When Dr. Baron arrived here in 1993, there was only one other pediatric gastroenterologist. Now, there are five—three of them in his practice, Pediatric Gastroenterology and Nutrition Associates. After earning a degree in his native state at the University of Minnesota Medical School, Baron headed to UCLA for a fellowship in his subspecialty. He hasn’t left the West since. Here are the highlights from his recent interview with Heidi Kyser:
There is a huge problem with food allergies. A lot of times, what people don’t recognize is the symptoms they’re experiencing actually could be related to what they’re eating. Statistically, about 40 percent of eczema under a year of age is food-allergy-related.
A lot of people come in and say they’re gluten intolerant, whereas they have no immune response in blood testing, which is very sensitive and specific if done appropriately.They say they took gluten out of their diet, but they frequently didn’t really do that, because gluten is also in rye, barley and spelt. [Nevertheless, they say] they feel better. Gluten is found in processed foods, so if you change your diet to fresh foods, your bowel habits are going to be better, and overall you’re going to feel better for reasons that have little to do with the gluten.
We see a tremendous amount of childhood obesity, [which affects] the digestive tract, such as inflammation of the liver. We see probably 30 kids per month who have body-mass indexes in the obesity range and elevated liver enzymes.
We manage hundreds of children who have nutrition support by means of a tube that goes directly into their stomach. We usually have a handful who have intravenous nutrition at home because of the inability to tolerate even tube feedings, and many of the digestive diseases that we treat, such as inflammatory bowel disease, have adjunctive nutritional concerns.
I’m part of an experimental system called ImproveCareNow, and it’s a network of 51 pediatric gastroenterologist centers in the U.S. and Great Britain. Focusing on inflammatory bowel diseases in children, we created a database so that we can share successes and failures with each other, and try to improve the quality of care that the children receive. By collaborating, we streamline diagnoses, standardize treatment regimens and increase their chance of staying in remission and living happy, healthy lives.
We have increased the remission rate, network-wide, from 50 percent when we started in 2006 to nearing 80 percent today. And this is not with an experimental drug; it’s not with a new test or service or procedure. It’s simply making sure that every place, no matter where it’s located, has access to the same materials and tools, and collaborates with the others, getting feedback on performance.
Every two weeks our team gets together and reviews the patients on the schedule. We give each other suggestions, make sure their medicine doses are calculated correctly, that someone is calling to get their blood tests done, etc.
I find that I now do pre-visit planning for every single one of my patients. It’s put a level of efficiency in my practice, in that I almost never see a patient who didn’t need to be there.
There is an incredible amount of really high-quality work being done here in Vegas, especially in pediatric specialty care—cardiology, neurology, critical care. I trained at two large university institutions, and my colleagues in specialty pediatrics here are at least at parallel with the people I trained with in those places.