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Nell Fay, PT
Nell Fay, PT (she/her) graduated from MGH Institute of Health Professions with a Doctor of Physical Therapy, where she developed an interest in women’s health. She has been working exclusively in women’s health and pelvic floor outpatient physical therapy since 2016. She sees adult patients of all genders with constipation, fecal and/or urinary incontinence, pelvic pain, difficulty with urination, bloating, weak abdominal muscles, pain with sexual intercourse, nighttime urination, urinary frequency, prolapse, gas pain, low back or sacral pain, and abdominal pain, among other conditions.
Amanda Holmes, PT
Amanda Holmes, PT, MS (she/her) has been practicing as a physical therapist since 2000 between and among Massachusetts, Illinois, and the United Kingdom. Amanda obtained her BS and Master of Science in Physical Therapy from Northeastern University. Amanda also obtained a Postgraduate Certificate in Pelvic Floor Rehabilitation and Continence for Physiotherapists from the University of Melbourne. She started evaluating and treating patients who suffered from pelvic floor muscle dysfunction right away, during her Advanced Practicum of her Master’s Program, in 2000-2001.
Amanda brings highly skilled manual therapy, therapeutic exercise, biofeedback, electrical stimulation, and other therapeutic modalities to her evaluation and treatment of patients who suffer and struggle with pelvic pain, urinary and fecal incontinence, constipation, urgency, as well as urogenital prolapse.
Hemorrhoid Banding
CRH O’Regan System
IGIC is now offering the CRH O’Regan System - a simple, painless and effective way to treat hemorrhoids.
Hemorrhoids are nothing to be embarrassed about – in fact, about 50% of the population will suffer from them by the age of 50.
For many, ointments and creams will only mask symptoms to provide temporary relief. They do not address the root of the problem that is causing the pain, itching, bleeding, and overall discomfort.
If you’re serious about getting rid of hemorrhoids once and for all, it’s time to consider a definitive treatment.
The CRH O’Regan System offers patients a painless, proven effective solution to the problems associated with hemorrhoids through a unique take on a procedure called hemorrhoid banding, or rubber band ligation.
Much less invasive than a surgical hemorrhoidectomy, hemorrhoid banding with the CRH O’Regan System is a simple treatment that can be performed in just minutes with little to no discomfort. There isn’t any prep or sedation and most patients are even able to return to work the same day.
How it Works
Gentle suction is used to place a small rubber band at the base of the hemorrhoid in an area where there aren’t any nerve endings. This only takes about 60 seconds. After a few days, the hemorrhoid will begin to shrink and fall off – you probably won’t even notice when it does!
Watch a video to learn more about the CRH O’Regan System:
Upper Endoscopy (EGD) and ERCP Prep
ONE WEEK BEFORE YOUR PROCEDURE
1. FIND A FAMILY MEMBER OR FRIEND TO DRIVE YOU HOME AFTER YOUR COLONOSCOPY You cannot operate a vehicle until the day after your procedure because of lingering effects of the anesthesia. We cannot perform the procedure without a ride. Taxis or ride shares (Uber, Lyft, etc.) are not allowed.
THE DAY BEFORE YOUR PROCEDURE
2. DO NOT EAT OR DRINK ANYTHING* AFTER 11 PM THE NIGHT BEFORE YOUR COLONOSCOPY EXCEPT THE SECOND PART OF THE PREPARATION No food, drink, gum, candy, etc. are allowed.
Patients cannot smoke/vape/consume or use marijuana on the day of the procedure as it impairs ability to sign informed consent and raises lung risks.
THE DAY OF THE PROCEDURE
9. *REGARDING MEDICATIONS - (CALL OFFICE WITH QUESTIONS) Take ALL your morning medications with a SMALL sip of water, unless otherwise discussed with your provider or during scheduling.
If you are taking lisinopril for blood pressure, please hold the morning of your procedure.
If you are taking diabetes medications, take only 1/2 a dose the morning of your procedure.
Please call the office if you have been diagnosed with any new medical conditions or if your insurance has changed as we may need to reschedule your procedure. Please keep your phone near you the day of the procedure so we can notify you of delays or even earlier appointment times.
If you need to reschedule or cancel your procedure, please give our office 48 hours’ notice. Procedures cancelled or rescheduled within that time will be subject to a $50 fee prior to rescheduling.
Thank you! We look forward to providing you with excellent care.
What is Inflammatory Bowel Disease (IBD)?
Types of IBD
There are two main types of IBD:
Ulcerative colitis: This condition causes inflammation in the large intestine (colon), leading to bloody diarrhea.
Crohn's disease: This condition can cause inflammation in the small and/or the large intestine, leading to diarrhea, weight loss, and anemia.
Both ulcerative colitis and Crohn's disease can involve severe diarrhea, abdominal pain, fatigue and weight loss. IBD can be debilitating and sometimes leads to life-threatening complications if untreated.
Symptoms
Signs and symptoms that are common to both Crohn's disease and ulcerative colitis can include:
Diarrhea
Fever and fatigue
Abdominal pain and cramping
Reduced appetite
Unintended weight loss
Diagnosis
Your doctor may perform one or more of the following procedures to diagnose IBD:
Colonoscopy. This exam allows your doctor to view your entire colon using a thin, flexible, lighted tube with an attached camera. During the procedure, your doctor can also take small samples of tissue (biopsy) for laboratory analysis. Sometimes a tissue sample can help confirm a diagnosis.
Flexible sigmoidoscopy. Your doctor uses a slender, flexible, lighted tube to examine the rectum and sigmoid, the last portion of your colon. If your colon is severely inflamed, your doctor may perform this test instead of a full colonoscopy.
Upper endoscopy. In this procedure, your doctor uses a slender, flexible, lighted tube to examine the esophagus, stomach and first part of the small intestine (duodenum). While it is rare for these areas to be involved with Crohn's disease, this test may be recommended if you are having nausea and vomiting, difficulty eating or upper abdominal pain.
Capsule endoscopy. This test is sometimes used to help diagnose Crohn's disease involving your small intestine. You swallow a capsule that has a camera in it. The images are transmitted to a recorder you wear on your belt, after which the capsule exits your body painlessly in your stool. You may still need an endoscopy with a biopsy to confirm a diagnosis of Crohn's disease.
Treatment
The goal of inflammatory bowel disease treatment is to reduce the inflammation that triggers your signs and symptoms. The goal is to achieve not only to symptom relief, but also long-term remission and reduced risk of complications related to untreated IBD. IBD treatment usually involves either life-long medications or surgery. Your doctor will work with you to decide which treatment options are best for you.
Medications
Your doctor will often start you on a short-term steroid medication such as prednisone or budesonide to quickly shut down the inflammation in your intestine. People often start to feel better within days of starting these medications. You will then work with your doctor to decide which long-term medication is best for you. These may include anti-inflammatory drugs such as mesalamine (Asacol HD, Delzicol, Lialda, and others) or a stronger immune suppressant such as azathioprine, mercaptopurine, or methotrexate. In some cases, your doctor may recommend that you start an injection or IV immune suppressing medication. These may include adalimumab (Humira), infliximab (Remicade), vedolizumab (Entyvio), ustekinumab (Stelara), and others. For more information, you can read about these medications through the Crohn’s and Colitis Foundation.
Surgery
For some cases, surgery (removal of the colon or part of the small intestine) may be the best treatment option. This is often when people have not had a good response to multiple medications or for people with Ulcerative Colitis who do not want to be on life-long medication. Your doctor will discuss surgical options with you as well.
If you are concerned you have IBD, call your doctor. You can also call us at 978-459-6737 to request an appointment.
Are Colonoscopies Effective?
A study recently published in the New England Journal of Medicine about the effectiveness of colonoscopy is making the news!
This study, the NordICC trial, which was performed in Norway, Poland, and Sweden, claims that it found that colonoscopy is not as effective at preventing colon cancer and death as previously thought. However, there are several issues with the study that may not make it applicable to colonoscopies in the United States:
The Study is Not Representative of Colorectal Cancer Screening in the United States
This study was conducted in Norway, Poland, and Sweden which has a population very different than in the United States and may have different rates of polyps and colon cancer, especially among communities of color.
In the United States, guidelines state that gastroenterologists should be detecting adenomas (pre-cancerous polyps) in at least 25% of screening colonoscopies. This number makes sure that gastroenterologists are performing high-quality exams and finding enough adenomas. A recent study actually found the average adenoma detection rate in the United States is 39%. In contrast, in the NordICC trial, almost 1/3 of the endoscopists had an adenoma detection rate below 25%. This means that the gastroenterologists in the study may have been missing polyps.
Half of the Patients in the “Colonoscopy” Group of the Trial Did Not Have a Colonoscopy
In the NordICC trial, only 42% of people invited to have a colonoscopy actually had a colonoscopy. But even the people who did not go through with a colonoscopy were still included in the “Colonoscopy” group when calculating the results. This likely brought down the calculated effectiveness of colonoscopy.
In the people who did get a colonoscopy, colonoscopy was effective — their risk of colorectal cancer was reduced by 31% and the risk of dying from colorectal cancer was reduced by 50%.
Prior studies have shown that colonoscopy reduces the risk of colorectal cancer by more than 50% and reduces the risk of dying from colorectal cancer by almost 70%.
Colonoscopy is Still the Gold Standard
Colonoscopy remains the only test that screens, detects, and prevents colorectal cancer.
The U.S. Preventative Services Task Force recommends that Americans begin colorectal cancer screening at age 45.
See the original study here.
Screening versus Diagnostic Colonoscopy: What’s the Difference?
Perhaps the first time you heard the terms “screening colonoscopy” and “diagnostic colonoscopy” was when you called your insurance company to ask about your coverage.
You were probably told a screening colonoscopy was covered 100%, while a diagnostic colonoscopy had a copay or coinsurance.
Understanding the difference between them can make life a little easier – and help you know what to expect for your out-of-pocket costs.
What’s The Difference?
Screening colonoscopies and diagnostic colonoscopies are performed similarly using the same equipment. The difference is how the procedure is billed to your insurance. Billing will depend on your symptoms (or lack of symptoms) and what your doctor finds during the procedure.
A colonoscopy is considered preventive screening if the patient doesn’t have any gastrointestinal symptoms and no polyps or masses are found during the colonoscopy.
The Affordable Care Act (ACA) considers preventive services “essential health benefits” and requires insurance companies to pay all associated costs. That also means you won’t have to pay a copay or coinsurance for a screening colonoscopy.
Since a diagnostic colonoscopy isn’t considered preventive, your insurance may require you to pay a copay or coinsurance.
Screening Colonoscopy
A screening colonoscopy is a preventive procedure to examine the colon to ensure it’s healthy. All adults 45 and older need screening because colon cancer is one of the most common and deadly cancers. It is also typically treatable when it’s caught early. Better yet, colon cancer can be prevented by finding and removing polyps before they can develop into cancer.
According to the American Cancer Society, people with an average risk of developing colon cancer should have a screening colonoscopy every ten years.
A colonoscopy is considered screening when:
You’ve had no lower gastrointestinal signs or symptoms before the colonoscopy
No polyps or masses are found during the colonoscopy
There’s no family history of polyps or colon cancer
You have no history of polyps or colon cancer
Diagnostic Colonoscopy
Unlike a screening colonoscopy, you may be required to pay a deductible or coinsurance for a diagnostic colonoscopy, according to your insurance policy.
A colonoscopy is considered diagnostic when you’ve had:
Signs or symptoms in the lower gastrointestinal tract noted in your medical record before the procedure, including:
Abdominal pain that doesn’t improve
Anemia
Change in bowel habits
Constipation
Diarrhea
Rectal bleeding
Blood in the stool
Polyps within the past 10 years
A positive stool-based test or CT colonography and require a follow-up colonoscopy
Can Screening Become Diagnostic?
It’s true that you may go in for a screening colonoscopy and come out with a diagnostic colonoscopy. If your doctor finds a mass needing biopsy or finds a polyp, your colonoscopy is considered diagnostic at that point. That’s why it’s essential to understand your insurance coverage before your procedure.
What You Need to Know About Insurance Coverage for Colonoscopies
Medicare and most private insurance companies fully cover screening colonoscopies, including the deductible or coinsurance. Medicare coverage is often slightly different than private insurance plans.
Medicare Coverage
Medicare covers a screening colonoscopy:
Every 10 years, if you’re not high risk
Every 2 years, if you’re high risk, or have:
A history of polyps or colon cancer
A family history of polyps or colon cancer
A personal history of inflammatory bowel disease (IBD), which includes ulcerative colitis and Crohn’s Disease
Medicare covers a diagnostic colonoscopy without a deductible, but you will be required to pay 20% coinsurance.
Private Insurance Coverage
Private insurance coverage for diagnostic colonoscopies varies. Always ask your insurance company about out-of-pocket costs, including copays, coinsurance, deductibles, limits, or exclusions.
Grandfathered Plans
The ACA was passed in 2010 and any plans that were established before then are considered “grandfathered”. That means they are exempt from the coverage requirements for colonoscopy. People who have one of these plans may pay more (co-pay, co-insurance) for a screening colonoscopy.
Some states have their own laws that may still require insurance plans to provide coverage, even if the plan is older.
Knowing whether or not a colonoscopy is considered a screening or diagnostic is not always simple. It’s important to call your insurance provider before your colonoscopy appointment to have the best idea of what your out-of-pocket cost will be.
Don’t delay your colonoscopy if you are 45 or older – schedule an appointment today!
Pivio Health
IGIC is excited to start offering Pivio, a complete health improvement program! Pivio is built on the foundation of CHIP, the first lifestyle medicine program certified by the American College of Lifestyle Medicine (ACLM).
What is Pivio?
Pivio is a lifestyle medicine program focused on whole-person health. Pivio is a 12-18 session program over 30-90 days in an in-person group environment with dynamic group discussions and peer support. Pivio integrates optimal nutrition, exercise and behavioral psychology principles and tools.
What does Pivio include?
Pre-and post-health status assessments
Weekly facilitated group sessions
Edutainment style video content to teach participants how to apply lifestyle medicine to your daily life and build lasting, healthy habits
A journal to track your progress and reflect on your journey towards better health
A cookbook to find healthy, nutritious recipes and a meal delivery option to simplify and ease participants into healthy eating
Educational materials such as articles, fact sheets and explainer videos on topics related to lifestyle changes and healthy living
How can I join Pivio?
We are hosting info sessions for you to learn more about the program. Check on our news page for upcoming dates or contact us using the form below.
OverStitch/TORe (transoral outlet reduction endoscopy)
The Transoral Outlet Reduction (TORe) procedure is a specialized endoscopic technique tailored for patients who have had gastric bypass surgery but are experiencing weight regain or less than expected weight loss. This advanced procedure is carried out using the OverStitch endoscopic suturing system. The primary focus of TORe is to reduce the size of the enlarged stomach pouch and the stoma, the opening to the small intestine, which can stretch after surgery. A significant advantage of this technique is its minimally invasive approach, as it is performed through the mouth using the OverStitch device, eliminating the need for external incisions. This approach not only minimizes the risk of complications but also facilitates a quicker recovery compared to traditional surgical methods.
TORe, performed by specialized gastroenterologists, marks a significant advancement in the field of gastrointestinal and bariatric care, particularly for post-gastric bypass patients looking for a less invasive method to address their weight loss challenges. The procedure is known for its balance of efficacy and safety, typically resulting in minimal discomfort and a swift return to daily activities. Each procedure is customized to the patient's specific needs by skilled gastroenterologists experienced in endoscopic techniques. As with any medical procedure, it's crucial for patients to consult with their healthcare provider to discuss the potential benefits and risks of TORe and determine its suitability for their unique health objectives and situation.
Small Bowel Capsule Endoscopy
Prep instructions here.
Video capsule endoscopy is a procedure used to examine the inside of your small intestine, an important part of the digestive system. This test is often suggested for investigating symptoms like ongoing stomach pain, bleeding, or conditions such as Crohn's disease or celiac disease. It's particularly useful when other tests, like endoscopies or colonoscopies, haven't provided clear answers.
During this procedure, you'll swallow a small capsule that's about the size of a vitamin pill. This capsule has a camera in it, which takes pictures of your small intestine as it travels through. These pictures are sent to a recording device you wear, giving your doctor a detailed view of your small intestine to help diagnose your condition. The procedure is non-invasive, meaning there are no cuts or incisions. You won't need any sedation, and you can carry on with most of your normal activities. The capsule is eventually passed naturally in your stool. Before undergoing video capsule endoscopy, it's important to talk to your healthcare provider. They will guide you on how to prepare, what happens during the test, and any specific instructions for after the test.
Upper Endoscopy
An EGD, or esophagogastroduodenoscopy, is a diagnostic procedure that helps doctors examine the inner lining of your esophagus, stomach, and the beginning of your small intestine (duodenum). This test is often recommended if you have symptoms like heartburn, upper abdominal pain, difficulty swallowing, or ongoing nausea and vomiting. It's also a valuable tool for investigating unexplained gastrointestinal bleeding and can aid in diagnosing conditions such as gastroesophageal reflux disease (GERD), stomach ulcers, or celiac disease.
During an EGD, a doctor uses a specialized instrument known as an endoscope – a flexible tube equipped with a camera and light. Before the procedure, you'll typically receive medication to help you relax. The endoscope is carefully inserted down your throat to provide a clear view of the upper gastrointestinal tract. This process allows for detailed imaging and, if necessary, biopsy for further analysis. The EGD procedure usually takes about 15 to 30 minutes and is performed on an outpatient basis. While some discomfort is possible, it is generally not painful. Discussing with your healthcare provider is key – they will guide you on preparing for an EGD, what the procedure involves, and the recovery process, including any potential risks and addressing your questions.
