(upbeat music) Howdy, y'all. Welcome to our Let's Talk About Poop Podcast. Every Monday, we go live and answer questions you guys have. We also have a deep dive in which we go into a topic as well. So if you're joining for the first time, my name is Dr. Islam, who am I? I'm a board, certified gastroenter, I'll just train at the Mayo Clinic. I've been doing this for over 10 years. I've treated thousands of patients and written papers all about the GI tract. If you're new to this channel, don't forget to subscribe to my channel, listen to our podcast, watch our live stream as well. So the way we do this podcast is that I go through a deep dive on a couple of topics that patients have asked me about during my week as a gastroenterologist and towards the second half of the podcast. If you're on my live stream and answer any live questions you guys have as well. So you haven't already. Don't forget to like what you see, like what you hear, let me know where you're watching this, if you're watching this live or on the replay, and also let me know what social media stream you're watching this at and where you guys are watching this at as well. So today, we're gonna do a deep dive on a couple of different topics. We're gonna talk about bear to esophagus. We'll discuss three ways, easy ways to add in fermented foods and why you should do this. And have you ever noticed you have a cyst on your bottom? What are reasons for that? And also what can you do to make sure that's doing okay? So without further ado, if you're a first topic, bear to esophagus. So I got this question today because I actually had a patient come see me who just got diagnosed with bear to esophagus. He had a lot of questions about exactly what was going on. He was like a 50 year old male having chronic acid reflux for a long time. Nothing really worries him. Maybe just wondering why we still have any issues with this esophagus. And so we actually did an upper endoscopy and we actually diagnosed him with this condition which is called bear to esophagus. So what is this? So bear to esophagus is a pre-cancerous lesion of the esophagus that over time has the potential to go into esophageal cancer. In fact, bear to esophagus is the highest risk factor for progression into esophageal cancer. The reason this is courage is that you have two different cells kind of within your upper GI tribe. You have cells in your stomach called columnar cells and you have cells in your esophage called squamous cells. Now the cells in your stomach love acid. They don't care, they can bathe in acid, not a big deal. It's because they have these columnar cells or we have these columnar cells in the stomach that are normally made to hold onto acid and to not have any significant complications from them. The issue that occurs with bear esophagus is that when the acid actually goes into the esophagus, your esophagus is not like acid. It doesn't like it. And over time, those squamous cells inside the esophagus can actually get converted into stomach-like cells because the cells in the stomach are the ones that can tolerate acid. But the issue in bear esophagus is that transformation from normal esophageal cells to stomach cells does not stop. In fact, the transformation keeps on going and going and going to the point where it can actually become cancer inside the esophagus. And this is actually what bear esophagus can come from. So whenever we have somebody who has bear esophagus, the way we know this is that the way we diagnose some of the bear esophagus that involves two different things we have to do. Number one, I have to visually see what's going on. So we do what's called an upper endoscia or an E-G-D. This is a procedure when we push you to sleep. We use a very small camera and I can take a look inside the upper GI tract. You see exactly what is going on. And with that, I can assess, do you have bear esophagus? What is the extent of that? Are there pre-cancerous cells in the esophagus or what is going on? When we see that, we also need to confirm that with biopsies. We actually need to see that transformation of those cells from the squamous type cells to those columnar cells that are typically seen within the stomach. So how do you know if you have bear esophagus? Well, there are kind of six symptoms that bring up a red flag that make me think you have something going on in that esophagus. So number one is that you can have trouble swallowing, so difficulty swallowing. So trouble swallowing is never normal. And any time you have trouble swallowing, you need to make sure you don't ignore that because that could be a problem going on. That could actually could be a sign of that condition called bear esophagus. Chest pain. Yes, chest pain can actually be due to your esophagus. In fact, the second leading cause of chest pain, besides the heart or issues going on in the esophagus, whether it's reflux, bear esophagus, or even spasm as well. You also have regurgitation of food, food coming up that is a classic definition of heartburn or GERD, which should also lead to acid reflux. Chronic cough. Coughing all the time, we don't quite know why. You have a normal chest sector. You have a normal asthma test. You don't have COPD. You don't know why. Chronic cough can be due to chronic acid reflux, which should also lead to bear esophagus. And then having horses with the voice, same thing that acid goes up into the voice, the vocal cords to cause your voice to become horse as well. However, the most common symptom of bear esophagus is chronic acid reflux. Absolutely. In fact, acid reflux is the number one reason why you can get bear esophagus. And so what we need to do is we actually need to make sure we can do that. Now, there are three main reasons why you can have bear esophagus. But the first one obviously is chronic acid reflux. So if you had reflux all the time, or even if you have reflux intermittently, this can predispose you to have bear esophagus. I've had patients who come to see me say, "Hey, doctor, it's some." I have the occasional reflux. It's not all the time that he comes and goes. They had other risk factors for bear esophagus, which we'll talk about. And because of those risk factors, we decided to take a look with an upper scope. We actually found them to have bear esophagus. So besides reflux, what are some of the other risk factors for acid reflux? Number two is obesity, especially central obesity around your belly. Having a big belly, a Santa Claus type belly, a beer belly will predispose you to have acid reflux. That pressure can actually make more acid go up into the esophagus cause worsening issues to occur. Number three also is being a middle age Caucasian man. That is the epitome of somebody who will get esophageal cancer and bear esophagus. And then lastly, smoking will certainly predispose you to develop bear esophagus. So the way we diagnose it is that we take a look with an upper scope and let's say you have this diagnosis. How do we treat these patients? What do we do to treat patients who have bear esophagus? Well, the mainstay of treatments is really comes down to acid reduction therapy. And the best medication, in fact, the only medications I've been shown in clinical trials to decrease your risk for developing bear esophagus are proton pump and hemorrhage or PPIs. So H2 antagonists don't have not been shown in clinical trials to decrease your risk for bear esophagus. And acids have not been shown in clinical trials to decrease your risk for bear esophagus. Other things have not been shown, they can help, but by far the mainstay of treatment are PPIs. And actually having bear esophagus is one of the very few reasons why you have to be on a PPI. I know patients ask me all the time, hey, Dr. Rissam, do I have to be on a PPI? Is it safe? Do I need to worry about this? What if you have bear esophagus? My discussion for you is not, should you get off of it, but we need to continue on this as long as we can, because this is the only thing that's been shown in clinical trials to prevent the risk of this progressing into esophageal cancer. Number two is that sometimes lifestyle changes can help out. So when changing your diet, having more of a Mediterranean diet type diet, adding fiber, having healthy fats, trying to minimize the process, using fast foods are gonna make things better as well. Number three is losing weight. Like I told you before, obesity is a risk factor for developing bear esophagus. So losing weight in any way that you can, it's gonna make things easier for you as well. And then also too, lastly, but also significantly important is making sure you get your routine EGDs. My patients who have bear esophagus typically need routine EGDs depending on the style of the degrade, the degree, and the length of bear esophagus, and whether there's pre-cancerous cells or not. And that routine EGD is going to be the thing that will prevent this from progressing any worse in the future. It's also going to be the thing that's going to prevent this from progressing into cancer as well. So, mainstay of therapies, ass reduction therapy, lifestyle changes, losing weight, change your diet, and getting routine EGDs done. Now, if you have bear esophagus, I would encourage you to go see a GI doctor, someone like me, so we can see what's going on, make sure it's doing okay, and hopefully get that taken care of you. Unfortunately, bear esophagus is very calm. I see it's all the time. And unfortunately, I've had a good number of patients who had the opportunity to prevent them progressing into esophageal cancer, but there are those in which they did not do their routine surveillance EGDs, their upper scopes. And because of that, they unfortunately progress into cancer of the esophagus. And something I don't want for you, nor do you want for yourself as well. All right, next topic, fermented foods. All right, it's very hard for myself, and I'm sure for you to add in new foods. So, in this part of the podcast in the video, I'm going to discuss exactly different ways to do it, we'll discuss exactly what are the reasons, what are fermented foods, why do we even care about adding this? And I'll give you some simple, easy ways, three easy ways in which you can incorporate fermented foods into your body. So, what exactly are fermented foods? Fermented foods are foods that actually contain live bacteria in them that can actually be added to what you're eating as well. So, we need this bacteria to help adjust our gut microbiome. There's a constant battle in our gut microbiome between the good guys and the bad guys. And commonly, for a lot of my patients that have gut issues, the bad guys overwhelm the good guys to cause bloating, distension, nausea, seabell, gastric reflux, heartburn, all these other conditions that are there. And we need to do what we can to make sure the good guys in our gut can win and to save the day as well. And so, by adding fermented foods, you're able to do that in a very natural and effective way. And the healthier your gut microbiome is, the healthier you're gonna be as well. The more diverse your gut microbiome is, the more diverse your health is gonna be as well. But that's not the only benefit because fermented foods also have a lot of vitamins, nutrients, minerals to help improve your overall health and get you feeling better as well. So, I'm a big component and proponent of adding fermented foods to every single meal that you can. So, here are three ways that you can do that. Number one, I would recommend for you to add either kimchi or sauerkraut to any salad or sandwiches that you're eating. It's easy, use this as a garnish on the other garnish that you're having. These are basically just cabbages that you're adding or fermented cabbage that you're adding to your food. And so, if you can do this, add this to your salads, add it to your sandwich. It's an easy way to hopefully change your gut microbiome and not make a significant change to your overall habits as well. The other good thing about adding kimchi or sauerkraut is that it actually has ingredients in there to lower cholesterol and to lower insulin resistance, which will make things easier for other conditions, including diabetes. Tip number two, I recommend adding yogurt as a sauce. Yes, you can. Marinate your chicken and yogurt or have it as a dipping sauce as well to dip in your fruits and vegetables. Yogurt actually has bacteria in them and the bacteria can also change your gut microbiome as well. So, it has those probiotics, but not only that, it also contains phosphorus, vitamin D, calcium, and other ingredients and vitamins and minerals to improve your gut microbiome. So, add, use yogurt as a dipping sauce or a way to marinate your food as well. Tip number three, make a cheese board. Absolutely, this will work. Cheese, especially certain cheeses that are fermented, can give you the good probiotics and the probiotics that you need to improve your gut and your GI tract as well. Does this include foods like, or cheese like Swiss, provolone, AIDS, cheddar, gouda? These are very nice, tasty, and fermented cheese. Not all cheeses are fermented. So, crafts, okay, I'm sorry. Craft cheese is not fermented. Macaroni and cheese is not fermented, but these other cheese are fermented. And so, if you can add this, it'll help improve and change your gut microbiome as well. And by doing this, they're very simple ways to improve your health, to get you feeling better, and to at least add something into your diet that otherwise you may be missing as well. All right, now I'm going to our third topic, a cyst on your bottom. I got this from a patient who I saw last week, "Hey, Dr. Islam, "I have a cyst on my bottom. "What is going on? "And what are the symptoms that you need "to kind of be aware of "that you may be having a cyst on your bottom?" So, let's talk about this. So, what exactly, what exactly is a cyst on your bottom? We'll talk about what the cause is, what are some of the risks, and towards the very end, I'll talk about the treatments that I would recommend as a poop doctor to get this is taking care of you. So, what exactly is going on? When you have a cyst on your bottom, a cyst on your butt, this is basically an infection that occurs within the creases of your bottom area. This typically can happen when you have a hair that's clogged up. You have skin cells that are irritated. We have some sort of dirt that's clogging up a follicle. This will cause that cyst to occur inside that bottom area. Now, what are the symptoms? How do you know if you have a cyst? Well, number one, you can have some tenders whenever you're standing, or whenever you're sitting for a long time in your bottom area that tenders could be a cyst that has that blockage that's there. Number two, you can have some redness in that area as well, some warmth, just some irritation that's there that you can notice, especially if you can feel in the area, it feels a little tender in that area. Number three is that you can actually have some pus that drains from that particular cyst that may smell not very good. And that pus could be an infection that's from that cyst as well. And then if you have systemic symptoms, you'll also have fever and flu-like symptoms that can't occur from this cyst as well. So why do people get these cysts on their bottom? So we honestly, we don't quite know exactly why that's the case. There may be multi-factorial as to why people can get that cyst on the bottom. So for some people, that area in your bottom can be an area where it's very vulnerable, where they have a lot of bacteria that's there, a lot of dirt that's there, it's not very clean. Another reason that it's also an area where you have a lot of pressure. So if you sit for a long time, or you're in a situation where you really can't move, that can cause that to cause irritation, things get clogged up and cause that area to become a cyst as well. Now there's certain risk factors that we have seen, and they can make it more likely for you to have this cyst. So for example, if you're obese, if you have trauma to the area, if you sit down for a long time, if you don't clean that area, if you have a lot of hair on your bottom, this can predispose you for developing more cysts in that bottom area to cause issues to occur. Now, if you are having a problem with the cysts in your butt, what can you do? Well, so number one, come see someone like me, where we are butt experts to see exactly why you have that cyst. So there are some non-surgical treatments, there may be some surgical options that we can offer for you. So for the non-surgical treatments, you gotta remove that hair in that area. If that hair is matted, if it's too hairy, if things are getting stuck in there, you just got to remove that hair to make it easier for you. And sometimes we can give you medications, sometimes oral antibiotics or topical antibiotics. We can give you antiseptic washes, we can maybe use some injections and some steroids to hopefully cause that cyst to be reduced, and to make it easier for you as well. Also too, we actually may need surgery to remove that cyst. So whether it is an excision of that cyst, an roofing of that cyst, or sometimes even cutting it out, that can be a way to get that taken care of you. And so, if you're having issues with these cysts, or you're having symptoms, come see someone like me where we can actually take a look and see what's going on, and maybe do the treatment there, or refer you to someone who can do that. So if you're watching this video wondering, oh my gosh, I do not want a cyst in my bottom, what can I do to make sure it doesn't happen? So there are a couple of tips I'm gonna recommend for you to make sure that you don't get a cyst. So number one, avoid prolonged sitting, and avoid prolonged sitting down for a long time. And so if you're able to get out and stretch maybe every hour or so, that's gonna allow you to not have the pressure on your bottom to cause that cyst to occur. Number two, try to manage your obesity. So if you're obese, this will predispose you to have more cysts, and so try to do what you can to minimize just the weight around the belly as well. Number three, you want to clean and exfoliate the skin around that area. Keep in mind that cysts can form because you have dirt in that area, or a hair follicle is just clogged up. So try to clean and exfoliate that area. And then next, try to trim up that area as well. If it's bushy and a lot of things are going on there, you can't see anything, it's like a jungle in there. Just cut some of that hair out and keep it clean as well. And also make sure that you avoid clothes that are very rough in that area. So like denims or things that are tight, that's gonna make it more likely for you to have any issues going on in your bottom. So if you have a cyst in your bottom, come see me, where you can find out what's going on and hopefully get that cyst taken care of for you as well. All right, I think that's all we got for today. I wanna thank you for watching. You haven't already, don't forget to smash that like button, like, share, and subscribe. If you like what you see, if you like what you hear, give us a five super view, subscribe to our channel, and come see us on the gas show for all your GINAs. And thank you for watching, hope you guys have a great day. Look forward to see you guys next week, and hope you guys are doing well. Thanks and take care. (upbeat music)
