- It's once again time to get gutsy with Liz Hall
and her expert guests on the Gutsy Babe Podcast.
- Welcome to this episode of The Gutsy Babe.
I'm your host, Liz Hall. Today's guest is Dr. Anna Toker.
Dr. Toker is a distinguished award-winning board certified
colorectal surgeon with nearly 20 years
of expertise in the Dallas area, renowned for her ability
to translate complex medical concepts
into everyday language.
Dr. Toker attracts patients from across the country seeking
her surgical expertise
and nutritional guidance
as seen in her highly acclaimed gut check program.
I am so excited to have a conversation with you, Dr.
Anna Toker. So thank you for joining us today.
- Thank you for inviting me, Liz. This is awesome. Yay.
- I am a huge fan of yours on social media.
I follow you and I love all the information that you share.
- Oh, I'm glad. Yeah.
It's like a mission of mercy for me to spread.
I've been in practice for a long time. Mm-Hmm. .
And I think as you get older, you start to get wiser
and it's a good idea kind of to pay back.
There's a lot of false
information and I thought, you know what?
I'm just gonna put out real
information and we'll see where it goes.
So
- That's beautiful.
So let our listeners know a bit about your backstory.
What got you involved in colorectal surgery
and why did you start integrating diet, lifestyle
and supplements into your treatment?
- Well, you know what, I was born
essentially to be a doctor.
I mean, I can remember, I don't ever remember
not wanting to be a doctor.
And I probably started wanting
to be a surgeon at a very, very young age.
So I always knew I was gonna be a doctor.
I always knew I was gonna use my hands. Mm-Hmm. .
And so being a physician
was something I always wanted to do.
Now, a young child motivated in this way
is not thinking about getting married,
having children, lifestyle.
What does it involve? It was an academic pursuit for me.
Mm-Hmm. . Um, so when I got married
and we're getting through our residency, then I got pregnant
and I had this sort of a clear vision
image one night in the middle
of the night while I was doing a trauma case.
So a patient comes in
and riddled with bullets, we take 'em to the operating room
and, and at the time I was pregnant
and no one could know that that was like for Boden.
I could have been fired. I was the chief resident,
but they would have gotten rid of me had they known.
Right. So, so I was kind of already in
that mode of thinking about
how I was gonna manage my family, being a general surgeon.
And then I looked at the anesthesiologist who's like the
65-year-old man,
and the, the attending surgeon helping me was a
65-year-old man.
And I thought, oh my God. What?
Wait a second, I'm gonna be doing this at two o'clock in the
morning until I'm in my sixties.
Like, who's gonna take care of the child?
Like it never, ever, ever occurred to me.
And now, you know, I had been out of medical school
for five years, again, chief resident,
about to start my practice.
And it just was one of those clear vision moments where
trauma surgeries probably not good
for my family, for my family.
Um, and so then I just kind of, I was really fortunate
'cause I always made good grades
and good test scores and Mm-Hmm. .
Um, so I really could choose whatever I wanted to choose.
And I was recruited heavily for plastic surgery, actually.
Oh, wow. Um, but they do trauma too.
Like people that people think plastic surgery.
Oh, it's boobs and liposuction.
No, it's facial reconstructions.
It, you know, it's hand reconstructions near
amputations in the middle of the night.
There's a lot of that. And again, it was just
the concept of of having to be up all night every night.
And the only doctor I never saw in the hospital in the
middle of the night was the colorectal surgeon, .
I like what his patients love him.
I had never been to a clinic for colorectal surgeon.
I had no idea what was involved except
the big surgeries that we helped him with.
Colon cancer and diverticulitis and those kind of things.
So, so he saved lives from nine to five.
And I thought, you know what? That is what I need to do.
You know? And so when I did my fellowship,
my first day in fellowship, we were in clinic.
I had no idea. Wow. It was so as fixated. I had no idea.
It's like, it was the, I thought it was the
worst decision I had ever made.
I went home to my husband and I said, I can't do it.
We defiled so many people.
I was just, I could, I was just heartbroken.
I could not do that for a living.
And you know, he gave me the baby. By then I'd had the baby.
I mean, I got literally two weeks off after this child
and then started my fellowship and um, okay.
I got the baby. And he goes, I hug the baby.
He goes, you feel better. I was like, I feel better.
I made the right decision. And he goes, well,
you could always go down the street and be a trauma surgeon.
You're a board certified surgeon.
He knew I didn't wanna do that. Right.
So I was like, all right, I'll go to work tomorrow.
And then the next day we were in the
operating room and it was awesome.
And I thought, that's fine. I will just sort of play
with clinic a little bit.
It has made me reasonably entertaining.
And, and that's one of the reasons why I think patients
gravitate towards me because you gotta make it playful,
otherwise it's scary.
Uh, you know, if you go in there with your butt hurting,
it's kind of scary to look at people
and have to explain all these kind of private issues
and nobody wants to talk about it.
And so anyway, I have made a career of, you know,
at the time when I started my practice, I had now two small,
I got fired when I was pregnant
with my first job out of practice .
So my first, my first job was going swimmingly
and then I got pregnant and then I got fired.
So I had to start private practice with two babies.
My husband was now in medical school.
And um, you know, I just, I kind
of got more focused on talking to the patients, getting
to know their families.
Mm-Hmm. . Um, I had, there was a lot
of politics involved in this world.
I live in a man's world. Yeah.
And there's a lot of politics.
So it was very hard for me to get referred to this day.
I do not get referrals from those doctors.
Um, I get the referrals from
the patients and their families.
That's asinine to me. That's crazy.
Well, it's, you know, you just have to understand though,
the men are very protective.
Um, there's a lot of stereotypes where
surgeons are always supposed to be kind
of like on this little pedestal.
I was never like that. Yeah. I don't respect the author.
I'm very belligerent . Right.
So they like me for this reason,
but the patients love me for that reason.
So most of my patients do come from word of mouth.
The female doctors, most of whom are, are gynecologists,
obviously send a lot of patients to me.
'cause we do pelvic floor surgeries together.
And that's kind of how I built a career on that.
And now I'm sort of at the end of my career.
And, and as to the nutrition thing,
because I do get to know my patients and,
and most surgeons we have a saying in surgery, uh,
you know, you meet someone, you treat someone, you treat
that person, you are never supposed to see 'em again.
If you do your job as a surgeon,
colorectal surgery is a little bit unique
because there is some primary care to it.
Mm-Hmm. colonoscopies, like you do a colonoscopy,
you're kind of with me until we both die,
is essentially what happens.
You know? And then you'll come in, like a lot
of these patients came in.
Initially there were women who just had babies.
Their hemorrhoids were terrible. Mm-Hmm. .
Well those women as they get older,
are getting diverticular disease, God forbid, cancer.
They're sending their parents.
People are starting to fly
to me from all over the country just based on word of mouth.
Yeah. What I've noticed in particular, in the last,
well this was before Covid when I noticed this,
so I guess the last 15 years,
but from 2010
to 2019, there was an,
an alarming change in the overall health of, of humanity.
Yeah. And you know, I, I just have,
I'm a simple country surgeon and I have a simple practice
and I've known these families for a long time
and you could see it as they age.
I could see it in myself. Mm-Hmm.
, getting tired, gaining weight,
getting the high blood pressure.
I really wasn't doing anything different than I
had ever done, ever.
I blamed a lot of it on menopause until I started sort
of paying attention.
The guys didn't, were not in menopause. Right.
The 20 year olds were not in menopause.
What are we doing with these obese 20
year olds with hypertension?
That's crazy. It's our food. Yeah.
Well, yeah, it's of course right.
, it's So, you know, Soylent Green as people,
like it's in the food.
There's something in the food or the water. Yeah.
For both, you know.
And it just sort of sent me on a kind
of a mission I noticed very rapidly.
Mm-Hmm. that patients who came in with ib.
And this is the other thing, because now you've flown from
across the country to see me Mm-Hmm. ,
you can't come into my office
and me not offer you some kind of advice.
Right. Because every other doctor you've seen in America has
said nothing wrong with you, leave my office please.
So I felt like, okay, I cannot actually do that to someone.
So I just started asking 'em, well
what do you eat for breakfast?
Yeah. What do you eat for lunch?
Have you kept the diary of when you're hurting?
Like maybe it's something you're eating.
And it just kind of turned into like,
that's my course of action now.
Food diary, you have to do it.
And I would say 90% to people who come to see me
are not eating properly.
And if they literally would add, would do one thing,
and that's go gluten-free.
If you go gluten-free, most patients would never need me.
- Wow. - If you go gluten-free,
add a kiwi fruit in the morning
and say magnesium into your life,
you probably don't need me at all.
So I, IFI feel like I'm educating my way outta practice,
but you know, there's always gonna be a need for surgery.
Of course. So, so to me, it's not a threat to offer
medical advice.
A lot of surgeons get nervous about that
because they're like, well,
I'm just gonna operate on the patient.
I'm thinking your outcomes are terrible
'cause you're operating on the wrong people.
Yeah. Now you gotta operate on the right people. Exactly.
And to do that, you gotta, you gotta do a lot of stuff
to prep a patient for an operation to know
will the operation help them.
And a lot of times, honestly, this conversation,
they call you back and say,
you know what, I'm actually better.
Don't even need the colonoscopy. I'm fine.
So, you know, that's kind of how I got into it.
- That's amazing. I mean, I have
so many questions I just Sure.
- Ask them. I mean, I'm here. What the hell.
- So you're obviously, you're spot on.
I, I am so right there with you that it is in our foods.
Our food has changed. We have so many preservatives now.
Our soil quality, even in our water, like it, it's,
it's really, really sad.
But what you said is, okay by
gluten, gluten-free and eating a kiwi
because of the fiber content and magnesium.
What kind of magnesium would you recommend?
- Uh, so there's three that help patients who have
constipation, right?
Mm-Hmm. . So, um, uh, magnesium citrate,
magnesium sulfate, or the two big ones
because they help with constipation.
Now if you do not have constipation,
but you got the restless legs, magnesium glycinate
or glycinate
- Yeah.
Glycinate. That's the one I would
- Yeah, for sure.
Because it's less likely to cause the bowel issue.
Yes. Right. So it, it just kind of, my magnesium advice
is structured around which patient's talking to me.
Is this person constipated or do they have diarrhea?
But everyone needs it.
I, the way we grow our food is so ridiculous that you,
the plants don't have enough time
to really absorb the magnesium out of the soil.
Or the soil is so deprived Mm-Hmm.
that there's nothing there. And that's where we are supposed
to get our magnesium from.
You know. So, and I know you do a, you have a,
a travel, A travel ease.
Is that the name of your product?
- Yeah, I do. Oh
- Yes.
Because it's got magnesium in it, right?
- It does, it has magnesium glycerin. Um, oh,
- There you go.
Yeah. Okay, perfect. Perfect. Yes.
And that's a great, and that's, that's good
for a restless leg and it's good for, um,
muscle relaxation and focus.
And there's a lot of things that honestly, if you'll reach
for some magnesium patients will do well.
You don't need to have the poopy forms.
Um, but you do wanna have a relaxing form
of magnesium. So most people
- Are, most people are deficient in magnesium,
- Zinc and magnesium are the two big ones.
Zinc and magnesium wasn't the two biggie.
- I used to have restless leg syndrome.
And ever since I've incorporated magnesium, of course,
from my product, but also as an additional supplement,
it's really changed my life
- For certain, just no question.
- So I, um, my personal journey, I used
to suffer from constipation most of my life.
Um, I had endometriosis
and it was in my rectum area.
- Oh, I hate that. Did you have to have surgery?
- I did. - Multiple, yeah. Yeah. Usually that's the case.
Oh my gosh. Yes. That's a big surgery too.
- Yeah. So I've, uh, suffered from it for many years
and um, of course not being able to go to the bathroom,
like going once a week was like huge.
And just up until recently, actually right
before, um, our call, I started thinking about it.
I'm like, oh my gosh. I actually go to the,
I have two bowel movements a day now.
And that's literally since this past year only.
And that's actually supposedly normal.
And I am like so grateful that I get to go
to the bathroom Now. ,
- I've achieved normalcy. Oh my God. Yeah.
Twice a day to twice a week. That's normal.
Joan, congratulations.
- Thank you. . So what's the difference
between a gastrologist and a colorectal surgeon?
I'm curious if it's the same or not.
- It's, they're very different.
First of all, the gastroenterologists have a cooler title.
, it's, it sounds very scientific.
Colorectal involves the word rectal. Yes.
And I can't say the word rectal on social media
without getting flagged.
Like it is very difficult.
And I say it every time I give,
every time time I do a video, I'm like,
I'm your friendly neighborhood colorectal surgeon.
So, um, so that's the first and most important thing.
And I think that is a travesty.
Um, but gastroenterologists are a medical specialty only.
So those doctors don't do any surgery.
They, uh, will do a three-year medicine, um, residency,
internal medicine residency.
And then they do a fellowship training in gastroenterology.
They will do like colonoscopies and EGS and ERCPs.
The scoping, the scoping things. Mm-Hmm. .
And then they hand out medicines obviously.
And they do the IV interventions
for inflammatory bowel disease.
If you really are bad off
and you need some of these very specialty IV medicines,
it's not your surgeon doing that.
It's gonna be a GI doctor who's an internist, um,
a colorectal surgeon on the other half.
And to be a colorectal surgeon, you have
to be a board certified general surgeon.
So that's a five year residency in general surgery.
And then their colorectal surgery
residency is not a fellowship, it's a second.
Board certification is only a year long
because you're already a surgeon.
Mm-Hmm. , we tend to restrict our practices
to kind of the middle of the small bowel
to the anus essentially.
And that's simply not to kind of tick off a lot
of general surgeons.
Mm-Hmm. and we'll do colonoscopies,
but we don't do EEGs so that we don't tick off.
So we, we walk in a fine line. Do you understand?
There's like a tightrope.
The politics involved are kind of, um, are kind of difficult
because everyone is afraid you're stealing their business.
And it doesn't trust me,
you could plunk a hundred colorectal surgeons around me.
I'm not stealing their business.
They're not stealing my business.
My niche is so uniquely mine that I have zero , zero fear.
But it is always very difficult when you're dealing
with new doctors when they hear the cases
that you do and they wanna know why.
Or hospital administrators who are like,
well why do we need a GI doctor and a colorectal surgeon?
'cause like you, maybe they don't know the difference.
Right. I think colonoscopies, everyone's doing colonoscopies
and it is, it is, it is a different specialty.
What we're looking for completely different.
Our mindset is completely different.
I think if you're gonna have colon cancer
screening, in my opinion.
Mm-Hmm. . Or if you have a symptom, a problem,
you really should go see the colorectal surgeon.
That way you're immediately on the schedule
if something is found.
The other issue is if your gastroenterologist plays golf
with a general surgeon, no matter how bad he is, that's
who he's sending his patients to.
Yeah. And then someone like me has to correct the damage.
So , no offense if you are a general
surgeon 'cause I am too.
So I'm just saying sometimes the referral base in politics
goes to the guy you go duck hunting with
and not necessarily the person
who is the best technical surgeon.
Mm-Hmm. . So you just kind of have to know
who your doctors are.
If you think you have a serious problem,
go see the colorectal surgeon first.
And that doctor might say, listen,
there's no surgical problem.
You need a medical specialist and they'll send you to gi.
That's how I would prefer it.
And the GI doctors will say completely the opposite of
what I just said, , you know, they'll just flip it.
But that's just, that's the nature of competition.
- It is. And I always like to say, you have
to be your advocate.
Be and Yeah. I totally get why you have a huge
following and it's all by referral
because you truly care about your patients
and you're doing what's best for them
and you're actually listening to them.
A lot of doctors don't listen anymore.
- And I can I just tell you this totally aside,
I know we're supposed to be talking about gut health , but,
but one of the big things that comes up in some
of the conversations, not just in my office
but on social media will be why don't doctors listen
to their patients?
And it's, it's interesting, I,
I started medical school 32 years ago
and back in those times, that is what you did.
You sat and you had an interview with the patients
in the first three years of training.
When you're in medical school,
that's all you're doing is talking to patients
because you have to learn how to talk to a patient.
Um, in the modern era, a couple
of things have interfered with that interaction.
Uh, one of them is modern testing.
So when I was an intern, we did not, the CT scan was
so coveted you didn't ever use that.
Like, like brain injury was like about
the only thing you ever used it for.
So if you came in with belly pain, incomes,
the surgery resident who does the interview,
does a physical exam, makes their best assessment.
And if you thought the patient needed a CT
scan, you would get it.
But we actually would take you to the operating room.
Like that was our part
of our physical exam was operating on you.
Believe it or not. Wow. That was just 30 years ago. Yeah.
Um, so the modern era, we've saved a lot
of these exploratory surgeries,
but it also means people have gotten away
from physical exam.
What's the point of the physical exam?
But the machine's gonna tell us. Right.
So, so there's that limitation
and when you combine that with the way modern medicine is
reimbursed, so in other words by a third party payer,
it's very difficult to stay in practice
if you actually take 30 minutes per
patient with the patient.
It's one of the reasons I insist patients do their paperwork
before they come to my office.
Every minute you spend in my office doing paperwork you
should have done at home is one you.
So that motivates me.
If you want me to speak to you,
we gotta use our time quite wisely.
now. So when I was an employee of a hospital,
they mandated my schedule.
They never gave me time to talk to a patient. I was overrun.
It was, it was a blessing.
They decided to get rid of all of their subspecialists
because someone in the mathematics department decided
surgeons cost insurance companies money
and we were just bought by an insurance company.
Mm-Hmm. . They're like, oh,
we'll just get rid of our biggest expense.
The surgeons. So they got rid
of all the subspecialty surgeons only to find that
because what they bought was also a hospital.
The surgeons actually are generating money for the hospital.
Mm-Hmm. because we're operating on people when someone
comes in with diverticulitis isn't about to die.
Who's going to save that patient's
life if you don't have a surgeon?
So anyway, they got rid of me Right. As Covid was hitting.
And it was a blessing
because I was able to reset my practice in a way where,
you know, kind of in the image that I wanted, I wanted
to spend more time with patients.
Yeah. During that period of time where we were not allowed
to operate on anybody, I got to sort of hone some skills
by way of telemed like you and I are talking.
Mm-Hmm. , you know, well let's try
something non-surgical first.
'cause God knows I can't get you in the
operating room unless you're dying.
That was the mandate for about six months.
You had to be 24 hours from
death or you couldn't have surgery.
And that included cancer and
diverticulitis, believe it or not.
So, so I got to talking
and it's shocking how many people you could talk outta some
surgeries, not cancer obviously,
but some early diverticulitis
and chronic constipation stuff and hemorrhoids.
Yeah. You can talk them out of an operation with proper diet
and, and exercise and that sort of thing.
So that kind of is what launched the wellness Dr.
Anna as opposed to Dr. Toker, the surgeon. So
- Oh it was meant to be then because
- Yeah, it was, it was all, yes.
It's all God's plan. So I'm just along for the
ride, - .
It's true. God is in control. He correct. He has the plan ,
- Even when you think you're in charge.
Mm-Hmm. , you might
as well just enjoy the scenery 'cause you are not .
So, so that's what I'm doing.
- So speaking of hemorrhoids,
how can you avoid hemorrhoids? And can you,
- You can, first of all, let me just clarify
'cause people are shocked to hear this.
Mm-Hmm. this.
But, but hemorrhoids are normal anatomy that you are born
with because they're just blood vessels coated
with either skin or the lining
of the lower rectum. So you're born with them.
- Okay, - Time because we are bipedal animals.
Gravity, because we spend a lot of times sort
of squatting and tying our shoes.
Or you have a baby or you have constipation
or you just read while sitting on the toilet.
All of these things worsen hemorrhoids
because simply because of gravity.
This is physics now talking, you know, if you can think,
like if you work out, you know,
you've got little veins in your hands.
If you hold your hands at your side
and pump up those veins, you can see them pumping up
or your butt's doing the exact same thing.
If you're sitting in a squatted position
and lifting something.
So men who are mechanics
or electricians who have to squat into small spaces
and exert horses, they're putting
that pressure on their hemorrhoids when they read
and sit on the toilet,
they're putting pressure on their hemorrhoids.
Women as we have labor and delivery
and now we're chasing around a two,
how many shoes have you tied in your lifetime?
Get up and you can't get on your knees
and sit on the floor and pick up toys.
It's a squat up, down, up, down.
Of course that's terrible for your hemorrhoids.
So a lot of my practice with hemorrhoids are men
with mechanical jobs
and women who either have children or like to garden.
Um, you know, or have constipation.
So, so if you can avoid here, the,
here's your tips on avoiding hemorrhoids.
So you're ready. So I just outlined who gets 'em?
We just talked about, well,
we're hemorrhoids and who gets them.
So now how to stop number one,
do not read while sitting on the toilet.
Never do that. That's like the number one thing.
And if you've got a job
or you have to kind of squat down to kind of do something,
do not squat and do it, get on your knees or sit on a chair
or they have gardening stools with these tall handles.
If you're, if you're in the garden,
I do a video on my website on how
to avoid hemorrhoid surgery.
And we talk about the patron saint of hemorrhoids,
who literally, because of a gardening feat got terrible,
terrible hemorrhoids, right?
So he's demonstrating that squatting
and lifting something heavy causes hemorrhoids.
Now the cure of his hemorrhoids was to sit on a rock.
And so pressure manual compression
to those hemorrhoids will actually help you.
The, so when hemorrhoids swell,
they wanna fall outta your body.
'cause your body mistakes, this tissue for poop falls out
and you gotta push against it to push it back in.
So if you've got swelling, hemorrhoids, put pressure
to the area, right?
So avoid the hemorrhoids by no prolonged squatting
and exerting yourself if you're constipated,
take the kiwi fruit 'cause it helps with constipation.
Drink lots of water.
If they swell, just put a little pressure against them
to pop 'em back on the inside and then lay down.
Some patients, I'll make them use a little suppository right
before bedtime, right?
So hot bath, relax the muscles
and put a little suppository in, lay down in bed.
And that way that thing will dissolve
with the hemorrhoids pushed back inside.
And then they can kind of resorb the blood flow.
Can resorb, some people get to a point where it's too late,
too far gone, and then you need surgery.
- And is the surgery, um, a fissure?
Like I've heard of a fissure.
- Well, they're, those are two different things. Okay?
So, um, most people
who think they have a fissure will come in
telling me they have a hemorrhoid .
Um, so a hemorrhoid is a blood vessel
and usually they do not hurt
unless they get a blood clot in them, or very, very swollen.
Um, whereas a fissure almost always hurts.
That's a little cut in the lining of the anal canal.
And it just, it's like a ripping tearing sensation.
You know it when you have it, you may not realize
what it is, but you know it.
Yeah. And I've seen grown men crying
because they're in so much pain from a fissure.
So fissures are very painful,
the surgeries are very different.
Okay, so a hemorrhoid surgery.
God, I pray you don't ever need a hemorrhoid surgery.
We try to do those minimally invasive,
but dude, that's, that's tough.
Listen to me now people, if you can avoid it, if, this is
what I tell people in hemorrhoid surgery, if your
butt is dictating your life, it's time for an operation.
If your butt is not dictating your life,
do not randomly have the operation just
because you had a colonoscopy
and someone said you had hemorrhoids.
Okay. So that's kind of how I define that.
The, the fissure people are usually hurting so bad,
they're asking for an operation
and their surgery is much simpler
and actually much less painful than a hemorrhoid surgery.
So I never shy away from a fissure surgery,
but I always try to talk people out of hemorrhoid surgery.
- Surgery. You have shared such a wealth of information.
I'm so grateful for you. So thank you, thank you, thank you.
Well, that's it for this episode.
Don't forget to hit the subscribe button
for more gutsy babe content.
Until next time, move with love and ease.
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