Juicebox Podcast: Type 1 Diabetes

Episode #1804 – Dr. Aaron Shiloh

Date: March 21, 2026
Host: Scott Benner (“A”)
Guest: Dr. Aaron Shiloh (“B”), Interventional Radiologist, USA Clinics Group
Main Theme:
Obtainable, minimally-invasive solutions for conditions often treated with surgery or conventional approaches—focusing on new treatments for hemorrhoids, fibroids, and related vascular issues, with a candid personal account from the host.

Episode Overview

This episode departs from the usual Type 1 diabetes focus to spotlight life-changing minimally invasive procedures for painful, stigmatized health conditions. Host Scott Benner speaks with Dr. Aaron Shiloh, an interventional radiologist who performed a hemorrhoid artery embolization for Scott, solving a debilitating, embarrassing, and previously untreatable issue. The conversation ranges from Dr. Shiloh’s career path and practices, to technical explanations, insurance frustrations, and raw, relatable patient experiences.

Key Discussion Points & Insights

1. Dr. Shiloh’s Background and Interventional Radiology

• Dr. Shiloh's Education and Path to IR

  • Studied biology/pre-med at Penn State; University of Pennsylvania for medical school.
  • Initial aspirations in neurosurgery, shifted to general surgery.
  • "As someone who grew up loving video games, [IR] felt a little bit like playing a video game in the human body." (B, 03:16)
  • Specialized in interventional radiology after discovering the innovation and effectiveness of image-guided, minimally invasive procedures. (03:00–05:10)

• Early Career Achievements

  • Chief of Interventional Radiology in a large private practice.
  • Pioneered advanced cancer treatments in the Philadelphia region—including the use of radioactive beads for liver tumors. (06:00–07:30)

2. Scope of Current Practice

• Current Procedures at USA Clinics Group (08:00–09:35)

  • Vein treatments for varicose veins.
  • Uterine fibroid embolization.
  • Hemorrhoid artery embolization (main focus).
  • Embolization for knee pain, enlarged prostates, and peripheral arterial disease.

  "So basically now I do vein treatments, treatments for fibroids, hemorrhoids, knee pain, prostatic enlargement, and peripheral arterial disease." (B, 09:33)

• How The Technology Works

  • Most IR procedures involve closing off abnormal blood flow (vein disease), opening arteries (arterial disease), or delivering tiny particles/plugs to block flow to problematic tissue (embolization). (09:40–10:20)

3. Uterine Fibroid Embolization: An Example of Minimally Invasive Care

• Overview

  • Fibroid embolization allows preservation of the uterus; most women are still offered major surgery (hysterectomy) for benign fibroid disease.
  • Procedure shrinks fibroids 70–80%, usually significantly improving symptoms. (12:01–12:44)
  • "I like to refer to it as like a grape into a raisin. So they dry up and they desiccate." (B, 12:11)

• Symptoms & Impact

  • Heavy bleeding, anemia, pain, frequent urination, constipation, depending on fibroid location.
  • Emphasizes importance of location: "Fibroid disease is like real estate—location, location, location." (B, 14:01)

• Insurance and Recovery

  • Covered by insurance, takes about 20 minutes, recovery around a week. (16:27–17:22)

4. Varicose Veins: Medical, Not Just Cosmetic

• Insurance Misconceptions
  • Many providers and patients wrongly assume varicose veins are only cosmetic.
  • "Vein disease is a medical problem... and we treat that as well." (B, 17:46)
• Covered by insurance if medical necessity established.

5. Scott’s Personal Hemorrhoid Story: Patient’s Perspective

[18:30–23:10]

• Chronic, Stigmatized Suffering

  • Scott details years of unpredictable, life-altering rectal bleeding causing embarrassment, social avoidance, and major lifestyle changes.
  • Tried all home/token remedies with no success; surgery options seemed traumatic with poor outcomes.
  • Discovered embolization by asking AI—found Dr. Shiloh nearby. Insurance refused coverage, but procedure was worth the out-of-pocket cost.

  “I have not had any issues... beyond the pressure being gone up inside... it changed my life in a split second.” (A, 36:49)

6. Hemorrhoid Artery Embolization: What It Is & Why It Works

[23:15–46:00]

• Origin & Rationale

  • Procedure stemmed from techniques to stop severe GI bleeding.
  • Anatomy: hemorrhoids stem from vascular lakes fed by rectal arteries. A breakdown in tissue matrix leads to chronic swelling and bleeding, not just “veins gone bad.” (30:00–32:00)

  “You have a swelling that takes place in the venous side... what you really are having there is like an arterial venous malformation.” (B, 31:57)

• Why Common Treatments Fail

  • Banding and other office procedures target the symptom, not the underlying blood supply.
  • “Banding literally paints over the spot without getting to the root of the problem.” (B, 31:30)

• How Embolization Works

  • Small catheters are threaded into the rectal arteries, which are then blocked with coils/particles, “depressurizing” the hemorrhoid.
  • Success rates high when done by experienced IRs; technique refined to also block accessory arteries for better outcomes. (36:58–39:00)

  “For patients like yourself, it’s really an amazing, amazing, amazing treatment, and I’m really confident it helps people.” (B, 39:26)

7. Recovery, Side Effects, and Real-World Experience

• Procedure Details & Recovery

  • Outpatient, moderate sedation, minimal pain, short downtime.
  • Some local bruising at catheter site.
  • Immediate and lasting symptom relief for Scott.
  • Typical office workflow (“felt like I went to lunch and came out; I was home two hours later”). (A, 42:14)

• Rare or Unusual Side Effects

  • Scott described brief episodes of warmth in the penis head for a few weeks post-procedure, theorized to be redistribution of blood flow—Dr. Shiloh hadn’t heard this particular complaint but explained the likely mechanism in anatomical terms. (45:03–45:36)

8. Barriers: Insurance Battles and Advocacy

• Insurance Denials and Frustrations

  • Embolization may be covered (Medicare, United, various Blue Cross, sometimes Aetna), but policies vary and criteria are opaque.
  • Cigna’s refusal highlighted: “They said, next time the bleeding happens, just go to the ER and they’ll embolize it... isn’t that going to cost you more?” (A, 53:06)
  • Hospital-based embolization is only approved for acute, severe arterial bleeds—not for chronic hemorrhoids.

• Need for Education

  • Dr. Shiloh urges advocacy for patient and primary care awareness.
  • “Hopefully we can remove the stigma and the shame... and get more patients treated...” (B, 41:10)
  • Patient-to-provider feedback can drive change.

9. Cautions and Considerations

• Not All Rectal Bleeding is Hemorrhoids
  • Colonoscopy to rule out cancer or other causes still essential.
• Conservative Management Before Intervention
  • Not everyone needs embolization; some may improve with diet, medication, or lesser procedures.

10. Final Words: Empowerment and Support

• Scott: “It wasn’t that bad to show Dr. Shiloh my butt... once we did the procedure, it still felt like a very private thing. It was just easy, to be perfectly honest.” (A, 58:50)
• Dr. Shiloh: Committed to helping as many patients as possible, including redirecting those who need other care. (59:12)

Notable Quotes & Memorable Moments

• On Interventional Radiology’s Appeal:

  “It felt a little bit like playing a video game in the human body.” (B, 03:16)

• On the Impact of Hemorrhoids:

  “If I would have told somebody that two, three times a year... I started bleeding uncontrollably... people would be horrified... when you tell them it comes from your rectum, then all of a sudden it’s funny.” (A, 18:31)

  “You have no idea. I started thinking, I don’t know how many people are going through something like this, because I never would have told anybody.” (A, 27:05)

• On Hemorrhoidal Anatomy & Embolization:

  “The hemorrhoid is like looking up in the ceiling and seeing a brown spot develop... Banding literally paints over the spot... What we’re doing is... getting to the source by putting the catheter in and blocking the arteries to reduce the pressure.” (B, 31:30)

• Scott’s Immediate Results:

  “As soon as you were done... all the pressure in the lower part of my body is gone. I didn’t realize I was living with so much pressure.” (A, 28:26)

• Insurance Frustrations:

  “By the way, Cigna, go to hell.” (A, 53:06) “It was demoralizing, to say the very least, candidly.” (A, 22:00)

• Empowerment & Advocacy:

  “Hopefully we can remove the stigma and shame... and get more patients treated and not have them feel that same, you know, shame of what’s going on.” (B, 41:10)

• On Affirming Patient Experience:

  “I stood up in a paper gown and hugged you... I’d come do anything for you. I can’t tell you how thrilled I am.” (A, 50:10)

Key Timestamps

• Dr. Shiloh’s Background: 02:40–07:40
• Procedures in Clinic/Technology: 07:40–10:25
• Fibroid Embolization Deep Dive: 10:24–13:45
• Varicose Veins as Medical Issue: 17:32–18:27
• Scott’s Personal Story: 18:27–23:16
• Hemorrhoid Embolization Origin & Explanation: 23:16–34:06
• Procedure Experience & Recovery: 34:06–44:00
• Insurance & System Issues: 53:06–58:24
• Consultation Process & Who Qualifies: 47:01–50:10
• Wrap-Up/Support: 58:24–59:38

Actionable Takeaways

• Suffering in Silence Isn’t Necessary: Modern, minimally invasive solutions now exist for conditions like fibroids, varicose veins, and hemorrhoids. For many, these can be life-changing.

• Patient Advocacy & Second Opinions Matter: Don’t accept “just live with it” or dismissive answers, especially for stigmatized problems.

• Insurance Coverage Varies: Check with your provider, push for peer-to-peer reviews, and advocate for yourself. Consider cash-pay options if possible—relief may be worth it.

• Reach Out for Evaluation:
  Not all bleeding is benign. Get a colonoscopy to exclude cancer, then consult with an experienced IR if indicated.

How to Find Out More

• USA Hemorrhoid Centers:
  usahemorrhoidcenters.com
  Nationwide locations, most major insurances accepted.

• Dr. Shiloh’s Commitment:
  Open to consults and guidance, even if just to help redirect to the right care.

Why It Matters for Type 1 Diabetes Listeners

While not directly diabetes-related, the challenges of invisible, stigmatized chronic issues and the pursuit of effective care is a universal patient experience—shared by many in the diabetes community. The episode serves as an example of self-advocacy, breaking stigma, and the hope offered by medical innovation.

“Hopefully we can remove the stigma and the shame from it and get more patients treated and not have them feel that same... shame of what’s going on.”
— Dr. Aaron Shiloh (41:10)

For listeners seeking transformative care, this episode is a candid, technical, and empathetic roadmap to understanding and overcoming some of medicine’s most hidden, frustrating problems.