Sawbones: A Marital Tour of Misguided Medicine - Sawbones: Can Black Widow Venom Cure Diabetes?

Episode Date: May 5, 2026

After all the listener support, it’s only fair we give back! “We” meaning Dr. Sydnee is giving back to the listeners by answering their medical questions! Can hanging upside-down cause lasting damage? Are hangnails random or is it part of my life choices? Why did the black plague end? Does flexing my calves strengthen my bladder? And how many living cells are in poop? Music: "Medicines" by The Taxpayers https://taxpayers.bandcamp.com/ Marsha P. Johnson Institute: https://marshap.org/ Thanks to everyone who participated in this year's MaxFunDrive! Still want to get in on the action? Follow this link to support this show (and get in on our limited-time keychain sale to benefit the Center for Constitutional Rights): https://maximumfun.org/joinsawbones

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. Hello everybody and welcome to Sawbones. It's a marital tour of misguided medicine.

host Justin McRoy. And I'm Sidney McElroy. Oh man, it's such a pleasure to be with you, Cid. We had such a lovely MaxFund Drive. I want to thank everybody for their support. It really means a lot to us. Yeah, you all were so supportive. You always show up for us and we really appreciate it. Yeah. So thank you so much. If you went over that URL, Maximumfund.org, or for it's last join. We really appreciate you taking the time to do that. This week, we have a wide variety. You know, I feel like after we ask people to give to us, it's only fair. that we give back. You know what I mean? And by we, I do mean you. Because, yeah. In the form of not medical advice, but answers to your weird medical questions. Yes. But not medical advice.

As my dad says, it's for fun. Yes. So. If you are concerned, you have a medical condition, please go see your health care provider. I need to do. Thank you. I'm realizing, Sid, I should do a tick check. I need a tick check this weekend.

We both need a tick check. I found two on my shoulder. Rip them off without seeing them, which is not... Don't do that. Don't do what I did. But I just, like, I felt them, and I knew that's what they were, and I just, like, just ripped them off. And then, like, I was in the shower and I just, like, held them in front of me, like, screaming out them.

Ah! It was just... Ticks are upsetting, man. I hate ticks. They are. Anyhow. Not as bad as mosquitoes. Yeah.

But still bad. Mosquitoes are the bits. Listen. Um, nature's worst killers. Listen. We hate mosquitoes here at Sawbones. We are, we are for, right? Aren't we for the eradication of mosquitoes?

We're for the eradication of mosquitoes. And we talked to bug experts, similar our leading experts. Entomologists. Mm-hmm. Okay. Well, I think they probably prefer that to bug experts. I mean, maybe they like bug experts. I don't know.

And that's fine if you do. But I would assume entomologists is what you would. It's like, I call bat experts. Experts in these terrifying bugs with wings. with their leathery wings. Then I would be a body expert? A body and blood

and bone expert. A bodyologist. A body a... No. Body ideologist. That's me. An FBI federal body inspector

or a body audiologist if you prefer. This is a Q&A. So let's take your questions and pass them on over to Sid and she thinks. Sidney, this is one where I feel like

I should already know the answer, but it's definitely too late to ask now. If you're upside down and all the blood rushes to your head, could that actually cause lasting damage? If you stay that way too long, what do you say, Sid? Yes. It just says, whoa, really? Yes. I didn't think you'd say that.

I thought you'd say no. No, the answer to this question. Now, I'm going to give you more context, but yes, there is. So generally speaking, hanging upside down for brief periods of time is not harmful. Yes. Okay. Okay. And what is a brief period of time?

I mean, I think that really varies on your specific, like, physiology and your underlying medical conditions and your age and your size and all kinds of things, right? So, like, I can't give you a magic number. But there are routinely people as part of their, like, exercise and wellness routines hang upside down for a couple of minutes. Okay. Are you familiar with that idea? Yes, because in, like, Batman, he slept that way in some of the Batman movies Bruce Wayne did. All night? Yeah.

I don't think it was probably good. for him though, right? Maybe it made him Batman. No. Batman powers or I don't know. I would say that's bad for you to like, I mean, if we're talking about an eight hour ish. There's no, hey babe, I don't mean to be all like, um, actually, but like, there's no way Bruce Wayne is getting a clean eight hours of sleeping night ever.

He's Batman. I don't know. He's really rich. And like, rich people are able to, they have the privilege that they can afford. Right. The kind of like health and wellness lifestyle that we all, aspire to and are told to seek, but then capitalism grinds it out of us. Yeah.

Bruce Wayne could get it. Yeah. That's fair. Okay. Fair enough. But he is Batman, too. That's fair. That's true.

Yeah. So I don't know. I mean, it depends. And I also will say that if he was sleeping that way all night, even if it's like five or six hours, I still wouldn't recommend it. That would be too long because he doesn't have like bat physiology. He just likes bats because he got scared of them in a well once. And so now he likes them.

Right. Is that the story? I'm not going to spend it anymore. I'm not going to. I know when I'm being baited, madam. and I won't accept it. There is, yes, there have been cases of people dying from hanging upside down too long. There are generally circumstances where people have been trapped in some way where they are

hanging upside down. Like in a cave, there was an individual who died in a cave that they were like trapped hanging upside down. There have been people who have become quite ill from roller coasters that have been trapped in upside down. So there's a nightmare for us all, right? Sorry. Sorry, I introduced that idea into our brains.

sitting still so I don't become like associate to what you're doing right now. What is that what is this like horror? What is this final destination you've queued up for us? Our cardiovascular system. Everything that pumps blood through your body is made to be upright or laying down or sitting right. But it is it it's not made to work upside down. So while we have mechanisms when you stand up there is a mechanism that squeezes the blood so that it doesn't pool in your feet so that it continues to get up to your brain. It's wild. And if because of doesn't work, you pass out. It's like a life-saving mechanism. That's your body's way of saying like, no, no, no, your brain needs blood. Ah, fall. Well, there is no mechanism for if you're upside down to keep it from pulling in the top part of your body. It just does. And so it's bad for

multiple organ systems. Most of the time, the thing we worry most about is the heart. All that blood is pulling in the heart and over-stressing and stretching and over-capacity for what the heart can continue to pump through the body and you could die of heart failure. So that's like the big concern. But the lungs are delicate organs as well. They're on top of everything underneath them for a reason. They can get kind of smushed. So the weight of the other, your other internal organs. The way that your mezzanitary kind of suspends your intestines, now they're smushed against your diaphragm. So it's bad for your gut. It's bad for your lungs. It's bad for your heart. You can have too much.

congestion of blood in the brain. It's bad for your brain. So it's bad. It's a bad. For a short period of time, most likely you're fine. But you should not hang upside down for prolonged periods of time if you can help it. There you have it, folks, straight from Sydney to you. Hi there.

Most of my life, I would very rarely get hang nails, maybe once every few months. In the last year, I've consistently been getting them every couple weeks or so. What makes a person more or less likely to get them? did I make some kind of lifestyle change that unknowingly made them get them more often? And that is from Anthony. Maybe. You might have.

So when I first read this question, I thought, eh, I think they're just kind of random, right? Like you just randomly get a hang nail. It feels like just one of those things that happens. And a hang nail, can you define that?

Because I used to be confused about what it is. It's a, well, I mean, it's a piece of either your nail or cuticle that is partially detached. Okay. I always used to think it was like

if you were trimming your nail, and then you just stopped halfway through. And that's how you had a hang nail. You just like left it. But like I thought that's what it was. That's why I was ambitioning. But it's really a split down the other way. Yeah.

Because it could because, yes, it is a split. You're talking about like running along. Yes. Like parallel to the nail bed. Yes. Or to the direction the nail is growing. I'd always imagine the perpendicular to the nail bed. Yes.

Well, you could. But more than likely the nail tore for some reason. Whether it's because it got caught on something or because you're picking. at your cuticles like I do, that's possible. If you have dry hands when it's cold, if the skin is dry, if you are not taking good care of your cuticles, if you do pick at your cuticles, there are a number of skin conditions that do make you at higher risk for hangnails. I didn't realize that.

I kind of thought it was random, but if you're not taking proper care of the skin of your hands, specifically if they're getting really dried out, if you're exposing them to harsh chemicals a lot, if you're immersing them in water. So if you do something where your hands have to be wet, I always imagine like if you're washing dishes all day or something where you'd be immersing your hands in water a lot. These are all things that can predispose your nails to tearing and then you can get hang nails. Yes. So taking good care of your hands can help reduce the frequency of hang nails. So possibly or sometimes it's just happenstance.

Also don't pick at your cuticles. Do as I say, not as I do. Here's one I didn't think I'd be asking you today. Dear Doctor and Mr. McElroy, can Black Widow Venom cure diabetes? Love the show, Vosti. Justin, I didn't know this. I learned something. I'm pulling my computer to me so I can tell you exactly what this is.

There is something in Black Widow Venom. It does not cure diabetes, so let me make that clear. Somebody's like slowly setting the Black Widow back down. Yeah, let me preface with this. Please do not intentionally get bitten by a Black Widow spider. Now, this part is not. Now, see, I get so confused it, is this medical advice? Well, that's just like life advice.

Yeah, okay. So this is just like regular life advice. Yeah, life advice. Do not intentionally. I mean, I do not intentionally get bitten by something. It's just standard advice. Or like by anything. Right?

Maybe. Yeah. Maybe in some cases. But what about the blood say, like what about the life saving bite of the leech? Perhaps. You can't be universal. Well, that's not. I mean, generally it's not life saving.

There are medical application. Anyway, we're getting lost. This is not, there is no evidence that if you get bitten by a black widow spider and everything else goes well, you'll also have your diabetes cured. That is not. So don't do that. Don't do that. But where does this come from? There's a, it's, I love these things where there's a grain of truth. Okay. So there is a neurotoxin. We know that black widows can cause neurological symptoms as part of the whole thing that happens when you're exposed to their venom. Is there a paralysis of sorts? Can be lots of different neurological symptoms. Okay. Depending on the dose and, you know, all of that. So there is a neurotoxin, alpha latrotoxin, okay, that you can find in Blackwoodo spiders.

And it is a receptor agonist, which means it will bind with a specific kind of receptor that is already in our bodies. And there are lots of substances we find that do that. A classic example would be like opium. Okay. We know that, and then all of its directs. derivatives, we have receptors in our body for this substance out in the earth, and this will bind to it. Black Widow Venom has this substance in it that will bind at those receptors. Do you know what else binds to those receptors?

What's it? Well, have you heard of GLP-1s, honey? Yes, and yeah. Glucagon-like peptide amide. That is also GLP-1, which has been made famous, I think, that phrase, because of the GLP-1 class of medications that are used for diabetes and are now used. used for weight loss. And so I think it's become very popular in the media. I think I understand what Sydney is saying. And so can I just go ahead and wrap up for you here? Sydney is saying that the black widow spider, the bite of the black widow will prompt you to lose weight. No. And that is

stunning. No. I can't believe that here is where that information is being rolled out. No. Okay. No. I'm not saying that. I absolutely am not saying that. What a tragic misunderstanding. So when this binds with that receptor, it could stimulate the secretion of insulin from your pancreatic beta cells, which is similar to how GLP1, I mean, that's how GLP1 medications work, right? Like the way that we treat diabetes is we either want to make your cells use insulin more efficiently or we want to make you make more insulin. So this is one of the ways we can treat diabetes. And this is, has structural homology, meaning they are similar and combined to these. receptors. Interestingly, there is also a toxin from the gila monster that is a structural, like, it is the same.

Okay, folks, you heard it here first. The bite of the gila monster cures both diabetes and what was Alzheimer's? No, no, no, no, no. No. So I think it's fascinating. And I think what we do with information like this is we look at these substances and things. could we use this as a basis for drug development? We don't say go get bitten by a black widow spider or a gila monster because obviously you get all the negative stuff. So I think we talk about this on the show a lot that it's not that there aren't cures and treatments that exist somewhat out in nature. It's that it's not a refined cure or treatment.

You got to get something that's a little bit closer to the source. Something that's like more refined. Well, we got to take what piece of this is working and let's isolate that and then make it safe to put in a human body. Black Widow spider venom is not safe to put in a human body, even though this one substance might work like a diabetes medication works. So, but I do, I mean, this did, as I was reading it, it felt like the synthesis of like a black mirror episode or something. Right. Where people are intentionally getting bitten by black widow spiders and gila monsters. We do not have evidence that that would in any way help your diabetes or help you lose weight or do any of those things you may be seeking.

Please take medications that have been approved for those. But that is where that comes from. So it is based in some truth. Well, there you go, Sid. I'm as surprised as anybody on that one. That did not have the ring of truth. Me too. Me too. A cousin of mine recently had a doctor's appointment that revealed a polyp in her lung and another in her throat.

her doctor said he would order a test on her to determine whether there was cancer anywhere in her body and then they would let her know the next step to plan this news baffled me but some preliminary searching online by my brother a nurse showed us that such a test does exist how does it work and why have you never heard of it i'm stunned this technology exists and assume we don't receive all the tests at our annual physicals due to a cost and crappy american medical system would love to hear thoughts love Nina. So I think this is a really good question because you'll occasionally see like quote unquote full body scans advertised by health care facilities. The idea being like just come on in and we'll take a picture of your whole body and tell you if there's anything to worry about. And it's usually like

a cash deal. It's usually not like your insurance is going to cover it. It's just like pay this flat fee that would be way cheaper. It always felt like pay this fee and then walk behind one of those x-ray machines like on the Simpsons like Dr. Just to take a see everything in your body. I don't know exactly what tests you were researching. My guess would be a PET scan. And this is a commonly used test if we find evidence of some sort of cancer in one part of the body. We may at that point want to see if there is evidence that cancer could be anywhere else in the body.

And the way we do that is we look for areas in the body of increased metabolic uptake. cancer grows fast. It eats stuff quickly. And so if we see an area on a scan where something's metabolizing things quickly, which we can use with like a radio tracer, and then we look for areas that are brighter than others is what we're basically looking for, that area could indicate a cancer's growth. Could. Not 100%. What we know is that this is an area of higher metabolic up. uptake, and in the setting of someone who we believe already has cancer, that would be very

suggestive of a metastasis, right? We think the cancer's gone somewhere else. Is that an indication, though, that you'd need to get more tests, or is it just sort of like narrowing down the possibility? Depending on how much information we have at that point. I mean, that's a very individualized question. Have we done a tissue biopsy, and we have like, yes, it's this kind of cancer and it originated in this organ, and now we're going to look to see, like, these are likely metastasis

in these other places? or do we really have no idea what's going on here and we're using this as a tool to try to refine where are the problem areas and can we get a piece of tissue from there? So it's very individualized, but my point is this, to just randomly put somebody in a PET scan

would not necessarily tell you anything. If I don't have some sort of clinical indication, like why am I doing this on you? What did I find that made me think that? So it's one piece of information, but it is not diagnostic for 100% this is cancer, first of all. Okay.

It does not tell us that. And in the setting of no other information, no other testing, it would be maybe a dangerous test to do in the sense that if I see an area of increased metabolic uptake, am I going to biopsy it? Because I don't know what it is. Maybe. Maybe. Well, probably. Because at this point, I've kind of hem myself in. And this is the same if you think about like, why don't you just stick me in an MRI?

Why don't you just stick me in a cat scanner? Why don't you just look in my whole body and see if there's anything in there? we might find a lot of things that are not the like the standard what we see in a human body every time right but for you it may be completely normal we have a term sometimes we use called incidentaloma

incidental oma it's some sort of oma oma is sort of the like the ending that's on a lot of masses that we find and it was an incidental finding we were looking at something else and incidentally we found this adenoma or whatever so it's an incidentaloma most of the time it can mean nothing.

But once we find it, we're going to start doing tests on it. You have to, right? Yes. From a liability standpoint or something else. And these scans may be external, non-invasive. And in a sense, low risk, although for some of these, there's radiation involved. We may be putting dye in you. So there's some risk involved.

But even if all of that risk is pretty low, it might lead us to do higher risk procedures to try to figure out what's going on. And at that point, you are risking that you went down this whole pathway when you were well and really didn't need any testing. And now we've done things to you that could cause harm unnecessarily. So this is why we don't typically, there's no evidence right now to recommend full body scans to look for anything. And we do not have a single test that I can use on you and then immediately say, yes, you, I saw this thing on an image and I know for sure it's cancer. We can highly think, like, yes, this is very suggestive. But until we look at that tissue under a microscope, we don't know for sure. And so we might be going barking up the wrong tree, so to speak.

So I think that's the test you're talking about. And I think it's a good reason why we don't do whole body scans all the time. Let's take a quick break there. I actually have already prepaid for one of those scans. So I have to get that done and pay for it. And then I'll be right back. And we'll do the next half. Then it's good that we're going to the billing department.

Yeah, we'll need it. Let's go. The medicines, the medicines that Eskilnit Macabreve for the mouth. Good news. Practically perfect in every way. Believe or not, that's what they said. I've been taking omeprosol, OTC. Got that in one because we do say that around in this house.

Yes, we do. Meprosol daily for a couple of years now to treat my heartburn and acid reflux. It seems to usually be sold in packs of 14, one pill, daily as a two-week treatment, but as soon as I stopped taking it, my acid reflux come back with a vengeance. So I just keep taking it every day. My mom has also been taking it for years. Recently, she was having blood work done and the phlebotomis said they they stopped taking omenpresol because they heard it causes loss of bone density and can accelerate conditions such as osteoporosis. Is there any true to this? Thanks. Love the show. Joe.

This is a really great question because I, for one, I know anecdotally that a lot of people take omeprosol or medications like it. They're in a class called proton pump inhibitors or PPI. I'm going to use that for short, PPI's. Yeah, thank you. Because every time you say proton pump, I get excited that it's a ghost posture thing and it never is. It's not. It's definitely not.

So this class of drugs, when it was developed, to treat acid reflux, as it is colloquially known. When it was developed, the thought was that it would be a temporary short-term treatment for the majority of patients. Now, there will be some outliers who have maybe some other chronic or genetic. it conditions that they need it chronically. But the thought was that this would be a four to six week treatment, usually six weeks, for either acid reflux or peptic ulcer disease, something like that, and then you would stop it. They were not created for chronic use.

Yeah. But that is not the way that the American public, at least, has embraced it. We know that it is probably overprescribed. And then because it is over the counter, we probably are using it more than is really necessary. And so now we are starting to do these what are called observational studies, meaning, well, we thought that you would take this medication for a few weeks, but now you've taken it for a few years, and I don't really know what that's going to do. So observational studies have shown association, this is not causation, but association with increased fractures, cardiovascular disease, dementia, chronic kidney disease, some mineral and vitamin deficiencies. So there's a lot of different things that we have seen

If we look at a study of these people take PPI's and these people don't We see a higher rate of this in this population than that We don't know if that means they're causing it right now But there is some sort of correlation And we do have some conflicting data There's some data out there that says like well, yeah, they might decrease your calcium But they don't actually cause an increased risk fracture We don't have that so like right now we don't know for sure we see some association

But the problem with these medicines is that if you take them for more than four to six weeks, you'll get rebound acid when you stop them. Oh, right. So even if it feels. You're going to feel like you need them forever, whether you do or not. So it's really hard if you've taken them for a while. And I am not suggesting right now that I know you need to stop them. I don't have data to say that. Please talk to your health care provider. But if you are going to consider trying to stop them and seeing if it, if it is good for you, you need to know that when you first stop them, you're going to have worse acid reflux than you had to begin with. And you're going to need to take other things to help cope with that until that sort of

flushes out of your system after a few weeks. And then it kind of equalizes and you see where you are. Yeah. Now, that's why it's so hard for people to stop them is because of that rebound acid reflux. And I totally understand there was a period in my life where I had to take them a lot. But again, talk to your own health care provider, but that's the problem with PPI's. We didn't intend for them to be forever use. But that is definitely how the American public has embraced them. I really, I feel like that's kind of my relationship with ibuprofen, too, which I didn't even realize was something that you should do for a short run and then bail on. Yeah, there are a lot of, that's the problem with over-the-counter meds. And like the, I think we have created this block in our brains that if it's over-the-counter, it's safe to take whenever we think we need it.

And if it's prescription, then that's when it needs to be regulated. When over-the-counter meds can be dangerous, if not used appropriately. And so if you find yourself having to take over-the-counter meds all the time, it's at least worth a conversation with your health care providers. are like, hey, is this cool? Like, I do this every day. Is this okay? Because there are alternatives. There are other medicines for acid reflux that aren't PPI's that you may be able to,

that may control your symptoms and you don't need to take a PPI. So at least ask. Just ask. It never hurts. Hey, Sydney and Justin, I have a quick query for you to. Why did the black plague end? And are there other plagues humanity was able to end pre-vaccines slash antibiotics? I've heard the survivors gain immunity to the plague causing the spread of the illness to slow.

But didn't this happen? Why didn't this happen with other plagues? That's from Eric. Well, it did. Yeah, we're not still having them, right? Right. I mean, that's the thing we do. I mean, some illnesses, epidemics, outbreaks,

plagues throughout history are better publicized. Because I think, honestly, the ones that we know the most about are either ones that have very obvious and dramatic physical presentations. So like smallpox springs to mind. Right. And plague is another good example. You could get giant boobos in your armpits. Sorry, say it again.

Bubos. Big black swollen lymph nodes. But the other thing is that they kill a lot of people. Those are the things that stand out. There are plenty of things that maybe don't get as much press, but also had impact on human history. Before vaccines, we just got them. Now, of course, there is no vaccine for the plague. We just treat it now.

Yeah. So before vaccines, before antibiotics, we got them. and some of us lived and some of us died. Yes. And those who lived hopefully developed immunity, depending on what it is. Or they had children whose children's children's children's children's made vaccines. Yes. And those who didn't, that was it.

And I, you know, that's, I think we kind of take it for granted because we don't see this now. Well, yet. But yeah, that's the thing. No illness that we know of. I feel like I should knock on when I said this kills 100% of people who get it. There's something that come pretty close. Yeah.

But there's going to be survivors. Now that is not an argument for so let it burn personally. I went into medicine so I don't know why I would make that argument. But they do. I mean, I think what you're talking about is exactly what happened

pre-vaccine pre-antibiotics. Some lived and gained immunity and were able to pass on their genetics to the next generation. And sadly, many, many didn't. And now we have vaccines and you should get them. I recently gave birth. And in my discharge instructions, it said to flex my calf six times a day.

I thought this might have to do with circulation after being in bed for three days. But then I read it on pregnancy website that flexing the calf muscles improves bladder function. They called it a biohack. Is this true? If so, how does it work? Thanks, Mary. You were right, Mary. I don't know what the connection between calf muscles and bladder function.

would be. I tried to find if there was any sort of like a paper published on this that somebody was investigating or something. And I couldn't find that. It is good advice regardless. And it is your circulation. So you were, you were spot on. Your risk of getting a blood clot, a deep vein thrombosis, a DVT after pregnancy is increased specifically in the postpartum period. It is during pregnancy as well, but in the postpartum period, those first three weeks is a much increased risk, and then up to six weeks after delivery, increased risk of blood clot. So doing things to prevent a blood clot from forming in your legs is a good idea. Getting up and walking around is one option. But it's tough when if you've just delivered a kid, especially if you had a C-section.

Exactly. So there may be reasons why you're not up mobile as much as you would be. So flexing your calves is another way of creating circulation, blood flow, and trying to prevent a DVT. So that's a really, I think that's a good piece of advice. And also, like, your body has just been through a traumatic, stressful event and light exercise that you can tolerate, like flexing your legs while lying down is a good idea. So that you were right. Okay, so not really a weird medical question, but recently I've heard multiple people go to their clinics and have doctors or PAs ask if they could use AI scribes.

what is the security around these and how common are they becoming in the medical field because they honestly freak me out and I have to go past my comfort level to say that no, I won't allow it. That's from Emily. I think this is a really timely question. So I don't use the AI scribes,

but I know I have many colleagues who do. The agreements that are being signed with these AI tools protect you, the patient, from data sharing, right? I mean, that would be the understanding is that this ambient listening device is going to hear things, generate a note, but will not be creating its own database, I guess, of information about you. And then certainly we would not, as a health care organization then,

be allowed to share that information with all of the people who want data, like Amazon or whatever, right? Like whoever buys data to sell you things better, because that's generally what they're doing. All of those agreements are put in place. That being said, as we increasingly engage with AI and health care, I definitely see this as a place where there will be security issues. I mean, it's hard for me to imagine that we won't see breaches in this process periodically where people's data is released to third parties intentionally or unintentionally, where health care offices and doctors are maybe the subject of lawsuit. based on this technology. And I really feel that the real pain point is right now, AI is being used a lot to generate the note,

and there's a lot of arguments for it saves your doctor time. They're more efficient. They're less likely to burn out if they don't have to write the node, if the AI writes it for them. But on the flip side, there's also increasingly technology that would actually diagnose and treat the patient for you. Boom. And in that case, who's on the hook if it's wrong?

Is it if I am using it as the physician? Is it me because I use the AI technology? Or is it the creator of the AI technology? Is it my healthcare organization that purchased it? Who's on the hook for that? I don't know. I mean, that trial will come, right? Like that case law will be written if it's not already in process.

So I would say right now, the use of AI to generate the note is not, I don't think it's particularly controversial in health care. I mean, Justin, don't you think a lot of people are using AI for a similar idea? Yeah. Record this conversation and turn it into a document. Yeah, and I think that AI is going to mean a lot of different things in a lot of different contexts. I think a lot of the AI that's being advertised to people is going through a lot of the big tech companies and to their servers, things like, you know, Jim and I and I, and Chad GPT and all those services. I understand why they would be, you know, guaranteeing security and safety and stuff

and guaranteeing that this data wouldn't be used to train the models, but I don't know that I would buy it. Honestly, I just wouldn't believe it. If it was me, I would say, no, I don't. I would rather you just, you know, I don't know, wrote it down or something. I don't necessarily need an AIScribe listening. I don't know. Sorry, just to add, there have been recently, like, stories in tech companies of AI working in environments that should be more secure that, like, took it upon themselves to delete information, release information, whatever. Well, I heard a, or I read one, as I was looking into, like, the legal issues around it, how are you protected?

And one interesting question in this is, if you are in a state that requires consent for recording, your provider has. to ask you if you think about it. Yeah. And so that's that's going to have to be written in there so that you are going to have to have a conversation if you're in a state where that's not allowed. Now in our state it would be allowed. Yeah. So I wouldn't have to ask my patient if I was going to use this technology. I could just use it.

I still think it would be a smart thing to do. I will not use it because I think that the more we have used computer generated notes pre-AI, just the computer-generated notes, skeletons that we use a lot in EMRs, electronic medical records. I think put so much trash in our notes, so much just ridiculous, yes, stuff that they make our notes almost unreadable. And since I do chronic care for patients and I am the main person who needs to read those notes in the future and understand what was past Sydney doing, what did we decide and what were we doing moving forward, I write all my notes. I free text. I might use an algorithm to like plug in symptoms. But when it comes to the story and the plan, I free text. of it because I think my notes are higher quality for future health care providers to read

and understand the plan for the patient. So for me, I think I get better quality and my patient gets better quality from free texting my notes and I will stick to that and I'll just live with it. But I am also in a privileged position because I have great support from my boss and my health care organization and they do not overload me with patients to a point where I would have to use a tool like that to survive. And many of my colleagues have to or else they cannot finish their work, period, like ever. There is not enough time. They could go without sleeping, eating, peeing, and they still would not be able to keep up with the load of work that doctors are being asked to perform these days. I'll say that the health care system sucks and there's very little about AI that

is going to make it less sucky. I think it'll just allow it to suck more for longer. They want to churn more work out of each provider. And this is a great way to try to churn more work out of us and try to convince us that they're helping us. I was wondering about how many living human cells would be shared when you will poop. I suspect it would be a small number. I also suspect it wouldn't be zero. I don't want to talk about this. Let's talk about poop, Justin.

Mark wants to know how many living human cells are in poop. You got a guess? 80. 10 million. Okay. 10 million colonocytes, like the cells that line your colon. Epithelial cells that line your colon. They're about 10 million.

However, there's 100 billion living bacterial cells in your feces. So your poop is more bacteria than human. Oh, God, this shows sometimes, man. We got one more. Hi, Sidney. I am 24. I have my first cervical screening coming up, and my period has come at the most inconvenient time.

How important is it to not be on your brain? period for this procedure. I've heard people say it's better to have it in the middle of your cycle, but that seems tricky to attempting an appointment with such specific timing. And it made me wonder just how much the phase of your cycle affects the results of a cervical screening and why that's from CAT, they then. So I think this is a really great question because the data on this has kind of changed over time. So initially we did use to counsel patients that prior to their cervical screen or pap smear, you may call it. Prior to your pap smear, it was best if you were not actively bleeding, like having your menstrual cycle.

The thought was that the cells, the blood cells, would interfere with when we're trying to put those cervical cells on a slide and look to see any evidence of like pre-cancerous changes or cancers changes, that the blood cells would get in the way and interfere with the sample. And I think that is theoretically still a possibility. I'm not going to say there couldn't be a sample where you would see it and there would be so many blood cells that you wouldn't get a clear picture. That is theoretically still possible. That being said, one, we had, I found a study out of 2025 that looked at patients receiving a pap smear while actively bleeding on their menstrual cycle and those who didn't. And they did not see any difference in sensitivity and specificity of the pap smear in those two patient populations. And this is just from last year. So maybe we were worrying about nothing.

the other reason that we have pushed back against this through the years is that it is really hard to get a timely appointment to get the screening done. We know that, especially in this country. And if we don't do it at the moment that you're there, there's a high likelihood we lose you. And you put off your screening for a while and maybe we lose this opportunity to catch something in an early stage and save your life. and by the time we catch it, you're in a later stage and then something tragic happens. So the stronger recommendation is go ahead and get it done. Most of us won't reschedule.

Most of us will just say, I'll get to it at some time, and you won't. And it's better to get it done. And worst case scenario, even though I've never had this happen, it is theoretically possible that we go, eh, it wasn't a great slide, we maybe need to do it again.

I've never had this happen, but I'm not going to say it's impossible. But most likely it will still be a great sample and a good test and you'll have your screening done. Could it be uncomfortable? That's the other issue. Yeah, I mean, as somebody who menstruates, yeah, I would prefer not to.

And I will say, full disclosure, I have put off a PAPSMEAR because of my cycle because I just didn't want to go through it. But I also am privileged that I have access to my OBGYN, I can text her a caller and say, hey, when can I get in to see you to reschedule this? And I can do that really quickly. If I did not have that access...

Did you reschedule that, well? Yes, I did. If I did not have that access, I would just get it done and that would be my advice to most patients unless this is obviously if you're going to be traumatized and if it's super uncomfortable

I mean I would never encourage you to force yourself to go through with something but for most of us just go through with it I promise you as someone who has performed many pelvic exams and many pap smears I am unbothered your provider will not care

will not notice will not it will not even cross their mind that you're still having a period It will not bother them. You may be uncomfortable, and that's totally valid, but your provider will not care. I promise you. There's nothing we haven't seen or tackled. It is nothing.

Thank you so much for listening to our podcast. Thank you to everybody that supported us in the Max Fund Drive. I really appreciate it. Thanks to the taxpayers for the use of their song medicines as the intro and outro of our program. A quick note just to remind everybody, these Q&A episodes sometimes remind me, Sydney is S-Y-D-N-E-E. I know that she would never get upset about her to say anything, but I love her, and she makes me really proud. So that's how you spell it. Does that bother you?

It does, because you're my favorite. It doesn't. It doesn't bother me, but it is an unconventional spelling. And I've been talking a lot about names recently, and I think it's important, S-Y-D-N-E-E. It's ultimately my parents' fault for spelling my name the way they did, I think. Where did they get that one against it? They got it from a Playboy centerfold named Sydney Rome. Although, to be fair, I bet you anything, Sydney Rome, spelled it, S-Y-D-N-E-Y.

Really? Because I bet it was Sydney, Rome, like Sydney, Australia and Rome, Italy. I bet you anything, it was spelled that way. Oh, that's like the pun. Honey? S-Y-D-N-E. One-E. Holy crap, and our birthdays are only 10 days off.

I mean, not year. But date. There you go. Wow. S-Y-D-N-E. Now that would have been, okay, now, straight up, what would you, I mean, what would you prefer? With the one E, no one would ever get that, right?

You'd probably have to stop everybody for that. But yeah, I thought it was S-Y-D-N-E this whole time. I've been telling people that you've been named out of this person your entire life. Wow. Her name is often misspelled, S-Y-D-N-Y or S-D-N-E. Even in tribute names Sometimes it's spelled S-Y-N-E

Isn't it wild This is the first time I've ever Googled her I have never Googled her Until this moment What an episode What an episode What a moment Thank you so much for listening

That's gonna do This week on Salvos Until next time My name is Justin McRoy I'm Sidney McRoy As always Don't drill a hole in your head Maximum Fun

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