Bowel Changes: The Return of Side Eff@¢ks

Tina 0:00

Welcome to episode 23 of the cancer pod. In this episode, we're talking about bowel changes. Why do they happen and what causes them? I'm Dr. Tina Kaczor And as Leah likes to say, I'm the science-y one

Leah 0:12

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

Tina 0:16

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

Leah 0:20

But we're not your doctors

Tina 0:22

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

Leah 0:27

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

Tina 0:31

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

Leah 0:38

Welcome to the cancer pod. hey, Tina. Hi, Leah. We're talking about

Tina 0:58

poop today. Yes. Today. And for the next few episodes,

Leah 1:02

these are our. Pook episodes. That's right. This is a really important subject because bowel changes, whether it's diarrhea or constipation, those can affect how your treatment is

Tina 1:18

administered. Yeah. Yeah. We do talk about stool changes in everyone's bowel function at every appointment throughout. True.

Leah 1:28

Yeah. And beyond pretty much if you're going to see a naturopathic doctor expect to talk about.

Tina 1:35

Yeah. And we, you know, if you have an animal, you watch their poop and assess their health. If you have a child and you're changing diapers, I mean, you, you, you do know, everyone knows, everyone knows that watching changes in stool can signify, you know, what's going on internally.

Leah 1:53

So and then you throw cancer and cancer treatment into the mix. And I mean, the whole thing just goes out the window. I mean, it's just, you know, yeah. What's going to happen. What day, I mean, it really, it becomes unpredictable. So that's our first episode that we're going to talk about why these bowel changes happen. Um, you know, why is it important, especially during treatment to manage it. And then, you know, if, if symptoms persist afterwards, you know, you know why that can happen and then we'll go into more of the details in the next two

Tina 2:28

episodes. Yes. We'll dedicate a whole episode on constipation and then a whole episode on diarrhea, loose stools. All right.

Digestion- an overview by system

Tina 2:38

So shall we start with function?

Leah 2:40

Yeah, let's talk about, let's talk about. Like what, what do our bowels do you know? How has, poop?

Tina 2:47

Yeah, so I'm going to start at the very top, cause I know we're gonna talk about bowels, but you know, I like to put everything into context. So as soon as you start eating, you start digesting There are enzymes found in your saliva that start to break down carbohydrates. Then you swallow that food. The first third of your esophagus, you're in charge of the last two, thirds is involuntary. That just gone. It goes through a, a wave process to push the food down into your stomach. And once it's in your stomach, that's where acid is secreted, right. and pepsin. But without going into too much detail, the acidity of the. Is important because that sets up the rest of the cascade for digestion. So if your stomach acid is adequate and it's very acidic, it's much more acidic than say vinegar. It's extremely acidic as a pH of say two, it dumps into your small intestine, the very first part of your small intestine, which is called your duodenum, or do a denim depending where you live and that do a Dina is where. Your bile acids come in and your pancreatic juices go in. So the more robust your digestion, the more enzymes that are secreted by your pancreas and a good amount of bile is secreted from your gallbladder. Bile is made in the liver, sits in the gallbladder, waiting for you to eat that your gallbladder contracts and send out a bolus, a bile to help you digest that food. When it hits the small intestine, pancreatic enzyme, same thing come out in a big bolus because there's a signal that goes to your pancreas and says, there's food here. So while that's going on, there's also enzymes produced by the small intestine itself. So the small intestine makes enzymes, so you have the pancreas making enzymes, which I think most people are familiar with. Your saliva actually has some enzymes and you get some enzymes from your first segment of the small intestine they're called brush border enzymes. Is required to break down some of the carbohydrates as well. And then onward, it goes down the small intestine from the small intestine. It enters into the large intestine, which is also called the colon through the ileocecal valve. And that's the area where the appendix also is in any. When it enters into the colon, it is the consistency of a milkshake. And then by the time it goes through the colon and the water is absorbed into your system, it comes out as a solid or semi-solid.

Leah 5:06

I think that really good explanation, you know, especially towards the end, because it kind of sets you up. Seeing, you know, like how diarrhea can happen, right? Because if it enters the large intestine with the milkshake, consistency, and it comes out the rectum with a milkshake, consistency, there's not absorption going on, as you were saying this, I just kept thinking about all of the surgeries that patients have, so that could lead us into, you know, why. Ken cause bowel changes. And so let's start with surgery first because you just, you just created that visual. So if there are any surgeries that affect that small intestine, the gallbladder, the pancreas, and the large intestine, there can be bowel issues that fall.

Tina 5:53

Yeah, that is a good place to start because even as the patient tries to understand what's going on, it's good to find out

Surgery- effects on bowel function

Tina 6:01

exactly what has been resected or removed so that you can then understand functionally what has been removed.

Leah 6:08

Yeah, because I've had a number of patients who have had gallbladder surgeries, whether it was prior to a cancer diagnosis or as a result of, you know, one of their cancer surgeries, their gallbladder was removed and they had. Bowel changes afterwards and they never met with a dietician. They never had met with anyone who talked to them about this could be a potential consequence of having the surgery.

Tina 6:32

Yeah, that's a good point. I think it's, I think it's important if there has been any intervention at all along the GI tract and there's bowel changes to. Rule that out as a possible cause

Leah 6:42

or any sort of surgery where the large intestine is affected or shortened. Um, that brings a whole new dynamic into managing bowel. Right,

Tina 6:53

because without the six feet of length of the colon, if it's shortened for any reason, then you're going to not absorb the water as readily or as well. Right.

Leah 7:03

And so that, that requires a little bit more management, which we're not necessarily going to go into here, but, um, hopefully some of the tips that we've we talk about can be

Chemotherapies- effects on bowel function

Leah 7:12

helped. So that's the surgery summary, um, chemotherapy chemotherapy. We've mentioned this before. I mean, this is what causes the mouth sores that happen part of the digestive tract. You have rapidly dividing cells, you know, that's that affects like you were mentioning like the, the brush border enzymes, anything that replicates quickly, including cancer cells, but it's also. You know, it's the collateral damage that can happen with

Tina 7:41

chemo therapies in some more than others. So If someone's getting a chemotherapy and. Diarrhea is listed as a side effect and it's, it's going to be listed for most of them, but for some of them it's nearly a hundred percent. Right. So very few people don't get diarrhea with certain drugs. So learning about that and how to manage it beforehand is, is really important.

Leah 8:01

Yeah. So some of the drugs that I think of are like, cisplatin is, is a big one for bowel changes Irinotecan is infamous for bowel changes, um, vincristine. At the attack, some of the taxanes, oh, and then the AC of the Adriamycin and the cytoxin that a lot of patients get for breast cancer. Those also are notorious, um, the five F family, you know, Cape side of bean and five, a few itself gemcitabine, which is, often for pancreatic cancer. Yeah. I mean, there, there are these, these families and, you know, they, they have different effects on the body and so they can either, cause you know, that's, what's so confusing. It's like, because a patient will ask, oh, am I going to get diarrhea or constipation? And it's like, the answer could be yes, because you're not quite sure which way it'll go. Like you're saying, you know, it's not necessarily like, oh, you're getting a, and your result is going to be B. It could be

Tina 9:05

BRC. Right. Right. And a lot of these drugs require a steroid like dexamethazone alongside when they get the infusion. If that's the case dexamethazone does tend to constipate people. So it could be changing from constipation to diarrhea in the matter of days or a week

Leah 9:23

easily. Yeah. And you know, other other treatments, you know, the targeted therapies, for some people, they can't be. A lot less side effects, but bowel changes still can happen. Um, diarrhea would be a big one and then diarrhea also can happen with immunotherapy because some patients get colitis, which is an inflammation of the colon.

Tina 9:45

Yeah. Yeah. Colitis is pretty common with those immunotherapies. Like those, uh, Opdivo Kaytruda they're being advertised on the nightly news these days and it has to be managed very

Immunotherapies- colitis / diarrhea

Tina 9:55

differently than. Any other diarrhea we're talking about because that's actually the immune system being turned on and attacking your own colon in the process of turning on the immune system to to kill the cancer cells, a cross-reaction happens. And that isn't more of an auto-immune process. So that has to be managed aggressively by the, by the medical team.

Leah 10:17

Yeah. Maybe

Official definitions- diarrhea & constipation

Leah 10:19

I was going to talk about the next treatment, but maybe we jump into the. The toxicity criteria for both diarrhea and constipation. Yeah. So grade one diarrhea is considered an increase of less than four stools per day. Over. The baseline. So over what normally happens with, the patients, you know, bowel habits, grade two is an increase of four to six stools per day. Over baseline. Grade three is an increase of over seven stools per day, over baseline. And this often can result in hospitalization and then grade four would be to where the point is life threatening. And, these grades are important because it can affect how your treatment is given if you have treatment delays or reductions in treatment. And it may result in treatment changes as well. So that's kind of why this grading system exists. And then for constipation grade one, constipation is occasional or intermittent symptoms. Occasional use of stool, softeners, laxatives, dietary modifications, or Animas grade two is persistent symptoms with regular use of laxatives or enemas. Grade three is the symptoms are interfering with activities of daily living. And oftentimes manual evacuation is needed. And then grade four is life-threatening consequences, like obstruction and toxic mega colon. So managing it as soon as possible.

Tina 11:57

Yeah, What we'll talk about is preventative strategies, and this is really important to pay close attention to your bowels during treatment, and even for regular health after treatment, getting your bowel function back. And the ideal is to have a bowel movement every day. And keeping that in mind and don't let it go too far. That will be something that comes up over and over is like, don't let it go. Don't think that, you know, having a Bama when every third day is normal, you really want to stay on top of this and make sure that you're doing things to prevent changes in the bowel, whatever direction, whether it's diarrhea or constipation. Right.

Radiation- effects on bowel function

Leah 12:33

And so the last treatment that I guess I'll mention is, uh, is radiation. And this is definitely a treatment where. Not only during active treatment, you see the bowel changes, but they may persist for some period of time afterwards.

Tina 12:50

yes. Depending on how much damage the radiation has done. A lot of times it causes diarrhea because some of the intestines, whether it's the small or the large can be part of the radiation field, So the might not be aiming the radiation, particularly at the small intestine, but if they're aiming it at the prostate or the uterus Or

Leah 13:11

the cervix, right? a lot of patients That I've seen who had treatment for, for cervical cancer have persistent bowel changes.

Tina 13:20

Yeah. And if you have radiation planned, your radiation oncologist is very, very specific about. Is being affected by the radiation. What is in the radiation field, the therapeutic field, you can find out what might be in the path of the radiation. That's not even part of the therapy. So this is collateral damage or side effect with radiation. So finding that out, usually you can overcome this. Um, it takes a lot of time, depending on how, again, how much radiation dose an area gets, will determine, you know, whether it can be completely healed and how long that'll.

Leah 13:57

And I will say that, from when I first started practicing from when I last practiced at the cancer center, I saw a lot fewer issues with diarrhea and belching. For patients who had radiation for prostate cancer, because just the technology changes so quickly. And so they, you know, being able to be a lot more precise and not having the surrounding area as effected, I guess the last part on, you know, why do these changes happen? Is, is the cancer

Cancer- direct effects on bowel function

Leah 14:29

itself. So the tumor itself can be obstructing part of the lower digestive tract. The type of cancer can also affect, you know, I think of like carcinoid tumors causing diarrhea and then, you know, adhesions, following surgeries as well. Sure.

Tina 14:48

Yes, because the colon itself in particular uses a muscular contraction that pushes the food along at some point. And if you have adhesions that can impair

Leah 14:59

that. Right. And just think of it as like, you know, it's like, it's like tethering the colon. So it's unable to do its little undulations, its little like snaky, like movement.

Tina 15:09

And often that comes with spasm or a sense of pain when that's happening because it's being.

Leah 15:13

It's being held back. I D you know, I just, I think of it being held back.

Tina 15:18

And the last thing, maybe just to mention, because it's inevitably going to be affected by any treatment is the microbiome, the microbiota in the gut, both small intestine and large intestine. It will be affected by every treatment, regardless of what type one is getting. And it's something that we want to optimize after treatment too. So some inhabitants of the gut will cause constipation and other. Make you lean towards diarrhea, but in any case, the microbiome is, is on that list of things to take care of, to optimize health.

Leah 15:50

Definitely. So, okay. Let's take a quick break and then we'll come back and talk a little bit more on medications and even supplements that can result in Belgium.

16:02

Here's a hot tip for anyone starting or changing treatments. make sure you have some over the counter anti-diarrhea medications, as well as a variety of laxatives. That way you're prepared for whatever comes your way.

Medications that may lead to constipation or diarrhea

Leah 16:21

Okay, now we're back. And we're going to talk about medications as well as supplements that can contribute to changes in stool and our bell changes. And. One of the big ones, pain medications. Yeah.

Tina 16:36

Specifically all

Leah 16:36

those opioids or opioids, but even like the, you know, we've got the anti-inflammatories, ibuprofen Neproxin those can also contribute to constipation so that, you know, as soon as a patient is prescribed an opioid, I make sure that they. they have MiraLax on hand that they have a regimen on hand because it's inevitable. Yeah.

Tina 17:01

I think that's a really important one. So any narcotic, whether it's oxycodone Oxycontin, hydrocodone could be in combination. So look on a label. If you see any type of opioid or narcotic that can lead to pretty severe constipation, they always I'm with you always get something alongside I favor. Stimulant laxatives like Seneca with those.

Leah 17:23

Yeah. And combining them, and we'll get, we'll get more into that, but yeah, the combinations of laxatives, you know, is really important. Um, anti-nausea medication.

Anti-nausea MEDS- a cautionary tale

Leah 17:36

And do I have a story for you? I may have told this story before. Um, when we talked about nausea, I don't quite remember, but like my big fear. With chemotherapy was nausea. Good story. That's my story. That's my poos story.

Other medications that lead to constipation or diarrhea

Leah 20:10

So let's continue with our medications. Um, antidepressants another one that causes. Bowel changes. Yes.

Tina 20:18

Wait, can I just interject something here? Sure. That people may not realize that neurotransmitters that are made in our brain are also made in our gut. And that's why the gut is called our second brain. So yes. Any antidepressants that you might be taking for depression of course can affect your

Leah 20:37

gut because of those neurotransmitters that are also hanging out in the gut. Um, medications like, like for diabetes. Yeah. Patients sometimes are diagnosed with diabetes along with their cancer diagnosis, or maybe they had unmanaged diabetes and suddenly it's being managed by, by their doctors. Um, but yeah, some of those medications are notorious for diarrhea. And then laxatives in antidiarrheal medications, those over-the-counter things. Patients can be taking something that they take regularly and they don't think about it. They're taking their, you know, their Metamucil or something and they take it all the time. And then when they start treatment, it kind of pushes them into, one direction or the other, depending on what medication they, they normally take. Maintain, they forget about it. I take it all the time. It's, it's part of my routine and, and, and that could be causing it. So someone might be getting loose stools with their treatment, but because of a laxative that they take on a regular, on a regular basis, it's pushing them into Frank diarrhea. And so if they pull back on that laxative, there's still my main normalize.

Tina 21:51

Yeah. And that's a good reminder going into treatment to make it really clear to your, to your treatment team. If you do tend towards constipation, tend towards diarrhea. If you're taking any, anything over the counter, anything natural and medications that are specifically to affect your bowels, that they know about it. Yeah.

Leah 22:08

And especially the fiber supplements

Supplements that affect bowel function

Leah 22:10

and that brings us into a supplement. So yeah. Taking a fiber. You may be keeping you regular on a day-to-day basis, but once you start treatment, it can send you in one direction or the other.

Tina 22:22

Yeah, and that that's important one direction or the other, cause people will wonder how does fiber constipate? Well, if you don't drink enough water with the fiber, it can set up. I always use the image. I mean, maybe this doesn't isn't valid for everybody, but I always use the image of when you put like concrete powder in a barrel and then you add water to it and then if you're mixing it around, it gets, it can set up and be so. Hard to move unless you put enough water, in which case it's it, it can move freely. Maybe not everyone can relate to that.

Leah 22:56

I'm not necessarily relating to that, but I do know that yes, the issue with, with a fiber supplement would be. If there is a lot of vomiting and a lot of loss of water, plus the fact that water might taste weird. You're just not taking in enough fluids in general. Um, yeah, that fiber can work against.

Tina 23:17

Yes, fiber supplements must have a lot of water alongside or else they do set up and cause constipation. So that's kind of important all the time. Cancer, no cancer

23:26

oh,

Leah 23:26

absolutely. Yeah. That that's kind of, yes, that's that's that's fiber one. Oh one, but you forget about it when you go into treatment and everything else changes around that.

Tina 23:37

Yeah. Yep.

Leah 23:39

Another really constipating supplement Can be Kelsey.

Tina 23:43

Yeah. Especially the calcium carbonate, which is Tom's. Yeah. So that can happen pretty easily. You can have an upset stomach and take Tums and start popping it. Cause it helps with your upper GI stuff. And then you end up constipated because you took in so much because truth be told Tom's is calcium carbonate and calcium carbonate is. As in chalkboards,

Leah 24:05

but Tums is a lot tastier than chalk. Well, not that I've eaten chalk, but Tums are kind of tasty. Well, it's chocolate additive flavors with strawberry flavor or whatever's in it. Yeah.

Tina 24:16

It's pink somehow.

Leah 24:17

Yeah. Cause you know, Tums and I, we became friends during treatment. So then, and then I'm trying to think of, if there's anything else off hand that's constipated, it's more the ones that cause diarrhea. Like magnesium, magnesium is a big one. Cause that's something else that sometimes the patient is taking, they might be taking it just on their own. They could be taking it for hot flashes or something. And then they change treatment. They start treatment and they have this onset of, diarrhea. And uh, you know, I'll ask, did you stop taking your magnesium? And they're like, oh no, I did not. I forgot. Um, cause it wasn't bowel related that you know why they were taking it in the first place. So another one, which is kind of surprising is vitamin C. Like if somebody takes super high doses of vitamin C, which is not usually recommended during treatment, um, but if somebody takes really high oral doses of vitamin C, that can lead to two loose stools as well.

Tina 25:17

Yeah. Yeah. And it magnesium and that high dose oral vitamin C can cause loose stools or diarrhea in the same way, which is a. When you take more in your mouth, then your small intestines can absorb and that vitamin C or that magnesium makes its way all the way to the colon. It starts to hold that water that's in the colon. So it doesn't release it. So you end up loosening the stool that way, which is desirable if you're constipated, but. During treatment, you have damage to the upper intestines and that magnesium you were taking before now is not absorbed. It goes float and buyers, small intestine and the and makes it in your colon. You're going to pull water in and that water's going to lead to loose bells. And that's true. The vitamin C too.

Leah 25:58

Yeah.

Tina 25:59

And on the heels of this not absorbing so well in the upper small intestine, the last one is if someone's taking fish oil or a good amount of fish oil, any oil doesn't have to be fish oil could be flaxseed oil. It could just be, you know, oil in the diet. If the small intestines are not absorbing that oil, then that will cause looser stool. You could even see fat in the toilet,

Leah 26:21

kind of like floating stools because the fat is just. Yeah. And that should be

Tina 26:27

reported cause that's a sure sign of malabsorption.

Leah 26:30

you know, definitely seeing if you can get in with, oncology, trained, registered dietician to help even manage the diet, to manage those side effects, if that is available. All right. So that brings us to. Lifestyle causes of bowel changes. And we're going to kind of touch on also, like, why do these, why do these symptoms sometimes persist after treatment ends?

Tina 26:55

A specialty diet aptly named the low residue diet is sometimes prescribed to soothe the GI tract. The goal is to limit the number of residual food particles in the colon. By design all low residue diets are low fiber.

Lifestyle measures to maintain GI health

Tina 27:12

All right. So if we're going to talk about some lifestyle, things that we can maintain, hydration has to be top of the list.

Leah 27:19

Yeah. I mean, we kind of touched on that before, right? With treatment, you know, you have taste changes and so water might taste funky. you may be nauseated. And so it's hard to keep things down. You know, there were a lot of reasons why hydration in general, can go down during treatment,

Tina 27:35

maybe difficulty swallowing. Sure. For some people I think you're right. Taste changes are probably number one of the number one reason.

Leah 27:43

Yeah. I just keep thinking about, you know, the metallic taste changes, you know, we're water tastes like metal, so yeah, that's the big one, right? Just finding ways of getting that hydration in. And especially when we'll go into this more in a future episode, in two episodes for now, but, you know, especially if there's a lot of water loss, if there is a lot of vomiting, It was also, diarrhea, just making sure that you are maintaining that hydration. So yeah, that's, that's, uh, that's the big one.

Tina 28:14

Yeah. And another one is lack of movement, which is common during treatment. Understandably,

Leah 28:20

at least at the cancer centers where I worked, it was totally encouraged, you know, go for a walk. I lived in a small town when I did my training and I would see patients going for walks. Because they lived in the neighborhood or they, they lived nearby and you would see them going for walks. So walking can be the one of the simplest ways. And I like yoga. I think yoga, you know, doing a cat cow, which, you know, people can look up if they're not familiar with cat cow. And that way you really don't even have to get out of bed. You just got to like, kind of get in, like on your hands and knees, like in what they call tabletop position, cat cow can even be done seated. And that kind of moves. It kind of moves your guts, moves your guts to move your, to move your

Tina 29:09

yeah. And that movement of the guts is due to the reflex that runs down. There's a reflex that runs down the back of our leg, on the hamstring. And when that's pulled on, it sets off an automatic involuntary reflex through the spine and to the gut. So there are nerves that community. From your legs directly to your GI tract that tell your GI tract to go ahead and create some propulsion for the food.

Leah 29:36

So, yeah, so, so finding movement and it, you know, even moving, you know, when you're in bed, just kind of like putting your feet on the bed, knees towards the ceiling and just gently windshield wiper, bring your knees back and forth, you know, kind of gives your, your lower abdomen, a gentle twist. So. Finding ways to move can definitely help with constipation, just the general change in the diet. Right? So some people lose their appetite and maybe are only able to tolerate really bland kind of like those white foods. And those tend to be constipating. Um, other. Just suddenly introduce all these fruits and vegetables and fiber filled foods to their diet and suddenly their bells start moving faster. So it can be, it can

Tina 30:27

be both. Yeah. A change in diet in any direction will change the bowel. Generally speaking. Yes.

Leah 30:33

And then, um, the change in routine, right? So, maybe, maybe there were like specific times of the day that you would go to the bathroom, but now you're going to treatment instead, and you don't want to go to bathroom at the cancer center and maybe you're at work and, you know, just any sort of change in routine or you're not at work, you know, that that definitely can affect our bowels.

After treatment- Survivorship and GI challenges

Leah 30:56

Yep.

Tina 30:56

And so let's move on to after treatment because one of the things. I know you see, and I certainly see in practice is that it's understandable that all bets are off during treatment. People kind of get that and they're told about it, constipation, diarrhea, maybe it changes back and forth. And then afterwards, if there's a persistence in either or both, then it starts to. More frustrating as far as people feel a little bit like they should be back to normal play from time period. Right? Yeah.

Leah 31:26

You hear that a lot. Oh, well, you know, since treatment I've had these bowel changes and I mean, microbiome that's, that's probably, you know, a huge influence as is the effect on like what we were saying on that small intestines. So. We know a big thing that we hear is ever since treatment. I've been lactose intolerant. I could tolerate dairy before and now I can't. And that's because of the effect of those brush border enzymes in the small intestine.

Tina 31:56

So I think thank you to advertising and media. Most people have heard of Lactaid, which is lactate as a. Toasts enzyme is lactase. Lactase is the enzyme that breaks down lactose and lactase is normally made by the upper small intestine. It's a brush border enzyme made by a small intestine. And so when people go through treatment, if there's enough damage to that small intestine, then the cells themselves. Can no longer make lactase. And usually it's transient most of the time that recovers as the gut recovers, but it takes a lot of time. We're talking, you know, six months to a year for full recovery, if full recovery is possible. Right. So it depends how much they're damaged. So if it's chemo and radiation together, they might get more damage.

Leah 32:43

And you mentioned, you know, with radiation, as we mentioned before, definitely that those radiation side effects we've seen persist. any surgeries that, as we mentioned before that affect the bowels, you know, that that's a permanent change. And then. People who have had surgeries to their small intestine, there's the short bowel syndrome where, um, you know, they find that certain things, you know, like maybe even foods high in sugar kind of trigger. And then the hormonal changes that can happen with therapies.

Tina 33:17

Yeah. So there's a lot after treatment that needs to kind of be teased out as far as causation and then tackle that. Cause even with surgery, let's say somebody has half of their colon removed, then the stools will become looser and how to manage that and how to make up for it. I mean, that's it, some people can recover from that and that half of a colon can become more efficient and absorbing water. In other times we have to manage it and find ways of managing the stool. Right.

Wrap-up- The unofficial theme song announced

33:44

All

Tina 33:44

right. So that's a quick little primer on the bowel changes. So, uh, that brings us layer to our song.

Leah 33:59

This is our unofficial theme song for this episode. This is the

Tina 34:03

chit-chat chit-chat

Leah 34:04

changes. Exactly. Has nothing to do with poop, but it's about changes. And that is what we are talking about today. And I have to say, I feel like a holding myself back because there's so much information that I want to give, but we've got two more episodes coming up. Our next one being constipation. Oh, and we have a good song for that one, but before you go, I want to thank everybody for listening If you've got something to say, I love the comments on Instagram, but, you know, go onto where you listened to the podcast and leave us a comment. Yeah.

Tina 34:38

It really helps us out actually in that way. When other people look at us, they know, uh, what we're about. So what you like, what you didn't like and pass it around. And we really do appreciate every listener.

Leah 34:48

And I do want to add, um, we have not mentioned this. We actually have a buy me a coffee. that helps too for us to, to keep doing what we're doing. Um, so that we can. Pay for a producer and an editor and you know, a social media person. If you like what you hear buys a coffee,

Tina 35:09

let's all have coffee someday.

Leah 35:12

We'll all have coffee together. And our next episodes, we will be discussing a little

Tina 35:17

bit of coffee. That's true. Coffee will come up as a topic. we have a whole episode on it in the past for those who don't know, but we try to bring

Leah 35:25

it up into as many episodes as we

Tina 35:27

can. We try to talk about coffee as often as possible. All

Leah 35:32

right. So on that note, I'm Dr. Lee Sherman

Tina 35:35

and I'm Dr. Tina Kaeser,

Leah 35:37

and this is the cancer pod until

Tina 35:39

next time.