Multi-Organ Transplant
PodcastDX
This week we will discuss Multi-Organ transplants with Zachary Colton. Zach is 35 years old and recently underwent a successful 5 organ multivisceral intestinal transplant surgery at the Toronto General Hospital in his home country of Canada. The organs he received were: stomach, small intestine, colon, liver, and pancreas. In 1954, . Liver, heart and pancreas transplants were successfully performed by the late 1960s, while lung and intestinal organ transplant procedures were begun in the 1980s. From the mid-1950s through the early 1970s, individual transplant hospitals...
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Ectoparasites
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This week we will discuss Ectoparasites. The CDC says: "Although the term ectoparasites can broadly include blood-sucking arthropods such as mosquitoes (because they are dependent on a blood meal from a human host for their survival), this term is generally used more narrowly to refer to organisms such as ticks, fleas, lice, and mites that attach or burrow into the skin and remain there for relatively long periods of time (e.g., weeks to months). Arthropods are important in causing diseases in their own right, but are even more important as vectors, or transmitters, of many different...
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Pasteurization For Your Health
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Over 200 years ago Louis Pasteur was born in Dole, France. Among Pasteur's major contributions and their benefit to society, the most important is the heat treatment of foods and beverages to reduce spoilage and eliminate pathogens for consumers. Probably the greatest achievement of Pasteur was the process that bears the name of this famous scientist who perfected the technique: pasteurization. For liquids, this process does not involve boiling the product to sterility but simply applying just enough heat (ie, par-boiling) to 50–60°C for a specified period to reduce spoilage microbes and...
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Spontaneous Pneumothorax with Jack
PodcastDX
In this episode we are talking again with our audio editor Jack Scaro. The topic again is: spontaneous pneumothorax, or collapsed lung. Spontaneous pneumothorax is an abnormal condition of the lung characterized by the collection of gas in the pleural space between the lungs and the chest wall. This condition occurs without an obvious etiology and can be classified as either primary or secondary. Patients may present with symptoms such as tachycardia and dyspnea. The diagnosis is based on clinical suspicion and can be confirmed with imaging. Jack had this condition which surprised...
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Bile acid malabsorption (BAM) part 2
PodcastDX
This week we will continue our coverage of Bile acid malabsorption (BAM), a . It’s a common cause of . When bile acids aren’t properly absorbed in your intestines, they build up, upsetting the chemical balance inside. Excess bile acids trigger your to secrete extra water, leading to watery stools. This week we will continue our coverage of Bile acid malabsorption (BAM), a . It’s a common cause of . When bile acids aren’t properly absorbed in your intestines, they build up, upsetting the chemical balance inside. Excess bile acids trigger...
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Bile Acid Malabsorption
PodcastDX
This week we will discuss Bile acid malabsorption (BAM), a . It’s a common cause of . When bile acids aren’t properly absorbed in your intestines, they build up, upsetting the chemical balance inside. Excess bile acids trigger your to secrete extra water, leading to watery stools. What are bile acids? Bile is a substance your makes while filtering your blood. Your liver sorts waste products, such as toxins, dead blood cells and excess cholesterol into bile. Bile acids come from synthesizing these products together. The different acids in bile help...
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Veteran's Hesitancy to Healthcare
PodcastDX
This week we will discuss a Veteran's hesitancy to receive healthcare at the government hospital system known as Veterans Administration or "VA". Although many veterans may share the concern over receiving care through a government agency due to the medical care they got while in training or active duty; i.e. sucrettes and tylenol being the standard of care when Jean Marie and I were in training. Our guest, Mark Frerichs, has different reasons to question the quality of care. Mark, a Navy veteran who continued working as a contractor post-war in Afghanistan. It was during his work...
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Adrenal Insufficiency
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In this episode we discuss adrenal insufficiency You can have either primary, secondary, or tertiary adrenal insufficiency. Primary adrenal insufficiency is also called Addison’s disease. When you have this type, your adrenal glands are damaged and can’t make the cortisol you need. They also might not make enough aldosterone. Secondary adrenal insufficiency is more common than Addison’s disease. The condition happens because of a problem with your pituitary gland, a pea-sized bulge at the base of your . It makes a hormone called adrenocorticotropin (ACTH). This is the...
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Heart Attack on a Train
PodcastDX
Have you ever wondered "what would happen if you or a family member had a medical emergency while using public transportation" Today we feature Bill H. who had a cardiac event after boarding a Chicago Metra train and the two bystanders that weren't about to let these be his LAST train ride! can help save lives during sudden cardiac arrest. However, even after training, remembering the steps to use an AED the right way can be difficult. In order to help keep your skills sharp, we've created a quick step-by-step guide that you can print up and place on your refrigerator, in...
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EDS and Gastroparesis
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This week we are speaking with Dani, AKA, Stoned Zebra. It took almost 7 years of her health declining after giving birth, until she finally received her EDS diagnosis. She was initially misdiagnosed with Lupus, Fibromyalgia, Neuropathy, or chronic pain syndrome. Her gastroparesis, symptoms (bloating, nausea, early satiety, severe constipation, weight loss, dehydration, belching, belly pain) began July 2022, and after a ton of aggressive testing, she was diagnosed in May 2023. EDS just tacks on chronic pain, joint instability and other comorbidities like POTS, MCAS, and OH that...
info_outlineThis week we will discuss Bile acid malabsorption (BAM), a gastrointestinal disease. It’s a common cause of chronic diarrhea. When bile acids aren’t properly absorbed in your intestines, they build up, upsetting the chemical balance inside. Excess bile acids trigger your colon to secrete extra water, leading to watery stools.
What are bile acids?
Bile is a substance your liver makes while filtering your blood. Your liver sorts waste products, such as toxins, dead blood cells and excess cholesterol into bile. Bile acids come from synthesizing these products together. The different acids in bile help to stabilize the lipids in the mix and keep them in a liquid form.
Your liver sends bile through your bile ducts to your small intestine to help with digestion. Bile acids in your small intestine help break down fats for absorption. When that work is done, they are supposed to be reabsorbed themselves, returning to your circulation and then your liver to be recycled into bile again.
What is malabsorption?
Malabsorption is any failure of your intestines to absorb all of the chemicals they’re meant to. Malabsorption can be a problem with your intestines themselves, or it may result from a chemical imbalance. For example, you may have too much or too little of a certain chemical for your intestines to absorb.
Who does bile acid malabsorption affect?
BAM has been historically underdiagnosed due to a lack of accessible ways to test for it. But studies now show that at least 30% of those diagnosed with functional diarrhea disorders may have BAM. Functional disorders are those that have no apparent cause and are likely to go undetected during a medical examination, such as irritable bowel syndrome (IBS).
BAM is seen in people with conditions such as:
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Diarrhea that persists after a bacterial infection.
It can also happen in people who receive certain medical treatments including:
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Surgical bypass or resection of the ileum, the last section of the small intestine.
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Gallbladder removal (cholecystectomy).
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Radiation therapy, especially in the abdominal-pelvic region.
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Metformin, a treatment for type 2 diabetes.
What are the symptoms of bile acid malabsorption?
Typical symptoms include:
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Watery diarrhea.
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Painful stomach cramps.
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Urgency and difficulty holding bowel movements in.
Some people also have:
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Steatorrhea (fatty stools.)
Long-term symptoms can include:
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Weight gain.
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Weight loss.
About half of people have constant symptoms, and the other half only report occasional symptoms.
What causes bile acid diarrhea?
The symptoms of bile acid malabsorption — primarily, bile acid diarrhea, or BAD — result from the buildup of bile acids in your colon, where food waste turns to poop. Normally, 95% of the bile acids in your small intestine are reabsorbed in the last segment (the ileum) before passing on to your colon.
When too many are left over, however, they pass into your large intestine with the rest of the waste. Bile acids in your colon irritate the mucous lining, triggering it to secrete extra fluid and speeding up the muscle contractions that move poop along. This causes frequent, urgent diarrhea and cramping.
What causes bile acid malabsorption?
What causes bile acids to build up in your intestines is another question.
Researchers have classified the possible causes of BAM into four different types. Sometimes they classify BAM as either primary or secondary.
Primary BAM is caused by your liver overproducing bile acids (types 2 and 4.)
Secondary BAM is caused by damage to your small intestine due to disease, surgery or radiation treatment (types 1 and 3.)
Type 1 BAM is caused by a problem with your ileum itself. This is considered true malabsorption, because the problem begins at absorption stage of the bile acid cycle. You may have type 1 BAM if you’ve had the last part of your small intestine surgically removed, altered or bypassed to treat another condition. Certain diseases, such as Crohn’s disease, and treatments such as radiation therapy can also damage the ileum. Significant damage impairs its ability to absorb.
Type 2 BAM has sometimes been called “idiopathic,” which means that it happens spontaneously or for unknown reasons. However, current research suggests that it's a problem with the chemical signaling between your intestines and your liver. This signaling is what normally regulates your bile acid cycle (enterohepatic circulation.) Chemicals in your blood signal when your liver should produce and deliver more bile acids and when it’s time to stop, reabsorb and recycle them. But with type 2 BAM, your liver doesn't get the memo to stop. So, it keeps sending bile acids — too many for your ileum to absorb.
Type 3 BAM is caused by gastrointestinal diseases that can affect your ileum along with other parts of your digestive system. These include celiac disease, chronic pancreatitis and small intestinal bacterial overgrowth (SIBO).
Type 4 BAM is caused by excessive bile acid production as a side effect of taking Metformin.