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KNX Midday News with Brian Ping | KNX 1070 NEWSRADIO
Infant ibuprofen recalled from Walmart, CVS, Family Dollar
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Show 1154: How to Take Good Care of Your Eyesight
...leadtokidney injury I'm Joe Graydon, Terry Graydon, welcome to this podcast of the people's pharmacy. You can find previous podcasts and more...
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Organ Transplants are AMAZING: Healthcare Triage Podcast
Welcome to healthcare. Tree podcast episode was super interesting in long, and therefore I'm going to skip right past the news. If you go watch this week's healthcare triage news, otherwise let's jump right in our guest. This week is Dr Jonathan for Dell good friend of mine and also a transplant surgeon here at Indiana University school of medicine, so I'm going to let him introduce himself burst. And then I'm gonna ask him lots of questions. Hi, this is Jonathan Fidel am chief transplant at Indiana University. I mainly specialize in pancreas transplants. But I'm kind of jack-of-all-trades I do livers and males and used to do kidneys originally from Montreal. And I've been in Indiana now since two thousand and two so how do you get to be a transplant surgeon? So clearly, you went to college I and then medical school merger go to medical school. I went to medical school in Montreal. And then what did you do after that? So the training in Montreal Montreal's a little bit different because they have a different schooling system. So instead of going to great allow. Twelve and thirteen is glad she goes to grade eleven than we do two years ago college after that I went to an early acceptance program at McGill for medical school following medical school. It's a five year general surgery training for residency. There was an opportunity span extra time in the lab. And I took advantage of that. I did two years and then following that it's a two year fellowship in transplantation. And after that, you go look for work so to become a pancreas transplant surgeon is any extra training to specialize there or is that just part of the general transplant fellowship. So in order to become a pancreas transplant surgeon, specifically most people go through training for multiple organs and the program, you train, it has to have a certain number of pancreas transplants that they perform a year so that their fellows get enough experience. They can start. How do you know, you wanna be pancreas transplant surgeon piped internationally want to be a pancreas transplant surgeon? I think originally I wanted to do livers and intestines, and I really was interested in pediatric livers, and when ended up happening is when I came to India. Anna I noticed that like many other programs. They would only do pancreas transplants. When there was an ideal offer with an ideal recipient, and I sort of felt like there was a lot of Oregon's here that we're going to waste or were being sent out to other programs, and I originally became interested as an attending because I wanted to not waste those Oregon's. All right. So let's back up for a second. Can you explain what Panthers does? Sure pancreases an Oregon in the upper abdomen lives in the back of the belly. It's an organ that participates in digestion. And also participates in the endocrine system, and the part where interested for pancreas transplantation is the endocrine part pancreas makes insulin glucose gone mad at Staten a bunch of other hormones, particularly of interest is diabetes happens when you don't make enough insulin. So we transplanted pancreas. So that we make people who don't make insulin make insulin. So pinker transplant effectively would cure type one diabetes. It's sort of like ideal treatment for it. Why don't we do it forever? Everyone that that's a great question. Actually, most common consults. We get our patients that are well controlled diabetics, and they're sort of looking down the line in they're worried they're going to lose their vision or big develop neuropathy or kidney problems, and they want to just get a pay increase. But the the balancing act is you take a person who's taking lifelong medications and at risk for chronic diseases. You do a big operation. First of all second of all you put the money amino suppression medications for the rest of their life. So instead of being a diabetic patient. They become a transplant patient in. It's not really worth that risk unless there's something else that tilts the balance by far the most common reason to do a pancreas transplant is that they're already gonna get a kidney transplant for diabetes related kidney disease. So you might as well also put in a pancreas. So they won't be diabetic. And basically have taken all the risk of the immunosuppression off the table because they've already committed to lifelong immunosuppression for the kidney transplant. So it's it's like a plus one operation like as long as you're getting another kind of transplant. We. Might as well fix this at the same time. And while I while the patient survival is better if you get both organs and the survival on the waiting list for patients who are diabetic and have kidney failure is amongst the highest. So this is a really at risk patient population with a huge benefit. So it's it's not decorative. But there are also patients that have life threatening complications from their diabetes. In fact in patients like that. We would do a pancreas without a kidney, the most common of those is hypoglycemia unawareness, those would be patients that have low sugars, they don't get any warning signs. So they I find out that their sugars low when they wake up on the floor. Somebody has to revive them. Somebody has to give them something sweet frequently emergency room visits EMT calls in hospital admissions for this. So I'm sort of fascinated how do they fix the timing? I imagine we're going to do it with a kidney transplant than we have to have some kind of aligning of the stars. That a kidney is available at the same moment of pancreases available. Or is it something that if they've already had previous can you? Transplant and therefore on immunosuppression later. We can do a pancreas transplant. So that that's a complicated question because we could do either of those frankly when I see a patient who needs a kidney and pancreas like all regular kidney patients. I asked him if they have a living donor, and it is possible to get a kidney first and then follow that with a Pancras at a later date. Much more common is to perform both Oregon's from the same organ. Donor pancreas graft survival is slightly better. But the waiting time is longer, and there's all kinds of pluses and minuses for that. But the way the allocation works in the country if you are listed for a kidney pancreas and your pancreas number comes up than the kidney travels with it. Okay. So let's I wanna talk a bit about when he travels with it. Exactly what happens because I'll say this when doing these kinds of talks, especially with people who are France. I sometimes reveal some information. I don't think you'll be embarrassed by this. But you've canceled on us more times for dinner. Yeah. Their friend. I have in the sense that like you clearly are on call. So it feels like almost twenty four seven you're the closest in my experience of what I felt like my father was at a as a trauma surgeon had where it any moment. Clearly, the Belka go off and you have to go because that's when an Oregon appears. So could you walk us through what happens when that you get that page? How do you get notified? And what is the first step that you do? So it's it's not really done as an emergency. So I don't get a phone call drop what I'm doing in leave and it's not done as an elective case. Unless it's a living donor for a kidney transplant the reality. Is that we'll get an organ offer that will accept and they won't go to the operating room to procure that particular Oregon Intel some twelve to forty eight hours after the time we get that notification and accept the Oregon. So we know that the organs coming down the pipeline, but there's very little control of our life after that. So I won't ask you some further pieces, but that one what does it mean to accept the Oregon, and how do you do that? Let's start there. Okay. So Colonel away the organs are offered is through a system called donor net. This. Has a national system where they send out offers. You look at the offer electrically and you make a decision if you would like to accept it or not we have a partnership with Indiana donor network, and they communicate that information to us. Once you look at that. And you decide if that organism appropriate for transplant, and it's appropriate for your recipient. You say yes, or you say, no, how do you decide that? Like, what are the how how do you decide that? Well, it's probably the most important thing for an organ is how it actually looks. When you go to procure at and so most of what you do with the offer you get as decide if you're going to go and look at it. So for example, if it's a person in their twenties in their lean in their healthy, and they have an isolated head injury of some sort then that's going to be an ideal donor a where it starts to get a little bit fuzzy as when you get to the extremes of age, or if you get the extremes of body mass index or on the other scale, if it might be very small you look at the labs you look at the cat scans the mechanism of injury. Or if the person had a stroke, whether they are fast. Disease. You take some of their social history into account nowadays, we have a lot of organ donors from IV drug abuse, for instance, and other high risk behaviors as we screen all of our donors for the typical viruses hepatitis b hepatitis and HIV, but certain people fit into high risk categories. And we use those words, but we have to put a little bit more thought into them. So to these organs come from all over the country or are they geographically separated? So you know, separates their offers into local regional national local for us. We have our Opio or organ procurement organization is this end of the makes the offers captures all of Indiana, or the majority of Indiana and currently in Indiana, they have our program, and there's a two other programs do kidney transplants in one of them that does some pancreas. And then after that, it goes to regional for us the region would be region ten and that would be Ohio and Michigan in addition to us. And then after that, they go national. And for some organs. They tend to be shared regionally, but mostly go locally some Morgan's. We offer small around the country. Okay. So you've not decided to accept the Oregon. What happens next will after you've accepted, the Oregon we call the recipient in majority of cases, we'll send out a team to go. Procure the organs, and what does that mean to go do the organ retrieval operation means to go out there? The the person is most of the cases the person is brain dead, which is a legal definition and medical deck, finishing which means their heart still beating and they've got a ventilator pushing Lum air through them in oxygen through them. But they are basically disconnected from their brain. They will never have an independent thought. They would never take a breath. Right. So basically, the organs are all getting blood flow until we go to get the Oregon's we do an operation to prepare the organs as much as possible. But ultimately, we're trying to do is flush them all out with preservation solution. Take them out safely and put. Them in packages with ice. So who goes, and how do they go different programs have different philosophies? Our program almost always ends out in attending with a trainy fellow to go and retrieve the organs. So it's it's a it's an attending surgeon and a like a resident or a fellow. It's a transplant surgeon from our team and usually a fellow sometimes rather than anyone else, nurses, anything else. Just usually the two we have per fusionists ago with the team those are the people that would take the kidneys and put them on pumps. We currently pump all of our kidneys in Indiana, many programs to it for many of their kidneys. We do it for all of our kidneys. That's a system that basically constantly profuse as preservation solution through the kidneys. And do you drive or fly or yes? Okay. Anything that'll be longer than an hour. Draw drive will usually fly 'cause we're always trying to minimize the amount of time the organs route of the bodies at this time. And so then you have to really get almost like a charter jet, actually, Indiana donor network owns two jets. Okay. They control and they actually hire out to other Opio z-. In addition to that, if our planes are all busy than we start chartering flights. So you wouldn't flat commercial, and like wait for your flight or hope that there was a time a lot of kidneys used to travel by commercial? I think many of them still do for livers. That's almost never for intestines. That's almost never for pancreas. We tend to treat them like livers here as I'm programs still use commercial flights. So you go you fly. You get there. You you're doing the operation you remove you remove the Panthers and the kidney or do you have to bring two different kinds of transplant surgeons while they take they take out everything we would usually send one surgeon to take out all the organs. They take out deliver in the pancreas, and the kidneys or liver and the kidneys have liver. The pancreas intestine the readiness. There's usually a separate team for the organs some chest. We should say. Yeah, that's a heart and lungs, right? Sometimes there's teams they're splitting livers so they can use one liver for two recipients not unusual for there to be different teams for that. Sometimes we will have a team for the liver team for the pancreas at team for the intestine. It all depends on the donor. And so what what did they do with the organs after that they package them in preservation solution to keep them until they're transplanted. They put them in ice, and they transport them to the recipient hospital. And so you then fly home with them. And so how long do you think there is usually between you've harvested the organs? And now, you're you need to put them into to somebody else for most of the organs that we transplant so liver pancreas intestine as soon as we get back to the hospital working on the back table preparation of the organs. That's literally a table in the back of the room where we prepare the Oregon's and get them ready. So that all we have to do. So the blood vessels frequently. There's a separate team that starts the operation on the recipient. So so is it is easy as attached in order to blood vessels off you go all use a kidney transplant as an example. Because that's probably the most rate forward anatomically because there's a single artery going into it in a single vein coming out, essentially we. Oppose the blood vessels in the recipient African knee transplant. We use the Elliott artery in vain. And so there is an artery going into the kidney innovation coming out of the kidney. And we attach the vein going out of the kidney to the vein in the recipient than we attach the artery going into the kidney to the artery in the recipient. So when we take off the clamps blood runs toward the leg up through the kidney back through the vein. Draining the leg. So there's no need to attach a nerves or anything else. It just boilers no nerves, but for almost every organ, there's some kind of drainage required. So for the kidney, there's the ureter that has to be sewn to the recipients bladder for pancreas transplant. You know? The pancreas has an excellent function that helps you digest foods that makes fluid that usually drains into the duodenum, which is the first part of the intestine we actually bring back the duodenum from the organ donor, and we attach that to the test of the recipient for bell transplants. You have to reestablish the continuity of the intestine in for liver. Transplants says the bile duct. How commoner intestinal transplants? They're not very common. There's only a handful of programs in the country that perform them a big program is a program that does probably up twenty what's the disease that leads to an intestinal transplant. The most common indication for an intestine transplant is gut failure. So short gut usually from reception, but occasionally for functional reasons like people have pseudo obstruction, very common to perform a combination of a liver and pancreas intestinal together. Gaffe? That's like the whole, okay? Just swab in an all out while the pictures are phenomenal have a if he can catch a photograph. When all of the organs are out of the belly. It is very impressive. But that's usually for patients that have TBN induced injury for longtime a shortcut failure. Here. We do quite a few multilateral transplants for patients who need a liver, but the entire portal, MS enteric, Venus system, all the veins draining the intestine and the pancreas are all clotted off. That's become. Less common. But we've done quite a few for that. We've also done it for some centrally located slow growing tumors like neuro endocrine tumors where you can't get everything out. So you take out everything and given new everything how do they decide who gets in Oregon? So that's sort of an open ended question in all cases at some kind of end stage organ failure. That's not going to recover. So for kidney transplant patients when they have enough kidney damage that their kidney function reaches below a certain threshold that's less than Craton clearance at twenty or that they're on dialysis than we can put in Oregon and fix that. By making them start making urine again for a pancreas transplant. This is a bit of a grey area. Because we used to say the person had to be a type one diabetic that either needed another organ transplant usually gave me or they had life threatening complications from their diabetes, but more and more. We're doing Panthers transplants for some type two diabetics. So why would you do pinkish transplants? More for type one than type two diabetes bankers transplantation has been around for a little bit over. Fifty years and the philosophy of pancreatic transplants was very similar to the philosophy of kidney transplants. We do a kidney transplant because someone doesn't make enough urine. And so if you put in a kidney, and it's a hetero topic graft, which means we don't take the old kidneys. We just add a new one if you put one in that's making urine than you fix the problem. So the logic for pancreas transplants was a dental. It was if they're not making insulin. We don't take out their old pancreas at still doing lots of good things. But we add one pancreas that's making insulin. And now they're not diabetic anymore. And I think that we felt for years that you were specific to the type one diabetics because they weren't making insulin the mechanism for type two diabetes is that they are resistant to their insulin. But they are making it. So people didn't think it would work very recently people have been embracing it and doing it more and more. I think the definition of type two diabetes is a little bit loose think the way we're defining. It is a C peptide positive C peptide is a little protein that you make with IMP. Colin that gets cleaved off, and you can measure the level in the blood. So if you wanna know if somebody is making insulin rather than injecting, insulin injected, insulin doesn't have a peptides. He measure z I level, and you know, whether or not they're making insulin. So I think they started off by doing C peptide positive people that looked like type one diabetics based on their age diagnosis and their body habit is other things and then gradually when they realized that that work. They started applying it to type two diabetics and more and more. We're doing type two diabetics that aren't requiring a lot of insulin. That also need a pancreas transplant. So the reason that we're doing way more type ones is everybody's comfortable with that. And people are just beginning to embrace type two bowl. I got even just in my head. It's hard to wrap around the idea. Why would work as much for type two diabetes because it's just seems like insulin resistance again, yet will be the major problems giving them more insulin. I'm like, I don't know. Yeah. But if you consider what the typical treatment is for type two diabetic, some people will be died controlled some of them will pill control. But ultimately we end up. Putting them on insulin. When that doesn't work, and we do get them under control for liver transplant of psoriasis as irreversible. When somebody develops a you can start talking about it. But usually have to start developing some complications from their cirrhosis usually related to the portal, hypertension, patients develop encephalopathy in SAD's and things like that. And for livers, we have a special scoring system that tells you how sick the person is in their likelihood of dying from their liver disease. So we actually triage patients for their liver transplants based on the scoring system. So but clearly United States like we still we have more people who probably could get transplants than we have organs available. How did they decide which person once they have one of those issues gets the the Oregon versus another person who has those issues? So, you know, says the United network for organ sharing that say government-sponsored group that has buy in from volunteers mall around the country all types of organ transplants, and from the public in general, and they have a team setup for every type of Oregon. We transplant and that's their main mission is to figure things like that out for liver transplants. They've been trying to optimize the patients dying from liver disease on wait lists. So they would want the sickest patients on the list to get those organs. Currently they're looking at geographic disparities for that. And trying to optimize that for kidneys. They would like for kidneys that have the potential to last for decades to go into recipients that will as well as they've recently changed their allocation to make that more suitable for pancreas transplants sits, you know, more based on wait time than anything else, which I've always thought was a very fair system. But the more I do this the more I realized that certain patients have urgent need. And certainly if somebody comes in, and they immediately need an organ transplant. We do have systems to give them high priority on the list. I mean, it seems like something I'm sure ethical ethicists have been involved in because it just seems like one of those issues where it's like there's no perfect answer that they have to find some kind of ordering system, but it's going. To make somebody upset at that's a very common ethical dilemma as you have one Oregon who do you put it in writing? And sometimes you do get into them locally when you're actually looking at the patients and trying to decide what you're gonna do with an Oregon you have two people to qualify. Usually, the easiest thing is to default to the whatever the list is because so much thought has gone into the allocation system, can you split a pancreas or is that a one to one you can and it has been done. Currently the number of pancreas transplants were doing in the country have been dwindling there still are a lot of them being performed the numbers have gone up in the last couple of years. But if you look at the trend over the last decade and a half the numbers have gone down substantially, which means from my perspective. If there's patients on the list, they're likely going to get transplanted within a reasonable period of time as probably not worth the extra technical, exercise and potential complications. Splitting one in half. Why isn't left the number's been going down? We don't have a very good reason. I think that the quality of the donors have certainly changed. Some of it is practice. I think you know, Pancras trans. Transplants is complicated. Takes an awful lot of effort to get it. Right. So I think that we have become a little bit conservative on the choices. We're making in the organs will accept I think we're listing fewer patients some of it has to be the effective better control for diabetes. So certainly with pump technologies in continuous Commodores, and, you know, the potential for those to to communicate. There are probably fewer patients that are getting towards renal failure. From this fewer patients that have the life threatening diabetes complications, we are talking about. But it's really hard to put a finger on which exactly caused all this. When we weighed the long term potential complications from your suppression versus type one diabetes. I mean, I clearly know the complications that type one diabetes can actually feel like I know some of the complications immunosuppression. But it's odd. I'm not liking my head. I'm like would would would immunosuppression be worse is it it certainly can be most patients tolerate immunosuppression very well, or I don't think we would do this. But the main toxic. The cities of the immuno suppression are that they affect kidney function, which is sort of ironic that we're doing a kidney transplant and put him on an effort, doc medication. But that's why they have to have their levels monitored for years, some of the minero toxic, but much more importantly as the opportunistic infections and cancers. And they aren't as selective as diabetes diabetes. Kind of takes years and depends on how you control your diabetes. And then you see what happens, but we will have bizarre things happened with immunosuppression like grafters, his host disease and like post transplant lymphoproliferative disorder, which is a type of foam on. It's these weird complications that old just pick a patient. They make it kind of frustrating and every patient needs to be warned that immunosuppression is not without risk. And these are all very uncommon complications. But you know, when you see them happen. You kind of wonder why it picked this particular person. So do all of the organs stay in. Or do you take some out and get rid of them terminology? We use as hetero topic or Ortho topic. And so in some. Mm cases, the sick Oregon is in a place where it's causing the problem so hearts livers so a liver that psoriatic the main reason patients were having a problem isn't this Roddick liver of a some of it is that they're not making the proteins. They need to make the most of the problems come from the portal, hypertension. So the back pressure on the blood vessels feeding into the liver that lead to viruses in the Asaf a- guests and lead to a site. He's so we literally have to remove the liver and put in a new one in the exact same place to fix all of the pressures in the blood vessels for other organs where they aren't making something they're supposed to make like urine or insulin. We don't need to take out the original, Oregon. We could just add an extra one as long as they're making what they need to make. They'll be fixed seems like I can picture finding room for kidney pancreas and the by. But I'm having a hard time wrapping around the idea that you could squeeze an extra liver in there. Yeah. That's that's why we do take out the old one and replace. That's I don't know but other programs we actually spent quite a bit of. Time trying to figure out if livers are gonna fit so we do look at the body habit. So the donors but nowadays everybody gets AT scans. And there's so many good mechanisms for sharing C T scans that we can usually predict based on the size of the liver and the size of the recipients liver in abdominal cavity that we're going to be okay for size, and I imagine for gut transplants. The the old gut is gone or has to come out. The bigger problem is that if it's already been removed. We do lose a lot of terrain his things tend to contract downright as sometimes a very big person that's had everything removed doesn't have a lot of room in their belly. And we have to put in smaller donors organs into them can people donate a pancreas. If there if they choose to live, I guess unless like my brother needs pancreas, can I give up Packers the so it's it's technically possible to do it. There's an experience in living donor pancreas transplants at university of Minnesota. And in parts of Asia where they don't believe in brain death. Where they've embraced living donor most often what they would do as a lap risk donor. Frechman Distel pancreatic to me, and they were transplant just the tail and then they would usually drain it into the bladder. It's it's possible to do that. But in our country, even university of Minnesota where they have a history of having done this most people get transplanted with categoric organ donors. Can you can is anyone working on our official pancreas? It's not the way you're picturing it, you know, he sort of picture this little robotic fish shaped item that you put in the back of your belly. But they actually used that terminology g to describe the insulin pump that has a closed loop reineck Asian with the glue Commodore. So it's an external device that looks like the insulin pump benigo Commodore, but it's a computer programming that makes it challenging. And I think a lot of these pumps have insulin Anglo gun in them. This is always baffled me because it seems like one of those things where it should be able to do it. I because we're just we're just saying like. Check the blood sugar give them insulin. You know, monitor like, this is we know what the Panthers is doing. We know how to do the reading we know how to deliver. I I've never been able to figure out why we can't tackle that issue. But it clearly people working on it for a long time with with not a lot of success. Now, why they actually do have the first FDA approved paying Chris like this where it's extra Nolan the devices communicate, and the reason that it took a long time to reach this point. Is that people who had a tendency to hypoglycemia unawareness, they would overshoot their targeting end up with low sugars now the newer pumps that have glue gun. That's less of a problem. Just a little bit of a waiver. I'm I'm not an endocrinologist. But I do see all the technologies that my patients come in with when they're looking for a pancreas transplant. And usually the ones that are saying are the ones that have failed pump technologist my my K award from back in two thousand three was about mobile technology fats diabetes management. And I remember multiple people telling me at the time don't even bother with this because this was going to be here. Any second now and we'd have diabetes solved. And of course, it's fifteen years later, and I'm like well. No. So I'm always amazed at like this always seems like it's right there. But we just can't we can't seem to get. Yeah. And addition to the pump technologies I mean, there's all kinds of other sciences that are being explored certainly islet cell transplantation, is is close to being a clinical reality. Currently it's mostly done. Under study protocol doesn't quite have the longevity of pancreas transplant, but you remove all of them were bitty of the pancreas transplant operation, you go into more detail with what that is. What's an islet cell transplant? That's where they digest a patriots with enzymes. And they ultimately bring it down to the point where they literally have the oil. It's languor hand. Isolated islets of Blanca hands are the part of the pay increase that secretes the hormones. Okay. As specifically insulin in this case and the most common way to put them into the recipient is they're injected into the portal Vena system where amber lies an. Into the liver, and they start making insulin in that could be done either surgically or done perky taniwha sleep in directional radiologists. They literally stick a needle into the liver into the portal Vena system. And then as they come out they plug the hole that they made do all of the donors are often donors, technically brain dead or how else might that work. Well, we do living donors for certain organs, so kidneys be our preference to do a living donor kidney more and more programs restoring to living donors for liver transplants. They could do either le- left side for pediatrics where they can actually take the right side for an adult. In addition to the living donors, a vast majority of our donors are deceased in brain dead. And as I mentioned before brain dead, basically means that you don't have a brain stem anymore. You'll never have independent thoughts or breaths. Are you're legally and ethically and medically considered deceased. We sometimes see obituaries for the patients before we go and retrieve the organs there's another category. This is. These are donors that are not brain dead. But they're they're having unsurvivable injury. So in these cases, they might allocate the Oregon's pending withdrawal of care at the family's wishes. And what we do is we allocate the organs, and we go to the donor hospital, and then we're allowed to give heparin and get the abdomen prepped for surgery. But we have no interaction with any of the decision making regarding the death pronouncement, basically the person that would have withdrawn support with the family present upstairs in the ICU does the exact same procedure that they do in in the operating room and the person's allowed to peacefully expire. And then we give an extra five minutes to make sure everybody's comfortable in the, you know, we haven't changed our minds, and which point the person is legally and medically unethically deceased just like they were if they were brain dead, and we can go in and retrieve organs at that point. And this is a very common procedure for kidneys, very common for live. Vers- some programs us paying Chris's from these donors as well. So clearly, we don't have enough organs for all the people who need them. And one of the major things is we don't have enough organ donors. How do we make that better? I think the the most straightforward way is is we have lots of mechanisms where you can become an organ donor. But I think the most important thing is started dialogue with your family. Make sure your family knows what you would wanna do. You know, transplantation helps thousands of people a year. There are people who are dying waiting for organs. And there's a lot of things people can do, you know, the time when somebody passes from tragedy is always extremely painful, and one of the wonderful things about transplant is it does put a little bit of light in that moment in it does allow someone to live on. So I would encourage people to have conversations with their loved ones in honestly, consider being an organ donor. This seems like one of those were simple behavioral economic trick could make such a big difference too. We we make it that the default is not to be a donor enforce people to actually say there. Going to be a donor other countries do the opposite where your default. No. I mean, your default a donor and you have to opt out which again, everybody's right? But that would probably massively just increase the number of donors overnight. Why don't we do that? Well, it's made a huge difference in certain countries, and they're working donation rate. But I think our default in our country as a reasonable that people have a right to decide what can happen with their body. But on the other hand that just makes our job a little bit more difficult, but we're up to the challenge. I think we have to educate people to make sure they're aware of what transplant can do and how transformative it could be. And you know, I think the more people know about the more they interact with people who've had transplants, hopefully, the more willing, they'd be Doric donate their organs. Not a perfect message. I think to end on. So thank you. We're going to switch over to questions. Now question number one. I'm scared of bats, why isn't the rabies vaccine widely available like the MR polio vaccine so one I'd argued that. I mean, you might have a different answer. But it's like, I I don't first of all it's not nearly as common or infectious in the sense. You know, measles, you can catch just by. Being in the room rabies as specific vector that you have to get bit by an animal that has rabies which doesn't occur that often that this is something we want to do. Plus, it's a horrifically difficult and painful vaccination to go through. It's not like take a shot while your baby and be done. So both both my think from an economic cost effective standpoint. And also probably from a how much pain is involved. Just don't seem like something we'd ever do. That's on. Right. I I also hate bets. I didn't realize that they Indiana Brown bat is a protected species in say, you shouldn't just kill them, and you shouldn't touch them. So it's actually not a bad idea to get someone to get it out of your house. If you have one we've actually I've I've had to we've removed multiple bats from from our houses a kid. I remember that it was always sort of my dad in a picture min. This'll sound strange, but like in his underwear with like a a helmet on going after the bat. Trying to catch is crazy anyway adamant Kelly ask I'll be soon starting medical school this summer, and I'm very excited eventually become physician. My girlfriend is currently finishing her first year nurse. In school on his equally excited. We really enjoyed the absorber Amy talked about her occupations nurse practitioner, and it definitely opened our eyes the diversity of healthcare field. That's our goal. I'm thrilled as a future doctors couple. We were curious about the nature of your relationship. Was there ever any sort of power dynamic between you because of your different job titles had other people treat you as a doctor skull additionally due to enjoy discussing medical talk or do you prefer to avoid it? This is a perfect answer. A question for both of us because John's wife is a oncologist actually at another type of doctor at IU school medicines. A he can actually offer a different perspective. It's interesting. You ask this Amien? I've often decide like we just should not be doing the same thing at the same time. And so we've actually had a few instances where work is almost overlap because she's clinically involved in some of my research, and I just don't I don't know. I don't love it because there's a different scene work, Aaron and home Aaron and Amy will be the first person to point this out. And there's only been a few times, I think she's actually interacted with work Aaron, and that's a different guy. And so I tried to keep it separate. But there's no power dynamic in the house of bit. I feel like I'm more knowledgeable or better in any way. Amy is a phenomenal primary care practitioner. And I'm a good researcher. I think and I think I'm inadequate pediatrician. But to be honest with you, I deferred to Amy on on many issues that would be sort of primary care pediatrics because she's doing that every day. She's also incredibly knowledgeable about taking care of adolescence and about a birth control issues because those are the things that she does every day. And so it's a different job. And I think most bosses have different jobs. And so it hasn't been much of an issue. You're you're both physicians, but why don't you answer the same question? So my wife is actually also a transplant her, but she does bone marrow transplants and she works one floor above me. But we almost never bump into each other at the hospital, we realized very early on in our careers that we probably shouldn't come home and talk about. Immunosuppression as we actually talk shop very little. We talk medicine very little except when something's interesting as far as behaviors at home in power dynamic. I I I don't see a problem we both approach issues very differently me being a surgeon in her being an internist. I I know we've been first responders to several things, and I'll usually walk by all say that the person's breathing, and I'll be relieved and wait for help to come. Because the only thing that I feel like I can do at the side of the road without someone enemy instruments is I I can maybe provide an airway, whereas my wife will get it entire history and ask what medications they're on ask about their past medical history and get all the information for the MD and usually gets all the credit for everything. So. It's an I'm going to go to my question my own where it's my dad to retire. But he was a surgeon used to travel. We were gone vacation with basically, I think enough equipment to do an epic. He just everywhere. He went it was just a ridiculous. I think he felt like he had to other surgeons do this or was he just crazy. I do not do that. Okay. Good. To hear that as I just wanted to because I think feel like he could almost just on the side of the road do stuff because he was just he always had this equipment with him. It was crazy. Rachel asks. What's the latest thought on antibiotic ointment Bali's boringness, born, etc. My dermatologist doesn't seem to recommend them anymore. Should toss them all and replace them with plano petroleum jelly. What is the science say? It depends. What you're using them for you know, they clearly have a use in the treatment of localized topical infections. And I'd also argue that in some cases, especially with my children. I have used them. You know, one time only that thinks as placebo in the sense that like oh my God. I have this hurts, and I think I'm wrote about this recently. We might have even talking about this in an episode. Oh, it was the steps that. Yeah. Like, I'll put a little cream on and be like this'll take care of it and the gay, and then it's over, and it's like that's a very low cost low risk way to to care for many problems that I know are just going to go away. I wouldn't use them long term and that route. Because of course, we don't want to overuse antibiotics I in any way. But I don't think that there's no use for them. It just may be that you're getting a little more discriminatory in what he or she is applying them force. I wouldn't throw them away. Of course. Of course, if they're ten years old. I'm not sure if they'll they'll still work anymore, but other than that, I still think absolutely those things have used. In fact, I know that there have been in randomized controlled trials of even wound clearing, a wound healing studies. Which show that, you know, the use of such with coverage works better than of course, exposing things and letting dry out. We've definitely talked about that in previous episodes. So I don't think that they are useless your your surgeon, though, how do you feel? Oh, how do I feel? I think that the transplant programs in most hospitals were the epicenter of resistant organisms. So actually, we try very hard not to overuse, Amy -biotics. But because we're Muniz press patient population. We tend to use them a lot. So I think my recommendation is if there's not a Pacific indication for an antibiotic, including an antibiotic ointment we try not to use them, you know, a lot of hospitals. These days are using these says he HD Beth's to try to prevent line infections. And we we actually resisted that in transplant because we had that such a such a specific concern that we were going to breed out these resistant, super bacteria and our patient populations. All right. This is from no-name attack. I don't usually take a multivitamin, but I'm pregnant so I have to take a prenatal. How much of a difference is there between the ten dollar bottle of Costco, and the hundred dollar bottle at whole foods. I'm gonna guess almost none. And again. As long as it's a comprehensive multivitamin. And it's got the fully that the doctors were going to recommend to you yet. And there's no difference whatsoever. You might as well save the money. I don't have a specific comment. I guess taking them as probably better than not taking them in the difference between not taking them because it's too expensive for taking the ten dollar. I can't imagine there'd be a difference. Yeah. And he says one of the hardest parts of being vegan for the past six years as having to listen to the pseudoscience and quackery that gets bandied about the community. The last claim I've heard is that a whole foods plant based diet can cure cancer, some go safari to discourage people from undergoing chemotherapy, unless the individual has I switched to a whole foods plant based diet. Is there evidence demonstrating that this can indeed cure cancer? And if not how do we combat the spread of that misinformation? The no, I mean, no, no, there's no evidence that this cures cancer. Let's just struck there. In fact, I started I'm pretty sure I started to beef chapter in my book with a discussion of camembert the guy's name. But it's the guy that started the macrobiotic diet who basically was making these kinds of. Claims. And of course, eventually he got I think it was lung cancer and died of pedia pancreatic cancer. And he was like the original wrote the book on the plant based diet, and that's why it's going to cure cancer. So look there are some times health reasons for changing your diet and everything else. But but no, there's no solid evidence. That this kind of thing cures cancer. Final question, then appropriate for the day. How often are those stories about, you know, getting knocked out in foreign countries and waking up in a bath tub of ice with your kidney missing. Because someone's going to transplant turn out to be true. I'm gonna guess most of these are pocketful. I don't think there are roving bands, especially I would imagine especially in the United States there, plenty of legal legitimate ways for people to get organs. And I think that these studies are mo-. I mean, these kinds of stories are much more scary than they are real. You know, it's it's a it's a black market that we're discussing here. And so it would be impossible to guess how frequently it occurs and think much more often than much more often Lee occurring, then the. Waking up in the bathtub with your kidneys stolen, would be people who are coerced into donating organs people who don't have a sense to their name and are offered a small amount of money for a kidney, and that's illegal behavior in the United States. That is a perfect note to end on John. I can't thank you. This has been fascinating as thank you as always thanks so much for Pirin. I'm sure we could bring it back in the future, and we have more specific questions, but this has been absolutely a pleasure. Little housekeeping is we closed, please. Remember as always good healthcare, trash dot info to get your questions in for the next episode again, that's healthcare, triage dot info. As always we appreciate any support for the show that you can do patriot dot com is a great way for you, the listener to support the show in any way, you can't even if it's just a dollar month. And if you don't want to that's fine. The show will always be free. But if you're interested paycheck dot com slash healthcare, jazz again that patriot dot com slash healthcare trash, you can get all your great healthcare. Chaz merch at ATT merch dot com. Once. More eighteen March dot com, and I mentioned a few times in this episode. But if you interested my new book, the bad food bible is still available in stores at appreciative pick up a copy. We will see your next episode or you will hear us next episode.
Healthcare Triage Podcast
Aired 5 months ago 59:12
In Through Your Dick (with the Sklar Brothers)
Is maybe the night Bill. My let me know. Honest is a goal shoe, honest heavy what you do to me confrontation nethon new TIMMY, you could bring a bullet, bring swore bring a more, but you can't bring the TIMMY, Alexa, play Kendrick, Lamar and says, okay. With Amazon music, avoi-, all you need get tens of millions of songs, download the Amazon music app today. There's a new podcast app that delivers chilling true crime stories straight to your mobile device. Everyday. They release a new episode that investigate the gruesome true acts of America's war, sue killers, and you can explore into the minds of psychopaths and murderers to get started, finding download murder minute from the app store or visit murder minute dot com. That's m. e. r. d. r. m. I n. u. t. dot com to get your daily dose of true crime creeping delivered straight to your mobile device Gouda show. Hey, everybody. It's me Steve and I'm back, but I'm not alone this week. I don't have a guest. I have two guests. Yes. Escalating Rutherford. My good friends, Randy and Jason Sklar the Sklar brothers age. He Larry's comedians who also have not one, but two podcasts. Here we, we have dumb people town, which you have done multiple times. You've done it so much that you actually have a section of the thing that we are you. Whenever we try and guess the age of someone doing dumping we call it guess edgy. So every time we invoke your beautiful way when taking early. Charlie, just reported one just didn't once it is true crime. No one dies and it's just dump people doing dumb things. We try to make fun of their behavior jubilee that the world is getting dumber. Yeah. I mean, yes. We may have more knowledge in if we're gonna put it in the context of your podcast like yes, web MD exists now where it didn't, you know twenty years ago or but I guess people didn't know or thirty is that making us smarter or is it just making us learn like one piece of what's going on and think we're smarter. I had to remove the web the app off my phone. I did have on my arm that it was just getting alerts. I have. No, I've always. I wanna start a website for actors who are hypochondriacs called web. I him db. I would've called it hyper contractor. There's. Come on, do it, please. Upload your simple things as I as God. God. He's been into a lot of green. Green is had a lot of staircase. She hasn't been in a movie in about three years, but he's had three trips to cedar Sinai insane. That's pretty good. He's been active, but you guys are almost the same age as this. This we're forty almost forty seven so like you know, approaching fifty and you know, dealing with our bodies which are failing daily. Have you gone for the big boy checkup? Yeah, yes or dad died of colon cancer. And so we, I've just I need to get another call on. On earlier this year I have to schedule it. I think I'll be okay. So listen this Randy and I and this is gross in weird and I hate talking perfect for the show. I both had ham, Royds welcome to the club because we shit wrong, but either way you're doing it wrong wrong. Yeah. Chubais angle. You're doing pushups. That weird. So no. So we and and went to a guy to have an operation like it, it got about I was getting injections to try and like reduce the pain and bleeding and his terrible. And then Randy and I ran went and got a surgery, a ham, Royd ACTA me and it was super painful and awful. But he was like do it because I don't have hemorrhoids anymore. And I'm like, shit, I'll do it. Yes, I don't want it any week of pain and then for a lifetime of success. So I went and did it week of pain. It was the most painful thing I've ever endured in my adult life and then the ham came back. Oh my God, I couldn't even win. You're like the one percent the guys like, yeah, once in a great great while it just doesn't work. And I'm like, oh. Get your money back. All so that. So Jason, I this summer, you know, I mean, you know, our comedy we've is is built and based on like two people working together to create this like interesting thing between the two of us complex built on lots of layers. Like who do you base your, what? Comedians, you bet your comment. I would say we probably base are comedy a little bit more on. We were influenced more by like the beastie boys in terms of delivery because we loved how this, where they finish each centers sentences and they overlap, and then they sometimes they kinda hit it together and then they branch off into different directions scripts. I don't think it was as conscious as it was that it just happened and felt really, really good for us. And so then this summer, our buddy Jeff Ross was like, and and we guest guest judge celebrity judge the roses up in the commie star so fun. We love it so much and it just it's really an area that we just, yeah, it's an amazing show and we walk in not knowing anything and just know that we're going to score a bunch times with jobs because it's what we do is what we love. So Jeff is like, all right, we have season three of roast battle. We're not doing a bracket. We're doing like just main event battles and under cards like I'm doing, I'm doing Blake Griffin each other, and there's a couple of other people that are going to big time. People are going to do each other like Todd berry and Brennan wall sugar going to be a David, like attacking. Funny. He's like, I want you guys to battle each other or like, wow, that is so outside of the realm I love that idea to and we're just sort of at first, like I dunno, Jeff. I don't know if we can do that. I don't know if we can do this. We've never battled anybody. Let alone each other. He's like shit heard a little like, yeah, so then we, we finally were like yell, it's do it, and we wrote the jokes and we did it and it was you write them together? Did you actually write them separately? Some them we did kind of help each other with and some we didn't. So we want surprise each other surprises in great. But my first joke was Jason had hemorrhoids surgery that didn't work. So no matter what happens tonight. His ass is getting creamed. Great. Roasted Hamre. And it deal, but that was that was yeah. I mean, I've been fine. I've had a lot of health things. I broke my foot last. Was it last year? Yeah. Last year summer cast and everything you had a cast and you know, cast boot did a boot, but I broke. I mean, I literally I was playing tennis. I, I know that this is a body breakdown thing, but this isn't like a fear of death. You weren't like fearful that you were going to die from that experience where you know. But no, this is not just about that. I mean, this is straight up any medical issue, so, but I'd broken my foot, my left foot. You don't even know that was that was that was. Daniel day Lewis. Sorry, I thought it was Jeremy Irons. Annandale's I know. Not the same guy. I broke my foot and and broke the metatarsal and and I, it was rows playing tennis and it was in the wrong shoes. Those in running shoes playing tennis, which had a narrower soul, knee like tennis shoe, a tennis shoe that kind of spl as out and gives you more service heiress. You can't do what I did, which was all your role and literally lights. Now. Like someone cracked a carrot it was like, am I? There went my, I just heard like. And that was like it. And I was like, oh, my God am. I was with two friends, and I was like, it's broken. It's broken fucking broken. I was so mad. I was like, it's broken. It's broken, but they're like, you don't even know. I was like, dude, I heard it went out to the Burbank lake, accurate care and there and the guy animal hospital. I don't know why you to actual. The good news is I got my board. Tell shot just getting a d. from what's happening. You know, d from what's happening is a veterinarian journalist out of here. It's true. I was having what is, hey, hey, what is this gonna? Screw it up. What is going on. And and and it was broken into really wait like a good sixteen weeks before I could get out there. But I waited. So I waited twelve weeks. We had to go do comedy. We had to go to comedy right after that, and it was. He was very nervous because he thought he'd have to be on crutches, and you can't stand on stage and do comedy in crutch. It changes the dynamic doing it suddenly is all about that and you're like, wait a minute. This is not what is two of you. So if one standing you kind of both have to be, it's just a boot, which actually was fine actually was able to do the booted people can really tell and it was fine. But I just was unhappy about just the injury and I broke my foot a decade earlier two different place, but two years, ROY bro- broke it in the same spot, play sports, one playing basketball, and then another one molded, but it just was a running. It just was like a fracture that you know an in back in the day. I used a very. Revolutionary. This guy Dr Clapper who'd does like all the thank you. He does all the Lakers and stuff like all the does like a radio show, whatever he had like seen us and knew who were. And he decided to treat me even though he does does mostly knees elbows. He said, I have this thing. I want you to try because I wasn't that should put the x Ray and the area that should be white was black meeting. It's it's rose. Yeah, there's a space there that needs to be filled in with bone and it wasn't growing bone because the where it was called a Jones break. So why don't you try this thing where we slide a sleeve. You have to do this for ten hours a day. So you do it while you're sleeping, or if you're sitting down whatever you slide this, like it looks like a sleeve with a cord connected to a box that you turn on, and it sends magnetic waves through the sleeve to the area that needs to end. It is a magnetic bone growth stimulator. They were early prototypical. It wasn't even like out in the market. What year is this is probably two thousand and eight. No, no, no. Earlier than that, like two thousand five maybe earlier two to two thousand five. And I was like two thousand six and I was like, okay, I guess I'll try it and I did, and it worked. It worked, yes, stimulated quickly over the course of the next three weeks. It's. They showed me the x Ray from when they're now. And how long had it been from the break until you try this ten weeks and nothing was ever just like, man, this should be a lot fuller, but it's not. And then I came back, they said, come back in three weeks when it tries to do every day, do not do it ten to twelve hours every day. So I would just slide and on when I went to sleep for eight or nine hours. And then if I was I was off my feet a lot. So it'd be watching TV. I just slide it on, you know, whatever I was working whatnot. I was just sitting down and it was it worked. I could not believe it. I was like this field, the break. So the break was on the fifth metatarsal and it was lower than where it connects where like it just starts to connect on the to- so like by the pinkie toe all the way down a little bit lower closer to the ankle, and that's called a Jones break. Is that just on the foot, or is it anywhere in your body? The reason it's called the jobs rig is because it's like a dancers sometimes to that and then break it. It's like a kind of a physical dancing break move. They see a lot of dancers who have NY. The irony is that break Verani kept him out of the Alvin Ailey dance company that went to Jones break for spring Jones. Break. Great outdoor venue, it's so was that a common thing that they do? So I think they do magnetic bone to grow stimulation. Although for this most recent break which was like, couldn't you that twelve years later? They're just like being the boot. I loved my doctor. My doctor was such a cool dude. I would just come in and just chat with him. He was like the head of this a foot, like a fidelity trista was the head of orthopedic Serta at cedars, and he was just like a great young dude. He was about to have a kid and now just we'll just go in there and be like twenty five minutes. We were just shoot the shed and then like two minutes like, you're good, you're good, don't worry about it. It's weird, our age. No, we go into see Dr. You're older than the dog doctors younger than me. Yeah, minor to, yeah, it's cra-. It is really crazy like you do start to wonder like you know guy any good also. Like I'm just one of thirty dollars. You start to wonder. Is this kid any good? Yes, it got what it takes. Randy. And I both though, I mean you talk. About like a deeper, a deep bladder of it's like a sign of a worse thing. But raining, I both had to deal with kidney stones. I don't know if you've ever dealt with that. We, it's a huge topic was fine smaller. My wasn't as battle though. I had it while we were shooting a TV show. So we're like onset and I would be backed behind the set. I was doubled over in pain, like dove fella who were passing it while you're my. Our on the set. Alan Thicke may rest in peace was on that. He was on that that that week, that's right, but rank. But so he got his about six months after I had mine. And might I swear to you? My mind came late mine my kidney stone, my first one to the worst. Okay. So mine was this was ten years ago. I know it was ten years ago because it was my wife while I was recuperating told me that she was pregnant and I was because my son's almost ten. So I just know that. And I was like. I wanted to kill myself. I so I got this kidney stone. It started to pass raining. We're supposed to go do a gig, a college gig outta town that and and I woke up at three in the morning the morning that we're supposed to wake up at like seven to get on a plane and go there. And it felt like my side was in a vice unite was I couldn't breathe and something was rice, got up and I, I didn't know what it was. I thought it was my appendix unknowingly later my life. I had my appendix. My appendix started bursaries, but so I was like, this isn't a pound Dick's and I'm freaking out. I'm walking around. I don't know what to do, and I drove myself to the hospital because it was the middle of the night. And I just by the way if feels better when you stand up. Yeah, started feel better as it up, but I was driving through red lights because the pain was unbearable. I got to the hostile on the pain was just excruciating and they're like, you have a kidney stone and I, I got there and I was trying to get it out and trying to pass it. And I was in the emergency. I'll all emergency room all day. And there. Giving me all this fluids and trying to get it out, and then it gets impacted in my yard or wall. So it won't come out. Oh my God. I don't even know that was a thing. So then they have to go in and do a surgery where they go into your deck and they, which is their term term. Yes. Dr into your peanuts. Scrape it out of the wall and remove it k- they removed the stone. So the stones out, but because they fear scarring, they put a stand up in inside of you in your urine or and the stent is more painful than the kidney don't because every it is because every time you p when you finish peeing, there's that moment where you sort of retract back up, but you're, you're won't close because the stent is there and it was as painful as the stone it self because it's like every time you every time I p so I would hold my p. an only p like while the stem was in. Then they take the stent out ten days later, and you just go into an office and a Filipino woman Filipino woman, and it was it was dodgers is it was like at a Bank. Work for the doctor to the volt. I just wanna make a withdrawal. She comes in, I'll take they take this little hook thing, stick it into your peanuts and hook it in and then yank the whole thing out of your dick while you're sitting there in a way, and it happens really fast and it was super painful. This summer was the first time ten years later where I got another kidney stone and it came back and I was like, oh my God, I can't believe this happening. It was so painful. I went to the hospital again, took it over. I took a lift, the hospitals yelling at the. Tells you so Jay's wife. She's with my case. She can't leave the kids wake them all up and bring hospital. This is another middle of the night thing. This is, yeah, middle of the night and I, I go to the, I go to the ER and I'm like, I know what it is. It's a kidney stone and please his and it was so painful, but I tell you, I wasn't passing. I wasn't passing. It was in so much pain. And I went to the country store in laurel canyon, which is our little because I live in laurel. Candidates are little Goto when you don't. It drive all the way to a real supermarket Bipasha Paci restaurant. It's little cute store and the guy who runs the store is I think he's from India, but he's name is Tommy which I'm like, is that your name? I don't know, and he's got the worst to pay ever, but he is the nicest repay bays, the three. Bad at it. He's the nicest. Sweetest guy always calls me daddy. Hi daddy. 'cause he's my kids. It's so nice. I love him and I, he's like, you look, you don't look so good. And I'm like, I have kidney stone and I literally, I'm like, I'm trying to pass it. It's not working. It's like I have something for you. I was like, yeah, trust this guy as like an old Indian. Like he goes to the back and he gets me get cranberry juice concentrate concentrating like member time. I reminds us of the time when we were in college at blues, traveler played it our fraternity like when their their first album, but but anyway, and like New York droppings, men wise, see and all those songs. So they played in our in our thinking John Popper at the time before his lap band surgery was enor- huge. So he goes into and he's in our kitchen, like where we're hanging out because they performed in the dining area. My God is raising before they were huge and he's in the kitchen, and he's just like he wants something to drink, and he opens their frigerator and. Grabs frozen orange juice concentrate opens it up and starts drinking, and I was looking one carton of that makes like a thousand classes of. And I remember touching on his back just like Pat him on the back and the ripple of fat back. Our dad was not a healthy guy and passed away, and he was overweight and I just was always like he reminded me of, we look at old pictures of our dad. There's like a John Haubert him. I always the so we actually immediately like drawn to him and liked him. And I was like, dude, you gotta do some because you're gonna die. You cannot drink a thousand glass things straight. Yes. So anyway, became got diabetes from drinking too much work Schwartz. TV king died from playing the house j you so. So I. So I am not passing the stone and they're like, you should have passed it by now. And so this guy's like drink this and you will pass the stone and I was like, all right, and I drank it. And in like five hours pets stone, it could've been could've just been it was it's time or maybe it was and I was taking flow max. I was doing all that stuff, but I'm telling you, I think there was something in that and I now from now on if I ever get it again. I when I pass my first kidney stone, I wasn't sure what it was because it was just like when the first time you're like, what? The fuck it. Y twisting my by it. Breath in your bed or someone punched you in the back in your out of breath. And it would only feel good if I stood up. Because if I laid down it was obviously putting pressure on a ureter. Yeah. So. Thuc. If I wonder if it's a kidney stone, if it is just in case, I'm gonna just start drinking water to just make me after piss. He hadn't pass it. And I went in the kitchen and I had one of those giant cranberry juice bottles, the big plastic kind of rectangular ones. And I just drank the whole thing of cranberry juice. Yeah. And in like four hours, I passed my kidneys way bombers has totally re engineered socks with comfort innovations that ad up to one of the most comfortable para socks. You can own two years of research and development led to multiple improvements of the sock design performance and comfort, arch support systems that provide extra support where you need it most and feel like a hug around your foot. You ever just like have your shoes and socks off and your feet across and you like grab your foot around the art and squeeze it, and it feels amazing. That's bombis. Stay up technology. A hundred and thirty three tension levels were tested to find the perfect tension that's comfortable stays in place while not being too loose and never leaves a Mark. I got big, fatty legs sometimes sometimes my socks, the ones that aren't is I take them off and there's a indentation in my leg that can't be good. 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Now, thanks guys. You should talk to Tom Papa because his dad, I, I met on Saturday. You are Yock to him about his dad used to get chronic kidney stones all the time. And then someone recommended this tea and he bought it on Amazon just by like in bulk. And this was years ago and he started drinking. The teeny has not had a kidney stone since. Wow. So he was like an early adapter to Amazon. That's all I hear from their ordering of Amazon. No, but there is so my so I still have to go and I still haven't done this because our mom recently had a stroke and so we've been dealing with that, but I have to go back to my urologist and do a PT test. I don't know if you've done that. Check for blood, a p. collection you Glenn for twenty hours. You gotta put it in the refrigerator, which is always like a great moment. Everyone's like, what's this in my fridge, apple, right? You put that in the fridge and you and you dump the first one of the day. And then for twenty four hours, you give a p. collection and they analyze what's going on for you and tell you what you need to change your diet in your life. And that was going to be the the third movie in the Billy crystal Robert era. Allies. Piss this this, but it is interesting that you've had a stone that we've had and I do having had it come back at, you know, the fact that ten years went by and it didn't come back. I really did think that I wasn't gonna have to deal with it. Genetic or or mom has them are mama's had them, and it's, you know, it's, it's crazy drink a lot of water. I drink a lot of water and I drink water with lemon in it because there's drink at ton of bubbly water. That's all I drink like at night and at home, I just probably drink like four or five. I haven't kidney stone right now. You do have one I went in because I was having back pain earlier this year, and I was like, fuck and I was paranoid. So I went to my urologist who is like, hey, if you ever think you might have a kidney stone, he's like, come in and you can get an x Ray ultrasound. And if you have one that's big enough, it will show up in an x Ray. He's like, don't wait and then go to the emergency right. Have to spend thousands of dollars smart. It is. And so I went in and I had the x Ray in in ultrasound, and he said, it's a boy. It's like he's like, and they do the urine test because if there's usually the first line is there's blood in your urine, but it's like so microscopic, they like you don't see it, right. He's like, well, the good news is there's no blood and urine, but there is a kidney stone showed it, and it's in the bottom of my kidney ureter is at the top of your kidney. So he goes, there's a good chance. This will just stay in here and never ever ever pass. He's like, come back in six months and we'll see if it's moving up. So I, I have to go in like soon and have that look. That's scary. And there is a like impending doom like, you know, the time bomb is. So there's something it's a foreign thing inside of the don't want, but I do there is a thing about, like, you know, a friend of ours not to like plant play on your hypochondria a friend of mine, one of the fittest guys, we know a wonderful, great dude, a few weeks ago, woke up, I say, like six weeks woke up in the middle of the night and into the left. Side of his body was Tinguely. He's like, what is going on? This is so weird in his balance was off and he went into the other room and lay down on the couch. He's like, maybe I just slept wrong. And I on your arm in a weird. Sleep with my arm under my pillow shooting out to the like right side, and then you lay out of Chile on my camp, though my arm, it's not a part of me. So he women lead on the couch and they welcome morning. He was feeling really weird and he wasn't talking right? And so his wife to he had a stroke. So this is like the fittest guy. We know forty six years old and so and and he had to deal with an inflator out, had a heart problem all that stuff. But like so that is been in the back of my mind. And I recently like two and a half weeks ago, I got sick and had a cold and it just wouldn't go away and kept getting worse. And I felt really horrible and I couldn't sleep at night, and there was a part of me that was like, do I have to Monja do? I don't know if you get go to that place. I'm like, of course I do. I don't know if you who have created a whole podcast about this stuff go to that place. You seem like a pretty. Disregards the signs I was like, do I have pneumonia? Is this the kind of thing that I'm just new neglecting? And then it's going to kill me. I mean, I feel like those thoughts weren't coming into my head when I was thirty six. Sure. But when you're forty six or forty, seven and you've lived through to kidney stones and you, you know, you start to go like, what is this thing? And and should I deal with it? I have to deal with it. I mean, I mean, that's the whole, really the theme of this whole podcast is bucking, go, get checked, go get checked, go get checked it. It just reminds me. I got us schedule this colonoscopy. I half to. I really need to back when I did it six years ago. Eight years ago whenever I did it, she did. When you're like forty, the ad are added just away and I was like, it was terrible. You had to drink like this fund all my God. You're pissing out your ass and you just drink this terrible. It's like if someone were to take the. The. I didn't even know what it is. It's like just like a white, milky terrible. He's Terraki full, awful, awful. And you got to pound not just one glass of it like seven glasses of it, and it's just the worst and then you're shitting all night. I was like, I'm down to it just you just, you know that you would be fucked up for the next couple of days, but I didn't. I was fine. Now, j. you said it's not so bad. It's not as bad. The president has been the prep is not as bad, but but it is still like, does take time someone has to take you that you're out of it. You watch Morgan spurlock documentary series on flicks where he went to Bangkok to that like five star hospital. That's like, looks like the four seasons. And you go in and like there's no weights like he's like, yeah, Morgan spurlock. I'm here to talk to a doctor about an MRI and it all started. He fucked up his shoulder in New York and saw doctor and the doctor like charged them all this money just to look at his shoulder and then it's like you need 'em are I? We don't do it. You have to go to another clinic and that's, and so he's like, fuck this. Any went to this place because Americans are doing this thing called medical vacation. When they go to Bangkok in go in and it's dirt cheap, and he went and while he was there, like he goes and he's checks in these, like I'm here to see the doctor and they're like, oh, yeah, and it looks like a hotel. She's like, go to the fourth floor and you can while you're just like a boy. Uh-huh. But he goes up stairs. She's like how the seats in the waiting room are like lazy boys, and he sits down and starts talking. The cameras like, well, I've just checked in. We'll see how long this, and before you can even finish the sentence, the doctoral see, you know, and he goes. And so it's super cheap. And he's like, while I'm here, I'm gonna have a colonoscopy. I'm going to have you know my heart check and he did all the shit. That was like just a couple thousand dollars for everything and his Kohanovsky was you still have to drink the shitty stuff, but then the next eight, you swallow a camera, you swallow a pill, it's a huge pill, but it's got a camera that shoots all directions and then it's constantly recording your digesting it, and then you come back six hours later shit out, but then they have the footage on a computer and they look and they're like, yeah, looks fine. What? Yeah. Genius was what was crazy for me is I remember, I don't know if you, I'm assuming you hate the feeling of going under like for anything like that. Don't remember it. But yeah, I don't like that. I don't love it because there's always a minute where I'm like, what's going on here? And then you're like they could do anything to me right now because I am totally, and I was being wheeled into my. Into the colonoscopy? I looked to my right and I could've sworn, I saw the doctor who delivered my first child now. I don't know why the hell he would have been there. Dr cats. I'm like, what is he doing here? And I waved to him and I remember it was like an odd moment, and then I never and I'm like, did I really see that? Or was that loosened? I don't know. But because he he would have no reason why he would be at the specialty surgical place, but probably wasn't him. I remember when I went into my appendix out and they gave me like a pre up injection to calm me down. It really fucked me up. And so I was super loopy and they, I talked about this on the podcast before, but they we owe me into the operating room and they lay you on the table and I didn't know this, but the tables has arms that go out to the side so they can put IV's and you. They're like, strapping my arms down and just as I'm going under, I go just like Jesus. I heard all start laughing was the last thing I remember. Okay. So my so my youngest daughter had a cavity when she was, I mean, I wanna say five, six. Well. In a baby tooth? Yeah, the Anna baby tooth, and that was the only cavity that she's had. She actually eats really healthy and is not a big candy person, but she had the cavity just happens and and I was in while the doctor and her dentists such a great guy, Dr Randy neater, core us, he can't associate he this, how great this guy's. He goes to like eastern Ohio, or he's from where he's from into a very rural area that has like very low income and does dentistry work for free. You know, grads which is unbelievable guys. So we were at hilarity in Cleveland, and he brought a whole crew people to see us. Now we had we were on a flight to Minneapolis and he was going to Minneapolis onto Cleveland. We saw at the airport, he's like, I'm Cleveland going back to do this. We're like, are you there in the end of June or end of may because we're gonna be there. He's like, yes, I'm going to be there. I'll come see, that's last week heard of it. And then he brought a group people out. Also he's he's taking and they gave her laughing gas. And she's she's a talkative person, but like she's. She's just like a measured, Lee talkative person. The gave her the laughing gas and she and I was just in there watching it 'cause like we could watch it. It just was happening with simple. She talked so much like you got a chance to see what it would be like if your kids were like she was talking so much like talking talking talking talking talking and it was, you know, in moments, whereas a kid, she probably would have been quiet and waited for something where you just not. She filled the entire thing with conversation. I thought it was the funniest thing I've ever seen like that. 'cause you saw a little piece of who she was when all the wall down? Exactly. It was crazy. He gotta get high that same time when I had my appendix out before they wield me into the operating room in my room, and my mom is they're sitting by the bed and there was a phone in the room I was. So I had no barriers psych. Mum, you hit me the phone and dial pastor Clem. Why do you want to call the. I have to break the news to him that there is no God. I gotta take care of this shit. Right? It just hit me and she's like, oh. Number Honey. Do you ever tell or stage that is. Areas. I love it. Please do that very real. Oh Honey, he knows. He's aware also remember. Remember talking to you guys? I, I was going into an episode of children's hospital the best. And you just, yes, that's why this up is you. You got really sick on. So what would you that it was what happened was, you know, I mean, we're flu season good friends with core dri and love him and were. So I think we pitched him and ideal the show. And then he writes, this beautiful thing for us to do is really funny, epiphany idea. The what if we back in the old day of the show, one of us we were wireless was a doctor and that they, we both are on the show, but they did this complicated split screen of just me where it was like new spots, green technology. Like I had to figure out where my hands were to Jason's just sitting offset so we could've used him, but they just decided not to use sitting off said, that's hilarious. I had no lines, no lines. They just had to cut away to me to just shake my head like because rain rains. Like, can I put my hand? I do crossing the line. And then I'm like, is this okay? And my son really complicated guys as really tough, and then they just pan over to me and I'm like, aching, my head. So David Wayne shooting it who we love and just wanna work with and just think he's the best director and we are in an and we're doing it. And that is soon as the day's going on Jay's looking. He's wearing a green sweatshirt. Now you look that turning green and I'm like, like you could tell, you know, when someone's sick when like their lips turn white. Yes. Frosty right. There's like there's like the color drains and I couldn't tell if I was hot or cold. I didn't know it was going my neck felt weird. It's just all of it was starting to feel weird and they get to the shot. I'm making it through, but I'm holding on and they were to use it in the thing we're looking disgust look disgusted because I really was ceiling and Randy and they do the whole scene. This work is I put my hand here is at work, and then they cut to me and I shake my head and. David Wayne goes, okay, that's great cut. And as he says, cut, I lean forward because in my mind and Mike, okay, I'm gonna faint or I'm going to die or I don't know what's going to an I lean forward and I- projectile vomit all set like like with one hundred people looking at you as you do this. Most embarrassing. Like it was like almost like a joke, like open my mouth and it all started coming out. That's the last first of all. We're guest stars. All we wanna do do a great job. Everybody happy. And I mean, and I was still a pri- felt so bad and everyone was really nice me, but I'm like, I got to get out of here. I don't wanna make anyone sick. And fortunately that was my last shot of the day. I'm driving home Ida pullover impune out of the side of my car. I mean, I'd open the door and puke into the under the road. It will on the one. Oh one. I I pulled over on the one on one in Puget onto the shoulder. It was so awful. I. When they were shooting raising, we're shitting better. Call Saul it and Albuquerque. You don't realize like how high up Albuquerque's fifty two hundred feet. It is. Yes, it so you don't realize it. And so I got there at I immediately. I don't know what it was. Lack of water. Maybe here the flight there. What I was dealing with. I started feeling like crazy altitude sickness. I'm like, go to sleep. You never have good dreams. When you're an altitude have himself. The next day were shooting like these two really complicated long, deep, deep shot. One will your music store. No back we went back into this is the time when there was the it was the the second time this. The second time we went. We have those couple of scenes where like we bargain with him about the price and there was that whole thing. And I remember I was like, I, I was like, Bob, I tone Kirk. I'm like, I do not feel well. He's like, listen, I got this stuff. You. Drink it. You put in the water, it allows your body to retain Warren. The just keep pounding, water pound pounding. I've got a headache. I feel like I'm gonna fall over. They gave me a b. twelve shot. I'm taking oxygen between takes. I was like, this is what happened to is gonna thousand feet five thousand feet. Imagine the people go to Everest. I mean, I had a friend who told me that he our buddy in in Denver said that he and his dad went to Everest base camp. I was like was if fine is like the whole time, people were passing out and I was throwing up and I fell off on, I felt dizzy and I was like, why would anyone worth it? No. Why would anyone doubt about it? Hey, everybody stitch fix is an online personal styling service that finds delivers clothes, shoes inaccessible to fit your body budget in lifestyle. I've talked about him before I'm talking about him again. Just go to stitch, fix dot com slash doc. That's DO see and tell them you're sizes, what styles. Like in how much you want to spend on each item, you'll be paired with your very own. Personal stylus will hand pick five items to send right here door than you try them on pay only for what you love and return. The rest shipping exchanges and returns are always free free. That's one of my favorite words. There's no subscription required. You can sign up to receive scheduled shipments or get your fix whenever you want. I mentioned this before, I'm a giant guy and for a while they didn't have big and tall sizes, but guess what they do. They have big and tall sizes for people. I'm six foot six, almost three hundred pounds you guys. So you could definitely find something at stitch, fix. Stitch fix a styling fee is only twenty dollars which is applied toward anything you keep from your shipment get started now at stitch, fix dot com slash doc, that's DO see, and you'll get an extra twenty five percent. Off when you keep all five items in your box that stitch fix dot com slash doc to get started today, stitch fix dot com. Slash docs did on it. Speaking of cordray I went to that comedy festival. They do tell you ride started with like Brian huskey Morrison, Jason Zukas? Yeah. And I've been to Denver a bunch of times and have never had a problem embers about five thousand feet. And so they'd been asking me for years and we couldn't make it happen and Safai only this year I was able to go to the comedy festival in telluride, which is about nine thousand feet. And so we have to fly into a place called Montrose which is like an hour away and Montrose is five thousand feet and its tiny plane. We get there. We get our shit off the plane carrying it to the car, like all my heavy camera bag and everything, and everything's fine. I feel fine at five thousand feet. We get in the car driving hour hour and a half to tell you ride. I get out of the car at the hotel. I walk ten feet and have to stop and rest for as you're breathing hard. I can't breathe. You can't can't hit calculate. Right. And it was that way for like, were you panicking too? Because once she started. Like realize that you can't catch it. Another thing is in and you have the panic. I was constantly worried and for for like two and a half days it was, and we did a show that night and I had to sit in the green room with oxygen, went out, couldn't walk around on stage. I just rested on the Mike. STAN. Did my set walked off, took oxygen again g the next day. I like it was so beautiful. So beautifies like I'm gonna walk into the main street and take some photos. I walked a block and it was like, I'm just going to go back to the condo and it was bucking horrible. And that was like. Feeney's weird. And I feel like in moments like that, you feel your own limitations and your own mortality. It's like a reminder of your own mortality. You're like, I can't can't do this this. I cannot things I can't do in this world. I wonder if I was in my twenties, if this would still be a problem, maybe be a lot better. It'd be better with it. I remember we went to the Aspen comedy festival, two years in a row. That's eight thousand feet. We did ask them to didn't bother me at all. I was fine. Brennaman said she saw arcade, fire play in Aspen, and the drummer had an oxygen mask the whole time. I. Only believe it. You got their thing from Canada? Yeah, I doubt they're like. And they're like, oh, you got to come back next year. And I was like, I think if I go back, I'll have to go in like, I'll need my own sherpa four days. Comedy sherpa to acclimate four days earlier climatize. I was supposed to do a movie in Bogota Colombia, three years ago. I remember that and that was that's like ten thousand feet. Oh my God. There were some people who are like I had a headache for the first week, like a really bad fucking headache for a week, but you didn't do it. I didn't do. My dad died God. I had to like I had to bail literally like three days before I started shooting. I felt so bad. I was like, my I woke up three days before and my mom's like your dad's in intensive care. I had to cancel. Nobody ever will give you create for that. Nobody know. In fact, James was like, I would be disappointed if you showed up, went to Bogota. Understand that we all have those. I went down to Patagonia for my year after I got married for our real honeymoon. Oh my God house the best. Unbelievable, unbelievable. We were at the bottom of the earth essentially like I have friends who are going there later this year. So we went into the Dashiell park. There's tourists l. piney which is the national park down there. And we stayed at this really cool hotel and it was really awesome. And I was down there and this is in two thousand three. And I, I remember we were sitting there. They make all their own food and bread, and it was unbelievable. And we were sitting there having lunch. And this woman starts walking towards me with a cordless phone and I was in my mind, I'm like, oh shit. Our dad died. That is the, I thought that was in my head. I pick up the phone. I'm like, Hello, and it's Randy. And he said before he said, Hello. He's like, dad didn't like he knew. I knew I'm calling him on this thing. Don't worry, and he calls me up and he's like, e. s. so arrested development wrote something for us to do. Like man, this is like day six of twenty day trip. Like I won t days, dude. We were in Chile and Argentina, like I went away those Mike, my honeymoon. That's a long honeymoon. It was great. It was really awesome. Did you come back for? I looked into it to see if I could, but then I didn't come back and then we never did the show and it was a bummer. It was a real bummer because I was like, of course that happens. Let me ask you this, where in South America, how many countries did you hit those twenty days? Peru, we went to well, we know we didn't. Her SCO would know we went to santee ago and then to ensure late. And then we went when a SARS to San Diego. And then we went down to Patagonia and then we went back to when Cyrus and then we went to Amazon. No, no, that was. So then then we went to what's the, what's the? They're really good. They're always really good saw. No, no, no, not Argentina. Uruguay to Uruguay to which is right next to ours. I mean that was it. Ugo boy, that's like the southern most tip of, no, so so we went to whatever's right next to that in Chile Chile. So we went to the bottom port portend Attala I think is what it's called Serena's now for. Arenas. So is like is like fifty miles from anarchy Madre and you, and then you come out and then you go three hours up and your into into Dalians wroto. Did you. Did you get sick at all? I did not get sick of the food in Argentina. There was a restaurant. We ate at twice, and there was a a chain of like ice cream or July tow chain. They're called freight. Oh, that I still think about fifteen years later. And I'm like this place. They had like for real. They don't say the Lecce sort of wicked in through all the good. I thought it was going to get sick. I did not get sick at all. It was such an amazing trip at all. Like I'm going to start taking probiotics before because those they're, they're the the cities. We were in a lot of street food, but like the restaurants you go to or as good as any restaurant. First world country restaurants. Now, I've been to Mexico. I was I was in Mexico and like, you know, we went to Mexico City and to a couple cities like in the mountains, Guanajuato and Sammy Gilda yen to cool releases. And like I ate chop Alina s- which is like crickets. And whatever that shit is a. Oh, I had to try. I was like some places like, you know, and I went to a Hakka know in those places. I didn't eat off the street. I had at restaurants, but I didn't take any probiotic. Fine. I was totally fine. Yeah, that was my biggest fear prepping to go down to Columbia, just releasing the organisms inside. You take started taking probiotics regularly in which someone said that. That'll definitely help. It started as I had a friend who had shot down there in vogue Italia and he's like, dude, it's just like Los Angeles. Yes, that's the truth. We have a friend who married of Columbia. My friends a, you could drink the tap water. No, it's great. I always love going to play up to Lake Tahoe. Bunch of got friends that have a place up there and drive up there. It's my favorite drive up through l. through on the three ninety five through the little town mono lake June lake. All those lakes in the Eastern High Sierras are on the left, and then you make it up there scorgeous but I love the. You can still drink the tap water friends called tau tap, and you just turn on the water in the sink. And I'm like, I don't know what it is. This moment of just gone and we've been Janai both went to Cuba back in the day, like back in the day, like in two thousand and two, I was there and you were there in two thousand one thousand two thousand one. So when two thousand two for a wedding of a family friend of my wife's parents and you know, the kids we knew and and it was great. It was. It was truly unbelievable thing that I loved most about is that it's ninety miles away from Florida. I was staying one night standing in my wearing. Her grandfather's tuck said he had made handmade in China in nineteen fifty seven. Standing out in the capital e. which is big, capitol building overlooking a Havana and all the old cars smoking Montecristo number two. And I'm not a cigar smoker, but God damn it. It's the, it's the smoothest fucking thing I've ever smoked and I'm not again a huge smoker. I don't smoke cigarettes. This cigar was perfect. The Montecristo number two hand-rolled there. I'm standing this cigar standing next to her stepfather great guy and were just out puffing on cigars. Looking out in the world at house like this is as close as you can get being being in a timeshare. To go back in time ours. I'm like, I'm of the photographs. They need to get down to looking out over these every cars from nineteen fifty. Nine. Yep, I'm in a suit is in a tuxedo from nineteen fifty. Seven. I'm smoking a cigar and it's nighttime. So the darkness put you in a little bit of a dream state and it really did feel like you're going back in time. I do feel a little that same way like I'm back in the seventies when I take the sink and turn it on and put a glass of water and drink it. I'm like photos of yourself from Cuba. Kind of find I'll send you those. We do have some really good ones I took. I took more photo and got it framed. I had. Oh, yeah. Walked around with color in black and white. Oh my God. And it was so cool. It was them. Yeah, it was really speaking of the tap water. I have a friend Brian, he he lives in Joshua tree in last time. I was there visiting him and he had told me like I called him a day earlier when I got to Joshua tree and I didn't see him till the next day. Like, sorry, I was up in the mountains, getting water. I was like, what are you talking about? OT he accidentally like a year or so ago was up in like the big bear area. He, he liked not pans for gold, but he uses one of those metal detectors and there's a lot of golden them are hill. Sprint go. And they find like little nuggets of gold that he finds as ING. So he was up there and he found this pipe that was just sticking out of Iraq, and it was just pouring water outer? Yeah, just watered. There was no tap on it to stop. It was just constantly pouring water out wasteful. And he, he saw a guy walk up and like just put a giant under it and fill it up and drink it. And he's like, is that that save and the guys like I've been drinking this water for years. He goes, this pipe has been here for over one hundred year. Any walked to anti Atta tale. Normal. So Brian. Next time it was up there. He saw like a mountain biker fill up their water amazing. And then he was just talking to all these people are. This is the cleanest water I've ever had my life to aero head giant jugs. And he just fills me to stand gal. Of course, it goes up in his truck and fills up fifty gallons of water. It's what he makes us coffee with. It's what he cooks with its Jane, all he drinks and call the pipe. I had it and it's amazing. He saw he was out there New York bagels with engine. It was up there with his fifty gallons of, you know, bottles, filling it up in a park ranger, came up a fuck. I'm I'm busted. The Park Rangers walked up, took out his canteen started filling it up and didn't say anything. And Brian was like, have a good day. Hey, do you drink this water? Cool, right? And he goes, yeah, this has been here for over one hundred years. He goes, you know, because it's in a national park. He's like as a as a ranger, we had to have it checked out. He's like, we bottled it and took it to allowed to get tested. He's like, this is the purest fucking water. It's it's got alkaline in it. You know, there's like that. I don't know what the bottom the those green like sparkling bottles. The glass ones have that water has like alkaline in it. It's like seven percent or something Brian who had had cancer. So he everything he has to be. And he tested that water in it was higher alkaline content in the other one, but it was amazing, but it is there is this for a hypochondriac to understand that our world is so dangerous that like this is like a rarity to go up in geez. Two. Way, and it makes you wanna go. I know you spent a lot of time out in Joshua tree all the time. Like big bears another place. That's really jar buddy. John door lived out there to go up there until breathe clean air to Bob. What we have to it is really special. Josh, like four thousand feet. High desert? Yeah, high desert desert more. I think we're at time you guys beautiful, you have. What else do you want to plug people. Danny van, Kirk the you. Did we have you from the cheap seats, which is sports and comedy, and indie rock. We did a really fun cool project that I think you would love that's on audible dot com called sq Larssen stripes where we went. Oh, yeah. I listen to it. Thank you, ten different cities at every city. We tried to write ten minutes of comedy about that city from the plane landing Thursday. By Saturday night, we document our travels. We do and then you see us to come up with material at the chapters about thirty minutes, ten chapters great audio battery auto com. And if you like just sign up for audible for free trial, you can just get it as a free title. It's the best no money will ever spend. And working. They find you on social networks. So were at Scarborough others on Twitter at Sklar, brothers on Instagram, and if you go to super Sklar dot com, you can see if we're we're coming. We have a ton of live dates just through through June. We were going to be in in Austin, Austin, right? We're in the seventh through the tenth of November. We're going to be in Saint Louis, the twenty four th of November. We got shows here in LA were doing a live dump people at Largo on December tenth, and then we're going to do headline flappers on the twentieth we got our back in Burbank. We got San Diego in January Portland in, you know, San Diego. Portland may be Madison in March. Hopefully, fingers crossed. April were back in Austin for the moon tower. Comedy festival in June, were at this great casino in in west Siloam. You ever need a feature on my man. I just I, I have a lot of people want you feature for us at on the flapper show. I would love to you. Twentieth but also maybe we'll bring him to to the casino to west Siloam spring. Yeah, and you'll be our guest on dump people town and then all can open you open for us for us and Dan van kurkin then you'll be our guest on. I have a bunch of friends in Austin, and they were. They're always trying to get me to come out here and they specifically named you guys like, why don't you come out with the Sklar brothers? I was like, I actually have a wedding that we will next year. Next year we come because we usually come in the fall and then we come, then we'll bring in here Lavers on the twentieth and then may we bring you out in June to this West Palm springs will love it. All right. Thanks guys. Thanks for listening. Everybody by. The following message is brought to you by days in they. They wake up. Open your eyes to something new every day. Maybe then you'll see that sometimes you have to go far to get a little closer seize the days.
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