Joey Wahler (Host): It's important to stay on top of with regular screenings. So we're discussing colon health. Our guest is Dr. Jeremy Albin. He's a General Surgeon with Columbus Community Hospital. This is HealthCast, a podcast from Columbus Community Hospital. Thanks so much for joining us. I am Joey Wahler. Hi there, Dr. Albin. Welcome.

Jeremy Albin, MD: Thanks Joey.

Host: Thank you. We appreciate the time. So first, give us an idea, please, in a nutshell, Doctor, why is colon health such a critical part of our overall wellbeing? It's connected to a lot of things in the body, isn't it?

Jeremy Albin, MD: That's right. The colon is an organ that people would just as soon not think about, but it is incredibly important to our overall health. The colon's main job is to take the waste that our body eliminates, remove any additional or excess water, and then eliminate it in an orderly fashion.

And so you can imagine that's not a fun topic for most people. I wouldn't count myself in there, but most people don't enjoy talking about that stuff. Problems with the colon can lead to a bunch of other problems and can be indicative of deeper problems as well.

Host: Speaking of which, what are some of the most common colon issues you encounter in your experience?

Jeremy Albin, MD: So, a vast majority of the colon issues that we see are related to not going or going too much. We see a lot of people that will come in for blood in the stools, pain in that area, and then other problems or irregularities with elimination.

Host: Now, of course, on the more serious side is colon cancer, which some of those symptoms could be indicative of. Am I right? But not necessarily.

Jeremy Albin, MD: Right. Those symptoms are not specifically tied to colon cancer, although there's a chance that some of those things could indicate, like I said, bigger problems occurring in the colon itself.

Host: And so at what age, therefore should people start getting screened for colon cancer? And how has that recommendation changed in recent years? Because there's a reason behind why it has. Right?

Jeremy Albin, MD: That's right. A couple years ago, the initial screening age for colonoscopies and, and other screening modalities was revised downward from 50 to 45. This reason is because the kind of using population data, researchers were able to determine that the rates of colon cancer in the 45 to 49 age group were almost identical to the rates of colon cancer being diagnosed in 50 to 59-year-old age group.

And the incidence of colon cancer in people who are between 45 and 49 has increased about 70% since the 1970s. And so letting those folks know that there's an increased risk population-wide. Now that risk increases if you've had a family member who's had colon cancer, specifically mom, dad, brothers, sisters, that risk increases if there's cancer syndromes that occur in your family. That risk would also increase if you have a personal history of other types of cancer, such as breast, or ovarian cancer. And so those folks are ones we really want to get in and, and be able to evaluate with the colon screening.

Joey Wahler (Host): And in doing so, Doctor, the colonoscopy, which you mentioned is of course the gold standard, if you will, the most common screening. Are there other screenings these days and why would someone have something else besides a colonoscopy?

Jeremy Albin, MD: There are other screenings. The two broad categories of screenings that we have are stool based tests and then direct visualization, so to speak, based tests. The stool based tests are typically performed either at home or by your doctor, in the office. There's the stool cards, which everyone's familiar with. Those typically will look just for blood. So not terribly specific. There's also something called a FIT test, which is similar to the just regular colon blood card. But it's checking, actually checking for DNA in the stool. And then there's also the Cologuard test, which is checking for actual abnormal DNA in a larger sample, of the stool. Those are all, the first two are yearly tests, the Cologuard's typically every three years. And there's quite a robust debate, if you look at some of the society guidelines about which of those tests is the best, which is going to capture the most people, the most pathology, but it's also not going to lead to unnecessary procedures.

Host: But at the end of the day, as we said, the colonoscopy is the most common and it's the most thorough, right?

Jeremy Albin, MD: That's right. Yeah. The colonoscopy, allows us to not only examine the lining of the colon, which is where the colon cancers can start as pre-cancerous lesions called polyps. It also allows us to intervene and remove those polyps if, they're concerning. One of the things that helps with the colonoscopy is someone who's experienced at identifying those and removing the ones that have a high likelihood of being pre-cancerous.

Polyps do range from being totally benign to being pretty aggressively pre-cancerous, if not harboring, small bits of cancer. So, the colon screening test that we do is a full colonoscopy examining the entire colon. There's also a shorter colonoscopy called a flexible sigmoidoscopy that can be options for people who have either had colon surgery before for unrelated issues or in conjunction with some of those other screening tests.

 Some of the newer modalities that are available to people are called a CT colonography, which unfortunately still requires you to clean out. There are some centers doing video capsule colonoscopy. Again, that's not common. Mostly in academic centers is where you would find something like that, but those are unproven to be any better than the standard colonoscopy.

Host: And there was an irony attached to the colonoscopy it seems in that on the one hand, it's about as simple and painless and quick a medical procedure as one can have these days, right? But on the other hand, it's so dreaded. It's got a bad rap, doesn't it, Doctor? And it's so necessary, and yet so many people put it off and they're really doing so unnecessarily.

Because the other irony, if I may, is that the buildup, the prep is really more strenuous, if you will, than the procedure itself for the patient, right?

Jeremy Albin, MD: You're, absolutely right. Yeah. The prep not something that anyone's going to look forward to. On that front, there are a couple different options that we have for people that decrease the overall volume of fluid and water that you would have to drink in preparation. In addition, there's less cramping and discomfort associated with it. Now, the only way to clean out the colon is to eliminate everything that's in there. And so the requirements, for not eating anything for the preparation time and also the process of purging the colon are not going to change anytime soon.

However, the methods have, I think, improved, as someone who's been on that side of the curtain, so to speak, the modern preps do make things easier, rather than having to measure out how much of the stuff that you gotta drink or you gotta finish the whole bottle or whatever, you have a defined amount of things that you have to take either pills or in a bottle. And those are typically go down very easily for people. So folks that have had a lot of nausea or a lot or vomiting and a lot of problems with their preps may find that these new preps do make it easier. I won't say it makes it easy, but they do tend to make things easier. They also provide an excellent preparation, which allows me to do my job, as well as I can.

Not having to do a lot of irrigation, not having to clean out additional material from the person's colon that makes detection of these little precancerous lesions much easier.

Host: So to be clear, when we say prep for those unfamiliar, those who haven't had it done yet, you need to drink usually some sort of a solution multiple times the night before and in the wee hours before you go in for your procedure that following day in order to clean out your system so that there's nothing left to block your view once the procedure begins. It doesn't taste the best, and it can make you feel odd, as you pointed out so well, Doctor, but once all that's over with, that's the hard part, right? Because the procedure itself is like going to sleep, waking up, not feeling a thing. And I know personally, having had it done multiple times, I didn't even realize I was asleep.

Jeremy Albin, MD: That's, right. Yeah. So once you've finished with the prep, the hardest part's getting to the hospital. Once you're at the hospital, you get in that we do a very mild sedation. It's one that works very quickly, allowing you to fall asleep very quickly. You typically people have no discomfort during the procedure.

Because of the deep sedation too, there's not a lot of pushing, which makes our colonoscopy much safer. Then when you're finished, the medicine tends to wear off very quickly as well. And so, instead of spending three to four hours in the hospital waking up from the anesthesia, which was common when I first started practice, people are in and out of the hospital in less than two hours, which is absolutely remarkable compared to where we've come from, again, very little discomfort. Oftentimes people feel wide awake to the point where they remember everything you tell them after the procedure. And then of course, with our recommendations, because you have had sedation, you can't do anything crazy the rest of the day. The following day's typically back to normal.

So it's I think the advances, in our anesthesia, the advances in the efficiency of us being able to process things, newer equipment, allows us to see things more clearly. We have better cameras, better visualization, different filters that we can use to identify polyps even easier.

Lot of times we'll see questionable tissue. Should I biopsy that not? These filters allow us to make a definitive call on that and then, I think our techniques are improving as well. I think, there's a couple different ways that people go about doing the colonoscopy, especially people who've had trouble with colonoscopies in the past that made things even easier.

So it's the prep, no one's going to lie to you, it's not pleasant. I do think it's easier than it used to be, and I think that, as you, alluded to, the colonoscopy experience has improved significantly for people.

Host: Yeah, no question about that. How about, you mentioned earlier, Doctor, that other things can be discovered on a colonoscopy short of colon cancer, like pre-cancerous polyps, but also other conditions can be discovered that are far less serious than cancer, but still that need to be addressed. Right?

Jeremy Albin, MD: That's exactly right. One of the most common things we identify during the colonoscopy would be hemorrhoids. Those are things typically that we can either, take care of with a simple procedure during the colonoscopy or can recommend medications, lifestyle changes that can improve the symptoms that folks would have from those.

In addition, we can find little pockets in the colon called diverticula. These diverticula are very common. They're not typically dangerous by themselves. They can represent a genetic change, that people have. It can run in families, but it can also be related to pressure. If folks have been battling with constipation for years, these diverticula, these little pockets, can become more common. If, from time to time, these little pockets can become very irritated. And they can cause a mild inflammation or infection called diverticulitis. Sometimes this infection can be severe. People receive care in the hospital, oftentimes it involves antibiotics, resting the bowels, changing the diet for a short time.

In extreme, situations, it can require surgery to help improve somebody's way of life because that discomfort can be troubling. In addition to that, we can also see inflammatory diseases such as Crohn's disease and ulcerative colitis, and typically we're doing scopes because someone's had bleeding, they've had changes in their bowels, they've got some kind of an indication for us to go and look at things. And sometimes we can identify those diseases and they are different degrees of inflammation, different parts of the colon, but they do oftentimes present in a similar fashion. And the only way to sort of differentiate the two is with a evaluation and typically removing a small amount of tissue and looking at that under a microscope to tell us why the inflammation is there.

We're often treating those with the help of our gastroenterology colleagues because it can require different, very powerful medications to help manage that inflammation and irritation in the bowel.

Host: Gotcha. So in short, a lot of important reasons potentially to go and get that colonoscopy. A few other things here. How much of an impact do diet and overall lifestyle choices really have on colon health? What are a few tips you have for people joining us about keeping that colon as healthy as possible?

Jeremy Albin, MD: So there's actually been, this very question has been subject of a fair bit of research over the last 10 years. What researchers have found is that people who maintain a healthy diet, so that's high in fiber. So fruits and vegetables, whole grains, that's low in red meat.

That's not going to play well in Nebraska necessarily, but a diet that's lower in red meat protein sources, instead such as fish, chicken, and vegetable sources of proteins, and then people who are well hydrated. And then also the final component of that is people who maintain a healthy weight and are active, which is defined as someone who has an elevated heart rate for 150 minutes a week.

Sounds like a lot. It's really not if you break it up. But those folks tended to have about a 50% lower risk of colon cancer than people who were on the opposite end of the spectrum. People who had a very high fat diet that was very high in red meat. People had a very low fiber diet. People who tended to not drink as much water and then maybe drinking other things, sugary drinks or, things like that. But if you take the two extremes, so people who are in the top 25% on that spectrum and the people who are on the bottom 25%, the people at the top had a 50% lower risk of colon cancer than the people at the bottom.

So a sedentary lifestyle, diet changes, all that thing actually really, they really do impact, the risks of colon cancer and not just colon cancer. There's other cancers that having positive lifestyle changes really do reduce your risk, of those. But yeah, colon cancer is probably a really big one.

Plus those things help colon health as well. A diet high in fiber allows the stool to retain water, allows it, makes it easier to pass. Then if you're well hydrated, the colon doesn't have to steal as much water from the stool in order to maintain a good fluid balance.

It also provides a diet that's like a good protein, high in fiber provides, a lot of fuel for the colon cells and so they don't wear out so easily and they are able to pass the stools that you have with less difficulty.

Host: Then finally here, in summary, you just mentioned some eye-opening numbers a moment ago. Speaking of that, the statistics show that there's such a difference in early detection when it comes to warding off colon cancer. So maybe just leave us please, Doctor, by stressing to those joining us, just how important it is to get that colonoscopy on a regular basis, because it's not being overly dramatic, is it, now, when you say it could be the difference literally between life and death, right?

Jeremy Albin, MD: Well, you're absolutely right. Colon cancer is the third most common cancer in US adults. It's one that I don't think it's a stretch to say, almost entirely preventable. Now, there's always outliers, but if someone would get their regular colon screenings, if there's someone that has these precancerous lesions, you get those removed.

And with regular follow-up, your risk of developing colon cancer is about the same as someone who doesn't have any polyps. And so we know that our interventions actually do make a huge difference in people's lives. Someone enduring colon cancer goes through surgery, sometimes chemotherapy, radiation therapy, depending on where the malignancy would be.

In addition, there's always the risk of recurrence. There's always a risk that things could pop up elsewhere. And so by sort of taking out that dragon before it has a chance to get started is in everyone's best interest. Colonoscopies are one of the best forms of preventative care. But even if you choose not to do a colonoscopy, sitting down with your physician or your provider and having an honest conversation about your risks and about what is the best method of screening will go a long way, to helping head things off and then also early detection if something were to change. Elimination is something that we don't enjoy talking about, but it is something that's incredibly important. So if you notice changes in your bowels, again, very, very important to talk to your physician about. If you notice bleeding again, also very, very important.

Oftentimes it is from benign conditions, but it may not be, so if you're experiencing blood in the stools, changes in your bowel habits, bloating that's unusual or progressive over time, if you have a low blood count. Those are things, all those things are things that need to be evaluated and can be done easily, locally.

You don't need to go anywhere to get those things done. We are happy to take care of those. We have a fantastic medical community here in Columbus and we all work very, very closely together. And so our utmost concern is the health of our community, and this is one way I think that we make a very positive impact on that.

Host: Absolutely. Well folks, we trust you are now more familiar with good colon health. Dr. Albin, valuable information and advice indeed. Thanks so much again.

Jeremy Albin, MD: It's my pleasure. Thanks for having me on.

Host: Absolutely, and for more information, please do visit Columbushosp H-O-S-P.org. If you found this podcast helpful, please do share it on your social media. I'm Joey Wahler, and thanks so much again for being part of HealthCast, a podcast from Columbus Community Hospital.