Dr. Jeffrey Milsom is the Chief of Colon and Rectal Surgery at New York-Presbyterian Hospital/Weill Cornell Medical Center in New York City and the Executive Director of its Center for Advanced Digestive Care. Named as one of New Yorks Best Doctors, Dr. Milsom has unique expertise and unparalleled experience in minimally invasive surgery. ThirdAge talked to him about digestive diseases and the exciting medical breakthroughs in his field.
ThirdAge: So many people have digestive complaintseverything from indigestion, stomach upset, constipation and diarrhea. How can they tell when a problem is serious and they should see a doctor?
Dr. Milsom: Someone should see his or her doctor if they have a problem that wont go away. Even if it seems to be a minor problem like heartburn. Also you should see your doctor if it is sudden and serious such as an acute pain. What you shouldnt do in that situation is try to treat yourself and take someone elses prescription. Another important thing is to consider your own and your familys history. Even if it seems like a minor complaint, but your family has a history of intestinal problems, go and see your doctor.
ThirdAge: There is an expression dying of embarrassment. Arent people often too embarrassed to talk about digestive or intestinal problem to their doctor when they really should?
Dr. Milsom: Fortunately people are a lot less embarrassed than they once were. But it is true that people in all strata of society can be reluctant to talk about these things. My advice is that if you have a family member who might feel shy or embarrassed about something that is bothering him, go with him to the doctor. And seek a doctor who is solicitous and easy to talk to. It helps to bring a spouse or a friend along and to have a doctor who wants to listen. Then speak up. ThirdAge: Many women seem to suffer from Irritable Bowel Syndrome. Whats the best way to treat this disorder?Dr. Milsom: IBS is definitely a real problem and it is frustrating problem for both the patient and the doctor who is treating it. If you have the symptoms, bloating, for example, and bouts of constipations and diarrhea, have it checked out. It is reassuring to find it is not something more serious. There is no specific remedy and patients find it comes and goes but they also can learn to handle and control their symptoms. It is interesting that women talk more about having IBS. I am not sure women have this condition more than men but because they seem to able to talk about it more easily that can help give them a sense of control.ThirdAge: Colon cancer is one of the leading causes of cancer deaths in America. Everyone over 50 is advised to have a colonoscopy. Yet recently colonoscopies have been questioned as not always totally reliable. Still would you agree with this advice? Also is a virtual colonoscopy as effective as the traditional colonoscopy?
Dr. Milsom: Yes, absolutely, people should have a colonoscopy, and, no, a virtual colonoscopy is not as good. If comfort is your concern, a virtual is much more uncomfortable. They blow you full of air. It also involves radiation. You are getting a CT scan. Also if a doctor sees something, then you have to a regular colonoscopy. Most people complain about the prep but you have to do the same prep for a virtual or a traditional test. ThirdAge: I know you are a pioneer in laparoscopic surgery for diseases of the colon. But in many parts of the country surgeons are still using traditional methods of dealing with these diseases. What would you advise if your need colon surgery and your surgeon does not raise the possibility of laparoscopic surgery with you --what should you do.Dr. Milsom: It is hard to get a handle on it but in our country probably less than 20 per cent of colon surgery is laparoscopic which is less invasive than traditional open surgery and allows for a quicker recovery. You need a pretty high skill set and advanced equipment to perform this type of surgery. If a surgeon does not offer this option, you can speak up and ask to consult with another surgeon who does. In most metropolitan areas there are doctors who can perform this type of surgery. But what is most important in surgery is that the doctor who does it is highly skilled. I would always say if the choice is between a highly skilled and experienced doctor who performs open surgery and another doctor you know less about even if he performs laparoscopic surgery, the answer is obvious to which surgeon to choose. . ThirdAge: What are the next breakthroughs in your field?
Dr. Milsom: Doctors say if we can find the problem we can treat it. Well, there has been a great expansion in extremely sophisticated image modalities and high resolution scanning such as ultrasonography, MRIs. PET scans, CT scans, along with endoscopes, which are miniature cameras that can be placed almost anywhere in the digestive tract. And there are advances in robots and in the miniaturization of equipment that can be used in surgery. We are now able to replace operations, even laparoscopic operations where people might have tiny little incisions, with operations done within the channel of the intestine. That means people can have intestinal surgery without general anesthesia. We are replacing, two or three hour operations, painful incisions, a hospital stay, with operations where you get a little sleepy and you can go home afterwards. Thats big. This developing technology can also help us treat all parts of the digestive tract including the liver, the gall bladder and the pancreas. People should know bioengineering is one of the fastest developing and most exciting parts of medical research today. .ThirdAge: What are three things you do personally to stay healthy?Dr. Milsom: I try to have yearly checkups. And, even though its hard, I try to exercise. I know I should do it every day but I try to get to the gym two or three times a week. I also try to practice what I preach and be very open if I feel there is something wrong with me. I tell my spouse and I tell my doctor.
