Colon And Liver Cancer

>> are we really what we eat? stomach & colon issues tonight on call with the prairie doc >> good evening. welcome to "on call with the prairie doc." we all have favorite foods or remember a great meal with friends that when our digestive system isn't working as it should, our quality of life can be compromised. problems with our stomach or colon can be as basic as making us uncomfortable or make a profound effect on our lives to the points of deteriorating lifestyle or even death. we answer your questions as they are called in or sent to us via facebook or email. should there be more questions than we have time to answer during the broadcast, we'll continues live streaming on the website after the show in our after-hours portion of the evening.

call in your questions at 1-888-376-6225, or email us at oncall tv.org, and click on the question button. tonight to assist us in's drink issues of the stomach and colon we're joined by christina hill-jensen of the avera medical group, gastroenterology, and tim ridgeway of the sanford school of medicine in sioux falls, both in sioux falls. thank both for joining us. >> thank you for having us. >> i love to think about how you were a college student doing -- special honors course, had to do some research and shadowed me for a couple summers. >> yep, a couple summers, six weeks, i did the a.c.p., spent the course with a mentor, loved all the colonoscopies i did. >> maybe that's what got you here. >> we did on hospice. i refer to it all the time. you went to med school was? and your residency? >> tulane university, new orleans and my fellowship

started there and i underred up at the universities of iowa. >> that was a good exposure, you had a different -- >> yep. make lemonade out of lemmons, right? >> there you go. >> back to south dakota. >> just yesterday you were college students there. >> tim, you were really probably professor of medicine more than anything, how much teaching are you doing? >> i do a lot of things with the medical school, rick. i oversee the faculty affairs at the universities, campus dean of our sioux falls campus so basically i oversee third-year students' clinical opportunities and i still teach. i love going down to vermillion, giving the clinical aspects to teach our students why they're learnings the fundamentals and why they need to do it, but in addition to

that, i'm still practicing. >> and there's a no -- no time left for your family and you-of >> you always have to find time for that. all about balance. >> where did you train? >> i did my medical school, as well, at the university of south dakota and then did i my internal residency at the mayo clinic and it was there i got turned on to gastroenterology. they had an incredible group of young gastroenterologists and here i am, people ask why did we choose gastroenterology and i think it's because of associations of people that were our mentors and we wanted to be like them. >> this is an important issue. i want to hear your questions, i won't beg for your questions, this is your show. 888-376-6225. >> 40% of my office visits are about bloating so i have a lot of bloats in my clinic and i

don't know if jim has that, so i think we'll get some bloating, some reflux tonight. >> let's hit that. what is it that causes bloating? >> it can be quite a few things, first of all, people when they eat suck in a lot of air. >> as well i don't ling air. >> excessive gas >> they can be, and gulping down food, maybe not taking time to dine but it also can be related in what we talk about as you kinds of alluded to in your intro, you are what you eat and so we work a lot with diet, talking about ruling out diet, as long as we make sure there's nothing else going on. >> there's problems with milk,

recently all this rage about gluten and celiac disease. how much do you see these problems? >> gluten, 1 out of 100 individuals, we used to see in caucasians but now it's one out of 100 in the united states. the lactose intolerance is caucasian-based, 4 out of 10 will become lactose intolerant so these are common issues. >> so lactose -- a little kid, you can tolerate milk but you get older, lose that ability -- >> lose that insight. you can't tolerate what you used to i either a bowl of ice cream, i'm then -- uncomfortable, by afternoon time i'm struggling. >> how about not enough fiber,

is that a cause for bloating? >> sometimes too much fiber and sometimes people in february and march who have been on a wonderful healthy diet, eating at rights fruits and vegetables, sometimes too much fiber can be a problem. >> tim what, is your most common problem? >> i do a lot of endoscopies at the medical center and one of the timely things that's been in the news and i think many of our viewers are questioning about, i gets this get this question of infected endoscopes, where they have passed on infections to their patients and so these patients

come in to me and it's either a family member or the patient that says, what is my risk for getting a serious infection from one of these -- >> what is it? >> it's important that our viewers know that for the standard procedures, colonoscopy and upper endoscopy, that risk is not there. the problem was in these special procedures we do, called e.r.c.p., and we use a special scope called the duodena scope, and with that is a little elevator that we use to lift our little plastic tube to put in the duct and it was that little device that was not being cleaned thoroughly that has led to these outbreaks. so >> ercp is when the scope goes through the mouth, down into

the small intestine and they look into the pancreatic and bile ducts. >> most common thing we do with that is remove bile duct stones. the most important thing is first of all, there's new methods now to color oh three clean that. it's important for our viewers that for standard tests there's minimal risk and even if you have to have an ercp, it's because you had need its and the scopes are being thoroughly cleansed and i think that risk at this point in time is very low. >> very good. >> the colonoscopy, it is the best test to find colorectal cancer early but for doctors it is often a hard sell to reluctant patients. >> we talk about the limitations of the testing and that's something most patients

want to hear from their physicians. if it's the cost of the test or if it's how sensitive or specific a test is, they want to make sure that if they're going to go through the work of the prep, that they're going to, you know, be evaluated and then what's appropriate screening, so we tell them their options to either get the stool test for blood, that's one method or we do an endoscopy every ten years and low-risk individuals, or high-risk individuals we do these every five years and a lot of it comes when we have preventive maintenance visits and i came from training in nebraska where we learned to do flexible sigmoidscopy, and that's where we screened patients to look for colon cancer.

i remember probably in my first six months of practice, wednesday an elderly gentlemen show up for his annual exam and i basically pleaded to him to get his screening exam done. he said no. a couple months later, he came back for a check-up and sure enough, he agreed to get it done. we did the flexible exam, the flexible sigmoid scope is much shorter than the complete endoscope and we did the exam and found colon cancer. it was really empowering to that patients to understand the value of why we did screening. he's still my patient today, 16 years later and without that screening test, we would have not made that connection and saved that life. >> i have a similar story that just happened this last months, this last week, i was seeing a patient we sent home the stool

cards, a method to test for human bloods in the stool and we do that on patients who either are very ill, have advanced illnesses and may not want to undergo the invasive procedure that colonoscopy, we don't do flexible sigmoidscopy, the most current care is colonoscopy, he also was a gentleman with advanced lung disease so we had to do him in a hospital setting and worked our way through his colon and sure enough, found other lesion. so that journey for that patient begins again in how we can hopefully give him a similar good outcome 6 [music] >> thank you, rob for that information. that was at the state medical meeting last year and, you

know, we thought we'd put in it right here, bringing the point about colorectal cancer and screening for -- by colonoscopies. do you do a lot of them? >> every day, it's so important, age 50, get in there, do it. the worst part is truly the prep. what happens the night before. but even that is getting slightly better. there are a few newer preps that seem to be a little more tolerable for individuals so things are getting better. >> a heck of a lot better than colon cancer. lives me with a bad test in my mouth. anything that you want to finish up with that, that was pointed out -- >> i think rob made a very good point. there are some patients that are just going to say, look, i do not want a colonoscopy.

they may have had a bad experience with a relative, what have you. i think the key point is there are other methods of screening. dr. alison mentions testing the stool for blood. there's newer tests coping out now that's testing for dna that can be shed by the pre-cancerous polyp or pre-cancer and that's even more specific. if those tests are negative, you're good. if they're positive, then you need a colonoscopy but at least you've had that initial screen that was not invasive. so i would urge patients, get some form of screening, whether it's colonoscopy, a stool test, but something because it's the one type of cancer we can prevent. >> it can be a miserable end. >> very much. >> from iowa, what do you -- what recommendations do you have for a patient with

diverticulitis, or diverticulosis? >> itis means inflammation in the little pockets of the colon. >> so the pockets >> it's probably due to poor diet. >> sub-saharan africans, we do not see this. >> also a genetic thing. >> absolutely. >> the more white and northernwestern european, the more it seems to happen have the >> uh-huh. >> i think the big point i like to make, the big myth out there that i would like to dispell and i see you see this in your practice, for years, people have been told if they have diverticulosis, you need to avoid foods with seeds, nuts, popcorn. the theory was that they would get caught in these pockets and create a diverticulitis, it's a myth and we now have very good studies that prove it's a myth. and i still see this where patients are -- think about it,

they're avoiding foods that are good for them, you know. and for no reason and it's funny, when i tell people that, they've been told for years and so they're still a little uneasy. my advice to them is, if you notice a food does cause you problems, obviously then you may want to stay away but don't avoid these foods because of the fear of diverticulitis. >> higher fiber, which is popcorn and -- >> exactly. and they did a really nice study probably about four, five years ago that looked at over 10,000 patients, got diverticulitis, overweight patients got it. that was the conclusion of the study, they looked very closely at diet, no correlation. >> but i've seen skinny people with really bad -- >> yeah. >> how good if they sit on the can and they push and push, is it popping out those things, do

you think the time -- how many newsweeks they've read on the toilet might have anything to do with it? >> you don't know that answer. >> i would doubt it >> we don't know that answer. [ laughter ] >> i lift you with your mouth agag. >> we both didn't know how to answer it. >> mitchell, 66 years of age, please discuss color of stool. does the color of stool mean anything? what brings on differ colored stool? >> a lot of factors determine that and we get that question. people are scared if it looks green. well, that simply could be because you got a little more bile that's coloring the stool. actually, our stool would be white -- >> if it weren't for -- >> bile. the bile acids are secreted -- acids are secreted

and help us absorb fats and the remainder gets emptied into the colon which gives it brown, green, sometimes even yellow stool. >> so it's bile. >> blood makes it black. >> blood makes its black. if you have a black, what we call a tarry looking stool, beware. now, pepto bismol, that will make it black and iron pills can make it black. nonetheless, if patients are seeing black that's at least cause for concern and obviously if you see frank red blood, that's also cause. >> that's a big sign. >> blood in the stool, now, that's not toilet paper blood from hemorrhoids, that's stool. that's a big red flag, blood in the stool. >> yes. >> and i want to -- there was anything else? people with gallbladder disease will have floating feces and flatulence and yellow stool,

any truth to that? >> yeah, and pancreatic disease, you're going to see a greasy shown to the stool if you're having malabsorption, so, yes, pay attention to your stool, look at it, that's okay. >> it may be poop to you but it's breads and butter to us. bad joke. caller's daughter tested positive for celiac after symptoms of constants hunger and constipation. mother is asymptomatic but also tested positive. discuss that. positive celiac test in a person without symptoms. >> you find it, most often you'll find it in the drive-by upper endoscopy so you're looking for reflux disease, you go, complete your test, you look in the small bowel and say something doesn't look right here, you biopsy, so an asymptomatic patient will have celiac disease and in the mother's case, i better once

she becomes gluten free, she'll start to notice a few changes. maybe more regular stools, maybe a little bit more energy so i think over time she may have some improvement, or notice some change. >> i think it was the -- they looked at people they found had no symptoms but were positive because of family members and they put them on gluten free diet and they remarkably improved. they were normal and they improved from normal >> the other thing you brought up was constipation. when i was in training, we always thought of spoo as diarrhea, another name for celiac. but we are learning now it can manifest in a broad range. bottom line is, if you have digestive symptoms that you just are having a hard time explaining it's worth giving a

consideration. >> a patient of mine, dear friends, came in with iron deficient see anemia, i'm afraid he has colon cancer. i did the colonoscopy and it was normal. so i had the surgeon do the egd and she took the normal biopsies, he did, he took the normal biopsies and it came back, oh, hint that there could be possibility of celiac disease. so i did the antibody blood test, boom, he had it and since i put him on a celiac diet, his iron deficiency anemia went away and he was wasting away to nothing. he gained wait, now he weighs more than he wants to. so amazing story. celiac disease presents in many different ways. can attacks of diverticulitis be prevents -- prevented and what should be avoided? attacks of diverticulitis. >> there's no way to prevent it.

we have learned if you get diverticulitis at a younger age, that can portend a more aggressive approach and certainly you want to treat the initial attacks if at all possible and especially with antibiotics but if that young individual keeps coming in with documented, and i think the key here is documented recurring diverticulitis, that's the individual you want might want to consider surgery earlier because what request happen is, diverticulitis is when there is a small perforation of one of these pockets and so you get normal bacteria in the colon. leaks out into the cavity, the abdominal cavity and that sets up an infectious process and an abscess >> and this is where they normally occur. [ talking at the same time ]

>> we can see them all over. but with diverticulitis, what happens is one of these little pockets can break and bacteria will seep out and this sets up an inflammatory reaction. over time, it can form a large abscess cavity, a pocket full of pus, if you will. that's when it gets serious and that sometimes we try to drain it with catheters and sometimes surgical intervention is necessary and what we want to do is prevent that from happening. >> after having g.i. issues all his life, corey finally got tested for celiac disease after his daughter was diagnosed with a gluten intolerance. >> interestingly, i have always had symptoms as a child, i just didn't realize it. i wasn't diagnosed until my daughter, audrey, was diagnosed when she was about two years old.

her pediatrician noticed that she wasn't gaining enough weight and it was actually an issue through my wife's pregnancy with audrey, as well. she wasn't gaining enough weight in the womb so my wife was bed ridden for the last months or so of the pregnancy because of that, and when she was born, we started tracking weight and growth and she was always in the very low percentile of growth for pretty much everything that they monitored. and the pediatrician's daughter had a gluten intolerance and similar issues so she just suggested we take audrey off gluten and it worked. >> she started gaining more weight and growing. and so the pediatrician said it's usually genetic and one of you, meaning my wife or me, is probably gluten intolerant, as well.

so she suggested that which cut out gluten and it was more likely me because i had always had digestive issues as a child and a tablier and young adult, anyway, so i cut out all forms of gluten that i could. and i started feeling really good. i felt great, much better than i ever had in years before. and then eventually, probably in 2007 -- 2008, maybe, i actually had a biopsy done and it was confirmed that i had celiac disease. >> i home-schooled for -- but i used to go to first grade at hillcrest and i brought my own lunch but i brought the milk. i just brought my own lunch, usually i brought a sandwich and an apple. i really like macaroni and cheese and my daddy just made some pumpkin bread so i like that, too. >> i don't have any issues now.

i think probably it is biggest problem for me is shampoos, body washes, conditioners, because some of those have oaths or vitamin c supplements that contain gluten and i don't think as often to check facial products or body products and so i will, like, just a few weeks ago i used some shampoo that had vitamin c supplement and i had a rash break out on my face and shoulders. >> one time when i left to sleep over with my friend maggie, she let me borrow some of her face soap and my eyes got real puffy. >> hy-vee here is great and they'll order anything that you want, as well. most of the restaurants in town actually have gluten-free varieties of foods, too, like the biggest thing that i missed when i cut out glut ten was the sandwich, just a nice sandwich

so i think it's finding somebody that has been living with it and just has gone thousand the trial and error, unfortunately, of trying to figure it out. and then talking to a doctor. i never really consulted with the doctor other than being having the biopsy done and getting an informational sheet about this is what the traditional things you need to avoid but for me it was just trial and error, you kind of figure out which products work for you and which ones don't. >> we thank you for your questions. christina, if i thought i had celiac disease and i went on a celiac diet and then i wanted confirmation, how does that work? >> that makes it tough. it's a big challenge, don't do what the magazines, your

women's magazine or whatever will tell you. please remain on gluten until you see out and we'll do a blood test. primary care doctor can do a blood test, because if we really wants to know if you have celiac, you have to be on gluten, otherwise it can be a false negative. >> if i go on a gluten-free diet, the problem goes away and... >> exactly. the blood test can normalize, the biopsies can normalize, we'll never know and by that time go the patient is feeling so good, he or she will say i don't want to go back on gluten again, they don't want to risk it so if you have an inkling it could be celiac, gets it tested. >> this is not an easy diet and to commit yourself to a lifelong gluten-free without the disorders can be tough. >> maybe if i do a little bit of a gluten-free diets, what do

you think of that? >> i think that obviously that's not good because i always tell patients, if you just smell, if you just sniff gluten, that's enough to set off this intestinal reaction. >> what is the cause of the reaction? i mean, is it immune system problem? >> right, it's a protein actually in wheats and rye that causes an immune reaction in the small bowel and that causes a nice infection of the bowel to become like a tiled floor where -- >> like a shag carpet to a tiled floor. >> that's what i tell my patients and you cannot absorb -- >> malabsorption, you lose nutrients and all sorts of long-term bad things can happen. get the blood test, not a very expensive test. >> no, no. >> good points. >> docs say it's still functioning normally. do the doctors on the show have any idea what's causing the

pain? my comment is, it's hard sometimes to make that diagnose of gallon gallbladder disease. we miss it, don't we? >> we really do. i think both dr. hill-jensen and myself, we see sometimes where the gallon bladders are taken out and the symptoms are still there. didn't cause the diagnosis. i personally get so wrapped up in trying to make certain if we're going to recommend surgery, it's absolutely indicated. every now and then, we miss it. the gallbladder is a difficult organ and the key is communication. it's communication between it is patient and the provider, listening to each other, carefully discerning these symptoms and trying to make the best decision possible. >> i had a patient who had gallbladder, i said this is it, ultrasonic, normal. came back, this is -- this is

perfect gallbladder disease, gallbladder function test, normal. and i finally said, you know, i'm going to have the surgeon -- the surgeon said this is gallbladder disease, i'm scheduling your surgery tomorrow. surgery gone, gallbladder problem went away. >> rick, that was classic teaching even in a fellowship. the best predictor of, is that patient going to do well after gallbladder surgery, do they have classic symptoms? the key is, understanding what the classic symptoms are. >> what are the classic symptoms? christina >> pain, starting midline after eating, moving over to the right side and associated with food. nausea, can be accompanying it. >> that's good enough. >> nausea alone... >> abdominal pain, there is a lot of things that cause abdominal pain, how do you evaluate -- do you go rights to the cat scan?

people come in with abdominal pain -- >> by the time they see us, they've usually had a cat scan. >> the thing about the cat scan, they're very good but, remember, this is radiation that we are -- >> chest x-ray. >> and so you have -- there's nothing that replaces -- i'm going to sound old-school here but there's nothing that replaces a very good history and physical examination. we have all these wonderful technologic tests but it's the doctor listening carefully to the patient telling them their symptoms that is the best way to make diagnoses. >> absolutely. did you hear that? the history and exam and the doctor taking some time and listening. >> it's huge. >> huge. >> caller wants to know if bile is affected when most of her ilium has been removed and says hello to dr. ridgeway. >> the answer is yes, most of the bile secrete from our

gallbladder and secreted into the small intestine, helps to absorb fats. the majority of it is absorbed back in to the last part of the small intest tin. >> before it dumps into the colon. >> so one of the things we see commonly if people have had removal of part of that last portion of the small intestine, the ilium, we call it, which comes right off, right like you're showing there, rick, if that's been removed for a variety of reasons, what happens is more bile gets dumped into the large intestine and that's literally like taking exlax. it secretes water secretion of the colon and guess what, diarrhea. >> i had a ton of people who had their gallbladder -- you're saying that this part is also -- >> absolutely. and the other thing we will see, a certain vitamin that's

absorbed in that area, vitamin b-12 so if they've had enough of that small intestine removed, you better have a b-12 level checked to be certain. >> well, i think people, particularly with any neurologic symptoms, any numbness, should always have a b-12 >> cheap and easy to replace. >> anything you would like to add? you treat it -- >> yes, so with the diarrhea associated with the gallbladder being out, works very well, absorbs everything. be cautious cause it can absorb your medication so you have to time it and -- exactly. >> the toughest part about it, you have to make sure they take it away from their other medicine. >> so, quick one. how much effect does the brain have on intestinal tract? >> well, that's not a quick answer. >> the whole center for neurogastroenterology so it has a huge effects on the g.i. tract,

starting with meals, the brain sends signals, it's huge. >> there is a new drug out for people who have irritable bowel syndrome. we'll talk about that when we come back. are you prescribing a lot of it and what is it and how does its work? >> it's related to brain, or am i wrong? >> which one. >> i'm blocking -- the new irritable bowel drug. [ audio indiscernible ] no, that's not brain, that's still colon. >> it's colon. >> but, the point is, we've known for many years that certain medications that have brain function, a common antidepressant only in doses that's not -- it's called nortriptyline, certain patients with irritable bowel syndrome get better and the interesting thing is that when we look at all the treatments for irritable bowel syndrome, one of the things that works the best,

periodic visits and the physician being supportive and listening and just not telling the patient, it's all in your head, get out of here. >> but it's not, and they struggle. >> as christina said, we think there is a huge connection between the brain and the gut and we've just touched the surface in terms of how much. >> one last thought about crohn's disease. crohn's disease had nothing to do with neurologic. it is an inflammatory disease of the small and large intestine, anywhere from the lips to the anus. any quick explanation for crohn's disease? >> another autoimmune disease, affecting half a million people in this country, causing deep ulceration in the lining of the tract. like potholes. they can bleed, cause pain, discomfort, but there's other types of crohn's disease causing fistulas, abnormal storage between organs, and narrowing scarring of the small

bowel, as well. a tough disease. >> a tough one and we're getting closer and closer to the ideology. it is an immune disease and the bottom line, if you want to simplify it, the bowel is an incredible immune organ and with these inflammatory diseases, we think that the pro inflammatory -- we call them cytokines or proteins, they outweigh the protective ones. the bottom line is there is an imbalance and when you get more pro inflammatory proteins, they attack the bowel lane and that leads to the symptoms she was talking about. >> anita fisher started having g.i. issues seven years ago. after a crohn's disease diagnosis, her life has never be the same. >> first it was irritable bowel syndrome, chronic inflammation of the stomach. it took my job away from me, the illness did. i'm on disability, i can no longer work full time. >> i have to rest, i get tired out very easily. my blood sugar, i have to be very careful with my blood

sugar, what i do. just cleaning the house at home, i get sick and -- if i eat, i get sick and have the pain. if i go for like, two, three days, without eating, then there's no vomiting, there's no pain but then the blood sugar drops so then by day four, i have to eat and then it starts all over again. >> find someone to talk to. go online, find support groups, find a good specialist that deals with it, friends, family, church -- i'm a christian but i'm not a church-goer but you question your faith, you get mad at god, you need someone to talk to, not necessarily to give you an answer. i've never wanted sympathy, i just wants someone to listen and let me yell, scream, cry. because it's all life-changing and it completely runs -- it's hard to not let it run your life but it does. it does.

>> that looks like a very tough disease. i saw she appeared very emotionally drained from the whole thing. what do you do for your crohn's patients who are so wiped out by it? >> i feel that as a gastroenterologist, i in some ways become their primary care physician because this is a debilitating disease. who wants to go out and explain their diarrhea their pain, their weight loss. a very emotional thing and so what i always try to do is get them to support groups and it's amazing what happens when you get a group of people in the room that have the same struggles and that is as therapeutic, frankly, i think as any drugs we can give to try to control this. we have immediate -- medications that are getting better and they work along the immunologic line to get that

balance back in sync but we can't cure this disease. a chronic disease. >> a disease we have to live with and supports these people who have it. >> very much needs support. that individual said it best when i think i just sometimes need somebody to listen to me cry, scream, whatever and understand. >> very good. >> there's been an epidemic of salmonella that presents itself with sometimes very bad diarrhea. tell me about that, christina. >> in the works, you can see bloody diarrhea, you think of eggs, chicken, huge outbreaks different parts of the country and i don't know where the latest one is now. >> those are kinds of similar, listeria is a bacteria. it's one that comes with kids, babies in particular with their immune system. >> i think there's an outbreak

now in hummus, recalling that, ice cream for listeria, uh-huh. >> i've heard that the salmonella is in the kids coming back from spring break so of course we love spring break but also there are some problems that can occur. we have some graphics, apparently, that we can look at here you want to cook it, don't drink raw milk. clean your foods and your hands because it's bacteria on your hands ant doesn't take very much salmonella. >> not at all and any time we make this diagnosis, it's reportable to the state health department because we want to control and contain these outbreaks. >> well, we have a bunch of questions, how dangerous is an umbilical hernia? >> it can be if it's large enough, it incarcerates some small bowel, so small bowel is getting stuck in the area, not able to push the area back in. >> you're in trouble, starts to hurt. >> it gets inflamed, you're in trouble.

>> small ones, usually asymptomatic and they do okay. >> do we see diarrhea, is there a spate of diarrhea illness right now? are you seeing what i see, a little bit here or a little bit there, it seems to run, no pun intended, periodically but seems to be there all the time. i see an infectious diarrhea all the time. the most common cause of diarrhea in this country is irritable bowel syndrome but having said that, the key is if you're walking along doing fine and never really had much diarrhea and all of a sudden you get sudden own onset for a couple of days, that's serious and you better get tested. >> 35-year-old mason, south dakota, is a person old to get fistula track repaired. someone has a fistula track can -- is the person able to get a fistula track repaired? tell me about one, i'm thinking crohn's disease, anal fistulas, but what else?

>> that's mainly it, anal fistulas or crohn's disease, we see them, as well, and the issue there is how symptomatic is this fistula. what is that, an abnormal communication, a communication from one organ, usually to another or to the skin and you drain fluid from the gut out this track, and it's commonly seen down in the anal area. >> so this is the colon and then this is your buttocks. >> correct. >> so where is the fistula? >> it's usually will start in this low rectal area, so commonly, you might see drainage out a little tiny track in this perry annual region and -- perian natural region. surgeons can do this, very skilled at it and sometimes they can just open this up and create a bigger drain to allow everything to heal inside. are you ever too old -- i'm not sure you are because it doesn't require a major operation.

i think the key is seeing somebody who's very skilled and knows when to do something but, more importantly, when not to. >> anything to add? >> with crohn's disease, it can be a major issue, as well, sometimes not only with -- it will require heavy duty medication so seek a g.i.owe owe >> i do wants to point out with crohn's disease, you want to avoid surgery because that can make it worse. in the simple fistulas, surgical repair, excellent, but with crohn's disease, you want to be careful. >> medication, wow. we're going to run through questions, quick answers. >> fire away. >> stomach becomes distressed when she goes to sleep, feels the need to eat. what causes nighttime stomach distress? christina >> you could think of peptic ulcer disease, are they having reflux type symptoms. >> when they lay down. >> absolutely.

>> maybe they're eating ice cream after supper. >> that could be and try not to eat right before bedtime, three hours. >> they say you should eat breakfast like a king, lunch like a prince and supper like a pauper and nothing afterwards. >> what are the differ symptoms of i.b.s. and other things in the gut? >> let's do bacterial overgrowth. >> irritable bowel syndrome, what is it? the commonest cause of g.i. symptoms that we see. there is a multitude of ideologies. we're still trying to determine one specific etiology. we think there is a gut-brain. motility means the motor function of the gut. that can be disordered in irritable bowel syndrome. it can manifest in many different ways. bloating, can occur. dr. hill-jensen said up to 40% of the population has bloating.

it can be a change in bowel habit. one day you'll have diarrhea, the next day you'll have constipation. usually symptoms can be relieved with a bowel movement. >> we've gotten meds for constipation. >> you can have constipation freedom instant or diarrhea, like dr. drue was saying, so you try to treat those symptoms, so it treats spasm, treat the underlying constipation, underlying diarrhea. >> i like ground flax seeds and avoid milk and a little bit of amitriptyline. >> i had a nurse for years that was sold on flax seed and she sold me on it. >> i've had my flax seed today. 80-year-old caller had colonoscopy, one poll up removed, a week later discussed the criteria for getting the next colonoscopy. >> hopefully at 80 no more. guidelines are really kind of variable that -- 75 to 80, need to have a talk with your physician as to -- and sometimes these are tough talks

but do we need to continue to do preventive type screening in these individuals, so maybe no more colonoscopy. >> if there was a polyp, you should follow up. >> follow up and talk about that but start talking about life expectancy, these are tough things. >> risk of colon cancer versus the risk of the procedure itself. now, i want to reassure this person that wrote n bleeding can occur. we remove a polyp, if we use cautery, it forms a scab, a scar, if you will, and when that sloughs off, just like if we scrape our arm, if it sloughs off early, bleeding can occur, to no faults of the colon scoper. every now and then we have to go back in and rarely would surgery be necessary. >> someone is overweight, very little abdominal muscles due to abdominal surgeries. anything that can be done to support the abdomen because it's uncomfortable and you know

that, there's these people who have had surgery and they had this large kind of abdominal hernia that is dangerous, just uncomfortable. nothing? >> nothing -- >> no, try ab to be nam support wraps that i recommend to try to help them but it's very difficult. that's a tough problem. >> i had a patient who had this kinds of surgery at the mayo and they took muscles and they wrapped the muscles around, i mean, it was very expensive surge like, postoperatively painful but the hernia hasn't reoccurred. there was some muscles that came back but one more problem associated with overweight and kind of hard to help them when they're pretty heavy. >> one thing, rick, i wanted to get back to that person that asked about bacterial overgrowth. symptoms are exactly the same and the key is for the doctor to think about it because it can be treatable.

>> one more reason not to go with antibiotics, avoids them if you can because it brings on bacterial overgrowth of the colon. what about probiotics, do you prescribe them? >> they're over the counter but we talk about them. i tell patients a 50-50 shot, it has -- in some individuals, if you have overgrowth you treat and put them on a prebiotic. patients who have ulcers, i think we're looking at it with other diseases like crohn's disease but it doesn't hurt. i will say, no offense to jamie lee curtis but you cannot eat enough activia-- >> beware of the yogurts, the amount of probiotics is so small -- >> you have to eat six to equal one pill. >> and the biogia is that the one? >> for my patients who have recurrent infections, i use -- vfl number 3. vsl number 3. >> okay. vsl number 3. what's the age limit that a colonoscopy no longer, 80 for screening but not if there's a problem. >> how often should children have colonoscopies?

ages 45, 50 and 51, that's her children. >> her children -- >> dad and grandma had colon cancer, mom has celiac disease, should her 40, 50-year-old and 51-year-old. >> the question s at what age was the dad diagnosed with colon cancer. if you've been diagnosed, a relative, under the age of 60, that is risk but if it's over the age of 60, we know that risk isn't that high. >> we'll be back right after this. >> quit smoking and in 20 minutes, your blood pressure returns to normal. in 12 hours, carbon monoxide levels in your blood drop. then your taste and smell improvement. within two weeks, your lungs work better, you heal faster. nine months means nor energy, fewer illnesses and in five years, your risk of hearts attack is half of what it is now. take a deep breath. you can do this.

>> a 20-something gentleman presented to the walk-in clinic a if is years ago with severe diarrhea was working at a feedlot where he was exposed to cattle and all their by products. an estimated two to 5 billion episodes of diarrhea illness occur every year. in 2013, more than one in a quarter million people, mostly babies, died from dehydration due to diarrhea, mostly the consequence of contaminated water. it is in the amazing small intestine and colon where roughly two gallons of fluid flow through daily, only to be reduced to about a half a cup of fluid that exits in the stool. that is, unless something goes wrong. the word "diarrhea" literally means throw flow. the electrolyte explanation for what causes diarrhea runs on like a chemistry teacher on too

much caffeine but suffice it to say that we are still learning the complexities of such a system that when working correctly, turn the stuff we shove into our mouths into micro nutrients and water and then carries the necessary parts of this slurry into the bloodstream in order to keep us alive and working. non-infectious causes of diarrhea causes partial blocking of bowel, ulcerative colitis and intolerance to certain floods like food products and gluten in grain. the diagnosis for infectious diarrhea is made primarily from the patient's history or story, clues for the cause can include previously attending a day care or anywhere diarrhea illness is present, working where there is exposure to animals, eating undercooked or spoiled food, and traveling to another country south of the border. antibiotics are rarely needed to treat infectious diarrhea and in contrast,

life-threatening diarrhea can result from an exposure to antibiotics. the most challenging cause for diarrhea comes when a person is burdened with the very nervous and sensitive bowel called irritable bowel syndrome, or ibs. this diagnosis is made when everything else is ruled out. a professional should evaluate any diarrhea lasting longer than a week or produces internal bleeding. i admitted my patient to the hospital for i.v. fluid hydration, the diarrhea resolved spontaneously without antibiotics, and he vowed to do better with washing his hands. >> this brings us to the ends of our show this evening. i sincerely thank our fantastic guests tonight, christina hill-jensen and tim ridgeway, thank you christina and tim. our friends at south dakota help line center are hosting a 5k run-walk at the sdsu campus in brookings this saturday, april 11th, to raise funds and awareness. for more information or register, go to helplinecenter.org. as early 20th century american politician frank clark

noted, a child like your stomach doesn't need all you can afford to give it. and until next time, from all of us here at "oncall with the prairie doc," stay healthy out there, people.