIAL AND ERROR --

THERE ARE CONCERTED

ALGORITHMS OF HOW YOU TREAT

WITH MEDICATIONS AND OTHER

FACTORS, DIETARY --

THAT WASN'T HAPPENING.

SHE WAS KIND OF ON HER OWN.

SHE'S DEVELOPED WHAT'S CALLED

SITOPHOBIA, WHICH IS GREEK FOR

"FEAR OF EATING."

AND THIS CAN HAPPEN, BECAUSE IF

SHE EATS AND THAT STRETCHES THE

STOMACH AND PEPTIDES ARE BEING

RELEASED, IT STIMULATES THE

BOWEL, AND YOU GET PAIN.

SO SHE CONDITIONS HERSELF --

 

 

HARRIS:

 

ESPECIALLY WHEN IT'S

CHOCK FULL OF NUTS.

 

 

DROSSMAN:

 

AND THE BIG THING IS, PEOPLE

THINK IT'S -- YOU CAN'T EAT

A CERTAIN FOOD.

IT'S SOMETIMES JUST THE VOLUME.

AND PEOPLE JUST CUT BACK ON

EATING, AND THEY LOSE WEIGHT.

 

 

SALGO:

 

NOW, EMOTIONALLY,

GOING FORWARD, NOW, YOU'RE IN

COLLEGE, YOU CAN'T EAT WITH THE

OTHER KIDS, I'M GUESSING,

AT THAT POINT.

 

 

SLATER:

 

RIGHT.

 

 

SALGO:

 

WHAT'S IT ALL LIKE?

 

 

SLATER:

 

MY FIRST TWO YEARS, I LIVED

IN A -- WELL, FIRST YEAR, I

LIVED IN A DORM, AND THE SECOND

YEAR, IT WAS KIND OF LIKE A DORM

BUT MORE LIKE AN APARTMENT.

AND SO THEY PROVIDE THE FOOD

FOR YOU.

SO IT'S, YOU KNOW --

 

 

SALGO:

 

OH, THE DREADED

MEAL PLAN.

 

 

SLATER:

 

THE MEAL PLAN.

AND SO I COULD EAT WITH OTHER

PEOPLE, BUT I WAS EATING

CONSTANTLY THE SAME FOODS OVER

AND OVER AGAIN.

 

 

SALGO:

 

BUT IT SOUNDS LIKE --

I'M CATCHING A SENSE HERE THAT

YOU WERE DIFFERENT, THAT

EVERYBODY ELSE WAS OUT THERE,

EATING THE MEAL PLAN, GOING OUT,

HAVING A ROLLICKING GOOD TIME --

 

 

SLATER:

 

RIGHT.

 

 

SALGO:

 

AND YOU WERE BUSY TAKING

LITTLE TINY BITES OF FOOD, AND

EVERY TIME YOU DID, YOU FELT

AWFUL.

 

 

SLATER:

 

RIGHT.

 

 

SALGO:

 

WHAT DID THAT DO

TO YOUR SOCIAL LIFE?

 

 

SLATER:

 

I HAD NO SOCIAL LIFE

WHEN I WAS IN SCHOOL.

SENIOR YEAR, YOU KNOW, IT'S

SUPPOSED TO BE THE PARTYING

YEAR.

NO, THAT DIDN'T HAPPEN, EITHER,

BECAUSE I WAS SICK.

WHEN YOU'RE IN COLLEGE, YOU'RE

SUPPOSED TO, YOU KNOW, MEET NEW

PEOPLE AND GO OUT AND

EVERYTHING LIKE THAT.

I WAS BASICALLY -- I WENT TO

CLASS, I CAME HOME, I STUDIED, I

WENT TO SLEEP, TOOK WHATEVER

HyoMax I HAD TO TAKE, BECAUSE I

WAS IN PAIN BY THE END

OF THE DAY.

WOKE UP, REPEAT, OVER AND OVER

AGAIN.

 

 

SALGO:

 

THIS IS

AN EMOTIONAL TOLL.

THIS IS NOT A PHYSICAL TOLL

RIGHT NOW.

 

 

SHAH:

 

YES, THE COMMUNICATION

BETWEEN THE PHYSICIAN AND YOU

IS BROKEN DOWN.

 

 

SALGO:

 

SO THIS GOES TO WHAT

YOU WERE TALKING ABOUT AND WHAT

YOU ALLUDED TO AS WELL.

NOBODY IS TELLING HER HOW TO

DEAL WITH A DISEASE WHICH IS

WELL DESCRIBED, IT'S IN THE

LITERATURE, WE KNOW HOW TO DEAL

WITH I.B.S., BUT NOBODY'S

TELLING YOU HOW.

WELL, WHAT HAPPENED NEXT?

 

 

SLATER:

 

THIS WAS MY SENIOR YEAR

AT PENN STATE.

I'M EATING SIX FOODS...

AND BASICALLY MENTALLY

DETERIORATING.

I WAS HAVING HORRIBLE, HORRIBLE

ANXIETY --

 

 

HARRIS:

 

 

AND, SEE, HERE'S THE SAD PART

ABOUT THIS WHOLE VERY, VERY,

VERY, VERY SAD STORY,

IS THAT REALLY, HER PRIMARY CARE

PHYSICIAN SHOULD HAVE BEEN ABLE

TO COUNSEL YOU AND TO TALK TO

YOU AND MAKE SURE THAT

YOU HAD APPROPRIATE FOLLOW-UP.

ONE OF THE MOST IMPORTANT THINGS

WITH I.B.S. PATIENTS IS TO LET

THEM KNOW THAT

THEY'RE NOT ALONE

AND THAT THERE IS SUPPORT, AND

MAYBE THE PAIN ISN'T GONE YET,

BUT WE'RE WORKING THROUGH THIS

TOGETHER, AND THIS IS THE PLAN

OF ACTION THAT'S IN PLACE.

 

 

SALGO:

 

NOW, YOU KNOW, WE'RE

GOING TO BREAK ONE OF THE RULES.

WE RARELY HAVE THE CAREGIVER ON

THE SAME SHOW AS THE PERSON

WITH THE PROBLEM.

BUT SOMEONE HAD TO LISTEN

TO HER.

YOU WERE THAT PERSON.

WHAT DID YOU DO?

YOU SAW HER.

 

 

DROSSMAN:

 

YEAH, WELL, I MEAN, I THINK

THAT FIRST OF ALL, SHE WAS

IN A LOT OF DISTRESS.

I MEAN, IT WAS ALMOST LIKE TWO

CONDITIONS NOW, I MEAN, IT WAS

THE BOWEL SYMPTOMS, THE PAIN,

WHICH WAS THE PARAMOUNT THING,

IT WAS THE BEHAVIOR OF NOT BEING

ABLE TO EAT.

IT WAS THE EMOTIONAL DISTRESS OF

NOW FEELING REALLY OUT OF

CONTROL AND VERY HELPLESS AND, I

THINK, SCARED.

YOU KNOW, AND I THINK THAT'S ONE

OF THE THINGS THAT I DID DO, I

SPENT A LITTLE BIT OF TIME

ASKING HER, WHAT ARE HER

WORRIES, WHAT DOES SHE THINK IS

HAPPENING, WHAT DOES SHE WANT?

AND TRY TO GET A KIND OF PROFILE

OF WHAT IT'S BEEN LIKE FOR HER,

WHICH GIVES ME THE INFORMATION,

ASIDE FROM TREATING THE PAIN.

 

 

SALGO:

 

SO WHAT I'M HEARING

IS THAT THERE WERE TWO -- TWO,

IF YOU WILL, TWO FORKS HERE.

ONE IS, YOU'VE GOT TO GET SOME

MEDICATION THAT'S GOING TO HELP

YOU WITH THIS AND FIX YOUR DIET.

AND SOMEBODY'S GOING TO HELP YOU

WITH YOUR EMOTIONAL WELL-BEING.

ISN'T THAT RIGHT?

I MEAN, SHE SOUNDS LIKE SHE'S IN

REAL PAIN PSYCHOLOGICALLY.

 

 

HARRIS:

 

 

ABSOLUTELY.

 

 

SHAH:

 

COPING WITH THIS, WITH YOUR

STRESS, IS -- SHE NEEDED

SUPPORT, AND NOT ONLY SUPPORT,

MAYBE SHE MAY NEED SOMEBODY TO

GUIDE HER WHICH DIRECTION TO GO.

 

 

SALGO:

 

AND YOU WERE THERE.

SO WHAT WAS YOUR JUDGMENT HERE,

WHAT NEEDED TO BE DONE?

 

 

DROSSMAN:

 

WELL, I THINK WE HAD TO

ADDRESS THE PAIN, AND I THINK

HER CONSTIPATION MIGHT HAVE BEEN

TO THE POINT WHERE FIBER COULD

BE GOING THE OTHER WAY, BECAUSE

SOMETIMES IF YOU'RE TOO

CONSTIPATED, THINGS JUST GET

PLUGGED UP.

I THINK WE DID MiraLAX FOR THE

CONSTIPATION, AND THEN I PUT HER

ON AN S.N.R.I. AGENT.

 

 

SALGO:

 

WHAT'S AN S.N.R.I.?

 

 

DROSSMAN:

 

IT'S A TYPE OF ANTIDEPRESSANT

THAT ALSO CAN WORK FOR PAIN.

 

 

SALGO:

 

OKAY, SO YOU'RE GIVING

AN ANTIDEPRESSANT FOR PAIN?

WHY WOULD AN ANTIDEPRESSANT WORK

FOR PAIN AND IRRITABLE BOWEL

SYNDROME?

 

 

DROSSMAN:

 

THIS IS A LOT OF WORK WE'VE

BEEN INTERESTED IN.

THE ANTIDEPRESSANTS -- FIRST OF

ALL, ANTIDEPRESSANTS, EVEN IN

LOWER DOSES THAN TREATING MAJOR

DEPRESSION, WORK ON THIS,

WORK ON I.B.S.

THEY WORK IN THE BOWEL BY

CONTROLLING MOTILITY, OKAY, AND

THEY CAN WORK IN THE BRAIN BY

CONTROLLING THE PAIN REGULATORY

SYSTEM.

 

 

SALGO:

 

OKAY, SO THEY'RE

AFFECTING THE WAY THE BOWEL IS

ACTUALLY MOVING.

AND HOW DO THEY DO THAT?

WHY DOES AN ANTIDEPRESSANT

AFFECT HOW THE BOWEL MOVES?

 

 

DROSSMAN:

 

BECAUSE THE NERVES OF THE

BOWEL ARE PRETTY MUCH THE SAME

BEGINNINGS AS THE NERVES

OF THE BRAIN.

SO SEROTONIN IN THE BRAIN, BUT

THERE'S MORE SEROTONIN

IN THE BOWEL.

 

 

SALGO:

 

THAT'S THE CHEMICAL THAT

MAKES THE BOWEL MOVE.

AND SO YOU'RE TRYING TO AFFECT

SEROTONIN LEVELS IN THE GUT.

 

 

DROSSMAN:

 

IN THE GUT, BUT THAT'S NOT

THE WHOLE PICTURE.

THEN I WANT TO DEAL WITH THE

BRAIN'S -- YOU KNOW, THE --

IN THE '60s, WE BEGAN TO REALIZE

THAT PAIN IS NOT JUST A ONE-WAY

STREET.

THE BRAIN CAN SEND DOWN SIGNALS

TO MODIFY IT AND BLOCK IT.

AND YOU CAN DO THIS WITH

HYPNOSIS, YOU CAN DO THIS WITH

MEDITATIVE TREATMENTS, AND YOU

CAN ALSO DO IT WITH

ANTIDEPRESSANTS, BECAUSE THOSE

ANTIDEPRESSANTS ACT TO BLOCK THE

PAIN COMING UP.

 

 

SLAGO:

 

HOW DID ALL THAT

WORK FOR YOU?

 

 

SLATER:

 

OKAY, SO, AT THIS POINT, I

WAS TAKING -- I WAS OVERDOSING

ON HYOCYAMINE -- I MEAN,

OVERDOSING.

SO I TOOK THE ANTIDEPRESSANT.

WITHIN A WEEK AND A HALF,

I WAS OFF HyoMax.

 

 

HARRIS:

 

SO HERE'S

THE RED FLAG FOR ME.

SOMEBODY IS CONTINUALLY

PRESCRIBING HyoMax AND NOT

SEEING HER.

 

 

SALGO:

 

NOW YOU'RE FEELING

BETTER --

 

 

SLATER:

 

YES.

SO DID YOU RUN RIGHT OUT AND

HAVE A STEAK AND EGGS

AND BREAD AND LOTS OF FIBER,

OR WHAT?

 

 

SLATER:

 

OH, NO, NO, NO, NO, NO.

 

 

SALGO:

 

HELP ME HERE, WHAT HAPPENED?

 

 

SLATER:

 

SO MY GOAL -- I HAD NO -- I

DIDN'T ANTICIPATE, YOU KNOW,

GETTING ALL THE WAY BETTER.

I JUST WANTED TO BE ABLE TO EAT

A LITTLE BIT MORE FOOD AND

MAYBE SIT DOWN AND HAVE LUNCH --

EVENTUALLY I WAS GRADUATED, AND

WHEN I WAS WORKING -- TO HAVE

LUNCH WITH MY COWORKERS.

THAT'S ALL I WANTED.

AND BASICALLY, THE FIRST TIME I

WENT TO THE GROCERY STORE, I

WENT TO ORDER THE DELI TURKEY,

AND I WAS SO SCARED, I ALMOST

FAINTED IN THE GROCERY STORE,

BECAUSE I WAS SO SCARED TO ORDER

FOOD, TO THINK ABOUT FOOD, TO

EAT FOOD, THE FOOD BE NEAR ME, I

WAS TERRIFIED.

 

 

DROSSMAN:

 

HOW MANY YEARS WAS IT SINCE

YOU ATE, REALLY ATE?

 

 

SLATER:

 

UM...FIVE YEARS.

 

 

HARRIS:

 

SO SHE'S DEVELOPED A

SECONDARY EATING DISORDER DUE TO

THE I.B.S.

 

 

SALGO:

 

THIS WAS THAT PHOBIA.

 

 

DROSSMAN:

 

SITOPHOBIA.

 

 

SALGO:

 

THAT YOU WERE TALKING ABOUT.

ALL RIGHT, I WANT TO PAUSE FOR A

MOMENT AND SORT OF SUM UP WHAT

WE'VE DISCUSSED IN THIS SECOND

PORTION OF THE BROADCAST.

WHILE IRRITABLE BOWEL SYNDROME

CAN BE BOTH PHYSICALLY AND

EMOTIONALLY DISRUPTIVE TO A

PERSON'S LIFE, THERE ARE GOOD

TREATMENTS AVAILABLE.

ONCE THE SYMPTOMS HAVE IMPROVED,

MOST I.B.S. PATIENTS FIND THEY

CAN LEAD NORMAL, BETTER LIVES,

BUT THE TRICK IS GETTING THE

DIAGNOSIS, FINDING SOMEONE WHO

ACTUALLY TALKS TO YOU --

DOESN'T GIVE YOU A PILL AND

KICKS YOU OUT THE DOOR.

 

 

SLATER:

 

YEAH, THAT'S PRETTY

DIFFICULT.

 

 

SALGO:

 

BUT THAT'S WHERE YOU ARE NOW.

HOW ARE YOU DOING?

 

 

SLATER:

 

I AM GREAT!

YEAH, I AM -- I'M -- I'M A

DIETICIAN, I TALK ABOUT FOOD

ALL DAY. [Laughs]

 

 

SALGO:

 

WHAT ADVICE DO YOU HAVE FOR

PEOPLE OUT THERE WHO MIGHT HAVE

THESE SYMPTOMS, WHO THINK IT

MIGHT BE IRRITABLE BOWEL

SYNDROME?

WHAT SHOULD THEY DO?

 

 

DROSSMAN:

 

WELL, TO START, IN THE

DIAGNOSTIC WORK-UP, THERE ARE

CRITERIA.

AND SECOND, THE BIG ISSUE IS,

YOU KNOW, LISTEN TO THE PATIENT.

IT'S OSLER WHO SAID,

"90% COMES FROM THE HISTORY."

WE ALL KNOW THAT.

YOU KNOW, YOU SAID SOMETHING

VERY IMPORTANT BEFORE, THAT --

THAT SHE WAS TELLING THE STORY.

IT'S NOT LIKE SHE WASN'T

TELLING -- YOU DIDN'T

HAVE TO DIG.

THIS WAS NOT A MYSTERY.

IT WAS JUST A MATTER OF

ACCEPTING IT.

AND I THINK THERE'S ALSO AN

ISSUE SOMETIMES WITH DOCTORS'

NOT ALWAYS BELIEVING IN I.B.S.,

AND THAT CAN BE A FACTOR.

 

 

SHAH:

 

I THINK MOST PHYSICIANS

ARE VERY UNCOMFORTABLE

DEALING WITH I.B.S.,

IN MY OPINION.

AND THE COORDINATED APPROACH IS

NOT THERE, YOU KNOW, TO HAVE A

DIETICIAN AND A PSYCHOLOGIST

WORK -- OR A SOCIAL WORKER

WORKING WITH YOU, SO THAT WE CAN

DIG INTO THESE PSYCHOLOGICAL

ISSUES.

 

 

SLAGO:

 

LISA, LAST WORD

IS YOURS.

 

 

HARRIS:

 

SO, FOR THE

PATIENT, THE SYMPTOMS ARE YOURS,

AND THEY'RE REAL, AND YOU NEED

TO MAKE SURE THAT YOU'RE BEING

HEARD, AND IF YOU'RE NOT BEING

HEARD, YOU FIND -- YOU KEEP

SEARCHING UNTIL YOU FIND SOMEONE

THAT IS HEARING YOUR STORY.

 

 

SLAGO:

 

ALL RIGHT.

LOOK, I WANT TO THANK ALL OF OUR

CLINICIANS FOR JOINING US TODAY.

BUT ESPECIALLY YOU.

THANK YOU FOR JOINING US.

UNFORTUNATELY,

WE'RE OUT OF TIME.

I HOPE YOU AT HOME CONTINUE THE

CONVERSATION ON OUR WEB SITE.

THERE, YOU'RE GOING TO FIND THE

ENTIRE VIDEO OF THIS SHOW, AS

WELL AS THE TRANSCRIPT AND LINKS

TO RESOURCES.

THE ADDRESS IS

SecondOpinion-tv.org.

THANK YOU ALL

FOR WATCHING.

I'M DR. PETER SALGO, AND I'LL

SEE YOU NEXT TIME

FOR ANOTHER "SECOND OPINION."

 

 

 

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