Kelly McCann, MD (00:00.029)
is fine.
Kim Vopni (00:01.838)
Hi Kelly, welcome to Between Two Lips. Nice to see you and nice to have you on the show. I'm excited to chat about some different technologies and different viewpoints you have in terms of vaginal health, bladder health. You blend kind of a background. You said you were an internist and pediatrician initially, now a functional medicine doctor. And a lot of what you talk about and cover is to do with toxins.
Mass cell activation syndrome, which we were talking just before we jumped on but I'm curious to dive deeper into how this influences our pelvic health, our vaginal, vulval vaginal health, bladder health and yeah, so I'm excited for all you're going to share but let's start out first with just having you let us know who you are and what brought you to this world of health and women's health in particular and focusing on toxins.
Kelly McCann, MD (00:55.411)
Thank you, Kim. Thanks for the invitation to be on your podcast and to share with your listeners. I think this will be very valuable for all your listeners. As you said, I was trained as an internist and a pediatrician, so I got my medical degree at Tulane and then went on and did a residency program in Arizona and then subsequently studied integrative medicine, functional medicine, environmental medicine, kind of all of the things. And as I was
progressing in my practice in Southern California, I kept getting more and more complicated patients and really had to come up with more tools of how to help them. So I deal with mold and chronic infections, environmental chemicals, mass activation. And then a couple of years ago, I discovered a company called MicroGenDX and they do a kind of technology called next generation sequencing.
And over the course of my practice, there have been these game changers where my practice just elevates because of a new technology or a new supplement. And this was absolutely one of those game changers because now we could actually see what organisms were in the bladder, in the vagina and treat them. So cool.
Kim Vopni (02:19.319)
Very cool. next generation, I wrote this down to next generation sequencing. What I guess, what is it? How does the technology work?
Kelly McCann, MD (02:29.693)
Let's go back a little bit and talk about what the conventional technology is now. You have burning bladder symptoms. You think you have a UTI and you go to your doctor, they collect a urine. They look at a urinalysis, which is gonna tell us are there white blood cells, red blood cells? Do they have a couple of markers that look like it might be a UTI? If so, then we're gonna send it off for culture.
And when they do that, they literally put it on a Petri dish and they watch it grow, right? Which requires that whatever is going to grow has the food in the Petri dish to be able to grow and flourish. And then you have to have a certain number of organisms that are there that will qualify as a UTI. This technology is over a hundred years old.
What? This is our gold standard technology? That's kind of crazy. Or if you go to a gynecologist and you think you have like BV or a trichomonas or something like that, what do they do? And they're grabbing a swab out of the vagina and putting it on a slide and looking at the slide. Really? That's our gold standard these days? That's crazy. In the world of AI and all that we can do and quantum computing is right around the corner. We must have a better solution. So
Kim Vopni (03:30.336)
Yeah.
Kelly McCann, MD (03:56.627)
50 years ago, they developed what's called PCR, that's polymer chain reaction. And what they could do with PCR is create a probe of a known organism. Say I have E. coli or I have, you know, Gardnerella. And from these probes, then I could inquire, does this specimen contain this strand of DNA? And so that's great, that's much improved, but...
It only is good if you have probes for all the organisms. So if you have a hundred probes, you can look for a hundred organisms. If you don't have a probe for it, you can't find it. Next Generation Sequencing flips that on its head and says, okay, let's look for all the DNA in the specimen. This makes sense, right? And then we have a library of tens of thousands of organisms that we can match it to. And then we can really know what is actually in the specimen.
Kim Vopni (04:43.309)
Hmm.
Kelly McCann, MD (04:54.695)
whether that's a vaginal specimen, a urine specimen, men, a prostate, semen, sinuses, wound, anything. It doesn't matter what the specimen is. We can find what's in there. Super
Kim Vopni (05:09.793)
Very cool. And so how does that work then? What is a tester? Like, like, what would what would a patient experience be if they were undergoing this testing?
Kelly McCann, MD (05:20.237)
I give them a kit that they take it home and they collect it in the comfort of their own home. for women, it would be, you know, two long cotton tip swabs that they would insert into the vagina and then put in a tube. And then they would collect a urine specimen and then they would ship it off to the company in Florida. They run the test and you get your results back in about four or five days. Yeah.
Kim Vopni (05:45.9)
Wow. this, I, this is happening a lot now where there's there, there's the conventional approach to testing. go in, we would usually it's blood testing and then we go back and visit our doctor and, get our test results. And now there's a lot of stool sample testing, all sorts of blood online where people are being shipped the test kit. They then send it off. They get the results back, but we need help.
Interpreting what the results mean so we still would benefit from seeing somebody so I so you give the kit to the person they think the results come back to them or to you. Okay.
Kelly McCann, MD (06:13.447)
Yes.
Kelly McCann, MD (06:23.165)
The results come back to us, yeah, because the recommendations on the results are antibiotics, which require a prescription. And you know what, you can learn as a lay person what you're looking at, but it is a little daunting when you look at these reports the first time, because what happens is it lists out all the bacteria. It tells you,
what the percentage of the bacteria, amount of the bacteria, excuse me, was it found by PCR or next generation sequencing? And then they also separate out the fungi. So were there fungus in the specimen? And then what are the antibiotics or antifungals that are going to be, that those organisms are going to be sensitive to? So you get this bar chart of different,
Kim Vopni (07:17.623)
Got it.
Kelly McCann, MD (07:21.395)
check marks. So, you know, the, the, for example, a E coli might be sensitive to augmentin and Bactrim and phosphomycin, but it won't be sensitive to flagell, for example. And these are different antibiotic names. Yes. And so figuring that that's the job of the clinician then is to figure out
Kim Vopni (07:29.773)
Thank
Kim Vopni (07:40.405)
And those are antibiotic names. Yeah.
Kelly McCann, MD (07:49.179)
What are the antibiotics, antifungals that are going to be most useful at killing the organisms that the patient is presenting?
Kim Vopni (07:58.67)
Got it. So you reference things like UTIs. So common things you mentioned offline, we were talking about sexual pain, symptoms of UTIs could also be bacterial vaginosis. So any sort of infection of some kind can create many different symptoms. What do you see as being the most common bacteria that could be creating symptoms of UTI or pelvic pain?
Kelly McCann, MD (08:27.251)
Well, that's the thing that's amazing about this testing is that it's so many different things. It's really crazy. And some patients will have one or two bacteria and then some patients will have like 10 bacteria. I have some women whose vaginal microbiome is a list of 15 different bacteria.
Kim Vopni (08:32.503)
Wow.
Kelly McCann, MD (08:54.099)
And they may be very in very small percentages, but some of them are definitely causing a problem and maybe even the synergy of those organisms is causing a problem. So some of the symptoms that patients might present with, you know, pretty commonly like, yes, I think I am having burning pain. I'm going to the bathroom all the time. you know, patients who have interstitial cystitis,
They will often have a bacterial colony that is part of the picture, but it's just not in high enough amounts that it's gonna show up on our conventional testing. I have patients who have just urinary frequency, getting up in the middle of the night multiple times to pee, right? They don't have any symptoms of pain or dysuria, but they're...
Kim Vopni (09:36.759)
Got it.
Kelly McCann, MD (09:50.323)
they've got urinary frequency. And then with the vaginal issues, it could be vaginal pain, could be pain with sex, it could just be a bad odor, it could be a variety of different things. And what's also really interesting too is that we get bacteria in the bladder from either the colon,
Kim Vopni (10:06.401)
Mm-hmm.
Kelly McCann, MD (10:18.967)
or the vagina. And sometimes what's in the bladder is a mixture of both. You most people, when they tend to get urinary tract infections, they'll hear about E. coli. you have an E. coli infection. And we do see E. coli a lot because that's from the colon and it tends to be on the surface of what's called a biofilm. So that's a whole nother thing that we need to talk about.
but I've seen plenty of fungal infections in there as well as, bacteria from the vagina in the bladder.
Kim Vopni (10:59.351)
Okay, so let's come back to biofilm in a second. another question I have is, is this something that you are offering this? Is this common in the functional medicine space or how would people who are maybe not in your area to be able to work with you be able to find something like this?
Kelly McCann, MD (11:18.019)
there's probably other companies that are doing this now, but you can go to micro gen DX and search for providers who are on their list or contact the company and say, I'm looking to do this sort of test because I've got an issue. there a provider in my area that I can work with?
Kim Vopni (11:37.966)
Got it. OK. So you talked about the technology can identify all sorts of different bacteria. And as I understand from many other practitioners, we want predominantly lactobacillus in the vaginal microbiome. think about gut health, we want all sorts of them. But in the vagina, we really don't want a whole heck of a lot. We want more so the predominance of lactobacillus. So you're saying there are people who may present with them.
sorts of different ones and this test can help identify that which could potentially be a reason why they are dealing with symptoms that aren't being you know they're drinking more water they're not constipated they were they do the pelvic floor as they do all the other things and they're still not helping this could be a reason. Would it always require bacteria you know that is antibiotic does it always require an antibiotic are there
Kelly McCann, MD (12:17.939)
Right.
Kim Vopni (12:30.007)
herbal remedies or other ways that we can treat it or will this always be an antibiotic situation?
Kelly McCann, MD (12:36.409)
there are other herbal ways. think that the challenge with herbs is that, unless you have a very, unless the practitioner has a very deep knowledge of herbs, it's, it, it would be based on the practitioners ability to identify an organism and say, okay, this organism is susceptible to these different herbal anti-microbials. And then
We don't necessarily know about the time course either. how long is it going to take? You know, with, with antibiotics, we pretty much know, you know, the duration of time that you need to be treated. typical UTI might be seven days. I've actually found that sometimes we need to do, you know, 14 days, 21 days, depending upon, the burden of the infection and you know,
the frequency with which we want to test because, when we talk about biofilms, it'll make, make it more clear. It's rarely a one and done kind of situation. Unfortunately. we tend to have zoos of organisms and we kill some and then other ones show up and we kill some more. And then other ones show up as we're going through the biofilm layers.
I have found that the antimicrobials are the fastest way to kind of get things resolved for most people.
Kim Vopni (14:12.365)
Okay, why, before we go to biofilm, I know I keep delaying that, why would somebody be prone to these bacteria? Where would they, how would these bacteria get there in the first place and what makes somebody prone to them or not?
Kelly McCann, MD (14:31.699)
You know, those are good questions. I mean, I think there's structural issues for some people like how the perineum is all structured, whether or not somebody is post-menopausal and the nature of the tissue can really predispose somebody to having more of an issue or not. It may also have to do with
their microbiome when they were born. So what was their mom's vaginal microbiome? That's what's going to show up in their gut microbiome. you know, simple things like, hygiene over the time, over time, that can be an issue. having intercourse when, when things are uncomfortable and you know, we like to think that
We're sterile, our bladders aren't sterile. Our partner's bladders aren't sterile and we're swapping bacteria back and forth from the time we're fairly young until we're older. And then with the whole biofilm idea, I think the biofilms are like this accumulation of bacteria and fungi over time. So a younger person dealing with issues may be able to wrap things up in, you know, a handful of tests, whereas
some of my 78 year old patients or my older patients, they're doing 10, 12 repeated tests to really try and eradicate the issues.
Kim Vopni (16:11.405)
Okay, now we can talk about biofilms. I understand the term biofilm to me is something where bacteria or parasites or the intruder can hide under or hide within. Is that accurate?
Kelly McCann, MD (16:14.63)
Okay.
Kelly McCann, MD (16:26.843)
Yeah, that's pretty accurate. Think about it like a mucus layer, almost like a jello layer where once they're inside that layer, it's not just jello, it's not just mucus. There's structure there. There are proteins and structure, but they're more protected. They're protected from the immune system. Some biofilms are so strong that they can protect those bacteria.
110,000, I'm sorry, a thousand times what they could do on their own. So, and they're made up of these different proteins. And so anywhere that bacteria exist, they're in a biofilm. Dr. Costerton, who was the cutting edge researcher in biofilms in the 1970s wrote about biofilms. So we've known about biofilms for a really, really long time.
And it hasn't really yet made the jump into clinical medicine, which is kind of shocking because it's been a long time, 50 years, right? So, so it is crazy that biofilms aren't something in, you know, most conventional doctors, languaging and understanding. but if we think about plaque on our teeth, that's biofilm.
Kim Vopni (17:33.698)
Yeah.
Kelly McCann, MD (17:52.037)
If we think about scum on a pond, that's biofilm. If you've ever had a glass, or you have water in the glass, and the water, you let it sit out and the water evaporates. There's that ring, right? There's that mineral deposit. That is the structure of the biofilm that's left on the glass. So biofilms exist everywhere.
and they're in our bladders, they're in our GI tract. If people have Lyme disease or chronic bacterial infections or internally, those bacteria can make biofilms as well. And that's actually where I first learned about it was learning about Lyme disease, that Lyme creates these biofilms. Turns out they're everywhere. And so what happens, the way that I think about it is it's a little bit like lasagna, you so you've got your...
Kim Vopni (18:40.493)
You
Kelly McCann, MD (18:47.399)
Biofilm, is the pasta and then underneath that you've got the cheese and the meat sauce That's your bacteria and or your fungus and you've got another layer of pasta and more more Bacteria and as we age we just keep you know our bacteria. Just keep making more biofilm thicker and thicker and thicker
Kim Vopni (19:02.207)
El Zonja gets bigger.
Kim Vopni (19:07.933)
So we have like when you when the testing is done the next generation sequencing testing it can is it detecting the biofilm or is it able to detect even though the biofilm is there it can it can get in and find more things.
Kelly McCann, MD (19:23.379)
That's a great question. So what we do as part of our protocols is put people on biofilm busters, which are a supplement of digestive and proteolytic enzymes, fibrinolytic enzymes that will break down the biofilm that will enable more of the bacteria or organisms to be released so that when you do the test, we'll see what's actually in the bladder.
Kim Vopni (19:50.712)
Yeah, I remember doing that before I got like a poop test that I did. I don't remember the name of the specific biofilm disruptor, but that was the first time I had heard that term and learned about what biofilm was and why we needed to break it down. So it doesn't like it would break down anywhere. It's not like site specific or is it?
Kelly McCann, MD (20:11.091)
No, it's not really site specific. sometimes when I have a patient who has sinus issues and bladder issues and vaginal issues, I'll have them do the BioFoam Buster and collect all three specimen at the same time because we're breaking down biofoams everywhere. And they could do a poop specimen too if they really wanted to.
Kim Vopni (20:30.731)
Yeah, yeah, that makes sense. let's say we have a person who, like you had mentioned before we got online, that there's different antibiotics for specific strains of bacteria that you find. So that person that you said sometimes you find 15 different bacteria, would that require 15 different antibiotics? how would you tackle a situation like that?
Kelly McCann, MD (20:56.519)
Right. It really depends. So that's where the percentages are very helpful. So if you have the vast majority of the organisms covered, and you know, it, when we're talking about vaginal specimen, the cool thing about that is we can do vaginal suppositories. So yes, we can use commercially available products like metronidazole or clindamycin, we can also utilize compounding pharmacies to make.
vaginal suppositories. So if the zoo is in the vagina, you know, it may be like, okay, we'll do a week of metronidazole, vaginally, and then I'm going to compound a vancomycin or a levoquin, you know, in different antibiotic for, to kill the rest of the guys. And then I'm also making choices because as you mentioned, lactobacillus is,
Kim Vopni (21:29.165)
You
Kelly McCann, MD (21:53.211)
an organism that we want to have in the vagina. And so if lactobacillus shows up in my zoo, I'm going to want to try and preserve that as much as I can. Sometimes I can't, but then after the fact, I can replenish the microbiome with a vaginal probiotic, which is really cool, right? This is what we do to help heal our gut. What I found is that if we use
Kim Vopni (22:02.189)
Mm-hmm.
Kelly McCann, MD (22:21.523)
vaginal probiotics put directly into the vagina that are mostly lactobacillus species. What will happen is that the next time we do the test, not only will the bad guys be gone, but there'll be more good guys. And then fortunately too, the vaginal lactobacillus tends to migrate over. And I think they go on holiday and they show up in the blood and like, okay, hey, we like it. We're going to stay.
Um, they show up in the bladder and they stay. And so that is also good because lactobacillus in the bladder is considered a commensal organism in the bladder. And the more good guys you have in the bladder, hopefully they can crowd out the bad guys. And so we try to avoid killing lactobacillus there also.
Kim Vopni (23:08.833)
Yeah, and that was a question I'd written down was, you know, antibiotic everybody now is is nobody wants to take anti but well, not very many people do anymore. They recognize it's not so great. Is there any other options? You've explained why it would be antibiotic. So then what happens after and how we kind of repopulate and make sure we replenish and you've you've explained that beautifully from a vaginal probiotic perspective. There are some vaginal probiotics that are taken orally and there are some that are vaginally to me a vaginal protocol.
probiotics should be vaginally. I just think it should go where we're treating it. Yes. Yeah, there's a whole bunch of other things that needs to go through. are there specific and I don't know if you have any affiliation with brands, but are there specific companies? know seed has one, Vitanica has one, which I believe is oral. There's not a lot out there with regards to vaginal prob.
Kelly McCann, MD (23:43.027)
It's really hard to get it from your mouth all the way to your vagina. It just said they're not that close
Kim Vopni (24:07.181)
probiotics for the vagina. So are there ones that you would recommend?
Kelly McCann, MD (24:09.699)
so one of the, yeah, sorry. one of the compounding pharmacists that I have been working with on this issue has said for younger women, who have enough secretions that they can, that the secretions can digest a capsule. could actually put like culture L which is lactobacillus GG in the vagina at night. And that's one way to do it.
For postmenopausal women, if they don't have enough lubrication, it might be more difficult to break down that capsule. And so I typically prescribe a compounded vaginal cream that's made by a specific pharmacy. And I found that to be very, very effective. And because it's a cream, it's a lot easier for a postmenopausal woman to apply.
Kim Vopni (25:02.219)
Okay, I didn't think about that being able to be compounded. For those that don't know what compounding is, can you just elaborate and explain that?
Kelly McCann, MD (25:08.871)
Yes. When you go to a commercial pharmacy, CVS, et cetera, they have what the pharmaceutical industry has created specific drugs and they have a variety of different inactive ingredients in these medications in addition to the active ingredient. And there's kind of a one size fits all. Yes, there are different.
different doses sometimes depending upon what you're looking at, but that's what you're going to get from a regular pharmacy. Compounding pharmacy, the pharmacist actually takes the raw material and they're able to put that in a different carrier. So for example, a lot of women who are menopausal may have heard of bioidentical hormone replacement and a compounding pharmacist can then take
the estradiol or estriol and either put it in a vaginal suppository, put it in a cream, lotion, an oil, and that can be administered to a person. So you're getting a lot less of the inactive ingredients and a personalized way of delivering the pharmaceutical. And then the compounding pharmacies can do a lot of other things too. So they can combine
They can combine medications and creams. can, you know, combine it for a variety of different, delivery mechanisms. They can take, you know, for a lot of my patients who are very sensitive, who can't tolerate like the polyethylene glycol or, you know, any of the other junk, the dyes and the, the, the, inactive ingredients, you know, all the, the crop we can do say a
Kim Vopni (26:58.209)
the additives and fillers and that.
Kelly McCann, MD (27:04.86)
compounded Benadryl that has not none of the other pink dyes or anything in it. It's just the pharmaceutical and a very inactive excipient carrier. You always have to have some sort of carrier and that works much, much better. The downside to compounding, it's not often covered by insurance.
Kim Vopni (27:15.959)
Yeah.
Kim Vopni (27:26.859)
Yeah, yeah, and compounding is technically how pharmacy started. That's that's what pharmacies used to do before there was a regulatory body that had to have exact and and you know when you when you hear about compounding aside from the cost associated with it. We kind of go to that question that's being asked about a lot of things these days but why why the fillers why do we need those fillers in there and yeah yeah.
Kelly McCann, MD (27:33.49)
Yes.
Kelly McCann, MD (27:54.803)
We don't.
Kim Vopni (27:56.748)
Yeah, so if we can compounding seems so I had never even thought of compounding a vaginal probiotic. So that's that is so logical now that you just have explained it that way. If people are taking you mentioned hormone replacement therapy, if if somebody generally a postmenopausal person, if they were taking vaginal estrogen, would that decrease their risk of
meant like these infections compared to somebody who wasn't.
Kelly McCann, MD (28:29.157)
Yes, theoretically, yes. I mean, it really depends on the health of the vagina and the bladder before you went through menopause, but the idea of having adequate estrogen in the tissues means that the tissues are more plump. And so the, the, the pathway from the anus to the, you know, the bladder opening is
Kim Vopni (28:36.866)
Mm-hmm.
Kelly McCann, MD (28:59.003)
is not as straight, it's not as direct. So it can really make a difference. But I think it depends on the health of everybody's organisms and biofilms, et cetera, before they go through menopause too.
Kim Vopni (29:00.577)
Yeah.
Kim Vopni (29:13.805)
Yeah, I have been going this is a bit of a sidebar tangent, but it'll come back to the question I have. I've been going through I've starting a parasite cleanse and I've been learning a lot about parasites and detoxing and what have you and there there are foods and things we can can consume that can make our body less hospitable to put
parasites. Generally, a lot of people are like, if you have a pulse, you have a parasite, it's whether or not they're, they're being dead, they're damaging to us. So we are always going to be exposed to toxins. It's about it's about creating a body that can manage that. So what can we do to make sure that we are less likely to contract these bacteria? Yeah.
Kelly McCann, MD (30:03.981)
it's all, it's all the healthy lifestyle stuff, right? So if you eat a healthy diet and you minimize your pesticides and your additives and all of your junk, in terms of diet, that's part of it. We also, we just have to reduce our environmental toxicant burden. So all the chemicals drink out of glass, don't eat, don't heat your food in plastic. when you go to Starbucks, don't
drink it, bring your own cup, right? Don't even use their cup. And if you do use their cup, take the plastic lid off because that's just like the worst way to get so much plastic in you. And all of these little insults are suppressing our immune system, causing an inflammatory response in our immune systems. And so the more healthy lifestyle that we can lead, the better.
you know, getting enough fiber, getting enough sleep, all of these things will impact our microbiome in our gastrointestinal system and likely will be impacting our microbiome elsewhere too. So I really think about our resilience as lifestyle and that's gonna be the best way to protect yourself. And you know, probably in terms of
Kim Vopni (31:17.921)
Yeah.
Kelly McCann, MD (31:24.613)
Accumulating different bacteria. think if you have a single partner and you're staying with that partner, at least you're swapping known bacteria back and forth. I mean, these aren't STDs, but it becomes this communal soup. If you're having multiple partners and non-protecting yourself with sex.
Kim Vopni (31:34.445)
Mm-hmm.
Mm-hmm.
Kim Vopni (31:43.638)
Right, right. Another topic that you talk about a lot is mast cell activation syndrome, MCAS. And I read about this. I follow lots of different health things. I've heard of this. I don't really know a ton about it, but I know it's a reason for people to have different sort of inflammatory responses, histamine reactions. And this is also something I didn't necessarily think of being something that could influence our
vulvavaginal health or bladder health. So can you talk a little bit about what symptoms could potentially present that may indicate? Well, first of all, what is mast cell activation? And then you can answer that question.
Kelly McCann, MD (32:25.651)
Sure, yeah. So mast cells are a part of our immune system and we all have them. They've been around for, I don't know, probably a billion years. So they're super important. And their job is to search the body, particularly at the areas of interface. So mouth, GI tract, respiratory tract, upper respiratory tract, lower respiratory tract, all the mucous membranes in our genitalia.
And then they like our nerves and our skin, blood vessels. So their job is to fight foreign invaders. And when they perceive a foreign invader, they are filled with all these chemical messengers called mediators. And they, when they see, when they perceive a threat, they release their mediators into the local environment.
which then sends out these inflammatory signals to the rest of the body, to the rest of the immune system, hey, we have a problem over here, come over here and help us deal with this problem. And in genetically susceptible lucky people who make up about 17 to 20 % of the population, we are at risk for dysfunctional hypersensitive mast cells, which means that
we're going to have a more vigorous hyper hyper response to a threat, including our own tissues, the food that we eat, the air that we breathe, you know, things like that. Usually the mass cells get triggered over time by accumulated exposures to mold, environmental toxins, infections, things like Bartonella, which is cat scratch fever or Lyme disease can trigger a mass cell activation. So, and then
What happens is that the mast cells in different parts of the body can respond. So you might eat a food that your body and your mast cells aren't liking, but it's not just gonna cause symptoms in the gastrointestinal tract. You can get symptoms in any system of the body. And so the kind of the definition is multi-symptom, multi-system allergic inflammatory and growth response is.
Kelly McCann, MD (34:45.181)
the clinical diagnosis of mast cell activation so that you could have allergic type symptoms, itchy watery eyes, sore throat, sneezing, coughing, gastrointestinal symptoms, cardiac symptoms, neurological symptoms, brain fog, headaches, et cetera. And then, know, kind of bladder issues, bladder pain, bladder spasms, vaginal spasms, vaginal pain, et cetera.
somebody can have bladder issues and vaginal issues and they don't have mast cell activation, but if somebody has a whole constellation of symptoms, including vaginal and bladder symptoms, then I would be more suspect that they might have mast cell activation.
Kim Vopni (35:30.253)
Yeah and a lot of interstitial cystitis, was a hard time, painful bladder syndrome. I was following a woman who talked a lot about from a food perspective and a lot of it was low histamine. Is histamine intolerance part of mast cell activation or are they two separate things? And so my mind's also now going to
Kelly McCann, MD (35:54.451)
Good question.
Kim Vopni (36:00.01)
if somebody is dealing with painful bladder or IC, I'll say that. This is a test that I think would be beneficial for them. So then the next question is how do you test for it?
Kelly McCann, MD (36:09.939)
Um, sure. So no, that's okay. So is histamine intolerance the same thing as mass cell activation? And the answer is no, there are different conditions. Histamine is one of the many, many mass cell mediators. So, um, mass mass cells can have a hundred, a thousand different mediators and histamine is just one of them. Um, so you can have all sorts of inflammatory allergic symptoms that
Kim Vopni (36:12.129)
That was a lot of questions in one.
Kelly McCann, MD (36:40.071)
don't really involve histamine at all. And those are the people who have all these symptoms and they take antihistamines and it does nothing for them. I have plenty of those in my practice. And then histamine intolerance has more to do with how we metabolize histamine in the gastrointestinal tract. So there are two ways that we metabolize histamine in the body. One is through methylation and then in the GI tract,
we have an enzyme called DAO and histamine intolerance is essentially a DAO enzyme deficiency. So a low histamine diet will only be helpful in somebody who has a problem with not being able to metabolize and break down their histamine. And usually it's more GI symptoms, but they certainly can get IC, bladder symptoms,
Kim Vopni (37:17.133)
Hmm.
Kelly McCann, MD (37:36.787)
etc. So it's always worth a trial of a low histamine diet, to see if you get any benefit. If you don't get, if any, get any benefit, it doesn't mean that you don't have mass cell activation. but you may not have histamine intolerance.
Kim Vopni (37:44.961)
Mm-hmm.
Kim Vopni (37:53.25)
Got it. So then how would you test for both of those like histamine intolerance and mast cell activation?
Kelly McCann, MD (38:00.787)
There is one company that I'm aware of that can test DAO enzyme levels. It's a blood test through precision analytics. They have an advanced permeability, intestinal permeability test that enables you to identify DAO enzymes. Now, DAO enzymes can fluctuate. So for example, somebody might be normal and then they get exposed to mold.
the mass cells go crazy. I don't know exactly what happens if the enzyme just gets depleted or exactly what that physiology is. haven't read the literature on that, but, the DAO enzyme, function gets depleted and then people get more histamine intolerance symptoms. so we don't have great tests for that. what I would say is your best option is
Kim Vopni (38:38.999)
Mm-hmm.
Kelly McCann, MD (38:57.893)
and elimination diet of the high histamine foods and to see if that works after a couple of weeks, you should have an idea in terms of mass activation testing. That's even more complicated, right? Because I just told you that there are hundreds, if not thousands of mediators and commercially available tests. can test for triptase histamine, chromogranin A that's it. If you do some specialty testing through places like Mayo or her other labs,
Kim Vopni (39:11.134)
Mm-hmm.
Kim Vopni (39:20.461)
Hmm.
Kelly McCann, MD (39:26.355)
They can look at a few other markers, some prostaglandin markers, the Kachin markers and their inhibitor, I'm sorry. their mediate metabolites. can also do biopsies and look at a specific kind of stains of the cells. So if somebody is actually having a bladder biopsy, uh, gosh, I'm sorry. Um, you can ask, you can request CD one 17 stains. Um, same thing with a colonoscopy or an endoscopy.
Kim Vopni (39:45.727)
Yeah, that doesn't sound...
Kelly McCann, MD (39:55.143)
That's a pretty easy way for me to get a look at how many mass cells are present. Now, it's mass cell activation is not a mass cell overabundance condition, but we're using it kind of as a biomarker. So there are not great tests. It's considered a clinical diagnosis. One caveat on that, there are what I would call two groups, two consensus groups. One is
consensus one is your allergies who have a very rigid definition of mass activation where you have to have a triptase level that's, you know, I don't remember the exact formula, but it's kind of a stupid formula because, there's a baseline. And then when you're in a flare, you have to have a certain increase in your triptase triptase levels are related to the number of mass cells in the body. I just told you it's an activation problem, not a mass cell overabundance problem. So
if you happen to end up in suspecting that you have mass activation and you end up in an office with an allergist or one of the consensus one people, and they're not helping you never fear, go find a consensus to person. The consensus to people are the people that follow Dr. Larry Afrin, Dr. Theotheo Theohardies, myself, and many other functional medicine doctors who recognize that mass activation is a clinical.
disorder and it needs to be diagnosed clinically.
Kim Vopni (41:23.853)
Mm hmm. Got it. Okay. And would that be in terms of treatment for mass cell activation? Is it also low histamine or what other ways would somebody start to overcome that?
Kelly McCann, MD (41:35.997)
So many ways, so many ways. Yeah, oftentimes we'll run through the antihistamines. There are other pharmaceuticals, ketatophin, chromalin, things like Benadryl, your H1 blockers, Zyrtec, Zizol, Allegra, Claritin, H2 blockers like Pepsid. And then there are so many supplements. There are low histamines.
probiotics, quercetin, luteolin, pycnogonal, tumeric, resveratrol, paramine, you know, I could go on and on. And then the key is finding the things that work for each individual person. And that's really where the art of medicine comes in. I actually muscle test patients to try and help figure out what's gonna be the things that work best for them. Because we have
Kim Vopni (42:14.603)
Yeah.
Kim Vopni (42:23.373)
Mm-hmm.
Kelly McCann, MD (42:33.583)
dozens if not a hundred different things I could potentially give them. And then on top of that we really have to work on the nervous system, the vagus nerve, the limbic system, and helping people find safety in their bodies because Mass Cell Activation Syndrome is really a syndrome where the mass cells do not feel safe.
Kim Vopni (42:37.421)
Mm-hmm.
Kim Vopni (42:55.851)
Hmm. So interesting. Something I can't remember where I saw this or who shared this. But I recall something about anti histamines like chronic use of anti histamines being was it detrimental to the cognitive function? Is that accurate?
Kelly McCann, MD (43:14.351)
Yes, so there is a correlation between those things and the way that Dr. Afrin has described it is correlation is not causation. And is it possible that the people who were taking antihistamines for extended periods of time were doing it for specific inflammatory reasons like
Kim Vopni (43:20.789)
Okay.
Kim Vopni (43:27.426)
Mm-hmm.
Kelly McCann, MD (43:39.313)
they felt a little bit better taking the antihistamine because they actually had mast cell activation because they actually had lead exposure or mold exposure or other environmental chemicals or chronic Lyme disease. And it was actually the thing that was driving the histamine or driving the inflammatory response in a mast cell patient who was not properly diagnosed. And the thing that got them
Kim Vopni (43:45.005)
Hmm.
Kim Vopni (44:05.517)
Got it.
Kelly McCann, MD (44:09.403)
with dementia was the thing that was driving the inflammatory response in the first place, right? So, yeah. And, you know, sadly they didn't get the medical care that they really needed.
Kim Vopni (44:14.977)
Yeah, yeah, yeah, that makes sense.
Kim Vopni (44:24.811)
Yeah, yeah. This has been so interesting. I've learned a ton that I did not know. And I feel like I know a lot about the vagina, but this is a whole other path that I've gone down. I so appreciate that you that you shared this with us and for the work that you're doing, where can people find out more about you potentially work with you or just learn more about what you offer?
Kelly McCann, MD (44:44.839)
Thank you. I have a brick and mortar practice in Southern California in Costa Mesa. You can find the clinic at thespringcenter.com. I actually happen to have medical licenses in about 11 other states. So if you don't live in California, it's a good possibility that I have a medical license in the state where you do live. And then we just ask that patients come to California the first time.
Kim Vopni (44:58.541)
Cool.
Kelly McCann, MD (45:10.599)
they establish care and then annually after that and we can do a lot of this work via telehealth, thank goodness. I also have a personal website at drkellymccann.com. I'm launching a gut course soon and writing a book and there are blogs and so there are more ways to find me.
Kim Vopni (45:32.077)
to your busy lady. That's amazing. Thank you so much, Kelly. I so appreciate your wisdom. And I'll have all of that in the show notes for everybody to check out.
Kelly McCann, MD (45:42.173)
Thank you so much, Kim.
