Episode Transcript
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(00:00):
Bozeman as King T'Challatransformed Hollywood for many
black Americans offeringrepresentation long overdue
accomplishing so much in just afew short years, all while
waging a personal and privatebattle.
A statement on Instagramrevealing the star just 43 had
undergone treatment for coloncancer since 2016, making movies
(00:21):
during and between countlesssurgeries and chemotherapy.
News of Boseman's untimely deathstunning the world.
Denzel Washington, who helpedpay for Boseman to study acting
at the British Academy ofDramatic Acting in Oxford,
saying he was a gentle soul anda brilliant artist.
to be young, gifted and black.
We all know what it's like To betold that there is not a place
(00:44):
for you to be featured, we couldcreate a world that exemplified
a world that we wanted to see
Chris (00:54):
Welcome to pulse check, Wisconsin.
(01:36):
Good morning.
Good evening.
Good afternoon.
This is Dr.
Ford Pulse Check, Wisconsin.
And I wanted to thank you forjoining us We have a good
episode here for you today.
As you heard from the introtoday, we're going to be
discussing a topic that is onthe minds of a lot of folks
right now, which is colorectalcancer.
As we've seen, at least inrecent years, we've seen an
(01:57):
increase in the rates ofcolorectal cancer.
We've seen it more readily inthe media.
We've seen celebrities, JamesVan Der Beek, Chadwick Boseman,
who have been either diagnosedor have died secondary to
colorectal cancer.
And so it's something that weneed to take a look at and
(02:19):
something that I continue to getfan questions about, uh, what is
their risk, who should getscreened, things of that nature.
And so, um, um, I thought itwould be good to go directly to
the source and have one of ourexperts on the topic really
speak out and to give us somepointers and give us some tips
about it.
So today we have with us Dr.
(02:40):
Erin King Mullins, who is aboard certified colorectal
surgeon in Georgia.
Dr.
King Mullins has a couple ofdifferent resources that are
available.
She's an author.
She has her own website.
She has her own organization,which is focused on increasing
awareness about colorectalcancer and about colorectal
(03:00):
cancer screening as well.
So with that being said, we arevery fortunate to have her with
us and hope you enjoy thisinterview.
(03:27):
right.
All right.
We're going to get startedagain.
Uh, Dr King Mullins I appreciateyou coming out and speaking with
us on this topic.
Again, we've got a lot of, Uh,fan questions about it and we
just more so wanted to dig alittle bit more into it and I
gave an intro for you at thebeginning of this episode, but
if you could, could you share alittle bit, about yourself and
who you are and then about yourjourney into medicine?
Erin (03:48):
Sure.
Thanks for having me.
Um, always a pleasure toenlighten anyone on colorectal
cancer and the risks and just,colon health in general, because
there's so many myths out thereand so many things that we
understand stood about it haschanged over time.
So we just gotta, you know, keepour ear to the ground.
So I'm a colorectal surgeon.
I've been in practice for almost10 years now.
(04:11):
I, you know, when I first wentinto medicine.
So I knew since I was about 12that I wanted to be a doctor.
I didn't have some big, like,aha moment or some, like, crazy,
scary medical situation withmyself or my family member.
It was just kind of I knew it.
And so I was privileged to havemy older sister, who's about 11,
12 years older than me, sheactually pursued medicine.
(04:34):
And so I kind of was able to seethat trajectory.
So people were like, you know,did she inspire you?
And I'm like, yeah, it was weirdthough.
Cause I kind of knew before shewent to medical school that I
wanted to be a physician, but Iwas able to actually, you know,
kind of mirror her footsteps.
Once she was there.
And then kind of after all ofthat, just going through the
process and you know, really notfraying from that, just going
(04:56):
straight through high school,you know, college, mid school,
residency and all of that stuff.
My solidification on what Iwanted to specialize in really
just didn't, Come until time andexperience to figure out what I
liked and I didn't like.
Yeah.
Chris (05:10):
Yeah.
And, and, you know, you bring upa good point there too,
especially being able to see itand, and kind of walk those
steps that your sister did too.
We, we had another discussion onwith actually a few other
physicians that came on too, andit's the, the idea comes up over
and over again of, you know, youcan't be what you can't see and
what you can't perceive yourselfin those, in those roles.
And so it's really good that.
(05:31):
You had that experience and thatyou had, someone who also is in
that, in that Avenue and you'reable to see the educational
steps as well as the training sowe, we brought it up at the very
beginning.
I believe it was season one thatwe talked about one of the
potential topics that we weregoing to discuss.
And the reason being is, We'reseeing a lot of social and
health disparities associatedaround colorectal health,
(05:53):
especially in the, in the commonarea right now, we're seeing,
you know, these rates ofcolorectal cancer being
diagnosed, you know,unfortunately, in some cases in
late stages, what.
What unique challenges do youthink, you know, African
American patients face when itcomes to colorectal health and
just colorectal health ingeneral for all demographics?
Erin (06:10):
So I think a lot of just kind of what we understand about
disparities in general withunderrepresented populations in
this country a lot of thedisparities in colorectal health
can just mirror that.
Those who are from lowersocioeconomic classes, uh, may
have decreased access to certainscreening and care.
(06:32):
Um, but it's interesting, youknow, the studies have actually
shown that if you Mitigate allof the disparities and just look
at person to person.
There's no real disparity in theoverall outcomes of colorectal
cancer, the ability to getscreened, the willingness to get
screened.
So there's something that'sgoing on along the way that
(06:54):
that's causing this to happen.
And time will tell as we're ableto perform more research.
What is the key factor?
We just talked about if youcan't see it, you can't be it.
And again, the studies show thatwhen you have a concordance of
the gender, race, ethnicity ofpatient and provider, there's a
better relationship there.
(07:15):
And the patient is much morelikely to have better outcomes
and to adhere torecommendations.
And then also outside of that,you know, when they did some
research, they found out thenumber one.
Reason that people don't getscreened is actually not being
told they have to be screenedAnd so again, so there's so many
(07:37):
levels and layers to all ofthis.
Um that that that plays a role
Chris (07:41):
Yeah, and you know, you brought up a good point because
you know, it's not just inafrican american communities,
too, right?
We're seeing in the hispaniccommunities as well You know,
there was a study that came out,I think it was about like 2020,
I'm sorry, 2013 or so, wherethey saw that, you know,
minority populations had a rateanywhere from like 15 percent to
26 percent higher, beingdiagnosed with colorectal
(08:02):
cancer.
But like you said, some of thatis, how much exposure that you
have to primary care physicians,how close that, that, that
treatment is and even beingaware that you're at risk for it
is a whole differentperspective, right?
Like knowing that you should bescreened and what those risk
factors are.
Yeah.
And so in 2020, so this is theone, this is the question that I
(08:23):
get the most.
So in 2020, we were alldevastated by the loss of
Chadwick Boseman.
You know, we all know him fromhis roles, various roles, right?
So, um, yeah, the most notableone for most is, you know, King
T'Challa and Black Panther thatput colorectal cancer, back on
the map for a lot of us becausehe was so young when he, when he
died of it, he was still in hisforties.
(08:44):
Um, and at that point in time,you know, the, the cancer had
progressed to the point where,it was, it was, it was
unfortunately terminal.
Why are we seeing in yourestimation, why are we seeing
such a higher rate of colorectalcancers and being more severe in
these cases now on young,younger demographics than we've
seen before?
Erin (09:00):
So I'm actually going to start out with, um, uh, a stat
that is, that's current by theyear 2030.
Now that sounds like somefuturistic date, right?
Five years from now, by 2030,colorectal cancer is going to be
the number one cancer killer inpatients or persons under the
(09:24):
age of 50.
Okay.
Um, and Again, this is somethingthat it's complex.
You know, when I refer toChadwick Boseman, I tend to tell
people.
So he was actually diagnosedwhen he was 38.
Okay.
He underwent a surgery, hadtreatment and all of those
(09:44):
things.
And, um, I'm not sure if he, youknow, had, um, if he went into
remission and it came back orwhatever kind of progressed to
him to get to that point, but hewas originally diagnosed at 38.
38.
Now, what we don't know is washe having symptoms for a period
of time that either he ignoredor that he reported to a
provider that that got ignored?
(10:07):
Don't know.
Or was he at increased risk forsome other reason?
Was there a family history ofUh, of a hereditary, um, factor
or colorectal cancer that eitherhe didn't know about or, or, you
know, you know, didn't pursuescreening early.
So there's so many things topotentially consider that we
don't know.
But what we do know is he was38.
(10:28):
He was young.
And so across the board, youknow, um, we're learning about
all of the environmentalchallenges, um, the
microplastics, the, the GMO andprocessed foods and steroids and
food and pesticides and food,um, you know, the relative, uh,
when you look at the overalllevel of activity of most,
persons these days, I'm so usedto train to say patients, but
(10:51):
the, the activity levels that weall have right now are much
lower than, our ancestors, ourBMIs, right?
The baseline body mass and allof those things that the ideal
body weight is shifted.
So there's so many of thosethings.
It's hard to trigger what theexact, um, and there is probably
not going to be one exact, likesmoking gun that we're going to
(11:13):
find, but all of those Thingsplay a role.
And what that does is feed intohow we have to then screen your
family and, and, and talk andfamily children, you know,
earlier and more frequently oncethis age and your family keeps
getting lower and lower.
And then the one key thing thatI really want to hit on as well
(11:35):
is everybody talks about whetheror not they had a family history
of colorectal cancer.
But you also have to talk aboutif there's a family history of.
Polyps because polyps are a precancer, right?
That's what eventually grows andturns into cancer.
So when you get a colonoscopy,yeah, you may have a polyp.
Your family member may have hada polyp that was removed that
was benign, but they need toknow about it because again,
(11:56):
that's a pre cancer.
So that also increases risk.
Chris (12:00):
And that's, you know, that brings up a good point too.
Just how important that historyis.
We're taught in medicaleducation.
We're taught in medical schoolas well.
that the history is the mostimportant thing that you can
obtain.
Not labs, not tests, not, youknow, whatever.
Right.
Um, but actually having thatcontext, especially in the cases
of things like cancers, right.
Colon cancer, breast cancer, youknow, you name it.
(12:23):
having that family history andknowing your quote unquote
genetic history as well, thingsthat you're predisposed to, um,
you know, what effect that willhave on you and what effect
that'll have on your, yourworkup and the way that your
doctor is looking at your caseor even your symptoms is, is
paramount.
And a lot of that too is loss,right?
So if you think about it,especially as we are nearing in
(12:45):
more and more states that we'reseeing now, we're trying to
expand the access of care,especially in primary care.
You know, I can tell you for afact.
that my grandmother, you know,Oh, my father said, I didn't go
to the doctor all the time.
Right.
And, and, you know, I can tellyou many people, you know,
probably you have family memberslike that too.
And so, a lot of the thingscould be risk factors that we
don't know about.
Uh, and even if we had thatinformation that we couldn't
(13:07):
tell, our physicians about too.
And so those are all the thingsthat, you know, we need to
consider when we're looking atall these parameters that could
be extraneous, factors playinginto why these colorectal cancer
rates are going up so high.
Erin (13:20):
Yeah.
And it's key to, you know, asyou said, as one of those
primary providers, right, thatsees a more longitudinal, um,
developmental pattern with yourpatients and just kind of all
the baseline.
When you go, I tell patients,like, when you go and have your
annual visits or you go see aspecialist and this and that,
like, You need to be updatingyour primary care physician on
(13:42):
new findings, not only foryourself, but also in the
family, right?
Because that impact of you allof a sudden you're fine, you're
trucking along.
And then all of a sudden, Hey,yeah, last year my mom did go
and have some, um, have acolonoscopy and she had several
polyps removed.
So now that's going to change myindex of suspicion on certain
things.
If you come to me next year orthe year after with certain
(14:06):
complaints or symptoms, my earsmight be in tuned or peaked or
may think you need moreaggressive evaluation of those
symptoms because now you are ina higher risk category than if
you would have been at steadystate, no family history, no
nothing, you know?
So again, it's also important toupdate your family history with
your different doctors.
Chris (14:26):
Right.
Absolutely.
One of the questions that camein specifically was having to do
about biological, uh, thebiology of the patient or
genetic factors.
Are there any, intrinsicbiological or genetic factors
that disproportionately affectminority communities, African
American, Hispanic communitieswith colon cancer that, that
you're aware of?
Erin (14:46):
So not that we're immediately aware of, um, and
one of the things is justbecause as we know, um, African
Americans are less likely to berepresented in scientific
studies.
And so a lot of the different,data banks, you know, when you
hear about the Lynch syndrome orthe HMPCC and all of those types
of things, you know, typically,underrepresented populations.
And so African American, NativeAmerican, you know, um, Latin
(15:08):
American, um, Patients will beunderrepresented in those
studies and those data banks.
So it's hard to, at this point,distinguish a true genetic or
hereditary link, or is it moreof what we call is epigenetic
and environmental, you know,type due to diabetes tends to
run in families, not because.
Mostly genetics, but becausethey tend to have the same
(15:31):
dietary habits and, and, andphysical, um, uh, activity or
lack thereof.
And so right now those are gonnabe the most, contributing
factors that we know of forsure.
And hopefully over time as weget increase the numbers and of
the biogenetics of cancers andtumors and polyps, we can then
truly look back and see, youknow, is there truly a genetic
(15:53):
leak or is it just mostly, um,epigenetic or environmental?
Chris (15:57):
Absolutely.
And I'll link, you know, for ourlisteners, cause some of our
listeners are medical, some arenot.
And I'll link some of thatinformation just kind of getting
into, you know, polyps versusprimary cancers and things like
that too, in case you guys wantto do a deep dive on all of that
but a couple of things that youbrought up there leads us to our
next point.
You know, like you said, a lotof the studies that we have
right now do not unfortunatelyinclude some of those
(16:18):
populations that are mostaffected, right?
And we had Dr.
Jane Morgan come on who was acardiologist in Atlanta as well.
And she spoke to that, right,because she does a lot of these,
uh, a lot of these studies and,you know, she, she, she's
begging folks in some cases to,to be a part of those cardiac
studies, just because a lot ofthe data that we have is not
based on our epigenetics andit's not based on, you know, the
things, the, the demographicsthat we commonly see represented
(16:41):
in our populations and in ourfamilies.
And so with that being said,colon cancer is often
preventable and, you know, wesee the things like Cologuard
and things like that are coveredby insurance.
at age 45, right?
What are some of the mosteffective strategies for
prevention and you know, how canthose be better communicated or
made better available, uh, tothose communities most affected
Erin (17:03):
so the number one, um, single piece of power that you
have is the power ofconversation.
Okay, so to talk to yourproviders, um, talk to your
family members, your kids, likeeverybody, just understand, you
know, who had what and when.
And sometimes it's not as simpleas who had colon cancer or who
(17:25):
had polyps, but if you startseeing a pattern of different
cancers, so, you know, asmattering of people had breast
cancer and then somebody hadpancreatic cancer and then
somebody had prostate cancer,that's another potential genetic
link that might increase yourrisk of colon cancer.
of colorectal cancer.
So number one, just having thoseconversations before you even
worry about involving doctorsand procedures and doing all of
(17:46):
that.
Um, also there's a differencebetween, we have to understand
the difference between screeningand diagnostic.
So screening means that, youknow, you've reached a certain
level of risk where we need tostart looking.
You're not having any symptoms,there's no problems.
So the average risk individual,the recommended age for
(18:08):
screening is now 45.
The age decreases with certain,um, family history or personal
history.
If someone has inflammatorybowel disease or Crohn's
disease, ulcerative colitis,again, family history of
different cancers of colorectalcancer or polyps, um, screening
may need to occur earlier.
Now, that's different thandiagnostic, meaning if someone
(18:29):
presents with symptoms, so achange in their bowels,
abdominal pain, uh, bleeding,um, from the rectum or blood
mixed in the bowel movements,that's a diagnostic examination.
And so that's a different reasonto go look.
So a colonoscopy is consideredto be both a screening and
diagnostic tool and atherapeutic tool.
If you see something, sometimesyou can do something about it
(18:52):
right then and there.
You see the polyp, you remove itand preventing it from growing
and turning into cancer.
So you've diagnosed a precancer, you've screened for
colorectal cancer, but you'veprovided a therapy all in one
fell swoop.
Some of the other what we callour non invasive testing, like
the, um, the, the stool basedexam.
So people may see the brand nameCologuard quite a bit.
(19:15):
Um, there's different testingfor microscopic blood and the
bowel movements.
Again, those are all screeningexaminations and not everybody
is a candidate.
for those.
So anybody with any increasedrisk.
So family history, they'reautomatically not a candidate
for those things because it'snot quite as sensitive or
specific to really pick that up.
(19:36):
Um, and then also if they havesymptoms, it's not advised to do
it because there can be a falsepositive or a false negative.
It's not going to diagnose thechanges in your bowels, right?
Um, and then the last thing, uh,and I hope this doesn't just get
me booed off the stage, but Thenon invasive tests that are
(19:56):
frequently advertised, um, ordiscussed or preferred sometimes
by patients, you have tounderstand the risks of using
that examination and testing.
Knowing if it's the mostaccurate examination for you.
So we talked about AfricanAmericans not being as
represented in research studies.
(20:18):
And so some of the studies forsome of these stool based
examinations did not have.
Fully adequate numbers ofAfrican Americans in them to say
that the sensitivity,specificity, accuracy, all of
those different statisticalwords you want to talk about, is
as good in the African Americanpopulation as in the general
(20:39):
population.
So it's better than nothing.
Yeah, if, if number one, youcan't get anybody to do anything
else or doing a colonoscopy isan investment.
So not only do you have to takeoff work for that day, someone
else may have to take off workthat day.
You need a driver, you know,there's so many things that go
into it.
So if you cannot get the goldstandard examination, the
(21:01):
colonoscopy, I'd rather you getsomething, but understand what
you're getting out of that testand what it means.
Chris (21:08):
And that's key too, especially, you know, I, I won't
go on my tangent about some ofthe, you know, the, the
financial aspect of medicine andthe financial aspect of some of
these kits and medications andet cetera, et cetera, we can go
on for days and days.
But as you start to see more ofthe commercialization of these
tools, like you said, it's, it'sreally, You know, it's hidden in
(21:31):
there, like who that actuallyapplies to, right?
And you know, what those studiesare based of.
And even when they're talkingabout even those bullet points,
90 percent specific, thesensitive, I should say, uh,
specificity X, Y, and Z, whatdemographics that actually
includes and what demographicsthat does not include.
Right.
Um, and so those are things thatyou and I read those studies.
Studies knowing, because we wentthrough the training and we know
(21:51):
how to do it now, but that,that's key.
I feel like that's a key pointfor everyone to know.
Who's listening to this too?
You know, what, what thosenumbers actually mean and you
know, all the things that yousee, uh, coming up with a Super
Bowl or a national championshipon those commercials that may
not be, you know, what youexpect'em to be.
Erin (22:07):
Yep.
Yep.
Yep.
Yep.
Chris (22:09):
So screening is key to prevention, like you said, and
you know, whatever folks arewilling to, to, to do.
I can tell you, I've had many adiscussion and many of, uh, you
know, uh, of a fight with folksand trying to get them to get
the colonoscopies, bothpatients, friends, you know,
family members at thebarbershop, et cetera, et
cetera.
Right.
So what advice do you have forindividuals who may feel
(22:30):
hesitant or fearful about thecolonoscopy?
How would you approach them?
Erin (22:35):
Well, oftentimes, you know, the stories that people
always want to tell bad stories.
Okay.
How many people come to you andsay, Oh, I had my colonoscopy
and it was the best experienceever.
like reading those restaurantreviews online, right?
Y'all always got to add one ortwo points more because if
people just had a normal,traditional regular, I showed up
at the restaurant, they orderedtheir food, they enjoyed it and
(22:55):
they went home.
They're probably not going tonecessarily a writer review if
they didn't have a glowingexperience and the overwhelming
majority of people who had a badexperience are going to go.
On and talk about that.
So you have to understand that.
So that's what I advise folkstoo.
And then sometimes you just haveto meet people where they are,
like, understand what is theirfear?
What is their understanding?
(23:16):
What is their hesitancy?
Because there's a lot of mythsthat we as providers sometimes,
um, have to, you know, debunk.
And then especially in thefolks, um, When you think about
now, again, the younger andyounger age, um, of diagnosis, a
lot of these folks have youngerand younger children, okay?
(23:36):
We're talking about babies,toddlers, like people that they
are still responsible for.
It's not like the 70, 80 yearold grandma who have their
children who can actually helpthem in the process.
We're talking about thissandwich generation, and some of
these folks may have to care fortheir parents, and now they're
also caring for littles too.
And so What I usually say thatreally gets them.
(23:59):
I'm like, okay, do you have kidsor, you know, you have a loved
one, a spouse or anything?
They're like, yeah, I'm like,okay.
Um, you love them.
Yeah, of course you do anythingfor them.
You know, you, you jump in frontof a train, a bullet.
Oh yeah, yeah, yeah.
So why don't you live for them?
If you're willing to die forthem, let's make sure you live
for them.
Don't put them through a tragedythat they don't have to
experience.
(24:19):
But also again, what impacts youimpacts them.
If you have something bad goingon inside, like.
Wouldn't you want to be able toprotect your kids so that they
don't have to live through thesame battle that you go through?
Um, you know, and a lot oftimes, and then people are like,
Oh, you know, you got to die orsomething.
Colorectal cancer is not a funway out.
Chris (24:38):
That's the one you want to do the way you want to go.
Erin (24:41):
It's, it's, it's, it's not like, Oh, I had a heart attack
or a stroke and I'm just out andit didn't feel anything.
Okay.
And so those, those are the, soyou got to come up with your
tactics to figure out like who,how you're going to hit that
person that just.
for whatever reason.
Chris (24:57):
And that's the thing you're, like you said, you, you,
you have to live for your familymembers, right?
This is something that not onlyphysically is going to affect
you down the way for, in somecases, long periods of time.
I'm sure Dr.
King Mullins and I both haveseen patients for a number of
years who have had complicationsassociated with colorectal
cancer complications associatedwith some of the surgeries when,
(25:18):
you know, some of those thingscould have been prevented early
on.
And.
You know, not only that physicaleffect, but also the financial
burden on patients too, as we'restarting to see in the media
more and more, some of theseinsurance issues that folks are
having, you know, it's going toaffect you in every aspect of
your life.
And so, that, that's the thingyou got to consider when you're
thinking about some of the, anyaspect of your health, not even
(25:38):
colorectal cancer, but anyaspect of your health.
So we're trying to get people,to, to, to get access to primary
care doctors, to get access totheir medications, because you
know, this, the old ounce ofprevention, right?
This is, these are things thatwe're trying to prevent to
prevent you from having, youknow, that, that morbidity and
mortality down the road too.
Erin (25:55):
And again, just like kind of hitting back on when you
think about the concept of theyounger and younger generation
being affected, you know, a lotof these are primary
breadwinners for their family.
So it's not like folks that areolder in that near retirement
age and they had a.
And or a 401k that they buildingon forever.
So if they need to kind of slowroll into retirement now, um,
(26:16):
and you need another caregiver,a lot of times to help you with
that process.
So if you're 45 and beingdiagnosed with stage three
colorectal cancer, now you can'tgo to work and your spouse or
some other loved one can't go towork either.
So it's a double.
triple hit on the pocket of, youknow, the losing earning
potentially from more than oneperson.
And the financial impact of nowyou have to pay to cover all of,
(26:36):
you know, these medicines andinsurance.
So it's, it's so, it's so muchdifferent to just go in and get
your covered free screening,colonoscopy, screening
examination.
To ward off all of those evilspirits.
Absolutely.
Chris (26:53):
Absolutely.
So here's a question from, from,from one of my good friends on
our text thread here.
So one of the things that heasked was, so we all are below
the age of 45 right now.
We are not in the cohort thatwould qualify for any of these
home testings or things likethat.
Even the colonoscopy based onour risk factors.
What recommendations would youhave for someone who is in the
(27:15):
minority community as we'reseeing these incidences of colon
cancer, colon cancer.
Is this something that theyshould consider paying out of
pocket for for colon screeningshould just watch out for
symptoms.
What are some of the things withsome of the recommendations you
would give as a colorectalsurgeon?
Erin (27:29):
So the first thing is make sure you're actually in that low
risk category, right?
So go back and have them.
So go back and have thatconversation.
Ask your, your mama, everybody,whoever it's like, don't just
say specifically like whoever,just like, what did people die
of?
How old were they when they diedof it?
You know?
So all of those things.
So, and be explicit like, mama,did you have your colonoscopy?
(27:51):
You said it was fine.
What does that mean?
Did you have a.
Polyp that was removed.
They again, may have told youthat polyp was quote unquote
fine.
That doesn't mean that it wasn'ta pre cancer.
So we're
Chris (28:01):
good at doing that.
Oh, everything was fine.
Erin (28:04):
Exactly.
Exactly.
So get all in the business.
That's the number one.
So number one, make sure you arein that low risk category.
And then if you are, um, youknow, I can't advise you one way
or the other, you know, outsideof that, you know, really, um,
there, you may have access inyour area if you're really,
(28:24):
really concerned.
Um, you know, if you, you may bein an area that has some kind of
pretty low cost access to some,examination, colonoscopy or
whatnot.
Um, and so I'm just going toleave that to you and your
family to make that decision onhow concerned you are.
But yeah, but also don't.
ignore symptoms.
And the thing is, symptoms forcolorectal cancer are very, what
(28:46):
we call, are non specific.
So there's not going to be asmoking gun.
Um, so changes in your bowelsthat are persistent, naive.
If you ate the nachos lastnight, like most of us are
lactose intolerant.
Most of
Chris (29:00):
us need to take that lactate.
Erin (29:02):
So, you know, within, within reason, like a persistent
change in the bowels that can'tbe explained by a recent illness
or change in medicine or changein diet, you know, rectal pain,
bleeding, you know, any otherjust kind of prolonged
constellation of.
Things outside of your norm, notsaying you have colorectal
(29:25):
cancer, not saying you havepancreatic cancer or anything
else, but go talk to yourphysician and number in the, and
that again brings back theimportance of a primary care
physician.
I, and I, I get on my soapbox inmy office, you know, I
understand I'm a colorectalsurgeon, but I ask people all
the time, who's your primarycare doctor?
Cause you showing up to mesaying you saw rectal bleeding
and I'm like, who's yourprimary?
(29:46):
I'm like, I don't have one.
I'm just like, I'm your firstline of defense.
I'm like, no, I should not beyour first line of defense.
Because, you know, so if you'reseeing your primary care doctor,
they know your labs every year,um, your general disposition,
your general complaints.
So if you show up outside thenorm, they're like, wait, wait,
(30:06):
wait, no, no, no, they're moreof an advocate.
They're not, you know, they'renot going to, Brush you off.
They know you, they know yourbody.
Or, you know, you've beengetting labs all this long and
all of a sudden you're sayingyou see bleeding and I check
your labs and your labs havebeen hemoglobin 15 this whole
time.
And now it's nine.
Wait a minute.
I have a track record.
I know this is abnormal for you,but if you only showing up when
(30:26):
you have symptoms, nobody knows.
Chris (30:29):
Absolutely.
Thank you for that.
And so this is, this is a, thelast question here because this
isn't just came in not too longago.
Okay.
What role, and this is fromsomeone who is on the
nutritionist end too, what roledoes diet and lifestyle play in
reducing colon cancer risk?
And are there any specificrecommendations that you have
for the communities mostaffected by?
Erin (30:51):
Yep.
So, uh, my easiest punchline iswhat's good for the heart is
good for the good.
It's good for the butt.
Right.
So, you know, I'm going to steal
Chris (31:00):
that.
Erin (31:02):
But it's true, right?
Um, so, you know, the same thingthat I would tell anybody who's
trying to get right from acardiovascular standpoint, from
obesity, from a diabetesstandpoint, it's all of those
things that are leading to, youknow, toxicity, inflammation,
you know, dis ease within yourbody.
So you got to eat a diet, youeat all the colors of the
(31:23):
rainbow.
Okay.
Um, you need to eat off of theperiphery of the grocery store,
going up and down the aisleswill predispose you to packages
with.
All these extra sugars andingredients and preservatives
and all that stuff.
So eating whole foods, high ingrains, um, you know, and then
exercise.
So obesity is linked toincreased rates of colorectal
(31:46):
cancer, but even separately,just lack of exercise, right?
There's.
The blood has to flow to the gutfor you to digest and be
healthy.
And so the less you move, theless blood flow, the less oxygen
and nutrients are delivered tothe gut as well, to the colon as
well.
So no smoking, you know, alcoholin, you know, minimal to none.
(32:06):
Um, I'm not even going to saymoderation.
I'm going to say minimal tonone.
You know, avoiding red meatagain, not saying never, ever,
but that shouldn't be yourconsistent diet.
And so you're going to stickwith the fruits, the veggies,
the whole grains.
Um, and then everything elsethat's pleasurable, you're just
going to have as needed and notas the core of, your diet.
Chris (32:27):
And, you know, like you said, moderation is, is the key,
right?
And so a lot of the things thattaste really, really good.
moderation, right?
That's the thing.
And unfortunately, especially aswe see in a lot of our
communities as well, you got alot of these fast food places
that taste really good.
You got a Popeye's on everycorner, right?
Especially here in Milwaukee.
And you know, those things overtime.
(32:48):
Are, are not going to be goodfor your cholesterol.
It's not going to be good foryour heart, your gut, or your
butt.
As Dr.
King Mullins said, right?
So this is what we, this is thereality situation and you know,
it is what it is.
Right.
So,
Erin (33:00):
yeah.
Chris (33:01):
All right.
Well, Dr.
Erin King Mullins, I appreciateyou coming out and speaking with
us.
Any closing thoughts that youhave for our audience or
anything you want to impart andhow can they get more
information, you know, on you oryour specialty, et cetera.
Erin (33:13):
Sure.
So, um, so my website is colowellness.com.
Um, and, you know, parting wordsis, can have as, have as many
words as you can with yourfamily, with your kids, and all
of those types of things sopeople truly understand their
risk.
And I am gonna plug, um, I did,I, I started a book series, so
(33:33):
two book books down.
A couple more to go.
Um, can find them on Amazon.
So mommy, I made a boo boo, uh,talks, uh, helps with again,
that younger generation who hasyoung kids who got to start
talking about this stuff with.
So natural digestion, um, youknow, kind of the parts of the
body.
You can even learn the differentdigestive organs.
Um, book two is also availableon, on Amazon.
(33:55):
Mommy gets a colonoscopy.
So walking through that processof getting that screening and
then books three and four areavailable.
So, um, mommy's brave journey,she's going to talk about her
experience with colorectalcancer.
Um, and it's going to be afamily friendly book.
So you can talk with youngerkids about it.
And then ultimately, um, we'regoing to have, um, mommy's new
(34:16):
best friend or something.
I actually haven't officiallycreated the title, but mommy has
an ostomy bag, right?
So what are some of the longstanding ramifications of going
through these process?
So appreciate the time.
Um, and just letting me sharewith your audience.
Chris (34:30):
Absolutely.
And you know, kudos to you fordoing all the books.
I just purchased mommy.
I made a boo boo So you all goout and get that but but shout
out to you and and make Makingit more palatable for our
communities and making it morepalatable for our younger
generations, too And as you saidas we're starting to see this
more and more, you know, moreawareness is going to be the key
Uh more, you know avenues forresearch, etc, etc So I
(34:51):
appreciate all that you're doingand I appreciate you spending
the time here with us.
Dr.
Aaron King Mullins I appreciateyou.
Erin (34:56):
Thanks.
Chris.
Have a good one.
Chris (34:58):
Have a good one Alright,
Erin (34:59):
bye.
Recent information that we havefrom the NIH's National Cancer
Institute SurveillanceEpidemiology and End Results
Program demonstrates thatapproximately 4% of men and
women will be diagnosed withcolorectal cancer.
at some point in their lifetime.
And that's based on the datafrom 2018 to 2021.
And with that being said, 2020,the information is a bit off due
(35:23):
to COVID 19.
As of 2021, over 1.
3 million people living withcolorectal cancer in the United
States.
So this is something that isgoing to affect a lot of folks
in our generation, a lot offolks to, in generations to come
as well.
And so as Dr.
King Mullins had spoken to inour interview, there's a lot of
things that you need to have inthe back of your mind when you
(35:45):
are considering what is yourrisk for colorectal cancer.
As we discussed having adequateand accurate family history is
going to be key.
And with that being said, a lotof that's going to call back to
some of the things that we'vetalked about on this show before
and other episodes, havingaccess to that family history,
having access to primary caredoctors, making sure that your
(36:07):
family members do too, becauseyour history is tightly tied to
your family's history as well.
Your mother's risk factorsassociated, your father's, your
maternal, paternal grandmother,All your family members history
is tied to your own.
So make sure that you're havingthese discussions with your
family members as after King,well, I spoke to make sure that
you have that accurateinformation talking about if you
(36:28):
go to the emergency department,if you go to your primary care
doctor, Make sure your familymembers understand what they're
being told.
Make sure that they understandwhat the results of those test
are.
And if they need help,definitely give them the help.
Definitely reach out to yourprimary doctor if you have any
further questions.
Or you can always reach out tous here at Pulse Check
Wisconsin.
(36:49):
We try not to give any medicaladvice, but we can direct you in
the right direction to make surethat You're able to interpret
that information and take thatforward and helping to promote a
healthier lifestyle.
I want to thank Dr.
Aaron King Mullins for joiningus here today.
Hopefully we'll have her onagain.
We're looking forward to, uh,helping her continue to build
her brand, helping her continueto get the word out about
(37:11):
colorectal cancer, about whatshe does as a colorectal
surgeon.
Um, and just enjoyed speakingwith her today with that being
said, I want to let you guysknow, I appreciate you coming
out.
I appreciate you listening to ushere and giving us more
information, giving usquestions, a lot of what you're
saying, questions that you sendtranslate into how we're going
(37:32):
to tailor the show.
I want to make sure that we'remaking the show as interactive
as possible.
Want to make sure that you allknow that we are listening to
you.
We try to get back to everybody,uh, as soon as we get those
questions.
So keep them coming and, uh, younever know, your idea may end up
as a show.
So that being said, I want tomake sure that you guys stay
(37:52):
tuned.
We got good episodes coming uphere, uh, in season two, as we
round out season two.
So definitely keep thosecomments, stay tuned.
And with that being said,
Bozeman as King T'Challatransformed Hollywood for many
black Americans offeringrepresentation long overdue
accomplishing so much in just afew short years, all while
waging a personal and privatebattle.
A statement on Instagramrevealing the star just 43 had
undergone treatment for coloncancer since 2016, making movies
(00:21):
during and between countlesssurgeries and chemotherapy.
News of Boseman's untimely deathstunning the world.
Denzel Washington, who helpedpay for Boseman to study acting
at the British Academy ofDramatic Acting in Oxford,
saying he was a gentle soul anda brilliant artist.
to be young, gifted and black.
We all know what it's like To betold that there is not a place
(00:44):
for you to be featured, we couldcreate a world that exemplified
a world that we wanted to see
Chris (00:54):
Welcome to pulse check, Wisconsin.
(01:36):
Good morning.
Good evening.
Good afternoon.
This is Dr.
Ford Pulse Check, Wisconsin.
And I wanted to thank you forjoining us We have a good
episode here for you today.
As you heard from the introtoday, we're going to be
discussing a topic that is onthe minds of a lot of folks
right now, which is colorectalcancer.
As we've seen, at least inrecent years, we've seen an
(01:57):
increase in the rates ofcolorectal cancer.
We've seen it more readily inthe media.
We've seen celebrities, JamesVan Der Beek, Chadwick Boseman,
who have been either diagnosedor have died secondary to
colorectal cancer.
And so it's something that weneed to take a look at and
(02:19):
something that I continue to getfan questions about, uh, what is
their risk, who should getscreened, things of that nature.
And so, um, um, I thought itwould be good to go directly to
the source and have one of ourexperts on the topic really
speak out and to give us somepointers and give us some tips
about it.
So today we have with us Dr.
(02:40):
Erin King Mullins, who is aboard certified colorectal
surgeon in Georgia.
Dr.
King Mullins has a couple ofdifferent resources that are
available.
She's an author.
She has her own website.
She has her own organization,which is focused on increasing
awareness about colorectalcancer and about colorectal
(03:00):
cancer screening as well.
So with that being said, we arevery fortunate to have her with
us and hope you enjoy thisinterview.
(03:27):
right.
All right.
We're going to get startedagain.
Uh, Dr King Mullins I appreciateyou coming out and speaking with
us on this topic.
Again, we've got a lot of, Uh,fan questions about it and we
just more so wanted to dig alittle bit more into it and I
gave an intro for you at thebeginning of this episode, but
if you could, could you share alittle bit, about yourself and
who you are and then about yourjourney into medicine?
Erin (03:48):
Sure.
Thanks for having me.
Um, always a pleasure toenlighten anyone on colorectal
cancer and the risks and just,colon health in general, because
there's so many myths out thereand so many things that we
understand stood about it haschanged over time.
So we just gotta, you know, keepour ear to the ground.
So I'm a colorectal surgeon.
I've been in practice for almost10 years now.
(04:11):
I, you know, when I first wentinto medicine.
So I knew since I was about 12that I wanted to be a doctor.
I didn't have some big, like,aha moment or some, like, crazy,
scary medical situation withmyself or my family member.
It was just kind of I knew it.
And so I was privileged to havemy older sister, who's about 11,
12 years older than me, sheactually pursued medicine.
(04:34):
And so I kind of was able to seethat trajectory.
So people were like, you know,did she inspire you?
And I'm like, yeah, it was weirdthough.
Cause I kind of knew before shewent to medical school that I
wanted to be a physician, but Iwas able to actually, you know,
kind of mirror her footsteps.
Once she was there.
And then kind of after all ofthat, just going through the
process and you know, really notfraying from that, just going
(04:56):
straight through high school,you know, college, mid school,
residency and all of that stuff.
My solidification on what Iwanted to specialize in really
just didn't, Come until time andexperience to figure out what I
liked and I didn't like.
Yeah.
Chris (05:10):
Yeah.
And, and, you know, you bring upa good point there too,
especially being able to see itand, and kind of walk those
steps that your sister did too.
We, we had another discussion onwith actually a few other
physicians that came on too, andit's the, the idea comes up over
and over again of, you know, youcan't be what you can't see and
what you can't perceive yourselfin those, in those roles.
And so it's really good that.
(05:31):
You had that experience and thatyou had, someone who also is in
that, in that Avenue and you'reable to see the educational
steps as well as the training sowe, we brought it up at the very
beginning.
I believe it was season one thatwe talked about one of the
potential topics that we weregoing to discuss.
And the reason being is, We'reseeing a lot of social and
health disparities associatedaround colorectal health,
(05:53):
especially in the, in the commonarea right now, we're seeing,
you know, these rates ofcolorectal cancer being
diagnosed, you know,unfortunately, in some cases in
late stages, what.
What unique challenges do youthink, you know, African
American patients face when itcomes to colorectal health and
just colorectal health ingeneral for all demographics?
Erin (06:10):
So I think a lot of just kind of what we understand about
disparities in general withunderrepresented populations in
this country a lot of thedisparities in colorectal health
can just mirror that.
Those who are from lowersocioeconomic classes, uh, may
have decreased access to certainscreening and care.
(06:32):
Um, but it's interesting, youknow, the studies have actually
shown that if you Mitigate allof the disparities and just look
at person to person.
There's no real disparity in theoverall outcomes of colorectal
cancer, the ability to getscreened, the willingness to get
screened.
So there's something that'sgoing on along the way that
(06:54):
that's causing this to happen.
And time will tell as we're ableto perform more research.
What is the key factor?
We just talked about if youcan't see it, you can't be it.
And again, the studies show thatwhen you have a concordance of
the gender, race, ethnicity ofpatient and provider, there's a
better relationship there.
(07:15):
And the patient is much morelikely to have better outcomes
and to adhere torecommendations.
And then also outside of that,you know, when they did some
research, they found out thenumber one.
Reason that people don't getscreened is actually not being
told they have to be screenedAnd so again, so there's so many
(07:37):
levels and layers to all ofthis.
Um that that that plays a role
Chris (07:41):
Yeah, and you know, you brought up a good point because
you know, it's not just inafrican american communities,
too, right?
We're seeing in the hispaniccommunities as well You know,
there was a study that came out,I think it was about like 2020,
I'm sorry, 2013 or so, wherethey saw that, you know,
minority populations had a rateanywhere from like 15 percent to
26 percent higher, beingdiagnosed with colorectal
(08:02):
cancer.
But like you said, some of thatis, how much exposure that you
have to primary care physicians,how close that, that, that
treatment is and even beingaware that you're at risk for it
is a whole differentperspective, right?
Like knowing that you should bescreened and what those risk
factors are.
Yeah.
And so in 2020, so this is theone, this is the question that I
(08:23):
get the most.
So in 2020, we were alldevastated by the loss of
Chadwick Boseman.
You know, we all know him fromhis roles, various roles, right?
So, um, yeah, the most notableone for most is, you know, King
T'Challa and Black Panther thatput colorectal cancer, back on
the map for a lot of us becausehe was so young when he, when he
died of it, he was still in hisforties.
(08:44):
Um, and at that point in time,you know, the, the cancer had
progressed to the point where,it was, it was, it was
unfortunately terminal.
Why are we seeing in yourestimation, why are we seeing
such a higher rate of colorectalcancers and being more severe in
these cases now on young,younger demographics than we've
seen before?
Erin (09:00):
So I'm actually going to start out with, um, uh, a stat
that is, that's current by theyear 2030.
Now that sounds like somefuturistic date, right?
Five years from now, by 2030,colorectal cancer is going to be
the number one cancer killer inpatients or persons under the
(09:24):
age of 50.
Okay.
Um, and Again, this is somethingthat it's complex.
You know, when I refer toChadwick Boseman, I tend to tell
people.
So he was actually diagnosedwhen he was 38.
Okay.
He underwent a surgery, hadtreatment and all of those
(09:44):
things.
And, um, I'm not sure if he, youknow, had, um, if he went into
remission and it came back orwhatever kind of progressed to
him to get to that point, but hewas originally diagnosed at 38.
38.
Now, what we don't know is washe having symptoms for a period
of time that either he ignoredor that he reported to a
provider that that got ignored?
(10:07):
Don't know.
Or was he at increased risk forsome other reason?
Was there a family history ofUh, of a hereditary, um, factor
or colorectal cancer that eitherhe didn't know about or, or, you
know, you know, didn't pursuescreening early.
So there's so many things topotentially consider that we
don't know.
But what we do know is he was38.
(10:28):
He was young.
And so across the board, youknow, um, we're learning about
all of the environmentalchallenges, um, the
microplastics, the, the GMO andprocessed foods and steroids and
food and pesticides and food,um, you know, the relative, uh,
when you look at the overalllevel of activity of most,
persons these days, I'm so usedto train to say patients, but
(10:51):
the, the activity levels that weall have right now are much
lower than, our ancestors, ourBMIs, right?
The baseline body mass and allof those things that the ideal
body weight is shifted.
So there's so many of thosethings.
It's hard to trigger what theexact, um, and there is probably
not going to be one exact, likesmoking gun that we're going to
(11:13):
find, but all of those Thingsplay a role.
And what that does is feed intohow we have to then screen your
family and, and, and talk andfamily children, you know,
earlier and more frequently oncethis age and your family keeps
getting lower and lower.
And then the one key thing thatI really want to hit on as well
(11:35):
is everybody talks about whetheror not they had a family history
of colorectal cancer.
But you also have to talk aboutif there's a family history of.
Polyps because polyps are a precancer, right?
That's what eventually grows andturns into cancer.
So when you get a colonoscopy,yeah, you may have a polyp.
Your family member may have hada polyp that was removed that
was benign, but they need toknow about it because again,
(11:56):
that's a pre cancer.
So that also increases risk.
Chris (12:00):
And that's, you know, that brings up a good point too.
Just how important that historyis.
We're taught in medicaleducation.
We're taught in medical schoolas well.
that the history is the mostimportant thing that you can
obtain.
Not labs, not tests, not, youknow, whatever.
Right.
Um, but actually having thatcontext, especially in the cases
of things like cancers, right.
Colon cancer, breast cancer, youknow, you name it.
(12:23):
having that family history andknowing your quote unquote
genetic history as well, thingsthat you're predisposed to, um,
you know, what effect that willhave on you and what effect
that'll have on your, yourworkup and the way that your
doctor is looking at your caseor even your symptoms is, is
paramount.
And a lot of that too is loss,right?
So if you think about it,especially as we are nearing in
(12:45):
more and more states that we'reseeing now, we're trying to
expand the access of care,especially in primary care.
You know, I can tell you for afact.
that my grandmother, you know,Oh, my father said, I didn't go
to the doctor all the time.
Right.
And, and, you know, I can tellyou many people, you know,
probably you have family memberslike that too.
And so, a lot of the thingscould be risk factors that we
don't know about.
Uh, and even if we had thatinformation that we couldn't
(13:07):
tell, our physicians about too.
And so those are all the thingsthat, you know, we need to
consider when we're looking atall these parameters that could
be extraneous, factors playinginto why these colorectal cancer
rates are going up so high.
Erin (13:20):
Yeah.
And it's key to, you know, asyou said, as one of those
primary providers, right, thatsees a more longitudinal, um,
developmental pattern with yourpatients and just kind of all
the baseline.
When you go, I tell patients,like, when you go and have your
annual visits or you go see aspecialist and this and that,
like, You need to be updatingyour primary care physician on
(13:42):
new findings, not only foryourself, but also in the
family, right?
Because that impact of you allof a sudden you're fine, you're
trucking along.
And then all of a sudden, Hey,yeah, last year my mom did go
and have some, um, have acolonoscopy and she had several
polyps removed.
So now that's going to change myindex of suspicion on certain
things.
If you come to me next year orthe year after with certain
(14:06):
complaints or symptoms, my earsmight be in tuned or peaked or
may think you need moreaggressive evaluation of those
symptoms because now you are ina higher risk category than if
you would have been at steadystate, no family history, no
nothing, you know?
So again, it's also important toupdate your family history with
your different doctors.
Chris (14:26):
Right.
Absolutely.
One of the questions that camein specifically was having to do
about biological, uh, thebiology of the patient or
genetic factors.
Are there any, intrinsicbiological or genetic factors
that disproportionately affectminority communities, African
American, Hispanic communitieswith colon cancer that, that
you're aware of?
Erin (14:46):
So not that we're immediately aware of, um, and
one of the things is justbecause as we know, um, African
Americans are less likely to berepresented in scientific
studies.
And so a lot of the different,data banks, you know, when you
hear about the Lynch syndrome orthe HMPCC and all of those types
of things, you know, typically,underrepresented populations.
And so African American, NativeAmerican, you know, um, Latin
(15:08):
American, um, Patients will beunderrepresented in those
studies and those data banks.
So it's hard to, at this point,distinguish a true genetic or
hereditary link, or is it moreof what we call is epigenetic
and environmental, you know,type due to diabetes tends to
run in families, not because.
Mostly genetics, but becausethey tend to have the same
(15:31):
dietary habits and, and, andphysical, um, uh, activity or
lack thereof.
And so right now those are gonnabe the most, contributing
factors that we know of forsure.
And hopefully over time as weget increase the numbers and of
the biogenetics of cancers andtumors and polyps, we can then
truly look back and see, youknow, is there truly a genetic
(15:53):
leak or is it just mostly, um,epigenetic or environmental?
Chris (15:57):
Absolutely.
And I'll link, you know, for ourlisteners, cause some of our
listeners are medical, some arenot.
And I'll link some of thatinformation just kind of getting
into, you know, polyps versusprimary cancers and things like
that too, in case you guys wantto do a deep dive on all of that
but a couple of things that youbrought up there leads us to our
next point.
You know, like you said, a lotof the studies that we have
right now do not unfortunatelyinclude some of those
(16:18):
populations that are mostaffected, right?
And we had Dr.
Jane Morgan come on who was acardiologist in Atlanta as well.
And she spoke to that, right,because she does a lot of these,
uh, a lot of these studies and,you know, she, she, she's
begging folks in some cases to,to be a part of those cardiac
studies, just because a lot ofthe data that we have is not
based on our epigenetics andit's not based on, you know, the
things, the, the demographicsthat we commonly see represented
(16:41):
in our populations and in ourfamilies.
And so with that being said,colon cancer is often
preventable and, you know, wesee the things like Cologuard
and things like that are coveredby insurance.
at age 45, right?
What are some of the mosteffective strategies for
prevention and you know, how canthose be better communicated or
made better available, uh, tothose communities most affected
Erin (17:03):
so the number one, um, single piece of power that you
have is the power ofconversation.
Okay, so to talk to yourproviders, um, talk to your
family members, your kids, likeeverybody, just understand, you
know, who had what and when.
And sometimes it's not as simpleas who had colon cancer or who
(17:25):
had polyps, but if you startseeing a pattern of different
cancers, so, you know, asmattering of people had breast
cancer and then somebody hadpancreatic cancer and then
somebody had prostate cancer,that's another potential genetic
link that might increase yourrisk of colon cancer.
of colorectal cancer.
So number one, just having thoseconversations before you even
worry about involving doctorsand procedures and doing all of
(17:46):
that.
Um, also there's a differencebetween, we have to understand
the difference between screeningand diagnostic.
So screening means that, youknow, you've reached a certain
level of risk where we need tostart looking.
You're not having any symptoms,there's no problems.
So the average risk individual,the recommended age for
(18:08):
screening is now 45.
The age decreases with certain,um, family history or personal
history.
If someone has inflammatorybowel disease or Crohn's
disease, ulcerative colitis,again, family history of
different cancers of colorectalcancer or polyps, um, screening
may need to occur earlier.
Now, that's different thandiagnostic, meaning if someone
(18:29):
presents with symptoms, so achange in their bowels,
abdominal pain, uh, bleeding,um, from the rectum or blood
mixed in the bowel movements,that's a diagnostic examination.
And so that's a different reasonto go look.
So a colonoscopy is consideredto be both a screening and
diagnostic tool and atherapeutic tool.
If you see something, sometimesyou can do something about it
(18:52):
right then and there.
You see the polyp, you remove itand preventing it from growing
and turning into cancer.
So you've diagnosed a precancer, you've screened for
colorectal cancer, but you'veprovided a therapy all in one
fell swoop.
Some of the other what we callour non invasive testing, like
the, um, the, the stool basedexam.
So people may see the brand nameCologuard quite a bit.
(19:15):
Um, there's different testingfor microscopic blood and the
bowel movements.
Again, those are all screeningexaminations and not everybody
is a candidate.
for those.
So anybody with any increasedrisk.
So family history, they'reautomatically not a candidate
for those things because it'snot quite as sensitive or
specific to really pick that up.
(19:36):
Um, and then also if they havesymptoms, it's not advised to do
it because there can be a falsepositive or a false negative.
It's not going to diagnose thechanges in your bowels, right?
Um, and then the last thing, uh,and I hope this doesn't just get
me booed off the stage, but Thenon invasive tests that are
(19:56):
frequently advertised, um, ordiscussed or preferred sometimes
by patients, you have tounderstand the risks of using
that examination and testing.
Knowing if it's the mostaccurate examination for you.
So we talked about AfricanAmericans not being as
represented in research studies.
(20:18):
And so some of the studies forsome of these stool based
examinations did not have.
Fully adequate numbers ofAfrican Americans in them to say
that the sensitivity,specificity, accuracy, all of
those different statisticalwords you want to talk about, is
as good in the African Americanpopulation as in the general
(20:39):
population.
So it's better than nothing.
Yeah, if, if number one, youcan't get anybody to do anything
else or doing a colonoscopy isan investment.
So not only do you have to takeoff work for that day, someone
else may have to take off workthat day.
You need a driver, you know,there's so many things that go
into it.
So if you cannot get the goldstandard examination, the
(21:01):
colonoscopy, I'd rather you getsomething, but understand what
you're getting out of that testand what it means.
Chris (21:08):
And that's key too, especially, you know, I, I won't
go on my tangent about some ofthe, you know, the, the
financial aspect of medicine andthe financial aspect of some of
these kits and medications andet cetera, et cetera, we can go
on for days and days.
But as you start to see more ofthe commercialization of these
tools, like you said, it's, it'sreally, You know, it's hidden in
(21:31):
there, like who that actuallyapplies to, right?
And you know, what those studiesare based of.
And even when they're talkingabout even those bullet points,
90 percent specific, thesensitive, I should say, uh,
specificity X, Y, and Z, whatdemographics that actually
includes and what demographicsthat does not include.
Right.
Um, and so those are things thatyou and I read those studies.
Studies knowing, because we wentthrough the training and we know
(21:51):
how to do it now, but that,that's key.
I feel like that's a key pointfor everyone to know.
Who's listening to this too?
You know, what, what thosenumbers actually mean and you
know, all the things that yousee, uh, coming up with a Super
Bowl or a national championshipon those commercials that may
not be, you know, what youexpect'em to be.
Erin (22:07):
Yep.
Yep.
Yep.
Yep.
Chris (22:09):
So screening is key to prevention, like you said, and
you know, whatever folks arewilling to, to, to do.
I can tell you, I've had many adiscussion and many of, uh, you
know, uh, of a fight with folksand trying to get them to get
the colonoscopies, bothpatients, friends, you know,
family members at thebarbershop, et cetera, et
cetera.
Right.
So what advice do you have forindividuals who may feel
(22:30):
hesitant or fearful about thecolonoscopy?
How would you approach them?
Erin (22:35):
Well, oftentimes, you know, the stories that people
always want to tell bad stories.
Okay.
How many people come to you andsay, Oh, I had my colonoscopy
and it was the best experienceever.
like reading those restaurantreviews online, right?
Y'all always got to add one ortwo points more because if
people just had a normal,traditional regular, I showed up
at the restaurant, they orderedtheir food, they enjoyed it and
(22:55):
they went home.
They're probably not going tonecessarily a writer review if
they didn't have a glowingexperience and the overwhelming
majority of people who had a badexperience are going to go.
On and talk about that.
So you have to understand that.
So that's what I advise folkstoo.
And then sometimes you just haveto meet people where they are,
like, understand what is theirfear?
What is their understanding?
(23:16):
What is their hesitancy?
Because there's a lot of mythsthat we as providers sometimes,
um, have to, you know, debunk.
And then especially in thefolks, um, When you think about
now, again, the younger andyounger age, um, of diagnosis, a
lot of these folks have youngerand younger children, okay?
(23:36):
We're talking about babies,toddlers, like people that they
are still responsible for.
It's not like the 70, 80 yearold grandma who have their
children who can actually helpthem in the process.
We're talking about thissandwich generation, and some of
these folks may have to care fortheir parents, and now they're
also caring for littles too.
And so What I usually say thatreally gets them.
(23:59):
I'm like, okay, do you have kidsor, you know, you have a loved
one, a spouse or anything?
They're like, yeah, I'm like,okay.
Um, you love them.
Yeah, of course you do anythingfor them.
You know, you, you jump in frontof a train, a bullet.
Oh yeah, yeah, yeah.
So why don't you live for them?
If you're willing to die forthem, let's make sure you live
for them.
Don't put them through a tragedythat they don't have to
experience.
(24:19):
But also again, what impacts youimpacts them.
If you have something bad goingon inside, like.
Wouldn't you want to be able toprotect your kids so that they
don't have to live through thesame battle that you go through?
Um, you know, and a lot oftimes, and then people are like,
Oh, you know, you got to die orsomething.
Colorectal cancer is not a funway out.
Chris (24:38):
That's the one you want to do the way you want to go.
Erin (24:41):
It's, it's, it's, it's not like, Oh, I had a heart attack
or a stroke and I'm just out andit didn't feel anything.
Okay.
And so those, those are the, soyou got to come up with your
tactics to figure out like who,how you're going to hit that
person that just.
for whatever reason.
Chris (24:57):
And that's the thing you're, like you said, you, you,
you have to live for your familymembers, right?
This is something that not onlyphysically is going to affect
you down the way for, in somecases, long periods of time.
I'm sure Dr.
King Mullins and I both haveseen patients for a number of
years who have had complicationsassociated with colorectal
cancer complications associatedwith some of the surgeries when,
(25:18):
you know, some of those thingscould have been prevented early
on.
And.
You know, not only that physicaleffect, but also the financial
burden on patients too, as we'restarting to see in the media
more and more, some of theseinsurance issues that folks are
having, you know, it's going toaffect you in every aspect of
your life.
And so, that, that's the thingyou got to consider when you're
thinking about some of the, anyaspect of your health, not even
(25:38):
colorectal cancer, but anyaspect of your health.
So we're trying to get people,to, to, to get access to primary
care doctors, to get access totheir medications, because you
know, this, the old ounce ofprevention, right?
This is, these are things thatwe're trying to prevent to
prevent you from having, youknow, that, that morbidity and
mortality down the road too.
Erin (25:55):
And again, just like kind of hitting back on when you
think about the concept of theyounger and younger generation
being affected, you know, a lotof these are primary
breadwinners for their family.
So it's not like folks that areolder in that near retirement
age and they had a.
And or a 401k that they buildingon forever.
So if they need to kind of slowroll into retirement now, um,
(26:16):
and you need another caregiver,a lot of times to help you with
that process.
So if you're 45 and beingdiagnosed with stage three
colorectal cancer, now you can'tgo to work and your spouse or
some other loved one can't go towork either.
So it's a double.
triple hit on the pocket of, youknow, the losing earning
potentially from more than oneperson.
And the financial impact of nowyou have to pay to cover all of,
(26:36):
you know, these medicines andinsurance.
So it's, it's so, it's so muchdifferent to just go in and get
your covered free screening,colonoscopy, screening
examination.
To ward off all of those evilspirits.
Absolutely.
Chris (26:53):
Absolutely.
So here's a question from, from,from one of my good friends on
our text thread here.
So one of the things that heasked was, so we all are below
the age of 45 right now.
We are not in the cohort thatwould qualify for any of these
home testings or things likethat.
Even the colonoscopy based onour risk factors.
What recommendations would youhave for someone who is in the
(27:15):
minority community as we'reseeing these incidences of colon
cancer, colon cancer.
Is this something that theyshould consider paying out of
pocket for for colon screeningshould just watch out for
symptoms.
What are some of the things withsome of the recommendations you
would give as a colorectalsurgeon?
Erin (27:29):
So the first thing is make sure you're actually in that low
risk category, right?
So go back and have them.
So go back and have thatconversation.
Ask your, your mama, everybody,whoever it's like, don't just
say specifically like whoever,just like, what did people die
of?
How old were they when they diedof it?
You know?
So all of those things.
So, and be explicit like, mama,did you have your colonoscopy?
(27:51):
You said it was fine.
What does that mean?
Did you have a.
Polyp that was removed.
They again, may have told youthat polyp was quote unquote
fine.
That doesn't mean that it wasn'ta pre cancer.
So we're
Chris (28:01):
good at doing that.
Oh, everything was fine.
Erin (28:04):
Exactly.
Exactly.
So get all in the business.
That's the number one.
So number one, make sure you arein that low risk category.
And then if you are, um, youknow, I can't advise you one way
or the other, you know, outsideof that, you know, really, um,
there, you may have access inyour area if you're really,
(28:24):
really concerned.
Um, you know, if you, you may bein an area that has some kind of
pretty low cost access to some,examination, colonoscopy or
whatnot.
Um, and so I'm just going toleave that to you and your
family to make that decision onhow concerned you are.
But yeah, but also don't.
ignore symptoms.
And the thing is, symptoms forcolorectal cancer are very, what
(28:46):
we call, are non specific.
So there's not going to be asmoking gun.
Um, so changes in your bowelsthat are persistent, naive.
If you ate the nachos lastnight, like most of us are
lactose intolerant.
Most of
Chris (29:00):
us need to take that lactate.
Erin (29:02):
So, you know, within, within reason, like a persistent
change in the bowels that can'tbe explained by a recent illness
or change in medicine or changein diet, you know, rectal pain,
bleeding, you know, any otherjust kind of prolonged
constellation of.
Things outside of your norm, notsaying you have colorectal
(29:25):
cancer, not saying you havepancreatic cancer or anything
else, but go talk to yourphysician and number in the, and
that again brings back theimportance of a primary care
physician.
I, and I, I get on my soapbox inmy office, you know, I
understand I'm a colorectalsurgeon, but I ask people all
the time, who's your primarycare doctor?
Cause you showing up to mesaying you saw rectal bleeding
and I'm like, who's yourprimary?
(29:46):
I'm like, I don't have one.
I'm just like, I'm your firstline of defense.
I'm like, no, I should not beyour first line of defense.
Because, you know, so if you'reseeing your primary care doctor,
they know your labs every year,um, your general disposition,
your general complaints.
So if you show up outside thenorm, they're like, wait, wait,
(30:06):
wait, no, no, no, they're moreof an advocate.
They're not, you know, they'renot going to, Brush you off.
They know you, they know yourbody.
Or, you know, you've beengetting labs all this long and
all of a sudden you're sayingyou see bleeding and I check
your labs and your labs havebeen hemoglobin 15 this whole
time.
And now it's nine.
Wait a minute.
I have a track record.
I know this is abnormal for you,but if you only showing up when
(30:26):
you have symptoms, nobody knows.
Chris (30:29):
Absolutely.
Thank you for that.
And so this is, this is a, thelast question here because this
isn't just came in not too longago.
Okay.
What role, and this is fromsomeone who is on the
nutritionist end too, what roledoes diet and lifestyle play in
reducing colon cancer risk?
And are there any specificrecommendations that you have
for the communities mostaffected by?
Erin (30:51):
Yep.
So, uh, my easiest punchline iswhat's good for the heart is
good for the good.
It's good for the butt.
Right.
So, you know, I'm going to steal
Chris (31:00):
that.
Erin (31:02):
But it's true, right?
Um, so, you know, the same thingthat I would tell anybody who's
trying to get right from acardiovascular standpoint, from
obesity, from a diabetesstandpoint, it's all of those
things that are leading to, youknow, toxicity, inflammation,
you know, dis ease within yourbody.
So you got to eat a diet, youeat all the colors of the
(31:23):
rainbow.
Okay.
Um, you need to eat off of theperiphery of the grocery store,
going up and down the aisleswill predispose you to packages
with.
All these extra sugars andingredients and preservatives
and all that stuff.
So eating whole foods, high ingrains, um, you know, and then
exercise.
So obesity is linked toincreased rates of colorectal
(31:46):
cancer, but even separately,just lack of exercise, right?
There's.
The blood has to flow to the gutfor you to digest and be
healthy.
And so the less you move, theless blood flow, the less oxygen
and nutrients are delivered tothe gut as well, to the colon as
well.
So no smoking, you know, alcoholin, you know, minimal to none.
(32:06):
Um, I'm not even going to saymoderation.
I'm going to say minimal tonone.
You know, avoiding red meatagain, not saying never, ever,
but that shouldn't be yourconsistent diet.
And so you're going to stickwith the fruits, the veggies,
the whole grains.
Um, and then everything elsethat's pleasurable, you're just
going to have as needed and notas the core of, your diet.
Chris (32:27):
And, you know, like you said, moderation is, is the key,
right?
And so a lot of the things thattaste really, really good.
moderation, right?
That's the thing.
And unfortunately, especially aswe see in a lot of our
communities as well, you got alot of these fast food places
that taste really good.
You got a Popeye's on everycorner, right?
Especially here in Milwaukee.
And you know, those things overtime.
(32:48):
Are, are not going to be goodfor your cholesterol.
It's not going to be good foryour heart, your gut, or your
butt.
As Dr.
King Mullins said, right?
So this is what we, this is thereality situation and you know,
it is what it is.
Right.
So,
Erin (33:00):
yeah.
Chris (33:01):
All right.
Well, Dr.
Erin King Mullins, I appreciateyou coming out and speaking with
us.
Any closing thoughts that youhave for our audience or
anything you want to impart andhow can they get more
information, you know, on you oryour specialty, et cetera.
Erin (33:13):
Sure.
So, um, so my website is colowellness.com.
Um, and, you know, parting wordsis, can have as, have as many
words as you can with yourfamily, with your kids, and all
of those types of things sopeople truly understand their
risk.
And I am gonna plug, um, I did,I, I started a book series, so
(33:33):
two book books down.
A couple more to go.
Um, can find them on Amazon.
So mommy, I made a boo boo, uh,talks, uh, helps with again,
that younger generation who hasyoung kids who got to start
talking about this stuff with.
So natural digestion, um, youknow, kind of the parts of the
body.
You can even learn the differentdigestive organs.
Um, book two is also availableon, on Amazon.
(33:55):
Mommy gets a colonoscopy.
So walking through that processof getting that screening and
then books three and four areavailable.
So, um, mommy's brave journey,she's going to talk about her
experience with colorectalcancer.
Um, and it's going to be afamily friendly book.
So you can talk with youngerkids about it.
And then ultimately, um, we'regoing to have, um, mommy's new
(34:16):
best friend or something.
I actually haven't officiallycreated the title, but mommy has
an ostomy bag, right?
So what are some of the longstanding ramifications of going
through these process?
So appreciate the time.
Um, and just letting me sharewith your audience.
Chris (34:30):
Absolutely.
And you know, kudos to you fordoing all the books.
I just purchased mommy.
I made a boo boo So you all goout and get that but but shout
out to you and and make Makingit more palatable for our
communities and making it morepalatable for our younger
generations, too And as you saidas we're starting to see this
more and more, you know, moreawareness is going to be the key
Uh more, you know avenues forresearch, etc, etc So I
(34:51):
appreciate all that you're doingand I appreciate you spending
the time here with us.
Dr.
Aaron King Mullins I appreciateyou.
Erin (34:56):
Thanks.
Chris.
Have a good one.
Chris (34:58):
Have a good one Alright,
Erin (34:59):
bye.
Recent information that we havefrom the NIH's National Cancer
Institute SurveillanceEpidemiology and End Results
Program demonstrates thatapproximately 4% of men and
women will be diagnosed withcolorectal cancer.
at some point in their lifetime.
And that's based on the datafrom 2018 to 2021.
And with that being said, 2020,the information is a bit off due
(35:23):
to COVID 19.
As of 2021, over 1.
3 million people living withcolorectal cancer in the United
States.
So this is something that isgoing to affect a lot of folks
in our generation, a lot offolks to, in generations to come
as well.
And so as Dr.
King Mullins had spoken to inour interview, there's a lot of
things that you need to have inthe back of your mind when you
(35:45):
are considering what is yourrisk for colorectal cancer.
As we discussed having adequateand accurate family history is
going to be key.
And with that being said, a lotof that's going to call back to
some of the things that we'vetalked about on this show before
and other episodes, havingaccess to that family history,
having access to primary caredoctors, making sure that your
(36:07):
family members do too, becauseyour history is tightly tied to
your family's history as well.
Your mother's risk factorsassociated, your father's, your
maternal, paternal grandmother,All your family members history
is tied to your own.
So make sure that you're havingthese discussions with your
family members as after King,well, I spoke to make sure that
you have that accurateinformation talking about if you
(36:28):
go to the emergency department,if you go to your primary care
doctor, Make sure your familymembers understand what they're
being told.
Make sure that they understandwhat the results of those test
are.
And if they need help,definitely give them the help.
Definitely reach out to yourprimary doctor if you have any
further questions.
Or you can always reach out tous here at Pulse Check
Wisconsin.
(36:49):
We try not to give any medicaladvice, but we can direct you in
the right direction to make surethat You're able to interpret
that information and take thatforward and helping to promote a
healthier lifestyle.
I want to thank Dr.
Aaron King Mullins for joiningus here today.
Hopefully we'll have her onagain.
We're looking forward to, uh,helping her continue to build
her brand, helping her continueto get the word out about
(37:11):
colorectal cancer, about whatshe does as a colorectal
surgeon.
Um, and just enjoyed speakingwith her today with that being
said, I want to let you guysknow, I appreciate you coming
out.
I appreciate you listening to ushere and giving us more
information, giving usquestions, a lot of what you're
saying, questions that you sendtranslate into how we're going
(37:32):
to tailor the show.
I want to make sure that we'remaking the show as interactive
as possible.
Want to make sure that you allknow that we are listening to
you.
We try to get back to everybody,uh, as soon as we get those
questions.
So keep them coming and, uh, younever know, your idea may end up
as a show.
So that being said, I want tomake sure that you guys stay
(37:52):
tuned.
We got good episodes coming uphere, uh, in season two, as we
round out season two.
So definitely keep thosecomments, stay tuned.
And with that being said,
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