Weird Medicine: The Podcast - 545 - Myrtle Pays a Visit

Episode Date: March 20, 2023

Dr Steve, PA Lydia, and Dr Scott discuss: High white count cancer screening Mom swipes left: Areolar foreign body Hypnopompic episodes in history Ice as a direct anti-inflammatory Cradle cap Erythritol in the News Please visit: stuff.doctorsteve.com (for all your online shopping needs!) ed.doctorsteve.com (for your discount on the Phoenix device for erectile dysfunction) simplyherbals.net  (Dr Scott's website) simplyherbals.net/cbd-sinus-rinse (the best he's ever made. Seriously.) roadie.doctorsteve.com (the greatest gift for a guitarist or bassist! The robotic tuner!) Also don't forget: Cameo.com/weirdmedicine (Book your old pal right now while he’s still cheap! "FLUID!" Most importantly! CHECK US OUT ON PATREON!  ALL NEW CONTENT! Robert Kelly, Mark Normand, the O&A Troika, Joe DeRosa, Pete Davidson, Geno Bisconte. Stuff you will never hear on the main show ;-) Learn more about your ad choices. Visit podcastchoices.com/adchoices

Why did the barf and the booger fall in love? It's what's on the inside, that counts. What did the cats say when it answered the phone? Can you hear meow? What does Mr. Flamingo say when he's fed up? up. I've had enough. I'm putting my other foot down. If you just read the bio for Dr. Steve, host of weird medicine on Sirius XM103, and made popular by two really comedy shows, Opie and Anthony and Ron and Fez, you would have thought that

this guy was a bit of, you know, a clown. Why can't you give me the respect that I'm not? I'm entitled to! I've got diphtheria crushing my esophagus. I've got Ebola vibes stripping from my nose. I've got the leprosy of the heartbound, exacerbating my infectable woes. I want to take my brain out and blast with the wave,

an ultrasonic, ecographic, and a pulsating shave. I want a magic mill. 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. From the world famous Cardiff Electric Network Studios.

It's weird medicine, the first and still only on censored medical show in the history of broadcast radio, now a podcast. I'm Dr. Steve with my little panel, Dr. Scott, the traditional Chinese medicine provider. It gives me street cred with whack alternative medicine assholes. Hello, Dr. Scott. Hey, Dr. Steve. Tacey's not here today, but in her place, P.A. Lidia, back from

sabbatical. I hope you a let me go. Hey, y'all. This is a show for people who had never listened to the medical show on the radio or the internet. If you've got a question, you're embarrassed to take to your regular medical provider. Or if you can't find an answer anywhere else, give us a call at 347-7-66-4-3-23. That's 347. Pooh-Hood. Follow us on Twitter at Weird Medicine or at DR Scott WM. Visit our website at Dr. Steve.com for podcast, medical news and stuff. Goodbye. Most importantly, we're not your medical providers. Take everything you hear with a grain of salt.

Do you act on anything you hear on this show without talking with your health care provider. All right, very good. Don't forget stuff.dot.doctrsteve.com at stuff.com for all of your online shopping needs. It really makes a difference. And Dr. Scott's website at simplyherbils.net. And Dr. Scott brought us more CBD nasal spray,

the greatest thing that's ever been made. Check that out. It's simplyerbils.net. Now, we have a new sponsor, Dr. Scott and P.A. Lydia. Cool. This is the, we were talking the other day about erectile dysfunction. We talked about L. Prostodil. Okay.

And we talked about, in El Prostil injections, and we talked about the muse, L. Prostadone, L. Prostadil suppository. We talked about PD5 inhibitors like sylidephyl and. and Viagra and stuff like that. And somebody said, well, why didn't you talk about electrical, or, you know, electrical, acoustic shockwave therapy? And I texted him back, said, it'll just hang on because we had something going.

And this is the Phoenix, and it is a home acoustic shockwave therapy device. So I'm not going to turn it on because it's loud. Okay. But it delivers, it's like, you know, the kidney folks that have, kidney folks, them kidney folks. You know, them kidney folks? Yeah, people who have kidney stones and they can't get them out with a stent or something, they will use shockwaves. Right. This is similar.

And what it does is it induces some good inflammation in the cavernous spongy tissue in the penis. and it induces some healing and increased blood flow and over time will, you know, as will improve, you know, 80 to 90% of the time, improve erectile function. So I thought, we've got a couple of friends that have some issues. And you know what? Your old pal, Dr. Steve got a little issue as well.

I'm 67 years old. you have normal changes in your in your sexual function sure right and so i did a thing called the um oh did you go for it not oh yeah they stopped god i have a unit i did a thing called the um uh nocturnal tumessence test which is basically just a strap of of uh paper that goes around your flaccid penis and if you wake up in the morning and it's broken and you had an erection in the middle of the night. Well, several nights, you know, out of seven, I didn't break the, you know, it's like, oh, hell. I didn't break the strip of paper.

So I was not having nocturnal erections, which is, you know, that's a sign that there may be a problem. And I do, you know, I do UC Alice and stuff like that and get that nice big cat can't scratch it sort of. of you know blood flow so so anyway or ballpark can't scratch it or it looks like ballpark frank and the microwave that's a good example but anyway so but I would like to do it without taking a pill to get that effect so I did this one time and then I started noticing and really they say it could take anywhere from to 12 weeks after the first application. Me, this is me, so this is anecdotal, and some of this could be psychological, too, noticed that I was having, you know, nocturnal two messants every night.

As a matter of fact, I broke the, you know, the stuff every single night in a row for the seven nights after that. So I'm going to keep using it, and I'll let you know. But if you want to try it, you can get it for like $29 a month. It is pricey. but there's coupons if you use one of those coupon things I got like 175 bucks off of mine and I think if you use our link you get a discount as well so go to ed

erectile dysfunction dot doctor steve.com ed.orgate.com you can check the stupid thing out let me know what you think about it and don't forget patreon.com slash weird medicine that's Tacey and me Scott's been on there once he was on the Chad Zumach episode That was fun. Mm-hmm.

That was fun. And then cameo.com slash weird medicine, I'll say, you know, fluid to your mom or whatever you want me to say. All right. All right. Very good. Nice to see you, PA, Lydia. Thank you. It's great to be back.

And good to have you back. And Dr. Scott, check out his website at simplyerbils.net. That's simply herbals.net. And Tacey's not here today, but we're still going to do Tacey's time of topics. It's just going to be Lydia's time of topics. So we'll try to figure that one out. And we'll do that on the fly. Matter of fact, well, hell, let's just do it right now.

Throw her in a deep end. Yeah. It's Tacey's Time of Topics. Damn it. I got to get the timing right on that. Let's try it again. It's Lydia's Time of Topics. A time for Tate.

Lydia. Topics of the day. Not to be confused with Topic Time with Harrison Young, which is copyrighted by Harrison Young and Area 58 Public Access. And now here's Lydia. That was really ham-handed. Hello, everybody. All right.

What you got for us today, Lydia? Well, the main thing that I would talk about, I think, if I had the platform, which I do know, is my new found sware into anaphylaxis and kids. Oh, no. Oh, yeah. That's why you weren't here. That was why I was, why I was

away on sabbatical a bit longer than... So tell everybody what anaphylaxis is. So anaphylaxis is an allergic reaction, a type of allergic reaction, where, you know, in medicine we consider it what's called IGE-E-mediated. So it's a type of reaction. So a bit more serious than your regular allergies that cause maybe watery eyes or running nose or sneezing. Yeah, it's immediate. it. You may have airway compromise, meaning you could not breathe. You know, your airway could swell. People be unable to swallow. But you can also have gastrointestinal manifestations like vomiting

or extreme abdominal pain, low blood pressure, other end organ damage can affect your heart, liver, kidneys. So it's not good for you. It's not good. It's life-threatening. Okay. Yes. And so what does that have to do with you? Yeah, so I was just at work one day last week and got a call from my mother that my daughter was vomiting, and she's two. She's a vomiting. There's stomach bugs around. Here's how that call went. Lady, your daughter's a bombican.

Is that how she sounds? Quite precisely. And so I said, okay. She's got the green apple quick step, don't you know? And it was the first time, but I was prepared for that because there are a lot of gastroenter. Testinal illness is going around right now. That's right. So I door-dashed some pedi-light from my office.

Very good. I'm like, okay, there will be some pedi-light at your door soon. And then about, go ahead. That's so cool that you can do that now. Isn't it neat? Yeah. My kid was hungry one night and I just, you know, Uber eats something over to his house. They just delivered it to him.

It was cool. Yeah. Yeah, anyway. It's nice to do every once in a while. Yeah. So then about five minutes later, she called and she said, she's really saying her stomach hurts. I think you need to come over.

And I have a full clinic schedule, and I thought, well, you know, I don't. I think she'll be okay. You can handle this, Mom. I think you can handle this. She's still a bombing in York York to come to the house because she's out on the porch. And she's Karen putting on a, putting on a scene, I'll tell you that. Listen. Is that how it went?

It gets better. Yeah. So then five minutes later, she calls on FaceTime and says, I think she has a rash. I think she has a rash now. Oh, no. So I said, okay, well, let's give her some Benadryl. Oh, well, I don't have any Benadryl, Lydia. So I dooredash some Benadryl.

Oh, forget the six. I ain't got none of that hypeful. It's just getting long. I got some liniment, though. I's already understaffirals. Oh, now he's doing. We have no Benadryl. I got some possum grease and I could make a liniment out of it.

A poultice. Yeah, put a poultice on. God, no poultuses, please. Okay. So anyway, I noticed the rash in L. but when she was younger did have a milk allergy that had the potential to go and cause anaphylaxis because she had hives on her face. Ah, there you go.

Previously. So she had previously been prescribed in Epi-A, eurticaria. Yes, or urticaria. So I decide to leave, pick up some Benadryl from the hospital pharmacy, and start driving. And, you know, it's from exit, it's about a 20-minute drive. Yeah, yeah, it's about a 20-minute drive. So as I'm driving, I get phone calls. So you get on the 405, and I'll take her in now.

Head south. Anyway, essentially, moral of story, every five minutes I get a new phone call with a new symptom. Oh, no, now. Yeah, so now she's drooling, and now the rash is on her face. And now her face is, so I'm just, I said, call 911. You know, call 911. Really? I was like that.

Yeah. Very, very fast happening. So I got there and tried to get some Benadryl into her. By this time, her entire face was swollen. Her entire body was covered in high. So you walk in and... My mother is freaking out. in a separate room.

In a separate room. My two-year-old comes walking and screaming. Oh, no, I got the vapors. Drewl and vomit hanging out of her mouth. Oh, my God. Just comes up to the door. Your daughter did? Yes.

She came to the door? She came to the door. Mommy, mommy. It was quite traumatic. Anyway, I tried to like a scene from the exorcist. It did. It was terrible. And my mom's just like running around frantically, right?

Which is a highlight of its important. Does she listen to this show? She does not. God no It's important to train people who watch your kids How to be calm in a situation Yeah, yeah, yeah, true Anyway

You got, okay, she's okay I don't want to criticize your mom She's a nurse But what? She's a pediatric nurse for like 40 years Get the fuck up I swear And she's in the other room with the vapors

And your daughter comes to the door My two-year-old comes to the door Covered in hives It is different when It's, you know, somebody that's close to you but for sure so were you yelling at her you see you see your stupid minds

stupid stupid stupid that's terrible so yeah I just start giving her directions on what to do to go get my stethoscope out of the car and blah blah blah so I try I'm trying to put Benadryl in the mouth so she needed somebody to tell her what to do right then so now you're throwing out commands and she probably calmed down she did yeah establish some order which is what we try to do in code situations right Absolutely.

Anyway, so the ambulance arrived a few minutes later. There was no getting Benadryl into her mouth. She was just drooling out. She had probably obstructed. Everything was so swollen, edematous, that she just couldn't get anything down. Yeah, so we got in the ambulance, and I said, let's give Epi right now. Yeah, yeah, yeah, epinephrine. The MS crew said, well, her oxygen's okay.

Oh, no, no, no, no, no, no. They gave her a shot of Benadryl. I said, that will mask. anaphylaxis and airway closure we need to give epi yeah no we don't need to do you assert your PA authority I did not we did not give epi I watched her vitals like a hawk I held her while we went to the got down to the they know you were a PA they did yeah and even uh okay my my ex-husband was on the phone with one of them who ex-husband's a physician saying you need to give her epinephrine and they're like no okay okay we got to

talk about this yeah well go ahead and tell you There's a new training going on at that EMS center now. Yeah, for real. I mean, that's suspected, I mean, there's really no downside to the doses of epinephrine that we give for anaphylaxis. Yeah. For her, what would she've gotten like 0.1 or something? Point 1.5. Yeah, yeah, yeah.

Yeah. There's really no downside to that. It's all upside. Right. And especially in a kid. And, yeah, if you see it coming, then you can give epinever. That's why they give people epipeds. Yeah.

They don't wait until they're. They're drooling and puking and their faces bloated with hives to give it. You give it when you know it's coming. It was a traumatic ride down to the ER. So we got there, though, and she did start responding with the Benadryl, got more steroids in, Pepsid. They watched her for like six hours and said, yeah, we would have given Epi, but because she was already starting to respond when she got here, we were okay.

Okay. But yeah, I saw the pediatrician, and the pediatrician was like immediately, we are doing, you know, a new training with EMS teams. Apparently, it happens a lot where people are afraid to give epinephrine because they think of some negative consequence. You know, classically, in an adult, if you give epinephrine, you can warn them that they may have some chest pain, right, tachycardia. Essentially, it's a big adrenaline. I'm just translating on the floor. Thank you.

That's okay. That's all right. It's all right. It's a big adrenaline insertion into the body. Right. Yeah, that's what it is. Yeah. It's adrenaline.

So, anyway, she did all right, and now I travel with EpiPens. Okay, so what caused it? We, I am not sure. Oh, we still don't know. We don't know. She did have access to cashews, like probably 20 minutes before she started vomiting. And I had never given her cashews, but I'm sure in cooking, you know, just I do a lot of, like, Indian cooking and curries. I'm sure she's had exposure to it, which is an important point.

about anaphylaxis. You don't develop it the very first time you're exposed to something. It's the second time or whatever. Yeah, it's a second or third time. So you get a little bit of exposure to it. Your body starts priming the T cells or makes T cells primed to it such that next time you get it, you get this huge release of inflammatory cytokines or these inflammatory molecules that cause that reaction. So we'll do the testing.

Wow. Yeah. That's scary. It was scary. It was like thinking about a few minutes later If that ambulance hadn't been there I had a friend of mine His kid was allergic to freaking everything

And they would come home and find him In anaphylaxis, you know, on the floor And they'd have to give him epinephrine Just over and over again Because he smelled a pee You know literally it just opened something I had peas in it And the kids, you know, on the floor

Oh gosh Yeah He's now, at the time when he was little, they were wondering, you know, is he going to, you know, what's going to happen to this kid? And, you know, now he's the most, one of the most successful pharmacists, you know, around. He didn't mind me talking about it because it's not like it isn't public knowledge. Right. But anyway, yeah, it's crazy. Wow.

So anaphylaxis is a real thing, and you should not jack up the price of epipens. Oh, my goodness. Yeah, $600. dollars to get four pens Oh gosh How much were they at the peak Dang It's 150 bucks a pen

Mm-hmm Okay a vial of epinephrine It's cheaper Yeah it's like five bucks Yeah it is Of epip pens But you don't In an emergency you don't have to be figuring

No no no no no You and I could do that I asked the pediatrician about that I said can I have some vials of epi Yeah sure You can buy them. I can get them for you. And I think, I mean, if I stayed calm during that situation, I think I could stay calm enough to pull it up.

Yeah. Okay. So in the two years since the national controversy erupted over the price of Epipen, the market for epinephrine auto injectors has changed dramatically. Two years ago, EpiPen, manufactured by, I'm not going to say their name, had 90% of the market. Today, EpiPen brand accounts for just 10%. Well, yeah. Instead, the generic version of EpiPen, also manufactured by the same people, now holds more than 60% of the market.

I'm just looking at the price. Oh, my God. Yeah, the generic is still extremely expensive. You're paying for the injector because it's proprietary. But, you know, it's like we always tell people, if you can't afford androgel for your testosterone, own, just give yourself the shot. Or go

get the shot. It's like $10 every two weeks instead of whatever for the ender gel. I'm thinking to try it's switching over to the injections myself just for... I'll give you a shot in your ass. You'd like it. I will like it if it does what I want. He might like it from Taceymore.

Yes. No. No. I've been using the shots for years. Way better than the gel. Yeah. I do the shots. Oh, yeah. Way better. Well, you get that sinusoidal thing. And we had a guy on the show that he said it was more physiologic. I don't believe that because, you know, the testicles produced testosterone on an ongoing basis.

There's not this sort of bi-weekly up and down. But I think that getting that pulse probably that, you know, the week after you get it is probably awesome. So, yeah, I want to try it. Yeah. And I think another reason you don't want to take the shots too often, needles are kind of big. You're like 22s. Are they 22? You can't get much thinner because it's an oil lace.

Because it's thick. But it's still not bad. And they're intramuscular injections? Yeah. Yep. Yep. And it's a deep, it's deep, it's in oil so that it's not absorbed readily. It takes the body some time to leach it out of there. That makes sense.

Yeah. Very interesting. I think I'm going to try that. On the biovol of the podcast, we're going to talk about it. We have a new sponsor over there that is apropos of this discussion. But it doesn't have anything to do with testosterone, but it does have everything to do with giant meaty erections. Oh, goodness.

Just a little teaser. Oh, goodness. I don't want to come. Well, you'll be here for that. You'll be. That's what she said. I'd still think that was the funniest scene ever on the office was when he was being deposed and they said something.

And then it was almost as if they had been planning this for four years. And he goes, that's what she said. trying to be funny and they went, wait a minute. She said that. She said that. When did she say that? You know, Michael Scott's backing off. He has this quizzical look on his face like, well, wait a minute.

That's a joke. All right. So thank you, Lydia, for your topic time. Well, we're glad that it's little bit of it's time. No, it's from Lydia's time. I can tell, can I just say one more quick thing? Yes, of course. I wasted one of those epipens.

Yeah. There's another brand that's a square called AviQ. Okay. Anyway, they have the trainer, and the trainer speaks to you, and the pen speaks to you, too, and they look exactly the same. So we were cooking one day, and I was just going through the trainer, just to be prepared, and I was using the real pen. So I administered, injected myself with epinephrine. Yeah, and what happened? Absolutely nothing.

I got a white spot on my leg because it's a vaso constrictor. Right. It causes the blood vessels to contract and decreases blood flow to that area. And that was it. Wow. Anyway, wasted a hundred-something dollar hairs. Felt really stupid. Yeah.

At least I practiced, though. I practiced. You also see that when you do it, if you don't need it, the dose really doesn't do that much to you. That's what's amazing about it. So I've seen people who got, like they're at the allergist, and, And they gave them the 1 to 10 concentration instead of the 1 to 10,000 concentration of whatever the thing was, the people start going into anaphylaxis. And they give them the epi right then, and they're fine, totally fine.

Give them epi to get them out of the acute phase, give them some Benadryl to carry them through the day. They're fine. Cool. Yeah, yeah. Well, I'm glad she's okay. Me too. It hasn't happened again. No, it has not.

Isn't that something? We're a bit of a bubble family now. I love nuts, but we don't have any in my house right now. How old did they need to start testing them? They can test now. Yeah, you need to get her test. Yeah, it's Tuesday. Your mom did something to her is what it was.

That's probably what it is, yeah. She felt suspiciously guilty, so. Oh, yeah. She probably had a stokey or something. Well, it could be a shellfish thing. Maybe she was wading the mudbugs out of the creek. Oh, my God. Because, you know, the hams are good.

That's quite possible. Give her some mud bugs out of the crick. And the grits. Yep. Crits and mug bugs. Oh, my gosh. I love it. All right.

Hi, Dr. Steve. I'm a long-time listener. Oh, wait a minute. So. Number one thing. Don't take advice from some asshole on the radio. All right. Back in the original ONA days.

Hey, thanks, man. My question is, and I'd like to thank you, first of all. What's funny is my two partners that are in here now have no idea what you're talking about, because they are not plugged into the O&A. universe in any way whatsoever. So it's very interesting. They're making me a critical thinker regarding my medical condition and listening to my doctor. Anyway, my question is...

Well, thank you for saying that. That's always been our goal is, you know, we goof around on this show a lot. But if you've listened for a long time, you do develop this sort of sense of critical thinking. We talk about relative risk. We talk about absolute risk. What's the number needed to treat? that kind of stuff. So there is actual medical information being transmitted to people. So anyway, let's find out what he's got.

After a CBC blood test, why doesn't my... Okay, that was a complete blood count. Dr. order a cancer screening. Okay, we have the perfect person here to answer this. Okay, so let me back it up. This is a really important question because PA, Lydia, works in oncology. After a CBC blood test, why doesn't my doctor order a cancer screening? If my white blood count is higher and it's consistently higher, instead they send me to a hematologist who now orders it, which costs me a lot of more money.

Anyway, thanks for the being, thanks for educating us and educating me, and I look forward to hearing your response on air. Hey, thanks, man. So, Lydia, let me set this up for you. So you have a patient who has a white count and let's say the normal is 11.5. and there's as always 13.7. And then it's 14, and then it's 12. And then, oh, this time is 10.8, but then it's back up again. And this guy is saying, why can't my doctor just do some sort of cancer screening test?

And instead, they're sending them to you to get this doped out. So the first thing, I'll just say this from the primary care side, they don't know what the hell to do. They don't know what to make of it. There isn't just, I wish we had just, you know, one of those Star Trek auto, you know, med bots where you can just scan somebody and it says, yeah, this is what the problem is and here's how you fix it, but we don't have that. So you guys see these all the time on the hematology side. What do you do with that? We do, yeah. It's a, for us, a bread and butter consult, and it's a very timely question because, you know, as consults get sometimes overwhelming,

I was working with internal medicine physicians in the community to be able to empower them to do some of this workup, to save people what is a higher cost of coming to a specialist. Sure. You know, especially for the anemia's and stuff. We'll talk about that in a second. Yeah. So when we think about an elevated white blood cell count, you know, that can be something that's non-cancerous. So some type of inflammatory condition, even being overweight can cause a bit of inflammation that can raise. your white blood cell count.

But what you don't want to miss is a cancerous population of white blood cells that are causing the elevated white blood cell count, meaning there is a constant production of one type of white blood cell, that constant production does not turn off appropriately, and those are immortal cells, those are cancer cells. Right. So when we see a patient like that, we first think about all of the risk factors that could be non-cancerous that are causing it, but those are diagnosis. of exclusion.

Right. So our job, once you get referred, is to rule out the bad stuff. So we look at the entire system. We look at the kidney function. We look at the spleen, the size of the spleen. We look at the types of white blood cells there are. And the most beneficial test is a flow cytometry, where we send the vial of blood for a pathologist to review.

And then they also sequence the cell DNA and look at all of the receptors on those cells just to see if there are any mutations. or expressors consistent with cancer, with cancer cells. So, you know, that flow cytometry, spleen ultrasound, or liver and spleen ultrasound, and then just a general look at other inflammatory conditions. Would you do all that on somebody that just had, you know, 13.2, 13.7. You would do that sort of standardized workup on somebody like that. Because what are you really worried about in somebody?

Yeah, so it depends on what type of cell line is elevated, right? So if they are lymphocytes, which would be the most common and most benign, if you had a white blood cell count that was elevated because of elevated lymphocytes, you know, most of the time it is a benign condition. If it were a malignant condition, that would be called usually CLL or chronic lymphocytic leukemia. And we don't really worry about that until your white blood cell count gets above $100.000. It's crazy, isn't it? Yeah. CLL, it's, you know, people freak out because it is a leukemia. But it's like, yeah, well, here you go.

Here's a little hydroxy urea. What is it that you guys are using now? Well, a brutinib would be the first, the first line. So anyway, it really depends on what types of white blood cells are elevated. If they're monocytes or eosinophils or something that would be a more aggressive cancer, if those were the ones that were cancerous, then we would immediately go to that. If it's something where it's a very mild elevation in lymphocytes, we usually say continue monitoring, you know, every three to six months.

I don't know if I've ever seen an eosanophilic leukemia. There are, there are... How rare is that? But I'm not sure we would... It would have to be called leukemia. Yeah. No, I bet no parasites can get in those folks, so... Yeah.

Since eosinophils are pretty good for fighting parasitic infections. Anyway, yeah. Yeah, so he should have been sent to a hematologist. You agree with that. Yeah, I mean, it's... It's a lot of specialized knowledge to be able to look at someone and say with confidence. This is something, or it's not. Or it's not.

And so to expect, you know, someone who works in primary internal medicine or family medicine to have that level of expertise and make that decision, which is a big decision, I think is a lot. They could, and they statistically could probably just blow it off. but that'll work nine times or maybe 99 times out of 100 or nine times out of 10 whatever the number is for the people who actually have something serious and you start

you can lull yourself and go ah that's not anything but it's the ones that you miss that's where the tragedy happens and then you get pissed off patients right for sure see he's mad because he sent him to a hematologist if he hadn't sent him to a hematologist

and it turned out to be you know, something bad down the road, then he'd be mad that he didn't set them. So you can't, he kind of almost can't win something. And so the only way I could think about doing an internal medicine approach to the workup of that would be essentially to give the maximum screening to everyone or that very expensive flow cytometry test to everyone. That might not be appropriate. He might end up paying more out of pocket, you know, if his primary care ordered that test.

Yeah, one of the biggest things that waste money is someone that comes in says, I've fainted. and then they get a tilt table test and they get a stress test and they get you know and then that oh that wasn't exactly normal so now we're going to do a cardiac cath and you spend

10, 20, 50,000 and find out it was you just had a fainting spell happens EG I was on the tilt table were you? I did

that's a very archaic test yeah but it's very it gives you a lot of information so let's talk about tilt tables that you brought it up did you fomick I didn't but I did have a thinkable episode

on the tilt table Yeah, so people who faint, and you think there may be a positional aspect to their arrhythmia or their blood pressure that you can throw them on this table. So talk about it. They strap you out there. It's like an ancient, it is. It's like an ancient. I can't remember if they establish IV access first. I feel like they should.

But they strap you on a vertical table. So you stand up kind of like on a little platform. There's a padded table against your back. And then they tilt you to or, you know, you light. actually first and then they bring the table up to a vertical position and you're strapped there so you can't move your legs which means you can't really flex the muscles in your legs that help you support your blood pressure uh they strap your arms and then you have a blood pressure monitor and a heart rate monitor on you and it continuously uh on repeat checks your blood

pressure monitors your heart rate and they just leave you there yeah well they can move you around No, too. They can spin you around. How long? Yeah. All kinds of stuff. I don't know how long the normal test is when they would actually stop it. I want to say either 15 or 30 minutes. We could look that up.

I passed out within 10 minutes. You did. Yeah. Yeah. So what did they do for you? So as I was having the synchable episode come on, you know, you get this pre-syncopal episode where you start to get dizzy, you start to feel a little nauseous. A tunnel vision or black splotchy vision.

And you say, hey, it's. happening and they're like oh good we'll just check your vital signs and watch your blood pressure not appropriately increase i'm going down i'm going down so they let you fully pass out monitor what happens to your blood pressure and heart rate during that time and then they lay you back down flat maybe even have your feet a little bit elevated above the level of your heart and you come back too wow and then they say yep which is the key by the way if you have somebody fainting don't hold them up if you hold them up they will have a pseudo seizure Put their, lay them down gently on the ground and put their legs up over the level of their heart.

They almost always wake up. All right. Yeah, I'm with knot cupcakes here that says I'd no way I'd flip out too claustrophobic and being strapped down to a table. Yeah. And they can do anything to it at that point. I would be, I would be lit me out of this. And when you're passed out, they're grabbing your tits and stuff. Oh, God.

That's a different kind of. I would be cut and falling this. That's just Saturday night at Liddy. Yeah. Sorry. In the dungeon. I didn't mean to betray that confidence. You can't tell him anything, Liddy.

On that note, let's do the Mom Swipes Left question of the week. It's time for Mom Swipes Left has questions with Jen and Carol from the Mom Swipes Left podcast. Hey, Dr. Steve. Hey, Dr. Steve. It's Jen and Carol for Mom Swipes Left, and we have a question for you. Okay. Okay, little backstory. I was 24 years old.

I woke up in the morning wearing my sleep t-shirt because I'm super sexy. Nice. Sat up and immediately noticed a sharp pain in my left tit. Every time I moved, it hurt even more. So I lifted my t-shirt, looked at my nipple, and saw a gray thing protruding from it. I pulled it out and it did not hurt to pull out no it didn't and it was a three-quarter inch piece of straight metal no detail nothing that was describable about it except for the fact that if I held it between my pointer finger and thumb there was a little bit of flexibility to it what the fuck is that do things just go into nipples is it is it just that porous. Did I roll over onto something and it got sucked up

into a nipple hole? Please explain because Carol thinks it's alien. I do. I think I just rolled over on something. I think you were abducted in the night and somebody from an alien ship put a tag into your nipple. But there was nothing chunky about it. It doesn't matter. Their tech is way better than

ours, Jen. They don't need it to be chunky. But they probably didn't put it deep enough is what I'm thinking. Thank you, Dr. Steve. Thank you, Dr. Steve. I don't know about the alien theory. Yeah, so it's a great theory, but incorrect. Yes. Scott, you had an idea on this one.

She rolled over onto something, stuck her nipple. Yeah, I think you may be right on that one. I've got a story about that if you go here. But I have a sort of more out-of-the-box hypothesis. Lydia, you got anything on this? No, I would expect that she came into contact with it in her t-shirt. But it was in the nipple. It was going

So nipple has It has holes in it Sure Because that's it's got to For you know Babies to drink milk Kind of we forget We forget that's what it's for

Yes A lot of milk Came out of these Yeah and intercourse Was initially designed To you know Have the species Go forward to the next generation

But we don't think about that That much either So I wonder what the proportion of sexual Congress is compared to that

for procreation other words recreation versus procreation that's a whole another question but so there is a

thing called nipple sounding I think was that Jenner or Carol I don't remember which one it was but whichever

one of you this happened to there is a thing called nipple sounding where they take why people take wire and stimulate the nipple by placing wire into the nipple.

And I wish that she were on the show right now so I could ask her, did you engage or were you wasted and some dude could have done some nipple sounding and maybe you forgot about it? Is that possible? Or could it have been done years before and the guy just went, oops, and, you know, and I mean, I've seen that happen. Do you remember these condoms called Magnums? I don't mean the magnum size They were brand named Magnum

And they had a hard rubber Or harder rubber applicator So what it was was the condom was rolled up in this sort of applicator And you were supposed to put it on the end An erect slong And then if you just gave a little bit of pressure

It would go boop And it would load it onto the erect penis Sort of like how Maybe so what I hear is the prostitutes will do where they put the condom in their mouth, and then they'll, you know, insert the condom in the way. Didn't know that was a trick. That makes sense.

I've heard that. You know, so anyway. But then what you're supposed to do is grab this applicator and twist it to the right and take it off, right? Well, so it's Sunday morning, and I'm re, you know, I found this package on the floor, and I picked it up and said there's all kinds of writing on here. I'll just read it. And it was like, now my girlfriend,

And I already laughed, by the way. And it said, remove the applicator. And I'm like, applicator. Oh, no. Uh-oh. Oh, no. So I didn't take it off, but there was no applicator anywhere near where the used condom was. So that was inside my girlfriend.

So she faked it. No, no. There's no way that could have been miserable. No, well, it's only slightly thicker than the condom. Oh, okay. Yeah, yeah. Like a hard. No, no, no, no.

It's not like a hard thing. But she had no idea it was in there. I had no idea it was in there. If I hadn't read that, that's probably why they're not on the market because it was a little bit too complex for the heat of the moment. I mean. And I had to make her come back and say, I think there's something up inside you and assume the, you know, the dorsal orthotomy position. And I just got my hand in there and basically fisted her to get the thing out of there. Good Lord.

Were you a medical student at that time? No, I was resident. Okay, so it was inappropriate. Yeah, yeah, yeah, yeah, no. That's so funny. But that was interesting. And so that kind of stuff can happen. People show up in the emergency room with paper clips in their bladders where they, you know, lost them because they were doing urethro sounding.

Please don't do that anybody. And so I wonder if this could have been an episode of nipple sounding. Because really, how do you, I mean, the. odds that you would roll over onto a piece of wire and it would perfectly go up your nipple without you feeling it. But go ahead. I got a story for you. Okay. Give it to me. I was in college middle of the night. Okay. Dreaming, got in a fight in a dream. Yeah. A guy stabbed me in the leg with a knife. Yeah. And it hurt so bad. It woke me up. And I woke up and, you know, it was one of those pushpins that was in the wall above me and falling in my bed and I didn't know it. And

and I had rolled over on that pushpin. Wow. And I literally was completely embedded into my leg. I just couldn't have pulled out. I was like, holy gal. So that's why I'm sticking to the rolling over in bed story. Okay. That's another point.

So if it were sounding, right, you would expect maybe some attention to ducts, right? And that shouldn't be extremely painful. Right. Whereas if it was something that was more traumatic, it would not have attention to ducts. That's good point. Meaning it would just go into the nipple tissue. But I would have thought that there would be. blood and stuff.

You would think there would be blood. The impression I got is it came out of one of the ducts of the nipple, but maybe I'm misinterpreting that. Maybe it was actually just sticking through the skin. And in that case, yes, that's where the sharp Maybe it came from a bra or something, maybe a little wire.

Yeah. I think they're pretty, these two women are pretty savvy on the underwire stuff. I think they would, she would have noticed that. But that's interesting. I'm going to have to punt on that one, but I'm going to give Dr. Scott a bell for Tacey, wherever you

I'm up on you. That was a good one. All right. So we did that. Oh, here's a good one. You'll like this one. Hey, Dr. Stephen Friends. This is Evan from Wisconsin calling.

Hey, Evan. I had a quick question. It's kind of an interesting topic, I think. But basically, I'm in my early 30s right now, but since I can remember, I've basically been hearing voices, either when I'm close falling sleep or right after waking up and sometimes it will scare the the shit out of me I'm not you know it's it's a reason for concern you know I don't really talk to too many people about it but yeah is that anything to worry about and just if it's centered around bad time and also I'm a pretty

prolific dreamer too like yeah I dream a bunch and, yeah, just wondering if that's any sign for a concern. Okay. So anybody got anything? I know what this is. Well, I was just reading the auditory hallucinations while you're falling asleep or during sleep. I don't know. I got my finger on the button.

No, I don't know. God damn it. Scott. He's falling asleep. Oh, narcolepsy? No. Oh. It's called a, um.

No Instead of Hypnagogic Hypnagogic Auditory hallucin Give ourselves a bell Audit Hypnagic

Hypnagic hallucination But he also has Hypnopopic Auditory hallucination And those are When he's emerging from sleep So, and it's probably always REM sleep

But the hypnagogic ones Are the ones that I'm interested in visual hallucinations, moving shapes, colors, and images. And Dr. Scott and I have a hypothesis that so far has borne fruit that the type of hypnagogic episodes that you have, this is when you're falling asleep and you jerk, has something to do with things that you did repetitively in your past. So when I have it, it's somebody always kicking a soccer ball in my face.

and I've played soccer in high school. When he has it, it's always somebody throwing a baseball in his face. And he played baseball in high school. And we've had other people call in saying similar things. And so if you're going from non-sleep to sleep, that's hypnogogogic. If you're going from sleep to non-sleep, it's hypnopompic.

And so that's the visual ones. But auditory hallucinations involve usually background sounds, but it could be a phone. or a doorbell ringing or but people talking animal noises you can have that and they're not usually

associate oh they're not story like like dreams tell stories you know Paris is in my backyard that's the one I always like to use or my best friend from high school Bruce Donahue is skating on my linoleum floors and I'm like I didn't know you could do that

I didn't even think about it he lives in Colorado know, why is he here, and why is he skating in my kitchen? Oh, I love it. You know, so dream logic is ridiculous, but there is a story there. There's kind of a beginning, a middle, and the end, but these things, there's no story. It's just events. So this person who has these going into sleep and coming out of sleep, if it, you know, if it terrifies him, there are drugs that you can take to suppress it.

He needs a sleep, go to a sleep lab, get a sleep study done. Okay. Yeah, especially with all the very vivid dreams You said that he was Yeah, yeah, yeah Which if he could control those He could have a good time with that Tacey

I wish Tacey were here Because she had hypnipompic Sleep paralysis And she would When she was on the road If she was really stressed out When she was a, you know Manufacturer's representative

She would feel like somebody was laying on top of her And she couldn't move And that's classic way You wake up, you hear weird things. She would hear the pitter-patter of, like, baby, like, toddler feet running away from her. Oh, geez. And, you know, if you don't know what it is, you think it's ghosts or alien abductions or, you know, you're being molested by somebody. And I told her all she has to do to control it, because I got control of mine when I was having them, is to imagine her arm.

You can't move it. It's paralyzed. That's okay. You're still dreaming. So just imagine that your arm is raising and then look at your hand. And if you can control it that far, it's over. And she never had another one again. Just having that weapon in her back pocket.

My ex had those as well. Did he? And if you look on the internet or Google images, there are all of the photos of sleep paralysis and it looks like a demon is sitting on your chest or mixing something like that. I never had that. First time it happened to me I've told this story before but

there was a giant floating eye I woke up in the middle of the night and there was a giant floating eye just sitting there and I could see all of the furniture in the room everything in great detail and there was this thing floating

and then it blinked and I had like I felt like I was having a seizure and then I woke up and it was dark in there because it was dark in there. All of that that I was seeing was created by the cerebellum of my brain, the internal map that you carry with you of your surroundings.

And it was so detailed that I couldn't distinguish it from reality. It was amazing. Wow. Yeah. So this gentleman, yeah, sleep study. Yeah, get a sleep study. There's drugs to suppress it if you want to.

But a lot of times once you understand what it is, once I understood what was happening to me, then Badi is much. Then didn't bother me at all. I was like, oh, I'm having one of these. This is kind of cool. Let me fuck around with it a little bit. I think the classic thing that a layperson or a non-medical professional would think about when they're hearing voices is am I, do I have some type of psychiatric condition and it doesn't sound like that.

No, if it's always associated with induction or de-induction of sleep, then that's a sleep problem. This is one for you, Scott. Uh-oh. Hi, Dr. Steve. It's Phil from Tampa. I'm calling because I had a question about something I didn't think on social media. a lot recently. It might not be a new phenomenon, but I've noticed that a lot of fitness influencers

and basically people in general have been taking, like, ice baths a lot, where they will wake up and chisel the lightly frozen top layer off their bathtub and jump in and just, like, plunge in ice for X amount of minutes. And I know that in the NFL, they do a lot in a lot of sports leagues after a rough day. up, you want to jump in and cool off, sure. But, like, just to do that normally, it seems insane to me, but I don't know if it is really helpful. I know there's cold sculpting and cold therapy, but it just seems kind of bananas. And then as a follow-up, I've also seen people go from hot to cold.

Oh, yeah, I used to do that. Oh, yeah. Yeah, I used to do that a lot. I always felt like I was exercising my cardiovascular system because when you're in the hot tub, the blood vessels in your body, dilate to radiate that heat out, and then you jump in the cold water, and then they clamp down again. It kind of gives you an interesting feeling. But what do you think, Scott?

You're the sports medicine person, ice baths. Well, I know as a young person, the ice baths I thought were torturous because you'd roll an ankle or hurt your elbow, and they'd make you stick in a bath full of ice, and it was just awful because they didn't explain to you the benefit. Direct anti-inflammatory. Right. It's a direct anti-inflammatory.

You just thought the coaches were me and they sucked and they just want to urge it. You know what I mean? But as an adult, now the ice bass I like, I actually like to do the cold water plunges because it does. It stimulates a really healing response throughout your body. Supposedly now, this is what I'm reading, it increases leukocyte production in your body. But what I do with it? Blood cells. Yeah.

So presumably improves your immunity. It's because you're stressing. the shit out of your body. Yeah, but what I do now is I take really deep meditational and breathing, I get a big deep breath. And as I walk into this ice bath, I just breathe out. And then I just sit and just breathe and smile. Instead of panicking and it does feel so good when you get out. Yeah. Yeah. But yeah, there's claims that it improves mental health and it improves your immunity. I want to see the studies to show that it actually does something. But I know decreasing total body inflammation, if it does that, is good for you. It's a good thing.

Yeah, and I will tell you this, when we go, I take my dogs up on the mountain for a pretty long hike, so I'll come down and just kind of go in that cold bath. That's different. For five minutes. Post-exercise, it's been demonstrated that it improves pain in muscles and also improves healing. Yeah, yeah, post-exercise, recovery. Yeah, so there's two different, two different reasons for the same thing. Yeah.

Okay. I like it. Yes, I don't know. I don't think it does any harm. No, I don't think it does. It does cause shrinkage, though. Yes, it does. Yes, it does.

Hey, Dr. Seas. It's dude Randall. I was just calling about a question. I've got a problem with my face. You know, I get this red, irritated rash from time to time. My wife originally thought it was like cradle cap. Cradle cap. Dude, how old are you?

I mean, literally, we see that in a one-year-olds. He's an oil-based product on my beard. But I'm finding a case. keeps coming back, you know. Okay. We're starting to run out of time. Anybody have any idea what it is? I mean, it could be.

I saw Tenia Barbay one time, and I'll never forget it. Okay, so Tinia Barbie is, okay, I'll give you a bell on that one. Give myself a bell. That's one thing, so that is a fungal infection of the, basically, the follicles of the beard. And what else you got? Well, there's rosacea, but I don't think that's what it is. If she thought it was cradle cap, that's not it. I'm going to think, or I'm going to posit this probably a thing called seborriac dermatitis.

And what that is, is it really is a bacterial infection or a fungal infection. And shit, I can't remember what it is, is it malacasia fervor or something like that? Look that one up, yeah, Lydia. That'll earn you a bell. But we'll use Niseral shampoo for that, and you can use it on your body as well. And Nizarel is ketoconazol. It's an antifungal. And it works very well for that, if that's what it is.

And if you can't get it under control on your own, see a dermatologist or go see your primary care. And we'll make sure we're not missing something. Yeah, it is malacasia. Oh, that's a good, Dr. Steve. That's the spaghetti and meatballs. Yeah, spaghetti and meatballs, that's right. Yep, yep, very good. Dr. Steve coming through.

No, well, yeah, but Lydia confirmed it. So that's a bell for anything. Let's see. What do we got? I really want to do the artificial sweetener story. We'll probably do that on the podcast this week instead of on the Sirius XM show. So check that out and just go to wherever podcasts are found. And then let's do this one.

Hey, Doc, there's Steve. This is Steve down in Daytona Beach, Florida. Hey, Steve. I used to live in Franklin, Kentucky, then Franklin, Tennessee. So I've been in your stomping ground. That's sad to go. We just turned 60, my wife and I. Why are we always grunting?

We get out of bed. We bend down and pick something up. She's mad at me, so I'm saying, I'm going to call Dr. Steve and ask. All right, brother. Appreciate it later. Well, okay. I have an answer for this, too. Well, usually getting up and grunting and carrying on,

it is because you got a little bit arthritis, a little bit decreased blood flow into those needs. and joints and hips. But why grunting, you know? Why would joint pain cause them to grunt? Because you hold your breath because it hurts when you move.

Okay. And that's, yeah, I'll give you half a bell. Give myself. Hey, cool. I'm up on 1.5 to 1, Lydia. Good job. Yeah, the other thing is is that grunting, if you watch a tennis player,

they make the sound every time. And you go, why, that seems affectations. They go, oh, oh, oh, every time. You know, but it actually has been, there's been some studies. Nobody knows 100% why. But there have been some studies that show that you can actually increase the force of contraction of some muscles by grunting. And some of this has to do with the adrenal complex. And what do you got, Lydia?

I can tell you've got that look on your face. No, I'm just, that makes wonderful sense. Yeah. I was just reading about middle age reasons for grunting. There's nothing that is, yeah. Yeah. They've actually done studies on this. They had to be government studies because no corporation would fund this,

but where they looked at strength of contraction with grunting and not grunting, and it was increased when you grunted. So there you go. So it may just be that you're a little out of shape, and therefore you need that little bit of extra force that grunting provides, and we just do that naturally. I know I grunt when I turn over in bed. It's weird.

It's really sexy. Anybody want to check it out? Email me. Dr.steve.com. Anyway, we've got a couple other questions that we can do. Well, we are waiting for the music, and one of those is this one. Hello, Dr. Steve. I was calling because I have a question about the news.

that says the sweetener, artificial sweetener, I guess, eryzitol causes blood clots and heart attacks and strokes and shit like that. Can you give me some, like, I wasn't able to go on PubMed.gov and find the actual study. I did that for it. How it was done and such. Could you, like, give us some information on that? Please and thank you.

Bye. this was all over the news. Did you guys see it? Okay, the sweetener in question was erythritol. Now, this was in nature medicine, a good journal. Okay. But I am a little bit pissed off about this. As usual, I'm going to start doing a show where I just bitch and complain about medical journalism

until maybe somebody pays some attention to that. because this kind of, there's a little bit of bullshit to this one. It's interesting to know, and it's important for us to follow up on it, but the media frenzy based on this study is what I'm saying is a little bit of bullshit. So first thing, can we look and see what products use erythritol in them as a sweetener? Because it ain't Diet Coke, that's a spartame. And we've already dealt with that a thousand times on this show. And, you know, I think some of the, it's a sugar alcohol by its name.

So it probably like chocolates and stuff like that may have like Atkins style, low-carb chocolates may be sweetened with it. But can you guys find anything that is sweetened with this stuff? So that's the first thing. So this is what happened. they recruited a bunch of people that had pre-existing cardiac risk factors, right? And this was an international study. They tracked their health over time, and then they took blood samples. And they just looked at everything.

Okay. This is what we call a fishing expedition. Okay. They weren't even setting out to study erythrital, and that is the first thing we talk about when we're designing a study is that you have to define what the F you're looking for, and then you got to define your endpoint. What are you going to say as a positive result or a negative result, right? You have to do that.

They didn't do that in this. This is just let's look at a bunch of people, draw a bunch of blood, see what we can find. So what they found was the number one elevated, molecule in these patients who went on to have a heart attack or had a stroke was erythritol. That doesn't mean they were ingesting

erythritol. We don't know. We don't know what they were drinking or eating or anything. We, again, we don't know if this is a marker for heart disease, which would be awesome to know. Hey, you've got a high erythritol level. You've got a high C-reactive protein. You're at risk for heart disease. Okay. That would be awesome. Or is it that if these people eat erythritol containing substances,

that it makes them at risk for heart attack? And then in that case, we'll say, take the shit off the market, you know? All right? So those who had high levels of erythritol in their blood were more likely to suffer major cardiac event within three years than those with lower levels. So, okay. So, yeah, there is a sweetener called erythritol. Some people eat it.

Then some people have high levels of erythritol. We don't know if there's a connection between the two because we don't know if these people were eating erythritol. All right? Now, yes, so, but high levels of erythritol are associated with, you know, increased clotting and stuff like that. So there you go. So what are you going to do? So what, now, what they need to do is let's design a study to determine, whether ingestion of erythritol

is an issue. It's really easy. We've done this a thousand times on this show. Oh, you take a thousand people and you give them who are not, and none of them can already be taking erythritol. Or, no, this is going to be unethical, because I was going to say, give

half of arthritis and see how many art attacks have. You're going to have to find a population of people that are already ingesting erythritol and then match them, patient for patient, with people who don't ingest erythritol, and then see if they're increased erythritol levels in the people that are doing it, and do they have more heart attacks and stroke over time? That's about the only ethical way you could do this.

Now, if you find in the group of people that do not ingest these products, that some of them also have high arithratol levels, and they have heart attacks, and then basically you're disproving your hypothesis because it's not the aggestion. And then erythritorytol itself becomes a marker that we can use to detect people who are at high risk for heart attack and stroke. It might even be better than cholesterol. We'll see. I'm hoping that's what it is. I'm hoping it's got nothing to do with what you eat.

it just has to do with some factor in your body that makes you at risk for a heart attack and then you just draw that and you see now we've got to compare that see if it's more sensitive or specific than cholesterol alone there's a bunch of studies that can stem from this that makes sense

did you know your arithratol is fanning a lot of natural sure yeah absolutely I was going to say we're in trouble it's in beer soy sauce wine we're in trouble so you know what are we going to do and they say oh artificial sweeteners

it's artificial sweeteners and it's like it's in everything stop it now if you find anything any products that actually are sweetened with erythritol no you couldn't find any no I didn't look

B-A-I drinks BIA BIA I like Bia I like Bia Blue Sky is a craft soda made by Coca-Cola company and then the Halo ice creams Well, there you go.

That's really, it turns out that these people in this study, the 4,000 people, or the ones that were using just those products, then okay. Yeah. But, you know, you can't take this stuff out of everything. I think it's going to end up being a marker. I think some people either accumulate it, and that also, that chemical pathway in the body is also associated with making plaques in the, in the heart, you know, something like that. It's going to be something like that. Yeah, it's going to be something like that.

Okay, no, interesting. But, yeah, erythritol is considered one of the more natural sugar substitutes that's emerged as an alternative to artificial options, popularized through the last half century. This, stop it with this. Stop saying artificial sweeteners are the problem. They do not know that. It is an artificial sweetener. They don't know that.

That's why these people had elevated. You know, they're making a connection that isn't there. It's a, maybe a correlation. Right. Not, not. I don't even want to say that. They shouldn't even be bringing it up. They should say, oh, erythritol is in all kinds of shit that we eat and also is sold as an artificial sweetener that's hardly used and hardly effing anything.

Yeah. Yeah. I hear you. God. Get them, Dr. Siegham. Siggum makes me mad. All right.

Oh, here's a good one. Let's do this one. We'll close it out with this one. But I really do want to talk about this. And then I've got a show. I've got to do it. Hey, Dr. Steve, this is Dean in Northwest. Hey, Dean.

And I heard one thing that they say is that the anal sex makes the, butthole makes the ass bigger. My question is, does it make, do they mean that when they say that, do they mean that it makes the, the actual ass bigger or the actual hole? Oh, okay, I got it. Okay. Yeah, so it's an excellent question. Are there downsides to anal intercourse?

Because the one thing you don't want to do is engage in something like that and then be just dropping loads around. the house or you know the sidewalk when you're walking around and so they did a study on this they did a thing called anal monometry good yep so you stick a balloon that's partially inflated up somebody's ass and you say squeeze down and they squeeze down and you get a certain pressure you it's hooked up to a pressure gauge and you can see how much force can they apply to the balloon then you tell them go out and have a whole bunch of anal sex and come back and And this isn't really how we do it. What you would actually do is find a population of people who have never had anal sex

and then a population that have, and then compare them against a normalized curve. But anyway, but you go have a bunch of anal sex and then come back and we'll shove this monometer up your ass and have you squeezed down on it again. And what they found is there is a decrease in the amount of force that can be applied when you are having anal intercourse or if you're a general intercourse or if you're a general, doing ass play with devices that are about the size of a normal human penis. But the thing is, is that it doesn't cause them to be incontinent. There's plenty of reserve, you know, force.

Redundancy. Force, yes. Plenty of that so that you can lose a little bit of it. That's why, you know, it would be dumb if we were just designed that if we just lost a little bit of tone in our sphincter that all of a sudden we'd just start shitting everywhere. Oh, it would be terrible. Yeah, it would be. And when you're running away from saber-tooth tigers,

you don't want them to be able to track you because you're dropping loads everywhere. That's why we developed a continent sphincter. You know? Birds, it doesn't matter. They just shit whenever because they have cloacas. They can fly away.

You know? Birds have wings. They can fly away. No saber-toothed tigers going to chase them because they're dropping loads everywhere. That's why they didn't develop that. Yeah. Oh, my God.

All right. Well, so, yes, there is some loss of tone, and it is in the sphincter muscle. Yeah, but it is something you can do with. All right, let's get out of here. Thanks, always go to Dr. Scott. P.A. Letty, always a delight. I hope you can come more often tell your mom not to listen to this episode. Thanks to everyone who made this show happen over the years.

Listen to our Sirius XM show on the Faction Talk channel. Serious XM. Channel 103, Saturdays at 7 p.m. Eastern, Sunday at 6 p.m. Eastern on demand and other times at Jim McClure's pleasure. Many thanks to our listeners whose voicemail and topic ideas make this job very easy. Go to our website at Dr.steve.com for schedules, podcasts, and other crap. Until next time, check your stupid nuts for lumps. Quit smoking, get off your asses and get some exercise. We'll see you in one week for the next edition of Weird Medicine.

I'm going to go check myself into the tuberculosis for it. Thank you very much.