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Keepin' ya on your toes
81 Plays3 months ago
Dubbed the "shoo shoo" episode, starting off strong with some absolute randomness (patient-doctor dismissals, soup receipes, ingrown toes, weighted blankets) with a segue to some trending topics about sickle cell gene therapy and unethical psych hospital practices and a delightful discussion about "the Gout".
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Transcript
Introduction and Host Backgrounds
00:00:20
Speaker
Welcome everyone to a new episode of Chocolate with a Side of Medicine. I am here with my lovely host. We have Amy Jo MD. What's up, y'all? And we also have Dr. No-No.
00:00:39
Speaker
Hey, I'm back. But unfortunately, guys, we are missing one person, Dr. Sunshine. um She will be with us next time, I'm sure, but she could not make it to a recording this time. But she will be there next time, I am sure. And she will be missed. She's out in the doctor business. You know, she out here doing what she needs to do. um But that's okay. So be here next time. So But we are here, guys. How are you guys doing? I am busy. could say I'm chilling, but I guess, yeah. But aren't you always busy? Yeah, but it's particularly more busy. Yes. um I've got a, I am the keynote speaker for an event this weekend.
00:01:33
Speaker
um I have not finished writing my speech. How long is your speech supposed to be? So we have an hour dedicated, but they actually get to ask questions. So it'll be interesting. So like it's these, it's the South Carolina Black Lawyers National, I mean, ah annual conference. And so they're going to break into two groups. And so I'm the speaker that is going to be
Handling Disruptive Patients
00:01:59
Speaker
covering health. Right. And so I am trying to make it like somewhere between 30 and 40 minutes to leave 20 minutes to ask questions.
00:02:07
Speaker
Oh, nice. I hope they don't cross-examine you. Cross-examine you. I know, right? You know them lawyer types. I gotta come correct, right? I was in an argument. Yeah. So it just, it feels, it feels busy. Last week was crazy. um I had to fire a patient.
00:02:28
Speaker
um who was being very disruptive. I can't get into it because of course in every patient you fire as soon as they gonna sue. So, you know, I just, I
00:02:42
Speaker
Um, idea, you know, you kind of be a little soft when it comes to patients, especially difficult patients, difficult patients, as y'all know, grow on me. Right. So I have a fondness for my difficult patients. And so I work very hard for them. I do a lot of stuff, but you know, there be, there comes this fine balance between.
00:02:59
Speaker
trying to serve the patient, and then also respecting that there are other people in the hall, in the office, right? There are other people in the office, there's other people you know in the building that need to come in and feel comfortable with doing their job. And I'm not saying that there's not always some conversations, because I recognize that when I'm in the room, everybody's demeanor is a little bit different, patients and staff alike, right? We've all been there. But when it becomes a habit that there's always if If there's something spicy happening up front, and when I come up there, you are always involved, then you start to become the common denominator. So I had to you know let somebody go. And it was exhausting because it was like one of those days it was super busy and I i had to keep getting pulled out of my clinic, you know out of the you know patient encounters.
00:03:48
Speaker
Hey, can you come up here? Can you come up here? You're thinking you put the fire out, you go back, and there's more stuff going on. It was so exhausting that I was like, I needed a margarita when that was on. And I was like, let me go home. I hear you. Because it's too much. So it's crazy busy. So that was happening. I was a little bit behind. I caught up on my word, caught up on messages. Well, kind of caught up on messages. And now I need to write the speech. I've got a wedding to go to the weekend after next. It just feels like,
00:04:17
Speaker
It just never ends. Yeah. There's always something and it's not a bad thing, but it's like, okay. Got to get all this stuff done. Yeah. Yeah. I mean, it's tough. Yeah. Especially when you have to like dismiss a patient that's not always easy.
00:04:33
Speaker
And I think also for us, cause you know, we, we trained, I guess how we trained, we always ended up seeing quote unquote the difficult patients. Right. And so then it's kind of like for some people they might seem as difficult, but for us it's like, it's just a normal day. But also we also understand that, you know, a lot of times you could see a patient and you seen them on their worst day.
00:04:58
Speaker
And so they're not at their best, right? And you have to be empathetic to that as well. But like you said, if it's a pattern, then there's too many other people involved. We can't keep doing this. And then it's not beneficial for the patient because then the relationship becomes very contentious and it's just not helpful. Not at all. take I'm going to take Dr.
Recording and Language Barriers
00:05:24
Speaker
Sunshine's job and do people know what firing means in this context? So y'all can be fired. that That is a thing that we can do. Right. It means just what it says. You can be dismissed from practice. And I think that's something else that people don't understand like um that
00:05:43
Speaker
with With the exception of the emergency department and even there, there is some leeway, right? Like most places, you could be dismissed. I guess we shouldn't say fire. You could be dismissed from the practice. Most of us work in health systems, so obviously we're not dismissing people from health systems.
00:06:01
Speaker
but we are making the decision to say, I just think this is not a good fit. I think you would get better care someplace else. Now we hear it most of the time from the patient's perspective, right? So patients are often, you know, going on about how they dismissed their physician, right? I got rid of my doctor. I found someplace, somebody else. And we understand that, right? Like you have not been a doctor until some patient says,
00:06:29
Speaker
I'm not coming back. I'm going to go see somebody else. that That happens. It happens to some of us more often than not. I think we're we're in a really privileged um venue that most of us don't get fired um very often or don't get dismissed by patients, but it does happen. The part that they don't hear about very much is that you can also be dismissed by the physician.
00:06:52
Speaker
because for all for all kind of reasons, right? It needs to be a good fit. you know We talk about all the things that we do to make sure that you are heard and understood and everything, but it's gotta be a good relationship or else we can't get any good medicine done. So if every visit, there's gonna be so much frustration that by the time you get to me,
00:07:14
Speaker
your blood pressure's through the roof or you're you're crying, you're flustered, you're frustrated and we spend most of the encounter or most of the day trying to get everybody calm and back to baseline, then that does not benefit um anyone. And so you can be dismissed for ah inappropriate behavior, right? So inappropriate touching of a physician or threatening a physician, touching or threatening ah a the medical staff, um being a, you
Patient Non-compliance and Dismissal
00:07:43
Speaker
know,
00:07:43
Speaker
non-compliant patient that can get you dismissed. So, you know, you've got uncontrolled diabetes, hypertension, your cholesterol is through the roof. You've already had one heart attack and you've got two stents in your heart. And you think that you don't have to come in for your appointments. And so we are on, is and this sometimes takes a while, right? Like it's year two, the last time we saw you and we keep giving you medicine and you say, okay, okay, just give me a little short course of medicine and I'm going to schedule my appointment.
00:08:11
Speaker
You schedule it, you get your short course in medicine, and then you cancel that appointment because you're really not coming in. We will fire you. You gotta go. Because it's not safe. So if I'm sending you this medicine all the time and I never see you, I never lay eyes on you and everything, maybe it did make sense when I gave it to you two years ago, but things might've changed. I need to check your kidneys, your liver, your electrolytes. How you doing? If you have diabetes, what kind of diabetic are you? Controlled? A little uncontrolled amongst friends? Or girl, your blood is syrup. Like where are you?
00:08:46
Speaker
in the process, we need to know what that is. And if we cannot figure that out, you gotta go. And you can get fired on the inpatient side too. um It's a little bit more politics with it, but in any hospital you go to, if you get admitted,
00:09:03
Speaker
You can either get admitted under your private, your like your own primary care doc, or you'll be admitted under like a hospitalist service, which is a team of doctors that all they do is inpatient medicine, which is what I do, but I only do it at night. So you sometimes, we see it all the time, but sometimes patients will fire their primary care doc while they're in the hospital because they're just not satisfied with their care or something else is going on.
00:09:32
Speaker
Again, like Amy Jo said, its just not a good fit. So in that way, you'll be transferred to the hospital of service and that we will be resuming your care. um I've not gotten fired as a nocturnist yet because you literally only see me once.
00:09:45
Speaker
Um, but I'm sure that day is probably going to come. I don't know. Um, but, uh, yeah, it's just, just for people. I didn't know what the language was, um, fired. It's just like the easier way to say it, but like being dismissed for a multiple reasons, just because it's not a good fit is what we, what happens in medicine. so Yeah. It's, it's, it is rough. Even when I think they, even if I think, uh, I think a patient deserves it, I'm still like, Oh,
00:10:15
Speaker
Cause it's hard to reset. um But you know, this person in particular cut up in the office. Oh my God. I've seen that. Just cut up and I was like, oh no. but not Not saying any names, but I had this person that um came to our resident clinic um because we told her in addition with the pain medicine clinic that she was with that we were not renewing her um her opioids.
00:10:44
Speaker
She's been taking it for years. And for some reason, she's been going to like another clinic on some other part of I think Indiana to get this script refilled. And she came back to us to try and get that script refilled. And we were like, no, there's no indication for this medication. You don't need it anymore. At this point, if we did renew it, then there's some other substance issues that we need to talk about. Um, and so she came, we told her, I got so many pages on my pager when I was an inpatient that day. And then I actually got a call from our nurse manager. Um, uh, remember short. Yeah. Yeah. So she,
Discussion on Gout and Gene Therapy
00:11:24
Speaker
she called me and she was like, Dr. Dr. No, no, we, uh, we, we fired this patient cause she came in and was screaming at all the staff and, um,
00:11:34
Speaker
Yeah. So she's not coming back here anymore. Just want to let you know. I'm like, sounds great. All right. So yeah, so that, that does happen quite a bit. So just, just remember, I think it will kind of sometimes forget that, you know, we, we do provide a service, but we have to be on the same page when we provide that service. Like we're not, we're not expendable people. Like we actually want to form a relationship with you and get you feeling healthy and better.
00:12:04
Speaker
Um, so if you do anything to go against that and if you you know disrespect us or the staff Then it's it's no a no-brainer like it's it's it's just it's not going to work out and you can go somewhere else Yeah, and isn't the hard part. So the hard part is in these days of social media. Um And you know video phones and cameras we have created this in And just with just the suspicions of medicine, it always seems that um that the
00:12:35
Speaker
the Burden of proof is always on the physician, right? I got to prove that this is just not, you know, a good environment. um We take patients at face value, right? If they start recording at the, at the, you know, the time that sheds the light on, you know, patients in this worse environment, everybody's just like, Oh my God, what are those doctors doing? And this is not to say that they aren't, you know, they have, there haven't been some benefits to, um,
00:13:03
Speaker
You know, bringing light to, you know, things like we, we trained in underserved medicine. I've heard the stories. I am not saying that said bad things can not happen. It's so advocacy.
00:13:14
Speaker
or the ability to to create advocacy through social media, through recordings, through your camera phone are not a big deal. At the same time, that also has tended to turn things into, um advocacy means that whenever I don't like it, if I don't like your plan, then advocacy is to fight and say, you're going to change your plan, right? So the part of this is, I don't like your plan.
00:13:42
Speaker
doc and you gonna change that plan so that I can um get my way. And that's not medicine. That it doesn't mean that you have to like my plan. Like we can make different plans. You don't have to agree with the medications I prescribe or the the therapy or the timing of everything. You can absolutely disagree with that. And and in most cases, most doctors, whether it's Dr. No, whether it's Dr. Chris, whether it's inpatient or outpatient will say, well,
00:14:09
Speaker
Okay. Well, if that plan is not going to work, here's what I think we could do as an alternative. If you don't like either one of those, you say, I'm not doing any. That's okay. We can say, all right, we'll, we'll, we'll revisit it then we'll do nothing and we will revisit it or you're going to go off and do the thing that you want to do. And we'll go from there. All of those things are fine, but somehow that just turns into, if I don't agree, then
Ethical Concerns in Psychiatry
00:14:30
Speaker
it must be wrong. Or I, if I don't like the plan, if I can't follow or understand it, then I am being wrong here and now.
00:14:39
Speaker
I got to put it on all full display. I hate that it's turned into that because it actually waters down the advocacy you can get from the benefit of um technology. That's just me.
00:14:53
Speaker
I got so much worse after COVID. I don't know what happened. Like at least on the inpatient side, but um just so much, so much worse. Yeah. and You live in states like South Carolina where, um you know, it's a, I forget what they call it, one party, um one party permission to like record. So I always work from the standpoint now that I'm always being recorded. Cause you don't need my permission to record me. You only need your permission to record, right? so They can record in the comics? They can record wherever they want to. you and And how could you stop them or know if they have their phone on you couldn't? I have people that record all the time.
00:15:38
Speaker
um they and you know I just don't even say anything these days, but they record or they um they call someone. Yeah, I mean, that's what happens all the time. were to just listen but But they call someone and pretend like there's no one on the phone. And so the person is just sitting there quiet. And for the most part, I will ow will stay quiet and explain it. But if somebody's blinking at me and I'm like, okay, you have glazed over. I lost you 10 paragraphs ago. like I will say, hey, do you does the person on the phone, should we have any questions?
00:16:15
Speaker
Yeah. I mean, if you have there we might as well, you know, get this address it there. Like I'm, if it's usually like an elder, um, elderly parent coming in or someone that's not very good with like all their health issues, um, I actually
Personal Anecdotes and Audience Engagement
00:16:28
Speaker
invite them like, Hey, do you want to, you know, to call someone up to, you know, just make sure that we're all on the same page. And you know, usually they do, we have the conversation right there in the room and you know, all the questions are answered. Everyone's on the same page. I'm like, okay.
00:16:42
Speaker
Gucci. We're all good. You know, so, but I just, the recording without us knowing is just a little, I don't know, I'm not a huge fan of that. um Well, down here, they can do it. If only it were the seniors that came in and recorded, I'd be like, yes, thank you, because I'm so tired of going through this medication, this is you. But environment it's the, it's the young people, um,
00:17:06
Speaker
that are that I recorded. And I'm not saying that having somebody on the phone, like health literacy is not something that's just relegated to seniors and young people. I've got a lot of 30 to 60 year olds that I think I'm not sure that you get what I'm saying and have to say like, and really have to like challenge them on it. Cause they'll, they'll, they'll get it out, right? They'll shake their head and go, okay. who and you're like I believe, I don't believe, I don't believe that you even believe that you are following, you know what that is. And so it can be, it can be a challenge, but you know,
00:17:50
Speaker
I think with a lot of our um are other speakers, they speak like ah another language. is like they're um Even if you use the interpreter, um sometimes they'll be like, oh yeah, okay, okay. I'm like, no, I wanna make sure you actually got it. Can you repeat the plan back to me? And then I can answer any questions you have. And that usually that really works. But um yeah, too many times I've seen people just go up and start talking to um you know someone that's not in their native language and then they'll say, okay, yeah, okay. And I'm like, no.
00:18:19
Speaker
they don't know They don't have it. They don't have it. You got to, I i thank God for Google translate and we have an interpreting service like in-house at our hospital. Um, that like helps wonders, but you know, still you can like catch people like, you know, just running in the room, trying to like, you know, get like, Oh, can I just, can can we do this for you? Can we, can we do this real quick? And they'll say, yeah, okay. And they have no idea what they're going about to get. So, um, it's very important that you utilize that service and make sure that everyone is on the same page before you do it.
00:18:49
Speaker
Please and thank you. But yeah, note to self, don't get don't get fired. I'm assuming that anybody that's listening to our podcast is not somebody prone to get ah fired. Oh, absolutely. Oh, yeah. And to be honest, like for me to fire a patient, it takes a lot.
00:19:09
Speaker
It is a lot. It takes a lot for me to fire a patient because I don't i really don't normally fire it. So much so, like it's um like they're like, Dr. Chris, you're not going to fire this patient. like Because I'm always like, there's got to be a way. there's gotta be I always want to try multiple ways to get through to the person and try different things. But you know sometimes you're trying. You're trying. It just doesn't work.
00:19:38
Speaker
in it in it becomes not only a problem for the patient, but a problem for you too. And you have to realize. and have to learn to let go. I'm learning that as I go, that I have to sometimes learn to let it go. I've been so like gunhole, like, yes, no, we're going to get this A1C down. We're going to do this. And we're going to do it together. It's kind of like, well, maybe we can't do it together. Maybe you need to go someplace else because yeah I've tried all these things. This
Closing Remarks
00:20:07
Speaker
doesn't work. Or like you will have the patient, you're given the medicine. They're like, yeah, doc, I'm going to take it. They come consistently.
00:20:15
Speaker
every time and they tell you they're taking it but you know they're not taking it because it doesn't make sense because if they were taking the medicine the numbers would reflect differently and they're coming back with the same things and you're like but you're not taking it like you call the pharmacy and you verify that they get the medicine but they're not taking it so it's just like we're going We're seeing each other and we're going through the same conversation each time, but nothing's changing. So sometimes we have to let you go because it's just like you're getting the medicine. You're coming every time, but nothing's happening. There's no.
00:20:58
Speaker
It's kind of like you got to find yourself and what you really want from this relationship before you come back into it. And that's the fine. You know, some people are just not ready to make that big step yet. So if you need to, you know, let them go and and for them to find themselves, find, you know, inspiration or motivation. And then once they're ready to come back and be like, Hey doc, I'm ready to, I'm ready to get the A1C down. I'm ready to take my meds and do all that. And that's great. That's what we want. So.
00:21:27
Speaker
You know, it's funny, um, and maybe this is us growing, you know, to our, to our listeners, you i literally watching us grow of medicine. Cause when we started even this podcast, we were baby, baby docs. And so you get to watch some of the transitions and it's funny you say that, right? And so the new approach, because I think we, first when we all first got started, you're like, no, we're going to do it. We're going to get this blood pressure under control.
00:21:56
Speaker
Now come back here, come on, get with me." And you realize that like it's exhausting, one. Yes. um Some people just not down with the plan or not get down with the plan. I have some people come back that were horribly non-compliant and then all of a sudden they're like, bing, the life's on, they're taking their medicine, they're feeling great. And I don't think it had anything to do with me necessarily. They will say, you'll learn later, they'd be like, well, you know I heard what you said when you said it two years ago and and something happens, right? There's some scare or,
00:22:29
Speaker
Maybe as a family member, they're inspired by something they saw and they take your knowledge that you gave them last time and bring it all together. But me fighting by any means necessary to to push the knowledge, even if I'm right, was not beneficial. And so I have learned to not outwork patience. So I can't work harder than you.
00:22:54
Speaker
at doing something. And so it was funny because today I had a patient I've seen for a long time and there's some things that are just not as controlled, her diabetes or blood pressure is just not where it needs to be. and i And I say the same thing all the time, right? So my speeches are you know pretty, you know um I've gotten them down to a T and um she said, man, you're not, you're not ah you've changed.
00:23:24
Speaker
And I was like, what do you mean? Why? Cause I'm not yelling at you about your, and I told her, I was like, you don't need this speech. You've heard it. Like you've heard it multiple times. So what you're saying is that I'm not like revved up and giving you the.
00:23:37
Speaker
the the speech before the the final battle in the movie where we go in and say, you know, some of us may not make it out, but we will forge on. No, like you got that speech like two years ago. Like, hey, you already know, you already know the risks I think exist. You know, the benefits, you know, the disadvantages. And you're here, right? You've brought me no additional data, right? You ain't bringing me no food journals.
00:24:06
Speaker
So there's nothing for me to evaluate, even though I hand out food journals to almost about 90% of my patients get food journals on their way out the door to bring back with them when I see them. So you don't have any of that. So there's no data to kind of look to see what's changed.
00:24:20
Speaker
um you're kind of taking the medicine, but I really already see that, you know, and so I can tell you're not taking it even though you're like, yeah, I take it. I see that you picked up your last 90 day supply about four months ago. So there's no way you're really taking it. Um, so what are you, what am I supposed to say? Right. Right.
00:24:41
Speaker
right And so I think that that throws them off. Yeah. And at the end of the day, you know, we can't care more about your health than you do. Right. So like,
00:24:52
Speaker
if you don't care it's kind of like well then I can't I can't do it for you right because you have to be the one to take the medicine you have to be the one to put in the work and then sometimes they come patients come in like oh look at this I did this like it was it was you Dr. Chris that helped and I'm like no that was you you took the medicine, you decided to make the change. I was just, I helped you in the sense I told you what you what I think you should do and what would be good for you, but you're ultimately the one who did the work. Right. So.
00:25:30
Speaker
Right. Because when they get it, it's all their work. It's great. It's your hard work. like I got all this data. And I'm just telling you, we're here. All the steps I think you need to take. You need to take this medication. You need to work out five days a week. You need to eat this kind of diet. You need to track these things. You need to be on the lookout for this, this, and this. Oh, you know what? Your food journal's got some sabotages in it. You should probably, I would not recommend that. I know the commercial said that it was heart healthy.
00:25:57
Speaker
but look at all that added sugar in there. Oh, you saw it? Yes. So when they come back and they're like, this is what I've been doing and they feel good and they look good and they're like, yeah, I'm jamming, I'm jamming, I'm jamming. It's the best thing. They're so excited. I'm excited for them. We're all here like, get it, get it, get it. We're doing dances together. All right, let's go. I love it. Me too.
00:26:24
Speaker
Yeah, that's what we want to see. So you make the change. We just give you the tools you need to make that change. But at the end of the day, it's all you. Yep, it is. All right. It is intro stuff. I know. We're just shoe-shoeing. This might be a shoe-shoe episode. I'm just telling you, I'm warning you to leave. It's always good to be shoe-shoeing here and there. I'm not hearing these streets talking. I got all the songs in my head. I got to make it. You want to hear something random, though?
00:26:52
Speaker
I have an in-room toenail on my large toe. It hurts so bad. But I am irritated because I know it's so random. people The pain is not random. The pain is pure, y'all. It's pure pain in my big toe. Can you only clip the sides?
00:27:12
Speaker
so yeah Yes, I can. and i need to I need to work on it myself, but I'm irritated with myself because when I went to the shop and I saw her cut it down the side, i said before I said, no, you're cutting it too low. As soon as she did it, I said, this is going to be a problem for me. Y'all, my big toe is on fire. It's not as random as you think because we got episode coming up about gout.
00:27:33
Speaker
And while y'all don't have anything to do with ingrown toenail, my big toe is on freaking fire. All because this damn ingrown nail, like, I just be like, God, Lee, man, what did my big toe ever do to deserve this? So yes, I need to, I need to soak it. I need to start teasing out that, that, um,
00:27:52
Speaker
that angle. But, you know, I never let people cut the sides down, right? I don't even cut the sides. I foul it down. Like, I never wanted the ingrown nail, never in life. And now I know why and it is so painful. I'm irritated. Well, does your toenail, does it like kind of do like a curve like this or is it just straight? It's just straight. So the reason why I hurt so bad is that normally it's just straight and now it's curving into, you know, because it got cut on the side. So now when it's instead of be going straight, it's curving in a little bit.
00:28:21
Speaker
So I need to go in there and pull it out. And if I can't get it done over the next couple of weeks, then I will go subidiatrist. But I know it, look. There are very few things that make me squeamy in medicine. And that is, I had a patient come in and their whole big toe nail like just ripped off. Um, they actually peeled it off while they were in the room. I'm like, Oh my God. Is that in maggots? I can't anything with maggots. I am, I am done. But, um,
00:28:51
Speaker
I will, I'll come see you, but at a distance. yeah way but I do need to get this, I need to make this, get this out and just kind of slowly, but surely probably, um, you know, it's just got a growth from the bottom up and grow back flat, but it is so painful. I'm just like, I can't work out on it. It just, it hurts. Yeah. yeah to soak that so So good. And you can like get the nail to, um, you know, retain it's in the original shape and it should, should go back to normal.
00:29:17
Speaker
Cause I don't really want to go to podiatry because you know, they will, they, they'll just kind of to chemically cauterize it and you just won't get a nail to grow back up. And I was like, no, uh, the summertime will be back. Okay. I know we're in the fall. Happy fall. Happy fall season. But yeah, um we need, we need toenails next summer. So I'm going to get it, but just lying around.
00:29:42
Speaker
but Yeah, it's like 60. It hasn't gone above like 60 degrees today. It's there's like a chill in the air and I busted out our solo stove for the patio. I made a ah hearty pasta. I'm going to do chili tomorrow. Oh, what was your hearty pasta? It's a sausage and pepper pasta.
00:30:01
Speaker
um sounds good I want to do a vegetable, I want to do a vegetable soup. I don't know why I have a creamy chicken and noodle soup that I made the other day and it was delicious. Like we just smashed it. Um, but I am in the mood for like vegetable soup, which is not my husband's favorite. Cause he's not a tomato person, but for some reason, I can do like a minestrone.
00:30:26
Speaker
or Italian italian wedding that has the meats and some veggies in it. I might make him an Italian wedding, but I want a good old fashioned vegetable soup with the potatoes and the corn and the string beans. Ooh, I'm going to send your recipe. I found a potato cheddar broccoli soup with ah bacon bits in it. Ooh. It was really good. um I saved it to my like little TikTok playlist thing.
00:30:55
Speaker
I was going to make it later. yeah And shout out to your the lodge Dutch oven you told me about. That thing is three years going strong. by Love it. I'm trying to get more fiber in, too. Is anybody else trying to get more fiber in? Yes, definitely. Oh, yeah, for sure. Trying to do that. And of course, if I don't reel you in, you're going to just keep going on a tangent. I know, y'all. I'm a tangent. In randomness. I think that's my cue to do these trending topics. Give us a trending topic. All right, I got two. They came about maybe two or three weeks ago.
00:31:33
Speaker
So the first one is ah New York Times had released an article about how they actually started developing a gene therapy for sickle cell patients. Oh, nice. So for people who don't know sickle cell, it's a pretty much a disease where your your your red blood cells normally are like a kind of an oval shape. And that's a shape where they can like carry oxygen, and they can fit through your blood vessels to get to other parts of your body to deliver that oxygen. And sickle cell, your Your cells essentially look like a crescent or, you know, the sickle like, you know, death the reaper. um And that way they get stuck in those blood vessels and that can cause pain crises, which are the absolute worst. Like people end up in the hospital for days to get rid of these pain crises. um So it's a very bad, it's a very terrible disease and African-Americans are, are like the highest people, proportion of people that have it.
00:32:28
Speaker
So the gene therapy that they developed are essentially taking stem cells from bone marrow and they can actually introduce that to your system to help your body create more of the regular looking blood cells. So in theory, this would help you reduce the sickling events that you would have and also improving the quality of life for people that have sickle cell, which is which is great.
00:32:53
Speaker
Um, so the, I won't go into the nuances of the type of gene therapy, but that is something that is actually being done right right now. So we'll probably have an answer to like, when this gets out more into like the general pop about, um, you know, protocols and all that stuff. But for now it's, it's actually going on now and the results are extremely promising. That is great. That's cool.
00:33:17
Speaker
You know, that's a particular, you you know, if there is a patient population that you're always worried about, it is sickle cell patients who age out of pediatric, you know, ranges, me because it's just no good space for them to thrive. So, you know, when you're peas and you have sickle cell, we've got like all these things in place. And it feels like as soon as you hit 21, like the adult world is just not kind and thoughtful. So to have treatments that are like sustainable,
00:33:46
Speaker
that prevent, you know, exacerbations. That sounds amazing. That sounds amazing. It really does. the The big thing with sickle cell though is, um so like like you said, when people age out of the pediat pediatric population now, adults, you know, there's always, there's always that stigma about when um anyone comes into the ER and they're asking for like super high or very strong payments.
00:34:11
Speaker
Right. And you know, sicklers, when they, when they get a sickle cell crisis, it is the most excruciating thing you can imagine. Like literally your blood vessels are, are blocked off. You're not getting any blood to your tissue. So in a sense, those parts of your tissues are dying off because they're not getting that blood flow. So, and this can have, this happens all over your body. So if you can imagine how painful that would be and multiply it by a million, then that is what they're experiencing when they come into the ER.
00:34:40
Speaker
So, ah you know, where there's a lot of like talk about, you know, how, um, black people have a higher plane tolerance, like they can take it, like, and, you know, usually you're looked at with suspicion when you come in asking for like, Oh, I want the delighted. I want the fentanyl. I want, you know, all of that stuff. I want PCA pump. I want all of it. Um, yeah so in, in some cases that is, you know, you need that, like you need to get ahead of the pain and to get it to where it's a manageable point where, you know, we can treat it ah you know accordingly.
00:35:10
Speaker
But you know, that is a very big issue with people that come in with sickle cell crisis. It's just like they're escalating pain needs and it's the health community not realizing and then treating them with suspicion, which is ah just terrible. So. Right. Yeah. Yeah. That's a good one. So hopefully they, um, so hopefully we hear more about this gene therapy in the next year or two, but when we do, I will definitely give you some updates.
00:35:39
Speaker
Okay. And then my other trending topic, I'll see. I'm doing good. All my topics are home. I love it. Not a lot, but that's great. So my other topic is, um, this, I don't know if it's really, um, it's just kind of like a shitty situation, but so there's a psychotic, there's ah a group of psychiatry hospitals, um, that are run by Acadia healthcare that have actually been under investigation for falsely trapping people.
00:36:05
Speaker
in their hospitals to get more from their insurance payout. So girl i when I was reading, insurance for exactly. And that's what they're under investigation for. So, so literally when you, cause so kind of a side note, when you come into inpatient psych, you're either admitted voluntarily, like you come into the hospital and be like, I need to be admitted. You give us reasons why I'm like, okay, bet. And then you get admitted.
00:36:31
Speaker
Involuntarily is a little bit more nuanced in that usually it's conditions like where you're suicidal, you're homicidal, or you're having like a psychotic break, like you're hallucinating, you're um you're exhibiting behaviors that would put you at risk or someone else at risk and you need to be hospitalized for stabilization. Those are usually the only reasons you're admitted.
00:36:54
Speaker
So this company was actually um asking um the people that were not the doctors, like like in the administrators to falsely keep these people against their will, even when they didn't have any of those conditions, just so they can get the majority of the insurance money payout. And they were falsely keeping people in the hospital against their will because of that. So people had to get police involved. They had to get judge court orders to get them released.
00:37:23
Speaker
from the hospital. Like it was just, ah it was a humongous mess and they've been doing this for years. So they finally. How can they do that without the the doctors were signing off on this? Because. Yeah. And they need the diagnosis. So they were getting pressures from the C-suite to be like, Hey, um, this person needs to be stay a couple more days. They're not completely stabilized and that was it. So.
00:37:50
Speaker
a lot There's some little holes in the story that I need to look into, but um the fact that now this this entity is on investigation for it is is great because this is it's so unethical. It's ridiculous. These people got money, money, because I'm not invested in breaking the law.
00:38:11
Speaker
but But these kind of, like, insurance fraud is swift. It is crazy. Like, you get hung up in insurance fraud. It's gonna be time, money. It's gonna be a lot of different things. Like, you'll just never recover from it. So when I find that people are, like, willingly and conscious to, like, yeah, I'm about to commit this insurance fraud, I just don't... I'm like, who are the people? Like, you have no fear.
00:38:40
Speaker
What's crazy is that their revenue had like quadrupled during this time, and their stock prices had doubled. So there was they're probably going to they're probably going to go down for some insider trading as well. And that's not even a health care topic. But that just tells you the incentive of why they were probably doing this, is to get massive payouts and you know act like you know people wouldn't notice. So it's just.
00:39:06
Speaker
I was reading the article and I'm just like, oh my God. They were getting away with this for years. Like Medicare didn't even audit them. Right. I'm just like, where the audits? Where were the audits? Yeah. Because Medicare- You know, they audit your business so fast. Right. Cause if you, if they see you making all this money, all these, oh, they're auditing you. Like what is happening here? i don't know my my My family owned a home health agency many moons ago.
00:39:35
Speaker
and small business, right? Small business making small dollars, like nothing significant. And the amount of times that we were audited is crazy, which is why I'm always like, if there's a strong bias in healthcare care regarding who Um, who, you know, who they audit, who they don't and all these things. But it's, it's insane. Like the way they, the way they did the checks and balances for all that stuff is crazy.
00:40:15
Speaker
So, I don't know. and it's It's a mess. So again, I will have an update from that once I get more. Maybe I should just pay for this New York subscription. I don't know. waiting bought it But, um,
00:40:28
Speaker
Yeah, I mean, it's it's a very interesting story. So we'll we'll see what comes of it. just Interesting. That's all I got. Y'all, I'm still on random things. Of course. Of course.
00:40:41
Speaker
and because I'm sitting here and this dinosaur y'all can't see it listeners but I have this green dinosaur right because my godson um we are teaching him to spend the night out right so um mom is a nursing student she needs the weekends to study so he has to come over here which is a big transition for him So you know there's like weighted blankets for all the mommies, it well all the parents out there, there are weighted weighted stuff animals. So this little dinosaur is actually weighted, right? So that when we put it in the bed with him, it has like a little weight to it so it feels like somebody else is in bed with him.
00:41:20
Speaker
I was not sure if it was gonna work or not, but I, we tested it out and he slept like a baby, no pun intended. I mean, it was man down, him little dinosaur were all over the place. So of course it was time to go for the weekend. He was like, I'ma take my dinosaur. I was like, oh no, you're not.
00:41:36
Speaker
Oh, you didn't give it to him. No, I didn't give it to him. What you mean, Dr. No? Like, I need to sleep in my house. right Am I going to give it to him? Yeah, at bedtime, in this house, I'm supposed to give it to him. You can't risk that he forgets it, and then he don't have it. And then what you mean? He show back up here without that weighted dinosaur. We going to have real problems. You can go back home to go get it. Right, and y'all better to go home and get that dinosaur, because I don't know what you're trying to do.
00:42:02
Speaker
um So yes. the only way The only way that dinosaur goes home is if you had a second replacement in case. like Correct. No worries. Correct. You got another dinosaur. I don't know. I think Amy Jo about to keep that for herself. No, we're keeping this thing. I love it. It's so heavy.
00:42:17
Speaker
Like, you know, like twenty it nah it's a it's for a baby. So I was like, 10, five. have to the way But you know, I was like, man, why, you know, I was like too, and I had literally said one day, too bad you can't do like weighted blankets for kids, especially for small kids. They stopped that a while ago. They have like the little, the straight jacket things that you can use in like the bassinet.
00:42:42
Speaker
I don't want to torture nobody. So like, these are women's names. Now, he thinks it's fine, but he's three, right? So he's big enough that he would only be like torture. But this weighted dinosaur, y'all, is where the money is at. I love this thing. So any who, I just thought someone else around, if it were me, I'd probably be sleeping with it too.
00:43:01
Speaker
Correct. We all sleep with them. It's his. I leave it in here with his dinosaur sheets so that he can. Weigh the blankets are a godsend. I stole my partner's weighted blanket. The thing weighs like 50 pounds, by the way. So I stole it. I didn't get far with it. I just went down the room. So I'm like, I'm not carrying this downstairs. And I had the best sleep I've ever had in my entire life with that thing. It's so good. So now you can't. No, I can't sleep without it. You just set yourself up now. I am so mad. Like I need to have the fan on and this weighted blanket on me and I am after a night shift of 12 hours just dealing with folks.
00:43:45
Speaker
come back on. I am out until I wake up at like two that evening or afternoon. You'd be like, you don't need nobody. Just give me this blanket. Be like, I'm here. Take me in my blanket. Go away. I also got these 3D, 3D, what's it called? Eye goggles. What do you put on your eyes at night? What's that called?
00:44:08
Speaker
Oh, the eye cover is like the eye mask. Oh my God, it's 3D, so like the actual mask is off your face a little bit. But I put that on and everything is shut out. No light is getting through that thing. So any trip I go on, and if I'm sleeping after a night shift, those things are I got, I think I got like three of them because they're scattered all over the house. So if I need it, I can just pick one up and go to sleep. I know can't do that with complete darkness because I will sleep all day. i mean some some late no have knocked out i but
00:44:45
Speaker
But then I also need to do things, right? So if I'm sleeping and it's late, I'm like, oh, man, what time is it? I can't live someplace where it's not sunny a lot. Oh, then stay away from me. Oh, I need sunshine. I need more. Yeah. Or I'm just not going to get anything done. I'm not going to get to work and be like, oh, shoot.
00:45:09
Speaker
What time is it? Well, the sun didn't come up. I didn't know what time it was. All right. I'd be like, what then you mean? I've been asleep all day. I thought it was Saturday. Like, man, it is Tuesday. Right. You had work yesterday. Right. My bad. You were two hours late for work. We thought we were going to call 911. Call it. Come check on you. Shoot. I'd be like, dang. My That's all my truth. The randomness. Let me pull. Let me pull this back.
00:45:39
Speaker
All right. I'm ready though, because you know how to talk about big toes, so let's get to it. So we're going to talk about gout. What's the topic? Okay. Gout. The gout. The gout.
00:45:53
Speaker
the gal It's like a person, like you got the gout. Correct. Like the diabetes. For diabetes, we're going to talk about the gout. So for those who don't know what the gout is. So gout is an arthropathy, right? And so it is under an umbrella of things. For people who do not know what gout is, most of you all know what arthritis is, right? So arthur. Everybody knows arthur, but you may not know gout. They're under the same kind of conditions, right? And so gout is very specific, right? It is an acute
00:46:27
Speaker
inflammatory process that for most people affects their large toe, but it can affect a bunch of other things. How do you determine gout from other things? Gout is a single joint, right? So if somebody comes in and they say, ooh, ooh, doc, I got gout in my elbow, my knee, and my big toe, that's not gout. If it happened all the same time, that's not gout. It has to be a single joint. And it is typically acute.
00:46:56
Speaker
it gets beefy and painful and inflamed. If we cannot figure out if it's gout from your clinical um assessment, meaning just looking at it and most time we can, we wiggle that big toe, you come off the um you come off the exam table, mission accomplished, let's get you some medicine. But let's say we cannot figure it out, we can tap it. I rarely tap joints these days in the office, but if we had to, because we just could not figure it out,
00:47:24
Speaker
We could tap it to find your urate crystals in there, which you can look on under microscope, which is another thing. We don't have microscopes in the offices these days, which is whatever. um But that's how we would do it. So that is what gout is. Who gouts affect? Well, most most um people most affected by gout are older older men. So men more than women tend to get gout.
00:47:49
Speaker
um Premenopausal women tend to not get gout as much because you tend to excrete more of your uric acid in the urine. So perimenopause starts to line us up with men. Isn't that rude? Perimenopause is rude. We're going to talk about that one day, but whatever. So perimenopause and menopause tends to line women back up, but an 80-year-old man has a higher chance of getting gout than a woman. So if you are a 30-year-old woman, still menstruating, still fertile, your chances of gout are low. If you are a postman of pause, your chances get higher. If you are a a senior and a male, you are the highest risk category.
00:48:33
Speaker
um There's lots of different ways to treat it. It really depends, right? So there's there's a couple of things, right? If you are coming in and this is acute, what you probably want us to do is make your pain go away. And we can do that a couple of ways. We can use medicines like colchicine, endomethacin, which will help get it done right away. But if you've got kidney problems, right? And remember, we're talking about 80-year-old males. Sometimes your kidneys are not functioning well. We may have to use prednisone.
00:49:05
Speaker
both are really good and both actually do a really good job of getting rid of your gout symptoms pretty quickly right now maybe people are going to get one maybe two episodes in their life and that's fine if you get more than two episodes in a year or if you have what we call tofu so tofu is a cool word But TOEFI is literally, um somebody has gotten gout so much that you got these little bubbles, like these little bumps in the joint that keeps getting affected. Those are called TOEFI. So if you make your joint that keeps getting it that keeps getting affected with gout kind of inflamed and bumpy, that might be a reason for us to put you on chronic medicines to try to keep your symptoms under control, or if you get multiple episodes in a particular time, right?
00:49:54
Speaker
so What I probably didn't say was that at the heart of gout is something called uric acid. So when your uric acid levels are elevated, it causes you to have an increased risk of gout. Where does your acid come from? Ooh, I'm glad you asked. Even though you didn't, but you did. Oh, she's nerding out now. right Let her letter her flow. It comes from a lot of different things. Everybody remembers steak and lamb, right? So everybody thinks of red meat, but it's not just red meat, um beer.
00:50:32
Speaker
Technically, wine and other spirits can do it. elevated body mass and ah Elevated body mass index, so anybody with a BMI, I think it's like 30 or higher is at an increased risk. A lot of fructose intake.
00:50:49
Speaker
Not high fructose corn syrup, but fructose intake can increase it. Seafood can increase it. Meat consumption, dairy consumption. So I often have this long conversation, right? Because somebody will come in and they got horrible gout, right? They're getting it every other month. And they'll say, I got off steak. And I'm like,
00:51:11
Speaker
That ain't about to help you, friend. You get gout every other month. like Your meat consumption is a problem. So you will often hear me say, I need you to lower your animal product. right I actually stopped seeing meat a long time ago, your animal product. And while, yes, um red meats tend to be the culprit, seafood tends to be the culprit, but you're not saved um because you cut out lamb and steak and you don't eat shrimp anymore.
00:51:39
Speaker
some Most people learn down the line that they're like, I didn't even have any steak. I don't know why I had an outbreak. All I had was chicken. All I had was salmon. Well, meat consumption will do it. And then ironically enough, vitamin C will also exacerbate gout. I know, gout. You have to go all the way back. I had to go to the AEP website to pull up the old articles to pull it up. So I found it.
00:52:06
Speaker
um in in one of the articles and I was like, vitamin C? But yeah, apparently vitamin C can also do it. So maybe there's more, maybe I need to, somebody needs to do a study about the rates of gout during a flu and cold season because everybody's chomping down on vitamin C, nobody's business. No, it's probably higher around Thanksgiving and Christmas. Cause all y'all getting together with those, the turkey meat platter things and the gout, we see so much gout during that time. It's ridiculous. oh and holiday art. all like Yeah, and also if people like to eat gaming meat like deer. Oh yeah. yeah and also That's a Midwest staple. So yeah, definitely see that. Yeah. Have you ever had deer? Yeah, it's very good. Dr. Chris, you've had deer? It's so good. No, I haven't had deer. You've had deer, Amy? Yes. We're in a deer in Chicago. You know, I'm the person that...
00:53:00
Speaker
What haven't I had? i um I've had ants. I've had, uh, so, you know, if it smells good, deer was an easy decision. Oh, deer is great. I mean, we are in that damn termite in the middle of the jungle because I was out there, you know, messing with the people. Oh my God. I mean, coming from Michigan, like hunting season is a whole nother holiday season for us. So October,
00:53:25
Speaker
I think it's October, it's coming up, October something. and Everyone's out there shooting all the deer and we get venison and all that good stuff for a couple months to come. so Yeah, I wasn't actually, ironically enough, I was in Alabama when I first had deer. And yeah they were cooking, they had cooked it down in this crock pot.
00:53:46
Speaker
And it had this gravy to it. And oh my God, it was so good. I was like, what is this? I'm like, it's deer. And I was like, this is the best deer. yeah Let me find a deer out here in this street. So I'm about to take it out. So yeah, definitely love deer. But has anybody had gout before?
00:54:08
Speaker
hi yeah because the way tell you eaten a deer and all of that have you added yeah you know me this is why can't meet like had once time um I one time in, um, in college, ironically enough, which was really weird, right? So I am an anomaly because I'm typically not the person to do it.
00:54:27
Speaker
And I could not figure out what was going on. And I was like, Oh my God. Like my toe was on fire. And I remember going to the team doc and, and he touched and he was like, Oh, you got gout. I didn't know what that was. I was like, what is it? Is it gonna, is my toe gonna fall off? Take these incense and call it a day. I don't even remember what he gave me, but it it happened so fast. Like I was like, okay. Left out. Went and picked it up by the end of the day. I was like back to normal.
00:54:52
Speaker
But it was the strangest thing. So who knows how that happened, but yeah. But you know what? I would tell you this much. When you know it is, it's the easiest visit ever, right? Oh, yeah. Because they come in. I had this one patient. He was young, too. I think he was in his 30s or so. He came in. He was just like, the complaint was foot pain or whatever, right? So he comes in, and I think it was,
00:55:20
Speaker
yeah He was like, yeah, my foot hurts. It's like my toe, it's been going on for like two two days and it's really painful and I can't move it. And then he was like, I was like, uh-huh. And I was like, okay, so what were you doing? He was like, yeah, I was barbecuing, I was eating, I was drinking this. And i and i'm in in my head, I'm like, okay. yeah And then I looked at his foot and I'm like, I'm typing, I'm like, okay, you gotta get out. This is what it is. You can see it.
00:55:50
Speaker
ah Yeah, it was just like your classic. And then he's looking at me like he was so amazed that I took like two minutes. He's been thinking about this like all day, like what is happening? I don't know why why this is hurting and all this. And I literally told him everything that he did without him having to tell me.
00:56:11
Speaker
And then he was like, how did you know? um like like that is the That is the perfect vignette for like a step one question. We've seen that all the time. like We know what that is. Yeah, it was red. It was hot. It was warm touch. He was jumping off the table with your husband. Can't even move it. And it was just the one toe. When it gets those big joints, though, that's when they're usually in the hospital. Because they're like, I can't walk. I am falling. It it hurts like hell.
00:56:40
Speaker
yeah And they're taking like a crap ton of ibuprofen, Motrin, and their renal function's all messed up now, and usually they're like, all right. Yeah, and a lot of it is because you're dehydrated, you're not drinking enough water, and you have this backup of these ah the uric acid purines that stays into the joint, right?
00:57:00
Speaker
and so yeah I will say though, if you come into the hospital for red hot swollen joint and your history is not super clear, they will probably tap it. So that's tapping is to take fluid off of the joint to make sure it's not an infection because it was an infected joint. And obviously we treat that with antibiotics and other stuff.
00:57:19
Speaker
But if the the tap, you know, usually they'll do it in the ER. It comes back very quickly. You'll see all the crystals floating around in the fluid and like, all right, this this is how we can treat it as such. But if it's a septic joint, then as you we got to treat that with antibiotics. And you're in it you're in the hospital for that.
00:57:37
Speaker
Yeah, I should have let that out. So, you know, folks, they run into the ED for everything. Y'all can run to the ED if you want to. with gout It'll get tapped there. I won't tap it in my office, no um'm just but they will tap it in the ED because it's right there. They can send it off. They can get the information right away. So I'm just telling you right now, if you are not interested in us putting a needle in your joint and pulling that fluid off,
00:58:03
Speaker
then you might want to wait for your same day sick visit appointment the next day. Yes, please. You do not need to be admitted for this. You don't. Like, people are like, is my toe going to fall off? No, it's fine. For the past five years, getting this big toe every other month. So no, you don't need to go to the emergency room for, for gout.
00:58:23
Speaker
But if you do go, it is a place where they're going to you know investigate it. So um it's hard to miss. you You'll know Gout. I'm like you, Dr. Chris. I think Gout is you know so clear that you can't really confuse it with anything else. Again, it's got to be a single joint. It is never multiple joints. It happens right away. It is beefy. It is red. It is swollen.
00:58:50
Speaker
it is tender to the touch, you know it right away. And the cool thing about it is, is that we can get medicines on um and you know, keep going. So again, two or more flares per year, a TOFI or clear damage, right? If if something, we do an X-ray and your joint just looks jacked up, that is a reason to...
00:59:15
Speaker
I mean, that's true. That's just what it is. if it's When the x-ray is like, dang, this thing is cloudy. Like, where is your joint? Like, what happened to it? Yeah. We need to put you on medicines to lower it. That does not mean, though, you know, I did not put you on allopurinol so you can eat a steak every month, OK? I put you on allopurinol to lower your uric acid levels, not for you to add to them. So unfortunately, if you're somebody that's on, like, you know, a uric acid, laurine,
00:59:45
Speaker
medication, it's probably a good time for you to consider decreasing your animal product. That's a major thing changing changing your habits. It's like you do that a lot of times you won't have the flare-ups and you remember like each foot is painful and You don't want to keep having that all the time. and Right. I'm not not saying it's the easiest thing to do because the Western diet is very heavily influenced by like meat. Like we have to, as an American, we have meat with almost every single meal, like breakfast, lunch, and dinner. Correct. So, you know, this these changes do take time, but you know, like with little steps, like
01:00:27
Speaker
having like a meatless Monday, you know, starting with like one week a week. Just ah one day a week. Just don't take meat out of the, the your monthly meals for that day. And then, you know, next time you can but bump it up to like maybe a couple of days a week. But you know, those changes take time. And as you know, your, your doctors here, we're all with you and helping you with that, that transition. So, you know, we'll all be okay. No more gout. I agree. Yeah.
01:00:57
Speaker
um yeah the standard american diet is very sad when it comes to there's also fiber intake it's not it's not gal i'm sorry and laurine your proteins we just ain't we eat too many animal proteins we definitely do and we're hyper obsessed with enough water We don't drink enough water. We're hyperassesed with hyper obsessed with animal proteins, and we do not eat enough fiber. oh know And it's so bad. I don't know how we got here, right? like Well, isn't that the beef industry? People are like, OK, I'm going to get it together the first thing. I'm going to hand it to you. They're subsidized. like Aren't the beef farmers or cattle farmers subsidized? They get that's a shit ton of money. Right. It's the beef industry, because like nowhere else eats beef like we do. We subsidized.
01:01:48
Speaker
we subsidize animal proteins way more than we subsidize any vegetable or fruits that we grow in the United States. so and we need We need both to live, so but one definitely takes more precedence than the other. so Correct. um But even when we think about, okay, I'm going to get healthy, and it' you know it's time I'm going to start doing things. The first thing people say is, I got to get my proteins in. I'm like, okay, listen, if you have gout,
01:02:17
Speaker
getting your animal proteins in, you've got to find an alternative way to to do that. It's a lot of really, I know y'all are going to turn your nose up, but there are very good meatless alternatives out there that taste just as good as a real thing. You just got to season it and it tastes great. Like I had like a little stint during COVID where I was like, I was going to do pescatarian and then do like little meatless ah days throughout the week.
01:02:44
Speaker
And I found really good meatless options during that time. So they're, they're definitely out there. You got to do a little trial and error, but for the most part it is the, um, not vegan. Oh yeah. It's vegan vegetarian. That industry has like skyrocketed and has like did leaps and bounds for what they were doing like maybe 20 years ago. So it's yeah very good now. Yeah. I think I had like a bean burger the other day.
01:03:10
Speaker
I love a good black bean burger. Yeah, black bean burger, it was good. And that, what is it, that mushroom one? That was a Porto. I love a good mushroom burger. You know, a Cheesecake Factory used to have a bomb. I hope somebody who works at Cheesecake Factory listens to us. They used to have a really good...
01:03:27
Speaker
veggie burger and it was rice base so it was rice base and it had like a little bit of mushroom and oh it was so good and they stopped selling it they changed it to um the like more of the like processed burger the one that has like the carrots and like the mushroom it is not my favorite um or you can get a black bean burger but i loved their burger as a matter of fact um
01:03:59
Speaker
Covers used to, I think still has a garden burger. I will say that Covers has the best veggie burger that I have ever had. It reminds me that the next time I'm in there someplace where there's a Covers, I'm going to get one. so I love them. It is so good. But as long as it's the rice-based one, right? So I don't know if, I've not had one in a long time. So, you know, I don't know if they changed their formula, but they had the rice-based burger too, which which is my second favorite.
01:04:29
Speaker
besides the Black Bean Burger? I have to try that next time I'm over there. Yeah, we have Culver's. That's the Midwest. Like, forget five guys. And and it what was the other one? ah In-N-Out, Shake Shack. Culver's is where it's at.
01:04:42
Speaker
Yeah, we work, I'm close enough that we have, we have, but there's one in Charlotte. We don't have any in South Carolina, but there's one in Charlotte. And so when I go to Charlotte, I'm always like, I'm gonna get it. It's not a favorite of my husband. So when I go by myself, it's like, you're going to get covers. And I'm like, you damn straight.
01:05:00
Speaker
yeah
01:05:05
Speaker
You did what I did and I'll do it again. Like, I'm no coldest, okay? but um So don't talk to me about no coldest. That was a great topic. Yes, it was awesome. yeah I saw the segue from the ingrown toenail to the angry toe to gout. So it worked. Yes, it did. It wasn't as random as people thought, huh? so You know got you on your toes. I'm tired. don't mean i Don't mean it. I'm not. All right, that's all we got. We don't have any questions. yeah so No.
01:05:41
Speaker
Y'all didn't send us more questions. My feelings hurt, too. Right. Can you please send us some questions? Please. In my audience. You avoid randomness. Oh, dry. That happens. No, I think they like this. So that's why they're not sending them in. like Oh, they're going to just talk about random stuff. So let's like let them let them cook. Right. No, don't let us cook. We start singing all kinds of stuff. Send us questions. We need direction. um So um yeah, it's just, you know.
01:06:09
Speaker
Y'all didn't send us any questions, so we decided to ramble on. But we appreciate y'all, because y'all still listen. So even though you don't send us questions, you guys are listening. And oh, I love it. Yes, we are. Thank you, guys. You've been with us from day one, especially our day one. Yes, thank you for our day ones. Oh, man. I did that for you so you could start the song. I did that for you so you could start the song, because you were listening. I'm listening. I've been singing. Shout out to my day ones.
01:06:39
Speaker
What Dr. Chris is saying is that, y'all, I have been singing all night. Before we started recording, she can't say nothing. And I break into a song. And then it's my moment. And and here I go. You messed up. I know. over we like And Dr. Sunshine was here. She wouldn't have missed it. She would have picked it up. She wouldn't have. She'd have been like, oh, right.
01:07:01
Speaker
Aye, that's her thing, aye. So, we do it for her next time. We do it for her next time, but she don't miss it. Yeah. For next time though, you guys can find us on our socials, our Facebook, Instagram, Twitter. We are at thechocolatemds. Please send us questions through our Gmail, which is thechocolatemds at gmail.com. And also check us out on our website, which is www.thechocolatemds.com.
01:07:29
Speaker
where you can see our upcoming episodes and also send us questions and well wishes from our site. Oh, thank you. All right. All right, guys. So I guess this is it. Until next time. Bye, guys. Bye. Have an awesome day. Bye.