How my professional journey as a gastroenterologist guided me to leading the country’s first virtual clinic for chronic gut care.
There are so many reasons I chose to join Salvo Health as its Medical Director—with my professional journey as a gastroenterologist guiding me to lead the country’s first virtual clinic for chronic gut care. But to understand why our work at Salvo Health is so important, and why I’m committed to ensuring its success, I need to explain why I chose to become a gastro doctor in the first place, many years ago.
I have always been completely obsessed with food, even from a very young age. I love to cook, go out to eat, and try new foods wherever I am. I think about food constantly.
When I first started studying medicine, though, food was surprisingly absent from the medical school curricula. Our nutrition training was deep on physiology – how various nutrients get broken down and absorbed in certain parts of the gut. However, I was given little instruction on how to help people get the proper nutrients into their diet. For example, I was taught that vitamin B12 is absorbed in the terminal ileum (a fancy word for the last part of the small intestine) but not what foods are good sources of B12 or how a patient can work them into their diet. I knew that the foods we eat simply must be critical to how we feel every day, but general medical training wasn’t diving deeply into this area. As a result, I was drawn to picking a specialty that would allow me to explore food as a foundational piece of our health.
I am constantly motivated by and attuned to how much people feel and care about their gastro symptoms. Nobody wants to suffer through severe abdominal bloating and cramping after every meal. Food is supposed to be fun, right? Gut symptoms can easily get in the way of normal life and can be debilitating, so people want to feel better now when the gut is out of whack.
In my twenties, I learned first-hand how all-consuming gut symptoms can be. Over a period of six months, I developed severe heartburn and upper abdominal pain after every meal, even sometimes without eating. I had tests like an endoscopy, blood work, and testing for parasites but it all came back normal except for mild irritation in my esophagus. I tried everything I could think of – prescription and OTC medications, teas and supplements, elimination diets, even a juice fast. Some of it helped temporarily but then the symptoms would come roaring back without any clear trigger. I lost 25 pounds and was afraid to eat because I never knew what would set off a flare-up. I stopped cooking for my wife and our friends because I had no interest in eating myself. I was constantly worried about my symptoms.
After about six months of this, I went through a life and career change that I had been worried about for a while. In retrospect, my anxiety regarding change had been simmering below the surface for months, but I had either ignored or not realized how much it was affecting me.
Once the transition occurred, my abdominal pain and heartburn suddenly melted away. I didn’t change my routine, my meds, or my diet–I just was forced to address an unpleasant emotional state, and when I did, my gut symptoms completely resolved. This is not to say it was all in my head. I really did have acid reflux at the time (and I still get heartburn once in a while if I overdo it with spicy food), but the way in which I experienced my symptoms was deeply affected by my thoughts and emotions.
I learned just how much the gut can be impacted by external factors like stress and anxiety. So when I finished my medical training 10 years later, I wanted to help other people to get out of the cycle of gut symptoms that might be getting in their way as well.
When I went into practice as a gastroenterologist, I felt more and more over the years that I understood my patients’ symptoms and their challenges, and all the ways in which the gastro symptoms might be intricately interwoven with so many other areas of someone’s life. Pretty much everything we do can affect our gut symptoms and our gut symptoms can impact everything we do at the same time–the foods we eat, our jobs, our sleep and exercise habits, stress, relationships, and so much more. The gut is an incredibly powerful and central body system that is intricately tied to other critical systems like immunity, metabolism, and inflammation. But just because I understood how complicated gastro conditions could be or what medications or life changes might make the symptoms better–that still didn’t mean that it was easy to help people get to the heart of the issue and make impactful changes, especially due to the limitations of in-person care.
Early on in my career, I tried to do everything for everyone at the first visit. I never knew if someone’s insurance would change or they’d move away or forget to follow up. I would order many tests to rule out different conditions, try a new medication and a supplement, make a diet plan, and try to discuss sleep, exercise, stress, emotion– all at the same time, in a short amount of time. Sometimes it all clicked and the patient would digest the whole plan, make frequent follow ups, read over their test results, and make all the medication and lifestyle tweaks that I suggested.
But often there were bumps in the road or something would get lost in translation.
The patient would lose their password to the portal and not see the summary of our plan, or they might not see the email alerting them to new test results. Or we would do several tests and it might not be clear to them what the final diagnosis actually was. We would make a change in a medication, but then they might forget to follow up and we would never determine whether that medication really made an impact or needed to be adjusted. Or we would discuss how stress and anxiety might play a role but not have the time to address these factors during a traditional GI office visit. . Or I would suggest an elimination diet but the insurance wouldn’t pay for the nutritionist so the patient would try to go it alone.
In short–healthcare is complicated. Chronic gut conditions are complicated too. Providers often do not have the time or the resources to provide all the support to give patients truly optimal care for their gut health, and patients (for no fault of their own) have trouble navigating the system and knowing what to do when.
What patients needed most, I felt, was a system for managing gut health. A place where they could go to make a clear plan with their Care Team—and not a one dimensional plan like “take this pill and follow up in three months.” Instead, a plan that would address all the factors could be playing a role–diagnostic tests, medications, supplements, nutrition, sleep, exercise, stress, anxiety–and do it all in one place. And that place would be accessible any time, continuously, so that questions can be answered when they come up, and not three months later at the next visit.
When I first heard about Salvo Health after I was introduced to our CEO Jeff Glueck, I was amazed at how much the vision for Salvo aligned with so many of my own ideas about how to create the best possible care for people with gastro conditions. Salvo Health was designed from the ground up to remove friction and confusion and over-simplicity from GI care–to be truly comprehensive, continuous, evidence-based gastro care leveraging technology to make it convenient and to help people more easily integrate changes into their lives that will get to the root of their gut symptoms and allow them to feel better in a durable way. One of our core values at Salvo Health is to Respect the Complex and I think this sums best of all why I chose to join Salvo – because it has been in the company’s DNA from the start that we should not shy away from the chronic conditions that are complicated and heavily interconnected but rather to embrace their complexity and meet it with real solutions.