Weird Medicine: The Podcast - 374 - Influenza, Tetanus, and Trucker Food

Episode Date: September 11, 2019

A teacher wonders how to time the flu vaccine for maximal effectiveness, a trucker wonders how to eat healthy on the road, a pharmacist says some wacky stuff, and everyone wonders about vaping safety. stuff.doctorsteve.com (for all your online shopping needs!) simplyherbals.net (Dr Scott’s nasal rinse is here!) noom.doctorsteve.com (lose weight, gain you-know-what) tweakedaudio.com offer code “FLUID” (best CS anywhere) premium.doctorsteve.com (all this can be yours!) Learn more about your ad choices. Visit podcastchoices.com/adchoices

You're listening to Weird Medicine with Dr. Steve on the Riotcast Network, riotcast.com. I need to touch it. Yo-ho-ho-ho-ho. Yeah, me garreted. I've got diphtheria crushing my esophagus. I've got Zabola fives dripping from my nose. I've got the leprosy of the heart valve, exacerbating my incredible woes. I want to take my brain now.

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You can click on it. It's 30 bucks. That includes shipping. and you get a 32 gig hard drive or thumb drive and there's only 16 bit or mega, shoot, what am I talking about, 16 gigs of content on the hard drive so you get extra 16 gigs you can use for whatever you want. So it's a good deal. Anyway, check that out at Dr.steve.com. So somebody emailed me. You know, I have this thing about medical journalism.

Somebody emailed me a thing and this was a Facebook post, which is even one. worse. So you have, you know, peer-reviewed medical journals at the top of the list and you have medical journalism somewhere. And then you have Facebook posts where somebody was saying, oh, if you're going to get up and avoid your horrible bladder in the middle of the night, make sure you sit there for three minutes before you get up because you could die. And it was like, what in the hell is this from? Well, I finally found the article that this is from. Now, this is actually a WebMD synopsis because this article hadn't even been published yet. People take these things that are presented.

They've not gone through peer review. They're just presenting them at conferences, and then people take this down and then publish it as gospel, and it is not. But anyway, men and women who have to get up two or more times a night to urinate appear to be at increased risk of dead. researchers say, appear to be at increased risk of death. Now, what is that? Half percent, one percent, 20 percent? It's 20 percent I want to know about it. The increased risk of mortality was seen in all age groups,

20 to 49-year-olds, 50 to 64-year-olds, and 65-to-90-year-olds. In other words, 20 to 90. So a 70-year gap, or span, says, Varant-Cupilian, Ph.D., research science, scientist at the New England Research Institute in Watertown, Massachusetts. Nocturia, okay, nocturia is just a fancy way of getting up in the middle of the night to piss. Defined in this study is having to urinate two or more times a night, so I don't have nocturia. Once a week I have to get up in the middle of the night. Is a predictor of mortality, and surprisingly more so in relatively younger men and women rather than in the elderly.

Well, this makes sense. Remember, causation does not, or a correlation does not equal causation. So it's not the fact that they're getting up and falling down and hitting their heads and dying. This is apparently a predictor for increased risk of all forms of mortality. And that kind of makes sense. If you're a young person, you're having to get up to piss three and four times a night. you probably have diabetes and untreated diabetes because those people have what we call polyurea where they have to urinate all the time because the body is trying to get rid of all this

sugar that's in that's filtering out in the kidneys or they have some other problem because that's not normal to be getting up more than two times a night when you are a 20-year-old. Now, in older adults, falls and fractures that occur when people get up to the bathroom in the middle of the night may account for some may account for some of the increase in mortality they're not sure so that internet post you know was taking that small fraction of people and their small increased risk and they're not wrong they're not wrong that when you get to be my age your autonomic nervous system doesn't work as well as you as it should so let's just talk a little bit about why people faint when they get up you you think of your body

is kind of being this adynamic thing, that things don't change. Stuff is changing all the time. And when you're laying down, your blood vessels dilate a little bit to decrease the resistance to flow. And so because the heart is not having to pump against gravity. It's just pumping horizontally, right?

So the blood pressure at the head and the feet are pretty close to being the same, or at least the amount of flow. Now, when you stand up, you've got gravity pulling blood out of your head because it's trying to pull everything in your body toward the center of the earth. And therefore, those blood vessels have to constrict,

the blood vessels in the lower part of the body, particularly have to constrict, to increase the flow going to the brain. Because if they don't, you're going to faint. So you get these people that fall, you know, get up and they run to the bathroom and halfway there, they start feeling, uh-oh, I'm feeling faint, and then they fall and hit their head. Maybe they die. And those people who are getting into my age group, you know, 60 and older, start to notice this more and more. The other day, I was just at dinner and I thought I was going to freaking faint.

It's because my autonomic nervous system is not regulating the blood pressure to my brain as efficiently as it, did when I was 18. So in those cases, those people are recommended to stand up from a sitting position, if they've been sitting for a long time, and just stand there for a second. Hold on to the chair. And if you start feeling faint, you can sit back down. If after about 30 seconds you're okay, then you can maybe start walking, maybe a minute. These guys on this Facebook post were recommending three minutes.

I think that's excessive. but, you know, it's different for each person. So that part's right. So, but they're saying may occur. So obviously they didn't make any conclusions about that. In the study, Coppellian and colleagues mine data gathered during a large national health survey. Oh, the old fishing expedition. We've talked about these kinds of studies before that fishing expeditions are terrible ways to do science.

They're cool to catch fish. So if you want to find out things that are interesting to study later than do a fishing expedition. So that's what they did. This was a large national health survey looking at lots of different things, apparently, and then they wanted to determine the relationship of noctuary to mortality. Analysees were conducted on a sample of 15,98 men and women aged 20 and older. And they assessed nocturia by asking the question, how many times a night? you usually get up to urinate, parenthesis, pass water.

So I guess some people don't know what the word urinate means. The researchers found that over a nine-year period, men aged 20 to 40, who woke up two or more times a night to urinate, had a 2.5-fold increase of dying. So now, how many people are actually dying in that group? So this is a relative risk of 2.5 times. if the odds of someone dying in that group is 2%, then you're talking about, you know, a 6%.

Is that, would it be 6%? No, 4, it would be 5%. So it would be 5% instead of 2%. Now, I mean, that's a significant increase, but the chances are still 95% that you're not going to die. And if I gave you those odds and sent you to Vegas, you would take those odds and you'd bet everything on black. Women aged 20 to 29 with Noctuary had a 10% increase of mortality,

but that could have been due to chance. So in other words, it was not statistically significant. So instead of 250%, it was 10%. This again indicates that maybe these men had a problem with their prostate. And if you have a problem with your prostate when you're that young, There's something going on. You need to get it checked. A man aged 50 to 64 with noctuary had a 60% increased risk of dying, et cetera, et cetera.

So now when you got up to 90, you had a 32% increased risk because everybody has nocturie when you get up to 90. They did say that they took into account other factors that can affect mortality, including age, other medical conditions, stuff like that. So what we can take from this. is not very much. This was a fishing expedition. Now we need to do a prospective trial, as we've talked about multiple times in the past,

looking at just this one thing and trying to see if there are other risk factors involved, if diabetes, heart disease, congestive heart failure, those kinds of things. They don't know if treatment can affect the risk of mortality because it's probably not the fact that they're getting up that's causing them to die. So treating that underlying problem, though, may help them be more healthy.

The caveat, the very last paragraph, instead of saying this in the beginning so you can just skip it all together, is the study was presented at a medical conference. The findings should be considered preliminary as they have not yet undergone peer review in which outside experts scrutinized the data prior to publication in a medical journal has not even been published yet. So if you see this one, just take it with a grain of salt. But I do think if you are between 20 and 40, particularly, and you're getting up to piss more than two times a night, that should be reported to your primary care provider. No question about that. I don't have a problem with that at all.

Just don't freak out that you're going to die. All right. Okay. Let's take some phone calls. Number one thing. Don't take advice from some asshole on the radio. Thank you, Ronnie B. There's nothing more true than that.

Hey, Dr. Steve, this is Mark calling from Alabama. Hey, Mark. A question regarding kind of my profession and decisions about immunization. I'm a school teacher in a school with a very large immigrant population. And one of the things that concerns me is about getting the flu shot every year, making sure that's done, but also making sure it's timely. So given the seasonal considerations, when's the best time to get your flu shot? So that it's most effective. Yeah, his audio is not good, so I'm just going to cut him off there.

I think you all could probably understand that he's, it works in a school, so he's going to get every virus that there is, and probably have a really revved-up immune system, which is awesome, and he wants to know when to get the flu vaccine. They recommend it no later than the end of October. You can get it as early as right now. And when I say right now, we are in the middle of September of 2019, case this is, you're listening to this on replay. The,

what I usually recommend is assuming that you're not the first person to get influenza in your area, which you could be. It happens that someone will get it before they've had the flu vaccine. If you start hearing about influenza cases in your

region and listening to the local news usually is pretty good, or you can check the CDC website, or you can check the CDC website, or you can check your state or you can call the local health department and do some surveillance on your own. We usually recommend, you know, first of October to mid-October, but you can get it earlier than that if there are flu influenza cases in your community. Actually, in my community, there have been several reported influenza cases already,

so I already have my influenza vaccine for this year. And so people say, well, what are the benefits? The reason you have to do this every year is a stupid vaccine as it passes through the population. You know, it spends the summer in the southern hemisphere, our summer, in the southern hemisphere, and spends the winter in our hemisphere, and then it spends a little bit of time in between, and people are traveling and go from place to place, spreading this crappy virus. And it mutates. So what they'll do is they'll look at what's going on in the southern hemisphere during our summer and try to predict what we're going to need here.

And sometimes they hit it right on the mark and sometimes they don't. This is from the CDC website. What are the benefits? So I can keep you from getting sick with the flu. No shit. Prevents millions of illnesses and flu-related doctors visits every year. During 2016 and 2017, influenza vaccine prevents. prevented and estimated 5.3 million influenza illnesses, 2.6 million influenza-associated medical

visits. So that's about half the people that get it seem to go to the doctor. And 85,000 influenza-associated hospitalizations, and how many of those would die? That's a good question. If it's 10%, it would be 8,500 deaths. In a season when the vaccine virus has matched circulating strains, flu vaccine has been shown to reduce the risk of having to go to the doctor with the flu by 4,000. to 60%. Now, one year, I got influenza, even though I had had influenza vaccine and also been exposed to the flu mist, which is the live attenuated virus that they spray up, kids' noses. The dirty little secret about that vaccination is that it doesn't just vaccinate the kid.

The kids spread that virus throughout the community. And so I was exposed to it as well and still got influenza out of fever of 105, but I sailed through it. I was 59, I guess, or maybe 58 when that happened, and I was sick for a day, had to stay out of work for a week because of quarantine rules at my job, because I'm in health care, you know, want to be bringing influenza in. So, you know, I suffered the first day in bed. After that, I watched four seasons of Arrow on the CW. So there you go. I got caught up on that show. So I attributed a lot of that to the influenza vaccine. Flu vaccines can reduce the risk of flu-associated hospitalizations for children,

working-age adults, and older adults. And, you know, as we said, in 2016-2017, flu vaccination prevented 85,000 flu-related hospitalizations. In recent years, flu vaccines have reduced the risk of flu-associated hospitalization among adults an average of about 40%. And, oh, here, this is a good one, and I believe this. 2018 study showed that from 2012 to 2015, flu vaccination among adults reduced the risk of being admitted to an intensive care unit by flu by 82%. So even though I got influenza, I didn't have to be admitted.

I didn't die. I didn't have to go to the ICU. Flu vaccination helps prevent serious medical events associated with some chronic conditions like COPD, heart disease and stuff like that. It shows in separate studies to be associated with reduced hospitalization among people with diabetes and chronic lung disease. And it helps protect women during, after, and before pregnancy. So, you know, a 2017 study was the first of its kind to show that flu vaccination

significantly reduces child's death, or I'm sorry, child's risk dying from influenza. So we always assume that was the case now. It's been proven. So, you know, and getting vaccinated may protect people around you through this so-called herd immunity. If you can't get the virus, you can't transmit it. And the more people that can't get it and can't transmit it, the fewer people will actually get it. So it's not effective against cold viruses. You can still get the cold.

and I'll have people say that they swear they got influenza from the influenza vaccine. If they got the influenza shot, it's impossible. Not only are the particles that are in that vaccine, not viruses now. They weren't ever viruses. They are proteins grown and they were never alive, never even associated with DNA. You cannot get influenza from the influenza vaccine. Now, if you had flu mist, you do get a communicable disease from that. It's an attenuated virus, and there are some people that can get sick from that.

And as I said, it'll spread through the community as well, which actually confers some immunity when it works. Last couple of years, we haven't had flu mist. I think this year they're bringing it back. You'll have to check with your local pharmacist on that. But I'll have people say, well, no, I had documented influenza right after getting the influenza vaccine. know the influenza vaccine gave me the flu. So I go through this explanation about once every year, so we'll go through it again. If you get exposed to influenza, let's say on Saturday, you're probably going to get it

anywhere between Wednesday and the next Saturday. So let's say you're going to get it on Thursday. And on Wednesday, you go, hell, I hear there's influenza going around in my community. I'm going to go get my influenza vaccine. So on Wednesday, you go and get the influenza. vaccine, but you've already been exposed. And on Thursday, you get influenza. And you go in and you get the nasal swab and they say, yep, you've got influenza B. And you go, MF, this stupid vaccine gave me the flu. And there's no way you can tell one of those people, you can convince them that the vaccine

didn't give it to them. But I'm telling you it did not. That is impossible. It is not only unlikely it is impossible. It's like when we talk about particle physics with people, the Heisenberg uncertainty principle does not, which refers to not knowing the position and velocity at the same time, and there are other paired quantities like that that can't be determined with infinite precision.

If you know the exact position, then you can't know the velocity, et cetera, or momentum. You know, a lot of these paired quantities. And it's not a problem of we can't do it right now, that we just don't have a measurement that's precise enough. We can't ever do it. This is built in. It's inherent in the structure of the universe that you cannot measure these quantities

with equal precision. If you measure one with great precision, and the other one's going to become less precise. And it's not the universe effing with us. It's just if you do a thought experiment, you can demonstrate it to yourself that's not possible. So it's the same with this. If these viruses were never alive,

they're not reconstituting themselves once they shoot you up. There's no DNA. So it's not possible. Now, you can feel like crap after getting the influenza vaccine. I had that shingricks vaccine. I thought I was going to die. I mean, I felt like crap afterward. Just for a day.

And then the first day was fine. Second day was fine. Third day, I felt like crap. Fourth day, it started to wear off. Fifth day, I was back to normal again. Absolutely worth. The shingricks, if you're not familiar, is the new shingles vaccine. It's much more.

effective than the previous, what Zostovacs, whatever it was. But I felt like crap, but absolutely worth not getting shingles in my eye or any other part of my body, but there's a finite chance I could have gotten shingles in my eye. Now I will not get that. Same thing with influenza. It may make you feel kind of malaise because, you know, the body's only got a few ways to respond to inflammation, and that's to just make you feel like crap. And so when you get the influenza vaccine, your body mounts an immune response against

those proteins, training your immune cells to kill these things if they ever come back again. If they ever dare cross your doorstep again, they'll be ready to kill them. But when they're doing that and they're ramping up, you feel muscle aches and, you know, it may even feel a little feverish and just feel crummy. we call that malays. You, again, absolutely worth not getting influenza and ending up in the hospital on the ventilator or dying or worse. And talk to my friend on Twitter who's been on the show,

the creator and owner or co-owner of hyperphysics, Richard David Smith, I think that's right, RDS. He was not a fan of the influenza vaccine until he ended up on his way to move to Seattle getting influenza and ending up on the ventilator and almost dying. And now he gets his damn influenza vaccine every year. Whenever I start having people giving me shit

about influenza vaccine online, I just say go talk to him and he takes over. From personal experience. So anyway, get your flu vaccine, and that's the story with that. And get it no later than the end of October. but sooner if there are influenza cases in your community. All right.

Hey, Dr. Steve. I'm calling about the recent vapor-related illnesses that have been happening. And it seems that through what I've been seeing in the articles I've read, it's all related to the THC ones. And actually, none of them have been related to the regular nicotine ones. But it was initially from what I heard. related to counterfeit ones and then they kind of you know they were looking into that and then now it happened down in Oregon with one that was bought at a

dispensary so you know that one was actually a death and so obviously not a counterfeit one so now they've kind of been looking into it more and they've been finding traces of vitamin E in some of these yeah it's vitamin E acetate that were used as kind of a thickening bindings for the process, so which they're saying, you know, direct inhalation of that is going to give you pneumonia. Well, maybe. Okay, let me stop him there before we get too crazy. I'm just, this is from, what is the CBS News? Kansas health officials say they've confirmed the first death in that state in Kansas

related to an outbreak of a lung disease linked to vaping. Kansas became at least the sixth state to confirm a death possibly blamed on using e-cigarettes since last month so we got 50 states six of them have shown problems so so this this is an outbreak not an epidemic and but we don't want to have any more of this because I see these people walking around with these freaking you know things

like I've described and it looked like a clarinet and this big tank on it and they're blowing blowing out these giant billows of vape. And I've been saying this from day one that we don't know what the long-term effects of this are. You know, we've had talks of popcorn along. Now we've got this. I said many, many years ago that if you're going to do this as a bridge to quitting smoking, it's probably more safe, but we don't know.

And if you do it, it's for short term as a bridge to get you to total. clean air sobriety, you know. So let's see what's going on here. So the Kansas Department of Health Environment said a news released Tuesday. The recent death involved a Kansas resident over the age of 50 who had a history of underlying health issues. So that may be an issue in this. That's what we're going to look at over time is are there risk factors? Can a 20-year-old who's otherwise healthy do this with impunity?

Or are they going to have a problem? And, you know, this phenomenon is so new. We don't have 20-year data like we do with tobacco. We've got tobacco data going back to 1776 and probably before. And, you know, vaping is such a new phenomenon. We just don't have long-term data to say, who can do this with impunity, if anybody, and what are the safest ingredients to use in them to prevent this kind of thing.

Health officials say they do not have detailed information on what specific e-cigarette products were used by the deceased Kansas patients. So we don't know. The state has six reports of illness possibly associated with the National Lung Disease outbreak, including three, which they believe to be confirmed or probable cases. So the remaining three are still under investigation. So this is all really new. I don't want anybody to panic, but I want everybody to be smart.

Let's see. On Friday, officials in Indiana, California, and Minnesota reported deaths in their state. linked to vaping. Previous deaths have been reported in Illinois and Oregon. The CDC is urging people to consider stopping vaping as the number of cases of severe lung illnesses possibly linked to e-cigarettes as surged to more than 450. Okay, so what I would really like to know is out of how many.

How many people out there are vaping? And that is almost impossible to know, particularly when there are black market e-cigarettes out there and non-commercially or non-regulated vape pans and all this kind of stuff. This is very distressing to me because I always thought at least for cannabis use that vaping made so much sense because inhaling medication into your lungs is actually a more rapid way of getting stuff into your system than even IV use. And you go, well, how could that be? Well, when I give somebody an IV, an intravenous injection,

I'm doing it into a small peripheral vein usually. Now, I'm not talking about these large central catheters. I'm talking about a vein in your hand or your arm. And that bolus has to work its way up the arm. So let's say I inject it now, and now it's halfway up my arm, and now it's to my elbow, and now it's to my shoulder. But it's still a bolus. It's still mostly medication, and then it gets into the larger circulation, then it finally hits the right side of my heart, and gets pumped to the lungs for oxygenation, gets pumped back to the heart to get pumped to the aorta, and it's still mostly together.

And then at that point, it starts differentiating, you know, a little bit of it goes to my brain, some of it goes down through the aorta to the kidneys and the upper extremities and the lower. extremities, et cetera, et cetera. And eventually it all mixes up, whereas if I do it by inhaling the surface area of the lung is so huge, those little alveoli that are in there. I mean, it's just miles of surface area. It all gets absorbed pretty much at once and then gets incorporated into the blood supply that's bathing those alveoli from the heart and then end up going straight to the left side of the heart and getting pumped out to the body. So it's really faster. It seems counterintuitive,

but it's actually true, and it's been demonstrated with multiple medications. So I always thought that that would be the way to go. It seemed very safe. You're not doing that much. You might take a drag, maybe one in a day. If you're treating something medical, maybe two. But particularly with the potency of this stuff. So I'm very disappointed by this. It makes me really want to advocate even further for legalization and research on what's the safest way to deliver this stuff so that when we legalize it, we know that people can buy the safe version. You know, it's not too dissimilar from when the revenues would shut a still down. I think I've told you all my story of buying moonshine from a guy in Appalachian. because I grew up in Appalachia, and we drove way up this mountain out of the hauler on a dirt road to this guy that had a still.

And we were underage to buy liquor, but he didn't care. He'd sell to us. He'd sell to anybody. But while we were there, you know, this guy lived in a phone booth, by the way. It was literally a phone booth, or at least that's where he hung out during the day. And he asked us what time it was. We said, well, it's, you know, two in the afternoon, but is your watch not working? and he held it right like an inch away from his eye and said,

yeah, but I can't see it anymore. So needless to say, we didn't buy moonshine from him because his was probably contaminated with lead or something else that made him go blind. At least that was the story. But I can buy moonshine in a liquor store now, and I know that it is regulated and tested and it's made correctly, and you can safely drink it.

So I would like to see the same model for T's, THC delivery to the masses. I mean, this is ridiculous. You know, this is just another argument, really, for regulation and legalization so that we can get safer products into the hands of people that want to use this stuff. Anyway, that just makes me. It's so short-sighted, in my opinion, that we're allowing the black market, if this is black market stuff that's causing this, to rule when it comes to THC delivery,

when we can tax it and fund our colleges or fund research into whatever addiction, whatever you want to use it for. Schools. And anyway, it just pisses me off. Anyway, the new reported death comes as federal health authorities say vaping giant Jewel Labs. Illegally pitched its electronic cigarettes.

Uh-oh, as a safer alternative to smoking, including in a presentation at schools. Oh, no. The FDA on Monday issued a stern warning letter to the company raising concern about Jules' claims that its products are much safer than cigarettes. They certainly don't have tar, so in the sense that they're safer,

are they less carcinogenic? Almost certainly, although we've got to vet every single ingredient that goes into these things and simplifying them to the point that there are fewer active ingredients and fewer products that are of, so there's no combustion, so there's no products of combustion, but you can change things just by heating them and vaporizing them. So we need to quantify all of those things, make sure that we're not increasing people's risk of disease. Okay, so let's see. I had another thing from the CDC.

Let's see if I can find it here. So what a vaping illness investigator's found so far? The federal investigation to the link, this is from CNN, between vaping and severe lung illnesses is ongoing and is not identified a cause. But all reported cases have indicated the use of e-cigarette products, and some patients have reported using e-cigarettes containing cannabinoid products,

such as THC, again, that breaks my heart. We need to figure this out as quickly as possible. New York health officials said last week that extremely high levels of the chemical vitamin E acetate were found in nearly all cannabis-containing vaping products that were analyzed as part of the investigation. At least one vape product included this chemical has been linked to each person who fell ill

and submitted a product for testing in the state. Doesn't mean that was it. What if all of them have it? Then, of course, you know, if you're saying, well, vaping caused it and they all have it, well, then all of them will have vitamin E acetate. That does not necessarily mean anything now. If there is a whole huge cohort of people who are vaping and they don't have vitamin E acetate in them, and then every single one of the cases had products that did have vitamin E acetate,

now you might be able to say something. And that would be fodder for very, intensive rapid study right now to try to figure this out. Laboratory tests conducted at New York State Department of Health's Wadsworth Center in Albany showed very high levels of vitamin E acetate and the cannabis-containing samples. So that's become a key focus. It doesn't mean that's it. They also found vitamin E acetate in candy-flavored vapes.

And okay, so now Andrew Cuomo did the old knee jerk and said let's issue subpoenas to three companies that market thickening agents to companies that manufacture vape liquids and more companies are expected to be investigated. It's fine. Just calm down. They'll help you I think. Well, maybe you do have to give them some penis, but this needs to be investigated. If that's what it is, it's easy to fix. If that's not what it is, if there's a

co-factor, it's going to be a little bit harder. But if it's just one thing that's causing the problem, then we may be able to fix this and salvage something from this because there should be in the future some ability to transmit medications and other things through this mechanism into the lungs because it really, I mean, even insulin makes sense to do it through the lungs rather than skin popping because how long does that take? It takes a really long time for that stuff to get into the system. And when I say relatively long time, I'm speaking, again, relatively speaking, compared to inhalation. So I would like to see this be fixed ASAP.

In the meantime, I have to reiterate, I can't recommend vaping. And I used to say, look, if you're going to do it as a bridge, go ahead to get off smoking. I'm not even going to recommend that anymore. There is an FDA-regulated nicotine inhaler that you can use as a bridge to quit smoking. I think the brand name is even Nicorette, but I'm not sure. Let me see if I can find it. FDA approved nicotine inhaler. Here we go.

Yeah, it's a nicorette. And it doesn't have vitamin E acetate in it. So just do that. So I'm no longer even condoning casual use. I just can't recommend it. Look, it's free country. do what you want to do. You know what the risks are. There are probably millions of people that are vaping and four to 600 people had this. But what if, and I said this years ago as well, 10 years from now, all of these people end up with scarring in their lungs and fibrosis and so we've got no way to predict that. So I would really like to see a lot more research done on this before we wholly adopt this. And I feel bad for the people that make money off of vaping. And they're taking a huge, hit right now and this is going to affect jobs and small business people I get it I'm sorry I just

I can't recommend it not you know I'm not some namby-pamby just say no person do what thou wilt as Alastair Crowley used to say but I just can't recommend it okay can I say that enough times I guess I've said it enough anyway all right hello y'all y'all What up? I was wondering if you could answer this question on the podcast. Okay. But just a quick question on tetanus shot. Okay, we'll answer it on the podcast, too.

I recently hit my head on a rusty pole cutting grass. Okay. And I haven't had a tetanus shot. I'm 42, and I couldn't even tell you the last time I had one. So I was freaking out about it, and I was going to go to Walgreen, Pharmacist, there, to give me the shot. I told him what was up, and he was basically talked me out of it. What?

The shot would take two weeks to work, and, yeah, it might maybe help, but more or less, he was saying it was kind of pointless at that point. It might maybe help. Is that true? No. Am I going to die of tetanus now? No. No to both.

I cleaned it out real good, of course, but did not. Okay. Golly. see, you're a health care provider and someone comes to you and says it's been more than 10 years since my last tetanus shot. I just had a wound. Can I get a tetanus shot?

And they talk him out of it. That's just insane. Besides, you can sell a tetanus shot. You know, this I do not understand. Now, was he at risk of getting tetanus from hitting his head on a rusty pole? No. Probably not.

Number one, I in my 32 years of experience, have seen tetanus before I've never once, nor have I heard of it, in a person who got the original three shots as a kid. Maybe it can happen, but none of us that I've ever polled have ever seen tetanus in someone that has had tetanus shots in the past. Having said that, the protocol is every 10 years, you get a tetanus and diphtheria booster. That's the big T, T, little D. Your primary care can give it to you. You should be able to go to a pharmacy and get it.

If you can just tell them it's been 10 years. Now, if you have a deep wound, like a knife wound, an animal bite, if you step on a nail and it punctures your foot, and that nail was embedded in a board that was covered in. in a cow dung, then you should get your tetanus shot right then. So they'll recommend it for dirty wounds, particularly if it's been five years or more. But if it's been 10 years and you don't have any of those, then just doing it every 10 years is okay. But if you don't remember the last time you did it, if you can find out, that'd be great.

And if you find out and you know it's been more than 10 years, then just go get one. if it's been eight years then yeah the pharmacist maybe maybe the pharmacist had magic knowledge of your past history and knew that you'd had one in the last 10 years and you was telling you you didn't need it that's fine but they probably could have explained that better okay so tetanus vaccine good tetanus is a terrible disease to die from and it's completely preventable the one case I's every case I've ever seen has expired They call it lock jaw, but that's just because that's one of the sets of muscle, the mass that are muscles in the jaw that, you know, close the jaw. They're involved in chewing.

They become titanic or, you know, spasm, and you can't open the jaw. But also other muscles do the same thing, including respiratory muscles, so you can't breathe. And it's a really tough disease. And there are, we do have more things we can do about it now. than we did back in the day. So if you get it now, you're less likely to die from it. I wonder what the mortality from tetanus is in 2019. Let's find out.

Mortality from tetanus. Okay, here we go. Used to be 100%. But now, not so bad. Current statistics indicate mortality in mild and moderate tetanus, although I've never seen a moderate case of tetanus, is 6% for severe tetanus that can be as high is 60%.

Mortality in the United States resulting from generalized tetanus is 30% overall, 52% in patients older than 60 years, and 13% in patients younger than 60 years. And that makes sense because the patients younger probably have had more recent vaccination. Let's see. Oh, here's tetanus surveillance,

the United States 2001 to 2008. Tetanus is a life-threatening but preventable disease caused by the toxin of Clostridium tetany, ubiquitous, meaning it's everywhere, spore-forming, gram-positive bacillus found in high concentrations in soil. Ooh, an animal excrement. Reported tetanus cases have declined greater than 95%, and deaths from tetanus have declined greater than 99% in the United States since 1947 when the disease became reportable nationally. So there you go. Let me see, from 1947 to 2008, the number of tetanus cases reported each year, which had already decreased greatly since 1900, continued to decline. Okay, there's a figure, so let me see. Oh, my goodness.

Wow, that's a very impressive. You know what? If you think vaccinations are dumb, you should look at this. The number of deaths have dwindled almost to zero. The number of cases has gotten really close to, so it's below 0.5. um cases per million and it's like really really close to zero so it's pretty cool um average annual annual rate in ages five to nineteen is point zero four so it's not zero but you know the number of known deaths zero and in 20 to 34 zero in ages 35 to 49 four out of 350 million

people are 450 million so your chances of dying in this about one and a hundred million so anyway all right but get the vaccine okay hi dr steve this is jack from Wilmington North Carolina hey Jack and I drive over the road and I haven't been paying attention to like eating good food so I was wondering if you have any of his audio is terrible what he's at he's a over-the-road trucker asking about nutrition and we have covered this but it's been a while um you know ever since barry the blade passed away of swine flu by the way he he was our trucker uh correspondent and then we haven't heard from lady trucker in ages since she got divorced and she's out on the town doing her thing uh as a single woman so she

doesn't call in anymore either, so I don't have a trucker correspondent for trucker lifestyle. That whole trucker duty segment that we did back in the early days was pretty much fun and pretty educational. So anytime I see a Walmart bag on the side of the road, I know not to pick it up. At least if I do pick it up, don't puncture it, because it may be filled with fecal matter. But anyway, as far as trucker diet, every fast food place now, with maybe one exception, and I won't name them, has something healthy on their menu, but it isn't always something that you can go through the drive-in and then, you know, eat on the road. And what I'm talking about is salads with grilled chicken and vinaigrette dressing, which I, look, I used to poo-poo this. I wanted ranch and I wanted crispy chicken tenders. And I have learned to love this.

You just have to commit to it. By the way, you know, I'm doing Noom. I've had great results. They're not an advertiser. You can check out. Just come to my website and I can tell you about my experience with Noom. It's just a psychology app and I'm a huge advocate of it. It really helped me in a lot of ways in my life,

but also in losing weight and getting to my idea. deal body weight. But doing that, I've come to love my McDonald's or Subway. Subway has a great spinach salad. You can just say, no lettuce, just give me a double spinach, double tomatoes. And you can get the club that's got lean meats in it and some vinaigrette. And it's huge and it's heavy. You know, it weighs a couple of pounds. And that will really do you on the road, but you have to sit down and eat, which you should do anyway. We should be. We should be mindful of our eating. We should enjoy it.

It shouldn't be just something that we're cramming in our mouth while we're going down the road. So take a couple of minutes out, sit down, eat, enjoy it, look around, check out, you know, the hot women or hot dudes, you know, whatever is your proclivity in the place or just whatever. Listen to music. Just chill for a few minutes and eat and just enjoy it. And it's absolutely doable on the road now. and but as I said, harder to do when you're running through.

If you think that you're going to go to that other place and get the impossible burger, that's great for the environment. It isn't much healthier in my estimation than eating meat is, but you're not eating meat and you're not using up all those resources and water and all that other stuff that goes into making meat. Look, we're out of time. Thanks always go to Dr. Scott, who couldn't be here today. We can't forget Rob Sprance, Bob Kelly, Greg Hughes, Anthony Cumi,

Jim Norton, Travis Teft, Lewis, Johnson, Paul Ophcharski, Eric Nagel, Roland Campos, Sam Roberts, Pat Duffy, Dennis Falcone, Ron Bennington, and Fez Watley, whose early support of this show has never gone unappreciated. Listen to our SiriusXM show on the Faction Talk Channel, SiriusXM Channel 103, Saturdays at 8 p.m., Sundays at 5 p.m. Eastern, on demand, and other times at Jim McClure's pleasure. Many thanks. Go 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 crab 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 do i know the name of the show of weird medicine oh boy time to retire