The Clinic at Beverly Hills

Celiac

What is Celiac Disease?

Celiac disease (CD)is a serious autoimmune disease that occurs in genetically predisposed people where the ingestion of gluten leads to damage in the small intestine. It is characterized by the presence of chronic inflammation of the small bowel’s mucosa and submucosa.t is characterized by immune-mediated enteropathy, associated with maldigestion and malabsorption of most nutrients and vitamins. It is hereditary, meaning that it runs in families. People with a first-degree relative with celiac disease (parent, child, sibling) have a 1 in 10 risk of developing celiac disease. It may start at any age, both during childhood and adolescence, and is also relatively common in adulthood.CD is associated with increased rates of several diseases, such as iron deficiency anemia, osteoporosis, dermatitis herpetiformis, several neurologic and endocrine diseases, persistent chronic hypertransami-nasemia of unknown origin, various types of cancer and other autoimmune disorders. Treatment of CD dictates a strict, life-long gluten-free diet, which results in remission for most individuals, although its effect on some associated extraintestinal manifestations remains to be established.

Symptoms

The clinical presentation of CD varies greatly, ranging from asymptomatic to severely malnourished patients.

  • abdominal cramping pain with moderate to severe abdominal distension
  • frequently associated with relapsing or permanent dyspepsia
  • presence of gastro-esophageal reflux (GERD)
  • recurrent episodes of altered bowel habits (diarrhea and/or constipation)
  • weight loss
  • bone disease
  • anemia
  • Weakness
  • abdominal distension after meals
  • bloating flatulence
  • lactose malabsorption
  • Edema
  • Bone or joint pain

Cause

  • Unknown but is thought to be primarily immune mediated (tissue-transglutaminase autoantigen)
  • Often the disease is inherited

Triggers

The triggers for CD are specific immunogenic peptides that are present only and exclusively in the dietary gluten proteins, from wheat and similar structural cereals such as rye and barley. These peptides are resistant to digestion by gastric and pancreatic enzymes and find their way into the lamina propria of the small bowel, presumably after some changes occur in the intercellular tight junctions with an increase in the intestinal permeability.

Tests and Diagnosis

  • Serological screening tests
  • Endoscopic
  • Jejunal biopsy

Treatment

  • Gluten-free diet (Strict lifelong adherence to a GFD, in which the patient must avoid permanently all kinds of food products containing some wheat, rye, barley and oat)
  • Immunotherapy
  • Administration of iron preparations

Recipes

  1. Arugula & Canadian Bacon Egg White Omelet

Ingredients

  • 2 tablespoons Butter divided
  • 1 cup Arugula
  • 4 cherry tomatoes halved
  • 2 tablespoons Red Onions chopped
  • 3 Egg Whites
  • Salt & Pepper
  • 1 heaping tablespoon Basil fresh, sliced
  • 1 slice Jones Dairy Farm Canadian Bacon chopped

Preparation

  • Melt 1 tablespoon butter in 10-inch nonstick skillet over medium high heat.
  • Add arugula, tomatoes and onion and cook for 1 minute.
  • Remove from skillet and set aside. Wipe skillet clean.
  • Whisk egg whites with pinch of kosher salt and black pepper. Melt remaining butter in skillet over medium heat. Pour in eggs and cook for about 5 seconds. Lift cooked egg up around edges to allow uncooked egg to flow underneath, until omelet is set but top is still moist, about 2 to 3 minutes.
  • Arrange vegetables, basil and Canadian Bacon on one half of omelet and carefully fold over. Cook for an additional 1 to 2 minutes, or until heated through. Transfer omelet to plate and serve immediately.

  1. Baked Tomato Cups

Ingredients

  • 4 Medium Tomatoes
  • 1 Tablespoon Butter or oil
  • 4 Eggs
  • 2 Tablespoons Cream
  • 6 Jones Dairy Farm Golden Brown Breakfast Sausage Links sliced
  • 1 Cup Cheddar Cheese shredded
  • 2 Tablespoons Basil fresh

Preparation

  • Preheat oven to 350˚F. Slice tops and stems off tomatoes. Use knife to cut around inside of tomatoes and loosen ribs and seeds. Scoop out with spoon and discard.
  • Heat butter or oil in skillet over medium-low heat until melted. In medium bowl, whisk together eggs and cream until well combined. Season to taste.
  • Pour egg mixture into skillet and let sit 30 seconds without stirring. Then use spatula or wooden spoon to stir, lifting and folding from bottom. Continue until eggs are cooked through. Add sliced sausage to pan and stir. Add half of shredded cheese, stir to combine.
  • Fill each tomato with mixture and top each with remaining shredded cheese. Bake 10-20 minutes, until tomatoes are tender and cheese is melted and bubbly. Sprinkle with fresh basil and serve.

Dr. Ravi Kumar completed his Bachelor of Health Sciences at McMaster University. He then pursued his Medical Doctorate and Urology residency at The University of Ottawa. He subsequently completed a fellowship in Urologic Oncology and Robotic Surgery at the Princess Margaret Cancer Centre at the University of Toronto. During his fellowship, he obtained a Master of Engineering from the Institute of Biomedical Engineering at the University of Toronto. He is the co-lead author of the Canadian Urological Association/American Urological Association guideline on the diagnosis and management of adrenal masses.

Dr. Kumar treats a wide variety of urologic conditions including BPH and kidney stones, with a special focus on delivering cutting-edge care for prostate cancer, kidney cancer and bladder cancer.

Dr. Ashwin Maharaj obtained his undergraduate degree in Biology/Physiology from the University of Western Ontario (BSc). e became certified through is a Diplomate of the American Board of Surgery and was certified as fellow of the American College of Surgeons (FACS) and recently recertified. He is a member of the Canadian Association of General Surgeons. His current clinical interests are devoted to outpatient acute and chronic gastrointestinal medicine/surgery as well as abdominal wall hernia surgery and practices in certified facilities in Toronto. He has research experience in gastrointestinal disease as well as surgical education teaching resident surgeons and medical students.

Dr. Diana Magee completed her undergraduate education at Cornell University followed by a Master of Public Health degree at Boston University. She received her medical degree from Queen’s University and completed her urology residency at the University of Toronto. While in residency she enrolled in the Surgeon Scientist program and completed her Master of Science in Health Services Research. She completed her fellowship in urologic oncology at Fox Chase Cancer Center in Philadelphia. Dr. Magee’s area of expertise is in the management of urologic cancers as well as performing minimally invasive surgery.

Dr. Pianezza completed his medical degree (MD) at the University of Ottawa in 2002. He became a member of the Royal College of Physicians of Canada (FRCSC). He then completed a one-year fellowship in minimally invasive surgery and endourology at the University of Alberta in Edmonton in 2008.

Dr. M. Pianezza has been a staff urologist in Sudbury at the Health Sciences North since January 2010. He was Head of Urology from February 2013 to September 2016. He is an Assistant Professor of Surgery at the Northern Ontario School of Medicine.

Dr. Heimrath completed his medical school at the University of Ottawa, his surgical residency at McGill University, and his Endourology, Minimally Invasive, and Robotics Fellowship at the University of Toronto. Dr. Heimrath’s areas of expertise include the management of complex kidney stones and urologic cancers as well as performing minimally invasive surgery. Since 2016, Dr. Heimrath has worked overseas in Malawi and Rwanda to explore opportunities to build urologic and surgical capacity in the developing world. He is a partner in the Urology Global Surgery initiative at the University of Toronto and holds a lecturer appointment with the University of Toronto.

Endoscopy

Procedures & Conditions Treated

SIBO for IBS

Small intestinal bacterial overgrowth (SIBO) is a clinical condition characterized by a malabsorption syndrome due to an increase in microorganisms within the small intestine.

Gastric ballon

The Clinic at Beverly Hills offers patients the option between two industry leading gastric balloon procedures. The traditional endoscopy guided Orbera Gastric Balloon and the revolutionary swallowable Allurion Gastric Balloon.

Laser Hemorrhoid Treatment

Hemorrhoids are a natural part of the human body and, when healthy, assist with the closure of the anus.

Hemorrhoids are vascular cushions that move blood to and from the anus and help support the function of the sphincter. Most people think of hemorrhoids as the disorder known as hemorrhoids or piles.

Stress Urinary Incontinence

Stress Urinary incontinence (SUI) means the uncontrollable loss of urine – an involuntary loss or leakage of urine during precipitating activities like coughing, laughing, sneezing, straining, exercising etc. Early signs of SUI are complaints relating to dysuria, frequency, and urgency. At TCBH Surgical Centre, we offer two treatment options for Stress Urinary Incontinence.

iTind

Benign prostatic hyperplasia (BPH) is a condition in which your prostate grows in size. Your prostate is a gland that rests below your bladder and in front of your rectum. It’s about the size of a walnut, and it surrounds part of your urethra. Your urethra is a tube that carries urine and sperm (ejaculate) out of your body. If your prostate grows in size, it can prevent urine and ejaculation from passing through your urethra. BPH is not cancerous. However, symptoms of BPH may indicate more serious conditions, including prostate cancer. TCBH Surgical Centre provides two treatment options.

Rezum Water Therapy

How The Rezum™ Water Vapor Therapy Works

  • RezumTM Water Vapor Therapy is a novel technology that helps people who are suffering from BPH symptoms.
  • In each application, sterile water vapor is released to the targeted prostate tissue. When the steam turns back into the water, all the stored energy is released, causing the cells to die.
  • Over time, your body’s natural healing response removes the dead cells, shrinking the prostate. With the extra tissue removed, the urethra opens, reducing BPH symptoms.
  • The maximum benefit may occur within three months.
    Patients’ responses to treatment can and do vary.

Nanoknife for Prostate Cancer

NanoKnife or Irreversible Electroporation (IRE) consists of placing a number of electrodes into the prostate to surround the area of significant cancer.

Short pulses of electricity using very high voltage are passed between the electrodes. This causes micropores to occur in all cells, including the cancer cells, which lead to their death.

Dr. Luke Fazio is the current Chief of Urology at Humber River Hospital. Dr. Fazio received his medical degree from McGill University in 1999. Following this, he finished his Endourology and Minimally Invasive fellowship at the University of Toronto. As the Urology Medical Director, he has brought many minimally invasive programs to TCBH and is working on future projects. He currently sits on numerous committees and is an advocate for innovation in healthcare. He is the physician lead for the Da Vinci Robotic Surgery Program. He also is the Chair of the Innovation Committee.

Dr. Bhargava has a primary focus of providing care for her patients in the form of minimally invasive procedures and cutting edge technology. She is the Medical Director of TCBH Surgical Centre (The Clinic at Beverly Hills Healthcare) and has been instrumental in bringing Laser Hemorrhoid Treatment to her Centre.

Achievements:
Dr. Bhargava completed both her medical school and surgical residency at the University of Western Ontario. In addition to her Bariatric fellowship, she has also completed Minimally Invasive fellowship at the University of Cincinnati in Ohio.
Dr. Bhargava has published multiple research papers and lead articles.

Memberships:
Canadian Medical Association, Canadian Association of General Surgeons, Society of American Gastrointestinal and Endoscopic Surgeons, Royal College of Physicians and Surgeons of Canada, College of Physicians and Surgeons of Ontario, and American Society of Bariatric Surgery