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This week we will discuss Ectoparasites.  The CDC says: "Although the term ectoparasites can broadly include blood-sucking arthropods such as mosquitoes (because they are dependent on a blood meal from a human host for their survival), this term is generally used more narrowly to refer to organisms such as ticks, fleas, lice, and mites that attach or burrow into the skin and remain there for relatively long periods of time (e.g., weeks to months). Arthropods are important in causing diseases in their own right, but are even more important as vectors, or transmitters, of many different pathogens that in turn cause tremendous morbidity and mortality from the diseases they cause.
 

Over 200 years ago Louis Pasteur was born in Dole, France. Among Pasteur's major contributions and their benefit to society, the most important is the heat treatment of foods and beverages to reduce spoilage and eliminate pathogens for consumers.
Probably the greatest achievement of Pasteur was the process that bears the name of this famous scientist who perfected the technique: pasteurization. For liquids, this process does not involve boiling the product to sterility but simply applying just enough heat (ie, par-boiling) to 50–60°C for a specified period to reduce spoilage microbes and potential pathogens. Pathogenic microbes have a lower heat tolerance than most other bacteria. Recognizing that many individuals, from the highly educated to the peasantry, were aware of the effect, it took someone like Pasteur to formalize this knowledge into specific time-temperature standards to assure consistency. 

Unpasteurized foods are sold even though they have not been treated with high temperatures. Foods that haven’t been pasteurized include: 
raw milk some artisanal cheeses some unpasteurized versions of juices and meats Many food safety concerns and a high risk of foodborne illness are associated with eating unpasteurized foods, although there may be a few benefits.
Still, evidence indicates that the health risks appear to outweigh any potential benefits in most cases.
Here are the benefits and downsides of unpasteurized food products.
Benefits of eating unpasteurized foods Unpasteurized food is more likely to retain its organoleptic properties and may sometimes have greater nutritional value. The term “organoleptic properties” refers to the food’s taste, appearance, and smell.
Exposure to high temperatures during pasteurization not only kills harmful bacteria and viruses in foods. It may also negatively affect the nutritional quality, appearance, and flavor of the food.
For instance, some research demonstrated that pasteurization reduced the protective antibodies and immune-supportive vitamin C and zinc in donor human milk. 
However, other research shows that these nutrient losses in human milk are minor and that the benefits of pasteurization are greater than the risks. 
Downsides of eating unpasteurized foods Unpasteurized foods are associated with the occurrence of foodborne illnesses from bacteria, such as Brucella, Cryptosporidium, Listeria monocytogenes, and antibiotic-resistant Staphylococcus aureus.
In particular, scientific literature frequently mentions that unpasteurized milk and dairy products are particularly high risk foods and common causes of these foodborne illnesses. 
These bacterial infections may last from days to weeks. Effects range from mild symptoms — like fever, diarrhea, vomiting, muscle aches, abdominal pain, and poor appetite — to severe outcomes like miscarriage and even death. 
Unpasteurized foods present even greater health risks and are more dangerous to people with compromised immune systems, such as older adults, pregnant people, young children, and those with health conditions like cancer.
Summary Unpasteurized foods are slightly more likely to retain natural tastes, appearances, flavors, and nutrients, but they are strongly associated with foodborne illnesses. Evidence indicates that the risks of consuming unpasteurized foods greatly outweigh the benefits, especially for immune-compromised people.  (CREDITS)

In this episode we are talking again with our audio editor Jack Scaro.  The topic again is: spontaneous pneumothorax, or collapsed lung.
Spontaneous pneumothorax is an abnormal condition of the lung characterized by the collection of gas in the pleural space between the lungs and the chest wall. This condition occurs without an obvious etiology and can be classified as either primary or secondary. Patients may present with symptoms such as tachycardia and dyspnea. The diagnosis is based on clinical suspicion and can be confirmed with imaging. 
Jack had this condition which surprised everyone since he was a healthy 20 year old with no risk factors except.... you'll have to listen to this week's episode to find out what it is and whether you or a loved one could be at risk!

This week we will continue our coverage of Bile acid malabsorption (BAM),  a gastrointestinal disease. It’s a common cause of chronic diarrhea. When bile acids aren’t properly absorbed in your intestines, they build up, upsetting the chemical balance inside. Excess bile acids trigger your colon to secrete extra water, leading to watery stools.
This week we will continue our coverage of Bile acid malabsorption (BAM),  a gastrointestinal disease. It’s a common cause of chronic diarrhea. When bile acids aren’t properly absorbed in your intestines, they build up, upsetting the chemical balance inside. Excess bile acids trigger your colon to secrete extra water, leading to watery stools.
Bile acid malabsorption (BAM) is often misdiagnosed as Irritable Bowel Syndrome or is overlooked in individuals with Crohn’s disease.
Bile Acid Malabsorption happens when the small intestine is unable to direct bile acid back to the liver. This means that the body doesn’t absorb water properly and affects digestion. The condition results in what is known as Bile Acid Diarrhoea.
How will a new test for Bile Acid Malabsorption be developed?
Currently, the only test for bile acid malabsorption is the SeHCAT test which is expensive, time consuming and uses radiation.
The team have developed a test which they believe will diagnose the condition more rapidly and cost effectively than the current test. For its initial testing phase, it will be used on stool (poo) samples, and in its second phase the research team will assess whether it can also guide treatment decisions on what dose should be given to individual patients.
The aim of the study is to establish a better test for BAM, do the groundwork for a future study of the role of faecal bile acid measurements within the NHS, and use the data collected from this trial to prepare other studies to assist with the diagnosis and treatment of individuals with BAM.
Why diagnose bile acid malabsorption? Chronic diarrhea is one of the most common reasons why people get referred to specialist gastroenterology clinics, and can account for as many as 1 in 20 referrals. Bile acid malabsorption is a major cause of chronic diarrhoea and is thought to affect up to 1 million people in the UK.
As well as individuals with Crohn’s disease, as many as one in three people diagnosed with IBS with diarrhoea (IBS-D) may actually be experiencing BAM but the current gold standard SeCHAT test is only available in certain UK centres. It is also time consuming and costly.
In 2012 the National Institute for Health and Care Excellence’s Diagnostic Advisory Group concluded that a new test for the diagnosis of BAM was needed. (credits: Diagnosing bile acid malabsorption - Bowel Research UK :Bowel Research UK )
 
 

This week we will discuss Bile acid malabsorption (BAM),  a gastrointestinal disease. It’s a common cause of chronic diarrhea. When bile acids aren’t properly absorbed in your intestines, they build up, upsetting the chemical balance inside. Excess bile acids trigger your colon to secrete extra water, leading to watery stools.
​
What are bile acids? Bile is a substance your liver makes while filtering your blood. Your liver sorts waste products, such as toxins, dead blood cells and excess cholesterol into bile. Bile acids come from synthesizing these products together. The different acids in bile help to stabilize the lipids in the mix and keep them in a liquid form.
Your liver sends bile through your bile ducts to your small intestine to help with digestion. Bile acids in your small intestine help break down fats for absorption. When that work is done, they are supposed to be reabsorbed themselves, returning to your circulation and then your liver to be recycled into bile again.
​
What is malabsorption? Malabsorption is any failure of your intestines to absorb all of the chemicals they’re meant to. Malabsorption can be a problem with your intestines themselves, or it may result from a chemical imbalance. For example, you may have too much or too little of a certain chemical for your intestines to absorb.
​
Who does bile acid malabsorption affect? BAM has been historically underdiagnosed due to a lack of accessible ways to test for it. But studies now show that at least 30% of those diagnosed with functional diarrhea disorders may have BAM. Functional disorders are those that have no apparent cause and are likely to go undetected during a medical examination, such as irritable bowel syndrome (IBS).
BAM is seen in people with conditions such as:
Microscopic colitis.
Crohn disease.
HIV-related enteritis.
Diarrhea that persists after a bacterial infection.
Exocrine pancreatic insufficiency.
It can also happen in people who receive certain medical treatments including:
Surgical bypass or resection of the ileum, the last section of the small intestine.
Gallbladder removal (cholecystectomy).
Radiation therapy, especially in the abdominal-pelvic region.
Chemotherapy.
Metformin, a treatment for type 2 diabetes.
​
What are the symptoms of bile acid malabsorption? Typical symptoms include:
Watery diarrhea.
Frequent bowel movements.
Painful stomach cramps.
Urgency and difficulty holding bowel movements in.
Some people also have:
Abdominal bloating.
Gas and gas pain.
Steatorrhea (fatty stools.)
Indigestion.
Long-term symptoms can include:
Dehydration.
Fatigue.
Headaches.
Dizziness.
Nausea.
Weight gain.
Weight loss.
About half of people have constant symptoms, and the other half only report occasional symptoms.
What causes bile acid diarrhea? The symptoms of bile acid malabsorption — primarily, bile acid diarrhea, or BAD — result from the buildup of bile acids in your colon, where food waste turns to poop. Normally, 95% of the bile acids in your small intestine are reabsorbed in the last segment (the ileum) before passing on to your colon.
When too many are left over, however, they pass into your large intestine with the rest of the waste. Bile acids in your colon irritate the mucous lining, triggering it to secrete extra fluid and speeding up the muscle contractions that move poop along. This causes frequent, urgent diarrhea and cramping.
What causes bile acid malabsorption? What causes bile acids to build up in your intestines is another question.
Researchers have classified the possible causes of BAM into four different types. Sometimes they classify BAM as either primary or secondary.
​Primary BAM is caused by your liver overproducing bile acids (types 2 and 4.)
​Secondary BAM is caused by damage to your small intestine due to disease, surgery or radiation treatment (types 1 and 3.)
Type

This week we will discuss a Veteran's hesitancy to receive healthcare at the government hospital system known as Veterans Administration or "VA".  Although many veterans may share the concern over receiving care through a government agency due to the medical care they got while in training or active duty; i.e. sucrettes and tylenol being the standard of care when Jean Marie and I were in training. Our guest, Mark Frerichs, has different reasons to question the quality of care. Mark, a Navy veteran who continued working as a contractor post-war in Afghanistan.  It was during his work after the war that created a hesitancy in trusting anything related to the government.  
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Mark Randall Frerichs (born July 13, 1962) is an American civil engineer and former US Navy diver who disappeared in Afghanistan in January 2020 and was later confirmed to be captured by the Haqqani network, a group closely aligned with the Taliban. In September 2022, Frerichs was released by the Taliban-led government of the Islamic Emirate of Afghanistan in exchange for Bashir Noorzai.
Frerichs is a director of International Logistical Support whose work had led him to visit Afghanistan multiple times since 2012.  He served in the United States Navy as a diver.
​https://www.tiktok.com/t/ZTLL8pHkA/ 

https://www.tiktok.com/t/ZTLL8aDP6/ 
Frerichs disappeared in Kabul, Afghanistan, on January 31, 2020. The Associated Press reported that US intelligence officials tracked Frerichs's cell phone and raided a village near where he disappeared, approximately a week after his disappearance. Although they rounded up individuals from that village, the raid proved unproductive. The next month, Newsweek magazine reported that officials had confirmed that Frerichs had been taken captive by the Haqqani network, a group closely aligned with the Taliban.
Frerichs's sister, Charlene Cakora, questioned why the US government "signed a peace deal" with the Taliban in early February 2020 that did not include a provision for releasing her brother. The Federal Bureau of Investigation, the lead agency of the Hostage Recovery Fusion Cell, issued a statement saying the cell was working to ensure "that Mark Frerichs and all Americans held hostage abroad are returned home."
On May 10, 2020, the FBI offered a $1-million reward for information that helps lead to Frerichs's release or rescue. In addition, the Rewards for Justice Program offered a $5-million reward for information leading to his location. That same day, Taliban spokesmen asserted that they had conducted an inquiry of their subordinate and associated groups and confirmed they were not holding Frerichs.
​The New York Times reported Frerichs was still a captive on November 21, 2020, when Secretary of State Mike Pompeo traveled to Afghanistan to personally participate in peace negotiations with the Taliban. They reported it was unknown whether Pompeo raised Frerichs's captivity as an issue during the talks.
​On April 1, 2022, a video was released showing Frerichs pleading for help. Following the release of Safi Rauf, an American aid worker who was held captive by the Taliban between December 2021 and April 2022, the US State Department began an attempted inquiry into the release of Frerichs. The inquiry did not result in substantial headway in brokering Frerichs' release. Frerichs's family was a part of the Bring Our Families Home campaign.
​On September 19, 2022, Taliban Foreign Minister Amir Khan Muttaqi told reporters in Kabul that his government and a US delegation swapped prisoners at the Afghan capital's airport. Frerichs was exchanged for Bashir Noorzai. (credits: Mark Frerichs - Wikipedia)