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You may also submit a request electronically to HealthMark Group by registering for an account at www.medrelease.com/360. Once logged in, you may select Submit Request from the menu options and enter all required fields to submit an authorization to HealthMark Group directly. HealthMark Group will process your medical record request and provide notification via mail or email once complete. A complimentary copy of your record will be made available for you to download through HealthMark Group’s MedRelease 360 website.
Dr. Vulcano was born and raised in Phoenix, Arizona. He attended the Barrett Honors College at Arizona State University where he graduated with honors with a bachelor’s degree in biology. Dr. Vulcano continued his education at A.T. Still University – School of Osteopathic Medicine in Mesa, Arizona. He then moved to Milwaukee, Wisconsin where he trained in the Internal Medicine residency at Aurora Sinai and St. Luke’s Medical Center. Dr. Vulcano finished his training back where it started, in Mesa, Arizona, where he trained in gastroenterology and hepatology at Midwestern University through the majority of the East Valley hospitals, with transplant medicine at Banner University (Phoenix) and Mayo Clinic (Scottsdale). He is dual board certified in Internal Medicine and Gastroenterology/Hepatology. When away from his patients, he enjoys spending time with his family and soaking in the beautiful Arizona weather… most of the year!
This year has been dominated by the COVID-19 pandemic.
Although we’ve had a lot to worry about, and many of us have put our lives on hold this past year because of it, I wanted to discuss the importance of cancer screening.
Cancer screening is done to identify disease at an early stage in patients who do not have symptoms. The basic premise is that early detection of cancer can lead to eventual cure and improved outcomes.
There is data emerging about the effects of delaying routine medical care because of the COVID-19 pandemic. The worry is that delays in cancer screening specifically, will mean diagnosis of cancers at later stages.
Cancer is a broad term for a group of diseases caused by transformation of normal cells into abnormal cells. These abnormal cells grow uncontrollably, and have the potential to spread throughout the body. This can be caused by both environmental and hereditary (genetic) factors.
Environmental factors can be preventable and include tobacco, excess alcohol, dietary factors, obesity, and a sedentary lifestyle. The single most preventable cause of cancer is tobacco.
Cancer is the second leading cause of death in the United States, with heart disease the first. Cancer can develop at any age however most often occurs in middle age.
The risk of cancer also increases as we age. The lifetime risk for developing cancer is nearly one half in men, and one third in woman. The top four causes of cancer death the U.S. are lung, colon, breast, and prostate.
As a gastroenterologist, I am going to focus on the importance of colon cancer screening; however, age appropriate screening for common cancers is a discussion to have with your primary care physician.
Colon cancer is the second most common cancer in the U.S. Risk factors include age (about 90% diagnosed in patients over age 50), tobacco, family history, obesity, heavy alcohol, colon polyps, and a diet high in red meat.
Certain colon polyps are precursors to colon cancer, and are considered precancerous.
Signs of colon cancer can include blood in stool, change in stool caliber or bowel habits, and abdominal pain. Over the last two decades, as a result of improvements in early detection and treatment, colon cancer cases and deaths have been decreasing. However, when we look at the numbers closer, the improvements have occurred in the 50 and older age group.
A particular concern has been an increase in cases of colon cancer in a younger population. In 2020, it is estimated that about 12% of colon cancer cases will be in patients less than 50 — about 18,000 cases. The reason for this is not known, but likely related to lifestyle and dietary factors.
Currently only about 70% of the population aged 50 to 75 are up to date on colon cancer screening. The age at which screening for colon cancer begins depends on one’s risk. In patients at higher risk, which are those with a family history of colon cancer or polyps, generally screening starts at age 40 or earlier.
Average risk patients are those without a family history. The starting age is 45 for average risk African Americans, and 50 for others. However, recent recommendations from the American Cancer Society and United States Preventative Services Task Force (USPSTF) are to consider starting screening at age 45 because of increasing incidences of colon cancer in a younger population.
Screening is to be individualized in those between age 75 and 85 years old based on functional status and life expectancy.
There are several screening options to consider. The only screening test in those with a family history of colon cancer or polyps is a colonoscopy.
Screening options in average risk patients include a colonoscopy every 10 years, stool fecal immunochemical test (FIT) every 1 to 3 years based in which type of test is taken, sigmoidoscopy every 5 years, or CT colonography every 5 years.
An important distinction to remember is that colonoscopy is the only test that can both detect, and prevent colon cancer by removing colon polyps during the procedure. Additionally, if any of the other screening modalities are positive, a colonoscopy must be performed.
You should talk to your gastroenterologist or health care provider about the differences in screening options. A screening test for colon cancer is generally mandated to be covered by your insurance company. You can compute the amount of insurance using an Instant Insurance Cost Calculator. In depth information regarding colon cancer screening is also available at www.arizonadigestivehealth.com.
For the most part, I believe many diseases can be prevented with a well-balanced diet, exercise, avoiding tobacco and excess alcohol, and maintaining a normal body weight. Unfortunately, even by doing everything right, we can develop cancer.
Earlier detection of cancer leads to earlier treatment and the potential for a cure. We should also be serious about any symptoms we encounter. Any symptoms of blood in the stool, change in bowel movements, and abdominal pain; however minor one may consider them, should be investigated further.
This year has felt like a marathon, and we are getting closer to the finish line, but I fear that missed opportunities with cancer screening will lead to further suffering.
I would encourage every reader to discuss cancer screening with their healthcare professional or specialist.
Arizona Digestive Health would like to welcome our two new doctors, Dr. Anil Seetharam and Dr. Nayan Patel! These Board-Certified Gastroenterologists begin on November 1st at our 9767 N 91st St and 9755 N 90th St Scottsdale locations. Please learn a bit about our new doctors below and request appointments today!
Dr. Seetharam is a Board Certified Gastroenterologist and Transplant Hepatologist with Arizona Digestive Health in Scottsdale. In a distinguished academic career, he rose to UNOS Medical Director of liver transplantation at one of the highest volume centers in the country. He has performed extensive clinical research with over 100 published peer reviewed studies, national abstracts and book chapters. Driven by a desire to prevent most GI/liver disorders before they create serious problems and promote wellness, Dr. Seetharam is thrilled to offer office consultations on all GI/liver issues and performs GI procedures (EGD, colonoscopy, enteroscopy) at Scottsdale Endoscopy Center. Dr. Seetharam serves as chair of the Medical Advisory Board of the American Liver Foundation in the Southwest and is a Clinical Associate Professor of Medicine at the University of Arizona.
Dr. Nayan Patel is a Board-Certified Gastroenterologist and Transplant Hepatologist with Arizona Digestive Health in Scottsdale AZ. He performs routine GI procedures such as upper endoscopy and colonoscopy in the diagnosis, screening and surveillance of gastrointestinal diseases and cancers. In addition, he also specializes in advanced liver disease, and cirrhosis and formerly was co-director of a liver transplant program. He also specializes in general gastroenterology conditions and colon cancer prevention. He is a member of the American Association for the Study of Liver Disease and holds a national position as a member of the Training and Workforce committee. He is also a member of the American College of Gastroenterology and American Gastroenterological Association.
To our valued patients,
We want you to know that your health and safety is our utmost priority. In light of the pandemic and in an effort to protect the health and safety of our patients, we are pleased to announce that we are offering telemedicine services to our patients, click here now in case you need a cardiologist consultation who are prepared with the necessary medical supplies.
Having a “virtual” visit by telephone or video conference will allow you access to your physician from the comfort and safety of your home or workplace. Check this out to know about being healthy, fit and happy.
Please contact your physician’s office and our staff will schedule a telemedicine visit and provide you with the detailed instructions to conduct your appointment. As long as you have reliable phone and internet connection like EATEL / landline phone service, you can avail the service. Our physician’s and office locations are available on this website.
Very best regards,
The Physicians of Arizona Digestive Health
Information in Spanish
Does Fatty Liver Disease Cause Cirrhosis?
Summary: Without proper care, a fatty liver can lead to cirrhosis, a detrimental concern that may cause symptoms like skin yellowing, low energy, and pain.
A healthy digestive tract is important when it comes to how your body functions, and among the most vital organs of the gastrointestinal system is the liver. Located by the stomach, the liver is responsible for various essential functions, including breaking down fats, carbohydrates and proteins, making bile, preserving glycogen and minerals, eliminating drugs and hormones, and much more. However, when the liver is impacted by disease, it can carry out a harmful result on your total quality of life. A couple of these conditions are a fatty liver and cirrhosis. At Arizona Digestive Health, our exceedingly proficient group of physicians in Phoenix, AZ partners with patients to find out about their health needs and discern any illnesses.
What to know about fatty liver disease
Fatty liver disease is a problem characterized by the existence of fat cells within the liver. This disease has a couple of main classifications: nonalcoholic fatty liver disease (NAFLD) and alcoholic fatty liver disease (AFLD). While AFLD is caused by heavy drinking, NAFLD can be prompted by obesity, type 2 diabetes, or high cholesterol, and it is the sole most widespread form of hepatic steatosis in the United States. It is tough to discern whether you are experiencing a fatty liver considering that the illness generally does not produce any noticeable effects; however, it can be diagnosed by our Arizona Digestive Health team through a blood panel, imaging tests, or possibly a biopsy of the liver.
Symptoms of cirrhosis of the liver due to alcohol
If you keep a routine that produces harm to the liver, it’s possible that you could develop cirrhosis. Cirrhosis of the liver is characterized as the growth of tissue scarring on top of normal areas of tissue, which is replaced over time. Cirrhosis is not a disease that develops immediately, but it is usually an effect of a long period of injury to the liver, whether via heavy alcohol use or from another condition that remains unaddressed for many years. Comparable with hepatic steatosis (fatty liver disease), the early phases of cirrhosis do not typically cause signs to show up. Nevertheless, symptoms of cirrhosis you might experience as scarring continues to accumulate include:
- Bleeding gums
- Changes in bowel movements
- Pain in the abdomen
- Difficulty sleeping
- Darker than normal urine
- Lack of energy
- Memory problems
These are just a handful of the effects that may develop as cirrhosis of the liver intensifies over time.
Key differences between cirrhosis and fatty liver disease
Whereas fatty liver disease and cirrhosis both affect the liver, there are several primary distinctions.
- Hepatic steatosis is defined by the presence of fat cells within the liver while cirrhosis is the formation of scar tissue over normal tissue.
- Both types of hepatic steatosis (NAFLD and AFLD) can result in cirrhosis if not treated in a timely manner.
- The two illnesses take years to develop, but cirrhosis of the liver warrants a considerably more serious issue.
- Hepatic steatosis is much more prevalent.
If you have one of these issues, it’s important to obtain treatment as soon as possible. While both problems can be long term, having your illness addressed and your wellness maintained is important for your quality of life.
Learn about your liver health
Arizona Digestive Health is proud to feature a highly qualified group of trained gastroenterologists who have a comprehensive understanding of the gastrointestinal system and the vital organs that comprise it. We work hard to learn about your concerns to the most exhaustive extent and offer innovative medical technology to offer the most accurate analysis of your illness. Reach out to our staff in Phoenix, AZ today to schedule an exam and learn more about your liver health.
Factors that Lead to Fatty Liver Disease
The liver carries out several critical functions, like producing bile, filtering blood, and processing glucose, and is the second-largest organ in the body. Ongoing damage to the liver can result in cirrhosis of the liver, which is where scar tissue takes over healthy areas of tissue. Several medical conditions and liver diseases have been known to lead to cirrhosis of the liver. One such condition, called fatty liver disease, is a health concern for approximately 25 percent of people nationwide and is on the rise.
Between 20 – 40% of people in the United States are living with a fatty liver condition. If ever you or a family member could be at an elevated risk for having fatty liver disease, the proper medical care could help set you on the path to treating this unhealthy buildup of fat. The gastroenterologists at Arizona Digestive Health are trained to diagnose and treat fatty liver disease. Reach out to a digestive health specialist at one of our practices throughout the Phoenix, AZ area to discover more about this common but preventable issue.
What are the primary types of fatty liver disease?
When fatty liver disease is present, it means that there is an accumulation of fat in the liver. Although a small amount of fat in your liver okay, a fat constitution in excess of 5% may end up causing inflammation and cirrhosis, which is known to the medical community as hepatic steatosis. The two primary types of fatty liver disease are called AFLD (alcoholic fatty liver disease) and NAFLD (nonalcoholic fatty liver disease).
Common causes of fat in the liver
Excessive alcohol consumption can often cause too much fat to accumulate in the liver. When this condition leads to fibrotic tissue or inflammation, it is typically called alcoholic steatohepatitis. For Phoenix, AZ patients who consume little to no alcohol, the common underlying health factors for NAFLD are comprised of:
- Adult-onset diabetes
- Hypothyroidism (underactive thyroid)
- High cholesterol
If a fatty liver condition advances to the point of causing inflammation and injury to the tissues in the liver, it is diagnosed as NASH or nonalcoholic steatohepatitis. Nonalcoholic steatohepatitis will likely overtake the hepatitis C virus as the primary reason for liver transplant procedures among U.S. citizens.
How can I identify the symptoms of hepatic steatosis?
A person who is affected by fatty liver disease is unlikely to present any noticeable symptoms or signs at first. If and when indications of the condition do show up, however, they could indicate that considerable damage to the liver has occurred. These symptoms could include:
- A change in bowel habits
- Swollen abdomen and ankles
- Urine dark in color
- Feeling extremely tired
If you or someone you love is noticing such symptoms, contact Arizona Digestive Health and have a gastrointestinal specialist assess the condition. Without professional care, a fatty liver condition may progress to cirrhosis and possibly result in other problems, including ascites (fluid accumulation in the belly), swollen veins in the esophagus, hepatic encephalopathy (a decline in brain function due to liver disease), liver cancer, and the need for liver transplant surgery.
Can fatty liver disease be treated?
Generally, the recommended ways to treat fatty liver disease often include lifestyle changes. Individuals who have AFLD should refrain from drinking alcohol, which can stop the advancement of a fatty liver condition. Avoiding the consumption of alcoholic drinks is also recommended if a person’s fatty liver condition is not related to alcohol use. If you have nonalcoholic fatty liver disease, losing 10% of your entire body mass index (BMI) may considerably reduce the fat accumulation in your liver. Keeping up with heart-healthy exercises can often decrease the amount of fat in the liver as well. Adhering to a healthy diet may also help to better manage risk factors of fatty liver disease, including elevated cholesterol and type 2 diabetes, and lessen the overall fat content in the liver. For more details about liver treatment, use this link https://lnhlifesciences.org/snap-frozen-tissue.
Receive specialized care for a fatty liver condition in Phoenix, AZ
Excess fat in the liver might progress to damaging fibrotic tissue and liver failure without professional treatment. In the event that you or your loved one is at risk for hepatic steatosis, please reach out to Arizona Digestive Health in Phoenix, AZ to learn more about the methods used to address this medical issue. Arizona Digestive Health employs a qualified team of GI doctors that place the well-being and safety of their patients first.
All About Living Life with Celiac Disease
Typically found in popular ingredients, including barley, rye, wheat, noodles, breakfast cereal, and bread, gluten is often an essential part of a person’s diet. But for patients who have celiac disease, taking in food items with gluten can lead to major health challenges. The one effective treatment for this condition is the elimination of gluten from the diet. If you think you may have celiac disease, partner with a gastrointestinal (GI) specialist at Arizona Digestive Health to diagnose and address your gluten sensitivity. Our specialists will help you process your new condition and help you modify your food choices and daily intake accordingly.
Celiac disease and what it means
Known as an autoimmune disease, celiac disease is a condition in which ingesting gluten causes harm to the small intestines. Patients can have celiac disease at any point in life. It is estimated that about two million people in this country have developed celiac disease and that almost two-thirds of all Americans with celiac disease are not diagnosed or misdiagnosed. If treatment is not sought, this condition may result in serious health problems.
Some signs of celiac disease
Someone with celiac disease might have a single or more of these listed complications after ingesting gluten:
- Eroding enamel
- Abdominal swelling
- Pain, prickling, or numbness in the feet
- Fainting spells
- Trouble holding in bowel movements
When you or your loved one are seeing these common celiac disease signs, contact our practice to plan a consultation with a GI specialist. Having proper attention can help boost your total well-being and your intestinal health.
How is celiac disease detected?
A GI physician is able to diagnose celiac disease. Your physician might perform one or both of the following celiac disease tests to identify or rule out this disease:
- An HLA genetic test searches for the HLA-DQ2 and HLA-DQ8 genes, which can rule out a celiac disease diagnosis if not found.
- To diagnose celiac disease, a tissue transglutaminase (tTG)-IgA test is usually performed. This treatment requires our team to take a sample of your blood.
The next step in looking for celiac disease is to perform an upper endoscopy. Throughout this procedure, your gastroenterologist will check your small intestine for any damage by placing a thin camera device precisely through the oral cavity. Endoscopy is often a quick procedure that can be done as an outpatient option at Arizona Digestive Health.
What you can do to manage celiac disease
Even though celiac disease is a life-long condition, it may be treated by adopting a diet of gluten-free foods. For the majority of patients who have celiac disease, following a gluten-free lifestyle can serve to soothe issues and even encourage the intestines to heal. People who have the condition and stick to gluten-free eating habits usually see improvements to their digestive system within a few weeks. Isolating gluten from your diet might seem hard in the beginning, but through the guidance of an experienced dietitian and a physician at Arizona Digestive Health, patients in Arizona who have celiac disease can modify their diet and go on to have active lives.
Reach out to our Arizona team if you think you have celiac disease
Being gluten intolerant could affect your overall wellness, as well as interfere with many aspects of your life. To discover more about celiac disease and how to treat this digestive illness, please call Arizona Digestive Health. Our team prioritizes your health above all else and will work hard to restore your quality of life.