Could Your Gut Pain Be EDS-Related? with Dr. Pradeep Chopra

[01:02] Dr. Linda Bluestein: Welcome back, every bendy body, to the Bendy Bodies Podcast with your host and founder, Dr. Linda Bluestein, the Hypermobility MD. Today we are going to be talking about abdominal pain and gastrointestinal problems with EDS, HSD, POTS, and MCAS. I am 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, 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.
[01:42] I am 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 going to 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 at hypermobilitymd.substack.com. Let's get started.
[02:12] All right, 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. It's so great to see you again.

[02:22] Dr. Pradeep Chopra: It's wonderful to be back again. It's a real pleasure. I think Bendy Bodies is doing an amazing job because I get lots of patients that come in and say— 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, got it.

[02:44] Dr. Linda Bluestein: Well, good. I'm glad that we are reaching more and more people because, as you know, there's going to be a lot of things that we're going to 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. 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 start to track things down themselves and play detective, which is unfortunately really important in this day and age.

[03:17] Dr. Pradeep Chopra: I think one of the best things about going on a public forum and talking about diseases and sharing ideas is that it's empowering the patients to better understand what's going on with them. And I hate to say this, but it also helps them from being gaslit. But more importantly, they get to understand: okay, I have this condition, it sounds strange to me, my doctors think I'm crazy, but I heard these two people on Bendy Bodies talk about that exact same thing and they had an explanation. And that's what I like about it. This information is available to them free of cost.
[04:14] I know how much work you've put in. It's not like you just woke up one day and you knew everything about EDS. I personally know how much work you've put in. And I have spent weekends and days and nights reading, studying, understanding, researching, literally inventing treatments for conditions associated with EDS. And it's such a pleasure to share it with them. You know, that might be our legacy.

[04:41] Dr. Linda Bluestein: Yeah.

[04:42] Dr. Pradeep Chopra: It'll be on my tombstone. Thank you for being on Bendy Bodies or something like that.

[04:49] Dr. Linda Bluestein: I thought you were going to say that some of the treatments that you invented were going to be on your tombstone. Okay, you're going to have to have a big tombstone, but if Bendy Bodies makes it onto your tombstone, that would be pretty cool too.

[05:01] Dr. Pradeep Chopra: If I have to put everything that I invented or discovered or researched, it's going to be a massive tomb. It has to be something like the Great Wall of China or something. We'll just put a QR code on the gravestone.

[05:17] Dr. Linda Bluestein: There you go. You might have just invented something else that could be very valuable for a lot of people who want to share their life's work after they're gone. That's something I've thought about too. We help people when we see them one-on-one, of course, but we need to reach more people than that. What do I want my legacy to look like?

[05:45] Dr. Pradeep Chopra: If you left a good footprint on this planet — if everybody left a footprint that would be useful and followed their legacy — that's really going to change the world. It's not about having a big mansion or a building named after you or a hospital wing named after you. It's more that yes, I helped this mom understand what's going on with their kids, and those kids can then have a full life and pass it on to their kids and change families and generations.

[06:24] Dr. Linda Bluestein: So, I know that this started as you and I were talking on the phone the other day about this AGA clinical practice update on GI manifestations in POTS, hypermobile EDS, etc., that was published fairly recently in May of 2025 by Dr. Aziz and colleagues. 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 mention as additional factors to consider.
[06:49] Do we want to 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 add — do we want to get into that? Because we want to, as you proposed, which I think was a great idea, start with the teeth. We're not going to start with the esophagus or the mouth. We're actually going to start with the teeth and work our way down. So do we want to talk about the paper a little bit first, or do we want to just dig right into this whole journey through the GI tract?

[07:13] Dr. Pradeep Chopra: The good thing is that a paper was published recognizing the connection between the GI tract and EDS. That's the good thing. The not-so-good thing was that they came up with— I'm looking at it right now— it says clinical practice update. They've given a list of 16 updates, but most of them just center around POTS and mast cell activation syndrome. They talked extensively about MCAS and they talked extensively about POTS. But I think there was a lot that they missed.

[07:18] Dr. Linda Bluestein: Mm-hmm.

[08:07] Dr. Pradeep Chopra: They could have added that. I don't know the reason for not adding it. To me, GI means stomach, abdomen — anything in the abdomen is GI for me.

[08:09] Dr. Linda Bluestein: Mm-hmm.

[08:33] Dr. Pradeep Chopra: I can't say the liver is not GI. The liver is also part of the GI, and the spleen also, and all of those things. So what we are going to do today is leave the guidelines alone and talk about our research. We can supplement the guidelines, because they talked a lot about POTS and MCAS, which we've done on previous podcasts and talked extensively about. But we'll talk specifically about GI abdominal issues in EDS. How's that?

[09:07] Dr. Linda Bluestein: Yeah. Anything affecting the gastrointestinal tract or, like you said, the abdominal cavity, I think would be very helpful for a lot of people. So let's start with the teeth. There are issues with the teeth that can affect how you feel in your belly, right? So starting there is probably a good place.

[09:34] Dr. Pradeep Chopra: I have these weird ideas. In one of my previous podcasts I said that all my brainstorming happens when I brush my teeth.

[09:45] Dr. Linda Bluestein: Yes, you have said that before.

[09:46] Dr. Pradeep Chopra: See how clean my teeth are?

[09:49] Dr. Linda Bluestein: They look great.

[09:50] Dr. Pradeep Chopra: That's why all my ideas come when I brush my teeth for some reason.

[09:54] Dr. Linda Bluestein: So do you brush them for a really long time then?

[09:59] Dr. Pradeep Chopra: When I get really excited, I have my phone next to me, and if I get really excited about something I put my brush on the side and start typing — I've got toothpaste in my mouth — because your brain cells only work for so long. After 2 minutes you're like, what was that thing I was going to discuss? So I quickly type it into my phone before I forget. A lot of my ideas came there. And one of the ideas was that you and I are going to take a stroll — a little walk down the gastrointestinal tunnel. Let's call it a tunnel.

[10:41] Dr. Linda Bluestein: Okay.

[10:43] Dr. Pradeep Chopra: And we'll start with the teeth. Although teeth technically don't belong to the gastroenterologist, they belong to the dentist. But nothing will happen if you don't have teeth.

Dr. Linda Bluestein: Right.

[10:56] Dr. Pradeep Chopra: Teeth are very important. So teeth and gums are a big issue in EDS, hypermobile EDS. Teeth are connective tissue. The enamel on the teeth is connective tissue. And some people have what is called soft teeth.

[10:57] Dr. Linda Bluestein: Mm-hmm.

[11:19] Dr. Pradeep Chopra: We use hard bristles on our toothbrush, and the toothpaste we use — like the Colgate ones — those are all abrasive. Did you know that you can clean the headlamp on your car with toothpaste? Or you can clean old silver with toothpaste.

[11:38] Dr. Linda Bluestein: That's a little worrisome. That's a hack.

[11:40] Dr. Pradeep Chopra: That's a hack. So the enamel on the teeth is soft. You brush your teeth with a hard toothbrush and this abrasive sandy toothpaste and you scrape off some of the enamel, and then you worry, oh, I'm getting a cavity, and then you brush harder and harder, and finally you have a big hole in there and some germ decides to live in there. That's one problem.
[12:14] The second problem is that people with EDS have dancing teeth — they move around, they shift around.

[12:19] Dr. Linda Bluestein: Dancing teeth. I've heard that.

[12:22] Dr. Pradeep Chopra: You know, your oral facial pain doctor is working on a study about how teeth in EDS often move faster with orthodontia, but then often regress afterwards. Of course, that can happen to a lot of people.

[12:22] Dr. Linda Bluestein: Right. And I want to make sure, for people who just heard this about the toothpaste — I know that you have an alternative that you like for brushing teeth. Could you let us know what that is?

[13:04] Dr. Pradeep Chopra: There's a dental gel called LIV Fresh. L-I-V Fresh. It's a little expensive unfortunately, but it's not abrasive.

Dr. Linda Bluestein: Mm-hmm.

[13:12] Dr. Pradeep Chopra: It's what we call a chelating agent, which means it kind of wipes stuff off the teeth without scraping anything off. You just wet the toothbrush, put a little blob of this LIV Fresh, and gently brush it off. It works really well — actually it works well on the gums also. And that's one of the things.
[13:46] The other problem is the gums, because gum is connective tissue. If you brush too hard, you're scraping off gum tissue. We see a lot of gum recession in patients with EDS. Brushing hard is not a good idea.

[14:04] Dr. Linda Bluestein: I really like the Waterpik for that. And especially now they make battery-powered ones. I used to make a huge mess in the bathroom, but if you get the water-powered one, you can do it in the shower so you don't make as much of a mess.

[14:17] Dr. Pradeep Chopra: Those PowerJets, right?

Dr. Linda Bluestein: Mm-hmm.

[14:17] Dr. Pradeep Chopra: Those are amazing. They'll clean out anything. So yeah, I like those. Shall we walk through all 32 teeth?

[14:31] Dr. Linda Bluestein: We're going to walk through each one individually?

[14:33] Dr. Pradeep Chopra: No, no, no. But taking care of your teeth is important because any infection in the teeth is going to be carried into your GI tract and then into your blood, and then everywhere.

[14:47] Dr. Linda Bluestein: So having healthy teeth and gums is extremely important and also contributes to inflammation, right?

[14:55] Dr. Pradeep Chopra: Absolutely. If you have inflamed gums, that inflammation is going to spread. If you have an infection in the gums, it's going to cause inflammation everywhere. This is extremely important. I hope my dentist is listening. He'd be so proud.

[15:15] Dr. Linda Bluestein: You can always send this to him.

[15:18] Dr. Pradeep Chopra: He and I have had arguments about LIV Fresh. He's dismissed me many times. And I've proven him wrong, because after I started using it, he hasn't been able to find any cavities.

[15:33] Dr. Linda Bluestein: Oh, he's upset because you're putting him out of work. That's why.

[15:37] Dr. Pradeep Chopra: Yep. So the next thing I want to talk about is the throat.

[15:46] Dr. Linda Bluestein: Hmm. What about the jaw?

[15:49] Dr. Pradeep Chopra: Okay, the jaw. On the jaw, we have two things to talk about. One is TMJ dysfunction and the other one is what's called Eagle syndrome.
TMJ is the temporomandibular joint, and it's not a well-made joint — I'm sorry, I hope I don't get hit by lightning, but it's not a well-made joint. It's not just the EDSers; in non-EDS people also, it does dislocate or subluxate. And I think God wanted us not to open our mouths too big and we didn't listen to him. When you don't listen to that, your mandible dislocates.

[16:47] Dr. Linda Bluestein: I have a hack from my oral facial pain doctor — when you yawn, tuck your chin down to your chest, because then you can't open your mouth as wide. She gets a lot of patients that have open locking, so she recommends doing that. Because the jaw problems can contribute to chewing problems, which can obviously cause problems with digesting your food. Sorry, I interrupted you. Keep going.

[17:13] Dr. Pradeep Chopra: No, that's a great hack. We are allowed to interrupt when it's hack time — then you'll forget the hack.
[17:23] So on the TMJ: the masseter muscle is a really powerful muscle, and then there's the temporalis muscle. These are our chewing and grinding muscles. A lot of us subconsciously at night will grind or clench. There's also a phenomenon where, when you're lifting something heavy or when you're in pain, you tend to clench your teeth. It gives you that little extra boost of energy. So we tend to clench our teeth a lot. And what happens is these muscles get tired — during the day you're talking, you're eating, so they never get rest. They finally start to get inflamed and then they have muscle spasms and muscle knots in them.
[18:26] 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?

[18:38] Dr. Linda Bluestein: Well, we hear like 2 weeks, but— 4 months?

[18:40] Dr. Pradeep Chopra: 4 months.

[18:42] Dr. Linda Bluestein: Not 2 weeks.

[18:44] Dr. Pradeep Chopra: No, 4 months. So what I tell patients is to start subconsciously during the day and especially before bedtime, start thinking about not clenching, not grinding — kind of obsessing about it. What happens is the brain subconsciously registers that and then they don't clench and grind.
[19:10] I don't know if you ever had this, but it happens to me a lot. If I have to take a flight at 4 o'clock in the morning and I set my alarm for 3 o'clock, I will wake up 10 minutes to 3 and turn off the alarm before it even gets a chance to wake me up. That's because all day you'd be thinking: I've got to get up at 3, I've got to go to the airport. So subconsciously the brain sets its own alarm — it doesn't trust you to set an alarm. And so this is what happens with TMJ: if you start obsessing about not clenching and grinding, it helps a lot.

[19:50] Dr. Linda Bluestein: I have two hacks from Dr. Julie Robinson-Smith, who is my doctor. Her two hacks — because I clench a lot — first, teeth are supposed to touch only very rarely; they're not supposed to be touching. That's a huge problem right there. She told me to set a timer on my phone to go off every 15 minutes. Every time the timer went off, I was to pay attention to whether my teeth were touching or not. My proprioception is so bad that I have a hard time even telling if my teeth are touching, but this is what she wanted me to do. And it's gotten a lot better since then.
[20:26] So every 15 minutes you set this timer, and when it goes off, you note whether your teeth were touching or not. You start tracking and making sure that as you're paying attention, you're doing it less and less, because she gave me frequencies — if it's happening this much, you can decrease the frequency, and if it's still happening a lot, you keep checking every 15 minutes. This is of course while you're awake; you don't wake yourself up to see if you're clenching.
[20:52] The other hack is that SSRIs contribute to clenching. So just food for thought — pun intended.

[20:58] Dr. Pradeep Chopra: Really? I had no idea. So either you clench or you get depressed.

[21:05] Dr. Linda Bluestein: Right. Choose one.

[21:11] Dr. Pradeep Chopra: Okay. I didn't realize that. So even during the day, remember not to clench. There's a rule called lips together, teeth apart. And the other one, which I do, is I stick my tongue between my teeth. If I find myself clenching, I stick my tongue between my teeth and it kind of breaks that cycle.
[21:44] Now, the expensive or fancy way of treating TMJ is an oral appliance. These are highly specialized orthodontists who design oral appliances so that you're actually clenching on air when you're biting down. They have a day-use one and a nighttime-use one, and there are very few but some really good ones out there.
[22:16] The common thing that people do is give you this mouth guard, which I think doesn't make much sense, because now you're biting down on plastic. It does protect your teeth, but you're still clenching. It doesn't solve the problem.

[22:27] Dr. Linda Bluestein: You're still putting the forces to the jaw. Yeah.

[22:32] Dr. Pradeep Chopra: But I have a little hack for that. It's hard for people to do all these things and to keep remembering not to grind. So what I do is shoot some Botox into the masseter and the temporalis muscle. They still clench, but now they're not clenching as hard. It doesn't affect their eating or chewing, but when they clench, it's not that hard clench, and it does work. I know from personal experience. I had these headaches — I get migraines — and they wouldn't go away, and nothing was working, until I realized I was clenching and I could feel these muscle knots in my masseter muscles. So I had someone shoot Botox into these muscles.
[23:31] So that's for TMJ. But very often we get patients who come into our offices — you have seen them, I've seen them. They say, oh, I've got horrible TMJ. And you tell them, show me where your pain is. And they'll point to somewhere down here, not precisely here, but here. And they'd be told by a lot of doctors, oh, it's TMJ. But it's actually something called Eagle syndrome.
[24:04] Now, this has nothing to do with the bird eagle — this was actually Dr. Eagle who discovered this. Let me explain the symptoms.

[24:14] Dr. Linda Bluestein: And for people who are listening, can you describe where you're pointing?

[24:21] Dr. Pradeep Chopra: I'm pointing under my jaw — my handsome chiseled jaw — pointing under that. Lower than the angle of the jaw, coming down underneath on the neck area. Basically it's the jaw area.

[24:27] Dr. Linda Bluestein: Right.

[24:42] Dr. Pradeep Chopra: So when you think of TMJ and of extremely painful TMJ, always think: could this be Eagle syndrome?
[24:52] The symptoms of Eagle syndrome are difficulty swallowing, feeling like there's something stuck in the throat, and shooting pains from the throat to the ear. Less commonly, there's pain at the base of the tongue — I don't see that as often. But if you have them turn their head to one side and tell them to swallow, it's hard for them to do it; it hurts. They also have ringing or buzzing in the ears. It is associated with headaches — it's a very big reason for headaches.
[25:34] The way I examine them: I press under my mandible. There is a piece of bone called the styloid process. I press on the styloid process and they go "ouch." Then I do one more step — I put my finger into their mouth and go along the mandible, the side of the mouth, and sneak in behind the jaw.

Dr. Linda Bluestein: Mm-hmm.

[26:04] Dr. Pradeep Chopra: And I hit the styloid process, and it's really painful.

[26:20] Dr. Linda Bluestein: Are you finding that more unilaterally or bilaterally in your patients?

[26:26] Dr. Pradeep Chopra: It's mostly bilateral, but one side is always worse than the other. The anatomy is a little hard to explain, but basically there's a small bone at the back of the mandible that grows down and becomes longer, and it presses on a nerve that goes to the throat and the tongue. It's called the glossopharyngeal nerve.

[26:56] Dr. Linda Bluestein: We can add an image on the video for that so people can see it on YouTube.

[27:01] Dr. Pradeep Chopra: Yeah, absolutely. And then it can also, if you turn your head, press on the internal jugular vein. And in some severe cases, it can press on the internal carotid artery.

[27:01] Dr. Linda Bluestein: Hmm.

[27:20] Dr. Pradeep Chopra: Now that is extremely important because one of the reasons people have headaches in EDS is raised intracranial pressure. The pressure inside the head goes up. There are many reasons it goes up, but this one related to Eagle syndrome is that the amount of blood going into the head has to be the same amount that comes out. The internal carotid artery takes blood into the brain and the internal jugular vein drains that blood out. When they turn their head, the styloid process — that little bone growing down — actually pinches the internal jugular vein. So now you have blood going into your head but not the same amount coming out. And so they have this intense intracranial pressure headache. That's Eagle syndrome.

[28:20] Dr. Linda Bluestein: Before we leave Eagle syndrome — in terms of workup, besides your exam, are you also doing glossopharyngeal nerve blocks, or are you relying more on imaging?

[28:41] Dr. Pradeep Chopra: Both. Surgeons want a CT angiogram — a thin-slice CT. And they'll also do a glossopharyngeal nerve block.

Dr. Linda Bluestein: Mm-hmm.

[28:56] Dr. Pradeep Chopra: And if the patient gets relief and the imaging is positive, then the surgeon goes in there and shortens the styloid process.

[28:59] Dr. Linda Bluestein: Okay.

[29:13] Dr. Pradeep Chopra: It does work. The results are amazing actually.
So before we move away from Eagle syndrome, I just want to reiterate to everyone: if it's a really severe pain in the jaw area, think of Eagle syndrome. It could be TMJ, but TMJ is more of a low, annoying headache. Eagle syndrome is a sharp, very sharp pain, and it hurts to swallow.
[29:52] So we're still hanging out in the mouth area, but now we're entering into the esophagus. One little trick that I do: if patients with MCAS come in and I want to see if their GI tract is affected by MCAS, I look at the throat. And Dr. Bluestein, almost 100% of those patients have inflammation of the throat. I get surprised if it's not inflamed.

[30:29] Dr. Linda Bluestein: And are you saying almost 100% of your MCAS patients specifically? Because I know there's a tremendous amount of overlap — some have one diagnosis, some have all three. Does it seem more associated with the MCAS?

[30:52] Dr. Pradeep Chopra: MCAS. It's the MCAS patients that have inflammation. So that gives me a little idea that they may have it, because they have inflammation of the throat, which is the beginning of the GI tract. As I go down further, I look for other signs. And if you ask them, a lot get surprised. Some will say, yeah, I have a scratchy throat. Some get surprised that it's inflamed.
[31:31] This inflammation is not from infection — that's the point I want people to remember. This is a sterile inflammation. It's not an infection. It's from naughty mast cells misbehaving.
[31:49] So now we are walking into the esophagus — the food tube. Is "food tube" the right term for it?

[31:59] Dr. Linda Bluestein: I think that works. Let's talk about the esophagus for a few minutes, and then we're going to take a quick break and come back.

[32:06] Dr. Pradeep Chopra: The esophagus is affected in several ways in patients with EDS. Let's talk about the one that I worry about the most: eosinophilic esophagitis, which in plain English means inflammation of the esophagus — inflammation of the tube that carries food from the mouth to the stomach. It's a pretty difficult condition. A lot of these people present with difficulty swallowing. They feel like food is getting stuck in their esophagus. This inflammation of the esophagus is pretty much similar to MCAS inflammation.
[33:00] The diagnosis is based on doing an endoscopy — they put a tube down and look and take some biopsies. It's not acid reflux; acid reflux is different. You can get inflammation from acid reflux as acid goes up, but eosinophilic esophagitis is an immune-mediated condition. So they have difficulty swallowing, food stuck in there, and in children there are feeding problems, vomiting, poor weight gain, and basically failure to thrive.

[33:48] Dr. Linda Bluestein: I was going to point out that the suffix -itis means inflammation. So you can have esophagitis that's more general, related to heartburn or acid reflux. Eosinophilic esophagitis still has -itis at the end, but that's related to an increased number of eosinophils in the esophagus, found on biopsy.

[34:11] Dr. Pradeep Chopra: Right. Eosinophils are cells that start populating — they collect wherever there's inflammation. That's why it's called eosinophilic esophagitis, or EOE for short. This was not in the guidelines, by the way.
[34:32] One more thing on the esophagus: like we said with Eagle syndrome, patients have difficulty swallowing and feel like something is in the throat all the time, but it can also be from craniocervical instability — both preoperative and postoperative.

[34:50] Dr. Linda Bluestein: And that's more neurologically mediated difficulty swallowing, right? Rather than a more structural problem or inflammation.

[35:02] Dr. Pradeep Chopra: Right. When patients have craniocervical instability, one of the complaints is difficulty swallowing or as if something is stuck in the throat. And after surgery also they can have inflammation in that area, and for some time they'll have that difficulty swallowing.

[35:25] Dr. Linda Bluestein: Mm-hmm.

[35:31] Dr. Pradeep Chopra: It does resolve with speech and swallow studies and therapy.
[35:35] I can't think of anything else on the esophagus. So we talked about acid reflux. The question is, do people with EDS have more acid reflux? And the answer is yes, they do. Especially if they have MCAS, because it causes more production of histamine in the stomach, and that histamine then causes more acid production. So they kind of burp up acid and get more acid reflux. Hence, H2 blockers — famotidine or cimetidine — can be used for that. And the reason we use famotidine in MCAS is not just for the acid reflux part; that's a side benefit.

[36:19] Dr. Linda Bluestein: And what about the connective tissue not being as strong as we'd like, predisposing you towards a hiatal hernia — where there's an opening in the diaphragm and part of the stomach is actually coming up into the chest?

[36:35] Dr. Pradeep Chopra: Unless it's a really big hiatal hernia and is a significant problem, I recommend getting surgery for it. But if it's a small hiatal hernia, leave it alone. Things can go pretty wrong with hiatal hernia surgeries, and I've seen people getting into trouble.

[36:55] Dr. Linda Bluestein: We are going to take a quick break. When we come back, we're going to keep going — stomach, duodenum, small intestine, large intestine, and more. We'll be right back.

[38:27] Dr. Linda Bluestein: I'm back with Dr. Chopra, and we are taking a tour through the GI tunnel. We're going to resume at the stomach. Is that where you wanted to head next?

[38:39] Dr. Pradeep Chopra: Right. So we started with the teeth, then the throat and mouth, then we went down the esophagus. And now we are in the stomach.

[38:51] Dr. Linda Bluestein: Mm-hmm.

[38:52] Dr. Pradeep Chopra: For those who may not know, the stomach is a pouch in our abdomen where the food first goes in, gets its acid, and all that stuff is mixed there. The stomach and the entire GI tract tunnel can be affected by MCAS — we know that, and they really spoke well about that in the AGA guidelines.
[39:41] But we're pulling out different things here. And I think this might be the place to talk about MALS. What do you think?

[39:45] Dr. Linda Bluestein: I think that's a perfect place to talk about MALS.

[39:50] Dr. Pradeep Chopra: MALS is an awful condition to have. And for some reason, there is a whole group of physicians who think MALS is all hokey stuff.

[39:51] Dr. Linda Bluestein: Oh.

[40:06] Dr. Pradeep Chopra: To me, that makes no sense because you have objective evidence. But they're the same people who think that EDS doesn't exist. They're not our audience — though I hope they come one day.
[40:21] MALS stands for median arcuate ligament syndrome. It's also called Dunbar syndrome. I was giving a talk in Germany and they kept referring to it as Dunbar syndrome, and I was like, that's so much easier to write down. When you tell patients "you've got median arcuate ligament syndrome," they're like, huh?
Anyway, MALS is pain in what is called the epigastric region — the solar plexus, the upper mid abdomen. That's where you would feel burning if you had acid reflux. These patients have very classical symptoms. One of them is that the pain gets worse with eating — they'll always tell you that. Obviously, they also have weight loss. In kids especially, you'll see they get tired after a heavy meal. And the pain increases with physical activity.
[41:56] When I first read about MALS years ago and wrote down these symptoms, I thought: I don't think I'll ever see a patient with MALS. I literally see one every day.

[42:05] Dr. Linda Bluestein: Every single day? Wow.

[42:10] Dr. Pradeep Chopra: Well, every single time I see somebody with EDS, essentially. It's common — and commonly missed.
[42:21] Here's the thing: it gets better if they lie on their left side. So in the office, as I'm talking about other things, I'll have them lie on their left side, and after 10 minutes I ask how they feel. They'll say they feel better. It also gets better with lying on their stomach, and it gets worse with being upright.
[42:46] When I examine them, I don't start at the area of their pain. I'll start somewhere way off and press gently, gently, gently. Then I get to the epigastric region and push down with my thumb. I have a pain scale of my own — it's called the swear pain scale.

Dr. Linda Bluestein: Okay.

[43:14] Dr. Pradeep Chopra: The number thing doesn't work for me. So I ask them: what is your worst swear word? They'll tell me it's the F word. What's your least bad? Maybe "poop" or some version of that. And when I press over the epigastric region with my thumb, they give me a really dirty look. I call that number 1. Then I press on some other part of the abdomen with the same pressure — that's number 2 — and I say, do you still think 1 is as bad as 2? And they confirm that 1 is still the worst.
[44:11] So that's MALS. In a child, it would be failure to thrive — they can't eat, they don't like eating because their belly hurts. They often get misdiagnosed as functional abdominal pain or something like that. It doesn't cause vomiting.

[44:31] Dr. Linda Bluestein: 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. But imaging studies need to be done too, because of course you want to make sure you're going after the right etiology for the person's abdominal pain.

[44:57] Dr. Pradeep Chopra: Yes, you're absolutely right. The celiac artery supplies blood to what's called the foregut, or part of your intestine. The celiac plexus travels along with the celiac artery and gets compressed by the diaphragm. For the longest time we've thought it's because the artery is getting compressed. But the actual fact is that it's the nerve that's getting compressed. That's what causes the pain. And if you look at the nerve during a MALS surgery, it looks inflamed.

[45:40] Dr. Linda Bluestein: Can you see that with the naked eye?

[45:42] Dr. Pradeep Chopra: Yeah. It looks inflamed and swollen — the celiac plexus. It looks like a bunch of hair, it's so thin, but you can see it.
The reason I'm emphasizing the nerve is that some surgeons believe it's the artery only and just release the diaphragm without touching the nerve. Then there's a group of surgeons who believe it's the nerve also, and they remove the celiac plexus. The results of the latter group — those who remove the celiac plexus — are far better.
[46:35] So my advice to listeners: if you are going in for MALS surgery, make sure the surgeon is aligned with you on that — that they're going to remove the celiac plexus. I have a few patients who went to a surgeon who did not remove the celiac plexus, and now I can't convince another surgeon to go in there again and remove it.

[47:00] Dr. Linda Bluestein: Mm-hmm.

[47:02] Dr. Pradeep Chopra: And you know the celiac plexus nerve block? There are two reasons for having it. The first is they go in with a needle, inject some numbing medicine, and it's like magical — the patient can eat, there's no pain, and lots of things get better. It has diagnostic value for the surgeon. But the other thing it does is tell the patient: this is how you're going to feel after the surgery.
I do have a little unofficial secret on this. The surgeon I send my patients to is Dr. Richard Hsu, in Connecticut. He says the nerve block actually helps POTS.

[48:11] Dr. Linda Bluestein: Oh, interesting.

[48:14] Dr. Pradeep Chopra: Patients have come back saying their POTS got better. So I call up Dr. Hsu and say, hey, did you know it helps POTS? And he says, don't talk to me about POTS, I don't know anything about it, I'm a surgeon. I'm like, okay, just saying.
[48:35] But yeah, it does seem to help. This is one surgery I really think makes a big difference. The diagnosis is not that hard — we talked about the symptoms, we talked about the exam, and then they do a CT angiogram and a celiac plexus block. It's pretty definitive.

[49:01] Dr. Linda Bluestein: So that's MALS, or Dunbar syndrome. Interesting that he doesn't seem to think his patients are doing better with their POTS. But if you don't ask the right questions, you don't know.

[49:23] Dr. Pradeep Chopra: It's hard for a surgeon to get into the POTS arena. As it is, they're stressed out — this is not an easy surgery. I really feel for surgeons because it's not an easy job. The last thing they want is something like POTS to deal with. And honestly, I don't even know why it helps.

[49:26] Dr. Linda Bluestein: Interesting.

[49:55] Dr. Pradeep Chopra: There's no logical sense in it, but patients swear that it helps. But anyway, that's just a little aside.
[50:07] Moving on: anything else in the stomach? We have acid reflux from the stomach, inflammation from MCAS, the hiatal hernia. Otherwise the stomach behaves itself. So let's go down to the small intestine, or the first part of the small intestine, which is called the duodenum. I think this might be the right place to talk about superior mesenteric artery syndrome.

[50:40] Dr. Linda Bluestein: Either that and/or SIBO — whichever one you want to talk about first.

[50:45] Dr. Pradeep Chopra: Let's talk about SIBO first.

[50:46] Dr. Linda Bluestein: SIBO stands for small intestinal bacterial overgrowth. We are not supposed to have bacteria in our small intestines. 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. They're often treated with antibiotics, which can be very successful but sometimes requires a couple of courses. I'm sure you have more to add.

[51:23] Dr. Pradeep Chopra: Yes. So SIBO — we have about 1,000 different kinds of bacteria that live in our small intestine, and about 10,000 different kinds that live in the large intestine. Food in the GI tract moves from the small intestine to the large intestine and out. If for any reason your intestine doesn't move well — intestinal dysmotility, gastroparesis, or something like that, which would happen in MCAS — then these 10,000 bacteria that live in the large intestine start creeping over to the small intestine because there are only 1,000 defending their territory over there. So the large intestine bacteria overrun the small intestine, hence small intestinal bacterial overgrowth.
[52:30] Antibiotics do work, and these are antibiotics that don't get absorbed — they just live in the intestine, like neomycin. I call it Drano. You're basically killing all these bacteria and then starting fresh by putting in new bacteria. But the real treatment lies in treating the intestinal dysmotility. Otherwise it'll just recur.

[52:54] Dr. Linda Bluestein: Otherwise they'll just recur. Right.

[52:56] Dr. Pradeep Chopra: And that's what you said — we have to do this treatment a few times. But the real fix is to figure out why the GI tract is slowing down. Once you can figure that out and treat it, it takes care of the SIBO quickly. But otherwise the treatment, as you said, is antibiotics — or Drano as I call it — and then you start fresh with prebiotics and probiotics. Eat a lot of yogurt, get your bacteria back into their proper territories.
[53:46] There are several tests for this. It's a breath test, and it's the most boring test in the world. You breathe into about 10 tubes every half hour. First you breathe in normally, then you take this lactulose and start breathing into a tube every half hour for about 10 collections. It's a really boring test, but that's how they detect it. They've done studies by going in with a scope and fishing out bacteria to study, and it doesn't really help with diagnosis. The best is the breath test.
[54:34] Are we still hanging out in the duodenum and the small intestine?

Dr. Linda Bluestein: Yes.

[54:40] Dr. Pradeep Chopra: Good. We are at the junction of the duodenum and the small intestine. Let's talk about superior mesenteric artery syndrome.

[54:44] Dr. Linda Bluestein: Mm-hmm.

[54:55] Dr. Pradeep Chopra: This is a hard diagnosis to make. These patients present with very nonspecific symptoms. They'll have pain in their upper abdomen — not as bad as MALS pain, because MALS pain is nerve compression and there's no nerve compression here. They present with nausea, which patients with MALS do not have. They do have abdominal distension — their bellies get bloated, which you don't see in MALS. And the pain in the epigastric region gets worse when they lie flat on their back.

[54:57] Dr. Linda Bluestein: Mm-hmm.

[55:40] Dr. Pradeep Chopra: And it gets better when they lie on their left side or on their stomach, same as MALS. So there's a little bit of difference from MALS, but some similarities.
[55:53] The treatment of superior mesenteric artery syndrome is a little bit all over the place. Let me first explain why people have this. Basically there's an artery that travels over the fourth part of the duodenum, and for whatever reason, this artery compresses the duodenum so no food can pass. Which is why they get distension and nausea. It's essentially an obstruction of the fourth part of the duodenum, caused by an artery called the superior mesenteric artery. That is a very mischievous artery — a real troublemaker. And I'll show you why, because it causes a lot of problems.
Now, some researchers studied the angle of this artery and said that when the angle becomes really narrow, that's when the duodenum gets pinched. And the theory is that they're not eating, so they lose weight quickly, and because they lose weight quickly the angle becomes narrow. Somehow that theory has been accepted by everybody — except me. I think it's baloney.

[58:30] Dr. Linda Bluestein: You can absolutely use words like baloney.

[58:33] Dr. Pradeep Chopra: The reason I say that is because the artery is a soft tube — a little squishy tube — and the duodenum is also a squishy tube. How can two squishy tubes compress each other? It doesn't make sense to me. You eat pizza, it floats down your esophagus into your duodenum, and two squishy tubes can stop that?
The reason this matters is because the treatment recommended for superior mesenteric artery syndrome is to eat more food and gain weight. When I first read that, I said, no, this can't be true. But it is, and people do recommend it. Here's the problem: the whole reason you're at the doctor's office is because you can't eat. You have an obstruction. You're getting bloated, you're getting nauseous, and you have pain after you eat. How can you gain weight when you can't eat?
There are other treatments that are done. One is a bypass — a gastrojejunostomy — where they make a hole in the stomach and a hole in the jejunum and stitch them together, so food goes directly from the stomach into the jejunum, completely bypassing the duodenum. Another surgery is what is called derotation of the duodenum — the duodenum lies flat in the back of the abdomen, so they kind of move it or shift it out a little bit, and that makes a difference. Different surgeons do different kinds of surgeries and I don't have a strong opinion on which is better. But I can tell you that eating more food to gain weight is not the way to go.

[1:01:30] Dr. Linda Bluestein: What about people having multiple compression syndromes? Because that is also possible, correct?

[1:01:36] Dr. Pradeep Chopra: That's why I was calling the superior mesenteric artery mischievous — because as it travels downward, it compresses the renal vein, the vein that comes from the kidney. That's called Nutcracker syndrome. It's the same artery. So if I suspect superior mesenteric artery syndrome — or SMAS — I start suspecting Nutcracker syndrome also.
[1:02:10] The clinical diagnosis of Nutcracker is very difficult. Remember we talked about how the amount of blood going into your brain has to be the same amount coming out? It's the same with the kidney. If you block the exit pathway, if you block the vein, then not enough blood is coming out of the kidney. That's Nutcracker syndrome. And it can only happen on the left side — because of the anatomy, it only affects the left kidney, not the right kidney. Which means doing a urine or blood test for renal function is not going to be helpful because the right kidney takes over the job.
[1:03:26] These patients can present with blood in the urine. They can sometimes have pain on the left flank or even the left abdomen. The urine may have more protein in it, but that's not a very diagnostic point. In men, they can have varicocele — distended veins in the scrotum.
[1:04:05] As you can see, the symptoms are very vague. You can have blood in the urine from a urinary tract infection or a kidney stone, and left flank and abdominal pain from a kidney stone too. So you have to do a Doppler ultrasound, CT angiogram, or MRI angiogram to look at the vein compression. But my antenna starts buzzing when I see superior mesenteric artery syndrome, and I think: I have to rule out Nutcracker syndrome, because it's the same mischievous artery doing it.
[1:05:29] The treatment for Nutcracker syndrome: there is one medical center where they put a stent in the left renal vein, and I'm not sure how good an idea that is — putting a stent in a vein. But the recommended surgery is to take the left kidney and put it on the right side. So you do a renal repositioning — you pick up the left kidney, take it out from the left side, and put it next to its buddy on the right side. I've seen a few patients where they simply had a stent placed, and it makes me nervous putting a little stent in a vein because the renal vein is a very big vein. But those are the treatments.

[1:06:05] Dr. Linda Bluestein: And also, a lot of these patients have MCAS, so you're putting a foreign substance into somebody who is likely intolerant of some foreign substances anyway.

[1:06:17] Dr. Pradeep Chopra: I saw a patient today — they had put stents and coils in his vein. They had no idea what was wrong with him and thought it was a hernia and all kinds of things. For 5 years the man had been looking for treatment. And then I ask him all the MCAS questions and he meets everything to a T. Yes, I get nervous about putting foreign bodies in people with EDS.
Let's go to May-Thurner syndrome. May-Thurner syndrome is technically not an abdominal pain issue, but it can cause abdominal pain. It's more of a left leg problem. These patients have a dull, achy heaviness and cramping pain in the left leg — not the right, the left — and swelling in the left leg. The pain gets worse with standing and gets better with elevating the left leg. They may have varicose veins on the left leg — more and bigger than the right.

[1:07:20] Dr. Linda Bluestein: Mm-hmm.

[1:07:41] Dr. Pradeep Chopra: And the reason — it's a little complicated, but basically there's an artery on the right side that crosses over to the left side and compresses a vein on the left leg called the left iliac vein. The right iliac artery compresses the left iliac vein — that is May-Thurner syndrome.
[1:08:11] Because it compresses the vein, the blood slows down. And number one rule in medicine: never let the blood slow down. If the blood slows down, it clots.

[1:08:29] Dr. Linda Bluestein: Mm-hmm.

[1:08:30] Dr. Pradeep Chopra: Once the blood slows down, they start to have clots, and then they can have all kinds of problems. These patients can also present with pelvic pain, which is why we're connecting it to the abdomen. But primarily they'll have left leg issues — dull, achy pain, varicose veins, and swelling in the left leg. Classically, the pain gets worse with standing and better with elevating the left leg.
[1:09:10] There's another condition that does exactly the same thing: pelvic vein congestion syndrome. In pelvic vein congestion syndrome, the veins in the pelvis collect blood and get heavier and press on the organs and the pelvic floor. The pain gets worse with standing and better with legs elevated or lying down. But that's for our next episode.

[1:09:17] Dr. Linda Bluestein: Yes. We definitely want to talk about the relationship between that and POTS as well. But let's finish with May-Thurner. We need to do our hypermobility hack, and then we're going to continue in part 2 with the rest of the GI tunnel. So for May-Thurner, how do we work this up and what do we do about it if we make the diagnosis?

[1:10:10] Dr. Pradeep Chopra: Once they have the diagnosis — and even if you just suspect May-Thurner — the first thing is to put them on blood thinners. Because the last thing you want is a clot flying around and landing in your lungs or, worse, in your brain.

[1:10:27] Dr. Linda Bluestein: Mm-hmm.

[1:10:34] Dr. Pradeep Chopra: The treatment is often very simple. What they do is put a mesh stent into the left iliac vein. In some severe cases, they can do surgery to bypass the compression. But I think the stent works fine in this case.

[1:11:00] Dr. Linda Bluestein: So a stent in the iliac vein you feel more comfortable with than a stent in the renal vein?

[1:11:06] Dr. Pradeep Chopra: Yeah. It's a different kind of stent — it's like a tube, a mesh tube, and it's not caused problems. Even on the left renal vein I'm not sure it's definitively bad, but the known recommended treatment for Nutcracker is to reposition the left kidney. For May-Thurner you can put a stent in the left iliac vein, or do a bypass.

[1:11:41] Dr. Linda Bluestein: And sometimes we can do testing for metal sensitivity, but I know the sensitivity and specificity are not necessarily super high for those kinds of tests.

[1:12:01] Dr. Pradeep Chopra: Yes, you're absolutely right, Dr. Bluestein. We see this a lot — patients who get metal put into their bodies.

[1:12:12] Dr. Linda Bluestein: Mm-hmm.

[1:12:12] Dr. Pradeep Chopra: Chest ports are a big one. They start reacting. Metal stents and all that — they do start to react, and it's just a nightmare condition. I wish it were made more routine to check before implanting: we are putting this metal in your body, we just want to make sure you're not sensitive to it. A lot of patients don't know that about themselves.

[1:12:40] Dr. Linda Bluestein: Not only that — this is a hack: if you have had problems with metal in the past, let your doctors know. Even if it's just jewelry. I know someone who had a lot of reactions to different metal jewelry. If they're using an implant — say, a titanium alloy for a fracture — there might be some nickel in there, and maybe you've had reactions to nickel or other metals in the past. This is something doctors should be thinking about and testing for. And I know that in some cases orthopedic surgeons say, oh, that never ever happens. Oh yes it does.

[1:13:17] Dr. Pradeep Chopra: Yes it does. And when it happens, it's a nightmare.

[1:13:22] Dr. Linda Bluestein: It's a nightmare.

[1:13:24] Dr. Pradeep Chopra: Because now you have to remove it — that's a second surgery. It's awful. I see that with chest ports a lot, by the way. There's one particular brand of chest port that's considered more non-reactive.

[1:13:43] Dr. Linda Bluestein: Interesting. And do you have a preference for which kind of testing to use if you're going to test for metal sensitivity? There are a couple of labs that do blood testing, and there's also patch testing.

[1:14:04] Dr. Pradeep Chopra: Not really. If they can do patch testing, that's fine. What do they do, tape a piece of metal on the skin?

[1:14:13] Dr. Linda Bluestein: I think so.

[1:14:16] Dr. Pradeep Chopra: Or just give them earrings. This week you're going to wear titanium, next week stainless steel, third week iron. Let's look at your ear.
[1:14:29] But yes, I really think it should be made more routine, given the rise in autoimmune dysfunction and the massive increase in MCAS patients with chemical sensitivities. Because you're implanting it into the body — it's not an earring you can take off.

[1:14:56] Dr. Linda Bluestein: Right. If you can prevent a problem like that, that's absolutely huge. So we are going to have to cut off right here, because we have so much more to talk about. We'll keep the rest for part 2 of this conversation. But you know we like to end every episode with a hypermobility hack. Do you have a hack for us?

[1:15:26] Dr. Pradeep Chopra: I do. Gastroparesis. We touched on it a bit, but gastroparesis is slowing down of your stomach movements and hence the slowing down of your intestines. Here's the problem: when they test you for gastroparesis, they have you eat this radioactive egg and then they follow it around to see how long it takes to pass through.

[1:15:52] Dr. Linda Bluestein: Mm-hmm.

[1:15:54] Dr. Pradeep Chopra: But the problem with gastroparesis is that some days it's fine and some days it's not. You might just go on a good day. And a lot of this gastroparesis is related to MCAS — so if your MCAS isn't flared up, your stomach is fine.
[1:16:07] So I have a home test for it. You eat beets.

[1:16:25] Dr. Linda Bluestein: I love beets. I eat them all the time.

[1:16:31] Dr. Pradeep Chopra: You eat beets, and in the next 48 hours you should have no red color in your stool. If you have red-colored stool after 48 hours, you probably have some slowing of the GI tract.

[1:16:46] Dr. Linda Bluestein: Now, that could be slowing anywhere in the GI tract, right?

[1:16:50] Dr. Pradeep Chopra: True, but it's still slowing — and I don't care where, because it's still causing bloating and nausea. So you can go in for a radioactive egg test and they say it's fine. I know one patient who had it done 5 times and only on the 5th try did they find it. So I figured out: what if you just eat beets?

[1:17:21] Dr. Linda Bluestein: How many beets do you have to eat?

[1:17:22] Dr. Pradeep Chopra: I don't know. An ample amount of beets. You want to make really sure your stool is red. I've thought of other things — can you eat marbles?

[1:17:30] Dr. Linda Bluestein: Marbles? I don't know if that's a good idea. Maybe carrots — you could see pieces of carrots if they're not fully digested. But beets — okay.

[1:17:44] Dr. Pradeep Chopra: We'll stick with beets. The idea with marbles was that the day they come out, you can hear them and count them. If you ate 10 marbles and reached number 9 and the 10th is still in there, there's probably some slowing. But we don't recommend doing that.

[1:18:07] Dr. Linda Bluestein: No, don't eat marbles.

[1:18:08] Dr. Pradeep Chopra: Don't try that at home. Just eat beets. But you have to eat an ample amount because you want to make sure your stool is noticeably red.

[1:18:22] Dr. Linda Bluestein: And it might be helpful to track when it first starts turning red and then when it stops turning red.

[1:18:29] Dr. Pradeep Chopra: Yeah. If a week later you're still having red stool, you probably have slowing of the GI tract. It's a little home test that can be done without any lab.

[1:18:42] Dr. Linda Bluestein: That's a great hack. Can you remind us where we can find out more about what you're up to these days?

[1:18:43] Dr. Pradeep Chopra: Before that — I know time is short, but I wanted to remind people of something very important. When we were talking about the teeth: dentists love pulling out wisdom teeth. Now, if you have EDS, please wear a hard collar when you go to the dentist, because we have had cases where people developed craniocervical instability after a dental extraction or some kind of nasal surgery. This is not rare — we see it very commonly.
Even if you tell the dentist or tell the ENT surgeon, they can forget because they're busy doing whatever they're doing in your mouth or your nose. Anesthesiologists are generally good about that, I have to say, but others can forget. If I had EDS, I would put a nice firm brace around my neck and wear it, because I don't want anyone extending my neck no matter what.
[1:20:28] A good brace is a Miami J collar or a Vista Aspen collar. It has to be a hard brace. Even though you don't have CCI, you don't want to get CCI.

[1:20:42] Dr. Linda Bluestein: And are you suggesting they wear it for the actual procedure — the whole thing?

[1:20:47] Dr. Pradeep Chopra: Yes, the actual procedure. I've seen so many people develop CCI after a tooth extraction or something like that. It's very alarming.
[1:21:00] The reason that came to mind is because you asked what I'm working on next. When I come across something alarming that people should know, I post it on my website — it's a blog at painri.com. And this one we are actually publishing as a paper. We have a case series of 8 patients who developed CCI after a procedure.

[1:21:33] Dr. Linda Bluestein: Is there any problem with the dentist accessing what they need with the hard collar, since it limits range of motion?

[1:21:43] Dr. Pradeep Chopra: Don't worry about that. The dentist will figure it out — they're good at taking out teeth from anybody. Because once you get CCI, they're not going to be around to deal with it. You can always lift up the upper part of your face to open your jaw, or pull down the chin strap a little bit. After all, you can eat with a brace on, so you can open your mouth adequately.
[1:22:11] But this is serious. I really think it's alarming. I did talk to one of the neurosurgeons who does a lot of this work, and he said he sees it all the time — patients who did not have CCI, went in for a procedure on the face or a dental extraction, and developed CCI afterwards.

[1:22:34] Dr. Linda Bluestein: That's awful if that happens. So we'll be looking for that paper too.

[1:22:39] Dr. Pradeep Chopra: Yeah. I have to get around to writing it. But I have the cases.

[1:22:45] Dr. Linda Bluestein: How many cases will be in that paper?

[1:22:48] Dr. Pradeep Chopra: I picked 8, but I have more. I'm trying to cut corners. Just lazy. But if 8 is not enough to convince people, I don't know what is. Do you need 200 cases?

[1:22:49] Dr. Linda Bluestein: No, 8 is a lot. So, okay. Thank you so much. It was so great to chat with you again, and I look forward to part 2 of this conversation.

[1:23:15] Dr. Pradeep Chopra: Our walk through the GI tunnel. Absolutely.

[1:23:21] Dr. Linda Bluestein: It'll be fun.

[1:23:22] Dr. Pradeep Chopra: Thank you so much for having me.

[1:24:27] Dr. Linda Bluestein: Well, that was fun — going through the first part of the GI tract, or the GI tunnel, with Dr. Chopra. I know a lot of people have symptoms in their abdomen, and so I think this is going to be really helpful for so many people. I hope you will stay tuned for part 2 of this conversation.
[1:24:43] Thank you for listening to this week's episode of the Bendy Bodies with the Hypermobility MD podcast. You can help us spread the word about joint hypermobility and related disorders by leaving a review and sharing the podcast. This really helps raise awareness about these complex conditions. If you would like to meet with me one-on-one, please check out the available options on the services page of my website at hypermobilitymd.com. You can also find me, Dr. Linda Bluestein, on Instagram, Facebook, TikTok, Twitter, or LinkedIn at Hypermobility MD. You can find Human Content, my producing team, at Human Content Pods on TikTok and Instagram. You can find full video episodes up every week on YouTube @bendybodiespodcast. To learn about the Bendy Bodies program disclaimer and ethics policy, submission verification and licensing terms, and HIPAA release terms, or to reach out with any questions, please visit bendybodiespodcast.com. Bendy Bodies Podcast is a Human Content production. Thank you for being a part of our community, and we'll catch you next time on the Bendy Bodies Podcast.