members nor pbs el paso shall be responsible for the views opinions or facts expressed by the panelists on this television program please consult your doctor [Music] a colonoscopy believe it or not it's one of the greatest gifts you can give yourself to save your life colon cancer is one of the few cancers that are preventable a colonoscopy without question can prevent cancer and tell me how we're going to find out suspicious polyps that are removed during the procedure can prevent any chances of having that polyp turn into a cancer during this next hour we have physicians answering questions about prevention diagnosis and treatment of colon cancer and as you know this is a live show so if you have some questions of your own you want to think of and give us a call and ask the number is 881-0013 we are also streaming live on youtube and instagram so you can look up pbs el paso and go to the el paso physician and you'll be able to ask some questions there as well this evening's program is underwritten by texas tech university health sciences center and dr richard mccollum we also want to thank the el paso county medical society for bringing the show to you each and every month this is our 25th year good evening i'm catherine berg and you're watching the el paso physician it's interesting because i'll have some of these doctors on the show and yeah they're doctors but i've known them for 20 years we've been doing the show for 20 years you know he talks about farts and he talks about diarrhea and he talks about all kinds of things that nobody wants to talk about and that's what's great about the show because you get to hear those things on the show and go i'm not the only one it's great see your passive physician [Music] so one of the docs you saw on that intro is dr richard mccollum he's been a big part of this program for many many years again we're going on 25 years and he is known as the tummy doc and today we have three gastroenterologists and i remember the first time i did a gastroenterology show i thought my lord is that a word and i have to say but we have with us dr richard mccollum who is again gastroenterologist dr alejandro robles gastroenterologist and dr sharif el hanafi who's also a gastroenterologist so these all three have the same discipline but they kind of work in the spaces in different areas i know that you've been professor for quite some time and head of this and head of that so if we could dr mccollum start off with just your background just what you do here talk about texas tech a little bit what your role is there well i originally came catherine as the chairman of medicine brand new medical school in 2009 and also head of gastroenterology over time i've evolved into a more research directed position do a lot of work on gastrointestinal motility as you know still do a lot of clinical care look after patients do endoscopies and more or less look over and direct our research program and that's there's a lot of research to be done i know every time we do this program there's something new on the horizon that's coming about which is really interesting we have some gadgets toys uh props to look into today too which is kind of neat and help to help recruit the future and and you are the future we uh we've had a great um uh great opportunity to recruit um gi trainees who have become and some have stayed will stay as their gi fellows and shady that's the perfect gi faculty right let me say catherine to the audience out here uh catherine is just a great asset to the city of el paso she's done so much for us to teach us all about medicine and how to be involved with your own care and to advance that area and we in the el paso county society medical society so much appreciate you catherine thank you and i know the city needs to be aware of the many contributions you make every month thank you man you make me feel really good can you come every time have a shot dr sharif sharif el hanifi so i would love for you to talk a little bit about what you do all day every day again yes we're in the world of gastroenterology you are one of the newbies you are one of the the future so to speak but how would you describe what you do to the folks at home so i am a gastroenterologist in texas tech assistant professor and advanced endoscope i am also the director of endoscopy and the associate program director of philosophy okay gi fellowship i do endoscopy general endoscopy diagnostic endoscopy and therabiotic endoscopy i am a trained in advanced endoscopy i see patients in clinic and office i do clinical research teach resident fellows and medical students nice i'm sorry i'm trying to prep my phone really quick uh for those of you that that have been watching the show for several years we are we used to have people run little questions to us on cards but now we're getting all of our questions via the phone so i was just double checking and making sure that was the case so my apologies for the for the noises and the sounds that you hear um dr alejandro robles um and thank you again you sent in some questions that we're going to be asking i always like having some free questions to work from um but kind of the same question to a different person give us a background for the folks at home when they look at each one of you what is it that they'd like to direct each way okay so i'm a gastroenterology fellow so i'm in in the process of undergoing and completing my training i see patients in the hospital patients in clinic you know i assess with the endoscopy participate in research and with education of residents and medical students yes yes and you're like and that's that's it but all i'm practicing now and i'm going to start with dr mccollum because he's got the numbers you have all the information and why we're having this show i guess it's april but and i'll just let you take it from there right colon cancer awareness month was officially march but we're very glad to be here with catherine and you the audience and our experts to tell you about a challenge that uh really as i've come through gas neurology it's been a major major challenge every every year we're now getting a little bit of a grip on it but let me give you some of the numbers that are still concerning approximately 147 950 new cases of colorectal cancer are being diagnosed in 2000 2021 in the united states and 53 000 patients have died from colorectal cancer the incidence of colorectal cancer united states is 25 higher in men than women 20 20 higher in african-americans than in whites and the death rates are also higher about 40 percent or so in african americans compared to whites our colleagues will tell you about the hispanic population and there are differences there as well concerning differences which make it all the more relevant to promote and advocate screening in el paso and you were talking about screening too right before the show had started um and there's screening el paso screening and then screening in america and then screening around the world but in general where do we sit when it comes well the national core rental cancer round table has set the standard at 80 percent of our target population need to be screened that's a pretty tall order you always aim to always aim too high we're not there but around the country we may be getting close to 65 percent or so here in el paso we're less than that we're more in the 50s so again work to be done right work to be done and i don't know if we want to talk about it now actually i do want to talk about now because i don't want the show to go away and we haven't addressed it what i'd like to do right now is talk about the prep you were talking actually every time we do this program that is what patients come to you it's like oh what about the prep and they're scared of the prep because they don't know what the prep is so let's talk about we joked about the word cleansing right let's talk about cleansing the colon so that there are good images and we can really see what's going on inside so explain that process it's a little bit different you know there's two or three different ways of doing it but well the reputation is that you're asked to drink a gallon of this very powerful laxative on the afternoon and the evening before your procedure and it's pretty daunting and we have some older folks in particular who have a lot of trouble keeping up with that schedule so i try to tone it down i try to make it more pleasant when i get a colonoscopy i start fasting two days before my procedure i don't want much in my calling so the last night when i have to cleanse it very little remains so i drink ensure gatorade soup and two days in a row by thursday night if i get it done friday i just drink a little bit of that one gallon jar my stools are clean and water-like and i can stop okay and go to bed and and be prepared so there are other techniques but in general we do not promote eating up to the last minute right we promote fasting minimizing solid food intake drinking liquids and sure gatorade water and trying to minimize the trouble you go through the night before just drink a little bit of that stuff called go lightly and you'll have a very pleasant experience so on average when you're eating a meal and i know every system is different when you're eating a meal the 24 hours you're talking about two days ahead of time um usually if it's if other prep it's like okay 24 hours before stop you know start drinking but for our bodies to process a meal and i don't mean to be gross but that particular meal i'm not talking about the meal before or what you had earlier the meal that i'm eating right now and let's say it's 7 10. when for the most part will that meal re leave my body and i know it's different for everyone i know there's stuff left in there but say you finished your colonoscopy you haven't eaten anything now in two and a half days now i eat a meal how long for the most part will that meal take 15 to 24 hours okay and that's something i don't think people understand because they think you know i eat two hours later stuff comes out but that's from the whole day before and i think that's kind of important for us to know um how that works dr elhafani i would love for you because we're still in the beginning of the show and if we can look at uh using some camera work here you brought a really cool um colon with you for the lack of a better word and i would love for you as we see it on the screen right here describe to the people at home what happens when food starts going into the colon and and we're going to talk about cancers and polyps and all that good stuff but it's nice to hear and understand what the process is i will use this pen okay so colon is a part of the digestive tract it is called the large bowel this is around six feet long long so it here is a connection between the small intestine and large intestine the food come from the small intestine goes to large intestine and go all the way here up to the rectum and come out so during this passage of food they couldn't absorb water this is the main job of the colon absorb water and absorb electrolyte and some nutrient so it dry it up start very liquid and dry it up on the way out okay so then the colon expel and and push the remnant out which is called stool from director it is around six feet a long tube large tube and this is what we call the colon the main job of the colon is to absorb water and electrolytes so here's a question i know it's off topic a little bit but when people have diarrhea and there's a lot of liquid there what is happening with the colon in that the colon is not able to absorb some water for example they eat something not so great or they're ill in one way or the other just if you could just spend a little bit of time of why the colon doesn't always absorb water and what could be wrong or what could be the issue during that time if there is infection or inflammation in the colon the mucosa and the lye of the colon will be not working as should be so it will not be absorbing water as should be so there will be a lot of water remaining in the colon and it will has to come with the stool so this tool will be like the area okay and there is many reasons for the area infection or inflammation or sometimes cancer or a food some certain type of food which is ratios molarity which can pass to the colon and keep the water in the core and for some reason your colon is not liking what's going on so let's take that same question opposite and talk about when there's not enough water when there's constipation for example and again i don't want to spend a lot of time on this but i think everybody's curious so let's ask the question yes constipation is the opposite of the area when you have solid stool hard stool or you are not passing the stool every day or every other day so constipation you you don't your stool is dry right so you don't have enough water in the stool or your colon is not moving enough to push the stool out so you are you don't have more fibers or you don't eat a lot of fiber so your stool is is dry and not moving adequately in your colon so it is the opposite of the area and many people complain of constipation also if there is obstruction if there is cancer there can cause constipation or structure or divert closes there is a lot of condition can cause constitution and dr mccallum is expert in the mortality of the colon so it is one of the reasons can cause constipation as well see and dr mccallum knows that we're going to get those questions anyway might as well get them out of the park in the beginning so uh dr robles let's go to uh screenings and we talked a little bit about prep here but when should someone start getting a screening i know there's been a bit of a change uh for many years it's been start at 50. now it's starting at 45 which is great uh but let's let's talk a little bit about that and why the screening age has changed sure so i mean it is it is great you know as dr mccallum spoke you know colon cancer it's their most common cause of cancer cause and mortality so screening works you know year after year screening rates have been going up mortality incident rates have been going down it gives us great evidence that it works but when we look at the incidence of cancer we kind of break it down to specific groups you know maybe those less than 50 years of age we've noticed that actually colony cancer is actually going up on a yearly basis by about two percent right when we look at ages between 50 to 64 colon cancer is going up by about one percent on a yearly basis so this dropping in cancer is mostly driven by those ages between 65 and 75 who are seeing a steeper decrease great news excellent news for them but this kind of gives us more evidence that you know what we need to start screening earlier now why is there earlier onset uh colon cancer we're still not sure we have some theories could be more higher rates of obesity higher rates of diabetes we're not sure but we hope that by decreasing the screening age we can save more lives because we know it works and we have terrible diets and we have some attention to diet would be one of those things too um well one of the good news not to rub is but that is that the the early cancer 45 to 50 maybe is more reachable right that is correct that is likely on what's called the left side which he can show you on the diagram that is correct so um early on uh colon cancer is what we call mostly on the left side what is the left side it's pretty much elastic this was perfect i remember talking about this last time and why is it on the left side so we're still not sure you know it's a very it's a very good question but yeah it's more on the left side more on the distal portion on the last one third part of the colon uh it's way more reachable you know we talk about screening modalities and one of the things we can do is what we call the flexible stigma sigmoidoscopy instead of just doing a whole colonoscopy we can just take a look into this area and be able to count that as screening for these individuals so yes because chances are if there is something off it'll be there that's correct on that note might this be a good time to look at what this scope does yeah yeah okay let's do it um valeria is ready with the camera and so uh take this scope and again i think knowledge is power and knowledge helps fear go away absolutely exciting right so we're gonna we're gonna show uh people at home what the colonoscopy is so this is pretty much our scope that we use you know we has a little light very bright light we're going through the rectum and we kind of maneuver our way through the through the colon until we get to the very far side we can go up it's opposite here but we can go up we can go down we can go left we can go right this this device here has the ability for us to pass little instruments that we find a polyp we can remove it it gives us ability to wash stuff off in case maybe the prep wasn't optimized we can wash off we can spray water we can fill the colon with air so we can take a good look at the entire colon so very very fancy instrument you know great advances have been made with these things here right and in a few moments too we'll get to it but we're going to talk about the snips and the lassos and all that good stuff um unless dr mccollum we can go to that right away actually um doctor i know this is where it gets kind of funny because dr el hanafi is like well what about me you know where's the love um but we're going to get to that too but since we just looked at the the tool for colonoscopies you have a i think you call it something that lasso you have oh we have lassos we have all kinds of toys here for ours yes exactly so you know all these instruments can actually be passed through the scope to the area where we want to be in so this is what we call the um a force it a little small we use it to obtain uh samples from the colon whether we want to make a diagnosis we see inflammation at the same time we can remove small polyps maybe those polyps that measure from two to three millimeters we can grab it close it off and literally just rip them off so i know that we're on television it might be difficult to see but i'll kind of explain what that looks like sure yeah very very i mean tiny sports yeah and when the scope goes through and sees a polyp the claw is then able to go around the polyp and pretty much clip it off just like nail clippers pretty much so we pretty much you just uh you know we got these things here through here do you want to grab this right here doctor i'm counting with technician or dr hannah if you'll be our technician so we typically always have uh you know we have excellent nurses that we work with up in the endoscopy and excellent endoscopy techs who pretty much all help us be able to perform these procedures here so as you can see now it's coming out so as we maneuver through the colon we find a polyp or we need to take a sample maybe unfortunately let's say there's a tumor there we need to make a diagnosis before we can say what it is and be able to provide treatment so we get this there we open up the forceps we can get a piece of sample and after that we just pull it back we can open it right there we go yeah there you go and we can take a nice piece of tissue nice nice piece of tissue only a doctor would say that yeah i'm gonna take a nice piece of tissue you won't feel it you won't feel a thing no but that's actually that's fascinating um and so we don't have to insert the other one but there's another one that you can do we have what we called our um our snare so it's a little bit longer instrument in which we can um we can kind of lasso polyps we find a polyp i mean you see i'm not sure you guys can see that there it's like a little loop of a little wire that once we're in the colon we find a bigger polyps we kind of just go around it we get on top of it and we can close it off now this can either be cold meaning we just cut through it or we can use heat and which kind of categorizes to prevent bleeding throughout the procedure that is so important to say i think people also because i'd like to also debunk myths while we're here this evening so a pulp is taken out and you think oh my goodness they cut a polyp out of me so how do i make sure that there's a a small chance of bleeding you know very tiny chance yes dr mcconnell i can see your face going hey i got this one yeah well you know it's in the informed consent [Laughter] one in a thousand or whatever it is uh but we have to be careful many patients are taking anticoagulants aspirin motrin and other things that might potentiate the chance of a little cut bleeding a bit so we we very carefully make sure we understand what our patients are doing and stopping any appropriate medications but then otherwise as dr unhappy will attest to there are occasions when you take the polyp out and we're concerned about a bit of leaking a bit more uh blood if you like than we'd like and so he has a technique and others do where you put a clip and then you put a clip through the endoscope okay and you can essentially suture that little opening where the polyp was and stop any remote chance of bleeding okay so now you're on stage talk about you actually doing this with a patient so the clip goes through the scope and kind of walk us through it from there absolutely so removing polyps is most of the time is safe is and the risk of bleeding is really low around 1 000 especially in small polyps and when we remove large polyp we take our precaution so if based on the risk of observation is taking anticoagulation or taking aspirin we try to close the area where respect is a problem but multiple tools for that the most common we bought claps and discover calips to clip the area and approximate the edges and do the caps stay in the colon yeah it goes with the stool okay oh yeah one to two weeks it would go again nothing's there so it's almost like a scab for the lack of a better word i'm trying to describe it for the audience so it's like a scab once the scab finishes healing exactly it falls off and then it goes you flush it down it goes to the ocean as people would say so removing removing polyps is most of the time is safe and doable and the endoscopy field has expanded a lot and now we have a lot of tools to close either perforation or bleeding to stop bleeding so we have socials we can social the area of if the defect is big and approximate the edges or we use large eclipse to close it but it doesn't happen a lot is one in thousand and most of the time colonoscopy is a safe scaling method so bottom line is have your colonoscopy because it can save your life exactly big big big deal and if for some reason there is a bleed if you need to very very seldom you can go back in and and fix things so that's that's important for people to know it is most of the time it is flexible complication is rare and we have a lot of tools to fix most of the complications okay excellent um i want to talk about types of screening tests we're talking about colonoscopy right now um but i know there's cola guard i know that there are several different types of tests and i want to kind of get that out of the way because we see advertisements it's television magazines etc cetera and i don't know who wants to take that dr mccollum i'll go with you dr robles there you go it's on you buddy yeah sure so there's definitely a lot of different kinds of testing that we can do for screening and we usually decide upon this after you know discussing it with the patients kind of discussing the pros and cons of each uh there's stool tests you know there's one that's called the fecal cold blood test epo bt which they provide a sample stool we put a chemical looking for any signs of blood you know they're sending blood you know we're concerned there might be something that's bleeding like a tumor or a big polyp there's a test called the fit fecal immuno chemical testing which very similar to the fob t button here we use antibodies to check for blood now this color guard is what we call the the stool dna test it's actually a combination of tests it actually involves the fit test which is the antibodies in addition to that we're also looking for altered dna you know altered dna meaning dna from cancer cells cancer cells so most of the tests are performed on a yearly basis except for the dna test dna test which is performed every three years okay and of course you know we have our colonoscope here the screening colonoscopies which this test actually not only gives us the ability to screen look for polyps but actually gives us the ability to take those polys off which unfortunately with a steel test any positive stool test needs to be followed by a colonoscopy for the screening to be successful you know if you can do all the screen tests you want by stool but they keep coming back positive there's blood there's blood that's not going to do you any good it needs to be followed by a colonoscopy so we can look for these polyps we can look for the bleeding that's correct nice so let's talk about and i think it's good for the audience to hear of personal experiences on the show i had my first colonoscopy i'm 55 so five years ago um and i did the cola guard test this year so there was nothing was in there it was clean wait 10 years but to me i'm like i want to know so my doctors would like to do a cola guard test like i would rather do that than wait another five years for anything and again super easy you follow instructions at home you literally mail it in and so again if if it just frightens you for whatever reason there are other ways this without question and this is me as a layperson saying it colonoscopy is the way to go because if there's anything in there it's taken out it's during the screening you don't even know it like you said that you're asleep anyway things are clean and if you need further treatment there you go absolutely but i want to see if you had anything to add on that onion i think i i think patients also need you need to be aware of a syndrome called lynch syndrome lynn syndrome is where families have an exaggerated propensity for not just colon cancer but uterine breast ovarian lung there's a family and they have chromosomal abnormalities and these these patients need to be screened much earlier and therefore there could be families where you might do the color guard test or other tests in between their frequent colonoscopies so you can stay on top of them right where they've got a bad family history you know it's going to happen eventually we do colonoscopies every two to three years in some families but we might want to do a blood test also in between nice exactly just but i i but the colonoscopy catherine the way i look upon this is you know my age i'm worried about grandchildren that this is an investment in your future for an hour or so getting a colonoscopy you can sleep peacefully at night for the next five to ten years and know that there's no chance that this color guard blood test may be positive one week and negative the next right we looked up there there is nothing there that's a great psychological feeling and a great investment in your future i have time i can look at other problems look after my other medical problem agreed completely agreed uh we have a question here from the audience great question so i'm assuming this person has had a colonoscopy if a patient has developed pockets in the colon are they guaranteed to get diverticulitis and then from there what are chances of colon cancer development of polyps so pockets are different than polyps but we haven't talked about that yet so who would like to address that one yeah i can i can okay excellent so far so what's what's his what he means about pockets is diverticulosis this is called this is called diverticulosis come from the tear and wear of the colon was asian and it is common and most of the people above 60 around 50 percent of people above 60 has has has diverted closes and about almost everybody above 80 has divert clauses and um the not everyone has divert clauses get diverticulitis what's inflammation of the diverticuli around five percent about yeah it is many people many of us has diverticulosis and go without any symptoms so here's a question how do you know is the only way you can find out by doing a colonoscopy if you have pockets in the colon how would you know that are there symptoms and then they come to you and and test what are the tests for that yeah so usually if it doesn't if it is diverticulosis with no inflammation patient doesn't feel it some people get constipation i'm constipated some people when they are doing cat scan or imaging for any reason they found it but most of the people don't feel it the only symptoms come with it maybe constipation okay so but when it has complication like bleeding or inflammation called diverticulitis people start to have symptoms if you have diverticulitis you will have pain in the area and lower abdomen some people get fever and some people get bleeding so here you need to check see a doctor and he may get some emotion okay and treatment is usually easy some antibiotic is our is in the vein or in the mouse for a few days and most of the time it resolves few cases or a few percent of people get complication of diverticulitis so it is a very benign disease okay people shouldn't worry about it yes about about three percent also bleed so there's two different careers you can either bleed or have an attack of diverticulitis both rare three or four percent essentially everyone's got diverticulosis over the age of 40. and it's important to tell the patient this is diverticulosis not items because often it's misinterpreted and they go around telling you gee my doctor told me i have diverticulitis no this is osis it's like arthritis of the joints you've been passing stools for 20 30 40 years the bowels been squeezing and little pockets little pockets little cul-de-sacs right developed it's normal right it's normal and diverticula and diverticulum that are big may go into a blood vessel and bleed the diverticuli that are small trap stool and that stool could get lead to an infection called diverticulitis okay but it's like if there's a little little ulcers within the colon i guess i think i've heard it explain like that wear and tear yeah wear and tear we all have it only about three percent ever get into trouble okay and to to complete the answer for the the one who called there is no correlation or association between divert diverticulosis and colon cancer okay so there is many studies were done and then it's like there's a pocket versus a polyp yeah the polyp is a growth the pocket is just out pouching of the cold water so let's talk about risks i know that we talked about uh lynch syndrome uh but in general dr robles i'm going to throw this your way what are some risks in general genetics are one yeah for sure diets um genetics genetics genetics diet et cetera you know we speak a lot about genetics we bring it up but you know we i think it's the best ways to separate them into modifiable you know those risk factors that we can change ourselves or non-modifiable those risk factors that unfortunately we can't change so the modifiable risk factors there's been studies and about 55 of all the cancers of colon cancer have been attributed to a modifiable risk factor so it's definitely a very important topic here for risk now what are these well being obese being overweight now this link is a little bit stronger even in men smoking but as usual smoking has been attribute you're associated with multiple types of cancer heavy alcohol consumption when i mean heavy that's just two drinks for men and one drink for women so it's not even that much a diet high in red meats cooking your meats in very high temperature or eating a diet that's low in fiber now for the non-modifiable these are things that we cannot change this includes age you know unfortunately colon cancer correlates with age inflammatory bowel disease which is like crohn's disease ulcerative colitis now these are conditions that there's a constant state of inflammation in the colon and with inflammation the same way inflammation is bad for the heart inflammation is bad for the colon can eventually result in the formation of polyps and transforming of those polyps into cancer and like we said the genetic the hereditary type of uh cancers now these only comprise about five percent of all the cancers so 95 are what we call spontaneous or spontaneous type of cancers and very importantly family history family history of colony cancer particularly first degree relatives your parents siblings or even a child why is this a case well you know it could be some inherited type of genes could be a shared environment that can put you at risk for um for colon cancer and of course you know people who have a family history have different screening guidelines than what we have been discussing yeah i'd say the new kid on the block which is out there and everyone's going to try to blame it at some point is the microbiota i totally was going to ask about that because that's something that's like the the pill of the day right right are you different from me well yeah you might have a different personality you may be more nervous you may be more relaxed right we blame it on everything from autism to depression but it probably does play a role right there in the corn right where it's contacting food and the lining the skin of your mucosa although clear these are the bacterias that we naturally have in our guts anyway because although the the diet is interesting you know i got a family full of vegetarians and i i stored delight in telling them you know there's no data yet that vegetarians are spared from colon cancer it's not a it's not a straightforward story i'm sure you're healthy or you're fitter or that sure but it's not that straightforward so there's microbiota there's family history there's all these other issues which play in to diet exactly obesity is getting a lot of press led because everyone blames everything on obesity but it's getting a lot of press lately in these early colon cancer patients under 45. there seems to be a trend towards obesity in those patients that's correct and for the most part depending on a person's medical condition i think these are things that it's nice to bring these up during this program because they're lifestyle changes you know if it's possible i guess i realize that some people don't just it's not just a lifestyle change but in general when we're talking about upkeep and if you don't mind let's throw out fiber again i'm throwing out to anybody you can mix it up in your drink you can get it by food it's always better by food but who wants to take on fiber and what the best things to eat would be dr robles sure yeah yes so eating healthy is a is important for the your colon health so to keep your colon and bowel movement you'll see eat more fibers eat vegetables so what type of fibers matter more because you've got people that look at whole wheat bread and then you have people that look at the vegetables and you have people that well i'm just going to get a spoonful in my juice or whatever any fibers any fibers it make make your colon health better okay so it may it regulates your bowel movement and your colon will will be moving smoothly and your bowel you will have bone movement every day or every other day and it also regulates your microbiota and the the healthy bacteria in your in your colon so it is always to eat healthy drink carotenoid water keep yourself hydrated exercise as much as you can and if you see any any alarm picture like bleeding constipation abdominal pain weight loss fatigue seek medical help see your doctor and he will he will advise you what would be the next step so in general with gastro health and i'm thinking about we mentioned the word antibiotics earlier say somebody does have diverticul diverticulitis same i'm even saying it wrong but there are issues and there is an infection we need to clear that out so they're on antibiotics for an amount of time um and so the mic the beautiful biology that happens in the system and dr mccollum i'll have you take that there's a way to kind of get you back on track often your body just gets back on track sometimes there's a little bit of help you can give your body after antibiotics what are some of the questions that you've had from patients too we we preach uh the role of probiotics to try to restore balance you're out of balance certain organisms have become dominant and we're trying to bring you back into a symbiosis so we talk about probiotics as being very important not always a lot of data on it but we certainly all believe in them we know if antibiotics can lead to very dominant bacteria as in clostridium difficile diarrhea can caused by antibiotics which can be even very very serious right right so and then there's this data that you know antibiotics in children antibiotics here and there during your life are you more prone to colon cancer so that people try to link the fact that your probio your um microbiota have been changed and you've been exposed to more um inhibitory or more changeable bacteria from the antibiotics and some and some bacterias become dominant and so antibiotics are definitely in the picture and that's why we try to minimize them in general as far as being not too aggressive and i like the fact that we're bringing this up too and not related to diverticulitis sometimes the end-all cure in in my days growing up it's like oh we'll get some antibiotics and i feel that doctors in the last decade or so is like you know what if you don't need an antibiotic don't take it it was so easy to go to juarez in the years past just get antibiotics because i have a sore throat antibiotics so this would be one of those things too that is an educational program let's not take antibiotics unless you really you know there's a virus versus an infection very different different things um i don't know if we want to talk about that but what i do want to do before we start because i think we're about 18 minutes out but i want to talk about treatments some uh and dr robles you got pointed out uh dr elhanafi you got pointed out too so we can talk about uh different degrees of colon cancer let's start there and then talk about some of the small degrees or less invasive degrees and then go from there who who would like to start yeah so i can start here so so the aim of colonoscopy is to find polyps this polyps if are not removed has a potential to become cancer so we can move small and large polyps we have a lot of tools to remove that so and also we detect early cancer we see if we can sorry my apologies i'm going to see if we can put up uh the screens yeah is there a number on there that you'd like to show to people that the numbers are underneath uh yeah we're gonna start we're gonna start with with when oh good we'll start with a little bit of some really awesome pictures for you yeah um if you're squeamish keep watching because you know so this is a normal colonoscopy this is what we we all look to see so clean normal colonoscopies is actually one of the economists we did with dr robles so it is it is it is really it is a target to see this thing so if we go to the next that's a good cleanse right there yeah very definitely yeah if you see here in the right of the screen there is a little bit growth there this is a polyp small polyp it is easy to remove by endoscopy and we have a lot of tools to remove that if you go to the next slide so the pull-up is removed and we removed it by snare this tool we have here and is that cauterized this is cauterized okay so it's burnt a little bit tissue okay good exactly so we don't leave it there if we go to the next so this is a club this is what we meant so you close the area about a clip to seal it and don't allow future bleeding or perforation it's a small polyp it will not believe or profit but to make it secure and to have peace of mind patient go safely home so if you go to the next one this is larger purlip so this also was were able to remove it by endoscopy so and thanks dr obviously prepared this picture this is what we do every day we remove a lot of polyps like that if this polyp was not removed with time it will become cancer well that's at least a centimeter yeah that's at least the same worry we'll make it over a centimeter that's really magic so the earlier you do that your colonoscopy that the easier we remove the polyp so is this a clipping here or is this the lasso it is this is the last one this is the last one this is the one we have here which is cut cut the polyp at the base okay then if you go to the next one so this is a cancer this is what we don't want to see so we do a lot of colonoscopy and we found this thing people come late for screening so we found cancer so the treatment is totally different if you find the cancer early in early stages from late stages right so the earlier the better outcome so this is the target of colonoscopy this is the beauty of of screening that we discover if there is a problem we can treat it better and the outcome is usually better okay so if you go to the next next picture so this is another type of cancer because it closes a lumen and cause constipation or bleeding so whenever you have constipation or changing your bowel habits or you're changing the caliber of your stool there is something more abnormal there there is something you need to be checked so there's a lot going on there if you can explain the yellow on the left the white on the bottom there i see the bleeding yeah and in the back there the discoloration you know the nice healthy pink and then a discoloration in the back um so this this is a cancer so this is a mass which taking all the circumference of the all the lumen of the colon so we are looking to this mass by a camera what's in the end of this picture in the center is the rest of the colon is the lumen the black thing is there okay and the bleeding is due to our manipulation and biopsy so this what the yellow thing is just a stool and this is a tissue fragment from the cancer i see so this this patient i i remember came with bleeding and constipation wow so we have to do colonoscopy and we found this mess we're able to biopsy if you go to the next slide so we are biopsies ah the cancer and we send it to pathology they will let us know if this is cancer or not but it looks like cancer and what type of cancer do some gene studies and then we send patients for treatment as i get surgery or chemotherapy or radiation based on the site or chemo radiation before or so we first have to make sure that cancer didn't spread outside the colon because we it is totally different the treatment is totally different if it is spread out in the outside the colon or it is limited to the core and what kind of testing do you do to see if it has spread well dr roberts can review that to cat scans why don't you give us an update on that so we typically do a ct scan of the abdomen to look for any um spread of the cancer or whether it's just within the the colon we do a ct scan of the chest as well to see if there's any involvement of any nodules anymore what we call metastatic disease into the lungs and now we do this because treatment is going to vary treatment can be either surgical resection if the cancer is just localized in the colon or it can be surgery and chemotherapy if it's maybe penetrated a little bit more of the bowel now for cancer what we call late stage metastatic colon cancer which unfortunately has you know the higher mortality has gone to other areas of the body unfortunately we're limiting what we do there's mostly palliative chemotherapy immunotherapy just why you have to get your colonoscopy and you know i just want to emphasize i think that's the most important thing here of this discussion is that early onset colon cancer if caught early can has way more favorable you know prognosis could be cured the thing is it does not cause symptoms it's why you need to get screened it's why it's so important to get screened so nicely said and if no certain cancers naturally go to certain organs colon cancers does it have a favorite organ or two that it goes to first it likes the liver it likes the liver lymph nodes okay next to your colon first as well but they're off that's often good news they're often confined but the liver is a bad sign that something has seriously uh moved into the bloodstream in lymphatics and it's a challenge right but patients with liver metastasis can do well sometimes they do well in chemotherapy and then they the the lesions can be shrunk and removed so i got here some uh other questions from the audience i know we're talking specifically about colonoscopy we talked a little bit about cola guard we have several questions here one of the questions is is there another imaging process that can be done aside from a colonoscopy um yes but no not not in something taken away but i'd love for i'd like to respect that question because it says here um why do doctors want patients to get colonoscopy just because of the age i'm reading this cold even if they don't have any symptoms exactly what you said you know uh percentage of colonoscopies so that's the point it there are seldom if any symptoms so get the screening first and so here's the other question other images aside from colonoscopy yes yes there is there is a ctu colonography this is a ct which can detect polyps okay but it mainly detects large polyps it can make a smaller polyp smaller polyp can be missed okay it is it is also um a test when it is there is a polyp you need a colonoscopy to remove the polyp so and it will require bowel prep similar to the colonoscopy to make the colon killing to be able for the radiologist right who sees that polyps so do the colonoscopy anyway so to be honest do anything yeah do any test right so any test is better than nothing right so just do what's available for you and better than going without with no screening test stool test is okay cto chronography is okay but if any of them become positive you will need colonoscopy right so do what's available for you do what whatever your doctor recommend for you anything will be helpful and will protect you yeah okay yeah that's nice the evolving area is a blood test you know every woman like to get their blood test so to speak and that it's a hot ticket whether it's pancreas or whether it's the colon and we so irregular blood tests yeah there's a chemical called carcinogen carcinoma embryonic antigen cea carcinoma antigen which is definitely up when you have cancer but how early and what what is the sort of earliest increase that you would take if you were to do it every five years could you predict when i should get that colonoscopy or should i be more aggressive but everyone's looking for a blood test right yeah so when you're saying this are you looking at other cancers as well yes because you have that that cancer antigen in you right interesting i i was not aware of that that's something relative we'll have to talk about that that's a hot ticket yeah okay again there's there's like the the test of the day i'd like to talk about recurrence really quick so let's say somebody has had everything's treated let's say they've had surgery they've had chemotherapy uh so part of the colon is gone chemotherapy everything and now how often should that person be tested and what tests should they have so after diagnosis of colon cancer pretty much the your screening goes back it's no longer called screening it's actually called surveillance meaning that there's already a history of something being found and colonoscopy is pretty much the only method so after surgical resection let's say they removed the tumor they connected your bowels together great news things are great we recommend doing another colonoscopy in one year after that surgical intervention just to make sure there's no recurrence just to make sure there's no nothing crazy else is going on in the colon after that one year your next colonoscopy if everything is normal it's in a three year time period that's normal from then on it's every five years just for the fact that once you develop colon cancer there's something in your genes you cannot specifically tell which gene but there's something in the genes that's maybe promoting the development of colon cancer so we're a little bit more aggressive in our screening surveillance type of examination i know me i'd go back every year but that's me you know it's not it's not a paranoia thing it's like there's something we really want to know we've got about five minutes before the end of show so i just want to double check with all of you and see that we haven't missed anything that you wanted to get across yet tonight i'm going to start with you well i'd refer you to drone halfway because i need to go over your polyps you know you saw us take them all out and you saw us show the nice pictures but now where are they going you're under the microscope you know you you've gone beyond a pimple or beyond the little uh mold we found a polyp and you've got to plug into a very long-term program yes yes so a colon cancer i want to echo that colon cancer is one of the cancer as you said in the beginning which can be prevented right and you have the tools to prevent it we can remove small polyps and very large polyps by endoscopy we have a lot of a lot of techniques a lot of tools to help us to remove it by endoscopy and if we are not able to remove it by endoscopy we can remove it by surgery if it is not removable and it will not turn to be cancer because it is different again if you have cancer or you have large advanced polyp so we just encourage everybody to check get a screening test whatever modality and if he's able to get colonoscopy this is great this is the best modality but if he's not able to get colonoscopy we get some other tests and seek medical help in el paso we have a lot of good gastroenterologists who can do colonoscopy and remove polyps and it is not only the gastrointology it is a team and we are proud in university medical center in texas tech to have a great team who has is a lot of expertise in removing large polyps and do advanced procedure so i just wanted to shout to them and say thanks to all the help last year we did around four thousand five thousand colonoscopy in our universe goodness gracious wow good for you but once we found the pop doctor robert also tell you you're plugged in for life this is not god no thank god you know it's over this is the beginning of a career so the people is a marker that you're under the microscope how often do we do it and what what do we try to do yeah so you know we talked earlier about the change in screening age so there's actually been a change in how often we screen someone whether after we find a polyp so depending on the size of the polyp depending on how many polyps we find will determine when your next colonoscopy will be example we find two polyps you know they're small eight millimeters they're not showing any sort of malignancy cancer we can repeat one seven to ten years now we find more pops we find five polyps we'll recommend screening between three to five years and you know i just wanna finally just emphasize the point that um you know colon cancer again is very um treatable if cut early early stage most importantly we prevent it five years survival for cancer that is cut early is about 90 percent it's good you know what five year survival of that cancer that's cut when it's already gone to other organs i mean we're talking about 10 14 so it's important get screened get screen gauge screen prevent the spread any adherence to any screen modality is beneficial colonoscopy stool test just adhere to one screening modality right and if the test comes out a little funny go for the collaboration absolutely combining both you know genders male and female this this is the commonest you know we we're not trying to out compete breasts with women or along with men but combining everyone it's up there yeah and uh it's it's low-hanging fruit treatable and diagnosable right and i think we just need to preach that gospel i've seen a lot of change in my in my own personal approach i talk to patients much much more about when was your last colonoscopy just as much as i talk about how's your tummy good for you at parties you do that fourth of july party hey do you have a call to ask me yet yeah it's true [Laughter] uh we are about to wrap up the show and dr mccomb i'm gonna i'm gonna steal this from you for a moment um and if we can we can get this camera on there are a couple of things at the el paso county medical society i have to give them a huge shout out this is a peer-reviewed uh periodical that is written once every three months i understand exactly 45 years in the making so this is 45 the 45th anniversary of doing the el paso position in this periodical in this in this publications the show is 25 years old the el paso county medical society and patsy slaughter and elsa shapiro never get a high five so they get a high five today because they're the ones that make all of this happen uh also melissa huddleson who is uh answering all of our our phones this evening and she's sending along questions thank you so much melissa and it's great because that's what if i'm looking at my phone that's what i'm doing melissa is the one that's doing that dr mccollum every now and again you jump in and you help sponsor programs and that's a big deal not a lot of doctors do that so thank you for that um and again i want to say thank you to dr robles and dr elijah uh you guys have been great and it's always a dance to do this show right trying to figure out if it's a tangle or a wall so we've done it quite well but this is colon cancer awareness last month was the month but really every month is a month to save your life we joked at the beginning of the show that colonoscopy is one of the greatest gifts you can give yourself there's a little bit of prep don't eat steak 24 hours ahead of time i get it and then the prep won't be so bad so thank you so much for being here i'm catherine berg and you've been watching the el paso physician [Music] [Music] you