Breakthrough Treatments in Colorectal Surgery

Drex Dobson, M.D.: Welcome to the afternoon’s chat on Breakthrough Treatments in Colorectal Surgery. Dr. Dobson is with us today and welcomes your questions.
quidnunc: What breakthrough treatments exist today for colorectal surgery?
Drex Dobson, M.D.: Well, many treatment options exist for colorectal surgery…. I could better answer your question if you could give me a hint as to what topic you are interested in knowing about, ie cancer, hemorrhoids, etc…
Elizabeth: Since no one has asked a question yet, maybe you can start by telling us about some of the most common things you treat.
Drex Dobson, M.D.: I treat all sorts of things, from hemorrhoids and incontinence to various forms of cancer, as well as irritable bowel syndrome, inflammatory bowel disease, and other problems..
LaVergne: I’ve heard that there are new tests out now that are less invasive than a colonoscopy. Is that true? If so, what is it called and does Rush Copley do this new test?
Drex Dobson, M.D.: There are a few tests which are less invasive than colonscopy, but very few are as sensitive and specific to identify problems with the colon… specifically, there is a virtual colonscopy exam which appears less invasive, but requires a preparation much like colonoscopy, and the administration of a gas under pressure to fill the colon prior to receiving a special CT scan… we are currently in the process of establishing a Virtual Endoscopy Center here at Rush-Copley…
molly: What is the downtime for hemorrhoids. My internist told me that it would be months of stool softners and baby food. Comment please.
Drex Dobson, M.D.: That unfortunately is incorrect… Downtime for hemorrhoids depends on several factors, including the extent of hemorrhoids, the type of surgery required, and a patient’s pain tolerance. Most patients enjoy a regular diet within hours of their surgery, and maintain a normal lifestyle within 1-2 weeks of surgery…
quidnunc: What types of treatment do you offer for hemorrhoids and are there any risks involved in not treating them?
Drex Dobson, M.D.: Treatment depends on whether the hemorrhoids are inside, or out, or both. This ranges from simple rubber band ligation and banding to surgery with either a painless “stapled” hemorrhoidectomy, or the standard hemorrhoid operation which can be quite uncomfortable…
LaVergne: do you treat diverticulitis? Are there any new treatments for it? I understand that when you are having an attack there is nothing that can be done for it except to just ‘get though it’.
Drex Dobson, M.D.: The treatment of diverticulitis depends on the individual situation. For the most part, acute attacks are treated conservatively (with antibiotics) prior to definitive surgery. Here at RUSH Copley, we can perform laparoscopic surgery for the treatment of diverticulitis which results in removal of the disease colonic segment with a faster return to work and less painless recovery…
Drex Dobson, M.D.: quidnunc — I forgot to answer the second part of your question… there are minimal risks to not treating hemorrhoids… but a lifetime of pain and unnecessary suffering is not exactly a risk, but something that someone should not really have to go through…
Renee: With a history of hemorrhoid problems (many years)my current surgeon does not recommend removal. Flare up occuring 1-2 times per month. Is there a level of severity before removal is recommended?
Drex Dobson, M.D.: There is no definitive answer… What the answer should be is how does this impair your lifestyle… if it does, it should be addressed… 1-2 times/month to me would be a little more than I could bear…. ;o)
molly: What is a “stapled” hemorrhoidectomy?
Drex Dobson, M.D.: This refers to the “Procedure for Prolapse and Hemorrhoids”, a special operation for people with enlarged INTERNAL hemorrhoids only… that can be done, is painless, and prevents hemorrhoids from ever coming back… it is a lot more complicated than regular hemorrhoid surgery, and is not for everyone..
Elizabeth: What are the treatment options for irritable bowel syndrome? Can this be treated without surgery? What are the surgical treatment options?
Drex Dobson, M.D.: irritable bowel syndrome is a misnomer, in my opinion. it is the name given to diseases we cannot explain, understand or diagnose. it is the “catch all” for those complaints that afflict people than we cannot assign to a known disease… very rarely (in fact, almost never) is there a surgical option for this “disease” — it really is something that needs to be adequately explored and all possible causes diagnosed. if nothing is found, treatment is symptomatic….
Drex Dobson, M.D.: So, do we have any more questions??? I ready to type….!
Drex Dobson, M.D.: oops I am ready to type…
molly: If I were to have the hemorrhoids removed, how would it be done? Long a stay, outpatient, etc.?
Drex Dobson, M.D.: It depends on the type of surgery you need.. for the average type of hemorrhoid surgery (done with a scalpel), it would require a 20-35 minute operation, and is usually done as a same day surgery.. that is, you come in in the morning, have the surgery, and go home several hours later that day…. you may require several days off of work…
Elizabeth: Thank you for answering our questions. I just have one more — are you single?
Drex Dobson, M.D.: You are welcome…. I didn’t see that as an approved topic list…. ;o)
Heidi: I’ve heard so much about probiotics (right word for bacterial diet supplements?) helpful in maintaining healthy digestion. What is your opinion?
Drex Dobson, M.D.: Probiotics are a very important part of a healthy diet… some of the best ways are to ingest healthy natural substances (ie yogurt)… some people (like me) hate yogurt, so there are other alternatives.. such as probiotic preparations…. one note, however. any probiotic that is in pill form usually does not work.. the only probiotics that are helpful are those which are freeze-dried and need to be refrigerated….
gina: Is it true that eating a lot of seeds or nuts can trigger intestinal problems and undigested ones can cause problems severe enough to need an ileostomy?
Drex Dobson, M.D.: Gina, that is a myth…. in fact, seeds and nuts are a healthy part of a high-fiber diet. That has never been proven, and is “urban legend.”
cd: I totally agree with you Dr. Dobson on the irritable bowel syndrome. In some instances, an “elimination diet” is the best diagnosis. Although it sounds like a long drawn out process(and sometimes is) usually the patient has some idea about what is causing the problem. There also are different degrees of sensitivity and symptoms. For example some people can tolerate one ear of corn, but forget about the high fat popcorn at the movies!
Drex Dobson, M.D.: you are correct… usually they are allergic to the carrier molecules of the popcorn fat, for instance..
molly: I see that you treat incontinence. Is that fecal incontinence? I read that hemorroid surgery could even cause fecal incontinence. I also read that hemorroids could cause incontinence. (the old chicken/egg dilemma) I think it was mayo clinic info. What’s your take on that?
Drex Dobson, M.D.: yes, fecal incontinence… hemorrhoid surgery when done incorrectly can cause incontinence… everyone has hemorrhoids… including babies and neonates.. they are a normal part of our anatomy, and constitute between 5-15% of our mechanism for “continence”.. hemorrhoidal problems that go on for years can cause multiple problems, including incontinence secondary to scarring and/or prolapse…
cd: The trick with getting to a high fiber diet is to do it slowly and with plenty of fluids. Are you familiar with the current recommendations from the Amer. Cancer Society on grams needed per day?
Drex Dobson, M.D.: The ACS recommendations are just that.. recommendations. Lets not get caught up in numbers… Grams of fiber needed per day are not quantified by amount, but by effect.. This is a result of dietary intake (normal foods), supplements (ie fiber), and their effect on the density and water content of the stool. Some people need more, and some need less — a sort of titrate to effect type of situation. There is no absolute value, in my opinion.. What the amount should be is individually what a person needs to have a happy, healthy, bowel movement.
cd: So, how are everyone’s bowels today??
Drex Dobson, M.D.: Sorry, a little colorectal humor!
Heidi: Is it difficult to diagnose Crohn’s disease? What are the symptoms and treatments?
Drex Dobson, M.D.: It can be very difficult to diagnose Crohn’s disease in certain indivudals, but for the most part, most people can exhibit common symptoms… such as weight loss, diarrhea, mucus, blood, fistula to the anus, bowel, or other organs.. The treatment can range from simple dietary modificaiton to steroids, drugs, immunomodulary agents, and surgery…
Nancy: Do you think its normal for me to have a bowel movement like only once a week? I’m serious. I eat a lot of fiber, but I seem to have always had this problem. I’m afraid something is wrong with me.
cd: Is that individualized as well? Can some people truly go days without a BM while others have several per day? Is there some sort of standard that would indicate “abnormality” and cause for concern?
Drex Dobson, M.D.: These are both good questions. There is no minimal frequency or time frame for bowel movements to occur… some people go once a day, some once a week, and some even longer, in between bowel movements.. if that is your “norm” than its not a problem. If you experience, bloating, pain, etc., then its not normal… it all depends.. some people go normally two times a day… some three.. this is also not abnormal if this is what they’ve ALWAYS done.
zelma’: Should I be more concerned about red blood in my stool, or black (bloody) stools?
Drex Dobson, M.D.: Always be concerned with blood in your stool. Blood in the stool can be just a simple tear, or hemorrhoid, or can be so much more. It is imporant to have a doctor evaluate you and do a screening exam depending on age, risk, etc., and look inside to verify the cause of the bloody stool is not a malignant or premalignant or inflammatory problem…
molly: It seems that my doctor and Renee’s doctor are saying don’t bother with have the hemorroids removed, but I think you are saying, why live with them? I know this has to be individualized, but is that your recommendation?
Drex Dobson, M.D.: Why suffer?
Drex Dobson, M.D.: Yes, if they are that symptomatic, they should be removed.
Drex Dobson, M.D.: We only have two minutes left… any other questions that I might answer??
Heidi: At what age should you first have a colonoscopy if you have no family history of colorectal cancer?
Drex Dobson, M.D.: Usually at age 50 IF you are healthy, have normal bowel movements, standard yearly rectal examinations and FOBTs, and no other cause for concern..
Drex Dobson, M.D.: If anyone in the family that you are directly related to (mother, father, sister, brother, grandparent) has had a colon cancer OR polyp, you should have one no less than 10 years before they presented with their disease….
Drex Dobson, M.D.: Well, its time to go. Thank-you for joining me this afternoon and discussing current topics in colon and rectal surgery…