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

So when was the last time you remember discussing a colonoscopy or colon cancer or anything of the like?

Are polyps in your colon dangerous?

Is it something that can be removed?

Can cancer be prevented?

That's what we're going to be talking about today.

This evening's program is underwritten by University Medical Center.

And we also want to thank the El Paso County Medical Society for bringing this program to you for over 29 years.

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.

We're going to be talking about colon cancer and colon cancer awareness, this awareness of the digestive tract.

And we have one veteran here with us and Doctor Patel and I were discussing.

He said, wow.

I remember when we were recording the show back in the UTEP days, which means that you're one of the very first doctors we had on this program.

So welcome back.

It's nice to see you again.

This is Doctor of Vinay Patel, who is a gastroenterologist, and he's also the medical director of the Endoscopy Center.

And we have two newbies.

But I'll tell you what, you guys bring the energy in the room, I love it.

Grace was here early and introduce herself.

Is Grace, so.

Hi, Grace.

How are you?

Grace is doctor Grace Hopp, and she's also a gastroenterologist.

And then we have doctor Jesus Guzman, who's a gastroenterologist.

So, that being said, what I'd like to do is start off.

And Doctor Patel, you know how this works.

Gastroenterologist.

Sure.

What in the world does that mean to people who don't know?

Most of you probably will see us during your lifetime.

We deal with diseases of the gastrointestinal tract, which is anything between the mouth and the rear end, and that also includes the liver, the pancreas, the gallbladder.

So if you have abdominal pain or sometimes chest pain, which is not cardiac or if you have diarrhea or constipation or bleeding, And we get to talk about all that fun stuff.

Correct?

Absolutely.

And and sometimes just weight loss.

So, you certainly would see us for any of those.

And if you're anemic, if you're losing blood, that's another common reason.

Or if you're vomiting blood, that would be another reason why people would come to see us.

But one of the services we do provide is screening for colorectal cancer, which is certainly being a very hot topic in the last few years because of the significant increase in incidence and death rates in younger patients under the age of 50.

Exactly.

And that's something I'd like to really get into.

And I don't know if we know all the answers of the whys, but we'll talk about some people that have been affected that a lot of people know is household names.

Doctor Hopp, I didn't prep you for this.

Sorry about that, guys.

So what we do now is we talk a little bit about you before we start the show.

But you talked a little bit to that.

You grew up in Chicago?

Yes.

And did a lot of your training in San Antonio.

Talk about why you went into gastroenterology and what got you here?

Well, I grew up on the the West side of Chicago, West suburb.

And I've just been working my way down since, so I went to med school in Kansas City, and I got to do a rotation in gastroenterology and when you find what you love, there's just no way to put words to it.

It was.

It just captivated me.

I went home and I read about it, and I just.

I was the first person in the workroom every day.

It was just so excited to go to work, and I was always excited.

But this was just so new.

You got to talk to patients.

You got to actually fix people, fix a bleed, fix diarrhea.

So it's very satisfying.

And then you also get to do procedures.

So we get to use our hands and help diagnose and and kind of fix all at the same time.

So you need your common everyday problems.

Like everybody has had some reflux.

I tell you.

Yeah.

Yeah.

We actually talked about that once.

It's like it's not stuff you talk about with your friends, but you can talk about it.

Kind of love everything about that.

You'd be surprised how many people talk about it at the dinner table now.

Well, because they know that you're that guy.

If they didn't know you were that guy, you know?

So, Jesus Guzman, Doctor Guzman.

How about you?

Are you an El Pasoan?

Did you come to us from somewhere else?

No.

I'm born and raised in El Paso.

Yes.

I've actually done all my training in El Paso.

I did my medical school here, my residency and my fellowship.

As far as the reason I went into gastroenterology is similar to Doctor Hopps, as, like, it's something that you get to work with your hands and you get to follow your patients through and through.

And I knew it was a big need in the community.

Like in our community in El Paso, there's not a lot of gastroenterologists and, I knew that at the end of the day, I was going to end up being here.

My wife told me when I was going to medical school that I could go wherever I want so long as it's El Paso.

I like your wife.

Good job.

So let's get into the meat of why we're here.

Let's talk about the colon.

Because.

And I know usually, you know, we would have a model next time you have to bring a model, because that's always fun.

Because we've got the small intestine, the large intestine.

We've got the colon, we've got the rectum, all of that.

So if you can describe since we're talking about colon cancer, that's more of a thing than like you don't hear small intestine cancer.

You don't hear large intestine cancer.

Explain what the colon cancer situation is, where the colon is, why it's so dangerous.

You know, the Colorectal cancer has always been, an age related, disease, meaning I remember when 1995, when I started my practice, patients used to come in.

And the younger patients, we never used to worry about colorectal cancer.

We always used to think they had some benign disorder called irritable bowel syndrome as the cause or hemorrhoids or something.

And but as time has gone on, the statistics have changed.

And and the rise of colorectal cancer in young persons under the age of 50 is alarming.

I mean, you're seeing an increase of about 2% a year in incidence.

Oh, my 2% per year.

I mean, just to put things in perspective, for somebody who was born in 1999, has four times the risk of developing colorectal cancer compared to somebody who was born in 1950.

So here's the obvious question... And four times rectal cancer, if you're born in 1999 compared to 1950.

So that's a huge increase.

The big question is why do we know why?

I mean, I know there's a lot of educated guesses is the wrong word but educated guesses.

Yes.

So what are some of those that you in your symposiums and your conferences talk about?

Well, there's a lot of mechanisms, environmental factors.

For example.

It's what we're ingesting.

Our diet has changed over the last few decades.

We have highly processed foods coming into our diet.

We have microplastics coming into our diet.

And microplastics is big.

The problem is that we're still right at the beginning stages of learning about what the risks are.

I mean, we've all heard about plastic bottles, you know, don't drink from plastic bottles, especially if they've been out in the sun, because some of the ingredients they add to the plastics to make them more flexible or hard have, microplastics in them.

BHP's one of the the products you may have heard about.

And so as a result, I mean, we just don't know their impact.

But we do know that it does affect I mean, the use of antibiotics in young children is extremely high.

And that obviously alters the our biomes.

And that, certainly will affect our risk.

Food additives like colors, I mean, those things are adding to the risk as well.

So so it certainly I mean, there's so many factors and we're just beginning to learn, and I'm sure others will have other factors they've heard about or read about which will come up as the discussion goes on.

But at the end of the day, the facts are the facts.

And what we're seeing now is that what used to be a disease of the elderly is now also affecting the young people.

And I'm going to talk about we talked about in the beginning of the program when this started, for people who have been around for a while or of actually a little bit younger than my generation, but James Vanderbeek, who just passed away and he was in his 40s, who was diagnosed quite early.

Also Chadwick Boseman, you talked about that right when we walked in from Black Panther.

He was in his 30s.

So going into the idea, it's not the old person's disease anymore.

And then Catherine O'Hara.

Yes, she was in her 70s, and, she's someone who was a comedian, a lot of people are from Schitt's Creek and a lot of other shows as well.

She was in, Home alone.

Home alone, thank you very much.

She was the mom at home alone?

Yeah.

But, yeah, it is.

It is all over the place now.

And this is something to that Dr.

Hopp, I'm going to go to you and just say colon, when you're talking about a colonoscopy, what is going on in the colonoscopy, if you don't mind kind of walking us through it and why it can prevent that like the polyp removal, etc., etc.. So First and foremost, the patients do a prep One of the most common misconceptions is that the Prep is terrible.

It's very tolerable.

So they clean out their intestine the night before the morning of the procedure, and then they come to see us.

I mean, let's literally have diarrhea for , you know, 12 -15 hours It's not pleasant.

It's not like you can do it.

So yes.

The prep.

Yes.

Okay.

You drink a gallon of fluid that cleans out your bowel.

You're going to the bathroom on and off all night.

And then you come see our lovely faces in the morning, we put you, our anesthesia providers, put you to sleep for the procedure.

You lay on your side, and we use a long, flexible scope that's about the size of my index finger and has a camera and a light on the end of it.

We insert it through the rectum, and then we're able to look at the whole large intestine, which is inside our body, like an upside down horseshoe.

And we go to the very end where the large intestine meets the small intestine.

And then on the way back, we're looking for what we call polyps, which are like growths of abnormal tissue that arise on the lining of the intestine, the large intestine that we can remove during the procedure.

So those can be pre-cancerous.

They cannot be.

But we use what's called this snare, which is just a little circle that goes around the tissue, and we just scrape it right off.

We send it to our friendly pathologist who tells us what it is.

And then we're able to tell you kind of when you should come back to see us for your next colonoscopy, based on what risk profile those polyps have.

So we're able to prevent you from having colon cancer.

If we can kind of get all of those removed before they become a problem.

So I'm going to talk about you and me.

So literally last year I went and had my colonoscopy.

Doctor Patel was very nice.

Held my hand for a second, when I went in, but I did have a polyp.

And it was like, oh my gosh, I have a polyp.

So I now go in every five years, if there's no polyp, you go in every ten years.

But is that something that's changing because of the incident rate?

With colon cancer, I don't I don't know if that is something that's been talked about yet or if the screening is changing once you've had your colonoscopy, if there is no findings, do you still wait ten years?

At this point, you're waiting for less?

I think for now, anyway, most patients who have a clean colonoscopy and they have no other risk factors.

Then I think every 7 to 10 years would be a reasonable interval for most of them.

Now, in the younger population, it's hard to know because we don't have long term studies to show because they obviously have a different, profile.

And so it's possible that we may have to survey them at a shorter interval, and maybe even screen the matter shorter interval.

I think those are things which are still being investigated.

But for now, I think we're still applying the same, principles to them as well.

But that may change as time as, as more information becomes available.

Okay.

Excellent.

Doctor Guzman, now it's your turn.

See this?

Is that.

Sure we can we do ping back and forth.

So let's take it now.

From where Doctor Hopp left off, we have the colonoscopy.

Let's say there was a polyp, and now the friendly neighborhood would just call it.

Pathologist, has it.

So let's say that polyp comes back and it is malignant because benign means is no problem.

It was a polyp that just grew.

But now we think, okay, there's a little bit of cancer there.

Where do you go from there?

And I know it's different with every person, but for the most part.

So it so by definition - cancer will be when there's submucosal invasion.

say it slowly - submucosal invasion.

Yes.

Okay.

So that is what differentiates cancer because you can have dysplasia is that they'll say carcinoma in situ in a polyp which by definition is technically not a cancer.

Okay.

But in situ just means that polyp.

It has not crossed into the submucosal.

The reason being that that's important is because we have lymphatics, we have blood vessels in the submucosal area and that's how cancers can spread.

So the idea is that when we can remove something before it invades and that means you're cancer free, right?

Like if there's no carcinoma in situ.

In those areas.

And sometimes we get them in certain polyps like in the pedunclated polyps, they have longer stalks can go ahead and remove them.

Now if somebody actually develops cancer right.

Colorectal cancer depends on how deep and how spread out it is right now.

The importance of it is that the earlier we detect something, if we just detect it at an early stage, it has a much better survival rate at five years than if it was already, too late.

Like, as in, it's already spread and gone to other organs.

So, for example, in five years, your survival rate will be at 90% if it's detected in early stage.

So are you able to describe here what the stages would be.

So, say there was and let's just go back to that.

There's just one polyp that was removed.

That one was malignant.

What do you do?

Do you go back in and try to remove more of that area, or do you just know?

Usually if it is, in the mucosa, that's where we work.

Okay.

We can do EMRs, polypectomy.

It's, it's mucosal, submucosal, resection and mucosal resection is we lift the polyp off and separate it from the layers of the colon.

And we're able to resect the polyp.

Now, the thing is, we can go in a little deeper.

Now, it it has spread beyond that.

Then our role is more of the diagnostic and obtaining tissues.

At that point we work with our oncologist and our colorectal surgeons.

If it is still localized to the colon, they can remove that section of the colon.

And then depending if there's lymphatic spread or not, then there is a determination by the heme oncologist which is the cancer doctor, whether they're going to get therapy or not.

Sometimes they get neoadjuvant chemotherapy before they get cancer, before they start or afterwards.

And it is something, a decision that is made by oncologists Once they get the pathology, they see what type of cancer it is, how aggressive it is, if there's any lymphatic spread.

But that's the importance of catching things early, correct?

Yeah.

And that's a perfect transition to for Doctor Patel now.

So as a gastroenterologist now there is there is cancer specifically.

So now it's time to bring on the oncologist.

So in that team working, how I remember cancer boards or tumor boards back in the day, I don't know if that's still a thing.

It's still a thing.

So how does the conversation then have, you know, this is patient A has a polyp removed.

It is, malignant.

Now the oncologist comes in, how does that relationship start with the conversation, etc.. Okay.

So if you have a malignant polyp like Doctor Guzman said, you determine whether it's localized to the mucosa or if it's spread beyond.

Usually most of us, when we do remove, a malignant polyp, we will try and tattoo that site, okay.

Because we're getting the patient ready for possible resection of the colon.

And sometimes in early stage cancer, the surgeons looking through the belly button from the outside.

And they and they may not be if it's a very early stage cancer they will from the outside the colon looks completely normal.

Right.

And we need to make sure that they don't they don't cut out the wrong part of the colon.

Right.

Because my description of distance may be very different.

Colon's like an accordion.

Right.

You could be on the way in.

I could be at 60cm and on the way out I'm at 30cm.

So the distances can vary tremendously.

And so the idea of doing a tattoo is so that, I mean, I couldn't make a living being a tattoo artist.

All you need is a good sharpie.

X marks the spot.

So we do that for that.

We do that.

And then we actually sometimes we do preliminary staging as well.

While we're waiting to get the patient in to see a surgeon and the and the oncologist as well, because staging will determine if there's any spread beyond the colon, which is obvious, because that will then determine what exactly they will need.

And so normally let's say you had a malignant polyp.

I've tattooed it and there's some involvement of the lymphatic vessels under the microscope.

So then I'll pick up the phone and I'll call the surgeon and I say, hey, first I'll talk to the patient, obviously, that they have no surprises there, but, and then we'll talk to the surgeon and get them in to see a surgeon.

And sometimes, depending on your concern, whether they need an oncologist or not, I think you have to individualize some people.

It's still very early stage.

We wait for the surgeon to take out that segment of the colon, wait for the actual full pathology report and the surrounding lymph nodes, which have also been removed.

And then the determination can be made whether you need to have an oncologist involved or not.

Okay.

Because that will then determine, if they will need any chemotherapy or not.

And, you know, there's so many different types of scans available now.

We have Cat scans, we have Pet scans, we have MRIs.

And we're we're often reliant on the Pet scans for when it comes to malignancies, because it will detect any hotspots which may be of interest, to the surgeon and the oncologist and describe what pet stands for, because you've got the MRI, you've got the ultrasound, got the pet, and you know, just for people again, that this is positron emission technology.

And what happens there is that they're given in a substance which is then taken up by rapidly dividing cells, and it will appear as a hotspot.

Okay.

Nice.

Doctor Hopp, are you ready for this one?

Sure.

This is where it's silent symptoms.

So this is the one we prepped for.

And I do this because it's fun, right?

This is my homework.

This is their homework.

But we do this so we don't waste your time.

So when we talk about silent symptoms, these.

We were just finished talking about screening, so we don't know.

We don't, you know, we're just going to go in and be good people and have our screenings done.

So silent symptoms.

What are they?

And I think sometimes a lot of those are dismissed and maybe throw in some myths around there etc.. So time to talk about what you prep for today.

Well, just like they both alluded to, colon cancer can grow, you know, very slowly.

And we can catch the early stages.

So a lot of patients, you know, maybe having very, very subtle symptoms and disregard them because they're so subtle.

So things to look out for like changing in bowel habits like persistent diarrhea or persistent constipation for more than two weeks in complete evacuation where you feel like you didn't release your entire bowel movement, or like pencil thin stools, like your stools all of a sudden become very, very skinny.

That can all indicate that there may be a mass or a lesion growing in the colon.

That's changing how your stool is formed.

Another symptom that's often not so silent, but, rectal bleeding or blood in the stool is always alarming to people like us.

And we always want to go take a look and make sure there's not a mass there.

But that can look like bright red blood on a toilet paper and the toilet bowl, maroon stool, or even dark, tarry stool kind of higher up in the colon on the right side.

It can look, you know, a little darker when when the blood comes out.

Doctor Patel alluded to this earlier, but if you're having unexplained weight loss, that can be a very subtle sign.

Other things, like unexplained fatigue, can indicate that you're iron deficient, which Doctor Patel also alluded to.

So a mask can be oozing blood very slowly but so slowly that you're not seeing it.

But you eventually lose enough iron that you become symptomatic.

So very fatigued, weak, short of breath when you're walking around.

Those are all very alarming signs and reasons to seek evaluation.

There's more subtle things like bloating, nausea, vomiting, feeling of fullness, that are very, very subtle.

But if you are experiencing any of these, your friendly gastroenterologist would love to see you so that we can help you out.

I love this - your friendly neighborhood gatroenterologist.

So I love what you're explaining.

And along with colon cancer, which we're talking about that specifically tonight, but I want to talk about to some of those symptoms could be irritable bowel syndrome.

It could be a whole gamut of things.

And that's where again, it's so important to actually go see someone.

So this is where the ping pong comes here now.

Right.

So these are the silent symptoms.

What are some other issues that a patient can have having these symptoms that it may not be colon cancer specifically.

And we can talk about again irritable bowel.

We have I don't know, diverticulitis, diverticulosis.

And a couple of other things too.

So let's talk about some of those, because I think a lot of these are common.

Yes.

So, the most common one that you're going to hear is irritable bowel syndrome.

Okay.

Usually, most of the time, what we end up doing is we end up working up looking for the more serious things that can be detrimental to life, right?

Where, like, finding a malignancy if you have something like inflammatory bowel disease, which is different from IBS, this one is essentially where your body's attacking your colon, thinking it's something foreign and there's different forms.

There's something like Crohn's disease, which involves the entire GI tract, something like ulcerative colitis that involves the rectum and the entire large intestine.

Now, this is treated differently than somebody that has IBS.

These, something like inflammatory bowel disease requires medications.

On the more severe forms, things called biologics that things to suppress your immune system, to keep your body from attacking those areas.

And they present with subtle things like abdominal pain, diarrhea, rectal bleeding, also diverticulitis.

A lot of the times we get patients that come in from the hospital that they had an episode of diverticulitis, they went in, they got a CT.

And when it comes down to it, is that it's a little pocket that got full of pus.

And it's, and, your anatomy, that's what it is.

It's the way I describe it to most of my patients, it's like a pimple.

It's like, when, follicle gets clogged up and it develops an infection behind it.

That's what a diverticulum is.

It's an outpouring in your colon and a little piece of stool gets there in the right way, makes it stuck, and it'll cause it to get inflamed.

Now, the treatment of that is you just remove that area and then, you know.

No.

And so, that area is essentially a lot of nowadays we're actually even treating it conservatively without antibiotics, because most of the time they get better.

But, most of the time, if you end up going to the hospital because it's, that means it's a little bit more on the more severe side, they're going to give you some antibiotics to let it kind of cool down.

But the idea is that we want to prevent the reoccurrence.

People that have complications from like diverticulitis, we want to go in and make sure that it's not it's not caused by a malignancy.

Okay.

But if it is a very recurrent issue, then when we get our colorectal surgeons to help us out, and that's when we talk about trying to resect those areas to remove that part.

But that's later down the line.

So unless it's a very recurrent issue.

But as I was mentioning, irritable bowel syndrome is something that has to do with the brain, gut connection.

A brain gut connection.

I want to expand on that.

That's great.

Yes.

And, you know, Dr.

McCallum is a friend of the show.

Look who's here.

Because he was the last one was on the show.

So, he's he talks so much about this and, he was a huge advocate for it.

And, IBS it has to do.

Most of the time, what ends up happening is somebody comes into the clinic and we do a full workup looking for these other things, inflammatory bowel disease, diverticulitis.

And most of the times we come up with no answer that it means we're pursuing something we can't physically see.

Right.

And that is the brain gut connection.

The way I'd like to explain it to patients is that when you feel nervous, where do you feel that you talked about the vagus nerve last time?

If I remember that right, we so there is a connection between the brain and the gut.

And the thing is our emotions can also be presented in our gut.

And a lot of the times is that it is treating or getting away from stressors, getting away from, things that are causing you to have a physiological response.

But now we have some treatments for it, like, if somebody has there's two different forms IBS with diarrhea, IBS with constipation, and we try and treat the symptoms.

If we get somebody causing constipation, we have medications that, make you, you know, less constipated, don't make you go if you're having diarrhea.

We try some antibiotics.

So it's like facts and, but and once you have irritable bowel syndrome, do you have that for the rest of your life?

You're just managing how you present.

Is that kind of how that works?

The more the most of the time.

I've never seen a patient myself that, has come in like, hey, I've been cured, from my IBS If anything, it's like, hey, my symptoms are controlled.

And it's there's a couple of things that are, you'll see, especially now that patients are getting things at a younger age before, we had something called the wrong criteria and say, we would say if somebody has abdominal pain gets better with defecation, there's changes in, the consistency of the bowel.

There's changes in the frequency.

Those are things that we're like.

Well, in a younger patient, we would say it's IBS.

And nowadays with with the everything changing, it's.

I feel like that's going to change.

I see and again, you're, you're beautiful because you're teeing up now Doctor Patel here.

So, when because there's a lot to know.

And I want to talk about diagnosing all these different issues.

Colon cancer.

We talked about that that that's specific pathology diagnosis.

So when you're talking about I'm having issues like I have diarrhea one day and then two weeks later I'm constipated for a month.

And then I have diet.

So somebody is coming to you and they're describing symptoms.

What is the gamut of testing that you do?

You were talking about, a Pet scan.

You were talking about different.

So how does one diagnose what they have?

I think you start with the basics.

You get a good history and a good physical, and you obviously take into consideration the age of the individual, the duration of their symptoms, and if they have any hard findings, for example, have they lost weight associated with the symptoms?

Are they anemic with those symptoms?

I mean, or if they've had a change in the color of their stools, I mean, those things are things you can actually visualize, document and go from there.

You can certainly, you know, I'm going to introduce a term, called medical gaslighting, which is what doctor which is which is what Dr.

Guzman was getting to.

I thought you were going to talk about the sewage workers, which we talked about before.

We thank you for laughing, Grace.

We've been called a lot of things, but medical gaslighting basically a term, which is now come into focus for the younger patients because essentially the young patients in the past, like Doctor Guzman, said they would come in and we would say it's irritable bowel syndrome, okay?

And we would manage them conservatively and we would try and manage their symptoms as best as we could with the drugs we have available.

And they've certainly exploded in the recent past.

But you always get an idea of how not so good we are at treating these conditions based on the number of drugs available.

So when you have 30 different options, you know that we're not very good, right?

So, so and so what's happened as a result of this medical gaslighting is that the younger patients who are developing colorectal cancer and being diagnosed three out of four of them are at advanced stage, because by the time we get to the actual test which makes the diagnosis, the disease is so advanced.

And that's why when you see all these movie stars who are getting their colorectal cancers at a young age, they're dying within 2 or 3 years because by the time they've been diagnosed, they've been told so they've already had symptoms for a long time and they've been ignoring them themselves.

Or we say where to see physicians.

And I'm not seeing that physicians committed malpractice.

It's just the the nature of the disease.

I mean, this disease is no longer and a disease of the elderly.

And so it's better to go back to your question about how would I work a person up?

So if somebody in their 20s comes in, I'll get the history, get their physical and the history would include things like the duration or etc.

and then depending on the severity of their symptoms, I think most of us will probably try and treat them conservatively with medications we have available, but we probably won't sit on them for too long.

If I come back and you come back to see me in 12 weeks and you say, doc, you know what?

I'm not any better, then I think we will probably then talk about doing a procedure, probably a colonoscopy and maybe even an endoscopy, depending on where their symptoms allow us to go, if they have a lot of upper GI symptoms and oftentimes they'll end up having both, along with some imaging studies.

It could be an ultrasound, it could be a Cat scan and possibly even some stool studies.

There are certain stool studies which will allow us to differentiate between somebody who has an inflammatory process going on in their colon, such as fecal calprotectin versus, or even doing fecal leukocytes, which will tell us if there's increased white cells.

And you may even do some cultures and some ovine parasite studies, depending on if you've been traveling a lot, you know, and so there's a whole gamut of tests you can run.

And so I think what you order will vary depending on where the predominant symptoms are.

But at some point, most patients with irritable bowel syndrome will end up getting a colonoscopy and or an endoscopy.

Endoscopy would be from the mouth and above.

And there's and the reason I prefer to intervene earlier is because if a normal great we can move on.

Most people can live with it.

And you know what I found, having been in practice for so many years, once you tell the patient that the procedures were fine, all of a sudden the irritable bowel syndrome symptoms don't seem so bad.

Meaning that stress, because, you know, nowadays with access to the internet, a lot of people will Google their symptoms and they'll get a list of conditions.

And like Google will tell you, you'll start off with the worst.

Yeah.

My my daughter is a doctor Google searcher.

And so you'd be surprised.

And and there's this expectation patients when they come to see us that the only reason they're seeing a specialist is because they want this additional testing done because the primary doctor could do everything else.

So why am I coming to see you if you're not going to rule out all of these really severe diseases?

So all the things said and done, there's so many.

I think we're a lot better equipped today.

In terms of diagnosing.

I mean, you could have efficiency in disaccharide disease, which are enzymes that help you digest sugars.

So now we have tests.

We're able to do that for as well.

And we have medications.

It's like having lactose intolerance.

And you have lactaid for that.

And we have sucrose now which will help you digest other types of sugars as well.

Now as far as treatment goes for irritable bowel syndrome, certainly we'll try and modify their diet, their stressors, their medications, which might help with their anxiety.

And my experience with IBS has been is that they'll go through episodes of flare ups.

So you'll see a patient now and they'll be there for a few years.

Life gets better for them, and suddenly they hit another stage in their life where they've had some stress or whatever, and they'll flare up and suddenly they'll come back to you again.

I used to remember being that was nervous stomach.

Oh, he's got nervous stomach, you know.

And that was back in the 80s.

And then it became IBS.

And then it became like all these other things too.

And then I felt like healthy gut was such a term that is being used right now.

And Doctor Hopp, that's the transition to you now.

So we're we're looking at changing the diet.

Right.

But it's also you were talking about biomes, you were talking about I know there's there's a stool replacement.

I learned about that when Dr.

McCallum was here.

It's like, oh, that's another thing.

I don't even know if that really should be put in, but there's so many different ways of getting your gut healthy.

Let's talk about some of the easy, noninvasive ways.

First, if someone would come to you and they've got issues like, you know what?

First, let's change your diet.

Let's start doing what.

And that's what I'm asking you.

I think every gastroenterologist is going to recommend that you start a fiber supplement.

So there's lots and lots and lots of different fiber supplements.

They come in pouch.

It is become lonely means yes, it is overwhelming.

And there's different types of fiber.

There's soluble fiber, there's insoluble fiber.

So having a conversation, you know, with your primary care doctor or with one of us can kind of help you navigate all of those choices.

My personal favorite, and this is not an endorsement, but is benefit fiber.

I'm writing it down.

It comes in a little green, like, almost like a crystal light packet.

You just put it in your water, stir it up and drink it with an eight ounce glass.

Okay.

So, you know, that helps.

Actually a lot of patients stool consistency problem.

So if they're having diarrhea, more fiber will add bulk to the stool.

If they're having constipation, it can draw some water into the stool as well.

And not not a single one of us gets enough fiber just by our diets.

You can have the highest fiber diet, and you're probably still not getting enough.

So that helps a lot of people if you're having a lot of bloating, some patients don't prefer fiber because it can cause some bloat as well.

So it's just something to be aware of and kind of take the patient in as a whole.

Probiotics have been a hot topic for a long time.

I was just writing that down because you have the pro and then you have the pre, and then, you know, pro is like the hot topic and well, what about the pros?

And then they came in and somebody was getting jealous of the other, but talk about those because they are still something that's advertised quite a bit.

Yes.

Do you take the pro or the pre or do you take both?

You know, the benefiber has a prebiotic in it.

Okay.

So you're getting more fiber and a prebiotic if that's something you're interested in.

Okay.

I will say like a lot of these, probiotic type medications are not regulated.

And so we often don't know how many parts per million of whatever bacteria you're actually ingesting.

So what if my old mentors always told us, just take a spoonful of sauerkraut?

That's going to give you just as much fermentation.

It's a lot cheaper.

And we know actually what you're putting into your body.

And it's going to promote the growth of good bacteria for you.

So instead of spending all of that money on all of these fancy pills and running up your Amazon cart, just get a jar of sauerkraut.

See how you do.

You might.

We didn't talk about this before the show because I'm a German.

And so that's why you love sauerkraut.

I do, I love sauerkraut, or my grandparents always had it.

It's literally.

It's like kimchi in Korea, right?

You just have a little bit of it with your meal.

And it was just part of the meal.

And then later my grandfather used to say it's, you know, it's very healthy.

It's very healthy.

He was on to something there.

Yeah.

So I'm glad that you said that.

So, when you said sauerkraut and people talk about yogurt, too, like in the old days, you would drink yogurt or have some yogurt.

Is that still a thing?

You know, people, like, was too much sugar in the yogurt, you know?

Yeah.

I think, like, I'm not recommending people to go buy a jar of yogurt, but, it definitely has benefits, like, has a probiotic type effect.

So if that's something that you want, you kind of have to take the patient in as a whole.

If it's someone that doesn't have the means to go buying all of these fancy things, you have to work within their parameters.

So, it's definitely not like a first time thing that I say, like, go buy this type of go, right?

Right.

No.

But to your it's about, you know, just thinking.

Yeah.

When you're, when you're shopping and buying things.

Yeah.

Speaking about thinking and human thinking and artificial thinking because this is on your, this what you have studied.

So let's talk about, what advanced equipment are you using to perform colonoscopies and diagnostics and incorporate the use of AI.

Yes.

So, Doctor Guzman, that's you.

And it's it's it's fascinating to me in the medical world.

And we were talking about, I don't know, a couple episodes ago, we were talking about the pitt, that has, you know, there was an episode on there where AI was use good, bad, indifferent, etc.

but talk about where are we in gastroenterology with AI, how is it being used, what do you see in the future, etc.. So right now, essentially AI being incorporate into our colonoscopies in capsules, essentially one of the biggest things when we do a colonoscopy is something called our ADR, where all gastroenterologists are measured by, certain standards.

Right?

As far as an ADR, adenoma detection rate.

And say that slowly adenoma detection rate Okay.

And this is a way of being able to see that we're doing good quality colonoscopies, being able to take our time to look for these polyps because you can go in and come out quickly.

But if you don't detect the polyps.

And what's the purpose of the procedure?

So, especially with the use of AI, a lot of these polyps can be very subtle.

They can be very flat.

So a little bit harder to see what, when we do our routine colonoscopies, we essentially the AI tool is a gi genius where essentially is we're going highlights potential polyps.

So pardon my ignorance on this.

And my old ladiness on this.

So is the AI incorporated within the camera?

Does it read the images that the camera is taking images as it's looking at the images, it's like having a second pair of eyes, okay.

As we're when we're doing a colonoscopy, we're looking at a screen and we're going through the colon and we identify polyps.

So it's capturing the images on live essentially to be able to say, well, where there's an abnormality and what it'll do, it will highlight the area as we're going.

And then at that, it sometimes it has a lot of, it's too sensitive.

It'll it'll catch a lot of things.

And but that's why we're there where we go in and we say, well, no, that's not a polyp.

It's, just, you know, an irregular fold, and we keep going, but it alerts you to those things.

So especially when you're having, let's say you've done a lot of procedures that area your some fatigue is occurring in you.

It'll help you pick up all those things.

And I've asked and they've actually done studies where essentially they've seen are that an adenoma detection rate go up almost 15% just from having it in the, in the actual, procedure, our miss rate goes down as well.

So the mystery is the potential polyps that we could have missed, it usually is about 25%, with AI tools.

Essentially, it drops down to 15%.

And we at, at our institutions, we use the high quality scopes, high definition scopes, the better the endoscopy.

You can do a colonoscopy, but it gives you a clearer picture, the better the scope it is.

Because we can see better.

If you look back in the day, they were a little hazier, a little more grainy, not as much color.

Nowadays we can see very, very, very, very clear pictures as we do the procedures.

Okay, I want to piggyback on this straight and also something that, we talked about a little bit earlier.

So screenings, if there's no polyps and you started your screenings could be ten years.

It's probably going to go, less than that.

If there is a polyp, five years.

But I'd like to talk about the, the rate of growth of a polyp.

And I know, again, it's different with everyone.

But in my head, when I'm thinking there's no polyps, I'm just going to go back to the old days.

You're 50 years old, you had your colonoscopy.

No polyps.

You don't have another one until you're 60.

So what if there's one that's developing when you're 51 and you don't have a colonoscopy for nine years?

And in my head, always that, well, that type of cancer, that type of polyp, they might be really slow growing, but we're now looking at incidence rates a lot younger.

And I'm I don't know what question I'm trying to ask other than what have you seen over the last couple of decades in maybe growth rates of polyps?

Is that something that the academy is trying to change or whatever?

And I'm just because because you are the veteran.

You and I are the old people on the on the board.

Thank you for making me know I'm much older than these guys, but I'm a lot older than you.

But certainly.

And you can say I'm much wiser than these guys, but it makes me curious, right?

Because we're we're really looking at, again, a lot of younger people being diagnosed, and it used to be a slow growing cancer or polyps.

Is that still the case or is that being looked at more closely now?

Well, I think by and large it is the case that the the guidelines about the screening intervals came out not just from thin air.

They came out from studies, which they did the National polyp study, which went on for decades.

And I remember the I was no polyps.

Would you like to have been part of that?

That would be fine.

But we might have been.

We just don't know about it.

But at the time.

So what happened is that people who were who very much early on, places like the Mayo Clinic, you know, they're the first few clinics which realize it.

I remember because I did my residency there a long time ago, and people used to come from all over the country for their annual physicals, and they used to get a barium enema done as part of their work up.

Right.

And they used to see these polyps but didn't know what to do with them.

But when they went back and saw them and they studied them and said, oh, you know what?

That's what turned into cancer.

And that was one of the first indicators that polyps turning to cancer over time give me an approximate year.

So the average interval between normal to developing a polyp to turning to cancer can be anywhere between on average 10 to 15 years.

And that's what lends colon cancer prevention to colonoscopy because we can intervene.

You know, most people when they talk about screening, for example, breast cancer, you're not detecting precancerous conditions.

You're detecting cancer, right.

So even though it's colon cancer screening, you're actually looking for cancer.

We actually go one step before that.

We're actually trying to prevent colon cancer.

And that's what and I can only think of this is the only cancer where you actually prevent it from actually occurring by intervening sooner.

So long answer to your question 10 to 15 years.

Now the and the question and the answer I don't have is for the younger crowd whether the interval is still 10 to 15 years.

What I do tell patients now is that 45 is a new 50 okay.

And do not medical gaslight your symptoms.

Meaning I cannot tell you how many times I've seen young people come in with rectal bleeding.

And they said to my hemorrhoids, that is something I want to bring up.

When you talked about that earlier, I think there's a confusion between the two.

And it's like, well, I'm just dismissing this to bring that up.

Yes.

So what I tell my patients is if if you see the occasional blood, once every few months or something, probably not much to worry about as long as there's no other symptoms associated.

But if you see it on a regular basis, don't self-diagnose yourself.

Go see.

With hemorrhoids., let's talk about this.

And I know it's icky, but it's important, to state the obvious, if it's a hemorrhoid, usually you can feel it like there's some soreness there.

You can kind of feel it.

I know there's a lot of silent symptoms too.

I get that.

But this is where you kind of not self-diagnose, but also try to deal with hemorrhoids.

Even if you feel hemorrhoids and you can have both.

Okay, okay.

So if the bleeding is persistent and not going away, I would not just say and say, what's a hemorrhoid?

Go see a doctor and get yourself something done is necessary.

At least a rectal exam or a physical exam, because most of us do not do rectal exams on ourselves.

Actually, I do have some patients who come in and say I felt a nodule or whatever, but by and large most of us would prefer not to.

But having said that, I think it's very important to be aware of what your body is like.

Now some people will say, my gut was always like this, and that's what they are.

I mean, they only go to the bathroom every three days.

That's who they are.

Because normal can vary so much.

But there are certain things like bleeding or changing bowel habits.

You know, one of the things about changing caliber of the stool, with its shape of the stool changes, it's a very nonspecific symptom.

But if it's something where you were always had a certain style and suddenly it changes, then you may want to look into it further, because in irritable bowel syndrome, you get all set all types of stools and shapes and sizes, and they vary all the time.

So but it's again, to answer your question, 10 to 15 years is usually and that's why.

And when I say we find polyps and I said five years, that's based upon the size of the polyp, the number of polyp and the type of polyp.

You may have to go every year, you might have to go every two years.

And we also need to take into consideration other factors which are family history.

For example, you may have family members with colorectal cancer.

You have one family member in the age of 65.

You have you may have multiple family members of any age in those patients.

You may want to follow them every three years as opposed to every five years.

So I think every person has to be individualized.

But by and large, I think most people, if they get their colonoscopies done routinely, then at least we hope that we will capture most polyps and prevent them from getting colon cancer.

And if they were to get colon cancer, we would detect them at a much earlier stage.

So I'm going to ask this because we're in El Paso.

We have ten minutes left.

So I told you that would go fast.

So let's start things.

Start thinking about this stuff we haven't talked about yet that you want to talk about.

And this is just a PSA for if someone is watching right now and they have no idea who to call to get a colonoscopy, what do they do?

Doctor Hopp, would you like to know that you're out?

Hi, love.

I thought you were married.

But seriously, let's do that.

Let's talk about who they call.

Most patients start with their primary care doctor.

And their primary care doctor will put in a referral to gastroenterology.

And then, you know, I think all of us in the community do something called open access.

So if you're a young, healthy patient that's either having symptoms or due for your first screening because you're 45 or older, if you're healthy, usually we look over your chart and we just bring you right to the endoscopy center for the procedure itself.

If you're older or you have other comorbidities, you're on a blood thinner or other serious medications.

A lot of times we'll meet in clinic first.

And we'll kind of talk through the risks of the procedure.

If your blood thinner needs to be stopped and who prescribes it to you and what the risks of that that look like for you.

And then we can schedule your procedure from there.

But we don't want to prep you for your procedure, bring you in for your colonoscopy, and all of a sudden you're like, oh, no, you're still on your blood thinner.

We can't do this.

So we try to to screen patients, not waste your time, not waste our time, and make sure that, we have everything lined up.

But usually most cases, they start with their primary care doctor.

And I am new to El Paso, but I found that a lot of these primary care doctors are trying to meet these metrics.

And one of these metrics are if you're 45 or older, you need some form of colon cancer screening, preferably a colonoscopy.

And sometimes people are hesitant to get a colonoscopy.

One of the most common misconceptions are, you know, it's going to be painful or I'm embarrassed.

And so a lot of those primary care doctors will say, well, why don't you go see them first and we'll see them in clinic and talk through all of that?

I think sometimes just hearing about the colonoscopy and a lot of times I'll bring up like, I'll bring my laptop in there and bring up Google images so that you can see what the colonoscopy scope looks like and, and talk through kind of how that whole process looks like, because I think, you know, knowledge is power for us, for the patients.

So if they understand very clearly what happens during the procedure and the lead up, then they feel a lot more comfortable moving forward.

But yeah, anyone over the age of 45 should see.

Yes.

Not everyone you know wants a colonoscopy.

Despite our best, a little bit about Cologuard in the last show, I didn't want to.

I don't want to focus on it, I think gold standard.

Absolutely is colonoscopy.

If there's really a hesitancy.

Doctor Guzman, you want to talk about cologuard just because it's your turn?

Yeah.

Again, I will say proponent for sure.

Colonoscopy.

But if there's some that just won't go there, what is cologuard.

So first, I like to bring up two things that we there's more than one method to get screened okay.

We will push for the colonoscopy.

because like I say it's therapeutic and diagnostic.

We can prevent.

Now now is accessible to use the best okay.

There's two type of studies that are commonly done which is called the fit test.

And the color guard.

And what is fit test stand for?

That's a fecal immuno chemical test okay okay.

And this is essentially a test that you do yearly.

And it detects microscopic traces of blood.

And this is a good way of being able to detect cancers, but there can be other things that cause blood, like hemorrhoids, inflamed, inflammation in the colon, and it can cause it to be positive.

It's it has about a 72% detection rate.

Okay.

But that's why you do it yearly.

The color guard is better.

You do it every three years.

But that's because it can detect mutated DNA.

Okay.

Interesting.

I didn't realize that.

It actually has a higher false positive rate than the fit test.

It will be, just because as we grow, we have more mutations, and it can cause it to be a false positive.

That one usually ranges about the ten, 15%, that it'll be a false positive, but it's really good at detecting things at about a 92% rate.

Wow.

Okay.

But colonoscopy, at the end of the day, it's 95%.

So okay, so this is a patient that's really, really tries to do things proactively.

So I'm not going to have another colonoscopy 4 or 5 years or four years now would I would it be wise for me to do cologuard in 2 or 3 years just, you know, if this is a secondary now here, he's like, no, don't be paranoid.

No.

So at least in my practice so far, like I've seen, it causes a lot of anxiety.

Once you can see, you have a positive test, and then all of a sudden you're like, I had a colonoscopy last year.

As long as it was a good quality, colonoscopy that you had a good bowel prep, there's no need for you to do a secondary, test.

Now, if you had polyps in the past, you need to get a colonoscopy.

Exactly.

That's the only thing that's going to.

All right, so we literally are at five minutes.

So Doctor Patel, anything that we did not covered yet that you'd like to cover before we close out.

Well what I would like to see is people ask me all the time, what's the best test?

The test you get done is the best test.

Okay.

And I'm a firm believer that colonoscopy is the best test series available.

But for the patient, whichever, as long as you're asymptomatic and you're getting your fit test done every year, or you're getting a Cola got every three years or your colonoscopy every ten years, that's the best test.

Okay, I like that answer.

Okay, that was too quick.

All right, Doctor Hopp.

Now you're on.

You have a whole three minutes to cover.

Go for it.

No, I think we covered.

I think I could fill it in just in case.

I want to give everybody the opportunity just in this.

I appreciate it.

Just highlighting that if you're 45 or older, please come see one of us so that we can make sure that you get the screening that is best for you and whatever test you can get done.

Okay, Guzman.

I would say, you know, I would like to throw a plug for ourselves, as far as, yeah, absolutely.

Or I would say, just to kind of emphasize back our ADR, which is on an average, you want to do at 25% is a good ADR.

And here at UMC, say again, when ADR is adenoma detection rate, adenoma detection rate.

And this is a quality metric that we use to see the quality of the procedures.

Okay.

At UMC we have 54%, which is almost double of what is expected.

So we focus on quality.

We focus on the care of the patient.

And we have we have the best equipment to be able to provide that care.

So okay.

We're we're around for when the people need us, I like it.

I'm going to go back to something that, is always in my mind during these gastroenterology shows.

We're talking about red blood and doctor Hopp, you brought up black blood or something that looks kind of like tar.

Yes, I want to discuss that a little bit in our whopping three minutes that we have left, because how do you know?

And I guess too some people, and I'm just going to say it like a kid, some people don't poop for three days.

So if the blood's hanging out for three days, is probably is it red when it comes out?

Right for the most part.

So I want to see how can you detect blood when it doesn't look like red blood.

And I and I, if you can be as specific as possible.

I know you said it's dark, it's tarry.

Any other way you can describe it for people to pay attention.

Yeah.

So to start with, blood is usually like a laxative.

It's a very irritating to the intestine.

So if you're someone that's constipated and you start bleeding for some reason, usually you see your stools pick up in frequency, okay.

Which can be kind of an alarm bell for you.

Like this is not normal for me.

Something's going on.

The black tarry is actually from the body trying to digest the blood.

And so a lot of times it will have a really kind of specific foul smell to it.

So smell very different than your your normal bowel movements.

Yes.

And then we, we describe it like tar because a lot of times when people find themselves wiping, it's like actually sticky, like wet tar.

So those are kind of some, you know, alarm bell signals, when your body is bleeding slowly and digesting that blood.

Okay.

That's super helpful.

Yeah.

And that can happen when you have a lesion in the esophagus, the stomach, the small intestine and the large intestine.

So a lot of times we're doing an endoscopy or doing a colonoscopy.

And then if we don't find anything we're doing something called a capsule endoscopy where we have you swallow a little pill camera that takes pictures.

Remember doing that years ago.

Yeah, yeah, yeah.

And so we're looking for anything that may be bleeding slowly over time in your small intestine that we can't get to with our bigger cameras.

That can, you know, explain why you're having these dark times.

So we need to do another program and talk about that capsule.

We our an entire program.

It was fascinating.

And you have to bring images and show us how to bring in the little capsules.

Yes, I love it.

Okay.

We have to wrap up.

Thank you so much.

You guys have.

So we talked about the tango shows and the waltz.

This is a great waltz of a show.

You guys are wonderful.

You work great together.

And I learned a lot.

So if you have not watched the show before El Paso Physician, you can find this episode and many of the other episodes really a good couple of years back.

On three different platforms, you can go to KCOSTV.ORG.

you can go to the El Paso County Medical Society's website, and that's a dot com, but that's EPCMS.com.

And then you can also go to YouTube at any time, anywhere in the world.

All three of these anywhere in the world, you can just type in the El Paso Physician Whatever the latest program is, is going to be the program that pops up.

But you can also go back and learn about how shoulders are replaced.

And I always talk about the the fecal problems show, which is a couple of years back, but it actually had that in the title.

And people like why that's a thing.

It's a thing.

So thank you so much for watching.

I want to say again, Doctor Vinay Patel, who has been with us, I'm going to say 27, 28 years because back at UTEP, that's a lot, 31 years.

Okay.

Well, nice.

And then we have Dr.

Jesus Guzman Dr.

Grace Hopp, thank you so much for being with us.

I'm Kathrin Berg, and this has been the El Paso physician.

The El Paso County Medical Society is a nonprofit organization established in 1898 that unites physicians to elevate the health of the El Paso community.

We have been bringing the El Paso Physician Television program to your home for the last 27 years on PBS El Paso.

If you should have any medical questions relating to this program, you may email us at EPMedAOC @ aol.com.

And we will try to have our experts answer your questions.