Weird Medicine: The Podcast - 407 - Let's Get Physical

Episode Date: May 14, 2020

Dr Steve and Tacie discuss the perfect physical exam, new covid-19 drug trials, and more. 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 need to touch it. Yo-ho-ho-ho-ho-ho. I'm in the carri-de. I've got diphtheria crushing my esophagus. I've got Tobolabovir stripping from my nose. I've got the leprosy of the heartbound, exacerbating my infectable woes. I want to take my brain now, glassed with the way.

an ultrasonic, ecographic, and a pulsating shave. I want to magic pills. All my ailments, the health equivalent of citizen cane. And if I don't get it now in the tablet, I think I'm doomed, then I'll have to go insane. I want to requiem for my disease. So I'm paging Dr. Steve. Dr. Steve. It's weird medicine, the first and still only uncensored medical show in the history of broadcast.

Now a podcast. I'm Dr. Steve with my delightful wife, Tasey the Queen. of mean, the vicar of liquor, she who unlike Lady Diagnosis, will do absolutely nothing. Nothing. For a bottle of expensive wine, but will still demand that I buy it for. Demand it. This is a show for people who would never listen to a medical show on the radio or the internet. Hello, honey.

Hello, Steve. If you have a question, you're embarrassed to take to your regular medical provider. If you can't find an answer anywhere else, give us a call at 347-76-4-3-23. That's 347 Poohead. Check us out on Twitter at Weird Medicine. Visit our website at Dr. Steve.com for podcasts, 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 you hear with a grain of salt. Don't act on anything you hear on this show without talking over with your doctor, nurse practitioner, physician assistant, chiropractor, yoga master, acupuncturist, physical therapist, clinical laboratory scientist, registered dietitian, whatever okay um very good so don't forget to go to stuff dot dr steve.com stuff dot dr steve.com for all of your amazon needs really makes a huge difference and thank you for using that anytime you go to amazon and tweakedaio.com I had a person email me today saying they had a sale at tweakedaio.com they got x number of percent off

then they used offer code fluid and still got 33% off that. So those people are crazy. And by those people, I mean the people at tweakeda audio.com. I've never seen anybody give away a discount like that, and their stuff's already really reasonably priced. So check it out. Tweakedaio.com for the best earbuds for the price on the market and the best customer service anywhere, bar none,

use offer code fluid for 33% off your order. If you want to get to your ideal body weight while you're sitting there eating and drinking too much during self-isolation, go to noam. Dot, Dr. Steve.com. It's N-O-O-M as in Mary. Dot, Dr. Steve.com. And it's a great weight loss program, but it's not a diet. It's a psychology program. You'll get two weeks off and 20% off if you decide to continue, and it's only a three-week program, or a three-month program.

Yes. I'm going to need some tweet audio earbuds for my trip tomorrow. Oh, really? Okay. Well, I bet. You bought me some for Christmas, but I haven't seen them. I think they're, they've been confiscated. You think the boy's got them?

Yes. Well, I'll get you some. I'll get you some today. Just remind me when we get up. Oh, I also am going to need some things downloaded onto my iPad. No problem. I can help you with that as well. I'm also going to need a ride to the airport.

You got it. Okay. That I can do. And I'm also going to need some money. Oh, whatever you like, honey, I'm there for you. Check out Dr. Scott's website at simplyerbils.net, too. If you'd like archives of this show, you can go to Dr.steve.com. There's a link there for $30.

You get a 32 gig. flash drive with 17 gigs of shows. Who wouldn't want that? I don't know why anybody would want it, but we've had a few maniacs get it, and I appreciate it. Let's talk about Mother's Day real quick. I made you a strawberry cake.

You are the best Mother's Day giver of all. My day was so glorious. I had gumbo. I had strawberry cake with cream cheese icing, with real strawberries in it. Yeah, it was the first cake of it were made in my whole life. I had attention. I have a Mother's Day necklace that was homemade by this lady who makes jewelry and it's beautiful.

You could say her name. I guess we can give her a plug. I can't remember her name. It's Kyle Light Lester. Let me see. I don't know how to spell her last name, though. I don't either. I think it's L-E-S-T-E-R.

L-E-I-S-T-E-R, maybe? But she only sells stuff at the one place and then everybody knows where we live, yes. Okay, so. So it's Kyle Leicester, Leister, L-E-I-S-T-E-R, all-one word.com. And you can just look up Art of the Jewel. Oh, God, look at that. Oh, I'm glad you didn't want that one. Oh, I do.

I'm going to next year. And she does custom jewelry, and it's crazy-looking stuff, and it's really, really cool. And anyway, so, yep, that was good. And that was the first cake I ever made. It was fabulous, and I can't believe you've never made a cake before. I'm quite the amateur chef, but I've never made a cake before from scratch. And, you know, I've made pancake, not, well, pancakes, but cakes in the, what do you call them in the tray, sheet cakes? Cakes of pan.

Cakes of pan. I've made those before, but I've never actually made a layer cake from scratch. And it was fun to do, and I saw a lot of things that I could do better next time, including how to frost that damn thing. That's difficult. Did those dang kids eat the rest of that? No, there should be two pieces left to there. Okay, I'm going to be pretty pissed if it's gone. Yeah, now, cheesecake, I got it figured out, but cake cake, very difficult for me, or, well, just a new thing.

So I look forward, and if you know anybody that needs me to make them a damn cake taste, let me know because I'll make it for them. Me. Of course, if you keep making cakes and cheesecakes, then we're going to be talking about weight loss every freaking show, which is what we should be talking about anyway. Noom.doctrsteve.com. Noom.doctrsteve.com. So, yeah, let's talk about you participating in reopening by flying tomorrow. Now, our buddy Dave Landau has been flying to Detroit to see his family every weekend.

And so far so good, no problems. So I think a lot of the airports are pretty quiet. our friend Dan, who is involved in air traffic control, says that their volumes have been down, but I think they're starting to pick back up again some. I've been reading a lot about how they're canceling flights, so that would be great. I've also – I did get an email today saying that you are required to wear a mask, so I do feel better about that. Good. Well, that – right.

And again, the mask isn't so much to – protect you from other people, it's to protect other people from you. If you happen to be an asymptomatic carrier and you cough into the mask, presumably it will reduce transmission to a certain extent, and even a small percentage will help. When there were only 100 cases in the United States, it didn't make sense to wear masks. That's why they recommended people don't wear masks in the early days of this. But now that we've, you know, we've got thousands and thousands and thousands of cases, it does make more sense, particularly with the presumed high asymptomatic rate, wearing a mask in a place like an airport or in an airplane, hopefully will reduce transmission. So, why didn't

she just drive? Well, my friend that does this drive a lot said that she has had. trouble finding bathrooms in gas stations on the interstate. Okay. The bathrooms are closed. Yeah. And that is not something a 40, I don't know, six-year-old woman wants to deal with on the interstate. If I have to pee, I have to pee. I can't.

Yeah, it's not like you can just hold a Coke bottle up like a guy can. No, and I can't drive around. I mean, I would just pee on myself. I just kind of, it's so it's worth the ticket to me to do that. And plus, with all the uncertainty. going on right now, I really was a little bit afraid to drive. You know, everybody says, well, I can get there in six hours. I just don't think so.

I've never gotten there in less than seven and a half, but that's just what people say. Well, that's reasonable. So what I want you to do is to take some, you can't take the big thing of Chlorox wipes, but you could put some in a Ziploc. Okay. And if you have to go into the bathroom, you know, use them. judicious or not judiciously, liberally in the stall. I'm sure in places like airports, they're cleaning those bathrooms pretty frequently, but still, you know, people are gross.

Yes. And I hear, I've never been in the women's bathroom, but I hear women aren't that much better than men as far as just being gross in the bathroom. Sometimes not. I do have to say, most of the time, they really do keep the airport bathrooms clean. and they have those little things as you go out that you can touch and rate the bathroom touch the bathroom

wall as you're walking out no thank you it should just be nice and that's how it is and you shouldn't have to rate it that's hilarious yeah you just wash your hands and now they want you to touch this thing that other people who haven't washed their hands have touched and they took the doors out

so you wouldn't ever have to touch a door because people are nasty. So they took the doors out of the women's bathroom? Well, I mean, to go into the bathroom. Oh, okay. You know, you can wash your hands and walk all the way up. That's not what I thought you said at all. Yeah, not in the stalls.

That'd be hilarious. A bunch of people just squat and hey, how's it going? But, yeah, they're touchless entry, but just by having sort of a labyrinthine entrance, you don't have to put a door on it. I mean, I have the kind of anxiety. that alcohol won't kill. You know what I mean? Yeah.

Well, you want to do some square breathing? No. Okay. I just drink this one here. Okay. We have talked about square breathing for anxiety before. And one of my favorite apps that incorporates square breathing is Trip. It's a virtual reality app on Quest and,

Oculus Go. That's right, everybody. You heard that. We're big into virtual reality here now. We sure are. Well, we certainly are. But the trip app

is very therapeutic, and it's inexpensive, and you can actually, and I get nothing for this so I can say this without looking like I'm biased in some way. They liked

the interview that we did with their founder so much that they put out of code. use the code DR Steve, DR Steve, no spaces, Dr. Steve, no spaces. You get 20% off and it's already inexpensive app and they change it every day. And if you're having anxiety, the trip app is a great app to non-pharmacologically and non-alcoholically decrease your anxiety state. No fun.

Yeah. Yeah, it's so much fun to get hammered and then wake up with a hand. with a hangover. Yeah, at 4.30 in the morning, so I need to be very careful. Okay. Yeah, I guess I'm driving you, too, right? Well, you said you were. Well, I will.

He's such a nice man. He is driving me at the crack of dawn to the airport. Yeah. He doesn't have to do that. I would call it the crack of ass. It's very early. And, yes, but I have stuff I need to do tomorrow, so that'll force me to get up and do some things before the day gets started. So I'm totally cool doing that.

Thank you. All right. Well, thank you. All right. Do you have anything for us this week? Or are we just going to proceed? Okay. I'm not your little puppet anymore. Okay. You're listening to Weird Medicine. Hey, Tase, let's take a minute to talk about a new sponsor to the show. Deepdiscount.com. It's a great site to buy movies, TV shows, music, and so. much more at really great prices. I'm talking classics from back

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I love Blumhouse and I can't get enough of it. Yeah, theirs are just kind of fun. They are fun. They're just fun. I mean, you know, they're not the most intellectual thing, but that's not what you're always going for. Are they not? Would you, that would be interesting if they had a very literary Blumhouse film. I don't know what it would be.

I mean, a scholarly horror movie. I don't see it. Blumhouse's Richard the 3rd. If it is Blumhouse, I am all in. And they've got another Blumhouse movie, Truth or Dare, out. Is that right? No, I have not seen that. I do not think that I have either, and I do think that we must.

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You're listening to Weird Medicine. Number one thing, don't take advice from some asshole on the radio. Well, let's just answer some questions for once, then. How about that? I do have one thing that is not an audio question. Someone emailed, and it wasn't really a question. It was a statement, and it was an awesome statement. They said that Henry Ford Hospital is Henry Ford Health System in Detroit,

which is where I was born, by the way. They're doing a thing called WIP COVID-19. And it's very clever. These trial names are always very clever. It's will hydroxychloroquine impede or prevent COVID-19? So that came out WHIP, so WIP COVID-19. It's a study. It's 3,000-subject look at whether hydroxychloroquine prevents frontline workers

from contracting the COVID-19 virus. It's a randomized, double-blinded study designed to produce scientific answer to the question, does it work? Henry Ford Health System is one of the region's major academic medical centers with more than $100 million in annual research funding, is also involved in numerous COVID-19 trials with partners around the world. A participation is completely voluntary, and their forums are on the website, and I volunteered. I'm just letting you know. I don't know if they're doing anything outside of Michigan. But I volunteered, and it's henryford.com slash whip, which is W-H-I-P-P-H-I-H-P-1-9.

And we'll maybe if I think of it, I'll put this on the website at dr.steve.com. And you have to fill out a form that took me literally a minute and a half to fill out, and then you give them your name and your phone number and email address, and then they supposedly reach out. out to you and let you know if you've been chosen to participate. So that's pretty cool. That's cool. Yeah. And then, of course, it says, will I get paid to be part of the study?

It says there's no compensation for being part of the WIPP COVID-19 study, which there should not be. These should be volunteers, not paid volunteers. Happy to do it on your own. Yeah. Well, and you may get active drug. You may get a placebo. You just never know. But you'll be advancing

human knowledge, which is a big deal. So, okay, so that's the whip thing. Let's see what else we got here. How about, oh, yes. Okay. So there was this trial of lopinavir retonavir, which is an HIV drug. In adults hospitalized with severe COVID-19, and it really showed no benefit.

It said this was a Chinese study. and they were all people who had a low oxygen saturation, and they were randomly assigned in a one-to-one ratio to receive either lopinavir retonevir twice a day for 14 days in addition to standard care or standard care alone. So there wasn't a placebo, but it was a comparison against standard care. And they don't tell whether they matched those. that cohort very well.

And it was 199 patients with laboratory confirmed SARS-COV-2 infection. And 99 were assigned to the Lopinavir group and 100 to the standard care group. And again, it doesn't show whether there was any matching done.

And in these hospitalized patients with severe COVID-19, no benefit was observed with this combination beyond standard care. Now, we have advocated for some time they should be looking at people who have early disease before they get to the hospital. Because if we wait until they get to the hospital, we're not preventing hospitalizations,

which is the whole reason that we're doing social distancing is to prevent an overwhelming of the hospital system, right? So we want something that you can treat people when they're early. Hey, I've got a fever and I'm snotting and I'm coughing. I have this dry cough. Hey, let's do a test. Oops, you got the IGM. antibodies or they've got the new antigen test, positive, just sort of like the influenza tests that we do.

Here you go. Here's your drug X that will prevent hospitalization and prevent death. When we have that, we're back to normal for the most part. You know, then we're back to sort of 2009 influenza pandemic, which we had treatment for that, you know, and a very few number, although a significant number. I don't want to minimize that, but comparatively speaking, few succumbed to that illness. So if we could get it down to those numbers, we go back to normal again. Anyway, so lopinavir retonavir was tested again with interferon, beta 1B, and interferon is a protein that's produced by the body in the presence of viruses

and other insults, which is hypothesized to be why you usually only get one virus at a time. You know, once you get one virus, you usually don't get another virus at the same time, although there have been some concurrent influences in COVID-19 cases. But anyway, and then they use this other drug, ribavirin, which is also an antiviral drug. And this phase two clinical trial, now phase two clinical trials look at two things. safety and effectiveness, but they're in very small numbers, was successful in treating mild and moderate cases of COVID-19. So this is from medical news today.

This three-drug combination shortened the duration of viral shedding. That is the period during which the virus is detectable in a person's body and transmissible to others. The results of this new multi-center prospective, however, open label, not double-blinded, randomized trial appear in the journal The Lancet. They recruited 127 participants and they came from

six hospitals in Hong Kong where doctors had tested them for SARS-COV-2 and obtained positive results. On average, five days passed between the onset of symptoms and the start of treatment with the drug combination and they randomly assigned 86 of the

participants to the group that received the combination and 41 to a control group. So it was like a two to one. Okay. The combination group, participants took a combination of these medications, and the treatment lasted for 14 days. In the control group, they did, oh, just the lopinavir and rotonavir, which we've already shown didn't seem to do much by itself. Okay. So the results revealed the three-drug combination was safe and more effective than the lopinivir-rotonavir combination. combination and reduce the period of viral shedding and shorten the length of hospital stays.

Specifically, they did some swabs of the nose that showed the average time before the virus cleared with seven days in the combination group compared with 12 days in the control group. And side effects were pretty much the same across both groups. This is a phase two study. but it's a good study for a phase two study. And one thing that they have to look at is, well, maybe it's just the ribavirin, or maybe it's just the interferon that's doing it. Maybe you don't need this HIV drug at all.

So, you know, they're going to do some other studies on that as well. So we just study everything. And they'll be going into phase three directly, and we should have some phase three results in about three months. So, all right, not the knockout punch that we were hoping for, but at least something positive. Still looking for data on Favapiravir, which is the thing I'm sort of really hoping for right now. It's a single pill. You give it to people when they have mild disease, and if the studies show a good effect, again, we will be a lot closer to being normal while we're waiting for a vaccine, which will allow.

us to build up herd immunity quite quickly. All right. And all the anti-vaxers, don't worry about it. We only need about 55% of people to be vaccinated with this particular virus to get us into herd immunity. More would be a lot better, obviously. But if we have 10% of people that are abstaining, you know what? We'll carry the load for you guys on this one.

You know, when I think of an anti-vaxxer, I think just a fun, fun group of people. Yeah, they are fun. Just fun. Loads of fun. Loads and loads of fun. Yep. Yep. Going around, giving everybody stuff.

It's just fun. Giving people hell. Giving presents may not be things they want, but, you know, it's just great. Let me carry your burden. Thank you. Yeah. Thank you for the opportunity. Well, you know, on this one, I'm okay with that because I'll gladly stand in line and get the vaccine on this one.

Yes. And, I mean, I'm gladly standing in. line get the vaccine on all the rest of them. Now, when it comes to things like measles, where you've got an R-0, if you remember that number we talked about before, that's the average number of people each case will infect. With measles, the number is 12. And so when you have an R-0 of 12, you need about 95% of people to have antibodies to prevent outbreaks. And when you have, let's say, if you have a 10% of the population are not getting

measles vaccines now, we don't have that and we'll have continued measles outbreaks. We actually eradicated measles in this country. And this person called me a liar online because, oh, well, in that year when you said we eradicated it, we still had X number of cases. It's like, yeah, they all came from somewhere else. There wasn't. a single case that was natively transmitted that year, whenever that was, 2000-something. So measles is something we can eradicate, but we have to stay on top of it because when someone comes into our communities that is transmitting measles, they can transmit it. It's such a wildly communicable disease.

Or they take their whole non-vaccine getting family to Disney and touch and lick everything. It's not just their family. It's their whole group of, you know, their community that have decided they're not going to vaccinate. Yeah, they usually hang out and. Herds. Yes, herds. That's what I was going to say. It's herds.

Yeah. So, yeah, but on this one, if we only need, if the R0 for COVID-19 is truly 2.2, then we really only need a little more than half of the people in the country to get vaccinated. We'll be able to hit that pretty easily, I think. think so too i think anything more than that it'll it'll reduce the the duration of this pandemic exponentially what were you going to say i think everybody should pump themselves full of all the chemicals that they can find yep i ain't going to pump myself through all them chemicals yeah it's now they're not chemicals the the friend that we had the the baby who said she she didn't like the schedule of the shot so she she made up a better one yeah yeah no i mean i'm not

saying it's easy to watch your baby get five shots it's horrible and and the kid i mean it's it's the worst ever and there has to be a way for them on these kids like you and i remember we had to hold liam down and he's screaming because he didn't like being held down in the first place and then two or three nurses went at him with needles in both legs yeah do you remember that i do remember i mean how could you forget and i remember the same thing happened with beck it was Horrible. It's horrible. Yeah. There's got to be a way. And if we ever get Greg Poland, my mentor, who's at Mayo now, who is the country's premier

vaccinologist, and he was my mentor in residency, the smartest man I've ever met. And that includes my brother, who is a really smart S-O-B. But Greg Poland is, you know, one of these 250 IQ dudes. And he's got a great personality, which is insane. And he's, you know, an attractive guy, which is like, who's ever heard of this? God doesn't give with both hands. That's right. Well, in this case, well, there must be something wrong with it.

Something, yeah. Impotency. I don't know. I don't know. I don't know. Let's not start that. I can't say anything about that. That's Tacey saying that.

No, I was kidding. Of course. It's the one. Of course. He's a delightful man. I'm sure he satisfies everyone. one that he comes in contact with in every way in every single way but anyway that's something I'd like to ask him is why they can't take all these shots that these kids have to have put

them in one vial and just give them one shot I don't know I know I don't either so or figure out a way to give it orally because polio isn't given orling don't even get better I remember the last time that both of our boys got a bunch of shots and they were like 13 and 12 or whatever and and the first couple of shots they were cool with but then towards the end of the day they were like F this it was horrible and so we went and got ice cream after and it just wasn't enough to make up for it no I think I gave them both 20 bucks too it doesn't help no it's horrible here kid go buy yourself something nice if you've just been traumatized all right well anyway um

Where were we? I don't know. Oh, yeah, anti-baxers. They're delightful. Delightful, fun people. See, you're going to get me in trouble with the anti-vaxers the same way that GVAC used to get me in trouble with the intactivists. And you're sitting in his chair. I don't know anything.

I know nothing. I don't know what I'm talking about. It's just my own ignorant opinion. Well, he did it on purpose. Yeah. And he would even tweet to me, yeah, that circumcision, that's, That's awesome, right, Dr. Steve? And the intactivists are all, you know, this and that, right, Dr. Steve?

And you're sitting in his chair and he, his portrait is looking over your shoulder. Well, I could go on and on about that also. Because as, as when I was in college, I worked as a CNA and there's nothing worse than helping an 80-year-old man who has not been circumcised. Clean his penis. It hurts them. Yeah. But that's just, again, my ignorant opinion. I'm sorry.

Well, that's a very informed opinion, though, because you were there doing it. One thing is, for all the CNAs out there, if you retract someone's foreskin, let's say to put in a fully catheter. Fully catheter is a rubber tube that goes in the meatus of the penis, up the urethra, into the bladder. It's got a balloon on the end of it. You blow it up, and that keeps it in. And you can drain urine that way if someone's got some sort of obstruction or something like that. If you retract their foreskin to do that, make sure that you de-retract it. Because if you don't, there's a finite chance, particularly if they've got a little fymosis,

which is narrowing of the foreskin or tightening of the foreskin, that when you pull it back, it's going to start cutting off the blood supply to the head of the penis. It's just so many problems. then it will slough off. So just please, if you're going to retract one and put in a catheter, just de-retract. You've got to remember to do that. I used to have a protocol taste when I would do a digital block on someone's toe. You have to apply compression.

And a lot of people will use rubber bands, right? And so you're numbing up someone's toe so that you can take off their toenail. You have to numb the whole thing up. so you go at 10 and 2 with your needle and then you go circumferentially around the toe and you don't want to use lydicane with epinephrine because epinephrine we've talked about on the show is a vasoconstrictor and it will cut off the blood supply to the toe so don't do that the other thing is don't forget to take the rubber band off because if you want your patient's toe to sluff off after you've removed their toenail that's a great way to

do it like our cat do you remember when our cat had blood work and she's really furry and so they they had a band around her arm and um they didn't take it off and we didn't see it until her her arm almost fell off yeah yeah that was fun and uh fortunately now she's fine but she was pretty traumatized by that and for four years well the other thing that happened concurrently was we got a new puppy and he drove her crazy and those two things made that cat retreat to our son's room. And she didn't come out of there for, yeah, it was about four years. Four years.

And now she's back to normal and driving us crazy again. And I'm really glad that she's, you know, gotten over that trauma. That was awful. But, yes, you don't want your patient's toe to sluff off. So what do you do? You use a forceps and you wrap the, rubber band around the toe, but don't, not circumferentially, you kind of wrap it around, how can I say, like looping it around, so that if you let go of it, it would just fly off, right?

Okay. And then you clip it with foreskin, with your, yes, clip it with your foreskin. Flip it with, or God, clip it with forceps so that the forceps are holding it on and making the rubber band apply pressure to the toe. like a tourniquet. And that way, there's no way that a patient can put their socks on with that stupid forceps attached to their toe, you know, to the side of their toe. And you will never, ever be able to forget that you put that rubber band on if you do it that way. Well, that's good for me to know.

That's right. But if you just wrap it around like you would wrapping it around, I don't know, your finger or something like that, then you will forget it one time in a thousand. but one time in a thousand and somebody's toe sluffs off, that's bad. So you want zero times in a thousand for somebody's toe to slough. Why were we talking about that? Oh, we were talking about foreskins. Yeah.

If you retract your foreskin, de-retract it. Thank you. That's the PSA for the day. All right. Let's take a call here. I'm using a new program to play the calls. And, of course, it's not working. So let's see here.

Come on, you bastard. Oh, there we go. Hey, Dr. Steve. This is Albert from Albuquerque. Hey, Albert. How are you today? Good. How are you, man?

Great, great. Hey, I love your show and listen for a long time, first time caller. I thought this is interesting. I got a little bit of a family history. My oldest brother had a heart attack or two. Not a lot of heart issues in the family, direct family, all of my uncle, my mom's side, passed away of a heart attack young, and her father also. did. Okay. So in talking to my doctor, last time I saw him, I said to him, I said, you know,

should we be looking at anything in particular and doing a little more careful screening or anything in particular for me based on my family history? And he said, you know, he would like to see if I didn't mind paying for it because insurance won't pay for it, me get a calcium score. Yes. So for 130 bucks or so, I used my ETSA and went to the local hospital and got a calcium score done. It was super easy to get done. Oh, yeah. I know your your buddy, you lost him, and you felt that this could have been a

preventative measure for him. Absolutely. And so I was kind of apprehensive hearing what it could be. I was kind of a heavier guy and had a mixed lifestyle. But I went to see my doctor, and he said, you know, I'm jealous. Your calcium score was zero. Damn. That's for you. And I said, are you sure

this wasn't a bad reading? And he said, you know, I know, I know, we do see this. His was like an eight. He said, I'm kind of jealous of you being at this level. But he said, knowing your history, I'm 22 years recovered in alcohol. So I've been sober for 22 years. And he said he's seen a fair amount of incidents of recovering alcoholics having lower calcium scores. But the mix with me was, when I got off the drinking, went in to see my doctor for the first time in ages, and started trying to get a little more healthy, my cholesterol was running a little bit high, so he put me on

Crestor for a while, and I got off of that when my cholesterol came down. But I'm just curious, from your aspect, you know, reduced calcium score in relationship to, you know, whatever the chemistry happens when you're an alcoholic, you know, and you're abusing your system that way, or the combination of that and the Crestor coming out of the the alcoholism. Yeah, yeah. If that's a kind of a magic combination.

I do eat pretty healthy and I don't know about magic combination. There's, he has a strong family history, but he's been mitigating his risk. Look, it's all about risk mitigation. Taking Crestor

and not having a family history improves your risk, but it doesn't make it it doesn't mean you're immune to coronary artery disease. In other words, if you live long enough, you're going to die a cancer or a heart attack or a stroke. I mean, you know, that's sort of the common pathway if we live long enough with nothing else going on. But it does reduce your risk of having it done. So, or having that happen to you.

One thing you can do is Google a Framingham score. And we should do your Framingham score. Tate. You want to do it? Sure. Let's do it. Framing Ham Calculator. I'm just doing this on the fly.

I hadn't planned on doing this, but I just thought about it. Let's find out that I'm going to die soon, right before I get on a plane. You hear that, ladies? Okay, so you are years old, okay, and you are a female, and you are a non-smoker. Excellent. Very good. That wasn't always true. Nope.

Do you know what your total cholesterol is? It's terrible. I don't know what it is. I know my HDL is really good, and my LDL is not so good, but it is controlled on Crestor, which I hear Crestor is the bomb, diggity. So just give me an estimate of your total cholesterol. It was like 230? Yeah, it was bad. Okay, and then your HDL cholesterol was what? 60, something. And your blood pressure, your blood pressure is good, right? Yeah, it runs. It's probably not so great right now. And you're not on blood pressure medication, or are you?

No. No. Okay. Okay. So there you go. The average 10-year risk for someone your age is 1%. Another one in 100 will have it. Your risk is actually 0.4%.

I don't believe that for a second. Why? Because I'm pretty sure that my LDL is worse than what you said. And my HDL is better. I'm pretty sure. Okay. Okay, well, let's, okay, then, let's do it again. I'm going to use the same numbers, and let's make your LDL 300, but your HDL 90.

How about that? Okay. Okay. Now it's 0.7, so that did just about double your risk, but still lower than the average. And that's because your HDL is so good. Now, let's just say your HDL was down in the pits around 30, where a lot of people's are. Now, all of a sudden, your risk is 2.4%. You're 2.5 times normal.

So that HDL being good is, in your case, most likely genetic and also due to the fact that you exercise. And you drink a little bit of wine, which may also increase your HDL. But I thought if you drank a lot of wine, which I have been doing. You have been lately. Well, we haven't tested you lately. That it made it worse, right? That's right. I'm not getting blood work for months.

I mean. But it's amazing how much difference the. the H.T.L. makes. That's the good cholesterol. So take two seconds to talk about this. So just imagine someone's building a brick, brick wall, and you've got a brick layer who's laying down brick wall, and then you've got a brick stealer that at night comes along and steals the bricks. If the brick stealer can steal enough bricks, the brick layer will never finish building the wall, right? So think of the LDL as brick layer. That's the one that's laying down cholesterol in this is very simplified.

Inside your arteries. This is how you should talk to people all the time. Well, I do. Okay. Okay. I mean, you know, in my clinical practice. Yeah, I'm just saying it. So it's like, so the LDL is laying the bricks trying to clog up your arteries.

while the HDL is the brick stealer. So the more brick stealers you have, the less likely the brick layer, which is LDL, will be able to complete building that wall, which in this case is going to clog up your coronary artery and cause a heart attack or clog up a carotid artery, which is in your neck, and cause a stroke.

So the ideal ratio between the total cholesterol and the HDL or the good cholesterol is about 3 to 1. Now, there's more factors involved, but for the Framingham study, that's all they looked at. They simplified it, which is great. I love simple stuff. And this really gets you in the ballpark. So just making the adjustment on the HDL made a huge difference in your outcome.

Now, let's look at mine. So I am 64. I don't mind, and I am not female. I am no longer a smoker either. So I quit in, what, 1999? So I've been off for about 20, what, 21 years now? my hdl cholesterol or my total cholesterol was 130 no surely god it wasn't that low i did i won't even let you go that low let's say 170 and my hdl was 40 no 55 okay so the average jesus really

i am really old oh no no no it's good the good news is my risk is about half normal, but the average risk of somebody in my age group is 20%. I'm taking applications for husbands. But mine is down to 8.1%. So I have less than 1 in 10 chance of having a heart attack over the next 10 years. We'll just see if this is right. Oh, geez. I know.

Well, honey, I'm 64. 10 years from now, I'll be 74. You're going to be married to a 74-year-old man in 10 years. Such a young soul, though. I know. That's right. That's true. Just an idiot.

So anyway. So, yeah, I don't know that it's magic, but congratulations. Good job. And the calcium score, look, I just have to throw one caveat in. You can't have false negative calcium scores. And this is from Oxford. medical case reports as false negative results of a coronary artery calcium score are common due to small calcified lesions being missed using a three millimeter slice thickness.

So they use kind of a thick thickness when they're going through. And a threshold of, don't worry, about 130 hounds filled units and a minimum area of blah, blah, blah, blah, blah, but whatever. So you can have false negative results. So you could have some coronary artery disease and still have a score of zero. And my old primary care provider said they can have these sort of soft plaques that aren't fully calcified yet, too. And those can also be there and not show up anything. The gold standard for this is a cardiac catheterization, which, of course, they're not going to do in a person like him who's completely asymptomatic, but just at a high risk because it's very invasive. Okay.

So good. Congratulations. Good for him. But don't rest on your laurels. you know, you've got to continue to mitigate risk because of that strong family. No, and you've got to make sure you're taking your medicine. I remember one time my blood work came back horrible, and they were like, the Crestor's not working, and I said, I've been taking it.

And then I went to the pharmacist, and I haven't taken it in like six months. Oh. I've been forgetting to get it filled. So, yeah, you've got to stay on top of that. Yeah, you know, and I would like to see if someone's on Crestor, that that automatically at the pharmacies goes on the remind list so that people don't forget to get it. because at our pharmacy, if you don't click, hey, I want this medication, it'll just expire, you know?

So I'm always having to scan and make sure that we're not behind on things. So most pharmacies, though, you can actually tell them what you just remind me to refill this. All right. Hey, Dr. Steve. This is Stephen. Hey, Stephen. I was calling because I wanted to know what the range was.

So I got antibodies and I was a 4.9. And is there a range where it goes from like one to, 10 or is there a range that goes from like 1 to 100? That's my question. Thank you. Okay, so I'm trying to decipher this. I think this person had a COVID-19 antibody test and it said it was positive. And they just threw out this number.

And he's absolutely right. Is it 4.9 on a scale of 1 to 10, 4.9 on a scale of 1 to 100, which would, you know, be very low. 4.9 on a scale of 1 to 10 be right in the middle. So when they just throw numbers out like that, it's completely. useless. Completely useless. Without some context. So they need to say, hey, the threshold is less than 0.08, then all of a sudden, a 4.9 is a pretty high number. They need to tell you what that lower threshold is and what they're considering a positive test. So if it was 4.8 and yours

was 4.9, there's a possibility that's a false positive, for real. So what you need to do is call them back because every test is different. The test that we did didn't give you numbers, they just gave you positive and negative, and ask them, hey, what was the range on this? I'm just curious. And then let us know if you find out anything interesting. Okay. Hey, Dr. Steve, I'm listening to your show, and I'm kind of curious. You're talking about some false positives with the COVID testing. My wife works on a COVID for right now in New York state and they see a lot of actual false negatives where the patient doesn't test positive and then a week later during treatment, they're popping positive.

I'm curious about that. I'm wondering if you could talk about it on the show. Give yourself a bill. Okay, so he brings up a good point. No perfect tests. When we were talking about false positive COVID-19 antibody tests, what we were talking about, was they really aren't false positive. They're true positives.

It's just not positive for what we're looking for. So we want to know, do you have antibodies to SARS-COV-2? And these tests are looking at coronaviruses. Some of them are very specific for SARS-C-O-V-2, but there may be some out there, and there's suspicion that some of the early antibody tests were this way would also cross-react with other coronaviruses. And some of them are quite benign.

And so if you had a common cold caused by a coronavirus, you know, three months ago, you might have had this antibody. And so you think, oh, wow, I'm immune. I had COVID-19 when you really didn't. That's what we were talking about. Now, what he's talking about are most likely polymerase chain reaction. This is where they stick a swab up your nose, and they're looking for viral genetic material, which is pretty damn specific, right? If that shows up positive, it's going to be pretty specific. The problem with that is it's dependent on how well you get the sample, how far up you go,

were there virus, enough viral particles there for you to detect it, all that stuff. And those tests have a very high false negative rate. So we've talked about those cases where they thought people were getting reinfected. Do you remember that? Yes, I do. And those may be people who had two. two negative tests in a row and then had a positive test. And all three, the first two were false negatives, and the third one was a true positive.

Now, if you have a 20% false negative rate, the odds that you'll get two negative tests in a row is about 4%. Right? So 0.2 times 0.04. And so 4% of people who get two tests could have the first one negative. and the second one negative, even though they're actually positive. Well, you know, I've heard you talk about in the hospital people who tested negative, but it's kind of like. Yeah, they obviously have.

But then I've also heard something else that I think we should talk about because it's all over my Facebook is how people, how physicians are being incentivized or hospitals are being paid to list the cause of death as COVID on a death certificate. I've seen that all over the place. Now, I'm quite sure that you're not out there lying about what a patient dies of. Well, no, nor am I getting paid differently if we did that. Oh, come on. And you know, you get paid to write prescriptions, too.

I know. Which is why I have to work. Because it's not true. But anyway. I wish it, I mean, I'm an ethical person, so I'm glad it's not true. But there's a part of me that says, I wish it. were true that I could get paid just for writing prescriptions because I'd write the hell out of some damn prescriptions, you know?

But I can tell you what we have been instructed. We got zero instructions from anyone about how to fill out a COVID-19 death certificate until about a week ago when I got a thing from the Tennessee Department of Health that said, look, if you think that COVID-19 contributed to this patient's demise, then you put it on their death certificate, they will be listed as a COVID-19 death. So let's say you had someone who had congestive heart failure and they get COVID-19 and they decompensate their congestive heart failure and they actually die of the congestive heart failure. But the COVID-19 was enough of a stress on their body to stimulate this.

And we also know that COVID-19, you know, can affect your... attacks everything. Oxygen, and it can detect your heart and your kidneys and stuff. So it makes things worse. So those people, we were instructed in those cases, if you feel that it was a substantial factor in the patient's demise to put it on the death certificate and they'll be counted as COVID-19. Now, the only financial thing they said was if you don't do this on these people, the families

may not be able to get some sort of compensation. I don't know what it is. I never could figure out what compensation they're talking about, but there may be a fund somewhere if someone succumbs to COVID-19 that they can get some sort of compensation. I don't know the answer to that. You'd think I would, but I'm not an attorney, so maybe we should get an attorney on here or a financial person.

But anyway, they just said, look, we want to make sure that if COVID-19 contributed to their demise that gets put somewhere on there. So in that case, with congestive heart failure, person. I might code it like this. So this is, you have a principal diagnosis. They die to respiratory failure, secondary to congestive heart failure, secondary to atherosclerotic cardiovascular disease. Contributing factors include SARS C-O-V-2 infection. Okay. And then that would be listed as a COVID death. Well, because you don't just die a lot of times of one thing. That's right. I mean, sometimes it takes more than one thing.

to get you. That's right. But in no way have we been told, hey, you need to put down all these people as COVID-19 cases because we're going to get paid more because, you know, the hospital's hurting. I don't know that they're getting paid more for anything right now. Now, the other thing is they did say also that if you did not have testing but clinical suspicion for COVID-19 was high, you can code them as COVID-19. You didn't have to have a positive test. And that takes into consideration, the fact that some people are not making it to the hospital and dying, and you're not doing tests on them after they die unless you did an autopsy, and that there's a high false negative rate for some of the tests that we're doing.

So you go, it quacks like a duck, it walks like a duck, it, you know, has liquid feces coming out of its cloaca like a duck. it's a doc, you know. And therefore, if it's, it meets the clinical criteria for SARS-C-O-V-2 and you don't have a positive test, it's okay to code them that way, but you need to have a high clinical suspicion that needs to be documented in the chart. You can't just make it up, you know. So that's how we've been instructed.

That is the truth. And if anyone is interested in seeing that letter from the state of Tennessee health department, I'd be happy to post it or, you know, let them see it. Well, I'm sure many of my friends on Facebook will fight you over that. Well, I know, but they're just, those are faith-based statements. They're not based on reality, you know, or fact. They're just, they believe it to be true, so therefore it's true. And that's a faith-based statement.

Show me the evidence that we are somehow being improperly coerced into coding things a certain way. And then I'll believe it. But I got, you know, I'm open to being shown the evidence, but I haven't seen a shred of evidence that any of this is true. All right. We got about a minute 19. Woo-hoo! Let's see here. Okay.

Well, this is a non-COVID-19 question. Hey, Dr. Steve. I was wondering, is it true that when we die, that we secrete 28 grams of fluid out of our orifices? I was watching a movie, and I think they referenced that, and I was just wondering if it's true or not. I don't know if the 28 grams number is correct. I know when you die, of course, your muscles tense called rigor mortis, but then they will relax. And a lot of all the bacteria in your gut continues to grow. As a matter of fact, it starts to digest your deceased tissue.

And that can cause a lot of bloating in the abdomen, and you can have, I mean, the funeral directors will tell you, you can have explosive emissions from the rectum of, you know, liquid. And some of it is old stool and some of it is just, you know, body fluid. We've still got a lot of phone calls left to do. Maybe we could do some next week. Thanks. Always go to my wife, Tacey. She's quite delightful.

Thanks for being here. You're welcome. We can't forget Rob Sprantz. Eh, maybe we can't. He's, eh, we can forget, Rob. Can't forget Bob Kelly, Greg Hughes, Anthony Coomia, Jim Norton, Travis Teft, Lewis Johnson, Paul Ophcharsky, Eric Nagel, Roland Campos, Sam Roberts, Pat Duffy, Dennis Falcone, Matt from the syndicate,

aka Matt Kleinschmidt, Ron Bennington, and Fizz Watley, who supported this show has never gone unappreciated. That was my Larry David impression. Eh, and we can forget him. It was just okay. Why do we have to always thank all this? these people you're just so big on it i don't know i don't know just maybe i have no idea just you know 15 years i've been thanking everybody at the end of the show the list gets longer and longer

yes that's right well we have more and more people on that list why aren't you on that list because you're here and i just thanked you oh i thank you first all right well let's just make sure we keep it up listen to our serious xm show on the faction talk channel serious xm channel 103 saturdays at 8 p.m. Eastern, Sunday at 5 p.m. Eastern, on demand at other times at Jim McClure's pleasure. I'd really like to do some live shows. We've talked about that literally for 15 years, so maybe we can do that sometime. Many thanks. Go to our listeners. His voicemail and topic ideas make this job very easy. Go to our website at Dr. Steve.com for schedules and podcasts and other crap. Until next time, wash your hands, check your stupid nuts for lumps,

quit smoking, get off your asses and get some exercise. We'll see you in one week. for the next edition of Weird Medicine. Bye, everybody.