Transcription:
Get to Know Dr. Alexandra Columbus, Colorectal Surgeon

Scott Webb (Host): Today on the Health Works Here podcast, we're all going to have the pleasure of getting to know Dr. Alexandra Columbus. She's a colorectal surgeon with Emerson Health. And in addition to learning more about her and what she does at Emerson, she's going to encourage all of us to get screened for colon and rectal cancers.

This is the Health Works Here podcast from Emerson Health. I'm Scott Webb. Dr. Columbus, thanks so much for your time today. Welcome to the podcast.

Alexandra Columbus, MD (Guest): Thank you so much. I'm so happy to be here.

Host: Yeah. Well, I'm happy to have you here and happy to learn more about you, and I love when Emerson does these, where we just really get to know the doctors and their approach to care and so on. So as we get rolling here, as a colorectal surgeon, what do you do?

Guest: As a colon and rectal surgeon, I am specialty trained in treating disorders of the lower parts of the gastrointestinal tract. I work specifically with the small bowel, the large bowel or colon, the appendix, which comes right off the first part of the colon, the rectum and the anus. Believe it or not, there are many things that can affect our health in this area of our body. There can be benign diseases, malignant diseases, functional disorders. And I really have a passion, I think, for being able to work with patients to address issues that ail this area.

Host: Yeah, I could certainly sense that passion and I'm always interested when doctors and nurses, when I get to talk with them just really about themselves, you know how did you know, or when did you know, like what drew you to being a colorectal surgeon?

Guest: I think as a surgical trainee, you do have to engage in some, you know, trial and error, trying on different hats, figuring out what fits and what doesn't. Initially, early in my surgical residency, which was seven years long, I really thought that I wanted to be a trauma surgeon.

I knew that I loved operating in the abdomen, working with that anatomy, and at first I really thought that that's what I would want to do. However, when I became a more senior resident and started to practice trauma surgery a little bit more intensely, what I realized I was missing was really the longitudinal relationships that I might be able to have with patients.

I absolutely love working with people. I love being able to provide individualized care. To me, I very much like the opportunity to get to know someone and figure out what are your values? What in a care paradigm is going to be best for you? What might not work. With colon and rectal surgery, as I mentioned, I'm still working in the abdomen. I am working with the anatomy, the physiology, and the pathology that I love to work with. But we have a wide span of types of conditions that we deal with. Some things are emergent and there's not a lot of time to talk to get to know the patients, but many times I have the opportunity to meet you in my office first.

Get a chance to speak with you know how whatever it is that's bothering you is affecting you. And also I get the chance to normalize it. I think that some of the disorders pertaining particularly say to anal rectal disease, anything that has to do with poop, I think it's viewed as taboo in our society, our society. But believe it or not, everybody poops. Um, and this is something that when it's not going right, it can really affect our quality of life. And to me, I'm here to help. I have the opportunity to again, make it so that it doesn't feel like something you can't talk about. We want you to know that it's safe, it's normal, and we want to get you back to feeling well.

Host: You know, you're talking about how you really like to get to know patients when you have the time, when it's not something emergent or acute, and that's awesome. So maybe you can just drill down just a little bit more and talk more about your approach to care when dealing with patients both before, during, and after surgery.

Guest: To me, this has to be ideally is a step-by-step approach. As I mentioned, I think it's really important for us to have the opportunity to try to get to know each other even though it may not be a huge amount of time at first, but I want to get to know you as a patient. I want to know who you are, what are your values, what makes you tick?

And then I want to really take the time to hear about what's going on, what about the issue has been affecting your quality of life. What has worked, what has not worked. I also think trying to create a shared foundation of knowledge is extremely important. I want to make sure that you at least have some understanding of what the anatomy is of the lower GI tract is like. What condition are we talking about? How does that affect your anatomy and what are our options for treatment? That multidisciplinary, you know, working with colleagues too. Something I did not mention about what I love dealing with colorectal surgery is working with colleagues of other medical disciplines.

I work very closely with medical oncologists through the MGH cancer center, radiation oncologists, gastroenterologists, nursing staff, physicians assistants. I really want to make sure that we're gathering insights and perspectives from our whole team so that we can really put together a plan that will be most helpful for you.

And I think with that, it's really taking the time, making sure that questions get answered, and building a shared foundation of knowledge that we can go forward.

Host: Yeah. And sticking with the focus on colleagues, I want you to talk a little bit about the Mass General Cancer Center at Emerson, because I know that everything's under, you know, one roof. It's advanced, convenient care. Maybe you can talk about that a little bit.

Guest: Absolutely. Colon and rectal disease is really by nature a multidisciplinary disease spectrum. It's often not just surgical. There's something medical that's going on too, or there are parts of treatment that need to be surgical and parts of the treatment that need to be medical. If I worked in a silo all by myself, I would not be offering you the best care that you can possibly receive.

So I'm very fortunate to have such wonderful colleagues, specifically at the MGH Cancer Center, Dr. John Dubois and Dr. Julie Fu are both medical oncologists who treat gastrointestinal cancers. I probably speak to John Dubois on the phone as well as Julie, I think, you know, two to three times a day here and there, just asking opinions, being able to share concerns and treatment ideas for our patients. And I think that this really, particularly working with all of us who work so closely together all the time, I think it makes consistency of care very clear and easy for patients to navigate.

You know, when you come to my office, you probably don't really want to be there to meet me. We're there because we're having a conversation about something or a fact that we wish we didn't have. But part of my job is to be there to inform you and to share information and help make a plan so that we can absolutely work on getting you forward with your life. And I think being able to have easy access to team providers is absolutely critical.

Host: Yeah. Well, as you say, you know it is such a scary time and folks don't generally want to be there no matter how awesome you are and how likable you are. Most folks don't necessarily want to be there because it's so scary. Maybe you can talk about how you make it a little less scary, like how you take the sting out of it there in the office.

Guest: I think that stepwise approaches again means everything. We need to sit down. We need to break down the problem into its most basic components. We need to talk about what's going on. If we need more information, we need to talk about what that information is and why we need it. And then we need to talk about what are our possible treatment approaches.

I always tell my patients, you know, my most important job, number one, is to keep you safe. It's also very important that I be an information provider. My job is to help give you, as a patient, the most thorough body of information about what's going on and what the treatment options are so that we can make a shared decision about what to do that's going to be best for you.

In this approach, it's my hope that I'm able to convey that I'm there for you. My team of multidisciplinary providers, including the MGH Cancer Center, if applicable, our gastroenterologists, as well as our nursing staff; we're here for you. You don't have to go through this alone. You have support.

Host: Yeah, definitely. And let's talk about some of the advances in surgical options treating colon cancer. I don't know if you've been at this long enough, you sound so youthful. So I don't know if you've been in at this long enough where you, you know, came in doing open surgeries and now you're using like the da Vinci robot, or, you know, just want to know where are things at today? What are you excited about for the future? And so on.

Guest: I think another part of what I love to do with colon and rectal surgery is that there's a very wide variety of surgical techniques that we can use. Certainly over the past, I would say, 20 years, advancements in minimally invasive surgery have flown like wildfire. There's a ton going on. Here and there, there is the patient that simply needs open surgery for one reason or another. And I'm very prepared to do that if necessary, but I do think that we're able to, for many patients, laparoscopic, minimally invasive surgical procedures are going to be the safe and feasible answer.

I do the majority of my colon resections laparoscopically. Sometimes I'll use in my hand actually as an assist with a very small incision but surgery typically lasts somewhere between two and three hours. You're in the hospital on an average from two to five days. So I think these advances have helped to help advance recovery in such a way that patients don't necessarily have to be in the hospital for a very long time. Another technique that I've been trained in is doing transanal surgery. For certain kinds of lesions in the last part of the rectum, as well as in the anus. Larger incisions in the abdomen are not necessary.

We can actually employ minimally invasive techniques to remove lesions as high as 18 centimeters away from the anal verge or the opening of the anus. And this can be performed as same day surgery. And so I think, you know, we at Emerson are working very hard to make sure that we stay on top of the cutting edge of surgical techniques and technologies so we can continue to deliver this kind of care.

Host: Yeah, you definitely are. And always good to hear about where things are at, where they're going, and how it benefits really everybody, both the surgeons, patients, the whole team, if you will. Let's talk about what patients should do if they've been diagnosed with colon cancer. Like what are their next steps, because as we say, it's such a scary time. So when you share this diagnosis with them, what are the next steps, I guess?

Guest: I can only imagine, you know, how overwhelming hearing that information can be. And the majority of my patients may have found this out by undergoing a colonoscopy, either because of symptoms or because of surveillance or screening. We have excellent gastroenterologists affiliated with us.

I know that information is shared sensitive in as careful away as it can be. But I think a piece of what we really try to do is make sure that we have our next steps planned. You're not alone in this. And we can make an action plan fairly quickly. And so I think as soon as you hear this, you know, number one, it's taking a second to process.

I think if you have someone in your life who you view as a support system, someone who can help you process information, I think it's important to share it with those individuals. Because, you know, goodness knows that we will need each other. And I think being able to communicate that can be very helpful.

But then when you come to see me, as a surgeon, what we're going to talk about is what is the problem? Exactly how do we understand the cancer that you have? And then, what do we need to do next? Are there more tests that we need to get, specifically CAT scans and lab work that will help us better understand the stage of the cancer and then with that information, will we be planning a surgery in coming weeks?

Will you be seeing our medical oncologists? Will be, will we be working with nutrition? It really is something, I try to make sure that when the patient comes in for the initial consultation, that we have a very defined plan for what our next steps and our follow up are. What we want to do is make sure that we are keeping, or we're taking as much control over the situation as we possibly can.

And I think that's something that I'd want to assure my patients of is that and I know I've said this, but you're not alone. And that this doesn't have to be a completely amorphus entity that we don't know anything about or what to do with. Our job is to work together to make a plan of attack. And that's something that we take very seriously.

Host: Yeah, you do for sure. And, really great information today. And as we wrap up here, Doctor, just want to have you talk about, I know we can't outrun our family history and genetics, but generally speaking, when it comes to behavior, lifestyle, whatever it might be, how can we all sort of stay healthy and reduce our risk of the types of cancers that you work on, that you treat?

Guest: I think nature is ahead of science and we're working on it. I'll tell people that approximately 10% of colon and rectal cancers are those that we would consider hereditary or inherited. So I do think having conversations with your parents, your family members, about what's any relevant history? Has anybody ever had any colon polyps? Has anyone ever had any colon cancers? Any diseases like Crohn's disease or ulcerative colitis in your family? Because these factors may make us want to screen you, in terms of colonoscopy earlier. And that's one of the first things I would say is making sure that you're undergoing regular screening.

We don't always have the power to predict exactly who will develop colon and rectal cancers and our best tool for addressing things in early fashion, is colonoscopy at this time, so make sure you're getting your colonoscopy. From there on out though I think some of the advances that are going to happen in science for colon and rectal cancer over the next several decades, are going to be enhanced understanding of what factors in genetics and environment create combinations that put patients at risk.

We're still learning, but I think by principle now, the things that you think are good for you or know that are good for you, I should say, usually are. You want to make sure that you're living a healthy and balanced lifestyle. Factors that can contribute to developing colon and rectal cancer specifically, include smoking cigarettes, being overweight, having poor diet that is not high in fiber.

So, conversely, I recommend eating a high fiber diet, drinking lots and lots of water. You want to make sure that your bowel movements are softly formed, that you're not having to strain or not having regular diarrhea. Regular exercise is really important. Cigarette smoking should be avoided, moderate your alcohol. Moderate balanced living really does help reduce our risks of developing problems down the line.

Host: Yeah, that's perfect. So much knowledge and information and especially compassion today. Now, Doctor, thanks so much for your time. You stay well.

Guest: An absolute pleasure. Thank you.

Host: For more information or to make an appointment, call Emerson Health Surgery at (978) 287-3547. And thanks for listening to Emerson's Health Works Here podcast. I'm Scott Webb. And make sure to catch the next episode by subscribing to the Health Works Here Podcast on Apple, Google, Spotify, or wherever podcasts can be heard.