Finding The Right Balance w/ Dr. Eugene Trowers

Episode Information

August 19, 2020

Dr. Eugene Trowers talks about how younger people are increasingly getting colon cancer, the inner workings of the gastrointestinal system, and finding the right balance in life and the gut.

Topics Include:

• How seeing his uncle as a primary care physician led him to want to be a doctor
• How unique the doctor-patient relationship is and why it’s so important to recognize the other as a human being
• What goes into a diagnosis like heartburn and how to treat patients, starting with a complete patient history and then certain tests and labs (if necessary)
• How he’s seeing younger and younger patients present with colon cancer because of more screening due to family history instead of just treating more common ailments for younger people like hemorrhoids
• How research into the human genome is leading to more targeted personalized medicine
• His books: Gastrointestinal Physiology: A Clinical Approach, which is for healthcare providers to study the GI tract, and his second book Gut Feeling, which is geared towards patients
• How the gut has a “brain” of its own and can function without input from the brain to a certain extent
• How probiotics and fiber can help people have the appropriate mix of bacteria in the gut to produce healthy stools
• How he encourages patients to find credible online resources like Doctorpedia
• How it’s important to consider the “bio-psycho-social” aspects of a condition to treat patients in terms of biology, psychology, and society

Highlights

• “I also think that at the heart of the relationship is recognition that the patient is a human being in the final analysis. They’re not a collection of disease or some other type of descriptor. I think we should always keep that in mind because if we lose sight of that, if the person is merely either a client, so to speak, or a frequent flyer, if they come to the emergency room frequently – that’s not the way it should be perceived.”
• “One of the misperceptions, which may not be a dominant misperception but we do see it on occasion, is that some folks may believe that once they’ve been seen by a doctor that the doctor can either give them a pill to cure their illness or to take away their pain or discomfort. And that may not be the case.”
• “With the advent of being able to analyze the human genome, researchers are able to develop more personalized medicine, more targeted therapies, such that if a person – let’s say has a cancer that spreads – they can possibly utilize certain types of medicines or treatments based upon a person’s tumor genetic makeup, which may be more targeted and more effective. I think that type of more targeted personalized medicine is a great boon.”
• “In reference to colon polyps and/or colon cancer, I would hope that patients become more educated if we can get the word out through the media, through publications, etc. about the importance of being screened for precursors of colon cancer, such as adenomatous polyps.”
• “We are trying to educate patients about basic GI function, but then also our goal is to try to empower patients, so that with the knowledge that we’re extending to them, that they can then ask better questions, they’ll be better prepared to understand what their diagnosis might be, and better understand the course of treatment.”
• “Doctorpedia may have a reservoir of short video clips, which were prepared with the patient in mind. So, in other words, they’re kind of giving little mini-lectures or mini-talks, explaining either certain symptoms, conditions or tests such that the patient can go to the site site that is created in conjunction with reputable peer review experts, let’s say. And so folks are getting good information and they’re getting it in digestible chunks – if you don’t mind the pun.”
• “I try to have balance in my life. I enjoy working out. I enjoy listening to music, whether it’s anywhere from Prince to Pavarotti. And I enjoy reading and I especially enjoy reading non-fiction and I also enjoy writing.”

Relevant Links

• Constipation Website
• Hemorrhoids Website
• Ulcer Website

Episode Transcript

Daniel Lobell: (00:00)
This is Daniel Lobell for Doctorpedia and on the line with me, I have Dr. Eugene A. Trowers. How are you, Dr. Trowers?

Dr. Trowers: (00:10)
Well, I’m doing quite well. Daniel, how are you doing?

Daniel Lobell: (00:13)
Good. I’m excited to talk to you. There’s so much, so much to get into, but I think the first thing to do would be to have you introduce yourself to my listeners. Tell us (and I know obviously who you are and what you do), but tell the listeners in your own words.

Dr. Trowers: (00:29)
I’m Dr. Eugene Trowers. I’m a professor of medicine at the University of Arizona in Tucson and I serve as the Internal Medicine Residency Program Director at the University of Arizona – South Campus. I also serve as the Director of GI Services for the University of Arizona at the South campus.

Daniel Lobell: (00:54)
Do you ever meet a doctor who works in GI and his name is Joe. I’m always waiting to meet that guy.

Dr. Trowers: (01:01)
Not that I’m aware of.

Daniel Lobell: (01:03)
“Hey, I’m Dr. GI Joe.” What interested you so much about internal medicine? Why did you make that your focus?

Dr. Trowers: (01:14)
I think it goes way back in time. I had several uncles who were physicians and one of whom was actually a primary care physician. When I was younger, he would take me to his office and I got a chance to ride around in his car and so forth and it was very interesting to see some of the interactions that were taking place in the waiting room. And then also when the patients would leave, they usually came in and obviously they weren’t feeling well, they were under the weather, but in general when they left my uncle’s office, they seemed to be at least in better spirits. And so that kind of had an impression upon me. And so I think the idea of helping folks – even if you can’t cure them – is key. I find that my practice of internal medicine and gastroenterology allows me to help patients oftentimes, even if they can’t be cured. And I’m most interested in helping adult patients because I believe that’s where my proclivities lie.

Daniel Lobell: (02:31)
Well, I want to go back for a second to something you said – even if you can’t cure the person, you want to help them. As somebody who has always been on the receiving end of medical care, I know that one of the most helpful things is just seeing a doctor even before anything else. Just having that comfort of knowing that you’re going to someone who has some idea of what the heck is going on and they’re going to look into it for you – that right there is a huge relief to people.

Dr. Trowers: (03:01)
Sure, I would agree. I think that the doctor-patient relationship is a very unique one. And if you think about it, it’s a very unusual circumstance for an individual to literally tell you about their innermost secrets and especially in times of distress. And so I believe that, you know, that’s almost like a very – if you wanna use the word sacred – relationship, one that should not be taken for granted. But I also think that at the heart of the relationship is recognition that the patient is a human being in the final analysis. They’re not a collection of disease or some other type of descriptor. I think we should always keep that in mind because if we lose sight of that, if the person is merely either a client, so to speak, or a frequent flyer, if they come to the emergency room frequently – that’s not the way it should be perceived.

Daniel Lobell: (04:20)
Right, and do you have to remind yourself of that sometimes when you’re dealing with patients or at this point, is that second nature to you?

Dr. Trowers: (04:29)
Well, no. Sometimes you do have to remind yourself because again, when patients are ill, sometimes they’re not feeling well and they may be angry for a myriad of reasons. It could be that perhaps they lost their job or they’ve lost a loved one. They have copays that they may not be able to pay. There could be a number of reasons why a person is not feeling well and that may be manifest in their behavior. And so I think one has to constantly keep those things in mind.

Daniel Lobell: (05:08)
Right. I’m sure you’d probably have experiences where patients come in and they’re having a lousy day or like you said, they broke up with someone and they take it out on the doctor.

Dr. Trowers: (05:18)
Well, that’s entirely possible.

Daniel Lobell: (05:20)
Yeah. And going back to what you said about divulging these personal things, I mean, especially in your line of medicine – dealing with things like colon cancer screenings, you probably have people coming in in embarrassing situations.

Dr. Trowers: (05:37)
Exactly. You know, we may have folks who are coming in because their stool has changed color. Now usually talking about one’s stools or bowel movements is usually not considered cocktail party discussion topics. And so some of these things can be embarrassing or difficult for the patient to talk about. But as trained professionals in gastroenterology – the study of digestive disorders – we’re trained to not be dismayed by comments that are made by patients, but to try to focus on careful history taking and physical examination as well as analysis of tests to help ferret out what is actually the disease process that we’re dealing with and how can we best help the patient, if we can’t cure them?

Daniel Lobell: (06:33)
And when we talk about helping them, we talk about easing the pain, we’re talking about making the symptoms less so, or what? Put it in non-doctor terms.

Dr. Trowers: (06:41)
Sure. So let’s say if a patient complains of persistent heartburn, a burning sensation in the midline of the chest, which is oftentimes triggered by various things, whether it’s alcohol or taking certain types of medications or eating certain types of foods.

Daniel Lobell: (07:01)
…Getting certain bills in the mail.

Dr. Trowers: (07:03)
Sure. So if, if a patient, let’s say, is presented with those types of symptoms, then as a gastroenterologist, our task is to try to ferret out: “so what is the underlying cause?” All right? Now oftentimes this is due to a transient relaxation of this valve that’s at the bottom of the esophagus, the swallowing tube, and at the border between the esophagus and the stomach. And oftentimes this valve will relax on occasion, which will allow acid contents to move from the stomach up into the swallowing tube. Now, the swallowing tube runs the length of the chest, and so these patients may have significant heartburn and/or pain. And because of its location, one has to be very careful to make sure that we’re not dealing with a cardiac source of pain. Once we’ve determined that it’s not a cardiac source of pain, then we can proceed to further evaluate the patient for their symptoms and/or prescribe medications. Now, oftentimes we are able to help patients as well as cure them, but in a minority of cases, sometimes what we have to do is called palliative care. In other words, you’re trying to relieve symptoms or distress, but you cannot cure the underlying cause.

Daniel Lobell: (08:31)
Is that hard for you when you have to tell a patient that?

Dr. Trowers: (08:35)
Well, certainly. If you were to put yourself in the patient’s shoes and you’re having a significant problem and then you go see a specialist and then they tell you, well, here’s the circumstance, but it’s at a state that we cannot cure it. That obviously would be disheartening to anyone.

Daniel Lobell: (08:57)
Yeah. That valve that you were talking about – to me, that sounds like, it’s almost like a nightclub bouncer that fell asleep and all the riffraff is like coming in now. You know?

Dr. Trowers: (09:11)
I like that. That may be one way of looking at it.

Daniel Lobell: (09:13)
Yeah. Because, you know, the guard is down. And it’s amazing to me the intricacies of these little things that we don’t think about. In the body, you have all these little protective pieces and one of them – just one of them – just gets, as you put it “relaxed”, and everything can go awry.

Dr. Trowers: (09:33)
That’s correct.

Daniel Lobell: (09:35)
As a doctor, I guess I’m assuming part of your job is knowing all these, let’s call them “bouncers”, right? And knowing where they’re supposed to be, knowing where there’s supposed to be stationed and how alert they’re supposed to be. And that’s a lot of different things to juggle in your mind when someone comes in with a problem. So what’s your process of determining these things? Where do you start?

Dr. Trowers: (10:01)
I would say that we start with the history because oftentimes sitting down and talking with the patient and going through a complete history and review of their symptomatology is very key and oftentimes can lead you in the right direction to make a diagnosis. Now, once you’ve chatted with the patient and they give you the history or you may sometimes have to obtain the history from either a friend or a relative because the patient can’t communicate the symptoms to you directly. And it’s also important to review previous records if they’re available, if they’re not available to request them so that you could ultimately review them. So once you’ve obtained an appropriate history, then you should, in general, perform a directed physical exam. A directed physical exam would involve the region that you believe is the source or germane to the problem that the patient complains of. Now, once you’ve obtained an appropriate history and you’ve done a directed physical exam, then it may be appropriate depending on the circumstance, to order certain lab tests. Now, these can be basic blood tests. They may be certain types of imaging such as x-rays or CAT scans or MRIs, or they may be other serologic, you know, blood-based tests. It just depends. So the cornerstones of the assessment which can lead to appropriate management would be a directed history, physical exams, appropriate labs (if indicated), special labs (if indicated.) And then you can begin to approach an appropriate assessment of the problem and therefore come up with a differential diagnosis. In other words, which types of problems are more likely be the culprit. And then based upon that, you can consider your options and then pick one to further evaluate and treat.

Daniel Lobell: (12:27)
It’s interesting hearing the process, the behind the scenes. As a patient, it’s like anything else – you don’t see the chef in the kitchen, they just bring out the dish. So you don’t know how they got to that point where they’re telling you what to do. But to me it’s interesting. What are some of the misconceptions that people have about your specialty?

Dr. Trowers: (12:47)
Well, I think that one of the misperceptions, which may not be a dominant misperception but we do see it on occasion, is that some folks may believe that once they’ve been seen by a doctor that the doctor can either give them a pill to cure their illness or to take away their pain or discomfort. And that may not be the case. And so that’s why I point out that it’s very important to talk with the patient and effectively communicate with the patient. Try to give them some insight as to what’s going on and then how you can approach trying to figure out what the basic problem is and then also try to explain to them in terms which they can understand what the problem is and what their prognosis would be.

Daniel Lobell: (13:45)
I want to go back to the colon cancer screenings. I pick up little bits of information here and there, be it from the radio or from an article I’ll read, and I heard something recently that I’m going to ask you if you can verify this: that colon cancer is now becoming more common in people in their thirties. Is that correct?

Dr. Trowers: (14:04)
I would say yes. Based upon my experience, I’m seeing younger and younger individuals. I’ve seen at least two patients in the last several months who were in their thirties who had a cancer of the colon.

Daniel Lobell: (14:24)
Why do you think we’re seeing this change? Is it dietary? Is it environmental? What do you think is going on here?

Dr. Trowers: (14:33)
Well, I think that number one, because of the fact that we’re screening patients more than we were in the past. But, and then also, in preparation for those screening of certain patients, we naturally inquire about any family members, we’re able to pick off some family members who may be at an increased risk for developing colon polyps and/or colon cancer. But the other thing is that we’re also mindful of the fact that there is an increase in colon cancer in younger individuals. And so for example, let’s say in the past, if a person in their thirties – otherwise a young, healthy person – and they may not have a positive family history of early colon cancer. Let’s say we encounter this individual and the patient complains of let’s say seeing blood per rectum or you know, having rectal bleeding or some discomfort when you’re having bowel movements or maybe they complain of constipation. So, rather than merely telling the patient to increase fiber in their diet, increase hydration and so forth and then making an assumption that their symptoms are probably related to hemorrhoids, which is the much more common cause for rectal bleeding and the fact that cancer is somewhat unusual in a young person, to treat that person based on that type of an assessment may not be correct. And so I think what’s fortunate today is that we recognize that we have to at least perform a very focused history, physical, and in some instances, labs and/or special labs to assess the patient.

Daniel Lobell: (16:40)
So, it’s not a matter of making assumptions anymore. You just basically look at the symptoms and diagnose it without assumption in other words.

Dr. Trowers: (16:51)
Well, yes, I think that rather than jump to a conclusion that this is a benign circumstance, we have to try to consider a certain what we call “red flag signs” that would put a patient at increased risk. So if it’s significant rectal bleeding, is it unexplained anemia? Is it a significant weight loss, let’s say more than 10 pounds in a relatively short period of time without an otherwise explanation? Do we have evidence of family members who have had either colon cancer as first degree relatives (you know, mother, father and son, daughter, brother or sister, etc.) And so with that approach, I think we’re able to focus on individuals who are at a higher risk and then proceed appropriately.

Daniel Lobell: (17:50)
You mentioned a connection between colon polyps and colon cancer. What’s that connection?

Dr. Trowers: (17:57)
Okay, so we believe that the majority of colon cancers most likely began as a colon polyp, but a particular type of polyp which is referred to as an adenomatous polyp – in other words, is a certain type of proliferation of glandular cells. Okay. And so it’s the different variants of adenomatous polyp, given a period of time may develop into colon cancer. Now, the majority of adenomatous polyps are just considered, let’s say precancerous and of a benign origin. In other words, the majority of people who have adenomatous polyps will not develop colon cancer. However, in a minority of cases, some will and so that’s the whole point of colorectal cancer screening – that you are looking for adenomatous polyps and removing them if possible. Okay. Now there’s some other types of polyps which are benign and they have in general not an increased cancer risk. For example, a simple small hyperplastic polyp, you can think of is an extra number of cells which just generally reflect, let’s say the normal lining of the colon. Okay? And those do not in general lead to an increased risk of colon cancer. So it’s important if a patient has informed that after their colonoscopy, let’s say they were told that they have colon polyps – it is very important for the patient to understand what type of polyp? If they have a polyp which has some type of an adenomatous component, that would be considered a precancerous polyp. And it’s also important to determine whether there’s either a small focus of cancer in that type of polyp, that’s what I would say.

Daniel Lobell: (20:14)
Yeah. Are, are you seeing any new developments in technology when it comes to treating colon cancer? Is there anything that excites you on the horizon?

Dr. Trowers: (20:23)
Well, I think that with the advent of being able to analyze the human genome, researchers are able to develop more personalized medicine, more targeted therapies, such that if a person, let’s say has a cancer that spreads, they can possibly utilize certain types of medicines or treatments based upon a person’s tumor genetic makeup, which may be more targeted and more effective. And I think that type of more targeted personalized medicine is a great boon.

Daniel Lobell: (21:15)
Yeah. It’s like music. There’s like so many genres now. There’s something specific for everybody. Medicine is becoming specialized like that as well, huh?

Dr. Trowers: (21:24)
Correct.

Daniel Lobell: (21:26)
That’s funny – everything is becoming specific and less general in our society.

Dr. Trowers: (21:34)
Right. But that’s a great advantage because let’s say, from a historical perspective, you know, some of the medications and treatments in the case of let’s say colorectal cancer, which may have involved (depending on where it’s located, etc.) chemotherapy and/or radiation therapy, those types of treatments have certain adverse side effects and results in nausea, vomiting, etc.

Daniel Lobell: (22:05)
Like the commercials at the end of every commercial, where they tell you the adverse side effects. And it sounds worse than the thing – “nausea, vomiting, headaches, suicidal tendencies”. And at the end of it you’re like, “ah, I don’t even want to – I’m better off with the thing.”

Dr. Trowers: (22:18)
Right. And even the possible development of a different type of cancer, all of those things have to be taken into consideration. And so if you can direct your therapy to the person’s genome or the genetic makeup of a given tumor, and if you can then use agents which are more effective and which also have lesser side effects, then that’s really a great service to the patient.

Daniel Lobell: (22:47)
What do you wish your patients knew? Is there anything that you’re like slapping your forehead? “Gosh, how do these people not know this when they come into my office”?

Dr. Trowers: (22:58)
Well, I think, I would say in reference to colon polyps and/or colon cancer, I would hope that patients become more educated if we can get the word out through the media, through publications, etc. about the importance of being screened for precursors of colon cancer, such as adenomatous polyps, etc. That’s what I wish folks had a better understanding because some folks may believe that the mere fact that one of their relatives had cancer, therefore they could have cancer. That may be true, but not in all cases. But to understand that a person who may not have had any family member with colon cancer could develop a polyp and then ultimately develop cancer. A lot of folks may not be aware of that. And I think we need to do a better job as healthcare practitioners to get that word out.

Daniel Lobell: (24:02)
Hopefully we’re doing that now. I mean that is exactly what you’re talking about is using new media and that’s what we’re doing. I had no idea until you told me that just a minute ago that that was a connection. So I think even if one person gets helped by this, we’re doing some great work here.

Dr. Trowers: (24:19)
That’s true.

Daniel Lobell: (24:20)
What do you think is the main message of your books and of your research? If you have to narrow it down to one message, what would you say it is?

Dr. Trowers: (24:29)
Okay. Well, the first book that I’ve co-authored with Dr. Mark Tischler was a book entitled Gastrointestinal Physiology: A Clinical Approach. And basically–

Daniel Lobell: (24:44)
–that doesn’t sound like a light read…

Dr. Trowers: (24:47)
Right. So basically it was geared for healthcare providers who have studied how the GI tract works. In other words: what’s its physiology? What is its mechanism of action? So physicians who have had those types of courses and training and who now are in the process of starting to see patients, then we would want them to understand basic physiologic or functional principles so that they can better treat patients with underlying disorders. Now the second book that I’m working on with Karen Spear-Ellinwood, is entitled Gut Feeling. And basically, this is a book geared for patients. And basically what we’re trying to do, we’re trying to empower patients such that when they have an interaction with a gastroenterologist or their primary care physician, that they have a basic understanding of how their gastrointestinal system works in health and to a certain degree in disease. All right? So basically we are trying to educate patients about basic GI function, but then also our goal is to try to empower patients, so that with the knowledge that we’re extending to them, that they can then ask better questions, they’ll be better prepared to understand what their diagnosis might be, and better understand the course of treatment.

Daniel Lobell: (26:31)
Right, so it’s about being ahead of the curve.

Dr. Trowers: (26:34)
Yeah.

Daniel Lobell: (26:36)
I like it. I’ve heard people say the gut is the second brain. Is that something you’ve heard?

Dr. Trowers: (26:45)
Well, I mean the gut has a brain of its own. It can function without (to a certain extent) without certain types of input from the brain.

Daniel Lobell: (26:57)
Really?

Dr. Trowers: (26:59)
Yeah. Yeah.

Daniel Lobell: (27:01)
So tell me about, if the gut is a brain, what kind of brain is it? Compare it…

Dr. Trowers: (27:08)
Yeah. So basically, the gut, if you think of it as a hollow tube, but within the wall it has nerves which transmit certain types of impulses, you can think of them in an analogous fashion of nervous type, or electrical type impulses – although it’s not exactly that. Under certain circumstances, the gut will respond to certain impulses such that the gut will either contract or relax and you could have circumstances where a certain portion of the bowel – let’s say the nerves that are running from the spinal cord are severed – but yet the bowel can still function to a certain extent. And so, you know, that’s kind of what we’re talking about

Daniel Lobell: (28:03)
When we’re talking about cleaning out your gutters or cleaning out your gut, I hear people say things like, drink kombucha or probiotics, is there any validity to that? From a medical point of view, if I drink a bunch of kombuchas, is my gut going to be in any better shape than before?

Dr. Trowers: (28:26)
Well, I would say this. You have certain types of bacteria in your colon, let’s say, your large intestine, and those bacteria are very important to maintaining appropriate fluid balance in your colon. Basically, what that means: if you have an excess of water in your large intestine, naturally when you have a bowel movement and expel the content, the contents will be watery, such that it’ll manifest itself as diarrhea. Conversely, if the water that’s in your intestinal gut, you know, your bowel, if that water gets absorbed from the intestine and let’s say it gets absorbed from the intestine into the bloodstream. So now you’re removing water from the colon. So therefore your stools will become less liquidy. They’ll become firmer and that can contribute to constipation. You’d have more of a rock hard stool, which is difficult to pass.

Daniel Lobell: (29:44)
So how do you find that perfect balance?

Dr. Trowers: (29:47)
Well, so again, you need to have the appropriate mix of bacteria in the gut to help maintain a good water balance. We’ve found a specific type of bacteria called the bifido species, which is very important and you find that in certain types of probiotics. But then also having an appropriate amount of fiber in your intestine in general is a good idea because the fiber affects water balance. So oftentimes what it’ll do, it’ll attract water into your intestine to keep the stools from becoming rock hard so that your bowels, your stools rather, have a more normal consistency or concentration of fluid within the feces. And so when you expel the feces, they have more of a normal shape, a normal consistency and not diarrheal or watery-like.

Daniel Lobell: (30:55)
I’m going to shift gears with you here for a second. You know, we’re doing this interview for Doctorpedia, which is an online platform. And I wanted to talk to you a little bit about the online health space. Do you encourage or discourage patients to look online for information? Where do you stand on all this?

Dr. Trowers: (31:12)
Well, naturally, I encourage patients to become better informed. Oftentimes, you know, one can go to the internet and obtain a lot of information. What I think is most important is that patients go to reputable, peer-reviewed (where appropriate) sites to get information, which is not quackery or scientific.

Daniel Lobell: (31:43)
Oh yeah, I’ve been there – sorry to interrupt – where you have some symptom and you jump on there and two minutes later you think you’re dying, you know?

Dr. Trowers: (31:54)
Exactly. And so I think that, you know, certain reputable sites are a good source of information for patients. In fact, depending on the circumstance, I oftentimes may encourage patients to get more information about certain things, whether it’s their condition, whether it’s certain types of dietary considerations, from an appropriate peer-reviewed site on the Internet.

Daniel Lobell: (32:25)
So let’s talk about Doctorpedia specifically. What do you think they can do to assist the online health space?

Dr. Trowers: (32:31)
Well, I think based upon my experience with Doctorpedia, you know, oftentimes adult patients (let’s say) are interested in learning about a condition. So as I understand it, Doctorpedia may have a reservoir of short video clips, which were prepared with the patient in mind. So, in other words, they’re kind of giving little mini-lectures or mini-talks, explaining either certain symptoms, conditions or tests such that the patient can go to the site site that is created in conjunction with reputable peer review experts, let’s say. And so folks are getting good information and they’re getting it in digestible chunks – if you don’t mind the pun.

Daniel Lobell: (33:30)
[laughs] Everything is digestible with you, yeah.

Dr. Trowers: (33:33)
And so if you consider that the adult attention span is probably a lot shorter than most people would appreciate, having two or three minute video clips I think is an excellent idea and a great way to dispense, so to speak, important knowledge.

Daniel Lobell: (33:55)
Hopefully we’ll have our videos on Doctorpedia loaded with intellectual fiber and probiotics so people can absorb them. Right?

Dr. Trowers: (34:05)
Okay.

Daniel Lobell: (34:05)
All right. Dr. Trowers – it’s been a pleasure talking with you here today. Very informative. Very interesting. You know, you’d be surprised how few conversations one finds themselves having outside of the health space about the colon and it’s a refreshing and interesting change of pace for me.

Dr. Trowers: (34:30)
Well, thank you. I enjoyed it.

Daniel Lobell: (34:32)
Let’s leave off with this. Do you have any general health or wellness advice and what do you do to stay healthy?

Dr. Trowers: (34:39)
Okay, well, I think that when you consider patients and patients’ care, I think what’s important is to consider what we call (it’s somewhat fancy term) the bio-psycho-social aspects of a condition.

Daniel Lobell: (35:01)
That is fancy.

Dr. Trowers: (35:01)
First component – the bio. The biology of the problem. In other words, as we talked about earlier, if the patient presents with heartburn, the understanding of that weakening of the muscular valve that separates the stomach from the upper port, from the esophagus (swallowing tube) if you understand that biology in its normal function and then derangement, then you really need to have a good handle on that if you’re going to try to help someone with that problem. As far as the psychological aspects? Well, in the case of reflux or heartburn, sometimes stress, anxiety, and other social habits can have an impact on the symptoms that the patient has. So you need to understand that in order to try to help the patient. Okay? And then, as far as you know social – you have to have an understanding from a societal aspect. Let’s say the patient doesn’t have healthcare coverage or insurance. Well that may significantly impact their ability to obtain certain types of prescriptive medicine to help them. And so you have to have some understanding of that because that may shape your approach as to try to prescribe medicines or treatments to help the patient. In other words, in summary, you can come up with the greatest ideas and maybe your thought would be to use the latest, newest medication, etc. but–

Daniel Lobell: (36:57)
–If the patient doesn’t have the means, then there’s no point?

Dr. Trowers: (37:00)
That’s right. That’s right. That’s right. And so you have to consider all of those bio, psycho, social aspects if you truly want to help the patient.

Daniel Lobell: (37:10)
Fascinating. And to the second part of my question, what do you do to stay healthy?

Dr. Trowers: (37:15)
Well, I try to take some of my own advice. I try to have balance in my life. I enjoy working out. I enjoy listening to music, whether it’s anywhere from Prince to Pavarotti. And I enjoy reading and I especially enjoy reading non-fiction and I also enjoy writing.

Daniel Lobell: (37:40)
It’s a good mix of things to do. Maybe you could even do them all together. You could go on a treadmill, listen to some Prince/Pavarotti mashups while writing a book and you can pack them all in one point. That’d be funny if I go, what do you do to stay healthy? And you go, [coughs] what? Dr. Trowers, thank you so much for your wisdom and advice and I would encourage folks to find more from you on Doctorpedia and wherever available. Where can people get your books?

Dr. Trowers: (38:14)
Well, I would say that you can go online, and in particular, Amazon, Barnes and Noble, etc.

Daniel Lobell: (38:21)
All right, well, thank you very much.

Dr. Trowers: (38:24)
Thank you!

Daniel Lobell: (38:24)
And from Doctorpedia: stay healthy.

Dr. Trowers: (38:29)
Thanks again, Daniel. Have a great weekend!