Interviewed by Sokol Paja/

MARCH IS THE MONTH OF COLO-RECTAL CANCER AWARENESS

Colorectal cancer is a significant health concern in the United States and worldwide, with the disease being the second leading cause of cancer-related deaths. The lifetime risk of developing colorectal cancer is about 1 in 23 for men and 1 in 24 for women. Some of the risk factors for developing colon cancer include genetics, chronic inflammatory conditions of the colon, radiation, and lifestyle factors such as lack of physical activity, a diet high in processed meats, being overweight, obesity, alcohol use, and smoking. Common symptoms of colon cancer may include rectal bleeding or blood in the stool, change in bowel habits, abdominal discomfort or pain, weakness or fatigue, weight loss, and iron deficient anemia. However, it is important to emphasize that most of the patients have no symptoms. Because the incidence of colon cancer in men and women under the age of 50 has steadily increased over the years, the updated recommendation is to initiate screening at age 45 in all adults. Multiple screening tests are available to detect colorectal cancer, including non-invasive stool testing that checks for blood or altered DNA in the stool. However, they cannot substitute colonoscopy which remains the golden standard not only to diagnose cancer but also to detect and remove polyps (precancerous growths) before they become cancerous. Sadly, in Albania and Kosovo, there are no implemented screening strategies, and most cases of colon cancer are diagnosed at advanced stages. There are no data available about the colon cancer Albanian population in the USA. In my clinical practice, I encounter many Albanian patients who hesitate to get their screening colonoscopy due to myths and misconceptions. One common myth is that one cannot have cancer if they do not have symptoms or a family history of the disease. However, it is important to note that most patients diagnosed with colon cancer do not have any symptoms or family history. Many believe that the preparation is inconvenient and that the procedure is painful. The procedure is typically done with sedation in a monitored setting and is painless. While the preparation for the colonoscopy may be inconvenient, it is well tolerable and not painful. Having no insurance is another concern. For individuals who are not insured, there are charity programs that can help cover the cost of screening colonoscopy. Screening colonoscopy has been shown to significantly reduce the risk of colorectal cancer and save lives.

LONG-TERM EFFECTS OF COVID 19 INFECTION

The COVID-19 infection can affect multiple organs and systems in the body, including the digestive system. The infection can cause various gastrointestinal (GI) symptoms, including nausea, vomiting, diarrhea, and abdominal pain. In some cases, it may cause chronic gut symptoms long after the initial infection, a condition referred to as “long COVID.” According to a recent published study, 16% of COVID-19 patients with no prior GI problems reported having new digestive symptoms about 100 days after the infection. One possible explanation for these long-term gut symptoms is a change in gut-brain signaling that may occur after a COVID-19 infection, similar to post-infectious irritable bowel syndrome (IBS). COVID-19 can also affect the liver and cause liver damage, reflected by the elevation of the liver enzymes that may last for months after diagnosis. Researchers at Massachusetts General Hospital discovered COVID-positive patients had a “statistically significant” higher liver stiffness than the rest of the population. Liver stiffness indicates long-term liver injury such as inflammation or fibrosis, the buildup of scar tissue in the liver. The duration of these effects is not yet known. The lockdown and social isolation increased the consumption of alcohol, which contributed to liver damage. Many preventive services such as colon cancer screening were also delayed or canceled due to the outbreak. Following the pandemic, many people avoided going to the hospital because of fear of getting infected.

WHY ARE PHYSICIANS LEAVING ALBANIA?

Albania is facing an exodus of medical professionals leaving the country for various reasons. Albania lacks job opportunities, including in the healthcare sector, leading to disillusionment and a desire to leave. Physicians in Albania are underpaid, and their salaries are not reflective of the amount of training and responsibility they have. Corruption may also be a factor, with many professionals facing obstacles blocking the path to professional development and success. Additionally, work stress and feeling undervalued are other reasons why physicians and other medical professionals chose to leave Albania.

WHO IS DR. ELONA SHEHI?

Dr. Elona Shehi graduated with honors from the University of Medicine of Tirana. She completed her residency training in New York and is board certified in Internal Medicine. She is currently in her last year of training in the subspecialty of Gastroenterology. Dr. Shehi is one of the few Albanian women specializing is Gastroenterology, a highly competitive and mostly man-dominated field. She has been distinguished for her excellent patient care, passion for teaching and clinical research. Dr. Shehi was involved in clinical research about Covid 19, viral hepatitis, colorectal cancer, and other GI pathologies. Her research work was presented at world-known conferences in the United States and Europe and was cited in the updated colon cancer guidelines of the American College of Gastroenterology, and European guidelines for the management of a cystic liver disease. She is involved in treating and helping people of the Albanian community, helping uninsured patients in receiving medical care, and guiding young Albanian professionals who are interested in pursuing medical career training in the US.