Host: Hi, everyone. Thank you so much for joining us for this latest episode of Medically Speaking. Our special guest today is Beth Harvey, who is a colorectal surgeon for Kaleida Health. Thank you so much for being here.

Bethany Harvey, MD: Thanks for having me.

Host: It is an incredibly important topic when we talk about colorectal cancer for so many reasons. Before we jump into that, what made you decide to go into that particular specialty?

Bethany Harvey, MD: So, this is a question I get quite frequently from patients, is why would you want to do surgery or be a doctor for this part of the body, which is sometimes uncomfortable for people to talk about.

Host: Sure.

Bethany Harvey, MD: And I think that it's probably one of the best specialties because you're helping patients who do have cancer. You're able to help patients through a variety of different surgical techniques. You can use robotic surgery, minimally invasive surgery. You can do open surgery and you can do colonoscopies and other procedures that are more minor for patients, and try and get patients cured of their cancer without a surgery.

Host: Yeah. Let's talk about when it comes to colorectal cancer, what is the number one question that you wish patients would ask their doctors, whether it's you or preferably even before they would have to get to a point where they would need to see you for surgery?

Bethany Harvey, MD: Yeah. I think that one of the most important questions that patients can ask about colon cancer is what can I do to prevent this or decrease my risk of colon cancer? Because having a conversation with your doctor about that is really important so that you can learn about colonoscopy, what's involved, kind of dispel some of the myths that you might have out there, that you've heard from friends or, you know, from other people that you may come in contact with.

Host: Risk factors.

Bethany Harvey, MD: Right, exactly. Risk factors as well. So, things that would increase your risk or make you have a higher index of suspicion or reason to think that you may need to get checked out.

Host: Yeah. Let's just put it out there. People don't want to talk about—you said it—people don't want to talk about this part of the body. Nobody wants to have a colonoscopy. Nobody wants to talk about, you know, colorectal cancer. But it is so important that we do talk about it. I keep hearing in the news that there are higher rates among younger people, which to me is terrifying. But do we know the reasoning behind that?

Bethany Harvey, MD: So unfortunately, we really can't point to one thing right now and say that's the reason that people younger and younger are getting diagnosed with colon cancer, it's looking with the more research that we have that it's probably a combination of things, a combination of diet, a combination of changes that people are experiencing now younger, but it's really hard to say. So, that's why it's so important to pay attention to your body. Make sure you're listening, notice when things change. And talk to your doctor right away to see if something like a colonoscopy or other screening would be helpful for you.

Host: And not be afraid to talk about those things. I always say, you know, it beats the alternative, right?

Bethany Harvey, MD: Exactly.

Host: Being preventative, talking about it, knowing your risk factors versus potentially being diagnosed or, you know, having it progress to a later stage of the disease. We talk about some of the risk factors. What are some of the things that we should be mindful of, old or young, that could put us at a higher risk?

Bethany Harvey, MD: Yeah. So first of all, family history is always important. So talking to your family, aunts, uncles, parents, "Hey, have you gotten your colonoscopy? Do you have a history of having polyps when you go for your colonoscopy? Because having parents or close relatives with a history of polyps is an indication for you to get screened a little bit more frequently as well.

Host: And speaking of polyps, if you go and you get the colonoscopy, that's something that oftentimes you can take care of right then and there, right, to minimize that risk.

Bethany Harvey, MD: Yeah. So, that's one of the great things about colonoscopies, is that a lot of tests that we have out available right now that are screening for cancer, they can tell you yes or no, you have cancer. Whereas colonoscopies can find things before they turn into cancer, take them out of your body entirely so it eliminates the risk of that becoming a cancer.

Host: Is that why they say colon cancer is one of the most preventable, or the most treatable In that sense, because you can get ahead of the curve?

Bethany Harvey, MD: Exactly. You can prevent something from turning into a cancer by getting a colonoscopy and taking those polyps out.

Host: What about things like our diet, you know, obesity, weight, drinking, smoking? How do those play a role in the potential for being diagnosed with colon cancer?

Bethany Harvey, MD: Yeah. So, there's a lot of research right now into diet changes and changes within the microbiome of your colon. So, the different bacteria that live there, they're looking into which bacteria might increase your risk of cancer. Also, obesity, smoking, drinking, all of those things always increase your risks of cancer all around. So, anything that you can take care of to try and control those risks are something that I find is really empowering to patients, to say like, you can control this. You can decrease your risk by stopping smoking, cutting back your drinking and working on healthy eating habits.

Host: Yeah, I always hear about we need more fiber. We need more fiber. How big of a role does more fiber, a high fiber diet play when it comes to colorectal cancer?

Bethany Harvey, MD: So, the thought is behind fiber is it helps you continue to have your stool passing through your colon. It's not sitting there kind of affecting your tissues. And so, while there's not a direct link between fiber decreasing the risk of cancer, it helps promote gut motility, which is thought to help increase your gut health overall.

Host: Yeah. Again, genetics. Let's touch on that a little bit more. You and I were talking a little bit, my mom died of colon cancer when she was 58. And I think one of the scarier things, shocking things is her doctors—it was discovered very late. And they said that by the time they discovered it, she may have been sick for eight to 10 years without us even knowing it.

And I'm trying to replay in my mind, you know, were there warning signs? And I feel like there were things that she had mentioned that she maybe just played off a little bit, you know, busy mom, single mom. You know, it's just a stomach ache or, you know, it's just an upset stomach and that sort of thing. How do you balance, I guess, being a hypochondriac, but taking those symptoms seriously and maybe finding somewhere where you meet in the middle that it doesn't go undetected for almost a decade?

Bethany Harvey, MD: Yeah. So, that is a really hard thing with colon cancer because, a lot of times, it grows slowly over time. So, things like new constipation that just doesn't seem to go away or, you know, you're constantly feeling bloated when you haven't felt like that before; dark-colored stool, you notice your stool is a little bit dark or black colored, and that's unusual for you; thinner stool. All of those things are indications that you need to get checked out by your doctor.

Host: So, what would be your next steps if you notice some of those things? Who do you call? Is it your primary care? At what point would you and your team get involved? Obviously, on the surgery, but is there a sort of a middle ground there of a specialist?

Bethany Harvey, MD: Yeah. So usually, I always tell people to go to their primary first. They know you the best. They're kind of checking in with you most frequently. Then, you'll usually be referred for a colonoscopy. So, that's either with ourselves, the colorectal surgeons, or the gastroenterologist. And that really gives us a clear picture of everything going on inside of the colon. And that'll be able to tell us if there's a polyp there, something that looks like a little bit more advanced polyp, or if it's concerning for cancer. We'll be able to take samples of that lesion right away. And then, you would get referred to myself for colorectal surgery for further discussions at that point.

Host: Let's talk about colonoscopy again. People don't want to talk about it, you know, it's not your favorite pastime. Nobody really wants to do it. But again, I always talk about the alternative. It's a little bit of discomfort or embarrassment when you're talking about the prep. But it could improve your outcome down the line, catch something before it turns into cancer. Really considered the gold standard. When it you hear about some of the other tests and things that you can do, how do those other ones stack up to a colonoscopy?

Bethany Harvey, MD: So, there's several different tests now that can be used as alternatives for colonoscopy. And I say that in light of if the patient is unable to get a colonoscopy for any reason. So, there's something that we see commercials for all the time, the Cologuard, the box that has a stool sample. It looks for blood in the stool, and also DNA markers for advanced polyps.

The caveat with that is if you've ever had a polyp before, if you have a family history of cancer or polyps, you don't qualify for that, because you are at higher risk and need a colonoscopy.

Host: Sure.

Bethany Harvey, MD: If you have a positive Cologuard test at any point, then you're off of that path and going with colonoscopies. And there is a fairly high false positive and false negative rate. False negative is a scary one to me. About 13% of the time, you can get a negative test saying you're okay, when you actually have something going on in there that needs to be looked at further.

Host: So again, colonoscopy, the gold standard. People are always like, "Ugh, it doesn't sound fun." Again, it's probably not fun, but it's really not as bad as people think. And I feel like the prep has gotten better as well in terms of drinking the high volumes of liquid. Talk about how that has changed. I've had a couple because of family history over, you know, the past probably 10 years or so, much earlier than the recommended screening because of that, but just trying to stay vigilant. And I feel like it's gotten better from the first one to the second one.

Bethany Harvey, MD: Yeah. So, the prep has changed significantly, just even over, like you said, the past 10 years. A lot of people remember the prep is you get a giant jug of this salty water and you have to sit there all night drinking it. There are many, many alternatives. And that works just as well as that large volume prep that everyone used to get.

So now, we have MiraLax preps where you're drinking MiraLax, mixed with Gatorade for four hours.

Host: Smaller volumes.

Bethany Harvey, MD: Smaller volumes. You can use magnesium citrate, which is even smaller bottles. There's now pills as well that you can take. So, it's about six or eight pills that you drink with a lot of water, that some people prefer that. So, there's lots of options now that can really fit anyone's preference

Host: And talk about the importance of the prep and how that helps during the colonoscopy to get a better view of everything you need to look at and really making sure that you adhere to the prep.

Bethany Harvey, MD: Exactly. That is one of the most important things that I talk to all my patients about, is that this is going to be an unpleasant experience for about 12 hours or so before while you're drinking clear liquids, drinking the prep, cleaning everything out. But it's of utmost importance. Because if there's stool that's still in the colon, poop that we're not really able to see things, it makes it much easier to miss small polyps that could be pre-cancerous. And if you miss those and say, "Okay, everything's great. Come back in 10 years," 10 years could be enough time to have that polyp turn into cancer.

Host: Yeah. Let's talk about the screening. The recommended ages over the past couple of years, it has since been lowered. It used to be 50.

Bethany Harvey, MD: Correct.

Host: Yeah. Now, it's 45. And again, the reasoning behind that and the importance of people—you know, we hear about mammograms when you're 40, and I feel like people are so hypervigilant about, you know, going to the dentist and going to the OB-GYN. Colonoscopy, not always, you know, the top of their radar, but it should be.

Bethany Harvey, MD: Agreed. Yeah, it definitely should be. So, it has recently moved to 45. And I have inklings that in the next five years or so, we should probably be having it moved down again. I wouldn't be surprised because of all these young patients who are being diagnosed with cancer.

But right now, 45 is the age when we recommend everybody start getting colonoscopies. If you get your first colonoscopy done and it's normal, there is no polyps, then we say, if you have no other risk factors, we'll see you in 10 years, which is great news.

Host: Exactly.

Bethany Harvey, MD: You get that clean Bill of Health and you can take that off your mind and have one thing that you do once every 10 years, you get a good nap with the sedation and not too bad.

Host: And then, you have a great meal the next day, because don't get to eat during the prep. Honestly, that was, for me, probably the worst part, because I was like, "Oh, I'm a little hungry." But other than that, it's really not—I can promise you, it's not that bad. It is not that bad. And again, consider the alternative. And if you can take that 12 hours or that 24 hours to really put yourself in a really good position to stay on top of your health, why not do it, right?

Bethany Harvey, MD: Yeah. Think about those 12 hours, for the next five, 10 years, you don't need to do it again. If you get a good prep the first time and you really commit to making sure that you're all the way cleaned out, not trying to, "Oh, well, I'll just sneak like a half a granola bar," because you can see all of that during the colonoscopy.

Host: We want a nice clean slate so that doctors, you know, can get a good look. We talked about some of the warning signs, other things that people might dismiss that could be an indicator or at least a signal for you to reach out to your doctor to make sure it's nothing bigger.

Bethany Harvey, MD: Yeah. So, another thing that I'm hearing frequently, especially from younger people is that, "Oh, you know, I've had constipation on and off for my whole life. Sometimes I'd have some bleeding from hemorrhoids." So when they see that happening together, they don't think very much of it, but that is an indication that you should come and at least talk to your primary care; if not, get checked out further with a colonoscopy, because those are typically the symptoms that I hear from patients, or I see them because they've been having bleeding from their hemorrhoids. And when I look, their hemorrhoids look okay. So, "Okay, where's this bleeding coming from?" We need to look a little bit deeper.

Host: What can you say to folks who are scared, embarrassed, don't want to talk about it? You know, it is your job, right? I'm making it my job to, again, to scream it from the rooftops and to make sure that everybody who has a family history or who is 45 or who hasn't gone yet, if you're older, to do these things. How do you convince them to go?

Bethany Harvey, MD: I think what helps the most is having my patients, who go through it, talk to their friends. Because I'll see them on the morning before the colonoscopy and they'll say, "You know, Doc, I thought it was going to be way worse than that. It really wasn't as bad as I thought."

And so, I use my patients as advocates to go out to their friends and the community and their churches to really let people know that the prep isn't this big bad thing, that it's something that you can do. And then, you can have the peace of mind after that you've been screened and you've been checked out, and you can put that to rest.

Host: I have volunteered to drive people home because you do need a driver, because obviously you're under the sedation. But I'm like, "Do not let that be an excuse. If you don't have a ride, I will take you." And then, they're like, "No, no, no. I'm just, you know, making excuses." And I'm like, "Okay, no more excuses. You need to go. And you need to do this."

If unfortunately somebody hears the words, "You have colon cancer," and it's not just a polyp that can be removed, if it turns out to be something more serious, what are the next steps? And how does Kaleida get involved in terms of their care?

Bethany Harvey, MD: Yeah. So, the next step is if they had a colonoscopy as a gastroenterologist, they would be referred to us, the colorectal surgeons. If myself or one of my partners did the colonoscopy, we would call the patient, have them come meet with us, and kind of lay out the plan. And what that would include is getting some imaging studies done, CT scans to take a look at the rest of the body, make sure the rest of the body looks okay, and that there's no signs that the cancer may have spread. I tell my patients, "Then, we're going to talk about you behind your back." And what that means is we have a multidisciplinary tumor board conference where I have myself as the surgeon, we have the oncologist, the radiologist, the pathologist, the radiation-oncologist, anybody who could be involved in the patient's care meet and talk about that patient and the specifics of their cancer.

Host: So, it really can be specialized and tailored. One person's diagnoses and their treatment might not look the same as somebody else.

Bethany Harvey, MD: Exactly. As the research progresses and we're getting new treatments for cancers, we're looking more at each individual's cancer rather than "This is how we treat colon cancer. Everybody who has a colon cancer gets X, Y, Z." We look at it very individualized and say, "What is unique about their cancer and how can we treat that most effectively?"

Host: You talked about the different options for surgery. We've come a long way too, especially with robotic surgery, minimally invasive. How has that changed the way you look at different cases, the way you treat people? But also, how does that help maybe preserve function so that you don't need a colostomy bag or, you know, so that somebody can go back to living the most normal life possible. Because I feel like that might be a fear for folks too, "What is my future going to look like?"

Bethany Harvey, MD: One hundred percent. Yeah. So, I spend a lot of time talking to patients, about what surgery looks like, what alternatives there are to surgery, and kind of what the steps will be after surgery. And so, a lot of that depends on where in the colon their cancer is, because that will dictate the type of surgery that we do.

Colon cancers that are closer to the end of the colon or the rectum sometimes require a temporary ostomy bag to help the connection that we make in the operating room become water-sealed tight before we let stool and water go through it again. So, just a temporary measure.

Host: For healing, basically.

Bethany Harvey, MD: For healing. Exactly. Sometimes, and most of the time, if it's in other parts of the colon, there's not a need for an ostomy at all. We're able to put the colon back together safely at the initial operation, a lot of times just through small incisions using the surgical robot. So, we'll be able to take out the cancer in a safe manner. And the patient will wake up from surgery, only have four little incisions, and sometimes be going home the next day from the hospital.

Host: Wow. Just four small incisions. That's incredible. Any other long-term side effects or what does life look like after treatment? I would imagine, much like the treatment itself, everybody's a little bit different.

Bethany Harvey, MD: Yeah, of course, everybody's a little bit different. But for the most part, and most colon cancers, patients, usually have no change in their function whatsoever. Initially, some people may have loose stools earlier or more diarrhea, more frequent bowel movements. But most of the time, people recover very well and go back to their normal bowel habits.

Host: Yeah. What does screening look like after a diagnosis? Are you going for colonoscopies more frequently or is there other imaging that you have to go through to stay on top of it?

Bethany Harvey, MD: Yeah. So once you've been diagnosed with colon cancer and you've been treated, had surgery, hopefully successfully, and any other therapy that you need, we always recommend a colonoscopy one year after the surgery. And then, you'll also be following with your oncologist for periodic scans, checking blood levels for markers of cancer. And other things like that, we spread the colonoscopies out a little bit every year until about five years or so, we will spread it out even longer than that.

Host: Yeah. But there are folks who perhaps were diagnosed, had surgery, and today are living perfectly healthy normal lives that you might not even know they had cancer at one point.

Bethany Harvey, MD: Yeah, I would say over 50%, if not the vast majority of people, you would never even know meeting them on the street.

Host: Yeah. We've been talking a lot recently about, you know, cancer care at Kaleida Health, why should somebody come to see our team for their care and specifically for colon cancer.

Bethany Harvey, MD: Yeah, I think that we have a great team approach set up here with our multidisciplinary team. So if you come to see me, I'm going to get you in to see our oncologist right away. Sometimes in the same building is where I'm seeing my patients. We'll tag team and see the patient in the same visit to really try and help streamline their care.

Host: And I would imagine with a diagnosis or potential diagnoses, you don't want to waste any time. But I'm thinking as a patient too, that's so nerve-wracking if you're waiting days or weeks for that next appointment. I feel like that does something for your peace of mind and for your healing and getting you on that healing journey, getting it done sooner.

Bethany Harvey, MD: Exactly. Yeah. And we have great connections with the imaging teams at Great Lakes, so we're able to get our patients in right away to reduce some of that anxiety that you're talking about. Because I've talked to many patients, who say, "Okay, you've dropped this diagnosis on me and I feel like I've got a time bomb sitting there.

Host: Yeah. Now what?

Bethany Harvey, MD: Now what? And so, we really do our best to keep both the patient engaged, get them moving through the system as quickly as possible, and reassuring them that all of their providers are just as engaged and concerned as they are.

Host: Yeah. And if there should be the need for any sort of emergent care, we also have those capabilities as well with Buff General and with Suburban. Again, it's sort of the holistic approach and we have all of these different resources, which is also really great.

Bethany Harvey, MD: That's true. We have the hospital systems and for the surgeries themselves and any emergencies that may arise. We also have patient navigators through Kaleida who are able, and social workers and nutritionists and all of the things that come with a cancer diagnosis that you may have questions about. We have all of those services within the Kaleida system built for the Kaleida Cancer Care Team.

Host: Yeah, we talked about a lot. Anything that we missed or anything else that you can say to sort of break the stigma when it comes to talking about that part of the body? Not a lot of people want to, but again, we are making you listen here today. And we're going to get more people talking about it, because it is so incredibly important. It's not just an old person disease. For many years, we thought it was just, you know, older folks that had to deal with colon cancer.

Bethany Harvey, MD: Yeah. I always tell my patients, I'm like, "You know what? Everybody poops, you got to pay attention to your poop. When you see something changing, that's when you got to tell one of your doctors and come see me. And that's what I do all day and every day. And there's nothing embarrassing about it. There's nothing I haven't heard before. So, the more we talk about it, the better.

Host: Yes. And the earlier you catch it, I mean, when you talk about early detection, I would say there's no better reason than being able to catch it before it turns into cancer, right?

Bethany Harvey, MD: Exactly. That's, as you said, one of the best things about these screening tests for colon cancer, is the colonoscopy. You catch it before it becomes a problem and you take it out. So, we eliminate that risk at that time for that patient.

Host: Thank you so much for all of your insight and all of your expertise. If you have any questions, you can reach out to her. If you need a ride, you can reach out to me.

Bethany Harvey, MD: Perfect team.

Host: Yeah, exactly, exactly. Again, we want people to talk about this. It is so incredibly important. Your work that you do is so important. You know, eventually, in a perfect world, no offense to you, but you would be out of a job because we would eradicate this.

Bethany Harvey, MD: That would be okay with me.

Host: Yeah, exactly. We can find something else for you to do, but we have a long way to go, I think, to get to that point. But again, terribly important information. Listen to your bodies, talk to your doctors. Save a life, and potentially save your own.

Bethany Harvey, MD: Exactly.

Host: Yeah. All right, Dr. Beth Harvey, who's a colorectal surgeon for Kaleida Health. Thank you so much for being here today. Thank you. We appreciate your time. And thank you for listening to this latest episode of Medically Speaking.