Transcription:

Deborah Howell (Host): You know, more and more, we're all starting to realize that so many of our ailments begin in the gut. To talk about putting an emphasis on our gastrointestinal health, today, we'd like to welcome Johanna Taniguchi, a Gastrointestinal Care Provider here at Pullman Regional. Welcome Johanna. Or do you go by Jo?

Johanna Taniguchi, RN, ARNP (Guest): I go by Jo. That's fine. And it's nice to be here.

Host: Great. Now you're an Advanced Registered Nurse Practitioner with over 10 years of experience in the Gastroenterology field. What interests you about this particular field of medicine?

Jo: The GI system, the gastrointestinal system, just has a huge impact on general health. Let's face it, eating and elimination are what we all do every day. And if there's problems in those areas, it can have a big effect on our quality of life, even in the absence of a serious illness. Other diseases like diabetes, or if you've recently had a surgery, can have a huge impact on the functioning of the GI tract.

And it affects all ages from the young to the old. So, I enjoy getting to know my patients. Care needs to be tailored to their particular needs, their priorities. I kind of think of it as a fact finding mission. And discussing subjects that are sometimes embarrassing to talk about. You know, I just like doing that in a really matter of fact way, to make people comfortable, to really get to the bottom of what's going on.

Host: Sure. Now, what do you want your patients to know about you and what you can do for them?

Jo: You know, I started in gastroenterology as a medical assistant in my 20s. And then I got my registered nurse license. I worked in the endoscopy department where they do the colonoscopies and upper endoscopy's, many people are familiar with. So, when I got my graduate degree, it just made sense to stay where I was, to build on the knowledge I already had in that area.

I enjoy getting to know people personally, talking about what their priorities are. I've worked with a number of great physicians who've helped build my knowledge in this area and I've had a colonoscopy myself. So, one advantage of getting older.

Host: There you have it. You can speak from experience. Now, when would someone seek out Gastroenterology services?

Jo: So, certain symptoms always require an evaluation. Black or bloody bowel movements, suddenly losing 20 pounds without meaning to. Most of us would like to have that happen, but we don't actually like that to happen. A distinct change in your elimination habits, like new constipation or diarrhea or repeated vomiting, that's just a given, you need to get a GI evaluation.

But any symptom that your primary care doctor has been treating that relates to the GI tract that isn't getting better with the medications they've prescribed or the lifestyle changes they've recommended, you should see a GI doctor. Some of the most common things we see are persistent abdominal pain, complaints of bloating, heartburn, nausea, diarrhea, constipation. Those are the things we see frequently in the GI department.

Host: And why is it so important to place a focus on gastrointestinal health?

Jo: So, colon cancer is the third most common cancer in the United States. And it's the second leading cause of cancer death in the United States. And most often, these cases are preventable if you have screening. So, we tend to think of gastroenterology as the area where you screen for colon cancer. And I think that is one of our number one focuses in GI.

The screening age for first colonoscopy has been reduced to age 45 in the last year for those who have no additional risk factors, no family history of colon cancer. This has changed, has taken place because we're seeing more cancer in those under the age of 50. Now this could be due to better screening, but the data seems to show that even taking that into account, the rates have gone up so, screening for colon cancer is done ideally with colonoscopy, which is a prevention test. We're looking for things in the colon that we know could become cancer in the future.

And then for some, we do stool testing, and determining the right type of screening for you is something that in the Gastroenterology Department we're used to having, make those determinations and to have those discussions with patients.

Host: Got it. Now let's talk about some of the easy lifestyle changes we can make to improve our gastrointestinal health.

Jo: First thing that came to mind is fiber, fiber and fiber. Most of us do not eat enough dietary fiber. Recommendations for adults are to eat 20 to 30 grams of fiber a day and many require more. Fiber has been shown to reduce the risk of colon cancer, as well as improve conditions like diverticulitis and irritable bowel syndrome. Just to give you some examples, one slice of wheat bread has two grams of fiber. One cup of oatmeal has five. One cup of black beans or lentils have 15 grams of fiber. So, there's a wide variety of foods we can include in our diet to try and increase it. And fiber is the best way to improve the function of the colon.

It helps it do what it's supposed to do. If you don't get enough fiber, or even if you are eating a high fiber diet and not getting the results you want, adding a fiber supplement can be very helpful. Metamucil, psyllium, Benefiber, type fiber supplements often make a big difference.

Host: Now you mentioned bread, wheat bread. People listening might think, oh, then I'll just have English muffins, but it's not the same, is it?

Jo: It's not the same. We're talking whole grains and it's very easy to look up online, a list of high fiber foods. And they'll tell you exactly how many grams are in them. I pass those handouts out to people all the time that I see them in the clinic. Just to give you an idea, okay, I tend to eat these foods. How much am I really getting in my diet?

Host: Right. Now you mentioned other lifestyle changes. Maybe exercise comes into play?

Jo: Absolutely. When you move your body, you move your colon and it helps everything work better. Those who've had long illnesses where they've had to be bedridden for a time or after surgery, when you haven't been able to move, most people will notice a change in their bowel habits and getting up and moving again. Their bowel function is one of the reasons as nurses, we get you up after surgery and get you moving.

Host: Okay. And then I tell you what, you know, a lot of people have been switching including myself this year to almond milk from regular milk. And it's made a difference. I have to say.

Jo: So, lactose intolerance increases with age. There are certain ethnic groups that have much higher incidence of lactose intolerance. Those of African descent, those of Hispanic descent, those of Asian descent, and that's just a genetic predisposition, but most of us will not metabolize that carbohydrate, the lactose, as well as we age. It's a very large molecule. It has to be broken down by the gut and we're just not as good at that as we age. Can cause bloating, can cause gas, can cause diarrhea. So, that's one of the first foods I will eliminate from somebody's diet, if they're having uncomfortable symptoms.

Host: I tell you what it all comes down to we are what we eat, as mom used to say. And every, every bit of our health kind of begins in our gut. Is that correct?

Jo: We know the gut, the microbiome, that wealth of healthy bacteria in the colon have a huge impact on our wellbeing. There are new studies showing it can even affect levels of depression. We don't have studies that really quantify exactly what all those effects are. But anecdotally, we certainly know they impact many areas of life, not just our eating and elimination.

Host: All right, Jo, anything else you'd like to add to our conversation today?

Jo: I think there are a large variety of symptoms we attribute to the GI tract. Severity of those symptoms, how much they affect our life, doesn't necessarily correlate with a severe disease, but it really takes a good GI evaluation to determine that. So, if you're not feeling good, come in and talk to somebody.

Host: Do you need a referral?

Jo: Most insurance companies require referrals to specialists. Yes, but not all. And that's unique to your particular plan.

Host: Okay. So just check with your primary care physician.

Jo: Check with your primary care physician. And they're usually very willing to refer on if you're not improving with the interventions they've recommend.

Host: And how often should we get a colonoscopy after 45?

Jo: Colonoscopies are repeated based on the findings from the first colonoscopy and your family history. So, those who have a family history of colon cancer in a parent or sibling under the age of 50 need early and more frequent screening. Aside from that, if you have average risk, colonoscopy is done every 10 years if you have no polyps removed from your colon. Polyps are those things that we take out because we know over time, they can develop into cancer. If you have polyps, the frequency of colonoscopy could be reduced to three or five or seven years, depending on the type of polyp and how many you have.

Host: Well, Johanna, we so appreciate your time and everything you do to help our wonderful patients. Thanks so much for being with us today.

Jo: Thanks for having me.

Host: And you can learn more about this subject, providers and services at Pullman Regional Hospital online at pullmanregional.org/generalsurgery. This has been The Health Podcast from Pullman Regional. I'm your host, Deborah Howell. Thanks for listening and have yourself a terrific day.