Weird Medicine: The Podcast - 359 - Pudend of the World

Episode Date: May 8, 2019

Mick Jagger's heart valve Propofol Nerve damage in the taint Stool DNA vs colonoscopy Smoking cessation PLEASE VISIT: stuff.doctorsteve.com simplyherbals.net noom.doctorsteve.com freshly.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 need to search in, yo-ho-ho-ho-ho, yeah, me garreted. I've got diphtheria crushing my esophagus. I've got Tobolivide stripping from my nose. I've got the leprosy of the heart bow, exacerbating my impetable woes. I want to take my brain now, blast with my blood. wave, an ultrasonic, agographic, and a pulsating shave, I want to magic pills, all 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 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 broadcast radio, now a podcast. I'm Dr. Steve with my little pal, Dr. Scott. a traditional Chinese medical practitioner who keeps the alternative medicine assholes at bay. Hello, Dr. Scott. Hey, Dr. Steve. And Lady Diagnosis, she who will do most anything for a glass of expensive wine.

Hello, Lady Diagnosis. Hello, Dr. Steve. And he who buys her, said expensive wine, it's Dr. X, everyone. Hey, Dr. Steve. This is a show for people who'd never listen to a medical show on the radio or the internet. If you've got a question, you're embarrassed to take to your regular medical provider. If you can't find an answer anywhere else, give us a call. 347-766-4-3-3-23.

That's 347. Pooh-Hid. Follow us on Twitter at Weird Medicine and at Lady Diagnosis or at D.R. Scott W.M. And visit our website at Dr. Steve.com for podcast, medical news and stuff you can buy or go to our new merchandise store at CafePress.com slash Weird Medicine. Most importantly, we are not your medical providers. Take everything you hear with a grain of salt. Don't act on anything you hear on the show without talking it over with your doctor,

nurse practitioner, physician, assistant, pharmacist, chiropractor, acupunctrists, yoga master, physical therapist, clinical laboratory scientist, or whatever. All right. Well, welcome back, everybody. It's great to see you next week. We will be able to take phone calls again. Woo-hoo. Yay.

Yay. Oh, I hit the wrong button. Oh, that sounds terrible. Okay, let's do this. There we go. Let's do it again. Very excited. And we're going to bring.

back, the time-honored bit, Ask a Country Hick. We're going to have my mother-in-law in here answering questions from the listener. So if you have a question for Big Joe, call 347-76-6-4-3-23 or 347-Poohead. And you can leave a voicemail for Big Joe. We'll play it to her. She'll answer it, and then we'll, you know, cut up her response. And she's agreed to this?

Yeah. Well, I mean, she doesn't have any choice. She did a good one today I've got my little file that's shit Joanne says And every time she In my mother-in-law, Dr. X, you've never met her But she is a classic malaprop

And she'll often get The first letter of a word right And then the number of syllables right But the rest is just nonsense Not in close So for example She thinks that the cheese that you put in in lasagna is

retardo cheese. And she's very proud of herself that she made this lasagna with retardo cheese. She's not trying to be funny. She thinks that's what it is. She's not being ugly. She bought my wife some wine

and was very nice. She's a very nice person. Tacey, I bought you some wine and some of that Monique wine. It was Merlot. Close. And her favorite coffee. drink?

Flupy. A flupy. She sounds like my own mother, so I'm really, yeah. The struggle is real. Well, the flupy story just cracks me out because she's standing in line. My wife is there with her. They're standing in line at McDonald's, and a guy behind my mother-in-law is talking to his friend, and he says, now what's that new coffee drink they get?

Now, Joanne orders one every single day, and so she's going to school this guy. So she turns around and goes, it's called a floopy. and I order one every day So can you imagine She's going through the line every day going I'll have me one of them floopies And here comes that floopy lady And so we had her on here

And we tried to get her to say it again She said oh I know that ain't right It's a floppy So And she did that with another one of my favorite stories People who've listened to this show a lot have heard this But we were at the beach On the 4th of July

And you know how it crowded it is At a lot of beaches on the 4th of July So there's two lines of people With their umbrellas and stuff And then my mother-in-law is behind us with a botchy ball set And you know botchy ball, right? It's a little white ball you throw it And then you have the colored balls

And you try to throw them and roll them Try to get them the closest And so she's getting the fiddling with this thing And she wants to see if the boys want to play it And she yells Hang on a second Let me see if I can do this right She yells

boys, y'all want to play that bunghole game. And I'm like, what? I turn around, I go, what did you just say? And she goes, that bunghole game. And I'm like, shut the fuck up. That's not what it's called. It's not called bunghole. And everyone looked.

Of course, there's just hundreds of people down there looking at this lady yelling bunghole at the top of her lungs. So we had her in the studio, and we did a game called, Are you smarter than a sixth grader, I think? And it was Liam, was the sixth grader, my son. And we tried to get her to say it again. So I said, what is the name of the game that you use at the beach where you throw a white ball and you follow it with different colored balls? And she said, well, I know it ain't bunghole. I've learned it since then.

It's blueby ball. So that's my mother-in-law. The reason I'm bringing this up is she had a good one today. I walk up to her car and she was at Perkins and she had the window down and she's talking to the pharmacist at CVS and she's wanting to get her prescription and she keeps going, it's hits that nozzle spray. And they were like, what? I don't think we have anything like that. No, it's that nozzle spray for my allergy. So I guess it's for squirting up your nozzle.

So anyway, flat A. She's a keeper. She's something. I'll tell you that. She has something else again. Nozzles spray. We had this patient one time in an ER when I was a resident, and when she came in,

she always wanted to get her Dilly Dads, her Dillaudid. Oh, Dillie Dads. That's a good one. I need me a prescription for those Dillie Dads. So Daly Dads? I have not heard that one. I hear Dallada a lot. And when I hear Dahlada and Roxy's,

I know they're sort of into drug, you know, street drug culture, but Dilly Dads. That's actually what I have it in the EMR as, is for my personal prescription for that. What I, you know, give to patients is dilly dads. That's great. That's cute. Well, all right.

Number one thing, don't take advice from some asshole on the radio. Could not be more true today. You had a story, though, didn't she, Scott? I did. You know, so one of our favorite people, Nick Jagger, you know, had the heart problem recently. And I was just reading on here that as the story goes, he just had gotten done walking his dogs and went in and collapsed on his couch and his wife found him and um oh geez according to his brother um it's a heart valve issue his father or their father had died of the same exact issue

and it's um the um it's actually the same issue that killed a another famous rocker um when he was 50 years old so it looks like they did so what did he have uh they didn't say exactly which valve was, but it was a heart valve issue, but he had a surgery called a day. Didn't he have an aortic valve replacement? Yes, presumably it was his aortic valve. I hope it was. Dr. X, you work on these cases all the time. You want to talk a little bit about? Sure. You know, for years, if you had aortic valve disease, you had to have a median synonymy. They cut your breastbone in half, went down to the heart, cut the heart open,

cut the valve out, put a new valve either a mechanically made stainless steel rocker valve or more recently they would use pig valves. You know, kind of gave you a new feeling for bacon. Well, yeah, the pig valves

will last about 10 years. Yes. So that's... And you don't have to be on the blood thinners to be anti-coagulated if you've got the pig valve. With the mechanical valve, you have to have that anti-coagulation to keep it from forming

clots on it and you're having a stroke. We should get Alexa to tell us how many actuations there are in 10 years on that valve on that pig valve before it fails. Alexa, what is 70 times 60? 70 times 60

is 4,200. So what's for, Alexa, what's 4,200 times, well, wait a minute. Wait, so it's 70 a minute and 60 minutes. So, okay. Hang on. Sorry, Alexa.

Alexa, what's 4,000 times 24? Alexa, what's 4,000 times 24? 4,000 times 24 is 96,000. Alexa, what's 96,000 times 365 times 10? 96,000? times 365 times 10 is 350.4 million. There you go. So that pig valve will do, well, I know, but it's no fun.

When you're punching it on your stupid phone. Right. It's why we have a Alexa. And it drives everybody crazy that has an Alexa in their house because it all activates. And now across the country, these Alexas are going off answering the same question. But anyway. So, I already forgot the number. So it's 390, 360 million times that this pig valve will work before it fails.

That's incredible. That is. You know, we have very few mechanical things that will do something 300 million times without failing. But anyway, so go ahead. So anyway, that was the old-fashioned version. Open your chest, take the valve out, put a new valve either mechanical or bio-equivalent valve in. Currently what they're doing a lot is called the Tavar, which means trans-aortic valve replacement, and they go into your groin, right where your leg joins your body.

You find the femoral artery, thread a catheter up, your aorta. Yes, that's the kind of music we play as well. Very sensuous since we're in the groin region. thread the catheter up and cross the aortic valve typically they put a balloon through across that and kind of burst that valve open

because the aortic stenosis is what you typically have and stenosis meaning too tight and then they deploy a new mechanical valve down into there which has basically barbs on one side of it so that when they put it in place. It hooks onto the tissue that they, you know, they've opened the valve up. It hooks onto the tissue. So the old valve is just still there. It's still there.

Now, well, this thing, is the old valve just sort of wrapped around the body of this new valve? Well, you know, the valves are actually the valve leaflets are actually attached to kind of a fibrous band, the annulus. And so this valve goes in. And actually, has kind of a stint around it to keep those valve leaflet. The native ones pushed back out of the way so they don't occlude the new valve

or get into the way. So they do have a stint sheath around it and then the valve is in there and amazingly the patients are able to go home usually the next day. That's insane. When used to they would stay in four or five, six days

post-op. Be on the ventilator and have a cracked open chest. And we don't even, some of these valves, the mitral valve more so, we don't even put them to sleep. We just sedate them heavily for the procedure. So, it is. It's like having a colonoscopy or something. It's crazy. Yes.

It's crazy. Wow. Yeah, you know, and well, we can talk about this. So, propofol, and you actually, I'm guessing, don't do a whole lot of colonoscopies and that sort of outpatient stuff because you work. Oh, we do. Oh, you do? We also do some outpatient. Oh, you do?

Oh, you do? Okay. Yes. Okay. So for colonoscopies, what are you guys using these days? Propheaval. Almost exclusively. It's great. It doesn't cause nausea.

The patient's five minutes after we've quick. giving it to them they're awake yeah it's unbelievable they can have some coffee and put the clothes on and go home i i do my colonoscopies without anesthesia um because i i kind of you're sadist well i am in the sense that now i have to look up at the screen and see my giant hairy ass crack as the scope is getting closer and closer to it before they actually insert it and that to me makes that's what makes me physically ill the um the the the colonoscopy itself really isn't that uncomfortable and you can just pull up your drawers and expel a little gas and go back to work afterward and I don't have to take a day off or two days off which is what I have to do because

the anesthesia misses me up where you're going to say I would I would prefer to take the day off yeah if someone's putting a large two but my butt I want drugs and I want to be all I hear you I totally advocate the anesthesia free colonoscopy though but um I had an eGD So, you know, this is a scope where they go in your mouth and down into your stomach. And I have a really heightened gag reflex, so I have to do the propoval for that. That's how he says. And it's incredible how this stuff works. I mean, I'm laying on my side, and they say, well, we're going to give you this medicine.

I'm like, this isn't doing anything. And then the next thing I know, I'm kind of blinking going, when are they going to start? And it's like they're done. That's amazing. So tell us a little bit. I know people are fascinated by this. What are we actually doing with propofal and drugs like that to make us sort of jump forward in time in that way? What you're actually doing is part of the brain that is responsible for us being awake is the reticular activating system.

At least this is what we think it does. It's hard to do a study on this. But the reticular activating system, is what makes us be awake or asleep and we're putting that activating system to sleep and so therefore we go to sleep

and then when the drug is metabolized so quickly the half-life is in a range of minutes that's why we have to continually give it while we're doing that then your reticular activating system wakes up and you're awake and

it's insane as well where am I you're not numb you're just asleep You're just asleep. Yes. Yeah, with no awareness of what's going on around you whatsoever. It's amazing. Now, how do you keep – so if you're using propofal in the outpatient setting where you're not intubating somebody, you're not controlling their airway, is there any risk of respiratory depression with this drug? There is always that risk of respiratory depression, and as a matter of fact, that's what Michael Jackson.

and into trouble is he had a non-anesthesia provider. Yeah, that was going to be my next question. What do you think about using magic milk in the home for as an insomnia aid? You got something wrong with you if you can't go to sleep. Yeah, yeah. I could curl up in the corner and go to sleep and not have a problem. Sure. Don't need any propofoil.

So, yes, there is a risk. We give you supplemental oxygen through a binaasal cannula underneath your nose. we are trained in maintaining your airway sometimes we have to kind of pull your jaw up and we are also trained in how much to give to keep someone where they need to be and we have monitors on you the entire time the two important things your UKG your pulse oxymetry which is shining a light through your finger and telling us what percent of your hemoglobin is oxygenated versus deoxygenated and then the other key thing is we never leave the room while we're giving it.

Unlike Michael Jackson's cardiologist who left the room to go do whatever. Oh, is that right? We never leave the room when we're giving the medication so that we're there to take care of the problems that occur. So allegedly, Michael Jackson, was he not, were they not monitoring him?

No, apparently. Well, for a while to hang in the drip and just hoping for the best. Well, I think he went out to use the restroom and call his girlfriend or something the stories, you know, you hear a lot of different stories. None of us were there. Apparently, he was watching him the whole time except when he had to walk out of the room. I see.

You know, it's like I tell people when I'm putting them to sleep in, you know, back in the 60s, the hippies committed overdoses. Well, all they did was put themselves to sleep with heroin or whatever, and no one was there to breathe for them. You could give the same amount of medication in the operating room. And you'd be fine. And as long as an anesthesia care provider is there with you, breathing for you when you needed it, you would be fine. You would not overdose. The drugs themselves are not poisonous.

They're not going to kill you. It's the stopping breathing that kills you. Yeah, yeah. Not breathing is not compatible with life. That's a key. Bad for you health. Yeah, that's interesting. Hey, may I ask you a question real quick, though?

I've wondered about the propofol too. About how long can you do a surgery on someone if you're using propophil is the main anesthetic. I mean, are you limited, like to shorter procedures or can you know? No. Like total hips and knees? Yes, we do it for total hips and knees when we give someone a spinal to make them numb and then keep them sedated with that. Even sometimes when they're doing neurosurgical cases and they have to have neuromonitoring, so they're monitoring the electrical activity of the spine so that they're not, so they can tell if they're getting too close or damaging something. We're not allowed to use our volatile anesthetics during those cases, so we have to do that entire case using propophile to keep.

someone asleep. So we give them literally, to go to sleep, you get about 20 cc's for an induction dose. We will give them 2,000 Cc's, 2,500 C Cs during the course of one of those cases to put them to sleep and keep them there

for the time that they're having their surgery. So yeah, we give them gallons. Wow. That's wild. That's wild. Where are you going? Now you know everything. There we go. Well, let's take a couple phone calls here. I'm fading fast. Sorry about that. I am out

of it today. I only got about three hours of sleep last night, so I'm a little bit close. You didn't have any propofol? No, I didn't have any propofoil. Dr. Steve, hi, this is Dave. My question is about cliff bars and protein bars and those kinds of things. Why are they sold

in the pharmacy section instead of just in the granola section? I eat a lot of them because I'm... It's a great question. It's just marketing. It's really marketing. It's just the label. You used to come on our show and just say those things are just candy bars. They really are just candy bars.

Some of them, you know, there's so much sugar and stuff in them. But they call it a supplement or anything like that, then they can put it over in the pharmacy side. And it's all. And charge twice as much. Exactly. Yeah. And be real careful, too, if you're doing a low-carb diet, you know, we talked about ketogenic diets. I guess that was last show, right?

The first time I did one, I started craving sweets, and I went to GNC, and they had these chocolate. bars that were zero carbs and I got one and it tasted just like you know Hershey's Kiss or you know Nestle chocolate bar and so I ate like two of them

just right thin and there and halfway home I had to stop at like red lobster or something liquid shit screaming out of my ass because the way they sweeten those is with this stuff called sorbitol

And sorbitol isn't digested. It's a sugar, and it hits the taste buds just like sugar, but you can't digest it. And so since it's not digested, it gets into your GI tract, and then it's a particle. And what happens when you get a bunch of particles in your GI tract, it's going to attract water in through osmosis. And it's just like getting an anima from above. You get a shart. Yeah, you get a shard. Drive fast.

It was quite interesting. and not expected, not at all expected. All right. Oh, my. Hey, Dr. Steve. This is Joshua Harrington. I'm listening to your last podcast, and I kind of hope you hands for this question on that podcast.

But you were talking about five-touble Cs in pudendal nerves. I've been struggling with a pudendal nerve block. It's on the right side of my hip for the last four or five years now. I had a derotation osteotomy on my right leg in 2015, and then three months later, the hip doc did a, oh, my goodness, he scoped the hip joint and rebuilt that socket, and we were really hoping that that would help take care of all the pain, but the mechanics of the hip are fine, but the dendal nerve pain is just god awful. It constantly feels like I'm setting my asshole is sitting on a hot branding iron. Now, my dick works for the most part. It's very hard for me to pee. I have to be very, very relaxed, and it constantly feels like I always have to piss.

Now, another one that you probably know is once you go take a shit, once you get through for the next 20, 30 minutes, it still feels like you have the shit. and it has taken me a while to figure out that's not me needing the shit I'm not fixing the shit myself I'm done so I can get off the pot and leave but it's just I've had Pugendal blocks I've had

back cottle injections I let's see I had an S2 S3 block that just made my dick not work at all you need to fuck out for about a week and I'm just I don't want them to cut on me because I have heard that the surgery on that.

It's not worth having to cut that gluteous muscle and come back from that. So have you heard of pudendal nerve injuries occurring during hip surgery? Oh, yeah. Yes, it is possible. It's in that same region. And they do some manual manipulation. Yeah, when they start flaying. Yeah.

Oh, I mean, if you ever seen. You can YouTube some of these hip surgeries, and it's real meatball surgery. Did he say what approach they did? Was it anterior or lateral approach, maybe? But you know what? I didn't hear him say anterior versus lateral. He just, I didn't either. But, you know, we see a lot of these cases, you know, post-surgical pain cases.

And this is one of the worst ones because getting to the pudendal nerve is a beast. Well, it runs from the back of the pelvis to the base of the penis or vagina, and it branches off into other nerves at that point. sends messages to the brain from the genitals, anus, and other nearby body parts. So, you know, this guy's he says his anus feels like it's on fire. So he's got sort of a

pudendal neuralgia. Right. Oh, man. And it's a tough one. No, go ahead. No, I was going to say, we were talking about it in the context of bicycle riding. Yeah. And that I recommend, and I know you guys are going on a long bicycle ride,

I recommend those pedendal nerve sparing bicycle seats. Because Because, you know, there's nothing worse than just having an – even if it just causes burning and itching and numbness of the penis, I mean, that's a big deal. Right. Yeah, he's got – but, you know, any time those neuropathies they have after big surgeries like that, I mean, that's the worst things that we see. I mean, you know, those chronic regional pain syndrome kind of things and the RSDs and, you know, that's a hard – because I've treated pudendal nerve pain before and sometimes good, sometimes bad. But, I mean... Well, that pedendal nerve block, too, can be diagnostic.

If they know that they got the pedendal nerve, and a lot of times this will be an anesthesiology pain clinic or... Yeah, pain clinic or a neurologist if they're skilled in that. And then they'll numb it. And then if the pain goes away... You know you're on the right track. At least you know, that makes the diagnosis. But you know what?

If they're talking about doing a... Having to go in and cut part of his glute, so they almost had to go in from lateral hip, I guess. I would think so, yes. I would, he may not have any other option. I think... Just a release. Yeah, the release, you know, the fascial release,

maybe another surgery, but shit, that may be the only option. Yes. Honestly, you know, because even, you know, medications don't treat that neuralgia or neuropathy too well. What do you think, Dr. X? Well, it sounds like the same thing is like a carpal tunnel release that he's, or the older nerve transposition that they do for the arm. I have that. The nerve has...

scar tissue has formed around that nerve track that it goes through and it's just constantly irritating that nerve. Physical therapy might help. You know? May it make it a hell a lot worse too. Especially if he starts doing any kind of strengthening, stretching

stuff. If it is scarred, and there's shit, man, it can make it be a fucking worse. Yeah, if it's scarred, you may be right. I'm looking at this that would be my not dendal neuralia thing. It just says physical therapy relaxes and stretches the muscles at the lower end of the pelvis, known as the pelvic floor.

And it may be some simple... This can ease pressure that may irritate the peddendal nerve. Gentle, yen-style yoga, possibly. Yeah. Yeah, you need... We can let lady diagnosis get hold on in and see if that else. She can do a pudental nerve renalise. Pudendal nerve massage.

I would do that for you. I'd like one of those. For science. We used to have a... Oh, God, how can I tell this, I guess I can tell it. 35 years ago, the emergency room, when you would check in, it would say patient states, and then the clerk would write something in, right? And one of my favorites was patient states, patient hit on head by Plastic Santa at Walmart.

So that was a good one. But one of them came in and said, patient states wants one of Dr. Bird's internal treatments. So God knows what the family was doing. in there. All right. Don't ask. First time it worked for about 34 months.

The second time... Hey, Dr. Steve, it is J. Fred from Twitter. So, my question is with the colonoscopy, is the Kolo Guard as good, or will it replace the colonoscopy? First of all.

Can we do this question? No, we have not done this. I take Enchantics, trying to quit smoking twice. The first time it worked for about three, four months. months. The second time, it didn't work at all. It ended up making me sick to my stomach, and I couldn't even finish taking it. So would it be even worth it to try the third time to take it? Because I've literally tried everything to quit smoking. The only thing I have not

tried is the magnets on your ear. Otherwise, I've done the gum, the lozenges, hypnosis, chantics, well-butrin, everything. I've done everything. Okay. Well, let's talk about the Kola Guard first. The gold standard for screening for colon cancer right now is still colonoscopy. Colagard was approved in 2014. It's a stool DNA screening test for colorectal cancer. And the Centers for Medicare and Medicaid Services, so that's CMS, that's the big federal government payer,

are proposing national coverage for the test as part of their review program. So we're going to, you know, I don't know the numbers. Oh, wait, I have sensitivity and specificity. Okay, here we go. Sensitivity of Coligard. So that means it would be positive in disease was 92.3% overall and 94% for the earliest and most curable standard cases on a par with colonoscopy. That's not bad. That's not bad.

The sensitivity of fecal blood testing is very low. detection rates for polyps with high-grade dysplasia, in other words, pre-cancer stuff, was 69.2% with Colomagard versus, let me see, fecal immunochemical test, 46%. And it doesn't say for colonoscopy. So, yeah, that's not bad. It's not bad.

That's pretty good. Especially if you're high risk, I think they suggest you do that, at least initially. It's a little bit less. invasive than your colonoscopy. Well, you could certainly, I don't know how much Coligard costs, but I'm assuming it's less than a colonoscopy. One would think.

But, of course, then they're affecting, you know, jobs. Yeah. It's one less anesthesia and one less procedure by the GI guy. Well, the only problem I have is they state on the commercials that if it doesn't work for a certain

familial types of colon cancer, so... The higher risk people, maybe they're missing. Yes. I don't know. Yeah, let's see here. I think getting a good peek at it's a good thing. Colonoscopies detect 95% of all colorectal cancers

and advanced pre-cancerous polyps. Colagard, on the other hand, has no visual component. Instead, tests DNA for stool samples for the presence of cancerous or precancerous cells. to date, studies have shown Coligard detects 92% of colorectal cancers and only 42% of pre-cancerous polyps. And that makes sense because they don't have the quote-unquote cancer DNA yet. So you're able to detect cancer, but what we'd really like to be able to do is detect pre-cancer. And the best way still to do that is colonoscopy.

You know, I have no financial interest in people. getting colonoscopies are very little financial interest anyway. I don't have a financial interest. As a medical student and as a resident, the number of collectomies that we did at the VA and the other centers that I trained at were just astronomical. We did several a week and gave people colostomy bags and all that kind of stuff. And I don't see one of those happen maybe three or four times. a year anymore in my practice.

So screening colonoscopy is good for you. And that's one thing. Say what you want about the Affordable Care Act. It made colonoscopy is a lot easier to get for screening because part of the Affordable Care Act was to mandate screening, preventative screening tests. And colonoscopy fits that criteria. I remember when I was having some symptoms and my gastroenterologist said, well, We'll just call it screening because it'll be easier to get it covered than if, you know, we're doing it for abdominal pain.

Yeah. So, there you go. Good stuff. All right. Good. What else we got? Nothing. None.

Hell with all of you all. Hell with you. Well, Dr. X, it was great having you in studio again. Thanks for inviting me back. Having someone knowledgeable in here instead of me just. Besides just me. Thanks always. Go to Dr. Scott and Lady Diagnosis.

We can't forget Rob Sprantz, Bob Kelly, Greg Hughes, Anthony Coomia, Jim Norton, Travis Teft, Lewis Johnson, Paul Ophcharsky. Oh, you know what? Hey, wait a minute. What, Dr. Steve? We didn't talk about Dr. Scott's website. That's true. Simplyherbales.net. Simplyherballs.

You've got to go to simplyerbils.net and check out his herbal nasal spray. It's actually quite incredible. and it's my favorite nasal spray. It's a buffered saline. It's got some peppermine oil in it for anti-inflammatory properties, and it really opens up your nose, lets you clean out all those antigens and stuff, and it proves my symptoms very significantly.

Don't forget stuff.com.com. Stuff.com.com for all your Amazon needs. And tweaked audio.com, offer code fluid, for 33% off the best earbuds for the price on the market. And the best customer service anywhere, go to noom. Dottersteve.com. If you want to lose weight with me, get 20% off and two free weeks so you can try it out, noon.

Dot,doctrsteve.com. And if you want fresh prepared meals that make eating right super easy, you can use my link to get six dinners for $39 for two weeks. That's $20 off each week. Give it a try and let me know what you think. That's freshly. dot dr steve.com and then if you want archives of this show

go to premium.com and for a buck 99 a month you can get access to all of our past shows and premium content such as it is all right very good okay listen to our serious xm show on the faction talk channel series xm channel 103 saturdays at 8 p.m. Eastern Sunday at 5 p.m. Eastern on demand

and other times at jim mcclure's pleasure many thanks for our listeners whose voicemail and topic ideas make this job very easy go to our website site 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.