Weird Medicine: The Podcast - 406 - O Covid We Hardly Knew Ye

Episode Date: May 7, 2020

Dr Steve and Tacie discuss news of the day and review the "normal" adult physical exam and whether some providers today are just lazy. PLEASE VISIT: stuff.doctorsteve.com (for all your online shopping needs!) Feals.com/fluid (get 50% off your 1st subscription shipment of CBD!) simplyherbals.net (While it lasts!) noom.doctorsteve.com (lose weight, gain you-know-what) premium.doctorsteve.com (all this can be yours!) DEEPDISCOUNT.COM!  (new sponsor!) Learn more about your ad choices. Visit podcastchoices.com/adchoices

You're listening to Weird Medicine with Dr. Steve on the Riotcast Network, riotcast.com. I've got diphtheria crushing my esophagus. I've got Tobolivide from my nose. I've got the leprosy of the heart valve, exacerbating my incredible woes. I want to take my brain out and blast with the wave and ultrasonic. Geographic and a pulsating shave I want a magic mill All my ailments The health equivalent of citizen Cain 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 I'm Dr. Steve

With my little wife, Tasey The Queen of Mean, the Vicar of Liquor. She who, unlike Lady Diagnosis, will do absolutely nothing for a bottle of expensive wine, but will still demand it. Hello, Tacey. Hello, Steve. Do you like your new intro? Yeah, it's fun. It's fun.

This is a show for people who would never listen to a medical show on the radio or the Internet. If you have a question, you're embarrassed to take your regular medical provider. If you can't find an answer anywhere else, give us a call 34776-4323. Poo Head. Visit our website at Dr. Steve.com for podcast, medical news, and stuff you can buy, or go to our merchandise store at cafepress.com slash weird medicine. Most importantly, we are not your medical providers. Take everything here with a grain of salt.

Don't act on anything you hear on this show without talking to over with your doctor. Nurse, practitioner, physician assistant, pharmacist, chiropractor, acupuncturist, yoga master, physical therapist, clinical laboratory, scientists, registered dietitian or whatever. All right, very good. Do you know the story about why? diagnosis is introduced that way. No, I do not. Yeah, okay, you should ask her sometimes.

She did tell it on the air, but she apparently had a neighbor, and he kept bugging her and bugging her, and finally, apparently she agreed to show him her implants if he would buy her an expensive bottle of mine, and so we never let her live it down. And then she said, well, and then he just kept bugging me. It's like, really? No shit. Of course he just kept bugging you. I don't see her doing that.

I can't either. I think she's done things in her past, but she doesn't do anymore. She's quite delightful. She is. And she's really open to telling crazy stories like that too, which is really pretty fun. But she's so calm that I would never expect her to do anything like that. I think some of that is she's doing transcendental meditation now. And she's been doing it for a while, maybe even just right after you first met her.

I remember when she went, yeah. And I really think it's done something for her. So she keeps trying to get us to do it. And I tried to set us up and you have to go to this town, you know, 90 minutes away. And you've got to commit to all this time. It's just not happening. And do it. This is COVID-19 days.

Let's do it by Zoom. Can we not do that? I'll pay for that. I mean, yeah, why not? Why do we have to go there? I know. Why do we have to go there for them to teach us how to be peaceful and calm? They just lost customers.

So, yeah, they're stupid. Anyway, don't forget feels.com slash fluid. Feels.com slash fluid for 50% off your first order if you decide to do an subscription for broad spectrum CBD oil. It's pretty neat. Check out stuff. dot Dr.steve.com, stuff.com for all your Amazon needs. If you'll just use that every time you shop at Amazon,

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This isn't some namby-pambi, 5% off thing or free shipping with any order over X number of dollars. This is 33% off of your order. So if you buy three things, you get one of them free, if they're all the same price. Okay. And then noom. Dot, dr.steve.com. I'm all back in with Noom again because I talked about last time I backslip. it a little bit. And I'm all back in and my weight's coming right back down again. I'm very

happy. Good for you. The great thing I like about it is if my weight starts to creep back up, I don't freak out anymore. I just know that I've got a plan. And Noom is my plan. So Noem.doctrsteve.com gets you two free weeks and 50% off. No, that's wrong. 20% off if you decide to do the full three month program. It's less expensive than weight watchers. There's no points. It's not a diet. It's a psychology app. And it helped me in my real life, too, other than just my weight loss life. And, yeah, check out Dr. Scott's website at simply herbals.net. If you want archives of the show, which why would you? But if you do, you can go to premium.com and you can get all the archives of the previous shows for a

$1.99 a month. And it's, you know, so you do it for a month and you down. them all and then cancel it. It's totally fine. And you can also, on our website at Dr.steve.com, there's a place where you can purchase a thumb drive. It's a 32-gig thumb drive with 17 gigs of content from going back to show number one on Riotcast. And there you go. There you go. All right. Very good. Well, hello. Here we are again. Here we are again. What is this? Week 8 of this.

Oh, my God. And it's only Wednesday. It is only Wednesday. I know. It's something, isn't it? So, yeah, so I understand you're getting ready to take a trip, though. Yes, I am. I can't fucking take it here anymore.

And so I am going to go see a friend, and I'm going to fly to get there. Wow. So. I'm going to get the COVID. Well, you better not because I'm the one that's at risk. You're not because you are quite a few years younger than I am. But, yeah, so how do you feel about getting on an airplane? It's not the airplane.

There will be six people on your airplane. It's the terminal that kind of is the thing that's been bugging me, just the idea of it. Well, I plan on wearing a mask. We did have a friend who went to St. Pete. Remember, we talked to her yesterday. And she said that there's no liquor in the airports. That's interesting. I wonder why.

No alcohol at all. Is it because they don't want people congregating at the bar, or is it because they don't want drunk people doing stupid stuff? I don't know. I think that's interesting. She also said, what are you flying? I said American, and she said, well, get ready because they'll probably cancel your flight. Oh, God.

Which would suck without alcohol. Yeah. But she said it was like a ghost town. So. Well, okay. Well, we'll see. You can report back next time. We were supposed to report back this week on our foray into blood donation.

And that didn't happen. Conference calls getting away all the time. It's amazing. how supposedly we don't have anything to do except our days are packed with Zoom meetings. Yes. And then how lazy I am right now

is I don't have anything to do. I'm staring at my computer waiting on an email to come through. But if you add something to my schedule, it really just irks me. I just have become the most lazy person in the whole world. You just can't. Don't give me anything to do. I just can't.

I don't want to. I don't want to do it. Yeah. So, don't want to do it. I'll do whatever I want. Whatever. Whatever. I do it while I won't.

Well, all right. Well, you want to do some medical stuff? Or what do you want to do? Yes, I have prepared nothing because, like I said, I'm lazy. Okay. Me too. Okay. No questions for you.

No comments. And I probably won't pay attention. Fair enough. I wanted to, you had brought up this Kawasaki disease thing, which was very interesting and sort of disturbing, but I'm not sure what to make of it. This was symptoms of a rare inflammatory condition. And children, correct? Yeah, we're identified in 15 children in New York City hospitals.

And this, of course, alarmed pediatricians across the country and raised some concerns about a possible link to the coronavirus because, you know, there's this thing called coronavirus going around too. And so far, kids have been relatively spared from this. If you look at the age distribution, 10 and below, the numbers are so low as far as mortality to be virtually zero, although I know they're not exactly zero, but it's very close to being zero given the number of total cases. And then even going up to, you know, young adults, they seem to be doing very well with this. But here's these 15 cases, and they exhibited symptoms typically seen in a thing called Kawasaki disease or even toxic shock syndrome, which were things like persistent fever

and low blood pressure. Now, these kids were aged 2 to 15, and they were identified between April 29th and May 3rd, which is a very short period of time. They all had fever. More than half of them had a rash, abdominal pain, vomiting, or diarrhea. Well, you know, hmm, how often do we see fever, rashes, you know, vomiting and diarrhea during the regular year? But the New York Health Department said less than half the patients exhibited respiratory symptoms, which is interesting. and only four of these only, but four of them tested positive for COVID-19, 11 of them tested negative. So this could be completely unrelated.

Those four that were positive could be coincidental. So this could just be something else, and it's clustered in this small period of time. This is a question for epidemiologists to determine. The history of epidemiology started in England during a cholera outbreak. And there was a physician, and you could look him up if you wanted to. Look up this guy's name is like Featherstone or something like that. His name escapes me right now. But he traced cholera to a single well in the middle of London where people were getting their water from.

And this was the birth of epidemiology because it took some detective work. And contact, in his case, it wasn't really contact. tracing, but he was tracing people who got the illness and tried to find out what factors were in common. This says John Snow. John Snow, that's right. That's right, because you know nothing, John Snow. Well, he knew a lot.

That John Snow knew a lot. Thank you. And, yeah, so John Snow was the father of modern epidemiology. And they're going to need epidemiologists on this particular. whatever this is, I don't even want to call it an outbreak, this cluster of ailments to see if there's a common thread in there. And it's not COVID-19. That doesn't appear to be a common thread, at least not on the surface. And they don't tell what kind of tests they did on them. I'm assuming these were polymerase chain reaction tests that test for active RNA in the upper

respiratory tract. It doesn't say whether they did antibody tests. on them. So now if they all were positive for IGM and IGG antibodies for COVID-19, or for SARS COV-2, which is the virus that causes COVID-19, which is the disease.

If you remember, Tase, we talked about this before. IgM antibodies are the early antibodies, and IGG antibodies are the ones that persist after you've had an illness. That's sort of the body's immune memory. And if they had both of those, that

would show that these people tested negative because they had already started to clear the disease and were already forming those IGG antibodies, but they still had the acute phase antibodies. That would be very interesting to know. So we don't know anything about this. And I haven't seen this come up anywhere else. It's this one cluster during this one week in this one place. So I'm hoping that this has absolutely nothing to do with this pandemic. Because That's just what we need is more shit to worry about. More shit. So, but very interesting.

Vaccines, I'm getting more and more optimistic that we may have a vaccine by September, certainly by the first of the year. Now, why so? Well, because there are some accelerated vaccine trials going on. There's the one from Oxford, which. which at first I was discounting pretty significantly because they had demonstrated that their vaccine worked against rhesus monkeys. They had five rhesus monkeys. They inoculated them with the vaccine and then inoculated them with SARS-C-O-V-2 and they didn't get it. So that's pretty outstanding.

In a series of five monkeys, they had 100% effectiveness. And I'm like, well, that's great. except Moderna's already got their vaccine in phase one trial is getting ready to go to phase two. And so what's the big deal? Well, the big deal is, apparently with this Oxford vaccine, is that they were already studying it for other coronaviruses. And the safety studies have already been done. So they can maybe get rid of phase one and maybe even part of phase two or phase two altogether and go straight to phase three.

So theirs is sort of an interesting vaccine, rather than just synthesizing a bunch of spike proteins and throwing them in a vial and injecting them, they actually use what appears, and I'm just learning about this virus. So I may get this wrong to the virologists, but I'll be yelling at their, you know, the 1.2 virologists that listen to this show. Both of them. Right. So, yeah, there's two of them, but one's only listening sort of 20 with 20% of their brain. They are using a live attenuated approach where they've got a cold virus that has been relatively inactivated. And then they're sticking their DNA in this cold virus and somehow RNA and constructing a new live attenuated virus that will confer immunity to people.

So it still needs to be tested in humans, and we need to test it for safety and effectiveness. But as I said, the original safety stuff's already been done, so you could do some of this in the field. So it'll be very interesting to see how this works out. And then there are like 14 different vaccine candidates, and the federal government has started this warp speed. initiative to try to get a vaccine on the market as quickly as possible.

Because, you know, we talked last time about herd immunity, and that's the most painless way to get herd immunity in a population is through vaccination. It will also be interesting if the anti-vaxxers, some of those who may have been more politically minded rather than actually believing it should line up for a COVID-19 vaccine. Very interesting. So it will be very interesting. I'm not pumping my body full of chemicals mad. I'm getting that with this one, though, too.

I'm getting a little blowback on that. Some people say, well, I should just get the disease instead of pumping chemicals into my body. It's not chemicals exactly. But unless you, I mean, consider proteins to be chemicals. All right. So there we go. That's where we are on that. Fava-Pyrivere is a drug that was developed by Fujibir.

film, believe it or not. Well, I mean, who's using film anymore? They had to diversify into something. And they have a broad spectrum antiviral that inhibits RNA polymerase. So when you're an RNA virus, you've got to make copies of yourself, and so you need a polymerase enzyme to do that, and it inhibits that. And they've had some pretty good results in some small studies that aren't. as constructed as the, you know, to the quality that I would like to see, but they're getting

ready to do some broader trials. The great thing about this drug is it's already on the market. It's on the market in Japan for influenza. So they've already done phase one, phase two, phase three for influenza. So now they can jump really, just jump straight to phase three for COVID-19. Now, have we talked about the plastic? my thing. I don't remember, but we can. We can talk about that. That's one of the other new breakthroughs.

I just wasn't paying attention last week, and I don't want to bore people with, well, it's hard for me to pay attention too now because that, again, requires work. And like I said. Well, and it's your husband droning on and on and on. I know. No, I get it. Yeah, if you haven't discussed plasma, let's talk about it. Okay, so, yes, plasma. Oh, well, let me finish with this Fabapiramia.

Now I've got it, fami pypheraviravir. Okay. Shit, now I'm having a mental block. I've got to look it up, fami pypheraviraviravir. Favapiravapiraviravir. Favapiraviravir. There it is. I did pay attention to something.

Fabapiravir. Yes, okay, very good. It's a pill. Okay, so if it works, this may be the magic bullet that we were looking for. Now, let's say it's 90% effective. That's great. You identify someone with early stage COVID-19 in your office. They come in.

You do the test. You give them favavirpivir prescription, and they take it for, you know, five to ten days. and they don't go to the hospital and they don't die. If we have supplies and it works that way, then we can get these things down to... That's Rosie, everybody. Meet Rosie. Come here, Rosie. Rosie, come here.

Come here. Hush. Stop. You're goofy. Who are you barking at? Oh, is it Dr. Scott? Go get him. Go get him. Go get him. Get him.

Is he coming on up? No. I'm just trying to make her go. Make a run downstairs to go get somebody. You're listening to Weird Medicine. And though you will try to always get it right, the beauty of life lives inside of you. And I hope someday you find it too.

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become a member today by going to feels.com it's f-a-l-l-s-com slash fluid and you get 50% off your first order with free shipping That's F-E-A-L-S.com slash fluid to become a member. Get 50% automatically taken off your first order with free shipping. Feels.com slash fluid. You're listening to Weird Medicine. So you were asking about convalescent plasma? Yes, I was.

So when we are infected by, some organism. Let's say it's a virus. Let's just, I don't know, just say it's a coronavirus or something. And you recover from it. The reason that you recovered was because you developed an immune response to that virus and cleared it from your system. And the body is pretty perfect at doing that. Molecule by molecule, virus by virus, clears it from your system until there are none left. Now, that's not the case in herpes. and chicken pox, both of which are herpes viruses, because those retreat into a certain part of the body

that's not accessible to the immune system, which is the nervous system, but discounting those for the most part, that's what happens. And then you'll have these circulating antibodies that are around always looking out for the return of that same enemy, and if one of those antibodies or a group of them, recognize a foreign invader that sends out a signal to the immune system,

make more antibodies, mobilize white blood cells, come kill these bastards. And you can most of the time cut them off at the pass. And that's what immunity is all about. Well, you can take someone's plasma, which is the clear part of the blood. You take out the whole blood, take out the, you know, through a centrifugal, take out the clear part and put the red blood cells back in. And that'll be full of all the antibodies that they're circulating, including the ones to, let's say, this mythical, hypothetical coronavirus

that we're wanting to kill and other people. One donor can then treat three people. And the great thing about this immunity that you would receive from this is that it's long-lasting. I mean, it's not just you don't have to give people a, dose a day, you can give them one dose and it'll last for two months. And so you could use this on front line people, but now they're not developing natural immunity.

Now, if you give this to someone who's been infected and they're sick and giving them more antibodies will help them clear it faster, those people actually will develop their own immunity that hopefully will be long lasting. So convalescent serum is a great thing. there was a laboratory that just yesterday published a preliminary paper showing that they found a monoclonal antibody, and we'll discuss what that is in just a second, but it's an antibody, a human antibody, that will block SARS-CO-2 from entering human cells in cell culture. So they're doing this in a test tube. but they put the SARS-CoV-2 in there and they put a bunch of human cells

and lo and behold, in the presence of this antibody, they can't connect. So this could also be a treatment instead of having to have people donate convalescent plasma, you just make gallons of this stuff in the laboratory and ship it out and charge people for it. And it's a single blocking antibody, so you're not getting all this other co-factors

and all this other stuff that you get when you're getting plasma from somebody. So do you donate plasma? Can you donate it in like a blood donate place? Yes. Do you go to those really kind of scary places where you sell plasma? Or both? Well, you can do both. Let me see, because we've got a question about blood donation.

Let me see. Convalescent plasma donation. So let's just see. I'll put COVID in there just so we'll get something specific. Yeah, Red Cross. It says, here's Red Crossblood.org. And, okay, the FDA also has a website on this as well. Let me just see what they're saying.

In coordination with the U.S. Food and Drug Administration, that's the FDA. The Red Cross is seeking people who are fully recovered from the new coronavirus to sign up to donate plasma to help current COVID-19 patients. people who have fully recovered from COVID-19 have antibodies in their plasma that can attack the virus. Okay. They're saying the convalescent plasma is being evaluated as treatment for patients with serious or immediately life-threatening COVID-19 infections are those judged by a health care provider to be at a high risk of progression. So you will qualify if you're at least 17 years old and weigh 110 pounds. Check.

In good health, you generally feel well even if you're being treated for chronic conditions. condition, check, have a prior verified diagnosis of COVID-19, but are now symptom-free and fully recovered. So, yeah, so there you go. So they say on here, if you're fully recovered from new coronavirus infection, meet the above criteria, fill out the donor eligibility form below. And you can get this at red crossblood.org or just Google what I. I did, which was convalescent plasma donation COVID.

Now, let's see what the FDA is saying. It's probably the same thing. Yeah, okay, so basically they're doing the same thing. And then there's a bunch of different places. How can I donate convalescent plasma? Several resources are available. America's blood centers, American Red Cross, blood centers of America. Plasma donation places.

There's a national COVID-19 convalescent plasma project. Like, let's see what that's about. I'm clicking on it and it's going nowhere, so, okay. It's about nothing. Okay, so that is CCP19.org and enrollment for follow-up of treated patients. So there you go. So, yeah, there's all kinds of stuff on that. And then we're just waiting to see if this monoclonibody comes out.

You've seen these ads for, oh, I don't know, Tocelizumab or something like that. Anything, any ad that you see on TV with the words MAB at the end, where in the drug name, that's a monoclonal antibody. So what monoclonal antibodies are is where they've fused a basically immortal cancer cell line with cells that can produce antibodies. And so these things, when you fuse the two, they will continue to reproduce and continually produce antibodies. And so what you do is you take some antigen. Let's just say you've got a virus.

This is a real simplified version. You throw it in the vat with these cells, right? And now these cells start to produce antibodies. And you would then look for antibodies that you're wanting to preserve. Okay. And there's a lot of different ways that you can do. that. You can use a chromatography. There's methods where you put antigen in a dish, and then you see if it lights up, that means that there's antibody there to that antigen. And then you isolate

those cell lines that are producing that antibody. And when you do that successfully, and there's a whole technique for this. This used to be cutting edge science back in the 80s, and now they just use it, you know, as a tool. Once you do that and isolate those, then they will just continue to produce antibody over and over again. You can grow these things in big vats and just have tons of antibody produced. And I'm making it sound a lot simpler than it actually is, but it's a very cool technique to produce a single immune molecule that you can then use against disease.

So I'm looking forward to seeing that as well. Well, we really do want herd immunity. That's the answer to this, so that we don't have to keep giving ourselves antibodies and medicines and treatments and all this stuff. We want to just make this virus go away by not allowing it to attach to any enough hosts to keep it propagating through our communities. And the best way to do that is through vaccine. Yeah, the thought of living like this for two years, just really.

No, no. Think of this, though. So let's just say we achieve herd immunity. We talked about it last show. There's a formula for it. We figured out that if the number of people, each COVID-19 patient will, in fact, is around 2.2. And that's the estimated number right now with the data that we have. Then the formula is F, which is the fraction of people needed to achieve herd immunity.

equals 1 minus 1 over that number. So 1 minus 1 over 2.2 is like 0.45. So the fraction needed is 0.55 or 55% of people to achieve herd immunity. But all that means is we've gotten the R0 or the number of people that each person is infecting less than 1. So let's say we reduce it to 0.9. the epidemic or pandemic isn't over on that day that we achieve herd immunity. What that means is a thousand people will still infect 900 people, right? And then that 900 people will affect 80, you know, 810 people, et cetera, et cetera.

So it will decline over time and it will eventually decline to zero, but it doesn't mean the end of it just because we've achieved herd immunity. there will be a tailing off. All right. All right. Any other questions? Nope. Okay, that you can try to stump me. All right, let's do a non-COVID question for once.

That would be nice. For once. Hey, Dr. Steve. My name is Ken. I'm 54 years old, the way about 200 pounds, indecent health. Work out several times a week. Don't smoke.

Drink regular. Wait, indecent health? Mm-hmm. Or in decent health? But not to excess. My question has to do with my annual physical. My doctor retired a few years ago. He was in his late 70s.

The new doctor's younger, maybe in his mid-40s. When my previous doctor did my physical, I would get fully naked, and he would do a pretty thorough examination. Look up my nose, listen to my heart, fondle my balls, stick his finger up my ass, all that fun stuff. For God's sake. With the new guy, I don't even take my shirt off. All he does is take my blood pressure, read my EKG, and look at my blood work.

It's not that I miss the digital raping from the old guy. Yeah, I know. It's just that I feel the new guy is not doing a thorough job. Has blood tests advanced to the point that the old methods are no longer necessary? Appreciate it. Like the show? Thanks, man. I'm very interested to hear what you have to say about this because, in my opinion, the new doctor is lazy.

Okay, so he or she may be lazy, but they may also be adhering to the U.S.PSTF, which is the U.S. something of something for screening. I can't remember. You know, what is wrong? And it's because I'm old. So we have this organization called the U.S.PSTF and it's preventative task force, right? And what they look at is evidence what things help prevent death and destruction and what things are useless, right? So my dad was old school. He used to do this thing called an executive physical every year.

And he would go to this hospital and they would spend a day in the hospital. He had a real funny story. They ran out of beds in the normal ward. And they put him in the psych ward. And he had to have this sticker, right? This was at Ford Hospital in Detroit. and he had to have this sticker for what part of the hospital that you're in. And so he would go stand in line, say, for the EKG.

And he had this sticker that said, that, you know, indicated that he was from the nutbag ward, right? And everybody'd get out of his way and say, oh, no, you go first, you go first. And he'd like, no, no, no, I'm just, they just put me back there. You know, I'm fine. I'm fine. And they were like, sure, sure, now, don't get excited. So that was a pretty funny story. but they would do EKGs, they would do treadmills, they would do all this stuff.

And what we found is that there is this thing called pre-test probability. And pre-test probability is just exactly what it sounds like. It's the odds that you're going to have the disease before you do the test. And what we found is when you have a very low pre-test probability for something, And then you have this test that looks for this thing. The odds are much more likely you're going to have a false positive than a true positive. So any positive test you get doesn't really say that you've got the disease. It's just because of the way the math works.

So like a treadmill. If you take an 18-year-old kid and put him on a treadmill, there is a small possibility he's going to have a positive test. but that will almost surely be false positive because his pre-test probability is as close to zero as you could possibly get. So screening people using a treadmill without taking into account what their probability of having heart disease with is completely useless. Okay, I get that. What about listening to the lungs? Yes, I'm presuming that they are doing that. You can do that over the shirt.

It's kind of dumb. We're taught to do it skin to skin. but you could do that, but yes. It doesn't sound like that guy's getting even that. Well, let me tell you what the USPSTF recommends in somebody in his group. Okay. So blood pressure should be measured at each visit beginning at age 18. And they recommend annual screening for adults age 40 years and older

and for those who are at increased risk of high blood pressure. And people that are at risk of high blood pressure, people with high normal blood pressure, people who are overweight or obese, certain gender and racial groups could be higher or lower risk, and so they recommend that. Women, they recommend breast cancer screening beginning in their 20s, you know, be told about the benefits and limitations of breast self-exam, but that doesn't apply to this guy. So, and he doesn't, you know, they have some guidelines on cervical cancer screening, but again,

this is a dude. I'm just going to go through his, and we can talk about what women do. Cholesterol screening, that cholesterol screening should begin based on your other cardiac risk factors and any desire to be screened. So they do a 10-year risk and then calculate, you know, if you're at moderate to high risk, You should have your cholesterol screen. If you have a family history of early heart disease, diabetes, immediately you should do it. But screening may begin in non-pregnant adults at any age, but no later than age 40.

Okay. Now, colorectore cancer screening. How old did he say he was? Was he like... Let's run it back and just listen to the beginning. Hey, Dr. Steve. My name is Ken. I'm 54 years old.

Okay, so 54, beginning at age 50. Both men and women at average risk for developing colorectored screening should use one of the following tests. Either a flexible sigmoidoscopy every five years, a colonoscopy every 10 years, a virtual colonoscopy. And those are not as, you know, the gold standard is colonoscopy. And or you can also do tests that mainly find cancer. which are tests like fecal occult blood testing, which is a really terrible test. It's not sensitive nor specific. Or the DNA test, which is the Kola Guard, you know, every one to three years.

And it should be considered early or more often if people are at very high risk. My God, do you sell, like, crack? I've never heard anybody's phone go off so often. And so then there's counseling. There should be counseling done. None of this has anything to do with sticking a stethoscope on somebody about alcohol misuse, unhealthy use of drugs, violence, dental health, smoking, diet and exercise, that kind of stuff, right? Screening for depression.

I feel like people want to get their money's worth and need to at least have hands laid on at some point. Yes. Now, there are studies that show that people feel like they got a better value out of their office visit if the provider touches them at some point during the exam. I would believe that, yes. Human touch is a thing. Right now, we're not touching people as much. Yeah. You know, we're certainly not shaking hands, although I'll still listen and all that kind of stuff and I'll wear a mask when I'm actually examining somebody. more to keep me from infecting them if I'm asymptomatic than forgetting something from somebody. I saw a great meme, by the way, about masks.

Let me explain how masks work. And it said two people are standing in front of each other and they're both pissing. And now they're pissing on each other's leg, right? Now, if I wear my pants and you're pissing, I will block some of the piss from hitting my skin, but I'll still get wet. You may have said it to me, but if you're wearing your pants, your pants get wet and you don't piss on me. So that's really the value of a mask at this point is to prevent asymptomatic people from transmitting it to somebody else. So let's look at some of the other screening things, screen for depression, screen for eye disease, screen for hearing, do a heightened weight. You know, when you go in, they check your height and weight.

Are you obese? Is your BMI greater than 25? And then asymptomatic adults without known liver disease should maybe be screened for hepatitis C at some point in their life. Anyone who's ever injected illegal drugs or anything like that received certain clotting factors before 1987 should be checked for hepatitis C. And then a history and physical. Now they say a complete history and physical, and this is where this guy's question comes in. the discretion of the practitioner and patient. So that means, you know, getting out your stethoscope going from head to toe, okay? And that's what this guy isn't getting.

And, you know, testicular prostate cancer screening can include a digital rectal exam, but can be done by blood. And it's not perfect because no one can know through either a blood test very accurately. or a digital rectal exam, whether a cancer that you have is fast-growing and is going to cause problems. If you take 70-year-old men and do an autopsy on all of them that did not die of prostate cancer, about half of them will have signs of early to late prostate cancer. It's crazy. Syphilis screening, testicular self-exam is not recommended because the uncommon nature of the condition, the high cure rate when detected, which is interesting, although I do recommend it.

I say, check your stupid nuts for lumps. Every day at the end of the show, that's mostly for young men, and the young men are never told about this stuff. Why? I don't know. I mean, women are told about self-breast exams all the time, but young men, it's constantly. If anybody ever counseled you on checking your nuts for lumps? No, I've never heard of it.

And every year in October, when we do our yearly Check Your Stupid Nuts for Lumps show, I'll get one or two people saying, hey, I found something, and I went to my doctor, and it was the thing, and they took it off, and I'm fine. Which is why all this silly nonsense that you do is so worth it. That's right. That's right. Yeah, and that's what I'm going to say, if anybody says anything to me about my extracurricular activities at work. We have actually saved lives on this dumb shell. So anyway, the old school sort of executive exam has gone by the wayside to a certain extent. And we've gotten down to certain things that have good evidence that they prevent, that they prevent disease, mortality, and death down the road.

And those are the things that we're concentrating on right now. So don't smoke. Get your cholesterol checked. If you're diabetic, get your sugars under control and follow your diabetes. You can cure type 2 diabetes, but it's so uncommon because it's so many people have difficulty actually following the diet that they need to follow. And a lot of nutritionists don't know how to counsel people to stop eating the things that they'll still. I've been in the hospital and people have been on diabetic diet and there's mashed potatoes and there's orange juice and stuff. There's just less of it.

It's like let's counsel the high green leafy vegetables, lean animal protein and, next to zero-carb diet and see how many people we can cure with type 2 diabetes, but that's a different show. So if you were to do a physical right now, yes. Would you lay hands on the patient? Yes, of course. I would look in their eyes.

I would have them move their eyes, make sure they've got extraocular movements in day. I would look in their mouth and their nose. And what are you looking for when you do that? You're looking for tumors and say, you know, you might see one or two things in you. your career. Let's just say I heard of somebody once that looked in somebody's mouth during a routine physical and said, why do you have two tongues? And the person said, what the hell are you talking about? And this provider, let's say his name rhymes with Schmeave, said, why don't you look in the mirror and tell me what you see? And the patient looked in the mirror and said,

wow, yeah, I do have two tongues. What do you know? And that, and that, and up being something like a lymphoma or a tumor or something like that. So that's what you're looking for. You're looking for any kind of white spots or any gross that are abnormal. A thorough exam of the head and neck would include a bimmanuel exam. You know, when you have your pelvic exam and the person's got two fingers inside you and a hand outside poking around, what they're looking for is trying to find your ovaries and get them between those two hands and poke on them and see if they feel smooth or lumpy and feeling for any sort of extraneous masses

or anything like that. In my career, I've found one mass that way. So this is very low yield, but it's also low invasiveness, too. You're just looking, you know? So any of these sort of screening tests that don't require a lot of invasiveness, you might as well do them while you're there.

And they take two seconds. You look in the mouth, you look in the nose, you look in the eyes, feel the throat. you get behind the patient and you pull apart their neck muscles and then you'll take your hand and put it, I'm doing it to myself, can you tell, and you put it on their thyroid and have them swallow and then you can feel thyroid nodules that way. And then you do that again on the other side.

You feel for notes in the neck. That's screening for lymphoma. You feel for nodes above the clavicle. So you're starting at the top and you're working your way down. And looking in their hair and feeling their scalp and looking for lumps there as well, feel for nodes under the armpits. You're going to listen to the heart and lungs. You'll palpate the abdomen.

You're looking for liver. So you look under the right side of the rib cage. You're looking for an enlarged liver. Under the left side of the rib cage, you're looking for enlarged spleen. And then you're feeling, can you feel an abdormic aortic aneurysm? Well, now let's listen. Can you hear blood rushing through the abdomen? If so, there may be an aneurysm in the abdomen,

in which case, then you would, that's your screening test. You would do a more specific test like an abdominal ultrasound. Then as you work your way down, you're going to feel for pulses in the wrists, pulses in the feet behind the ankles. Feel for pulses in the groin. You can listen to the pulses in the groin. Are there any wishing sounds there? Are there any wishing sounds in the pulses in the neck?

You know, that would indicate stenosis or narrowing of those vessels that would require further look. Then you get the person up. If it's a male, you invaginate their scrotum, which sounds horrible. But what you're really doing is you're taking their scrotum and you're putting your finger at the part that hangs down the most. And then pushing up past the testicle to kind of make an inverted glitone. love, right? And you're sticking your finger up into the inguinal canal feeling for a hernia or masses. Get them to turn their head and cough. Why do they turn their head? So they're not coughing on your stupid head. That's the only reason, right? Or you can just have them bear down.

And then you do that. And then you feel the testicles. You feel for lumps, hydrazules, any sort of masses in there. Make sure that the testicles are both there because sometimes you'll have someone that's got a retracted or a non-descended testicle, they're at higher risk for having a testicular cancer. Then where are we? So we're in the, oh, then your rectal exam, you have them bend over. You stick the, you know, obviously put a glove on, loop it up, stick your finger up and press down toward the ground if they're bent over on the table in front of you. And what you're going to feel there is this sort of rubbery walnut shape thing. and that's the prostate, and this is in a male, of course.

And you're looking for masses or enlargement there. And as your finger comes out, there's going to be stool on it most of the time. You put that on a hemacult slide, put a little drop of develop around there and see if it turns blue. If it does, that's a sign of blood in the rectum. It can come from a million different things, including you sticking your finger up their ass. And then work your way down, check the joints. Are there any effusions redness of the joints?

You're looking at the skin the whole time. Are there any melanomas or irregularly pigmented, weird-shaped things or cysts or anything? Ooh, cysts that you can then cut out later and then work down to the feet and look for abnormalities of the feet. And that's a complete sort of physical exam. I probably skipped some stuff. I mean, that sounds more thorough than what I hear people get. these days. Well, that is a thorough physical exam that's pretty easy to do.

It only takes a couple of minutes to do. But none of that, because as I said, it's so low yield. So the under the tongue, say, mass, I found one, maybe two in my career. Some of those things that I was telling you about, you know, finding thyroid nodules that I didn't know about before, that's very unusual, maybe one or two in my career. So when you're talking about a 35-year career, they're very low yield, but they're also just take two seconds to do, so why not do them? But they're not required, and they do, not doing those things has not been shown to increase mortality or morbidity in a statistically

significant way. And that's why the USPS or USTS-TF has paired it down to these things that are essential to do. And that's what a lot of doctors are doing these days. Okay. That makes sense. So it's not necessarily them being lazy or four. No, it's just, you know, they're training them a little different. You know, what's the evidence show that's really going to benefit the patients? Now, obviously, if you look under somebody's tongue and you find a lymphoma or some mass under there, you've done them a great service. But, so that's why I would do it because I'm old school. Hell, I'm old, you know. But I also understand the wisdom of not doing a whole lot of things that really don't have any value, like my dad's executive physical, all the stuff that he did

back then did nothing to really show that he was healthy or not healthy because his pre-test probability was so low that it wasn't really worth doing. You know, that's why we don't do screening EKGs on people, you know. And you could think of a bunch of other things that we don't do, is screening treadmills. We don't do that. You've got to have a pre-test probability of around 50, at least 50%, before we'll put somebody on a treadmill to look for cardiac disease. Because otherwise, the numbers don't work out.

You know, if they've already had a heart attack, right? Okay, so they've had a heart attack. You know they have coronary disease, and then you put them on a treadmill. What's that going to do? If it says they don't have it, are you going to believe it? No, you know they have it. And if it says they have it, it's just telling you what you already knew. So there are some reasons to put people with heart disease on a treadmill,

but it's not to diagnose whether or not to screen for whether or not they have heart disease. Okay. All right, cool. Let's see here. Oh, this, we've got just two minutes left. This is about those drug discount cards. This pharmacist called in about it. I wanted to play this and see what he had to say.

Hey, Dr. Steve, I'm a pharmacist, and last week you asked why Medicare D. does not accept the coupons. The reason why is that these are used for more expensive brand name drugs. Okay. This, I, um, what, what he's talking about is these discount cards that you can get, like if you go to, I don't know, um, you know, Amatiza. not calm or something like that. And then you can get a discount card for this branded drug.

And so he's starting out saying it's because they're for the branded drugs, which is true. That's right. Yes. A lot of times, these are of little or no advantage to the cheaper generics, which are currently on the market. When we use these coupons, it perpetuates that cycle of a direct-to-consumerance, which is part of why here in America we pay, as you know, twice as much health care dollars as anyone else but we don't live any longer. Your pharmacists can use a discount coupon for any Medicare DRX, but it won't go directly to your deductible, and so you need to contact your third party and figure it out with them.

Okay, I kind of disagree with this. We don't have a lot of time, so let's save this until next time. I'm going to save his call, and the reason I disagree with it is there are certain branded drugs. Let's say REListore is a good example. Rillistore is methyl-naltrexone. It's used for opioid-induced constipation. And there really is no generic equivalent of that. No.

So there's not a cheaper generic drug that would work. He may be of the opinion, though, that it's no better than polyethylene glycol. Okay, so polyethylene glycol being a brand name Miralax is an osmotic laxative. But we use this stuff for people who are refractory to that stuff. And so all they're doing is just making it so Medicare patients have to pay this huge co-pay and everybody else gets a free ride. Yes, so I disagree with his argument. But everybody has different opinions when it comes to drug. I agree.

And you know what we ought to do is we have a really good friend who's a pharmacist and he's pretty balanced of mind. Let's get him in here and see if he can answer some of these questions. I think that'd be a great idea. I do not want to get into the drug costs and health care costs and all that stuff. My God, that would go on for a big farmer man. That would go on forever and just, it just doesn't do anybody any good. No, everybody's got their opinions and they're not going to change them. I want to save people money and those.

A coupon would do that. The coupon will do that. You say coupon. That's interesting. I say coupon. Yeah, I heard you make fun of somebody who said that the other day. You said coupon, really? That's how I say it.

Yeah, I thought, there you go. C-O-U. So is it a chicken coop or is it a chicken coop? Oh, are you cool? No, I'm just asking. I don't know what's right. It's a chicken coop. Right, that's a chicken coop.

But that's C O-O-O-P. So let me see if you're going to recoup something, that's C-O-U-P, right? It's interesting. I don't know where that coupon came from. So we'll have to, let's look into that too. We'll bring that. Maybe my mother. You know, I don't know.

Rebate. How about that? Well, you'd say all kinds of. kinds of stuff, if it was your mother. She calls it the Walmart. Does she say credit? She may say credit and vomit. But you don't say those things.

No. You know how to say them. Yes. So, yeah, I'm going to look that up, too. I'm going to wear that. Oh, yes. Please do. Look it up.

I can tell you're thrilled. What else? Okay, so, yeah, we'll do that. We'll get our pharmacist friend in here next time. And we can social distance. We'll have him sit there and you can sit next to me, and then we're six feet away, that table's six feet long. There you go.

Or actually, next week I won't be here, so maybe... No, I want you to be here for that. Don't you want to be here for that? Oh, okay. You're so sincere. Well, thanks. Always go to Tacey. We can't forget Rob Sprantz. Well, we can.

We can forget Rob Sprantz. Bob Kelly, Greg Hughes, Anthony Coomia, Jim Norton, Travis, Teft, Lewis, Johnson, Paul O'Charsky, Eric Nagel, Roland Campo, Sam Roberts, Pat Duffy, Dennis Falcone, Matt Kleinshmidt, Matt Hoffman,

Ron Bennington and Fez Wattley, who supported this show, has never gone unappreciated. Listen to our SiriusXM show on the Faction Talk channel. Serious 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. Until next time, check your stupid nuts for lumps. Quit smoking, get off your asses, and get some exercise. We'll see you. one week for the next edition of weird medicine. Goodbye.

Okay, I'm answering. Thank you.