Weird Medicine: The Podcast - 336 - CBD, Depression, PSA Velocity

Episode Date: November 8, 2018

Dr Steve answers a bunch of medical questions. Ignore the comments about the premium service, it looks like it's not going away after all. THANKS for your support! please visit: stuff.doctorsteve.com simplyherbals.net premium.doctorsteve.com 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've got diphtheriae, crushing my esophagus. I've got Tobolivide from my nose. I've got the leprosy of the heart valve, exacerbating my impetable woes. I want to take my brain out. Blast with the wave, an ultrasonic, ecographic, 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 aging Dr. Steve. It's weird medicine, the first and still only uncensored medical show in the history of broadcast radio, now a podcast.

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an email to me and I'll forward it to them for you and we'll get you unsubscribed because that will be ending sometime in December so I don't want anybody being charged for stuff they're not getting okay all right so I'm warning you with peace and love that as of December 10th the premium service will no longer exist unless I change my mind which is a possibility I guess all right let's let's do some phone calls let's see here Uh-oh. Well, Ronnie B, I messed up again like I always do. Number one thing.

Don't take advice from some asshole on the radio. Hey, Dr. Steve and Dr. Scott and lady diagnosis if you're there. She's not. Anyway, I know y'all have talked about CBD oil a lot. And I was talking to my mom a couple weeks ago about CBD oil. and antidepressants. And I was calling to, you know, just give you an idea of, you know, like, what are y'all's opinions on antidepressants versus just pure, like, natural CBD oil? And this is for, you know, anybody who wants to put their two cents in, so to speak.

Anyway, I'm a big fan of the show, and I listen to y'all all the time, and I hope y'all have a wonderful afternoon or night or wherever it is over there. By the way, it's Sarah from Louisiana. We had tweeted, me and Dr. Steve have tweeted back and forth a little bit. But anyway, thanks for listening. All right. Okay. I'm sorry. There was still a little bit left to go on that phone call. Okay, so CBD oil and depression. So CBD is cannabidiol. The legal stuff that you can buy at like, you know, the health food store and stuff like that. We have an Amish store called Yoters and you can buy it from there. So everybody and their sister is selling this, and it turns out I was a little confused about it because the FDA just scheduled cannabidiol.

In other words, they made it Schedule 5, meaning it's a controlled substance, no longer Schedule 1, so that it could be used in a drug for juvenile seizure disorders called Drouvet syndrome. And there is a company that is producing that and selling it as medicine. So I was confused because of it's scheduled. How in the heck can people be selling it? And are they all violating the law? And it turns out that if you derive your CBD, your cannabidiol, which is an active ingredient in marijuana, but it is not hallucinogenic or doesn't really make you high. It still activates certain cannabinoid receptors in the brain,

but not ones that cause euphoria. Well, anyway, so if you derive your CBD oil from hemp, it's legal because hemp is the non-THC-containing version of the cannabis plant. And hemp has been used for ages to make rope and soap and all kinds of stuff. And the CBD oil that is extracted from that is legal, whereas if it's extracted from the marijuana plant, it is now a scheduled substance, as I said, Schedule 5, meaning it's of low abuse potential. So here, this is the problem. If you buy the CBD that is produced by the pharmaceutical industry that is scheduled, it is tested by the FDA and quality controlled, and there are a lot of safeguards associated with that. So when you buy that, you know that you're getting the real deal.

Now, that stuff's going to be crazy expensive. I'm guessing $1,400 bucks a month. I may be wrong, but I think it's going to be really extremely extremely expensive. extremely expensive. The stuff that you buy at, you know, your friendly neighborhood head shop, you don't know what it is. As a matter of fact, the FDA has pulled some of those from the shelves looking at them and said that some of them don't even have any CBD in them at all. And so that's my concern. Now, I have a very reputable pharmacy in my town that is selling it.

And they swear that they've vetted the supplier and that they know that it's the real deal. So that's what I would recommend. If you're planning on using and buying this stuff, find out what the provenance of it. You know, what is the chain of ownership? How do you know that what's in it is actually CBD oil and not just because somebody said it? And even in my situation, I mean, I'm not buying it, but I've talked to the guy about it. You know, they, all I can tell you is they are reputable and they swear that what they're selling is reputable. And they've never steered me wrong in the past.

That's the best evidence I've got. Now, we could pull some out and send it off and do GC mass spec, which is one, you know, it's mass spectroscopy. Shit. You know, I was an organic chemist and I should spectro. Let me see, mass spectrometry. I'm an idiot. You know, this is one of the reasons why I'm thinking of dropping out a radio because I think I have dementia.

I was an organic chemist, and I couldn't remember mass spectrometry because I've said GC mass spec for so many years. Anyway, that's kind of humiliating. But anyway, we could do G.C. Mass. Speck, gas chromatography, and mass spectrometry on this stuff and see if it actually has C.B. Cannabodial in it. There are other things that we could do. There's nuclear magnetic resonance. There are other analytic chemistry techniques that we can use to determine this stuff. including just finding an antibody to it. And there are tests that you can do that use immunochemistry

to determine whether a specific molecule is present. And try to analyze these things. Buy 10 different brands and see which ones actually have cannabidiol in them and then promote those. And then assume that they continue to have cannabodial in them because some of these may be just re-bottling stuff that they're buying overseas and then selling them. In other words, look, when you buy certain supplements, there is no true guarantee that you're going to get what it says is in there. The FDA has pulled multiple penis supplements off the market because they actually had sildenafel in them.

In other words, they were putting a bunch of herbs together and then they'd crush up some Viagra and toss that in there too. So people would say, wow, this stuff really works. And so the – but they don't go through the rigorous process of FDA control and approval. And the FDA is sort of monitoring these things. thing sort of in a spotty way. You know, they'll pull some stuff off the shelf and check it every once in a while, but it doesn't give you the sort of warm fuzzies that it does when it's, you know, a prescription medication or an over-the-counter FDA-controlled medication.

But anyway, so we'll see. As far as CBD and depression, I looked at cannabidial and depressive. and depression. Here is one study. This is from progress in neuropsychopharmacology. And the article is from 2018. It says antidepressant-like effect induced by cannabodial is dependent on brain serotonin levels.

Well, isn't that interesting since Prozac and other drugs like that also manipulate brain serotonin. levels. This says cannabidial is a compound. It's not really a compound. It's a molecule of cannabis sativa with relevant therapeutic potential in several neuropsychiatric disorders, including depression. CBD treatment has shown significant antidepressant-like effects in different, uh-oh, rodent pre-clinical models. Uh-oh. How, in other words, they've used it in rats. And somehow they figured out that the rats were less depressed.

However, the mechanisms involved in CBD-induced antidepressant effects are still poorly understood. Let's see if we can find a human study. Let me move my iPad out of the way here. Again, I am at PubMed.com. This has, and you can search along with me. I am currently searching the keywords, cannabidial and depression. Let's see here. Not a whole lot.

This is the problem. Novel treatment options in depression and psychosis. We could look at that. Let's look at that one and see if it says anything about cannabidial. Nothing exciting there. So this is the problem. People are touting it for depression online. I have yet to find a good double-blind placebo-controlled human study on cannabidiol in depression.

So, you know, if you know of one or two, and one really won't do because we need to be able to reproduce it. So we need at least two looking at the same thing. I'm still looking, still looking. Let's see what else we have. have here. Is there a role for cannabodial and psychiatry? So anytime there's a question mark, then it's kind of an opinion piece. Um, well, nope. Nope. Nope. Fluorinated cannabodial derivatives enhancement activity and mice models predictive of anxiolytic antidepressant and antipsychotic effects. Again, these are pre-clinical, meaning they've not been tried in humans yet. They're looking at rats and trying to figure out, wow, is there something there? And then they'll bring this maybe to pigs and monkeys and then eventually humans. So I would like to find a human trial on depression. So I can't comment on it. I don't know. I've got here, if you go to Depressionelliance.org,

It says CBD has been found to be effective in the treatment of depression. Well, okay, let's see what their references are, if any. Let's go down to the bottom and look at their references. Okay, WebMD, that great medical journal, 10 natural depression treatments. Okay, these are good. So she asked, she didn't just ask about CBD oil. she asked about natural treatments for depression. There are non-pharmacologic treatments for depression that can be effective.

You want to do this under a psychiatrist or primary care provider's supervision, but getting in a routine makes a big difference and it needs to be an active routine. I know when I had depression and severe panic disorder, staying on my work routine, routine really helped. I had more trouble on the weekends when I didn't have to be somewhere at a certain time. And depression definitely can strip away the structure from your life, so you want to get that structure back and continue to, you know, make yourself do things that you don't want to do. Set some goals for yourself. Make those goals easy to accomplish in the beginning, but make them harder so that you can do more and more things so that you can see that you're doing these things. Exercise has antidepressant effects. Eating healthy, certainly because people can gain weight

or lose a lot of weight. Maintaining a balanced diet when you're depressed can make a big difference and getting enough sleep, which is easier said than done when you're depressed because depression will affect. Most people either have primary insomnia when they are depressed, which I I guess, is actually secondary insomnia if it's caused by the depression. Or they will have hypersomnia and sleep all the time. You're going to, you know, one of the symptoms of depression is apathy or not wanting to do things. So taking on responsibilities while you're depressed will help get you into that, again, into that structure. And not, don't allow yourself to sort of withdraw from life.

You have to, again, you have to force yourself to do this. It was very difficult for me to force myself to go to the lab every day when I was so profoundly screwed up in my head. But it really made a huge difference that I didn't allow myself to be affected by my mental changes. Challenging negative thoughts and checking with your doctor before you use any supplements. And do something new. you're going to be in a rut, push yourself to do something different, go to museums, do things that are uncomfortable so that you can see that you're not going to die by doing them, and that'll make a big difference.

So, but as far as CBD, I can't find any good evidence that it works. It may even do some harm. I just don't know. I don't know. I'll be the first to tell you. I think it makes sense that it needs to be studied because the kind of, you know, because The cannabinoid receptors in the brain are involved in a lot of different functions, and I think we should be studying it for depression.

They're looking at these mouse models if they're positive. In other words, if there's a positive effect, then they'll translate that eventually to human studies, and then we'll know more. I just don't know the answer. Quick question for you. How long does it take for me to get a new body? I know like my hip, for instance. That's not the one I was originally born with.

Cells have died, cells have been replaced. I've gotten a lot bigger, a lot bigger. Anyway, with the exception of your brain cells, I've always heard, never get regenerated. How long does it take for me to get a whole new fresh body? Thank you. Okay. That's a really interesting question. He's right.

So it begs a question, well, what is the person? If you upload your consciousness to a computer, and the computer now has your consciousness in it, and you destroy your body, have you committed murder? Is that still you in there? All these scenarios always drive me crazy, because if I upload my consciousness to a computer, unless the process of doing that erases my consciousness from my body.

Now, there's two people who think I'm me. One in the original body that goes, well, nothing happened. I'm still in this body. And then the other thing that goes, I just woke up inside a computer. And now, and I'm me, their experiences will begin to diverge immediately when that transfer happens. there was that show Hemlock Grove where they were going to transfer this woman's consciousness into a different body. But they didn't kill the original body.

So she was still running around going, well, nothing happened. And I'm still here. I don't want to die. And then the other person was like, well, wait a minute, but it's me. I'm in this other body. It's so crazy. So there are a lot of philosophical. questions. Another one. So Star Trek, you load yourself into a computer, right? And then you send that data to another place and then you're recreated. It's not like a space warp. You're being destroyed on one end and then recreated on the other. Well, what if I just don't recreate you on the other side? Oops. Well, now you're gone. So did I commit murder?

Or, yeah, well, I did. So let's arrest me and take me to trial. Well, just before my trial begins, I just turn the transporter on and recreate you on the other end. And now you're alive. So I didn't commit murder. Why couldn't I, if it's just data, put myself in there and then recreate myself a hundred times on a hundred different planets or a thousand times all on one planet. I'll let you think about that for a minute.

I certainly could do that. It's instant cloning. As a matter of fact, here's the other thing. If you saw the movie, oh, shit, not Star Trek Beyond, the one with Benedict Cumberbatch. Benedict Cumberbatch Star Trek. What was that one called? Shit.

Into darkness. Okay. So at the end of Into Darkness, if you remember, they used blood from, was it from, oh, now, see, I started this story

and I can't remember. But they brought Kirk back from the dead, I think, using Benedict Cumberbatch's blood, if I remember. And that means now they have the cure for death. No one should ever die in a Star Trek thing ever again. But they just completely forgot about that. So because it ruins everything when you come up with an idea like that. The other thing that kind of ruins everything that you have to use a lot of head cannon to get around was in the latest Star Wars movie, which is a really cool scene where Holdo, which was Laura Dern with purple hair, goes into hyperspace next to the first order ship and just blows it to smithereens. Well, they've had hyperspace in every movie since the first one, but no one's ever done.

done that before. So people on Reddit particularly are coming up with different types of head cannon saying, well, you have to do it just a certain way because first you go to light speed and then you go into hyperspace. And of course, when you're in hyperspace, you can't run into anything because you're in a different dimension. So it's got to be done just exactly right. But yeah, okay, I agree with that. Absolutely no reason in a place where you have droids where you couldn't have ships, piloted by droids that just go into hyperspace and kill the Death Star or any other ship. Why are they using blasters? They should be using hyperspace missiles.

Anyway, but it ruins everything if you do that. So that's no fun. So we have to just pretend it didn't happen. So anyway, I don't know. How did I get off on that? Oh, so we're talking about the fresh body. Well, anyway, so your body. that you have right now

is not the same one you were born with because of cell turnover. Your skin is all different. Your GI tract, most of it is different. The brain really doesn't do a lot of turnover, so it's pretty similar, although it has grown and evolved over time as well as you make new synapses and all this stuff.

I'm just reading an article. It says the human body contains 10 trillion individual cells, taking into account all of the specialized tissues, those that regenerate quickly and those that don't, and adults' body cells are likely to be on average between 11 and 15 years old. 11 and 15 years old. So the body you have right now is really no more than about 15 years old.

And all the cells that came before that are gone. It's crazy. So now I remember why I got into the, that tangent because this all is apropos to, say, the Star Trek transporter thing. Who am I? And why am I here? And why am I quoting Ross Perrault's vice presidential candidate for those that are old enough to remember?

Yeah. So, you know, it's kind of like the transporter thing. I destroyed my body. My body that I was born with is mostly destroyed. And yet I have this persistence of memory that says it's me. I've been here the whole time. So from a philosophical standpoint, it's kind of interesting. Hi, Dr. Steve.

My name is Phil from Tampa. Hey, Phil. And I'm calling a two-part question. First, I was curious when you felt that. So over the weekend, I think I tweet. to my knee a little bit. I can hear it popping when I move it sometimes

and it's sore, it feels heavy sometimes. I'm going to the doctor to get a checkout. I hope it's just a random thing, but my question is, at what point do you feel like it's worth it for someone to check something, the difference between something being

sore and something being a problem? And then my second question is, and this is I guess it's more metaphysical, but When do you think people are just destined to live with something, let's say knee pain or back pain or at what point is just consistent or do you just have to deal with it or do you keep trying to fix it either through physical therapy or medication or whatever? That's a cool question. It's just continuing close with the problem. Yeah.

If it bothers you, it's worth investigating. Period. And if it can't be fixed, then you've got to live with it. That's it. It's as simple as that. I have no more philosophical answer or more in-depth answer than that. And that is true of just about every physical malady that we have. I've got a stiff first finger.

I can still play bass and I can still play my synths man. And it just clicks every once in a while. It's not, doesn't bother me enough to warrant investigation. And since I, it can't be fixed, I have to live with it. My neuropathy, on the other hand, was driving me crazy. If you remember from last show, I think I talked about it. I couldn't stand up straight with my eyes closed. I would fall over.

And it was bothering me. So I got it investigated. My neurologist was kind of worthless when it came to actually doing something about it. So I investigated further and found some supplements that had actual scientific data behind it for the palliation and maybe even reversal of peripheral neuropathy, and it actually helped. If you're interested in that, you can go to Dr. Steve.com, upper right-hand corner, click on the link that says for peripheral neuropathy. And it's got a pretty long article talking about all sorts of different things that will make it feel better, but also four or five nutritional supplements that have data that indicate that they may be effective in helping to either ameliorate the symptoms or actually reverse the neuropathy. And I can tell you I can take a shower now and not worry about falling down. so there you go

I don't have a question I'm trying to help Jim and Sam show the head dog in six life I have a tell for the guy that is on the show that he cannot get hard on is natural so I don't know how to call that phone number so I'm getting calls for Jim and Sam now I remember back in the day

and this was maybe 14, 15 years ago when Big Kev and I were sharing the same spot on Saturday nights on the Saturday night virus, and I would get phone calls for him and he would get phone calls for me, and he would shit on my callers. And I would always be very respectful of his callers, of course. There you go. That's the difference between us. why they occur. I don't really have a... Yeah, hey, Dr. Steve.

I had a question for you. I was hoping you might be able to tell me a little bit about polynidal cysts. I have what I think is a pollenidal fist kind of near the bottom of my tailbone kind of up, you know, near the top of my butt cheeks, if you will, kind of inside a bit. I don't know what causes them, why they occur.

I don't really have a sedentary lifestyle. at least I don't think I do. But what's weird is it seems to come and go. It will flare up and, you know, get pretty uncomfortable and annoying. And then it seems to a drain. And then it goes away to what feels like I have a little bit of a scar there. And then it seems to come back. So I'm wondering if the best and only remedy for this is going to be a surgery of some kind.

And if I do have to have a surgery, how invasive is that? and what is the recovery time? Yeah, that's a great question. So pylonidal cysts. Pilo refers to hair. Nitis means a nest. So this is a nest of hairs. That's where it got its name because when they first opened these things up,

they would find a bunch of hairs inside. And it's an abnormal pocket of skin that contains hair follicles that have been driven under the skin. almost always at the cleft of the buttocks at the upper part near the tailbone. And the hypothesis is that hair, they're like extreme ingrown hairs. And the hair punctures the skin and becomes embedded. And then the pylonidyl cyst eventually gets infected. And then you get a painful abscess that drains and it becomes chronic.

and they can be drained, but then they usually come back. Most of the time, it has to be removed surgically to have a definitive solution to this. They're usually occurring young men, and people who sit for prolonged periods of time, particularly truck drivers, are at higher risk. Now, this guy had an active lifestyle. That's fine. Even if you play, let's just say you play video games an hour a day, and you're reclining.

So you're actually, instead of sitting on the isial tuberosity, which is the ass bone, if you're sitting up straight and you put your hand under your butt cheek, you can feel this bone that's actually making contact with the chair. And I'm feeling mine right now. That's what you're supposed to sit on. But there are people who will recline and they actually sit on the sacrum, which is the flat part of the back part of the ass. that, you know, you've got your lumbar spine, which is your lower back, and then as you go down, then you get into the sacral spine, that's the flat part where it starts to brought, spread out in the pelvis in the very back.

And people will recline and kind of lean back and sit on that part of their spine instead of sitting on the buttocks themselves. and that part of the body is thin. The skin there is thin, and you're cutting off some of the circulation to the skin when you do that, and you may be forcing hair follicles under the skin with prolonged day in and day out sitting like that. So you want to make sure that you are sitting straight up in your chair. I'll tell you the perfect chair.

Back in the 70s, we had these things called knee chair. And I think they still have them. Let me Google that real quick. And what they did was you didn't have a back on the chair. You had a front on the chair. In the front on the chair, you would put your knees on. Yeah, there they are. Pro-ergo ergonomic chairs, ergonomic kneeling chair.

Check that out. And it would force your spine into a straight physiologic position. and your weight went on the front of your knees. It wasn't that much weight instead of on your back and it forced you to sit up straight and you will not, well, you'll be at decreased risk of getting a pylonidyl cyst if you use a knee chair instead of a regular chair.

So watch your posture. That may have something to do with it. And then ultimately they will have to do surgery on these if you can't get it under control non-surgically. And even then, sometimes they'll come back if people don't fix their posture. Hi, Dr. Steve.

I'm 54 years old, and recently I had a PSA screening as part of some overall blood work in preparation for my regular annual physical. And my PSA results showed an increase since the last screening I had, which was back in

2015. the levels went from around 1.8 to about 3.25. So I have two questions about this. Along with the results that I viewed online, they include a quote unquote standard range. My current 3.25 value falls within that range, but it's right below the max for the range. So which is more significant?

The absolute value or the delta from the last screening? And my second question is, is from a bit of research, I've seen that there are many factors that can increase TSA levels like infections and things like that. But I also saw that there's some not completely conclusive evidence that recent ejaculation can increase PSA levels.

So I did have relations with my wife the night before my lab work. In fact, probably only about seven hours before the blood draw. Do you have any thoughts on the possibility that that can cause a PSA level increase. And lastly, I should say that my scheduled physical is in a few days, and it will include a digital exam, which I've had regularly for about 15 years, with no evidence of enlarged prostate or blood or anything like that.

So thanks. Oh, sorry. I was kidding. The digital rectal exam will tell you as much as just about, any of the other things that you've mentioned, the PSA being, okay, so he's talking about the prostateic specific antigen, and people, long-time listeners of the show will know that we've talked about prostate specific antigen when we're talking about female ejaculation, because female ejaculation, if it has prostateic specific antigen in it, cannot just be urine.

It must be derived from prostate-like tissue in the female body. So that's where you've heard us talking about that before. And besides, we're talking about prostate screening. So people, we used to do these PSAs. And when they got above four, we would start biopsying people. And we found that that may have been causing more harm than good. In other words, we had more false positives than we had true positives. And doing those biopsies can, you know, cause significant adverse events.

I had my other very good friend in town who's an attorney had a big giant prostate and a mildly elevated PSA. And they did a biopsy on him and he got septic afterward because the biopsy, of course, they did. do it by shoving a probe up your ass, and of course they prep it and stuff, and then they stick a needle through the back part of the rectum into the prostate. It's the easiest way to get to it. And even the best prep every once in a while will fail, and you'll introduce bacteria into the prostate. You get a raging prostateitis. If it's raging prostate, if it's raging enough, it can work its way out into the bloodstream, and the next thing you know, you're septic. Now, this is, you know, I don't know what the rate is.

It's very low, but it does happen. So they were causing some harm when they were doing it. And, you know, determining the accuracy of PSA testing has been very difficult. And so they look at sensitivity and specificity in these tests. Traditional cutoff for an abnormal PSA level has been four nanograms per milliliter. and the American Cancer Society looked at the literature assessing PSA performance. And, you know, remember we're talking about these meta-analyses where they pool all the data and then try to get a bigger study with more power out of it.

The estimated sensitivity of PSA cutoff was 21%. That's terrible for detecting any prostate cancer and 51% a little bit better for detecting high-grade cancers. using a cutoff of three where you're turning it down. So you say, wow, now we're going to catch more. We're going to cast a wider net, increase the sensitivity to 32 and 68%. And the specificity was 91% for a PSA cutoff of four, which specificity talks about if it's negative when you're healthy. sensitivity is positive when you have disease. So what you're kind of more interested in, though, is the positive predictive value.

In other words, what are the proportion of men with an elevated PSA who actually have prostate cancer? And the positive predictive value for PSA greater than 4 is about 30%. So, in other words, if you have a PSA greater than four, 70% of those people will not have prostate cancer. All right. So how do we improve this? You can do serial PSA measurements, and you measure it over and over again and see if it's increasing over time. You can do this thing called a PSA velocity. we were very excited about that at one time

that if you get an increase in greater than about 0.75 nanogram per milliliter per year. In other words, if you went from 3 to 3.75 in a year, we thought, ooh, now that's very exciting. That increases the sensitivity and specificity of this test. And what they looked at were very small, a very small group of people, it was only 18 cancer cases.

So when they did a subsequent analysis, they found really there wasn't a lot of advantage to doing the PSA velocity. So there's this thing called the free PSA. And a separate meta-analysis of free PSA noted considerable variability in free PSA assays, specimen handling, cutoffs, and patient populations. the authors concluded more research was necessary. So there's all these other things that we can do. Just, you know what?

Just talk to your urologists. They stay up on this. And, you know, there's just no consensus on using any of the PSA modifications. None of them has been shown in clinical trials to reduce the number of unnecessary biopsy or improve clinical outcomes. And the total PSA cutoff of four has still been the accepted standard because it balances the trade-off between missing important cancers at a curable stage and avoiding the detection of insignificant disease

and subjecting men to unnecessary prostate biopsies. So I still, so yours is under four. So, you know, I'd talk to your urologist, but I don't think they're going to pursue that. They will, however, monitor you over time since your PSA increased and they'll check it again in probably six months to a year and see you now if it increases and gets above four, then they may subject you to a biopsy at that point. And hopefully it'll turn out okay.

So keep us in the loop on that one. All right. Hey, Dr. Steve, Phil here again. Question, can X-rays mess up your flora? And my mother and I were talking, just wondering about that. He can't. Let me know.

Appreciate it. Thank you. That is a fascinating question. So what he's asking is, can the radiation from just getting an abdominal x-ray mess up your gut flora? Now, I'm not aware of any study that's ever shown that a plain abdominal x-ray, which has very little ionizing radiation in it anymore. You know, back in Wrenchen's day, it was insane

how much radiation you would get trying to make a film. But the sensors have become more and more sophisticated, increasingly sensitive, so they've ratcheted down the dose of radiation that you get from a plain x-ray.

Now, that's not the case in radiation oncology, where they're hitting you in doses that are measured in rads, or centigrade, which is the new terminology for, or the new SI unit for radiation. And there are some studies that show that probiotics may help prevent the damage from external beam radiation to the stump or to the abdominal cavity.

So I am, these are, again, are rat studies. And probiotics, this is, I'm just looking at a study from PubMed. Probiotics are considered safe microbial supplements containing fermented foods such as yogurt, fermented milk, and juice. They were reported to restore normal intestinal microflora, eliminate pathogenic enteric bacteria, and reinforce the intestinal barrier. Let me see. They're affected for travelers' diarrhea, infantile diarrhea, irritable bowel syndrome. And they evaluated the effects of various kinds of probiotics against radiation-induced diarrhea. Most of them showed beneficial effects of probiotics for the incidence of the diarrhea.

One clinical study which reported a negative result for anti-diarrieal effect revealed that the probiotics could delay the onset time of the loose stool. So they seem to be improving diarrhea caused by radiation enteritis. And so therefore, I mean, that implies that the radiation, yes, can affect the intestinal flora if probiotics can correct that. But this is high dose radiation to the abdominal cavity, not the same thing as a plane x-ray. So not aware of any effects of that. Dr. Steve, I just left you a question about shingles and whether or not they can be fatal. Okay, I've only got a minute left. Rarely shingles can cause encephalitis, in other words, a brain infection, and rarely people can die from that.

But that is extremely rare. 30 years, I've never seen it. I've read maybe one case report on that. Second question, follow-up. My wife is 51, and she has had a kidney transplant as well as a pancreas transplant. Can she get shingricks? Okay, so shingricks is the new shingles vaccine. It is an adjuvant-killed vaccine.

And I don't believe there's a contraindication to people who have had transplants. As a matter of fact, they may want you to have it, but you need to talk to your transplant coordinator about that. don't take my advice on that. Talk to them first. And let me know what they say. All right. Thanks always go to Dr. Scott. Who isn't here today? Lady Diagnosis also not here. My wife Tacey and everybody else has ever been involved in the show. We can't forget Rob Sprantz, Bob Kelly, Greg Hughes, Anthony Coos, Jim Norton, Jim Norton, Travis Tepp, Eric Nagel, Roland Campos, Sam Roberts, Pat Duffy, Dennis Falcone, Ron Bennington, Fez Watley, and Jim McClure, who's support of this show has never gone on a appreciate it. 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 McClure's pleasure or Lewis Johnson's pleasure. 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. 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.