Ep. 24 | Jeff Anucha, MD, Gastroenterologist, SGMC Health

Transcript

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- Welcome to another episode of What Brings You In Today. I'm Erika Bennett.

- And I'm Taylor Fisher.

- And we wanna start off first by thanking all of our listeners for tuning in to the What brings You in Today podcast.

- And if there's any topics you would like us to talk about, you can submit those on our website at sgmc.org/podcast.

- Also be sure to leave us a review. Today we are here with Dr. Jeff Anucha and he's a gastroenterologist at SGMC Health. So Dr. Anucha, what brings you in today?

- I'm here to talk about all things gi.

- All right. And you know, GI I feel like is always a, something that most people don't really wanna talk about. Right. It's,

- It can be uncomfortable.

- Yes. For a lot of reasons. So, first let's just hear a little bit about your journey to become a gastroenterologist. Okay. And kind of how you got to SGMC health.

- Okay. So my journey started with medical school. I went to medical school in Ghana. And when I in, well, when I was in medical school, that's when I started appreciating GI more, especially with the disease processes involved in the GI tract as well as the pathology and the physiology involved as well. And then after medical school, I became a sort of like a hospitalist in, in Ghana, West Africa. And then subsequently I took my licensing exam to move over to move over to the us. And in the US I started my medical residency, internal medicine residency in New York, Harlem Hospital. And then in Harlem, during my residency, that's when I began to also appreciate GI more because I was able to observe procedures, GI procedures, colonoscopies, upper endoscopies, and ERCPs. And I was like, wow, this is what I want to do when I'm done with medicine training. And so subsequently I was done with my internal medicine residency. I became a chief resident for one year. And that was during Covid. And then after Covid and after the chief residency here, I became a, a GI fellow. And then subsequently, after I was done with my GI fellowship or during my training, SGMC Health reached out to me, gave me a phone call, I came down, we loved what we saw. We loved the neighborhood, we loved the, the environment, we love the city. And that's where we are now.

- Awesome.

- And the rest is history.

- Awesome. We're definitely glad that you're here because I didn't even realize until I, you know, started, you know, knowing some people that needed to see a gastroenterologist, how important they are and how many different things that you guys deal with. And we're really glad to have both you and Dr. Menal and then all of our other affiliated gastroenterologists.

- For sure. It certainly seems like a rare find to get gastroenterologists in rural Georgia, you know, rural, rural places.

- Yeah.

- So tell us a little bit about what you see in your practice. Or let's start maybe with when someone would come to see you, what kind of issues might they have?

- So the most common complaints we get in to see in the GI clinic is acid reflux, unintentional weight loss sometimes. And we get chronic constipation, chronic diarrhea. And then occasionally we get some bleeding as well. Mostly silly rectal bleeding. Those are the most common ones we, we get.

- Do you have to be referred to a gastroenterologist from primary care? Yes,

- It's, yeah. 'cause it's a specialty, it has to be referred by a primary care physician.

- Okay. So again, that plug, that common theme that we see when we talk to all of our specialists, it's so important to make sure that you have a primary care physician so that they can get you access and help guide you to the specialist when you're having these concerns. That's right.

- Yes. Definitely. My dad had to see one of our gastroenterologists, and I'm not sure if it was you or Dr. Menal, but he got diagnosed with AVMs.

- Okay.

- So that was something that I had never encountered. And it's like, there's all these different things you don't think about with your digestive system.

- That's right.

- That could be causing you issues. So I mean, can we just talk a little bit about gut health? Gut health? Is there

- Anything that you can proactively

- Yes. If

- That, yes, that's

- Where I was going

- Proactively due to decrease your odds of having to come see you. Okay.

- First of all, it's so gut health, there are three things that are very important for gut health, fiber, physical exercise, and water. So fiber, you need to take in more fruits and vegetables, essentially the ideal diet is a Mediterranean diet that consists of fiber, essentially fruits and vegetables, healthy oils such as avocado, oil, what was the other one? There's so many of them. Avocado oil. Peanut oil and coconut oil, just kind of oils. And then you also have the, the other one I was thinking about is whole grains. So these are the things that are consist of in the Mediterranean diet. And then physical exercise, you have to at least 30 minutes to 15, 30 minutes to an hour, at least three times a week. This will help to stimulate the gut. 'cause Well I've come, what we've come to notice is that patients who are very sedentary tend to, the GI system tends to slow down as you slow down. And then patients come a lot with love, constipation. And we also try to tell patients to drink more water, at least eight glasses a day if they can. But water is essential to life. So it's also essential to your GI tracts to get things moving as well. So water, fiber and exercise is,

- That is, that's interesting. I would like definitely think the water and the fiber, but the exercise component affecting your gut health is very

- Fascinating. Well, I've noticed that personally, like if you don't go to the gym or exercise for a while and then go back.

- Yeah,

- There's definitely movement. Not,

- Yeah, not necessarily just gonna the gym, you can just go for a brisk walk around

- The neighborhood. Yeah. Moving exercise after you've been, you know, sedentary for a while, I've noticed, I'm like, okay, this is different.

- The more you move, the more the gut moves. And that's why when you fall asleep, the gut falls asleep as well. So the more you move, the more the gut

- Moves. Wow.

- And that's what we prescribe for to patients with chronic constipation. You just gotta move more active, get exercise more, get active.

- Well, and then also if you're more active, you're probably drinking more water.

- Yeah.

- And then you are also likely probably to eat a little bit healthier. I know I am. When I, I have a better routine, I tend to eat better. And then, yeah. So that, that's good.

- Yeah.

- What about probiotics? And can we talk about how important, you know, the kind of biome of your gut is?

- So probiotics, you can get them from fermented food products like yogurt, keer, and then sauerkraut, sauerkraut as well. And probiotics provide a good balance to the microorganisms that exist as a microbiome in your GI tract. And so when we talk about a microbiome or the microorganisms in your GI tract, we're talking about the good bacteria, the good fungi, the good viruses that exist within your GI tract. And we always try to tell patients to be on probiotics because this will help to allow the proliferation, the growth of the good bacteria in your gut. And this will help with the gut health,

- Especially if you've had to take antibiotics frequently.

- Yeah, antibiotics, which is

- Something I've been told by physicians is that then you're at risk for killing the good bacteria as well. So it's good to balance it out with the, you know, other supplements.

- That's correct. Yeah.

- That's so interesting.

- How about food allergies and like food insensitivities? Yes. Insensitivities, I guess is the better term. I feel like we're seeing a lot more of that. Or hearing at least glu people are having a lot more. Are they just more aware of it or do we think there's something, I mean our gut is just reacting differently based on the stuff that's in our food or Yeah. What are your thoughts on that?

- So, so there are two things. There's food intolerances and then there's food allergy. With the food allergy, you are allergic to the food, right? So you get the whole hives, you get the facial puffiness, the redness, and the difficulty swallowing and breathing that. So essentially food allergy, you get an immune

- Response.

- But with food intolerance, it's kind of like lactose intolerance. You just don't, you're not able to break it down. So you get your bloating, your diarrhea, and your abdominal discomfort. So that's where we get with the food intolerance. You essentially don't have an immune response, but you don't necessarily, in some cases don't have the enzymes to break down setting food products. And that where we try to do an elimination diet, if you're not having the immune response, you definitely have intolerance. So what we do is we try to eliminate certain foods. In my clinic, in our clinic, we have a sheet of paper where we tell them, these are the things that are likely causing your symptoms. Try to eliminate them over the next six weeks and see how you feel. And then patients usually come back feeling, yeah, this actually worked for me.

- Yeah, I think that's so interesting. I'm there, my, my little nephew had a milk in or lactose intolerance when he was born. But I think they've slowly been able to reintroduce it as he's gotten older. And it's just so crazy how your stomach, your gut responds to different things like that. Yeah.

- Sometimes the enzymes aren't present and eventually they do form.

- So as far as I, because I was like, well is there any tests that you can tell about that? Well, the elimination process, that can be a long and lengthy kinda thing to figure out. But for preventative screenings, so we'll talk about maybe the most common one that everybody knows or has heard about is the colonoscopy. Oh dear. Everyone's favorite topic. Yeah, I know, I know. So tell us who qualifies for that currently. I know sometimes it can change depending, but who qualifies? And then why is it so important to you get that screening?

- So the screening is for both average risk and for high risk patients. So for average risk patients, meaning that they don't have a personal history of colon cancer and they don't have a family history of colon cancer, family history that we're most concerned about is colon cancer in a first degree relative, meaning a sibling or a parent. And these are the patients who are high risk for colon cancer. Average risk, don't have any of this risk at all. So typically for average risk patients, we start screening at 40, age 45. And then we do it subsequently every 10 years if it, if the first scope was normal. So for high risk patients, they might be required to come in 10 years earlier than most average risk patients because of their high risk.

- And what does the, I mean the colonoscopy, what is it looking for? What are you

- Looking for? Yeah, so with the colonoscopy, we are looking for polyps that could become cancerous. We're looking for any abnormal tissue in the lining of the colon that needs to be removed. We're also looking for colon cancer because some patients come with rectal bleeding. And then when we go in, there's a mass sitting in the colon that needs to be biopsied. And then

- The - Pathologist will give us a final diagnosis and then we refer the patient to a surgeon to have that mass sticking out.

- Are we seeing more colon cancer or less? More,

- We're seeing more colon cancer because the screening is slowly going up and patients are, even patients don't necessarily need to do just the colonoscopy. Some patients are very uncomfortable with the colonoscopy, but if the average risk, we can offer them, especially with the primary care, they can offer them stool-based testing. And just recently the FDA just approved blood-based testing for colon cancer screening. Wow. So that is also another option for patients. So with that, driving up our screening rates, we're seeing more colon cancer detecting more colon cancers, especially in younger patients. And I think that has a lot to do with diets right now. Right. There's a lot of, our diet is moving towards more processed food, more saturated fats, and that is also increasing the, the mutations that are causing the colon cancer to form in the colon.

- Wow. I hadn't thought about that. That's really interesting because I know we've heard about, you know, the Cologuard, you see the commercial. Yeah. So that's the stool based screening. Yeah. A stool

- Based test detects abnormal DNA from shed by the cancer cells into the stool.

- And then now they have a blood test

- As, and now they have a blood test as well. Yeah. Well

- Hopefully, yes, that will make more people wanna do it since it's a less invasive

- Procedure. So the stool base and the, and the blood base will only be for average risk patients. Because if you have a high, if you're high risk because you have a parent or a sibling, then automatically you should just be getting colonoscopies every or so often.

- And the importance of finding it early versus later. Yeah. What is, I mean, what do we see with that?

- So if we find cancer early, meaning it's in the early stages, we are able to remove it without you undergoing further chemo or radiotherapy. Because just taking out the colon, taking out that part of the colon is curative found early. So subsequently, you obviously will have to get colonoscopies every one to three to five years because you're not considered high risk. So detection is key, prevention is key. But you, you also have to come in early as well.

- And do you ever find it and people were having, patients were having no other issues?

- Yeah. Yeah. Some patients come in with anemia, some patients come in for just routine screening

- Because

- Yeah, their, their loved ones were like, it's your time to get a colonoscopy. And then they just say, okay, fine. I show up and then we detect cancer and they, they're shocked. So yeah. Yeah.

- Wow. Yeah. I'm sure it takes a little nudging from somebody. Yeah. A loved one. Nobody is just like, oh, why? Hey, my

- Colonoscopy. Lemme go get that scheduled. Right. Yeah. Is it more, are you, have you seen if it's more common in men or women as far as colon cancer's

- Concerned? I think it's, I think it's balance. It's balance. I mean I have seen quite a bit of men recently, but I've also detected in women as well. So I think it's balance in my, in my experience.

- I was just curious.

- Okay.

- What kind of changes have you seen throughout your career or just in the field in general that how treatments and detection and stuff have evolved?

- Okay. So in the field of gi, a lot of advances have been made. I know when I was in residency and then fellowship, there were a lot of drug companies coming up with biologic drugs that we used to treat ulcerative colitis and, and Crohn's disease. I know it used to be just a Remicade. And then the Vedo Entyvio, those are the drugs that usually were backed back then. But now there are probably like 50 different drugs right now out the market to treat patients with ulcerative colitis and Crohn's disease. And then there's also the fact that the FDA just approved the two drugs, the two tests for colon cancer screening through blood. And then there's also the use of weight, weight loss drugs now, I mean, as for the obese patients, we used to always have to refer them to, to a bariatric surgeon for weight loss surgery. Now they are getting placed on these drugs and reduce and losing a tremendous amount of weight. So that's, that's a lot of advancements. And then also with the procedures as well, a lot of GI, advanced GI doctors are now doing weight loss procedures through an endoscope as well. And also doing minimally invasive surgery so that patients don't necessarily need to get their colon taken out. For example, the doctors can go in and then and take out that area minimally without major surgery involved. So yeah, a lot of advances are being made and are being made as we speak.

- What is the impact, I've mean, I've heard a little bit about this. So the, if people are using the weight loss drugs, like the ozempic or the

- Wegovy

- Yes. And it slows down your digestive track. Yeah. So what, what, what are your cons? You know, you have to be very careful when you're on those. And that's also another important reason you should probably do that under the care of a primary care versus

- Exactly.

- There's a lot of companies I've seen, like you can buy it online and things like that. But tell us how that impacts the gut and just what, what maybe people should kind of be aware of. So

- Yeah, the drug is, is definitely, I mean, it not only makes you lose weight, it also improves your, reduces your mota reduces mortality from cardiovascular complications. But yes, it affects the GI tracts by slowing things down. Some patients get very bad constipation on it and then eventually just have to stop the drug. And, and some patients get worsening reflux. And so this, this two complications for some patients, especially the ones that cause it causes abdominal pain in some patients as well. So these three things make some patients fall off the drug. So we always offer other options such as weight loss surgery. So it's always an option for patients. Everybody's different, everybody's responds differently to, to drugs. So

- Yeah, - We just offer patients, if this drug doesn't work for work for you, we always have weight loss surgery, which is readily available and has good outcomes.

- Yeah. We actually just welcomed bariatric surgeons. Yes. That's all. Yeah. So we're in the stages of getting that program up and going. So that's awesome for our community. And then the, this is the one I wanted to ask. You know, you always hear people say trust your gut and you know, they say that your gut can, you know, you can sense things through your gut. What do you know about that, if anything isn't an old wives tale, but you know, you can get a bad feeling in your gut Yeah. About things. Yeah. What, what do you gotta say about that? You're the true gut doctor, so,

- So yeah. Trust your gut, essentially. Trust your gut means that you always, you know your body.

- Yeah. - It's a way of saying that you know your body and that when things are, when you sense something is going wrong with your body, you might experience a weight loss. You noticing that your trousers are falling off or your trousers are getting wider or you are, you're getting more nauseous than usual or you're losing your losing appetite. So essentially trust your gut just means you know your body, you know your senses. Something is different about what's going on with your body. And you just have to report, seek medical attention, speak to a primary care physician

- And actually talk to your, like tell your primary care P physician.

- Yes. - Don't just go and say hello, everything's fine.

- Yeah. Pretty much.

- I think your gut is really, I mean it's kind of like the center of your body. Yeah. Like for people that deal with anxiety, I deal with anxiety and I don't know if it's, you know, technically called like gut anxiety, digestive anxiety. But I do, when I start to feel anxious, I feel it in my

- Gut.

- In your gut more than any other place. And that's how I truly know that I am having anxiety.

- Yeah. So there's a, there's a two-way communication between the gut and the brain. And so any patient who comes in with symptoms of irritable bowel syndrome, we always, I always try to delve deeper into their mental health, asking about anxiety and depression. 'cause because of this two-way pathway, patients with underlying anxiety and depression are prone to developing irritable bowel. Especially in patients with, with anxiety, they tend to get more diarrhea because the brain is sending more signals to the, to the gut to, and that makes the, the bowel more irritable and they go to the bathroom more often.

- Yeah. I think in children especially too, like if they say like, oh I'm sick, I don't feel like gonna school. And you know, you're like, well let's dig into that. Maybe they just are nervous about something, a test or

- I've heard it kind of like a, like a kind of caveman response. You're like scared flight or Yeah. And your body's just saying, evacuate. Yeah, let's, let's evacuate so we can run

- Flight or fight. Fight flight or fight reflects.

- Yeah. I just think it's so interesting how so many things are connected to your mental health. Yeah. And your brain even as so far as your gut. Yeah. I feel like it all goes back to mental health.

- That's correct.

- And what would you say to patients who are nervous about cu to see you or any or any gastroenterologist?

- Because

- I'm sure it's scary, like Oh

- Yeah. It's, I understand their nervousness, but I always try to put them at ease that they're in the right place. It's better to know what's going on than to continue to live in ignorance because something terrible might be going on and you decide to ignore it and then becomes too late. So coming in to see us early will allow us to start the detection process early enough and then we can fix the issue and then you can go on to live a healthy normal

- Life. Do you see a lot of patients that like ignore things for a long amount of time and then they finally come to you and you fix it and they're like, man, I wish I would've done this earlier.

- Yeah. Yeah. Yes. Especially especially with men.

- Yes. Yeah. I was gonna say, I'm just gonna throw my dad under the bus here for a minute.

- I dunno, it's, I think it's a trend we see just in general, especially in South Georgia. I mean, I think it's getting better as we're getting more education out there. We're having more specialists here. That's correct. That people are able to talk to and get to know. But you know, a lot of people do have like the white coat syndrome where they're just nervous about going

- To see the doctor. I feel like I doctor, I have a little bit of that with my anxiety. Just I, I've gotten more comfortable since I've worked here, but still when I go to the doctor or I had to get my flu shot the other day and I was so nervous the whole entire time. But again, it's nothing I can control. My stomach is just like, this isn't good.

- I think education is helpful and that's one reason we wanted to sit down with you today. And also to get, to get to know you because you are very friendly and you make me feel at ease. If I needed anything, I would feel comfortable for that. But, but we appreciate you, we appreciate you being dedicated to this field.

- Thank you. And

- Helping take care of us. Talk

- About one more thing that no one wants to talk about. What even more than colonoscopies. Hemorrhoids. Oh goodness. I know, I know it's not, it's not the best thing to talk about, but it's so common, right?

- Yeah, it is.

- So how can people prevent these?

- So

- Is there a way

- Water, fiber, exercise the same thing? Exactly. So if you don't strain as much, if you're not constipated as often, then I mean, I mean definitely some women who get pregnant, they have, they have hemorrage that's unavoidable. Can't

- Control control that. More of like a, a hormone type thing that's causing it. Or is it, it's a pressure from the pressure the baby.

- Baby on the, on the pelvic. Okay. Yeah. It's lower pressure down

- There. But that was like a hormonal imbalance that made it susceptible. But just that baby weighing down

- On Yes. Sitting on vessel. Yeah.

- Well nobody wants to talk about or admit that they have no hemorrhoids. It's definitely, and then they, they can go away. I guess over time they can go away, but then if they are not going away,

- Yeah. Right. Especially if they're bleeding, you can come see us if they, if we do a colon, if you come in with bleeding, we have to do a colonoscopy. Even though we know it's hemorrhoids, we just want to make sure there's nothing else in the colon. And then we also have techniques that we use to, to treat the hemorrhoids. If we can't, we can always refer to a surgeon who can take care of the, especially the external hemorrhoids, surgeons can be able to take it out.

- So you don't just have to suffer.

- No, you don't have to.

- And how long should someone, you know, be dealing with this suffer before they come see you? Yeah, before they decide to come. I mean, how long is a normal period when they should go away?

- It should, if it should, you should come in when you don't feel co, when you feel it's still persistent. Especially with persistent bleeding, you should definitely come in. 'cause it's not just hemorrhoids, like I said, it could be something else. So if you see bleeding and it's still persistent, even after a week, you should probably talk to your primary and then they'll refer you to us.

- Okay. Another thing that regularity, like I know some people say these are the things people wanna talk have, they don't about movement like once a week or something like that. How often should you have a bowel? What is a healthy

- Bowel movement? Ideally?

- Once a day. Once a day?

- Okay. Yeah, once a day it's ideal. Okay. But some patients, everybody's different. Some people go once a day, some people go three times a day. Some people go once every three days. But once a week it's a little, it's a little

- Extreme. Yeah. And then what is the deal with people that go on vacation and they like, don't have a bowel movement while they're on vacation? Do you know what I mean? They're uncomfortable. It's not me, but I just do know several people, like when they're on vacation or out of their normal realm, they can't like, it goes back. Goes back to your gut and your

- Mental health. It's that mental.

- Yeah. Pretty much.

- You're just, I'm not comfortable

- Here. You're not comfortable. I can't go here.

- I mean, I've struggled with that myself. And then

- You're like, my son would not use the bathroom number two at school. Oh, not this one in the room, the other one. But he will ne he'll hold it till the very, and which I'm like, that's probably not healthy either. But it's just interesting that Yes,

- Yes. It's just the brain. Just

- A psyche.

- Yeah. They're comfortable at home. That's where I want to do my business. Yeah. That's pretty much what happens.

- I mean, I think these are the hard hitting topics people wanna know about. I know, right? Everybody goes, you can't be ashamed to talk about it. That's right. Yes. You do need to drink your water. I'm guilty of not drinking enough water sometimes.

- Lately I've been bad with just being, having so much of unc, all the different things that have happened around our community lately. And you kind of get off that routine of drinking water, but, but it is nice to know that it really is that basic. Yeah, it is. To kind of keep your gut in check.

- That's right.

- So good. I can handle that. I think I can handle those things. I

- Think so. I think that this has been a really good

- Conversation. Yeah. Anything else you wanna share with us? Anything that, any common misconceptions or common questions that you get asked that we haven't already covered that you'd like to share with the public or, or we've done a pretty good job

- Of Yeah, I think you've, I think we've covered a lot. I think we've called covered a lot.

- All right. Well very good. Well we just wanna thank you. We can wrap it up now and then if we get any hard hitting other questions, we'll bring you back. I'll And

- You have my number. I'll be here.

- He does. Okay. Alright. Alright. Well

- Thank you for joining us. Thank you everyone for joining us today. And if you have any questions for Dr. Anucha or any of other physicians or providers, please submit them at sgmc.org and we'll see you next time.

- Thank you. Thank you.