Weird Medicine: The Podcast - 579 - Rabid for Ketamine

Episode Date: February 24, 2024

Dr Steve, Mel B, Dr Scott and Tacie discuss: Thyroid surgery A Good Listener? Mathew Perry and ketamine Renal stones Rabies Mesenchymal stem cells Please visit: simplyherbals.net/cbd-sinus-rinse (the best he's ever made. Seriously.) RIGHT NOW GET A NEW DISCOUNT ON THE ROADIE 3 ROBOTIC TUNER! roadie.doctorsteve.com (the greatest gift for a guitarist or bassist! The robotic tuner!) see it here: stuff.doctorsteve.com/#roadie Also don't forget: Cameo.com/weirdmedicine (Book your old pal right now because he's cheap! "FLUID!") shoutout1.com/weirdmedicine (either one works!) Keep Dr Steve in Ham Radio! Send a TIP here! Most importantly! CHECK US OUT ON PATREON!  ALL NEW CONTENT! Robert Kelly, Mark Normand, Jim Norton, Gregg Hughes, Anthony Cumia, Joe DeRosa, Pete Davidson, Geno Bisconte, Cassie Black ("Safe Slut"). Stuff you will never hear on the main show ;-) Learn more about your ad choices. Visit podcastchoices.com/adchoices

And though you will try to always get it right, the beauty of life lives inside of you. And I hope someday you find it too. You've heard all the ads, and seen the shops for CBD, and maybe you've wondered, what's the hype? Cannabidiol is known for its ability to provide non-habit-forming relaxation, and now you can have it in a convenient nasal spray.

You can take it anywhere. Just go to simplyerbils.net. That's simplyerbils.net. Check out Dr. Scott's buffered saline CBD nasal spray. Just a couple of toots. You'll see why he's America's top CBD nasal spray. While you're there, check out his line of supplements from fatigue reprieve to stress less. Dr. Scott has it all.

That's simplyerbils.net, simplyerbils.net. Give thyself a bell. Can you please stop bullshitting and get to the question? You see? You see? Your stupid minds. Stupid, stupid, stupid. Man, you are one pathetic loser.

If you just read the bio for Dr. Steve, host of weird medicine on Sirius XM103, and made popular by two really comedy shows, Opian 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 entitled to? I've got diphtheria crushing my esophagus. I've got Tobolivis stripping from my nose. I've got the leprosy of the heartbound, exacerbating my infestimates. I want to take my brain now, blast with the wave, an ultrasonic, ecographic, and a pulsating shave, I want a magic pill, all my ailments, the health equivalent of citizen cane, and if I don't get it now in the tablet, I think I'm doomed, then I'll have to go insane. I want to requiem

for my disease, so I'm paging Dr. Steve. From the world-famous Cardiff Electric Network Studios in beautiful downtown, Bedabler City. It's weird medicine. The first and still only. I'm censored medical show and the history of broadcast radio. Now a podcast. I'm Dr. Steve with my little pal, Dr. Scott. The traditional Chinese medicine provider gives me street cred. Tobacco alternative medicine assholes. Hello, Dr. Scott. Hey, Dougste. My partner in all things, Tacey. Hello, Tacey. Hello. And back from somatical, ladies and gentlemen, N. P. Mel B. This is a show for people who would never listen to a medical show on the radio or the internet. If you have a question, you're embarrassed to take to your regular

medical provider if you can't find an answer to anyone else. Give us a call at 347-76-4-3-23. That's 347. Pooh-Hith. Follow us on Twitter at Weird Medicine or at DR Scott WM. Visit our website at Dr. Steve.com for podcasts, medical news and stuff you can buy. 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 to it over with your health care provider. Please don't forget stuff.doctrsteve.com at stuff. dot, dr.steve.com for all of your shopping needs. It makes a huge difference.

It really, as much as anything else, helps keep the show on the air. So stuff. Dot,doctrsteve.com. You can scroll down, see the things that we talk about on this show, including the adult toy, the, um, one. Luminizer. Mm. Yes.

So you can check that out, or you can look at the Rodey robotic tuner at rody.orgie.com, or it's right there on stuff.com. I checked out the link. Tweakeda audio still works. Tweektoadio.com offer code fluid will get you 33% off. None of this nambi, pambi, 5% or 10% discount crap. 33%. You buy three things, you pay for two. And then Dr. Scott's website at simplyerbils.net.

We'll talk about that in a minute. Check us out at patreon.com slash weird medicine, doing some exclusive live streams there. Also exclusive shows. We have the, what do we call the exam room? We haven't done one of those in a while where we have a celebrity come in and they ask us questions. It's kind of fun. But anyway, that's patreon.com slash weird. medicine.

And then if you want me to just to say fluid to your mama, I will be happy to do so at cameo.com slash weird medicine. As cheap as they'll let me be. I would do them for free just because they're fun. And we need to do one for Donna Pittman here in a minute because she ordered like three of them and one of them's a 24-hour one, so we've got to do it. But Scott, I can do it if you guys are too hot and you want to get out of here. But anyway, all right, very good.

So welcome, everyone. Good to see you. Don't forget Dr. Scott's website at Simplyerbils.net. That's simplyerbils.net. Tis the season for CBD nasal spray apparently. Yes, it is. Yes, it is. Oh, good.

Good deal. All right. So, N.P. Melby, you haven't been here for a while. No, haven't. And people listening to you may notice that your voice sounds a little different. Yes. I don't have the raspy. You don't have the

Smoker's voice doll. The sexy voice I masturbated doll voice from the crazy old lady from my initial encounter or from the Andy Griffith Fun Girls.

Yes. And then the other one Hello doll. Yes, all gone. All gone. So what happened? What's going on? Well, I have a very large thyroid

nodule that just kept growing and it was compressing my vocal cords, and it is now gone. They removed it surgically. They did, and my entire thyroid with it. Oh, is that right? Yes, the whole thing. Okay, so I'm displaying for the people who are watching live, they can see the picture.

If you want to see it, you can go to YouTube.com slash at Weird Medicine and see what is, it looks like a big, looks like sweetbreads. I guess it actually is sweetbreads. Well, that is, I mean, sweetbread did thymus gland, right? Looks like barbecue chicken. Yeah. Oh, that's gross, too. So the two lobes in this thing is the thyroid, I'm assuming. And then the big thing in the lower right-hand corner is the nodule itself.

That is the very large mass. So what was the pathology of the mass? Not cancer, so that's great. It was some type of cyst that just kept getting bigger. Really? Yes. We kept growing for whatever reason. Hmm. So you had it removed and tell us about that procedure. Well, just surgical procedure. They cut across my neck right around, right where my collarbone is.

Yeah. Right there in that notch. Okay. Got a large scar, a couple inches across there and they just cut into it. They removed both lobes of my thyroid and that tumor. And that tumor, that mass that was there was about almost. just eight centimeters. Wow. So it's pretty big.

It looks huge. About the size of the baseball. Is it the North American record, I wonder? Not quite. So now you have to be on medication the rest of your life? With my thyroid gone, I have to have thyroid replacement. Really? So we're still working on getting that adjusted.

Yeah, I talk to Tacey about that. It is a nightmare. It is an ongoing thing. It's like you feel good, and then they take blood, and they make an adjustment, and then you don't feel so good. Yeah, and what Tacey's run into is that they tend to treat you based numbers on a piece of paper. They do. They treat based on your TSA level, and that's not always reflective of how you feel.

Correct. And we've learned that treating just based on numbers is. fraught with all kinds of problems because the numbers themselves are suspect. If you take a sample of 1,000 people, and I just wonder how many people are undiagnosed with thyroid disease in this country. Oh, a bunch, I would think. Yeah, so you're including them in the normal. Just walking around, feeling like shit. So you take 1,000 people, you get the mean, and then you go two standard deviations from the mean, and you call that normal.

But what if there's a significant fraction of people that are low and they're skewing those numbers down so that normal looks normal when it really shouldn't be normal? We see this with testosterone all the time where there's a, you know, it's estimated to be upper to 90% of men who have low testosterone don't know it. So they'll end up in that sample of, quote, unquote, normal. So, you know, then you have the problem of people that are absolutely symptomatic. Going to their doctor, they do the lab work and said, well, your number's 350. That's normal. It's low normal, but it's considered normal, but it's not normal. If you talk to any men's health or urologists that know anything about it, they say, you know, your number should be 500 to 800 to 800.

You know, and I've got a question about it to be not symptomatic, and it's the same thing with thyroid. Yeah, I've got a question about it because, you know, we see that so much with testosterone and certainly thyroid's, but there's, there, are there test run in adolescence, let's say, or even young adulthood, just to get baselines as a general rule, there's, there are not, are they typically, like if you went in for just a normal physical as a 21-year-old, they're not necessarily going to check your thyroid or your testosterone if you're feeling normal. And I think, you know what I mean, but I just wonder if you should at an earlier age. Well, sure. Just so you get a baseline so that when you're 45 and you're feeling like shit and they go, well, your testosterone's 350, you're like, wait a minute. Oh, I see what you're saying. You do your own control. Correct.

Yeah. So when you're 21 years old, you can say, look, dude, when I was 21, my test off there was 600. I said, fuck's sake. I like that idea. No, it's a good idea. It is a good idea, but. To do a baseline. It'd be simple.

It's a really simple, inexpensive test. It is. It isn't until patients go to the doctor and they start complaining about fatigue and they start drawing things. Right. And then they say, well, weight gain and hair loss and things like that. It's normal. We can't treat it.

We're not going to treat it. It's got to be something else. How many people men do we have that tell us that they have fatigue, physical weakness, muscle weakness, loss of libido? Lus of libbo. What do I say? Lus of libido. Libino. Libino.

Lovibbo. Lovibo. Living labibo. Living labibo loca. So, and erectile dysfunction, and then they go to their doctor and the testosterone is 350 and they just say now you're normal. And it's acinine. Yeah, that's terrible.

This is incorrect. That's bad medicine. You've got to listen to your patients. And they, if you are listening to me, And you have this? Right. Thank you. You have to listen to your patience.

Give thyself. Oh, for my first meal. Oh, my God. Oh, she shut out so far. Oh, no, no. Well, you'll get yours when you do Tacey's Time of Topics. Oh, will I, though? Oh, that's interesting.

Since someone threw mine away. Since somebody threw yours away from two weeks ago? Yes. When they cleaned the studio? Yes, they were laying right here where I sit. I do not trash your stuff. That'd be a terrible idea. Yeah.

And it had topics that had already been done on there, right? No. That you had done some of them? Because I saw that and I purposely threw it away. It's like, well, we don't need this. And that was two weeks ago. There you go. No bells for you.

Oh, I see how this is getting turned around. You throw it away, but it's my fault. There you go. Yeah. You left it there. Anyway, so I could use it next time. Well, you're just so used to me never cleaning the studio. That was the, that was the aberration as I cleaned the studio.

And I've got, we have our new sign up here and stuff. Which is beautiful. No one can see. But let me see, I think they can see it. You can see a little bit over my head, you can a little bit. And it is very clean in here since the end of time I was here. I still have a ways to go. And I'm just, these can't, it doesn't mind.

Nobody who's listening on the radio. cares, but I'm moving the cameras around. That thing is going over here and so that we can actually see it because over Scott's head, it's a little bit visible. But I want to

have one camera that just zooms in on that so that's what we're showing at the beginning. But anyway, like I said, that's just for we don't even do a visual aspect of the show, really, but now I'm kind of getting obsessed with doing it properly.

You know, anyway. All right. So I'm not on TV right now? No, no one can see you. I did my makeup and hair and everything. Oh, I'm sorry. Well, you can stand up and wave at the camera. That's not good.

The cameras are all behind you. A lot of our guests don't want to be on camera, so I kind of did that on purpose. I actually put makeup on today, too. Well, you look fantastic. Why, thank you. Gorgeous. Yeah, you we can see. Okay, now I'll suck my gut in.

Okay. Baby's out. Got sucked in. There you go. Chest up. I'll let you know when your camera's on taste. Shoo, that's hard. Cameras off pace, you can relax.

It's really a lot of work to sit like that. Talking about... No one cares about any of this. Thiroid and all that other stuff. I mean, how many years did you feel like complete and utter shit before you were diagnosed? So the... Well, before anybody paid attention to. The noddle we've known has been there for at least six, seven years.

And it was tiny, just like a few centimeters. That's how much. Tiny, tiny, like, I think two centimeters. And then over about a year, it more than doubled in size. But before you were diagnosed with Hashimoto's or whatever, how long did you think or know something was wrong? My TSA has always been, quote, unquote, normal. So normal being like 0.5-ish to about 4-ish. It's always been in the normal range.

But I felt bad for years. I had a lot of joint pain, a lot of aches and pains, just feeling tired, really fatigued all the time. My hair's been falling out for like ever. I just figured it's because I was getting old. But just little symptoms like that. So they, I've got some other autoimmune issues, definitely. So they've just been treating that. But never with thyroid replacement, never with levothoroxine or cynthroid.

And then February of last year, they checked the nodule. It had more than doubled in size. It was about four centimeters at that point. They felt it or they did an ultrasound? They did an ultrasound. As part of, because they monitor it for every year for several years now. So it was about four centimeters. They finally decided because the hoarseness, the increase in symptoms I was having,

and just really completely felt like shit. Been gaining weight, probably about 30 pounds in the last couple of years. Just not feeling like exercising anything. So referred me to a surgeon. And finally had the mass taken out and the thyroidctomy in the end of June. Wow. So, and it got postponed because of some other health issues with my family. So I got that done in June.

And since then, I feel fantastic. Yeah, you look. You look like a million bucks. Yeah, this is the best I felt in probably close to 10 years. I want mine out. I've lost 27 pounds. Yay. I have energy.

the minor just kind of I guess depression I felt just feeling blah not wanting to get up didn't want to get out of bed didn't want to exercise yeah wasn't in the mood just tired all the time I feel so much better I exercise most every day I walk two to three sometimes four miles a day but you had to advocate for yourself I did and when they when the ultrasound came back at four centimeters they well they said I'm normal I'm normal I'm I guess this is just my life. Yeah. So when it was four centimeters, my physician initially said, well, let's get another biopsy. I've already had it biopsy twice, which was no fun. What did your biopsy say? One indicated how she-modos, but the rest of them just said non-cancerous. See, mine said actually lymphoma.

What? Yes. And so then, but, and so that doctor said they wanted it out. but then two other doctors were like, no, thyroid cancer won't kill you. So I don't know where I am in this whole spot. That is exactly what happened, Steve. Okay. Okay.

I saw you shake your head. No, no, I was looking at him. Yeah. I thought that's a crazy thing to say. Well, when my doctor suggested another biopsy, I said no. I was reacting to him. It was me, I swear. But I said no.

And I said, let's maybe go talk to a surgeon. Yeah. And because of the symptoms, I was having a lot of hoarseness. If I turned my head to the left, my voice would totally go away. Well, my God, it was huge. And I was starting to have a lot of trouble swallowing food and things. So the surgeon was immediately like, yeah, let's take it out, gave me an option of a partial thyroidectomy and just take the tumor. It was on the left side.

So they were going to take the mass and the left side of my thyroid. If it came back cancerous, they would likely have to go in and do the other. side. So that was some conversation that you and I had. Yes. And we talked about whether or not to do a complete thyroidectomy. Yeah. And we talked about, it was like a scale that you had me do. And I can't remember what it was called. I don't even remember. But we talked about the, the pros and cons of both. Yeah. And I decided, the deciding factor for me is I did not want to have the surgery done more than once in my life. Because it is not pleasant. It was not pleasant. Yeah. And just with family history and things, I decided to go ahead and have the whole thing done.

I'm glad I did because I feel like a million bucks. That's awesome. Still don't exactly have my levels where it needs to be. So most women usually feel better when their thyroid is somewhere between about 0.2 to 0.4 and less than about 2.5. And so that's my goal is to get my thyroid levels down there. When you say your thyroid, you mean the TSA-H? The T-S-H levels, yes. The thyroid stimulating hormone.

So that'll be high when your thyroid is low and low when your thyroid is high. It's bad-ards, yes. So when I first had the surgery, they put me on levithroxine, which is the thyroid replacement. And about six weeks later, they checked my blood work, and my T-SH was extremely low is like 0.2. And the doctor said, no, no, that's too much medicine. And they lowered my medication. Well, at the time I felt great and wonderful. I had energy.

It was like the energizer bunny. Now we've got to change everything. Yes. So they lowered my medication and I went back down and into a little bit of a slump, still feeling better than I did before the surgery than I did this time last year. Yeah. After another six weeks, my TSA levels went up to eight point something. So it was like the other extreme, and they put me back on the previous dose.

So just had my thyroid check last week. My TSA is down to 3.8, I believe, which is not where I want it. I do feel better. If you were feeling good, for the medical students and people out there, and the reason we're going on and on and on about this is because there are a lot of people out there that have this same sort of thing. It's important. You need to advocate for yourself.

But what they should have done when you get an abnormal lab test is you repeat the fucking thing, you don't just react to it. So when you had a low TSA, because you've already seen, they went down and then they overshot, and now they went back to the dose they were out, and that's three. It's not point two now. Right. So what's different? The difference is all they needed to do was give you two weeks. and just recheck it.

So always, if you get an unexpected abnormal result, just recheck it before you just go knee-jerking and doing things. Because really what they did was they allowed you to be miserable again for a little while. Right. So we're researching as to whether or not, because levitroxine, sorry, is a T4 replacement, which is long acting. And then there's lyothyrine, which is the T3. Which is the T3. So there's lots of studies that say there's no benefit to doing T3 replacement. But what the hell?

Yeah. You're on lyothirine, or agitaceous? And the sensoroid, yes. So we are looking. I talked with my doctor about the adjusting my dose a little bit to increase my met, my levitroxine, just a little bit by about 100 micrograms a week divided into small doses. See, now you have the knowledge. to do this. Yeah, what I've got.

And then versus trying the, what's the medicine? The Liothirine. The T3 replacement and starting with just a low dose of that to see if it makes me feel any better. So you can go in there and negotiate this. Can you imagine if you're like a musician or an artist or just somebody that has no medical knowledge? Right. What are they supposed to do? I told my doctor yesterday.

When I saw him this week, I said, you know, I'm not leaving here unless we are doing something. the blood work says, I'm good where I'm at, but I don't feel as good as I could. Tacey, tell them about your experience. You left, the endocrinologist and never went back. In the middle of the consult, I got up and just walked out. Oh, wow. Wow. Because.

He said, don't let the depression get you down. And I knew it was my thyroid. I just knew it. Man, I just felt, you know, you know. And I just got up when he said that and got my bag and just walked. walked out. Well, depression is a thing. It can be situational.

You know, things can happen in our life that will make us feel depressed. It can be chemical and things going on in our body that can make us depressed. And we kind of know the difference. I was not depressed. I was psycho. Sacco with a slash of depression. I mean, I was fucking crazy. I call that knucking futs.

Yes. That's how I was. And it wasn't, I mean, it wasn't just your typical old depression, because I've had that before. I knew what that was. This was different. No. And he was not listening to me. All you medical students out there listen to your patients.

Yes. So luckily, I have a great doctor who listens to me, and he gave me some options. Oh, you're so welcome. Darth Nuggs earlier When you guys were talking about tennis shoes He's like two Hillbilly Yantas talking about tennis shoes Now we're Hillbilly Yant is talking about our sign

It's what's okay I make the residents that I train Come through take a listing skills test And it's a 25 question test I got it from a book Really? How do you test listening skills? Well I found it I was accused by my special lady friend of not being a good listener.

Okay, so let's hear it. And I said, that's categorically false. I want this. Send this to me. I want to share it with my students. And I said, and I'm going to prove it because if I'm a bad listener, I want to know why. You want to be better. I want to be better because I'm all about, if I'm bad at something, I want to be better. I said, I'm going to find me books.

I found this book called The Zen of Listing. And it's a psychologist in California. And she does research on listing skills. So I'm reading the first half of this book And in the middle of the book is a quiz And it says take this quiz honestly And I did And the whole time I'm taking it

I'm like, oh my God, she's right, she's right I'm the worst listener ever And Max scores 25 And I had 21 And to this day Meaning higher is bad No no no 25 is perfect Perfect

Yeah 21 And you're only a 21 Right As a man that's impressive It's insane And I've not had a single resident even over 15. And I made everybody my, and you know my staff,

I made all my staff take it. One of them made to double digits. And I said, that's why I... And not your girlfriend. Not my special lady friend. I think she pulled in a solid nine. I hope she's not listening now. Let's hear this test.

Here's the test. But this is true, yeah. I want it, yes. That's an excellent. I perform another task while listening to someone talk about something upsetting to them. So that would be like folding laundry, skimming an article, cooking, watching TV, et cetera. Always often, sometimes rarely or never.

Now, if it's something that's upsetting to somebody, I'm not doing anything. Yeah, if it's upsetting to them. But if Tacey's just talking about her day, I'm cooking because that's when we talk. So I'll put sometimes on that. If we can exclude. I'm a flat tire today, Steve. Oh, that's great, honey. Would you like some ketchup with your french fries?

I daydream while listening to someone express his or her thoughts or ideas. Always. You're in always on that? Nope. My mind never stops. I'm always thinking about something. I'm always thinking about something. I will stop a speaker in mid-sentence to interject my opinion.

If I disagree with a statement he has made, I'll say yes on that one. Well, I just don't have time. I don't have time to listen to bullshit. So then I need to work on that. There's a difference between bullshit and somebody. that you just disagree with. Well, and to them, it's not bullshit, though. No.

That's the thing. When I listen to a speaker, I make eye contact, yes. And I nod my head in agreement what the speaker is saying, yes. I'm not sure whether I've grasped a speaker's point correctly. I summarize my understanding of what he or she has said to confirm that I've got it right. Yes. Well, somebody. What do you think about that one, Tase?

Do I do that? I wasn't listening. Yeah. She's a zero. If the speaker doesn't engage my interest, my mind water. I'll text to you. Thank you. What's that?

Yeah, I got it. I'll send tea. I shifted my chair or tap my feet when I listen to other people speaking. I do that all the time. I do that. I'm bad about that. Well, that's just my body wants to do it. Yeah, I think it's anxiety now.

Yeah. I can't sit still. I make disapproving faces when I don't approve of what others are telling me. That's a sign of goodness. Only when Robin's talking to me to do it. Oh, for God's sakes You're in trouble. Oh, no, Lexa, I don't think she's listening today.

If a speaker mispronounces a word, I immediately correct him or her. Now, come on, that's my job. When Scott says Islet sells, that's hilarious. Do you enjoy when you correct your friends? I only do that to my kids. They always come up with the best words. Go to next questions, okay? Oh, God, there are a lot of them, aren't there?

Yeah, it was 25. Okay. Okay. I wait for a speaker to finish his or her point before I make a mental judgment call on what was said. I'm going to say sometimes on that one. If a person feels the need to vent his or her emotions to me, I wait till they let it all out before I comment. I audibly groan or make another kind of disapproving sound when someone states something I agree with. You better say always. Me? Yeah. I do? Yeah. Yeah. Fuck off. God, he does. He's the worst.

fuck off I hate all You make all kinds of noise Do I? Yeah a little bit Hey listen We'll be playing music And I'll hit like a wrong note

And I can hear him go I'm like When we're on the phone And I'm presenting a problem And I need advice And opinion and talk through something I always know when I need to speed it up Because you start making noise

Like Well usually what it is I'm fussing at the person That you're talking about And that is something I've got to work on because, I mean, I've always had to work on it. You know, someone will tell me something, well, that person is like, and I'm like, and they think I'm mad at them, but I'm, I'm, my, my ire is at the person that they're talking about.

But, okay, I interrupt when I have something to add. Yeah, I do that. When listening, I make sure I'm facing the speaker. I do do that. I'll interrupt a serious discussion to take a personal call. Fuck on. If you're on call, you have to. That's only happened once.

I finish other people's sentences before they have a chance to. You have an important job. You have to be available. I'm not sure good listening is a skill we need to be for it. Maybe we shouldn't be talking about. No, I was going to say, he'll take my bell away. He's going to debel me. Yeah, I don't like the song and dance.

It says I act impatient when someone beats around the bush. It's like I don't need the song and dance He actually said that to me Was it yesterday or the day before When we were furniture shopping I was explaining why we need to be Oh no no no I said they don't need the song They don't need the song and dance

We were going to buy we were going to buy furniture Well there's people she works with So it was a joke And she was like well And we had the lizard in that room And now we're going to clean the walls And we're going to do this and that And it's like okay they don't need the song and dance

Let's just buy it I was trying to be funny, but of course I failed. Well, that's because you're an idiot. All right. So what do you score? This one's got... Are you still taking it? Yes, there's more.

When listening to a speaker, I pay close attention to his or her body language. That I do do. Yes. Good God. This is 30 questions. When a conversation turns to a subject, I find harder to understand. I do pay close attention to see if I can learn something. For me, listening is an active process.

I do think so. Well, for what? Okay, there's more. Let me see. Well, nobody else has listened. I know, okay. Everyone else has quit listening to them. They're tapping their feet and rolling their eyes and grud.

Okay, I'm just going to just do the next one's okay. So, okay, I've scored a 43, so it's a completely different scale. What a waste of time. Well, 43 is probably good. You're a good listener. It says when you're interacting with others want to add a word in edgeways or simply want to move the conversation along and can be a challenge for you to sit quietly and wait.

You have some degree of patience, but it's limited. I'd say this is probably true. This is simply a trait that needs to be developed further. When you're not feeling particularly patient, it could potentially result in interrupting or difficulty being fully attended, which can disrupt the flow of a conversation. In order to keep the interactions with others harmonious, it's important that you strive to improve in this area. There you go. Yeah, not so great for a radio host, but in my real life, yeah, I'll put this link in the chat and in our, what do you call it? in our fluid family

fluid family but also on the YouTube yeah but you know I think the most important thing is if people take the test and read the next part of the book which tells you how to improve on where your skills are lacking which is what I do and I think Steve and I have a couple

of the similar lacking skills which is you know I'm notorious for saying listen I don't want the whole story get to the end of the story you know I don't need yeah I don't need And you know, if you're on call and you have somebody calling you and saying, well, they have the nicest little dog and he's always licking my hand. And it's like, okay, it's two in the morning.

Get to the point. Can you just? And then it's always up, well, I need a refill on, you know, roxanol. Or someone's like, you could have just called me and said, I need a refill of roxanol. And I hate to be a dick. I really don't like it because it bothers me afterward and I ruminate about it. And I'm always worried that I've offended somebody. And it keeps me up at night.

But it's like, how can you at 2 o'clock in the morning call somebody? And then you don't know. Well, how much have they taken? Well, I don't know. It's like, how do you not know? Oh, my God. Well, all of those, the bottle's empty. All right.

Didn't you win an award for, like, being the best doctor to wake up at 2 o'clock in the morning? Yes. Awesome. That's because he doesn't wake up to him. He's not going to sleep. He's not gone to sleep. Oh, well, that may be it. Yeah, that is.

You're still awake? No, I'm still awake. Probably true. Okay. Let's move on to something that's sad to me, which is well, it's sad. It's, it's Matthew Perry. So we are recording this on December 16th. And some of, some people will be listening to it much later.

But Matthew Perry died of acute effects of ketamine, the autopsy cells. Now, the reason I bring this up is because I've been extolling the virtues of ketamine on this show. And a bunch of people have been tweeting this at me. Well, Steve, be careful. Be careful. Well, okay, so you got to hear the whole story, though. So he drowned, and he had a high dose of ketamine in his body. And he was found unresponsive in the hot tub, in his home in Los Angeles, and the drowning coronary artery disease.

and the effect of buprenorphine had contributed to his death, but then the autopsy ascribed his death primarily to acute effects of ketamine. Now, ketamine is a powerful anesthetic, and it has become increasingly popular as an alternative therapy for depression, anxiety, post-traumatic stress disorder, and other hard-to-treat mental health problems, but it's also used recreationally. Now, he had gotten a ketamine infusion

but it was 10 days before. Now, the half-life is like four hours, so it was out of his system. This had nothing to do with the therapeutic ketamine of infusion that he had. He had high levels of ketamine in his post-mortem blood specimens. And so what they think happened was that he ingested ketamine on his own, whether it was prescribed or not, we do not know. but he had high levels of ketamine in his system.

And then he was in a hot tub. And he dozed off and didn't wake up when he started drowning. And did this ailments the box on he was on? No. Well, it doesn't say anything about that. It's just talking about that. He played pickleball at 11 a.m. He is assistant left the home to run errands at 137 p.m.

And at 4 p.m., they found him floating face down. And, yeah, it's sad. because I really, I always really liked him. I never watched Friends, but I liked him in other stuff. I saw him in that studio 66. He was amazing in that. And he was just so personable. And the fact that he had these demons, you just didn't know.

You couldn't tell from the art. At least I couldn't. And, you know, it was, yeah, it's just terrible. But two things. I have people that come to me that don't want to to take fentanyl for their cancer pain because they've seen stories about fentanyl deaths in the news. Well, there's one thing about taking something under the supervision of a provider, licensed provider. And another thing of, you know, taking something that's off the street and you don't know what's in it and, you know, et cetera, et cetera.

So I have to have that explanation. Same thing here. I don't know what he did, but it wasn't the ketamine infusion that was done under the supervision of a health care provider that caused his demise. It was taking it outside of that therapeutic environment. And even if he was taking a prescribed amount of ketamine, he had to know the effects that it has on you. I don't get in water that can cover. your mouth and nose. That's six inches. Don't get in six inches of

water if you're taking any drug that can sedate you. Xanax, lorazepam. Alcohol. Any of those things. Ambien. Ambien. That's a good one. Sleep things. Don't take that and get in a hot tub. Right. Or a pool. Or

take a bath. I mean, that's what happened to Whitney Houston. She was taking a bath. And she dozed off or passed out. And I mean, apparently, legendly, that's what happened. And she drowned. Yep. So, yeah, we do not have good defenses against drowning when we are unconscious.

Well, we don't have good defenses against anything. Yeah. But that urge to breathe is great until your body can't, you know, make you conscious again, you know. Very hard to drown yourself. But if you're taking a drug that causes you to be completely sedated, it can happen. So please don't do that. We don't need to lose any more people of, you know, famous or not, through drowning because they were taking a sedative-aiding drug and they got in water. Okay.

I know it feels good. Yeah. And it feels like it's going to feel good, but you've got to set that boundary up front. Yep. All right. And never allow yourself to do that. Okay, doke. Anybody have any stories?

Did you bring one, Mel B? Well, you brought your thyroid. I brought my thyroid with me. Okay. and Tacey's stuff got thrown away. So let's do some questions, then. You got any questions from the fluid family before I do this? Not yet.

Okay. Number one thing. Don't take advice from some asshole on the radio. All right. Let's try this one here. What sayest thou? Oh, boy. Here we go.

Hi, Dr. Steve. Hey. Calling about kidney stones. Okay. I don't have me. Thank goodness, but I was just wondering. Yeah. So kidney stones are made up mostly of calcium.

Well. Is there anything we can do? It depends. You know, kidney stones can be calcium stones. They can be uric acid stones. There can be oxalate stones. There's all kinds of things that can be, you know, in a kidney stone. Through to just a thought of it makes me hurt and cross my legs.

So is there anything that we can do to prevent them from ever coming? I understand that drinking, somebody, I think it was my neighbor who said drinking tons of ice tea made from like a powdered mix caused him to have kidney stones. But if it's calcium, it seems like milk would be a big, you know, reason why you get kidney stones. I don't drink milk, thankfully. But is there anything that I can do that will prevent or that, not me, but that we can. do that will prevent maybe from having kidney stone? Yeah, yeah, yeah, absolutely. So it sounds like he's never had one.

He's just worried about getting one. If you've never had one, it is kind of unlikely that every day that you go where you haven't formed a kidney stone, it's less likely that you're going to. But there's always a first time. So staying well hydrated. What do you think, Melby? It looks like you want to say something. No, I'm just laughing.

Oh, you're just laughing. Okay. I was going to suggest sitting cross-legged. Yes. Five times a day for three minutes. Really? To prevent kidney stones? I just might give this guy something to do.

Oh, okay. Give him something to do to think about something else. Yeah. Yeah, I remember. Drink lots and lots of water. Cranberry juice is good. Just kind of flush things out a little bit. Well, what causes kidney stones?

Well, it depends, doesn't it? So if you have high uric acid and you've got the wrong pH in your urine, you'll form kidney stones. And as a matter of fact, there's a drug that we use to help people excrete more uric acid called probenicicin. And if you just give that to people, they're going to start peeing out massive amounts of uric acid. They'll make kidney stones almost every time. But if you give them potassium citrate to change the pH of their urine, they will not. So if you have uric acid stones, if you have gout and you're making stones, you can put people on potassium citrate to prevent them. You can, you know, tea can cause kidney stones if you are prone to make kidney stones.

But green tea looks like it won't. It actually prevents kidney stones from being formed. But it just really depends. Some kidney stones will form in an acidic environment, some in a basic environment. some in a basic environment. So you have to know what kind of stones you have. And so if you have a kidney stone, make sure that they take it and analyze it, then they can put you on a diet or give you a medication to help prevent the stones.

Now, if you just want to generally prevent kidney stones, do what NPMLB said, drink lots of water, stay well hydrated, and it looks like maybe green tea might be beneficial in preventing kidney stones in general all cause kidney stones so you could try that and then just go from there yeah lay off the sodas right well right

and you know there are other things to worry about but you get these things in your head we our kid when he was I don't know 10 or 8 he thought he had he was going to get rabies I don't know where he heard about it but every night he would call me in there and say

can you get rabies from petting a cat and it's like nope you can't get rabies you do not have rabies and and then he would uh what were some of the other things he was always about rabies yeah it was worried about getting rabies yeah and uh i don't know where it came from you learned about it in school or something i remember when i was a kid rabies was like terrifying they used to have commercials about not petting wild dogs and some before they had rabies vaccine and i remember this horrible i was four years old i remember this like a was yesterday, I'm watching the TV and they're doing an anti-rabies commercial, and this guy's walking down the stairs, and all of a sudden he starts having seizures and foaming at the mouth

and the screen is flashing. Oh, geez. I remember the sound of it? It scared the ever-living shit out of me. And we have a friend that's from India, and they didn't have, in her area, didn't have rabies vaccine. Dogs that you didn't know were monsters to them. and when she would see our dog, she would freak out.

She won't come into the house. So we had to put them in a thing so we go to their house now. When I worked at the health department, we always got calls about Ramees. Yeah. People, I had a bat in my house. What do I do? Yeah, yeah, yeah. Go to the emergency room, tell them, you know, and they'll give you the rabies vaccine.

This woman did not want to go, did not want to go. So we just told her, well, if you get rabies, you will surely die. Yep, that's true. Rabies, it's about 100%. Shots. Is it like a bunch of shots in the stuff? It used to be, you had to get an intraperitoneal shop, but now I don't think that's the case. It's a rabies vaccine.

It's not a pleasant treatment, but rabies is not pleasant either. And again, you will surely die. Yeah. Two IM doses now. It says, okay. So a regimen of four, oh, well, now, wait a minute. Regiment of four 1ML doses, a vaccine should administered intramuscularly to previously unvaccinated person.

The first dose of the four-dose course should be administered as soon as possible after exposure. Additional doses should be administered at days 3, 7, and 14 after the first vaccination. For adults, the vaccine should always be administered into the muscle in the

deltoid area of the arm. For children, they do it in the thigh is acceptable. The gluteal area area, in other words, ass cheek, should never be used because observation suggests, administer this area results in lower neutralizing antibody tires. It's because Americans have fat asses, and it doesn't end up in the muscle.

It ends up in the fat. So, yeah, post-exposure prophylaxis, wound cleansing. All post-exposure prophylaxis should begin with immediate thorough cleansing. And then a full dose should be infiltrated around any wounds. This is rabies immunoglobulin. So these are antibodies against rabies. And they're saying you give a full dose around any wounds and any remaining volume should be administered. I am at the anatomic site distant from the vaccine administration.

So what they're doing is they're injecting you with antibodies that were generated, you know, in a vat or whatever by monoclonal, you know, cells. And to mop up any, you know, viruses that are laying around. you don't have any antibodies. And then the vaccine, and it says, yeah, one ml, one each on day 0, 3, 7, and 14. Now, I remember when I was a kid, when they finally came out with the rabies vaccine, it was intraperineal. You had to actually give it into shots into the abdomen. I think that's what you're thinking about.

Yeah. And it was like 20-something or some crazy amount. It was very scary. If you get bit again after you've been vaccinated, you don't have to do the rabies immunoglobulin. You do all the other stuff. And then the vaccine is just two days. That's just bad look.

Yeah. Well, you know, like wildlife officers and stuff, they get called to deal with rabid animals. We had a rabid skunk in my parking lot when I was in rural Tennessee practicing. We had to get them out there to get it. So, you know, those people get bit.

How could you tell it was rabid? Was it foaming at the mouth? It was stumbling around during the day in our parking lot. I'm surprised one of your nurses just didn't go get a gun and shoot. They would have. Exactly. Anyway, yeah, very interesting. That's wild.

Old rabies. Well, we don't have to worry about that so much, although it still happens. And hopefully this guy won't get kidney stones Right Good luck, buddy Yeah, you just worry about stuff Sometimes you get it in your head And you start worrying about it

If you see some Yeah, and you see somebody go through a kidney stone That is not pleasant No, you don't want it I passed one on an airplane once Oh you have a history of kidney stones? I've had two What the hell isn't wrong with you?

Oh my gosh I'm not pregnant Okay, there you're good So what kind of kidney stone was it Did you save it? Calcium That was the first one one calcium phosphate calcium oxalate do you know I don't even remember and never again I had one more I didn't save it I didn't try to go after it on the airplane it wasn't bad it was small I mean it hurt but oh yeah I can't do it I think it was the beer I drank before getting on the airplane that probably helped that we were talking last time you two weren't here about the time when I was on an airplane and they said is there a doctor on the airplane

and I got up and this guy was having chest pain and it's like well do you have nitroglycerin do you guys have this do you have oxygen and all this stuff and after we got him sort of settled down and laid him down and got his feet up because his blood pressure was low they said what kind of doctor you said I'm a hospice doctor that you felt great

yeah oh my god stupid all right hey Dr. Steve Sam from Australia wow a call from Australia Paul from Australia.

By the way, my friend, I saw that this guy actually spent money because the area code started with 6-1. You can just record it on your phone and email it to me, DR Steve 202 at gmail.com. I'll take it that way. I don't want you spending your hard-earned money. I'm calling this dumb show. To show. Vice.

I'm considering going to coast. for you to get some mizankhamal stem cell treatment. I've got some old M&A injuries, and I've also got a injury from a burst appendix. So I was just wondering if you think that is a sort of good way about going with things. Anyway, thanks, Steve. Have a great day. All right. You got anything on this?

Stem cells? No, mizankumal stem cells. Oh, no. But I can look them up. Well, I mean, okay. No, it's okay. Misenkimal stelle cells are known as mizankable stromel cells. And they are multipotent cells that can, they differentiate into a bunch of different cell types.

And they can turn themselves into bone, cartilage, muscle cells, fat cells, all kinds of stuff. So the question is, do they seriously not have this anywhere closer? to you than Costa Rica. That's a long way to go. And what's he trying to fix with him? He said something about, what did you say, a ruptured appendix injury? And some MMA injuries or something like that, maybe.

Yeah. You know, there is some research that's being done on these for making, you know, repairing cell damage. But I am not up to date on the research, but I'm looking at this. And, you know, the term has been debated for years.

The use of them has been debated for years. Whose stem cells are they? Are they going to take your own? And then treat them and inject them back in. You know, there's not good data on this. There's a lot of concern about marketing and application of this. Now, you know, do I think that it's going to do him any harm? If they use his own stem cells, I think the amount of harm is minimized, but I just wonder how much good it's going to do.

Well, you know, the younger you are, the healthier of your stem cells, typically the older, like some of the people that we have to get stem cells, the older you are, the less viable most of the stem cells are. A lot of times it's when you get donor stem cells. Right. But you know what we see is a general rule someone has to have something there to work with. It doesn't magically reproduce something that's gone. So if you've got a knee that's completely eroded or a hip that's got like an avascular and necrosis or something like that, you can't put a stem cell in there and make it all of a sudden grow back. So I'm looking here, mizankhamal stem cell based therapy for rheumatoid arthritis.

This is from the International Journal of Molecular. science. And they said, you know, in the recently investigated mesencomal stem cell-based therapy is considered a promising approach in rheumatoid arthritis. So, I mean, it's not complete horses yet. Here's application of mizankable stem cell therapy for aging frailty. So we'll look at that. I'll tell you what.

We'll look into this further and then we'll try to come up with some concrete information about it. My question would be, what's health care like in Costa Rica? Well, they can do stuff that they can't do other places. We'll talk about that. So anyway, this mezenkimal stem cell therapy research. This is from the journal Theronostics. And it says transplantation of MSCs represents a promising therapeutic strategy to address pathophysiologic problems of frail syndrome. In other words, medical frailty. The therapy has undergone phase one and phase two trials in human subjects

that have endorsed the safety and efficacy of mesenchable stem cells for aging frailty. Caution is still needed with regard to potential to form tumors, and further large-scale studies are warranted to confirm the therapeutic efficacy. of mesenchable stemthel Jesus, mesenchable stemtel therapy. And that was in 2021. Let's see. Okay, here's one for knee osteoarthritis.

Here we go. Injective mesencomal stem cell based treatments for knee osteoarthritis from mechanisms of action to current clinical evidence. It says, despite the constant presence of positive and satisfactory results in the studies analyzed, the complexity of MSC metabolism-related therapeutic effects, as well as the weakness of most of the studies,

do not allow withdrawing definitive conclusions about the superiority of one tissue source over another, as well as about the best cell dose and long-term durability. So there is some positive data, but they haven't nailed down, how to do this the best, or what the dose is, or where to get the cells from, et cetera, et cetera. and that's from knee surgical sports traumatology and arthroscopy journal.

So anyway, all right? Yeah. I've got something to add to that. You don't want to be interesting to do to see if they did a study with the injection of those stem cells and a placebo injection of nothing. Because if you all remember, roughly 20 years ago, they did a study on knee arthroscopies. And they did this in Houston. And they had, it was like 20, 20 patients all had,

we're going to have a knee arthroscopy for like a minor menisical tear. Okay. And they all knew they were going to be it. Ten of them were going to have the surgery. Ten of them were not. But they all were all put to sleep. They all had the surgical incision made. Ten of them then were sent out.

The other ten had the arthroscopy. And the ten that did not have the arthroscopy went straight to PT. And they went better. They did better. And they hypothesized that it was. was because of the needle going in there and stimulating the healing, and they didn't even really need to do this, which is what we see a lot. I like dry needling.

Yeah, which is what we see a lot with, you know, any kind of the stuff we do. You know, you know, needling around joints. Yeah. I thought dry needleing. It was bullshit until it got done to me, and it fixed me right off. Well, yeah, you don't have to, you don't always, and a lot of times they're doing that with trigger points now. They're not always having to use so much of the medicine.

Right. A lot of times, it's just the needle going into the muscle. That's crazy. And it's because the body now gets a red flag. It's like, oh, wait, we're supposed to go help here. And that's kind of what they think. Yeah, yeah, yeah. That'd be interesting about those mazincomal cells.

Yeah, well, I tore my calf muscle. Oh, yeah, that's right. When you're in rehab. When I was in, yeah. I was at Skytera, jackass. At least he was listening to me this time. Fuck off. Yeah, I was at a wellness retreat.

And, you know, I tore, the first exercise, I tore my, which, the soleus muscle, thank you. And I got a massage, and I got some physical therapy, and then he did dry needling, and it really fixed me right up. I was able to do everything the whole time, so. Wonderful. Yeah. The last time that happened to me, I was non-weight-bearing for, you know, days and days and days. Yeah. So I was very impressed with that.

Anyway, all right. You got anything from the fluid family? Stacey wanted to know about why is it that every new drug that comes out warns about not having, not taking it if you have TB? Say it again? Yeah, Stacey was wondering about why is it that every, what is it about tuberculosis that every new drug says don't take it if you have tuberculosis? I don't think it's every new drug. It's the monoclonal antibodies and immunotherapy and stuff. Yeah.

Because they don't want tuberculosis to kill you. Tuberculosis can go crazy if your immune system is lowered. If you suppress your immune system, it'll go crazy. Right. Your body no longer can find it off. Right, because the tubercles are caused by the immune system trying to wall it off. I mean, the immune system's reaction to the tubercula, you know, mycobacterium tuberculia or whatever the shit it is. It's been so long since I've dealt with it.

You can have tuberculosis and not be symptomatic because it lies dormant in your brain. You used to deal with that a lot of time. I did. I was the tuberculosis nurse. Was that right? Yeah. Oh, wow. And all of the county.

Did you work with Dr. J.M? I did. Yeah, okay. Yeah. I trained under him. Oh, cool. Yeah, yeah, yeah. I don't want to say his name, but I knew you'd know who I was talking about.

I was the tuberculosis nurse for a while. And so tuberculosis. It's still a real thing. Right, it is. It's still around. They got the consumption, don't you know? I had lots of patients that I treated. So if you are exposed to tuberculosis, so if we're all sitting in this room here, one of us has tuberculosis and we're coughing and everything, all of a sudden the other three of us are exposed, and we can get tuberculosis.

That doesn't mean we're going to get sick. It doesn't mean that we're going to die, nothing like that. It just means that it's now in your body and it lies dormant, kind of like chickenpox and shingles. Interesting, yeah. Yeah, so it lies, too. Yes. It lies dormant in your body. And if your immune system becomes compromised. So if you get treatment for other things that lower your immune system, then your body's no longer going to be able to keep that in a dormant state. And the infection then becomes active in your body. And that's when you get sick. And when you become sick and active, that is when you have to get treatment. So you take antibiotics and there's like several different kinds and, like, several different kinds. Lots of treatment.

You got to take B-12, I think. B-6, I think. B-6, I can't remember. Because the treatmental. The isinia. I haven't dragged that out of my head for 30 years. And Ruffampin. Yep.

I'm trying to remember all the treatment. That's okay. It's like five drugs, six drugs, something like that. I gave mouth-to-mouth to someone with active tuberculosis when I was a resident. And that was. back when we still gave mouth-to-mouth. I remember what room it was in, and I can name it. If I do, I'll really be doxin myself because it's not too many rooms,

and the hospitals have this particular room nomenclature. But I remember it like it was yesterday, and they coded, and I was doing mouth-to-mouth, and I never got it. I never tested positive. Never tested positive? No, no. Funny story, I'm allergic to tuberculin. The test thing.

Oh, really? So what do they have to do? Just chest x-ray then? So every so often, I have a little chest x-ray. Wow. It doesn't seem like they've made us do PPDs at work in a long time. Why is that? No, they do a screen for me now.

I don't know why. We used to have to do that every year. We don't do it anymore. So when I was leaving the health department, one of the things that I'm trying to recall, I think the tuberculin, the TB test, if you do it every year, it becomes not accurate because your body gets exposed to it so many times and then you just quit

like oh I've had that before and like your body won't react even if you're positive I see so even if you've you've got this in your body all of a sudden your body doesn't recognize the tuberculine because you've had it every year for 20 years interesting yeah and it's just not as accurate so they don't do them as often they try to limit that test as often as possible and just, you know, screen you for symptoms. So that was when we were still doing yearly TB test. I couldn't do the TB test. So there was screening all these questions.

Have you had night sweats? Do you have an unexplained cough for a long-dust week? Can you please stop bullshitting? Have you been exposed? I'm sorry. Wrap it up. We can turn it on an air conditioner. Okay.

That's all he said. I think it feels good here. I was actually listening. And Scott's just thinking it's hot in here. Sorry, I really did I have one other question that I wanted to do Okay And it's from a friend

It says, hey, Dr. Steve, it's Sensei Hey, Jay, hello AJ, what's up? I hope y'all are doing well, miss everyone And I hope to be back in studio for an episode one day Yeah, dude, you're welcome any time A couple of questions I have Just never seem to remember to call in When you're doing a live show

It seems to me AJ's forgotten how we do the show We haven't taken live questions in a long time. First is what's the difference between a pick line and an IV? N.P. Melby, you want to take that one? Because I know you've done both. A pick line goes in peripherally into your body. And once it gets into your body, then it goes into a central line, into a central vein in your body.

So what does pick stand for? You had to ask me that. It's okay. Peripherly inserted central catheter. Yes. So, yeah, it's like having a central line, but they could do it in a peripheral vein. So they start it usually in the arm. And it usually goes in the upper arm.

And they go in that way. And then the catheter goes all the way through the veins into a central artery. Correct. So that's the difference. And those, they do that because the veins are very fragile. And a lot of medications will just burn them up and blow them up. Yeah, if you've got to do sex. six weeks antibiotics.

You don't want some little dinky butterfly needle in your hand. You've got to have, but you don't want to always be put in a central line in people either because there's caught. So you can leave them in for a long time. First time I tried to put in a central line, I dropped the person's lung. Of course, that was an intern. Well, we were doing subclavian, which is under the collar loan. And you have to do it a certain way and damned it. You know, I got it in there, but I did an x-ray afterward.

and there was air between the lung and the chest wall. All right. Okay, what's the second question? I've always been curious if you can explain in detail what an aortic dissection is. Yeah, his dad had that. It was rushed to emergency

surgery. And he lived? I don't know. I don't know if he did or not, to be honest with you. I know his dad died a few years ago. A few years ago. It may have been from aortic dissection. but I thought I had an aortic dissection last night.

Oh, goodness. Well, I get this as Sabajeel. That's terrible. This is the first year hearing you're like. No, she heard about it. She's talking about not listening. But anyway, yeah, I'm having lancinating chest pain, radiating to my back. Well, can you just be quiet?

I'm trying to sleep. Oh, well, if I'm asleep, then they're just. Right, that's right. I have esophageal spasm, and it causes a really sharp pain. The first time it happened, I'm like, okay, here I come, Martha. You know, I'm having the big one. It's the big one. But I drink cold water, and it goes away.

So that's not an MI. It's not a myocardial infarction. It's not an aortic dissection. But there are layers to the aorta, and those layers can split. And when they do, that's called an aortic dissection, and it can be crime. or it can be acute and kill you. They can get thrombus in there. And when the clot between the layers of the aorta

can then acclude the vessel itself, which are a problem, you know, because you can't pump blood, so all kinds of things. So did you have something else to say about that? You're looking like that explanation. She's probably a lot. You're both hot. All right, very good.

Well, listen, thank you, everyone. I guess we'll get out of here. Thanks to Dr. Scott. Thank you, Tacey. Thank you, N.P. Melby. We hope to see you back more often now. No, I'm feeling better. I feel like talking.

Yeah. I think the last time you were here, you did the Navage for the inventor of the Navage. And we probably need to mark today's show as the first time I've been here, sober. Oh. That's true. I don't even need to be able to do that. You get nothing. You lose.

Okay. Anyway. Okay. Well, that's good. So was there a reason for that? Or you just have to drive? I have a cat issue going on. I've got to deal with the dead cat in my car.

Yeah, we'll talk about that after the show. All right. Thanks to everyone at Sirius XM, who's steadfast support of the show, sustained us over the years. Thank you to the fluid family, including, oh, Stacey Deloche, Darth Nuggs, um, not cupcakes, Amanda, um, Amanda Davidson, oh, hello Amanda.

And, uh, Mick Ribs and some others. I can't see him there. Don't I know Stacy Deloge? You do? Yeah, yeah, yeah. Just checking. He's been here when you were here. So, uh, yeah, don't, don't, don't acknowledge him because then, you know,

that's funny. Stace is a good little failure. Many thanks to our listeners, his voicemail and topic ideas, make this job very easy. Go to our website at Dr. Steve.com for schedules, podcasts, and other crap. Listen to our podcast at wherever podcasts are found.

This thing still says riotcast.com. We are now finally with Studio 71. So you'll hear Dr. Scott's ads and some other stuff. It should be better. We're back on a weekly schedule. it'll be by God every week or I'll eat a bug so it's going to be a lot better we're going to be doing we're going to be doing video stuff I did a whole live stream last night and I tried a new configuration and none of it went out so I recorded it and anyone that had the link could see it and interact with me but nobody else could see it and so I started editing it and I was just going to upload it and I said screw it I'll just do another one tonight and do it right anyway it's me right. Until next time, check your stupid nuts for lumps. Quit smoking. Get off your asses. Get some exercise. We'll see you in one week for the next edition of weird medicine.

Thanks. Bye. Bye. Thank you.