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- [00:11]
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Welcome to the Therapy for Black Girls Podcast, a weekly conversation about mental health, personal development and all the small decisions we can make to become the best possible versions of ourselves. I'm your host, Dr. Joy Hardin Bradford, a licensed psychologist in Atlanta, Georgia. For more or to find a therapist in your area, visit our website@therapyforblackgirls.com while I hope you love listening to and learning from the podcast, it is not meant to be a substitute for a relationship with a licensed mental health professional. Hey y', all, thanks so much for joining me for session 464 of the therapy for Black Girls Podcast. We'll get right into our conversation after a word from our sponsors.
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This is an I Heart podcast.
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Guaranteed Human have you heard of the Lip Bar? It's a Black owned beauty brand with products that are really easy to wear and just fit into your routine. They have everything from complexion to lip and it's the kind of makeup you can put on during the day and still feel good about if you're heading out later. Their non stop Liquid Matte in the Shade Boss lady has been a longtime favorite of mine and is a red I think every black woman should have in her collection. When you wear the Lip Bar, it will do what it needs to do. You can find the Lip Bar at retailers nationwide or on thelipbar.com and use the promo code TFBG for a 20% discount. The Trump administration and its backers in Congress are messing around with their healthcare. They already passed a law defunding Planned Parenthood that blocks Medicaid patients from getting life saving care like cancer screenings, wellness exams, birth control, STI treatment and more. And now these lawmakers want to shut down health centers by defunding Planned Parenthood permanently. Our communities deserve better. To learn how you can get involved, Text update to 22422 mom, can I have Lingokids?
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Dad? Lingokids, please. When did we become the Lingokids House? No idea. Last week it was Dinosaurs.
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A
This week it's Lingo Kids.
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B
Why Lingokids? Because it's the best thing ever. We can play games with astronauts, wild animals and superheroes. With more than 4,000 interactive games, songs and shows, LingoKids is the number one
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entertainment platform for young kids.
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So no Dinosaurs and dinosaurs.
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Lingokids.
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Everything kids love. Download it for free.
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Ready or not, here they come. The new generation of leaders is in the making. And these girls are already strong, smart and bold. Girls, Inc. Is the leading expert on girls and they're dedicated to helping them develop their inherent strengths and abilities uncover new ones and tell the world about their potential. No matter what path she chooses or dreams she has, Girls, Inc. Equips each girl with experiences, skills and confidence to succeed whether you're ready for them or not. Visit girlsinc.org. When was the last time you really thought about your colon health? For many of us, conversations about digestion, gut health and colorectal cancer can feel uncomfortable or easy to put off. But the reality is that colorectal cancer rates are rising among younger adults and Black communities continue to face significant disparities when it comes to diagnosis, treatment and outcomes. So today I'm joined by gastroenterologist and health advocate Dr. Sophia Balzoro and to talk about what we all need to know about colon health. Dr. Balzora helps break down what the colon actually does, the warning signs we shouldn't ignore, and why early screenings can be life saving. We also discussed the unique ways colon cancer impacts Black women, how stress and diet can affect gut health, and the importance of advocating for yourself in medical spaces when something doesn't feel right. If something resonates with you while enjoying our conversation, please share with us on social media using the hashtag tbginsession or join us over in Patreon to talk more about the episode. You can join us at Community therapy for black girls.com here's our conversation. Well, thank you so much for joining us today, Dr. Valdora.
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B
Of course. It's my pleasure. Thank you for having me.
- [04:34]
A
So for those who may not be familiar, can you tell us what a gastroenterologist and a hepatologist actually do?
- [04:41]
B
Oh, definitely. A gastroenterologist is a digestive disease doctor. So basically we deal with all diseases from the mouth to the anus. So if you're having belly pain, if you're having reflux symptoms or heartburn, if you're having diarrhea, constipation, you name it, blood in the stool, that's what we're here for. Even low blood counts can involve digestive disease docs and then a hepatologist is a section of like what we think about more generally as gastroenterology and they deal specifically with liver issues. So if people have abnormal liver tests or cirrhosis, hepatitis B, hepatitis C, autoimmune diseases that affect the liver, those are all encompass saying and that's what pathologists do. So there are some gastroenterologists who do some liver stuff and some hepatologists or liver doctors who do some GI stuff. When we think about those disease entities like those are like What I just mentioned were, like, the more specific nuances.
- [05:34]
A
And I'm always really interested in hearing from physicians how you actually chose your specialty.
- [05:40]
B
That's a great question. I'll say that in the exam room, that question comes up because, you know, I deal with butts and guts. So admittedly, I do deal with, like, the nether regions and areas that people can be a little bit ick about, which is part of why I'm here, to demystify that. Right. And destigmatize that there aren't that many women in the field. Right. There are more now than there were when I trained. You know, it's still under 25%. So that, to be honest, that drew me to the field. And then by extension, obviously, there's much fewer black women in gastroenterology compared to other specialties. So I think that that coupled with fact, I like to use my hands. I love doing procedures. It's definitely a highlight of my work. And then I think the culture of the field and the people who were attracted to it and the disease states, like, all of those things really landed me into a field of gi so.
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A
And I know that there is so much that we can talk about because your field covers so much, but specifically today, we want to talk about colorectal cancer. So can you tell us about this cancer and what it is and how it presents?
- [06:45]
B
Absolutely. So, unfortunately, colorectal cancer is incredibly common, and it is a cancer that affects the large intestine. So when we talk about colon, that's synonymous with large intestine. So when you think about the body, the mouth, you have the food pipe or the esophagus, you have the stomach, there's the small intestine, and then there's the large intestine. So when we talk about colorectal cancer, we're talking about cancers of the large intestine. And then when we talk about the rectum, that's just the very last part of the large intestine before the anus.
- [07:14]
A
And you mentioned that it is fairly common, and it does feel like we are hearing more about it recently, or at least I am. Right. Like, it could just be because more people are talking about it social media. But is it something that has increased in diagnosis in the past maybe three to five years? And can you talk about, like, why it is such a common cancer?
- [07:34]
B
Yeah, absolutely. So, I mean, when you think about men and women combined, it is up there in terms of cancer deaths, unfortunately, and is also quite common in terms of diagnoses. When you think about men and women combined, the second most common cancer killer. And America, unfortunately, has now creeped up to the first or to the most common cancer killer in those under the age of 50. So, you know, it's gaining a lot of traction because we're seeing so many young people being diagnosed with colorectal cancer and unfortunately dying from it. So it's definitely more than something that's just like an anecdote or a story. Like, this is a phenomenon that we're seeing in the literature time and time again, and it's becoming increasingly obvious that no one is immune to it, which is definitely one of the points I want to get across today. Everyone is at risk for colorectal cancer. Unfortunately, there are some that are at even increased risk. And we'll talk a little bit about that. And in terms of why that's happening, there's so many different proposed reasons. A lot of things, a lot of medical problems. It's usually not just one thing. It's a combination of different factors, many of which we can change the tide on. I think the more aware we become about them, the more we can do something about them and perhaps decrease the rates over time. But it's incredibly sad to see because when we look at the older folks, colorectal cancer is always thought of a, like an old person disease, right? Until recently. And thankfully those rates are lowering in folks who are over 65. But this, this trend that we're seeing of people under the age 55 being diagnosed is incredible. It's one in five new diagnoses of colorectal cancer that are happening in people under the age of 55, which is shocking.
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A
And can you talk about, like, some of the. Of course there's not one thing, but what are some of the factors in the field talking about as people talking about influencing the increase in rates?
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B
That's a, that's a good question. So. So we're seeing this big block of folks, like this whole generation of people who are being diagnosed. We're thinking about people who are like Gen Xers and millennials, essentially, right? So like those born, like, after 1950, people who are, are mostly like, in their 40s and 50s who are being diagnosed. We're thinking about exposures, right? We're thinking about, like, what are people's diet and lifestyle habits? What are the things in our everyday life that are making things much more convenient for us but maybe harming us. There's talk about, like, microplastics, and there's talk about the microbiome, which is basically like when you think about the composition of bacteria in your gut, what impact is that having on your health? What type of exposures did you have in utero, Right? Like, so before you were even. You were even born, like, what kind of exposures did your mother have, the person who birthed you? So all of those things are what's really being looked at. And we think about things like the obesity epidemic. It's not to say that everyone who gets colorectal cancer at a young age is obese, but there are definitely, because it's affecting this large group of people born at a certain age, which we call the, quote, unquote, birth cohort effect. Then we have to think about what exposures did this age group have environmentally that has led to this. This increase in colorectal cancer?
- [10:40]
A
And of course, as therapy for black girls, we definitely want to hone in on the ways that this is impacting the black even more drastically. Right? And so Black Americans are 15% more likely to be diagnosed with colorectal cancer, but 35% more likely to die from it. So can you talk a little bit more about that gap and, like, why, you know, this is impacting the black community in this way?
- [11:02]
B
Yeah, absolutely. And I think it's important to focus on the fact that this is not like just the simple fact of genetics, right. Or family history. Like, there's a lot of systemic factors that are impacting why we're seeing these differences. And we talk about systemic factors, that means things that are in our environment, right? Where we grow up, where we pray, where we go to school, where we work, all of these factors are contributing access to care. All these factors are contributing to the different rates that we're seeing. So, yeah, we oftentimes quote that, unfortunately, black people are about 20% more likely to get colorectal cancer, about 40% more likely to die from it, from their white counterparts. What does that do to. Number one, we can think about screening rates, right? So though black people don't have the lowest rates of screening, they're not as high as we want them to be. And so when we talk about screening, we're talking about when people have no symptoms whatsoever, they go to the doctor, they get screened for colorectal cancer or cancer of the large intestine, even without symptoms. Because it's important to realize that for colorectal cancer, especially in its earliest stages, people have no symptoms whatsoever. So that's why screening is so important. Right. We think about people even being referred to get a colorectal cancer screening. So sometimes there Is that barrier there? Is your primary care provider recommending a colonoscopy at the appropriate age? And that age is 45, by the way, if you are average risk. And we'll definitely hone in on that and mention that over and over again. So we remember that by the end of our time together. But we have to think about the people that our communities are seeing to get the care they need. Are they being referred at the right age?
- [12:35]
A
Right.
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B
So that's important too. Family history. We know that unfortunately colorectal cancer does run in families. And so it's, it's important not to keep those issues, those medical problems that people don't want to talk about inside and not discuss it with their family. Because if you do have colorectal cancer in the family, you actually have to get screened earlier than 45. So that's important too. A lot of it is about having conversations, bringing the awareness to the forefront, knowing what your family history is, knowing when you should be screened, knowing the different options you have for screening. All of those sorts of things are really important. And then things that you can do for yourself when you think about your dietary choices, thinking about being more active, thinking about not smoking, limiting how much alcohol you consume, and getting screened at the appropriate time can all be really helpful.
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A
So you mentioned the screening and I definitely want to spend some time there. So the colonoscopy I think is probably the most common way, or at least that I know about in terms of screening. What are the other screening procedures that can happen besides a colonoscopy?
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B
That's a good question, because I think that colonoscopy is one that's most often talked about, especially in the US that's oftentimes what's most recommended as the best test. And I'll say that for people who are average risk, meaning they have no increase factors either in their family history or their personal medical history that would predispose them to earlier onset colorectal cancer, meaning they would get it earlier than the average individual. So people who are considered average risk, they have a lot of different options available to them. Colonoscopy, which is a procedure that's done under sedation, which means that you're nice and comfortable. It's not general anesthesia, there's not a machine breathing for you. You get medication through the vein to make you nice, sleepy, comfortable. People say it's the best sleep they've ever had. And for about 20, 25 minutes, I'm in there with a camera and I'm looking inside your large Intestine, you don't feel a thing, you wake up, it's like I was never there. But I'm able to find small growths that we call polyps and remove them before they become colorectal cancer. So for that reason, the colonoscopy is considered the preferred test because you're really preventing colorectal cancer. Like you're taking out a growth that could otherwise lead to cancer in the future. The barriers to that exam, or I think what makes people fearful of it or people may shy away from it, is because it is under sedation and some people are admittedly afraid to get sedated. We take all of the measures that we need to keep you safe. Of course, the preparation, which I think it's the worst wrap, right? That's what the colonoscopy is notorious for. And that is basically something you have to do the evening before the procedure where you drink a medication that's essentially a laxative. So it makes you go to the bathroom. There's no like mincing words there. That's what's going to happen. Because we need to see, right? We're looking for things that are millimeters in size. I'm talking like literally this big. And in order to do that, the colon needs to be clean of stool. And the last thing I think is bringing an escort. So you do have to have somebody along with you, right? You have to have a trusted adult, so someone over the age of 18 to leave with you because you will have received the medication to make you sleepy. So when we think about different communities who may have barriers to those things, right? Either the time that they have to be at work, it's hard to find an escort, right? Or they're the caregiver for someone else. They have to take time off of work, right, to be sedated. Those things are real. That's reality. And I know that that can be really difficult for people. But thankfully, if you're average risk, you have other options available. So there are some, what we call non invasive screening, which means that it doesn't involve a procedure. One is pooping in a box, which I'm sure a lot of people have heard of before. And that's a stool DNA based test, which means that they take a little bit of your stool. And what they're looking for is hidden blood, like so blood you don't see with the naked eye in the toilet bowl or mixed with the stool. And they're looking for abnormal cel of the lining of the large intestine that might signal a cancer or a very large growth that can become cancer if it's not taken out of your colon. So that's a really attractive option. You know that you don't have to miss school, right? You don't have to miss work. You can do it in the comfort of your own home and then you send it in and you get a result back. If the test is positive, next step is a colonoscopy, right? So it's not a one and done. The test is positive, you need to get a colonoscopy that's like the full screening. If the test is negative, you repeat it in three years. Another non invasive test just looks for hidden stool, it doesn't look for abnormal cells. And that's been around for quite some time. And the same theme, if it's positive, next step is a colonoscopy. It's negative. You repeat it in the appropriate time frame, which is usually a year. And then the last test I'll mention is a what we call a virtual colonoscopy which is like a CAT scan, special type of CAT scan. You still have to drink the preparation but it's not invasive. They able to take pictures of your belly, pictures of your abdomen and look for any abnormal growths. And if it's a positive test then you have to get a colonoscopy. So the important caveat is that for these non invasive tests, like all the tests that are not colonoscopy, if they are positive, the next step is a colonoscopy. So that's an important understanding and conversation you have to have with somebody if they choose not to get a colonoscopy. Which is fine if their average risk is, but with the understanding that there is another step involved.
- [17:41]
A
More from our conversation after the break. Have you heard of the lip bar? It's a black owned beauty brand with products that are really easy to wear and just fit into your routine. They have everything from complexion to lip and it's the kind of makeup you can put on during the day and still feel good about if you're heading out later. Their non stop liquid matte in the shade Boss lady has been a long time favorite of mine. And as a red I think every black woman should have in her collection. When you wear the lip bar, it will do what it needs to do. You can find the lip bar at retailers nationwide or on thelipbar.com and use the promo code TFBG for a 20% discount. Every parent should know the car ride soundtrack. Are we there yet? How much longer I'm bored. If you're taking an extensive car ride anywhere and you've downloaded the Lingokids app prior to leaving the house, you may experience something strange. You may experience silence from the backseat. Your kid may go an entire car ride without asking once if they were there yet. And by chance of a miracle, they may even ask if you could drive longer. That's the magic in lingokids. Over 4000 interactive games, songs and shows, including their favorite Disney characters that kids get completely hooked on. It turns the longest drives into the easiest ones, and honestly, you won't understand why you didn't download it sooner. Lingokids is the number one entertainment platform for young kids, and it's free to Download or go. Plus, with a LingoKids subscription and unlock even more content your kids won't be able to get enough of, you can save up to 60% on the yearly plan, search lingokids in the app Store or Google Play. Everything Kids Love Ready or not, here they come. The new generation of leaders is in the making, and these girls are already strong, smart and bold. Girls Inc. Is the leading expert on girls, and they're dedicated to helping them develop their inherent strengths and abilities, uncover new ones, and tell the world about their potential. No matter what path she chooses or dreams she has, Girls Inc. Equips each girl with experiences, skills and confidence to succeed, whether you're ready for them or not. Visit girlsinc.org these days, most things cost an arm and a leg, especially vacations. But not in Rhode Island. Between affordable luxury stays, succulent seafood right from the source, and spectacular shopping that won't break the bank, you get a real bang for your buck in the Ocean State. The memories will be priceless, but the cost will be a lot less. Rhode island, all that. Plan your trip today@visitroadisland.com that's visitroadisland.com. So for the more non invasive procedures that you talked about, when might those be suggested? Like if it's before the age of 45, like under what circumstances would those be suggested versus a colonoscopy?
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B
It's still the same age actually, if your average risk Screening starts at 45, regardless of the modality. So regardless of what you end up choosing, 45 is the year if you have blood in your stool, right? If you have blood in your poop. And when I say that, that means blood when you wipe. So blood on the toilet paper, blood mixed with your stool, blood in the toilet bowl, all of those things, we consider that blood from the intestine So I want to make clear that. And so what I've heard from a lot of patients is oh, the blood was bright red or it was just on the toilet paper. That doesn't mean that it's normal. Like we can't be in denial. I think that's human nature, right? For us to be in denial. But blood anywhere from your bottom is never normal. It doesn't always mean colorectal cancer, but it's never normal. So if you have blood in your stool, if you have belly pain that you can't explain, right? Not just a one off, but something that's like it keeps happening and you're just trying to figure out why. If you're losing weight without trying, if you were three time a dayer and now you're like at three times a week or, or the opposite is occurring. So like there's a change in how often you're going or what it looks like when you poop, like if the consistency has changed or if you're anemic, which means your blood counts are low or your iron is low, Any of those things. We take the non invasive tests off the list, right? Because at that point you're having symptoms. It's no longer a screening exam. The appropriate exam is a colonoscopy. A colonoscopy can happen at a age, right? Sometimes people are like, I'm too young for colonoscopy. There's never an age where colonoscopy is 100% off the table. There are some situations where it might be a discussion and you see if it's right for you. But those types of symptoms, it's really not appropriate to get a non invasive test. You need a more thorough look.
- [22:17]
A
Got it. And is there any concern with false negatives with the non invasives? Well, you may do like the more non invasive one and then it's like, oh, actually you probably should have actually had the colonoscopy.
- [22:29]
B
That's a really good question. No test is 100%. No test is 100. So just like there are false positives, meaning that the test is positive, you do the colonoscopy, you don't find anything. False negatives do exist too and that that happens. So it's really important to choose the right test for you and the one that gets done properly and completely. I'll say that with colonoscopy, the likelihood of a false, a false negative test, meaning like there's a colorectal cancer there, that you had a colonoscopy but they didn't See it? I mean, the likelihood of that is exceedingly low compared to like non invasive tests. So the non invasive tests are good and especially in the right situation, as I described. Or someone's like, I'm either getting non invasive screening or no screening. Like, obviously we welcome the non invasive screening with open arms and it does increase access. But if your concern is exactly like you mentioned, like, what if the test comes up negative but I actually have colorectal cancer, the way to decrease that fear and have that occurring, much less likely it would be with a colonoscopy.
- [23:34]
A
Got it. So you mentioned that as a part of the colonoscopy, you're looking to see if there are any polyps and if there are, then you're removing them. Is it the expectation that polyps are normal? Do most of us have polyps or is it. Some people don't actually have any polyps.
- [23:47]
B
So what I like to tell people is that polyps by definition aren't normal, but they are very common for someone who has average risk, as I mentioned. So no family history of colorectal cancer. They don't have a chronic disease like Crohn's disease or ulcerative colitis. They don't have certain genetic mutations that predispose them to colorectal cancer. They don't have something like cystic fibrosis, which can increase their risk of colorectal cancer. In the absence of that, if your average risk on your first colonoscopy, you have about a 1 in 3 to 1 in 4 chance of having at least one pre cancerous, benign polyp. So I'd say, you know, that's pretty common. But polyps by definition aren't necessarily normal. It doesn't mean that if you have a polyp you should automatically freak out and be anxiety ridden. And I do really need to drill that into patients. But at the same time, they are very common, just like colorectal cancer is. And that's why screening is so important, because that polyps don't cause symptoms, nor does it colorectal cancer in its earliest stages.
- [24:43]
A
And what are the chances, if you can give us a number like of polyps returning after they've been removed if you find them during a colonoscopy.
- [24:52]
B
So I will say, you know, when we remove a polyp, it's gone, right? If it's removed correctly. But if you remove a polyp, it's gone. So but I'll say that people who have a propensity to grow precancerous polyps, we bring them back for their next colonoscopy sooner than someone who never had polyps, because the chance of them growing new polyps is higher than someone who has never grown them. So we're not so concerned about the same polyp removed we removed coming back more. So we know that, hey, you've grown polyps before, we're going to keep a closer eye on you. We're going to bring you back sooner than someone who's never grown polyps because your chance of growing them again is higher than someone who's never grown them.
- [25:31]
A
Got it. So you are supposed to get your first colonoscopy age 45. If there is nothing found, when is the next time you should have another colonoscopy?
- [25:41]
B
So if you had a good exam, and when I say good exam, I mean like your colon is clean as a whistle. There's no stool that's covering polyps. We got from beginning to end and back again. We call that a quality exam. And you had no polyps. You don't have to return for 10 years. So colonoscopy is an infrequent exam. Yeah, it's generally an infrequent exam. And that always gives people a huge sigh of relief when I tell them that, like, their face completely relaxes. And, you know, because the prep is tough. As amazing as the sedation is, the prep is tough. I'm not gonna try to tell people that it's not or pretend. But yeah, it's an infrequent exam. So, like, if you're average risk and you have no issues in the interim, like no digestive issues between the time that I see you and you have no polyps, the next time you're gonna have your colonoscopy, it's 10 years. It's not like a mammogram that's every year or, you know, like prostate screening or something like that. So it's an infrequent exam. And so I so strongly impart to people, it's a pain. It's a pain in the butt to do. It's time out of your day, you got to take this laxative. But it is a life saving exam that it's really not. It doesn't happen that often and it is truly life saving.
- [26:45]
A
But if there are things found, then is it something that you're repeating like every year or every two years? Like, what's the cadence after that?
- [26:52]
B
So I'll say that it's a rare occurrence when people have to repeat colonoscopies every year. Those are people who are quite High risk. So I was alluding to before people who have Crohn's disease that affects the large intestine or the colon, or ulcerative colitis, or people who have these genetic mutations that significantly raise their risk of colorectal cancer. Outside of that, I'd say you go in there and you find a pretty large polyp. And when I say large, I mean about, like think about the width of your pinky nail, something like that. Or larger. If you have a polyp that looks a certain way under the microscope. So. Or if you have a number of precancerous polyps, like if you have like 3, 4, 5, something like that, then we actually have people return in three years. Because if you think about no polyps whatsoever in your average risk to colorectal cancer, there's a lot in between. And so if you find like one small dinky polyp, right, like something that's 2, 3 millimeters in size, like the size of a hangnail, those people don't have to come back for seven to 10 years because their risk of getting colorectal cancer is much lower than someone who has a big polyp. One that looks like a certain way into the microscope is closer to the colorectal cancer spectrum. And so those are people we keep a close eye on. So we would say come back in three years. But I'll say for most people, they're coming back if they have a quality exam, a couple very small polyps, nothing too concerning, they're coming back in seven to 10 years.
- [28:09]
A
So I want to go back to the prep, because I think so we had a kind of preliminary conversation about this in our community and this is the thing that most people were concerned about, as you mentioned. Right. So has the prep for this change really at all? Kind of since the invention, it feels like, like this is the thing that has happened. Like, have we made no progress in that there no pill form. You got to just.
- [28:32]
B
I know.
- [28:32]
A
Stuff. Yeah.
- [28:34]
B
And people are like, you bring people like they're astronauts going to the moon, all these things are happening. And you guys can't create a better prep.
- [28:41]
A
What.
- [28:41]
B
And I get that there are a lot of different formulations for preps, right? There's over the counter versions, there's prescription liquids that taste disgusting. There are pills, a lot of pills, but there are pills. So I will say for most people who have like pretty non complex medical problems or of a young age, all the preps are really available to you and your body will do a pretty good job of cleaning itself out with the pills, it's very person dependent. If you have chronic constipation, you may not clean out as well. And you need a little bit of help with the liquid prep. If you're not as mobile, your prep might not be as good. If you have kidney issues, some preps may not be as favorable because they can cause abnormal electrolytes, sodium and potassium and those sorts of things that we have to be mindful of. But there are a lot of different versions. There's liquid and there's pills. So I will say that in my practice I do prefer the liquid because it's tried and true. And I don't think that's me necessarily being stuck in my ways. As much as I hate to see a patient do all do a lot of work at home, come in, and their prep is not good. And when their prep is not good, you know when I was talking about that quality exam, it's not a quality exam. And you can miss polyps and you can miss small cancers. And so in order for me to feel confident in the exam that I do, I would have to bring somebody back, which means they have to take another day off of work or school, which means they have to have another escort arranged to take time off of their work or school. You gotta, it's a whole other thing. You gotta buy another prep. And so I'd like to get it right the first time with whatever prep you choose. It's just really important to follow the directions to a T, review the instructions, make sure a healthcare professional reviews it with you. And I'll also stress to people the, the night before the prep when you're about to start is not the time to read the directions. Because then people read it and they're like, oh my gosh, I wasn't supposed to eat this, that or the other, or I was supposed to stop this medication. Or you're supposed to take this a couple days beforehand. And we hate those kinds of surprises. We want you to be as well prepared and relaxed and stress free as possible coming in there. And I think like you said, because the prep causes so much anxiety, knowing about it beforehand is your best defense. But I'll, I know I have a lot of people come in the next day and they're like, yeah, it sucked, but it wasn't as bad as I thought it would be. I hear that a lot. Like both the, from the procedure standpoint itself and then the prep, they're like, it wasn't as bad as I thought it would be. And I do think a Lot of what we read online and absorb online is really the worst of it. But there are ways to make it easier. Put it in the fridge, chill it. You can put things like crystal light powder in it to make it more palatable. I know some people have like prep parties. If you really have your have close friends that you don't mind sharing a bathroom with that you've known for a long time, and they're all of the same age, it makes things easier. And like everybody goes to the bathroom. Like everybody's the bathroom, everybody farts. Like these are normal things. It's just so important to destigmatize these things that are absolutely normal. Like the body has to make waste and get rid of it. Like that is a normal process. Whether you're sitting on the toilet to do that or you have an ostomy or what have you. Like, these are normal processes. And so that's just really important to understand and remember we're all human and these are things that we do. So there's no point in being shy about it. But, but I definitely understand how difficult the prep can be for some people. But I'd like for people to do it right the first times. They don't have to come in again when they otherwise wouldn't have to.
- [32:07]
A
I kind of love the idea of a prep party. It makes it like a social, like a health intervention. Right. We are all of the same age. Let's all schedule this for the same day, do the prep together, talk about it, share results. Like I kind of like that idea.
- [32:20]
B
Yeah. And I also see a lot of couples come together so they'll come in for their appointment to talk about the procedure and then they'll bring a third person as their escort and they'll have it done on the same day. I've had people take pictures in the post op area holding hands, both in a stretch. And it's a great promotion of good health habits. We're doing this together. We're in the this together. We're kind of suffering through the prep together. I think it's like a, it's a beautiful thing, quite honestly. So, so I hope that that, like, I hope we spread the word on that and people take that in.
- [32:48]
A
Yeah, yeah, that definitely be fun. More from our conversation after the break. Have you heard of the Lip bar? It's a black owned beauty brand with products that are really easy to wear and just fit into your routine. They have everything from complexion to lip and it's the kind of makeup you can put on during the day and still feel good about if you're heading out later. Their non stop liquid matte in the shade boss lady has been a long time favorite of mine and as a red I think every black woman should have in her collection. When you wear the lip bar it will do what it needs to do. You can find the lip bar at retailers nationwide or on thelipbar.com and use the promo code TFBG for a 20% discount. Hey, quick question for the parents listening. When's the last time your kid asked for something and you actually felt good saying yes? Because lately a lot of families have been hearing the same thing. Can I have Lingokids please? And here's the thing. Lingokids is the number one entertainment platform for young kids with more than 4,000 interactive games, songs and shows. Astronauts, wild animals, superheroes, dinosaurs. It's literally everything kids love all in one place. So when they ask for it, you can actually feel good saying yes. Download Lingokids for free and start exploring today or unlock even more amazing content with LingoKids Plus. And if you go with the yearly plan, you can save up to 60%. Search LingoKids in the app Store or Google Play. Everything kids Love Ready or not, here they come. The new generation of leaders is in the making, and these girls are already strong, smart and bold. Girls Inc. Is the leading expert on girls and they're dedicated to helping them develop their inherent strengths and abilities, uncover new ones, and tell the world about their potential. No matter what path she chooses or dreams she has, Girls Inc. Equips each girl with experiences, skills and confidence to succeed whether you're ready for them or not. Visit girlsinc.org these days, most things cost an arm and a leg, especially vacations, but not in Rhode Island. Between affordable luxury stays, succulent seafood right from the source, and spectacular shopping that won't break the bank, you get a real bang for your buck in the Ocean State. The memories will be priceless, but the cost will be a lot less. Rhode island, all that. Plan your trip today at visitroadisland.com that's visitroadisland.com. To talk about the screening, especially for men. There is sometimes a connection between like the way this procedure is done to sexuality.
- [35:31]
B
Right.
- [35:32]
A
That feels like it also adds this level of stigma. Can you address that and talk about dispel any kind of myth there?
- [35:38]
B
Yeah, that happens a lot more often than you would think. And I couldn't stress enough that this is a completely medical procedure. Like as physicians, we're not remembering what people look like down there. Quite honestly, we see so many butts a day, we and I. And like I tell people, like we've seen it all and there's nothing sexual about it in any stretch of the imagination. Again, it can be a life saving procedure for some people. And just knowing that we have higher rates of colorectal cancer and it is a highly preventable cancer for most people, I hate to see that be the barrier. So that's why I do love when I see black men get in front of the camera, in front of the screen. Not the camera that I use, but I mean like in front of the camera, on social media, in front of the screen, screened, talking about how they got screened and even talking about their fears with it I think can be really impactful. But I can't stress enough that that is like the furthest thing from our minds. What is a medical procedure? Just like any other. Just like any other. I think that that's really important to impart.
- [36:39]
A
Yeah. So I want to address a few more myths in the form of a little game. So I'm going to throw out some things that I've heard people say about colonoscopies and colorectal cancer and I want you to tell me whether this is a myth or a fact and then tell me why it matters. Okay? Okay. So the first one is that colorectal cancer is mostly something men deal with.
- [37:02]
B
I would say that's not true. I think for all intents and purposes we should be thinking of this as a disease that affects all sexes. All genders. No one is at low risk for colorectal cancer. You're either at average risk or high risk. But I wouldn't say men suffer from it at a significantly higher risk. Great.
- [37:19]
A
Got it. The next one is a colonoscopy is painful.
- [37:23]
B
I'll say that is also false. The majority of folks get. The overwhelming majority of folks get sedation for their procedure. The type of visitation may differ across different regions of the US but you are asleep, you are comfortable, you are dreaming. Well, you wake up. People say, that was the best sleep I ever had. As I said before, verbatim or I didn't even remember it happened or when are we starting and we've already finished. So it is a painless procedure. We taking good care of you the entire time and you don't feel a thing. It's like we were never there.
- [37:57]
A
Is there pain or discomfort after the procedure? Dr. Beldora, that needs to be addressed.
- [38:02]
B
The expectation is that you shouldn't have any I'll say that we do put air inside the large intestines that we can see. The majority of the time you're walking around, there's either feces in your or stool in your intestine, or it's collapsed like there's no air. But for us to see things, we put air inside the intestine with the camera afterwards. Some people may complain of a little bit of bloating or gas. I'll say if you walk around as the day passes, you're going to pass the gas, it's going to expel out of your body and you should feel fine. I'll also say that for some people, I do do colonoscopies unsedated. So I don't know if Dr. Joy, if you heard of that, but some people do get unsetated colonoscopies, either because they're like, I gotta go to work after this. I have to drive, or I have to take care of a minor or some other thing that prevents them from getting sedated or unfortunately, they don't have the support system to have somebody with them. And so they get procedures unsedded. And I think it is actually a more common phenomenon now than it had been like when I first started practicing a decade and a half ago. And it's for the majority of folks, they tolerate it extremely well. Like you would be surprised. I will say it's not painless, but it's not necessarily like a procedure that is causing excruciating pain, like, the entire time. It's very subjective. But that is an option for folks that they can always talk about with their doctor if it's something that's attractive to them. And so I don't want to take colonoscopy off the table for folks who don't have an escort or have some other reason why they otherwise think that they're. They're not able to have a colonoscopy. But back to your original question. We shouldn't expect any pain afterwards, even when you remove a polyp. Right. Even if you're totally awake, you have no sedation, you're not going to feel that. So the only thing you really feel is air. And sometimes you might feel that afterwards, but that's usually not so common.
- [39:42]
A
And for the unsedated version of the colonoscopy, is there like a local anesthesia that you're using or is it just completely nothing?
- [39:51]
B
You're awake as you and I are right now.
- [39:53]
A
Got it. Okay.
- [39:54]
B
Yeah. I will say for people, especially for speaking to a black Female audience Fibroids, history of any pelvic or abdominal surgeries, endometriosis. That may make the procedure more technically challenging. Which patients may feel right because they're going to feel you going through the turns. The procedure is longer than usual, not as comfortable. And so that's why I do think it warrants a discussion to see if that's right for you. But again, like, men, women, like, and anything in between. Like, we do a colonoscopy unsedated. The majority of the time, they actually tolerate it.
- [40:29]
A
Okay.
- [40:29]
B
And they're not going to feel me taking tissue samples, they're not going to feel me removing polyps. It's definitely something to consider in the right patient.
- [40:35]
A
On the next one, if my stool test came back fine, I don't need a colonoscopy.
- [40:40]
B
That's true. If your average risk. And when I say, when you say fine, I'm going to, I'm going to interpret that as negative, meaning the test was normal. Then you don't need a colonoscopy. Like, you don't need to do more than one screening test. If the test is negative, the non invasive test is sufficient.
- [40:54]
A
If colorectal cancer runs in your family, screening won't change the outcome.
- [40:58]
B
Okay, that's a great question. And the answer is definitely no. You're not destined to get colorectal cancer. And that's why screening is so critical. I will say for people who do have a family history, which it's so important to talk about, they get screened earlier than the average individual. So if it's someone who is in your immediate family, we're talking parents, siblings, children, that gives you the highest risk of getting colorectal cancer yourself. So we advise people to get screened 10 years before your immediate relative was diagnosed with colorectal cancer. So if your mother was diagnosed at age 50, you should get screened at age 40. If your mother was diagnosed at age 45, you should get screened at age 35. So if you have a first degree relative with colorectal cancer, you either start at 40 or 10 years before that person was diagnosed. 40 is the latest we would start.
- [41:51]
A
Got it. And is this something that is typically, this may not be something you can answer, but is this something that's typically, like, approved by insurance? Like, if you, you know, you have a family history and you need to get screening earlier than you know what's typically advised, Is that something that's typically covered by insurance?
- [42:06]
B
I hate to say that that's true across the board, which is absolutely terrible, but yeah, because it is still a screening exam, but because the age is before 45, it can definitely depend upon your insurance.
- [42:20]
A
Got it. And I think you addressed this, but I want to make sure that the audience knows this and that I'm reminded. If there is a family history and you are wanting to start an early screening, you still suggest a colonoscopy, not one of the other non invasive ones.
- [42:35]
B
Absolutely, yes.
- [42:36]
A
Thank you. I appreciate you sharing that.
- [42:39]
B
Yeah.
- [42:39]
A
In addition to all of the work that you're doing kind of in your full time job, you've also co founded the association of Black Gastroenterologists and hepatologists in 2021. What were you seeing that made you feel a need to create the organization?
- [42:54]
B
Too much. It's 11 of us co founders and we're hepatologists, physician scientists, community physicians. And we, you know, we knew each other through different circles. Like we were either friends or, I mean, there aren't that many Black GIs and hepatologists, so. So there's that. But in 2020, peak Covid, we were just writing back and forth, like, trying to be community for each other and leaning on each other. So it was like all through, like WhatsApp chats and. And then George Floyd was murdered. And then we saw what happened with Breonna Taylor. And then Chadwick Boseman died so early in his life from colorectal cancer. And we were like, let's create a PSA at least to let people know about colorectal cancer screening. Because similar to breast cancer screening or mammograms, as you recall, the rates had of course dropped down in terms of screening because people can go to the doctor. We knew that there would be a cascading impact with that, especially for black and brown people. And so we created this psa and then we said, we need to start something formally. Like, if we need each other so much, we can imagine what's happening to people who are siloed, people who don't live in big cities. They need us. They need to see our faces. They need to. They need community. And so Those were the 1, 2, 3 strikes that really got us to form an organization. Because we know that there are so few black GIs and hepatologists in this country, there's less than 600 of us. That's abysmal. When you think about how many black people are in the United States. When you think about how we suffer from digestive disease cancers disproportionately compared to other races and ethnicities and how we're Just our outcomes are so bad. And not even for people who die from the disease, which is terrible, especially for preventable ones like colorectal cancer. But even those who survive, right? Like, what mental health resources do they have? What's their nutritional status? Right. What's the impact of the finances that are required to get the care that they need? All of those sorts of things. And it's not just digestive diseases, right? Like, that's the field that I'm in. But unfortunately that's a stat we see across the board for so many chronic conditions. And it was a call to action. And we're here five years later, thankfully, and we're bringing along people with us. And I think it's just so important to have a future of GI that is more reflective of the country that we live in, because we need to be seen. And we just hear so many patient stories of people, how people are dismissed or, you know, they even. They did all the steps that they needed to and they still didn't get where they needed to be. And that's just horrible. And so we just don't want people to be dismissed. We don't want people to be. To feel unseen. We want people to know that we are here for them. Seeing as somebody who looks like you, who shares your experiences in the doctor's office is gold. Right? It's like I said when I was talking about how people have this like, weight that lift that's just lifted and their face relaxes and they're able to tell their story, that translates into better health, better health care, better outcomes. And so that's why ABG exists.
- [45:52]
A
So it sounds like a lot of it is like health promotion. You mentioned it kind of started with the PSAs. What else does the organization do?
- [45:58]
B
We do a lot. And sometimes it's hard to actually realize it when you're in the thick of it. You know, we have professional development events where we're creating community for other Black GIs and hepatologists, connecting them to people outside of the field of gi because collaboration is key. Right. And we can lift each other up in that way. We have a. And then when we think about the patient side of things, we have a lot of community facing resources. We have this phenomenal campaign, the doctor will see you now, that was rooted in the statistic that 6 out of 10 black people change their appearance because they think it will improve what their doctor experience is like. They think they will be treated differently if they change their appearance. So six out of ten people believe that. So we had this campaign and coupled with that is this doctor discussion guide. So we give people the tools to empower them for when they're going to the doctor's office. Questions to ask how to be best prepared, bringing somebody with them so they have an extra set of eyes and ears, someone who can advocate for them, all those types of things. And so providing resources, partnering with community based organizations, having initiatives that help promote scholarship. Right. Bring faculty to meetings, bring trainees to meetings to meet leaders in the field. Because those things are really hard like financially to get to these meetings. And so anything we can do to make the future of GI much more colorful than it is right now and also by extension having that impact in patient care and having patients see us is really like what all of our programming and initiatives are about.
- [47:29]
A
Perfect. And we have covered so much ground today. Dr. Belzora, if there was one thing that you would want people to walk away with from this conversation ready to do, what would it be be?
- [47:40]
B
I would say screening saves lives. Screening starts at age 45. Don't ignore symptoms and know your family history.
- [47:49]
A
And where can we stay connected with you? What is your website as well as any social media channels you'd like to share?
- [47:55]
B
So my social media channels are Sophie Balzora MD across the board, that's Instagram and LinkedIn and and for Black and Gastro especially what I referenced with the doctor will see you now and other all the other things that we have going on. Www. Blackandgastro.org is where you can find us and all of our resources are there and our upcoming events that I encourage you to to come to because we have a lot of community facing events. We have physician and physician trainee events and we just have a lot for everyone in our community and so we're so excited to share that with you.
- [48:27]
A
Beautiful. We'll be sure to include all of that information in our show notes. Thank you so much for spending some time with us today.
- [48:33]
B
Thank you for having me. I appreciate it.
- [48:35]
A
Thank you. I'm so glad Dr. B. Zora could join us for today's convers to learn more about her and her work. Be sure to visit the show notes at therapy for black girls.com session464. And don't forget to text this episode to two of your girls right now and tell them to check it out. Did you know that you could leave us a voicemail with your questions or suggestions for the podcast? If you have a message for us, drop it at Memo FM Therapy for Black Girls and let us know what's on your mind, we just might feature it on the podcast. If you're looking for a therapist in your area, visit our Therapist Directory at therapy for black girls.com directory. Don't forget to follow us on Instagram at Therapy for Black Girls or come on over and join us in Patreon for exclusive updates, behind the scenes content and much more. You can join us at community.therapyforblackgirls.com this episode was produced by Elise Ellis Indechubu and Tyree Rush. Editing was done by Dennison Bradford. Thank y' all so much for joining me again this week. Thank you. I look forward to continuing this conversation with you all real soon. Take good care. Have you heard of the Lip Bar? It's a black owned beauty brand with products that are really easy to wear and just fit into your routine. They have everything from complexion to lip and it's the kind of makeup you can put on during the day and still feel good about if you're heading out later. Their non stop liquid matte in the shade Boss lady has been a longtime favorite of mine and as a red I think every black woman should have in her collection. When you wear the Lip Bar, it will do what it needs to do. You can find the Lip Bar at retailers nationwide or on thelipbar.com and use the promo code TFBG for a 20% discount.
- [50:19]
B
Mom, can I have Lingokids? Dad, Lingo Kids please? When did we become the Lingokids house? No idea. Last week it was Dinosaurs, this week it's Lingo Kids. Why Lingo Kids? Because it's the best thing ever. We can play games with astronauts, wild animals and superheroes. With more than 4,000 interactive games, songs and shows, LingoKids is the number one entertainment platform for young kids. So no dinosaurs and Dinosaurs.
- [50:45]
A
Lingokids.
- [50:47]
B
Everything kids love, download it for free.
- [50:51]
A
Ready or not, here they come. The new generation of leaders is in the making and these girls are already strong, smart and bold. Girls, Inc. Is the leading expert on girls and they're dedicated to helping them develop their inherent strengths and abilities, uncover new ones, and tell the world about their potential. No matter what path she chooses or dreams she has, Girls Inc. Equips each girl with experiences, skills and confidence to succeed whether you're ready for them or not. Visit girlsinc.org these days, most things cost an arm and a leg, especially vacations, but not in Rhode Island. Between affordable luxury stays, succulent seafood right from the source, and spectacular shopping that won't break the bank, you get a real bang for your buck in the Ocean State. The memories will be priceless, but the cost will be a lot less. Rhode island all that. Plan your trip today@Visit Rhode Island.com that's Visit Rhode Island.com this is an iHeart podcast.
- [51:52]
B
Guaranteed human.