Constipation: The Return of Side Eff@¢ks!

Leah 0:00

Welcome to episode 24 of the cancer pod. On today's episode, we're talking about constipation, what it is and what you can do about it.

Tina 0:09

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

Leah 0:13

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

Tina 0:17

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

Leah 0:22

But we're not your doctors

Tina 0:24

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

Leah 0:28

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

Tina 0:33

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

Leah 0:39

Welcome to the cancer pod.

Tina 0:56

At Tina. Hi,

Leah 0:58

Leah. We're moving on to number two.

Tina 1:01

We're moving on to number two. I like it. I got it.

Leah 1:07

Yeah. So this is our second in a series of episodes where we talk about bowel movements

Tina 1:15

or lack thereof.

Leah 1:17

Or lack thereof. Yeah. So we're talking constipation. All right. Let's do it. Yeah. What is constipation? And then we're going to talk about some integrative approaches to managing it, and then we'll wrap it up with some pharmaceutical and over-the-counter, and we're not starting with the pharmaceutical. Cause a lot of people, you know, they get the prescriptions and stuff, so they're kind of familiar with those, but so we thought we'd start with the integrative, but before we do. Tina, what is constipation?

Constipation- what is it, exactly?

Tina 1:46

There is the commonly accepted definition, bowel movements, less than three times a week. But patients will perceive constipation and report constipation. If there are symptoms that suggest a slowing down that could be straining at deprecation. So there's just difficulty passing stool. It could be that the stools are dry. It could just be distension, a feeling of discomfort

Leah 2:11

like bloating. You're talking about like, like a bloated feeling. Yeah,

Tina 2:15

like things aren't moving a sense of that. And so there's distension bloating with that. And of course the infrequency. So if someone's going less than every day, generally speaking, that is what we natur pass. Consider constipation. A lot of people are used to not going every day and they go every other day, they come in and report. They've always gone every other day or even every third day. I wouldn't classify that as normal. I would still classify that as. Not frequent enough every day is kind of the bar we want to get to. And

Leah 2:45

as we have mentioned previously, um, especially during active treatment, making sure that those bowels are moving, but not too much because it's helping your body to naturally eliminate The residual. Stuff that that goes along with, with getting chemotherapy. Yeah.

Tina 3:03

Because when you're constipated in particular, you reabsorb things in the small intestine, right? So you might be passing certain compounds or even drug compounds through your small intestine. But if it's not moving along at a normal pace, then you can reabsorb some of it and you really don't want to reabsorb it. It's expected to move along and out into the stool.

Leah 3:24

Yeah. So, so keeping those bells moving. But not too much, really important. And so laxatives, right. There are different types of laxatives. They're not all the same and they can be used singly and they can be used in combination.

Tina 3:41

I find that this is something that, um, isn't talked about enough

Laxatives- the 4 ways they work

Tina 3:45

because you know, a lot of people are tackling at least mild constipation on their own and just. Foundational understanding of the fact that there's four different types of laxatives, both natural accidents, as well as prescription there's, osmotic, stimulant softeners, and bulking agents. And so let me go through those a little more slowly, osmotic laxatives, create osmosis. What that is is. Magnesium, for example, I mentioned this in the last episode, when magnesium reaches the colon, it will pull water in with it. So that's considered an osmotic laxative, right? So

Leah 4:21

us Moses is the water moving across a.

Tina 4:26

Right. So as Moses is the water following the solid particle, which in this case is magnesium they're stimulant laxatives. And so this goes under stimulation of the muscles of the colon to tell the food to move along, right? So this is the Seneca and such, and then their softeners and softeners are separate from the osmotic laxative because softeners work more like a detergent does. And in softening the stool itself in the colon. Bulking agents are things like that. Metamucil. So a bulking agent is literally exactly what it sounds like. It creates bulk to the stool and when stool has bulk to it, it pushes on the walls of the colon. And that's what gets the colon stimulated to push it along. Assuming it's capable of that. I mean, there are drugs that stop that muscular reflex. In general, if everything's functioning, normally a bulking agent will cause the stool to increase in caliber and be pushed along because you stimulate that.

Leah 5:26

Yeah. And I think that going back to the first in the series where you talk about the anatomy, and I think knowing, you know, the anatomy and physiology, just in a really basic level, Someone to understand the types of laxatives and their actions.

Tina 5:44

Yeah. Yeah. And it lets people know that if one doesn't work, you might want to change the type of laxative or combine it with another type. Yeah.

Leah 5:51

The combination is really important that if you are having hard stool and then you have that bloating feeling that, you know, things aren't moving, you can do a softener. And then add a stimulant. Exactly. Yep. All right. So I guess that brings us to our first break. And when we come back, we're going to talk about integrative and naturopathic approaches to constipation. All

Tina 6:14

right. See another side.

Leah 6:16

Prunes have quite the reputation for being laxatives. they not only are great sources of insoluble fiber, they also contain sorbitol and naturally occurring sugar that has an osmotic laxative effect. All right. We're back after our little tea break and we're going to talk about dietary and lifestyle approaches to managing constantly.

Diet & Lifestyle- helpful approaches for constipation

Leah 6:45

And hydration, which we mentioned in the first episode, hydration is so important and it can be one of the hardest things to maintain while going through treatment.

Tina 6:55

Yeah. And I always, I always think of hydration or dehydration, the connection between dehydration and constipation is interesting. Cause when you think about why you're putting fluids in your mouth, it's to get to your bodily tissues. And so that gets priority. Consistency of stool. In other words, your body needs the water. So it's going to go take it from the colon. If there's not anything left over, then your stools are going to become difficult to pass because they're.

Leah 7:22

And what are the really common things that I hear from patients is like, oh, well, I don't like water. I don't want to drink water. Water tastes bad. And hydration doesn't necessarily have to mean water. And especially in treatment, you know, it's, it's finding those little tips and tricks to maintain hydration, to be able to not only hydrate your whole body, but also your bowels and, you know, move that stool along. Yeah.

Tina 7:46

So you're talking about things. Adding lemon to the water and getting changing the taste of it.

Leah 7:51

Sure. Or having maybe. Mild herbal teas, drinking broths, um, popsicles, if you can, if you can tolerate popsicles, if your treatment doesn't make you sensitive to cold, um, popsicles are a great way of getting hydration. Uh, jello that's mostly water that's hydration. Um, certain fruits. Sure. melons like watermelon cantaloupe and then grapes. Yeah, another great, great source of water. So it doesn't necessarily have to be, you know, a bottle of water, a glass of water. Sure. That makes sense. You can find other ways and preferably not caffeinated tea is what you want. And you know, it's got some caffeine in it. That's probably okay. Ideally some sort of an caffeinated beverage.

Tina 8:41

Right? Right. So the herbal teas that have no caffeine, whether they're hot or cold doesn't matter, right?

Leah 8:45

Yeah. Because you can make an ice tea, you know, you can make an herbal green tea or yeah. You know, hibiscus or something. So yeah, there, there are other options besides just water.

Tina 8:57

Yeah. And one of the things that I. Ask people to do. If they're going through a treatment, they're really having a hard time keeping their fluids in. And I will sometimes have them just get the oral rehydration salts, even ORs. You can find that in stores or online, but I I'm an advocate of that because it kind of gives them a little bit of everything. It's kinda like having the. There's a little more than just water

Leah 9:20

going in. Yeah. And you know, like in soups are nice, you know, soups or soups or easy, um, probiotics in terms of food, probiotic, foods. Yeah. Those are, those are a fun one. Cause there's so many, there's so many

Tina 9:36

available and if you tolerate dairy, I can say that what I have observed in patients is that yogurt is fine. And if you tolerate it, try some Kiefer as well. Kiefer has a larger variety of bacterial strains in it. So I have noticed in my observations that Kiefer can help keep people regular, who are, you know, yogurt's not quite enough to do that.

Leah 10:04

What do you know about Keifer water? I've never had that. I've seen that advertised, like it's delicious really? Cause I don't do Kiefer. So, which is weird. It's an acquired taste and it's not something I have quite gotten used to, but what's key for yeah. Keep her water. Talk about that.

Tina 10:19

So Kiefer water, there's all sorts of flavors out there right now. There's mango and pineapple and all these, I think they're widely available now. Um, but it's basically organisms you would make in the Kiefer with the dairy, but in water. So it's a. They're very tasty in my mind.

Leah 10:33

Oh, nice. I'll have to try it.

Tina 10:35

One of the things that helps is just a large variety. I think a diversity of strains helps in general, whether it's key for something.

Leah 10:44

Yeah. And I, I do recommend that if somebody is eating yogurt, you know, mix up the brands sometimes because there will be different strains, you know, try to mix in, if you like sauerkraut beet sauerkraut is like one of my favorite foods, so delicious. And then you can find, there are some products that are like sour cream or, you know, other dairy products that have probiotics added into them. And then it'll

Tina 11:08

say it on the label. Generally, the word on the label is cultured. So when it's dairy products, they'll, it'll say cultured sour cream or

Leah 11:15

cultured. Yeah. And cultured butter is, is pretty tasty. So just trying to, you know, incorporate as many probiotic foods as you can, sometimes that can cause bloating, which if if your bowels aren't moving, you may experience more bloating. so just be aware of that. So probiotics kind of leads us to their friends, the prebiotics,

Tina 11:36

the substance formerly known as

Leah 11:38

fiber. Right

Tina 11:41

The shape and size of your stool can provide valuable information on your gut health. To relay this information to your medical providers. There is a visual tool. Called the Bristol stool chart. They can help you describe, uh, your medical provider. What you saw at home?

Leah 12:00

So. Fiber is really important for helping to regulate our bowels as we've discussed. And we'll go into this with diarrhea as well. But you know, there are two main classes of fiber. You've got the soluble fiber, which slows down

Fiber- soluble versus insoluble

Leah 12:16

the bowel movements. Insoluble fiber, which speeds it up. So knowing which fibers you're taking in, depending on how your bowels are going. So if you are eating a lot of the soluble fibers and you're having issues with constipation, maybe swap those out for the insoluble fibers.

Tina 12:35

Yeah. And so. Just the term soluble versus insoluble, um, is literal. So just so people understand what we mean. So I was using apple as an example, you know, when you look at an apple, it has soluble and insoluble fiber, a whole apple, the peel is insoluble. It does not dissolve. You cannot dissolve it. You could boil it in some water for as long as you want. It's really not going to dissolve readily the inner aspect with all that pectin is. Right. And so you can imagine applesauce, it's very sizeable. It kind of falls apart. It's soft in it dissolves. And that's what we mean by. Versus insideables the peels generally, it's the seeds, it's the fiber as parts that it would be left over. Um, the part that gets stuck in your teeth, if you're biting into a nectarine or a peach, you know, those are insoluble parts of it. The Cybil part is the part that would turn mushy and get all soft.

Leah 13:30

Okay. That's a good explanation. It

Tina 13:34

also explains why, what you're saying happens, those insoluble fiber. Don't dissolve in our system and they go down and they kind of stimulate the inner aspect of your colon as they work their way through. And they stimulate movement by mechanical stimulation. So that's, that is the insatiable fibers do that. Like the Metamucil

Leah 13:55

is as well. Yeah, I think of as like scrubbing, I think of them as like, like colon scrubbers. And, you know, having that hydration on top of consuming, those insoluble fibers is really important or else they're not going to move and you might contribute more to your constipation.

Tina 14:11

Right. Right. This is another scenario where nature makes it just right. Right. So they usually come in combination in nature Cybil plus insoluble. They often occur together. So you have exactly what you need in the whole food. Yeah.

Leah 14:25

Um, another thing which we touched on in the first episode is lifestyle, right? Recognizing those signals that you have to go and not. Trying to hold, you know, hold back. So knowing when your body says it's time to have a bowel movement, trying to find a bathroom. And again, that's hard because it's so unpredictable when you're going through treatment.

Tina 14:47

Yeah. Yeah. But if you hold a bowel movement, it will go away. Right. So everyone knows that if you don't go right away, you don't listen to when nature calls. The reflex will leave for a time, whether that's hours or a day or whatever it's going to be. So listening to it. Yeah. I'm with you. That's essential.

Leah 15:06

Definitely. Yeah. You know, definitely. Um, not ignoring any, any urges to go. And we mentioned, movement, so whether it's walking or yoga or, doing some little exercises in bed, um, It's sitting in a chair and just, kind of marching in place while, while, while you're seated. There are, you know, that's, that's very important too. To get those bowels

Tina 15:33

moving. Yeah. And you know, if you think about it, toilets, I've only been around for so long. We used to squat and a full squat position in many parts of the world, they still do where they don't have toilets or there's a different type where they just

Leah 15:45

squat. They don't have the porcelain Thrones that we, you know, But we're used to,

Tina 15:50

right. In some ways the toilet itself is not a natural position to be in for the human body to have a bowel movement. So sometimes those stool, the footstool that they could put in front of the toilet that brings the knees higher than the pelvis, Squatty potty,

Leah 16:04

the Squatty potty,

Tina 16:05

Squatty potty. That's what they call it. Those

Leah 16:07

I have had patients say that those are life-changing.

Tina 16:10

Yeah, it makes sense. Right? Because we're keeping more with the natural anatomy of the body for a bowel movement.

Leah 16:17

Yeah. So that's, you know, they, they, they're not our sponsor yet, but there you go. Um, and then kind of moving into like more of,

Herbs- and how they work

Leah 16:30

you know, the naturopathic approach, which would be kind of more, more herbs and supplements that help with constipation. Aloe is a big one.

Tina 16:39

Yes. And Alica be used in two ways. Right. And can you use just the inner gel or the inner leaf filet or you could use the.

Leah 16:48

Right. And it's that external leaf that is the stimulant laxatives. And so it's a lot harsher. And then sometimes that can lead to cramping. And so if it's not going to interact with any treatment that the patient is on and I recommend ELO, then I typically recommend the inner leaf because I would rather kind of do a gentle approach than to risk

Tina 17:08

cramping. Yeah. And the cramping is. Annie stimulant laxative taken at a time that the stool cannot pass through for whatever reason will lead to cramping. So you're stimulating the muscles to push stool along and there's some reason it can't pass. Whatever that reason is. It can lead to cramping because the stool has nowhere to go. So you do have to be careful with all stimulant laxatives, whether they're natural or.

Leah 17:34

And some other gentler approaches, um, slippery Elm, you know, and I guess, you know, marshmallow could be in the same category.

Tina 17:43

Yeah. Yeah. I think of slippery on was a little more. Slippery. It does exactly what it sounds like, and it lubricates the intestines. Um, it's also very soothing to the intestines. So if there's any irritation, whether it's colitis or, you know, elitists or any kind of irritation along the way, slippery I'm can be very soothing to the.

Leah 18:02

And what I have seen, I had one patient who used slippery Elm powder to kind of do the dance between diarrhea and constipation. They were on targeted therapies and it would, you know, their, their bowels were changing all the time and they figured out how to use slippery Elm to, you know, just depending on how much they were using to kind of go between the two to manage their bowels. And they did a really good. Yeah,

Magnesium- how it works and which work best

Leah 18:28

magnesium is another one, which we talk about all the time. Um, and that one I had sometimes recommended as a powder, because then that way you can also do the dance, you know, you can kind of add a little bit more to your water or your beverage, and then pull back. If, if you need to, it's a, it's a little easier than using capsules. That's way easier than using capsules. And it's a little easier than breaking tablets.

Tina 18:52

Yeah. Well, and magnesium, that's interesting when you use it as a lab. Actually the least expensive magnesium makes for the best laxative over the counter. So magnesium oxide is very inexpensive. Um, it's not a great magnesium if you're trying to get magnesium to your tissues, but if your object is to get it to your colon and pull in water and loosen your stool. Well, because it's so poorly absorbed compared to other forms out there. You can use other forms, you know, magnesium, citrate, glycenate, Malai whatever, if you take enough of them, you'll still have some reach the colon, but just so people know that cheapest magnesium or the counters magnesium oxide, and that really is. Well, the one most effective for creating looser stools and

Leah 19:38

the brand that I think of that's the powder that I have recommended. I think it's spam museum citrate. So that's also like a very popular form of magnesium to kind of move the Bell's a kind of, I don't know, spa day of, of getting your magnesium in is soaking in an Epsom salt bath. So are you, if you're able to get in and out of the bath tub safely, Adding a nice amount of magnesium to the bath can also help to move things along. It's relaxing. So it helps to relax the bowels as well as all muscles in your body. But it also. I've seen it where it moves the bowels.

Tina 20:15

Yeah. Yeah. And if you buy Epsom salt, you'll see one that it's, it is magnesium sulfate. That's what Epsom salt is. And on the label, they'll give you a recipe for creating a laxative. If you took it internally on all Epsom salts that I've seen, there's always a recipe on there. If you were to use it as a laxative orally, and if you do it in a bathtub, just use a lot of it. We measure it in cups. When you put in. Oh, yeah.

Leah 20:40

Yeah. Like you're, you're, you're getting, it's getting gritty in there.

Tina 20:43

Yeah. You want to really saturate that water because the object is to get that to go through your skin. So you need plenty of it in the water to soak through

Vitamin C- how it works

Tina 20:51

your.

Leah 20:52

So something else that we touched on in the previous episode was vitamin C. And you know, this isn't something that I recommend often because taking high dose of vitamin C might not be compatible with every treatment, but definitely, you know, they talk about bowel tolerance when increasing levels of vitamin C and that's because it can lead to diarrhea. So if you're constipated, but it's not something that I

Tina 21:18

use often. So yeah. So vitamin C oral vitamin C in bowel tolerances is an old fashion kind of thing to do. Isn't it Linus Pauling's beginning. It wasn't it didn't start with Linus. Pauling. What hit him using it as a laxative? No. To bowel tolerance. Oh, oh, maybe advocating use to bowel tolerance. It's in the books 40 years. 50 years ago.

Leah 21:41

Interesting.

Fruits- how they work and which ones are best

Leah 21:42

I was wondering where that started, you know, what we didn't cover in the, in the diet approach is, um, dried fruits. Oh yeah. Prunes, you know, dried cherries actually, you know, regular cherries. Yeah. Um, yeah, it was just there, you know, just, again, a lot of those fruits, um, plums do it. Right. Cause those are. Those are hydrated prunes. Well,

Tina 22:09

yeah, you realize prunes have been around forever and known to be good for constipation or to relieve constipation, whether it's prunes hole or prune juice, they do function as both a fiber source as well as a mild stimulant. So there is something in the prune juice that does stimulate the bowel. But it's a mild stimulant and they are often no longer called prunes. They're called dried plums.

Leah 22:33

They got rebranded.

Tina 22:34

They were rebranded as dried

Leah 22:36

plums. They're not, they're not your grandma's, uh, friends anymore. That's right there. That, yeah. I don't know their hip now. I don't know what they are. So yes, that's something else where I'm like, we totally forgot to mention that. So dried apricots, raisins, prunes, all of those. And there even is a compote recipe that I have seen. But handed out by the nurses and by dieticians. And so I will put that, um, a link to that in our show notes, I'll put that on our website and then I'll put a link in the show notes and so y'all can have your own compote and it's nice. Cause you can put it on toast or on pancakes or just even take a spoonful or so. And it's, it's a great way to take, to get those foods in and to get the bowels moving. And so

Probiotics- how they are best used for constipation

Leah 23:22

just kind of going off of, we talked about probiotic foods. There are probiotics themselves that can help with, with constipation. I always caution if someone is going through active treatment, that to not take probiotic capsules, if your white blood cells are low, if you're told you have a low a N C and then also. You know, being cautious if you're getting immunotherapy taking probiotics, because you just, you don't want to favor just one strain of microbe. You know, you want a diverse strain. And so that's, again, you know, why the foods in my opinion are the way to go because you're getting a more diverse population. Yes,

Tina 24:03

I totally agree. When it comes to supporting the microbiota of the gut, diversity is your friend

Leah 24:09

and, there are. It's called sin Biotics. And actually I think that those would probably be not really the best thing because it's probiotics and prebiotics, prebiotics being the food that the probiotics eat it's mixed together. And you know, now that I think about it, I have seen formulas like that and they can lead to gas and bloating.

Tina 24:32

Yeah. Yeah. Yeah, the CIN Biotics and specifically those prebiotics Han, like when they w at F O S M in particular, which is fructo oligo saccharides they tend to lead to bloating in some people.

Leah 24:45

Yeah. I kind of think of it as, you know, the, the microbes, like start eating and they're having a party and, you know, I kind of leads to a little, a little bloat. That's just the way I explain it.

Tina 24:58

No, that's true. Yeah. They, they take in. Sugar and they metabolize it out and it could, they could create all sorts of gaseous by-products from that. Yeah.

Leah 25:07

Yeah. Which is not what you want when you constipated. So before we go to break, I want to mention, a lot of people like to drink coffee because it helps to stimulate their bells in the morning. Um, any hot fluid can do that. So drinking. Uh, tall mug of hot water. I sometimes recommend that when patients wake up in the morning, before you reach for your cup of coffee, take into hot water, you can add lemon. You don't have to, um, the lemon is just to mask the lack of flavor or the metallic flavor if that's going on. But yeah, have a nice big, hot mug of. Before having the coffee because it's, it's that heat. And then when you're having the water, you're getting the hydration as well. I like that one. Yeah.

Tina 25:53

The coffee's slightly dehydrating, which you don't want, but, you know, we will always make room for someone's morning coffee. We're not going to take that from anybody.

Leah 26:01

I take that away, but you know, you're sleeping at night. Your body like is taking all the water out of your, your colon, ideally. And so let's, let's rehydrate. Let's get some water. And even before you, you have your coffee, it sounds practical. All right. So we'll be back. ground flax seed is a great source of both soluble and insoluble fiber Other foods within soluble fiber include whole grains, beans, lentils, peas, berries, dried fruits, popcorn, and almonds.

Prescription & OTC medications for constipation

Leah 26:36

Okay. So this is the part where we talk about pharmaceutical and over-the-counter treatments for constipation. So going off of what you said is there are the osmotic agents and those are things like you mentioned, magnesium, magnesium, citrate. You know, common one that patients can use, um, lactulose is another one and MiraLax, and then the next category would be stimulants. And that would be like, like Senna. So like Seneca. I guess like a natural, you know, um, cascara like is the other one, right?

Tina 27:16

Yeah. Yeah. Those, that kind of combo that people will see in those teas, like smooth move tea.

Leah 27:21

Yeah. Yeah, exactly. Like, like that, those are the stimulant laxatives. And then you have the stool softeners, which would be like Colace. And then finally there are the bulking agents, which, you know, it it's mentioned in, in natural as well, psyllium, which has Metamucil. And then Citrucel is the other one. And that's, um, methylcellulose I think, and the thing with the bulking agents is those, you have to be really cautious if there's any suspicion of obstruction. And then also it's not really recommended with opioid induced constipation. Because it can contribute to constipation as well, you know, and make things a little worse. And so I don't usually recommend those. If somebody comes in and they're taking, if they're taking a fiber supplement or Citrucel just like for their daily management of. Bowel movements, you know, we'll definitely dive into diet and see what can be modified, discuss hydration, and then maybe switch them to another one or a combination, you know, you'll often see like a stool softener and a stimulant, you know, or the osmotic agent cause you need to soften the stool and then you have to move it along. Right.

Tina 28:30

Right. So yeah. So the senokat S senokat spelled. And then dash S S stands for softener. Yeah, they have,

Leah 28:40

they've got those combo ones and then you can also do the combination yourself, which I kind of like, because that way you can kind of control when you need what, you know, it's, it's kind of, it's a dance.

Tina 28:52

Yeah. And I would say. You know, to talk to the doctor, of course, but the ones that are least likely to cause trouble are the softeners and the osmotic laxatives things that soften the stool more so than anything else. If it's just, you know, episodic, constipation. Yeah.

Leah 29:08

So, and those stimulants can really cause cramps. Which just adds another layer of discomfort. Yeah. Oh, I do want to mention there is another category that is the prescription, you know, mostly prescription category. And that would be the ones that are specific for like the pain medication, the opioid induced constipation. And those are things like Rella store or Movantik

Tina 29:30

yes. Specific to those opioid induced constipation states. Yeah.

Leah 29:34

Yeah. All right.

Tina 29:37

I think that covers.

Leah 29:38

Yeah. I mean, that's just like, kind of like, you know, I guess with most of my patients there use a combination of natural and, and over the counter.

Tina 29:49

Yeah. I often put it into like different categories or here. This is what can keep you regular prevent constipation. Here's what you do with it's episodic constipation. And then during treatment, it's very different and we're more aggressive during treatment time. So if it's treatment induced constipation, then I get more aggressive and usually pharmaceuticals are needed.

Leah 30:08

And pharmacists are a great resource. Yeah. And you know, oftentimes the oncology nurses. Protocols as to, you know, like it's a little algorithm, like, you know, if, if this is what's going on, then try this and then add this one in. And so, you know, that's a good resource too. All right. Chinks, only a Coke.

Tina 30:29

I hope everyone has stereo on cause that was in stereo. Hey, so this brings us to our. Our

Leah 30:37

song

Announcement- our unofficial theme song for Constipation

Leah 30:39

The song is constipated and it's by weird Al so weird owl. He does the parody songs, right. And this is a parody of Avril. Levine's complicated, but it's constipated and it's perfect. I, you know, I do these searches for songs and who knew that there was actually, there are actually several songs about constipation. So, um, okay. So the second runner up is also a weird Al song and it's, I think it's called won't eat prunes again. And it's the who song? Of course. Yeah. Won't be fooled again. Yeah. When, when he prunes again. So that's the second runner up, but we're going to stick with, with consummated as our, um, an official. Perfect. Yeah, I'll be embedding the video on the website and putting a link on, um, in our show notes. Sweet.

Tina 31:33

Yeah. So this is the part where we ask people to share like and subscribe. Oh yeah. That part.

Leah 31:40

Yes. Yeah. So if you, if you, if you hear something and you like it, share it with a friend, do you think might benefit from

Tina 31:47

it? This is kind of like, if you see something say something, but only if it's, if you hear something and you like what you were hearing, say something.

Leah 31:54

Yeah. Let us know. Let us know if there's a. It's something you have questions about. That we, you know, we, we talked on, maybe we didn't go into depth on it, but you want to know a little bit more we're on social media, right? We're on Facebook. Sometimes we're here laughing.

Tina 32:11

I'm laughing because I think we really are bad at this part. I know we are.

Leah 32:15

We're on Facebook and Twitter and we're on Instagram and those are great places to share this information. I know we're, we're, we're not really like good at pushing

Tina 32:27

ourselves. Solicitation in general is not our thing. No.

Leah 32:30

And speaking of solitude and speaking of solicitation, I think I

Tina 32:34

say salacious. Okay, let's go on. We're not done yet.

Leah 32:37

Speaking of solicitation, we're also, we also have a buy me a coffee, so. Anything that you want to contribute helps us in terms of finding producers or editors or someone to run our social media for us. you know, so, cause this is, this is all grassroots right here, you know, it'll give us more time to focus on. This valuable content. I feel now like we've moved into the MPR asking for money saying,

Tina 33:07

yeah, I think we lost everyone by now. We're going

Leah 33:09

to keep talking. No,

Tina 33:11

we did lose that. Everyone they've already changed the station. Nobody's listening anymore.

Leah 33:15

I never listened to those fundraising. I know I'm so bad anyways, on that

Tina 33:19

note. Wait,

The sign-off- a little laughter therapy

Tina 33:20

if we're moving to our NPR, should we put on our NPR voices? Okay.

Leah 33:25

On that note. I'm Dr. Leah Sherman

Tina 33:29

and I'm Dr. Tina Kaeser, and this is the

Leah 33:31

cancer pod

Tina 33:33

until next

Leah 33:34

time,