August 12, 2025 • 29 mins
Dr. Sandeep Rao brings the borderland the latest information in healthcare, medicine and technology. He considers himself a hacker in the positive sense, using his intimate knowledge of the medical system to break down some of the barriers to accessing new medical technologies and information.
For more information call Dr. Rao's office at 915-500-4370 or email Rao@medicalhackers.com
Be the first to hear the show in News Radio KTSM-AM Saturdays at noon, an iHeart station.
For more information call Dr. Rao's office at 915-500-4370 or email Rao@medicalhackers.com
Be the first to hear the show in News Radio KTSM-AM Saturdays at noon, an iHeart station.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:05):
Good afternoon. It's another weekend here in the heart of
the dusty Chuahuan Desert in West Texas, and you're listening
to the Medical Hackers. However, you may be tuned in
this week and I'm your host, doctor Sandy Brow. I'm
here to bring the Borderland the latest information in healthcare, medicine,
and technology on the show. I consider myself a hacker,
(00:25):
a hacker the positive sense, a hacker using my intimate
knowledge of the medical system to help me break them
down some of the barriers to accessing new medical technologies
and current healthcare information. So right now in studious I
just got myself and got my producer Hamber with me.
Speaker 2 (00:42):
Oh La.
Speaker 1 (00:43):
Hopefully I might have other folks joined me, but we'll
see the weather. There's always an issue out there.
Speaker 3 (00:48):
Well, choose some random person on the street.
Speaker 1 (00:50):
Exactly, and anybody's welcome. We could do in the past.
I don't know if you've done this, Amber, I've done
this thing where I just did like a random thing
where anybody can just ask me a question. So I
had a few folks. I got like an undergrad at
UTAB who sat in and just started asking me random questions.
It was like a stump the doctor kind of a thing.
So I haven't done that. I haven't done that in
(01:11):
a while, and I don't want to get into it now.
But what I want to do is I want to
get into something that I got a lot of cases
of this in the past week in the hospital and
it's related to DVT deep vein thrombosis. So you have
arteries in your vein, in your blood supply, you got arteries,
(01:34):
you got veins. Arteries sends blood away from your heart.
Veins brings blood back towards your heart. Those of you
who might have seen varicose veins in your leg, they're
very big palpable vessels. That's those are your veins. Those
your theo's not your deep veins, but they're your superficial veins.
There's two sets of veins. That sends blood back to
(01:56):
your heart. So when the blood in your heart pumps
down to your feet eat as an example, it needs
to come back up centrally to the chest. So most
of it goes through the deep system, which is very
centrally located. It's like the main highway going back to
your chest. But then there's also this superficial system, meaning
it's very much at the periphery of your your leg.
(02:20):
Think of it almost like you got I ten. But
we also have these other little ways to get from
one side of town to the other side. It could
be you could puse maybe Montana or maybe even something bigger,
like slightly bigger, maybe like border highway right, if you're
if you if there's a.
Speaker 3 (02:36):
Blockage, Yeah, that's what happened to me today, exactly.
Speaker 1 (02:41):
So. So the the issue is that we sometimes have
clots form in the deep system, and so what is
the treatment for that is the question? And so most
of the time the treatment is what we call anticoagulation.
Put you on blood thinners, so that's just medication. I
(03:03):
put clot busting medication to just break down the that's
developed in your vessels. And that's usually the best thing
to do. It's the most non invasive way to do it.
But frequently in what's happening increasingly is I'm getting calls
directly from the emergency room asking can we skip that
step or can we go a little bit more aggressive?
(03:27):
Can we actually go in and forcibly remove that clot
from the veins. So that's actually something called thrownback to
me so that's a mechanical process where I can actually
put in a device like a catheter and I can
suction out that clot. So that's exactly what happened this
(03:48):
past week. So I started getting a lot of calls.
There's one facility that I cover which tends to be
a little bit more aggressive on the aggressive side and
will frequently ask for me to go in and try
to take clot out. And I sometimes have to push
back because sometimes I tell them, you know what, maybe
we should actually give the drugs a chance to work.
But now the question is what's the reason why we
(04:09):
have to treat clot in the leg? What do you
think if.
Speaker 3 (04:12):
There's a blockage in the leg, I would assume there
might be swelling and it can affect.
Speaker 1 (04:17):
The heart in some way exactly. So the one thing
is you can you come to the emergency room or
if you're at home, you didn't have swelling in your legs,
that's how you're going to present. But this clot that's
in your legs, your DVT can actually fly up into
your chest and that's what it causes what we call
a pulmonary emblass. So that's the number one thing we
were trying to prevent. We don't want a clot to
fly into your lungs. Then then you're not going to
(04:38):
breathe anymore. So that's the number one serious complication you
can have. But there are long term issues if we
don't deal with this clot or if this clot does
not completely clear up. And there's something called post trombotic syndrome.
So what that means is that we can have long
term swelling and changes in your legs. So if the
clot is blocks off your deep system, now how is
(05:00):
that blood going to get back to your chest. It's
going to now overwhelm the superficial system, the other pathway
to your chest, So you might start having also back
up of the of the blood in your legs. So
that can cost can changes. It can cause a lot
of swelling, thickening. I've had patients even do up ulcers
of their legs from that, from this thing that we
(05:23):
call post robotic syndrome. That's the reason why we need
to deal with DVT. So the question is when should
I go in and try to forcibly remove plot as
opposed to just giving you blood thinners. Because the vast
majority of patients I would say even if I had blood,
even if I had developed a clot. As you know,
I fly quite a bit, and flying is actually predisposes
(05:46):
patients to developing blood plots. That's why we say if
you're flying, if you're doing a long distance flat, I'm
not talking about a short distance flat from here to
say Phoenix, which is maybe you know, an hour, but
if you're flying across country, for flying overseas, seven hour flats,
ten hour flats, it's really good to get up and move. Honestly,
I don't follow my own advice. I tend to sit
parked in my seat watching a movie. But if you
(06:09):
don't do that, we're compression stockings. That's another good thing
you can do. Compression stockings will help push all that
blood that's in your feet back up to your heart.
I've also had patients do long distance drives. Imagine you're driving.
Speaker 3 (06:22):
What about like an eighteen wheeler, a trucker.
Speaker 1 (06:24):
Exactly if you don't want to stop. So there are
some folks who just sit in one position, and it's
good to stop and move, not just empty your bladder,
but to also get that circulation moving, get the calf
muscles pumping, because that's what helps the blood go back
to your chest. When your calf muscles pump, it pushes
those veins, the blood in the veins back to your heart.
(06:45):
So if you're not doing that movement, at least we're
compression stockings. But for me, if I were to develop
a clot, I would say the first thing I would
want done for myself is put myself on blood nurse.
I don't think I want a doc like myself to
go and it's forcibly suction that clod out because there
can be some issues you have with it. There can
be some vessel damage that can happen. You can damage
(07:07):
some of the valves in the veins, so you don't
want to be super aggressive. But the question is when
would I actually ask for a doc to go in
and suction that clout out. That's when you have two issues.
There are certain times when giving a patient blood thinners
is not advisable where it's contraindicated. So if you're a
patient who actually has had maybe a head bleed in
(07:29):
the past, maybe have a history of stroke, maybe you
have a history of gi bleeding, you're passing blood in
your stools. By giving you a blood thinner, what I'm
actually gonna do is I'm actually going to force not
just your the blood in your veins to thin out,
it might also cause bleeding elsewhere in your body. Same
thing if you are a very old patient. Sometimes patients
were in their nineties, you know, sometimes they're more prone
(07:50):
to having head bleeds with being on blood thinners. So
we try to say, you know what, maybe that's a
high risk of bleeding. Maybe you want to be more
aggressive to go in and take that. Another thing is
sometimes the swelling in your legs is actually very very severe,
to the point where it can actually threaten your limb.
I don't see this very often, but sometimes the swelling
(08:11):
associated that one leg will be completely changed in color.
It might be like extremely blue because all that blood's
backed up, and you might potentially actually suffer from limb
loss because there's so much severe backup of blood and
there's so much pain. Then that way, we might need
to go and take out that clot. That's a syndrome
(08:32):
called flegmasia that can develop inside your legs. So if
that happens, that's a reason to go and enforceably remove plot. Now,
there are some folks who say, if you are a
younger patient like us, and you develop clot a little
bit more centrally in the what we call the iliac
vein the femeral vein, you might want to be a
little bit more aggressive if the tinners don't work initially,
(08:52):
because we want to prevent long term problems with clot development,
which is what I said. We don't want to have
long term swelling, long term issues twenty years down the line.
Speaker 3 (09:03):
Now, when you say centrally iliac femur, that's like the
groin area.
Speaker 1 (09:06):
That's actually the pelvis, the pelvis. So the iliac vessels
are in your pelvis, the femur, the femeral vessels extends
down from your pelvis down into your pie So if
it's more centrally located, then you want to be a
little bit more aggressive. Not a clot maybe say in
your calf, we probably wouldn't do it. So those are
all things that we want to do to be a
(09:26):
little bit more aggressive. So something to think about. Another thing.
If you're a pregnant patient to develop clot, you don't
want to give blood thinners because you can affect the
feetus potentially if you also have recurrent clots in your legs,
if you've had a clot, you come back and you
have more clot. Maybe there's some underlying mechanism, maybe you
want to be more aggressive. I'm gonna take a quick
break on the hackers and go in a little bit
(09:48):
different direction.
Speaker 2 (09:50):
You're listening to the Medical Hackers with doctor Sandy Brow,
Board certified vascular interventionalist, bringing you insights on treatments for
common medical problems on news radio six ninety KTSM. For
more information on the issues being discussed, or to contact
doctor Row, call nine one five five hundred four to
three seven zero or by emailing raw at medical hackers
(10:13):
dot com.
Speaker 1 (10:17):
Background the Hackers, So JUNI walked in here, got out
of the rain, Doc, the rain and the traffic and
the traffic exactly because in El Paso, if you have rain,
you have to have traffic. Right, it was a clot
on it ten, That's true, exactly. The main, the main highway,
the main that was our main artery, the main. But
in this case we're actually talking about veins, and so yes,
(10:39):
we're talking about what if there's a blockage in your
deep veins. So imagine if the deep veins, which is
the main system, like yourphemeral vein, your popolitical vein. That's
a main highway going from your feet back to your chest.
If that develops a clot, when do I pursue doing prombectomy,
which is me going in with a catheter suctioning it out,
(11:02):
as opposed to just giving blood thinners. And so I
went through a few different scenarios in which I tend
to rely more on doing just administering blood thinners. But
definitely there's times when you have to be more aggressive.
And the most aggressive time is when you have this
condition called flu majia seri lea dolans. You don't need
(11:22):
to know that term necessarily, but it is a condition
in which your deep veins and many times your superficial
veins have all completely shut down. So not just imagine
not just Iten shuts down, but now somehow border highway
shuts down, maybe the takeoff through Hopkins, the side path
(11:46):
to through Mesa shuts down. At that point you got
to be very, very aggressive. You need to be more
aggressive because that's gonna when you have that much blockage
in your vessels, when every single vessel is blocked off,
you need to restore that venus blood flow or you
can start having a possible side effect of losing your limb.
(12:07):
So that's where you know, we do start patients like
that on blood thinners. That needs to be kind of
running immediately. They can't come in through the emerging room.
Start them on blood thinners, but you might want to
do what's called thrombolysis.
Speaker 3 (12:18):
That's a real quick question regarding blood thinners.
Speaker 1 (12:22):
Why do you use blood thinners in a case like that?
So the first reason to do blood thinners is you
want to start softening that clot up. Okay, and blood thinners.
I can essentially start blood thinners immediately on you. When
you start talking about breaking up the clot, suctioning out clot.
That takes a little bit more effort. I have to
get you into a X ray room. I need to
(12:43):
get you into a floral room, an angio suite. That
takes time. I got to wheel you over there, I
got to put a catheter in you. But if I
notice you have clot, I can immediately administer blood thinners
through an IVY.
Speaker 3 (12:55):
Gotcha, got you?
Speaker 1 (12:56):
So that's the ex verst aggressive step. You know one
thing you should first do. You can always just elevate
the leg that's something we do immediately elevate the leg
above the heart at least at sixty degrees and that'll
start helping improve the venus drainage. That's the first thing
you would do, which you can do at your home.
You might need to also if a patient has had
a lot of blood loss or a lot of inability
(13:17):
to move that blood, you might start administering fluids, so
not just drinking fluids, but through an ivy started giving
them fluids in addition to doing the anti coagulation that
I mentioned. My preferred drug a choice is heparin. It's
sort of a first line drug treatment that we do.
We give that sort of like in a huge amount
called a bolus, and then we start keep running that
(13:38):
throughout the hour. Throughout the hours as we're waiting to
go to the next step, we just thrombolysis. Trombolysis just
means license means breaking up. Promise means QLOT. So I'm
breaking up QLOT. And the way I do that is
we can put a little catheter in your vessels and
we can drip an even stronger version of drug usually
(13:59):
call TP also place and that we can do that
medication very very strongly breaks up that clot. Wow, Like
immediately it should start breaking it up. It is a
very short half life, meaning when I administer it, it's gonna
work really fast and then it will dissolve immediately the
action potential is gone. But that's something we can do. Now.
(14:21):
After we do that, we can go to the next
step if needed, which is thrombeck. To me, that just
means ect to me means removal thrombus. Obviously clot. Throm
bec to me means removal of the plot. I can
put a little device to suction out that plot, usually
using a very big catheter, a large wide diameter inside
the vessels. Like it's almost like putting in a big straw.
(14:43):
So I'm a big fan of Slurpees. I don't know
if you know that, but you can't drink slurpees, you know.
You know they have two tops of Slurpee straws when
you go to the the seven to eleven. You know,
I can't just use a normal coke straw to drink
my slurpece, I gotta have that big there's like a
big straw, exactly bigger straw, that's right, because that that stuff,
(15:05):
that slurpy, that solution. It's very thick. Right, you're drinking boba,
you want to get those little tapioca pearls in same thing.
When you're talking about clot, you have that big straw,
not a tiny straw. So you have to put a
much bigger cather, a much bigger straw in there to
suction out all that that junk. And so that that's
pretty much what we do. And we use a big syringe,
not just a typical syringe you might use to administer drugs,
(15:27):
but of a huge syringe to really suction it back.
So those are all the steps that we do for
suctioning out clot, treating clot in a very when it's very,
very severe. So I kind of wanted to pivot here
into a totally different area, and largely because Juni, we
had a discussion about this earlier and you were wondering
(15:48):
about how I treat the thyroid.
Speaker 3 (15:51):
Oh yeah, I'm very interested both hypol and hybridoc.
Speaker 1 (15:55):
Yeah, because there's a treatment that we do for the
thyroid for thyroid disease, and I want to kind of
get into overall just what is what is the thyroid?
The tyroid you know, it sits right under your your
neck in that neck areas right there, you know when
you look at your Adam's apples kind of it's you know,
for those of those guys like you'll feel this this
cartilage here, and that's called the thyroid cartilage and it
(16:18):
kind of sits right blow there. And so there's it's
a it's an organ. It's a it's an endocrine organ.
It secretes pyroid hormones. So when you think about the tyroids,
it's a very important gland for a lot of different people.
But your brain actually stimulates that organ. Now, so that
(16:38):
gland that you have there, your brain, if it feels
like it's not performing, the tyroid's not performing, it stimulates
it to work using a hormone called thyroid stimulating hormones.
So the brain sends a signal and says start working okay,
and sometimes it'll tell it to make this hormone called
T four. So T four is a main hormone that
is developed by a tyrol land T four. So whenever
(17:02):
you go get your labs test tested, your dock is
probably gonna test if they're suspecting thyroid disease, they'll check
for T s H. They'll check your T four, and
they'll also check for something called the T three. So
even though your thyroid creates this hormone called T four,
then that T four actually becomes an active form that
(17:24):
actually works in your body called T three. So T
four turns into T three as it works in your body.
So T three is almost like what we call the
gas pedal for your body's metabolism. So if you it
tells your cells how fast work, how much energy you
need to burn. That's why people who have very high
per hyper thyroid meaning they have very high levels of
(17:46):
thyroid hormone. That means your body's saying, step on that gas,
step on that accelera, we need to go as fast
as possible. That's why you might start talking really fast
sometimes if you if you hear me talking really fast.
That's not the way that most people manifest high levels
of hyper thyroidism, though, but they may have very high
(18:09):
heart rates. Okay, your HeartMate might be really high. You
might start diaphor recent, meaning you start sweating a lot.
When you have high levels of thyroid hormone, your body
will start burning off more calories. It's just going at
a much faster rate. That's why people of hyper thyroid,
they tend to be a little bit skinnier than someone
(18:29):
who's hypo. That means hypo means basically it said, you
want to slow down, we're going through a school zone.
Just go at a very very slow rate and your
body's not going to burn as much energy. So I
like to think of the thyroid, the T three hormone
almost like the gas pedal for your body's energy. So
the question is I think, actually, I'm gonna take a
(18:51):
quick break here and talk about problems that we can
encounter with the T three, T four and the tsh
and why I might need to do something about it.
As a vascular.
Speaker 2 (19:01):
Internationalist, you're listening to the Medical Hackers with doctor Sandeep Row,
board certified vascular interventionalist, bringing you insights on treatments for
common medical problems on news radio six ninety KTSM. For
more information on the issues being discussed, or to contact
doctor Row, call nine one five five hundred four to
(19:21):
three seven zero or by emailing rawat medical hackers dot com.
Speaker 1 (19:30):
Back youn The Hackers talking about thyroid disease. So every
now and then, your immune system, that is the same
system that you have in your body that attacks bacteria,
viruses can actually attack your thyroid gland. So your immune
system creates antibodies, as we all know, but sometimes it
(19:50):
creates an antibody called thyroids stimulating immunoglobulins that actually mimic
the shape of your TSH. So the TSH, as I said,
your brain secretes TSH and tells your thyroid to start
working faster. But now imagine if your an immune system,
that immune system that creates these antibodies creates another molecule
(20:16):
that also mimics TSH. So now that means your immune
system is actually going and telling your thyroid to work faster. Okay,
and you don't want that because you don't want your
thyroid to work faster. Even though you might think I
would love to have a ton of thyroid hormones circulating
in my body. I want to benefit from weight loss, yeah.
Speaker 3 (20:38):
Eating, getting to eat more and still burning.
Speaker 1 (20:40):
It off Exactly. There's a lot of different things that
can happen if you have hyper thyroidism that you don't
want because ideally you want to be you thyroid. You
want to be in that same in a sort of
normal thyroid stape, not hyper, not hypo. You want to
be in a normal state, you don't have too much
of this thyroid hormone. And the reason for that is
I'll give a few cases of patients who have hyperthyroidism.
(21:03):
So I've seen patients who have eyes that are bulging forward.
So that's a classic example of where so your thyroid
stimulates these antibodies in your thing that it stimulates the thyroid,
it can also stimulate another type of cell, so then
your tyrol will stimulate something called the fibril blast. Okay,
So fibrol blast is a it's a type of special
(21:25):
type of cell that's deposited in various parts of your body,
but it can actually be deposited behind your eye and
cause your eyes to sort of push forward. So if
you've ever seen somebody who you can almost see the
entire wide of their eye around them. So look at
when I looking at you, Junior or Amber, I see
just the black the iris of your eye, but I
only see the sides the white. But if imagine if
I can see the full white around your eye, that's okay.
(21:48):
That means your eyes is actually getting pushed out. So
now these fibroblasts are the same things that creates hyaluronic acid.
That this is the same stuff that I inject into
knee joints as gel. In fact, anybody who's had lip
fillers out there, this is the same thing that they
inject into lip fillers, hyaluronic acid fiberblasts, because what it
helps to do is it helps draw water into that
(22:11):
area and puffs up the skin. Now, unfortunately, with hyperthyroidism,
the same fiber blasts, the same hyaluronic acid can be developed,
can be deposited behind your eye and push your eyeball out.
So that's why you don't want to be hyper thyroid.
Speaker 3 (22:24):
Wait, you get skinny and you get bigger eyes, I'm
still waiting for the negative.
Speaker 1 (22:29):
Do you get bigger lips? Unfortunately, unfortunately, yes, you're not
gonna get the benefit of the lip fillers that that
have been so popularized out there on on social media.
So here's a problem. When you do have your eyes
getting bulging out, Okay, you can get double vision. Okay,
(22:51):
So if your eye really pops out that much and
you can start seeing the entire wide of your eye,
and it's not it's not a it's not a great look.
I'll be honest with you. You know, some people might think, oh,
but if you google hyperthyroidism eyes or Graves disease eyes,
you'll see it's quite a weird look. But that misalignment
(23:13):
can cause double vision, and in worst cases, if it's
really left unchecked, you could potentially leave to blindness because
it's actually putting pressure on your optic nerve, which sits
behind your eyes. So you don't want to be in
that state. You don't want to have too much thyroid
hormone circulating in your body. So the other thing is
the same TE three hormone. It also makes you more
sensitive to hormones like adrenaline. Okay, so when you have adrenaline,
(23:38):
that's like a fight or flight sort of a hormone
in your body, and your eyes are actually going to
want to open much more wider. So if you think
about it, when you're in a fire flat response, if
a big a lion or tiger jumped into this office,
your eyes would probably pop out. That's what your eyes
are going to look like when you're in a constant
state of being affected by T three hormone. The other
(24:01):
thing is things you might notice. You might notice a
very severe bounding pulse because remember I said, when you
have high levels of thyroid, your heart is pumping much harder.
It's causing you to be your blood pressure goes up,
your heart rate goes up because you're in the sort
of increased fight or flight response system as well with
(24:22):
the adrenaline going there, and so you're in what's called
a hyper dynamic circulatory state. So your heart's pumping more,
and you'll start noticing a very bounding pulse in the neck.
And one of the most important things that you notice
is also your thyroid gland sometimes just starts growing at
a much faster rate. Going back to why Juni, you
brought this question up about why I treat the thyroid,
(24:45):
which is a lot of patients deal with the thyroid surgically.
Sometimes if your thyroid gland has gotten too bigger because
now your brain is now attacking it, or your immune
system is attacking your thyroid tissue by creating more TSH
or immune system is caused it. It's a symptom or syndrome
called Graves disease that a lot of people suffer from.
(25:05):
But it just means your thyroid gland is now can
get very very bigger. You might have nodules developing in
your thyroid, which can also be a little bit of
cosmetic defect. But the reason why I am involved as
a vaster in venalist is there's actually a minimally invasive
procedure that we do. Instead of getting a big surgery,
instead of getting a cut to have your thyroid removed,
I can go in through the blood vessels and actually
(25:27):
deprive your thyroid gland of blood flow. So there's about
four blood vessels, four or five blood vessels that feed
your thyroid gland that come off the neck, and I
get into those blood vessels, either throw an ivy in
your wrist or an ivy and your groin, and I
put medication in to starve your thyroid or blood flow.
Now you might think, am I going to kill the
tyroid gland completely? The answer is no, because out of
(25:49):
those five vessels, I might only treat three of them.
So I'm going to shrink a significant portion of your
thyroid gland, but leave still some of it opens, still
some of it working because you do want to have
hormone in your body. So I go in, put that
medication in, and then your thyroid gland will hopefully reduce
to a normal size and your thyroid hormones in your
(26:11):
body will also come to a normal level, So that's
not an immediate thing, though it's important to know. Sometimes
it takes about a month or so to start seeing
these results. To start seeing the reduction of the size
of your thyroid g line, is that after you exactly. So.
The name of this procedure is called thyroid artery embolization,
and the reason why people want to get this done
as opposed to getting a surgery is imagine how a
(26:33):
surgeon went in and just took out your thyroid glind.
Now you're not going to have any thyroid tissue left behind.
Or maybe they actually did what's called an ablation, a
radioidine ablation, so they put medication in to destroy your
thyroid glind. Now you're going to be left hypothyroid. At
that point, you don't have your body secreting your own
thyroid hormone, so now you have to be on lifelong
(26:56):
hormone thyroid hormone supplements. So if you're wondering, if you
ever wanted to, if you notice that your T three
level in your body, your T four levels in your
body is at a lower level, we can always give
you medications to get your thyroid hormones up, but it's
something that you're gonna have to be on laflong so
to avoid being on lifelong medications of thyroid supplementation. That's
(27:18):
why someone like myself comes in to do a much
more precise breaking down of the thyroid land as opposed
to just taking out the whole thing. This is a
more much more pinpoint strike on that thiro tissue. We're
not just going in this It's almost like I'm going
in like a sniper. I'm going in in a very
focal I'm dropping you know, I'm taking that B two bomber.
(27:41):
I'm just dropping it right in a very focal area
and just destroying that thyroid tissue and not taking out
the entire city, which is what a surgeon might do.
Not that they're parallels in any current events that we
have going on out there, so I've heard of them,
though exactly there's lots of different ways to take out
(28:01):
tissue that's that's not good out there. So we're kind
of running out of time here on the hackers, So unfortunately,
our time this Saturday is up. If you are interested
in any more information on any of you mentioned, mini
million invasive techniques. You can always call to get more
information at nine one five five hundred forty three seven.
(28:22):
It's forty three seventy that's five zero zero four three
seven zero. You can also reach me by email at
raw at medical hackers dot com. That's last name r
Ao at medicalhackers dot com. I hope these healthcare hacks
have helped you navigate our complex medical system. If you've
been tuned into us this whole time, bless your heart
and your health. I'm doctor Sandy Row, and you've been
(28:43):
listening to the medical hackers
Good afternoon. It's another weekend here in the heart of
the dusty Chuahuan Desert in West Texas, and you're listening
to the Medical Hackers. However, you may be tuned in
this week and I'm your host, doctor Sandy Brow. I'm
here to bring the Borderland the latest information in healthcare, medicine,
and technology on the show. I consider myself a hacker,
(00:25):
a hacker the positive sense, a hacker using my intimate
knowledge of the medical system to help me break them
down some of the barriers to accessing new medical technologies
and current healthcare information. So right now in studious I
just got myself and got my producer Hamber with me.
Speaker 2 (00:42):
Oh La.
Speaker 1 (00:43):
Hopefully I might have other folks joined me, but we'll
see the weather. There's always an issue out there.
Speaker 3 (00:48):
Well, choose some random person on the street.
Speaker 1 (00:50):
Exactly, and anybody's welcome. We could do in the past.
I don't know if you've done this, Amber, I've done
this thing where I just did like a random thing
where anybody can just ask me a question. So I
had a few folks. I got like an undergrad at
UTAB who sat in and just started asking me random questions.
It was like a stump the doctor kind of a thing.
So I haven't done that. I haven't done that in
(01:11):
a while, and I don't want to get into it now.
But what I want to do is I want to
get into something that I got a lot of cases
of this in the past week in the hospital and
it's related to DVT deep vein thrombosis. So you have
arteries in your vein, in your blood supply, you got arteries,
(01:34):
you got veins. Arteries sends blood away from your heart.
Veins brings blood back towards your heart. Those of you
who might have seen varicose veins in your leg, they're
very big palpable vessels. That's those are your veins. Those
your theo's not your deep veins, but they're your superficial veins.
There's two sets of veins. That sends blood back to
(01:56):
your heart. So when the blood in your heart pumps
down to your feet eat as an example, it needs
to come back up centrally to the chest. So most
of it goes through the deep system, which is very
centrally located. It's like the main highway going back to
your chest. But then there's also this superficial system, meaning
it's very much at the periphery of your your leg.
(02:20):
Think of it almost like you got I ten. But
we also have these other little ways to get from
one side of town to the other side. It could
be you could puse maybe Montana or maybe even something bigger,
like slightly bigger, maybe like border highway right, if you're
if you if there's a.
Speaker 3 (02:36):
Blockage, Yeah, that's what happened to me today, exactly.
Speaker 1 (02:41):
So. So the the issue is that we sometimes have
clots form in the deep system, and so what is
the treatment for that is the question? And so most
of the time the treatment is what we call anticoagulation.
Put you on blood thinners, so that's just medication. I
(03:03):
put clot busting medication to just break down the that's
developed in your vessels. And that's usually the best thing
to do. It's the most non invasive way to do it.
But frequently in what's happening increasingly is I'm getting calls
directly from the emergency room asking can we skip that
step or can we go a little bit more aggressive?
(03:27):
Can we actually go in and forcibly remove that clot
from the veins. So that's actually something called thrownback to
me so that's a mechanical process where I can actually
put in a device like a catheter and I can
suction out that clot. So that's exactly what happened this
(03:48):
past week. So I started getting a lot of calls.
There's one facility that I cover which tends to be
a little bit more aggressive on the aggressive side and
will frequently ask for me to go in and try
to take clot out. And I sometimes have to push
back because sometimes I tell them, you know what, maybe
we should actually give the drugs a chance to work.
But now the question is what's the reason why we
(04:09):
have to treat clot in the leg? What do you
think if.
Speaker 3 (04:12):
There's a blockage in the leg, I would assume there
might be swelling and it can affect.
Speaker 1 (04:17):
The heart in some way exactly. So the one thing
is you can you come to the emergency room or
if you're at home, you didn't have swelling in your legs,
that's how you're going to present. But this clot that's
in your legs, your DVT can actually fly up into
your chest and that's what it causes what we call
a pulmonary emblass. So that's the number one thing we
were trying to prevent. We don't want a clot to
fly into your lungs. Then then you're not going to
(04:38):
breathe anymore. So that's the number one serious complication you
can have. But there are long term issues if we
don't deal with this clot or if this clot does
not completely clear up. And there's something called post trombotic syndrome.
So what that means is that we can have long
term swelling and changes in your legs. So if the
clot is blocks off your deep system, now how is
(05:00):
that blood going to get back to your chest. It's
going to now overwhelm the superficial system, the other pathway
to your chest, So you might start having also back
up of the of the blood in your legs. So
that can cost can changes. It can cause a lot
of swelling, thickening. I've had patients even do up ulcers
of their legs from that, from this thing that we
(05:23):
call post robotic syndrome. That's the reason why we need
to deal with DVT. So the question is when should
I go in and try to forcibly remove plot as
opposed to just giving you blood thinners. Because the vast
majority of patients I would say even if I had blood,
even if I had developed a clot. As you know,
I fly quite a bit, and flying is actually predisposes
(05:46):
patients to developing blood plots. That's why we say if
you're flying, if you're doing a long distance flat, I'm
not talking about a short distance flat from here to
say Phoenix, which is maybe you know, an hour, but
if you're flying across country, for flying overseas, seven hour flats,
ten hour flats, it's really good to get up and move. Honestly,
I don't follow my own advice. I tend to sit
parked in my seat watching a movie. But if you
(06:09):
don't do that, we're compression stockings. That's another good thing
you can do. Compression stockings will help push all that
blood that's in your feet back up to your heart.
I've also had patients do long distance drives. Imagine you're driving.
Speaker 3 (06:22):
What about like an eighteen wheeler, a trucker.
Speaker 1 (06:24):
Exactly if you don't want to stop. So there are
some folks who just sit in one position, and it's
good to stop and move, not just empty your bladder,
but to also get that circulation moving, get the calf
muscles pumping, because that's what helps the blood go back
to your chest. When your calf muscles pump, it pushes
those veins, the blood in the veins back to your heart.
(06:45):
So if you're not doing that movement, at least we're
compression stockings. But for me, if I were to develop
a clot, I would say the first thing I would
want done for myself is put myself on blood nurse.
I don't think I want a doc like myself to
go and it's forcibly suction that clod out because there
can be some issues you have with it. There can
be some vessel damage that can happen. You can damage
(07:07):
some of the valves in the veins, so you don't
want to be super aggressive. But the question is when
would I actually ask for a doc to go in
and suction that clout out. That's when you have two issues.
There are certain times when giving a patient blood thinners
is not advisable where it's contraindicated. So if you're a
patient who actually has had maybe a head bleed in
(07:29):
the past, maybe have a history of stroke, maybe you
have a history of gi bleeding, you're passing blood in
your stools. By giving you a blood thinner, what I'm
actually gonna do is I'm actually going to force not
just your the blood in your veins to thin out,
it might also cause bleeding elsewhere in your body. Same
thing if you are a very old patient. Sometimes patients
were in their nineties, you know, sometimes they're more prone
(07:50):
to having head bleeds with being on blood thinners. So
we try to say, you know what, maybe that's a
high risk of bleeding. Maybe you want to be more
aggressive to go in and take that. Another thing is
sometimes the swelling in your legs is actually very very severe,
to the point where it can actually threaten your limb.
I don't see this very often, but sometimes the swelling
(08:11):
associated that one leg will be completely changed in color.
It might be like extremely blue because all that blood's
backed up, and you might potentially actually suffer from limb
loss because there's so much severe backup of blood and
there's so much pain. Then that way, we might need
to go and take out that clot. That's a syndrome
(08:32):
called flegmasia that can develop inside your legs. So if
that happens, that's a reason to go and enforceably remove plot. Now,
there are some folks who say, if you are a
younger patient like us, and you develop clot a little
bit more centrally in the what we call the iliac
vein the femeral vein, you might want to be a
little bit more aggressive if the tinners don't work initially,
(08:52):
because we want to prevent long term problems with clot development,
which is what I said. We don't want to have
long term swelling, long term issues twenty years down the line.
Speaker 3 (09:03):
Now, when you say centrally iliac femur, that's like the
groin area.
Speaker 1 (09:06):
That's actually the pelvis, the pelvis. So the iliac vessels
are in your pelvis, the femur, the femeral vessels extends
down from your pelvis down into your pie So if
it's more centrally located, then you want to be a
little bit more aggressive. Not a clot maybe say in
your calf, we probably wouldn't do it. So those are
all things that we want to do to be a
(09:26):
little bit more aggressive. So something to think about. Another thing.
If you're a pregnant patient to develop clot, you don't
want to give blood thinners because you can affect the
feetus potentially if you also have recurrent clots in your legs,
if you've had a clot, you come back and you
have more clot. Maybe there's some underlying mechanism, maybe you
want to be more aggressive. I'm gonna take a quick
break on the hackers and go in a little bit
(09:48):
different direction.
Speaker 2 (09:50):
You're listening to the Medical Hackers with doctor Sandy Brow,
Board certified vascular interventionalist, bringing you insights on treatments for
common medical problems on news radio six ninety KTSM. For
more information on the issues being discussed, or to contact
doctor Row, call nine one five five hundred four to
three seven zero or by emailing raw at medical hackers
(10:13):
dot com.
Speaker 1 (10:17):
Background the Hackers, So JUNI walked in here, got out
of the rain, Doc, the rain and the traffic and
the traffic exactly because in El Paso, if you have rain,
you have to have traffic. Right, it was a clot
on it ten, That's true, exactly. The main, the main highway,
the main that was our main artery, the main. But
in this case we're actually talking about veins, and so yes,
(10:39):
we're talking about what if there's a blockage in your
deep veins. So imagine if the deep veins, which is
the main system, like yourphemeral vein, your popolitical vein. That's
a main highway going from your feet back to your chest.
If that develops a clot, when do I pursue doing prombectomy,
which is me going in with a catheter suctioning it out,
(11:02):
as opposed to just giving blood thinners. And so I
went through a few different scenarios in which I tend
to rely more on doing just administering blood thinners. But
definitely there's times when you have to be more aggressive.
And the most aggressive time is when you have this
condition called flu majia seri lea dolans. You don't need
(11:22):
to know that term necessarily, but it is a condition
in which your deep veins and many times your superficial
veins have all completely shut down. So not just imagine
not just Iten shuts down, but now somehow border highway
shuts down, maybe the takeoff through Hopkins, the side path
(11:46):
to through Mesa shuts down. At that point you got
to be very, very aggressive. You need to be more
aggressive because that's gonna when you have that much blockage
in your vessels, when every single vessel is blocked off,
you need to restore that venus blood flow or you
can start having a possible side effect of losing your limb.
(12:07):
So that's where you know, we do start patients like
that on blood thinners. That needs to be kind of
running immediately. They can't come in through the emerging room.
Start them on blood thinners, but you might want to
do what's called thrombolysis.
Speaker 3 (12:18):
That's a real quick question regarding blood thinners.
Speaker 1 (12:22):
Why do you use blood thinners in a case like that?
So the first reason to do blood thinners is you
want to start softening that clot up. Okay, and blood thinners.
I can essentially start blood thinners immediately on you. When
you start talking about breaking up the clot, suctioning out clot.
That takes a little bit more effort. I have to
get you into a X ray room. I need to
(12:43):
get you into a floral room, an angio suite. That
takes time. I got to wheel you over there, I
got to put a catheter in you. But if I
notice you have clot, I can immediately administer blood thinners
through an IVY.
Speaker 3 (12:55):
Gotcha, got you?
Speaker 1 (12:56):
So that's the ex verst aggressive step. You know one
thing you should first do. You can always just elevate
the leg that's something we do immediately elevate the leg
above the heart at least at sixty degrees and that'll
start helping improve the venus drainage. That's the first thing
you would do, which you can do at your home.
You might need to also if a patient has had
a lot of blood loss or a lot of inability
(13:17):
to move that blood, you might start administering fluids, so
not just drinking fluids, but through an ivy started giving
them fluids in addition to doing the anti coagulation that
I mentioned. My preferred drug a choice is heparin. It's
sort of a first line drug treatment that we do.
We give that sort of like in a huge amount
called a bolus, and then we start keep running that
(13:38):
throughout the hour. Throughout the hours as we're waiting to
go to the next step, we just thrombolysis. Trombolysis just
means license means breaking up. Promise means QLOT. So I'm
breaking up QLOT. And the way I do that is
we can put a little catheter in your vessels and
we can drip an even stronger version of drug usually
(13:59):
call TP also place and that we can do that
medication very very strongly breaks up that clot. Wow, Like
immediately it should start breaking it up. It is a
very short half life, meaning when I administer it, it's gonna
work really fast and then it will dissolve immediately the
action potential is gone. But that's something we can do. Now.
(14:21):
After we do that, we can go to the next
step if needed, which is thrombeck. To me, that just
means ect to me means removal thrombus. Obviously clot. Throm
bec to me means removal of the plot. I can
put a little device to suction out that plot, usually
using a very big catheter, a large wide diameter inside
the vessels. Like it's almost like putting in a big straw.
(14:43):
So I'm a big fan of Slurpees. I don't know
if you know that, but you can't drink slurpees, you know.
You know they have two tops of Slurpee straws when
you go to the the seven to eleven. You know,
I can't just use a normal coke straw to drink
my slurpece, I gotta have that big there's like a
big straw, exactly bigger straw, that's right, because that that stuff,
(15:05):
that slurpy, that solution. It's very thick. Right, you're drinking boba,
you want to get those little tapioca pearls in same thing.
When you're talking about clot, you have that big straw,
not a tiny straw. So you have to put a
much bigger cather, a much bigger straw in there to
suction out all that that junk. And so that that's
pretty much what we do. And we use a big syringe,
not just a typical syringe you might use to administer drugs,
(15:27):
but of a huge syringe to really suction it back.
So those are all the steps that we do for
suctioning out clot, treating clot in a very when it's very,
very severe. So I kind of wanted to pivot here
into a totally different area, and largely because Juni, we
had a discussion about this earlier and you were wondering
(15:48):
about how I treat the thyroid.
Speaker 3 (15:51):
Oh yeah, I'm very interested both hypol and hybridoc.
Speaker 1 (15:55):
Yeah, because there's a treatment that we do for the
thyroid for thyroid disease, and I want to kind of
get into overall just what is what is the thyroid?
The tyroid you know, it sits right under your your
neck in that neck areas right there, you know when
you look at your Adam's apples kind of it's you know,
for those of those guys like you'll feel this this
cartilage here, and that's called the thyroid cartilage and it
(16:18):
kind of sits right blow there. And so there's it's
a it's an organ. It's a it's an endocrine organ.
It secretes pyroid hormones. So when you think about the tyroids,
it's a very important gland for a lot of different people.
But your brain actually stimulates that organ. Now, so that
(16:38):
gland that you have there, your brain, if it feels
like it's not performing, the tyroid's not performing, it stimulates
it to work using a hormone called thyroid stimulating hormones.
So the brain sends a signal and says start working okay,
and sometimes it'll tell it to make this hormone called
T four. So T four is a main hormone that
is developed by a tyrol land T four. So whenever
(17:02):
you go get your labs test tested, your dock is
probably gonna test if they're suspecting thyroid disease, they'll check
for T s H. They'll check your T four, and
they'll also check for something called the T three. So
even though your thyroid creates this hormone called T four,
then that T four actually becomes an active form that
(17:24):
actually works in your body called T three. So T
four turns into T three as it works in your body.
So T three is almost like what we call the
gas pedal for your body's metabolism. So if you it
tells your cells how fast work, how much energy you
need to burn. That's why people who have very high
per hyper thyroid meaning they have very high levels of
(17:46):
thyroid hormone. That means your body's saying, step on that gas,
step on that accelera, we need to go as fast
as possible. That's why you might start talking really fast
sometimes if you if you hear me talking really fast.
That's not the way that most people manifest high levels
of hyper thyroidism, though, but they may have very high
(18:09):
heart rates. Okay, your HeartMate might be really high. You
might start diaphor recent, meaning you start sweating a lot.
When you have high levels of thyroid hormone, your body
will start burning off more calories. It's just going at
a much faster rate. That's why people of hyper thyroid,
they tend to be a little bit skinnier than someone
(18:29):
who's hypo. That means hypo means basically it said, you
want to slow down, we're going through a school zone.
Just go at a very very slow rate and your
body's not going to burn as much energy. So I
like to think of the thyroid, the T three hormone
almost like the gas pedal for your body's energy. So
the question is I think, actually, I'm gonna take a
(18:51):
quick break here and talk about problems that we can
encounter with the T three, T four and the tsh
and why I might need to do something about it.
As a vascular.
Speaker 2 (19:01):
Internationalist, you're listening to the Medical Hackers with doctor Sandeep Row,
board certified vascular interventionalist, bringing you insights on treatments for
common medical problems on news radio six ninety KTSM. For
more information on the issues being discussed, or to contact
doctor Row, call nine one five five hundred four to
(19:21):
three seven zero or by emailing rawat medical hackers dot com.
Speaker 1 (19:30):
Back youn The Hackers talking about thyroid disease. So every
now and then, your immune system, that is the same
system that you have in your body that attacks bacteria,
viruses can actually attack your thyroid gland. So your immune
system creates antibodies, as we all know, but sometimes it
(19:50):
creates an antibody called thyroids stimulating immunoglobulins that actually mimic
the shape of your TSH. So the TSH, as I said,
your brain secretes TSH and tells your thyroid to start
working faster. But now imagine if your an immune system,
that immune system that creates these antibodies creates another molecule
(20:16):
that also mimics TSH. So now that means your immune
system is actually going and telling your thyroid to work faster. Okay,
and you don't want that because you don't want your
thyroid to work faster. Even though you might think I
would love to have a ton of thyroid hormones circulating
in my body. I want to benefit from weight loss, yeah.
Speaker 3 (20:38):
Eating, getting to eat more and still burning.
Speaker 1 (20:40):
It off Exactly. There's a lot of different things that
can happen if you have hyper thyroidism that you don't
want because ideally you want to be you thyroid. You
want to be in that same in a sort of
normal thyroid stape, not hyper, not hypo. You want to
be in a normal state, you don't have too much
of this thyroid hormone. And the reason for that is
I'll give a few cases of patients who have hyperthyroidism.
(21:03):
So I've seen patients who have eyes that are bulging forward.
So that's a classic example of where so your thyroid
stimulates these antibodies in your thing that it stimulates the thyroid,
it can also stimulate another type of cell, so then
your tyrol will stimulate something called the fibril blast. Okay,
So fibrol blast is a it's a type of special
(21:25):
type of cell that's deposited in various parts of your body,
but it can actually be deposited behind your eye and
cause your eyes to sort of push forward. So if
you've ever seen somebody who you can almost see the
entire wide of their eye around them. So look at
when I looking at you, Junior or Amber, I see
just the black the iris of your eye, but I
only see the sides the white. But if imagine if
I can see the full white around your eye, that's okay.
(21:48):
That means your eyes is actually getting pushed out. So
now these fibroblasts are the same things that creates hyaluronic acid.
That this is the same stuff that I inject into
knee joints as gel. In fact, anybody who's had lip
fillers out there, this is the same thing that they
inject into lip fillers, hyaluronic acid fiberblasts, because what it
helps to do is it helps draw water into that
(22:11):
area and puffs up the skin. Now, unfortunately, with hyperthyroidism,
the same fiber blasts, the same hyaluronic acid can be developed,
can be deposited behind your eye and push your eyeball out.
So that's why you don't want to be hyper thyroid.
Speaker 3 (22:24):
Wait, you get skinny and you get bigger eyes, I'm
still waiting for the negative.
Speaker 1 (22:29):
Do you get bigger lips? Unfortunately, unfortunately, yes, you're not
gonna get the benefit of the lip fillers that that
have been so popularized out there on on social media.
So here's a problem. When you do have your eyes
getting bulging out, Okay, you can get double vision. Okay,
(22:51):
So if your eye really pops out that much and
you can start seeing the entire wide of your eye,
and it's not it's not a it's not a great look.
I'll be honest with you. You know, some people might think, oh,
but if you google hyperthyroidism eyes or Graves disease eyes,
you'll see it's quite a weird look. But that misalignment
(23:13):
can cause double vision, and in worst cases, if it's
really left unchecked, you could potentially leave to blindness because
it's actually putting pressure on your optic nerve, which sits
behind your eyes. So you don't want to be in
that state. You don't want to have too much thyroid
hormone circulating in your body. So the other thing is
the same TE three hormone. It also makes you more
sensitive to hormones like adrenaline. Okay, so when you have adrenaline,
(23:38):
that's like a fight or flight sort of a hormone
in your body, and your eyes are actually going to
want to open much more wider. So if you think
about it, when you're in a fire flat response, if
a big a lion or tiger jumped into this office,
your eyes would probably pop out. That's what your eyes
are going to look like when you're in a constant
state of being affected by T three hormone. The other
(24:01):
thing is things you might notice. You might notice a
very severe bounding pulse because remember I said, when you
have high levels of thyroid, your heart is pumping much harder.
It's causing you to be your blood pressure goes up,
your heart rate goes up because you're in the sort
of increased fight or flight response system as well with
(24:22):
the adrenaline going there, and so you're in what's called
a hyper dynamic circulatory state. So your heart's pumping more,
and you'll start noticing a very bounding pulse in the neck.
And one of the most important things that you notice
is also your thyroid gland sometimes just starts growing at
a much faster rate. Going back to why Juni, you
brought this question up about why I treat the thyroid,
(24:45):
which is a lot of patients deal with the thyroid surgically.
Sometimes if your thyroid gland has gotten too bigger because
now your brain is now attacking it, or your immune
system is attacking your thyroid tissue by creating more TSH
or immune system is caused it. It's a symptom or syndrome
called Graves disease that a lot of people suffer from.
(25:05):
But it just means your thyroid gland is now can
get very very bigger. You might have nodules developing in
your thyroid, which can also be a little bit of
cosmetic defect. But the reason why I am involved as
a vaster in venalist is there's actually a minimally invasive
procedure that we do. Instead of getting a big surgery,
instead of getting a cut to have your thyroid removed,
I can go in through the blood vessels and actually
(25:27):
deprive your thyroid gland of blood flow. So there's about
four blood vessels, four or five blood vessels that feed
your thyroid gland that come off the neck, and I
get into those blood vessels, either throw an ivy in
your wrist or an ivy and your groin, and I
put medication in to starve your thyroid or blood flow.
Now you might think, am I going to kill the
tyroid gland completely? The answer is no, because out of
(25:49):
those five vessels, I might only treat three of them.
So I'm going to shrink a significant portion of your
thyroid gland, but leave still some of it opens, still
some of it working because you do want to have
hormone in your body. So I go in, put that
medication in, and then your thyroid gland will hopefully reduce
to a normal size and your thyroid hormones in your
(26:11):
body will also come to a normal level, So that's
not an immediate thing, though it's important to know. Sometimes
it takes about a month or so to start seeing
these results. To start seeing the reduction of the size
of your thyroid g line, is that after you exactly. So.
The name of this procedure is called thyroid artery embolization,
and the reason why people want to get this done
as opposed to getting a surgery is imagine how a
(26:33):
surgeon went in and just took out your thyroid glind.
Now you're not going to have any thyroid tissue left behind.
Or maybe they actually did what's called an ablation, a
radioidine ablation, so they put medication in to destroy your
thyroid glind. Now you're going to be left hypothyroid. At
that point, you don't have your body secreting your own
thyroid hormone, so now you have to be on lifelong
(26:56):
hormone thyroid hormone supplements. So if you're wondering, if you
ever wanted to, if you notice that your T three
level in your body, your T four levels in your
body is at a lower level, we can always give
you medications to get your thyroid hormones up, but it's
something that you're gonna have to be on laflong so
to avoid being on lifelong medications of thyroid supplementation. That's
(27:18):
why someone like myself comes in to do a much
more precise breaking down of the thyroid land as opposed
to just taking out the whole thing. This is a
more much more pinpoint strike on that thiro tissue. We're
not just going in this It's almost like I'm going
in like a sniper. I'm going in in a very
focal I'm dropping you know, I'm taking that B two bomber.
(27:41):
I'm just dropping it right in a very focal area
and just destroying that thyroid tissue and not taking out
the entire city, which is what a surgeon might do.
Not that they're parallels in any current events that we
have going on out there, so I've heard of them,
though exactly there's lots of different ways to take out
(28:01):
tissue that's that's not good out there. So we're kind
of running out of time here on the hackers, So unfortunately,
our time this Saturday is up. If you are interested
in any more information on any of you mentioned, mini
million invasive techniques. You can always call to get more
information at nine one five five hundred forty three seven.
(28:22):
It's forty three seventy that's five zero zero four three
seven zero. You can also reach me by email at
raw at medical hackers dot com. That's last name r
Ao at medicalhackers dot com. I hope these healthcare hacks
have helped you navigate our complex medical system. If you've
been tuned into us this whole time, bless your heart
and your health. I'm doctor Sandy Row, and you've been
(28:43):
listening to the medical hackers
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