FAQ

Age 45. We used to recommend that colorectal screening examinations begin at age 50. However, because we have seen so many cases of colorectal cancer in younger individuals over the last two decades, the national recommendation was changed to age 45 for average-risk individuals. If there are other risk factors like a family history of colon cancer or polyps, we usually begin beginning screening at age 40. If an adult has colorectal symptoms such as rectal bleeding or persistent change in bowel habits, they should tell their doctor regardless of age. Read how screening colonoscopy saved this doctor's life.

There are several different preparations for colonoscopy, and they are all unpleasant. From the doctor's point of view, the SUPREP prep is probably the most effective, but a little sweet. Our patients tell us that the new SUTAB pill prep seems to be the least troublesome. However, each case is different, and certain individuals require special preparation, such as those with kidney disease. These are the most common preps.

Thankfully, no. During the examination, you will not be aware of the procedure and should not experience any pain. Colonoscopy is a painless procedure because special anesthesia is called Monitored Anesthesia Care, or MAC. MAC anesthesia is ideally suited to a short procedure like a colonoscopy. It is quick-acting and very safe. Unlike general anesthesia, you breathe on your own and do not require a breathing tube. You feel no pain or embarrassment during the procedure. The anesthesia wears off quickly in the recovery room, and unlike many other anesthetic regimens, postoperative nausea and vomiting are rare.

Not really. While any screening test is better than none, you should know that there is a difference between preventing colon cancer and detecting colon cancer. Unlike most other common cancers, colon cancer starts as a small non-cancerous polyp. Screening colonoscopy is very successful at finding these polyps and removing them BEFORE they become malignant. The new blood tests and the Cologuard “little white box” you see advertised on TV are very good at finding colon cancer AFTER you have it. They are not so good at finding polyps before they turn to cancer. In fact, the new blood test misses 87% of polyps. Screening Colonoscopy is the only colon cancer prevention test. The others are colon cancer detection tests.

If you experience heartburn at night, we suggest that you sleep on your side, left side down. Your stomach is not symmetrical. In this position, the stomach acid lies well below the opening of the esophagus, making it difficult for acid reflux to occur during the night. Of course, we also suggest elevating the head of the bed 4-6 inches. You can accomplish this with a simple wedge, which is placed on top of the mattress, or by placing blocks under the feet of the headboard. If you experience heartburn day or night on a regular basis or if it is severe or associated with difficulty swallowing, tell your doctor. This short video may help explain.

Your diaphragm is a broad, muscular sheet that separates your chest from your abdomen. To connect your esophagus (“foodpipe”) to your stomach, it must travel through the diaphragm. This opening is called the hiatus. If this opening stretches over time, your esophagus can “pull your stomach” through the hiatus and up into your chest. The part of the stomach in the chest is called a hiatal hernia.

No. Don’t waste your money…. Currently, these tests cost hundreds of dollars and benefit the seller much more than the buyer. Common brands are VIOME, FLORE, BIOHM, and THORNE, and new ones appear monthly. The gut microbiome refers to the trillions of microorganisms, including bacteria, viruses, fungi, and other microbes, that inhabit our digestive tract, primarily the intestines. These microorganisms play a crucial role in our overall health by aiding digestion, producing vitamins, regulating the immune system, and protecting against harmful pathogens. Various factors, including diet, environment, genetics, and lifestyle, influence the composition of the gut microbiome. A healthy, diverse microbiome is essential for maintaining digestive health, metabolic function, and even mental well-being. Current stool tests used to analyze the gut microbiome have several limitations that make them less reliable for providing a comprehensive picture of an individual's gut health. These tests typically involve sequencing the DNA of microbes found in a stool sample to identify and quantify the various species present. While this approach offers some insights, it has significant drawbacks. Moreover, the gut microbiome is influenced by many transient factors, such as recent diet, medication use, and stress levels, which can cause significant fluctuations in microbial populations. Our understanding of the gut microbiome is still in its infancy. Scientists have identified only a fraction of the microbial species that exist, and the functions of many known microbes still need to be fully understood. This limited knowledge makes it challenging to interpret stool test results accurately and translate them into actionable health recommendations. These tests can't give you accurate recommendations concerning your diet based on the limited science in 2024. There is hope for the future. As research advances, more comprehensive and precise methods for analyzing the gut microbiome are expected to emerge, improving our ability to assess and understand this complex ecosystem's impact on human health.

Probiotic foods contain healthy bacteria that promote good digestive function. The best Probiotics do not come from pills or supplements, but rather from food, particularly fermented food: Yogurt - Made from fermented milk and contains live cultures of probiotic bacteria. Try to avoids those with high levels of sugar. Kefir - A fermented milk drink similar to yogurt but with a thinner consistency, containing a variety of bacteria and yeasts. Sauerkraut - Fermented cabbage that is rich in probiotics, fiber, and vitamins. The best are refrigerated and served cold. Cooking kills the healthy bacteria. Kimchi - A Korean dish made from fermented vegetables, typically cabbage, along with various spices and seasonings. Miso - A Japanese seasoning produced by fermenting soybeans with salt and a type of fungus known as koji. It's often used in soups and sauces. Pickles - Cucumbers that have been pickled in a solution of salt and water. It's important to choose those that are naturally fermented. They are refrigerated. Kombucha - A fermented tea drink that is slightly effervescent and contains a variety of bacteria and yeast. Cheese - Particularly aged cheeses like Gouda, mozzarella, cheddar, and Swiss which live cultures.

The most important thing you can do to improve your Gut Health is to appreciate and take better care of your gut microbiome. The gut microbiome, a community of trillions of bacteria, fungi, viruses, and other microorganisms living in your digestive tract, plays a crucial role in your overall health. This intricate ecosystem influences everything from digestion and immune function to mood and metabolism. Maintaining a healthy gut microbiome is essential for your well-being, and diet is one of the most significant factors affecting it. Here’s a detailed guide on the best diet for a healthy gut microbiome. Understanding the Gut Microbiome The gut microbiome acts like a virtual organ that produces essential chemicals and nutrients your body needs. A balanced microbiome supports immune function, brain health, and metabolism. Conversely, an imbalanced microbiome has been linked to various health issues, including diabetes, heart disease, and inflammatory bowel diseases. The Importance of a Diverse Diet Diverse Plant Intake: Aim to consume 30 different plants per week. This includes fruits, vegetables, nuts, seeds, herbs, and spices. The diversity of plant-based foods provides a range of fibers and nutrients that feed different types of beneficial microbes in your gut. Eat the Rainbow: Incorporate colorful fruits and vegetables into your diet. These foods contain polyphenols and other beneficial compounds that support gut health by promoting a diverse microbiome. Fermented Foods: Include a variety of fermented foods in your diet, such as yogurt, kefir, kimchi, and kombucha. These foods introduce beneficial microbes to your gut and help maintain a balanced microbiome. Whole Grains and Fibers: Whole grains like oats, brown rice, and quinoa are rich in fiber, which is essential for gut health. Dietary fibers act as prebiotics, feeding the beneficial bacteria in your gut. Types of Fiber and Their Benefits Soluble Fiber: Found in foods like oats, peas, beans, apples, and citrus fruits, soluble fiber dissolves in water to form a gel-like substance. It helps lower cholesterol levels and regulates blood sugar. Insoluble Fiber: This type doesn’t dissolve in water and is found in whole grains, nuts, and vegetables. Insoluble fiber promotes regular bowel movements and prevents constipation. Resistant Starch: Present in legumes, green bananas, and cooked and cooled potatoes, resistant starch acts like a prebiotic, feeding beneficial bacteria and promoting gut health. Potential Risks of a High-Fiber Diet While increasing fiber intake has numerous benefits, it’s essential to do so gradually. Rapid increases in fiber can lead to bloating, gas, and other digestive discomforts. Ensure you drink plenty of water to help fiber move through your digestive system and avoid constipation. Foods to Avoid Ultra-processed Foods: These can harm your gut microbiome. Processed foods often contain additives and lack the nutrients necessary for a healthy microbiome. High Sugar and Artificial Sweeteners: Excessive sugar and artificial sweeteners can negatively impact the diversity and function of your gut bacteria. Meal Timing and Fasting Allowing a 12-14 hour fasting period overnight can benefit gut health. Fasting gives your gut microbes time to rest and regenerate, promoting a healthier microbiome. How about Microbiome test kits? Not yet… Microbiome science is in its infancy. Despite all the TIKTOC sites selling microbiome test kits and promising personalized nutrition, we are not there yet. Most of these products benefit the seller much more than the user. Future advances in microbiome research will likely lead to personalized medical treatments, including tailored probiotics and prebiotics to enhance the effectiveness of medications and improve health outcomes. Additional Tips for a Healthy Gut Stay Hydrated: Drinking plenty of water helps maintain the mucosal lining of the intestines and supports the balance of good bacteria in the gut. Get Enough Sleep: Adequate sleep supports immune function and gut health. Aim for seven to eight hours of sleep per night. Manage Stress: Chronic stress can negatively impact your gut health. Practices like yoga, meditation, and deep breathing can help manage stress and promote a healthy gut. Regular Exercise: Physical activity promotes the growth of beneficial microbial species and contributes to a diverse microbiome. Conclusion A healthy gut microbiome is vital for overall health, and diet plays a significant role in maintaining this balance. Making conscious food choices every day can significantly impact your health. For optimal gut health, embrace dietary diversity, include fermented foods, and reduce ultra-processed foods. By incorporating a diverse range of plant-based foods, whole grains, and fermented foods into your diet while avoiding ultra-processed foods and excessive sugars, you can effectively support your gut health. Adequate hydration, sleep, stress management, and regular exercise are also crucial components of a gut-healthy lifestyle.

It happens to all of us from time to time. CONSTIPATION! Constipation is a common yet often uncomfortable and disruptive digestive issue. It is defined by infrequent bowel movements, typically fewer than three times per week, or difficulty passing stools, which can be hard, dry, and painful. What Is Constipation? Constipation occurs when bowel movements become less frequent or difficult to pass. Normal bowel habits can vary significantly among individuals; for some, three bowel movements per week is typical, while others may have them three times a day. However, a sudden change from your usual pattern could indicate constipation. The symptoms of constipation are often unmistakable and can include fewer than three bowel movements per week, straining during bowel movements, hard or lumpy stools, and a sensation of incomplete evacuation. Additionally, individuals may experience a feeling of blockage in the rectum or need to use manual maneuvers, such as using their fingers, to facilitate stool passage. These symptoms can vary in severity and may significantly affect an individual’s daily life and overall well-being. Acute vs. Chronic Constipation Based on its duration and severity, constipation can be classified as acute or chronic. Acute constipation is a short-term condition often triggered by changes in diet, routine, travel, lack of exercise, illness, or medication. It usually resolves within a few days with lifestyle modifications or over-the-counter treatments. On the other hand, chronic constipation persists for three months or longer and can significantly impact a person’s quality of life. This type often requires medical evaluation and intervention, as it may not respond to standard dietary and lifestyle changes​. Causes of Constipation Constipation can stem from various factors, including dietary habits, lifestyle choices, medical conditions, and medications. Diet and Lifestyle: A common cause of constipation is a diet low in fiber. Fiber adds bulk to stool and helps it pass easily through the intestines. Fiber-rich foods include fruits, vegetables, beans, and whole grains. Inadequate fluid intake can also contribute to constipation by making stools harder and more difficult to pass. Regular physical activity helps stimulate intestinal function so that a sedentary lifestyle can slow down the digestive process. Additionally, ignoring the urge to have a bowel movement can lead to prolonged retention of stool in the colon, where it becomes drier and harder. Medications: Certain medications are known to cause constipation as a side effect. These include opioid pain relievers, antacids containing calcium or aluminum, iron supplements, and certain antidepressants and antihypertensives. If you are taking any of these medications and experience constipation, it’s important to discuss this with your healthcare provider, who may adjust your dosage or recommend alternatives. Medical Conditions: Various medical conditions can affect bowel function. Digestive disorders such as irritable bowel syndrome (IBS), colorectal cancer, and inflammatory bowel disease (IBD) can cause constipation. Endocrine disorders, including diabetes and hypothyroidism, can also impact bowel movements. Neurological conditions such as multiple sclerosis, Parkinson’s disease, and spinal cord injuries can interfere with the nerves that control bowel movements, leading to constipation. Risk Factors for Chronic Constipation Several factors can increase the risk of developing chronic constipation. These include being female, as hormonal changes during menstruation, pregnancy, and menopause can affect bowel function. Older adults are also at higher risk due to slower metabolism, reduced muscle tone, and a higher likelihood of taking multiple medications that can cause constipation. A sedentary lifestyle and mental health conditions like depression or eating disorders can further contribute to chronic constipation. Complications of Constipation Chronic constipation can lead to several complications if not properly managed. Straining during bowel movements can cause hemorrhoids, which are swollen veins in the anus. Persistent straining can also lead to anal fissures, small tears around the anus that cause pain and bleeding. Severe constipation can result in fecal impaction, where hard stool becomes stuck in the colon or rectum, requiring medical intervention. In rare cases, prolonged straining can cause rectal prolapse, a condition where part of the intestine protrudes from the anus. Diagnosis and Treatment Diagnosing constipation involves thoroughly reviewing the patient's medical history, symptoms, and lifestyle. Your doctor may also perform a physical examination, including a rectal exam, to check for blockages or abnormalities. Additional diagnostic tests, such as blood tests, abdominal X-rays, and colonoscopy, may be necessary to identify underlying causes​. Treatment typically begins with dietary and lifestyle changes: Increasing fiber intake through fruits, vegetables, whole grains, and legumes can help add bulk to the stool and promote regular bowel movements. OTC fiber supplements like Metamucil or Benefiber may help Drinking plenty of fluids and engaging in regular physical activity can also improve bowel function. Establishing a routine for bowel movements, especially after meals, can help maintain regularity. For those with persistent constipation, over-the-counter laxatives can provide short-term relief. These include stool softeners and osmotic or stimulant laxatives like Miralax. However, it is important to use laxatives as directed and not rely on them for long-term management. In cases of chronic constipation, healthcare providers may prescribe prescription medications such as lubiprostone, linaclotide, or prucalopride to help stimulate bowel movements. In very rare instances, surgery may be necessary to correct structural problems in the digestive tract, such as blockages or significant rectal prolapse. However, surgical intervention is typically considered a last resort when other treatments have failed. Constipation is a common condition that can be effectively managed with the right approach. Understanding the causes, symptoms, and treatments can help you take proactive steps to prevent and alleviate constipation. Preventing constipation involves adopting healthy dietary and lifestyle habits. Eating a fiber-rich diet, drinking adequate fluids, and staying physically active are vital to maintaining regular bowel movements. It is also important to respond promptly to the urge to have a bowel movement and establish a regular bathroom use schedule. By making these changes, you can reduce the risk of developing constipation and improve your overall digestive health.

Good news! NO…Hemorrhoids are just swollen veins in a very sensitive place. They do not turn to anal or rectal cancer. That said, you can’t assume that any rectal bleeding is coming from hemorrhoids until an examination confirms this to be true. The worst thing you could do is ignore chronic red rectal bleeding and then find out that an anal or rectal cancer was actually the cause, and now it’s too late for a cure. If you have symptoms, tell your doctor. Never assume.

Diet for Fatty Liver Disease Fatty liver disease is a condition characterized by the accumulation of excess fat in the liver. There are two main types: those caused by alcoholism and non-alcoholic fatty liver disease (NAFLD). Newly termed Metabolic dysfunction-associated fatty liver disease, MAFLD is the most common liver disease affecting millions of individuals worldwide. This is important as fatty liver disease can lead to serious health complications such as cirrhosis and liver cancer. Improving liver health through diet is crucial for managing this condition. Understanding Fatty Liver Disease Fatty liver disease occurs when more than 5-10% of the liver's weight is composed of fat. Often, this condition presents without noticeable symptoms but can progress to more severe liver damage over time. Implementing lifestyle changes, particularly dietary adjustments, is the primary strategy for preventing and managing fatty liver disease. The Role of Diet in Fatty Liver Disease A healthy diet is essential in managing fatty liver disease, especially since no specific medical treatments for NAFLD exist. Dietary and lifestyle changes are the most effective ways to prevent or reverse liver damage. A diet can play a pivotal role in this management by reducing fat accumulation in the liver, improving insulin sensitivity, and combating inflammation by including specific foods. Recommended Diet for Fatty Liver Disease The Mediterranean diet is highly recommended for individuals with fatty liver disease. This diet is rich in fruits, vegetables, whole grains, lean proteins, and healthy fats, making it beneficial for liver health. Here's a detailed look at the components of this diet: Healthy Fats Olive oil, rich in monounsaturated fats, is known to help reduce liver fat. Omega-3 fatty acids in fish, flaxseeds, and walnuts improve insulin sensitivity and reduce inflammation, making them vital for liver health. Fruits and Vegetables Antioxidant-rich foods like berries and leafy greens protect liver cells from damage. Fiber-rich foods, like broccoli and apples, aid in digestion and help reduce fat absorption in the liver. Whole Grains Whole grains like brown rice, oats, and quinoa are high in fiber and help maintain stable blood sugar levels. This reduces the liver's workload and prevents fat buildup. Lean Proteins Fish and seafood, rich in omega-3 fatty acids, support liver health. Plant-based proteins, such as legumes and nuts, are beneficial due to their low fat and high nutrient content, making them excellent choices for a liver-friendly diet. Beverages Surprisingly, coffee consumption (up to three cups a day) has been linked to a lower risk of liver disease progression. Green tea, rich in antioxidants, can help protect liver cells from damage. Foods to Avoid Certain foods can exacerbate fatty liver disease and should be limited or avoided to maintain liver health. These include: Saturated Fats Foods high in saturated fats, such as red meat and full-fat dairy, can increase fat accumulation in the liver. Sugary Foods and Beverages Sugary snacks and sodas, high in fructose and other sugars, can lead to insulin resistance and fat buildup in the liver. Processed Foods Fried foods and baked goods, often high in unhealthy fats and sugars, can worsen liver fat. Alcohol Excessive alcohol consumption can cause and worsen fatty liver disease, particularly in individuals with NAFLD. Lifestyle Changes In addition to dietary changes, certain lifestyle adjustments can significantly benefit individuals with fatty liver disease. Weight Management Gradual weight loss, aiming to lose 5-10% of body weight slowly, can significantly reduce liver fat and inflammation. Regular Exercise Aerobic exercises like walking, cycling, and swimming can help reduce liver fat. Strength training can also improve overall metabolism and liver function. Managing Comorbid Conditions Proper management of diabetes and cholesterol is crucial, as these conditions are risk factors for fatty liver disease. Conclusion Dietary and lifestyle changes are powerful tools in managing fatty liver disease. The Mediterranean diet, rich in healthy fats, lean proteins, and fiber, stands out as the most beneficial diet plan. Avoiding harmful foods, incorporating beneficial supplements, and adopting a healthy lifestyle can significantly improve liver health and prevent the progression of fatty liver disease.

Diverticulosis of the colon is a condition rather than a disease. The inner wall of a healthy colon is strong and relatively smooth. The colon wall affected by diverticulosis forms weak, balloon-like sacs or pouches that protrude outward like a bulge forming on a worn inner tube. Diverticula are often quite small – about the size of a pea – but can be larger. Once you get diverticula, they don’t go away. The presence of these pouches in the colon is called diverticulosis. Some people may have several small pouches on the left side of the colon, while most of the colon may be affected in others. When the pouches become inflamed or infected, it is called diverticulitis. (In medicine, the suffix “-itis” refers to inflammation or infection...like appendicitis.)

There’s a lot of buzz on TikTok around going gluten-free, with everyone from celebrities to pro athletes touting the benefits of a gluten-free diet. Gluten is a protein found in wheat, barley, and rye. Unless you have celiac disease or a diagnosed gluten sensitivity (also called gluten intolerance), there's no medical need for you to be on a gluten-free diet. Despite popular trends, there is little evidence that a gluten-free diet has health benefits for people who do not have these conditions. Some people think going gluten-free means not eating carbohydrates, but this isn’t true. Many foods containing carbs, such as rice, potatoes, and beans, don’t contain gluten. Celiac disease Celiac disease is straightforward. Your doctor can order blood tests, genetic tests, and intestinal biopsies that verify the diagnosis with certainty. Celiac is an autoimmune response to gluten that causes the body to attack the small intestine, causing belly pain, nausea, bloating, or diarrhea. People with celiac disease can’t tolerate gluten in any form and need to follow a gluten-free diet for the rest of their lives. Once the diagnosis is made, a lifelong, strict gluten-free diet is prescribed, and these patients do well. Gluten Sensitivity: Is It Real? Unfortunately, this is not so clear. No blood test, genetic test, or biopsy can confirm the diagnosis of nonceliac gluten sensitivity. Many individuals who experience symptoms of gas, bloating, and abdominal pain experiment with a period of gluten avoidance. Some do well, and others do not. Most Gastroenterologists recognize that nonceliac gluten sensitivity does exist. However, this is a new area of study, and researchers still need to understand the condition, its risk factors, and its prevalence. While many documented cases of possible gluten sensitivity exist, more research is needed before scientists understand the causes, symptoms, and effects. What Should You Do? So, there is no harm in trying a gluten-free diet if you have these symptoms and feel that you may be sensitive to gluten. Keep a food and symptom diary for at least four weeks to see if this makes a difference. There are a few downsides to a gluten-free diet: 1. Eating out is tricky as you can’t always trust what is said on the menu. 2. Grocery shopping for gluten-free products is definitely more expensive. 3. Cutting out gluten can lead to nutritional deficiencies because many gluten-containing foods are good sources of fiber, vitamins, and minerals. If this is to be a long-term diet, add a daily multivitamin and non-gluten sources of fiber in fruits and vegetables to your regimen Suppose you're considering a long-term gluten-free diet. In that case, it's important to talk to your doctor or a registered dietitian to discuss the potential benefits and risks and ensure you get all the nutrients your body needs.

EPI (Exocrine Pancreatic Insufficiency) is when the pancreas does not produce enough enzymes to digest food properly. These enzymes break down food and absorb nutrients, including fats, proteins, and carbohydrates. Symptoms can vary but often include: Steatorrhea: Fatty, foul-smelling stools that are difficult to flush. Diarrhea: Frequent, loose, and watery stools. Weight Loss: Unintentional weight loss due to poor nutrient absorption. Bloating and Gas: Excess gas and a feeling of fullness. Abdominal Pain: Discomfort or pain in the upper abdomen. However, these symptoms can be associated with many different conditions. It's important to remember that a TV advertisement is not a diagnostic tool. If you are experiencing symptoms that concern you, the best action is to speak with your doctor. Consultation with a Gastroenterologist can arrange specific tests, such as stool tests, blood tests, or imaging studies, to determine if you have EPI or another condition. In most cases, the condition is permanent. However, treatment is available. The primary treatment for EPI is pancreatic enzyme replacement therapy (PERT), which involves taking enzyme supplements with meals to aid digestion.

Don’t panic. Most pancreatic cysts are benign (non-cancerous). Pancreatic cysts are fluid-filled sacs on or in the pancreas. Most pancreatic cysts are discovered during imaging tests for other health issues, as they often cause minimal or no symptoms. However, these cysts range from benign (non-cancerous) pseudocysts to malignant (cancerous and spreading) cysts. If a cyst is found, your doctor will recommend further tests to determine its type and whether it's precancerous or cancerous. These tests may include an endoscopic ultrasound, where a thin tube with a camera and ultrasound device is passed down your throat to your stomach and small intestine, providing images of your pancreas. While the presence of a pancreatic cyst can be concerning, it's important to remember that they are fairly common and most cysts are not cancerous. Even those with cancerous potential can be effectively managed with regular monitoring and timely treatment. If you have been diagnosed with a pancreatic cyst, it's crucial to have regular check-ups and follow your doctor's advice. More information can be found here.

The medical term for difficulty swallowing is dysphagia. Occasional difficulty swallowing, such as when you eat too fast or don't chew your food well enough, usually isn't cause for concern. However, if you consistently have trouble swallowing, it may indicate a more severe condition like esophageal narrowing (stricture). Trouble swallowing is one of the SEVEN cancer warning symptoms, so esophageal cancer must be ruled out. Fortunately, cancer is an uncommon reason for difficulty swallowing. If you often have difficult or painful swallowing items such as meat, bread, and clumpy rice, you need to tell your doctor. A consultation with a gastroenterologist and probably an upper endoscopy examination “scope exam” would seem to be in order. It is important to explain the underlying cause of the symptoms and to exclude serious problems. Read on...

All abdominal surgery is a shock to your system. But, in most cases, these changes are temporary and improve within a few weeks of the operation. About 5% of individuals, however, are troubled by persistent diarrhea after their gallbladder is removed. The symptoms may vary, but most patients complain that they often experience urgency and watery diarrhea shortly after eating. The diarrhea may even force them to stop and head for the closest bathroom before they finish the meal. This is especially embarrassing when it occurs at work or when dining out with friends. Why some patients develop this side effect after gallbladder surgery, and others do not is still a mystery. Unfortunately, there is no way to predict before surgery who will develop this problem afterward. Having this side effect does not reflect on the skill of the surgeon or how the surgery was done. It is really just bad luck. There is no cure for this problem, but treatment is available. The mainstay of treatment is a powder called cholestyramine resin (Pronunciation: kole ESS tie ra meen). In the past, this medication was primarily marketed as a drug for patients with high blood cholesterol. It has been replaced by more effective drugs such as the statins. It is still available to help those with diarrhea after gallbladder surgery. Read more…

YES, we are happy to offer convenient online scheduling.

Gastroenterology is a branch of medicine focused on the health of the digestive system, or gastrointestinal (GI) tract. The GI tract includes organs like the esophagus, stomach, small intestine, colon and rectum, pancreas, gallbladder, bile ducts, and liver. This field covers a wide range of common and important conditions such as colon polyps and cancer, hepatitis, gastroesophageal reflux (heartburn), peptic ulcer disease, colitis, gallbladder and biliary tract disease, nutritional problems, Irritable Bowel Syndrome (IBS), and pancreatitis. In essence, all normal activity and disease of the digestive organs are part of the study of Gastroenterology.

Gastroenterologists, the doctors specializing in this field, have a detailed understanding of how food moves through the digestive tract, is broken down (digested), is absorbed into the body, and how waste is removed from the body. After 4 years of college and 4 years of medical school, a Gastroenterologist must complete a three-year Internal Medicine residency and then be eligible for additional specialized training (fellowship) in Gastroenterology. This fellowship is generally 2-3 years long, so by the time Gastroenterologists have completed their training, they have had 5-6 years of additional specialized education following medical school.

The Center for Digestive Health & Nutrition (CDHN) is a private medical practice of eight experienced Gastroenterologists, Nurse Practitioners, and staff dedicated to preventing and treating digestive disorders. Our physicians have been serving the needs of those in Western Pennsylvania and surrounding areas since 1977, having cared for tens of thousands of individuals with digestive problems. Our medical staff has over 250 years of collective experience treating digestive disorders and is available to help those in need.

CDHN is conveniently located at 725 Cherrington Parkway (Bottom Level), Moon Township, PA 15108, a pleasant suburban setting north of Pittsburgh, PA. There is ample, on-site free parking for patients and their families. CDHN shares the first floor of this medical building with a surgical center devoted to gastrointestinal procedures: the Three Rivers Endoscopy Center (TREC), where most of our outpatient endoscopy "scope" procedures are performed.

Our team employs cutting-edge technology to diagnose and treat all digestive conditions, including colon cancer, colon polyps, heartburn, acid reflux, celiac disease, swallowing problems, digestive bleeding, stomach ulcers, chronic indigestion, liver disease, hepatitis, gallstones, diseases of the pancreas, irritable bowel syndrome, ulcerative colitis, Crohn's disease, internal hemorrhoids, persistent nausea/vomiting, weight loss, gas and bloating, abdominal pain, chronic constipation, and diarrhea. We do not perform surgery. Our focus is concentrated on diagnosis and medical treatment. We are all highly trained and experienced in endoscopic examinations of the stomach (gastroscopy) and colon (colonoscopy). We have had great success with the O'Regan Hemorrhoidal Ligation procedure to treat internal hemorrhoids. Since 2005, we have offered the option of the amazing “camera in a pill” PillCam™ procedure to enhance the views of the small intestine.

This depends on your insurance provider and insurance plan. Please get in touch with your insurance company for details about your coverage.

Gastroenterology is a specialty practice, and unlike primary care providers, routine appointments may take several weeks. For emergencies, we set aside several openings each day in our schedule.

Yes. You can schedule an office visit with one of our providers and complete most of your registration information when you book an appointment online, helping us make your visit more efficient and saving you time. An endoscopic "scope" test can begin online, but our appointment staff will need to contact you to finalize the details and provide any necessary preparative instructions. To schedule online, visit our website, www.gihealth.com. An online registration prompt is sent by text and or email 5 days prior to an office visit and 10 days prior to a procedural visit such as a colonoscopy.

No. Our physicians treat patients who are 16 years old or older. A pediatric gastroenterologist should see children under the age of 16. Our endoscopy center, TREC, only accepts patients over 18. Younger patients who need an outpatient endoscopic procedure are scheduled at a local hospital surgery center.

No, CDHN does not handle Workman's Compensation claims.

Coordination of care is an essential part of a specialty consultation. Physicians often refer patients to us concerning a specific digestive problem. Depending on the type of problem, we may initiate diagnostic studies or treatment. Most patients will continue to be cared for by their primary care physician after establishing a diagnosis and treatment plan. Under certain conditions, we may also continue to monitor your gastrointestinal problems. Your personal physician will receive a comprehensive report with recommendations, usually transmitted before you leave our facility.

Our physicians provide inpatient gastroenterology consultations and perform inpatient and outpatient procedures at Heritage Valley System’s - Sewickley Hospital and Heritage Valley System’s Kennedy Hospital (formerly Ohio Valley General Hospital). However, most outpatient endoscopic procedures are performed at our endoscopy center, Three Rivers Endoscopy Center, conveniently located in the same facility as our outpatient medical practice.

The quickest way to schedule an appointment is to do so online at www.gihealth.com. You can also call our schedulers at 412 262-1000. You can also contact us on our Contact Us page on our website.

YES. TREC is a member of the American Association of Ambulatory Surgery Centers, fully certified by the Pennsylvania Department of Health, and approved as a Medicare and Medicaid provider. We are proud that Three Rivers Endoscopy Center has been licensed by the Accreditation Association for Ambulatory Health Care (AAAHC) since 1996. TREC was the first endoscopy center in Western Pennsylvania to achieve this endorsement.

We also are honored to have recently received the American Society for Gastrointestinal Endoscopy ASGE Unit Recognition Award, which recognizes practice units demonstrating their commitment to the highest standards of quality care and effectiveness in delivering such care. These recognition programs take into account unit policies, credentialing, staff training, competency assessment, and quality improvement strategies.

TREC specializes in gastroenterology and endoscopy procedures and was designed with efficiency and patient convenience in mind. Our staff members are specifically trained in GI procedures, and our team of highly skilled doctors and nurses is committed to providing the highest quality endoscopic services in a controlled, comfortable environment. Our physician-directed, patientfocused approach is intended to promote your long-term GI health, resulting in high patient satisfaction.

The benefits of having your procedure performed at TREC: Endoscopy is performed by a trained Gastroenterologist, assuring you of quality, personalized care. Endoscopy is more economical at TREC because the overhead costs are lower than a hospital's. The average charge for treatment here is about 50% less than having the same procedure at a hospital surgery center. This is especially significant for our patients in an era of increased copays and deductibles. Simplified admitting and discharge procedures ensure convenience for the patient and free onsite parking also adds to the convenience. A patient's family can relax in our center's calm waiting area. Realizing that each case is unique, we always provide close, personal attention.

Colonoscopy Flexible Sigmoidoscopy Colon polyp removal EGD (esophagogastroduodenoscopy) Esophageal Dilation of Strictures BRAVO Esophageal Ph testing Endoscopic Retrograde Cholangiopancreatography (ERCP) at local hospital X-ray department Capsule Endoscopy or "Pill Cam" in our attached clinical office Internal Hemorrhoid Banding in our attached clinical office Percutaneous Endoscopic Gastrostomy (PEG Feeding tube) at the local hospital surgery department Infusion Services for inflammatory bowel disease in our office infusion suite

That depends. Every case is unique. You may need to visit our office before scheduling a colonoscopy if you are a new patient. Our physician or Nurse Practitioner will perform a history and physical to ensure that you are healthy and have no medical problems that may hinder the procedure's safety. If you have no digestive symptoms but need a screening exam, we often review your family doctor's last evaluation. Further details may be necessary and will be requested during a phone call. Returning patients who have been treated recently only need a preoperative office visit if their health status has changed.

Yes. Scheduling an endoscopic procedure (Gastroscopy or Colonoscopy) can begin online, but our appointment staff will need to contact you to finalize the appointment details and provide any necessary preparative instructions.

Yes. A colonoscopy is the most accurate way to determine the health of your colon. We check for cancer, polyps, colitis, diverticulosis, and other less-common lower digestive problems during this procedure. Even more importantly, a colonoscopy can help prevent colon cancer by effectively detecting and removing precancerous polyps.

Yes. Someone over 18 with whom the doctor can discuss the procedure's findings, with your permission, to do so, as it may be difficult to remember what you are told due to the effects of any medications you received. The person you bring must also drive you home as you will not be able to drive safely until the next morning.

For your gastroenterologist to have a clear picture of the inside wall of your colon, the colon needs to be thoroughly cleaned out. The colon prep is a type of laxative that induces the colon to empty all its contents, thus allowing the physician to see clearly. Problems can arise if the colon is not thoroughly prepared. It is important during bowel preparation that you follow the instructions very carefully and thoroughly. A colonoscopy is safe and accurate when performed by an experienced doctor, qualified support staff, state-of-the-art instruments, anesthesia, AND A CLEAN COLON! We strongly emphasize the importance of a "clean" colon for a successful outcome.

Yes, you can! The prep solutions ' bad taste is a major complaint with past colonoscopy preparations. Now we have SUTAB, a new pill preparation that became available in early 2021. It is not "a pill," but 24 pills. The night before your colonoscopy exam, take 12 pills over about 20 minutes with a lot of water. Repeat the process about 6 hours before the exam, on the morning of your colonoscopy. The pills are about the size of a large vitamin capsule.

In the past, colonoscopy preps were given the night before the examination. The colon was nice and clean when the patient went to bed, but problems arose overnight as bile and mucous in the small intestine entered the right side of the colon and covered the lining, making the test far less accurate. By cleaning out the colon the night before and "polishing it" again 6 hours before the examination, the right side of the colon is almost always suitably prepared. Gastroenterologists in the US switched to this so-called "split prep" a few years ago.

If you develop symptoms of nausea or vomiting, stop the prep for 30 minutes, then resume the process. Go slower by drinking one eight oz. glass every 30 minutes instead of every 15 minutes. Cool down the prep in the refrigerator, or in an ice bath, before drinking it. If you need help completing the prep, please call (412) 262-1000 and speak with our nurse or doctor on the night call.

Your procedure will probably be canceled. It is dangerous to receive sedation if you have had something to eat or drink before your procedure. Our first concern is your health and safety. Sedatives administered before your procedure affect your body's ability to retain food and liquid in your stomach. If you eat or drink several hours before your procedure, there is a risk that food or beverage will travel up into your esophagus, where it could enter your lungs. Your procedure will be rescheduled if you do not follow the instructions provided by your doctor. You must be totally fasting for four (4) hours before your procedure; eat and drink nothing!

The stool output should look clear and without particles like the liquids you are drinking..

A typical sign of success in your preparation is passing clear or yellow-colored fluid from your rectum after following the procedure for bowel preparation. If, on completion, you are still passing formed stool, your procedure may have to be rescheduled. To determine the next step, contact us immediately at 412 262-1000 and request to speak with a nurse or doctor on a night call.

You are encouraged to carefully follow all the instructions for using the prep, so please make every effort to drink all of the solution. Purging a colon is not influenced by the height and weight of a patient. Remember, you are trying to clean out your entire digestive tract. The physician can only perform a thorough exam if your colon is clean. If the prep is not completed properly, you may have to reschedule your test for another day.

There are many bowel movements during a colonoscopy preparation. You can minimize soreness in the anal area using soft toilet tissue and a baby wipe like Huggies. Applying a topical barrier cream such as Zinc Oxide, Butt Paste, or Desitin Diaper Rash Cream will not interfere with the results of a colonoscopy. An over-the-counter numbing cream called Recticare can help.

No. The bowel prep may cause dehydration, and it's important to drink lots of water or clear liquids during your bowel prep to stay hydrated.

Tell your doctor about all medical conditions and any drugs, vitamins, or nutritional supplements you take regularly. Please talk to your prescribing doctor if you are taking prescription blood thinners (Coumadin, Jantofen, Warfarin, Eliquis, Pradaxa, Plavix). They may need to be temporarily stopped. Continue to take all medications unless otherwise instructed. If you take medicines for high blood pressure, take them every day, including the day of your colonoscopy prep and the morning of your procedure, with only a tiny sip of water.

One consistent factor that causes poor preparation for colonoscopy is constipation. Starting the colon prep when you are constipated will make you sick and probably result in inadequate preparation for the exam - which may have to be rescheduled. If you are constipated, you may require a "pre-prep" with a more extended period of a clear liquid diet and additional laxatives to prepare your colon for your colonoscopy. Please make sure your Gastroenterologist knows that you are constipated before the procedure.

Since you are on a liquid diet, you may need to adjust your diabetes medication the day before your procedure. Please refer to your diabetes instructions for details. In addition, check your blood sugar levels regularly during preparation, as it may not be safe to receive anesthesia for your procedure if your blood sugar is too high or too low.

Drink liquids with added sugar the day before your procedure, and do not rely on sugar-free drinks. You must consume 150-200 calories when on a liquid diet to maintain your blood sugar. Refrain from eating solid foods during your preparation, or your procedure may have to be rescheduled.

Yes, menstrual periods and tampons do not interfere with a colonoscopy.

Most routine procedures are scheduled within four weeks of seeing the doctor. We also reserve some appointments on our schedule for urgent cases.

Medicare-accredited facilities are required to have a separate chart for all patients. In addition, our staff is trained to make sure we have your most up-to-date health information. Although the Three Rivers Endoscopy Center is located next to the CDH&N offices, questions you’ve answered while seeing a doctor or provider at CDHN are maintained in a separate health report.

Small jewelry items can easily be lost when changing into a patient gown before the examination.

You should wear loose, comfortable, casual, easily removed, and foldable clothing. Avoid girdles, pantyhose, or tight-fitting garments. We recommend leaving your jewelry, other valuables, and high heels at home. Do not wear dark nail polish, perfume, or cologne on the day of surgery. (Dark nail polish interferes with the pulse oximeter readings we put on your finger to alert the clinical team of your oxygen level.)

Bring your insurance card(s), driver's license, valid photo ID for identification purposes, and any financial patient responsibility details, such as a copayment.

You may brush your teeth, but avoid swallowing additional, unnecessary water. Refrain from using mouthwash. You may apply deodorant on the morning of your procedure.

No. During the examination, you will receive intravenous pain suppressants and sedation. You will not be aware of the procedure and should not experience any pain.

Yes. Before the procedure, you will be evaluated by the Anesthesiologist. During the procedure, you will be continuously monitored by a Certified Registered Nurse Anesthetist (CRNA) using the latest equipment.

Our CRNAs may use one of several medicines specifically selected for you based on your health history. Medications commonly used are Propofol (a sedative), Fentanyl (a narcotic used to control pain), and Versed (a medicine used to promote relaxation). This is called Monitored Anesthesia Care, or MAC. MAC anesthesia is ideally suited to a short procedure like a gastroscopy or colonoscopy. It is quick-acting, very safe, and you feel no pain or embarrassment during the procedure. The anesthesia wears off quickly in the recovery room, and unlike many other anesthetic regimens, postoperative nausea and vomiting are rare.

This is a normal and common fear. Most individuals fear losing control, giving away their secrets, or saying something embarrassing while asleep. While in a state of MAC anesthesia, it is very unusual for patients to speak.

Anesthesia required for gallbladder surgery is a general anesthetic. An anesthetic for a colonoscopy or upper endoscopy does not require general anesthesia or a breathing tube. You will be breathing on your own and, simultaneously, be pain-free during the procedure.

No. The sedation administered by the anesthesia team takes effect almost immediately. Patients are completely sedated before the procedure starts. They usually wake up in the recovery area about three minutes after the procedure ends, with a sense of it all happening in "the blink of an eye."

We recommend that no chewing tobacco be ingested for at least 8 hours before your procedure. The liquid from your saliva mixed with chewing tobacco often ends up in your stomach. Before administering anesthesia, your stomach must be empty of these kinds of acidic fluids.

Like chewing tobacco, gum also generates saliva that is ingested, producing stomach acid. Therefore, we strongly recommend that you abstain from all gum, mints, etc., for at least 8 hours before the procedure.

No. More and more individuals are using medical or recreational marijuana. This can interfere with the anesthetic medications. Therefore, we strongly recommend that our patients abstain from all marijuana or THC products for at least 8 hours before the procedure.

Patients experience nausea and vomiting after procedures for a variety of reasons. Some are prone to nausea and vomiting due to other pre-existing conditions. Some patients have a history of motion sickness, which can be correlated with postoperative nausea and vomiting. Please let the attending anesthesiologist know your history if you suffer from this problem; in many cases, we can add or adjust medication to block that response. Because of the specific drugs we use for sedation, postoperative nausea, and vomiting are rare after endoscopic procedures.

There is no single anesthesia or dose for all patients. Every anesthetic must be tailored to the individual and to the procedure that is being performed. The amount of anesthesia necessary varies according to age, weight, gender, prescribed medicines, or specific medical conditions. Heart rate and rhythm, blood pressure, breathing rate, and oxygen levels are monitored continuously during the procedure. Adjustments are made to anesthetic levels for each patient to keep the patient comfortable and safe.

Sedation will be administered before and during your procedure to help you relax and make you sleep. You'll be on your left side as a flexible tube slowly advances into the rectum and colon. The procedure will cause you no discomfort.

If you are scheduled for an endoscopic procedure, plan to be in our center for two to three hours. Procedures such as gastroscopy or colonoscopy require sedation for safety and comfort. Although the test takes about 30 minutes, you will need extra time for registration, preoperative check-in, the test itself, and postoperative recovery. Currently, our patients' average stay is less than three hours. Suggest to your accompanying adult to bring something to help pass the time. Free Wifi is available in our waiting room.

In most cases, yes. Our doctors are trained in the latest endoscopic techniques. All but the largest polyps can be removed at the time of colonoscopy. The polyp is then sent to a pathology lab for microscopic analysis. The final biopsy result is usually available within ten days; after that, the information from the report and any plans for follow-up care will be sent to you and your referring physician.

No. There are many reasons why your doctor may take a small sample or biopsy of your stomach or colon lining. Most have nothing to do with cancer.

No. The physician will talk with your family member or friend immediately following the procedure.

No, you will not be kept overnight in the endoscopy center.

After your procedure, you will probably have a slightly dry mouth and feel drowsy, gassy, crampy, and hungry. The sedation causes dry mouth and drowsiness, and the symptoms will gradually wear off. The gassiness results from puffs of air introduced into the digestive tract during the endoscopic procedure to help your doctor examine the inside of your stomach or colon. Most air is removed before the procedure ends, but some must pass naturally. Don't be surprised when you feel a small tube inside your rectum in the recovery room. This is inserted to facilitate the passage of air to reduce abdominal discomfort. The tube will be removed before you get dressed.

Our nurse will offer you some juice as soon as you wake up. After you get home, you can have a light breakfast or lunch, whatever you feel like. Just go slow at first and use some common sense to avoid becoming nauseous.

Because of being sedated, you must NOT go out to eat; go home to eat. You may stop at a take-out if you remain in the car.

No. Since you will have received narcotics and sedatives during your procedure, mixing alcohol and these medications is dangerous. You may drink alcohol the following day.

No. You cannot drive your car or operate machinery until the next day because of the sedation.

Endoscopic examinations such as colonoscopy and gastroscopy require sedation. The sedation relaxes the patient but will cause grogginess for several hours and slow reflexes for up to 12 hours. This is why you cannot drive your car or perform activities that require quick reflexes until the following morning. It is necessary for you to come with a friend or family member who can safely drive you home after your test is over. We require that your driver stays for the entire time you are treated at our center. It helps us for them to be available to answer questions and allows the doctor to explain your test results in the recovery room. IF YOU ARRIVE WITHOUT AN ESCORT, YOUR PROCEDURE WILL BE RESCHEDULED.

Most patients can return to work the following morning.

They are available immediately. With your prior approval, your doctor will discuss the procedure results with you and your family member or friend. We also give you a written explanation of the results and what future treatment, if any, is anticipated. You or your family member will also be able to ask questions on your behalf as your memory may be impaired by the sedation. Any biopsies of samples taken for lab analysis will be available on a different day than your procedure. Still, you will be contacted when our office receives the results.

CDHN has its own pathology laboratory, with highly skilled laboratory staff and a board-certified pathologist that provides high-caliber results. Having an onsite laboratory simplifies direct communication between our endoscopists and the pathologist, resulting in better patient care coordination and quick test results for the physician. Our pathology laboratory is CLIA certified and contracted with most major insurances. Pathology services are billed separately.

If any polyps are removed and sent to the CDHN pathology laboratory for examination, you will usually receive your results within one week of undergoing your procedure. Some health insurance companies have contracts with other pathology laboratories nationwide, so your biopsy specimens must be mailed to that laboratory for examination, delaying your biopsy results for up to two weeks.

Our Endoscopy Center accepts most major insurance coverage plans. If you have a screening colonoscopy and no polyps are removed, the fee will be approximately $1500. If you have the same procedure at a hospital facility, that cost will almost double to $2500 - $3000. Your health insurance may cover all or a portion of the expense. Any fees are established on the individual procedure. Fees may be discussed with our billing department staff before scheduling a procedure. You will learn exactly how the fees are broken down, what portion you will pay, what your health insurance will cover, and if any additional fees may apply before your appointment.

Our website lists current health plans accepted at Three Rivers Endoscopy Center. The list is frequently updated but may only include some plans accepted by TREC. Please get in touch with our office if your plan is not listed.

Many insurance plans cover colonoscopy and upper endoscopy procedures. Insurance plans vary, so you need to contact your insurance company to discuss your benefits. You will be responsible for any co-pay or deductibles. If you need assistance in determining your benefits, please get in touch with our office. If you are over 45 and have no colorectal symptoms, and you're just having a routine screening colonoscopy, you may be eligible for a free colonoscopy every ten years. Call your insurance company for coverage verification. The procedure code is 45378 or G0121, and the diagnosis code is V76.51. If you're having a colonoscopy because a family member has had colon cancer, the diagnosis code is V16.0, and the procedure code is 45378 or G0105.

Depending on your symptoms or previous diagnosis, your physician will order tests that they feel are medically necessary. Should any of these tests be considered not medically necessary by Medicare, you will be asked to review our Advanced Beneficiary Notice (ABN) which explains the services ordered, the cost of the services, and why Medicare may not consider these services medically necessary. Should you choose to proceed with the treatment, you will sign the ABN accepting entire financial liability.

Should a service claim be denied, we will assist you in working with your health plan.

Co-insurance is the percentage of the cost for which you are financially responsible, according to your health plan. For example, if your insurance covers 70 percent of the allowable fee for a particular service, you are responsible for paying the remaining 30 percent. This is called coinsurance. Co-insurance is separate from co-payment.

There are many variables to this question dependent upon our treatment suggestions. We can provide you with a co-insurance estimate before any services are scheduled.

As a courtesy, CDHN will submit health insurance claims to your health plan. You will be financially responsible for paying any deductibles, co-payments, and co-insurance costs.

The patient is responsible for remitting payment at the time of service. We understand that circumstances beyond your control can arise that create hardship. Please discuss any adverse financial situations by speaking with a Billing Manager BEFORE your visit to the clinic or procedure if you cannot pay your balance in full on the day of your appointment. Otherwise, your procedure may be rescheduled

Once your insurance carrier has reimbursed us for your visit or procedure, any remaining balances will be billed to you. Payment is due upon receipt.

Our office practice CDHN does have online Bill Pay at PAYMYDOCTOR.COM. (Check “Quick Pay” and follow online prompts.) Our Endoscopy Center (TREC) does NOT have online pay.

You will receive one bill from our facility (Three Rivers Endoscopy Center) for professional services performed by the physician, one statement from the Anesthesia group that administered and monitored your sedation, and one bill from the pathology lab if you had tissue biopsied or removed.

When you have a procedure at Three Rivers Endoscopy Center, your insurance company will be billed by the following entities: The Center for Digestive Health (CDHN) will bill your insurer for the professional services provided by your gastroenterologist. For billing questions, call (412) 262-1000 and select option #6. Three Rivers Endoscopy Center (TREC) will bill your insurance for facility costs, including equipment, procedure rooms, supplies, staff, and medications. For billing questions, call (412) 262-1000 and select option #6. Perioperative Anesthesia Consultants is our anesthesia provider. Please expect an invoice from “Perioperative Anesthesia Consultants for anesthesia services provided during your procedure. For billing questions, call 800 222-1442. You may also send an email with billing inquiries to customer.service@anesthesiaLLC.com. For anesthesia questions NOT related to billing, please contact admin@periopanesthesiainc.com. Pathology Lab. If you had polyps removed or biopsies taken, the lab will bill your insurance for the laboratory's processing and pathologist's interpretation of the results of the biopsy specimens. If you have questions regarding a bill from CDHN for pathology services, then you should contact our Billing Department: (412) 262-1000, Option 6. For questions regarding bills from other labs (i.e., Quest, Heritage Valley Health System (HVHS), etc.), then you should contact the phone number on their invoice.