Sawbones: A Marital Tour of Misguided Medicine - Sawbones: Anyone Else Get Pee Shivers?

Episode Date: November 25, 2025

Cozy up by the fireplace with some weird listener medical questions. What's the difference between a disease and a disorder? Where does the extra blood during pregnancy come from? Did getting my gallbladder removed change my taste buds?  Plus an update on the CDC website's recent posting about vaccines.Music: "Medicines" by The Taxpayers https://taxpayers.bandcamp.com/Native American Aid: https://nativepartnership.org/naa/

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. All right. Tommy is about some books.

One, two, one, two, three, four. Two, three, four. We came across a pharmacy with its windows blasted out. Pushed on through the broken glass and had ourselves a look around. The medicines, the medicines, the Escal and McCormack. for the mouth Hello everybody and welcome to Sawbones, Marital Tour of Misguided Medicine.

I'm your co-host, Justin McElroy. And I'm Sidney McElroy. I like to have my chair at a height where my legs are just fairly off the ground and it makes me feel like a little rascally boy. Do you like that? I like to keep my chair at that height because most of the time I sit crisscross applesauce, you know,

which is not good for. me at a 45-year-old man. I can't imagine doctors would recommend that. No. I, I can't do that anymore because of my knees. That's actually, see, that's why I don't like the chair to be at this height. It hurts my knees. I got a little, do you want me to lower it for you? I don't get it lower. Oh, whoa, too much. Okay, hold on. Up, up, up, up, up, up, up, up, up. A little more, wait, a little more. Wait, a little more. A little more. You got a stand. You got a stand. I can't up without you helping. Okay. A little bit lower. A little bit lower. Okay. Okay. That'll work. That'll work. That'll work. That'll work. That was a fun ride.

Woo! That was fun. That was a fun. Okay. I'm sorry I didn't adjust that for you. No, I don't know why. I can't expect everybody to sit crisscross applesau. The chair that I have at work that I sit in when you got me that has lumbar support because I only sit on stools. It doesn't lower enough for my feet to go flat on the ground. I'm like on my toes all the time. And then my knees hurt at the end of the day instead of my back. I'm a mess. Can you take my tape measure next time you go and measure the seat to floor and so I can find a different seat or make something different? No, actually the rest of the staff has made it illegal for me to bring any more chairs to work because I keep bringing new stools.

This is the third stool-like thing I have brought to my place of work. Some people are obsessed with like the perfect chair and now no one understands my obsession with the perfect stool. It's so I can roll in and out of my clinic's tiny and I can. roll in and out of my like where I type my notes and where I go to see the patient and I just roll back and forth. In my defense, there is a height difference in the chairs because of the cushion. My special, my special cushion over here. So that does lead to some adjustment. I don't have a special derrier cushion. Oh, well, I would say, it's interesting that you felt the need to add that because I would think that it would be implied that if it's a seat cushion, it's for your butt. Huh. I wonder

of why you felt the need to add, huh? I didn't say but. Yeah, but it's like unnecessary context, it feels like a little bit. What are we doing this week, Sid? Justin, I thought it would be fun to do another weird medical questions. We haven't done one in a while. I love it. And there's always so many.

We always have lots to answer. And I like those because I feel like I learn something every episode, too. Not to say I don't normally, but like I learn like trivia that I can bring up to people. These are like really trivia-rich episodes, I think. Do you know, Justin? I mean, I learn every time I researched an episode of Sawbones, but I learn a lot of this stuff specifically for these episodes. A lot of it I am learning right before because they're just a lot of the questions that you all ask are not necessarily things that we would cover in medical school because it's kind of, they're just like interesting facts, right? And they're not essential necessarily for diagnostic and treatment purposes.

But it's like new. So it's cool because I am often learning these things as I go. Not all of them. Some of them I know. Some of them I know. But others I'm learning. Are you ready for a question? Yes, I'm ready. I recently had an ear infection. You did? Gosh, that's a good gag. I love that gag.

Do you? I'm so glad to have that. I'm usually the one that deploys that gag and it's such a good guy. I think it's a really good. Sorry, sorry. Carry on. No, it's good. It's warm. I recently had an ear infection and was given an oral antibiotic. Earlier this year, when I had an ear eye infection, I was given a topical antibiotic. What determines the antibiotic route? Are there even antibiotic eardrops?

Thanks. Love all you do, Laura. So I think this is a great question because we do, we use different delivery methods of antibiotics, right? And antibiotics generally are something used to kill an infection, a bacterial infection in this case. And the way in which we want to administer the antibiotic depends on where, like how can we penetrate the area that is infected to kill. the bacteria in it, right? And so if you think about, like, a lot of us have topical antibiotic ointment in our homes, something like vasatracin or neosporin or like the generic triple antibiotic ointment,

that sort of thing. And it's over the counter, you have it in your home, and what would you use it on? Cuts and abrasions. And, like, superficial ones, like very surface, right? Because if you're worried about that germs got into it, they're probably just right there under the skin. So you can penetrate to where the bacteria is by just applying a topical, something that you put on the surface antibiotic. And this is true for a lot of eye infections. There are a lot of things like pink eye that we can treat by simply putting a drop or an

ointment on the eye or right inside your eyelid. And that will get to the area where the bacteria have accumulated, destroy the bacteria, done. We do use ear drops, antibiotic ear drops. Many people, you may have used them at some point for an infection in the external part of your ear, like in the canal, the part that's outside the eardrum, the part that you could touch with your family. Don't stick things in your ear. Don't. Don't. Even I know this one.

Don't stick things in your ears. But that's the part. So if you get an infection there, we would use drops often because that's what we're going to treat. The reason we would use an oral antibiotic is when we need to penetrate somewhere that you can't get to with a topical application, right? So if we're talking about like a middle ear infection, so behind the eardrum, we can't get there by putting drops in or an ointment or anything like that, right? So we need to get there through your bloodstream. So if we got to get there through your bloodstream, then we got to put antibiotics either in your mouth or if it's a really severe infection or in certain other body cavities like a joint space that's really hard to get to, then we would have to put antibiotics through your IV, actually, you know, put them into your bloodstream. So that's why we would choose a different delivery method.

it depends on where are the germs and how can we kill them. That sounded more intense than I. Yeah. But, I mean, I'm a doctor. That's like I'm in a never-ending battle. Between two gross. With germs. Oh, germs.

Yeah. You hate germs, like osmosis Jones. Well, I don't hate Osmosis Jones. No, Osmosis Jones hated germs. Oh. He's like a medicine. Oh, that's right. He did hate germs.

And his partner, I love the show, Sidney, Justin. Thanks for all you do. My question is this. How do babies' eyes turn? We watched that movie. You remember we watched that movie? I forgot that we watched that movie. How do baby's eyes turn from blue to whatever color they eventually become?

Is the blue they are born with just a pigment that eventually fades away to reveal the permanent color? Our foster dog just had puppies and seeing their blue eyes. Maybe think of this. Do all mammals' eyes start out blue? Many thanks for Courtney in Alabama. I, okay. Justin, do all babies' eyes start out blue? Yes.

No. Dang. You know, when people say, oh, it's not. almost always a trick and I know that but you know what it is it's my instinct to keep the show fun and engaging and moving I wish if I had taken even a half beat you know for my pride I would have got it right uh you just so you get it wrong on purpose to make an educational opportunity for the listener sure of course you do I you know this is a common misconception while yes it is true that there are humans born with blue or kind of

like a light gray eye color and then it changes as they get older that definitely is something that occurs commonly not all babies are born with blue or like light colored eyes in fact there was one study i thought those was really interesting out of stanford that showed 20 percent of babies are born with blue eyes 20 percent way lower than i think i think there is a misconception that like well babies are always born with blue eyes i would also say that is a misconception based on who was getting to write the papers and do the studies for a long time. I mean, if you think about racial disparity,

yeah, there's definitely racial bias there because the majority... I mean, racial bias in the scientifics. There's like a biases to the data. Yes, we are the misunderstanding that all babies are born with blue eyes. No, not all baby. Of course all babies aren't born with blue eyes.

Now, you're really digging in on this, Sydney. Again, I was just trying to keep the show fun and engaging. No, I'm sorry that I got it wrong. Oh, I don't mean directed to you. I think this is a common misconception. among both lay people and scientists. I think a lot of medical professionals have this misconception. But not me.

So I think, well, I think it's important that we check our biases and that we understand, like, why did we think this? Oh, and we have to, you know, come to terms with why we think these things. Sure, but I'm just saying it's not one that I personally, I was just trying to keep the show fun and engaged. I got you. Okay. I got you.

Yes. So many, many children are born with blue or light colored eyes. And then what happens is as the melanocytes, the cells in our. irises that produce pigment that produce melanin as those are exposed to light they begin to produce melanin the color that your eyes end up being depends on how much melanin is produced and so that is genetically determined right okay wait okay no wait hold on is melanin the compound that determines skin color as well yes so okay this is going to sound really really stupid but i'll just put it in the most stupid way possible why are babies not all born white and then the the like what is

the same process not a fact that happened in the skin do you know so there are there's definitely going to be i mean well if you think about it our skin does change over time in the sense that like all those little areas on our bodies and you have many you have more than me that have freckles those are areas that were exposed to sun and then those melanocytes produce melanin okay so now obviously again there are genetic differences because there are many babies born with brown eyes right so the melanin's already there so that's i mean genetically the it's It's the amount of melanocyte. Gotcha.

Right. And so, yes, there will be changes. And certainly that occurs across skin colors. I think when we think about like freckles and you or me, because we are both very fair-skinned, you see those freckles. And so you see that change with light exposure very obviously. But people with all skin colors can have, you know, changes in that skin color over time with exposure to sun. Right? Yeah.

But I thought that was really interesting. Now, eye color will start to change as you get old. If you're born with blue or light-colored eyes, it may change, usually between three or nine months. Does it ever go the other way, brown to blue? No, no, you're not going to lose melanin production. So you said 20% of babies are born with blue eyes? Mm-hmm. How many, like, what's the-in-this-one study?

What's the percentage of people who have blue eyes, period? Worldwide, 8 to 10% somewhere in there. Okay, so we're talking about like double. Mm-hmm. So that's statistically significant. So it is, I mean, both of our children have blue eyes when they were born. We talked about that. They have blue eyes now.

We didn't know if they would stay blue. They did. So far. That's your, that's, well, that's a combo of our, but the reason is our genetics. That's why they stayed blue is because. Do you have a recessive blue? I have a recessive blue gene because my mom has blue eyes. My dad has brown eyes.

I got a recessive blue. We combined and had two blue eyed children. The majority of the world has brown eyes. Blue is the second most common color, but it is a smaller. I mean, if you think about it, only 8 to 10%. your eye color can continue to change up into three years old before it's the final iteration of what it's going to be. Yes, most mammals eyes do change colors. So a lot of kittens and puppies and other mammals are born with blue eyes and then they may change as they get older.

So it's not just humans. And as I was researching this, I found this really interesting fact. Reindeer, their eye color changes seasonally. It's not an age thing. Impossible. In the winter, their eyes tend to be blue, and in the summer, the warmer months, their eyes tend to be like a golden brownish color. Isn't that interesting? Amazing.

And that's unique. As far as I can tell, it's pretty unique to reindeer. This is, oh, man, reindeer are better than people. In this one. In this one. In this one regard. Yeah. Next question.

Hi, Sydney and Justin. What does it mean health-wise when people say a food is processed? I mentioned to my aunt that I bought some multi-grained cheery. and she made a disapproving face saying that they were highly processed. To be fair, she pretty much only meats and salads, feeling all of the foods is unhealthy. Still, can multi-grains slash plain Cheerios really be bad for you? Does processing food actually make it worse for you? Thanks, PJ, she, slash her.

I think this is an important conversation because of all of the, some of the actual helpful health information and some of the misinformation that surrounds processed food. And then also the general sort of like, we cannot separate the kinds of food we eat from socioeconomic disparity. Yes. You know, and so I think it's an important conversation to have. First of all, what processed means from food to food differs, right? There are foods that, I mean, when we talk about a processed food, generally, I think what people are indicating. Because it's almost, you know how organic has taken on its own meaning at this point?

I think processed is similar. Do we mean that there are specific substances added to this food to make it shelf stable for longer, to provide an artificial color to it, or something like cereal as an example, something to keep it from getting soggy as fast? Like, are we talking about those sort of things? Or are we talking about, like, if you think about processed meat specifically, they have gone through a series of preparations that allow it to stay stable much. much longer, and we do think that because of some of the substances that then are in the meat as a result of that process, that perhaps there are some negative health effects from it, right? So I think process means a lot of stuff. I will say in the world of cereal, a lot of times what people are referring to is the way that the grains have been reduced or have strayed from their like whole state, right? So the idea would be these started as this whole thing and then they've been processed into something that like is cheaper.

or more sugar or, you know, higher on the glycemic index or whatever. Exactly. I think what we need to remember about food is, first of all, it's important that everyone have access to food. Whoa. Yeah. Yes. Hard agree.

And there are a lot of things that we've done scientifically like genetic modification that has allowed people who didn't have access to food to have access to food. And those are not bad things. No. Right. I do think it's important to tease out the difference between this is a food that is highly processed. And as a result, I mean, you really got to get scientific about it, look into what was that processing. So when we talk about meat specifically, because if we're going to say, what are the negative health effects, I think that's where we can point to actual science.

We know that meats that have been highly processed. And think hot dogs, I think, got the big headline right. Do you remember when they were declared a carcinogen? Yes. And the headlines were all like, hot dogs cause cancer. Cancer. Eating a lot of highly processed meats has been linked to a higher risk of colon cancer. So that is a fact. And we have medical evidence in science and that is why it was listed as a carcinogen. I will say, for the record, so is alcohol. Which we didn't necessarily see the headlines about that. But that has been true for quite a while. So yes, eating certain highly processed foods in large amounts on a regular basis is not healthy in the holistic sense. And we should. should limit those things. I think that to get into the debate, should you ever eat them?

That's a really, that's a tough question. I don't know, scientifically, I could tell you, like, never let this food into your body. Oh, that whole thing. I mean, I feel like, I feel like when you start getting into words like should or healthy or, I mean, anything that brings judgment to a food specifically, I feel like you, you are just playing into a disordered eating there. You know, nothing is bad, nothing is good, nothing is unhealthy or healthy. It's all about, like, choices over a long span of time and what your goals are and what you, you know, what you like. And honestly, y'all, it brings you joy. This creature over here next to me is one of the best people I know, and she is not going to stop eating charcutory.

Guys, she's not going to do it. It's a third of her diet. It doesn't matter what it's going to do to her. I'm not going to take that from her. I'm not going to take away her charcutteut. Listen, don't make me sound bougie. They sell these pre-made charcutories. No, no, I'm not talking boosy, y'all.

No, no, no, no, no. It's not fancy stuff. It's so good, though. It's just a big bag of meat and cheese. What you need is some chili fig jam to put on it. If you give me some chili fig jam on any charcuter I'll eat. That's going to sound bougie, too, but it's like literally the only thing that she buys. It's just a stack of chili fig jam in the cupboard.

There's 12 jars. We buy in bulk for the savings on chili fig jam. And then this woman will just eat her cutity full time. I don't know what it's doing to her, but I'm not going to say don't eat it. Because it's hurt. You only get one go round, you know? If you want to have some smoked sausage, you want to have a little pursuit, you know? That's the truth.

There can't be a should. I think the best that you can do is recognize. Yes, of course, we should all have access to all of the different food groups that are essential to provide nutrients and amino acids and all of the things. our body needs, right? Like, we need fat. We need carbs. We need protein. We need vegetables and fruits. We need all of these things. And in a perfect world, we would all have access to them in large amounts at affordable prices or free, you know, right there in our neighborhoods. The truth is that's not the world we live in. And so we do the best we can to

eat a diverse diet, knowing that if you eat, you know, bacon or sausage or hot dogs every single day. That's not, you know, I mean, ideally, we wouldn't, but we make lots of choices that aren't, I don't know. If you're just talking about, I don't think there is a way to live the ultimate perfect wellness existence. And I think there's a lot of rhetoric out there that would tell you you're supposed to. And I don't, I don't think that's realistic. So make the best choices you can day to day. I would never, as a physician, say, do not eat Cheerios. That would not be an, I don't I can't see myself ever giving that advice. I would say don't only eat Cheerios.

Yeah, but you don't need a doctor for that one, do you? Right. I mean, here's what, and I will say this, if we're talking in terms of facts, Cheerios are probably the lowest sugar in terms of, like, the commercially available, like, big heavy hitters in cereal. I do think that if you're worried about sugar or whole grains, if that's something that's on your mind, a Cheerios is the lowest in terms of overall sugar, I think. And I will say, we could get into a whole other conversation about how Americans decided that desserts were breakfast at some point. You are not in, you are in unfriendly territory.

You're not going to find a warm reception for this little. This little soliloquy will fall on an icy stare and cold silence. Can I remind you? Good nature dripping out of me when this one, Dr. Small Macroy. That our youngest daughter asked for a Christmas tree cake, a Little Debbie Christmas tree cake for breakfast, and we had to have the conversation. We occasionally let our kids have donuts for breakfast. Nutritionally, tell me the difference between a donut and a Christmas tree cake. There isn't one.

That's why we let her have the Christmas tree cake. And she didn't like it. And she didn't like it. She took one bite and she said, never mind. I'm just saying. Get me some yogurt. Yeah. She wanted yogurt.

I don't know. This next question, both people, we had two, we had two, Listeners asked the same question, so I wanted to give them both credit because I learned about a new syndrome. Read them both? Mike and Sophie both shiver when they pee. I mean, do we even need to say more than that? They shiver when they pee. Yes.

I mean, we could put a lot of other, Mike and Sophie both shiver when they pee, and we can put a lot of other verbosity on it. We could throw a lot more language at it, but I think what it comes down to, and tell me if I'm wrong, if you want to offer a second opinion, it sounds like, Why can Sophie shiver when they pee? They both shiver when they pee, and they want to know why. I will say my guest, is it some kind of nurse stimuli, which is sort of, you know, this is close to the answer. So I want to give him credit for that. But yes, since I had two emails asking me about shivering when you pee, I thought, is this a thing? Because I've, this was not a thing I'd heard of.

It is a thing. It has a name. That's how much of a thing it is. Post-micturition convulsion syndrome. Post-mictor. Say it again. Micturician. Mictrician.

Okay. As in peeing. Gotcha. After you peed. Got it. Got it. Got it. You peed.

Anyway, it is a syndrome. We do not know exactly why. There are no peer review studies about why some people shiver after they pee. Mike and Sophie both have just leaned over and turned off their radio dial, sadly. They won't get the answers. No, we have theories. Okay, good. Okay, turn the radio back on.

We have theories. It is a real thing. It seems to be something that is experienced more often. by men than women, but it can be by either, okay? But that plays into part of what they think is the cause. That's why I mention it is this is part of why they think it happens. So the best we can guess, there are some people out there who thought it had something to do with temperature. It was just simply like you take off your pants when you pee. So maybe it's that. But what they noted is that it can happen in infants who pee in their diapers. And you wouldn't necessarily think

they'd get cold, right? Right. So why is this happening? We think it has to do with the autonomic nervous system. That's the best guess. This is just a hypothesis, really. So when you start, like, the peeing process is activated by the sympathetic nervous system. You've got your sympathetic and parasympathetic. It's just important to know there's two different things. They do different things in your body.

The sympathetic sends a message to your brain that says, your bladder's full. You got to pee. That's when you know, like, I got to go pee. In order to relax your bladder and actually urinate, the parasympathetic nervous system takes over. They think that it's in the conflict between the two. Two, one is going to lower the blood pressure, one is going to raise the blood pressure. They're doing two different things. And in that conflict between the two, the cross signals result in a shivering response.

Okay. That is the best guess we have at this point. And the reason that they think maybe it happens more in men is because not all, but generally, men stand to pee and women sit. I'm speaking in broad generalities, I'm not, if you do something different, that is totally fun. no judgment. But generally, because of that, you are going to sense that, like, blood pressure drop and raise, that disparity that happens very quickly. You might sense it more. Your body may react to it more strongly because a change in your blood pressure when you're standing can have more consequences, you know, passing out than a change in your blood pressure when you're sitting.

So that may be why more men or people who stand when they pee experience a post-urination shiver than women, but either can. And that is the theory right now. So it's a way. It's got a name. It's a real thing. We're still, I mean, I don't know. Maybe do it. Mike, Sophie, you all want to do a study? Study. Get a few more people together. We need a peer-reviewed article. Well, you got a stew going. Justin, before we do the next question, I think we need to go to the billing department. All right, Sid, let's go. The medicines, the medicines that ask you let macabre for the mouth.

Hi, Justin and Sydney. That's us. I recently had emergency surgery to get my gallbladder removed. I work at a brewery and when I was done with my antibiotics, I was excited to get back to enjoying beer again. For at least three weeks after my surgery, beer tasted different and tasted super bitter and off. Is there any reason why getting my gallbladder removed would change my taste buds or how certain things taste or was it all just in my head? Victoria. Thank you, Victoria. This is, again, I always like learning about these are real syndromes.

And a lot of these things are not, again, things we talk about a lot of medical. school because the the consequences are more their annoyances or they like I hate to say this but their quality of life but not necessarily medical problems and we don't always- Quality of life, not quantity of life. Well, we don't always learn about those things. So this is a common thing that can you can experience after having first, let's talk about the gallbladder specifically. After you remove your gallbladder, the way that bile enters from the liver into your intestines is different because it doesn't get held in that pouch that is the gallbladder anymore. It's not that.

So there's just going into the small intestine. That can slightly change your digestive pattern. Sometimes you can have some bile that refluxes back into the stomach at times. All of this can result in if you have changes to your digestion, in the rate at which you digest food and how long stuff sits in your stomach and all that, that can change your experience with food, smell and taste both. So both of those things can be impacted by your digestion. It also can change like the bacterial components that live in your intestines that are okay. We're supposed to have bacteria in there. So all of those things definitely can change the way food or alcohol, in this case, taste,

to you. It usually is something that sort of levels out over time. So you would experience it for a while, like you said, but then it might go away as your body sort of equilibrates to this new status. The other thing is generally after surgery, that can be a kind of a hangover effect from anesthesia. You can have changes in smell and taste for several weeks after anesthesia for any surgical procedure, no matter what you were having done. this is a common complaint post-surgical is I don't know things smell different or things taste weird again usually it goes away the other thing I will say is you mentioned antibiotics and there are a lot of antibiotics that change the way things taste or can leave a taste in our mouth yeah and I don't know specifically what you're on but there are many that you may like a great example is metronidazole or flageal which I thought of right away because if you drink alcohol while you're taking metronidazole you can get very very sick it also can leave like a better metallic taste in your mouth a while. Also, the antibiotics that I had when I was a child for pneumonia left a banana flavor in my mouth that I did not enjoy. And that could be another thing to consider. And I imagine

when you were a child, it really threw the taste of alcohol off for you. No, I had not begun drinking it. Sydney. So it was not in your head. These are all real things that happen. Either it's the anesthesia, the surgery itself, or the antibiotics. All of those things could have thrown off your taste. I'm pregnant. What? I am pregnant, and I have read that during pregnancy, the body has 50% more blood. I find this highly concerning for a couple of reasons. Where does all that blood come from? What is being turned into blood?

Two, where is that all that blood being kept? I'm not getting 50% bigger. So how can I contain that much more blood? Three, does that mean I can bleed more without running out of blood? Or do I really need all that blood? Thanks for all you do, bloody concerned, Kenna. I love this question. 50% more blood.

Yeah, 30 to 50% your blood volume increases when you're pregnant. What? Yes. Why? Yes. No. Why? Stop. Why, Justin? Because they got to pump it through the baby. We have a, you have a baby to support in there. There's a life growing inside you that also needs blood and the stuff carried thereby. Also, all of those organs that are being stressed now to create a human and, you know, support it also need more blood flow. So for you and for the developing fetus, you both need more of the stuff that blood carries around the body. in the Bloodmobile, if you will.

So that's the why. There is another reason why, which you kind of alluded to, does that mean I can bleed more without running out of blood? Well, that is one of the physiological reasons why more blood is advantageous to someone who is eventually going to give birth. Because you do lose blood during the birth process. Obviously, at times, that can be a huge problem. And having more blood volume to pull from is an advantage. So, yes, there are advantages to having more blood to you, to baby, and in the delivery process. Where does the blood, first of all, where does it come from?

It's mainly plasma that's expanding, not as much the actual blood cells themselves, but the stuff that the blood cells are in, the plasma. And the way it expands is your kidneys start filtering out less fluid to, like, keep more stuff in, right? So your body is all the stuff you pee out, you're keeping more, not the toxins, but like the fluid. itself and the electrolytes and all that. All that stuff is being held inside to expand what is inside. And that's where it's staying. It's in your blood vessels. Our veins are kind of floppy and stretchy and can actually hold more.

They can expand and contract as needed. Arteries are more muscular. They're like tighter tubes. Vains are floppy urine. But anyway, it's being held within your circulatory system and it is expanding because of the plasma. It's also why there can be this sort of anemic state during pregnancy where you have, more of the fluid and not more of the blood cells. And so you get dilutional, you know, you get more blood cells, but not as much as you get

plasma. So that's, anyway, those are the reasons. You can contain more blood without getting 50% bigger. It's being kept in your blood vessels and heart, you know, all the places we keep it. And that's how it happens. What gets something labeled a disorder versus a syndrome versus disease? Man, I wondered this exact question like five minutes ago. For example, irritable bowel syndrome versus Crohn's disease or degenerative disc disorder versus, that's not my fault.

That's a hard one. Generative disc disorder. Why did I go back for a second? Helping. I don't know. Versus carpalton syndrome. Are we just adding the last label on and retconning logic later? Thanks, Joe.

Okay. This is confusing. I had to look up all the definitions myself to clear. So I wanted to be able to articulate it clearly. a disease is a condition that impairs the normal functioning of the body or mind generally it has a clear identifiable cause okay okay we know why it's happening we know what is you know you have pneumonia it's from mycoplasma we know what's causing it and we know how to treat it therefore because we treat the underlying cause okay that's a disease a disorder is an abnormality and function of body or mind unlike a disease we don't always have a an easily identifiable cause. Mm-hmm. Okay.

Does that make sense? Disease, something inside you is wrong. Disorder, something is wrong with you. Yeah. Well, that feels very accusatory. But yes, there's a problem with functioning. Yes, there's a problem with functioning. We base it on the symptoms and the impact on your functioning, but we don't necessarily

know what is causing it. Okay. Okay. Okay. And the symptoms may not always be clear cut themselves. It's not like a list. Okay. Which is different from a syndrome, which is a collection of symptoms that frequently occur together. And so we name it based on a specific condition. But we may never understand exactly what is happening in the body for that syndrome. Or we might.

Disease, something inside you is wrong. Disorder, something is wrong with you. Syndrome, lots of stuff is wrong. And they cluster together in this way that we call this syndrome. Oh, you're just adding. My concision is my only strength, Sydney. I mean, it is important in medicine. I will say that things, there are gray areas where, like, disorders could become diseases and whatnot. I mean, if you think about, like, having high,

blood pressure and then over time developing heart disease as a result of it. You know, those kinds. I mean, like, there are ways where, like, one can sort of become other. And there are definitely lines where you would say, I don't know, is that a syndrome or is that a disorder? Like, I think that it is a, it's hard to make those as like very distinct. But that generally is why we call one, one something that are different one. Hi, folks.

Is it really Sydney who's in charge of the inbox? It feels like she's doing too much for one lifetime already. Anyway, is it, Sydney? Yes, it is me. I am the one who checks the inbox. Have you ever looked at our inbox? Don't be accusatory. Of course I have.

I have to log in there all the time. It's primarily me. So thanks for answering my question about the nail matrix, whose scientific name I have diligently already forgotten. Another question that I dare not research via search engine because it will invariably tell me I'm doomed. Why do we hear a cracking or crunching noise when we have a stiff neck or shoulder or other joints and they free up?

This is not the most elegant way to describe it. But you know what I mean? Surely it's not the bone making the noise popping it back into its proper place or something. Okay. There were two good questions here, but I'm going to answer that one first. Most of that popping, crunching, crackling sound, do you know what it is? Gas. Gas bubbles.

Yeah, very good. Yeah. Most of the time, that's what you're hearing. You're just hearing gas bubbles pop. Like when your knuckles crack, right? Yep. That's gas. There's gas bubbles in your synovial fluid and they're popping. Now, occasionally it could be the sound of like a tendon or ligament like snapping over. They can move. They have a little bit of mobility. And if they snap back over a bone surface, does that, you know, can you imagine that that it would make a sense? sound. Yeah. I can imagine that. You don't want to imagine that. It's unpleasant, but I could do it.

There could also, most of the time, it, I shouldn't say most, it does not necessarily mean that you have any problems in your joints, hearing popping or cracking. That can just happen. That can be a normal thing. If you do have arthritis in your joints, like degeneration in the joints, you could also have popping and cracking from like a torn bit of cartilage or something like that. So yes, things that are pathologic can cause popping and cracking, but also it can just be normal physiology as well.

Gotcha. Lunula, what's the name of the nail matrix? I thought this was a second question, too, that was a good one to ask. Yeah, you may have received this note, but your very own family sends you another bit of extra work. In the most recent idioms episode of Schmanor's debate revolved around whether your bladder could explode if you kept in your weave for too long. Teresa voiced a suspicion that the bladder would rather leak than pop, but she deferred humbly to you. Here it is, sitting the ball has been. Thanks, Claire. The ball's been passed from Teresa to you.

Yes. To deal with bladder. So the bladder generally does not explode. It's a rare thing. The bladder can rupture. I would use the word rupture. Yeah, because it's not a bomb. It is possible. Yes. The bladder can rupture. But Teresa is right that generally the bladder does not rupture. If you are holding in too much urine for too long, a couple, I mean, one, yes, leaking, like not being able to keep that muscle contracted that holds it in long enough and, you know, losing control of your.

bladder can happen. Certainly, that would be more common. Also, the bladder walls can become distended and damaged and floppy as a result of holding your pee too long. So go, go pee when you have to pee. The bladder can rupture. Most of the time, this is like a traumatic event. Like you're in some sort of motor vehicle accident or something externally ruptures the bladder. It is possible that so much urine could be in the bladder. And for whatever reason, perhaps that muscle that relaxes is, it can't for other neurological reasons, and then the bladder could conceivably rupture. It is very rare. It is possible, but it is very rare. Most of the time you would just pee. Just pee. The final is not a question. We had multiple people who wrote in just in the last 48 hours asking about, one,

had I seen the new vaccines and autism page on the CDC website and to asking what we thought about it. And so I thought, even though this isn't a weird medical question, we would not be sawbones if we didn't address vaccine stuff when it pops up in the news. So I think it's important, first of all, to note that, yes, the CDC did put up a new page on its website, the Centers for Disease Control, on the government web page, that says very clearly that there is, to say that vaccines do not cause autism is not an evidence-based statement. So that is false what is on this CDC webpage.

Right. It's a lie. Yes, it is not true. I would not refer to that webpage for information. And it does, as many people have pointed out, it does call into question everything that the CDC publishes as public health information, right? I thought that's where we were at. Was that not where we were at? We had not seen that level of misinformation coming from the CDC at this point, right?

We were concerned about the quality of what would come out of the CDC. We were concerned about the conversations that were happening and about some of the stuff that's been scrubbed from the website. Absolutely. These are all true statements. But to actually see that sort of statement on the CDC webpage, this is shocking and disturbing and needs to be highlighted as not like, Well, you know, R.FK Jr., we need to take this seriously. Yeah, you should take it seriously, but you should also recognize it for what it is. At least for me, when I'm looking at it, what I see is a Republican Party that got its clock cleaned very recently and is trying desperately to try to ignite its base, to try to make good on some of the things that the leader promised early and is absolutely inept at delivering on. I think that this is a, this is really meaningless because if you know who is in charge of the CDC and you know that, then obviously you understand this context, right, and you can treat it like the joke that it is.

This is like a desperate attempt, I think, to placate people to try to get them like back into the fold, right? Because they haven't made any progress for these maniacs and they're trying to hand wave at it without actually doing anything. The Tylenol thing didn't work for them. We all read it for what it was, right? A very obvious joke. Well, I think that... Why was that not the straw that broke the... That was from the CDC, right?

Well, that was from RFK Jr. I mean... So, here's the thing. I think, and that was interesting the way that all played out, because then he came out and said, we don't have any evidence linking Tylenol and pregnancy to autism,

even though we did come out and say, we think it does. Which I think, I don't know, I'm not a lawyer, I'm a doctor, but my perception of it is that, I don't know if you saw Texas sued Tylenol after that statement was released, and then all the sudden, I mean, I imagine that then you would have to haul RFK Jr. or whoever from the HHS into court to say, this is our

evidence. This guy said that it caused it. And he had nothing to stand on. Anyway, I don't know. So he kind of walked that statement back. Now, obviously, we knew RFK Jr. was going to come after vaccines. We knew it. We knew it. We knew it. Anything he said to the contrary was clearly a lie. And now here he is. And so on the CDC webpage, it suggests that we don't know if vaccines might cause autism. We know they don't. We know they don't. We know that. And there was a statement immediately put out saying medical researchers across the globe have spent more than 25 years thoroughly studying this claim. All have come to the same conclusions. Vaccines are not linked to autism. And that statement comes from, I'm not going to list all of the medical organizations. It was led

by the American Academy of Pediatrics. Because you would have to list all of the medical organizations. It was led by the AAP, the pediatricians coming in strong. But, I mean, like my group, the AAFP, American Academy of Family Physicians, came in, the American Medical Association. I mean, every group, every major medical organization, groups that specifically represent autistic individuals and their families, public health groups, everyone came together to issue an immediate response to this saying this isn't true. Right. Vaccines do not cause autism, period. That's it.

Moving forward, all of these, and that was a press release, so you can easily find that statement from those medical organizations. Those are all places that you can find valid, up-to-date, evidence-based medical information. If you're looking for information on vaccines, start with the American Academy of Pediatrics. There's the American Academy of Family Practice. The American College of Obstectrics and Gynecology has been great on these issues. I mean, there's so many legitimate medical organizations. I'm not even mentioning a fraction of them here,

where you can go and find accurate medical information instead of the CDC. So will, do you think it's safe to say that like until, at least until the end of the Trump administration, that we should stop using the CDC as a source? I get yeah I mean I if they're in control of this they could change the the web pages like I think that the the CDC like I don't think we can point to them as like a resource it's yes and I hate to say that because probably the majority of information on the CDC website is still accurate right but we don't know moving forward what will be changed and what won't be and

we don't know how many subtle ways I mean this is headline making stuff right we knew this would be because it's a hot button issue. How many subtle, not headline-making ways could they change information on that web page if they can do this? I mean, and so I do think it caused the entirety of what they published into question now. And this is heartbreaking. I spent so many years in my life wanting to work at the CDC when I grew up. I mean, it is heartbreaking to see this happen. And I will say, and I'm sure I'll get emails from you because I know I've received them before. This does not undermine the truth that there are brilliant, dedicated, evidence-based scientists working at the CDC at this moment who hate this, who are just as outraged and just

as opposed to this as we are and all of these organizations are, but they have no control over this. Yeah, but you got to quit. No, I'm not going to call. You got to quit. Don't work there. Don't work at the CDC. You got to quit. I work in the American House. health care system. If that was the right thing to do, I should have quit years ago. But I work within a corrupt, profit-driven system that hurts patients and hurts the people who work within it in hopes of trying to still help within that environment. If you cannot trust the person at the top of the organization, then you can't trust the organization. I don't think it's that simple. I've worked in healthcare for a long time. And I think you can always find a way even in a broken system to help people. Just because this was put on a

web page doesn't mean that all these great scientific minds are frantically researching autism and vaccines to try to find a link between the two. They're not. Most people aren't because it's a waste of time because all this work has been done and we know that there is not a link. But generally speaking, the profit-driven American health care system with insurance has been hurting people and causing harm for so long and I not only work in it I paid six figures to work in it to get the education

to have the privilege to work within it I'm going to keep fighting to try to help people within it no matter what happens next and I imagine there are a lot of people at the CDC who feel the same way who may even be listening right now who are saying the same thing I you know what my heart is with them

and I'm not I it is unfair me to be telling people who I don't know what to do with our lives. I'm just saying like it must be a very scary situation right now to be working there. Maybe I should have that should be the focus. But I, I, it is, I guess it's just kind of, it's, it's, it's tough to see this organization turn into this. It's a real big bummer. It's been such a sort of guiding light for the show for a long time. But I am for, for, yeah, as a people. It is. And it is on all of us to speak out against this because these, these are public institutions, our taxpayer dollars go to fund this. And this misinformation is being put out on our dime.

Yeah. And so it's up to us to demand better. Yeah. Yeah. I agree. And to spread the truth, which is that vaccines do not cause autism, please continue to follow standard vaccine schedules that will still be widely available. All of your provider's offices are still going to have those standardized. vaccine schedules that they can advise you. Yes, when your kid is this age, they need this one. Yes, because of these health conditions, you should get this one. You're still going to be able to do that. It's the time of year. You should be getting your flu shot. You should be getting a COVID booster if you're eligible for it. This is still, you need to maintain all of those vaccine standards. And you will have plenty of people around you who are experts in this area and can help guide you. Check with your health care provider to make sure you're up to date. Thank you so much for listening to our podcast. We hope you have a

enjoyed yourself. If you have questions, where can people send them, Sidney? What's our email? I forgot. I hope you knew. Sawbones at maximum fun.org. Well, it's in both of our subconscious. It's in both of our...

No, Sawbones show is the other one. Sawbones at maximum fun.org is the email address. You can use it. What's maximum fun.org? That's our podcast network, where there's a lot of great shows on there. If you haven't checked it out, go to maximum fun.org right now and listen to all the great programming, because I think you're really going to enjoy it. If you have a weird medical question when you email us, just put weird medical question in the subject line, because that's how I search them up when I make these episodes.

Candle Nights is just around the corner. It's coming up on December 6th. If you haven't gotten tickets yet, go to bit.ly. forward slash candle nights 2025 that's not just a live show that's going to be happening at the beautiful keitha halby theater in huntington west virginia is also a live streaming event you'll get access just by buying a ticket but you can also get just the virtual ticket that's going to go live December 19th we're going to be live in the chat at 9 p.m. You can get tickets to either one at bit.orgia ford slash candle nights 2025. It's going to be a really exciting show. Yeah. If you can come in person please join us in Huntington. There's going to be all kinds of fun activities that we're putting together around candle nights like scavenger hunts and i think a lot of the local like bars and restaurants are going to have like little special drinks and things so yeah it's a whole event come visit our hometown and see our show or buy a streaming ticket and all the proceeds go to harmony house

harmony house is a day shelter for people experiencing homelessness here in huntington i have been working there as a physician for the last six years now we do wonderful work that sounded really braggy harmony house does wonderful work um helping connect people with resources to get them housed to get them Food and clothes and to help get them back on their feet after going through a rough time in life. And the people there are amazing, and we need your support now more than ever. We need your support. It's hard to find resources to help people experiencing homelessness, and the need is greater and greater in this country we live in right now.

Yep. So, bit out of the Wai, 4.Sach, Kellenice, 2025. Thanks to the taxpayers for use of their song, Medicines, as the intro of our program. And thanks to you for listening. That's going to do it for us. Until next time, my name's Justin McRoy. I'm Sidney McRoy. And as always, don't draw a hole in your head.

Maximum Fun. A Worker-owned network of artist-owned shows. Supported directly by you. Thank you.