How to Find the Right Doctor for IBS and Digestive Health: What to Know Before You Book

Jessie Wong 00:00:00 Welcome to the IBS Nutrition Podcast, your go to source for navigating the complex diagnosis of irritable bowel syndrome. Here, we dive deep into IBS and discover the power of diet and lifestyle to find freedom from your IBS symptoms. I’m your host, Jesse Wong, Fodmap dietitian and a gut expert. For years, I suffered from debilitating gut symptoms that kept me out of work, feeling constant discomfort in my body and anxious around food. Today, I’m in control of my IBS, able to eat the food I love again, travel whenever I want, and spend quality time with loved ones. It is my mission to help you do the same and transform the way you live with IBS. Let’s get started. Hi everyone! Welcome to another episode of IBS Nutrition Podcast. Today we have the best and most exciting guest with us to talk about GI health and a condition that we probably want to raise more awareness of, and how to find better care for ourselves. Now let me welcome our guest today. So we have Doctor Andrea Love, who has been on the IBS nutrition podcast in the past.

Jessie Wong 00:01:04 She shared with us about different type of tests that we need and we don’t need. If you need to listen to it, if you want to listen to it, you can go back and find it in our podcast archives. And Doctor Andrea Love is an immunologist and microbiologist with over a decade of experience in basic science, translational medicine, and clinical research. She works full time in life science biotechnology in the field of vaccinology, immunology and immunotherapy, cancer cell and gene therapy, and much more. She’s passionate about improving science literacy and addressing pseudoscience and misinformation as it relates to science and public health. She is the founder of immunologic, a newsletter and science communication organization. She’s also the executive director of the American Lyme Disease Foundation, a columnist for Skeptical Inquirer and was the 2023 American Medical Writer Association MacGuffin Award recipient. You can find Doctor Andrea Love on social media across different social medias at Dr. Dot Andrea Love or immunologic.org immunological substack.com. For her newsletter. We will put all the links in our show notes, so don’t worry.

Jessie Wong 00:02:24 And we also have Doctor Wendy Labrecque here. Doctor Wendy Labrecque is a gastroenterologist and board certified internal medicine physician. She is passionate about educating the public about digestive health. She has over 100 followers on TikTok and Instagram and creates educational content. As an SoCal gastro doc. You’ll find it dispels SoCal gastro. She was recognized by her peers in the field of gastroenterology as Healio gastroenterologist social Media Influencer of the year. In 2023, she is a trusted voice on gastrointestinal health and has been featured in numerous publications including self, The Huffington Post, Business Insider, Well and Good and Real Simple. Doctor Labrecque holds a Bachelor of Arts in Economics from Stanford University and graduated from the University of California, San Diego School of Medicine. She completed her internal medicine residency and gastroenterology subspecialty fellowship at UCLA. Her research has been published in several leading gastroenterology journals, including Gastroenterology, the American Journal of Gastroenterology, Clinical Gastroenterology and Hepatology, and The Lancet. Wow, you guys are very high achieving humans. Let me just put it that way.

Jessie Wong 00:03:50 And thank you so much for joining the IBS nutrition podcast.

Dr Wendi LeBrett 00:03:53 Thank you for having us. Yeah we’re excited.

Jessie Wong 00:03:55 All right. So we have three topics we want to talk about today. One is Doctor Andrea Love is going to share her experience being a GI patient and the process of finding the right doctor for herself. As we know on this podcast and working with a lot of clients, finding the right providers sometimes is more difficult than we think. And a lot of the times our clients go to multiple gastroenterologists before they find someone who would really listen to them and help them create a plan. And in this episode, we want to talk about that process and how to help you maybe fast track the process so that you can find the right fit sooner rather than later, and can better manage your condition so that Doctor Andrea Love will share her story. And then number two will talk about how to find the right doctor for yourself. And point number three, topic number three is how to prepare for a specialist appointment so that you can get the most out of it.

Jessie Wong 00:04:49 So Andrea, take it from here. Tell us everything.

Dr Andrea Love 00:04:53 We’re going there. and actually, I think, Jesse, you really set the stage. Well, because with GI conditions, there are often different types of providers, right? Do you go to a gastroenterologist? You go to a colorectal surgeon. How do you know which one to go to? And so, Wendy, I can’t wait to hear some of your insight on that. But, you know, we’re I’ve talked about this on my social, channel. So it, you know, isn’t terribly new, but I had I developed a chronic anal fissure back in the end of 2019, December of 2019. And I remember because it was the day after I ran a marathon and after having a bowel movement, I had the worst pain that I’ve ever experienced in my entire life. And I say that as someone who was a competitive judo player and has torn my labrum in my shoulder and has had many different surgeries over the years, so this was really incredible.

Dr Andrea Love 00:05:44 Searing pain. There was blood, there was throbbing. And it, it continued for, you know, throughout the course of that day. And, you know, my immediate inclination was this is probably a fissure, because, again, I’m in the sciences. And while I don’t specialize in GI conditions, of course we we have an understanding of anatomy and physiology. And all the symptoms were pretty, you know, consistent with my understanding of that. And so I was like, all right, well, you know, that happens, right. nothing really precipitated it. So I kind of just was like, all right, well, you know, take some take some Tylenol, take some Advil, kind of, you know, go on, go on with my day. But the problem was, is that it continued, right. It continued to happen for days, for weeks. And then it was months. Right. So this was in December 2019, January 2020, February 2020. I was getting to the point where, you know, I know with with some people with chronic anal fissures, which for my understanding, are fissures that typically don’t heal in a period of I think it’s six weeks or less.

Dr Andrea Love 00:06:51 But kind of they they continue. Right. There’s there’s that tearing sensation, there’s bleeding, there’s pain, etc.. And so, you know, now I’m three months in, it’s not healing. And mine, while I know there are some people who only have pain during a bowel movement or sometimes they’re almost asymptomatic, but there’s visible blood. mine was pain all day, every day. I could barely function. I, you know, was sitting on heating pads just to help alleviate any sort of pain. It was throbbing. It was stabbing. It was it was really affecting my quality of life really dramatically and obviously was not getting better. and so, you know, I got to a point where I knew I needed to, you know, get kind of a preliminary official diagnosis so I could start to figure out seeing a specialist. And so I went to primary care. They confirmed that, yes, this was in fact, a fissure. They confirmed that, you know, you have some visible scar tissue, You, you know, at the rectum there was a skin tag, which essentially is, is, formed from all the repetitive tearing, and, you know, decided that we would try some of the non-surgical interventions while I awaited consult with.

Dr Andrea Love 00:08:03 And they had recommended a colorectal surgeon because this was dealing specifically with the rectal area. but, you know, I increased fiber intake to make, you know, stool softer, even though I already had a pretty high fiber diet. But I was I was logging 40 50g of fiber a day. kind of during that phase, I was really ramping up water intake to compensate because of course, if you increase fiber, you need to increase water. I was doing the the warm water baths, the sitz baths. I even got a prescription for some of the compounded knife doping in the off chance that that was going to do anything. and then in March of 2020, there was a pandemic and I was I was right at the point where I was starting to see, you know, different providers in February. and of course, I’ll go I’ll go back to that in a second. But I ended up seeing four different colorectal surgeons as consults before settling on the provider I was going to see, and we were going to start scheduling things.

Dr Andrea Love 00:09:07 And then, of course, all elective procedures were canceled and a Fisher Ectomy was considered an elective surgery. So that got postponed until July. which was excruciating. But, you know, I started looking for providers towards the end of January. And so initially I, I, I have some friends in the area and several of them are emergency nurses. And so they work at the hospital down the road, which is affiliated with a large medical institute. and I was like, hey, you know, you work with a lot of these folks. Is there any colorectal provider that you recommend? And so, one of them gave me a name, and I went to see him. And, you know, he was very pleasant, very polite. but I had done a little bit of literature review, and I recognize that I have that benefit because I’m someone in the science field that I can, you know, understand and do literature review. And I had a basic sense of some of the newer procedures that were being implemented for chronic fissures.

Dr Andrea Love 00:10:10 And, you know, he wasn’t presenting that as an option. And so I asked him during my my appointment, I said, well, you’re recommending this, this lateral internal sphincter ostomy, which is a procedure where it’s kind of the the legacy standard where they, they cut a small incision of the internal sphincter to relax, you know, to essentially release the muscle so the wound can heal. and he was like, well, you know, this is what I’ve always done. So this is this is what I recommend. You know, this is the procedure that I typically go with. And I was like, well, what about, you know, these instances of fecal incontinence? I’m 30, 30 years old, 32 years old. I don’t want to have poop leaking out. I’m a runner. and he was like, well, that’s pretty rare. And I was like, yeah, but if you look at the sex distribution, it’s more common in women than men. And, you know, didn’t really kind of address that.

Dr Andrea Love 00:10:59 And I was like, Didn’t, didn’t have a great feeling. So I went to a different provider in the same practice and, similar kind of approach. I actually was probably less pleased with him. So I was like, you know what? I’m gonna go see a woman. I’m going to go see someone at Penn. Penn is great. I found this young woman who was seeing, seeing patients went there. She knew her stuff. Certainly. She was very intelligent, very educated, very kind of up on things. she actually the the proposal that she presented was similar to what I ended up going with, but her bedside manner was really displeasing to me. And her physical exam when I was already in an excruciating pain, was not gentle at all and I left there. I actually went on my lunch break because I was working in the lab in Philly. and I went back to work and I just could barely function because she exacerbated all the pain that I was experiencing. And again, I’m sure she’s an excellent surgeon, but when you’re looking for provider, you know, you want some of that.

Dr Andrea Love 00:12:03 You know, you need some of that kind of understanding of the quality of life situation. Right. so then I went to a fourth, and this one was actually referred to me by a runner friend who’s who worked in a physical therapist office and the lead physical therapist. she said, you know, he was married to a colorectal surgeon, and she loved him. She thought he was fantastic as a provider. So I looked her up. She was at Jefferson, which is also in Philly. And so she was taking new patients. So I made a fourth appointment and I went to see her, and she was fabulous. And I could tell going in. So right off the bat, she, she was young. She was recently boarded maybe two years before. which means, you know, I know a lot of people are. Well, if they’re new physicians, maybe they’re inexperienced. But it also means that they’ve studied specifically on some of the emerging techniques and technologies. And that’s part of that, that licensure.

Dr Andrea Love 00:12:58 So I was like, all right. I’d also looked up her publication record, and I knew that she worked really heavily in these sorts of, particular colon and rectal conditions. She also was involved in the residency training program and with with her exam, she actually brought a med student who was rotating and she asked, you know, is it okay if they come in and, you know, participate in the exam? And I was like, listen, we got to teach people. So she came in, had a really good kind of you could tell that she was passionate. You could tell that she knew what she was doing, and she was the only one that actually explained why she would recommend an alternative surgery. So, you know, as a scientist, I like to understand the Rationale for something, right? Because I’m always looking at the data. And so the other ones, they’re like, well, we’re doing this sphincter ostomy because that’s what we’ve always done. But she went in and said, listen, when you look at the anatomical differences of women versus men and the sphincter length, the female sphincter is about an inch shorter, half an inch to an inch shorter.

Dr Andrea Love 00:14:02 So if you cut into it, you’re cutting the same amount. That’s going to make a more pronounced difference in females and males, which is why there’s a higher rate of fecal and flatulence incontinence among women. She was like, I would never start with this as a first line surgery in women, because once you cut that that sphincter, you can’t undo it. You can’t put it back together. So she was like, what I typically do, especially for young women, especially for active women. And I don’t have children. But she was like, you never want to exclude that possibility. but the more trauma down there, the less receptive that that part of the body can be. She was like, I would first, excise the scar tissue doing what they call a finger ectomy where you cut out the raggedy bits, and then you take the skin tag and you create a little flap of skin to protect the cut so it can heal. And then she said, I would also include, Botox injections to paralyze the sphincter muscle, to relax it so that it can heal.

Dr Andrea Love 00:15:02 And I was like, well, you’re the first person that actually presented some data and also some rationale. So I you know, by the time I left that appointment, I was like, sold. This is who I’m going with. She had excellent bedside manner. She really knew her stuff. And I felt very comfortable, you know, putting putting a medical issue that is very stigmatized in our society into her hands. And I think, you know, with that experience that was that was kind of when I realized or when I decided I was like, you know what? I talk about a lot of science topics, but I don’t really talk about like, those topics. But I was like, you know what? This is a lot more common than people think. But but things, poop things, things related to topics that are very stigmatized. Like nobody talks about them and then nobody knows what sort of information is credible or not. I was like, you know what? I’m gonna I’m just gonna talk about it because I’ve been in so much pain and I’m at my wit’s end.

Dr Andrea Love 00:15:54 And so I was like, listen, I’ve been dealing with this. It happened completely out of nowhere. It’s idiopathic. We don’t know why it sucks. You know, I’ve I’ve I’m getting surgery, you know, and this and this is what’s happening. And I got so many messages from people who are like, oh my God, you’re the first person I’ve seen that’s talked about this. I thought I was the only one. I’ve been in so much pain since I gave birth, and it’s not healed or this, that and the other. And, you know, I think, granted, I’m not the one doing any medical procedure, but I think simply just talking about how this is a legitimate medical issue and there are treatment options, and it can be really frustrating to find a provider just help assuage a lot of concerns. But I think even beyond that, you know, People have been conditioned to not feel comfortable about sharing intimate details about these types of medical issues, right, because there’s stigma attached.

Dr Andrea Love 00:16:45 And so when you go to a provider, you know, for me, I overshare because I’m a scientist. And also that’s just my thing. But I think that there’s often this tendency for people to not maybe share all of the details or share the scope of the pain they’re in, or share the scope of the symptoms. And that can lead to delays and diagnosis or delays, inappropriate treatment policy protocols. And and I think it’s been I mean, Wendy, I love your social I think you do a great job at kind of demystifying and debunking a lot of these topics that I think are really stigmatized. But I think it really underscores how challenging it can be for someone like me who’s actually in a related field versus someone who, you know, has no, no context and doesn’t have maybe the health literacy or understand how to advocate or, you know, they leave with a bad feeling. Well, you know, if someone’s going to do surgery on your butt, you want to make sure that you feel very comfortable sharing all details with them before you commit to that.

Dr Andrea Love 00:17:45 And that includes, you know, their your rapport. I think, you know, I’m always very evidence driven, but I think when you’re talking about patient provider interactions, that personal connection is, is also really important.

Dr Wendi LeBrett 00:18:00 Yeah. Very essential. And I would also add that, you know, so many people feel embarrassed to talk about these topics. I have so many patients who say to me, oh, I feel so awkward talking about this. Like, and I’m like, it’s literally my job to talk about this. Yeah, we should talk about this every day. So I’m really glad you shared your experience, because I think there’s so many people out there like experiencing this. And and I think actually there was an article that was just published in one of the gastroenterology journals about how the rise of social media like patient voices on social media about GI conditions has been really helpful to kind of bring a voice. And when people talk about their constipation, their idea. So thank you for bringing up this topic.

Dr Andrea Love 00:18:45 And that’s I think that’s the other thing. Right. Like for me, you know, I’ve never felt embarrassed about poop or bowel movements or gas or things like that. But it’s also like part of my field, right? I talk about anatomy and bodily functions, but I’m also like a distance runner, and it’s like a joke. In the running community. We’re literally like whenever we run with a group, we’re just talking about pooping. Everyone’s pooping before a run, everyone’s pooping after a run. Like it’s it’s just like we don’t really think about it. Right? But but there are a lot of people where it’s like, taboo. You’re not supposed to talk about it, you know? And so, you know, I have young nieces. And so we talk about these things all they’re very proud about all of their bathroom habits. And you know, we got we have a game, we have poop bingo. We play poop bingo. We look at poop of other animals like, you know, I think I think getting getting people to like, destigmatize the topic at an early age so that if and when a medical issue arises where they do need to talk about it to a relative stranger, you know, they can do so without feeling embarrassed because it shouldn’t be embarrassing.

Dr Andrea Love 00:19:50 And if they’re embarrassed about it, that means they might withhold really important information that you need to do your job.

Dr Wendi LeBrett 00:19:56 Exactly. Normalize poop talk is what I say. Yes, I love how.

Jessie Wong 00:20:00 You bring this up, because we look at poop in our clinic and sometimes clients know that coming to work with us, but sometimes we still need to get them to, hey, you need to post this. And they are so embarrassed. And we’re like, don’t be embarrassed. We’ve seen everything. Now for anybody listening, if you want to learn more about poop health, we do have a site that’s completely free is called poop PDF. Talk for you to learn more about different types of stools so you can see what type of stool you may have and how to improve your stool consistency by making dietary, dietary, or lifestyle changes. And while Andrea, thank you for sharing. And Wendy, thank you for chiming in. Let’s move on to our second topics. So how to find the right doctor for someone with IBS.

Jessie Wong 00:20:42 Normally what we hear when people start having GI symptoms they go to their PCP first. So maybe a nurse practitioner in the practice that they go to. And then if they are lucky, they will get a referral to see a gastroenterologist. And I say lucky, maybe not so much lucky, but if they’re prepared and they’re presenting their symptoms very well, and their physicians understand that this is something they should probably refer on to a GI, then they get a referral pretty quickly. But, let’s maybe walk us through the process. When did you mind, doctor? Let’s walk us through the process. How can patients get better? Care to find the right physician faster? Yeah.

Dr Wendi LeBrett 00:21:20 And I will agree with you that I think there’s data that shows like over 70% of IBS is seen in the primary care settings. So by and large, it will be your primary care doctor who may diagnose your IBS or treat your IBS and IT. Some people never see a gastroenterologist. so I think it’s important that if you feel like you’re not getting the care you need and want from your primary care doctor about your GI symptoms, whether it is or isn’t IBS to speak up and ask for that referral.

Dr Wendi LeBrett 00:21:53 I think that’s really important, because some primary care doctors are great at treating irritable bowel syndrome, but some of them do not have the specialized training. So I think trying to find a gastroenterologist is really important. And then speaking to Andrea’s point again, not all gastroenterologists are created equally. Some people love treating IBS. That’s their passion. They do research about it. They know all the latest data. And some people, yes, there they kind of tolerate IBS because that’s part of GI and that’s a really common condition. But you know, their passion might be in a different, digestive disease, for example, inflammatory bowel disease or the liver. So I think it may take a bit of searching. And I think I would advocate for doing the same thing you did. Andrea, if you’re not finding that your doctor is the right fit, even if they’re an amazing gastroenterologist and someone else recommended them for another condition, they may just not be the right doctor for you. And I think there’s a lot to be said, especially with IBS for that patient doctor relationship, because I think that therapeutic relationship, especially with IBS, is so important in terms of finding a doctor with IBS and how to kind of navigate that.

Dr Wendi LeBrett 00:23:07 I think if you I think word of mouth is always helpful. There’s lots of patient communities asking around for your specific condition, not just what who’s a good gastroenterologist, because maybe someone had a great experience with someone who did their colonoscopy, and they’re excellent at colonoscopies, but they may not be the right person to treat IBS. And that’s a very different skill set. so trying to find someone who’s had IBS had that experience and directly looking at that. I think Andrea brought a really great point on how she approached her search. If you can look at people’s bios online, see what research they did, if they have done research in IBS, that in itself is an expression that I am interested in IBS. I’m doing the latest research, and I will say that IBS is a condition that has evolved a lot in the past 5 to 10 years, so finding someone who is up to date on that information, the new treatments is really important as well. And then for that reason, I actually think finding a younger physician might also be a better, option.

Dr Wendi LeBrett 00:24:14 There are lots of experts in IBS who are older, but I think to get a better reach or a better, a better shot at finding a doctor who is familiar with this new research. I would say someone who’s more recently trained and out of fellowship might be a better bet because they will know the latest data. And I will say a lot of the treatments have changed even in the last five years.

Dr Andrea Love 00:24:40 Yeah. And I’m just gonna tag on there. But you bring up a good point because whether it’s someone in private practice or affiliated with a hospital or an academic medical center, they always have on their website. So you don’t have to necessarily read their papers, but they have, you know, specialties, research interests, you know, target patient groups. And so looking for those keywords because as you mentioned, Wendy, you know, gastroenterology is a huge field. And so yeah, I mean you might be an expert on all topics, but there’s always going to be areas you veer off into because that’s your passion.

Dr Andrea Love 00:25:14 And so finding a fit, you know, should also be linked to the actual medical condition. Right. It’s it’s the same with looking for a good oncologist, right. There are different oncologists that specialize in certain types of cancers pediatric versus adult blood cancers versus solid tumors. It’s the same approach that you should take with something like this, too.

Dr Wendi LeBrett 00:25:38 And other buzzwords to look for. Or if they don’t explicitly say IBS or everybody writes IBS because it’s a very common condition. So looking for things like motility, if someone has had motility training, that’s a buzzword for IBS, or if someone is interested in like integrative digestive care or nutrition, I think those are aspects where IBS that would kind of point you to have higher success at finding someone who’s interested in IBS and will have that knowledge, and then I will say finding someone. I am not in academic medicine, I’m going to be in private practice. But I think actually finding if you have the capability in the city that you live in and your insurance, somebody in an academic setting, you might have again, better success, because a lot of the academic centers have resources like dietitians and GI psychologists and like they have a whole multidisciplinary team already set up.

Dr Wendi LeBrett 00:26:38 So that might also help with your success. And that’s not to say there are lots of wonderful private practice gastroenterologists and private practice guest GI dietitians like yourself, Jesse. But I think if you’re struggling and you’ve tried that private practice route a little bit, that might be where an academic center might serve you a little bit better.

Dr Andrea Love 00:26:58 Well, and I think it’s also, you know, it really goes to this topic of health literacy, right? Like if you don’t know where to start in this search and you’re kind of throwing spaghetti at the wall, an academic center, they often have like resources like guidance tips and, and, you know, tools to help you parse out this really overwhelming situation. And so they often, you know, there’s often directories that do include private practice providers as well. And maybe they have, you know, surgical privileges at the at the hospital center. And so they’re going to be there and they’re going to have certain specialties. and so I think, you know, if you don’t know where to begin or you don’t know anybody in your area that has suffered with the same condition, and so you can’t get a personal referral, that can even just be a good start to start to kind of create that, that wish list of features and skills that you’re looking for.

Dr Wendi LeBrett 00:27:50 Exactly. And I think academic centers also just have a very wide like referral base, so that if you see a doctor in that setting and they say, oh, I’m not the right fit for your condition, but my colleague, because there’s like 20 or 30 gastroenterologists in that setting as opposed to four, then they’ll be able to connect you with the right person to.

Jessie Wong 00:28:10 And I want to add to that is, you can also Google a physician too. And see, I think one of the ways that really helps patients to find somebody that may be a better fit is reading their reviews online to see whether they have good bedside manner. So to see what kind of patients have seen them before in the reviews, sometimes that can be really helpful.

Dr Wendi LeBrett 00:28:29 I’ll say that’s plus minus because sometimes I Google my colleagues and I’m like, this person’s great. Like, why do they have like three star reviews? And then some people have amazing reviews, but I think I agree with you. Like usually if someone has all five star reviews, that’s a good sign.

Dr Wendi LeBrett 00:28:45 But if somebody looks good on paper and their Google reviews are great still, yeah, still give them a shot. Maybe not. If they’re all one star reviews. And also people who are upset tend to be more likely to leave a review.

Jessie Wong 00:29:00 That’s true, I think. Read the reviews to see who leaves the one star review. If they have, you know, if it’s just one person versus everybody else is like 4 to 5 stars, it’s probably worth it. And I will have to say, be careful of the reviews from the institutions itself, because usually they take away the reviews that are not five stars. So be mindful of that when you’re doing your research. And then maybe do your research there and then look into that physician, whether they specialize in irritable bowel syndrome. Right. Like looking for the buzzwords motility. What is that. Functional gastroenterology. That’s another one. Integrative gastroenterology. Those are all buzzwords that you can look for that can kind of tell you that they know more about the condition and can maybe provide better strategies to help you manage.

Dr Andrea Love 00:29:44 So I have a question for Wendy. And it’s kind of related to this provider search. And you know, obviously something that was pretty obvious for me because my GI issue and granted, you know, my family has history of various other GI things, diverticulosis and, you know, other, other sorts of conditions. And so there was, you know, after my surgery, they did take pathology and tissue and make sure that, you know, there wasn’t precancer and other things that were causing this. But, you know, for me, the actual acute site of issue was the rectum. So it was obvious that I’m going to colorectal. But how do people figure out if they’re going to go gastroenterology or colorectal or even theoretically ENT right. For upper GI right. There could be some. So you know, obviously this is is, you know, kind of geared to IBS. But even within that, you know, symptoms can be different right? Symptoms could be upper versus lower. So, you know, what do you advise people in terms of, you know, should they start with with a gastroenterologist and then kind of go from there? Or are there certain recommendations that you would make based on symptoms?

Dr Wendi LeBrett 00:30:55 So it’s a little bit hard.

Dr Wendi LeBrett 00:30:56 And I think it’s, it’s it does like depend on this specific condition. I think depending on I mean, starting with your primary care doctor, they might be able to point you to the right person. They might have that nuance. I think it depends what you’re looking for. If you’re looking for a surgical procedure or some sort of procedure, for example, in your case, and you had tried all the medical therapies there. If you go see a gastroenterologist, most likely their wheelhouse is more towards the medical treatment of things. So by medical, I mean, you know, using pharmacological medications, supplements, doing the blood tests like working up why you’re having diarrhea or why you’re having heartburn if you’re trying to investigate the problem, and then trying medications for the problem, that’s when I would see a gastroenterologist. If you already know what the problem is, and very likely you need a surgery for that problem, then that’s when I think a surgeon would be a better option. The one complicating thing is sometimes we do procedures endoscopic only now.

Dr Wendi LeBrett 00:32:08 So sometimes you think you need a surgeon, but actually it’s a gastroenterologist who will do an endoscopic procedure. But by and large I think thinking about has the problem been like definitively diagnosed? If not, then I would go to a gastroenterologist and then if what treatments are you looking for? If it’s a surgery, then go to the surgeon. If it’s not, then you know you’re you want to try everything but surgery. Then I would go to the gastroenterologist and then usually the gastroenterologist or the surgeon if they think, oh, first I want you to see the gastroenterologist or first, I need you to also consult with the surgeon. And often they work hand in hand. And like even in someone who may need surgery, we want to explore all the other options first or make sure you get the right testing. So usually you’ll be connected to the right person. But I agree, it’s very confusing and I think sometimes even doctors get confused about who the right person is and and the treatment you might be offered will depend on which person you see first.

Jessie Wong 00:33:11 And I think it might be important for the patients to really track the symptoms first and then bring it up, maybe with your primary care physician and discuss the different options with your PCP, and then your PCP can help you decide, or maybe help you kind of talk about things and recommend accordingly. So discuss this. I think for most people who may not have the medical literacy, discuss this with your health care provider. So while you can read up a lot of things, but it might still be good for you to talk to someone who has a medical training. They may not be a specialist, but they might be able to help you create the next step and give you more confidence. And whatever step you wish to take can give you the right guidance. All right, how about we move on to the third topic and that is how to prepare for a specialist appointment? a lot of the times this is something we tell our clients to do, is to really documents their symptoms for 1 to 2 weeks leading up to the appointment.

Jessie Wong 00:34:06 We want to see all of your bowel movements. We want to see everything you’re eating and tell me when you have bloating, when does the bloating and does it ever end? or do you have pain? When does the pain happen? What type of pain you have? So we really tell patients to document everything so we can kind of identify to see what may be going on. Do they need more tests? Do we need to send them back to their GIS. Now when they go to a specialist or maybe PCP or GIS, what are you looking for during the appointment so that the patients can get the most out of it?

Dr Wendi LeBrett 00:34:35 Yeah. So I think the most helpful thing to do as a patient, and I tell my family members to do this is make a list. Make a list of your symptoms and put them in order of most important to you, least important to you. Because you might have six symptoms, you may not have time to go through each of them. So having that priority done down is really helpful.

Dr Wendi LeBrett 00:34:58 So we can prioritize your symptoms. And to start off the appointment by saying I have these x number of things I want to talk about, the most important one is this. So kind of having that organization, having that plan a lot of people like have a notes app. Like when I see my doctor, I have a notes app. I write my questions down ahead of time. So having that preparation helps. And then I think some of the basic things that Jesse said, you know, pay attention to your symptoms and kind of observe, we’re going to ask questions like, when did it start? How long has it been going on for? How often are you having symptoms? are there things that make it better or things that make it worse? Are there any triggers? So kind of just having all those little details for each symptom is really helpful. And if you’ve already thought about these things, that can kind of help you cover more ground during the, the visit with your doctor and having that organization, another really helpful thing for any appointment is if you’ve already seen another doctor and had testing done, if you can access those and have those ready for that appointment, that is extremely helpful.

Dr Wendi LeBrett 00:36:07 So some patients will print out their labs, or they will print out their imaging reports or their colonoscopy reports, their endoscopy reports. Anything you can get your hands on is really helpful. And if you have access to the physical copy, bring it along. Even if the other doctor has said, oh, I’m going to send that information along because a lot of things get lost. They don’t reach in time, they’re buried somewhere. And so I think just if you have that access that will just like expedite things, and you may not have to repeat the same blood test or procedure. and then this is what I tell all patients to get the most out of their appointment, more so than for the doctor’s sake. But as a patient, like, have a very clear plan about what’s happening next with your doctor. So I always tell, you know, my parents, my family members ask the doctor, like, okay, this is what at the end of the appointment recap, these are the they’ll probably have a number of medications or treatments that they want to try.

Dr Wendi LeBrett 00:37:12 And then ask them if this doesn’t work, what is the next step? Am I supposed to see you again? When do I see you again? Can we get an appointment to see you again? Because often I will say a lot of doctors will say, just try it and let me know how it goes. And it’s very vague. And then you can’t schedule another appointment for three months. Often it’s hard to see a specialist. And I like will tell. Like, I tell my parents this all the time, like, why didn’t you get another appointment on the books? So even if you think I may not need to see the doctor again, if they allow you or they make it possible to schedule a follow up appointment, schedule that follow up appointment so that you can cancel and you can always cancel it anytime. It’s much easier to get an appointment on the books than the other way around. So those are my takeaways, almost as like a doctor who wants to help my own family members and help the people listening to this podcast to get out of it.

Dr Wendi LeBrett 00:38:08 Because sometimes doctors can be you see them, they’re great during the appointment and then it’s really hard to get a hold of them. So making sure you have that plan in place and that ability to advocate for yourself so you get that follow up that you need.

Dr Andrea Love 00:38:22 I think that that action item at the end, that’s that’s that’s clutch. I think I think providers can be the best providers in the world, but they’re frazzled, right? They’re juggling a million things. And, you know, it’s it’s almost like they’re not even thinking about it. Right. And so I think I think prompting that is is a great like checkpoint. Right. So we’ve agreed on this. I’m going to try this. And if this doesn’t help in X number of days weeks, months, you know, what’s the next step. Or should I go ahead and schedule a follow up in X? I mean I do that with my psychiatrist. You know, that it’s you know, okay, well, I’m going to schedule see you again in three months and I schedule that before I leave.

Dr Andrea Love 00:39:06 You know, my office because, you know, we know it’s really hard to get appointments. And as you said, it’s much easier if you’re standing in front of the receptionist and they’re looking at the calendar than trying to get them on the phone. down the line if something happens. But I love that that little, check at the end. I think that’s that’s really, really important.

Jessie Wong 00:39:26 Yeah. Thank you. And that’s I think what we hear being complained of all the time from patients and clients is that they see their GI ones. They don’t see them in another three months. They don’t know what they’re doing. They have questions. Nobody’s answering their questions. And it makes it really hard, especially with IBS. Right. We need to change strategy as they try things out. It’s never like one size fits all for everybody. I mean, if it’s that simple, IBS would be treated, there wouldn’t be IBS, but IBS is so personalized that you really need to have a tailored plan. And yeah, that’s great.

Dr Andrea Love 00:40:00 Now one one other thing I think because, you know, certainly I alluded to this as well. And I’d love to hear Wendy’s thoughts on, you know, advice for people who maybe are not as comfortable talking about some of these topics that don’t come naturally. Maybe they’ve been kind of convinced that they’re not supposed to talk about them, that they’re embarrassing. You know, of course, you already outlined writing a list, keeping track of symptoms, keeping track of what aggravates them, what what doesn’t, you know, what are some things that you tell patients to maybe alleviate some of the embarrassment? Like it’s it’s easy to say, well, you shouldn’t be embarrassed, right? But it’s not as easy to like actually do away with those feelings. Right. So is there something that you do with your patients to kind of get them to a place where, you know, they feel more comfortable almost oversharing? Right. Because I feel like as a provider, you’d rather have excess information that is ends up being irrelevant than information left out because they’re shy about it.

Dr Wendi LeBrett 00:41:06 Yeah, I think a lot of it has to do with your bedside manner and sort of those nonverbal cues. So kind of that establishing that patient rapport. Because if there’s someone you’re just not comfortable with, they can tell you, feel free to say anything or give me all the details. And if you just don’t connect with that provider, for example, provider number three that you saw, you’re just not going to want to share that information with that person. So I think a lot of that is a physician is like an a gastroenterologist in particular, is making your patient feel at home and having them feel like they’re in a safe place. And we, you know, sometimes we end up talking about trauma. We talk about fecal incontinence. So having that established patient rapport, rapport is so essential. and then things you can say is, I think just normalizing the situation, I always try to normalize, you know, this is a common problem. I have patients who sometimes have fecal incontinence when they are having diarrhea.

Dr Wendi LeBrett 00:42:08 Is this something you experienced? So not asking, do you have fecal incontinence but actually explaining? I’m asking this because I already know that patients have these issues and you may be one of them. Or I have patients who find it very painful to have sex because of their constipation. Is this something you experienced? I think a lot of it is the way you ask the question as well, but I think that’s a great point. It’s very hard to get someone to that point, and it might take a few visits for them to open up with you as well. And I’m sure Jessi experiences this as well in her practice.

Jessie Wong 00:42:40 I think, you know, practice is a bit easier because we have a course as well that goes along with our work, so they kind of know who we are and they know what we’re expecting. So they come in with everything filled out so we know the right questions to ask. But then it’s asking the detailed questions. Right? I think one of the things I find very interesting is you ask people, are you drinking enough fluids? They always tell you they’re drinking enough fluids.

Jessie Wong 00:43:00 But when you have them, as you walk me through your day yesterday and yesterday, never have enough fluids. And then they will always say, yesterday was not a typical day, right? But in, you know, seven days in a week, how often is a typical day happening? Right. So those are the things that we really try to ask a lot of questions. And like you said, making our patients or clients feel comfortable sharing those, intimate details. Right. Drinking fluids. That’s not intimate. But then going to the bathroom really asking, when did this happen? How much came out? It’s like, which picture is this? Like, which picture is that second bowel movements that give us so much information to go into. And and I will say as providers, we’ve seen it all. Don’t be embarrassed if you’re listening to the podcast. Don’t be embarrassed to bring pictures. Bring as much information as we can. We want more information and we can filter out what we need, what we may not need.

Jessie Wong 00:43:51 It is okay. We want more information than less because that really helps us to understand better what is going on and help you create a better plan in managing your IBS. Now, I will.

Dr Wendi LeBrett 00:44:02 Confess I do see a lot of poop pictures and that is very common. So it is very appropriate to show your gastroenterologist a poop picture.

Dr Andrea Love 00:44:11 Yes, I have my my nieces for my birthday. They were allowed to pick out, a gift for me and I got a poop plush. So clearly we talk about that a lot.

Jessie Wong 00:44:21 I’ve got my hair.

Dr Wendi LeBrett 00:44:22 Can you see?

Speaker 4 00:44:23 I had a feeling you had like, yeah.

Dr Wendi LeBrett 00:44:26 Yeah, I have like a little squeezy, like, stress poop ball, I love that.

Jessie Wong 00:44:30 Yeah. And so don’t be afraid. And, well, there are sometimes guys who may not have the best bet site manners. And then we see a lot of clients or patients actually go to the alternative routes, like maybe both of you share a little bit of your what your thoughts on these are.

Jessie Wong 00:44:47 I know Andrea shares a lot in a previous episode, so if you’re curious, you can go listen to it, but I would love to hear it again. How can we bring these patients back into Yeah. Actual medicine actually. Evidence based medicine.

Dr Andrea Love 00:44:59 Yeah. So I’ll just go quickly because I kind of ranted about that. quite a bit, but I think but I think, you know, here it’s a little bit of a different topic, you know, because I’m talking a lot about my personal connection with providers. But first and foremost it was are they doing evidence based treatments. And that was ultimately why I kind of eliminated the first two, because, yeah, I mean, the procedures they were offering were evidence based, but they weren’t updated. Right. And so it wasn’t informed by the best, most novel, most relevant scientific information. And, you know, so for me that that was kind of, you know, an elimination criteria, but for other people who maybe, you know, they don’t have that understanding or that awareness, it can be really, really hard to know who’s credible and who’s not.

Dr Andrea Love 00:45:53 I mean, we know, we We all know physicians and scientists who are selling fraudulent products to people under the guise of gut health and, you know, GI function and GI health. And so there’s always those red flags, right? You want to make sure that people you’re going to don’t have an obvious financial conflict of interest, right? If they’re trying to sell you a product that they’re profiting off of directly, or their website that you go to is not talking about their expertise and their relevant background and research, but instead it’s full of products and buzzwords and things that they’re selling you. Those should be red flags. Now, if you’ve already inadvertently kind of been frustrated by the medical establishment, we know it’s really hard. I mean, I went to for right. And I and I have insurance and I have, you know, word of mouth and I had all the things and it still took me a long time. And it can be really tiring and frustrating, especially with chronic medical conditions. And so it’s really it’s very attractive to get swept up by those phrases that sound really appealing, that make it sound like they’re going to have a cure all for you.

Dr Andrea Love 00:47:01 And so, you know, if, if that’s, you know, happened to you, there’s nothing wrong in acknowledging that, you know, that was a misstep. You know, maybe you tried this detox, this protocol, this, you know, test that is an FDA approved. And and it didn’t work for you. You know, any credible provider will welcome you with open arms if you want to come back. and, and so I think we want to encourage that right. When we dispel misinformation, we’re not targeting the person that’s fallen prey to it. We’re targeting the misinformation itself and the people that are spreading it intentionally, not the people that are the innocent victims that, you know, fell for it. It’s the people, the people that know better, the people that are profiting off of it. And so, you know, if you want to try to parse out the real from the not real, you know, things claims that sound too good to be true, especially in the context of complex GI issues.

Dr Andrea Love 00:48:02 Those you know should always make your spidey senses tingle. and you know, things that aren’t, you know, FDA approved. They don’t have evidence to support them. You know, those things are usually a sign that, you know, they’re either too early in the research phase to really have evidence to be able to recommend them. And so that’s it’s not going to be informative or useful. Or there have been studies and they haven’t been shown to be helpful. And I think it’s also important to remember that, you know, the appeal to kind of seek alternatives or, you know, take, take bits, you know, from conventional medicine, evidence based medicine and alternative is is appealing. Right? A lot of people think, well, you know, what’s the harm if I’m going to do this at the same time? And I think especially with GI issues when we’re talking about liver and digestion and nutrient absorption, a lot of those things that are unregulated supplements and so on, they can exacerbate these conditions.

Dr Andrea Love 00:49:01 They can cause harm. They’re not just, well, what’s the harm? They’re benign. It’s not actually the case. And so if you happen to be someone who is taking some of those products and you are seeing a gastroenterologist, you also need to let them know what you’re taking, because that’s going to change their treatment plan. And they’re exploratory. They’re their diagnostic methods right there. If those things are known, they have knowledge that those things affect things like liver enzymes or so on. That’s going to impact how they interpret your tests, how they interpret your symptoms and how they ultimately treat you. So, you know, I think that’s also something really important to remember.

Dr Wendi LeBrett 00:49:42 Yeah. And I’ll just add like there’s like Andrew said, these are complex conditions. So if there is like a one size fits all approach. That is probably not the scientific evidence based approach, because not everybody is going to need, you know, this one product or this one thing is the cause of your symptoms. It’s just not that simple.

Dr Wendi LeBrett 00:50:05 Because if it was that simple, there would you wouldn’t be hearing about it. You wouldn’t be struggling about it. So if it sounds too good to be true, it it is unfortunately too good to be true. And I will say, like, I’m not opposed to some alternative therapies. You know, there are alternative therapies in IBS that have been studied. So like acupuncture has been studied in IBS, they’ve done randomized controlled trials, they do sham needles and actual like acupuncture. And they’ve compared and they’ve shown that that can improve outcomes. So I think if that is your jam, there are gastroenterologists who are willing to work on like looking at evidence based kind of complementary therapies, but it’s really important to find someone who’s open to both. And I would say like often these like pseudo scientists, they’re the ones who are saying, oh, doctors like ignore what your gastroenterologist is saying. Like, don’t listen to your doctor. They don’t know. I think that’s when you need to be afraid, when someone is ignoring the other provider, because I think a lot of doctors will at least be open to having a conversation with you about why they think this is not the right approach, or how they can work with that within reason, with your condition.

Dr Wendi LeBrett 00:51:22 You know, some people come in and they’re like, I really want to do this with a non medication approach. And with IBS there’s lots of non-medical therapies that have been studied. Diet is a very important one. But there’s a gut brain behavioral therapy. So these are all like well established studied treatments. So it doesn’t have to be doctor medication doctor procedure. There are ways to kind of explore things within what’s comfortable for you.

Jessie Wong 00:51:52 I love that, thank you both. And I love what Andrea was saying. If you come back, any of the evidence based providers will welcome you with open arms. And that’s a lot of what we see, because by the time a patients usually get to a dietician, they’ve seen four gastroenterologists, they’ve been to two natural baths. And then finally they’re like, okay, nothing is helping. We’re coming back. And what we do is we really help you find another guy that maybe listens to you. And then we work together as a team to help the patients. So, and if you’re interested to learning more about tests that you might have been wondering about, such as the food sensitivity test or the gut microbiome test, you can go listen to Doctor Andrea Love and, episode number six.

Jessie Wong 00:52:31 So to see, you know, if you’ve done that or why you why we may not recommend it. What are the evidence behind it. So take a listen to that. We’re not discounting your experience, but we are saying, you know, follow the evidence. There are better ways to treat IBS And, okay. Wow, this episode is really packed with so many things, and I think.

Dr Wendi LeBrett 00:52:51 We could go on forever. Yeah.

Jessie Wong 00:52:53 Thank you for tuning in to the IBS nutrition podcast. We hope today’s episode has brought you closer to understanding and managing IBS. Remember, you are not alone on this journey and finding freedom is possible. For more on IBS, make sure to follow us on your favorite podcast platforms and please leave us a five star review! We would really appreciate that you can access links mentioned in this episode in the show notes. To learn more about your type of IBS and how to identify your own food or lifestyle triggers, Register for our free IBS Masterclass. Three steps to IBS relief for our proven, holistic, three steps approach to managing IBS once and for all, head to IBS dietician.

Jessie Wong 00:53:36 Com forward slash masterclass to register and till next time, take good care of your gut and here’s to your health and happiness.