- From "RuPaul's Drag Race"
to Kim Kardashian
to "The Deadliest Catch"
there's a variety of reality shows.
But we're gonna react to some of the most
interesting medical scenes.
Let's get started.
- Peewoop.
- You got this, sister.
You were super, super close.
Right in the kisser.
Show that knight who's boss?
- This is a weird game.
(intense music)
Oh!
I did not expect that.
I thought it was gonna like...
(crickets chirp)
I don't know what I expected.
(beep)
(watermelon splats)
Oh my God, she got rocked
right in the face.
- Are you okay?
- I can't feel my face.
- And the watermelon broke.
She's lucky that she didn't lose teeth,
broken bones, no cuts.
- Are you waiting for the bathroom, honey?
No, my friend got sick.
Is he vegetarian?
- No. - No.
What did he have?
The lobster tail.
- The lobster sometimes has Vibrio,
which is a type of bacteria,
that most of the time is pretty self-limited.
Meaning that it goes away on its own
after some nausea vomiting, diarrhea.
But in severe cases,
we do prescribe antibiotics for this.
- Smell it.
Seriously fishy.
- I can smell the ammonia.
- Smelling ammonia means there's some kind
of decomposition happening.
Which likely means that the lobster
wasn't prepared as freshly.
Which means that there's some of that Vibrio
that we just talked about.
- It's being pulled apart and then decomposed.
- [Restaurant Employee] That's what makes it bad?
- Well, it's not the ammonia that makes it bad.
It's still the bacteria.
But the ammonia is what is released by the bacteria,
so it signals the presence of the bacteria.
Oh, my sun island friends
- Your name is Justin. - Mm, hmm.
And your heart is okay, as far as you know?
- As far as I know, yeah. - Okay.
Can you feel a difference between love and lust?
(group laughing)
And, so you can feel the difference
between like, love and lust?
- Yeah. - Okay.
(group laughing)
- Patient's gotta be so confused.
It's like sometimes a patient will come in for like,
an unknown arthritis,
and then we'll ask about sexual history and they'll be like,
"Why are you asking about sexual history?"
I'll be like, "Gonorrhea can cause arthritis."
The more you know.
(group laughing)
- Let me take your temperature.
(doctor laughing)
- That's like the Mom's way
that they feel the child.
Not gonna lie.
The back of my hand is pretty good
at knowing temperatures.
Not tested and not validated,
but feels like it's pretty accurate.
- Why don't you check this guy's reflexes, Sal.
- Check your reflexes.
(reflex hammer taps)
- [Group Member] Oh, there you go.
- See that... (peewoop bleep)
(group and doctor laughing)
- Hmm.
(reflex hammer taps)
- You're hitting it a little bit too high.
And he's hitting it directly on the patella.
- (laughing) Leg is good.
(reflex hammer taps)
I think your right leg is dead?
(group and doctor laughing)
- This happens all the time by the way.
Not the laughing obviously.
But like, the fact that one leg has good reflexes
and then the other...
Once they see what I do doesn't work,
it's because the patient's actively keeping it compressed.
In order for the reflex to work,
the muscle has to be fully relaxed.
So, in a lot of those cases, I actually ask the patient,
usually a child,
to pull their hands apart as hard as they can
and look up at the ceiling.
And when they do that, they automatically relax the leg
and it allows the reflex to come.
A cool thing that I do is
when I don't have a reflex hammer available,
I'm like one of these old school doctors,
I use this guy right here
and I go (popping sound)
and then the patients are like,
"Whoa, I don't know you could do that."
And I'm like, "Yeah, we're having fun in the hospital."
Uh oh, I imagine a big injury's incoming.
- Gag. Big girl.
Come on, bitch. Yes
- Someone's gonna fall.
- [Dancer] I land and I feel my knee pop.
- If it was the front leg,
my guess, is it's an ACL.
- [RuPaul] You need time to heal.
- She spills the tea.
She spoke to the doctor personally herself and let me know.
She was like, you have to have immediate surgery.
You did tear your ACL.
- Mechanism of injury.
I keep saying it on this channel.
It's one of the most important things
in making a diagnosis when it comes
to musculoskeletal complaint.
That's why when patients are like,
"Doc, can you stop asking me questions
about what's going on and just examine my leg?"
I'm like, look, examination's part of it for sure.
But I need to get the mechanism of injury.
Where were you sitting?
How did you fall?
Which leg did you fall on?
What motion were you making?
How high was the step?
All these questions sound silly
but are of utmost importance.
(toilet flushing)
- Aah.
Oh, ... (peewoop bleep)
- Never want to hear,
- "Oh, ..." (peewoop bleep)
in the operating room or in the bathroom.
- I have slipped discs that are pinching nerves
and I just was taking a... (peewoop bleep)
- I can't believe this is real.
This feels scripted.
This feels like Impractical Jokers.
- Oh, why this... (peewoop bleep) happen?
- Watch your step.
- I gotta go left foot first.
- Go. - Oh, oh. Okay.
- So discs are these padded little sacks
that function in between the vertebrae.
Which are the bones of the the spine.
These sacks provide cushioning.
And sometimes if there's a herniation
or a bulge in these sacs,
they actually end up putting pressure on the nerves
that end up giving sensation and motor function
to the lower parts of your body.
AKA, your legs.
So, if you get pressure on a nerve
from a disc bulge high up,
you essentially get a pinched nerve.
And then anything below
the level of that nerve is impacted,
Which means the strength of your legs.
The pain that you're experiencing.
Weird sensory changes.
Because nerves don't like to have pressure put on them.
- Oh yeah, dude.
- Oh, he's getting swollen there too.
- [Narrator] After being crushed between two deck boards.
Andy's finger swells fast.
- So, the problem is when you have a
Subungal Hematoma,
which is an enlarging bruise,
a tumor of blood,
starting to spread underneath the nail,
that pressure expands and it becomes problematic.
Commonly, runners who experience these type of blood pockets
under their nails will heat up a paperclip
and actually put it on the surface of the nail,
therefore melting the nail, which has no sensation,
and therefore creating a hole
and allowing the blood to pool out.
- [Narrator] Andy braces himself
for some old school boat medicine.
- Look, they're doing it.
- Sterilizing, then we're gonna stick it.
- Okay, get it done. - Oh, yeah.
- I don't know why they're acting like it's gonna hurt.
It should not hurt if they do it correctly.
- Ow, Ow.
Pull out. Pull out
- Cauterizing the wound can actually become problematic.
Because when you cauterize the wound you stop the bleeding
and then that can create a blockage.
And then if the hematoma keeps being enlarged.
- [Narrator] John Walcheck has been nursing
a badly infected finger.
- Finger infections are incredibly problematic.
There are so many places for them to spread.
Think about how many different joints there are in the hand.
Every connection is a area where septic arthritis can begin.
The bones, the tiny little bones of the hand,
that's an Osteomyelitis waiting to happen.
Oh, that's really bad.
- [Medical Person] So how long's it been like that?
- It was, it was brought to my attention about
four days ago and it was pretty,
it was pretty well advanced.
All the telltale signs. It was red.
It was swollen. It was hot.
- That looks like a septic arthritis.
At this point. I'm starting IV antibiotics.
- [Medical Person] Did you injure it in some way?
- Must have been stuck by a crab or a codfish or something,
- [Medical Person] Okay. Got some kind of...
- So that means it's a deeper infection,
because if you're getting poked by something,
that means it's going deeper in the joint.
Makes it more likely to be dangerous.
There's also toxins inside some of the seafood.
- What we did is we soaked it
in a warm saline solution. - [Medical Person] Okay.
- And the first time we lance this thing
we hardly got anything out of it.
- [Medical Person] So how did you lance it?
- Big sewing needle.
- Okay. Sterilized sewing needle?
You just popped it? - Yeah.
- I don't know if popping is ideal.
I don't see really a clear abscess,
which is a formation of puss and bacterial products
inside a closed environment.
I don't really see that here.
I just see generalized swelling.
- The next day they worked it after a hot saline soak.
It came up with a lot.
And it's been coming up with a lot until yesterday.
- We need a hand surgeon.
We need IV antibiotics.
We probably need a proper scan to see what's inside.
To see if there's an abscess.
- I think you need to definitely come in into the clinic.
May actually needs an IV antibiotics.
And I mean, this could be something you can't work through.
- I agree.
But again with the hand,
you don't want bone destruction.
So you wanna act early
if you suspect septic arthritis or osteomyelitis.
- Try the last do this,
walrus to get it on board.
- Why are they trying to get a walrus on?
- No. No. No. (water splashing)
- What is happening right now?
That water looks really cold too.
- The guy a (bleeping) maniac.
[Mike Rowe] If Freddy doesn't get
out of the water in 60 seconds,
hypothermia could set in.
- Hypothermia is really dangerous.
Obviously there's stages to hypothermia.
You have mild, moderate, severe.
The severe hypothermia can actually get so bad
that it can lead to full on cardiac arrest.
- I almost had it.
(doctor laughing)
- [Crew Member] I know, dude.
The water's colder than you think.
- Hypothermia is no joke.
Even for severe hypothermia,
we actually do active like intravascular warming
in order to help people warm up.
Because the hypothermia can be that bad.
For those who have cardiac arrest and their heart stops.
We actually do like, a hypothermia protocol
to help slow down the cellular activity
and potentially mitigate some of the damage
from a cardiac arrest.
'Cause there's some post cardiac inflammatory changes
that happen after someone's heart stops
and then gets restarted.
- Everything seems to be going well.
And then the girls get to their second jump.
(onlookers gasping)
- Oh. - She just twisted her ankle.
- Oh, my god. - Can you stand on it?
- Yeah.
- That's actually a good first test to do,
because weightbearing immediately after the injury
is one of the Ottawa Ankle Rules
that we use to decide whether
or not a patient needs an x-ray.
It's definitely like a grade one or grade two ankle sprain.
Just solely based on what happened.
Solely based on how she's feeling right now,
that she's able to point.
This is a mild injury.
Because if there is a very serious tear
or a very serious fracture,
weight bearing is near impossible.
Movement is near impossible
with the amount of swelling that happens quickly,
especially in kids.
You obviously can't compete with an ankle like this.
But it's not a very long recovery
as long as you do it properly.
- [Doctor] Looking at the x-rays,
it looks like a stress fracture.
- Whoa, I thought she fell on her ankle.
You know what this might be?
She might have an ankle sprain
and then because they got an x-ray
when they might not have needed to.
I don't know exactly what happened.
But then incidentally, also found a stress fracture
from constantly jumping and doing all those things,
which happens in kids.
- She really needs to go all out
to impress the Joffrey ballet scout.
- I actually have had patients
that come in with stress fractures of let's say the tibia,
which is their shin bone,
preparing to run for like the New York City Marathon.
I diagnose 'em with a stress fracture.
I'm like, "You cannot compete
in the marathon in the next two weeks."
And they say, "Well, I'm gonna do it anyway
because I've trained for this so long and hard.
There's no way I'm gonna give up now."
And I have to warn them very brutally honestly,
that by running in the marathon you could snap
your shin bone in the middle of the race.
And it happens.
More than we'd like to talk about.
- [Narrator] After just 14 hours in the desert.
Dr. Drew Penske is feeling severely unwell.
- How you feeling?
- It's bad.
If you need a vomit, go see you doctor.
- They're telling the doctor to go see the doctor.
I love when people tell me that.
- [Narrator] Dr. Drew is with the camp medic.
- I suspect most likely diagnosis is dehydration.
- Dehydration is part of it.
But what's leading the dehydration?
He pointed out the symptom.
But what's the problem?
- Is there any point to an IV?
- [Camp Medic] If I do an IV,
I think we pull you off the course.
- IV is quicker for sure.
And if you are not delivering
enough blood flow to vital structures,
then yeah, IV's really important.
But, if you're just like a little nauseous
drinking water, you'll hydrate,
- [Narrator] With severe heat exhaustion...
- Heat exhaustion.
- [Narrator] Dr. Drew is being medically
withdrawn from the course.
- Wow.
- Bring Dr. Mike on that show.
- Literally my whole head feels bruised
'cause it's been pounding for so long.
And I've been throwing up blood.
It's so intense.
- I thought this was just a simple migraine,
but throwing up blood is...
something else is going on.
Migraines can be so debilitating that it can
severely impact quality of life.
That's why there's medications that we use that are
abortive in nature,
meaning that they break a migraine when it starts.
Ideally you take the medication very early,
at the first onset of the headache.
There's also medications that we can give
that are prophylactic in nature, preventative.
Honestly, all those symptoms are really reasons
to go visit an ER.
- Are you on any medication?
- [Chloe] I'm on that birth control.
- Migraines with auras,
meaning that you start seeing like a little visual sign
that the migraine is coming on,
is actually a risk factor
and almost a contraindication
to not taking birth control.
'Cause it increases the risk for developing a clot.
- There was nothing left in me to throw up that it was like,
just, like it was really horrible.
- You could actually develop something known
as a Mallory Weiss tear,
which is a tear of the esophagus from constant retching
if nothing's coming out.
And then if it gets really problematic,
it could develop into Boerhaave's Syndrome,
where you get a complete tear
and obviously that's like an emergency situation.
- [Doctor] Today, you're gonna do MRI and MRA of your brain.
- The times where we decide to do an MRI with contrast,
there's a sudden change in frequency
or intensity and headaches that have been lifelong
or have a a long enough history.
Certain risk factors,
like waking up in the morning with a headache.
Headaches that worsen with exertion.
Most specifically sexual exertion.
That could be a sign that there's an aneurysm there.
So you really want that MRI with contrast done.
Ones that happen with new neurologic features,
like the vision loss that she was talking about.
All those are really strong red flags
that I would get an MRI.
- It's just so annoying that I get them
and I wish there was like...
This is why.
- Some of the best evidence that we have for medications
for migraines is a medication
that's a Triptan in combination
with a non-steroidal inflammatory known as Naproxen.
- [Kim] Today I woke up and my hands are a bit swollen.
- Do you drink enough water? - Yeah.
- I don't know why drinking not enough water
would cause hands to swell though.
- Based on the symptoms I've googled.
It looks like I have Rheumatoid Arthritis
- Dr. Google.
A lot of doctors get very frustrated with it
and I tend not to.
If you're gonna have a question,
you're gonna want it answered as fast as possible,
especially in the day and age of Google and chat GPT.
That being said,
what you get the results of is not always accurate.
That's why you need a medical professional by your side
to help guide you through this.
And, there's all different types of arthritis, by the way.
There's Osteoarthritis, Rheumatoid Arthritis
Psoriatic Arthritis.
All these things can potentially be happening.
It's not as simple as, "Is it this?"
"No, then I'm good."
No, we need to rule out other conditions.
- [Dr. Daniel Wallace] Your antibodies are
positive for Lupus.
- In a situation like this,
what we test for
is inflammatory markers called ESRCRP.
Those are non-specific inflammatory markers.
So, they just tell us that, if they're really high.
There's something going on creating
massive inflammation in the body,
especially in this situation that comes
with these types of symptoms.
Then we also simultaneously do some testing to rule
out conditions like Rheumatoid Arthritis.
So, you do a CCP test.
You do a Rheumatoid Factor Test.
At the same time you do
Anti-Double Stranded DNA antibody Test.
Which is what she is being tested positive for.
And that could be a sign of Lupus,
which is an autoimmune condition,
which does impact joints among other parts of your body.
Like the classic thing is the Malor rash that you get
across the bridge of your nose.
- I have this like rash.
Chloe seems to think that I have Ringworm
and I don't even know what that is.
Well, Chloe went to medical school I'm sure,
but I see and how long has it been there?
- About a week.
- They look pretty plaquey.
This could be early sign of something related to the Lupus.
Could be Psoriasis.
- Well, it's not Ringworm.
Chloe was off,
But it's Psoriasis.
- I mean, in order to make the diagnosis
besides looking at it.
You could also look under a microscope
and see what inflammatory cells are there, if any.
- I have heard of it before
because my Mom has always had it.
But you know, my Mom didn't have like,
red, flaky dots all over her.
- Some people have Plaque Psoriasis,
which is like way more skin involvement than just that.
- When I gain a pound, it's in the headlines.
Imagine what the tabloids would do to me
if they saw these spots.
- I'm curious what the tabloids would do.
I think if you come out as a positive role model
showing that this happens to even the most
beautiful people on the planet,
it could be an inclusive moment.
And maybe tabloids would celebrate it.
I don't know. Maybe I'm wrong.
- And you do not,
do not have Lupus and Rheumatoid Arthritis.
- Yeah, see, I think that there was
something a little bit weird with that initial diagnosis.
I was skeptical.
- Probably had Psoriatic Arthritis.
Because Psoriasis comes and goes.
- Yeah, I mean Lupus comes and goes too.
But like, the idea is it's not as simple as,
"Oh, you have it or you don't have it."
You need a really thorough clinical picture.
You need a really thorough physical exam.
And then you need some blood work
in order to make a definitive diagnosis.
And there are times you do false positives.
This isn't a screening.
When you do a screening,
you're testing someone with a blood test
who has no symptoms.
She was having symptoms
and they were trying to make a diagnosis.
So, this is not a screening blood test.
This is a diagnostic blood test.
What's harder medical school or dental school?
We actually argue about it here with my good friend,
Dr. Rubenstein.
Click here to check it out.
As always, stay happy and healthy.