My top career choices were pediatric neurology and gastroenterology. I liked the idea of procedures in addition to clinical work, so I decided on gastro. I’ve come full circle though. In my work with autonomic conditions, I’m able to incorporate my love of both specialties.
In large part it’s that I work with my husband who is an autonomic neurologist. They don’t come to see us because we’re any smarter than anyone else, but our collaborating allows us to work in a more comprehensive way in trying to understand the mechanisms of disease.
Autonomic disorders are the result of the body not being able to regulate involuntary body functions. As a GI specialist, I work with patients experiencing neuro/gastro and autonomic conditions such as cyclic vomiting disorder, chronic idiopathic nausea and motility disorders, all of which are often associated with other symptoms. These overlapping symptoms are now called Chronic Overlapping Pain Conditions (COPC). Many patients are coming to us with chronic fatigue and pain that doesn’t show up in scans and tests. We work together, along with colleagues in physical therapy, occupational therapy, psychology and other specialties, using a biobehavioral approach to treatment which includes physical therapy, cognitive behavioral therapy, exercise and other lifestyle changes. When we use medications, we only use non-addictive options to help modulate the pain or improve the motility. We also see younger kids with undiagnosed GI/neurological conditions, working very closely with genetics in these cases. We’re always looking to determine what role the brain is playing or how the way the brain connects with the rest of the body is making the person respond the way they are.
We’re the combination of two people who believe in our patients. We don’t dismiss them, and we think outside the box. I think that’s what makes us different.
A lot of the teens I see with COPC – or combinations of conditions such as irritable bowel syndrome, fibromyalgia, migraines, chronic fatigue and others – have been told in the past that their symptoms are related to anxiety or depression, and there’s nothing that can be done. The first thing I tell them is, “I believe you. I believe in your symptoms.” I often joke that this is what I do for a living. If I didn’t believe my patients, I’d be bankrupt!
I also explain that what they’re experiencing is the result of a software problem, not a hardware problem. Their brain is wired differently, which is why they may have had several GI scopes that didn’t find anything but that doesn’t mean there’s nothing wrong. Then I spend time teaching them how we are going to care for them. Yes, we may use medications, but not in a primary way. Our primary approach is biobehavioral. We’ll take baby steps. If they’ve been curled up in bed, maybe the first step is sitting up with their legs hanging off the edge of the bed as we start challenging their body to a more upright position.
We don’t have a magic pill, and we cannot address their issues in a 15-minute appointment. I spend an hour with my patients at each visit to address all their symptoms and develop a thorough approach to care that’s built on trust.
The brain coordinates how the gut moves and receives signals from the body, which the brain then interprets as pain, bloating, nausea, etc. The brain makes the decision of what is painful and what isn’t. When a person needs to have a bowel movement, the colon begins contracting. Most of us don’t even notice, but kids with autonomic and chronic pain issues often register this as increased sensations of pain. The bodies of people with chronic pain are in excessive sympathetic mode with lower parasympathetic (also called vagal) responses which contribute to the physical reactions and overlap of symptoms.
The opposite of this would be the example of the football player who broke their leg but is so focused on winning the game they don’t realize until later that it hurts.
The brain/gut axis is pivotal to our approach to care as we work to change the way the body is perceiving signals and registering symptoms.
I have a huge vision! We have the right team and facilities to be a top program in the country. In terms of patient care, I want to expand our clinics for inflammatory bowel disease, feeding, eosinophilic esophagitis and neurogastrointestinal disorders. I’d like to partner with the adult GI team to provide seamless care for patients from birth to 100.
With the exciting news about VCU Health’s new Institute for Liver Disease and Metabolic Health, there is great opportunity for developing our liver transplantation services in pediatrics as well. We’ll be looking to bring two hepatologists onto the team in this process.
I also want to increase our role with medical students and residents and develop a pediatric gastroenterology fellowship program. This next generation of providers is who’s going to continue our work.
Lastly, we’ll be investing in research. We can’t be a top GI program with clinical work alone. Faculty come to an academic medical institution to grow in this area and we want to allow them the time and space to do so. Research also brings new technology and innovation, which feeds better patient care.
These are the pillars of an academic medical center – patient care, education and research – and we’ll be cultivating all three.
Our team is here for them. We’re working hard to increase availability and make it easier to make appointments for common concerns, as well as complex issues that have been difficult to diagnose and treat elsewhere. We want to be in the community, so they have easy access to us while we’re continually improving patient care and incorporating research.
I want patients to know that I believe in family-centered care where the child and caregivers are key members of the team. They’re important and they deserve to be heard without feeling hurried.
For pediatricians, we will get back to them when they call, and they will get a letter after every visit. Whether they’re looking to refer a patient or for advice on next steps, we’re here for them and for the kids.
Continued growth of our people and programs is fueled by Children’s Hospital Foundation and generous donors in our community. Your support helps us recruit and retain top talent like Dr. Chelimsky.
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