Gut Health: A Family Affair, with Adam Moskowitz

Episode Transcript

Ariel: Hello everybody, and welcome back to another episode of the “Colon Health Podcast.” I’m your host, Ariel Bridges. And today we have Dr. Adam Moskowitz with us today. Hello, Dr. Moskowitz. How’s it going?

Dr. Moskowitz: It’s going great. Thank you.

Ariel: I’m so glad to hear that. Can you please share exactly what it is that you do with our audience?

Dr. Moskowitz: Well, I’m a gastroenterologist, which means I trained first in internal medicine and I followed by a fellowship in gastroenterology. And that’s what I’ve been doing since 2002.

Ariel: Quite some time. That’s at least 20 years. Wow.

Dr. Moskowitz: I actually did two years of psychiatry residency before that, but I felt my skills were better with a colonoscope than they were with dealing with bipolar disorder. So I love my psychiatry colleagues, but this is where my calling is.

Ariel: Yes. And I was just going to ask you because I did notice that when I was reading your bio that you had a background and some other specialties other than gastroenterology. So I was just curious, what made you decide to move in that direction? You mentioned you were better with a colonoscope, but is there any particular thing that had you even decide to pursue gastroenterology in the first place?

Dr. Moskowitz: Well, it’s a little bit personal because there’s some family history of gastrointestinal disease on my father’s side. My grandfather passed from colon cancer. My father also died of a cancer that we weren’t sure of the primary. And my brother and sister both have Crohn’s disease, which is in the family of what’s called inflammatory bowel disease. And is a disease process where basically, the body attacks itself. And it’s a lifelong problem that they have to deal with, and it’s lots of medications and, unfortunately, some surgery. So that’s really where a lot of my interest came.

Ariel: Wow. That is an extensive amount of family history. And I have some questions that I want to ask you later on about how families can work together for their colon health, and also kind of maybe some of the genetic predisposition that some of us may have to these different type of diseases and things and how that works. But first, I wanted to ask you just off of the top, I like when we chat to GIs about their practice to ask them, especially if they’ve been practicing as long as you have, if they have any kind of interesting stories about how screening may have really helped someone, or they came at the right time, because screening is so important and it’s something that I always like to kind of hammer home on this podcast.

So I wanted to ask you, do you have any wild stories about one of your patients where screening really came in for them and was something that it was great that they came and did it?

Dr. Moskowitz: Well, I wanna say wild, but there’s been a recurring story. Well, I wanna say that when we talk about colon cancer screening, most people think about colonoscopy. And I inform my patients, there are other options, and the only option that I will disagree with is the option to do nothing. If patients don’t wanna have colonoscopy, there are options such as there are stool tests that are available and that there are also X-ray studies that are available.

And if a patient says, “I don’t wanna do anything,” sometimes giving a patient some cards, I tell them, “Go home, when you go to the bathroom, put a little sample on the card.” And there have been many times where the patient comes back and I tell them there’s blood on the stool. And now we have to figure out where that blood is coming from. And they have been on more than one occasion we found a colon cancer based upon just from using a simple card like that.

So I encourage patients that getting screened is absolutely important because this is one of the most treatable forms of cancer if we find it early and as being a long hollow tube, the colon is probably one of the most accessible parts of the body that we’re able to go in and find evidence of cancer and treat it. And in many cases if we find it early, we treat it without surgery before it even happens.

Ariel: Yes. Thank you so much for sharing that because that’s something else that we like to try and share on this podcast is you have options and there are physicians that can help meet you where you’re at. So if colonoscopy seems scary to you, that’s fine, you have other options that you can do and it can be so, so beneficial to your health.

Dr. Moskowitz: Absolutely. And like I said, the only option I disagree with is to do nothing because there are so many great ways that we can test and it’s all out there and it starts with a conversation with your doctor.

Ariel: Amazing. It’s as simple as that, everybody. And I’m just so curious. So I wanna get back to what we were just discussing. So I know you have backgrounds in internal medicine and also family medicine as well. I wanted to ask you, how can families work together to make sure they’re doing what they need for their collective gut and colon health? Like, is there anything that’s important to know in kids versus adults, or I’d love to hear your thoughts on that?

Dr. Moskowitz: Well, my feeling is, first of all, eating healthy is the key to everything over here. There are some people that look at medicine as food. And a lot of times, my personal approach is if a patient has a symptom, I try not to start off with medication. I try to look at what they’re eating, what’s in their diet. Are they eating healthy? Are they eating healthy grains? Are they eating fruits and vegetables? And, unfortunately, we’re not eating enough of healthy fruits and vegetables. And if we were to do just that, that would change a lot of the issues that we have.

I mean, patients come to me all the time with change in bowel movements, constipation, bloating, and gas, and the vast majority of time is going right back to the diet. And having healthy meals, healthy eating can not only keep your gut healthy in terms of digestion, but also can prevent the beginnings of some colon cancers in some cases. So starting off from the get-go and learning good diets is absolutely important.

As far as getting the family involved, if we’re getting to the point of screening, there are some people that just say they don’t wanna bother. And sometimes getting the family to encourage the patient to go ahead with the screening is very helpful. Sometimes patients come in with a family member, like a man comes in with his daughter and he doesn’t want anything. And at that point, sometimes the patient’s not happy, but I recruit the daughter in helping convince the patient that this is a good way to go. And at least to consider some options that are out there.

Ariel: Yes, it can help when you have that support system rallying around you, help you feel more comfort with maybe trying something that you are uncomfortable with or just kind of making sure we’re all working together. We all wanna be as healthy as possible.

Dr. Moskowitz: Absolutely. Just starting off, choosing your snacks, sometimes having fruits and vegetables, learning to enjoy those things and also having good, healthy fiber, whole grains. Starting off at an early age, we have to learn those good healthy habits. Unfortunately, we’re a fast-food society and it does affect us in terms of our overall health and our weight and other issues. So eating healthy is the key to everything.

Ariel: And that’s great too, because that’s something that you can just start today. You don’t have to wait for your doctor’s appointment or speak with a professional. You can just go to the grocery store, check out your fridge, what’s in your cabinets, and make some changes.

Dr. Moskowitz: Absolutely. I 100% agree

Ariel: When it comes to when we’re just trying to keep an eye out on everybody’s health, is there anything that’s different within maybe a developing GI system versus adults? Do the warning signs for diseases and things look different in kids than adults? How can adults make sure they’re doing what they need to for their children’s GI health?

Dr. Moskowitz: The first thing is to recognize also that children have…sometimes their own individual needs are not always little adults. And my practice is a focus of adult medicine. So there are times where patients…families will say they want me to see their 13-year-old child. And I said, I would love to, but my focus is on adult medicine. There are certain needs unique to the pediatric community and they really should see their pediatrician. And if necessary, see a pediatric specialist.

Recognizing that patients at a young age, even when they have abdominal pain, sometimes pain is a hint for something else. As I mentioned, I have siblings that grew up with inflammatory bowel disease. And this started when they were in their teenage years. And sometimes they have symptoms of change in bowel habit or weight loss or cramping. My brother had arthritic symptoms and they were working him up, they thought he might have had rheumatoid arthritis until they detected that he had inflammatory bowel disease, which can affect other parts of the body.

So knowing that children have their own special needs, they need to recognize that there’s a difference. And I encourage families not to ignore when children say they have a tummy ache, they sometimes have something really going on. But I also want them to make sure that they understand that they need to see the right people. And I encourage if there are people that come to me and they’re too young, I’m happy to refer them to a pediatric gastroenterologist that will help them.

Ariel: Yes. And for anybody who’s curious, we got to chat with a lovely pediatric gastroenterologist and in a different episode, be sure that you go and check that out. She shared some excellent tips on identifying some symptoms in children and things to look out for and how you can help with your children’s gut health. So be sure to check that out. But yes, so we wanna make sure that people are aware that children and adults are different. There are different systems in a growing body versus an adult body.

I wanted to know too, because you mentioned that all of your family, or not all of your family, but a lot of your family members have these varying gut health issues. Do you have any statistics or knowledge about how those sorts of things are passed down or the likelihood of people to have certain genetic predispositions to these gut conditions?

Dr. Moskowitz: Well, I was speaking more general terms, but it does tend to run in families. And if you notice at a young age, a child is developing more than an occasional stomach ache, or they’re complaining about when they go to the bathroom, I would first question, well, did anyone else in the family have this problem? Is there an uncle, an aunt, a cousin that had similar problems? And that might be a key to looking further to seeing if there is any further history. And then there would be a workup in terms of blood tests and imaging and other tests to see what’s going on with that child. So looking at family history is certainly important.

Ariel: And just from speaking with you, it seems like you’re very involved with your patients and you love chatting with them and educating them. I think that’s amazing. And I wanted to chat with you about the ways that you interact with your patients, or if people want to learn more from you or schedule an appointment with you, how can they go about doing that?

Dr. Moskowitz: Well, if they want to, they can reach me very easily at my office. My office is located in Far Rockaway, which is in on the Queens-Nassau border. It’s called Vantage Medical Associates. The number is 718-970-8700. I could be found on Zocdoc. And if patients are not in that geographic area, I’m accessible, also we do tele-visits through the office. I’m on some platforms like Sesame Care also that I can easily reach out and communicate with patients and discuss whatever their concerns are. And you’re right. My fault is I do like to talk with my patients too much, but I wanna make sure that I understand them and they understand what I’m trying to help them with and their problems.

Ariel: I know it’s maybe a fault for like timing purposes, but I know it’s something that patients really appreciate and make them feel hurt, especially with a lot of these kinds of GI conditions where they maybe feel lost or they’re having…it’s been a whole journey for them. I know that it’s great to talk with a provider who really hears you and wants to work with you.

Dr. Moskowitz: Well, one of the first lessons that you learn in medical school, and I try to keep it to heart is sometimes stop and listen. And if you listen to your patients, 85% of the time, they will tell you exactly what’s going on. So in my training, I’ve seen people where sometimes the doctor will ask and answer a question and I try to listen to what the patient’s telling me. And after I hear them, I say, let me make sure I understand what you’re telling me. And it may sound redundant. I repeat back and I say, “Is this what we’re discussing here?” And this way I understand them and I’m able to help them a little bit better.

And the other thing I always try to do is I try to be honest with patients. I don’t try to sugarcoat anything. I tell them good and bad, and I try to make sure that they understand and the positives and negatives of whatever’s going on. Whether it’s their condition or it’s a test that I recommend to them, I try to be honest with them and tells them this is the plus side, this is the downside.

Ariel: Yeah. It might just be me, but I feel like there’s never too much communication. I don’t think it’s possible to overcommunicate. So being able to repeat back to them and sharing all sides clearly and honestly, I feel like goes a very long way in helping patients make the best decisions for themselves.

Dr. Moskowitz: Right. In all fairness, well, sometimes in some busy practices and some hospital-based practices, there’s a time constraint. You’re almost up against the clock, that there are factors at hand that try to push as many patients through the door as possible. And on the other hand, you wanna stop and be able to talk to the patients. Sometimes it’s a little bit of a struggle. And sometimes we do a follow-up conversation. We have sometimes a phone call afterwards to make sure that everything is okay. And in my office, if someone calls, they have a question, and even if I saw them the next day, I speak to them on the phone and we go over it again. I wanna make sure that they’re heard and that they count and they matter.

Ariel: That’s so great. It seems so straightforward, but I know that a lot of people have difficulties feeling like they’re heard. So I know that’s something that our listeners can appreciate. I am also curious as we’re winding down, since you take so much time to chat with your patients, are there any misconceptions that you hear frequently in your office that you think are worth just clearing up today with our audience?

Dr. Moskowitz: Well, I try to clarify there are sometimes…well, what we were talking about in the beginning, let’s say for colon cancer screening. And when a patient says, I don’t wanna have this test done or that test done, and I ask them, why? Because I heard about a friend of mine who got very sick, who needed surgery, who died on the table. And when I talk to patients about colon cancer screening, I go over each test. I tell them the risk and benefits. Like, for example, over the years, I used to send patients for a barium enema, and now there’s something called PT colonography. Two ways of looking for colon cancer using X-rays.

So I tell them, I say, this is the benefit. It’s not as invasive as a colonoscopy, but these are the concerns, it’s radiation. And too many X-rays can put you at risk for certain problems. When I tell them about colonoscopy, I tell them this is a test where we’re looking inside your body, it’s not surgery, but I need to be honest that there’s a chance that if you’re not cleaned out, there’s a chance that I might miss something over here during the colonoscopy. So you tell them the good and bad of every test and you help the patient make an informed consent of what they’re doing. And that’s the best way to approach it.

Ariel: Again, yes, the clarity of communication helps us make the best decisions possible. Love it. We are just about out of time. Is there anything else today that you’d like to share with our audience?

Dr. Moskowitz: Well, just reminding people, it’s still March, which is annual Colorectal Cancer Awareness Month, and that it is a message that I cannot repeat enough, even when it’s not March, when it’s April or May, I’m still gonna be repeating this message that there are so many types of cancer that by the time we find it, unfortunately, it’s often at a late stage, if you find pancreatic cancer, if you find sometimes lung cancer. Colon cancer is something we can find early and we can treat, and we can prevent a lot of disease and people having a great quality of life. And we start screening now in our 40s. That’s the other message I wanna take. It used to be we start at 50, we moved it down into the mid-40s because we’re finding earlier evidence of colon cancer. So get checked, speak to your doctor. There are options out there, but don’t ignore it. That’s my message.

Ariel: That’s a great way to end things off. Everybody, I will drop Dr. Moskowitz’s practice information down in the show notes as I always do. So if you’re wanting to schedule a call with him or chat with him if you are in the area, or if you want to try and schedule a telehealth appointment, feel free to scroll on down and check out that information below. Dr. Moskowitz, thank you so much for being here today. I really appreciate. You’re absolute pleasure to talk to.

Dr. Moskowitz: Thank you so much for having me. It has been an honor to be able to speak to you and to your audience. And I wish everybody happy Purim and happy St. Patrick’s Day as that is both holidays today.

Ariel: Yes, we’re doing a lot of celebration today with those two holidays and with Colorectal Cancer Awareness Month, as you mentioned. So everybody, like I always say at the end of the podcast, we all have colons, make sure you ask your questions, do your research, and have a conversation. All right. Until next time, see you.

Dr. Moskowitz: Bye-bye.