Could Your Gut Pain Be EDS-Related? with Dr. Pradeep Chopra (Ep 157)

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Dr. Pradeep Chopra: [00:00:00] What happens is that these 10,000 guys that live at the large intestine start creeping over to the small intestine because there are only a thousand people defending their territory over there. And so these 10,000 guys from large intestine overrun the small intestine, hence small intestinal bacteria over.

Dr. Linda Bluestein: Welcome back every bendy body to the Bendy Bodies Podcast with your host and founder, Dr. Linda Bluestein in the Hypermobility md. Today we are going to be talking about abdominal pain and gastrointestinal problems with EDS HSD pots and MCAS. I'm so fortunate to have Dr. Pradeep Chopra with me back again on Bendy Bodies.

Dr. Chopra is world-renowned for his incredible work in EDS and HSD pots, [00:01:00] mast Cell Activation Disorders, CRPS and Central Sensitization Disorders. Dr. Chopra is a Harvard trained board certified pain medicine specialist with over 25 years of experience. We will link all of Dr. Chopra's prior Bendy Bodies podcast episodes in the show notes for easy access.

I'm so excited to have this conversation because I know that you very well may be suffering from abdominal pain and other GI symptoms, so I hope this is gonna be super helpful for you. As always, this information is for educational purposes only and is not a substitute for personalized medical advice.

Stick around until the very end so you don't miss any of our special hypermobility hacks. Please also subscribe to the bendy bulletin. It's hypermobility md.substack.com. Let's get started.

All right. Well I am so excited to be back with Dr. Chopra, and today we're going to be talking about abdominal pain and other problems in the GI tract, and it's so great to see you again. 

Dr. Pradeep Chopra: It's wonderful to be back [00:02:00] again. It's a real pleasure. And you know, I think antibodies is doing an amazing job because I get lots of patients that come in and say like, I'll give them a diagnosis.

And I think I'm like this hotshot giving them a diagnosis and they're like. Oh, yeah, we heard it on bendy bodies. I'm like, 

Dr. Linda Bluestein: got it. Well, good. I'm glad that we are reaching more and more people because, you know, as, as you know, there's gonna be a lot of things that we're gonna talk about today that we've talked about on previous episodes.

This kind of education doesn't have to happen one-on-one in a doctor's office. And a lot of these things, people don't have great resources. So they'll hear things that we talk about and it will lead them to get more diagnostics or, you know, start to track things down themselves and play detective, which is unfortunately really important in this day and age.

Dr. Pradeep Chopra: You know, I think, uh, one of the best things about, uh, going on a public forum and talking about diseases and sharing ideas is that [00:03:00] it's empowering the patients Yeah. To better understand what's going on with them. And I hate to say this, but it also helps them from being gaslit. Uh, but more importantly, they get to understand, okay, you know, uh, I have this condition.

It's a weird, sounds strange to me. My doctors think I'm crazy, but you know what? I heard these two guys on bendy bodies talk about that exact same thing, and they had a explanation. Mm-hmm. And that's what I like about it. And it's, this information is available to them free of cost. And it's not like, I know you've spent millions of hours studying this.

It doesn't, it's not like you just woke up one day and you know everything about EDS. I personally know how much work you've put in. I know that. And, you know, I have spent weekends and weekends and weekends and days and nights reading, studying, understanding, [00:04:00] researching, uh, literally inventing treatments for, uh.

Conditions associated with EDS, and it's such a pleasure to share it with them. Mm-hmm. And, you know, that might be our legacy. Mm-hmm. Yeah. You know, it'll be on my, it'll be on my tombstone. Thank you for being on Bendy Bodies or something like that. 

Dr. Linda Bluestein: I thought you were gonna say that like the, some of the treatments that you invented were gonna be on your tombstones.

Okay. Well, you're gonna have to have a big tombstone, but if bendy bodies makes it onto your tombstone, that would be pretty cool too. 

Dr. Pradeep Chopra: Oh yeah. No, I, it, if I have to put everything that I invented or discovered or researched, it's gonna be a massive tombstone. Yeah. I mean, it has to be something like the Great Wall China or something.

Right, right. But, you know, we'll just put a little, this thing, we'll put a QR code on the Great Store. There you go. And there you go. 

Dr. Linda Bluestein: Yeah. Yeah. You might, you might have just invented something else that, uh, that [00:05:00] could be very valuable for a lot of people who wanna share their life's work. After they're gone.

So, and de definitely, that's something that I've thought about too. You know, we help people when we see them one-on-one, of course, but we need to reach more people than that. And so I think about that all the time, you know, what do I want my legacy to look like? So 

Dr. Pradeep Chopra: if you left a good footprint on, on this, on this planet, everybody left a footprint that would be useful and will follow their legacy.

That's, that's really gonna change the world. 

Dr. Linda Bluestein: Yeah. 

Dr. Pradeep Chopra: It's not about having a big mansion or a building or something like that named after you, you know, or a hospital wing named after you. But it's more of, um, yes, I help this, uh, mom understand what's going on with their kids. And those kids can then have a full life and then they will pass it on to their kids and change families and generations.

Dr. Linda Bluestein: So I know that [00:06:00] this started, as you and I were talking on the phone the other day about this, a GA clinical practice update on GI manifestations in pots, hypermobile EDS, et cetera. Um, that was published, uh, fairly recently in May of 2025 by Dr. Aziz and colleagues. And there were some really great things that they did in that paper, but I know there were some other things that we were going to, uh, mention as additional factors to consider.

Do we wanna start out by talking about some of the things that we thought were valuable from this paper, or, I know we have quite an extensive list of things that we want to, um, add on to that. 'cause we wanna, as you proposed, which I think was a great idea, we're gonna start with the teeth. Uh, we're not gonna start with the esophagus or the mouth.

We're actually gonna start with the teeth and, uh, work our way down. So, do we wanna talk about the paper a little bit first or do we wanna just dig right into the, this whole, uh, journey that we're gonna take through the GI tract? 

Dr. Pradeep Chopra: I mean, the good thing is that a paper was published recognizing the connection between.

GI tract and [00:07:00] EDS. Mm-hmm. That's the good thing. Mm-hmm. Uh, the not so good thing was that, you know, they came up with these, it's not really guidelines, they actually came up, it's, I'm looking at it right now. It says, uh, practice, clinical practice update. Mm-hmm. And, uh, so they've given a list of them 16 updates, uh, but most of them just center around hearts and mass cell activation syndrome, which was, you know, yeah.

They talked extensively about MCAS and they talked extensively about hearts. Uh, but I think there was a lot that they missed. Mm-hmm. And we, they could have added that. I don't know the reason for not adding that. Um, there may be a reason, uh, 'cause the gastroenterology, they don't consider. I don't know. To me, [00:08:00] GI means stomach, ab, abdomen, anything in the, in that, in the abdomen is GI for me.

Mm-hmm. Mm-hmm. I mean, I can't say the liver is not, I mean, the liver is also a part of the gi and the spleen is also in all of those things. And so what we are gonna do today is we are gonna leave the guidelines alone. Uh, we talk about our, we, we can, we can supplement the guidelines. Mm-hmm. Because, uh, they talked a lot about POTS and MAS mm-hmm.

Which we've done on previous podcasts and Right. We've talked specifically about it, but we'll talked specifically about, uh, GI abdominal issues in, in EDS. How's that? 

Dr. Linda Bluestein: Yeah, yeah. Anything affecting the gastrointestinal tract or like you said, the abdominal cavity I think would be, uh, very helpful for a lot of people.

So, yeah. Let's, let's start with the teeth. So there are. Issues with the teeth that can affect how [00:09:00] you feel in your belly. Right? So starting with that is probably a good place to start. 

Dr. Pradeep Chopra: Well, um, so I have, I have these weird ideas. Okay. You know, I think in one of my previous podcasts I said that all my brainstorming happens when I brush my teeth.

Dr. Linda Bluestein: Yes. You have said that before. Yeah. My teeth are clean. They look great. 

Dr. Pradeep Chopra: Yeah. That's why all my ideas come when I brush my teeth for some reason. And anyway, so do you brush 

Dr. Linda Bluestein: them for a really long time then? 

Dr. Pradeep Chopra: Um, I wind up and then when I get really excited, I have my phone next to me and if I get really excited about something, I start, you know, I've got toothpaste in my mouth and I put my brush on the side and I start typing in.

Okay. Just because you know, you know, your brain cells only work this long, like right after two minutes you're like, what was that thing I was gonna write, discuss. So I quickly type it into my phone before I forget. Yep. And [00:10:00] so, yes, a lot of my ideas came here and one of the ideas was that you and I are gonna take a stroll.

We're gonna take a little walk down the gastrointestinal tunnel. Let's call it a tunnel. Okay. Okay. Uh, and, and we'll start with the teeth, although teeth technically don't belong to the gastroenterologist, uh, they belong to the dentist. Mm-hmm. But it's, nothing will happen if you don't have teeth. Right.

Teeth are very sure you can. Right. So, so teeth, teeth are actually a big issue. Teeth and gums are a big issue in EDS, hypermobile EDS, um, is that teeth is connective tissue. The enamel on the teeth is connective tissue. And, and some people have what is called soft teeth and. They brush, we use hot bristles on our toothbrush and, and the toothpaste that we use, like the Colgate [00:11:00] ones and all those, uh, those are all abrasive.

Do you know that you can clean your, the headlamp on your car with, with toothpaste or you can clean silver, old silver with toothpaste. Oh, that's hack. That's a worrisome. That's a hack. Yeah, that's a hack. That's a hack. Yeah, that's a hack. Okay. So, um, so anyway, um, I, I digress. Um, so the, so the enamel on the teeth is soft.

And so, you know, you brush your teeth with this hard toothbrush and you have this abrasive sandy toothpaste, and you scrape off some of the enamel, and then you worry that, oh, I, I'm getting a cavity. And then you brush harder and harder, and then finally you have a big hole in there, and then some germ decides to live in there.

Mm-hmm. And that's one problem. The second problem is that. Did you know that people in EDS have dancing teeth? 

Dr. Linda Bluestein: Dancing teeth? 

Dr. Pradeep Chopra: They move around, they shift [00:12:00] around. I I've heard that. Did you know that? 

Dr. Linda Bluestein: Well, yeah. My, my, my oral facial pain doctor is working on a study about how teeth in EDS often do move faster with orthodontia, but then often will regress afterwards.

Of course, that can happen to a lot of people, but, uh, but I have never heard them referred to as dancing teeth. And I would like, oh, that's, yeah, that's your term. That's my, okay. And, and I wanna make sure for people who just heard this about the toothpaste, um, I know that you have an alternative, uh, that you'd like for brushing teeth.

So if you could let us know what that is too. 

Dr. Pradeep Chopra: Right. So, uh, my recommendation on that is there's a, there's a dental gel called Live Fresh. Mm-hmm. LIV Fresh. Mm-hmm. It's a little expensive, unfortunately, but. It's not abrasive. Mm-hmm. So it's what we call as a chelating agent, which means it kind of wipes stuff off the teeth Mm.

Without scraping [00:13:00] off anything on that. And, you know, you just wet the toothbrush and you put a little blob of this live fresh and just sort of go gently, sort of applying and gently brushing it off. Mm-hmm. And, and it works really well, actually. It works well on the gum also, gums also. So, so that's one of the things.

The other problem with, um, with teeth is the gums, because gum is connective tissue. And so if you brush too hard, you're scraping of gum tissue. And we, we see a lot of gum recession in patients with, um, EDS, uh, so. Brushing hard is not a good idea. 

Dr. Linda Bluestein: I really like the water pick for that. And especially, you know, now they make the battery powered ones.

I used to make a huge mess in the bathroom. Uh, but if you get by the water powered one, you can do it in the shower so you don't make as much of a mess. 

Dr. Pradeep Chopra: Oh yeah. Those, uh, power jets, right? Mm-hmm. 

Dr. Linda Bluestein: Mm-hmm. 

Dr. Pradeep Chopra: Uh, those are amazing. Uh, and they, they'll clean out anything. [00:14:00] Uh mm-hmm. So, yeah, I like those. So we just walked through all the 32 teeth.

I guess 

Dr. Linda Bluestein: we're gonna walk through each one individually. 

Dr. Pradeep Chopra: No, no, no, we're not gonna, oh, okay. But taking care of your teeth is important because Yeah. 

Dr. Linda Bluestein: Very, 

Dr. Pradeep Chopra: um, any infection in the teeth is going to be carried into your GI tract and then into your blood, and then of course, uh, everywhere. So having healthy teeth and gums is extremely important 

Dr. Linda Bluestein: and also contributes to inflammation, right?

Dr. Pradeep Chopra: Absolutely, absolutely does. If you have inflamed gumps, that inflammation is gonna spread. And so any, I mean, if you have an infection in the gums mm-hmm. It's gonna cause inflammation everywhere. And this is extremely important. I hope my dentist is listening. He's so proud. 

Dr. Linda Bluestein: You can always send this to him.

Dr. Pradeep Chopra: He and I have had, he and I have arguments about live fresh. He's fooled me off many times and I have proven [00:15:00] him wrong because I, after I started, I used live fresh. And after I started using it, he hasn't been able to find any cavities. Oh. Oh, he's upset because 

Dr. Linda Bluestein: you're putting him out of work, that's why.

Dr. Pradeep Chopra: Yep. Yep. So he is, um, uh, the next thing I wanna talk about was, uh, the throat. Well, what about the jaw? Okay. The jaw. 

Dr. Linda Bluestein: Yeah. 

Dr. Pradeep Chopra: Uh, so on the jaw, we have two things to talk about. One is TMJ dysfunction. Mm-hmm. And the other one is, um, what's called eagle syndrome. And, you know, TMJ is not so that, so that, so this TMJs temperament joint and it's a of a very, uh, it's not a well made joint because I know, I'm sorry.

I hope I don't get hit by lightning. But, uh, it's not a well made joint. It's, it, it's not just the EDS. [00:16:00] Also in the non-ED people, it does dislocate or sub blocks. Mm-hmm. It does. Mm-hmm. And, uh, I think God wanted us not to open our mouths too big and we, we didn't listen to him. And so when you don't listen to that, you, your mandible.

Dislocates. Mm-hmm. 

Dr. Linda Bluestein: And, and I have a, and I have a hack from my, uh, my oral, uh, oral facial pain doctor, when you yawn to tuck your chin down to your chest, 'cause then you can't open your mouth as wide. Right. Yeah. So she, she, 'cause she gets a lot of patients that have open locking, so she recommends doing that.

So because, because yeah, the job problems can contribute to chewing problems, which can, you know, obviously cause problems with digesting your food, et cetera. So, but I did, sorry, I interrupted you. Keep going. 

Dr. Pradeep Chopra: No, that's a great hack. I love it. Oh, we we're allowed to interrupt when it's hack time. Oh, okay.

'cause then you'll forget the hack. 

Dr. Linda Bluestein: Exactly. 

Dr. Pradeep Chopra: So on the TNJ, uh, [00:17:00] we talked about, so this muscle is called ambassador muscle. Mm-hmm. And it's a really powerful muscle. And this muscle is called a temporal muscle. Mm-hmm. And these are our chewing, grinding muscles. Mm-hmm. And what happens is that a lot of us subconsciously at night will grind our cch.

Mm-hmm. And it also, there's a phenomenon where you. When you're lifting something heavy or when you hurt, you tend to clench your teeth. It gives you that little extra boost, uh mm-hmm. And energy. Uh, and so we tend to clench our teeth. You know, when you're lifting something heavy, you pick up your whatever.

And so we do clench and grind our teeth a lot. And what happens is these muscles get tired and then during the day you are talking, you're eating, and then they, they, so they, they will get rest. Mm-hmm. And they finally start to get inflamed, and then they have muscle spasms and muscle knots in [00:18:00] them. It's really hard to treat TMJ from grinding because it's a change of habit.

And changing a habit is very difficult. You know how long it takes to change a habit? Well, you, we hear 

Dr. Linda Bluestein: like 

Dr. Pradeep Chopra: two weeks, but 

Dr. Linda Bluestein: four months. Four months. Oh, wow. Okay. Four months, not, not two weeks. 

Dr. Pradeep Chopra: No, four months. Okay. 

Dr. Linda Bluestein: Wow. That is a long time. 

Dr. Pradeep Chopra: So, so what I tell patients is to start subconsciously during the day and at night, especially before bedtime, start thinking about not clenching, not grinding, the kind of obsessing about not clenching and grinding.

Mm-hmm. And it, what happens is the brain subconsciously registers that mm-hmm. And then they don't clench and grind. You know, I don't know if you ever had this, because it happens with me a lot. I'll set, if I have to take a flight at four o'clock in the morning and I set my alarm for three o'clock, I will wake up 10 minutes to three and turn off the alarm before it even gets a chance to wake me up.

[00:19:00] Mm-hmm. Mm-hmm. And, and that's because all day you be thinking like, oh, okay, I gotta get up at three. I gotta get up at three and I gotta go to the airport. And so subconsciously the, the brain sets its own alarm. It doesn't trust you to set an alarm. Mm-hmm. And so you set your own alarm and it happens. And this is what.

TMJs, if you start obsessing about not clenching and grinding, it helps a lot. 

Dr. Linda Bluestein: I have two hacks from back from, uh, Dr. Julie Robinson Smith, who is, like I said, my doctor. Um, so, so her two hacks, 'cause I clench a lot and the teeth I know are not only supposed to touch like very rarely, they're not supposed to be touching.

Like that's a huge problem right there. And she told me to set a timer on my phone to go off every 15 minutes and every time that the timer went off to pay attention if my teeth were touching or not. Now my. I dunno if it's my EDS or, or what, but my proprioception is so bad that I have a hard time even telling if my teeth are touching or not.

But this is what she wanted me to do. And, um, it's gotten a [00:20:00] lot better since then. But anyway, so every 15 minutes you set this timer and when it goes off, you write down if your teeth were touching or not, and, and then you start tracking and making sure that as you're paying attention, you're doing it less and less and less.

Because, uh, and then she gave me like frequencies that if it's happening this amount, then you can decrease the frequency. And if it's still happening a lot, then you keep checking every 15 minutes. Um, this is, of course, while you're awake, you don't like wake yourself up to, to see if you're clenching. Um, but that was one hack.

And the other hack is, um, SSRIs contribute to, uh, clenching. Right. So that's really, that's mm-hmm. 

Dr. Pradeep Chopra: Oh, I had no idea. 

Dr. Linda Bluestein: Yep. Yep. So 

Dr. Pradeep Chopra: either you clench or you get depressed. 

Dr. Linda Bluestein: Right, right. So just, just choose what, just food for thought and pun intended. Okay. I didn't realize that. 

Dr. Pradeep Chopra: Oh. So if you find yourself, so do even during the day, uh, just remember not to clench.

Mm-hmm. And there are a couple of things I can do. There's a rule called [00:21:00] lips together, teeth apart 

Dr. Linda Bluestein: mm-hmm. 

Dr. Pradeep Chopra: Together, teeth apart. And the other one is, which I do, is I stick my tongue between my teeth. So if I find myself clenching, I stick my teeth and my tongue between my teeth and I, it kind of breaks that cycle.

Mm-hmm. Now, the expensive way of, or the fancy way of treating TMJ is that they use something called an oral appliance. Mm-hmm. So these are orthodontists, uh, highly specialized orthodontists who design oral appliances. And so you're actually clenching on air when you're, when you're biting down. That's, so they have a day used one, and then they have a nighted used one.

And there are very far and few, but they are some really good ones out there. The common thing that the people do is they give you this mouth guard, which I think is, doesn't make much sense because then now you're biting down on plastic. Mm. So it does [00:22:00] protect your teeth, but you're still clenching. It doesn't solve the problem.

Dr. Linda Bluestein: Mm-hmm. You're still putting the forces to the jaw. Yeah. 

Dr. Pradeep Chopra: Yeah. But I have a little hack for that. 

Dr. Linda Bluestein: Okay. 

Dr. Pradeep Chopra: So it's, you know, it's hard for people to do all these things. Mm-hmm. And remembering there is, you know, keeping up not to grind, not to able to do all those things. So I, I'll do is I'll shoot some Botox into the massacre and theus muscle.

And what that happens is that they still clench, but now they're not clenching as hard. Mm-hmm. And it doesn't affect their eating or, or chewing. Uh, but when they clench, it's not that hard clench. Mm-hmm. And it does work. It does work because I get it and I know it works. Oh, yeah. So I had these, he, I have headaches, I get migraines.

So I have these headaches and they would go away. It wouldn't go away. And I was, nothing was working until I realized I was sitting like this and I like [00:23:00] felt it, and I could feel these muscle knots in my, uh, masseter muscles. And I realized that. So I had someone shoot Botox into these muscles. So that's, uh, for TMJ, but very often we get patients that come into our offices.

You have seen them? I've seen them. Oh, you know, I've got horrible TMJ, I've got horrible TMJ. And you tell them, show me where your pain is. And they'll point to somewhere down here. Mm-hmm. Mm-hmm. Not precisely here but here. Mm-hmm. And they be told by a lot of doctors, oh, it's EMJ, but it's actually something called Eagle Syndrome.

Now this has nothing to do with the bird eagle. This was actually Dr. Eagle who discovered this. So let me explain the symptoms of Eagle syndrome. 

Dr. Linda Bluestein: And, and can you, you, you, you're pointing, and for people who are listening, can you make sure to describe where you're pointing? 

Dr. Pradeep Chopra: So I'm pointing to under my jaw, my handsome chiseled [00:24:00] jaw pointing under that 

Dr. Linda Bluestein: you're pointing lower.

Lower than A little bit, yeah. Lower than the angle of the jaw, right? Not, not the neck, but like coming down underneath on the neck. Okay. Yeah. I'm sorry. Keep going. 

Dr. Pradeep Chopra: Keep going. But basically it's the jaw area, Uhhuh, right? So when you think of TMJ, and if you think of, of extremely, uh, paid full TMJ then always think of, well, is this, could this be Eagle syndrome?

Mm-hmm. So the symptoms of Eagle syndrome are, uh, difficulty swallowing. They feel like there's something stuck in their throat. Mm-hmm. And then they have shooting pains from their throat to their ear. And they, uh, this is not so common. There's pain at the base of the thumb. I don't see that as often. Um, but if you have them turn their head towards side and you tell them to swallow, it's hard for them to do it.

It hurts. And [00:25:00] then they have ringing in or buzzing in their ears. Um, it is associated with headaches. It's a very big reason for headaches. And, and the way I examine them is I press, so I'm pressing under my jaw, my mandible. Mm-hmm. I'm pressing under there, there is a, there is a piece of bone called the styloid process and I'm pressing on the thyroid process.

And, and, and then they go ouch with that. And then I do, one more step is I put my finger into their mouth and I go along the mandible, just the side of the mouth. And I sneak in behind the jaw Behind. Mm-hmm. And I, I hit the steroid process and, and it's really painful. It's very painful. 

Dr. Linda Bluestein: And, and I have a question about that too, is are you finding that more unilaterally or, you know, so one side or, or bilateral in your [00:26:00] patients?

Dr. Pradeep Chopra: It's mostly bilateral. Mm-hmm. But one side is always worse than the other. Mm.

And you know, the anatomy is a little hard to explain, uh, but basically there's a piece, there's a small bone at the back of the mandible. Mm-hmm. And that kind of grows down, down, and it becomes longer. And it presses on, uh, a nerve, which goes to the throat and the tongue. It's called the glossopharyngeal nerve.

Dr. Linda Bluestein: And we can add an image on the, on the video for that so people can see it 

Dr. Pradeep Chopra: on YouTube. Yeah, yeah, yeah. Absolute. Uh, and then it can also, if you turn your head, it can press, uh, the vein, it's called the jugular vein. Mm-hmm. And even, and in some severe cases, it can press on the internal carotid artery. Hmm.

Now, that is extremely important because one [00:27:00] of the reasons people have headaches in, um, in EDS is raised intracranial pressure. Mm-hmm. Pressure inside the head goes up. And the reason it goes up there are many reasons, but this reason over here is related to eagle syndrome, is that the amount of blood going into the head has to be the same amount that comes out now.

So the internal car, the carotid artery, takes the blood into the brain. Mm-hmm. And the internal jugular vein drains that blood out. Mm-hmm. And the, the, so when, when they turn their head. The standard process, that little bone growing down, it actually pinches the internal jugular vein. So now your blood going into your head, but not, not the same amount coming out.

And so they have this intense, uh, intracranial pressure headache. So that's Eagle syndrome. 

Dr. Linda Bluestein: Okay. Well, before we leave Eagle Syndrome in terms of treatment for Eagle syndrome, there, there is surgery of [00:28:00] course. Um, are you, uh, in terms of working up Eagle syndrome, what, what, besides your exam, are you also doing like glossopharyngeal nerve blocks to work that up?

Or are you relying more on imaging or can you elaborate a little bit on that? 

Dr. Pradeep Chopra: Both we, uh, so surgeons wanna look at, uh, they wanna look at, uh, ct, they look at the CT. And it's a thin slice. Mm-hmm. Um, they wanna see a thin slice, a ct. Mm-hmm. And they'll also do a glossopharyngeal nerve block. Mm-hmm. And if the patient gets relief and the angiogram is positive, then they, the surgeon goes in there and, uh, shortens the ster process.

Okay. It does work. Really. It's a, the results are, uh, amazing actually. So we're moving away from, from Eagle syndrome. Mm-hmm. So before we do that, I just wanna, uh, [00:29:00] reiterate to everyone is that if it's a really severe pain in the joy area, think of Eagle Syndrome, it could be tmj, but TMJ does hurt, but it's, it's more of a headache and it's, it's a low annoying headache.

Uh, but an Eagle syndrome is a sharp. Very sharp pain and it hurts to swallow. So we're, we're still hanging out in the mouth, right? We're going on a walk. Yep. And we walk down, we, we been walk, walking down and now we are entering into the esophagus. Yep. Uh, one little trick that I do if patients with MCAS comment, and I want to see if their GI tract is affected by MCAS, is I look at the throat.

Mm. And Dr. Bluestein, I have to tell you, almost a hundred percent of patients have inflammation of the throat. 

Dr. Linda Bluestein: [00:30:00] Mm. Wow. 

Dr. Pradeep Chopra: I get surprised if it's not inflamed. 

Dr. Linda Bluestein: And are you saying a hundred, almost a hundred percent of your MA patients or almost a hundred percent of your EDS patients? Which, which population specifically?

'cause I, obviously there's a tremendous amount of overlap, but. I would imagine some have one diagnosis, some have all three, you know, pots, EDS, and, and MAS. Um, so is it, it, does it seem to be more associated with the MAS or is that unclear? 

Dr. Pradeep Chopra: MCAS. Okay. It, these MCAS patients, uh, that have inflammation. So that kind of gives me a little, uh, it gives me a little idea that they have, because they have inflammation of the throat, which is the beginning of the, of the GI tract.

Mm-hmm. So it gives me an idea that, uh, they could be, and then as I go down further, I look for other signs. But that's one thing. And then, and if you ask them, a lot of them get surprised and there's, some of them will say, I, I, yeah, I have a scratchy throat, or something like that. And some of them [00:31:00] get surprised that it's inflamed.

Um, so that's one. But this inflammation is not from infection. That's the point I want to remember. Want people to remember. This is. Like a sterile inflammation. It's not an infection. Mm-hmm. It's from, it's just from, uh, naughty mast cells. Mm-hmm. Misbehaving. So now we are walking into the esophagus. Mm-hmm.

Which is the food tube. Is food tube the right term for it? 

Dr. Linda Bluestein: Uh, I think that works. And let's talk about the esophagus for a few, few minutes and then we're gonna take a quick break and come back and, and, but we can talk about the esophagus for, for a minute first. 

Dr. Pradeep Chopra: Okay. Um, so the esophagus, um, is affected several in several ways and in, in patients with, uh, with EDS.

Uh, let's talk about the word that I worry about the most, [00:32:00] and that's called eosinophilic esophagitis. Mm-hmm. Which in English, it means that this inflammation or the esophagus, or inflammation, or the tube that carries food from the mouth. To the stomach. And, uh, it's a pretty, uh, difficult condition on a lot of these people present with difficulty swallowing.

Uh, their, their difficulty, they feel like food is getting stuck, uh, in their esophagus. Um, it's this inflammation of esophagus is, uh, pretty much similar to MCAS inflammation. And so, and of course the diagnosis is based on doing an endoscopy. They put a tube down the thing and they look at it, and it takes a biopsies, uh, and it's, it's not acid reflux.

Acid reflux is different. So you can get inflammation from acid reflux. [00:33:00] As acid goes up, it causes inflammation of esophagus. But this is an immune-mediated condition that causes, uh, oph pH. And so they have difficulty swallowing. They have food stuck in there, and children have feeding problems and there's vomiting, there's poor weight gain and basically failure to thrive.

Dr. Linda Bluestein: And, and I was gonna point out that hack of, uh, itis is inflammation, right? So you can have a esophagitis that can be more general related to heartburn or, you know, um, acid coming up, right? Right. Or you eosinophilic esophagitis still hasis at the end, inflammation. But that's related to an increased number of eosinophils in the, in the esophagus that they, like you said, found on, on biopsy.

Right? 

Dr. Pradeep Chopra: Eosinophils are cells that, that start populating, uh, they start collecting wherever there's inflammation. And so that's why it's called eosinophilic esophagitis or e oe. Mm-hmm. In [00:34:00] short. Mm-hmm. This was not in the, in the guidelines by the way. One more thing on, uh, on the esophagus is, uh, it could also be like we said, you know, in, in, uh, Eagle syndrome, they have difficulty swallowing.

Mm-hmm. And it seems like there's something in the throat all the time, but it can also be from cranio cervical instability, both preoperative and postoperative. So it can be from there also. 

Dr. Linda Bluestein: And that's more neurologically that there's difficulty swallowing. Right. Rather than a more structural problem or inflammation.

Dr. Pradeep Chopra: Right. And oftentimes, uh, they have, when they, when patients have cardio cervical instability, they have, one of the complaints they'll have is difficulty swallowing or as if something is stuck in their throat. Uh, and, and it's, but the other one is that after the surgery also they can have inflammation in that area and that that kind of, for some time they'll have that difficulty swallowing.

[00:35:00] Mm-hmm. And it comes back with some. Speech and swallow studies and trait and therapy does resolve. Mm-hmm. Um, I can't think of anything else. So we talked about acid reflux. Question is, do people with EDS have more acid reflux? And the answer is yes, they do. Uh, especially if they have MCAS because, uh, it causes more production of histamine in the stomach and that histamine then causes more acid production and so they kind of burp up acid so they get more acid reflux, hence H two blockers that is, um, fem or, uh, tine or something.

They can u we use that, uh mm-hmm. But it's not just the reason we do use, uh, famotidine in MCAS is not just for the acid reflux spot, but it's a side benefit. 

Dr. Linda Bluestein: And, and what about if the connective tissue isn't as strong as we would like it to be? Uh, predisposing you towards a hiatal hernia [00:36:00] or where there's an opening in the diaphragm and, and part of the stomach is actually like coming up into the chest.

Dr. Pradeep Chopra: So that's the other thing. Uh, unless it's a really big hiatal hernia, then, then of course, um, and it's, it's a problem then, then, then I recommend getting surgery for it. Mm-hmm. But if it's a small hial hernia, leave it alone. Mm-hmm. Okay. 'cause things can go pretty wrong with hial hernia surgeries. Mm-hmm.

And I've seen people getting into trouble. 

Dr. Linda Bluestein: We are going to take a quick break. When we come back, we're gonna, we're gonna keep going. We're gonna go with the stomach, the duodenum, small intestine, large intestine, et cetera. We're gonna take a quick, quick break and we'll be right back.

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I am back with Dr. Chopra and we are taking a, uh, a tour through the GI tunnel, if you will, and we're going to resume at the stomach. Is that, is that where you wanted to head next? 

Dr. Pradeep Chopra: Right, so we started on the teeth. Mm-hmm. Okay. So teeth, throat, uh, mouth and all that. And then we went down the esophagus.

Mm-hmm. We [00:38:00] talked about the esophagus and now we're in the stomach. Mm-hmm. So for those, uh, you know, stomach is kind of a hard thing to explain to, uh, people is that this is stomach. But in actuality, stomach is a pouch in our abdomen. Right. And that's where the food first goes in there and it's gets its acid and all that stuff is mixed in there.

So the stomach can, the dire tunnel that we talked about, the GI tract, entire tunnel can be affected by MCA. We know that. 

Dr. Linda Bluestein: Right. 

Dr. Pradeep Chopra: Uh, which is inflammation of the lining of the, of the, of the intestines, which they, they, they really spoke well about in the guidelines, the A GA guidelines, American Gastroenterologist Association guidelines.

Uh, so, but we got, we're we're, we're pulling out different things over here and I think this might be the place to talk about mals. [00:39:00] What do you think? Okay. 

Dr. Linda Bluestein: I think that's a perfect place to talk about mals. 

Dr. Pradeep Chopra: Yeah. MALS is a, is an awful condition to have. Mm-hmm. It's for some reason there is a whole group of physicians who think mal is like.

It's all hokey stuff and Oh, that makes sense. Mm-hmm. Because you have objective evidence, but they, they're the same people who think that EDS doesn't exist, so. Right, right. They're not our, they're not our audience. No. But I hope they come one day. So MALS stands for median aqu ligament syndrome, you know, you know, it's also called Dunbar Syndrome.

Oh, interesting. Yeah. So I, I was giving a talk in Germany and they kept referring to as Dunbar Syndrome, and I was like, that's so much easier to write down It sort that median, a ligament syndrome. Right. And when you tell patients, oh, you've got median A and they're [00:40:00] look. Huh? What? Right, right. Like Dunbar Syndrome sounds like Dunbar is a nice guy.

Sounds like a nice guy, you know. Sounds like he lives in the caves and you know, off the, definitely earth, he's an earthy guy. But anyway, mouths is pain. That's in what is called the epigastric region. So for those who can see, it's the, what's called the solar plexus or the upper, upper abdomen. Is that how I could say that?

Mm-hmm. Mm-hmm. Uh, upper abdomen, mid upper abdomen. Mm-hmm. Uh, and that's where you would feel if you had acid reflux, that's what you would feel burning in. Uh, so these patients have classical symptoms, very, very classical symptoms. And one of them is that the pain gets worse with eating. They'll always tell you that the pain gets worse with eating and obviously that they have weight loss also, especially with kids, you'll see that, [00:41:00] uh, they get tired after taking a heavy meal and the pain increases with physical activity.

When I first read about MALS years ago and I wrote down these symptoms, I'm like, this is not, I don't think I'll ever see a patient with Mals. Mm. I literally see one every day. Uh, you see one every single day. Wow. Well, every single time I see somebody with EDS. Mm-hmm. Uh, so it's common. I'm not saying it's very rare.

It's, it's a common condition and commonly missed. Um, here's the thing. It gets better if they lie on their left side. Mm. So what I do is I have them in the office. I'll, as I'm talking about other things, I'll have them lie on their left side and then after 10 minutes ask like, how do you feel? And they'll say like, yeah, they feel better.

Uh, it does get better with also lying on your stomach. And it gets worse with being upright. And when I examine them, [00:42:00] uh, I sort of start. I don't start at the, at the area of their pain, which is the epigastric region or the upper abdomen. I'll start somewhere way off and I start pressing gently. Mm-hmm.

Gently and gently. And then I get to the epigastric region, I say, okay, let's call this number one. And I push down with my thumb, and that's when they get to the, you know, I have a pain scale of my own. Oh, okay. It's called the swear pain scale. Okay. So, you know, that number thing doesn't work for me. Right?

Mm-hmm. I don't, I don't like it. Either nine or 10 doesn't work for me. No. So I ask them like, what is your, what if you swear, what is your worst swear word? And they'll tell me, you know, Hey, it's the F word. And I'm like, okay, what's your least fear? Uh, you know, what's your least analytic like, or something like that, or some version of that.

Mm-hmm. And, and so when I press over there, it was like, okay, it's the F word when I press on the [00:43:00] epigastric region with my thumb. They're like, that's the worst pain. Mm-hmm. And they give you a really dirty look. And I call that number one. And to be sure, I'll press on some other part of the abdomen with the same pressure with my thumb, and I'll call that number two.

And I'll say like, do you still think one is as bad? Two? And then they'll, no, the one is still the worst. Mm-hmm. So that's mouths. So in a child it would be failure to thrive. They can't eat, they don't like eating because their belly hurts and they often get misdiagnosed as functional abdominal pain or something like that.

They're not vomiting. It doesn't cause vomiting. 

Dr. Linda Bluestein: And, and the problem, the problem is the celiac artery or the celiac nerve is being compressed. Correct. So there are surgical procedures that can be done for this. And sometimes they do a celiac plexus block as part of the workup. Correct. But also there's imaging studies that need to be done.

'cause of course you wanna [00:44:00] make sure if you're gonna do surgery, that you're actually going after the right etiology for the person's abdominal pain and, and other symptoms. Yes. 

Dr. Pradeep Chopra: So, uh, you're absolutely right. The CIC artery, which supplies blood to the, uh, what's called the four gut, are part of your intestine.

And, and then you have the Celia Plexus that travels along with the CIC artery, gets compressed by the diaphragm. So for the longest time we've thought that, oh, it's because the art is getting compressed, but. The actual fact is it's the nerve that's getting into breast. Mm-hmm. That's what causes the pain.

And if you actually look in a patient having a mal surgery and you look at when they get to that point, the nerve looks inflamed. 

Dr. Linda Bluestein: Can you see that with the naked eye actually? Yeah. 

Dr. Pradeep Chopra: Yeah. Wow. It looks inflamed and, and swollen. Mm-hmm. The Ceric plexus. But, [00:45:00] you know, Ceric plexus is, looks like, uh, like a bunch of hair.

Right. It's so thin. Mm. And, but you can see that. Mm-hmm. Uh, but the reason why I'm saying the nerve is the culprit is because there are surgeons who believe that it's the artery only. Right. And so they release the, the compression that you just said. They release the diaphragm and just the artery, and don't touch the nerve.

And then there are a group of surgeons that believe that it's the nerve also. Mm-hmm. And they'll remove the celiac plexus and the results of the latter half, the people who remove the celiac plexus are far better than those who don't remove the celiac plexus. So my advice to our listeners is that if you are getting going in for mal surgery, make sure that the surgeon is on ball with you on that, that he's gonna remove the celiac plexus.

[00:46:00] Because we, I have a few patients that have gone to somebody and he just did not remove the celiac plexus and now I can't convince the other surgeon to go in there again and remove the clec plexus. Mm-hmm. Mm-hmm. And that's, um, issue and, you know, the nerve block, you talked about the clec plexus nerve block.

Uh, there are two reasons for having that. The first reason is. So they basically go in, in with a needle and they inject some coming medicine and, and it's like magical. Now the patient can eat and there's no pain at all and a lots of things get better. A lot of things get better and they're just amazed by how much better.

But it only lasts for a few hours as long as the numbing medicine last. Mm-hmm. So it has a diagnostic value for the surgeon. Okay. So the Celia Plexus, it's mouths. We know that it's Compressional, Celia Plexus, [00:47:00] uh, but the other one is, it also tells the patient this is how you're going to feel after the surgery.

But I have a little secret, unofficial secret on this. The surgeon I go, I send my patients to is Richard Sue, Dr. Richard Sue in Connecticut, and he disagrees with this completely. Oh. Uh, is that, it actually helps hearts. Oh, interesting. So patients have come back and have said that POTS got better. So I call up Dr.

Richard Sue and I say, Hey, did you know that it helps? POTS don't talk to me. What pots? I don't know anything about it. I'm a surgeon. I don't care. I've no idea what POTS is. I'm like, okay, just saying. Uh, but yeah, it does help a lot. And I, I mean, you know, this is one surgery, I'm not a very huge fan of surgeries.

Mm-hmm. But this is one surgery I really think makes a big difference. [00:48:00] And the diagnosis is not that hard. It's really easy. I, you know, we talked about the symptoms, we talked about the exam, and then this and the, and then they do a CT angiogram and then they do the C plexus block was pretty definitive.

Dr. Linda Bluestein: Mm-hmm. So that, that's, uh, or Dunbar syndrome. So that's really Dunbar Interesting that Yeah. Yeah. That, that, uh, he, that he doesn't. Seem to think that his patients are doing better with their pots, but if you don't ask the right questions too Right. That you don't, then you don't know. So, 

Dr. Pradeep Chopra: yeah. But you know, you know something, uh, it's hard for a surgeon to get into the pots arena.

Yeah. 

Dr. Linda Bluestein: Oh yeah. 

Dr. Pradeep Chopra: Yeah. As it is, they're stressed out about this is not an easy surgery for them. Right. And they, you know, I can imagine if I was a surgeon, I would be stressed out to my eyeballs. Mm-hmm. And so I really feel bad for surgeons because it's not an easy job. Mm-hmm. And you know, so they, the last thing they want is something [00:49:00] weird like hots to deal with.

Mm-hmm. Because, and honestly, I don't even know why it helps. Interesting. There's no logical sense in that. And it does help, and patients have swear that it helps. Hmm. So I don't know what to say, but anyway, that's just a little aside. Moving on down to our, um, anything else in the stomach. So we have acid reflux from the stomach.

We have inflammation from them, MCAS, uh, and then we have, uh, the hial hernia can be included in this also. Uh, and then we have, uh, mouths, otherwise the stomach behaves itself. So let's go down to the, the small intestine, or the first part of the small intestine, which, which is called the deum. I think this might be the right place to talk about the superior metric artery syndrome.

Dr. Linda Bluestein: Either that and or sibo, whichever one you wanna talk about first. Okay. 

Dr. Pradeep Chopra: Let's talk about SIBO first. Okay. [00:50:00] You wanna talk about sibo? 

Dr. Linda Bluestein: Well, I will say that SIBO stands for small intestinal bacterial overgrowth, and we are not supposed to have bacteria in our small intestines. Correct. And because the.

Transit is slow. We can end up having bacterial overgrowth in the small intestines, which happens much more commonly in people with EDS MCAS and pots conditions like that. And, um, they often get treated with antibiotics and that can be very successful, but sometimes requires a couple of courses. I'm sure you have other things to add to that.

Dr. Pradeep Chopra: Yes, I do. Uh, so sibo, um, we have a thousand different kind of bacteria that live in a small intestine, and then we have 10,000 different kind of bacteria that live in the large intestine. Mm. And food in the, in the food, in the GI tract moves from the small intestine to the large intestine and out. And [00:51:00] what happens is that if for any reason your, your intestine doesn't move.

So you have, uh, intestinal dysmotility, gastroparesis or something like that. It's not moving a lot. Then what happens is these guys, and that would happen in MCAS, uh, uh, what, uh, what happens is that these 10,000 guys that live at the large intestine start creeping over to the small intestine because there are only a thousand people defending their territory over there.

Mm-hmm. And so these 10,000 guys from the large intestine overrun the small intestine, hence small intestinal bacterial overgrow. Yes, you're absolutely right. Antibiotics do work. And these are antibiotics that don't get absorbed. They just live in intestine, so like neomycin and all that, they just live in intestine.

I call it draino. It's like taking draino. You're basically killing all these bacteria, right? Mm-hmm. And then you start putting in fresh bacteria. [00:52:00] 

Dr. Linda Bluestein: Mm-hmm. But 

Dr. Pradeep Chopra: the real treatment lies in treating. Intestinal DYS motility. Right. 

Dr. Linda Bluestein: Otherwise it'll just recur. 

Dr. Pradeep Chopra: It'll recur again. And that's what you just said, that we have to do this treatment a few times, but the treatment really is to figure out why is there a slowing down of the GI tract.

Mm-hmm. And once you can figure that out and treat it, then it takes care of the sibo, uh, quickly. But otherwise, the treatment, like you said, was antibiotics, or as I call it, draino. And it essentially just kills everything in there. Uh, and then you start fresh. When you start planting new, new bacteria, you take a lot of prebiotics and probiotics and, you know, eat a lot of yogurt, and then you get your, uh, your bacteria back into their proper territories.

Mm-hmm. The small intestine gets their own and the large tine gets their own. There are several tests that they [00:53:00] do is a breath test. And it's the most boring test in the world. You have to breathe into these 10 tubes every half an hour or something like that. So they give you these tubes, test tubes, and every, I think first you breathe in just like that.

And then you take this lactulose thing, and then you start breathing in every half an hour for like 10 tubes, which is 10 times, half an hour. It's, it's a really boring test, but that's how they detect, it's a breath test. Mm-hmm. Uh, uh, they've done studies by actually going in there, uh, with a, with a scope and phishing out bacteria and studying, and it doesn't really help in the diagnosis.

The best is the breath test, and there are different kinds of breath tests. Uh. Is this a good time? So we are still hanging out in the deum and the small intestine. Mm-hmm. We're, yep. We're at the junction of the de and [00:54:00] the small intestine to be honest. Let's talk about superior metric artery syndrome.

Mm-hmm. This is kind of a hard diagnosis to make. Mm-hmm. So these patients with very non-specific symptoms, so they'll have pain in their upper abdomen. It's not as bad as the mouth pain because mouth pain is nerve compression. There's no nerve compression here. Mm-hmm. Uh, they present with nausea, which patients with mouth do not have, they don't have nausea.

Uh, they do present with abdominal distension. So their get bloated, which you don't see in mouth and. They do have pain in their, the pain in their epigastric region or their upper abdomen gets worse when they lie flat on their back. Mm. And it gets better when they lie on their left side or on their stomach.

Save as mouth. Mm-hmm. Mm-hmm. So there's [00:55:00] little bit of difference with mouths, but there's some similarities in there. Mm-hmm. The treatment of superior metrix syndrome, uh, superior metric artery syndrome is a little bit all over the place. Lemme first explain the reason why people have the Superior Metric Artery syndrome.

Uh, without getting into too complicated details, basically there's an artery that travels over the fourth part of the deum, and for whatever reason, this artery compresses the deum. So it's now compressing it so no food can pass, which is why they get, uh, they get distention. And they also get nauseous. So it's essentially an obstruction of the, of the intestine.

Mm-hmm. Or obstruction of the fourth part of the denna. And this is because of an artery called the superior s Andre Artery. [00:56:00] That is a very mischievous artery. It's a real troublemaker. And I'll show you why, because it's, it really causes a lot of problems. So this 2:00 PM e uh, you know, compresses the NU and it, and now no food gets passed through.

So they present with this bloating, they present with nausea, and then they have pain over the AL area, which is epi gastric region. It gets better when they lie on their side. It gets be worse when they're upright. And the diagnosis is done by doing a CT angiogram. So they shoot some dye into your artery, into your veins, and then they look at where the blood is going, and that's how they decide.

They can see the obstruction. So the superior metric artery, uh, is a branch from the aorta. Mm-hmm. Abdominal aorta. So there's another big huge fat artery called the aorta. And the superior metric artery comes off that, and it [00:57:00] comes off at an angle. So some, some guys, some, some, some people went and studied the angle and they said, oh, when the angle becomes really narrow, that's when the de them gets pinched.

And why would the angle get narrow? Is because they're not eating so they lose weight quickly. Mm-hmm. And because they lose weight quickly, the angle becomes narrow. Somehow that theory has, has been accepted by everybody except me. Oh. I think it's, I think it's baloney. But anyway, the treatment for that is, are we supposed to use words like bologna?

Are okay with that? You can, you 

Dr. Linda Bluestein: can absolutely use words like bologna. 

Dr. Pradeep Chopra: Okay. Um, yes. Uh, the reason why I said that is because the artery is a soft tube. It's little squishy little tube. And the deum is a squishy, [00:58:00] is is a big squishy tube. Mm-hmm. Tube. How can you take two squishy tubes and compress them together?

Right. So it doesn't make sense to me at all. Mm-hmm. So you eat food, you know, you just had a pizza and now that pizza is floating down your esophagus into your dur and now it's passing through the durum and two squishy tubes can, can stop that. I, it doesn't, the problem, the reason why I'm saying that is because the treatment recommended for superior metric artery syndrome is to eat more food.

To gain weight. And that is so mind blowing. When, when I was, when I first read that, I said, no, this can be true. But it is, and people do recommend it. 

Dr. Linda Bluestein: Mm-hmm. Yeah, they definitely do. 

Dr. Pradeep Chopra: Number one, you, the whole reason you are at the doctor's office is because you can't eat. You have an obstruction. You are getting bloated, you are getting nauseous, and you have pain after you eat.

So how can you gain [00:59:00] weight when you can't eat? So the idea is that, oh, if you gain weight, then the angle will become wider. Mm-hmm. And once the angle becomes wider, it won't obstruct the dear them anymore. Mm-hmm. I don't think that works. Uh, number one, even if that theory is right and I'm wrong, it won't work because people can't eat.

That's the whole idea why they're there and they can't, they're not gonna gain weight. Mm-hmm. Uh, just because they want some fat to go into that space. Between the artery, between the superior metric artery and the aorta, uh, there are certain treatments that are done. Uh, one is, uh. One of the treatments is to do a bypass.

So they do a gastrojejunostomy, so they completely bypass the, so they make a hole in the stomach, and then they make a hole in the, in the deum, the small intestine, and then they stitch that up together. So now food [01:00:00] goes directly from the stomach into the jejunum, bypasses the ome completely. Um, other surgeries that they do is what is called de rotation of the deum.

So they literally, uh, remember the ome lies flat in the back of the abdomen, so they kind of move it, uh, shifted out a little bit and that, that makes a difference. So there are different surgeons who do different kinds of surgeries. Mm-hmm. And there are different approaches to it. I don't know. I don't have an opinion if one is better than the other.

Dr. Linda Bluestein: Okay. That's what I was gonna ask you. Yeah. Yeah. 

Dr. Pradeep Chopra: I, I don't know if any, but. I, I can tell you that ga eating more food to gain weight is not the way to go. 

Dr. Linda Bluestein: And what about people having multiple compression syndromes? Because that is also possible. Correct? 

Dr. Pradeep Chopra: That's, that's why I was, I was, uh, talking about, uh, the mischievous superior metric artery.

Mm-hmm. 'cause this superior metic artery then travels [01:01:00] downwards and it compresses the renal vein, the vein that comes from the kidney. And that's called Nutcracker syndrome. It's the same artery. So if I suspect superior metic artery syndrome in somebody, or called SMES mm-hmm. I start suspecting Nutcracker Syndrome.

Mm-hmm. Because the di clinical diagnosis of Nutcracker is very difficult. It's blood. Remember we talked about how the amount of blood going into your brain, the same amount of blood has to come out. It's the same thing with the kidney. The amount of blood going to the kidney has to be the same amount coming out.

But if you block the exit pathway, if you block the vein, then not enough blood is coming out of the kidney. Mm-hmm. And that's what's called uh, Nutcracker Syndrome. Mm-hmm. And it can only happen on the left side. It only affects the, because of the anatomy. Mm-hmm. It can only happen on the left kidney, not the right kidney.

Mm-hmm. [01:02:00] Which means doing a urine, blood, urine test or a blood test for looking at renal function is not gonna be helpful 'cause the other kidney takes over the job. Mm-hmm. The right kidney takes over the job. So blood tests are not really very helpful in these cases. So it's the same superior metric artery that compresses the durum and causes superior metric artery syndrome or SMA syndrome.

Mm-hmm. As it travels down, it now compresses the left renal vein. And the left renal vein is longer than the right renal vein. Uh, so these patients can present with blood in the urine. Mm-hmm. Can, uh, they do sometimes have pain on the left flank or even the left abdomen. So technically the kidney is not part of the GI tract, but it's in the abdomen.

So that's where we're talking about it. Mm-hmm. Uh, it may have, the urine may [01:03:00] have more protein in it, but that's not a very, uh, diagnostic point in men. They can have varicose that means, uh, distant veins in their scrotum. Mm-hmm. Uh, so these are the common symptoms of Nutcracker syndrome. And as you can see, it's very vague.

I mean, you can have blood in the urine from a urinary tract infection. 

Dr. Linda Bluestein: Right. Or a kidney stone or something. Yeah. 

Dr. Pradeep Chopra: Kidney stone or whatever. Yeah. You, same thing. You have pain in the left flank and abdomen. If you have a kidney stone. So it's, it's very vague. So you have to do, uh, ct, uh, doppler ultrasound or a CT angiogram or a MRI angiogram to look at the vein compression.

But my antenna starts buzzing when I see superior metric artery syndrome. And I'm like, I have to rule out Nutcracker syndrome 'cause it's the same mischievous artery that's doing it. So the [01:04:00] treatment of Nutcracker Nutcracker syndrome is, uh, there's, there's one hospital they at one medical center, large medical center where they actually put a stent in the, in the vein, in the left renal vein.

And I'm not sure how good an idea that is putting a stent in a vein. Uh, but, you know, but it's the simplest thing to do. It's easy. It's not a major surgery, but. The recommended surgery is to take the left kidney and put it on the right side. Mm. So you do a renal transplant. Mm-hmm. So you pick up the left kidney, you get a promise on the left side, and you put it next to his buddy on the right side.

That's the treatment, uh, for, uh, Nutcracker syndrome. But I've seen a few patients where they have gone to this particular, um, academic center where they've simply put a stent and sent these [01:05:00] patients home. And it kind of makes me nervous putting a little stent in a vein. Uh, you know, because the renal vein is a very big vein, and so I'm not sure how good that idea is.

But anyway, these are the treatments. Uh, 

Dr. Linda Bluestein: yeah. And it's, and it's also a lot of these patients have MCAS, so you're putting a foreign substance in somebody who is likely. Intolerant of some foreign substances. Anyway. 

Dr. Pradeep Chopra: Oh my goodness. I saw a patient today, uh, yesterday. They put a stent in his, uh, vein, two stents.

Coils. They put coils. Oh his. And they had no idea what was wrong with him, and they thought it was a hernia and all kinds of things going on with him. His, for five years, the guy's been looking for treatment and then I asked him all the questions on MCA and he meets everything. Mm. To a t. So, um, yes, I get nervous about putting forward bodies in PP people with EDS.

Let's go to [01:06:00] May 3rd syndrome. Mm-hmm. May 3rd syndrome is technically not an abdominal pain issue, but it can cause abdominal pain. It's more of a leg, left leg problem. And so they, they have a dull, achy, heaviness and cramping pain in the left leg, not the right leg. The left. Swelling in the left leg and the pain gets worse with standing left leg again.

Mm-hmm. Uh, and the pain gets better with elevating the left leg. They may have varicose veins on the left leg, so the left leg has more varicose veins and bigger ones than the right. Mm-hmm. Uh, so these are some of the symptoms of Mayer Syndrome. Left leg. And, and the reason is, uh, it's, it's a little complicated, uh, but basically there's an [01:07:00] artery, so there's an artery on the right side, and it kind of crosses over to the left side and it compresses the left a vein on the left leg called the left iliac vein.

So the right iliac artery compresses the left iliac vein. And that's, uh, that is me Turner. And so because it compresses the vein, the blood slows down. Mm-hmm. And number one rule in medicine is you'd never let the blood slow down. Never let the blood slow down. If the blood slows down it a lots, yeah.

That's the number one cold and true. Mm-hmm. So once the blood slows down, they start to have clots and then they throw some clots and then they can have all kinds of problems. So that, so when I see, but these patients can also present with pelvic pain. Mm-hmm. And that's why we're [01:08:00] connecting it to the abdomen is because they can have pelvic pain also, but primarily they'll have is left leg issues.

There's dull achy pain to the left leg. There's varicose vein in the left leg, there's swelling in the left leg. And classically the pain gets worse with standing and gets better with elevating the left leg. There's another condition that does exactly the same thing. Uh, it's pelvic vein congestion syndrome.

Mm-hmm. In pelvic vein congestion syndrome. Uh, these patients, uh, they, the veins in the, in the pelvis, uh, get, they collect blood and they get heavier, and then they press on the organs and the pelvic floor, the, and so the pain gets worse with standing and gets better with, uh, legs elevated or lying down.

But that's for our next, um, episode. 

Dr. Linda Bluestein: Yeah, because we, [01:09:00] we definitely wanna talk about the relationship between that and POTS as well. Um, but let's finish Mayner because we're gonna, we're gonna wrap up with Mayer. We need to do our hypermobility hack, and then we're gonna continue in part two with the rest of the, uh, GI tunnel.

So for Mayner, how are we gonna work this up? And then what are we gonna do about it if we make the diagnosis? 

Dr. Pradeep Chopra: Okay. So once they have the diagnosis, uh, then the first thing you do is, and I think, uh, if you suspect me, Turner, the first thing is to put them on blood thinners, even if you suspect it. 'cause the last thing you want is a clot flying around.

Mm-hmm. And landing in your lungs, or worse landing in your brain. That would be bad. Mm-hmm. Uh, the treatment is often very simple. Actually what they do is they put a mesh, uh, stent in there, uh, into the left iliac vein. And they put a stent in there. [01:10:00] Uh, and then they can also, in, in some severe cases, they can do surgery where they bypass the, bypass it and decreases the compression.

But I think stent works fine in this case. 

Dr. Linda Bluestein: So a stent in the iliac vein, you feel more comfortable with an, a stent in the renal vein? 

Dr. Pradeep Chopra: Yeah. Okay. Yeah, it's a different kind of a stent that they put there. It's like a tube. Mm-hmm. And it's like a mesh with a tube in there, and there's not much, you know, uh, it, it's, there'd be no problems.

We haven't seen that. I mean, even on the left renal vein, I'm not sure. I would be a little nervous, but I'm not sure that if it works well or not. Recommended treatment from Nutcracker is you take the left kidney and put it on the right side. That's the known treatment. Mm-hmm. But in this case, you can do, uh, you can put a stent in the left, renal in the left leg pain, and, uh, or else, uh, they just do a bypass 

Dr. Linda Bluestein: and, and sometimes we can do [01:11:00] testing for metal sensitivity and things like that, but I know that the sensitivity and specificity are not necessarily really super high.

Right. For those kinds of tests. 

Dr. Pradeep Chopra: Yes, you're absolutely right, Dr. Bluestein. And, uh, you know, with, uh, we see this a lot, uh, patients who get metal, metal put into their bodies. Mm-hmm. Like chest sports. Chest sports is a big one. Uh, they start reacting. So stents, uh, metal stents and all that, they do start to react and it, it's just, it's a nightmare condition.

Mm-hmm. Mm-hmm. I wish they would make it more routine, like, you know, Hey, we're putting this metal in your body, we just wanna make sure you're not sensitive to it. 'cause a lot of patients don't know that. Mm-hmm. And so they can do that. 

Dr. Linda Bluestein: Well, not only that, uh, this is a hack. If you have had problems with metal in the past, let your doctors know.

Like, make sure, even if it's just [01:12:00] jewelry. 'cause I know somebody who did have a lot of reactions to different metal jewelry. And even if they're using, like, you know, I'm thinking of like other implants for fractures or something. And it might be a titanium allo alloy, but there might be some nickel in there.

And maybe you've had reactions to nickel in the past or some other metals. So maybe you are somebody who they should really be thinking about this and testing. And at least I know in some cases the orthopedic surgeons are like, oh no, no, no. That never, ever happens. Oh yes it does. 

Dr. Pradeep Chopra: Uh, yes it does. Uh, yes it does.

And when it happens, it's a nightmare. 

Dr. Linda Bluestein: It's a nightmare. Yeah. 'cause now you 

Dr. Pradeep Chopra: to remove it and all that, it's a second surgery. It's just, it's awful. You know, I see that in its chest ports a lot, by the way, for some reason. Hmm. Yeah. There's one particular brand of chest port that people use, uh, that, that's kind of non-reactive.

Mm-hmm. Mm-hmm. 

Dr. Linda Bluestein: Interesting. I 

Dr. Pradeep Chopra: do see that. Yeah. 

Dr. Linda Bluestein: And, and do you think that, uh, I think there's a [01:13:00] couple of labs maybe that do some, uh, blood testing for metal sensitivity and there's also a possibility of doing patch testing, but there, I mean, it's better than no information I suppose. But Do you have a preference for which kind of testing if you are going to do that?

Dr. Pradeep Chopra: Not really. I mean, uh, if they can do patch testing, that's fine. Uh, I don't know. What do they do? Tape a piece of metal on the skin? I think so. Oh yeah. Just give them a pair of earrings. So this week you're gonna wear titanium. Next week you are wearing stainless steel. Third week you're wearing iron. Right.

And let's look at your ear, or, um, so, but yes, uh, that's something to keep in mind. Mm-hmm. And I, I really think that it should be made more routine given the rise in autoimmune dysfunction and Right. Even the, you know, the massive increase in MCAS patients, uh, with, with sensitive chemical [01:14:00] sensitivities, this is something that really should be, because you're implanting it into the body.

Dr. Linda Bluestein: Right. Right. 

Dr. Pradeep Chopra: It's not a earing that you can take off. Right? Yep. And so, um. It should be more routine. Yeah, 

Dr. Linda Bluestein: absolutely. 'cause if you can prevent something like that, that's absolutely huge. Um, so we are going to have to, I think, cut off right here because, uh, we have so much more to talk about. So I think that we will keep the rest for part two of this conversation, if that's okay.

But, you know, we like to end every episode with a hypermobility hack. So do you have a hack for us, or you've already given us a bunch of hacks, so if you're hacked out, that's also okay. 

Dr. Pradeep Chopra: I do, uh, so it's a gastroparesis. Okay. You know, we, we, we sort of talked a little bit about it, but gastroparesis is slowing down of your stomach movements and mm-hmm.

Hence the slowing down of your intestines. And here's the problem. When they test you for gastroparesis, they have you eat this radioactive [01:15:00] egg and then they follow it around and see like, okay, how long does it take to pass through? Mm-hmm. Right. But the problem with gastroparesis is some days it's fine, and some days it's not fine.

Right. And you might just go on a good day. Mm-hmm. And you know, a lot of this gastroparesis is related to MCAS. And so your MAS is not flare up. Your, your, your stomach is fine. So I have a home, home get home test for it. Oh, okay. Uh, you eat beets. 

Dr. Linda Bluestein: Mm. 

Dr. Pradeep Chopra: You know beets? Those that red? 

Dr. Linda Bluestein: Mm-hmm. I love beets. I eat them all the time.

Yeah. 

Dr. Pradeep Chopra: Yeah. So you eat beets and in, and you should have no red color in your poop in the next, after 48 hours, if you have red color poop after 48 hours, then you probably have gastroparesis. 

Dr. Linda Bluestein: Now. Now that could be slowing anywhere though [01:16:00] in the GI tract, right? Or true, but. 

Dr. Pradeep Chopra: Slowing is slowing, I don't care.

It's still causing me or not right. Causing me to blow up and feel nauseous. So I really don't care where the slowing is. But it's slowing. And so, uh, because you go in for a radioactive egg test and they say, oh, it's fine. And then mm-hmm. I know this one patient I have, she had it done five times and on the fifth try they found out.

Oh, I'm like, so, uh, I figured out like, what if you eat beets 

Dr. Linda Bluestein: now? Now how many beets do you have to eat? 

Dr. Pradeep Chopra: I don't know. I mean, ample amount of beets to do that. 

Dr. Linda Bluestein: Okay. 

Dr. Pradeep Chopra: I've thought of other things like enough, can you eat? What about marbles? 

Dr. Linda Bluestein: Marbles? I dunno if that's a good idea. Maybe carrots. I don't know. I, you could see pieces of carrots if they're not fully digested, but that, no, maybe that's not the right thing.

But beets, okay, so I know 

Dr. Pradeep Chopra: beets we'll stick with bet. We'll stick with be, because the idea, listen. [01:17:00] This is a problem with me brushing my teeth. Okay. So marbles was one of the things I thought of and I said, well, the day the marbles come out, you can hear them right. And you can count. So if you ate 10 marbles and you reached number nine and the 10th one is still in there, there's probably some slowing.

Right. But we don't recommend doing that. 

Dr. Linda Bluestein: No. Donate marbles, don't do that. 

Dr. Pradeep Chopra: Don't try that at hope. All, 

Dr. Linda Bluestein: all kinds of bad things could happen. 

Dr. Pradeep Chopra: Yeah. Please don't do that. Just eat beets. Uh, but you can, you have to eat ample amount of beets because you, you wanna be really, make sure your poop is red. Mm-hmm.

Mm-hmm. 

Dr. Linda Bluestein: And, and, and it might be helpful to track when it first starts turning red, and then when it stops turning red, I, I think, I think that'd be helpful. Yeah. So, okay. 

Dr. Pradeep Chopra: Like if a week later you're still having red poop, then you're, you'd probably have slowing off the GI tract. Mm-hmm. Mm-hmm. So it's a little home test.

Yeah. It can be done without loving. Yeah. Okay. Uh, that's 

Dr. Linda Bluestein: a great hack. 

Dr. Pradeep Chopra: I don't have any, yeah, that's pretty much it. 

Dr. Linda Bluestein: Okay. [01:18:00] That's a great hack. Uh, can you remind us where we can find out more about what you're up to these days? 

Dr. Pradeep Chopra: You know something, uh, I'm sorry, I know the time is short, but I just wanted to remind people on something which is very, very important.

Uh, when we were at the teeth, if you, for some reason dentists love pulling out your, uh, your wisdom teeth. Hmm. And I think we talked about it in the last podcast. Like, I don't know why they love taking out the, uh, the wisdom teeth, but they do. Now, if you have EDS, then please wear a collar, a hard collar when you go to the dentist because we have had cases where people have developed cranio cervical instability when they went in for a dental extraction or some kind of nose surgery or something, and developed cranio cervical instability.

And it's not a few, we see this very [01:19:00] commonly. Mm. And even though you can tell the dentist that, or you can tell the ENT surgeon, uh, or even if you're getting general anesthesia, uh, they forget 'cause they're, uh, busy trying to, you know, do whatever they're doing in your mouth or your nose and they forget.

And what happens is, although anesthesiologists are good about that, I have to say that, uh, but they forget. And I think my, if I were to, if I had EDS, I would put up a nice little iron brace around my neck and go, because I don't want you to extend my neck no matter what. Mm-hmm. Uh, but a good brace is a Miami J collar or a vista Aspen collar.

But it has to be hard brace, even though you, you don't have CCI. You don't want to get CCI. 

Dr. Linda Bluestein: Mm-hmm. And, and are you suggesting that they wear it for the actual procedure then the whole 

Dr. Pradeep Chopra: Yes. [01:20:00] Okay. The actual procedure. Because I've seen so many people develop CCI after tooth extraction or something like that.

Mm-hmm. And it's, it's not, it's very alarming. So the reason I that came to my mind was because you asked me where I, where you wanna know what I'm doing next? Hmm. Uh, I, I kind of, when I come across something that's alarming or that's something people should know, I post it on my website. Hmm. It's a blog. I post it there.

Mm-hmm. Uh, it's called Pain i pain rri.com. Mm-hmm. And, um, I'll post it there and, but this one we're publishing a paper. Mm-hmm. We have a case series of eight patients where they developed, uh, CCI after a procedure 

Dr. Linda Bluestein: and, and is there any problem with the dentist actually accessing what they need to access with the hard collar and 'cause that limits their range of motion and of, of the jaw.

Right. 

Dr. Pradeep Chopra: Ah, don't worry about that. The dentist, they're good at taking out teeth from anybody. Okay. They'll, [01:21:00] they'll, yeah, they'll figure 

Dr. Linda Bluestein: it out. 

Dr. Pradeep Chopra: Yeah. Because once you get CC, I, they're not, they're not gonna be around, so mm-hmm. Don't, you can always, uh, lift up your upper part of your face to open your jaw, or you can even pull down the little chin strap a little bit.

But you can, I mean, after all, you can eat with a brace on so you can open your mouth adequately. Mm-hmm. Yeah. Okay. But this is serious. I really think it's mm-hmm. Uh, alarming. And I did, uh, I did talk to one of the, uh, uh, neurosurgeons who does a lot of this work, and he said that he sees it all the time.

Did not have CCI went in for a procedure on the face, went in for dental extraction, developed CCI after that. 

Dr. Linda Bluestein: Yeah. And that's, that's awful. If, if That's awful. If that happens. Okay. So we'll be looking for that paper also. Yeah. Yeah. Thank you. 

Dr. Pradeep Chopra: Yeah, I have to get around to writing it. Okay. But it is, I have the cases.

Dr. Linda Bluestein: How many cases will be in that paper? Um, I [01:22:00] picked eight, but I have more. Yeah. 

Dr. Pradeep Chopra: Wow. I'm, I'm, I'm trying to cut corners. Yeah. Just lazy. So, so I put in eight, I mean, if eight is not enough to convince people that I, I don't know what, what you need 200 cases. I really No, 

Dr. Linda Bluestein: it's, if it, it's, it's a lot. So, okay.

Great. Well thank you so much. It was so great to chat with you again. And I look forward to part two of this conversation. 

Dr. Pradeep Chopra: Our, our walk through the GI tract. Through the GI tract tunnel. Mm-hmm. Yeah, absolutely. It'll be fun. Thank you so much for having me.

Dr. Linda Bluestein: Well, that was fun with Dr. Chopra going through the first part of the GI tract or the GI Tunnel. I know a lot of people have symptoms in their abdomen, and so I think this is gonna be really helpful for so many people, and I hope you will stay tuned for part two of this conversation. Thank you for listening to this week's episode of the Bendy Bodies.

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