Clearing the backlog
A recent interview done with Dr Denis Cheong. Featured in The New Paper on June 12, 2016.
How would you explain what you do at the dinner table?
It depends on the company. I often tell them we are tops in bottoms.
So you have to explore places where the sun doesn’t shine. Do colorectal surgeons use fingers to probe, or are there more advanced ways to do so?
The finger, though useful, is pretty limited, Digital examination is a basic technique, and the “educated” finger useful in assessing certain conditions like anal fistulas and rectal cancer.
But we have many other tools in our pockets. Many things can be diagnosed using fibre optic colonoscopy. Small polyps and tumours can be removed using the colonoscope.
Diagnostic imaging with CT scan, MRI or just plain abdominal Xrays can be helpful too.
For lesions that are beyond the reach of the scope, we resort to “Pill Camtechnology”.
This is where the patient swallows capsule with a tiny camera system that takes pictures of the inside of the bowel as the pill passes through the gastrointestinal tract.
The images are sent to a recording device worn by the patient, and the pictures are downloaded to a computer and examined.
What kinds of conditions do you see?
Most patients consult me for anal conditions like haemorrhoids or anal fistulas, colorectal cancer, and other cancers of the gastrolntestinal tract.
I also see a number of patients with peritoneal tears from child birth.
What’s the most common condition?
When should people come to see specialist like you?
Blood in the stools is a problem. Changes in bowel habits like sudden diarrhea or constipation, abdominal pain or discharge, or a lump around the anus are also common reasons.
When it comes to how bad can it get? Do you manually relieved patients who are severely constipated?
Bowel movements vary in different people, depending on their diet and fluid intake. Anything from three bowel movements a day to once in three days is “normal”.
But when you usually have one bowel movement a day, and you suddenly start having three, it would be a change that should be looked into.
There is a small group of unfortunate who suffer from severe constipation.
They can pass motion only once a week, and even then have to take laxatives. Where possible, we try to induce movement with medication.
In circumstances where there is faecal impaction of the rectum, it may be necessary o manually evacuate the faeces by inserting a finger and digging it out.
This is, of course, is most unpleasant for both patient and doctor, and to be avoided if possible.
When us laymen think of poop, we think of the smell. So does it smell bad in colorectal surgeries?
Most of the time, the smell isn’t a problem in colorectal surgery, unless the bowel is obstructed,
Are you blase when It comes to faecal matter now?
I’m not too bothered by the smell.
What is the most complicated case you’ve seen?
It is difficult to say, as cases are complicated for different reasons.
In some patients, pelvic cancer is extensive and cannot be easily moved. Others have so many medical problems that it makes surgery hazardous.
For example, had a patient who was on so many types of medications, including blood thinners, that her bleeding haemorrhoids were causing to heart failure.
Doing surgery would put her at risk.
Are there perks to your job then?
Of course. enjoy what I do, and is highly gratifying to help someone.