Sawbones: A Marital Tour of Misguided Medicine - Hot Medical Question Summer

Episode Date: July 13, 2021

It’s time to answer more of your medical queries, like what is Texidor’s Twinge, when does the sunscreen clock start, and yeast infections: why?Music: "Medicines" by The Taxpayers

Sawbones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. that weird growth. You're worth it. Alright, talk is about books. One, two, one, two, three, four. We came across a pharmacy with a toy and that's busted out. We were shot through the broken glass and had ourselves a look around.

Some medicines, some medicines that escalate my cop for the mouth Hello, everybody welcome to wow got a little Greg Brady right to say your voice changing finally Hello, everybody and welcome to saw bones marital tour of misguided medicine My name is just a microwave and I'm Sydney, Mac, or I welcome to the show. Sorry. It was very disconcerting Wait a minute. Where do you think my voice is gonna go next? Oh, I'm excited to see what happened. I'm gonna dig it down here. I mean, I think it's gonna be one of these guys, one of these numbers.

Welcome to podcast. I don't know. That's why I like best when we podcast early in the morning when we both have nice low voices. Nice low voices. Nice low voices. By the end of the day, there's just nothing left. Yeah, nothing left in the tank.

Sid, this is one of my favorite episodes. It requires very little preamble. We've done them before. We're doing it again. And I feel like this is the one where we can actually help people. You know what I mean? Cause they bring to us their weird, wild,

wild and wonderful medical questions. And we actually help. I don't know if I help people. I've thought about this a lot. I think that we try to, on this show, for myriad reasons, most of them that I want people to actually get help that they need that's appropriate to them and personalize and not just generic answers from podcast type health health health help that made sense.

So I try never to answer actual medical like I need a doctor to help me with a problem questions. You know what I mean? Because you should actually go see somebody who can evaluate you and do all the proper stuff. Not just read your question on a podcast. So these are more like curiosity I think think, just a, I also want to know. Yeah, I, so we try to stay on that level. If I actually do end up helping someone, that's a, that's a little icing on that podcast cake.

And let's cut into our first slice of podcast cake right now. What would a podcast cake taste like? What flavor would it be? Well, flavor would it be? I don't know, that's a very big question. Take it from me. I wrote the book about podcasting. There's not just one cake.

There's lots of different cake parts. That's true. I had some are deep and rich and some are light and fluffy. And all of them are outclassed by pie at every turn. I think we can agree that, agree to that. No matter what kind of cake the podcast cake is, the pie will always do better. I don't agree at all.

We cannot rehash the cake first pie argument on this show. Cheesecake is cake. First question. You can't just do that. First question. And immediately after getting a vaccine, before the doctor puts the bandaid on, could you squeeze

your deltoid and squirt the vaccine back up the hole? I love this question. I'm not sure it's no, right? This is for Mal. Alright, thanks, Al. No, you can't. I do like this question. It's a little case L, so it can also be AI.

So this could also be some sort of learning routine. It's trying to calculate how a human client might works. If you've ever given or received like, especially a larger volume injection, you may have seen a little droplet like right outside the puncture at the end. So I could see where the beginning of this concept would come from, but you have to remember, and I think I may have used this analogy on the show before. What you're injecting into is a lot more like a sponge in terms of the tissue. Yeah, it's not like a water balloon.

It's tissue, that's good metaphor. Yeah, and so tissue is a good metaphor because if you think about something like a Kleenex or a paper towel or something you couldn't just Like squeeze like lay it flat on a counter and push your hands on it and expect all the water to come out Yes, so like if you immediately squeezed could you like get a drop out like the last drop that just went in that has not yet been absorbed possibly a drop out, like the last drop that just went in that has not yet been absorbed possibly, but the whole vaccine would not come back out or whatever your injection was. And I think this goes without saying, don't do that. Don't do that. Because whatever you just got injected in you, you probably, I mean, I hope you wanted

it there. It's good stuff. So, and vaccines are great. So, I mean, I wouldn't try it, but even if you did, you wouldn't be able to, you wouldn't lose that vaccine power. Get vaccinated, everyone, not just you out, everybody. Thank you. Interesting question.

In MASH, they have a few episodes which center around a hemorrhagic fever. Oh, C-E-N-T-R-E, I see we've got an intercontinental. Listen here, somebody's a little fancier. Center around a hemorrhagic fever, which they treat slash managed by restricting fluids. Is that an actual thing for certain hemorrhagic fevers? Or was that a depiction of a 1950s slash 60s slash 70s medicine? I believe the episode Soldier of the Month in season four when it was first brought up

And that's from Freya. Thank you for it So yes, I'm I'm really glad that you asked this question because I love mash I think I've made that clear on the show love mash Love the opportunity to dive back into an episode of mash to try to figure this out. And I think that this topic in general deserves a whole episode unto itself at some point. I did want to briefly answer the question though without spoiling too much of what, like I said. A MASH.

I won't spoil MASH for you. For all those who still haven't gotten around to watching MASH. The hemorrhagic fever that they're talking about is one of the Hanta viruses, Hanta Viridae, which is like a family of different viruses that the Hanta virus we know in the U.S. usually causes lung problems. There are also these hemorrhagic fever with renal syndrome, which is actually the way they're

abbreviated, HFRS, meaning you got one of those viruses and they caused kidney problems. It was a huge problem during the Korean War. It's estimated, the exact numbers aren't known because at the time you didn't always know what you were dealing with, right? Much like in the episode of MASH, I don't think they specifically say what it is. They talk about this in other episodes too. But about 3,000 soldiers got this syndrome, estimates are that maybe 300 people died of it, so it's a big deal.

It would, like I said, it would cause fever, headache, nausea, but also kidney failure was the hallmark of it. When your kidneys aren't working, they're one, they're not filtering stuff out right, so you can get really sick from all the stuff that's building up, the toxic stuff that's building up in your body. But the other thing is you get fluid overloaded. So you get a ton of like swelling. Your body can get swollen your legs, but also your lungs can fill with fluid, which is

bad for breathing, and can cause you to go into respiratory failure, which you stop breathing, and that's not really compatible with life, long term, to put it mildly, especially if we're talking about someone who's out in the field. Yeah. So fluid management was the main thing that they had to do for these patients during the war,

is restrict how much fluids they're bringing in in order to make sure they didn't get too fluid overloaded, but still give them enough fluid to keep so that they didn't have vascular collapse. Anyway, yes, this would have been one of the main treatments at the time. We would probably manage this differently nowadays. And certainly, they were managing this differently if they were actually like in a hospital somewhere where they could get the full range of critical care

that was offered, but out in the field, this was, I mean, it must have been a huge task for the doctors and nurses who were out, you know, on the front lines having to manage these patients because they were critically ill patients. But yes, fluid restriction would have definitely been part of it. So it's really interesting.

Does make sense. Slightly different than what we do today, similar, but we would be, you know, we'd use numbers and stuff. We'd use labs. Yeast infections. Yes. Why? It's kind of a deep one.

Why? Why? Also are there stages of yeast infections? Sometimes I experience discomfort in my bathing suit region, but when I use vagicill, it helps right away. Is that a different situation or is that an early stage of yeast infection? Also, can anybody get a yeast infection? Thanks.

That's from Ariel. I don't know if you've got the people to read. I don't know either. So yeah, okay. First of all, why? I think it's I don't know if we've ever talked about this before on the show. You know, I don't know. Maybe I may have mentioned it. So yeast grows when other when it's out competing other things that grow. We are supposed to have those of us who have vaginas. We are supposed to have, those of us who have vaginas, we are supposed to have a natural flora there.

There is bacteria that it's supposed to be there, and it's fine, it's good and healthy. There's no problem with it. If something gets thrown off, where yeast can grow better than that good natural bacteria, then you can get a yeast infection. So the yeast is out competing for growth in space, right? Overpopulates.

There aren't like defined stages in the sense that like, I would look at a yeast infection and grade it, like in my documentation, like this is a great one or a stage. We got to get in here. I mean, certainly you can have more severe infections, or like if you just begin the yeast growth, you know, to notice some symptoms, maybe you catch it before more severe symptoms happen. I wouldn't say it's a protocol or anything. They're all treated fairly

similarly in terms of there are pills that you can take that are prescription and then there are also a variety of over-the-counter creams and things that you can both apply to the outside. And then some of the creams, and anybody who's ever had yeast infection might know this, come with these little sort of injector things where you fill the tube with cream and then squirt it inside the vaginal cavity. Anyway, the point is that anybody can get a yeast infection. You can get yeast infections anywhere that's sort of like warm and damp and not necessarily exposed to the air. So not just in like a vaginal area,

you can get them in skin folds. They can happen under breasts or anywhere where there is, where there is skin touching skin in a dark moist area underneath. You know, I said it figures. I try to get yeast to bloom from my conscious, from my sweet breads, and they die. But then somebody just have an armpit and just get it. You just have to have an armpit.

Just get some, I get some without any work at all. It's worth noting too. Like it's the same thing if you've seen thrush in babies in the mouth, you can use infections in the mouth or in the throat You can grow a lot of places Um if it's something the vagicill clears up if you have some sort of discomfort That could just be some irritation or some dryness those kinds of things especially like dryness of the the outer tissues of the labia It could just be that Probably not yeast in that case.

But I think there's this inclination that whenever vaginas are itchy, it's got to be yeast, and I think it's a common misconception. It's got to be yeast. Remember? But if you're concerned, talk to your doctor. Hey, Dr. McGeroy and Justin, my question is more about how the science of different SSRIs work.

For example, why are my ADHD medicines and appetite suppressant and my OCD medicines and appetite increasing medicine? That's nice. You're taking both levels right now. I thought the drugs fixed my brain. Why are they messed with my gut so much? Thank you in advance. That's from Clay in Champagne.

I thought it was a good question to ask just because without knowing the specifics of your medications, and I'm not asking for that. It's hard to know exactly the mechanism of action and why they're doing what they're doing, but generally speaking, what's interesting is that you got to remember these medicines, they're not working on your gut directly. They are working on your brain, right? But it reminds us how much our brain influences our gut. So especially when it comes to appetite, so much of our idea of when we feel hunger,

when we feel fullness, you know, those things, they're coming from your brain. Those are signals, chemical signals, hormonal signals that are sent from the brain. And certainly there are receptors on the gut, so you have responses in the gut. But I think that that's always helpful when it comes to diagnoses like irritable bowel syndrome. And people will say like, it has to do with, you know, chemicals from your brain,

which can be misconstrued as, so it's all in your head. Or like, I've heard people just say, like, I have a quote-unquote nervous tummy. But no, it's just that it's all connected. Our brains and our bodies are all connected, which is why when you have a diagnosis that's primarily a psychiatric or a mental health diagnosis, it affects every bit of your body.

It affects your gut, it affects your stomach, it affects your appetite, and your your appetite, and your bows, and your muscles, and your joints, and everything. Everything feels related to this brain, primarily brain process. So that's why, because the medicines act on your brain, and our brain regulates everything. It's the control center.

I work in public health, and I've been working on COVID response like most of my colleagues since March of 2020, thank you. About six months after the response started, my office had a psychologist give us a presentation to explain how our brains are handling the situation. She explained that memory problems are super common.

My question is, how long are we gonna have these memory issues? We are calling it response brain or COVID brain. And honestly, I feel like it's getting worse, not better for all of us. At what point should we be concerned, that's from Ariel. Go ahead Justin, did you have a, you look like you had a thought? I'm not, I'm not, I'm not. I'm not, I'm not. I'm not, I'm not, I'm not.

I'm not, I'm not, I'm not, I'm not, I'm not, I'm not, I'm not, I'm not, I'm not , I'm not, I'm not, I'm not, I'm not, I'm not, I'm not, I'm not, I'm not, I'm not, I'm not, I'm not, I'm not, I'm not, I'm not, I'm not, I'm not, I'm not , I'm not, I'm not, I'm not, I'm not, I'm not, I'm not, I'm not, I'm not, I'm not, I'm not, I'm not, I'm not, I'm not, I'm not, I'm not, I'm not, I'm not, I'm not, I'm not, I'm not, I'm not, I'm not, I'm not, I'm not, I'm not, spotlight on me, I will say that I know that stress hormones like cortisol can have an impact on memory function. I think, well, what you're hitting on is exactly, and we've mentioned this briefly on the show before,

but I think it's always a good thing to reiterate because it's been so distressing for many people in the past year. Certainly people who are working in, like directly in the healthcare field or the public health field in response to COVID, but for everyone else as well. Who I should mention, by the way,

if you are in a healthcare field, or maybe even you're somebody who took it, to a lesser extent, took COVID extremely seriously for a very long time, being in those fields and then seeing the world like act like everything is fine now is going to be continuing. It's just like a delicious act too of trauma because that is like twilight zone level wild to see how some people are sort of like acting in response to COVID right now.

Well, I think the phrase gaslighting gets thrown around a lot, but in this case, it perfectly fits. A lot of us feel that way. Like did did was no one like, weren't we, didn't we all just live through the same thing this past year? What is happening, right? Like this all just happened, right? So we're just letting kids get, so we're just not worrying about getting.

We're just letting kids get COVID. That's just the thing. We're done. Okay. Got it. So I think that, I think you're right. That would be why you are, why these problems are persisting. And I think that I have, I have still heard people say like, I think maybe this was sort

of a question. I think maybe this pandemic has had some sort of effect on our health care workers and it's like, you don't know that. How are we not all rigorously addressing this issue that you have been probably undergoing trauma? I would assume a lot of us have. When you are in those sort of stress-inducing environments, stress hormones like cortisol,

make it difficult for you to, you're not forming the memories as the problem. It's not so much that you're forgetting, as in the moment, your brain is not being able to do the things that allow you to retrieve that memory later. Does that make sense? And that can happen in states of extreme anxiety or depression as well. You just, the focus and attention that's necessary for it to be stored and remembered later is not happening because you're also trying to process the constant threat of this virus and worrying about your loved ones.

And then if you're in public health worrying about our response as a species, which has been less than stellar, I would say. I wouldn't necessarily say it should be getting worse for everyone, but it could still certainly be getting worse and it needs to be addressed. Both on like company-wide levels, like businesses and healthcare facilities and all the different places where this work has been taking place should be bringing in people to like trauma counselors to work with people constantly. We still need that support all the time. The fact that it's not happening in every healthcare facility

across the nation, across the globe right now is, I mean, ridiculous. But you may also personally need somebody to talk to about this because this has been an incredibly traumatizing year for many people for different degrees of severity. And the idea that we should all just bounce back because like, it's hot girl summer. Which don't get me wrong, I want to. I want to be there.

I want to be out feeling great want I want to be out like feeling great and Living the roaring 20s like I want that I Obviously not living how we were living in April of 2020 I mean like no we have we have begun to to venture out a little bit and make like Calculated risks with selected people, but we also have two young children and with selected people, but we also have two young children. And the fact that the world seems to have forgotten that it matters if a kid gets sick or it matters, if even a few children succumb to COVID that that matters, it's wild, it's hard, it's scary, and it can make you feel very jaded, too.

Okay, we have many more questions to come, but first we're going to go to the Billing Department. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go.

Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go.

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Hi guys, so I recently learned about pre-cordial catch syndrome, aka, texidor's twinge. That is a heck of a name. And it's something I've been apparently dealing with for years now. It's characterized by a sudden stabbing pain on the left side of my chest, works in mind hailing and usually lasts only a few minutes before mysteriously subsiding. My question is, do you have any, there's more there, but my question is, do you have any idea what causes it? I can't find much info other than it's commonly seen

in adolescence, 27, and people with high stress, I'm thankfully not. So it's really interesting. I had never heard the term Texadour's twinge. I heard pre-cordial cat syndrome. That sounds like some Gary Guy dance like fifth edition D&D nonsense. Texts of the Swing is a wild name. It is one of the names that it goes by. I thought that was very interesting because I had never heard that. Pre-Cordial Catch Syndrome, you described it perfectly.

That is exactly the sensation people have. And a hallmark is that as this listener noted, you have a bunch of tests to work it up, and everything seems okay. Your heart and lungs are fine. Because obviously you don't want to just assume that it's nothing. You know, you want to be evaluated. Usually these episodes are very short. This listener mentioned that some could be up to 15 minutes, which is on the longer end. But at one point, someone suggested that they lift their arms and take a huge deep breath, and while it hurt to do it, it made the pain go away, which this is all a very classic description of pre-cordial catch syndrome. Why does it happen? It's the best guess is that it's probably, so in between your ribs,

you have their space, right? And there is a neurovascular bundle, meaning nerves and blood vessels that run in those spaces. So our best guess is that it's either like a pinched, what we would call intercostal, between the ribs, nerve, or a muscle spasm occurring,

because there's also a muscle there in between all those ribs. And that is our best guess. Now, it's hard to say exactly what it is because there's no real test. You know what I mean? Nobody, it happens so quickly, it's benign. You rule out the scary stuff.

This is what it is. There's no test I can do to prove it. But that is the thought process behind what it is. It was, I just thought it was interesting. It was originally named Hushard's syndrome for Henri Hushard who was actually the first doctor who described it back in 1893. But then later these other two doctors, Albert Miller and Tiodoro and Tonyo Texador did a lot more work on it. And then I guess got to rename it Texador's twins. Texador's twins. I love it. I'm going to remember that forever. It is more common in adolescence. It can happen at rest. It can happen with movement. It

can happen because you're hunched over. They thought maybe posture related. I don't know. There's still a lot we don't know. If you're having chest pain, you should always get checked out. But this is something, percordial catch syndrome or Texadors twins that can just happen and be no big deal and, you know, hopefully it doesn't happen again. Stretching and moving or laying down has been known to fix it. Hi there. I'm curious about the topic of breast milk versus formula.

I've heard that once an infant goes on formula, they cannot switch back to breast milk. I was wondering if this is true. And if so, why thank you so much, love to the show. Luca. I thought this was important just to mention that there is no reason you can't do both. You can do breast milk, you can do formula, you can do one, then the other, you can mix them together in the same day. This is all fine.

So I think that where this misconception might come from is that there is always the fear that because there is going to be a taste difference, that your infant might have a preference for one over the other and it would make it hard to go back and forth, right? So if I introduce formula, what if my baby likes that better, and then I can't breastfeed anymore? In practice, that's not usually an issue. Most infants do find moving back and forth between the two, unless there are special nutritional needs,

or they have to get a certain kind of formula or intolerances, but both work great and fed babies are healthy babies, so that's fine. Does the clock on sunscreen start when you go into the sun or when you apply it? Like, can I put it on sitting in total at our room for two hours and then go out there and be okay? That's from Devon.

I thought this was such a great question because I honestly didn't know. When I got this question, I thought, well, I've never thought about it. So from what I can tell, nobody is ever really, I don't think anybody's doing this. Like I don't think anybody's tried that. Like, I think the way that the studies are done

is we put on sunscreen and then go out in the sun and then measure the sun-protectant factor as time goes on. Because- I do know that water impacts it. So if you're swimming, it can be, it's greatly reduced, the speed at which you need to reapply. But so does just like sweating and then the general like shedding of skin cells

that we're constantly doing all the time. Sloughing. The swapping. Yes, so I don't, I mean, there is, I guess there's room for a study here where you have people sitting in a room for two hours and then go out in the sun. I would not do that at home

because you're naturally, it is going to wear off naturally just from being on your skin. And like I said, the sweating and the sluffing and the insensible fluid loss that we all do all the time, all those things, you're going to lose effectiveness. And it should be noted that that SPF 30 that you put on when you first went out in the sun, two hours later is not still SPF 30. The SPF has been dropping, which is why you have to reapply every couple hours. That's why that is so essential. So I would say for safety sake, as soon as you put it on,

that is when your clock starts ticking, even if it takes you another half hour to get the kids out the door, which is my case. I don't know if you've answered this before, but sometimes when I get really anxious or I'm in a high stress environment, my mouth feels and tastes weird. It's almost like I've gone dehydrated. Is there a medical reason behind it? Even better, is there a way to make it go away besides just waiting for things

out of your stress inducing a event to pass? That's from yours and medical interest, Emily. So this is actually a really common thing that can happen with anxiety. I don't know if you've ever experienced it. It's cotton mouth. Have you had this sensation? Yes, for sure.

And many people may have it. I'm gonna write it, I'm gonna go ahead and give it a thumbs down for a unpleasant. Disconcerting? There are a couple reasons. The most obvious that dry mouth or cotton mouth happens, I mean, because that's what, that's probably at the root of this is your mouth is dry.

It is, that's what the weird taste or sensation in your mouth is dry. The most obvious is that when you're anxious, you aren't as, you are more likely to breathe less efficiently through your mouth. And you may not process it, you're doing that at the time, because you're anxious, but you're probably breathing through your mouth and drying out your mouth. Also, don't do it. Don't do it. Exercise daily life. Give it up.

Mouth breathing is no good. I wrote a whole book about it. You don't want a mouth breathing. My nose is too small. Well, Sydney is kind of like that special. My nose holes, the nostrils, the augmentation. They're too. Time to get a cyber nose. Stinotic. Also, higher levels of cortisol and norepinephrine, which are things that are released when you're

stressed out or in a high anxiety straight, can cause a taste change in your mouth. If you've ever had a metallic taste or a bitter taste in your mouth, that is associated with that. It also changes how, I thought this was interesting, there have been studies done to say, when you're anxious, you do not taste as well.

Like, well, hold on, let me rephrase that. When you're anxious, you're not able to taste salty things as well or to taste sweet things. Like the sensation of salty and sweet is diminished when you are in a high anxiety state. So it also changes like your actual taste ability. So this is a very common thing.

I would say there's not, I mean, certainly if your mouth is dry, drinking fluids can help with that. But in terms of the causative, you know, the anxiety itself, ways to cope with stress and manage your anxiety are the things you need to focus on. All right. You asked for weirdness and grossness. I'm working on a screenplay about a chef who starts to use human flashes and dishes. So I'm curious what examples are

there met or their cannibalism in medical history? Was there ever someone who swore by the medicinal properties of human flesh? Thank you. And please don't report me to the authorities. Hey, listen, I can deal with this one said, this is why I did this. We never do this. We never plug the back cow. I'm telling you, we we just recycling episodes greatest. I just wanted to plug One of my favorite episodes we've ever done has from episode 38 April 8th 2014 medical cannibalism. That's right. There's a whole listen to the there's a whole yes Yes, there's a whole history there. That was the only reason I wanted to include that one. That's good

I'm telling you say greatest hits we got to start recycling these episodes, just run them as new. That's one of my favorites. No one's going to go back and listen to hundreds of episodes of podcast. Who would do that? Sometimes there's gunk in a hair follicle. Sometimes at the end, when I pluck a hair or in the follicle, almost like a blackhead, I can squeeze it out. I'm pretty sure it's not a blackhead.

What's up with that? It's from Jackie. I can squeeze it out. I'm pretty sure it's not blackhead. What's up with that? There's some jack. So at the at the bottom of a hair follicle, there's also like a gland, a little oil gland. And so that because there is an open space where oil is stored, one, you could there could be oil there. To any time there is, you know, Anytime there is, you know, an open space, dirt or skin cells can accumulate, and that can look like a little plug of, it can be clear, yellow, brown, black, you know, a variety of different colors.

But that's pretty common at the end of a hair follicle. That is not unusual at all. It's nothing wrong, and it's not necessarily a blackhead, although you may have a blackhead there. Very common. Hi. Why don't doctors make house calls anymore? I personally suffer from migraines and would love house calls to come back in style. Thank you, Katie. Dr. McAroy who just made a house call yesterday. I was going to say, well, that's in part, some of us still do house calls. I just did yesterday. And I know some of my colleagues do house calls, too, less in COVID, I would say I saw fewer

of those occurring. Prior to COVID, it was actually part of the curriculum. When I was a resident, you had to do a certain number of house calls so that you learned how to do that. I would say why don't doctors do it as much anymore? And I'm going to be very careful not to just use this as an opportunity to rail against the American medical system again because we already did that show. A lot of it has to do with one, the logistics. If you have a doctor who is like in an office established practice and they're seeing

lots of patients per day, like a busy family practice doctor would. So, you know, in theory, we're supposed to see a patient at least every 15 minutes or 30 if it's a new patient. You can see how it would be really difficult to fit a home visit into that structure, because that's how so much of it is structured these days. And if you do block off an afternoon to do a couple home visits, because you could only do a few in that time period, then one, you can't see a lot of patients who need you and two, the people

who like to make money off medicine don't make as much money. Home visits do build a lot higher. I have noticed, which is one reason I actually had patients who preferred, even though I offered it, they didn't want that because they cost more. How many is this too? Huh? How many is this too many? They do. Now, there are, we do have practices

that have become structured around that. I know there's one in our area where it is purely for patients who, for whatever reason, either prefer or can't make it to office visits. So you might look, there may be one of those in your area, but their whole business model is now structured around this. And they have like so many like doctors and nurse practitioners and physicians assistants,

and they can like deploy a fleet of people out to do this kind of work. And I don't know, but it, I mean, money, money is the shorthand. It's not that you're, and it's not even about like the physician themselves. I know a lot of my colleagues love to do home visits But it, I mean, money, money is the shorthand. It's not that you're, and it's not even about like the physician themselves. I know a lot of my colleagues love to do home visits

and wish they could do more. There's just, unless you're gonna do it on evenings and weekends, there's no structure for that in the system we have, usually. And before you get all excited, oh, Dr. McElroy's making house calls, she must be right in the big bucks. Don't get too excited to listen.

Is she, is she's volunteering?? I know I'm bummed out. It was a free home business. I wanted to start scraping in the the cash. As much as I can stop getting paid for my services, I'm trying. While we still eat. This is my silent protest. I'm raging against the machine by not making money. Not participating capitalism. She's a against the machine by not making money. Not participating in capitalism. She's a conscious of who's our root to the capital system. Objector.

Objector, there we go. When you have surgery, what happens to all the gas inside you? I know, it's just the visual surgeon cutting into your stuff. And it's just like all the parts come out. And once like, oh, that's just the visual. I was searching, cutting into your stuff, and it's just like, all the farts come out. And once, like, oh, that's where they were. Like, we're big stinky balloons. Um. This is actually, this is a good question, Tom.

I know it's real. I'm not making fun of the question, Tom. I just think it's a fun image. If you've ever had a procedure like a colonoscopy, you know that like afterwards you're gonna, there's gonna be some gas because like Where what do you mean inside your colon? Okay, because we stuck a camera up there You shoved all the farts into one and then all the well and extra air got in so now it has to come back out

Say you about and that does happen after a surgery after like all the air is let back out of the abdominal cavity Because like it's usually inflated, so to speak, because so many surgeries these days are laparoscopic, right? We use a camera, so we sort of inflate the area so we can get the camera around in there better. The air is then removed, but there's extra that is then like resorbed into the colon, and you've got to fart out later, burp out later, whatever.

But yeah, I mean, it, it comes out your butt. You don't have air bubbles inside you. Don't worry. That is not part of the surgical process. It is part of the aftermath. Sometimes when commercials for prescription drugs play, they say to tell your doctor if you or someone in your household has gotten vaccinated recently, I get what they need to do that if you had a vaccine.

But what does it matter if someone else did? How would that affect your ability to take the drug from a confused cast? I would say that in this case, what they're probably talking about are one vaccines that are live virus vaccines, which is not the COVID vaccine. Everybody already knows that probably,

but just to throw that out there again, the COVID vaccine is not a live virus vaccine. When you do have a live virus vaccine, there is this worry that after you get the live virus vaccine. When you do have a live virus vaccine, there is this worry that after you get the live virus vaccine, could you shed some of the virus in your stool, in your bodily out, you know, in your waste products? Is that possible? And because of that, and I'm guessing again, that the medications they're talking about are medicines that suppress your immune system, like medicines for different autoimmune diseases

and stuff like that. And the combination of those two could be concerning. So in those very specific situations with live vaccines and people in the household who are on immune suppressants who might be around those people, this is the concern that they're having. But it's because it's the same reason

that somebody who is immune suppressed may not be a good candidate for a live virus vaccine. But in all of these situations, they're very specific to the patient, the family, the disease, the drug, the vaccine, all that. So don't assume any of that based on a vaccine or medication. Please talk to your healthcare provider so that they can guide you in that situation because it would be very rare but specific situations. Okay, two more said, when you have nasal congestion, why is it that sometimes one nostril

will feel completely blocked or be running or the other nostril is completely clear? And why does it shift sides occasionally, such as when you sleep on one side versus the other, that's from Jonathan. You have terminates in your nose, these like outpouchings of tissue inside your nose that swell in response to allergens, or if it's an infection, or like a cold or something, or an allergen, or whatever seasonal stuff.

They swell and they alternate. One side swells, and then it goes down, and then the other side swells. This is why one side of your nose feels stuffy, and then then it goes down and then the other side swells. This is why one side of your nose feels stuffy and then it doesn't and then the other side feels stuffy. And it does switch back and forth. It is not a matter of blowing it out. That's why a lot of people think

it's like if I could just blow hard enough, then they would both be clear in that moment. And it's not like if you stuck a camera up your nose, you wouldn't see like a big plug of snot and boogers. It's the tissue on the side of your nose is actually swollen. But at least your body's nice enough to alternate it. So you can breathe out of one side or the other.

I don't know if that's more or less frustrating, honestly. Yeah. What's the deal with dark out of the eyes? Is the situation like cellulite or skincare and beauty companies just want me to feel insecure so they can sell me products? Or do they actually indicate a lack of sleep or nutrition? Why are they so darn dark in the first place?

That is from Sam. I would say that this is a combination of both. You can see darker circles under the eyes because of lack of sleep or fatigue or something like that, right? That is a possible cause. So, I'm not gonna say that that part is untrue, but then there are lots of other reasons that really aren't the solution

is probably not found in the beauty industry. One of the most common is allergies. They're called allergy shiners, allergic shiners, and it's dark circles under your eyes as a result of allergies that maybe aren't being managed as well as they could have. So seeking treatment for your allergies might help to alleviate that. There is also a genetic component to this, whether it's your actual skin pigmentation or just genetically you have darker circles on a darker area under your eyes.

That just happens. And that's not necessarily something you need to address in any way, unless it bothers you. There isn't a cure or a fix for that. It can be because of some sort of contact dermatitis or something like that. Obviously, like inflammation of the skin,

it can be because you rubbed your eyes too much. The blood vessels around our eyes are very fragile, and if you're constantly rubbing your eyes, you can see a darker area around your eyes or scratching your eyes, which may again be allergies. Sun exposure can do this, another good reason to wear your sunscreen. It also can just change with aging.

Lots of reasons, not necessarily that you're tired, although that can play a part two. And generally, the causes are not something to be concerned about. There are some of them can be addressed. But I do think it is something that has been made a lot of in the beauty industry as like it is very undesirable because it indicates that you are somehow dehydrated and tired every time we see dark circles. I think it's like, this is perfect. I'm just like cranking it out 24-7 and I don't have time to sleep

because I'm fully getting in the marrow of the whole thing. But see, this is the capitalism has made you feel this way. Finally, we found a bad thing the capitalism does. That you are glamorizing exhaustion. Not exact. Just for me, it's just from partying with my buds. I will say that no matter how much sleep I get, I always have dark circles under my eyes. They're very fetching.

Are they fetching? Do you think they're fetching? No, I sympathize. If you have that and it bothers you, I will say I empathize with you because it bothers me. No matter how many times I tell myself, you're fine, it's not that big a deal, it's just the media making you feel bad about yourself. I fall trapped in.

If you really don't like it, preparation age. But cream, it works. Does that really work for you? Secret of the Hollywood elite, like myself. There is. And there's also, I will say, if you... If you're a little dehydrated, your eyes can look puffy or bicontrast. But like, this is not to say water is the great cure all.

I mean, water is important, drink water. Get sleep, sleep is important. These are important things, not so much for our under eye circles, just for like our general functioning as humans. Hey, that's going to do it for us. Thank you so much for listening to this episode. Hey, did you know you can buy sobbing stuff? If you go to macrodemerge.com, we've got stuff there. We also have a, there's pins and t-shirts. This is a book. Saubhun's book actually you can find it wherever find books are sold. And we would really appreciate you doing that. Thank you for listening.

Be sure to share the show with a friend if you have it this week. This would be a great time to share Saubhun's with somebody. And if you've never listened to the episode where we talk about people eating mummies, move. That's a good one. That's a good one. Not to chew our own horns, but Well, the history is good. Thank you for joining us.

Be sure to join us again next time for Sabah. Until then, my name is Justin McElroy. I'm Sydney McElroy. As always, don't drill a hole in your head. Alright! Maximumfun.org Comedy and Culture Artist Oat? Audience Supported