Riverside Healthcare puts the health and wellness information you need well within reach.

Terry Streetman (Host): Hello, listeners. Thanks for tuning in to the Well Within Reach podcast, brought to you by Riverside Healthcare. I'm your host, Terry Streetman. And joining me today is Dr. Steven Groene, a general surgeon here at Riverside. He's here to discuss colonoscopies and address some of the most common questions that patients have. Thanks for joining us, Dr. Groene.

Dr. Steven Groene: Thank you for having me, Terry, and thank you for allowing me to come talk about something that's so important, colon cancer screening and colonoscopies.

Host: Absolutely, yeah. We want to make sure we get this information out there, because this is a procedure that I think there's a lot of misunderstanding and maybe apprehension about. So, before we get into all that, can you give our listeners a quick reminder of your role and background?

Dr. Steven Groene: Sure. So again, Dr. Steven Groene, I'm a general and trauma surgeon at Riverside. I've been here about five years. I lived, born, and raised in Kansas, worked there for a few years and then, again, for about the last five years, my wife and I have been here in the Kankakee area working at Riverside and having a good time.

Host: Awesome. Well, we're glad to have you here, and especially here in the studio. We'll start with the basics. Can you explain what a colonoscopy is, what that process is, and what is it that you're looking for?

Dr. Steven Groene: Sure. So, a colonoscopy is, first, an outpatient procedure, which means you come in, you have the procedure, you go home the same day. It is under a little bit of sedation, so anesthesia helps us to keep you nice and comfortable through the whole procedure so you don't remember anything, you don't feel anything. But really, what it is is it's a flexible scope that we use to look at the inner lining of the intestine, namely the large intestine or the colon, and that inner lining, it's called the mucosa.

Those cells are the cells that unfortunately can get mutations that can then become polyps or lesions and, over time, those could potentially become cancerous. And so, what our goal with a colonoscopy, first, hopefully to find absolutely nothing. That's our number one goal. But if we do find anything, our goal is to try to find those polyps or lesions when they're really tiny, really small. They're non-cancerous, so we can get them removed so they do not become a cancer in the future.

Host: Okay. Well, that's great. And I can speak from experience, the sedation is great, and I remember nothing about the process. So, what factors then can increase your risk of colon cancer and might make somebody more likely to want to get this done right away?

Dr. Steven Groene: Sure. That's an outstanding question. First, I just want to bring up just a little bit about colon cancer. It's actually the third most common cancer type in the United States for both men and women. About 160,000 people a year in the United States are diagnosed with colon cancer. In the world, about two million a year.

So again, this is something that's quite prevalent, unfortunately. When we talk about risk factors, it comes in two main groups. One are the people who have genetic predispositions. They have known mutations that put them at a very high risk. That's about 5% to 10% of the population that gets colon cancer. There are two main types. There's one, it's called familial adenomatous polyposis, or FAP. Unfortunately, in those patients, they just make so many polyps over their lifetime that sooner or later, one of those basically will become a cancer, no matter what you do.

The other one is actually on the exact opposite spectrum. It's called hereditary nonpolyposis syndrome. So, those patients are people who have a mutation. They don't make many polyps. But unfortunately, when they do, they're very, very aggressive polyps that become cancer. So again, that's 5% to 10% of people who are diagnosed with colon cancer that have that very specific situation.

For the majority of people, they have what we call spontaneous colon cancer. There are many things that do put you at a higher risk. One is diet. We know that diets high in red meats or processed foods put you at a higher risk. We believe it probably creates a chronic inflammatory reaction in the gut that puts you at that risk.

There's also obesity and just not being as active. I think it kind of all goes into the same just chronic inflammation. And most of these things we talk about, that's really what it comes down to, are things that create this chronic inflammatory state in your body. Alcohol use, significant alcohol use, tobacco, cigarette use.

If you've had a personal history of colon polyps, so if on previous colon cancers you've had a polyp, that could or can increase your risk. But that's kind of depends on what kind of polyps you've had. There are certain ones that are a little more aggressive, certain sizes. So if you've had one over a centimeter, that puts you at a little bit of a higher risk that at some point you might get another polyp that's cancerous.

Family history, even if you don't have one of those known genetic variations, we do know if you have a first-degree relative, that means a parent, A sibling or a child that has colon cancer, that puts you at a higher risk. Being over the age of 50 puts you at a higher risk. And then, lastly, something called inflammatory bowel disease, also known as Crohn's disease or ulcerative colitis. That's an autoimmune disease that you get where your body unfortunately essentially attacks its own gut, and those types of things put you, again, at a higher risk for colon cancer, especially that ulcerative colitis.

Host: Okay. So yeah, a lot of things people should be aware of and, you know, discuss this with their provider. In addition to these risk factors then, what are some warning signs or symptoms that if people notice these things, they should then go to their provider?

Dr. Steven Groene: Most of these I think are fairly straightforward, common sense things that people really know about. One of the main ones is blood in their stools. Now, we're not talking about when you wipe occasionally, you might see a little blood on the toilet paper, and then the next day it's gone. We're talking about a persistent, consistent blood in your stools, especially if it's in the toilet itself or on the bowel movements themselves. Those are things that are very, very concerning to us, especially again if they're consistent and persistent. That can be bright red blood. That can be kind of a dark tarry-looking stool. That can be maroon-looking stools with clots in them. So, those things kind of gear us towards concerns. Weight loss, unintentional weight loss, if you've lost 10, 20, 30 pounds over a few months and you weren't trying to lose that amount of weight, that's something that kind of spikes our concern or interest.

Changes in your bowel habits that are, again, persistent. So for example, if you were someone who had a bowel movement every day, and now for the last six months you've only had a bowel movement once a week, you start having more gassy pain or bloating, those kind of sensations. Again, we all have them from time to time. But again, if it's something that's persistent and different for you, we pay attention to those things. And then, if you just feel weak and fatigued all of the time, again, we all have those moments. But if you're someone who's been active, and then all of a sudden for six months, you just never have the energy to do anything like you used to, and especially if that's paired with some labs. So, one of the main labs we look at is what we call hemoglobin or hematocrit. Those are things that look at the amount of blood you have in your body. And if those are low, the fancy term is anemia, those things, if you put that along with all these other symptoms, that really makes us nervous that you may have something really insidious going on and things that might suggest you have colon cancer.

Host: Okay. You mentioned in there in the risk factors, folks over 50 have a higher risk. Is there a particular age at which people should start looking at, like, "Oh, I should go get a colonoscopy"?

Dr. Steven Groene: So actually, the new age is 45.

Host: Okay.

Dr. Steven Groene: This changed about seven years ago. It used to be 50. Unfortunately, the newest data suggests that while, again, this is still someone who is usually older that gets it, the prevalence and incidence in people under the age of 50 is actually rising. And so, our new criteria for starting colon cancer screening and colonoscopy screening is at 45. Then, we recommend doing routine screening until the age of 75. At that time, then it comes to each person individually whether or not the pros or cons are in favor of continuing with colonoscopy or screening tests. There's only two real caveats to that. Number one is if you did have a family history of colon cancer in a first-degree relative that's under the age of 55 when they were diagnosed. So for example, if your father was diagnosed at the age of 50 with colon cancer, we would recommend you start at 40.

The other one, again, are those patients with the known genetic predispositions, namely the FAP. They start growing polyps very young, and so we recommend they start around the mid-teens, the late teens to early 20s for screening.

Host: Okay. Before we get into our additional questions here, we're going to take a moment to discuss the importance of primary care.

At Riverside, our primary care providers are right here in your community, offering personalized care for you and your family, close to home and connected to the specialists and services you may need.

Having a primary care provider means having someone who knows you, listens to you, and helps you stay well through every stage of life, from annual checkups and preventative screenings to managing everyday concerns when they pop up, because remarkable care should never be out of reach. Remarkable care right where you live.

To find a primary care provider who's right for you and your family, visit myrhc.net/acceptingnew.

Okay. We'll jump back into our questions. We're going to do—it doesn't have to be a speed round, but we're going to hit some of the most frequently asked questions that we get. So, I think the big one people always ask about is the colonoscopy prep. It's got kind of mythical status around it. What tips do you have? What can you do to help people sort of understand and take some of that concern out of it?

Dr. Steven Groene: The first part of the prep that I always want to preface to patients and really allow them to understand is that there is a necessary evil behind it. We're not just doing it to be mean or malicious. But truly, we really need to get as much of the stool and poop out of your colon as we can. Most polyps, when you have them, they're very small, usually just a couple of millimeters. And to think about that, if you take the end of a pen, that's usually, honestly, about the size of most polyps. And so, if you still have a fair amount of stool in your colon, we might miss a small little polyp while it's still very small and benign, and over time that could become a problem. And so, there is a reason behind it.

A few other things I like to discuss with patients is to do what they can to complete the prep. Most preps are a lot of liquid over a very short amount of time that you're trying to drink it, and that is hard for a lot of people. It's just so much volume. Some people get sick, some people vomit.

What I always recommend and offer to those patients when they call in is just to go slow. It's much better to finish your prep, even if that means it takes a few more hours than what our instructions tell you, because our instructions are like, "Do this in this amount of time." But I'd much rather you slow down and finish the prep in a time that you can get it done. That's so much better than throwing up, stopping, and saying, "Oh, well, I couldn't tolerate it," and then showing up the next day and your prep is inadequate, and then we have to redo it anyway. So, just because we give you a timeframe. And if you can do it, great, but we'd much rather you get it done, even if that means a little more time.

Second thing I always recommend, if you can, try to take the day or at least the afternoon of the prep off. Everybody's a little different on when and how the prep really responds or how you respond to it, so if you can take that afternoon off, it's absolutely a good thing to do. We talked about how the prep has a lot of fluid in it. But remember, you're also having a lot of liquid-loose stools. And so, I know this next point might seem counterintuitive, but actually drink as much fluid as you can beyond just the prep. Again, I know it's a lot of fluid under a short amount of time. And a lot of people, they'll do that, and then they're done with the prep. They don't drink anything else. They just kind of let it be. Actually, if you can drink some fluid, again, it doesn't have to be a lot, but that actually helps with nausea. That helps with the dehydration that could be the next day. So again, if you can drink a little extra beyond just what we recommend with the prep, that helps you.

And then, lastly, know there are different types of preps out there. Some are the pre-made preps that people utilize. In our office, we all use over-the-counter medications that you buy and then you kind of mix together. So if you had a colonoscopy in the past and you had a prep in the past that you just hated or you didn't tolerate well, know there are options out there and alternatives out there that you might be more appropriate for you in making you feel better.

Host: Okay. Yeah, that's super helpful to know. A lot of that I wasn't aware of. I'll throw in my personal plug, too. Lime Jell-O saved my life during my lead-up to mine when I couldn't eat certain dyes and solids. So, great. So our next question then, how long does a colonoscopy take?

Dr. Steven Groene: On average, it's about 20 to 30-minute procedure. Do know that we have you come in about an hour before the procedure. You're in recovery about 20 to 30 minutes after the procedure. But in general, about 20 to 30 minutes. So two hours in the hospital, 20 to 30 minutes for a procedure. Although, again, it depends on what we find. I have had a couple that took an hour and a half. They just had a lot of polyps, or they had some challenging polyps. But again, on average, about a 20 to 30-minute procedure.

Host: Okay. Another question that we see crop up a lot is do women need a colonoscopy?

Dr. Steven Groene: Absolutely. As discussed previously, it's the third most common type of cancer for both men and women in the United States. And so, absolutely, women should get colonoscopies.

Host: Okay. And so if people are looking for these colonoscopies, here's another question that we get that I didn't provide earlier, but can you have that done in-house at Riverside? I think there's a perception that you have to go outside of Riverside to get one done, but you can provide that, right?

Dr. Steven Groene: Absolutely. Myself, all of my partners, we all do colonoscopies, absolutely. So, we're more than happy and capable to do that.

Host: Awesome. We love to have people come here and be within that Riverside myChart system. That keeps everything nice and orderly.

Dr. Steven Groene: Yes, it does.

Host: Okay. So, we're getting toward the end here. We've got a couple more. If you are high risk or you notice signs or symptoms, what should you do?

Dr. Steven Groene: The most important thing I would tell patients, talk to your primary care physician. You are obviously welcome to call our office directly at 815-933-2221. That's fine. But again, I think talking to your primary care physician is the best option. They're your hub for all of your medical needs and issues that you may or may not have. And so, having that focus or that point person to be kind of the hub of all of that is the best thing to do. And then, once you've talked to them, they can absolutely get ahold of us, and we're more than happy to then see you and get you scheduled for the colonoscopy.

Host: Awesome. Well, we're down to the last question. This one I always love to ask. What is the biggest thing that listeners should take away from this episode?

Dr. Steven Groene: Yeah. So, I have two.

Host: That's great.

Dr. Steven Groene: I'll try to get it to one, but I have two. Number one, do something. That is my probably biggest of the two takeaways. What do I mean by that? I mean, again, colon cancer we know is the third most common. We also know that it has a pretty good survival rate if it's caught early. If you look at all-comers, 65% of people at five years are still alive. And obviously, the earlier it's caught, the better that is. And so, absolutely do something.

The data, in my absolute not humble opinion, is that a colonoscopy is the standard of care for colon cancer screening. It does the best job of finding polyps and lesions. Not only that, but it's also therapeutic, which means we can then remove those polyps and lesions so they don't become a cancer.

But I do understand that not everybody is going to have that drive to have a colonoscopy, so there are other options out there. There's something called a Cologuard test, also kind of colloquially well-known as the poop in a box. There's the FIT test, which is another DNA test, a guaiac test, which is probably the least best, but it's okay. Basically, it looks to see do you have blood or not in your stools. So again, do something. It's better to do something than nothing to get some sort of colorectal cancer screening done.

And the second thing is, again, I can only imagine how scary it might be if you do have some of those symptoms we started talking about earlier. If you start having blood in your stools, you start having weight loss, you start having changes in your bowel habits. Again, I can't imagine the fear that might be in you or the concern or the nervousness, but please, please, please talk to somebody. Again, ideally your primary doctor, but please talk to a doctor, talk to a family member, bring it up with somebody so that we can get you the proper care you need, because we all at Riverside, every physician, including us in the general surgery clinic, we're absolutely here to help you and provide the best care for you and your health that we can. So, please don't be afraid to talk to somebody about those concerning findings or symptoms you're having.

Host: I love that. Yeah. That's something I think we try to drive home a lot is, you know, the sooner you can get some of these things seen and detected, the better your outcomes will be. So, thank you for that.

So if our listeners would like to learn more about Riverside's surgical services, you can visit myrhc.net/surgery. Thank you so much for being here, Dr. Groene.

Dr. Steven Groene: Absolute pleasure.

Host: So, thank you listeners for tuning in to the Well Within Reach podcast with our guest, Dr. Steven Groene, and me, your host, Terry Streetman.

Be sure to like and subscribe to Well Within Reach on Apple, Spotify, or wherever you get your podcasts. To learn more about the services at Riverside Healthcare, visit riversidehealthcare.org.