GERD Explained: Why Acid Reflux Is More Serious Than You Think

In this episode of Hormones and Hope, Dr. Chhaya Makhija sits down with Surgeon and Foregut Surgeon Dr. Tejal Pandya to discuss one of the most common yet misunderstood conditions—GERD (gastroesophageal reflux disease).

While many people associate reflux with occasional heartburn, this conversation reveals how GERD can present in multiple ways, including chest pain, throat irritation, chronic cough, and even symptoms that mimic heart or sinus issues. Dr. Pandya explains how reflux is not just about acid, but also about the physical movement of stomach contents into the esophagus.

They also dive into why medications like PPIs don’t always address the root cause, what red flags to watch for, and when it’s time to move beyond symptom management into deeper evaluation. From lifestyle habits to advanced diagnostics like endoscopy, manometry, and pH testing, this episode gives you a clear roadmap to understanding and addressing reflux properly.

If you’ve been dealing with persistent symptoms or feel like something is being missed, this episode will help you take the next step toward real answers.

Dr. Tejal Pandya is a board certified general surgeon and fellowship trained foregut specialist. She is on a mission to cure antacid dependence through education and comprehensive evaluation and treatment. As a specialist, Dr. Pandya is uniquely qualified to offer functional testing, endoscopy, advanced diagnostics, and surgery to serve patients suffering from heartburn and acid reflux related problems. 

She chose this specialty after seeing the major impact these diseases have on overall health and quality of life, and yet they are frequently not treated as diseases at all. She's here to change that.

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Transcript

SPEAKER_00 0:00

Gastroesophageal reflux disease, that's GERD, like you said, affects nearly one in five adults, and many don't even realize they have it. That is true. Number two, yes or no, is a patient more likely to develop complications from long-standing GERD like Barrett's ulcers or esophageal cancer? Yes. Number three, heartburn is the only symptom of GERD.

SPEAKER_01 0:23

False.

SPEAKER_00 0:24

Yes or no? Is there a difference between GERD and laryngopharyngeal reflux? That's LPR. I'm going to say yes and no. Over-the-counter medications like ranitidine-famotidine, is it okay for a person to take if they're experiencing heartburn? Welcome to Hormones and Hope, a podcast where we bridge science and wellness to help transform your health. I'm your host, Dr. Chaya Makija, or you can call me Dr. Chaya, a triple boat certified endocrinologist and lifestyle medicine physician and founder of Unified Endocrine and Diabetes Care. Each week we dive into the powerful intersection of clinical medicine and real-life lifestyle strategies to help you feel stronger, live longer, and show up as your most vibrant self inside and out. So let's get empowered. Hello and welcome everyone. A fun, fun, fun episode today at Hormones and Hope. This is your host, Dr. Makijah, and I'm delighted to introduce you to Dr. Tejal Pandeya. She's one of the very few surgeons who has a specialty or a special interest in foregut. And guess what foregut means? It's your upper gastrointestinal tract. So anything uh below your mouth or uh after your mouth is what she specializes in. So if you've heard about reflux, if you've heard about acidity, chest pain related to esophagitis, she deals with these individuals, does the appropriate fantastic evaluation, and also offers the right treatment, be it medical or surgical. So I'm very, very delighted to introduce you to Dr. Pijal Pandia. Thank you so much for having me today. Yeah, welcome, welcome to our episode. Um, this is going to be a sequence uh as I was sharing with you, where uh we had our previous episode with uh one of the dental surgeons who talked about oral health and how that impacts metabolic health. And now we dive into the upper GI tract where your specialty comes into play. So, Dr. Pandya, please tell us why did you pick surgery? What was your passion, and why this specific sub-specialty that piques your interest?

SPEAKER_01 2:37

Sure. Yeah, again, thank you so much. I'm really happy to be here today. I chose the surgery because it really, after experiencing everything in medical school, I truly did enjoy all of our rotations. But when I arrived at surgery, it really fit with my personality and my point of view about wanting to take a really whole and comprehensive care of a patient that in a way that would allow me to own the complete bottom line. And that's really how I feel or or employ surgery and the way that I approach my evaluations is to be thorough, to, to really own the whole patient and all of their um pathways that they end up taking and still be present all the way to the bottom line, which in my case would be a a procedure or an operation to hopefully you know goal to be restore them back to normal as much as possible when something changes. And it's something similar that made me interested in foregut surgery, which is really the treatment and evaluation between the mouth and the end of the stomach. That's the zone in the GI tract for foregut surgery and foregut medicine. And it helped me, because we do so much functional testing as well, it really helped me bring all of that classroom physiology from my college days back into surgery uh realm. And I really enjoy being able to be looking at the patient in all of those different dimensions. I also realized once I started working how broadly impactful for gut diseases are in the community. And at the same time, how underappreciated and under-evaluated they are. And I could see how much quality of life impact there was, and it made me want to go deeper and be the person that could provide that type of uh e-surp.

SPEAKER_00 4:22

And what for gut diseases that you commonly encounter?

SPEAKER_01 4:26

So the number one most common foregut disease is reflux, hands down. This means things that people sometimes call as GERD, sometimes call as heartburn, but can encompass a lot more other symptoms. And then there are also those disorders of motility, coordination, uh, swallowing, and those types of disorders, which can play a mixed role or can sometimes actually be the underlying condition that people have been passing off as heartburn or reflux, but it's actually something completely different once we do the functional testing.

SPEAKER_00 4:59

We're gonna learn a lot more about the functional testing and the procedures too. Okay, Dr. Pandya. So now as we are going to learn a lot more details about these four gut diseases, we'll start with rapid fire. And I have a lot more than I usually do for other guests because this is one of the topics that we haven't really touched on at Hormones and Hope. So, one word answer, and if you feel like that needs more nuanced answer or a solution, then we can talk about it in the deep dive. Okay, ready? Good. I'm ready. Okay. True or false? Gastroesophageal reflux disease, that's GERD, like you said, affects nearly one in five adults, and many don't even realize they have it. That is true. All right, thank you. Number two, yes or no. Is a patient more likely to develop complications from long-standing GERD like Barrett's ulcers or esophageal cancer? Yes. Ooh, okay. Number three, heartburn is the only symptom of GERD. False. All right. Number four, can reflux show up as chest pain, headache, palpitations, hoarseness, throat clearing, or is it only heartburn? Yes, it can show up as the things you mentioned, and also a little bit more. Okay. So we need to get into that. Number five, true or false, it's safe to stay on medications like the proton pump inhibitors, or meprazol, pantiprazol lifelong based on a clinical diagnosis of reflux?

SPEAKER_01 6:25

My answer for that is gonna say yes and no.

SPEAKER_00 6:29

So we'll have to talk about it. So it depends. All right. Number six, yes or no. Is there a difference between GERD and laryngopharyngeal reflux that's LPR? I'm going to say yes and no, or that one as well. Can medications like GLP1 medications worsen underlying GERD or even cause new symptoms or diagnosis of GERD? The answer is yes. All right. I just gave like three solo episodes on GLP1 medications, so we'll learn more from you. Number eight, one simple test that can diagnose gastroesophageal reflux or GERD.

SPEAKER_01 7:06

There is a simple screening test that people can actually administer to themselves. That's a questionnaire. So, yes, there is one. It's called the GERD HRQL, which means heartburn-related quality of life questionnaire. It's a validated one. That's a very good screening tool. So I'll say that is one. And when it comes to what the physician can do for you, I won't call it a simple test, but the test that we focus on is pHing.

SPEAKER_00 7:32

Okay. Number nine, over-the-counter medications like Ranitidine, Famotidine. Is it okay for a person to take if they're experiencing heartburn? Yes. All right. Thank you. So I think we have a lot of deep dives now since we had a few maybes and it depends. So before we get into that, you know, since we're focusing on GERD or reflux disease, if you can tell us what exactly does it mean? Like what does gastroesophageal reflux disease mean? And then how it presents or what are the symptoms?

SPEAKER_01 8:04

So gastroesophageal reflux disease means the pathologic movement of fluids or contents that are in the stomach moving upwards into the chest. And that is fundamentally reflux. A lot of times we associate it directly with the acid aspect of that disease process. And of course, our stomach is the place where we produce an acidic pH naturally. But reflux fits in that definition, whether or not it's acidic. And later in our conversation, I can clarify more about that. But that's what GERD means and what it stands for. And some of the um symptoms, they fall into kind of two categories. And this goes to the question you asked me about GERD versus LPR. But we kind of generally broadly call it into two categories. Some are typical symptoms, and then there's atypical symptoms. The typical symptoms are the ones that you see on commercials on TV, okay? Uh peptobismol commercials or the PPI proton pump inhibitor commercials. So those are things that are commonly a feeling of heart burn, which is uh like a burning or chemical discomfort sensation somewhere in the mid to low chest. Chest pain that often can be mistaken for cardiac problems. And many people do get cardiac testing from things that turn out to be reflux disease. And of course, we want to check your heart, so don't skip that. But it sometimes can be reflex, actually. Um, then there can be pressure or squeezing sensation that kind of broadly falls into that chest pain category. Some people experience bloating or pressure, especially in the upper abdomen. And some people experience kind of a pressure or pain sensation. Some people call it a soreness feeling, and that is often in that low chest and right under the breast phone location. So those are those are common typical symptoms. The atypical symptoms are also reflux related, but they are more like pro and respiratory type symptoms. So that means um hoarse voice, frequent throat clearing, having a sensation like you can never get the mucus to fully go away and go down, cough, either generally chronic cough that doesn't seem to have a good cause otherwise, or coughing after meals, post-nasal drip, kind of that like kind of runny nose on the inside constantly feeling and sometimes throat pain. So these are common atypical symptoms.

SPEAKER_00 10:36

So here on this on our podcast, we always also look at, you know, prevention or what can be done to avoid a certain symptom or a medical problem. So in terms of reflux or GERD, to be very specific, is there a cause? Like does every human have to deal with it? It's inevitable because they ate something, or is there a pathological reason which is modifiable versus unmodifiable? So if you can break that down, something that could be preventable and something that needs to be addressed by an expert like you.

SPEAKER_01 11:12

Yeah. So um I think this will fit up your alley for sure, that um lifestyle and eating habits play a big role. And those are the things that are largely in the hands of the patient or the individual that they can do for themselves. Specifically, when we're talking about GERD or reflux disease that is not solvable by anyone other than a practitioner like me, we're talking about a situation where the natural anti-reflex barrier has been lost. That barrier has multiple components, and it has a lot to do with the specific geometry and configuration of how the esophagus plugs into the stomach, the way that the stomach is oriented relative to the diaphragm. And the diaphragm, this natural space in the diaphragm, which is called the hiatus, which allows the esophagus to connect to the stomach, has usually become too stretched out, too big. And so once that happens, the organization of that zone where the stomach and the esophagus meet, the relationships get lost. And um, because of that, slowly, slowly, it's like a series of dominoes, slow motion dominoes, that one by one you lose all the components. And so it's like putting a shoe in the door so it doesn't close. And that is a stage at which an individual cannot do anything to change or prevent that. There's nothing you can do other than a surgical repair to bring those things back in line and back in order together to do their job or as originally intended. So the preventive aspect comes from doing your best to arrive in that situation. And so some of the most important things include not overeating, because when we eat big meals, we distend, we stretch out the stomach a lot, and it puts a lot of pressure. You can imagine you're trying to hold the door closed and someone is pushing it. You really have to put a lot of effort and pressure into keeping the door shut. And that's exactly what a really big meal that stretches out your stomach does to that antibeflex barrier. So not eating overeating or eating big meals, not eating overly fatty meals, which slows down the movement of the food out of the stomach. And so what that means is now your stomach's stretched out and it stays like that longer than normal, with a lesser fatty meal, not eating late at night, you know, making sure you have at least two to three hours before bedtime that you're finishing any food consumption so that again, for the same reason that we're not leaving a large volume of stuff inside the stomach that can really put pressure. Because when we lay down, I like to visualize it as like a two-liter bottle of soda, you know, that's half empty. When you lay a two-liter bottle down, there's nothing stopping the soda from flowing up to the cap, you know, it's a totally free flow of fluid. And that's exactly what happens when you lay down with a lot in your stomach, it just flows right up. And when your anti-replex barrier is broken, that flow just flows all the way right up to your throat, potentially. It can move that way very easily. So these are a lot of the basic healthy lifestyle choices and eating habits that can help keep us from developing this broken barrier.

SPEAKER_00 14:31

Yeah, yeah. We learned in childhood, especially in India, that eat up to you're 80% full, not completely full. And now, you know, we have so much of scientific data and uh discussions about that. This was good, like preventive steps, but if those are not happening, what it leads to. And I love the analogy of the half-filled soda and what happens if you're, you know, uh flat, if there is a heavy meal and it's breaking the anti-reflux barrier. What is actually happening in that tract, like in terms of the inflammation or the ongoing damage that's leading to a symptom and uh the disease?

SPEAKER_01 15:09

So the stomach is a very special organ. It can tolerate things that no other organ does. And that is apart from a significant aspect of that is producing very high acidity fluid naturally for our digestion, but the other functions as well. And so the way that the body is organized and the GI tract, among everything else, is that the cell type that lines the inside of the organ is specialized to handle its job. And the cell type that lines the esophagus is completely different from the one that lies the stomach. And although they are next to each other and they directly plug into each other, the one cannot do and tolerate the thing of the other. And specifically for the esophagus, you know, the food from the stomach with its acidity and everything, it's meant to move downwards. It's meant to move into the small intestine. After the food leaves the stomach, the bile will mix with that. It will change the pH. And the rest of the GI tract is made to handle those changes in the content of the fluids and the pH of the fluids. The esophagus is not built for that. It is above those processes. And so when you have this free movement, whether it's acidic or not, it's not meant to handle that. So it's very irritating. It can be directly cell damaging. And that's where we start talking about things like esophagitis, ulcers, or erosions, or even the precrancerous cellular transformation that we call Barit's esophagus. Those the esophagitis, the ulcers, those are those are symbols when we do endoscopy to us that there has been injury causing inflammation causing exposures coming up there. And it's usually not our food. Unless you have just a straight drink, like a cleaning fluids and and toxic materials, that doesn't usually happen with our food. It's usually just from what's coming from the stomach. And then the Barret's esophagus represents the fact that this may have been happening so much for so long that the esophagus, the body is smart. The body always is looking for ways to protect itself, to protect you. And so it finally decides, you know what, you just keep injuring me. I'm gonna replace my cell type with a new one that can actually fill out some soothing material, which is not the normal role of the esophagus cellular lining. And so Barrett's esophagus is not a cancer, but it's a strong symbol that you've been having so much injury for so long that the body got fed up and changed its ways. And it's triggers to us that we should really be taking your evaluation even that much more seriously. Yeah.

SPEAKER_00 17:50

So step by steps, it's it's an ongoing, consistent wrong exposure that is leading to all these injuries. Thousand paper cuts. Yeah, and this was I could like visualize everything that you were saying. So now shifting, right? You gave us an understanding of what GERD is and what is actually happening if it's not addressed, or if you're causing the symptoms to happen more frequently with what is being fed to the body. Say if someone's dealing with this symptom and someone who's listening to this podcast or even watching it, and they're actively going through the symptoms, either typical or atypical, what are the first few steps in terms of their clinical evaluation that they should be either seeking or asking their physician or requesting if there is a specialist involved?

SPEAKER_01 18:38

Yeah. So I think the first screening test, even if you're still in that phase of working with your primary care doctor, is that GERD HRQL screening questionnaire, because it is a very good and strong indicator of someone that really needs something more deeper evaluation. And if viewers want to find me on Instagram and send me a message, I will send them the questionnaire for them to apply for themselves. The other thing that to me are red flags is that if you are on a medication like a PPI, like Oma Brazal or something in that family, very consistently taking it correctly for six months or something or more, and you are not getting relief or you're not getting complete enough relief where where the symptoms are still interfering with your quality of life and your normal functioning. To me, those are red flags. The original intention, if you buy it on bumpers all over the counter and you look at the box, it says that you should give it a two-week trial, right? So even when I say to you that, you know, six months is too long, that's actually beyond too long. But the reason I say it that way is because it is so common and so easy to prescribe or get in some way these medications and to rely on the medical treatment without going further, because it does at least dull the symptoms, if not treat them completely. So to me, that like six or more months, 12 months, you've been on this, you've renewed it a few times, and you feel like you're not really getting anywhere, and you cannot lean yourself off even though you're not better. To me, those are huge red flags. That's a good rule of thumb in my mind that okay, life's happening, but hey, I need to circle back and focus on finding someone that can help me go that next layer deeper. And what would that be?

SPEAKER_00 20:29

Like what kind of testing would that be?

SPEAKER_01 20:31

So when patients come to me in that situation, I do three things, not in the same visit. But what I organize for them typically is first of all, a really in-depth history about the variety of the symptoms they've been having and the way it's been impacting them because there's really big nutritional quality of life, stress, mental health, impacts of reflux disease that I think are very underappreciated. So I take a very thorough history, and then for their evaluation, I set up three things. First is an endoscopy. And it's important to understand that we really need to get a kind of like a 360-degree view. Like we really want to get like all of the angles information about what could be happening to you with relation to the symptoms that you're having. I don't like to assume that heartburn is acid reflux because heartburn can also represent other disorders. And it's important to stay with that clean mind and not make assumptions about what's going on with someone and set them down a path that actually might not be right. We don't want to make you worse, we want to make you better. So I set up an endoscopy that lets me look at the anatomy, understand the configuration, take biopsies, look for a hernia, take measurements and such. The next thing that I set up after that is esophageal monometry. And the third is pH testing. They both are separately. Done the monometry? There's a couple of different ways to do pH testing. So there's a 24-hour impedance pH testing, and then there's wireless pH testing. And so you employ them in different ways. The the wireless one is called Bravo. It's an implantable device that you put at the time of endoscopy. So if that's what we're doing, then that's that's when that gets placed. If we're doing the 24-hour impedance monitoring, then you need your monometry information to deploy that the other one. And so then those are the two things that get paired together. And they give us, both give us pH information, but they give us different other surrounding information.

SPEAKER_00 22:44

And how is that helping in the diagnosis?

SPEAKER_01 22:48

So endoscopy, I think, is a little bit easier to understand, more intuitive, how that helps us. Hyedal hernia represents a significant disruption to that anti-reflux barrier that I was talking about, because you can only form that when those relationships of the organs have been lost. Manometry is important because it is a functional test that allows us to understand the strength and coordination of your swallowing. One of the deeper or next level typical symptoms that people can have with reflux disease is dysphagia, which is difficulty or discoordinated swallowing. Sometimes that is the disorder in itself. And because they're not swallowing well, things may be getting hung up on their way down. And then that's giving them feelings like chest pain, like burning. Other times, and more commonly, I do have patients, in fact, I saw one this morning, part of their symptom complex is feeling that the food gets stuck. And we need the manometry to help us understand for what reason that's happening and whether it's a motility disorder or not. And to help us understand what is the sort of the strength or efficiency of their swallowing, meaning how well are they clearing things out of the esophagus? One of the things that happens is that when we have reflux, it's injuring the surface lining, but it's also injuring the nerves that feed the muscles that squeeze down kind of like a worm, right? They squeeze the food down. And when those nerves are getting inflamed or injured or stunned, so to speak, they're not able to move in that nice coordinated fashion. And food gets hung up even without motility disorder. So we need to know that type of information because it informs what you're going to tolerate later. If we operate on you and you have very, very weak muscle controls at that stage, you can recover. It's a little bit of a chicken and egg. You can recover after anti-reflex surgery when the injury stops occurring and you can heal. But you have to be able to tolerate the anti-reflex surgery because we're newly placing an appropriate barrier to the movement of fluid up, but that also for a short time can feel like a barrier of food going down. So this is the reason we do monometry. Okay. And then the pH testing, it helps us establish and prove and quantify and measure and analyze how often flu fluids and acids are moving up and down. How long are they staying in the esophagus? How long do they linger? How high up do they get? And this just helps us give the global picture of how your symptoms are getting produced.

SPEAKER_00 25:25

Okay. I'm going to simplify this because commonly you said GERD is the most common for gut disease. And, you know, individuals are taking the proton pump inhibitors or the H2 blockers. But if they're not getting relief with the medications, or they're getting these symptoms, or if they stop the medications and they're still getting the symptoms, one, I hope they've had their endoscopy done. But uh if the endoscopy is done and it's just giving a diagnosis of, say, GERD or you know, minimal gastritis or minimal esophagitis beyond PPI, and that's not resolving the clinical symptomology, then you proceed with, you know, referring to someone like you or getting these tests, which are pH testing and the manometry, right? When this is done or when medications are not helpful, the prescriptions, so is that the only place now to resort to in terms of treatment like the surgical options, or is it anything in between?

SPEAKER_01 26:24

Well, let me take a step back. Very often when people are coming to me with very high scores on their GERD quiz and they've had long-standing symptoms with partial, at best, partial response to their um PPI. But some of the symptoms are because of acid, the pH of what's coming up there. And the PPI can deal with that, right? That's its job. But some of the symptoms are from the fluid movement itself, right? And so a lot of times the patients are struggling with that. That is the reason why they can't lay down flat at sleep at night. That is the reason why they stop going to a restaurant is because if they eat, it's gonna come back up and they feel embarrassed and they feel anxious and these type of things. To be honest with you, by the time a patient finds their way to someone like me, very often there is something to repair because there's no medication that can become a barrier to fluid movement. And that's when we start thinking about the utility of repairing that reflex barrier. For people who have all of these tests and the results are pretty minimal or, you know, not very dramatic. There are people, sometimes they um may combine a PPI in the morning with uh with an H2 blocker in the evening and see if that kind of combination helps. Sometimes people use medications like GAVISCON because it's a soothing and it creates kind of a kind of like a barrier or a or a saran wrap, you could say, around the gastric um contents. And so even if they do move up and down a little bit, it's not as inflammatory um effect on on that tissue lining. But the other thing is that then, you know, if people are having strong symptoms and they're not having very dramatic test results, often they want to get off medications, you know, that's part of the reason why they end up coming to see me. And that's when we might start going into a little bit more rare functional issues or or hypersensitivity issues, which are a thing that may be for someone, but they're far from the most common things that we see. So there is more. There's more to and to think about and evaluate.

SPEAKER_00 28:43

Okay. So then when they're considering surgical options and uh getting that care, is that more of a mortality correction, or is there a correction even in the pH or the acid issue off GURD?

SPEAKER_01 28:59

So when we have a functioning anti reflex barrier, we shouldn't have to think about the pH anymore. It should not um impact us negatively. And, you know, there's a reason why nature created us to have acidic stomach, right? Because it plays a role. It plays a role in our nutritional absorption and our digestion and also in our immune as an immune barrier to getting sick, right? So if you have a natural or surgical functioning anti-reflux barrier, we don't have to worry about pH anymore. My patients don't take PPI. Most patients don't take PPI from day one anymore. After surgery. After surgery, yes. There are some people who have been on on really high doses for a long time and they can get a rebound acidity, like like an overblown acidity, basically, when they stop cold turkey. Um, and that's because of the hormones involved in regulating the acid production, and the body thinks it needs to make more, and so it has overstimulated those people, we wean them. But that's a sort of a more special situation. Most people were done with that the next day. And so the operation is really to restore anatomy, restore anatomical relationships, organ relationships, and to make sure that you have a door that closes when it's supposed to at the end of the esophagus. Very cool.

SPEAKER_00 30:24

Yeah. I wish we, uh I'm pretty sure in your clinic you probably have it, like, but the models of the stomach and the esophagus and just more pictorialization of the pH or the acid. And uh, I love the explanation of how important that acid is in the right manner and all the evaluation. So we don't want to get to the surgical place. But like you said, GERD is so common, and we talked about one in five adults. I think we need that specialty, right? Rather than people feeling miserable and just uh the way you were saying how it uh leads to embarrassment or just avoiding foods completely that can cause reflux or being on medication but no resolution. Last few words into, you know, in a in especially uh in terms of GERD, you know, your uh surgical skills and any gems or tips that you can give individuals who are struggling with the typical orate typical symptoms of GERD.

SPEAKER_01 31:20

I think it's helpful for people to understand that their reflux is really impacting their whole person. It's very unfortunately, it's very easy for people to be dismissed or gaslighted for their reflux symptoms because every one of us will experience something that we call heartburn at some time or another. And it's because it's so common, it's easy to ignore when it becomes really serious, when it becomes into a disease. So I would say to people, first of all, take your symptoms seriously and find yourself a provider that does the same. Because when you've crossed over, there's nothing anyone can do except these evaluations and really understand how to restore you back to normal, to be honest with you. And understanding that if you are having increased stress from your reflux, that's important impacting all your organ systems. You're not sleeping well, you're not eating well, you're not, you're on maybe PPI for a really prolonged period of time. Person I saw this morning was like 15 years. So you're not absorbing nutrients that are meant to be absorbed in an acidic environment for 15 years. These are not casual. And so I say that to empower people to be bolder about seeking out someone who takes it as seriously as they do, and for them to understand that that they should do that and it's okay and it's not, you're not being too much, you know, um, when you do that.

SPEAKER_00 32:47

Yeah, yeah. So get the right care. Yeah, don't suffer, don't be living in misery if these symptoms are ongoing, frequent, common. And uh, where can our audience, our listeners, find you in terms of learning more about GERD and how to prevent or how to approach care for it?

SPEAKER_01 33:05

Yeah, thank you. So um, you can find me on Instagram and YouTube. You can also find me on my website. So at all of these places, my handle is the same. It's tajalpandia MD, uh tajlepandiamd.com or my handle on both of the other platforms.

SPEAKER_00 33:21

Yeah, thank you. So go check out the the questionnaire, or you can ask Dr. Pandey about the questionnaire because that's one of the simple tests that even I learned, which I don't know existed. Yeah, thank you so much. Yeah, thank you very much. Thanks for hanging out with me on hormones and hope. If you've loved this episode, do me a favor, hit subscribe, share it with someone you care about, and drop a review if you're feeling generous. Want more tools to support your hormones and health? Head over to unified endocrine care.com. We've got free guides, resources, and more waiting for you. Until next time, stay curious, stay kind to your body, and keep your hormones happy.