Become a Creator today!Start creating today - Share your story with the world!
Start for free
00:00:00
00:00:01
Beyoncé, Blood Clots, and Bomb ass gummy bears 😋😋😋
195 Plays1 year ago
Renaissance Tour was AMAZING!!! 🐝🐝🐝 (No spoilers) STDs are back like they never left. And Dr. Nono gives a great blood clot prevention talk. 😉
Recommended
Transcript
Introductions and Recent Activities
00:00:17
Speaker
What's up? What's up? What's up? It's a another episode of chocolate with the side of medicine. I am your host, Amy Jo MD, and I have with me Dr. Chris. Hello guys. Dr. Nono. Hey. Dr. Sunshine. Here present and ready to roll. Yes. Welcome back, Dr. Nono. She was out here saving lives last time, but she's here.
00:00:38
Speaker
I was out being jealous of y'all post some pics from your Beyonce concert experience. Don't be jealous, don't be jealous. You know how heated I was to see y'all up there, just like your booty, the church girl. And I'm over here writing my 20th admission. Heated. I got the cools, let me down. I was heated. Don't be mad, because he was making coins, OK? He was making money. Yes, that's true. OK, you were making money. While we were out here missing those good RVUs, you were making money.
00:01:07
Speaker
Yes, we were shaking our booty. Yes, we were having a good time. But you made some
Trip to Nashville: Highlights and Stories
00:01:11
Speaker
money. I didn't make no money shaking my booty. I spent it. Yeah, your sister Dr. Chris over here didn't even remember that she was off work. I didn't.
00:01:23
Speaker
Yes, yes, I got too. That's how many days off Chris be taking this. She'd be freaking six days off. I reject that. I reject that. What is your excuse then? Who forgets that they took days off from work? I don't. Me either. Because I've been working so hard. That might be, I feel you. I support that. You're working so hard that you just forgot that you took a day off. Oh, yes. Yes, that can happen.
00:01:50
Speaker
But I will say, Nashville, listen, Nashville peeps, love your city. Had an amazing time. Yes, it was so much fun. I would go back. Nashville, I could easily do again and again because it was just good vibes. The food was delicious. It was great.
00:02:10
Speaker
I mean, y'all were between three different cities at one point. It was Nashville, obviously, here. And then, what was the other one? New Orleans or Cali? Houston? Oh, yeah, New Orleans. You want to know in Cali, right? At the LA, what's the new giant stadium they just built? SoFi. SoFi. SoFi, yeah. Oh, yeah. But Nashville is Liddy. I've always loved Nashville, always. And it was Dr. Chris' first time in Nashville, so we showed her a good time. We showed her a good time. Yeah. Good time.
00:02:37
Speaker
I did. We got to go back because it was a short trip. I didn't realize how short it was. Y'all there for what, two days? Yeah, not even. Like a day. Really? No. Because I flew out, flew out Friday after work and then got there like 1 a.m. Saturday, flew back on Sunday. Yeah. Well, I got there early Friday. So I hit I got there Friday, hit up with some brunch spots, had a good time. Yes. Met up with Dr. Chris. Took a nap.
00:03:06
Speaker
Then got back up. She definitely took your nap. She had a whole day though. You had a whole day.
00:03:12
Speaker
Y'all have been drinking. By the time you got there, I've been drinking all day. It's time for now. I know, she was living. First of all, y'all should also know. Y'all should also know, Amy Jo. Listen, Amy Jo knows people everywhere. I don't think there's a major city that Amy Jo could touch down in, and she don't know nobody. Amy Jo literally hit one of her friends from life, right? And was just gallivanting around Nashville before we even got there.
00:03:40
Speaker
Look. Taking pictures like, ooh, I'm here. Ooh, I'm here. Ooh, look at this flower wall. Ooh, look what I'm drinking. Froze, Froze. Oh, y'all behind. That, that, that, that, that. That was good. I'm like, what? It was delicious. I regret nothing. I'm sure you know. I'm sure you know. You went to sleep. Man, you got on that couch and you were like, I ain't around to. Talk about, oh, when they land, they got to catch up. I'm like, OK, all right. Catch up with the snap. Listen, but wait, Dr. No-No, hold on.
00:04:10
Speaker
But what they haven't mentioned, which I think is important, is that I took time out of my brunch drinking to go buy them snacks and all the stuff, right? I was like, I gotta get over here and let me buy some snacks real quick. And then after that, I went and started drinking some more. So I paused the drinks, went and got some more drinks to make sure that when I did finally get dropped off in front of my Airbnb, that I had snacks for them.
00:04:40
Speaker
And then I went to sleep. She did that. And that was very thoughtful. Not only that, she also bought ponchos because it was supposed to rain. Thank the Lord it didn't. Shout out to Beyonce.
Concert Fashion and Experiences
00:04:51
Speaker
But yeah, she bought us ponchos and everything. And she also introduced me to the best gummy bears known to man. And I don't even know the name of the gummy bears, but it's the best gummy bear I've ever tasted.
00:05:00
Speaker
By far the best in my lifetime. Don't you go anywhere because I brought it here. I don't know the name of it. She literally put them on the table. Yes. They are literally the best gummy bears I have ever tasted. And then she goes on to tell me how other people are also addicted to these things. And I'm like, oh my goodness.
00:05:23
Speaker
Yeah, I want to I want to blame one of my bridesmaids for these right so one of one of y'all you wouldn't expect who but the coach
00:05:39
Speaker
She is the reason why I'm addicted to these things. And now we got Dr. Sunshine out here. She's like, yo, what is this? What are these things? She's literally eating them like, what is this thing that I'm eating that is so good? This is so delicious. And I'm like, yep, got you too. Got you too.
00:05:59
Speaker
Yeah, she definitely got me because I started, I started taking a couple. I'm like, Hmm, yeah, I noticed. I just keep going and take it. So I'm like, Oh, these are good. She's like, Oh man. Okay. That's why I bought this big pack. Yeah. Now Dr. Chris started the weekend off like, so my outfit, you know, just give me some mixed nuts with no salt. You know, that's what I'm going to do. And I was like, I gotta fit into my outfit. I'm about to get these Pringles and these sprites.
00:06:25
Speaker
and some gummies, and then I'll get your unsalted nuts. Them nuts was still on the table when I left for the airport that morning. Listen, I got my nuts, okay?
00:06:38
Speaker
I'm sure you did. I'm sure you did. No pun intended. No pun intended. We're here all night, people. Dr. Chris always gave her nuts. Don't y'all, don't y'all be full. I like my nuts. So yeah, but it was good. I had a good time. Listen, let me tell people, anybody, you know, the US leg has now started. We all know that.
00:07:02
Speaker
But these people came, they were not for play play. Like the magic that folks, I mean, everybody was dressed. I mean, and I'm talking about like you had to have on heels or anything, but you knew that everybody walking through the door had taken some time to think about what they wanted to wear specifically to match the vibe of the event. It was so cool.
00:07:24
Speaker
So, you know, outfits people, just go ahead and do it. If I were to put a theme on the outfit, I would call it like futuristic disco... Futuristic disco cowboy parade. Vogue cowboy parade. That's probably what I would call it. Yeah.
00:07:48
Speaker
Lots of rhinestones and sparkly stuff with metallic colors. And don't forget the cowboy hat. Don't forget the cowboy hat. Lots of cowboy hats. Lots of sheer, lots of playing with colors. But lots of metallic. Dr. Sunshine, your sister was offended that I had this top that I was going to wear. Well, that I did wear. I wore the top.
00:08:14
Speaker
And... Y'all, listen, I saved her from being a fashion no-no. Lord Jesus, help us all. I wanted to put a cute tank top underneath the top. It was sheer, but it was, like, metallic and sparkly. And it had, like, all these different colors. It was shiny. I loved the top. But I also had been brunching. And, you know, unlike Dr. Chris, who was, like, give me some salty, lightly salted nuts, I was like, let me get two appetizers, full meal, ten dishes.
00:08:43
Speaker
So by the time the gospel came around, my belly was big. You know what I'm saying? So I wasn't going to hold it in. I can't sing Beyonce and hold in my stomach. What would you do? If you don't sing Beyonce, it's going to require your full effort. Right. You need all the breath. You need all the breath. I come from your diaphragm or deep down. Yes. And Beyonce is expecting me to sing with my full voice. So I can't be in here holding my stomach in.
00:09:09
Speaker
and singing Beyonce. So since I understood that, and I knew that I wasn't willing to sacrifice all these brunch spots that we were doing, because the food looked great, you know? I'm having oyster Rockefeller and all this stuff. I was like, maybe I should put a little tank top on her knee so, you know, I'll cover it up. She was so offended. She was like, oh my God.
00:09:30
Speaker
What are we talking about right now? First of all, first of all, she comes in and she models it for me, right? And when she's modeling it for me, because she's like option A, option B, option A, option B, what do you think? I'm like, oh, Beth, option A. She's like, cool, I'm going to go put a tank top on underneath it. I'm like, why?
00:09:51
Speaker
It looks great. It looks great the way it is. She's like, blah, blah, boobies out. Everything's all out. I'm like, right. That's what makes it fly. I was like, what are you talking about right now? I'm like, that's going to be lame. And then the way I said it, I think it really hit her in the heart. I was like, fine. Right on the show. You know what? I was like, fine. What would Beyonce say right now? Beyonce say, girl, we're going to give the summer what it's going to get. So they got it. Brunch belly, stomach.
00:10:21
Speaker
Jelly and sheer top. I was cute, though. You couldn't really tell. I was pretty excited. I know, too. I felt like a selfie book. It's nice. Yeah, so it was good. But just, it was a good time. I was like, girl, you look super cute. I'm like, move this out. You got the colors. You got the sheer. Doing your own version of a little Kiki Palmer going on. I'm like, great. Dead. I got my Kiki on. Yes. It was good, though. I had a good time. I can't wait to do it again. We got to plan for the next one in like 10 years, I guess.
00:10:51
Speaker
Plan for the next what? You about to go. Concert. No, together. Together. Together. She means like next time, all together. Whatever. Yeah, whatever. Yes. Now don't feel bad for Dr. Nona, y'all, because I'm like, dang, they left her. Dr. Nona will be floor seats in Chicago, OK? So don't worry. She's on the floor. Her and Beyonce go high five when she comes skipping down it.
Health Discussions: STDs and COVID-19
00:11:16
Speaker
Al, so don't, she's good. I feel good girl, keep going. Yeah, it's gonna be a good time. It's gonna be a good time. Last time we went to see a concert at the Soldier Field, we were in the 400s, because we were poor med students, and we literally did not hear anything from the show. We heard vibrations. I think that might be from the ladies, I think. Yes. Yeah, okay. And then we can see Lake Michigan from our seats. That's how high up we were, so.
00:11:45
Speaker
I'm with you, Dr. Nono. The last time, well, not the last time, the first time I saw Beyonce in Soldier Field, I was in the second to, I had no money, none. Second to last row from the top.
00:12:03
Speaker
Oh my God, 500, we have a 500 selection. Yes, I was in the second to last row from the top. It was so high that the music sound like it was turned down. I was like, damn, what song is that? Couldn't, could not. It was, it was, we were high enough that, you know how like before something starts and everything's kind of quiet, you just kind of hear the rumbly ends of people talking.
00:12:27
Speaker
That's how it sound up at the top in the middle of the concert like you know, I told him he said you can hear everything I remember like Lord, please let me pass these steps cuz
00:12:55
Speaker
I'm sure you can hear me whispering, because that's how I am, okay?
00:13:01
Speaker
If you could just enlarge my territory so that I too can come down and see Beyonce, can I at least see the sparkles? The light ain't even getting up. The speed of light ain't fast enough to get up here that I can catch a sparkle from her little outfit.
00:13:20
Speaker
I'm so high up. So let me get down a little bit further. I'm going to report back and let you guys know. And look what God has done. Look what he did. Look what he did in your life. Can't tell me, God, won't he do it? This time I saw Jesus right past me like, God. Yes, Jay, Jay, Jay, Jay.
00:13:46
Speaker
He ain't say nothing, but he won't pass. I saw him. So, you know, life has gotten better. We don't know. Amy Jo got the eye. Amy Jo got the eye because she was like, she was like, Ayyada's baby face. Ayyada's J. Ayyada's J. I'm like, whoa, whoa, whoa, whoa, whoa, whoa, whoa, whoa, whoa, whoa, whoa, whoa, whoa, whoa, whoa, whoa, whoa, whoa, whoa, whoa, whoa, whoa, whoa, whoa, whoa, whoa, whoa, whoa, whoa, whoa, whoa, whoa, whoa, whoa, whoa, whoa, whoa, whoa, whoa, whoa, whoa, whoa, whoa, whoa, whoa, whoa, whoa, whoa, whoa, whoa,
00:14:05
Speaker
Yeah, that used to be trying to record the whole concert. But you know why? But Jay walked out at the exact right time. Because as soon as the concert started, all of our attention is on the stage. And then that's when he walked by, with Blue and the whole crew. They all walked by. I ain't seen Miss Tina.
00:14:20
Speaker
No, I didn't see Martina either. So yeah, they come out, they come out once she gets started so that, because people at that point are like looking at her. So they're not really paying attention. The lights have gone down and everything, but I was looking. I paid attention to everything. So yeah, it was, it was good.
00:14:53
Speaker
who has the event, but I still want to, and oh, I know who has it, but the person who has it does not want to talk about the syphilis that's out here in these streets. No, I don't. And when you're talking about summertime shy, this is not against Chicago right now. I can talk about syphilis, it's okay. We always giving people bad, we always giving people bad news about STDs. Listen, I don't want that too. We always breaking bad news, always. Breaking news, breaking news. Yo, look. We talking about for people.
00:15:22
Speaker
Look, the World Health Organization that ended the pandemic and people outside, I just want them to know it ain't safe in these streets. It ain't safe, it ain't safe. Put your loins up, okay? What was it? Dr. Chris, what was the numbers? I think it said 128%. Hold on, let me tell you. 128% rise in syphilis cases in Houston area linked to pregnant women. Yo.
00:15:50
Speaker
Y'all raw dogging, obviously, because she gets syphilis. I mean, look, I know you're outside, but all I'm telling you is that it ain't safe this summer, OK? Every summer, it gets progressively worse. Two summers ago, we had an drug-resistant gonorrhea. It's still there.
00:16:10
Speaker
Now we got this increase in syphilis. And listen, we don't always test for syphilis. So you could carry that for a little while. I'm just saying. I was just telling y'all about the, I've seen a case of lymphobranuloma venereum, venetia.
00:16:30
Speaker
All I'm telling y'all is listen cuff and season need to come a little bit earlier. I know it's hot outside And you know, I can't say we outside no more cuz I'm outside with my husband but She clashes the ring across the screen
00:16:50
Speaker
But y'all, man, it ain't safe out here. So I think y'all need to cuff a summer buddy, right? Like make a pack. Get a roster, man. No long rosters this summer because it's stuff out here that you can't give back this summer. And I don't want it to be the summer, the summer you saw Beyonce and you couldn't give back what you got after the concert. So please, please, please protect yourself. Guard your loins. Or get you a really good summer buddy that's like, listen,
00:17:20
Speaker
You need to be outside. I need to be outside. We want to go outside separate places. I'll meet up with you later. Let's get this STD test checked at the beginning of the summer. Let's commit to, you know, a little deal, package deal, and then let's go on if you must. A little package deal. I love it. No, a little something. Just make some deals, y'all. A little pact that it's going to be all together. You need a summer pact. Yeah. I mean, that's cool. Yeah. COVID's still out here, so you can't actually be busting the slide with everybody because
00:17:50
Speaker
Ooh, I am not at the, you know, people be sharing drinks. I'm like, I'm not there yet. I'm not there. I wasn't even really sharing drinks before COVID low key. But like, even if I was, I'm not there yet. Yeah. No, I don't want to taste it. It's okay. I'll get my own. I'm good. Oh, you said it's good. No, it's cool. I'm gonna order my own. I got it. I got it. I trust you. Let me order me one. Yeah, exactly.
00:18:17
Speaker
Give me one of those. I want one of those. Yeah, so no COVID plus gonorrhea plus syphilis. I mean, it's a bad way to live. Oh, that's horrible. It is. And I got a few cases. I'm still sprinkling cases in of COVID. So, you know, contrary to popular belief.
Heatwave Safety Tips
00:18:34
Speaker
We met at a couple of COVID mnemonias like two, three weeks ago. I had seen that in a very long time, but they
00:18:42
Speaker
Sure enough, they had it real bad. Yeah, well, you know, because they come in waves. It's like here, like you thought you thought I was gone. You forgot about me, but oh, you know, oh, you don't. Yeah, right. So this was just a wave of three and not like.
00:18:57
Speaker
hundreds, so thousands? Yes. Yeah, I'll take that. I had to cancel somebody today because they had COVID and they were like, man, I really want to come. I've been waiting so long for this appointment. It was a new patient too. I felt bad. But they had COVID and I was like, look, we'll squeeze you in someplace else, but you can't come. Not today.
00:19:15
Speaker
No, it's OK. It's OK. We can reschedule. We can reschedule. Don't worry about it. We got you. Listen, I'll be telling them. I'm like, listen, my nurses can look out for you. If there's a cancellation, they'll call you. They'll figure it out. We'll get you in. It won't be another three-month wait. Maybe another couple of weeks. But we'll figure it out. We'll figure it out. Yeah. We got you covered. Don't squeeze in here. So it is cool. I got to tell you guys about the case. I just remembered since we were on the COVID topic. So this lady came in.
00:19:42
Speaker
And, you know, she, she had like fever, cough, runny nose, whatever, like, you know, at this point, like a bunch of hospitals are not doing the mandatory COVID testing for you to get up to the floor. And I think, I think at some point people were just like, Oh, whatever, surprise, like pneumonia, just give her the antibiotics. And I'm like, you know what, COVID is still here. Like she fulfills all the criteria for it. Let's throw on a nose swab just to
00:20:09
Speaker
And sure enough, she had, she came up and the time that it took for them to do the swab and the time she came to the floor, she went from saturating on room air to like five liters. And of course, when she was in her room, she was called the positive. So my, you get in Decadry, you get room desert, you get in the kitchen sink right now. All the stuff.
00:20:33
Speaker
If I, in like an hour or two hours for her to get up to her room, her oxygen levels had dropped so much that she required, you know, supplemental oxygen. Like that's what COVID can do to you. So just, yeah. It didn't drop any further, otherwise we would have had.
00:20:50
Speaker
we would have had problems, so. Yeah. Y'all know, hey, there is a vaccine, update vaccine coming out in about September, right? So right just in time for a flu and cold season. So there's going to be something interesting about this vaccine. So for people who have been keeping up, right, the last updated vaccine for COVID was a bivalent vaccine. We kept talking about new bivalent, new bivalent.
00:21:16
Speaker
Well, this new one is actually going back to monovalent, which is the word on the street is going back to monovalent. And it's dropping the original string.
00:21:27
Speaker
Oh, so, so the vaccine that comes out and I'm doing this off the cuff y'all because I've been reading since we've been going. I missed y'all. Um, um, so this one will, the thought process was the original strain isn't circulating as much as some other ones that are a little bit problematic that are some of the variants and different ones. And so,
00:21:51
Speaker
it didn't make sense, especially since most people who wanted to had already been vaccinated from the original strain. So this updated one is going to go back to the monovalent strain, and it's going to be focused on the latest strains that are circulating. Oh, that makes sense. So good to know, because some people are going to be like, why am I getting it again? It's going to be the same. Actually, this will be the first time that it's not the same, and it's going to actually be a little different.
00:22:16
Speaker
So for people who are on the fence, they're like, I'm exhausted. I can't figure out why I need to keep buying the same thing over and over again. This one will be a little different, just for people who are curious. Now, of course, we do know that the vaccine waxes and wanes. That's cool. But do you have some protections? Yes, you do.
00:22:34
Speaker
And so while we encourage people to get it, I also don't believe in scare tactics. I do think you are somewhat protected if you've been vaccinated before. So I don't want to pretend like you're just out here vulnerable. I want people to know the data so you can make decisions about if you want to get vaccinated or not. So September is coming. Enjoy your hot girl summer, wear condoms. When September comes, get your vaccine should you choose to do so.
Blood Clots: Risks and Treatments
00:22:59
Speaker
Mind you, speaking of the hot girl summer, I just wanted to throw out there that the majority of the US has gone through some pretty severe heat waves. And it's really getting hot out there. And I came across an article that was just basically the basic information that most people should know, but I can reiterate it. Basically, it was an article saying that once the temperatures get above 104, it's really hard for the human body to continue to regulate itself.
00:23:25
Speaker
and it increases your metabolism by about 35% if you're outdoors for too long when the temperatures are above 104. And there are multiple states where the temperatures are higher than 104. And some of y'all are used to it, like the Texas, Oklahoma's, and them's. Y'all are used to seeing it. But then there are some other states that are getting hotter than they're used to. So I just wanted to kind of put it out there that you guys have to remember to drink water. I know there's some people out here who hate drinking water, but you guys gotta drink water.
00:23:55
Speaker
You guys got to be sure to not be outside for extended periods of time. Be cautious about your kids. Okay. I know kids it's summertime. They want to go out and play and they want to go out and play basketball. Make sure you tell them to stay hydrated, give them some Gatorade something. And if you feel like, you know, you're kind of feeling a little woozy, you know, you got to get inside or at least put like an ice pack on like the hotspots. The hotspots are basically like your neck, your wrists, you know, areas like that to make sure that like your cold points are good. Neck, wrist, chest, temples.
00:24:26
Speaker
breathable clothing, things like that. Just stay cool because we don't need any of y'all passing out. Roll talk. Yeah, I don't know. I have a bunch of friend groups that are still moving like to Texas. And I am born and bred in the Midwest. I can't fathom having two, three months of just triple digit temperatures and just like being okay with it. I would literally
00:24:52
Speaker
I just couldn't leave my house at that point. That's, that's so, that's too hot. Listen, if you got AC, you're okay. Yeah, I mean, yeah, but not in the Midwest. If we got temperatures up here like that, like not every house
00:25:08
Speaker
has like AC, like some, a lot of these houses have like window units. But I mean, I guess that would be the standard down in like somewhere like Texas where everywhere should have central AC. So cooling would be a lot. They focus a lot more on that, which is fine. We were just trying not to die under a snowbank up here in Chicago. What? Yo, it's just, actually, we haven't had a lot of really snowy seasons
00:25:32
Speaker
in the past like two or three years, which it's not terrible, but polar vortex are never fun either, so. Yo, I'm never getting over that polar vortex. I understand that's why you guys left. Yeah, I can't. Can't do it. I mean, I wasn't convinced I was staying before that, but that definitely was the nail in the coffin. I'm like, oh, no. Oh, no.
00:25:56
Speaker
This ain't it. I don't know where I'm going to live, but where it's not going to be is here. Right. And then we had to wear sweaters and end of June. I was like, this is wild. OK. I remember that. I had to wear a sweater. And I was like, this is wild. Yeah. I mean, listen, my birthday is in May. And I was upset. I was like, it's still cold. It's still cold out here.
00:26:22
Speaker
I was like, I don't understand how people do this. But the thing is, is that you actually don't have to put up with that. You actually could just live somewhere where the temperatures are mild, and you could just live in a major city where things are vibey. If you can afford it, yes. Come through. Come through.
00:26:43
Speaker
Listen, but to be honest with you, I actually like the Mid-Atlantic weather pattern as well because I feel like they get all the seasons and the seasons are in the appropriate ratios and none of them are too extreme. So like, you know, the Carolinas, Virginia, I feel like they do a really good job of getting all their seasons and then doing nothing lasts too long. And I like that.
00:27:05
Speaker
I like that. And they even have a true fall, you know, because I really do like fall and the East Coast does fall the right way. The Midwest falls too quick. And of course, you know, we don't really get one over here.
00:27:29
Speaker
Hey, we are talking about blood clots. So. But I ain't Jamaican, man. Why would you do that? Why would you do that? That was hilarious. And I didn't even know you were going to say that. You know I would have helped you. Yes. Listen, don't be putting me on at night. It's late. I'm going to have a crazy week. Don't put me on it. We're talking about blood clots.
00:27:59
Speaker
So blood clots, we're mainly talking about the blood clot that you get in your lungs and in your leg. So when you have a blood clot in your leg, it's typically called a deep vein thrombosis. And when you have a blood clot in your lung, it is called a pulmonary embolism. Because usually, most of the time, when you have blood clots in your lung, they can break off from blood clots in your legs and travel up to your lung and cause a lot of issues. So essentially, what are some risk factors for you to get a blood clot?
00:28:30
Speaker
There are actually a couple. We use a criteria called the Wells criteria to kind of see, um, score probability of you having a blood clot. But usually if you tell us you have one of these few things and you're at higher risk for a blood clot. And that's usually things like if you had any provoking factors, so things like surgery, recent trauma, if you've been like sitting around the house and just been in mobile for like days or weeks, even.
00:28:58
Speaker
And usually that's something you get after surgery. Like if you had like a knee replacement or a hip replacement, you're actually a lot higher risk of getting a blood clot after surgery. And most of the time, or some of the time you'll be put on some prophylactic blood thinners to help prevent that from happening. And other big things like if you're on hormones. So previously we used hormones for
00:29:21
Speaker
some other things to help, you know, symptoms from menopause or things of that sort. And the certain hormones can actually increase your risk of developing a blood clot. And the biggest thing, probably the most common thing that we see when people come into the hospital is usually if you have some form of active cancer, some cancer is probably more, but usually we kind of clump them all together. If you have some form of an active cancer, you're at much higher risk for developing a blood clot. Yeah.
00:29:51
Speaker
So, and then I talk about meds, diagnosis, things of that sort. I usually see blood clots a lot more in my practice, just because if you guys probably see someone with like a swollen leg and they have one of those risk factors or, you know, symptoms that, you know, they're breathing hard, they're short of breath, you take their vitals, their oxygen saturations are low, like low where they need oxygen, then they're usually coming straight to the hospital.
00:30:19
Speaker
So I don't know if you got, I mean, I remember in our clinic, we did have a guy that cut, came in to Inglewood and he, if I remember this one, he did not move from his house. Like he didn't move around his house at all for like two weeks. So he was like sitting for like two weeks straight and then came in to our clinic and his like, his right leg, his entire right leg was swollen. Like you can think of like an elephant Titus type leg, which is like really big.
00:30:50
Speaker
like really big. It literally, it don't literally look like that. So he was kind of talking to him. He was telling me his story and I'm looking at his leg and his calf was like hella tender. It was red. I'm like, giving your history. This probably is a blood clot, but sometimes cellulitis, which is an infection of the tissue can actually present like that as well. So
00:31:13
Speaker
Given his fines, we sent him in. I chart stalked him and he did get an ultrasound done to show he had a really, really big blood clot. So I don't know if that's happened to you guys in clinic. It would happen every once in a while, but. I mean, I've had some clots in clinic currently, but I don't know if I've had anybody just was, I'm surprised I didn't get a clot after residency because I'm pretty sure I laid a rindy and nothing for like two weeks straight.
00:31:37
Speaker
Well, I get, I've gotten a lot of patients that come in because they think they got clots. And it's usually because sometimes, yeah, they don't. But another risk factor is obesity. So that is also a big risk factor too. And usually you have the, it's usually one leg that is swollen more than the other. So, and other things like having,
00:32:04
Speaker
being on like a long flight and not getting up, those are some risk factors too. You gotta ask all these questions, right? And a lot of these patients, they're like, oh, my leg is big. So I think I have a blood clot and they're scared. So sometimes I'll do the ultrasound to check. And a lot of times sometimes it's negative, but there's sometimes it can be positive. So it's one of those things that you have to really tease out and see the risk factors and tease out the story to kind of determine.
00:32:32
Speaker
Do you guys have an imaging center in your clinic? Do you have bedside ultrasound capability? No, but we're able to get a stat ultrasound if you need it. If they meet the criteria, you can usually get a stat ultrasound outpatient that same day. Depends on what time they come in though, right? Nothing worse than a 340 patient that comes in and they need ultrasound. You can't get it then. You got to send them over to the emergency room, to the ED.
00:33:01
Speaker
But if they're in the first half of the day, then technically you can order it as like ASAP or stat and have your team call and put it in so that you can get it. But it's got to be planned out. But you do see a fair share of them in the office.
00:33:21
Speaker
And I mean, I don't know if you're gonna get to talk about this, Dr. Noah, but also even there are some that are blatantly obvious, right? Like the guy that Dr. Noah is talking about. Yes, but sometimes it's not. And I will never forget this. I remember this was like in the beginning of like COVID.
00:33:41
Speaker
This person was new to me. Um, they were coming in and they just had kind of non-specific things. You know, my shoulder hurts a little bit, my arm, something like that. And, but you know, wasn't short of breath. Cause since, you know, they had said they'd had COVID like you short of breath and you know, anything blah, blah. No, no, no. My arm hurts a little bit, you know, blah, blah, blah. Man, she had a, so two days later she saw me, she did get short of breath. She ended up going to the emergency room. She had a large PE.
00:34:08
Speaker
Wow. I remember this. Yeah. And she was hot. She was hot. Excuse me. Did you not hear me tell you about my arm? And I was like, I did. I was like, yo, I heard you. And I documented. I was like, you can go back and read my note. Nothing that she said was not documented. But even when you see them, they're obvious. You do have to stay on it because sometimes the information is just not very specific, right?
00:34:36
Speaker
So she was not tachycardic. She was not hypoxic. She had some nonspecific arm pain. But two days later, there she was. And I got it. She was mad. I think she came back to make sure that I knew she was pissed off. And she's mad. They didn't come back no more. Yeah, but those are the hard ones. But those are the hard ones. They're so hard. Because if you don't have certain things,
00:35:03
Speaker
That's another thing that people don't understand. If you don't meet certain criteria, you can't necessarily get the imaging outpatient to really rule these things out, right? Because I'm not thinking that you have a blood clot in your lung if you're not
00:35:18
Speaker
tachycardic, meaning that your heart rate is really high, or hypoxic, or shorter breath, or anything. Your oxygen level is low. If you don't have those things, I'm not really thinking that, right? So if anything, if I'm going to do something, I'm probably going to check if I disrespect the cloud. I probably think it's in your leg first before I think to do anything in your chest, right?
00:35:41
Speaker
Yeah, it was my first like post COVID clot, you know, right is that kind of was becoming a thing. I think once we realize that you come a little bit sensitive to it, but I think about that person a lot. And I'm like, I still would have like, that wouldn't have been my first guess. So clots are not always easy to catch. So, you know, I generally tell people to be, you know, vigilant, give us all the history, all the data, as much as you can, because
00:36:11
Speaker
You know, everybody's not going to walk in with one swollen leg. Oh, look at this leg. It's super big. I've been sitting down for two weeks. I don't know what's going on. Some people, I'm like, you know, we're just out of other options. We've tried everything else. So let me just scan you. And you're like, what is that doing in there? So, yeah.
00:36:30
Speaker
Well, I usually err on the side of caution. So like, even if I don't suspect it, I tell them, I don't have a high suspicion that this is what it is. But because you are concerned about this and do an ultrasound, I'm like, let's do it. You know, cause. I mean, it's kind of, it's kind of a way that we think a little differently in outpatient and inpatient. Cause I'm, if you're coming into the hospital, there's obviously something wrong enough where you probably need to be hospitalized. Right. A blood clot, sometimes you can actually give, um,
00:37:00
Speaker
as which we'll get into treatment later, if you have no other risk factors and you have extremely good follow-up, I have seen some ERs will give like a course of a blood thinner and then have you follow up with the PCP. I have seen that. But if you have like more complicated history, you have a higher risk blood clot, like if it's like
00:37:22
Speaker
This is all medical stuff, but depending on the size of the blood clot in your lung, if it crosses over into the lung, if it's big enough where it causes your blood pressure to be really, really low, you need special medications. And sometimes you need special therapies to actually go in and remove the clot. And you are in the hospital, almost all the specialties, cardiology, pulmonary, interventional,
00:37:49
Speaker
cardiology, all of them are on that case because if that clot gets any bigger than you, it can stop your heart. You can't die from it. So it can, it can really get to be that serious. So people are like, Oh, it's a little blood clot. I'll go away. No, like these blood clots.
00:38:03
Speaker
these can kill you. The other thing is, if you have a family history of clotting disorders. I was just gonna talk about that. No, no, you are good. No, no, no, I was just gonna mention that. I'm happy you mentioned it. I was gonna mention that and also the increased risk of clots with COVID. Those are probably the two that we haven't really touched on too much, but go ahead. No, you're hitting it all.
00:38:26
Speaker
No, I'm just, I literally, I've been getting like PEs and DVTs for like the past three weeks. So this is like fresh in my head, but, um, no, yeah. So if you're coming in, like, if you have family history, so I remember past episodes we talked about.
00:38:40
Speaker
You know, when I come down as a hospitalist and I ask you questions like, Hey, you know, what's your past medical history? Do you have any surgeries? Do you have any family history? Um, and if I'm concerned that you may have a blood clot, I'll ask, Hey, um, do you have any family history of like, you know, people with that bleed easily or they had like blood clots, you know, lungs, heart, legs, and they're like, you know what, by the way, yeah.
00:39:06
Speaker
You know, my mom had a blood clot, my dad had a blood clot, you know, my sister had a blood clot, blah, blah, blah. And if it's a pattern that's pretty significant, then you kind of dwell a little bit deeper. Like I love my jogs. I can play Sherlock Holmes every once in a while. I'm playing Sherlock Holmes at like four in the morning, but still, you know.
00:39:26
Speaker
My, my brain is sharp. So, um, but yeah, those are questions you have to ask because family history is extremely important. Um, cause if we need to test you for like thrombophilia, if you're missing a clotting factor, um, missing, um, yeah. So if you're missing like a part of the clotting cascade, then, you know, those are tests that we'll need to run. And then those are things that you may need lifelong blood thinners for.
00:39:52
Speaker
which no one wants, but like I said, these clots can be very deadly. I've ran the test a few times in my office because there's some patients where either, and there's a couple other conditions that could cause you to clot more often, especially certain autoimmune conditions. We can dive into that if you guys want to, like lupus and such.
00:40:14
Speaker
When it comes to the testing, because we can do the testing outpatient, I do have some patients where, like Nono said, they just have multiple family members who've had clots. And I'm like, did anybody ever investigate why they had the clots? They're like, no, not really. We just keep it pushing. I'm like, no, no, no, no. I'm like someone needs to be tested. There's too many people on this same bloodline who keep getting clots, and it doesn't make any sense.
00:40:38
Speaker
You know what I mean? Yeah, especially young. I'm like, this is young, don't have any other reasons or health conditions or anything. So yeah, but long story short, there are certain there are certain genetic mutations that you can have. And we can run a blood test for that to see if your body is more prone to clots than someone else's.
00:40:59
Speaker
Yeah, I don't know if we mentioned birth control. Yeah, she did. She said hormones. I said hormone therapy. I was thinking just straight hormones, but yes. I mean, birth control, the different options in it can also increase your risk for blood clap.
00:41:14
Speaker
Okay. And not, and not all, not all birth control and not all hormones, specifically estrogen products specifically. So that would be your pill, your patch, your Nuva ring. Uh, what am I forgetting? Pill patch Nuva ring. Yeah. Yeah. There you go. Yeah. So keep note of that. So yeah. All right. So I think we touched on those top top ones. So medication. So.
00:41:43
Speaker
You come in to your PCPs office, you come to the hospital, I got a swollen leg, I feel short of breath. How we diagnose you, we usually get an ultrasound, which compresses the veins in your legs to see if there's any issues with compressibility. And then that's usually how we diagnose a DVT, a blood clot in the leg. And then usually if you're coming in, the suspicion is a super high that you probably have a blood clot in your lung. We'll just send you straight to the CAT scanner. And they take a really fairly,
00:42:12
Speaker
sophisticated picture of your chest and looking at the, um, the pulmonary arteries. And then they'll give you dye to help kind of light that up. So when you look at the scan, you can see that you a blood clot, like it could go all the way out to the sub segmental branches of your lungs, the segmental bigger branches, or it can be what we call a saddle, which is a really big, um, blood clot that sits like right in your, in your, um, pulmonary arteries, in your heart, heart lungs. So yeah.
00:42:41
Speaker
So essentially, so we see that again, the treatments are a little bit different. So we're going to just talk about regular, you know, blood thinner treatment for people that come in. Every hospital policy is a little bit different, but sometimes I know with my hospital system, we usually will put people on a heparin drip. So you're like, why am I being hooked up to like this medication that can like thin my blood and I can bleed out any minute?
00:43:07
Speaker
It's not, it's not like that. So the, the medication specifically made to help break out the clots that may be present in your lungs and your, in your leg. And then sometimes, you know, we'll continue that, uh, the drip until we can get you onto an oral medication or the one that's injectable so you can inject yourself at home.
00:43:26
Speaker
with current, you know, ways of, you know, it's easier, a lot easier to take a pill than take a needle to the arm or to the leg or whatever. So usually we're going to discharge you home on like a pill that you will continue to take. Again, if it's a provoked blood clot or a non-provoked blood clot that will typically determine how long you're on this blood thinner for. So yeah.
00:43:48
Speaker
Now, so, you know, people always ask me like, how long is it going to take the medicine to dissolve my clot? But technically, blood thinners don't dissolve your clot. Blood thinners are there to prevent sequelae, right? You already have a clot.
00:44:14
Speaker
that clot has formed, it has hardened, it has stuck somewhere in your system, and we're trying to get that to go. It's the reason why Dr. Noah is talking about, you know, if you got a pulmonary embolism, a clot in your lungs, if it's big enough
00:44:29
Speaker
then we're not giving you drugs for that. We've got to remove it, right? You still end up on blood thinners after we remove it because we're now trying to prevent another clot from forming or more clots from sticking to the current clot that's in there.
00:44:44
Speaker
And I say that because people will come back and they'll say, okay, it's been three months. You put me on this medicine. I had this DVT or I had this PE. It's time to stop it. Are we going to take a picture to see if it's gone? And that's not what blood thinners do. Blood thinners prevent worsening of a clot that's there that we don't remove and make sure that other ones don't form. That one is going to be there and it actually can take quite a long time.
00:45:11
Speaker
for it to go away. It's going to go away slowly over time. And I think it's important to know that because I think people get super freaked out and they demand a repeat clot. And listen, we might be doctors, but we're humans. We fold. Some people fold and be like, okay, I'll do what you'll feel better. But it creates a therapeutic nightmare. We've all been there, right? Somebody got a clot and
00:45:37
Speaker
They did their therapy and then somebody repeated the CT to see if the clot was still there and it was still there. So they extended the blood thinners and then they did the, somebody repeated again, it's still there. And so then you end up with this poor person that's on blood thinners for life because now everyone's scared to like change the therapy. So listen, it's gonna go away. What we're trying to do is make sure you don't have another one.
00:46:05
Speaker
Yeah, because typically if you have one, you know, you're on it for like, what, the blood thinner for like six months. If you have two, then it's like, it's a wrap. You're going to be on it. You know, it's interesting because technically the literature leaves it a little ambiguous, right? It does. So it says three months, but if you keep reading a couple sentences down, you can do it as high as six months. And then they'll say, you know, two months.
00:46:29
Speaker
three to six, right? They don't, they don't give you that you should go for this time. They say three to six depending on what the clinical circumstances are. Yeah. Yeah. And that's why it's also kind of a point with the provoked and unprovoked because provoked meaning that there was, you know, the reason why it had it, why the person had it, like, Oh, they were on
00:46:48
Speaker
birth control when, you know, that's what caused it. They were on birth control and had a long flight and then got COVID. So that was the reason, right? Exactly. So that's the reason. But unprovoked is kind of like, well, you don't know how they really got this. So all of that matters. There are some special circumstances. So there is different in the nuances of like, which blood thinner is purely up to your doctor. The literature is pretty clear about
00:47:16
Speaker
which blood thinner you would use for each situation because if you get a clot, say if you get a clot from like a cancer or like a heart, a funny heart rhythm, so something like AFib or something like that.
00:47:30
Speaker
The blood thinners that you use for those situations may be different and your doctor will explain to you essentially why. But another thing are, it is possible because people are like, if I'm on a blood thinner for life, then I should never get another blood clot, right? It happens. It does happen. So, you know, it's not, no medication is foolproof. Like, not saying that it's like,
00:47:57
Speaker
It's like saying everything in life is 100%. So there are situations that can arise where it's not very common, but you can get another blood clot, even if you are taking one of the oral blood thinner medications. That is possible. If that's the case, you probably just need a modification of the dose, or there's many other blood thinner medications within that family that you'll probably end up making the switch to.
00:48:22
Speaker
But that happened so very rarely. So just a heads up if you do this. That does happen to you. That did happen to you. Another thing, so also very important because people actually end up in the hospital from this as well. So if you're on a blood thinner, there are some precautions that you need to look out for. So by God, if you fall and you hit your head and you pass out and you were on a blood thinner, please take your butt to the nearest hospital right away.
00:48:53
Speaker
like if you if the fall was severe enough for you to lose consciousness you know that is and you are on a blood thinner we have seen catastrophic
00:49:03
Speaker
brain bleeds from very, seemingly very minor falls when people had been on a blood thinner. So that does happen to you. You need to come into the hospital, but you're like, Hey doc, I'm on a blood thinner for this blood clot that I have in my lung. Like if I had to come off of it and I have a bleed, like what are they going to do? So you're like, Oh, well, I mean, obviously, you know, we're just going to leave the blood clot there.
00:49:28
Speaker
Not the case. So if you do have any complication from a blood thinner, you have a history of developing blood clots in your leg or lung, whatever, the doctor will have a good conversation with you about getting something called an IVC filter. So it is exactly the description is what it does. They take a literally a little filtering device. So it kind of looks like a
00:49:53
Speaker
I don't know, like an upside down palm tree mesh. I don't know. How would you guys? Yeah, that sounds like a little upside down and grabber. What's best on it.
00:50:01
Speaker
Yes, right, exactly. So they put that in the big inferior vena cava, so it's a big vessel on the side of your body, and that will actually collect any clots that may break off from your leg. If you do have a leg clot, it'll collect or prevent those blood clots from going up and going into your lung.
00:50:23
Speaker
So essentially the blood clots, if you do have blood clots in your lung, those will eventually go away. But if you are at risk for developing blood clots, because they usually come from your legs, at least the IVC filter will prevent those clots from causing issues and ending up in your lungs. So if the doctor comes to me like, I got to put a filter in you, they're like, put a what? You know, that's essential. And usually those are in for forever.
Addressing Recurrent BV Infections
00:50:50
Speaker
So yeah.
00:50:52
Speaker
Any of our older listeners, when we do have to choose a blood thinner, typically we like to go with Eliquis, which is twice a day dosing, even though they don't like it. It's a little easier on the organs for the older patients, easier on the organs than like a Zarelto, so on and so forth. We really try to get, I haven't seen a patient on Warfarin in so long. I have so many, I don't want them to go to Eliquis, it's so bad. Yeah, there's a couple of them. The ones who I have seen on Warfarin,
00:51:21
Speaker
They've been on it for a long time. And they usually don't want to switch over. But Warfarin is still used. It's out there. Zarelto, Eliquis, is what I'm forgetting. It's OK. It doesn't matter. But point is, Dr. Ruchis is right up to you. Well, you don't usually discharge Pradaxa. Yeah. I have some people on that. Yeah.
00:51:46
Speaker
Oh, one thing. So the nice thing about one of these, this is a nerd tip if anyone cares, but the newer oral medications, the blood thinners, so you don't have to do levels on those like you do warfarin.
00:52:01
Speaker
But the thing is that Warfarin has been around the longest, maybe? Heparin is longer, I'm not sure. But Warfarin is the one where you actually have blood tests that you need to go in periodically to make sure are within therapeutic range. So usually a lot of primary care clinics, like you don't have to keep coming to the hospital, there is.
00:52:20
Speaker
A lot of primary care clinics will have a center where you can go in and get your levels tested and make sure you're therapeutic so your doc can readjust, you know, your levels as needed. And pharmacy teams are amazing for that. So thank your local pharmacist for helping also make those readjustments and giving our little PCPs here a break. They are, but so many things interact with Warfarin, so it's pretty annoying.
00:52:47
Speaker
Yeah. Like food, medicines. So that's why it's just so much easier since they came out with Eliquis and Zorroto. And now it's a little bit more affordable for people. So it's just so much easier to just be on it and don't have to monitor. Right. Right. Yeah. So that's all I got.
00:53:21
Speaker
What's the question? The questions. It's the question. I knew it was going to come. I knew you were going to come. I knew you were going to come. Come on. The question's going to come through. I heard you with the questions come over. OK. OK. OK. Because you saw Beyoncé. I have no questions tonight. Questions come on over. Yes. The Beyoncé edition. Right. All right.
00:53:51
Speaker
Here's one question. Hey, ladies. Love the show. Thank you. What should I do if I keep getting recurrent BV infections despite doing everything I can? Oh, I think that's a good question. I've got a lot of patience. Well, I don't have a lot. I got a few people. Well, this is a hard question. This is probably your sunshine question, because this is her niche.
00:54:19
Speaker
It depends on why you keep getting them. I think it's the first question. And the why is probably the most important thing to figure out because it's going to direct traffic. For a lot of my women, there is a new partner. And even if it's a committed partner, right, because for y'all listening, I am not saying this is
00:54:42
Speaker
something's happening. I've seen it in cases where from what we can tell, both partners are in a committed relationship. There is no extracurricular activities going on, but for whatever reason, the skin flora on the partner skin
00:54:58
Speaker
And the vagina of the person that's complaining is not, it's just not vibing. The pH is always thrown off and we don't know what to do. In that case, you know, if we test you, if we test you a couple of times, it comes back positive. We treat you, we can in some cases put you in a longer therapy of metronidazole. Sometimes that'll work. It does not always work. I typically encourage my patients to use condoms.
00:55:25
Speaker
very strictly for at least six to 12 months to see if we can get this to calm down. Everybody looks at me like I'm crazy and I'm like, I feel you, but what do you care about most? Irritated.
00:55:41
Speaker
fishy vagina because of BV, or having to use condoms because you still get to get laid, right? And so most of the time I will tell them to do that. If it's just happening because, and this also counts for my LGBTQ, because every now and then I'll get to women and say, but I'm not sleeping with a man. My partner is a woman. I still think the same thing applies if you're using hands, fingers, toys,
00:56:09
Speaker
Anything that penetrate the vagina, if that's not covered in some kind of protective anything, then you need to practice those things, right? There is dental down for oral sex. You can use, you know, they used to have the little finger condoms for like, you know, digital penetration. Anything like that, I would tell women to use for the next six to 12 months to see you can just get the floor to calm down. Sometimes that works. What you think, Dr. Sun? Yeah.
00:56:38
Speaker
Oh, I didn't mean to cut off. Were you going to say something, Dr. Chris? No, I was going to say also sometimes with the therapy, you do a longer course of the metronidazole and also do that boric acid also for a couple months. I hate boric acid. It's supposed to work, but those treatments are like, it's hit or miss. Sometimes it works for people and sometimes it really doesn't. So it is tough to treat.
00:57:00
Speaker
So in our women's health clinic, we actually have, I don't know if you guys have this, but we actually have an expanded swab. We have an expanded swab where it can test patients for really resistant forms of yeast and for lesser, kind of lesser known bacterias that could also cause you to have BV.
00:57:22
Speaker
And I do also have the privilege of working in a women's health clinic. And I also work side by side with gynecology. So we have a lot of extra swabs that a lot of PCP clinics don't really have. Because sometimes you'd be surprised by the resistant types of yeast, especially with recurrent yeast infections, and also the lesser known bacterias that can kind of just keep lingering around. And they're just not as common as the ones that cause typical normal BV.
00:57:48
Speaker
Like the megasphere. That comes up a lot on mine. We do do that. Well, Guine will do them. And so the megasphere bacteria will come in and I will see Guine say, okay, this is a megasphere. It's causing BV and they will do a longer treatment.
00:58:06
Speaker
You know where it might come up if you don't have the really detailed swabs? When you do a pap smear and you send off the cytology, and sometimes cytology will say, hey, the cells look normal, but we saw a hint of insert random bacteria, and you're kind of like, what's that? You Google it, and you're like, oh, this is one of the lesser, lesser causes of BV.
00:58:30
Speaker
And it's not going to be picked up on the typical swab, because the typical swab is usually looking for three, four things, not too expanded. But there are other bacteria that can cause BV. And they might need a different type of treatment as well. So that's always something to think about. I completely co-signed everything Amy Jo said and everything Dr. Chris said. And I don't know if I have too much more to add to that.
00:58:55
Speaker
I do have a question, though, for y'all as providers, because I am currently working with another doctor in my practice, and they swear by metronidazole gel and never prescribe the pill. I mean, I feel the efficacy is the same.
00:59:16
Speaker
No, no, no, no. I thought that the efficacy will see y'all listen here. This is welcome to medicine. I thought the efficacy was better for the oral treatment than the jail. Correct. That's what I was under the impression of. I have used it before and let me tell you when.
00:59:32
Speaker
I had a patient that would not finish because they were like, I'm outside, I'm trying to drink. And they kept restarting, right? So I would put them, and the problem is, it's a long treatment, right? So it's seven days.
00:59:47
Speaker
And so they would see me on a Wednesday, we would start the treatment, they would go away and they'd come back three weeks later and say, well, I did it, took it Wednesday, Thursday. And then I stopped it Friday, Saturday, Sunday, and I figured I couldn't start it back up again. And so they kept doing that. And in that case, I gave her vaginal metronidazole so that she could enjoy alcohol without stopping our therapy.
01:00:12
Speaker
But technically, it's a fine treatment. But on the technicality, the oral is a more effective medication than a vaginal. That's what I thought. But it does come with the side effects. You cannot drink. I just want to add, because people may not know. This is a very commonly tested board question. If you drink alcohol while you're taking the oral form metronidazole, you will literally be sick as a dog.
01:00:41
Speaker
It creates a disulfram reaction. And that literally just means the worst hangover, multiply that by a thousand, maybe a million, because that's literally how bad it feels. So we literally do not
01:00:59
Speaker
Do not drink any alcohol while you're taking the oral form as medication, or you're going to regret it immediately. Well, I normally prescribe the pill most of the time anyway. Some people ask for the gel, so I give them the gel. But for the most part, that's what I, I just give the pill.
01:01:19
Speaker
So do I. Pill's my go-to. I'm always like, Jill, I'm always like, man, this is not going to get it done. And then I got to wonder if it worked the way it was supposed to. Then they going to come back for another swab. It's going to be, I'm like, mm-mm. We just, we going to skip all of that. We going to skip all of that.
01:01:35
Speaker
But I will also say just know that, you know, I feel like if I were just a typical PCP and if I didn't work at a hospital, I also work in a hospital and I also work like next to OBGYN. But if also typical PCP and I have a patient who keeps getting ongoing, ongoing recurrent BV over and over and over again, I don't think it hurts to at least send them to gynecology at least once. So the gynecology can kind of dig a little bit deeper, use some special swabs, kind of
01:02:03
Speaker
Just kind of at least for a one-time thing just kind of as a console To get some guidance and then some it might help it might not maybe this be be that that recurrent BV is tough Especially when it's partner driven Because almost in every situation when it's partner driven is not a partner that they want to get rid of
Engagement and Closing Remarks
01:02:25
Speaker
You know, like if it was somebody that was casual and you'd be like, yeah, right. That's fine. I ain't gonna fool with him. I'm not gonna mess with her anyway. We're good. But it's always like two people that are like trying to like really establish a relationship and it is just like, it's off. So, and I'm always a little hopeful.
01:02:45
Speaker
I'm always a little hopeful that maybe we don't know that there's an extra partner in there somewhere and that is playing a role in what's throwing off the pH. Look, because people date casually all the time, right? Like nobody necessarily wants to give up their roster until they know for sure. And so there's always a little part of me that's hoping like, maybe, maybe this is going to get better. For some people it does, but there's always that one group that they're like, it never got better every time we have intercourse.
01:03:11
Speaker
I am irritated afterwards and I have to start the whole cycle over again because I cannot imagine having to use Metro every month. Yeah. And some people get it consistently and they're not even sexually active. So it just happens. And I think it's probably, that's partly could be related to what they're eating and their diet or just that, that's just how their flora is. It's just, it's just.
01:03:37
Speaker
I was going to say I've even sent some patients to gynecology and you'd be surprised because sometimes gynecology might even take like biopsies of just like the vaginal canal just to kind of see like what's going on in there. And sometimes they'll find something like if you have a condition where let's say you have like
01:03:52
Speaker
There's a certain condition called lichen, like L-I-C-H-E-N, like lichen planus, but of the vaginal tissue. Then that means you have ongoing inflammation, ongoing changes. And we talked about this in other episodes. Anywhere where you have ongoing inflammation, anywhere it makes you more prone to infections.
01:04:10
Speaker
So there's little things like that that we could be missing. And you might just need deeper investigation. That's all. Because I'm not doing a vaginal canal biopsy in my office. I'll be real with y'all. I'm not doing that. We're not doing that. I'm not doing that. Not in my office. Go someplace else.
01:04:29
Speaker
I don't, I don't even know. How do I even go for that? I don't even know. I'm sorry. I can't, I literally cannot do that. Oh man. I missed a goal. Golly God. See y'all are so, y'all are so riveting that I just miss, you know, shout out to the, shout out to the U S women's national team. They are in the world cup. We just scored another goal three. Oh, uh, sorry.
01:04:54
Speaker
It's OK. I think you got to wrap this up. That's no, but it's cool. I can talk to you forever. They can get my chocolate kiss on over there. Yeah, but they can get my chocolate kiss because I love me. So we're there. I think one question is good. We'll do the next question. Yes. Yes. Your chocolate kiss is for the women's.
01:05:12
Speaker
U.S. Women's National Team. I love them. Listen, I'm a past soccer player. I love me some soccer. They trying to 3-P and this team is full of much more melanin than before and they look so good. They so crisp. We up 3-0 right now.
01:05:27
Speaker
My chocolate kiss actually goes, since we're on that route, my chocolate kiss goes to coach Joni Taylor and the U19 USA women's team that is currently in Spain competing for the FIBA championship. So they are doing amazingly well. They have won every game they've played. I think they've got about, I think, I think
01:05:50
Speaker
quarterfinals is where we are at this moment, the quarter or the semi, everyone's the quarterfinals. So here's to the U19 USA women's girls and their fearless leader. So all the chocolate kisses to y'all. Kisses to Joni and the girls. That's amazing. I guess my chocolate kiss goes to two of my girlfriends. My girl, their family are here.
01:06:20
Speaker
visiting me over the weekend so we're going to go see Beyonce on Sunday. It's so funny because going from the bottom we're literally, well actually we're going from the top now down to the bottom and that would be floor seats so we've been through a lot and this kind of very restorative trip for all of us and we're both, we're all really excited for the concert just happy to
01:06:49
Speaker
be with each other once again. So shout out goes to Marjah and Valerie. Oh, that's really sweet. That's dope. So my chocolate kiss is not necessarily going to be that. So mine is I had a great time in Nashville. So shout out to Nashville.
01:07:11
Speaker
And I had this Uber driver, she gave me all the information, like told me what broke down Nashville for me, and it was awesome. It was great. Nashville's a lady. So shout out to Nashville's lady, lady, lady. Had a great time. Oh, right. So I was not on the last recording, but apparently these girls told me
01:07:33
Speaker
After the fact about our threads, apparently threads is not with the culture, but to the whole episode and I create a threads account. So we now have a threads account. Um, uh, handles the same as our everything else. So you can follow us at, at the chocolate MDS on threads and the one that is for the culture shout out to spill. Um, we have a new threat spill page there, so please check us out there.
01:08:02
Speaker
And then as usual, Facebook, Instagram, Twitter, same thing. You want to send us questions, please check out our website, www.thechocolatemds.com. And please send us your questions. Questions back is there. Y'all be safe this summer. We'll see y'all next time.