Detangle by Kinjal
Detangle is a podcast created by health psychologist and writer, Dr Kinjal Goyal. Each episode is a conversation with an expert in their field, as they dive deep into their journerys and experiences. The conversations are full of insight and a great way to hear, first hand, how the mind plays a pivotal role in almost everything that we do. The guests range from doctors, to writers, to those in entertainment and of course, those from mental health fields.
Detangle by Kinjal
Detangle with Dr. Parimal Lawate
Embark on a journey through the complex maze of our gut and its profound influence on mental wellness, as I, Dr. Kinjal Goyal, along with esteemed gastroenterologist Dr. Parimal Lawate, shed light on the intricate gut-brain connection. This enlightening dialogue traverses the ABCD framework—abdominal pain, bloating, constipation, and diarrhea—and the pivotal role of endoscopy in the treatment of gastrointestinal issues. We share insights into a typical day in the life of a gastroenterologist and delve into the synergy between our digestive systems and psychological health, illuminating how this relationship affects everything from our moods to our metabolism.
Prepare to be fascinated by the inner workings of our gut microbiome as Dr. Lawate and I examine a case where anxiety and physical health intertwine, revealing the complexity of the gut as more than just a digestive organ. We venture into the realm of the enteric nervous system, a network so extensive it's often likened to the brain itself, and explore the multitude of roles our gut plays, from hormone production to its critical part in the immune system. Understanding the 'strong voice' of our microbial inhabitants is crucial, and we emphasize the burgeoning field of research unraveling the microbiota-brain axis, which promises to revolutionize our approach to health and disease.
Lastly, the intricacies of managing irritable bowel syndrome (IBS) and the undeniable effects of stress on gut health are brought into focus. Dr. Lawate shares personal narratives, highlighting the need for empathy and a comprehensive approach in medical practice. We underscore the importance of lifestyle choices, the interplay between the gut and the brain, and the profound implications for conditions like IBS. This episode is a treasure trove, offering profound insights into the dynamic dance of our physical and emotional well-being, and the spiritual dimensions of healing that often go overlooked in the world of medicine.
#GutBrainConnection #DrParimalLawate #GastroenterologyInsights #ABCDFramework #DigestiveHealth #PsychologicalWellness #GutMicrobiome #EntericNervousSystem #MicrobiotaBrainAxis #IrritableBowelSyndrome #StressManagement #MedicalNarratives #LifestyleChoices #EmotionalWellbeing #HealthAndDisease #MedicalInsights #Podcast #DetangleByKinjal #InnerWorkingsOfTheGut #MedicalPractice #HolisticHealth #SpiritualHealing #ResearchInnovation #PhysicalWellBeing #EmotionalResilience
Welcome to Detangle, where we have tangled the complexities of life one conversation at a time. I am your host, Dr Kinjal Goyal, a psychologist and a writer. Butterflies in your stomach, a sinking feeling in the pit of your tummy, the elusive gut microbiome and all the things that fascinate us about the connection between the gut and the mind make the crux of today's episode. We have with us today one of India's leading gastroenterologists, Dr Parimal Lavate. With an MD in medicine and DM in gastroenterology, Dr Lavate is the director of the Department of Gastroenterology and Liver Disease at Jahangir Hospital. He is also a consultant at the DMH Phune. With more than 31 years of experience. He has nearly 22 publications to his name. Beyond medicine, Dr Lavate is an avid photographer and plays the keyboard too. Welcome to Detangle, Dr Lavate, and thank you so much for joining me today, my pleasure.
Speaker 1:So, dr, there are lots of questions that I have for you, lots of things that I personally want to know about the gut and the brain. Let's get into the questions and let's see where they lead us. So, dr, to begin with, what pulled you into gastroenterology as a field in the early years?
Speaker 2:So when we were doing MD medicine at BJ Medical College, phune, there were various units of medicine one unit per week sorry per day and each unit was kind of doing a little specialized work, like some units for doing neurology, some for doing nephrology. The unit where I got admission into was predominantly into gastroenterology, so naturally what happens is when you are exposed to patients related to gastroenterology, you tend to get a liking for that subject. The other thing which was very important was in those days there were hardly any tests available in the other fields.
Speaker 2:So in neurology you had hardly any tests. In kidney disease you had hardly any test but in gastroenterology there were tests where you could imagine how the thing works, you could image them properly, like doing barium test and, most importantly, you could go inside the gastroenterologist and track with an endoscope. And we were lucky that in our unit we have the first endoscope of Phune and we could go inside the patient stomach and actually see what's going on.
Speaker 2:So endoscopy was very primitive in those days but it was something which I felt that, as compared to other specialties, we had something where we could actually see what is going on and there was tests which were being developed. There was ultrasoundography for the liver, gallbladder, so it seemed to be a very exciting and upcoming field, so I thought this could be a good option.
Speaker 1:Wow, I think that was well chosen because, like you said, what was beginning then has now picked up so fast and there's so much now almost in every field, but, of course, in GI2. So take us through a regular day of your work. What are the kind of patients, what are the kind of ailments that you deal with on a daily basis?
Speaker 2:So, as gastroenterologist, we have two types of patients whom we do the work on patients. So one is you see patients clinically, which is like any other doctor. So you take the history, you examine in them clinically, then you formulate a plan as to what you are going to do by way of diagnosis and treatment and then arrange for the followup. So that is clinical gastroenterology.
Speaker 1:The second part is endoscopy.
Speaker 2:We won't go into it in details, but here we do an endoscopy test, either an upper or lower endoscopy, which is called as gastroscopy or colonoscopy and then there are of course, lot of advanced endoscopy techniques.
Speaker 2:So the second part of practice of a gastroenterologist was doing endoscopy in selected patients to know what is going on inside the patient's stomach. So by and large the day is divided between clinical gastroenterology and endoscopy. There is a wide spectrum of complaints and types of patients whom we see in practice. Now if you look at any doctor's practice I think gastroenterology related complaints are amongst the commonest presentations.
Speaker 2:So you will have I call it as ABCD so you can have abdominal pain, bloating, constipation, diarrhea, so these, in combination of singly, these are by and large the most common symptoms with which a patient will go to a doctor, be it a general practitioner, a physician or even a gastroenterologist.
Speaker 1:So, there.
Speaker 2:You have to remember that these patients who come with these complaints, they can have some disease as a cause for their complaints. So it may be a peptic ulcer or inflammatory bowel disease or something like that. But by and large you will be surprised that most of these patients do not have a disease. So you do as many tests as you want on these patients but you find no abnormality. So these patients have what is called as functional disorders and there is a very important difference between disease and disorder. So both will cause symptoms. Both will trouble the patient. Possibly the disorder patients are more troubled because there are lot of psychological element in it and the disease patients may have little lesser over your other symptoms.
Speaker 2:But most important is if you leave that patient of a disorder untreated, without any treatment, he may be bothered by symptoms but there will be no bodily harm by and large.
Speaker 2:While in a disease if you leave it untreated then you can have bodily harm. So if you leave an ulcer which is there untreated. So that is why it is important to do the endoscopy tests and other tests to make sure that there is no disease in that patient which you are missing out on. By and large, when you are practicing for so many years, you will have a clear idea in most patients as to whether this patient has some underlying disease or whether there is a disorder. So you can make out on clinical grounds. The other important thing to remember in gastroenterology is, which I always tell patients, is that gastrointestinal symptoms are rarely because of disease. So if you have this ABCD type of patients coming to you suppose you have, say, about 40 patients who you have seen in this group of symptoms you will find that only one or two may have some disease when you evaluate them and all the rest will have water condense functional disorders.
Speaker 1:Well, that is a very large number.
Speaker 2:It is a very large number.
Speaker 1:So I think there is a whole balance that you are striking on a daily basis. Yes, you are trying to explain that.
Speaker 2:I think psychoeducation must be a very strong part of your work, then yes, actually, it is very important for a gastroenterologist to have some knowledge and evolve himself as he practices over the years.
Speaker 2:You can call him a psychiatrist or a psychologist or a psychotherapist. And I think the key to all this is listening to the patient, because many times what happens is patients have a long list of symptoms with them. They come with so many symptoms beyond gastroenterology. And the most important thing is to, because there are some patients who can say that I kind of felt brushed off when I presented my symptoms to a particular doctor, so that we should make a conscious effort that we do not allow that feeling to seep into the patient.
Speaker 1:So talk as a psychologist, I am very keen to know more about this gut and the mind connection. So we all know that there is a connection between stress and the impact on the GI health. Moreover, we are now also talking backwards. We are talking about the gut-brain connect too. So from the brain affecting the gut to the gut affecting the brain. Can you shed some light about this? Yes, so actually when?
Speaker 2:like we talked about why I went into gastroentery. So those days were about mid-80s, you can say so that time a lot of these disorders were considered as brain gut axis. So if you had somebody, coming with what was diagnosed as an irritable bowel syndrome, the predominant focus of medications was on the brain. That is, you give some anti-depressants, anti-anxiety agents and not much was available and not much was known about the gut influencing the brain. So now the whole thing is completely reversed.
Speaker 2:So, one has to remember. Still, it remains a two way traffic, but now the focus is not from brain gut axis, it is completely from gut to brain axis. So if you look at treatment review articles which were published, say, 80s and today, you find lot of treatments today which are predominantly directed on the gut environment, with the in the lumen of the gut, wall of the gut or the signals will go from the gut to the brain. So the whole paradigm shift has occurred where we try to focus more on the gut and then treat these patients.
Speaker 1:So this makes me go back to this patient. She was a young girl I think she was in standard 12 or maybe first year and she kept saying that she feels anxious and she feels like crying all the time, but despite all evaluation we couldn't figure out that this was any kind of stress disorder or anxiety neurosis. Eventually she was diagnosed with she just needed a deworming medication. She was feeling hungry all the time because she had this gut problem and the minute that was solved she started feeling better, stopped crying so much, so it went the other way around for her. So exactly what you said. So don't tell me about his gut microbiome. I think this word is being used and abused crazily on social media, on even print media. Now, what exactly is this microbiome and how is it important for us?
Speaker 2:So when we learnt our medicine, we looked at the whole digestive system as a very mechanistic set of organs.
Speaker 1:Right.
Speaker 2:So the food went from your mouth to the food pipe, then it went into the stomach where it was churned into a kind of a slurry, then it went into a small intestine. In the small intestine and tubes it was broken down into smaller parts so that it got to what could be absorbed from the intestine wall and then sent to the bloodstream. And then whatever was left was sent to the colon, large intestine, and it came out as a residue called as stool. So this was a very mechanistic thing where we believed that this was the only thing which the gastrointestinal tract did. But over the years the thinking has changed. So now what we realise is it is not only this functionality which the gastrointestinal system does. It has its own brain, which is called as enteric nervous system.
Speaker 2:So I will put some fun facts or trivia here. So if you like, take the number of neurons in the enteric nervous system or the system of nerves which is there around the gut, it will be as much as they are there in your spinal cord. Oh, really, yeah. So that is one thing. So it has its own nervous system. The second thing is we never believed that the gastrointestinal tract could be an endocrine organ. So there are almost 20 hormones which are secreted by the gastrointestinal tract and actually, if you put the number of cells which work as these hormone producing cells and take the weight, it may possibly be much more than the weight of all endocrine organs put together.
Speaker 1:Wow, so you have a new super heroine organ, so in thyroid you have only two or three hormones which are formed.
Speaker 2:If you look at adrenas there, if you look at the gut, you find that almost 20 peptides are made by the gut and they are. They act locally. Also. What they do is they modulate the amount of juices which are required for digestion, the movement of the intestine and so on, and lot of them can traverse from these nerves which I mentioned to the brain and then tell us as to how good or bad you are feeling. And so one thing we said was it has its own nervous system, it has its own endocrine system and, very importantly, it has its own immune system. Immune system is very important because the moment we take so it is an exterior which is interior. You can see, in the sense that you have your skin, which is an exterior which is exposed to the exterior. This whole tract is inside but it is exposed to all exterior influences, like food drugs so many things which we take supplements.
Speaker 2:And our immune system has to do two things it has to identify what is good for us, what is bad for us and that which is bad for us it should try and eliminate. Now here, like I said, why I came to all this before your question of gut microbiome, you may be wondering why I am telling all these things. So the thought process has changed from a mechanistic organ Now we understand that the GI tract is much more than just a mechanistic organ. So, like we said, it has its own nervous system, own endocrine system and own immune system. Now. So till then we felt that these were two organs the gut and all these.
Speaker 1:Now we have realized that it is not only this.
Speaker 2:There is an organ within this gastrointestinal tract which is called as the microbiome.
Speaker 2:So our gastrointestinal tract has trillions of bacteria and again, if I have to put some trivia, if you take the weight of these microbiomes put together, it may be almost as much as our brain, or maybe a little less. So there is a system within a system, so organ within an organ, which is the microbiome. And these bacteria are not without function and they are there from the time we have evolved and if you remove them you can be in big time trouble. So you cannot have a person without bacteria inside. Now one would wonder why they are there inside, because there has to be some reason why there are trillions and for the bacteria, they are very happy staying there because it is a protected environment.
Speaker 2:It is a dark environment. You are eating food. They are automatically getting it. So it is a very happy situation for the bacteria. So that is why they have been there. But it is not only for their benefit, so they are there for even our benefit. So there are lot of functions which these bacteria do which we can discuss little later.
Speaker 1:And, important thing, to remember is that this microbiome produces lot of nutrients.
Speaker 2:Undigested food which is left over, it can digest and make energy and the most important thing is there is a thing called as metabolome. So there are lot of products with these microbiomes make. They are very similar to the hormones which are made by our own body and these microbiome, the bacteria, fungus, viruses, all put together in this microbiome. They are very close to the intestinal cell layer. So the things which they secret, they can be taken up by ourselves and they can be transmitted via the enteric nervous system to the brain. So that is actually the kind of origin of this thinking of the microbiota affecting your brain. And there is so much research which is going on in this field.
Speaker 1:So they seem to have a very strong voice inside us. We just have to start listening now, yes, talk.
Speaker 1:Let's now start talking about one thing which I think you see all the time. These patients see physicians all the time. They see psychologists all the time. Irritable bowel disease or irritable bowel syndrome, ibs Now, this is a very commonly experienced set of symptoms, but it can be so physical in its presentation that very few people believe that there could be an emotional cause behind it. So what is your take on IBS? How do you treat it and how do you think it should be treated?
Speaker 2:Yes. So if you look at, suppose I assume that there are 20 patients sitting in my clinic with these type of A-B, C-D complaints which I mentioned in the beginning and blindly, even without seeing any patient, I say that all of you have IBS, the statistical chance of my being corrected very high, because most patients who come to us with these symptoms.
Speaker 2:They have irritable bowel syndrome. Very few will be without irritable bowel, like I said earlier, and who will be having a disease. So the point which I am trying to drive in is that irritable bowel syndrome is the commonest presenting symptom. You have to remember that they have two sets of symptoms. One is gastrointestinal and, very importantly, like you said, there can be lot of other symptoms. So there can be packet, there can be migraines, there can be some tingling, numbness in their feet, there can be weakness in the legs and so many other symptoms, insomnia. So it is a combination of not only gut but also extra gastrointestinal symptoms and I think in these patients you have an over sensitive gut and you have an over sensitive brain.
Speaker 2:So like suppose you have a family where there are so many members who are all very sensitive to small little things of life.
Speaker 2:You can imagine that the family is never going to live in peace. There will be always anxiety and frictions and so on. So the same thing happens in our gut. So these patients have a very sensitive brain. They have a very sensitive mind. So what would not really disturb another patient may disturb these patients a lot. And many times what we tell patients is suppose, what do you mean by sensitivity of the gut? So suppose there are four friends who are friends for like decades and they realize that every time they go out there, one friend who will always have say some nausea he will have burning, he will have cramps in the stomach, he will have to go to the washroom again.
Speaker 2:So this is a patient who has, in very simple term, sensitive intestines. Now, this is a very important factor. So because, if you like, open our whole intestine and spread it, the surface area will be as much as, maybe, a basketball field, and you can imagine this basketball field is started with sensors of various types.
Speaker 2:So you can imagine the amount of sensation which is going from this intestine system towards the brain. You have sensations for spicy food, you have sensations for distention, you have so many other sensations. So these patients probably have an over representation of these sensors in their system. So they pick up these signals and then send them to the brain.
Speaker 1:I think that's one of the most visual ways I have seen the GI tract recently. I mean to be able to visualize this shear size and the shear scope of what goes on within us. It's, you know, even if you read it, it doesn't hit you hard enough because you can't visualize it so clearly. You feel it's a stomach. It's a stomach, I mean, how much is it going to do?
Speaker 2:but apparently it's been doing and our system, the gastrointestinal system, is a quiet system so we don't realize it is there.
Speaker 1:Right, it doesn't do anything.
Speaker 2:So, generally, what happens is there are two controllers for it. One is the enteric nervous system which we mentioned. So it is like the central government and your state government. So the state government is working automatically and unless there is something really going wrong with it? The center will not, the brain does not feel the need to interfere in it. But at the same time, the enteric system is sending continuous impulses to the brain. So, like I said, with so many sensors, you can imagine how many influences are going to the brain subconsciously.
Speaker 2:So over the years, like suppose you have gone with a friend to some restaurant and then things have not turned very pleasantly during that visit, then you may say that no, I don't want to go to that restaurant, or you may not feel that the food there is very good to taste.
Speaker 2:So these are influences which are slowly created by the signals going into our center and our system and that is then modified, then you have each person has a set of likes and dislikes. So some have a sweet tooth, some don't like sweets at all. I have lot of patients who have never eaten a mango. They just hate it. So there, I think, for whatever reason, that tract is developed in such a way that the brain tells that no, this is a mango, I don't like it, I don't want to have it.
Speaker 1:Very interesting actually. So basically, lifestyle factors, all the simple things you know exercise, sleep, hydration, all these we know affect mental health, but do they also affect gut health on a daily basis?
Speaker 2:They do so. Two very simple words if you want to talk about lifestyle. We live as a mind partner you have. Diet is the most important and in diet you have three things which you have to look at. One is what is the content? The second thing what's the timing? And, off late, what is the variation? Because you have a lot of people who are traveling throughout the year to so many places within the country, outside the country, and their food is constantly changing.
Speaker 1:Right.
Speaker 2:Like, for that matter, even if it goes from the east to the west, in India, the diet will become completely different. So one is the diet. Second is exercise and physical activity, whether he's doing it properly or not.
Speaker 1:Third, is habits.
Speaker 2:Most important is smoking and alcohol, and then there are many others also, and the fourth is the circadian rhythm. So you find a lot of young people today who sleep at 2am, 3am. They get up at 11am.
Speaker 2:So, their circadian rhythm is completely gone for us and that definitely affects the gastrointestinal tract in the SPS Because whole cycle is completely disturbed. So it is very important that these four factors in the lifestyle diet, physical activity, habits and circadian rhythm these are corrected by patients as well. So it is very important that lifestyle. Now if you look at any gastrointestinal complaints in very simplistic terms, there are three factors One is the body, the second is the mind and third is lifestyle.
Speaker 2:So body what I mean is there is either a disease or disorder. The second is mind. So if you look at all these patients who have functional disorders and you put, say, like a graph, you put these three bars next to each other, the lifestyle bar and the mind bar will be far, far higher than the body bar. So you will find that these are the main drivers of the complaints, and it is not only the medicines or the counseling which is going to help the patient, but these two factors definitely did correct.
Speaker 1:So you see this on a daily basis, then that a patient who heals emotionally, let's say through psychiatric treatment or even psychological treatment, does that gut health also improve in the long term.
Speaker 2:Definitely absolutely no towards that. So you require in lot of these patients two ways you can go about it. You can talk to the patient, you can try and explain what is going on with him. But there are lot of patients who will need either a psych I think they require more of a counselor or psychologist than a psychiatrist.
Speaker 1:Right, of course there are some who require a psychiatrist.
Speaker 2:Of course, but, like very rightly said, lot of these patients need counseling and try to find out what happened. There are childhood experiences which somehow in India never we don't ask for them. As to what is the childhood experience? How good was the family atmosphere? And I have had patients who have voluntarily told me that they had a very abusive father and he had no habits. But he was very abusive and there was lot of physical violence, also in the house, and these things definitely give a long term effect on your brain, mind and True Dog.
Speaker 1:let's talk about social media. I think it's one of those platforms where now everybody has become suddenly very aware of everything that they're doing with respect to their gut, especially. You know macro nutrients, micro nutrients, what you're eating, how you're feeling. Do this, don't do this. There are, there's good advice, there's bad advice, there's complete trash, and there's people are even threatening. Now, if you do this, you will ruin your gut. If you don't do this, you will not do anything for your gut. So, with so much information, misinformation I'm sure people have tried crazy things and then come to you to clean it up and say you know what, dog, I did all this and now it's not working for me. So, offhand, you remember any patient who's done some crazy things for their gut?
Speaker 2:Yes, so we had we have had so many of these patients doing so many crazy things Right and instantly. I'll tell you that there was a patient who read that he has to eat some dates and whatever, some dry fruits, and then he was with me for a long time. He used to keep on coming and one day he came with severe abdomen pain.
Speaker 1:So I said have you eaten something outside.
Speaker 2:He said no, no, I haven't eaten anything outside.
Speaker 1:I said have you eaten very spicy?
Speaker 2:He said no no, I haven't eaten anything. So was there a change in your diet? He said no, I definitely changed my diet because I read on the net that you have to eat these things, and you would imagine that guy was eating about half a kg of dates.
Speaker 1:Every day.
Speaker 2:Every day half a kg of raisins.
Speaker 1:Oh, my God wow.
Speaker 2:So they can do a lot of crazy things and, like you rightly said, social media is like a double-edged sword. So the patient has to use his own wisdom, try and look at sites which are genuinely scientific and then see, and there are a lot of things which now patients come and tell us. So patient will ask dog, do I have a leaky gut? I think I have Candida Superinfection. I think I am gluten sensitive. So there are two things. One is doctors we should not brush them off.
Speaker 1:Right.
Speaker 2:So you have to address what they are saying, but at the same time you have to dispel any myth which they are carrying in their mind and put true scientific facts before them, and that will help that patient.
Speaker 1:True. So, dog, we as psychologists know that if a patient is undergoing a long period of stress or has anxiety or generalized anxiety disorder, they will have some or the other gut issues as well. But have you seen anybody presenting the other way around, Somebody who's had a constant gut issue and because of that it has impacted their mental health?
Speaker 2:Yeah, so actually I don't know if this is the right platform to say but the way. I classify stress myself and which I find very useful in clinical practice is that there are four types of stress. Okay, one is there's circumstantial stress. This is of two types acute and chronic. So I was coming to your studio and the circumstantial stress can be traffic on the road Right.
Speaker 2:It's an acute circumstantial stress, where I want to reach and I cannot reach. Then there is chronic circumstantial stress. So interpersonal, inter-family, workplace and so on. So the circumstances are there, which themselves are enough to cause stress, even in a normal person. Okay, the second is the stress-prone individual, extremely common. So these patients are always anxious about something wrong going to happen. So I'm coming to your studio, I feel that the car may puncture in the way. There may be some car which breaks down in front of me. So this is stress-prone personality. The third is self-induced stress.
Speaker 2:This is very common nowadays, especially in people who are in IT fields or something like that Say they get a project Now. They know that they can't finish it by mid-March 24. It is going to be 15 April 24. But still they will feel that we should finish it early.
Speaker 2:So it's a stress filter induced themselves and the whole team. Everybody is stressed out and finally at the end of the day they know that they have not completed the project. We'll see for them. And the fourth type of stress the reason I told all this is coming to this fourth type of stress. So the fourth type of stress we commonly see in functional disorders.
Speaker 2:So there's a patient who has gone from doctor to doctor to doctor, which is very common and I don't think any doctor should feel bad about it, because finally the patient wants to leave and he has had multiple tests, maybe repeats of the same test, and finally nothing is found. So these patients get a kind of stress related to this lack of diagnosis. So in them many times, even if you very stressfully enforce on the patient's mind, see many times what medicine is taught in a way where we have to have some. It is very easy if you have a disease, so if you have an ulcer, whether I give him a proton pump inhibitor, you give him a proton pump anybody gives he is going to get cured.
Speaker 2:The art of medicine, beyond science, comes in all these functional disorders when it depends on how you listen to the patient. The patient has to get the feeling that the doctor is listening to me and addressing all issues which they have raised. So then it becomes a two-way relationship and a good doctor-patient relationship, and this is nowadays. It is very commonly affected because of lack of time. It is important to not brush off these patients and leave them more time, and then you can have better results. In these patients, although not universally better, in most patients you can do a good job.
Speaker 1:True, I think, all the kinds of stress that you have listed out. They may not be a classical way of differentiating one stress from the other, but they are all equally important?
Speaker 2:Yeah, because patients find it easier to put them in one of these four backs.
Speaker 1:Correct.
Speaker 2:There is much more to it.
Speaker 1:Correct, but I think it is very important that you start the conversation at least. Yes, Once you start talking about it, they also feel like there are more people who are experiencing this. They can themselves come out with yes.
Speaker 2:yes, I have self-induced stress. I unnecessarily expect others to do what I want to do. That is a self-induced stress type of personality Fantastic.
Speaker 1:It is very rare that somebody in a field which is so different from psychology is using so much of psychology in a very clear way. You are not doing it to identify the problem, you are doing it to identify the solution, Because the minute you know what kind of stress it is, the patient will probably start understanding.
Speaker 2:okay, this is what is causing this?
Speaker 1:Yes.
Speaker 1:So a lot of children before an exam will have loose motions or they will say you know we are not able to sit tight so they understand, but unless that solution is presented to them in a concrete way, either by a parent or by the doctor, that doesn't resolve. It kind of continues into adulthood. So I am loving the way you have done this. Has there been any patient or any experience in so many years of practice where you had this Eureka moment? First you thought it was something else and then you know, by digging deeper and just trying to figure out where this puzzle was taking you, did you figure out? This is not what I was thinking and this is more emotional than anything else.
Speaker 2:I think I can't put it as one Eureka moment. There is an internal process and internal evolution of every physician over the years. So many times what happens is when you ask a particular pointed question to a person and a lot of times we have our undervalued, post-valued surrounders.
Speaker 1:They later on ask you as to sir, why do you ask this?
Speaker 2:question to the patient. So that is something you try and learn. So I don't think there can be some of them. I can't remember which they were, but by and large it is like a process of learning over the years and trying to identify what is wrong with the patient the moment the patient walks in. So you know that this is more of a psychosomatic patient.
Speaker 1:So you get tuned into body language, you get tuned into eyes, you get turned the other thing is about less switch patients bring to you.
Speaker 2:So a lot of patients bring two or three pages of lists.
Speaker 1:Really yeah.
Speaker 2:So I personally, the way I look at it, is that you read all the things which are mentioned and my personal practice is to write the answers in brief to that problem which has brought up. So suppose there are 12 numbers of questions, like yesterday there was a patient who came with 12 questions and then I wrote medicines and then into brackets I wrote 1, 2, 12, 1, 2, 4 and 12. So I told the patient that if the brackets have written the numbers, you go on and read them and this medicine addresses your problems 1, 2, 4 and 12. And other thing I do is I like to write the answers to their questions in one or two words or a short line with a different ink, so that they can go up and read it and then they really feel that, yes, this doctor has really gone through each and tried to address each question.
Speaker 1:I think it's very important to empower them.
Speaker 2:So I think in the journal of medicine when I don't remember, and it was about 20-25 years back, there was a writer who is writing a list of symptoms, a sign of mental disease.
Speaker 1:Oh really.
Speaker 2:Yes.
Speaker 1:That would be an interesting one to read.
Speaker 1:Thank you, dr Gautam. Wow, so I think it's very important to empower the patient. I mean, by giving them information, you're also giving them power, you're giving them direction so at least they can start looking up the right words online, like you said, instead of going to random websites and random influencers. They can at least start looking up what matters to them. Let's get to a very personal question, doc. This is a question I ask all my podcast guests. So you know what's a physical first aid box. We keep painkillers. You might keep some antiseptics for those minor cuts and bruises.
Speaker 1:But what if I were to ask you for an emotional first aid box, something which you could open and feel good at any time of the day. If you had a bad day emotionally, you're feeling run down. What would you put in a box which would give you intense happiness immediately?
Speaker 2:So actually, what I feel is for every doctor, like I'm a gastroenterologist, there may be a neurologist, so there has to be life beyond gastroenterology, life beyond neurology, and passions which you have, which will immediately put you in a different zone.
Speaker 1:And I play the keyboard and not a professional, but I've heard you and I think you're brilliant.
Speaker 2:Yeah, so if you put a keyboard in that box of yours and you give it to me and you say that today you had 14 hours nonstop work and I'm giving you this box and open it, then I think that will give me a lot of happiness. Now, that is one thing, and then, of course, very important is your personal relationships in the family and all these things. That is, of course, standard, but addressing your question if you put one keyboard in that box will give to me.
Speaker 1:Well, that sounds like a beautiful box to make.
Speaker 2:It will have to be a big one.
Speaker 1:So how nice. Before we come to a close of the discussion, I leave the floor open to my guests. Is there any question that you want to ask me as a psychologist?
Speaker 2:Yes, you are a psychologist. So, see, I think what happens is we, as gastroenterologists, we tend to focus more on the body part of it we may not focus. So the question is obviously predictable as to what you would look at, see, because both patients who have diseases and patients who have disorders both need psychological support. So, the way you look at it from your perspective because you have had patients, I believe, from all around the globe, and I am sure there was a lot many with gastroenteritis, still complaints, oh, yes.
Speaker 2:So the way you look at it and….
Speaker 1:So I will tell you a very interesting patient I had recently, about six months ago, that he stopped therapy. But when he started coming he had severe IBS and he had so many symptoms which was so intensely physical in nature I mean he would be completely debilitated with pain, he would have cramps, he would have bleeding, everything. He would keep getting admitted, he had multiple invasive tests, he had everything. Eventually his doctor thanked God for him. He told him look, you need help, but it is not me who can help you. You have to seek psychological help.
Speaker 1:And then he came and he started therapy saying, oh, I am good and there is no problem in my life, there is no stress, I have all the money I need, and he was very good looking, he was from Delhi. But there was a pattern Every three to six months he would have a flare up. So it took us a very long time to establish what was happening every three months or every two months. So he had a wife and he had a girlfriend.
Speaker 2:So this would flare up Every time his girlfriend visited.
Speaker 1:Delhi and it took us. It was like solving this puzzle, because he could not figure that this caused that and eventually he realized, oh my God, that is the amount of stress he underwent, trying to keep the two apart, trying to make his time work. So circumstantial stress which he brought upon himself. I think he picked all the stress boxes that you have. But yes, it happens.
Speaker 1:Usually, patients who come for psychological help will be sent by the doctor and the first thing they come and ask me I don't think this is emotional, I don't think this is mental, so how can you help? And so you have to start very slowly and tell them okay, we are not labeling, we are not writing you off. In India, I think even abroad, a lot of people feel that if this is psychological or if psychology helped us, that means it wasn't real in the first place, everything was fake and we will be judged. So my first job is to tell them you will not be judged, it is not fake, everything that you felt was real nonetheless. It's after that that the patient starts opening up and, like you said, therapy helps both Somebody who is suffering from a chronic disease, from a disorder.
Speaker 2:From an illness.
Speaker 1:It helps in healing. It helps in compliance. Sometimes I also need to help patients be compliant with their doctor. The doctor has given them a long term treatment protocol, but they don't want to follow it. They want shortcuts online. They want to do something which gives them their health immediately back. So there are lots of layers we work with in GI health and a lot of good results.
Speaker 1:Actually, it's one of the fields which has the best results Because patients actually see the difference and then they start believing that, okay, we need to take care of ourselves Emotionally, physically, you know, from all angles.
Speaker 2:So two things One is there are a lot of patients who may open out with a psychologist if they are available in matches and tell a lot many things which has never disclosed to even the closest person in life Happens. That is one. The second thing is the doctor should never say that this is all in your head. He will reject that doctor's outbreak Absolutely. So we have to acknowledge that he is suffering, the symptoms are genuine, and then go about it.
Speaker 1:So one of the pet peeves I have with a lot of consultants who send me their patients Initially, when I had started practice, I would get a call from a senior consultant it could be a cardiologist, or somebody is calling up and saying in front of the patient that, oh, you know, I've done all the tests, everything is normal, arey kuchne, it's just stress, and that was it. He had clamped down the patient right in that one moment. So then we started having workshops, started talking to doctors about how to send patients to a psychologist, not by saying it's nothing, by saying that it is something which is different from what you expected. Let's work around it. So, yes, you can't write off a patient.
Speaker 2:We write this because many times we think from our perspective. We feel that we are the ones who are assessing the patient and observing him.
Speaker 1:But you have to remember that the patient also is observing the doctor?
Speaker 2:Oh yes, and his body language, and they can immediately make an opinion as to how this relationship is going to be.
Speaker 1:Absolutely, and I think it's very nice that you're so tuned into both sides. This has been one of those conversations, doc, where I started off with a different mindset. I thought you know, we'll just talk about the mind and the gut and the. You know the connections. But we started talking about so much more because in any kind of practice, in any field of practice, the doctor brings so much into the room, the patient brings so much into the room, this whole interpersonal connection, this whole interplay of emotions. I think this has been a fantastic discussion for me. So thank you for taking the time. Thank you for explaining so much about the gut to us in so many nice ways. I will always see the gut when I see your basketball field. Now. Well, that's what we know. Well, thank you for taking time off.
Speaker 2:And my chief in Christian Medical College fellow where I did gastroenterology. He once gave a lecture on irritable bowel syndrome. And you know what he said at the end. He said that irritable bowel syndrome is a condition which God has made so that the physician always remains a caring physician.
Speaker 1:How nice. I think these words are what we are going to close with and these words are what I hope all physicians can listen to. I hope there are a lot of doctors listening to this podcast as well. But thank you for taking the time off on such a busy day and thank you for sharing all your wisdom with us. It was a pleasure being here today. Thank you, doc, thank you.
