February 5, 2023 • 25 mins
02/05/23
The Healthy Matters Podcast
Season 2 - Episode 05 - Yep, We’re Talking About Your Colon...
A wise man once said that the colon is the organ that is responsible for modern human society (it’s actually our guest who said this, which, in itself, is probably deserving of its' own episode). From colonoscopy prep to polyps, in this episode, we shed some light on an organ that literally lives where the sun doesn't shine.
Okay, enough jokes. Colon cancer is the third leading cause of cancer - in both men and women - and it’s estimated that without proper screening, approximately 8% of the population (1 in 12 people) will get it. That’s a pretty high number for something that can be effectively treated if identified early on. Join us for a conversation with Dr. Jake Matlock, Director of the division of Gastroenterology at Hennepin Healthcare, as we go over the function of the colon, your options for screenings and current guidelines, and what can be done to reduce your associated risks. Just in time for Colorectal Cancer Awareness Month in March - it's colon health! - on the Healthy Matters Podcast (seriously, where else are you going to hear this?). Join us!
Got a question for the doc? Or an idea for a show? Contact us!
Email - healthymatters@hcmed.org
Call - 612-873-TALK (8255)
Twitter - @drdavidhilden
Find out more at www.healthymatters.org
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:04):
Welcome to the Healthy Matters podcast with Dr.
David Hilden, primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health, healthcare and
what matters to you.
And now here's our host, Dr.
David Hilden.
Speaker 2 (00:20):
Hey everybody, it's Dr.
David Hilden.
Welcome to episode five.
And as you know, if you've beenlistening to this podcast on
this show, we talk abouteverything today, we're gonna
prove it as we talk about yourcolon, otherwise known as your
large intestine.
To help me out, I have Dr.
Jake Matlock on the show today.
He is the director of theDivision of Gastroenterology at
(00:41):
Hennepin Healthcare and acolleague of mine for over 20
years.
Jake, welcome to the show.
Yeah, it's a
Speaker 3 (00:47):
Pleasure.
Thanks for having
Speaker 2 (00:47):
Me.
So you're a gastroenterologist.
Why should people care abouttheir intestines?
What can go wrong?
Speaker 3 (00:51):
So, you know, your intestines are actually the one
of the most amazing organs inyour body, in my opinion.
Uh, and I like to tell mypatients that the colon is the
organ that's responsible formodern human society
Speaker 2 (01:03):
.
Okay, you're gonna have toexpand on that.
Speaker 3 (01:07):
So your, your intestinal tract provides about
three liters of liquid waste toyour colon every day.
And your colon is responsiblefor taking that three liters of
liquid waste and converting itto a small volume of solid stool
and providing you theopportunity to eliminate that
stool on a voluntary basiswithout your colon.
We'd be like birds, we'd be justconstantly leaking stool
(01:29):
whenever we were walking aroundin the day, and we wouldn't be
able to get anything else done.
So without your colon, modernsociety wouldn't exist.
Speaker 2 (01:37):
And I absolutely love that we're gonna geek out about
your colon and stool today.
You know, I never really thoughtof it that way, but you know, it
actually does make life a littlebit more manageable since it,
uh, your whole digestive systemis something sort of under your
control.
Speaker 3 (01:49):
Yeah, yeah.
Without, without your colon,you'd be walking around, uh,
constantly looking for water cuzyou'd be dehydrated all the time
from losing all that fluid and,uh, constantly pooping.
Okay.
Speaker 2 (01:58):
So most of us haven't thought about our intestines in
that way.
Let's talk about what could gowrong.
Speaker 3 (02:04):
So the thing that people, I think hear about the
most with your colon is, iscolon cancer.
And colon cancer is obviously a,a very important topic.
Uh, it's the third leading causeof cancer in both men and women
in this country.
Uh, and does get a lot ofattention in the media for folks
who are younger.
Uh, we often, uh, havedifficulty with, uh,
(02:26):
inflammation in the colon.
There are a variety of differentinflammatory disorders that can,
uh, impact the colon.
And then there's a whole classof problems that the colon can,
can suffer from that don'treally shorten your life or end
your life, but can make thingskind of miserable along the way.
And here I'm thinking about, uh,issues like chronic constipation
or chronic diarrhea of anon-inflammatory state that, you
(02:47):
know, again, don't kill you, butcan make you pretty miserable.
And, and, and which we can helppeople
Speaker 2 (02:52):
With.
I would say those are issuesthat make people extremely
miserable.
I hear, I hear it about it allthe time, both in the hospital
and in the clinic.
If people's bowels aren'tworking, it's a daily fact of
life that is more thanbothersome.
Speaker 3 (03:05):
Absolutely.
Yeah.
I mean, it's a, it's a hugequality of life impact if a
person's bowels are not workingin a way that, uh, that kind of
meets their expectations.
Speaker 2 (03:13):
So you mentioned colon cancer, and I think we
will focus on a little bit, uh,of that today because, you know,
you're the guy that people go tosee to get the colonoscopy.
Ta talk a little bit, if youcould, about colon cancer.
How common is it and, uh, whatpeople should know about
screening?
Speaker 3 (03:28):
So it is, it is a very common form of cancer.
Uh, you know, as I mentioned,it's the third leading cause of
cancer in this country amongboth men and women.
It's a common misconception thatit, that there is a, a
significant gender predominance,uh, and that it's more of a male
problem than a female problem.
That's absolutely not true.
So I hope that, that, uh, ifthere's any myth that we can
(03:48):
dispel today, uh, it's an equalopportunity.
Uh, uh, cancer, the estimatesare that if you don't do
anything to protect yourselffrom it, if you don't do any
screening, that roughly 8% ofpeople will get cancer.
So about one in 12, uh, will getcolon cancer in their lifetime
with effective screening that'sless than 2% and less than 1%
(04:12):
will die from it with effectivescreening.
And so, uh, I think the messagethere is that screening,
although imperfect works, it'seffective at reducing your risk.
I would encourage everybody toengage with their doctor on
Speaker 2 (04:25):
It.
That's a dramatic drop actually,from doing nothing to doing some
screening.
You can.
So it's sort of a good newsstory in that there is something
you can do to, uh, reduce yourrisk.
Speaker 3 (04:36):
Yeah, I mean, and we, we continue to refine the
recommendations about who andwhen and how screening should be
done.
But I think the take homemessage is that the important
thing is to do it, uh,regardless of how you do it, get
it done.
Uh, and, and, and that's themost effective way to protect
Speaker 2 (04:53):
Yourself.
When you say screening, what doyou mean?
So the
Speaker 3 (04:55):
Variety of different screening modalities that are
used for colon cancer, I thinkthe one that, that everybody
thinks about and everybody'sheard of is colonoscopy.
And that that still remains thegold standard screening method.
However, there are other methodsthat are available, uh, and, uh,
that some people might considerdepending on their risk factors
and discussion with their own,uh, healthcare provider.
(05:16):
The least invasive, uh, testingmethods are, are stool-based
tests.
Uh, so we can take a sample ofsomeone's stool to look for
markers in their stool thatmight indicate that they have
either a pre-cancerous conditionor a, an actual cancer.
The advantage of thesestool-based tests is that
they're non-invasive.
They're fairly easy to do.
(05:37):
Uh, they're very effective ifdone correctly, and at their
appropriate frequency.
The disadvantage of them is,number one, you do have to do
them more often anywhere fromevery one year to every three
years.
And if they come back positive,well then you have to follow it
up with a colonoscopy to, tofigure out what the issue is,
what's tripped to the positivetest and what you're gonna do
(05:58):
about
Speaker 2 (05:58):
It.
And these tests, I i order theseall the time for patients who
have elected to go that route.
And there's a misconception,this isn't like bringing a large
sample.
I know, I know this is a lovelyconversation, but you know,
it's, we gotta talk about it.
It isn't, you, you put a littleteeny bit and you put it on a
card and mail it, don't
Speaker 3 (06:16):
You?
Yeah, I mean, that, that's truefor, uh, for several of the
tests, uh, the, the I fob andthe FIT test mm-hmm.
, uh, there is aslightly more involved one
called the Cologuard, which, uh,does involve producing a larger
sample for, uh, analysis.
But again, all of them arenon-invasive tests.
Uh, they don't involve any, uh,additional visits to a
(06:38):
healthcare facility.
They don't involve anythinggoing into you or, or touching
you if that is a, an, an issuefor you.
Uh, again, the, the majorlimitation that we see of these
tests is that people don'tperform them at the appropriate
frequency.
People are people, they let itslide, and if you don't do them
at the right, uh, frequency thanthey really aren't very
(06:59):
effective.
Speaker 2 (06:59):
So that's one option.
What are the other options?
Speaker 3 (07:02):
So, uh, again, the other major option is, uh,
colonoscopy, which, uh, weperform all day every day here
at Hennepin and, and at, atother healthcare facilities
around the, the cities and thecountry.
Uh, colonoscopy offers theadvantage of offering a longer
horizon of benefit, I guess Iwould say.
So you, you don't have to docolonoscopy nearly as often as
(07:24):
these other tests for people ataverage risk, the recommended
interval is every 10 years.
So it it, if you have a normalcolonoscopy, you can, you can
take that off your plate and notthink about it for a decade.
Obviously, if you have findingsthat are of concern, your doctor
might recommend a more frequent,uh, evaluation.
But, uh, it, it, it is a, alittle bit easier in terms of
(07:46):
keeping track of the logistics.
The thing that is of concern topeople for colonoscopy is, is
more invasive.
It is more involved, uh, than astool test.
Uh, it does involve doing apreparation to clean out your
colon.
It involves a scope going inthrough your rectum and, and,
and all the way to the top ofthe colon, uh, involves an extra
visit to the, um, uh, ahealthcare provider.
(08:09):
It involves, uh, sedationusually for most people and, and
a driver to get you home.
So it's, it's a little bit morecomplicated on the front end,
but does provide a longerbenefit.
Speaker 2 (08:19):
When should people start doing these tests?
Speaker 3 (08:21):
So the guidelines have recently changed on that.
Uh, historically we'verecommended starting at the age
of 50 for people who are ataverage risk,
Speaker 2 (08:30):
Which is most people, right?
Speaker 3 (08:31):
Right.
Average risk just means don'thave a close family member who
has colon cancer or has colonpolyps.
However, guidelines haverecently shifted, and we've
started to recommend starting atage 45.
And that's because of arecognition that the
demographics of colon cancer doseem to be shifting to involve a
younger population of people.
Speaker 2 (08:49):
Why might that be?
Do we know, uh, if,
Speaker 3 (08:52):
If, if somebody knows they haven't told me
, I, uh, you know, you,you could point to to diet, you
could point to exercise, youcould point to all sorts of
environmental risk factors thatmight be in play.
But I think the short answer iswe don't know.
So
Speaker 2 (09:06):
If you're average risk, you're in your mid
forties, it's time to startthinking about it.
I
Speaker 3 (09:10):
Think that's a safe thing to say.
Yeah.
Speaker 2 (09:11):
What about if you are mom or your dad or your brother,
your sister had problems intheir colon?
Speaker 3 (09:16):
If you have a, a family history of colon cancer
and the, the most importantfamily history is, is in your
first degree relatives.
And, and by that we mean mom,dad, or siblings, uh, then you
should start screening earlier,how much earlier?
Depends on what they had, whenthey had it, and how many of
them had it.
So it's a bit of a complexdiscussion, but definitely worth
(09:37):
bringing up with your primarycare provider if that is an
issue for you.
Once you get out to seconddegree relatives, grandparents,
aunts, uncles, cousins, that canbe important.
But it, it only is germane if itinvolves multiple family members
in that second tier.
So if you do have a familymember with, uh, colon cancer or
(09:58):
colon polyps, it's definitelyworth mentioning to your, uh,
primary care provider becauseit, it will impact your risk.
But whether it changes therecommendations really depends
on the particulars of your, yoursituation.
Speaker 2 (10:08):
So you've mentioned the word polyp in addition to
the word cancer.
What's the difference?
So
Speaker 3 (10:14):
A polyp is a small growth coming off the lining of
the colon.
It is the thing that over timegrows and eventually turns into
colon cancer.
So polyps are the precursors tocolon cancer.
And in people who do not haveunderlying inflammatory
conditions of their colon, webelieve that it is the sole
pathway for the development ofcolon cancer.
(10:36):
Oh,
Speaker 2 (10:36):
So they don't, cancers don't arise from
anything else, correct.
From the polyps,
Speaker 3 (10:40):
Yeah.
So, so by identifying polyps,which we can again, do either
with stool-based tests or withcolonoscopy, and by taking them
out, which we can do withcolonoscopy, we can protect you
from getting colon cancer.
Speaker 2 (10:51):
So you can prevent it.
We
Speaker 3 (10:53):
Can, and again, the, the, the strategy is not a
hundred percent effective, butyou know, as we were talking
about earlier, it is highlyeffective at reducing your risk
and preventing you fromdeveloping colon cancer.
Speaker 2 (11:04):
We're gonna take a quick break, and when we come
back, we'll resume ourconversation with Dr.
Jake Matlock, director of thedivision of Gastroenterology at
Hennepin Healthcare, and one ofthe best medical educators I
know.
When we come back, we're gonnaresume the conversation.
Stay with us.
Speaker 1 (11:20):
You are listening to the Healthy Matters podcast with
Dr.
David Hilton.
Got a question or comment forthe doc, email us at Healthy
Matters hc m e d.org, or give usa call at six one two eight
seven three talk.
That's 6 1 2 8 7 3 8 2 5 5.
And now let's get back to morehealthy conversation.
Speaker 2 (11:44):
Jake.
Um, I was thinking about acouple more things that came to
mind about polyps.
Do all polyps turn into cancer?
So like when you tell a patient,yep, I took out some polyps.
Should that patientautomatically assume that those
polyps were destined to becomecancer?
That's
Speaker 3 (12:01):
A good question, and it's a hard one to answer.
Uh, as you can imagine, you,you'd be really hard to study
that question because you, to
Speaker 2 (12:08):
Study, you believe some of them,
Speaker 3 (12:09):
You'd have to leave them behind and see what
happens.
And I, I don't know anybody whowould sign up for that study.
Uh, I've been told, and I don'tknow if this is an apocryphal
story or not, that, that therewas a study done in the fifties
in a Indiana prison populationwhere they followed polyps, uh,
over time and found that reallysmall ones sometimes do go away.
(12:29):
I've never been able to findthis study, so I don't know if
that's true.
However, the current beliefabout the polyps based on
studying the biology and thegenetics of, of the tissue in
polyps is that once they reach acertain size and, and most
people say about a centimeter,they're committed, they're gonna
become cancer.
If not, if not removed, how
Speaker 2 (12:50):
Long?
Like, what's the timeframe?
So
Speaker 3 (12:53):
That's another very important point.
I think, you know, when, when wedo a colonoscopy and we take
polyps out today, we're notprotecting you from colon cancer
next week.
We're c we're protecting youfrom colon cancer several years
down the road.
And so the time horizon of thebenefit that you get is measured
in years, not weeks or, or evenmonths.
And that's important.
(13:13):
I think a lot of people, whenthey have a positive stool test
or when they just get arecommendation from their
provider to get a colonoscopy,that it, it introduces a great
deal of anxiety and pressure.
I gotta get this done rightaway.
My opinion on that or my, mycounsel on that would be, it's
important not to let it slide,not to forget about it, but I
wouldn't rearrange your lifearound it.
Mm-hmm.
You know, get it done soon, butit's not an emergency.
Speaker 2 (13:37):
That's reassuring actually.
What do you tell people aboutthe chance that the day after
their colonoscopy, they'regrowing another polyp?
And if you wait 10 years, aren'tyou missing out on something?
Speaker 3 (13:47):
So that's a question that actually comes up a lot,
uh, in the colonoscopy suite.
And what I think it's importantto keep in mind with any
screening evaluation, and thisis true of colon cancer or
anything else, is what we'redoing is we're trying to change
the odds that you are gonna getsick.
So if you come in at 45 or 50,uh, you don't have any risk
(14:07):
factors for colon cancer and wedon't find any polyps in your
colon, what we can say is, youknow, you've lived four and a
half to five decades of yourlife without forming polyps.
And so that, that puts you in aneven lower risk group for the
formation of polyps in thefuture.
It's not zero.
And that's among the reasonsthat the screening, uh, strategy
(14:29):
doesn't reduce that risk, uh,over your lifetime, all the way
to zero.
That problem is that how oftenyou want to have a colonoscopy,
you know, you want to get, doyou wanna do it every month just
to
Speaker 2 (14:39):
Be safe?
Like never safe
Speaker 3 (14:40):
, uh, you
know, so at some point there's a
balance that has to be struckand, and there's been enormous
population studies done withthousands of patients over
several decades that thatsuggests that 10 years for the
average risk population seems tobe a, a reasonable interval that
balances the benefit that you'regonna get from the test against
(15:00):
the risk and the, theinconvenience of doing it.
What
Speaker 2 (15:03):
About when you do find a polyp and you remove it?
Is it still 10 years?
Speaker 3 (15:07):
No.
Uh, so the, that's an area that,that is also in evolution.
So we do remove all polyps thatwe see.
We send any polyps that weremove down to the pathology lab
so that somebody can look at itunder the microscope and tell us
what it looks like and what itsrisk is, uh, of progression over
time.
But the number, size andappearance of the polyps that we
(15:30):
find dictate when we recommendthat you come back.
And usually, not always, butusually it is a shorter
interval, and that shorterinterval can be as, as long as
five to seven years or as littleas three months.
Uh, you know, again, dependingon how many you have, how big
they are and how bad they lookunder the microscope.
Just
Speaker 2 (15:49):
In general, can you just see'em?
Are you just looking at'em, say,yep, there's one.
Yeah.
Speaker 3 (15:54):
I mean, I, I think that, uh, you know, I, I could
offer all sorts of descriptorsof what a polyp looks like, but
I, it's, it's kind of liketrying to describe your Aunt
Martha, you know, or when yousee her mm-hmm.
, uh, and, and Imight be able to, to describe to
you,
Speaker 2 (16:07):
Hopefully she doesn't look like a poly
Speaker 3 (16:08):
, well,
Speaker 2 (16:09):
, but,
Speaker 3 (16:12):
Uh, they do have a fairly characteristic
appearance.
Um, you know, as we were talkingabout earlier, the, the, the
polyps that we're looking forare quite small.
You know, once they're, oncethey're a centimeter, they're,
they're committed, but we'relooking for things as small as
one or two millimeters.
And so it is important that wehave a good clean colon to, to
look at.
So
Speaker 2 (16:31):
Let's let, that's a good segue.
So you need a clean colon.
Okay.
Folks, your colons are generallyfilled with your stool.
That's what the prep's about, isgiving a clean colon.
Talk about the importance of theprep, and is there anything
other than drinking for quartzof that stuff?
So
Speaker 3 (16:49):
The, the importance of the prep is, is the thing
that keeps me up at nightbecause it, quite frankly, it's
the most important qualitydeterminant for the colonoscopy.
And it is the thing that iscompletely out of my control.
Mm-hmm.
, because it's alldone before you arrive for your
colonoscopy.
You know, again, we're lookingfor things that can be quite
small, and so we need your coloncompletely cleaned out in order
(17:12):
to see it.
And in order to clean your colonout, we basically have to create
a tidal wave that runs throughyour colon.
Mm-hmm.
, uh, you alludedto drinking for liters of, uh,
prep.
Uh, the most common prep that'sused is this stuff called
golightly, which, uh,
Speaker 2 (17:25):
which the,
whoever named that.
Come on.
Speaker 3 (17:28):
Somebody with a very good sense of humor, I guess.
But I
Speaker 2 (17:30):
Think everybody in your line of work has to have a
pretty good sense of humor.
Oh,
Speaker 3 (17:33):
Yeah.
, you know.
Yeah.
I mean, you
Speaker 2 (17:34):
Guys,
Speaker 3 (17:36):
Uh, yeah, us and the urologist.
Um, so the, the Golightly prep,uh, although challenging is
probably the, the preferred prepfor most gastroenterologists.
And the reason for that is thatit is the least likely to fail
it, it's the most reliable prep.
Uh, it's also the safest, uh,because it is neutral in terms
(17:59):
of fluid balance and electrolytebalance.
So it, it travels through you,it doesn't get absorbed into
your bloodstream, so it doesn'tinterfere with any of your
medicines, any of yourphysiologic processes.
It just runs right through youcarries,
Speaker 2 (18:12):
It's the tidal wave you're looking for.
Speaker 3 (18:13):
Yeah.
And, and so that, that method ofproducing the tidal wave by
drinking the ocean is effectiveand safe.
Speaker 2 (18:20):
But it's a bummer.
It is
Speaker 3 (18:22):
A bummer.
And there, there are,
Speaker 2 (18:24):
Yeah.
Listen, admit it.
There,
Speaker 3 (18:25):
There are methods that's just nasty.
Yeah.
There are def, there aredefinitely other methods and,
and, and for some people theyare, uh, reasonable options.
And the, the other methods, uh,which may involve lower volumes
of fluid, or even there are somepill based preps that are out
there, that challenge with thoseis that they rely on stealing
fluid from your bloodstream Oh.
(18:46):
To create that tidal wave.
And so you're ability tomaintain your hydration or pay
attention to the maintenance ofyour hydration is much more
important.
Uh, your ability to keep yourelectrolytes in balance, which
relies on your kidney function,is also much more important.
So those options exist and theyare definitely good for the
right person.
But that's something you'd needto discuss with your doctor
(19:08):
about whether or not that's theright answer for
Speaker 2 (19:10):
You.
So what we've learned so far,get your colon cancer screening
at the appropriate age, usuallyage 45 or 50 if you're at
average risk, get the follow updepending on what they find and
the importance of a prep.
Uh, those are some key take homepoints so far.
Yeah.
I know colonoscopy is safe, butno procedure is 100% risk free.
And in people often worriedabout, what are the chances of
(19:33):
you popping a hole in my colon?
Speaker 3 (19:35):
Yeah.
So you're right.
There isn't, and there's nothingin medicine or life that's
completely without risk.
Uh, the risks associated withcolon cancer are principally
bleeding and perforation arepopping a hole in the colon, as
you said.
Uh, both of those differdepending upon what we do when
we're in there.
So if you have a colonoscopy andI remove a really large polyp,
(19:58):
now I say something, you know, acentimeter and a half or two
centimeters, your chances ofhaving bleeding after that are
about one in 500.
And by bleeding, I mean bleedingsignificant enough to need to
come to the doctor to need toget a blood transfusion.
So it happens mm-hmm.
, uh, but not ascommonly as you might think.
Uh,
Speaker 2 (20:17):
Yeah.
That, that isn't as much as Imight think.
Yeah.
And it's usually for the bigger
Speaker 3 (20:21):
Polyps, and that's, yeah.
And that's in somebody who'sgot, you know, a, a larger polyp
that we've removed.
Perforation, I think is thedreaded complication of
colonoscopy.
Uh, and, uh, it, it dreaded byboth patients and, and
colonoscopist mm-hmm.
, uh, none, nobodywants that to happen.
That also is usually, uh,something that occurs with the
(20:41):
removal of large polyps, andit's dreaded because it's
something that produces a needfor immediate surgery.
Uh, in most cases, we cansometimes close perforations
with the scope if we recognizethem quickly enough, but
Speaker 2 (20:55):
That's because the contents of your colon, which
are not sterile, are
Speaker 3 (20:59):
Spilling out, spilling into the, into your
abdominal cavity where theydon't belong.
Right.
And, and so, you know, what I,what I tell people, uh, is that
your risk of getting aperforation with a colonoscopy
is about one in five to 10,000.
Again, depending on the studiesthat you look at, depending on
what we do.
So it's low but not zero.
It is usually, uh, when I havemade a judgment call that, you
(21:22):
know, this polyp that I'm gonnatry to take out is big, but
needs to come out.
And the balance of the risk is,do I take the risk and take it
out now and give you a, a smallchance that you'll need surgery
because of what I've done,versus just taking photographs
of it and guaranteeing thatyou'll need surgery,
Speaker 2 (21:40):
Then you for sure gonna have to have a surgery to
take it
Speaker 3 (21:42):
Out now.
Yeah.
So it, it, it's not risk free,but it's typically the lower
risk path.
Speaker 2 (21:47):
We've had a great conversation here about the,
the, the real truth about yourcolon, your colon health and
colon cancer with Dr.
Jake Matlock.
To wrap it up, if you could tellpeople three things about their
colon health, what would theybe?
Speaker 3 (22:00):
So the most important thing is get screened for colon
cancer.
Uh, and, and, uh, I hope thatpeople take away from this, that
how you get screened is lessimportant than that.
You get screened and, uh, youknow, I think that myself, my
colleagues all carry a biastowards colonoscopy.
We try not to, uh, let that biascome out because the most
(22:23):
important thing is that you dosomething to get screened.
Speaker 2 (22:26):
The best screening test is the one you're gonna do.
Speaker 3 (22:28):
Absolutely.
Okay.
And, and, and they, all of theavailable screening tests are
effective if used correctly.
So please get your screeningdone.
The second thing that I wouldemphasize is that if you do have
things about your colon health,things about the function of
your colon that interfere withyour life, talk to somebody
about it.
You know, it is not the casethat we can make things perfect
(22:49):
for everyone, that that would befoolish to even suggest, but we
can usually make things betterwith some work.
Uh, and that, that work mayinvolve changes in your diet,
changes in your lifestyle,occasionally, medication
therapies that can help to bringyour bowel function more in line
with, uh, what you're hopingfor.
Um, I like
Speaker 2 (23:09):
That
Speaker 3 (23:09):
Tip.
Yeah.
I mean, it, it, you know, that'swhat we're here for mm-hmm.
Is, is to try to help.
And again, we can't always makeit perfect.
I, I'm too old to promiseperfection to anyone anymore,
but, but we can usuallymake it better.
The third thing, I guess I wouldsay is if you do have colon
problems, as difficult as it is,let your family know, cuz again,
(23:30):
that that risk for colon canceris, uh, increased in first
degree relatives of people withproblems.
So if you have polyps, if you'vehad colon cancer and you have
family members you care about,let'em know cuz it changes their
risk.
Speaker 2 (23:43):
Awesome tips.
We've been talking to Dr.
Jake Mattlock, the director ofthe Division of Gastroenterology
here at Hennepin Healthcare indowntown Minneapolis.
I've known Jake for, I dunno,how long have we known each
other?
Some 20 some years.
22 years.
22 years, something like that.
And all the way since we trainedtogether here at this very
institution.
I wanna thank you, Jake, forcoming on the show and, uh,
(24:04):
talking us through this.
Yeah, thanks David.
It's fun.
It's been great to have you onthe show.
Listeners, I hope you've pickedup some tips for your own health
as I have, and I hope you'lljoin us for the next episode.
And in the meantime, be healthyand be well.
Speaker 1 (24:17):
Thanks for listening to the Healthy Matters podcast
with Dr.
David Hilden.
To find out more about theHealthy Matters podcast or
browse the archive, visithealthy matters.org.
You got a question or a commentfor the show?
Email us at Healthy Matters hc me d.org or call 6 1 2 8 7 3
talk.
There's also a link in the shownotes.
(24:39):
And finally, if you enjoy theshow, please leave us a review
and share the show with others.
The Healthy Matters Podcast ismade possible by Hennepin
Healthcare in Minneapolis,Minnesota, and engineered and
produced by John Lucas AtHighball Executive producers are
Jonathan Comito and ChristineHill.
Please remember, we can onlygive general medical advice
during this program, and everycase is unique.
(25:00):
We urge you to consult with yourphysician if you have a more
serious or pressing healthconcern.
Until next time, be healthy andbe well.
Welcome to the Healthy Matters podcast with Dr.
David Hilden, primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health, healthcare and
what matters to you.
And now here's our host, Dr.
David Hilden.
Speaker 2 (00:20):
Hey everybody, it's Dr.
David Hilden.
Welcome to episode five.
And as you know, if you've beenlistening to this podcast on
this show, we talk abouteverything today, we're gonna
prove it as we talk about yourcolon, otherwise known as your
large intestine.
To help me out, I have Dr.
Jake Matlock on the show today.
He is the director of theDivision of Gastroenterology at
(00:41):
Hennepin Healthcare and acolleague of mine for over 20
years.
Jake, welcome to the show.
Yeah, it's a
Speaker 3 (00:47):
Pleasure.
Thanks for having
Speaker 2 (00:47):
Me.
So you're a gastroenterologist.
Why should people care abouttheir intestines?
What can go wrong?
Speaker 3 (00:51):
So, you know, your intestines are actually the one
of the most amazing organs inyour body, in my opinion.
Uh, and I like to tell mypatients that the colon is the
organ that's responsible formodern human society
Speaker 2 (01:03):
Okay, you're gonna have toexpand on that.
Speaker 3 (01:07):
So your, your intestinal tract provides about
three liters of liquid waste toyour colon every day.
And your colon is responsiblefor taking that three liters of
liquid waste and converting itto a small volume of solid stool
and providing you theopportunity to eliminate that
stool on a voluntary basiswithout your colon.
We'd be like birds, we'd be justconstantly leaking stool
(01:29):
whenever we were walking aroundin the day, and we wouldn't be
able to get anything else done.
So without your colon, modernsociety wouldn't exist.
Speaker 2 (01:37):
And I absolutely love that we're gonna geek out about
your colon and stool today.
You know, I never really thoughtof it that way, but you know, it
actually does make life a littlebit more manageable since it,
uh, your whole digestive systemis something sort of under your
control.
Speaker 3 (01:49):
Yeah, yeah.
Without, without your colon,you'd be walking around, uh,
constantly looking for water cuzyou'd be dehydrated all the time
from losing all that fluid and,uh, constantly pooping.
Okay.
Speaker 2 (01:58):
So most of us haven't thought about our intestines in
that way.
Let's talk about what could gowrong.
Speaker 3 (02:04):
So the thing that people, I think hear about the
most with your colon is, iscolon cancer.
And colon cancer is obviously a,a very important topic.
Uh, it's the third leading causeof cancer in both men and women
in this country.
Uh, and does get a lot ofattention in the media for folks
who are younger.
Uh, we often, uh, havedifficulty with, uh,
(02:26):
inflammation in the colon.
There are a variety of differentinflammatory disorders that can,
uh, impact the colon.
And then there's a whole classof problems that the colon can,
can suffer from that don'treally shorten your life or end
your life, but can make thingskind of miserable along the way.
And here I'm thinking about, uh,issues like chronic constipation
or chronic diarrhea of anon-inflammatory state that, you
(02:47):
know, again, don't kill you, butcan make you pretty miserable.
And, and, and which we can helppeople
Speaker 2 (02:52):
With.
I would say those are issuesthat make people extremely
miserable.
I hear, I hear it about it allthe time, both in the hospital
and in the clinic.
If people's bowels aren'tworking, it's a daily fact of
life that is more thanbothersome.
Speaker 3 (03:05):
Absolutely.
Yeah.
I mean, it's a, it's a hugequality of life impact if a
person's bowels are not workingin a way that, uh, that kind of
meets their expectations.
Speaker 2 (03:13):
So you mentioned colon cancer, and I think we
will focus on a little bit, uh,of that today because, you know,
you're the guy that people go tosee to get the colonoscopy.
Ta talk a little bit, if youcould, about colon cancer.
How common is it and, uh, whatpeople should know about
screening?
Speaker 3 (03:28):
So it is, it is a very common form of cancer.
Uh, you know, as I mentioned,it's the third leading cause of
cancer in this country amongboth men and women.
It's a common misconception thatit, that there is a, a
significant gender predominance,uh, and that it's more of a male
problem than a female problem.
That's absolutely not true.
So I hope that, that, uh, ifthere's any myth that we can
(03:48):
dispel today, uh, it's an equalopportunity.
Uh, uh, cancer, the estimatesare that if you don't do
anything to protect yourselffrom it, if you don't do any
screening, that roughly 8% ofpeople will get cancer.
So about one in 12, uh, will getcolon cancer in their lifetime
with effective screening that'sless than 2% and less than 1%
(04:12):
will die from it with effectivescreening.
And so, uh, I think the messagethere is that screening,
although imperfect works, it'seffective at reducing your risk.
I would encourage everybody toengage with their doctor on
Speaker 2 (04:25):
It.
That's a dramatic drop actually,from doing nothing to doing some
screening.
You can.
So it's sort of a good newsstory in that there is something
you can do to, uh, reduce yourrisk.
Speaker 3 (04:36):
Yeah, I mean, and we, we continue to refine the
recommendations about who andwhen and how screening should be
done.
But I think the take homemessage is that the important
thing is to do it, uh,regardless of how you do it, get
it done.
Uh, and, and, and that's themost effective way to protect
Speaker 2 (04:53):
Yourself.
When you say screening, what doyou mean?
So the
Speaker 3 (04:55):
Variety of different screening modalities that are
used for colon cancer, I thinkthe one that, that everybody
thinks about and everybody'sheard of is colonoscopy.
And that that still remains thegold standard screening method.
However, there are other methodsthat are available, uh, and, uh,
that some people might considerdepending on their risk factors
and discussion with their own,uh, healthcare provider.
(05:16):
The least invasive, uh, testingmethods are, are stool-based
tests.
Uh, so we can take a sample ofsomeone's stool to look for
markers in their stool thatmight indicate that they have
either a pre-cancerous conditionor a, an actual cancer.
The advantage of thesestool-based tests is that
they're non-invasive.
They're fairly easy to do.
(05:37):
Uh, they're very effective ifdone correctly, and at their
appropriate frequency.
The disadvantage of them is,number one, you do have to do
them more often anywhere fromevery one year to every three
years.
And if they come back positive,well then you have to follow it
up with a colonoscopy to, tofigure out what the issue is,
what's tripped to the positivetest and what you're gonna do
(05:58):
about
Speaker 2 (05:58):
It.
And these tests, I i order theseall the time for patients who
have elected to go that route.
And there's a misconception,this isn't like bringing a large
sample
I know, I know this is a lovelyconversation, but you know,
it's, we gotta talk about it.
It isn't, you, you put a littleteeny bit and you put it on a
card and mail it, don't
Speaker 3 (06:16):
You?
Yeah, I mean, that, that's truefor, uh, for several of the
tests, uh, the, the I fob andthe FIT test mm-hmm.
called the Cologuard, which, uh,does involve producing a larger
sample for, uh, analysis.
But again, all of them arenon-invasive tests.
Uh, they don't involve any, uh,additional visits to a
(06:38):
healthcare facility.
They don't involve anythinggoing into you or, or touching
you if that is a, an, an issuefor you.
Uh, again, the, the majorlimitation that we see of these
tests is that people don'tperform them at the appropriate
frequency.
People are people, they let itslide, and if you don't do them
at the right, uh, frequency thanthey really aren't very
(06:59):
effective.
Speaker 2 (06:59):
So that's one option.
What are the other options?
Speaker 3 (07:02):
So, uh, again, the other major option is, uh,
colonoscopy, which, uh, weperform all day every day here
at Hennepin and, and at, atother healthcare facilities
around the, the cities and thecountry.
Uh, colonoscopy offers theadvantage of offering a longer
horizon of benefit, I guess Iwould say.
So you, you don't have to docolonoscopy nearly as often as
(07:24):
these other tests for people ataverage risk, the recommended
interval is every 10 years.
So it it, if you have a normalcolonoscopy, you can, you can
take that off your plate and notthink about it for a decade.
Obviously, if you have findingsthat are of concern, your doctor
might recommend a more frequent,uh, evaluation.
But, uh, it, it, it is a, alittle bit easier in terms of
(07:46):
keeping track of the logistics.
The thing that is of concern topeople for colonoscopy is, is
more invasive.
It is more involved, uh, than astool test.
Uh, it does involve doing apreparation to clean out your
colon.
It involves a scope going inthrough your rectum and, and,
and all the way to the top ofthe colon, uh, involves an extra
visit to the, um, uh, ahealthcare provider.
(08:09):
It involves, uh, sedationusually for most people and, and
a driver to get you home.
So it's, it's a little bit morecomplicated on the front end,
but does provide a longerbenefit.
Speaker 2 (08:19):
When should people start doing these tests?
Speaker 3 (08:21):
So the guidelines have recently changed on that.
Uh, historically we'verecommended starting at the age
of 50 for people who are ataverage risk,
Speaker 2 (08:30):
Which is most people, right?
Speaker 3 (08:31):
Right.
Average risk just means don'thave a close family member who
has colon cancer or has colonpolyps.
However, guidelines haverecently shifted, and we've
started to recommend starting atage 45.
And that's because of arecognition that the
demographics of colon cancer doseem to be shifting to involve a
younger population of people.
Speaker 2 (08:49):
Why might that be?
Do we know, uh, if,
Speaker 3 (08:52):
If, if somebody knows they haven't told me
could point to exercise, youcould point to all sorts of
environmental risk factors thatmight be in play.
But I think the short answer iswe don't know.
So
Speaker 2 (09:06):
If you're average risk, you're in your mid
forties, it's time to startthinking about it.
I
Speaker 3 (09:10):
Think that's a safe thing to say.
Yeah.
Speaker 2 (09:11):
What about if you are mom or your dad or your brother,
your sister had problems intheir colon?
Speaker 3 (09:16):
If you have a, a family history of colon cancer
and the, the most importantfamily history is, is in your
first degree relatives.
And, and by that we mean mom,dad, or siblings, uh, then you
should start screening earlier,how much earlier?
Depends on what they had, whenthey had it, and how many of
them had it.
So it's a bit of a complexdiscussion, but definitely worth
(09:37):
bringing up with your primarycare provider if that is an
issue for you.
Once you get out to seconddegree relatives, grandparents,
aunts, uncles, cousins, that canbe important.
But it, it only is germane if itinvolves multiple family members
in that second tier.
So if you do have a familymember with, uh, colon cancer or
(09:58):
colon polyps, it's definitelyworth mentioning to your, uh,
primary care provider becauseit, it will impact your risk.
But whether it changes therecommendations really depends
on the particulars of your, yoursituation.
Speaker 2 (10:08):
So you've mentioned the word polyp in addition to
the word cancer.
What's the difference?
So
Speaker 3 (10:14):
A polyp is a small growth coming off the lining of
the colon.
It is the thing that over timegrows and eventually turns into
colon cancer.
So polyps are the precursors tocolon cancer.
And in people who do not haveunderlying inflammatory
conditions of their colon, webelieve that it is the sole
pathway for the development ofcolon cancer.
(10:36):
Oh,
Speaker 2 (10:36):
So they don't, cancers don't arise from
anything else, correct.
From the polyps,
Speaker 3 (10:40):
Yeah.
So, so by identifying polyps,which we can again, do either
with stool-based tests or withcolonoscopy, and by taking them
out, which we can do withcolonoscopy, we can protect you
from getting colon cancer.
Speaker 2 (10:51):
So you can prevent it.
We
Speaker 3 (10:53):
Can, and again, the, the, the strategy is not a
hundred percent effective, butyou know, as we were talking
about earlier, it is highlyeffective at reducing your risk
and preventing you fromdeveloping colon cancer.
Speaker 2 (11:04):
We're gonna take a quick break, and when we come
back, we'll resume ourconversation with Dr.
Jake Matlock, director of thedivision of Gastroenterology at
Hennepin Healthcare, and one ofthe best medical educators I
know.
When we come back, we're gonnaresume the conversation.
Stay with us.
Speaker 1 (11:20):
You are listening to the Healthy Matters podcast with
Dr.
David Hilton.
Got a question or comment forthe doc, email us at Healthy
Matters hc m e d.org, or give usa call at six one two eight
seven three talk.
That's 6 1 2 8 7 3 8 2 5 5.
And now let's get back to morehealthy conversation.
Speaker 2 (11:44):
Jake.
Um, I was thinking about acouple more things that came to
mind about polyps.
Do all polyps turn into cancer?
So like when you tell a patient,yep, I took out some polyps.
Should that patientautomatically assume that those
polyps were destined to becomecancer?
That's
Speaker 3 (12:01):
A good question, and it's a hard one to answer.
Uh, as you can imagine, you,you'd be really hard to study
that question because you, to
Speaker 2 (12:08):
Study, you believe some of them,
Speaker 3 (12:09):
You'd have to leave them behind and see what
happens.
And I, I don't know anybody whowould sign up for that study.
Uh, I've been told, and I don'tknow if this is an apocryphal
story or not, that, that therewas a study done in the fifties
in a Indiana prison populationwhere they followed polyps, uh,
over time and found that reallysmall ones sometimes do go away.
(12:29):
I've never been able to findthis study, so I don't know if
that's true.
However, the current beliefabout the polyps based on
studying the biology and thegenetics of, of the tissue in
polyps is that once they reach acertain size and, and most
people say about a centimeter,they're committed, they're gonna
become cancer.
If not, if not removed, how
Speaker 2 (12:50):
Long?
Like, what's the timeframe?
So
Speaker 3 (12:53):
That's another very important point.
I think, you know, when, when wedo a colonoscopy and we take
polyps out today, we're notprotecting you from colon cancer
next week.
We're c we're protecting youfrom colon cancer several years
down the road.
And so the time horizon of thebenefit that you get is measured
in years, not weeks or, or evenmonths.
And that's important.
(13:13):
I think a lot of people, whenthey have a positive stool test
or when they just get arecommendation from their
provider to get a colonoscopy,that it, it introduces a great
deal of anxiety and pressure.
I gotta get this done rightaway.
My opinion on that or my, mycounsel on that would be, it's
important not to let it slide,not to forget about it, but I
wouldn't rearrange your lifearound it.
Mm-hmm.
You know, get it done soon, butit's not an emergency.
Speaker 2 (13:37):
That's reassuring actually.
What do you tell people aboutthe chance that the day after
their colonoscopy, they'regrowing another polyp?
And if you wait 10 years, aren'tyou missing out on something?
Speaker 3 (13:47):
So that's a question that actually comes up a lot,
uh, in the colonoscopy suite.
And what I think it's importantto keep in mind with any
screening evaluation, and thisis true of colon cancer or
anything else, is what we'redoing is we're trying to change
the odds that you are gonna getsick.
So if you come in at 45 or 50,uh, you don't have any risk
(14:07):
factors for colon cancer and wedon't find any polyps in your
colon, what we can say is, youknow, you've lived four and a
half to five decades of yourlife without forming polyps.
And so that, that puts you in aneven lower risk group for the
formation of polyps in thefuture.
It's not zero.
And that's among the reasonsthat the screening, uh, strategy
(14:29):
doesn't reduce that risk, uh,over your lifetime, all the way
to zero.
That problem is that how oftenyou want to have a colonoscopy,
you know, you want to get, doyou wanna do it every month just
to
Speaker 2 (14:39):
Be safe?
Like never safe
Speaker 3 (14:40):
balance that has to be struckand, and there's been enormous
population studies done withthousands of patients over
several decades that thatsuggests that 10 years for the
average risk population seems tobe a, a reasonable interval that
balances the benefit that you'regonna get from the test against
(15:00):
the risk and the, theinconvenience of doing it.
What
Speaker 2 (15:03):
About when you do find a polyp and you remove it?
Is it still 10 years?
Speaker 3 (15:07):
No.
Uh, so the, that's an area that,that is also in evolution.
So we do remove all polyps thatwe see.
We send any polyps that weremove down to the pathology lab
so that somebody can look at itunder the microscope and tell us
what it looks like and what itsrisk is, uh, of progression over
time.
But the number, size andappearance of the polyps that we
(15:30):
find dictate when we recommendthat you come back.
And usually, not always, butusually it is a shorter
interval, and that shorterinterval can be as, as long as
five to seven years or as littleas three months.
Uh, you know, again, dependingon how many you have, how big
they are and how bad they lookunder the microscope.
Just
Speaker 2 (15:49):
In general, can you just see'em?
Are you just looking at'em, say,yep, there's one.
Yeah.
Speaker 3 (15:54):
I mean, I, I think that, uh, you know, I, I could
offer all sorts of descriptorsof what a polyp looks like, but
I, it's, it's kind of liketrying to describe your Aunt
Martha, you know, or when yousee her mm-hmm.
you,
Speaker 2 (16:07):
Hopefully she doesn't look like a poly
Speaker 3 (16:08):
Speaker 2 (16:09):
Speaker 3 (16:12):
Uh, they do have a fairly characteristic
appearance.
Um, you know, as we were talkingabout earlier, the, the, the
polyps that we're looking forare quite small.
You know, once they're, oncethey're a centimeter, they're,
they're committed, but we'relooking for things as small as
one or two millimeters.
And so it is important that wehave a good clean colon to, to
look at.
So
Speaker 2 (16:31):
Let's let, that's a good segue.
So you need a clean colon
Okay.
Folks, your colons are generallyfilled with your stool.
That's what the prep's about, isgiving a clean colon.
Talk about the importance of theprep, and is there anything
other than drinking for quartzof that stuff?
So
Speaker 3 (16:49):
The, the importance of the prep is, is the thing
that keeps me up at nightbecause it, quite frankly, it's
the most important qualitydeterminant for the colonoscopy.
And it is the thing that iscompletely out of my control.
Mm-hmm.
colonoscopy.
You know, again, we're lookingfor things that can be quite
small, and so we need your coloncompletely cleaned out in order
(17:12):
to see it.
And in order to clean your colonout, we basically have to create
a tidal wave that runs throughyour colon.
Mm-hmm.
prep.
Uh, the most common prep that'sused is this stuff called
golightly, which, uh,
Speaker 2 (17:25):
Come on.
Speaker 3 (17:28):
Somebody with a very good sense of humor, I guess.
But I
Speaker 2 (17:30):
Think everybody in your line of work has to have a
pretty good sense of humor.
Oh,
Speaker 3 (17:33):
Yeah.
Yeah.
I mean, you
Speaker 2 (17:34):
Guys,
Speaker 3 (17:36):
Uh, yeah, us and the urologist
Um, so the, the Golightly prep,uh, although challenging is
probably the, the preferred prepfor most gastroenterologists.
And the reason for that is thatit is the least likely to fail
it, it's the most reliable prep.
Uh, it's also the safest, uh,because it is neutral in terms
(17:59):
of fluid balance and electrolytebalance.
So it, it travels through you,it doesn't get absorbed into
your bloodstream, so it doesn'tinterfere with any of your
medicines, any of yourphysiologic processes.
It just runs right through youcarries,
Speaker 2 (18:12):
It's the tidal wave you're looking for.
Speaker 3 (18:13):
Yeah.
And, and so that, that method ofproducing the tidal wave by
drinking the ocean is effectiveand safe.
Speaker 2 (18:20):
But it's a bummer.
It is
Speaker 3 (18:22):
A bummer
And there, there are,
Speaker 2 (18:24):
Yeah.
Listen, admit it.
There,
Speaker 3 (18:25):
There are methods that's just nasty.
Yeah.
There are def, there aredefinitely other methods and,
and, and for some people theyare, uh, reasonable options.
And the, the other methods, uh,which may involve lower volumes
of fluid, or even there are somepill based preps that are out
there, that challenge with thoseis that they rely on stealing
fluid from your bloodstream Oh.
(18:46):
To create that tidal wave.
And so you're ability tomaintain your hydration or pay
attention to the maintenance ofyour hydration is much more
important.
Uh, your ability to keep yourelectrolytes in balance, which
relies on your kidney function,is also much more important.
So those options exist and theyare definitely good for the
right person.
But that's something you'd needto discuss with your doctor
(19:08):
about whether or not that's theright answer for
Speaker 2 (19:10):
You.
So what we've learned so far,get your colon cancer screening
at the appropriate age, usuallyage 45 or 50 if you're at
average risk, get the follow updepending on what they find and
the importance of a prep.
Uh, those are some key take homepoints so far.
Yeah.
I know colonoscopy is safe, butno procedure is 100% risk free.
And in people often worriedabout, what are the chances of
(19:33):
you popping a hole in my colon?
Speaker 3 (19:35):
Yeah.
So you're right.
There isn't, and there's nothingin medicine or life that's
completely without risk.
Uh, the risks associated withcolon cancer are principally
bleeding and perforation arepopping a hole in the colon, as
you said.
Uh, both of those differdepending upon what we do when
we're in there.
So if you have a colonoscopy andI remove a really large polyp,
(19:58):
now I say something, you know, acentimeter and a half or two
centimeters, your chances ofhaving bleeding after that are
about one in 500.
And by bleeding, I mean bleedingsignificant enough to need to
come to the doctor to need toget a blood transfusion.
So it happens mm-hmm.
Uh,
Speaker 2 (20:17):
Yeah.
That, that isn't as much as Imight think.
Yeah.
And it's usually for the bigger
Speaker 3 (20:21):
Polyps, and that's, yeah.
And that's in somebody who'sgot, you know, a, a larger polyp
that we've removed.
Perforation, I think is thedreaded complication of
colonoscopy.
Uh, and, uh, it, it dreaded byboth patients and, and
colonoscopist mm-hmm.
That also is usually, uh,something that occurs with the
(20:41):
removal of large polyps, andit's dreaded because it's
something that produces a needfor immediate surgery.
Uh, in most cases, we cansometimes close perforations
with the scope if we recognizethem quickly enough, but
Speaker 2 (20:55):
That's because the contents of your colon, which
are not sterile, are
Speaker 3 (20:59):
Spilling out, spilling into the, into your
abdominal cavity where theydon't belong.
Right.
And, and so, you know, what I,what I tell people, uh, is that
your risk of getting aperforation with a colonoscopy
is about one in five to 10,000.
Again, depending on the studiesthat you look at, depending on
what we do.
So it's low but not zero.
It is usually, uh, when I havemade a judgment call that, you
(21:22):
know, this polyp that I'm gonnatry to take out is big, but
needs to come out.
And the balance of the risk is,do I take the risk and take it
out now and give you a, a smallchance that you'll need surgery
because of what I've done,versus just taking photographs
of it and guaranteeing thatyou'll need surgery,
Speaker 2 (21:40):
Then you for sure gonna have to have a surgery to
take it
Speaker 3 (21:42):
Out now.
Yeah.
So it, it, it's not risk free,but it's typically the lower
risk path.
Speaker 2 (21:47):
We've had a great conversation here about the,
the, the real truth about yourcolon, your colon health and
colon cancer with Dr.
Jake Matlock.
To wrap it up, if you could tellpeople three things about their
colon health, what would theybe?
Speaker 3 (22:00):
So the most important thing is get screened for colon
cancer.
Uh, and, and, uh, I hope thatpeople take away from this, that
how you get screened is lessimportant than that.
You get screened and, uh, youknow, I think that myself, my
colleagues all carry a biastowards colonoscopy.
We try not to, uh, let that biascome out because the most
(22:23):
important thing is that you dosomething to get screened.
Speaker 2 (22:26):
The best screening test is the one you're gonna do.
Speaker 3 (22:28):
Absolutely.
Okay.
And, and, and they, all of theavailable screening tests are
effective if used correctly.
So please get your screeningdone.
The second thing that I wouldemphasize is that if you do have
things about your colon health,things about the function of
your colon that interfere withyour life, talk to somebody
about it.
You know, it is not the casethat we can make things perfect
(22:49):
for everyone, that that would befoolish to even suggest, but we
can usually make things betterwith some work.
Uh, and that, that work mayinvolve changes in your diet,
changes in your lifestyle,occasionally, medication
therapies that can help to bringyour bowel function more in line
with, uh, what you're hopingfor.
Um, I like
Speaker 2 (23:09):
That
Speaker 3 (23:09):
Tip.
Yeah.
I mean, it, it, you know, that'swhat we're here for mm-hmm.
Is, is to try to help.
And again, we can't always makeit perfect.
I, I'm too old to promiseperfection to anyone anymore,
but
The third thing, I guess I wouldsay is if you do have colon
problems, as difficult as it is,let your family know, cuz again,
(23:30):
that that risk for colon canceris, uh, increased in first
degree relatives of people withproblems.
So if you have polyps, if you'vehad colon cancer and you have
family members you care about,let'em know cuz it changes their
risk.
Speaker 2 (23:43):
Awesome tips.
We've been talking to Dr.
Jake Mattlock, the director ofthe Division of Gastroenterology
here at Hennepin Healthcare indowntown Minneapolis.
I've known Jake for, I dunno,how long have we known each
other?
Some 20 some years.
22 years.
22 years, something like that.
And all the way since we trainedtogether here at this very
institution.
I wanna thank you, Jake, forcoming on the show and, uh,
(24:04):
talking us through this.
Yeah, thanks David.
It's fun.
It's been great to have you onthe show.
Listeners, I hope you've pickedup some tips for your own health
as I have, and I hope you'lljoin us for the next episode.
And in the meantime, be healthyand be well.
Speaker 1 (24:17):
Thanks for listening to the Healthy Matters podcast
with Dr.
David Hilden.
To find out more about theHealthy Matters podcast or
browse the archive, visithealthy matters.org.
You got a question or a commentfor the show?
Email us at Healthy Matters hc me d.org or call 6 1 2 8 7 3
talk.
There's also a link in the shownotes.
(24:39):
And finally, if you enjoy theshow, please leave us a review
and share the show with others.
The Healthy Matters Podcast ismade possible by Hennepin
Healthcare in Minneapolis,Minnesota, and engineered and
produced by John Lucas AtHighball Executive producers are
Jonathan Comito and ChristineHill.
Please remember, we can onlygive general medical advice
during this program, and everycase is unique.
(25:00):
We urge you to consult with yourphysician if you have a more
serious or pressing healthconcern.
Until next time, be healthy andbe well.
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