Scott Webb (Host): This is Putting Your Health First, the podcast from Health First. I'm Scott Webb. And on today's podcast, I'm speaking with double board-certified surgeon and colon and rectal surgeon, Dr. Yaphet Tilahun, about colon conditions that may require surgery.

Doctor, it's nice to have you back on the podcast. So, we got to know you a little bit better last time. Today, we're going to talk about colon conditions that may or may not require surgery, what folks need to know. But before we get there, just tell us just a little bit about yourself, how you became double board-certified, how you got to Health First, all that good stuff.

Dr. Yaphet Tilahun: You know, I was raised in Ethiopia, but I moved to the United States around 1999. And then, I did my college education at the University of Massachusetts in Amherst in Microbiology, and I got my master's at the same time. Afterwards, I wanted to see what microbiologists would do. So, I worked for a few years as a microbiologist and scientist and, at that time, decided that my path was really sort of in medicine.

And so, I applied and got into University of Massachusetts in Worcester Medical School. And at that time, I initially wanted to become an infectious disease doctor. But once I had my surgery rotation, it was obvious that my path was in surgery. I did my residency down here in Florida just to get a different view and a different experience and a different system.

And then, I went up to Rhode Island for fellowship for colorectal surgery. And then, I came back to work for AdventHealth for the last seven and a half years, and looking for a new challenge. Now, I'm here with Health First, and looking to build a program and serve the community in Brevard County.

Host: Yeah. That's awesome. I want to talk a little bit, Doctor, about the importance of screening, maybe early treatment, but give folks a sense like can colon surgery be avoided through screening and earlier treatment?

Dr. Yaphet Tilahun: Absolutely. Especially for colon cancer-related colon surgery, if we're getting our patients screened, then the likelihood that they will develop cancer would be lower and lower over time. And so, as long as we're catching the pathology in the form of polyps, that can be removed during a colonoscopy, then they'll never have to deal with a colon cancer in their lifetime. And so, they never have to meet me in their lifetime, which is the ultimate goal.

Host: Right. You are a nice person, and I have gotten to know you as we've done these. But like we talked about last time, you know, folks don't maybe want to meet you. They don't want to be in that room. They maybe don't want to have these conversations. So, the importance of early screening, treatment, all of that. Maybe you can just go through some of the, let's say, common colon conditions that might require surgery.

Dr. Yaphet Tilahun: Sure. So for colon surgery, the three main ones would be for cancer related. So, sometimes it's a large polyp that can't be removed endoscopically or it could be a cancer that needs to be removed. So, we'll remove a segment of the colon. Usually, this doesn't require us to remove the entire colon, but only section of the colon that needs to be removed. The other one is for inflammatory bowel disease. Another one would be something, for example, like diverticulitis that requires surgery. And there are other ones such as volvolus and other colon conditions that are not as common but may require intervention surgically as well. But the most common ones we tend to see are for diverticular disease, inflammatory bowel disease and colon cancer.

Host: Right. As best we can, Doctor, any diagrams, what does surgery entail, I guess? And maybe you can explain colectomy and just give us a sense of the different approaches.

Dr. Yaphet Tilahun: Sure. Majority of the time, it tends to be segmental. So, we will refer to the colon as, for example, the right side, left side, the transverse, the sigmoid colon, or the rectum. And we'll be very specific in terms of what segment of the colon is being affected and how we can surgically approach the treatment for that segment.

So for example, if we take that particular disease as an example, majority of the disease tends to be in the sigmoid colon. And so, we would review when you come to my office, the anatomy of the colon, including the sigmoid colon, how we remove it, and how we reattach the colon back together after the removal of the sigmoid colon.

Host: Yeah. Just kind of following you here and trying to connect all the dots and want to get a sense from you anyway as best I can the difference between colectomy, colon resection, colostomy. Like, what do all those things mean, and how do you decide, Doctor, like which surgical approach is appropriate for each patient?

Dr. Yaphet Tilahun: I'm glad you asked that question because I think a lot of the verbiage can mean the same thing, but using different words. So, colon resection means the same as a colectomy. So, those two things are exactly the same thing. And then, the ostomy is what most people will refer to as a bag, where we have to bring up part of the intestine up to the skin. So, stool is coming out into a bag and not going out through the ends. Those are the big terminology differences. And almost always, the plan is to find you a surgical solution. So, you never have to have a bag.

Host: Yeah. Yeah, I wanted to ask you about that. Because I'm sure a lot of us think, well, if we have colon surgery, that just means we're going to have to have a colostomy bag. But it sounds to me like you work hard to put folks back together, so to speak, so they don't have to have a bag.

Dr. Yaphet Tilahun: Correct. And I think most of the time as colorectal surgeons, we see majority of our patients it's actually to reverse bags that potentially needed to be placed in an emergency situation. But from the colorectal perspective, our profession, one of the goals is to reduce the number of bags that patients are getting overall. So, we do our best to minimize that risk as much as possible.

Host: Right. Yeah, speaking of risks, let's talk about maybe the risks, potential complications that patients need to be aware of.

Dr. Yaphet Tilahun: Overall, the risk of the operation is small, but it is major surgery, and having a part of the colon removed comes with its own risks. The big major one we worry about is where we put the colon back together, if it has any issues. Where we put it back together is called the anastomosis.

And the worry is always, is there a problem with the connection site? Is there a leak? And so, we check it in multiple different ways to make sure the connection is intact and safe. And then, after surgery, we monitor our patients to make sure that it's healing appropriately and that there's no issues afterwards.

Host: I'm thinking, doctor, is there a way to prepare for surgery? I know how you might prepare for surgery, but for the rest of us, physically, mentally, like, would it help to lose some weight beforehand if we have that kind of time? Like, what could we do to help ourselves?

Dr. Yaphet Tilahun: If the indication for surgery is, you know, if we don't have to rush the surgery, for example, in a few weeks, then yeah, I think losing weight always helps. But if, for example, we have to go to surgery for the unfortunate situation, for example, if cancer is involved, in those situations, the best thing I usually tell my patients is do your best to stay physically fit as possible.

And I don't expect them to go to the gym and do heavy lifting and working out, but, you know, just staying active in the form of walking, proper hydration so that their body's not dehydrated coming into any operation. And I think depending on the indication, mental health is a huge component. Stress can play a huge role in terms of how you recover after surgery. And so, you know, an individual or a person is a person of faith, I always encourage them to find some form of peaceful place to be in preparation as well. Not that something bad would go on, but so that they're not worrying to a point where the stress itself may affect how they recover and going to surgery itself.

So, I think, it's a very important thing, actually. I'm glad you brought it up. And it's something I usually have a conversation with most of my patients, especially for more of the serious stuff like cancer.

Host: Yeah. You know, the physical stuff seems so obvious. But as you say, like the mental part of it, the stress that folks might be under heading into surgery, none of that is going to help, of course, especially with recovery. So, great advice from an expert today. Let me get a sense from you, Doctor, like how long does recovery take? Folks want to get back to golf and pickleball and whatever else they do, right? So, how long is recovery?

Dr. Yaphet Tilahun: So, you know, the beauty with, robotic surgery or laparoscopy is that recovery is much more simpler and straightforward. And so because incisions are smaller, we get you back on your feet faster. So for my golf players, I always tell them this is a great time to work on your short game. You know, I usually say anywhere from six to eight weeks before you can take a big swing.

But if you wanted to go, work on your short game, you can slowly start to go back within two to three weeks. But most of the time, most of my patients, you know, the day after surgery, I want you up walking in the hallway. I joke with most of my patients, please don't vacuum, but don't ask for water, because we want you to be up and about. And for the most part, initially you'll feel tired, but the energy starts to slowly come back over several weeks after surgery.

Host: Right. Yeah, it also makes me wonder when we think about after surgery, you know, recovery, if you will, you know, how surgery might affect diet, bowel habits, just quality of life in general. I'm assuming it's going to improve that, but from you?

Dr. Yaphet Tilahun: It depends on what segment of the colon we remove. Certain parts of the colon when we remove it, the bowel function can be quite different, and it becomes an adjustment. And my job after surgery is to understand what your bowel movements are like and to help you find a solution that fits your lifestyle and works for you.

But that's something we talk about as well before surgery, but a lot of times we won't know how the functionality is until afterwards. But it's a very important thing that you brought up because I think sometimes depending on what the focus is and why we're doing the surgery, we don't discuss it upfront, but it's an important thing to keep in mind.

Scott Webb: Well, you know, Doctor, we've covered a lot today and we've done a couple podcasts together. Just give you a chance here at the end. I don't know if you want to file this under myth-busting or not, but what do you wish more people understood about colon surgery?

Dr. Yaphet Tilahun: And I think it kind of touches base on what you said earlier. I think a lot of times when people hear colon surgery, they automatically assume that they're going to have to have a bag. And so, they don't even wanna come in to have a conversation. And I think there was a time period where that was the case, but it's not anymore.

The majority of colon surgery now is done with small incisions, and we're able to reconnect everything afterwards. And I think in that sense, I want to bestow your audience with confidence in coming in to talk to us, in knowing that that's not always the end result that they should expect.

Host: Right. Well, I appreciate your time and your expertise. Great having you on. Great to meet you and learn more about you and your approach to care. Thanks so much.

Dr. Yaphet Tilahun: Absolutely. Thank you for having me. This was great. Appreciate it.

Host: And to our listeners, if you're facing colon surgery, we hope this episode gives you confidence and clarity. You're not alone. We have incredible surgeons and teams ready to support you every step of the way. If you have a concern you'd like to schedule an appointment with Dr. Tilahun or a primary care provider, visit hf.org/findadoc.

And if you enjoyed this episode, please be sure to tell a friend, share on social media, and check out our entire podcast library. We look forward to you joining us again.