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Logo of AMEN 2015: CrossTraining

CrossTraining With the Latest in GI

Joe Kretschmar

Description

This seminar will review some of the notable advances in hepatology and GI as per the ACP, but with an emphasis on how to evaluate these advances from the perspective of a physician trying to be a medical missionary. The presenter will discuss how he tries to bring Christ and His healing into the encounter.

 

Objectives:

  • Teach participants how to pick out what is important in the medical literature
  • Identify the important recent studies in GI according to the ACP
  • Discuss ways to move the encounter toward Christ’s healing methods 

Presenter

Joe Kretschmar

Gastroenterologist in Greeneville, Tennessee

Conference

Recorded

  • October 30, 2015
    4:15 PM
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OK My name is joke right you are as you can see. I'd thought I'd start with some disclosures. I'm aghast for all ages and Greenville Tennessee with Tacoma Medical Associates But most importantly and. This is something that's very important to me I'm actually a certain Jesus Christ and want to be. Have that clear to all my patients when they come to me that that is very important to me. So before we start any further. Let's our heads for prayer. Father have we've heard a that had this time. You may be lifted up. That everything that is said here. May be to your honor and glory. We pray this in Jesus' name. Even. So I started thought I'd start with a patient encounter. This is a six year old lady who was overweight which is not uncommon in where I'm coming from. Very nice looking lady very pleasant. Very intelligent. But she had had Donald Payne. Not something I see a lot as a guest for all just. She had a normal liver enzymes which is fairly common. She. She was over fifty and she not had a screening call and ask to be she had a some pains in constipation and no energy and she didn't have the energy to finish her day at work every day. And that really distressed her and she just had multiple complaints along those lines. So being a gastroenterologist we discussed what to do about this. We ordered some tests to find out what's going on with their liver. I thought it was probably going to be fatty liver but we need to make sure wasn't some other issues. Side look in her stomach and a colon to an ultrasound. And then we discussed. What to do for her sentence I said Would you like to hear. Some things you can do in the meantime while we set these things up. Things you can do to try to minimize these symptoms. And so you can get some help with. What's bothering you. So I presented to her something that I've been presenting to many of my patients. And so I told her right up front I said you know. I'm going to try to persuade you or convince you they look at me and they kind of look strange. At saying I'm trying to convince you and. So I may or may not succeed but let me see if I can try. So I started with this OK Would you agree with me that every machine. You can think of. Runs on fuel. I go yeah. Would you agree that it's going to run best if it runs on the fuel is designed to run on rather than you would you deciding to put whatever you jolly well want to in there. I had one patient tell me. You know in my chains I supposed to have gas and oil mixture I just put straight gas and burn the thing up. Well. Thus they grieve. OK next question I asked them Would you agree with me. That when you swallow. Once you swallow. What ever you eat or drink for your body at that time that's going to be your fuel cycle Yeah so I say OK. So what's the best fuel for humans I said you can read ten different books of probably get twelve different answers. So what's the best fuel. I said you know I came across a simple consonantal Mike Tindall like simple ideas. So there's the concept I came across the concept was. The way to know if a food is good for you is. Whatever food has the most nutrition in it. And the fuels hunt for some says and it per calorie. That's the best food. So what food is I said actually we know the answers are been studied in published in medical examiner the answer the most increases food turns out to be the food that grew from the earth. Greens in factual fruits. Beings whole grains nuts and seeds. Unless until it's a very big. Unless unless you take that very food. And you put a factory. One comes out the other end they've been processing it so they've been taking out nutrition. Putting additives in which aren't good for you didn't rule. So when it comes out the other in his not good for you anymore it's good for the factory owner. And they said well it's and then there is another concept. The same principle applies to take foods a group from here. And you feed it to an animal. By the time you eat the animal. You've lost nutrition compared to where you started from. Plus if you think about it. That animal as it's living gets exposed to who knows what it could be heavy metals pesticides radiation. Fungus bacteria viruses and a body. I mean and. She's not your head by this time said. So not only have you lost nutrition you added talks and so it's not your dog and that animal or even what the animal produces we're talking about the dairy the milk the G.D.S. that IP. Not as good as what you from your the originally. Because he goes yeah. Because you're saying. So basically what I told him I'm trying to suggest what you want to eat. Is the food as close as you can hope to from the earth. But then I said to her. May I now share with you. What persuades me personally that this is the best way to eat. But it's my personal opinion there share that with you. You know. They'll let you share with you that you know if you asked that to let you share their the doctors also them to tell Doug No I don't want to share what your opinion is not going to say that to you. They actually let you. So I said OK. But now in the interest full disclosure. I have to tell you I believe we have a God who created this. And we're I'm working in East Tennessee lot of people believe that so that's actually kind of nice. They said. And you know what else. He actually loves us I happen to think that is way cool. He actually loves us. He wants us to be in good hell. And he gave us His Word the Bible to instruct us. So he goes yeah. I see that. So OK From that perspective see if this makes sense. When God made our very first parents. Adam and Eve. He put them in the perfect ideal location gardening. And if you read the very first chapter in the Bible in Genesis one verse twenty actually tells us what he came to eat. It was fruits. Grains nuts seeds. And the tree of life that's actually pretty cool. That was very important thing. They got the the tree of life. But then they sent you read about that and Chapter three of Genesis. And so God can now The Guardian Why do that with the just trying to be mean. No he didn't want them continuing to eat from the Tree of Life and living your life dissenters. So she understood that. I said OK. So basically in chapter three guys hunger consequences. Yes you're going to die. You're going to earn your keep from the sweat of your brow that mean you're going to work towards it says was in your life that means you can have difficulties going to paying with their children be also said. Now you're going to eat the planet. The field. So what does that mean. What that means is you're not just going to eat. What the plant produces I did go around issue just eating stuff off. But that's all they had to do. But now says you're also going to now. Eat the plant itself so forget what do eat their roots. Things like potatoes and be sin nine years and carrots right. What you eat there stands things like asparagus and broccoli and brussel sprouts and all that that the stuff. What we are leaves Well that's all the greens from the south I think so he got the idea. And understand that. I said. So basically what we're saying is that's what they got to eat. At that time. And eating that way at that time. People will be nine hundred plus years. But here's where a problem came in they start to turn their back on and reject God So can you imagine giving someone who has rejected God. Nine hundred plus years to live. You know someone like Hitler Stalin to you name the bad guy you know. They go out it's really bad yeah. Well it was that's why the flood came. Now after the flood. God knows. People can't handle living one hundred plus years they get away too much mischief they just they can have and I'm telling her all this. And he said God also knew that there's a biblical principle. The principle is. If you kill you are killed and that principle kicked in. Because it was after the flood that God first caveman permission start eating some animals and animal products. So every time you kill an animal and he did it actually killed you a little bit and shorten your life. And I said we don't learn I don't let you do more do it should not we don't. But however when you if you fast forward years may new they'll be nor death or dying. So back to eating. God's region died. So that was just all preamble. So you know what to eat. So the first half. Thing yet remembers OK. Eating Animals lose meat or animal products what they produce. Was something that God allowed us to eat after the flood in part to shorten our life so no think you're going to pass on all that stuff. Now what we're supposed to eat or you have to is never a concept that when I came across it. I thought man this is brilliant. So are you ready. Here's what I figured out. If you think I'm Bridget here's what I figured out that smarter night. That brilliant. Now look at me. Well duh. Party smarter. But I said. If you really believe that it actually makes a difference what you can eat. Because if you believe that actually smarter than you are. What you're going to do is you're going to eat the food as close as you can to how he made it rather than try to process the something that we do and we mess the thing up. So basically if you remember that so I said as an example have a choice between corn for corn chip. They go well with what you would ask that of corn. But how about between say. Curios or old meal. Well. Old meal he said. OK OK How about orange orange juice. Well. Orange. I mean. OK had one. And they go. I said if I do the candy maybe the can but most times I have them does not to frozen maybe frozen. So she's getting the idea. OK. So I said Now I have one that filly and turning up from this is silly. OK. What did God give Adam and Eve to drink in the Garden of Eden was a Mountain Dew or water. Named OK. That's still the only no but water obviously. And then I said OK if you want sweet. How does God. Package sweet. I tell the fruit. Some say honey. I go. Well that I checked. Bees. Aren't plants. They aren't animals. So basically. How does God. Package. Sweet fruit. So basically that the principle eat the food. As close as you can to help. He made. Now she was receptive to all this and she's kind of sitting there with a kind of a shocked look on her face. But she's thinking. And I said Did you know this actually works. Now it doesn't work because I said so maybe we decided he's smarter NY right. So I said. Can I read your bible verse. She's going OK. Let me let you read. Have you read your bible verse so I said Look first let me give you a background about the by there's a lot people don't really know that much about the Bible. So I'd give her background member there was a ram Isaac and Jacob and they were all men of God and God to communicate with them and they had a lot of knowledge about what to do but. Jacob had twelve sons and when the sense was Joseph and brother got jealous of Hamas a slave in Egypt lost track of him will God didn't lose track of them he eventually became prime minister and there was a family that was predicted and. So his sons. Is family came down to check it out he tested and found other good guys so he called the whole family on down and they lived happily ever after and tell. That whole generation dies that holds that Pharaoh dies it comes a whole new fair own egos who are these people there multiply like rabbits they're going to go my country I know make them slaves I make some slaves. So until they're all this. Now they're slaves for a couple hundred years or so. And while you're slaves you have a lot of rights to do whatever you want. Not so much. So they lose the knowledge of what they should be doing which shouldn't be doing some general this. And basically. They do remember. Enough to call on the Lord and take on the Lord Lord races that Moses and Moses. Comes to Pharaoh and says Let my people go and he goes on so they have like never want to come back for let my people going to goes on to live like number two that my people go on a plague number three fine on the tenth play years I get up thinking go. So they're going up there gives the Red Sea. And there goes What was I thinking I need to go after him so he goes after him but most God opens a red sea and air goes I go after him that was really bad idea because water fall and fall into feral. But now guy has all these people in the wilderness who've been slaves who don't know what they should be doing. And God's having to instruct him so through most of his instruction to him so I said let me give you one more bit of information. Before I read the verse and the bit of information is people from our age have found mummies of Egyptians from that general time period. Put them through scanners and documented many of those people suffered from me the same disease we suffer from today. You know the arthritis the stroke the cancer. You know different things. Because they were eating and living like we do today. Because OK with that in mind. Let me read you the verse and so I pull out my phone. Hope it doesn't go off. And I reached X.'s fifteen twenty six so I showed them as a show it to her as I'm reading I says. Here's Moses talk in Chile visual so he's teaching and he says. If that will diligently hearken to the voice Lord I got to say what does diligently hearken mean that means. Really really pay attention listen right. And will do that which is right no cites of said inducted. More than listen you have to actually do it after listen and do it now you going to say it again. That will give ear to his commandments What does that mean again. Listen. Right he goes yeah listen. And keep all these statues what that means. Do it do what he said you to do then here's the promise I'll put none of these diseases Aponte which I brought upon digit sions find the Lord ideality. And you know. I says. That's not me. I said I one things I figured out is I'm not all that smart. By know someone who is really smart. Listen to him. Because that's one point you to eat the food is close you can to help. He made. I get. Well. We had these tests and procedures of worth I didn't see her for about a month now thérèse about her story later. So first of all let me start the talk. Time for me to get my talk started. So what the outline your First of all what is truth we're going to answer that here tonight what's true. How do we apply the information. How that PI truth to medical information and look at some of the top job papers accord American College of Physicians. And how to incorporate God into patient counters because that me. Is really all that every encounter should be all about. So what is truth actually we have an advantage I mean a lot of people are always to actually know what is truth we have it from the Bible if we do believe that God is truth he's given us three definitions here and for John fourteen six. Who is speaking here. It's. Jesus says. I am the way. The truth. The life noncom of the father of I me so anything to do with Jesus is truth. What's a second here John seventeen seventeen. That's Jesus would cause high priest Lee prayer sang to them screw. Sanctify them through the truth. What you define truth as die. Word is true so what is the word well we know it's Jesus from John one. But we also know it's God's Word the Bible so that is truth right. And then Psalm one thousand nine hundred fifty one that our Nero Lord. And all the i what commandments are truth. So what is were are God's commandments. They're an expression of his character. So basically we're back to God is truth so basically what does. How does that or how to apply this. How do we do we really believe it is truth. How do we learn about it we have to actually immerse ourselves in him and that's the point I think I've heard brought out this. We could in multiple talk. You have to have that relationship with him. If you don't have that you won't have anything to share and it's all about him. And the truth is completely his. So we filter everything through him. And how was God's Word written it was through the inspiration of the Holy Spirit. And if we believe that the spear prophecy was inspired by the same spirit. Then I think there's truth in those writings as well. So we know the truth by studying the genuine and what is the genuine The Bible is very prophecy. So here's a very famous statement from the Ministry of healing. Page one twenty seven it. Here's the health principals pure air. Sunlight as stench Asus. And by the way absentia snus is basically be moderate isn't it. Rest. Exercise proper diet use of water trust and divine power. And these are some things that I think they made the acronym. New Start. But these are the true remedies. And every person should have a knowledge of them is essential to understand the principles involved. For treating the sick I think that is a given. So back to what we're saying. We study the genuine which is the Bible the spear prophesying. There's a couple acronyms I mention new start in creation. But here's a very easy easy way of knowing what is truth. And how to treat a patient so here's basically medical school in two sentences. You've basically find out what are people doing that they shouldn't be doing. Most OP that. And what should they be doing that they're not doing well. Start that. I mean really. That is it. It's amazing. If you. We have to actually listen to him but actually there's a lot of truth that just do it to me thing. Now I brought I put this letter because these are some of the sites I have used and I specifically want to underline this one here Nutrition Facts dot org I saw that. Dr Nellie's going to have Michael Greger has one of his speakers and. I believe that man is put done an amazing amazing work because he reviews all the medical literature on nutrition and puts a little vignette and. I don't think he knows he's doing this but to a very great degree what he's documenting is that the best die for humans turns out to be the one that God gave us. Gave man. Originally. And he's giving the scientific background so if someone questions you. That's a good source of start with to look for. Whether the information is out there and he puts the latest up there so I just wanted to make sure I underlined that. And specifically because I'm going to have several slides in this presentation that are drawn from this particular site and so point that out when I get to them but the work is just brilliant I really want to recommend it. So here's a way to look the medical literature. If it agrees on the principles of God's word. And I think we should probably accept it if it disagrees. There's God's word. Need work. I'm never going to a presentation once were so i'm presented you know we looked over the principles from the spear prophecy. And ninety five percent of it was correct and I thinking. What's wrong with this picture. Was God wrong five percent of the time. I'm thinking. Science was off on that TAR energy but that's just struck me so let me get into this part. The American College position top just studies. For two thousand and fourteen. And here's a couple guys who reviewed all the medical literature and published an article in The Archives of Internal Medicine. So who are these guys John Allen was the present American gas for all your association and. He's from Yale University. And David Weinberg was chief of G.I. at Temple health foxes Chase Cancer Center in Philadelphia so I'm going to review the part of the information that they thought was important but then make a comment on each OK. So the first point they made was about us and focus off a giant us. And basically the point they made is it's fairly common four hundred thousand Americans in looking at about seventy five million men and women under the age of sixty five it was found in almost half a million people. And what is it is allergic to sulfa giantess in its allergic. Inflammatory condition. That involves the use in a fills. And it leads to people feel like who gets stuck in the It's awful good. And I've had people come in and they can't pass the food and. Do you know they call me in the middle of night. From the emergency room it seems like if the patient gets stuck at six to come in the yard. Eight and the are will work on until about midnight in the Call me. But we need to try to open that up. So how do we diagnose it who look in there and you can't find a stricture. But you do a biopsy. And then microscopically. They'll find there's a lot of allergic cells in there and it's treated by. So tickets and loops and went. Here we go. The flu to kiss him which is steroids inhaler but you're not supposed to actually inhaler supposed to swallow it or it can be treated by eliminating elimination diet. And here's specifically the elimination diet. That people can be allergic to milk proteins Sawyer nuts. Eggs wheat and seafood. And you know my comment is I'm back to your god's word I am. And so as a general rule. It seems like if we follow the diet he originally set up for us. Many times. If you get rid of the foods that are specifically better to avoid like the dairy. The exit seafood. It may be you may not be allergic to Sunday's other things so that's. I still suggest listening. Most closely God with this is the elimination diet. So I had a row. Road worker who came to my office and had. Who had gotten stuck so he came for a follow up after we got out of this office. Milla night one time. And the back to show it was you most of us in a feel like a soft giantess. And we discussed. Diet versus medication so I gave him the medication but also talked about the diet he said well you know I'm lame track. And the rural people make that lunch me so it's hard to control us as well you know. It takes effort. You actually have to do some planning. So he says he try it and you know he came back one time he said you know that medicine. Just like the medicines that I made some of the changes he talked about and I'm not having that problem you more. And we just heard our last presentation can't just go by results but I'm still I'm convinced. If you listen to and follow God does He has a blessing. He promised that. Now let's talk about the next subject today right. Barrett's Esophagus and here what they're saying is people with berets and low grade dysplasia if you do an ablation. It's just it's a little bit better than just taking biopsies periodically that's what in this copy surveillances. So what is bear is for those of you who aren't gassed we're all just and don't look down people's esophagus all the time. This is actually what looks like this is normal. Lining of this office and this line of the stomach. Creeping up this office so if you see this this shouldn't be there. And so you do biopsies. And what you don't want to have happen is have it become a cancer and. Here's some slides from talking to Michael Gregor's work in nutrition facts that or basically ISAF your cancer has increased dramatically as you can see has increased six fold. And even a greater extent than melanoma rest or prostate cancer. So with radio frequency ablation you can get the bears to disappear. But some of the cells may still be below the line that you can't see so you still have to sample the esophagus periodically. But here is another way of approaching the treatment here they chose to give a preparation basically strawberries. And what they found was that helped get rid of some of the lesions. So it's an alternative treatment. And here's their summary. It decreased. The histological grade the precancerous off your lesion so the point I'm making with this light is. There are treatments out there. Just by following. What God. Suggested we eat. That can help fix things. When the things I've discovered about the way God works is it tends to be a package deal on your lines that again. In the excuse lights but when the side effect of following the type of diet and lifestyle God recommends fixes all sorts of things. I kind of like them. So here's another study suggesting that you want to have all these antioxidants from all of these fruits and vegetables. And here's the different types of ones that you can get different ones that just get a whole variety of the foods that God made for us to eat. Now here's their next point on chronic pain for Titus patients with chronic pain could hide has had increased cancer mortality Well that makes sense kind of peg ties really bad Z's. And you have an increased risk for cancer diabetes. All sort of chronic obstructive polar disease and kidney disease. And even stroke. Well it seems like the things that lead you to have chronic banker Titus tend to be the type of lifestyle decisions that make you a higher risk for these other things so I don't think that's adding a whole lot of information just what they're telling you by so giving you all this is. Watch for these other things. And that's not even including the idea of tobacco and alcohol which are major players in causing printer Titus. So as you can see these kind of hang tight. Is a so I guess many does. Société with many diseases. So that I do is you should stop tobacco and alcohol and lifestyle may have fact many of these these we know about that. So how do you avoid kind of peg or ties which can lead to chronic to pancreatic cancer. And here's one of the things I thought was interesting. The idea of fat. But it was mostly from animal sources. Not from plant sources that you tended to get the pancreatic cancer. OK their next point about colon cancer detection. And this is one that actually kind of indicts. Those of us to do whole not appease. They said that if you're having your colon ask these at a regular basis when your should. And between time they found you got you had cancer. Well the reason was. You either missed it. It wasn't removed or you didn't buy it to the right thing. Again you're going to try to move around and just biopsy. So what's the comment on that. Well. They already. They have as you can imagine. Standards that those of us do. Call ASCII should be meeting high had at Noma detection rates. Now the words. If you look at a number of different people who are doing call ask peas. And some people find a whole lot more polyps. Than others. And they're all the same group practice. Something's not right. So that's one of the ways you need to might do some remedial work why you're not finding as much. And this may have to do with how long it takes you. Once you get to the secret to come back. How good your prep is need to comment on that in your report. You need to have good equipment. And you also need to be doing this more than just once every three or four weeks you probably should be doing it regularly so you know what to look for. But basically here's what I think the take home method whatever you do. Do it hardly as a lord into Mensa who are doing a for really to glorify God not just to get done to get more and more procedures that's that's I think the take home message here. So here's our next one stool D.N.A. testing can detect advance precancerous lesions and color rectal cancer. But it costs a lot and specificity is reduced. Well the comment from this is do we want to wait until someone has cancer before we find it. Colon cancer is actually a preventable disease. That's kind of kind of really good news. And here's one of things they looked at. They're looking at the diet of African-American cock Asian Americans versus native Africans. And why is it that blacks here in America have a lot higher incidence of colon cancer than the ones in Africa. So they look at that and they naturally thought it was five or. But now they're saying you know. They are eating. As low fiber in Africa. As we are here in America. What's the difference. It's the mount of meat and animal fat consumption. Was much lower. And that seems to be the biggest issue in developing colon cancer. In fact so here's the conclusion from this one is. It's the animal product consumption not fiber member we had that idea from the. Just from what the Bible told us. When man started eating animal products that's what shortened our lives and it's still true. And here's like I was saying. It really is a package deal. And I think that's just it just an amazing. Evidence of just how wonderful a God we serve. Because they don't know well what is it. Is it the animal fat is it the cholesterol is that the protein. Well actually it may be just a combination of all faith because a diet that has this rich and one is rich and all of them. And so basically you want to stay away from all that stuff and way you do it is by eating the diet the way. God designed us to eat. The next point. Here's inflammatory bowel disease and cancer patients with implanter valve disease were found of overall risk. Increased risk of cancer. How are their suggest or intestinal cancer. Decreased over the past decade. Decade while non gastro intestinal cancer remained stable. So basically if you haven't found her valve disease your risk of cancer is increasing. That's what they're noting. So why are we getting inflammatory bowel disease. And here they're talking about high protein intake from beginning repetitious isn't it. There seems a common thing are you noticing. Animal protein that's what seems to be. So again. In found her about these appears to preventable and to a great degree is because of diet so what has change well. They look at the experience of Japan. And there seems to be a lot. Increase incidence of Krohn disease compared that use. How used to be. Now did the genes of the Japanese people change. Since World War two Is that what happened. What changes they became Western I just started eating like we do. And by the way here's the other side. The people ate the most vengeful protein. Had decreased. Incidence of inflammatory bowel disease. So it's not the protein it's where the protein is coming from it's again a package deal where it's coming from. And here's another flight that documents that high protein intake and plan proposes. Was restricted to animal protein. And here's. They talk about what's happened since World War two. This happened both in Japan. And in Belgium they had a marked increase in meat consumption. And that may explain something crease Rense of in found her ballsy since World War two. So a diet high in protein. Particularly animal protein. Increase in found her valve disease. And why is this well. Turns out. If you eat a lot of animal protein. You increase because some of the in products. Of cloning micro floor which is the bacterium the colon such as hydrants sulfide are toxic the colon. And this can and in fact effect even. Which makes a bacteria you have. And how they respond with inflammation and chronic inflammation we've already heard that in some other talks earlier today. Can lead to increased disease which is increase in functor about disease. In fact there's even evidence suggesting that sulfur compounds. Can be a source of all Steve collide is and. This tends to be most concentrated in the rectum because that's where the in product of what happens early or in the colon it gets changed. Down in to the rectum and that's where people get the first manifestation of most of Clyde as. So Michael. Floor of the colon. Elaborate toxic products from food. That have hidden so five which are the food from animals like eggs and meat and so forth. And that leads to inflammatory bowel disease. So I guess we've already basically made that point. Now. Hepatitis C.. That was and this is now as you can see it was an article written. Early this year and hepatitis C. has been changing dramatically. I can remember when I first started it was disease that was difficult to treat people take shots three times a week for a year and you get maybe ten to fifteen percent people. Cured of the ones I could tolerate it. And they're saying it may become rare but here's the key sentence cost effectiveness was not evaluated. Those of you who are adultry any patients with hepatitis C. know the cost of the medication is obscene. Is Over a thousand dollars a pill which is just amazing. So it is very treatable and as you can also know many of our life choices can lead to exposure so it's best if you prevent it but it is. I can tell you it is wonderful to know that most people when they walk in the door. If they have hepatitis C. even if they have tried. Treatment previously and failed or even if they have cirrhosis. We now have different medications to try that can really lead to a cure in fact those of you who have phoned it can take apps there's an app you can download that will get updated anytime there's any changes recommendations so you know exactly what to do and that's very useful. And here's specifically at that time when they wrote this article they were impressed with this particular Sofosbuvir and let live if a sphere. In fact. And this is just an all or Also no shots that was one the big things people hated was taking shots for a whole year and. Depending on the case of the patient doesn't have cirrhosis. And they haven't been treated before. With this particular medication they can be cured in eight weeks. I mean that just amazing in two months. They're done. And you check in again three months later and. If there's still. Virus free they're considered cured. But something. We have to really make sure they understand is if they get reeks posed they'll get it again. So that doesn't mean they're cured and. If they do something that exposes them to the virus again they won't get it again. They will get it again so I actually had a patient who went through all the shots back in the day and got cured. And then came back a couple years later. And she had it again. Oh I met this guy and he and I just start a new way lot of bad choices so don't get reaction post. So again. They have to see. Treatment is evolving rapidly. Lot of companies are getting into the market. And it's now a very treatable disease for which I'm thankful. If you can afford it. And that's the really big deal. You know here's. They were really. Reporting. Statens in the liver. Statens as you know are the medications that can be used to lower the cholesterol. And they found liver injury in only twenty two of over a thousand patients. And one fatal case and they were saying this. This is great news that means we don't have to keep monitoring the live. Liver that these guys is conclusion. My comment is wait a minute. And this is again a copy from nutrition fact that Orbitz lied. Here is a cardiologist who he documents. For every two hundred people who take a staten. One can develop diabetes. And every one hundred people at risk for heart disease. One or two will avoid one. By taking a staten. I mean this is not the fix all. That's not how you fix. Heart disease by throwing a pill at it. And I think that's where people get to thinking well if I just take a medication. I won't. I then can keep doing the things that cause a problem the first place. I just think that's just a bad idea to me it's somewhat analogous I sometimes tell my patient. If you look at the sink they have a sink in every room for us to wash our hands if you. If you and I come in here and there's water pouring off a sink What's the first thing we reach for. Is it a mop. I turn off the water. Take care of the problem. Because the farmers who come here happy to sell you mops. Just by the bucket load but that's not the problem. So and. We all know about how statens can cause muscle injury and cause rhabdomyolysis and. You can have your Basically pain your muscles Albert. And for example has an older patients who are somewhat weak in the first place and prone to falls if they are on statens they may get weaker and even more prone to falls and. So that's not really the answer. And if you notice on that slide one of those stands. Has caused death and they're still thinking that's great news I'm thinking that's not good news. So who needs Staten and. Here's the conclusion from editorial only pure vegetarians don't need statens most the rest of us do and I'm thinking. Wait a minute. Shouldn't we tell them that basically. You don't have to have the disease. I mean that's where I love it when I finish I'm telling my patients you know. Listen to him he made us he knows what works. So we know diet lifestyle will lower cholesterol levels. And what are the side effects of following that type of diet. The side effects is a fix is all sorts of other things. I mean we've I've already mentioned that and I go over that with the patients. You know and tell him you know if you do that. That's what really helps. Then they made a point about diverticulitis. And they're saying is being treated less aggressively with antibiotics or surgical intervention fact just today. I got a phone call from a. My office. About a patient who had some concerns because she feels like she may be getting about a dive to collide with and she's pregnant. And her G.Y.N. doesn't want to take an antibiotic I'm saying well I'm not going to prescribe one if you're if you're obese. And so your O.B. doctors and give you I'm not going to be the one to give it to you let me put you more toward the less aggressive treat which is. Take away some of the causes of it in the first place. Eat the foods that grew from the earth. Here's kind of just some slice of show you what they look like this is from into scopic view this obviously is after it's been removed from the body so. This person no longer has that particular part of the bell. That's not what you want here's one actually that. Perforated to a surgeon would have seen this. This is is here's a piece of stool stuck in there and people say all have means if I'd ever to kill I can't have thieves anywhere Well turns out that's not correct information. What you want to avoid just through that doesn't have fiber that's what gets stuck and there's not the seed so if you have plenty of fiber. That's real revelation people are really happy to know they can eat their strawberries again they somehow want to peel their strawberries. So here's the article that they were talking about. And how do you treat it a hopeful plant based that will prevent and treat this disease so they don't have to all these other interventions. Now proton pump inhibitors. This is actually big business this is a medication as you well know that is used by people to suppress acid. And the point they're making with this is did you know. They did a study in the U.S. and Canada the United Kingdom. That people that take it. According to this particular study. Didn't have increased pneumonia this is really good do that's according to them. And I'm thinking. We're doing the wrong thing here. Why don't we treat. Why it happened in the first place. So basically they've discovered that high dietary fats associate with increase reflux. Where the high fiber diet. Decreases the risk. So here is an article does actually. Shane is common here in the West it's getting more and more common in Korea because there's tourney like we do and it has all sorts of complications chronic reflux can lead to bleeding. To narrowing which is gets food stuck to the Barents what you've talked about and even cancer. And the main treatment is the proton pump inhibitors are your members all. And so map resolves opera's all those medications. And these numbers are in billions. So K.. So we're talking big money. So they have a real interest in fact these are the pharmaceutical reps and love to show up in the office. And I try to smile with at them and say yes you have a very good medication that it won Best to have no one take it. So that basically as you well know. There's many adverse reactions to long term you have to post to be on these medications even according to their studies for than just a few weeks. And people are on a free years. That's not good by the way. Do you know asses supposed to be there. God put it there for a reason because what we eat isn't sterile Did You Know That. So we're supposed to help sterilize it. So what are some of the long term problems according to this article. They've talked about B twelve deficiency are in deficiency the pneumonia that's what this article. That was talk here that was less of a problem. Further infections down the gut fractures hyper gastronomy a. And so we want to find a correctable. Risk factor and what are the correct will respect as well. We already know it's better not to be overweight here that's a good idea metabolic syndrome we know about what that is that's the idea of having the diabetes and high cholesterol no be city and insulin resistance and all that type of thing. And should avoid alcohol tobacco Yes. But what about diet so that's what this study is all about so they've found that high dietary fat was associate with increased. Reflux. Whereas high fiber. Decreases the reflex so this is looking at diet now. This is looking at as you increase the fat. What happens lower soft use think your lower sock just think there is the muscle learned sockets that. Once you swallow it opens let things to a close also things don't come sloshing back up. But there's a lot of fat in there tends to open up. So that's where. If you're eating a lot of fat. Then you have more of the drop in lower such as fainter whereas high fiber. You didn't have that happen. Or how about meat well. They found that meat in high fat to you'd have more cancer of the. Esophageal gastric junction. Whereas you didn't have that was fruit vegetables. Because they had a lot of antioxidants in them. And you can choose your cancer. If you want yes offer to red meat if you want more in the stomach you eat poultry. But bad choice. I just don't like that particular choice. Now they call a meat. Alternatives what are meat alternatives as well. Beans and nuts. You didn't have as much of the cancer that's what they found here. We kind of knew all this don't we now how about food supplements. There's a in virtual Aisha's ship between fruits vegetables and antioxidants. With getting bare to soft what you talked about earlier. But if you just take supplements and vitamins. It doesn't reduce it. I'm back to idea God smarter Naim. If we decide well I'm going to take something from these things and make a pill out of it. How we improved on things got smarter than we are we just remember that concept it really helped. Just save your money I tell people my favorite pharmacy is the farmer's market. That's where you go to get your medicine. Eat the foods that grew from the earth. Again here's another one. Talking about eggs and causing reflux. Here's again talk about eggs and cause us to kind in which causes Laurus off the. Lower soft your sphincter to relax and you have more reflux. So getting back to the idea of reflux and the vegetarian diet. Non-vegetarian diet was associated reflux. But that you turned out I had a protective effect. So that's something that I think we can take home and teach our patients just eat the way we're designed to eat we do have a maker he made us he knows what works. And guess what. If you do that it has some side effects. So what are side effects. It lowers oxy stress reduces blood limpid levels. It's less cardiovascular disease diabetes. Oh and by the way. It also can help decrease refunds. So that's a rundown of the top. Papers in G.I.. According to those particular authors. I'm back I guess think got smarter than we are. If we just listen to him we argue no the answer point. People to him. And it is a package deal. And what I got to tell this lady that I didn't mention to you as I told you no that's not even the best part. You know the best part of doing this. If you follow this. You have better health. But that's a side effect. It's a cool side effect I happen to like that. Side effect a lot that you feel good. But that's a side effect the whole point of it is actually. So you'll feel good to have a clear mind. Because you know that the God that made us actually want to have a relationship with us. I mean came out yes you want to spend eternity with us. I tell I can't imagine spending attorney with myself. But he wants to have eternity with us I mean I think that's just remarkable. And not only that he wants to offer us the gift of His Son. On the cross who paid the penalty for our sins. So we can spend eternity with him. That's the whole point of all this. The feeling better is actually just a side effect. But she came back after we done all the tests. So I walk in the door. And I asked her how you doing. She says. Fine I said no no no. How are you doing. I mean you know pleasant. You know that you're fine. No she not a really I'm fine because I actually been doing what you. What we talked about. She said. Not completely but a lot. I'm really doing most of it and did you know. I feel better. I'm not sore in the more I can I have energy I can make it through my shift and even people in my work have commented on it. In fact. My one concern is the place I'm going to work X. you work in a place that takes care of mentally challenged people. They make some changes and she may lose her job and that's what most of her concern was how I got to talk to her about where to take her carers to because basically. It's only God that can give you peace of mind and matter what happens to use who spent the rest of the time praising him and then I glanced at her chart and looked over and said you know. I see you've lost fifteen pounds you said I did. I wasn't even trying to I was just following what he said. That's what happened. I happened to. I mean to me that's when I walk out of all the interaction I get I think you know how God is just so cool. So how do you incorporate God to patient counter and now. You know it has as much time as I happen to have with this latest in that time I try to take that I can but you don't necessarily. But you never know how you're going to have an encounter. So basically obviously want to listen to the patient. Listen to if they're open to a because not everyone are going to have an interaction like that some people don't want that. But I have to tell you with each patient encounter. As I ended. I will say one more thing. And a look at me. What. I like to pray with people. May I pray with you. Once in awhile you'll get turned down. But the vast majority of time people appreciate it and want you to do that with them. And you never know. I'll tell you. Situation just happened as we can try to use some things fresh. Just this past Saturday night they had little talent program. In our school. And I wasn't on call. But they call me anyway. From the market they had a lady there who came in with a him with open of six that kind of low. A few more detail she was well over three hundred pounds. Diabetic of course you know of high cholesterol I would be all all-American. Look. On oxygen. And she's going. Need be brought in and she says what call the hospital need to make sure G.I. is on boards because it. Need to figure out what's going on. OK I'll take care of him. But she had a concern. I could be came in to see her and her daughter was there. And she had a concern. She said If some time back when I went under anesthesia took me days to wake up I had to do was under ventilator for a long time so I'm scared to death then Assia. I said well that's a valid concern. It really is. But we would probably being aware of that have an A C to talk to ahead of time to make sure that we find the right thing and. I didn't tell her this. But sometimes we do what's called your OK anaesthesia. That means we tell him You're OK You're OK You're right but we do what it takes. But the point I make is I said will try to do some. Dean. But you know what we really need to do you mind if I pray with you about this because I understand you have a difficult situation. He said yes. Let's pray. And so she got transfused and so Monday. All day Sunday and so forth and then I see to talk her head a time so she was OK. So we brought her down to do the industrial as she's coming in the room. Beforehand I'd saw the anesthesia provider and he said you know she's really fragile. But one thing we can do we can pray and God loves us and he answers prayer and. So she was being wheeled in. And as she's Will Then she opens her arms wide and says. Before they put me under. I want Doc to pray for me when I was going to do that anyway cause I pray with people who I do any procedure with them and I said yes let's pray with you. So we prayed and did you know. It went well but what was in she is. She was bleeding. But as soon as I washed the blood off you can see a spot. Chad what's called Dilip for a that some artery. That's near the surface that can open up and bleed. But then when I saw spleen it. Contracts as a muscle layer. And there's no Also there. So you can't find where she pled. Well by God's grace she happily leading right then so we put injected it and then put a clip on it and took care of it so afterwards I went over to talk to a family now this time it was her sister who was there. And so I told everyone well because you're a very anxious. And I got to pray with her about I said she's doing well and she's all thank God you know if people afterwards. And I found this many cases when I do a procedure with him. And I prayed with him beforehand. But ackwards I go talk to me if they go. Talk therapy for praying with me now what they're telling you want to pray going. So I say may pray with you again and thank God it's so many times we ask God. But we don't thank God enough let's stop and thank God can we do that together. And we do that and that is meaningful. At a nother lady just for I came down here who had veered pancreatitis. And so I was talking to her son afterwards. And mentioned to her. How severe. Things were and how to how danger she had been the doctor in years and she had to really to work on her and she said she was so mad at me she felt he was she said she was going to hit me if I kept talking or but she finally got magnetite is and it got in trouble so she came in turns out she's in renal failure I mean that's she said very fragile lady. And as we're talking. We're going you know she is fragile and keep real close eye on her. And he said yeah but we do have a God who heals and so right there in the hallway I said. Can we pray together about it. And so we stop right there and had prayer together. But how do you bring it into a into of. Got into your patient encounter you got a first by Got a member we said you got to have that in your life you have to die daily you have to ask a man you have to ask sir. You have to immerse yourself in the information. Of how to live a healthy living. Immerse yourself an ID everything filters to look to God and then you have something to share. And when you have something to share you filter through it and you watch for opportunities. I never had an opportunity to young men come in who was about twenty six the had. You know maad clothes on and Mikey hair and you know just. And so he was unhappy because he had had some problems with his bow pattern and passing some blood to ease concerns so we elected to look in there and see what's going on to a call last night trying to think how my going to share with him. Anything to do with God. So I elect. We have electronic medical records where I work at. And in my experiences slows me down. Maybe for us for you up or for me it slows me down but I decided OK since it slows me down. I'm going to my note right there in the room so case have any questions. They can talk to me while I'm doing it. I tell him not trying to ignore you but if you have any questions asked so I'm typing away. If I says Doc Is there anything I can do now. My mom says my diet is not so good I'm going he asked. OK. So I went over the presentation like I did that first lady in at the end he's kind of looking at me and a question like asked him is he joined or stand my prescription. Because you're going to prescription that's your prescriptions to follow that fact I one lady. As I'm doing it with the husband. She doesn't like that would as he don't have to like it. That's my prescription. Just do it do it for three weeks OK. Try for three weeks and come back. But he's looking at his junior senators Yes. I said Is it doable. Do it. I said Are you happy with how you're feeling. He says no I'm not. And so basically says. I think I'll try it. That I haven't. I've had motile times were. It's a couple and the wife looks and says he'll never do it and I'm saying what he thinks of. I'm going to try to set some. So after that so I told him. Let me tell you one more story. And I tell you one story about this I don't a patient as he said. Here's what happened one time. Said Do you know how you go to a place to put gas in your car and. When you're putting out your car there might be another car on the other side. Putting gas in their car now I'm talking about says Well I went in and I put that's putting gas in my car and there's another guy putting gas in his car and he got a silver I guess he recognized me. So he looked at me and he comes over he starts doing this patting his stomach. They looked at me and goes you memory do you. I'm going to tell me. You got to help me he says. Well I was in your office. Couple three months ago. And we talked. And I'd gone over kind of what I told that first lady. And he said. I've been doing what we discussed. He said. I've lost twenty pounds. I'm off most of my medicines. And I'm feeling good. And you know we spent the rest of the time praising God like there in the service station. That is when Bina doctors went and did you know. They actually pay you I was listening to a talk or someone said it. Really you know it builds your character you're not going to hundred doors and the two people want to talk to you. Do you know when your patients come in you get to talk to him. And they're paying you to do it. That's kind of nice. And you're giving them cutting edge medical advice. If use look at that. So my final flight I have all sorts of cases I can tell you about and how you get to talking you start talking to people about different than just listen to him just listen to. But my final slide. There's a few more at. I started but I want to start of this slide is why favorite slides. Proverbs three five to six. Says trust in the Lord with all your heart so are we supposed to trust. But who is in the Lord was. And just part time we trust him. All our heart and lean on to your medical training is that what it sign. No was it things in the not on your own Understand Men really filter everything to the truth what is Truth is God. And in all your ways who is supposed to acknowledge. And who will direct us. He will. But our heads. Father in heaven we thank you for your love and mercy. Thank you that you love us. And that you showed us through your word. And the death of your son that you want us to live with you eternally. And you want to give us method that we can know that if we follow. There's a special bless him for that we pray in Jesus name in this media was brought to you by audio person. A website dedicated to spreading God's word through free sermon audio. And much more. If you would like to know more about audio verse or you would like to listen to more sermon. Leave visit. W.W.W. audio verse or.

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