Sawbones: A Marital Tour of Misguided Medicine - Sawbones: More Weird Medical Answers

Episode Date: March 30, 2017

We're continuing our celebration of MaxFunDrive by giving back to you, our lovely listeners and even lovelier donors with an all Q&A episode of Sawbones. Why do runners poop? Can you skip a day of antibiotics? Enquire within! Music: "Medicines" by The Taxpayers

Saubones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. that weird growth. You're worth it. Alright, Tommy is about to books. One, two, one, two, three, four. We came across a pharmacy with a toy and that's lost it out. We pushed on through the broken glass and had ourselves a look around.

Some medicines, some medicines that escalate my cop for the mouth. Wow. Hello, everybody and welcome to Saw Bones, a marital tour of Miss Guided Medicine. I'm your co-host Justin Tyler McElroy. Hey. I'm Sydney McElroy. I can feel more like an event. You know, when I come on the show. Like you're an event.

Like I'm an event. You are an event, honey. Thank you. All to yourself. It's the maximum fun drive. We're going to talk about what that means in a little bit. But let me give you a very exciting time of the year. Let me give you the short version. You need to go to maximumfund.org right now. And donate some money to us

and the rest of the shows on this network. Once a month, Nope, once a year, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no,

no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, but to celebrate, we decided to, if we're going to ask you for money, we thought we could offer you some help in exchange. That's right. That's right. That's right. We usually, well, I mean, our listeners often suggest topics, I will say. So it is not rare that ideas for what we should talk about would come from you guys, because

you are good about sending us wonderful things to talk about. But sometimes you have questions in medicine. Like, not necessarily questions about yourself in terms of like what's my diagnosis or what should I do about it. But just kind of those like, why does this work this way? What does this mean? Kind of questions. So we're going to address as many of those as we can. Right, because I really like to say we're from medical advice. So this is more just medical interest. Still just for lofts, folks. This is from at-signus woman or perhaps sickness.

It's hard to say. My guess would be sickness. Signus probably. Why does my bob Bobby, Bobby? Why does my Bobby? That's a, that's a body, honey. Your body, I can answer this one. Your body is the physical form of yourself. Okay. Why does my body make tonsilists? Yeah. My dad has them too. Had I lived with them and mitigate their occasional vial eruption? Now you mentioned this one to me last night. I have no idea what that term means. I have no clue. Yeah. So tonsilists are tonsil stones. Okay. When you hear a lift at the end of something,

monolith. Sure. One big stone. Right. But when you hear the the lyth part in there, otoliths or stones in your ears, when we talk about a nephrolith, that's a kidney stone. Okay. Lythmean stone. Lythmean stone. There you go. Yeah. Okay, got it. So we're talking about tonsil stones. And I will I will tell you that I get asked about tonsil stones, not infrequently. Lots of people want to know what the deal is with tonsil stones. So basically, if you've ever had them, you will know right away as I described them. They're little clumps of like calcified mineral material that can collect in your tonsil,

specifically in what we call the crypts of your tonsils, crypts. Yeah. Which are like that, well, it's just like the indentations. You know, tonsils aren't smooth, typically. They're kind of like bumpy and they have ridges and little hills and valleys. Okay.

They're like, our state. They're yucky. You can just say yucky. And you can get little stones stuck down in there, calcified lumps of material. And people don't like them because they can be uncomfortable because you can feel them. Some of them can even be larger, and they can be pretty uncomfortable because you can feel them in the back of your throat.

They also usually contain anaerobic bacteria, and anaerobic bacteria, it's actually the same ones that can cause like gum disease and stuff. So those bacteria produce sulfide compounds that can smell bad. Okay. So people also don't like them because they feel like they make their breath smell bad. And where are they? They're in the back of your throat and your tonsils. Like stuck to them? Okay.

But we, usually we diagnose them just by looking and seeing them. Okay. Like I look in the back of your throat, I see a white lump on your tonsil, you got a tonsil stone. It's that simple. About 7% of the population has them, so it's not uncommon. They might be related to recurrent bouts of tonsilitis, so that might be why you have them,

is if you had a lot of tonsil infections, inflammation of your tonsils when you're younger, or you might just have them. Sorry. Sorry. Almost 10% of the population does. So you might just have them. They're not usually a big deal

when we think of medically speaking. They don't do anything for the most part. Certainly a really large one might cause some infection there on abscess, but for the most part, you can kind of prime out with the tip of your tongue. If that doesn't work, you can use like a soft tooth brush. I mean, you don't want to do anything that's going to cause harm to the tissue, but you can use like a soft tooth brush to brush them out. You can rinse them out, rinsing the back of your throat, it was pretty effective to get rid of them. And really severe cases, you can do things

like laser cryptolysis, where a doctor would go in and actually smooth the surface of your tonsils with a laser, because then there's no crypts for in which the stones can form. But there shouldn't be any medical reason why you would need to do that. And that's a lot of concern. And will they reform if you do?

You wouldn't have the surgery. Well, if you don't have the crypts there, no. The crypts aren't going to reform. So you shouldn't get the tonsils anymore, or you shouldn't get the stones anymore. But again, since they're not dangerous, that's kind of quite like, should we really do that? And I guess in severe cases, you could take your tonsils out, but again, that's a surgery for something that most of the time is not severe. Now they do, like I said, they can be associated with bad breath. Although some of that is just your perception,

as as they come out, they do smell bad, like the stone itself smells bad, but it's not necessarily making your breath smell as bad as you think it is. They have assessed this with something called halitometry. I only mentioned this because there is a way we have come up with to objectively assess whether or not your breath is bad. It measures those sulfur compounds that I talked about, that anaerobic bacteria make. VSCs, volatile sulfur compounds, and parts per million in your breath. So we don't have to say your breath is stanky. We can use a halitometer. Okay. Listen, don't think of me. Take it over the robot. Sorry, it's not my fault. The halitometer says your breath is stanky.

Sorry. Here's a question from Gwen Cooper that says, can you have gas pain anywhere else besides the abdomen? My best friend used to say she had gaspains up near her shoulder. It's a question mark exclamation point is one step shrub in a tarot bank. Now that's that is true that people will complain of gaspane in their in their chest and in their shoulders and in their upper body. I have known people maybe that are sitting in this room who have said things like that to me before. Perhaps, yes, perhaps. Perhaps. Yes. And what you're probably talking about is what we call referred pain. Do you not refer pain is, Justin? I mean, I could come up with something, but I don't think it'll be

true or right. It's pain that is felt in a place other than the place that originates. So here's, okay, now why would this happen? Why would you have a problem down in your stomach and feel pain up in your shoulders? Well, there's, it's a little thing called innervation, Sid. Nerves connect different parts of your body. So just because you hurt yourself in one place

I mean you're necessarily gonna feel it in that place like Sometimes you wipe too hard in your third hurts, you know what I mean? No, that's not a that's not a thing that happens, but You were almost there you were so close I was The second part was a joke No, that's not a joke. It is actually that is a real thing that has happened to me before.

You're wiping wrong. I wiped in the wrong place and my neck hurt. You're wiping very wrong. So let me give you an example. This is the classic example of referred pain. The nerves that sense pain in your goal bladder. Now, do you know where your goal bladder is? Yeah, it's right here.

Did you describe where you just pointed to? I'd rather not. Let's just take it at faith that I pointed to the right place. It was that you're right upper abdomen. Would you say that? That's where it was? Yeah, me. Yeah, I agree. Right. So, so the nerves that feel pain in that area of your stomach where your gallbladder is, your gallbladder kind of sits right nestled underneath your liver there. where your gallbladder is, your gallbladder kind of sits right nestled underneath your liver there. They enter your spinal cord at the levels T5 to T10. What that means are thoracic vertebra T5 to 10. It's kind of in the middle of your back, okay?

Okay. The your thoracic vertebra is right in the middle where your ribs connect around in the back of that area, okay? So that's where those nerves enter your spinal cord. That is the same what we call dermatome, which means when we talk about dermatomes, the way that you feel things, it's due to different nerves as you travel down the body that come from different places in your spine.

And so you can look at really cool charts of this. I mean, if you just Googled dermatome, you'll find a picture of like a naked person all covered in multicolored stripes and each stripe it has a letter on it C1, T5, L4 and it has to do with where that nerve root what patch of skin is Intervated and makes you feel from that nerve level. Okay. So if at the same that nerve level. So if at the same nerve level, your gallbladder nerves enter and the patch of skin that is right over your shoulder blade enters, if your gallbladder hurts, your shoulder will hurt. So that is a classic example of referred pain. If you have a gallbladder problem,

your right shoulder might hurt. Similarly, on the left side, if your spleen ruptures, your left shoulder might hurt. So if I have gas in my heart, it's not because there's gas in my heart and I'm dying. No, honey. Okay. Because I feel like I'm learning something new right now. A lot of this has to do with just your visceral organs, organs in your gut, where their innervation enters, and if like you have gaspane, because something's getting stretched or moved around,

and then it's at the same nerve root as something in your upper body, you're gonna get some pain there. Here's another question from Melissie's, Saturn. Why do cross-country slash track runners poop themselves? Why running? I've heard this happens.

Yes, this can. I've never run enough shame on me. I've never run enough to poop my pants. I haven't either. And it really is something that tends to happen to people who are doing marathons, who are doing long distance running, not the kind of running that Justin and I typically would engage in. It's been called Runners Diarrhea or Runners Trots, which I enjoy. I like Runners Trots. And it has to do with a couple different factors, because this is a real thing, either the need to poop frequently while you're running or

losing control of your bowels while you're running. It has to do with a couple different things. One, probably just the jostling around of all of your intrib domino organs and the stuff inside them. So your intestines are bouncing around, all the stuff's bouncing around, it's moving along. That mechanical action probably has something to do with it. But there are other reasons. There's a lot of fluid and electrolyte shifts going on inside your bowel, because you're using so much fluid. You know, you're using it fluid very quickly.

That's causing fluid shifts inside what we call the lumen, which is like inside your intestine, the inside part, inside the tube, in and out. And that can cause things to move along a little faster in the GI tract. The other thing is that you don't get as much blood flow to your intestines. And that can cause things to kind of shut

a little longer faster. And then there's things like you're probably amped up and nervous right before you go running and that probably plays a role in it too. In addition, for some runners, it's simply a matter of you lose time if you go poop too often. So they're just hardcore love. There are some pictures. If you start looking into this, because I didn't.

I'd rather. There are some pictures of some, I don't know if you want to call them brave. We'll just say brave, some very brave marathon runners out there. Very brave. Visa V8 poopoo playing their pants. They're wearing those little runner shorts and there's just diarrhea everywhere. I hate this question. Thank you for asking. There are even worse cases. I mentioned that you have decreased blood flow to your intestines when you run long. You can not always, not always, but you can when you run long, run long

distances, that can even cause damage to your intestines. Something called a schemia, which means lack of blood flow can cause damage. You even have runners who have bloody diarrhea. I'm bleeding afterwards. You can avoid this somewhat by making sure you're nice and empty before you run. So some like I found some runners blogs that would advise things like have a little bit of coffee or something to get you going beforehand so that you're completely cleaned out so you don't have to poop while you run. Some other things I saw were avoid really fibrous foods the day before stuff that's going to make you go try to hold off on that.

And don't challenge yourself with a brand new food you've never had before or something that you know makes your stomach a little queasy the day before. Peanuts, I always going to try those. Some running peanuts. Right. For energy. Sydney, is there, this is from Richard S. Is there a pedagogical reason? What? Pedagogical?

Pedagogical. Not pedagogical? Yeah. Pedagoguism teaching. Is there a teaching reason? Pedagogical reason for the long hours, interns slash residents work, raised a hazing kind of thing? I know this one. Go for it. It's so rare that I know one.

Do you want it? Go for it. There is a good reason for doctors to work such long hours. And it is a continuity of care. So if you have somebody check in to the hospital and they're there, like they would have a check. Hello, someone's taking my bag of urine. Sorry, I'm in a hospital. If you have somebody admitted to the hospital and they're going to be there for 24 hours, if you have people swapping out every eight hours or whatever your typical shift would be, you're gonna have people passing off control of that person's care every eight hours. And every time there's a handoff like that, there's gonna be some loss of continuity of cares. There's more room for error and more room for

mistakes and also time loss by having to re-explain like what's going on with the patients. That's a really good answer, Justin. And it's always a balance. Let me say that this has been a debate in medical education, what we call graduate medical education, which is residents and interns and fellows, since as long as we've had that concept, how do you balance a tired resident with the danger of multiple transitions and a patient's care? Because that really is, that is the most precarious moment in a patient's care is when you're handing them off from one physician to another. So I have to leave the hospital for the day. I'm ending care of this person over to you.

I'm going to communicate everything that's happened. All the issue, you know, every result, every complaint, everything I did, everything we talked about, the entire physical exam, I've got to tell you everything. And it has to be written down in some way. And I have to do that for every patient I've taken care of. And that's a very difficult thing to do well correctly and efficiently. And the more, just like you said, the more you have to do that, the more opportunities there are for errors. And so a lot of studies have said, are tired residents really more dangerous than more hand-offs? And the truth is, probably not, you're probably better off having that sleepy resident still there Who knows the situation than you are handing the care off multiple times

So I know it seems mean and I've lived it and it feels mean and it feels rough to do it to answer your question There is also definitely a Hazing element to it because that's why the residents and interns were doing it and the attending physicians are not. Okay. Well, and then I mean, I mean, I mean, I'm even hazing. It's just like they're the new people and they have to do it. And the next new people have to do it. That is true.

There is a seniority issue here. I don't do this anymore because I'm an attending physician. No, I think there are people in some higher demand specialties like trauma surgeons who may feel differently about that comment. But I don't care. I'm not married to them. I don't do a lot of that anymore. It isn't hazing, though, because I don't feel like hazing has a purpose.

And there is a malicious intent. Yeah, there is no malicious intent. This is just part of your training. And you learn more this way, too. If you're able to admit a patient, care for them for the entire beginning of their admission for the diagnostic process and beginning therapeutic process, and then you leave, you're much better suited to manage that problem in the future

than if you admit somebody and then leave an hour later and never find out what happened till the next day, you've missed all those critical steps. So it helps with teaching, it helps with training, it helps reduce patient error. Yes, it's hard and yes, it's a balancing act. Because there is a limit. We are only human.

We can only work so much before then it does become dangerous. But people are thinking about it. I want to get in one more question before we take a break. Do weighted blankets actually help with anxiety? That's from Tara. Have you heard of this? No. This is a true, this is a true thing. So there are studies that have shown that something called deep touch therapy, DTP, which can involve hugging, squeezing, swaddling, stroking, holding, and kind of simulating that with something like a weighted blanket is effective in calming anxiety and they also use it for some other things like cognitive developmental disorders and sensory

modulation disorders. It really does help with that. So that's one thing that they found for you know in children I think swaddling is a really good example. If your baby's really upset and you wrap them up really tightly, they chill out most of the time. And so they've found that for certain adults and older children that, you know, this act of like hugging somebody very tightly or if they, if you don't necessarily want that physical contact or they don't desire that physical contact, a way to blanket can do that. We didn't take a break right now to talk to you all about the maximum fun drive. Um, there are a lot of shows of the maximum fun network. All of them need your

support. And if you listen to shows on our network, I know you do because it's your hearing, and you're hearing this, but especially to be listened to multiple shows in the network, I know you do because you're here and you're hearing this. But especially to listen to multiple shows in the network, we come to you once a year and say, Hey, can you help us out and help pay for shows in the network? That goes into hosting costs. It goes into equipment fees. It goes into paying people who make the shows and people who host the shows and we'll edit the shows and people who make art for the shows, and so on and so forth. And it helps us make our shows better and bring new shows.

That's exactly right, Sid. So we really need the Saw Bones fans, you, a Saw Bones fan, to help support us. And the cool thing is when you sign up and you say you listen to saw bones while you pledge, your money goes directly to the shows that you say you listen to. So, Portia is the next one. Right? So it goes to us or whatever other shows you listen to get split up between them. So you're directly supporting those shows. And we're going

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If we haven't made it clear for upgrading donors. Sure, yeah. So if you're already a donor and you think maybe you're in a position to up your donation this year, this is a wonderful time to do it because lots of free gifts as well. And you help us meet our goal. And when you do, if you do upgrade, you can update the shows you listen to. So if you start listening to new shows this year, make sure to do that as you're finishing up. So maximumfun.org for slash donate. That's where you go. And if you could do it right now, just take a couple of minutes to do that. It would really mean a lot to us. So thank you. Thank you. Thank you. We, like I said, just this only happens once a year, but if you enjoy our program, don't rely

on other people to do it. Please, you hop in there and let your dollars be a vote for solbos, is that my sense? Good, a maximum fund.org, click on donate, and if you can, and pledge some money and include all bones in there. How about that? At Krispy Taters has a question. You know that thing where sometimes you yonder open your mouth wide and you hear a big crunch in one ear, what's going on there?

Now, when I read this question, I think I'm, if I'm interpreting this right, you mean kind of like popping your ears is what most people would, what I think, call it, but I think you could call it a popper or crunch or crackle or any of the rice crispy sounds. Yeah, what's happening though? What's happening is, so in order for us to hear, at waves of sound need to travel through the atmosphere, through your your tempanic membrane, your eardrum, from the outer ear to the inner ear and make it vibrate. And the tempanic membrane is there so that sound waves,

but not any kind of liquids or objects or anything, can pass through it, right? Now in order for that to happen, the pressure outside the tempanic membrane, the eardrum, needs to be equal to the pressure inside, okay? So you have to have a way of equalizing that pressure across that membrane. Well, you have a way on the outside,

the opening of your ear, but you gotta have an opening on the inner ear side. Well, you do, it's called your U-station tube and it's a little teeny tube that goes from your inner ear to the back of your throat. There's a tiny little opening in the back of your throat. And the purpose of that is to allow air to pass through it to the back of your throat to equalize that pressure

in your eardrum. Now, the way that you can do that is using muscles called tensor velipalitini muscles, which are attached to your soft palate and also your u-station tube of course. And anytime you yawn or open your mouth widely, these muscles, because they're attached to your soft palate up in the roof of your mouth, will open up and also activate that U-station tube to equalize the air pressure. So what

you're hearing is air move through that U-station tube every time you do it. The pop and crackle of air as it vibrates through that teeny little tube. This is essential to do on a plane. So most people think of this happening on airplanes. And it's because of atmospheric pressure changes as you go up in the airplane. So the panic membrane is starting to bulge out if you're able to look at it, it's starting to push outward. It's the opposite of when you go underwater like scuba diving, it starts to bulge in. And what you have to do is start yawning or opening your mouth wide or swallowing.

All these actions will allow air to pass through that you station tube and equalize the pressure across your eardrum. If you have like an upper respiratory infection like a cold in your throat sore, you might notice that it's really difficult because that you station tube is swollen and blocked off. And that can cause you some pain. It's actually there's kind of a cool thing you can do where you like you turn your head to one side and tip your ear to that shoulder and hold your nose and cover your mouth and swallow. Okay. It'll make your ears, it'll make your nose and cover your mouth and swallow. Okay. It'll make your ears, it'll make your ears pop

even if you've got a cold. I'll stay with the tried and true gum, I think. Gum words too. Don't try to force it, by the way. Don't try to like hold your nose and blow, you know, when you like cover your mouth, hold your nose and try to blow really hard. Oh, I hate that.

Unless you wanna rupture your ear drum, don't try that. All right, deal. Gina has one. Why does coffee make you hoop? Justin, why do you think coffee makes you poop? Caffeine. You're wrong. Oh, really?

We thought yesterday, yesterday you said I was right. Yeah, and then I read about it and were at your wrong. Okay. Doctors thought that for a really long time, that was always the answer. Why does coffee really long time meaning until last night when I said? Other doctors figured it out before me. Okay. Then we thought it was caffeine and then they did a series of challenges where they give people decaf coffee and they still had a boop. There's something in coffee that stimulates what we call your

gastrocholic reflex, which is when food hits your stomach. It makes your colon start what we call parasolting, crazy and it moves stuff out of the way to allow new stuff in. And it stimulates that reflex and it also stimulates the release of gastrin which is a hormone that moves things along in your GI tract. We're not sure why. Like I said, we think it was caffeine but it's not. On a side note, you know, we also tend to think of coffee as a diuretic that'll make us pee. Do you know you grow tolerant to that? No. Yeah, chronic coffee drinkers, it really doesn't work so well.

I thought that was an interesting side effect. It is interesting. I have another question for you, Sydney. Okay. Can someone have more than one spleen? Who wants to know? Jimi, right. When I was a kid, they did.

Lynn wants to know. When I was a kid, they did an ultrasound for something and in the process discovered I had multiple slash accessory splines. Is this really, the accessory spline is the spline that drives the getaway car. Is this really a thing or just something they said a weird out of kid? If it's a real thing, what is the function? This is absolutely a real thing, Lynn. Accessory spines, or I like, there's multiple names.

I like splinules. Splinules. Splinules. They're totally a thing. They are little segments, little tiny pockets of splinic tissue that are found outside the main spleen. They occur at about 10% of people. Yeah.

What? A lot of people have extra little spleenies. They happen usually developmentally, because man, if you get into it, I won't get certain embryology. It's pretty fascinating. It's also very difficult to take a test on, but it's very fascinating.

The spleen develops initially right in the middle in the midline of the fetus. Okay. Okay. And then it migrates over to the left upper side of your abdomen. All right. So it's got to move over there. Well, on its on its track, it can leave spleen cells behind sometimes like little teeny like a Johnny Abel, say behind it. And so then you get little splinis. And so you can find them anywhere around the spline, the stomach, the intestines, the pancreas. You can have little teeny, teeny pockets of splinic tissue.

Also during development, the area where your spline is forming is really close to where your gonads form. So you can get a splinno gonadal fusion, which will result in after the two begin to go their separate ways. The gonads can have a little bit of splinic tissue still attached to them. So as they begin traveling down to where they belong in your pelvis, they might leave a little trail of splinic tissue behind them as well. So you get little pockets of spleen all the way down into your pelvis. I think it was like a Hansel and Gretel situation. It was like a trail of

breadcums in case it ever wants to visit the spleen again. You can get this from trauma too, but it's is largely an interesting embryonic kind of thing. They really don't matter for the most part, except for one way they matter is imaging. If we do a cat scan or an MRI or something and we see a bunch of extra little dots that we don't recognize, we might. No, not like that. No, we don't like that. And we might think it's like an enlarge lymph node or something and you might end up with extra procedures or biopsies and really it was just an accessory

spleen. So that is a danger of them, so to speak. And then if for some reason you have a condition that requires splinectomy, which we talked about, there are a couple reasons why you might have your spleen removed in the spleen episode. If you have that condition

and we remove your mainsbleen and we leave accessories bleens, you may still have symptoms of that condition because you still got splines in there. All right. So, but other than that, they're fine. You just got little baby in there. All right. So, but other than that, they're behind. You just got little baby splines.

Don't worry, Lynn. Matt has been terrified of tapeworms since he was a little kid. Is there anything you can tell me to make me less terrified of them than thanks? No. Oh, we'll see. No, sorry, man. Well said. Tapeworms are awful. They suck. No. Sorry, man. They're awful.

They suck. No, I'm kidding. I mean, I can understand your fear. They're pretty horrifying. They're these big, long, flatworms that attach to the inside of your gut wall and they suck out all your nutrients. And they get longer and longer. And I need my nutrients.

Right. You need your nutrients and they get longer and longer unless you kill them with medicine. And then if you do kill them with medicine, that's great because then they're going they're gonna leave but they're gonna leave through your butt and you're probably gonna see that happen and that's awful too Now let me say this though First of all, I don't know where you're writing from Matt, but if you live in the US, you're probably okay They're pretty uncommon in the US Um, not on her note. They're not unheard of. I'm not saying they don't happen. I'm just saying they're pretty uncommon.

They were once used as a weight loss aid. See, you got that. It was fashionable for very fancy ladies to swallow tapeworm eggs and then attempt to lose weight. I would highly not recommend that. Not kidding. Also, they're really easy to treat with usually like one dose of medication. Okay. One dose of medicine and they're gone. They're easy to avoid. Wash your hands, wash your hands before you cook for sure. Wash your hands after the bathroom. Avoid raw fish

and meat, freeze stored meat because that kills the eggs. Don't eat worms. Don't eat worms. And if you're going to places where it it's more prevalent places in the developing world, I would avoid raw fruits and vegetables. It's better just to cook them. Okay. Worse comes to worse. That is a great story. To have one and then talk about that time. A big worm came out of your butt. Overcoming. Yeah, that's true. In the circles, iron, it's a cool story. Yeah, we all get to have skade and unscade their own ways. You'll be fine. Don't worry, yeah. We all get to know I've skated and unscathed in our own ways, man. You'll be fine. Don't worry, Matt, you're going to be fine.

Don't worry. Juliana, my question is this, why is your stomach growl? Is it actually your stomach making the noises? Why do we say we must be hungry if we hear the noise? I have no idea. Okay, first of all, the word for this is one of my favorite words in medicine. The word for your, when you're stomach growls, when it grumbles and makes noises, is borbarrigme.

Borbarrigme? Borbarrigme. Borbarrigme. I love the name, borbarrigme. Hey, if we have another kid, then we'll teach them about borbarrigme, moving on. Okay, so borbarr me or those noises when your stomach growls, it's largely air gas moving around inside your intestines.

Not really so much your stomach, so to speak, is your intestines. There's also like food and fluid and stuff in there that move around. Plus they do that thing I already mentioned called peristalsis, which is when they squeeze, kind of do the wave to move stuff along. All those things in the air inside make those kind of grooney-growing noises. It doesn't have to mean you're hungry. If you eat something that's really gassy, you might find that you have some of those noises too.

Okay. Or if you got to go to the bathroom really bad and you're not for some reason. It does seem to happen when you're hungry, though. Well, and that's probably because there's more air moving around in that empty space, because you got no food in there. And more air translates to more sound waves being able to reverberate around. Well, it's all liquid that you wouldn't hear the sound as well. So you also hear them more because there's air in there and then it'll all sound a a lot of sound to travel better. Well, that's true. I guess. In addition. In addition to it's the air itself moving. Yeah, but like, having more air in there means that the sound waves

can travel better and that makes it more prominent to hear. Okay. It makes sense. I know what you're saying. Okay. It makes sense. It don't understand. Okay. It makes sense. It shows me fair enough. It's in. It's like you know, we don't film movie theaters with water because then you couldn't hear the movie as well. And also the breathing that. Yeah.

Also the breathing. Um, there is some thought that maybe it is your body's way one way your body tells you to eat because like your blood sugar is dropping. Ah, wasn't that air move around. Come on, stupid eat something. How much longer do I have to more berig me for you? Please. We just got a couple more here.

Donnie said, I'm a young person with multiple chronic conditions. Every time I go to a new doctor, I spend what feels like an eternity going over my entire medical history. Do you, Dr. McAroy, have any advice for me about making the process easier for me and the practitioner? Donnie, you actually, this was the session, a longer email, and you mentioned, I'll give you credit for it because you mentioned it, exactly what I would recommend. If you are somebody who has a lot of chronic conditions, it doesn't hurt to carry with you. Kind of like a like he called it a resume. And I think that's not a bad approximation for it. If you have your own list, because we always tell patients to carry a list of their medications,

that's a pretty, that's a pretty standard piece of advice. It helps to have, I have lots of patients who will laminate it and put it in their wallet. And I have a little list of all their medicines and their doses. And even, even better is what you take it for. That's even, you know, a step further. Well, if you have kind of a complicated medical history, having already typed out like a condensed list of just what your diagnoses are, maybe if you've had major procedures done,

what they were in win, like the year. You know, you don't have to have like a whole in-depth, just, I mean, literally, like a list, your medications. That might save you a lot of time because obviously the reason that your doctor's asking you these questions is because they need to know your medical history, that's how we make, you know, help make decisions with your care. But the other very practical thing is,

we got to put all that into your chart. We got to enter it all into your medical record and nowadays with an electronic medical record, there's very specific ways that that information gets put in. And I need it all to be there, not just because I'm supposed to. I need it to be there for the future, for when I look at your chart in the future, so I don't have to ask you over and over again, it's already in front of me. And if you see another doctor, it's already entered into your chart as well. So it's important. And if you hand me a list, I can save a lot of time with the typing and the business and asking you exactly what year was that and what leg was that

and all that stuff. I can focus on the big picture. How are you now? What problems are you concerned about right now? I can address any acute issues. I can get the gist of your medical history. I have a condensalist of what we need to talk about immediately, what meds you might need refilled or whatever. And then at some point, I'm gonna ask you for your whole chart and everything anyway. That's always part of a first new visit is where was your last doctor? Could I get your records from there? Could I get your most recent labs, whatever. So that list is really something I can use to refer to later to flesh out your chart and focus more on you the patient in the visit, which is what that's always my preference.

And I think most physicians feel the same way. I would much rather be talking to you, making eye contact and us connecting on your care, then asking you to give me, and what dose was that, and how many times a day, and you know, that stuff I can get from a piece of paper. I wanna know you from you. So if we got a couple more quickies here,

you wanna just tear through them? Yeah, let me do these real quick. Bridget wanted to know, I'm on the depot shot and don't get a period. Is that harmful in some way? No, it's fine. The depot shot thins out the lining of your uterus and you won't have periods. It is okay. As a general answer for several people ask me this question.

It is okay if you're on some sort of medicine or contraceptive that stops you from having periods, don't worry. Unless you think you're pregnant, of course, please go get that evaluated. Please find out if you're pregnant. But in general, it's okay. It's okay. You don't need to have periods. If you're worried about it, talk to your doctor, but in general, it is totally okay.

I get that question all the time, and so I think it's helpful to give that information. Howard had not a weird question, but something that Howard has been wondering, how bad is it when kids are on antibiotics to miss a dose one day and make it up later? Of course, missing one day and then still finishing out your course, that's not the end of the world. Preferably you'd take them all in order, but if you're going to finish them out, that's even better. One reason I want to address this is finishing the course of antibiotics is key. That is the critical thing. The reason we have those number of days of antibiotic are because we have good evidence that says that will actually rid you of whatever bacteria

we're treating with the antibiotic. If you don't finish out your course of antibiotics because you're feeling better, so you just stop taking them. And, oh, please don't save them so that you can take them randomly when you think you're sick again in the future. But if you, if you save them, you have now selected for the biggest, baddest bugs who were able to resist all those early doses of antibiotic, but are still hanging around. You got to kill all the bugs. So please finish out your course of antibiotics, even as Howard says, even if you miss a day, go ahead and extend your course one day.

It's really important that you do that because this is part of why we have so many resistant bacteria that are difficult to treat with antibiotics. Not the only reason there are many, many reasons, but please finish your antibiotic courses. All right. Folks, that's gonna do it for us this week.

We hope you have enjoyed yourself and learned something because I have learned something. Many things, actually. Things I'm going to take back out in the world and be a better person. You're going to go straight to the internet and look up pictures of marathon runners pooping themselves.

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