Weird Medicine: The Podcast - 327 - Pecker Head

Episode Date: September 6, 2018

Diabetic Gastroparesis neurostimulators, chronic pain patients suffering (again), methadone, home naloxone, diving reflex, sperm shelf-life, prostate infections, and more! PLEASE VISIT: STUFF.DOCTORSTEVE.COM simplyherbals.net Learn more about your ad choices. Visit podcastchoices.com/adchoices

You're listening to Weird Medicine with Dr. Steve on the Riotcast Network, riotcast.com. I need to touch it. You know, ho, ho, hey-ho. In the garretid. I've got diphtheria crushing my esophagus. I've got Tobolivir stripping from my nose. I've got the leprosy of the heartbells, exacerbating my incredible woes. I want to take my brain now, blast with the wave,

an ultrasonic, agographic, and a pulsating shave. I want a magic pill for my ailments, the health equivalent of 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 a requiem for my disease. So I'm paging Dr. Steve. Dr. Steve. You know, take a calph. It's weird medicine, the first and still only uncensored medical show in the history of broadcast radio.

Now a podcast. I'm Dr. Steve with my little pal. Lady Diagnosis, she who will do most anything for a glass of expensive wine. Hello, Lady Diagnosis. Hello, Dr. Steve. And we have, again, the man who would know more than anyone what she will do for a glass of expensive wine. It is Dr. X, everyone. Hello, Dr. X.

Hey, Steve. This is Lady Diagnosis boyfriend. I guess that's what you are. This is a paramour. This is a show for people who would never listen to a medical show on the radio or the Internet. If you have a question, you're embarrassed to take to your regular medical provider. If you can't find an answer anywhere else, give us a call at 347-76-4-3-2-3-2-3-2-2-7. If you're listening to us live, the number 754-227-3-6-47, that's 754.

Take it away, Dr. X. Hey, uh... One-E-2 penis. 102 penis. Or 754, bare-knit. Follow us on Twitter at Weird Medicine. Lady Diagnosis, or D.R. Scott, W.M. Visit our website at weirdmedicine.com for podcast, medical news and stuff you can buy or go to our merchandise store at cafepress.com slash weird medicine.

Most importantly, we are not your medical providers. Take everything you hear with a grain of salt. Don't act on anything you hear on this show without talking about talking over with your doctor, nurse, practitioner, physician assistant, pharmacist, chiropractor, acupuncturist, anesthesiologist, yoga master, physical therapist, barista, or whatever. Veterinarian? Oh, dang you. I stole your joke and then you just added another one on top of it. In comedy, that's called tagging Lady Diagnosis.

Oh, did you just tag me, Dr. Steve? No, you just tagged me. Oh, I tagged you. Yay. All right. Hey, don't forget to go to stuff.doctrsteve.com. We had a very interesting new product that we reviewed last time. That looks really interesting.

I still haven't received mine because we're recording this on the same day, but I'm hoping it will come next week, and I'll be able to talk to you about it. Also, tweakeda audio.com offer code fluid for 33% off the best earbuds for the price on the market and the best customer service anywhere. And they are a Tennessee. They're a Tennessee company. We've got to go see them. They're in Franklin. I know.

Let's go. Okay. We'll do a weird medicine road trip. Are you in Dr. X? Absolutely. Okay. We have to go to Nashville. That's where Franklin is, right?

It's where Vanderbilt is, by the way. Okay. Yeah, very good. Vanderbilt. Is that a restaurant? No, Lady Die. It's the true black and gold, not that place in Iowa. Oh, the hot guys.

Here we go. I don't give a shit. Simplyurbals.net is Dr. Scott's. Dr. Scott's herbal website. Herbales. And he has, oh, this stuff. You know. Those nose spray.

Dr. X, I'm going to tell you something. My partner on the radio is kind of a nut. But he has this herbal sinus rinse. And really what it is is it's buffered saline, but he put peppermint oil in it. And it is fantastic. It got me off of afrin and flonase and all kinds of stuff. So I'm very impressed with it. Peppermint oil itself does have some anti-inflammatory properties.

So, you know, it's really good stuff. So you can get that at simplyerbils.net. And it's cheap, too. He could charge $10 for that. And I don't think he charges anything. close to that. No, I had another guy text me the other day saying how great he loves that stuff. Yeah. Best ever he said. Well, and GVAC loved his. Oh, he said fucking amazing. GVAC loved his fatigue reprieve. Yeah. And my wife likes the stress less. So it's, you know,

that's all very anecdotal. I would love to do a double blind placebo controlled study on some of Dr. Scott stuff just to see what's there. Right. You know, we obviously in Western medicine don't know everything. He's got something. Always learning new things, but the problem with things like these herbal supplements is they don't have to do any studies. They could just put them out. And then they finagle it by saying, well, this is not intended to treat or diagnose any specific disease. But then it'll say kidney health on it or whatever. So I'm, but I am confident that Dr. Scott would have some positive results with his stuff. And, One of the things that we talk to our listeners about is just how do you know things?

You know, how would you know if his stress less, like people say, well, is it any good? Well, good for what? What do you want to accomplish? Do you want to be less fatigued? Well, we could do a study for that because there are validated fatigue scores. I was going to say, can you measure it? Yeah. Well, there are these validated tools that are the best that we, you know, we can't do a blood test for fatigue.

but it's a subjective complaint anyway. So there are instruments that are basically surveys that have been studied and validated and shown to be consistent from one group to another that you could use. So now that's going to be the tool we're going to use. And our endpoint, we have to choose an endpoint, right? So our endpoint is going to be we want to see

a statistically significant improvement in those fatigue scores. It could just be health-related quality, of life. That could be something else that we could study. There's instruments for studying that. So we'll say, well, maybe we won't get anything on the fatigue, but maybe we'll get something on the health-related quality of life. And then you give 100 people or whatever, you pick an arbitrary number, but needs to be large enough. So if there's a negative result, it's got enough power to be statistical. So let's say we get 100 people. We give

100 people fatigue reprieve, and another 100 people, we give them a a placebo that looks and smells and tastes just like it. And we don't know which one is which. They're coded with a code. And that's in a book somewhere that somebody else did. And so we have no idea what we're giving the patient is a placebo or its active study drug. And the patients don't know because if the patients know, they may be biased one way or the other. Like if they don't believe in herbal stuff, they're going to be biased against it.

Say, oh, hell, no, that stuff didn't do anything, even though maybe they would have and, in effect, if they had been honest about it. Right. I remember I was in a double-blind placebo-controlled acne study when I was in college. And I went in to get tested, and they do this commodone count, where they count the number of basically zits and pre-zits and post-zits on your face in a certain part of your face. And I said, I don't think this stuff's doing anything.

I must be getting the placebo. And the woman said, oh, well, let me check. And she goes, oh, no, you're getting active drug. It's like you just screwed the whole study. She ruined the whole study by doing that, okay? She should not have had it. No one in the study should have had access to that. That should have been hermetically sealed in a mayonnaise jar.

That's exactly right. With some semen. Oh, sorry. That was the last show. Wrong show. But so anyway, so no one can know. And that way they can't have a bias. And then at the end, you give them those, whatever these instruments are,

health-related quality of life, fatigue, scale, and you have them do a survey. And then once you get all those stacks of paper, now you can decode it and say, well, this one was placebo. This one was active drug. And you see if there's a statistically significant difference in any, any of it. Any, it could be post-exercise fatigue. There's a benefit, but not, you know, early morning fatigue. Things like that. I mean, those things can dope that out. And you can say a statistically significant difference. And now, once you've done that, it needs to be

repeated somewhere. So you publish your study and let somebody else repeat it to show that it's reproducible. And if it's reproducible and statistically significant, then you can make a blanket statement that this stuff has some demonstrated efficacy

for whatever it is. But, you know, choosing your endpoints, the big thing, if you choose your endpoint, okay, for Viagra when they were studying it, not a very good blood pressure medicine. You know, their initial endpoint wasn't erections. It was blood pressure. And it was terrible. And they were, you know, maybe even thinking of just trashing this drug and moving

on to something else, except that people were like, dang, you know, all of a sudden, my erect penis looks like, you know, a Nathan's Frankfurter in the microwave. And, and it's, that's not my joke. the way, but I use it every time because it's so great. It's so descriptive of what a Viagra penis looks like. And so then they changed their endpoint and studied Viagra. The act of ingredient is sylidephyl for erections. And when you change your endpoint, all of a sudden, you might show something different. So, you know, Dr. Scott's thing could be the cure for cancer, and we would never know it if we didn't study for it, you know, study it for that. Yeah, go ahead.

So what, like there's the CDC for drugs and FDA for food, who can, does somebody monitor this stuff? They do, and Scott could tell you there is a, the FDA still monitors this stuff. So, for example, every once in a while you'll see an herbal medication for erectile dysfunction get pulled from the shelves. And the reason it got pulled from the shelves is because it had sildenafil in it, which is the only way you can get that in the United States is with a prescription. Well, they were doing some herbal stuff, and then they crushed up some Viagra and stuck it in there so that, you know, to improve the efficacy. So people go, yeah, this stuff really works. Well, the FDA will pull these things from the shelves and test them looking for things like that.

But to put that label on saying, like stress less, they don't say, no, you have to prove it. No, no, no, because it's a nutritional supplement. But they have to be careful about the claims they make. And I have seen things getting pulled because their claims were too specific. You know, so there you go. That's why, you know, Dr. Scott calls it stress less. It doesn't say cures fatigue. Yeah.

Energy bills. Or, I mean, yeah, right. Or, you know, decreases. Well, he doesn't make any claims at all. Right. You know. But anyway. All right.

Very good. Let me see if we've got. Oh, so I had this thing. I want to read this story to you. And if I can get back to it. This is from CNN politics. And it says, David Pecker, the head of the company that publishes the National Enquirer, was granted immunity in the federal investigation into President Donald Trump's former attorney Michael Cohen in exchange for providing information on hush money deals, according to the Wall Street Journal.

Pecker, the CEO of American Media Incorporated, told federal prosecutors that Trump had knowledge of Cohen's payments, whatever, blah, blah, blah. So I have this picture of a screenshot from CNN. Did you say pecker is the head of media or meaty? He's the meaty head of media. So this is actually from MSNBC, and it is that woman that says sort of all the time, and I can't think of her name, but says Trump worried about pecker leaking. It's just too great. Real life. Yeah.

So I don't even know if that's a Photoshop or not, but I could actually absolutely see them saying that. There's just too many jokes. Just write your own joke. I don't have to make a damn joke about this guy's name. It's like, you know, why don't you just have your name be cock, cock. I always wanted to have a liquor store and call it Cox Liquors. Well, they couldn't say anything, you know, just COX, like that's the, well, it's a family name.

Right. Cox, Liquor. That was the head of the urology department where I trained. Oh, is that right? Dr. Cox. Is that right? Absolutely. We have a dermatologist named Rash.

And there was the retina surgeon named Dr. Blinder. That's awesome. Yes. That's cool. My doctor, when I was a kid, was Dr. Cocaine. It was spelled C-O-C-A-N-N-E, but, It was pronounced cocaine. So, you know.

All right. Let's see. You want to take some medical questions? Sure. Don't take advice from some asshole on the radio. All right. Hi, Dr. Steve. I'm from South Dakota.

I am type one diabetic and I've got gasbrook parisic. And I was hoping that between yourself and Dr. Scott, maybe you could, uh, So, throw me in on what I can do to lessen the effects of that and hopefully make myself more comfortable instead of being bloated all the time. Yeah. What did he say he had? So he has gastroporesis, which means that his stomach is basically paralyzed. And, you know, diabetes causes a lot of nerve problems. People hear of diabetic neuropathy where people will lose the, you know, feeling.

or they'll get burning and stinging or heat feeling or electrical discharge kind of in their fingers and feet and stuff. I've seen people before in the burn unit that had diabetic neuropathy so bad that they felt cold all the time and stuck their foot or feet in the oven to warm them up and then end up in the burn unit because they fell asleep and they burned their feet up.

So it's a really bad disease. And when it affects the nerves of the stomach, of course, it paralyzes the stomach. Stomach needs impulses from the nervous system to, you know, to massage food and mix it up and then get it to pump out to the intestine. And when it doesn't do that, yeah, you just feel bloated and you can have reflux and puke and stuff like that. So you got any experience with this? Because we could talk about the medication, but now there's a surgical procedure for this. Yeah, my experience is pretty limited from back when I was a student and a resident when they were doing double-blind placebo studies on that.

Some new drugs that got pulled. Yeah. So, yeah, it's a horrible disease. So what was the name of that one? It was, oh, geez. It's right on the tip of my tongue. It was a great drug, too. Prokinetic.

Let me look it up. Drug removed. Let's see if it comes up. Sissopride. That was it. Sissopride. That's what I was going to say. Cisopride.

Okay, so Sisypride was one that worked really well, but there were some adverse effects, and it got removed from the market. It worked on serotonin receptors in the stomach, and it was primarily used to improve muscle tone in the lower esophageal sphincter, which our listeners know what that is, the little ring of muscle between the esophagus and the stomach that tries to prevent reflux, in other words, food getting from the stomach back up into the esophagus. People were getting irregular heartbeats from it, and it was removed from the market. So there's some other medications. There's one called uricoline, betanacol.

And we would use that sometimes for people that had post-delivery ilias, which is a paralysis of the bowel, where it just sits there and it's flaccid. It doesn't contract like it's supposed to, so people blow it up and they don't have bowel movements. It's supposed to help the stomach empty faster. And then there's the classic one that we all use is metaclopramide. Metaclopramide is a drug that helps improve peristaltic function in the GI tract all the way through.

But I'm assuming if you're calling, you've tried all of these things. And if you have and that doesn't work, then it's still a real problem. So there is this thing called a gastric pacemaker. You guys ever put one of those in? I've had patients that have had them in, but I don't think anyone in our area is implanting them. Okay. So what this does is it's an electrical stimulator, like a pacemaker for the heart. And remember, signals from the nervous system are basically electrical signals, right?

And if you put a pacemaker on the stomach, you can actually stimulate it to now contract, whereas before it wouldn't contract. And I don't know how these things work if they're programmed to only start contracting after the stomach has distended or any of that. So I know nothing about it. So maybe somebody that knows something about it can call in. That would be the way I would design one with a stretch receptor on it. So when food goes into the stomach, it starts to stimulate gently in one direction from the body of the stomach to the antrim. I think there's a way they can activate it once they've eaten or start to eat. Oh, is that what it is?

Some of them will have, well, some of them will have a little. like you can, some pacemakers, you can put a magnet on them and that gives it a signal. I'm not sure how they do that. Well, they, okay, so I'm looking at this article here. It says the electrical stimulation involves attaching two insulated wires to the lower body or the antrum of the stomach. The electrodes attach to the neurostimulator that is placed in a subcutaneous pouch on the abdominal wall.

So like a pacemaker, you know, they insert this little pouch under the skin and you've got this little place there. It says it can be programmed to enhance the frequency of gastric contractions and the mild electrical stimulation of the antrim portion of the stomach muscle wall helps to reduce nausea and vomiting. Wow. Well, that's pretty damn cool. So that's what I would go for if I had this and everything else had failed. So talk to your gastroenterologist or your gastric surgeon about consideration of gastric

electrical stimulation if everything else has failed. You got anything else to add to that? No, sir. Okay. Hey, Dr. Steve. It's Brian from New Hampshire. I got a facet joint arthritis and my doctor left

and my new doctor automatically, first thing he says he wants to take some of my pain meds away and I barely get enough to work or anything. And I'm on 50 microgram an hour fentanyl and three per fives a day. My other doctor said I was just under what the government

was requesting, whatever it is. And the new doctor says, I'm over it. I know what's going on. I don't know how to do that math to what it equals to on, I have no memory anymore. Well, that's okay. I can help you with that. So he's on transdermal fentanyl, 50 micrograms an hour patch.

And that's equivalent, and this is the equivalents we use, and I'll be interested in hearing your thoughts on this, that one microgram an hour is equivalent to two milligrams per day of morphine. So if he's on a 50 microgram patch, an hour, that would be equivalent to 100 milligrams of oral morphine, or 10 Lortab 10s. I always, when we talk to lay people, we always convert to Lortab 10 equivalents because that always makes sense.

If I say you're on 875 oral morphine equivalents, nobody knows what the hell I'm talking about. But if I say you're on 87 and a half Lortab 10s, they go, oh, God, you know, that's something they can relate to. We use morphine equivalents in anesthesia. Sure. So, that's our. Would you agree that 25 or 50 might. breaks per hour would be roughly equivalent to 100 milligrams of morphine a day.

Is that about what, the conversion that you use? Okay. So that's 100, and then he's on five milligrams of oxycodone three times a day. That's what those perk fives are. The active drug is oxycodone and acetaminophen. We'll forget about the Tylenol and concentrate on the oxycodone. So five milligrams of oxycodone is equivalent to seven and a half milligrams of morphine. So let's figure, I can't do that in my head.

Alexa, what's 7.5 times three? I'm just 23. Thank you. 22.5, right? Uh-oh. 7.5 multiplied by 322.5 equals 2,418.7. It's 22.5, right? We don't have to ask for that.

Okay. So 22.5 plus 100 is 122.5 oral morphine equivalents. 1.5 multiplied by 3.20. All right. So, she's hilarious. So, most states have a threshold of 120 milligrams. If they have guidelines at all,

they're going to have a threshold of 120 milligrams of oral morphine equivalents for doing things like referring somebody to a board-certified pain specialist. And there are other things that you have to do like in Tennessee if you're on 120 oral morphine equivalents

and you're on a benzodiazepine which is the tranquilizers like Valium Xanax and Ativan I don't want to drink after you You're gross I don't know what's been in your mouth today

So you don't want to know Dr. X raises his hand That's a good move on the radio Anyway, so if they're on benzodiazepines, they also have to be referred to mental health specialist if they're on greater than 120 oral morphine equivalent. So he's right on the borderline of that. Well, he's actually technically over it. So that's what his doctor is telling him. The CDC has its own guidelines, and they say go easy over 90 milligrams.

And so we've got a lot of doctors. But they don't say don't write 90 milligrams or more. They just say that should be your target. But if you have to go over that, just document why you had to go over that. A lot of doctors have taken that as to be a hard stop. And 90 morphine equivalence is not a whole lot for people that are on long acting and short acting. In other words, people who have chronic, non-malignant pain that requires round-the-clock dosing. Those people will often be on what he's, things like he's on, you know,

120 milligram of oral morphine equivalents or more. And so they all run a foul of the CDC guidelines if their doctor all of a sudden says, well, I'm not going to write more than 90. You know, particularly cancer patients need, many of them need much more than that. I've got people on, well, I think the most I've ever had was 7,000 oral morphine equivalents a day. This was a person that had such horrible, horrible, horrible people. And I can tell this isn't the HIPAA violation because it's not identifiable.

And it's for educational purposes. Let's just say it's a, it doesn't matter why they had their pain, but it was so horrible that somebody else had put them on a dilauded, you know, hydromorphone PCA pump at 14 milligrams an hour. And they were breathing? Yeah, they were, totally, because they hadn't got there overnight. You know, they'd gotten there. It started at, you know, 0.4 milligrams an hour. and then went to one milligram, then two, then four, and then eight. And so 14 milligrams an hour.

Let's let Alexa help us with this. Alexa, what's 14 times 24? 14 multiplied by 24 equals 336. So that's 336 milligrams of IV dilaudid per day. So, wait, I just said the number. What'd she say, 324? That was she said. Alexa, what's 324 times 30?

324 multiplied by 30 equals 9,720. Alexa, what's 9,720 divided by 1.5? 9,720 divided by 1.5 equals 6,480. Okay, so it's 6,480 milligrams of oral morphine a day or 640-something Lortab tens a day. And that's, I think that's my record. occurred. And so that's very, very unusual. Patients like that, we can convert them to methadone, and methadone is so potent that you can get them down to like 30 milligrams three times a day sometimes. But we would do that first line for people. Methadone's a wonderful drug for pain,

but it carries the black box warning that it can cause a thing called prolonged QT syndrome, which is just don't worry about what that is if you're listening to this. But it's a change on the electrocardiogram, but it predisposes you to an arrhythmia called Torsad de Pua, which is, you know, it can be a pulseless rhythm sometimes and can cause fatality. So I did some research on that and found of five million people that were treated with methadone at a high dose, only five had Torsad de Pua. So, and not all of those died from it. So it's one and a million. Those are pretty good odds. If I gave you those odds, you'd go to Vegas and bet everything on red, you know, but, but anyway, so, uh, so yeah, so that's the issue. So he, this guy is either

going to have to find somebody that's more comfortable writing pain medication. That would be a port certified pain management specialist. And, uh, uh, but that's harder and harder to do these days because people are terrified to write opioids, you know, and when I say people, I mean, health care providers who are writing legal prescriptions for them. The dealers on the street have no problem. Have no problem with it. And one thing, Dr. X, and you may be aware of this, since 2010, the number of prescriptions for pain medication this country has fallen precipitously.

And if you go to Dr. Steve.com, scroll down, and look at a, for an article called an interesting take on the opioid crisis. You can see the number of scripts declining very fast, almost as fast as they went up for the years preceding that. But the rate of opioid overdose is increasing geometrically. And I'm talking about deaths from opioid overdose. So you may say, well, how in the hell is that possible? And I'm sure you've got some ideas why that would be. Let me just throw that out and see how smart you are.

Not very, but a lot of it they're getting street drugs. They're getting stuff in from China. Give yourself a bill. Of course, that's what it is. And those little white packets with Chinese fentanyl in them don't have the microgram amounts on them. And, you know, something might get stepped on, aka cut with an inert ingredient, could get stepped on twice or might get stepped on five times. And the one that's been stepped on five times is going to be less potent. and if you're used to that, and then your supplier gets something that's got been adulterated less than that,

you're just shooting up the same amount of powder, but it could be five times more potent. And fentanyl's scary because it's, you doasted microgram amounts. Yeah, I tell people all the time in my practice, you know, they'll be afraid of overdosing on, me overdosing them on drugs. And so overdose drugs are not inherently dangerous. They're not going to kill you. they just make you stop breathing. As long as I'm around to breathe for you, you're going to be fine. All those heroin addicts back in the 60s would not have died.

They had someone to breathe for them. That's right. The medicine would have gone away and they'd have been fine. And that's where the home naloxone, which she mentions... Give yourself a bill. I was hoping you'd bring that up. It comes into play. Of course, I often wonder who's going to administer it.

Well, it's usually going to be their buddy that they're shooting up with. But a lot of times they'll know that something's going on. If they're still conscious. Yeah, if they're still conscious. Yeah, if they're both unconscious, then that's a problem. But, yeah, so what Dr. X is talking about is home naloxone therapy. A lot of, like, CVS in some areas will just give it to you. You don't even have to have a prescription.

It's not a controlled substance. And it will successfully reverse narcotic overdose pretty much 100% of the time. But it's short-lived. So what you want to do is have this in your house And then you can go to I think it's narcan.com Is it or getnarcan.com? Let me see

Let me look it up because I want everybody who's listening to this To go to this and learn about this Because you know you need to learn CPR Okay, let me see Now okay, getnarcan.com isn't it? Let's see if it's get naloxone Get naloxone now.com dot org. Okay. Here we go. Okay, now I got it. It is, okay, go to www.

get naloxone. That's n-a-l-l-X-O-N-E now.org. And just read this. It's just like learning CPR. You know, you're seeing someone that's having an overdose and you're going to save their life. But when they wake, so you give the stuff and then you call 911 immediately because if they've really overdosed, I've seen this before. where someone has so much in their system that you give the Narcan and they wake up and they're fine and they go right back under again. And I've seen patients that required a Narcan drip before, you know, where we had to set up a constant infusion of Narcan to keep them alive while this stuff got out of their system. So you give it and you call 911 and you save somebody's life.

It's the same way you learn how to do CPR on somebody you can save their life. So is it a needle you shoot it? Or how do you do it? Okay. Excellent question. It's a nasal spray. There's a nasal spray. Oh, okay.

And if your insurance won't cover it or if it's too expensive, they can give you pre-filled syringes of Narcan that you can just, you know, shoot them up with it. You just pop it under the skin. I've also seen where they have syringes of Narcan and they give you a little nasal speculative. them and you stick that in there and just shoot it in their nose that way well you know like pulp fiction when they that was such bullshit so that's all i can think so that's not real no um it's on tv taking a giant needle full of adrenaline and then as hard as you can jamming it into somebody's chest wall and injecting it directly into their heart is not a way to treat a heroin overdose now a cardiac arrest we have done that in the past

I've got to, you know, you run codes all the time. When's the last time you did an intracardiac, you know, injection or, you know, you might have done a paracardial. Decades ago. Yeah. We just really don't do it anymore. There's no need for it. It's never been shown to be better than doing it the good old-fashioned way.

Plus, we usually have IV access, so. Right. Yeah. And you've got to know where you're sticking. Oh, yeah. You just stick it anywhere on the text or so. You got John Travolta. He's just, you know, he's going, foo, I mean, it was just, it was just.

And like it was even harder than a paracardial thump. I mean, they were just jamming this needle. Now, that I've done recently. Have you? Yes. When I was an intern, we were doing paracardial thump while we were waiting for the pacemaker to get there. And you could thump this person in there and you would see this electrical discharge. And you would get a pulse with it.

Yeah. And as long as we were doing that, they were okay until they could get the external pacemaker on this person. It's crazy. So you're beating the life into somebody. Well, and. Just pounded them? The amount of force that you use is really just how much gravity would pull your hand down. Oh, okay.

But just that percussion on the chest wall is enough in some people to stimulate electrical activity in the heart. That's cool. Have you ever done a diving reflex? You're probably not old enough to have done that. I'm not that old. Yeah, see, I'm quite a bit older than you are. When I was in training, we had a case where somebody. had atrial, paroxysmal atrial flutter.

And this was before the days, or did he have an SVT? I can't remember, but it was before the days of adenison and stuff like that. So we just decided we were going to do a diving reflex on this guy. We were interns and you were running the show. What's that? Well, I'm going to tell you. So what we did was we took a bucket of ice water and we shoved his head. And within 30 seconds, his arrhythmia completely resolved.

And he was back in a sinus rhythm again. We were like, damn. But apparently all mammals have a diving reflex. And that's how whales and other dolphins and stuff, you know, mammals that live in the ocean, can survive, is when they dive, their metabolism starts to decrease, their heart rate slows down. and they can stay down there for all of these. You know, it's not just great lungs and great circulatory systems. And they're all derived from land animals.

And so for some dang reason, all mammals have this. And we never use it, but I used it that day. It was interesting. That's crazy. The old diving reef. We used to do some damn shit. I remember. How do you coat, you know.

I remember one of my senior residents. You didn't. It's, yeah. No, we didn't charge for that. $5,000 for a bucket of ice. Right, and $5,000 for knowing what to do with it. Exactly. I remember my senior resident at Chapel Hill getting a C-Arm X-ray machine,

and he got a big syringe full of dye, and he was injecting into this person's sub... How was he doing this? he was oh oh okay no I remember what it was this person had a subclavicular central line right and so he was injecting dye in and then going shoot shoot and then having the x-ray person take a shot and what he was trying to do was get a pulmonary angiogram I was doing it up in the ICU just because he thought he could do that didn't work too well did no it didn't work very well and he I'm pretty sure this was the beginning of the end of residents just getting to do stuff that they

wanted to do back then we used to plate our own urine um urine cultures and we would read them and then we would report it into the chart it never went to the lab you know and then we would treat based on that and i remember uh the first time it happened in 1986 when i was an intern in the emergency room and i wanted to do a wet prep of my own and they said no no you have to send that to the lab now and so i sent it to the lab and it came back act normal and I called up the lab and I said if you saw clue cells I'm just asking if you saw them would you report it and clue cells are an indicator of bacterial vaginosis they're just white blood cells that are you know no not white blood cells they're just regular vaginal cells that have

bacteria all over yeah and you can see them and I said if if you saw clue cells would you report it and they said oh yeah yeah we would and then two minutes later we get an amended report says three plus clue cells. I was so fucking pissed because it was like if I had done it myself, I would have seen it and I, I, you know, I would have gone ahead and treated this person already. But instead, I had to send it to somebody who was less skilled at it than I was. And then I had to call him on the phone just to get the right report back when, you know, and I was not allowed to use a microscope in the emergency room anymore. So, you know, for us old school people, that was a real kind of step backwards, but anyway.

You know what was great, though? If we're talking about the old days, and I don't have any old school music, like from the 40s to play. Let me find. Alexa, play swing music. Here's a station for swing music. Swing jazz on Amazon music. Let's see. Come on,

Alexa, next song. This is not going to be worth it. There we go. Ah. So, back in my training, I, now I totally forgot what I was going to say. After all.

Old school stuff, who knows. Oh, yeah. We used to calculate our own amino glycoside dosing. And we used to use this thing called a serubigram. The guy that developed, so for the people who don't know out there, there's a class of drugs called amina glycosides, and there were tobermice and the genome. mice from the two most well-known and they're great for sterilizing a urinary tract and some

other stuff like that and using for with other drugs the the problem that they had was that they would kill people's kidneys and their and their inner ears and so they would have kidney failure and they'd be dizzy or go deaf yeah and they'd go deaf as well so they'd be dizzy deaf and have be on dialysis like lady diagnosis So they would, so they worked, did a lot of research to try to figure out a way, how can we dose this stuff? And this guy, Felix Serubi, actually from Chapel Hill, figured out a nomogram for correlating creatin clearance with amino glycoside dose. So in other words, how well your kidneys could filter something out, that's how you would dose this. stuff. So if your kidneys were worse at filtering things out, you would give them less.

You might give one dose every 24 hours. And so we would calculate these things with these ruby grams. And then that guy actually went to East Tennessee State University, believe it or not. If they gave out Nobel Prizes for saving people's renal function, he would have gotten one, you know, but they don't do that. But he ended up somehow at East Tennessee State University. a little place in Upper East Tennessee, and that's where he finished out his career. Well, anyway, I remember the first time that I was told I couldn't dose my own amino glycoside. I was really proud of this thing, and I've never heard anybody's kidneys. And the pharmacist said, oh, no, we do that.

And then it turned out they were using the same formulas. They were using the exact same thing. You know, they were using some rubygrams, too, but they had to do it now because they didn't trust us to do it. I guess a lot of doctors who didn't go to Chapel Hill didn't get thrown, you know, serubis, nomograms down their throat. But now it's like the greatest thing in the world. You just write pharmacy to dose genomycin. So I'm used to it now. It's so much easier.

And then now if they f it up, it's on them. So, yeah. So anyway. All right. Enough of the old days. Alexa, stop. Let's take another call. Hi, Dr.

Steve, hi, Dr. Scott, lady die. I'm wondering how long sperm can live when wiped up with a towel. No one can live for like five days when you pump it inside your lady, but what about when you, like, what about if you like jerk off into like a paper towel and then you toss it in the trash can? Hmm. Okay, somebody's got a fraternity suit. Well, it's got to be what it is. I mean, why else would you care?

He's worried that someone's going to pick that jizz rag out and then, you know, somehow shove it into their vagina and get pregnant and he's got no control over it. Number one, how about flushing it? Don't throw it down the trash. I mean, you know, if it's tissues as so many people use, if you're really worried about it. Yeah. And if it's a sock, throw it in the washing machine. that sperm can live up to five days in the uterus swimming around looking for an egg to fertilize and outside the body it just depends now people have tried to claim that they got pregnant in a

hot tub not possible sperm would die almost immediately because of the temperature and the chlorine and exposure to just plain water now in saline they can last for quite a while And in a sperm collection cup, they can last for quite a while because I did a motility study. And when my wife was trying to get pregnant, because you've got to first figure out if it's the dude, right? If I was shooting blanks, there wouldn't be any point putting her through a big long workup. And so I took a cup into the bathroom at the hospital, and I masturbated to completely. and then took this cup in, and they probably, it was about an hour before they looked at it, and they, you know, there were still motile sperm in there, because it was still liquid.

They hadn't dried out, but in a towel and it dries out, and it's minutes. You're talking minutes. I agree. There you go. Thank you. I think that's correct, Dr. Steve. Although, which restroom was that? Because I don't want to use that one?

Yeah, it was the one next to the doctor's lounge. Oh, thanks. And that one that I found. You just went in the bathroom and did it? Where else am I going to go? Don't they have stalls? No, not at the lab at the hospital. Here's your masturbation style.

Here's the masturbatorium. No, you just got to go in the bathroom. I found out later that the lock on that bathroom doesn't work because I was sitting in there, you know, defecating one day. And I know I locked it and somebody hit the handle to come in and it just popped the lock open and they just, you know, walked in. They're like, oh, excuse me. Can you imagine if that had happened while I was trying to get this sperm sample? We would all have heard of it. How would I explain that?

Well, I would have to explain it as I was doing a sperm sample, and here's my collection thing. But, yeah, everybody would have heard of that. Thankfully, my other story, you probably haven't heard this one. It's a good, in-the-hospital bathroom story. So I came back from a trip out of the country or out of the 48, you know, the Continental 48, and came back with a raging case of Teresa, and we were worried that it might have been Giardia. because I did get exposed to fresh water while I was there. And so they wanted a stool sample.

So I go into the bathroom on the floor. And, you know, I'm sitting there and I got this little cup and you just kind of got to position it just right. And make sure that you don't overfill it because then it's just a mess. And I just got just enough in there. And I, like an idiot. Okay. Smarty pants. Always.

Always, always put the lid on everything right after when you're done with it. But I set it up on the side of the sink, which is porcelain and slippery. And I'm going to pull up my pants after sort of cleaning myself up. And you know how when your pants are down below your knees, it's sort of like a bowl, right? And as I'm pulling my pants up, no clue how this happened. That thing just slipped off of the sink and dumped right into. my pants. So into the bowl, right?

And what can you do about it? You sop it up the best you can with tissues and stuff and scrape it up, but you can't get all of it. And now when I pull up my pants, it's cold. And you can't leave without your pants on. Is that why they called it street?

It's cold and liquidy, and I'm pulling up my pants, and I've just got this huge shit stain on the back of my pants. So back then, I carried a clipboard. So I walked down the hall, just sort of real tiny little steps, holding my clipboard over my rear end, and had to take towels and put it down in my car so I could go home and take a shower and change clothes. And I just threw those pants away.

I guess in retrospect, I was so mad. But in retrospect, and I was late for rounds and the whole thing, you know. But in retrospect, I could have thrown those pants in the washing machine. and wash them and then take them to the dry cleaners. But I just never want to see these pants again, and I threw them away. So bad. So, anyway. All right.

We have about two minutes left. Let me see if I can answer one of these really quick. Well, hello. Hey, Dr. Steve, this is Jason in Texas. I got a question about a bladder infection. I had one a while back, and it was so severe that I couldn't urinate for like almost 14 hours and ended up going to the emergency room and getting a catheter. And then after that, you know, they put me on antibiotics and it cleared up.

I'm starting to have those symptoms again. any any thoughts on where the yeah yeah we're running out of time that's not a normal urinary tract infection when you can't urinate to the point where you need a catheter that's usually a sign of a prostate infection and where the prostate is enlarged to the point where it's just cutting off flow from the bladder so he needs to see a urologist the only thing that could do this though there's two things that can cause you an inability to pee and one is a urethral stricter and the other one is, you know, an enlarged prostate, you know, I guess a neurogenic bladder or something like that, but that's not what we're really talking about here. He had a bladder outflow obstruction.

So he needs to see a urologist get that check. There's something going on with his prostate or he has a stricter in the urethra. If I was a betting person, it would be the prostate. Me too. I bet on the prostate. Yeah. So a urologist is going to be in the best position to treat that, my opinion. Thanks always go to Lady Diagnosis and Dr. X. Listen to our SiriusXM show on the Faction Talk channel. SeriousXM

Channel 103 Saturdays at 8 p.m. Eastern, Sunday at 5 p.m. Eastern on demand and other times at Don Wickland's pleasure. Many thanks to our listeners. And go to our website at Dr. Steve.com for schedules and podcasts and other crap. 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.