and good evening.

Thank you so much for watching HealthLine on PBS for Wayne.

>> I'm your host tonight Mark Evans tonight since it is March the month of March of course and Colorectal Cancer Awareness Month we have invited for a return guest our doctor tonight on the panel Dr. Susan already he is a colon and surgeon and doctor.

So nice to have you here on the program this evening.

Thank you, Mark.

It's been about three years I mean long before covid since the last time you were here and I guess there have been some medical advances in your particular expertize.

>> We'll talk about some of those but diverticulitis and the treatment options we'll discuss in the phone numbers on your screen at two six zero or 866- (969) to seven to zero.

Please call in your questions whether it's for you or someone you love and we'll get those answered for you and then you can determine whether or not this individual needs to go see a physician.

>> That's what this show is about to help you.

So Dr. let's talk about something here when I Googled today diverticulitis by golly diverticular diverticulitis came up too.

>> So they sound the same kind of .

But there are two different things.

>> So why don't you explain those first?

Yes.

Yeah.

So the diverticular says it means a condition where the large intestine develops outpourings and pockets.

Normally the the architecture of the colon the large intestine is small but as we grow older because of the dynamics of the stool moving through, sometimes people get these little pockets we can pull up the slide one oh no weight gain a little bit more about that.

Right.

I'll take just a couple of seconds.

What are we going to see when that comes up so you can see uh slide one there we go there as you can see this is just depicts what happens in the colon as we get older.

Um, normally the colon pushes the stool through smoothly but with time if the stool is not enough for the colon to push the pressure mechanisms work on the bowel and wherever there is blood supply those actors weak points and the pressure leads out partings as you can see in the picture OK in these patches have what inside of them.

>> So these pages are like just the tiniest layer.

The bowel is quite thick in fact but these pouches are very thin.

They're made of like a little shell so they're very susceptible to rupture and now the presence of these pouches is called closest and we see that in 80 percent of people 80 percent of your patients.

>> Yes.

So most of us will have a form of this but it doesn't become diverticulitis until win until one of those pocket ruptures.

>> Oh, OK.

Yes.

All right.

So and that happens and only 10 percent of people with diabetic losses.

>> All right.

So hinging on that, how common is diverticular?

>> It is diverticulitis.

Diverticulitis is in fact quite common on an average in the in the nation there are at least two million diagnosis of diverticulitis a year of whom at least two hundred and fifty thousand need to be admitted to the hospital.

Oh wow.

Overall it's about one and a half billion dollars in cost to the health care.

>> Well, and you mentioned that most of us will have some form of diverticular losses at one time or another in our lives, especially the older we get.

>> So in diverticulitis happens to happen who is mostly likely to get that?

>> What are the risk factors?

So the risk factors are actually we're still trying to understand why this happens.

So the understanding right now is that dietary factors a ethnicity as well genetics and lifestyle impacts the formation of the diverticular and then subsequently the attacks.

But overall it's the older population, obese population, those who smoke alcohol and people who consume more red meat, less of whole grains and more high fat dairy.

These are the risk factors for diabetic losses and subsequently diverticulitis.

>> OK, what we're going to talk more into prevention and treatment here in just a minute but we have some calls coming in excuse me.

>> It looks like line five we have Jill who prefers to be off the air and that's quite all right.

So we'll just read a question for you.

She is asking how often does someone need a colon colonoscopy rather after the age of 70 and you know, colonoscopy come in handy for diverticulitis?

>> Yes, absolutely.

OK, good question.

Colonoscopy I can't overemphasize the need for screening colonoscopy march being colon cancer the next month.

This is a good thing to discuss.

So colonoscopy we do recommend for patients after 50 years of age and not the guidelines are actually saying four to five years of age to start doing the colonoscopy is now if anyone has no polyps and colon is normal that colonoscopies we typically do not recommend doing the colonoscopy after to five years of age just for screening purposes.

However, there is any family history of colon cancer or prior colon polyps.

Then we recommend to continue doing the colonoscopy as long as they can undergo the prep and it is safe for them to get anesthesia.

>> OK, so when you're doing a routine colonoscopy check your checking for diverticulitis.

>> Uh, the colonoscopy is done to check for colon polyps and colon cancer.

OK, but the diabetic this is something we see in almost 80 percent of people getting routine colonoscopy as well as Crohn's disease.

>> Can you find that?

Can see that as well.

Yes, you can see inflammation like Crohn's disease or ulcerative colitis or various other colon pathologies can be detected at colonoscopy.

>> All right.

Very good.

And that phone number of course is on your screen.

It's to I always say to six zero but the long distance toll free number of course 866- (969) to seven to zero feel free to call that.

We're talking to Dr. Sunil Reddy, a colon and surgeon.

>> Let's go ahead and talk about the dangers of diverticulitis.

>> Is it actually a life threatening condition?

Fortunately there is a spectrum of diverticulitis.

Not all diverticulitis attacks are life threatening.

Majority of the attacks result in mild inflammation that leads to pain in the belly maybe some nausea, vomiting, fevers.

Majority of them do not have any past pockets.

It's just mild inflammation which can be treated with antibiotics rest.

Uh, but there is a minority of patients with diverticulitis who do get life threatening condition.

There is a real rupture of the colon that results in a massive infection in the belly and that can result in death.

Well, we can talk about the causes and the symptoms here in just a minute but well let's go ahead and slide into that topic .

>> What does cause diverticulitis?

So as I discussed earlier, the change in the pressure dynamics result in these pockets of rupturing.

There has been some talk about popcorn or nuts and seeds triggering this.

All the studies have not proven that but anecdotally we do see patients reporting that they eat some popcorn and nuts and it happens.

So we really don't know what actually triggers the attack but when it happens people get quite a bit of abdominal pain fever.

They really don't feel well and that's the time that they should seek health care professionals help.

>> Well, what causes the fever and all this is that the infection it's the infection and the inflammation.

Oh, whenever there is an infection there, the human body tries to respond to that infection with inflammation and that leads to fever and pain.

>> All right.

And you mentioned a few of the symptoms before.

I like to go over those a little bit more thoroughly if you don't mind some red flags.

What are the symptoms of diabetic colitis?

>> So the diverticulitis typically happens on the left side of the colon so any left sided abdominal pain, loss of ability to eat nausea, vomiting, fevers this should alert the the public and the patients to seek medical help.

>> OK, now where the appendix left side or right side the appendix will be right side.

>> Right side.

So if you have pain on the left side OK, so nausea, vomiting, chills.

>> Yes.

If the fever is really high and yeah.

Um and of course not in all cases but in some the bleeding no bleeding is a manifestation of Bavetta losses.

>> Oh you need not have inflammation typically in older population the pocket will have a small blood vessel and that can rupture and result in torrential bleeding.

So that's a totally different presentation where people come at massive bleeding from the side and that comes from the diverticular even without a rupture or inflammation.

>> Oh OK.

So you get that either way how is this diagnosed?

>> So as I discussed, uh, the symptoms like abdominal pain fever and when they come to their hospital either as an ambulatory setting or to the E.R.

the main test that we do to figure out what's going on is a CT scan of the belly because that will help us understand a bit of this pain is related to appendicitis or Crohn's disease or is it diverticulitis.

>> So that's the first test to do in addition to blood tests.

All right.

Uh, what about a sigmoid Skippy?

>> Yes.

And would you explain what that is?

Sigmoidoscopy is basically colonoscopy.

OK, but we're here we're just looking up to the sigmoid colon which is the left colon.

That's where the attacks happen.

Um, but we typically don't the colonoscopy at that time of the attack because we don't want to make things worse so we give antibiotics cool things down but we want to make sure what we're seeing is not colon cancer with colon cancer.

It is a it's a big imitator.

It can present inflammation, perforation, obstruction.

So that's where the colonoscopy comes into play to make sure this is not colon cancer.

So we do that after six weeks after the attack is cool down and the patients are fit enough to get the procedure.

>> And I notice too and we talk very candidly on this program as you know.

But I noticed that, uh and some some of the diagnoses stool sample is required.

>> What are you looking for in that stool sample?

We test the stool sample to rule out infections that can lead to inflammation in blood to being passed possibly.

>> Yes.

We I mean the bleeding is one of the manifestation of any inflammation in the colon not that specific for diverticulitis but we test the stool for mostly infections.

>> OK, now as we've talked about the uh, diagnosis and talking about some of the symptoms, how is diverticulitis treated?

>> What would be your first step?

>> So it depends on how severe the attack is if it is a mild inflammation limited to the colon without any perforation, uh, we treat them with antibiotics, you know, give bowel rest nothing to eat any solid food and within 48 hours things start getting better.

The pain starts settling down and then they can go home with some more antibiotics for a few days.

Subsequently we do a colonoscopy and make sure it's not colon cancer now before that attack is severe but there is a perforation and a pocket next to the colon that needs to be drained.

So we talk to the radiologist and they'll put a small catheter and drain that place out in the worst case scenarios if there is a major rupture and the stool or pus all over the belly that calls for an emergency operation if you go in cut out that one foot of colon on the left side and maybe do a temporary bag, that's where people get a colostomy temporarily at least to cool things down and that is the traditional resection colon resection.

All right.

And then you had mentioned in some of my correspondence with uh via email the Nici procedure procedure for treating diverticulitis.

>> Yes.

Now some people get the letters which are mild or just have a small pocket but they keep happening again and again.

Now that's the case where we recommend elective colon surgery to prevent it from happening again.

So these days we do this with minimally invasive techniques with laparoscopy in the robot and the techniques have allowed us to reset the colon and put it back together without the need for a colostomy bag.

Um, it's very small incisions so patients can recover fast.

They can go home, you know, within a couple of days the NICU technique it's also got a nice technique.

Uh, it's the technique where uh ,incisions are absolutely small.

The colon is also removed from the side so we don't even have to make even a bigger incision at all.

>> Do we have a slide on that?

Uh, yes.

We can, uh, look at pull ups like three um which is a picture of uh a patient two weeks after the operation.

So this is it looks those little tiny incisions are what we use with the help of the robotic laparoscopy and what kind of surgery is done with so this patient had recurrent attacks of diverticulitis.

>> So to prevent it from getting worse we removed about one foot of the colon and put the colon back together and you can do that with those small incision I would imagine a huge incision a foot long perhaps it used to be it used to be that way a couple of decades back before Laparoscopic came and now with the help of the robotic techniques, the colon itself is taken out from the side.

So the resulting incisions are just tiny keyholes.

>> So this patient could go home the next day and he was back to work five days after the surgery.

That's amazing because I know years ago people have had these kinds of surgeries.

It was a month or two before they can go back.

You also have other Slive like to bring up because I think it's very interesting whenever doctors bring slides I like to look at them and I'm sure the viewers like to look at them as well.

>> But slide number two , what are we looking at right there when we bring that up?

There we are.

I wanted to show the viewers what this diverticular actually look like.

>> I mean you do a colonoscopy so if you look at the the curves that's their normal, um, muscular pattern of the colon.

But a little gaps you're seeing those which look like caves uh, those are actually the pockets the divesture closest oh.

And that's what eighty percent of people have.

Um and those are the pockets that can result in diverticulitis tax.

>> Very interesting.

Well thank you for bringing those slides now we already talked about when we need surgery and so forth so we've talked about the nice procedure in the colon resection.

>> So let's talk about prevention.

Is there a magic pill you can take in order not to get diverticulitis or diverticulitis?

>> I mean so how do we prevent that so it's an interesting question because we're still understanding the pathophysiology of this problem why it happens.

In fact, if you look at, uh, historical notes that's never existed before the 18th century .

>> This disease is a problem of industrialization and our refined diets.

Uh, really they didn't have these problems for say one hundred and fifty years ago.

>> This wasn't even existent in human population even to this day if you look at the Third World countries where the industrialization is not as prominent and the diet is still traditional, diverticulitis is not a problem at all.

Um, it's mainly a problem of European, uh, Americans.

>> And what does it boil down to nutrition?

Uh, diet?

Yes.

Uh, there is some element of genetic factors as well but our predominant assumption is that the diet so any diet that is high in red meat more than 50 grams a day um anything that's high in refined grains and high fat dairy that triggers altered dynamics in the colon that results in these pockets forming.

So the prevention aims that finding the diet and including more fiber, more fruit and vegetables, more whole grain in addition to smoking and obesity do contribute to the overall colon health .

So cutting down smoking and weight loss physical exercise always helps.

>> All right.

Well, if you're joining us, we are talking about colorectal situations and problems and specific diverticulitis and we have Dr. Sunil Reddy who is a colorectal surgeon and been very informative so far on tonight's program.

If you have any questions for him, please give us a call and the number on your screen entry number on the screen at 866- (969) 27 two zero.

We have about ten minutes left in the program and we're moving on very nicely about this topic.

>> If I've had a bout of diverticulitis how likely am I going to have a repeat episode of it?

>> It's difficult to predict but overall the likelihood of another attack is about 30 percent over the lifetime.

>> So once you've had it, there's a good chance that you might get it again.

OK, well that's good to know.

>> Well, do you think diverticulitis can be cured once is a life form.

Once the close happens it cannot be cured.

Oh, they are a part of the colon.

>> They cannot be removed just like that.

Um so but the fortunate thing is not everyone with the diverticulitis gets your tax and not everyone with their tax needs the surgery as I said most of the attacks are mild and can be managed with antibiotics, bowel rest and then subsequent lifestyle changes.

>> So it's more of a prevention than cure.

>> Um, so the uh uh treatment protocol is aimed at trying to improvise the diet, um try to prevent future attacks.

Um, and if the attacks do happen we emphasize on timely diagnosis so it doesn't get missed.

Only two major issues that may end up getting an emergency surgery because anytime there's an emergency colon operation there's a high chance of getting a colostomy.

>> Yeah.

Oh, I have a friend who just went through that.

Um, can I still get diverticular if I've had an affected part of my colon removed?

>> Very good question since most of the diverticulitis attacks happen in that left side one foot um when we remove the the one foot of the colon um to treated every colitis the risk of subsequent attacks is much less the rest of the colon for some reason does not get the attacks even though the diverticular exist everywhere.

So the risk is less than 10 percent.

>> So the surgery is actually quite effective in preventing a serious, uh, recurrence.

Yeah, it just sounds like there are a lot of unanswered questions regarding diverticulitis and diverticulitis.

While we have a question here coming on line five, Carson decides he would rather not be on the air but he is asking what is the youngest age someone should get checked for diverticulitis or diverticulitis?

>> Um, since the diagnosis is very prevalent in the population, there is no recommendation or guidelines to check for the diverticular.

Um, most likely many people do have them and they're silent.

They're not cause problems.

As I said, only 10 percent of people with that particular issue get the attacks right so you don't have to worry about getting checked for that.

Uh, but if you do get an attack then that's something that you should keep a watch on.

Be in touch with your health care professional um and avoid a bad attack coming up.

>> Uh, and that's very good and wise information there.

Here's something I had a boss one of my first jobs in many, many years ago.

I had a boss who once in a while could not work because he had diverticulitis and it was because he had eaten or he said that he had eaten some KDDI foods like popcorn and some grains and things like that.

But now we're saying that really isn't the case and you mentioned that earlier the conversation was something I did want to address because a lot of people don't eat those types of foods high fiber foods because they're afraid it might trigger the diverticulitis.

>> Correct.

It has become a prevalent practice for people to avoid not seats and popcorn.

And there's been recent studies that show that eating nuts and seeds and popcorn does not really increase the risk of attacks of diverticulitis.

>> As such it is safe to eat nuts and seeds.

Um, what we do recommend is that you will make sure it's balanced and make sure there's enough uh um a carbon fiber supplements along with it to to make sure the digestive process goes and you know, without any issues.

Well and now we're saying in the same conversation to eat that kind of food and also a lot of fibrous foods.

>> Uh, what is the fiber doing?

Is it is it cleansing or what's it doing to the intestines when you eat that?

>> So the fiber does an essential job of absorbing water and keeping the stool bulk because for the colon to push the stool out it needs the bulk in the colon so that way it works well to push it out in the absence of fiber if you eat uh, a diet that is rich and just meat or dairy the results in the colon not having enough stuff in the colon to push it out so the pressure mechanics change and that that results in the muscles in the colon getting too strong and then the pressure results in pockets forming up.

>> So in this case the more the fiber the better for oh yes.

Yes OK well that makes sense.

That actually makes sense.

>> So how much fiber should I eat during a day?

So the recommendation is about twenty five grams of fiber so what's that and uh it comes to uh as simple as a cup of cereal OK with probably a couple of vegetables or fruit and this has to be consistent something every day correct.

The emphasis is that to start the high fiber diet from younger age we do see a lot of people who switch to a healthy diet once they hit the third and fourth decade.

But by the time you already have this diverticular problem already there so the uh, dietary modification or the lifestyle changes start really young almost when you old school age.

>> Um, well and for the fiber and for our viewers just uh to educate them we're talking about whole grain foods like breads, pasta crackers, barley brown rice oatmeal, berries and other fruits.

>> What are some really good vegetables to have that are fibrous, um, beans, peas, anything that's Skansen peels, you know, cucumbers.

Most vegetables have uh a significant amount of fiber and then substituting white bread with whole wheat bread, you know, substituting pasta with whole wheat pasta or something which is unrefined cereal that really helps.

>> OK, well if I can't get enough fiber from my diet or other like fiber supplements that uh that are good you know, don't mention any brain brand names but can you buy those off off the shelf.

>> Absolutely over the counter.

Fortunately there are so many brands available and they're very cheap and they're all natural.

They're made of seed husks wheat bran so it's not addicting to the colon and it's really very healthy, uh, thing to take every day.

Um, there are other benefits to using fiber which is decreasing the cholesterol.

Um, it also keeps the overall health good.

>> All right.

What about antibiotics and supplements?

Uh, anything that we should be taking on an everyday basis to help ward off any infection in our intestines?

>> Uh, routine antibiotics are not recommended.

In fact it could be harmful.

But probiotics is something that's, uh probably most people are aware of my next question.

Yes.

So essentially probiotics are the healthy bacteria which the bowel needs.

Uh, and today we have supplements available which will kind of uh uh give you all the healthy bacteria you need in the form of capsules or even a cup of yogurt will provide all the probiotics you need.

So there is some talk about probiotics preventing colon problems.

We don't have strong evidence in the literature.

Um, but there is some studies that have shown that it does help in keeping the colon overall healthy.

>> All right.

A lot of things I've actually been able to put together and gather from this program tonight is that when you have these situations as far as your your digestive system, what we're talking about intestines and your bowels and your and so forth, the medical advances have advanced so much in the last couple of decades that I can see from doing my research that there really isn't any reason to fear having these things checked out.

>> I mean you talked about the minimally invasive surgery also the minimally invasive tests that people can take.

>> So once you speak about that since we have a couple of minutes left in the program, absolutely colorectal problems are prevalent in our population so it's always wise to seek health care, professional advice and assessment in a timely fashion.

Number one because Colon cancer one in twenty five Americans get colon cancer in their lifetime.

It's that prevalent so the number one thing that we as colorectal surgeons or even primary care physicians we want the patients to not get colon cancer.

Uh, and it's very easy to prevent colonoscopy as are widely available.

It's just uh the patients need to go and accept and get it done and that will detect a lot of colon problems which we can treat in a timely fashion.

>> And what are the things that you need to ask your physician?

Uh, because the physician is definitely going to be referring you to another physician of that specialty.

>> So what kind of conversation do you need to have when you go in and say I've got some concerns what honesty is the best policy but what are some of the main things that they need to know?

>> Uh, the main things they need to know that these procedures are safe.

For example, colonoscopy, it does have some risk like any other medical procedure.

That's a piece of cake right.

>> But it's absolutely safe.

Uh, the risk of complications happening is one in a thousand and one in ten thousand and even those if you detect them you can treat them.

So there's no need to be concerned about problems happening during these tests and the almighty colonoscopy.

>> I mean they find so many things they can actually take some of those polyps out if you happen to have polyps so they can take those out during that procedure, can't they?

Absolutely.

90 percent of polyps are very small and we can dig them out right then.

>> Very good.

Yes.

Well, Dr. Reddy, thank you so much for being here.

Always informative and we'll have to have you back again.

>> But I'm glad we had you here for March Colorectal Cancer Awareness Month.

>> Thank you very much.

You're very, very welcome and we thank you for watching and we'll be back next week for more on HealthLine here on PBS Fort Wayne.

>> Until then, good night and good