Weird Medicine: The Podcast - 332 - Whatever Apnea Baby Jane?

Episode Date: October 11, 2018

A "cure" for osteoarthritis, surgery, testing and non-surgical treatment for sleep apnea, stress reduction, lumpy legs, and more!   PLEASE VISIT: stuff.doctorsteve.com simplyherbals.net Learn more about your ad choices. Visit podcastchoices.com/adchoices

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That's Blue Apron.com slash medicine to get your first three meals free. Blue Apron, a better way to cook. You're listening to Weird Medicine with Dr. Steve. on the Riotcast Network, riotcast.com. I need some touch in, ho, ho, ho, yeho. I'm a garretin. I've got diphtheria crushing my esophagus. I've got Zabodovibre stripping from my nose.

I've got the leprosy of the heart bow, exacerbating my incredible woes. I want to take my brain now, and blast with the wave, an ultrasonic, ecographic, and a pulsating shave. I want a magic bill. Oh, my brain. ailments, the health equivalent to citizen

cane. And if I don't get it now in the tablet, I think I'm doing, then I'll have to go insane. I want to requiem for my disease. So I'm paging Dr. Steve. 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,

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And then if you're interested in our archives, right now you can listen to the first or the last five episodes free. Go to premium.com. That's premium.com. For a buck 99, a month, you can get archives forever. And listen to it on the weird medicine app. That's the easiest way to do it. Weird medicine app on iTunes or Google Play. So, hey, there's some new research published in the Journal of Annals of Rumatic Diseases that shows an innovative blocking agent can stop the degeneration of cartilage when injected into the joint. So this is for people with osteoarthritis or wear and tear arthritis. It occurs most often in the hands, hips, and knees, but it can affect the spine as well.

30 million adults in the United States have osteoarthritis, including your old. pal doctor steve i'm getting some in my hands which is kind of slowing down my synthesizer playing and me and you as well a little bit in my knees a little bit in my shoulder yeah well you were a little bit an elite athlete and i've noticed elite athletes get osteoarthritis in their knees pretty easily oh yeah it's definitely the most prevalent form of arthritis and uh you know there's really no cure for it uh but these scientists may have found a treatment the promises to stop the disease from progressing. So these would be people who've already shown some wear and tear of the cartilage in

their joints. And what they want to do is stop it from real. We have no disease modifying treatments right now. We've got disease mollifying treatments. We can make it seem better, but the disease itself just keeps getting worse. And so that research is started by focusing on a molecule that they previously found to cause inflammation, break down cartilage, and deplete the body of collagen. And so that's sort of our, the body's plastic, you know.

And in this new study, the scientist, developed a compound that blocks that molecule. So the first thing I had to do is identify the molecule and then figure out a way to block it. And let's see here. They recently discovered a molecule called microRNA 181A5P. Cool. Say that five times real fast. has a critical role in destruction of the joints. In the present study, the team on to see if a blocking agent can counter this damaging molecule,

so they tested therapeutic potential of so-called locked nucleic acid antisense oligoneucleotides. In rats, rodents, cell culture, and tissue samples from people from knee and spine osteoarthritis. More specifically, they had tested the effects of a blocker called LNA-M-I-R-18. 181A5 PASO and found it to be effective. In this study, we provide the first evidence that intra-articular injection of in vivo, that means actually in a body, as opposed to in vitro, which is in the test tube, grade this stuff. I'm not going to say the molecule again, can attenuate cartilage degeneration in preclinical models.

Okay. Preclinical means they're not trying it in humans yet. So that would be the next thing. first you got to is it going to be safe in humans right and then can we try it in humans so they'll do efficacy studies they'll do safety studies if all this stuff works they'll figure out a way to make billions of dollars off of that and uh the orthopedists have plenty of other stuff they can do other than replacing knees so if we can uh you know put them out of business on that one let them concentrate on other stuff it'd be good so uh yeah this is really interesting in this

blocker is based on what they call anti-sense technology, and it blocks the destructive activity caused by this microRNA and stops cartilage degeneration. So this probably won't help me, probably won't help you. Uh-oh. Yeah, probably not. Oh, you know who that is. We may be past help. Tacey, you're on weird medicine.

Uh-oh. We're out on time. She can't even just say hello? No, you know, and the crazy thing is we're now doing this on another normal day, and she can still manage to find out when we're recording. That just speaks to how many times a day she calls me. That's true. It really is what it is.

She's got a, you know, about a, after 14,000 calls a day, you're going to. She doesn't know what I do for a living because just call me whenever. No. All right. So that's pretty interesting. That's pretty cool. I kind of wonder if they would start giving it. at an earlier age to kids, especially that are pretty active?

Or if it's at it, you know, after they've reached puberty or once they've reached, down the road. If they can demonstrate, which they pretty much can, that like playing football results in osteoarthritis 10 years later, could they use this prophylactically to try to prevent osteoarthritis? And you'd have to identify very specific populations of people who are at very high risk. But, yeah, you could do it. Yeah, that would be cool. It's pretty cool.

It is awesome. I got another one. This is from the European Society for Medical Oncology. They had their 2018 Congress. And they had two new studies that showed that people with sarcoma, which is a type of tumor of connective tissue, often take complementary and alternative medicine with little regard for the potential risks or ways they may interact with conventional cancer treatment. Now, this is no surprise. People who have cancer, people have high blood pressure, people have depression, take alternative, complementary and alternative medicine stuff. They go to Dr. Scott and he throws needles at them and then hits him up with some, you know, dung of a flying squirrel and some other things.

And other things like that. And, but what Dr. Scott will do, which other people won't do if you just walk into a health food store and just start picking stuff off the shelf is because he went to four-year traditional Chinese medical school, he knows which of these medications may have potential interactions with our things. Exactly. He'll warn people about it. Absolutely. So. And plus I evaluate all their medications and consult the prescribers if we need to. These guys looked at drug-to-drug interactions between complementary and alternative.

medications and conventional cancer treatment, such as chemotherapy or these thing called tyrosine kinase inhibitors. And they found that this stuff is not without risk. And they said that 44% of the participants weren't interested in complementary and alternative medicine before they got a cancer diagnosis, but they certainly were after. Because, you know, you're desperate to try anything. Absolutely. Just like I did with my neuropathy.

You know, I wasn't taking supplement. Well, I was taking vitamin D, I guess, but I wasn't taking supplements before that. But I got desperate when my neurologist said, well, I don't have anything. And, you know, I searched the medical literature. I did it a little bit differently. I just didn't go to the health food store and say, you know, you got anything for neuropathy, man. That's right. I went to PubMed.org and looked for dietary supplements that have data that show that there's

benefit in peripheral neuropathy or damaged nerves in the fingers, hands, and feet. And I found, you know, several studies that pointed to some nutritional supplements. So I take those. So that could be considered alternative medicine because my neurologist didn't prescribe it for me, but at least there's medical data behind it. It said the Internet and other media were the top sources of information for these respondents. That's the problem. Friends and healing professionals came second and third, respectively.

15% were friends. So 43% went to the Internet. 15% went to friends and only 14% went to, you know, healing professionals. And let's see, they addressed precisely the risk of drug-to-drug interactions. that reviewed data on 202 patients treated for sarcoma with chemotherapy or these other things called tyrosine kinase inhibitors. And drug-to-drug interactions occurred in 18% of the cases. And let me see if there was any particular drug that they did, they list the drugs that were the biggest offenders. They really didn't say anything about that.

They said that they acknowledge the benefits of exercise, mindfulness, yoga, acupuncture, and hypnosis as an addition to conventional cancer treatment. However, oh, here we go. Antioxidant supplements, including herbs, minerals, vitamins, and phytoestrogens have not been linked with any part of positive or harmful effect. So they didn't really list the ones that, you know, I would be interested in the complementary. medications that cause the most problems, but that's the one thing they don't list in this article. But anyway, just if you're going to take this stuff, talk to your provider about it. You may feel like, oh, well, they won't talk to me about it.

No, they will. If someone brings in something to my oncology practice and says, I want to take this supplement, there's a bunch of different websites and, you know, computerized, resources that I have, including a system called Epocrates, another one called Up to Date, where we can look these up and see if it's going to be a problem with what you're taking, looking for drug interactions and stuff. And the things that you're worried about are drug interactions that cause

arrhythmias, that there's a certain class of drug that can increase a parameter on your EKG called the QT interval. And when you prolong that, it increased. increases the risk of a certain arrhythmia called Toursade de Poix, which can be fatal and certainly will end you in the emergency department for sure. The emergency department or the ICU if it happened. So, you know, these are things that we can help you with. So please bring those supplements with you to your doctor's appointment and show the, you know,

when I say doctor, I'm using shorthand to your health care provider's office, including your N.P. And clinical nurse specialists and advanced practice nurses, whatever, and MD or DO. And it's just so I make sure I say everybody, because I'll start getting emails from people. And just bring them in, let them look them up. If they will not or if they shit on you, find somebody else because they're not worthy of the title, in my opinion. We need to have an open mind and we know that our patients are using these things. And some of may be helpful. Right.

Well, like the ones you're taking are helpful. Yeah. But some of them are not helpful. That's right. You know, and some of them can be even worse than not helpful. Very, very dangerous. So it's vital that you let everybody know what you're taking. Yep.

Communication. Yeah, cha-cha. Yep. There you go. All right. You got anything over there or should we do some phone calls? Yeah, I was looking real quickly, kind of interestingly, and I was surprised that there was a research study done on almost a children in Spain, and the children who were up to age three were in, followed in a daycare,

they were at a higher risk to have upper respiratory infections if they used soap and water versus a hand sanitizer. Really? Which, I was very surprised. I thought, well, that's exactly the opposite of everything we've ever. So if they used soap and water to wash their hands. Yep, up to 21% higher. Wow. Yeah.

That's interesting. Yeah, I was very surprised. I'll do some more digging on this to find out what exactly it's about. I mean, that would bring up the question, do they have potable water in that daycare? Right. I was in the Dominican Republic ones, and I was staying in a hotel in downtown San Diego. It wasn't one of the resorts, and I was there on business. And, you know, I was brushing my teeth.

drinking the water and out of the faucet and all this stuff. And I speak Spanish, but I didn't notice the little sign next to the faucet that said, you know, El Agua no es potable, which means that water is not drinkable. And I shat myself for the next, you know, three days. I've had a little bit of that myself. We probably ought to talk a little bit about Traveler's Diary. a lot of times it's not an actual infection in the, but, or a parasite. Sometimes it's just that they have different bacteria on the surface of their fresh vegetables and in their water that our bodies aren't used to.

And I, every time I go to Hawaii, and that's in the United States, I know the water's clean. I know everything's clean. But when I go to Hawaii, I will get the shits for two weeks afterward. And it has everything to do with just different bacteria on the surface that's colonizing my gut biome that my body in used to. And I'm just particularly sensitive to that. Yeah, you get to create a little bit of an irritable bowel, I guess. Yeah, that's kind of what it does. Yeah.

But it's not a parasite. There's nothing wrong with the water or the food. It just has different colonies of bacteria on it than, then, what I'm used to around here. True. And again, I just happen to be sensitive to it. So if you want to prevent Traveler's diarrhea, they recommend that you use abismuth subsilicillate, and that is peptobismal tab.

Peptobismal terrible anacin, but it's really pretty good for preventing Toresta. And the reason is the molecule itself has a very high surface area, and it just kind of bind all those bacterial toxins and partial bacterial bodies that are hitting up against your GI tract and causing inflammation. Right. You know? So. And then there are some docs that will give you a prescription for a fluoroquinoline to take if you get it. Now, and that's a specific type of antibiotic, don't take fluoroquinolones just.

for no reason, because they can cause some real problems, including, weirdly, Achilles tendon rupture. I don't know why that happens. I would love to know what the mechanism of that is. We can probably look that up. That might be something good for you. Sure, look up, Dr. Scott. Just look up quinolone and Achilles tendon rupture. Okay, you want to take some questions?

Let's do it. All right, let's go. Number one thing, don't take advice from some asshole on the radio. It's absolutely true. all right a little dead air there mm-hmm hmm I'm wondering I've had over the years I'd say at least seven eight years now almost at different points of the day almost I would see kind of like traces I would see like little not even like more than an inch like black lines that would come and go sparks that would kind of come and go and I would

feel these kind of sensations in my head almost like blood flowing if you want to call it that like almost like electric kind of a sensation and it would have again come and go doesn't cause me any real issues i've had tests on MRIs uh with contrast without and everything seems fine i've had a ida last year everything seems fine with that but at school the last like i said over five six years i've experienced these kind of spark splashes these little tracers that come and go and disappear yeah very interesting so you wonder When you see traces, is there something wrong with the eyes or something wrong with the area around the visual center of the brain? And that could be migraine.

You know, when people have the constriction of the vessels that starts a migraine, they have changes in the blood flow to that part of the brain and they'll see oras. You know, they might see cascading marquee sort of lights that look like, you know, a marquee, lights that march through the periphery of the vision. But this isn't that. It's just real quick and it's there and it's gone. Sometimes you'll get flashes of light when you have tension on the retina caused by a retinal detachment. But he's had his eyes checked and it's not that. I'm assuming that they looked for that because that'd be the first thing they would look for.

They didn't have that. But he also has this electricity feeling in his brain. And this sounds very much like a thing called a brain zap. Now, I had brain zaps bad when I came off of my antidepressant, Symbolta or deloxetine. I came off of it. I wasn't on it because I was depressed. They put me on it for abdominal pain. It really didn't do very much.

And I felt like a zombie on it. that was just me lots of people do really well on it i didn't need it so it didn't do very well for me if you need it makes you feel pretty good um so uh but when i came off of it i had a horrible um because i'm an idiot first off i just stopped it suddenly instead of tapering off of it i stopped it suddenly and uh for two weeks i had Terminator eyes oh wow meaning that you know how in the movies, when the Terminator's eyes move, you hear those servos moving, sort of that real high-pitched sort of when their eyes move. So when my eyes would move, I would hear that, like I had servos in the back of my eyes controlling my eye movements. And I would have these brain zaps.

And I looked them up and they're pretty common in people who have stress. persistently elevated stress is the most common cause of brain zaps and the only way that you can eliminate is you've got to reduce your stress so dr scott you're the king of non-pharmacologic stress reduction why don't you talk about that for a little bit certainly there's a bunch of different options um guided meditations one thing i love and you can find a lot of great guided meditation uh online youtube is a great source and and you But sometimes it's great to get a counselor or someone in your area to help you with it. Certainly, I love the acupuncture for stress release, calms the system down, increases serotonin, decreases cortisol levels.

And there's a lot of all-natural things out there that are helpful for stress reduction. Like beer, wine. Well, yeah, I know she has a problem. Well, that's for some of us. But no, we have a bunch of medications. You know, I personally love the CBD. oils and even some of the in the states where it's legal. I love some of the, um, the, uh, um, I think I figured out the legal thing with CBD oil.

Okay. So there's this drug called Epidilex that just came out. And it's for childhood seizures. Mm-hmm. And CBD oil derived from, uh, sativa plants, you know, pot plants, was schedule one, okay? Meaning it was illegal. The FDA just rescheduled it to Schedule 5, which just goes to show you, because Schedule 5 are the things that really are not very abusable. It just shows you it shouldn't have been Schedule 1 in the first place.

But they scheduled it to Schedule 5 so that this insurer or pharmaceutical company could sell the damn stuff. But so and you go, well, shit. Well, does that mean all CBD oil is Schedule 5? And it turns out no, if it is derived from hemp plants. then it's apparently legal. Okay. If it's derived from pot plants, it's not legal. Okay.

Which sounds to, smacks to me of a political thing rather than a real thing. Because if you're not making decisions based on what's best for the patient or on what's real, i.e. science. Right. Then it's, you're making a political, political statement. So. Agreed. If it's derived from hemp, it's the same molecule. Cannabodial is cannabodial, whether it comes from hemp or comes from pot.

Right. But if it comes from hemp, that's what they're selling at like Yoders Amish store, which is not too far from where we live. And also selling at the pharmacies and health food stores and stuff like that. Now, I have a lot of people telling me, be careful because the stuff that you buy in those places, they'll do. G.C. Mass spec on those, which is a way to, you know, do an analysis to see if a certain molecule is present. A lot of times it's not present. So you want to get it from a reputable place. I've got a compounding pharmacy that I get mine from. I trust them to have the stuff that's been tested and actually has the stuff

in it. I don't have bought it. By the way, even the stuff that's derived from hemp may have as much as 0.3% THC in it. Right. That may be enough to trigger a very sensitive THC urine drug test. The, um, we have a large employer around here employs 12,000 people. They just sent out a memo to everybody that says, you can use CBD oil, but if it gives you a positive, uh, THC on your drug screen, you're out of here. Wow.

So, and I can't tell you ahead of time whether the CBD oil that you're going to take is going to trigger a positive THC test. So I'd be very careful about that. Either find out, is there any tolerance for using CBD at the workplace if it triggers a positive THC? And if the answer is they don't have any tolerance for it, your risk and your job. Yep. Until they lighten up about this stuff. Hopefully, which will be soon. I hope so.

But, you know, if you can't use that, you know, there are other wonderful old Chinese medications for stress, you know, the one that we use at our office as simple herbal stressless, which we've renamed, by the way. What? Well, we've renamed it Smile More Stressless because we had this asshole in Atlanta that was harassing us about our names. Oh, really? Oh, he had something himself that was trademarked that was called Stressless. Right. And I don't know why he's not suing Lipton T for. Yeah, they say stress less too, right?

They sure do. Hang on. So I'm actually considering changing the name to F-U-A-K instead of smile more stress less. Oh, I thought you meant to F-U to that guy. Yes, that's what I'm going to change it to. Yeah, here we go. New Lipton wellness product, stress-less herbal. There you go.

There you go. So surely he's not just going after the little guy that he knows he can bully around. I think he's going after the guy's up. Is that right? Isn't that interesting? Yeah, so like I said, I'm going to rename it. So if we have all of our friends out there in Radio Land that if they get online, they see an F-U-A-K. That's just a new name for StressLess.

Oh, I see. We've renamed it. Okay. So, that's funny. Feel free to purchase that. Well, this guy's initials are AK by any chance. Oh, gosh, you know, they are. Oh, what a quinky dick.

What a quinky dig. That is hilarious. Okay, well, that's Dr. Scott, everybody. That's me, not anybody else. It's all me. All me. And he's sort of taking sides in that. I'm always on your side.

But it does seem ridiculous. How many other places? Let's look, let's just Google stressless. They've got stressless furniture. Oh, really? There's a furniture company. Yeah, it's a bunch of bullshit. And quite honestly, I mean, we're just so small.

I don't have the money for lawyers to fight them. So we'll just change our name. Yep. Stressless comfort, recovery. Kleiner Furniture. It's even Stressless.com is their website. Exactly. Oh, my goodness.

And this piece of shit. It's kind of. Okay. Now, you're saying that. I'm saying this is not, has nothing to do with this show or anyone affiliated with the show. This is strictly me. Okay. So, all right.

I had no idea. We were getting into this kind of stuff when I was asking you to do the, the stress reduction thing. I'm a big fan of non-pharmacicic stress reduction. Massage, exercise, exercise, Dr. Finding out what's stressing you and getting out of that. If it's your significant other, go to counseling. It really does help. Or get a divorce like I did.

Or get a divorce, but you should try counseling first. It's very expensive. You know, a couple of sessions of counseling a lot cheaper than splitting up half your shit. That's very true. All right. And I am a big fan of yoga. Hey, another dumb-ass question for you. No such thing.

I've always heard taking antibiotics and then drinking milk while you're taking antibiotics. Is there any, does the milk do anything to lessen the effects of the antibiotics? Yes. And it's specifically tetracycline antibiotics. If you drink milk with that, it will bind, the tetracycline will bind to the calcium and then it won't be absorbed. So that's all of that. And what adult is still drinking milk? Drinking milk.

Don't drink milk. Too old. Hi, Dr. Steve. I had a question on a sleep study I had done. Okay. Because I think I had sleep apnea. And the study showed that I had 64 respiratory events within an hour. And my O2 level dropped to 77%.

Damn. Do those two figures can, that I possibly have sleep apnea? Well, it depends. Yeah, I mean, the hypoxia, in other words, the dropping of the oxygen is certainly suggestive of that. But the insurance companies, before they'll pay for a CPAP or a bi-PAP machine will require a little more information, but I'm sure they did all this. There's a thing called the apnea hypopnia index. And what that looks at, it looks, it's an index to indicate severity of apnea, it's represented by the number of apneas and hypopnea.

So apnea is totally stopped breathing. Hypopnias are decreased breathing per hour of sleep. And let's just say that yours was, let's say that the number that you are quoting is the apnea and hypopnea together. And apnea has got to be at least 10 seconds and associated with a decrease in blood oxygenation. So if yours was greater than 30, you have severe sleep apnea. And you should be on some program to improve that.

So what do you do? Well, the most common thing is a CPAP machine that's continuous positive airway pressure. And the easiest way to do that, with a mask and it just all it does is supply pressure and you don't feel it you feel the mask obviously but when the pressure is there it's weird when you take the thing off there's a whole lot of flow that goes on when you take it off that you're not experiencing when it's on you just the pressure simply keeps your airway open when you are sleeping so when you uh the mechanism of

obstructive sleep apnea is the the tissues in the back of the throat and the upper pharynx collapsed during sleep. And most of these people snore because that's part of it. But then you get this kind of and then you have to wake up. You have to wake up a little bit to open up your airway. So you'll gasp and you'll breathe real fast for a few minutes or a few seconds. And then you'll go back into this again. And when you're doing this, what do you say?

64 times. That's once a minute. Yep. This is happening. He's spending a great percentage of his day, a third of his day, if he gets eight hours asleep, being an anerobe. Yep. And you've got to be asleep without waking up for 15 minutes before you get into REM sleep.

If you don't get into REM sleep, then you're not getting good restful sleep. Right. Poor Haji. So he's waking up once a minute. There's never any time when he's sleeping for sleep. 15 minutes. No. So you get the CPAP on now.

When they do the CPAP sleep study, one of two things will happen. It'll either make it better and they can run the pressures up and down until they get you to open up your airway. Or it may make it worse. There are people, and I'm one of them, that when you get the CPAP on, you just stop breathing all together. That's called central sleep apnea. So people who have obstructive and central sleep apnea, that's called complex sleep apnea syndrome, which of course I have that. Of course you have, yes. And those people need a thing called bipap.

And what the biap machine is is it's a non-invasive ventilator. In other words, it pushes air in when you don't breathe and you breathe out against some resistance, which is the CPAP, you know, the expratory part. And that keeps your airway open and it keeps you breathing. So I have my pressure is up pretty high, and I can tolerate them now. But even then, every once in a while, I'll have a night where I have 15 an hour. Now, 15 an hour is considered moderate. It was severe. Jeez.

So it's better, but still 15 an hour is one a lot. Every, you know, every four minutes. I really want to get it down to, you know, when I sleep eight hours and I've got three episodes an hour, I feel like I'm on speed. Oh, wow. You know, it really feels good. Oh, yeah, so much better. So, but anyway, yeah, so this guy needs to have the follow-up, get it taken care of, and don't fuck around with this. The downside of sleep apnea is you fall asleep while you're driving.

You fall asleep at your desk. You feel fatigued all the time. But worse than that, with severe sleep apnea, you can get right heart failure. How in the hell does that have? happen. Well, the lungs have this mechanism when there's a lack of oxygen to a certain part of the lung. Let's say that you get a clogged up section of the lung. There's no point in sending blood to that section anymore if it's dead. So the blood vessels around that area will detect low alveolar, the alveoli are the little spongy places where oxygen goes. And they'll notice that

There's low oxygen in there, and so they will shunt blood away from that. Well, how do they do that? They contract or they constrict. And now there's increased pressure going to that area, or sorry, increased resistance to that area. So blood will tend to shunt around that area. Well, what happens when your whole lung is like that? Each little capillary doesn't know that the other lung is doing the same effing thing or that other even sections of the lung are doing.

It doesn't have a mechanism for that. So it constricts the blood vessels to the whole lung. Now you have increased resistance getting to the whole lung. You end up with a thing called pulmonary hypertension, where it's hard to get blood into the lung because the heart's got to beat extra hard to get this blood to flow through the lung. And you get pulmonary hypertension, and it's the right side of the heart that beats, you know, pumps to the lung. so then you'll get right atrial enlargement, right heart enlargement, you can get right heart failure, and then you start having sleep apnea and swelling of your extremities, okay? And that, if it's bad enough, it's called Pickwickian syndrome, and it's a sign that someone has had untreated sleep apnea for way too long. So don't let that happen to you.

If you snore bad, if you are tired during the day, get a damn sleep stut. You know, I think a lot of people fear putting on a see-peper-by-pe machine because they think they won't be able to sleep with it. It's the greatest thing in the world. Yeah, but I encourage them to, there's a lot of new device out there and a lot of new ways that they can help you breathe at night. But it's vital. I feel naked sleeping without it now. Yeah, you'll get used to it. And there are a bunch of different ways they can do it.

Jim Norton posted a picture of himself with his nasal pillows. Oh, funny. Yeah. So, I'm glad. I'm not talking out of school because he posted it on his Twitter. And, you know, I have the full face mask. I thought I wouldn't like that. I thought I would much prefer to have the nasal thing.

But the problem with the nasal thing is if you open your mouth, all that air just comes flowing out of your mouth and it doesn't do anything. So they recommended that I try the full face mask. And like I said, the first night that I woke up and I thought I didn't have it on, but I did have it on, that's what I knew I was getting used to it. Good. And now I can't sleep without it. So, all right, get that shit checked. Agreed. Hey, Dr. Steve.

I am wondering something here. My family has a history of snoring, and I believe I do too, because I catch myself snoring once in a while in my sleep. But the other part of it, too, is I heard you talking a couple of times. shows ago about somebody having their urea at the back of your throat removed and I kind of hard to tell but I feel like that is making my voice sound really weird not it's almost like I it's blocking the back of my throat in a way all the time and I can see definitely see myself snoring because of that yeah well if you have a partner they'll tell you if they're snoring the other thing that you can do is record yourself right uh during the night if you don't have a partner and you can hear and then you can tell if you're stopping breathing uh if you have the fatigue and all that stuff get a sleep study one of the things that can be done and that's why i wanted to play this phone call next is a thing is a surgery called a uvulopalato pharyngeoplasty and it's also known by the abbreviation

UPP, and it is a surgical procedure where they take out the uvula and they attack up to decrease the size of the small, of the soft palate. Okay. And what will happen with this, of course, is you know, it changes the way your palate is. It may change your voice. But I've known people that have this now when they drink certain liquids. If they're not really careful, it comes flying out their nose, stuff like that.

But it tightens up all those tissues so that you're less likely to obstruct your airway when you're lying supine. In other words, you face up. On your back, right. Yeah, lying on your back. May we talk real quickly, though, just for everybody's clarity. As far as sleep studies, they have a couple versions, right? Yep. And I think that would be something to clarify for a lot of folks.

They may not know what a sleep study is. Exactly because you could do the take home. Well, okay, so the take home is a screening test. Right. So what they'll do is they'll give you a probe that you put on your finger. Like a pulse oxy've had it. Yep. Like a pulse oxymetry.

So it's a probe on your finger that will look at your oxygen saturation. And then you wear a band around your chest. And the band on your chest has an actuator in it or a sensor that can tell when you're expanding your chest and when you're contracting it. Gotcha. And what they can look at is over time, you'll see the sine wave as you're breathing up and down, up and down, up and down. As this sensor, you know, this stretch receptor notices when you're breathing in and out. When you stop breathing, of course, you'll see a straight line. And then we correlate that with, because you line it up.

You know, you set the time, you know, they all start together. You synchronize the two clocks. Right. And then you can see as this. straight line kicks in, you can see the oxygen saturation start to decrease. And that's a positive screening test. You can't put somebody on CPAP because of that, but that'll tell you, is it worth doing a sleep study? Then during the sleep study, they kind of already know you have sleep apnea, so they'll let you kind of cycle for an hour, and then they'll slap the mask on you.

And they'll do a titration study, which means they will run the pressure. up until they see that you're no longer obstructing. And then if they see that you stop breathing and you have complex sleep apnea, they'll turn the Bipap machine on. Gotcha. And they can do that all in one thing. It used to be two and three different sleep studies, but now it's all in one. Good.

That's what I thought. And it should have been with that other guy. They should already tried him on a mask and said, dude, you need a mask. But now if they just do a regular sleep study to diagnose you. and they don't put the mask on, and they tell you you have sleep apnea, then you've got to go back and do the sleep study with the mask. Okay, got you. Okay.

And, you know, in serious cases or people, you know, for whatever reason that need to have surgery done, then they can you do this uviloh palatophorangeoplasty. And any time you hear plasty on the end of a procedure, it means that they're going to change the shape of it. Okay. All right. Ostomy means they're going to make a hole in it. Otomy means they're going to cut it. And plastic means they're going to somehow change the shape.

It's like plastic surgery. Right. Okay. All right. I'm just seeing. Yeah, UPPP is typically administered to patients with obstructive sleep apnea in isolation. It's administered as a standalone procedure in the hope that the tissue, which obstructs the patient's airway, is localized in the back of the The rationale is that by moving, by removing the tissue, the patient's airway will be wider and breathing will become easier.

So let me see what the effectiveness of it is. The results are variable, as explained to sleep apnea is often caused by multiple coexisting obstructions. So not only that, but it doesn't say, it doesn't give me any statistics. So anyway, all right. Hi, Dr. Steve. I rarely have seasonal allergies, but this spring I was having some nose and ear congestion. So I picked up AllerTech, which is a generic Zyrtec. So within a day or so, everything cleared up.

After about six weeks, I went away and forgot it for a few days and had horrid itching on my feet and legs, but I assumed it was crappy hotel detergents. Then two weeks ago, I wanted to stop the Zyrtec, and after about 48 hours, I started having that horrible itching and breakouts all over my way. legs and body. Yeah. They were so bad, it was making me feel sick to my stomach and wake up in the middle of the night, no creams or anything seemed to help.

Itching would go away for a few hours, then come back for a few. Now almost two weeks later, it finally stopped itching. I'm just wondering, if Surtec withdrawal is a normal thing? The Google results seem to say so, but the Internet seems to be the only worst place for medical advice than somebody on the radio. Yeah, got it. Well, what he's having is antihistamine withdrawal, and of course, we'll use antihistamines for people who are itching because very often histamine is the cause of their itching. Other times it can be activation of what we call peripheral mu opioid receptors.

Those are people who have itching with like liver failure. So antihistamines usually won't do much for them. But unbearable itching after withdrawal of antihistamines is not a common phenomenon. As a matter of fact, you go to PubMed and you don't find a lot of published reports of this association. I did find an article called Unbearable Pyrritis After Withdrawal of Livo Satyrazine, which is a non-drowsy antihistamine from 2016 in drug safety case reports, which is a journal. And they looked at 12 different people who had this exact. thing. And so they said levo satirazines were reported to cause problems with kidneys and liver. It's unlikely cause of the paritis in these cases. So they don't know. They said how

long-term treatment with non-drowsy antihistamines can cause this withdrawal reaction isn't own. You know, it's got to be a stimulation of histamine, though. It's very commonly prescribed drug, and you can get them over the counter. And so it just, you know, I'm going to read their conclusion. It says based on the cases reported to the Netherlands pharmacovigilance center, we suggest a causal relation between the withdrawal of levo satirazine and the occurrence of unbearable paritis. You know, health professionals should be aware of this. And And that's, you know, didn't give any answer. Wow.

That's tough. So, yes, it can happen. It's uncommon to the point where I would say it's rare. But, yeah, it can happen. And, you know, you've got a couple of choices at that point. You can go back on the stuff and then taper off. The nice thing about these are, most of them are tablets. They can be cut in half and then cut in quarters and see if that helps.

If that doesn't help, then there are other medications that you can use for itching that may be of some, assistance, including steroids, just to get you through the withdrawal, which probably won't last more than a week or two. Yeah. But that's a tough one. That's a tough one. Jeez. Yeah, good luck, buddy.

Of course, he called like six years ago. All right. I think we got time. Hey, Dr. Steve. This is Mike from New York. Hey, Mike. Back in December, I tripped and hurt my thigh and never bruised, but I limped for about three or four days.

About a week and a half ago, in late February, early March, I noticed a lump appeared in the same area where I initially heard it. I'm just wondering if that could be a sebaceous cyst or something else, and should I have it checked. Possibly, but the most likely cause is that you did have a bruise there and you didn't see it because it was in the thigh could be very deep. And a hematoma in the thigh, which is a really, you know, just squishy, Big muscle. Big, you know, muscle. Full of blood. A collection of muscle.

It's just full of blood. When that hematoma goes away, it's got, first off, you get a hematoma on the back of your hand, it's not got a whole lot of space to expand. Sure. In the thigh, lots of space. So there can be a large collection of blood there. When it goes away, the body can remove that. But what it can't remove for whatever reason is the calcium. left behind by that hematoma.

So whether, you know, it's inorganic calcium, it just can't get rid of it. There's some granulated tissue in there, too. And you end up with a big chunk of calcium. And, yeah, and there may be some connective tissue associated with it. And you'll get a lump. And that's what it is. And if you get an x-ray, you may see a thing of calcium there. Now, if this thing is growing or is painful, anything like that, you've got to get a check.

And you should get your primary. care to check it anyway just to feel it so they'll know that it's there in case it ever changes they can feel like they've got some baseline that they can go on all right so there you go thanks always go to dr scott um appreciate you being here we can't forget rob sprance bob kelly greg hughes anthony cumia jim norton travis teff eric nagle roland campos sam roberts pat duffy dennis falcone ron bennington and fez watley whose early support of this show has never gone unappreciated. Listen to our SiriusXM show on the Faction Talk channel. SiriusXM. Channel 103 Saturdays at 8 p.m. Eastern Sunday at 5 p.m. Eastern on demand and other times at Jim McCleur's

pleasure. Many thanks to our listeners whose voicemails and topic ideas make this job very easy. 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.