ZurMed: Dr. Hans Burkholder

Dr. Hans Burkholder is Gastroenterologist and colon cancer expert who specializes in colon and rectal surgery. In this episode, he discusses how he detects and treats illnesses that cause bleeding from the rectum.

Host: How do you initially start off treating a newly diagnosed patient?

Dr. Hans Burkholder: I start off by talking to the patient and helping them work through some of their anxieties. If they cannot cope with the emotions surrounding the diagnoses, they msg delay treatment. We develop the best treatment plan for the patient based on their individual case such as the cancer location and staging.

Host: Can an early stage patient go to surgery right away as a cure?

Dr. Burkholder: Yes, the chance for cure with surgery is in the high 90% percentile.

Host: Why are colon cancer deaths decreasing?

Dr. Burkholder: People are getting screened more so colon cancer is being found at earlier and earlier stages. The quicker it’s treated, the better the chances are for survival.

Host: Seeing blood after bowel movements is one of the common warning signs that there is a problem. How do you treat patients with this symptom?

Dr. Burkholder: I conduct a complete history and physical exam and try to determine what’s causing the bleeding. Most of the patients who come to me do not have colon or rectal cancer. However, that is always in the back of our minds. Typically, during the exams we look for things like hemorrhoids, anal fistulas, and anal fissures which can all cause bleeding and are not cancer. 

Host: Why do some patients delay seeing a doctor about bleeding?

Dr. Burkholder: Rectal bleeding is never normal but some people get it and ignore it thinking it’s just hemorrhoids when it actually is cancer. This can even happen to people in their 20s and 30s. 

Host: What operating techniques do you use to remove tumors?

Dr. Burkholder: In most cases we use minimally invasive techniques like laparoscopic or robotic processes which lessen pain and result in shorter recovery times.

Host: What’s a laparotomy?

Dr. Burkholder: That’s the scar line that runs from the bottom of the chest to the belly button. Now, you can barely see that scar anymore because the technology is getting better. Aside from being cosmetically advanced, it also leads to faster recovery like being able to sleep, eat, and move their bowels normally again not long after the surgery is complete. 

Host: How soon can someone walk or eat after surgery?

Dr. Burkholder: Ideally, they will walk again through same day a few hours after coming out of surgery. As soon as the anesthesia wears off, we want them out of bed and sitting in a chair and, as long as they are not lightheaded or dizzy, walking. That helps recovery. As for food, the first day we give them clear liquids and if they handle that then we give them their regular diet the next day. Now we use less tubes and catheters due to all his new technology and it really does have a positive impact on recovery. It’s common sense; the less tubes you have in your body, the faster you recover.

Host: How long after rectal or colon surgeries do patients stay in the hospital?

Dr. Burkholder: The average is between two to five days. The faster they get out, the better. People are more comfortable at home and therefore recover better. Plus, you can pick up infections in hospitals more than at home. 

Host: What causes rectal bleeding?

Dr. Burkholder: Not all rectal bleeding is cancer. It can be due to a big external or internal hemorrhoid or maybe the patient was constipated and pushing very hard. Even a job sitting too long can cause problems. 

Host: How can you treat hemorrhoids?

Dr. Burkholder: We can dk rubber band ligation, burn them using a heat process called infrared coagulation, conduct hemorrhoidectomy surgery, or even strictly through diet and lifestyle changes. Most of these processes are painless.

Host: What’s an anal fissure and why might they bleed?

Dr. Burkholder: Anal fissures happen after a patient has a traumatic bowel movement which typically happens as a result of constipation. When they strain it push hard, the opening tears a little bit and the anal muscle becomes too tight in reaction. Then, the patient has burning pain and some bleeding when they go to the bathroom. With treatment like medicines or surgeries we can get their pain to stop. 

Host: Is it true that Botox can be used to treat these conditions?

Dr. Burkholder: Yes, it’s one of the newer treatments for anal fissures since it can paralyze the anal muscle and make the opening a little larger with relieves pain and allows the tear to heal. Botox treatments like this can work on 80% of patients. It’s a very good new technique.

Host: What surgery do you do if the Botox doesn’t work?

Dr. Burkholder: We perform a sphincteratomy where we cut some of the muscle that is making the opening too tight. Making the opening bigger helps allow bowel movements to pass easier, lets the fussier heal, and relieve the patient’s pain. 

Host: What are natural or lifestyle remedies to help people in pain with these kinds of issues?

Dr. Burkholder: Eat fiber-rich foods like fruits and vegetables—or even take a fiber supplement. Also, if you soak in a warm bath it can help.

Host: What other illnesses can cause recurring rectal bleeding and what are their symptoms?

Dr. Burkholder: If a patient’s blood counts aren’t normal or if they are having changes in their bowel habits, it’s a warning sign of inflammatory bowel disease aka IBD. So is diarrhea and abdominal pain. These can also be signs of Crohn’s disease or ulcerative colitis.

Host: If someone needs to have their colon or a piece of bowel removed, what’s the most minimally invasive way to do that?

Dr. Burkholder: We always try to do the most minimally invasive surgery that will still be effective in curing the patient. If you screen often and catch diseases early on, we can take minimally invasive approaches and get a full cure.

Host: What’s a colectomy?

Dr. Burkholder: It is the surgery where the colon is removed but it’s not something that every patient needs. Most people fear having to live life with a “bag” but the majority of people don’t require them. If we can avoid giving people a bag, we do. That said, people who do need a bag often find that it’s not as bad as they feared and some bags are just temporary and can be removed about three months after surgery.