Health Vibes - May 13th 2026

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[00:01:30]pharmacy bringing vibes to women each and every Wednesday from 10 to 11:30 a.m. with your host Trudy Christian and cause pharmacist Justinta Fagan and Leona Jeremiah. Education, information, and a bit of humor and not forgetting lots of vibes. Charlie's Pharmacy is bringing health and vibes together with health vibes. So, be sure to tune in each and every Wednesday on Q95 from 10 to 11:30 a.m. Charlie, leading the way in healthcare.

[00:02:05]Good morning. Good morning. Good morning and welcome to another episode of Jollie's Health Vibes, the health radio talk show that promises to always bring you lots of health education, but with a little vibes thrown in there. My name is Trudy Christian and this morning I am alone in studio. However, we do have a guest for this program who will be joining us virtually and in just a bit.

[00:02:35]But it is my pleasure as usual to be on with you on another Wednesday for health vibes. It's a rainy rainy Wednesday morning. I know that some people maybe wished that they could stay home this morning when they heard the rain. So those people that had to go to work maybe thought to themsel you know staying in bed for for the morning would be good. But it is always good to be in the land of the living and to give thanks for that uh regardless of the weather or anything else. So it's a pleasure as I always say to be here on a Wednesday with you for health vibes. I want to shout out the nurses. Yesterday was International Nurses Day and we also celebrated nurses week from May 6 to May 12th. Yesterday was the culmination of that with International Nurses Day. So I want to send belated greetings to all the nurses here in Dominica and anywhere where my voice is being heard right now.

[00:03:45]Uh wishing you just a happy uh International Nurses Day. nurses are critical of course in the health care system and for our care. I personally have not, thank God, had much experience um with being hospitalized, but when I did have a procedure at the Dominica China Friendship Hospital some time ago, I was so grateful to a nurse who held my hand in the operating theater and made sure that I did not uh I did not panic, I did not cry, I did not um I was not fearful when I was doing a procedure.

[00:04:25]without anesthesia. So I was wide awake and that nurse, Nurse Coffee, I want to say a special greeting to her. We must acknowledge when nurses really do the best job that they possibly can in ensuring that we are well taken care of in our times of sickness, in our times of fear, in our times of, you know, uncertainty about our health. So big up to the nurses and I really do hope that those nurses who are doing a wonderful job can really feel appreciated as we celebrated yesterday International Nurses Day. So all the nurses in the land and to the the faculty of health sciences at the Dominica State College where of course nurse nursing education is brought forth where we produce nurses. I also want to wish all nurses of the faculty of health sciences at the Dominica State College uh belated um greetings for international nurses day.

[00:05:27]Now this morning we do have a topic uh scheduled for discussion. As I said, we have a guest who will be joining us virtually, and it's a topic I think that many of us would be interested in hearing about. Definitely not something we've brought up before on Health Vibes.

[00:05:50]So, as I like to say, if you are listening to the program and you want to share it, now is a good time to do so.

[00:05:57]our online listeners, online viewers, those joining us via the Q95 FM's Facebook page or YouTube channel. I want to say a special good morning to you.

[00:06:10]Typically, you all pop on bright and early and let us know in the comments that you are on and you are with us on Health Vibe. So, a very special good morning to our online listeners. To those of you on radio, good morning, of course. And if you want to jump on to Facebook or YouTube, you can do so. We're going to just take a quick break. When we get back, we will introduce our guest. We'll introduce the topic. And as I can tell you, this is something that we have not discussed on the program before. And you will definitely be interested in getting this information from our program. So stay tuned. Tell a friend to tell a friend.

[00:06:53]Share the live. We'll be back after a few minutes.

[00:06:57]>> Pharmacy is bringing vibes to health with health each and every Wednesday from 10 to 11:30 a.m. with your host Trudy Christian and co-host pharmacist Justinta Fagan and Leona Jeremiah.

[00:07:11]Education, information, and a bit of humor. And not forgetting lots of facts.

[00:07:16]Charlie's Pharmacy is bringing health and vibes together with health vibes.

[00:07:20]So, be sure to tune in each and every Wednesday on Q95 from 10 to 11:30 a.m.

[00:07:25]Charlie, leading the way in health.

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[00:08:04]>> Available at Jolie's Pharmacy.

[00:08:06]>> Jolie's Pharmacy is bringing vibes to health with health.

[00:08:11]each and every Wednesday from 10 to 11:30 a.m. with your host Trudy Christian and co-host pharmacist Justinta Fagan and Leona Jeremiah.

[00:08:20]Education, information, and a bit of humor and not forgetting lots of vibes.

[00:08:25]Charlie's Pharmacy is bringing health and vibes together with health vibes.

[00:08:29]So, be sure to tune in each and every Wednesday on Q95 from 10 to 11:30 a.m.

[00:08:34]Charlie's Pharmacy, leading the way in healthcare.

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[00:10:01]And we are back with you. Of course, you're listening to Jollie's Health Vibes here on Q95 FM. And now we are live on Facebook. So, good morning to the Facebook listeners who maybe had missed the opportunity to say hi Julie.

[00:10:16]I see you. Good morning to you. And we are getting into our program and our topic for this morning. So, you're right on time if you're joining now. And if you're listening and still want to jump on to the social media platforms, you still have the chance to do so. So this morning, we're going to be addressing a topic. As I said, we haven't spoken about this on health vibes prior, but of course the general idea, general topic of cancer often gets a lot of, you know, a lot of discourse, a lot of discussion.

[00:10:54]But on health, this particular type of cancer we have not discussed prior and that's colurectal cancer. That's our topic for this morning. And joining us to help us navigate this particular topic and get the information that we should have correctly. We are joined by oncologist Dr. Asha Mate. And Dr. Mate is joining us virtually. And let's just see if we can hear each other. Dr. Mate, Good morning to you.

[00:11:25]>> Hi, good morning Trudy.

[00:11:28]>> Good morning.

[00:11:28]>> Can you hear me?

[00:11:29]>> Yes, we are >> fabulous.

[00:11:32]>> It is a pleasure to have you on the program. How are you?

[00:11:35]>> I am well. Thank you. First of all, thank you so much for inviting me. Um I always love the opportunity to to to share knowledge and impact um the health especially of those of Dominicans um sacred domier and um it's truly an honor to be part of the program this morning.

[00:11:58]>> Okay. I I I know Dr. matter. You are in a specialty that many people would be afraid to have to visit your particular specialty. You are an oncologist and um I know that oncology is not a oncology is not a an area that you know people want to have to interact with. Dr. Mate and I'm understanding that our listeners were not hearing you clearly. So let me just reintroduce for those who were not hearing that we have with us oncologist Dr. Asha Mate. She's joining us virtually on the program and she is going to tell us because I'm very interested in this. Why oncology? Why was that your choice? Especially when you know it's an area as I said that many patients would not want to have to see you at all.

[00:12:55]>> Fair. No, I mean that's fair. That's fair. And I mean in all honesty um everything you said there is quite true. [laughter] I am not I'm usually the last doctor that someone wants to see for good reason. But um in terms of what led me to oncology, when I finished my undergrad training in Cuba in ' 07 and I returned home, I did internship and then afterwards I was working as a house officer, junior medical officer on internal medicine and that is really the time that you get to kind of you have to make the decision what it is that you want to do in terms [clears throat] of specialtity and nothing really spoke to me. um you know on like a a a deep level until one day I was asked to assist with the oncology clinic that they used to have before it used to be once a week that's when we used to be in the old hospital the old princess for those of us that remember [snorts] >> and it used to be once a week and it used to be led by Dr. calendar and she needed some assistance because the clinic even back then had started to get overwhelming, right? And then so I said, "Okay, sure. Not a problem." Um, Dr. Elwin, I just want to take a a moment here to just recognize Dr. Elwin's great impact in healthc care in the country and that she will be sorely missed. May she rest in peace. So Dr. Elwin at the time who was my mentor and head of department of internal medicine. She said, "Mate, go down there, man. Help help them out." I was like, "Okay, cool." And then that was it. I went down there. I got to interact with the nurses that were working there and to interact with Dr. Calendar. And then by the end of the day, I was like, "Yeah, this is it. [laughter] >> This is it. This is it." And I stayed working in the clinic until I left to go and specialize in 2011.

[00:14:58]in 2011 [laughter] until I left to go specialize in 2011 and then um yeah and I did my specialtity training in Jamaica at the Muna campus and upon completion I returned home and I was working home until 2022 and then this opportunity came for me to move to St. Lucia and that's why currently I'm in St. Lucia working >> okay >> and residing >> okay and that's why you're joining us virtually but you know still still very much a part of you know as you said >> oh yes Dominican to the bone >> right [laughter] and wanting to to educate um our our local population Dr. doesn't matter. We, as I said in in the intro, we've discussed cancer many times on the program, but this specific one, we have not. Interestingly, I heard you on another program which was supposed to be about breast cancer, I believe, or cervical cancer. It's it was and I heard you mention of the high incidence of colon cancer and I said to myself okay well this is something that we don't you know we don't discuss and this form of cancer you know as I said I don't think we've done it on on health vibes so I said why not get you to to give us a bit of insight on colorectile cancer what is the picture that you are seeing in with this form of cancer and what exactly does it entail? What does it what what is colurectal cancer? I know colon cancer is sometimes said colurectal what is the difference? So let me know the colorectile cancer picture currently.

[00:16:49]>> Okay. And and and I'm so happy when you reached out to me and you told me what the topic was. I was like yes we definitely need to talk about that because there are some stark realities that are present right now in the setting of colarctile cancer. So just to kind of establish as somewhat of a of a reality check it is now the leading cause of cancer related mortality aka cancer related deaths in the Caribbean.

[00:17:20]There is a 2.5% annual increase in incidents in the Caribbean.

[00:17:27]47 and they expect to be a 47% increase in incidents by the year 2040 which isn't that far away.

[00:17:38]>> And about 91% of all the patients diagnosed with colon cancer have never been treated, have never been screened.

[00:17:46]So they're coming to us with their disease oftent times unfortunately at very advanced stages. So that's why and in my practice both in the public system and in my private office I am definitely seeing an uptick um in the number of cases in the number of colon cancer cases and the patients are getting younger.

[00:18:10]>> Wow.

[00:18:10]>> Historically colon cancer used to be a disease essentially of old people. is old people that used to get that and in tutus you hear papa have colon cancer and before you blink papa gone right but by that time papa was probably like around in his 70s in his 80s that kind of situation now I'm my my clients my patients are now in their 40s not even in their 50s and their 60s they're in their 40s and I've had the unfortunate experience of treating some even in their 30s right so I just want so so this is a this is a very important topic at this time considering the trend that we're noticing with the colon cancer cases specific and I and I'm speaking specifically to the Caribbean specifically to the Eastern Caribbean which is us >> that is a very alarming um a very alarming picture that that you have you know that you have just painted. Um I did when I looked up worldwide statistics see that colorectile cancer was the second leading cause of mortality in the world. But you're saying in the Caribbean region we're looking at it as the it is the is the the top one the number one um >> cancer mortality cause uh in our region.

[00:19:33]What what doctor what and you said that you're seeing younger patients as well.

[00:19:39]What do you think is causing that shift?

[00:19:44]>> Well, I mean again to the thing about oncology is that a there's a lot of research associated with this um specialtity. So we actually have pretty clearcut idea of what of what may be causing or what are the risk factors for what we're seeing. So the first one I want to talk about of course is nutrition or our dietary practices.

[00:20:08]Right? Over the past couple decades we have moved away from our more traditional locally sourced foods kind of diet that our parents and grandparents adhere to.

[00:20:23]We're now consuming much more a much more along a western diet type thing.

[00:20:29]And as a result of that, we're consuming a lot of highly processed foods, highly processed meats, highly processed carbohydrates, and and foods that are known to be extremely low in fiber.

[00:20:43][snorts] We have essentially cut out fiber from our diet. And especially when we're talking about the colon fiber is ex is is is is emerging more and more as we do more and more research where we're understanding how much of an important component of our daily nutrition it is.

[00:21:02]So [snorts] say for instance for most for most adults adults less than 50 we should be consuming as women we should be consuming at least 25 g of fiber and for the men even more up to 38 to 40 g of fiber a day. [snorts] And then when we get older say past the age of 50 our fiber requirements drop a little bit to like 20 for women and 30 for men respectively. [snorts] But now we're consuming foods that if you were to look at the nutrition um bar at the back of the food, some of them contain absolutely no fiber or negligible amounts of fiber. And that is what we're consuming. And fiber [snorts] has and a lack of fiber in in the diet has increases your risk of developing colon cancer in some instances by up to 38%.

[00:21:52]So we're not talking about little numbers here, right? We're talking about significant things. And I mentioned the nutrition aspect first because that's where we can actively if we make small incremental changes in our nutrition we could see a significant impact in terms of decreasing the risk of developing cancer in the first place quite significantly and there's also a very strong correlation to metabolic syndrome. So that's the people with the diabetes, hypertension and dysipidemia aka high cholesterol. As we know we in the Caribbean particularly in the Eastern Caribbean this has been an epidemic for us for many many years and it's just getting worse and we're seeing younger and younger patients starting to develop hypertension, diabetes and dysipidemia. So, and then when you have that syndrome on board, it [snorts] significantly increases your risk of developing um colon cancer in some instances by up to 68%.

[00:23:00]Right? That that's an eye watering number. And the reason being is that the insulin resistance is known causes increased insulin levels and increased insulin. Insulin is a cell growth stimulator. So you know so again what is cancer but uncontrolled cell growth. So we can understand why that would happen.

[00:23:23]Metabolic syndrome is also associated with this chronic lowgrade inflammation.

[00:23:28]And we all know what inflammation does to the body. And then it also changes your gut microbiome. So it changes the healthy bacteria that is supposed to exist in your gut and that is actually protecting you from cancer development.

[00:23:44]But because of the metabolic syndrome, those healthy bacteria get killed off and unhealthy bacteria takes its place.

[00:23:53]That promotes again uncontrolled cell growth. And of course, the last one that I want to remember that I want to mention in terms of risk factor is alcohol and tobacco consumption. Now, we know in the Caribbean, we like our fit, right? We enjoy a good time, right?

[00:24:11]We're known for that. But and I'm not talking about your mother drinking the one glass of ginger wine at Christmas time. That's not the alcohol consumption I'm talking about. I'm talking about the regular overconumption of alcohol as well as any consumption of tobacco by them individually. Each of them is associated with significant risk increased risk of colon cancer as the one we're talking about but all cancer.

[00:24:39]and together you can imagine is like a double whammy.

[00:24:44]So I mean I mentioned these three because these are direct the these are the quote unquote lifestyle associated risk factors that individually everybody should be paying close attention to. And if we want to widen the scope from a point of view of public health, these are things that you know um health ministries can definitely focus on to help to decrease the risk of incidents of colon cancer specifically.

[00:25:16]>> Okay. So doctor, you've led us through three, you know, modifiable risk factors. [clears throat] Our our diets which are increasingly high in processed food and and low in in fiber. um or metabolic um disorders to include diabetes, hypertension and that alteration of the gut um biome you mentioned and then the use of alcohol overuse over consumption of alcohol and um use of tobacco. I know anytime we have uh a programs and we speak about modifiable you know risk factors that are behavioral um in nature people people have a lot of opinions on these it's interesting that the alcohol consumption one keeps coming up the diet of course keeps coming up and so it is so important that we you know we having this this discussion I want to ask since you said that these are you know lifestyle possibly related lifestyle.

[00:26:15]Are there any risk factors that are non-modifiable? Is there a genetic risk factor for co?

[00:26:21]>> Yeah, definitely. I mean, in terms of the non-modifiable risk factors, there's a small cohort of patients usually make up less than 10% of patients who have inherited cancer syndromes.

[00:26:35]>> So, that's that's through no fault of theirs. They inherit a gene that predisposes them to develop colon cancer. So the main one would be Lynch syndrome. But then you also have people that have infl chronic inflammatory bowel disease. Um you know like colitis, ulcerative colitis or Crohn's disease that also just by the nature of that entire organ which is the colon being under constant high inflammation that exponentially increases the risk of developing colon cancer. there are certain racial links that that that are being teased. So they've found that people of Afro descent tend to have a slightly higher incidence. But again too, anytime you're talking about something like race, you have to also mention the fact that often times when we're looking at it, we're also looking at the impact of the socioultural issues based on someone's race and where they're growing up and how they're living. So is it that it is the race that is causing the increased incidence or is it the fact that because of the person's race they live in a certain place and they eat certain things and they interact with certain things because that is the socioultural norm of where they are and thus those things are increasing their risk of developing you know something like colon cancer. So that always tends to be a little bit of a gray and somewhat controversial um factor, but it is listed as one of the of the non-modifiable risk factors for the development of colon cancer.

[00:28:13]>> Okay. So and and I mean that's an interesting that's that's interesting as we speak to whether the it's causation or correlation when it comes to race and a lot yes that is another point that you know people often have very strong opinions on but we've we've so we've gone through the risk factors backtrack just a little bit um to the the the cancer itself colorectile cancer what does it affect as I said I've heard colon and I've heard colurectyl I've used it interchangeably are we speaking about a form of cancer affecting the colon and the rectum is it either or what is the really definition of colon >> yeah so I mean again to kind as as you so rightly said to kind of take it back to the basics when we speak about the colon we're speaking about what we euphemistically have always called the large bowel right So the large bow will starts um from as soon as your appendix ends >> right that little area there. As soon as your small intestine ends [snorts] that is where your large bowel begins and the large bowel is divided into different regions and those regions it's important for us to know what they are because depending on where the cancer develops depending on the region that the cancer develops the symptoms may end up being different. And I and I and I definitely want to want to dedicate a little time in terms of talking about the symptoms that the patient should be looking for.

[00:29:50]So say for instance when your colon starts it starts at the right. So you have your right colon and usually by the time your material is leaving your small intestine and entering into your large bowel into the right colon into the right part of the bowel, there's still a lot of fluid and liquid associated with that bulk that's moving into that segment. So often times patients with cancer of the right bowel, they do not complain about constipation. They do not complain really about pain because that part of the bow will is adapted to receive large volume. So it takes much longer for those sorts of symptoms to develop. However, what tends to happen with patients with cancer from the right bowel is that they may present often times with anemia. So because of the circulation to that part of the bowel there's a lot of of of vascule entering there. So those patients tend to present more so with low blood count. So they will talk about boy I feeling weak. I feeling weak. I feeling tired when I going up the stairs. I getting I'm feeling short of breath and I have palpitations and I have this and I have that. And often times what ends up happening is that they will do a blood test and the doctor will say, "Oh, your blood count's low. You anemic. Here's some iron, >> right?" And then that kind of masks what is happening until it becomes an untenable situation. So that's the right bowel. From the right bowel, we move into the part that goes across your abdomen. So that's called your transverse colon. There aren't really any cancers in that area. they're they're the rarest. We don't often see um colon cancers of the transverse colon for whatever reason. I'm not exactly certain, but in terms of symptoms right now, you're starting to lose a lot of the fluid from the bulk that's moving through the colon. So, you'll find the patient more complaining of collicky type pain. Um, as you know, everything is gas until proven otherwise. So they probably be complaining of gas and those sorts of things, right?

[00:32:08]>> And those are the common complaints. And they may start noticing a difference in how they move their bowel. So whereas they could probably move their bowel at least once a day, sometimes twice a day.

[00:32:20]The frequency of bowel movements may decrease, the stool may become harder to pass. All those things are the little little red flags that are starting to to come off. And then from the transverse colon we go into the descending colon or the left colon and that is further subdivided into other sections. So so at the end of it you have your rectum. So that's why you hear colar rectal and then at the very very after the rectum the part if you look at someone's backside right what you will see outside like the puckered area that is your anus. Your anus is also considered to be part of your colon and they divide colarctyl because rectile cancers tend to react a little bit differently than the than cancers from the other parts of the colon. So that's why they made that demarcation in terms of colarctyl and the most common site of colon cancer is actually the left colon. that is the one that is most associated with um the modifiable risk factors that I spoke about. So particularly with the diet and the metabolic syndrome and those sorts of things you find when we have disregulation of particularly of those two factors we see a lot of leftsided bowel disease and um that is the one that tends to present with significant constipation decreased size of the stool pain that is it's it's it's the cancers originating from the left bowel >> the left bowel okay so Dr. So okay. So you've gone through very nicely the the anatomy of the of the large intestine and the the occurrence of cancers in different areas of the large intestine.

[00:34:11]The the large bow as we say uh what what type of symptomology you would you would see. You said though in the left bowel it's most common.

[00:34:22]>> It's the most common and you did mention pain. You did mention um constipation.

[00:34:27]>> Constipation. If there is a is there if there is another change in bowel movement in relation to diarrhea. So not constipation diarrhea.

[00:34:37]>> Is that a concern as well? Frequent diarrhea.

[00:34:41]>> So I mean the most common change would be from regular free flowing stool to constipation but sometimes some patients do present with diarrhea. Right. So what we're looking at is not necessarily the consistency of the stool. We're looking for the change and a persistent change.

[00:34:59]So I mean, you know, if you have a little loose stool for like one, two days, stand or nothing. If you have a little constipation, probably you never drink enough water, you this, you can always find a reason that that's that's not necessarily something to run for.

[00:35:12]But if this is consistent and persistent over two to three weeks, that is not normal. And another thing I want to point out is that oftentimes particularly with the leftsided sometimes patients will say well when I wipe I see blood it may be bright most likely bright red blood and then you will you will always hear oh but I had piles I have piles I have hemorrhoids that kind of thing or sometimes unfortunately and I and and and I'm speaking frankly here about the medical fraternity patients will go to their doctors and they're like doc when I pass through my stool hard and then when I wipe um I seen blood to the so obviously that oh well you know you put you're forcing to pass stool so that's why when you wipe you see the blood and we just assume that that is what is happening that it's just local trauma or sometimes the patient actually may have piles because hemorrhoids are are relatively common right [snorts] and then that is just brushed aside but no especially if the patient is coming if there's a change if the patient did not have chronic constipation Right? If the patient is saying, "No, but this but it's not just blood when I wipe. I'm seeing blood in the bowl." Right? That is a lot of blood. You're not I always tell my patients, you're not supposed to bleed >> from there. So, anytime you're bleeding, especially if it's consistent bleeding, that is that not even a red flag. That's that's that's a red billboard, >> right? go and get that.

[00:36:49]>> So, don't don't don't delay on on something like that.

[00:36:52]>> Don't delay.

[00:36:54]>> So, I like that. Not a red flag, a red billboard. Uh doctor, what about what about um the position of pain? You did mention um patients may complain of pain uh particularly that left bowel um occurrence of of the cancer. What >> how would the pain feel where exactly would the patient complain of pain? Um, >> no man, I mean that's that's that's that's a credible question. So again, it depends on where the blockage is because think of think of your colon as a tube, right? And that is why we have the pain.

[00:37:33]Your colon is a finite tube. There's certain parts of it, as I said, that can stretch a little bit more than others, but it is a finite tube. And anytime and with colon cancer, think of colon cancer growing into the tube causing blockage of that tube. So the pain that is felt is the bowel fighting to get the stool past that area of blockage. It's stretching, it's pulling, and the nerves there don't know what to do. So it is being interpreted as pain, right? It's it's it's being it's being transmitted as pain. So essentially dependent on where the blockage is that's often where you will feel the pain. So if you're having it on your right side because there are many patients who have gone in for an appendix surgery and then when they go in because the appendix is on the right side and when you go in they're like oh that's not that's not your appendix. You understand that sort of thing. So you have this cramping pain. It feels like a cramping pain for those of us with wounds and being blessed with um menstrual cycles. It feels almost like collic, right? That's how the female patients describe it. It feels like a collic. Um sometimes it feels like a gasping. Sometimes it feels like it's moving and you're just like it like it moved. And some patients will even tell you when I belch I feel better >> because again the blockage is causing the backup of all things not just the solid material but also the air that moves through your bowel. So if you're able to release that pressure sometimes you will feel a little better right but [snorts] the pain returns and then what starts to happen as the obstruction gets worse the pain becomes more constant.

[00:39:20]Whereas it used to come and go now it's there much more constant. is coming more frequently and is lasting longer.

[00:39:27]>> Okay. Okay.

[00:39:31]>> So, so that and that's and and often when we talk about pain and other symptoms in general, but specifically pain um publicly. I like to kind I like to get it as precise as we can because you know how people self diagnose all the time and >> people and and you know once it's gas man go and drink a hot cos go and drink a Andrews go and look look drink some drink some bush tea take some ginger tea put a little cinnamon in that dash a little bit in that all kind we we know we know how to we in quotation marks we know exactly what is wrong with us and exactly what to do about it and we self diagnose and self treat a lot. That's a cultural thing.

[00:40:15]>> So, so we've spoken about sto um pain.

[00:40:19]We've spoken about bloody stools. Uh we've spoken about well dependent on if the the cancer is located and the right um large bowel anemia um right this is where I was going.

[00:40:35]>> I read something recently and it resonated with me Dr. Mate. It said, you know, I read about symptoms of a disease and I think I may have it until I get to the symptom that says weight loss. And I know it's definitely not me.

[00:40:49]>> That resonated with me because you know weight loss is weight loss is is just not something that happens for me. You know what I mean? So let's talk about weight loss. So again too with the weight loss the weight loss comes as a result of so often times because the patient feels uncomfortable and remember they often feel uncomfortable after they eat right because again you have stuff moving through the bowel you would find that they would subconsciously decrease what they're decrease the amount that they're consuming because they know when they eat their stomach hurts so I they subconsciously start eating less also through and and again because of the pain because of everything they eat less so the appetite drops. They will tell you my appetite just disappear. Also to cancer in and of itself causes a decreased appetite and also because cancer is a highly inflammatory disease. [snorts] It in turn uses a lot of energy and nutrients and vitamins and minerals. Think of it like as as like a parasite that's just sucking all your nutrients and it's right in the bowel where all your nutrients and vitamins are being absorbed. But the cancer instead of it being absorbed into you, it's being absorbed into the cancer. So it's drawing from you. So all those things can and do lead to weight loss.

[00:42:16]When we speak about weight loss, we we always tell the patients the metric that we use is approximately a 10% um unexplained weight loss. We're not talking about the person that is on their you know their summer body journey and they're exercising and da da and they're doing all the things and they're calorie checking and they're doing of course they're going to lose weight.

[00:42:39]That's not who we're talking about.

[00:42:40]We're talking about the person that was living their life regularly and having abdominal pain, decreased appetite, and unexplained weight loss, something is happening that that that's the weight loss we speaking of.

[00:42:56]>> Okay. So, so doc, if someone is experiencing some of these symptoms >> um and they they go in to to to a doctor and the suspicion is there may some form of of cancer or there may be colorectile cancer. What are what is the testing? Um what is the diagnostic process >> for for a patient? So the gold standard gold standard diagnostic test is a colonoscopy >> where you go to a gastroenterenterologist or sometimes a surgeon and they have a a an instrument a tool that they use it it looks like a flexi tube very thin small flexi tube with a camera at the end of it and they would put it up entering through through the anus and traverse your colon. on looking to see if there's anything there. And the reason why is the gold standard is that not only can they see, there are also small tools within the head that they can then take a biopsy of it, take a piece of it that we can then use for testing to confirm whether or not what is found in the bowel is actually cancerous. Now, the colonoscopy is the gold standard for diagnosis, but it is also the gold standard for screening. And I want to bring in screening here a little bit. Hope just in case, you know, we don't get time to it. Screening, early detection saves lives. And I want people to remember that colon cancer is preventable if we catch the precancerous lesions. Much like cervical cancer, why we advocate for the papsmear because we can we can catch it before it becomes cancerous. It is the same thing for the colon. And as a matter of fact to reflect the younger age of incidence of colon cancer, the age of screening for colon cancer has dropped before it used to be 50. It is now 45. So you should have your first screening test from the age of 45. So now as I said the gold standard is a colonoscopy, but there are other non-invasive screening tools. So you can do your fit test where we actually test for um hemoglobin in the stool. It's not it's not the gold standard but it is used and often times it can be used in conjunction with the colonoscopy. So the patients could come to the office and complain. So you could let them do the fit test first and if the fit test is positive that then adds more evidence to them needing the colonoscopy and then you can then use that to be able to advocate for the colonoscopy. Sometimes some some physicians will send the patient for imaging. So they will send them for CT scans or stuff like that.

[00:45:52]But a CT scan is not considered to be a screening tool because for the CT scan to show something abnormal in the colon, a significant portion of the colon has to be obstructed and so you can miss some of the early stage disease because the CT scan is just not a sensitive tool to um to diagnose it. We also used to use a barerium swallow essentially where you swallow something that when you do the X-ray it kind of lights up. But again with the barerium swallow the quite a large portion of the bowel of the area where the cancer is would have to be obstructed already for it to see something significant. and you would still then have to go on and do something like a colonoscopy to be able to confirm the appearance that you're seeing in the barium.

[00:46:49]>> Okay. So, what I'm hearing is, you know, the colonoscopy is almost a must um for for the >> It's standard. Yeah, it is standard for a reason. [laughter] >> I know that we do have some aversion to to that. I will ask about that. I'll ask about that in one second, but I just want to open the lines at this point.

[00:47:10]We're ready, you know, past the midway point. And I do know we were getting some calls a bit earlier. I'd like to have the opportunity to ask a question.

[00:47:19]We've spoken about it thus far. Our number is 4493095 4493096 4493097 or 6164257 if you're overseas and you want to get a hold of us on the program it's 3054329624 yes so we are discussing colctile cancer Dr. Dasha Mata is in the house virtually and she's an oncologist and she's been leading us through the information. I see that the lines are already going.

[00:47:55]Let me >> let [laughter] caller. Good morning.

[00:48:00]>> Hello. Good morning, Doc.

[00:48:02]>> Hi. Morning.

[00:48:04]>> Yes. Um I have problem.

[00:48:09]Um but it is in my back of my Okay, we we lost. Yes, we lost that caller. So, caller, please try again.

[00:48:23]Um, we are we are open to to calls at this time. Yes, Dr. Mart, I was going to ask about the colon colonoscopy. Um, I do know that some people are fearful of any insertion of any instrument, >> anything in the back passage. Yes.

[00:48:40][laughter] I was going to say into any orifice but specifically >> specifically it is the back passage.

[00:48:47]>> Yes. Um what do you tell patients or what do you tell people to allay that that that fear? I I've never had a colonoscopy but I've had a gast gastroscopy and it was it it was not pleasant because I did it awake.

[00:49:02]>> There you go.

[00:49:03]>> I did it awake. But what do you tell patients you know to >> it's it's it's really I often find it's not about like frightening the patients right it's really like this conversation that we're having this is much the conversation that I have with my clients with my with both my public and private patients I just kind of break it down for them in a way that makes sense that just like okay I understand you don't you're uncomfortable with having an instrument ment placed up your anus. I mean just saying it out loud. Anal probe what is that right? No one most let me let me not let me not say no one most people are a are you know averse to that. So I work with them I say okay well let's start with something non-invasive. So that's where the doing the stool test is almost like an entry. So often times if we do the stool test, but you always have to give it with the caveat that the stool test is not as sensitive as the colonoscopy and we could get a false negative, right? And just because the stool test didn't show anything doesn't mean that there isn't anything, right?

[00:50:19]And often times doing more than one stool test is recommended. So you space it out a little bit. You do one one week, probably in two weeks time you do another week and then two weeks after that you do another one. So you're kind of spreading it out trying to ensure that you really are able to capture something, right? Because a negative stool test in the setting of significant symptomatology does not help you. But a positive stool test definitely tells you, hey, hey, hey, hey, hey, we need to do something. Right? So I mean that's usually how I approach it with with with the clients and I and I've found that when you just upfront and open and calm with them, they often tend to acuest because remember the goal here is diagnosing the disease at a stage where it is it is curable.

[00:51:11]>> It is treatable and thus curable. If we allow this to progress to a point where it isn't, then this it becomes a completely different discussion in terms of management.

[00:51:25]>> Doc, as it as it relates to the colonoscopy as a screening um tool, you mentioned the age of 45. Um >> yeah, I'm I turn I turned 45 this year.

[00:51:37]I'm actually due on [laughter] >> the Yeah, the age of 45 for the commencement. But is it is it recommended for people who um possibly know of a genetic uh background?

[00:51:52]>> That that that is so awesome that you brought that up, Trudy, because the age of 45 screening is for people with standard risk, >> right? Standard risk, you don't have any family history of it. You don't have any no known genetic predisposition. You start at 45. For those of for those for those patients who have a firstderee relative, say a parent or sibling or first degree, right, that developed colon cancer, they either start screening from the age of 45 or if the person was diagnosed young, right? So say the person was diagnosed at the age of 50, >> then they should start their screening from 10 years before that patient was diagnosed. So if you have a parent that was diagnosed with colon cancer at age 50, your screening should actually start at age 40. You should not wait until 45.

[00:52:45]And then for the other for the those with like Lynch syndrome or ulcerative colitis or Crohn's disease, their screening actually starts from adolescents because they can develop colon cancer from teenagers from in their 20s. So they on a completely different screening protocol but the age of 45 is for those with standard average risk.

[00:53:11]>> Okay. Okay. And does it does it differ between men and women or does the incidence of colurectal cancer show any um sex uh >> there tends to be a slightly higher incidence in men.

[00:53:28]>> Okay. There tends to be a slightly higher incidence in men and they tend to present a little bit younger as well men right and unfortunately just by the nature of men not to really be health seeking they also unfortunately tend to be diagnosed at a much more advanced stage than a woman would >> because women would be like oh uh-uh I going Whereas the man would be there suffering and not say anything and not go anywhere especially when he hear something have to go up his backside we boy problems.

[00:54:10][laughter] >> Yeah. So so but but despite that we still the age is still 45 for both both >> for both men and women.

[00:54:21]>> Okay. All right.

[00:54:22]>> For average risk >> average risk or standard risk. Okay.

[00:54:26]Yeah. Okay. So let's let's go a bit into um the prognosis if you know a diagnosis is made at a certain stage as compared to another stage and what is the the possible outlook for a patient diagnosed with colurectal cancer? Um what what is the outlook >> dependent on stage of diagnosis? So dependent on stage. So stage one and stage two are considered to be early stage and management management of stage one is surgery. There's no further often times there's no further systemic treatment that is required. Say for instance like chemotherapy or anything like that. You go in you have stage one disease the surgeon then goes in cuts it off and that is it. You're just on surveillance after that. For stage two disease, [snorts] the most of the patients can also be managed with just surgery as well. [snorts] But it becomes a little bit of a gray area when there are certain quote unquote high-risisk factors based on the surgical sample that is taken. So that's where the interpretation of the pathology report comes into play and the burden of that falls on the oncologist to be essentially to go through the report and determine whether or not certain high-risisk factors were present that indicate that the patient would benefit from additional therapy usually in the form of chemotherapy.

[00:56:06]And then stage three disease from the time you start stage three is considered to be advanced because now we have the disease moving from the colon alone and now starting to invade the surrounding lymph nodes that are attached to the colon. So that is considered to be advanced disease and management for that is surgery followed by chemotherapy.

[00:56:32]That is that's a hard strong recommendation. Why? Because we found that in patients who just had surgery and no chemotherapy there's a high incidence I think it's if if memory serves over 75% chance that within the next 6 months they will have recurrence of their disease. And the unfortunate thing of um colon cancer recurrence is that the recurrence when it occurs is often times at distance. So now we would move from a patient that has stage three disease to now has having the most advanced stage of disease which is metastatic disease. Colon cancer often spreads to the liver because they share circulation. So when it's moving it will often move It's it's main area of spreading is to the liver. And then we have stage four disease. But just just to kind of come back to stage three with stage three disease, if the patient has surgery and gets appropriate therapy, that patient can often do very well. And if when we check in terms of life expectancy, and when you when you hear life expectancy, we're usually looking at a 5 to 10 year period. The majority of those patients who respond well to therapy are still still remain in remission with no with no recurrence. Right.

[00:58:01]>> Okay.

[00:58:02]>> But we're but we are talking about advanced disease here and unfortunately there are there is a a cohort of patients who in spite of best efforts do go on to have progressively worsening disease and unfortunately pass as a result of their disease. Now stage four disease that means the cancer has spread outside of the colon and we're often times looking at spread to the liver and sometimes spread to the lungs. [snorts] Now that is where colon cancer is a little bit different than other cancers because if say for instance if the cancer spread to the liver but it's only localized in one area of the liver. It is recommended that we actually go and take out what that area of the liver that the cancer has spread to and also take off the area in the colon that has the cancer and give the patient appropriate treatment and actually over 50% of the of those patients approximately 50% let me not oversell it approximately 50% of those patients can also then go into remission aka having no identifiable evidence of cancer >> at stage four.

[00:59:13]>> At stage four. At stage four. Yeah.

[00:59:16]Yeah. Yeah. So it's so so it's one of those that we've actually been able to achieve very good outcomes even in patients with with known advanced disease. But of course, you know, we it's it's something that we keep working on and we're getting better and hopefully we can increase those numbers particularly for those with advanced disease.

[00:59:39]>> Okay. So we're saying at stage four um there is you know there is a possibility of entering remission after treatment and surgery.

[00:59:49]>> What about the stage? Is there a stage five?

[00:59:52]>> No no no no there's no stage five.

[00:59:54]>> Okay. So stage four is the most advanced stage.

[00:59:57]>> Yeah is the most advanced stage.

[00:59:59]>> Okay. So [laughter] doctor I don't know.

[01:00:02]I just felt like a number five had to come in there. So, so stage four is the the most advanced stage and there is there is a possibility um of remission.

[01:00:13]Uh but doc, what is the what is the change in the individual's um life process with the removal of a part of the colon? How how what are the changes that >> Well, it it really depends on how much of the colon had to be removed because your large bowel is big, right? It really depends on how much of the bowel had to be removed in the surgery and it also depends on where the surgery was done. So, say for instance, if you have to remove your entire right bowel, right? So, do like a hemlectomy.

[01:00:50]Remember the the the the material that is coming there from the small intestine is a lot of fluid and liquid and all sorts of stuff. And sometimes that can mean that the patient now has to deal with essentially chronic diarrhea because of how of the volume that is put that because we take out that quote unquote transition point of the of the right colon. They now have a have a much bigger volume entering the rest of the colon. Um so there could be that and of course there's some patients who now have to have what is known as a col a colostomy essentially based on and that's more of a surgical thing than a medical oncology thing. So it's really the surgeons when they go in and they and they're doing their surgery they have to make the assessment of whether the patient has like a a temporary colostomy or the patient unfortunately would have a permanent colostomy. So that's where they have to have the a piece of the colon is ex is um put outside of the body and there's a bag that collects the stool. Um of course I mean anyone can understand that that could be um significant in terms of um just you know how the patient views themsel, how the patients feel comfortable about themselves. Some patients would tell you me it's not bothering them at all.

[01:02:12]Whereas some patient it really does affect them in terms of knowing that they have they call it the the poo poo bag having a permanent poo poo bag on them that kind of thing. They they're self-conscious about the smell. They're self-conscious about everything. So it can have it can change the patients um you know social interactions significantly.

[01:02:34]But um you know the the the the alternative would be you know having progressive disease and that unfortunately will most likely lead to your death. So those are the those are the decisions that we have to make.

[01:02:56]>> Hello are you there?

[01:03:02]>> Yes. Yes, we had a little shutdown. So, apologies, but um you're back. I was just saying that we have >> Hello.

[01:03:10]>> Yes.

[01:03:11]>> Yes, we can hear you. We can hear you. I guess you're not hearing you're not hearing us yet.

[01:03:33]No. Okay. So, we we had a question coming in from the live stream. Um, if you're hearing, just give me a thumbs up.

[01:03:44]>> You're still hearing me now?

[01:03:45]>> Yes, I'm hearing you.

[01:03:46]>> Okay. Okay. All right. So, yeah. So, that was that.

[01:03:52]>> Yes. So, we had a question coming in for um >> Yes, we had a question coming in for our live stream. Um I'm going to give it to you. The question is how frequently I don't think the doctor is hearing so may we may need to log out and sign back in.

[01:04:14]Yes.

[01:04:21]Let's take a quick Let's take a quick break. Let's take a quick break whilst we rectify these um technical issues and we'll get Dr. Mate back to answer that question in one in one second.

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[01:05:51]Okay, Dr. Mate, we are back and hopefully we both hearing each other now.

[01:05:56]>> Yes, we are. We are. I love it there.

[01:06:00]>> Yes. Yes. So, apologies and apologies to our listeners. We did have a bit of a technical difficulty occurring here in studio, but we're back. Uh, Dr. M, I was saying there's a question that came in through the live stream that I wanted to to pose to you.

[01:06:16]One of our listeners has asked how frequently do germs in water cause colorectile cancer. Is there any association to H pylori? That is the question coming in.

[01:06:31]>> So the H pylori the H pylori link is actually quite significant. It's one of what is known as the encogenic um bacteria and it is something that is acquired often times via food via contaminated food or contaminated water that sort of thing. So we often hear of people getting tested for hepatitis but most people don't get tested for HB H pylori which they should. Now where H pylori is really significant in terms of causation of cancers is more so in the stomach. It does not mean that it cannot cause cancer in other parts of the bowel, but most of the cancers that it causes occur in the stomach and it causes a specific a specific type of lymphoma that is present in the stomach. But sometimes I have had the unfortunate opportunity of treating patients that develop that same type of lymphoma in the in the bowel. I have had like very few probably like one or two cases. So it's rare that it occurs in the bowel but it but it can occur um but it's more so um significant for gastric cancer.

[01:07:49]>> Ah okay. Okay. And another question is also coming in and this is one I definitely needed to ask. How frequently should the colonoscopy screenings be continued if you've had a good result?

[01:08:02]So what is the frequency of screening that's required?

[01:08:05]>> Usually you hear like every five years.

[01:08:08]So you do you so say if you have like three and again the guidelines have have been changing recently right. So I mean you know I do encourage everyone to do their own research trust but always verify. Um if you have I believe it is two to three consistently normal colonoscopes then your physician can then transition you to every 10 years I think after you've had two consecutive normal scopes. Then you can then have it done every 10 years up to up to an age of I believe 75. So we get to the point where life expectancy for the population. So our life expectancy in the Eastern Caribbean is anywhere I think between 70 and some instances 78 or 76. So once we get into those ages then there's no real reason to go ahead you know doing the scopes because we have arrived at quote unquote our standard life expectancy for the population. So that's usually where where in terms of frequency once it's normal you do one you do two two normal then your physician can transition you to every 10 years based on you know the current guidelines but as I said the guidelines change [laughter] now with a with a frequency that even I sometimes I often times not even sometimes I often times go and brush up on them because stuff changes I think I think they change they change the screening guideline for for for colon cancer must be just last year if memory serves either last year or 2024. So I mean these things change with with with frequency as we in the medical fraternity learn more about certain diseases and as our prevalence and incidence of these diseases change so too our screening needs to change. So it's dynamic.

[01:10:03]>> Okay. And and do if if I may ask does it mean because I noticed the screening this the the the screening gaps the or the time um gap between screening is is is long um compared to other you know screening guidelines. Does that mean that colorectile cancers are slow um in growth? Traditionally they are traditionally it takes anywhere some some books will quote you 8 years some books will quote you some literature will quote you 10 years some literature will quote you 5 years so that's why it it it takes a while often not always and that's and that's how sometimes we have patients getting diagnosed in between screening times >> but for the most part it tends to be one of those that takes a while to grow so that's why we can lengthen the screening time.

[01:10:57]>> Okay. All right, Doc. I mean, we did have a little a little gap there where we had [clears throat] a little technical difficulty, but we have arrived almost at the end of our time >> program. So, you've given us such a wealth of information. This morning, we've we went through what were the risk factors for colurectal cancer. We went through the symptoms um based on the location of of occurrence of the cancer.

[01:11:28]We went through the treatment um options and the prognosis for the patient.

[01:11:34]>> Went through the screening method and what the importance of that. And now I just want to ask you to wrap up and give any you know any closing remarks that you you would like to specifically on on this topic or in general cancer as an oncologist. um what would be your your your final remarks here on health vibr?

[01:11:56]>> Yeah man. So once again I just want to you know say tell you truly thank you so much for this opportunity to you know spread knowledge and awareness to our people both home and abroad and anyone who may be listening.

[01:12:10]The main points I want people to take away from this as we speak to colon cancer is that the incidence is rising and the age of presentation is dropping.

[01:12:21]So if you feel something, go and get it checked out. There's no such thing as too young. Okay? So I just want people to recognize that. Also too, most of the work can in terms of prevention can be done by you. Just simple lifestyle changes. Um, it doesn't have to be that you go on this this grand detox monklike sort of existence. Small consistent incremental changes will get you there much quicker. I I know it may seem counterintuitive. Much quicker and much longer than trying to do anything too drastic. So, just add, you know, a little cup of beans to your food. Add a little cup of vegetables. Add some nuts.

[01:13:10]Add some, you know, just to increase your fiber intake. Instead of the white rice, transition to brown rice. It's a little bit more ground provision. Stay away from the processed foods as much as possible. Balance balance is needed and required. And if you feel something, don't don't be fearful. Approach it.

[01:13:31]find out because early detection, early stage of disease and early detection saves lives. And that statement goes for all cancers. Early detection saves lives.

[01:13:48]>> Doc, thank you so much for that. I mean, and and your final words are so on point. Um it's it's something that our medical professionals keep appealing to us um to do you know to always be proactive um get yourself checked if there is any suspicion of anything and to not be fearful you know of of of medical intervention because as you did correctly say early intervention can create better outcomes and can save our lives.

[01:14:18]>> Yes. So I I really thank you for this. I I I wish that we could have had more time because you mentioned [laughter] you mentioned detox and I wanted to go into a whole other program.

[01:14:32]>> I want that's why I dropped it in the end, you know. I I I don't want to be taken down that route. But yes, [laughter] >> yeah, that could have opened up a whole other program at the end. and I really appreciate your time and you being here with us on the program this morning. Although you're not in studio, but virtually we made it work. So, Dr. Ma, thank you so much. And we do hope sometime in the future we could have you back on the program, maybe another form of cancer, but definitely thank you so much for the colctal cancer discourse that you had with me this morning. Thank you so much.

[01:15:09]>> All right, [snorts] dear. Bye.

[01:15:11]>> Yes. Goodbye. So it is 11:31 here in Dominica Studios of Q95 FM and it is the end of another episode of Jolie's Health Vibes. I thank you the listeners for sticking with us through the program and for posing your questions in the chat. I do know that we had some people who tried to get us on the phone and were unable to do so. But as we continue through Health Vibes to try to bring topics of health education that are relevant to the population, we do hope to engage with you maybe on another program if you didn't get through on this one. So until next week when we'll be on again, God willing, I'd like to wish everyone a great Wednesday, a great rest of the week. Stay healthy, stay strong. will be back hopefully to bring you another health education talk show with a bit of vibes next week.

[01:16:09]Until then, signing out. Goodbye.

[01:16:12]Jordan's Pharmacy is bringing vibes to health with health each and every Wednesday from 10 to 11:30 a.m. your host.