Weird Medicine: The Podcast - 382 - Death and Saxes

Episode Date: November 14, 2019

Vitamin D loses its luster, toxic fumes kill a restaurant worker, it's time to talk Living Wills! Another fun, fun episode from your favorite ghoul. The only good news: Dave Ray Cecil has a new song! PLEASE VISIT: 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 some touch it. Yo-ho-ho-ho-ho-he-ho. Yeah, me garretid. I've got diphtheria crushing my esophagus. I've got Tobolivis stripping from my nose. I've got the leprosy of the heart valve, exacerbating my incredible woes. I want to take my brain out and blasted with the web.

an ultrasonic, agographic, and a pulsating shave. I want a magic pill. 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 a requiem for my disease. So I'm aging Dr. Steve. It's weird medicine, the first and still only uncensored medical show in the history of broadcast radio. Now a podcast, I'm Dr. Steve, and this is a show for people who would never listen to a medical show on the radio

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The holidays are coming. It's a great way to do your holiday shopping online and also help out your pals at weird medicine. So go to stuff.com. You can scroll down, see all the different things that we talk about on the show. None of that tickles your fancy, as my high school English professor would say. And then just click through to Amazon. If you use the link at the top of the page, just click, click right through. Still helps us out.

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anyway neum dot dr.steve.com do it with me I'm at my day old body weight, and now it's been a month, or a month, a year since I started Noam. I started right after Halloween last year when I ate a whole bag of Halloween candy. I said, I think I have a problem. And it wasn't the crappy stuff. It was a whole bag of those little snickers, the ones that are about two inches long. And I, you know, I just eat one. And then, oh, well, hell, if I ate one, two more isn't going to do anything.

And then, well, just one handful. How many can I get in my hand? Five. And before I knew it, I had eaten the whole bag, and I had a whole big pile of wrappers, and I felt like crap. I felt like crap for hours afterward. And I said, I have a problem.

So I got on Noom, and it changed my relationship with food. Might do it for you, too. Obviously, not for everybody, but give it a try. Nothing wrong with two free weeks. And if you're lazy like I am, I like Freshly. Dot, Dr.steve.com. You can get 40 bucks off.

freshly and they deliver fresh prepared meals that make eating right super easy and they got some new recipes that we just tried one the other day that we really liked and uh it was um a what the hell well oh it was um shrimp and chicken with sort of a cauliflower you know everything's gluten-free but the cauliflower mash was outstanding i mean it was so well seasoned i had no idea that's what it was i'm like well they put potatoes in here some of the stuff has potatoes because they're gluten-free too but this one had cauliflower flour and the vegetables were really good. And it comes in a tray.

You just stick it in the microwave. Now, it's microwave food, okay? So there are limitations to some of the things that they can do. But you get about, to me, it seems about twice as much as I used to get when I was eating lean cuisines, and the quality is way better. As far as it's really like it's hand-cooked. It's not seemed like it's done by a machine. And if you're interested in getting our podcasts, archives, go to premium.com.

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It's totally fine. I have the paywall there to keep my employer out of my business. All right. What have we got today? We have talked multiple times on this show. about vitamin D and I have always contended, look, low vitamin D is associated with a lot of different conditions. Low vitamin D correlates with increased risk for cancer, for increased risk of heart attack and stroke, and certainly is low vitamin D, chronic low vitamin D, is responsible for rickets, and we know that.

Now, you can prevent rickets by giving someone vitamin D. Can you, though, prevent heart attack, stroke, and cancer by giving someone vitamin D? In other words, is the low vitamin D a cause of these problems, or is it simply a marker for these problems? In other words, persons at high risk for heart attack and stroke, and there's something in their metabolism that, you know, results in low vitamin D. And replacing the vitamin D would just simply mask that signal, but it wouldn't actually fix the problem. Does that make sense?

So if, let's say, whatever is caught, maybe it's the inflammation that's causing the high risk for heart attack and stroke also causes vitamin D. Well, then replacing the vitamin D isn't going to do anything for that. It's just going to make that marker, that sort of, red flag disappear.

I'm trying to think of a good analogy for that. I'll think one. Yeah, okay. Well, hmm. Yeah, okay, maybe this, if your car is burning oil

and there's smoke coming out of the back, putting on a, let's say, some sort of filter that would reduce the amount of smoke coming out of your exhaust. pipe would take care of the outward appearance of the problem, but it wouldn't fix the underlying problem. That's probably the, you know, on the fly, I hadn't really thought about it that much.

That's the best analogy I could come from, come up with. But anyway, so you kind of get the idea. Is vitamin D a marker or a cause of disease? So this is from the Journal of the American Medical Association, not some crappy journal. It's an editorial. It says vitamin D. health outcomes subtitled

then well wait a minute then no then came the randomized clinical trials okay so anyway

that was not worth the time it took for me to do that I'm just going to read some of this with you you can just go to jamman network.com

and search for vitamin D and you can find this but this is an editorial but it's based on some recent studies This is not long ago vitamin D was riding high. And this was the thing that used to drive me crazy is another article would come out and say vitamin D is associated with this ex-disease, let's say increase in, I don't know, diabetes. I'm just making this up.

And then I would get people emailing me, well, you know, do you get it now? You know, what's it going to take for you to recommend vitamin D supplementation? I kept saying, look, you can take vitamin D. no harm in it. You don't want to overtake it because there is a condition called hypervitaminosis D. We won't get into that too much unless you guys are interested, but you can take too much vitamin D. So take a normal amount and bring your level to normal. I have no problem with that. You'll certainly prevent rickets, if not all this other stuff until we know, you know, maybe it is a co-factor and it would actually improve your outcome. So I don't have a problem with it, but I can't

recommend it based on the evidence that and tell people, yes, if you take vitamin D, it's going to prevent heart attack, stroke, and cancer. So anyway, not long ago, vitamin D was riding high. Beyond its role in calcium homeostasis, ooh, that just means keeping your calcium in line homeostasis, basically just regulation. So you're regulating your calcium. It didn't get too high, get too low. And bone health. Animal studies. linked to vitamin D deficiency to numerous chronic illnesses including high blood pressure, diabetes, autoimmune disorders, and cancer.

Corroborating human observational studies reported associations between vitamin D deficiency and increased risks of high blood pressure, diabetes, cardiovascular disease, autoimmune diseases, and cancer. Right, so correlation is not causation. But the lay press seized on this chorus of observational studies, testing of serum, you know, vitamin D levels

proliferated, you know, doctors of those check your vitamin D, and supplementation with vitamin D increased significantly. Then came the randomized clinical trials, and this is why I want to read this to you guys. Multiple trials have failed to demonstrate significant benefits of vitamin D supplementation. This argues toward the idea that low vitamin D is a market. of disease, not a cause of disease, except for rickets. That's well known that causes rickets. What is rickets?

It's like a bone disease, and these kids, Google it. You can see pictures of rickets. These kids tend to be bow-legged and stuff like that. It's a disease of children that's actually caused by vitamin D deficiency, and they have poor calcification of their bones, and it softens the bones and distortion of the bones. And so you can see why they're bow-legged, because when they're standing up, you know, if you have rubber legs, they would bow out. And they kind of have rubbery bones as far as, you know, relatively speaking. But anyway, so these multiple trials have failed to show any benefits.

For example, vitamin D supplementation compared with placebo failed to reduce high blood pressure in patients with pre-high high. hypertension and stage one hypertension. There's two stages of hypertension, there's prehypertension, stage one and stage two, and prehypertension and stage one patients they were looked at and they didn't

have any benefit from vitamin D supplementation. High dose, monthly oral vitamin D compared with placebo, didn't reduce the risk of cardiovascular disease or death. So this is a long-term study where they followed people over a period of time,

taking this stuff. And when you do these, you've got to control for other things. Like it's not fair if in the vitamin D group, everyone is a smoker and in the placebo group, nobody's smoking. They need to be matched. So to the best of your ability, within statistical significance. So if you've got 10 smokers in the vitamin D group, you need to have 9 or 11 in the other group or, you know, as close to 10 as you can get. And you need to control for that. And that's hard to do. You know, so you have to have big studies and control for as many variables as you can. And then at the end, you say, look, we can control for this, but we don't think that's any big deal.

And then somebody can go in later and do that study just looking at that one thing. So in the vitamin D in type 2 diabetes trial, the vitamin D supplementation compared with placebo failed to lower the risk of incident type 2 diabetes in patients with prediabetes. So they identified people with mildly elevated blood sugars, gave them vitamin D, followed them over time, and they still developed diabetes. The largest vitamin D trial was the vitamin D in omega-3 trial. It was called the vital trial. It was randomized, double-blind, placebo-controlled. And let me see. Oh, clinical trial of 25,871

Participants Using a two-by-two factorial design, Vital Tested Weather Supplementation with Okay, so they had two things in this, Omega-3s and Vitamin D. So they were either treated with vitamin D or Omega-3s or both or placebo, so that would be four things.

And they wanted to see if they would reduce reduce the risk of cancer and the composite cardiovascular outcome of heart attack, stroke, or cardiovascular death compared with placebo. And during a median follow-up of 5.3 years, it's a nice

long study. Neither vitamin D supplementation nor omega-3 fatty acid supplementation was significantly better than placebo. No, I'll hit the wrong one. All right, all right. So in this issue of the Journal of American Medical Association, these authors reported the results of the vital DKD study, which was a pre-specified secondary study involving 1,300 participants in the vital study.

So this is a subset of that original study we just talked about. And they had type 2 diabetes, and they agreed to undergo additional testing. of kidney function and protein urinary albument excretion. That's how much protein they're peeing out because you don't want to pee out your protein. You need that to make muscles and stuff.

At baseline and two and five years after randomization. So in other words, they randomized them into two groups and followed them at baseline, two years, and five years to see what their kidney function was like. And the author's test of the hypothesis that supplementation with vitamin D and omega-3 fatty acids would reduce the rate of kidney functional decline in patients with diabetes, because as you know, patients with diabetes are an increased risk of kidney failure.

So the primary outcome was changed in estimated glomerial for filtration rate. Don't worry about that. That's just how the glomeruli, which are the little units that filter in the blood, how things get from one side. to the other, in other words, from the blood side to the urine side. And let's see it. Baseline, the mean EGFR, in other words, you know, the arithmetic mean was 85.

Don't worry about it. It's milliliters per minute per 1.73 meters square. Don't worry about that. Just remember the number, 85.8. 16% of participants had an EGFR less than 60, and 9% had a little bit of protein, and that was greater than 30, milligrams per gram creatine.

The mean, okay, come on, give me some damn answers here. Okay, by year five, the mean EGFR had declined to 73 from 85, despite this substantial loss of EGFR, there was no significant difference in the decline between the vitamin D and placebo groups. or between the omega-3 fatty acid and the placebo groups. Okay. So that kind of sucks. Likewise, no beneficial effects of vitamin D or omega-3 fatty acid supplementation on protein in the urine,

and no between-group differences in the secondary composite income, which occurred in hundreds of, what was that? that? Let's see now. Okay. Vitamin D is essential for gastrointestinal absorption of calcium. And healthy individuals, vitamin D deficiency jeopardizes calcium regulation. They say homeostaceous, but I'll say regulation, and stimulates secondary increases in parathyroid hormone. So there's this hormone in your thyroid glands. There's four of them. It's pretty interesting. So the thyroid is kind of a weird, mushy little gland right at the front of your. throat that sort of wraps around, the Adam's apple where the voice box is.

And they're deep inside that thyroid gland, which is really mushy kind of the consistency of firm jelly. There are four little sub glands, and those are the parathyroid glands. And when parathyroid hormone is excreted, your calcium will go up. And when it's not excreted, it starts to drift back down again. And so people that will have a parathyroid adenoma, in other words, a benign tumor of the parathyroid gland, those things will secrete an increased amount of parathyroid hormone. And because of that, the patient's calcium goes over and you go, well, who cares? Well, okay, I understand.

You don't hear about calcium so much. You hear about potassium and magnesium, sodium, but you don't hear about calcium that much. But hypercalcemia, which is what that's called, can cause a myriad of effects, including making people goofy as goofy can be and start seeing aliens and throwing bedpans and stuff like that. So when we see those sorts of behaviors, or they can just become profoundly weak, particularly in cancer patients we'll check a calcium level if they're elevated we need to treat it

so anyway that's the parathyroid gland let's see here anything else interesting in here yeah not really

oh here we go one randomized placebo controlled trial coincidentally also called vital it's a different one vital they had 281 patients suggested a modest anti-proteinuric effect of the activated vitamin D analog paracalcitol. It's not one that I'm familiar with. I'm not even sure if you can buy it over the counter.

Let's ask Echo if we can. Echo, buy Paracalcitol, please. Are you trying to shop for paracalcitol? Yes. I just added paracalcaltol. Okay, so apparently you can buy it over the counter. When added to blockers of the reninangiotensin, oh, geez, okay, I'm going to get far afield if I go through all of this. In patients with type 2 diabetes, mildless and chronic kidney disease.

So I'm not advocating you go by paracalcaltol, even if you have diabetes. Talk to your diabetologist, your endocrinologist, or your primary care. Other randomized placebo-controlled trials found no. No beneficial effects of paracalotol and left ventricular structure. That would be heart structure. That's the beating, the chamber of the heart that beats to the brain and to the rest of the body, the kidneys, everywhere. The only place it doesn't beat to directly, the lungs and the right side does that. So, hmm, okay.

Well, it does, okay, let me rephrase that. the right side of the heart takes hypooxygenated blood in other words blood that has been used and needs oxygen takes it and pumps it through the pulmonary artery to the lungs where in the alveoli which the little air pockets in the lung

carbon dioxide is exchanged for oxygen so you get rid of carbon dioxide that's when you exhale you have more carbon dioxide, and then oxygen that's sitting in those alveoli from you breathing in is absorbed into the bloodstream. And to do that efficiently, you've got to have a lot of surface area, and so the lungs are just amazing amount of surface area in there, because the little alveoli are tiny, and there's bigillions of them.

And so that's what I'm talking about when I'm, say, primarily pumping there. The lungs themselves actually need a blood supply, and so there are arteries that supply the lungs with oxygenated blood that they can use. But anyway, all right. So that's enough of that. The take home from this is, fine to take vitamin D. I have no problem with it. It's good for calcium homeostasis.

It prevents rickets. There may be some benefits that we're not aware of, but they apparently are not huge or we would know about them. Does not appear to be the panacea that we hoped for when we found that low vitamin D levels were correlated with all these conditions. We were really hoping that it would be as simple as that as just give people vitamin D and these things would go away, but that doesn't appear to be the case. Now, this was looking at things other than the vital trial was not looking at cancer, but,

no, yes, it was too. The original vital trial was looking at the risk of cancer and cardiovascular compositional composite outcome so yeah even that so that you know if you want to avoid cancer do your screening catch it early and prevent cancer by avoiding repeated exposure to cancer causing toxins if I may use that word as much as I eschew that word in this case it's appropriate like nitrosamines those are things found in charred meat so if you grill every single day. You may increase your risk of heart attack.

The big one, of course, tobacco, avoiding tobacco. And if you can't quit, call in and we'll walk you through it. Because Scott, I know I used to smoke three packs a day. Pretty sure Scott used to dip, if I remember correctly. And he had a hard time quitting. So you'd think that would be the most noxious thing. It'd be so easy to quit, but it's not. So it just shows what the human body.

you can get used to. But those are the big ones and get your colonoscopy done. Get your kids vaccinated for HPV causing or HPV-derived cancers like benile cancer, cervical cancer, rectal cancer, and head and neck cancers. Those are big ones. And, you know, if you work in an asbestos mine, absolutely don't smoke because quadruples your risk. I'm getting lung cancer.

Okay, all right. So there you go. Last time, we talked about the reaction between bleach and ammonia. And we were just kind of talking about, I can't remember what brought it up, but sodium hypochlorite, when mixed with ammonia, can release chlorine gas as well as chloramines and some other things like that. So it's naughty, naughty to do. that and uh but it can happen you know if you're using a um easily obtained vinegar or

ammonia containing cleaner on your let's say on your table and then you follow it up with a bleach containing um cleaner and the two things mix because they're still wet uh you can release some of these toxic gases now for the most part i and i said for the most part these things tend to be more irritating than deadly in the sense that, I mean, it doesn't feel good. I've took a whiff of it myself in a closed environment. It was pretty scary. But I got out and I was okay. It didn't do any permanent damage.

But like everything else, if you are in an enclosed environment or if you get a huge dose of this stuff, then of course it can be toxic to you and even deadly. So this is a story out of Burlington, Massachusetts, a worker at a local wing place, and Burlington died from injuries, suffered in a chemical incident at the restaurant on Thursday evening. This is from WCVB, I guess a TV station in Massachusetts. The incident happened sometime before 6 p.m. at the location, and investigators said they were called to the restaurant after receiving a restaurant. report of a chemical reaction in the kitchen area. Authority said the employee was exposed to a strong cleaning agent and was suffering from nausea, as believed that he was breathing in fumes from the cleaning agent.

He was rushed to lay into this hospital and later died at the hospital. The restaurant was evacuated following the accident or the incident. Total of 10 victims, including employees and customers, checked themselves into the hospital for evaluation with difficulty breathing and eye irritation. The interim fire chief said one worker who first prepared the floor to be clean was immediately exposed to the chemical but quickly left the area to get fresh air. The gentleman that passed away was an employee of this wing place who attempted to squeegee the product out of the building when he was overcome.

Now, what this says to me, I wasn't there, I don't know a lot of the details, but if he's trying to squeegee it out of the building, they had a spill. There was a lot of it on the floor. And it says anyone at the restaurant at the time believes they may be impacted should seek medical treatment immediately. They said the chemical used was sodium hypochlorite. Now, they said someone prepared the floor. So did that person use an ammonia-based floor cleaner? I don't know.

And then they had a spill of bleach over the floor, and then this thing reacted, and it released chloramines and chlorine gas. And this guy was trying to do in his best to protect everybody by squeezing it out and getting it the heck out of there. And he took the ultimate hit. It's tragic. So I'm just going to this may not save anybody's life out there. But if you are in an environment where you're smelling something chemical like that and it's not normal, just get the hell out of there until somebody with a respirator can get there and go in and clean it up. Don't try to do it yourself. And even if you think you're going to get in trouble because you were the one that spilled it,

it's better for you to be in a little bit of trouble because accidents happen than for you to make the ultimate sacrifice. Now, please don't just run the hell out of there, though. If there's other people at risk, let them know. Some run around to the front of the restaurant and tell everybody, get the hell out of here. Something bad's happening in the back. but definitely save yourself and we see this a lot in airplanes when the masks

come down and you're supposed to put the mask over yourself before you do it for the kid and it seems weird like usually our instinct is to save the kid first and I'll put my mask on later first I need to save the kid

but really you're doing them a disservice because if let's say you're three seconds away from succumbing and you put the thing on the kid and it takes you four seconds to do and the kid is I don't know two and doesn't know what the hell's going on you don't get it on you succumb now the kid doesn't have the masks they succumb and they're going to be a flight attendant running around trying to make sure everybody's masks on because they've got to have their mask on too so put it on yourself first and then even if the kid passes out because it took you five seconds and they're going to succumb in three, they're not dead. Just put the mask on when they're still breathing. They're just not able to get enough

oxygen to their brain. Then put the mask on them and then both of you will live, okay, instead of neither of you. Okay? Very important. All right. That's all I've got for today. Do you guys have anything? If you do, give us a call. 347-76-4-3-23. Leave a voicemail. I'll get to

But usually I'll try to text you back. And I thought if we have enough time today, we will take some random phone calls from the voicemail bank because I haven't had a chance today to download them. All right. Let's see what we got here. In a coma for a month and a half. Oh, wait. We answered this question before.

Okay. Let's try this one. The normal. I don't know why. Nope. Answer that one before. Okay. Let's try this one.

That's a new message there, Dr. Steve. Anyways, this is Phil if he gets a chance, I was wondering I had watched something on Anthony and Coomia Network about your practice care, which I've always known about. But I never dawned on me. I mean, you kind of deal with situations where you have to see, you know, older people pass away, I was always wondering, how do you numb yourself from that or deal with that, you know? He's got more to this question, but the first answer is don't numb yourself to it, because I don't think that's possible. And if you did numb yourself to it, then you're going to be a numb, unfeeling robot.

And I don't think that's the way to go about it. Let me see what the rest of his question is. It's like a vet having to euthanize a cat or a dog or whatever. I always wondered, you know, how do you deal with that? I know it gets probably numbing, but just wondered how you... No, I don't think I've ever been numb to it. You get accustomed to it. Now, look, you guys are going to make fun of me.

It's fine. But I feel I was called to doing hospice care. And when you're called to do something, if you don't do it well ask Jonah you end up in the belly of a fish right but you know if you don't do it you're going to feel this hole in your

life all the time so I was called to do it so that makes it a little easier for me if someone tried to force themselves to do it and they didn't have the heart for it I could see it being a real problem for them yeah death and dying I think one of the reasons I did it was

because I was dealing with my own mortality, and that's one thing. The other thing is, is there was, I don't want to get too heavy. You know, my mom had the worst death that I've ever seen, and I never wanted anybody else's mom to go through what my mom went through. So when we had the one lecture on end-of-life care in my seven years of medical training, I really paid attention, and I made it my goal to try to ease suffering, particularly at

the end of life and make sure that nobody is suffering as I said like my mom did and I also saw the value of it through another episode that happened in my training and it's just a long story and I cry every time I tell the story 35 years later so I will beg your indulgence in letting me not tell that story but there was just another thing that happened in my training that made me realized that there's more to medical care than just prescribing pills for high blood pressure. And, of course, that's an oversimplification, but we got away from really paying a lot of attention to symptom management and quality of life, particularly in the 80s. In the 80s, all this stuff was happening. you know, swan gans catheters and new antibiotics and new medications to keep the heart pumping

and new procedures to keep the heart pumping and new chemotherapy agents. It was the sort of the emergence of modern chemotherapy was just starting. And I remember I had a chief resident and he was one of these guys that was just really into short-term outcomes, I guess, is one. He would not characterize it that way, but that's the way I saw it. For example, we had a lady whose blood pressure was 70 over nothing. She was modeled. Her temperature was 104.

We were all on rounds together, and her potassium was six. Now, she was obviously actively dying, but her potassium was six. So he barks out these orders, you know, do this, do that, do some calcium, do some LASICs, K-X-Late, all these things. And he barked out all these orders, and then we went on our way. Well, that afternoon, we came back for afternoon rounds, and we got her potassium. It was down to four. And he starts, you would think, I mean, just imagine Rocky at the end of Rocky 2. Or the statue of Rocky in Philadelphia.

you. That's a better example. That's what he looked like. He was, yes, yes. And pumping his fists in the air and strutting up and down in the ICU, you know, whoa, you know, we rule and all this kind of stuff. And I'm like, even then, I'm like, dude, look at this patient. Of course, she, you know, she died the next day. And all of this did nothing, but he was merely looking at a number on a piece of paper. And that's the thing. That's, to me, those are the people who are numb.

and are the ones that see patients as numbers on a piece of paper. You have to look at the whole patient. That's why it's good to do home visits because you're not seeing your patients in a vacuum in our environment. You're seeing them in their environment. And you can learn a lot from seeing them in their environment. Likewise, when you're doing a depression screen, you can have your nurse hand them a piece of paper and have a mark on it.

Or you can ask the questions yourself. And when you ask for the medical students and doctors, who still have somewhat of an open mind that are out there listening. If you ask the questions yourself, it takes a minute longer for your visit, but you gather so much valuable information from watching the patient answer these questions and how they say it, what they say, do they avoid the question when you ask it, as opposed to just circling a number on a piece of paper on a bunch of nine or 25 questions or whatever instrument that you're using.

So don't become numb to this. I'm never numb to it. It doesn't break me up. You know what breaks me up? I'll tell you what breaks me up. Are kids that are going through this and people's families, who particularly have kids,

that are watching an older loved one pass away, without any understanding. It breaks me up when people get to the end of their life and they never discussed with anybody what they wanted, would they want life support, would they want CPR, would they want to be shocked? And the families are just, you know, in chaos, not knowing what to do because it was never discussed.

So I'm going to take this opportunity just for a second to advocate to all of you that you do a living will. Now, you say, well, I'm 25, why do I need a living will? Or, you know, I'm not dying. What do I need a living well for? I want you to remember Terry Shivo. Terry Shivo was a 24-year-old woman, had a stroke,

and she was in a persistent vegetative state, which is a form of coma. It's one where you have normal sleep, wake, cycles, but you're still unresponsive. And she was unresponsive. And her husband, after some period of time, felt that she would not want her life to continue this way. Now, you can impugn his motives if you want to. There are people that do.

But, you know, he argued that a reasonable person would not want to be kept alive in this situation with no hope of ever recovering. And that she was one of those people. didn't want that. So he wanted to pull her tube. Well, her parents, and understandably, it's their kid. I get it. They said, no, no, she would want it. They, you know, she would want to be kept alive.

Now, the husband goes to take the tube out. The parents get a judge to stop them from doing that. He goes and gets another judge to allow him to do it. And I think this thing went back and forth a couple of times. In the meantime, she's on CNN, MSNBC, Fox News, regular networks day in and day out for months. And you know, as a 24-year-old woman, she would have been mortified to know that her face was plastered over the TV day in and day out like that. Congress even got into the act. And eventually, the husband,

prevailed, they pulled the tube, and she passed away sometime after that. Now, what's the point of this story? If Terry Schiavo, 24-year-old woman, had had a living will, we never would have heard of her. You can also call it an advanced directive, but a living will is a form of advanced directive, so I like using the more precise term. We never would have heard of her, because a living will is not the same thing as a will. has to do with after you die. A living will has to do with everything before you die.

And it would have said, yes, I want tube feedings, or no, I don't. Now, there's several types of living will. Some of are more comprehensive. And if you guys are interested, I can send you living wills. Just email me. Just go to Dr.steve.com and click contact.

I'll send you blank living wills you can fill out. There's a bunch of them. The one in Tennessee is very comprehensive and very precise, but it's complex in its, or in its logic, at least relatively so. However, in Virginia, Virginia models its living will after a lot of the ones the attorneys do that say if two of my physicians agree that I'm terminally ill and the continuation of

artificial nutrition or hydration or medical interventions would serve merely to prolong the dying process that I authorized the withholding or withdrawal of such services. blah, blah, blah, stuff like that. That's a pretty narrow circumstance, but it's functional. It would have worked in Terry Shivo's case if her physician had said, yeah, she's never going to get better, and just continuing this is just continuing the dying process. Well, anyway, there are other ones that say, look, if I'm in a permanent coma and I'm never going to, going to improve, that I authorize no tube.

feeding. That's a little more precise. A little would have been an easier one for the husband in Terry's case if she had had one like that, if that was indeed what she wanted for him to argue that there wasn't any question that she wouldn't want to be kept alive like this. So anyway, talk to your attorney, but I'm just going to throw this out, and this is no shade on the attorneys out there. This is really a medical document. It really should be done by medically trained professionals rather than legally trained professionals. But look, there's some attorneys out there

that are really good at doing these and there's some doctors that are really, really shitty at it. So if you have any questions, I'm happy to answer these questions anytime. And you can call them in. We can talk about them here. 4, 2, 3, 4.000...

No, what is it? That's not right. It's 347-766-4-3-23. I know there was 4-2-3 in there somewhere. 347-766-4323 or go to Dr.steve.com. Click contact. Just ignore the warnings. Make sure you put your email in correctly

because if you don't, I have no way of emailing you back. So, yes, so everyone needs a living will. You need one. If you're listening to this, you need one. The only ones that really don't need them are minors and their parents are their power of attorney by default. Now, the other cool thing about an advanced

directive like this you can determine in advance who's going to make decisions for you so let me make this recommendation that you not do that make this a political decision other words you got four kids but the oldest one you know you don't think will follow your wishes and you don't think they'll understand what it is that you really want and you think that they'll make you do things when you're not able to fight for yourself that you wouldn't want and yet you want to make to make them your primary decision maker on this form because they're your oldest and if you don't they'll get mad don't do it for that come up with an excuse say well i just didn't want to burden you with this i thought that your brother would be uh you know better able to uh follow my wishes

or whatever you have to say to them or you know you're a crank and i'm i'm not doing it but i don't want you doing stuff to me that i don't want because there is a whole lot we can do to somebody at the end of their life that isn't really doing anything for them. And we just want to do things to you. I mean, we don't want to, I mean, we, dang it. We just want to do stuff for you. We don't want to do stuff to you. With regard to Code Blue, for example, you have an 18-year-old basketball player, prime of their life,

and they keel over on the basketball court, and they die. Tragedy when it happens. We would do CPR. In other words, we would do chest compression. We would break the ribs. We would shock them. We'd take a big tube that's about an inch in diameter and shove it down their throat into their trachea, you know, right above the lungs to breathe for them and put them on life support. The odds that that 18-year-old basketball player is going to survive only 15%.

That's to survive to walk out of the hospital. So if you throw in a couple of medical problems in a couple of years, that 15 drops to 10, drops to 5, drops to 1, gets vanishingly close to 0. and the closer to zero it gets, the more likely it is we're going to end up on the machines forever if by some miracle they're able to get our heart started up again. So if that's something you'd like to avoid, you can just specify that that you wouldn't want that, particularly on your living will, if you say if I'm in a coma or I'm permanently confused, or I'm permanently dependent, that's my big one. And, you know, if my wife has to change my, you know, change my diaper and has to feed me and all this stuff and I can't do anything, I don't want to be kept alive artificially.

You know, some states will have a rule that says you can't withhold artificial nutrition and hydration. So you get around that by saying, well, we're going to offer comfort feedings. We will allow the person to eat if they want and drink if they want, but we're just not going to do it via tubes. So, all right, so there you go. There's your, yeah, thanks, dude, for calling in about death and dying. Nothing more hilarious than a death and dying talk. And Dr. Steve's experiences treating the terminally ill. Okay, all right, let's see if we get something else.

Okay, that one is not supported. Oh, I know why. This person sent this in, as a different kind of file. The dude that called in about scabies that sent me the audio file, I'll get it on next week. Sorry. All right.

Dr. Steve, I got a quick question for you. I got my flu shot today. But before the lady stuck me with the needle, she said, oh, I got to find a way around your tattoo. Can you not get a shot through a tattoo? Thank you. yeah sure you can um that really shouldn't be a problem uh both uh intramuscular and subcutaneous vaccines can be given through a tattoo um and uh really should not be an issue so i'm not sure

why i think look there's um you guys are familiar with the Torah right and then there's the Talmud. So the Torah is the central book of, you know, what the Christians call the Old Testament, you know, first five books of the quote unquote Old Testament. And then you've got the Talmud, which was commentaries about the Torah and other things like that, you know, interpreting law and stuff like that. And then they eventually wrote it down. So you have this sort of parallel book. And in medicine we have the same thing. I'm just making an analogy that we have what is documented scientific stuff. And then we have this sort of oral history that is passed down from doctor to doctor verbally or nurse to nurse or doctor to nurse or whatever. One of these

that I encounter all the time is that morphine is absorbed through the mucosa of the mouth. So if you have someone that can't swallow, you can just put morphine in their mouth. and it'll be absorbed through the mucous membranes of the mouth. This is complete falsehood. It still has to be swallowed. The only reason that it works at all is because those people eventually swallow it. Now, if they've got a complete obstruction of their esophagus and they're just drooling constantly and it never hits the stomach,

then it won't work. And this has been demonstrated time and time again. But still, it's passed down from provider to provider. Oh, yeah, you can just do this. And it's complete BS. Okay? So it's sort of this parallel oral history, in this case, BS. And maybe the same thing in this is that that nurse was told by a nurse who was told by a nurse,

who was told by another nurse, who was maybe told by a doctor. You know, in the 1800s, don't stick a needle through a tattoo, and it's still being passed down. But that should be okay. I'm fine with not messing up my tattoo with even the tiniest scar. So, yeah, it's fine. Work around it. have a problem with that, but you can do it, whether you should is a whole other thing.

All right. Hey, Dr. Steve, I was listening to your recent podcast on lucid dreaming. Okay, yeah, we were talking about lucid dreaming and how to initiate same, and I've still not had much luck with it. Of course, I forget about it every night I go to bed, but anyway. I have this happen to me very regularly, sometimes as much as. as once or twice a week and then it might go away

for a little while and then come back and happen regularly again. It's very fleeting. It only lasts for maybe a minute or what feels like a minute or so in my dream. I will quite literally be able to say it to myself and be conscious of, oh, I'm dreaming. That's cool.

The question is, now, what I would ask him if he were here, so you know you're dreaming you're in your dream and you say I'm dreaming can you now say now I want to fly or I want to have intercourse with that person over there or whatever that's that's what I'm interested in is being able to live in this world where I am basically able to create my own reality be able to walk around in it interestingly though I still feel bound by the same rules of the yeah isn't that crazy this stupid dream world rules. The same stupid dream world rules where I can't ever have sex with anybody in a dream, if I get even close, then I wake up.

Bullshit, stupid dream world. World, I guess you could say. Or physics, it's not as if I can go outside and jump up into the sky and fly around like a bird. Well, what good is it then? Oh, I'm dreaming, but I'm still stuck here. How is it that gravity works in a dream? I had a dream the other day that

one of my kids fell out of a hot air balloon. It was horrified. This one in a dream is a nightmare. And I'm telling you the image of him falling. Of course, he landed and he was fine, which is great because it was a dream, modeled really the laws of physics. I mean, he was accelerating as he fell. I couldn't measure it to tell you it was 10 meters per second per second,

but it sure looked like it. It's quite interesting how that stuff's ingrained in our heads. It doesn't work like that. Like I said, it's very quick. but I am conscious of when I am dreaming. That is cool as hell. I'd like to talk about this more. Again, give us a call 347766-6-4323.

If you have lucid dreaming or sleep paralysis, I'd like to get that trucker duty thing going again. I had a trucker approach me on Twitter, and she's quite attractive. So I was trying to think of an excuse to have her on, and then I thought about the trucker duty things. and hotter than a gorgeous over-the-road trucker talking about taking a jump in a Walmart bag.

So we'll see how that goes. I wanted to play something for you guys, and I'm not really ready to play it all yet. And I don't think he wants me to play it either. But Dave Cecil was in the studio recently, and we're doing a demo for him for a, I guess it's another singer-songwriter competition or something like that. And he had a song that he did many years ago. And he never released, because he had somebody else sing it. And he was never happy with it.

So I'm going to just play you. I'll play you. And I'll have to talk during it so that you guys, you know, every once in a while I thought you know, uh-oh, there's Big Joe. Let's see what Big Joe's got going on today. Big Joe, you're on weird medicine. Are you there? Well, never mind.

Let's see if she calls back. Anyway, so he came up and we did a demo. You all may not be aware, but I have the podcast part of the recording studio, but we also do regular music on the other side. I don't play a lot of it over here. I get people complaining that we're doing music. That's why I do it at the very end. So you can tune out if you want to.

But go to our YouTube channel, and it's YouTube.com slash Lobsta Johnson, I think. It's L-O-B-S-T-A Johnson, all one word. Or just put Dr. Steve, Dave Cecil, see if that works. And we had him in the studio. He did an outstanding job. I thought I did a pretty good job recording him long. and you don't have to listen to my blabbering. You can just go to the comment section

and then click on the links that I put in there just so that you can just hear the songs. But check him out. And then here's his new song. It's called Running That Shine. It's not actually a new song, but it's just redoing it. And this is nothing more than the guitar

and his vocal and some effects. So in the middle, there will be a dobro. solo or something and there will be bass and maybe a fiddle maybe we'll see um but we'll this is just the early sketch but i'm very happy with how it turned out and um let's see what you think Brought up on nothing is how I was raised, but I tell you something, I won't die that way. Now, I made a man who taught me his rules. He said if I could drive, I never would.

lose. Now I'm running these backroads on time. With each tick of the clock means a dime, it don't matter if they say I'm wanting to find when I cross that borderline running that shine. You're listening You're listening to Dave Cecil on Weird Medicine The rumor has it Sheriff's got my plate Breaking his lawns It's me he does hate

He sets up them roadblocks Day after day Balsie will catch me But I'm miles away Because I'm running these backrooms on time With each tick of the clock means a dime It don't matter They say I'm a wanted to find

When across that border line Running that shine I want to change my way from bad to good Start a living man Way that I should All right, this is where the solo kicks in And that's where I'm going to leave you Always leave them wanting more

So we'll play the rest of the song when it's finished and we'll have Dave in the studio. We got really good response to him being here before. So you guys have a great week. Until next time, check your stupid nuts for lumps, quit smoking. Get off your asses, get some exercises. See you in one week for the next edition of Weird Medicine. Late one night came to fight, share for my tale.

A hundred twenty-five per hour, hear me, don't fail. Wine knees back rows like a few years. Thank you.