- 4 months ago
John DeBella speaks with Dr. Gregory Seltzer, Gastroenterologist. Subjects include GI conditions including probiotics, diet, swallowing, bloating and reflux.
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00:00Hi, I'm John Develo from WMGK, and I'm here with Dr. Gregory Seltzer, who is a gastroenterologist.
00:06Hiya, Gregory.
00:07Hi, John. Thank you for having me.
00:08Gregory, what made you specialize in this field?
00:11You know, in reality, it is actually a wonderful field.
00:14I have a mixture of patients that I see once, and I don't see them again for 10 years.
00:20And then I have a whole lot of patients with chronic illnesses like Crohn's disease that I see regularly,
00:27and I feel like I get to help people a lot.
00:30So I get some days I'm doing procedures all day long, so I'm not just stuck in the office.
00:35Some days I'm in the hospital with really sick people.
00:39Some days I'm in the office with sometimes sick, sometimes not so sick,
00:43but either way I can get to help people in a lot of different clinical settings,
00:45which, you know, I like the varied landscape of my job.
00:49I think it's the best part of gastroenterology.
00:51As an enteroologist, I mean, you're dealing with heartburn and you're dealing with stomach pains,
00:55plus you're dealing on the severe side with IBS and Crohn's.
01:00What causes these things, and at what point should you be calling a doctor?
01:06I mean, those are great questions, and, you know, we can talk about them for hours.
01:10I'd let you know, why don't we take a step back,
01:12and why don't we talk about, you know, things that cause general stomach aches and upset stomachs.
01:18And, yes, I mean, IBS is a real diagnosis.
01:21We can talk about when to call your gastroenterologist, which is very important,
01:25and we're definitely not going to forget that.
01:27But, you know, generally for most people, right, who have occasional bloating,
01:31who had maybe a workup, but they still don't feel great,
01:35and they know it's related to their diet.
01:36I mean, there's a couple things for people to realize is there is no one diet that works for everyone and their symptoms.
01:42And that's, a gastroenterologist usually can help you try to figure out based on,
01:47and I use your symptoms, like what is your biggest complaint, right?
01:52Is it your bowel movements?
01:53Is it gas and bloating?
01:54Is it, you know, heartburn or indigestion?
01:56Because some of the dietary recommendations will change,
01:59and it can be very complicated at times.
02:04There are certain foods that are very good for you,
02:07but they can cause a lot more gas and bloating.
02:10I mean, you know, one of the favorite things that we love to talk about is gas and flatulence, right?
02:15Everyone complains about it because we all somehow think it's abnormal, and it's completely normal.
02:20But healthy foods cause a lot of gas and flatulence, but they also cause a lot of bloating.
02:25All right, so you've got bacteria, you've got gut bacteria, you've got probiotics, you've got prebiotics, right?
02:30But break them down, what do probiotics and prebiotics deal with?
02:36Sure, and I tend to keep it pretty simple.
02:39I mean, I generally say, people say to me, well, what's the best probiotic?
02:42I mean, as if we're like hiding it from them.
02:44And now I say the one that helps you is the best probiotic,
02:47because there are so many different types of probiotics.
02:50And a lot of times, you know, for instance, the one that I would say is,
02:53and I don't, you know, I don't want to throw out brands,
02:55but, you know, especially because I'm about to say something negative about it,
02:57but the one that I would say is probably the most commonly used,
03:01at least in my practice, you know, amongst my patients and my patients love,
03:05I personally know what I can't take, you know?
03:07So I think we all have different makeups.
03:09And I don't think we've ever really figured out a way to figure out
03:12what probiotic would be better for you.
03:14So unfortunately, it is a little bit of trial and error.
03:16I do encourage people not to spend too much money on them.
03:19They can get very pricey.
03:21And I don't think it's necessarily necessary.
03:23When you talk about prebiotics, well, and there are probiotics in certain foods like yogurts.
03:28But again, my theory on yogurts is you're either a yogurt eater or you're not.
03:34You know, for me to prescribe a yogurt every day is on somebody, you know, it's like,
03:39you know, if I can get you to take a probiotic every day, if I want, you know,
03:42that's usually a win.
03:44It's a lot harder to convince somebody to take a yogurt every day.
03:48I've got to tell you, I appreciate the way you guys go about dealing with the patient
03:52and dealing with the care for something that a lot of people are uncomfortable with.
03:57Correct.
03:57And that's, and hopefully your doctors, you know, do.
04:00And I know a lot of mine will continue to work, you know, with their patients and stuff.
04:04But it's funny.
04:05I mean, you know, let's go back to the FODMAP diet, right?
04:08When you talk about dairy yogurt, it's, you know, dairy has lactose, which is, you know,
04:14a lot of people, they're lactose intolerant.
04:16You know, well, yogurts and probiotics are good for me.
04:19Yeah, but you may also be sensitive to the dairy in it.
04:22So it's a lot more complicated than just like, oh, you know, I heard Dr. Greg Seltzer talking
04:27on the radio.
04:28I'm going to, you know, I'm going to go start eating yogurt.
04:30It could actually make some people worse.
04:32And that's kind of where the fine tuning comes in.
04:35And hopefully your doctors can help you.
04:37So with all of that, when is it time to call a GI doctor?
04:40Great question.
04:41And there are definitely some red flags in gastroenterology.
04:44And it, it kind of almost scares me sometimes when people mention them and act like, you
04:48know, it's normal because a lot of people do think it's normal.
04:52Number one, I mean, you know, on the list when, you know, when I think about this is,
04:57is trouble swallowing.
04:59I have, I meet people who are in their thirties and forties who say, yeah, I have trouble swallowing
05:05food gets stuck, but it's been going on forever.
05:07It's normal for me.
05:08And you kind of, again, that's my, I was like, you know, it's not normal.
05:13It doesn't mean it's something bad, but it could be, but it definitely could be something
05:18also very treatable.
05:20And, and you need to see a gastroenterologist.
05:23You need to be evaluated.
05:24But I do, I find it amazing how many people have trouble swallowing where I meet in the
05:29emergency room setting with food stuck in their esophagus.
05:31And you find out they've been having trouble possibly for years and, and they never sought
05:36medical attention for it because they thought it was normal for them.
05:40The other thing, you know, people talk about reflux all the time.
05:44Every one of us, you know, eat too many wings, you know, eat too much pizza, eat, you know,
05:51Thanksgiving dinner, a couple of glasses of wine laid out on the couch and we get a little
05:54indigestion or heartburn.
05:56That's usually okay.
05:57Right.
05:57I mean, that's usually normal for people.
05:59But if it's happening regularly, recurrently, several times a week, if you're taking some
06:04medicines over the counter, but, you know, you're not able to come off those medications
06:07or, you know, you know, or it continues to happen despite the medicines for sure, then
06:14you definitely need to seek medical attention and contact the gastroenterologist, not necessarily
06:19emergently, but you definitely need to get that evaluated and find out why that's happened.
06:24You know, understand a weight loss.
06:26Americans are not very good at losing weights.
06:28If we're losing weight and we're not trying, um, you need to be evaluated.
06:31Um, any kind of pain, I mean, if you're having pain in your stomach or, um, you know, chest,
06:38I prefer you to see cardiology first just to make sure, but if you're having pain, it
06:42needs to be evaluated and it should require a change or problems with your bowels, right?
06:47If it's a different consistency, if it's diarrhea, constipation, and it's not normal for
06:53you, it's not normal.
06:54Now, again, if you ate something bad, you have one or two days of diarrhea and it goes away.
06:59Okay.
06:59You know, do you need to call a GI doctor?
07:01Probably not.
07:02But if you're, if you're having problems, if it's happening recurrently, then definitely,
07:07you know, you need to pick up the phone and, uh, or go online, um, you can make appointments
07:11right online and, uh, and be evaluated.
07:14But, and also along with weight loss, the number one red flag in gastroenterology is bleeding.
07:20Okay.
07:20Um, you know, the two biggest red flags are bleeding and weight loss.
07:23And if you have bleed, you know, I like to say bleeding is never normal.
07:27Of course, you know, a lot of people come to me and say, well, it's just hemorrhoids
07:31or, and just, you know, I mean, they assume, you know, yes.
07:35I mean, you know, when you come to me with rectal bleeding, I too hope it's hemorrhoids
07:38and there's other benign conditions that cause rectal bleeding, but you do need to get it
07:42evaluated because it's never normal.
07:45Let's talk about colon cancer and the importance of colonoscopies, or as I like to call them the
07:50best nap ever, right?
07:52What are the signs?
07:53When should somebody be doing this?
07:55Well, what age should they start at?
07:57And what is the process and the prep?
08:00When you talk about colonoscopy, it's important to understand it is really the gold standard
08:03when you talk about colon cancer screening.
08:05And there are other options and ways to screen for colon cancer.
08:10Um, a lot of people have seen commercials for, you know, uh, you know, a mail away box,
08:15can test your stool for blood.
08:16And, um, you know, also just checking your stool for blood every year is also another
08:20way to screen for colon cancer.
08:23The problem is what, what separates colonoscopy and which makes it the gold standard, as opposed
08:28to any of the other testing is it's not just a screening test, right?
08:33A screening test by definition is designed to find cancer before you have symptoms.
08:38So it's easier to treat it.
08:40It's also a preventative test.
08:42When we're doing colonoscopies, we're looking for polypsies gross in the colon.
08:47At every colon cancer begin as these growths called polyps.
08:50So if we take out a polyp in your fifties or forties, we prevent that polyp from turning
08:56into the cancer in your sixties and seventies.
09:00There was actually a study in 2017 where they kind of looked at some of the effectiveness
09:04of colonoscopy.
09:04And they actually found that colon cancer is actually declining in the 70 year old population
09:09having colonoscopies.
09:11And, you know, they're basically said it's working.
09:12The problem is the overall rate of colonoscopy of colon cancer was going up and they found
09:19people were getting diagnosed younger and younger.
09:22Um, the recommendations now for most societies is to begin screening and most insurances are
09:30paying beginning at age 45 now, because again, we want to find the polyps before they turn
09:36into cancer.
09:37Makes it a lot easier to treat.
09:38And we, we can actually prevent colon cancer by doing a colonoscopy at 45.
09:43I got to tell you, I don't know what is better.
09:44That delicious drinker eating all that jello.
09:47And they do have smaller volume, you know, perhaps where you just drink water, some pill
09:52preps out there.
09:53Um, you know, and your gastroenterologist can certainly go over some of the options.
09:57Um, there's, uh, so, I mean, yes, the prep, the problem is no matter what we give you,
10:03the outcome's the same, right?
10:04We can't make stool disappear.
10:06It has to, uh, it has to come out.
10:09So we have to make you sick, um, you know, feel a little sick and give you a little diarrhea.
10:13So, you know, that is definitely the most unpleasant part of the procedure, but you know,
10:17you are sedated for the procedure.
10:18You won't feel a thing.
10:19How many office locations do you have and how easy is it to make an appointment?
10:24At Virtua GI and Digestive Health, we have over 40 providers with 19 office locations throughout
10:31South Jersey.
10:32And, and we do procedures at multiple different surgical centers.
10:35Um, very convenient for people.
10:37With all those locations, I mean, the process has got to be easy.
10:41I mean, I've been through this a number of times myself, and I got to tell you, you guys
10:45make it as easy as all get out to get an appointment and to get this done.
10:50You don't even need to, if you don't want to, you don't even need to see the doctor.
10:54You don't need to meet the doctor before the procedure.
10:56Um, people are busy, right?
10:58Um, we have a fast track program where people want to, you know, sign up as long as they
11:04qualify, they have to be healthy, meet certain criteria.
11:07They have to be of age, right?
11:08They can't say, Oh, I want to get it done at 35 just because I want to be super safe.
11:13Um, you know, they have to meet certain criteria, but if you meet,
11:15the criteria, you can just schedule your colonoscopy and you can, you'll get the instructions
11:20and you'll meet your gastroenterologist the day of the procedure.
11:23Now, the easiest way to find out more is go to virtua.org backslash gut health and all
11:28of the answers you need are going to be right there.
11:31Thank you so much for coming on today, Dr. Seltzer.
11:33Thank you, John, for having me.
11:35It was great speaking with you.
11:36Well, it was great talking to you as well, Greg.
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