Your doctor speaks II; Ulcers

The University of Illinois Medical Center campus in Chicago percents your doctor speaks during this series doctors in the colleges of medicine dentistry pharmacy nursing and graduate college at the University of Iowa and I will discuss the latest advances in cancer and heart research. Painless dentistry psychiatry nursing care and modern drugs. All of these and more will be presented on your doctor speaks. Your host for this series is Jacques Rogge camera coordinator of public service radio and TV programming for the University of Illinois Medical Center campus and champagne Urbana. This is Jack programmer our guest today is Dr. Philip thorax professor of surgery University of Illinois College of Medicine and professor of surgery Cook County graduate school. Talk about peptic ulcers. Doctor what is meant by a peptic ulcer

to just give a broad definition jank an ulcer is sort of a scooped out area. You get a scratch on the skin and start a little auser If you nick your skin it's an ulcer. Anything that breaks the surface and pertaining to the stomach the first part of the bone known as the do again I'm if you injure the inner lining the mucosa is as we call it that's an ulcerated area. The term peptic applies to digestion of the stomach C creates a substance known as PEPs and there are other technical terms but this pepsin supposedly digests a little area of the stomach. Now why the pepsin or the acid if you will digest certain parts in some people and not in others is not known. This is this is going to a long theoretical

discussion but let's say then in brief that is just a little so are on the inner lining of the stomach or the duodenal him. Brought about by too much acid digestion in the stomach. Doctor Oh do we know any of the causes of ulcers. I've heard some psychiatrists say that having an All-Star is related to emotional and other types of problems and this is what causes the churning in the stomach and it's mainly for 65 or 70 percent in the head. And if you had tranquil up stairs you wouldn't have problems downstairs. Is this any basis. Yes there's a lot of basis Jack but we'd have to differentiate. You see we use the term peptic ulcer in a very broad way. And in this little discussion of ours what I want to do is emphasize emphatically and this is

a personal view based on many years of experience and much reading that when you say it does stress our worry play a part and alter I have to return and say to you what kind of an ulcer are you talking about. By that I mean are we talking about a stomach ulcer known as a gastric ulcer or are we talking about a duodenal ulcer I repeat and I have to emphasize this that the deal with genome is the first part of the small bowel just outside of the stomach so to your question. Does worry or stress play a part in the house or we believe it plays a very important part in duodenal ulcer there. We're not so certain that it plays a part in gastric or stomach ulcer. In other words the nervous individual the executive the high pressure fellow this man is the type of fellow that should get a duodenal ulcer. Not a gastric ulcer.

Oh what are some other distinctions you brought up duodenal ulcer which is what I had. I still have I don't know if it's not you know what's the other distinctions between the two between the gastric ulcers and I do you know this is a vital question Jack this is a very important question because as our discussion goes on you will see that I believe the treatment is so different in these in fact I look at gastric ulcer and duodenal ulcer is two different diseases. This is taking an extreme view but a duodenal ulcer I would say is due to worry stress something that makes the stomach pour out too much acid. There used to be a cliche an aphorism too much acid gives and I'll swear. Now this again applies to the duodenal ulcer. But the cause of a gastric ulcer is not so dependent upon too much acid. There's a part of the stomach which gives off substance called a hormone known as gas trim.

I don't want to get too technical. This gastric is given off in a certain part of the stomach at the end of the stomach. We believe it's too much gastric and that has to do with a stomach ulcer. So you see what I'm driving at some causes are entirely different. I've got to cut down the acid for the duodenal ulcer and I've got to cut down the gastric and for the gastric ulcer two entirely different situations. You've heard about the Laurie nerve we're clear the biggest nerves the very nerves. We believe that this has very little to do with gastric ulcer. This has a lot to do with duodenal ulcer so you see we're developing a concept here. There are two different diseases and so I used to be lumped together as one. Exactly. A patient walks in Doctor what do I do for my Also period yeah right. I throw right back a question I have to make a diagnosis first. Isn't it gastric ulcer is it a duodenal ulcer in my writings I have repeatedly in my

teachings I repeatedly stated that the first and most important part of surgeries diagnosis the second most important part of surgery is diagnosis and the third most important for the surgery is diagnosis. When my diagnostic batting average is high my morbidity my mortality is low so diagnosis is the sin acquire known the moustache of good treatment be it medical or surgical. Before I ask you what do you do. For once also then you can decide in tell me what you do for both of them. Which is most more common is the doorjamb of the duodenal ulcer is more common and there's some very fascinating things that we learn. There seems to be more. Ulcers in certain parts of the world and in other parts of the world. They say the more civilized we get the more our ulcer ratio goes up. Possibly this is due to the stress of life. This is highly theoretical but there's no doubt that ulcers have some geographic distribution also. But duodenal

ulcer is our more common castrate and incidentally far more common in men than in women. Now women worry you know this as well as whether they have some inborn protection. We don't know but one of the complications which we may have time to get onto with a ruptured ulcer the perforated Yes or in 30 years of surgery I've only seen three perforated ulcers in females and I've seen hundreds in male women who seem to have some resistance. Please don't misunderstand me I did not say women don't get ulcers. Yes but fewer women get ulcers than men. As you will attest. Yes yes I shall. You know the more I hear about or talk to doctors about various subjects in medicine the more I find out that women that sex is a lot stronger than the male sex. Yes that are yes they are they're far more resistant to haemorrhage they're far more resistant to shock and I were beginning to toy with the modern concept of female

astronauts using Michael may be able to take outer space better than we males. Okay now what does one do for Nelson are you can break it down into two we've been talking about what you do for the villain in the other one. Let's put it this way Jack I think I would say if I have an ulcer This is my ulcer now and then it becomes a very personal thing and based on the knowledge you have of reading and being exposed to ulcers I would say this if I had a duodenal ulcer I would stay as far away from a surgeon as I knew how I'd want a good medical man to handle me. And now let's look at the opposite side of the coin if I had a gastric ulcers. Now I'm going to make a dogmatic statement and I may be stepping on some toes. If I had a stomach ulcer a gastric ulcer. I would stay as far away from a medical man as

I knew how I'd want to be very close to a surgeon and dogma's pretty good pedagogy and there are shades of gray it is not all black or white. But now I will amplify what I mean by this statement. I mention to you that I thought that these were should be treated as two different diseases. I have never yet seen in all of my years I have never seen a Dillard anal ulcer associated with cancer. I'm sure that some skeptics and there's always a heckler in the audience you rest assured you're going to get 1 percent of hecklers are going to come up. They read about duodenal dancers and duodenal officers one tenth of one percent if you will but this duodenal ulcer does not go along with cancer and as long as I don't have cancer to fear I realize an occasional cancer is reported very rare. I've never seen one as long as cancer is not the lorry

and duodenal ulcer. I want to stay away from surgery I don't want it cut out and so I will go to a good internal medical man if I have a guess strick ulcer a stomach ulcer. This is a post tension cancer. I did not say that every gastric ulcers is cancer statistics I didn't test statistics. I just don't like to be there than necessary yes. Yes somebody once said three classes a liars plain liars doggone liars and statistician. But I'm afraid of statistics so I can say to you that 5 to 20 percent of gastric ulcers become cancerous. I have said exactly nothing. It's of no value but I do know with an introspective individual such as myself a worrisome individual if I had a stomach ulcer I'd want that thing out just as fast as I know how because it's a potential

cancer. I'd imagine you'd immediately turn around and say no just a minute Doctor wouldn't you treat a stomach ulcer medically and I ask you this I would assume the average person would throw that question at me. I would say yes but with the greatest of caution with the greatest of care and give it only a very short period of time to respond. I think if it's a gastric ulcers and you put this patient on medical treatment it's got to respond rapidly. The pains got to go the x rays got to look fine if you guess or scope the patient. It's got to disappear within a period of three to six weeks. Otherwise get it out. The saddest story we have Jack in cancer overall cancer the saddest story is cancer of the stomach. You know we cannot save five to eight people over five years with cancer of the stomach the results are miserable. There are good results in cancer and other organs.

But as long as this is a potential cancer and we still don't know whether the ulcer gives the cancer the cancer ulcerate we don't know. Let me get this thing out. Let me get a gastric ulcers out now let's go back to the duodenal ulcer what would I do if I had to do it any longer. Like I don't want a surgeon I want a good internist and I want him to put me on good medical treatment diet diet. Yes that's very interesting. Many doctors have diet number one diet number two diet number three and I am not sure. I'm sure you've been exposed to it. I sit down with my patients I dread thinking that the day of the computer and the day of cybernetics is going to divorce us from a nation doctor relationship only this is something we must maintain Yes. And although I'm a surgeon I still will tell a patient if they discuss diet with me forget the typewritten diet. Think of the letter S and you'll know what to eat and what not to

eat. No foods with strings no foods with seeds no foods with stands. I don't have to go into the strings with celery in the sand or the berries in the stingray's of the apples and so forth. No stimulating foods. Now what do we mean by stimulating alkaloids. That's one of them. That's one of them. And caffeine. Yeah. Coffee tea cocoa has and caffeine also and no foods with spices in them. Let's lay off of the hot sauces the mustard so that bass goes up that bird all boy you know this all too well and then that final lesson I'm rabbit. Smokey smoke can you head it had I'm a randon anti-tobacco and this guy refused to treat a patient with an ulcer who won't quit smoking I can't prove that smoking gives ulcers but I

believe there is cause and effect and we don't know whether it's the nicotine or the or the cigarette paper. The skeptic wants the filter he wants the pipe. I think smoking is one of the most ignorant adolescent ridiculous dumb expensive rotten stinking habits in the world to use only a few adjectives. Got some very good stuff. I feel that it's a miserable habit. Just terrible and with all the scare of carcinoma the long and coronaries if you will and vascular it is enough Azuma bronchitis onin Mendus Lee coming in now. What's happening to this cigarette. Going right on right now exactly so that I just think it's a nasty habit. It can do no good. It may do harm. Therefore why use it. So this is the letter S that I give to my patients the strings the seeds the skins the stimulating foods the spices I think they should have a very liberal diet. This idea of milk and cream a little

cooked cereal and milk and cream. This this is out. We let them have boiled broiled foods. Very liberal diets they have to have a good diet if they're going to heal a sore and an ulcer is a sore. But let's stay away from the strain the seedy spicy things. And I'm not pushing products but there are decaf and I coffee. Oh sure there are many things that one can enjoy the answer patient should enjoy a good life. Thank you. Maybe maybe after a while he can enjoy is martinis after a six week X-ray shows that it's healing on a full stomach. Oh do very definite better. Very definitely. But as he goes along and here's a patient you can play with for a year. You treat them for a year with this duodenal ulcer. It isn't think the gastric ulcers I'm scared. This is cancer this is a potential cancer will go right along. Plus that we have certain medications that they can take the anticholinergic says. I mean

these are medicines that cut down acid. They do a chemical vague out of me they knock the biggest They knock the Lorrie nerves out. These are not tranquilizers they don't stop you from worrying but they should they not be the stimuli in the Vegas nerves out so that too much acid isn't made in other words if I operate on a duodenal ulcer I'm going in and I'm going to clip those nerves to cut the acid no acid no answer. I get rid of the acid the ulcer should heal you see. But this medicine does a chemical they got to me in many individuals. So and plus that they can take their antacids their milk their cream their oil corporations are correct correct. Doctor you talked about a perforated ulcer. One is up the gum. I didn't serious want to rephrase of course why would one wait so long to have an ulcer perforated don't you have you have one

I had mine I had Panda stomach and the whole bit so I figured I'd better go see a doctor or something wrong like that you don't have to people wait to use it on 40 men wait to get all it's got to be something else something I hate. Exactly. Well let me go to the next phase here Jack I said if I had to do it in a welcher I would stay as far away from a surgeon as I knew how now. If I get one of the complications of a duodenal ulcer I've got to see a surgeon. And what are the complications of a duodenal ulcer you mentioned one. I like to give the following OK. The refractory patient. The fellow who won't do what he's supposed to do that's a complication. Doctor I can't I'm I'm in business I've got to get on a plane I've got to get over here I've got to smoke with my clients and drink. There's no point wasting time energy and money out of the individual of this type that's a refractory patient. Number two the refractory officer this is the fellow who will do everything. Healey is the most diligent patient you had. But

the ulcer goes on and on deeper and deeper and deeper that's the refractory ulcer. Then there is the penetrating ulcer that's the ulcer that's eating into a nerve there organ the perforating ulcer that's the one that's on its way to break. Then the perforated ulcer That's the fellow you talk about the one that busts and they bring him into the hospital as an emergency with a peritonitis and shock like symptoms and there's hemorrhage and then of the ulcer lasts long enough it may scar and cause an obstruction so I've given you seven complications of an ulcer which will require surgical care. This is also true of the peptic ulcer. This is a duodenal. I'm just talking about the duodenal Can the same complications be in yes yes let's say you have that longer than your big trouble that I saw. But as I said to you I wouldn't dare treat this gastric ulcers for a year because I'm afraid of cancer you see. Yeah but one of the points is the guy that has a stomach ulcer and also are not on the back of the guy has a pain and hasn't been diagnosed by a physician

and keeps putting it off and keeps putting off I'm going to find out what he she may say oh it's an ulcer but it's probably just the you know there would be a lot to worry about the balance or sometimes the last man I can just take I get my Malcolm forget about it. He is putting himself in a behind the eight ball as it were because he might have the other kind of also because the pain I assume is the same the problem is same as far as the lay person is he unfortunately the pain I think you'll attest to this. The pain of a duodenal ulcer or a gastric for that matter is a mild pain it isn't a severe problem. It's been described as annoying or a hunger pain. That's it and if I take a little milk or off goes away. Right it's gone so why should I bother about a doctor. Exactly. So it's a mild pain. But this ulcer can go on and on and the road into a big blood vessel in this fella drops on the floor bled out half of his blood can be lost and they bring him in with a severe hemorrhage. Yeah. Oddly enough the ulcer The bleeds rarely heard. It isn't pain that brings him in but the ulcer may not bleed it may go on and bust that fellow's dropped with pain. And that

hole has to be closed maybe something else has to be done. OK another operation along with it but he's a poor risk then you know how he's a very poor risk and we've got to treat him for shock and hemorrhage and so forth. So it's a pretty nasty thing it's a pretty dangerous thing to wait. Should a way to get pandas to go see her. Well you should be seeing a physician every six months of the year anyway I would say so to you that would take care of you going to handle check ups you know we get pretty negligent. Boy and how. Let's talk about the aspect that you're in the surgery now. If you get it at the right and proper time. Either one. We're talking about the the gas trickles or of course you said See your surgeon should be close to you and say well you know you are but I will even talk about the other one too if the complications arises and that's would be a time when you would want to have surgery. How good a surgery today for ulcers either kind. Well we will take those up this way Jack. Now if I had a duodenal ulcer. I'm not worried about cancer

but and I want to get surgical treatment. Please let me keep my stomach. Yes I want him clipped my Vegas nerves. Those are the worry nerves that will cut the acid down and make a new opening you have to given out with to the ulcer how you make that opening you can do it with cutting a certain segment or taking out a little segment or making a new opening here or there. So we do have a got to me whereas if I had a gastric ulcer that did not respond rapidly I want no worry nerve operations I want a half or two thirds of my stomach removed already that much Greenly radical. Well we used to take two thirds you notice I first said one half. We take out a good segment the stomach with a gastric ulcer. The surgical results for a gastric ulcer if there is no cancer are excellent. They rarely recur. There is a recurrence rate however with duodenal officers the results are not as good they're good but not as good as with gastric ulcers So again two different

diseases you see different cause different effect different treatment different response. You know the first ulcers specials that I've had on who have broken down the two areas I think this is very good to get this point across because I wasn't even you know I have a problem I have discussed it with physicians too aware that you treat them separately. And we get anything out of this program. If people would realize if they are to suffer type problems and I think out of the out of the program today is lay off that smoking. I think that's another point we want to get. Doctor I want to thank you very much for being on today it's been a very interesting program. Highly interesting. Our guest has been Dr. Philip thorax professor of surgery University of Illinois College of Medicine and also professor of surgery Cook County graduate school you have just heard another in the series your doctor speaks produced by the University of Illinois Medical Center campus in Chicago in cooperation with this

station during the series such topics as cancer and heart research. Painless dentistry psychiatry nursing care and modern drugs will be presented on your doctor speaks. Your host for this series is Jack Gray camera coordinator a public service radio and TV programming for the universe their own II Medical Center campus and Champaign Urbana. Your doctor speaks is produced and directed by Mr. Reagan. This program was distributed by the national educational radio network.