Centered on Health 3-12-25 - Surgical management of gastroparesis with Dr. Kristofer Nava

Centered on Health 3-12-25 - Surgical management of gastroparesis with Dr. Kristofer Nava. 

Episode Transcript

Speaker 1 (00:01):
It's now time for Centered On Help with Baptists Help
on US Radio. Wait forty TELWYJS Now here's doctor Jeff Tubber.

Speaker 2 (00:11):
Good evening, everyone, and welcome to a special Wednesday night
episode of Centered on Health with Baptist Help here on
news radio eight forty whas. I'm your host, doctor Jeff Tublin.
We're joined by mister Jim Fenn from our studio, who
is waiting to take your calls tonight to talk to
our guests this evening. Our phone number is five oh two,

(00:32):
five seven one, eight four eighty four if you want
to call in and be a part of the show tonight.
We're talking about various surgical topics, but specifically gastroparesis. Gastroparesis
affects two percent of the population and three to five
percent of patients with diabetes, which is a very common disease,
and also up to fifteen percent after gastric surgery. So

(00:54):
tonight we have doctor Chris Navo with us, who is
a general surgeon at Baptist Floyd, New Albany. He was
born and raised here in Louisville. He attended Male High School.
I'm undergrad at University of Kentucky. And Ross University for
medical school. He was a surgical resident at West Michigan
University at Kalamazoo, and did his fellowship in minimally invasive

(01:15):
BORGA and bariatric surgery at Spectrum Health Brand Rapids, Michigan.
He spent the last two years in Owensboro practicing as
a general and bariatric surgeon. He enjoys snowboarding, soccer, and
spending time with his wife, Barbara and their ten month
old son Luca. Welcome to Center it on Health.

Speaker 1 (01:34):
Thank you appreciate you having me.

Speaker 2 (01:36):
Oh, we're excited to have you. But I guess we
better get this right out of the gate here because
you went to university, grew up here in Louisville, but
went to UK. So who's going further in your bracket
this year?

Speaker 1 (01:49):
I guess all the way.

Speaker 2 (01:51):
Okay, you did tell me you were an avid UK fan.
I left that out at the INSUC You can tell us.
Well tonight, we're talking about gastro parsis, and as I
mentioned it, it's not the most common condition. So tell
us a little bit about how you became a surgeon
and how you started into this area specifically.

Speaker 1 (02:10):
Sure, so, I come from a long line of physicians,
my father, my grandfather, one of my understands a great
aunt for all pedisers. So I sort of grew up
in medicine life took me towards you know, med school,
and then through there kind of found out that I

(02:32):
like quick solutions with my hands and that naturally was
a good surgery and yeah, and from there it wasn't
really until I was about a third year resident where
I ran into a mentor, Alan Ellien, who sort of
got me interested in making that quick approach and thinking

(02:52):
more long term solutions. Holse, can you help people with
your hands, but help them, you know, really for the
rest of their lives as opposed to you know, six
weeks straight, And so that got me interested in Barry
the national transition from that is a lot of the
skills that there actual surgeons employed to health their patients
can be translated to multiple surgeries, particularly of the stomach.
And you know, you was a gastroenterologist can certainly understand

(03:16):
this that gas for paresis affects patients that can that
usually are suffering quite a bit. It's kind of difficult
to help them really, and this fit very well with
my barrier. My bariatric populations been suffering for years, and

(03:37):
I sort of developed a special place in my heart
for them, and a lot of that was angst the
doctor Ellien and then just an hour north of where
I trained for residency at uh FOR, they had a
similar mindset as far as so it sort of just
took off from there. And then when I was in Owensboro,
nobody was offering these kinds of surgeries, and so I've

(04:00):
really been able to sort of come into my own
as far as helping patients with this condition.

Speaker 2 (04:06):
Well, Ron, I'm thrilled to have you on here for
multiple reasons. One is, I don't think we talk about
gastroprisis enough and I think that this is a great
opportunity to educate our listeners as to what that condition is. Plus,
you know, you're doing something that I think is not
done everywhere, as you mentioned, and so I'm really excited

(04:26):
to be able to highlight that. So tell us what
is gastroparesis? What does that mean?

Speaker 1 (04:33):
Yep? So gas for purses literally means is paralysis of
the stomach. Patients that have this condition may have heard
of the notion of delayed gas or ganting. I sort
of think of it as a spectrum in that delayed
gash nanting sort of on the lower end, and pull
blown gas prices is on the on the other end.
But essentially what you can think about is the stomach's
not working. Usually it relates to the end of the

(04:55):
stomach not working. So there's sort of two ways to
think about gas for parices as a condition. Like in
one idea is that the end of the stomach, in
particular the pylorus, which is a muscle that should relax
and allows the end of the stomach, excuse me, the
stomach to just empty. But that sort of thought is
one idea that something's going on with that muscle, and

(05:17):
then if we do something about that, the stomach will empty,
and the condition is treated the other ideas instead of
just one muscle being the pyloris as the problem is
that it's sort of a global issue that the entire
stomach as a muscle, which is essentially what it is,
a wind sack, that's a muscle. And again the whole

(05:37):
sort of hypermotility issue or notion rather is that the
whole stomach isn't working as a muscle. And so the
question is which is right the name what patients will.
They come in with a myriad of symptoms. The most
common one in my experience is a nausea and then
from there vomiting more often not it's what we call

(05:58):
non bilious vomiting or just vomiting stuff that you just
ate something that's not green or your emesis is not green.
Abdominal pain can be very common, bloating, The list goes
on and on. So, as you mentioned, we don't see
a lot of it because it's not super common. But
it's really hard to peg down. It's not like we

(06:18):
see patients in the open and go oh yes based
on your symptoms. You have to ask for paris kind
of a nuanced conversation, but we do a whole work
up before it and then hopefully we can lead somebody
to a solution, whether it's surgical or non surgical.

Speaker 2 (06:34):
Well, you know it's even though it's not the most
common condition. Boy, I mean, both you and I know
that when patients have this and it's bad, it is
a major impact on people's quality of life. So we're
so thankful to be talking about it. And I would
imagine I'm glad you told us a little bit about
the pyloris part versus the entire stomach part, because I
would imagine that has some implications on what the surgical

(06:57):
and treatment options are. Who gets this.

Speaker 1 (07:03):
Great question, not typically, but the way we kind of
think about it is that there's three three types of
patients that can get it. You have diabetics, so we
could think of again the stomach as a muscle. Right
muscle has to have nervous supply or innervation as we
call it, and diabetes affects those nerves. So under controlled

(07:27):
diabetes can lead to what we call neuropathy, and the
stomach is certainly can be a target of that, so
we see it in patients with diabetes. In my world,
I do a lot of four gut surgery, and unfortunately,
sometimes the vagus nerve which travels on either end of
the esophagus and goes down into the added or it
criss crosses in front of the beginning of the stomach.

(07:50):
Any surgery in that area can can cause inflammation or
temporary paralysis, sometimes permanent and the worst case scenario of
that nerve and that nerve gives tone or nerves applied
to the stomach, so you can see it. And as
you mentioned post stomach surgery patients are just post forget patients.

(08:14):
And then the third one, and this is the one
that I really feel for, this notion of idiopathic gash
for parusis So what does that mean? That means we
don't know. It means, yeah, we don't know what's causing it.
But I find that to be the biggest challenge. You know,
we don't know about why this is happening, so how
can we come up with a solution. But it's luckily
it's twenty twenty five and not nineteen fifty five, so

(08:35):
we have some some nuanced ways of figuring that out.

Speaker 2 (08:37):
Now. Yeah, and you mentioned, and I also said in
your introduction the term foregu and just so our listeners
can understand until we get a sense of kind of
what you do and the kinds of surgeries you do,
what do you mean by forega and what kinds of
surgeries just in general do you do in that area?

Speaker 1 (08:54):
Sure, So it's when I say fore going to mean
something very different as opposed to you if we were
talking to a group of anatomists, medical students and reologist,
it means something very different. For me in my world,
it means diseases of the esophagus and stomach. But if
you talked to somebody else, you're you're talking about anything,

(09:16):
including the gallbladder, small intestine, spleen, and so on and
so forth. But for me, it's in particular the esophagus.

Speaker 2 (09:23):
And stemmach fantastic. Well, I do want to start talking
to you a little bit about how we treat this,
and we're going to do that when we come back.
But we're going to take a short break here, and
you are listening to Centered on Health with Baptist Health
here on news radio eight forty w h AS. Our
phone number is five oh two, five seven one eight
four eight four five oh two, five seven one eight

(09:45):
four eight four. If you want to call and ask
a question to doctor Chris Naba, who's talking to us
tonight about gastopriesis and other general surgery issues, we'll be
right back. Welcome back to our special Wednesday night episode

(10:14):
of Centered on Health with Baptist Health here on news
radio eight forty WATS. I'm your host, doctor Jeff Tumblin,
and tonight we've been talking to Chris Chris Nava, who
is a general surgeon at Baptist Floyd, New Albany, who's
talking to us about gastroprisis and surgical management of this condition.
If we have time, we'll get to some other things
that he specializes in, but we're focusing on gastroparesis. And

(10:39):
our phone number is five oh two, five seven one
eight four eighty four if you want to call in
and ask a question. So, right before the break, we
learned about gastroprisis and what it is and how sometimes
this condition comes about. So I do want to jump
into a little bit of how to treat it. So
obviously our initial intention is to keep people out of

(11:00):
a surgeon's office. So how would this be normally managed
medically before somebody would would come to a surgeon?

Speaker 1 (11:10):
A great question. So the first thing we think about
is lifestyle changes. You know, is there something we're doing
maybe a little bit different that we can change and
then go on from there. So, like one example is,
as I mentioned, diabetes is a very common cause of this.
So when we look at diabetes, or at least from astical standpoint,
we look at you know, an A and C can

(11:31):
globe at A and C and we sort of use
that as a surget to say this diet the space's
diabees is under control or it'satic control. So that's like
one thing we can do as far as lifestyle changes goes,
and there's medications involved without of course, but one lifestyle
change is really how how do we eat? You know,
So maybe we're doing something different with with our diet,
but in particular there's this idea of a dash for

(11:53):
Priest's site, and in general you can think of it
as foods that are easy to digest. So we're talking
about avoiding raw fruits and vegetables, heavy foods, heavy carbohydrate
foods like breads and so on and so forth, but
not just what you eat, but how you're eating it.
So six small meals a day sort of grazing throughout
the day as opposed to doing three square meals like

(12:15):
like most of us are probably used to doing. So
that's one idea sort of just changing lifestyle habits. And
then from there, yeah, we get onto some medications, and
as you sort of alluded to, I don't really see
this part of it, but right you know, there there
are a couple of drugs out on the markets that
we try and the idea is to stimulate the motility

(12:39):
of the of the stomach. The most popular one on
the market right now is something called metaooke fromide or regt. Now.
It's it's a good medication and you know, it's efficacy
is pretty good. The issue is it's got really bad
side effects, one called tarted diskinesia. So that is where

(13:01):
you sort of have uncontrollable movements of your of your face.
And so I've seen patients with this before and sort
of like uncontrollable lips smacking, and unfortunately that can be
permanent in some cases. So Reglund really is only meant
to be a temporary drug. The latest studies that I
saw was anywhere from three weeks to three months. When
we were in Owensboro, we did three months of a

(13:22):
trial really just to see what what what would happen?
You know, is this going to help you?

Speaker 2 (13:25):
Is it not?

Speaker 1 (13:26):
And if it helps you, great, But what happens after
three months. The other medications that we're using is oddly enough,
in antibiotic called retheiosin. It's the same thing. It's a
pro kinetic. In addition to an antibiotic, there are other
sort of more esoteric medications on the market that are
sort of used as a promotilic or promotilic agent. And

(13:51):
one of the really interesting ideas is that there are
groups in the country that think of gas for prices
as an autoimmunity sort of the bodies attacking it. So
and I have seen some patients who end up on
iv IG essentially subplemental antibodies if you will, to try
and and curb this disease. And sometimes it works, but

(14:13):
sometimes it doesn't. But AnyWho, that's essentially the general things
regularly from my sid we started getting in to the
weeds about medications and you know, iv IG when those
are if those don't work, then you sort of that's
when you start seeing somebody like me.

Speaker 2 (14:29):
Well, I will tell you, as not being a gastroentrologist,
that was a pretty pretty good summary of all the
non surgical options. So that's that's pretty great. And I
think it's great what you said about the way that
we eat, because you know, as we talked about at
the beginning of the hour, some of the symptoms are
not just so your natural inclination is to limit when

(14:51):
you eat, and sometimes that ends up making people eating
too much at one time because they're trying not to eat,
and that's when the symptoms occur, so that advice is
is really well received. And I hope if anybody's listening
that has this, that that's a really powerful way to
control things. I do want to ask you, you know,
as sort of a synergy almost between your your history

(15:13):
with bariatric surgery and your your knowledge about gastroparesis some
of these new medications, the g LP ones, some of
their side effects can relate to the motility. Are you
seeing people with gastroparesis more because of some of these agents, Yes.

Speaker 1 (15:33):
Yes, I am. You know sort of how I understand
how they work is the whole notion is you don't
empty your stomach. A lot of people that take one
because we did not just surgically. Also the medical management
of OBC in Owensborough and so I prescribed these medications
with lots of people and for what I told people

(15:53):
is not magic. It just literally makes your stomach stop emptying,
and so you're going to feel sick, You're going to
feel auviated. Now, the question is when does that stop.
More often than not, it stops when the medication stops. However, unfortunately,
I have seen a handful of patients who that that's
a permanent change. Luckily it's not common, but I have

(16:15):
seen that happen outside of the stomach. I've taken out
a lot of gall bladders that developed biliary discognesia. Very
rarely is it so severe that they develop an infection
of in the er. That's certainly the exception to the rule.
I've also seen it affect the colon. I've treated several
stereochoral ulcers, so yeah, that's somebody gets so constipated and

(16:35):
roads to the wall of the colon. I've seen that
a lot too, So it's really not just a medication
that targets the stomach. Ultimately, that's what we're that's the goal,
but unfortunately does sort of cause a global hypomocilium. So
I do get to see that, but luckily it's not often.

Speaker 2 (16:51):
So you mentioned you know about the red land. You
know the ideal use of it would be on a
limited basis. So what point should somebody think about sending
their patients to you. I mean, are we waiting too long?
In your opinion, by the time they come to see you,
Have we waited too long and we should be sending
patients to you sooner.

Speaker 1 (17:15):
Uh, that's kind of a little bit of a loaded
question because really I think the trigger, the trigger to
send somebody to a surgeon is very much dependent on
the patient. You know. So when I when I saw
these patients at Owensborough, a lot of the times there
was maybe no work up, maybe they hadn't tried a

(17:36):
trial of medications or or what have you, and so
a lot of them are like, why am I seeing
a surgeon?

Speaker 2 (17:42):
You know? Right?

Speaker 1 (17:43):
So I think a lot of it's an individual conversation
with whoever's referring, and then whenever the patient's comfortable seeing
a surgeon. But you know, if you're on a medication
and it's working, you're not having any side effects, fantastic.

Speaker 2 (17:57):
You know.

Speaker 1 (17:57):
I try not to operate on people if we can
help it. But I think the person that needs to
see a surgeon is when they've sort of exhausted all
options and really it's looking like surgeries probably the only
thing that's gonna end your suffering. The question is when
it was.

Speaker 2 (18:13):
Well, yeah, that's probably different, as you mentioned, kind of
on a patient to patient basis.

Speaker 1 (18:19):
So tell us.

Speaker 2 (18:20):
In general, what are the different types of surgery that
can be done for gas shrow press.

Speaker 1 (18:27):
Yeah, there's quite a few. The really interesting thing is
there's no consensus on which one's like the standard. So anyway,
we just like with overall management, we go non aggressive
to aggressive. Same thing in surgery, uh, you know, we
go as least invasive to all the way invasive. So
as far as least invasive, we're talking about incisionless types

(18:51):
of surgeries. So sort of starting on the lower end.
Something that's really not recommended with a lot of great
data is the idea of treating the muscle at the
end of the stomach of pyloris with botox. And it's
just like everybody thinks, you know, you eject botox in

(19:11):
your face and relaxes the muscle and the wrinkles go away.
It's sort of the same notion. It's the same drug
using boxylinum toxin to temporarily paralyze the pyloris. I use
that as a diagnostic as opposed to the therapeutic. And
it's nice when it works because the patient feels better.
It's like, Okay, great, but understand this is going to

(19:33):
go away. And the problem with that is with multiple
treatments you can cause scaring, and so it makes further
surgical interventions much more challenging. But anyways, that that is
an option. Another option is to do and by the
way that that's done endoscopically or with an upper endoscopy.

(19:53):
But tearing on from there, you can balloon dilatee, so
you literally stretch out that muscle with a balloon. Also
sort of a temporary thing because when the the way
this works is we're stretching the lining of the stomach
as well as the muscle, and that breaks into controlled
fashion and when that heels, it's gonna scar again. So again,
you know not it's sort of like a temporary fix.

(20:15):
But moving on to more definitive things there, and I
want to say it's in the last decade or so,
but the idea of cutting the muscle and dyscopically it's
invasive in the sense that you have to go asleep
for it whatnot. But there's no incisions. And this is
sort of like the forefront of what's hot right now

(20:36):
in this in this field. So it's something called pop
or a perr oral and the scopic piler myotomy. I
don't do these, but the way I understand it, if
you're going in with a scope making a small nick
on the lining of the stomach before the muscle going

(20:56):
in there, dissecting through all the layers, cutting that muscle only,
and then sort of closing your defect on the way out.
And I think that's a really neat neat idea. I
don't do them. I don't know how to do them,
so I don't offer that.

Speaker 2 (21:12):
Well, let's take a let's yeah, dotor novl let's take
a quick break and then we can come back to
the get into more of the surgeries that you do.
I just want to take a quick break. Here. You're
listening to Center It on Health with Baptist Health here
on news radio eight forty w h as. I'm your host,
doctor Jeff Cablan. We're talking to Chris Nova tonight about
capsule presis and surgical options. Our phone number five oh

(21:33):
two five seven one eight four eighty four five oh two,
five seven one eight four eight four if you want
to call in. Our producer, mister Jim Finis on standby
to take your calls. We'll be right back. Welcome back

(21:58):
to Center on Health with Have to Selp for our
Wednesday night show ben It on Health here on news
radio AD forty w AHS. Tonight, we are talking to
doctor Christopher Nava about gastroparesis and the surgical management. He
is a general surgeon at Baptist Floyd with a specialty
in gastro parsis and obviously knows a lot about this.

(22:19):
So we are super fortunate to have him talking to
us about this tonight. Doctor Nava. Before we went to
the break, you were starting to you were kind of
taking us from what almost least aggressive to a little
bit more aggressive about the surgeries and procedures that are available.
So we'll just pick that back up and tell us
a little bit more about how you do surgery for this.

Speaker 1 (22:43):
Sure, so there are right now there are three ways
we try and get somebody through this type of disease
with an operation. I do two of them, and then
when I don't. But well, we'll talk out a gastric stimulator.
Because right now, if you were to ask, like a

(23:04):
surgical resident, how do you treat gastroparesis, they'd say gas
or pace maker or a stimulator, if you will. So
that is kind of like when somebody has a bad
heart and uh, they need a device that pumps their
heart for them in a way, and you can think

(23:25):
of the stomach as the same way as the heart
and the stomach, or I hope nobody from cardiology has
an issue with what say, but they're sort of the
same in a sense. It's it's a it's a bag
of muscle, right, and it pumps things, but instead of blood,
we're talking about whatever you eat. So any part of
that is it's a surgery. Now, from what I understand,

(23:48):
they sort of temporarily do this with what's called like
a trans nasal lead. So they stick these these wires
down the nose and in the stomach and can can
past the stomach, and if that works, the way I
understand is that they'll go ahead and the implant a
pacemaker surgically. And right now, that's kind of a standard,

(24:10):
if you will, with how to treat this this disease.
I I don't do that. We did them in residency,
and we did not do that in fellowship, and I
was sort of given an argument I couldn't really argue with.
And for that reason, I do not place gastric pacemakers.
But luckily, and if that's something a patient wants to do,

(24:33):
we have somebody in the level that can I can
do those anyway for for my approach. I have to
two surgeries that I employed. One is called a pyloroplasty
and the other one's called a subtotal gas structomy. And
the way I decide how this, you know, which way
we go left or right, is based on what I've

(24:54):
already sort of alluded to, and that's the use of botox.
So somebody sees me and we think this is going on,
we try and prove it. And there's two ways that
I do that. One's called a gastricinting study. The other
things called upper endoscopy. And there's a third modality that
I've never used before. We didn't have an Owensboro or Michigan,

(25:17):
and so I haven't used that particular modality before. But anyways,
moving on to the treatment. What I tell patients is,
here's the two things that we think is going on.
Either it's the end of the stomach or it's the
whole stomach. So let's figure out which one it is.
And so I will offer them endoscopic injection of botox

(25:40):
into the pylorus and then we wait in sort of
an experiment, if you will, and then I see them
back in the office in about six weeks and literally
to the visa is how do you feel? And if
life changing, excellent, Okay, you know it only lasts about
six weeks, it will go away. And so if this
is game changer for the patient, then I say, okay,

(26:02):
let's make this change permanent. And that's what a pyloroplasty is. Essentially,
you're cutting the muscle using surgery, cutting the muscle, and
if you think about it, we're going along the length
of the muscle and then we're going to close it.
And I'm sure it sounds like we're just redoing exactly
what I did, but actually we're closing it in a

(26:22):
ninety degree fashion. So if you think about a horizontal line,
we're closing it vertically. And it's called a Heineke nickel.
It's pyloroplasty. And the whole point of this is to
make the pylorus wider than it was before. It's done
minimally invasive. In these days, we do it robotically. That's
my preferred method. It's not done as an outpatient yet.

(26:44):
I'm sure some where they're doing that that I'm not
not there yet. So I do at least one one
night in the hospital, and you know, we sort of
advance the diet kind of slowly and everything's going great
in the morning. Send that patient home. For patients that
tell me they have no effect with botox, then I

(27:04):
give them two options. Either we can opt for a
gastric pacemaker, or we can do something called a subtotal
gas tract. To me, now, that means taking out most
of the stomach, and that's understandably so a wild idea
for many people. I'm very biased. I'm a geriatric surgeon.

(27:24):
I do this to people all the time, sort of.
And what I mean by sort of is one of
the surgeries that I did for weight loss something called
a gastric bypass, and that's essentially disconnecting the majority of
the stomach from the rest of the GI tract and
nothing gets removed. We just re reroute things, and a
subtotal gastrectomy we do the exact same surgery, except we

(27:47):
remove the offending organ. There is a small subset of
surgeons that tried to do just gas erc bypass for
patients with gastroparesis, and in my opinion, understandably so, that
didn't work out so great. So about twenty to thirty
percent of those patients in this study that I'm sort
of referencing required a second surgery to remove that stomach

(28:12):
may not seem like a lot, but in surgery, that's
that's kind of high. So for that reason, I offer
these this particular set of patients this option if that's
something they want to do now that that is as
aggressive as as I get. When they were initially studying
these things a couple of decades ago, that was considered
very morbid and understandably so, you know, you're missing our stomach.

(28:34):
It does have a function. But that said, there are
plenty of people walking around that have had a gasterer
bypass and that are living whole new lives. Comparing outcomes
now subtal gas tractor or gastra paress versus back in
the nineties, it's totally different. We're doing these things minimally

(28:54):
invasive one night in the hospital. We understand patient that
need this surgery better than we did before. We're more
like this, we have better workups for it, and now
we have this this motox idea, and so in my opinion,
we're able to select better patients that would benefit from it.

Speaker 2 (29:18):
So let me let me play devil that it for
just a second, because I'm really curious as to like
what you're going to say about this. So if we
go through sort of the algorithm that that you've laid out,
were people get to you because they I mean hypothetically
people get to you because medicines and diet aren't aren't working,
and then they get this botox which doesn't alleviate their symptoms.

(29:43):
So the thought is then to talk about subtotal gastroctomy.
In their mind, they've tried all these things that have failed,
and now part of the stomach is going to come out.
What's the success rate? How do you quote that to
your patients to guide them through deciding to take on
that that issue?

Speaker 1 (30:00):
Sure? Sure, well, the question I asked them is what
are you trying to get out of all this? You know,
what's your your biggest issue that gas for priests is
giving you and against usually acknowledge and vomiting kind of
hard to vomit if your stomach's gone, and so that
that that usually is you know enough amother people can

(30:22):
wrap their minds around that. Oh okay, that makes sense.
But as far as the data goes, there is a
study by Kevin al Haya I think is his name.
He's out of Southwestern United States, if I'm not mistaken,
where they did comparisons of this, and the thing that
they were comparing was quality of life. And so they

(30:43):
compared pyloral plasty gas rep pace maker and sub total
gas tracty and eighty percent of patients that had this procedure.
And mind you, this is about a two hundred patient study,
so not a wild retrospective, you know study, so level
two data. Eighty percent of patients it affected their quality

(31:06):
of life for the better. I can't find a number
better than that in any of the studies that I've seen.
So I tell them both of those things, and you
know that they will do with that information what they will.
But that's sort of what I rely upon is that
eighty percent of the time in that study, patients had
a significant difference in their quality of life. I either

(31:28):
sentims went away.

Speaker 2 (31:30):
Which is in this condition, you know, it's not pre cancerous,
it's not a cancer. So the quality of life is
the endpoint that you're looking for. So I think that
sounds like an extremely effective way to have that conversation.
Let's take our final break, and we're going to come
back and talk just a little bit more about the
types of surgeries that you're doing. You're listening to center

(31:52):
It On Health with Baptist Health here on news Radio
eight for y whas our guest tonight, doctor Christopher Nava,
talking to us about gas, Joe priests and surgical options.
I want to remind you that if you missed any
part of this show or want to hear all the
excellent information in its entirety, download the iHeartRadio app. It's free,
it's easy to use and give you access to tonight's
show and all the other features the app has to offer.

(32:13):
We'll be right back. Welcome back to cen It On
Health with Baptist Help here on news Radio eight forty wahs.

(32:37):
I'm your host, doctor Jeff Tublin, and tonight we are
talking with doctor Chris Nava about Dasho presis and it's
surgical options, and he has just done a fantastic job
of talking us through the condition and the medical treatment
and now the surgical treatment. Remember to download the iHeartRadio
app to re listen to this or any of our
previous segments. Doctor Nava, I want to pivot just a

(33:00):
little bit because one of the things that I really
like to do on this show when we have somebody
with expertise like you is to talk about things that
might be being done in our Baptist system that we
may not be doing too much other places. So one
of the things I know you're you're interested in is
kind of a rarer condition. But tell us a little
bit about the meaning in arcuate ligament syndrome and what

(33:21):
that is and what you're doing with that.

Speaker 1 (33:25):
Sure. So that is a condition whereby a hole in
the diaphragm that's used to allow blood vessels to go
from the order to the abdomin. That hole has a
ligament called medi ligament, and sometimes when that is too
big or what we would call hypertrop feed, that can

(33:47):
kink one of those orders called the ciliac carter. There's
three main blood vessels that go from the order and
supply blood to our gut, and the ciliac carter is
one of them. When that artery is compressed, you can
have symptoms as if you were sort of having, if
you will, a heart attack of the gut. And what

(34:08):
I mean by that is when patients are having chest
pain or left arm pain from not enough blood to
the heart, you can sort of have something similar in
the way of feelings that you would have if you
didn't get enough blood to your admin. So one of
those feelings is sort of abdominal pain, sort of like
a crampy abdominal pain. In particular, there's this idea of

(34:31):
food fear, where eating causes you pain and so you're
sort of scared to eat. And the whole readon that
is is when you're using your gut for digestion, if
you're not getting enough blood flow, it's sort of like
working out and not stopping working out, so your muscles
get soora the same same thing with your your intestine,
if you will, and so it's it's almost like a

(34:53):
rule out disease.

Speaker 2 (34:54):
It's very rare, yeah, it.

Speaker 1 (35:00):
But it's almost thought of it as a vascular surgery
kind of issue, and so we do all these other
tests to try and prove it's nothing else. And so
it's sort of this exhaustive work up and at the end,
the way we try to confirm that is we try

(35:20):
to understand, well, what's going on with this ligament. So
one thing to do is either a cat scanner or
an MRI and try to understand can we see this ligament,
can we see any compression on the artery itself, and
then one thing to do is an ultra sound what
we would call a mesantery duplex. And the whole idea
behind that is we're trying to measure how fast is
the blood going through that artery if something is obstructing

(35:43):
it from the blood flow after the instruction will actually increase.
Think of it like you're running a hose and you
put your thumb over at the end of the hose
and we'll shoot out faster. And that's kind of the
same idea. So we employ all these diagnostics and at
the end of the day, if everything pointing towards that,
and then you can see a surgeon for that. Ordinarily,

(36:07):
and I mention it's a vascular surgery issue, but a
lot of times these kind of things are tasked to
four gut surgeons. And the reason is is, well, it's
in our backyard. This ligament exists a couple of centimeters
below where I normally am, and that's the esophageal hiatus.
So again I mentioned the diaphragm as a couple of

(36:28):
holes in it, and one of those holes is for
the esophagas I'm there all the time, and right below
that is the media arct ligament. So I'm very familiar
with the territory, as are all four Gut colleagues, and
so we take care of that.

Speaker 2 (36:41):
And is it literally just snipping the ligament to release
it or is that what you're doing or what's the surgery?

Speaker 1 (36:49):
Yeah, yeah, that's pretty much it. Yeah, it's a little
thinkter tightening, if you will, because you're operating right next
to the order and that things can happen. But yeah, complex, Well, no.

Speaker 2 (37:04):
It's good to know, you know, because just having set
people for this, you know, as you said, it's an
exhaustive work up. They've been through so much they're still
not getting relief and it can be a very frustrating
experience for both, you know, the provider and the patient.
And so that relief just must be it must be
a big sense of satisfaction for you to be able

(37:25):
to provide that that relief.

Speaker 1 (37:28):
In the operating room and in in the office. Yeah. Again,
it's kind of a scary surgery to do, but does
a lot of help for the patients and they feel
great afterwards.

Speaker 2 (37:41):
And so if somebody wanted to get in touch with you,
what what would what's the best way to reach you?
Where's your practice and how would somebody find you?

Speaker 1 (37:51):
Yeah, so you know, I'm one of the general surgeons
that Baptist Floyd on State Street. Our office is a
little bit down the ways from the main hospital. Can
be found on our website, and you know our practice
is right there. We see patients Monday to Fridays and available.

(38:14):
I want to say we're open from eight to five
if I remember correctly.

Speaker 2 (38:18):
I won't quote you on that, but you are open
most most business hours, which that's rough. Well, I just
want to I really want to thank you. We're coming
to the end of our time together and we barely
scratch the surface of all the things I really wanted
to pick your brain about, so clearly we are are
just going to have to have you back again. So
doctor Nava, I want to thank you so much for

(38:40):
joining us tonight to talk to us about gastroparesis and
both the medical and the surgical management of it. We
are thrilled to have you in the community. We know
you'll be rooting for UK. I want to thank our producerviceer,
Jim Fenn, and I want to thank you the listener
for joining us. I know tonight was a special night
on a Wednesday, but catch us every Thursday night at

(39:02):
seven o'clock on news Radio eight forty whas. I hope
everybody has a great rest of your week and a
fantastic weekend. Have a good night. This program is for

(39:32):
informational purposes only and should not be relied upon as
medical advice. The content of this program is not intended
to be a substitute for professional medical advice, diagnosis, or treatment.

Speaker 1 (39:42):
This show is not designed to replace a physicians medical
assessment and medical judgment.

Speaker 2 (39:48):
Always seek the advice of your physician with any questions
or concerns you may have related to your personal health
or regarding specific medical conditions. To find a Baptist health provider,
please visit Baptist Health dot com.