Exocrine Pancreatic Insufficiency

Posted on April 18, 2025 by Patrick Hercules

Exocrine pancreatic insufficiency (EPI) occurs when the pancreas doesn’t make enough digestive enzymes. Enzymes are proteins that cause chemical reactions in the body. Digestive enzymes break down food, allowing the body to get nutrients.

When you have EPI, food passes through the intestines in an undigested state, resulting in the body not receiving the needed nutrients. There are different types of pancreatic enzymes, including:

Amylase
Lipase
Protease and elastase

The main cause of EPI in adults is chronic pancreatitis. As many as 8 in 10 adults with this disorder develop EPI. Pancreatitis causes inflammation and swelling of the pancreas. Over time, chronic inflammation can damage the digestive enzyme-making pancreatic cells. Other causes of EPI in adults include:

Celiac disease
Diabetes
Inflammatory bowel disease (IBD)
Pancreatic cancer
Surgery on the digestive tract, including weight loss surgery

Cystic fibrosis is the top cause of EPI in infants and children. Children inherit cystic fibrosis from a parent. Cystic fibrosis causes thick mucus to build up in the lungs, making breathing hard. Mucus can also collect in the pancreas, keeping digestive enzymes from reaching the small intestines.

Nearly 9 in 10 infants with cystic fibrosis develop EPI within the first year. The rest are at risk of developing EPI during childhood or adulthood.

Shwachman-Diamond syndrome (SDS) is another inherited condition that causes EPI in children. SDS causes the part of the pancreas that makes enzymes not to work properly.

People with EPI have a particularly difficult time absorbing fats from foods, which leads to uncomfortable digestive problems, such as:

Abdominal pain, gas, and bloating
Constipation
Diarrhea
Fatty stools
Unexplained weight loss or failure to thrive in infants and children

Many digestive problems can cause symptoms similar to EPI. A healthcare provider may suspect EPI if you have a condition that affects your pancreas.

You may get one or more pancreas function tests that include:

Fecal elastase test (FE-1)
Fecal fat test
Secretin pancreatic function test

You may also get a CT scan, abdominal ultrasound, or other imaging tests that can spot problems with the pancreas that lead to EPI.

People with EPI can’t absorb enough fats, proteins, and carbohydrates from the foods they eat. This problem is called malabsorption. Your body needs these nutrients for energy and to maintain organ function. Malabsorption of nutrients can lead to malnutrition. Signs of malnutrition include:

Dry skin
Depression
Edema
Fatigue or dizziness
Feeling cold all the time
Irritability
Memory and concentration issues
Muscle loss

EPI is a lifelong condition. Treatments for the condition focus on the body receiving the necessary nutrients to maintain good health. Treatments include:

Pancreatic enzyme replacement therapy (PERT)
High-calorie, high-fat diet
Vitamins

To prevent EPI, it is helpful to avoid smoking and alcohol use as they make the pancreas work harder and can contribute to pancreatitis, which leads to EPI.

Unfortunately, cystic fibrosis and SDS are inherited, so they can’t be prevented, and the risk of EPI with these conditions can’t be lowered. Keeping a close eye on symptoms can help identify possible EPI and treat it immediately.

If you are experiencing symptoms of exocrine pancreatic insufficiency, you can schedule an appointment with a gastroenterologist at Flushing Hospital’s Ambulatory Care Center by ca

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.

Fatty Liver Disease

Posted on April 16, 2025 by Patrick Hercules

Steatotic liver disease (SLD), formerly known as fatty liver disease, describes the buildup of excess fat in the liver. A healthy, high-functioning liver contains a small amount of fat. However, fat buildup can become a problem when it reaches over 5% of your liver’s weight.

Healthcare providers classify SLD based on its causes and the conditions associated with it. The types of steatotic liver disease include:

Alcohol-related liver disease
Metabolic dysfunction-associated steatotic liver disease (MASLD). Risk factors associated with MASLD include:
- Obesity
- Type 2 diabetes
- High blood pressure
- Lipid normalities
Metabolically associated steatohepatitis (MASH)
MASLD and increased alcohol intake (MetALD)

In most cases, the fat buildup in the liver doesn’t cause serious problems or prevent it from functioning normally. In some cases, the condition progresses to liver disease. It usually progresses in stages:

Hepatitis– in this first stage, called steatohepatitis, your liver goes from fatty to inflamed, damaging the tissue.

Fibrosis– in this second stage, causes bands of scar tissue to form where the inflammation damages the liver, causing it to stiffen.

Cirrhosis– in this third stage, extensive scar tissue caused by inflammation replaces healthy tissue. This is called cirrhosis of the liver. Without treatment, cirrhosis can lead to potentially fatal conditions like liver failure and liver cancer. About 90% of people who develop hepatocellular carcinoma (a type of liver cancer) have cirrhosis.

Steatotic liver disease doesn’t always cause symptoms. When they are present, symptoms can include:

Abdominal pain or a feeling of fullness in the upper right side of your abdomen
Extreme exhaustion or fatigue

People will more commonly notice symptoms once SLD has progressed to cirrhosis of the liver. When cirrhosis develops, you may experience:

Nausea
Loss of appetite
Unexplained weight loss
Jaundice
Swelling in the abdomen
Swelling in the legs, feet, or hands
Bleeding in the esophagus, stomach, or rectum

Steatotic liver disease has multiple causes. You are more likely to develop SLD if you have a cardiometabolic risk factor, if you consume unhealthy amounts of alcohol, or both. You have a greater chance of developing SLD if you have the following:

Alcohol use disorder
Metabolic syndrome
Type 2 diabetes
Are overweight (a BMI of 25 to 29.9 kg/m2)
Obesity (a BMI of 30 kg/m2 and above)
Polycystic ovary syndrome (PCOS)
Obstructive sleep apnea
Hypothyroidism
Hypopituitarism
Hypogonadism
Take certain prescription medications

Without treatment, a steatotic liver can progress to cirrhosis of the liver, which can lead to liver failure, liver cancer, and cancers outside the liver. People with MASLD are also at increased risk of heart disease, which is the leading cause of death in people with MASLD.

Because SLD doesn’t usually cause symptoms, a healthcare provider may be the first person to notice an issue. High levels of liver enzymes that turn up on a blood test for other conditions can raise a red flag. Elevated liver enzymes are a sign of liver damage.

To diagnose SLD, a healthcare provider may ask about your medical history and perform a physical exam, imaging tests, and a liver biopsy.

There are no specific treatments or medications for SLD. Instead, healthcare providers focus on helping you manage risk factors that contribute to the condition. This can include making lifestyle changes that can improve your health. Your healthcare provider may recommend that you:

Avoid alcohol
Lose weight
Take medications to manage metabolic conditions
Get vaccinated for hepatitis A and hepatitis B

A healthcare provider may change your prescriptions if your medicine is causing fat to accumulate in your liver.

The best way to avoid SLD is to maintain your overall health. You can prevent SLD by:

Exercising regularly
Limiting your alcohol consumption
Maintaining a weight that is healthy for you
Taking medications as prescribed if you have Type 2 diabetes or metabolic syndrome.

Working with a specialist at Flushing Hospital Medical Center’s Ambulatory Care Center can help you determine your biggest risk factors for liver damage, identify medications that may lead to further damage, and find the right treatment for any scarring or disease you are experiencing. To schedule an appointment, please call (718) 670-5486.

Risk Factors for Gallstones

Posted on April 9, 2025 by Patrick Hercules

Gallstones are hardened deposits of digestive fluid that can form in your gallbladder. They can range in size from as small as a grain of sand to as large as a golf ball. Some people develop just one gallstone, while others develop many gallstones at the same time.

People who experience symptoms from their gallstones usually require gallbladder removal surgery. Gallstones that don’t cause any signs or symptoms typically don’t need treatment.

Gallstones may cause no signs or symptoms. If a gallstone lodges in a duct and causes a blockage, the resulting signs and symptoms may include:

Sudden and rapidly intensifying pain in the upper right portion of the abdomen
Sudden and rapidly intensifying pain in the center of the abdomen, just below the breastbone
Back pain between your shoulder blades
Pain in your right shoulder
Nausea or vomiting

Gallstone pain may last several minutes to a few hours.

It isn’t clear what causes gallstones to form. Doctors think gallstones may occur when:

Your bile contains too much cholesterol
Your bile contains too much bilirubin
Your gallbladder doesn’t empty correctly

The types of gallstones that can form in the gallbladder include:

Cholesterol gallstones
Pigment gallstones

Factors that may increase your risk of gallstones include:

Being female
Being 40 years old or older
Being Native American
Being Hispanic of Mexican origin
Being overweight or obese
Being sedentary
Being pregnant
Eating a high-fat diet
Eating a high-cholesterol diet
Eating a low-fiber diet
Having a family history of gallstones
Having diabetes
Having certain blood disorders such as sickle cell anemia or leukemia
Losing weight very quickly
Taking medications that contain estrogen such as oral contraceptives or hormone therapy drugs
Having liver disease

There are several complications of gallstones, including:

Inflammation of the gallbladder
Blockage of the common bile duct
Blockage of the pancreatic duct
Gallbladder cancer

You can reduce your risk of gallstones by:

Not skipping meals
Losing weight slowly
Eating more high-fiber foods
Maintaining a healthy weight

There are several tests and procedures used to diagnose gallstones and complications of gallstones, including:

Abdominal ultrasound
Endoscopic ultrasound (EUS)
Other imaging tests
Blood tests

A healthcare provider will determine if treatment for gallstones is indicated based on your symptoms and the results of diagnostic testing. Treatment options for gallstones include:

Gallbladder surgery (cholecystectomy)
Medications to dissolve gallstones

Flushing Hospital Medical Center offers multiple options for gallbladder removal surgery, this includes robotic surgery. To schedule an appointment with a specialist, please call (718) 670-5000.

Alcohol Awareness Month

Posted on April 8, 2025 by Patrick Hercules

April is Alcohol Awareness Month. It is an opportunity to raise awareness and understanding of alcohol use and misuse, and its impact on health.

The National Council on Alcoholism and Drug Dependence (NCADD) started the Alcohol Awareness Month program in 1987. The program targets teenagers and college-aged youth, aiming to educate them on the dangers of heavy drinking and other harmful behaviors that can be common during these years.

Binge drinking and heavy drinking are two patterns of excessive alcohol use. The Centers for Disease Control and Prevention (CDC) defines binge drinking as consuming four or more drinks for women and five or more for men on a single occasion. Heavy drinking is defined as consuming eight or more drinks per week for women and 15 or more drinks per week for men.

There are several ways to support Alcohol Awareness Month, including:

Wear a red ribbon
Participate in an alcohol-free 72 hours
Host dry parties
Talk with kids and teens about alcohol
Talk with friends and family about alcohol
Reflect on your relationship with alcohol

Alcohol Awareness Month’s primary goal is to increase public awareness and education about alcohol and alcohol use disorder (AUD), formerly known as “alcoholism”.

Preparing for Allergy Season

Posted on April 4, 2025 by Patrick Hercules

Spring has arrived, and with it comes longer days, warmer weather, and the blooming of trees and flowers. However, as trees and flowers bloom they release pollen, causing those who suffer from seasonal allergies to experience allergy symptoms. Spring allergy symptoms can include:

Runny nose
Watery eyes
Sneezing
Itchy eyes and nose
Dark circles under your eyes.

Some ways you can reduce your exposure to allergy triggers include:

Staying indoors on dry, windy days. The best time to go outside is after a good rain, which helps clear pollen from the air.
Avoiding garden chores like mowing the lawn and pulling weeds that stir up allergens.
Removing clothes worn outside and showering to rinse pollen from your skin and hair.
Avoid hanging laundry outside because pollen can stick to sheets and towels.
Wearing a face mask when doing chores outside.
Checking your local TV or the internet for pollen forecasts and the current pollen levels.
Taking allergy medication before symptoms start or if high pollen counts are forecasted.
Closing doors and windows at night when there are high pollen counts.
Avoiding outdoor activity when pollen counts are highest.

There isn’t a miracle product that can get rid of all allergens from the air in your home, but ways to keep indoor air clean include:

Using air conditioning in your house.
Using high-efficiency filters if you have a forced air conditioning or heating system, and following regular maintenance schedules.
Keeping indoor air dry with a dehumidifier.
Using a portable HEPA filter in your bedroom.
Cleaning floors with a vacuum cleaner that has a HEPA filter regularly.

Here are some over-the-counter medications that can help ease allergy symptoms:

Oral antihistamines
Corticosteroid nasal sprays
Cromolyn sodium nasal spray
Oral decongestants

If you are experiencing seasonal allergy symptoms, you can get an allergy test and treatment at Flushing Hospital Medical Center’s Ambulatory Care Center. To schedule an appointment, please call (718) 670-5486.

Meet Our Doctors: Dr. Brittany Choe

Posted on April 4, 2025 by Flushing Hospital

Meet Dr. Brittany Choe. She is thrilled to join the MediSys team as Chair of the Department of Emergency Medicine at Flushing Hospital Medical Center.

Dr. Choe completed residency training in Emergency Medicine at Northwell Staten Island University Hospital. She then went on to complete a Fellowship in Emergency Medicine and Hospital Administration coupled with an Executive MBA.

Throughout her career, Dr. Choe has been dedicated to developing processes that deliver safe and effective care to all patients. Her work has focused heavily on performance improvement initiatives that expand the scope of Emergency Medicine and provide increased access to care for patients in the Emergency Department. As a daughter of first-generation Korean immigrants, the opportunity to work in “The World’s Borough” of Queens is both an honor and a privilege.

Through this new role as Chair of Emergency Medicine, she aims to support the mission and vision of the MediSys Health Network, serving the community of Flushing and continuing the delivery of high-quality patient care.

Healthy Eating Tips for Seniors

Posted on April 3, 2025 by Patrick Hercules

As we age, our metabolism slows down, causing us to require fewer calories than we did in our younger years. Our body also needs more of certain nutrients. Eating a healthy diet can support healthy aging.

Here are some tips to help get the most nutrition out of your meals:

Know what a healthy plate looks like
Eat more whole foods and limit processed foods
Look for essential nutrients
Read the “Nutrition Facts” label
Use recommended servings
Stay hydrated by drinking water with your meals and eating water-rich foods
Focus on getting enough protein to prevent muscle loss
Eat fiber-rich foods
Watch your sodium intake
Subscribe to a grocery or meal delivery service

Making these simple adjustments to your eating habits can go a long way toward building healthier eating habits. Getting the most out of foods and beverages can help you meet your nutrition needs and reduce the risk of disease. Be sure to speak with your healthcare provider about creating a dietary plan that works best for you before making changes to your diet.

STI Awareness Month

Posted on April 2, 2025 by Patrick Hercules

April is STI Awareness Month, a month observed to educate people on sexually transmitted infections (STIs).

S.T.I.s are infectious diseases spread through sexual contact. S.T.I.s are common medical issues, however, many people don’t know they’re infected because they have mild symptoms that are easily overlooked or have no symptoms at all.

STI Awareness Month is important because it

It teaches others to be more responsible
It encourages regular S.T.I testing
It corrects the stigma and misinformation

Ways to observe STI Awareness Month:

Get involved in youth sex education
Educate yourself on S.T.I.s
Contribute to an S.T.I organization
Practice or promote safe sex

STI Awareness Month provides an opportunity to raise awareness about sexually transmitted infections and how they impact our lives. Getting involved can help remove the stigma from S.T.I.s.

Vertigo

Posted on March 31, 2025 by Patrick Hercules

Vertigo is a sensation that makes the environment around you spin in circles. It can make you feel dizzy and off-balance. Vertigo is a symptom of several health conditions rather than a disease itself, however, it can occur along with other symptoms.

Other symptoms that might be experienced when you have vertigo include:

Nausea and vomiting
Dizziness
Balance issues
Hearing loss in one or both ears
Tinnitus
Headaches
Motion sickness
A feeling of fullness in your ear
Nystagmus

There are two main types of vertigo: peripheral and central. Peripheral vertigo is the most common type. It occurs when there is an issue with the inner ear or vestibular nerve.

Subtypes of peripheral vertigo include:

Benign paroxysmal positional vertigo (BPPV)
Labyrinthitis
Vestibular neuritis
Ménière’s disease.

Central vertigo is less common. It occurs when a condition affects the brain, such as an infection, stroke, or traumatic brain injury. People with central vertigo usually have more severe symptoms like severe instability or difficulty walking.

The causes of vertigo vary from person to person. Causes can include:

Migraine headaches
Certain medications such as antibiotics, anti-inflammatories, and cardiovascular drugs
Stroke
Arrhythmia
Diabetes
Head injuries
Prolonged bed rest
Shingles in or near your ear
Ear surgery
Perilymphatic fistula
Hyperventilation
Low blood pressure
Ataxia
Syphilis
Otosclerosis
Brain diseases
Multiple sclerosis (MS)
Acoustic neuroma

Vertigo can cause falls resulting in bone fractures or other injuries. It can also interfere with your quality of life and hinder your ability to drive or go to work.

To diagnose vertigo, a healthcare provider will perform a physical exam and ask questions about your symptoms. They may also recommend one or more tests to confirm your diagnosis. Healthcare providers can also perform tests to diagnose vertigo, including:

Fukuda-Unterberger test
Romberg’s test
Head impulse test
Vestibular test battery
Imaging tests

Treatments for vertigo depend on the underlying cause. Healthcare providers use a variety of treatments, including:

Repositioning maneuvers
Vertigo medication
Vestibular rehabilitation therapy (vertigo exercises)
Surgery

If you are experiencing vertigo symptoms, visit Flushing Hospital Medical Center’s Ambulatory Care Center. To schedule an appointment, please call (718) 670-5486.

Bloating

Posted on March 28, 2025 by Patrick Hercules

Bloating describes a feeling of fullness or tightness in the abdomen. It may or may not be accompanied by a visibly distended or swollen abdomen. The feeling can range from mildly uncomfortable to intensely painful. It usually goes away after a while, but it can be a recurring problem for some people.

The most common cause of stomach pain and bloating is excess intestinal gas. Another cause may be a digestive issue after eating. It could be as simple as eating too much too fast, a food intolerance, or another condition that can cause gas and digestive contents to build up. Digestive issues and hormone fluctuations can cause cyclical bloating. Menstrual cycles are another common cause of temporary bloating.

Between 10% and 25% of otherwise healthy people complain of occasional abdominal bloating. As many as 75% describe their symptoms as moderate to severe. About 10% say they experience it regularly. Among those diagnosed with irritable bowel syndrome (IBS), it may be as much as 90%. Up to 75% of women experience bloating before and during their period. Only 50% of people who experience bloating also report a distended abdomen.

If your bloating is due to something you ate or drank, or hormone fluctuations, it should begin to ease within a few hours or days. If you are constipated, bloat won’t go down until you start pooping. Water, exercise, and herbal teas may help. If bloating doesn’t go away or gets worse, seek medical attention.

If bloating is caused by diet or alcohol consumption, it can be prevented by making certain lifestyle choices such as:

Eating enough fiber
Drinking enough water
Getting exercise
Avoiding processed foods
Practicing mindful eating
Notice stomach sensitivities

What can help relieve bloating depends on the cause. A professional diagnosis may be needed to get to the bottom of it. However, if you are looking to combat bloating in the interim, some home remedies can include:

Peppermint oil capsules
Antacids
Magnesium supplements
Probiotics
Fiber supplements
Regular exercise

To schedule an appointment with a gastroenterologist or dietitian at Flushing Hospital Medical Center, please call 718-670-5486.