Ologies with Alie Ward - Radiology (X-RAY VISION) with Varshana Gurusamy

Episode Date: April 17, 2018

Hey, kiddo, it's what's INSIDE that matters -- like your guts and bones and squishy brain and intestines and stuff. Meet Dr. Varshana Gurusamy: diagnostic radiology resident, Texan and amazing person with great stories. You'll learn the difference between an MRI and an ultrasound, between a CT scan and a CAT scan and why you should not put big things in orifices that you might not be able to retrieve them unaided. You'll want to hug a radiologist ... as soon as they take their lead gonad shield off.More episode sources & linksSupport Ologies on Patreon for as little as a buck a monthOlogiesMerch.com has hats, shirts, pins, totes!Follow @Ologies on Twitter and InstagramFollow @AlieWard on Twitter and InstagramSound editing by Steven Ray MorrisMusic by Nick Thorburn

Hi, it's your uncle's ex-wife who collects wind chimes, Ally Ward. So you, fine listener, are a bag of chaos. Just organs and tubes, fluids, benign lumps, squishy miracles. Let's get to know what's inside you and me, and me, I've got all of that too, but first, thank you. Thank you so much for listening to oligies and thanks for telling your friends and co-workers and your tax preparators about the show. So many new people listening lately and it's all thanks to you guys for yakking about it.

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Okay. It comes from radiare, which is Latin, meaning to emit light after the radiation involved in x-ray technology, but since x-rays were developed so long ago, we've got other types of imaging. Radiology now essentially means, I'm going to paraphrase, medical technology that lets us gaze upon our disgusting, wonderful guts and bones and stuff. Thisologist I'd met before through my very good pal, Cara Santa Maria of the podcast talk nerdy.

She's awesome. I was over at Cara's house while this guest was in town and I kind of pulled Cara's side and I was like, do you think she would be on my podcast? Cara was like, dude, she listens to allergies already. She totally would. It was like when you find out that your crush likes you back, except platonically, and instead of going to the prom, she came over one evening and we sat on my couch to talk about lead smocks and foreign objects being stuck in people's bodies and me crying about brain

imaging and DIY ultrasounds and very savage word family pranks and what kind of classic American hip hop is best to listen to when you're 13 hours deep in images of brains and guts and just casually saving lives on a Wednesday. So she is a doctor doing a radiology residency. She's planning on a fellowship in interventional radiology. You'll find out what that is in a minute and you will love her. Please lie back, stay still or cuddle up under your heaviest blanket for radiologist, Dr. Varshana Irassami.

Ask you everything about your life and all of your secrets. That's not true. Okay. So now you live in Texas. Yes. I live in Houston. Are you from Texas? So I grew up in Keller, which is a small town north of Fort Worth.

Dr. Varshana Irassami went to Baylor College of Medicine in Houston for her undergrad and then she got a master's in Texas. She went and did grad school and med school in Philadelphia and then she headed back to Texas back to Baylor. Were you excited to go back to Texas? Yes. I really wanted to come back to Texas. My parents live here.

I just wanted to come back and I want to do interventional radiology and Baylor has a really strong reputation for that, so that's why I chose that program. But I'd always thought about coming back to Texas. At what point did you know you wanted to do radiology? So this was really interesting because I never wanted to do radiology. What? It sort of happened by accident. So I went into medical school wanting to be a general surgeon.

I was gung-ho general surgery. I did all the things for surgery and I remember as my very first clinical rotation as a third year med student. I was on my pediatric rotation and we get to do a one-week subspecialty and I wanted to do it in surgery and pediatric surgery, but the surgeon was out of town at this little hospital in Monmouth and in New Jersey. So they said, well, the surgeon's out of town. You have to do it in radiology.

And I was like, oh man, it's going to be so boring. I don't want to watch people read these CT scans and X-rays. It's going to be terrible. So I sat down at this workstation and there was a resident there and he'd saved all these interesting cases. So rather than have me watch him read scans, he let me work through these on my own, which was really interesting. And I should say watching someone read or do radiology is kind of boring.

It's like watching someone write a paper. So they're going through the scan. You might not understand what they're doing. So it can be boring, but when you're doing it on your own, it's like figuring out a puzzle. You're going through someone's body and it was awesome. So that kind of hooked me, but I kept thinking about surgery. And then I noticed on every clinical rotation I did, like OBGYN, I really liked looking at the ultrasounds.

And when I was on surgery, I loved that rotation, but we'd always go down to the radiology reading room and ask the radiologists about the scans and preparation for surgery. And I loved how the radiologists were such good teachers. And they always took the time to go through everything. And I knew I wanted to teach. I really liked that aspect of their medicine, but I knew I wanted to do something with my hands. Sorry, this is like a long explanation.

So someone told me, maybe you should think about interventional radiology, where we use image guidance to do procedures. So that would marry the two things like I liked working, looking at images, and I wanted to work with my hands. And then I did a rotation in interventional radiology and I totally fell in love with it. Can you explain two things? What is radiology and what is interventional radiology?

I know that you handed me a pamphlet with an old white dude on the front, but I'm going to have you explain instead. I was sitting in bed writing this episode. It's a Saturday. I'm not wearing pants. I haven't worn them all day. I wanted to describe the pamphlet that Dr. Garasami brought me, but it was in the other room, which was approximately 15 feet away.

So I spent upwards of five minutes looking for a PDF of the same pamphlet online instead of just getting up. And finally, I just got up and got it. So it has an older white dude wearing scrubs on the front. There you go. All of that, just to tell you that. Okay. So radiology is the study of images and making diagnoses based on images and then using that

to do procedures. So not all, so there's sort of a misconception that radiologists just sit in a reading room and look at their computers all day and they don't ever see patients or other doctors. That's not true. They all do some kind of procedures. So that we look at four different types of imaging, mostly ultrasound x-rays, CT scans and MRIs. Those are like the four main imaging modalities.

And there's many different subsets of radiology. So people specialize in neuro radiology where they may read brain CTs and brain MRIs. They specialize in that or body imaging, which is everything from like the neck down to the pelvis. Is there a weird line in your neck where it stops being the head and it starts being the body? No, there's definitely some overlap. Yeah.

I know. It's a little like, oh, I can't do that. That's below the clavicle. Right. I don't know. Like what's the thyroid? The thyroid's like, what am I? So I guess your head is just your skull and face and jaw and your neck is part of your

body. But then the whole thing is really part of your body. But if you think about your body, like where does your body really end given like air and space and your microbiome? What is your body? Honestly, you know what? These thoughts are starting to spiral into things that are college sophomores during a blacklight poster would say.

So let's just move on. I mean, basically we use images, a real time x-ray, ultrasound or CT to guide whatever procedure we're doing. So there's lots of different procedures like gallbladder removal and tumors and stuff. We don't do gallbladder removals because that would be surgery, but we do put drains and gallbladders and patients that aren't healthy enough to go through a surgery. So we might divert their gallbladder and have that like drain outside. Where does it go?

I'm so sorry. Into a bag. Does it really? Yeah. They're really restricted and they need to like, you know, and they can't have their gallbladder removed. Maybe they have gallstones, but they, you know, maybe it's like a really sick 85 year old and she can't get surgery or something.

We might put a tube or a colostostostomy tube in her. Is it like tapping a Capri Sun? Kinda. Why don't you think about it that way? Can we make it more satisfying? Just a bile flavored Capri Sun. Delicious. Tap it, drain it, move it on.

Just backtrack, take a closer look at those four main imaging modalities or the dark wizardry that radiologists use to stare into solid objects, including your brain and butt. Can I make you tell me a run through the four different modalities, ultrasound, MRI, CT scan and X-ray? I know that those are like just big breathing for you, but I only found out the difference between a CT scan and MRI like a year ago. That was like most radiologists probably when they started training. I didn't know.

I was like, which one uses X-rays? I thought radiology was only to do with X-rays, but MRIs and ultrasounds don't use actual X-rays, right? So what is, like, what's the difference? Oh, and also CT scans used to be called CAT scans. Yeah. People still call them CAT scans. Okay.

What's the difference? Nothing. Okay. Just like an easy way of saying CT scan. Okay. Side note, CT stands for computed tomography and CAT, CAT, stands for computed axial tomography. The axial, it just refers to the way that the machine spins around you, taking a bunch of X-rays as it goes.

So CT scan, it's the up-to-date way of saying CAT scan. It's a new, easier phrase. With more syllables, CT, CAT, one's got two syllables. Okay. Pay attention because this is radiology in a nutshell. This is how it works. I guess within all the different specialties, we probably use some variation. Maybe use more CT or MRI in certain specialties, but, I mean, I can go through, like, how we

generate those images. Yeah. So ultrasound basically is sending a sound wave and measuring the echoes back, and different tissues will send those sound waves back at different speeds, and then we use that to construct an image. So that's, like, briefly ultrasound. And then X-ray, you know, like, X-ray is just, like, a form of, you know, like, one part of the electromagnetic spectrum.

We send X-rays from a source through the tissue, and then tissue, depending on how dense it is, will attenuate or stop the beams. And so, like, bone is very dense. It tends to stop a lot of the X-ray beam where something that's air-filled, like, the lung would let a lot of X-rays pass through it. Then all those X-rays are sent to a detector, and then an image is generated from that. And CT scan is like an X-ray, but it's, like, a moving X-ray, and it's two-dimensional. So that's how they reconstruct that image.

Oh, so a CT scan kind of revolves around you, so it's like an X-ray that does loop-de-loop in a spiral around you, and then it creates kind of, like, almost, like, a 3D image of your inside guts. Yeah, like, a 2D image that we can scroll through or step through, like, looking through your feet up through your body. And then MRIs are magnetic? Yeah, so an MRI, so most tissue, most tissue in our body is made up of water, which, and water has a lot of hydrogen atoms.

So an MRI generates a magnetic field, and we measure how the hydrogen atoms spin and what's their angle relative to this field, and we use that to generate an image. So that's different from CT and X-ray, in that it's not ionizing radiation. It's not, you know, causing radiation. It's just a magnet that's sending a pulse. Which is crazy to me. I had to learn what an MRI, the difference between a CT scan and an MRI for a shoot, and I was in the hotel room the night before, and I remember being like, wait, wait, wait.

All of your hydrogen atoms in your body line up? Yeah, we send a pulse to line them up, and then we see how they, like, fall down, or the, you know, speed or angles at which they fall down. How come you can be in the MRI tube? All of your hydrogen atoms are lining up like soldiers, and it just is like, doop-de-doop-de-doop. It's just... You don't die. Yeah, I don't really understand the physics of that yet.

That is something that I'm still learning in my trade, eh? So essentially, your body has tons of hydrogen atoms, like water, fat, lots of hydrogen. So we're made up of maybe 60% hydrogen. And hydrogen has an unpaired proton, which also has a magnetic spin. So when you have a strong magnetic field around you, like an MRI machine, these hydrogen atoms respond by lining up. So the machine throws out radio frequency pulses too, which causes the protons to spin again in the other direction, and that energy change can be detected by the imaging equipment

to figure out how dense and what kind of tissue you've got going on. This whole process makes a sound like a foghorn and a car alarm. I had a love child that had a lot of opinions. Now that is very, very super, super nutshell and not textbook. That's just the basic, like, what the hell is happening of it in case you've ever been in the clangy tube getting peeped at by magnets. Have you ever had to get a medical imaging done for yourself? Yeah, I have.

I tore both of my ACLs. So that's probably why I used that as an example earlier. What? Yeah. What happened? Doing dumb stuff. What kind of dumb stuff? I played, like, intramural basketball in college, and I tore my right ACL then.

Then I played flag football in med school for, like, five minutes and tore an ACL. I thought people in college who played flag football were only in Zima commercials. Like, they were only in, like, beer commercials. Being in Zima. You know, of, like, a happy, amazing group of college people just being, just having fun out on the field. Yeah. Had to hang up the cleats after that.

Oh, man. So, I've had, yeah, I've had those MRIs done, and the magnet's noisy. And even for someone who was, I wasn't in radiology residency at the time. I was in medical school. But even someone who was medically illiterate, it was kind of scary and, like, it's weird. It's noisy. You don't know what's going on. You're in there for, like, 45 minutes.

But it gave me some perspective on what it's like to be a patient in that magnet and maybe getting, like, a head, you know, a brain MRI, how much scary that would be when something's around your brain. Yeah. What kind of tools do you have to have in your pocket, like, psychologically to help patients? Because, I mean, TMI, I had to get a brain MRI last year, and my mom has MS, so, like, I'm familiar with, like, brain imaging, and it's kind of scary.

But I had to go in because I thought maybe I had a brain tumor, just, like, a pituitary tumor. Check it out. So I was, like, okay, well, I'm just going to go by myself. It's fine. And I got to the hospital, and as soon as I checked in, I started sobbing. I totally, totally unexpected. I was just, like, hey, what happened?

And then, like, the radiologist was, like, hugging me and, like, wiped mascara off my face. She's, like, you're going to be fine. You're going to be fine. That's good. Because it's just, like, you're right in the threshold of knowledge you might not be prepared to take. Yeah, definitely.

Do you ever have, do you ever see patients just fucking lose it? All the time. And I'm so glad to hear that a radiologist was, you know, able to comfort you before, you know, getting the scan done and everything. I mean, we can, for people who are really anxious, we can sedate them. We can give people volume and help them relax. But I think just talking to someone and explaining, you know, what's going to happen and how we're doing, how we're doing the MRI is really helpful.

And a lot of times, people will give you headphones to listen to. They probably didn't do that because you were getting a brain MRI. But with my knee, I remember they did. So it helps drown out the sound of the magnet. And in pediatrics, sometimes they give kids these little glasses where they can watch a movie to help distract them. So we have those kinds of tools to help, you know, patients go through these scans. If you have some shit going on that's not good, particularly with like neuroimaging,

do you ever have to have a poker face where you're like, okay, see you later, Mrs. Wilson. And then you're like, oh, wow, she's screwed. Or do you like the, because I think that's always what's so scary when you're, when you're getting diagnostics done as a patient is how long till I find out. And if it's something's wrong, will I find out now? Or will I just go about my business for two days and you know what I mean? So typically when we're reading the scans, we're in a reading room that's like dark with these huge monitors and we're far away from the patient.

So we don't always get to, I mean, we usually don't get to tell the patient like, oh, I saw this and I can tell you immediately. We read it and we dictate a report and it's sent to the electronic medical record. And then your primary physician may tell you. But when we're in the ER, we're reading emergent scans in the ER, if we see something emergent, we'll call the physician immediately and they'll tell the patient. But when we're in that diagnostic reading room, we don't get to communicate that to the patient. Right.

Because there's so many protocol steps that I'm sure it has to go through. Yeah. And there's just so many studies. Like we're just crushing studies. Oh my God. You can't pop up like a gopher and be like, hey, whoa. Yeah, exactly. Go to Disneyland tomorrow, man. Seriously.

Leave it up. Do you have friends that text you pictures of the inside of their guts and be like, hey, have a look at this? Really? All the time. And not just like the inside of their guts, but like rashes and stuff. And I'm like, man, I'm not a dermatologist. Or like, you know, just my family member has this like weird, you know,

she's getting nauseated every time she eats chips. I'm like, I don't know, like, that's not my job. Do you ever see someone like out and about like in line at the grocery store, like on a plane or something? And you're like, oh, I can definitely tell that they have like a certain condition that they may or may not know about. Yes. Really?

Yeah. Like, you know, sometimes I'll see people that are like really like short of breath and they have like really edematous legs. P.S. edematous means casually kind of squishy because of retained water. So next time you feel bloated, just say, my, my, my, I am an edematous fox today. Also, that's not really a joking matter because please take care of yourself for real. I'm like, they probably have congestive heart failure or something, you know, just like stuff that we saw a lot of in in medicine.

Would you ever tell someone? No, no, I don't think I could. Yeah, that's not really legal, huh? Yeah. Someone's like probably crossing some line. Someone's like, I'm just here to watch the boat show. Like, what are you doing? Just let me live my life.

So what else does Dr. Garasami working as an interventional radiologist do? So I'm so excited about like the neuro interventional radiology that we do. It's awesome. We do a lot of spine injections like I was talking about, but we do endovascular work, which means we work in the blood vessels, which is a lot of what interventional radiology is. So I can just give you an example of a really interesting case. Yeah, I had a lady that came in, she was at 60 something,

came in with a cute left-sided arm and leg weakness and like left-sided facial droop. So she's probably having a stroke. A stroke, yeah. So she comes into the ER, she gets a head CT, like that's what we would do right off the bat. So they ordered a CT scan where they injected contrast to look at the blood vessels to see if there's a clot causing her stroke. And one of the diagnostic radiologists saw something that looked a little funky. I was on call that night and I called my attending the neuro interventional radiology attending. And we brought this patient into the IR interventional radiology suite.

We went in through an incision in her groin, which is what we do for a lot of interventional procedures. So back in the day, when you did surgery, you would open the patient totally up. But interventional radiology is going through vessels, making a small incision and using X-ray guidance to know where you're going. So we're going through her right femoral artery. We're going up to her aorta, up to her internal carotids and looking at the vessels in her brain by injecting contrast and taking real time X-ray. Like I was talking about before, contrast is going into a certain location and then it's just not going past that. So we're thinking that's the area of the thrombus and that's what's causing her left-sided weakness. Wow.

The block is on the right side and it's causing the left side weakness. Right. So we put another catheter up through the vessel all the way up there and it's kind of attached to a little vacuum. Whoa. And you suck to the clot out and right after the procedure, we asked her to like move her left arm and leg and she could. Whoa. It was so cool. That was like one of those moments where I was like, this is why I'm a doctor.

Oh, my God. It was so badass. It's that's like the most heroic version of unclogging a drain ever. You know what I mean? Like you're like, yeah, got it. Now, where are you? Well, all this is going on. Are you six feet away?

Are you across the room? Are you operating a robot? Like how are you imaging while operating? We're right there. So, you know, we're standing right by her groin where we're we're using that access to manipulate wires and catheters up to her brain. Oh, my God. And there's an x-ray and that's like over her head, her head or neck. So it does seem like surgery as well as radiology.

Like how is it not in terms of the nomenclature? How is how is it not radiological surgery as what you know what I mean? Yeah, I think it's not surgery because we aren't cutting the patients open. And we're just making a small incision. So, I mean, I like to think of it as image guided, minimally invasive procedures. OK, because when this woman came out of her procedure, she just had a little band-aid on her groin, like a one centimeter incision. And we were like, we were just up in your brain, something clawed out. That's nuts.

Yeah, I just feel like if the guy that like trims your gums is an oral surgeon, like what you do is surgery, you know what I mean? Up in there through the brain, just like boop, when you were a kid, were you ever fascinated with like x-ray glasses or invisibility cloaks or anything sci-fi like that? No, I don't think I was. That's so interesting. I was really into blocks and building. And my mom said that they never brought me barbies because I was never interested. And people would come to visit and like I got like one or two as a child growing up

and I took their heads and like legs off. And she was like, all right, like Jeffrey Dahmer, like no more barbies for you. If they make you feel any better, we had barbies. And once my sister and I read about Jonah Vark and we're so inspired that we cut off our barbies hair and burned her at the stake in the yard. Remember, my mom came out to be like, rise to rowdies. What are you doing? We're like, she's Barbie of arc.

That's awesome. We took a Ken head and put it on a snake's body once put in the freezing. I don't know, 80s were a weird time. They were a weird time. But do you feel a little bit like a detective? Like, do you like puzzles and mysteries? Yes, that was like what I what really attracted me to radiology is I loved the puzzle. Every scan, every x-ray is a puzzle and you just do that all day.

I thought it was so fun. It's also mentally exhausting. Really? Yeah, like I leave every day feeling like I just took like the boards or they say I'm because it's tiring, but it's so fun. It's just never boring. And do you do a lot of it real time while the patient is kind of in the bay? Getting the scan or do you get it and then spend two hours

looking at everything slice by slice? It depends. So if it's something not urgent, like an outpatient, you know, shoulder, hip MRI, we may do that. You know, later, it may take a couple hours for things that are emergent. Like someone comes in a motorcycle crash and they get a head to toe CT. We're reading that very quickly within minutes. So the patient will come in, they'll get scanned in the ER scanner and the trauma team will walk in as the CT is being done.

Oh, wow. And so they'll expect you to go through it real time with them very quickly. And that's kind of where you grow up in radiology. I remember doing that rotation as a first year resident. And I was like, oh, no, I don't want to look stupid in front of the whole trauma team. For real, it's and it's like times a ticking. Yeah, exactly. Time is ticking. And what you say is important for their operative plan.

So, you know, we'll go through the scan quickly and just point out the big stuff. Liver lacerations, broken bones, things like that. Where we think bleeding may be coming from. So have you based on your work in imaging decided like that you're never going to ride a motorcycle? Yeah, I'm never running a motorcycle like this crazy. These people come in with the worst pelvic fractures. We're always like, why do people keep doing this?

Oh, why? It's like I. I would not sit on the top of a car. Yeah. Why would I just why? It's like driving a car, but without the car. I get it. It's quick. It's the fuel economies top of the line. But I just had a boyfriend that rode a motorcycle and I was like, every time it'd be like, well, if you die, goodbye now.

Like it's dangerous. They get just gnarly pelvic fractures. We had one guy who we were doing an embolization on for his pelvic bleeding. And he also had a very like severe de-gloving injury of his thigh, which if you don't know what de-gloving is, it's like kind of what it sounds like. But it's like your skin and your muscles being like, you know, just peeled off.

Oh, that's going to be no for me. Yeah. So do you have a strong stomach? Because if you went into if you were willing to go into surgery, like I can't I can barely salt raw chicken without like breaking down and crying. Like how do what kind of stomach or what kind of resolve do you have to have in order to put someone who might be hamburger meat on a slab? Yeah, I think a lot of us have really strong stomachs.

I think a lot of surgeons do. And there's only one thing that grosses me out. And it's a sound of like spit in your mouth. So like when someone's like intubated and they make that like spit noise, I'm like, that's the only thing you caprice on a gallbladder. But like saliva grosses me out. Like I can deal with poop and pee and blood just like blood everywhere. And I can't handle spit.

Yeah, exactly. I'm just like, bye bye. You're a survivor. Bye. Oh, my God. Oh, I had another question. I'm going to have to cut this out because I can't remember. Oh, yeah. So.

I had a boyfriend. He was telling me the story before I met him. He got into a car accident. OK. Rear ended and he had to go in. He was messed up. Like he lost a tooth, his neck and back were all messed up, right? So he went in, he had to get an MRI.

I think it was an MRI, not a CAT scan, whatever. And he was in bad shape. But he got he found out how much it was going to cost without insurance. And he went outside and threw up from the sub just from stress. Well, I think it was like $13,000 or something. Why is imaging so, so, so expensive? The machines are very expensive. They cost like millions of dollars.

And the time that we use the machines is very valuable. So that's why. I mean, I don't know why like an MRI costs like of $5,000 or $10,000. Like, I don't know how it gets assigned that number. I think it seems worth it just to purchase your own MRI. Just in case you need it. Let's talk about ultrasound goop. OK. The hell is that stuff?

The gel. Yes. The gel helps create an interface between the ultrasound transducer and your body because air doesn't let sound travel very well through it. So we use the gel to help the sound waves like go to the body and like come back. What is the gel? I don't know what it's made out of. I should look that up.

It's just ultrasound. It's made out of elf tears. You always see that in TV shows where like this like big blue goo. Yeah, this big farty goop of like like on a pregnant. Oh, yeah. And it's always cold. Always freezing. I've gotten an ultrasound of my thyroid before and they're like, you're like, goop it up. What is the goop?

What is the goop? So she emailed me later to say, quote, I asked like four radiologists what this was made of and no one knew. So I felt better about myself. So then I went, I did a little more digging. Your buddy, your pops, A.W. here, I found out that ultrasound gel is polyacrylamide and it's made up of glycerin and propylene glycol, a bunch of stuff.

But I stumbled on this one forum where someone was asking what to use if you run out of it. And folks were like chiming in that aloe vera gel or lotion works for their home Doppler machines. And then I was like, what? Some people have ultrasound machines at home. I don't even have a dishwasher. Anyway, I guess to check in with fetuses and like get a jump on parenting.

So Tom Cruise apparently was doing ultrasounds on Katie Holmes and baby Siri Cruz and the American College of Radiology did not like it. One Yale doctor through the following shade, quote, if Mr. Cruz and Ms. Holmes want their child to be a film star, they should wait until it is born. I hope that Yale doctor also does skin grafts because that was a sick burn. Oh, I have a question. You know, those airport X-ray machines.

Oh, yeah. They're always like, don't worry, it doesn't do anything to you. And I'm like, you're what? You're looking inside of my body to see if I'm smuggling any like drugs or weaponry. How much radiation do those airports scanning machines have? That is such a good question. I love this question about radiation dose.

So the background radiation that you're exposed to just by living and doing your daily activities is about three millisieverts. And a severt is like an SI unit that we use to say like if one severt is like equal to a 5.5 percent chance of getting cancer. OK. So now we're talking about millisieverts. So three millisieverts is just your background exposure to radiation. Just like walk around doing what you do.

Quick aside, what exactly is radiation and where does it come from? So it's defined as the emission of energy as electromagnetic waves or as high energy particles that cause ionization. What is ionization? I looked this up and I'm reading it verbatim. It's when an atom or a molecule acquires a negative or positive charge by gaining or losing electrons to form ions. So do what you will with that information.

It's none of my business. So there is background radiation we experience every day just from space and the sun and uranium in the soil, etc. But in the case of airport scanners, it said that they're about 0.02 micro severts per scan. That's what they thought. But then it turns out the technicians were just measuring them wrong. But the good news is it might only be a tenth of what they thought it was.

They took 10 measurements and a lot of them forgot to divide by 10. OK, guys. But I also went and looked at scans to see what the people at the airport are looking at and they can totally see your junk and boobs and stuff. See all of it. Anyway, speaking of boobs and something like a mammogram would be like 0.4 millisieverts. So like the equivalent to like six or seven weeks of just daily radiation,

which is nothing. I know like people always worry about getting exposed to radiation when they get a chest X ray or a CT scan. But when you think about what you're exposed to daily, it's not that much. And we're talking about millisieverts and one severt would be a 5.5 percent chance of getting cancer. What if I travel a bunch?

Yeah. And I'm going through those things all the time and on airplanes all the time. Yeah. So I like a cross country flight in an airplane is like 0.03 millisieverts or something like that. That's like the background radiation that you would get. So all this radiation, I mean, you have to get exposed to a certain amount of radiation before you would, you know, maybe get something start to cook your own body. Right. What happens when you're exposed to radiation?

Like, what's the risk here? Is it changing your gene expression? What's going on? So radio ionizing radiation or like UV radiation causes breaks in the DNA. And your body has ways, your cells have ways of repairing that DNA. But sometimes it doesn't. The DNA just gets wonky and it's it's replicated in this like wonky state. OK. And that's how you get cancer.

So that's how radiation would cause cancer. OK. But you would have to get, you know, exposed to a significant amount for that to happen. OK. Good to know that puts me at ease a little bit. Good. And the other thing is about the airport scans is you can always opt out and then you get like a free. Yeah, you get the full. You get the massage. Yeah. Someone and if you've been traveling and you're a little lonely

and then someone just comes and caresses your back looking for weapons. I didn't refuse to scanner. They just were like, you're getting the pat down. And I was like, all right, whatever. I saw a guy get a pat down the other day and he just willingly dropped his pants and they were like, sir, sir, you can keep them on. And he was he was so like indignant that he was getting batted down. He was like, have a look, look at everything.

And they're like, sir, please. I like how they do the back of the hand. Like it's less invasive when they're like rubbing your vagina. They're like, OK. They're like, I can sense less. But just to know I feel slightly less violated, I guess. If you listen to the gynecology episode right now, you're thinking about vulva taxonomy and I'm proud of you for that, kiddo.

On a first or second date, I only let someone touch me with a back of their hands. Don't give me that front hand. No, no front hands till marriage. OK, I have questions from listeners. OK, are you ready for a rapid fire? Oh, my goodness. You can take as long as you want to answer these. I call it rapid fire, but I never hold anyone.

OK, good. But before we take questions from you, our beloved listeners, we're going to take a quick break for sponsors of the show. Sponsors, why sponsors? You know what they do? They help us give money to different charities every week. So if you want to know where oligies gives our money, you can go to alleyword.com and look for the tab, oligies gives back.

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Gary Jungling wants to know, are radiologists always afraid of becoming sterile or getting cancer? That is like right to that is a good question question. So being exposed to radiation is a occupational risk, especially in a in a field like interventional radiology, where you are exposed to more radiation than a diagnostic radiologist. Why is that? Because you're using real time x-ray, like I was saying.

And so you're standing next to the machine that's producing the x-rays. OK, so we wear lead suits. Oh, so we wear like a lead thyroid collar. Whoa, a lead vest and like a lead skirt. And that helps reduce some of the radiation. We wear leaded glasses. Wow. So we all leaded up. What about lead poisoning?

I wasn't sure if I was just being paranoid. So I looked into it and last year, the American College of Radiology published a paper that means no words. This was the title, quote, lead aprons are a lead exposure hazard. Dang, OK. So they collected 172 lead garments worn by radiologists and they took down the age and the appearance of the aprons, not the radiologists.

Anyway, 63 percent had detectable lead dust on the surface. And the shittier the apron looked, the more lead dust was typically found. Now, interestingly, garments kept on hangers had fewer positive lead tests. So maybe you need new lead garments. I found a site that has a whole catalog and it was very fetching. Different patterns, different colors, skirts, thyroid colors and even things called gonad shields, which resemble like large eyepatches.

So keep your radiation garments look of fresh and unhazardous. You can replace old ones or hang them up in a fashion that would make even mommy dearest proud. I bought you beautiful dresses. And you treat them like they were some dishrag. But no matter how you hang them, those lead blankets are fucking comfy, right? Whenever they put the lead blanket on me at the dentist,

I'm like, this rules never take this off. Oh, it's so like heavy. I know, it's like they sell those anxiety blankets when you're like, oh, yeah, I could just go to the dentist and hang out there all day. I find the lead very comforting, too, because it just like, you know, isn't it's just fitted to you. But when you're in these procedures for a really long and you're wearing a sterile gown, masking gloves and everything over it,

you can sweat a lot. Oh, so you might get stinky, but not sterile. Yeah. So do radiologists worry about that? Or do you feel pretty well protected? I feel pretty well protected, but we wear radiation badges that measure how much radiation we're exposed to. So you'll get a warning if you've, you know,

been exposed to too much radiation, and we can reduce the amount of radiation we're exposed to, not just by wearing the lead by but by also imaging smaller parts of the body. So you take a lot of precautions? We do. OK, good. Megan C. Great question, Megan.

Weirdest thing they have seen inside someone? Man, this is such a good question. We actually people like to talk about the things that patients put in their butts. I think the weirdest thing I've not seen anything super weird. Someone had a rolled the one of those like old school rolling deodorant things a roll on. Yeah.

Like a wet like a band roll on. Yeah, except for butt stuff now. Whoa, that's a butt stuff. Yeah, but I mean, people I heard about someone who put a beer bottle in there, like a Corona. Man, you can Amazon Prime anything you need these days pretty anonymously. So after this interview, the doc and I exchanged a series of text messages from radiology textbooks.

And I honestly. I don't know where to start. I will say PSA, if you would like to experiment with pleasures involving forbidden orifices to hit up Amazon Prime, free shipping, get yourself something rubber. I was treated to photographs that looked like a gauzy human body was being haunted by the ghosts of a beer bottle. Or as one text message from another radiologist said, quote, beer bottles are child's play. This is a 1979 Left Bank Bordeaux, which is a wine.

Bottle. You know what I mean? So the most common improvised rectal foreign body as medicine politely demures seem to be containers that once held alcohol. What are the chances Gatorade bottles to leaders of Mr. Pib they just don't seem to incite insertion experiments quite in the same fashion. But still one X-ray image entry on a radiology site. And yes, I Googled some one was called Radiopedia reported that aerosol cans are a relatively common improvised rectal foreign body.

And in this one just stunning illustration of X-ray versus CT scan imagery. Oh, my God, I was sent a photo from one super famous case that involved a synthetic human fist. This is a forearm up to the elbow that had just simply gotten away from someone just slipped up out of reach there. And in the X-ray, it's blurry and faint. It takes a minute to like see it and get your bearings kind of like a faded super imposition. But by comparison on the CT scan, it's like watching a 3D IMAX documentary about fisting. I will put it on the Patreon page for the truly curious, but no matter what the lesson here is,

just don't opt for items that shatter. OK, Corona long necks are like, don't look at me, man. I know, right? That's not what I'm here for. Exactly. I have to deliver beer to your mouth. Have you ever seen anyone swallow anything weird like car keys or? Yeah, I we did X-rays on a patient that swallowed razor blade.

She's swallowed like parts of a spoon. Oh, so first intervention is getting those things out, right? Yeah, especially like something like a razor that's going to, you know, be getting things on its way down. Do you have to go in and do like laparoscopic surgery? Where does that go? How do you how do you escalate that case? So, I mean, for us, we would read the X-ray and we'd be able to tell the surgeons where it was. Or maybe the GI physician who would go down and scope it and try to fish it out.

That seems what do you do? Put a magnet on a string? I don't know. Yeah. So don't swallow the stuff, guys. Jordan S says, really dumb question. Why do certain types of ultrasounds feel so uncomfortable, particularly abdominal and pelvic ones? Because sometimes we have to push down really hard to get a better picture. So you might feel a lot of pressure when someone's pushing on your stomach or like on your kidneys.

And the other thing is, if you're ultrasounding something, chances are there's something funky going on down there. Or yeah, there's something that brought you there. Also, like ultrasounding your bladder is like uncomfortable because it makes you feel like you have to pee. That's true. Does anyone ever pee on a table? Not with me, but I wouldn't be surprised. We also ask when we do pelvic ultrasounds, we ask patients to have a full bladder. And we may give them fluids or have them drink a lot of water because it was like we're talking about air is not a really good medium for allowing sound waves to pass.

So fluid in the bladder gives us a good window. So that's like another trick or whatever. But it's really uncomfortable when we're looking at your uterus and we're pressing on this full bladder. I've had a lot of patients who were like, I really need to pee, I need to pee, I need to pee, I need to pee. And I'm like, just hold on please. You're like, that's the point. Yeah. It's working out just as I wanted to.

Jennifer Buzz asks, do you ever harness the radiation in your workplace for your own purposes? For example, leaving your pet tarantula next to it and then coaxing it to bite you, making rocks glow, etc. Also, do you ever wear the ledge shield just for fun or for exercise? Man, I should wear that ledge shield for exercise. Like go out like a little run with it. Up and down the stairs in the hospital. Yeah, that would be nice. No, I've never done that.

And I mean, I don't think we use enough radiation to do anything like really exciting. To become a superhero or anything? No. I guess it's kind of illegal. Probably. Rump. Well, Jennifer Buzz, if she does do that, then she shouldn't get the idea from you. Bob wants to know what kind of fun, cool things have you scanned after hours?

Ooh, I don't do that. We're not like allowed to. Would they know? Would they be like, wait a second, this MRI has been used 12 times today, not 11. Oh, yeah. They would definitely know. To do that, we'd have to like, you know, put it under a patient. That would be medical fraud.

Yeah. It's not like using the microwave. Yeah. So I haven't done that. Sorry. That's not interesting. You've also never been to jail. That is true.

Jack Keller wants to know, why are we still using such old technology? Isn't there something more modern that's less dangerous? That is a little bit of shade thrown at x-rays. Dang. I know. It's debating here. Yeah. I like it.

I mean, they've been around forever. That's true. X-rays have, but I'm, I mean, they're still good. You know, it's a little bit of radiation. Just getting a chest x-ray gives us a lot of information about a patient. And we can use that as a screening tool to get more advanced imaging like a CT or an MRI or decide if the patient needs a procedure. So this, yeah, these things have been around forever, but they work and they're safe.

What do you think about the history of x-rays where, didn't Edison try one on like an intern and ended up killing him? Like he tried it like a million times. Have you heard that story? No, I haven't. I probably should have. But I know about like Rankin who like invented the x-ray and like the first x-rays of his wife's hand and you can see her ring.

Oh. Yeah. That's cute. Was it cute? Well, William Rockin, the German man whose name I probably just mispronounced. In 1895, discovered and named x-rays after x because it was an unknown ray for radiation. Made the first medical x-rays of his wife's hand and it looks kind of like a fuzzy x-ray. You can see she's wearing a ring in it and upon seeing it, she said, I have seen my death.

But I don't know. Germans are so goth. Now, as for Edison history with radiology, Clarence Madison Daly was an employee of Thomas Edison and after many, many, many, many experiments with x-rays, he developed carcinoma on his hands and then arms and despite amputations died. Thomas Edison was quoted in 1905 as saying, quote, don't talk to me about x-rays. I'm afraid of them. So he was like, I don't fuck with x-rays.

Of course, this was early on while we were still like writing donkeys to work and indoor plumbing wasn't really a thing and we didn't know a bunch of stuff. Moving on, April wants to know, is being big boned really a thing? Oh, hmm. Yeah, I guess some people have, like, bigger or more dense bones. I mean, you could find this out if you've got a dexa or a bone scan. But whereas, like, you're just big boned, you're not fat. I don't know about that.

Like the subcutaneous tissue doesn't lie. Like, if there's a lot of tissue there, then it's not your bones. I guess could you say I'm just ample with subcutaneous tissue? Yes, I have an abundance of subcutaneous tissue. And that's why my bathing suit doesn't fit. You're welcome. Which I'm in that. I mean, both of us.

That's why my pants split this week. That's why my pants split this week. Hashtag diet stars on Monday. Both of us, I feel like we're speaking from a place of ripped pants. So like, we are not throwing shade. We get it. For the sake of transparency, I'm just going to come out with it. The week that we recorded this, both myself and Dr.

Garasami, separately, totally randomly, had border of male functions involving trouser ripping. So she, as she got into an Uber and nice slacks and myself as I foolishly tried on jeans that I had not worn in some time. Trousers, zero points, subcutaneous tissue in the lead with two points. Greg wants to know, where are we with 3D printing and AI integration as tools for radiology today? Like how much improvement in medical imaging technology can we expect

within the next couple of years? Well, I'm so glad he asked this because we were talking about AI artificial intelligence at this conference. So we use some computer aided detection or some form of artificial intelligence now, like especially in mammography. We use something called CAD or computer aided detection to help us find lesions and breasts, like masses that we may not see, just like little tiny things. And that's just a tool that the radiologist has to make sure they're

being very thorough and looking at everything. And that's probably what we started with. And now we're expanding that to looking at things in chest x-rays and CTs. But what this talk that I went to today was from these radiologists in Stanford we're talking about was that they won't replace radiologists necessarily. It may notice that something's wrong, but you have to use the context. Like you have to know the medicine and understand what the meaning of that finding is.

So these are all just tools, but they are definitely changing the way that we read scans. Is it kind of like you can be a writer and spell check helps, but that doesn't make you a writer? It's a tool, but not you can't rely on. Yeah, something like that. And I think those algorithms for recognizing, you know, findings in imaging are just getting better and better. Do you have to consent to have your images put in that database?

I think so. I think they must, yeah. I think that's nice though. Yeah. I mean, you know, if it can help someone else. Your contribution. Yeah, you know, put your, put your guts in the library in the gut, in the gut berry. Carolyn Steele wants to know, I had a hip arthrogram last year and found out afterwards

about Chuck Norris's wife and the gadolinium toxicity thing. Is this madness or should I be concerned? I want you to know, by the way, Ially word don't know what most of those words meant. Yeah, that's fine. Gadolinium toxicity and a hip arthrogram. I do know what Chuck Norris is, but address that. So gadolinium is the type of contrast that we use in MRI. So we didn't talk about this earlier when we talked about imaging, but we use contrast

to help opacify or make the blood vessels more dense or the tissues that are being fed by blood vessels may look brighter on a scan. There, there are people that, you know, may not respond well to gadolinium. It's processed by your kidneys and eliminated by the body through your kidney. So if you have kidneys that aren't functioning well, that puts you at a greater risk. And some people can get toxicity from gadolinium, even though that they didn't have problems with their kidneys. So this is just a, you know, like a very rare risk.

Chuck Norris and his wife, Gina are suing, get this, I just looked it up for $10 million. Also, then I went down a rabbit hole about Chuck Norris trivia. Brazilian jiu-jitsu black belts, which he has, tooth veneers, which he also has, mustache memes, but then I hit some stuff about political affiliations and a stopping fun. Anyway, as long as we're on a downbeat, this episode was recorded a few weeks ago. And this next question comes from a patron and an oligite and an internet friend of many years who I just found out passed away suddenly today. So I'm so sad to hear it.

I know he loved when I read his name and his questions. He loved the show. He was an awesome friend to the pod. So please raise a glass and send some good cosmic vibes to his wife, Chris. Brian Edge wants to know, are people too worried about the side effects from imaging? No, they're not too worried. I think that people just don't know. And I didn't really understand, you know, I couldn't really quantify what was,

you know, how much radiation I was being exposed to from an x-ray versus how much I was being exposed to just by living my life. So I think that's a really valid question. And I like when patients ask that and we can explain it to them. And I feel like we can dispel some of the like fear and myths behind getting, you know, imaging done. So that's a valid question. That's a valid question. Hillary Mazer wants to know, how do radiologists learn to read images that just look like fuzzy

blobs to the uninitiated? Man, it's really hard. Yeah. You're like, that's why I'm a doctor. I mean, you know, you kind of have some idea in medical school because you get exposed to some imaging. You look at a little bit of ultrasound and CT and MRI through medical school. So you have some framework and you know where the organs are relative to each other.

So you have a little bit of an approach. So people tend to develop a search pattern. Maybe they start looking at the lungs and then the heart and then the bones or whatever. On a CT scan. So we, you know, try to approach things methodically and systematically and, you know, ask for help, look at resources. But it takes a long time. There's a lot of anatomy.

We're doing all the anatomy in the entire body and in weird, like three dimensional, like rotated ways. So it's complicated. I imagine it must be like, if you don't know a language well, it would be really hard to discern regional dialects. But if you have spoken it for years, you would be able to say like, Oh, are you from Philadelphia? Or, you know what I mean?

Yeah. Little things, the more familiar you are with something, it must get easier to pick out abnormalities. Or so glad you use that analogy as language because this is what I felt like it was when I was a first year radiology resident. I was like, I don't know the language. I don't know what you guys are talking about. Like Millie Sievert.

What's that? And the physics of radiology is very complicated. So I feel like now I speak the language and I can understand what people are talking about. Paulo Hanley wants to know, you know, if you're behind the scenes when a patient is getting a scan, do you have any stories of like good news where you saw something where you're like, whoosh, all clear. Like, are there any of those like feel good moments? All the time.

Oh, that's cool. We get, you know, scans for people where they're, you know, have like vague abdominal pan. You're like, oh no, like what's this going to be anything? And we're just happy when it's like not something terrible. I would just like to take a moment to impart a family story. So my older sister, Janelle, used to get migraines. And one day I went to visit her in Detroit and I asked her how her head was feeling.

She got really serious and she told me she's glad I asked. She's been to the doctor and they discovered a growth and she waited until I had tears on my actual face. Also, it was my birthday to clarify that this was her way of announcing that I'd be getting a niece or nephew. The growth was a baby. Her head was fine. She just is a rascal and I'm still shaken.

It was a great prank and a great joke, but it was my birthday crying. But my nephew is super cool. So all is forgiven. Now, what if you were growing shards of a skeleton that's not a baby? It is exciting when you see something unique that's like a learning opportunity. But usually something that's fun and interesting for a radiologist is probably not good for the patient. So we try to understand that or remind ourselves of that.

You're like, you have a teratoma. They're like, fuck you. Exactly. Have you ever seen a teratoma? Yes, I have. They're so cool. They have teeth and hair inside of them. They're awesome.

What do they look like? I mean, I've seen pictures. If you really want to, say, cut down on your snacking, all you have to do is google image search teratomas and you will not be hungry. Or play the sound of someone's secretions. But what was the first time you saw a teratoma? Just to get you up, a teratoma is a random ball of bones or teeth or hair or tissue. It's like a ball of hair that just grows inside some people for decades for no reason.

They aren't even tax deductions and no one gives you their seat on the bus if you're growing one. So it was like an ultrasound of, it was a pelvic ultrasound. Oh, so it was like on the ovary? Yeah. It was, what are those called, some kind of cyst? Dermoid. Dermoid. Yeah.

So we saw a little bit of calcium and we saw this kind of like wavy pattern that was like the keratin or hair and we're like, oh, we're gonna get an MRI of this. Oh, god. And then yeah, we could, yeah, it was pretty neat. Do those people get to keep the teratomas if they want? No. Oh, you mean when they're removed? Yeah.

No. They, we send them to pathology because the pathologists have to slice up the tissue and make sure there was like no underlying kids or anything. 01:00:32,720 --> 01:00:36,480 So you never get to, I know people ask to keep weird things. They ask to keep everything. I mean, if I grew teeth in my butt, I'd be like, let me keep it. I worked 17 years on that.

No. I got an extra set. It was like wind. Seriously, like so gross. They come from the word for monster. Oh, they do. Yeah. Teratoma.

It does sound really terrible. Yeah. It comes from, you're like, I grew a monster in my body. Anyway. Awesome. Mike Melchior wants to know, is it true that X-rays are actually visible to the naked eye? Uh, no. Okay.

Good to know. Jennifer Overby wants to know, are dental X-rays worse because radiation is shooting directly to your head? My mom told me this at some point now. Every time I go to the dentist, I'm sure that it's taking years off my life. No, they're a really low dose. Krista Avampato wants to know, I know there are so many mixed opinions about mammograms and ultrasounds for women.

What's the right age to start them? And if someone has a risk factor like family history, should they start them earlier? So are there any new innovations in the works that might replace mammograms? And Krista, I'm going to guess that you had an uncomfortable mammogram. Yes. I've never had one myself. Have you ever had a mammogram? I haven't.

No, they just squish your boob. I mean, I've seen them. They look really uncomfortable. So we typically start them at age 40 unless they've had some risk factor. If they have first-degree relatives that have breast cancer, we may start them 10 years before. Okay. But people with women who are 35 or younger and have very dense breasts may not... They usually don't get mammograms.

They'll get breast ultrasounds because your breast tissue is so dense. Do you think they're going to have different modalities for imaging that doesn't involve making a fruit roll-up out of your boob? It does feel like they squish it into fruit leather. The reason that they do that is so they can spread out all the tissue and it's less dense. So it helps us scan through it and see things better. Dr. Garasami says that in higher-risk patients, like those who might have the BRCA gene mutation, a contrast-enhanced breast MRI can detect breast cancer.

It has a sensitivity of up to 90% with the MRI versus 38% for mammography or ultrasounds. So 90% versus 38% pretty good. Way to go contrast-enhanced breast MRI. Tuck those stats in your breast pocket like a kerchief. In all of this, though, with any of this comfort, you're like, it's better to be uncomfortable for 15 minutes than to be not alive. Yeah, I use that kind of message a lot. The shit I've been through for one to two months of having a hair-free face,

you know what I mean? What's one thing about your job that sucks or about radiology that frustrates you? Let me think. I mean, it's tiring. Like, so we sit a lot when I'm not doing interventional radiology stuff, when I'm not doing procedures and I'm doing the diagnostic part. I'm sitting a lot and I'm just sitting for 14 hours and it's so busy. And I think sometimes people think there's a misconception that we just sit in that room

all day and we don't talk to patients or we don't do procedures and that's not true. But I think because we're sitting in the room is dark and we can listen to music that we're not working hard, but it's hard. What kind of jams do you pump? Oh, all kinds of jams. Like on nights we were like old school bone thugs. Really? While you're diagnosing like all sorts of crazy stuff?

Yeah. That's fantastic. Actually, bone thugs is like kind of appropriate considering that you are. It's like kind of quiet and like, oh yeah, bone thugs. Like you're looking at bones. This is true. Never thought about that. It's a little fun fact.

Until radiology was developed, scientists had no idea that the busy bone was connected to the wishbone and the wishbone was connected to the lazy bone. The lazy bone was connected to the crazy bone. The crazy bone was connected to the flesh and bone. So this aside is only going to matter to you if you're familiar with the bone thugs and harmony roster. What is your favorite thing about what you do or the most rewarding aspect or something that's just super really peaks your curiosity? I love that radiology is like so technological and it's always changing like with the

artificial intelligence and with interventional radiology, we're always coming up with new techniques to like get in the brain or get to where we're going. And I just love that it's always changing. And I like the puzzle of reading the scan and I love working with my hands. It's just for me, it hits everything. So after the interview, Dr. Garasami, aka Varsana emailed me some links and at the very end she said, quote, we talked about my least favorite part of my job, which was when people thinking I was just chillaxing listening to bone thugs rather than mainlining CTs, MRIs, etc.

But I think what goes hand in hand with that is that radiologists really have an image problem. She goes on to say, I realize the irony in saying this given we are imagers. Reading someone's scan allows you to know, see them in a way they may never be able to see themselves. It's weird and beautiful and so damn interesting to see your innards the way we do. Have you ever gotten anything back from patients where they were really kind of surprisingly grateful for what you do? Does anyone ever bring you donuts or anything? No, but one of my co-residents got a bunch of socks. What?

They weren't like compression socks, which would have actually been really helpful because we're standing, but they were just like nice wool socks. Then it was really sweet because it is cold in the angiosweet where we do our procedures. That's really sweet. Yeah. So thank you radiologists. Honestly, some radiologists are the first line between like you and a box of Kleenex. I will never forget going in for that MRI and just crying and having someone be like, it's okay, it's gonna be okay. That's so good to hear. It's almost like dealing with like shelter dogs or something where they're going to be shivering and kind of scared. And breast radiologists deal with this a lot because for women, I think sometimes we feel

like our breasts are just ticking time bombs and you know you have to go in and get that mammogram, like you have to go get your colonoscopy or whatever. And when you may need another study or an ultrasound, the radiologist is right there with you and they're explaining things to you. And I think that part of radiology that, you know, real direct patient care is really helpful. Yeah. Meaningful. I mean, it's crazy that you are a conduit to so much knowledge about someone's body. Like it's kind of cool. Yeah, that's true. You're like an interpreter between like me and my body. You're like, okay, let me let you know what's going on. Like that's pretty cool. All your insides. I know. Look at my guts. Thank you for letting me ask you so many questions. You're

welcome. I hope I was helpful. Next time I get any kind of body scan, I'm just going to send it to you first. You should. Don't send me a rash. So save the rashes for your dermatology friends, people. Now for links from this week's episode, head to alleyward.com slash allergies are for super sensitive pictures, you can become a patron for as little as a dollar a month at patreon.com slash allergies. That means you get to ask all just questions and also see photos in this case that are too delicate for Instagram. Dr. Varshana Garasami is on Instagram and Twitter, but much like the things that you have wedged in your rectum, her accounts are private. I myself am very publicly at alleyward with 1L on Twitter and Insta and allergies is at allergies on both.

Now to rep the podcast to start some conversations about it and also cover your nude body, you can head to allergiesmerch.com for shirts and sweatshirts and pins and dad hats. The proceeds help support the show. They let me pay my amazing merch folks, Shannon Feltas and Bonnie Dutch as well as editor Prince in the kingdom of podcasts, Stephen Ray Morris. Thank you, Aaron Talbert and Hannah Lippo for being admins in the online science party that is the allergies Facebook group. The music for allergies was composed by Nick Thorburn and please do not forget to ask smart people dumb questions. Just do it. They're so fun and learning stuff and making connections is why we're all here on the planet and while you're at it, while you're asking smart people dumb questions, tell someone today

that they are great and you're glad that you know them. Okay now for my secret at the end of the show. I went to like pluck a hair off of my body and I just didn't grasp it right and instead I curled it and it was really upsetting. I just curled it like gift wrap ribbon and I was like come on. Sometimes it happens. Okay, bye-bye. Cup it up.