Episode 47.2 Dr. Steve Heart to Gut (Extended Release)

Transcript

Speaker: Everything on the podcast is for entertainment purposes only.

Speaker: Nothing I say is meant to treat or diagnose, or it's not even advice for you to follow.

Speaker: So remember, when you're listening to the podcast, I am a doctor.

Speaker: I'm just not your doctor.

Speaker: Welcome to On Talk with Dr. Dave.

Speaker: Today we're talking to Dr. Steve.

Speaker: Dr. Steve is a family medicine doctor, and I appreciate you coming on and spending the evening with us.

Speaker: Oh, thanks so much for having me.

Speaker: Just really honored to be here with y'all.

Speaker: Tell us a little bit about yourself and what type of medicine you practice.

Speaker: Yeah, I'm Dr. Steve.

Speaker: I practice family medicine in what you'd call a community-based type of practice where I practice in a certain community.

Speaker: I don't work in a hospital, so it's outside of a hospital facility.

Speaker: So it's a typical general practice that you would think about a community doc that has a office somewhere in a smaller community.

Speaker: And then I take care of the people that typically live geographically by me.

Speaker: And part of family medicine is you treat a little bit of everything.

Speaker: You don't get to pick and choose what you're going to see.

Speaker: And people have all kinds of problems when they come in.

Speaker: And that's really what you are.

Speaker: You're there to take care of some of it and you're there to refer some of it.

Speaker: And since you're in a smaller community, do you take care of friends and family, people that you know?

Speaker: Yeah, that can be sometimes a challenge, but yeah, absolutely taking care of people that I know it's not a isolated community, like some rural docs, they would be taking care of family because they have no other options, but just geographically when you live, where you practice, then you are going to run into people that you take care of.

Speaker: And some of them are going to be family.

Speaker: Some of them are going to be friends.

Speaker: Try not to get too close of relatives to take care of just because you have all those family biases you carry with you.

Speaker: Try to keep them at arm's distance when you're taking care of family.

Speaker: But definitely people in the neighborhoods, you see them at the grocery stores and things like that.

Speaker: Yeah, I tend to only take care of family or friends when it's more of an urgent thing.

Speaker: Somebody split their eyebrow open or just small things with family members like small lumps or bumps or just things that really don't take a high level of care, but I don't do surgery on family members.

Speaker: Yeah, absolutely.

Speaker: It's hard to carry those relationships.

Speaker: You don't want to minimize someone's pain complaints or something like that just because you're used to their history.

Speaker: Definitely.

Speaker: Now, when we were talking a little bit before doing the podcast, you'd come up with a list of interesting stories that you collected through your career in family medicine.

Speaker: And we love stories.

Speaker: That's basically what the podcast is about.

Speaker: So let's just jump in.

Speaker: Let's just hit your top story.

Speaker: What came to mind first?

Speaker: It doesn't even have to be the best story, but when you were thinking and making the list, what just came to your mind first?

Speaker: Yeah, the first one was actually when I was in residency and we had a guy come into the emergency department and he was coming in for a complaint and we needed to get imaging of his head and MRI of his head.

Speaker: So we went ahead, I think he was having headaches and they'd been going on for a while.

Speaker: So we get the MRI back and we see something weird on it.

Speaker: There's like a BB by his eye, but it's behind his eye.

Speaker: We asked the radiologist, what is that?

Speaker: He looks like there's a BB back there.

Speaker: And it was right by the optic nerve.

Speaker: It was touching the optic nerve in the back of his eye.

Speaker: So we went and talked to the guy and he said, the MRI looks good.

Speaker: It doesn't look like you have any tumors or you haven't had a stroke or something.

Speaker: But we have a question.

Speaker: Did you ever get shot in the eye with a BB gun?

Speaker: He's kind of start shaking his head and thinking he's, yeah, when I was a kid, like 15, 20 years ago, my friend and I were shooting each other with BB guns in my backyard.

Speaker: And I swear he shot me in the eye, but nothing ever happened.

Speaker: It was really weird.

Speaker: If they were like that BB went in through the corner of your eye, rode the road around the orbit and then stopped right at the optic nerve.

Speaker: And that's one of my craziest stories that we've ever had just to find that 15 years later by chance on an MRI.

Speaker: And the MRI makes me a little nervous too, because you never know what those old BBs were made out of.

Speaker: So thank goodness it wasn't magnetic and didn't get pulled around.

Speaker: Yeah, I'm taking out some BBs from people just because we don't know what they're made out of.

Speaker: And so nobody wants to do an MRI.

Speaker: So I've removed BBs that have been in people for years.

Speaker: just because they need an MRI.

Speaker: So yeah, and just to think it stopped that short of the optic nerve.

Speaker: And it just kept going just a little bit further.

Speaker: He would have known he got shot in the eye.

Speaker: We've talked about it on the podcast before, but while we were growing up, it was anarchy.

Speaker: This happened all the time.

Speaker: Shooting these guns to each other, fireworks, you name it.

Speaker: The parents didn't know where we were.

Speaker: That's incredible.

Speaker: I think maybe I got shot in the eye.

Speaker: I don't know.

Speaker: I forgot about it.

Speaker: Showed up how many years later?

Speaker: That is wild.

Speaker: Yeah, it's a really interesting story.

Speaker: And the MRI, we were really nervous after that because we're like, this could have been catastrophic with the MRI.

Speaker: You're not even supposed to wear metal buttons when you go into an MRI machine or anything metallic.

Speaker: I know some of the newer BBs are made out of things that aren't magnetic.

Speaker: We always think back to a Christmas story.

Speaker: You'll shoot your eye out.

Speaker: And it's amazing how many BB injuries I've seen just in my career, let alone all this other people walking around with BBs in their orbits.

Speaker: Yeah, totally wild.

Speaker: Now, you were also talking to us about having your wife sleepwalking or your wife as a patient that was sleepwalking.

Speaker: I didn't quite understand who was sleepwalking and who was the patient.

Speaker: So let's dive into that a little bit.

Speaker: During residency in family medicine, you learn a little bit of everything.

Speaker: You're trained in deliveries and things like that.

Speaker: And I was on my OB rotation.

Speaker: And one morning, my wife, when I woke up, she said, Hey, how'd you sleep last night?

Speaker: I said, Oh, fine.

Speaker: Yeah, totally fine.

Speaker: She goes, Oh, cause you were delivering babies last night.

Speaker: And I like laughed.

Speaker: I like, yeah, I'm on the OB service.

Speaker: We're delivering babies.

Speaker: And she goes, no, I was the patient.

Speaker: I said, what are you talking about?

Speaker: She said that when we had both fallen asleep, all of a sudden I woke her up and I grabbed her legs and I jerked her towards me.

Speaker: And then I started saying things like, we're at 10 centimeters.

Speaker: Here comes the head.

Speaker: All right, the baby's coming down.

Speaker: I deliver this baby and she was going to wake me up.

Speaker: But then she realized what was going on.

Speaker: And she's always just like having, I was like sleepwalking to be sleep delivering here.

Speaker: So she just whatever, got done with the delivery.

Speaker: She went back to sleep and then I did it again.

Speaker: And then I did it again.

Speaker: And I guess I delivered like six babies that night.

Speaker: And she just was like laughing and cracking up about how it had happened.

Speaker: And yeah, I think there's just much stress on the OB rotation.

Speaker: What point in the career was this?

Speaker: Was this early on?

Speaker: This was in residency.

Speaker: So it was in the first year of residency.

Speaker: Okay.

Speaker: A lot more stress during the first year of residency, a lot more sleep deprived.

Speaker: Have you delivered any babies since in your sleep?

Speaker: No, thankfully, no more deliveries.

Speaker: I'm not on call for deliveries anymore.

Speaker: Oh my gosh.

Speaker: Like delivering, I wake up with work dreams and I'm always mad because it's, we work so hard anyway.

Speaker: And then you wake up and you're,

Speaker: at work in your dreams but i don't think i've ever done anything like that you're aware of no not that i can remember but i will be the first to admit that i learned to tune out the phone the pager the any noises like in the middle of the night noises just because you probably got to pray for the hospital it's something that doesn't concern me i have no way of doing any of this i'm maybe i'm not as reliable but i have not been jerked away

Speaker: to deliver a phantom baby.

Speaker: No.

Speaker: That's not happening.

Speaker: Oh my God.

Speaker: No night surgeries.

Speaker: No, no, no.

Speaker: No, I'm not doing surgery in the middle of the night while I'm asleep.

Speaker: I do a lot of middle of the night surgeries, just not at home and not with you in the bed.

Speaker: Yeah.

Speaker: So speaking of surgeries and different things like in family medicine, you do some procedures, you're not as procedurally based as a surgeon.

Speaker: That doesn't mean you guys don't do quite a bit.

Speaker: And I know some family medicine doctors will deliver babies or sew things up.

Speaker: Even I know some people with family medicine training would do even C-sections, but it's not common anymore, but some of these rural communities.

Speaker: but you traditionally don't put in central lines.

Speaker: So you'd mentioned that at one point a patient had a central line stilt in and showed up in your clinic.

Speaker: So explain to the audience what a central line is and why most people aren't just walking around with one.

Speaker: So a central line, when you need to access to put in like a medication or you need to draw blood and you need to draw a large volume of blood, if you use the little veins that are out in your arms and your hands, they're just not big enough to put some of these drugs in that could be, they could damage those veins and cause scarring in them.

Speaker: So you put in these bigger catheters that go centrally.

Speaker: And so meaning that they're not in your arms, they're more central in your chest.

Speaker: And so these central lines are typically for critically ill patients, patients that are getting recurrent drug therapies.

Speaker: You may have some central line in that case.

Speaker: And in my instance, it was a port-a-cap, which is a type of central line that we use when you're getting chemotherapy.

Speaker: Because some of these chemotherapy drugs are given over weeks and weeks, and sometimes the patients get really sick and dehydrated when you put in these central lines, then you can always have a reliable access to give them the drugs that they need to give them.

Speaker: My story on that one is I had a lady come in establishing as a new patient and she was there because she was having a hard time breathing.

Speaker: And she seemed like she had like really bad COPD and she was a smoker, but it seemed like she was like

Speaker: smoking like three packs a day for how young she was and how bad her breathing was.

Speaker: And so I was treating her.

Speaker: She had some health history, but she just moved from another state and she was disorganized in the way that she gave information.

Speaker: Anyways, the reason that I needed to take care of her that day was to treat her hard time breathing.

Speaker: And she'd done really well when she got antibiotics and steroids in the past.

Speaker: So I said, okay, let's get those started, but we need to get an x-ray as well.

Speaker: So I sent her to go get an x-ray.

Speaker: And I got a call from the radiologist and the radiologist said, I just wanted to talk to you, which is weird, right?

Speaker: When you order an x-ray, usually just get a report.

Speaker: The radiologist does not call your office to track you down.

Speaker: So he said, it looks like she actually has a broken port-a-calf and it's lodged, you know, in the central venous system still, but that needs to be taken care of.

Speaker: And of course I'm a family doc.

Speaker: I know what a central line is.

Speaker: I know what a port-a-cap is, but I don't know how to manage a broken one.

Speaker: So I proceed to ask him, I say, so tell me if you were to take care of this, what kind of things do you do to take care of this?

Speaker: Cause I'm just scrambling or like, what do I do next?

Speaker: And he goes on the interventional radiology.

Speaker: A lot of times we can go in there with a snare and we'll grab the end of it and we can kind of snare it out of there.

Speaker: and he's walking me through like how interventional radiology could manage it or sending her off to a cardiothoracic surgeon if we needed to.

Speaker: And I said, okay, thanks for all those things.

Speaker: And I hung up with him and I called the patient and I said, hey,

Speaker: Do you have a catheter in your chest?

Speaker: And she's, oh yeah, I was undergoing chemotherapy for this cancer that I had.

Speaker: And I said, is it, did you know that it was broken or that like, it wasn't connected anymore?

Speaker: She goes, no, I don't know what you're talking about.

Speaker: So at some point she'd had some kind of like an up

Speaker: upper extremity movement or an injury or something, the port-a-cat, you bury a small portion of it under the skin that you can access.

Speaker: And then the rest of the catheter goes into the central system so you can deliver the drugs.

Speaker: And it had broken off from there.

Speaker: And luckily it had lodged in the central venous system.

Speaker: I want to say that it was like

Speaker: in the right atrium is where it had got stuck.

Speaker: And so she had no idea that was going on.

Speaker: It wasn't the reason that she was having the shortness of breath.

Speaker: We sent her to the ER, they did a CT.

Speaker: And ultimately they got back to me and said, hey, yeah, she has this thing going on.

Speaker: It's not causing a breathing problem.

Speaker: She doesn't have any embolisms from it.

Speaker: And so then it was up to me to try to get ahold of IR and make sure that she got her broken port-a-caphrine.

Speaker: See, that's what I love about family medicine.

Speaker: You don't know what's coming in.

Speaker: That's why I can't do it because I need a little bit more.

Speaker: I need to know.

Speaker: I don't like these surprises.

Speaker: I don't like medical mysteries, but I love that that's what you get to see and you just don't know what's going to walk in.

Speaker: Now, it seems like in this situation, Goddard, I are, but it sounds like sometimes it takes a really long time to get

Speaker: a specialist involved and it sounds like in family medicine you've had to branch out and start doing more than you were trained to do to be able to take care of your patients and in this situation I'm specifically talking about what you had brought up with psychiatry where you have to sometimes do more mental health than you thought you'd end up doing when you were going through your training

Speaker: So tell me a little bit about that.

Speaker: It's like, how did that come up?

Speaker: Did you just decide, I'm going to just start counseling people?

Speaker: Did you take some courses?

Speaker: What led you down that path?

Speaker: Yeah.

Speaker: So when I first got into practice, I was in a, it was in a bigger city.

Speaker: One of the things that I learned really fast was that when you refer someone, let's say somebody comes in with a psychiatric

Speaker: Whether it's bipolar or schizophrenia, maybe they're suicidal and they really need to get in to see a psychiatrist.

Speaker: When I started referring these people out, the feedback I was getting was that they were going to get an appointment in three months.

Speaker: And to wait around and see what happens with your bipolar disease or with your suicidal ideation or with really bad depression or even schizophrenia, you just can't wait that long.

Speaker: Of course, the ER is there.

Speaker: Someone's like actively suicidal.

Speaker: But there's a lot of people that have a lot of really heavy psychiatric illness and you can send them off and wait three months and see what happens to them.

Speaker: Or you realize that in family medicine, you have to rise to what the community needs are sometimes.

Speaker: If your community that you're in needs psychiatry and there's no access to it.

Speaker: you can learn to give them that access you're not going to become an expert but you can definitely do a lot of things while you're waiting three months for someone else to help you out or you can make phone calls and ask questions and kind of co-manage patients with them and there was a lot of that that was definitely one of the things that was surprising to me is that i would end up doing a lot more psychiatry than i thought i was going to do

Speaker: Do you feel like you get enough support for that?

Speaker: Do you feel like there needs to be more training and residencies, more rotations, or is that something that you think if somebody is really passionate about, they could do maybe an extra few months or cross train with psychiatry for six months to a year?

Speaker: I know there's sports medicine that you can add on to family medicine and there's different tracks you can take.

Speaker: Do you think there's room for pursuing a psychiatric family medicine subspecialty?

Speaker: Yeah, I definitely think there is.

Speaker: I have never heard of a fellowship, like a family medicine sports med fellowship like you were talking about, or they have family medicine OB fellowships that you can do.

Speaker: But if there were one offered where you could do like a one year or six months of psychiatry to just really hone your skills on it, I think that would be a really helpful thing to do.

Speaker: When I was in residency, I had some elective rotations and one of the electives I did was with childhood psychiatry.

Speaker: And it wasn't a full month's worth, but it was two weeks worth of it.

Speaker: And it was an invaluable time to just see how psychiatry would manage a child that has anxiety, depression, ADHD, OCD, some of those things.

Speaker: So definitely a lot of need there.

Speaker: It's hard because I think all of us are humans and all of us deal with

Speaker: psychiatric illness at some level in our lives, anxiety and depression.

Speaker: I don't think anybody's a stranger to those kinds of feelings.

Speaker: So definitely a lot of it in family medicine.

Speaker: Yeah.

Speaker: And you are the frontline doctors that people are going to see.

Speaker: And even if you're not treating it on a regular basis, getting people to the right place or at least taking care of them until they can get into the specialist seems like something to be very much needed.

Speaker: And I don't think mental health is going to be less important based on what's going on in the world and with our societies.

Speaker: Yeah.

Speaker: Just, I don't know how we get that started.

Speaker: I'm guessing an oculofacial plastic surgeon is not the right person to get that off the ground, but.

Speaker: You seem good intentions.

Speaker: You could do it.

Speaker: I love psychiatry.

Speaker: I love my own therapist.

Speaker: From what I can gather, obviously there's this bridge right between

Speaker: in the interim that you can get somebody with more long-term care.

Speaker: But I feel like part of this can help with burnout.

Speaker: If you don't feel like you're stuck with what you can do for your patient, if you can expand what you can do for them to take care of them the way that you really, like your heart really wants to do, I think that would really help with feeling, you're fulfilling why you've gotten to the center of care in the first place.

Speaker: Yeah, I think the ability to pivot is important.

Speaker: We just interviewed an ER doctor who is spending more time doing hospice.

Speaker: And that's really helped him refocus and reinvigorate himself on why he loves medicine.

Speaker: And you wouldn't think an ER doctor would be the best person to do hospice medicine, but he's doing home visits.

Speaker: He is hanging out with these patients, is really connecting with them on a deeper level than he's ever able to in the emergency department.

Speaker: And so the ability to do psychiatry or to

Speaker: pick up new skills and help people in different ways, I think would be really important.

Speaker: Now, that brings up the point of lifelong learning, continuing to learn things, pick up new skills, more information.

Speaker: And that doesn't only apply to doctors, but also applies to patients.

Speaker: If you want to tell us the story of your lovely old lady that came in, I think you said she's 80 years old and kind of decided that she was going to do better than she had previously.

Speaker: Yeah, she was a cool lady.

Speaker: She was actually really, she was 80 years old and not in very good condition.

Speaker: She was, you know, 80 to a hundred pounds overweight.

Speaker: She had a really bad heart condition where she had a new valve.

Speaker: She had pulmonary hypertension, which was probably a cause from her being overweight and having a hard time.

Speaker: having normal breathing.

Speaker: And she was just coasting along in her personal healthcare journey.

Speaker: She was going to all her specialists and doing the things she needed to.

Speaker: And one day she decided she was going to start walking.

Speaker: And she came into the office not long after that.

Speaker: And she said, yep, I've started walking and I'm walking 30 seconds on the treadmill.

Speaker: And that's all she could handle was just 30 seconds on the treadmill.

Speaker: And so I said, you're doing great.

Speaker: Keep it up.

Speaker: And she goes, is that OK for me to do?

Speaker: Is it worth it for me to do?

Speaker: And I was like, 100%.

Speaker: You're like, you're doing more for yourself than I could ever do.

Speaker: So make sure you're doing that.

Speaker: And so she was persistent about it.

Speaker: And every single day, she'd get on the treadmill and walk.

Speaker: And eventually, she got up to where she was walking minutes, like seven, eight minutes at a time on the treadmill.

Speaker: And to see her a couple of months later, and she was up to that number, it was so cool to see how invigorated she was that even at 80 years old, even with all these chronic problems, she was still able to improve her sense of well-being and improve her health.

Speaker: And that was just amazing.

Speaker: That's an amazing story.

Speaker: And people, I think, underestimate their ability to solve problems sometimes that they have.

Speaker: She was just such a great example.

Speaker: I think sometimes we get frustrated or we give up on people.

Speaker: We were listening to a comedy special the other day, Mike Verbiclia.

Speaker: And he was talking about how he was diagnosed with type two diabetes and the doctor wanted to start on medicine.

Speaker: And he said, no, I want to do this out in medicine.

Speaker: I want to lose some weight, improve my health.

Speaker: And the doctor just looked at him and said,

Speaker: I'm not optimistic.

Speaker: Let's just start the meds.

Speaker: Wow.

Speaker: Yeah.

Speaker: Right.

Speaker: Cause like for every person that's, you know, loses weight, there's more people that don't.

Speaker: And so I think sometimes we as doctors, sometimes we also limit people with just some of our own negative experiences with people not following through on our advice.

Speaker: And so sometimes it becomes hard to get that advice for the hundredth time that month.

Speaker: And you're not certain if they're going to listen, but we never know when the right moment is.

Speaker: I'm sure some of these specialists have been telling her to walk for years and she didn't.

Speaker: But then at one moment she did and she improved her life.

Speaker: So I think we give up sometimes a little too early.

Speaker: I think people can surprise us.

Speaker: Well, I also think that we take for granted, especially when we're not in her 80s,

Speaker: or 70s or 60s or 50s.

Speaker: That's going to be a big deal one day.

Speaker: And taking care of ourselves now is not necessarily the fit in a certain size of pants.

Speaker: It's to be able to survive maybe a pandemic or to be able to walk for 10 minutes when we're 80.

Speaker: Those are the goals that you morph into as you get older, but to keep that eye on the prize, good honor for taking it on and be like, I want to be able to walk.

Speaker: And it's not too late to do that.

Speaker: Never start.

Speaker: Or just also how simple it can be to start.

Speaker: Yeah.

Speaker: 30 seconds.

Speaker: It wasn't much.

Speaker: Her start was not dramatic.

Speaker: It wasn't impressive.

Speaker: But that 30 seconds became a minute and so on.

Speaker: And hopefully she's continuing to move forward and doing better and more.

Speaker: The other area in which we sometimes, it's a love-hate the internet.

Speaker: When people come in and

Speaker: having Googled or searched their disease or their condition, I have some people that come in and they've watched their procedure online.

Speaker: So they've seen a surgical video.

Speaker: And for some people it's nice and they know what to expect.

Speaker: And some people are freaked out because now they can imagine what's going on during their surgery.

Speaker: And for every person that comes in with a list of things that is the wrong diagnosis, every once in a while you have somebody that comes in and they come in with a diagnosis that turns out to be correct,

Speaker: Or in your situation, they come in with a diagnosis that maybe you weren't that familiar with.

Speaker: Yeah.

Speaker: Internet is a very interesting place.

Speaker: So I had a lady come into my office one day and she said, I got this thing on my finger and I think it's Aachenbach syndrome.

Speaker: And that's that was like that was my meeting her.

Speaker: This is the first time in the office.

Speaker: And that's just what she said.

Speaker: I was like, well, back up.

Speaker: Hang on.

Speaker: Like, tell me what's going on and tell me what Ackermack syndrome is, because I've never heard of this thing ever.

Speaker: Like you're talking in words I don't understand.

Speaker: And of course, it's pretty intimidating as a doctor to have somebody come in and throw out medical information that you're unfamiliar with.

Speaker: Because in that relationship, you're supposed to be the expert.

Speaker: You're supposed to know a little bit of everything in family medicine.

Speaker: And so if someone knows something you don't, that's intimidating.

Speaker: She started to tell me about the situation she had.

Speaker: Auchenbach syndrome is really weird.

Speaker: It's a rare bruising on the hand and typically it's paroxysm.

Speaker: That means it's like a jack in the box.

Speaker: It just pops up out of nowhere.

Speaker: It doesn't necessarily have to be a trauma or anything.

Speaker: You get this swelling and pain in your finger and then usually it has a small bruise and then it will resolve on its own over the course of a couple of weeks.

Speaker: And if you even read about it on up to date, it has one sentence on it.

Speaker: And up to date is a resource for the physicians use.

Speaker: It's like the Bible.

Speaker: It's like a Wikipedia for medicine.

Speaker: It has the answer to everything.

Speaker: We don't use paper books anymore.

Speaker: It's up to date.

Speaker: So anyways, that's what she said she had and everything matched and fit perfect.

Speaker: So I said, all right, we're diagnosing you with Aachenbach syndrome.

Speaker: And that was the visit.

Speaker: It was so weird.

Speaker: So the wild thing, I thought, am I just naive?

Speaker: Do other people know about this?

Speaker: So I got four of my family medicine doctor colleagues and I texted him the same thing.

Speaker: I said, do you know what Aachenbach syndrome is?

Speaker: Have you ever seen it?

Speaker: And the only one that knew what it was is this gray haired physician in a rural town that was one of my attendings in residency.

Speaker: But that guy, he's like the wizard.

Speaker: He just has seen and done everything.

Speaker: The other four, they were like, I have no idea what you're talking about.

Speaker: So that was reassurance that I wasn't delayed in my education.

Speaker: Yeah.

Speaker: Just for my own edification, is there a treatment for it?

Speaker: Or is it just reassurance that you know that it's not associated with anything horrible and it just happens sometimes?

Speaker: Yeah, you're just reassurance.

Speaker: In fact, I had another patient come in and this was years later and they came in with the same thing and they're like, I got this weird blue thing on my finger.

Speaker: And I was like, Agenbach syndrome.

Speaker: It was like, it's so weird that when it presents, it's the only thing that it is.

Speaker: And it's anticlimactic because you just wait.

Speaker: We don't know why it is.

Speaker: And you just wait.

Speaker: The bad news is we know what it is.

Speaker: The bad news is there's nothing we can do about it.

Speaker: And the good news is it's not going to cause any long-term issues.

Speaker: It's going to go away.

Speaker: So I could be much worse.

Speaker: And every time I Google anything, I have Panther.

Speaker: So Dr. Google can send you down some rabbit holes.

Speaker: I think it's really helpful for people, especially because they could get reinsurance if they know what's going on.

Speaker: I think the hard part is that Dr. Google doesn't tell you when not to

Speaker: know where that's what medical training teaches you it says when to worry what the red flags are what the really bad things are and just the general public doesn't know that and dr google doesn't reassure you to say oh because you don't have this one symptom mark cancer off the list that should be a poster you put in your offices like dr google doesn't tell you when not to worry that would be great

Speaker: Now, on top of being a family medicine doctor, you've also started a side business.

Speaker: So on top of learning about rare diseases like Achenbach syndrome, you are now doing something.

Speaker: It's not outside of medicine.

Speaker: It's medicine adjacent.

Speaker: So tell me a little bit about what you're doing.

Speaker: I would say spare time, but I know it's not your spare time.

Speaker: It's not spare time.

Speaker: It's on top of everything else you're doing.

Speaker: So what have you added into your life here?

Speaker: Yeah, I think as doctors, we're really good at seeing problems and trying to find solutions for them.

Speaker: And I think that's where you get things like Aachenbach syndrome and things named after doctors is because they're trying to find solutions to things.

Speaker: There's plenty of medical devices that are done that way.

Speaker: And when I was first into practicing, there's always certain things that people dread when they come into your office.

Speaker: And one of those for me was IBS because there just wasn't great education on what to do for it.

Speaker: And then an article came out and it was talking about something called the low FODMAP diet.

Speaker: And I thought, this sounds promising.

Speaker: It was like reducing people's symptoms.

Speaker: It was treating IBS symptoms and making their quality of life better.

Speaker: So I was like, great, these guys probably should have, tell me more about the diet.

Speaker: So I was researching and I thought, wouldn't it be great if they have a shake or something that they could take?

Speaker: And there was none, there was none on the market.

Speaker: It was like 2015.

Speaker: And so it always sat in the back of my mind, if there's a market for a shake, this could be a thing to really help people out to make the elimination diet within the FODMAP diet work to make the FODMAP diet easier.

Speaker: And so that's eventually what I got into was saying it's time that there's a meal replacement shake to make it easier for people that have IBS to have some kind of a safe meal that they can take where it doesn't give them the symptoms of pain and gas and bleeding.

Speaker: So that's the little side gig that we're pushing on.

Speaker: How is that for people that have?

Speaker: I know there's a couple different types of IBS.

Speaker: There's like the constipation type and then there's the diarrheal type.

Speaker: Does this help with both constipation or diarrheal or is it more for the kind of the, it sounds like most people that I'm familiar with have more of the diarrheal type.

Speaker: I'm not as familiar with the different types.

Speaker: Obviously I work from the neck up.

Speaker: So this is not my area.

Speaker: Yeah, it probably works better for the diarrhea predominant rather than the constipation predominant really helps.

Speaker: seems like a lot of fiber is the thing that will help them and safe types of fiber and this product we just didn't put a ton of fiber in it so it could help either one of them but it's probably more for people that are for diarrhea type and especially if you're getting the gas and bloating that's really what it's going to help out with because

Speaker: these low FODMAPs or sugars that digest really easy, they don't ferment when they get into the intestines.

Speaker: So if they don't ferment, they don't make the gas, they don't make the bloating, they don't make the cramping and stretching.

Speaker: It causes pain.

Speaker: So is this a product that's on the market now?

Speaker: Yeah, we just launched the product in August.

Speaker: And so it's a online e-commerce store and yeah, it's available to the public.

Speaker: So we're getting great feedback from them.

Speaker: We've had several people with IBS that have said it's really just changed my life.

Speaker: And those are the stories that I absolutely love because it's not necessarily about making, building a fortune in things, but with medicine, we're always trying to help people get a better quality of life.

Speaker: And that's really, I hope the niche that this one

Speaker: can fit into is that people can have a safe meal that they can go to so that their IBS doesn't have to control every aspect of their life.

Speaker: That's an important thing that's often overlooked.

Speaker: So that's why I said I love people in family medicine.

Speaker: You guys see it all.

Speaker: You do it all.

Speaker: You're doing psychiatric help.

Speaker: You're getting old ladies on treadmills.

Speaker: You're diagnosing heart catheters that are like central lines that are broken, caring about IBS.

Speaker: So the breadth of what you can do is pretty amazing.

Speaker: So I appreciate what you do and the patients that you care for and that you're always looking for ways to help more people.

Speaker: That's so kind of you.

Speaker: Yeah.

Speaker: But we can't make it without specialists.