Hello, my name is Doctor Sarah Walker, and I'm honored to serve as the 2025 president of the El Paso County Medical Society.

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Presented by the El Paso County Medical Society and hosted by Kathrin Berg.

A colonoscopy.

One of the greatest gifts you can give yourself to save your life.

Because by removing suspicious polyps during the procedure, cancer can be prevented.

During this hour, we have physicians talking about the importance of early detection about diagnosis of colon cancer.

This evening's program is underwritten by tenant.

The hospitals of Providence.

And we also want to thank the El Paso County Medical Society for bringing this program to you since 1997.

I'm Kathrin Berg, and this is the El Paso Physician.

Neither the El Paso County Medical Society, its 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.

Thanks again for joining us tonight.

We're talking about colon cancer and the importance of early detection through the last decade or two.

We've all been hearing about actors, people who are celebrities, who have been diagnosed with colon in their 30s and their 40s, and some don't make it.

Years ago, that was something that we didn't even start screening until the age of 50.

So we're going to talk a lot about that tonight.

Maybe have some special guesses, educated guesses as to why some research that's going on, but continuing there.

But tonight that's what we're going to be speaking about.

So with me, I have Doctor Arturo Hernandez, who is, family practice physician, and he's been in El Paso for about 15 years.

And I want to steal your thunder because I'm gonna ask you guys introduce yourself as well.

And then we also have Doctor Avery Walker, who is the colorectal surgeon on our board here today.

So, Doctor Hernandez, I would love for you to talk a little bit about what you do all day, every day for our audience.

Okay.

I'm a primary care physician, so we are the gatekeepers, you know, all the help, we're trying to prevent.

And that's why I love the way you present, the colon cancer.

Because it's one of those things that you can prevent if you catch it on time.

The patients they have, much better outcome if you catch it in a later stage.

And, it's very important.

I think there is somewhere here is because we need to emphasize and prevention instead of, surgery or I tell you, doctor, Walker is going to talk about all that, but I think is very important, the prevention in this case, in colon cancer, it makes a big difference.

Completely agreed.

And, there was a traveling colon in town lately.

And we'll talk a little bit about that, too.

But it was really cool because you could see life size, like, literally not life size, much larger than life size.

You can kind of walk in there.

She would have polyp looks like she what is normal, what is it normal, etc.

so it's always nice to be able to see that.

Doctor Walker, let's talk about you.

Again, you're a colorectal surgeon.

Correct.

And we were talking a little bit prior to the program that you were in the Army for a while, so you're kind of from everywhere.

Yeah.

So give us a background of why you got into colorectal surgery in the first place.

Sure.

So, like you said, I was in the Army for 13 years.

And I trained as a colorectal surgeon, initially as a general surgeon, got my fellowship within the Army and, practice colorectal surgery here at, in El Paso for about five years.

And then stayed in El Paso when I got out of the Army and continued as my doing my colorectal surgery practice.

And I love it.

It's it's a wonderful place to practice, and it's very busy.

And just like we're talking about, prevention is the key, but I do love to operate.

And I will operate when I need to.

I will operate when I need to.

I, like we said, that prevention is the key, I love that.

We were joking before because you said you were here since 2017.

If you were a grown up in El Paso type of a person, would you just say, oh, where'd you go to high school?

That doesn't count for you.

So now, if you are an implant, we get to ask you what your favorite Mexican food restaurant is.

Don't answer now, but maybe before the end of the show and you might have.

Some people were crying, or some people were like, oh, we need to take them somewhere else, right?

So let's talk first about what the colon does.

So we hear colon cancer.

Sometimes we hear colon and rectal cancer at the same time during the same, wording.

But you never hear small intestine cancer.

You never hear not often you hear stomach cancer.

You don't hear these other words.

So, doctor, Hernandez.

I'm going to ask you first, what is the role of the colon, and why are we seeing colon cancer versus anything else in the digestive digestive tract?

It kind of takes over.

It's like colon cancer is the most prevalent.

Of course, there are other ways and places to get cancer.

But why is the colon the super star there?

Because is there third, cancer?

In, in incidence.

So basically and also very important we need to emphasize that we're seeing patients, younger patients every day with colon cancer, like you said before, the standard of care, it was colonoscopy by 50.

But, since 2021, the guidelines changed to, 45 because we're seeing younger and younger patients with, colon cancer.

So I think that's very important.

You know, to emphasize something that, you know, that is the third cause of, of cancer.

And is this something cause of death by cancer in United States of America?

So this is a hard question to ask, because I don't think there's a real answer yet.

And I'm going to throw this out to both of you.

But since you started, the incidence of younger diagnosed colon cancer is now, and usually there are no symptoms.

And that's the hard thing.

It is a silent cancer.

The kind of creeps up on you.

And sometimes you don't know anything until you have had the screening.

So on that end, the guidelines now are at 45.

However, if you've had other risk factors, what are those?

And the people who are listening and watching go, you know what, that's a risk factor.

Maybe I can talk to my doctor and see if I can get screened starting at 40, maybe even at 35 of the risk factors are there.

What are some of those risk factors.

And yeah, sure.

So I what I tell a lot of my patients that I see when I, when I see my patients, they're already having symptoms.

Typically they've seen their primary care doctor and they're having the symptom.

And those symptoms could be anything from abdominal pain.

That's not getting better.

It could be bloody stools that they're having.

It could be constipation.

It could be bloating.

All these things that people will think of that are normal until they're not.

And so what I tell patients are, if you're having symptoms that don't get better on their own, see your doctor and tell them that.

And then if the doctor, the primary care doctor, says, well, let's try some things and they don't get better, then the primary care doctors say, you know what?

We need to do a little bit more work and get you a colonoscopy.

Typically your constipation, your bloating, your maybe a some blood in your stool typically will go away for healthy people, right.

But if they don't, that's that.

And this is me being a disrupter because sometimes I'll miss the point.

So when when these things go away and the reason I'm saying this is I want to be very specific, not cause alarm, but do make things very serious if you're having issues like that and they go away, what could have those causes been.

So there's IBS, there could be it could be anything.

It could be something you ate.

Right?

It could be a virus.

It could be some bacteria that you picked up somewhere.

It could be anything.

But if those things get worse or you're starting to have worsening symptoms, weight loss, you're starting to have fevers, something that's just not the normal kind of course of action when it comes to just a simple sickness, that's when you talk to your primary doctor.

The things you tell them make, you know, convince them to say, okay, you need something more than just some medication.

You might need a CT scan, you may need a colonoscopy, maybe something that we can start looking and we can't push these patients away because a lot of times back in the, you know, in the past we would say, oh, it's no big deal, you know, and then sure enough, it would be a big deal.

And so anybody who really shows up in my office with any problems, they're getting a colonoscopy.

And that's like, that is what?

Because by the time they've gotten to me, they've gone through their primary care doctor a couple times.

And at that point I'm not going to turn them away because my colleague here is probably done a lot of work up at that point to say, hey, this person I'm concerned about, I need you to do the extra work to find out what's going on.

And the worst thing that could happen is that you don't find anything.

And that's great, right?

Because that means we did all the work.

Exactly.

And I'm going to cover two and I do I just just people are listening.

We are going to cover to the, topic of hemorrhoids, of IBS and diverticulitis.

We're going to cover all that.

So if you're kind of wondering, hey, I've been my doctor said, I have a couple of these things we're going to cover that in, in the area.

And the map also is colorectal cancer.

Go ahead.

And the risk factors, first of all, it could be age, you know, we're seeing a search in, colon cancer in young patients.

But still the majority of the patients with colon cancers are about 50 years old.

So age was one factor.

The other one, it's, also diet, you know, red meat, processed red meat, like hot dogs and stuff like that.

You know, the those are risk factor as well, you know.

And the other thing, it's, very important.

Regarding the the risk factors, it's family.

You know, if you have a family history of colon cancer, unfortunately, is one of those, those, cancers.

They, they are in families.

So it's very important to, go to your physician, let them know another, risk factor that is, also besides the is, obesity.

Yeah.

Unfortunately, here and United States, we have, you know, obesity, pandemia.

And, that's one of the also the risk factors, you know, rich fat diet, big, big factor as well.

So if you see, there is a lot of it's multifactorial.

It's not just one thing is multifactorial.

And, that's why it's very important, the prevention, you know, with diet, exercise and all the stuff.

But all those, are, very important.

There is also some basic genetic component of it.

Those are not very common, you know, like Lynch syndrome that is, associated with all the types of prevention that.

You're right.

Those are more specific.

And that's why it's very important to, to address it with your, with your doctor.

But if you see the risk factors are not, super special, you know, they are very common things.

Our diet it could be a factor.

So that's why it's very important to find for size.

And so I want to bring somebody up who's here today who happens to be a family member of yours.

And so there's a couple of pronged attacks here.

So number one, she's going to find out if she's going to be admitted to nursing school.

Yeah, hopefully.

Yeah.

We'll see.

But number two, with how old are you?

Do you mind if I ask you?

They're 19.

You're 19.

Oh, your life's in front of you, darling.

I love everything about that.

So Valeria, then, has probably grown up with processed foods by no fault of the family, by no fault of anything.

It's just kind of our society now.

It's really easy to either get fast food, even in the grocery store, the packaged stuff that you get right and left.

I was just visiting my my kids in Austin and the H-e-b, they they have like literally green onions, cut up, put in a package on the shelf.

And I'm like, okay, is there some kind of, you know, preservative in there, etc.. So, when you're talking to young 19 year old, your daughter's family members in general, because this it is now a newer diagnosed disease in younger patients.

What is and from both of you, what are you telling people.

What are you telling the young ones in nursing school.

What are you talking about?

The medical students are coming up because it is a whole different field than when when we were growing up.

Yeah, unfortunately, I don't think we have very good, discussions about diet enough.

We don't have a lot of time with our patients because we're very busy.

And so to sit down and have a detailed discussion about what they're eating is difficult.

That being said, just like you said, the processed foods are just everywhere.

And we think that's maybe the reason for this, that there isn't good data to say this is the answer, because if it was, we would we would be able to prevent it.

Right.

But it makes sense.

And so to try to avoid the processed foods as much as possible, that's what we push to the patients.

You know, green leafy vegetables try to stay away from the packaged foods, try to do your own cooking.

We're all very busy.

It's very difficult.

But to stay away from those, you know, packaged foods and processed foods, that's, I think, a big factor in why we're seeing younger patients with colon cancer.

But it's not guaranteed because you can talk to 100 different patients who do eat those things and they don't have colon cancer.

But the one person does, for some reason, has some disposition to getting colon cancer.

And so it's just best to avoid those kind of things if you can.

And that's what I push to my patients.

A lot of my patients come with constipation with hemorrhoids, as you mentioned, and a lot of that also has to do with low fiber.

We get know we get very low fiber in our diet in general, and it's very hard to get the amount of fiber that we recommend in general.

So I constantly push fiber to all my friends and family and all my patients.

And when you ask them how many, how much fiber they get, they don't know.

They think, they think they got that, you know, whole wheat bread sandwich.

And that's all the fiber they need.

And it's not it's nowhere near.

So I love that you're saying that.

So be specific on what they can eat more of.

So we all hear more fiber more fiber.

But what does that mean.

So there are supplements.

There are fiber supplements.

You know we can do name brands or not.

It's up to you.

Yeah.

I mean, to your patients.

What do you tell them.

So I mean fiber supplementation.

Absolutely.

I think is is appropriate specifically Metamucil or psyllium husk.

But that can only get you about five grams of fiber.

We recommend 30g per day.

So if you're only getting five, you got 25 left to get somewhere.

And so what I always tell patients is try to get something green in every meal of the day, and that can get you anywhere from 15 to 20g a day.

And you have to actually make an effort to do that.

And that's hard.

You know, patients don't like people don't like to eat salads.

People don't like green things.

I tell patients, I do it myself.

I take a shot of Metamucil every night before bed.

And then I also eat that because people are going to listen to this.

Yeah, I literally that that's colon cancer.

It's part of my it's part of my nightly routine.

I take a shot of Metamucil right before bed.

Follow that with some water.

And then throughout the day, every meal, I have something green, whether that be broccoli, beans, peas, something like that, something with high fiber.

And also, I try to avoid the processed foods.

I don't like going to the fast food restaurants.

I don't like, you know, eating packaged foods.

Now, granted, we're busy.

You got to snack on things every now and then, but the majority of the foods that I try to eat are, you know, homemade or purchased, you know, in more of an organic fashion.

And I tell my patients, I know it's hard, you know, these can be expensive type foods.

But you also got to realize what you put in your body can really affect you, right?

You know, so that's what I do.

So Doctor Hernandez, I'm going to take things back to you because you are the first line of fire.

You know, you're you're the person that everybody comes to.

You, they give you all your problems, you listen to them, and then you figure out if you need to send them off somewhere else.

So I would love for you to think of a case study or two.

No names.

Of someone that you're like, this doesn't sound right.

I'm going to order a colonoscopy for you.

And what is it that patients are saying to you?

Because, again, a lot of the the diagnosis first, clinical right?

And clinical means ask all the questions.

And what do you physically see when what are some of those questions.

Yes.

What you just asked, it.

It hit home unfortunately.

I have a family member.

40.

40 years old.

40 years old.

No symptoms at all.

You know, a patient with no symptoms at all.

Just some, you know, discomfort for bloatedness, mild weight loss, but not significantly.

But, at the time, she was on, on a diet, so we thought probably it's that, all of a sudden, she started with a little bit of blood in the stool, you know, take her to the... I'm going to stop you there.

Only because that's a big question in our audience.

When you say blood, what does that look like?

Because it could be dark.

It could be bright red.

So describe what what she saw and what the symptoms could be usually is bright red blood.

You know, it all depends.

In the anatomy, where exactly the side of the bleeding it is, usually the closer you are to the rectal area, there is more, is going to be more, bright red blood if you go a little higher in the upper GI system, you know, storm, you know, the beginning of the, the small intestine, you can see black, tarry stools, you know, it's basically because in the way to the, you know, outside the blood, it gets oxidized and it turns the, the stool black.

You know, what we call melon.

So and so we can even describe it.

And I just think it's nice to say this out loud that when you get a scab it's not bright red forever.

Like the bright red starts going away.

So I just think if there is a little bit of time there, your scab is going to turn a dark red even to a brown.

So that's what people are looking for.

If they're a little bit of time to get through the track.

Exactly.

And to be honest, there were not a lot of symptoms to be on it.

So when we took her to the colonoscopy, I was expecting everything but cancer, to be honest, when the doctor came, you know what?

This is a situation.

It was, already stage three.

You know, according to the after they get everything they checked.

But I was surprised that, believe me, there was no major symptoms.

And I think that's the message.

You know, you don't have to wait until you have a rectal bleeding or bright red blood or blood in the stool.

You, if you have symptoms like cloudiness and they're very general.

Don't think it's like a, like, excruciating pain.

No, it's just my opinion.

It's already different.

Something's off.

Something's off, you know?

And, and, you know, because of, the diet we have here in the, in this area, unfortunately, I'm very glad Doctor Walker talk about it, because I think the fiber, you know, is sort of a conversation when you hear now in, social media and everything, everything's about fad and protein, and people wants to take more protein, but nobody talks about fiber, and that's super important.

I think in this case, I might just do the little shot before bed of, you know, it'll change your life.

You know what?

I bet it does.

I mean story, but not.

But when I was pregnant, I always be nauseous in the morning.

So I eat literally a boiled egg every night before bed because that way I don't have an empty stomach.

So maybe I made switch that out with a little bit of Metamucil, because then it keeps you a little bit swole.

So it kind of.

And you know, I want to emphasize the fact that, you know, looking at your poop is okay.

You know, it's a big deal.

Like, this is the doctor and this is what I do.

And I tell patients, look at your poop, right?

It's okay.

It's got to look great.

You got to be proud of it.

And you got to look at and see what to look.

What's in there?

Okay?

You got to know your patterns.

You got absolutely to win.

So on that note, so people who maybe have not yet ever looked at their poop, what's your poop supposed to look like.

And again this is something too.

It's a little bit different for everybody.

Everyone has a different system, a different clock.

And that's all good.

Yeah, but find out what your clock is so what would normal poop.

That's a very good point to start off with.

Everybody is different.

But everybody should have a pattern.

Right.

So if you go once a day and that's your pattern forever, that's okay.

If you go once every three days and that's your pattern forever, that's okay.

If that pattern changes for some reason over time, like a few weeks and all of a sudden you're not going every day, that's a problem.

That's one of those symptoms where it's like, now I have a change in my bowel habits.

If your stool starts to have the dark colors or if it's got blood in it, and that's a problem, right?

If it changes shape.

Right.

So if it should look like a nice S-shaped solid sausage, that's what should come out.

You shouldn't have the strain.

You should be able to sit down on the toilet.

It should fall right out of your butt.

And you should have a couple wipes and be good.

That is the perfect poop.

Okay, okay.

Yeah.

And I tell my patients all the time, and I ask them, how does your poop look?

Half of them will say, I don't look.

The other half say, you know, they look, everybody looks well, they don't.

And so, you know, when you when you actually, you know, joke about it, they, they, they actually mess up.

Right.

So that's why I like to talk to my patients and have a good time with them talking about their poop.

And they, they laugh and we get more, you know, history in that sense.

But you should be able to, you know, have a nice long be proud of what your poop looks like.

And then, you know, you can you can understand what what changes might look like if they occur.

And this really involves a lot of fiber.

If you have good fiber, the stool should look like a nice sausage shaped, shaped stool.

When you don't have fiber, that's when the stools become hard or they become very loose because the the job of the colon, as we mentioned earlier, is to absorb water.

Right?

That's the main function of the colon.

And so what would your body is going to do is and it's going to stop all the water it can.

And then whatever's left is what comes out.

If you don't have fiber to to hold some of that water in or to bulk up the stools, then that stool is going to be very thin and it's going to be very watery.

And then you're going have the problems associated with that.

If you have a nice big, solid stool, you're not going to have the hemorrhoid problems.

You're not going to have the constipation problems, and you're not going to have hopefully these these colon cancer problems.

So on that note and Doctor Hernandez I'd like to ask you this because there are times when you do you eat something funny or for whatever reason it's like okay now I have diarrhea for a couple of days.

Maybe it's a virus, maybe it's something I ate.

And or.

Well, now I'm kind of constipated for a couple of days, like traveling.

And I'll be the first one to tell you I'm from Germany.

I go home once or twice a year.

I have an issue like about 2 or 3 days.

I'm.

I'm an everyday pooper.

Just throwing it out there.

When I go home, it's like it takes 2 or 3 days for for me to have a bowel movement.

And I'm like, years ago I thought, something's really wrong with me, but I don't know what the deal is on that.

Right.

But that's now normal for me.

I get that.

Yeah.

So on that.

But I would argue and I'm sorry to interrupt, but I would say that that's probably not normal if you're, if you if you can if you can count, if you can put that associated with your traveling, you're probably not either getting enough water while you're traveling or you're not getting enough the right food that while you're traveling.

In terms of the fiber intake, again, the goal of the colon is to absorb water.

So if you're traveling and you're not getting enough water, you're calling it sucking every ounce of water it can to hydrate your body, which leaves hard stools, which leaves, which turns that into constipation.

So the combination of fiber and water is probably the reason why patients have the abs, why they have the constipation, why they have the hemorrhoid issues.

All of these things are likely related to fiber and water.

Okay, until the passes all the time I say how much water you drink?

Oh, I don't, I don't drink a lot.

I don't like water.

Okay.

Right.

There you go.

Or I don't like the fiber I don't like to have.

I what the best question I love it, I have every day I say how much fiber did you get?

And patients say, oh, I don't know.

I say, okay, tell me what you had for breakfast, lunch and dinner.

Okay.

I, I don't eat breakfast or I had a burrito for lunch and I didn't eat dinner.

Okay.

Where's your time?

None.

And they're shocked.

So, like, I really didn't get any fiber.

Okay.

And so if you're doing that every day now you see why you're sitting in my office with hemorrhoids or you're having constipation, or you're or you're having very loose stools because you're not doing the things that your body needs.

You think about our grandparents.

That's all they drank was water, right?

You think about what they ate.

They only eat stuff they could grow or go from the local grocery store.

Right.

They didn't have these problems.

Right.

And so now we're having these problems because we're not eating correctly in general.

That's my theory exactly.

All right.

Doctor Hernandez so I would like for someone you're the surgeon, but I want you to describe a colonoscopy.

And then we're going to, we're going to follow up with some surgery questions.

But I say this because some people that have never had a colonoscopy.

Oh it's awful you know.

Yeah.

Yeah, yeah.

This is really not bad.

And I really want to say that out loud because I've had two of them.

One was polyp.

This one has a polyp.

So now, you know, I do it every five years.

But my own experience is you take your Go Lightly or whatever the preparation is.

You literally have diarrhea for less than 24 hours.

I call it a really healthy cleanse.

Everything gets out of there.

But that's that's the worst part of it.

And it's not bad at all.

Like literally.

But if you can describe to the audience the prep, yes.

But then what is happening during the procedure so that when people hear it, they're like, okay, I get it now because you hear colonoscopy, they think you have to put you out.

There's there's a tube going up.

You like what?

What does all that mean?

So when patients ask you, doctor, what really happens in that room?

What is it that really happens in that room?

Well, the colonoscopy, we have to see it as a gold standard, you know, for the screening, for early detection of colon cancer.

Basically, it requires for the patient to be, under, you know, a very potent, laxative, you know, because they want to cleanse everything because it's very important for the for the, gastroenterologist or the colorectal surgeon to see the walls of the the colon.

Right.

So that's why it needs to be cleaned completely.

A good, preparation is essential to, you know, how to, excellent outcome in the colonoscopy.

You know it.

So I recommend my patients, you know, like, one day before.

Just do just, liquid, you know, just, liquids, so they don't.

I mean, you don't want to eat enchiladas, you know, the day before, and it's going to be a mess, you know, with the with the laxative.

So to do it more, more, more liquid, it doesn't have to be bread, right?

You know, it's very important.

Especially they can do some jello stuff like that.

And in their day of the colonoscopy basically just show off your fasting.

You know, you have to be fasting at that time.

Usually it's in, in a surgical center in the hospital, or specialty center for the colonoscopy.

They, basically after a good preparation, they take you to the, to the or and or the procedure room and basically as they put you under anesthesia and, basically they endoscopies in certain angle or this is very important because these tests, it can check the whole colon.

So describe for those that don't know what is an endoscope, describe what that it's equipment is.

It's like a little camera you know that it goes through.

It is very thin.

The thing is is very thin.

So it can go all the way because guided by the by in this case, a surgeon or gastroenterologist.

And basically they want to check the walls.

Yeah.

To look for polyps.

We're going to probably talk about polyps.

And, that's very important, you know, to check for polyps, but also is not only for polyps or cancer.

You know, you can find out the vertical axis, which is very common.

And we go again with, the problem with the fiber, that's one of the things with fiber here.

Believe me if I tell you that, at least in my experience, in my patients, at least, you know, this is more anecdotal.

From what we eat, my practice is at least 90% of those patients they have or hemorrhoids or diverticulosis.

All right.

So all those things that those are important to check for that, you know, not only that the colon cancer, which is basically the main thing, you know, that you want to rule out, but there is also other pathology that it can show you during the the procedure of colonoscopy.

Okay.

You know, doctor, walk along those lines.

I do colonoscopy myself.

I did 4 or 5 this morning.

Okay.

And just like, you know, doctor never saying it's very, very simple.

You you come in, you go to sleep, they put you to sleep and you don't feel anything.

It's actually a wonderful experience if you've never had anesthesia.

And so, basically you go to sleep, you wake up, you get a report, and it's done.

It's not a big deal.

And the true benefit, really, of colonoscopy is getting rid of those polyps because we know that.

So let's talk about you're in there.

You see a polyp.

You got a little catch you at the end of the tube.

So describe that.

You think that's so as you do a colon.

Awesome.

You'll you'll see these polyps.

And we essentially cut them out right there through the scope.

The scope is about the size of your finger, a little bit bigger than your finger.

And you go in there, you see the polyp, you put a little basically like a lasso, and you snare that thing and take it out.

We send that off to the pathologist and, and, you know, nine times out of ten, even higher than that, it's a benign polyp and it's not a cancer by any means.

But what you have done is you have prevented that polyp from going to a cancer.

And that is the key.

You don't want to find a colon cancer because that means it's too late, right?

Too late in the sense that you didn't prevent the cancer.

You want to find the polyp because then you have prevented it from going to a cancer.

And so you do that.

And based on the findings of how many there are, how big they are determines when you need to get your next one.

And again, the prep is the worst part.

But again, it's really not that big a deal.

There are other preps out there that if you request it, we can make things happen.

We can do things differently that might involve a little bit more, it might be more costly, but if it's not, if you're not able to tolerate it.

So there are things that if patients are worried about the type of Prep that we can, we can adjust and do things for it.

But yes, you know, I do colonoscopies almost every other day.

And we find polyps all the time.

And this is, you know, very, very important to, to do.

Agreed.

100%.

Agreed.

What I'd like to do is kind of move a little bit and talk a little bit about hemorrhoids.

So you were talking about hemorrhoids are the product of not enough water and not enough fiber.

And the reason I want to bring those up is that we are talking about a symptom of finding blood in your stool.

So the question can be, sometimes upon a physical examination, if the hemorrhoid is what is bringing the blood to the toilet paper, again, look at your poop.

Look at the toilet paper.

See what things look like.

When it how do you describe that to your patients?

When somebody does have hemorrhoids?

I don't want to say just hemorrhoids because they're painful.

Hemorrhoids versus something that that could be in the stool.

So let me show differentI let me kind of take this on, because this is the number one reason I see patients.

Okay.

This is the main patient population comes to see me is I have hemorrhoids.

First of all, hemorrhoids are completely normal.

They're part of your normal anatomy.

I tell patients that just like your left arm, everybody has one.

Okay?

The only reason why you wouldn't have hemorrhoids is if you didn't have an anus, for whatever reason.

Right?

So they're completely normal.

The completely part of your anatomy.

That being said, they grow and shrink based on what's coming down the the tube and that's because the hemorrhoids are basically the last little bit of closure of the anus.

Okay.

So they grow and shrink in terms of what's coming down.

If you have very watery stool, the hemorrhoid tissue is going to swell up with blood and try to seal that anus so that you're not losing stool out your bottom.

If you're straining and putting all this pressure down there because of hard stools and constipation, then they're going to swell up too, because of the pressure.

Again, they're doing what they're supposed to do so that you're not stalling on yourself and they're reacting to what's coming down.

So if you have nice bulky, soft stools coming down because of the fiber, then the hemorrhoid tissue is going to be normal and that's going to not bleed.

It's not going to cause any issues.

And what don't hurt what what hurts is when they become when a blood clot gets in them, sometimes a blood clot can form and that can be very painful.

There can be other anatomy or other, disease processes within the anal canal that can cause pain.

But hemorrhoids don't hurt.

You can think of hemorrhoids like, like, varicose veins.

Varicose veins don't hurt.

They get swollen.

Patients feel tired.

The legs get heavy.

You put compression stockings on them to help them go better.

That's exactly what hemorrhoids are.

They're.

They're vessels that are in the anal canal for specific purpose.

And so when they bleed, it's because you're doing something wrong.

Are you wiping too hard?

Do you have constipation?

Are your stools too loose and are swollen?

Do you have a blood clot in there.

And that's causing severe pain that we can treat right away.

If that's what happens.

But again, hemorrhoids are completely normal.

They're part of your anatomy and we shouldn't do things to them if they're not causing any problems.

Like I said, you shouldn't do things you said.

You said you had some issues when you were pregnant.

Every pregnant woman has swollen.

Gosh, I never knew what they were.

And the reason why.

The reason why is because that baby is growing and sitting right on the Big bang is coming up from your legs.

That blood is trying to get back up.

It can't.

It goes around and it goes around the baby and wears once place and stops in the anal canal.

So we get called all the time.

And these pregnant ladies with big hemorrhoids and they say, what do you want to do?

When I say, have the baby and they'll go away?

Why?

Because they're normal.

So yeah, I had this conversation that that company that just did.

Right now, this is what I have every day.

Okay?

I had no idea what a hemorrhoid was until after I had my baby.

And that's like, what is, you know, again, too much information, but not so much because initially they're very big and they can bleed a lot.

And to the point where doing the things that are natural, normal won't help.

And so there are interventions, they're very painful interventions.

And so I don't like to do a lot of interventions on hemorrhoids.

But there are things that I can do that aren't very painful, that can kind of reset the system.

And that's what I tell patients I'm resetting your system.

I'm not going to cure your hemorrhoids because again, they're like your left.

I'm going to cut off your arm because it hurts right?

Fine.

What's causing the pain or causing the issues, not the bleeding.

So that's that's kind of my hemorrhoid spiel.

Okay.

So I'm going to pivot a little bit too, because I want to talk a little bit about IBS because I feel irritable bowel syndrome.

Because I feel like with the media, we've heard a lot about it over the last decade or so.

I used to say, well, that's somebody who has a nervous stomach, you know, there's just something that just something always triggering and they've got gastro issues.

What is IBS?

I don't want to spend too much time on it, but, doctor walkers look at me like I don't want to go there because it's a loaded question, and I. And I am in full respect of that.

But we hear it all the time.

Some people like, oh, I have IBS and they kind of brush everything else off and say it's IBS.

So who wants to tackle that first?

Doctor Hernandez, it's kind of your turn to talk.

You want to tackle that?

Yes.

Okay.

And then feel free to chime in on that.

Yeah.

Well irritable bowel syndrome is one of the it's very common.

You know the disease is very, very high.

There is three types.

One is the it's the robinow syndrome when you think about it, change, think of changing the pattern.

You know, sometimes, it could be, more, more constipation in some cases.

So it's IBS with predominance of constipation.

There is also the IBS with predominance of diarrhea.

And the other one is mixed.

You know, you can and that's a little, you know, harder to do because you can have these effects in some people are just like, I'm this one.

Did this one, you know.

Yes.

So it's one of those things that, the best thing to do, though, is, what with Doctor Walker, you know, was mentioned about the, the high fiber diet, you know, try to avoid especially here and, you know, in where we live, you know, in our community, spicy food also, you know, it can be anywhere.

You know, you read out, you know, to your to the colon and all this stuff.

But basically it's you can see a change in the pattern of, the, the stool of the patients.

One of the most things that the patients from, complain about.

Okay.

Well, and the reason why I give you that look is because I can't operate on IBS.

Right.

So.

Right.

So as a surgeon, I like to operate.

But that being said, I think when you sit down and I think when the primary care doctors and the gastroenterologist sit down and talk with the patients, with quote unquote, IBS, if you get into their history and their their mental history, their dietary history need to get a real detailed, you know, idea of what has happened in their life.

You can pinpoint a lot of things to things other than their diet that might be causing this, these, this IBS symptoms.

And again, I can operate on and so when they show up with I don't typically see IBS patients in my clinic.

But patients will tell me things like, oh, as soon as I eat, I gotta poop.

I'm like, that's that's normal.

That's not IBS.

That's that's what's supposed to happen.

Your body's having that reflex of time to get rid of.

So, you know, you have these discussions with patients and you find out that it's not necessarily a true problem.

It's what you're eating or what you're what's going on in your life.

There could be some stress.

There could be some anxiety.

That's a component of it.

There could be some trauma back in the day that's now is associated with these different types of situations.

So, you know, when patients come to me with this kind of complaint, that's kind of the discussions we have.

Do we want to talk about the vagus nerve at all in that when it comes to IBS?

And the reason I'm talking about that is I haven't really heard too much about it in the last couple of years.

When we do colon type shows, that the reactions that our gut has and our gastro system in general, it's like nervousness does really matter.

Yeah, I think there's just not that much, data out there on kind of what, how that really affects.

But we do know that there's a definitely a brain gut connection that, has a lot of effects on the, on the, on the gut and things that can occur.

But again, I can't operate a person.

I can't operate on that, you know, doctor non is what I'd like to do is we did talk about a colonoscopy, which is.

Absolutely.

And I'll say this out loud to everyone in the room, it's the gold standard.

Yeah, it's the, if for some reason, let's say, for example, I have five years before I'm supposed to do my colonoscopy again, but if I'm just kind of like, you know what, maybe in two years I want to do cologuard or I want to do because again, we see advertisements right and left about other ways to do screenings.

So let's just throw a couple of those out.

But also keeping in mind that the colonoscopy, the only place that you can actually snip a polyp away, is by doing a colonoscopy that is on the table.

But if there is somebody that is like, say you're 30 and you do have a family history and maybe your doctor says, yeah, you're not ready for a colonoscopy yet, but maybe do A, B, C, and D, what are you finding in your practice with this subject is happening as far as screenings go?

Sometimes, the patients, you know, they, they want sometimes they don't want to do the call and ask me sometimes, you know, and, sometimes it's preferred.

There is a stool studies 1 to 1 balance of it, basically what they're trying to find there.

It's, fecal occult blood, you know, in the in the stool, they can see microscopic blood there.

There is another one.

And it's very common just mentioned, you know, the color is basically includes, on top of the, the, the occult blood.

They have, biomarkers, ten biomarkers of DNA where they can, diagnose colon cancer.

You know, they have, you know, effectiveness of, 92%.

You know, that's what they're that the data set.

So say that they have an effectiveness of 92%, 92% to detect colon cancer.

Okay.

But the thing here is what they're going to miss probably is going to be the polyp that it could be already with some dysplasia.

It can resolve almost, 50% of it.

So that's what marks the difference.

You know, between so why do I recommend this, instead of that, if you have a patient with no risk factor whatsoever and no symptoms at all, it could be a, good option for them if they want to go that route, if the patient has symptoms.

You know, I think it is not the best way to go.

I think it will be the colonoscopy.

Yeah.

I just felt strongly we had to address it because if we didn't address, it'd be like, why did they didn't talk about it?

So again, what I tell patients do is like, if you get a cologuard and it comes back positive, guess what?

Yeah, go get it.

Go get a colonoscopy So you know, to me, I, I agree 100%.

If they have no symptoms and they want it more power to you, we can do that.

But if you tell me one symptom at all, I'm pushing for a colonoscopy because you're going to potentially miss that simple polyp or that, you know, maybe another disease process that's going on.

You know, maybe you have an inflammatory bowel disease, ulcerative colitis or a Crohn's disease or something going else that, you know, is that we can identify on colonoscopy as opposed to the polyp that you're concerned about, or the cancer that you're concerned about.

So again, colonoscopy: gold standard all the way 100% of the time.

So I don't know if there and I don't think I've ever asked this question.

How how and why does a polyp develop.

Does anybody know.

Or is it just one of those things?

It's like your right arm.

They may be there, they may not.

We'll just see.

But again risk factors, food, diet etc.

except just like Doctor Hernandez said earlier, you know, 15% or so of patients are genetic based.

So they'll have some genetic component that may make them grow more polyps than anybody else.

But that means that 85% of patients are sporadic, meaning these polyps is show up random and we don't know one.

That means you're probably going potentially one potentially, but not necessarily right.

There are probably genetic factors that are involved that we don't know about that are causing these polyps to to form.

We know that as you get older, you have more chance of getting polyps, just like anything else in terms of cancer, as you get older.

But we know that polyps, the vast majority of paths in the vast majority of cancers are sporadic and random, which is why we recommended at 50, now its 45 to get your colonoscopy.

Okay.

We've talked a little bit about diverticulitis because, Doctor Hernandez, you were talking about sometime in the colonoscopy, you will find that just quickly describe what diverticulitis is for those that were listening to it thinking, what is that?

Well, they were, first of all, diverticulosis They're like pouches.

Usually the sigmoid called in the left side.

It could be the descending colon, to the to the Sigma colon.

They don't have too many symptoms.

These are not infected.

You know, those little pouches sometimes they can happen because of the diet, lack of fiber or water.

But we already talked about it already.

So these, most of the time, they don't give you symptoms, but sometimes they can get infected.

And that's when you start having the pain.

You know, it can be very painful.

And, so are they infected?

Because stool gets left in there is a stool that moved out.

It's very good question.

And the fact the problem is, is we don't really know why we think that might be a reason.

But the data on diverticulitis and the reasons why people get diverticulitis is currently unknown.

And it's frustrating because patients say, why do I get this?

I say, I don't know, patients say, how can I prevent it?

I say, I don't know.

I say, what you can do is the fiber.

But we don't even know if that really helps.

Yeah.

What is a treatment for diverticulitis?

Take your losses.

You know, you don't like to do it is either directly.

Colitis is what's infected, okay.

And it's okay.

And here the problem is, there is two big problems that it can happen with it.

One is the formation of an abscess and the other one is perforation.

You know, so that's why it's very important, if the patient has a lot of sense of like pain, fever, they look sick, you know, when they have diverticulitis They when they spat, they look sick.

So in that case, probably the best course of action is get a CT scan.

And it all depends, you know, how bad is the problem?

But, in that case, you can treat them.

Usually when they're mild, you can treat with oral antibiotics.

Sometimes when when you know, you see more inflammation perforation or a possible abscess.

Rather they need to be admitted to get antibiotics.

And the interesting thing about diverticulitis as well is that the treatment is different all over the world, right.

In Europe they don't give antibiotics, they give some Tylenol, and then they get better.

And here we give antibiotics and we get better.

And again, this is all the whole process of we don't really know why, but we know that when you do get really sick, we treat them like you described with antibiotics.

If they get really, really sick then we potentially have to go to surgery.

Okay.

It's very individual based and interesting.

Okay.

Crohn's disease, that is a very specific diagnosis.

Correct.

And how is that diagnose Crohn's disease and and all sort of colitis falls under the inflammatory bowel disease.

So this is this is something that I potentially could operate on.

So this is something that I'm very interested in.

Ulcerative colitis is a disease that extends from the anal canal all the way up to the, potentially the small bowel.

So in includes all of the, the colon Crohn's disease can occur from the mouth to the anus.

Oh that's right I remember that.

And there is no cure for Crohn's disease.

Crohn's disease is treated with medicines now if, there are, significant, symptoms that can occur or problems that can occur with Crohn's disease that need a surgery, but most often it's a medical diagnosis.

And you can treat that with special medications, ulcerative colitis as well.

You can treat that with these medications.

But there is risk for long term inflammation that can cause cancers.

And you can actually cure ulcerative colitis with the surgery.

But most of the time is treated with the medicine.

And these are all diagnosed again with colonoscopy.

But these patients will typically show up with abdominal pain or bloody stools that when I see them in the hospital they're really sick.

They're bleeding.

They are, on a lot of steroids, no question.

That's very they're super sick.

Yeah.

And when I see them, typically, if they're being treated by the gastroenterologist, they're, they're pretty mild symptoms.

They're on these long term medications and they do very, very well.

But sometimes about 15, ten, 10 to 15% of patients will need a big surgery, and an emergency surgery kind of thing.

And, you know, that can you actually cure they also have colitis.

But again, Crohn's disease, you can't okay.

So we are at an 11 minute mark before the show ends.

It happens really, really fast.

So at the beginning of the program, I said we're going to kind of stop questions for me, and I want you all to think about something that perhaps we've already gotten across.

But you want to reiterate, or is there something that we would like to talk about before we wrap up the show?

So, I feel like there's so much packed into the whole gastro system, the plumbing system, so to speak.

But in general, Doctor Hernandez have we not covered something that you would like to cover or something you would like to really emphasize?

Well, I think pretty much we cover what what, you know, the primary care standpoint we do.

I think what I want in a nutshell, you know, if someone is watching your show right now, what they need to understand is one thing that I don't, think that, colon cancer, in this case, that was the topic is going to have great manifestations.

Don't wait.

Because a lot of times I talk to my patients, said, you know what?

It's time to do a colonoscopy.

And the first thing that I said, no, no, I don't, I don't there's nothing wrong with me.

So it is very true.

A lot of hesitation when you suggest colon there really is okay, I agree.

Okay.

There are.

So when when you have a patient they need to understand that in reality you don't have to have bouts into like severe pain or a lot of blood in your stool.

Sometimes it can be very mild, and that indicates that these things are already advanced.

You know, the cancers are advancing.

And, here the key is our early detection.

Yeah.

What you detect in, in an early stage, the outcome is going to be a lot more, much better than, when it's already in the late stage or it's already spread to other organs.

No.

So that's that's where it's very important, where if you have any symptom GI, even if they're mild, like simple constipation, if you see a change in your pattern, you know, I used to go every day, but now it takes me 2 or 3 days.

And also my stool is, you know, the caliber.

It was a little, you know, more more thick now, just small, you know, in that they mentioned just just a little, you know, like, like little pieces of stool.

There is something that it doesn't mean necessarily cancer but is something, but check it out.

It needs to be checked.

And that's in a nutshell.

You know, go to your primary care, go to your GI, go to your, follow colorectal surgeon and discuss about.

And so I'm going to I'm going to stop for a second there because most people don't know a colorectal surgeon.

Most people don't know GI guy.

So super important to go to whoever it is that gives you your care.

Of course.

And I say that specifically in El Paso, in our region, because some people don't even have their internal medicine doc.

So if that is the case, what would you say to people who are watching or listening if they've not said they've never been to a doctor before and they're 42 years old, that's not rare in this community.

Where would they go and who would they talk to to be that first person?

I think primary care, you know, usually it could be a family practice.

It could be internal medicine, usually where they gatekeepers.

When do you bring into the conversation the colonoscopy.

Since the beginning.

The first encounter that I have with a patient the first that there is a lot of things that I need to cover.

First of all, it's, family history.

If there is a family history of colon cancer or family history of polyps, sometimes they'll tell, you know, on my mom, she just got her bonus copy not too long ago, and they found some polyps.

Chances are that you might have it.

Even you don't have manifestation of it.

So the risk factors, you know, when you go to the review systems, one of them is the GI, you start talking about it.

So there is a lot of chance for us, you know, as a primary care to cover those when you ask some questions that came to us that, okay, maybe there is something else here and something we need to go a little more profound and a little more deep into it to see if there is a major risk factor for this patient.

That was the subject to reiterate the fact that, you know, if you don't have a doctor, you can go to one of these urgent care facilities, right?

You can go to an E.R.. I get called all the time.

Hey, this patient's here.

They had some rectal bleeding, and they're stable.

But, you know, they need to see somebody because they they do have they don't have a primary.

So if they go to the ER or they go to the urgent, urgent care, they can get sent to a primary care first or they can get to my office, I'll get a call or whatever.

But that's I think the best way to, you know, get these kind of things figured out.

Right.

So now we're at your turn.

So is there anything that you want to talk about tonight that we haven't gotten to yet?

Yeah, I think I think we did a very good discussion here.

I think the one of the big factors is, is you got to be comfortable with your poop, and you got to be comfortable with your symptoms and be able to talk and be able to talk about it gets okay.

All right.

Is our normal bodily functions that we have to say this doesn't feel right.

This is isn't normal.

I need to go get some help.

And unless you do that then you're going to run into these problems where, you know, I see these patients in the hospital and they never got a colonoscopy and it's too far gone.

And there's not much that I can do.

So, you know, if you have symptoms, the main thing is to talk to your doctor about it and say this is not right.

And if the doctor, unfortunately, they're pushing you off, then you need to really go find somebody else who's going to help you because it's a big deal.

Yes.

It's okay.

Yeah.

It shouldn't you shouldn't have these problems.

They're not normal symptoms.

You know having symptoms is not normal.

And so somebody needs to, you know, help you out okay.

So I always like to reserve like these last five minutes on what's new.

Like what's coming up.

Several years ago we did an entire program on the pill that you can swallow that takes its time to go through the entire tract.

And I want to say, if I remember it right, because we brought up in the last show, but just briefly toward the end, that the that the camera would activate at a certain point in the system.

Do you know about this pill?

Is it something.

And I say a pill.

It goes all the way through.

It's literally you're swallowing a camera and then it gets disposed.

And then you need to be comfortable with your poop and go find it and bring it to your doctor.

But what is that?

Is that something that we're looking at?

Is that something that was kind of a fad a couple of years ago that was talked about?

You see, it's a tool.

You know, it's a tool, when you have a patient, for instance, that has anemia.

As an orthodontist.

Okay, okay.

And you do an endoscopy, the endoscopy, you know, it goes to your stomach, do the, the cell focus the stomach and they don't find anything.

Then do the colonoscopy.

They don't find any source of leak.

Then you have the, the camera that you can look into the things that are not endoscopy.

Your colonoscopy can look into it Thats you know, is was one of the things we use for it.

Okay.

And you don't have to go.

You don't have to go find it.

It, you have a little box and it, like, records it all for you, so you don't have to go find it.

Oh, you don't have to go find it.

Oh, but it's okay.

I don't like that.

It's okay.

But, I think one of the, the newer things that are coming around is, so I do a lot of robotic surgery, and there's a robot in town that we were able to do surgery with through one little incision.

And this is going to be, I think, a game changer for a lot of these polyps that are big in the rectum.

For example, we didn't talk much about rectal cancer.

No.

But but rectal cancer is different than colon cancer.

But sometimes if you can find rectal cancer early enough, there are ways to remove it without needing chemotherapy, without needing radiation.

And sometimes with this newer robot that's out here, we can resect it through the anus without any kind of incisions on the belly, and get and cure that cancer before it, you know, grows to where you need a bigger surgery.

So you brought up a great point.

So the rectum is how big compared to the anus of size.

So literally when people just visually so the anus is the very last part is about two centimeters and females about three centimeters in males.

That's the first.

That's the very last part of the GI tract.

Then you have 15cm of rectum, above there and then 15.

So that's pretty long.

Yep.

It's about that long.

And then the rest of the colon is about six feet of colon okay.

So the rectum though is unique in the sense that it's in the pelvis.

And so we can treat things differently.

When you have a cancer for example you can treat it with radiation.

With chemotherapy the surgery is a lot different.

Is a lot more difficult.

There are a lot more complications that can occur with rectal cancer.

But rectal cancer is, very unique in the sense that when you do treat it, there are certain things that can occur with rectal cancer that you don't get with colon cancer, for example, with radiation and chemotherapy, you can actually cure the rectal cancer without needing surgery.

This is something that's becoming more and more common, where we see these tumors just disappear with the radiation and chemo, which is wonderful.

We have these robots now that we can operate on within that through the anal canal and respect the tumor.

And there's nothing that's needed after that, which is pretty amazing.

We use a tiny little, you know, robot arm.

They go in there and cut it out.

It's beautiful.

He is so excited.

Oh, it's what I do.

That's like it's the goal of a 12 year old.

But.

So, you know, these are these are the technologies that are coming up.

And like I said, rectal cancer is very unique.

And, we could have a whole nother our talk on just rectal cancer.

And I remember when we used to combine those to colorectal cancer.

And I feel like in the last couple of decades, two we really separated the two.

You have to because they're treated completely differently.

And so and and it has a lot more dramatic effects when you have a cancer in the rectum as opposed to the colon.

There are blood vessels, there are ureters, there are bladders, there's uteruses, vagina, there's all these different organs that are that are, can be affected.

Prostate that.

So you have to be aware of that takes a lot of different thought processes to treat.

Okay.

Very nice discussion.

I loved everything about that.

We have two minutes and 16 seconds.

So this is like the lightning round.

Or I can just kind of wrap up.

But I really want to say thank you to, Doctor Tudor Hernandez, who again is a family practice physician with hospitals in Providence, and then Doctor Avery Walker, who was colorectal surgeon, again worked at Beaumont for a while now with Hospitals of Providence.

And this program is called colon Cancer and the Importance of Early Detection.

I also want to say thanks to the two Valeria's in the room.

So we have I never say hi to you guys.

So when I say you guys, I know you can't see them, but the super stars of the PBS show, that record, this is Valeria and Emily, and thank you so much, are the ones that mic us up and make sure everything goes well.

And if an ambulance comes by, obviously.

Hold the show.

Hold the show.

We got to do everything, that we have, Larry.

And then, Rick, thank you so much for joining us.

But if you want to watch this program again or any program that PBS El Paso does, you can go to PBS El paso.org or if you want to watch this show again, and or any show that the El Paso Physician has put together for you, you can go to pbselpaso.org you can also go to YouTube.

And you can also go to the El Paso County Medical Society site.

And that site is EPCMS.com and literally on the, EPCMS.com you will find the logo on there.

Same thing with PBS El Paso that's locally recorded.

Thank you guys.

Doing this for 29 years and on YouTube, just dial in there.

The El Paso physician.

What will happen is this program will pop up first because it's the latest one that's recorded.

But if you're interested in knee replacements or if you're interested in eye surgeries or whatever, you can kind of put that in the search engine and find those there.

So that's always a nice thing to do.

But I want to say thank you to YouTube very much.

This has been the El Paso musician we are recording in the Turner home, which is the home of the El Paso County Medical Society, and it is over 100 years old, and we haven't seen any ghosts yet, but maybe one day.

Thank you again for watching.

This has been the El Paso Physician, I'm Kathrin Berg, and good night.