Dr. YCJ 🩺 Bowel Surgeon⚕️

colorectal surgeon. I talk about your gut so you don't end up on my table

[Dr. YCJ 🩺 Bowel Surgeon⚕️ @Dr_Ycj]

1/ the toilet is not a waiting room.

a lot of the hemorrhoid flares i see in clinic start the same way. someone sits down, opens their phone, and 15 min later they're still there.

what i end up telling almost every one of them:

[Dr. YCJ 🩺 Bowel Surgeon⚕️ @Dr_Ycj]

@LDLSkeptic fair, i went off the post, not the full talk. i'll give it a watch. where i land is the RCT and mendelian randomization data, and FH patients are the ones i'd least want off a statin

[Dr. YCJ 🩺 Bowel Surgeon⚕️ @Dr_Ycj]

@LoriShemek sugar matters but fiber is what the good bacteria actually eat. most people i see eat way too little of it

[Dr. YCJ 🩺 Bowel Surgeon⚕️ @Dr_Ycj]

@Rainmaker1973 ferroptosis in a dish keeps getting headlines and rarely makes it to patients. the anti-pd-1 mouse result is the part i'd watch

[Dr. YCJ 🩺 Bowel Surgeon⚕️ @Dr_Ycj]

@EricTopol @natBME retina scans make sense since it's the only place you can see small vessels directly. curious how well it holds up outside the training population

[Dr. YCJ 🩺 Bowel Surgeon⚕️ @Dr_Ycj]

7/ Question for you: did your appendix go the textbook way, or did it fool everyone?

Tell me how it started. Pretty sure half of you thought it was food poisoning.

[Dr. YCJ 🩺 Bowel Surgeon⚕️ @Dr_Ycj]

Most appendicitis I operate on didn't start where people think.

It started around the belly button. Vague, crampy, "maybe I ate something bad." Then over half a day it walks down to the lower right.

That walk is the thing to notice. 🧵

[Dr. YCJ 🩺 Bowel Surgeon⚕️ @Dr_Ycj]

6/ Does it always mean surgery? Mostly yes. Usually keyhole, three small cuts, home in a day or two.

For some simple cases antibiotics alone are an option now. But it can come back, and that's a talk with your own surgeon, not your group chat.

[Dr. YCJ 🩺 Bowel Surgeon⚕️ @Dr_Ycj]

you do not need to poop every day.

anywhere from 3 times a day to 3 times a week is normal. what matters is whether it's changed for you, or comes with blood or pain.

if you're a once-every-two-days person and feel fine, stop worrying.

what's your usual?

[Dr. YCJ 🩺 Bowel Surgeon⚕️ @Dr_Ycj]

@drmarkhyman @hubermanlab 3am wake ups are often just alcohol or a late dinner tbh. worth checking those before blaming melatonin

[Dr. YCJ 🩺 Bowel Surgeon⚕️ @Dr_Ycj]

@Kelvinequeen epiglottis is quick but the real hero is the swallow reflex timing. when it gets off by a bit you get that coughing fit

[Dr. YCJ 🩺 Bowel Surgeon⚕️ @Dr_Ycj]

@paulsaladinomd the intestines part always gets a reaction lol. casing for sausage is literally the same tissue, just cleaned

[Dr. YCJ 🩺 Bowel Surgeon⚕️ @Dr_Ycj]

@Yasirrasheed300 fiber gap is everywhere honestly. beans and lentils are the cheap fix in most places

[Dr. YCJ 🩺 Bowel Surgeon⚕️ @Dr_Ycj]

how much fiber do you honestly eat in a day? i'll go first: not enough, and i give this speech for a living

[Dr. YCJ 🩺 Bowel Surgeon⚕️ @Dr_Ycj]

Today is Día de los Muertos. In Mexico families put out the dead person's favorite food. Marigolds, bread, his tequila.

We don't do Nov 2 in China, we have Qingming in spring. Same idea really. You bring what he liked to eat.

Ward story, some years ago. Old man, rectal cancer, end stage, barely ate for weeks. Last thing he asked his son for was a bowl of wonton from the little stall outside our hospital gate. Son ran down. He took two spoons, said too salty, and smiled. Died next morning.

Every Qingming the son buys wonton from the same stall and brings one bowl to the grave. He told me this when he came back for his own colonoscopy. (Clean, by the way.)

I did a lot of operations that year. This is the one I remember.

What food means one specific person in your family?

[Dr. YCJ 🩺 Bowel Surgeon⚕️ @Dr_Ycj]

@P_McCulloughMD @ChatGPT tapering anti seizure meds without a neurologist watching is where this goes wrong. withdrawal seizures are no joke

[Dr. YCJ 🩺 Bowel Surgeon⚕️ @Dr_Ycj]

@Rainmaker1973 gut microbiome part is the interesting bit. bigger guts cost a lot of energy so shrinking them probably paid for the brain

[Dr. YCJ 🩺 Bowel Surgeon⚕️ @Dr_Ycj]

First thing a lot of patients ask after waking up from surgery is not "how did it go."

It's "where is my phone."

On the ward this morning, a 74 yo uncle, day 1 after his colon op, IV line still in his hand, typing very slow with one finger. I thought he was messaging his son. No. His chess group. "Not dead. Tuesday game cancel."

His son works in Shenzhen, comes on weekends. The chess group already came Saturday, before the op, with a bag of oranges. Four old men in the corridor arguing about where they parked.

We ask every patient about family history, smoking, drinking. Nobody asks "who will notice if you don't show up on Tuesday." Maybe we should. I really think people get out of bed faster when somebody is waiting for them. No study for this, just years of watching.

Who's the first person you'd text after surgery?