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Summary
In this Care Lab episode, Dr. Lawrence Schiller, a gastroenterologist, explores the link between gut health and Parkinson’s disease. He discusses how the gut’s nervous system functions, the potential role of the microbiome, and the theory that Parkinson’s may begin in the gut before affecting the brain. The conversation also highlights common gastrointestinal issues in Parkinson’s patients, such as constipation and swallowing difficulties, and stresses the importance of early diagnosis and proactive healthcare engagement.
Key Takeaway
- Gut and Parkinson’s Connection – Emerging research suggests that Parkinson’s disease may originate in the gut decades before neurological symptoms appear, potentially spreading to the brain through the vagus nerve.
- The Gut as a Second Brain – The gut has its own complex nervous system, capable of functioning independently, with as many nerve cells as the spinal cord.
- Common GI Symptoms in Parkinson’s – Patients frequently experience constipation and difficulty swallowing due to impaired muscle function, requiring proactive management.
- Probiotics and Gut Health – While probiotics are widely marketed, scientific evidence on their effectiveness is still limited, and they are not regulated by the FDA in the U.S.
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Patient Advocacy Matters – Patients should actively communicate with their doctors, report ongoing issues, and seek specialized care (e.g., gastroenterologists, speech therapists) to improve their quality of life.
Transcript
Brandy Archie, OTD, OTR/L
Hi everybody, welcome to Care Lab.
Emilia Bourland
Hi, welcome. We have a really, really wonderful guest here today. We have Dr. Okay, sorry, I'm gonna start over again. Just starting to, Brandy, would you just start that over so that, let's start the whole thing over so Malik has an easier time.
Brandy Archie, OTD, OTR/L
Let's start the whole thing over.
Lawrence Schiller
Yeah.
Brandy Archie, OTD, OTR/L
Okay.
Lawrence Schiller
Thank
Brandy Archie, OTD, OTR/L
Welcome to Care Lab.
Emilia Bourland
Hi, welcome. We have such a fantastic guest here today. We have Dr. Lawrence Schiller. He is a gastroenterologist at Baylor University Medical Center in Dallas. If you are a local Dallas folk, that is also known as Bumsy or Big Baylor, shout out to Dallas. He's a clinical professor at the Department of Medical Education at Texas A College of Medicine on the Dallas campus, the chair of the Institutional Review Boards for Human Subject Protection at Baylor Scott and White Research Institute in Dallas.
and he is an incredible speaker and educator as well. We're so, so happy to have you on today. Dr. Schiller, thank you for being here on CareLab.
Lawrence Schiller
My pleasure, Amelia. Thank you for having me.
Brandy Archie, OTD, OTR/L
So we're here to talk about what we do and why that's important for others. But at this moment though, I want to talk about what we don't do. So my question to everybody is, what would be a medical specialty that you would swap jobs with today? If you couldn't be an OT, if you couldn't be a gastroenterologist, what would be the other medical profession specialty you would do?
Lawrence Schiller
Well, I would probably be a radiologist if I had the gumption to do all that training because that strikes me as a very useful part of medicine and it's very exciting technologically. It's a long period of training for that.
Emilia Bourland
Well, that's.
That's it. First of all, that's a really good answer. Brandy, this is such a hard question. I'm kind of mad at you right now. my gosh. You know what? There are so many aspects of medicine and just caring for other people that I think are really, really fascinating. And there are so many professions.
Lawrence Schiller
You
Brandy Archie, OTD, OTR/L
That's good. I'm good with that.
Lawrence Schiller
Hahaha.
Emilia Bourland
in medicine and healthcare that are really, really valuable as well. I think that if I weren't an OT, would be an OB-GYN actually. I've always thought like so fascinating everything about it and like the ability to be part of the moment when life comes into the world is just like, wow, that would be.
Brandy Archie, OTD, OTR/L
Ooh, interesting.
Emilia Bourland
would be incredible. So I think that would be my answer, at least right now. What about you?
Brandy Archie, OTD, OTR/L
soul.
I'm gonna let it of the way.
Emilia Bourland
I'm a here. Can you hear me?
Brandy Archie, OTD, OTR/L
Okay. You're back. I marked it. Sure, we're good. Okay, but here's my question though. My question though is, yeah, she might be here for the beginning of somebody's birth, but you also might be there for the end of a woman's ability to produce a kid, like for hysterectomies and stuff.
Emilia Bourland
Okay, am I back? Okay, great.
Emilia Bourland
That's true. That's yeah, that's true. mean, I think first of all, I would say that the value of a woman's life is not measured in whether or not she can produce a child. And so and so, you know, for me, like if someone has that, that's like a personal thing. If someone has to have a hysterectomy or if someone is like making whatever choices, then that, you know, to me, that's all just a part of health care. So I guess I don't, you know,
Brandy Archie, OTD, OTR/L
Totally.
Emilia Bourland
That doesn't feel necessarily like a downer part of that job for me. But I just think that like, I just think all that stuff and how it works is crazy fascinating. It is insane. It's insane actually, if you think about it. Yeah.
Brandy Archie, OTD, OTR/L
It is. It is. It is. That's so true. Mine would be a PCP actually. I'd be a primary care doc.
Emilia Bourland
You'd be really good PCP.
Lawrence Schiller
Okay.
Brandy Archie, OTD, OTR/L
Thank you. Listen, the reason I didn't go to medical is I didn't want to learn how to do surgery. I never wanted to have that level of life in my hands. But I like the quarterbacking of organizing everything and making sure everybody's getting what they need. And I know it's a thankless job. But yeah, that's what I would do. I'd be a PCP, geriatric PCP at that.
Emilia Bourland
Yep, you'd be great at that. Okay, so we could wax philosophical probably all day long about this kind of thing, but we have Dr. Lauren Schiller here to talk about some real stuff. And particularly, we're gonna be talking about the gut and Parkinson's disease today, which is a really fascinating and way more involved topic than I think
Lawrence Schiller
You're kidding, man.
Brandy Archie, OTD, OTR/L
Let's talk about some truth.
Emilia Bourland
we have known in the past. you know, I'm wondering if you would just start by talking about like maybe generally how is Parkinson's disease related to the gut either symptomatically or in terms of disease process? Can you speak a little bit about that just to get started?
Lawrence Schiller
Sure. Well, there's a lot of fascinating things going on in this area as well. Just as you were excited about the physiology and whatever of OB-GYN in Parkinson's disease, there's a lot of interest in this area right now because one of the theories that's coming to bear is that the disease may actually start in the gut and affect the nerves there and then travel into the brain.
So that's a very exciting theory, but in real life, what we deal with are patients who have problems and lots of patients with Parkinson's disease have issues with their gut, with symptoms like constipation or trouble swallowing, what have you. And that can really decrease the quality of life. And the good news is that we often have things that we can do to help with those symptoms so that people can have a
more rewarding life within limitations that the disease presents.
Brandy Archie, OTD, OTR/L
When you say like that, it's like, of course it has so many effects there. Because you know, what's happening with Parkinson's is slowing the connection from the brain to the muscles acting. And so we think about the muscles that control our legs and our shuffling gait and our hands and our tremors, but our bowels and our stomach and our ability to swallow are all controlled by muscles too. So if those are also being slowed down, it makes total sense that that would be impacted and something that I probably have never talked about with a-
patients who have had Parkinson's.
Lawrence Schiller
Yeah, well, there are different sorts of muscles in the gut than out in the arms and legs and the rest of the body. The gut has smooth muscle and the rest of the body has skeletal muscle. And the regulation of the muscle and the action of the muscle is different. And Parkinson's was recognized always by those symptoms you mentioned with the problems with the gait and difficulty with tremor. And as a result of that,
For the last 200 years, it's been focused on that part of the nervous system. So we have a lot of information about how the brain works or doesn't work right in Parkinson's disease and how it affects the skeletal muscle function. What we're finding out though is that many of the GI symptoms where sometimes the smooth muscle is affected are in fact also related to the Parkinson's disease and not just some.
incidental thing that's due to the medicines we use to treat the Parkinson's or to other problems the person may be having. So it's really been a turnabout. We have to start thinking about Parkinson's as being a total system disease, not just the central nervous system, but also the peripheral nerves and the nerves in the gut, which are a very special part of the nervous system.
Emilia Bourland
Can you talk a little bit more about the nervous system of the gut? So full disclosure, everyone, I became aware of Dr. Schiller because I attended a really fantastic talk that he gave. So I got to learn about some of this during the talk. the information that you shared about the nervous system in the gut was first, really new to me, and second, like mind blowing in the way that I have
thought about the gut and gut health since then. Can you tell our audience a little bit about that?
Lawrence Schiller
Sure. Well, we always used to think about the nervous system, the gut as being a branch of what's called the autonomic nervous system, where the nerve cells are in the brain stem. They extend down to the gut and have ganglia, little collections of nerve cells that they interact with that then go on to innervate the organs. And it really is maybe 40, 50 years ago now. We started to change that notion. For one thing,
The number of connections between the brain and the gut, for instance, through the vagus nerve, which runs from your brainstem down to the abdomen. There are many more nerve cells in the gut than there are nerves going to the gut. So it's not a telegraph system where you're going one-to-one, where the brain nerve is running one set of neurons down the gut.
And instead, what we're now thinking of the gut nervous system is being a little brain. It has nerves that are sensory nerves that detect what's going on in the gut, what kind of food you ate, how much you ate. And then it has what are called interneurons that connected to the motor nerves that make the organ move and function, secreting juices and moving things down through the gut. And that's a very complex system.
that's really quite fascinating in terms of its complexity. In fact, you can cut all the connections from the brain down to the gut and it still works fairly well. For instance, we do intestinal transplants now where we take the intestines from someone who's passed on and give it to someone who doesn't have intestines that work well enough. And even though there are no nerve connections, it works pretty well. So,
Brandy Archie, OTD, OTR/L
Huh.
Lawrence Schiller
The gut is a little brain. The number of cells, nerve cells in the intestine is about the same as the number in your spinal cord. So it's really a tremendous number of nerves that really regulate a lot of the system. And we're learning also that some of the hormones that we know work the gut and react to when we eat a meal. For instance, there's a hormone called cholecystokine and it's released from the upper intestine.
when you eat proteins or fat. That doesn't work directly on the pancreas cells. What it does instead is work on the vagus nerve endings and then those nerves work the pancreas to make it secrete fluid to digest the meal. So it's become a very interesting area of investigation and we've learned a lot about it. Scientists have mapped out pretty much all the connections that we know of down there in terms of
what kind of nerve goes to which part of the gut and what chemicals those nerves use to cause the actions that we see in the intestine. So it's really quite fascinating. And I think that that's been a major advance that's occurred in the last 40 or 50 years that really has improved our understanding of how things work in the intestine.
Brandy Archie, OTD, OTR/L
That is so interesting. with that like new knowledge, relatively new knowledge, and maybe this is a really bad analogy. So correct me if I'm wrong. But when I think about my brain and the fact that I can take in information, process it, output different things, and we do things to modulate that. We go to school, we learn things, we do that on purpose because we know our brains have that function. If it's a little mini brain in our gut happening, do we have some control over
what we could be doing to make it better or to affect some kind of change because we feel gassy or something else going on in our body. Are there some levers that we can pull as individuals to help ourselves?
Lawrence Schiller
Well, probably so, but it's not been explored in great detail. We know, for instance, that you can learn how to regulate your lower esophageal sphincter, and you can be hypnotized and affect the pressure there. You can change some of the other functions. Most of what we do now is sort of indirect. So, for instance, if you're constipated, we don't say, think about your gut and making it move because we don't have a direct...
Brandy Archie, OTD, OTR/L
Mmm.
Lawrence Schiller
the connection there that we can exploit. Right, right, exactly. Right, right. But in fact, you can modify your diet some and change your fiber and things like that. And that can modify the gut function secondarily. So we do have a lot of things we can do to help control gut function, but they're mainly indirect right now. For the most part, what we do is try and manage symptoms when
Emilia Bourland
Think peristalsis. Think peristalsis.
Brandy Archie, OTD, OTR/L
Ha ha ha ha!
Lawrence Schiller
this whole system doesn't work really well. And that can involve a lot of self-actualization in your brain and learning to live with things and not catastrophizing every time you have a cramp or a belly ache. And that can be very important in making your life better. But that direct connection that you suggest like, you know, going to the gym and working out and getting stronger, we don't have quite that connection just yet.
Emilia Bourland
little gut barbells that you can, maybe someday, maybe someday.
Lawrence Schiller
That's right. Exactly. Maybe someday. I mean, it's really amazing the things that we're learning about that connected system. And we're learning about things in the other direction too. mean, for instance, the vagus nerve that I mentioned, most of the nerves and most of the nerve fibers in that nerve, there are about a hundred thousand of them. 90 % of them are nerves that are going up to the brain.
and sending messages from the gut up to the brain telling it what's going on down in the gut and what to be ready for. And there's a very fascinating area of vagal nerve stimulation now that's being explored for treating things as diverse as rehabilitation after a stroke. If you stimulate the vagus nerve while you're doing exercises, that can sometimes help with regaining function. And then also even more strangely, but amazingly,
Brandy Archie, OTD, OTR/L
Mm-hmm.
Lawrence Schiller
Things like depression, vagal nerve stimulation may have a role in mediating depression and improving it some people. So there are lots of things yet to learn about how the nervous system works. It's a very complex system, especially when you get up into the brain. The gut system is simple in comparison. It has far fewer nerves, far fewer connections, but the brain is a whole largely unexplored area right now.
Emilia Bourland
This is all just like so fascinating to me. And I think that one of the things that I'm always delighted by, and then I promise I'll get to a question. One of the things that I'm always delighted by in learning about different ways that the body works is actually how much we are still learning. And it really is still like this open frontier. We feel like we know a lot, right?
Brandy Archie, OTD, OTR/L
Yeah.
Lawrence Schiller
Okay.
Brandy Archie, OTD, OTR/L
Mm-hmm.
Emilia Bourland
But the deeper we dive into, like externally, it seems like we know a lot, but the deeper we dive into it, the more we realize that there's so much more that we don't know. And to me, that's really exciting because that means that as we learn more, we have way more opportunities to help people and help people to live longer, better, healthier lives that are high quality of life too. And that's just like.
Lawrence Schiller
Yeah, true.
Emilia Bourland
I mean, I don't know what I'm doing on this planet if that's not the goal here, right?
Lawrence Schiller
Yeah, no, I think it's an excellent point. And I think the other interesting thing is that as we develop more understanding of things and technology advances, we're able to do much more in terms of understanding the basic processes and how they go wrong in people who have problems.
Emilia Bourland
So kind of getting back to the topic at hand, those common like gut symptoms that we see in folks with Parkinson's disease, constipation is like the primary one that often comes to mind, but there are other symptoms that people can have as well related to the gut and Parkinson's disease. Can you talk a little bit about that?
Lawrence Schiller
sure. Well, one of the other real common problems that people have with Parkinson's disease is trouble swallowing. And most of that is sort of easy to understand conceptually because the muscles that control swallowing up in your mouth and throat and the upper part of the esophagus are skeletal muscles, just like the ones that aren't working quite right in the rest of the body and your arms and legs.
The swallowing process depends on a lot of coordination. And so if the muscle is not behaving properly, you get discoordination and things can get messed up in the sense that we have a basic design flaw and that our airway crosses our foodway in the throat. And so if material is misdirected while you're swallowing, it can go down your airway and cause problems like pneumonia or asthma, things like that.
So, it can have serious consequences too. The biggest consequence of trouble swallowing though is that people eat less. If you had trouble doing something all the time, you try and avoid it. Well, eating is sort of important to keep you healthy and to keep the rest of your body functioning. So, that becomes a big issue for quality of life for people with Parkinson's disease. And the medicines we use to treat the dopamine deficiency in the brain
Emilia Bourland
Mm-hmm.
Lawrence Schiller
help with swallowing to some extent, but not completely always. And we have to depend on speech and language therapists to help us give people ways of being more mindful about what they're doing when they swallow so that they can do it better. Now, most of us, swallowing is just sort of an ingrained process. You put food in your mouth, you know, think a whole lot about chewing it. You just sort of do it. And then
Your body seemingly automatically swallows it when it wants to, but all that's under control of your brain. And when that control is lacking, you can have problems. And I think the speech and language therapists help us out a great deal by bringing that to new consciousness. What am I doing now? How am I going to swallow this? How am I going to make sure that that gets done as effectively as it can be?
The therapy really depends on improving your mindfulness of what you're doing. And that's really important. So that's another problem that people have. And depends who you ask. If you just ask somebody with Parkinson's disease, do you have trouble swallowing? Maybe 10 or 20 percent of them will say yes. But if you go into it more deeply,
easily more than half of the people have some difficulties at times. And the same is true with constipation. If you ask about it, you know, 80 % of people with Parkinson's disease have problems with constipation. And that sometimes is a side effect of the medicine because the medicines we use to improve the dopamine levels in the brain also have an effect elsewhere in the body and
and the effect of dopamine in the colon is to slow down its movement. it tends to be a constipating drug. you know, it may be some of this neurologic dysfunction as well.
Brandy Archie, OTD, OTR/L
So I hear a lot about the gut microbiome and prebiotics and probiotics. And frankly, I'm like not necessarily clean and clear on like what we should be doing and how that impacts how our bodies feel and function. Can you dive into that a little bit?
Lawrence Schiller
Well, you and I share that lack of knowledge about what is good about these things. They've been studied some for years, but in large part, we don't really know what we're talking about when we talk about these things. There are concepts we have that are useful. for one, feel that they do good things for some people. But if you show me two germs, like you had a police lineup or something and
Here's five different germs, pick the germ that's the good germ. I couldn't do it for you because we don't understand what makes a good germ. We know there are bad germs, pathogenic germs, things that cause plague and cholera and things like that. And we know they're bad because they largely make toxins that disturb body function.
these good germs don't have something equivalent, a good equivalent to a toxin that we can identify. They seem to have their good effects by altering the environment in the gut, by metabolizing different food products differently, by affecting other organisms, and changing how they're living in the gut. And that somehow produces an improvement in symptoms.
But all that is somewhat hypothetical. The other thing is that, at least in the US, these aren't regulated items. So that they never have to go in front of the FDA and prove their claims. They're sold as food supplements and regulated at a much lower level. We think of probiotics as being live organisms that, when consumed, have good health benefits.
Brandy Archie, OTD, OTR/L
Mm.
Lawrence Schiller
It's an easy definition, but it's just hard to predict what germ will be good or bad. And so most of it's just arbitrary. For instance, one of the germs that sold was discovered back in World War I in somebody's poop. And that person did not get the dysentery that other people got. And so they have cultured that organism for 100 years now.
and it's still sold in some products as being a probiotic organism. But we couldn't identify it a priori and say, this is going to be a good germ or not. So that's true for most of these items that are out there. And the other problem you run into is when you go to the drugstore or the supermarket and see the shelves full of these things, not all of those organisms are alive.
You know, they may have been sitting in the bottle too long. And you just don't know what you're getting necessarily. So if you're going to use probiotics to try and help out, make sure it's one that has some scientific basis for using the agent and that when you get it at the store, it's going to be a live product and not just a bunch of dead organisms that you're ingesting.
Brandy Archie, OTD, OTR/L
So how do we know if the probiotic has some level of research behind it or since it's not regulated or anything like that, how would you know?
Lawrence Schiller
Yeah, no. Yeah, well, you have to look it up and rely on some of the claims that you'll see on the internet, for instance. You can Google the Asians, see what they have, and some of them will have more science behind them. They'll tell you that, you know, they're analyzed and 98 % of the organisms are alive and whatever. Some of them are maintained in cold chains. They're like in the refrigerated section rather than just sitting on the shelf.
Those may be more substantial. But basically, you want to go and look for items that have some evidence behind their use. It's really a bad situation if you look at the official positions of the two large gastroenterology societies, the American Gastroenterological Association and the American College of Gastroenterology.
Brandy Archie, OTD, OTR/L
Mm-hmm.
Lawrence Schiller
says there's not enough evidence to make any decision. And ACG says that, maybe there is some modest evidence for some of them. So it's not an overwhelming endorsement by the organizations that sort of rely on to look at the information and make an assessment. So it's pretty much out there right now as to how good these things are. But personally, I've seen patients that do better with them.
and I've recommended them to patients at times, particularly after you've been on antibiotics for a while and may have disturbed the germs down in your gut. It may make some sense to be on a probiotic for at least a little bit to try and get things back to a more normal thing. again, it's an area of great interest. Almost every other paper it seems that you read in the literature is about the microbiota and its effect on this or that.
And it may have a really important role to play. It most likely does. But we're just very early in our understanding about these things, even though they've been around for 100 years.
Emilia Bourland
That's so interesting. I think it's so hard as a consumer. Sometimes when you like, we all want to do things that are good for our health. It seems like a really easy thing to do to go out and, you know, buy a supplement or a probiotic or something like that. And it says it's going to do something good for you, but to your point, you don't really know. Do you think that, do you think that people's best course is to have a conversation with
with their doctor, with their gastroenterologist, with their primary care doctor, and just like at least have some kind of vetting process on that.
Lawrence Schiller
Well, I wish I could tell you that's a great idea. in the, well, in the five or six minutes they have to talk with you, they just don't have a lot of knowledge about this. I mean, they're in the same condition as the rest of us, by and large. There's a lack of good evidence. the Congress changed the law a few years back to say that as long as they didn't make a specific health claim,
Emilia Bourland
It's hard, right?
Emilia Bourland
Mm.
Lawrence Schiller
these things could be marketed, they would not have to pass FTA muster. That's the situation we're in. Now, in Europe, they're a little tighter about this. And so, they have some products on the market that have been vetted to some extent. But even there, the evidence base is not that great. There's small studies, a few dozen people, and it's not enough to really base.
medical decisions on, but it's the best we have available.
Brandy Archie, OTD, OTR/L
Mm.
Emilia Bourland
So if someone, I'm gonna steer the conversation a little bit differently now. If someone is having gastrointestinal symptoms as a result of Parkinson's, or I really suppose anything, but thinking about Parkinson's here today, is the fact that we know that these things can happen commonly with Parkinson's disease, that doesn't necessarily mean that people should just accept it and like.
hope for the best, right? There are things that we can do. So at what point when someone is noticing that there's constipation or they're concerned that there might be trouble swallowing, like when is the best time for people to seek intervention for these things?
Lawrence Schiller
Well, certainly as soon as they recognize that, that sort of problem. And I think the big hope of the various groups like the Parkinson's Society and whatever is that people by educating the fact that these symptoms do occur, it's not just an incidental problem they happen to have, that they will bring it up to their doctors early on. Doctors can be helpful in dealing with the symptoms because we have a huge base for dealing with
symptoms in other people. For constipation, know, about 30 % of the population has problems with constipation at one time or another, which is an enormous number when you think about it. And we have lots of medicines that can help with that problem and lots of interventions that we can do to better understand it. You know, for instance, about a quarter of people with constipation have problems opening up the muscles
down around the anus to let the stool out. And that sort of outlet obstruction is something that can be dealt with with therapy. There are physical therapists that specialize in pelvic floor problems and that can make a huge difference if you have chronic constipation that's due to that. And so that's something that can be explored with diagnostic tests. And if you have that, a therapist can help you out with that.
that problem. If you have trouble swallowing, we have lots of different tests that are available to try and see how those muscles are working. And it's not always the problem with the skeletal muscles in the upper esophagus and throat. It may be a problem in the smooth muscle of the esophagus or a narrow spot in the esophagus due to reflux disease and formation of a narrow spot of stricture. So
So there ways of investigating these things and the best way of dealing with them is to let your doctor know about them early. Don't just put up with things, you know, ask about them and they can get you to someone who can investigate and get you on the proper treatment. So those things are important to recognize. And again, I think my big takeaway message for listeners to this program would be if you're having GI symptoms, talk to your doctor.
Lawrence Schiller
talk to a gastroenterologist about the problems, who as often we can help out. And that can make a big difference in your life.
Brandy Archie, OTD, OTR/L
So that's my question to follow up to that is, let's say I am having some of those gut problems and I go to my primary care doctor and because there's so many other reasons you can have gut problems and look at your med list and I'm like, okay, well, constipation is a side effect of like five of these drugs and doesn't further us on to see a gastroenterologist.
Lawrence Schiller
Bye.
Brandy Archie, OTD, OTR/L
I guess what would be your advice to somebody who was at that point? Like, should they, I'm not saying they shouldn't take their advice to the PCP. I guess I'm saying like, how do you know if this is like a symptom, a side effect of something you're taking or if it's something that you can help moderate with some other, and when do you need to elevate to a gastroenterologist?
Lawrence Schiller
Well, Brandy, in your ultra ego as a geriatric primary care doctor, you would have a lot of ways of dealing with these problems, which are really common problems in the population. And it's very likely that it won't be the first time your doctor's heard about constipation, even that day. So they'll have ways of dealing with it. And most of those work pretty well. You know, some simple laxatives may be all you need.
Brandy Archie, OTD, OTR/L
Ha ha ha.
Brandy Archie, OTD, OTR/L
Yeah.
Lawrence Schiller
And that may be something they're very comfortable providing to you. What the good primary care doctor will do is think about the problem that you're describing and decide whether there needs to be more diagnosis to it. There may be some warning signals. Maybe if your constipated you had weight loss or had some bleeding, some problem like that. Then they would say, well, you know, we need to do more testing and make sure this isn't something important.
But if it's just that you're not moving your bowels regularly, they'll give you some advice about maybe increasing fiber in your diet. That's a common thing. Using simple, safe type laxatives on an intermittent basis to try and help with the problem and see how that does. That's perfectly fine. And I think that's a good place to start. The thing is that if that doesn't work, don't get disappointed.
and say, well, he doesn't know anything about that. I won't mention it ever again. When you go back to see the doctor, tell him this isn't working. And that's usually a warning signal to the primary care doctor. They probably should get a consultation for you. So I think that's really the scheme that I would follow. And the same is true. I mean, there's nothing special about the primary care doctor in the situation. A gastroenterologist you see for constipation just as an independent problem without
Brandy Archie, OTD, OTR/L
Mm-hmm.
Lawrence Schiller
Morning signals will do the same thing. And you have to be prepared to say, well, this isn't working. you know, can you help further? And then they'll start thinking about doing some of the other tests or things that may be useful. So, medicine is a partnership these days. We rely on patients to report symptoms. Sometimes we ask them about them, know, sort of expectantly, you know, they're one of medicine that's constipating.
We'll ask them if they're getting constipated and then try and do something about it. But often it's a two-way conversation. The patient says, I'm having this problem. The doctor says, okay, yeah, let me think about it. They think about it and say, well, try this out. And you have to complete the circle. If that doesn't work, you need to let them know, I'm still having that problem. mean, none of these are necessarily life-threatening problems, but they're a nuisance problems.
Emilia Bourland
Mm-hmm.
Brandy Archie, OTD, OTR/L
Mm-hmm.
Lawrence Schiller
You don't want to have them if you can prevent them. So you want to get them dealt with. So again, let your doctor know what's going on. As smart as doctors may be, we're not people who can intuit your thoughts from just looking at you're holding your hand. So we need to get the information. So don't be shy about saying, this didn't work out.
Brandy Archie, OTD, OTR/L
Avoid it. Yeah.
Emilia Bourland
Yeah, yeah.
Brandy Archie, OTD, OTR/L
Man, we talk about a lot of topics on CareLab, but the one, if nobody gets anything else from CareLab, the one theme I hope you recognize is that you are an integral part in the healthcare and that you're, all the people in your, on your team need to hear back from you. So I appreciate you, Dr. Schiller, for saying, you know, hey, if it didn't work, don't just ignore it or not come back and say that that's a quack, you know, like come back and say that didn't work. Okay, I got step number two, let's try this, you know, and that's really important.
Lawrence Schiller
Yeah, yeah, and don't assume your doctor knows what's going on with you. I think that's the other thing. If you're having a problem, share that with them and see what their response is to that.
Brandy Archie, OTD, OTR/L
Yeah.
Emilia Bourland
Yeah, and I think having there's so much value in having real conversations with your health care providers, because the more information that we can gather that's that's relevant to that issue, the easier it is to kind of figure out what what the problem is. So I would say as like as an occupational therapist, when I first started working, I did a lot of work in skilled nursing and I treated a ton of folks who had Parkinson's disease and constipation was absolutely one of the
biggest complaints that had. So, you know, obviously I'm not the physician, I can't prescribe the meds, but I could work on them functionally to think about how we can manage those symptoms. And one of the things that came up all the time was a lot of my patients with Parkinson's disease, they weren't drinking enough water because they were having issues getting to and from the restroom and they didn't want to have to do that all the time. So sometimes, you know,
Brandy Archie, OTD, OTR/L
Mm-hmm.
Emilia Bourland
These issues come from, like are there specific things with a disease process or maybe with a medication that can interfere? But oftentimes we also have to look at this like bigger, more holistic picture of all the factors that can go into things because it's pretty rare that there's like a one step solution for problems that are incredibly complex. So again, just reiterating that conversations and being part of that care team is so, important.
if you want to get the best outcome for yourself or maybe for your loved one that you're advocating for.
Lawrence Schiller
I agree and that team idea is really important in medicine these days. You know, all of us have our own little silos and we aren't always super effective at reaching out to the other members of the care team about problems that, you know, may be more in their domain than ours. So, for instance, you know, a patient tells you, I'm constipated, you would hope that the doctor would read your note.
Emilia Bourland
Mm-hmm.
Lawrence Schiller
that would include that mention and might take some action on it. But often that's not the case with people being as busy as they are. That's exactly.
Emilia Bourland
That's why we call Dr. Schiller. That's why we say, hey, are you guys aware? Are you aware that this person is reporting constipation? Because, you know.
Brandy Archie, OTD, OTR/L
I have a car.
Lawrence Schiller
That's the point. I think that you have to be a little bit of a nuisance and pick up the phone or send the text or whatever to make sure that connections are made because it's so easy in the complicated world we live in where everyone's busy doing things on the clock to lose that thread. And that's a real loss.
Emilia Bourland
Well, I have one more question before we wrap up here and hopefully it's not too big, but I think it's one that's really interesting. You mentioned at the beginning of the episode that there is some research suggesting that maybe Parkinson's disease actually starts. It's possible that it could actually start in the gut. Are there signs or symptoms of that?
people can be aware of early on at this point, or do we just not know yet?
Lawrence Schiller
Well, it's an evolving story. So I don't want anyone to take this as gospel truth right now. But I think one of the really fascinating things is that Parkinson's, like other degenerative brain diseases, has a really long course. And what we're understanding is that the disease may actually start or be initiated maybe 20, 25 years ahead of the time.
that someone starts having a stiff gait and tremors and difficulty with activities of daily life. So it's a very long time course. And one of the theories that is attracting attention right now is that people who have disorders that disrupt the lining of the gut, there's a layer of cells that runs from your lips down to your anus that
are part of the tube that makes up the GI tract. And if that layer is damaged in some way, it doesn't have its defensive role of separating the body, the insides of the body from what's happening in the inside of the gut. And so things can penetrate through there, maybe viruses, maybe bacteria, maybe chemicals.
We don't know what exactly it is. But it seems that people who've had very common problems like reflux esophagitis, where the acid from your stomach gets back up into the esophagus and causes little sores or ulcers in the lining of the esophagus, that that break in the mucosa layer, the inner lining layer of cells,
may allow things to get into the body that then can travel up the vagus nerve to get into the brain. And they may cause problems in the gut. The neurodegeneration is not only in the brain and not only in the basal ganglia where the dopamine centers are that are so prominent in Parkinson's disease, but they may also have similar degenerative changes in the gut nerves. And that may cause
Lawrence Schiller
problems with gut function that again build up over a long period of time. This isn't some acute illness like COVID or pneumonia that you get maybe after a day or two of incubation you get sick with. This takes decades to develop. And again, we don't have all the parts of the picture put together. But it seems that some of the process of misfolding the proteins, which is the basis
for Parkinson's disease may happen in the gut decades before it happens in the brain. And then it may travel to the brain and cause difficulties there. So it's really a fascinating theory. There's a lot more work that needs to be done to substantiate it and see if there's any way of picking this up earlier, preventing it. But again, it points out the fact that...
Our bodies can have a lot going on that we're just not aware of for a long period of time. It can cause consequences later on when everything's not an acute illness.
Brandy Archie, OTD, OTR/L
Well that... I feel like I have so many more questions.
Emilia Bourland
Yeah, I know. That's why I was like, do I even ask? Because like you could, we could, craziness. We could keep going forever. Yeah.
Brandy Archie, OTD, OTR/L
We can keep going, I know. So. But I really appreciate you coming and sharing your knowledge with us and especially in such a user friendly way so that everybody can understand, you know, a thing that we probably don't hardly ever think about. So thank you for coming on show.
Lawrence Schiller
That's fine with me.
Lawrence Schiller
It's been my pleasure. Thank you for having me and good luck to all the patients and caregivers out there in dealing with these difficult issues.
Emilia Bourland
Thank you again so much for being on the show, Dr. Schiller. If you made it to the end of the episode, please make sure, take a second, subscribe, download a couple more episodes, maybe leave a comment. Maybe you have a question about something you would love us to cover on the next episode of Care Lab. Until next time, dear listener, we'll see you right here, back on Care Lab. Bye.
Brandy Archie, OTD, OTR/L
Bye everybody.
Lawrence Schiller
Bye bye.
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