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SEASON 3 FINALE
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All pregnant people are cute, right? 😅😅😅 Coco Gauff 🏆, Liver talk, and put down the dark liquor 🥃. SEE YA'LL IN SEASON 4!!!!
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Transcript
Season 3 Finale Celebration
00:00:17
Speaker
It's another episode of Chocolate with a Side of Medicine. I am one of your hosts, Amy Jo MD, and I've got here with me, Dr. Chris. What up, y'all? Dr. No-No. Hey, guys. And Dr. Sunshine Plus. Greetings. Sunshine Plus bonus. Yep, that's what your name is now. Plus plus bonus, boy. Dr. Sunshine Plus. She got rainbows. Rainbow, y'all. Dr. Sunshine Plus. We're all four here.
00:00:46
Speaker
We are. We are together. Just in time to close out this season. Can y'all believe this is the end of season three? I can't. Round of applause. Round of applause. Applause. Round of applause. They say if you can make it past your sophomore season, you might be doing something.
00:01:11
Speaker
Okay. Okay. Yeah. So I don't know. Maybe. How many of y'all been rocking with us for day one, but it feels kind of good to be like shout out to all of y'all that's been rocking with us for day one. We appreciate y'all. Shout out to my day one.
00:01:26
Speaker
We are, we are end of, uh, season three. It's
Season Highlights: Personal Milestones
00:01:29
Speaker
interesting though, cause this season, um, we got, we gave y'all all the highlights, right? We didn't got married folks out here having babies. We didn't save lives. We didn't, you know, bought houses. We have done a little bit of everything in this season. So it made it a little, um, you know, atypical of how we roll, but here we are.
00:01:49
Speaker
End of season three nonetheless. And I'm hoping that, you know, you all have liked the content. It's late again. So don't expect anything from me, but pure foolishness because it's late out here in these streets.
Impact of Pregnancy on Appearance
00:02:01
Speaker
For me as well. Cause you know, once you start the foolishness, I go with you. I know. Um, Dr. Chris is on a diet because she's gonna be out here in these Vegas streets. Yes. I'm so hungry. Trying to steal Kiki man.
00:02:16
Speaker
I am. I'm so hungry, but it's okay. I'm trying not to pass out. She's back with old dude now anyway. Listen, she's a mother now, okay? She got a baby. She's a mother. Right. She's a mother after all. She's a mother after all. Looking fly. Looking amazing. She looks great. I mean, looking great. I wish.
00:02:44
Speaker
Look, if that's what babies do, Dr. Sunshine about to be fine as wine out here. Y'all are fine.
00:02:52
Speaker
Yes, but you know, this is the thing though. This is why you can't sell me on a baby because it's like, it's one or two ways. It's either you look great or you don't. What do you mean? What do you mean by that, Chris? That's true. You know what I mean. That's true. What you trying to say? I'm so confused. For some women, it looks great on them. Listen, having a baby is a beautiful thing. It's a great, I think it's beautiful.
00:03:17
Speaker
But, you know. Are you talking about after pregnancy the bounce back body or while they're pregnant? What you mean? Both.
00:03:24
Speaker
What? What are you talking about? I'm so confused. It kind of happens so fast. It's like you're like, it does. It looks like something happened and they're just like, I'm over it. They're like, cute, cute, cute, cute, cute, cute over it. Right. Right, yeah. I mean, there's some people in there that don't even show like in their third trimester, which I still don't understand, but I mean, there's those unicorns out there, but proud to be. Dang, I feel like Dr. Chris out here,
00:03:54
Speaker
You really get no people. Geez. We have every bit of confidence that dark sunshine is going to be out here cute as a button. I'm just talking for myself. I'm not talking about this is what I think in my head for me. You don't think you would be a cute pregnant person? I'm afraid of the after all either way. I don't know. I don't know. I'm not sure. I'm not sure if I want to chance it right now. I'm not sure. What? Do you think I will?
00:04:22
Speaker
I think you look great. You're going to be fine. Oh, well, thanks, y'all. I appreciate that. I didn't really give much thought to that beforehand because it's really about the baby. It's not really about me, but you know. I was out here like, oh, I'm a slave while I'm pregnant. Like, no, that wasn't what I'm thinking. I mean, but I'm thinking that because I'm not, right? So I have all these thoughts. Don't worry about my thoughts. It's fine.
00:04:47
Speaker
It's okay. I mean, some people either really be like doing it up, like your sweet cousin, fellow bridesmaid, like she's out here in these pregnancies looking fabulous. Her pictures. Oh man. Oh yeah. Oh my God. I got to get that photographer. That one there. She didn't have like a photographer slash graphic designer slash. I'm like, who do you have putting you in these castles? Yes.
00:05:12
Speaker
I mean, looking fabulous. But then you do see some people and they look like they are so over being pregnant. Like everything spread, they get, you know, I think everybody gets a pregnancy nose, but some people's nose get like super spread and they're like, look at this. And you're like, it's fine. It's gonna go away, it's gonna be fine. And you're cute, you're cute. And most people be cute as a butt, but I have seen a few noses where I'm like, dang, they got you.
00:05:42
Speaker
They're the ones that look very uncomfortable and look so like they're just over it. And I think because they look over it, then you're like, dang, I'm sorry, boo.
00:05:53
Speaker
But you know what, they don't come to play though. Those women come in, they be like, what we need? We need to be just done, okay? I want my body back. How many fishes? 10 count, chin to chest? Got you. All right, let's go. They've looked at you like, why are you slowing down on the pushes? We need to get another set in. You're like, oh, excuse me, okay.
00:06:11
Speaker
Push down here. Let's go. Feel these fingers. Right here. This is where I want you to focus. You got it? Yes, they are not playing. But babies. Oh, it's going to be so cute. I can't wait to spoil your kid. Don't send your kids to my house. They're going to know how to curse and everything. I just want to tell you right now. Wow. Wow. Oh my God. You're not even going to know how to curse. Don't send your kids to my house because what? They're going to know how to curse. They're going to know how to curse and everything. She's not even going to apologize. We believe in full vocabulary is in my house.
00:06:41
Speaker
Wow. And we have big words and curse words. I'm just saying. So, you know. I mean, there is a study that people that use more curse words are actually more expressive and intelligent. So it could be Dr. Yeah, Amy Jo could be doing you a favor. I don't know about all that, because then you then they're gonna say it when they're at school, then you got to then they'll call you. You got to say it correctly, though. All right. Then you're going to be the one calling them like, I know I'll touch you better than that.
00:07:11
Speaker
You didn't use curse word in a proper sentence. That is inappropriate. Excuse me. Excuse me. We called you here today because your son used the word fuckery. Well, did he use it properly? What was the context? What was the sentence? He said, wow, we don't get recess. This some fuckery.
00:07:33
Speaker
Be like, what's wrong with that? Seems like he used it properly. Seems like he used it correctly, you know? Be like, what happened? Your kid said, you know, we were running over and he was under damn duress. Be like, yes, baby. He said duress though?
00:07:55
Speaker
Yes. I told you we give them big words and curse words. They got to put it together. They're going to be a connoisseur of curse words, okay? But then she's going to get all the phone calls from school, not you. Sure is. I'd be like, if they ask you where you get this from, you tell them from your mama, okay? Yeah, just give them Amy Jo's number, then she can feel good. I got it from your mama. Be like, I know exactly who y'all need to talk to.
COVID-19 Update and Testing Importance
00:08:33
Speaker
For my trending topics, we're going to do like a rapid fire of trending topics because so much is happening. So many things have crossed my, so I get this thing. I don't know if y'all get this, but ever since I was in college, I subscribed to like the Washington Post. So I get like some of their emails and I read like the Washington Post articles, either way, whatever. So the post does this thing where it's like seven things you need to know every day.
00:08:58
Speaker
And it could be anything from like pop culture, nature, science, or seven random things.
00:09:04
Speaker
And then three of the things that were on their seven, I was like, dang, this is really something we should talk about. Or at least mention, because it's too much stuff going on in the world. One thing I will mention is that COVID numbers are on the rise, and y'all know how much I hate talking about COVID. Y'all know I hate it. I talk about it all the time, because Amy Jo and Dr. Chris be talking about how much they want to tell us about all the stuff that's going to kill us, and I hate it.
00:09:30
Speaker
COVID numbers are on the rise and it's presenting at least this strain in my office is presenting a sore throat and ear pain. So if you think, oh, nah, it's just my sinuses or something back in my throat, a tickle. I don't know. It's getting my ear too. I listen, go ahead and do the swabby swab. Go ahead and do it. Go ahead and do the swabby swab. You might be positive because that thing is, uh, that thing is stinging. It's out here. I'm not even getting people to come back positive. We, we ran out of COVID tests, um, a couple of weeks ago.
00:09:59
Speaker
Same here. Yeah, we were out. So listen, for like a week, we couldn't swap anyone. In the office? In the office. And everybody was coming in like, man, my throat hurts. I got ear pain. I just, I don't know. And I was like, you probably got COVID, but that's all I can tell you.
00:10:19
Speaker
I've admitted so many COVID mnemonias in the past like week and a half. I'm just like, Oh, we're, we're back. So I started so much going from desert rear deck of drawing. I'm just like, Oh, okay. I had her and do this all over again. So. Yeah. Cause we, we back make the hubs to wear a mask on the plane. We flew out to Philly and I was like, yo, we're ma we're back to masking.
00:10:42
Speaker
We never left. Sidebar. Remember we were talking earlier or maybe last episode about how I didn't know how I felt about Philly? How do you feel about Philly? Because I'd be like, I don't know if I like Philly or if I don't like it. I feel like I'd be getting mixed feelings for Philly every time I go there. I don't know if I like it as a city. Did you have a good time at Philly? I did. Didn't you just pass through?
00:11:07
Speaker
It was a quick trip. On your way to Jersey, right? Yes. My husband's people are from South Jersey.
A Visit to Philadelphia: Mixed Feelings
00:11:18
Speaker
We flew to Philly. We went over to Jersey, but we did go to Philly because we went to Philly. We met up with his brother, his brother's girlfriend.
00:11:28
Speaker
hung out, you know, for a little bit. And so, you know, just kind of driving around the city, I was like, this is interesting. I need to see it again, right? Like, I need to see, like, I need to sun out. I need to see downtown. I need to see what's happening. Yeah. I need to see some other spaces. Like, we went to a cool cigar lounge, you know, had some drinks. It was mad expensive downtown. Like, I felt like I spent more money in Philly than I've ever spent in Chicago.
00:11:55
Speaker
Huh. Really? And I was a little confused. What? I was like, um, that's weird, but okay. That is weird. It was. I was like, yo, this is...
00:12:07
Speaker
This is expensive. I mean, who's cigar lounge, where you all at? Look nice. They have like the red velvet. Listen, Amy JoMD. She has somebody's celebrity cigar lounge. Talk about some. I don't know why this is so expensive. It's one of those that need a membership to go.
00:12:30
Speaker
Watch it. Watch it turn out to be like Jay-Z's Cigar Lounge. No, it was Ashton Cigar Bar. It was Ashton Cigar Bar. It was a dope spot. Don't get me wrong, right? It was casual, but it was really nice. We spent a lot of money. I don't know. I didn't find it to be a... I don't know.
00:12:53
Speaker
Let me not say, cause you know, Philly be out here representing and I got a lot of people around here from Philly. So this is not to down Philly. Cause I was like, cause I thought I need to come back and just fly into Philly and just spend the weekend just doing Philly.
00:13:10
Speaker
Like, let's hit some brunch spots, let's walk around, let's do downtown. I mean, I've been before, but the last time I went, I was an athlete. So I was just going to practice, play a game. You get to get a nice dinner and then you're out. And so I thought, okay, let's see what it's like as an adult. The place I went to, I liked the whole lot. We took an Uber and drove around a couple, you know, places. And so that seemed pretty cool, but I don't know.
00:13:37
Speaker
It still doesn't rank with Nashville for me. You know, Nashville is surprisingly up there. Philly's got a vibe to it where I can't, maybe I'm just not in the right parts of Philly.
00:13:52
Speaker
But I'm also not trying to be in the hood in Philly. I'm trying to find where is the good time in Philly that's not going to get me shanked. You feel me? I can't find it, right? I think that's the thing. Now, I can't put my finger on it, but it's interesting because- I mean, Broad Street, that's like- Yeah, but even Broad Street, we went back and forth across Broad Street. I feel like
00:14:13
Speaker
every other place like Chicago, you're either you're downtown, you're up north, you're out east, your south side, or you're in the hood parts. Philly is kind of doesn't have a division, right? Like it is equal, it is equal like
00:14:32
Speaker
thrills and hood at the same time. So if you're going to Philly and you're like, send me to the place where people party safe or not around the hood. It's not there, right? Like it's just Philly is just Philly. It's all there. So you get
00:14:47
Speaker
And you get the perfect sample of everything, no matter where you are. That's what it felt like to me, right? I felt like I was both on a campus sometimes, because you're driving past Drexel and Temple and all those spots. And then you'd be like, oh, wait, I am downtown. Wait a minute. I am in the hood. Wait a minute. Where are we? It was just kind of all there.
00:15:09
Speaker
I think other cities have it separate, where Philly was like, nah, you want some Philly? You come get all of Philly everywhere you go. We are just Philly, up and down. So that was really interesting. So I feel like you have to go a couple of times. Could Philly, Italian Philly, Black Love Philly, bro-y Philly, like the bro, like the bros with the kegs. You'd be like, why is, where, where, what, what, where?
00:15:36
Speaker
Yeah, it's not segregated like Chicago, where you're like, oh, I'd know what side of town I am if I just look around. You just felt like you were always everywhere at the same time. Calling the city of brotherly love everybody together. Yeah.
00:15:52
Speaker
Everybody out here. Everybody out here. That was my fault. I got us off track. We were talking about COVID, but COVID's out here.
Steve Harwell's Passing and Alcoholism Discussion
00:16:03
Speaker
Aside from that, which is very interesting. So I came across one of the points of the day, which is that you guys remember the group Smash Mouth? They sing All Star. Hey there.
00:16:18
Speaker
Yeah. So Steve Harwell, he's basically the lead singer of Smash Mouth. He died. Yep. And he died from what Dr. Nono was going to talk about today, which was liver failure. Yeah. And he was 56 years old and he battled with addiction, like, especially alcoholism. So I thought that that was really wild because I'm like, man, 56 is young, y'all. And because he was battling with it and he died from liver failure, I'm like, man, that is on brand with what
00:16:46
Speaker
you know, Dr. Nono is going to enlighten us all on. I saw that, but I've actually been getting a lot of younger people, like people like our age coming in with like end stage liver failure just from drinking, like just nonstop. You know, the belly is humongous. They're yellow as a highlighter. Just, I'm just like, man, you are too young for this. Like what is going on? But I saw that announcement when it came up and I'm like,
00:17:14
Speaker
Yeah, we got to talk about this again. I know we did an episode on alcohol, which I did like. That was fun to talk about. But we can now talk about one of those major complications from drinking too much. And that would be cirrhosis. So we'll get into that a little bit later. See, I shouldn't say that's the last one. That would have been a smooth transition, but I'm not that smooth. It's cool.
00:17:40
Speaker
I lost this movement. I just want to say that I feel like California and everything around our way as of recently has been like
00:17:53
Speaker
a
Extreme Weather Events and Global Warming
00:17:53
Speaker
global warming weather nightmare as of recently, from the hurricane that happened a couple weeks ago to it raining like crazy and burning man and people just being stranded in the mud and all types of stuff. This is just my little PSA to lots of people in the California area and Nevada and, you know, Oregon, everything, just everybody on the West Coast. I feel like because I'm a Floridian and y'all got to go crazy for saying this, I feel like you grew up with like a really
00:18:22
Speaker
large respect for nature because you know that nature can really eff you up like for real like whether it's hurricanes, alligators, whatever it is just like a just you know I think over here a lot of people in California they just like admire nature like oh look at that mountain like oh look at this beach like they admire it but they don't really have like a respect for it like nah like
00:18:43
Speaker
You could fall off that mountain or like, yo, like you can get got. And I feel like recently over the last two to three weeks, there's just been a lot of stuff in the news about people just like not navigating the hurricanes well, like taking the rain for granted. Like, yo, if it tells you it's going to rain, it's going flood, it's going flood. Like you guys need to really take this stuff seriously. And I just want everybody to be safe because this global warming is real.
00:19:06
Speaker
And weather everywhere is nuts. And we haven't even gotten deep into fire season. And we haven't even gotten into the bulk of hurricane season. The next thing you know is going to be winter. We're going to be talking about a blizzard. So I just want everyone to be safe. This is just a nature PSA. And hopefully everybody who's stranded at Burning Man in the mud, because their cars are stuck in the mud. They can't get out. They can't even get out of the fairgrounds with y'all knows in the middle of the desert somewhere.
00:19:30
Speaker
I just want everyone to just make good decisions and be safe. That's all. So I thought that they could hike, but they could not drive out. They were allowing people to, not that it was like, oh, just walk over there, but they were allowing people to
00:19:44
Speaker
to leave on foot, but you had to leave your vehicle. So that was one of the main things that was keeping people- No, they're letting people leave today. Well, they let people left yesterday, so people are now driving out. It's rough because all the roads are shitty, but people are now driving out of the grounds. Yeah, but before that, they weren't letting people out. You could walk.
00:20:06
Speaker
but you could not, you couldn't drive. In the middle of the desert, where'd they go to walk to? It was like a, it was like a, there was a whole, there was like a five mile walk or something like that, or three mile walk. Yeah, that people like could make. And the reason why I know that is that whatever that first hotel is that they were all staying at, like stopping at, quickly booked up because people were like, forget it, let's walk. And so they were shuttling people like to the next closest, like, you know, facilities.
00:20:35
Speaker
So people were walking, don't quote me on how many miles it was, but I thought it was like somewhere between two and five miles, you could walk to like your closest, you know, place. You just could not drive because I guess, and this is the part I didn't understand, read the articles. They were like, people, there's a few people earlier on they were like, we can get in our cars and go before they really like shut it down. They were saying, they're destroying the terrain. And I'm like, isn't the flood destroying the terrain? Like how the vehicles,
00:21:02
Speaker
But I was like, whatever. They were talking, I think with that, they were talking about like how Burning Man was supposed to be like, you know, very eco friendly concert and people, they're bringing a lot of like, single use, like things into the park, you know, like plastic bottles and whatever.
00:21:20
Speaker
So it kind of like lost the mission of the festival being like eco-friendly and people were just leaving all their trash and stuff all around the festival. When the whole purpose of it was to be like, you know, you guys re-bring like, you know, metal stuff, like bringing stuff that you can continue to use and reuse. So that's, I think that's where they were getting that destroying the terrain from.
00:21:42
Speaker
Cause yeah, the floods came in. It made like the roads look like quicksand. So you could not walk. It'll be extremely hard to walk out of there and like take a car out of there just because everything, everything would probably get stuck immediately if you didn't have anything less than a, anything more than like a four by four. So, and that guy died. Someone died. Yeah, somebody did die. And they were like, Oh, this is really on lockdown. And like, you know, it was like all the police and investigators. They said they died from the rain. Yeah.
00:22:10
Speaker
I didn't, I didn't get it, but they said, yeah, it was. Mind
Coco Gauff's US Open Triumph
00:22:15
Speaker
you, mind you, this has nothing to do with health or anything, but it's one that they're out there that I'm hardcore rooting for Coco golf. Yes. I watched her do her doubles yesterday. Killing it. Killing it. Great. Doesn't she?
00:22:32
Speaker
I was like, listen, her form, like that killer serve. I was like, okay. I was thoroughly impressed. She did really well on the doubles yesterday. She had her personal events like today, she won today. It was on at like noon. Of course I couldn't catch it because I was
00:22:48
Speaker
seeing these patients. Trying to save lives, y'all. So I couldn't see it. So I'll watch the highlights later. But Coco Gough is doing really good. And she's actually slated as one of the front runners to actually win this US Open. So I'm sending her good vibes and good juju. We're rooting for you, black girl. We're rooting for you, rooting for you, boo boo. Especially after she had to
00:23:05
Speaker
Yes, had to be like, y'all gonna keep on letting this girl pause or what? I saw that, that was ridiculous. Yeah, it was crazy. And in true tears, right? So the German player hits us with the good tears in the interview, like, have I not given enough? What they got to do with you pausing? Like you pausing, okay?
00:23:24
Speaker
Let's keep moving. And she was like, you know, she can't do that. You know, there was one clip, Coco was eating some fruit, but she's standing up and she's like, you know, she can't sit down, right? Coco is young. She got all the energy. She is a combo of both Serena and Venus Williams all tied in together. She was like, nah, I can do this all day. What you sitting down for? Get off them knees. It's time to go. Let's get it. Let's get it. Why she's sitting down, you know, she can't sit down, right? Why you breathing heavy over there? You serving or not?
00:23:53
Speaker
I'm ready. Why you not ready? I'm just saying. Why everybody? I got to tell the whole stadium to tell you to get ready. I mean, you're here, right? You don't see me standing here. You don't see me ready, sir. She's giving all the energy. And I love it. In the most polite of ways, right? So when you play it back, she is both innocent and fierce. Because she's just like, she can't stand there. She can't just sit there. She's over her time.
00:24:23
Speaker
She's over her time. I'm reclaiming my time and she needs to get back to this line so she can come get this work. And not the audience behind her like clapping for her, like supporting her. I was like, oh my gosh. Yes. The audience is here for it. They're like, yeah. You tell her, Coco.
00:24:42
Speaker
You tell her to be ready for that serve. She's got to be ready for me. That's what she said. She's got to be ready for me. Like, those are the rules. So as Coco get ready to go serve, the little girl go over there and get an, ooh, I need a towel break. Ooh, I need a water break. Ooh, I need it. I'm like, why is this girl stalling? You can tie her shoe like 10 times. I'm like, man. Yeah, I'm like, why she keep, why she keep tying it? I'm on here.
00:25:03
Speaker
because old girl don't want to take that serve. She'd be like, yo, I got to, I got to, I got to pause a minute. I mean, the game got to end at some point. Like you delaying the inevitable is not going to help. So yeah, but the ref is supposed to be checking her on that and the ref wasn't checking her. Right. Because players do it. They do it to freeze people out. Right. It's, you know, it's the, it's the basketball equivalent of calling the time out when, when the person comes up to the line. So you were essentially stalling your, your, um,
00:25:31
Speaker
Your you know your competitor to try to you know change the rhythm and she's like yo she can't do that Because she's like even though she tried to do it. I'm still ready. I'm still here Listen watching her play like
00:25:47
Speaker
And you could tell in the doubles yesterday, I forgot what country they were playing. But in the doubles yesterday, you could tell like on the opposing team. So one of the girls was like ready to play. She was sharp. And I felt like the other girl was like, she was like so intimidated by Coco and she was just off like the whole game. You could tell like,
00:26:06
Speaker
Cuz she messed up a couple times early like one of that, you know early in the set and she was just off the rest of the time I was watching this match. I'm like, yo, I know old girl when I throw her partner away because Coco is lighting them up like lighten them up. I was like, yo What make you make it make it making them sprint forward sprint backwards pivot hit the backhand Oh, I'm like yo Coco's making y'all run across this entire court. Yeah
00:26:33
Speaker
You know in tennis, when they make them hit that split, when they be trying to reach, when they can't reach, they hit that split like, ooh, lie. No, it was rough. It was rough. Anyway, shout out to Coco. Today, let me preface earlier, and we're going to talk about liver cirrhosis.
00:27:00
Speaker
So
Cirrhosis Causes and Prevention
00:27:01
Speaker
you guys may hear this kind of tossed around, you know, if we get like an ultrasound or you got an ultrasound for like whatever reason, and we see some weird looking stuff on your liver, you know, the reading that the radiologist will give us will say, Oh, this looks like cirrhosis. You really go, Oh my God, what's that?
00:27:17
Speaker
So typically cirrhosis can be caused by a lot of different things. In the US, however, the top three causes of cirrhosis that we hinted at earlier, first one is alcohol, second is hepatitis C, and third is non-alcoholic steatotosis hepatitis. We call it NASH for short. So usually when you come in, you may have some symptoms that may require some additional workup.
00:27:46
Speaker
When I'm coming in, or when you're coming into the hospital, it's usually, you know, sometimes people come in, they haven't seen a doctor in years and they're coming in and be like, doc, my belly is big and I'm yellow. And I'm like, okay, you see that on the triage note and you're like, oh, I think I know what's going to happen. So cirrhosis, when you get like, you know, advanced stages, you can usually have like what we call a fluid developing on your belly is what we call the ascites.
00:28:13
Speaker
In the yellowing of your skin, that is what we call jaundice. So it's when you have issues with production of your bilirubin, which is a lab marker that we use to check for that.
00:28:27
Speaker
and it can cause all these different physical or skin ailments that we can see in early cirrhosis. Usually when people come in also, they'll come in either to your clinic and complain of these symptoms or they'll come in looking like that and to the hospital and we get the same story. But typically symptoms like I've been losing a lot of weight, I feel really fatigued and tired,
00:28:52
Speaker
Or if you're a friend bringing your person in saying, oh, they've just been really confused, they've been off the wall, saying a lot of gibberish type of stuff. Those are all things for concern. So actually, I don't know how often you guys get like serotic patients into your clinic. Does it happen often or do you guys see it in different stages or how do you deal with that?
00:29:14
Speaker
Somebody walked them off and it looked like a human highlighter. I mean... Not the ER in the office. No. I was talking to her and I was really like, um...
00:29:25
Speaker
Were you this yellow last time I saw you? I'm like, did you see this? Like you see this? Like literally. And I tested her and her liver and his eyes were through the roof. And then she later said, I'm so glad you said something. I wasn't gonna say anything. I had been very, she'd been very depressed. So, you know, obviously taken in a whole lot of alcohol, but I have seen like, man, why are you so yellow? I don't think that,
00:29:53
Speaker
I think in an outpatient setting, you catch it during the labs. Unless they are known to be taking in a lot of alcohol intake for your number one cause, which is alcoholic cirrhosis, I think you have to catch it in the labs and then have to know a little bit of the history. But I think the vast majority of people,
00:30:15
Speaker
don't underestimate your functioning alcoholics, right? We've talked about this before, right? These are your people, and I'm sure we all have a lot of these people. We know them all. They drink maybe a beer or two during the week, right? They might come home, have a beer, and be fine because they work Monday through Friday. But at five o'clock on Friday until eight o'clock Monday morning, all bets are off. And so they are binge drinking
00:30:42
Speaker
all through the weekend. They are no good to no one. Don't give them any keys. Don't give them any responsibilities. They ain't got it. And then on Monday, they're back to their regular selves. And so they're quite functional. And so I think sometimes you catch them. You suspect that their alcohol intake is too high, but it's nothing that they are going to endorse and complain about. And then you get a CMP and you see
00:31:07
Speaker
AST, you know, through the roof, ALT kind of high and you're like, okay, we need to revisit your drinking. So for viewers, AST and ALT, those are what we call part of your liver function test. So it's a very easy test, usually one of the basic labs you'll get if you go into a PCP's office or the hospital. And that usually tells us like what your synthetic liver function is doing.
00:31:31
Speaker
With that, we'll also add on, because liver cirrhosis can also cause issues with bleeding. When I say bleeding, I mean a shit ton of bleeding. You will have engorged veins within your throat that we call esophageal varices. They can also happen in your stomach. You can see them on your skin that we call telangiectages. When your liver is not able to
00:31:58
Speaker
to process, then you can actually have a lot of issues with just spontaneous bleeding. And any one of these viruses can rupture at any moment. So when you come in, you're saying, oh, you know, I think I may have threw up some blood or I see some blood in my poop. You need, we need to see you immediately. Do not, do not go to your PCPs office. Do not collect $200. Go straight to the ER because that isn't a medical emergency.
00:32:25
Speaker
The last time I was really taken off guard recently, an outpatient was in a patient where she has dual care. So she has me and another PCP. Sometimes that happens where I work because people have dual coverage. Either way, point is, I do hurt. She's in front of me talking. We going over her lab results. These liver function tests were like in the hundreds, like 200s, 300s, 400s, like they were high. And they were normal last time I saw her. And literally it was just the elevation from her starting a statin.
00:32:58
Speaker
She's like, well, my outside PCP put me on the statin because my cholesterol was kind of high. Her cholesterol was kind of high, you know, like 170s, 180s. And they were like, ah, let's just get ahead of it because she was in her 60s, 50s, 60s. And they put her on the statin and those liver enzymes were high. I'm like, we were from 20s and 30s to basically 300, 400. And I was like, we are stopping this. You can tell your outside doctor to be mad at me if you want to, but we stopping this today.
00:33:26
Speaker
She's like, oh my God. But that's just another thing that can cause it to be high as well. It's a side effect, y'all. So don't go out and stop your Lipitor, Crestor, whatever you're taking. But that is a side effect of statins where they can cause a hepatotoxicity and cause your LFTs to go through the roof.
00:33:47
Speaker
A lot of meds out there can do that. These are little lesser known side effects, but there are some things that we need to get regular labs on just to make sure that they're not continuing to get worse is the big deal. We gave you the medication, first of all, to treat the active issue that you have at that moment. But if we see something like your LFTs are starting to creep up and they're getting into that range, then at that point, then we'll likely stop the medication and recheck your LFTs and make sure they're doing okay.
00:34:16
Speaker
Can I take us on a small tangent to ask a question? Yeah. Quick question. At your jobs, do you guys have pharmacogenetic testing at your job? No. We do not in my office, but there are offices around me that will do pharmacogenetic testing. So I have had a few of my psych patients come back to say psychiatry ran some pharmacogenetics and discovered that I can't use this, this, this, this, this SSRI. Yes.
00:34:44
Speaker
And, but I can use that. So it does happen. I just don't do it. Like I don't order the test personally in my office. They just added it. I think the brand we have, I think it's the phaser phaser pharmacogenetic and it includes, we have it at our job, which is shocking, right? We have it of all people leave it.
00:35:03
Speaker
I wish we did. But it has all the different types of mental health medications on there. Opioids are on there. Statins are on there. Inseds, different inseds are on there. And they run your blood. They run your genetics and see if any of these medications do not agree with you so that you can pick a statin that works for you or you can pick the SSRI that works best for you based on your genetics. It's pretty cool. Can't that just be standard? Why can't you just run that to a standard? Because it costs a lot of money. Because it's expensive. Insurance won't cover it? No.
00:35:32
Speaker
I don't think all insurance coverage. And for us, it's a limited time. They said this test is only available until the new year. So you have until January 1st, 2024 to do this test at this facility. We didn't got a coupon. It's a Groupon. The government then bought a Groupon lab. It's a government grant or something. I think it's to help with their mental health and PTSD.
00:35:56
Speaker
But the test itself, the panel includes more than just mental health, but it's nifty though. But anyway. What I was going to say is some of the people that I see that come in and they have the diagnosis of cirrhosis, I don't see people like
00:36:14
Speaker
mostly not for alcohol, but big non-alcoholic causes of cirrhosis. And the burning question that they all have, like, I don't understand how did my liver feel? How do I have cirrhosis? Like, I don't drink. And it's just like, oh, well, you've had this fatty liver that you did not really pay attention to. And then it turned into
00:36:37
Speaker
cirrhosis, right? And like, we tell you these things like, Hey, your enzymes elevate, your cholesterol is elevated, probably need to lose that weight and eat right. And then they don't do it or something happens. And then they end up in the hospital because they had some of these symptoms that you were talking about. And then they come to find out that they had, they had cirrhosis and then they come to their PCP and they come to me like, Oh, how come you didn't tell me? I'm like, cause you didn't have it when I saw you.
00:37:09
Speaker
That's the other thing. People will think that when they see people like, oh, I get stories like, oh, grandpa had a big belly, but he drank a lot. They had to take fluid off of him every once in a while. But alcohol is not, I say it's one of the top causes in the US, but there are a lot of zebra cases out there that can cause cirrhosis. I'm not even touching the top 50 different causes of cirrhosis that we have and that we learn about in medical school.
00:37:35
Speaker
Um, so autoimmune things. So if you think of like, um, uh, you know, buzzwords for us would be like Wilson's disease or alpha one anti-tripsin disease, you know, other different types of diseases that can also cause cirrhosis. But the thing that I want to bring up the point that Dr. Chris said, so we can.
00:37:53
Speaker
we can screen for different types of cirrhosis or cause of cirrhosis in your PCP office. So when we see that your cholesterol or your triglyceride levels are like off the charts and we do an ultrasound or that shows that you have like a fatty liver, then we have interventions that we can do to prevent that from progressing to advanced stage cirrhosis.
00:38:14
Speaker
And believe me, when you get to advanced stage cirrhosis, there's only so much that we can do before we got to like go to a liver transplant. So when we find these things like in the office and on your labs and with your screening.
00:38:27
Speaker
We really stress that, hey, we got to take care of this now. Do not wait on this because it can get so much worse. I feel like I'm the person in the podcast that was like, if you didn't do this shit, this is what's going to happen. So listen to you guys. I feel like that's what my role is. Because you're sitting in the hospital like, so you ain't listening to your doctor, huh? I'll be like, I did it.
00:38:50
Speaker
If you send me home, I'll take my medicine. I'll tell you the most, because you see some wild, wild crazes at county. But in one case, I remember distinctly, I will never forget, this lady came in, and her daughter brought her in. On the triage note, they just said big belly. And I'm like, that's like a med student. I'm like, was she fat? So I went down there to go see her.
00:39:15
Speaker
this lady when i tell so when we say yellow as a highlighter like we literally mean as yellow as a highlighter because when you walked in the room this lady looked like she was glowing and her belly looked like she had maybe a quintuplets in there like it was humongous
00:39:33
Speaker
And that's a really big complication from cirrhosis is that you get what's called ascites and that just is a fancy word for fluid in your belly. So that fluid collects in that space and it has nowhere to go. So usually what we do to treat that is that we have to stick a needle in your belly to drain out that fluid. And that's what we call a paracentesis.
00:39:56
Speaker
Amy Jo has a very funny story that she likes to tell me about you need to watch when you're doing a paracentesis, you need to watch to make sure the patient keeps the needle in the belly. Because if they take it out, the fluid is just going to go everywhere and you got to do it all over again. So I'm still scarred.
00:40:16
Speaker
I think I talked to him next week, but yeah, it was funny. So yeah, so typically that's where I was going with that. I also mentioned that part of the symptom, so someone brings you in either to your
00:40:32
Speaker
Your office or to the hospital usually will get a complaint of like oh mom has been like really She's been really confused and just not acting right, you know She's also been really tired and just like just can't move it has no energy and you go into the room and you see that You know, they're they're like picking at stuff They're trying to like touch you trying to like grab at stuff in the air and they just feel they feel like they're hallucinating or they're out of it so usually we can do a blood test for that and that is called the ammonia level and
00:41:02
Speaker
And usually when your ammonia level is high and cirrhosis, that is what we call hepatic encephalopathy. And encephalopathy is a very, very fancy word for that you are bat shit crazy. You're very confused and we need to lower that ammonia level quickly. So there are different ways that we can do it. I'm doing this as a disclaimer because one of the biggest complaints that we get when people come into the hospital with this
00:41:28
Speaker
is that, doc, you're giving me a medication that's making me poop every three minutes. Why do I need to take this? And I'm being like, because you need to take it. Because if you saw the ammonia level that you came in with, you'd be like, oh, I need to take this, doc. And it's also one of the most discontinued drugs as outpatient, because people are like, I don't want to take this thing that makes me poop every hour.
00:41:52
Speaker
So when your ammonia level is high, that means that your liver cannot get rid of it because it is impaired in cirrhosis. So it builds up in the blood and it can cross into the blood-brain barrier and it can cause this type of confusional state. So when we give lactulose, so like I said, if you're too tired or mom is not able to swallow pills or eating, then sometimes we may need to put in what's called an NG tube.
00:42:19
Speaker
And we give the lactules through the NG tube or we got to give you an enema and I know I think most people know what an enema is So either way that the way that we get rid of that is that we make you poop it out You should be aiming for like three to four poops a day And sometimes your GI doctor or your PCP will give you this medication to go home on So that you can continue to you know Make sure that ammonia level doesn't build up and please for the love of God do not do not skip this medication
00:42:49
Speaker
It's a very easy way to avoid a hospital visit. You give me county flashbacks, man. I think it was a damn shame how many of our patients had liver failure. It was a damn shame. It was so many. That little procedure team, I felt like they were just running all around the whole county hospital, just putting in little needles and draining people's bellies. I'm like, how many times they got to do this a day? But they are busy. They're very busy.
00:43:18
Speaker
The GI department there is getting that work, so. Yeah. Very much so. Even with the yellowing of the skin and everything, I feel like the eyes always got me, man. If you look in their eyes and their eyes start to get yellow, I'm like, yo, it just blew. It just creeped me out so much. I don't know what it is. I mean, don't get me wrong. The whole body is yellow. But when you look into like, you know, the whites of their eyes and it's just so yellow, I'm like, man,
00:43:43
Speaker
This person not gonna make it. He trying to die on me. He trying to die on me. It was crazy is that some people will just come in completely oblivious to it. I'm like, no one told you how yellow you are. Don't be the little Prieto patients talking about they drink like two cases of Tecate a day. I'm like, what is, that's how I knew what Tecate was. I'm like, what is this Mexican beer that is just,
00:44:05
Speaker
wreaking havoc on Little Village. I think the other thing, too, is especially if you're kind of like a little light and kind of already baseline, a little yellowish, it's kind of hard to see until you really see it in the eyes. Like, okay, you're looking different, right? Because if you're already light skinned kind of at baseline,
00:44:28
Speaker
Are you basically talking about Chris Brown color? Is that what you're talking about with you, Chris Brown? Is that what you're trying to say? I mean, there's some people. You just look at them and you're like, you're not quite sure. You're like, hey, do you look a little young? Is this how you always look? You're like, I don't know. You had to think about it. And then you look at those eyes and you're like, mm-mm.
00:44:50
Speaker
God, it's a lot. Are you always this high yellow? Yes. I literally ask questions like that. Our light-skinned brethren, we love y'all. We love y'all. We do. We really do. I'm trying to get the whole picture, OK?
00:45:11
Speaker
Yeah, so, and when I tell you the crazy amounts that I found that people can drink in a day, I'm just like, oh my God, like I throw up after a shot, you know, so it's just like, people are coming in, they'll tell you because you part of the history that we've alluded to in multiple episodes that you got to ask about that social history because you will, you will find I found diagnoses just by asking the social history. I'm like, Oh, okay.
00:45:37
Speaker
When you ask people like, okay, so how much do you normally drink? Sometimes they'll start out saying, oh, you know, I drink socially.
00:45:44
Speaker
And you're like, okay, but what's social? I feel people say I'm really annoying when I do this, but I'm like, I need a number. Telling me that you drink socially could be anything from drinking a seltzer to packing a pint in one sitting. So we need to, this is why we ask. But I think the one case I got that was like, oh my God, this guy was drinking
00:46:09
Speaker
Uh, two handles and a 12 pack of beer every day for like the past 20 years. That's expensive. How do you even have that much excess income? Handles? It's not expensive. Handles? Handles of what? I don't know. As far as the cheapest liquor you can get. Bernat's, Tito's. What's that really nasty one from the South? I forget what it's called. Nasty one from the South. What are you talking about? Oh, that's more than that. You talking about Moon? Yeah, no. Oh, that's probably Moon Shine. That's it.
00:46:38
Speaker
Um, but yeah, so the amount that people can drink will surprise me every time. Um, but like we said, that is no alcohol is the number one cause within the U S there's also hepatitis C, which you should be screening for at your doctor's office. And then the, um, Nash, which is like the, you know, fatty liver and whatnot. So those are all to kind of close that point up. Those are all the things that you can get tested for. And then those are some of the symptoms that are alluded to that you'll probably be coming in and that we will take care of.
00:47:06
Speaker
the one major caveat and then I'm all done. So
Reversing Cirrhosis: Fact or Fiction?
00:47:10
Speaker
a lot of these causes are reversible. So that means that you can reverse the damages from cirrhosis if you just follow the treatment and we treat you based on the type of cirrhosis that you have. So like I said, if you're drinking alcohol, stop drinking. And then you will deliver as a very, very good organ at healing, at self-healing. So if you stop drinking alcohol,
00:47:36
Speaker
you will be surprised at the amount of people that have been like, oh, well, my enzymes look great. I'm not yellow anymore. I don't have the issue with the swelling. I look great. You're good to go. Other things like hepatitis C, you'll usually be seeing either a PCP who handles treatments for hepatitis, or they'll be referring you to a GI doc or a hepatologist that will put you on the treatments for hepatitis C, the treatments and the cures for hepatitis C.
00:48:04
Speaker
But either way, those are all the things I have for cirrhosis. There are so many more. I could probably make this into a two-parter, but I think I'll leave you on that caveat that if you get this really bad disease, it is somewhat reversible if you just take the medications and stop doing the thing that caused it in the first place. And I'm done.
00:48:23
Speaker
I love how you just say stop drinking like that, like it's easy for people to stop drinking. Listen, just go ahead and stop. Usually y'all are forced to stop because you are admitted and we have to go through the whole alcohol withdrawal and that's a topic for another day. But alcohol withdrawal, get it all out your system and then we can start working on healthy habits because Lord,
00:48:51
Speaker
That day two, day three? Hit you like a ton of bricks, especially when you're not watching.
00:48:59
Speaker
You know, Phenobar, Precedex, and Ativan are your best friends in the hospital, so. And don't get behind. You got to stay ahead of it. No, we are knocking. As soon as you come in that door, shaking like a leaf, and you start seeing cats on the wall, you're getting a shot of that Phenobar, and you are going night-night for a while. Man. They taught us why. That dude was like, man, my uncle in here. Me and the attendant both turned around.
00:49:31
Speaker
Give him some more. What's your uncle name? He was like right there. He needs some more medicine.
00:49:54
Speaker
All right, people, so protect your livers out here is what we're trying to tell you. And let's get these questions. Let's get these questions in. Protect your liver and this is the answer to these questions. What would y'all do if I forgot to edit this?
00:50:09
Speaker
Just give them what they want. If your name is Dr. No, it'll be in there, right? I have to remember who's going to be editing to make sure I don't say nothing. No. Because Dr. No be like, yeah, it's staying. But I figured we should do this question because I guess it's on.
00:50:32
Speaker
on task with it.
Debunking Liquor Myths
00:50:33
Speaker
Is it true that dark liquor has more sugar and can worsen diabetes more than light liquor? You know, this is so funny. This has got to be somebody from the South.
00:50:50
Speaker
I've never seen people, not even in liquors, right? Like there are sometimes that I'm talking to, like I've been talking to a patient once and they were like, okay. And I'm like, yeah, you got an infection, right? You got a URI, upper respiratory infection or something. And they were like, literally they turned to their significant other and was just like, all right, let's run to the store and get Sprites and ginger ale because we got all dark soda.
00:51:15
Speaker
in the house and we gotta drink like solar. And I was like, I'm sorry, wait, what? And they were like, yeah, we gotta go to light cause we're not feeling well. So we drink light when we're not feeling well and then we can go back to the dark. And I'm like, wow, like that's crazy. And then I've also heard them say it about liquor too, like, oh yeah.
00:51:35
Speaker
Yeah, I need to, I need to, you know, drink light, you know, cause I'm trying to, you know, get healthier. And I'm like, wow. Hold on, hold on, hold on. But with liquor, it's not a myth. With liquor, this is not a myth. It is not a myth. So listen, especially if you drink dark and especially if you be drinking the cognac, like, especially like the dark thick liquors is full of sugar.
00:52:00
Speaker
And listen, if you compare some Remy or a Cognac to vodka, the difference in the calories is night and day. And the difference in the sugar content is night and day. It's just not the same. Now mind you, if we're talking about overall health in general, you could probably reduce your alcohol intake across the board. We just talked about the liver, save your liver, okay? But if we are comparing liquor to liquor, there is a difference, for sure. That is true because
00:52:30
Speaker
It says here, of course, you know, I go to the Google to find out the actual sugar content. And it says that vodka has zero grams of sugar in 100 calories per 50 mLs. Gin is zero grams of sugar in 97 calories. Tequila, it said is zero grams of sugar in 97 calories per 50 mLs. And whiskey is 0.03 grams of sugar in 105 calories. And rum, it says no sugar in 97 calories.
00:52:59
Speaker
That's a lie. I know. Barbecue or it's sweet as hell. I know. Well, listen, they didn't necessarily say if it's white versus dark. Oh, here we go. Honey in the dark, honey. Oh, my God. Yeah, I get it. So I thought, you know, I really distilled the highly distilled. They say shouldn't really contain as much sugar. Correct. Correct. Because the more you distill it, it ends up burning off the sugar. Yes, correct.
00:53:28
Speaker
So I guess what did that make sense of for like the older, like, you know, when you barrel age, like bourbon or whiskey, like, you know, the older they are, the less sugar they have? No, no, no, no, no, because no, because it's made in two different ways. Because when you're distilling something, it's like, it's like a chemistry project. Because when you're distilling it, you have that you have the sugars and you have the alcohols. And then when you're distilling it, you're getting the purified, purified, like higher alcohol content.
00:53:55
Speaker
Because you're using the sugar to do the distilling. And then you have less sugar. But the way that you make cognacs is different. Because cognacs are made from grapes. But let's find out. I'm not sure.
00:54:13
Speaker
It is, I know. Approximate amount of added sugar in cognacs is 1.5 grams per liter. Ooh. Yes, but it's also based in, it's based off of like- Yes, it's from fermented grapes without any additional sugars added during production. Girl, y'all know my family own a liquor store. I know my liquor's don't blame me.
00:54:35
Speaker
I know the cognac's gonna kill y'all. Put the cognac down. Put down the yak. Put down the yak. They like it though. They like their cognac.
00:54:44
Speaker
They do, but it's killing them slowly. Not even slowly. When I asked Google, and it says, is cognac bad for a diabetic? It said, it's not recommended for diabetic patients to consume brandy or any other form of alcohol due to its effects on blood sugar levels.
00:55:03
Speaker
Not any other form of alcohol. You shouldn't be drinking. Why is this a question in the first place? If you were diabetic, you shouldn't be drinking at all. Shout out to Google. We better not be co-signing Google after all the time we make one of these patients who told us what Dr. Google said. You better not be quoting Google, Dr. Chris. No, I'm not co-signing Google. I'm just saying what Google said. Lord Jesus.
00:55:34
Speaker
Dr. No, Dr. No, no key. Tell the people where to find this, please.
00:55:38
Speaker
I
Season 3 Farewell and Season 4 Teaser
00:55:38
Speaker
sure can. So check us out on our Instagram, Facebook, Twitter, threads, and spill with our handles at thechocolatemds. Feel free to send us questions, advice, well wishes to our Gmail at thechocolatemds.gmail.com and please check out our website at www.thechocolatemds.com. We'll post little updates on upcoming shows and whatnot and also all of our upload episodes are at the bottom of the page.
00:56:08
Speaker
And that's it. Thanks for rocking with us. See you later in the books. Thank you. This is a season three finale. We will catch y'all after our break. For season four, all it has to offer. Please be safe. We love y'all. And like Amy Jo said, thanks for rocking with us. Deuce. Deuce. Bye.