Darrell Rebouche (Host): When it comes to our health, we don't always talk about what's going on in our gut. Things like heartburn, bloating, abdominal pain, constipation and diarrhea. Well, we might just hope those problems go away in a day or so, and you probably do it too.

Welcome to Health on Point, presented by Willis-Knighton Health. I'm Darrell Rebouche. And today, we're going to talk about trusting our guts with a gastroenterologist and two very key people in his clinic. Dr. Sherif Michael joins us from Pinnacle Gastroenterology at Willis-Knighton Health, along with physician assistant Megan Johnson and nurse practitioner Krista Jarrett.

So, gastroenterology, Dr. Michael, it sounds like a big word for some people. And did I say that right? I mean, it's all about your gut and, I guess, somewhere between your throat and your thighs. What does a gastroenterologist do?

Dr. Sherif Michael: We try and keep it simple for people and just call it GI. And it encompasses anything from the mouth to the bottom. So, all the way through the entire digestive tract. And also includes the, liver and pancreas and biliary system. But yeah, your entire what we call the gut belongs to the GI.

Host: I guess I started a little bit low. So from the mouth to all the way down below, that sounds great. So, well, when should someone come to your clinic? I mean, what are the indications that, "Wow, I need to go see a GI doctor"?

Dr. Sherif Michael: That's a big question. I mean, you know, anybody could think of any kind of GI symptom. It could be anything from reflux to abdominal pain to change in bowel habits to bleeding. It's a pretty large gamut of GI symptoms that we specialize in.

Host: You have a partner, and then you also have the two advanced practice practitioners who are with us today, Krista and Megan. So, Megan, let's start with you. How does everyone in there work together? Dr. Michael, Dr. Ryan Palmer, his partner, and the two of you and everyone in your clinic, I mean, you guys all work together, and how do you guys work together to help the patients?

Megan Johnson: You have it right. We're a team for sure. So, the physicians are the ones that do the procedure, so that's something that they are, you know, specialized in. And those procedures would be an EGD or a colonoscopy. And so, Krista and I help facilitate that as far as we run the clinic, so we're in the clinic, morning and afternoon.

Both of our physicians are in the clinic afternoons as well, but mainly in the morning they're over, in the GI lab doing the procedures as far as whatever needs to be done for the patient per se. There's different reasons we do that, and we'll get to that soon. But so we help with clinic as far as ordering labs, ordering radiology tests, deciding maybe who needs to be having a procedure and who doesn't, doing follow-ups after those procedures, kind of tying up any loose ends, kind of managing from that perspective.

Host: And Krista, a nurse practitioner versus a physician assistant, there's some overlap, but there's some difference as well. Can you explain to people how the two of you work together?

Krista Jarrett: Yeah, we work well together just all as a team and, you know, we both just order tests and see patients, new patients, also see them in follow-up. But we pretty much do basically the same things and just all work together as a team as far as taking care of patients and diagnosing patients and ordering tests and medications that patients need for their GI issues.

Host: Dr. Michael, what are the most common complaints people come to your practice with? I think we laid them out at the beginning. Maybe I left something out, but what are you seeing most often?

Dr. Sherif Michael: Yeah. There are some that, you know, obviously are pretty common amongst everybody. Most of us, whenever we have issues, whether they're stressful life situations, stress, work-life, a lot of it kind of manifests right in the GI tract. So, some of the more common symptoms that we have are things like abdominal pain, change in bowel habits, heartburn, reflux, trouble swallowing. Of course, people always come and see us for standard colorectal cancer screening as well. So, you know, amongst the GI symptoms, those are probably the most common ones.

Host: And I think the most important one you mentioned is colorectal cancer screening, and we're certainly going to get into that into some depth. But is it fair to say, as we did at the outset, that often people may have some symptoms that they just hope go away in a couple of days and maybe they do, but they could be more serious than they realize.

Dr. Sherif Michael: Absolutely. And I think most of us, our general inclination is just kind of see how things go. Sometimes we say, "Okay, well maybe it's something I ate. Maybe it's stress from life." And sometimes it is. But, you know, obviously, we would encourage anybody that has persistent symptoms that don't go away, and we know what those are. We know what kind of keeps us up at night and what worries us and says, "Well, maybe I should have this checked out." If anybody has any of those internal symptoms and signs and says, "Well, maybe I should get this checked out," that's usually a good sign to go get it checked out.

Host: You know, one of the best things about going to your clinic is you come in there as a patient, maybe you're anxious because you have been having these symptoms and maybe you don't know what to expect, but you get to interact with Krista and Megan and, of course, you and Dr. Palmer are both very pleasant.

Is it true, Krista and Megan, that people often come in anxious and are maybe anticipating the worst? Maybe they think by the time they're coming to you that it's already decided that they're going to have to have some kind of procedure.

Megan Johnson: Yeah. So, a lot of people automatically think they walk through this door and they're getting a colonoscopy, but that's not always the case.

Krista Jarrett: Right. Right. Yeah. A lot of people can just make some changes, dietary or lifestyle changes, but you can also order some non-invasive tests too. You know, so not necessarily every time you come in, it's automatic procedure.

Host: The procedure you most often talk about, you mentioned a colonoscopy. There's also EGD, which,,you know, colonoscopy goes in from one side, EGD goes in from the other. So,could the two of you maybe just kind of lay out for the people who may not be familiar with it, may have heard these terms and they're getting of a certain age, and maybe it's recommended that they do it, but they've never done it before. So, what's involved with these two procedures?

Megan Johnson: Okay, I'll do upper, you do lower.

Okay.

Oh, okay. So, what the upper is, or an EGD. So, that's where we go in with a lightened camera, and we basically just go in through the mouth while the patient is asleep. So, we do not torture people here, okay? We have a great anesthesiology department that, whenever it comes time for a procedure, they're doing the sedation, and then our physicians are able to do the procedure and just focus on that.

So once again, we have a great team over there. We all are team-oriented. So for that EGD, we put the patients to sleep. We go in with a lightened camera. We look in the esophagus, we look in the stomach, and then we look in that first part of the small intestine, the duodenum. So, that's the E, the G, the D.

And so, when we do those tests, we can tell if people have ulcers. We can tell if people have maybe some sort of like gluten issue or celiac disease. You know, gluten's a really, you know, hot topic. You know, everything has to be labeled these days for those patients, thankfully. We can tell if you have some sort of esophagus issue. Maybe you're having some trouble swallowing. While they're in there, they can stretch out your esophagus. So, the point of the upper scope is to see kind of what's going on. It's one of our best exams. diagnose what's going on with a biopsy or whatnot, and also do something therapeutic to help the patient to fix their problem. So, that's the upper.

Krista Jarrett: Yes. And a colonoscopy is really important for colon cancer screening. The purpose of that is for us to go in and look and see if you have any colon polyps. When you have this done, you also get the same anesthesia like you did for the EGD.

The most important part of it is doing the bowel prep. That's also the worst part of it. You know, you got to do a clear liquid diet and also drink a bowel prep to get you good and cleaned out, because colon polyps can start off real, real small, like the size of like a little like, you know, pimple or a pea. And so, any little bit of stool in there can cover that up, and we wouldn't be able to see it.

So, you know, colonoscopy is only going to be as good as like your bowel prep is. So that's the most important part of the colonoscopy so that we can get a good look. But we start screening at age 45 for a colon cancer screening, so we would schedule you for a colonoscopy. But we'll go in with a scope with a camera and a light at the end that goes in through your rectum and goes all the way through and looks for any colon polyps, and we can take those out, if we see them.

Host: colonoscopy prep is legendary and mythical, and people have heard a lot of things about it. I can tell you from personal experience, recent personal experience, in fact, that it's just not bad. You know, you get to sit around the house, and you get to clean yourself out, and I didn't mind it at all. So, I just want to reassure everyone who's watching or listening that whatever you've heard about that colonoscopy prep, it's not as bad as you've heard.

Megan Johnson: We've come a long way.

Host: It really has. It's just a tiptoe through the tulips, frankly. But you got to be compliant, right, Dr. Michael? I mean, there's a couple things I want to ask you about here. The consequence of not being compliant with your prep, because I think it's vital that that happens. S if a patient doesn't do that, you know, what can go wrong, especially for you? And then, can you be a little bit more specific? Because Krista and Megan did a really good job of explaining what they are. But can you take us through the experience you and Dr. Palmer have when you're doing these procedures? What are you seeing?

Dr. Sherif Michael: Yeah, absolutely. So to start with the prep, like you said, I mean, they've improved over the years. It used to be pretty difficult to get through. Generally, our prior prep was about a gallon of fluid, but now our modern preps are a l- a lot easier to tolerate. They're smaller volume preps. So, they're a lot easier to get through than the old what we call GoLYTELY or big, big jug of prep. So, they've improved in terms of quantity.

And you asked about what happens if they don't get cleaned out. Well, that's not the news you want to get after your colonoscopy, because as Krista was mentioning, your bowel prep is essential to an adequate colonoscopy. If we can't see well in there, then we can't technically say that we didn't see anything because small polyps can hide very, very easily in a colon. So if the colon is not fully cleansed out, then unfortunately you have to repeat the process all over again.

And what are we seeing while we're there? It really depends on what procedure we're doing. But in terms of a colonoscopy, you know, we're going through the entire large intestine or colon, and we're looking for polyps, which are growths in the colon that can eventually turn into colon cancer. So, the goal of a colonoscopy is to find these growths at a very early stage and remove them so that they never have a chance to give you any problems through life.

Host: I want to repeat the phrase you said. These polyps can eventually grow into colon cancer. Polyp is a scary word. Biopsy is a scary word. But because you might say polyp to a patient or because you might say biopsy to a patient, that doesn't mean they have cancer. It means that you're trying to prevent that cancer, and that's the cancer screening that we're talking about and why it's so important.

So can you elaborate please on how-- I remember, you know, my dad, for instance, you know, he came out of a colonoscopy, and I told the gastroenterologist to say these words to him, "You don't have cancer." I mean, it's just that important. But you probably don't, and that's why we're doing it, right? So, can you tell us a little bit more about the screening process and what is involved in it?

Dr. Sherif Michael: Yeah, absolutely. So, you know, like you said, polyps do not mean you have a cancer. And in fact, most of the polyps that we remove are pre-cancerous, which means they have the potential to develop into a cancer. But thankfully, we found them early enough that they haven't had a chance to develop into cancer.

And importantly, whenever we remove these polyps, all of this tissue gets sent to our pathologists. They give us a report on the exact type of tissue, and we bring you back to the office to review everything together. And then, when we repeat these colonoscopies depends on the type, the size of these polyps, the number of polyps, all determines when you repeat another procedure.

Host: And at a certain age, isn't it recommended every 10 years, every five years? Can you make a general statement about the schedule? When you should start and how often you should do it?

Dr. Sherif Michael: Yeah, absolutely. As Karissa mentioned, we start now at 45. We used to start at 50, but unfortunately we found that younger people are starting to develop more colon cancer. So, our screening guidelines changed in the past couple years, and now we start at 45 if you're at average risk of colorectal cancer, which means you don't have a family history of colorectal cancer, you don't have any symptoms that would trigger concerns for potential colon cancer, that's when we start at 45.

So, that's when our screening begins. And then when do we repeat this? If you're at average risk of colorectal cancer and we don't see any polyps during that colonoscopy, then it's 10 years. That's the news everybody wishes for at the end of their colonoscopy, "I'll see you again in 10 years." But if you do have polyps, like I said, the number of polyps, the size of polyps, the type of polyps all determine when we bring you back sooner.

Host: This is Health on Point, presented by Willis-Knighton Health. Our topic is trust your gut. We're talking to a gastroenterologist and two advanced practice practitioners in his office, Dr. Sharif Michael from Pinnacle Gastroenterology at Willis-Knighton Health, along with Krista Jarrett, a nurse practitioner, and Megan Johnson, a physician assistant.

Megan, I suspect you and Krista, have to do a lot of counseling with people not only about their emotions but also about their diet, about their intake, about their medicines. Tell me about the conversations you have and how much convincing and cajoling you have to do to get people to do what they need to do to protect their gut health.

Megan Johnson: So, you know, food is medicine, and so we respond to medicine in different ways, so we do respond to food in different ways. Certain foods are going to trigger more reflux. They're going to relax the esophageal sphincter and allow you to have more indigestion or heartburn.

So, you know, we have to go into detail, ask about like coffee intake, alcohol, tobacco, you know, greasier foods. What time are you eating? That, you know, that can be a factor that a lot of people don't really, you know, incorporate into eating. As far as bowel issues, certainly, you know, certain foods are going to help and certain foods are going to hurt, okay?

So, we do a little bit of an analysis and, we're not really big on strict diets for the most part, okay? I just kind of tell people, "Hey, look, let's 80/20. Let's try to do really well." Now, you know, certain instances like celiac, yeah, we're going to be more strict. But, in general, people, as long as they're kind of watching when, what, and how, in a general aspect, you're going to notice a significant improvement in whatever the problem is. And then that improvement helps kind of precipitate further positive behaviors. So, we do talk about a lot of dietary changes here.

Host: Krista, we've talked generally about the procedures, screening, that kind of thing, but Megan mentioned something specific, celiac disease. So, you have this kind of broad brush thing that gastroenterology practices do, but there are some specific conditions and diseases that you guys see too. So, what are the most common ones?

Krista Jarrett: Yeah, celiac disease is a pretty common one. We see a lot of patients with that. we have a lot of like IBD. Like, ulcerative colitis and Crohn's are big ones that we see a lot of too. But also, IBS with constipation or diarrhea or even both. Those are some really common ones that we see, that do require, you know, dietary changes and, you know, lifestyle changes too. But those are probably our most like common ones. But also, Barrett's esophagus is a big one and GERD, is also another one too. Those are probably our most common ones that we treat.

Host: Dr. Michael, all of these things can be unpleasant. I mean, they impact your life, your GERD, your gastroesophageal reflux disease, heartburn, acidity, and we've talked about some lower GI problems that may take you to the restroom more often than you like. And you also have abdominal pain, all these discomforts. At what point—what's the threshold of when it becomes serious or severe enough that they really, really need to come see you?

Dr. Sherif Michael: To me, it's a very low threshold. I always kind of err on the side of caution. You don't want to wait until something is so severe that whatever is underlying could be so far advanced that your chance of recovering from it just significantly diminishes. So for me, I always err on the side of caution. We all know when something bothers us, and we know when it's time to ask for help. You know, most of us will try different things at home, over-the-counter medications. Maybe it's stress, maybe I'll feel better next week. But my trigger is pretty, pretty close. I would not recommend people sit on symptoms for a long period of time and just see what happens, because oftentimes that's when people get into trouble. I would say if you're feeling something that's out of the norm for you, get it checked out. Better safe than sorry.

Host: Hi, Megan. Myths and misconceptions. People come in all the time with stuff they think they know and stuff you wish they knew and stuff you wish they didn't think they knew, if that's not too confusing. So, what are you having to talk people off the ledge about more often than anything else?

Megan Johnson: Everyone thinks that they have a parasite.

Host: Really?

Megan Johnson: So, I reassure a lot of—I mean, now granted recently there was a significant increase in parasites. But, anyways, you know, another thing everybody thinks that they have to take a probiotic and that it's necessary, but that's not always the case.

Just because there is a supplement over the counter that you see that has a great marketing team doesn't mean that you need that. You know? So, really, that's one of the main things kind of by coming in they'll say, "Okay, I'm doing this, this, and this. I'm still having all this problem." I say, "Well, well just because you're doing that doesn't mean that maybe those fix your problem. Let's think about it in a different way." And also, you feed your algorithm too. I have to tell patients that, you know, like, "If you keep searching this, your algorithm's going to keep telling you this." So, that's kind of with newer technology have kind of changed things in that way.

Host: Social media isn't always our friend. Algorithms are certainly not our friend.

Megan Johnson: It can be a great tool, and AI is not always correct. You know, I had a problem at the airport this last weekend. I was like, "Well, AI said this," but I tell my patients all the time, "Well, AI isn't 100% correct in this capacity. That's why you're coming to see us, and that's why we're going to do these tests."

Host: I have to admit, you surprised me a little bit, so I'm going to come back to Dr. Michael on this. Megan said parasites? A, people think they have parasites? And B, what kind of parasites?

Dr. Sherif Michael: Well, there's all kinds of ones. I mean, you know, if you watch the news anytime recently, you saw, you know, all kinds of—if you watch the news for even a week, you'll see 10 reports on lettuce is infected, you know, salmonella. We just recently had an outbreak from infected lettuce.

So, you know, it's kind of the consequence of where we live. You know, all of our foods, unfortunately, in the United States are heavily processed, and there's a risk for infections. But yeah, I mean, parasitic infections are just one type of infection. If you spend a lot of time outdoors, drinking from well water or anything like that, I mean, you're at high risk in lakes. And we're pretty outdoorsy here in Louisiana, so our risk of parasitic infections is there. But it is not always a parasite. There are other things that can cause GI symptoms. But yeah, I mean, there's a lot of things out there.

Host: I had no idea. It never crossed my mind to come see you and say, "Ah, I think I have a parasite." Let's go back to those polyps though, Dr. Michael, because the one thing we need to close the loop on, I think, is, let's say the bad news comes, and you do think it's cancer, and you send it off to pathology, and it comes back. So, what's next after that? I mean, if the bad news comes, if one of those polyps is malignant or one or more. So, what's the consequence of that?

Dr. Sherif Michael: That's an important question. And I think that's where things have really improved for patients over the past decade or so, is that our treatments for colon cancer, our surgical management of colon cancer, everything has improved dramatically over the past few decades. So, outcomes of colon cancer have improved dramatically in turn.

So, we work very closely with our radiologists, with our surgeons, with our oncologists, to coordinate care for patients. So as soon as we find a polyp or a mass that looks suspicious for a colon cancer, of course, we take biopsies. The biopsies are, you know, sent to our pathologists. We get the reports, and the ball quickly rolls after that.

Depending on the type of polyp, the stage we find it, sometimes the treatment is just surgery. Sometimes surgeons can find that area, we mark it for them during the colonoscopy. And if we found it early enough, then the surgeons can just go in, resect that small piece of colon, reconnect things, and patients move on with their lives.

And that's the benefit of coming for a colonoscopy. You know, it's not a procedure that people are looking forward to, but really you have to keep in mind that once we find these lesions early enough, the outcomes are really good. And, you know, people are always worried about, "Well, gosh, am I going to have to have a colostomy, a bag that I'm going to have to have for the rest of my life?" And like I tell my patients all the time, that's the point of coming in for these procedures early. If we find them early enough, sometimes it just requires a surgery, and you move on with life.

Host: Krista, Dr. Michael talked about the collaboration and being part of the Willis-Knighton system makes that collaboration easy in a lot of ways. I mean, tell us about that. Tell us how you work together, because there are a lot of people who are literally within walking distance of where you are who will work together to address whatever's going on with these patients.

Krista Jarrett: Yeah, we all play a role in just working well together as a team. You know, me and Megan collaborate a lot together in the office, but we see a lot of all the same patients. Like, a patient will come in as a new patient and then, Dr. Michael or Dr. Palmer will provide the procedure and do the procedure.

And then, we get together with them on the results and discuss the plan and, you know, what's next for that patient, too. And me and Megan do the same in the office as well, and just all kind of collaborate and just, you know, it's always a team effort and providing the best care that we can for the patients.

Host: And Megan, outside the clinic, I mean, we've got this comprehensive team of people across Willis-Knighton Health, oncologists, surgeons, Dr. Michael talked about that a little bit, and just the integrated system works to everyone's advantage, don't you think?

Megan Johnson: It really helps. So, you know, even on our floor, there's some general surgeon offices on the same floor as us. The dietary, you know, nutrition office is right down the hall as well. Right across the street, we have the oncology department. And so, we, you know, work well with them. Obviously, there's another colorectal group within the system. So, we're blessed with great resources to help facilitate and expedite everything.

The fact that we all use the same computer system helps as well. If somebody just saw the surgeon earlier in the day, I can glance at that note and see exactly what they said, did, and what they've ordered. So, that expedites things as well. And we all work really well as a team. You know, we all have each other's cell phone numbers, for the most part, and can call directly. If I'm in a room with a patient, "Hey, hey, Dr. So-and-so, what are you really going to do for this? Let's see. Let's get a good plan to help expedite this."

Host: And I'll remind anyone who's watching or listening that the portal, your patient portal is really going to be transforming too.

Megan Johnson: For sure. For sure. Yeah.

Host: So, you know, that's something that you can go and see your own results. You know, you got raw data there. So, work on finding that patient portal. Dr. Michael, I'll give you the final word. What is the takeaway that you would like patients to have? What are the key components to maintaining your best health so they don't have to come see you?

Dr. Sherif Michael: I'm a bit of an old soul and a kind of old school. And I think we all kind of share the same sentiment in our office. We are not a throw medicine at you kind of practice. We believe in a healthy, balanced life, and that's where I usually start with my patients.

I can't overestimate the importance of a healthy diet, healthy lifestyle, regular exercise. This is all common sense stuff that we all know. But in terms of our gut and our GI tract, it can't be overestimated the importance of a balanced life. So, having a good, healthy, balanced diet, exercise, it just can't be overestimated the importance of that.

And then, the title of the talk pretty much sums it up, trust your gut. You know, people, you have to listen to yourselves. You know your symptoms, you know your body more than I do, more than Megan and Krista will know your bodies. You live with it twenty-four hours a day. And your body talks to you. It lets you know if something is off, if something's off balance. Don't ignore those signals. You know, listen to yourself. Trust your gut. And if there's something that you feel is off, get it checked out.

Host: These are great healthcare providers who also happen to be very nice people. Great healthcare providers, very nice people when you go to Pinnacle Gastroenterology, and we got nice people all across the system. But they're here today, and I want to thank you so much for joining us. I want to thank you for being on the podcast with us today. And for everyone, thank you for joining us for Health on Point, presented by Willis-Knighton Health.