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Welcome to the next installment of

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Live Well with UCI Health.

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My name is Gina Grad

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from ALT 98.7 and iHeart Radio.

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But that's not important.

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The really,

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really important people who.

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I'd love to introduce you to

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our Doctor, Jaehyun Kim

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aka Doctor J Kim.

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That's what all the cool kids call him.

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Gastroenterologist

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specializing in common

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digestive conditions

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and colorectal cancer screening.

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And Doctor Catherine Zhu,

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colorectal surgeon

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specializing in minimally

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invasive surgery,

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including laparoscopic and robotic

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assisted surgery.

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What? Amazing!

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in the treatment

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of colorectal diseases,

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both from UCI Health.

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Thank you both for being here.

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This is really, really exciting.

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Thank you for having us here.

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Absolutely. I'm going to first jump in.

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I always like to kind of horn my way

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up to the front

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with personal questions

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because, you know,

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it's like it's

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one of the perks of being here.

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I just had my first colonoscopy,

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and I'm one of the people

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that was a couple years

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late to the party

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because I didn't want to do it,

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and I kept putting it off,

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and it kept going.

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No, no, it's I get it, it's important.

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And then going,

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oh, I have to wash my hair that day.

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So, you know,

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I still have to see

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how I'm doing in six months.

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And I finally just was smart enough.

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In fact,

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somebody who I know

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had just been diagnosed

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and they said, this is not a joke.

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This is not something that's like,

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oh, maybe I'll get my hair

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cut a different day.

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This is this can be life or death.

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Would you like your life to be saved?

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I said, I most certainly would.

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I did it, I was it.

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It is so not a big deal.

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I'm asleep.

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Yeah. What do I care?

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So I just want to first say on record,

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as someone who's a big giant baby

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who cries over a hangnail.

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This is not scary.

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It is not a big deal.

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And I am so happy

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to have a clean bill of health.

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And I was told,

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I think I don't have to come back

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for like seven years,

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which to me feels like the grand prize.

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So, so I want to make sure

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that other people understand

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that not only is this

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unbelievably important,

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but it's it's

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just not that big of a deal.

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Does that does

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does that ring true for you

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both as doctors?

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Yeah.

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I mean, I think it's

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one of the most commonly done

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procedures in our fields

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and in the medical field.

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You know, it's recommended that

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now everyone over, you know, at age 45

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or above or earlier,

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if you have any, you know,

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family history, right.

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Colon cancer plus get an earlier,

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you know,

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I always tell my patients, really

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the hardest part of the colonoscopy

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is really not even the procedure

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when you come for the procedure

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will give you medication to date

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you like.

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Some people can actually even do it

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without sedation.

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If you're.

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That's not something I'm interested in.

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I know most people are not,

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but some people are.

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The hardest part,

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you know, for most patients

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is the prep. Here we go.

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That's right. Yes.

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Which is a very

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nice way of saying,

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I'm going to make you

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drink a lot of laxatives,

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and you will need to be

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by your bathroom the whole night.

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You know what?

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So again, like, I was really scared.

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Not that not that bad.

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And I've heard

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I remember

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when my dad did it back in the day

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and he had to drink like a giant

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jug of literal salt water.

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Yes. This is like it was like Kool-Aid.

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It's not a big deal.

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Now. We've come a long way.

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Yeah, as far as bowel preps go.

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So there's,

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kind of lower volume

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prep where you drink

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like a eight ounce of laxative

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followed by,

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you know, three bottles of water.

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And then I did crystal light,

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you know, or Gatorade. Right.

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And even if you do have

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to drink the big jug,

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I always tell patients,

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put a crystal light mix in it.

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Trust me,

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it will taste a lot better

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because, you know, without it,

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it does taste like drinking.

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You know, seawater.

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So you're allowed to mix stuff

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like Crystal Light, like.

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Yes.

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And typically, you know,

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we might even say drink.

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You can, you can mix

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and so whatever is clear liquid,

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so like, like crystal light, lemonade,

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even Gatorade,

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as long as it's not like, red purple.

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Oh, I also got that one.

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You want

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water's always,

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you know, a safe choice.

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But, But, yeah, any of those are.

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Well, and that's,

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I mean,

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I was told basically by the doctor,

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not in these words, but like,

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stay away from the blue and purple,

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you know, popsicles

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because we don't want you to.

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The good news is you're healthy.

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The bad news is,

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did you know you're part Smurf?

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Like you're not going to be able

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to see most of the things

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you need to see if I'm purple, right?

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Or blue.

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It's interesting.

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So every instruction has that.

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And you know, which I think it's fair.

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I think it can interfere

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with sort of the things,

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certain parts of your colon. Okay.

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But and so we do. Yeah.

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We do ask like avoid anything

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like how red color. Yeah, cherry stuff. Yeah.

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But and so,

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you know, tell patients to get like,

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lemon lime flavor or,

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you know, or like a those like,

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anything that's kind of clear.

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That's. Yeah.

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Again, just avoid kind of red or purple kind of color.

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So really.

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Yeah.

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This is

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this is a person you are trusting

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with a lot being unconscious

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and then having to do it.

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That don't make it harder for them.

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Right. That's what I would say. Yeah.

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So what exactly is colorectal cancer.

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Can we just kind of

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start at the beginning.

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Because this might also be

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a stupid question because, you know,

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I assume like colorectal,

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you know, rectum, colon.

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But where does it start

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and how do we get to that diagnosis.

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Yeah, I mean,

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I think everyone's familiar

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with the word cancer and what it is.

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But basically if I had to define

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colorectal cancer

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it's a massive malignant,

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you know, cells that continue

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to divide and divide

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until it invades into 

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you know, into your colon.

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And it starts

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it most often starts

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in the lining of your

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inner lining of the colon and your

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and the rectum.

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So colon is about

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is the last part

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of your digestive tract. Right.

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So, you know, it

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starts in your, you know,

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mouth into the

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stomach small intestine

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and the colon and the rectum,

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which, you know,

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we do differentiate it,

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but really

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they're all kind of the same.

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Right part,

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I guess, for the same highway. Exactly.

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It's about five feet long

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and it kind of starts,

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in the right lower

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part of your abdomen.

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Okay.

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Comes all the way around through, like,

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just below your rib

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cage to the liver, goes

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across to the left

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upper part of your spleen,

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and then kind of goes down

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and where it connects with the anus.

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Okay. Yeah.

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And then it's just

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all jumbled in there.

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It's really none of our business

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or business makes like a big question.

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Yeah okay. Got it.

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The small intestine

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I would say

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is is jumbled up in cancer

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free floating,

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but the colon itself is

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anchored in this box or this question

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mark shape.

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I'm glad you said that.

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And that's a great time to remind you

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that there is nothing you can say

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that is too simplistic for me.

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That's a place

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saying it's anchored

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where it's to be works for me.

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And like Doctor

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Kim said,

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the majority of them

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start on the inside

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lining of the colon.

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And so,

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that's why

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colon, you know,

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colonoscopy is recommended

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because we can

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physically see those polyps

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forming and developing into a cancer.

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Whereas a lot of patients

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ask us saying like, well,

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I had a CT scan,

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right, a few months ago,

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they didn't see that.

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And the answer is no.

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A lot of times

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they're too small,

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to really be picked up on MRI

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or CT

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scans until they grow to a certain size

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in which you wish you had gotten

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right before. Exactly. Yes.

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So that's at the point

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at which they start to become visible

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on imaging.

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You're pretty far down the road.

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Yeah.

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Or or developing symptoms.

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It may have already grown to a pretty big size 

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So you you mentioned symptoms.

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What are the symptoms?

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I would say the most common

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symptoms are,

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you know, rectal bleeding

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or blood in the stool. Okay.

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Change in bowel habits.

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So all of a sudden, let's say

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you were regular as a clock or,

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you know, for most of your life,

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and all of a sudden now

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you're having you're

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feeling more constipated.

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You're having,

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you're having trouble going, or now

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all of a sudden

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you're having diarrhea,

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you know, all of a sudden

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that's new for you.

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And, you know,

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I'm not talking about diarrhea.

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After you ate out and had some diet,

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I was in a hot dog eating contest.

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Exactly.

00:07:47:10 - 00:07:48:03
I'm talking like,

00:07:48:03 - 00:07:48:22
now there's some

00:07:48:22 - 00:07:50:02
some change you've noticed

00:07:50:02 - 00:07:51:08
that's consistent, right?

00:07:51:08 - 00:07:53:05
That's not temporary.

00:07:53:05 - 00:07:53:15
Got it.

00:07:53:15 - 00:07:56:13
And, of course, abdominal pain,

00:07:56:13 - 00:07:57:06
can be one,

00:07:58:06 - 00:08:00:15
you know, weight loss.

00:08:00:15 - 00:08:01:16
And then all of a sudden,

00:08:01:16 - 00:08:03:16
also like your stool changing,

00:08:03:16 - 00:08:06:11
like inconsistency, like, again,

00:08:06:11 - 00:08:08:16
like you've had certain consistency

00:08:08:16 - 00:08:09:05
all your life,

00:08:09:05 - 00:08:10:05
your diet hasn't changed.

00:08:10:05 - 00:08:11:20
And then boom, all of a sudden now

00:08:11:20 - 00:08:13:18
it's very like thin or okay,

00:08:13:18 - 00:08:15:00
so something's different.

00:08:15:00 - 00:08:15:10
Okay.

00:08:15:10 - 00:08:16:17
I'm actually glad you brought

00:08:16:17 - 00:08:18:12
that up and challenge

00:08:18:12 - 00:08:20:01
accepted to embarrass me.

00:08:20:01 - 00:08:21:10
So,

00:08:21:10 - 00:08:23:03
we actually we were talking about this

00:08:23:03 - 00:08:25:11
on the radio show that I co-host,

00:08:25:11 - 00:08:26:10
and because we really we're

00:08:26:10 - 00:08:27:04
trying our best,

00:08:27:04 - 00:08:29:09
as, you know, just normal dummies

00:08:29:09 - 00:08:30:06
to try and figure out, like,

00:08:30:06 - 00:08:30:22
what's normal

00:08:30:22 - 00:08:32:15
when it comes to bathroom habits.

00:08:32:15 - 00:08:34:13
And we were made to understand

00:08:34:13 - 00:08:35:07
that when suddenly it

00:08:35:07 - 00:08:36:20
when it's very thin,

00:08:36:20 - 00:08:38:21
long and thin, that can be a problem.

00:08:38:21 - 00:08:39:23
Why is that?

00:08:39:23 - 00:08:40:14
You know, again,

00:08:40:14 - 00:08:43:00
everyone has like a range of normal, right?

00:08:43:00 - 00:08:43:07
Like,

00:08:43:07 - 00:08:44:00
I have a lot of patients

00:08:44:00 - 00:08:44:21
come to me and says,

00:08:44:21 - 00:08:45:07
you know,

00:08:45:07 - 00:08:47:12
like I'm not having one probably

00:08:47:12 - 00:08:48:00
And every day

00:08:48:00 - 00:08:49:06
it's like every other day, right?

00:08:49:06 - 00:08:50:09
And I've been like this all my life.

00:08:50:09 - 00:08:52:09
And I reassure them, that's your body.

00:08:52:09 - 00:08:53:12
Exactly.

00:08:53:12 - 00:08:55:21
Because there's a lot of role play.

00:08:55:21 - 00:08:56:20
The reason why we,

00:08:58:00 - 00:08:58:21
get concerned about

00:08:58:21 - 00:09:00:19
all of a sudden can like this gradual

00:09:00:19 - 00:09:02:12
but persistent change in this long,

00:09:02:12 - 00:09:03:11
thin. Yes.

00:09:03:11 - 00:09:05:00
Is if you were to have a mass,

00:09:05:00 - 00:09:06:11
especially like in the rectum

00:09:06:11 - 00:09:08:11
or the left part of your colon.

00:09:08:11 - 00:09:10:17
So when, when the mass or cancer grows,

00:09:10:17 - 00:09:12:00
it tends to kind of

00:09:12:00 - 00:09:14:13
grow inwards as well outwards.

00:09:14:13 - 00:09:15:06
So the

00:09:15:06 - 00:09:16:06
so the opening

00:09:16:06 - 00:09:18:12
diameter of your colon is more narrow

00:09:18:12 - 00:09:19:11
Okay.

00:09:19:11 - 00:09:20:17
Now of course,

00:09:20:17 - 00:09:23:01
I would say the most, you know,

00:09:23:01 - 00:09:24:09
I mean, you can still get narrow

00:09:24:09 - 00:09:25:10
still from your diet.

00:09:25:10 - 00:09:26:02
That's why

00:09:26:02 - 00:09:27:13
if you know last night, don't

00:09:27:13 - 00:09:30:07
everybody run to WebMD, please.

00:09:30:07 - 00:09:32:02
So like if last night you had,

00:09:32:02 - 00:09:32:11
you know,

00:09:32:11 - 00:09:33:21
normally you're very like,

00:09:33:21 - 00:09:34:23
like a lot of vegetables,

00:09:34:23 - 00:09:35:21
fruits, a lot of fiber.

00:09:35:21 - 00:09:36:23
And then yesterday

00:09:36:23 - 00:09:37:20
was you're like, you're

00:09:37:20 - 00:09:39:04
you're your wedding anniversary,

00:09:39:04 - 00:09:40:02
or cheat day

00:09:40:02 - 00:09:41:15
you go to a nice steak restaurant.

00:09:41:15 - 00:09:41:20
You know,

00:09:41:20 - 00:09:42:18
you're not going to get a salad.

00:09:42:18 - 00:09:43:17
You can get a nice porterhouse.

00:09:43:17 - 00:09:45:06
Yeah, maybe next day loaded.

00:09:45:06 - 00:09:46:11
But it's a little bit exactly.

00:09:46:11 - 00:09:47:11
Got a lot of fiber.

00:09:47:11 - 00:09:48:00
And the next day

00:09:48:00 - 00:09:49:02
might be a little narrow.

00:09:49:02 - 00:09:51:09
But again, it's more of that,

00:09:51:09 - 00:09:52:03
so, you know,

00:09:52:03 - 00:09:52:23
but then if you go back

00:09:52:23 - 00:09:54:16
to your regular diet,

00:09:54:16 - 00:09:56:02
it should reflect what you're used to.

00:09:56:02 - 00:09:56:22
Exactly.

00:09:56:22 - 00:09:57:14
But, you know,

00:09:57:14 - 00:09:59:09
consistent thinning of the stool

00:09:59:09 - 00:10:01:09
when you haven't changed your diet.

00:10:01:09 - 00:10:02:13
And, you know,

00:10:02:13 - 00:10:03:17
especially if present

00:10:03:17 - 00:10:05:01
with other symptoms.

00:10:06:01 - 00:10:07:04
Let me ask you this.

00:10:07:04 - 00:10:07:12
I know

00:10:07:12 - 00:10:09:15
this is become kind of a buzz phrase,

00:10:09:15 - 00:10:10:07
and to be honest,

00:10:10:07 - 00:10:11:15
I don't totally understand it.

00:10:11:15 - 00:10:12:09
I've been told

00:10:12:09 - 00:10:13:12
I have it by a doctor

00:10:13:12 - 00:10:17:03
I got okay, but what what is leaky gut?

00:10:17:20 - 00:10:19:02
Is that a thing?

00:10:19:02 - 00:10:20:03
It it is,

00:10:20:03 - 00:10:21:14
it is something that, you know,

00:10:21:14 - 00:10:22:15
we talk to patients about.

00:10:22:15 - 00:10:23:22
I think probably Doctor Kim

00:10:23:22 - 00:10:25:22
talks a lot patients about it.

00:10:25:22 - 00:10:27:06
The idea that

00:10:27:06 - 00:10:29:12
the cells of the intestine

00:10:29:12 - 00:10:30:16
have attachments to each other.

00:10:30:16 - 00:10:32:01
So they form a layer.

00:10:32:01 - 00:10:33:10
And when there is inflammation

00:10:33:10 - 00:10:34:08
involved in the gut,

00:10:34:08 - 00:10:37:17
it causes a change in signals and cell,

00:10:38:21 - 00:10:40:04
cells touching each other

00:10:40:04 - 00:10:42:11
and the sort of molecules

00:10:42:11 - 00:10:43:14
that they produce

00:10:43:14 - 00:10:44:13
and the connection

00:10:44:13 - 00:10:45:13
between the cells is,

00:10:45:13 - 00:10:47:02
is not so tight anymore.

00:10:47:02 - 00:10:48:17
Oh, so it becomes more like a mesh.

00:10:48:17 - 00:10:49:16
Like. Exactly. Okay.

00:10:49:16 - 00:10:50:14
So that's a great way of putting it.

00:10:50:14 - 00:10:51:00
Okay.

00:10:51:00 - 00:10:52:21
And basically it's a

00:10:52:21 - 00:10:54:04
it's like another way to say that

00:10:54:04 - 00:10:55:01
there is inflammation

00:10:55:01 - 00:10:56:18
in the gut and okay.

00:10:56:18 - 00:10:59:19
And so that is sort of not really

00:11:00:06 - 00:11:00:22
like it's,

00:11:00:22 - 00:11:02:02
it's not really associated

00:11:02:02 - 00:11:03:12
with cancer itself.

00:11:03:12 - 00:11:03:21
Okay.

00:11:03:21 - 00:11:05:04
Thing that can indicate that

00:11:05:04 - 00:11:06:18
perhaps your gut health is not.

00:11:06:18 - 00:11:07:23
But like you said, it

00:11:07:23 - 00:11:09:22
indicates inflammation, correct?

00:11:09:22 - 00:11:10:05
Yeah.

00:11:10:05 - 00:11:11:14
Also something that is very,

00:11:11:14 - 00:11:13:06
very scary to me is,

00:11:13:06 - 00:11:15:08
people are getting diagnosed younger

00:11:15:08 - 00:11:16:16
and younger.

00:11:16:16 - 00:11:17:08
This is something

00:11:17:08 - 00:11:17:22
when you think of like

00:11:17:22 - 00:11:18:19
colorectal cancer,

00:11:18:19 - 00:11:19:04
you're like, oh,

00:11:19:04 - 00:11:20:21
my grandfather, who's 78

00:11:20:21 - 00:11:22:01
and you know, this just hit him.

00:11:22:01 - 00:11:24:01
This young people in their 30s.

00:11:24:01 - 00:11:25:13
This is happening to.

00:11:25:13 - 00:11:27:12
Do we have any explanation for this?

00:11:27:12 - 00:11:29:16
There's a lot of theories, okay.

00:11:29:16 - 00:11:31:15
But we don't exactly know.

00:11:31:15 - 00:11:32:15
The short answer is

00:11:32:15 - 00:11:34:08
we don't actually know. We don't know.

00:11:34:08 - 00:11:36:04
There's not a there's not a slam dunk.

00:11:36:04 - 00:11:39:04
There's not a, smoking gun.

00:11:39:06 - 00:11:40:13
There's a lot of potentially

00:11:40:13 - 00:11:42:15
contributing factors.

00:11:42:15 - 00:11:44:10
But yes, we are seeing it in younger

00:11:44:10 - 00:11:45:04
and younger people,

00:11:45:04 - 00:11:46:05
and we're seeing it in the media

00:11:46:05 - 00:11:48:03
all the time of, of right people

00:11:48:03 - 00:11:49:10
that we know, people

00:11:49:10 - 00:11:51:20
that are famous who are suddenly struck

00:11:51:20 - 00:11:53:06
with this disease.

00:11:53:06 - 00:11:54:08
And again, that sort of goes

00:11:54:08 - 00:11:54:16
back to what

00:11:54:16 - 00:11:55:19
we're talking about earlier,

00:11:55:19 - 00:11:56:15
is that

00:11:56:15 - 00:11:58:09
the symptoms may not be apparent

00:11:58:09 - 00:12:00:17
until the cancer is quite advanced.

00:12:00:17 - 00:12:01:01
Right?

00:12:01:01 - 00:12:02:05
Which is why you want to get this

00:12:02:05 - 00:12:04:03
checked out far before.

00:12:04:03 - 00:12:05:01
And okay,

00:12:05:01 - 00:12:05:15
to be clear,

00:12:05:15 - 00:12:06:20
you know, while it's

00:12:06:20 - 00:12:08:00
very frightening

00:12:08:00 - 00:12:09:09
that there are so many young people

00:12:09:09 - 00:12:10:17
being diagnosed,

00:12:10:17 - 00:12:12:06
we do have to remember

00:12:12:06 - 00:12:13:20
that the majority of people

00:12:13:20 - 00:12:15:16
getting diagnosed are older people.

00:12:15:16 - 00:12:16:13
So it is

00:12:16:13 - 00:12:16:20
colon

00:12:16:20 - 00:12:19:05
cancer is still a cancer of older

00:12:19:05 - 00:12:20:14
people.

00:12:20:14 - 00:12:21:08
And, you know,

00:12:21:08 - 00:12:22:14
if we look at

00:12:22:14 - 00:12:25:02
people who are in their 70s, 80s,

00:12:25:02 - 00:12:27:15
the risk of colon cancer is like,

00:12:27:15 - 00:12:31:01
you know, 200 to 400 per 100,000.

00:12:31:01 - 00:12:32:22
So these are all big numbers.

00:12:32:22 - 00:12:34:16
But but it's very high.

00:12:34:16 - 00:12:36:21
Whereas for for people

00:12:36:21 - 00:12:38:12
under 50 years old,

00:12:38:12 - 00:12:39:22
which is what we call early onset

00:12:39:22 - 00:12:41:06
colorectal cancer,

00:12:41:06 - 00:12:42:15
the number is more like 10

00:12:42:15 - 00:12:43:18
to 12 per one.

00:12:43:18 - 00:12:44:22
Okay okay.

00:12:44:22 - 00:12:47:10
So so, as Doctor Zhu mentioned,

00:12:48:11 - 00:12:50:09
you know, you look at the current,

00:12:50:09 - 00:12:51:13
the most recent data

00:12:51:13 - 00:12:52:20
for how many people

00:12:52:20 - 00:12:55:06
are getting early onset colon cancer.

00:12:55:06 - 00:12:56:11
You're talking about,

00:12:56:11 - 00:13:00:08
at 13 patients out of 100,000

00:13:00:08 - 00:13:02:13
each year for under,

00:13:02:13 - 00:13:03:10
you know, age of 50

00:13:03:10 - 00:13:04:07
will get colon cancer.

00:13:04:07 - 00:13:06:16
So you know, that number compared

00:13:06:16 - 00:13:08:11
to like, again, 200 to 400,

00:13:08:11 - 00:13:09:16
you know, out of 100,000

00:13:09:16 - 00:13:10:23
it's still much lower.

00:13:10:23 - 00:13:12:05
You need to put it in perspective.

00:13:12:05 - 00:13:12:15
Perspective.

00:13:12:15 - 00:13:14:14
But but but here's a perspective

00:13:14:14 - 00:13:15:10
that is

00:13:15:10 - 00:13:16:10
scary and alarming

00:13:16:10 - 00:13:17:09
for all of us in

00:13:17:09 - 00:13:20:10
this field is the incidence rate.

00:13:20:17 - 00:13:21:18
The rate has

00:13:21:18 - 00:13:23:13
basically triple quadrupled

00:13:23:13 - 00:13:24:11
compared to like,

00:13:24:11 - 00:13:25:07
you know, 50 years ago.

00:13:25:07 - 00:13:27:11
So back, you know, in like say

00:13:27:11 - 00:13:30:02
1950 only maybe two out of a,

00:13:30:02 - 00:13:32:00
you know, just giving that number.

00:13:32:00 - 00:13:33:09
There are only maybe 2 or 3

00:13:33:09 - 00:13:34:22
out of a hundred thousand.

00:13:34:22 - 00:13:36:14
Wow. Had it. But now 13.

00:13:36:14 - 00:13:38:22
So now 13 is now jump.

00:13:38:22 - 00:13:39:18
It is a jump.

00:13:39:18 - 00:13:40:14
And boy

00:13:40:14 - 00:13:41:21
you're taking me on a real roller

00:13:41:21 - 00:13:44:02
coaster ride right now emotionally.

00:13:44:02 - 00:13:47:17
And, and again, we don't exactly know

00:13:48:04 - 00:13:49:12
there isn't a smoking gun.

00:13:49:12 - 00:13:51:07
We do think a diet plays a role.

00:13:51:07 - 00:13:51:16
You know,

00:13:51:16 - 00:13:53:06
we do think processed food, processed

00:13:53:06 - 00:13:54:23
food plays a role, all of these things.

00:13:54:23 - 00:13:56:08
But ultimately,

00:13:56:08 - 00:13:57:04
we don't

00:13:57:04 - 00:13:59:19
we don't have an exact reason why.

00:13:59:19 - 00:14:02:20
And so, like a person born in 1950,

00:14:03:09 - 00:14:04:03
you know, if you're born in

00:14:04:03 - 00:14:06:01
1990, like I was,

00:14:08:07 - 00:14:09:22
you know, a person born in 1990

00:14:09:22 - 00:14:10:19
is twice

00:14:10:19 - 00:14:11:11
as more likely

00:14:11:11 - 00:14:12:21
to have colon cancer

00:14:12:21 - 00:14:14:10
compared to someone at that,

00:14:14:10 - 00:14:15:12
you know, at the younger age

00:14:15:12 - 00:14:17:17
than someone in born in 1950

00:14:17:17 - 00:14:18:13
and four times

00:14:18:13 - 00:14:20:01
more likely to have like rectal cancer.

00:14:20:01 - 00:14:21:04
So so it's all about

00:14:21:04 - 00:14:22:00
perspective, right.

00:14:22:00 - 00:14:23:01
So overall

00:14:23:01 - 00:14:25:07
the number is still not

00:14:25:07 - 00:14:26:18
you know it's only 13 right.

00:14:26:18 - 00:14:29:11
The cases I don't want to go to two.

00:14:29:11 - 00:14:29:21
And again

00:14:29:21 - 00:14:32:08
there's hundreds of millions of people.

00:14:32:08 - 00:14:35:05
Yeah. Between age you know 20 to 50.

00:14:35:05 - 00:14:36:15
And we are like you know

00:14:36:15 - 00:14:38:17
Dr. Zhu and I, you know, we,

00:14:38:17 - 00:14:39:11
work together

00:14:39:11 - 00:14:42:11
and we have a handful of patients who,

00:14:43:03 - 00:14:45:18
are in their 30s and, and,

00:14:45:18 - 00:14:47:16
like, rarely 20s.

00:14:47:16 - 00:14:49:03
The thing that is sort of more

00:14:49:03 - 00:14:51:15
alarming for us is doctors, the trend

00:14:51:15 - 00:14:53:00
and the trend of these

00:14:53:00 - 00:14:54:01
younger individuals

00:14:54:01 - 00:14:55:15
being more and more likely

00:14:55:15 - 00:14:56:22
with each year

00:14:56:22 - 00:14:58:13
to be at a higher risk

00:14:58:13 - 00:15:00:12
of colorectal cancer and actually,

00:15:00:12 - 00:15:01:14
you know,

00:15:01:14 - 00:15:02:17
a report came out

00:15:02:17 - 00:15:04:09
just a month or two ago

00:15:04:09 - 00:15:05:11
where you know,

00:15:05:11 - 00:15:06:13
they found that actually

00:15:06:13 - 00:15:07:20
colorectal cancer

00:15:07:20 - 00:15:09:11
is the most common

00:15:09:11 - 00:15:10:21
cause of cancer death.

00:15:10:21 - 00:15:12:05
And people under 50

00:15:12:05 - 00:15:14:02
of the top five causes

00:15:14:02 - 00:15:15:15
colorectal cancer was the only one

00:15:15:15 - 00:15:17:03
that has been having an increasing

00:15:17:03 - 00:15:18:13
trend, whereas the other four

00:15:18:13 - 00:15:20:03
have been having a decreasing trend.

00:15:20:03 - 00:15:20:19
I'm wondering

00:15:20:19 - 00:15:22:11
if some of that has to do with

00:15:22:11 - 00:15:23:18
like we've we've talked about

00:15:23:18 - 00:15:24:04
when we

00:15:24:04 - 00:15:25:11
we want to hit people over the head

00:15:25:11 - 00:15:27:16
with the kind of like shyness factor.

00:15:27:16 - 00:15:30:09
I don't really want to do a colonoscopy

00:15:30:09 - 00:15:32:03
and I'll just pray if I wish it away.

00:15:32:03 - 00:15:33:09
I just want to think about it.

00:15:33:09 - 00:15:34:08
So I'm just hoping

00:15:34:08 - 00:15:35:23
that people are really aware.

00:15:35:23 - 00:15:37:16
And also,

00:15:37:16 - 00:15:38:20
I know that it's like you

00:15:38:20 - 00:15:39:22
said, it's standard to start

00:15:39:22 - 00:15:40:23
when you're 45.

00:15:40:23 - 00:15:42:04
Do you think that that age

00:15:42:04 - 00:15:44:21
will come down given the the stats?

00:15:44:21 - 00:15:46:10
You know, it's it's so hard

00:15:46:10 - 00:15:47:21
because of what we talked about

00:15:47:21 - 00:15:49:02
as the absolute

00:15:49:02 - 00:15:51:17
number was still so low. Right.

00:15:51:17 - 00:15:53:06
You know, we're talking

00:15:53:06 - 00:15:55:21
you know, a full like, you know,

00:15:55:21 - 00:15:57:14
ten times less risky

00:15:57:14 - 00:16:00:01
than people in their 60s. Right? Right.

00:16:00:01 - 00:16:00:13
Okay.

00:16:00:13 - 00:16:01:22
So it's still

00:16:01:22 - 00:16:03:08
the absolute number is still small.

00:16:03:08 - 00:16:04:09
And if you increase

00:16:04:09 - 00:16:06:12
the number of screenings,

00:16:06:12 - 00:16:08:14
particularly with colonoscopy,

00:16:08:14 - 00:16:09:11
you're increasing

00:16:09:11 - 00:16:11:05
risk in a different way.

00:16:11:05 - 00:16:12:07
Because colonoscopy,

00:16:12:07 - 00:16:13:18
while it is very safe,

00:16:13:18 - 00:16:14:06
there is a

00:16:14:06 - 00:16:15:21
very small portion of patients

00:16:15:21 - 00:16:16:09
who will have

00:16:16:09 - 00:16:18:02
some kind of complications. Okay.

00:16:18:02 - 00:16:19:08
And so if you multiply that

00:16:19:08 - 00:16:20:14
by all of the 20 year

00:16:20:14 - 00:16:21:13
olds in the country,

00:16:21:13 - 00:16:23:08
then you're putting some people

00:16:23:08 - 00:16:24:18
at unnecessary risk.

00:16:24:18 - 00:16:26:12
And so yeah, that makes sense.

00:16:26:12 - 00:16:27:22
Can I just stop and commend

00:16:27:22 - 00:16:28:17
you both

00:16:28:17 - 00:16:31:16
for doing what nobody does anymore.

00:16:31:16 - 00:16:33:08
And it's just such a relief

00:16:33:08 - 00:16:34:01
to hear

00:16:34:01 - 00:16:35:00
somebody who has

00:16:35:00 - 00:16:36:05
gone through the training

00:16:36:05 - 00:16:37:20
and does this for a living say,

00:16:37:20 - 00:16:38:23
we don't know.

00:16:38:23 - 00:16:40:00
And there's just something

00:16:40:00 - 00:16:41:06
so comforting

00:16:41:06 - 00:16:44:01
to not being hit over the head with,

00:16:44:01 - 00:16:46:13
you know, just some, some theories and...

00:16:46:13 - 00:16:48:02
I just want to thank you for

00:16:48:02 - 00:16:49:09
for your honesty.

00:16:49:09 - 00:16:50:11
I think it's a lot about

00:16:50:11 - 00:16:51:18
how we’re trained as doctors.

00:16:51:18 - 00:16:52:10
You know, we

00:16:52:10 - 00:16:52:22
yeah,

00:16:52:22 - 00:16:54:00
we can't really pin

00:16:54:00 - 00:16:56:03
any one thing on a certain cause

00:16:56:03 - 00:16:58:02
because the biology in the world

00:16:58:02 - 00:16:59:16
doesn't work that simplistically.

00:16:59:16 - 00:16:59:22
Right?

00:16:59:22 - 00:17:02:03
People want to hear an easy answer,

00:17:02:03 - 00:17:03:02
but I appreciate this,

00:17:03:02 - 00:17:03:21
is that

00:17:03:21 - 00:17:05:23
it even just basic,

00:17:05:23 - 00:17:07:16
you know, medical conditions

00:17:07:16 - 00:17:08:20
that you think about

00:17:08:20 - 00:17:11:00
the ramifications are

00:17:11:00 - 00:17:12:05
endless possibilities.

00:17:12:05 - 00:17:12:11
You know,

00:17:12:11 - 00:17:14:12
we can't just say simplistically that,

00:17:14:12 - 00:17:15:21
you know, this is the cause of this.

00:17:15:21 - 00:17:16:17
And if you do this, then

00:17:16:17 - 00:17:17:16
this will never happen.

00:17:17:16 - 00:17:19:21
It is just too it's just too simple.

00:17:19:21 - 00:17:20:16
It's too simple.

00:17:20:16 - 00:17:22:15
And we're so used to being fed

00:17:22:15 - 00:17:23:17
that on social media.

00:17:23:17 - 00:17:24:14
It's just it's

00:17:24:14 - 00:17:25:15
such a breath of fresh air.

00:17:25:15 - 00:17:27:02
So thank you.

00:17:27:02 - 00:17:29:15
I mean, I do think that more research

00:17:29:15 - 00:17:30:17
definitely needs to be done

00:17:30:17 - 00:17:33:00
because even though we share,

00:17:33:00 - 00:17:34:14
we don't know exactly what it is.

00:17:34:14 - 00:17:36:10
We do have some ideas

00:17:36:10 - 00:17:38:03
that definitely need to be explored.

00:17:38:03 - 00:17:40:09
And it's it's an opportunity

00:17:40:09 - 00:17:41:15
for us to do better.

00:17:41:15 - 00:17:42:19
Well, one theory

00:17:42:19 - 00:17:44:06
that I've heard, thrown around

00:17:44:06 - 00:17:45:19
and being originally from Kansas City,

00:17:45:19 - 00:17:49:05
I don't like it is barbecued meats.

00:17:50:04 - 00:17:53:04
So can you guys please confirm or deny

00:17:53:10 - 00:17:54:08
that that's a problem?

00:17:54:08 - 00:17:56:03
Because some of us come from barbecue

00:17:56:03 - 00:17:57:05
meat land. Yes.

00:17:57:05 - 00:18:00:00
Red meat is not healthy for the colon.

00:18:00:18 - 00:18:02:01
And specifically on, like

00:18:02:01 - 00:18:03:18
a char, like a charred meat.

00:18:03:18 - 00:18:06:08
Charring, creates oxygen radicals.

00:18:06:08 - 00:18:08:04
They are very harmful for the body.

00:18:08:04 - 00:18:09:00
And of course,

00:18:09:00 - 00:18:09:23
everything we talk about with

00:18:09:23 - 00:18:11:07
diet is with moderation. Right.

00:18:11:07 - 00:18:12:11
So it's not like you're banned

00:18:12:11 - 00:18:14:00
from ever eating red meat. Yeah.

00:18:14:00 - 00:18:16:00
Or barbecue, but,

00:18:16:00 - 00:18:17:06
red meat itself is

00:18:17:06 - 00:18:19:14
is pretty pro-inflammatory.

00:18:19:14 - 00:18:21:15
It's it's not particularly healthy

00:18:21:15 - 00:18:22:15
for the colon,

00:18:22:15 - 00:18:24:10
in large quantities over

00:18:24:10 - 00:18:25:23
many, many years. Okay.

00:18:25:23 - 00:18:27:11
So just be aware.

00:18:27:11 - 00:18:29:01
Enjoy. Moderately.

00:18:29:01 - 00:18:30:05
Yes. Okay.

00:18:30:05 - 00:18:32:02
So for those of us

00:18:32:02 - 00:18:33:17
who are either new to this

00:18:33:17 - 00:18:34:21
or maybe, you know,

00:18:34:21 - 00:18:35:16
we're getting nudged

00:18:35:16 - 00:18:36:18
by our family and friends,

00:18:36:18 - 00:18:37:19
go get this done.

00:18:37:19 - 00:18:39:06
And I don't really know what it is.

00:18:39:06 - 00:18:40:07
Can you kind of walk us

00:18:40:07 - 00:18:42:10
through the screening options?

00:18:42:10 - 00:18:45:01
Because also I've also done,

00:18:45:01 - 00:18:46:23
the tests where it's like, okay,

00:18:46:23 - 00:18:48:13
you go play scientist in your bathroom

00:18:48:13 - 00:18:49:11
and send this to us.

00:18:49:11 - 00:18:50:17
But, but apparently got

00:18:50:17 - 00:18:51:19
some really good information out of it.

00:18:51:19 - 00:18:52:21
So can you just kind of walk us

00:18:52:21 - 00:18:54:05
through all the options?

00:18:54:05 - 00:18:54:13
Yeah.

00:18:54:13 - 00:18:54:21
I mean,

00:18:54:21 - 00:18:57:12
I do think that one of the great things

00:18:57:12 - 00:18:59:01
about in the past couple of decades

00:18:59:01 - 00:19:00:20
is we have more options now. Right?

00:19:00:20 - 00:19:01:21
So,

00:19:01:21 - 00:19:04:16
the gold standard is still colonoscopy.

00:19:04:16 - 00:19:06:08
And the reason being why it

00:19:06:08 - 00:19:08:06
it has the highest,

00:19:08:06 - 00:19:11:02
yield or accuracy of being able to

00:19:11:02 - 00:19:12:17
detect cancer, but,

00:19:13:17 - 00:19:13:23
you know, I

00:19:13:23 - 00:19:14:10
always tell my

00:19:14:10 - 00:19:15:03
patients, really

00:19:15:03 - 00:19:16:01
the biggest benefit

00:19:16:01 - 00:19:17:01
with colonoscopy

00:19:17:01 - 00:19:20:19
is being able to detect and remove

00:19:20:19 - 00:19:22:16
precancerous growths called polyps.

00:19:22:16 - 00:19:24:19
Yes, they look like little warts.

00:19:24:19 - 00:19:25:10
If I find them,

00:19:25:10 - 00:19:27:07
I can actually remove them,

00:19:27:07 - 00:19:28:07
when they're small

00:19:28:07 - 00:19:28:19
and that they're

00:19:28:19 - 00:19:29:23
at the precancerous stage

00:19:29:23 - 00:19:31:17
so that they don't have any chance

00:19:31:17 - 00:19:32:16
of becoming,

00:19:32:16 - 00:19:33:06
left alone

00:19:33:06 - 00:19:35:00
and becoming cancer in the future.

00:19:35:00 - 00:19:37:07
Okay, so it's really, the

00:19:37:07 - 00:19:38:16
I would say the biggest benefit with

00:19:38:16 - 00:19:41:16
colonoscopy is the ability to prevent

00:19:41:16 - 00:19:42:17
potential colon cancer

00:19:42:17 - 00:19:45:02
by being able to remove

00:19:45:02 - 00:19:46:12
pre-cancerous growths.

00:19:46:12 - 00:19:48:04
Now, the word precancerous is scary.

00:19:48:04 - 00:19:49:01
And we do take it seriously,

00:19:49:01 - 00:19:50:08
but precancerous polyps

00:19:50:08 - 00:19:53:04
in colon are extremely common. Right.

00:19:53:04 - 00:19:55:05
And, you know, being able to find these

00:19:55:05 - 00:19:57:05
and remove them,

00:19:57:05 - 00:19:58:07
you know, drastically does

00:19:58:07 - 00:19:59:09
reduce the risk of colon

00:19:59:09 - 00:20:00:06
cancer in the future.

00:20:00:06 - 00:20:00:17
Okay.

00:20:00:17 - 00:20:01:11
That makes sense

00:20:01:11 - 00:20:02:13
because that's instead of

00:20:02:13 - 00:20:03:05
just going like, well,

00:20:03:05 - 00:20:03:17
you're all clear

00:20:03:17 - 00:20:04:22
or you're not come back

00:20:04:22 - 00:20:07:04
and will remove it. It's done. Correct.

00:20:07:04 - 00:20:07:18
And you know,

00:20:07:18 - 00:20:10:06
if you once you start forming polyps,

00:20:10:06 - 00:20:12:01
you're more likely to form

00:20:12:01 - 00:20:12:22
polyps in the future

00:20:12:22 - 00:20:14:06
at different places.

00:20:14:06 - 00:20:14:22
So that's why,

00:20:14:22 - 00:20:16:09
you know, if I based on

00:20:16:09 - 00:20:18:02
the number, the size and,

00:20:19:03 - 00:20:20:11
the pathology results,

00:20:20:11 - 00:20:22:01
the biopsy results of the polyps,

00:20:22:01 - 00:20:23:16
I usually tell patients to come back

00:20:23:16 - 00:20:25:05
usually earlier than ten years.

00:20:25:05 - 00:20:25:13
Okay,

00:20:25:13 - 00:20:26:15
so if we don't find any polyps

00:20:26:15 - 00:20:28:04
and you don’t have any family history,

00:20:28:04 - 00:20:29:15
I might say come back in ten years.

00:20:29:15 - 00:20:30:14
But if I find, you know,

00:20:30:14 - 00:20:31:09
multiple polyps

00:20:31:09 - 00:20:33:21
might be like 3, 5 or 7 years.

00:20:33:21 - 00:20:35:21
Okay. That goes for family members too.

00:20:35:21 - 00:20:37:03
You know, if you have family members

00:20:37:03 - 00:20:38:11
who have polyps,

00:20:38:11 - 00:20:40:06
then your risk of having polyps

00:20:40:06 - 00:20:41:02
is higher as well.

00:20:41:02 - 00:20:42:01
So that also affects,

00:20:42:01 - 00:20:42:18
you know, the interval

00:20:42:18 - 00:20:44:10
that we may recommend. Okay.

00:20:44:10 - 00:20:46:06
So this is encoded in your DNA

00:20:46:06 - 00:20:48:18
in a lot of ways it is in some sense

00:20:48:18 - 00:20:49:11
but you know

00:20:49:11 - 00:20:51:01
when we ask patients like

00:20:51:01 - 00:20:52:04
do you have a family history of polyps,

00:20:52:04 - 00:20:52:23
most people don't know

00:20:52:23 - 00:20:54:04
because it's not like idea.

00:20:54:04 - 00:20:54:21
It's not true.

00:20:54:21 - 00:20:55:12
You I'm up at dinner.

00:20:55:12 - 00:20:56:11
Typically you talk about a

00:20:56:11 - 00:20:57:05
Thanksgiving dinner,

00:20:57:05 - 00:20:58:20
but you should take that opportunity

00:20:58:20 - 00:20:59:23
to talk during Thanksgiving

00:20:59:23 - 00:21:01:16
dinner about,

00:21:01:16 - 00:21:03:10
you know, about your life doing this.

00:21:03:10 - 00:21:04:22
You keep doing this for a long time,

00:21:04:22 - 00:21:06:08
tell me about your history.

00:21:06:08 - 00:21:08:03
You know, like I always tell patients,

00:21:08:03 - 00:21:09:17
especially if I remove a lot of polyps

00:21:09:17 - 00:21:11:10
in the colonoscopy, I say, listen, ultimately,

00:21:11:10 - 00:21:12:22
this is like, you know, up to you.

00:21:12:22 - 00:21:14:11
But I highly encourage you to

00:21:14:11 - 00:21:15:00
talk to your

00:21:15:00 - 00:21:16:18
especially your first-degree family members

00:21:16:18 - 00:21:17:03
Okay.

00:21:17:03 - 00:21:18:02
So like your siblings,

00:21:18:02 - 00:21:20:04
parents, children, hey, like the

00:21:20:04 - 00:21:21:13
I had a I had a colonoscopy.

00:21:21:13 - 00:21:23:09
I had a lot of polyps removed. Okay.

00:21:23:09 - 00:21:24:03
My doctor said

00:21:24:03 - 00:21:25:11
you guys should really get it,

00:21:25:11 - 00:21:26:18
you know, get a colonoscopy,

00:21:26:18 - 00:21:28:04
and get that checked out. Okay.

00:21:28:04 - 00:21:29:22
I certainly would never ask you

00:21:29:22 - 00:21:31:06
to break any HIPAA laws, but

00:21:31:06 - 00:21:31:22
I'm kind of curious

00:21:31:22 - 00:21:32:11
about something like,

00:21:33:16 - 00:21:34:03
what's the

00:21:34:03 - 00:21:35:04
most polyps

00:21:35:04 - 00:21:38:04
you've ever seen in a colonoscopy?

00:21:38:06 - 00:21:40:22
I think for me,

00:21:40:22 - 00:21:43:22
I think somewhere like 19 or 20.

00:21:44:21 - 00:21:46:08
So, so they're all

00:21:46:08 - 00:21:47:21
also genetic conditions.

00:21:47:21 - 00:21:49:06
No, they're not common.

00:21:49:06 - 00:21:50:14
But there are genetic conditions

00:21:50:14 - 00:21:52:06
that create a syndrome

00:21:52:06 - 00:21:53:10
called Polyposis

00:21:53:10 - 00:21:54:18
where people just

00:21:54:18 - 00:21:55:21
there's a mutation

00:21:55:21 - 00:21:56:20
that makes the polyps

00:21:56:20 - 00:21:58:15
form much more easily.

00:21:58:15 - 00:22:00:12
And so patients who have a particular

00:22:00:12 - 00:22:02:07
genetic condition,

00:22:02:07 - 00:22:05:21
called FAP. it’s Familial Adenomatous Polyposis

00:22:05:21 - 00:22:07:23
These patients form

00:22:07:23 - 00:22:09:11
a carpeting of polyps

00:22:09:11 - 00:22:10:20
all across the colon.

00:22:10:20 - 00:22:12:06
And to the extent

00:22:12:06 - 00:22:13:11
that they're guaranteed

00:22:13:11 - 00:22:14:23
to have colorectal cancer

00:22:14:23 - 00:22:16:02
in their lifetime,

00:22:16:02 - 00:22:17:19
and usually by a certain age.

00:22:17:19 - 00:22:19:04
Oh, so, so,

00:22:19:04 - 00:22:21:11
so, so those people are an anomaly.

00:22:21:11 - 00:22:22:10
Yeah, for sure.

00:22:22:10 - 00:22:25:06
But, a lot of people do have polyps.

00:22:25:06 - 00:22:26:01
It's very common.

00:22:26:01 - 00:22:27:01
And like Doctor Kim said,

00:22:27:01 - 00:22:30:01
not all the polyps become cancerous.

00:22:30:08 - 00:22:31:14
But you want to tackle them

00:22:31:14 - 00:22:33:03
before they become. Absolutely.

00:22:33:03 - 00:22:34:14
Well, now I feel like an underachiever.

00:22:34:14 - 00:22:36:03
Only one though.

00:22:36:03 - 00:22:38:03
So if this does happen.

00:22:38:03 - 00:22:38:16
Sorry.

00:22:38:16 - 00:22:40:08
I know you asked me about other options

00:22:40:08 - 00:22:41:05
I want to go into,

00:22:41:05 - 00:22:41:22
because I don't want to

00:22:41:22 - 00:22:42:17
just say colonoscopy.

00:22:43:17 - 00:22:44:23
We know that's the gold standard.

00:22:44:23 - 00:22:46:04
That's all standard, but,

00:22:46:04 - 00:22:48:00
there's other options as well.

00:22:48:00 - 00:22:51:03
So, you can also, get the

00:22:51:07 - 00:22:53:10
I think you mentioned the kit at home.

00:22:53:10 - 00:22:54:08
Yeah. Correct.

00:22:54:08 - 00:22:55:11
Said there's,

00:22:55:11 - 00:22:57:03
mainly two different stool

00:22:57:03 - 00:22:58:20
testing that you can do. Right.

00:22:58:20 - 00:23:01:04
One is called, and,

00:23:01:04 - 00:23:02:06
popularized by, like,

00:23:02:06 - 00:23:04:04
Saturday Night Live skit about it.

00:23:04:04 - 00:23:05:17
Cologuard.

00:23:05:17 - 00:23:08:01
You know, I think was it Woody

00:23:08:01 - 00:23:10:12
Harrelson I think was, oh, that's

00:23:10:12 - 00:23:11:21
it's really funny.

00:23:11:21 - 00:23:13:14
But basically, yeah, it's a, it's a,

00:23:13:14 - 00:23:14:04
it's a kit

00:23:14:04 - 00:23:15:05
that they send you to home

00:23:15:05 - 00:23:16:11
and you do have to,

00:23:16:11 - 00:23:18:09
you know, they'll give you a little hat

00:23:18:09 - 00:23:19:11
that goes over your toilet,

00:23:19:11 - 00:23:20:12
you have a bowel movement,

00:23:20:12 - 00:23:22:04
you put a little sample in it,

00:23:22:04 - 00:23:22:20
ship it out.

00:23:22:20 - 00:23:24:02
And basically what it detects

00:23:24:02 - 00:23:25:07
is combination

00:23:25:07 - 00:23:27:08
of microscopic level of blood

00:23:27:08 - 00:23:30:06
as well as, like cancer DNA.

00:23:30:06 - 00:23:32:17
Wow. And so, incredible.

00:23:32:17 - 00:23:34:12
So if it's positive,

00:23:34:12 - 00:23:35:11
meaning there is either

00:23:35:11 - 00:23:36:23
blood or cancer DNA,

00:23:36:23 - 00:23:37:17
then the next step

00:23:37:17 - 00:23:39:08
is colonoscopy, right?

00:23:39:08 - 00:23:41:11
If it's negative, you're good for,

00:23:41:11 - 00:23:42:15
three years.

00:23:42:15 - 00:23:44:09
The other testing is,

00:23:44:09 - 00:23:46:10
something called fecal immunochemical

00:23:46:10 - 00:23:48:12
testing or F.I.T or FIT.

00:23:48:12 - 00:23:49:00
It's,

00:23:49:00 - 00:23:49:18
it's a it's

00:23:49:18 - 00:23:51:01
it detects every,

00:23:51:01 - 00:23:52:20
microscopic level of blood

00:23:52:20 - 00:23:53:18
and same thing.

00:23:53:18 - 00:23:55:02
You collect a sample,

00:23:55:02 - 00:23:56:12
you bring it in, and it's

00:23:56:12 - 00:23:58:01
going to be positive or negative.

00:23:58:01 - 00:23:59:02
If it's positive again,

00:23:59:02 - 00:24:00:16
the next step is colonoscopy.

00:24:00:16 - 00:24:02:13
If it's, negative,

00:24:02:13 - 00:24:03:23
then you have to get that one.

00:24:03:23 - 00:24:05:15
You have to get every year. Okay.

00:24:05:15 - 00:24:07:01
So it's, it's a first step

00:24:07:01 - 00:24:08:01
if you're just trying to

00:24:08:01 - 00:24:10:14
put things in front of you especially.

00:24:10:14 - 00:24:11:08
Exactly.

00:24:11:08 - 00:24:14:08
And I have to, clarify that,

00:24:14:08 - 00:24:17:07
these screenings are for people

00:24:17:07 - 00:24:18:17
considered average risk.

00:24:18:17 - 00:24:20:05
So what I mean by that,

00:24:20:05 - 00:24:20:23
people who

00:24:20:23 - 00:24:22:11
don't have any family history

00:24:22:11 - 00:24:23:19
of, you know, cancer

00:24:23:19 - 00:24:25:15
or even, like a lot of polyps. Right?

00:24:25:15 - 00:24:25:22
If you

00:24:25:22 - 00:24:27:04
if your family has a lot of polyps,

00:24:27:04 - 00:24:29:12
you really should take colonoscopy

00:24:29:12 - 00:24:31:03
or who's never had a polyp before.

00:24:31:03 - 00:24:31:22
So okay.

00:24:31:22 - 00:24:33:21
For patients, let's say,

00:24:33:21 - 00:24:35:09
you did you did share with us

00:24:35:09 - 00:24:36:08
you had a one polyps.

00:24:36:08 - 00:24:36:18
Yeah.

00:24:36:18 - 00:24:38:02
Just take you as an example.

00:24:38:02 - 00:24:39:09
Do in seven years,

00:24:39:09 - 00:24:40:02
seven to 10 years, you

00:24:40:02 - 00:24:41:00
should get a colonoscopy.

00:24:42:15 - 00:24:44:02
You you really

00:24:44:02 - 00:24:45:15
shouldn't go back to cologuard

00:24:45:15 - 00:24:47:03
because you've had a polyp before.

00:24:47:03 - 00:24:50:02
You are considered higher risk.

00:24:50:02 - 00:24:51:14
And and the reason being is

00:24:51:14 - 00:24:53:00
there's a lot of false positive

00:24:53:00 - 00:24:54:05
and false negative results

00:24:54:05 - 00:24:54:20
with the test.

00:24:54:20 - 00:24:55:23
Again,

00:24:55:23 - 00:24:57:14
I always tell patients,

00:24:57:14 - 00:24:59:01
screening is better than no screening.

00:24:59:01 - 00:25:00:03
for people who are considered,

00:25:00:03 - 00:25:01:12
you know, who’ve had a polyp before...

00:25:01:12 - 00:25:02:22
No, you need a colonoscopy.

00:25:02:22 - 00:25:05:11
Okay, okay. That makes more sense.

00:25:05:11 - 00:25:08:06
So say somebody does get a colorectal

00:25:08:06 - 00:25:09:20
cancer diagnosis,

00:25:09:20 - 00:25:11:16
what does the treatment look like?

00:25:11:16 - 00:25:13:04
And I imagine it looks different

00:25:13:04 - 00:25:15:07
for somebody who this is you know,

00:25:15:07 - 00:25:16:11
this is like square one

00:25:16:11 - 00:25:18:01
or this is like well, you

00:25:18:01 - 00:25:18:15
we really wish

00:25:18:15 - 00:25:19:05
you would have come in

00:25:19:05 - 00:25:20:04
a couple of years ago.

00:25:20:04 - 00:25:21:14
I know that's a really great question,

00:25:21:14 - 00:25:23:10
and it really depends on each

00:25:23:10 - 00:25:25:10
person's individual cancer,

00:25:26:10 - 00:25:28:09
and how advanced it is.

00:25:28:09 - 00:25:29:22
And you may interface

00:25:29:22 - 00:25:31:04
first with an oncologist,

00:25:31:04 - 00:25:33:21
a cancer doctor or a surgeon or a GI.

00:25:33:21 - 00:25:35:08
It just sort of depends on

00:25:35:08 - 00:25:37:21
who you ended up seeing first.

00:25:37:21 - 00:25:40:06
But typically for colon cancer,

00:25:40:06 - 00:25:41:04
the majority of time,

00:25:41:04 - 00:25:42:06
the first step is going to be

00:25:42:06 - 00:25:43:16
a surgery. Okay.

00:25:43:16 - 00:25:44:17
And so those are for

00:25:44:17 - 00:25:46:08
cancers that have not spread

00:25:46:08 - 00:25:48:19
to other organs in the body.

00:25:48:19 - 00:25:50:02
Once we have verified

00:25:50:02 - 00:25:52:13
that with some workup, some imaging,

00:25:52:13 - 00:25:53:01
so typically

00:25:53:01 - 00:25:53:16
what would happen

00:25:53:16 - 00:25:55:08
is, you know, you get the colonoscopy,

00:25:55:08 - 00:25:56:21
you get the diagnosis,

00:25:56:21 - 00:25:58:08
you get a bunch of tests done

00:25:58:08 - 00:25:59:23
just to evaluate

00:25:59:23 - 00:26:02:07
to see how advanced the tumor is.

00:26:02:07 - 00:26:05:07
So CT scans, some lab tests,

00:26:05:14 - 00:26:08:00
and then if that all comes back clean,

00:26:08:00 - 00:26:10:02
then surgery is usually the next step

00:26:10:02 - 00:26:12:09
to just you just remove that section.

00:26:12:09 - 00:26:12:15
Yeah.

00:26:12:15 - 00:26:14:13
So a lot of patients,

00:26:14:13 - 00:26:15:15
ask me actually saying,

00:26:15:15 - 00:26:17:05
oh, you're not going to just take out

00:26:17:05 - 00:26:17:16
the tumor.

00:26:17:16 - 00:26:18:11
You're actually taking

00:26:18:11 - 00:26:20:04
a portion of my colon out.

00:26:20:04 - 00:26:21:05
And the answer is yes.

00:26:21:05 - 00:26:22:10
We can't just carve out

00:26:22:10 - 00:26:23:09
the tumor itself.

00:26:23:09 - 00:26:24:06
We have to remove

00:26:24:06 - 00:26:25:09
a segment of the colon

00:26:25:09 - 00:26:27:06
that contains the tumor. Okay.

00:26:27:06 - 00:26:29:11
There are these, little balls of tissue

00:26:29:11 - 00:26:30:08
called lymph nodes

00:26:30:08 - 00:26:31:09
that are next to the colon.

00:26:31:09 - 00:26:33:17
We have to remove all of that together,

00:26:33:17 - 00:26:34:19
to get our best chance

00:26:34:19 - 00:26:35:18
to get an idea

00:26:35:18 - 00:26:37:22
of how advanced the tumor is.

00:26:37:22 - 00:26:39:12
So for colon cancer,

00:26:39:12 - 00:26:40:23
that is usually the first step.

00:26:40:23 - 00:26:42:22
How does that change someone's

00:26:42:22 - 00:26:44:11
or does it change someone's day to day

00:26:44:11 - 00:26:45:15
to not have that piece of their colon

00:26:45:15 - 00:26:46:16
or those lymph nodes?

00:26:46:16 - 00:26:47:17
It's a really good question.

00:26:47:17 - 00:26:48:10
The lymph nodes,

00:26:48:10 - 00:26:49:12
you're not going to notice them.

00:26:49:12 - 00:26:50:13
They just exist in the body.

00:26:50:13 - 00:26:52:03
Okay. There's a lot of them.

00:26:52:03 - 00:26:53:20
And then for the colon itself,

00:26:53:20 - 00:26:54:19
it really depends on

00:26:54:19 - 00:26:56:19
where in the body the,

00:26:56:19 - 00:26:58:07
the tumor is located,

00:26:58:07 - 00:26:59:09
if it's on the right side

00:26:59:09 - 00:27:01:01
or the left side,

00:27:01:01 - 00:27:02:15
and it just depends

00:27:02:15 - 00:27:05:02
on the anatomy of the colon itself.

00:27:05:02 - 00:27:07:00
The majority of the time when we remove

00:27:07:00 - 00:27:08:05
just a segment of the colon,

00:27:08:05 - 00:27:09:20
there's no functional outcomes.

00:27:09:20 - 00:27:10:13
Differences.

00:27:10:13 - 00:27:12:07
Oh, well, patients are able to have

00:27:12:07 - 00:27:13:08
maybe maybe they'll have, like,

00:27:13:08 - 00:27:15:23
one more bowel movement than usual

00:27:15:23 - 00:27:17:07
in the day.

00:27:17:07 - 00:27:18:22
But it just really depends on

00:27:18:22 - 00:27:20:12
sort of where the tumor is located.

00:27:20:12 - 00:27:21:07
Okay.

00:27:21:07 - 00:27:22:14
So it shouldn't be.

00:27:22:14 - 00:27:23:23
It's, it's and again

00:27:23:23 - 00:27:25:01
I'm, I'm speaking

00:27:25:01 - 00:27:26:22
so from I'm in the dark

00:27:26:22 - 00:27:28:00
this isn't like

00:27:28:00 - 00:27:29:11
oh like suddenly I'm

00:27:29:11 - 00:27:31:08
using a colostomy bag or this isn't

00:27:31:08 - 00:27:32:13
that's not what we're talking about.

00:27:32:13 - 00:27:32:22
No.

00:27:32:22 - 00:27:35:00
So not for patients who come in like,

00:27:35:00 - 00:27:36:10
you know, in this routine basis

00:27:36:10 - 00:27:37:12
where they're

00:27:37:12 - 00:27:38:19
they're relatively healthy,

00:27:38:19 - 00:27:39:04
you know,

00:27:39:04 - 00:27:42:04
their cancer is not terribly advanced.

00:27:42:04 - 00:27:44:08
And, they've had a bowel prep

00:27:44:08 - 00:27:45:20
and everything.

00:27:45:20 - 00:27:47:12
They go in for the surgery,

00:27:47:12 - 00:27:49:17
they don't come out with a bag.

00:27:49:17 - 00:27:52:03
And, and then they live a pretty

00:27:52:03 - 00:27:52:22
normal life.

00:27:52:22 - 00:27:53:10
Okay.

00:27:53:10 - 00:27:54:14
This is specifically talking

00:27:54:14 - 00:27:55:04
about colons.

00:27:55:04 - 00:27:56:02
Yes, yes.

00:27:56:02 - 00:27:56:09
Vessel

00:27:56:09 - 00:27:58:15
cancer is a bit of a different beast.

00:27:58:15 - 00:28:00:11
And so rectal cancer,

00:28:00:11 - 00:28:02:19
we've actually had a huge evolution

00:28:02:19 - 00:28:03:12
in treatment

00:28:03:12 - 00:28:06:12
over the last ten, 15, 20 years.

00:28:06:13 - 00:28:07:14
It used to be that

00:28:07:14 - 00:28:09:04
patients would get radiation

00:28:09:04 - 00:28:10:10
and then they would get surgery,

00:28:10:10 - 00:28:12:00
and then they would get chemotherapy.

00:28:12:00 - 00:28:12:15
Wow. Yeah.

00:28:12:15 - 00:28:13:22
But we've changed up the order

00:28:13:22 - 00:28:16:01
of how we do things to get patients

00:28:16:01 - 00:28:17:21
the best benefit of completing

00:28:17:21 - 00:28:19:20
all three forms of treatment. Okay.

00:28:19:20 - 00:28:21:16
Some rectal cancers, the early ones,

00:28:21:16 - 00:28:23:18
only need a surgery.

00:28:23:18 - 00:28:24:22
Some we can get away with

00:28:24:22 - 00:28:26:14
not doing any surgery at all.

00:28:26:14 - 00:28:27:15
So we can do

00:28:27:15 - 00:28:29:19
just radiation and chemotherapy

00:28:29:19 - 00:28:31:12
and the cancer goes away.

00:28:31:12 - 00:28:32:11
And then there are some

00:28:32:11 - 00:28:34:14
very specialized,

00:28:34:14 - 00:28:36:08
rectal and colon cancers

00:28:36:08 - 00:28:37:13
that if you actually

00:28:37:13 - 00:28:38:22
give them immunotherapy,

00:28:38:22 - 00:28:41:03
a different kind of injection,

00:28:41:03 - 00:28:42:09
they don't even need radiation.

00:28:42:09 - 00:28:43:11
So it's, it's

00:28:43:11 - 00:28:45:03
there's a lot of different treatments.

00:28:45:03 - 00:28:46:08
And one of the benefits

00:28:46:08 - 00:28:46:21
of being treated at

00:28:46:21 - 00:28:49:21
UCI is that we have a rectal cancer,

00:28:50:07 - 00:28:51:14
tumor board.

00:28:51:14 - 00:28:52:12
So, you know, I

00:28:52:12 - 00:28:53:12
participate in this to board

00:28:53:12 - 00:28:54:08
every single week.

00:28:54:08 - 00:28:56:19
We have a big group of oncologists,

00:28:56:19 - 00:28:58:03
radiation doctors,

00:28:59:17 - 00:29:01:11
radiologists, pathologists.

00:29:01:11 - 00:29:02:17
We all get together

00:29:02:17 - 00:29:04:09
and we discuss every single

00:29:04:09 - 00:29:06:05
rectal cancer case that hits our door

00:29:06:05 - 00:29:08:19
because the options are so varied

00:29:08:19 - 00:29:11:02
and so patient specific.

00:29:11:02 - 00:29:11:18
You know,

00:29:11:18 - 00:29:13:12
just just a couple

00:29:13:12 - 00:29:14:16
centimeters difference

00:29:14:16 - 00:29:15:22
in where the tumor is located

00:29:15:22 - 00:29:16:20
Totally different treatment

00:29:16:20 - 00:29:18:11
may change our treatment options.

00:29:18:11 - 00:29:21:00
So, so we discuss every single case.

00:29:21:00 - 00:29:23:05
We get a consensus, we take these

00:29:23:05 - 00:29:24:03
this consensus

00:29:24:03 - 00:29:25:21
to, you know, to the patients

00:29:25:21 - 00:29:27:23
and present them with their options.

00:29:27:23 - 00:29:29:01
And at UCI, we can

00:29:29:01 - 00:29:29:18
we can communicate

00:29:29:18 - 00:29:30:11
with each other very,

00:29:30:11 - 00:29:32:17
very quickly and very easily.

00:29:32:17 - 00:29:32:22
You know,

00:29:32:22 - 00:29:34:12
when you're at an academic center,

00:29:34:12 - 00:29:36:01
we have very close communication,

00:29:36:01 - 00:29:37:20
very easy communication,

00:29:37:20 - 00:29:38:23
where we can,

00:29:38:23 - 00:29:40:15
you know, immediately

00:29:40:15 - 00:29:43:00
just message our, our,

00:29:43:00 - 00:29:43:17
you know, our partners,

00:29:43:17 - 00:29:44:20
our oncologists

00:29:44:20 - 00:29:46:01
and, and,

00:29:46:01 - 00:29:47:20
formulate quick changes in plans.

00:29:47:20 - 00:29:49:06
And so it's so cool.

00:29:49:06 - 00:29:51:11
So, so the treatment for rectal cancer

00:29:51:11 - 00:29:52:11
is, is very,

00:29:52:11 - 00:29:54:18
very different than colon cancer.

00:29:54:18 - 00:29:57:10
But that just means that we have,

00:29:57:10 - 00:29:57:16
you know,

00:29:57:16 - 00:29:59:03
a lot of people that weigh in

00:29:59:03 - 00:30:00:18
and give us information.

00:30:00:18 - 00:30:00:23
Well,

00:30:00:23 - 00:30:01:22
and I don't want

00:30:01:22 - 00:30:02:23
to get too far away from this

00:30:02:23 - 00:30:04:06
because we're talking about treatment.

00:30:04:06 - 00:30:06:23
And I want to talk about the robots.

00:30:06:23 - 00:30:09:08
Can we talk about robots?

00:30:09:08 - 00:30:09:22
Sure.

00:30:09:22 - 00:30:10:22
Yes, yes.

00:30:10:22 - 00:30:12:21
Tell me about the robots.

00:30:12:21 - 00:30:13:21
So unlike what

00:30:13:21 - 00:30:16:21
a lot of patients imagine, which is a,

00:30:17:07 - 00:30:19:14
a robot doing the surgery.

00:30:19:14 - 00:30:20:07
Yes.

00:30:20:07 - 00:30:22:13
The robot is not -- I’ve seen them fold napkins, 

00:30:22:13 - 00:30:23:21
I’ve seen them do all kinds of things.

00:30:23:21 - 00:30:26:01
The robot is a set of four arms

00:30:26:01 - 00:30:28:06
That I control as the surgeon.

00:30:28:06 - 00:30:30:00
So there's a console.

00:30:30:00 - 00:30:31:16
So I sit at the console.

00:30:31:16 - 00:30:32:18
I'm not even necessarily

00:30:32:18 - 00:30:34:09
touching on the patient.

00:30:34:09 - 00:30:36:20
Now, I do still touch the patient.

00:30:36:20 - 00:30:37:06
You know, there's

00:30:37:06 - 00:30:39:04
there's still an involvement before,

00:30:39:04 - 00:30:40:11
at the end of the procedure.

00:30:40:11 - 00:30:41:16
And there's usually an assistant

00:30:41:16 - 00:30:42:02
at the,

00:30:42:02 - 00:30:43:13
at the patient's bedside

00:30:43:13 - 00:30:45:17
who is helping me to,

00:30:45:17 - 00:30:46:13
you know, manage

00:30:46:13 - 00:30:48:08
the instruments for the robot.

00:30:48:08 - 00:30:51:12
But I control all the arms, and I get,

00:30:52:11 - 00:30:53:14
these, you know,

00:30:53:14 - 00:30:55:06
a really great visualization

00:30:55:06 - 00:30:56:10
of the inside of the abdomen

00:30:56:10 - 00:30:59:02
because the resolution of the camera

00:30:59:02 - 00:31:00:15
is so good,

00:31:00:15 - 00:31:02:08
that I can see, you know,

00:31:02:08 - 00:31:03:15
I can see lymph nodes.

00:31:03:15 - 00:31:04:16
I can see

00:31:04:16 - 00:31:06:12
I can see the nerves that are around

00:31:06:12 - 00:31:07:19
the pelvis.

00:31:07:19 - 00:31:08:22
I can really get

00:31:08:22 - 00:31:11:00
into deep portions of the pelvis

00:31:11:00 - 00:31:12:15
that I would not be able

00:31:12:15 - 00:31:15:05
to easily reach with my hands.

00:31:15:05 - 00:31:16:08
And I make just these

00:31:16:08 - 00:31:17:17
small little incisions,

00:31:17:17 - 00:31:20:08
and I'm able to do the surgery through,

00:31:20:08 - 00:31:21:21
you know, just little incisions

00:31:21:21 - 00:31:23:02
instead of making a big one.

00:31:23:02 - 00:31:25:17
When you first started,

00:31:25:17 - 00:31:26:14
doing surgeries,

00:31:26:14 - 00:31:27:15
were you already working

00:31:27:15 - 00:31:28:11
with this kind of stuff

00:31:28:11 - 00:31:29:10
or was this introduced later?

00:31:29:10 - 00:31:29:19
You're like,

00:31:31:00 - 00:31:31:22
everybody hold on.

00:31:31:22 - 00:31:33:23
when I started my training program,

00:31:33:23 - 00:31:35:15
it became progressively more of a

00:31:35:15 - 00:31:38:15
thing as I progressed in my training.

00:31:38:15 - 00:31:38:21
You know,

00:31:38:21 - 00:31:40:22
the uptake of the robot has been

00:31:40:22 - 00:31:42:15
has been just like, really,

00:31:42:15 - 00:31:44:22
you know, I bet just astronomical.

00:31:44:22 - 00:31:45:05
Yeah.

00:31:45:05 - 00:31:48:01
In the past, you know, 10 to 15 years.

00:31:48:01 - 00:31:51:03
So the adoption has become very high.

00:31:51:03 - 00:31:52:01
Okay.

00:31:52:01 - 00:31:53:10
But, for,

00:31:53:10 - 00:31:55:04
for rectal cancer specifically,

00:31:55:04 - 00:31:56:22
I pretty much always use the robot

00:31:56:22 - 00:31:58:00
because it really gives me

00:31:58:00 - 00:32:00:17
great maneuverability in the pelvis,

00:32:00:17 - 00:32:02:17
which is a very tight location.

00:32:02:17 - 00:32:03:09
A lot of it's

00:32:03:09 - 00:32:04:13
hard to get around corners.

00:32:04:13 - 00:32:06:00
Yeah, it's hard to get around corners.

00:32:06:00 - 00:32:07:09
So the robot gives me

00:32:07:09 - 00:32:09:04
just so much more ability

00:32:09:04 - 00:32:11:13
to maneuver in that tight space

00:32:11:13 - 00:32:13:06
than I can with my hands

00:32:13:06 - 00:32:15:19
or with my physical eyes.

00:32:15:19 - 00:32:16:08
Right.

00:32:16:08 - 00:32:17:11
Or,

00:32:17:11 - 00:32:19:20
or the laparoscopic instruments, which,

00:32:19:20 - 00:32:22:20
laparoscopy is essentially like a,

00:32:22:21 - 00:32:23:15
you know, it's

00:32:23:15 - 00:32:24:20
the version that we had

00:32:24:20 - 00:32:26:00
before a robot

00:32:26:00 - 00:32:28:10
where we still use it very frequently,

00:32:28:10 - 00:32:29:08
but the instruments are

00:32:29:08 - 00:32:30:05
all straight sticks.

00:32:30:05 - 00:32:31:10
It's like operating with chopsticks.

00:32:31:10 - 00:32:33:22
Oh. So, so operating with chopsticks.

00:32:33:22 - 00:32:36:05
My hands are on those instruments.

00:32:36:05 - 00:32:38:21
It is can be fatiguing on my body

00:32:38:21 - 00:32:40:08
to to do that kind of surgery,

00:32:40:08 - 00:32:41:13
but it allows us to stick

00:32:41:13 - 00:32:42:23
with the same small incisions.

00:32:42:23 - 00:32:44:15
Okay, so the size of incision

00:32:44:15 - 00:32:45:00
is probably

00:32:45:00 - 00:32:46:23
about the same between laparoscopy

00:32:46:23 - 00:32:47:23
and the robot.

00:32:47:23 - 00:32:50:00
But the maneuver, maneuverability

00:32:50:00 - 00:32:51:01
and the visualization

00:32:51:01 - 00:32:52:05
is much better with the robot.

00:32:52:05 - 00:32:53:07
So I would imagine. Yeah.

00:32:53:07 - 00:32:55:08
Like this is just the next step

00:32:55:08 - 00:32:56:15
in the future of yes.

00:32:56:15 - 00:32:58:07
And laparoscopy is never going away

00:32:58:07 - 00:32:59:14
because it's such a it's

00:32:59:14 - 00:33:00:03
such a cost

00:33:00:03 - 00:33:02:09
effective and honestly useful

00:33:02:09 - 00:33:04:09
means of doing standard.

00:33:04:09 - 00:33:06:16
And and surgeries are quicker with less

00:33:06:16 - 00:33:08:02
to be interesting like, oh really.

00:33:08:02 - 00:33:09:16
I think part of as the robot makes us

00:33:09:16 - 00:33:10:17
focus a little bit too much

00:33:10:17 - 00:33:11:16
on some of the details.

00:33:12:17 - 00:33:13:16
But it's,

00:33:13:16 - 00:33:14:08
you know, both of

00:33:14:08 - 00:33:16:00
them are great tools

00:33:16:00 - 00:33:16:18
for what we call

00:33:16:18 - 00:33:18:21
minimally invasive surgery.

00:33:18:21 - 00:33:20:10
So, so all of us

00:33:20:10 - 00:33:22:00
as a group of colorectal surgeons

00:33:22:00 - 00:33:22:13
that, you see,

00:33:22:13 - 00:33:25:07
we all use both, both techniques,

00:33:25:07 - 00:33:26:09
for different purposes.

00:33:26:09 - 00:33:31:05
And, it does improve patients’ satisfaction.

00:33:31:05 - 00:33:32:12
I think, because their recovery

00:33:32:12 - 00:33:34:04
is much faster,

00:33:34:04 - 00:33:36:14
there's less handling of intestines.

00:33:36:14 - 00:33:37:19
And so,

00:33:37:19 - 00:33:40:14
instead of our, our, our, our big hand,

00:33:40:14 - 00:33:42:18
like, touching all the intestines,

00:33:42:18 - 00:33:44:03
it's just these little instruments.

00:33:44:03 - 00:33:45:21
It's much more delicate.

00:33:45:21 - 00:33:47:20
Patients just recover much faster.

00:33:47:20 - 00:33:50:06
And, you know, they're they're,

00:33:50:06 - 00:33:51:03
a lot less risk

00:33:51:03 - 00:33:52:09
for certain complications. And.

00:33:52:09 - 00:33:52:20
So funny,

00:33:52:20 - 00:33:53:07
you go back

00:33:53:07 - 00:33:53:16
and you watch

00:33:53:16 - 00:33:55:08
these old medical shows or, like,

00:33:55:08 - 00:33:55:13
you know,

00:33:55:13 - 00:33:57:01
something that takes place in the 20s,

00:33:57:01 - 00:33:57:11
like this.

00:33:57:11 - 00:33:58:23
Kind of, like spooky hospital.

00:33:58:23 - 00:34:01:12
It's like, I'm just so glad I live now.

00:34:01:12 - 00:34:02:08
I mean, this is really

00:34:02:08 - 00:34:03:00
I mean, it's just, like,

00:34:03:00 - 00:34:04:11
really exciting stuff.

00:34:04:11 - 00:34:05:10
It is very exciting.

00:34:05:10 - 00:34:06:13
And neither of you,

00:34:06:13 - 00:34:08:12
I imagine, are particularly squeamish.

00:34:08:12 - 00:34:10:05
No, no, no, it's terribly.

00:34:12:05 - 00:34:13:02
Well, I

00:34:13:02 - 00:34:14:23
thank goodness that we have

00:34:14:23 - 00:34:17:10
people like you taking care of us.

00:34:17:10 - 00:34:18:17
But when it comes to

00:34:18:17 - 00:34:20:12
empowering ourselves,

00:34:20:12 - 00:34:21:17
what would you say are like

00:34:21:17 - 00:34:22:18
just a couple tips

00:34:22:18 - 00:34:25:00
lifestyle wise, me diet, whatever

00:34:25:00 - 00:34:26:17
that we can do to kind of decrease

00:34:26:17 - 00:34:27:10
your both lovely,

00:34:27:10 - 00:34:28:22
but decrease our chance of ever

00:34:28:22 - 00:34:30:16
having to come see you now.

00:34:30:16 - 00:34:31:23
Of course I think,

00:34:31:23 - 00:34:33:00
like we mentioned, diet

00:34:33:00 - 00:34:35:08
does play a huge role.

00:34:35:08 - 00:34:36:07
As we as doctors,

00:34:36:07 - 00:34:37:15
you talked about previously,

00:34:37:15 - 00:34:39:10
you know, eating a lot of red meat

00:34:39:10 - 00:34:40:21
or processed foods,

00:34:40:21 - 00:34:41:16
eating a very low

00:34:41:16 - 00:34:43:13
fiber diet, which, incidentally,

00:34:43:13 - 00:34:44:20
the vast majority of Americans

00:34:44:20 - 00:34:45:16
don't get the.

00:34:45:16 - 00:34:47:12
Yeah, I'm on the fiber. Recommend this.

00:34:47:12 - 00:34:48:12
Yeah, yeah, for sure.

00:34:48:12 - 00:34:49:11
Once you start tracking it,

00:34:49:11 - 00:34:50:01
you realize how,

00:34:50:01 - 00:34:52:03
oh, I've actually been nowhere near.

00:34:52:03 - 00:34:53:08
Yeah, right.

00:34:53:08 - 00:34:55:04
So, you know, eating a high fiber diet,

00:34:55:04 - 00:34:56:16
all of this can be very helpful.

00:34:57:16 - 00:34:58:14
I think, you know,

00:34:58:14 - 00:34:59:18
there's definitely some research

00:34:59:18 - 00:35:02:15
saying leading an active lifestyle,

00:35:02:15 - 00:35:03:15
can be helpful.

00:35:03:15 - 00:35:04:20
You know,

00:35:04:20 - 00:35:05:18
tobacco use

00:35:05:18 - 00:35:07:02
and alcohol use does increase.

00:35:07:02 - 00:35:07:07
You know,

00:35:07:07 - 00:35:08:06
there has been some evidence

00:35:08:06 - 00:35:09:14
that does show increased

00:35:09:14 - 00:35:10:17
risk of colon cancer.

00:35:10:17 - 00:35:12:04
So, you know, again,

00:35:12:04 - 00:35:13:08
trying to avoid those

00:35:13:08 - 00:35:14:15
at the very at the very least,

00:35:14:15 - 00:35:16:16
like moderation if possible.

00:35:16:16 - 00:35:17:22
I think that comes to mind.

00:35:17:22 - 00:35:18:19
I think the amount of time

00:35:18:19 - 00:35:19:19
that I talk to my patients

00:35:19:19 - 00:35:21:14
about fiber is,

00:35:21:14 - 00:35:22:21
is can be pretty shocking

00:35:22:21 - 00:35:24:00
for the average person.

00:35:24:00 - 00:35:24:16
But it was a drinking

00:35:24:16 - 00:35:26:07
game would be wasted.

00:35:26:07 - 00:35:27:03
But really,

00:35:27:03 - 00:35:29:04
I mean, fiber is, you know, it

00:35:29:04 - 00:35:30:16
it is healthy for the gut.

00:35:30:16 - 00:35:32:06
It's anti-inflammatory.

00:35:32:06 - 00:35:36:01
And it does decrease risk overall. It does.

00:35:36:01 - 00:35:37:17
not just of colorectal cancer

00:35:37:17 - 00:35:38:07
but of other

00:35:38:07 - 00:35:39:20
GI conditions

00:35:39:20 - 00:35:40:15
because, you know,

00:35:40:15 - 00:35:43:07
fiber is is so important.

00:35:43:07 - 00:35:45:02
I've heard a lot of good things,

00:35:45:02 - 00:35:46:01
and I know I've eaten it.

00:35:46:01 - 00:35:46:22
I actually don't mind it.

00:35:46:22 - 00:35:47:02
Well,

00:35:47:02 - 00:35:48:22
what do you guys think of chia seeds?

00:35:48:22 - 00:35:49:05
Is it

00:35:49:05 - 00:35:50:02
the end all, be all,

00:35:50:02 - 00:35:51:05
or is it just okay

00:35:51:05 - 00:35:53:18
When it comes to cleaning you out?

00:35:53:18 - 00:35:55:08
There's a lot of fiber in chia seeds.

00:35:55:08 - 00:35:57:03
I actually eat it most mornings.

00:35:57:03 - 00:35:58:06
Ok, there you go.

00:35:58:22 - 00:35:59:04
Yeah.

00:35:59:04 - 00:36:00:10
I mean, I think,

00:36:00:10 - 00:36:00:21
you know, the

00:36:00:21 - 00:36:02:06
the thing that I tell my patients

00:36:02:06 - 00:36:03:08
about fiber,

00:36:03:08 - 00:36:04:04
you know, is

00:36:04:04 - 00:36:06:01
so everyone's gut's a little different.

00:36:06:01 - 00:36:08:20
We have different genetics.

00:36:08:20 - 00:36:09:17
You know, we have different

00:36:09:17 - 00:36:11:12
gut microbiome, like the bacteria

00:36:11:12 - 00:36:12:16
that live in our intestine.

00:36:12:16 - 00:36:13:19
That's symbiotic.

00:36:13:19 - 00:36:16:19
So, that leads to different,

00:36:16:21 - 00:36:17:23
everyone's different ability

00:36:17:23 - 00:36:20:06
to ferment certain types of,

00:36:20:06 - 00:36:21:10
you know, sugars

00:36:21:10 - 00:36:22:18
or carbohydrates and fibers

00:36:22:18 - 00:36:23:10
and things like that.

00:36:23:10 - 00:36:23:22
So, you know,

00:36:23:22 - 00:36:25:22
I have patients who do very well

00:36:25:22 - 00:36:26:19
with certain type of,

00:36:26:19 - 00:36:28:00
you know, fiber rich food

00:36:28:00 - 00:36:29:11
like avocado, kiwi.

00:36:29:11 - 00:36:30:06
But then some patients

00:36:30:06 - 00:36:31:04
don't can't

00:36:31:04 - 00:36:32:03
handle that very well,

00:36:32:03 - 00:36:32:21
most likely due

00:36:32:21 - 00:36:34:20
to certain type of food intolerances.

00:36:34:20 - 00:36:36:10
So, you know, they in that case

00:36:36:10 - 00:36:37:20
I can't eat a lot of kiwi

00:36:37:20 - 00:36:39:17
just very rich in fiber.

00:36:39:17 - 00:36:40:16
But you know, certain

00:36:40:16 - 00:36:41:13
type of

00:36:41:13 - 00:36:42:22
the sugars, fermentable sugars

00:36:42:22 - 00:36:43:14
that just as you can,

00:36:43:14 - 00:36:44:20
can't handle very well.

00:36:44:20 - 00:36:45:21
So I always I'm

00:36:45:21 - 00:36:47:08
a very big advocate of like,

00:36:47:08 - 00:36:48:13
you know, listen to your body,

00:36:48:13 - 00:36:49:08
find your fiber,

00:36:49:08 - 00:36:50:05
find your fiber,

00:36:50:05 - 00:36:51:01
you know, find this,

00:36:51:01 - 00:36:53:22
find your experiment, you know,

00:36:53:22 - 00:36:56:22
keep track of what food that, you know,

00:36:57:05 - 00:36:58:19
you can tolerate and you can

00:36:58:19 - 00:37:00:06
you didn't, you know, good quality.

00:37:00:06 - 00:37:00:20
That doesn't cost

00:37:00:20 - 00:37:03:05
you too much bloating or you know that.

00:37:03:05 - 00:37:04:09
And that's that is a big one.

00:37:04:09 - 00:37:05:02
And finally,

00:37:05:02 - 00:37:05:21
I just have to ask

00:37:05:21 - 00:37:07:07
because I take them

00:37:07:07 - 00:37:09:19
and I know lots of other people do.

00:37:09:19 - 00:37:10:04
I know I'm

00:37:10:04 - 00:37:11:09
not four years old, but like,

00:37:11:09 - 00:37:12:06
how do we feel about, like,

00:37:12:06 - 00:37:14:02
gummies, like fiber gummies?

00:37:14:02 - 00:37:14:22
Or should we actually be

00:37:14:22 - 00:37:16:19
eating food like... Not a fan

00:37:16:19 - 00:37:18:01
Lay it on me, I want to hear it.

00:37:18:01 - 00:37:19:10
The gummies have very little fiber

00:37:19:10 - 00:37:19:21
in them,

00:37:19:21 - 00:37:21:18
and I prefer the powder

00:37:21:18 - 00:37:23:07
because it makes me drink more water.

00:37:23:07 - 00:37:24:00
Yes.

00:37:24:00 - 00:37:25:02
Because the water

00:37:25:02 - 00:37:26:06
is the other component

00:37:26:06 - 00:37:27:18
that's really important, right?

00:37:27:18 - 00:37:29:04
Fiber does not work without water.

00:37:29:04 - 00:37:30:08
They activate each other, right?

00:37:30:08 - 00:37:32:15
Well, the fiber grabs onto the water

00:37:32:15 - 00:37:34:02
and helps to just,

00:37:34:02 - 00:37:35:02
you know, hydrate you.

00:37:35:02 - 00:37:35:13
So,

00:37:35:13 - 00:37:36:13
I think the gummies

00:37:36:13 - 00:37:39:05
are much inferior to the powder.

00:37:39:05 - 00:37:39:20
I'm so glad I asked.

00:37:39:20 - 00:37:41:22
I will throw away my Dumbo feather

00:37:41:22 - 00:37:43:13
that isn’t doing anything for me

00:37:43:13 - 00:37:44:05
and we will.

00:37:44:05 - 00:37:44:13
Yeah.

00:37:44:13 - 00:37:45:10
The powder

00:37:45:10 - 00:37:46:01
that makes sense

00:37:46:01 - 00:37:47:12
because you have to drink the water.

00:37:47:12 - 00:37:48:23
You can't get the powder down.

00:37:48:23 - 00:37:50:08
But what you were saying about just

00:37:50:08 - 00:37:51:07
how can we empower

00:37:51:07 - 00:37:52:07
our patients is

00:37:52:07 - 00:37:54:00
I think the first step is awareness.

00:37:54:00 - 00:37:54:05
Yeah.

00:37:54:05 - 00:37:55:07
So,

00:37:55:07 - 00:37:56:04
just knowing that there

00:37:56:04 - 00:37:57:05
is that risk out there

00:37:57:05 - 00:37:58:19
and maybe your personal risk

00:37:58:19 - 00:38:01:00
is not going to be terribly high.

00:38:01:00 - 00:38:02:05
But to know what symptoms

00:38:02:05 - 00:38:03:00
to look out for

00:38:03:00 - 00:38:04:07
or to feel empowered

00:38:04:07 - 00:38:05:10
to bring to your physician,

00:38:05:10 - 00:38:05:23
you know, I'm

00:38:05:23 - 00:38:07:15
having some rectal bleeding.

00:38:07:15 - 00:38:09:03
What's going on with that?

00:38:09:03 - 00:38:10:02
Where do we go from here?

00:38:10:02 - 00:38:10:18
And not necessarily

00:38:10:18 - 00:38:12:22
taking, you know, no for an answer,

00:38:12:22 - 00:38:13:06
you know,

00:38:13:06 - 00:38:14:22
Being your own best advocate.

00:38:14:22 - 00:38:15:06
Yeah.

00:38:15:06 - 00:38:16:23
Advocate for getting yourself screening

00:38:16:23 - 00:38:18:19
if you feel like you are at some risk.

00:38:18:19 - 00:38:19:10
Okay.

00:38:19:10 - 00:38:21:17
And, you know, to not be shy

00:38:21:17 - 00:38:22:07
about talking

00:38:22:07 - 00:38:23:14
about these things, right?

00:38:23:14 - 00:38:24:15
No one wants to talk

00:38:24:15 - 00:38:25:17
about their constipation

00:38:25:17 - 00:38:27:10
or their rectal bleeding.

00:38:27:10 - 00:38:28:23
These are two of the most common

00:38:28:23 - 00:38:31:19
symptoms of colon cancer. Absolutely.

00:38:31:19 - 00:38:34:07
So to, to know, to bring those concerns

00:38:34:07 - 00:38:36:00
up, you I just I can't

00:38:36:00 - 00:38:37:05
thank you both enough,

00:38:37:05 - 00:38:38:11
Doctor Zhu, Doctor Kim

00:38:38:11 - 00:38:40:03
You are literally saving lives

00:38:40:03 - 00:38:42:17
every day and embarrassment be damned.

00:38:42:17 - 00:38:44:06
You're keeping us alive.

00:38:44:06 - 00:38:45:19
So thank you so much

00:38:45:19 - 00:38:46:19
for giving your time.

00:38:46:19 - 00:38:49:00
We're so honored to have you both.

00:38:49:00 - 00:38:50:19
And thank you for keeping us healthy.

00:38:50:19 - 00:38:52:17
No, for having us here.

00:38:52:17 - 00:38:53:22
Yeah. Thank you, thank you.

00:38:53:22 - 00:38:55:21
This is live well with UCI Health.