Written by Swati Iyer
Dr. Dyer Heintz is a Pediatric Gastroenterologist working at Dell Children’s Medical Center in Austin, Texas. I had the wonderful opportunity of meeting with Dr. Heintz, who took time out of his busy schedule, to talk about gastroparesis and his life as a pediatric subspecialist. Here’s what he said:
What is your routine like on a daily basis?
In our office, we split call. We take call for a week at a time, day and night. During the day, when we are on call, we may see one or two patients in the clinic, but most of our time is spent at the hospitals. We cover Dell Children’s Medical Center, hospitals that have NICUs and another with a small pediatric unit. At night, we answer phone calls from parents and the emergency rooms. Occasionally, we get calls where children have swallowed a battery, or coin, or something else. It feels as though it always happens at two in the morning. We will then go in to perform a procedure to remove the foreign body.
The other times we run a clinic. It is normal clinic hours, from 8 AM to 5 PM. During this time, we approximate sixteen to twenty patients a day.
Is gastroparesis a common condition that you tend to see as a physician?
It is not all that common when looking at other conditions, but we do see it regularly. To put it into perspective, celiac disease is much more common than gastroparesis. In kids, gastroparesis tends to be shorter lived when compared with adults. When adults have gastroparesis, they tend to have it for the rest of their lives because of diabetes or other auto-immune conditions. However, when kids have gastroparesis, it is usually related to an infection or a medication they are given, so gastroparesis usually presents itself very briefly in kids.
What is your overall approach to treatment for gastroparesis?
Treatment for gastroparesis is very difficult because you are dealing with damaged nerves. Because nerves do not heal easily, it is very hard to make them functional. The medication we most commonly use nowadays is a low-dose erythromycin, an antibiotic which works on motilin receptors in the GI tract. These receptors help to stimulate the gut, which causes better contractions. There are other medications with similar actions such as metoclopramide or Reglan. Reglan tends to not be used frequently because of its Black Box warning of causing tardive dyskinesia. Interestingly, Reglan is the only FDA approved drug for gastroparesis, but it has fallen out of favor due to its side effects. For more of your chronic conditions, especially in adults, a gastric pacemaker is placed. This is a device that actually sends an electric signal to the stomach, causing the stomach to contract.
What advice would you have for a parent whose child is diagnosed with gastroparesis? Any local resources for parents?
The best local resource for parents in Austin would be a pediatric gastroenterologist. There is no local group or foundation specific to gastroparesis. As far as advice goes, it really is patience more than anything else. It takes time. Most kids are going to get better – that is often the case with pediatric patients. If an underlying cause is known, it is easier to treat the condition. But again, most often, this condition just self resolves. For most kids, gastroparesis lasts for a few months, and is usually not a recurrent condition, unless there is an underlying cause for the illness, such as autoimmune diseases or motility disorders.
Favorite part of being a GI Doctor?
I like the variety. I have clinic, but I also like doing procedures. It is really satisfying that I can find an answer while doing a procedure because many things in medicine can be more esoteric. I also don’t just work with one organ, which makes it more exciting.
Any words of advice for someone who wants to follow in your footsteps?
This has to be something that you really want to do. Subspecialties in pediatrics, specifically, have to be something that you have a desire to do since they require a longer time commitment to training. It really has to be something you are passionate about. Otherwise, you are going to be miserable and have wasted a lot of time. But if this is what you want to do, it is very fulfilling and rewarding.