November 4, 2025 • 62 mins
Ever turned the bathroom into a reading lounge? Same. We unpack the “anal cushions,” why some hemorrhoids hurt (and others don’t), myths that need flushing, and what actually helps—without the shame. Come for the puns, stay for the relief.
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Episode Transcript
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(00:00):
.99999999938There's a waiting room. 2 00:00:00,929.99999999938 --> 00:00:06,269.9999999995 Most of us never think about, the kind with magazines and soft elevator music.
(00:07):
I'm talking about the one in your own the bathroom.
For some, it's a reading nook.
For others, a scrolling station. 6 00:00:16,469.999999999 --> 00:00:17,969.999999999 We sit, we linger.
Forgetting this space was never meant for long visits. 8 00:00:21,929.999999999 --> 00:00:23,340 Here's the strange part.
longer you sit, the more pressure builds in a place.
You often don't think about.
(00:29):
The anal canal inside our tiny cushions, little bean bags of blood. 12 00:00:36,59.999999999 --> 00:00:36,900 supposed to be there. 13 00:00:37,349.999999999 --> 00:00:39,599.999999999 They keep things sealed When you cough or left.
.999999999But when you strain or sit too long, those cushions sag and swell. 15 00:00:44,804.999999999 --> 00:00:50,655 And one day you notice a streak of blood on the paper or a lump that makes sitting miserable.
(00:51):
when people panic.
They Google blood and stool. 18 00:00:53,924.999999999 --> 00:00:58,755 And the algorithms often offer cancer colitis catastrophe.
does it whisper the far more likely truth.
.999999999Hemorrhoids.
.999999999And here's the misunderstanding. 22 00:01:05,594.999999999 --> 00:01:07,755 Hemorrhoids aren't some alien growth.
They're normal anatomy.
Everyone has them.
(01:11):
.999999999They only become a problem when they enlarge and they remind you of their existence in the most inconvenient way possible.
So today we're going to do what few people dare talk about your butt.
We'll break down the hidden anatomy, why some hemorrhoids hurt and others don't.
.999999999What's myth and what's real and why a quick doctor's visit can turn a source of embarrassment into something surprisingly manageable. 29 00:01:38,184.999999999 --> 00:01:40,615 Because hemorrhoids aren't about shame.
(01:41):
They're about how something so ordinary can become quite literally a pain in the butt. 31 00:02:01,787.66353627 --> 00:02:06,56.02293033 and opinions expressed in this podcast are those of the hosts and guests do not reflect the official policies or positions of any affiliated institutions or organizations. 32 00:02:06,272.689597 --> 00:02:10,672.689597 This podcast is for informational, educational, and entertainment purposes only, and it is not intended to provide medical advice, diagnosis, or treatment. 33 00:02:10,956.02293033 --> 00:02:19,418.21534486 Listeners should consult their own healthcare professionals for any medical concerns, I'm Brody. 34 00:02:19,418.21534486 --> 00:02:19,718.21534486 Nolan. 35 00:02:19,718.21534486 --> 00:02:20,678.21534486 I'm an emergency doctor. 36 00:02:20,953.89716304 --> 00:02:22,783.89716304 I am Josh Levitts Internal Medicine. 37 00:02:23,36.98807213 --> 00:02:25,46.98807213 And I'm James Jung, a general surgeon. 38 00:02:25,496.98807213 --> 00:02:28,466.98807213 This is not another medical podcast. 39 00:02:30,309.18789177 --> 00:02:31,29.18789177 Perfect. 40 00:02:31,29.18789177 --> 00:02:31,479.18789177 James. 41 00:02:31,479.18789177 --> 00:02:32,859.18789177 Drinking outta the blue. 42 00:02:33,69.18789177 --> 00:02:34,449.18789177 The blue blue cup. 43 00:02:35,48.69469449 --> 00:02:36,758.69469449 Oh, yeah, it's a way to do it. 44 00:02:38,978.69469449 --> 00:02:42,699.18789177 Not sure what I, I don't know what we're talking, I don't, I have no clue. 45 00:02:43,149.18789177 --> 00:02:44,499.18789177 Weirdest introduction ever. 46 00:02:46,478.69469449 --> 00:02:46,688.69469449 Yeah. 47 00:02:46,898.69469449 --> 00:02:54,587.69469449 Not sure man, Uh we should pick this what's, yeah, I know we're starting this off on a real low point here. 48 00:02:54,632.69469449 --> 00:02:55,478.69469449 Let's, yeah. 49 00:02:55,632.69469449 --> 00:02:57,339.18789177 let's, let's oh boy. 50 00:02:57,428.69469449 --> 00:02:58,208.69469449 is up. 51 00:02:59,439.18789177 --> 00:03:00,9.18789177 That's it. 52 00:03:00,609.18789177 --> 00:03:02,409.18789177 You, that, that was my plan all along. 53 00:03:02,438.69469449 --> 00:03:08,798.69469449 gotta, you gotta start low and hopefully there'll be some incremental changes along the way. 54 00:03:09,579.18789177 --> 00:03:09,789.18789177 yeah. 55 00:03:10,419.18789177 --> 00:03:10,689.18789177 Yeah. 56 00:03:10,874.18789177 --> 00:03:14,499.18789177 There's, there's probably a tie in to what we're gonna talk about today with that statement. 57 00:03:14,918.69469449 --> 00:03:16,62.69469449 There you Nice, nice. 58 00:03:16,89.18789177 --> 00:03:17,139.18789177 Mm-hmm. 59 00:03:17,379.18789177 --> 00:03:17,389.18789177 Mm-hmm. 60 00:03:17,624.18789177 --> 00:03:18,44.18789177 Mm-hmm. 61 00:03:18,222.69469449 --> 00:03:18,422.69469449 that. 62 00:03:18,812.69469449 --> 00:03:19,102.69469449 Yeah. 63 00:03:19,839.18789177 --> 00:03:19,989.18789177 Yeah. 64 00:03:19,989.18789177 --> 00:03:20,859.18789177 It's too early for that. 65 00:03:21,914.18789177 --> 00:03:22,204.18789177 Yeah. 66 00:03:23,82.69469449 --> 00:03:26,513.69469449 What's, uh, what's new guys? uh. 67 00:03:27,923.69469449 --> 00:03:38,693.69469449 And so, um, you know, like, um, we have a relatively bigger backyard than condo in Toronto back in the days. 68 00:03:38,753.69469449 --> 00:03:40,289.18789177 Um, Mm-hmm. 69 00:03:40,402.69469449 --> 00:03:41,212.69469449 it's a fair statement. 70 00:03:41,423.69469449 --> 00:03:44,333.69469449 uh, I'm not like a handy person. 71 00:03:44,333.69469449 --> 00:03:47,963.69469449 I, uh, don't know how to do landscaping at all. 72 00:03:47,993.69469449 --> 00:03:49,162.69469449 Right? Mm-hmm. 73 00:03:49,242.69469449 --> 00:03:49,522.69469449 Mm-hmm. 74 00:03:49,639.18789177 --> 00:03:50,99.18789177 Uh oh. 75 00:03:50,169.18789177 --> 00:03:57,323.69469449 What? What did you do? I've kind of like neglected, you know, like getting rid of the, the weeds. 76 00:03:57,323.69469449 --> 00:04:03,533.69469449 Like, you know, I try to like mow the lawns and, you know, fertilize and water and all this stuff. 77 00:04:03,533.69469449 --> 00:04:17,363.69469449 But, you know, there are all this naturalized, naturalize, the areas where, you know, these are like wooden mules, right? And then it's been just overtaken by all these weeds, right? And I, you know, and of, of course they, they look kind of messy. 78 00:04:17,363.69469449 --> 00:04:21,263.69469449 So I've been trying to like pick out like little bit of weeds here and there. 79 00:04:22,373.69469449 --> 00:04:26,633.69469449 these neighbors kids, two of them probably around like. 80 00:04:27,443.69469449 --> 00:04:38,423.69469449 15, 13, you know, and they're really like savvy and they're like great business people and they just walk around and they actually like, do quite a bit of landscaping around the block. 81 00:04:38,843.69469449 --> 00:04:45,233.69469449 And like, they came up to me like, while I was like, you know, picking up these weeds and they're like, Hey, uh, Dr. 82 00:04:45,233.69469449 --> 00:04:45,683.69469449 Jang. 83 00:04:45,713.69469449 --> 00:04:49,223.69469449 And whenever you hear that, you know, whenever you, they call you Dr. 84 00:04:49,223.69469449 --> 00:04:50,647.69469449 John, they know Yeah. 85 00:04:50,709.18789177 --> 00:04:50,999.18789177 Yeah. 86 00:04:51,83.69469449 --> 00:04:52,957.69469449 They're very Yeah, Mm-hmm. 87 00:04:53,189.18789177 --> 00:04:54,144.18789177 yeah, they're yeah. 88 00:04:54,323.69469449 --> 00:04:58,373.69469449 like, we could, uh, we could do that for you, you know, over a few weekends. 89 00:04:58,373.69469449 --> 00:04:59,573.69469449 I was like, okay. 90 00:04:59,573.69469449 --> 00:05:02,873.69469449 Like, you know, I, I You're like, and got sold, right? So. 91 00:05:03,804.18789177 --> 00:05:05,694.18789177 yeah, you're like, I, I am Dr. 92 00:05:05,904.18789177 --> 00:05:06,144.18789177 Jung. 93 00:05:06,354.18789177 --> 00:05:07,764.18789177 I would love you to do that. 94 00:05:08,138.69469449 --> 00:05:16,178.69469449 So, uh, yeah, they've, you know, ordered like, we ordered like 15 cubic yards of mulch, which is a lot. 95 00:05:16,568.69469449 --> 00:05:17,839.18789177 I did not Mm-hmm. 96 00:05:18,428.69469449 --> 00:05:19,448.69469449 how much that is. 97 00:05:19,898.69469449 --> 00:05:29,348.69469449 Uh, and you know, these kids have done really good job and I was like pretty impressed with their work ethic and they're very honest with like how many hours they're working. 98 00:05:29,348.69469449 --> 00:05:31,88.69469449 Like, so impressed. 99 00:05:31,88.69469449 --> 00:05:32,468.69469449 Like very professional. 100 00:05:32,489.18789177 --> 00:05:32,979.18789177 Awesome. 101 00:05:33,68.69469449 --> 00:05:36,428.69469449 wow, this generation, you know, I'm not worried about them. 102 00:05:37,469.18789177 --> 00:05:37,959.18789177 Awesome. 103 00:05:38,214.18789177 --> 00:05:42,878.69469449 Well just, just wait, just wait, wait for the identity theft and then then we'll talk you, That's right. 104 00:05:43,898.69469449 --> 00:05:45,278.69469449 No, but I was so impressed. 105 00:05:45,338.69469449 --> 00:05:48,638.69469449 So that's, that's what we've been doing over multiple weekends now. 106 00:05:49,704.18789177 --> 00:05:57,497.69469449 we, we've been doing, I, I love that you said we've been doing games, these like little kids to do James just sitting on the porch, just watching and be like, yep. 107 00:05:57,863.69469449 --> 00:05:59,357.69469449 Yeah, you by the hour. 108 00:05:59,357.69469449 --> 00:05:59,837.69469449 Let's see. 109 00:06:00,124.18789177 --> 00:06:03,634.18789177 I, I, I went to my first kids concert. 110 00:06:04,474.18789177 --> 00:06:09,604.18789177 Like, not like my kids performing in a conference, but I mean, like actually like going to the concert for Yeah. 111 00:06:10,24.18789177 --> 00:06:12,364.18789177 Uh, so what was it? to Danny Go. 112 00:06:12,394.18789177 --> 00:06:20,365.68108905 If anyone has kids, he's like a YouTube singer, Danny but like, he got together Look at 'em up now. 113 00:06:20,434.18789177 --> 00:06:29,914.18789177 making up songs and just makes up songs with his like high school friends and gotten super popular on YouTube enough that he's like touring North America right now. 114 00:06:29,944.18789177 --> 00:06:31,660.68108905 So did a stop in Toronto He is. 115 00:06:31,660.68108905 --> 00:06:37,924.18789177 Um, it was, uh, honestly uh, top 10 concerts of my life. 116 00:06:38,635.18789177 --> 00:06:45,424.18789177 Really I maybe only been to 11, but it honestly was like, it was so much fun. 117 00:06:45,694.18789177 --> 00:06:47,194.18789177 It was uh, energy. 118 00:06:47,524.18789177 --> 00:06:49,54.18789177 It was like a rave the whole time. 119 00:06:49,54.18789177 --> 00:06:50,164.18789177 The girls were going crazy. 120 00:06:50,164.18789177 --> 00:06:51,394.18789177 There were go glow sticks. 121 00:06:51,394.18789177 --> 00:06:54,214.18789177 Everyone was like having a good time. 122 00:06:54,304.18789177 --> 00:06:56,110.68108905 The, this is right up your alley. 123 00:06:56,134.18789177 --> 00:07:02,530.68108905 sweet, honestly, like, We, uh, I, I'm just, I'm just looking up to any go and, and the pictures are very bright. 124 00:07:02,530.68108905 --> 00:07:10,249.18789177 There's lots of glow sticks and he has such songs as Glow in the Dark, shapes Escape from Tiger Island in the Mood for Food Mm-hmm. 125 00:07:10,270.68108905 --> 00:07:11,200.68108905 and many more. 126 00:07:11,599.18789177 --> 00:07:11,959.18789177 Yeah. 127 00:07:11,959.18789177 --> 00:07:11,969.18789177 Yeah. 128 00:07:12,439.18789177 --> 00:07:14,659.18789177 It was, I am in, knows It was a party. 129 00:07:14,800.18789177 --> 00:07:16,270.68108905 know, I know. 130 00:07:16,279.18789177 --> 00:07:16,399.18789177 Yeah. 131 00:07:16,480.18789177 --> 00:07:21,319.18789177 like these kids in the neighborhood, Like the show was so good. 132 00:07:21,319.18789177 --> 00:07:31,339.18789177 I like highly debated buying a t-shirt, merch on the way out, and I'm like, I mean, why wouldn't you? But it was, These, these, good. 133 00:07:31,459.18789177 --> 00:07:32,239.18789177 It was so good. 134 00:07:32,269.18789177 --> 00:07:46,675.68108905 I I'm always, I'm always interested in, I'm just, I'm interested in the backstory of all these, like these ones and the Wiggles and all these, like how, how do you, how do you get into like are these actors that do it, are they singers are, there's like, this is a great market. 135 00:07:46,675.68108905 --> 00:07:47,725.68108905 I'm getting in on this. 136 00:07:47,899.18789177 --> 00:07:48,109.18789177 totally. 137 00:07:48,109.18789177 --> 00:07:48,439.18789177 And that's it. 138 00:07:48,439.18789177 --> 00:07:50,419.18789177 There's some that You, kind of sketchy. 139 00:07:50,419.18789177 --> 00:07:52,459.18789177 I don't wanna maybe like, name some Danny Go's. 140 00:07:52,459.18789177 --> 00:07:53,635.68108905 Not one of them, but some yep. 141 00:07:53,989.18789177 --> 00:08:00,145.68108905 backgrounds are a little more, um, uh, noted of, Yeah. 142 00:08:00,355.68108905 --> 00:08:08,755.68108905 Well, it's funny, there's, there's a, there's, there's a Wiggles documentary and I watched it just to see the Dark Side of the Wiggles, but they're all like perfect human beings. 143 00:08:08,785.68108905 --> 00:08:09,745.68108905 There was nothing dark. 144 00:08:09,745.68108905 --> 00:08:10,975.68108905 It is like, they're all happy. 145 00:08:10,975.68108905 --> 00:08:11,995.68108905 Everything went well. 146 00:08:12,175.68108905 --> 00:08:13,15.68108905 I was like, well, fine. 147 00:08:13,75.68108905 --> 00:08:13,855.68108905 I guess it does happen. 148 00:08:14,89.18789177 --> 00:08:16,609.18789177 And I was really hoping there'd be a dark end to the way only for like entertainment. 149 00:08:16,609.18789177 --> 00:08:17,125.68108905 I don't like, Yeah. 150 00:08:17,179.18789177 --> 00:08:18,319.18789177 they're wonderful people. 151 00:08:18,499.18789177 --> 00:08:19,690.68108905 Um, Yeah. 152 00:08:19,690.68108905 --> 00:08:19,750.68108905 Yeah. 153 00:08:19,789.18789177 --> 00:08:20,839.18789177 wish Emma would come back. 154 00:08:20,839.18789177 --> 00:08:29,359.18789177 Like, there's, what I wish upon children of, ask me about Oh, music and I got nothing, but, all right. 155 00:08:29,359.18789177 --> 00:08:30,889.18789177 Let's do Wiggles and Danko. 156 00:08:30,889.18789177 --> 00:08:33,565.68108905 We got, oh. 157 00:08:34,585.18789177 --> 00:08:35,569.18789177 well, I man. 158 00:08:35,575.18789177 --> 00:08:36,739.18789177 these are Yeah. 159 00:08:36,820.68108905 --> 00:08:42,400.68108905 it's cool you know, uh, entrepreneurs, you know, doing, entrepreneurs. 160 00:08:42,804.18789177 --> 00:08:43,344.18789177 That's it. 161 00:08:43,489.18789177 --> 00:08:44,590.68108905 That's Just like us. 162 00:08:44,620.68108905 --> 00:08:45,520.68108905 Just like us guys. 163 00:08:45,520.68108905 --> 00:08:47,560.68108905 Just like us and this podcast. 164 00:08:47,659.18789177 --> 00:08:48,220.68108905 have a lot less Yeah. 165 00:08:48,349.18789177 --> 00:08:48,739.18789177 screen. 166 00:08:48,769.18789177 --> 00:08:49,339.18789177 That's what we need. 167 00:08:49,339.18789177 --> 00:08:51,379.18789177 We need like, I don't need a dinosaur head. 168 00:08:51,379.18789177 --> 00:08:55,870.68108905 I need like a mobile full dinosaur animated background with like a That'd be awesome. 169 00:08:55,999.18789177 --> 00:08:56,980.68108905 That's how Yeah. 170 00:08:57,229.18789177 --> 00:08:58,219.18789177 that's how we do it, guys. 171 00:08:58,240.68108905 --> 00:09:00,760.68108905 You know, most people, you know, Mo, most people just listen to this. 172 00:09:00,760.68108905 --> 00:09:02,209.18789177 They don't watch us, so reason. 173 00:09:02,230.68108905 --> 00:09:04,30.68108905 don't, I don't, I dunno if you want to go there. 174 00:09:04,249.18789177 --> 00:09:06,529.18789177 I think most people don't listen to us either. 175 00:09:06,529.18789177 --> 00:09:06,859.18789177 Josh. 176 00:09:06,859.18789177 --> 00:09:08,680.68108905 I think it's, Very true. 177 00:09:09,100.68108905 --> 00:09:09,820.68108905 Appropriate. 178 00:09:09,850.68108905 --> 00:09:10,90.68108905 Yep. 179 00:09:10,270.68108905 --> 00:09:10,960.68108905 Very true. 180 00:09:11,110.18789177 --> 00:09:11,740.18789177 All right. 181 00:09:13,450.68108905 --> 00:09:24,499.18789177 So what are we, uh, what are we getting into today? So, James, do you want to, uh, do you wanna take us into the wild world of hemorrhoids? I mean, I would love to, you know, No, no segue for that. 182 00:09:25,309.18789177 --> 00:09:26,485.68108905 Just No, we're go. 183 00:09:26,530.18789177 --> 00:09:30,730.68108905 just straight, I don't think, uh, I don't think hemorrhoids need a segue. 184 00:09:30,840.18789177 --> 00:09:39,270.18789177 It's got like, this is one of those things that everybody in the world has heard of hemorrhoids, like, we'll bring up other diagnoses people like, what is this? You know, hemorrhoids, everyone just go, oh yeah, I know those. 185 00:09:39,389.69469449 --> 00:09:39,689.69469449 yeah. 186 00:09:39,699.69469449 --> 00:09:42,9.69469449 Hemorrhage is, is very frequent. 187 00:09:42,159.69469449 --> 00:09:45,519.69469449 Uh, a lot of people experience it, especially as they get older. 188 00:09:46,269.69469449 --> 00:09:47,469.69469449 You know, it's often. 189 00:09:48,129.69469449 --> 00:09:50,169.69469449 Misdiagnosed or undiagnosed. 190 00:09:50,259.69469449 --> 00:09:54,819.69469449 People don't like to show their butt, so, often, you know, they're undiagnosed. 191 00:09:55,569.69469449 --> 00:09:57,189.69469449 and people suffer in silence. 192 00:09:57,289.69469449 --> 00:10:06,664.69469449 I think, there's no glamor, uh, in, in treatment of these or, or, you know, examination of these or suffering from these. 193 00:10:06,664.69469449 --> 00:10:11,294.69469449 But I, I think it's such an important entity that affects a lot of people. 194 00:10:11,324.69469449 --> 00:10:14,684.69469449 So if you are a listener who. 195 00:10:14,974.69469449 --> 00:10:21,784.69469449 You know, things that they have hemorrhoids, but, you know, unsure or, you know, don't want to get examined by doctors. 196 00:10:21,784.69469449 --> 00:10:23,404.69469449 Like, I think this is episode for you. 197 00:10:24,184.69469449 --> 00:10:26,284.69469449 A lot of, there's a lot to unpack here. 198 00:10:26,344.69469449 --> 00:10:29,674.69469449 Uh, a lot of misconception, a lot of confusing anatomy. 199 00:10:29,674.69469449 --> 00:10:32,674.69469449 So, you know, that's why I picked this topic. 200 00:10:32,944.69469449 --> 00:10:34,414.69469449 Uh, we're gonna have a little bit of fun. 201 00:10:34,414.69469449 --> 00:10:45,15.18789177 I think, uh, whenever we talk Always uh, know, there, there, are few topics, you know, that, uh, kind of lends itself I. 202 00:10:45,364.69469449 --> 00:10:47,44.69469449 real fun, you know, discussion. 203 00:10:47,44.69469449 --> 00:10:56,254.69469449 And I think this is probably one of them, but there's nothing funny about having hemorrhoids, so I, I don't, I mean, I don't, I don't, I like that. 204 00:10:56,794.69469449 --> 00:11:01,834.69469449 Um, and guys, like, I don't wanna call us heroes, but we're, we're talking about the things that people don't wanna talk about. 205 00:11:01,834.69469449 --> 00:11:06,544.69469449 So, um, you know, there's, uh, there's, there's, there's big words to put to us here. 206 00:11:06,673.20149721 --> 00:11:06,943.20149721 James. 207 00:11:06,943.20149721 --> 00:11:11,983.20149721 I do appreciate the themes of your episode, though, farts, but hemo like it's, it's good. 208 00:11:12,163.20149721 --> 00:11:12,784.69469449 It's Yep. 209 00:11:13,414.69469449 --> 00:11:13,684.69469449 Yep. 210 00:11:14,194.69469449 --> 00:11:14,914.69469449 It's body of humor. 211 00:11:15,214.69469449 --> 00:11:17,314.69469449 Um, now Brody, we're gonna try something. 212 00:11:17,314.69469449 --> 00:11:18,454.69469449 James, you can't answer. 213 00:11:19,174.69469449 --> 00:11:24,454.69469449 Uh, just to prove to listeners that doctors, uh, don't know much outside of their own little world. 214 00:11:24,664.69469449 --> 00:11:29,259.69469449 Brody, what do you know about hemorrhoids? I. 215 00:11:29,488.20149721 --> 00:11:33,628.20149721 I certainly know they are a common cause for coming to the emergency department. 216 00:11:34,44.69469449 --> 00:11:34,264.69469449 Mm. 217 00:11:34,348.20149721 --> 00:11:35,64.69469449 you Mm-hmm. 218 00:11:35,248.20149721 --> 00:11:42,634.69469449 quiz my anatomy for the reason why they're there? How they're there, those No, no, happily defer that to our surgeon expert no. 219 00:11:42,889.69469449 --> 00:11:48,139.69469449 I am, I am literally trying to show that I know nothing about hemorrhoids except they bleed. 220 00:11:48,178.20149721 --> 00:11:48,568.20149721 Yeah. 221 00:11:48,679.69469449 --> 00:11:51,859.69469449 if they bleed a lot, I sometimes see them and send 'em to someone else. 222 00:11:51,919.69469449 --> 00:11:55,279.69469449 I know nothing about them, so I'm like super excited about this. 223 00:11:55,513.20149721 --> 00:12:02,359.69469449 wonder if the at-home diagnosis of hemorrhoids has improved since the camera phone just saying pretty Hmm. 224 00:12:02,359.69469449 --> 00:12:02,449.69469449 Hmm. 225 00:12:02,563.20149721 --> 00:12:04,813.20149721 like, take a quick pic, see what's going on down there. 226 00:12:05,173.20149721 --> 00:12:06,703.20149721 Is there something deleted? I'm not too sure. 227 00:12:06,703.20149721 --> 00:12:30,193.20149721 It's a bit hard to see, but I feel like before that your options were either like old school foam it or school, take a picture, send it off to get processed, pick it up three to five days later, You mean like the, the actual films or like Yeah, the or like the, the two mirrors if you can kind of get things aligned, like, I don't know. 228 00:12:30,253.20149721 --> 00:12:30,613.20149721 Yeah. 229 00:12:30,733.20149721 --> 00:12:35,83.20149721 To, to get back to your recent, you know, your, your point James, about the, me being undiagnosed. 230 00:12:35,404.20149721 --> 00:12:36,264.69469449 Yeah, it, Yeah. 231 00:12:36,364.20149721 --> 00:12:38,494.20149721 hard to see it yourself. 232 00:12:38,794.20149721 --> 00:12:49,954.20149721 Um, you know, we have certain range of motion in our, in our spine, but not to that degree for most of us at least, unless you work for c cti sole. 233 00:12:50,404.20149721 --> 00:12:55,654.20149721 Uh, so it is certainly hard to see, you know, a lot of it is kind of symptoms. 234 00:12:56,74.20149721 --> 00:13:01,864.20149721 So sometimes the symptoms could be vague, sometimes it could be concerning when there's blood involved in the toilet. 235 00:13:02,254.20149721 --> 00:13:05,734.20149721 Uh, so, you know, I think, you know, we should just really dive into it. 236 00:13:05,824.20149721 --> 00:13:12,904.20149721 Uh, and you know, what better way to start than, uh, understanding the anal canal anatomy. 237 00:13:12,964.20149721 --> 00:13:14,824.69469449 So I think it's Yeah. 238 00:13:15,34.20149721 --> 00:13:16,744.20149721 to kind of understand and. 239 00:13:17,344.20149721 --> 00:13:22,294.20149721 know, I don't think there, there are many of us who think a lot about anal canal. 240 00:13:22,564.20149721 --> 00:13:27,518.20149721 Uh, but certainly, know, during, that's an understatement. 241 00:13:28,24.69469449 --> 00:13:31,869.69469449 Many, many of us, there are many of us that think about this all the time. 242 00:13:32,324.20149721 --> 00:13:48,104.20149721 You know, when, when you go through general surgery, you know, training, you know, this is certainly, uh, a very important anatomy that we, we learn about and, you call this your butt and butter? no, no. 243 00:13:49,154.20149721 --> 00:13:55,34.69469449 So, uh, You may have, you may have to explain that joke for, uh, some people, Brody. 244 00:13:55,784.20149721 --> 00:14:00,404.20149721 so, uh, the ed canal is the very, I'm just gonna move on. 245 00:14:03,119.20149721 --> 00:14:06,389.20149721 It's the, it's the very end of your GI Trek. 246 00:14:06,449.20149721 --> 00:14:14,459.20149721 And, I think the easy, easiest way we could think about this is, this is what's palpable of the GI Trek, with your finger. 247 00:14:14,819.20149721 --> 00:14:30,609.20149721 Uh, I'm not saying that you should put your finger in to, you know, palpate the anatomy, relevant anatomy, but if you are thinking, you know, if, if, if you visualize, like, you know, the extent of what's palpable is kind of the anal canal from the anal verge. 248 00:14:31,969.20149721 --> 00:14:32,839.20149721 It has. 249 00:14:32,929.20149721 --> 00:14:44,419.20149721 Uh, in about two centimeters in it has something called a dentate line, which is kind of the division from external or external, closer to the skin, what you see and internal hemorrhoids. 250 00:14:44,749.20149721 --> 00:15:01,789.20149721 Um, and the internal hemorrhoids, uh, first of all, the, the, the hemorrhoids, uh, or hemorrhoidal, uh, plexus, uh, are not abnormal anatomy to begin with, but we all have these hemorrhoidal tissues in, in the anal canal. 251 00:15:02,209.20149721 --> 00:15:14,314.20149721 But as they get, stressed, they get, there's a repeated trauma, uh, or if they get inflamed or if the vasculature gets engorged, they get bigger than, normal. 252 00:15:14,314.20149721 --> 00:15:18,4.20149721 And that's when you start to notice them, uh, and. 253 00:15:18,324.20149721 --> 00:15:22,74.20149721 In the internal hemorrhoids, there are actually three pockets of the cushions. 254 00:15:22,104.20149721 --> 00:15:27,384.20149721 So these are kind of the, cushions that we, all have, there are three of them. 255 00:15:27,774.20149721 --> 00:15:31,344.20149721 Uh, there's one on the, uh, on the left, and then there are two on the right. 256 00:15:31,704.20149721 --> 00:15:38,634.20149721 And then these are kind of the cushions that exist and they really help with kind of the control of continence. 257 00:15:38,904.20149721 --> 00:15:52,434.20149721 Uh, so, you know, some of those, uh, those, uh, you know, liquid bowel movements, uh, and you're laughing hard, you know, controlling that and holding that in is kind of in addition to this sphincter muscles. 258 00:15:52,434.20149721 --> 00:15:56,673.20149721 These really help with this, uh, kind of like the unsung heroes of the day. 259 00:15:56,703.20149721 --> 00:15:58,159.69469449 They really kind of Mm-hmm. 260 00:15:58,173.20149721 --> 00:15:58,863.20149721 everything in. 261 00:15:59,124.20149721 --> 00:15:59,424.20149721 yeah. 262 00:15:59,523.20149721 --> 00:15:59,943.20149721 Yeah. 263 00:15:59,994.20149721 --> 00:16:01,164.20149721 be socially awkward. 264 00:16:01,383.20149721 --> 00:16:01,683.20149721 Yeah. 265 00:16:02,829.69469449 --> 00:16:04,479.69469449 Well, I guess not if everyone was doing it. 266 00:16:05,284.20149721 --> 00:16:07,593.20149721 Yeah, if it's a norm, right? Like Right. 267 00:16:07,594.69469449 --> 00:16:08,193.20149721 No, no, Yeah. 268 00:16:09,94.20149721 --> 00:16:10,89.69469449 that would be no. 269 00:16:10,564.20149721 --> 00:16:19,564.20149721 Uh, and, and then, the below that dentate line is the external hemorrhoid, uh, where the external hemorrhoids could, uh, could abnormally grow. 270 00:16:19,564.20149721 --> 00:16:28,734.20149721 So external hemorrhoids, there isn't really hemorrhoidal tissues there, but there's an engorgement of, the, the tissue below that Dante line. 271 00:16:29,4.20149721 --> 00:16:33,474.20149721 Uh, it's not discreet like the internal hemorrhoids where they're kind of the three cushions. 272 00:16:33,624.20149721 --> 00:16:41,94.2014972 Uh, these external hemorrhoids could form kind of in anywhere, uh, but it's just an engorgement of the tissue there. 273 00:16:41,144.2014972 --> 00:16:42,554.2014972 And those are the external hemorrhages. 274 00:16:42,884.2014972 --> 00:16:48,734.2014972 The dentate line is important because the innervation is different from internal and external. 275 00:16:49,4.2014972 --> 00:16:50,234.2014972 So external. 276 00:16:50,234.2014972 --> 00:16:51,944.2014972 So the on the skin side. 277 00:16:52,184.6946945 --> 00:16:55,34.2014972 You just, just explain, uh, innovation, is. 278 00:16:55,34.2014972 --> 00:16:55,754.6946945 It's what you mean by that. 279 00:16:55,754.6946945 --> 00:16:55,994.6946945 Yeah. 280 00:16:56,924.2014972 --> 00:16:58,308.2014972 So we're talking Supply. 281 00:16:58,394.2014972 --> 00:17:11,694.2014972 are the sense, you know, nerves that help you feel? Uh, so on the external side, which is close to your skin, uh, the, the innovations or nerves, are more prone to feeling pain. 282 00:17:11,844.2014972 --> 00:17:17,454.2014972 Whereas internally, uh, there's less innervation of the sensory or the pain. 283 00:17:17,934.2014972 --> 00:17:22,314.2014972 Uh, so because of that, the external hemorrhoids will be painful. 284 00:17:22,494.2014972 --> 00:17:22,554.2014972 Yeah. 285 00:17:23,634.2014972 --> 00:17:26,634.2014972 internal hemorrhoids often aren't painful. 286 00:17:27,354.2014972 --> 00:17:51,164.2014972 So when we do an examination, uh, and when we, let's say pinch, and we're gonna talk about some treatments for internal hemorrhoids or band, squeeze the hemorrhoidal tissues above the level of dentate line, patients don't often feel anything, but if it's, you know, you're pinching or stretching or pointing at the external hemorrhage below the dentate line, it's painful. 287 00:17:51,524.2014972 --> 00:17:53,624.2014972 So external hemorrhoids are the painful ones. 288 00:17:53,654.2014972 --> 00:17:54,524.2014972 Internal hemorrhage. 289 00:17:54,674.2014972 --> 00:17:55,274.2014972 Painless. 290 00:17:57,479.6946945 --> 00:17:58,589.6946945 Question for you. 291 00:17:58,709.6946945 --> 00:18:00,479.6946945 Um, maybe we're in this, maybe we didn't. 292 00:18:00,509.6946945 --> 00:18:13,94.2014972 So are hemorrhoids the pathologic name for when these tissues become inflamed and, and things you'll get into? Or do we have literally hemorrhoidal tissue? Is that what we call it when it's healthy and everything? Yeah. 293 00:18:13,94.2014972 --> 00:18:16,4.2014972 So, uh, I think hemorrhoids are. 294 00:18:17,69.2014972 --> 00:18:27,969.2014972 Uh, now accepted as kind of the, the pathologic, like internal hemorrhoids, external hemorrhoids, but the hemorrhoidal plexus or hemorrhoidal tissues is actually a normal name for normal, anatomy as well. 295 00:18:30,369.6946945 --> 00:18:31,479.6946945 See, I'm learning stuff. 296 00:18:31,479.6946945 --> 00:18:32,679.6946945 I love this podcast. 297 00:18:33,243.2014972 --> 00:18:33,423.2014972 Yeah. 298 00:18:33,693.2014972 --> 00:18:42,393.2014972 Yeah, I think the, the external and internal hemorrhoids like would be, you know, the internal hemorrhoids being painless, external hemorrhage being painful, um, uh, I think is really important to you. 299 00:18:42,393.2014972 --> 00:18:50,793.2014972 I mean, if you, if you think once you rip that bandaid off of meeting someone else who's had hemorrhoids or then talking with people, hemorrhoids, then often there's a little bit like, oh, minor painful, minor painless. 300 00:18:50,793.2014972 --> 00:18:57,693.2014972 Like, there's a little bit of that sometimes where people are worried about whether it is hemorrhoids or is not hemorrhoids, if it's painful or not painful. 301 00:18:57,693.2014972 --> 00:19:07,503.2014972 So I think it's kind of helpful to know, 'cause if you're talking about your hemorrhoids as a whole, like your experience might be very different than someone who, you know, if you had internal hemorrhoids, there's blood in the toilet. 302 00:19:07,743.2014972 --> 00:19:14,493.2014972 Your experience might be very different than someone who had external hemorrhoids who like, wow, it's, this is like the most painful thing and I couldn't take a poop for forever 'cause it hurt too much. 303 00:19:14,493.2014972 --> 00:19:18,744.2014972 Like, I think it's, it's good for, uh, yeah, just to, just to know that Yeah. 304 00:19:19,23.2014972 --> 00:19:20,264.6946945 can vary quite a bit Yep. 305 00:19:20,343.2014972 --> 00:19:23,673.2014972 those two, depending on whether they have that nerve supply that you can feel it or not. 306 00:19:25,314.2014972 --> 00:19:25,734.2014972 Yeah. 307 00:19:25,739.2014972 --> 00:19:38,724.2014972 I, I think that's very important because, you know, I think this is kind of theme of a lot of what we talk about, you know, as, as patients or, you know, average listeners, you know, we things, those are the symptoms, right. 308 00:19:39,114.2014972 --> 00:19:45,354.2014972 And not, not all symptoms are specific to certain pathologic process. 309 00:19:45,594.2014972 --> 00:19:49,254.2014972 Like pain in the butt can be from, or pain in the anus. 310 00:19:49,254.2014972 --> 00:19:56,754.2014972 And, uh, anus could come from a variety of things, right? so I think it's very important to get examined. 311 00:19:56,874.2014972 --> 00:20:03,84.2014972 And same thing with like the bulge in the anus, which, you know, can be external and internal hemorrhage. 312 00:20:03,264.2014972 --> 00:20:04,734.2014972 If the internal hemorrhage get bigger, they. 313 00:20:05,529.2014972 --> 00:20:09,939.2014972 Prolapse, and then you could, you know, you could experience bulge in the anus. 314 00:20:10,29.2014972 --> 00:20:11,829.2014972 Uh, that could be both internal or external. 315 00:20:11,829.2014972 --> 00:20:16,149.2014972 So very important to be, uh, examined by experts. 316 00:20:18,189.6946945 --> 00:20:23,484.6946945 I just, uh, before Brody says any, before Brody says anything, I'm pretty sure he has a pain in the butt joke right here. 317 00:20:23,484.6946945 --> 00:20:24,504.6946945 I'm gonna call him on it. 318 00:20:24,528.2014972 --> 00:20:30,888.2014972 No, I was just gonna say, I'm so proud of us 'cause there's such an easy layup for making pain in the butt joke and none of us went for it. 319 00:20:31,248.2014972 --> 00:20:32,238.2014972 I'm really proud of us. 320 00:20:32,238.2014972 --> 00:20:33,108.2014972 That's all I was gonna say. 321 00:20:34,38.2014972 --> 00:20:35,448.2014972 you and I were like, don't say it. 322 00:20:35,448.2014972 --> 00:20:36,493.2014972 Don't say it. 323 00:20:37,869.2014972 --> 00:20:39,78.2014972 It, it, it was just Alright. 324 00:20:41,69.6946945 --> 00:20:41,909.6946945 I am having fun. 325 00:20:42,108.2014972 --> 00:20:48,48.2014972 James, you talked about, um, hemorrhoids being the result of repeated trauma, inflammation. 326 00:20:48,138.2014972 --> 00:20:55,499.6946945 Like what does trauma look like for the butt? Like, I know that may be maybe obvious, maybe not obvious, but like what, That's an appropriate question. 327 00:20:55,629.2014972 --> 00:21:06,9.2014972 it, Yeah, So, uh, the most often trauma, like most frequent form of trauma in the, you know, canal would be if you're having really hard stools. 328 00:21:06,279.2014972 --> 00:21:14,859.2014972 So if you're constipated, you know, you don't consume enough fiber or you don't consume enough water, uh, and the stools are like rabbit stools. 329 00:21:15,129.2014972 --> 00:21:20,958.2014972 Uh, which by the way, I don't know if you've seen rabbit stools, they look like cocoa pups You can't I do. 330 00:21:21,919.6946945 --> 00:21:23,304.6946945 I've, I've seen cocoa pots. 331 00:21:23,309.6946945 --> 00:21:23,489.6946945 Yeah. 332 00:21:23,799.6946945 --> 00:21:24,89.6946945 Yeah. 333 00:21:25,239.2014972 --> 00:21:32,649.2014972 Uh, so, you know, like as you pass those hard stools, you know, it could create mucosal traumas along the way. 334 00:21:32,649.2014972 --> 00:21:34,299.2014972 So that's a form of trauma. 335 00:21:34,569.2014972 --> 00:21:43,509.2014972 Uh, or if you're straining, putting pressure, like if you're spending a lot of time on the toilet and in straining, that pressure could be a form of trauma with the hard stool. 336 00:21:44,349.2014972 --> 00:21:57,549.2014972 it could also be, you know, from penetrating trauma, like anal intercourse, uh, or instrumentations or, you know, even being examined, uh, for, uh, you know, with the anal scope. 337 00:21:57,849.2014972 --> 00:22:02,979.2014972 Uh, although we do it very gently with like lots of lubricant, but it, it can be a form of trauma. 338 00:22:05,274.6946945 --> 00:22:11,454.6946945 And I think it's, it's interesting as we talk about this because the things that cause it are probably the things that help prevent it too. 339 00:22:11,454.6946945 --> 00:22:17,664.6946945 If you, if you do things the right way, if, and, and I, you'll probably talk about it later, but keeping the stool soft and regular bowel movements and all that. 340 00:22:17,664.6946945 --> 00:22:20,214.6946945 So, um, it's one of those kind of easy connections here. 341 00:22:20,289.2014972 --> 00:22:21,309.2014972 Very important. 342 00:22:21,459.2014972 --> 00:22:27,798.2014972 Uh, and I'm sure we're gonna have a bulk of our conversation around those Oh, I see what you did there. 343 00:22:28,8.2014972 --> 00:22:28,938.2014972 Bulk fiber. 344 00:22:28,998.2014972 --> 00:22:29,688.2014972 Nice. 345 00:22:29,814.6946945 --> 00:22:30,474.6946945 Love it. 346 00:22:30,804.6946945 --> 00:22:31,404.6946945 Love it. 347 00:22:31,638.2014972 --> 00:22:34,29.6946945 Um, James, And that AI did not give you that joke. 348 00:22:36,738.2014972 --> 00:22:41,868.2014972 James, I've heard before of different, like grading or severity of, of hemorrhoids. 349 00:22:41,898.2014972 --> 00:22:45,258.2014972 Um, can you maybe kinda break that down a little bit for what that might kinda look like? So someone. 350 00:22:45,549.2014972 --> 00:22:51,519.2014972 So, uh, the, the, the grading that we often use is for internal hemorrhoids. 351 00:22:51,519.2014972 --> 00:22:58,809.2014972 So there are four grades, so it goes from one to four, one being the mildest form and four being the most severe form. 352 00:22:59,169.2014972 --> 00:23:07,719.2014972 So grade one internal hemorrhoid is, uh, hemorrhoidal tissue that is, uh, enlarged and that could bleed. 353 00:23:07,719.2014972 --> 00:23:12,309.2014972 So if there's a blood in the toilet, uh, uh, and if that. 354 00:23:12,639.2014972 --> 00:23:20,949.2014972 That hemorrhoidal tissue, or it gets in engorged and it's collapsed into the, the lumen, like within the anal canal. 355 00:23:20,949.2014972 --> 00:23:27,129.2014972 That'll be grade one, grade two is that, that, you know, that tissue collapses out of it. 356 00:23:27,129.2014972 --> 00:23:36,754.2014972 So kind of like, you know, if you're pooping, like it just collapses out of it, but it spontaneously goes back in three is that it comes out and you need to manually push it in. 357 00:23:36,759.2014972 --> 00:23:46,719.2014972 So manually meaning like with finger or, you know, uh, tissue or to push it back in grade four is the one that's prolapsed and it, it doesn't go back in. 358 00:23:46,719.2014972 --> 00:23:47,643.2014972 So it Gotcha. 359 00:23:47,649.2014972 --> 00:23:58,239.2014972 severity of how big the tissue is, uh, and grade one, even if it's not enlarged, if it's bleeds, then you know, it's still considered a hemorrhoidal or, or internal hemorrhoids. 360 00:24:00,39.6946945 --> 00:24:04,344.6946945 Just kind of going back to what you started talking about, people need to get this looked at. 361 00:24:04,344.6946945 --> 00:24:12,594.6946945 I, I'm guessing there are people who are walking around with like grade three prolapse hemorrhoids that are just pushing 'em back in and not getting checked out, not getting treated. 362 00:24:12,594.6946945 --> 00:24:14,574.6946945 It's, I'm guessing it's pretty common. 363 00:24:14,769.2014972 --> 00:24:15,759.2014972 it's very common. 364 00:24:15,849.2014972 --> 00:24:21,819.2014972 Um, I've done some kind of, uh, research into like how frequent this is. 365 00:24:21,879.2014972 --> 00:24:41,459.2014972 You know, I think the studies are actually very poorly done, but some of the survey studies from 1980s and and nineties demonstrate that in the us the prevalence of hemorrhoids is about four to 5%, but when they do a colonoscopy, and then we document, we always perform digital rectal examination. 366 00:24:41,459.2014972 --> 00:24:48,659.2014972 And, and we also do a retro, uh, retro reflection view of the hemorrhoidal tissue or to look at the hemorrhoidal tissues. 367 00:24:48,959.2014972 --> 00:24:55,859.2014972 Uh, and when we, when we see that, you know, the actual prevalence of hemorrhoids is more about like 20 to 30%. 368 00:24:56,949.6946945 --> 00:24:57,449.6946945 It is huge. 369 00:24:57,679.6946945 --> 00:24:57,969.6946945 Okay. 370 00:24:58,259.2014972 --> 00:25:05,819.2014972 a big discrepancy between, what patients would report versus, you know, what, what is actually happening. 371 00:25:07,664.6946945 --> 00:25:07,904.6946945 Okay. 372 00:25:08,264.6946945 --> 00:25:14,174.6946945 So that's, um, that's the internal me, the, the internal hemorrhoid, not internal medicine, the internal hemorrhoid world. 373 00:25:14,714.6946945 --> 00:25:21,554.2014972 Um, what, uh, what do we need to know about the external hemorrhoid world? Brody, like, uh, I'm sure you see some external hemorrhages. 374 00:25:21,554.2014972 --> 00:25:22,899.6946945 So what, uh, I. 375 00:25:23,264.2014972 --> 00:25:25,483.2014972 do you have, uh, kind of, you know, tell me about your Yeah. 376 00:25:25,844.2014972 --> 00:25:29,24.6946945 Uh, other than calling me, uh, middle of the night to Yeah. 377 00:25:29,24.6946945 --> 00:25:35,819.6946945 Or, or, or, or listen or Brody, if you, if you have hemorrhoids yourself, uh, to talk about your personal experience. 378 00:25:36,398.2014972 --> 00:25:47,199.6946945 I am going to, um, choose to not share about my personal hemorrhoid journal journey, um, or, uh, uh, verify or deny whether I have ever had personal Fair enough. 379 00:25:47,258.2014972 --> 00:25:47,978.2014972 'cause I'm embarrassed. 380 00:25:47,978.2014972 --> 00:25:48,679.6946945 I'm just I. 381 00:25:48,938.2014972 --> 00:25:50,348.2014972 to make that, that statement now. 382 00:25:50,768.2014972 --> 00:25:56,888.2014972 Um, but no, it, so external hemorrhoids are probably the most common type of hemorrhoids I see in the emerge. 383 00:25:57,128.2014972 --> 00:26:00,518.2014972 And to get back to the reason it's 'cause they, like, they are a giant pain in the ass. 384 00:26:00,518.2014972 --> 00:26:02,888.2014972 They are so, so painful. 385 00:26:02,888.2014972 --> 00:26:09,608.2014972 And so, you know, there is often people have more pain before they may have bleeding, um, sometimes with, with this. 386 00:26:09,638.2014972 --> 00:26:16,208.2014972 Um, and so, you know what I see, uh, when, when patients are coming with external hemorrhoids, um, there are these little kind of. 387 00:26:17,363.2014972 --> 00:26:21,443.2014972 pocketing kind of, you know, bulging things of tissue usually. 388 00:26:21,443.2014972 --> 00:26:21,713.2014972 Right. 389 00:26:21,713.2014972 --> 00:26:29,333.2014972 Again, within kind of that, the, you know, the, the, your anus itself, uh, the anal verge, um, and they're extremely tender. 390 00:26:29,333.2014972 --> 00:26:35,98.2014972 Like even sometimes just like kind of spreading the butt cheeks, if you will, to try to get a view of it can cause enough kind of that that's. 391 00:26:35,773.2014972 --> 00:26:36,643.2014972 Quite painful. 392 00:26:36,913.2014972 --> 00:26:44,833.2014972 Um, and that's kind of usually what what we're seeing then I'd say most of them are maybe the size of like a marble or so, like they're, they don't have to be quite big. 393 00:26:45,163.2014972 --> 00:26:46,873.2014972 Um, but they're extremely painful. 394 00:26:47,143.2014972 --> 00:27:14,713.2014972 Um, you know, when you're coming into the emergency department, the one thing that we're thinking, is there something we can do about this? And maybe this is kind of advancing a little bit, James, what you're gonna talk about afterwards, but for us is trying to figure out is this like a, a fresh hemo, external hemorrhoid or is it a quote unquote thrombose external hemorrhoid? So is it, has it, is it, is it firm now? The blood in the, the blood inside is clotted and that allows us to do treatments like lysing it and cutting it open, which really a leaves kind of some of that pain. 395 00:27:15,73.2014972 --> 00:27:18,613.2014972 Um, but that's usually what I see from an external hemorrhoid perspective. 396 00:27:18,643.2014972 --> 00:27:20,953.2014972 Extremely painful and uncomfortable. 397 00:27:21,163.2014972 --> 00:27:24,283.2014972 Uh, and really these small like marble grape like sizes. 398 00:27:24,584.2014972 --> 00:27:25,4.2014972 Mm-hmm. 399 00:27:25,889.6946945 --> 00:27:26,129.6946945 Yeah. 400 00:27:26,224.6946945 --> 00:27:31,889.6946945 And, and Brody, before, uh, we kind of go anymore, I think it's really important to talk about how people present to you. 401 00:27:31,889.6946945 --> 00:27:43,589.6946945 Like why, why then what brings them into the emerge and says, okay, I've been, is the story, I've been dealing with this for six months and today's the day the pain got too bad, or is I was fine yesterday. 402 00:27:43,589.6946945 --> 00:27:44,579.6946945 I I'm not today. 403 00:27:44,579.6946945 --> 00:27:49,133.2014972 What, what does the story sound like? usually a fairly acute thing, like it might be over a day or two. 404 00:27:49,133.2014972 --> 00:27:53,633.2014972 It really progresses to the point now that they're having so much pain that they're actually trying to not have a bowel movement. 405 00:27:53,633.2014972 --> 00:27:56,363.2014972 Because again, you can imagine if you're, you know, when you're. 406 00:27:56,793.2014972 --> 00:28:00,393.2014972 Having a bowel movement, again, you're the anus opens up to allow all your poop to come out. 407 00:28:00,444.2014972 --> 00:28:00,864.2014972 Mm-hmm. 408 00:28:01,113.2014972 --> 00:28:10,83.2014972 that itself is so painful that sometimes they'll go be, they'll try to really avoid trying to have a um, having a bowel movement because of how painful it is. 409 00:28:10,83.2014972 --> 00:28:11,13.2014972 So that's usually it. 410 00:28:11,13.2014972 --> 00:28:14,133.2014972 I'd say it's more pain that that brings them in at the big ones. 411 00:28:14,133.2014972 --> 00:28:17,973.2014972 Or sometimes it's, Hey, I went to the bathroom and there was some blood in the toilet. 412 00:28:18,33.2014972 --> 00:28:19,499.6946945 There was blood when I Yeah. 413 00:28:19,533.2014972 --> 00:28:20,163.2014972 is new. 414 00:28:20,163.2014972 --> 00:28:22,199.2014972 And even that is quite scary Mm-hmm. 415 00:28:22,323.2014972 --> 00:28:23,13.2014972 a lot of people. 416 00:28:23,13.2014972 --> 00:28:29,283.2014972 And you know, this is going back to earlier episodes about like bleeding and blood and it's hard to know how much blood you're actually losing. 417 00:28:29,283.2014972 --> 00:28:31,383.2014972 That's especially true when it goes right into the toilet. 418 00:28:31,383.2014972 --> 00:28:36,513.2014972 So you can have like a small amount of blood, but once it hits the water in your toilet, your whole toilet bowl is red. 419 00:28:36,659.2014972 --> 00:28:37,79.2014972 Mm-hmm. 420 00:28:37,83.2014972 --> 00:28:39,33.2014972 so if you're the kind of person that. 421 00:28:39,338.2014972 --> 00:28:42,98.2014972 Turns around and looks at the, you know, looks at your poop before you flush. 422 00:28:42,308.2014972 --> 00:28:50,489.6946945 Um, that could be really scary, like Which I recommend doing Well, just to make sure seriously. 423 00:28:50,528.2014972 --> 00:28:51,398.2014972 not everyone does. 424 00:28:51,398.2014972 --> 00:28:55,834.6946945 I'm one of those that yeah, I have a look just to kinda see, does it, yeah. 425 00:28:55,988.2014972 --> 00:28:57,779.6946945 the Well, especially since having kids. 426 00:28:57,809.6946945 --> 00:28:57,989.6946945 Yeah. 427 00:28:58,148.2014972 --> 00:28:58,508.2014972 that's true. 428 00:28:58,508.2014972 --> 00:28:58,658.2014972 Yeah. 429 00:28:59,138.2014972 --> 00:28:59,918.2014972 There's no shame once you. 430 00:29:00,914.6946945 --> 00:29:02,84.6946945 Um, and Brody. 431 00:29:02,594.6946945 --> 00:29:11,564.6946945 Brody question, what? When people come to see you and the think this is important to talk about, is it kind of an embarrassed, I hear embarrassed story when they're talking to you. 432 00:29:11,564.6946945 --> 00:29:16,94.6946945 Are they open about it? Because I think it's important if people are embarrassed to be seen for these kinds of things. 433 00:29:16,523.2014972 --> 00:29:21,614.6946945 I think honestly for, for the ones they're, they're quite scared, right? And when I think of the Yeah. 434 00:29:21,833.2014972 --> 00:29:28,103.2014972 hemorrhoids and all of a sudden there's blood in the bowl, they're very afraid that it might be something cancer, right? Um, that would be up there. 435 00:29:28,163.2014972 --> 00:29:37,904.6946945 Uh, they're just worried like have they blood too much, that they're feeling dizzy, lightheaded, are they gonna need surgery? Um, and then for those that have the external hemorrhoids, they're in so much pain that I think that kind Yeah. 436 00:29:38,63.2014972 --> 00:29:40,574.6946945 mitigates a little bit of that, like not wanting to come Takes away. 437 00:29:40,793.2014972 --> 00:29:41,33.2014972 it. 438 00:29:41,303.2014972 --> 00:29:42,704.6946945 Um, Gotcha. 439 00:29:43,493.2014972 --> 00:29:47,229.6946945 there is definitely James, I'm guessing yeah, a bit more, you know, shy about I. 440 00:29:47,294.2014972 --> 00:29:48,879.2014972 pain is, you know, is. 441 00:29:50,549.2014972 --> 00:29:55,829.2014972 Something we see often with kind of external hemorrhoids that have just acutely thromboses, that kind of marble. 442 00:29:55,889.2014972 --> 00:30:00,929.2014972 Like you, you know, you can't even sit, you know, on your butt 'cause it's so painful. 443 00:30:01,49.2014972 --> 00:30:01,349.2014972 Right. 444 00:30:01,349.2014972 --> 00:30:02,909.2014972 So it's very hard to do anything. 445 00:30:02,909.2014972 --> 00:30:07,739.2014972 So I think at that point they're like, I'll just do something, do anything. 446 00:30:07,769.2014972 --> 00:30:09,589.6946945 Um, you know, I'm all I don't have a choice. 447 00:30:10,559.2014972 --> 00:30:15,509.2014972 Um, but there are other symptoms, uh, you know, like, like Brody says, you know, the bleeding. 448 00:30:16,109.2014972 --> 00:30:18,629.2014972 think that's another one that worries a lot of people. 449 00:30:18,629.2014972 --> 00:30:29,399.2014972 Maybe not to a point they, they'll go to the emergency room, but certainly to a point that they'll talk to their doctors and get referral to, you know, one of us or colorectal surgeons for, to get it checked out. 450 00:30:29,819.2014972 --> 00:30:34,49.2014972 Uh, and again, the bleeding part is very important because we talked about this. 451 00:30:34,79.2014972 --> 00:30:37,169.2014972 Uh, and then, you know, often especially. 452 00:30:37,634.2014972 --> 00:30:54,884.2014972 If you have family history of colorectal cancer or if you're of a certain age over 40, you know, especially nowadays with the increased incidence of colorectal cer, colorectal, uh, cancer in younger population, you know, something that you definitely should be checked out and, and receive investigations for. 453 00:30:56,159.2014972 --> 00:31:04,709.2014972 Uh, you know, quite often, you know, it's because of the internal hemorrhoids, uh, which is, uh, a relief to a lot of people. 454 00:31:04,709.2014972 --> 00:31:09,809.2014972 But it's something that, you know, uh, you know, people will have to work on to improve on. 455 00:31:09,929.2014972 --> 00:31:14,369.2014972 'cause the hemorrhoids can get bigger and can cause, you know, issues down the road. 456 00:31:15,509.2014972 --> 00:31:17,939.2014972 and then there's the lump or the bulge. 457 00:31:18,149.2014972 --> 00:31:30,509.2014972 So as the internal hemorrhoids get bigger, they tend to occupy the space more and more to, and then to a point that they prolapse down into, you know, through the, an, uh, anal, uh, uh, anal verge. 458 00:31:30,509.2014972 --> 00:31:37,859.2014972 And then you could either see, like, feel, and see them, uh, at the level of the, you know, anal sphincter or anal verge. 459 00:31:38,259.2014972 --> 00:31:43,509.2014972 So those are kind of the usual symptoms that patients will come with. 460 00:31:43,929.2014972 --> 00:31:50,379.2014972 Uh, there are other things like some itching and irritation around that area, which is quite common when you have kind of the anal pathology. 461 00:31:50,379.2014972 --> 00:31:53,19.2014972 It's just the seepage of the, the mucus coming through. 462 00:31:53,379.2014972 --> 00:32:00,249.2014972 Uh, or there could be some mucus discharge or, or, you know, or some of the, some of the feces just coming through as well. 463 00:32:00,249.2014972 --> 00:32:04,949.2014972 So those are kind of the symptoms that, that, will prompt, uh, patients to come in. 464 00:32:04,949.2014972 --> 00:32:06,539.2014972 So if you're having these symptoms. 465 00:32:07,584.2014972 --> 00:32:16,404.2014972 very important for you to be examined, you know, show your butt to, well, not to anyone, but to medical professionals with the, the right qualifications. 466 00:32:16,469.2014972 --> 00:32:18,9.6946945 Not to, Ask. 467 00:32:18,9.6946945 --> 00:32:19,419.6946945 Ask for a license, please. 468 00:32:19,419.6946945 --> 00:32:19,539.6946945 Yeah. 469 00:32:19,794.2014972 --> 00:32:21,954.2014972 Please verify the license before you do that. 470 00:32:22,344.2014972 --> 00:32:27,684.2014972 Uh, but it's very important because you wanna make sure that it's, you know, it's, yes. 471 00:32:27,684.2014972 --> 00:32:36,114.2014972 I mean, first if it's hemorrhoids, they're in effective treatments, and second, uh, to make sure it's not something more sinister like, you know, colorectal cancer. 472 00:32:37,684.6946945 --> 00:32:37,904.6946945 Yep. 473 00:32:38,364.6946945 --> 00:32:40,779.6946945 And, and just to really. 474 00:32:41,199.6946945 --> 00:32:42,759.6946945 Um, clarify it. 475 00:32:42,759.6946945 --> 00:32:50,229.6946945 Who should be seeing the doctor, and I'm guessing the family doctor is probably the frontline outside of the kind of emerge visits and, and the more serious stuff. 476 00:32:50,649.6946945 --> 00:32:55,493.2014972 So when should you see a doctor? Anytime you have bleeding. 477 00:32:55,613.2014972 --> 00:32:56,63.2014972 Yeah. 478 00:32:56,93.2014972 --> 00:32:57,233.2014972 Anytime you have any of those symptoms. 479 00:32:57,233.2014972 --> 00:32:57,533.2014972 Right. 480 00:32:57,533.2014972 --> 00:33:05,783.2014972 And I, think James, to your point with like the instant the, the rising incident of colorectal cancer, even in younger people, you know, we're not screening till later on that we're seeing a lot of these cases. 481 00:33:05,783.2014972 --> 00:33:09,533.2014972 Sometimes any of those things I think is super reasonable to, to go and to be seen. 482 00:33:09,593.2014972 --> 00:33:09,893.2014972 Yeah. 483 00:33:10,344.2014972 --> 00:33:20,78.7082999 I was gonna say, um, maybe quickly, like if they are going to see you James, or see a doctor in clinic, do you want to, do you wanna talk quickly about what's gonna happen in there? I, I think, yeah, thank you. 484 00:33:20,78.7082999 --> 00:33:21,698.7082999 Thank you for, for reminding me, Josh. 485 00:33:21,698.7082999 --> 00:33:24,114.2014972 So I think it's, You're very welcome James. 486 00:33:24,578.7082999 --> 00:33:25,988.7082999 I think it's very important to. 487 00:33:26,873.7082999 --> 00:33:46,553.7082999 kind of explain, set the scene for a lot of the listeners who may be suffering in silent, but really afraid, what's gonna happen to them when they go see a colorectal surgeon or GI doc, uh, who does these anal pathology? Um, so, you know, it's gonna start off with, you know, having conversations about your history. 488 00:33:46,613.7082999 --> 00:33:55,403.7082999 And then, you know, the part that we're worried about the most is the physical examination, right? So the physical examination will involve, uh, perianal examination. 489 00:33:55,403.7082999 --> 00:34:04,343.7082999 So examining your anus, and I think there's a lot of shame, uh, and, you know, embarrassment or fear about that. 490 00:34:04,793.7082999 --> 00:34:21,923.7082999 Um, maybe, you know, it might be that some patients will feel that they're being judged, uh, uh, but really for, for a lot of us, uh, the, the physicians, you know, we do these perianal examinations a lot. 491 00:34:22,283.7082999 --> 00:34:32,633.7082999 Uh, like thousands and thousands of times that, and, you know, really it's not something that, that we will take a mental note of or, or think about a lot. 492 00:34:32,993.7082999 --> 00:34:38,273.7082999 We're just really interested to understand whether there's any, any perianal pathology that we could treat. 493 00:34:38,753.7082999 --> 00:34:44,483.7082999 Uh, so don't feel like, you know, the doctors are judging, you know, how your butt looks. 494 00:34:44,573.7082999 --> 00:34:45,563.7082999 Uh, we don't care. 495 00:34:45,837.7082999 --> 00:34:46,127.7082999 Yeah. 496 00:34:46,913.7082999 --> 00:34:48,767.7082999 only Yeah, there's a Yeah. 497 00:34:48,863.7082999 --> 00:34:53,522.7082999 not, so, There's no way to I, the number of butts seen that. 498 00:34:53,522.7082999 --> 00:34:54,334.2014972 I feel like yeah. 499 00:34:54,362.7082999 --> 00:34:58,742.7082999 like, even of our medical career, we've seen more butts than there are treason for us. 500 00:34:58,742.7082999 --> 00:35:00,739.2014972 Like there is, it's very hard to, Yeah. 501 00:35:00,743.7082999 --> 00:35:03,473.7082999 well, I'm sure you do a lot of digital rectal examination. 502 00:35:03,863.7082999 --> 00:35:11,148.7082999 Uh, it would be very abnormal for me to go, you know, a single emerge shift without seeing multiple, multiple buts Mm-hmm. 503 00:35:11,394.2014972 --> 00:35:11,754.2014972 Yeah. 504 00:35:11,754.2014972 --> 00:35:18,654.2014972 And, to your and it's really, it, it's, it's interesting 'cause we know you, you as a patient are, this is the one time this is happening to you. 505 00:35:18,654.2014972 --> 00:35:19,974.2014972 So it's a huge deal. 506 00:35:20,244.2014972 --> 00:35:25,884.2014972 And us as doctors, like when we become patients, we're all nervous about this stuff too, even though we see it every day. 507 00:35:26,154.2014972 --> 00:35:29,4.2014972 So it's completely normal to, it's, in like that. 508 00:35:29,438.7082999 --> 00:35:47,288.7082999 I certainly understand, you know, where does fear and embarrassment come from? Like, but you know, I, I think the benefit of being seen trumps, you know, that little bit of embarrassment that you may have, um, and, and you know, just to set the scene about the examination table. 509 00:35:47,618.7082999 --> 00:36:01,448.7082999 Sometimes it'll be just regular exam table and they'll ask you to do kind of, you know, a lay on your side and kind of tuck your, uh, legs in to be able to expose the, the anus better. 510 00:36:01,748.7082999 --> 00:36:04,328.7082999 But they're also in, especially in colorectal. 511 00:36:04,723.7082999 --> 00:36:24,673.7082999 Uh, clinics, uh, they're the specialized chairs where you're kind of sitting with on your, on your knees and then kind of draped, you know, your, your body forward so that it's a little bit easier for, you know, more ergonomic for you to, show the butt. 512 00:36:25,663.7082999 --> 00:36:36,73.7082999 or it could be that, you know, they have, uh, the stir ups, so you're gonna be on your back and then your legs on the stir ups, like, you know, if you will, in gynecology. 513 00:36:36,433.7082999 --> 00:36:44,559.2014972 Um, uh, so those are kind of the three position in which you may be examined? it's, list listeners. 514 00:36:44,589.2014972 --> 00:36:52,179.2014972 Listeners, you can't see this, but James is giving us demonstrations on the camera of what the positions are and it's, it's quite entertaining. 515 00:36:52,389.2014972 --> 00:36:52,449.2014972 Yeah. 516 00:36:52,453.7082999 --> 00:36:55,242.7082999 in our yoga poses that he just created. 517 00:36:56,173.7082999 --> 00:36:57,339.2014972 That's Yeah. 518 00:36:57,339.2014972 --> 00:36:59,499.2014972 Really the Hemorrhoidal yoga poach. 519 00:36:59,903.7082999 --> 00:37:05,33.7082999 Uh, so it, it usually starts with the visual examination inspection of the, the anus. 520 00:37:05,333.7082999 --> 00:37:14,633.7082999 Uh, and then oftentimes the doctors will talk to you because we know that you are anxious, uh, you know, and go through what the steps are. 521 00:37:14,993.7082999 --> 00:37:25,313.7082999 And oftentimes it does involve, uh, a finger in the butt examination, the digital rectal examination, and oftentimes it involves a anal scope. 522 00:37:25,403.7082999 --> 00:37:48,83.7082999 So these are small kind of speculum or small kind of scope that goes into that anal canal with the light so that it allows us to examine the mu, the or the lining of the, the anal canal so that we could see whether there are any internal hemorrhoids and if they are, whether they're bleeding and what size. 523 00:37:48,983.7082999 --> 00:37:54,593.7082999 and also, um, uh, it just helps us to visualize, uh, the pathology really well. 524 00:37:54,593.7082999 --> 00:37:57,353.7082999 So, and when we do that, you know. 525 00:37:58,223.7082999 --> 00:38:01,523.7082999 Lots of lubricant to, you know, minimize trauma. 526 00:38:02,3.7082999 --> 00:38:09,623.7082999 Uh, and it's gonna be a little cold because oftentimes it's either plastic or, metal, uh, uh, instruments. 527 00:38:09,683.7082999 --> 00:38:17,273.7082999 Um, so that's something that, you know, you may expect really it should take not more than 10 minutes. 528 00:38:17,603.7082999 --> 00:38:24,713.7082999 So, uh, you know, I want to kind of lay the fear around being seen, uh, for, for this. 529 00:38:26,237.7082999 --> 00:38:37,74.2014972 James, when you're putting the an aScope in, often is there a fart that sneaks out? Again, just to normalize it Yeah, again, if Very, very appropriate. 530 00:38:37,247.7082999 --> 00:38:57,324.2014972 you're now opening the cushions, Well, I mean, so, so that's very interesting because it's no longer kind of fart because there's no like sphincter, it's all spread out, Hmm there isn't that I, you know, sound that comes through tight, uh, anal sphincter, uh, you know, Yeah. 531 00:38:57,488.7082999 --> 00:38:58,508.7082999 kind of all spread out. 532 00:38:58,508.7082999 --> 00:39:01,958.7082999 So it's more of the, just the gas that just comes out. 533 00:39:01,958.7082999 --> 00:39:04,832.7082999 So if uh, passing wind. 534 00:39:04,958.7082999 --> 00:39:07,119.2014972 that's, there you go. 535 00:39:07,274.2014972 --> 00:39:10,539.2014972 I, I was, I was gonna say temporary fan, but Yeah. 536 00:39:10,747.7082999 --> 00:39:11,37.7082999 yeah. 537 00:39:11,138.7082999 --> 00:39:23,18.7082999 would say if you're providers and maybe you're more of a junior trainees, I don't recommend putting your entire face too close and recommend wearing, Hmm, eye shields, uh, mask. 538 00:39:23,387.7082999 --> 00:39:23,807.7082999 Mm-hmm. 539 00:39:24,38.7082999 --> 00:39:26,888.7082999 so don't, don't do it, uh, without much protection. 540 00:39:27,38.7082999 --> 00:39:28,794.2014972 And don't put your eye Brody. 541 00:39:28,808.7082999 --> 00:39:28,988.7082999 there. 542 00:39:29,912.7082999 --> 00:39:30,212.7082999 Yeah. 543 00:39:30,494.2014972 --> 00:39:30,844.2014972 Brody. 544 00:39:30,884.2014972 --> 00:39:35,679.2014972 I, I think that was the best question of the podcast, and I'm, I'm really proud of you for doing that. 545 00:39:35,709.2014972 --> 00:39:37,269.2014972 That was a great question. 546 00:39:37,322.7082999 --> 00:39:39,842.7082999 I'm like, I Yep, how you don't, I don't know how you don't fart. 547 00:39:40,209.2014972 --> 00:39:41,289.2014972 yep, at that yep. 548 00:39:41,559.2014972 --> 00:39:41,589.2014972 I. 549 00:39:41,693.7082999 --> 00:39:43,772.7082999 Except no mechanisms to keep it in anymore. 550 00:39:43,772.7082999 --> 00:39:44,582.7082999 You just can't be polite. 551 00:39:44,633.7082999 --> 00:39:47,183.7082999 passively just passes the gas. 552 00:39:47,252.7082999 --> 00:39:47,642.7082999 Yeah. 553 00:39:48,92.7082999 --> 00:39:54,92.7082999 It just becomes, with the one, with the room, just no, shut. 554 00:39:54,383.7082999 --> 00:39:55,703.7082999 it's completely normal. 555 00:39:58,73.7082999 --> 00:39:58,853.7082999 Completely normal. 556 00:39:59,603.7082999 --> 00:39:59,783.7082999 Yeah. 557 00:39:59,783.7082999 --> 00:40:04,823.7082999 So, uh, that's what's to be expected when you're being seen. 558 00:40:04,943.7082999 --> 00:40:11,237.7082999 And then let's say you have, let's say, internal hemorrhoids, so let's say, one to three, right? yeah. 559 00:40:11,483.7082999 --> 00:40:31,643.7082999 the more of the milder ones, you know, the, the real cornerstone of, of treatment is lifestyle and it's really about, addressing the root causes, which tend to be in North America, uh, that we just. 560 00:40:32,258.7082999 --> 00:40:34,178.7082999 Don't eat enough dietary fiber. 561 00:40:34,228.7082999 --> 00:40:38,698.7082999 Sometimes we don't drink enough water and we're spending too much time on the toilet. 562 00:40:39,448.7082999 --> 00:40:44,788.7082999 these are all kind of contemporary uh, that we have. 563 00:40:44,908.7082999 --> 00:40:47,428.7082999 So let's break down like, you know, all of them. 564 00:40:47,428.7082999 --> 00:41:14,188.7082999 So, fiber, um, studies have shown that, you know, less than like 5% of Americans consume adequate amount of fiber and adequate amount of fiber from like 25 grams to 30 grams a day, depending on your size and everything, oftentimes they come from, you know, leafy vegetables, fruits, um, know, the vegetables with stems, the cellulose and those things. 565 00:41:14,548.7082999 --> 00:41:20,638.7082999 Um, it's very hard to consume all of that from just diet only. 566 00:41:20,998.7082999 --> 00:41:23,788.7082999 Um, especially in, in our. 567 00:41:24,403.7082999 --> 00:41:24,913.7082999 You know, right. 568 00:41:24,973.7082999 --> 00:41:26,233.7082999 North American diet. 569 00:41:26,623.7082999 --> 00:41:33,493.7082999 Uh, so I think, you know, for most of us, it's important to supplement with some sort of supplemental, uh, fibers. 570 00:41:33,493.7082999 --> 00:41:42,493.7082999 So those include, cilium husk or, um, uh, some, some brand names like Metamucil and things like that. 571 00:41:44,519.2014972 --> 00:42:03,449.2014972 And, uh, I think just 'cause I, I don't, when we say 25 grams of fiber, and I don't know this either, I have to look it up, like things like half an avocado come up or, um, one tablespoon of chia seeds or two tablespoons of nuts or things like that. 572 00:42:03,449.2014972 --> 00:42:05,459.2014972 So there's, you can just look it up, obviously. 573 00:42:05,759.2014972 --> 00:42:08,789.2014972 Um, so not, not, it's not a ton, like it's doable. 574 00:42:09,148.7082999 --> 00:42:27,898.7082999 I, I think the easiest way to consume that amount of fiber, this is actually, I'm gonna give a credit to Sammy Chatty at the Toronto General Hospital who taught me this, uh, is the, the brand cereal, the brand buds, those are the, the purple box. 575 00:42:27,958.7082999 --> 00:42:30,958.7082999 They look like dog food tastes like crap. 576 00:42:31,194.2014972 --> 00:42:31,314.2014972 Hmm. 577 00:42:31,522.7082999 --> 00:42:31,882.7082999 food. 578 00:42:32,519.2014972 --> 00:42:33,59.2014972 Hmm. 579 00:42:33,238.7082999 --> 00:42:34,349.2014972 Uh, the chains. 580 00:42:34,349.2014972 --> 00:42:35,189.2014972 Sell it, buddy. 581 00:42:35,873.7082999 --> 00:42:38,938.7082999 Uh, those contain the most amount of dietary fiber. 582 00:42:39,238.7082999 --> 00:42:46,468.7082999 And when you look at the, the nutritional content, uh, I think like half a cup will give you something like 20 grams of fiber. 583 00:42:47,518.7082999 --> 00:42:54,448.7082999 but most of, and when you're doing that, and I, I recommend that you do that if you're not getting enough fiber and if you're constipated. 584 00:42:54,868.7082999 --> 00:42:59,518.7082999 Uh, but when you do that, don't start at like full cup or half a cup. 585 00:42:59,668.7082999 --> 00:43:00,658.7082999 Start at like. 586 00:43:01,273.7082999 --> 00:43:07,444.2014972 quarter cup and do it for a week, and then go to the half a cup, and then the, uh, hmm. 587 00:43:07,633.7082999 --> 00:43:08,83.7082999 quarters. 588 00:43:08,353.7082999 --> 00:43:11,623.7082999 Because if you start at high level, you're gonna get really bloated. 589 00:43:11,653.7082999 --> 00:43:15,253.7082999 'cause your GI system's not used to having this much of fiber. 590 00:43:15,253.7082999 --> 00:43:18,133.7082999 So you, you know, you'll feel very much bloated. 591 00:43:18,223.7082999 --> 00:43:22,393.7082999 So your body needs some time to adjust to this amount of fiber. 592 00:43:22,393.7082999 --> 00:43:25,973.7082999 So just kind of go incremental level, Okay. 593 00:43:26,13.2151027 --> 00:43:26,988.7082999 take the fiber So. 594 00:43:27,858.7082999 --> 00:43:33,948.7082999 So I'm hearing if I, uh, didn't do well in my fiber for the last four days, I should not try to make it all up in one day. 595 00:43:35,103.2151027 --> 00:43:37,452.2151027 no, I, Let's have a giant explosive poop. 596 00:43:38,673.2151027 --> 00:43:38,823.2151027 Yeah. 597 00:43:38,823.2151027 --> 00:43:40,368.7082999 You, you'd be very Uh, Got it. 598 00:43:40,563.2151027 --> 00:43:43,458.7082999 Uh, so I've made, I've made some big mistakes, guys. 599 00:43:43,893.2151027 --> 00:43:48,33.2151027 yeah, we definitely don't recommend it and definitely don't recommend following Josh after he poops. 600 00:43:50,202.2151027 --> 00:43:55,362.2151027 it was also, I think, our first official, uh, commercial in ad, not sponsored, but it was also terrible. 601 00:43:56,202.2151027 --> 00:44:00,372.2151027 Fiber, zero looks, gross screws, but it'll help you poop. 602 00:44:00,372.2151027 --> 00:44:02,763.2151027 It's like the buckleys of like that's right. 603 00:44:02,802.2151027 --> 00:44:04,752.2151027 butt, you know, like it's. 604 00:44:05,643.2151027 --> 00:44:07,38.7082999 Uh, I love it. 605 00:44:07,173.2151027 --> 00:44:08,613.2151027 other, the other part is hydration. 606 00:44:08,613.2151027 --> 00:44:16,473.2151027 So, you know, if you're really dry, then your GI tract will reabsorb more of the water from the diet. 607 00:44:16,623.2151027 --> 00:44:19,533.2151027 So, uh, it's important for you to be well hydrated. 608 00:44:19,593.2151027 --> 00:44:24,513.2151027 Recommend like eight glasses of water as Brody's drinking water right now, you know, to keep his poop soft. 609 00:44:24,993.2151027 --> 00:44:35,583.2151027 Uh, and, and I think the most important, and this is really a contemporary health problem, is just the, you know, good bowel habits. 610 00:44:35,583.2151027 --> 00:44:39,273.2151027 So what I mean by that is spend more than five minutes on the toilet. 611 00:44:39,948.2151027 --> 00:44:43,998.2151027 To go, you should try not to strain that much. 612 00:44:44,388.2151027 --> 00:44:48,228.2151027 You know, that's hard If you have really hard stool, that's hard. 613 00:44:48,228.2151027 --> 00:44:50,388.2151027 If you don't have enough fiber or water. 614 00:44:50,718.2151027 --> 00:44:57,318.2151027 Uh, but you know, I I it's really important that you don't watch like Netflix on the toilet. 615 00:44:57,708.2151027 --> 00:44:58,908.2151027 Finish the whole episode. 616 00:44:59,598.2151027 --> 00:45:02,562.2151027 That'd be, I think this is the to knock. 617 00:45:03,42.2151027 --> 00:45:09,288.2151027 That is Yeah, time and like that this is the, you're like, yo, You're hiding there. 618 00:45:09,912.2151027 --> 00:45:13,878.7082999 half my day I'm doing emails, it's the only solitude we get. 619 00:45:13,878.7082999 --> 00:45:15,798.7082999 James, don't take this away from us. 620 00:45:16,698.2151027 --> 00:45:16,953.2151027 Yeah. 621 00:45:16,953.2151027 --> 00:45:28,398.2151027 I mean, you know, I mean, you guys are all adults so you can make your own decisions, but, you know, do you get the happy time versus hemorrhoids? Uh, you know, it's, there's always pros and cons. 622 00:45:29,172.2151027 --> 00:45:29,442.2151027 right. 623 00:45:29,442.2151027 --> 00:45:29,922.2151027 All right. 624 00:45:30,282.2151027 --> 00:45:30,852.2151027 Consider it. 625 00:45:31,308.2151027 --> 00:45:31,458.2151027 Yeah. 626 00:45:31,458.2151027 --> 00:45:36,708.2151027 So those are the, the preventative measures, which are really the core important ones. 627 00:45:37,188.2151027 --> 00:46:00,618.2151027 Uh, but when you do have hemorrhoids, how do you, you know, keep it clean and how do you help swelling reduce? There's, uh, you could really, you know, we call it sits bath, but, so there are specific, um, uh, kind of bucket that allow you to put some water, uh, and sit on it. 628 00:46:00,948.2151027 --> 00:46:09,768.2151027 Um, I think, you know, if you were pregnant before, you probably receive something similar after you deliver a child, like just a little plastic bucket kind of thing. 629 00:46:09,768.2151027 --> 00:46:17,718.2151027 So, but really you could just do it in, in your, um, in your bathroom, like in, in your bath, put some water. 630 00:46:18,108.2151027 --> 00:46:20,778.2151027 Uh, I don't recommend putting any salt or anything like that. 631 00:46:21,48.2151027 --> 00:46:21,538.2151027 Uh, just. 632 00:46:22,443.2151027 --> 00:46:25,218.7082999 Regular water and just sit there Ouch. 633 00:46:25,293.2151027 --> 00:46:25,953.2151027 a little bit. 634 00:46:26,343.2151027 --> 00:46:30,963.2151027 Uh, it just to help, you know, uh, with the, the swelling going down. 635 00:46:30,963.2151027 --> 00:46:31,253.2151027 Okay. 636 00:46:31,458.2151027 --> 00:46:39,253.2151027 And then maybe kind of get into the more, uh, significant treatments, the more interventional treatments, things like that. 637 00:46:39,257.7219054 --> 00:46:40,733.2151027 internal Medications. 638 00:46:41,837.7219054 --> 00:46:55,517.7219054 uh, particularly large, like grade three or four, or they're internal hemorrhoids that bleed they continue to bleed, then there are some office space procedures that can be done. 639 00:46:55,907.7219054 --> 00:47:10,517.7219054 So if we identify those hemorrhoids that we could place a rubber band around that hemorrhoids, uh, and over time that will constrict the blood vessels there and then it will. 640 00:47:10,922.7219054 --> 00:47:17,72.7219054 It will basically dry up that tissue,, and that's an effective way of controlling that hemorrhoidal tissues. 641 00:47:17,942.7219054 --> 00:47:27,242.7219054 we could do that because it's above that dentate line where we talked about the innervation or nervous system, pain, isn't specific to sensory, so you don't really feel it. 642 00:47:27,242.7219054 --> 00:47:30,992.7219054 So you shouldn't be feeling pain after this tight rubber bend goes around it. 643 00:47:31,412.7219054 --> 00:47:38,282.7219054 It's a quick five, 10 minute procedure that's done in the office setting, uh, with the endoscope. 644 00:47:38,552.7219054 --> 00:47:41,871.7219054 Uh, and you don't need sedation because there's really Right. 645 00:47:42,458.2151027 --> 00:47:42,878.2151027 no pain. 646 00:47:42,932.7219054 --> 00:47:43,832.7219054 that's expected from this. 647 00:47:45,618.2151027 --> 00:47:57,978.2151027 Do you know what I love about medicine guys? We have things like robotic surgery and stem cell research and transplants, and then we have rubber bands like it is, our lives are incredible. 648 00:47:57,978.2151027 --> 00:47:58,848.2151027 It is so funny. 649 00:47:59,57.7219054 --> 00:48:04,924.2151027 We started, uh, we got a kid, another version of operation, like the kids game, and now it's like a whole other yeah. 650 00:48:05,27.7219054 --> 00:48:07,238.7219054 rubber band now, and just, go. 651 00:48:07,844.2151027 --> 00:48:08,504.2151027 Oh, yeah. 652 00:48:09,802.7219054 --> 00:48:14,267.7219054 I'm assuming the band Then once the hemorrhoid comes out, the band, you just poop the band out with it. 653 00:48:15,77.7219054 --> 00:48:16,457.7219054 band doesn't stay latched thereafter. 654 00:48:16,457.7219054 --> 00:48:18,407.7219054 It's just once whatever's holding, it comes out too. 655 00:48:18,578.7219054 --> 00:48:19,118.7219054 goes away. 656 00:48:19,187.7219054 --> 00:48:19,197.7219054 yeah. 657 00:48:19,628.7219054 --> 00:48:22,958.7219054 And, uh, I don't recommend bringing that back to the doctor that put it in. 658 00:48:23,48.7219054 --> 00:48:24,519.2151027 Uh, Yeah. 659 00:48:24,527.7219054 --> 00:48:26,297.7219054 need to Or, or, reuse them. 660 00:48:26,529.2151027 --> 00:48:26,949.2151027 yeah. 661 00:48:27,128.7219054 --> 00:48:28,719.2151027 We don't, we, we tend not Yeah. 662 00:48:28,847.7219054 --> 00:48:29,57.7219054 good. 663 00:48:29,79.2151027 --> 00:48:30,699.2151027 And don't, and don't use it. 664 00:48:30,699.2151027 --> 00:48:31,719.2151027 Don't use it in the kitchen. 665 00:48:31,719.2151027 --> 00:48:33,69.2151027 Don't, don't, don't reuse. 666 00:48:33,69.2151027 --> 00:48:34,29.2151027 Just let it go. 667 00:48:35,94.2151027 --> 00:48:35,384.2151027 Yeah. 668 00:48:36,98.7219054 --> 00:48:45,338.7219054 It's a very small band, so hopefully Okay, so that's the, the band ligation and then the surgery. 669 00:48:45,338.7219054 --> 00:48:54,8.7219054 So, you know, inevitably, you know, if you Google about hemorrhoids or if you talk to some friends, you know, they've undergone surgical procedures. 670 00:48:54,218.7219054 --> 00:48:59,528.7219054 That's to remove the hemorrhoidal tissue, uh, that is really reserved for. 671 00:49:00,458.7219054 --> 00:49:11,858.7219054 four or, uh, hemorrhoids that are so recurrent, uh, that keep coming back, or if there are, uh, multiple of them and it's very hard to manage. 672 00:49:12,248.7219054 --> 00:49:15,98.7219054 Uh, so those will be done under general anesthesia. 673 00:49:15,428.7219054 --> 00:49:18,128.7219054 Uh, the idea is to remove that hemorrhoidal tissue. 674 00:49:18,338.7219054 --> 00:49:40,268.7219054 There are many ways of doing this, so I'm not gonna get into the weeds of this, but it's either by, removing them with cautery or with stapler, um, but these are effective way of treating these, they're super painful as my mentor and, uh, former colleague Marcus Bernstein at St. 675 00:49:40,268.7219054 --> 00:49:44,108.7219054 Mike's used to say, this is the most painful surgery that patients could have. 676 00:49:44,418.7219054 --> 00:49:44,808.7219054 Wow. 677 00:49:44,844.7219054 --> 00:49:46,224.7219054 he does a lot of these surgery. 678 00:49:46,614.7219054 --> 00:49:47,544.7219054 Uh, so I trust them. 679 00:49:47,904.7219054 --> 00:49:54,804.7219054 Uh, This is why we don't recommend hemorrhoidal surgery for small hemorrhoids. 680 00:49:55,104.7219054 --> 00:49:58,524.7219054 We don't recommend hemorrhoidal surgery for the first time. 681 00:49:58,524.7219054 --> 00:50:00,834.7219054 Small, especially first time small hemorrhoids. 682 00:50:01,224.7219054 --> 00:50:09,654.7219054 You know, if you do have these small hemorrhoids and if the surgeon recommends surgery on that, you know, I would get a second opinion. 683 00:50:09,894.7219054 --> 00:50:11,635.2151027 Uh, it's extremely Hmm. 684 00:50:12,24.7219054 --> 00:50:12,654.7219054 the pain. 685 00:50:12,984.7219054 --> 00:50:20,275.2151027 Your life will be miserable for like four weeks, uh, because of the Like the recovery, not, not the surgery itself, just the the after the fact. 686 00:50:20,425.2151027 --> 00:50:20,665.2151027 Yeah. 687 00:50:20,784.7219054 --> 00:50:21,774.7219054 but the recovery. 688 00:50:21,984.7219054 --> 00:50:34,224.7219054 So, it, it's, you know, it certainly if you're recommended to have it and you have, you know, really big hemorrhoids, recurrent, uh, very problematic hemorrhoids, it's, you know, certainly effective treatment. 689 00:50:34,374.7219054 --> 00:50:37,974.7219054 Uh, and for those who have indications for them. 690 00:50:37,974.7219054 --> 00:50:38,184.7219054 Cool. 691 00:50:39,834.7219054 --> 00:50:41,814.7219054 And, um, I don't, I don't think we've talked about it yet. 692 00:50:41,814.7219054 --> 00:50:48,594.7219054 What about external hemorrhoids? What do we do for treatments? I'm guessing it's a bit more streamlined, a bit less, uh, less complicated. 693 00:50:48,648.2287081 --> 00:50:52,128.2287081 you as much or like, those are, those are again, what I see the most in the emerge. 694 00:50:52,128.2287081 --> 00:50:52,799.2287081 And Mm-hmm. 695 00:50:52,968.2287081 --> 00:50:55,488.2287081 me, it's a matter for whether they're like thrombo or not. 696 00:50:55,488.2287081 --> 00:51:01,68.2287081 So again, are they hard firm? Are they purple? Like, have the blood inside, Is there blood clot clotted. 697 00:51:01,218.2287081 --> 00:51:01,728.2287081 Yeah. 698 00:51:02,28.2287081 --> 00:51:07,758.2287081 Um, and if it is, then the treatment for that is it's, we would do, uh, like to, to to lance it. 699 00:51:07,758.2287081 --> 00:51:10,728.2287081 So to cut it, get the blood out, and then usually it'll shrink over time. 700 00:51:11,208.2287081 --> 00:51:13,128.2287081 Um, that's done with some, some. 701 00:51:13,518.2287081 --> 00:51:14,88.2287081 Anesthetic. 702 00:51:14,328.2287081 --> 00:51:18,48.2287081 Again, it can be painful, but done in the emergency department of the clinic type setting. 703 00:51:18,348.2287081 --> 00:51:25,128.2287081 Uh, and usually after that then the, once the, the, know, that that blood clot is out, the tissue is still enlarged. 704 00:51:25,128.2287081 --> 00:51:30,798.2287081 But over the next couple weeks, we'll kind of shrivel up, become like a bit of a skin take sort of thing in a few weeks, few months time. 705 00:51:31,68.2287081 --> 00:51:35,658.2287081 James, I don't know if that's kind of what you see or you, or you get a lot of those referred to your practice as well. 706 00:51:35,754.2287081 --> 00:51:42,924.2287081 so excision for these external hemorrhoids are often performed at a really acute level. 707 00:51:42,924.2287081 --> 00:51:48,24.2287081 So if these occurred acutely, acutely thrombosis, that's a window of opportunity there. 708 00:51:48,444.2287081 --> 00:51:56,364.2287081 Uh, if it's sub chronic or it's been there for a number of weeks, the idea is to that it will, you know, get better on its own. 709 00:51:57,144.2287081 --> 00:52:01,554.2287081 so we won't necessarily do excisional surgery for, for those ones. 710 00:52:01,554.2287081 --> 00:52:01,914.2287081 Yeah. 711 00:52:01,959.2287081 --> 00:52:08,694.2287081 And, and then maybe just to, to, to fi to finish on that sense, sometimes people come in and their external hemorrhoid is not thrombosis yet. 712 00:52:08,694.2287081 --> 00:52:15,924.2287081 And unfortunately then I like acutely, I actually don't have much to offer other than the dietary things and some pain medications to try to get them through it. 713 00:52:15,924.2287081 --> 00:52:22,494.2287081 It's kind of giving it a few more days until it does become, then you can kind of do that, uh, excision at that point in time. 714 00:52:23,725.7219054 --> 00:52:25,910.7219054 And, and a good old therapeutic communication. 715 00:52:26,630.7219054 --> 00:52:27,650.7219054 You reassure them. 716 00:52:27,650.7219054 --> 00:52:29,30.7219054 You tell 'em what's gonna happen. 717 00:52:29,30.7219054 --> 00:52:31,880.7219054 You, you give 'em the Brody charm and say, Hey, we got you. 718 00:52:31,975.7219054 --> 00:52:32,265.7219054 Yeah. 719 00:52:32,334.2287081 --> 00:52:34,475.2287081 do your best to try to have a poo Yeah. 720 00:52:34,619.2287081 --> 00:52:38,135.2287081 Yeah, bath, you know, bowel regimen. 721 00:52:38,419.2287081 --> 00:52:41,180.7219054 yeah, Uh, bring your phone into the washroom. 722 00:52:41,180.7219054 --> 00:52:41,570.7219054 Yeah. 723 00:52:41,825.2287081 --> 00:52:42,564.2287081 watch yeah. 724 00:52:44,105.2287081 --> 00:52:46,914.2287081 uh, on the And all the, all of the fiber cereal. 725 00:52:46,974.2287081 --> 00:52:48,234.2287081 Just take the whole box. 726 00:52:48,320.7219054 --> 00:52:48,560.7219054 Mm-hmm. 727 00:52:48,684.2287081 --> 00:52:49,584.2287081 James's device. 728 00:52:49,734.2287081 --> 00:52:53,870.7219054 Go At once, Just, full bloat. 729 00:52:54,449.2287081 --> 00:52:56,450.7219054 All right, James, I wanna Well listen. 730 00:52:56,450.7219054 --> 00:52:56,480.7219054 Oh. 731 00:52:56,699.2287081 --> 00:53:03,29.2287081 favorite segment of this podcast as of last episode of anyone listen to it, which is our myth busting segment. 732 00:53:03,29.2287081 --> 00:53:04,55.2287081 So, do it. 733 00:53:04,949.2287081 --> 00:53:07,979.2287081 any myths associated with hemorrhoids? Let's address 'em. 734 00:53:08,69.2287081 --> 00:53:08,609.2287081 Let's get to it. 735 00:53:09,335.2287081 --> 00:53:33,611.7219054 So the ones that I hear a lot from patients is like, you know, sitting on the cold surfaces, like, you know, should I always warm up my seats? Like, especially, you know, if you live in Northwest or Northeast, uh, when it's a little co cooler in the winter, uh, do they cause hemorrhoids? What do you guys think? Oh, no, I think, I think they would help, wouldn't it? Wouldn't it help feel better? A little, a little ice, a little, yeah. 736 00:53:33,866.2287081 --> 00:53:34,496.2287081 it's false. 737 00:53:34,496.2287081 --> 00:53:34,736.2287081 Yeah. 738 00:53:34,736.2287081 --> 00:53:38,36.2287081 They don't cause hemorrhoids and hemorrhoids as we talked about. 739 00:53:38,66.2287081 --> 00:53:46,196.2287081 Really the root causes are, you know, constipation, straining, repeated trauma into the, those hemorrhoidal tissues. 740 00:53:47,216.2287081 --> 00:53:53,366.2287081 you know, Josh, to your point, you know, maybe it will help reduce the swelling a little bit possible. 741 00:53:54,176.2287081 --> 00:53:54,896.7219054 don't, Yep. 742 00:53:54,945.2287081 --> 00:53:55,785.2287081 of beans, find out. 743 00:53:55,796.2287081 --> 00:54:01,271.7219054 any randomized controlled trials on them, but Nope, we can, we can probably leave it with, it won't hurt. 744 00:54:01,406.2287081 --> 00:54:03,71.7219054 it won't hurt, it'll help. 745 00:54:03,221.7219054 --> 00:54:06,96.7219054 Yeah, but it yeah, the hemorrhoids, yeah. 746 00:54:06,116.2287081 --> 00:54:07,935.2287081 bust it, myth, Nice. 747 00:54:10,616.2287081 --> 00:54:12,6.7219054 Anything else that you guys Sure. 748 00:54:14,210.2287081 --> 00:54:16,846.7219054 What about, um, Um, what about spicy I. 749 00:54:17,750.2287081 --> 00:54:30,770.2287081 Like again, is there any like correlation with like, heat, pepper, pepper level, um, oh my God, what's the, the term for the hot sauce? How they're measured. 750 00:54:30,770.2287081 --> 00:54:31,640.2287081 Scoville units. 751 00:54:31,640.2287081 --> 00:54:34,121.7219054 Scoville units and uh, nice. 752 00:54:34,121.7219054 --> 00:54:34,601.7219054 Yeah. 753 00:54:34,751.7219054 --> 00:54:35,291.7219054 Nice. 754 00:54:35,390.2287081 --> 00:54:46,331.2287081 duration or, So, so not directly related in terms of consumption of spicy food and, you know, um, development of hemorrhoids per se. 755 00:54:46,451.2287081 --> 00:55:00,461.7219054 But if you do develop diarrhea or loose bowel movements or, you know, uh, ring a fire, if you will, after eating spicy food, It had to come up. 756 00:55:01,631.2287081 --> 00:55:10,841.2287081 you know, that, that would inevitably cause repeated trauma to your, anus, uh, and to the, uh, hemorrhoidal tissues. 757 00:55:10,871.2287081 --> 00:55:14,146.7219054 So that could in turn, I. 758 00:55:14,411.2287081 --> 00:55:17,381.2287081 develop, uh, engorgement of hemorrhoidal tissues. 759 00:55:17,381.2287081 --> 00:55:21,941.2287081 So may be some correlation, but not directly. 760 00:55:23,45.2287081 --> 00:55:24,176.7219054 And definitely not Cool. 761 00:55:24,755.2287081 --> 00:55:26,510.2287081 while you actively have hemorrhoids. 762 00:55:27,371.2287081 --> 00:55:31,31.2287081 And, and you are expected to have diarrhea after eating spicy food. 763 00:55:31,31.2287081 --> 00:55:32,846.7219054 Yeah, I definitely do not recommend Yeah. 764 00:55:35,6.7219054 --> 00:55:35,366.7219054 All right. 765 00:55:35,366.7219054 --> 00:55:44,726.7219054 The one, the one that I think everyone hears and talks about is only people of advanced age get hemorrhoids, and we won't go into a number here, but as a, as a general rule. 766 00:55:44,726.7219054 --> 00:55:46,151.2287081 Is that true? not true. 767 00:55:46,181.2287081 --> 00:56:00,371.2287081 But, hemorrhoids could occur across any age, but it's certainly true that, you know, uh, increasing age means there's more exposure for trauma in the anus. 768 00:56:00,521.2287081 --> 00:56:01,831.7219054 Um, Mm-hmm. 769 00:56:01,991.2287081 --> 00:56:08,831.2287081 about, you know, if you're constipated, heart stools and things like that, and constipation, prevalence increases with age as well. 770 00:56:08,831.2287081 --> 00:56:10,291.7219054 So there Mm-hmm. 771 00:56:10,301.2287081 --> 00:56:16,541.2287081 associations that are age related that are likely to be risk factors for you to develop hemorrhoids. 772 00:56:17,261.2287081 --> 00:56:19,331.2287081 So Yeah, but. 773 00:56:20,111.2287081 --> 00:56:26,471.2287081 There's some temporal associations or associations related to, uh, development of hemorrhoids. 774 00:56:27,221.7219054 --> 00:56:30,701.7219054 there's probably more, more prevalence as we get older. 775 00:56:31,451.7219054 --> 00:56:34,1.7219054 It can ha, it can happen at any age, but it's there. 776 00:56:34,601.7219054 --> 00:56:34,991.7219054 Okay. 777 00:56:35,215.2287081 --> 00:56:48,85.2287081 James, you know, I think, um, maybe talked, touched on it a little bit, but, um, they come back? Like, do, do hemorrhoids always come back? Is it something like you have it once, this is gonna be a lifelong Like what does that. 778 00:56:48,770.2287081 --> 00:56:49,576.7219054 What does that look like? I. 779 00:56:49,961.2287081 --> 00:56:50,261.2287081 yeah. 780 00:56:50,261.2287081 --> 00:57:00,41.2287081 So they, there's tendency for them to reoccur in your lifetime, and mostly because the root causes are not addressed. 781 00:57:00,311.2287081 --> 00:57:06,761.2287081 So, you know, what led you to have hemorrhoid the first time, which were constipation training. 782 00:57:07,766.2287081 --> 00:57:24,596.2287081 And let's say you adopted lifestyle modifications to help them, uh, reduce, but then, you know, you're looking, you have another child and you're looking for more solitude and you, you're, you're locking yourself in the toilet and watching Netflix, you know, heh is gonna come back. 783 00:57:24,656.2287081 --> 00:57:25,286.2287081 I'm sorry. 784 00:57:26,576.2287081 --> 00:57:29,781.7219054 So, uh, so pick a good show. 785 00:57:29,951.7219054 --> 00:57:30,741.7219054 Don't regret it. 786 00:57:31,135.2287081 --> 00:57:32,65.2287081 Make make it worth it. 787 00:57:32,966.2287081 --> 00:57:35,156.2287081 trade off, right? so yeah. 788 00:57:35,156.2287081 --> 00:57:39,866.2287081 So if you, if the root causes are well managed, then you know, the treatments are very effective. 789 00:57:39,866.2287081 --> 00:57:44,786.2287081 So really the pillar, the basic pillar of the treatment is a lifestyle modification. 790 00:57:46,76.2287081 --> 00:57:52,436.2287081 um, it's hard to, as we talked about it, lifestyle modification is hard to stick by them and adhere to them. 791 00:57:53,6.2287081 --> 00:57:57,386.2287081 Uh, so if there are deviations, uh, these things could come back. 792 00:57:57,386.2287081 --> 00:57:57,876.2287081 Awesome. 793 00:57:58,171.2287081 --> 00:57:59,941.2287081 Good myth busting segment, buddy. 794 00:58:00,510.7355108 --> 00:58:01,140.7355108 Bust it. 795 00:58:01,621.2287081 --> 00:58:03,661.2287081 Yeah, busted. 796 00:58:03,661.2287081 --> 00:58:05,71.2287081 Confirmed a bit of both. 797 00:58:05,85.7355108 --> 00:58:05,625.7355108 Uh huh. 798 00:58:05,754.7355108 --> 00:58:06,54.7355108 All right. 799 00:58:06,54.7355108 --> 00:58:10,35.7355108 Should we wrap it up for listeners? A couple of take homes? Let's do it. 800 00:58:11,304.7355108 --> 00:58:11,694.7355108 All right. 801 00:58:12,384.7355108 --> 00:58:15,811.2287081 go first because I feel you haven't gone first in a while, so I'm gonna divot Oh, good one. 802 00:58:15,834.7355108 --> 00:58:16,771.2287081 right? Yeah. 803 00:58:17,124.7355108 --> 00:58:17,454.7355108 Okay. 804 00:58:17,724.7355108 --> 00:58:25,44.7355108 So my, my, my take home is don't beat up your butt, like lessen your anal trauma. 805 00:58:26,184.7355108 --> 00:58:27,234.7355108 Be kind to your butt. 806 00:58:29,304.7355108 --> 00:58:30,384.7355108 Talk to it nicely. 807 00:58:30,624.7355108 --> 00:58:31,614.7355108 Be gentle with it. 808 00:58:32,364.7355108 --> 00:58:36,294.7355108 Have your James, that, I, um, you appropriately. 809 00:58:36,294.7355108 --> 00:58:37,914.7355108 Don't waste it on reality TV shows. 810 00:58:38,385.7355108 --> 00:58:40,605.7355108 Yeah, I think that's a really good one. 811 00:58:41,25.7355108 --> 00:58:48,405.7355108 And I'm gonna, you know, bring up Marcus Bernstein again, who taught us to treat anus like cornea. 812 00:58:49,619.7355108 --> 00:58:52,411.2287081 Ooh, oh, I like that. 813 00:58:52,561.2287081 --> 00:58:53,551.2287081 Yeah. 814 00:58:53,805.7355108 --> 00:58:56,664.7355108 Don't rub it Yeah, You know, yeah. 815 00:58:56,865.7355108 --> 00:58:59,726.2287081 Very about what goes in there, you know? You, I. 816 00:58:59,925.7355108 --> 00:59:03,435.7355108 have one butthole to live with for the rest of your life. 817 00:59:04,104.7355108 --> 00:59:04,314.7355108 Wow. 818 00:59:04,396.2287081 --> 00:59:06,466.2287081 you have two corneas, so you should be even. 819 00:59:06,495.7355108 --> 00:59:06,735.7355108 go. 820 00:59:06,766.2287081 --> 00:59:07,786.2287081 Oh my gosh. 821 00:59:08,146.2287081 --> 00:59:08,686.2287081 Okay. 822 00:59:10,876.2287081 --> 00:59:11,326.2287081 Okay. 823 00:59:11,626.2287081 --> 00:59:12,556.2287081 I'm going second. 824 00:59:12,586.2287081 --> 00:59:15,646.2287081 'cause James, it's your pod podcast, so you get to finish this off. 825 00:59:15,886.2287081 --> 00:59:18,196.2287081 So I'm just going to stress the lifestyle things. 826 00:59:18,736.2287081 --> 00:59:22,96.2287081 Fiber water, fiber water, and then exercise and movement. 827 00:59:22,306.2287081 --> 00:59:26,236.2287081 Um, and honestly, the 25 grams of fiber a day, it's not so hard. 828 00:59:26,236.2287081 --> 00:59:28,456.2287081 And I'm saying that personally 'cause I suck at it. 829 00:59:28,486.2287081 --> 00:59:34,186.2287081 And now I'm going to actually just keep a little spoonful of nuts or something at the side and I'll, I'll take that and I'm good for the day. 830 00:59:34,635.7355108 --> 00:59:37,5.7355108 Something about spoonful of nuts that you know. 831 00:59:37,426.2287081 --> 00:59:38,266.2287081 It does sound. 832 00:59:39,136.2287081 --> 00:59:39,856.2287081 Yeah, yeah. 833 00:59:39,856.2287081 --> 00:59:40,786.2287081 No, I'm gonna stick with that. 834 00:59:40,816.2287081 --> 00:59:41,446.2287081 I'm gonna own it. 835 00:59:41,641.2287081 --> 00:59:41,931.2287081 Yeah. 836 00:59:41,955.7355108 --> 00:59:42,555.7355108 fair enough. 837 00:59:43,395.7355108 --> 00:59:49,65.7355108 So, for the internal hemorrhoids that are larger, that. 838 00:59:49,410.7355108 --> 00:59:53,940.7355108 Are very bleedy, uh, and they recur frequently that become big issues. 839 00:59:53,940.7355108 --> 01:00:01,410.7355108 There are effective office-based treatments like band ligations or for some select patients. 840 01:00:01,650.7355108 --> 01:00:05,610.7355108 Surgery for them are very effective, but quite painful recovery. 841 01:00:06,570.7355108 --> 01:00:11,640.7355108 so talk to colorectal surgeons who do this every day. 842 01:00:12,0.7355108 --> 01:00:16,680.7355108 You know, get your butts seen if you're having the symptoms of bleeding, bulge pain. 843 01:00:17,670.7355108 --> 01:00:20,100.7355108 Very important for your butts to be seen and examined. 844 01:00:21,939.7355108 --> 01:00:22,989.7355108 In the dark most of the day. 845 01:00:23,139.7355108 --> 01:00:26,926.2287081 Let them come, come to the light, but Come to the light. 846 01:00:27,616.2287081 --> 01:00:29,266.2287081 We have a lot of good slogans on this one. 847 01:00:30,16.2287081 --> 01:00:32,596.2287081 You can make some t-shirts and public service announcements. 848 01:00:32,610.7355108 --> 01:00:33,736.2287081 your butt It's catchy. 849 01:00:34,269.7355108 --> 01:00:35,326.2287081 get your butt Yeah. 850 01:00:35,619.7355108 --> 01:00:37,336.2287081 that, that's Let your butt into the light. 851 01:00:38,199.7355108 --> 01:00:38,679.7355108 slogan. 852 01:00:38,811.2287081 --> 01:00:39,101.2287081 Yeah. 853 01:00:39,219.7355108 --> 01:00:40,306.2287081 saying we've, Yeah. 854 01:00:40,479.7355108 --> 01:00:40,749.7355108 yeah. 855 01:00:40,980.7355108 --> 01:00:43,440.7355108 surgery, uh, colorectal, uh, cancer screening as well. 856 01:00:44,709.7355108 --> 01:00:45,9.7355108 Yeah. 857 01:00:45,166.2287081 --> 01:00:45,676.2287081 Absolutely. 858 01:00:46,119.7355108 --> 01:00:46,439.7355108 Yeah, yeah, yeah. 859 01:00:47,319.7355108 --> 01:00:49,650.7355108 James, thank Um, was Oh, Josh. 860 01:00:50,986.2287081 --> 01:00:52,186.2287081 I'm gonna say, I'm gonna do mine again. 861 01:00:52,186.2287081 --> 01:00:54,796.2287081 So, spoonful of Nuts is not in this, but. 862 01:00:56,679.7355108 --> 01:00:57,69.7355108 too late. 863 01:00:58,891.2287081 --> 01:01:01,801.2287081 It's, uh, now that we say it over and over, I'm like, we can't do this. 864 01:01:01,904.7355108 --> 01:01:05,319.7355108 How long have you been like, I've been like percolating there for the last like two minutes. 865 01:01:05,319.7355108 --> 01:01:08,109.7355108 He's like, I must get rid of the spoonful of nuts. 866 01:01:08,409.7355108 --> 01:01:08,679.7355108 Now. 867 01:01:08,679.7355108 --> 01:01:10,359.7355108 You've just like I will, it, man. 868 01:01:10,449.7355108 --> 01:01:13,891.2287081 Like it's, I I will, I will rarely take something out. 869 01:01:13,951.2287081 --> 01:01:15,121.2287081 I'm like, let's not do that. 870 01:01:15,121.2287081 --> 01:01:17,589.7355108 I, a like three minute clip of you just saying, A spoonful of nuts. 871 01:01:17,649.7355108 --> 01:01:19,861.2287081 A it's ful of nuts, spoonful nuts. 872 01:01:20,11.2287081 --> 01:01:29,740.7355108 There's some auto, some auto tuning, that's Danny Goes' second song collaborating so coming up after, after Happy hemorrhoids, spoonful of nuts. 873 01:01:30,550.7355108 --> 01:01:31,60.7355108 All right. 874 01:01:31,67.2287081 --> 01:01:31,587.2287081 I love it. 875 01:01:31,840.7355108 --> 01:01:34,60.7355108 kids music venture after all guys. 876 01:01:34,120.7355108 --> 01:01:34,420.7355108 Yeah. 877 01:01:34,591.7355108 --> 01:01:35,222.2287081 that's it. 878 01:01:35,912.2287081 --> 01:01:44,72.2287081 So I'll just say it, if you can edit this back, let's say, I'm just gonna have a, a spoonful of trail mix around me at all times. 879 01:01:44,741.7355108 --> 01:01:47,351.7355108 James, thank you so much for taking us on this journey. 880 01:01:47,621.7355108 --> 01:01:50,21.7355108 Um, I think really important again. 881 01:01:50,231.7355108 --> 01:01:50,531.7355108 Yeah. 882 01:01:50,651.7355108 --> 01:01:51,521.7355108 Third of people have 'em. 883 01:01:51,551.7355108 --> 01:01:51,971.7355108 It's great. 884 01:01:51,971.7355108 --> 01:01:56,441.7355108 Super common uh, yeah, I think we, yeah. 885 01:01:56,698.2287081 --> 01:01:57,178.2287081 underrated. 886 01:01:57,418.2287081 --> 01:01:59,98.2287081 I learned a ton from you, James and Brody. 887 01:01:59,98.2287081 --> 01:01:59,538.2287081 Thank you guys. 888 01:01:59,687.7355108 --> 01:01:59,867.7355108 Yeah. 889 01:01:59,867.7355108 --> 01:02:00,221.7355108 This boys. 890 01:02:00,221.7355108 --> 01:02:00,581.7355108 We'll see you soon. 891 01:02:01,877.7355108 --> 01:02:02,627.7355108 Take care guys.
.99999999938There's a waiting room. 2 00:00:00,929.99999999938 --> 00:00:06,269.9999999995 Most of us never think about, the kind with magazines and soft elevator music.
(00:07):
I'm talking about the one in your own the bathroom.
For some, it's a reading nook.
For others, a scrolling station. 6 00:00:16,469.999999999 --> 00:00:17,969.999999999 We sit, we linger.
Forgetting this space was never meant for long visits. 8 00:00:21,929.999999999 --> 00:00:23,340 Here's the strange part.
longer you sit, the more pressure builds in a place.
You often don't think about.
(00:29):
The anal canal inside our tiny cushions, little bean bags of blood. 12 00:00:36,59.999999999 --> 00:00:36,900 supposed to be there. 13 00:00:37,349.999999999 --> 00:00:39,599.999999999 They keep things sealed When you cough or left.
.999999999But when you strain or sit too long, those cushions sag and swell. 15 00:00:44,804.999999999 --> 00:00:50,655 And one day you notice a streak of blood on the paper or a lump that makes sitting miserable.
(00:51):
when people panic.
They Google blood and stool. 18 00:00:53,924.999999999 --> 00:00:58,755 And the algorithms often offer cancer colitis catastrophe.
does it whisper the far more likely truth.
.999999999Hemorrhoids.
.999999999And here's the misunderstanding. 22 00:01:05,594.999999999 --> 00:01:07,755 Hemorrhoids aren't some alien growth.
They're normal anatomy.
Everyone has them.
(01:11):
.999999999They only become a problem when they enlarge and they remind you of their existence in the most inconvenient way possible.
So today we're going to do what few people dare talk about your butt.
We'll break down the hidden anatomy, why some hemorrhoids hurt and others don't.
.999999999What's myth and what's real and why a quick doctor's visit can turn a source of embarrassment into something surprisingly manageable. 29 00:01:38,184.999999999 --> 00:01:40,615 Because hemorrhoids aren't about shame.
(01:41):
They're about how something so ordinary can become quite literally a pain in the butt. 31 00:02:01,787.66353627 --> 00:02:06,56.02293033 and opinions expressed in this podcast are those of the hosts and guests do not reflect the official policies or positions of any affiliated institutions or organizations. 32 00:02:06,272.689597 --> 00:02:10,672.689597 This podcast is for informational, educational, and entertainment purposes only, and it is not intended to provide medical advice, diagnosis, or treatment. 33 00:02:10,956.02293033 --> 00:02:19,418.21534486 Listeners should consult their own healthcare professionals for any medical concerns, I'm Brody. 34 00:02:19,418.21534486 --> 00:02:19,718.21534486 Nolan. 35 00:02:19,718.21534486 --> 00:02:20,678.21534486 I'm an emergency doctor. 36 00:02:20,953.89716304 --> 00:02:22,783.89716304 I am Josh Levitts Internal Medicine. 37 00:02:23,36.98807213 --> 00:02:25,46.98807213 And I'm James Jung, a general surgeon. 38 00:02:25,496.98807213 --> 00:02:28,466.98807213 This is not another medical podcast. 39 00:02:30,309.18789177 --> 00:02:31,29.18789177 Perfect. 40 00:02:31,29.18789177 --> 00:02:31,479.18789177 James. 41 00:02:31,479.18789177 --> 00:02:32,859.18789177 Drinking outta the blue. 42 00:02:33,69.18789177 --> 00:02:34,449.18789177 The blue blue cup. 43 00:02:35,48.69469449 --> 00:02:36,758.69469449 Oh, yeah, it's a way to do it. 44 00:02:38,978.69469449 --> 00:02:42,699.18789177 Not sure what I, I don't know what we're talking, I don't, I have no clue. 45 00:02:43,149.18789177 --> 00:02:44,499.18789177 Weirdest introduction ever. 46 00:02:46,478.69469449 --> 00:02:46,688.69469449 Yeah. 47 00:02:46,898.69469449 --> 00:02:54,587.69469449 Not sure man, Uh we should pick this what's, yeah, I know we're starting this off on a real low point here. 48 00:02:54,632.69469449 --> 00:02:55,478.69469449 Let's, yeah. 49 00:02:55,632.69469449 --> 00:02:57,339.18789177 let's, let's oh boy. 50 00:02:57,428.69469449 --> 00:02:58,208.69469449 is up. 51 00:02:59,439.18789177 --> 00:03:00,9.18789177 That's it. 52 00:03:00,609.18789177 --> 00:03:02,409.18789177 You, that, that was my plan all along. 53 00:03:02,438.69469449 --> 00:03:08,798.69469449 gotta, you gotta start low and hopefully there'll be some incremental changes along the way. 54 00:03:09,579.18789177 --> 00:03:09,789.18789177 yeah. 55 00:03:10,419.18789177 --> 00:03:10,689.18789177 Yeah. 56 00:03:10,874.18789177 --> 00:03:14,499.18789177 There's, there's probably a tie in to what we're gonna talk about today with that statement. 57 00:03:14,918.69469449 --> 00:03:16,62.69469449 There you Nice, nice. 58 00:03:16,89.18789177 --> 00:03:17,139.18789177 Mm-hmm. 59 00:03:17,379.18789177 --> 00:03:17,389.18789177 Mm-hmm. 60 00:03:17,624.18789177 --> 00:03:18,44.18789177 Mm-hmm. 61 00:03:18,222.69469449 --> 00:03:18,422.69469449 that. 62 00:03:18,812.69469449 --> 00:03:19,102.69469449 Yeah. 63 00:03:19,839.18789177 --> 00:03:19,989.18789177 Yeah. 64 00:03:19,989.18789177 --> 00:03:20,859.18789177 It's too early for that. 65 00:03:21,914.18789177 --> 00:03:22,204.18789177 Yeah. 66 00:03:23,82.69469449 --> 00:03:26,513.69469449 What's, uh, what's new guys? uh. 67 00:03:27,923.69469449 --> 00:03:38,693.69469449 And so, um, you know, like, um, we have a relatively bigger backyard than condo in Toronto back in the days. 68 00:03:38,753.69469449 --> 00:03:40,289.18789177 Um, Mm-hmm. 69 00:03:40,402.69469449 --> 00:03:41,212.69469449 it's a fair statement. 70 00:03:41,423.69469449 --> 00:03:44,333.69469449 uh, I'm not like a handy person. 71 00:03:44,333.69469449 --> 00:03:47,963.69469449 I, uh, don't know how to do landscaping at all. 72 00:03:47,993.69469449 --> 00:03:49,162.69469449 Right? Mm-hmm. 73 00:03:49,242.69469449 --> 00:03:49,522.69469449 Mm-hmm. 74 00:03:49,639.18789177 --> 00:03:50,99.18789177 Uh oh. 75 00:03:50,169.18789177 --> 00:03:57,323.69469449 What? What did you do? I've kind of like neglected, you know, like getting rid of the, the weeds. 76 00:03:57,323.69469449 --> 00:04:03,533.69469449 Like, you know, I try to like mow the lawns and, you know, fertilize and water and all this stuff. 77 00:04:03,533.69469449 --> 00:04:17,363.69469449 But, you know, there are all this naturalized, naturalize, the areas where, you know, these are like wooden mules, right? And then it's been just overtaken by all these weeds, right? And I, you know, and of, of course they, they look kind of messy. 78 00:04:17,363.69469449 --> 00:04:21,263.69469449 So I've been trying to like pick out like little bit of weeds here and there. 79 00:04:22,373.69469449 --> 00:04:26,633.69469449 these neighbors kids, two of them probably around like. 80 00:04:27,443.69469449 --> 00:04:38,423.69469449 15, 13, you know, and they're really like savvy and they're like great business people and they just walk around and they actually like, do quite a bit of landscaping around the block. 81 00:04:38,843.69469449 --> 00:04:45,233.69469449 And like, they came up to me like, while I was like, you know, picking up these weeds and they're like, Hey, uh, Dr. 82 00:04:45,233.69469449 --> 00:04:45,683.69469449 Jang. 83 00:04:45,713.69469449 --> 00:04:49,223.69469449 And whenever you hear that, you know, whenever you, they call you Dr. 84 00:04:49,223.69469449 --> 00:04:50,647.69469449 John, they know Yeah. 85 00:04:50,709.18789177 --> 00:04:50,999.18789177 Yeah. 86 00:04:51,83.69469449 --> 00:04:52,957.69469449 They're very Yeah, Mm-hmm. 87 00:04:53,189.18789177 --> 00:04:54,144.18789177 yeah, they're yeah. 88 00:04:54,323.69469449 --> 00:04:58,373.69469449 like, we could, uh, we could do that for you, you know, over a few weekends. 89 00:04:58,373.69469449 --> 00:04:59,573.69469449 I was like, okay. 90 00:04:59,573.69469449 --> 00:05:02,873.69469449 Like, you know, I, I You're like, and got sold, right? So. 91 00:05:03,804.18789177 --> 00:05:05,694.18789177 yeah, you're like, I, I am Dr. 92 00:05:05,904.18789177 --> 00:05:06,144.18789177 Jung. 93 00:05:06,354.18789177 --> 00:05:07,764.18789177 I would love you to do that. 94 00:05:08,138.69469449 --> 00:05:16,178.69469449 So, uh, yeah, they've, you know, ordered like, we ordered like 15 cubic yards of mulch, which is a lot. 95 00:05:16,568.69469449 --> 00:05:17,839.18789177 I did not Mm-hmm. 96 00:05:18,428.69469449 --> 00:05:19,448.69469449 how much that is. 97 00:05:19,898.69469449 --> 00:05:29,348.69469449 Uh, and you know, these kids have done really good job and I was like pretty impressed with their work ethic and they're very honest with like how many hours they're working. 98 00:05:29,348.69469449 --> 00:05:31,88.69469449 Like, so impressed. 99 00:05:31,88.69469449 --> 00:05:32,468.69469449 Like very professional. 100 00:05:32,489.18789177 --> 00:05:32,979.18789177 Awesome. 101 00:05:33,68.69469449 --> 00:05:36,428.69469449 wow, this generation, you know, I'm not worried about them. 102 00:05:37,469.18789177 --> 00:05:37,959.18789177 Awesome. 103 00:05:38,214.18789177 --> 00:05:42,878.69469449 Well just, just wait, just wait, wait for the identity theft and then then we'll talk you, That's right. 104 00:05:43,898.69469449 --> 00:05:45,278.69469449 No, but I was so impressed. 105 00:05:45,338.69469449 --> 00:05:48,638.69469449 So that's, that's what we've been doing over multiple weekends now. 106 00:05:49,704.18789177 --> 00:05:57,497.69469449 we, we've been doing, I, I love that you said we've been doing games, these like little kids to do James just sitting on the porch, just watching and be like, yep. 107 00:05:57,863.69469449 --> 00:05:59,357.69469449 Yeah, you by the hour. 108 00:05:59,357.69469449 --> 00:05:59,837.69469449 Let's see. 109 00:06:00,124.18789177 --> 00:06:03,634.18789177 I, I, I went to my first kids concert. 110 00:06:04,474.18789177 --> 00:06:09,604.18789177 Like, not like my kids performing in a conference, but I mean, like actually like going to the concert for Yeah. 111 00:06:10,24.18789177 --> 00:06:12,364.18789177 Uh, so what was it? to Danny Go. 112 00:06:12,394.18789177 --> 00:06:20,365.68108905 If anyone has kids, he's like a YouTube singer, Danny but like, he got together Look at 'em up now. 113 00:06:20,434.18789177 --> 00:06:29,914.18789177 making up songs and just makes up songs with his like high school friends and gotten super popular on YouTube enough that he's like touring North America right now. 114 00:06:29,944.18789177 --> 00:06:31,660.68108905 So did a stop in Toronto He is. 115 00:06:31,660.68108905 --> 00:06:37,924.18789177 Um, it was, uh, honestly uh, top 10 concerts of my life. 116 00:06:38,635.18789177 --> 00:06:45,424.18789177 Really I maybe only been to 11, but it honestly was like, it was so much fun. 117 00:06:45,694.18789177 --> 00:06:47,194.18789177 It was uh, energy. 118 00:06:47,524.18789177 --> 00:06:49,54.18789177 It was like a rave the whole time. 119 00:06:49,54.18789177 --> 00:06:50,164.18789177 The girls were going crazy. 120 00:06:50,164.18789177 --> 00:06:51,394.18789177 There were go glow sticks. 121 00:06:51,394.18789177 --> 00:06:54,214.18789177 Everyone was like having a good time. 122 00:06:54,304.18789177 --> 00:06:56,110.68108905 The, this is right up your alley. 123 00:06:56,134.18789177 --> 00:07:02,530.68108905 sweet, honestly, like, We, uh, I, I'm just, I'm just looking up to any go and, and the pictures are very bright. 124 00:07:02,530.68108905 --> 00:07:10,249.18789177 There's lots of glow sticks and he has such songs as Glow in the Dark, shapes Escape from Tiger Island in the Mood for Food Mm-hmm. 125 00:07:10,270.68108905 --> 00:07:11,200.68108905 and many more. 126 00:07:11,599.18789177 --> 00:07:11,959.18789177 Yeah. 127 00:07:11,959.18789177 --> 00:07:11,969.18789177 Yeah. 128 00:07:12,439.18789177 --> 00:07:14,659.18789177 It was, I am in, knows It was a party. 129 00:07:14,800.18789177 --> 00:07:16,270.68108905 know, I know. 130 00:07:16,279.18789177 --> 00:07:16,399.18789177 Yeah. 131 00:07:16,480.18789177 --> 00:07:21,319.18789177 like these kids in the neighborhood, Like the show was so good. 132 00:07:21,319.18789177 --> 00:07:31,339.18789177 I like highly debated buying a t-shirt, merch on the way out, and I'm like, I mean, why wouldn't you? But it was, These, these, good. 133 00:07:31,459.18789177 --> 00:07:32,239.18789177 It was so good. 134 00:07:32,269.18789177 --> 00:07:46,675.68108905 I I'm always, I'm always interested in, I'm just, I'm interested in the backstory of all these, like these ones and the Wiggles and all these, like how, how do you, how do you get into like are these actors that do it, are they singers are, there's like, this is a great market. 135 00:07:46,675.68108905 --> 00:07:47,725.68108905 I'm getting in on this. 136 00:07:47,899.18789177 --> 00:07:48,109.18789177 totally. 137 00:07:48,109.18789177 --> 00:07:48,439.18789177 And that's it. 138 00:07:48,439.18789177 --> 00:07:50,419.18789177 There's some that You, kind of sketchy. 139 00:07:50,419.18789177 --> 00:07:52,459.18789177 I don't wanna maybe like, name some Danny Go's. 140 00:07:52,459.18789177 --> 00:07:53,635.68108905 Not one of them, but some yep. 141 00:07:53,989.18789177 --> 00:08:00,145.68108905 backgrounds are a little more, um, uh, noted of, Yeah. 142 00:08:00,355.68108905 --> 00:08:08,755.68108905 Well, it's funny, there's, there's a, there's, there's a Wiggles documentary and I watched it just to see the Dark Side of the Wiggles, but they're all like perfect human beings. 143 00:08:08,785.68108905 --> 00:08:09,745.68108905 There was nothing dark. 144 00:08:09,745.68108905 --> 00:08:10,975.68108905 It is like, they're all happy. 145 00:08:10,975.68108905 --> 00:08:11,995.68108905 Everything went well. 146 00:08:12,175.68108905 --> 00:08:13,15.68108905 I was like, well, fine. 147 00:08:13,75.68108905 --> 00:08:13,855.68108905 I guess it does happen. 148 00:08:14,89.18789177 --> 00:08:16,609.18789177 And I was really hoping there'd be a dark end to the way only for like entertainment. 149 00:08:16,609.18789177 --> 00:08:17,125.68108905 I don't like, Yeah. 150 00:08:17,179.18789177 --> 00:08:18,319.18789177 they're wonderful people. 151 00:08:18,499.18789177 --> 00:08:19,690.68108905 Um, Yeah. 152 00:08:19,690.68108905 --> 00:08:19,750.68108905 Yeah. 153 00:08:19,789.18789177 --> 00:08:20,839.18789177 wish Emma would come back. 154 00:08:20,839.18789177 --> 00:08:29,359.18789177 Like, there's, what I wish upon children of, ask me about Oh, music and I got nothing, but, all right. 155 00:08:29,359.18789177 --> 00:08:30,889.18789177 Let's do Wiggles and Danko. 156 00:08:30,889.18789177 --> 00:08:33,565.68108905 We got, oh. 157 00:08:34,585.18789177 --> 00:08:35,569.18789177 well, I man. 158 00:08:35,575.18789177 --> 00:08:36,739.18789177 these are Yeah. 159 00:08:36,820.68108905 --> 00:08:42,400.68108905 it's cool you know, uh, entrepreneurs, you know, doing, entrepreneurs. 160 00:08:42,804.18789177 --> 00:08:43,344.18789177 That's it. 161 00:08:43,489.18789177 --> 00:08:44,590.68108905 That's Just like us. 162 00:08:44,620.68108905 --> 00:08:45,520.68108905 Just like us guys. 163 00:08:45,520.68108905 --> 00:08:47,560.68108905 Just like us and this podcast. 164 00:08:47,659.18789177 --> 00:08:48,220.68108905 have a lot less Yeah. 165 00:08:48,349.18789177 --> 00:08:48,739.18789177 screen. 166 00:08:48,769.18789177 --> 00:08:49,339.18789177 That's what we need. 167 00:08:49,339.18789177 --> 00:08:51,379.18789177 We need like, I don't need a dinosaur head. 168 00:08:51,379.18789177 --> 00:08:55,870.68108905 I need like a mobile full dinosaur animated background with like a That'd be awesome. 169 00:08:55,999.18789177 --> 00:08:56,980.68108905 That's how Yeah. 170 00:08:57,229.18789177 --> 00:08:58,219.18789177 that's how we do it, guys. 171 00:08:58,240.68108905 --> 00:09:00,760.68108905 You know, most people, you know, Mo, most people just listen to this. 172 00:09:00,760.68108905 --> 00:09:02,209.18789177 They don't watch us, so reason. 173 00:09:02,230.68108905 --> 00:09:04,30.68108905 don't, I don't, I dunno if you want to go there. 174 00:09:04,249.18789177 --> 00:09:06,529.18789177 I think most people don't listen to us either. 175 00:09:06,529.18789177 --> 00:09:06,859.18789177 Josh. 176 00:09:06,859.18789177 --> 00:09:08,680.68108905 I think it's, Very true. 177 00:09:09,100.68108905 --> 00:09:09,820.68108905 Appropriate. 178 00:09:09,850.68108905 --> 00:09:10,90.68108905 Yep. 179 00:09:10,270.68108905 --> 00:09:10,960.68108905 Very true. 180 00:09:11,110.18789177 --> 00:09:11,740.18789177 All right. 181 00:09:13,450.68108905 --> 00:09:24,499.18789177 So what are we, uh, what are we getting into today? So, James, do you want to, uh, do you wanna take us into the wild world of hemorrhoids? I mean, I would love to, you know, No, no segue for that. 182 00:09:25,309.18789177 --> 00:09:26,485.68108905 Just No, we're go. 183 00:09:26,530.18789177 --> 00:09:30,730.68108905 just straight, I don't think, uh, I don't think hemorrhoids need a segue. 184 00:09:30,840.18789177 --> 00:09:39,270.18789177 It's got like, this is one of those things that everybody in the world has heard of hemorrhoids, like, we'll bring up other diagnoses people like, what is this? You know, hemorrhoids, everyone just go, oh yeah, I know those. 185 00:09:39,389.69469449 --> 00:09:39,689.69469449 yeah. 186 00:09:39,699.69469449 --> 00:09:42,9.69469449 Hemorrhage is, is very frequent. 187 00:09:42,159.69469449 --> 00:09:45,519.69469449 Uh, a lot of people experience it, especially as they get older. 188 00:09:46,269.69469449 --> 00:09:47,469.69469449 You know, it's often. 189 00:09:48,129.69469449 --> 00:09:50,169.69469449 Misdiagnosed or undiagnosed. 190 00:09:50,259.69469449 --> 00:09:54,819.69469449 People don't like to show their butt, so, often, you know, they're undiagnosed. 191 00:09:55,569.69469449 --> 00:09:57,189.69469449 and people suffer in silence. 192 00:09:57,289.69469449 --> 00:10:06,664.69469449 I think, there's no glamor, uh, in, in treatment of these or, or, you know, examination of these or suffering from these. 193 00:10:06,664.69469449 --> 00:10:11,294.69469449 But I, I think it's such an important entity that affects a lot of people. 194 00:10:11,324.69469449 --> 00:10:14,684.69469449 So if you are a listener who. 195 00:10:14,974.69469449 --> 00:10:21,784.69469449 You know, things that they have hemorrhoids, but, you know, unsure or, you know, don't want to get examined by doctors. 196 00:10:21,784.69469449 --> 00:10:23,404.69469449 Like, I think this is episode for you. 197 00:10:24,184.69469449 --> 00:10:26,284.69469449 A lot of, there's a lot to unpack here. 198 00:10:26,344.69469449 --> 00:10:29,674.69469449 Uh, a lot of misconception, a lot of confusing anatomy. 199 00:10:29,674.69469449 --> 00:10:32,674.69469449 So, you know, that's why I picked this topic. 200 00:10:32,944.69469449 --> 00:10:34,414.69469449 Uh, we're gonna have a little bit of fun. 201 00:10:34,414.69469449 --> 00:10:45,15.18789177 I think, uh, whenever we talk Always uh, know, there, there, are few topics, you know, that, uh, kind of lends itself I. 202 00:10:45,364.69469449 --> 00:10:47,44.69469449 real fun, you know, discussion. 203 00:10:47,44.69469449 --> 00:10:56,254.69469449 And I think this is probably one of them, but there's nothing funny about having hemorrhoids, so I, I don't, I mean, I don't, I don't, I like that. 204 00:10:56,794.69469449 --> 00:11:01,834.69469449 Um, and guys, like, I don't wanna call us heroes, but we're, we're talking about the things that people don't wanna talk about. 205 00:11:01,834.69469449 --> 00:11:06,544.69469449 So, um, you know, there's, uh, there's, there's, there's big words to put to us here. 206 00:11:06,673.20149721 --> 00:11:06,943.20149721 James. 207 00:11:06,943.20149721 --> 00:11:11,983.20149721 I do appreciate the themes of your episode, though, farts, but hemo like it's, it's good. 208 00:11:12,163.20149721 --> 00:11:12,784.69469449 It's Yep. 209 00:11:13,414.69469449 --> 00:11:13,684.69469449 Yep. 210 00:11:14,194.69469449 --> 00:11:14,914.69469449 It's body of humor. 211 00:11:15,214.69469449 --> 00:11:17,314.69469449 Um, now Brody, we're gonna try something. 212 00:11:17,314.69469449 --> 00:11:18,454.69469449 James, you can't answer. 213 00:11:19,174.69469449 --> 00:11:24,454.69469449 Uh, just to prove to listeners that doctors, uh, don't know much outside of their own little world. 214 00:11:24,664.69469449 --> 00:11:29,259.69469449 Brody, what do you know about hemorrhoids? I. 215 00:11:29,488.20149721 --> 00:11:33,628.20149721 I certainly know they are a common cause for coming to the emergency department. 216 00:11:34,44.69469449 --> 00:11:34,264.69469449 Mm. 217 00:11:34,348.20149721 --> 00:11:35,64.69469449 you Mm-hmm. 218 00:11:35,248.20149721 --> 00:11:42,634.69469449 quiz my anatomy for the reason why they're there? How they're there, those No, no, happily defer that to our surgeon expert no. 219 00:11:42,889.69469449 --> 00:11:48,139.69469449 I am, I am literally trying to show that I know nothing about hemorrhoids except they bleed. 220 00:11:48,178.20149721 --> 00:11:48,568.20149721 Yeah. 221 00:11:48,679.69469449 --> 00:11:51,859.69469449 if they bleed a lot, I sometimes see them and send 'em to someone else. 222 00:11:51,919.69469449 --> 00:11:55,279.69469449 I know nothing about them, so I'm like super excited about this. 223 00:11:55,513.20149721 --> 00:12:02,359.69469449 wonder if the at-home diagnosis of hemorrhoids has improved since the camera phone just saying pretty Hmm. 224 00:12:02,359.69469449 --> 00:12:02,449.69469449 Hmm. 225 00:12:02,563.20149721 --> 00:12:04,813.20149721 like, take a quick pic, see what's going on down there. 226 00:12:05,173.20149721 --> 00:12:06,703.20149721 Is there something deleted? I'm not too sure. 227 00:12:06,703.20149721 --> 00:12:30,193.20149721 It's a bit hard to see, but I feel like before that your options were either like old school foam it or school, take a picture, send it off to get processed, pick it up three to five days later, You mean like the, the actual films or like Yeah, the or like the, the two mirrors if you can kind of get things aligned, like, I don't know. 228 00:12:30,253.20149721 --> 00:12:30,613.20149721 Yeah. 229 00:12:30,733.20149721 --> 00:12:35,83.20149721 To, to get back to your recent, you know, your, your point James, about the, me being undiagnosed. 230 00:12:35,404.20149721 --> 00:12:36,264.69469449 Yeah, it, Yeah. 231 00:12:36,364.20149721 --> 00:12:38,494.20149721 hard to see it yourself. 232 00:12:38,794.20149721 --> 00:12:49,954.20149721 Um, you know, we have certain range of motion in our, in our spine, but not to that degree for most of us at least, unless you work for c cti sole. 233 00:12:50,404.20149721 --> 00:12:55,654.20149721 Uh, so it is certainly hard to see, you know, a lot of it is kind of symptoms. 234 00:12:56,74.20149721 --> 00:13:01,864.20149721 So sometimes the symptoms could be vague, sometimes it could be concerning when there's blood involved in the toilet. 235 00:13:02,254.20149721 --> 00:13:05,734.20149721 Uh, so, you know, I think, you know, we should just really dive into it. 236 00:13:05,824.20149721 --> 00:13:12,904.20149721 Uh, and you know, what better way to start than, uh, understanding the anal canal anatomy. 237 00:13:12,964.20149721 --> 00:13:14,824.69469449 So I think it's Yeah. 238 00:13:15,34.20149721 --> 00:13:16,744.20149721 to kind of understand and. 239 00:13:17,344.20149721 --> 00:13:22,294.20149721 know, I don't think there, there are many of us who think a lot about anal canal. 240 00:13:22,564.20149721 --> 00:13:27,518.20149721 Uh, but certainly, know, during, that's an understatement. 241 00:13:28,24.69469449 --> 00:13:31,869.69469449 Many, many of us, there are many of us that think about this all the time. 242 00:13:32,324.20149721 --> 00:13:48,104.20149721 You know, when, when you go through general surgery, you know, training, you know, this is certainly, uh, a very important anatomy that we, we learn about and, you call this your butt and butter? no, no. 243 00:13:49,154.20149721 --> 00:13:55,34.69469449 So, uh, You may have, you may have to explain that joke for, uh, some people, Brody. 244 00:13:55,784.20149721 --> 00:14:00,404.20149721 so, uh, the ed canal is the very, I'm just gonna move on. 245 00:14:03,119.20149721 --> 00:14:06,389.20149721 It's the, it's the very end of your GI Trek. 246 00:14:06,449.20149721 --> 00:14:14,459.20149721 And, I think the easy, easiest way we could think about this is, this is what's palpable of the GI Trek, with your finger. 247 00:14:14,819.20149721 --> 00:14:30,609.20149721 Uh, I'm not saying that you should put your finger in to, you know, palpate the anatomy, relevant anatomy, but if you are thinking, you know, if, if, if you visualize, like, you know, the extent of what's palpable is kind of the anal canal from the anal verge. 248 00:14:31,969.20149721 --> 00:14:32,839.20149721 It has. 249 00:14:32,929.20149721 --> 00:14:44,419.20149721 Uh, in about two centimeters in it has something called a dentate line, which is kind of the division from external or external, closer to the skin, what you see and internal hemorrhoids. 250 00:14:44,749.20149721 --> 00:15:01,789.20149721 Um, and the internal hemorrhoids, uh, first of all, the, the, the hemorrhoids, uh, or hemorrhoidal, uh, plexus, uh, are not abnormal anatomy to begin with, but we all have these hemorrhoidal tissues in, in the anal canal. 251 00:15:02,209.20149721 --> 00:15:14,314.20149721 But as they get, stressed, they get, there's a repeated trauma, uh, or if they get inflamed or if the vasculature gets engorged, they get bigger than, normal. 252 00:15:14,314.20149721 --> 00:15:18,4.20149721 And that's when you start to notice them, uh, and. 253 00:15:18,324.20149721 --> 00:15:22,74.20149721 In the internal hemorrhoids, there are actually three pockets of the cushions. 254 00:15:22,104.20149721 --> 00:15:27,384.20149721 So these are kind of the, cushions that we, all have, there are three of them. 255 00:15:27,774.20149721 --> 00:15:31,344.20149721 Uh, there's one on the, uh, on the left, and then there are two on the right. 256 00:15:31,704.20149721 --> 00:15:38,634.20149721 And then these are kind of the cushions that exist and they really help with kind of the control of continence. 257 00:15:38,904.20149721 --> 00:15:52,434.20149721 Uh, so, you know, some of those, uh, those, uh, you know, liquid bowel movements, uh, and you're laughing hard, you know, controlling that and holding that in is kind of in addition to this sphincter muscles. 258 00:15:52,434.20149721 --> 00:15:56,673.20149721 These really help with this, uh, kind of like the unsung heroes of the day. 259 00:15:56,703.20149721 --> 00:15:58,159.69469449 They really kind of Mm-hmm. 260 00:15:58,173.20149721 --> 00:15:58,863.20149721 everything in. 261 00:15:59,124.20149721 --> 00:15:59,424.20149721 yeah. 262 00:15:59,523.20149721 --> 00:15:59,943.20149721 Yeah. 263 00:15:59,994.20149721 --> 00:16:01,164.20149721 be socially awkward. 264 00:16:01,383.20149721 --> 00:16:01,683.20149721 Yeah. 265 00:16:02,829.69469449 --> 00:16:04,479.69469449 Well, I guess not if everyone was doing it. 266 00:16:05,284.20149721 --> 00:16:07,593.20149721 Yeah, if it's a norm, right? Like Right. 267 00:16:07,594.69469449 --> 00:16:08,193.20149721 No, no, Yeah. 268 00:16:09,94.20149721 --> 00:16:10,89.69469449 that would be no. 269 00:16:10,564.20149721 --> 00:16:19,564.20149721 Uh, and, and then, the below that dentate line is the external hemorrhoid, uh, where the external hemorrhoids could, uh, could abnormally grow. 270 00:16:19,564.20149721 --> 00:16:28,734.20149721 So external hemorrhoids, there isn't really hemorrhoidal tissues there, but there's an engorgement of, the, the tissue below that Dante line. 271 00:16:29,4.20149721 --> 00:16:33,474.20149721 Uh, it's not discreet like the internal hemorrhoids where they're kind of the three cushions. 272 00:16:33,624.20149721 --> 00:16:41,94.2014972 Uh, these external hemorrhoids could form kind of in anywhere, uh, but it's just an engorgement of the tissue there. 273 00:16:41,144.2014972 --> 00:16:42,554.2014972 And those are the external hemorrhages. 274 00:16:42,884.2014972 --> 00:16:48,734.2014972 The dentate line is important because the innervation is different from internal and external. 275 00:16:49,4.2014972 --> 00:16:50,234.2014972 So external. 276 00:16:50,234.2014972 --> 00:16:51,944.2014972 So the on the skin side. 277 00:16:52,184.6946945 --> 00:16:55,34.2014972 You just, just explain, uh, innovation, is. 278 00:16:55,34.2014972 --> 00:16:55,754.6946945 It's what you mean by that. 279 00:16:55,754.6946945 --> 00:16:55,994.6946945 Yeah. 280 00:16:56,924.2014972 --> 00:16:58,308.2014972 So we're talking Supply. 281 00:16:58,394.2014972 --> 00:17:11,694.2014972 are the sense, you know, nerves that help you feel? Uh, so on the external side, which is close to your skin, uh, the, the innovations or nerves, are more prone to feeling pain. 282 00:17:11,844.2014972 --> 00:17:17,454.2014972 Whereas internally, uh, there's less innervation of the sensory or the pain. 283 00:17:17,934.2014972 --> 00:17:22,314.2014972 Uh, so because of that, the external hemorrhoids will be painful. 284 00:17:22,494.2014972 --> 00:17:22,554.2014972 Yeah. 285 00:17:23,634.2014972 --> 00:17:26,634.2014972 internal hemorrhoids often aren't painful. 286 00:17:27,354.2014972 --> 00:17:51,164.2014972 So when we do an examination, uh, and when we, let's say pinch, and we're gonna talk about some treatments for internal hemorrhoids or band, squeeze the hemorrhoidal tissues above the level of dentate line, patients don't often feel anything, but if it's, you know, you're pinching or stretching or pointing at the external hemorrhage below the dentate line, it's painful. 287 00:17:51,524.2014972 --> 00:17:53,624.2014972 So external hemorrhoids are the painful ones. 288 00:17:53,654.2014972 --> 00:17:54,524.2014972 Internal hemorrhage. 289 00:17:54,674.2014972 --> 00:17:55,274.2014972 Painless. 290 00:17:57,479.6946945 --> 00:17:58,589.6946945 Question for you. 291 00:17:58,709.6946945 --> 00:18:00,479.6946945 Um, maybe we're in this, maybe we didn't. 292 00:18:00,509.6946945 --> 00:18:13,94.2014972 So are hemorrhoids the pathologic name for when these tissues become inflamed and, and things you'll get into? Or do we have literally hemorrhoidal tissue? Is that what we call it when it's healthy and everything? Yeah. 293 00:18:13,94.2014972 --> 00:18:16,4.2014972 So, uh, I think hemorrhoids are. 294 00:18:17,69.2014972 --> 00:18:27,969.2014972 Uh, now accepted as kind of the, the pathologic, like internal hemorrhoids, external hemorrhoids, but the hemorrhoidal plexus or hemorrhoidal tissues is actually a normal name for normal, anatomy as well. 295 00:18:30,369.6946945 --> 00:18:31,479.6946945 See, I'm learning stuff. 296 00:18:31,479.6946945 --> 00:18:32,679.6946945 I love this podcast. 297 00:18:33,243.2014972 --> 00:18:33,423.2014972 Yeah. 298 00:18:33,693.2014972 --> 00:18:42,393.2014972 Yeah, I think the, the external and internal hemorrhoids like would be, you know, the internal hemorrhoids being painless, external hemorrhage being painful, um, uh, I think is really important to you. 299 00:18:42,393.2014972 --> 00:18:50,793.2014972 I mean, if you, if you think once you rip that bandaid off of meeting someone else who's had hemorrhoids or then talking with people, hemorrhoids, then often there's a little bit like, oh, minor painful, minor painless. 300 00:18:50,793.2014972 --> 00:18:57,693.2014972 Like, there's a little bit of that sometimes where people are worried about whether it is hemorrhoids or is not hemorrhoids, if it's painful or not painful. 301 00:18:57,693.2014972 --> 00:19:07,503.2014972 So I think it's kind of helpful to know, 'cause if you're talking about your hemorrhoids as a whole, like your experience might be very different than someone who, you know, if you had internal hemorrhoids, there's blood in the toilet. 302 00:19:07,743.2014972 --> 00:19:14,493.2014972 Your experience might be very different than someone who had external hemorrhoids who like, wow, it's, this is like the most painful thing and I couldn't take a poop for forever 'cause it hurt too much. 303 00:19:14,493.2014972 --> 00:19:18,744.2014972 Like, I think it's, it's good for, uh, yeah, just to, just to know that Yeah. 304 00:19:19,23.2014972 --> 00:19:20,264.6946945 can vary quite a bit Yep. 305 00:19:20,343.2014972 --> 00:19:23,673.2014972 those two, depending on whether they have that nerve supply that you can feel it or not. 306 00:19:25,314.2014972 --> 00:19:25,734.2014972 Yeah. 307 00:19:25,739.2014972 --> 00:19:38,724.2014972 I, I think that's very important because, you know, I think this is kind of theme of a lot of what we talk about, you know, as, as patients or, you know, average listeners, you know, we things, those are the symptoms, right. 308 00:19:39,114.2014972 --> 00:19:45,354.2014972 And not, not all symptoms are specific to certain pathologic process. 309 00:19:45,594.2014972 --> 00:19:49,254.2014972 Like pain in the butt can be from, or pain in the anus. 310 00:19:49,254.2014972 --> 00:19:56,754.2014972 And, uh, anus could come from a variety of things, right? so I think it's very important to get examined. 311 00:19:56,874.2014972 --> 00:20:03,84.2014972 And same thing with like the bulge in the anus, which, you know, can be external and internal hemorrhage. 312 00:20:03,264.2014972 --> 00:20:04,734.2014972 If the internal hemorrhage get bigger, they. 313 00:20:05,529.2014972 --> 00:20:09,939.2014972 Prolapse, and then you could, you know, you could experience bulge in the anus. 314 00:20:10,29.2014972 --> 00:20:11,829.2014972 Uh, that could be both internal or external. 315 00:20:11,829.2014972 --> 00:20:16,149.2014972 So very important to be, uh, examined by experts. 316 00:20:18,189.6946945 --> 00:20:23,484.6946945 I just, uh, before Brody says any, before Brody says anything, I'm pretty sure he has a pain in the butt joke right here. 317 00:20:23,484.6946945 --> 00:20:24,504.6946945 I'm gonna call him on it. 318 00:20:24,528.2014972 --> 00:20:30,888.2014972 No, I was just gonna say, I'm so proud of us 'cause there's such an easy layup for making pain in the butt joke and none of us went for it. 319 00:20:31,248.2014972 --> 00:20:32,238.2014972 I'm really proud of us. 320 00:20:32,238.2014972 --> 00:20:33,108.2014972 That's all I was gonna say. 321 00:20:34,38.2014972 --> 00:20:35,448.2014972 you and I were like, don't say it. 322 00:20:35,448.2014972 --> 00:20:36,493.2014972 Don't say it. 323 00:20:37,869.2014972 --> 00:20:39,78.2014972 It, it, it was just Alright. 324 00:20:41,69.6946945 --> 00:20:41,909.6946945 I am having fun. 325 00:20:42,108.2014972 --> 00:20:48,48.2014972 James, you talked about, um, hemorrhoids being the result of repeated trauma, inflammation. 326 00:20:48,138.2014972 --> 00:20:55,499.6946945 Like what does trauma look like for the butt? Like, I know that may be maybe obvious, maybe not obvious, but like what, That's an appropriate question. 327 00:20:55,629.2014972 --> 00:21:06,9.2014972 it, Yeah, So, uh, the most often trauma, like most frequent form of trauma in the, you know, canal would be if you're having really hard stools. 328 00:21:06,279.2014972 --> 00:21:14,859.2014972 So if you're constipated, you know, you don't consume enough fiber or you don't consume enough water, uh, and the stools are like rabbit stools. 329 00:21:15,129.2014972 --> 00:21:20,958.2014972 Uh, which by the way, I don't know if you've seen rabbit stools, they look like cocoa pups You can't I do. 330 00:21:21,919.6946945 --> 00:21:23,304.6946945 I've, I've seen cocoa pots. 331 00:21:23,309.6946945 --> 00:21:23,489.6946945 Yeah. 332 00:21:23,799.6946945 --> 00:21:24,89.6946945 Yeah. 333 00:21:25,239.2014972 --> 00:21:32,649.2014972 Uh, so, you know, like as you pass those hard stools, you know, it could create mucosal traumas along the way. 334 00:21:32,649.2014972 --> 00:21:34,299.2014972 So that's a form of trauma. 335 00:21:34,569.2014972 --> 00:21:43,509.2014972 Uh, or if you're straining, putting pressure, like if you're spending a lot of time on the toilet and in straining, that pressure could be a form of trauma with the hard stool. 336 00:21:44,349.2014972 --> 00:21:57,549.2014972 it could also be, you know, from penetrating trauma, like anal intercourse, uh, or instrumentations or, you know, even being examined, uh, for, uh, you know, with the anal scope. 337 00:21:57,849.2014972 --> 00:22:02,979.2014972 Uh, although we do it very gently with like lots of lubricant, but it, it can be a form of trauma. 338 00:22:05,274.6946945 --> 00:22:11,454.6946945 And I think it's, it's interesting as we talk about this because the things that cause it are probably the things that help prevent it too. 339 00:22:11,454.6946945 --> 00:22:17,664.6946945 If you, if you do things the right way, if, and, and I, you'll probably talk about it later, but keeping the stool soft and regular bowel movements and all that. 340 00:22:17,664.6946945 --> 00:22:20,214.6946945 So, um, it's one of those kind of easy connections here. 341 00:22:20,289.2014972 --> 00:22:21,309.2014972 Very important. 342 00:22:21,459.2014972 --> 00:22:27,798.2014972 Uh, and I'm sure we're gonna have a bulk of our conversation around those Oh, I see what you did there. 343 00:22:28,8.2014972 --> 00:22:28,938.2014972 Bulk fiber. 344 00:22:28,998.2014972 --> 00:22:29,688.2014972 Nice. 345 00:22:29,814.6946945 --> 00:22:30,474.6946945 Love it. 346 00:22:30,804.6946945 --> 00:22:31,404.6946945 Love it. 347 00:22:31,638.2014972 --> 00:22:34,29.6946945 Um, James, And that AI did not give you that joke. 348 00:22:36,738.2014972 --> 00:22:41,868.2014972 James, I've heard before of different, like grading or severity of, of hemorrhoids. 349 00:22:41,898.2014972 --> 00:22:45,258.2014972 Um, can you maybe kinda break that down a little bit for what that might kinda look like? So someone. 350 00:22:45,549.2014972 --> 00:22:51,519.2014972 So, uh, the, the, the grading that we often use is for internal hemorrhoids. 351 00:22:51,519.2014972 --> 00:22:58,809.2014972 So there are four grades, so it goes from one to four, one being the mildest form and four being the most severe form. 352 00:22:59,169.2014972 --> 00:23:07,719.2014972 So grade one internal hemorrhoid is, uh, hemorrhoidal tissue that is, uh, enlarged and that could bleed. 353 00:23:07,719.2014972 --> 00:23:12,309.2014972 So if there's a blood in the toilet, uh, uh, and if that. 354 00:23:12,639.2014972 --> 00:23:20,949.2014972 That hemorrhoidal tissue, or it gets in engorged and it's collapsed into the, the lumen, like within the anal canal. 355 00:23:20,949.2014972 --> 00:23:27,129.2014972 That'll be grade one, grade two is that, that, you know, that tissue collapses out of it. 356 00:23:27,129.2014972 --> 00:23:36,754.2014972 So kind of like, you know, if you're pooping, like it just collapses out of it, but it spontaneously goes back in three is that it comes out and you need to manually push it in. 357 00:23:36,759.2014972 --> 00:23:46,719.2014972 So manually meaning like with finger or, you know, uh, tissue or to push it back in grade four is the one that's prolapsed and it, it doesn't go back in. 358 00:23:46,719.2014972 --> 00:23:47,643.2014972 So it Gotcha. 359 00:23:47,649.2014972 --> 00:23:58,239.2014972 severity of how big the tissue is, uh, and grade one, even if it's not enlarged, if it's bleeds, then you know, it's still considered a hemorrhoidal or, or internal hemorrhoids. 360 00:24:00,39.6946945 --> 00:24:04,344.6946945 Just kind of going back to what you started talking about, people need to get this looked at. 361 00:24:04,344.6946945 --> 00:24:12,594.6946945 I, I'm guessing there are people who are walking around with like grade three prolapse hemorrhoids that are just pushing 'em back in and not getting checked out, not getting treated. 362 00:24:12,594.6946945 --> 00:24:14,574.6946945 It's, I'm guessing it's pretty common. 363 00:24:14,769.2014972 --> 00:24:15,759.2014972 it's very common. 364 00:24:15,849.2014972 --> 00:24:21,819.2014972 Um, I've done some kind of, uh, research into like how frequent this is. 365 00:24:21,879.2014972 --> 00:24:41,459.2014972 You know, I think the studies are actually very poorly done, but some of the survey studies from 1980s and and nineties demonstrate that in the us the prevalence of hemorrhoids is about four to 5%, but when they do a colonoscopy, and then we document, we always perform digital rectal examination. 366 00:24:41,459.2014972 --> 00:24:48,659.2014972 And, and we also do a retro, uh, retro reflection view of the hemorrhoidal tissue or to look at the hemorrhoidal tissues. 367 00:24:48,959.2014972 --> 00:24:55,859.2014972 Uh, and when we, when we see that, you know, the actual prevalence of hemorrhoids is more about like 20 to 30%. 368 00:24:56,949.6946945 --> 00:24:57,449.6946945 It is huge. 369 00:24:57,679.6946945 --> 00:24:57,969.6946945 Okay. 370 00:24:58,259.2014972 --> 00:25:05,819.2014972 a big discrepancy between, what patients would report versus, you know, what, what is actually happening. 371 00:25:07,664.6946945 --> 00:25:07,904.6946945 Okay. 372 00:25:08,264.6946945 --> 00:25:14,174.6946945 So that's, um, that's the internal me, the, the internal hemorrhoid, not internal medicine, the internal hemorrhoid world. 373 00:25:14,714.6946945 --> 00:25:21,554.2014972 Um, what, uh, what do we need to know about the external hemorrhoid world? Brody, like, uh, I'm sure you see some external hemorrhages. 374 00:25:21,554.2014972 --> 00:25:22,899.6946945 So what, uh, I. 375 00:25:23,264.2014972 --> 00:25:25,483.2014972 do you have, uh, kind of, you know, tell me about your Yeah. 376 00:25:25,844.2014972 --> 00:25:29,24.6946945 Uh, other than calling me, uh, middle of the night to Yeah. 377 00:25:29,24.6946945 --> 00:25:35,819.6946945 Or, or, or, or listen or Brody, if you, if you have hemorrhoids yourself, uh, to talk about your personal experience. 378 00:25:36,398.2014972 --> 00:25:47,199.6946945 I am going to, um, choose to not share about my personal hemorrhoid journal journey, um, or, uh, uh, verify or deny whether I have ever had personal Fair enough. 379 00:25:47,258.2014972 --> 00:25:47,978.2014972 'cause I'm embarrassed. 380 00:25:47,978.2014972 --> 00:25:48,679.6946945 I'm just I. 381 00:25:48,938.2014972 --> 00:25:50,348.2014972 to make that, that statement now. 382 00:25:50,768.2014972 --> 00:25:56,888.2014972 Um, but no, it, so external hemorrhoids are probably the most common type of hemorrhoids I see in the emerge. 383 00:25:57,128.2014972 --> 00:26:00,518.2014972 And to get back to the reason it's 'cause they, like, they are a giant pain in the ass. 384 00:26:00,518.2014972 --> 00:26:02,888.2014972 They are so, so painful. 385 00:26:02,888.2014972 --> 00:26:09,608.2014972 And so, you know, there is often people have more pain before they may have bleeding, um, sometimes with, with this. 386 00:26:09,638.2014972 --> 00:26:16,208.2014972 Um, and so, you know what I see, uh, when, when patients are coming with external hemorrhoids, um, there are these little kind of. 387 00:26:17,363.2014972 --> 00:26:21,443.2014972 pocketing kind of, you know, bulging things of tissue usually. 388 00:26:21,443.2014972 --> 00:26:21,713.2014972 Right. 389 00:26:21,713.2014972 --> 00:26:29,333.2014972 Again, within kind of that, the, you know, the, the, your anus itself, uh, the anal verge, um, and they're extremely tender. 390 00:26:29,333.2014972 --> 00:26:35,98.2014972 Like even sometimes just like kind of spreading the butt cheeks, if you will, to try to get a view of it can cause enough kind of that that's. 391 00:26:35,773.2014972 --> 00:26:36,643.2014972 Quite painful. 392 00:26:36,913.2014972 --> 00:26:44,833.2014972 Um, and that's kind of usually what what we're seeing then I'd say most of them are maybe the size of like a marble or so, like they're, they don't have to be quite big. 393 00:26:45,163.2014972 --> 00:26:46,873.2014972 Um, but they're extremely painful. 394 00:26:47,143.2014972 --> 00:27:14,713.2014972 Um, you know, when you're coming into the emergency department, the one thing that we're thinking, is there something we can do about this? And maybe this is kind of advancing a little bit, James, what you're gonna talk about afterwards, but for us is trying to figure out is this like a, a fresh hemo, external hemorrhoid or is it a quote unquote thrombose external hemorrhoid? So is it, has it, is it, is it firm now? The blood in the, the blood inside is clotted and that allows us to do treatments like lysing it and cutting it open, which really a leaves kind of some of that pain. 395 00:27:15,73.2014972 --> 00:27:18,613.2014972 Um, but that's usually what I see from an external hemorrhoid perspective. 396 00:27:18,643.2014972 --> 00:27:20,953.2014972 Extremely painful and uncomfortable. 397 00:27:21,163.2014972 --> 00:27:24,283.2014972 Uh, and really these small like marble grape like sizes. 398 00:27:24,584.2014972 --> 00:27:25,4.2014972 Mm-hmm. 399 00:27:25,889.6946945 --> 00:27:26,129.6946945 Yeah. 400 00:27:26,224.6946945 --> 00:27:31,889.6946945 And, and Brody, before, uh, we kind of go anymore, I think it's really important to talk about how people present to you. 401 00:27:31,889.6946945 --> 00:27:43,589.6946945 Like why, why then what brings them into the emerge and says, okay, I've been, is the story, I've been dealing with this for six months and today's the day the pain got too bad, or is I was fine yesterday. 402 00:27:43,589.6946945 --> 00:27:44,579.6946945 I I'm not today. 403 00:27:44,579.6946945 --> 00:27:49,133.2014972 What, what does the story sound like? usually a fairly acute thing, like it might be over a day or two. 404 00:27:49,133.2014972 --> 00:27:53,633.2014972 It really progresses to the point now that they're having so much pain that they're actually trying to not have a bowel movement. 405 00:27:53,633.2014972 --> 00:27:56,363.2014972 Because again, you can imagine if you're, you know, when you're. 406 00:27:56,793.2014972 --> 00:28:00,393.2014972 Having a bowel movement, again, you're the anus opens up to allow all your poop to come out. 407 00:28:00,444.2014972 --> 00:28:00,864.2014972 Mm-hmm. 408 00:28:01,113.2014972 --> 00:28:10,83.2014972 that itself is so painful that sometimes they'll go be, they'll try to really avoid trying to have a um, having a bowel movement because of how painful it is. 409 00:28:10,83.2014972 --> 00:28:11,13.2014972 So that's usually it. 410 00:28:11,13.2014972 --> 00:28:14,133.2014972 I'd say it's more pain that that brings them in at the big ones. 411 00:28:14,133.2014972 --> 00:28:17,973.2014972 Or sometimes it's, Hey, I went to the bathroom and there was some blood in the toilet. 412 00:28:18,33.2014972 --> 00:28:19,499.6946945 There was blood when I Yeah. 413 00:28:19,533.2014972 --> 00:28:20,163.2014972 is new. 414 00:28:20,163.2014972 --> 00:28:22,199.2014972 And even that is quite scary Mm-hmm. 415 00:28:22,323.2014972 --> 00:28:23,13.2014972 a lot of people. 416 00:28:23,13.2014972 --> 00:28:29,283.2014972 And you know, this is going back to earlier episodes about like bleeding and blood and it's hard to know how much blood you're actually losing. 417 00:28:29,283.2014972 --> 00:28:31,383.2014972 That's especially true when it goes right into the toilet. 418 00:28:31,383.2014972 --> 00:28:36,513.2014972 So you can have like a small amount of blood, but once it hits the water in your toilet, your whole toilet bowl is red. 419 00:28:36,659.2014972 --> 00:28:37,79.2014972 Mm-hmm. 420 00:28:37,83.2014972 --> 00:28:39,33.2014972 so if you're the kind of person that. 421 00:28:39,338.2014972 --> 00:28:42,98.2014972 Turns around and looks at the, you know, looks at your poop before you flush. 422 00:28:42,308.2014972 --> 00:28:50,489.6946945 Um, that could be really scary, like Which I recommend doing Well, just to make sure seriously. 423 00:28:50,528.2014972 --> 00:28:51,398.2014972 not everyone does. 424 00:28:51,398.2014972 --> 00:28:55,834.6946945 I'm one of those that yeah, I have a look just to kinda see, does it, yeah. 425 00:28:55,988.2014972 --> 00:28:57,779.6946945 the Well, especially since having kids. 426 00:28:57,809.6946945 --> 00:28:57,989.6946945 Yeah. 427 00:28:58,148.2014972 --> 00:28:58,508.2014972 that's true. 428 00:28:58,508.2014972 --> 00:28:58,658.2014972 Yeah. 429 00:28:59,138.2014972 --> 00:28:59,918.2014972 There's no shame once you. 430 00:29:00,914.6946945 --> 00:29:02,84.6946945 Um, and Brody. 431 00:29:02,594.6946945 --> 00:29:11,564.6946945 Brody question, what? When people come to see you and the think this is important to talk about, is it kind of an embarrassed, I hear embarrassed story when they're talking to you. 432 00:29:11,564.6946945 --> 00:29:16,94.6946945 Are they open about it? Because I think it's important if people are embarrassed to be seen for these kinds of things. 433 00:29:16,523.2014972 --> 00:29:21,614.6946945 I think honestly for, for the ones they're, they're quite scared, right? And when I think of the Yeah. 434 00:29:21,833.2014972 --> 00:29:28,103.2014972 hemorrhoids and all of a sudden there's blood in the bowl, they're very afraid that it might be something cancer, right? Um, that would be up there. 435 00:29:28,163.2014972 --> 00:29:37,904.6946945 Uh, they're just worried like have they blood too much, that they're feeling dizzy, lightheaded, are they gonna need surgery? Um, and then for those that have the external hemorrhoids, they're in so much pain that I think that kind Yeah. 436 00:29:38,63.2014972 --> 00:29:40,574.6946945 mitigates a little bit of that, like not wanting to come Takes away. 437 00:29:40,793.2014972 --> 00:29:41,33.2014972 it. 438 00:29:41,303.2014972 --> 00:29:42,704.6946945 Um, Gotcha. 439 00:29:43,493.2014972 --> 00:29:47,229.6946945 there is definitely James, I'm guessing yeah, a bit more, you know, shy about I. 440 00:29:47,294.2014972 --> 00:29:48,879.2014972 pain is, you know, is. 441 00:29:50,549.2014972 --> 00:29:55,829.2014972 Something we see often with kind of external hemorrhoids that have just acutely thromboses, that kind of marble. 442 00:29:55,889.2014972 --> 00:30:00,929.2014972 Like you, you know, you can't even sit, you know, on your butt 'cause it's so painful. 443 00:30:01,49.2014972 --> 00:30:01,349.2014972 Right. 444 00:30:01,349.2014972 --> 00:30:02,909.2014972 So it's very hard to do anything. 445 00:30:02,909.2014972 --> 00:30:07,739.2014972 So I think at that point they're like, I'll just do something, do anything. 446 00:30:07,769.2014972 --> 00:30:09,589.6946945 Um, you know, I'm all I don't have a choice. 447 00:30:10,559.2014972 --> 00:30:15,509.2014972 Um, but there are other symptoms, uh, you know, like, like Brody says, you know, the bleeding. 448 00:30:16,109.2014972 --> 00:30:18,629.2014972 think that's another one that worries a lot of people. 449 00:30:18,629.2014972 --> 00:30:29,399.2014972 Maybe not to a point they, they'll go to the emergency room, but certainly to a point that they'll talk to their doctors and get referral to, you know, one of us or colorectal surgeons for, to get it checked out. 450 00:30:29,819.2014972 --> 00:30:34,49.2014972 Uh, and again, the bleeding part is very important because we talked about this. 451 00:30:34,79.2014972 --> 00:30:37,169.2014972 Uh, and then, you know, often especially. 452 00:30:37,634.2014972 --> 00:30:54,884.2014972 If you have family history of colorectal cancer or if you're of a certain age over 40, you know, especially nowadays with the increased incidence of colorectal cer, colorectal, uh, cancer in younger population, you know, something that you definitely should be checked out and, and receive investigations for. 453 00:30:56,159.2014972 --> 00:31:04,709.2014972 Uh, you know, quite often, you know, it's because of the internal hemorrhoids, uh, which is, uh, a relief to a lot of people. 454 00:31:04,709.2014972 --> 00:31:09,809.2014972 But it's something that, you know, uh, you know, people will have to work on to improve on. 455 00:31:09,929.2014972 --> 00:31:14,369.2014972 'cause the hemorrhoids can get bigger and can cause, you know, issues down the road. 456 00:31:15,509.2014972 --> 00:31:17,939.2014972 and then there's the lump or the bulge. 457 00:31:18,149.2014972 --> 00:31:30,509.2014972 So as the internal hemorrhoids get bigger, they tend to occupy the space more and more to, and then to a point that they prolapse down into, you know, through the, an, uh, anal, uh, uh, anal verge. 458 00:31:30,509.2014972 --> 00:31:37,859.2014972 And then you could either see, like, feel, and see them, uh, at the level of the, you know, anal sphincter or anal verge. 459 00:31:38,259.2014972 --> 00:31:43,509.2014972 So those are kind of the usual symptoms that patients will come with. 460 00:31:43,929.2014972 --> 00:31:50,379.2014972 Uh, there are other things like some itching and irritation around that area, which is quite common when you have kind of the anal pathology. 461 00:31:50,379.2014972 --> 00:31:53,19.2014972 It's just the seepage of the, the mucus coming through. 462 00:31:53,379.2014972 --> 00:32:00,249.2014972 Uh, or there could be some mucus discharge or, or, you know, or some of the, some of the feces just coming through as well. 463 00:32:00,249.2014972 --> 00:32:04,949.2014972 So those are kind of the symptoms that, that, will prompt, uh, patients to come in. 464 00:32:04,949.2014972 --> 00:32:06,539.2014972 So if you're having these symptoms. 465 00:32:07,584.2014972 --> 00:32:16,404.2014972 very important for you to be examined, you know, show your butt to, well, not to anyone, but to medical professionals with the, the right qualifications. 466 00:32:16,469.2014972 --> 00:32:18,9.6946945 Not to, Ask. 467 00:32:18,9.6946945 --> 00:32:19,419.6946945 Ask for a license, please. 468 00:32:19,419.6946945 --> 00:32:19,539.6946945 Yeah. 469 00:32:19,794.2014972 --> 00:32:21,954.2014972 Please verify the license before you do that. 470 00:32:22,344.2014972 --> 00:32:27,684.2014972 Uh, but it's very important because you wanna make sure that it's, you know, it's, yes. 471 00:32:27,684.2014972 --> 00:32:36,114.2014972 I mean, first if it's hemorrhoids, they're in effective treatments, and second, uh, to make sure it's not something more sinister like, you know, colorectal cancer. 472 00:32:37,684.6946945 --> 00:32:37,904.6946945 Yep. 473 00:32:38,364.6946945 --> 00:32:40,779.6946945 And, and just to really. 474 00:32:41,199.6946945 --> 00:32:42,759.6946945 Um, clarify it. 475 00:32:42,759.6946945 --> 00:32:50,229.6946945 Who should be seeing the doctor, and I'm guessing the family doctor is probably the frontline outside of the kind of emerge visits and, and the more serious stuff. 476 00:32:50,649.6946945 --> 00:32:55,493.2014972 So when should you see a doctor? Anytime you have bleeding. 477 00:32:55,613.2014972 --> 00:32:56,63.2014972 Yeah. 478 00:32:56,93.2014972 --> 00:32:57,233.2014972 Anytime you have any of those symptoms. 479 00:32:57,233.2014972 --> 00:32:57,533.2014972 Right. 480 00:32:57,533.2014972 --> 00:33:05,783.2014972 And I, think James, to your point with like the instant the, the rising incident of colorectal cancer, even in younger people, you know, we're not screening till later on that we're seeing a lot of these cases. 481 00:33:05,783.2014972 --> 00:33:09,533.2014972 Sometimes any of those things I think is super reasonable to, to go and to be seen. 482 00:33:09,593.2014972 --> 00:33:09,893.2014972 Yeah. 483 00:33:10,344.2014972 --> 00:33:20,78.7082999 I was gonna say, um, maybe quickly, like if they are going to see you James, or see a doctor in clinic, do you want to, do you wanna talk quickly about what's gonna happen in there? I, I think, yeah, thank you. 484 00:33:20,78.7082999 --> 00:33:21,698.7082999 Thank you for, for reminding me, Josh. 485 00:33:21,698.7082999 --> 00:33:24,114.2014972 So I think it's, You're very welcome James. 486 00:33:24,578.7082999 --> 00:33:25,988.7082999 I think it's very important to. 487 00:33:26,873.7082999 --> 00:33:46,553.7082999 kind of explain, set the scene for a lot of the listeners who may be suffering in silent, but really afraid, what's gonna happen to them when they go see a colorectal surgeon or GI doc, uh, who does these anal pathology? Um, so, you know, it's gonna start off with, you know, having conversations about your history. 488 00:33:46,613.7082999 --> 00:33:55,403.7082999 And then, you know, the part that we're worried about the most is the physical examination, right? So the physical examination will involve, uh, perianal examination. 489 00:33:55,403.7082999 --> 00:34:04,343.7082999 So examining your anus, and I think there's a lot of shame, uh, and, you know, embarrassment or fear about that. 490 00:34:04,793.7082999 --> 00:34:21,923.7082999 Um, maybe, you know, it might be that some patients will feel that they're being judged, uh, uh, but really for, for a lot of us, uh, the, the physicians, you know, we do these perianal examinations a lot. 491 00:34:22,283.7082999 --> 00:34:32,633.7082999 Uh, like thousands and thousands of times that, and, you know, really it's not something that, that we will take a mental note of or, or think about a lot. 492 00:34:32,993.7082999 --> 00:34:38,273.7082999 We're just really interested to understand whether there's any, any perianal pathology that we could treat. 493 00:34:38,753.7082999 --> 00:34:44,483.7082999 Uh, so don't feel like, you know, the doctors are judging, you know, how your butt looks. 494 00:34:44,573.7082999 --> 00:34:45,563.7082999 Uh, we don't care. 495 00:34:45,837.7082999 --> 00:34:46,127.7082999 Yeah. 496 00:34:46,913.7082999 --> 00:34:48,767.7082999 only Yeah, there's a Yeah. 497 00:34:48,863.7082999 --> 00:34:53,522.7082999 not, so, There's no way to I, the number of butts seen that. 498 00:34:53,522.7082999 --> 00:34:54,334.2014972 I feel like yeah. 499 00:34:54,362.7082999 --> 00:34:58,742.7082999 like, even of our medical career, we've seen more butts than there are treason for us. 500 00:34:58,742.7082999 --> 00:35:00,739.2014972 Like there is, it's very hard to, Yeah. 501 00:35:00,743.7082999 --> 00:35:03,473.7082999 well, I'm sure you do a lot of digital rectal examination. 502 00:35:03,863.7082999 --> 00:35:11,148.7082999 Uh, it would be very abnormal for me to go, you know, a single emerge shift without seeing multiple, multiple buts Mm-hmm. 503 00:35:11,394.2014972 --> 00:35:11,754.2014972 Yeah. 504 00:35:11,754.2014972 --> 00:35:18,654.2014972 And, to your and it's really, it, it's, it's interesting 'cause we know you, you as a patient are, this is the one time this is happening to you. 505 00:35:18,654.2014972 --> 00:35:19,974.2014972 So it's a huge deal. 506 00:35:20,244.2014972 --> 00:35:25,884.2014972 And us as doctors, like when we become patients, we're all nervous about this stuff too, even though we see it every day. 507 00:35:26,154.2014972 --> 00:35:29,4.2014972 So it's completely normal to, it's, in like that. 508 00:35:29,438.7082999 --> 00:35:47,288.7082999 I certainly understand, you know, where does fear and embarrassment come from? Like, but you know, I, I think the benefit of being seen trumps, you know, that little bit of embarrassment that you may have, um, and, and you know, just to set the scene about the examination table. 509 00:35:47,618.7082999 --> 00:36:01,448.7082999 Sometimes it'll be just regular exam table and they'll ask you to do kind of, you know, a lay on your side and kind of tuck your, uh, legs in to be able to expose the, the anus better. 510 00:36:01,748.7082999 --> 00:36:04,328.7082999 But they're also in, especially in colorectal. 511 00:36:04,723.7082999 --> 00:36:24,673.7082999 Uh, clinics, uh, they're the specialized chairs where you're kind of sitting with on your, on your knees and then kind of draped, you know, your, your body forward so that it's a little bit easier for, you know, more ergonomic for you to, show the butt. 512 00:36:25,663.7082999 --> 00:36:36,73.7082999 or it could be that, you know, they have, uh, the stir ups, so you're gonna be on your back and then your legs on the stir ups, like, you know, if you will, in gynecology. 513 00:36:36,433.7082999 --> 00:36:44,559.2014972 Um, uh, so those are kind of the three position in which you may be examined? it's, list listeners. 514 00:36:44,589.2014972 --> 00:36:52,179.2014972 Listeners, you can't see this, but James is giving us demonstrations on the camera of what the positions are and it's, it's quite entertaining. 515 00:36:52,389.2014972 --> 00:36:52,449.2014972 Yeah. 516 00:36:52,453.7082999 --> 00:36:55,242.7082999 in our yoga poses that he just created. 517 00:36:56,173.7082999 --> 00:36:57,339.2014972 That's Yeah. 518 00:36:57,339.2014972 --> 00:36:59,499.2014972 Really the Hemorrhoidal yoga poach. 519 00:36:59,903.7082999 --> 00:37:05,33.7082999 Uh, so it, it usually starts with the visual examination inspection of the, the anus. 520 00:37:05,333.7082999 --> 00:37:14,633.7082999 Uh, and then oftentimes the doctors will talk to you because we know that you are anxious, uh, you know, and go through what the steps are. 521 00:37:14,993.7082999 --> 00:37:25,313.7082999 And oftentimes it does involve, uh, a finger in the butt examination, the digital rectal examination, and oftentimes it involves a anal scope. 522 00:37:25,403.7082999 --> 00:37:48,83.7082999 So these are small kind of speculum or small kind of scope that goes into that anal canal with the light so that it allows us to examine the mu, the or the lining of the, the anal canal so that we could see whether there are any internal hemorrhoids and if they are, whether they're bleeding and what size. 523 00:37:48,983.7082999 --> 00:37:54,593.7082999 and also, um, uh, it just helps us to visualize, uh, the pathology really well. 524 00:37:54,593.7082999 --> 00:37:57,353.7082999 So, and when we do that, you know. 525 00:37:58,223.7082999 --> 00:38:01,523.7082999 Lots of lubricant to, you know, minimize trauma. 526 00:38:02,3.7082999 --> 00:38:09,623.7082999 Uh, and it's gonna be a little cold because oftentimes it's either plastic or, metal, uh, uh, instruments. 527 00:38:09,683.7082999 --> 00:38:17,273.7082999 Um, so that's something that, you know, you may expect really it should take not more than 10 minutes. 528 00:38:17,603.7082999 --> 00:38:24,713.7082999 So, uh, you know, I want to kind of lay the fear around being seen, uh, for, for this. 529 00:38:26,237.7082999 --> 00:38:37,74.2014972 James, when you're putting the an aScope in, often is there a fart that sneaks out? Again, just to normalize it Yeah, again, if Very, very appropriate. 530 00:38:37,247.7082999 --> 00:38:57,324.2014972 you're now opening the cushions, Well, I mean, so, so that's very interesting because it's no longer kind of fart because there's no like sphincter, it's all spread out, Hmm there isn't that I, you know, sound that comes through tight, uh, anal sphincter, uh, you know, Yeah. 531 00:38:57,488.7082999 --> 00:38:58,508.7082999 kind of all spread out. 532 00:38:58,508.7082999 --> 00:39:01,958.7082999 So it's more of the, just the gas that just comes out. 533 00:39:01,958.7082999 --> 00:39:04,832.7082999 So if uh, passing wind. 534 00:39:04,958.7082999 --> 00:39:07,119.2014972 that's, there you go. 535 00:39:07,274.2014972 --> 00:39:10,539.2014972 I, I was, I was gonna say temporary fan, but Yeah. 536 00:39:10,747.7082999 --> 00:39:11,37.7082999 yeah. 537 00:39:11,138.7082999 --> 00:39:23,18.7082999 would say if you're providers and maybe you're more of a junior trainees, I don't recommend putting your entire face too close and recommend wearing, Hmm, eye shields, uh, mask. 538 00:39:23,387.7082999 --> 00:39:23,807.7082999 Mm-hmm. 539 00:39:24,38.7082999 --> 00:39:26,888.7082999 so don't, don't do it, uh, without much protection. 540 00:39:27,38.7082999 --> 00:39:28,794.2014972 And don't put your eye Brody. 541 00:39:28,808.7082999 --> 00:39:28,988.7082999 there. 542 00:39:29,912.7082999 --> 00:39:30,212.7082999 Yeah. 543 00:39:30,494.2014972 --> 00:39:30,844.2014972 Brody. 544 00:39:30,884.2014972 --> 00:39:35,679.2014972 I, I think that was the best question of the podcast, and I'm, I'm really proud of you for doing that. 545 00:39:35,709.2014972 --> 00:39:37,269.2014972 That was a great question. 546 00:39:37,322.7082999 --> 00:39:39,842.7082999 I'm like, I Yep, how you don't, I don't know how you don't fart. 547 00:39:40,209.2014972 --> 00:39:41,289.2014972 yep, at that yep. 548 00:39:41,559.2014972 --> 00:39:41,589.2014972 I. 549 00:39:41,693.7082999 --> 00:39:43,772.7082999 Except no mechanisms to keep it in anymore. 550 00:39:43,772.7082999 --> 00:39:44,582.7082999 You just can't be polite. 551 00:39:44,633.7082999 --> 00:39:47,183.7082999 passively just passes the gas. 552 00:39:47,252.7082999 --> 00:39:47,642.7082999 Yeah. 553 00:39:48,92.7082999 --> 00:39:54,92.7082999 It just becomes, with the one, with the room, just no, shut. 554 00:39:54,383.7082999 --> 00:39:55,703.7082999 it's completely normal. 555 00:39:58,73.7082999 --> 00:39:58,853.7082999 Completely normal. 556 00:39:59,603.7082999 --> 00:39:59,783.7082999 Yeah. 557 00:39:59,783.7082999 --> 00:40:04,823.7082999 So, uh, that's what's to be expected when you're being seen. 558 00:40:04,943.7082999 --> 00:40:11,237.7082999 And then let's say you have, let's say, internal hemorrhoids, so let's say, one to three, right? yeah. 559 00:40:11,483.7082999 --> 00:40:31,643.7082999 the more of the milder ones, you know, the, the real cornerstone of, of treatment is lifestyle and it's really about, addressing the root causes, which tend to be in North America, uh, that we just. 560 00:40:32,258.7082999 --> 00:40:34,178.7082999 Don't eat enough dietary fiber. 561 00:40:34,228.7082999 --> 00:40:38,698.7082999 Sometimes we don't drink enough water and we're spending too much time on the toilet. 562 00:40:39,448.7082999 --> 00:40:44,788.7082999 these are all kind of contemporary uh, that we have. 563 00:40:44,908.7082999 --> 00:40:47,428.7082999 So let's break down like, you know, all of them. 564 00:40:47,428.7082999 --> 00:41:14,188.7082999 So, fiber, um, studies have shown that, you know, less than like 5% of Americans consume adequate amount of fiber and adequate amount of fiber from like 25 grams to 30 grams a day, depending on your size and everything, oftentimes they come from, you know, leafy vegetables, fruits, um, know, the vegetables with stems, the cellulose and those things. 565 00:41:14,548.7082999 --> 00:41:20,638.7082999 Um, it's very hard to consume all of that from just diet only. 566 00:41:20,998.7082999 --> 00:41:23,788.7082999 Um, especially in, in our. 567 00:41:24,403.7082999 --> 00:41:24,913.7082999 You know, right. 568 00:41:24,973.7082999 --> 00:41:26,233.7082999 North American diet. 569 00:41:26,623.7082999 --> 00:41:33,493.7082999 Uh, so I think, you know, for most of us, it's important to supplement with some sort of supplemental, uh, fibers. 570 00:41:33,493.7082999 --> 00:41:42,493.7082999 So those include, cilium husk or, um, uh, some, some brand names like Metamucil and things like that. 571 00:41:44,519.2014972 --> 00:42:03,449.2014972 And, uh, I think just 'cause I, I don't, when we say 25 grams of fiber, and I don't know this either, I have to look it up, like things like half an avocado come up or, um, one tablespoon of chia seeds or two tablespoons of nuts or things like that. 572 00:42:03,449.2014972 --> 00:42:05,459.2014972 So there's, you can just look it up, obviously. 573 00:42:05,759.2014972 --> 00:42:08,789.2014972 Um, so not, not, it's not a ton, like it's doable. 574 00:42:09,148.7082999 --> 00:42:27,898.7082999 I, I think the easiest way to consume that amount of fiber, this is actually, I'm gonna give a credit to Sammy Chatty at the Toronto General Hospital who taught me this, uh, is the, the brand cereal, the brand buds, those are the, the purple box. 575 00:42:27,958.7082999 --> 00:42:30,958.7082999 They look like dog food tastes like crap. 576 00:42:31,194.2014972 --> 00:42:31,314.2014972 Hmm. 577 00:42:31,522.7082999 --> 00:42:31,882.7082999 food. 578 00:42:32,519.2014972 --> 00:42:33,59.2014972 Hmm. 579 00:42:33,238.7082999 --> 00:42:34,349.2014972 Uh, the chains. 580 00:42:34,349.2014972 --> 00:42:35,189.2014972 Sell it, buddy. 581 00:42:35,873.7082999 --> 00:42:38,938.7082999 Uh, those contain the most amount of dietary fiber. 582 00:42:39,238.7082999 --> 00:42:46,468.7082999 And when you look at the, the nutritional content, uh, I think like half a cup will give you something like 20 grams of fiber. 583 00:42:47,518.7082999 --> 00:42:54,448.7082999 but most of, and when you're doing that, and I, I recommend that you do that if you're not getting enough fiber and if you're constipated. 584 00:42:54,868.7082999 --> 00:42:59,518.7082999 Uh, but when you do that, don't start at like full cup or half a cup. 585 00:42:59,668.7082999 --> 00:43:00,658.7082999 Start at like. 586 00:43:01,273.7082999 --> 00:43:07,444.2014972 quarter cup and do it for a week, and then go to the half a cup, and then the, uh, hmm. 587 00:43:07,633.7082999 --> 00:43:08,83.7082999 quarters. 588 00:43:08,353.7082999 --> 00:43:11,623.7082999 Because if you start at high level, you're gonna get really bloated. 589 00:43:11,653.7082999 --> 00:43:15,253.7082999 'cause your GI system's not used to having this much of fiber. 590 00:43:15,253.7082999 --> 00:43:18,133.7082999 So you, you know, you'll feel very much bloated. 591 00:43:18,223.7082999 --> 00:43:22,393.7082999 So your body needs some time to adjust to this amount of fiber. 592 00:43:22,393.7082999 --> 00:43:25,973.7082999 So just kind of go incremental level, Okay. 593 00:43:26,13.2151027 --> 00:43:26,988.7082999 take the fiber So. 594 00:43:27,858.7082999 --> 00:43:33,948.7082999 So I'm hearing if I, uh, didn't do well in my fiber for the last four days, I should not try to make it all up in one day. 595 00:43:35,103.2151027 --> 00:43:37,452.2151027 no, I, Let's have a giant explosive poop. 596 00:43:38,673.2151027 --> 00:43:38,823.2151027 Yeah. 597 00:43:38,823.2151027 --> 00:43:40,368.7082999 You, you'd be very Uh, Got it. 598 00:43:40,563.2151027 --> 00:43:43,458.7082999 Uh, so I've made, I've made some big mistakes, guys. 599 00:43:43,893.2151027 --> 00:43:48,33.2151027 yeah, we definitely don't recommend it and definitely don't recommend following Josh after he poops. 600 00:43:50,202.2151027 --> 00:43:55,362.2151027 it was also, I think, our first official, uh, commercial in ad, not sponsored, but it was also terrible. 601 00:43:56,202.2151027 --> 00:44:00,372.2151027 Fiber, zero looks, gross screws, but it'll help you poop. 602 00:44:00,372.2151027 --> 00:44:02,763.2151027 It's like the buckleys of like that's right. 603 00:44:02,802.2151027 --> 00:44:04,752.2151027 butt, you know, like it's. 604 00:44:05,643.2151027 --> 00:44:07,38.7082999 Uh, I love it. 605 00:44:07,173.2151027 --> 00:44:08,613.2151027 other, the other part is hydration. 606 00:44:08,613.2151027 --> 00:44:16,473.2151027 So, you know, if you're really dry, then your GI tract will reabsorb more of the water from the diet. 607 00:44:16,623.2151027 --> 00:44:19,533.2151027 So, uh, it's important for you to be well hydrated. 608 00:44:19,593.2151027 --> 00:44:24,513.2151027 Recommend like eight glasses of water as Brody's drinking water right now, you know, to keep his poop soft. 609 00:44:24,993.2151027 --> 00:44:35,583.2151027 Uh, and, and I think the most important, and this is really a contemporary health problem, is just the, you know, good bowel habits. 610 00:44:35,583.2151027 --> 00:44:39,273.2151027 So what I mean by that is spend more than five minutes on the toilet. 611 00:44:39,948.2151027 --> 00:44:43,998.2151027 To go, you should try not to strain that much. 612 00:44:44,388.2151027 --> 00:44:48,228.2151027 You know, that's hard If you have really hard stool, that's hard. 613 00:44:48,228.2151027 --> 00:44:50,388.2151027 If you don't have enough fiber or water. 614 00:44:50,718.2151027 --> 00:44:57,318.2151027 Uh, but you know, I I it's really important that you don't watch like Netflix on the toilet. 615 00:44:57,708.2151027 --> 00:44:58,908.2151027 Finish the whole episode. 616 00:44:59,598.2151027 --> 00:45:02,562.2151027 That'd be, I think this is the to knock. 617 00:45:03,42.2151027 --> 00:45:09,288.2151027 That is Yeah, time and like that this is the, you're like, yo, You're hiding there. 618 00:45:09,912.2151027 --> 00:45:13,878.7082999 half my day I'm doing emails, it's the only solitude we get. 619 00:45:13,878.7082999 --> 00:45:15,798.7082999 James, don't take this away from us. 620 00:45:16,698.2151027 --> 00:45:16,953.2151027 Yeah. 621 00:45:16,953.2151027 --> 00:45:28,398.2151027 I mean, you know, I mean, you guys are all adults so you can make your own decisions, but, you know, do you get the happy time versus hemorrhoids? Uh, you know, it's, there's always pros and cons. 622 00:45:29,172.2151027 --> 00:45:29,442.2151027 right. 623 00:45:29,442.2151027 --> 00:45:29,922.2151027 All right. 624 00:45:30,282.2151027 --> 00:45:30,852.2151027 Consider it. 625 00:45:31,308.2151027 --> 00:45:31,458.2151027 Yeah. 626 00:45:31,458.2151027 --> 00:45:36,708.2151027 So those are the, the preventative measures, which are really the core important ones. 627 00:45:37,188.2151027 --> 00:46:00,618.2151027 Uh, but when you do have hemorrhoids, how do you, you know, keep it clean and how do you help swelling reduce? There's, uh, you could really, you know, we call it sits bath, but, so there are specific, um, uh, kind of bucket that allow you to put some water, uh, and sit on it. 628 00:46:00,948.2151027 --> 00:46:09,768.2151027 Um, I think, you know, if you were pregnant before, you probably receive something similar after you deliver a child, like just a little plastic bucket kind of thing. 629 00:46:09,768.2151027 --> 00:46:17,718.2151027 So, but really you could just do it in, in your, um, in your bathroom, like in, in your bath, put some water. 630 00:46:18,108.2151027 --> 00:46:20,778.2151027 Uh, I don't recommend putting any salt or anything like that. 631 00:46:21,48.2151027 --> 00:46:21,538.2151027 Uh, just. 632 00:46:22,443.2151027 --> 00:46:25,218.7082999 Regular water and just sit there Ouch. 633 00:46:25,293.2151027 --> 00:46:25,953.2151027 a little bit. 634 00:46:26,343.2151027 --> 00:46:30,963.2151027 Uh, it just to help, you know, uh, with the, the swelling going down. 635 00:46:30,963.2151027 --> 00:46:31,253.2151027 Okay. 636 00:46:31,458.2151027 --> 00:46:39,253.2151027 And then maybe kind of get into the more, uh, significant treatments, the more interventional treatments, things like that. 637 00:46:39,257.7219054 --> 00:46:40,733.2151027 internal Medications. 638 00:46:41,837.7219054 --> 00:46:55,517.7219054 uh, particularly large, like grade three or four, or they're internal hemorrhoids that bleed they continue to bleed, then there are some office space procedures that can be done. 639 00:46:55,907.7219054 --> 00:47:10,517.7219054 So if we identify those hemorrhoids that we could place a rubber band around that hemorrhoids, uh, and over time that will constrict the blood vessels there and then it will. 640 00:47:10,922.7219054 --> 00:47:17,72.7219054 It will basically dry up that tissue,, and that's an effective way of controlling that hemorrhoidal tissues. 641 00:47:17,942.7219054 --> 00:47:27,242.7219054 we could do that because it's above that dentate line where we talked about the innervation or nervous system, pain, isn't specific to sensory, so you don't really feel it. 642 00:47:27,242.7219054 --> 00:47:30,992.7219054 So you shouldn't be feeling pain after this tight rubber bend goes around it. 643 00:47:31,412.7219054 --> 00:47:38,282.7219054 It's a quick five, 10 minute procedure that's done in the office setting, uh, with the endoscope. 644 00:47:38,552.7219054 --> 00:47:41,871.7219054 Uh, and you don't need sedation because there's really Right. 645 00:47:42,458.2151027 --> 00:47:42,878.2151027 no pain. 646 00:47:42,932.7219054 --> 00:47:43,832.7219054 that's expected from this. 647 00:47:45,618.2151027 --> 00:47:57,978.2151027 Do you know what I love about medicine guys? We have things like robotic surgery and stem cell research and transplants, and then we have rubber bands like it is, our lives are incredible. 648 00:47:57,978.2151027 --> 00:47:58,848.2151027 It is so funny. 649 00:47:59,57.7219054 --> 00:48:04,924.2151027 We started, uh, we got a kid, another version of operation, like the kids game, and now it's like a whole other yeah. 650 00:48:05,27.7219054 --> 00:48:07,238.7219054 rubber band now, and just, go. 651 00:48:07,844.2151027 --> 00:48:08,504.2151027 Oh, yeah. 652 00:48:09,802.7219054 --> 00:48:14,267.7219054 I'm assuming the band Then once the hemorrhoid comes out, the band, you just poop the band out with it. 653 00:48:15,77.7219054 --> 00:48:16,457.7219054 band doesn't stay latched thereafter. 654 00:48:16,457.7219054 --> 00:48:18,407.7219054 It's just once whatever's holding, it comes out too. 655 00:48:18,578.7219054 --> 00:48:19,118.7219054 goes away. 656 00:48:19,187.7219054 --> 00:48:19,197.7219054 yeah. 657 00:48:19,628.7219054 --> 00:48:22,958.7219054 And, uh, I don't recommend bringing that back to the doctor that put it in. 658 00:48:23,48.7219054 --> 00:48:24,519.2151027 Uh, Yeah. 659 00:48:24,527.7219054 --> 00:48:26,297.7219054 need to Or, or, reuse them. 660 00:48:26,529.2151027 --> 00:48:26,949.2151027 yeah. 661 00:48:27,128.7219054 --> 00:48:28,719.2151027 We don't, we, we tend not Yeah. 662 00:48:28,847.7219054 --> 00:48:29,57.7219054 good. 663 00:48:29,79.2151027 --> 00:48:30,699.2151027 And don't, and don't use it. 664 00:48:30,699.2151027 --> 00:48:31,719.2151027 Don't use it in the kitchen. 665 00:48:31,719.2151027 --> 00:48:33,69.2151027 Don't, don't, don't reuse. 666 00:48:33,69.2151027 --> 00:48:34,29.2151027 Just let it go. 667 00:48:35,94.2151027 --> 00:48:35,384.2151027 Yeah. 668 00:48:36,98.7219054 --> 00:48:45,338.7219054 It's a very small band, so hopefully Okay, so that's the, the band ligation and then the surgery. 669 00:48:45,338.7219054 --> 00:48:54,8.7219054 So, you know, inevitably, you know, if you Google about hemorrhoids or if you talk to some friends, you know, they've undergone surgical procedures. 670 00:48:54,218.7219054 --> 00:48:59,528.7219054 That's to remove the hemorrhoidal tissue, uh, that is really reserved for. 671 00:49:00,458.7219054 --> 00:49:11,858.7219054 four or, uh, hemorrhoids that are so recurrent, uh, that keep coming back, or if there are, uh, multiple of them and it's very hard to manage. 672 00:49:12,248.7219054 --> 00:49:15,98.7219054 Uh, so those will be done under general anesthesia. 673 00:49:15,428.7219054 --> 00:49:18,128.7219054 Uh, the idea is to remove that hemorrhoidal tissue. 674 00:49:18,338.7219054 --> 00:49:40,268.7219054 There are many ways of doing this, so I'm not gonna get into the weeds of this, but it's either by, removing them with cautery or with stapler, um, but these are effective way of treating these, they're super painful as my mentor and, uh, former colleague Marcus Bernstein at St. 675 00:49:40,268.7219054 --> 00:49:44,108.7219054 Mike's used to say, this is the most painful surgery that patients could have. 676 00:49:44,418.7219054 --> 00:49:44,808.7219054 Wow. 677 00:49:44,844.7219054 --> 00:49:46,224.7219054 he does a lot of these surgery. 678 00:49:46,614.7219054 --> 00:49:47,544.7219054 Uh, so I trust them. 679 00:49:47,904.7219054 --> 00:49:54,804.7219054 Uh, This is why we don't recommend hemorrhoidal surgery for small hemorrhoids. 680 00:49:55,104.7219054 --> 00:49:58,524.7219054 We don't recommend hemorrhoidal surgery for the first time. 681 00:49:58,524.7219054 --> 00:50:00,834.7219054 Small, especially first time small hemorrhoids. 682 00:50:01,224.7219054 --> 00:50:09,654.7219054 You know, if you do have these small hemorrhoids and if the surgeon recommends surgery on that, you know, I would get a second opinion. 683 00:50:09,894.7219054 --> 00:50:11,635.2151027 Uh, it's extremely Hmm. 684 00:50:12,24.7219054 --> 00:50:12,654.7219054 the pain. 685 00:50:12,984.7219054 --> 00:50:20,275.2151027 Your life will be miserable for like four weeks, uh, because of the Like the recovery, not, not the surgery itself, just the the after the fact. 686 00:50:20,425.2151027 --> 00:50:20,665.2151027 Yeah. 687 00:50:20,784.7219054 --> 00:50:21,774.7219054 but the recovery. 688 00:50:21,984.7219054 --> 00:50:34,224.7219054 So, it, it's, you know, it certainly if you're recommended to have it and you have, you know, really big hemorrhoids, recurrent, uh, very problematic hemorrhoids, it's, you know, certainly effective treatment. 689 00:50:34,374.7219054 --> 00:50:37,974.7219054 Uh, and for those who have indications for them. 690 00:50:37,974.7219054 --> 00:50:38,184.7219054 Cool. 691 00:50:39,834.7219054 --> 00:50:41,814.7219054 And, um, I don't, I don't think we've talked about it yet. 692 00:50:41,814.7219054 --> 00:50:48,594.7219054 What about external hemorrhoids? What do we do for treatments? I'm guessing it's a bit more streamlined, a bit less, uh, less complicated. 693 00:50:48,648.2287081 --> 00:50:52,128.2287081 you as much or like, those are, those are again, what I see the most in the emerge. 694 00:50:52,128.2287081 --> 00:50:52,799.2287081 And Mm-hmm. 695 00:50:52,968.2287081 --> 00:50:55,488.2287081 me, it's a matter for whether they're like thrombo or not. 696 00:50:55,488.2287081 --> 00:51:01,68.2287081 So again, are they hard firm? Are they purple? Like, have the blood inside, Is there blood clot clotted. 697 00:51:01,218.2287081 --> 00:51:01,728.2287081 Yeah. 698 00:51:02,28.2287081 --> 00:51:07,758.2287081 Um, and if it is, then the treatment for that is it's, we would do, uh, like to, to to lance it. 699 00:51:07,758.2287081 --> 00:51:10,728.2287081 So to cut it, get the blood out, and then usually it'll shrink over time. 700 00:51:11,208.2287081 --> 00:51:13,128.2287081 Um, that's done with some, some. 701 00:51:13,518.2287081 --> 00:51:14,88.2287081 Anesthetic. 702 00:51:14,328.2287081 --> 00:51:18,48.2287081 Again, it can be painful, but done in the emergency department of the clinic type setting. 703 00:51:18,348.2287081 --> 00:51:25,128.2287081 Uh, and usually after that then the, once the, the, know, that that blood clot is out, the tissue is still enlarged. 704 00:51:25,128.2287081 --> 00:51:30,798.2287081 But over the next couple weeks, we'll kind of shrivel up, become like a bit of a skin take sort of thing in a few weeks, few months time. 705 00:51:31,68.2287081 --> 00:51:35,658.2287081 James, I don't know if that's kind of what you see or you, or you get a lot of those referred to your practice as well. 706 00:51:35,754.2287081 --> 00:51:42,924.2287081 so excision for these external hemorrhoids are often performed at a really acute level. 707 00:51:42,924.2287081 --> 00:51:48,24.2287081 So if these occurred acutely, acutely thrombosis, that's a window of opportunity there. 708 00:51:48,444.2287081 --> 00:51:56,364.2287081 Uh, if it's sub chronic or it's been there for a number of weeks, the idea is to that it will, you know, get better on its own. 709 00:51:57,144.2287081 --> 00:52:01,554.2287081 so we won't necessarily do excisional surgery for, for those ones. 710 00:52:01,554.2287081 --> 00:52:01,914.2287081 Yeah. 711 00:52:01,959.2287081 --> 00:52:08,694.2287081 And, and then maybe just to, to, to fi to finish on that sense, sometimes people come in and their external hemorrhoid is not thrombosis yet. 712 00:52:08,694.2287081 --> 00:52:15,924.2287081 And unfortunately then I like acutely, I actually don't have much to offer other than the dietary things and some pain medications to try to get them through it. 713 00:52:15,924.2287081 --> 00:52:22,494.2287081 It's kind of giving it a few more days until it does become, then you can kind of do that, uh, excision at that point in time. 714 00:52:23,725.7219054 --> 00:52:25,910.7219054 And, and a good old therapeutic communication. 715 00:52:26,630.7219054 --> 00:52:27,650.7219054 You reassure them. 716 00:52:27,650.7219054 --> 00:52:29,30.7219054 You tell 'em what's gonna happen. 717 00:52:29,30.7219054 --> 00:52:31,880.7219054 You, you give 'em the Brody charm and say, Hey, we got you. 718 00:52:31,975.7219054 --> 00:52:32,265.7219054 Yeah. 719 00:52:32,334.2287081 --> 00:52:34,475.2287081 do your best to try to have a poo Yeah. 720 00:52:34,619.2287081 --> 00:52:38,135.2287081 Yeah, bath, you know, bowel regimen. 721 00:52:38,419.2287081 --> 00:52:41,180.7219054 yeah, Uh, bring your phone into the washroom. 722 00:52:41,180.7219054 --> 00:52:41,570.7219054 Yeah. 723 00:52:41,825.2287081 --> 00:52:42,564.2287081 watch yeah. 724 00:52:44,105.2287081 --> 00:52:46,914.2287081 uh, on the And all the, all of the fiber cereal. 725 00:52:46,974.2287081 --> 00:52:48,234.2287081 Just take the whole box. 726 00:52:48,320.7219054 --> 00:52:48,560.7219054 Mm-hmm. 727 00:52:48,684.2287081 --> 00:52:49,584.2287081 James's device. 728 00:52:49,734.2287081 --> 00:52:53,870.7219054 Go At once, Just, full bloat. 729 00:52:54,449.2287081 --> 00:52:56,450.7219054 All right, James, I wanna Well listen. 730 00:52:56,450.7219054 --> 00:52:56,480.7219054 Oh. 731 00:52:56,699.2287081 --> 00:53:03,29.2287081 favorite segment of this podcast as of last episode of anyone listen to it, which is our myth busting segment. 732 00:53:03,29.2287081 --> 00:53:04,55.2287081 So, do it. 733 00:53:04,949.2287081 --> 00:53:07,979.2287081 any myths associated with hemorrhoids? Let's address 'em. 734 00:53:08,69.2287081 --> 00:53:08,609.2287081 Let's get to it. 735 00:53:09,335.2287081 --> 00:53:33,611.7219054 So the ones that I hear a lot from patients is like, you know, sitting on the cold surfaces, like, you know, should I always warm up my seats? Like, especially, you know, if you live in Northwest or Northeast, uh, when it's a little co cooler in the winter, uh, do they cause hemorrhoids? What do you guys think? Oh, no, I think, I think they would help, wouldn't it? Wouldn't it help feel better? A little, a little ice, a little, yeah. 736 00:53:33,866.2287081 --> 00:53:34,496.2287081 it's false. 737 00:53:34,496.2287081 --> 00:53:34,736.2287081 Yeah. 738 00:53:34,736.2287081 --> 00:53:38,36.2287081 They don't cause hemorrhoids and hemorrhoids as we talked about. 739 00:53:38,66.2287081 --> 00:53:46,196.2287081 Really the root causes are, you know, constipation, straining, repeated trauma into the, those hemorrhoidal tissues. 740 00:53:47,216.2287081 --> 00:53:53,366.2287081 you know, Josh, to your point, you know, maybe it will help reduce the swelling a little bit possible. 741 00:53:54,176.2287081 --> 00:53:54,896.7219054 don't, Yep. 742 00:53:54,945.2287081 --> 00:53:55,785.2287081 of beans, find out. 743 00:53:55,796.2287081 --> 00:54:01,271.7219054 any randomized controlled trials on them, but Nope, we can, we can probably leave it with, it won't hurt. 744 00:54:01,406.2287081 --> 00:54:03,71.7219054 it won't hurt, it'll help. 745 00:54:03,221.7219054 --> 00:54:06,96.7219054 Yeah, but it yeah, the hemorrhoids, yeah. 746 00:54:06,116.2287081 --> 00:54:07,935.2287081 bust it, myth, Nice. 747 00:54:10,616.2287081 --> 00:54:12,6.7219054 Anything else that you guys Sure. 748 00:54:14,210.2287081 --> 00:54:16,846.7219054 What about, um, Um, what about spicy I. 749 00:54:17,750.2287081 --> 00:54:30,770.2287081 Like again, is there any like correlation with like, heat, pepper, pepper level, um, oh my God, what's the, the term for the hot sauce? How they're measured. 750 00:54:30,770.2287081 --> 00:54:31,640.2287081 Scoville units. 751 00:54:31,640.2287081 --> 00:54:34,121.7219054 Scoville units and uh, nice. 752 00:54:34,121.7219054 --> 00:54:34,601.7219054 Yeah. 753 00:54:34,751.7219054 --> 00:54:35,291.7219054 Nice. 754 00:54:35,390.2287081 --> 00:54:46,331.2287081 duration or, So, so not directly related in terms of consumption of spicy food and, you know, um, development of hemorrhoids per se. 755 00:54:46,451.2287081 --> 00:55:00,461.7219054 But if you do develop diarrhea or loose bowel movements or, you know, uh, ring a fire, if you will, after eating spicy food, It had to come up. 756 00:55:01,631.2287081 --> 00:55:10,841.2287081 you know, that, that would inevitably cause repeated trauma to your, anus, uh, and to the, uh, hemorrhoidal tissues. 757 00:55:10,871.2287081 --> 00:55:14,146.7219054 So that could in turn, I. 758 00:55:14,411.2287081 --> 00:55:17,381.2287081 develop, uh, engorgement of hemorrhoidal tissues. 759 00:55:17,381.2287081 --> 00:55:21,941.2287081 So may be some correlation, but not directly. 760 00:55:23,45.2287081 --> 00:55:24,176.7219054 And definitely not Cool. 761 00:55:24,755.2287081 --> 00:55:26,510.2287081 while you actively have hemorrhoids. 762 00:55:27,371.2287081 --> 00:55:31,31.2287081 And, and you are expected to have diarrhea after eating spicy food. 763 00:55:31,31.2287081 --> 00:55:32,846.7219054 Yeah, I definitely do not recommend Yeah. 764 00:55:35,6.7219054 --> 00:55:35,366.7219054 All right. 765 00:55:35,366.7219054 --> 00:55:44,726.7219054 The one, the one that I think everyone hears and talks about is only people of advanced age get hemorrhoids, and we won't go into a number here, but as a, as a general rule. 766 00:55:44,726.7219054 --> 00:55:46,151.2287081 Is that true? not true. 767 00:55:46,181.2287081 --> 00:56:00,371.2287081 But, hemorrhoids could occur across any age, but it's certainly true that, you know, uh, increasing age means there's more exposure for trauma in the anus. 768 00:56:00,521.2287081 --> 00:56:01,831.7219054 Um, Mm-hmm. 769 00:56:01,991.2287081 --> 00:56:08,831.2287081 about, you know, if you're constipated, heart stools and things like that, and constipation, prevalence increases with age as well. 770 00:56:08,831.2287081 --> 00:56:10,291.7219054 So there Mm-hmm. 771 00:56:10,301.2287081 --> 00:56:16,541.2287081 associations that are age related that are likely to be risk factors for you to develop hemorrhoids. 772 00:56:17,261.2287081 --> 00:56:19,331.2287081 So Yeah, but. 773 00:56:20,111.2287081 --> 00:56:26,471.2287081 There's some temporal associations or associations related to, uh, development of hemorrhoids. 774 00:56:27,221.7219054 --> 00:56:30,701.7219054 there's probably more, more prevalence as we get older. 775 00:56:31,451.7219054 --> 00:56:34,1.7219054 It can ha, it can happen at any age, but it's there. 776 00:56:34,601.7219054 --> 00:56:34,991.7219054 Okay. 777 00:56:35,215.2287081 --> 00:56:48,85.2287081 James, you know, I think, um, maybe talked, touched on it a little bit, but, um, they come back? Like, do, do hemorrhoids always come back? Is it something like you have it once, this is gonna be a lifelong Like what does that. 778 00:56:48,770.2287081 --> 00:56:49,576.7219054 What does that look like? I. 779 00:56:49,961.2287081 --> 00:56:50,261.2287081 yeah. 780 00:56:50,261.2287081 --> 00:57:00,41.2287081 So they, there's tendency for them to reoccur in your lifetime, and mostly because the root causes are not addressed. 781 00:57:00,311.2287081 --> 00:57:06,761.2287081 So, you know, what led you to have hemorrhoid the first time, which were constipation training. 782 00:57:07,766.2287081 --> 00:57:24,596.2287081 And let's say you adopted lifestyle modifications to help them, uh, reduce, but then, you know, you're looking, you have another child and you're looking for more solitude and you, you're, you're locking yourself in the toilet and watching Netflix, you know, heh is gonna come back. 783 00:57:24,656.2287081 --> 00:57:25,286.2287081 I'm sorry. 784 00:57:26,576.2287081 --> 00:57:29,781.7219054 So, uh, so pick a good show. 785 00:57:29,951.7219054 --> 00:57:30,741.7219054 Don't regret it. 786 00:57:31,135.2287081 --> 00:57:32,65.2287081 Make make it worth it. 787 00:57:32,966.2287081 --> 00:57:35,156.2287081 trade off, right? so yeah. 788 00:57:35,156.2287081 --> 00:57:39,866.2287081 So if you, if the root causes are well managed, then you know, the treatments are very effective. 789 00:57:39,866.2287081 --> 00:57:44,786.2287081 So really the pillar, the basic pillar of the treatment is a lifestyle modification. 790 00:57:46,76.2287081 --> 00:57:52,436.2287081 um, it's hard to, as we talked about it, lifestyle modification is hard to stick by them and adhere to them. 791 00:57:53,6.2287081 --> 00:57:57,386.2287081 Uh, so if there are deviations, uh, these things could come back. 792 00:57:57,386.2287081 --> 00:57:57,876.2287081 Awesome. 793 00:57:58,171.2287081 --> 00:57:59,941.2287081 Good myth busting segment, buddy. 794 00:58:00,510.7355108 --> 00:58:01,140.7355108 Bust it. 795 00:58:01,621.2287081 --> 00:58:03,661.2287081 Yeah, busted. 796 00:58:03,661.2287081 --> 00:58:05,71.2287081 Confirmed a bit of both. 797 00:58:05,85.7355108 --> 00:58:05,625.7355108 Uh huh. 798 00:58:05,754.7355108 --> 00:58:06,54.7355108 All right. 799 00:58:06,54.7355108 --> 00:58:10,35.7355108 Should we wrap it up for listeners? A couple of take homes? Let's do it. 800 00:58:11,304.7355108 --> 00:58:11,694.7355108 All right. 801 00:58:12,384.7355108 --> 00:58:15,811.2287081 go first because I feel you haven't gone first in a while, so I'm gonna divot Oh, good one. 802 00:58:15,834.7355108 --> 00:58:16,771.2287081 right? Yeah. 803 00:58:17,124.7355108 --> 00:58:17,454.7355108 Okay. 804 00:58:17,724.7355108 --> 00:58:25,44.7355108 So my, my, my take home is don't beat up your butt, like lessen your anal trauma. 805 00:58:26,184.7355108 --> 00:58:27,234.7355108 Be kind to your butt. 806 00:58:29,304.7355108 --> 00:58:30,384.7355108 Talk to it nicely. 807 00:58:30,624.7355108 --> 00:58:31,614.7355108 Be gentle with it. 808 00:58:32,364.7355108 --> 00:58:36,294.7355108 Have your James, that, I, um, you appropriately. 809 00:58:36,294.7355108 --> 00:58:37,914.7355108 Don't waste it on reality TV shows. 810 00:58:38,385.7355108 --> 00:58:40,605.7355108 Yeah, I think that's a really good one. 811 00:58:41,25.7355108 --> 00:58:48,405.7355108 And I'm gonna, you know, bring up Marcus Bernstein again, who taught us to treat anus like cornea. 812 00:58:49,619.7355108 --> 00:58:52,411.2287081 Ooh, oh, I like that. 813 00:58:52,561.2287081 --> 00:58:53,551.2287081 Yeah. 814 00:58:53,805.7355108 --> 00:58:56,664.7355108 Don't rub it Yeah, You know, yeah. 815 00:58:56,865.7355108 --> 00:58:59,726.2287081 Very about what goes in there, you know? You, I. 816 00:58:59,925.7355108 --> 00:59:03,435.7355108 have one butthole to live with for the rest of your life. 817 00:59:04,104.7355108 --> 00:59:04,314.7355108 Wow. 818 00:59:04,396.2287081 --> 00:59:06,466.2287081 you have two corneas, so you should be even. 819 00:59:06,495.7355108 --> 00:59:06,735.7355108 go. 820 00:59:06,766.2287081 --> 00:59:07,786.2287081 Oh my gosh. 821 00:59:08,146.2287081 --> 00:59:08,686.2287081 Okay. 822 00:59:10,876.2287081 --> 00:59:11,326.2287081 Okay. 823 00:59:11,626.2287081 --> 00:59:12,556.2287081 I'm going second. 824 00:59:12,586.2287081 --> 00:59:15,646.2287081 'cause James, it's your pod podcast, so you get to finish this off. 825 00:59:15,886.2287081 --> 00:59:18,196.2287081 So I'm just going to stress the lifestyle things. 826 00:59:18,736.2287081 --> 00:59:22,96.2287081 Fiber water, fiber water, and then exercise and movement. 827 00:59:22,306.2287081 --> 00:59:26,236.2287081 Um, and honestly, the 25 grams of fiber a day, it's not so hard. 828 00:59:26,236.2287081 --> 00:59:28,456.2287081 And I'm saying that personally 'cause I suck at it. 829 00:59:28,486.2287081 --> 00:59:34,186.2287081 And now I'm going to actually just keep a little spoonful of nuts or something at the side and I'll, I'll take that and I'm good for the day. 830 00:59:34,635.7355108 --> 00:59:37,5.7355108 Something about spoonful of nuts that you know. 831 00:59:37,426.2287081 --> 00:59:38,266.2287081 It does sound. 832 00:59:39,136.2287081 --> 00:59:39,856.2287081 Yeah, yeah. 833 00:59:39,856.2287081 --> 00:59:40,786.2287081 No, I'm gonna stick with that. 834 00:59:40,816.2287081 --> 00:59:41,446.2287081 I'm gonna own it. 835 00:59:41,641.2287081 --> 00:59:41,931.2287081 Yeah. 836 00:59:41,955.7355108 --> 00:59:42,555.7355108 fair enough. 837 00:59:43,395.7355108 --> 00:59:49,65.7355108 So, for the internal hemorrhoids that are larger, that. 838 00:59:49,410.7355108 --> 00:59:53,940.7355108 Are very bleedy, uh, and they recur frequently that become big issues. 839 00:59:53,940.7355108 --> 01:00:01,410.7355108 There are effective office-based treatments like band ligations or for some select patients. 840 01:00:01,650.7355108 --> 01:00:05,610.7355108 Surgery for them are very effective, but quite painful recovery. 841 01:00:06,570.7355108 --> 01:00:11,640.7355108 so talk to colorectal surgeons who do this every day. 842 01:00:12,0.7355108 --> 01:00:16,680.7355108 You know, get your butts seen if you're having the symptoms of bleeding, bulge pain. 843 01:00:17,670.7355108 --> 01:00:20,100.7355108 Very important for your butts to be seen and examined. 844 01:00:21,939.7355108 --> 01:00:22,989.7355108 In the dark most of the day. 845 01:00:23,139.7355108 --> 01:00:26,926.2287081 Let them come, come to the light, but Come to the light. 846 01:00:27,616.2287081 --> 01:00:29,266.2287081 We have a lot of good slogans on this one. 847 01:00:30,16.2287081 --> 01:00:32,596.2287081 You can make some t-shirts and public service announcements. 848 01:00:32,610.7355108 --> 01:00:33,736.2287081 your butt It's catchy. 849 01:00:34,269.7355108 --> 01:00:35,326.2287081 get your butt Yeah. 850 01:00:35,619.7355108 --> 01:00:37,336.2287081 that, that's Let your butt into the light. 851 01:00:38,199.7355108 --> 01:00:38,679.7355108 slogan. 852 01:00:38,811.2287081 --> 01:00:39,101.2287081 Yeah. 853 01:00:39,219.7355108 --> 01:00:40,306.2287081 saying we've, Yeah. 854 01:00:40,479.7355108 --> 01:00:40,749.7355108 yeah. 855 01:00:40,980.7355108 --> 01:00:43,440.7355108 surgery, uh, colorectal, uh, cancer screening as well. 856 01:00:44,709.7355108 --> 01:00:45,9.7355108 Yeah. 857 01:00:45,166.2287081 --> 01:00:45,676.2287081 Absolutely. 858 01:00:46,119.7355108 --> 01:00:46,439.7355108 Yeah, yeah, yeah. 859 01:00:47,319.7355108 --> 01:00:49,650.7355108 James, thank Um, was Oh, Josh. 860 01:00:50,986.2287081 --> 01:00:52,186.2287081 I'm gonna say, I'm gonna do mine again. 861 01:00:52,186.2287081 --> 01:00:54,796.2287081 So, spoonful of Nuts is not in this, but. 862 01:00:56,679.7355108 --> 01:00:57,69.7355108 too late. 863 01:00:58,891.2287081 --> 01:01:01,801.2287081 It's, uh, now that we say it over and over, I'm like, we can't do this. 864 01:01:01,904.7355108 --> 01:01:05,319.7355108 How long have you been like, I've been like percolating there for the last like two minutes. 865 01:01:05,319.7355108 --> 01:01:08,109.7355108 He's like, I must get rid of the spoonful of nuts. 866 01:01:08,409.7355108 --> 01:01:08,679.7355108 Now. 867 01:01:08,679.7355108 --> 01:01:10,359.7355108 You've just like I will, it, man. 868 01:01:10,449.7355108 --> 01:01:13,891.2287081 Like it's, I I will, I will rarely take something out. 869 01:01:13,951.2287081 --> 01:01:15,121.2287081 I'm like, let's not do that. 870 01:01:15,121.2287081 --> 01:01:17,589.7355108 I, a like three minute clip of you just saying, A spoonful of nuts. 871 01:01:17,649.7355108 --> 01:01:19,861.2287081 A it's ful of nuts, spoonful nuts. 872 01:01:20,11.2287081 --> 01:01:29,740.7355108 There's some auto, some auto tuning, that's Danny Goes' second song collaborating so coming up after, after Happy hemorrhoids, spoonful of nuts. 873 01:01:30,550.7355108 --> 01:01:31,60.7355108 All right. 874 01:01:31,67.2287081 --> 01:01:31,587.2287081 I love it. 875 01:01:31,840.7355108 --> 01:01:34,60.7355108 kids music venture after all guys. 876 01:01:34,120.7355108 --> 01:01:34,420.7355108 Yeah. 877 01:01:34,591.7355108 --> 01:01:35,222.2287081 that's it. 878 01:01:35,912.2287081 --> 01:01:44,72.2287081 So I'll just say it, if you can edit this back, let's say, I'm just gonna have a, a spoonful of trail mix around me at all times. 879 01:01:44,741.7355108 --> 01:01:47,351.7355108 James, thank you so much for taking us on this journey. 880 01:01:47,621.7355108 --> 01:01:50,21.7355108 Um, I think really important again. 881 01:01:50,231.7355108 --> 01:01:50,531.7355108 Yeah. 882 01:01:50,651.7355108 --> 01:01:51,521.7355108 Third of people have 'em. 883 01:01:51,551.7355108 --> 01:01:51,971.7355108 It's great. 884 01:01:51,971.7355108 --> 01:01:56,441.7355108 Super common uh, yeah, I think we, yeah. 885 01:01:56,698.2287081 --> 01:01:57,178.2287081 underrated. 886 01:01:57,418.2287081 --> 01:01:59,98.2287081 I learned a ton from you, James and Brody. 887 01:01:59,98.2287081 --> 01:01:59,538.2287081 Thank you guys. 888 01:01:59,687.7355108 --> 01:01:59,867.7355108 Yeah. 889 01:01:59,867.7355108 --> 01:02:00,221.7355108 This boys. 890 01:02:00,221.7355108 --> 01:02:00,581.7355108 We'll see you soon. 891 01:02:01,877.7355108 --> 01:02:02,627.7355108 Take care guys.
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