Ep. 51 | Allen Woods, MD, Gastroenterology, SGMC Health

Transcript

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- Welcome to another episode of What Brings You in Today? I'm Erika Bennett and I just wanna thank our listening audience for tuning in. If you haven't already, please like and subscribe so that you can get notifications when we release our new episodes. Today I'm here with Allen Woods, who's a gastroenterologist with SGMC Health. So Dr. Woods, what brings you in today?

- We're going to talk a little bit about gastroenterology and what you need to know gastroenterology wise for your own health.

- All right, well let's hear a little bit about you first. So tell us a little bit about your career and what led you to gastroenterology.

- Alright. It really started in medical school where I had a professor, Dr. Fran Tedesco, who wrote one of the original papers about Clostridium difficile, which is a big health problem causing severe diarrhea associated with antibiotics and with his energy level, getting up at 4:30 and making rounds on patients to know him better than his medical students and residents. That impressed me and he ended up becoming the president of the Medical College of Georgia after that. So he was multifaceted.

- Okay. And and that c diff was, is that what you're referring to? C diff? Yeah, c diff.

- Okay. - So that attracted you to go into gastroenterology or maybe just the professor you saw

- More The professor. Okay. But the combination of gastroenterology where it's a thought process, but also a procedure oriented process with the upper endoscopies and the colonoscopies. But the emphasis on where we were going, coming back in practice were two factors. Number one, I fell in love with the beautiful woman at Valdosta State. And then number two, we were in married housing in 1978 when Converse Hall burned and a couple saw our picture in the paper looking through our burn depart and said, I want that couple to come live in our guest house. So we went over and looked king size bed kitchenette pool table happened to be a pool outside the door also, and they said you could live rent free until the end of the semester or until we found something. And that started a process with Dr. Stubbs and Miss Stubbs 45 years ago.

- Okay.

- Where we ended up in Valdosta.

- Yep. All right. Well, tell us now about the type of patients you see. When would somebody come see a gastroenterologist or when should they call? Make an appointment with a gastroenterologist

- When they have a GI problem, but not always, but but not always in that situation because we see a group of folks that starting at age 45 need to come in to start their colonoscopy screening program. But if people have issues with heartburn or indigestion, we see 'em. If they have constipation, diarrhea, we see 'em. If they have GI bleeding of any sort, either upper or lower or black tarry stools, we would see 'em. But we continue to venture out and we see folks here locally for liver related issues since we don't have a hepatologist in the area. And also biliary tract diseases and inflammatory bowel disease. So anything from stem to stern is usually our calling cart.

- All right. And let's just mention a little bit about the preventative aspect of screenings. Talk a little bit about that and about when someone should get a colonoscopy and what do you say to encourage people to get, because I feel like that's, people are probably not very compliant on

- They,

- That particular procedure.

- There can be a tendency in that direction, but I think they're, they have been made more aware of it. Recently. One of the big New York publications today, as a matter of fact, talked about the fastest rising cancer in patients under 50 is colorectal cancer. And it's the number one cause of deaths in that group under age 50.

- Okay. And colonoscopy, what, I mean, tell us what that is just for someone and why it's important. So you're going in and you're detecting if they have what

- We're looking to see, if they have a source of bleeding, if they're having bleeding. But from a screening viewpoint, it's a situation we're looking for problems that we can take care of before it becomes a cancer. And that's the thing. And really the great interest that I had in gastroenterology is we could take care of problems before they became major problems, such as colon cancer. And we go in and take a look and we remove the polyps that we see. And if you take a 45-year-old female, she would have probably a 25% chance of having an adenomas colon polyp. If we did a screening colon colonoscopy on her, the male would have about a 30% chance of having adenomas colon polyps. And if we can take that adenomas colon polyp out before it turns into a cancer, we've cured a cancer before it's, and there's not a lot in medicine that we can do. Right. In that regards to get those results. I mean, it's great results to have there and it's important from that aspect. And who should be getting colonoscopies? Anybody with a colon starting at age 45? It used to be age 50, but we saw that trend of colon cancers starting in people that were under 50 and the recommendations have changed to age 45.

- Do you think that has anything to do with our food that we're eating? What is

- There are,

- What do you think? That's

- A, a lot of things that are involved in that smoking would be one, obesity would be another modification behavior that could improve things. But when you look at that age group now that is, you know, around 45 to 50, somehow that ties in when all the processed foods started hitting the market in the seventies. Yeah. And I think that plays a big role in that. There are certainly a lot of other things that are, are 3% of colon cancers that are from inherited. I was gonna issues

- Or I was, if there was any genetic or hereditary.

- Listen, I've been doing look gastroenterology since 1985, and it's a situation where in the last five years I have done more genetic testing than I did in the first

- 35

- Years. So,

- And what are you looking for when you do that?

- Well, it's actually a very simple test to do. We have several companies that we can send samples to. One of the easiest is we have them spit in bag and send that for the genetic testing. And we've got several families in the Valdosta area through the years that I've taken care of with familial adenomas polyposis. And that's an important thing to make a diagnosis because by the age of 21, about 80 or 90% of those folks will have colon cancer already at age 21. So if there is a family history of somebody in your family, mom, dad, brothers, sisters with multiple polyps, such as some can have a thousand polyps in their colon. And when you see groups like that, it can be prevented by appropriate intervention that occurs earlier. Now, if you have not a necessarily a inherited situation, but a first degree relative with colon cancer, then your increased risk of colon cancer during your lifetime is two to three times the increased risk of the average population. Now what do you think the percent of colon cancer occurrence in a US male and a US female is during their lifetime?

- The percent, 30%.

- Okay. You should have guessed a little bit lower than that.

- Oh, okay.

- But most people, when you look at it with the female, it's 5% during their lifetime with the female and 6% with the male. So you're talking about that's good. A 10 to 15% risk. What you're talking about is in the neighborhood of 150,000 cases of co new cases of colon cancer each year with that five to 6% risk. And once you get that first colonoscopy done at age 45 and everything looks good, you would need to come back in 10 years. But by doing that initial step and getting a good test result, that decreases your overall risk of colon cancer. You're not in that five to 6% group because typically it takes seven to 10 years to go from a colon cancer, I'm sorry, to go from a colon polyp to a cancer that is occurring in the colon.

- Okay. So that right there gives me a little bit more motivation. If you're eligible, get the colonoscopy right. If you're in the clear, then you can feel a whole lot more comfortable

- And And we moving

- Forward.

- Yeah. And we say if you do not have any colon polyps on your initial colonoscopy, then it would be a 10 year follow up or if you had development of symptoms. Okay. Now, some people may decide to do the Colo guard and that's certainly an option, but it's not an option. If you have had a history of colon polyps or somebody in your family has had colon polyps or a colon cancer, then you can't do the box test on your doorstep there. And there are other screening situations that we can do, but the gold standard buy and buy is colonoscopy.

- Okay. And you mentioned smoking, which I had no idea that that would be related to your GI system or increasing your odds for colon cancer. I mean, we've, the last two episodes we've recorded heart and vascular and obviously lung, you know, smoking being a big risk factor for those. But I just never would've put smoking and GI together. So that's

- Interesting. Oh, smoking in gi, when you have the tobacco history, your chances of esophageal cancer and Barrett's esophagus is markedly increased. And Barrett's esophagus is a potential precursor of cancer of the esophagus. That over the last 15 to 20 years has been one of the fastest rising situations as far as occurrence increasing in the US population.

- Wow. All right. Well you heard it again, don't smoke or quit smoking. If you are, what other risk factors for gut health? What, what can we do to keep our guts healthy so we don't have to come see you?

- Well, when you, there's

- All kinds of stuff about like probiotics and gut health. You know, you can really get overwhelmed

- With

- All that.

- I was headed in that direction as a matter of fact. And the trillion dollar business that is going to occur is in the probiotic air era. And what is going to be done is everybody is going to have their own individual organisms that they have in their body, and they are going to look at what yours are and what is ideal and generate a probiotic for you in that situation. Okay.

- I see that.

- And really the secret there is probably going to be a particular type of bacteria that is been noted to be the one that occurs in healthy 100 year olds compared to 60-year-old unhealthy folks. And it's a particular bacteria that they'll probably continue to develop and supplement. And that's going to be one of the big features that you see.

- So we're gonna ship off our DNA, they're gonna do the results.

- You're gonna ship off your,

- Your, your gut,

- Your gut, your gut bacteria.

- Okay.

- And

- They'll analyze it and tell us what we need to

- And give us a supplement. Okay. With the bugs to put back in there.

- Okay.

- But that's going to be a big, big area.

- Yeah, I can see that. Well, what do you recommend? I mean, is there anything recommended over the counter that is proven to really make any difference

- In some

- Or is it all scams?

- No, it's not all scam, but the probiotic is a, is a big feature. They did a study where they looked at physicians with heart attacks and they found out that in that group of folks of physicians that took aspirin, that their instance of colon polyps and colon cancer was lessened when they looked at a different area of that research. Yeah. And if you tolerate the aspirin well without complications such as bleeding, it may be something that you want to talk with your physician about in that regards,

- What's the most common misconceptions that you've seen in your field?

- Let me give that some thought.

- Okay. Yeah, I'm just thinking anything you hear that you're just like, oh my gosh, I keep hearing this, but like this makes no sense.

- Well, probably one of the things might be that I don't have to take my medicines on a regular basis. And if you're having breakthrough heartburn more than three times per week, you probably need to be on chronic therapy. And the proton pump inhibitors that we use such as Prilosec or Protonix and some of the others, they have been very effective in cutting down ulcer disease. And with that, we've had a marked decrease since the 1970s of gastric and duodenal surgeries that were, because there are less complications from that. And I do remember when the first proton pump inhibitor Prilosec came out and you would have to get an edict of God from the pharmacy to get it approved for that. And now you can go out and get it over the counter yourself with paying attention to the written warnings. But people will come in and say, well, it says you can only take it 14 days. And I said, yeah, but then it says without doctors' recommendations. And so we do have patients on a lot of therapy like that. One area that has tremendously changed over the last 10 to 15 years is fatty liver disease. And another name for that is metabolic associated theto liver disease. And that's why I call it fatty liver disease to make it very simple and plain. And one feature of that is with diabetics, they have a increased risk of fatty liver disease. And if they have fatty liver disease with say, associated obesity and elevated triglyceride and cholesterols, they can have up to a 30% chance of development of cirrhosis of the liver with the fatty liver disease. And that's not something that we appreciated 20 years ago. And we have noticed the increased chances of cirrhosis development in that group and the increased need for liver transplant has been noted. And they do have an increased risk of cancer of the liver with the fatty liver disease, with the development of the cirrhosis. And you're seeing a lot of things going on now, the GLP one agonist.

- I was gonna ask about that. What kind of issues are you starting to see from that? Because,

- Well, well, what I like about the medicine and not the side effect or issues is it is very helpful in getting weight off people. And if somebody has fatty liver disease and they lose 10% of their body weight, if you had a liver biopsy before they started it and after the 10% reduction in body weight, it would be improved. And so I'm a advocate of the GLP one weight loss because weight loss, weight loss and weight loss are the first three treatments of fatty liver disease. And then you address issues such as diabetic control, taking medications for an elevated cholesterol. If you're not obese and you have an elevated cholesterol or triglyceride, that in itself can also predispose you to fatty liver disease. But that's one of the areas it's the fastest growing cancer in the GI tract right now is having a liver cancer develop related to cirrhosis from fatty liver disease.

- Well, what do you tell somebody, how do you, I mean, I'm sure people are nervous about going to the gastroenterologist because it's just a sensitive topic and you, so how do you convince patient, I mean, I know your patient's already coming in, but if you are speaking to someone in general that you know is nervous about going to see Yes. How do you comfort alleviate any fears that they may have?

- Well, number one, we sit down and talk with them. And I think that's the important aspect of it. And let 'em know what we're going to be doing step by step. We've got excellent people in our office that help 'em with the patient education Leading up to that, and I'm just, we will walk you through say a scenario here of a a 45-year-old male that comes in with no problems for screening colonoscopy. And we sit and talk with him, we find him out about any medicines that he's taken. We tell him what to stop if he's on a blood thinner type medicine to when to stop it. And we discussed the risk of bleeding, perforation, drug reaction, infection with the patients. And we discuss about the sedation for the procedure. And uniformly these days throughout the US it's changed from the dero ed sedation that I initially started doing back in the eighties where you would have a medicated period for three or four hours after the procedure where you were still sedated and not remembering well during that period of time. Now we have anesthesia provide usually propofol therapy that gives amnesia plus sedation. The nice thing we like about it is with the medication, it can be stopped 30 seconds later. It's out of your system. So if somebody's having a breathing issue, we can just have the anesthesiology personnel to turn that off and it's over in a short period of time. That again, is a extremely rare situation and we seldom have to do that. But then what everybody's concerned about is the colon prep.

- Yeah. - Now I have to ask them a lot of times how a colon prep and going to church are alike.

- Okay.

- And that's one of the ways that I get into talking with them about it and also making 'em feel comfortable is the humor and a colon prep and going to church both should move you.

- Okay.

- And it will move you. We have got various preps that will work in getting the stool out of the colon so that we can see with our scope. The colonoscope is about the size of my finger here. And we even have pediatric colonoscopes we use in adults because a lot of times they're easier to get around people, especially thin people. In that situation. You wouldn't think that thin people can be difficult to get a colonoscope around. They can be because the angle is increased. The more obese people it, they can also be challenging at times too. But you're supposed to be able to get around the colon 95% of the time when you start. And most of us have percentages higher than that, getting around the colon. But there may be a chance that we can't, and then we have to look at other modalities to try to make sure we feel comfortable with giving them a pass on their colonoscopy.

- Do you tend to see more, just in your practice, do you see more people with issues or more people just coming for preventative? Or what's the case mix of that?

- Just

- Curious.

- Well, it's interesting that you mentioned that. Now I practiced for 35 years here in Valdosta. And then I've been away from the Valdosta area for about five years. And in that period of time, I've got to see a lot of patients. We went to Jackson Hole, Wyoming and did one week a month at the hospital out there starting a GI practice. They didn't have one there. It happened that my, just for some reason, my daughter lived there and my son-in-law and a grandchild. And so we decided to go out there. And we did that for 13 months and started the practice helping it continuing to go with another gastroenterologist that came out there. But I see a wide variety of folks. And the thing that I've noticed since coming back here is that it has taken me longer to go through the information that I'm getting because the problem list is much, much longer. Now, some people may focus and try to concentrate on doing screening colonoscopies, but I like the whole gambit of gastroenterology. And I can tell you it takes longer to sit there the night before and go through the information to see what you need to address. Yeah. So that there's no wasted time when you're interacting with the patient. So it has been more complex. Now, one of the areas that we have made the single most progress in during my time practicing gastroenterology is with hepatitis C. And in 1992, we finally had a test developed where we could check to see if somebody had hepatitis C with a hepatitis C antibody. And a year after that we started treating the hepatitis C. And Hepatitis C is a viral illness that can be associated with cirrhosis of the liver and cancer of the liver from the cirrhosis. And with the hepatitis C, we initially we were using interferon and then came along rebuttal for the treatment. And we would treat them with this God awful infusion regimen with a lot of side effects. And we would cure 12% of the people with hepatitis C. But this was really the first time that we had a treatment that would eradicate or cure a viral illness, not only in GI, but in really all of medicine. And then after that, we had additional developments. And again, I said we would cure 12%. And now when somebody comes in with hepatitis C, we put them on a single dose medicine for eight to 12 weeks, and there's a 98% healing rate and clearance of the Hepatitis C. And you look at 12% versus 98%. And that's one of the most significant improvements in medicine that we've had in the last 40 years.

- Yeah. Come a long way. And that's, that's great. What is, what do you like best just about being back in Valdosta, serving this community? Or what are you most excited about?

- I'm glad to be back home and I'm getting to see some of the patients I've taken care of in the past. They're filtering in and slowly coming in to see me. And a lot of them are friends.

- Well, we're glad to have you back and glad that you're still serving this community. I know you have a wonderful reputation throughout. So is there anything else that, if you just had one thing, advice you would share to any of our listeners, what would it be?

- Take care of yourself.

- Okay. All right. Well, Dr. Woods, we appreciate you for taking time to sit down with us and we will link information below to the practice if anybody wants to get in contact with them. And we just thank you for listening.

- And we're with South Georgia Gastroenterology and we can be contacted through their office.

- Very good. Alright, thank

- You. Alright, thank you.