Diarrhea Revisited

Why the Re-release?

Leah 0:00

Tina, didn't we already do an

Tina 0:05

but we're gonna do it

Leah 0:06

guess this the same episode we previously released but we actually updated of

Tina 0:13

So our re-release this episode is because

Leah 0:17

it used to

Tina 0:18

and it's

Leah 0:20

breast cancer

Tina 0:22

hot.

Leah 0:22

They're toasty They are toasty And there yeah there is some new information new treatments and and so we kind of wanted to add that in

Tina 0:32

and we're gonna get there enjoy the summer a little bit as we prepare for season three in September well.

Leah 0:38

Yeah So if you like this idea of doing updates, let us know and yeah, we hope you enjoy episode again,

Tina 0:48

And our next episode will be, New material, just so you know.

Leah 0:52

That's right

Tina 0:54

I'm Dr. Tina Kaczor And as Leah likes to say, I'm the science-y one

Leah 0:58

And I'm Dr. Lee Sherman and I'm the cancer insider,

Tina 1:02

and we're to naturopathic doctors who practice integrative cancer care.

Leah 1:06

But we're not your doctors

Tina 1:08

This is for education, entertainment, and informational purposes only.

Leah 1:13

do not apply any of this information without first speaking to your. doctor

Tina 1:18

The views and opinions expressed on this podcast by the hosts and their guests are solely their own.

Leah 1:24

Welcome to the cancer pod.

Introduction

Leah 1:41

Hey, Tina. Hi, Leah. So I'm wondering if we should do like a content warning for this episode. I don't know if people would be kind of sensitive about talking about diarrhea

Tina 1:53

Yeah. I think we're desensitized as naturopaths.

Leah 1:58

Yeah. Cause we talk about poop all the time and we didn't do a content warning for constipation, but yeah, if you're like, Grossed out from talking about bodily functions. This might be an episode that you skip

Tina 2:09

or we'll just, we will be gentle. We're not gonna be graphic.

Leah 2:12

No, but we're just talking about, it's like, like with the vomiting episode, just by saying the word sometimes that triggers people. So this is your trigger warning. All right. That's it. So this is the third episode in our side-effects pod. And. Uh, first one, we covered kind of the basics on why bowel changes happen. And then our second one was about constipation. And now we're talking about diarrhea, the flip side, the flip side. Yeah. So what is. What do you do about it? Integratively? What do you do about it? You know, from the pharmaceutical or over the counter standpoint. And then we end this episode with not only our song,

Diarrhea- Defined

Leah 2:54

but our moment of

Tina 2:54

whoa. Great. Yeah. And we'll go, we'll go through diarrhea and loose stool. We should just say loose stool. Cause it really. That's when you start to treat it, don't you think? I mean, you don't wait for overt diarrhea if you can help it,

Leah 3:07

but people define it differently. So diarrhea is defined as being loose or watery stools three or more times a day. So back in the first episode, when you talk about kind of that milkshake, consistency that happens as the stool moves into the large intestine, basically. Water isn't being absorbed out of that and it continues to pass. Then there you go. That's your diarrhea. So yeah. Looser, watery, stools, yes. With frequency.

Tina 3:39

Yes. So that is the definition of diarrhea

Leah 3:41

that opposite. See, I just, I just fit that in,

Tina 3:45

slipped it in there. Well, and I want to just say acute diarrhea is considered. Less than two weeks of diarrhea and chronic diarrhea is two weeks or more if it's lasting longer than

Leah 3:56

two weeks. Right. And you know, there are patients who will enter treatment with this being a chronic condition, you know, like. It's just something that they've managed and lived with. It's the same with constipation. Like you, that's kind of your baseline. And so that's really, when, we want to be really proactive because the treatments aren't going to, I mean, sometimes they'll shift you to the other way, but you know, you just want it. You want to stay on top of it because again, diarrhea is one of those side effects that treat. Can be held doses can be reduced because of the consequences of the symptom.

Tina 4:32

One of the largest consequences besides actual pain identification, which can happen with diarrhea is the electrolyte issue, right? Like losing your electrolytes more quickly than you're replacing them would be the big, one of the big consequences which can lead to spasms and weakness. Low sodium can present as weak legs. For example.

Leah 4:52

Yeah, so people become dehydrated because that all that fluid is just coming out. And so staying on top of hydration, not only, you know, with water, but we'll go into more, um, of other ways of replenishing what gets lost.

Tina 5:06

Let's take a break and come back with some details on what people can do about it.

Leah 5:10

Perfect.

Tina 5:13

Did you know that your stool is mostly composed of water? After that most of the solid part of your stool is actually bacteria. What you often hear referred to as the microbiota of your gut.

Causes

Leah 5:30

So in our first episode, we kind of touched on why. Bell change has happened. And we, it was just kind of a general overview, but I guess we can quickly review some causes of diarrhea during treatment.

Tina 5:42

Yeah. Yeah. The most obvious causes the treatment itself

Leah 5:46

rapidly dividing cells,

Tina 5:48

right? Some treatments will list diarrhea as a side effect of that treatment. And some of them are chemotherapies. If you're getting any radiation to the. In particular, um, that can cause diarrhea.

Leah 6:01

Oh, if you get radiation to your spine in a location that is on the other side of your gut, I think that's something also people don't really expect or if for prostate cancer patients, the GYN cancers to cervical cancer, that's a big side effect.

Tina 6:18

Yeah. So if there's radiation hitting anywhere along the GI tract, whether intentionally or due to the radiation field, including the GI tract, whether it's the pelvis or the abdomen, And then surgery, short bowel syndrome could be an issue or just a portion of the GI tract has been removed due to the cancer, right?

Leah 6:39

Like just even for people who have had gallbladder surgery or anything that would affect the pancreas where you would not have enzymes that help to process your food. And then the targeted therapies was a big one, as well as the colitis that could happen with immunotherapy. Right. And

Tina 6:56

then lastly is some cancers they're not common, but there are some cancers that present with

Leah 7:01

right. The carcinoid. Yeah. Yeah. And then I guess ultimately, you know, the changes to the microbiome, right?

Tina 7:07

Yeah. It's always going to be a consequence. The microbiome will change during

Leah 7:10

treatment. Right. and that would also be like infection. So something like C diff you know, Present in a lot of people. And then with treatment, it gets out of balance and then it becomes really, you know, difficult to treat an important to treat issue. So,

Tina 7:28

yes. So first off, try to pursue the cause of the diarrhea so that you can treat the cause if that is possible or at least know how to manage it with keeping the cause in mind. And then afterwards there can be. Abnormalities and your endocrine function, their auto-immune reactions that have been triggered.

Leah 7:45

There's all sorts of reasons. So when you're saying endocrine, you're talking about like thyroid issues. Yeah. Yeah. So the point is back down to the people talk.

Tina 7:55

Yes. So follow up with primary care physician, it's important to keep a primary care physician as part of your care team, so that when treatment is over, if you have lingering symptoms, that's the most appropriate person to address lingering symptoms after. Whether it's diarrhea or anything else, right? Not

Leah 8:12

your oncologist, even though we all do go back to our oncologist and talk to them about those things. Cause we probably see them more often than we do our primary care. This is

Tina 8:21

true. This is true. But studies suggest. Bringing in and keeping a primary care physician, you get better

Leah 8:28

outcomes. I'm just thinking like you see your oncologist like every three months or so. And then, you know, like, right. It's a lot of doctors. I know. I'm just, I'm just saying I'm just, I'm just here to

Integrative medicine treatments

Leah 8:39

keep it real. Okay. So, um, what to do integratively, what are the things that we think of with, with the patient who has diarrhea? So we've ruled out infection. 'cause that would be like C-Diff. And then for that they're getting antibiotics.

Tina 8:56

Um, so yeah, after managing the hydration aspect and making sure that lots of fluids are going in and sometimes intravenous fluids are required, the diarrhea is severe avoiding anything that's going to trigger. It is probably the most obvious thing to do first. So lay low on dried fruits, fruits, and general fruit juices. Caffeine things that are stimulating to the bowels, dairy, dairy, even if you tolerated it before treatment. So sometimes people during treatment can have that damage to the upper GI

Leah 9:24

area

Tina 9:25

that normally helps you break down lactose in the dairy. If you don't break that lactose down with your lactase enzymes, then that will lead to loose stools. And that can be transient. It will heal eventually,

Leah 9:37

but dairy is a big trigger because of that damage. Yeah. Yeah. The brat diet is a really popular thing that people will hear have probably heard of it even before going through treatment. But that's bananas white rice. Applesauce and toast like burnt toast, kind of really toasty toast. And, um, that is kind of like the staple, the Bret diet don't use brown rice that has too much fiber. You got to use the white rice and that can help to slow down the bells as well.

Dehydration - Rehydration options

Leah 10:10

And you touched on the hydration. Um, I commonly recommend cause everyone kind of reaches for Gatorade and I don't know really if Gatorade has the right balance of electrolytes, but it's popular and it's out there. I tend to steer patients towards. Pedialyte, I prefer them to do the flavor lists, but if, if they want the flavored, if that's what they tolerate better, that's fine. Um, I also really like the fact that Pedialyte has the Pedialyte pops, which are like in these little plastic sleeves, they look like those Otter pops that you used to get when you're a kid and they're brightly. And sometimes that's just easier to tolerate because of the, you know, it does have strong artificial flavor, but it's frozen and it's just, it's a little comforting. It's easier on patients.

Tina 10:57

Yeah. That's a good point. And then the, I often steer people towards the oral rehydration salts as well, which is the official kind of world health organization packet formula that has. A significant amount of sodium potassium. And it does have glucose because it's important. It's not just important. It's essential to have some glucose alongside the sodium, because the way we have. Sodium in our small intestine is that it's transported into the cells and into our system, right. Alongside glucose. So that's called a sodium glucose co-transporter and without the glucose, this is why you can't drink sea water. Sea water would give you diarrhea because that sodium will come out the other end because there's no glucose alongside it. Not to mention that's a huge dose of sodium, but in any case you need the glucose. And I say that because I feel like there's a lot of in the natural foods. Electrolyte formulas that do not put glucose in because they don't want sugar on their label. And if they don't put that in, then the sodium's not going to get absorbed. So it's not going to be as valuable. Pedialyte for example.

Leah 12:05

Right. And you'll see, it'll say dextrose, on the Pedialyte label, I believe, but, yeah, and that always made me wonder about those kind of electrolyte drinks, the ones that don't have sugar at all, they have like artificial sugars in them for people who have, issues with their blood sugar. I'm just wondering How those work, I mean, are they working entirely? So it's just something to think about. No, they don't. Well, there you go. They don't work. Okay. No, they don't work. You're just drinking gross salty blue drink. Yeah. So, so yeah, so, so do be mindful, especially if you do have blood sugar issues that you will need some glucose to really process that. I mean, you can still replenish with the other electrolytes, but it just might not be as effective.

Tina 12:50

Yeah. And you can always remember to salt your foods and either use no salt, which is a potassium. No salt is potassium instead of sodium. It's the stuff that they sell in the store is a grocery store is when people don't want to be doing a lot of sodium in their diet. Um, that's a possibility. And then there's foods that are high in potassium. Like avocados are a classic

Leah 13:11

example, white potatoes. I know people always think about bananas, but white potatoes, avocados, most lagoon. I don't know if you really want to eat

Fiber

Leah 13:20

legumes, though, if you're having diarrhea, just cause of all that fiber that's true, which brings us to fiber. we talked about fiber in the first episode, you want to look at soluble fibers because that kind of slows things down, soluble slows. And so oats, I think of oatmeal as like. Uh, good soluble

Tina 13:39

fiber. Yeah. And this goes back to knowing why you have loose stools or diarrhea, because if it is due to irritation of your colon, if there is a level of colitis or even if there has been a removal of part of the colon, either way, the insoluble fibers are not going to be well tolerated. So Metamucil, psyllium, and just inside will fibers from foods. So the peels of things. Part that's not soluble. The fibers sources that are irritating to the lining will definitely be contra-indicated in anyone with any kind of irritation of their GI tract and particular the colon if they have diarrhea.

Leah 14:17

So yeah, so the inside of the apple, so the apple sauce without the skins, like if you have a friend who brings you over homemade applesauce with skins, that would not be helpful.

Probiotics

Leah 14:26

Um, probiotics are the big thing that people think of and, you know, it's, I think that. Our good brands of probiotics. It's just so hard to say, like which ones specifically, because of the different strains and Saccharomyces boulardii is a really popular one that I've seen used for antibiotic induced diarrhea. And it can be really helpful, but if you're going through active treatment, I do caution. patients, because there are risks with it. Patients who are older, if they are receiving enteral nutrition, if they are immunosuppressed, you know, they have neutropenia, or if there's any sort of inflammation of the GI tract, like whether it's from surgery or from the cancer. there have been cases of people who have sepsis after taking Saccharomyces boulardii. So it's just a caution.

Tina 15:20

I'm sorry. I just want to clarify, when you say sepsis, you mean the sacrifice he's boulardii makes it into their bloods. Yeah, what's

Leah 15:26

it? Um, it's fungemia I think it's called because

Tina 15:30

Saccharomyces boulardii is a fungus technically. Yeah, it's a

Leah 15:34

yeast. Yeah. It's related to sacrifices survey CA which makes beer ferments. So, yeah, so it can leak into the bloodstream and it can cause people to be really sick. We had a hospitalist, um, where I worked lasted. He had seen several cases of that. So, yeah, it's just something to keep in mind.

Tina 15:55

Yeah. And that's interesting because that translocation of any organism, whether it's lactobacilli, Saccharomyces any organism, other types of yeasts that can translocate in that means it goes from either the mouth of the GI tract somewhere where it's contained in the. Into the bloodstream, which causes a sepsis. Sepsis is basically infection your blood. That is usually due to a combination of. Immune suppression and the ability to translocate, meaning there's some kind of neither mucositis stomatitis like you said,

Leah 16:27

irritation or right. Inflammation of the GI track. Yeah. It just, there's a little passageways. And so again, that's why if a patient is taking probiotics, with their therapy, They are told that they are neutropenic. They need to stop, you know, if they start to feel feverish and they start to feel the symptoms of having low white blood cells, um, which would be fever and you know, all of that. So, so they would stop taking the probiotics as well.

Tina 16:52

Right. So just so it's clear, these are rare

Leah 16:55

events. But it's just, it's something, I mean, neutropenia is not necessarily,

Tina 17:00

why don't you manage a peanut? The sepsis is a rare

Leah 17:03

event. Oh yeah, yeah, yeah. No, these infections are not common, but they have happened. And so it's just better to be cautious. Yeah. So

Medications/Supplements that can make it worse

Leah 17:11

stopping medications, speaking of stopping supplements, you know, there are certain medications that people take day to day, they came and taken their MiraLax and they suddenly have diarrhea from treatment. And they don't think about their. The thing that they take all the time to manage their bowels, you know, stopping certain medications, stopping supplements, like magnesium, vitamin C, anything that has that affect the bowel effect. Oh, that reminds me of a story. Okay. Tell a story, Tina,

Tina 17:40

it was during my residency and I was reviewing supplements with a patient who had unrelenting diarrhea. It was bad. She had seen GI specialists. She was sent to me to help out with it. And I looked through her records and all I did was take her supplement history and she was taking a huge amount of magnesium. And my point was she had like seen other people who just didn't do a thorough enough intake and looked at every item that she was putting in her mouth closely. Noticed it, anyone would have noticed it, any nurse or doctor pharmacists would have noticed it. If they had taken a thorough history and seeing how much she was taking, but everyone just kind of wrote off, she's taking a magnesium supplement. They didn't see that she was taking an immense amount of it.

Leah 18:20

So why was she taking a huge amount? I don't remember. Oh yeah. I mean, I would see magnesium and I would just like, be like it. Okay. Yeah, because that is something that you commonly see, someone's taking magnesium for some other issue. They don't think of it with their bowels. It never affected their bowels before the treatment changes and all of a sudden, the dam breaks, so right. Yeah. Immediately stop any of those things. Anything else that we, we think about, um, to be mentioned slippery on, I think we mentioned it in a previous episode, slippery Elm is one of those, herbs that can. Help with either diarrhea or constipation just depends on how much you take

Tina 19:03

Yeah. So slippery Elm, sometimes prebiotics can be helpful again, depending what the cause is of the diarrhea. So if it is because of the microbiome shifting and just. You know, reasons, not no actual physical issue, like colitis or surgical consequence, then something as simple as prebiotics, like large, a rabbinical lacked hands, which are a prebiotic that you can get

Leah 19:28

in a powder. Yeah. And you know that for some reason, I just thought of sometimes if there's an obstruction, People experienced diarrhea. So because it's just that small little passageway, if there's a partial obstruction in their bowels. And so the only thing that gets through is the liquid. So whether the obstruction is from impaction of stool or if it's a tumor that actually can present itself as, as diarrhea. So for somebody who's like, oh, I'm so constipated, you know, and now I have diarrhea that that could be why. So I think that's another kind of consideration. To keep in the back of your mind. There's also, um, charcoal that was looked at for one specific chemotherapy for, with and that's a whole protocol. That was something that we would use for patients.

Tina 20:19

And the T can is also called CPT 11. So just for the listeners out of.

Leah 20:26

So let's see, I think that's, that's probably. It's probably it, you mentioned the foods to avoid the fatty foods, spicy foods, anything that would trigger it, taking antibiotics, you know, if somebody takes antibiotics for any sort of infection, it could trigger, um, as well.

Tina 20:44

Yeah. And I want to say when there is almost like an acidity. When it's exiting, someone can feel some acidic aspect. Sometimes that can be because the food is going through so quickly. Your beer bile acids are fairly acidic. So stool, a normal pH of stool is around six give or take. And if it goes through and it comes out and more acidic, you're going to notice. At the exit and that

Leah 21:08

will be irritating. So if you, if you have burning poop, if you have burning diarrhea,

Tina 21:13

I'm trying not to gross people out

Leah 21:15

if your poop stings, when it comes out. Yeah. Think that maybe you're having rapid

Tina 21:19

transit. Yes. And the one thing that can prevent that as petroleum at the time. To protect the tissue until you figure out how to get it, you know, improve the, the absorption. And that's where the charcoals come in handy in these adsorbents, whether it's whatever the source is that you're going to adsorb with those soluble fibers

Leah 21:39

and the, you know, there is caution with. And, you know, we'll talk about more of the, over the counter stuff next, but there's caution with those things like charcoal and, um, and different fibers, in terms of interfering with the absorption of oral medications. And so being careful not to take them, alongside and then also, um, yeah, charcoal, I wouldn't recommend. Charcoals use to like absorb poisons. And so it's not something that I would recommend for just regular diarrhea, because I don't know. I just feel like it there's always potential for it to interfere with something.

Tina 22:16

Oh, as far as oral agents or other drugs.

Leah 22:19

Like if you, if you're getting diarrhea from taking an oral agent,

Tina 22:23

So speaking of oral agents, have you been seeing more of the new drug class, these cell cycle inhibitors being used at the hospital?

Leah 22:31

I Ibrance and Zenio Zenio I've seen a lot prescribed for patients with metastatic erpr positive breast cancer. And stage, but high E R P R, breast cancer, and So yes, Taking

Tina 23:03

prepare as But it's, it's good that you the generic, because I think name brand changes around the world, gets a different name in different

Leah 23:18

so yeah, up to 90% patients taking this

Tina 23:27

pretty much a given,

Leah 23:28

It's pretty much a given and Most people are told to take Imodium if the diarrhea kind of gets outta control. If There's also sometimes abdominal pain, cramping and if the symptoms get bad, then there can be a dose reduction and so that's why you gotta kind of stay on top of it. I have seen some patients who are prescribed WellCall, which is a bile acid sequestering,

Tina 23:56

sequestering. It's a fancy word for binding bile acids.

Leah 23:59

Yeah, it's has other purposes, but it's being used in this case for the diarrhea that is, at least from Zenio.

Tina 24:08

Mm-hmm.

Leah 24:09

And that's, that seems to help. when I was looking at up to date, There was something about if Zenio is taken with a high fat meal, it increased the time that the drug was in your body. So that might be something to kind of consider, like maybe not eating such high fat foods. Greasy foods, that kind of thing. I don't know if anyone's looked at that specifically, but you know, you don't want the drug to stay around any longer than it was designed to. We've talked about that before. Um, I did reach out because I was seeing a lot of patients with this and I was like, I don't think probiotics are really helping. And so I reached out to some colleagues and one of them said that they've been using. like a scoop of slippery elm mixed into some applesauce or oatmeal.

Tina 24:55

well with oatmeal. Yeah.

Leah 24:56

a desert,

Tina 24:57

Yeah, it does.

Leah 24:57

um, and then for anyone who's concerned with, you know, slippery Elm potentially being endangered or whatever, marshmallow root, I'm guessing would do the same thing. The thing is with those two herbs, you just need to take it like an hour before or several hours after you take your prescription medication, because of what we just said about ads absorbents, ab absorbent type of thing.

Tina 25:17

Yeah. Yeah. So I guess that means that these. Bile acid sequesters, like well call that are used for diarrhea from these oral agents like Zenio. We could put it in the same categories. Charcoal, like don't take it alongside other things that could be also binding to it. Medications especially, but even supplements alongside those binding agents, whether it's well call or it's charcoal or it's clay, or anything that people are taking that binds things in the gut. Just take it away from medications.

Leah 25:44

Right. Oh, I have one more little thing because I was looking up marshmallow root to see what the dosage was. It's really not as easily found as slippery elm in terms of products with it, but I found something cool. It was on a, like a, someone who has like an ostomy website, Talked about actually eating marshmallows, which at one point were made from marshmallow root, but now they're not. But actually eating marshmallows to help with diarrhea.

Tina 26:14

modern day marshmallows or that has marshmallow root.

Leah 26:18

No, no. This person said eating actual marshmallows, strange because I think of the sugar would

Tina 26:29

I don't even think they're made of anything that's like, I'm, they're so not food. I could put a marshmallow. I'm like, Shelf and it just won't rot. I mean, it's just

Leah 26:38

Well, maybe it slows down transit. I mean, I'm just saying I saw it on an os on like a, like a bloggy type of a personal ostomy website. I thought it was interesting.

Tina 26:50

it's interesting. I wouldn't recommend doing marshmallows unless you're really in desperate need of, it's like a drug. Marshmallow as a drug. I call it non-natural.

Leah 27:01

If somebody has really bad diarrhea, if I had really bad diarrhea and I had a bag of marshmallows, I'd freaking try it.

Tina 27:08

Well, that's what I mean, like a drug, you desperate times call for desperate measures. But I wouldn't recommend it as something you try upfront. I would try the natural stuff first. I'm also not a fan of marshmallows, so I think they're gross. But that there's that. So I might be, uh, a little biased against the marshmallow.

Leah 27:21

Eating marshmallows reduces ileostomy output. A randomized control crossover trial.

Tina 27:27

Is there really a trial

Leah 27:29

Hold on. I have to look at the results here. Eating marshmallows leads to a small but statistically significant reduction in ileostomy output. Boom. Science. Fiber rich foods have some combination of both soluble and insoluble fibers. If you're trying to slow down your. try oatmeal, barley and bananas, soluble fiber foods also are supportive for heart health and help regulate blood sugar.

Medications-that can help

Tina 27:56

All right. So of course there's plenty of medications that are used for diarrhea as well, both over the counter, as well as

Leah 28:04

prescriptive. Yeah. So these are the things, cause you're always mentioning about like commercials for pharmaceutical stuff and I don't ever see those commercials, but these are commercials from like my childhood that I remember. Right. So, let's start with like the antisecretory. Medications. And so those are like bismuth, which is Pepto-Bismol the classic. And yeah, my caution with Pepto-Bismol is it can turn your stool black and it can also have turned her tongue black. Right. It's good to remember, which could be freaky. Yeah. Yeah. So, so that's, that's a little heads up about that. we also have already kind of touched on the ad absorbents, which is the activated charcoal, but there's also Kaopectate, So that's another one that kind of just kinda like stuck. Whatever's going on in the gut. And then, um, the antimotility agents would be like Loperimide, which is Imodium, which is another common one that patients will take. And then just, yeah,

Tina 29:08

I was just gonna say, I think that's the most common one that I've seen prescribed here.

Leah 29:12

Yeah. And the caution with Imodium is it can send you in the other direction, depending on how you take it. So taking it as prescribed by either, you know, your doctor or the nurse who recommends it, you know, there is a certain way of taking it, a protocol. So making sure that you, you know, you follow that so that you're not sending yourself into constipation. And then yeah, there are the prescriptions I think of like Lomotil, which is it's has atrazine in it. And so that's, that is another medication. Um, and I may have mentioned this already. I can't remember. I know I wanted to mention this, but like my, my bit of advice is going into treatment to have. Imodium on hand and having, you know, a couple of different kinds of laxatives on hand, because you don't know which way it's going to go. And then once it happens, especially with the diarrhea part, like you want to make sure that you don't have to get out and go to the drug store. You already have it as part of your, your kit, your chemo kit.

Doctor Tales

Tina 30:13

Right. So I know I keep coming back to figuring out the source of the diarrhea or loose stool, but it's probably because of my experience with so many people and assuming it was one thing, and it turns out to be another, I had a patient many moons ago who had unrelenting diarrhea, but she also had a cancer that caused diarrhea.

audioTinaKaczor63615270325 30:33

it was a carcinoid tumor This can cause. The excretion of a lot of bile acid it was fairly well managed, but not well managed enough to have a normal life. She still had to stay home every morning until 11 or 12 before she could really start her day. So it was, it was pretty consequential. in any case we managed as best we could. We managed the GI doctor We did everything possible. We removed dairy one day unbenounced to me this entire time, she was an avid consumer of dairy products. And I said, well, take out the dairy and see what happens. And don't, you know? she was actually lactose intolerant the entire time. And this was about three years of lactose intolerance. That was undiagnosed. And unfortunately I too didn't repeat. I didn't go back and ask and probe more because I also assumed it was a consequence of her cancer, like everyone else. And so it took us longer than, than it should have to figure it out.

audioTheCancerPod53615270325 31:32

And there are certain foods when someone has a carcinoid tumor that needs to be avoided. But I don't know if dairy is one of them.

audioTinaKaczor63615270325 31:39

No, It's not.

audioTheCancerPod53615270325 31:40

It's not. Yeah. oh, you know, and then that also lends itself to that has its own. Specific treatment. Octreotide is used for patients with carcinoid, but yeah, carcinoid could be really, tricky because It's a symptom of the cancer and it can be hard to manage, but then, you know, people are more than just cancer, right. They're complex. And so they've got other things going on as well. Yeah. That's, that's a tough one. that was a good catch.

audioTinaKaczor63615270325 32:04

Well, this is why I probably am someone who rounds back and says, look at the cause. And even when you think, you know the cause if what you're doing, isn't working, given that causation, you know, I kind of have this thing in my, my head. It's a little Diddy that goes reassess, reassess, put your ego to the test.

audioTheCancerPod53615270325 32:20

Yeah. I find that. Yeah, the first place I'll go. If it's, some sort of mysterious onset of. diarrhea. I immediately go to, what are they taking? That they start something new, even like a change in the diet. You know, you get somebody who suddenly starts like doing green juices with all the fiber in there. And that can, that can definitely move your bowels. And so just really, you know, playing detective, being an investigator and it might not be the treatment. It could be a number of other things.

audioTinaKaczor63615270325 32:50

Yeah. Don't give up, if you're doing something that should work and it doesn't work, you have to round back and say, what else could it possibly be? And just be a little bit dogging and unrelenting, and that can be helpful. And there are times that, there is nothing but management, you know, and I think of the. Post resection, you know, when a good part of the colon is removed, it's very difficult to control loose stools because there's not enough. there's just not enough time for the body to, or length of colon to re absorb the water. that's in the stool. So that, that becomes more of a management issue. A lot of the time.

audioTheCancerPod53615270325 33:24

So your story reminds me of a patient that had a mysterious onset of diarrhea. And after going through her medications and her supplements and, checking for any change in diet, she was like, you know what, I've been eating a lot more fruit and she ate like a bag of cherries and that's what CA that's what did it. And so,

audioTinaKaczor63615270325 33:45

Yeah.

audioTheCancerPod53615270325 33:46

Sometimes it's something where it's like, yeah, I changed my diet. I'm like eating all these fiber filled foods that can send you so caution about those cherries.

audioTinaKaczor63615270325 33:54

All right.

Moment of Woo

audioTinaKaczor63615270325 33:55

So does this bring us to our moment of woo.

audioTheCancerPod53615270325 33:59

Yeah. We have a song and we have a moment of womb. So let's start with a moment of whoop, which we haven't done it a lot. So I feel like I'm a little out of practice, but, okay. So for those who are just joining us moment of Wu is something that more like folklore or traditional medicine. And I try to find some sort of science to back it up. So today's moment of woo is castor oil pack. Castor oil packs are, something that we learn how to do in naturopathic school. And you take like a cotton or linen or towel. And you saturate that with castor oil, which you could find in the drug store. They're applied to the abdomen. you can apply it kind of like over the rib cage, like kind of on the right side where the liver is, and then you can apply it over the actual, lower abdomen, if there's constipation and then some sort of heat sources put on top, whether it's a low level heating pad or a hot water bottle, and you just kind of sit back and you relax for a short period of time and it's supposed to help with constipation. you can also rub castor oil on your belly and then get into a hot tub. And it's supposed to have the same effect, heat isn't apparently needed for it to be effective, but people often like that feeling, I don't necessarily have patients apply it over any area where there's a malignancy. and that's just, I think that's just something I learned in school. And so I just run with it. But, Castro oil itself is derived from a plant from the castor bean. And it's something that is found in cosmetics. Like, you'll see it on the ingredient list and lipstick. And then it's also used internally as a laxative. So if you're taking castor oil and you have a sudden onset of diarrhea, Stop that, and it's also used to stimulate labor. midwives have used that kind of a fun fact is it's used in paclitaxel, which is a chemotherapy used for ovarian cancer, as well as breast cancer. And it's known as crema for crema for, I'm not sure how to pronounce it, but it's the delivery system for the drug. And so. A lot of drugs are commonly bound to something to carry it to where it needs to be. And in paclitaxel, that is what it's bound to. And that's what causes the allergic reaction that people can have when, when getting the drug.

audioTinaKaczor63615270325 36:22

Yes.

audioTheCancerPod53615270325 36:23

And in terms of studies, I couldn't find an actual study. I found the abstract on looking at the effect of castor oil packs in an elderly population at these restrooms in Turkey. And they monitored the patients for seven days prior to doing the castor oil pack three days during and four days after. And.

Leah 36:48

About 80% of the study participants had reported constipation for 10 years or longer. And applying castor oil packs didn't have any effect on how many bowel movements or how much they were passing through, but it decreased what was known as the feces consistency score. And so it lessens straining as they were passing their bowel movements. And it also helped with. Feeling of incomplete evacuation.

audioTinaKaczor63615270325 37:13

Okay.

audioTheCancerPod53615270325 37:13

So, yeah, I don't have access to any of the methods or anything, but, um, that was the only study. Well, there was another study that I found, which was, I think, through the Edgar Casey Institute. I can't remember what it's called now, but Edgar Casey is, he was a faith healer in psychic, in the 1920s and he really popularized the use of castor oil packs. And so. They had looked to see if there was any sort of way that the castor oil was actually being absorbed. And that was the kind of mechanism of action for it helping. And when applied externally castor oil, didn't, have the same. By-product that is excluded when taken internally. So through your urine, if you take castor oil internally, there is this a poxy di carboxylic acid that's excreted. And that was not found when it was done. Topically. Okay. Thought was well, maybe because transdermal drugs don't go through first-pass liver metabolism as they do when they're orally taken. And so maybe that's why it wasn't excreted in the urine, but they were just trying to figure out is this being absorbed?

audioTinaKaczor63615270325 38:26

Which is funny because Edgar Casey was a faith healer, so they shouldn't have to try to prove it. if they was his people doing it, it's kind of funny that they were looking for evidence when all he needed was faith.

audioTheCancerPod53615270325 38:35

Yeah. And you know, it was like I said, I mean, they only had three volunteers who are familiar with using castor oil packs. And so it was, I wouldn't even, I, would put study in quotes.

audioTinaKaczor63615270325 38:46

yeah, I was just going to say that deserve some air quotes. study.

audioTheCancerPod53615270325 38:49

Yeah. And so, you know, a caution with castor oil packs, other than, you know, my caution with using the heat over malignancy would be, it can be irritating to the skin.

audioTinaKaczor63615270325 38:59

the Edgar Casey brand of castor oil is that heritage that has that.

audioTheCancerPod53615270325 39:04

Oh, that's what the Institute is. The heritage Institute. That's who did the study?

audioTinaKaczor63615270325 39:08

They still sell that brand of castor oil.

audioTheCancerPod53615270325 39:11

Yeah, I know that. Yeah. So Edgar Casey also had a thing, apparently like when I was little, I think my sister read a book about him and he would sleep with his ear on his elbow. Like his elbow bent in his ear, on his elbow to like, kind of get information through osmosis. He'd have like a book underneath his pillow. I think that was at Casey. Anyways. We don't have to include the story, but it doesn't work. I just want to tell you it doesn't work. I tried it. and just a little aside just for working with any oils, because castor oil is so thick. it's really hard to clean out a fabric. When we learned about it in school, we would advise people to kind of wrap saran wrap around the pack, you know, to try to keep it from getting on clothing or sheets and put an old t-shirt. They don't care about over the pack. Um, you can use baking soda To take out the oil, you know, just apply that immediately to whatever gets all oil. These are my Martha Stewart tips.

audioTinaKaczor63615270325 40:05

I'm laughing because I'm not sure we convinced anyone to actually do the pack.

audioTheCancerPod53615270325 40:09

I'm just saying no, I'm just saying it's, it's a good thing. I'm sure that I'm sure that, you know, Gwyneth Paltrow's talked about it and people are doing it. Who knows, or maybe she hasn't done it yet and she's going to listen to us and she's going to be like, I'm going to talk about this. People use it because they, they use it for detoxification and.

Leah 40:26

That's not what we're doing here. We're trying to, we're trying to detoxify by having people poop.

audioTinaKaczor63615270325 40:33

Right,

audioTheCancerPod53615270325 40:34

So don't use this. If you have diarrhea, this is for constipation.

The Unofficial Theme Song

audioTinaKaczor63615270325 40:37

right.

audioTheCancerPod53615270325 40:38

Are you ready for the song?

audioTinaKaczor63615270325 40:40

I'm so ready for the song?

audioTheCancerPod53615270325 40:41

Okay. You got to get the, you got to get the duck ready because I can't say the name of it without getting.

audioTinaKaczor63615270325 40:47

yes. So to avoid the explicit rating for the podcasts, we don't allow any

audioTheCancerPod53615270325 40:52

No bad words.

audioTinaKaczor63615270325 40:53

profanities. Yes.

audioTheCancerPod53615270325 40:55

Yeah. So the unofficial theme song for this episode is by L seven. from the 1992. Bricks are heavy and the song is sht list.

audioTinaKaczor63615270325 41:07

All right.

audioTheCancerPod53615270325 41:08

So it doesn't really have to do with poop. Other than you got to list, you're going to be put on it.

audioTinaKaczor63615270325 41:12

Okay. So it's not about diarrhea, but it is about a shit list.

audioTheCancerPod53615270325 41:16

Yeah. I mean, when I get mad and I get pissed, I grabbed my. And I write out a list and you know who it was on that list, diarrhea. I just changed the lyrics.

audioTinaKaczor63615270325 41:28

Okay. Got it.

audioTheCancerPod53615270325 41:29

So, yeah. So that's, that's, that's the song. It's an awesome song. They were a great band. So that's our song. we've pretty much come to the end of our pod are side effects, pod, our side effects, pod, for, you know, for the family

Wrap up

audioTheCancerPod53615270325 41:45

crowd. remember to. Subscribe, wherever you listen to podcasts, subscribe to our podcast and leave a review. We are getting these awesome comments on Instagram and leave it where you, where you listen

audioTinaKaczor63615270325 42:00

Yes,

audioTheCancerPod53615270325 42:01

so that other people can read it. And then they want to listen to.

audioTinaKaczor63615270325 42:05

That's right. Telephone.

audioTheCancerPod53615270325 42:07

Share it on social media and we are on social media. We're on Facebook, Twitter. And like I mentioned, we're on the Instagram, so, and on Tik TOK, but I never do anything on Tik TOK.

audioTinaKaczor63615270325 42:16

I'm not on most of them.

audioTheCancerPod53615270325 42:18

I know. Well, well I'm, I am as the CA we are Tina. We are, as the cancer pod, we are on. on the talk on the ticket talk.

audioTinaKaczor63615270325 42:28

We're on the tick-tock. Huh? So all these crazy things. I think in my head, I could put a video too and go viral.

audioTheCancerPod53615270325 42:34

Yeah, I think we're going to have to start putting the corgi and videos because that's the only way we're going to go viral.

audioTinaKaczor63615270325 42:39

I think the viral. videos have to do with the core. You're getting along with something it's not supposed to get along with like a hamster.

audioTheCancerPod53615270325 42:44

and you know, if you like what you hear, you can also buy as a cough. So the link should be in our show notes as usual. And it's basically a way to support the podcast if you like us. And it will help us hopefully be able to hire an editor and a producer, maybe someone to run the social media and just let us focus more on.

audioTinaKaczor63615270325 43:09

That's right. Want to reach a lot of people? That's the goal.

audioTheCancerPod53615270325 43:11

So, yeah, you can buy us a coffee. I like Americano decaf please.

audioTinaKaczor63615270325 43:18

I'm an Americano fan myself.

audioTheCancerPod53615270325 43:20

Oh, twinsies two Americanos please. 16 ounce.

audioTinaKaczor63615270325 43:23

Oh no. 12 ounce. extra room. Sorry.

audioTheCancerPod53615270325 43:26

Oh man. 16 ounce, no room. Boom. Okay, there you go. That's our order. And on that note, Um, Dr. Leah Sherman,

audioTinaKaczor63615270325 43:36

And I'm Dr. Tina Kaeser

audioTheCancerPod53615270325 43:37

and this is the cancer pod.

audioTinaKaczor63615270325 43:39

until next time.

Leah 44:24

Boom. Science.