0:00

No one ever wants to hear a cancer diagnosis,

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that a family member with cancer can't get to

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life.

0:32

Welcome to The Referral. I'm Dr. Curran,

0:34

a surgeon in the UK. This is

0:36

the podcast to go to if you want

0:39

actionable, evidence- based information

0:41

to help improve your life. On

0:43

today's podcast episode, we're gonna be talking

0:46

about invisible conditions. Now, it's

0:48

very likely that today, if you've been out

0:50

and about, you've been walking past people who

0:52

suffer with this condition, inflammatory

0:55

bowel disease. This is an umbrella term for

0:57

bowel conditions like ulcerative colitis

1:00

and Crohn's disease. And today, we're

1:02

gonna be joined by Misha Moinurad,

1:04

also known as Mr. Colitis Crohn's Online.

1:07

And he has almost 5.5 million

1:10

followers across all social media platforms.

1:12

And we're gonna be talking about how to navigate

1:15

life with a stoma, how to live a

1:17

fuller life with a chronic invisible

1:19

condition.

1:20

I had to change the way I viewed

1:23

my body and how I viewed a stoma. And

1:25

like you said, it's enabled me and

1:27

not disabled me. And obviously, you'll

1:29

get your chance to ask me a question in CrowdScience.

1:33

If you've got a question you want me to answer, head

1:35

over to thereferralpod.com and

1:37

shoot me a message. And excitingly, I'm gonna

1:39

be answering even more of your questions on

1:41

CrowdScience Extra. Just head over to

1:43

the Referral Show page on Apple Podcasts and

1:46

hit Try Free to start your free

1:48

trial today. And also coming up, we've

1:50

got If It Ducks

1:50

Like A Quack. This is a segment where I

1:52

completely decimate these nonsense

1:55

myths that you see online. But first, we

1:57

have What The Health. Let's take a quick

1:59

look at

3:59

So if you've been listening to any news

4:02

over the past couple of weeks, you've more than

4:04

likely heard about the Titan

4:06

submersible which went down to see the Titanic

4:09

shipwreck and the tragedy

4:11

that followed after that where the submersible

4:14

imploded and these people lost

4:17

their lives. I've had a few

4:19

messages from people online asking me

4:22

about how they lost their life and

4:25

if they felt any pain while

4:27

the submersible collapsed or imploded.

4:30

Now, this is quite a sensitive topic but

4:33

from a purely biological standpoint,

4:35

there is some science which may help explain

4:38

why they probably didn't feel any pain.

4:41

So to process pain, our

4:44

brain requires around 100 milliseconds

4:46

to actually, you know, process

4:48

that sensory information

4:48

about pain. And

4:51

to process the visual inputs,

4:53

our eyes need about 13 milliseconds.

4:56

The implosion we are led to believe

4:59

took less than one millisecond.

5:01

So it's likely for these people

5:03

in the submersible, it was instant light

5:06

out without any knowledge of it without

5:08

any pain.

5:13

So as a busy surgeon trying to balance

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6:14

Why were medieval priests

6:16

so worried that women were going to seduce men

6:18

with fish that they'd kept in their pants? Who

6:21

was the first gay activist?

6:23

And what on earth does the expression sneezing

6:26

in the cabbage mean? I'll tell you, it's

6:28

not a cookery technique. That's for sure. Join

6:30

me, Kate Lister, on Betwixt the Sheets,

6:32

the history of sex scandal in society,

6:35

a podcast where we will be bed hopping throughout

6:37

time and civilization to

6:39

bring you the quirkiest and kinkiest stories

6:42

from history. What more could you

6:44

possibly want? Listen to Betwixt

6:46

the Sheets today, wherever it is that you get your

6:48

podcasts. A podcast by

6:50

History Hit.

6:57

Today's guest, Mr. Colitis

6:59

Crohn's, Misha Moynrad, is

7:01

an inspiring person. This

7:03

man almost lost his life at

7:06

the hands of inflammatory bowel disease and

7:08

he was saved and he was given

7:10

a stoma which gave him a new

7:12

lease of life. He is an incredible

7:15

influencer and inspiration to people

7:17

out there living with invisible conditions, with

7:20

chronic conditions and certainly with

7:22

stomas in the way that he

7:24

basically does everything

7:26

and anything he wants to. And

7:28

today I want to speak to Misha about how to live

7:31

life to the fullest with a stoma.

7:34

Misha, thank you very much for joining me

7:36

here. I started TikTok in 2019

7:38

and then I think very early 2020, I started

7:41

following you and we

7:45

were both following each other.

7:47

What were you doing on TikTok

7:49

and what do you do online? So

7:52

like yourself, I started pushing short

7:55

form video content

7:57

in 2019 in lockdown because

8:00

couldn't do my job. So I thought, where

8:02

can I put my energy? And it was

8:04

social media, I really lent into that. And

8:07

the idea for me creating content, and it

8:09

still lives within the thoughts of what I do

8:11

is to help people. It's to help

8:13

people that have got a medical condition like

8:15

me and are living with an invisible condition.

8:18

But it's also to educate

8:20

people that haven't got it and don't

8:22

understand it. So every day

8:24

I create content around the raw reality

8:27

of what I'm going through with a stoma. Yeah,

8:29

that's brilliant. And you're improving

8:31

directly people's awareness, but also

8:34

health literacy of people with

8:36

stomas as well. Yeah, it's getting people to understand

8:38

the little things and the tips and tricks, and

8:41

also empowering them to show you know, you

8:43

have got this, but it's not a limitation.

8:46

It's something that you can do amazing

8:48

things with still, you just need to be

8:50

strong enough and almost mentally resilient

8:53

enough to take those steps in the right direction. A

8:55

lot of people have no idea what a stoma

8:58

is. It's literally an opening,

9:00

usually on the surface of the skin on their tummy, where

9:04

a piece of urine testing often is

9:06

brought out to the surface of your skin to divert

9:09

feces or urine or other waste

9:12

matter. You have that, but

9:14

just looking at you, the average person on the street would

9:17

not know. How did

9:18

you come to have a stoma? So

9:21

my journey kind of started in 2013. I

9:23

was at university studying high performance

9:26

coaching nutrition, like just a normal student

9:28

going out five or six times a week drinking

9:31

a lot. And I

9:33

just started to feel a bit unwell, just wasn't well

9:35

at all. I have three GPs

9:38

come and visit me at home. And they actually diagnosed

9:40

me with gastroenteritis, which

9:43

is essentially a stomach bug. Yeah, yeah.

9:45

In fiction, inflammation of the bowel. And

9:48

I kind of thought, okay, I'll listen to my doctors.

9:51

This is what it is. And left it following

9:54

week. And in this time, I was being

9:56

sick a lot. I was bringing up a lot of bio. I

9:59

was just really feeling. I'm well. My

10:01

dad come and took one look at me and was like,

10:04

we're going to the hospital right now. So obviously he could

10:06

see something was a little bit more

10:08

than what my body was giving on. So

10:11

we went to hospital after that week and

10:14

I got to the reception desk at Southampton

10:16

General. I remember looking straight

10:18

into the receptionist's size, sort of

10:20

explaining what was going on. And

10:23

I just passed out. I actually knocked one

10:25

of my teeth out on the floor. I

10:27

was put into an induced coma

10:30

for about three and a half weeks. And

10:32

at that point I was given about 20%. So it was

10:35

a real touch and go time for me in terms of my

10:37

health. So when you were in a coma, you still

10:40

hadn't had an operation? No.

10:42

So my health was in a really good place

10:45

before that. And basically what had happened

10:47

actually had a ruptured appendix. So

10:49

that was the first sort of battle I had

10:51

with NFT medical in my life.

10:53

And then it was only following

10:56

that after I woke up and recovered

10:58

after the night, I'd say probably eight to

11:00

nine months after that initial surgery

11:02

that I actually recovered. And

11:05

then I started getting symptoms of bowel disease. And

11:08

what the doctors said is because I was so inflamed

11:11

inside and I was getting

11:13

put down to theatre for eight or nine hours

11:15

a day over the course of that coma, they

11:18

were taking all of my stuff out,

11:20

washing it and then vac packing

11:22

it back in position. And then I would go

11:25

back. I mean, by the sounds of it, I don't

11:27

know your specific surgical details,

11:29

but it sounds like you had

11:31

a laparotomy. So a big cut in

11:34

the middle of your tummy, literally opening

11:36

you up like a suitcase. So through

11:38

the skin, through the muscle into your

11:41

abdominal cavity,

11:42

and your intestines were out on show. And

11:45

eventually once you were

11:47

diagnosed with Crohn's colitis,

11:50

you had your entire colon removed.

11:53

Exactly that. So I tried medication

11:55

for around four years, and

11:58

it just didn't actually give me any relief.

13:59

sex? How am I going to open up to my

14:02

loved one? How am I going to be in a relationship?

14:04

How am I going to function? Now

14:07

you've got a fiance now, you recently proposed. Congratulations.

14:10

Thank you very much. Come back from Maldives. But

14:13

when you had a stoma first,

14:16

were you single with a stoma and then got into a

14:18

relationship? Or were you already

14:20

going out with this person pre-stoma? No.

14:23

So I think one of the things going

14:25

back to what you said earlier about that, sort

14:27

of like an instant negative association

14:30

with having something different on your body. I

14:32

think the thing with a stoma is

14:34

it's taught very much end of line.

14:37

So doctors, medical professionals

14:39

often say, if

14:40

things don't go right, you'll need

14:43

a stoma, which in a patient's mind,

14:45

or anyone's mind, it's already categorised

14:48

as negative. Yeah, seems like a bad thing. So

14:50

then you've planted the seed there that

14:52

it's a bad thing. So immediately, whenever you talk

14:54

about that now, it's going to be a negative thing. And that's why

14:56

I try and show online that it's not the

14:59

end. It's not positive. Yeah, it's an opening. It's a new

15:01

start. It's a fresh beginning. I guess, like, you

15:03

know, all those things that you spoke about from, am

15:05

I going to be able to continue

15:08

with my work, relationships, all

15:10

of those things, like, they're definitely impacted.

15:12

You have to be careful. I have to be mindful

15:15

of things I do because I'm at a risk

15:17

of opening up other medical problems like

15:19

herniations and prolapses and all those things.

15:22

But in terms of like, sex and

15:24

people don't have to do normal things. It's

15:27

completely like anyone else. It's the same thing. It's

15:29

just a small bag on your stomach. I always

15:31

say to people that ask me about relationships and stuff

15:34

like that. If you find the right person,

15:36

they'll love you for you. They're not

15:38

interested about whether you've got a stoma

15:40

or whether you're missing an arm or whether you've got a medical

15:43

condition. It's part of you, right? I think in

15:45

a very, very strange way,

15:47

that it's almost an incredible discriminator

15:50

of someone who really loves you. Yeah, it's

15:53

an amazing filter. Yeah, exactly.

15:55

So you can just filter off anyone

15:57

who, you know, has a negative association.

15:59

and not interested, she knew what she was

16:02

getting into as such, because I've always been from the

16:04

minute I started social media, very

16:06

open, honest, and showed

16:08

my reality, right? Yeah, 100%. And that's

16:10

why we started following each

16:12

other, and we did lots of stuff about stomas. And

16:16

what I wanted to ask is, obviously, going back to

16:18

your history where you were suffering with

16:20

these weeks of tummy

16:22

pain, and you were diagnosed with a ruptured appendix,

16:25

and it took a while for you to be diagnosed.

16:28

And this is something,

16:29

not to this extent that you experience,

16:32

but this is something I see quite often. I

16:35

do clinics with bowel patients who've

16:37

got bowel problems, diarrhea, constipation,

16:39

abdominal pain, bloating. And

16:42

a lot of patients I see as a general

16:44

surgeon, they have been self-diagnosed

16:47

with IBS, irritable bowel syndrome,

16:50

or their GP or someone has told them

16:52

they've got irritable bowel syndrome, maybe just looking

16:54

up online or based on just symptoms. And

16:56

I see them, and I'm thinking,

16:59

you could easily have inflammatory bowel

17:01

disease, which encompasses Crohn's or ulcerative

17:03

colitis. And that's the thing. If

17:06

you have symptoms like you experienced, maybe

17:08

unexpected weight loss or changing

17:10

your bowel habit to diarrhea or constipation,

17:13

bleeding, get it checked out, and

17:15

don't just say it's IBS. I mean,

17:18

how many months or weeks before you went

17:20

to hospital did you have symptoms for? That's a really

17:22

good question. Because of stuff

17:25

like I remember very vividly

17:27

looking on the edge of

17:29

the buses and the underground of

17:32

the cancer awareness post,

17:34

if you're losing blood, come

17:36

forward, go and see a doctor, it

17:39

was almost too scary for me

17:41

to do that. So I probably left it longer than

17:43

I should. So you probably had symptoms for

17:45

months before. Yeah, and I left it because

17:47

I was just worried. I

17:50

think quite often as a patient and as a

17:52

person, you kind of see the medical

17:54

industry as against you, as opposed to

17:56

for you. So you're scared because

17:58

you know that there could be the news that comes to

18:01

you, you've got the big C. Devastating news, yeah. But

18:03

the fact of the matter is, the quicker you act

18:05

upon something like that, a lot of these conditions are very

18:07

treatable. So it's kind of like making sure

18:09

that you do go forward. And I had loads of testing.

18:12

I had more fingers than I've got on my

18:14

hands and my bum, which isn't fun,

18:17

but it's part of looking after

18:19

yourself. And the more that we talk

18:21

about this and open up the conversation and show

18:23

the realities, it de-stigmatize, but also

18:26

takes away the fear. And I think that's one of

18:28

the biggest things that someone can watch one of my videos

18:29

and say, actually having

18:32

a stoma isn't as scary as it looks. Going

18:34

for these tests isn't as scary as it looks.

18:37

They could come forward sooner and it could save

18:39

their life or give them more longevity

18:42

in their life. I mean, you were a fitness

18:44

professional before your surgery. You

18:46

still are a fitness professional now, as well as

18:48

a huge influencer. And you

18:50

deadlift, you lift heavy weights. What's

18:53

your take on weightlifting,

18:55

strenuous activity after

18:58

stoma surgery and a major abdominal

18:59

surgery? So when I was in hospital

19:02

again, and remember this clear as day, there was

19:04

a nurse that came in to see me and

19:07

she said, you will never have a physical job

19:09

again. Yeah, so that was literally the word

19:11

she said. There was also another nurse at

19:13

the same time that said, you're never

19:15

gonna have a six pack like Peter Andre. And

19:18

I was like, there's certain things

19:20

you don't say to a young bloke

19:22

who's just come off the back of a massive

19:24

surgery who was really into the health of fitness.

19:27

And they're led there about five and a half stone. That's a really weird thing

19:29

to say. Really weird thing to say. But instead

19:32

of me looking at that and seeing

19:34

it as something like, maybe she's right. I'm not

19:36

gonna do anything like this. It actually turned

19:38

something on in me. It's a challenge. We're thinking,

19:41

I'm gonna prove you wrong. And that's exactly what

19:43

I done. Before stepping into social

19:45

media full time and having my

19:47

businesses within social media now, I

19:50

was a rehab coach. So if you had a

19:53

triple heart bypass, a hip replacement, a

19:55

knee replacement, a stoma fitted, you

19:58

would come to the clinic that I was at and then I would rehab. have you

20:00

back to full health, even preoperative, postoperative.

20:02

So I know anatomy and

20:05

physiology and the body and how amazing

20:07

the body can be. And I've

20:09

always pushed those boundaries but safely. So

20:12

I know that I'm at a higher risk of a prolapse

20:14

or a herniation. I know that I can be more

20:16

fatigued than the average person sometimes. The

20:18

reality is although I've got a stoma

20:20

now, it's not the end of my journey. It's

20:23

just another part of my journey. It doesn't mean I'm

20:25

cured. And that's what I try and express

20:28

to people getting a stoma

20:30

isn't always clean sailing for everyone. It's not gonna

20:32

work for everyone because like you said, surgery

20:35

comes with complications and you've got to be

20:37

aware of that. But for me, I've

20:40

been lucky enough to sort of

20:42

get through it quite complication free. I mean,

20:44

that's the thing with Crohn's disease, as

20:46

of right now in 2023, there is no cure. We

20:50

can help to reduce symptoms and

20:52

sometimes it can go

20:55

into quiescence where it just quietens down

20:57

to a point where you may have minimal symptoms,

20:59

but it's a chronic condition which

21:02

we can manage with removing pieces

21:04

of bowel, et cetera. But actually there's

21:06

no curable thing for it. And you

21:08

mentioned the prolapse and the herniation. And

21:11

that's what I wanted to talk about with you specifically.

21:14

From my own experience, the

21:16

literature and speaking to all my colleagues,

21:18

colorectal surgeons,

21:20

I don't wanna say 100%, but I would say

21:23

the majority, if not close to 100% of people with stomas

21:27

will have a parastomal hernia,

21:29

which means a hernia, something from the

21:31

inside of their abdomen poking out next

21:34

to their stoma. Have you experienced

21:36

that and with people that you coach and rehab?

21:38

So I'm very lucky in the fact that I

21:40

haven't got one, even though I lift and stuff, but obviously

21:43

I designed a brace myself, which

21:45

I wear religiously. I've got one on right now, so I wear

21:47

it all day every day, particularly when I'm training and stuff.

21:50

But like you said, the percentages

21:53

are on the bad side of that happening. And

21:56

you can't

21:57

control everything within your health.

21:59

That's the fact of the matter is you can do as much

22:02

as you can but you can get a hernia or

22:04

a prolapse like that from sneezing, coughing.

22:07

Most patients I speak to, that's how they got their hernia

22:10

is from sneezing or coughing or getting out of bed incorrectly.

22:12

I always tell people to

22:14

roll to the side. Roll and brace

22:17

yourself. Yeah, brace yourself. But effectively,

22:20

it's

22:21

normally a case

22:22

of not if it will happen, it's

22:24

when. Yeah, 100%. Yeah,

22:27

like you said, hernia

22:30

belts, you've got an incredible one that you've designed.

22:33

Bracing yourself and probably

22:35

initially after surgery being mindful of

22:37

heavy lifting but then afterwards, probably

22:40

essentially do what you want. Live your life. And

22:42

I think what you said there about living your life

22:44

is something that I feel the medical industry needs to get

22:46

better at explaining to people because what

22:49

they can do is they can tell patients

22:51

not to eat certain things,

22:52

not to do certain things. People

22:55

like me will always push those

22:57

boundaries and show them

22:59

and prove them wrong that you can still do these amazing

23:01

things. Like I've done skydives, I go swimming all the time,

23:03

I do the gym six times a week, I very

23:05

much live my life but some people

23:07

sadly take that word as gospel

23:10

and then

23:11

they are imprisoned even though they've

23:13

had their surgery and they should

23:16

be living their life, they are imprisoned

23:18

with what they've been told. I think exactly.

23:20

The thing is, there's bespoke management for every

23:22

patient. And you touched there on an important

23:26

thing there, diet as well with stonemas.

23:28

How is your diet, is it restricted in any way?

23:31

No. Again, I kind of

23:33

went against the grain because when I left hospital,

23:35

they gave me a pamphlet and it was like

23:37

you basically are going to be eating beige for

23:39

the rest of your life. And I was like from

23:41

a health standpoint,

23:44

all the minerals, vitamins and everything that you

23:46

get from certain foods are not within

23:48

that palate. I was like, this isn't sustainable,

23:51

it affects my bone density, my

23:53

development of muscle and everything. I was like, this can't

23:55

be right. So the way that I done it, I

23:58

pulled my diet right back.

23:59

I started off with tinned pears, rice

24:02

and chicken, plain. That's all I had. And

24:05

I ate that for about

24:06

two or three months. And then what I'd done

24:08

is I introduced food very slowly

24:10

back into my diet. And I just was

24:13

very cautious about how my body responded.

24:15

So I could eat something, it would be

24:18

positive, it would be fine, I'd try a little bit

24:20

more. And over the course

24:22

of the years and years of doing that, I

24:24

found that the things I have to be mindful of is

24:27

chewing certain foods, making

24:31

sure I use the chew 20

24:33

times kind of rule on certain foods. I've

24:35

also learned that very dense fibrous

24:38

foods are just not good for me, I need

24:40

to stay away from them because they cause me like discomfort

24:43

and blocking because the end of the stoma is very

24:45

small. It's like the size of the end of my small

24:47

finger. And it narrows over time as well. So

24:50

all the food that you put in your mouth has got to go

24:52

through that, it's got to come out of that hole. So

24:55

quite often I like empty

24:57

my bag or I feel in my bag and I'm like, I

24:59

can literally feel like a bit of sweet corn. Yeah,

25:02

so it's important that I choose stuff, otherwise

25:04

it quite literally comes out and goes in.

25:06

Yeah, so you're not getting the nutrients from that. Exactly

25:08

that. I think

25:10

the important point there is that again,

25:12

it's bespoke for the person. So

25:15

if something works for you, it may not work for someone

25:18

else. Like you've been brave in your choices, but

25:20

you've been smart in the way you've done it. You've

25:23

added in things slowly and that's what I would advise

25:25

for anyone. Even people with IBS

25:28

sometimes ask me, I've been told I can't eat

25:30

fiber and you can. And in fact, you should

25:32

eat fiber because your gut bacteria need it, but

25:35

it's slowly

25:37

and gently adding in things and seeing

25:39

what works, what

25:40

doesn't work. I think as well,

25:43

the best friend for

25:45

a person who's got a stoma is the stomanous.

25:48

It's not your surgeon who they can do operations,

25:50

they can refashion your stoma, recite

25:53

it, put it in a different position fix your hernias,

25:55

whatever. Great, they've done their bit. But the stoma

25:58

nurse is the most...

25:59

underrated and the best friend

26:02

of anyone with a stoma because they've got these little tips

26:04

and tricks that no one else can teach you Yeah,

26:07

absolutely. You know, I always say to people make sure

26:09

you've got good contact with these people Um,

26:11

but I also say to people as well as the stoma nurses

26:14

Talk to other patients. Yes, the power

26:17

to the patient is something I'm a huge advocate

26:19

of because they actually have lived

26:21

experience of what works

26:24

what doesn't work I think a lot of people aren't

26:26

told at the beginning of their stoma journey The

26:29

association between having a physical

26:31

condition and your mental health That

26:34

right there is missing in terms

26:36

of when I left hospital I

26:38

had no support and was never told

26:41

by my surgeons by my nurses that

26:43

this would really impact my mental health And

26:46

it knocked me for six when I first had my stoma

26:48

fitted because I was alone Everyone around

26:50

me in the bowel ward was 50 years older than

26:53

me and I had no one to relate to and

26:55

that's why I turned To social media

26:57

because I was like there's got to be other people Experiencing

27:01

what I'm experiencing now. How can I contact

27:03

them and just talk and that's

27:05

been my biggest sort of Almost

27:08

like the yeah victory and port of recovery

27:11

has been talking to people and venting how I'm feeling

27:14

Yeah, it's a chronic condition and it's

27:16

been known that chronic condition is

27:18

A linked with mental health issues

27:20

as well. And you know, it's a burden

27:22

of dealing with that on a daily basis

27:26

If I told you today that

27:29

I could reverse your stoma, would you

27:31

want it reversed?

27:34

No for me People

27:36

that want to get rid of a bag quite often.

27:38

It's for the aesthetic. It's just physically

27:41

Mentally, they can't handle having

27:43

a bag on their body. Whereas for me now, it's

27:46

just become part of my life It's enabled

27:48

me to be healthy and it's given

27:50

me my life back So I'm not willing to

27:52

risk that the pros don't outweigh

27:55

the cons So for me,

27:57

this is all working for me right now. I'm not willing

27:59

to risk it

27:59

No, I agree with

28:02

that 100%. What do you do when you're

28:04

sort of out and about on a plane, traveling,

28:06

public spaces? Do

28:09

people give you any sort of weird

28:11

looks?

28:12

Not only you having

28:14

your stoma, but also the

28:16

fact that this handsome,

28:18

fit young guy is just walked into

28:21

the table toilets and comes back out

28:23

and thinking, what's this guy done? Yeah,

28:26

so I guess it's a difficult one because

28:28

when you live with an invisible condition, people

28:31

associate disability quite often with

28:34

a wheelchair, something that's visual and you can

28:36

see there and it's out in the open. And

28:39

for a long time, and a lot of people I speak to as well,

28:41

they just don't go into disabled access facilities

28:44

for that reason, because they're worried about

28:46

someone judging them or someone calling them out. The

28:49

worst time I had it was about

28:52

two months after I had stoma surgery and

28:54

I was quite fragile. I was very

28:56

weak, so I was quite feeble in itself. At

28:59

that time, not ashamed of it, but

29:01

I was like, I didn't want people openly knowing I had

29:04

a stoma at that point. I went

29:06

to use a disabled toilet

29:08

in a big supermarket.

29:11

As I went into the toilet, one of the staff members shouted

29:13

out, that's the disabled access toilet across

29:16

about eight or nine people.

29:18

I was like, yeah, I'm aware of that.

29:20

And they were like, yeah, the gents' toilets there. I

29:22

was like, well, I need this one. And they were like, well, it's a disabled

29:24

toilet. And at that point, I was kind of like,

29:27

I just went in there and closed the door and I actually

29:29

had like, I was raging. I was like really

29:31

upset, like almost in tears. I'm annoyed

29:33

just listening to that. Yeah. And I thought,

29:35

for me, if that made me that upset, and

29:38

for

29:38

the type of person that I am, I'm like a,

29:41

brush my shoulders off, right, let's just get on with it. That's fine.

29:43

But for other people that could have put them in a position

29:45

where they were suicidal,

29:48

if they hated and resented their stoma

29:50

already, that is just pushing them over

29:53

the edge. And no one should be judged or

29:55

looked upon or frowned upon for using something

29:58

that is essential for them.

33:59

is some sort of psychopathic trait. They

34:02

do say that

34:03

when you're in a high-stress job,

34:06

if you're a CEO, if you're a pilot,

34:08

if you're in the military, if you're a surgeon, you have

34:11

psychopathic traits which are

34:13

desirable. You can keep calm

34:16

in a stressful situation. So if there's major bleeding, you

34:18

don't panic. You're like, okay, there's some bleeding there. Let

34:20

me sort it out. Because you want to be calm then. You

34:22

don't want to panic. So those are some psychopathic

34:24

traits where a psychopath would also keep

34:27

calm under pressure. There's also some undesirable

34:29

psychopathic traits. And there are some surgeons

34:31

and people in everyday life who are psychopaths.

34:35

So when I cut into humans, and

34:37

if I do surgery, I see bleeding, even

34:39

in my very first surgery, I was

34:42

thinking, this is cool. I

34:44

didn't think anything of it. I know people who

34:46

have fainted just at the sight of blood, who

34:48

faint in theatres, just seeing a bit

34:50

of bowel. I had a med student recently who

34:53

fell face first into an open abdomen,

34:55

had a face full of intestines and organ juice. And

34:58

my boss just yanked him out. He's like,

35:00

get out. We're going to cause a wound infection. Didn't care about the

35:02

student. Get out. But my

35:05

first ever surgery, major-ish surgery,

35:07

was appendisectomy, removing someone's appendix.

35:10

And I just thought, wow, I get to play with this fancy

35:12

tool and do this kind of stuff. And

35:14

at no point was I like, I'm cutting

35:17

into someone and their life is in

35:19

my hands. So I don't know what to say. Is that

35:21

good or bad? I don't know. But I've never

35:24

felt queasy or weird when I

35:27

see shit, piss, vomit, blood,

35:29

juice. I'm just thinking, wow, this

35:32

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35:34

that.

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36:43

I hope you enjoyed that conversation with Misha.

36:46

It certainly really brings to light how

36:48

many people are out there that suffer with

36:50

inflammatory bowel disease and chronic conditions. And

36:53

maybe we need to be a bit more open and

36:55

sensitive to what's going on in other people's

36:57

lives as well.

37:03

This is the bit that I'm really passionate about

37:06

because there is so much garbage

37:08

online. It's time to take out the trash

37:11

and debunk those myths. Okay, so

37:13

I've got this question a fair few times.

37:16

Can Crohn's disease be caused

37:18

by stress? If you've watched this episode,

37:20

you're going to know that Crohn's disease is an inflammatory

37:23

bowel condition, and it's a type of autoimmune

37:26

condition, which means there is some glitch

37:28

in your immune system, which means that

37:30

your own body, your own immune system

37:33

fails to recognise its own cells and starts

37:35

to attack it, which leads to inflammation,

37:38

pain, bleeding from the bottom end, weight

37:40

loss, and all of these nasty things which are

37:42

associated with Crohn's disease. Now,

37:45

while stress doesn't cause Crohn's

37:47

disease, stress can actually exacerbate

37:50

Crohn's disease and worsen some of

37:52

the symptoms. And this is because stress

37:54

is not just a psychological state, it's

37:56

also a physiological one as well.

38:00

When you are anxious, you get changes to

38:02

your heart rate, you get various hormones

38:04

which are released. You can also get a

38:06

change in your gut microbiome and

38:09

we know that a lot of the symptoms

38:11

can be worsened in inflammatory bowel

38:13

disease by an alteration in

38:15

your gut bacteria or gut microbiome. You

38:18

can go into dysbiosis. So, these

38:20

can be worsened. Those symptoms of Crohn's

38:22

or hostess of colitis, even irritable

38:25

bowel syndrome can be worsened by

38:27

stress. So, actually trying

38:29

to regulate your stress if you have inflammatory

38:32

bowel disease or bowel issues can actually

38:34

help with symptom control. I

38:38

am constantly sent videos about this sort

38:40

of stuff on TikTok. It is rife

38:42

online colonic hydrotherapy.

38:45

Is that real? Do we need to flush out

38:48

our colons from toxins and parasites?

38:51

Absolutely no. This

38:53

is a myth and a dangerous

38:54

one as well. Your body has several organs

38:56

which are self-cleaning and self-detoxifying.

39:00

Your kidneys, your liver and

39:03

your colon as well. To emphasize

39:05

my point as to why colonic

39:07

irrigation and colon hydrotherapy

39:10

is dangerous, I'm going to give you an anecdote of

39:12

a patient and I'll change a few details. I

39:14

had a patient a few years ago who presented

39:17

with a hole in their bowel and they

39:19

ended up needing emergency surgery and

39:21

a stoma formed. The reason they had

39:23

a hole in their bowel, it was an elderly patient,

39:25

their bowel was slightly more thin as well. They

39:28

had gone to a colonic irrigation

39:30

spa session where they had basically a

39:33

high pressure jet of water insulating

39:36

their rectum and this had caused a

39:38

traumatic perforation, a traumatic

39:41

hole in their bowel and all the

39:43

shit from the inside leaked outside. You don't need

39:45

to be medical to know that shit leaking

39:47

is not good. Now if you feel

39:49

you need colonic irrigation to relieve

39:52

your constipation, there are other things you can

39:54

do. Increasing your fiber content,

39:56

increasing your water content from the top end,

39:59

not from the bottom end. recommend, and even

40:01

simple things like laxatives. If these still

40:04

don't work and you have chronic constipation,

40:07

your first port of call should not be, hang

40:09

on, let me put a jet spray of water

40:11

up my ass, it should be to go to your doctor

40:14

to find the underlying cause as to why

40:16

you have constipation. Even if you

40:19

have colonic irrigation and they clean out

40:21

your intestines, that's not going to fix the root

40:23

cause. The underlying cause of your constipation

40:25

will still be there. And as mentioned

40:27

before, this is highly dangerous, not

40:30

only because it can cause

40:32

risk of injury to the bowel, but also

40:34

it can cause a shift

40:36

in your electrolyte to the bottom end because you're pouring

40:39

water into your intestines, and

40:41

this can change your electrolyte balance. And

40:44

that's also not good.

40:52

Okay guys, before we go, let's have one

40:54

list of questions. This week it's from

40:56

James in Nottinghamshire. James

40:58

says, I work in a manual labour job

41:01

outside all day in the UK

41:03

in all weather conditions. One of

41:05

my big concerns at the minute is the sun. I

41:08

know the obvious protection, drinking water, sunscreen,

41:11

using clothes to cover the skin, but as

41:13

shade is not an option and I'm often sweaty

41:15

and warm, what more can I do to

41:18

stay protected in the sun?

41:20

That is a really excellent question from James,

41:22

particularly as the UK has been

41:24

experiencing a heat wave over the last couple of weeks

41:27

and this summer is going to be baking hot

41:29

and wherever you are in the world and if it's hot,

41:31

you need to know how to keep yourself cool.

41:34

So definitely James, you should keep drinking

41:37

water because sweating

41:39

is how we thermoregulate, how we

41:41

regulate our internal body temperature. So

41:43

if we can't sweat, then

41:46

we can't reduce our body heat. So

41:48

if you're very dehydrated, your

41:50

sweating will be one of the first things to stop

41:52

and then you will just be like a pig

41:54

who can't sweat and you'll overheat because pigs

41:57

literally cannot sweat and they are prone

41:59

to heat stroke. So don't be like a pig, drink

42:01

water, stay hydrated so you can sweat

42:04

and stay cool. And this next one might

42:06

sound counterintuitive, but actually

42:08

you should consider eating some spicy

42:11

food. If you look at warmer countries

42:13

around the world, India, Pakistan, places

42:16

like that, they eat spicy food

42:18

in very hot conditions because

42:20

capsaicin, the active

42:23

ingredient in spicy food, which

42:25

gives us that chilly burning sensation,

42:28

actually tricks our body into thinking

42:30

that we're hot. So our body

42:32

tries to counteract and compensate for that

42:35

by cooling us down and vasodilating

42:37

the blood vessels near the surface of the skin. So

42:40

it helps to cool us off. So that's another

42:42

little trick that you can do. And in

42:44

addition to doing the things you're doing already, water,

42:47

sunscreen and shade, another thing

42:49

you can do is specifically try to find

42:51

shade that's green. So plant

42:53

shade, not only do plants provide

42:56

a natural barrier and protection against

42:58

the sun, but they also help to cool you

43:00

down as biological natural

43:03

air conditioners. So the leaves

43:05

from plants actually release some

43:07

of the humidity and moisture as

43:10

part of their evaporative cooling. So it actually

43:12

helps to cool you down when you're near

43:14

trees and plants and shrubs. And

43:17

with regards to clothing, you can actually buy

43:19

specific UV protective clothing,

43:21

which can also help as well. These may be expensive,

43:24

but you can combine this with just covering

43:26

those bare areas, basically your head

43:29

as well, which can heat up far more quickly

43:31

as it's got a larger surface

43:33

area compared to other parts of

43:35

your body. James, thank you very

43:37

much for that question. Very appropriate for the time of the

43:39

video.