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Diverticular Disease Discussion
81 Plays5 months ago
Olympics aftermath followed by an interesting development in people who use Ozempic, delightful discussion about diverticular disease and to top it off with a closing statement about your fiber intake (SPOILER: You aren't getting enough!)
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Transcript
Podcast Introduction
00:00:20
Speaker
Ladies and gentlemen, welcome to another episode of Chocolate with a Side of Medicine. I am one of your hosts, Dr. Sunshine. And I am here with, of course, this trio of lovely ladies. We got Amy Jo MD. What's up, y'all? We got Dr. Chris. Hey, guys. And Dr. No-No. Hey.
Post-Olympics Reflections
00:00:41
Speaker
So I hope that you guys enjoyed our previous episode, which was all about the Olympics because I'm sad because the Olympics are over. And ah my husband likes to watch John Oliver and John Oliver did like this like sketch where he basically took clips from all the other like news. yeah Like all the things that people missed.
00:01:01
Speaker
and No, not just that. But basically, like he took clips of all the other like news shows and everybody just repeating over and over again how much they missed the Olympics. But he's like, in case you guys didn't know if America misses the Olympics, it was like a clip from like Good Morning America, The Today Show, like all these different clips. And everybody's just like, oh my god, what am I going to do with my time? ah Oh, what do we even do anymore? The Olympics are over. right What do we do? What do we do? Go back to what? Hating each other now?
00:01:30
Speaker
like It's like we momentarily forgot that we kind of hate each other. and It's like, oh my gosh, this is ridiculous. Anyway. You're like, that's the most patriotic we've been in a long time, all rooting for the same thing.
Transition to Regular Sports
00:01:47
Speaker
taste too It's taken me a little while to warm back up to the WNBA because I'm like, man, I miss the Olympics. Not that I don't, and I, you know, I was in a good groove with WNBA. Like I've been keeping up with the games and everything, but I felt like last week I was like, I'm not ready.
00:02:02
Speaker
The Olympics is over. I just, I don't know. You know what? I could see that. I could see that because you've been watching this super team and I like, Oh, I guess we gotta all separate and be back on regular teams again. That's true. And I think I missed the variety. So, so for those of y'all who didn't figure this out from last episode, me and Dr. Sunshine are probably the two most fanatic Olympic watchers in this group.
00:02:29
Speaker
And and i when I tell y'all I watched everything, I watched damn near everything. I think I missed the shooting.
00:02:41
Speaker
And not all of it, just some of it, because I definitely saw the, i saw the um what is it, the archery? The shootout between ah ah South Korea and China? Yo, that was so good. So I am somebody that will watch everything. But I'm also the person that watched all the trials. I watched the you know every single one. I watched the ones that nobody watched. So I really enjoy seeing the variety of of every single thing to see like, you know, it all come together. So for me, I'm like, man, all you got for me is just basketball right now.
Anticipation for 2028 Olympics
00:03:14
Speaker
these That's it. No other sport. Like, can I see somebody do some archery something? Yo, you know what? You know what I found out, though? Like, because they already released like the plans for Olympics in 2028. Yeah. And at least like five of the locations for the Olympics are going to happen like in Long Beach, like close to where I live. But I'm like, this is
00:03:34
Speaker
wild. Because they're happening all throughout the city, but like five of the different events are happening because we have all the waterways and everything. So like the triathlon swim, the rowing, like at the convention center, I'm like, this is so interesting
New Olympic Sports Discussion
00:03:50
Speaker
to me. And swimming, surprisingly, is happening at SOFI. I thought that's where where they were going to do track and field. They're going to do it at the Coliseum. They're not doing it at the news stadium for the Rams and the Chargers. That's where swimming is going to be, which I thought was so interesting.
00:04:03
Speaker
um And gymnastics is going to be a staple center, of course. Shout out to Lakers, a staple center. So I'm excited. I have four years to wait, but you know it is what it is. It's going to be a good time. I am super excited.
00:04:19
Speaker
And they are adding, like because every Olympics you get to add and take away certain sports. So next Olympics, they're adding ah baseball, flag football, lacrosse, cricket, and squash. So cricket, was I reading that cricket hasn't been in the Olympics for like? Yeah, I heard they said that, and which I thought was so strange. like wouldn't Yeah, because cricket is big in the Caribbean and in India. They play cricket too. And don't they play in England?
00:04:42
Speaker
Yeah. Was it over 30 years or something like that since it's been in the Olympics? Was I hearing it right? Mm-hmm.
Breakdancing Controversy
00:04:49
Speaker
I think so. And breakdancing is not coming back. Yeah, but that's crazy, right? Because breakdancing, it came and then it left. And I'm like, well, y'all just going to come and feature it with these weird Australians that did it. That Australian girl, though, they
00:05:07
Speaker
I feel like if you premiere a new sport, you need to at least let it ride out for at least two or three Olympics. Because like, those people get tired and they're like, oh, like I'm gonna like.
00:05:19
Speaker
You know, you know, bootleg breakdancing in Long Beach, it's gonna get shot up. I'm saying they didn't even give the they didn't even give USA a chance to be like, okay, that was cute, which I did four years ago, but this is like for Roto.
Olympic Trials Fairness Debate
00:05:37
Speaker
If it would be in the US, do you could get people from like the Bronx to come over and show it like what it like show everyone what it's all about, you know, but I feel like how do you Olympic sports work? Like, Oh, wherever you close your, your local people, code it'd be easier to get to I figured the cross ocean weren't there. That's not why they weren't there. That's not how the Olympics works, my friend.
00:05:57
Speaker
Well, how did they recruit them in the first place? So that's why you bring up an interesting point. So the aust Australian, the professor and her husband, like I think they're being sued for fraud because essentially they kind of manipulate it like how you get chosen. Because somebody posted a video of an Australian breakdancer that lost to this lady that ended up in that first of all. So there is there are rumors that they're being sued for fraud because essentially um her husband was on the committee that selected, just like you watched the Olympic trials and everything, all these things have trials, right? Every sport has a trial that where they they use what's supposed to be- Damn y'all, stop. I can't, I can't even fathom someone losing touch. I can't. So great dancing was not different.
00:06:43
Speaker
you know, even though it was new, but yes, that that Australian professor husband was on the committee and she, you know, miraculously got picked, but now they like being super fraud because they say they kind of rigged it. Man, I hope their 10 seconds of fame was worth it, but um yeah, that's probably because of the hefty fame. They never removed it. So it's so bad. It's so bad. And it is so um over the top that um Peacock has removed it. Like, you know, you can still watch all the replays.
00:07:12
Speaker
Yeah. Who can I watch her? So you're going to get on YouTube. What? They are taking hers off TV. Like, this is causing too much trouble. Wow. And she's still standing. She's standing 10 toes down that tray. Yeah, I saw that interview. I was like, man. I was really proud of myself. I just, you know, wanted to have an opportunity. She sounded like you now, Dr. Nona. Well, I was close. I just wanted to pull up and see if what i how I could test it out. Do not. Absolutely not.
00:07:37
Speaker
That's not the place you test out your skills, right? like thats That's of all the places to say, I'm just going to see how it goes. We don't use the Olympics for that. It's the Olympics, for crying out loud. And even if it is the first time I had been to the Olympics, like I just didn't appreciate her.
00:07:53
Speaker
conversation, it was legit. like She was like, well, I thought it would be fun. you know And then in the end, she throws in, but I took it very seriously. But the whole first part of her interview was like, I thought it'd be cool to do. I thought it'd be fun. I just wanted to feel really proud of myself for trying something. Girl, this the Olympics. You're not here to try. You're here to compete. And you you gave up somebody's
Ozempic and Health Concerns
00:08:16
Speaker
seat. You took somebody's seat that probably could have done a a better job than you.
00:08:21
Speaker
so yeah the trending topics transitioning okay y'all listen because i ran my mouth so much i'm gonna keep i'm gonna keep it cute i have been meaning to bring this up i feel like i mentioned it in passing but i went back to find um the article so that i would not speak poorly on it because somebody asked me about it the other day and this is about olympic okay so i had to go find the article because somebody was like hey am i gonna lose my i'm gonna go blind using olympic and i was like well
00:08:52
Speaker
I would have told you no before, but I don't know. So there is um some early studies, um I think it was um published in JAMA Ophthalmology, um that said that Ozimpic could possibly be responsible for non-arteritic anterior ischemic optic neuropathy.
00:09:18
Speaker
And so um it can essentially impact the optic nerve and the fibers behind there and cause a blindness that is irreversible. Now, um though so essentially the blood flow to the optic nerve gets reduced or blocked and it leads to sudden vision loss, which was quite frightening when you think about it.
00:09:40
Speaker
Now, of course, Gemma's ophthalmology article said that they need to do more studies, but they're they're trying to confirm how um consistent the link is between this drug and the vision problem, but they have noticed a slight increase in nanion. I think that's how they do it, is the is the acronym NAION.
00:10:03
Speaker
nanion but it is the second most common optic nerve disease in the U.S. and it occurs in 10 out of 100,000 people um according to the American Academy of Ophthalmology and it's the one of the most common causes of sudden blindness and the condition is permanent with no known treatment. So I think that that part is the issue is that does ole zippig have a significant link to this um and what does that mean? Of course they're saying it is not happening enough that they are making any recommendations and there's no screening tool. So the new study was based on an analysis of records over six years, about 16,800 patients in the Boston area, none of whom were originally initial or were initially diagnosed with Nanion. And the researchers found that about 1,700
00:10:53
Speaker
either who either had diabetes or were overweight or had obesity um were compared 36 months after they were prescribed semiglutide versus those that weren't, that worked. um And I don't think they used any of the other GOP ones. The only one that was in this study was a semiglutide. People who do not know that it's Ozimpic and Wegovi. Both Ozimpic and Wegovi are semiglutide. Ozimpic is for diabetes. Wegovi is for weight loss.
00:11:22
Speaker
and almost 200 of the diabetic patients were prescribed semiglutide. 17 went on to develop NANION, but that rate is more than four times higher than those not prescribed the drug. For the obesity group, 361 people were prescribed semiglutide and 20 people developed the condition, seven times the higher rate.
00:11:42
Speaker
So the studies do suggest that the rate is higher, but they don't know why, right? So they are trying to figure out in that group that had this higher rate, is there another factor that plays a role in there that has something to do with it? I have a question. yeah it it Was it like dose dependent? So they didn't say they didn't say anything about the dosing if maybe on the lower dose versus the higher doses.
00:12:08
Speaker
No. Right. Now in fairness, I read the article. I didn't actually read the study. And so I don't know. And the article, while it told me the rates of like people who develop the disease, it didn't say if they were on 0.5, one milligram, you know, to 2.5 because the, the dosages are different on both
Ozempic's Popularity vs. Skepticism
00:12:30
Speaker
sides for people who don't know. So Ozimpic goes 0.25 to 0.5 to one to two.
00:12:36
Speaker
But wegovi does like 0.25, 0.51, 1.7, 2.4. Yeah. And so it's a little bit different. They did not say um what it was. They said that the risk factors for NANION is sleep apnea and hypertension um in addition to, you know, diabetes and people with obesity. And they said that it's plausible um that it can cause a condition but they finished the study saying like it's premature to conclude and the study can only generate a hypothesis of a possible link. So even though they did the study and even they saw like this weird number trend
00:13:20
Speaker
I don't think they um are ready to say, yes, this is absolutely, positively is going to be done. But at the same time, the ophthalmologist, the neuro ophthalmologist, everybody is saying it's plausible that the GOP one um could have this paradoxical biological effect.
00:13:44
Speaker
I haven't saved your life from diabetes, but could give you sudden onset. I am going to dig like deeper into this, mainly one because I have the time to do so. But the problem I'm having with this is, so semaglutide is FDA approved. So I won't go too deep into this for the listeners, but in order for a drug to be FDA approved, these drugs have to go through clinical trials and there's different phases. There's phase one, phase two, phase three, phase four.
00:14:11
Speaker
Like the first phase is saying, hey, is it safe? Phase two is like, you know, how well does this drug do what you want it to do? And then phase three is like, you know, is anyway, point is there's different phases, but specifically in phase four, which is the problem we're in right now.
00:14:30
Speaker
who Phase four is when people have been on this medication for a longer period of time and they want to make sure that there is no long term effects as an Oh, does this drug eventually give you cancer? Does this drug eventually make you suddenly go blind like that type of thing? So I'm wondering what phase like what but I'm wondering how we got through. Right, but but you said, but when you were talking about this trial, you said a total of it's been what, like six years? Like they follow these people for six years or so? You said something about six years, but I kind of feel like it takes longer than six years to get through the first three phases, right? Like it takes a while to go through these phases. Right, but you did oh oh, you weren't with me. ah Dr. Chris was with us.
00:15:14
Speaker
Keep in mind, so- But I'm saying it's 2020, it's 2024. Yes, but it's been out longer than that. It's been out long for a while now. And the only thing I say to this is that me and Dr. Chris, what, second year residency? Yep. Went to, we went to something. Oh, that puts us at 2017. And Saxenda was in. Saxenda was already out. Already out, being sold. And I remember we were talking about it because we couldn't get it at county.
00:15:42
Speaker
So we couldn't have it, but Saxena was already out and they were talking about, there's also one that is out that was gonna be a once a week. Like I remember the guy telling us that, then he was like, yeah, you have to take this one every day. Cause he was taking it, him and like the whole crew, we were like, look at us, we're so skinny, we take it every day. But there's one, he was, he was like going in and I was like, I'm a little jealous, but whatever. um Right, cause you're not residents, y'all was so fluffy. Anyway.
00:16:09
Speaker
um he was like, there's one coming out that is um that is that is once a week. So it's been out longer than that. And then I remember there was another article that talked about um a study that they did that um ah study they did to figure out how long would you be able to keep the weight off after you stopped?
00:16:33
Speaker
to my blue tide, and the answer that was four years, right? So in order for you to have studies that long, there's been a group of people that have been on this longer than 2020, right, when it kind of had a big boom. But it'll be interesting. I can't wait to watch you find, because when I tell y'all, if somebody's going to find something, Dr. No or Dr. Sunshine going to find something, where you find it, I'll read it after you find it. But they will discover some stuff. So I can't wait for you to look for it.
00:17:03
Speaker
because it's been a little bit longer than that. Because that's been like the ongoing, like I'll say joke on social media, like the ongoing thing where it's like, oh, everybody wants to know like what's in the COVID vaccine and the tests that they went through. But then as soon as those things came out, everybody like, give it to me. Shoot me up. No, no, no. And it's like, you don't want to know what's in this or how long they did research on it. Mm-mm. It's going to let me lose weight. Shoot me up. Shoot me up. I'm like, what is happening right now? What happens to all this research that I was going to be doing? People want to lose weight that bad.
00:17:31
Speaker
They don't care. They don't care. They don't care. But I'm sitting here like, it still has to go through like, because you guys are right. Because you're right. That would have been in 2017. It's 2024 now. So there's enough of a time frame where you're right. It would be in phase four. Yeah. This is the, hey, does this cause you any long term effects down the line? Because now we're there.
00:17:54
Speaker
Yeah, they definitely want to do this. They're like, yes, give me the medicine. Oh, it could cause this. I'll be fine. Or I even have patients like, oh yeah, I was just recently hospitalized for pancreatitis. But I need to lose weight. But let me try it anyway. Can I try it again? And I'm just like, no. Yeah, too. I had two cases.
00:18:13
Speaker
Yeah, I had two cases of that in the past couple of months. Pinkery Tyres induced by the GOP. I had so much soul. I had a patient. She was like, nah, that didn't happen. Send me to another GI ah doctor.
Patient Stories and Ozempic Use
00:18:26
Speaker
yeah And then went to see the other GI ah doctor said the same thing and confirmed that it was likely the GOP one that caused it. And then she like, well, can it can I put it? Can I start it again on a low dose? And I said, no.
00:18:43
Speaker
No, but I need some while I have seen somebody like that like went on it what had a history excuse me had a history pancreatitis Came off of it because it thought I think it started year please, please, please, please, please, please, please. I think she i think she purposely let her A1C get a little bad so that um we'd have to put her back on it. Try it again. Came back and like, she is sitting and I was like, I will see, you no, I will see you. She is sitting so uncomfortable. And I'm like.
00:19:15
Speaker
Does your stomach hurt? She's like, no. Remember that part in Bridesmaids when you make your food poisoning? She's like, you want a mint? And she's like, yeah yeah, it's delicious. That's kind of how I feel. So your stomach don't hurt? And she was like, no. And I push on her her stomach. And she is wincing. She's like, mm-hmm.
00:19:40
Speaker
Oh my God. I was like, man, we're not doing this. like We got to stop. That's how much people like want this medication, despite all the, it's crazy, y'all. But they don't want to they don't want a COVID vaccine, because like yeah they'll take the chance that it's going to die. No, they won't take the COVID vaccine, but they'll take ivermectin mixed with hydrochloroquine yeah and some other cocktail or whatever random bleach, maybe, I don't know. And they'll take that, but they won't take the vaccine. I'm just like, okay. But I ain't gonna lie though, cause you know, I might be a doctor, but I'm still black. This is scary. It is. I ain't trying to have no sudden vision loss. I ain't trying to do it. No, I agree. I'm like, y'all not scared? Now, here's the real funny part. Where are the people bringing me this article? Because this article has my full attention, and ain't nobody brought me this, right? Ain't nobody did their research and pulled up on this. Oh, you mean the patient. You mean the patient. Right. I'm like, yo, are y'all reading this?
00:20:42
Speaker
sudden iss acute sudden like It's like having a stroke in your optic nerve. They're not bringing you completely irreversible, yeah they're not really weird basketball but they're going to tell you that they can't take metformin because ah because of what people were saying. Aye, I wear the poop.
00:21:01
Speaker
Um, so give me some metformin, um, give me some metformin and a little B12 in case I get a little deficient. But yeah, but I'm honest, but I'm honest with the patients. We talk about different medications and stuff and they tell me which ones they don't want to take. They don't want this. They don't want that. I'm like, listen, cause some of the medications I'm like, listen, this one's been around a long time. We've studied it a long time. Like it's a tried and true like metformin statins like some of these have been around for a while as in like there's been enough people on it we've been deeply into phase four everything looks okay you're not gonna get something weird when you start talking about these new medications and stuff like that like you need to keep up with the updates because they're not done researching it there's new studies all the time like there's you know
00:21:46
Speaker
It's going to change. It could change for the better, for the worse. Who knows? They might say, oh, we could start giving a Olympic to, you know, because they were start because they started talking about giving it to pediatric populations. Remember? Yeah. Yeah. And they started. Yeah. They started talking about giving it to kids. And then like, you know, when you're still researching stuff on new medications, like you got to let it play out sometimes. And I'm not saying I'm a doctor that's like anti anti new drugs. But I have to tell patients, I'm like, hey, like this is new and sometimes pros have a con. So you just gotta to got you got to, I didn't hear about the pediatric use for it. That's, that's a little, yeah, they're trying to give it because pediatric obesity is like a huge, huge, like, rise. Yeah, it's on the rise. And they're trying to see if they can give it to pediatric populations. But then it gets into topics about like pediatric populations, especially adolescents and their self esteem. And if they have like mental health along with that, and yeah it gets, it gets dicey. And then eating disorders, it gets weird. So it's, ah it's a lot of research going on there.
00:22:45
Speaker
Well, thank you for the update. I appreciate that because listen, it's a little bit over here causing blindness, man. I gotta, I gotta, I need to send it, you know, go deep I can't believe I have a sentence to you. I thought I sent it to you all. Sometimes I've seen yourself just to hold my place, but let me make sure I see this article. Cause I was like, Oh no. Um, no, it wasn't big for me. No, I'll say a little fluffy, but, um, I'm not losing my sight.
00:23:12
Speaker
I'm going to be squeezing through that. Excuse me. Oh, I'm sorry. I bumped that. I'm so sorry. At that point, you're not even going to see how fluffy you are. Oh my God. I know. I'm just knocking over. I'm not going to... I'm bumping into people. I decided that thick is the way to... Nope, nope, nope. Anyway, Dr. Chris, do we have time for your topic? Is your
Introduction to Diverticular Disease
00:23:33
Speaker
topic long? No, my topic is not very long.
00:23:36
Speaker
um What's poppin' boo? So I picked, so my topic is gonna, it's called diverticular disease. So I know people are like, what does that mean? So basically, I see this all the time. I'm sure you do.
00:23:53
Speaker
like thought nodo k probably yeah yeah that you could talk about But we see it in the outpatient too. So basically, this is a disease that pretty much affects your large intestine. Okay, so a lot of times when patient comes to see us in the outpatient setting, they um complain of having like abdominal pain a lot of times mostly acute abdominal pain mostly on the left lower side of the abdomen but sometimes it could be on the right they can have some fever chills nausea not able to um low ah low appetite can't keep anything down but they're mostly like just tender and sore in that area they can have some diarrhea or constipation so with the
00:24:42
Speaker
So this particular thing that I'm talking about, a lot of times they present with what's called diverticulitis. So that's just inflammation of the diverticula. So there are a lot of, within diverticular disease, it's a category of different diseases, which includes diverticulosis, diverticulitis, and also diverticular. So basically what that is is a condition when you have diverticular disease it's just a condition when you have tiny pockets in your colon okay so when you have diverticulosis that's usually it's a lot of times it's usually painless and it's just those tiny pockets that are there that can just happen it could be genetic um usually happens when you have a lot of pressure in your colon it could be due to ah various things like
00:25:37
Speaker
chronic constipation, taking chronic opiates or um things like that can increase your risk of that. Also the type of foods that you eat, like having a diet that's not high in fiber, um obesity, and usually the risk factor for that is or when you're over the age of 50. So if you've had colonoscopies,
00:26:03
Speaker
A lot of times when you've had colonoscopies, they can tell you that you have diverticulosis, which is just having those little tiny pockets and they tell you not to eat seeds or anything like that because the seeds can get stuck in those tiny pockets.
Managing Diverticulitis
00:26:16
Speaker
um So that's what that means. Diverticulitis is just inflammation of those pockets that can occur. So you can just, it can just be from chronic inflammation or it can be because maybe some stool got stuck in one of those pockets and it ah causes an infection or an abscess. That can happen.
00:26:37
Speaker
um Another thing under that diverticular disease is diverticular bleeding that can happen. So you just have like just small blood vessels that pouch out, that break and causes some bleeding. And usually someone who presents with that, they usually have some bright red blood that comes out the, wreck bright red bleeding out the rectum that can, that can occur usually mixed with the stool. And that can happen, but that's not as common.
00:27:05
Speaker
um So Dr. Chris, and can I interrupt you for a second? Yes. I'm just going to interrupt just to help with the ah the visual and explain it the way that I explained it to my patients. So if you imagine that, because she's talking about your colon. So if you imagine that your colon, which is your large intestine, imagine it's shaped like a tube, for example. So say you have a tube and say this tube is really, really filled with a lot of poop, like you're constipated. Sometimes that tube can all of a sudden get bulky and it can bulge outward, like a little bit.
00:27:43
Speaker
So if you imagine that tube and that tube bulges out a little bit, sometimes when it's really full with that pressure, it creates those pockets that Dr. Chris is talking about. So you have this bulky tube, it creates these little pockets, and those pockets are what she's talking about. Those pockets can bleed, they can get infected, or sometimes they can just exist and you don't even know that they're there.
00:28:05
Speaker
but it's pockets along the tubing, which is your colon, and eventually you use, of course, your colon to poop. That's what she's talking about. Yes, thank you.
00:28:19
Speaker
I guess. So, um and a lot of times when this happens, um it's painful. And so people want to, so when you come in, we can a lot of times we just can diagnose you clinically, we can do labs just to make sure that there's no other things going on, just kind of rule out other things that could be happening. A lot of times to diagnose it, to really know if you really have diverticulitis, the best test usually is doing a CT scan to see if you have that. But we don't normally just send everybody for a CT scan if we think you have diverticulitis. If we suspect it, it kind of depends on the severity. If it's mild, moderate to severe. So they, in the past, I know
00:29:09
Speaker
they used to if they if you suspect that the person had diverticulitis you just give them some antibiotics and it usually helps and goes away. Now we're moving away from that because if it's mild to moderate what they tell you to do is maybe it can be managed outpatient and you can just kind of do like a liquid diet kind of like give you about a little bit of rest um for a few days and advance your diet as tolerated, and it usually helps with those symptoms. Now, sometimes it doesn't go away like that, and you do need to have treatment. And when that happens, you got to go to the emergency room and then you'll see Dr. No, right? And she'll be helping you with that, right?
00:29:53
Speaker
so At that point, usually, they if you're having to go to the emergency room, you're usually getting a CT scan for them to see. And basically, just to figure out, do you have the diverticulitis? And if there's probably an abscess that is there. And if there is an abscess that you need to likely get it drained, or they have to put you on some IV antibiotics and stabilize you.
00:30:17
Speaker
So Dr. Chris brings up a great point. So diverticular disease, specifically the infection part of it, diverticulitis. You know, abscess is probably the most common complication, but there are a lot of other things that can happen with diverticulitis. You can have the abscess formation small versus big that need to be drained. um You know, you can also have a perforation of the bowel. So like little microperforations within the um youil the tube Dr. Sunshine was talking about, or it can be like a big perforation where there's a big hole somewhere in your colon that's causing air and stool to get into your abdominal cavity. And that requires a very extensive surgery and long-term antibiotics. So usually you're coming in with like just just really bad belly pain. You got fevers, your labs are all just out of whack. And usually when that happens, we're calling surgery.
00:31:12
Speaker
And you're going to be in the hospital for a little bit while we take care of this. Yeah. it's It's never a good thing when stuff inside the colon gets outside of the colon. but those are Those are bad when it's complication. But normally the ones that I would see or Amy Jo and Dee would see are usually the mild cases that can really just be managed with just um your diet and you know increasing your fluid intake, things like that.
00:31:43
Speaker
In fairness, I put most of my diverticulitis on antibiotics. Because by the time I see them, they've kind of waited, you know, oh, I was having a little bit of pain. I was having a little bit of pain. And now they're kind of really uncomfortable. That left lower quadrant is pretty tender. You push on it, they're like, yep, right there.
Diverticulosis vs. Diverticulitis
00:32:03
Speaker
So if I were being honest in my office, they probably do get a CT to confirm what we suspect.
00:32:10
Speaker
and we put them on antibiotic therapy. She's talking about oral, y'all. Not the IV ones that Dr. Nolan was talking about. No, oral antibiotic therapy. And I just want to just really make it clear that there is a big difference between diverticulitis and diverticulosis. So there's been people that have been diagnosed with diverticulosis, which is the weakening of the the colon wall, poo pockets in your colon. So if you got poo pockets in your colon, it does not mean that you're destined to have the
00:32:48
Speaker
diverticulitis, so itis of the colon. So think about itis, it's gonna happen right now. I got the itis, which means it's happening now. Losis is something that's gonna happen over time. If you got diverticulosis, then we're talking about a diet issue. You need to eat more fiber. If you got the itis, you need to see a doctor, okay? Because the itis is gonna take you out. And I would prefer you not wait you know a week And then come in and see me and you are like kind of, you know, leaning forward a little bit hunched over because you're in so much pain and I give you a gentle push on that left quadrant and you're about to come off the table. Yeah. That's going to get you, that's going to get your CT and some antibiotics. Right. Yeah. So when Dr. k Chris, Oh, go ahead.
00:33:36
Speaker
No, I was just going to say that sometimes like if you had it if you had one bout, you could get another bout, but it doesn't necessarily mean that you would keep getting another bout of diverticulitis. And if you have frequent bouts of this, sometimes what happens is the treatment is when you see the specialist, they recommend taking one part of your colon out so that it doesn't keep happening.
00:34:01
Speaker
all the time. I mean, to be honest, across the board, long story short, most people do not know that they have diverticulosis until something happens. Either number one, you have blood in your poop.
00:34:12
Speaker
Number two, you get a colonoscopy and they tell you. Those are really the two main ways that people know they have diverticulosis because patients will come in and they're like, oh my gosh, there's blood in my poop. Painless blood, as in you went to the bathroom, didn't really, you know, like tear anything, nothing crazy. And they see blood in the toilet bowl, which of course people come in, tell you blood in the toilet bowl, the first thing they think is cancer, right? Like, oh my God, I got colon cancer. And I'm like, slow down, slow down. We had to figure it out.
00:34:40
Speaker
or A lot of times people will do the take-home test, either the cola guard or they'll do like the take-home fecal test and it'll be positive as in you have blood in your stool. And then if you have blood in your stool, of course, you got to get a colonoscopy. Like that's the reflex. If the screening test comes by positive, you got to get a scope. ah They'll be like, oh, what does this mean? And I'm like, well, the scope will tell us what we're dealing with. So those pockets can bleed. So when you eventually, no matter how it shakes out, you're going to end up getting the scope anyway, either so that we can make sure it's not something scary or confirm it's
00:35:14
Speaker
diverticulosis or something else that's causing the bleeding, and then we give you a treatment plan and a management plan going forward.
Importance of Fiber Intake
00:35:22
Speaker
Typically, that's how it shakes out. But people just don't live their lives and just be like, I think I got diverticulosis. Like, it's not like a thing that you would just know that you have. But like Dr. k Chris said, it is more common in certain populations, especially if you have a history of chronic constipation. That's a really big one. um But you won't really know until it either has a symptom that you recognize or you get the scope. And then we are scoping um patients earlier. We did a whole colon cancer episode. That's actually one of the first episodes we ever did. And we talked about Chadwick Boseman. That was in season one. if y'all for y'all For y'all hardcore fans, hardcore fans out there. That was season one. So we did a whole episode with Chadwick Boseman and we talked about it. um But that's more along the lines of colon cancer screening, but that's how you would know that you have diverticulosis.
00:36:16
Speaker
who Yes. You know, um this puts me on a soapbox that I've, well, puts me back on a soapbox that I've been on. I have many soapboxes, but there's a couple that have been driving my life recently. And that is fiber, so the standard American diet.
00:36:35
Speaker
sad for short um it knows that ah that Americans probably only get I think up to 12 so I think it was ah so adults 2 and older ah so consume maybe 12 to 14 grams of fiber for every 1,000 calories in their diet. That's not what's recommended. That's how it's recommended. It's way higher than that. I think it's like almost three times. We're supposed to be getting 25 to 30 grams per day from food sources. This is important rather than supplements. Because what happens is um you ask people like, hey, are you you know are you have you increased your fiber? And everybody says, yeah, I started taking menomusil last week.
00:37:22
Speaker
But the recommendation is that it's 25 to 30 grams of fiber from a food source. Y'all we're not eating nearly as enough um fiber. i I would say that fiber is probably as big of an issue as how much refined sugar we take in.
00:37:45
Speaker
when you think about it. So when people are talking about de you know people who eat plant-based diets and in higher amounts of plants and less animal product, a part of that is the fiber. Some of it is the calcium. So we know the calcium in the in the um plant-rich foods has a protective measure from colon cancers.
00:38:10
Speaker
but also the other part of it is fiber, right? So fiber is a broom. So remember those poo pockets that Dr. Chris was talking about? If you don't want those little pockets, your diverticulosis, if you don't want your diverticulosis poo pockets to stay packed, you need a broom.
00:38:27
Speaker
And that broom is fiber. So not only do you end up with diverticulosis, you're constipated, you push harder, you end up with hemorrhoids and diverticulosis and bleeding. And it's because we don't eat enough fiber. We've got to eat the fiber though. Like I'm okay with people taking a supplement. I want folks to supplement it, but we really need to eat it. And wouldn't that be more fun? So you're not hungry. Like eat, eat the fiber. We've got to eat it. Like chew it, swallow it, eat it, not supplement it as much as we do.
00:38:57
Speaker
Yeah. And you're going to get it from those veggies. You get it from like oatmeal, you get it from, there's a lot of fiber rich foods and things, not things that you would probably normally want to eat, but it's, it's there. Yeah. And I mean, think some of these risk factors are things that we can make changes, right? You can, you have control of it to, you know, decrease your risk. I mean, there is a genetic component to getting diverticulosis, right? But like there's some.
00:39:27
Speaker
there's some things that you can do to like help decrease your risk. And also smokers have a higher risk of it as well. Um, uh, people who drink heavy amount of alcohol too. And, you know, and sometimes people who have to be on opiates or, or have been on opiates to manage chronic pain over time, cause it just causes your gut to like, just move a lot slower. Right. And then it just makes more of that issue, you know, causes the chronic constipation.
00:39:54
Speaker
right And it's just harder. but if you But if you do it properly, you can have a good high-fiber diet. like You can get your stuff together and get like some oatmeal, apples and pears and avocados and nuts and stuff. like There's a way to do it. but But depending on the type of life you live, especially sometimes people get really busy and they eat a lot of fast food or you eat out a lot, you're not you're likely not getting the fiber that you need. Because it is it does require you to spend a little more time in that produce section. And sometimes when we're really busy, we not kicking it in the produce section. Yeah. It requires you to be more intentional about what you're doing and yeah paying attention to what you're eating to help reduce your risk of things.
00:40:36
Speaker
Yeah, because you're scooping that Chipotle on the way home. You're not over there picking out raspberries. Right? Right. that that partner that There's a GI doc that I follow. Don't ask me his name. I don't remember. But he is always pushing that. He thinks that for for good ah go how health, you should have a handful of berries every day.
00:41:05
Speaker
I can see that. we've made up We've made a point to incorporate berries into like our morning routine. And I just do it with yogurt. So I have yogurt, honey, we buy mixed berries from Costco, and then a little granola on top. I make my own parfait at home, basically, just so we make sure we get the berries in the morning.
00:41:24
Speaker
Because if
Exploring Granola and Chia Seeds
00:41:25
Speaker
you don't eat them in the morning, yeah. I'm also not working, so I got time to be making parfaits. I'm like riding course. Yes. OK, but berries are good to have around, because if they're around, I will eat them. Like, fruit is something to me where if fruit is around, I will eat it. And especially if it's in the front of the fridge and I see it, I'll eat it for snacks. Like, I'll grab a nectarine. Like, I'll grab a pear. I'll make a smoothie. like I'm down. The problem is that when you, when you're not on the produce section, you don't like buy it or pick it up and you're not intentional. Like Dr. k Chris said, then yeah, you just don't have it in your fridge. Cause it's just, it's not there. You ain't, you ain't by none.
00:42:05
Speaker
but right I mean, berries are a really easy way to get your fiber in, but um I literally just pulled up this chart because I just wanted to see how much fiber I was getting in and it needs to be better. But there's like different vegetables. So green peas like per cup has about nine grams of total fiber. um The most actually per this chart for Mayo Clinic are split peas, which are boiled about one cup will give you 16 grams of fiber. ah Your lentils, your black beans are about the 15 gram, 15 gram range.
00:42:37
Speaker
And ah chia seeds, which, you know, ah all those influencers are putting chia seeds in their yogurt and stuff and their drinks, but there's actually some benefits to that because it gives you 10 grams of fiber, your daily intake for the day. So, so just kind of, you know, figure out like what we've been saying previously, just figure out kind of what works with your schedule and like your meal plan. And you can really kind of plan your meals around like a couple of vegetables, berries.
00:43:02
Speaker
um There's some like whole wheat spaghettis and like actually breads that you can have like the fiber added into it I'm like the I get it at Costco. It's like in a green It's in a green um ah Package but it has like I think it's like 15 grams of fiber like per ah two slices of a bread there once I find it I'll let you guys know but just kind of works on your schedule I did not even know that chia seeds had all this fiber. So whenever you go somewhere, if you go to one of those fancy places that makes a fruit bowl, it's like an acai bowl. And you can add whatever you want in there, add fruit, and this and that. There's a little section where they're like, at least we have a fancy one over here, where they're like, oh, which type of granola would you like? I'm like, there's more than one. And they're like, yeah, we have maple granola. And we have this granola and this granola. They're like, would you like chia seeds? And I'm like, no. Because I'm like, what the hell is a chia seed? I just keep it pushing.
00:43:55
Speaker
I mean, where am I supposed to have some? I have some. Dr. Sunshine, how have I failed you? I have been eating chia seeds forever. What? Girl, I didn't know what that was, but they were like, would you like some chia seeds? And I'm like, no, it sounds nasty. Don't put that in my bowl. Oh my gosh. Give me them strawberries. I put them in my smoothies. Give me them strawberries and pineapples, though. I am certain. Maybe not your dirt sunshine, but I feel like I have made Dr. Noel a smoothie, and I am certain I put chia seeds in your smoothies.
00:44:22
Speaker
I didn't even know what it was, but now- You gave me fried green tomatoes though. I remember that. I did make fried green tomatoes. I made somebody a smoothie. Maybe there's Dr. Chris. Dr. Chris will drink my smoothies and I definitely put chia seeds in it. There's always chia seeds in my mouth. Listen, I didn't even know what it was, but I'm already on the other side of town. This place is fancy. They asking me about different types of granola. I'm like, I don't know, girl, pick for me. Like, I don't know. You're right. I want regular granola. Which one? Give me the standard. Yes, the standard. This is purely a California thing, because it was one type of granola. I think I only got one type of granola. But that was a good topic, Dr. Christian. Awesome topic. Good job. I don't know if there's anything else anyone wanted to add, but I just wanted to focus on that. It's not all that common, but I've been seeing it.
00:45:09
Speaker
more so in my office lately. Girl, I see it all the time. I think every shift, I met someone with diverticulitis, a complication of it. Someone got a big old abscess. Okay, y'all, so hold on one second. it So at the place I was talking about, I put up their website. So under granola, it's hemp, granola, pumpkin flax, maple quinoa, or chocolate with chia seeds. Those are their types of granola. Is quinoa a chia? I thought that was different. Quinoa is different.
00:45:37
Speaker
Maple quinoa is a type of granola, apparently. It's a type of granola. Oh, I see what you're saying. These are all types of granola. And she asked me about it. I was like, girl, I don't know. It's the regular. There's no regular granola. Regular granola. That's it. The maple quinoa looks the most regular granola, because the one I have at home is a little chunky.
Gratitude and Celebrations
00:45:57
Speaker
It's a little chunky. It's got little bunches in it. I'm like, that one.
00:46:01
Speaker
I'd be like, give me regular of everything. I just want regular. Actually, the target granola is pretty good. I picked some of that up. I like to love that white fat. It's very good. And I told her, I'm like, I'm so sorry. I'm from the South, and I've never been here before. And then she's like, OK, do you want any type of butter with it? I'm like, what kind of butter? She's like, oh, we have peanut butter. We have almond butter. We have, I'm like, you know what? You know what? We're just going to. No butter. good I'm straight. I'm fine. Like, what? What are we doing? Just got options. That's good.
00:46:30
Speaker
Yeah, but like, you know, but to be honest, ask y'all ask me this again in like five years. I'll be like, oh, let me tell you how to make an ultimate bowl right now. I'm just like, I don't know. I'm like, I'm like the fruit. The fruit look good. Let me get the fruit. Thanks. You know how la it would take me to make a decision. I'd be there like.
00:46:47
Speaker
Hm, I don't know. Which one do you think? I'll be sitting there thinking about it. There's some people like that. And the way that they do it, they make it in front of you. So there's some people standing in the line, and they're like, oh, can I try can i try that granola? Can I try this granola? Can I try this one? And there's some people sitting there just trying stuff. and then Oh, so this is not the place where you like make your own yogurt and you have to weigh it at the end?
00:47:06
Speaker
Because I definitely did that and paid $30. No, they make it for you. For those that care, it's a place called Blue Bowl in California. So you guys can Google it on your own. They have tons of options. Anyway, maybe I'll be more savvy later. I love how we ended up talking about different types of granola.
00:47:24
Speaker
oh liber Fiber. Because the fiber will help to prevent the diverticulosis. The fiber is the broom of the colon. There we go. We want you to not poop. We have a problem. so Exactly. If you're not pooping or you're constipated, then you get all that negative stuff that Dr. Chris and Dr. Nona were just talking about. So yes, excellent talk. Wonderful. Please poop.
00:47:50
Speaker
Yes. We also, we also. Oh, go ahead. dr No, I say I have a question. So please your questions because this episode, we don't have a question. I think and I'm put all you on the spot. um I think we have to do a throwback. No, not a bad on the spot. We actually haven't done chocolate kisses in like a whole season.
00:48:10
Speaker
So I feel like this will be a good time for us to at least say some chocolate kisses and say some things that we are thankful and grateful for and such. um Since we don't have a question, um I will go first to allow y'all some time to think about things and such. I am going to give my chocolate kisses to um my parents and also my in-laws.
00:48:36
Speaker
i I recently came across a lot of stuff on like your timeline, your feeds and stuff. And long story short, I'm just very aware that like active and involved grandparents are really a luxury, and people really don't have that. And a lot of people don't have a solid village and a support system. um And me and my husband, we do. And I'm aware that that's not something that a lot of people have, and I'm very grateful for it.
00:49:06
Speaker
And um it's also why I try to be, I try to be a little more purposeful in terms of y'all know I got lots of God children. I got God children everywhere. Like all my friends, I had kids before me and that's fine. But it's another reason why I try to be a little more purposeful as well for like, you know, being there for my God children, because I think villages are important and not everybody has one. So chocolate kisses to my parents and my husband's parents because they've been um the real MVP recently. So that's my chocolate kiss.
00:49:37
Speaker
That's a good one. How are we going to follow that up? Oh, sorry. Sorry. My chocolate kiss um goes to your AC man. Right. Chocolate kiss to the man that fixed the haircut.
00:49:58
Speaker
because what were I being without you, okay? In the hotel? Yes, still staying in the Marriott property. ah So my... My Chocolate Kiss... um I can't give that one yet. I'll give that one one day soon. My Chocolate Kiss goes to one of my dear friends, Joni Taylor.
00:50:24
Speaker
Oh snap, she needs some kisses. Shout out to her. She is amazing. She is out here making it look so easy. She just brought home an Olympic gold. Yes. Hell hello As an assistant coach for women's basketball, so chocolate kisses.
00:50:44
Speaker
to her, um she juggled a whole lot over this summer. And so, you know, I really appreciate, I know some bomb women, y'all. And I know I've talked about, you know, the women that I know, the ones on this podcast, there are more behind these people. So these are just a, these are just a small group of the dynamic, amazing, fabulous women I know, but chocolate kisses to Joni Taylor for her Olympic gold.
00:51:10
Speaker
and for having an amazing summer. um And then coming home and like literally she comes home the next day and we're having the most regular conversation. She's like, yeah, I'm fit to hit the grocery store. Cause the kids start school on Monday and I got to get these snacks. And I'm like, weren't you just in Paris? Like was row in the to me a dance with Tamia, like, and now you're like in the grocery store. Like nothing happened. I was like, that's so sad. Sometimes I don't even think Johnny's a real person. Like Like I'm just, I just, I can't even fathom to do what she does. I'm like, I just, I just don't understand. Like how, how, how? That's so funny because you all have known, you have known of her because I talk about my friends a lot, but now y'all know her because y'all are all in my wedding together. It's not your life. She's not real. It's funny. She seems less real to you now, especially Dr. Sunshine. Yes. She's less real to Dr. Sunshine now. And she's like literally met her. Like you've known her, like y'all didn't hung out and everything.
00:52:05
Speaker
And she's like, nah, she's no real person. Like, seriously, just tell her i want to be I want to be her when I grow up. Like, I feel likerific don we all have of no but far like real. Like, what am I doing? I'm just not. No, but for real, she needs to write a book. She needs to write a book. She's cool. Like, really? Which part? Like, she needs to write she write a whole series, a trilogy. Right. All the parts. Just, like, all the parts.
00:52:27
Speaker
And release on every other year or something like that. like i mean People will be hooked. She's so amazing. And Joni, I don't know if you heard this, but you need to write a book. So there you go. And and then the thing about it, too, is like she's so classy and so like calm and just chilling. She's so even. Yes. All the time. Yes. Are you kidding me? Let's come home with a gold medal. Nobody would know what to do with me. I'd be like, am I doing? Why am I working? like I'll be walking around with my goat like, do you see this? Like, do you see what I did? You can't tell me nothing. Right. I would go in like, well, why am I going to work? I'm just taking my stuff and I'm going home. Did you not hear that I'm a Olympian? Did you not hear that? I'm an Olympian.
00:53:16
Speaker
like I had my rings tatted on my arm, okay? like My rings got tatted. I had the man come to my house and put them on there because I couldn't couldn't get out the house. Right. I'd be like, I have epic messages. I'm an Olympian. I don't answer those. Right. right Like, I'm i'm thinking. this later I need to think about it right now. I'm thinking about my gold, but I will. Right. Right.
00:53:38
Speaker
Because I'm a whole Olympian. like that The mortgage come be like, oh so where's the mortgage? I'm like, did you not hear I want i went to Olympics? I'm an Olympian. Let me ask you how much is that medal? That's the next question. Don't worry about that. I went to the Olympics.
00:53:54
Speaker
And I want to be blessed. You should be blessed that I live here. Much less asking me for mortgage. Are you kidding me? Do you know who I am? Oh my God. And this is why I'm not. Right. Right. This is this is what the Lord knew, right? He's doing a whole lot of things. Don't make me an Olympian and don't give me no big old booty, because I've been what's no good, OK? What? Oh my God. um by yes and so i answer to the most relatable and most fabulous, right? Like um to the most fabulous relatable woman. Yeah. She was just in the, in the hood club with us in Chicago with you for your bachelorette. No one's like, wow. Talk about multifaceted girl.
00:54:39
Speaker
That was a night. That was a night. What a night. Wish I could remember it. Chocolate kiss. Oh, we won't go back down there. I'm having fun. All right. I got a chocolate kiss. Who are your kisses going? All right. My kiss goes to my lovely father who announced his retirement.
00:55:00
Speaker
Um, so he's now officially retirement.
00:55:10
Speaker
He will probably listen to this a month after it comes out. So we're going to have like a little, we're playing a little retirement party for him down in Detroit, um, at one of his favorite restaurants. Um, so I didn't tell him we're going to be in town yet, but but that's what's coming. So yeah. That's dope.
00:55:27
Speaker
50 years of working and he was like, I think I'm done. No, shout out shut up to the OG, the OG doc. He the OG. Yeah, so that's why. Let us know how to do it. Oh, for sure. I'm trying to retire in like 10 years. i'm not trying No, I don't. Let me see what I mean. We all trying to retire early. Here go Dr. No-No talking about some. He done put in 50 years of service. That's too much. I may have graduated. I'm going to become an Olympian. I'm going to become an Olympian.
00:56:06
Speaker
It retracts our dreams on Dr. Chris. That's it. Yo, not to divert on the Olympics again, but old girl who was like in grad school at Harvard, she just like picked up cycling like randomly like and started cycling through Central Park. Next thing you know, she's an Olympian. She's like, yeah, I didn't grow up doing this. It's just something I'm good at. I discovered it like three years ago. And here I am. I'm going to go battle. I'm like, what? What?
00:56:28
Speaker
No, that's crazy. So you're telling me if I spend enough time on my peloton, I could probably go for the Olympics. I guess. She did the cycling where they go around that little track multiple times, like the speed cycling. Oh, that one. Oh, that looks dangerous. I don't know. I don't know why I didn't do this for my own thing. But there was a cyclist that really literally just came back from the Olympics that they found deceased. She choked. She had a choking accident. Whoa. And yeah, it's crazy. Oh, no. That's wild. That's wild. That's terrible.
00:57:09
Speaker
Geez, ah Dr. Chris, your chocolate is going to make us feel better. Is that going to make us feel better than that? oh yeah yeah Um, I'm trying to think, you don't sound convinced. know right if It's late. I'm tired. It's late. I'm tired. Um, my chocolate kiss.
00:57:31
Speaker
yeah
00:57:34
Speaker
Um, who would it be? Um, I guess, you know what? I'm gonna say you guys, cause I really appreciate you guys for real. a you know I really enjoy this. just It's really just coming and talking to y'all. I really just enjoy that. You like kicking it? I do. And y'all are like my real friends, like forau for real, for real. Not like, you know oh, we friends, and it's like, okay. We're not just your work friends?
00:58:08
Speaker
We were work friends at one point. Actually, you were never really my work friend. You were always my friend friend, even from the beginning. yeah From the first night, I know you were i knew you was a real one. I was like, ah we going to have a good time. Yeah, that's true. Yeah, that's true. You kicked it with me last, but then we partied the night away. And I was like, oh, this is a real one right here. This a ro is a real one right here. Because we went out to brunch, and then you're like, oh, let's go to a day party. I'm like, OK. And then the day party turned into a night party. And then we watched it fireworks.
00:58:40
Speaker
They didn't have to go to work the next day. Oh, y'all doing too much. ahs but But they sold me on the day, because it was a day party. Nah, you know this, Dr. Sunshine. It never happens just during the day. It's not. It's not. It's tomorrow. It goes into tomorrow. It's not. But you know what? i I am thankful for you guys, because I moved to Chicago. I didn't know anybody. And I left Chicago, and I made awesome friends. And it's great. And I still have these friends.
00:59:10
Speaker
ayyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyyy Oh, it just warmed my heart. um All right, y'all. So you can find us on thechocolatemds.com, our website where you can submit your questions, get details about upcoming events that we may have. Everything's on the website. um You can also check out our socials. We're on Facebook, Twitter, and Instagram. Our handle is at thechocolatemds. And feel free to send us questions via those venues or send us a Gmail at chocolatemds at gmail dot.com.
01:00:06
Speaker
right it's been real y'all we'll seea next