Bridging the knowledge gap in cyclic vomiting syndrome

Steve Wartenberg: Welcome back to our ongoing series on cyclic vomiting syndrome with Dr. V. I'm Steve Wartenberg, and this is Dr. Thangam Venkatesan, the world's leading expert on CVS.

Today's episode is called Bridging the Knowledge Gap in CVS, and we'll talk about CVS education and training here at Ohio State and how it can help improve the diagnosis and treatment of CVS for people here in Ohio and well beyond. We have three special guests who will meet over the course of this episode, so Dr. V., why don't you get us started by introducing our first guest?

Thangam Venkatesan, MD: I'm really pleased to have Dr. Antoinette Pusateri. She's a third-year fellow. She's also the Chief GI fellow for our fellowship.

Steve Wartenberg: Okay, so Antoinette, how has the opportunity to work with Dr. V. helped not only you in your education, but also how you helped to train your fellows?

Antoinette Pusateri, MD: Absolutely. Well, Dr. Venkatesan has really helped us elevate the academic experience in cyclic vomiting syndrome, but really all of neuro gastro motility. Dr. Venkatesan really brings us the evidence, a lot of which that she did and researched and published, just really telling us through her experience, patient stories, and guiding us as we learn how to care for these patients has been a really incredible opportunity.

Also with our education, so we have a series of lectures for the fellows as they progress through their training, and we have a whole neuro gastro motility series that Dr. Venkatesan helped create along with her colleagues, of course, and really fun, creative, interactive ways that again, we can reflect on and study the research, the patient cases, and really be able to bring that next moment to help somebody.

Then the research opportunities, Dr. Venkatesan brings that research just experience and how to do research, how to ask these focused clinical questions, and that helps us no matter what field of GI we end up going into.

Steve Wartenberg: Wow. Do you know what field of GI you're going to go into?

Antoinette Pusateri, MD: I do. I actually will be going into inflammatory bowel disease, so the care of patients with Crohn's and ulcerative colitis. That's exactly what we talk about. The disorders of the gut-brain interaction happen in all patients, and so everything that we talk about and we learn and study I know I'm going to use to help my patients as a specialist here too.

Thangam Venkatesan, MD: Yeah, and I really do need to give a shout-out to Antoinette. We work very closely with our fellows, and I really think it's very important to foster the next generation of learners. So, I think definitely the learning experience, not just in clinic and with Antoinette's help, we have a whole series of presentations and lectures, and this itself is something that I'm very grateful that Antoinette could come and do with us. Then hopefully, other fellowships around the country will follow suit and do this.

Steve Wartenberg: Now, I understand you're not satisfied with the status quo and you're expanding the program. Tell us a little bit about what you're going to do to make it even bigger and better.

Thangam Venkatesan, MD: We really need to start at a grassroot level, and I'm really happy to say that actually, we have started the first cyclic vomiting syndrome fellowship. It's a dedicated one-year program where fellows will really be spending time with me in my clinic doing research and also on the inpatient service, understanding how to manage this. So, I'm really very excited that this CVS fellowship is starting and the GME ... It is a GME program, and we will be having our first fellow shortly.

Steve Wartenberg: Wow. Okay. Well, thank you, Antoinette, and good luck-

Thangam Venkatesan, MD: Thank you.

Steve Wartenberg: ... in the future, and-

Thangam Venkatesan, MD: Thanks for having us.

Steve Wartenberg: ... we'll be right back, and we'll meet another fellow with a bit of a international flavor.

Thangam Venkatesan, MD: This is Dr. Saranya Arumugam, and she's actually one of our visiting CVS research fellows.

Saranya Arumugam, MBBS: I graduated from Kilpauk Medical College. It's one of the prestigious colleges in Southern India. I've always been interested in gastroenterology, especially the GI neuromotility disorders. I wanted to be a physician-scientist.

I came to know about Dr. Venkatesan's work in cyclic vomiting syndrome and how she's trying to navigate her way into this typical disorder, which we have a very poor understanding about. Being able to contribute in some way to help people with this condition with CVS research has been really great, and I'm looking forward to further research in the future.

Steve Wartenberg: How do you think this year here is going to impact your future career?

Saranya Arumugam, MBBS: Because I wanted to be a physician-scientist in U.S., here, I'm learning a lot about U.S. healthcare system, and I'm learning about research, and I'm also shadowing Dr. Venkatesan in her CVS clinic. I think this is facilitating me to have a smooth transition into my residency period, yeah.

Steve Wartenberg: Dr. V., you're creating an international tree of mentees, so why is that important, and who's next?

Thangam Venkatesan, MD: Cyclic vomiting syndrome is not something that's only prevalent in the U.S. I think it's actually very underdiagnosed and misdiagnosed, and one of my goals is to increase awareness of CVS, not only nationally, but also globally because I think it's very important. CVS affects people wherever they are.

Really, my intent with this aspect of the educational initiative is to have people from different countries. They come and they learn about it, and they really take all this back to their country. I think it's important to make these bridges so that we can actually work globally as a community. So, the hope is that this will inspire them to really pursue careers either clinically or become physician-scientists, but ultimately, this is all going to grow.

Steve Wartenberg: Saranya, thanks for joining us, and good luck in your career here or wherever in the world it takes you, and we'll be right back with our third special guest.

Thangam Venkatesan, MD: This is Dr. Abdulla Nasser, and he's actually one of the hospitalists at the Ohio State University. He's really played a very pivotal role in a collaborative effort to develop what we call clinical practice guidelines for the management of CVS at OSU.

Steve Wartenberg: Oh, so Abdulla, tell us how you two met and began to collaborate.

Abdulla Nasser, MD: Yeah, sure. Almost my first year, I was fortunate enough to be introduced to Dr. Venkatesan, and we decided that we need to develop a local clinical practice guideline for the management, the diagnosis of cyclic vomiting syndrome.

Thangam Venkatesan: While we have the national guidelines, I think it's very important to really make sure that one, people are aware, hospitalists and providers and even ED physicians are aware that there's national guidelines, two, make it easy for providers in an inpatient setting to follow the guidelines. Because you can have the best guidelines in the world, but A, nobody's aware of it, and B, if you don't make it easy for them to follow these guidelines, it's not going to work.

Abdulla Nasser, MD: Yeah, so when we decided to put together a team, we realized that it had to be a multidisciplinary team that involved a representative from a ED, the ED physicians-

Steve Wartenberg:
Emergency department.

Abdulla Nasser, MD: ... Emergency department, a representative from nursing, a pharmacist, hospital medicine, gastroenterology, as well as case management. Once that team was in place, everybody was able to add something to the process, and we were able to finalize our own OSU clinical management guideline for the management of cyclic vomiting syndrome.

Steve Wartenberg: If I understand this correctly, there's national guidelines that you help develop. How do we incorporate these locally for patients that you may not see, but you're going to see in the hospital, either in the emergency department or inpatients at the Wexner? This are the steps we need to do to treat these people properly.

Abdulla Nasser, MD: Correct, correct. The final product was a clean, simple, easy-to-use document that is very user-friendly, any provider is able to read it, go through it. We actually took it one step further, and we used this guideline to come up with our own cyclic vomiting syndrome management electronic medical record order set to make the management of these patient a little easier as well.

Our goal is over the next few years to see more and more CVS patients in the hospital as they come in an acute episode and treat them properly, but then the very last step should be the proper referral to the CVS clinic.

Thangam Venkatesan, MD: So now, the ED department and the hospital section understands that there are these care plans, so there's less frustration on everybody's part. There's a very clear pathway now.

Steve Wartenberg: Putting together this plan, where are you with it? What stage is it in?

Abdulla Nasser, MD: Yeah, recently the clinical practice guideline for CVS was approved by the OSU Committee, and it's now available and ready to use by a provider.

Steve Wartenberg: Thank you, Dr. V. and Abdulla, Saranya, and Antoinette for filling us in on how Ohio State is leading the way in bridging the CVS knowledge gap. Thanks for joining our ongoing series on cyclic vomiting syndrome.

The Ohio State University Wexner Medical Center logo

For more information, visit wexnermedical.osu.edu/CVS