Advanced Imaging and Health Accessibility, with Dr. Kevin Tin

Episode Transcript

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

Dr. Tin: Hey, Ariel. I’m doing well. Thank you.

Ariel: We are so excited that you’re here today. And to start off, can you please share with our listeners exactly what it is that you do?

Dr. Tin: Absolutely. I am a gastroenterologist. I work in New York City. Gastroenterologist is pretty much a physician that specializes in all gastrointestinal disorders. So anything from the esophagus going down all the way to the rectum and everything in between.

Ariel: And what is it that made you decide to specialize in gastroenterology?

Dr. Tin: So I feel that gastroenterology is a very diverse field in the fact that it involves a lot of clinical, as well as procedural aspects to it. And it also involves a lot of technology in terms that, you know, given that technology’s always evolving, the amount of procedures that we’re able to do now definitely has been evolving over the last few decades. So now we are actually doing a lot of things minimally invasive.

Ariel: I’ve never actually thought about that, but you’re right. GI is one of those few specialties that has surgery, and regular, and sometimes more sort of internal medicine type things, and you get to use technology, like you mentioned. It has a lot of stuff all wrapped up into one specialty.

Dr. Tin: Yeah, for sure. So there’s even more remote things that they’re trying to incorporate now. For instance, I was just reading about this new technology where you can actually swallow a pill at home, and then someone can control it remotely and examine the stomach that way. So all the images are directly visualized by a physician, and you don’t even need to be in the office for it.

Ariel: Whoa, that is really cool. And is going to do so much in terms of increasing access. And maybe also we talk about eliminating the stigma or some people have some fear around going under and getting a colonoscopy. So that makes it super easy and also convenient from your own home. It sounds like a win-win situation.

Dr. Tin: For sure.

Ariel: I was reading some background about you, and I really love that you are passionate about overcoming cultural barriers to make sure that we’re providing more competent care to communities that are often underserved. Can you share more about the patient population that you work with and the ways that you serve them?

Dr. Tin: Yeah, absolutely. So I grew up in Chinatown, Manhattan, and the patient population that I deal with, they are predominantly Chinese currently. And because there’s a big immigrating population, there is a lack of understanding and a lack of education, you know, within this population. So a lot of times, the patients don’t really know why we do colonoscopies and things like that.

And sometimes they feel that, “Oh, my bowel movements are fine. You know, I don’t have any abdominal pain. You know, I’m eating well. Why do I need a colonoscopy?” They don’t really have the concept of colon cancer prevention or preventative services in their mind. So as long as they think they’re doing okay, you know, they don’t think they really need to undergo any procedures or any other radiologic imaging or anything like that.

So just trying to work with this patient group, you know, for sure it’s a lot of education and trying to get these community events to really get that message and get that notion out there. So that way they know about these preventative measures and how important they are. And know that, you know, by doing colonoscopies, we’ve decreased amount of patients dying from colon cancer by about 40% over the last few decades.

Ariel: Man, yeah. Having access to just even understanding that it’s something that needs to be done because I guess you could say you don’t know what you don’t know, right? So making sure they understand what they need to even do is such an important first step.

And I guess since there aren’t these types of access to this general knowledge base that you’re trying to bring to this population, are there any types of conditions that you see most frequently within your patient population?

Dr. Tin: Yeah. So in terms of my patient population, we do see a lot of patients with gastric pain or upper abdominal pain, you know, reflux heartburn-like symptoms. We see a lot of hepatitis B actually just because, again, I have a lot patients from this area in China where there’s a high prevalence of hepatitis B, which is a chronic liver disease that patients live with.

And currently, there’s no cure, but it’s totally manageable with medications, and making sure that these patients are being followed routinely for surveillance ultrasounds because they are at higher risk of developing liver cancer. Other than that, the standard things as well, you know, like irritable bowel syndrome is very common, you know, functional GI disorders. And other than that, you know, the change of bowel habits, constipation, diarrhea, things like that.

Ariel: And for your population, since we’re here trying to make sure that we are educating them and everyone else, are there any prophylactic or preventative measures that people can be taking when it comes to their gut health that you’d like to share with us today?

Dr. Tin: Yes, absolutely. So, I mean, I think, in general, just living a healthy lifestyle in terms of having a high fiber diet, generally, 30 grams of fiber per day, making sure that that’s complimented by drinking enough water per day, just because fiber does require water to help and for it to be effective. So generally, we would recommend about 64 fluid ounces of water. For sure like exercise, sleeping right.

Just because in terms of the gut health, the brain and the gut shares a lot of nerve fibers, and irritable bowel syndrome is pretty much a disorder of partly the brain as well. And patients that undergo a lot of stress, anxiety, depression, they tend to have more functional GI disorders, like irritable bowel syndrome. So I think keeping the mind healthy, keeping the body healthy complimented by those high fiber diets, adequate hydration is probably the best way to go.

There are some studies that showed like a low-FODMAP diet, which are the poorly absorbed fermentable carbohydrates have shown to worsen irritable bowel syndrome-like symptoms. So for that, in particular, we generally recommend a low-FODMAP diet to help with those symptoms as well.

Ariel: Yes. I love everything that you said. We try and really remind people the importance of the connection between your brain and your stomach and how it really creates these kind cycles with your physical and mental health, and how it’s so important to make sure that you are tending to both.

Dr. Tin: Yes, no, absolutely. A lot of times when patients are able to just rest and get, whether it’s a vacation or get the break that they need, you know, they also feel that their, you know, stomach and bowel habits are actually a lot better as well.

Ariel: I know I’m definitely one of those people that when I’m really stressed, my stomach gets all upset with me. So I can testify to that. Something else that I was interested in when reading about your background and your practice is what you do with endoscopy. So can you share what endoscopic ultrasounds and endoscopic retrograde cholangiopancreatography are, and why someone might need these procedures?

Dr. Tin: Yes, absolutely. So that falls into what I was just mentioning about how technology has evolved over the last few decades. Endoscopic ultrasound is an ultrasound probe which is attached to a standard endoscope. So pretty much with that, we are able to get ultrasound visualization more targeted at a certain area.

So what more commonly we do it for is generally disease of the pancreas. So the pancreas is the organ that lies directly behind the stomach, and a standard ultrasound, a transabdominal ultrasound, where they use the ultrasound probe on top of the abdomen, they don’t get good images of the pancreas per se.

So in terms of endoscopic ultrasound, you’re using an endoscope going down into the stomach. And then now you have this ultrasound probe where you’re able to directly press the probe from the stomach and get direct visualization of the pancreas. And with that also, we are able to use needles to actually aspirate fluid, drain some pancreatic cysts, and those type of things.

And then in terms of ERCP, or what you mentioned is endoscopic retrograde cholangiopancreatography, that is a side-viewing endoscope. So it’s a specialized endoscope that we actually go from the mouth as well, go down to the small intestine or to duodenum, and then we’re able to visualize the ampullar, which is the area that connects the bile duct into the small intestine.

And we’re able to place instruments into the bile duct directly and remove gallstones, take biopsies of any suspicious masses, put in stents to help drain the bile and things like that. So, definitely these are considered more advanced procedures and definitely, again, has really changed the landscape of how we deal with certain diseases.

Ariel: Okay. So I know you mentioned some cysts and abscesses and things. Can you share some more specific, I guess, diagnoses or conditions where people might need some of these procedures? Is this something that your doctor would tell you that you needed?

Dr. Tin: So pretty much for endoscopic ultrasound, or what we call EUS for short, we commonly use that for like pancreatic cysts, as you mentioned, sometimes pancreatic abscesses where we are able to drain it directly. Sometimes if there’s a pancreatic mass, we may need to do an endoscopic ultrasound and do what we call fine-needle aspiration.

So that’s, again, where we use a probe, we go down to the stomach and from the stomach, we have a needle that can directly target the mass and take tissue sampling from that mass, and then make a diagnosis of whether it’s a benign or malignant tumor. We also can use the endoscopic ultrasound to also kind of grade and stage stomach cancers as well just because we can see the level of the involvement of the stomach tumor inside the stomach, as well as the rectum.

If there’s any like neuroendocrine tumors or any other tumors in the rectum, we’re able to use the same probe and then exactly see the depth or involvement of that lesion. So those are the more common things that we do the endoscopic ultrasound for. And we can also visualize if there’s any gallstones in the gallbladder or the bile duct as well.

And that’s usually in combination with the ERCP, where if there is a stone that we see in the common bile duct, you know, we are able to go in and actually take it out. So for an ERCP, usually, that’s mainly targeting any pathology within the common bile duct itself.

Ariel: Got it. Okay. Yeah. So this definitely seems like something doctors would recommend, it’s not like a colonoscopy where you reach out to your GI and say, “It’s time for me to get this regular procedure.”

Dr. Tin: Oh, no, no, no, no. Yes. So this is definitely something that if there is something of concern or of interest that we would recommend endoscopic ultrasound or ERCP for. It’s not something that we just do routinely like a colonoscopy.

Ariel: Amazing. And is there anything else that you wanna share with our audience for today?

Dr. Tin: So I just wanna say March is Colon Cancer Awareness Month. So I encourage everyone to get their colonoscopies, you know, definitely saves lives. We’ve diagnosed colon cancer in patients of all ages, you know, as young as people in their 20s. So definitely understand your family history, speak to your family, you know, if there is any history of colon polyps or colon cancer, and definitely get screened.

It’s a very straightforward test. It’s about 15 minutes or so, 15, 20 minutes. You’re under sedation generally. So pretty straightforward. Worst part is usually fasting the night before but, you know, it is important screening modality, and again, it saves lives. So everyone, consult your healthcare doctor, your primary care doctor, and speak to your families about it.

Ariel: Amazing. We love that. We are huge advocates of testing, reminding everybody to get tested themselves, tell your family and your friends, especially during Colorectal Cancer Awareness Month, but at all times of the year, it’s always a great time to get a colonoscopy.

Dr. Tin, thank you so, so much for being here today. I learned some really interesting things.

Dr. Tin: That was good. I’m glad that, you know, I was able to get on this platform, and yeah, share the knowledge, and just let everyone understand things a little bit better.

Ariel: Yes. And if you happen to be listening in the New York City area, I will share some information about how you can book an appointment with Dr. Tin in the show notes, as well as some other educational materials as always. And like I say at the end of the podcast, we all have colons, make sure that you ask your questions, do your research, and have a conversation.

All right. We’ll see you next time on the “Colon Health Podcast.” Bye, everyone.