Weird Medicine: The Podcast - 631 - Stupid Cletus Puppet

Episode Date: April 28, 2025

Dr Steve and Dr Scott Discuss: despondent over missing Hackamania (stay tuned, there may be an answer) Stupid Cletus Puppet Cancer staging Lipoprotein(a) Dr Perkins isn't a doctor, apparently? HPV vaccine sweating after exertion male morning sickness fluid family stuff youtube.com/@weirdmedicine Please visit: simplyherbals.net/cbd-sinus-rinse (the best he's ever made. Seriously.) instagram.com/weirdmedicine x.com/weirdmedicine stuff.doctorsteve.com (it's back!) youtube.com/@weirdmedicine (click JOIN and ACCEPT GIFTED MEMBERSHIPS. Join the "Fluid Family" for live recordings!) youtube.com/@normalworld (Check out Dave and crew, and occasionally see your old pal!) CHECK OUT THE ROADIE COACH stringed instrument trainer! 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!") 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

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They're classic shows featuring Jefferson the Scheister, double-basectomy turd, aka Adidectomy Todd, aka Fecalicious, GVAC, all kinds of stuff. You ever say a word a bunch of times? Go back and then. You can check those out on patreon.com slash weird medicine. And I'm still doing cameo. Camio.com slash weird medicine. If it weren't for Donna Oliver, I wouldn't have any cameos to do.

But I appreciate it, Donna. Thank you very much. So, you want me to say fluid to your mom today, to be honest with you. This is a bad day. Check out cameo.com. It's a good day, and it's a bad day. So I'm in a double bind. I'm going to feel like shit no matter what decision I make.

But so when Patrick Melton invited me to come to to Las Vegas to do our final show. He didn't know at the time when he invited me. But, you know, I decided that would be our final Sirius XM show. We're going to do a live show and go out with the bang and all this stuff. Okay. I knew it was on Mother's Day. And I talked to Tacey about it.

And I said, you know, it's on Mother's Day. And she's like, well, just make sure that the boys spend the day with me because it's Mother's Day. You don't have to be here. And that was cool. I appreciated that. That's fair. So I scheduled it. I've been spending hours making videos for this thing, and I bought a new stream deck nano so I can fire my events and the videos and the pictures.

And I've got a big full-screen picture of Chad, Zumach, that says, you know, please clap. And, you know, that I could use if things were lagging. And I was also very excited. I was going to take a bunch of money, and we were going to do some gambling and enter a poker tournament. Oh, cool. And doing dinner with Patrick Melton and the rest of the group Thursday night. I'm going to get to hang out with friends that I haven't seen in quite some time who I really cherish their friendship. And so everything was cool.

Well, Liam gets a letter. from the dean and saying that he's graduating summa cum laude. He's got the highest grade point average in his class, in his college class. And graduation is May 10th. And he wasn't going to walk. He said, I've, you know, screw it. I'm not one for ceremony. He didn't say it in so many words.

It was probably more like, uh, uh, but. Yes. Knowing him, yes. But, I mean, the kid is a, He's brilliant, but articulate, not so much. And he's a wonderful child. Yeah, no, he is. He's got a great heart.

If he catches a fish and it dies, he cries. God, I can't talk. I mean, he gets that from me. I cried watching Willie Nelson and Shnade O'Connor doing Peter Gabriel's Don't Give Up. Have you ever seen that version? It was right after she got booed off the stage, the night after. after she tore up the the picture of the Pope. And then nobody

knew why she did that. They just thought she was being a turd, but she had a real good reason in her mind for doing what she did. And, you know, she got pilloried for it. And so Willie, she got booed off the stage. So Willie said, look, let's just record

it in the studio and we'll do a video. And it is heart-wrenching. Now, when Peter Gabriel did the song, And I went down this whole rabbit hole starting with, if you want to see something weird, go to YouTube and search for Midnight Special, which was a TV show when I was in high school, that would have Glenn Campbell on, and then they would have King Crimson. Oh, wow. You know, it was just this weird, eclectic group of just crazy bands that they would just throw together. And Genesis, the early 70s Genesis was a program. band. It wasn't the band that a lot of people

know today. And Peter Gabriel was fucking a lunatic. Really? Yes. You have to watch this. Just search midnight special Genesis. It was like 1974. It's one of the craziest things I've ever seen. Well, I watched that live

and it stimulated me to go down this whole rabbit hole, mostly centering on Peter Gabriel but other people. It just interesting who he turned out to be. But anyway, you watch his version of Don't Give Up, and it's almost hopeful. And you watch the Willie Nelson version, and you're not sure how this is all going to turn out, you know.

And it's just fucking brilliant. But anyway, where was I? What was I talking about? Why did I get off on that? Liam's Walking. Oh, Liam Walking. May 10th. What that have to do with Peter Gabriel?

Going to... Oh, crying. Yeah, crying over stuff. Yeah, that's right. Here I am. I'm in tears. Fish dying. 6.30 in the morning, and I've got tears running down my face watching this video.

But anyway, so he gets the letter, you're graduating, summa, cum laude, you're number one in your class. And he says, you know what? I worked my ass off, and I was right there with him from the first week of school when he called me crying because he got a 68 on a syllabus exam, which is not even worth one point. And he was worried he was going to lose his scholarship. Oh, bless it. Oh, no. Poor little guy.

God bless. He's a perfectionist, and he didn't want to lose that 4-0. And so his head was exploding this last semester. And all of a sudden, yesterday, he announces, I'm going to walk. Oh, goodness. Because of, you know, he gets this letter from the dean and all this stuff. So I'm not like some people. I don't have to, some people will get this reference,

take video from the nosebleed section of my kid graduating because I wasn't invited to his graduation. I'm going to feel like shit either way because Tacey said, well, you're still going to Las Vegas? And I'm like, yeah, I can't get out of it. And then the more I thought about it, it's like, if I'm in Las Vegas, excuse me, having a big, old time, I'm going to feel like shit, knowing that he's walking and I'm not there.

Right on. Likewise, if I cancel at this late date on Hackmania, I'm going to feel like shit because, you know, Patrick Melton went out of his way to invite me. He got, he paid for my room. He was going to pay for my flight, but I already had bought it. I wasn't going to let him do that. And, you know, I have all these production pieces that I did. did. I've got 50 decks of the wet brain card game that I was going to sell there to use

for my buy-in for the poker tournament, which I'm going to have to figure out a way to unload these now because it would have been easy there. This is a great, great party card game, by the way. People are going to really love it. And maybe I'll just put it up on eBay or something. but anyway, I've got 50 of them and can make more, but I found a place it doesn't matter, too much detail. Anyway, so I'm going to my son's graduation and I'm canceling Hackamania

and if I had decided to go, I would feel like shit and if I'm not going, I feel like shit. And, you know, this is a second live event I've bailed on. I bailed on Dabletcon 2 as well, although I did send in my roast set by video. So you don't get a third mulligan on this. So, you know, in this universe, I'm done. You're out.

And, well, I am. And I don't blame them. But, you know, I love my friends. And I'm hoping that we can just get together and, you know, do a no pressure, just get together for a weekend or spend some time in Cape Coral with Carl and his lovely wife. And a bunch of us go, you know, have a meetup down there where we're not doing a show. And we can just hang out. you know when we were done with the show

and we were in Clearwater that was my favorite time because we could just hang and just be together as friends and we had such a lovely time and despite you know their jobs

shitting on people you know which is you know that's their job they are lovely people I don't care what anybody fucking says right on so

you know And so I'm really sad that I'm not going to be able to go. But you got to, the family's got to come first. Well, your kids do. Your spouse, not so much. Yeah, but you sleep with her. No, I don't. Yeah, she's pissed.

There's no way you can. Well, no. I, I'm, if she hears that, she'll be very angry at me. We, yes, you're correct. But you don't want to mean, them. Right. We live together. Yes, yes.

You share the same. Well, we share everything. Yes, yes, yes, yes. But anyway, no, I'm just, I'm being an asshole. She doesn't get my humor like that. I have friends who get my gallows humor, and Tacey doesn't get it. And so she just gets mad at that stuff. So I have to, I'm going to take all that back.

But you know as well. I'm not editing it out. Liam would be fine. The boss would, she'd whip your ass. I don't even care about that. You're right. He told me, just go. It'll be fine, but I can't do that.

No, no, I agree. I think you're doing, you made it right. My kids down there with the purple sash or whatever, and he's actually decided he's going to walk and recognize the four years of fucking hell. Hard work. Hard work. It wasn't all hell, but, you know, it was, there were hellish moments. Yeah, it's hard work. And to pull off a 4-0 and get a full ride and all that.

So I owe it to him to go. No, I think it's great. I think it's great. So. Yes. Oh, he's a good one. But, anyway. We could see his future back when he did that.

then what was it the bit that he did with the Ashley Madison and we could see his potential oh my God I wonder if I can find that oh that is still my favorite we have we have played it a couple times not let me see

here talk Dr. Scott I was saying so years ago when when Liam was just little Dr. Steve made up this the most hilarious I think a little bit with

Liam talking, like, and then he bleeped in some words or bleeped out some words. I meant it sound like Liam was this foul-mouthed 10-year-old. When my mom is a b***, my daddy goes at esleymedicine.com. There he can p. Lots of other women. When I grow up, I'm going to be an Ashley Madison man. Because my daddy's raising me without any moral compass whatsoever. Ashley Madison, find your lovers here.

Why exactly are we singing? Daddy, what's a road to history? So there you go. We knew he was going to be good. Oh, my God, that's hilarious. He's a good little fail. What really pisses me off about all of this is I love it. I love it.

I bought the Cletus puppet, and I was going to blow up my last spot. You know, I was going to blow up my spot. Instead of doing something dramatic at the end, I got this stupid-ass puppet to do Cletus, because Cletus used to call into Cardiff's show all the time. Oh, no. And for the people who are watching this, if you want to watch this stupid stuff,

you go to YouTube.com slash at Weird Medicine. And let's see if I can get his corn cop pipe in his mouth here. Well, how are you all doing there? So he was going to do, well howdy do miss tight boxy surely are a sight for sore eyes lordy you are finer than a frog hair split four ways uh let me see um now miss lucy i'm addicted to break fluid don't you know but that's okay i can stop any time well because you know a break you know they they stop coleslaw uh what did one i say to the other and between new

It should be betwixt. Betwixt, you and me, something smells. Well, you know, because that's because, you know, there's the nose in there. You smell with your nose, don't you know? Coldlaw. What do you say to a llama that loves going to a picnic? Alpaca lunch. Because, you know, an alpaca is one of them kind of animals, you know.

I can't stand them Russian dolls, you know. They're so full. of themselves. You know what up in them rest of the doll, Dr. Scott? You open one, there's another one inside there. Cold slaw. Well, hey, Dr. Scott, why couldn't the pony sing in the church choir? Oh, gosh, I have no idea.

Well, he was a little horse. There you go. Well, you get that. Cold slaw. I had one where Miss Lucy was going to say that. Here, you be Miss Lucy. all right, Dr. Scott. Okay, I'll be Miss Lucy.

All right. Tell me, oh, you know what? The mailman made a pass at me. Go ahead. You can improvise it. Well, you know, the mailman made a pass at me other day. Oh, how dare he? Oh, he did.

He surely did. Well, how dare he? Do you get it? Because Dary is the milkman. Don't you know? I was thinking it's the mailman, but it's the milkman. I'm so confused. The milkman, you damn, dumb ace.

Miss Lucy, I'm going to give you some advice. Don't never believe what an Adam says. They make up everything. Oh, you get it. Because, you know, Adams. Anyway, that was what you're missing. They miss it. Oh, my God.

That's what you're going to miss at DabbleCon. That was going to be my finale. I love it. I have 10 minutes of that. And I was going to do the Opie Hughes rule of comedy, which is, it might be funny. it starts out funny, then it becomes not funny. You keep doing it until it becomes funny again. Okay, got it, got it.

But anyway, so that's not going to happen now either. Anyway, all right. Oh, man. Oh, man. Why do teenage girls always travel in odd-numbered groups, Dr. Scott? Because they just can't even. Oh, do you get it? Because they say that.

Oh, they can't even. There you go. All right. God. All right. And I haven't, God, I didn't just knock us off the air, did I? Oh, no, they were there. Okay.

All right, you want to answer some questions? Let's do it. All right. For one thing, don't take advice from some asshole on the radio. So what I'm doing here is there are just voicemails that I have not downloaded, and we're just going to do them off the cuff, okay? Gotcha. These are people who called 347776-4-3-3-23 left a voicemail. Normally I download them and I will respond by sending a text.

But I didn't do that on any of these. So we're just basically going to be doing them, as I said, off the cuff. And the first one is from our buddy, Stacey Deloge. What a surprise. Let's see here. Hey, folks. I hope you all are doing good and everything. Oh, yeah.

And the food family is healthy. Got a little question for you. you, you hear about the different levels of cancer, stages one, two, three, and four. So since four is the highest, and that's generally, as far as I would know, would be terminal and everything, what's the characteristics of stages one, two, and three? Okay. When would you elevate from one to the next? Yeah.

And it, and it, you know, bye, take, hey, hey, bye. Well, we'll see you later. We'll see you. So stages of cancer. Why do we stage them? We stage them, not because we just like classifying things, but because it may speak to prognosis or treatment. Gotcha. So treatment of stage one cancer may be, well, will be different usually than treatment for stage four cancer.

So mostly the stages one through three have to do with size in a tumor that is still in. the place where it started. Okay. So if you have, let's say, a breast cancer, stage one may be, you know, a certain, we could look it up, but it's different for different cancers. But let's just say some cancer, stage one is one to two centimeters in size. And then stage two would be, you know, 2.1 centimeters to 4 centimeters. Stage 3 would be greater than 4 centimeters, but still in that location.

and I'm just making up these numbers. Stage four would generally be a cancer that is spread to a distant sight. Could be skin, could be liver, brain, whatever. Now, when Stacey says stage four is generally considered terminal, maybe, you know, we're getting a lot better at this. Some stage four cancers we can control. We're not to the point yet where we're curing a lot of those, but that's coming. That CAR T-cell therapy that we've talked about, the chimeric antigen receptor T-cell therapy, where they take white blood cells out, train them and inject them back in to kill cancer cells, has in some, particularly in the experimental models, cured people with stage 4 disease. And there are some viral oncolic treatments for, say, multiple myeloma that have affected cures, too.

So we're getting there. But, yeah, stage four, definitely worse than stage one, two, or three. Which stage four is that something that most people have heard metastases? Correct. That would be metastatic cancer generally. And there are exceptions to this. And the staging, again, the reason they stage it is because of differences in prognosis or treatment. So, for example, small cell lung cancer really only has two stages.

It has limited stage, meaning it's confined. to the lung or extensive stage, meaning it is now metastasized. And the reason for that is there's just really two ways of dealing with it. Oh, okay. And the prognosis is different between those two, but everything in between, there's not that much change. You would treat it the same. Prognosis is the same.

So that's the cutoff for that one. But that's basically what that is. And every tumor type is different. And I mean, some of them are. are very similar and may even have the same criteria for staging them, but they're different diseases. And it's still all a disorder of the immune system, and very soon we're going to have nothing but immune modalities for treating cancer. And I really feel like we're going to look back at the era of chemotherapy as being barbaric.

a little bit more scientific than the era where we were bleeding people to get rid of their malodorous humors, you know, but not much more. So anyway, all right. Okay, let's try this one. Oh, yeah, here's a good one. Dr. Steve. Yes.

I'm trying to get a hold of Sam Roberts. Okay. Let's not forget that Val Kilmer played John Holmes in Wonderland. Yeah, that's a non sequitur for me. I'm not sure what that was about. But, yeah, I can pass the message along to Sam. And if you want to reach out to him, he is at not Sam on X, formerly known as Twitter. All right.

Let's see here. Hey, Dr. Steve. It's your old pal Joe in Virginia Beach. Hey, Joe. Hey, I wanted to talk to you about my heart. Okay. I have high levels of lipoprotein little A. my doctor ran a test, and my level is 152, which is high by any standard.

Yep. And as you know, they do not typically run this test in a standard lipid panel. Correct. So being on my crestore as I am and my trilypics and vasipa, my numbers have all been in the normal range except for this lipoprotein little A. Yeah. So I'm a little concerned about my heart. heart health because of that. I am curious if there is a cardiologist out there, if it's standard practice at all,

to get an angiogram at the ripe old age of 54, just to see if you have any blockages, any silent blockages going on. Yeah, I like the way he thinks. We have an answer for him, I think. I've had the calcium score twice. My last one was five, and that was about two years ago. But I'm just a little concerned at my... Yeah.

So lipoproteins, let's just talk about that. Lipoprotein A is a type of LDL. That's a low-density lipoprotein, and it's got an extra protein attached to it called apolyproproteen A. and high levels of that are a known risk factor for heart disease and stroke. Now, knowing that you have high risk factors means you're less likely to die from it because you're going to do something about it. The problem is that despite the fact that we know high lipoprotein A levels are associated with increased risk of heart attack strokes and other cardiovascular problems, there's no medication currently approved to directly lower lipoprotein A levels. That's the problem.

There's a lot of research going on. We don't even know whether this is a marker or a cause. It may simply be a marker because lipoprotein A levels are largely determined by your genes and lifestyle changes have much less of an impact than they do with LDL cholesterol. The fact that his calcium score is extremely low is encouraging. Now, the calcium score will not show soft plaques, but most people don't have those. So you could talk to a cardiologist. I'm going to bet that they're going to be very unlikely to be convinced to do an angiogram on you.

Because in your case, so there's this thing called Bayesian logic. And when you do a test, there is a pre-test probability and a post-test probability. So, for example, if you have no sore throat, right? And no symptoms, your pre-test probability of having strep throat is close to zero. If I do a test that has, say, a 10% false positive rate and your risk. rate and your test is positive for strep, I'm still not going to believe it because the post-test probability is still going to be exceedingly low, okay, even though you have a positive test. That makes sense?

So you have to take these things into account. Now, the angiogram is the gold standard, no question about that. But I think they're going to go, your pre-test probability is so low that the risk outweighs the benefit. Now, that's just what I am guessing they're going to say. If you have a strong family history, we didn't tell us any of this stuff. If you have diabetes, if you're a smoker, you have high blood pressure, that kind of stuff, then they might be convinced to at least do a stress test on you. And the stress test would then, if it's stone cold normal, I think they would be very unlikely to proceed with an angiogram.

But that, I think, would be okay. And it certainly would be okay to ask them about it, particularly if you have multiple risk factors. When are they going to come up with a pill form of an angiogram? That's what I want to know. Like a pill form for the GI tracks. Oh, yeah, yeah. Wouldn't it be cool? Yeah, something that would just go to the blood vessels and then you could just take a regular x-ray.

And just kind of trace it through. Wouldn't that be cool? Yeah, it would be cool. I mean, it'd be obviously team. Oh, you mean something that would actually work its way through the blood. Shit, I don't want that in there. No, no, I mean, I'm talking like super teeny. Well, it'd have to be a nanoparticle.

It'd have to be a nanoparticle. And then how would it be able to see anything? That's the problem. If it's small enough, the wavelength of light will be greater than the size of the thing. Yeah, but when you think maybe it could show off like light and you can take pictures of it as it goes to that. Oh, now that might be something. And then you look at the light and it all of a sudden does this. Yeah, yeah.

Pinched, you're like, oh, and it's right. Okay. Yeah, maybe. That's our next million-dollar idea. That's a good idea. All right. Let's see here. That's Joe and Virginia Beach.

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Hey, Dr. C. It's the R. Perkins. You asked me to give a call in with my suggestion for your next podcast. Okay. It's DR Perkins. I always thought it was Dr. Perkins. It's like we have this place and it's M.R. Cleaners.

And if you go in there or you call them and say this Mr. Cleaners, they get all huffy. And they go, no, it's MR. Cleans. No, it says Mr. Cleaners. Yes. Yes, I know what you're talking about. Make it M. Period. period, maybe people will get it.

Yeah, I agree. You know, if you don't want people calling it, don't get huffy about calling it Mr. Cleaners when it's literally Mr. Cleaners on your side. But anyway, so D.R. Perkins. Okay. Now I know. Probably no one better than you could give a short tutorial on how to pick a good hospice. Okay.

And now that you're retiring, I think it'd be a good topic for you. Yeah, because I'm going to be an office. I and my dearly departed high school sweetheart picked a bad home hospice. Their doctor never showed up in the two months. span of time before she died during her death crisis their nearest nurse was two hours away we got lied to they said they'd had nurses nearby yeah they probably they had nurses on call 24-7 but they weren't nearby and you know some of it well we'll talk about all this we'll get a little bit maybe maybe not as you're retiring like I said you can be candid maybe yeah no I would

absolutely I'm going to be candid anyway this doesn't have anything to do with me retiring no And I'm not retiring, retiring. I'm still going to be working for the next six and a half years. Well, six now, now that Beck has retired. I will retire the day Beck graduates from veterinary school. And that's six years from now now. So because he's completed his sophomore year of college. But I have no problem speaking candidly about this.

There are shitty hospices out there. There are shitty hospitals. There are shitty doctors, there are shitty post people, shitty people who own cleaning, you know, cleaners. You know, there's all kinds of stuff. So you will run again some really crummy ones. I ran into one that, well, God, I can't even talk about it, but they were really bad. And, you know, some of them have rules that are outside the Medicare rules. I'm just getting mad thinking about some of these cases that I've dealt with.

So there are crummy ones out there, and how do you weed them out? Well, word of mouth is one. I mean, they told him that there was going to be somebody nearby, and that was incorrect. Now, lots of reasons could have been there. They could have had a nurse that was in their area that quit, and now they had to cover, or maybe that person was on vacation, the person covering was two hours away. Some of these hospices have huge catchment areas. So you have to ask them that.

I think, but word of mouth, who did you have a good experience with? They all have to be Medicare certified, so they have to meet certain minimum requirements. But what I've found is Medicare doesn't pay a whole lot of attention unless they get a complaint to, say, a hospice agency that does their interdisciplinary team meeting without a physician. present, or that dismisses people because they cost them too much money. That's actually not legal for them to do. So hospice, basically, for a Medicare patient, kind of is a federally funded program. In other words, Medicare will pay 100% for hospice services for people who have a prognosis of six months or less, who have decided not to pursue curative.

for life prolonging treatment. Those are the only criteria. Now, I'm going to give you all one, you know, if you're playing poker, you need to know the rules. If you know the rules and the other person doesn't know the rules, you're going to win, right? So here's the one rule of hospice. This patient or my mother or my father or my brother, sister, or my, you know, whatever, would be more comfortable if only they had X.

Whatever X is, they pretty much have to give them. So you'll hear, well, hospice doesn't do blood transfusions. Well, my father has myelodysplastic syndrome. They have symptomatic anemia, and they would be more comfortable if only they had a couple of units of blood. Then they have to do it. Okay. There are people who say, well, you can't get IV fluids. Well, my uncle, who is in hospice.

is having agitated delirium from severe dehydration, he would be more comfortable if only he had a bolus of IV fluids, then they have to do it. So as long as you couch things in terms of comfort, it is true if you have bone marrow failure, they will not check your, you know, come out once a week, check your blood and transfuse you if the number is under eight. but they will transfuse you, or they're supposed to, if you have symptoms from your anemia. So anyway, when they come out to the house, you need to ask them these questions. If I have an emergency, what's going to happen? How far away are people? If that person, do you have somebody in my area? Oh, yeah, we have a whole office full.

What are the odds that I'm going to call you at two in the morning and there's somebody's going to be two hours away? Well, if they say, well, you know, we rotate call and, yeah, probably two-thirds of the time it's going to be something like that. You might think of getting somebody else. Here's another thing. Where do you admit your inpatient hospice patients to? In other words, if my symptoms get so bad that they cannot be managed at home, every hospice agency is supposed to have a contract with some facility where they can put you in and do symptoms. management. If they tell you, well, we can put you at this nursing home and it doesn't have a good reputation, then that might not be satisfactory for you. You want a place that either has a

hospice house or access to a hospital where they can have people on call 24 hours a day, seven days a week, doing symptom management. You know, where do you do your respite care? So if you are a caregiver and you're taking care of a hospice patient and you become exhausted, where are they going to put them? There's a five-day benefit for putting somebody in a hospice house, a hospital, or a nursing facility for what they call respite care. Where do you do that? How does that, you know, what's the mechanism?

You know, if I need, if I fall and break my ankle, do I need to call you first, which, by the way, you always should? And are you guys going to pick up the phone when I call, that kind of stuff? So, and you'll know, just by the admission process, if it's cumbersome and disorganized and chaotic, then their care may be as well. But, you know, a lot of times a liaison will come out to the house. That won't be the nurse that you're going to be seeing. But hospice is a great program. You just want to have a really good one.

Right. And you get nursing care specialty trained. you get any medical equipment paid for 100%. Could be oxygen concentrator, hospital bed, trapeze for your bed, that kind of stuff. And it'll pay for any medication required to keep you comfortable. So they're not going to pay for your blood pressure medications. You can still take them. But they're not going to pay for it.

They're going to pay for anything that's required to keep you comfortable. Gotcha. And yeah, you just have to talk. And the other thing is, if you get one and they're unsatisfactory, call another one. one, get them to come out there, and then once you've got them set up, then fire the other one. You can do that. You can vote with your pocketbook any time. Only you can revoke your Medicare hospice benefit.

Okay? Gotcha. All right. That's good news. All right. I hope that helps. All right. Let's see.

Hey, Steve, quick, well, it's not really a quick question, but it's okay. I'm not concerned, but my knowing that I'm. okaying a vaccine for my daughter, specifically HPB, I don't know why, this one's tricking me out because she's older, is, I'm assuming that it's a standard vaccine and long-term studies, all that, like as opposed to some other vaccines that we recently had. Correct. I know what you're talking about, and thank you for not making me go into that again. I don't want to get any more dunning letters from people.

Thank you. What is the best way about going to research these things? Yeah. And, you know. Yeah, I know. Instead of just doing a Google search and getting, you know. Google search isn't the worst thing as long as you're using quality sources. It's from mainstream.

So. Yeah. So let's talk about the HPV vaccine. It is our first, although I had a doctor, you know, fuss at me for saying that it's the only cancer vaccine that we have right now. And he reminded me that the hepatitis B vaccine technically will prevent cancer in people who get chronic hepatitis B and end up getting hepatocelular cancer. So he was right about that.

But the HPV vaccine was designed to stop the scourge of a common cancer, aka cervical cancer. And HPV strain 16 and a couple other ones are known to increase the risk and to be the precipitating factors for cervical cancer, which is a really, really shitty cancer. It's considered very safe. It's had extensive monitoring. It came out, I think, while we were doing the show and we didn't have long-term data, but we were in favor of it because. the studies were so good in preventing infection with the really pathogenic human papillomavirus strains, which caused, by the way, not only cervical cancer, penile cancer, rectal cancer, and head and neck cancer. So we're talking about a lot of different cancers that this stupid shit-ass virus causes.

And there can be some mild side effects. temporary. You know, the serious adverse events, I can't say that they don't ever happen, but they are extremely rare. When they do happen, it's, you know, a problem. And, you know, it's usually anaphylaxis. It's usually three cases per one million doses. That is very treatable. According to my high-quality sources, there's no evidence of long-term side effects associated with HBV vaccination, and the benefit far outweighs the risk because we are seeing already a decline, a statistically significant decline in abnormal pap smears and a decrease in the incidence of new cases of cervical cancer.

So it's working. We're not quite a generation in. When did the HPV vaccine come out? Can you look at that? Yeah. And I will, I know Carl loves it when, but he's, when I Google stuff on the air, but H206. Okay, so 2006, so we're looking at nine years. Okay.

So we've got, you know, 10 years considered long-term data, so we're coming up on that. Yeah. And can you also Google decline in cervical cancer, um, sales. since 2006 and see what we can attribute to the vaccine because I know that there has been. I can put my fingers on the data for the decline in abnormal pap smears. Looks like the introduction of the HPV vaccine has been linked to a significant decline in cervical cancer rates, particularly among young women. Studies have shown substantial reductions in mortality with some reporting 62% drop.

Jesus. And cancer deaths in young women. women under 25, which is, I'd say, that's pretty significant. Yeah, now that, okay, now that's a relative risk number. The total numbers of young women dying from cervical cancer are pretty low. Right. But that makes it really low. But that, right.

Correct. Really, right. 62%. We do things in medicine for a 5% improvement. So, and I bet that's aggregate, including women that have not had the vaccine. I'm going to bet. because I'll bet if you look at just women that had the vaccine, the number is even lower than that. So anyway, all right.

So I got a little more information. I just freaked a little up about. I understand what's going on and I'm hoping my daughter is not one of those. Yeah, yeah. I can tell you this. I had my kids get the vaccine if that tells you anything. Real quickly. They also showed that there's been less head neck cancers in men and boys.

Yeah. Uniform infection, yeah. Head and neck cancer can kiss my ass. Oh, it's terrible. Terrible. So, um, yeah, rectal cancer's no walk in the park either. No. And, okay, can I throw in penile cancer into that mix?

They all suck. No, no. Don't do that. Don't do that. Because. There you go. I love to masturbate. So that would be a bad cancer to have.

So, yes. So that one, I'm feeling pretty good about recommending. You know, read the package insert. There are risks to everything. The risks to walking across the street as well. So walk across, it'll always look both ways. And when you're going to get a vaccine, look both ways. If you want to email me, I'll send you some of the research that's out there.

You can go to PubMed.gov and look at HPV vaccine safety, and there's tons of articles about it. that two phase three and phase four all right okay this one I answered last time okay let's see here we go hey dr. Steve this is Bill from Texas good to talk to you again I hate to see you go but I understand but again I hate to see you go and dr. Scott Cincinnati Red sucks still my question is I have a bowel movement majority of the time it sinks to the bottom of the bowl oh we did this one last time yeah we did this one yes in the

Reds do still suck. Yeah, yeah. Okay. Okay, I think we've exhausted those new voicemails. Let me delete all these here. All right. Well, let's go to some of the other ones that we've got in the, we've got like thousands in the, in the bag. Hey, Dr. Steve.

Why the fuck do I sweat for a half hour straight like a pig after a workout? It's really embarrassing. Thanks. You want to take that one, Dr. Scott? Well, he's... Everybody's different for one thing. Everybody's different, and for one thing, it's good that you're sweating and sweating out the heat, so you don't overheat. Correct.

Some people... Older people like me who exercise who don't sweat are at risk for heat stroke, and I've seen it where people's core temperature jumps up to 104. You think sweating doesn't do that much? The evaporative process does carry off a lot of heat. Yeah, and sometimes your nervous system just isn't balancing itself out properly between the autonomic and... Yeah, so my thing is if he's working out and he's sweating, could he just jump in the shower and cool off that way and then stop sweating?

Yeah, or do something less intense towards the end of his workouts. Yeah, do the higher intensity. I am going to throw this out here if you're having abnormal amounts of shortness of breath with palpitations or nausea. And while you're sweating because you're exerting yourself, I want you to talk to your primary care about that. Because one of the symptoms of angina, or some people call it angina, is a thing called diaphoresis, which is profuse sweating. And it's usually associated with exertion. So my dad had it, but he had a typical angina in that it was his left shoulder would hurt.

and he just thought he had bursitis or something when he would work out and he would sweat and he would have this versitis in his left shoulder and when they put him up on the treadmill he started sweating and then he had the classic, you know, changes on the EKG and he started having the left shoulder pain

and he said, oh, I just thought that, you know, was my shoulder and it turned out that was his presentation of angina. So if there are any other concomitant symptoms or if you are at risk for heart attack, i.e. family history, diabetes, high blood pressure, high cholesterol, or you smoke.

Please talk to your primary care about this just to make sure we're not missing something. Okay. Yeah, I mean, unless he suits, you know, profuse to the lot of time, he might have like a hyperhydrosis, but right, if it's all the time, yeah. But if it's just with exertion,

I always, you know, you always want to rule out the really bad things first and then you can attend to the sort of lifestyle. Yeah, and if it's, If it's just, just after exercise, I would say, try to turn off that autonomic nervous system, you know, cool everything down right at the end of the exercise. Yeah. You know, no way maybe you won't sweat as long. Get in front of a fan.

Yeah. All right. Yes, hi. My name is Jed, and I'm calling from Jackson Hole, Wyoming. Hey, Joe. Oh, Jackson Hole. I have a little issue, which only happens in the mornings. When I wake up.

I feel a little sick to my stomach and then I get a little bit of the dry heaves and then it goes away for the rest of the day and then it repeats itself again in the morning. I have spoken to my primary about this and really the only thing that we can find is that I have higher than normal blood pressure, which we are currently going to go in with diet and exercise and so on and so forth. but that hasn't helped with my little morning sickness. Yeah. Do you know what he has? I think I have. Well, I've got two I just. Okay.

He can have post-nasal drip draining into his sinuses. Okay. At bedtime, and I can make you nauseate at the morning. Sure could. Number two. Because your stomach's full of mucus. Yep. And number two thing is he could have some gastroporesis and a slow gastric amtrient can give him gurd.

Give myself a bell. I think it's reflux. Yeah. I think it's probably reflux too, but it could be a little bit of both. So, yeah, when you lay down, your gravity isn't pulling, pulling stomach contents into the bottom of your stomach. It's layering it out and it can fill up your esophagus even. And people who have silent reflux in the middle of the night will wake up with nausea as their primary symptom. And the gagging goes along with it.

So I would recommend a couple of things. first make sure you'd tell your primary about this second well he did he did because I would take maybe some Fomodidine before bedtime that's you know known as also Pepsid a floating antacid like gaviscon and then put a brick under the head of your bed just enough just a couple of inches doesn't they much if you band if you use one of those pillows that bends you it's going to be worse, particularly if you're even a little bit overweight, because then that bend will push in on your stomach and it will force more contents into your esophagus, but you want to raise the whole bed and see if that doesn't help.

If it does, that pretty much makes the diagnosis, but at some point you're going to want to maybe even get scoped so they can see where your hiatal hernia actually is and how bad it is. The other thing real quickly is just making sure your stomach isn't cold at nighttime. Oh, yeah, this is Dr. Scott. Maybe a little warm tea before bed will help increase, you know, motility of your stomach. And no carbohydrates within six hours before you go to bed, maybe even longer. And sometimes if you can. And no alcohol, too.

If you can poop before you go to bed. Oh, yeah. If you can have a bowel movement before bedtime, then when you go, then things will start to move through your stomach and you'll have that feeling. There you go. I'm pretty regular, Dr. Scott, but I can't. Well, there you go. I can't rightly go to the outhouse in the middle of the night like that old black winter. bite me on my beehide or black bear or the black bar oh no oh no all right shut up there you go

all right dr scott before we go let's hit the fluid family if you want to join the fluid family at youtube.com slash at weird medicine and click join and you don't have to pay anything and just click accept gifted memberships and sometimes myrtle goes in gifts memberships and uh I I wanted to thank Corn Diff for being a member for 14 months. He is a talking ear of corn, quite delightful. And when Opie asked him why at corn, he said, well, we're not that, you know, we're not that unusual. Corn's pretty plentiful. That's pretty funny.

All right. Yep. Outlaw Josie Wales says Dr. Steve puts the spice in hospice. So that's hilarious because I used to have a screen or a log-in that was Doc Hospice, because Hospice Doc was already taken. Tacey came down. She said, who's do-cho spice? Oh, my God.

Yeah, docho spice. Oh, my God. So anyway, let me see. Can explain why Cardiff is a potato? I miss something. Are you serious, McRibbs? Yes, absolutely. I can explain why Mr. Cardiff is a potato.

There used to be a show called. called Mom's Swipe Left. They were delightful from Maine. I was on their show once and guessed. They played a 20 questions guest game that was what's in, oh, somebody's vagina. Oh, God, I'm so sorry, ladies, I've forgotten her name, but what's in so-and-so's vagina?

And I took like three guesses and guessed it was a stapler. It looked like a genius. It was just a lucky guess. But anyway, so there was a guy who was a simp for them, and he was called Palm De Terre, and he had a potato filter, and he would do a breakdown of their show. And Cardiff started goofing on Palm de Terre by having a potato filter that was exactly the same filter, and he would do mom swipes left after swiping laughter or something like that. He did a show making fun of Palm to tear. And then he kind of couldn't get rid of it. Now he's the floating potato.

Oh, my. So he actually stole it from somebody else. Oh, my. Let's see here. Oh, yeah, King of All Diffs. I'm sorry, dude. I know. I know.

I know. He said you were 90% of the reason I was going. 10% potato orange and broccoli. Oh, the broccoli would be too key. No, they're awesome. They're way more fun than I. I am. And I am really, really friggin' bummed about this. And it was one of those situations where I was going to be bummed either way, but I, you know, I've got to do what's, you got to do

my kid. And, yeah, outlawed Josie Wales says, thanks for all the shows over the years. Weird Medicine fans since day one. These shows have been cool. And then he tries to trick me into saying something that I will say on the very last show, but I'm not going to fall for it. It has to do but someone's mother's nether regions. And let me see. Okay, Crispy Biscuit. I've been a hospice RN for 5.5 years. I worked for small hospices for four years.

Now the biggest one in the country for 1.5. I'm honest with families on the pros and cons, a big good, good. Well, Krispy Biscuit, we should have you on the show sometime. We love our hospice nurses, and I work with them every single day. So, and, you know, I want to make sure everybody understands the vast, vast majority of hospices and the overwhelming majority of people working in hospice, except for the few that are burned out, are wonderful, wonderful people. And if they're shitty, they don't last very long.

So, crispy biscuit, here's to you. She must be a good. Yeah. Well, wait a minute. I don't have a... A bell? Oh, no. Here she can.

He or she. I say she absolutely could be a huge. There's lots more bros in nursing now, which I think is really cool. When I walk through the internal, the ICU in our biggest hospital, I'd say 60% of the nurses in there are guys now. Yeah, which is good. Yeah, it's good. It does, that does a couple of things. A woman who is a physician doesn't automatically get assumed to be a nurse anymore because, I mean, there have been women, doctors, forever.

And actually in my class, which was 19. 82 to 86, there was a majority were women, but I still have women partners who are physicians who walk into the room and they still think that they're nurse. So that is changing with more bros

being in nursing. And the stigma of the male nurse is no longer. In the 80s, there was a certain stigma about it and that does not exist anymore. So all of that stuff is good. It's all very positive. So

crispy biscuit if I mischindered you, I apologize. McRibbs, says Dr. Steve went to my doctor last week, asked about that bump above my ribs below my incision, but was trying to cover his ass so much. He never wrote in my chart other than I'm benzodiaependent. Oh, no. So what did he tell you? He or she tell you. Oh, he said he. Goodness gracious.

Saxon Savage says he's going to miss Myrtle. No, you don't have to. I am bummed right now And honestly this morning I'm like I'm packing all this stuff up And I'm selling it That's not going to happen We're still going to do shows

They're just not going to be serious XM shows And I'm really afraid I burn my bridge With the dabbled verse And I'm very bummed about that Because this is kind of last minute I mean it is May 10th And that is what two weeks Two weeks from now

So it's kind of shitty to bail this soon But Liam told me last night You know, so... It's his fault. No, I'm proud of him. I'm proud of him. D-cabinet, no, it's not the end, just the end of Sirius XM. And, okay, McRibb said, Mr. Doctor asked if I'm still taking my 80 milligrams of Lipitor.

I told him I'm done. Too many side effects than he came out with. I read it causes diabetes. What? What? Yeah, there's still... A lot of shit. Study showing Staten's cause type 2 dose.

Well, he was on a megadose statin. Hey, diabetes, diabetes. Yeah. Okay. McRibs says, OMG, I thought the potato was to hide because of something he did.

Well, no, it's not because of something he did. He started hiding his face, and now he can't stop. And it's become a bit, you know, that we're, and look,

if you've ever gone to one of the live events, you've seen him, you've talked to him. Lots of people have seen him and talk to him And lots of people know who he is But he's done I have a picture of him Dabbing in front of a clock that's stuck at 420

And it's one of the greatest I can't post it You know So I did post a group picture once That could have docksed some people Without thinking about it But you know That's all right

Oh Krispy Biscuit says No worries I'm a male So I'm glad I at least acknowledge that I've probably mischendering you. I get mistaken for the doctor all the time, right? There you go. See, it works the other way. I quickly correct.

I'm sure you do. No, I believe it. Don Phillips showed up. There's old Dawn. What's up, Dan, Don Phillips? Dandy Dawn. Saw the announcement on Reddit. Is this really...

No, this is not the final episode. What that announcement on Reddit was is that I'm not going to Hackamania. but the hackamania was supposed to be the final episode. I sent an email to Jim McClure today just saying, you know, when do you want me to do the final episode? I would like to say the YMB thing live on the air. So we'll see. Hopefully doing that, they're not just going to go, okay, well, you're done.

We're just going to play replays until we find something else. Saxon Savage, you're doing the right thing. Thank you. your good dad. Actually, it's one thing I'm proud of. I think I am a pretty good dad. And good dads have to make hard decisions sometimes. Thank you. Actually, Saxon, of all the things anybody said to me about this since this started, that makes me feel better than anything anybody said to me. So thank you. And we don't even know each other. If they knew your kids, they know that's true. They turn out great.

Yeah, they're good kids. Despite they're raising. Yeah, Don, we still have a few episodes to go. So anyway, all right, I didn't see any other questions in there. Nope. All right. Well, listen, my friends, thank you all very much for hanging with us. And thanks always goes to Dr. Scott and everyone who's made this show happen over the years. Listen to our Sirius XM show on the Faction Talk channel.

SiriusXM Channel 103, Saturdays at 7 p.m. Eastern, Sunday at 6 p.m. Eastern on demand at other times at Jim McClure's pleasure. And many thanks to our listeners, particularly the fluid family. 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 get some exercise we'll see in one week for the next edition of weird medicine thanks everybody thank you Thank you.