Colonoscopy Basics, with Dr. Kenneth Yang

Episode Transcript

Dr. Teoli: Hello, folks, and welcome to “The Colon Health Podcast” brought to you by colonoscopy.com. I’m your host, Dr. Dac Teoli, and I want to thank you for sharing this time with us and even more so for your interest in learning about colon health. Be sure to like us on social media and reach out with topics that you want to hear more about in the future. In the meantime, I’ll tell you we have a terrific episode lined up today. We have a guest all the way from the Lone Star State, Dr. Kenneth Yang. Thanks for being here, Doctor.

Dr. Yang: Thank you very much.

Dr. Teoli: Today, if it’s okay with you, I’d like to, kind of, hit the ground running with some basic information, almost like a 101 class. You know, I think a lot of our listeners have heard about a colonoscopy before. In fact, I’m willing to bet on it. If nothing else, this is from colonoscopy.com. But I bet a big portion of that audience might not know exactly what a colonoscopy is or what it entails. So if you don’t mind, Doctor, can we just start there? What exactly is a colonoscopy?

Dr. Yang: No, that’s a great question to start with. Most people hear about colonoscopy via jokes, but it plays a very important role in healthcare. Backing up a little bit, the primary reason most people get it is to decrease the disease burden of colorectal cancer, and we’re talking about the number three leading diagnosed cancer in both males and females and when combined in regards to mortality, the number two cause of death in males and females.

So colonoscopy itself is a fiberoptic scope that we pass through the entire colon in order to examine it carefully to detect colon cancer at an early stage at which point is extremely curative, and the second benefit is we can also detect polyps which grow in the colon of a certain type of colon adenoma. And by removing those, we actually take one step earlier and not allow that to develop into a colorectal cancer. And that is thought to be why this procedure has been so successful in decreasing the disease burden of this continued predominant cancer in our country.

Dr. Teoli: Gotcha. This procedure, I mean, that’s just what it is. So I imagine that I’d want to be having it done by someone well-trained in it. Do all physicians perform colonoscopies or…?

Dr. Yang: No, that’s an excellent question. What I would do to patients… Sometimes it is difficult to gather the answers, but I would ensure that the physician they choose is somebody who is well-trained in the procedure, has done multiple countless numbers in training, and also meet certain criteria specifically kind of making it as basic as possible in the fact that they take their time when they do the procedure. And also there are statistics out there that are kept to see how many polyps they find during colonoscopies on average and also how long they take to examine the entire colon during the procedure because it sounds like common sense, but the longer you take, it means the more careful you are and you’re going to have a much higher yield in benefiting patients by finding these lesions so that you can help the patient.

So typically I would say board-certified gastroenterologists are going to be the ones that do colonoscopy most often. There are colorectal surgeons that do colonoscopy. And other than that, there are certain general practitioners that do it when there are not many physicians in the area that they live that do colonoscopy and also general surgeons. But for the most part, if you are in an area where you can find a gastroenterologist or a colorectal surgeon, that’s usually who you’re going to lean toward going to do the colonoscopy.

Dr. Teoli: Gotcha. No doubt. It sounds like it’s super important to have done. When it comes to screening, you know, I may be off base here but I imagine there are some guidelines regarding screening. When should I or my loved ones start talking about having this procedure done with my primary doctor or my internist?

Dr. Yang: Yeah. So for many, many years, because colorectal cancer to this day still remains a cancer that increases as we get older. Typically the big bump is between 50 and 60. So the guidelines used to say start at age 50. And for a long time, we have asked that African-Americans start at age 45 because they tend to get colorectal cancer at a younger age. But those guidelines have, in the past year, changed to where the American Cancer Society has recommended dropping that age to start at age 45 and some of the gastroenterology or GI societies have followed suit and dropped that to age 45. And that’s primarily because we’re seeing an increased incidence, which means just case numbers of colorectal cancer being diagnosed in younger individuals. Now, is 45 the magic number? It is difficult to say, but what the thought process is that age group is the patient population that is most important in our society because they are caring for their older parents, they’re also caring for children, and they also have predictive jobs in society. So the hope is to prevent that patient population getting colorectal cancer and being taken out of the workforce or being unable to care for those other people.

Dr. Teoli: Gotcha. I mean, that really hits home, too, because what was it just last year or pretty recently what we… We lost Chadwick Boseman, the renowned actor who played Black Panther. But he was young. He just died of colon cancer I think in his early 40s.

Dr. Yang: Absolutely. And that’s why, just like you said, like, how do we catch these young cases. And we still have not figured that out, because if we dropped that screening age too early, then we will have too many, what we call, negative or normal tests and the cost to society becomes prohibitive because any screening cost you have to weigh how much you’re spending on it to the procedure itself and how much money you save society in general in the long-term and caring for patients with colorectal cancer.

Dr. Teoli: Gotcha. Let’s take a detour for a little bit, something on a little bit of a lighter note. Now that our listeners have been able to hear from you, are you able to tell us a little bit more about yourself, Dr. Yang?

Dr. Yang: Sure. I trained most of my years in Dallas at the University of Texas Southwestern, probably most known for Parkland Hospital where JFK was taken after he was assassinated, and did my medical school there, residency and fellowship training at Parkland. But I did have an interesting detour because, out of med school, I was deadset on becoming a pediatrician. And I actually did my internship at Vanderbilt and loved my time there. Absolutely loved everybody who worked there, but I decided I missed the sickest of sick patients, and usually thankfully you’ll see more of that in the adult population. So that’s how I ended back in internal medicine, and I came to Parkland and eventually worked myself over to Fortworth where I’m a gastroenterologist and in general practice.

Dr. Teoli: Gotcha. Yeah, well, I’ll tell you Vanderbilt, Southwestern, you can’t go wrong at any of those institutions, huh?

Dr. Yang: They’re great places. Great places to be. Good people. Good training. Great opportunity for patient care.

Dr. Teoli: Perfect. And did I read that correctly—you were also chief resident?

Dr. Yang: I was. It’s a good learning experience getting to work with some huge giants in internal medicine and also learning how to balance the needs of hundreds of interns and residents and also learn to teach in the academic field.

Dr. Teoli: Oh, yeah. Oh, yeah. And you nailed it. I think teaching probably plays a big role just in your day in, day out. It might surprise a lot of our listeners because, I think, well, you’re a physician. You practice clinically, but I imagine so much of your job is teaching not just colleagues, teaching me right now, but also teaching your patients as well.

Dr. Yang: Absolutely.

Dr. Teoli: All right. Well, let’s jump back into it a little bit. Let’s say we got our appointment booked with our gastroenterologist. What should I or what should the patient expect leading up to right before having their colonoscopy performed?

Dr. Yang: So, the two questions I get most often from patients is, first of all, are they going to be asleep for this test or are they going to feel discomfort. And I always reassure them that they are going to be asleep the entire procedure. And the kind of sedation they get most often is the kind where they’re breathing on their own but they do not feel any discomfort. In addition, what we use to kind of insufflate or inflate the colon so we can see better, it used to be just air but that’s now transitioned over to CO2 or carbon dioxide which absorbs nicely. So afterwards there’s really no significant discomfort from distention of the colon.

As for leading up to the procedure, the hardest part truthfully is the bowel preparation regimen where they have to drink a solution to clean up the colon because otherwise we cannot visualize the lining very well and find these important lesions. And there are very many prep regimens out there, but they’ve gotten much more user-friendly and patients tolerate them much better than they have in the past years.

Dr. Teoli: Gotcha, gotcha. So just to set the record straight, the preparation or the bowel prep, I guess it could be called different things, it is not a step that you would recommend being skipped by the patient.

Dr. Yang: Yeah, it is absolutely necessary because otherwise, it’s not worth the patient’s time because we cannot see anything without that bowel prep.

Dr. Teoli: Gotcha. And another point you just made that was so important and I want to make sure our folks in the back heard this one, because just me myself, there are so many folks that I know that are overdue to the point of maybe a decade by having not their second but their first colonoscopy even done, and they have a really low pain tolerance, and they’re really worried that it hurts. But as you mentioned, it sounds like the team closely addresses this. The patient isn’t going to be awake bouncing off the walls during this procedure, that you guys really focus on making the patient comfortable. Do I have that right?

Dr. Yang: You are absolutely correct. And I always find it humorous that, after their procedures, when I meet the patients in recovery to go over the findings, the vast majority say that was the best sleep they’ve ever had and they want to come back right away. It really is quite funny. They will always naturally be hesitant and fearful or leery if they’ve never had one before, but once they have one and when they come back and see me in several years, it’s not a big deal and they’re very comfortable getting a second and third one done.

Dr. Teoli: Gotcha. So after the procedure then, let’s say everything went okay during the procedure, when can a patient expect to be back on their feet, eating regular meals, returning to work, basically going back to their regular life?

Dr. Yang: We always, kind of, make it fun for them. As they’re getting sedated, we ask them where they’re going to go eat as soon as they’re done. As we have no dietary restrictions after the procedure, their ride can take them straight to a restaurant down the street if they want, and our only requirement that they not drive or work the rest of the day and that’s only because of them getting sedation. But they can return to full work duties the next day. And also circling back to your prior question, which was excellent in regards to bowel prep, they also have to usually be on a liquid diet 24 hours prior to the procedure and that’s part of the cleanup process.

Dr. Teoli: Well, I’ll tell you this has been phenomenal. So far, I know I’ve learned a lot. I’m sure our listeners have learned a lot as well. I’m curious is there anything else that you think we should know right now or any other topics you wanted to touch on briefly whether it’s about colonoscopies or, hey, we can just open it even to a little bit broader, to colon health in general??

Dr. Yang: Yeah. So one thing I did want to circle back to as you asked that great question of when should you or loved ones start getting a colonoscopy to screen for colon cancer. And when I talk about the general population, what we kind of focus in on is those who have no family history of colon cancer. That changes though if you have a parent or sibling with colon cancer and then your age of starting the procedure would be younger most often. So if that is present in your family history, I would definitely advise you seeking advice from your primary care doctor or gastroenterologist to see when you should start the examination and how often you should get it done. But for the normal patient, as we talked about, the age currently is 45 to 50. And if it’s a normal test without any findings, you only need it done once every 10 years, and people don’t often realize that, “Hey, it’s not that bad at all.”

Dr. Teoli: Yeah, once a decade or so, not bad at all. It doesn’t have to be every year.

Dr. Yang: Absolutely. Every year would be too burdensome taking people out of work. Our goal is to let people miss the least amount of work and provide the best yield.

Dr. Teoli: Gotcha. With colon health being such a big thing now not just in the news but just touching everyone’s lives, just even myself, family members, classmates way back when even from grade school have been having issues here, I’m curious with you and your experience, you know, as a subspecialist in gastroenterology, do you enjoy your job? I mean, let’s say there’s some kids out there, or maybe a parent listening, or a grandparent listening and their relative is interested in going to medical school and becoming a gastroenterologist, you know, that’s a little bit of a wild card, but I’m interested in hearing, do you enjoy your work?

Dr. Yang: Oh, absolutely. I think it’s a very fun balance of getting a good time in the office, getting to know people, and balance that with the technical aspect of procedures. And as technology improves with the colonoscopy and what we can do, it keeps that aspect interesting and it also creates great stories. I’ll tell you that.

Dr. Teoli: Oh, yeah, I can imagine. My background in the emergency department, I’ll tell you, oftentimes were always… It seems like we’re calling the gastroenterologist at 2 in the morning, and we’re definitely happy to have you guys.

Dr. Yang: Yeah, we have conversations all the time.

Dr. Teoli: Well, I’ll tell you what. I really want to thank you for being here tonight, Dr. Yang, and sharing your expertise with our listeners.

Dr. Yang: No, absolutely. You’ve been very kind. Thank you for having me.

Dr. Teoli: And you know what? Just as much, I want to thank you folks for tuning in and listening to this episode whether at home, on your commute, or even at work. Please be sure to share or like this episode on social media or your favorite podcast app. Remember, it helps us ensure that we keep bringing you the content you want to hear when you want it. And as always, we’ll have a summary of today’s episode including key points and a list of resources available on colonoscopy.com. Please take care. Good night and good health.