What do all the new oral drugs available for treating IBD have to do with military service? Being diagnosed with IBD might mean leaving the military for some service members. Part of the reason is that it’s not possible to be deployed while receiving a drug that’s an injection or an infusion. But when a medication works well and happens to be in pill form: that’s a game-changer. Dr Anish Patel, the Medical Director of the Inflammatory Bowel Disease Center at Brooke Army Medical Center gives an update on how IBD is treated in the military, what he sees on the horizon for IBD, and his best advice for every patient living with a chronic illness.
Find Anish Patel, DO, LTC, FACG, FAGA at:
- Facebook: https://www.facebook.com/anish.patel.31392/
- Facebook: https://www.facebook.com/profile.php?id=100089635157883
- Instagram: https://www.instagram.com/anishpa81/
- Twitter: https://twitter.com/FocusGI2022
- LinkedIn: https://www.linkedin.com/in/anishpa-armyibd/
- Web: https://www.focusgi.org/
- Crohn’s and Colitis Foundation, Veterans with IBD: https://www.crohnscolitisfoundation.org/veterans
- Facebook Support Group for Veterans with IBD: https://www.facebook.com/groups/525843515658644
- VA Podcast Network: https://news.va.gov/va-podcast-network/
- My HealtheVet: https://www.myhealth.va.gov/mhv-portal-web/home
- Veterans Crisis Line: https://www.veteranscrisisline.net/
- Fragmented care and IBD: Outcomes in U.S. veterans: https://ihpi.umich.edu/news/fragmented-care-and-ibd-outcomes-us-veterans
- Irritable Bowel Syndrome in U.S. Veterans: https://www.verywellhealth.com/ibs-in-veterans-1944720
- Kent KG. Prevalence of gastrointestinal disease in US Military Veterans under outpatient care at the Veterans Health Administration. SAGE Open Med. 2021;9:20503121211049112. doi:10.1177/20503121211049112 https://pubmed.ncbi.nlm.nih.gov/34646564/
- Bookwalter DB, Roenfeldt KA, LeardMann CA, Kong SY, Riddle MS, Rull RP. Posttraumatic stress disorder and risk of selected autoimmune diseases among US military personnel. BMC Psychiatry. 2020;20(1):23. doi:10.1186/s12888-020-2432-9 https://pubmed.ncbi.nlm.nih.gov/31941473/
Find Amber J Tresca:
- Verywell: https://www.verywell.com/ibd-crohns-colitis-4014703
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[Music: IBD Dance Party]
Amber Tresca 0:00
I’m Amber Tresca and this is About IBD. I’m a medical writer and patient educator who lives with a j-pouch due to ulcerative colitis. It’s my mission to educate people living with Crohn’s disease or ulcerative colitis about their disease and to bring awareness to the patient journey.
Amber Tresca 0:19
Welcome to Episode 141.
Amber Tresca 0:21
Look, there’s never a good time to receive a diagnosis of IBD. But being diagnosed when you are an active member of the US military brings some specific challenges. For some it may lead to being separated from service. Now that could be for a lot of different reasons, including the need for treatments that are infusions or injections.
Amber Tresca 0:40
However, there seems to be a sea change taking place in recent years. One factor is that there are now more options for treatment that are oral medications. Plus the understanding of IBD is increasing and with more effective treatment options, some people may find that their disease is better controlled overall.
Amber Tresca 0:57
My guest is Dr. Anish Patel. Dr. Patel is the medical director of the Inflammatory Bowel Disease Center at Brooke Army Medical Center. He is also the only formally trained IBD specialist within the Department of Defense.
Amber Tresca 1:10
He explains the challenges of managing IBD during active military service, how he helps people stay in the military once they’re diagnosed. And he offers some tips that anyone living with IBD or chronic illness needs to hear.
Amber Tresca 1:24
Dr. Patel, thank you so much for coming on About IBD
Anish Patel, DO 1:27
Oh, thanks again, Amber for having me. I really appreciate it.
Amber Tresca 1:30
Oh, it is my pleasure. Absolutely. So I wonder if you would start by introducing yourself. Sure.
Anish Patel, DO 1:35
Sure. My name is Dr. Anish Patel. I’m actually an active duty Lieutenant Colonel in the US Army. I’m currently the director of the IBD Center here in San Antonio at Brooke Army Medical Center. And I have the opportunity on the only average trained person in the US military. I got trained in Mount Sinai around 15-16 When I got trained in it,
Amber Tresca 1:56
Dr. Patel, that was actually my first question for you. I read that you were the only formally trained IBD specialists within the Department of Defense, which I found absolutely wild. So I wonder if you would start by telling us why did you decide to make this your focus?
Anish Patel, DO 2:18
Yeah, you know, it’s funny. My fellows always asked me this question, too. Every time they see IBD patients are in clinic, the first question he has is Why did you do this? And it not to be offensive, any IBD patient? It is a difficult field. I mean, patients are complicated, they’re really sick. I think it was a niche need. You know, when I when I graduated fellowship in 2013, I actually want to be a liver specialist, I actually want to be hepatologist. I was geared towards it ready to go? Right?
Anish Patel, DO 2:49
The day before. The military does like a matching system. Right? Didn’t even quite pull my I pulled my my application. I say, You know what, I don’t know if I want to do live from the rest of my life. So that, you know, I spent like a year up at, you know, Fort Cavazos, which is now North Fork, or previously North Fort Hood. And I saw like 80 patients, I mean, to the point where they’re getting mismanaged, I mean, civilian network, wherever they’re at, we’re getting really mismanaged. I’m like, You know what, this is something especially active duty soldiers, mean people that, you know, I put the uniform on for, for a reason to help these people. And they’re coming in like, miserable, sick, I was like, I, you know, I like I, I started liking it, you know, once I started helping them, getting them on therapies, like getting better.
Anish Patel, DO 3:29
So they can I can maybe make this like, hopefully a career for myself, you know, my own personal stuff me, I went through some medical issues, and I haven’t been able to scope because my medical issue so I was like, Well, if I can’t scope, what am I going to do? I mean, you know, the livelihood of most doctors just scoping. So then so then, you know, this became the passion, IBD became the passion because I, you know, my medical disease doesn’t affect my brain. If I can still think and help people that I’m going to do it. So that’s kind of how I fell into IBD.
Anish Patel, DO 3:56
You know, there are mentors too. I mean, I you know, I had the opportunity with Crohn’s and Colitis to go to one with fellowship at in San Francisco with Dr. Mahadevan and her husband, and that really kind of like solidified my interest in IBD. And obviously, you know, then go into Mount Sinai just, I mean, some of the big name figures that you know, at Sinai, I’m Columbel to Dubinsky to quorum with me, these are juggernauts in the field that I got the chance to sit down to next to get to know them as as not just super humans, but humans. Got to know them as people.
Anish Patel, DO 4:30
We really got to be very humbled. I really did solidify him after the fellowship, it really solidified. This is what I want to do. This is my passion, my interest. And I think the nice thing was in the military, there was nobody who did it. Yeah. Nobody, nobody, you know, was selected ever in a row anytime in the military history and gastroenterology to anybody wanting to go do an IBD fellowship.
Anish Patel, DO 4:52
So for me, it was one probably more of a livelihood thing is that you know, it’s one of the things like I will always have a job number one, number two Who’s gonna be it was a nice, nice practice. I mean, you know, for me, like, I’m the only person doing this in the military, you know, dead set forth, you’re trained in this one. So, you know, it allowed allowed me to have my agenda, which is very small, but it’s more to push military medicine to the brink and get people taken care of with it.
Amber Tresca 5:20
It’s really interesting, you know, because it’s, it’s, it takes into consideration your own personal interests, but then also the people you met along the way. And then also just other things that just set you on this path, which I’m grateful for, because there’s clearly there’s clearly a need, I can’t believe I still can’t believe you’re the only one. Yeah,
Unknown Speaker 5:40
yeah. I mean, it’s, it’s like a, it’s like a blessing and a curse at the same time. Yeah, is that, you know, I had mentors that pushed me to do it. And, you know, you really kind of fought in, you know, got the paperwork through and enabled me to go do it. But you know, the curse is I am the only one before you’re trained. I’ve been very lucky because I get to train fellows every single day. And I’ve had via one of my good colleagues, Dr. David Delaney is with me now. And he stayed on his staff. And so he’s like the next, you know, he really can take her on IBD with me.
Anish Patel, DO 6:01
And I also have fellows that graduated other sites that are interested in IBD. So, you know, for me, you know, it is a bit of a curse, but it’s also something we build on. I think that’s what it is, I mean, even even on the only person but I can build on that, and hopefully get more people interested in it. But also highlight the fact that the military does have these issues, they do have people that have this disease is a little bit of a different way we manage them on when it comes to typical civilian people. And I think that’s where that’s where the blessing of doing that fourth year does help with that one,
Amber Tresca 6:48
You lead right into my next question, which is, what is the difference in what you do versus what is done in the civilian space for IBD?
Unknown Speaker 6:57
Yeah, yeah. That’s a great question. So one of the big things we do so for example, if you’re in civilian sector, and you got diagnosed today, you know, you’re obviously going to take in consideration your jobs and what you do, obviously, okay. But it may not affect your livelihood. Like, if you’re a CEO of a corporation, you can still go into Fusion, or an injectable, and be fine. In the military, you can’t.
Anish Patel, DO 7:23
So if you’re if you’re a pilot, for example, I can’t put you on injectable therapy, because they can’t fly in the plane with injectables, they can’t refrigerate that one out, you know, my army folks who get deployed, that they’re sleeping in tents outside, you know, they can’t, there’s not like you get like a nice little like, Maytag refrigerator, you know, deployed west. So you can’t keep it in the fridge. So becomes a really big logistical thing, too.
Anish Patel, DO 7:47
And this is where the orals you know, help us a lot. So, you know, for me, I have to take into consideration not, not obviously what they want to mean, obviously, you know, if, you know, there are considerations on treatment manager, but also I have to be aware of what the military wants to remember, you know, visit volunteer service. So, many of these folks, you know, come in these guys and girls come in, and they, this is their livelihood. This is they want to make a career out of it, and then they get diagnosed with something to build have IBD you know, no one asked them to get it, you know, you know, you know that we always have the joke in your armies that if the army wanted to have something, they’ll just, they’ll just, they’ll just keep it to you. Okay, you know, the supply for you know, it’s it gets applied IBD.
Amber Tresca 8:27
So I think that’s where the big difference is, like I needed to take their career to consumption, but also military. I mean, I need to make sure they can deploy and make sure they can do their job, what they’re doing, because if we lose some people, what happens, your donation can’t get protected very well. Mean, so there’s a lot of, you know, interplay with with might not just medical management, their job, but also career limitations, all kinds of stuff that goes on that I can say to my buddies at the IBD Center has to it’s like, you know, every single time is like, well, how are you different? Anybody else? Well, we do and I give them the same thing. I just kind of told you that like,
Anish Patel, DO 9:05
We think about that. We go Yeah, that’s right. That’s my job. To think about that. Yeah. Yeah. So it’s a little bit different spin on how we manage them with it. Yeah.
Amber Tresca 9:14
100% and it makes them it makes perfect sense. But also, though, it goes beyond injectables, because people with IBD need more care than just, you know, prescribing them a drug. So how do you work with other providers in order to give your patients that holistic care that patients need?
Unknown Speaker 9:34
That you know, you know, the whole house and you hit on the big thing, Amber is going to be this whole multidisciplinary care kind of package. And it’s talk we’re military, okay, you know, I don’t have the courtesy of an ivory tower where we get tons of funding and I can have a dietician a psychologist and a coordinator.
Anish Patel, DO 9:52
And I remember I mean, I get what I get, unfortunately, okay, we were able to build IBD center from scratch with whatever Scott’s like. Yeah, I mean, so I don’t have an embedded dietician, I don’t have an embedded psychologist, we have vetted, like, so we had divisions that have this, their departments that are there. So I embedded some psychologists to help us, um, nutrition been a little bit of a tough deal.
Anish Patel, DO 10:13
So I actually, myself got selected to go to Cedar Sinai Nutrition Program, which is year long program. So I personally took it on my own is to be the only person and IBD in the military doing nutrition, also, nutrition IBD. But part of that, I mean, obviously, I can’t we can’t do I mean, we have 1520 minute appointments. So we all know we can’t do everything and that whole time. So we started doing this, we started kind of farming it out a little bit. So my mentors at Mount Sinai. So this is, you know, with Dr. Dubinsky and Dr. Keefer, when they started Trellus Health, Trellus Health has been a huge, really big game changer for us and militaries, for example. It’s because they take care of all the ancillaries that we don’t have, the military will pay for, from social working to nurse practitioners to IV nutrition that are trained in their program.
Anish Patel, DO 10:20
So we have been able to offload a good chunk of patients to them, to help them help us and they co manage it. So they’re not going to sit there and you know, go and say, oh, you know, this patient found that allows you to change your biologic, they’re taking care of you. So So psychosocial aspect of the thing to help us out. Like I would do some of it in clinic like my fellows know how to do it might you know, I teach them how to do it, but it mean, you open up Pandora’s box?
Anish Patel, DO 11:28
I mean, the one big question my fellows hate, hate when I come in to their room to talk to a patient is how are you doing? It is it is like, it’s the most simple question you can ever ask somebody in IBD patient and not so much. The cat comes out of the box, and then 20 minutes when he goes into 40 minutes with that one, and we get pushed behind. That was so a lot of the you know, for the first like couple years, I mean, I was doing everything. And it was tough. It was tough trying to do nutrition and psychology and stuff like that. And I I don’t have a psychology background. I’m not I’m not a psychologist.
Anish Patel, DO 12:06
So for me kind of doing like resiliency training, coping kind of stuff. I’m not I mean, I learned it and was very lucky to be with mentorship with Dr. Keefer at a Sinai. But I can’t do a whole session like she does. So you know, with her help a lot of generalized psychology with her push a lot of people to her independent kind of stuff. But now that they started their own platform with trellis, it’s been a huge game changer for us. So lots of we’re now we’re kind of saying Roman Roman Roman well, as another dietary one that I do recommend patients to also, I bet a lot of these things. I’ve been myself, like, I will personally go talk to them. Me it unfortunately, in San Antonio itself.
Anish Patel, DO 12:47
And this is like, it’s not just us. And this is like, across the whole country. There’s obviously a lack of psychological care. I mean, because they’re inundated. But also finding somebody that’s dedicated to chronic care management that I nutrition is as dedicated to gi kind of stuff is very hard to find. Right? You know, for years, I’ve been told all the time, by you know, some of my colleagues at Ivy towers is that, well, usually you’ll find somebody was like, Okay, awesome. So you want to interview like 50 people, but only me, I don’t have time for this kind of stuff. without one.
Anish Patel, DO 13:21
So we’ve been very lucky now that we have Trellus. Now, a lot of stuff we’ve been in kind of kind of piggybacking with them and helping us with that kind of holistic care kind of management with it. But I also, again, my military ones are very dedicated folks. I mean, so a lot of them are doing, you know, we’re very lucky at the military base, we actually have a Wellness Center. So a lot of them doing yoga, we can send them out to like chiropractic kind of stuff, we can send them out to like acupuncture. So I will add your more complimentary kind of stuff along with the to the kind of kind of piggyback with it too.
Amber Tresca 13:53
Yeah, I’m glad you’ve found those resources, because you certainly don’t need anything else to do in your life.
Anish Patel, DO 13:58
It’s never been easy at all, ever, ever. There’s no such thing.
Amber Tresca 14:25
So there’s something that I have been thinking about the past several years, as I’ve interviewed some active service people, and then also some veterans who were separated from the military due to their IBD. And so I’m just wondering, like, what might be the difference? And can you talk about some of the things that you’ve seen and why people might be separated or why they might be allowed to stay?
Speaker 2 14:51
Yeah. So it’s a great question. So I will tell you where we were five years ago, a lot of this changed for us and that will was because the oral therapies. So So you know, like I mentioned before, if you’re an infusion, biological agent, whether it be infusion or a injection, you can’t deploy. Once you say you can’t deploy, automatically, you go through what we call a medical board. You’re the military, each one Air Force, Army, Navy, they all have their own on the whole regulations. If you don’t meet the deployment regulation, you end up going through this process.
Anish Patel, DO 15:25
So a lot of people ended up unfortunately, you know, you know, asking the disease, but you need a therapy, that’s maybe the biological agent at that time. And you can’t stay depending what the job was, too. So there’s a lot there’s a lot of interplay with stuff. But the basic factors tend to be with our job was, for example, if you, if you’re someone who’s in a tank, you know, working in the tank all day, you know, the tanker, or like f 16 pilot, you can’t be on infusions, injectables, it just, it doesn’t you can’t sustain that you can’t be deployed on that kind of stuff.
Anish Patel, DO 15:55
About five years ago, when we had the first Jak inhibitors came out, this was a game changer for us. I mean, like, mine was a game changer. Now we have another three orals now, to Jak inhibitors into ES one PS, this has been a huge game changer for us. Because a lot of times what you can do now is use these folks, once you get them under control and oral therapy, I can deploy them because the bottom so they can do take like a six month shipment with them in their in their backpack with them. And then they can also get it. So we’ve gotten to the point where we’ve also talked to their like their their line chain, the pharmacy chains as a hey, can you supply them? If they went somewhere? Can you supply them this though? Yeah, we can they come it comes in a big ol shipment and they can they can get over there. So that’s really been a big difference between us right now, in the last five years.
Anish Patel, DO 16:43
That one, the other big things play a role too, like they had surgeries or the complications that that plays a huge role to you can’t have multiple resection really can’t have a pouch that we get. I’ve kept out patch patients. But I think the overall arching thing, you have to have an advocate, I think that’s what I learned when I when I got when I was in fellowship. You know, these folks, even though they were really adamant they want to stay in the military, they didn’t have an advocate for themselves. Because most of the providers like well, you have IBD based on the regulations, well, you gotta get out. We’ve changed it.
Anish Patel, DO 17:17
I mean, we all said, you know it before me here, my colleagues, I’ve changed the paradigm is, you know, we we want to fight for you. We want to fight for the soldiers. I mean, if you want to take your if you want to be John wounded 20 years, I will find a way to fight for you, as the oral therapies come in, so that I can play that game. But also, I will fight for you tooth and nail, I will send letters memos, talk to their bosses, and we do it we ever got a 70% retention rate in the last six years that we’ve done internally that we did the number I mean, it’s like it’s like, it’s a mind blowing number.
Anish Patel, DO 17:47
But again, it’s also based on it’s not it’s not like 1000 patients use it’s still a small number that get that room, but we’re very good at it. Because we can we want to be advocates, I mean, a lot of places may not be comfortable treating IBD. Or they just really don’t understand the implications of regulation. So do I push the envelope? Of course I do. Of course I do. But I push it not to hurt them. But I also don’t want to hurt the military. Because you don’t want to employ somebody, if they’re really sick, and they get sick downrange, like they’re in the middle of like Afghanistan, or Iraq or wherever it happens. And they get sick. I’m putting everybody at risk.
Anish Patel, DO 18:24
So but these are conversations I have in my clinic, these are these are questions like kind of piggybacking your old, your old question and difference between us and civilians. This is part of it, too, is like, you know, you know, you know, I had that education of the patient, like, look, if I put you on this therapy, you might not be able do this. I mean, it is, it might close some doors for you. But it may open some other doors. So I think that’s where the beta economy comes into play. It’s hopefully changing soon, like over the last couple of years, I think we’re going to see a paradigm shift only because we train a lot of the fellows in the military, and they trained with me and my colleagues in the see what we’re doing. So a lot of them will go to other bases.
Anish Patel, DO 19:00
They for example, you know, I just I just went out to traverse the Air Force Base out in California and was talking to them about this kind of stuff. And they’re like, mind blown, like what I can get keep pilots on this stuff. But yeah, they thought this is phenomenal. We need to do this has been a nice, you know, the blessing again, is that, you know, I have the ability to go out to these other places and teach them what we’re doing, and our institution and getting, you know, getting people to stay on letting them do their job and letting that out.
Anish Patel, DO 19:26
We are full careers and military and I have from I have like two to three star generals all the way down to like lower enlisted e ones and e twos I received your is your at the unfortunately kind of at the lower end like II ones that kind of the lower enlisted officers a little bit of a difference. Again, that’s like the minutiae, which I won’t get too much into. That depends on their job, and that kind of stuff.
Anish Patel, DO 19:48
But yeah, but but I think we’re hoping we’re hoping and trying to be policy changes too. I mean, this is something that we’re fighting with, you know, with people up at the Pentagon, and that kind of stuff and my wife myself, my colleagues are trying to fight to Change them with regulation, which are all. They’re all. They don’t take into account mesme in the shocks, we want to change regulation. So we don’t have this happen where we have a lot more people leaving want to stay in, people will fight for them and be able to get maybe we don’t oral therapy and still be able to be successful in their career with it.
Amber Tresca 20:16
Yeah, with these newer oral therapies, some of them might be difficult to get if for those of us that are in private insurance in the civilian space, how does that work for?
Speaker 2 20:30
Sneaky sneaky, sneaky. I like I like I like it. So, so, so much. So we’re funded member so we, we, you know, the military medical system is a funded system right. Now, a lot of times these oral therapies, we do have opportunity to get them first line close to this reason, okay, is that I, I will talk to the pharmacy, I will talk to you know, TRICARE whoever the insurance carriers are, you know, we do it, firstly talk to him and say, Look, I need the oral therapies, I need to put them on first time or therapies, because I need in this day I do if I pull if I pull between so you know, typical military lingo mission capable, or mission, mission non capable.
Anish Patel, DO 21:09
What happens if I tell them? Well, you know, what, I have this, you know, you know, high, you know, high ranking person who’s phenomenal, highly general, but you know, I need the oral or otherwise, you know, if I put them on like an injectable or infusion, they can’t stay in the military anymore. When I say by a lot, what we have done is part of the progress that we’ve done you the fight we’ve done for the last five years, is be able to get these first line, be able to get these JAK inhibitors and S1Ps.
Anish Patel, DO 21:38
Yes, you’re correct. In the real world is very difficult to get them first line. We have strategize and been very lucky to have phenomenal leaders in both the pharmacy inpatient, outpatient pharmacy, but also the use of above that’s fully supported, what we’re doing is more, you’re knocking down bricks, I lose that knocked on bricks one by one, and find it and you really kind of use that that whole spiel that you do the military folks, man, I gotta keep them active. And one thing to do orals and we really, we haven’t had a knock on wood desk here. Knock on wood. I haven’t had an issue so far with that one. Yeah,
Amber Tresca 22:17
I mean, it just makes a lot of sense. So I would, I would hope so. I would hope that there’s not as many fingers crossed hoops that other people might have, because it just makes sense.
Amber Tresca 22:48
So I have talked to a few different veterans who transitioned. And this was usually because they were diagnosed with IBD. And then they were separated from service. And then they had to transfer and you know, learn how to manage the condition, also, while learning how to receive care in a different system. So I’m wondering what kind of advice or tips that you have for people who might be going through that? ,
Unknown Speaker 23:16
Yeah, so So this is a great point. So we actually, it’s funny enough, we actually did a study on this. So I actually was able to get a small grant to do a study looking at transitioning. So what what I would always notice, especially people came in saw me was that their health literacy was very low. Because part of it when I asked them, what happened was your whether you read 21-20, how old you were, you get diagnosed, what happens it’s like getting the cancer diagnosis is like all you have you see and it goes, everything else goes through your head, over your head, you’re like I don’t want in my life I don’t really want to do and, and they forget about everything else around it.
Anish Patel, DO 23:51
So I started learning that, you know, I need to I need to start educating people and us for educating the soldiers, especially in them of transitioning out. So the study idea was looking at the military has own transition process is a standard way to do every single person, every single military sector does this. It’s a one week long process is not being medically oriented. I mean, there’s some VA kind of stuff but doesn’t go through your diagnosis.
Anish Patel, DO 24:15
So I split patients into doing that regular stuff. And then doing that plus me. They we have surveys like to see what kind of what areas of their, of their medical health literacy and that kind of stuff they were lacking. And we do extra education on that one. So we noticed kind of like you we saw, obviously, a big spread, we saw people who were more health literate or have more resiliency or coping skills that they got out of military as opposed to ones who did not have the same training.
Anish Patel, DO 24:40
And we will follow through six months out they got to military, and you know, many of them flared, unfortunately, because of some GI issues. But even though the ones that give teachings to they still maintain resilience and coping, they’re able to manage their care without having to be like, you know, having the detrimental consequences of it. So when we started doing we actually have a transition clinic so we actually PART of our PART of our IV clinic, those who we know are transitioning, we typically will see them, you know, we know six months out, they’re going to be transitioning. Yeah, we don’t know exact date.
Anish Patel, DO 25:10
But within a timeframe, I start I start the conversation, Hey, what is your plan? What are you going to be doing? Do you even know we’re going to be going? Where are you going to be living? With VAs near you, I start that conversation. About three months before they’re getting out, I really solidify it. Okay, okay, what state you go into, you know, who you’re living with, what your job wouldn’t be, we’re getting insurance, we’re gonna go the kind of stuff that and then, you know, a month before they get out, we do the same thing I, that one I read about solidify answers. That one. A lot of times, once they once they get through due to working with paperwork to say that there are other military, we saw that they have contact with us.
Anish Patel, DO 25:42
So many of them will have like my my email address, very select few of my cell phone number. So whether transitioning if they have an issue, they can email us directly, and have contact with us still, and I could give them some more advice. What we noticed when the problem was is that even though we gave them good, you know, health literacy, coping skills, and all that kind of stuff, we still had a gap between getting out of military and the VA kind of stuff. And and that’s a work in progress that we’re trying to work through, that there’s still a lack of limited access to care, depending on where they go, obviously, you know, if they’re going to a big mega city IBD care is going to be easier in the VA, when you go to like small little places, you may not get the care. And a lot of like wait times are like eight weeks to 10 weeks to see a primary care doctor who has the hospital for Gi.
Anish Patel, DO 26:30
So it’s not like you go straight to GI and got a military, you have to go straight first primary care, then gi we’re not they have gi there or not. And so there’s a lot of delays that happen in the back end after they get on the military. With that one, a lot of that stuff is you know, for me, what we’re trying to do now is trying to approach that earlier, a child trying to break them that that that harm and that break, and figure out where they’re going try to find a way to be the liaison between us in the VA and get them and we’ve done a lot with San Antonio VA. I mean, I work with them. I know the docs very, very well.
Anish Patel, DO 27:03
So we do a lot of transitioning between if they stay in San Antonio, I will do a lot between them here in Austin. Also, I do a good chunk up there too, just to kind of have that continuity between them but but it is I mean the once you get into VA system it’s a very I don’t want to say broken because is not the right word. I’m thinking of it. I can’t I can’t remember it’s very disjointed system. Yeah, because there are great IBD centers don’t get me wrong, there was no phenomenal IBD centers within the VA. But they’re like East Coast or West Coast.
Amber Tresca 27:34
Anish Patel, DO 27:35
The whole part of the middle of the US is a big glut. And most human beings and most military people for the most part are in the glut.
Amber Tresca 27:43
Anish Patel, DO 27:44
So it becomes a very difficult scenario. But a lot of times I tend to be advocates for yourself. I mean, I’ve done it where I told people you know, banging Doors Down literally be the jerk future. Well that one to me it sounds awful. It’s awful a doctor saying this one because I’ve been on the other hand, I really don’t want patients being jerks to me for your pain the but that one but but for me as I this is your can your livelihood isn’t this IBD Okay, the last one is a flare.
Anish Patel, DO 28:09
Yeah, even flare because what happens when you’re controlling the military? Could we have pride in what we do in the military, we are pride and getting these people we don’t want to let them leave until they get control of their disease, whichever where the medical therapy surgical, whatever it be. I you know, we don’t want them to leave and go and be in this gray zone and say well, you know, the military had me half covered or half controlled. Now I wait for the VA I don’t know what I’m gonna get in the VA.
Anish Patel, DO 28:35
So we don’t want that we don’t want that gap. That won’t but but a lot of times I tell the veterans is an important place has done a great job as a Crohn’s Society has a website for veterans. If you Google Crohn’s and Colitis veterans there’s actually a whole website that I help how to help Crohn’s or colitis help develop my argument is actually a video on there to hear me again if you want to painfully I’d have to have some alcohol to that one. On with that one. But but it has great I mean, so I help them help kind of spearhead you know, the assets there the handouts, that kind of stuff to help them guide them through the VA debacle sometimes.
Amber Tresca 29:17
So we talked about oral therapies and how that’s been a game changer actually didn’t realize I knew that it would be but it didn’t realize how big of one it would be. Is there anything else that’s being researched? Anything you’re researching or anyone else’s doing that may help any of these process either keeping people retaining them or helping them as they transition and in avoiding flare ups during that during that gap time that they have?
Anish Patel, DO 29:44
Yeah, we were surprised to be surprised how what you’re gonna do like I literally have no idea like in last few years removed a lot of the oral therapies. I didn’t realize how much we were going to use like when they first came out. I was like, I don’t know if people are going to use it or not for so you see infusions injectable Rules.
Anish Patel, DO 30:00
When you start dabbling and realizing that oh my goodness, like we can we can do like, mind blowing things with these drugs not only just from efficacy standpoint, but also from like, a duty standpoint, I think we’re doing great. I mean, what we’re looking at the pipeline really is orals, like what we, you know, essentially what what we’re looking for is obviously, what I was looking for the drug that is the most effective, and that’s the safest, more likely oral is what we look for in the military sector. Okay. That’s the common sense.
Anish Patel, DO 30:26
One, the one big area that we’re still struggling with in the military, and I think that’s what civilian too, is perianal disease. On unfortunately, we just had one drug that was very hopeful. That unfortunately, did not make the FDA cut, which was very frustrating. That one, it has approval in the EU in Japan, but just didn’t make it our cut for some reason. That was detrimental. I mean, not to me, it was like literally, I mean, there was a lot of curse words that night, or not, when I saw that, that that statement that came out was very, very angry and mad a lot of patients are we’re looking forward to it. I think that’s where an area that still a big gray zone.
Anish Patel, DO 31:05
I think the oral coming in the pipeline, they’re going to be magical for us, like I mean, magical, without what I’m reading right now. And I mean, if they get safer, more efficacious, I mean, that’s going to be our juggernaut. I mean, that’s going to be our first line therapy, we were using the first line, but that’d be a dripping workhorses. But I think the pipeline still needs a very good perianal disease therapy. I think that’s what we’re still lacking.
Anish Patel, DO 31:26
You know, our personal research, and we do like clinical research. We do some clinical trials. But my area is really my need. And my, my fun is clinical research. And we feel for what I will my colleagues want to do is we want advanced science is our whole goal. You know, I work with a consortium with a bunch of IBD centers, like my own colleagues, you know, around the same level as me, we’re on all IBD IBD centered around the whole country. Okay, well, we call it remote IBD is the name of it.
Anish Patel, DO 31:54
So a bunch of senators from like Mount Sinai to Washington University, Wisconsin, as his name a few of them, I mean, I’m no, I’m a bunch of them. But we’ve all got together, no egos aside, and we just said, Look, we just want, we want to put that out there. We want to put data like on these new Jak inhibitors, real world data, we want to put it on the new S1Ps, or the new il-23. We want to do this and we can do it in big volume without having the you know, cronies of a crony. Or having like, having these egos kind of played a big role in there. And this we’ve done and in what we’re doing, I mean, we have we have components coming at DDW, hopefully, here next year.
Anish Patel, DO 32:31
So that’s what we we really push the envelope for, but also what we’re going to do, you know, part of our internal kind of kind of research, looking at the active duty model, looking at looking at, you know, we don’t have di problems. Like we don’t have problems with a racially, you know, insensitive problems, like everyone gets equal care in a funded system. So we put we’ve done abstracts, we will be publishing a paper on this one, you know, looking at, you know, the cost of stuff, we’re looking at cost savings, how is it in one system? Could we see it?
Anish Patel, DO 33:03
I mean, we went biosimilars for infliximab, and we saved 2.1 million in one year, that stuff. So we, we want to be able to show in a system based model, it really was a funded system, we can show changes, we can show improvements, but also showing that we were going to do some prevalence, and we’re doing a bunch of studies in the IBD realm, to show that military IBD is here. We have people handling and managing it, but we can be very aggressive.
Anish Patel, DO 33:30
And showing like our whole goal is to show that if you’re aggressive early, long term management is better for also using these advanced therapies like oral therapies first, yeah, proving that point. But you know, screw the FDA with all this stuff. It’s like he had to step through receptor receptor receptor, we want to bypass we want to say, Look, you don’t have to, if you go straight to the big juggernauts up front and people who really need it, you’re going to save money in the long war, you’re going to save time, you’re gonna help the patient. So I think that’s what we really kind of push to strive for when it comes to the research side with us.
Amber Tresca 34:02
Yeah, and so many people, of course, would agree with you.
Anish Patel, DO 34:06
Yes, I have the ones that need the military, in the first words are many curse words. I can’t say them on the podcast. We might be pimping me out, leaving me out. But if they are me, they literally and they go to civilian sector because you know, they lose their military, their spouse, they don’t get, you know, the extra care right? Or, you know, they don’t have the military benefits and they’re stuck. They’re in the glut.
Amber Tresca 34:34
Anish Patel, DO 34:34
They look at me I can get these things here. I can’t get them now unfortunately This is unfortunate. There’s a higher insurances. Our insurance is just not not built to help people. Fortunately, we just had enough to say, you know, I’m a big believer. I mean, I’m in a system that’s a funded system, I believe in insurance platform. But it just it’s not. It’s not it’s not doing right, but people and I think we’re I think we’re failing people a lot, unfortunately.
Amber Tresca 34:56
Yeah, I agree with you and In the interest of not failing people, you already mentioned that Crohn’s and Colitis Foundation does have a section of their website dedicated to veteran. I don’t know, if it’s veterans or active military or those veterans. Okay, I believe that they also have a Facebook group. Do you know of anything else? Or is there anything else that you send your patients to?
Anish Patel, DO 35:24
Yeah, so, so actually Crohn’s and Colitis? And I believe it’s have a look at it. Again, I think it’s on the written website, they actually do have support groups, right. So the military, actually, so there’s actually a couple of these kind of got together and either spouses of activity, people that actually got together into a support group, I can see I can email it to you, you want to put it up on
Amber Tresca 35:48
I will put it in the show notes.
Speaker 2 35:50
Yeah, I can send you that that flyer that came through from them. So there is a support group for military or military folks, and but also their spouses also on there, the Facebook ones are still there at Facebook. I think it comes by veteran websites, the big one, there are some local, there’s not like a dedicated military one, I think that’s what we’re trying to get.
Anish Patel, DO 36:12
And I think Crohns and Colitis did a great job of having this one start with that one, but we’re trying to also do it on our own system. Within the military system, we try to find like a global virtual support group that we can do within the military system. And that’s something that’s, I’m hoping, you know, it’s in very, very, very early progress. With that one, I mean, we’re probably looking at another year or so that we can get something like that together.
Anish Patel, DO 36:35
A lot of this is gonna be kind of like talking to the providers drafted duty, he’s talking to your provider, and getting getting getting kind of the know how, but but also, if you’re, if you’re active duty and you’re seeing activity provider, they’ll have access to upset the applecart Medical Center, okay. You can always email us message us within the medical record system.
Anish Patel, DO 36:53
And we’re more than happy to be supportive, we’re more than happy to be no more having to give a phone call to somebody I get a message from or email from, I’ve done it already. I gotten emails from people from, like, families from Tripler, that were coming back to San Antonio, I just got an email today that I’ve answered back, like, you know, hey, I have family members, I have firms that are have this disease, they’re coming into the city, what can you help them with? And I haven’t seen these patients in like years. That were I’ve never seen them before. And I’m more than happy.
Anish Patel, DO 37:20
Like I know, for me, it’s not had nothing to do with money. Pride, right. Like to, you know, to me is is you know, when what I’ve learned a long time ago, and it took me a while to kind of you understand this one of the state long in the military is that putting the uniform is very prideful. We hear a lot of pride and doing it. I mean, I think it’s why my wife and I are still in the military more if you’re going to college in the military. I think it’s it’s very humbling when you go in and walk in the door, you have a uniform on, good to see somebody in uniform, and you get to help them with the career get to have a browser have their family to
Anish Patel, DO 37:49
Yes, because you know, you say for example, if the spouse is the one that flipped it, not the not the activity person, but you give them a backup, you give them a life, because what’s what’s the first thing that person are worried when they get deployed, whatever, my spouse, but there we go the hospital again, we’re gonna get surgery without me being here. So I think that’s this is where we’ve come in and said that, you know, this is not a pride thing. This is something that we want to help we want to have a more you can trust me, I would love to have like, every whatever, you know, we have about probably 100,000 soldiers that have this disease, that when I will have every single one of them if you could I have my pride is not that big, am I seriously, this is what we do.
Anish Patel, DO 38:25
And and not just because I’m on this podcast with you, my fellows, my staff, my colleagues tell you the same thing. I don’t change. Don’t change your I leave here, I leave this podcast, I don’t change. You’re going to my office, I fell asleep I see a patient in the office that want to meet me, our goal is to help soldiers. This is what we put the uniform on. So I have the flag on the right hand side on my arm is to help these people meet and get them to the point where they’re not scared to leave. They’re not scared to do anything. On what that one.
Amber Tresca 38:55
Yeah. And military spouses. Gosh, that’s a whole other topic for another episode. Yeah. All right. I’m gonna put it on my shortlist.
Amber Tresca 39:14
You’ve talked about so many things and opened my eyes and of course the listeners as well as they’re hearing this. Do you have any general advice? Any any last tips that you have for anybody who’s active military or veteran who’s living with IBD? Yeah,
Anish Patel, DO 39:29
and I always do that using a two prong thing. Okay. One is going to be have hope. Okay. Don’t lose the hope. Even if doors close on you in certain ways. Don’t lose the hope because always when people are going to help you. Okay, so don’t ever lose hope.
Anish Patel, DO 39:43
The second thing is be your advocate, like I mentioned before, be an advocate. If you have the hope you advocate for yourself, things will get better. And it’s for every single person that leaves the military. This is a last line leave them with. Exactly I just told you I leave them with every single one of them is have hope and being advocate.
Anish Patel, DO 40:01
Those are two big things I think I believe in I still hard to myself. I do it myself. I’m a big believer in it. Well, that one, but I also want them to believe in it too. That hope is not lost when you leave the military.
Amber Tresca 40:12
I love that. Dr. Patel, you’re a busy person you’ve taken a lot on. But I’m wondering, what do you do for fun in the five minutes a week you have in your spare time?
Anish Patel, DO 40:27
Yeah. Amber. So, so I’m the sports guy. You asked me before my favorite color was so yeah, big football, baseball, basketball. My wife and I go to spurs games a lot here in San Antonio. I mean, I have a 64 year old who did take a lot of my time with that one too, you know, hanging out with them. You know, I’m simple. Like, I’ll tell you, I’m like a hermit. I just want to I just want to sit around, you know, have a little thing of whiskey and watch my Netflix.
Anish Patel, DO 40:54
I’m happy camper are like very simple and easy. I’m a big sports guy. I mean, for me, sports is like kind of like my, my, my saving right now the giant stink this year. They’re frustrating. So they don’t help me a lot. I want that one. But I do I mean, me, for me is the family. The way I can do what I do now. And the way you know, give me the ability to be an advocate and have this access and be able to do things like this with you is my family. I mean, I mean, I mean, everyone always says it takes a village and I believe in it.
Anish Patel, DO 41:24
And I mean I have my kids are amazing little kids. My wife is probably the biggest saint in the world. I think she’s an amazing soldier. She’s a doctor, a phenomenal mother, my best friend, my soulmate. I mean, she’s the one that probably brings all together, I my parents are involved, my brother, like all these ones, have really kind of built and helped me build this platform that we have.
Anish Patel, DO 41:48
And I think this is where I show I mean, my family comes to my office and my my, my my whole plate knows my my children. I mean, they come every single Halloween every single Thanksgiving and Christmas, and Easter, they’re hanging up candy to everybody. We give candy, they are hanging up candy everywhere in the house random people, and they love it. We I want them I want them to know that. I do have a human side. My family My family is probably the number one thing that drives me and got me to do this kind of stuff. I have the passion I do as them.
Amber Tresca 42:16
Well, when I reached out to you, you said yes to me right away and which was amazing. And so I understand now how you are probably a lot of people’s first go to when they when they have a problem because you’re, you’re a yes man, you’re gonna say you’re gonna say yes. And you’re gonna help people. Yeah. S
Amber Tresca 42:38
o well, you know, on behalf of everyone who lives with IBD because what you do is not only helping the patients in front of you, it’s also helping all of the rest of us, especially with the research. So thank you so much for doing all of that and for helping your individual patients who are active military. I don’t think they could ask for a better advocate and thanks for talking with me today without
Anish Patel, DO 42:59
Thanks for having me Amber I really appreciate this is a great opportunity. Love it. Love to talk to you again in the future.
Amber Tresca 43:04
Well, I’m gonna hold you to that.
[Music: IBD Dance Party]
Amber Tresca 43:13
Hey, super listener.
Amber Tresca 43:14
Thanks to Dr. Anisih Patel for taking time from his busy schedule to talk to me. What he’s doing is so important because it is creating change for people with IBD both in the military and outside of it. Plus, it was really fun to connect with him and talk about not only these important issues, but also our mutual love have a good whiskey.
Amber Tresca 43:32
November is National Veterans and Military Families month, November 11 each year is Veterans Day.
Amber Tresca 43:38
I’m including a number of links to information and resources for active service people and for veterans in the show notes.
Amber Tresca 43:45
The Veterans Crisis Line is available 24/7 by dialing 988 and pressing one, by sending a text to 838255, or by chat at VeteransCrisisLine.net.
Amber Tresca 44:00
Plus, as always, links to a written transcript everyone’s social media handles and more information on the topics we discussed is in the show notes and on my episode 141 page on about ibd.com
Amber Tresca 44:13
Thanks for listening.
Amber Tresca 44:14
And remember until next time, I want you to know more about IBD.