What a Good GI Doctor Can be Like

Joefnh · Post by **Joefnh** » Fri Jul 23, 2010 4:31 pm

I had my monthly follow-up appt with my GI doctor today and was pleasantly surprised at the outcome. We discussed my current use of Entocort for the past 3 months and the results of trying to unsuccessfully taper off of it earlier this month. Dr Nagri is willing to let me stay on the Entocort for another 6 months for CC as long as we feel that the Crohns symptoms are not getting worse.

I had presented several articles posted here on both the relationship of diet to Crohns and the extended use of Entocort (Thanks Tex!). Overall he was familiar with the studies and echoed the importance of diet in dealing with CC and Crohns; I was somewhat surprised at his knowledge and progressive medical attitude, especially after reading all the other members posts on this site, and their not so pleasant GI doctor experiences. Even since my last appointment, Dr Nagri has been looking into CC and is even more up to date than as little as a month ago, this was evident in how his attitude changed regarding the longer term use of Entocort.

The main concern in my case is the presence of CC and Crohns, and he is concerned that the Crohns may not be well controlled by just the Entocort. The plan for now is to have a capsule endoscopy in late August after returning from my upcoming trip, then a repeat of that test in 4 months while adhering to the strict Gabes paleo like diet. I reviewed with him again a copy of the "Gabes Cooking Corner" diet he and was quite impressed both with how well it was thought out, and that I and others can stick to this diet essentially eliminating gluten, dairy and soy from our diets (Thanks Gabes!!). This will essentially be a test to see how Crohns (jejunum) responds to Entocort and diet alone, keeping in mind that the Entocort really does not treat the Crohns jejunum directly.

Well I have all my meds refilled and am ready for travel to Australia in about 2 more weeks; looks like it will be a good trip!

Thanks to all on this site for all of the help and support.

--Joe

mbeezie · Post by **mbeezie** » Fri Jul 23, 2010 5:06 pm

Joe,

Glad to hear you had a good visit. It's refreshing to hear about a positive interaction once in a while!!

Mary Beth

wonderwoman · Post by **wonderwoman** » Fri Jul 23, 2010 5:56 pm

Joe, Good work with your doctor. Now if only your doctor would share this info with others so more GI's would be educated and would be able to help their patients.

Joefnh · Post by **Joefnh** » Fri Jul 23, 2010 6:23 pm

Mary Beth and Charlotte thanks for the replies.

Charlotte the thanks really goes to all on this site for all of their information and help. Dr Nagri really deserves the kudos for showing the willingness to do the research and be up to date on these topics. It was a pleasant surprise, I was prepared for more of a conflict of ideas.

-Joe

Post by **tex** » Fri Jul 23, 2010 7:22 pm

Joe,

It doesn't get much better than that.

Tex

Joefnh · Post by **Joefnh** » Fri Jul 23, 2010 7:40 pm

Nope Tex you cannot ask for more. I was surprised at the outcome, especially given his earlier tone regarding Entocort. In case anyone is in the northeast and interested, his Name is Dr Srikrishna Nagri in Nashua NH. Definitely a CC friendly GI doctor.

Probably the only part I did not like was the discussion regarding the possible use of immunomodulators should it be necessary to deal with the Crohns in a more direct fashion later on.

Thanks again Tex for all the articles.

--Joe

Gloria · Post by **Gloria** » Fri Jul 23, 2010 8:29 pm

Joe,

So nice to hear about a positive GI visit with a "meeting of the minds." It's great that he's revised his opinion about long-term use of Entocort. He's probably spoken with other GIs or has done some additional research.

Gloria

Post by **tex** » Fri Jul 23, 2010 8:32 pm

Joe,

You're most welcome.

Thanks for the full-text copy of that research article on the mapping of the celiac peptides. I read that article in detail, and I have to admit they did a heck of a lot of work, but I still don't see why they think that they will be able to develop a desensitizing treatment, (or a vaccine), based on that work. Even if they were to be successful in desensitizing the immune system against those major peptides, the immune system will simply divert it's attention to any of those dozens and dozens of minor peptides, and there is no way that it would be practical to try to desensitize anyone against all of them.

I have a hunch that they don't realize that the immune system tends to work it's way through a hierarchy of allergens, sequentially, if the major allergens are deactivated. IOW, as the major allergens are removed, the minor peptides will become major triggers, in sequence. IMO.

Tex

ant · Post by **ant** » Fri Jul 23, 2010 11:01 pm

Dear Joe

It is so good to hear of your GI visit. Gradually I am sure more and more doctors will get the message.

All best, Ant

angy · Post by **angy** » Sat Jul 24, 2010 7:47 am

Thats amazing joe....my gi doc hasnt a clue about diet....he thinks i should continue eating as normal...every appoint ment i get (6 monthly) its a different doc...

I gues thats cos i gave him a telling off about a letter he sent my employer...when i was first ill..he made me look a fool in front of my employer....god i was mad...

Anyway thats that,,,You kn ow there are more and more foreign docs coming into uk....and there has been some controversy about their practice and qualifications...appears there has been some huge medical mistakes with nhs patients...the nhs are going to be fully vetting these foreign docs who claim to be qualified to uk standard...

hope you continue to receive great care from your doc and that you stay well...Have a fabby!! trip...post up sonme pics when you get back...

Joefnh · Post by **Joefnh** » Sat Jul 24, 2010 10:08 pm

Angy that's not good regarding your doctor. Having an open and untroubled line of communication is key. When I first went to this doctor ( he was my second GI) I was a bit skeptical at his background, given that his main education was in India; not that the schools are bad there, just that there have been several stories regarding how patients are treated by the doctors there

After dealing with him, I am glad to say I would recommend him over his US trained counterpart in a heartbeat. I have read a few of the articles on the BBC website regarding some of the problems the UK has had with foreign doctors. What requirements are there for a foreign doctor to be able to practice there?

--Joe

Post by **tex** » Sun Jul 25, 2010 7:18 am

Joe,

Your mention of the problems with medical care in India reminded me of what the neurologist who diagnosed me with Parkinson's disease, a year ago, told me. He was born and raised in India, but he received his medical training in England. He told me that frankly, he wouldn't take his dog to a national health care facility in India. He said that the people who can afford private doctors, get good medical care. The rest either take their chances, or do without.

Tex

Joefnh · Post by **Joefnh** » Sun Jul 25, 2010 7:27 am

I had heard similar horror stories and was skeptical at first, fortunately all worked out well with this doc. On a good note he did a 2 year rotation at Mount Sinai's GI department. Overall I lucked out with this doctor. Just goes to show you can't judge a book by it's cover...

--Joe

Post by **tex** » Sun Jul 25, 2010 8:33 am

Joe,

Your doctor is probably dispensing pills in this country, rather than his birthplace, for the same reasons as the neurolotgist that I mentioned above - he was/is fed up with the health care system over there, and he wanted to get as far away from it as he could.

Tex

wonderwoman · Post by **wonderwoman** » Sun Jul 25, 2010 8:50 am

I had a doctor from India prior to 2005 when I became eligible for Medicare. I liked him very very much. Then I had to leave him as we went with Cigna Medicare for Seniors. Was very satisfied with those doctors but then I didn't have the problems I'm having now. I just requested a new PCP and had the choice of one from India or going with the American doctor my husband sees. I chose his doctor as he likes him so well. Have my first appointment with him Aug 12.

I wish it were sooner as I'm really having some terrible D problems. GI doctor had me switch from Pepto Bismol to Imodium and took 8 of them Friday and Saturday and am still having D big time. Twice this morning already. Seven "D" on Friday and 13 on Saturday. Now I have discontinued all vitamins, calcium, B's, flax, fish & E. Can't understand what it could be. Had several close calls yesterday. One was at a computer class when I couldn't get into the women's restroom so I used the men's. Then I went to Costco and was in and out of their restroom 3 times in about a half hour. I purchased 400 generic Imodium there for $5.39 and took two while in the store.

Had sigmoid on July 16 and nurse called Friday and said "biopsies were negative" I said, Negative for what? What is he checking for when he did the biopsies again? She came back to the phone and said Colitis. I said what kind of colitis and she didn't know. I said in Feb I was Dx with CC and are you telling me that now I don't have CC? I don't know what she answered me but she was getting upset with me and I was upset with her so I left it go. I will get the operative, lab, and pathology reports. The lab reports for the stool samples are not back yet. They can up to 14 days. In the mean time I will just keep doing what I am doing.