Neil Thornbury (Host): Welcome to Pulse and Perspectives where we dive into the latest innovations in healthcare and are making a real difference in the lives of our patients and communities. I'm your host, Neil Thornbury, CEO of TJ Regional. In today's episode, it's my pleasure to welcome Dr. Riggs, our gastroenterologist who leads this service for our health system.

Dr. Riggs brings both clinical expertise and a passion for advancing patient care in the area of liver health. Today he'll be walking us through an exciting tool that's transforming how we proactively assess liver disease, the FibroScan. So please join me in welcoming Dr. Riggs, this innovation and how it's improving diagnosis and guiding treatment plans for our patients.

So, hello, Dr. Riggs. How are you today?

Jeff Riggs, DO: I'm doing great. Thank you so much for this opportunity.

Host: Absolutely. Good. Good. Well, let's, just jump right in for the listeners. So for those that are unfamiliar, what exactly is a FibroScan and, how does it differ from traditional, assessments of the liver, biopsies, those type of things?

Jeff Riggs, DO: Well, the most important thing about the FibroScan is that it's noninvasive and there's no pain. So people don't like pain and it's a very quick and easy test. Takes about five minutes to do in the office, but yet it helps us to classify how hard the liver is and how much fat is present in the liver, and identify those patients who are at increased risk of developing cirrhosis.

Host: Excellent. And I would say I would probably be first in line for anything that's non-invasive. So along with many people. Let me ask you, who should consider getting a FibroScan? Or are there, if you will, are there warning signs or risk factors that people should watch for, to kind of identify whether I'm a candidate for this or whether I should get this type of assessment?

Jeff Riggs, DO: Yeah, there are several indications. If you have a history of Hepatitis B or Hepatitis C, that's one indication, but primarily we're using it a lot in those patients who have fatty liver disease. It's estimated that about 25% of people in the United States have what's called metabolic associated fatty liver disease.

 But if you can factor in the obesity epidemic, it's closer to 90 percent. And so the benefit of this test is identifying how much fat truly is in your liver. And not only that, but how stiff is your liver? If there's no cirrhosis, there are things we can do, whether it be through lifestyle modification or there's a medication we can use.

But once you have cirrhosis, there's not much we can offer you. In fact, fatty liver is becoming one of the number one reasons for liver transplants in the country.

Host: Wow. yeah. Pretty significant there. So, in relation to that, I come in, it's very non-invasive. It's about a five minute procedure or assessment and then how about the results coming back out of that, how quickly do I get my results and get on my treatment plan if I require that?

Jeff Riggs, DO: Well, the technician can give you the score on that day, and if they see me in the hallway, I can usually have the results for you immediately. Either myself or one of my team members, whether that be Bailey Knox, one of our nurse practitioners, or Tracy Anderson, all three of us can interpret that for them.

So we can usually give you the results on the same day that you have the test.

Host: So from there, is this something that, as a patient I can request myself? Do I need to go through my primary care provider, does my insurance cover it? Kind of questions like that.

Jeff Riggs, DO: Sure it is something that you can request, but we're pretty attuned to it right now. We're seeing a lot of fatty liver. And cirrhosis, unfortunately here in Barron County, and the surrounding community as well. So we're recommending this test on quite a few of our patients, but certainly if your doctor, especially if you're seeing your primary care doctor, you can certainly request that they have this FibroScan test and it can be ordered, in our office.

Host: Excellent. So, walking the patient through the entire process, I'm able to get into your clinic, FibroScan, very non-invasive. So it's an easy procedure, following up to there, trying to identify, if you will, stiffness and fatty liver disease, getting on a good treatment plan.

And just really, if you'll go a little bit more in depth of, and you kind of touched on this, and I think this is probably the most important thing, I would say to the listeners. Because if you're listening, this is important to you. And I just think the prevalence or the potential population that could really utilize this scan, if nothing else, just to rule it out. So give a little more detail around, who is out there, what's the population?

Jeff Riggs, DO: Yeah, it's projected that from 2015 to 2030, the incidence of this metabolic hepatitis, if you will, it will increase to 63% to 16.5 million patients. So obesity is not going away, unfortunately. Diabetes, hypertension, hyperlipidemia. These are all components of the metabolic liver disease.

I tell patients all the time, it's one thing if your ultrasound shows fatty liver, but if your ultrasound shows fatty liver and your liver labs are abnormal and you're obese, and you have diabetes and you have high blood pressure, and you have high cholesterol, then your risk of developing cirrhosis is markedly increased.

 And I use the analogy, we can do whatever we can up until you get cirrhosis. It's kinda like burning toast. Once you burn the toast. I can't go back and re-fix that. You just have to get a new piece of bread. And once you get cirrhosis. I can't fix that. Ultimately, you'll end up getting a new liver if you qualify for a liver transplant.

So we're trying to keep people from getting that, and an important tool is FibroScanning so that we can identify those patients early on when they have just fatty liver itself and not the significant inflammation. If we can identify that and be proactive in controlling their blood pressure, their cholesterol, and their blood glucose and weight loss, then we can prevent them developing cirrhosis and prevent the need for even consideration of a liver transplant. And so the FibroScan is a tool to help us identify those patients who would benefit from, proactive therapy.

Host: Now kind of on the other side of the equation, as I say, there is a group of people out there in our world where we really do look at, what's your family history? So let's just say I fall into a category where, I have a family history of this disease whether it be my parents or whomever, but I really don't have the symptoms. Is this something I would want to be proactive and do because it's in my history?

Jeff Riggs, DO: Yeah. Fatty liver in and of itself may not necessarily be a hereditary thing. It's the metabolic components that are hereditary, the diabetes, the high blood pressure, the high cholesterol, and the obesity itself. Those components all formulate the increased risk for developing fatty liver and which subsequently can lead to the hepatitis there and cirrhosis. So we're trying to combat the components of the fatty liver.

Host: Really kind of diving in just at a very basic level, can you explain a little bit of, what if I'll leave it unchecked. What if I've got fatty liver and I just I keep kind of postponing it. I don't do the necessary things to go out and be proactive. What are the outcomes?

Jeff Riggs, DO: It will rapidly progress from no fibrosis or scarring to cirrhosis, usually within a six year window if we don't do anything.

 So we're trying to be proactive to prevent that from happening. Over my 30 years of doing this, I've had several patients end up going to liver transplants.

I've had several people that we've been successful in preventing liver transplants. I've also had several patients who subsequently have expired from their liver disease because of fatty liver. So it is one of those things that, we all know what to do. We just don't always do it. And certainly if you're prone to have diabetes, then yes, we need to be proactive with controlling that blood sugar and with dietary modifications and the medications that are available.

 Weight loss, it's real easy to say, but very difficult to do. I encourage patients all the time, especially in the summer months, to lose weight in the summer because if I'm having this conversation with you in October, November, or Christmas, it's just not going to happen because it's realistic.

There's too many temptations, but if you can lose whatever weight you can lose in the summer; if you do gain over the holiday period, you're still ahead. But if you don't lose over the summer, then you're that much further behind. So there's just some practical things that we try to talk to the patients about.

And plus, obesity is a sensitive subject to a lot of people, so we try our very, very best to identify with our patients and empathize with them that we're not judging them because of obesity or because they have high blood pressure, high cholesterol, but it's a significant threat to their life that has some risk factors that can be modified just with lifestyle modifications and then certain medications.

There's a medicine called Rezdiffra that we can utilize to help decrease liver inflammation. But once you have cirrhosis, I can't use it.

Host: So what has been kind of the feedback from patients since we've put in the scan and we've started the process, what's some of the feedback just from the patient level?

Jeff Riggs, DO: Well, the fact that it's not an invasive and there's no pain, patients love it. From the staff standpoint, it's a very easy test to do. And then the patients, they just can't eat or drink anything for two to three hours before they come in. They lay on their back and then the technician takes over and does the test, and it, literally feels like, somebody has flicked you on the side with their finger.

There's no pain involved at all. And then once we have that information, then we can more intelligently tell them, Hey, this is the stage where your liver is. We need to be serious about what we're doing with your treatment. Or this is where we are. Your liver's a little bit more progressed and we need to figure out how we're going to go about treating that, whether or not they need referral, to the tertiary center for transplant evaluation, or whether or not it's something we can still handle here at TJ.

Host: Yeah, and I think, the listeners out there, if you're grasping one piece of this, it's really our encouragement is always going to be, be proactive with your health. And for this particular procedure and this particular scan, again, this is completely non-invasive. This is, as Dr. Riggs just described, something that is very easy, it's easy to get done.

The team can get you in and out and you can get this read and at least if nothing else, rule it out and be proactive because again, the other side of that is not being and hoping, and as we say in healthcare, hope is not a strategy. You've gotta be proactive with your health, and that's what we're here for.

So any last thoughts you have for the listeners and any particular message?

Jeff Riggs, DO: Well, I think the benefit of this test is not only that it's helpful to help guide our therapy, but it is a way of falling in line with what TJ Sampson's mission statement is to provide for that health and wellness of the community, in a respectful, compassionate, and convenient. We're right here in town and it's really easy to have done.

And, uh, we can take care of those liver needs here. We'd want to work with you to prevent you from getting to cirrhosis.

Host: Well, thank you Dr. Riggs. I would tell you that our health system, our communities, is very fortunate to have Dr. Riggs in this community, to have somebody of his expertise bringing, items and tools, just like the FibroScan that are being proactive to everyone's health.

 So in closing, I thank you for joining us on Pulse and Perspective. I would like to extend my sincere thank you to Dr. Riggs for joining us today and sharing your insight on the FibroScan. We're incredibly fortunate for this technology. To our listeners, if you have concerns about your liver health, or risk factors like obesity, diabetes, all of those that Dr. Riggs just spoke about, please reach out to your provider, and see if you are a fit for the FibroScan. Very noninvasive procedure. If this conversation resonates with you, please subscribe on your favorite podcast and share on social media. I'm Neil Thornbury urging you to keep your pulse on the future and your perspectives wide open.

Until next time, stay informed, stay proactive, and stay well. Thank you.