Dr. Beart (pronounced like beard), has such a disarming manner that it didn’t even feel like a Q&A session. More of like, well like how Luke must’ve felt in the presence of Yoda. Yeah, that’s right, I’m a geek, get used to it ;)
And of course, with the exception that Dr. Robert Beart is far younger and better looking than Yoda, but you get the gist. After my talk with Dr. Beart, I can honestly say that I feel a whole lot smarter about what we didn’t know about colostomies and much more at ease…
Me: First off, of all the fields, what made you choose colorectal surgery?
Dr. B: Well, I was at the Mayo clinic and I had actually trained as a liver transplantor, but when I got there, just out of residency, they didn’t really need anybody to do liver surgery, so I was sort of looking around for an area to focus on and this one needed development at the Mayo clinic, so I decided to go back and get my boards in this area and it worked out very well.
Me: I remember seeing a movie when I was younger about a pro, woman golfer who had to have a colostomy and continued to play golf with it (Babe Didrikson). I remember how it made me cringe when it leaked. That’s the extent of my knowledge, so when I went in to sign the surgery consents and saw that they’d written “possible colostomy” in there, I was shocked and freaked out a little. That was the first anyone had mentioned in the weeks leading to my Sigmoidectomy. When the surgeon came up to me just before the surgery I told him I didn’t want a colostomy “under any circumstances.” I realize now that I was putting my life at risk because I didn’t know any better. My hope is that we can tackle these unasked questions here to make the colostomy better understood by the general public, to encourage them to get screened to avoid it and to give those who may need to face it, a clearer sense of how manageable they are nowadays, so they don’t put their lives at risk unnecessarily.
Dr. B: It’s interesting you say that, because the AMA did a study a while back that found 70% of people thought that if you got colon cancer it was a death sentence and 60% believed that if you had surgery for colon cancer it meant you’d end up with a permanent colostomy.
Me: That doesn’t surprise me one bit. So, when would someone need a colostomy?
Dr. B: It’s a bit philosophical. The general deal is whether the area of the colon that’s damaged, heals well or not. Some surgeons routinely do a colostomy on every surgery with a plan to come back six weeks later. Other surgeons try to go by judgement. I don’t think there is a hard and fixed rule. I will say, the more experienced the surgeon, the less often they will do it routinely. Also, there is new technology on the horizon that helps to predict healing better and it should decrease even an inexperienced surgeon’s need to perform a diverting Ileostomy (temporary colostomy), but that’s a couple years off.
Me: When is a temporary colostomy needed?
If a colostomy is necessary, most doctors will have a former patient, someone who’s been there that can walk you through it, and afterward there are some great support groups available as far as identifying information, where to get equipment and support, etc.
Me: So, when would a permanent colostomy be necessary?
Dr. B: The reality is that if placed in the hands of people who know what they’re doing, it’s probably 1% or 2% that would ever need a permanent colostomy and that’s only when the anal muscles are directly involved (rectal cancer). My point is that the need for a colostomy should be preciously low and they should be able to determine prior to surgery whether a colostomy is necessary, but ultimately it is your body and your decision. Even in that situation where it is recommended, but you refuse a colostomy, there are things we can do. Although, I think at this point they’re mostly experimental. I can technically do it if demanded, but I don’t recommend it.
Me: How does a permanent colostomy alter someone’s day to day life?
Dr B: It changes your body. It changes your body image, but you shouldn’t be afraid of it. There are techniques with irrigation and other stuff (like flat, odorless bags), so that once every 2 or 3 days you irrigate it and then you don’t have to worry about it for the next couple days, so people should understand that if a colostomy is necessary, nowadays it’s consistent with a very high quality of life.
Me: I think we know the answer, but it still needs to be asked. Is there any chance that a permanent colostomy could be reversed now or in the near future?
Dr. B: Well, technically the answer is no. There are some things that we can do, but it’s all very experimental at this stage.
This brings to mind that debate over breast cancer, where so many women were concerned they would be disfigured, that they delayed or avoided mammograms. Since they’ve come out with better information and better surgical techniques, the screening rate has gone up, but it’s those kind of misconceptions that have been generated through the years that can really hurt people.
Me: I agree, definitely. If I knew then, what I know now, I wouldn’t have hesitated to get a colonsocopy done when I first noticed the symptoms. So, what do you think about the DNA testing they’re doing these days?
Dr. B: Well, DNA testing is used for several things. We use it to evaluate risk and that’s very simple and I think we get really good data that’s helpful. We use it to evaluate prognosis and there it’s probably somewhat helpful, but we’re looking for more sophisticated ways to do that, and finally we have and there it can be helpful and the more we learn about targeting, so we can effectively predict whether a particular therapy would work or wouldn’t work, so we don’t put patients through treatments that will not work. So that answer is, it’s in its infancy. I think it’s going to be terrific, but you’ve got to be careful. Judgement is still important. We haven’t eliminated the need for judgement yet.
Me: Got it. So, coming to a close here, if there is one thing that sinks in for the reader from our conversation here, what do you hope it will be?
Dr, B: Well, 2 things; one is that colonoscopies saves lives and there’s a long lead time to find polyps. And the second is that if you get cancer, get into the hands of someone who knows what they’re doing, because that’s the most important thing in predicting outcome, avoiding colostomies and everything else, so picking your surgeon is probably the single most important decision you have to make if you get cancer.
Me: I like that and I agree. I completely trusted Dr. Jamshidi and that’s why I was so calm before the surgery. I knew I was in good hands.
Thank you so much Dr. Beart for clearing all this up for us. You rock~
Dr. B: My pleasure.
Me: Take it from Dr. Beart, it is very rarely ever necessary to have a permanent colostomy done, but if it is ever the case then I want you envision this guy, because this is the handsome face (and body) of someone here and now, living life with a permanent colostomy, to say he’s been there, done that and he’ll walk you through it.
-Dr Beart is a 1971 graduate of Harvard Medical school and worked at the Mayo Clinic from 1976-1992. He’s currently the medical director for the Colorectal Surgical Institute at Glendale Memorial Hospital in Glendale, CA.
Throughout nearly 40 years of practice and research, he pioneered many innovations, including the ileal pouch-anal anastomosis, the development of laparoscopic colon surgery and the advancement of complex rectal cancer care.