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Giving the Smallest GI Transplant Patients a New Lease On Life
The best part about working with kids is that “I get to laugh every day,” said Ke-You (Yoyo) Zhang, MD, clinical assistant professor for pediatrics–gastroenterology and hepatology at Stanford Medicine in California.
Everyday life for them is a challenge.
Dealing with sick children is difficult. “But I think the difference between pediatrics and adults is despite how hard things get, children are the single most resilient people you’re ever going to meet,” she said.
Kids don’t always know they’re sick and they don’t act sick, even when they are. “Every day, I literally get on the floor, I get to play, I get to run around. And truly, I have fun every single day. I get excited to go to work. And I think that’s what makes work not feel like work,” said Dr. Zhang.
In an interview, she discussed the satisfaction of following patients throughout their care continuum and her research to reduce the likelihood of transplant rejection.
She also shared an inspirational story of one young patient who spent his life tied to an IV, and how a transplant exposed him to the normal joys of life, like swimming, going to camp and getting on a plane for the first time.
Q: Why did you choose this subspecialty of pediatric GI?
I think it’s the best subspecialty because I think it combines a lot of the things that I enjoy, which is long-term continuity of care. It’s about growing up with your patients and seeing them through all the various stages of their life, often meeting patients when they’re babies. I get pictures of high school graduations and life milestones and even see some of my patients have families of their own. Becoming a part of their family is very meaningful to me. I also like complexity and acuity, and gastroenterology and hepatology provide those things.
And then lastly, it’s great to be able to exercise procedural skills and constantly learn new procedural skills.
Q: How did you become interested in the field of pediatric intestinal and liver transplantation?
I did all my training here at Stanford. We have one of the largest pediatric transplant centers and we also have a very large intestinal rehabilitation population.
Coming through residency and fellowship, I had a lot of exposure to transplant and intestinal failure, intestinal rehabilitation. I really liked the longitudinal relationship I got to form with my patients. Sometimes they’re in the neonatal ICU, where you’re meeting them in their very first days of life. You follow them through their chronic illness, through transplant and after transplant for many years. You become not just their GI, but the center of their care.
Q: What challenges are unique to this type of transplant work?
Pediatric intestinal failure and intestinal transplant represents an incredibly small subset of children. Oftentimes, they do not get the resources and recognition on a national policy level or even at the hospital level that other gastrointestinal diseases receive. What’s difficult is they are such a small subset but their complexity and their needs are probably in the highest percentile. So that’s a really challenging combination to start with. And there’s only a few centers that specialize in doing intestinal rehabilitation and intestinal transplantation for children in the country.
Developing expertise has been slow. But I think in the last decade or so, our understanding and success with intestinal rehabilitation and intestinal transplantation has really improved, especially at large centers like Stanford. We’ve had a lot of success stories and have not had any graft loss since 2014.
Q: Are these transplants hard to acquire?
Yes, especially when you’re transplanting not just the intestines but the liver as well. You’re waiting for two organs, not just one organ. And on top of that, you’re waiting for an appropriately sized donor; usually a child who’s around the same size or same age who’s passed away. Those organs would have to be a good match. Children can wait multiple years for a transplant.
Q: Is there a success story you’d like to share?
One patient I met in the neonatal ICU had congenital short bowel syndrome. He was born with hardly any intestines. He developed complications of being on long-term intravenous nutrition, which included recurrent central line infections and liver disease. He was never able to eat because he really didn’t have a digestive system that could adequately absorb anything. He had a central line in one of his large veins, so he couldn’t go swimming.
He had to have special adaptive wear to even shower or bathe and couldn’t travel. It’s these types of patients that benefit so much from transplant. Putting any kid through transplant is a massive undertaking and it certainly has risks. But he underwent a successful transplant at the age of 8—not just an intestinal transplant, but a multi-visceral transplant of the liver, intestine, and pancreas. He’s 9 years old now, and no longer needs intravenous nutrition. He ate by mouth for the very first time after transplant. He’s trying all sorts of new foods and he was able to go to a special transplant camp for children. Getting on a plane to Los Angeles, which is where our transplant camp is, was a huge deal.
He was able to swim in the lake. He’s never been able to do that. And he wants to start doing sports this fall. This was really a life-changing story for him.
Q: What advancements lie ahead for this field of work? Have you work on any notable research?
I think our understanding of transplant immunology has really progressed, especially recently. That’s what part of my research is about—using novel therapies to modulate the immune system of pediatric transplant recipients. The No. 1 complication that occurs after intestinal transplant is rejection because obviously you’re implanting somebody else’s organs into a patient.
I am involved in a clinical trial that’s looking at the use of extracellular vesicles that are isolated from hematopoietic stem cells. These vesicles contain various growth factors, anti-inflammatory proteins and tissue repair factors that we are infusing into intestinal transplant patients with the aim to repair the intestinal tissue patients are rejecting.
Q: When you’re not being a GI, how do you spend your free weekend afternoons?
My husband and I have an almost 2-year-old little girl. She keeps us busy and I spend my afternoons chasing after a crazy toddler.
Lightning Round
Texting or talking?
Huge texter
Favorite junk food?
French fries
Cat or dog person?
Dog
Favorite ice cream?
Strawberry
If you weren’t a gastroenterologist, what would you be?Florist
Best place you’ve traveled to?
Thailand
Number of cups of coffee you drink per day?
Too many
Favorite city in the US besides the one you live in?
New York City
Favorite sport?
Tennis
Optimist or pessimist?
Optimist
The best part about working with kids is that “I get to laugh every day,” said Ke-You (Yoyo) Zhang, MD, clinical assistant professor for pediatrics–gastroenterology and hepatology at Stanford Medicine in California.
Everyday life for them is a challenge.
Dealing with sick children is difficult. “But I think the difference between pediatrics and adults is despite how hard things get, children are the single most resilient people you’re ever going to meet,” she said.
Kids don’t always know they’re sick and they don’t act sick, even when they are. “Every day, I literally get on the floor, I get to play, I get to run around. And truly, I have fun every single day. I get excited to go to work. And I think that’s what makes work not feel like work,” said Dr. Zhang.
In an interview, she discussed the satisfaction of following patients throughout their care continuum and her research to reduce the likelihood of transplant rejection.
She also shared an inspirational story of one young patient who spent his life tied to an IV, and how a transplant exposed him to the normal joys of life, like swimming, going to camp and getting on a plane for the first time.
Q: Why did you choose this subspecialty of pediatric GI?
I think it’s the best subspecialty because I think it combines a lot of the things that I enjoy, which is long-term continuity of care. It’s about growing up with your patients and seeing them through all the various stages of their life, often meeting patients when they’re babies. I get pictures of high school graduations and life milestones and even see some of my patients have families of their own. Becoming a part of their family is very meaningful to me. I also like complexity and acuity, and gastroenterology and hepatology provide those things.
And then lastly, it’s great to be able to exercise procedural skills and constantly learn new procedural skills.
Q: How did you become interested in the field of pediatric intestinal and liver transplantation?
I did all my training here at Stanford. We have one of the largest pediatric transplant centers and we also have a very large intestinal rehabilitation population.
Coming through residency and fellowship, I had a lot of exposure to transplant and intestinal failure, intestinal rehabilitation. I really liked the longitudinal relationship I got to form with my patients. Sometimes they’re in the neonatal ICU, where you’re meeting them in their very first days of life. You follow them through their chronic illness, through transplant and after transplant for many years. You become not just their GI, but the center of their care.
Q: What challenges are unique to this type of transplant work?
Pediatric intestinal failure and intestinal transplant represents an incredibly small subset of children. Oftentimes, they do not get the resources and recognition on a national policy level or even at the hospital level that other gastrointestinal diseases receive. What’s difficult is they are such a small subset but their complexity and their needs are probably in the highest percentile. So that’s a really challenging combination to start with. And there’s only a few centers that specialize in doing intestinal rehabilitation and intestinal transplantation for children in the country.
Developing expertise has been slow. But I think in the last decade or so, our understanding and success with intestinal rehabilitation and intestinal transplantation has really improved, especially at large centers like Stanford. We’ve had a lot of success stories and have not had any graft loss since 2014.
Q: Are these transplants hard to acquire?
Yes, especially when you’re transplanting not just the intestines but the liver as well. You’re waiting for two organs, not just one organ. And on top of that, you’re waiting for an appropriately sized donor; usually a child who’s around the same size or same age who’s passed away. Those organs would have to be a good match. Children can wait multiple years for a transplant.
Q: Is there a success story you’d like to share?
One patient I met in the neonatal ICU had congenital short bowel syndrome. He was born with hardly any intestines. He developed complications of being on long-term intravenous nutrition, which included recurrent central line infections and liver disease. He was never able to eat because he really didn’t have a digestive system that could adequately absorb anything. He had a central line in one of his large veins, so he couldn’t go swimming.
He had to have special adaptive wear to even shower or bathe and couldn’t travel. It’s these types of patients that benefit so much from transplant. Putting any kid through transplant is a massive undertaking and it certainly has risks. But he underwent a successful transplant at the age of 8—not just an intestinal transplant, but a multi-visceral transplant of the liver, intestine, and pancreas. He’s 9 years old now, and no longer needs intravenous nutrition. He ate by mouth for the very first time after transplant. He’s trying all sorts of new foods and he was able to go to a special transplant camp for children. Getting on a plane to Los Angeles, which is where our transplant camp is, was a huge deal.
He was able to swim in the lake. He’s never been able to do that. And he wants to start doing sports this fall. This was really a life-changing story for him.
Q: What advancements lie ahead for this field of work? Have you work on any notable research?
I think our understanding of transplant immunology has really progressed, especially recently. That’s what part of my research is about—using novel therapies to modulate the immune system of pediatric transplant recipients. The No. 1 complication that occurs after intestinal transplant is rejection because obviously you’re implanting somebody else’s organs into a patient.
I am involved in a clinical trial that’s looking at the use of extracellular vesicles that are isolated from hematopoietic stem cells. These vesicles contain various growth factors, anti-inflammatory proteins and tissue repair factors that we are infusing into intestinal transplant patients with the aim to repair the intestinal tissue patients are rejecting.
Q: When you’re not being a GI, how do you spend your free weekend afternoons?
My husband and I have an almost 2-year-old little girl. She keeps us busy and I spend my afternoons chasing after a crazy toddler.
Lightning Round
Texting or talking?
Huge texter
Favorite junk food?
French fries
Cat or dog person?
Dog
Favorite ice cream?
Strawberry
If you weren’t a gastroenterologist, what would you be?Florist
Best place you’ve traveled to?
Thailand
Number of cups of coffee you drink per day?
Too many
Favorite city in the US besides the one you live in?
New York City
Favorite sport?
Tennis
Optimist or pessimist?
Optimist
The best part about working with kids is that “I get to laugh every day,” said Ke-You (Yoyo) Zhang, MD, clinical assistant professor for pediatrics–gastroenterology and hepatology at Stanford Medicine in California.
Everyday life for them is a challenge.
Dealing with sick children is difficult. “But I think the difference between pediatrics and adults is despite how hard things get, children are the single most resilient people you’re ever going to meet,” she said.
Kids don’t always know they’re sick and they don’t act sick, even when they are. “Every day, I literally get on the floor, I get to play, I get to run around. And truly, I have fun every single day. I get excited to go to work. And I think that’s what makes work not feel like work,” said Dr. Zhang.
In an interview, she discussed the satisfaction of following patients throughout their care continuum and her research to reduce the likelihood of transplant rejection.
She also shared an inspirational story of one young patient who spent his life tied to an IV, and how a transplant exposed him to the normal joys of life, like swimming, going to camp and getting on a plane for the first time.
Q: Why did you choose this subspecialty of pediatric GI?
I think it’s the best subspecialty because I think it combines a lot of the things that I enjoy, which is long-term continuity of care. It’s about growing up with your patients and seeing them through all the various stages of their life, often meeting patients when they’re babies. I get pictures of high school graduations and life milestones and even see some of my patients have families of their own. Becoming a part of their family is very meaningful to me. I also like complexity and acuity, and gastroenterology and hepatology provide those things.
And then lastly, it’s great to be able to exercise procedural skills and constantly learn new procedural skills.
Q: How did you become interested in the field of pediatric intestinal and liver transplantation?
I did all my training here at Stanford. We have one of the largest pediatric transplant centers and we also have a very large intestinal rehabilitation population.
Coming through residency and fellowship, I had a lot of exposure to transplant and intestinal failure, intestinal rehabilitation. I really liked the longitudinal relationship I got to form with my patients. Sometimes they’re in the neonatal ICU, where you’re meeting them in their very first days of life. You follow them through their chronic illness, through transplant and after transplant for many years. You become not just their GI, but the center of their care.
Q: What challenges are unique to this type of transplant work?
Pediatric intestinal failure and intestinal transplant represents an incredibly small subset of children. Oftentimes, they do not get the resources and recognition on a national policy level or even at the hospital level that other gastrointestinal diseases receive. What’s difficult is they are such a small subset but their complexity and their needs are probably in the highest percentile. So that’s a really challenging combination to start with. And there’s only a few centers that specialize in doing intestinal rehabilitation and intestinal transplantation for children in the country.
Developing expertise has been slow. But I think in the last decade or so, our understanding and success with intestinal rehabilitation and intestinal transplantation has really improved, especially at large centers like Stanford. We’ve had a lot of success stories and have not had any graft loss since 2014.
Q: Are these transplants hard to acquire?
Yes, especially when you’re transplanting not just the intestines but the liver as well. You’re waiting for two organs, not just one organ. And on top of that, you’re waiting for an appropriately sized donor; usually a child who’s around the same size or same age who’s passed away. Those organs would have to be a good match. Children can wait multiple years for a transplant.
Q: Is there a success story you’d like to share?
One patient I met in the neonatal ICU had congenital short bowel syndrome. He was born with hardly any intestines. He developed complications of being on long-term intravenous nutrition, which included recurrent central line infections and liver disease. He was never able to eat because he really didn’t have a digestive system that could adequately absorb anything. He had a central line in one of his large veins, so he couldn’t go swimming.
He had to have special adaptive wear to even shower or bathe and couldn’t travel. It’s these types of patients that benefit so much from transplant. Putting any kid through transplant is a massive undertaking and it certainly has risks. But he underwent a successful transplant at the age of 8—not just an intestinal transplant, but a multi-visceral transplant of the liver, intestine, and pancreas. He’s 9 years old now, and no longer needs intravenous nutrition. He ate by mouth for the very first time after transplant. He’s trying all sorts of new foods and he was able to go to a special transplant camp for children. Getting on a plane to Los Angeles, which is where our transplant camp is, was a huge deal.
He was able to swim in the lake. He’s never been able to do that. And he wants to start doing sports this fall. This was really a life-changing story for him.
Q: What advancements lie ahead for this field of work? Have you work on any notable research?
I think our understanding of transplant immunology has really progressed, especially recently. That’s what part of my research is about—using novel therapies to modulate the immune system of pediatric transplant recipients. The No. 1 complication that occurs after intestinal transplant is rejection because obviously you’re implanting somebody else’s organs into a patient.
I am involved in a clinical trial that’s looking at the use of extracellular vesicles that are isolated from hematopoietic stem cells. These vesicles contain various growth factors, anti-inflammatory proteins and tissue repair factors that we are infusing into intestinal transplant patients with the aim to repair the intestinal tissue patients are rejecting.
Q: When you’re not being a GI, how do you spend your free weekend afternoons?
My husband and I have an almost 2-year-old little girl. She keeps us busy and I spend my afternoons chasing after a crazy toddler.
Lightning Round
Texting or talking?
Huge texter
Favorite junk food?
French fries
Cat or dog person?
Dog
Favorite ice cream?
Strawberry
If you weren’t a gastroenterologist, what would you be?Florist
Best place you’ve traveled to?
Thailand
Number of cups of coffee you drink per day?
Too many
Favorite city in the US besides the one you live in?
New York City
Favorite sport?
Tennis
Optimist or pessimist?
Optimist
In a Parallel Universe, “I’d Be a Concert Pianist” Says Tennessee GI
She also relishes opportunities to think, to analyze, and solve problems for her patients.
One of her chief interests is inflammatory bowel disease (IBD). It’s reassuring to focus on a field of work “where I know exactly what’s causing the issue, and I can select a therapeutic approach (medication and lifestyle changes) that help a patient achieve remission,” said Dr. Pointer, co-owner and managing partner of Digestive and Liver Health Specialists in Hendersonville, Tenn. She’s also the medical director and a principal investigator of Quality Medical Research in Nashville, and currently serves as chair of the AGA Trainee and Early Career Committee.
Starting her own practice has been just as challenging and rewarding as going through medical school. Medical training does not prepare you for starting your own practice, Dr. Pointer said, so she and her business partner have had to learn as they go. “But I think we’ve done very well. We’ve taken the ups and downs in stride.”
In an interview, Dr. Pointer spoke more about her work in IBD and the ways in which she’s given back to the community through music and mentoring.
Q: Why did you choose GI?
I knew from a very young age that I was going to be a physician. I had always been interested in science. When I got into medical school and became exposed to the different areas, I really liked the cognitive skills where you had to think through a problem or an issue. But I also liked the procedural things as well.
During my internal medicine residency training, I felt that I had a knack for it. As I was looking at different options, I decided on gastroenterology because it combined both cognitive thinking through issues, but also taking it to the next step and intervening through procedures.
Q: During fellowship, your focus was inflammatory bowel disease. What drew your interest to this condition?
There are a lot of different areas within gastroenterology that one can subspecialize in, as we see the full gamut of gastrointestinal and hepatic disorders. But treating some conditions, like functional disorders, means taking more of a ‘trial and error’ approach, and you may not always get the patient a hundred percent better. That’s not to say that we can’t improve a patient’s quality of life, but it’s not always a guarantee.
But inflammatory bowel disease is a little bit different. Because I can point to an exact spot in the intestines that’s causing the problem, it’s very fulfilling for me as a physician to take a patient who is having 10-12 bloody bowel movements a day, to normal form stools and no abdominal pain. They’re able to gain weight and go on about their lives and about their day. So that was why I picked inflammatory bowel disease as my subspecialty.
Q: Tell me about the gastroenterology elective you developed for family medicine residents and undergraduate students. What’s the status of the program now?
I’ve always been interested in teaching and giving back to the next generations. I feel like I had great mentor opportunities and people who helped me along the way. In my previous hospital position, I was able to work with the family medicine department and create an elective through which residents and even undergraduate students could come and shadow and work with me in the clinic and see me performing procedures.
That elective ended once I left that position, at least as far as I’m aware. But in the private practice that I co-own now, we have numerous shadowing opportunities. I was able to give a lecture at Middle Tennessee State University for some students. And through that lecture, many students have reached out to me to shadow. I have allowed them to come shadow and do clinic work as a medical assistant and watch me perform procedures. I have multiple students working with me weekly.
Q: Years ago, you founded the non-profit Enchanted Fingers Piano Lessons, which gave free piano lessons to underserved youth. What was that experience like?
Piano was one of my first loves. In some parallel universe, there’s a Dr. Pointer who is a classical, concert pianist. I started taking piano lessons when I was in early middle school, and I took to it very quickly. I was able to excel. I just loved it. I enjoyed practicing and I still play.
The impetus for starting Enchanted Fingers Piano lessons was because I wanted to give back again to the community. I came from an underserved community. Oftentimes children and young adults in those communities don’t get exposed to extracurricular activities and they don’t even know what they could potentially have a passion for. And I definitely had a passion for piano. I partnered with a church organization and they allowed me to use their church to host these piano lessons, and it was a phenomenal and rewarding experience. I would definitely like to start it up again one day in the future. It was an amazing experience.
It’s actually how I met my husband. He was one of the young adult students who signed up to take lessons. We both still enjoy playing the piano together.
Q: When you’re not being a GI, how do you spend your free weekend afternoons?
I’m a creative at heart. I really enjoy sewing and I’m working on a few sewing projects. I just got a serger. It is a machine that helps you finish a seam. It can also be used to sew entire garments. That has been fun, learning how to thread that machine. When I’m not doing that or just relaxing with my family, I do enjoy curling up with a good book. Stephen King is one of my favorite authors.
Lightning Round
Texting or talking?
Talking
Favorite junk food?
Chocolate chip cookies
Cat or dog person?
Cat
Favorite vacation?
Hawaii
How many cups of coffee do you drink per day?
I don’t drink coffee
Favorite ice cream?
Butter pecan
Favorite sport?
I don’t watch sports
Optimist or pessimist?
Optimist
She also relishes opportunities to think, to analyze, and solve problems for her patients.
One of her chief interests is inflammatory bowel disease (IBD). It’s reassuring to focus on a field of work “where I know exactly what’s causing the issue, and I can select a therapeutic approach (medication and lifestyle changes) that help a patient achieve remission,” said Dr. Pointer, co-owner and managing partner of Digestive and Liver Health Specialists in Hendersonville, Tenn. She’s also the medical director and a principal investigator of Quality Medical Research in Nashville, and currently serves as chair of the AGA Trainee and Early Career Committee.
Starting her own practice has been just as challenging and rewarding as going through medical school. Medical training does not prepare you for starting your own practice, Dr. Pointer said, so she and her business partner have had to learn as they go. “But I think we’ve done very well. We’ve taken the ups and downs in stride.”
In an interview, Dr. Pointer spoke more about her work in IBD and the ways in which she’s given back to the community through music and mentoring.
Q: Why did you choose GI?
I knew from a very young age that I was going to be a physician. I had always been interested in science. When I got into medical school and became exposed to the different areas, I really liked the cognitive skills where you had to think through a problem or an issue. But I also liked the procedural things as well.
During my internal medicine residency training, I felt that I had a knack for it. As I was looking at different options, I decided on gastroenterology because it combined both cognitive thinking through issues, but also taking it to the next step and intervening through procedures.
Q: During fellowship, your focus was inflammatory bowel disease. What drew your interest to this condition?
There are a lot of different areas within gastroenterology that one can subspecialize in, as we see the full gamut of gastrointestinal and hepatic disorders. But treating some conditions, like functional disorders, means taking more of a ‘trial and error’ approach, and you may not always get the patient a hundred percent better. That’s not to say that we can’t improve a patient’s quality of life, but it’s not always a guarantee.
But inflammatory bowel disease is a little bit different. Because I can point to an exact spot in the intestines that’s causing the problem, it’s very fulfilling for me as a physician to take a patient who is having 10-12 bloody bowel movements a day, to normal form stools and no abdominal pain. They’re able to gain weight and go on about their lives and about their day. So that was why I picked inflammatory bowel disease as my subspecialty.
Q: Tell me about the gastroenterology elective you developed for family medicine residents and undergraduate students. What’s the status of the program now?
I’ve always been interested in teaching and giving back to the next generations. I feel like I had great mentor opportunities and people who helped me along the way. In my previous hospital position, I was able to work with the family medicine department and create an elective through which residents and even undergraduate students could come and shadow and work with me in the clinic and see me performing procedures.
That elective ended once I left that position, at least as far as I’m aware. But in the private practice that I co-own now, we have numerous shadowing opportunities. I was able to give a lecture at Middle Tennessee State University for some students. And through that lecture, many students have reached out to me to shadow. I have allowed them to come shadow and do clinic work as a medical assistant and watch me perform procedures. I have multiple students working with me weekly.
Q: Years ago, you founded the non-profit Enchanted Fingers Piano Lessons, which gave free piano lessons to underserved youth. What was that experience like?
Piano was one of my first loves. In some parallel universe, there’s a Dr. Pointer who is a classical, concert pianist. I started taking piano lessons when I was in early middle school, and I took to it very quickly. I was able to excel. I just loved it. I enjoyed practicing and I still play.
The impetus for starting Enchanted Fingers Piano lessons was because I wanted to give back again to the community. I came from an underserved community. Oftentimes children and young adults in those communities don’t get exposed to extracurricular activities and they don’t even know what they could potentially have a passion for. And I definitely had a passion for piano. I partnered with a church organization and they allowed me to use their church to host these piano lessons, and it was a phenomenal and rewarding experience. I would definitely like to start it up again one day in the future. It was an amazing experience.
It’s actually how I met my husband. He was one of the young adult students who signed up to take lessons. We both still enjoy playing the piano together.
Q: When you’re not being a GI, how do you spend your free weekend afternoons?
I’m a creative at heart. I really enjoy sewing and I’m working on a few sewing projects. I just got a serger. It is a machine that helps you finish a seam. It can also be used to sew entire garments. That has been fun, learning how to thread that machine. When I’m not doing that or just relaxing with my family, I do enjoy curling up with a good book. Stephen King is one of my favorite authors.
Lightning Round
Texting or talking?
Talking
Favorite junk food?
Chocolate chip cookies
Cat or dog person?
Cat
Favorite vacation?
Hawaii
How many cups of coffee do you drink per day?
I don’t drink coffee
Favorite ice cream?
Butter pecan
Favorite sport?
I don’t watch sports
Optimist or pessimist?
Optimist
She also relishes opportunities to think, to analyze, and solve problems for her patients.
One of her chief interests is inflammatory bowel disease (IBD). It’s reassuring to focus on a field of work “where I know exactly what’s causing the issue, and I can select a therapeutic approach (medication and lifestyle changes) that help a patient achieve remission,” said Dr. Pointer, co-owner and managing partner of Digestive and Liver Health Specialists in Hendersonville, Tenn. She’s also the medical director and a principal investigator of Quality Medical Research in Nashville, and currently serves as chair of the AGA Trainee and Early Career Committee.
Starting her own practice has been just as challenging and rewarding as going through medical school. Medical training does not prepare you for starting your own practice, Dr. Pointer said, so she and her business partner have had to learn as they go. “But I think we’ve done very well. We’ve taken the ups and downs in stride.”
In an interview, Dr. Pointer spoke more about her work in IBD and the ways in which she’s given back to the community through music and mentoring.
Q: Why did you choose GI?
I knew from a very young age that I was going to be a physician. I had always been interested in science. When I got into medical school and became exposed to the different areas, I really liked the cognitive skills where you had to think through a problem or an issue. But I also liked the procedural things as well.
During my internal medicine residency training, I felt that I had a knack for it. As I was looking at different options, I decided on gastroenterology because it combined both cognitive thinking through issues, but also taking it to the next step and intervening through procedures.
Q: During fellowship, your focus was inflammatory bowel disease. What drew your interest to this condition?
There are a lot of different areas within gastroenterology that one can subspecialize in, as we see the full gamut of gastrointestinal and hepatic disorders. But treating some conditions, like functional disorders, means taking more of a ‘trial and error’ approach, and you may not always get the patient a hundred percent better. That’s not to say that we can’t improve a patient’s quality of life, but it’s not always a guarantee.
But inflammatory bowel disease is a little bit different. Because I can point to an exact spot in the intestines that’s causing the problem, it’s very fulfilling for me as a physician to take a patient who is having 10-12 bloody bowel movements a day, to normal form stools and no abdominal pain. They’re able to gain weight and go on about their lives and about their day. So that was why I picked inflammatory bowel disease as my subspecialty.
Q: Tell me about the gastroenterology elective you developed for family medicine residents and undergraduate students. What’s the status of the program now?
I’ve always been interested in teaching and giving back to the next generations. I feel like I had great mentor opportunities and people who helped me along the way. In my previous hospital position, I was able to work with the family medicine department and create an elective through which residents and even undergraduate students could come and shadow and work with me in the clinic and see me performing procedures.
That elective ended once I left that position, at least as far as I’m aware. But in the private practice that I co-own now, we have numerous shadowing opportunities. I was able to give a lecture at Middle Tennessee State University for some students. And through that lecture, many students have reached out to me to shadow. I have allowed them to come shadow and do clinic work as a medical assistant and watch me perform procedures. I have multiple students working with me weekly.
Q: Years ago, you founded the non-profit Enchanted Fingers Piano Lessons, which gave free piano lessons to underserved youth. What was that experience like?
Piano was one of my first loves. In some parallel universe, there’s a Dr. Pointer who is a classical, concert pianist. I started taking piano lessons when I was in early middle school, and I took to it very quickly. I was able to excel. I just loved it. I enjoyed practicing and I still play.
The impetus for starting Enchanted Fingers Piano lessons was because I wanted to give back again to the community. I came from an underserved community. Oftentimes children and young adults in those communities don’t get exposed to extracurricular activities and they don’t even know what they could potentially have a passion for. And I definitely had a passion for piano. I partnered with a church organization and they allowed me to use their church to host these piano lessons, and it was a phenomenal and rewarding experience. I would definitely like to start it up again one day in the future. It was an amazing experience.
It’s actually how I met my husband. He was one of the young adult students who signed up to take lessons. We both still enjoy playing the piano together.
Q: When you’re not being a GI, how do you spend your free weekend afternoons?
I’m a creative at heart. I really enjoy sewing and I’m working on a few sewing projects. I just got a serger. It is a machine that helps you finish a seam. It can also be used to sew entire garments. That has been fun, learning how to thread that machine. When I’m not doing that or just relaxing with my family, I do enjoy curling up with a good book. Stephen King is one of my favorite authors.
Lightning Round
Texting or talking?
Talking
Favorite junk food?
Chocolate chip cookies
Cat or dog person?
Cat
Favorite vacation?
Hawaii
How many cups of coffee do you drink per day?
I don’t drink coffee
Favorite ice cream?
Butter pecan
Favorite sport?
I don’t watch sports
Optimist or pessimist?
Optimist
New SVS Task Force Explores Vascular Certification Program
The Society for Vascular Surgery (SVS) executive board has established a task force to explore developing a vascular certification program for inpatient and outpatient care settings.
Noting the shift in professional reimbursement from payment for volume to payment for quality, along with a surge in outpatient endovascular care, “The SVS executive board believes that it is a critical time for vascular surgery to set standards based on quality improvement, efficiency and appropriateness,” said Dr. R. Clement Darling III, SVS president.
Task force chair Dr. Tony Sidawy will oversee two subcommittees, one for inpatient and one for office-based endovascular care (OBEC). Dr. Krishna Jain has been appointed chair of the OBEC subcommittee. A chair for the inpatient subcommittee has yet to be named.
“Vascular surgeons represented by the SVS should take the lead in defining quality and value standards for vascular care before they are defined for us,” said Dr. Sidawy.
“Offering an SVS-led certification process will inspire the most appropriate, high-quality vascular care and optimal outcomes for all patients,” Dr. Jain added.
Many SVS members are pioneers in the design and delivery of care in office-based practice settings, and they have been fierce advocates for this effort, said Dr. Darling. “We have heard our members loud and clear. They want SVS to play a major role in shaping the future of the office-based endovascular center, setting the bar for appropriateness and quality and helping all practitioners achieve it.
“We feel that to provide the best vascular care in a data-driven, quality-based system, the SVS needs to be actively involved in this process," he added. "Vascular surgeons have a long history of making data-driven decisions about which patients need an intervention, and since we treat patients medically as well as by endovascular or open techniques, we have a unique perspective."
A data registry is a critical component and will be provided by the SVS Patient Safety Organization and Vascular Quality Initiative (SVS VQI). VQI registries are already used in more than 430 vascular care settings, ranging from academic to community practice. VQI data can be used to benchmark performance and improve the quality of vascular care.
“Given that the SVS VQI has already been adopted by all types of facilities, including OBECs and vein centers, the SVS VQI is well positioned to help assess and improve quality of care,” said Dr. Jens Eldrup-Jorgensen, SVS PSO medical director.
The process will include discussions and potential collaboration with partners such as the American College of Surgeons, the Outpatient Endovascular and Interventional Society and the Intersociety Accreditation Council, Dr. Darling said, as well as societies such as the American Venous Forum, the Society for Vascular Ultrasound, and the Society for Vascular Nursing.
If established, a pilot program would be launched in 2018 with a full launch planned in 2019.
The Society for Vascular Surgery (SVS) executive board has established a task force to explore developing a vascular certification program for inpatient and outpatient care settings.
Noting the shift in professional reimbursement from payment for volume to payment for quality, along with a surge in outpatient endovascular care, “The SVS executive board believes that it is a critical time for vascular surgery to set standards based on quality improvement, efficiency and appropriateness,” said Dr. R. Clement Darling III, SVS president.
Task force chair Dr. Tony Sidawy will oversee two subcommittees, one for inpatient and one for office-based endovascular care (OBEC). Dr. Krishna Jain has been appointed chair of the OBEC subcommittee. A chair for the inpatient subcommittee has yet to be named.
“Vascular surgeons represented by the SVS should take the lead in defining quality and value standards for vascular care before they are defined for us,” said Dr. Sidawy.
“Offering an SVS-led certification process will inspire the most appropriate, high-quality vascular care and optimal outcomes for all patients,” Dr. Jain added.
Many SVS members are pioneers in the design and delivery of care in office-based practice settings, and they have been fierce advocates for this effort, said Dr. Darling. “We have heard our members loud and clear. They want SVS to play a major role in shaping the future of the office-based endovascular center, setting the bar for appropriateness and quality and helping all practitioners achieve it.
“We feel that to provide the best vascular care in a data-driven, quality-based system, the SVS needs to be actively involved in this process," he added. "Vascular surgeons have a long history of making data-driven decisions about which patients need an intervention, and since we treat patients medically as well as by endovascular or open techniques, we have a unique perspective."
A data registry is a critical component and will be provided by the SVS Patient Safety Organization and Vascular Quality Initiative (SVS VQI). VQI registries are already used in more than 430 vascular care settings, ranging from academic to community practice. VQI data can be used to benchmark performance and improve the quality of vascular care.
“Given that the SVS VQI has already been adopted by all types of facilities, including OBECs and vein centers, the SVS VQI is well positioned to help assess and improve quality of care,” said Dr. Jens Eldrup-Jorgensen, SVS PSO medical director.
The process will include discussions and potential collaboration with partners such as the American College of Surgeons, the Outpatient Endovascular and Interventional Society and the Intersociety Accreditation Council, Dr. Darling said, as well as societies such as the American Venous Forum, the Society for Vascular Ultrasound, and the Society for Vascular Nursing.
If established, a pilot program would be launched in 2018 with a full launch planned in 2019.
The Society for Vascular Surgery (SVS) executive board has established a task force to explore developing a vascular certification program for inpatient and outpatient care settings.
Noting the shift in professional reimbursement from payment for volume to payment for quality, along with a surge in outpatient endovascular care, “The SVS executive board believes that it is a critical time for vascular surgery to set standards based on quality improvement, efficiency and appropriateness,” said Dr. R. Clement Darling III, SVS president.
Task force chair Dr. Tony Sidawy will oversee two subcommittees, one for inpatient and one for office-based endovascular care (OBEC). Dr. Krishna Jain has been appointed chair of the OBEC subcommittee. A chair for the inpatient subcommittee has yet to be named.
“Vascular surgeons represented by the SVS should take the lead in defining quality and value standards for vascular care before they are defined for us,” said Dr. Sidawy.
“Offering an SVS-led certification process will inspire the most appropriate, high-quality vascular care and optimal outcomes for all patients,” Dr. Jain added.
Many SVS members are pioneers in the design and delivery of care in office-based practice settings, and they have been fierce advocates for this effort, said Dr. Darling. “We have heard our members loud and clear. They want SVS to play a major role in shaping the future of the office-based endovascular center, setting the bar for appropriateness and quality and helping all practitioners achieve it.
“We feel that to provide the best vascular care in a data-driven, quality-based system, the SVS needs to be actively involved in this process," he added. "Vascular surgeons have a long history of making data-driven decisions about which patients need an intervention, and since we treat patients medically as well as by endovascular or open techniques, we have a unique perspective."
A data registry is a critical component and will be provided by the SVS Patient Safety Organization and Vascular Quality Initiative (SVS VQI). VQI registries are already used in more than 430 vascular care settings, ranging from academic to community practice. VQI data can be used to benchmark performance and improve the quality of vascular care.
“Given that the SVS VQI has already been adopted by all types of facilities, including OBECs and vein centers, the SVS VQI is well positioned to help assess and improve quality of care,” said Dr. Jens Eldrup-Jorgensen, SVS PSO medical director.
The process will include discussions and potential collaboration with partners such as the American College of Surgeons, the Outpatient Endovascular and Interventional Society and the Intersociety Accreditation Council, Dr. Darling said, as well as societies such as the American Venous Forum, the Society for Vascular Ultrasound, and the Society for Vascular Nursing.
If established, a pilot program would be launched in 2018 with a full launch planned in 2019.
VAM ’17 Will Be a ‘Spectacular Meeting’
Participants at the Vascular Annual Meeting (VAM) have lots more to look forward to than sunny skies, beaches and palm trees. A number of new program features are planned to add interest and value to the meeting, said Dr. Ron Dalman.
Dr. Dalman chairs the SVS Program Committee, which develops programming and content for VAM, the premiere meeting for vascular specialists.
The 2017 meeting will be May 31-June 3 in beautiful San Diego, with plenaries and exhibits set for June 1-3.
Changes for 2017 include:
• More and potentially longer sessions with collaborative specialty societies, such as the American Venous Forum, the Society for Vascular Ultrasound and the Society of Thoracic Surgeons. “These sessions provide a multi-disciplinary perspective on our common problems and showcase the SVS’ leadership role in vascular health and disease management,” said Dr. Dalman. Members provided positive feedback on last year’s partnership sessions, so this year, these program features will be significantly expanded.
• An educational review course highlighting some of the more frequently missed questions from the latest version of the Vascular Education Self-Assessment Program (VESAP3).
• Guideline summaries, organized by the SVS Document Oversight Committee and presented by the authorship group for each, on critical topics such as abdominal aortic aneurysms, aortic dissection, venous disease and more. These summaries will be incorporated into post-graduate programming. “It makes sense to cover current practice guidelines and consensus documents, as several high-profile efforts are being updated this year,” said Dr. Dalman. “We can give attendees an executive summary of current guidelines by their respective authors, and attendees will come away with unique insights into why the most impactful and significant changes were included in each respective document.”
• Sessions of potential interest to surgeons in community practice environments, marked in the schedule as such by the SVS Community Practice Committee.
“These improvements will increase the value of the Annual Meeting for all attendees,” Dr. Dalman said. “We’re emphasizing interactive education, not simply passive learning. It’s going to be very exciting – and different in both style and substance.”
A Californian himself, Dr. Dalman also is looking forward to showing off his state. “San Diego is a wonderful place to vacation and the meeting venue provides convenient access to the Gaslamp District, the waterfront and the world-famous beaches,” he said.
“We encourage our members to bring their families to San Diego and make a vacation out of it.”
With the programming additions, increased opportunities for participation, the educational activities planned plus the perfect location, he added, “This is going to be a spectacular meeting.”
Participants at the Vascular Annual Meeting (VAM) have lots more to look forward to than sunny skies, beaches and palm trees. A number of new program features are planned to add interest and value to the meeting, said Dr. Ron Dalman.
Dr. Dalman chairs the SVS Program Committee, which develops programming and content for VAM, the premiere meeting for vascular specialists.
The 2017 meeting will be May 31-June 3 in beautiful San Diego, with plenaries and exhibits set for June 1-3.
Changes for 2017 include:
• More and potentially longer sessions with collaborative specialty societies, such as the American Venous Forum, the Society for Vascular Ultrasound and the Society of Thoracic Surgeons. “These sessions provide a multi-disciplinary perspective on our common problems and showcase the SVS’ leadership role in vascular health and disease management,” said Dr. Dalman. Members provided positive feedback on last year’s partnership sessions, so this year, these program features will be significantly expanded.
• An educational review course highlighting some of the more frequently missed questions from the latest version of the Vascular Education Self-Assessment Program (VESAP3).
• Guideline summaries, organized by the SVS Document Oversight Committee and presented by the authorship group for each, on critical topics such as abdominal aortic aneurysms, aortic dissection, venous disease and more. These summaries will be incorporated into post-graduate programming. “It makes sense to cover current practice guidelines and consensus documents, as several high-profile efforts are being updated this year,” said Dr. Dalman. “We can give attendees an executive summary of current guidelines by their respective authors, and attendees will come away with unique insights into why the most impactful and significant changes were included in each respective document.”
• Sessions of potential interest to surgeons in community practice environments, marked in the schedule as such by the SVS Community Practice Committee.
“These improvements will increase the value of the Annual Meeting for all attendees,” Dr. Dalman said. “We’re emphasizing interactive education, not simply passive learning. It’s going to be very exciting – and different in both style and substance.”
A Californian himself, Dr. Dalman also is looking forward to showing off his state. “San Diego is a wonderful place to vacation and the meeting venue provides convenient access to the Gaslamp District, the waterfront and the world-famous beaches,” he said.
“We encourage our members to bring their families to San Diego and make a vacation out of it.”
With the programming additions, increased opportunities for participation, the educational activities planned plus the perfect location, he added, “This is going to be a spectacular meeting.”
Participants at the Vascular Annual Meeting (VAM) have lots more to look forward to than sunny skies, beaches and palm trees. A number of new program features are planned to add interest and value to the meeting, said Dr. Ron Dalman.
Dr. Dalman chairs the SVS Program Committee, which develops programming and content for VAM, the premiere meeting for vascular specialists.
The 2017 meeting will be May 31-June 3 in beautiful San Diego, with plenaries and exhibits set for June 1-3.
Changes for 2017 include:
• More and potentially longer sessions with collaborative specialty societies, such as the American Venous Forum, the Society for Vascular Ultrasound and the Society of Thoracic Surgeons. “These sessions provide a multi-disciplinary perspective on our common problems and showcase the SVS’ leadership role in vascular health and disease management,” said Dr. Dalman. Members provided positive feedback on last year’s partnership sessions, so this year, these program features will be significantly expanded.
• An educational review course highlighting some of the more frequently missed questions from the latest version of the Vascular Education Self-Assessment Program (VESAP3).
• Guideline summaries, organized by the SVS Document Oversight Committee and presented by the authorship group for each, on critical topics such as abdominal aortic aneurysms, aortic dissection, venous disease and more. These summaries will be incorporated into post-graduate programming. “It makes sense to cover current practice guidelines and consensus documents, as several high-profile efforts are being updated this year,” said Dr. Dalman. “We can give attendees an executive summary of current guidelines by their respective authors, and attendees will come away with unique insights into why the most impactful and significant changes were included in each respective document.”
• Sessions of potential interest to surgeons in community practice environments, marked in the schedule as such by the SVS Community Practice Committee.
“These improvements will increase the value of the Annual Meeting for all attendees,” Dr. Dalman said. “We’re emphasizing interactive education, not simply passive learning. It’s going to be very exciting – and different in both style and substance.”
A Californian himself, Dr. Dalman also is looking forward to showing off his state. “San Diego is a wonderful place to vacation and the meeting venue provides convenient access to the Gaslamp District, the waterfront and the world-famous beaches,” he said.
“We encourage our members to bring their families to San Diego and make a vacation out of it.”
With the programming additions, increased opportunities for participation, the educational activities planned plus the perfect location, he added, “This is going to be a spectacular meeting.”
DDSEP Plus Can Help You Achieve Your Educational Goals
Challenge yourself with these practice questions! This is just a sample of the nearly 900 questions available with an annual DDSEP Plus subscription. AGA member trainees receive a discounted subscription.
Purchase a subscription to continue learning.
Practice Question #1
A 45-year-old woman diagnosed with irritable bowel syndrome with diarrhea presents to your clinic. Her diarrhea is well controlled with loperamide, but her abdominal pain persists.
Her primary care provider previously prescribed dicyclomine, but this did not improve her abdominal pain symptoms.
What is the next best medication to treat her abdominal pain?
A. Amitriptyline
B. Codeine/acetaminophen
C. Hydrocodone
D. Meloxicam
Correct answer:
A. Amitriptyline
Commentary:
Amitriptyline is a tricyclic antidepressant medication that functions as a central neuromodulator. A systematic review of randomized controlled trials of 6-12 weeks’ duration showed a modest improvement in global symptom relief and abdominal pain in patients with IBS treated with tricyclic anti-depressants. Opioid medications and nonsteroidal anti-inflammatory medications are not recommended to treat abdominal pain in patients with IBS.
Practice Question #2
A 52-year-old man with hypertension and diabetes mellitus type 2 is referred to you for 8 months of troublesome regurgitation and heartburn. He has a body mass index of 29 kg/m2.
He had minimal relief with single-dose proton pump inhibitor (PPI) therapy before breakfast and partial response with double-dose PPI therapy taken before breakfast and before dinner. Regurgitation after dinner and at bedtime is his most troublesome symptom.
What is the next best step in management?
A. Counsel on weight management
B. Increase PPI to quadruple dose
C. Perform gastric emptying study
D. Refer for bariatric surgery evaluation
E. Switch PPI to before bedtime
Correct answer:
A. Counsel on weight management
Commentary:
This presentation represents typical symptoms of gastroesophageal reflux disease that are not responsive to an optimized regimen of PPI therapy.
Management of refractory gastroesophageal reflux disease symptoms begins with optimizing lifestyle and weight loss.
Quadruple-dose PPI therapy has no established role. A gastric emptying study would be recommended if gastroparesis was suspected.
This patient does not meet criteria for bariatric surgery as his body mass index is less than 30 kg/m2.
PPI therapy optimization with before-meal dosing (30-60 min before breakfast for single-dose therapy and before breakfast and dinner for double-dose therapy) would be the next step after weight management.
Challenge yourself with these practice questions! This is just a sample of the nearly 900 questions available with an annual DDSEP Plus subscription. AGA member trainees receive a discounted subscription.
Purchase a subscription to continue learning.
Practice Question #1
A 45-year-old woman diagnosed with irritable bowel syndrome with diarrhea presents to your clinic. Her diarrhea is well controlled with loperamide, but her abdominal pain persists.
Her primary care provider previously prescribed dicyclomine, but this did not improve her abdominal pain symptoms.
What is the next best medication to treat her abdominal pain?
A. Amitriptyline
B. Codeine/acetaminophen
C. Hydrocodone
D. Meloxicam
Correct answer:
A. Amitriptyline
Commentary:
Amitriptyline is a tricyclic antidepressant medication that functions as a central neuromodulator. A systematic review of randomized controlled trials of 6-12 weeks’ duration showed a modest improvement in global symptom relief and abdominal pain in patients with IBS treated with tricyclic anti-depressants. Opioid medications and nonsteroidal anti-inflammatory medications are not recommended to treat abdominal pain in patients with IBS.
Practice Question #2
A 52-year-old man with hypertension and diabetes mellitus type 2 is referred to you for 8 months of troublesome regurgitation and heartburn. He has a body mass index of 29 kg/m2.
He had minimal relief with single-dose proton pump inhibitor (PPI) therapy before breakfast and partial response with double-dose PPI therapy taken before breakfast and before dinner. Regurgitation after dinner and at bedtime is his most troublesome symptom.
What is the next best step in management?
A. Counsel on weight management
B. Increase PPI to quadruple dose
C. Perform gastric emptying study
D. Refer for bariatric surgery evaluation
E. Switch PPI to before bedtime
Correct answer:
A. Counsel on weight management
Commentary:
This presentation represents typical symptoms of gastroesophageal reflux disease that are not responsive to an optimized regimen of PPI therapy.
Management of refractory gastroesophageal reflux disease symptoms begins with optimizing lifestyle and weight loss.
Quadruple-dose PPI therapy has no established role. A gastric emptying study would be recommended if gastroparesis was suspected.
This patient does not meet criteria for bariatric surgery as his body mass index is less than 30 kg/m2.
PPI therapy optimization with before-meal dosing (30-60 min before breakfast for single-dose therapy and before breakfast and dinner for double-dose therapy) would be the next step after weight management.
Challenge yourself with these practice questions! This is just a sample of the nearly 900 questions available with an annual DDSEP Plus subscription. AGA member trainees receive a discounted subscription.
Purchase a subscription to continue learning.
Practice Question #1
A 45-year-old woman diagnosed with irritable bowel syndrome with diarrhea presents to your clinic. Her diarrhea is well controlled with loperamide, but her abdominal pain persists.
Her primary care provider previously prescribed dicyclomine, but this did not improve her abdominal pain symptoms.
What is the next best medication to treat her abdominal pain?
A. Amitriptyline
B. Codeine/acetaminophen
C. Hydrocodone
D. Meloxicam
Correct answer:
A. Amitriptyline
Commentary:
Amitriptyline is a tricyclic antidepressant medication that functions as a central neuromodulator. A systematic review of randomized controlled trials of 6-12 weeks’ duration showed a modest improvement in global symptom relief and abdominal pain in patients with IBS treated with tricyclic anti-depressants. Opioid medications and nonsteroidal anti-inflammatory medications are not recommended to treat abdominal pain in patients with IBS.
Practice Question #2
A 52-year-old man with hypertension and diabetes mellitus type 2 is referred to you for 8 months of troublesome regurgitation and heartburn. He has a body mass index of 29 kg/m2.
He had minimal relief with single-dose proton pump inhibitor (PPI) therapy before breakfast and partial response with double-dose PPI therapy taken before breakfast and before dinner. Regurgitation after dinner and at bedtime is his most troublesome symptom.
What is the next best step in management?
A. Counsel on weight management
B. Increase PPI to quadruple dose
C. Perform gastric emptying study
D. Refer for bariatric surgery evaluation
E. Switch PPI to before bedtime
Correct answer:
A. Counsel on weight management
Commentary:
This presentation represents typical symptoms of gastroesophageal reflux disease that are not responsive to an optimized regimen of PPI therapy.
Management of refractory gastroesophageal reflux disease symptoms begins with optimizing lifestyle and weight loss.
Quadruple-dose PPI therapy has no established role. A gastric emptying study would be recommended if gastroparesis was suspected.
This patient does not meet criteria for bariatric surgery as his body mass index is less than 30 kg/m2.
PPI therapy optimization with before-meal dosing (30-60 min before breakfast for single-dose therapy and before breakfast and dinner for double-dose therapy) would be the next step after weight management.
AGA Research Foundation: You Can Help
To my fellow AGA Members, I’m not the first to tell you that real progress in the diagnosis, treatment, and cure of digestive disease is at risk. Research funding from traditional sources, like the National Institutes of Health, continues to shrink. We can expect even greater cuts on the horizon.
GI investigators in the early stages of their careers are particularly hard hit. They are finding it much more difficult to secure needed federal funding. As a result, many of these investigators are walking away from GI research frustrated by a lack of support.
It is our hope that physicians have an abundance of new tools and treatments to care for their patients suffering from digestive disorders.
You know that research has revolutionized the care of many digestive disease patients. These patients, as well as everyone in the GI field clinicians and researchers alike, have benefited from the discoveries of passionate investigators, past and present.
This is where you can help.
New treatments and devices are the result of years of research. The AGA Research Foundation grants are critical to continuing the GI pipeline.
Help us fund more researchers by supporting the AGA Research Foundation with a year-end donation. Your donation will support young investigators’ research careers and help assure research is continued.
Be gracious, generous and giving to the future of the GI specialty this holiday season. There are three easy ways to give:
Make a tax-deductible donation online at www. foundation.gastro.org.
Send a donation through the mail to:
AGA Research Foundation
4930 Del Ray Avenue
Bethesda, MD 20814
Or donate over the phone by calling (301) 222-4002. All gifts are tax-deductible to the fullest extent of US law. Join us!
Dr. Camilleri is AGA Research Foundation Chair and Past AGA Institute President. He is a consultant in the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
To my fellow AGA Members, I’m not the first to tell you that real progress in the diagnosis, treatment, and cure of digestive disease is at risk. Research funding from traditional sources, like the National Institutes of Health, continues to shrink. We can expect even greater cuts on the horizon.
GI investigators in the early stages of their careers are particularly hard hit. They are finding it much more difficult to secure needed federal funding. As a result, many of these investigators are walking away from GI research frustrated by a lack of support.
It is our hope that physicians have an abundance of new tools and treatments to care for their patients suffering from digestive disorders.
You know that research has revolutionized the care of many digestive disease patients. These patients, as well as everyone in the GI field clinicians and researchers alike, have benefited from the discoveries of passionate investigators, past and present.
This is where you can help.
New treatments and devices are the result of years of research. The AGA Research Foundation grants are critical to continuing the GI pipeline.
Help us fund more researchers by supporting the AGA Research Foundation with a year-end donation. Your donation will support young investigators’ research careers and help assure research is continued.
Be gracious, generous and giving to the future of the GI specialty this holiday season. There are three easy ways to give:
Make a tax-deductible donation online at www. foundation.gastro.org.
Send a donation through the mail to:
AGA Research Foundation
4930 Del Ray Avenue
Bethesda, MD 20814
Or donate over the phone by calling (301) 222-4002. All gifts are tax-deductible to the fullest extent of US law. Join us!
Dr. Camilleri is AGA Research Foundation Chair and Past AGA Institute President. He is a consultant in the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
To my fellow AGA Members, I’m not the first to tell you that real progress in the diagnosis, treatment, and cure of digestive disease is at risk. Research funding from traditional sources, like the National Institutes of Health, continues to shrink. We can expect even greater cuts on the horizon.
GI investigators in the early stages of their careers are particularly hard hit. They are finding it much more difficult to secure needed federal funding. As a result, many of these investigators are walking away from GI research frustrated by a lack of support.
It is our hope that physicians have an abundance of new tools and treatments to care for their patients suffering from digestive disorders.
You know that research has revolutionized the care of many digestive disease patients. These patients, as well as everyone in the GI field clinicians and researchers alike, have benefited from the discoveries of passionate investigators, past and present.
This is where you can help.
New treatments and devices are the result of years of research. The AGA Research Foundation grants are critical to continuing the GI pipeline.
Help us fund more researchers by supporting the AGA Research Foundation with a year-end donation. Your donation will support young investigators’ research careers and help assure research is continued.
Be gracious, generous and giving to the future of the GI specialty this holiday season. There are three easy ways to give:
Make a tax-deductible donation online at www. foundation.gastro.org.
Send a donation through the mail to:
AGA Research Foundation
4930 Del Ray Avenue
Bethesda, MD 20814
Or donate over the phone by calling (301) 222-4002. All gifts are tax-deductible to the fullest extent of US law. Join us!
Dr. Camilleri is AGA Research Foundation Chair and Past AGA Institute President. He is a consultant in the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
Unlock the Latest Clinical Updates with the 2024 PG Course OnDemand
Did you miss out on the AGA Postgraduate Course this year?
Visit agau.gastro.org to purchase today for flexible, on-the-go access to the latest clinical advances in the GI field.
- Unparalleled access: Choose when and where you dive into content with convenient access from any computer or mobile device.
- Incredible faculty: Learn from renowned experts who will offer their perspectives on cutting-edge research and clinical guidance.
- Tangible strategies: Expert and early career faculty will guide you through challenging patient cases and provide strategies you can easily implement upon your return to the office.
- Efficient learning: Content is organized by category: GI oncology, neurogastroenterology & motility, obesity, advanced endoscopy, and liver.
- Continuing education: With CME testing integrated directly into each session, you can easily earn up to 16 CME and MOC credits through December 31, 2024.
Did you miss out on the AGA Postgraduate Course this year?
Visit agau.gastro.org to purchase today for flexible, on-the-go access to the latest clinical advances in the GI field.
- Unparalleled access: Choose when and where you dive into content with convenient access from any computer or mobile device.
- Incredible faculty: Learn from renowned experts who will offer their perspectives on cutting-edge research and clinical guidance.
- Tangible strategies: Expert and early career faculty will guide you through challenging patient cases and provide strategies you can easily implement upon your return to the office.
- Efficient learning: Content is organized by category: GI oncology, neurogastroenterology & motility, obesity, advanced endoscopy, and liver.
- Continuing education: With CME testing integrated directly into each session, you can easily earn up to 16 CME and MOC credits through December 31, 2024.
Did you miss out on the AGA Postgraduate Course this year?
Visit agau.gastro.org to purchase today for flexible, on-the-go access to the latest clinical advances in the GI field.
- Unparalleled access: Choose when and where you dive into content with convenient access from any computer or mobile device.
- Incredible faculty: Learn from renowned experts who will offer their perspectives on cutting-edge research and clinical guidance.
- Tangible strategies: Expert and early career faculty will guide you through challenging patient cases and provide strategies you can easily implement upon your return to the office.
- Efficient learning: Content is organized by category: GI oncology, neurogastroenterology & motility, obesity, advanced endoscopy, and liver.
- Continuing education: With CME testing integrated directly into each session, you can easily earn up to 16 CME and MOC credits through December 31, 2024.
Revival of the aspiration vs chest tube debate for PSP
Thoracic Oncology and Chest Procedures Network
Pleural Disease Section
Considerable heterogeneity exists in the management of primary spontaneous pneumothorax (PSP). American and European guidelines have been grappling with this question for decades: What is the best way to manage PSP? A 2023 randomized, controlled trial (Marx et al. AJRCCM) sought to answer this.
The study recruited 379 adults aged 18 to 55 years between 2009 and 2015, with complete and first PSP in 31 French hospitals. One hundred eighty-nine patients initially received simple aspiration and 190 received chest tube drainage. The aspiration device was removed if a chest radiograph (CXR) following 30 minutes of aspiration showed lung apposition, with suction repeated up to one time with incomplete re-expansion. The chest tubes were large-bore (16-F or 20-F) and removed 72 hours postprocedure if the CXR showed complete lung re-expansion.
Simple aspiration was statistically inferior to chest tube drainage (29% vs 18%). However, first-line simple aspiration resulted in shorter length of stay, less subcutaneous emphysema, site infection, pain, and one-year recurrence.
Since most first-time PSP occurs in younger, healthier adults, simple aspiration could still be considered as it is better tolerated than large-bore chest tubes. However, with more frequent use of small-bore (≤14-F) catheters, ambulatory drainage could also be a suitable option in carefully selected patients. Additionally, inpatient chest tubes do not need to remain in place for 72 hours, as was this study’s protocol. Society guidelines will need to weigh in on the latest high-quality evidence available for final recommendations.
Thoracic Oncology and Chest Procedures Network
Pleural Disease Section
Considerable heterogeneity exists in the management of primary spontaneous pneumothorax (PSP). American and European guidelines have been grappling with this question for decades: What is the best way to manage PSP? A 2023 randomized, controlled trial (Marx et al. AJRCCM) sought to answer this.
The study recruited 379 adults aged 18 to 55 years between 2009 and 2015, with complete and first PSP in 31 French hospitals. One hundred eighty-nine patients initially received simple aspiration and 190 received chest tube drainage. The aspiration device was removed if a chest radiograph (CXR) following 30 minutes of aspiration showed lung apposition, with suction repeated up to one time with incomplete re-expansion. The chest tubes were large-bore (16-F or 20-F) and removed 72 hours postprocedure if the CXR showed complete lung re-expansion.
Simple aspiration was statistically inferior to chest tube drainage (29% vs 18%). However, first-line simple aspiration resulted in shorter length of stay, less subcutaneous emphysema, site infection, pain, and one-year recurrence.
Since most first-time PSP occurs in younger, healthier adults, simple aspiration could still be considered as it is better tolerated than large-bore chest tubes. However, with more frequent use of small-bore (≤14-F) catheters, ambulatory drainage could also be a suitable option in carefully selected patients. Additionally, inpatient chest tubes do not need to remain in place for 72 hours, as was this study’s protocol. Society guidelines will need to weigh in on the latest high-quality evidence available for final recommendations.
Thoracic Oncology and Chest Procedures Network
Pleural Disease Section
Considerable heterogeneity exists in the management of primary spontaneous pneumothorax (PSP). American and European guidelines have been grappling with this question for decades: What is the best way to manage PSP? A 2023 randomized, controlled trial (Marx et al. AJRCCM) sought to answer this.
The study recruited 379 adults aged 18 to 55 years between 2009 and 2015, with complete and first PSP in 31 French hospitals. One hundred eighty-nine patients initially received simple aspiration and 190 received chest tube drainage. The aspiration device was removed if a chest radiograph (CXR) following 30 minutes of aspiration showed lung apposition, with suction repeated up to one time with incomplete re-expansion. The chest tubes were large-bore (16-F or 20-F) and removed 72 hours postprocedure if the CXR showed complete lung re-expansion.
Simple aspiration was statistically inferior to chest tube drainage (29% vs 18%). However, first-line simple aspiration resulted in shorter length of stay, less subcutaneous emphysema, site infection, pain, and one-year recurrence.
Since most first-time PSP occurs in younger, healthier adults, simple aspiration could still be considered as it is better tolerated than large-bore chest tubes. However, with more frequent use of small-bore (≤14-F) catheters, ambulatory drainage could also be a suitable option in carefully selected patients. Additionally, inpatient chest tubes do not need to remain in place for 72 hours, as was this study’s protocol. Society guidelines will need to weigh in on the latest high-quality evidence available for final recommendations.
AI applications in pediatric pulmonary, sleep, and critical care medicine
Airways Disorders Network
Pediatric Chest Medicine Section
Artificial intelligence (AI) refers to the science and engineering of making intelligent machines that mimic human cognitive functions, such as learning and problem solving.1 Asthma exacerbations in young children were detected reliably by AI-aided stethoscope alone.2 Inhaler use has been successfully tracked using active and passive patient input to cloud-based dashboards.3 Asthma specialists can potentially use this knowledge to intervene in real time or more frequent intervals than the current episodic care.
Sleep trackers using commercial-grade sensors can provide useful information about sleep hygiene, sleep duration, and nocturnal awakenings. An increasing number of “wearables” and “nearables” that utilize AI algorithms to evaluate sleep duration and quality are FDA approved. AI-based scoring of polysomnography data can improve the efficiency of a sleep laboratory. Big data analysis of CPAP compliance in children led to identification of actionable items that can be targeted to improve patient outcomes.4
The use of AI models in clinical decision support can result in fewer false alerts and missed patients due to increased model accuracy. Additionally, large language model tools can automatically generate comprehensive progress notes incorporating relevant electronic medical records data, thereby reducing physician charting time.
These case uses highlight the potential to improve workflow efficiency and clinical outcomes in pediatric pulmonary and critical care by incorporating AI tools in medical decision-making and management.
References
1. McCarthy JF, Marx KA, Hoffman PE, et al. Applications of machine learning and high-dimensional visualization in cancer detection, diagnosis, and management. Ann N Y Acad Sci. 2004;1020:239-262.
2. Emeryk A, Derom E, Janeczek K, et al. Home monitoring of asthma exacerbations in children and adults with use of an AI-aided stethoscope. Ann Fam Med. 2023;21(6):517-525.
3. Jaimini U, Thirunarayan K, Kalra M, Venkataraman R, Kadariya D, Sheth A. How is my child’s asthma?” Digital phenotype and actionable insights for pediatric asthma. JMIR Pediatr Parent. 2018;1(2):e11988.
4. Bhattacharjee R, Benjafield AV, Armitstead J, et al. Adherence in children using positive airway pressure therapy: a big-data analysis [published correction appears in Lancet Digit Health. 2020 Sep;2(9):e455.]. Lancet Digit Health. 2020;2(2):e94-e101.
Airways Disorders Network
Pediatric Chest Medicine Section
Artificial intelligence (AI) refers to the science and engineering of making intelligent machines that mimic human cognitive functions, such as learning and problem solving.1 Asthma exacerbations in young children were detected reliably by AI-aided stethoscope alone.2 Inhaler use has been successfully tracked using active and passive patient input to cloud-based dashboards.3 Asthma specialists can potentially use this knowledge to intervene in real time or more frequent intervals than the current episodic care.
Sleep trackers using commercial-grade sensors can provide useful information about sleep hygiene, sleep duration, and nocturnal awakenings. An increasing number of “wearables” and “nearables” that utilize AI algorithms to evaluate sleep duration and quality are FDA approved. AI-based scoring of polysomnography data can improve the efficiency of a sleep laboratory. Big data analysis of CPAP compliance in children led to identification of actionable items that can be targeted to improve patient outcomes.4
The use of AI models in clinical decision support can result in fewer false alerts and missed patients due to increased model accuracy. Additionally, large language model tools can automatically generate comprehensive progress notes incorporating relevant electronic medical records data, thereby reducing physician charting time.
These case uses highlight the potential to improve workflow efficiency and clinical outcomes in pediatric pulmonary and critical care by incorporating AI tools in medical decision-making and management.
References
1. McCarthy JF, Marx KA, Hoffman PE, et al. Applications of machine learning and high-dimensional visualization in cancer detection, diagnosis, and management. Ann N Y Acad Sci. 2004;1020:239-262.
2. Emeryk A, Derom E, Janeczek K, et al. Home monitoring of asthma exacerbations in children and adults with use of an AI-aided stethoscope. Ann Fam Med. 2023;21(6):517-525.
3. Jaimini U, Thirunarayan K, Kalra M, Venkataraman R, Kadariya D, Sheth A. How is my child’s asthma?” Digital phenotype and actionable insights for pediatric asthma. JMIR Pediatr Parent. 2018;1(2):e11988.
4. Bhattacharjee R, Benjafield AV, Armitstead J, et al. Adherence in children using positive airway pressure therapy: a big-data analysis [published correction appears in Lancet Digit Health. 2020 Sep;2(9):e455.]. Lancet Digit Health. 2020;2(2):e94-e101.
Airways Disorders Network
Pediatric Chest Medicine Section
Artificial intelligence (AI) refers to the science and engineering of making intelligent machines that mimic human cognitive functions, such as learning and problem solving.1 Asthma exacerbations in young children were detected reliably by AI-aided stethoscope alone.2 Inhaler use has been successfully tracked using active and passive patient input to cloud-based dashboards.3 Asthma specialists can potentially use this knowledge to intervene in real time or more frequent intervals than the current episodic care.
Sleep trackers using commercial-grade sensors can provide useful information about sleep hygiene, sleep duration, and nocturnal awakenings. An increasing number of “wearables” and “nearables” that utilize AI algorithms to evaluate sleep duration and quality are FDA approved. AI-based scoring of polysomnography data can improve the efficiency of a sleep laboratory. Big data analysis of CPAP compliance in children led to identification of actionable items that can be targeted to improve patient outcomes.4
The use of AI models in clinical decision support can result in fewer false alerts and missed patients due to increased model accuracy. Additionally, large language model tools can automatically generate comprehensive progress notes incorporating relevant electronic medical records data, thereby reducing physician charting time.
These case uses highlight the potential to improve workflow efficiency and clinical outcomes in pediatric pulmonary and critical care by incorporating AI tools in medical decision-making and management.
References
1. McCarthy JF, Marx KA, Hoffman PE, et al. Applications of machine learning and high-dimensional visualization in cancer detection, diagnosis, and management. Ann N Y Acad Sci. 2004;1020:239-262.
2. Emeryk A, Derom E, Janeczek K, et al. Home monitoring of asthma exacerbations in children and adults with use of an AI-aided stethoscope. Ann Fam Med. 2023;21(6):517-525.
3. Jaimini U, Thirunarayan K, Kalra M, Venkataraman R, Kadariya D, Sheth A. How is my child’s asthma?” Digital phenotype and actionable insights for pediatric asthma. JMIR Pediatr Parent. 2018;1(2):e11988.
4. Bhattacharjee R, Benjafield AV, Armitstead J, et al. Adherence in children using positive airway pressure therapy: a big-data analysis [published correction appears in Lancet Digit Health. 2020 Sep;2(9):e455.]. Lancet Digit Health. 2020;2(2):e94-e101.
Mechanical power: A missing piece in lung-protective ventilation?
Critical Care Network
Mechanical Ventilation and Airways Management Section
The ARDSNet trial demonstrated the importance of low tidal volume ventilation in patients with ARDS, and we have learned to monitor parameters such as plateau pressure and driving pressure (DP) to ensure lung-protective ventilation. What role does the higher respiratory rate play? There is growing evidence that respiratory rate may play an important part in the pathogenesis of ventilator-induced lung injury (VILI) and the dynamic effect of both rate and static pressures needs to be evaluated.
The concept of mechanical power (MP) was formalized in 2016 by Gattinoni, et al and defined as the product of respiratory rate and total inflation energy gained per breath.1 Calculations have been developed for both volume-controlled and pressure-controlled ventilation, including elements such as respiratory rate and PEEP. Studies have shown that increased MP is associated with ICU and hospital mortality, even at low tidal volumes.2 The use of MP remains limited in clinical practice due to its dynamic nature and difficulty of calculating in routine clinical practice but may be a feasible addition to the continuous monitoring outputs on a ventilator. Additional prospective studies are also needed to define the optimal threshold of MP and to compare monitoring strategies using MP vs DP.
References
1. Gattinoni L, Tonetti T, Cressoni M, et al. Ventilator-related causes of lung injury: the mechanical power. Intensive Care Med. 2016;42(10):1567-1575.
2. Serpa Neto A, Deliberato RO, Johnson AEW, et al. Mechanical power of ventilation is associated with mortality in critically ill patients: an analysis of patients in two observational cohorts. Intensive Care Med. 2018;44(11):1914-1922.
Critical Care Network
Mechanical Ventilation and Airways Management Section
The ARDSNet trial demonstrated the importance of low tidal volume ventilation in patients with ARDS, and we have learned to monitor parameters such as plateau pressure and driving pressure (DP) to ensure lung-protective ventilation. What role does the higher respiratory rate play? There is growing evidence that respiratory rate may play an important part in the pathogenesis of ventilator-induced lung injury (VILI) and the dynamic effect of both rate and static pressures needs to be evaluated.
The concept of mechanical power (MP) was formalized in 2016 by Gattinoni, et al and defined as the product of respiratory rate and total inflation energy gained per breath.1 Calculations have been developed for both volume-controlled and pressure-controlled ventilation, including elements such as respiratory rate and PEEP. Studies have shown that increased MP is associated with ICU and hospital mortality, even at low tidal volumes.2 The use of MP remains limited in clinical practice due to its dynamic nature and difficulty of calculating in routine clinical practice but may be a feasible addition to the continuous monitoring outputs on a ventilator. Additional prospective studies are also needed to define the optimal threshold of MP and to compare monitoring strategies using MP vs DP.
References
1. Gattinoni L, Tonetti T, Cressoni M, et al. Ventilator-related causes of lung injury: the mechanical power. Intensive Care Med. 2016;42(10):1567-1575.
2. Serpa Neto A, Deliberato RO, Johnson AEW, et al. Mechanical power of ventilation is associated with mortality in critically ill patients: an analysis of patients in two observational cohorts. Intensive Care Med. 2018;44(11):1914-1922.
Critical Care Network
Mechanical Ventilation and Airways Management Section
The ARDSNet trial demonstrated the importance of low tidal volume ventilation in patients with ARDS, and we have learned to monitor parameters such as plateau pressure and driving pressure (DP) to ensure lung-protective ventilation. What role does the higher respiratory rate play? There is growing evidence that respiratory rate may play an important part in the pathogenesis of ventilator-induced lung injury (VILI) and the dynamic effect of both rate and static pressures needs to be evaluated.
The concept of mechanical power (MP) was formalized in 2016 by Gattinoni, et al and defined as the product of respiratory rate and total inflation energy gained per breath.1 Calculations have been developed for both volume-controlled and pressure-controlled ventilation, including elements such as respiratory rate and PEEP. Studies have shown that increased MP is associated with ICU and hospital mortality, even at low tidal volumes.2 The use of MP remains limited in clinical practice due to its dynamic nature and difficulty of calculating in routine clinical practice but may be a feasible addition to the continuous monitoring outputs on a ventilator. Additional prospective studies are also needed to define the optimal threshold of MP and to compare monitoring strategies using MP vs DP.
References
1. Gattinoni L, Tonetti T, Cressoni M, et al. Ventilator-related causes of lung injury: the mechanical power. Intensive Care Med. 2016;42(10):1567-1575.
2. Serpa Neto A, Deliberato RO, Johnson AEW, et al. Mechanical power of ventilation is associated with mortality in critically ill patients: an analysis of patients in two observational cohorts. Intensive Care Med. 2018;44(11):1914-1922.