Weird Medicine: The Podcast - 341 - Girls on Phlegm

Episode Date: December 19, 2018

Dr Steve discusses hemorrhoids, leg edema, asthma during long-distance running, head lice, nipple piercings, high testosterone, and aspirin use for primary prevention. 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 some touch yet. Yo-ho-ho-ho-ho. Yeah, me garreted. I've got diphtheria crushing my esophagus. I've got Tobolabovir, stripping from my nose. I've got the leprosy of the heart valve, exacerbating my impetable woes. I want to take my brain now.

blasts 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. 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, and this is a show for people who have never listened to a medical show on the radio or on the internet.

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Don't act on anything you hear on this show without talking it over with your doctor, nurse practitioner, physician, physician, assistant, pharmacist, chiropractor, acupunctrists, yoga, master, physical therapist, or whatever. Okay, very good. Don't forget to check out stuff. Dot, Dr. Steve.com for all your holiday shopping, there's still time. Just, you go to stuff. Dot, Dr. Steve.com, and just at the top, there's a banner.

You can click through there, or you can scroll down and see items that we've talked about on the show before. and buy them directly from there. But it's really got a click-through site. You can click through to Amazon. Don't forget, Tweakeda Audio.com. There may be still time to get some stocking stuffers. Some of the best earbuds for the price on the market

and the best customer service anywhere. Tweakedaio.com use offer code fluid. That's FLUID. For 33% off your order, that's a huge deal. Offer code fluid at tweakedaio.com. Don't forget Dr. Scott's website at Simply Herbal net and let me talk to you just for a second about premium.com. So if you had a subscription to the premium service and you haven't signed up in the last

week or two, you don't have it anymore. And the reason for that was, if you remember, you know, a couple weeks ago I went through a, I'm going to get rid of everything, so I got rid of everything. And then that included the premium service. So if you don't mind, go back to premium.com and sign back up again. And if we get up above a certain threshold, I'll put something special on there for you guys. And I do appreciate it. And it gives you access to all the archives going back to the beginning.

So premium.com. So, oh, I guess this is our holiday edition. And we're going to talk about aspirin and primary prevention and head lice and all kinds of stuff. So very holiday. I just don't plan well. But after however many years we've been doing this, I guess you're well aware of that. Anyway, yeah, Dr. Scott's not here. So F.HM.

P.A. John hadn't been here for years. So F.M. Hope you all enjoyed the show last week when we did something. different. We had Dave Ray Cecil in. You can check him out at Dave Rayceasel.com or, you know, you can listen to it on demand. It was awesome. And I was an audio engineer before I went to medical school, and I was quite pleased with the quality of the recording that I did on him, given that it was all live in studio. So I was quite pleased with myself. But anyway, I wasn't so pleased with the levels. I couldn't.

never could get Dave to, you know, he's one of those music guys. They like to get far back and yell into the microphone. It was, so we had to do some normalization, and it was still every once in a while, his levels when he was speaking were low, but God, when he was playing and singing, it was awesome. So, anyway, check it out. You can also go to my YouTube channel, where I have his songs indexed, and that's at YouTube com slash lobster johnson so um anyway it's L-O-B-S-T-A Johnson all one word okay uh check out Dr. Scott's website at simplyerbils.net and don't forget to listen to our podcast wherever

you listen to podcasts and let's answer some medical questions don't take advice from some asshole on the radio exactly right thank you my friend well all right hey for the podcast please hey doctor steve i'm a healthy non he wanted this for the podcast that's okay we'll we'll do it on both overweight 55 year old guy with borderline cholesterol readings at about 200 total no heart attacks i exercise i'm not fat uh i was taking low dose aspirin for years on my own hoping that it will help my artery stay clear. Then I read a lot of stuff saying we shouldn't do this for various reasons,

so I stopped taking it. Now I'm getting a little freaked out that my tubes are getting all gunked up. So if low dose aspirin helps prevent clotting and keep your arteries from getting all gunked up, isn't that a good preventative measure for a lot of people, assuming you don't have any other issues with it? Thanks. Yeah, if it did that, it would be. The only things that really prevent arteries from getting gunked up, you know, chronically are good genetics.

And that's something you can't do anything about. And diet, exercise, and keeping your cholesterol down and not smoking. So the fourth way that you can even reverse some clots without, Cardiologists going in and doing them, you know, with a balloon or a drug alluting stint would be, you know, with a statin drug. And I'm glad Dr. Scott didn't hear because I'd have to deal with him, you know, roll in his eyes when I say that. Statins are the only drug that have been, you know, continuously demonstrated to reduce plaque accumulation. Notice I say the only drug. there are other ways to do it

and to maybe even have plaque regression once these plaques start problem with statins are multi-fold one you have to treat about 90 people to prevent one heart attack so the benefit to the individual is going to be pretty small

the benefit to society is great if you could prevent one out of every 90 heart attacks given the number of heart attacks in this country that's a non-trivial number. But you can work out the numbers from the package insert. Maybe we'll do that sometime as a special episode. Just do the math and show you how it works. But you take the absolute risk and you take the inverse of the absolute benefit

and that'll give you the number needed to treat. So I can just kind of run you through it. We've done this a couple of maybe once or twice before, but it's been a long time. So you hear this, oh, you know, people who take statins 35% reduction in heart attacks, right, or whatever the number is. It doesn't matter. So let me show you how that could be constructed that would have minimal impact on the individual. So let's take a drug. It doesn't have to be a statin, just any drug.

We're going to call it drug A. And it has some benefit for people. And let's just say, we'll just throw this out here. Hypothetically, it prevents heart attack. It doesn't matter. It could prevent prostate cancer, colon cancer, whatever. So you take a thousand people and you give them drug A. You take another thousand people and you give them a placebo, whatever, you know, placebo A is.

And a placebo should have no effect, although we know the placebo effect is so powerful that we have to subtract it from every study that we do. so we watch these people over time and let's say out of these thousand people 10 in the placebo group had the bad event a heart attack for example and in the active treatment group only seven had a heart attack well that's a 30% reduction you can say well there's a 30% reduction in heart attacks, but you can notice that the vast majority of people, 990 people, even in the placebo group, did not have a heart attack. So the absolute risk is going to be a lot smaller, right? Or the absolute benefit.

You can look at it a couple of ways. So there will be a – since the denominator is the same, we can just subtract these. So you had 10 in the placebo group. You had seven. in the treatment group so the absolute benefit was three people out of a thousand okay now if you take that three out of a thousand and inverse invert it you're getting a thousand people well three people you know um were prevented from having a heart attack so you would in this particular group of numbers you would have to treat a thousand divided by three three 33 people before you prevent a

one heart attack. Okay. Does that make sense? So that is the number needed to treat in this hypothetical, you know, fantasy world trial that we just did. So when you do that with the stat numbers, it's around 90 for primary prevention. And then there's secondary prevention. That secondary prevention is where you've had a heart attack.

You're trying to prevent another one. But we're talking right now about preventing a heart attack. primarily. So this guy's calling in. He's been taking aspirin. So the first thing I would have anybody do that's interested in this is to go just Google Framingham cardiac risk. And there's a calculator. So let's say this guy said his cholesterol was around 200. So let's say he's 45. And he's a male. And let's say he is a smoker. We'll just make this even worse. And his total cholesterol is 200. We have no idea what his HDL cholesterol is,

so I'll say it's 50. That's his good, so-called good cholesterol. And I can't remember if he said his blood pressure is okay. Let's say it's normal. So 120. And let me listen to the beginning of his phone call again and see, let me, let's just get all

this right. Hey, for the podcast, please. Okay. Hey, Dr. Steve. I'm a healthy, non-overweight 55-year-old guy. Oh, 55. With borderline cholesterol readings at about 200 total, no heart attacks. I exercise.

I'm not fat. I was taking low-dose. Okay, so let's change his age to 55. He didn't say anything about his blood pressure. So let's just say it's normal, that he's not taking blood pressure medicine because he didn't say anything about it. His 10-year risk of heart attack is 11.6. That's if he's smoking.

Now, let's just change it to non-smoking and watch what happens. It drops down to 5.9. If you're, I say it at the end of every show, quit smoking. It doubles your risk of heart attack. Okay. Again, this is a relative risk. But he has a 5.9% risk if he's a non-smoker. So if he is a smoker, it's 11.6, non-smoker, 5.9.

The average 10-year risk of heart attack, or death in his age group is 13%. So, you know, he's in pretty good shape. So let's look. There's this thing called the U.S. Preventative Services Task Force. And you can go to it, it just put in U.S. Preventative Services Task Force. Dot org. And this was their final recommendation statement, but I'm going to tell you when I tell you this,

it may not be up to date, okay, because they do lag behind the, data for a good reason. So they recommend adults aged 50 to 59 years, that's this guy, with a greater than 10% 10-year cardiovascular risk. So you've got to do these Framingham things. If he's a non-smoker, he's 5.9, he doesn't even fall into this group. But it says the USPSTF recommends initiating low-dose aspirin therapy for primary prevention, in other words, preventing the first heart attack.

And to prevent colorectal cancer. Isn't that weird? Aspirin, you know, people say, well, why are you giving morphine for trouble breathing? Well, why do we give aspirin, you know, for arthritis, but it also prevents colon cancer. There's two totally different things. These medications have more than one effect. So in adults age 50 to 59 years, we have a 10% or greater 10-year cardiovascular risk. who are not at increased risk for bleeding because that's the problem with aspirin, of course,

is it increases your risk of bleeding and have a life expectancy of at least 10 years and are willing to take it for at least 10 years. So you've got to meet all these criteria. If he's a non-smoker, he doesn't even meet the first criterion, which is he's got to have a greater than 10-year cardiovascular risk. If you're age 60 to 69 years like I am with a greater than 10, well, let's do mine. Hellfire. This is my show.

I'm 63. A male non-smoker. My total cholesterol, okay, and my systolic blood pressure last time, I checked it, was a little elevated at 140. Now, if I put in my cholesterol numbers on a statin where my total cholesterol was 120, my risk is 7.4, but I can't take the statin anymore. So it was 200 last time I checked. My HDL cholesterol was 60. So I've got a 9.9% risk. If my HDL cholesterol was 50, it'd be 11.6. So let's say it's greater than 10. We'll just, let's go with that. So the decision to initiate low dose aspirin use for primary prevention of cardiovascular disease and colorectal cancer in adults age 60 to 69 years,

who have a 10% or greater 10-year cardiovascular risk, let's say I do, should be an individual one. Persons who are not at increased risk for bleeding have a life expectancy of 10 years, I hope so, and are willing to take low-dose aspirin for 10 years or more likely to benefit. Okay, so I probably should take it. Persons who place a higher value on the potential benefits than the potential harms may choose to initiate low-dose aspirin. Well, okay. So that's the USPST. Well, there have been some new studies done on aspirin, and, you know, we've known for decades that aspirin can prevent recurrent heart attacks and strokes, which, as we said, is secondary prevention. There was a lot of mixed data, and the USPSTF went back and forth on this stuff.

In September, there is this thing called the Ascend trial, ASC, E-N-D, if you want to look it up. looked at aspirin for primary prevention and 15,000 patients with diabetes. So these are people at high risk for cardiovascular disease. And there was a modest benefit in terms of reduction of cardiovascular events. There was a fairly significant increase in the risk for major hamorrhage. So that was strike one. I'm getting this from Medscape. Strike two was the arrived study, a randomized trial of these are large studies,

13,000 patients with moderate cardiovascular risk, that'd be me. Aspirin had no effect on all-caused death or the cardiovascular outcome. So they may have had heart attacks, but didn't change whether they did well or didn't do well. And it didn't change the rate of dying from all causes. That's the thing we want, is we really want to see things stop us from dying, you know, or at least give us a better quality of life. Then strike three came in the form of a trio of papers published in the New England Journal of Medicine, examining the results of the previous trials. And this Esprit trial was a huge study enrolling 20,000 individuals in the United States and Australia.

It was targeted at people over 70, and these people would be expected to be at higher risk for cardiovascular disease or death. And the primary outcome, remember we've talked a bunch on the show about primary outcomes. You know, we have secondary outcomes, like, for example, for statins, a secondary outcome or endpoint would be lowering your LDL. Well, you've got to prove that every time you lower the LDL, you're decreasing heart attack and stroke because that's what we're really interested in, right? if I had a medication that tripled someone's bad cholesterol but decreased the rate of heart attack and stroke by 30 percent, I would give them that. So, LDL is, you know, it's a marker. It's not a perfect marker.

Well, the real marker of whether a statin is doing you any good is does it prevent you from having a debilitating heart attack? Anyway. So the primary outcome was composite of death. dementia or disability, which, so they incorporated what most of us would consider quality of life into this. And they were trying to capture the fact that in the older population, simply living longer, is not always the only goal. So let's see what they said. Let's go to page two.

Aspirin had no effect on the primary outcome. But then they got weirder looking at all-cause mortality. The rate was higher in the aspirin than the placebo group. Now, why would that be? well, they may have had more hemorrhagic strokes and stuff. Now, the absolute mortality rates were really low. Again, we just talked about relative risk versus absolute risk, relative benefit versus absolute benefit. For every 100 patients you treat with aspirin, you'll see one extra death over a five-year period.

You know, so anyway, so they published their second paper in the journal looking at the causes of death. And the findings were driven by, holy crap, cancer, the rate of new cancer diagnosis and death from cancer was higher among those taking aspirin compared with those on placebo. And this runs counter to much of what we know. And this may be a factitious result. remember death wasn't the primary outcome in this trial and you know because this was a secondary outcome it needs to be studied separately as as the primary outcome and then we'll see this this may just be a statistical anomaly particularly because we know for a fact that aspirin helps prevent colorectal cancer and people that are at high risk for colorectal cancer so and again one study doesn't

prove anything. But it's very interesting. So I suspect the USPSTF may amend their recommendations in the future. We'll see. For now, if you're taking aspirin, don't stop it. If you're not taking aspirin, don't start it on your own. Talk to your primary care. All right. Let's move on. The other day you told us that you were going to be canceling the podcast and the radio show, and that made me really, really sad. That entire week, I was not able to produce an erection. Whatever. No matter how many fucking back goes, I was sucking on the hand in my hand.

Now you've flipped the script and you're telling us that the shit's staying around. And I swear to God, Dr. Steve, I haven't had an erection. last this long and forever. It's been going on two weeks now, and the thing hasn't gone down. You're saying me too much, Dr. Steve. What do I do? Thanks. We'll get a blow it, my friend.

That's the answer to that. It's very easy. Very simple. Empty out those seminal vesicles. Thank you for the kind words. That's where I am really, I'm so glad. that we were able to figure all this out that I am getting new. I'm going to completely redo the studio for the long term.

So we're going to be in this for a while. Assuming that Sirius XM will let us come back and Riotcast will let us come back. But that's the plan. So redoing the studio, hopefully we'll be able to do some live shows over the next year until our contract is up in October, and then it'll just be up to Jim McClure at that point if he wants us to continue. So I hope we do because we really like being here

and we like being on riot cast. So, all right. Boy, now I'm pretty sure my five-year-old has head life. Got little eggs and little bugs in there. dust and big bugs and big eggs. Oh, my goodness. But anyway, what's the best way going about addressing this situation? It's the best to just go to the pharmacy, get the over-the-counter craft, or is there

something better I should do, something that I should know about, or should I take the pediatrician? Yeah, okay. You can, you can treat this yourself. There are a headlice or just tiny insects. They feed on blood from the scalp. It's crazy. And we have a medical name for it. It's called pediculosis capitis.

And for some reason, kids get it more than adults do. And it's usually because of direct transfer. So you see these kids at nap time in kindergarten, and they're all laying with their heads next to each other. The lice can easily jump from one place to another and start breeding. It's absolutely nothing to do with. with hygiene or the living environment, these dang kids just get it

and they just pass it from kid to kid. But there are over-the-counter medications and prescription medications and also some sort of more natural ways to do it if you don't want your kid exposed to chemicals. You may notice this, your kid may have an itchy scalp. You may notice the lice. You may notice the lice eggs.

What these things do is they'll plant their eggs on the hair shaft and those aren't the lice those are called knits and they're actually little egg sacks and um um you know the the louse life cycle is that these darn things will hatch after eight or nine days so if you kill all the lice but don't kill the eggs it'll come back eight or nine days later so um you know and they can only jump i'm sorry they can only crawl they can't jump. And so anyway, all right. So what do we do about it? You can go to your pharmacy and pick up a bunch of different things. There's a thing called Nix. It's Promethrin. It's a you know, it's a chemical that kills these things. They have other ones with additives.

they'll increase the toxicity, and it really does increase the toxicity for the lice, but not for your kid, in theory. There's a bunch of prescription versions. There's Ivermectin. There's malathion, lindane. That one has a risk of some severe side effects, and so it's not really used anymore unless everything else doesn't work. So you can get all those.

Talk to the pharmacist or your pediatrician about it. If you're interested in not using a medication, you can do an alternative home treatment. One is called wet combing. You use this thing called a knit comb. This is very tedious, but can be successful if you get all the nits and the lice. You know, a lot of the research is kind of inconclusive on this one, but, you know, for ages we did this before we had the chemicals. you lubricate the hair like with hair conditioner and then you comb the entire head from scalp to the end of the hair at least twice and should be repeated every three to four days for several

weeks. This is like, you know, we talked about for nail fungus, you can use VIX vapor rub, but you've got to use it every day, twice a day for 48 weeks. So it's kind of a pain. But there are essential oils that you can use. tea tree oil, anise oil. The problem with this is these oils are often meant for use and nebulizers and, you know, to smell them. And they're not regulated by the FDA.

So I am a little leery of this if you've got somebody that you feel as reliable. You still have to use the knit. home, though. And then you can smother the damn things. We've seen people use mayonnaise, olive oil, a petroleum jelly. I'm not a big fan of the petroleum jelly. If it gets inhaled or gets into the kids respiratory tract, it can actually cause a petroleum type of pneumonia. But mayonnaise, you plop it on there and you glob it on their hair so that it basically smothered. There's the thing. Now, remember, lice don't have lungs. They respire through holes in their joints and stuff. That's how they get oxygen in. So you have to smother them for a long, long time. And so a lot of people do this and then put a shower cap on. And then after 15 minutes, then you comb the lice through. The problem of this is this has been actually studied in the laboratory. And only petroleum jelly was effective. in killing a significant number of lice.

And I've already told you I'm not a big fan of that. Very little clinical evidence that this stuff works. So hot air, stuff like that. You know, the other, so I got to be honest with you, if it were my kid, I would use the over-the-counter rid for this and just follow the instructions. I've never seen any studies showing any significant toxicity with those medications. and you can just buy them over the counter, talk to the pharmacist about it. Now, if they're not on a scalp and feeding,

these eggs really don't survive. The chance of them surviving on household items is really small. However, if you've been sleeping on a pillow and there's lice in them and you're going to sleep every day, that's within the time they can still live. So we do recommend that you clean personal items that you might touch, particularly pillow cases, and anything in the previous two days and wash them in hot water and clean all your hair care items. It could be combs because if there's a knit in there and the stupid thing hatches, you know,

it probably takes more than one. I don't think these things can reproduce by parthenogenesis, meaning, you know, you know, asexual reproduction, but they certainly, if you get three or four of these things or three or four hundred of them on your comb and wash it through your hair, after you've gone to all this trouble, you can get it again. And, you know, give the floor and the upholstered furniture a good vacuuming, and you should be okay. I've seen people go bonkers after getting head lice where they just strip the beds and they

wash everything and they wash all these clothes in boiling water and then they're washing the upholstery, and you don't have to go that crazy. Just remember these things. After 24 hours of not feeding on your horrible scalp, they will die. Okay? So keep that in mind. All right. Well, hello?

Well, that's not a good phone call. Let's try that again. Hey, Dr. Steve. A question for you about hemorrhoids. I've had a fissure for a few years. It was actually diagnosed about a year ago. The proctologist had put me on a suppository that I think had zinc and a few other ingredients like, I think, Shea Butter.

He also gave me a clean to apply twice a day that was hydrochorazone and also a, I guess, a pain reliever in that. It didn't work at shrinking the fissure. It hasn't really gotten any worse or better over the past year. I was just wondering what, I guess, procedures are available if, you know, topical creams aren't doing the trick. Thanks. Yeah, now it's a great question.

So topical creams, a lot of times, will attempt to decrease inflammation. that's the purpose of the hydrochortosone and may try to shrink these things using, you know, vasoconstriction, decreasing the blood flow to these areas. But when they don't go away and you still got them, particularly, look, if you have a thrombost external hemorrhoid, these are, they look like a grape stuck on your rectum or on your anus. And they're intensely painful. And basically what it is is a hemorrhoid that has gotten a blood clot in it and it expands because blood can get in.

Now it can't get out and the thing just starts to blow up. And those vessels don't like that feeling of stretching. So you'll get an intense pain signal being sent to your brain. Those need to be surgically excised. So basically, I've gone through the procedure before since GVAC is no longer here. I can't gross him out with this. I'll just tell you all very quickly, you just numb it up and you cut an oval in it and extract the clot and then pack it with gauze or pack the ass crack with gauze. And most of the time that will completely relieve the pain and then that hemorrhoid will involute over time and just scar down and go away.

Now, if you have multiple hemorrhoids, you see these people sometimes it looks like, I don't know, like a cluster of grapes hanging out of their ass, but they're droopy grapes. It's not an attractive site. Those folks can have surgery, and you would have a hemorrhoideectomy. And there are some internal hemorrhoids that are amenable to being removed. with a little scope that they, this is kind of a cool thing. So the proctologist, and thank God for them, and somebody wants to do this job, will visualize the hemorrhoid, and if it's on a stalk, they can use a tube that's got a tube within a tube,

and it's got a rubber band up the end of it. So one tube, of course, if it's inside the other tube, has got a smaller caliber, and then it's protruding, let's say a quarter of an inch. and then you have the larger tube, you know, back a quarter of an inch. And then on that piece that's sticking out, you put a rubber band. And now you thread these long, really thin forceps through all the way through this tube. And when you find that hemorrhoid, you grab it with the forceps and pull it into the tube, right?

And then you push the outer tube over the inner tube, and then that will force the rubber band down. and it will now grab the base of the hemorrhoid and it will just cut off the blood supply to it and it will die. So in about four to five days you will defecate out a dead hemorrhoid. And this usually is painless and no bleeding and usually no problems. If they get it a little bit too much mucus membrane, sometimes you can't get an injury of the rectum that can cause inflammation, may even cause a fistula over time.

I've seen that maybe once in my career. I don't know what the incidence is, but talk to the proctologist about it if they're talking about doing this to you. Okay. All right. Well, all right. Hi, could someone get a very high reading on testosterone, something like 2,000 on total? And the pre-testosterone can be really high also? Can it be like a false reading?

Can the lab either mess it up when it seems like everything else on the blood work is pretty accurate? Or if you've been taking something like methylpredazone a week before, he took, you know, the 21 tablets over a six-day span and stopped about a week before. Could that mess it up, or could there be some underlying thing? Okay. So he's asking about elevated testosterone. We talk about low testosterone all the time on the show.

So he's got a hypothetical case of a person with a testosterone level of 2,000 with the normal being 350 to 850, depending on the lab. So what could cause this? The first thing you do when you get a very surprising result in a lab test is just to repeat the damn thing because it's unlikely if there's a lab error or, you know, just something transient that it will be that high again. So you repeat it. Let's say they repeat it and it's again 2000. Now they've got to look into this because they're can't. And the person to dope this out would most likely be an endocrinologist.

Endocrinologists are medical doctors who specialize in problems of glands. And this could be a lot of things. And one surprising thing that it could be is hyperthyroidism. There is a case of a 48-year-old guy who had a markedly elevated testosterone. They did a CT scan of his abdomen and pelvis, and pituitary didn't show any tumors that could be secreting testosterone or tumors that could be secreting other hormones that could cause you to produce elevated testosterone. But what they did find was his thyroid was completely out of whack. His thyroid stimulating hormone, if you remember that from a few episodes back was markedly low, meaning that his testosterone. was high, sorry, that his thyroid hormone was high.

So they treated his hyperthyroidism, and his testosterone level came back to normal again. Now, this is the kind of thing that really an endocrinologist is best at dealing with. Because the other things that it could be are so-called adenomas of the adrenal glands. Those are benign, quote-unquote, tumors that, you know, can secrete either to Testosterone or precursors, they get turned into testosterone, and then there can be adenomas of the pituitary gland, which would secrete hormones that would increase the testicles' propensity to make testosterone end up with an elevated testosterone level. Or there could be tumors that produce testosterone itself. So I would not fart around with this. I'm assuming if you know that your testosterone, you know, in this hypothetical case, that person got their testosterone checked for a reason.

And when it was that elevated, the primary care doc about crap their drawers and immediately called an endocrinologist and got that person in to get seen. All right. Hey, Dr. Stee, I was just listening to your podcast that you aired on December 1st, I want to say. I'm a week behind. Anyway, you were talking about nipple piercings. Okay, yeah, so let me get you caught up on this. We were just talking about nipple piercings, how, number one, it seems very uncomfortable. And number two, does it enhance it?

anything for the woman or for the guy. I know people that have them and they love them and I'm just want to know what it is because if I'm, you know, if I'm, you know, nuzzling on a nipple, I'm not sure, you know, getting metal in my mouth and clicking against my teeth is really sexy, but that's me. I'm just a weirdo and I'm old and I'm old school, so I want to know what these kids today are talking about. So here you go. Might be weird.

I'm not really sure. But anyway, you said something about what? wanted to hear from other people about nipple pearsons. Well, I had mine done for probably a year and a half, I want to say, give or take a few months. Anyway, I had them done, but I ended up having to take them out. But while I had them in, personally, I like them. um i liked when someone well for the sake of this you can say it my current husband would

you know like them or whatever i personally thought it felt better than nothing at all um and i asked someone so well you know does it feel word for you or you know like do you not like it or does it aggravate you. He said he likes it, too. He would prefer it. So, yeah, that's... And yet, you had them removed. I want to know that story. You need to call back. About it, and I hope y'all have a very Merry Christmas. Yeah. All right. Well, you too. And happy whatever holiday you happen to be celebrating when you're listening to this. Yeah, thanks for calling. That's interesting. I haven't had the opportunity to do anything with a nipple that's been pierced.

So I just have no experience in this, and I'm very interested in what people get out of it. Anyway, so she said it made her feel better, and her husband said he liked it better, and she had them removed anyway. So there's a story in there somewhere. Hey, Steve, my name is Matt, and I am overweight. person and I am getting some swelling in my ankles, lower leg and my ankles get a little puffy like above where my shoe kind of cuts that off. It just kind of swells up as basically just seems like it's just fluid. And I'm just sort of wondering if you could kind of go into what causes that and what

the hell am I going to do? All right, so swelling ankles can be caused by a lot of things. In otherwise healthy people, very often, it's bad veins, and that can be genetic. And so you look at your mother, father, grandparents, see if they had big legs, too. The hydrodynamics of the veins and the legs are such that, you know, there's very little back pressure to push blood back to the heart. So those veins coming up your leg that you can see have valves in them. The big ones do anyway. And so blood can only go in one direction.

But you've got the back pressure that there is from blood being pushed out of the heart through the aorta to the little arteries and then the capillaries and then through the capillary bed and then reconstituting back into a, you know, a vein on the other end of the. at trying to get blood back to the heart, there are competing pressures. One is if you're standing, there is the pull of gravity. So there's the force of gravity that is pulling the blood down. And then the body is through these valves and contracting muscles and stuff and the little back pressure that there is trying to push blood back up. And what that ends up producing is tension on the vein wall. and it pushes it out, right?

So you've got something pushing down, something pushing up. You're going to have tension on the wall, pushing the, trying to distend the vein. And that's all well and good as long as the vein can maintain its integrity. And when it can't, what happens is the vein wall expands to the point where those valves can no longer, you know, keep blood from flowing backwards, and the blood will rush backward. and will distend the vein causing a varicose vein. And over time, the body will re-equilibrate. In other words, the flow will continue up to the heart.

It just won't be helped by the veins valves. And because there's so much pressure on the vein wall, water and other clear fluids, usually clear, can sort of leach out between these sort of sorts of. stretch to the max vein walls that are just cells, right? So the little junctures are not big enough to let a red blood cell through, but they're big enough to let water molecules through, and you'll get puffy legs. So that's one way.

Venus insufficiency would be the term we would use in that regard. But there's one clue that you gave me, and I have nothing else to go on other than you said you were over. overweight. Now, overweight people often can have sleep apnea from obstructive sleep apnea. And if that goes on long enough, they can get puffy legs as well due to increased pressures in the right heart trying to pump blood to the lungs to get oxygenated. Now, why does that happen? Well, there's this mechanism in the lung where if you get a piece of lung that's no longer, getting blood flow, it will just shut down. It will constrict the vessels in that area to shunt blood around there because you don't want to try to send blood to an area of the lung that's no longer functioning. So there's a survival mechanism.

You get something in your lung or for whatever reason that part of the lung is no longer functioning. The blood vessels will constrict to shunt blood around that area. and go to other parts of the lung that are functioning. Well, what the hell happens when the whole lung isn't functioning properly? Then it's still going to constrict those vessels, but now there's no place to shunt the blood, too. And this occurs in sleep apnea because you're not breathing. And so your oxygen level is decreasing the oxygen level in the alveoli,

you know, the little pockets, the little balloon-like. pockets in the lung that transmit oxygen from the outside to the inside and carbon dioxide from the inside to the outside. The oxygen level will decrease. The lungs interpret that as, uh-oh, this part of the lung isn't working, but it happens over the whole lung. And so when you constrict the blood vessels to the whole lung, now as the right heart is trying to pump blood, you know, venous blood to the lung.

To get oxygenated, it has increased pressure. It's got to pump harder. And when it has to pump harder, it starts backing up. And when it backs up, what happens? You get increased pressure in those veins that are trying to supply this backed up heart, and you'll get puffy legs again. It's called right heart failure or caused by pulmonary hypertension. So, in other words, high blood pressure in the pulmonary artery.

taken to the extreme, we'll call this Pickwickian syndrome. And these are folks that need a sleep study ASAP and they need their obstructive sleep apnea treated right now. And it is to a certain extent reversible if you don't let it go too long. You sound pretty young on the phone. I just get checked. Make sure that that's not, you know, if it's just venous insufficiency, it's fine. but you know you need to lose weight anyway it may give you an impetus to do that and in the meantime you can do the sleep's apnea treatment would be CPAP or bi-pap and if you lose the weight and you want to try going off of it you have another sleep study done it's no big deal but that could significantly prolong your life if that's what it is so i like talking about the physiology of that so that's why i went into in-depth analysis of this situation i don't know for a at At all, that's what you have, but I would get this checked.

Any swelling of the legs, aka peripheral edema, warrants a trip to your health care provider when you first notice it. Okay, dope. All right. Hi, Dr. Steve. I've got a question about phlegm. I ran a 5K last Sunday morning, and it was about 45, 50 degrees out. And I woke up, I had a cup of tea and some water, and during the race, I was running at full speed. But I had a lot of phlegm that I've never experienced this before.

And I can't narrow it down. I'm not ill. You know, no indications like that. I had, the only thing I can think of is that I had a little bit of dairy the night before, but I thought that it would have been processed by the morning. So I'm just, you know, coughing and spinning up. through the whole race. But I was wondering, where does the phlegm come from?

Is it in my lungs? Is it in my digestive system? Is it anything I can take to cut that down when I am running at full speed? I just wonder about your thoughts. I couldn't find anything online to help me out. Okay, yeah. It's a great question. So there's a lot of reasons that you can get flam when you're running,

and particularly if you're running in cold weather, because you're just, you know, your mouth breathing and your mucus membranes are drying out, and they're trying to fix that, and so they just produce more mucus. So it may simply be that. However, you could also have exercised-induced asthma, and sometimes that can just come up out of nowhere. You could have had a cold that day. Could have been allergens in the air that were bucking you, and it'll never happen again. Could have just been the time of year.

and you ran into a cloud of some antigens that your body didn't like and it produced an allergic reaction if this happens a lot and that's what it is, sometimes running on a nondrosy and histamine is the way to go. But get checked and make sure you don't have exercise-induced asthma from your primary because that's something that's easy to treat and should be treated. Okay, well, look, I'm out of time. Talk about phlegm. I had to stop recording this show about six times.

because I was having coughing fits and stuff. But anyway, thanks for hanging in there with me. We can't forget, Rob Sprintz, Bob Kelly, Greg Hughes, Anthony Coomia, Jim Norton, Travis Teft, Eric Nagel, Roland Campos, Hugh Jassol, hello, hello, Bob from Florida, Sam Roberts, Pat Duffy, Dennis Falcone, Eton, Twatts, Fez Watley, Ron Bennington, and the rest of the crew who's, early support of this show has never gone on, appreciate it, and I do so love Riley Martin and miss him greatly. Listen to our Sirius XM show on the Faction Talk channel,

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