SORRY FOR THE VALLEY GIRL HEADLINE, but we're trying to get your attention here so you can get tested - like yesterday, you know. Duh. It would be totally tubular if you did.
Get tested? Tested for what?
Oh, don't be a Joanie. Haven't you heard? If you are a woman over 40, you are in a group with the highest rates of Hepatitis C infection. We know, we know. You're not an IV drug user and you might not even be sexually active. Doesn't matter. Women our age were alive back when blood supplies were not tested for Hep C and needles were sometimes reused. More importantly, blood transfusions were given that were often infected with Hep C and no one knew.
When she begins to speak, it is hard to take your eyes off of her. She is lovely, she is brilliant, she is captivating and inspiring--and clearly energized for the task at hand. Within five minutes she has completely captured first your attention, then your respect, eventually your affection, and finally, your imagination.
You can tell she is smart, right off the bat, even if you didn't know she was a Department Chief of Medicine for the Medical Staff at Carilion Roanoke Memorial Hospital.
You can tell she's on top of her game, even if you'd never been told she is the only woman out of 19 physicians in Carilion's gastroenterology division (the quality control of which, by the way, she has been charged with ensuring).
And you probably wouldn't have been told any of that. In the entire time we spent with her, Dr. Marrieth Rubio never mentioned a single credential.
We had asked her to speak to us about the changing digestive system in women over 40, and she is completely consumed with the idea of helping women by educating them about their bodies and their health.
You have to stifle a chuckle when she announces giddily: "The liver is my passion." She goes on to wax eloquent on the regenerative nature exhibited by the human liver.
As she's explaining the science behind the liver regenerating itself, I'm remembering the lizards I used to rescue from cats when I was a child. Their tails were gone and I would bring them to my mother, crying, and my mother would explain how the lizard's tail would eventually grow back. The lizard would not die, she would explain, then she would pull out the L volume of the World Book Encyclopedia to prove it to me, while drying my tears.
Basically, I think -- as I listen to Dr. Rubio's excited explanations -- our livers are like lizards. You can tell she is a hepatologist by training (a liver expert, basically). She is also a general GI practitioner.
"There is so much to cover," she says, trying to rush to fit it all into an hour interview (which we stretched to two hours before it was over). "We should make this a series. Each issue we could cover a different topic relevant to women's digestive health. Our digestive systems are crucially relevant to all of our health issues as we age. The gut is the seat of the immune system --the interface between our internal ecosystem and the outside world."
"Did you know that women between 52 and 72 -- the baby boomers -- are one of the groups with the hightest rates of Hepatitis C? The CDC is recommending every baby boomer be tested. Roanoke is one of the hotspots for Hepatitis C. We usually associate Hep C with IV drug use or having multiple sexual partners, but so many people have Hepatitis C and fall into neither category. Most women over 40 would never think of being tested, but it's so important to find out if you have Hepatitis C before your Hep C develops into cirrhosis."
Dr. Rubio volunteers in a community-wide effort - which includes major players like the Health Department, Blue Ridge Behavioral Health, the Roanoke Treatment Center and the Council of Community Services Drop-In Center - which has among its goals improving the rates of Hepatitis C testing and arresting the rate at which the disease is spreading.
Obesity and poor food choices are so common -- and so intractable -- that physicians don't even try to convince patients they can revolutionize their health with diet and exercise anymore. Patients don't want to hear it.
Dr. Rubio tells the story of one patient with fatty liver disease who complained about her after their appointment. "I was so surprised. I'd spent so much extra time sharing ideas on how the patient might try to change her diet and incorporate fitness goals." The patient stated in the complaint that she had waited a long time to see Dr. Rubio because she was an expert in fatty liver disease, only to be told she needed to eat better and exercise. "What do you do when the cure for fatty liver disease is to eat right and exercise, but your patients would prefer a magic pill? There is no magic pill. There are some new treatments coming down the pike, but basically, the cure for fatty liver disease is pretty simple: eating right and exercising. Where our medical expertise must intervene is when our patients do not eat right or exercise and we try to repair the damage."
"The hard part is convincing the patient how important these factors are and helping them strategize how they can make lasting changes in these areas. It's really not impossible to do, but it does takes know-how, planning and commitment."
At this point, we have been talking for two hours, as my photographer has been hovering, taking shots from various angles. We are exhausted, but Dr. Rubio looks as fresh as a daisy. I marvel that she is actually older than me. She could pass for 10, maybe even 20 years younger. I ask her what she eats. She says she focuses on veggies and grains, with lean meats and fatty fish, and sparing portions of carbs, mostly healthy carbs like sweet potatoes.
She hesitates then smiles guiltily: "I do love cheese. Cheese is my weakness. Cheese, chocolate and wine. But I measure myself." Her smile widens. "You can have what you love occasionally, as long as most of the time you are eating the right things."
Her inspiration is her mother-in-law who is 90 and works out two hours a day and eats chocolate and has a sharp mind. "She has a better mind than I do, she's a math whiz, and she's 90."
Alternative medicine - things like acupuncture, homeopathy, herbal medicine - all of these can be powerful adjunct therapies that complement conventional medicine, but she cautions that women should always check with their doctors to ensure what they are doing is not contraindicated. For instance, Dr. Rubio takes turmeric for her age-related joint aches and swears by it, but she warns that women who are on blood-thinners may not be able to take turmeric. Even with a simple root like turmeric, there can be dangerous interactions with certain medications.
"Tell your doctor everything," she recommends.
Dr. Rubio is especially adamant that you are never too old to reverse your health.
"Did you know that we have a physiological age that can be different than our chronological age? With liver transplants, candidates over 70 are generally excluded, but there have been studies showing that some 79 year old recipients can do as well or even better than young transplant recipients. It really is a function of their physiological, not chronological age. How healthy is your heart? How strong is your mind? How well do you move around? Muscle tone, energy level, kidney function, those are the factors that determine the age that matters."
She tells us that sometimes only half a liver is available, but once transplanted into the right body - a body that is being properly cared for - the transplated liver will regrow its missing half.
"Our bodies have an amazing capacity for healing, our cells replace themselves regularly, our liver regenerates itself. Even if we have done damage to our bodies in the past, it is almost never too late to turn it around. I truly have been in awe at what I have seen people survive and come back from. What seems impossible happens every day."
We have come full circle, I think to myself, remembering the lizards again.
I smile inwardly.
Dr. Marrieth G. Rubio is a physician in Gastroenterology and Hepatology at Carilion, Chief of Medicine for the Medical Staff at Carilion Roanoke Memorial Hospital and Chief of Hepatology at Carilion Clinic. She also is an assistant professor of Internal Medicine at the Virginia Tech Carilion School of Medicine. She has been in practice for over 20 years and received her medical training from Universidad De Chile and did her gastroenterology and hepatology fellowship at Tulane University.
Photo Credits: Rowen Miller
Dr. Rubio with her scheduling coordinator Daniela Hoch
Eating Right + Exercise
How to Get Your Liver to Love You
Our continuing conversation with Dr. Marrieth Rubio, MD
GET TESTED (like) YESTERDAY (puleeease)
By Donna Gail Broussard
"...we tend to equate food with comfort, and comfort foods aren't always the healthiest foods."
- Dr. Marrieth Rubio
"Did we mention she talks with her hands? It makes for animated conversation, but it can make it hard to get the shot right."
- Rowen Miller
"I could talk about the liver all day," Dr. Rubio says. And I have no doubt she could. It is 5 p.m., after a full workday,
and this woman's energy level has not waned. "There's not only hepatitis, but the new epidemic is fatty liver disease, affecting one-third of American population and our area is experiencing a significant problem with this."
I nod a great deal as she races through all the science, taking notes furiously, pretending I understand everything
she's saying -- even though her IQ is obviously several decades above mine.
"As a general GI, I can talk about acid reflux, H. pylori infection, all the types of GI cancers -- colorectal cancer being one of most significant. Women over 40 face increased incidence of constipation and diarrhea. As we age, we also tend to take more medications and this can be a problem. Ironically, baby boomers are famous for taking more vitamins and supplements to optimize health, and if those are not managed properly, we can do damage to our digestive system, leading to liver toxicity or even liver failure. Then there's a tendency to develop swallowing issues as we age. There is also the issue of C. Diff. We were accustomed to seeing C. Diff as a hospital-acquired disease, but now patients are coming from home with C. Diff."
There is clearly a lot to cover -- more than we can begin to touch upon in just one article. I agree with her completely. It's a good idea to do a series on these GI issues. Hepatitis C in aging baby boomer women? I never had any idea that was an issue before this conversation. The wrong mix or too many vitamins can lead to liver failure? Who knew? I start thinking about all the questions I want to ask. Is it true we have declining levels of stomach acid and enzymes to digest food as we age? What about leaky gut syndrome? Gluten intolerance? There are so many issues that intimately impact our lives and our health as mature women, and Dr. Rubio has offered to be our tour guide through the human gut.
However, I've taken in about as much science as I can stomach at this point, so I start asking her personal questions.
She is as forthcoming on these questions as she was when I asked about fecal transplants (Yes, they perform them at Carilion in Roanoke and the results are striking. We talked about fecal transplants and the human gut biome for 15 minutes at least. You can't blame me. Aren't you curious about those fecal transplants everyone is talking about? They've become more sought-after than facelifts.)
One of my first personal questions is what made her want to be a doctor? Growing up, she loved watching Dr. Marcus Welby MD and swooned over young Dr. Joe Gannon on Medical Center. Young Marrieth was born and raised in Chile, but apparently Dr. Welby was broadcasting internationally.
Later in life, her father's import-export work brought them to an island port city with a poor but very closed, insular culture where newcomers were shunned as outsiders. The doctors and lawyers who came there to do charitable work among the poor were ostracized as well. All the outsiders formed their own community, so Marrieth was surrounded by doctors, engineers and lawyers for all those years. She liked the doctors best and followed them around, asking them questions, listening to their stories. "They saved people's lives and it was all so exciting." One of those doctors she met back then ended up supervising her early surgical residency. No woman had ever completed a surgical residency in Chile, and Marrieth was only the second to try.
"How do you get people to open up to you so easily?" she asks me. "I don't tell people this much about myself ever."
I tell her it's because there's nothing I love more than telling women's stories. "I've been a storyteller all my life. I love people and I love to hear and share their stories. They can tell that, and so they open up. The same way the liver is your passion, stories are mine."
She nods, she understands, and she continues sharing her story, answering my questions even as they become more deeply personal.
Marrieth met the love of her life in medical school. He pursued her, but she was at first resistant. So he became her best friend, and she told him all her secrets. "At that point, I was faced with a decision," she says with a smile, "He knew all my secrets. I had to either marry him or kill him." Over the years, her husband visited his brothers in the U.S. and fell in love with America. He came first and convinced her to follow. Today, he works at Carilion too, as Chief of Pulmonary & Critical Care Medicine. I googled him when I left the interview. He's quite handsome and accomplished. I can see why she married him and followed him to America.
They have twin girls and a good life here, but she still gets homesick and goes back to Chile yearly to visit family and friends. Her father died last year, and he was her best friend. "I don't know that I will go home as often. It will be hard now that he is gone."
She generously tolerated my foray into her personal life, but she quickly returns us to the subject at hand.
"There was a woman..." she begins. I watch her face as she tells us a heartfelt story about a 70 year old woman who came in with blood in her stools. She'd had fatty liver disease noted on her charts almost five years before, but she had not stopped its progression. Dr. Rubio ordered tests for hepatitis and cirrhosis. The woman had no idea all of this had gradually been wreaking havoc in her body until she showed up at the emergency room with bloody stools. You can see Dr. Rubio's grief at this woman's catastrophic -- and completely preventable -- health crisis.
I ask her: if you had five minutes in front of all of our readers, what are the most important things you would try to convey to them? She was ready for that question, and it didn't take her five minutes: "Drink 8 glasses of water a day. Make sure you do some form of exercise for at least 30 minutes every day. Eat good food. Stay away from processed food and fast food. Eat mostly vegetables and grains, eat fish and lean proteins, fruits (but be careful with exotic fruits and grapes which are more sugary),get plenty of fiber, eat more fresh foods, limit your carbs and sweets, don't drink soda, eat less fat and eat healthier fats, limit portion sizes..."
My first thought is that all my readers have heard that particular song and dance. "We all know what we're supposed to do, " I tell her. "The question is why don't we do it?"
Dr. Rubio attributes it to many factors: our stressful lifestyles, the ease of relying on fast food meals, our love affair with sugary foods like soda, our culture of eating with massive portion sizes and Southern-fried everything. "We live fast, we eat fast. Even when meals are homecooked, we tend to equate food with comfort, and comfort foods aren't always the healthiest foods."