What can I do for hemorrhoids?

Summary

In this enlightening and humorous conversation, Dr. Megan Turley, a colon and rectal surgeon, dispels myths and sheds light on hemorrhoids, explaining their function, causes, and treatments. She emphasizes the importance of not dismissing rectal bleeding and the need for proper evaluation, advocating for open discussions about anorectal health to reduce stigma and shame. Dr. Turley also highlights her approach to treating hemorrhoids with office procedures and stresses the significance of early detection for conditions like colon cancer.

Takeaways

• 😀 Hemorrhoids are normal anatomical structures that everyone has, serving functions like providing moisture in the anal canal and aiding in 'anal sampling' to differentiate between gas, liquid, or stool.
• 😅 The interview starts with humor, acknowledging the sensitive nature of discussing rectal issues and aiming to normalize conversations around them.
• 🩺 Hemorrhoids can be internal or external, with internal hemorrhoids being up in the anal canal and prone to bleeding and prolapse, while external ones are highly innervated and sensitive due to being made of skin.
• 🤰 Pregnancy and hormonal changes, including those related to breastfeeding and menopause, can exacerbate hemorrhoidal issues due to their effects on bowel habits and the anorectal area.
• 💊 Conservative management of hemorrhoids includes fiber supplementation, warm baths, over-the-counter numbing creams, ibuprofen, and prescription steroid suppositories.
• 🍽 Dietary habits significantly impact hemorrhoidal symptoms; a high-fiber diet can help alleviate constipation and diarrhea, which are common triggers for hemorrhoid problems.
• 🏥 In-office procedures for hemorrhoids include rubber band ligation for internal hemorrhoids and excision for external ones, aiming to reduce symptoms and improve patient quality of life.
• 🚫 The script emphasizes the importance of not self-diagnosing and the potential risks of ignoring rectal bleeding, which could indicate more serious conditions like cancer.
• 👩‍⚕️ Dr. Megan Turley encourages patients not to feel embarrassed about seeking help for anorectal issues and stresses the importance of professional evaluation for proper diagnosis and treatment.
• 🔍 The discussion highlights the need for further investigation when conservative treatments fail to stop rectal bleeding, with a colonoscopy being a critical step in ruling out serious conditions.
• 🌐 The interview concludes with a reminder of the importance of screening for colorectal cancer, especially for those with a family history or showing symptoms, and the value of seeking second opinions in healthcare.

Q & A

What is Dr. Megan Turley's specialization?

Dr. Megan Turley is a fellowship-trained colon and rectal surgeon with a comprehensive robotic surgery practice.

What is the primary function of hemorrhoids according to the discussion?

Hemorrhoids serve as vascular cushions in the anal canal, providing moisture and mucus, and aiding in anal sampling, which is the body's ability to discern the nature of rectal gas or content.

What is the difference between internal and external hemorrhoids?

Internal hemorrhoids are located up in the anal canal, can bleed, and may prolapse or fall out during bowel movements. External hemorrhoids are made of skin and can become engorged and sensitive, often causing discomfort or pain.

What are some common causes of hemorrhoidal troubles mentioned in the script?

Common causes include constipation, diarrhea, straining from various activities, pregnancy, hormonal changes, and lifestyle changes like starting a new exercise regimen or diet.

How does Dr. Turley describe the process of treating hemorrhoids in her practice?

Dr. Turley starts with a consultation to understand the symptoms, followed by an examination that includes looking for external issues, performing a digital rectal examination, and using an anoscope to examine the hemorrhoidal tissue.

What is the role of fiber in managing hemorrhoidal symptoms?

Fiber supplementation is crucial in managing hemorrhoidal symptoms as it helps regulate bowel movements, reducing constipation and diarrhea, which can exacerbate hemorrhoids.

What are some non-surgical in-office procedures for treating hemorrhoids?

In-office procedures include rubber band ligation for internal hemorrhoids, which cuts off blood supply causing the tissue to fall off, and excision for external hemorrhoids to change the topography of the anal opening.

What is the significance of the cultural stigma around discussing rectal issues, and how does it affect patients?

The cultural stigma around discussing rectal issues can cause patients to feel shame and embarrassment, which may prevent them from seeking necessary medical care and evaluation.

Why is it important for individuals experiencing rectal bleeding to seek medical attention?

Rectal bleeding is not normal and can be a symptom of more serious conditions like colon cancer. It is essential to seek medical attention for proper evaluation and diagnosis.

What are some common misconceptions about hemorrhoids discussed in the script?

Common misconceptions include the belief that hemorrhoids are always painful or problematic, and that rectal bleeding is a normal symptom of hemorrhoids. In reality, hemorrhoids are normal anatomical structures, and bleeding is a symptom that requires medical evaluation.

What advice does Dr. Turley give regarding the use of over-the-counter treatments for hemorrhoids?

Dr. Turley suggests that over-the-counter treatments like Preparation H or other creams may not be as effective as more targeted approaches like hot baths, ibuprofen, and prescription steroid suppositories, especially for acute hemorrhoidal problems.

What is the role of a colonoscopy in evaluating rectal bleeding?

A colonoscopy is essential in evaluating rectal bleeding as it allows doctors to examine the colon and rectum for abnormalities such as polyps or cancer, which may be causing the bleeding.

What are some alternative methods to a traditional colonoscopy mentioned in the script?

Alternative methods include the use of a pill cam, which is a swallowable camera, and a colig guard or 'poo in the box' test, which analyzes stool for signs of blood or other abnormalities.

Outlines

00:00

😀 Introduction to Dr. Megan Turley's Discussion on Hemorrhoids

Dr. Megan Turley, a fellowship-trained colon and rectal surgeon, introduces the topic of hemorrhoids in a light-hearted manner, discussing the common misconceptions and the importance of understanding the condition. She explains that hemorrhoids are vascular cushions in the anal canal that everyone has and serve important functions, such as providing moisture and aiding in 'anal sampling' to differentiate between gas and stool. The conversation begins with humor, including a joke about a man with plastic horses in his rectum, setting a tone of openness and comfort for discussing this sensitive topic.

05:00

😅 The Anatomy and Function of Hemorrhoids

This paragraph delves into the anatomy of hemorrhoids, distinguishing between internal and external types. Internal hemorrhoids are located up in the anal canal and can cause bleeding or prolapse when they become engorged, especially during sitting and straining. External hemorrhoids, on the other hand, are made of skin and can become sensitive and swollen. Dr. Turley emphasizes the importance of recognizing hemorrhoids as a normal part of anatomy and discusses how symptoms arise when these structures become problematic due to various factors such as straining, constipation, or pregnancy.

10:01

😓 Hemorrhoids and Lifestyle Factors

The discussion continues with the exploration of lifestyle factors that can contribute to hemorrhoid issues, such as constipation, diarrhea, and straining from heavy lifting or illness. Pregnancy is highlighted as a significant risk factor due to hormonal changes and physical pressure from the growing fetus. The paragraph also touches on the impact of hormone changes during breastfeeding and menopause on hemorrhoid symptoms, underlining the complexity of the condition.

15:02

😖 Addressing Hemorrhoid Symptoms and Treatments

This paragraph focuses on the practical aspects of addressing hemorrhoid symptoms. Dr. Turley suggests starting with dietary changes, particularly increasing fiber intake, to manage bowel movements and alleviate pressure on hemorrhoidal tissues. She also recommends over-the-counter treatments like Preparation H and warm baths to soothe discomfort. The importance of differentiating between 'fluffers' and 'pushers' in hemorrhoid management is emphasized, with the former changing stool caliber and the latter stimulating bowel movement.

20:02

😉 Hemorrhoid Management and the Role of Hygiene

The conversation shifts to the role of hygiene in managing hemorrhoids. Dr. Turley advocates for gentle cleaning practices, such as using mild soap and water, and minimizing the use of toilet paper to avoid micro-tears that can exacerbate itching and discomfort. She also discusses the use of bidets for maintaining cleanliness and the importance of not overcomplicating anal hygiene.

25:04

😡 The Stigma and Shame Surrounding Hemorrhoids

Dr. Turley addresses the cultural stigma and shame associated with hemorrhoids and anal health issues. She emphasizes that these conditions are not a reflection of a person's cleanliness or morality and encourages people to seek medical help without embarrassment. The paragraph also touches on the societal expectations for women to be clean and the impact of these expectations on the willingness to discuss or seek treatment for such issues.

30:05

😣 In-Office Procedures for Hemorrhoid Treatment

This paragraph outlines the in-office procedures available for treating hemorrhoids. Dr. Turley describes rubber band ligation as a common method for treating internal hemorrhoids, which involves cutting off blood supply to the tissue, causing it to fall off. She also discusses other procedures such as infrared coagulation, sclerotherapy, and hemorrhoid liation, highlighting the importance of conservative treatments before resorting to surgery.

35:06

😖 The Impact of Hemorrhoids on Quality of Life

Dr. Turley discusses the significant impact that hemorrhoids can have on a person's quality of life, causing symptoms like urgency, pain, and seepage. She stresses that while hemorrhoids are a common condition, they should not be dismissed as a minor issue, and people suffering from them should seek medical attention to improve their condition and regain their ability to enjoy daily activities.

40:08

😡 The Importance of Seeking Medical Evaluation for Hemorrhoids

The final paragraph emphasizes the importance of seeking medical evaluation for hemorrhoids, especially when conservative treatments fail to resolve symptoms. Dr. Turley explains that persistent bleeding is not normal and should be investigated further, potentially requiring a colonoscopy to rule out more serious conditions like cancer. She encourages patients to advocate for themselves and seek second opinions if necessary.

Keywords

💡Hemorrhoids

Hemorrhoids are swollen veins in the lower rectum and anus. They are a common topic in the video, discussed in terms of their function as vascular cushions in the anal canal and their potential to cause discomfort and bleeding. The script mentions internal and external hemorrhoids, explaining that internal ones can bleed and prolapse, while external ones are sensitive skin tissues that can become engorged.

💡Anal Canal

The anal canal is the terminal part of the digestive tract that connects the rectum to the outside of the body. It is central to the discussion in the video, particularly in relation to hemorrhoids and their function within the canal. The script uses the term to describe where hemorrhoids are located and the importance of the anal canal in maintaining continence and facilitating bowel movements.

💡Prolapse

Prolapse, in the context of the video, refers to the falling or slipping of an organ or tissue from its normal position, specifically mentioning hemorrhoid prolapse. The script describes how internal hemorrhoids can fall out of the anus after straining during bowel movements, requiring manual replacement.

💡Constipation and Diarrhea

These terms refer to two common gastrointestinal issues that are discussed as potential causes of hemorrhoidal problems. Constipation is characterized by infrequent bowel movements with hard stools, while diarrhea involves frequent, loose stools. The script explains how both conditions can exacerbate hemorrhoids by causing straining and changes in bowel habits.

💡Fiber Supplementation

Fiber supplementation is recommended in the video as a method to alleviate hemorrhoidal symptoms by regulating bowel movements. The script emphasizes the importance of consuming 25 to 35 grams of fiber daily to reduce the risk of constipation and diarrhea, which can contribute to hemorrhoid issues.

💡Pregnancy

Pregnancy is mentioned as a condition that can cause or exacerbate hemorrhoids due to hormonal changes and physical pressure on the rectum. The script discusses how the increased pressure from the growing fetus, along with hormonal fluctuations, can lead to hemorrhoidal problems.

💡Infrared Coagulation

Infrared coagulation is one of the in-office procedures discussed in the video for treating hemorrhoids. It involves using infrared light to cause coagulation of the blood within the hemorrhoid, leading to its shrinkage. The script presents it as an alternative treatment option for hemorrhoids that do not respond to conservative management.

💡Rectal Cancer

Rectal cancer is a serious condition that is mentioned in the video as a potential cause of rectal bleeding, which should not be dismissed as merely a hemorrhoid. The script stresses the importance of seeking medical evaluation for rectal bleeding to rule out or identify serious conditions like cancer.

💡Colonoscopy

A colonoscopy is a medical procedure used to examine the inside of the colon and rectum. In the video, it is recommended for individuals with persistent rectal bleeding to ensure that there is no underlying condition like cancer. The script discusses the benefits of colonoscopies in screening for colorectal cancer and polyps.

💡Anoscope

An anoscope is a medical instrument used during the video's described examination process to visually inspect the hemorrhoidal tissue. The script explains its use in a proctology office to get a clear view of the anal canal and surrounding tissues for diagnostic purposes.

💡Banding

Banding, specifically rubber band ligation, is a procedure mentioned in the video for treating internal hemorrhoids. It involves placing a small rubber band around the base of the hemorrhoid to cut off its blood supply, causing it to shrink and fall off. The script describes banding as a quick and well-tolerated in-office treatment.

Highlights

Dr. Megan Turley discusses her role as a colon and rectal surgeon with a comprehensive robotic surgery practice in Austin, Texas.

Dr. Turley explains the anatomical and functional aspects of hemorrhoids, emphasizing that everyone has them and their role in anal health.

A humorous anecdote about a man presenting to the emergency department with five plastic horses in his rectum.

Dr. Turley provides detailed information on the symptoms and types of hemorrhoids, distinguishing between internal and external hemorrhoids.

Discussion on the causes and risk factors for hemorrhoids, including constipation, diarrhea, straining, pregnancy, and hormonal changes.

Dr. Turley emphasizes the importance of fiber supplements and hydration in managing hemorrhoid symptoms.

The conversation highlights non-surgical treatment options for hemorrhoids, including topical medications, warm baths, and over-the-counter remedies.

Dr. Turley shares that some hemorrhoid issues can be resolved with in-office procedures like rubber band ligation.

Explanation of more invasive treatments for severe hemorrhoids, such as hemorrhoidectomy and the potential recovery time involved.

Dr. Turley stresses the importance of seeking medical evaluation for rectal bleeding, as it can sometimes indicate more serious conditions like cancer.

Dr. Turley and the interviewer discuss the stigma and embarrassment associated with hemorrhoids and other anal health issues.

The importance of proper cleaning and hygiene for anal health is highlighted, including the use of gentle methods and products.

Dr. Turley describes her broader role in treating various colorectal conditions, including cancer, inflammatory bowel disease, and diverticulitis.

The conversation touches on the importance of screening for colorectal cancer, especially in individuals over 45.

Dr. Turley shares some of the unusual items she has removed from patients' rectums, emphasizing the importance of using proper tools for anal intimacy.

Transcripts

[Music]

hello everyone we're here today with Dr

Megan Turley she is a fellowship trained

colon and rectile surgeon with a

comprehensive robotic surgery practice

in Austin Texas she works at Texas colon

and rectal specialist in Austin thank

you so much for having me yay I was so

excited to talk about hemorrhoids today

I know how excited you are the most

excited yeah talk him out buttholes and

all that stuff poop all the things I'm

sure you hear a lot of poop jokes all

day do you know yeah I hear some good

ones and some that are basically like

poop but that's mostly for my kids oh

okay that's hilar I all like the little

like poop my like toys and figureheads

we have a lot of those around so fun

right I'll tell you a joke then okay's

up a man presents to the emergency

department with five plastic horses in

his rectum his condition is described as

stable oh my god well don't jokes that's

amazing oh my gosh I love that okay well

we can add sprinkle more those as we go

but all right okay so we have a question

from Kate and greenbell South Carolina

she says I have some summered

hemorrhoids that are not going away what

can I do about it so now so let's kind

of you know that's just an open-ended

question so can you describe to

everybody like what a hemorrhoid is

absolutely the very first thing you

should know is that hemorrhoids are like

arms they are anatomic everyone has them

they are vascular cushions in the anal

Canal the function they serve it tends

to be both providing kind of moisture

and mucus in the anal Canal as well as

doing what's called anal sampling so

sometimes people don't give the anus and

rectum enough credit for the job they do

but I want you to consider probably even

within the last few weeks you've been in

a place a crowded place with people you

respect and you decide you're going to

eek out a silent fart now in that moment

the nerves muscles and your brain have

to decide is this gas liquid or stool is

it going to be loud or is it going to be

quiet so your butthole has to figure

that out or else people would just be

their pants in public I'm sorry

can I say yeah okay people would just be

their pants in public all the

time if they were wrong yeah right so

now those signals can get messed up in

different types of anoral pathology so

for people who have thrombos external

hemorrhoids who have hemorrhoid crisis

all those things can get a little bit

mixed up but anyway that's the term anal

sampling is the ability of your body to

know like is this an okay time to try

and squeak this out or am I about to do

am I about to have like a big emergency

here I just I think this saw so funny I

saw something on Instagram the other day

and somebody was like it was a door and

the door like butthole and then it said

it was like a fart sh said fart and like

the fart was like getting ready to go

out the door and then some the guy was

said diarrhea and it like ran out the

door first oh yeah so it just think that

so so essentially anyone who comes to my

office to talk about hemorrhoids I

really listen to what the actual

symptoms are because essentially for

most people unless you're a proctologist

and or a GI doctor hemorrhoid really

just means like there's a problem with

my anus I can barely eek the words out

to tell you what it is and so our job in

proctology is to really figure out like

what are the symptoms that are bothering

you because most the time if hemorrhoids

aren't bothering you they certainly

don't bother me now as far as the

anatomy goes so hemorrhoids benign do

not cause any problems longterm but kind

of with the exception of like torrential

bleeding or what we call audible

bleeding that's where people tell me

they're like I sit on the toilet and I

can actually hear blood hitting the

water so that's kind of like a different

you know a different set so hemorrhoids

internal hemorrhoids and external

hemorrhoids are kind of the way we

designate and it can kind of help you

understand what the symptoms are so

internal hemorrhoids are up in the anal

Canal they tend to get big and engorged

when sitting and straining they can

bleed and they can fall out your butt

that's called prolapse so that if you

sit and you bear down and have a big

bowel movement and you feel like as

you're wiping you're pushing tissue that

belongs on the inside back up into the

inner Canal that's hemorrhoid prolapse

external hemorrhoids are made of skin

your anus or your butthole is made of

skin just like the skin on your hand

it's squamous tissue it's highly

innervated very sensitive for better or

worse and so when people have external

component of the hemorrhoid that can be

both the vascular involvement so a

tissue that gets bigger and smaller

based on your bowel habits if you're

sitting and straining if you're hiding

from your kids with your anal Canal

unsupported over the toilet bowl while

you finish that last YouTube video or

you're texting your mom and you just

want to get that final thought out and

then when you wipe you're like my God

are these grapes no it's just your

hemorrhoidal tissue filling with blood

because your Canal's unsupported at that

time now because it's made of skin there

that actually belongs on the outside so

a lot of people tell me like oh I have I

have hemorrhoid prolapse I have tissue

that's not supposed to be there well

external hemorrhoids are supposed to be

there that's skin it lives on the

outside now whether or not you like how

much skin there is or the vascular

component so whether or not get bigger

and smaller when you're sitting and

straining like those are things that are

modifiable but U just the mere presence

of tissue on the outside of your anal

Canal is pretty

normal I have a speech love in my office

it's called every anus is a flower and

all our petals are different oh and I

won't go into the details but

essentially it just means that like

butth holes are different and but holes

can be different when you're young when

you get older if you practice anal

intimacy if you have lots of babies if

you have surgery if you get infection

collections next to your butt and you

need surgery for that bottoms just look

different over time and there's

something wrong with that if you're

having symptoms that's when we want to

see you yeah I say that too about vulvas

you know it's like everybody's vulva is

different I have a lot of people come in

like my vulva looks weird it you know it

doesn't look like anybody else is I'm

like well what you know where are you

getting this information see either

usually like pornography or something or

just an anatomical pictures in an

anatomy book and everything looks

perfect in those things and the reality

is like you said about butth holes it's

like no one's is the same everybody is a

little different I think the more we

normalize this and talk about it like

okay like we all have them yes

absolutely and truly unless your partner

is a proctologist they probably don't

notice or think anything about your anal

opening other than they're excited to be

there because that's something you guys

have chosen to do yeah yeah around the

holidays I posted something on my

Instagram that was like everybody has a

butthole but don't be one yes I thought

was nice I love that or ask guess yeah

all the

same Okay cool so so what why I mean why

do they happen so you've basically said

How you know this tissue is normal but

then you know it's highly vascularized

so that means increased blood flow and

all that stuff for people that don't

necessarily know what that means so why

you know what are some common reasin

sure so everyone's body is a little bit

different and so some people are

predisposed to having Troublesome

hemorrhoids and some people are not I

really can't tell you kind of in your

families like who will or will not be

however there are some things that do

put people at risk so constipation and

diarrhea can give people hemorrhoidal

troubles and that can either be

engorgement sensation at the anal

opening it can be lots of mucus it can

be tissue that falls out that you have

to push back in it can be bleeding with

wiping and it can be that external

engorgement component now some people in

the setting of straining and I mean

straining in any sense so straining to

poop straining to move a piano straining

in the setting of like moving a hot tub

straining when you get sick and you're

throwing up a lot all those things can

change hemorrhoidal components and can

kind of precipitate them being more

bothersome than other times pregnancy

also a big one unfortunately not just

big old baby heads but the hormonal

changes surrounding pregnancy

surrounding things like ibf surrounding

things like breastfeeding and we pain in

and menopause all of those hormone

changes can change the way that our our

stools kind of form and evacuate and

those can all kind of precipitate

hemorrhoidal troubles do you think it

has more to do with estrogen or what

what do you think the hormonal

components should do so yes and no so

it's a combination of estrogen and

progesterone and our Gynecology

colleagues could probably get a lot more

sexy in the weeds as far as the

descriptions about which are more

constipating at one time or another but

because hemorrhoids can basically all

hemorrhoids can be exacerbated by all

types of hormone changes then I'm not

going to specifically assigned to one or

the other no I mean don't fingers don't

fingers I think hormones get like a bad

rep too especially estrogen like you

know that it's there's never absolutes

you know right there's it's just

understanding that but yeah I think that

there's almost a lot of embarrassment

especially postpartum with people saying

oh my gosh I have

H I'm like you know how many other

people have hemorrhoids that come in

here they marking all their Pap work but

they're not shouting it on the rooftops

I mean people aren't talking about this

on social media and stuff like that and

so yeah so it's pretty you know it's I

don't think it's anything to be

embarrassed about I mean it can be

embarrassing because it's your brought

ho but also you know it's it can happen

to anybody pretty much and apparently

moving Pian is a big

thing I see people holiday

piano moving all things that you think

it's just kind of like the force the

intra like abdominal pressure that

bearing down pressure on the tissue the

Val Salva uh motion so we call it kind

of breathing against the closed glaus

which means like when

you that oh also we didn't even I didn't

even blame my weightlifters I see lots

of people who are trying to make

Lifestyle Changes who are coming in

because they've just started trying to

like either like quotequote like get

jacked right so taking higher protein

powder plus heavy lifting without good

like a good breath control and I can see

those kind of causing different

hemorrhoidal stuff as well that being

said treating hemorrhoids that kind of

starts at the top right so the things

that you eat affect what comes out so

spicy in spicy out like if you're not

eating kind of overriding enough fruits

and vegetables things like that so I

have all my patients start on a fiber

supplement I take warm myself I am fiber

agnostic I do not care about brand or

whether you go the geriatric generic

route from like your you local pharmacy

or whether or not you get in the weeds

with the Millennials and do like Olli

pop water or whatever just as long as

you're hitting that 25 to 35 grams of

fiber in a day that's what's going to

try and kind of attenuate that

difference between constipation and

diarrhea so that's the place that I

start and it's act it's pretty

incredible how much that makes a

difference for hemorrhoidal symptoms of

enouragement bleeding and and prolapse

really really really helps so much so

that I have people come into their

followup just to tell me that they were

surprised that it worked yeah I think

that's great I think also yeah

understanding the mechanics behind it

right I think where people don't

understand is okay well I have a

hemorrhoid what am I supposed to do yeah

like kind of with the recommendations

with the fiber and things like that but

then also like you were saying like the

closed glotus just understanding like

breath so closed glotus is basically

when you're holding your breath and not

letting anything out but if you can do

it if you hold your breath with like a

slow exhale basically that is taking off

some of that pressure so if you are

starting to work out more and you're

noticing more are these symptoms it's

not necessarily saying to stop it's just

more of hey what as we take on new

routines new diets and and nutrition and

things like that our body is Shifting so

kind of being more gentle with yourself

and understanding okay well what switch

what are some exercises that I'm doing

that I feel like I'm straining more

so from a PT perspective you know I

would say which ones are you straining

on the most right so maybe we either

decrease that weight and then slowly

build you back up or rryy clo like a

slow like exhale when you're doing it

and then kind of seeing how you're

feeling with that aspect and then also

diaphragmatic breathing so you get the

diaphragm that helps prep push kind of

everything down and relax your pelvic

floor and then as you exhale everything

comes back up so with choc dimatic

breathing in previous episodes and it's

some of the videos are on my Instagram

and stuff but the point is is that yeah

all of that stuff I think that's awesome

and

so when so f is a good one and what you

know people I think when people hear

hemorrhoids are just like oh Preparation

H what is that even like what are your

thoughts give me give me in give me in

give me it all so you so for acute

hemorrhoidal problems so bleeding

prolapse itching pain yeah but you can

spend $1 million on the on the aisle in

the pharmacy and you probably would as

be just as good making a PST out of that

bill and apply to your butt it's like

something just doesn't work so what

works when you're when you're having

emid troubles in a short duration so

less than two weeks you can use things

like preparation age topical lidocain

that's kind of a numbing medication

honestly what people tell me works the

absolute best is sitting in the hot bat

relaxes the muscles of the pelvic FL

decreases that that inflammation and the

itching sensation you don't have to put

any special salts or anything in there

but that's like a a good really good

place to start a lot of people get

muscle spasm along the anal canal in

conjunction with hemorrhoid troubles so

medications like ibuprofen can be really

helpful probably even more so than

Tylenol although you can take them both

at the same time in these settings

prescription steroid suppositories

really are the most helpful in an acute

setting what I tell people is like you

if you get a mirror and you look and

you're like I don't even know where my

anus opening is make a guess put the

suppository as high up as you can

because the the entryway for all of that

engorgement and fullness is going to be

higher up in the anal canal and so

shmear it all over your anal skin isn't

going to do a whole lot of good but

getting it more up in the anal Canal can

be really helpful so like when in when

having troubles with hemorrhoids sit in

the hot bath tal andol ibuprofen steroid

suppositories up high in the anal Canal

numbing medic

often before you use a bowel movement

can be helpful so that's like your

lidocaine that's even over the counter

and then don't get constipated so use

your fiber supplementation and your

laxatives one thing that people find

helpful is to try to differentiate your

bow aisle in the pharmacy which is going

to be at a risk of being grass it's

going to be the fluffers and the pushers

so the fluffers are going to change the

caliber of your stool those are things

like powdered fiber supplementation

which I think is better than gummies or

tablets or things like that I don't have

any evidence I can't point to the

scientific paper that says that but um

kind of anecdotally in our society

that's what we believe it also

guarantees that you're drinking eight

ounces of water to try and get that in

so once you take your fluffer and you

need to drink it with plenty of water or

else you're going to poop out a fiber

brick then you can discuss whether or

not you need a pusher or laxative so

those are things with lax in the name

dokal LAX Miralax and those

over-the-counter type things those help

you kind of stimulate the bells to move

and can be really helpful when taking in

conjunction

too um it's about water yeah water and I

think water and exercise like

movement people do like like pelvic

Mobility kind of almost like they look

in the mirror like raise your heads up

hike your pelvis Rock back and forth

mean your colon is lined up all along

your abdomen and so getting all of that

moving too and even just walking I think

that yeah you know in our society now

there's a ton of sitting less exercise

and a lot of coffee right and so hey I

she's hiding her coffee but I am a huge

advocate for you know I love coffee so

I'm not saying anti- coffee stuff but

what it's saying is like yeah getting

people to kind of think like okay what

are some other things that I can be

doing that can help us

Beday huge fan of Beday so when people

come in saying like oh I have a

hemorrhoid problem often times it's

actually not not in a ically a

hemorrhoid problem it's a constellation

of symptoms right so anal pain anal

itching excess tissue moisture changes

so Beday are awesome for doing a number

of things so if you have anal

itching treat your butt like a baby butt

stop putting product on your butthole go

to exactly what you do for a baby right

do you just take a giant poop gentle

soap and water or a bedet quit wiping so

hard the you know the bougie wipes that

are kind of marketed to people as like

some sort of anal hygiene really more of

a self-cleaning oven so gentle soap and

water minimizing product easy on the

wiping those micro tears that you get

using toilet paper and being vigorous

can lead to these like very small

excoriations on the skin which

perpetuate this itch cycle well it's

funny because it's like even when we're

just like talking about poop right we

don't even have these conversations like

and even talking with the bul bus like

how can you even clean it right are like

scrubbing it with their their lofas and

like there's bacteria in there and just

just water some light soap the same

thing like when you're wiping your

butthole be gentle Easy Does It Easy

Tiger Easy Tiger but yeah like I have

I'm a huge fan of the the that like you

don't have to go out and get this huge

thing of your house you could get I got

one at Amazon for like 30 bus and he put

it on I accidentally turned it up super

high once and I was like I'm pretty sure

that probably a right or something

something I don't know but anyway the

point is like those are great too and

then like if you're traveling or

something those Perry bottles spray the

spray bottle you spray your cat with

totally fine to use on your butt yeah

well like when people train their cats

they like oh I know that that's cool I

don't have a cat but I just heard that

like if you're like no get off

that okay well or like if you're tra and

you don't want to bring the Parry bottle

like just those like wet wipes or

something like that kind of help I just

think it's so odd how much toilet paper

we is like like during coid when

everybody was buying all that toilet

paper I was like is everybody giving

themselves hemorrhoids at this point

like I wonder if there's a huge influx

IDs they didn't make it to the

office is true yeah yeah what I tell

people when when you talk about butt

stuff is I'm going to propose a toolkit

right and it and then you choose how

many things out of the toolkit you're

going to use in a different in a given

day in a given scenario right so like

you know oh I can't use a bedet because

my work doesn't have a bed I work in a

proctology office and I don't have a

bedet here so like I get it Google

probably doesn't have it I don't know

maybe Google does have a bday or apple

does I I've actually never been anywhere

that has one except for my

house yeah for things like I tell people

yeah you know you should take fiber you

know take your fiber supplement daily

take a laxative as needed yet don't take

a giant amount of Miralax and then go to

work that sounds incredibly

uncomfortable if you are a driver or

time it think about it fit it into your

day in a way that makes sense I can't

prescribe a agenda that's going to work

for everyone so you do have it does

actually take a little bit of work to

like know thyself Know Thy body and know

whether not when I give you fiber fiber

and mirax if you're G to poop on your

commute sorry no I yeah you shouldn't do

it with like a 10hour play right and

like just clog up the toilet no it's the

same I mean it really goes with

everything else it's like understanding

how to manage your symptoms and why and

you know if you're more susceptible to

them you start learning like what's in

your diet exercise pelvic Mobility hip

mobility breath work learning how to

relax your more there's different

stretches you can do for that like you

were saying spasming around the anus and

it's funny because when people come in

for PT sometimes they're referred by

their doctor and they're like I don't

know why I'm here I'm like oh okay like

I I get it because there's a lack of

information yeah and then they explain

all this and then they're like my gosh

that's crazy you know and the other

thing I'll see too is like when people

are really stressed out right and eating

really fast and not digestion digesting

so their body's in that fight or flight

so the digestion slows down and that all

starts in the M yep you know I think

people don't think about I mean I until

I was into public Flor I didn't think

about it I mean hard they took lunch

breaks I just swallowed they whole and

like why am I gloated and constipated

all the

time but yeah so that's

Funway all right

so

what what are some nod so we just talked

about some nod surgical things that into

it so say they do those things and you

know it's just not not getting better

one or some so they can come in and see

hypothetically fa they come see you yep

what are some in office procedures or

like what are some things that you could

prescribe for that next level sure so

I'll just give kind of like a a brief

overview of what it's like to come to a

proctology office and what I try and do

very much in my practice is make making

the appointment the most painful thing

right you finally decide like this I've

had enough so come to the office

obviously paperwork blah waiting room

looks like everyone else is waiting room

come to the office we meet we have some

like cursory chat what are your symptoms

just and almost everyone says like I

have a hemorrhoid I'm like what does

that mean to you so is it bleeding is it

itching is it redundant tissue and then

after we kind of get a sense of what

your symptoms are then I do an exam the

way I do an exam is first I look on the

outside so looking at the anal skin

looking for things like infection

collections which are pretty rare

usually if someone has a big sore in

there but they know about it they tell

me about it looking for things like

fissures which are small Cuts in the

anal Canal that can cause an extreme

amount of pain during bowel movements

those are I have to credit a dear

patient of mine who described it as like

pooping a pineapple right like real

spiky real sharp while having B

movements so I look for things like

fissures then I look at the caliber of

the external skin so is the external tag

is it part of the skin itself when I

retract or pull on it does it bring down

internal hemorrhoid tissue kind of

concerning for PRX are they all over

like circumferentially around the anal

opening or is it in one location versus

another is there a thrombos external

hemorrhoid which is a blood clot on the

outside in that skin those are extremely

painful and they look really tender and

then after that is a digital rectal

examination which is an examination with

the finger so finger in the bottom

feeling for any masses or irregularities

nodular ities changes in the mucosa

which is the tissue rinding the rectum I

always feel for muscles of the pelvic

floor to evaluate for tenderness there

or peen um and then I use a small scope

called an anoscope it's a just a couple

of inches long just a little bit bigger

than my finger and it has a side a side

slit that allows me to look at the

hemorrhoidal tissue itself everybody's

got some element of hemorrhoid tissue

some people have big bulky hemorrhoids

people who have big bulky hemorrhoids

who it doesn't bother them then it

doesn't bother me nothing to do but

they're like big bulky hemorrhoids and

they bleed big bulky hemorrhoids and

they fall out so for internal

hemorrhoids internal hemorrhoids without

a significant external component or an

extal component that doesn't bother you

you can do things in the office like

rubber band liation and essentially what

that is it's like if you put it like a

hair tie at the top of a like a plastic

bag right so the tissue there's tissue

on the outside and tissue underneath it

it cuts off the blood supply to the

extraneous tissue which then Falls off

with your poop in a couple of days most

people tolerate it really well women

tolerate it awesome because they

understand that you can bleed and have a

little bit of pelvic pressure and you're

not

dying my male patients take a little bit

more counseling yeah usually I'm I'm a

very conservative surgeon and so I

usually Place one and see how people do

I say go home hang out don't go like

don't write on your pelaton like don't

you know go on a family horseback ride

tomorrow but like pretty much other than

that you can do whatever you'd like if

that resolves the symptoms awesome not

usually the case usually it takes a

couple treatments for banding of

internal hemorrhoids then I have people

come back in about two weeks they say

yeah it really helped but didn't resolve

then we can place kind of two or three

more bands at that time to see if that

resolves the issue usually I give people

about two or three sessions to declare

themselves right if you have all of your

symptoms resolve at that time then we're

done if I find myself banding you into

Oblivion like you're coming in every few

weeks and it's still bleeding it's

that's just not working and we need to

start using another tool you talk about

the external or the excisional method

after this other therapies people do

infrared coagulation sclerotherapy in

the anal Canal hemorrhoid liation

there's a bunch of different other

strategies personally I think that

hemorrhoid banding is is easy well

tolerated done in the office and quick

so I use that as my in-office modality

now for externals I kind of include that

Under The Heading of anal

Landscaping changing the Topography of

your anal opening so for people who

don't really have acute hemorrhoid

issues but they have redundant external

anal skin either as a souvenir from a

prior hemorrhoid things like that so yes

you can excise these the risk is is that

the skin that grows back or the way that

it heals is not version 1.0 it's version

2.0 it looks different it feels

different it functions a little

different most people will tolerate it

well really well but if you make tags

you'll continue to make tags into the

future and so sometimes cos medically

you just have to make sure that you

understand that it may come back and

just may not be be different yeah your

your anus skin will look a little bit

different so those are in-office based

procedures so for people who have

substantial internal and external

hemorrhoid together so usually in three

columns um sometimes two columns are

more dominant or one column's more

dominant can expain column oh yeah so

column means the internal and external

component together so these are in lines

that run up the anal Canal from the

outside to the inside or inside to the

outside depending on your perspective so

for those people hemorrhoid exision is

kind of the the way to go and what that

is is going all the way to sleep in an

operating room lots of numbing

medication and then using a cery of some

sort to excise the tissue and put it in

the bucket some people sew the defect

closed some people leave it open what I

counsel patients is that it works great

right by the time you are recovered you

are no longer prolapsing prolapsing

internal hemorrhoids you're no longer

bleeding the external component is much

reduced sometimes you have to get some

detailing work later on but but it's

extremely painful I tell people take

four weeks off of work like that's a

long time I think people don't realize

how long that is you know and

cauterizing is basically just kind of

cutting off the blood flow cutting it

off with heat yeah it's so people that

is but yeah no I think that there is

this assumption that almost all of a

sudden you just need to go into surgery

immediately because they're embarrassed

or whatever like you're saying it's like

you can have a hemorrhoid and not have

symptoms and it's like this also with

like bashal prolapse too people somebody

can come in with a small prolapse and

have so many symptoms and I'll see

somebody with a pretty significant

relapse and didn't even know it was

there they just they found out because

of their OB or they just s symt or they

didn't have symptoms but we were maybe

their back pain didn't get better and we

were like okay well let's look at some

let's look at the P floor and see what's

going on there but yeah do do You' think

I just think silent farts are so funny

but they're so smelly because they're

literally silent but deadly what can

that c hemor if you're like secretly

farting all the time no Oh I thought

that was like

Wow stop it out

I don't think

so no it's just a it's just a tribute to

the extreme sensitivity of that

neuromuscular system I thought that's

where it was going my parents are GNA be

so proud of this you are literally a Ral

thet like what I think they I think they

like to think about the complex rectal

cancers that I'm curing with the robot

right I think they like to think about

that aspect of my job like

curing rectal cancer colon cancer big

abdominal surgery like healing people

with crohn's disease that's what they

like to think about not like did you

hear a podcast on on farts

and well yeah I mean you're doing all

those amazing things too and we can

definitely talk about that another

podcast if your family sarett um I was

just thinking more like a public floor

perspective which also you know I've had

people come in after rectal cancer and

do really well

in that you know just the inability

sometimes that that inability to kind of

know if you're about to poop or and you

don't know and so learning that it's the

bi feedback and just understanding hey

what's this New Sensation that I'm

feeling too it's a huge a huge part of

my practice it's the you know the sex

you make your parents proud is curing

cancer right but yeah the entire purpose

of of doing any medical intervention is

that people need to then go forth and

live their life not just be alive and

with people who have debilitating

proctologic symptoms they can't do that

right so people people who have feal

urgency can't go on a run with their

friends can't go to the movies like

can't go on a plane like that and it and

it's amazing how much people suffer with

that and then I do have another soap box

that I have to get on sure up we have

this cultural phenomenon of cleanliness

and godliness and so people truly feel

like deep amounts of shame that if

there's something wrong with my butthole

it must be related to me not being good

or clean or holy like all of these

things can like come into play and it

doesn't necessarily have to be conscious

but the amount of shame that people

carry with them that prevents them to

from coming to the office or seeking

care like

this I can help you with this this is

easy this is good we can take care of

this it has nothing to do with your

morality or your cleanliness or or you

know if you have leakage or seepage like

that is not about morality it's about

your biology and it's like giving you a

hard time but we can make that better

yeah exactly well because it's taboo to

talk about this stuff and especially for

women it's like

to be clean yeah oh my God supposed to

be right you're not supposed to poop

don't don't you're smell like Rosa uh

mine do but that's a separate

appointment yeah no I think that even

people coming in Republic or PT I

already know that there's something on

that's like especially with rectal

prolapse which is we can talk about

another side

basically you know when the rectum Falls

more into the vagina I also see people

say that you know they wi wi white and

then they're clean clean right it's

clean and then you know two hours later

they have boom Yep they're so

embarrassed I'm like okay first of all

everybody's had a Bo I'm sorry everybody

is shed at some point in their lives

like it is it just happens it's more and

the fiber helps with that if you have a

rectus seal if you have sticky poops

that get caught on your external

hemorrhoids the fiber really does help

with that and the cleanliness part yeah

just for a laundry sake yeah no I mean

and there is there's a lot of Shame

around it and it's almost like socially

acceptable for men to talk about it yeah

like I've always been a big talker about

the point where like my growing up in my

family prob every lady I'm like oh I

don't you're like I am am guess what I

have the biology to do this that's what

you poop too you poop too Everybody

Everybody Poops Everybody Poops but yeah

I mean and yes I want to make sure

everybody knows that you do more than

hemorrhoids right if you want to go

through all the the things that you do

treat just yeah so a colon and rectal

surgeon does surgical management of

diseases of the the true colon and the

rectum so from the right colon including

the appendix all the way over to the

sigmoid colon and the the rectum and the

anus and the anal opening so that

includes things like cancer inflammatory

vowel disease like Crohn's and

ulcerative colitis it includes things

like Diverticulitis and diverticular

surgery we do emergency surgery we do

elective surgery in we do comprehensive

management of rectal cancer working in

tumor boards to make sure people are

getting kind of the best guideline based

care in a disease that's incredibly

complicated we do the post-operative

management and surveillance so things

like looking at uh new Plumbing

connections that we make surgically

making sure there's no recurrence of

cancer or recurrence of disease and then

kind of what brings me on this podcast

is talking about you know what it you

know what is proctology like what are

the ways that your butthole can give you

frustrations and what's worth noting is

that a lot of people uh just say like oh

I have bleeding that's a hemorrhoid like

you got to get you got to get looked at

it's not normal to bleed from your butt

it's not normal to bleed from your butt

period it's not normal and so for people

who have ongoing bleeding you got to get

you got to have a conversation with your

medical provider you got to get a

colonoscopy got to make sure that you're

taking care of yourself so you can be

there to take care of your family uh

symptoms like rectal bleeding rectal

pain or all things that you know is it

probably a hemorrhoid yeah but in some

people it's not and I would hate for

your symptoms to be written off as just

a hemorrhoid when there's something else

that needs to be evaluated well I think

that that's also what it is I was

talking to a client earlier and she was

like oh my gosh I'm I have a hemorrhoid

and I'm so worried about it and and this

person I know they waited and then they

found out it was cancer and so I find

people jump to cancer all the time and

so what you know what is the biggest

distinguisher I mean om is obviously

people want to get it checked out in

general but and I what I see too

especially with like colon cancer

becoming much more up

your EXC me oh my

goodness much

more I know this is a little off topic

but it has to do with hemorrhoid and

anal Health basically and so if we're

not understanding this and just

embarrass to embarrassed to ask it's

like I mean this is what people you

people like you see every day doct like

you Insurgent so you have to be I I I

truly there is no one that I've given an

award to for surprising me yeah you I'm

not gonna say you can't surprise me you

certainly one of you out there could I

would be very excited to meet you but

really

like so much is normal yes you are you

are normal yes you are normal yes yes

because yes normal

and you know you might feel a little

embarrassed but you know if hopefully

hearing the way we're talking about this

is making it a little bit less taboo and

less scary I mean literally your Wi-Fi

password is starts with poop and so it's

like you have to have upun with it yes

yes and your problems are not unique we

just haven't done a great job of

branding right like like the appendix

great job appendix appendix team

congratulations gallbladder great job

everyone's like oo had to go the

hospital colitis G GBL her out like oh

you could say that you can say that yeah

during Thanksgiving and your grandma

would be like I also have a golf right

but but other problems that are so much

more common around things like

hemorrhoids anal pain fissures urgency

seepage Beal incontinence all those

things are far more common we're just

really bad at branding so well it's it's

literally digest so it's like we're more

open to talk about throwing up like oh I

vomited you know I got sick upet tummy

yeah versus like oh I have diarrhea you

know I honestly I I love it when

somebody is so open about like sorry

can't coming out I've got diarrhea I'm

like I am fully on board with you just

being so open about

that yes but yeah I mean it's it's

digestion and it's literally food you

just stay and you know hours ago and it

is just like peeing just out of your

butthole well you should similar out of

your mode if you're peeing out your

butthole I also would like to see you

yes but what I'm saying is like what

comes in comes out and it's in the form

of Po body yes and it's and it's biology

and it's great I mean it that's that's

how these body machines keep working I

think we were going to talk about how

like like who has a hemorrhoid and who

has cancer yes yes so

the the most honest way I can answer

that is come and get evaluated and you

can have hemorrhoids and cancer so if

you are a if you are a human and you

are an

adult colon and rectal cancer is

extremely rare outside of familial

syndromes in teenagers and young adults

that being said I have a patient panel

that includes people in their early 30s

with colon and rectal cancer and so if

you are bleeding you need to be

evaluated

usually how that goes if someone comes

to me with rectal bleeding we try some

conservative management right if I can

cure your hemorrhoids with fiber a day

and you come back and say I am no longer

bleeding and I'm 25 we can do a jumping

high five and you can go on your Merry

way but if you if I have not resolved

your bleeding with conservative

intervention right so try the fiber that

didn't help we do a band that didn't

work you you are on your way to

colonoscopy City so I can tell you with

certainty it's just your hemorrhoid

bleeding it is not an uncommon scenario

that people come to the office for what

they believe to be hemorrhoidal bleeding

and the colonoscopy says yes you do have

hemorrhoids and you also have a Cancer

and so that does need to be evaluated

too and um we're really good at working

with people to get get access to those

types of studies so all my colleagues

are very attentive to it you should not

be written off as just hemor bleeding if

we can't make your bleeding stop you

need a colonoscopy yeah and if you're

obviously if you're not in Austin and

you're being dismissed and you're like

something's wrong please find another

provider find some that will listen to

you I can't tell you even me being in

the medical field how many times I've

been kind of gaslit and just like oh

you're fine you're fine I'm like I'm not

you know and it's it's it's important

that we advocate for ourselves yeah no

this is kind of like a half lie right

where I'm me say no one's going to be

offended if you seek another opinion um

they are I feel like that's weird you

know I totally had hurt feelings when

people don't want to see me anymore but

at the same time I'm like a b like well

I mean that's human nature though it's

like it some some not everybody's gonna

get along with you not everyone's gonna

get along with me yes it it hurts but

it's also like obviously there was

something in me or or what they were

wanting was not what I was providing and

but the reality is ultimately they're

getting the care that they want and you

know yes and then the other thing is

screening screening screening coloral

cancer is identified on screening and so

our current guidelines as of 2021 if

you're 45 years old with no symptoms

please go get yourself screened get

yourself screened with a colonoscopy and

you know my obviously my procedur less

bias is that a colonoscopy is the way to

go I think the benefits certainly

outweigh the risks of the procedure

specifically with regards to polyps and

prevention of cancer into the future so

we can remove polyps at the time of

colonoscopy while not all polyps grew up

to become cancers almost all cancers

started out as polyps that's a a that is

different than doing something like a

colig guard or or a poop in the box or a

blood test or things like that that are

sometimes offered as equivalent gradings

yeah that's what I'm going to ask you

because I've heard people say like

there's this pill that you can take and

then they can you explain that the new

form of the poop in a box no isn't there

a pill that they're saying like rep not

replaces colonos was like kind of like

the first step of ping us oh like a pill

cam where you like swallow the camera

and then some poor soul has to look at

hours of video footage of your digestive

tract yeah yeah so pill cams great

definitely a rule for them the challenge

with that is you still have to take a

bowle preparation but you don't get the

MP okay so you have to do and again if

right and if there's something that you

so the next step for any of those tests

being abnormal or equivalent is a

colonoscopy so if you have find yourself

you know holding a positive colig guard

test in your hand you need a colonoscopy

if you got a CT urography right like oh

can I just like lay in the MRI scanner

and you guys like sure but if I see

something abnormal or equivocal you get

a colonoscopy and it can't see small

polyps and removing those can prevent

cancer in the future yeah I think people

think that M sometimes are like the Nel

like I mean there's so many images in

there talk so much about wrecked steel

yeah and it's just it's not the en all

you all no yeah not at all really kind

of just give you some ideas of what's

going on y we talk about

toolkits as like ways to kind of treat

medical problems but these are also

tools with specific functions for

diagnosing problems too

yeah what last question a little off

topic but you you hear more or at least

maybe it's just me but a lot of younger

men like in their third not a lot excuse

me but younger men in their 30s kind of

getting late stage colon cancer what

what do you think so the honest answer

is we don't know why young people are

getting more colon Ral cancer so you can

you can Google it and see a hundred

different hypotheses but the answer is I

don't know and that's why as far as

early onset disease so age less than 50

age less than 45 depending on what

guidelines you're looking at we have to

be listening you have to be listening to

people that come to your office you have

to be listening to your friends and

family you have to be willing to say

like hey bleeding at your bottom is not

normal and UNL and like you you got to

get that looked at it it's worth it's

worth the inconvenience of interacting

with the Medical Group to make sure that

you are healthy and safe we are losing

too many like beautiful young lives who

they have a role in their families in

their workplace in their friend groups

like because someone told you it was a

hemorrhoid because you didn't ever want

to say anything because you thought it

couldn't happen to you and like yeah I

mean what I would rather do negative

colonoscopies all day long and do

jumping high fives with you afterwards

and just be so proud that you saw it

care yeah deal with hemorrhoid stuff

later just make sure it's not anything

serious I I haven't told you this I'm a

cancer survivor myself I did not and so

basically I remember it was in 2019 I

had L those my colar around and end up

being hot chick I'm fine I'm good it's

been four years but the point was that

my first doctor kind of dismissed me and

then I went back again and it was kind

of dismissed and then I went to somebody

else was like I need this biopsy like I

need this biopsy and it was like as soon

as oh in the the initial scan missed it

somehow it was a golf ball size tumor

but my point is that I thought it was

stupid that I was getting it looked at

initially I thought it was dumb I I had

just started my business and I was like

this is a waste of $300 or whatever it

was why am I here yeah and please please

please just do it just get it checked

out and then it's just you know off your

bucket list of things should do and then

you don't have to worry about it because

I mean even just con that low grade fear

of worrying about it can take you know

can take a lot of stress on you too you

know so yeah props you for saving people

saving cancer saving people from cancer

or yeah yeah so any fun things that you

would like to add at the end here like

any stories or any I mean I'm sure what

is like the most common thing people ask

you when you tell them what you do oh

it's it's always what is the strangest

thing you've removed from someone's

rectum a

toothbrush the vibrating

ones oh oh okay okay nothing

else a dog Kong a what a dog Kong like

would you put peanut butter in and give

to your dog it's like shaped like a

pyramid oh I didn't even know that this

were a thing and anal intimacy can be an

important part in relationships but

please use designated toys with handles

or

flanges yeah and lots of blop and lots

of blop yeah the rectum is not

lubricated the way there vagina

in correct yeah yeah handles and blanes

please cool yeah yeah well thank you so

much for coming or I came here

so thank you for having me this is a if

if one person who's having bleeding gets

a colonoscopy because of our chat and if

one person who's been suffering with

what they thought was like Eternal

damnation of hemorrhoids gets it

evaluated pops a band on that sucker and

feels better my job son yeah yeah so

thankful that we were able to chat

you're so F thank you all right yeah you

guys are welcome to reach out to me if

you ever have questions um I'm

on I'm on Twitter you're on Twitter yeah

what's your Twitter handle cutting humor

I'll have to re like open it up but I

would or I can also tag where you're

working too yeah come and see me if

you're in Austin cool all right thank

sweet thank

you

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