Evo Terra (Host): This is Putting Your Health First, and I'm Evo Terra. With me is Dr. Jamie E. Sanchez, a double board-certified colon and rectal surgeon from Health First. And on this video version of Putting Your Health First, we'll get to know a little bit more about the doctor. Dr. Sanchez, welcome.

Jaime E. Sanchez, MD: Hello, Evo. Thank you so much for having me.

Host: Can you walk us through your journey into colon and rectal surgery? You know, why this specialty?

Jaime E. Sanchez, MD: Let me just start off by saying that to become a colon and rectal surgeon, or commonly known as a colorectal surgeon, you need to be a general surgeon. So, what that means is, after all of your undergraduate and medical school, you do a journey of at least five years in general surgery, where you can become a board-certified general surgeon. So, that's the double board that you mentioned during your introduction. Then, you go on to have an advanced subspecialty fellowship in colon and rectal surgery, where you focus on just operating on diseases of the gut, such as the colon, the rectum, colon cancer, inflammatory bowel disease, diverticulitis, lots of things that perhaps you may not have heard of, but many of which you have.

Host: And what experience helped shaped your approach when you became a surgeon?

Jaime E. Sanchez, MD: Well, one of my main reasons to go into colorectal surgery is I felt like I could really be a specialist in something and help at a very high level. So as much as I loved general surgery, colorectal surgery gave me that ability to really hone in and focus on a particular type of patient that had a particular need.

What helped me hone in on that was realizing that this was kind of a sensitive area. Nobody is ever excited to come see me in the office, and I'm okay with that. I get it. I get it. Why would you be? But there's an important need for there to be providers out there that can deal with topics and issues like this with sensitivity and caring, really at an advanced level where you're knowing you're getting the best care possible. And that really just appealed to me, and it appealed to me that I could help carry patients through a very difficult time in life in, hopefully, the easiest manner possible.

Host: And you bring up the uncomfortableness and the fact that nobody is really looking forward to anything they're going to have done with you. I can understand. I think everybody can understand that. But as a medical provider who is working with patients, how do you work through those uncomfortable issues? How do you build trust, and make them really feel at ease during their care?

Jaime E. Sanchez, MD: I think the very first step is to acknowledge that, right? To acknowledge that this is odd. This is not typical and normal. And you not having any idea of what's going to happen during a consultation is perfectly normal. It's my job, it's the job of my staff, and our desire to put you at ease, to let you know, "Hey, you know, this is what's going to happen. Nothing's going to happen without your consent. Nothing's going to happen without us telling you about it. And we're going to make it as easy on you as possible." Whether that's just a conversation about a very difficult topic, right? Whether that be cancer or something a little bit more intimate and embarrassing, hemorrhoids, anal fissures, anything that's going on, you know, below the belt that people are commonly embarrassed to talk about.

Host: And I would imagine that for you, a healthcare provider who focuses on these issues, there's no embarrassment for you doing this, obviously. So, they've got the best audience in the world when you've got the most uncomfortable thing to talk about. Colorectal surgeon sounds like the right kind of person to really get in there.

Do you find yourself to the point with your patients when you're working on it, do you try to get them joking and laughing about it, or is it just a total serious all the time? Does it matter? Does it depend on the patient?

Jaime E. Sanchez, MD: It absolutely depends on the patient. You know, after doing this for many years, I've got a good read on what people like, what puts them at ease. But truth be told, most people want to know that there's a little bit of levity in this, right? They know it's weird, you know it's weird. It's just acknowledging that it's an uncomfortable situation, but perhaps something that has to be done. You know, I don't love going to the dentist, but I like my dentist, and I know that I want good, strong, healthy teeth.

So I go, and they put me at ease, and we get through it, and I always think, "Well, that was much better than what I thought." So using that as an analogy, when they come to the office, we're going to work through whatever needs to be talked about to get them comfortable enough to understand that we're going to do this in the least invasive way possible, but to make sure that they get the maximum quality of care, because that's important, right? We need to do what needs to be done so that you have the best health possible, and I'm not there to push anyone to do anything. I'm just there to offer options and the best advice possible.

Host: Let's talk about this robotic surgery for colon and rectal cancer. How does it work?

Jaime E. Sanchez, MD: Sure. Well, we say minimally invasive because in the past, in the historical nature of surgery, to get into the abdomen to operate to remove tumors, to fix problems, you would have to access it. And that typically required a knife and a big incision in the abdomen to open it and see what was going on and to be able to have access to what you needed to do.

In modern surgery, there are various ways that you can operate through very small incisions because, geniusly, we've learned that we can inflate the abdomen. We call it insufflation or pneumoperitoneum. We actually make a very small incision and put in a cannula or a little tube, and then what we do is we push carbon dioxide in there, a very inert gas. It's not going to catch fire. It's readily resorbed by the body. As a matter of fact, when you absorb it, you're just going to breathe it out through normal breathing, right? We breathe in oxygen, and we breathe out carbon dioxide. Same, your body's going to be able to handle it with little to no consequence.

And by doing that, we make space in the abdomen. By making space in the abdomen, now we can use a camera on a long telescope. We call it a laparoscope, and you can insert that into the abdomen, look around, and through either other little incisions or other various techniques, you can use small instruments to do the things that used to take an incision to fit someone's hands in.

So imagine, these hands versus an incision this big where I can put small instruments. So whether you're doing that through a technique called laparoscopy, which was really the very first phase of minimally invasive surgery, laparoscopy using the laparoscope and small instruments to get in, to now robotic surgery, which is still the same concept.

The surgeon's still doing the work, but now they're sitting at a console controlling robotic arms that are inserted into the abdomen. So, a lot of people will say you have finer motor control, you perhaps have better visualization, and you're able to do more complex things that perhaps you couldn't do in the past through very small incisions.

Host: And do you have a preference? Is there a particular style that you go for? Obviously, a lot depends on the condition, but what's your go-to?

Jaime E. Sanchez, MD: No, that's a great question, because people will tend to gravitate towards a particular type of operating. So, I am a very advanced laparoscopic surgeon to the point where I do my operating through what's known as single-site surgery. So I have advanced to the point where I do all the laparoscopic operation through a small incision, just about 2 to 3 centimeters.

So using a special port, the camera and all the instruments go right through that one focal point, and I'm able to perform the entire operation with my very own hands holding the instruments, doing what needs to be done in such a minimally invasive way. Patients often look down, see one bandage, and say, "Is that all that was?" And by doing that, we can reduce pain, we can reduce the risk of infection, we can reduce the risk of future hernia. These are all great things. Although I'm robotically trained and I did it for years, I continued to gravitate and build expertise in laparoscopic surgery, although I could do a robotic surgery tomorrow if that were the interest and the need and the necessity.

There are other surgeons, for example, I have a partner coming to join me here at Health First, who's an expert in robotic surgery. He's chosen to really focus on using the robot the vast majority of the time to sit at a console and be able to manipulate those robotic arms a little bit remotely from the patient and achieve equally wonderful results.

So really, it's up to what your surgeon thinks is best for you and them to give you that same high-quality operation, all minimally invasive, all virtually equal outcomes.

Host: As we're winding down here, I want to talk—you talked a little bit what inspired you to get into this field, but maybe you could tell me about your personal philosophy when it comes to patient care.

Jaime E. Sanchez, MD: No, gosh. You know, it's that philosophy that drove me to colorectal surgery. I really feel like this field takes a special kind of doctor, special kind of provider. Those who work with me, whether they're doctors or they're not, we have a special caring and empathy for patients that we want to put them at ease and really get them through a tough time.

And a lot of people tend to shy away from those things, difficult conversations, embarrassing moments. I find that people that gravitate to colorectal surgery are really good at doing just that, being the people that get you through a difficult time in life. And you can find this in all fields of medicine.

You know, oncologists really require a person that deals with a lot of serious disease. You know, colorectal surgeons, I find, and it's my philosophy, that we want to be there during those difficult moments and help you get through those things because perhaps that's what we were called to do, and we feel like we can really make a difference there.

Host: Great. Great. Anything else you'd like to add before we wrap things up, Doctor?

Jaime E. Sanchez, MD: The only thing I'd like to add is, as always, get your colonoscopy. Because if you get that colonoscopy, perhaps you won't be seeing me for a surgery.

Host: Always great advice. Thank you very much for joining me today, Dr. Sanchez.

Jaime E. Sanchez, MD: Thank you so much, Evo. What a pleasure.

Host: For more information about or if you have a concern and would like to schedule an appointment with Dr. Sanchez or a primary care provider, please visit hf.org/findadoc. Again, that's hf.org/findadoc. If you enjoyed this episode, please share on your social channels and check out the entire podcast library for topics of interest to you. This has been Putting Your Health First. Thanks for watching.