Weird Medicine: The Podcast - 305 - A Peyronie for Your Thoughts

Episode Date: March 29, 2018

Lots and lots of calls this week, as Dr Steve is not distracted by Lady Diagnosis or Dr Scott. Topics include bent genitalia, methadone tapers, rhinoceros poaching, dry mouth, bleeding problems, and more! Please visit STUFF.DOCTORSTEVE.COM! SimplyHerbals.net Learn more about your ad choices. Visit podcastchoices.com/adchoices

Knock knock. Who's there? A fixed. A fixed who? A fixed your door. That'll be $50. I've got diphtheria crushing my esophagus. I've got Tobolivis stripping from my nose. I've got the leprosy of the heartbound, exacerbating my incredible woes. I want to take my brain out and blast it with the wave, an ultrasonic, ecographic, and a pulsating shave.

I want a magic pill. All my ailments, the health equivalent is citizen cane. And if I don't get it now in the tablet, I think I'm doomed Then I'll have to go insane I want to requiem for my disease So I'm paging Dr. Steve It's weird medicine

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So it's like buying six for the price of four. Anyway, and check out Dr. Scott's website. He's not here this week, but simplyerbils.net. And etncomedy.com is our comedy promotion website. We're just doing one thing so far this year, and it's August 2nd. It's Allendale Mansion in Kingsport, Tennessee. It's a free concert. So if you want to come, make plans to come and hang out with the Weird Medicine crew

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and maybe even BM John will show up. So that's August 2nd, 2018. And don't forget, try this, premium.com, premium.com. Premium.com. It's a buck 99 a month and you get access to all the archives and there's some premium material in there. But it helps us out and it's a buck 99 a month. And I'm not, I'm just, I don't think I'm going to do Patreon. I just, I don't get the vibe.

It just, you know, there's so much shit. And there's all these levels and all this stuff. And it just seems like multi-level marketing to me. I'm, if you will, if you don't even want to do that, if you'll use stuff. Dot, Dr. Steve.com, or just listen and don't worry about it. It's fine. We appreciate anything you do, including just sitting there and doing nothing but listening. Or ignore us.

That's fine, too. but I really appreciate our listeners and more than you can imagine. We really do. It's amazing to me that anybody listens to this shit. I don't have any real medical news today. We're still looking for a universal influenza vaccine. I did see in the news that now influenza A is on the way. Influenza B is making a resurgence.

And, you know, people are freaking out. Influenza B tends to be a little less virulent than influenza. a A usually, and it's making a late appearance on in the, this has been the longest damn flu season. It started really in September last year and is still kind of going on, although in our area we're seeing fewer and fewer cases. The flu shot won that great again this year, but it was a hell of a lot better than nothing. and people say, well, what's the deal with that?

Why doesn't the flu shot work every time? Well, this virus is a real piece of shit because it continues to mutate. So think about it this way. You got measles once or you got mumps or let's try chicken pox. Most people are listening to this probably had chicken pox unless you're so young that you had the chickenpox vaccine, in which case, there may be issues down the road, which we'll talk about in a minute. So you get that, you never get it again unless you can get chicken pox virus can reemerge again, but then we call it shingles. But the immune system is pretty good at knocking it back and then you can't get it again.

And that's because the next time you're exposed to that virus, you already have immunity to it. You've built up this immunity, and it recognizes the virus and it kills it before it can infect you again. And that's because the chickenpox virus doesn't mutate. For it to work, it has to have the same DNA and the same proteins on its surface, or it just doesn't work. If it does mutate, it's probably mutating to a form that can't infect humans. So, but influenza mutates all the damn time. It'll mutate in the middle of influenza season. So the way that they make the flu shots is in the summer, they go, okay, what's going on in the southern hemisphere on the other side of the world in the wintertime in their flu season?

And they'll say, well, we got this strain, this strain, and this strain. They go, okay, well, it's going to be something similar to that. we will, because there's some lead time to making vaccines, we got to make it based on what we're seeing in the Southern Hemisphere during their flu season. And so it's always this sort of lagging indicator. And we can't predict ahead of time how it's going to, how it's going to mutate. So they make the virus or the vaccine. And if the virus that they anticipated hits here, the vaccine works very well.

if the damn thing has mutated between then and the time that the vaccine comes out, it may not work as well. Now, there are studies that do show that even if you get influenza, because I don't know if you all remember two, three years ago, here I am, I guess I was 59, 58, 59, not a young man, not yet quite elderly. But at the end of, or the beginning of old age, at the end of middle age. And I woke up and had a fever of 105 and had influenza.

And not only had I had the flu shot, I'd been exposed to the flu mist virus. Flu mist was, we haven't had the last two years, a nasal spray vaccine. It was live, attenuated virus. It meant it was real virus. And my kids got it. And the sneaky little secret about the influenza. a nasal viruses, it's contagious. So if my kids got it, I got it. So I indirectly, even though I'm too old to get the flu missed, I got it anyway. And I had that and a flu shot and still got the

flu. But I just sailed through it. I had a fever of 105. I got a week off of work. I watched CW's Arrow from start till finish. I just binge watched Arrow. So I could, you know, I could I didn't feel like watching porn. When you've got a fever of 105, the last thing you want to do is get out your massive, meaty hog and start stroking it. So I watched nerd TV and enjoyed every minute of it, but just sailed through. And there are some studies that indicate that if you get influenza and you've had the flu shot, that it's more likely to keep you out of the hospital, which is all we really care about.

So, yeah, so the influenza vaccine this last, this last couple of years has not been great, but as I said, it's been better than nothing and probably still saving lives, still recommend it. But what we need, this is what we need. And they're very close from what I understand, close to having what's called a universal influenza vaccine. And so what that will be is like small. pox you get your smallpox vaccine and you can't get it again and you isolate the virus and then you wipe it from the face of the fucking earth because if we have a universal vaccine that would mean that they're actually targeting proteins that influenza must have

to be influenza and therefore if you get that vaccine you can never get that vaccine you can never get influenza. You may get peri influenza or echo virus or some other virus, but you're not going to get influenza. And if we do this properly, we may be able to wipe out human influenza. So that's what they're working on. And if we get that in the next couple of years, I will be definitely in favor of universal adoption of that, assuming that it's safe and as effective as we hope it will be. As I said, I have an issue with the chickenpox vaccine. I'm not sold on it yet, even though it's been out for quite some time.

And I'll tell you why, chickenpox, unlike measles, tends to be non-life-threatening. Although, you know, there aren't people who succumb to chickenpox, but it's less serious of a disease. And it's a lifestyle disease, makes you uncomfortable and you look goofy with all those pox all over you. And then later on, you can get shingles. So there is, I'm not saying there's no value to it. But what I'm concerned about is it's a killed virus. So how long does it confer immunity?

We don't know yet because it hasn't been out long enough. The one thing you don't want to do is get chicken pox when you're an adult, particularly if you're a pregnant adult. And I am concerned still that there are going to be people with diminished immune immunity living out there that are women of childbearing potential that may get chickenpox because the chickenpox vaccine ran out. So long-term studies are still ongoing. Hopefully, I'm not going to say hopefully I'm wrong because I don't have a position on

this. I'm just concerned about it. And I'm not saying don't get chickenpox vaccine. I'm not saying that. I am concerned to make sure that they continue to do long-term studies to make sure that the immunity is long-lasting. If it isn't, it's not that big of a deal. What you do is you just set up a booster schedule, just like tetanus. We get a tetanus vaccine every 10 years.

It may be that we need to get a varicella vaccine or chickenpox vaccine when you're a kid. And then again, when you're 21, and maybe you don't need one after that. And if you've ever seen anybody that got shingles of their eye, that is a disease that would be nice to prevent. So anyway, shingles of the eye sucks. It's like a herpes infection of the face and the eye. And it can affect this nerve called the trigeminal nerve, which is in the face. And if you ever heard of trigeminal neuralgia, it's one of the most painful conditions that we, know of and it's very difficult to treat.

It'd be nice to be able to prevent that kind of stuff. So anyway, not saying don't get varicella vaccine, just saying I have concerns about it. Just like I'm not saying no one should vape. I'm not convinced it's safe though. So I'm not a nambi pambi just say no type of asshole, but I am concerned of the long-term use of things like that. I'm just concerned. I'm not saying one thing or the other.

I don't have any concrete evidence yet. E.V. the night nurse in a couple of shows back did a story about acrolean, which is a known carcinogen being found in the urine of people who vape. That is concerning. I don't have any hard data yet that says that this stuff actually causes disease. But when I see these nuts with their tanks and their hipster, come on, two. on their on their vape pin and blowing out these giant clouds of of vapor that's you know it's unbelievable how huge they are and how smelly they are there I cannot imagine that this is good for you I'm hoping it's neutral I know it's not good for you I know that deep down inside

that doesn't mean it's bad for you I just there's no benefit to it and Now, as an aid to quitting smoking, I think vaping is certainly more safe than cigarettes, at least as far as we know. So if you're going to go from cigarettes to vaping to nothing, I'm all in favor of it. But remember, there is a prescription strength nicotine inhaler on the market called nicotrol that your provider can write for you that at least is FDA approved. So something to think about. All right.

Let's answer some questions. Number one thing, don't take advice from some asshole on the radio. All right, very good. Thank you, Dr. Bennington. Let's see what we got here. Uh-oh. Of course. Hello?

Hmm. All right. Hi, Dr. Steve. Oh, there we go. I'm currently in bed, having come back from the bathroom, trying to be sick. and I can't I have a bug at the moment I think it's supposed to be a vomiting bug but I've always found it incredibly difficult

to be sick I think the last time I was sick was about five years ago I'm not scared of it and all the Google stuff throws up a excuse the pun fear of vomiting I'm not scared I want to be sick because I want to get rid of whatever's in my stomach

making me feel ill but it's almost impossible. Why do I have this problem? What's the physiology of this? My dad has the same. He can't burp. He's never been able to burp, but I can. But, oh, God, I wish I could just be sick.

Okay, very good. I'm going to have to play this one on the podcast, too, because she's a podcast listener. I'm assuming unless, well, anyway, I'll just do that one on the podcast as well. Yes, so you're right. If you Google inability to vomit on the Internet, you will find emetophobia, which Dan Natterman and I share that malady, which is an unnatural or irrational fear of vomiting. And Dan would say, I don't find it unnatural at all. Makes perfect sense to me.

And he's not wrong about that. Vomiting is horrific. And I am really nervous about foodborne illness. I don't care if it gives me the shits. I just don't want to puke. But this woman has a different problem. She wants to puke. She's not able to.

And she answered her own question when she said her father couldn't do it. so this is likely genetic and her father can't burp and that implies a mechanical issue so he hit their stomachs so the way it works is the mouth leads to the pharynx which is the back part of the mouth or the oropharynx and that connects to the esophagus which is a tube that goes down into the stomach and the esophagus has to pass through the diaphragm. And that hole that it passes through is called the hiatus. And you can get a thing called a hiatal hernia, which is where the stomach actually bloops up above the diaphragm and gets compressed. Some of those people can't burp. Some of them burp too much. He could or both of them could have a kink in their esophagus that actually will prevent them from having gastroesophageal reflux. because if you can't vomit and you can't burp,

it's unlikely that gastric contents can get up into your esophagus. So this may be a blessing in disguise. Usually people get a puk bug about once every three to five years, and so she's going to be really uncomfortable wanting to vomit and being unable to do so once every three to five years. But then for the rest of her life, she's likely not to get gastroesophageal reflux, which if you have it and have to take things like Prylasek,

you know, you know what that, what kind of suffering that is. So it may be a blessing in disguise, but I suspect this is anatomical and it has to do with genetics and it's just the way they're built. There is a natural variation within some limits of the way human bodies are made. And that may, her malady or her inability to vomit may confer an evolutionary advantage at some point. If there was a, let's just say, an extreme example of a virus that came through that caused unremitting vomiting, people who couldn't vomit would probably live longer than people who were just puking up all their vital juices. So, you know, that natural variation is there.

Not to confer advantages, but, you know, natural selection will take advantage of those advantages. when selecting certain populations to pass their seed onto the next generation. So anyway, but that's most likely what's going on there. All right. Hi, this is a question for Dr. Scott. Oh, well, you're in here. What is the best alternative medicine to have lexapro, a flexer, Zoloft

Symbolta but what is the best alternative medicine to contract those I know that there is a couple that you can get

first thing Dr. Scott isn't here so we'll do this maybe on the podcast this weekend but I can answer a little bit. I'm pretty sure I know what he's going to say is that obviously exercise, yoga, those kinds of things that release endorphins are probably good for depression. People are depressed tend to be couch potatoes.

And most of the time it's caused by the depression. I'm not being critical. It just happens. You feel shitty. You don't want to get up and do anything. It's called apathy. And that's one of the symptoms of depression. If you can force yourself to at least do yoga three times a week, it might help to a certain degree.

Number two, don't treat depression yourself. If you are depressed, and remember, depression isn't sadness. Depression is a cluster of symptoms that includes apathy or the lack of desire to do things. Anhedonia or the lack of ability to take pleasure in things. depressed mood, insomnia or hypersomnia, in other words, any sort of sleep disorder, those kinds of things, loss of appetite or increased appetite, which makes it difficult. You've got to have these clusters of symptoms. Any one of those by themselves may not make the diagnosis of depression.

There are depression screening tools on the Internet that you can take. But if you think that you're depressed, you should talk to your primary care. I would say 70% of psychiatry is practiced in the primary care office, only about 30% in psychiatrist's office. So most of the time, if you have clinical depression, they'll do a quick workup. You never want to treat someone with low thyroid or low testosterone with an antidepressant. So you do some workup, a thyroid check, testosterone check if you're a male, complete blood count, because anemia sometimes can mimic depression or some of the symptoms of depression.

And then they can treat you. And if you want to do it without taking prescription medication, they could talk to you about it. If they're into complementary medicine, they may try you on a thing called St. John's Wart. And St. John's Wart isn't consistently effective for depression, but hell, what is? and it's not recommended that you use it to replace conventional care or postponing seeing somebody. It's, and St. John's Wart is real medicine, and it can interfere with other medicines. There's multiple drug interactions, and if you combine it with certain antidepressants, you can actually increase the amount of serotonin, which is a neurochemical in your nervous system to the point where you do yourself harm.

So just please don't try to treat depression on your own. If you go to someone that's interested in complementary medicine, they might try it, particularly for mild, non-life-threatening depression if someone really just didn't want to take, you know, a prescription medication. But remember, it's still medication, and it has some of the same effects of our regular standard antidepressants. All right. Okay, doke. Oh, well, and if you're interested, there was a. a 12-week trial with 73 participants, and they were, it said, oh, yeah, neither St. John's Wart nor a standard antidepressant decreased symptoms of minor depression better than a placebo. So minor depression probably does not require medication unless it turns into major depression.

Here's another 26-week clinical trial with 124 participants and St. John's Wart, a standard antidepressant, and placebo, were similarly effective in treating major depression of moderate severity. So even there, the placebo effect was quite strong. 2008 review of 29 international studies. So what this is is a meta-analysis. So in a meta-analysis, you take a whole bunch of studies and you pool the data, and then you do statistical analysis on that, and sometimes it helps to tease out a weaker signal because you're using more data points. They felt it may be better than a placebo and as effective as different standard preparation prescription antidepressants for major depression of mild to moderate severity.

So, you know, this depression is not the easiest thing to manage. And I really feel like unrecognized depression can be life-threatening if it proceeds to suicidality. And it's always better to have someone supporting you. And not only your family, but your primary care or a psychiatrist. So please, if you're suffering from this, just go see somebody. If you want to talk to them about St. John's Wart, feel free, but don't treat this on your own. Okay. All right.

Hi, Dr. Steve. Like the show called about five times. Hey, thanks. This one is for Dr. Scott. Okay. Now, there's this documentary series on Netflix called The Traffickers, and one of the episodes is about rhinoceros horn. Dr. Scott, can we please? stop the madness okay or if the shit really works then please give dr. Steve one of those

double blind study test placebo ordeals so either way we can stop killing off these rhinos all right oh please answer this one on the podcast if you can because I don't have the XM subscription anymore shit I'm gonna have to do all of these I'll just run this show on the podcast. Hey, Dr. Scott isn't here to defend himself, and he needs no defense on this because he is a graduate of four-year traditional Chinese medical school, which is one of the reasons I respect him. You know, he took four years out of his postgraduate life to pursue this, just like, you know, that's as much time as I went to medical school. and he's extremely knowledgeable. And he has disavowed the use of animal parts other than flying squirrel fecal matter, which is not endangered.

But he said that he does not use rhino horn. They were not taught to use rhino horn. That is not part of the traditional Chinese medical curriculum. And that it's a very small contingent of people. people who are poaching that and using it. And indeed, there's no double-blind placebo-controlled studies or any studies at all that shows that rhino horn does anything. It just looks like a big giant cock with a giant base.

And that's why. Remember, we talked previously about these whole food pharmacies that we've been to where the people told us that walnuts are good for the brain because they look like brains. when you crack them open. And carrots are good for the eye because when you slice one, you know, not not longitudinally, but axially, no, cronally, it will, shit. It will, it looks like an eyeball or, you know, because it's concentric circles. Big, you know, it doesn't look like an eye.

It looks like a sliced carrot. and that kidney beans were good for your kidneys because they're called kidney beans, and they look like kidneys, which is why they're called kidney beans, not because they're good for your kidneys. So that kind of, that sort of visual imagery that leads one to think that something has medical efficacy has no bearing in science whatsoever. And we try to be as scientific as we can. But anyway, Dr. Scott has disavowed that. He has nothing to defend himself on. He says, don't use that stuff. Don't create a market for it.

If the market disappears, poachers will stop killing rhinos and start killing other things, I guess. The market's got to disappear for ivory and for rhino horn. Among other things, you know, the last, I think, male white rhino is that, did I read that somewhere, died recently? and what they're hoping to do is create a new population by using his jiz to artificially inseminate other rhinos. So I applaud that. If anybody knows any more about that, call in. And that's something I would like to donate to because rhinos are cool. They look cool.

That's why we're going to Mars because Mars is cool. All right. Hi, Dr. Steve. It's Adam from San Diego. I have a question about... Oh, fuck. I fucked up again. Okay.

All right. I don't know what this. Hi back to Steve. I'm ordering some Taco Bell right now, and I see a billboard for a show. and it says friendship is the best medicine. I want to get your opinion on that. Thanks. No, methadone is the best medicine.

What are you talking about? Friendship, friendship, I actually think that there's data that shows that people with strong friendships have a better quality of life. That just kind of makes sense. I mean, who needed to fund that study? But anyway, yeah, I don't know, dude. I got no answer for you on that. Hi, I was calling I've been on methadone for about three years now.

Speaking of methadone. And I've been wondering what's the best way to get off of methadone. Thank you. Okay. I'm going to assume that you're on methadone because you had a problem with opioids in the past and you're taking methadone as a maintenance. So the reason that the federally licensed methadone clinics use methadone is because it's a wonderful drug.

If you have chronic pain, it's a great pain medication. It does not block the activity of other narcotics as people think it does. It is in itself an opioid. And it has a very long half-life. So it's one of the few that aren't enteric-coded or embedded in a wax matrix that actually stays in your body for a long time. And it's also dirt cheap. Pharmaceutical companies don't promote it. You know, nobody's got a patent on it right now.

So you can get a month's supply of methadone for like $17. So people, I mean, they could use oxycontin at a methadone clinic. They called it an oxycontin clinic. And you'd give people a large dose of oxycontin tell them to come back the next day, except it would be insanely expensive compared to. methadone. So I'm going to assume that you're on that and you're on a maintenance program. And since you're wanting to get off of it, it tells me, and I've just got to go with some scenario, that you feel that you've got a handle on your, you know, addictive tendencies and

you just want to get off of this stuff and be truly sober. So the thing that you do is you go talk to the addictionologist who's treating you and say, I would really like to try tapering off this stuff. Now, let's say you're on 120 milligrams a day. I advocate a very long, slow taper for people who are otherwise following their contract and are not diverting their medications and are not taking it pathologically. And methadone comes in 40s, tens, and fives. So it's really easy to make up a regimen that you can taper off of.

So let's say that you're on three 40s a day. I would maybe even go 10 milligrams, 10 milligrams a week. Who cares? So that would take how long? 12 weeks. It would take three months to do. So you would start off with 240s and, let me see, and 3 tens a day, right? and then you would go 240s and 210s and 240s and 110 and then 240s.

So now you're down to 80 milligrams. And you can do that week after week after week. Nice slow taper when you get down to about 10 milligrams. I probably wouldn't cut you to zero. I'd go to 5 and then maybe 2.5. So it'll take 14 weeks to do it that way. And if you get down to, let's say you get down to 40 milligrams, you can't go any further. Well, shit, you just tapered from 120 down to 40.

That's not a bad thing. That's going to decrease your risk of low testosterone, may decrease your risk of neoplastic disease because we're pretty aware that people on long-term opioid analgesics or, aka narcotics in the street vernacular. may increase cancer risk. So, but talk to your addictionologist about it. See if you can do a nice, long, slow taper because the goal is to avoid withdrawal and adverse effects. Hang on, that's my wife. Let's see if we can get her on the show real quick.

Uh-oh. Here we go. Whoops. Tacey, you're on weird medicine. every time there's Tacey everybody and uh good luck

good luck for sobriety what I think might be a sex headache last couple of times over last week my wife and I will have a deck then coming close to completion

I would have an onset of a massive headache on my left side of my head and um so much so that it would we would stop and not finish and then um after a four or five days of not finishing i decided to power through it and uh that was a couple of days ago and now i still have a headache um i don't i did i googled it and they say six headaches are coming but i've never had them before kind of freaking out a little bit yeah i don't blame you So Dr. Steve's rule on new onset of headaches is get them checked out every time. So there is a thing called a sex headache or post-orgasmic or pre-orgasmic headache.

They're caused by sexual activity, particularly orgasm, but could be pre-orgasmic. And these can be dull or they can be really sharp. Sudden, severe headache just before or during an orgasm is indicative of a sex headache. And most of them, he's right. He Googled it and most of them were nothing to worry about. But this guy powered through the headache and he still has it two days later. This needs to be checked out. What they would do is do an MRI. They may send you to a neurologist. If they do make the diagnosis of benign sex headache, they may not go away for some time if they ever do, but it is treatable. It's very treatable.

There are medications that you can take, including beta blockers and calcium channel blockers. These are blood pressure medications that change the ability of blood vessels in the brain to either spasm or contract. And, you know, if you're having these things every time you have sex, it's probably worth taking a medication every day to prevent. at them. Now, some of the beta blockers will cause erectile dysfunction. Well, that solves your problem right there. So the physician or a nurse practitioner or PA will have to select these things carefully, and you may have to try two or three different medications before you find something that works.

But please, please go get this checked. And, you know, for people that just have a sex headache, like every 10th time that they have sex, they'll give them a non-steroidal anti-inflammatory medication, like endomethysosone, or other anti-migraine medications that sometimes will help. So anyway, there you go. Sex headaches, everybody. Hey, Dr. Steve, I'm in Joe in New Jersey. Years ago, I was in the track accident at my back, my shoulder, and my neck.

I had been on the wonderful pharmaceutical miracle round. I was on all the oxytocotone, tramidol, gabapentin. I would try Lyrica and I was one of those poor souls who got he was had a pendency because I stopped that immediately finally struck upon

something called Opana ER Yeah, his audio is terrible so he was in a trucking accident and got chronic pain, was tried on a bunch of different medications and then he got put on this medication called Opana ER or oxymorphone.

This one was taken off the market and his question is, you know, why did they take it off the market and what am I supposed to do? So they did take the branded version called Opana ER off the market, and it was done voluntarily by request of the FDA because there were a lot of adverse effects that were coming from it. But it turned out that it may have been a binder in the pill itself that was causing the problem. And it was the main problems that were happening with Opana, which is a wonderful drug, by the way. were to people who were shooting it up.

So if people shot it up, which is obviously off-label, not recommended by the manufacturer, in a certain subset of people, it was causing kidney failure and a disease called thrombotic, thrombocytopinic purpura, which is where you get all these, you get so many blood clots in your body that you run out of platelets to make anymore. and you have heavy bruising and stuff like that. And they would get that in addition to renal failure. So this medication was voluntarily removed from the market. And I hate that because it was really great for what we call opioid rotation.

So if you've got someone that's on huge amounts of morphine, for example, those pills go up to 200 milligrams. You got somebody taking 203 times a day. It's really, you can keep going up, but all of their receptors are already saturated with morphine. You can do what's called opioid rotation, where you would rotate them to another medication, and then the body becomes sensitive again because those new molecules are hitting the receptors in kind of a different way. And one of the great medications for doing that with was oxymorphone or opana because it was three times more potent than morphine. So if you had somebody on, let's say, 300 milligrams of morphine a day and you want to rotate them, you could put them, first you would calculate the Opana dose, which would be 100 milligrams a day, and then because you're using a different molecule, you're going to decrease it even further

for what they call incomplete cross-tolerance, you end up with 50 milligrams a day. And that's a big difference from going from 300 milligrams a day to 50 milligrams a day, particularly just how it looks on the paper. They're equivalent doses because one's more potent than the other. But it was a really nice drug to use for what we call opioid rotation. Well, what's this guy supposed to do now? It's been taken off the market. Well, guess what?

The generic is still on the market. So just ask your provider for the generic, and you'll be fine if that particular molecule is working well for you. So generics to the rescue on that one. All right. Yes. I'm a 65-year-old male. I have what I think they call Peroni's disease where the penis starts curving. It's curving up. And I just wondered if there's anything I can do myself to help cure this or if there's a cure or what are the treatments for something. Okay. So this guy has Peroni's disease, which means when his penis, penis gets erect at bends. So how does this happen?

It's usually caused by vigorous intercourse, some maladventure or misadventure during vigorous intercourse with a semi-erect penis. So if you've been drinking or if you're on your way down after having an orgasm or if you have some erectile dysfunction, particularly if the woman's on top and she thrusts down and your penis isn't fully engaged in the slot that it's supposed to be in. And instead of it thrusting forward bends in two, you can actually get a tear or a contusion of the sheath around the penis and then scarring will set in. And anywhere where there's scar tissue, there will be a loss of elasticity.

And when you have loss of elasticity, when that thing starts to stretch, it will bend in the direction where that loss of elasticity is. So if you've got a scar on the right side of the shaft, when your penis becomes erect, it will bend to the right side. And it can be very painful and it can be severe. There are some people, you know, their penis will almost bend in a 90 degree angle and you want to get treatment for that. A little bend might be beneficial.

If it doesn't bother you, it may give the appearance. to your partner of a little bit more girth, because instead of being a perfectly straight needle dick, you've got this curved sort of more banana-shaped penis. And so the top part might be pushing against the left wall, while the middle is pushing against the right wall, and the base is, again, curving toward the left wall. So it'll give the illusion of more girth.

So it isn't necessarily the worst thing if you have a slight curvature of your penis. It's these lifestyle-threatening major curvature. that we have a problem with. So for a long time, there weren't very good treatments. Some people would try to stretch their penis using a device that has Velcro straps that go around the base and right under the Roman War helmet, and then you have these turnbuckles and you tighten and try to stretch your penis out that way.

And maybe there's some mild benefit to that. But they tried injecting these areas with calcium. channel blockers and other medications. Well, recently, the genius urologists came out with a collagenase injection. Now, collagenase, anytime you have ASE at the end, so you've got lactase. That's an enzyme that cracks lactose. So lactase will take lactose and convert it into its constituent parts. And so it's an enzyme.

So anything with ASE at the end is an enzyme. And collagenase is an enzyme that will dissolve collagen. And elastase would be an enzyme that dissolves or somehow performs an operation on elastin. So anyway, so they can inject this medication or this enzyme into the scar. And if they're skilled, they get it right into the scar. and then it starts to dissolve the scar tissue and make it more elastic. And that will really ameliorate some of the symptoms of Peroni's disease. So the only people that do this are urologists.

So go see a urologist. Don't be embarrassed. They see nothing but dicks all day long. And just tell them you've got Peroni's disease and they'll get to work on you. Okay? You don't have to live that way if it's causing problems. Hey, Dr. Steve, I am 58 years old, and it seems like that every time I touch fucking something, I bruised like a grape, or I'm bleeding. What the fuck is going on with that?

Love you, love the show. Hey, thanks, man. Yeah, so this guy, every time he touches something, he's bruising, and if he gets a little contusion, he's bleeding. This makes you worry about something going on with. the blood platelets or clotting mechanism in your bloodstream. So, you know, people with liver problem sometimes won't make clotting factors. Some people are genetically predisposed to not making clotting factors. And those people are called hemophiliacs. I would assume you don't sound like you're 15. And I can be wrong about that. I mean, you can't tell. But, you know, you would

think that you would know that already. So the other thing that I worry about is that your bone marrow isn't producing enough platelets, and the question is why. So what you got to do is you go to your primary care and they'll do a simple blood test called a complete blood count. And if that's not revealing, they can do a test for platelet function called a bleeding time. And basically what they do is they take a little, it's like a little spring contract.

that causes two small, very painless lacerations in your skin. And then they use blotting paper to wick off the blood that comes out of that, and then they time how long it takes for it to stop bleeding. And a prolonged bleeding time in the presence of normal platelets would give you an indication of decreased platelet function, whereas a decreased platelet count would make you wonder, well, where are they going? Some people just have an enlarged spleen, and the spleen's just eating up their platelets. That's all it is.

That's easy to fix. Sometimes it can be other things, it could be medications that you're taking, all kinds of things. Just go right now and call your primary care, make an appointment, tell them what you told me. They'll get you in that day because they don't want to fart around with this and get a complete blood count and maybe a bleeding time. And then call me back and let me know what they find. Okay. All right. Hey, my question is, this is the first time I've actually scanned and listened to your radio.

My question is, in 2015, I started having a burning sensation in my mouth in the morning. This has been, obviously, three years now. It's still going on. Went to a D&T, prescribed a bunch of different medicines for the acid going up in your throat. Yeah, reflux. acid reflux and then he did a septoplasy thinking it's something to do with my sinuses oh my goodness he did surgery nothing helped every morning i wake up it feels like my mouth has been scorched and i have better days and worse days but uh there's never a day i don't have that um and then i can't find any rhyme

reason why it some days are worse than others and sometimes i notice if i skip a meal i can start feeling the onset of it even in the evening. And I also, like, when it's really bad, it feels like it's up into my sinus cavity. Goodness. I don't think just in my tongue, roof of my mouth, it's also in my sinus cavity. So, yeah, I quit going to the E&T because everything he did was a waste of time and money. And that surgery was a big pain in the air. Yeah, no kidding.

So I understand why they did the surgery. They probably looked in there and saw I deviated septum and said, oh, well, We know what's going on. He's not breathing properly. He's mouth breathing because he has nasal congestion or he has post nasal drip. And that's what's causing this. And the weird thing is it's mostly happening in the morning, which makes you think snoring or just mouth breathing. But, you know, I texted this guy and he said, no, you know, they don't think that's what it is because I don't snore.

Well, I didn't think I did either. And I had to do a sleep study to prove to me that I was. mouth breathing and I had horrible, horrible pain in my mouth and my throat that would go away as the day went on because I was, you know, cracking the mucus membranes in my mouth and upper airway. So one thing you can try, if you haven't tried it already, is this stuff called biotene. There's a dry mouth moisturizing gel and you use it before you go to bed and as soon as you get up in the morning that might help the other thing is um you know could this be some form of uh thrush or a yeast infection of the upper airway uh you would think they would see it

but it's pretty easy to treat they can give you a mouthwash that has some stuff called nystatin in it that you can swish around and see if that helps and um you know i wouldn't give up on the en t just yet particularly if it goes on because it may have been something that they couldn't see, but now they can. Make sure you're not smoking. If you're smoking and you're complaining about pain and your pharynx, you know, I don't know what to say to you. So you got to, if you're smoking, you've got to quit. But try that biotene, see if that helps. And feel free to call back when we're able to discuss, because I have other questions I can't ask to a voicemail. Anyway, all right. Well, we're just about out of time. Thanks always. Go to Dr. Scott,

who isn't here today. Lady Diagnosis, who also couldn't make it. This is sort of the last of our vacation shows. We'll be back to regular shows next week. I can't forget Rob Sprantz, Bob Kelly, Greg Hughes, Anthony Coomia, Ron Bennington, and Fez Wattley, who's steadfast support of this show, never has ever gone unappreciated. Listen to our Sirius XM show on the Faction Talk channel. SiriusXM. Channel 103, Saturdays at 8 p.m. Eastern, on demand, and other times at Don Wickland's pleasure, including Sunday at 5 p.m. Eastern.

many thanks to our listeners whose voicemail and topic ideas make this job very easy go to our website at dr steve.com for schedules and podcasts and other crap and until next time check your stupid nuts for lumps quit smoking get off your asses and get some exercise we'll see you in one week for the next edition of weird medicine Thank you.