Are You Ready For The Great Sphincter Showdown? | Dr. Kaveh Hoda
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Hey, Will. Hey, what's up? I've been thinking, the U.S. healthcare system, it needs some improvement. Yeah, there's room for improvement. Yeah, it's a confusing, scary place for everybody involved. Absolutely. Physicians, families, patients, everybody. Everybody. And I've experienced it from both sides, right? I'm a physician. I've also been a patient. So I wanted to use my platform to give people practical education, really the only way that I know how.

By making jokes. So Dr. Glockenflecken's really fun and super uplifting guide to American healthcare is out. And it's a free resource that includes all my videos from the 30 Days of Healthcare series, alongside deeper explanations, also reliable facts, emphasis on reliable. Yes. All right. Figures, numbers, insights into how each of us can fight for a more humane healthcare.

better healthcare system. Also, it has jokes. Did you mention the jokes? I did. Jokes. Yes, definitely jokes. Well, this guide is great for anyone looking to learn more about U.S. healthcare, but especially if you are experiencing it from the clinician side for the first time. That's right. We really hope you'll check it out. Get the free guide sent straight to your inbox by signing up for our mailing list, glockenflecken.com slash healthcare. Enjoy. Oh, oh, oh, oh.

Knock knock. Hi.

Hey everybody, welcome to Knock Knock High with the Glockenfleckens. I am Dr. Glockenflecken, also known as Will Flannery, and you might notice, especially if you're watching this on YouTube, on a YouTube channel, that Kristen, Lady Glockenflecken, is not here. But we have someone that looks almost just like her filling in. Kave Hoda. Kave, thank you for joining us. I'm not looking to replace her on the show, but...

As much as I am looking to replace her in your heart...

That's good. I want a single white female her is what I'm trying to say to you right now. She better watch her back. I'm moving in. So Kaveh is a friend of the pod, been on a couple times and has his own wonderful podcast, House of Pod, which you all should listen to. And as soon as well, first of all, what we're going to do, I got a few things we're going to do. So first, I'm going to tell you exactly why.

Kristen is not on the show. Now, I intentionally did not tell you because I want to tell the story because there's a story behind it. Okay, good. And then after that, after the break, we're going to do something that we have talked about, you and I, Kaveh, for a little while. Yeah. We're going to do a sphincter draft. The first annual, I hope. The first annual because, I don't know, because as we all know, humans develop new sphincters every year. Yeah.

I think we could still shuffle it. I think, because I'm pretty sure what I pick this year, I'm going to regret later and then I'm going to want to redo it. Do your sphincter tastes change as you age? Yeah. As you get older? Yeah, certain things become more important to you. We'll talk about that. I don't want to spoil it. Taste may not be the right term. Taste is part of it, though. All right. So, first of all,

All right. Why is Kristen? Do you have any guesses? Just knowing nothing? Okay. First of all, because I've heard you guys tell me stories. You've come on my podcast and you've told me stories. And some of the stories are very nice. Some of the stories are very bad. And I'm guessing this is not a bad one or we wouldn't be laughing about it. Correct. Correct. I'm going to say this is...

uh something with the kids because it has to be it is something important to take one of you away from the show and that's what i think is the most important thing for you guys and that's part of the reason i love you guys so i would say on a scale from one to ten ten being uh your loved one has a cardiac arrest and you have to do 10 minutes chest compressions this would be like a four wow yeah yeah so here's here's here's the deal all right so

So we live, we have a few acres. Okay. And, um, and, uh, a few, when we moved into this place, uh, my father-in-law, uh, bought a child size, uh, four wheeler.

so so a um uh you know so it child it's not like a toy it's like a legit like four-wheeler but it's just smaller than like i wouldn't i would not fit on it right that's illegal i guess yes it's okay absolutely uh you don't have to have a license to drive it yes should it you know i guess my better judgment i i i just so we've had this thing for like a couple years now

And, uh, my, first of all, it was mainly for my, my, uh, now 10 year old. She is the daredevil of the family. As soon as she got on this thing, I was expecting her to take, this is a couple of years ago. Now I was expecting her to take a slow, but she was immediately doing donuts in the yard. And, and so this is a thing you can, it's got like grass tires, so you can drive it all over the, all over the place. Yeah. And, um,

Things have been going great until yesterday when she had a friend over and she decided to not only let the friend know,

the four-wheeler, but also that she was going to ride on it as well. Oh my God. This is not a two-seater. God. This is a one-seater. Does a trampoline play into the story at some point? No, thank God we don't have a trampoline. But, and then, so I'm out in the back. I'm like pressure washing some concrete as one does. When you have acres. Yeah.

Acres of concrete. The whole thing's concreted. So, so I'm, so I'm pressure washing, uh, the, the driveway. And, um, uh, and then Kristen runs up to me holding her hand, like holding an ice pack on her hand. And she was like, she told me, this is what she says. She says, uh, the four wheeler flipped. Uh, I burned my hand. I need medical attention.

And so, so first of all, I was like, my first thought was, wow, I am so impressed that she's coming to me as an ophthalmologist for medical attention. She doesn't have a lot of options. That's true. That's true. She doesn't have a lot of, but no. So what happened was they went over this little like retaining wall we had, that's like three feet high. Oh my gosh. The kid like drove it over the wall. Right.

for reasons I still don't quite understand. The kids are fine. The kids are totally, they're a little bruised up, but no broken bones. No, no, nothing. They just walked away as kids do. Right. They're like incredibly resilient. Uh, so they, uh, uh, they, they're fine, but the, the four wheeler, it, when it landed, it landed kind of on top of our 10 year old and Kristen, she saw it happen. Thank goodness. Right. So she ran over there and,

And her mom instincts... Hulk strength kicks in. She just grabbed it. She grabbed the overturned four-wheeler and just yanked it off. Unfortunately, she grabbed the muffler. Oh, my gosh. Or at least something close to it. She doesn't exactly know where she grabbed it. I don't know parts of a regular car, much less an ATV. Exactly, right? So whatever it was, it was 1,000 degrees, apparently. And so...

She immediately burned her hand. She got the thing off the kid, but she had like most of her palm was burned. So she was in a lot of pain. We went to the emergency room.

Uh, and she's doing okay now. She's doing okay, but she is on some pain medicine. I'll tell you what. Oh yeah. Uh, and so can we get her on? Cause I've never wanted to talk to her more than right now. As I'm going through this, I am, I am now thinking maybe she should have co-hosted this. It'd be amazing.

so many questions. It was mainly last night. I don't think she's as doped up today, but, uh, cause the pain is, is, is doing better. Yeah. But man, cause like, you know, I, I've burned my, you know, finger or fingertip or something, but man, her whole, like it was, so she has these, these second degree burns, kind of linear burns where she grabbed the, the thing, um, on like a good part of her palm. And so, um,

We went to the emergency room and, uh, they, they were great over there. I don't know. Uh, uh, I assist, they, I knew right away as soon as we walked in that they recognized me. Yeah. It's always a little bit awkward now. Like whenever I have to like go to a medical facility for like as a patient or family member of a patient, because I know that's kind of the case. Yeah. Um,

And I, I knew for sure when we were in the sitting in the, in the room, cause they, they, they got us to a room right away. Uh, because Kristen was like, she was just writhing in pain. Yeah. So they got us in right away into a room and, it wasn't too busy, fortunately. And, uh, um,

And then we saw, occasionally we would see people like peeking in through the window. Oh my God. You could just feel the energy in there. Because one of your most famous characters is the ER. He's like the most recognizable, you know, he wears like the helmet and the whole ER thing. Very distinctive. Yeah. So how...

I mean, your characters are all relatively complimentary and as doctors and specialties, I think we're all like a little bit like stoked if you do like the, you know, our, our specialty. So do you feel like our people, are your doctors like particularly attentive? Are they particularly nice? Are they, do they talk about it? Are they, are they trying to be cool and not like bother you? So no one mentioned it. The,

Pretty much the whole, no one mentioned anything. We got looks, right? I got some double takes. But no one mentioned anything about Glock and Flecken until we were just about to leave. And the MD walks in. This is like the third time she'd be in the room. And she finally, she said, you know, people out there recognize you.

And I was like, yeah, you know, kind of figured. Yeah. And, um, and then we just had a wonderful conversation. It was great because, well, first of all, Kristen's, her pain level was, was she was, she had, she had some dilaudid on board. So she was, she was feeling much better. And so the, the tension of the situation was kind of, you know, coming down. Yeah. Yeah. And, uh, and so we, um, we talked about the characters and it's my experience is that the emergency situation,

they love my depiction of their specialty. Oh my God. Is there any specialty that hasn't? That hasn't? I'm sure everyone has one or two characters that aren't into it, but in general, which is the least receptive? Historically, it's been family medicine. I've talked about this a little bit. I think it's because they're so...

They feel like they're already kind of taken advantage of in the medical and the healthcare system. I mean, for good reason, right? Uh, they feel, feel very undervalued. And so I think anybody poking fun at them is going to feel a little bit more difficult as opposed to like a surgeon, which their egos are so big.

and massive. Like nothing is going to, you can't knock them off their orbit. Like it's, it's there, it's, you know. And they're being compensated largely better than the family practice doctors are. So there's a part of that that's just like, yeah. Absolutely. And that being said, it's like a few family medicine folks. Right. The vast majority are like, yeah, we get it. Like we totally get it. We appreciate, you know, the depiction and everything. I was a little bit disappointed. I did not see a single bicycle helmet. Right.

While we were there. It's pretty... I gotta say, I'm a little disappointed that nobody ran out and got one to come into your... That's absolutely what I would have done. Once everything was, like, okay and I knew she was, like, cool, I would have, like, come for discharge wearing, like, the bicycle helmet.

I think that would have been absolutely brilliant. I do appreciate that they waited until things were calmer before like getting into the. I can imagine Kristen would be like, what the hell is going on? I need help now. I don't care. How's she doing now? Is she okay? She's doing great. She's just, she's, she's in bed, um, probably napping at this point, but she's got a nice big dressing around her, her hand. And, um, she got the, what's the zero form. Yeah. Zero form stuff. Yeah. Yeah. They put that on her.

So we got to take, you know, I'm in charge of dressing changes, which I haven't done a dressing change on a hand in quite a while. How, and is that all that needs to be done? Is she going to see like,

I don't know, plastics or something like that. I don't think it's going to be that bad. So it's like second degree burns, uh, that should heal up just fine. Wasn't circumferential. I guess that's an important thing because you can develop like scar tissue around the hand. So it's just the palm should heal up. Okay. But she's just going to be uncomfortable and, but would be a fantastic podcast guest for the next few days. Oh yeah. It's going to be amazing. I have another question for you. How was the conversation with the parents of the other kid?

Oh, so the parent was actually there as well. Good question. That was actually, as soon as I found out that my kid was okay, I was like, oh, shit.

Yeah. Like, what is, the kid's fine. And actually was even less bruised up than my own child, which is good. So everybody's fine. Everybody's okay. Yeah. If one of the kids has to take a little bit more of the rough treatment, you want it to be your kid in that situation. But I'll tell you, like, we're going to change some rules around the house. Oh, yeah. Around the acres.

Acres. By the way, I'm still stuck on acres. I live in San Francisco. You're looking at my guest bedroom slash music studio slash podcast space and you have acres. Okay. I will say your cost of living is a bit higher where you are. But you'll get acres of concrete at some point too, I'm sure. I hope so. Just acres and acres of concrete and steel. All right. Let's take a break. We'll come back with our sphincter draft.

So, Will. Yeah. You're always teaching me things about Demodex mites, your little friends there. Let's switch things up a bit. Okay. How about I ask you a couple questions to see how much you really know? Go for it. Okay. Let's do it. What are the only two main species of Demodex mites found in humans? Oh.

Type 1 and type 2? Hmm, got you on that one. Demodex follicularum, which are found in the eyelash follicles, and demodex brevis, which are found in the meibomian glands. Impressive. All right, next question. Why do people with demodex blepharitis often feel itchy eyelids first thing in the morning? I know this because I use it to gross you out. Demodex mites avoid light and they come out mostly at night to mate.

and move between your eyelash follicles. So many people will wake up with that itchy, irritated feeling along their eyelids. So gross. I'm surprised you even brought that up. I know. I know. I'm just trying to get used to these mites since demodex blepharitis is such a common disease and we keep talking about it.

talking about it. Well, that's a big step. And we know there's a prescription eye drop available to treat demodex blepharitis. To learn more about these mites and demodex blepharitis, visit miteslovelids.com for more information. Again, that's M-I-T-E-S-L-O-V-E-L-I-D-S.com to learn more. This ad is brought to you by Tarsus Pharmaceuticals.

Hey, Kristen, those sheets you told me to put on the bed last night? Yeah, my new Cozy Earth bamboo sheets. Yeah, you didn't tell me they were the most comfortable sheets on earth. That's why I was having you put them on. They're my new favorite summer sheets. I love them. Because I'm always hot when I sleep because you like to sleep with a thousand blankets. It's true. But I was totally fine. Yeah, they're temperature regulating. They kept me cool. They're magic. I slept like a baby. I want more and I will only sleep with Cozy Earth sheets. Okay, noted. All right, you promise? I have no problem with that. All right.

upgrade your summer. Go to CozyEarth.com and use code KnockKnock for 40% off best-selling temperature-regulating sheets, apparel, and more. Trust me, you'll feel the difference the very first night. Sleep cooler, lounge lighter, stay cozy.

All right, we are back with Kaveh Hoda as the fill-in for Lady Glockenfleckin today. And by the way, she was very receptive to you sitting in her, not sitting in her seat, but, you know, taking the mic.

for this episode. I wouldn't mind if you called me Lady Glockenflecken for the remainder of this podcast. If I do, it's, you know, you can understand. You're not dissimilar. Like, it's, you know. It's sort of like looking in a mirror sometimes when her and I are talking. Just a little bit. A lot. I want you to think of that next time you guys are intimate. That's what I want.

It helps that you don't have a beard, I guess, but that's about it. Yes, right. That's the pursuit of the two of us. For this sphincter draft, are we going to have theme music? Are we going to have an ESPN? We need to have... Can we get that in post? Sure, yeah. Producers will handle it.

Okay, perfect. I have no idea if that's possible, but we'll see what we can do. Okay, cool, cool. I think it's a great idea, though, because this is really important. Yeah. And the first time I think a sphincter draft has ever happened. So let me set it up. Okay. Like what exactly we're doing. First of all,

This is ridiculous. What's about to happen. But, uh, but I think it's, um, it's important for people to understand kind of the hierarchy of sphincters and what, what kind of sphincters there are in our bodies, because we have more sphincters, I think, than people realize. Yeah. Uh, and so what we're going to do is we're going to take turns and you're going to go first because you're, you're our illustrious guest. Um, and we're going to take turns, uh,

picking sphincters. And our goal is to put together a team of sphincters that would provide you with the best possible quality of life. Okay. We're putting together a team. Okay. Yeah. And whatever sphincters you don't get, you're

Like you're just, you have to live without those sphincters, right? So whatever sphincters you choose, that is what you're living with. That is what your life is like. Okay. This is, yeah, this is going to be a tough one. Now to put it in context, there are over 60 sphincters in the human body. What?

There's a lot. I looked it up before we did this. I thought there were like 12. There was apparently more. I don't know what you got your information, but if it was better than Wikipedia. It probably isn't. Probably from Wikipedia. Wikipedia was probably the source material. But just so for our listeners, your listeners, not mine. There are.

These are circular muscles. They normally maintain the construction of a passage. So for normal physiologic functioning of a lot of your organs, you do need something that can open and close. And that can be involuntary, which means you're not controlling it. It can be voluntary, which means it's like skeletal muscle that you are controlling. Or it can just be responsive to a certain type of stimulus. Now,

I'm assuming for the purposes of this, we are sticking solely to human sphincters because if we weren't right at the top of my list would be the blow hole of a sperm whale. That would be my number one sphincter, but we're keeping this human, correct? Correct. Okay. So I'm a GI dog, but also, um, I thank you by the way, for, for, for explaining sphincter. I, you did that better than I actually could. Um, and, um,

I have a question just before we get started. Yeah, please. Does...

Does every organ have a sphincter? It's only like organs that produce things. I don't think, yeah, I don't think every organ has a sphincter. Like the brain has no sphincter. I mean, there might be, there's valves like in the blood vessels, but there's not like a sphincter. I'm pretty, pretty sure. Okay. You work closer to the brain than I do. That's true. Okay. So anyway, let's, let's get started. Let's go first. So, uh, I'm a GI doctor. The first pick.

In the 2025 Sphincter Draft, Kaveh Hoda selects... This was a really tough call for me.

It has to be one of the anal sphincters, the internal or the external. These are part of the pelvic floor muscles, the sphincters that help control your anal canal and help you not only evacuate when you need to evacuate, but keep things closed when you don't need things closed. I'm probably going to say the internal anal sphincter will be my number one because we're talking about in terms of like your, in terms of like

keeping your dignity in terms of keeping like your comfort, being able to live a little more freely. This smooth muscle nestled within the walls of the inner canal is, is always there working for you. You don't have to think about it. It's closed when it needs to be closed it when it's working correctly and it opens up.

when you need it to open and you need to do your thing. You don't have to consciously decide when to relax it. It responds and it's, it's there for you, um, working there to make sure you aren't having unwanted leakage or accidents. So I think in terms of overall, like dignity of the patient of us, uh, I'm going to pick internal sphincter. It was a tough one, but I'm going internal sphincter is my number one. So good choice. Uh, you know,

you know, people probably assume that I would, cause there isn't an eyeball related sphincter. Uh, but no, I am putting my pride aside and, and I actually looking at all the different sphincters in the body, the eyeball related one is actually quite low on the list. Um,

I also was trying to decide for my first pick whether I would choose external or internal anal sphincter. Right? It's a big one. I chose... Actually, I was going to go with external anal sphincter as my number one. Yeah. Tell me your reasoning because this was close. I almost went this way. So the reason is because...

First of all, I just, I don't want to, I want to control whether or not I poop my pants, like bottom line. Right. Um, I feel like quality of life. That's huge. Uh, and with the external sphincter that it's skeletal muscle, right. You can control it. Uh, and I feel like you could like work it out if you need to.

Yeah, like Kegels. You can improve these things with training and strengthening pelvic floor exercises. It can. Yeah, you could go to the gym, but for strengthening your external anal sphincter.

And so that's why I went number one, because I feel like, I don't know. And I have no idea what the power of the sphincter, like which one is more is, is like which muscles stronger. Um, or, but like, I don't know if, if I just, if all I have is an external anal sphincter, what would happen? Well, that's the problem is you have to voluntarily control that. So I,

That's the only reason I didn't pick it because it's more of a backup control, really. If your internal one isn't working, then you have to constantly be like working on it. You can tell what I'm doing. I don't know if your listeners can tell, but people watching can tell just from looking at my face that I'm tightening up my sphincters. Gotcha. And, you know, I think that's exhausting over time. You probably could exercise it to the point, just like you're saying, train it to the point where maybe it's like...

constantly closed but i don't know you're gonna sleep at some point you might have a little bit of like uh you might pass some gas at night and you want to be able to control it without having to think too much about it i it it's a close call close like thinking about breathing right so the internal anal sphincter it's just it's always there for you yeah until it encounters something it needs to evacuate and then it relaxes that's exactly right yeah

Dang. Okay. But listen, I don't think it's unreasonable. I don't think it's unreasonable because just like you said, there are things you can do

to improve your external anal sphincter, it's hard to work your internal anal sphincter. No, you can't do it. Yeah, you can't. But you can improve your life with some steps. I think I could have one of the strongest, like, I don't know if there's a Guinness Book of World Records for like the amount of, like the length of time contracting your external anal sphincter, but I feel like I could approach it. You're famously known for that.

Right? Yeah. I think if anyone could pull it off, it would be you. I've been contracting it the whole time we've been talking. It's amazing. I'm not even thinking about it. It's just, I just have, I just, I can just do it. It's funny you say that. Now that we're talking about it, I do like, I'm kind of wriggling in my seat because I feel like I need to clench it more. Yeah. Right? It's like when you start to think about walking, it becomes really uncomfortable and you're like, wow.

this walking is so weird. What do I do? It's kind of like that. If we think I'm going to stop talking about my sphincter now, because I want to stop thinking about it. Let's go to number three, our third pick. What do you got? Okay. So again, I'm GI, which is, I'm assuming why you want it to do this. Cause you know that we are the king of sphincters. I'm going to say the lower esophageal sphincter is next on my draft. Now,

This is the muscle that separates your esophagus from your stomach. So it stays closed so you don't have stuff from your stomach. Again, this is all in the context of sphincters working the way they should.

People who have bad reflux and other issues, this may not be the case. But if your sphincter is working the way it should, it keeps stuff from your stomach, from getting up into your esophagus, giving you heartburn or reflux, from regurgitating, rumination syndrome, all this stuff. You don't want it open when you don't need it, but you need it to open when you do want it so you can swallow, things don't get stuck in your esophagus. So,

It's a pretty big one. It allows you to eat. It allows you to keep things from coming back up and aspirating and killing you. Probably for your health overall, it's probably more important, I think, to have a functioning sphincter because it helps decrease the risk of aspirating something into your lungs.

Although you could argue that if you're pooping yourself, you're creating infectious risk for infection. But I think, so I'm going to go with a lower esophageal sphincter as my number two. All right. That's a good one. Number two would be, you know, that's a good one. That's a good one. I was thinking with the lower esophageal sphincter. So if you don't have that sphincter, then things would just pass like,

up and down easily, right? It would be gravity dependent and if you lay down, you would have a problem. But what if you just took a bunch of, what if you just inhibited all your

So, okay, this is a great point. And this is why it's not number one, because as you're mentioning, there are a lot of things that you can do to fix this if you don't have one. I just would never eat spaghetti with meat sauce. Yeah, but what kind of life is that?

Yeah, that's true. So, but here, here, you're, but you are right here. Here's the thing. You know, when we treat reflux, most of what we're doing is indirect treatment of it. We're treating the acid in your stomach, not the problem. The problem is that muscle is weak and it's allowing things to come up.

But if you decrease the acid, you tend to have less of that issue. It tends to hurt less, but it doesn't make it go away. There are things that we can do. You can get surgery. There's surgeries, and those surgeries have improved over time. They become less invasive. There's even a lot of work around minimally invasive things like little bands, like the link system, which is like a little string with beads on it. It's not as popular right now, but there are things along that line.

lines are in the they're coming down the pipeline so there are more options for it but yeah all the treatment we have for reflux it's really indirect it's that muscle that's weak and the muscle's not closing the way it should and you do there are things you can do but largely they're surgical if you really really want to treat them yeah that's a good pick it's a good pick okay

All right. I went, I kept with the, um, the externals. I, so I went with external urethral sphincter for my, for my next pick. Yeah. Um, yeah, my, my top two were external anal, internal anal, and then I went external urethral. Yeah. Just because like quality of life, I don't want to be, we pee, we make so much urine.

I, you know, like, I feel like that would affect my quality of life quite a bit, but I could always just wear diapers. Right. I mean, the,

I feel like it's manageable. Like there's, it's enough of a problem. You can have a leg bag with like a calf or something. Exactly. Right. You could always, I think you can manage that and still like be able to function, you know, pretty normally in society because a lot of people have this problem. And so I feel like we've, we've got a lot of solutions to help with that. But I,

But I would still like to have that sphincter. You're not going with the eye though, huh? Not yet. I'll tell you why once we get there. I'll tell you why once we get there. Well, the urethral sphincter was actually my next one. Yeah. So that one you got. There's nothing I can do about that. What do you got? The next one I have is the, this is a tough one because it's kind of a valve. I don't know if you'll accept it. The ileocecal valve. I accept that. Okay. That was on my list. Okay.

So that separates the ilium, the end of your small bowel from your colon. And it helps regulate your GI system, helps regulate the flow of things through your gut. You can, lots of people live without it surgically. Sometimes it has to be removed for one reason or another. Sometimes it's really bad scarring from inflammatory bowel disease or there's some issue there. So there are people who do not have it.

Um, and there they can live normal lives, but it is still nice to have. It still keeps things, still keeps things sort of like regular helps you have a good normal peristalsis and helps your bowel movement. So that's my, that's, we're going down the list now, but that's slightly below urethral sphincter to me. So if you, if you don't have the ileocecal valve, what are your bowel movements like?

They can be a little bit looser. Things are moving through a little bit faster. But people will oftentimes get used to that. In fact, sometimes when people lose their part of their colon at first,

It's hard. A lot of water is absorbed there and, you know, you get watery stools. But over time, it's almost like the small bowel adjusts a little bit and it helps do a little bit of the work with the colon. So you can... Fix up the slack a bit. Yeah. And you also can change your diet a little bit and people do that over time, you know, and things get better. So it is manageable. But if you can maintain the ileocecal bowel, that's always best.

If a surgeon does not have to do a surgery that removes that part of the colon, they always want to because it helps patients. And it also complicates the surgery a little bit too. I feel like losing that valve would be a little bit rough for gastroenterologists because you get so much pride in reaching that valve on your colonoscopies. Yeah, we really do. It would take a little bit of the luster away from it.

You know, every time I get in, what I say, I say two point conversion every time I do that. And I'm sure the staff in there love it every single time. Every time. So weird. They always laugh. It's amazing. So weird.

Almost like they don't want to piss you off. Lightly staff doesn't actually try to kiss my ass in any way. Good. All right. I got my next one. Yeah. I'm going to step in on your wheelhouse. Oh, I know what you're going to say. God damn it. I'm going to go with the sphincter votey. Damn it. I knew that's what you were going to do. Yeah. Now, and I'm choosing this not because I really like

like fully understand what it does. Nobody does, but, but it does seem bad.

to constantly having pancreatic enzymes and bile just pouring into your small intestine. Yeah. Right? Well, I mean, so, okay, so for your... Tell us about the sphincter. Yeah, okay, so it is a bit complicated, but you have this biliary system. If you think about your gallbladder, it sits underneath, nestled up peacefully underneath your liver, and connecting your liver...

your gallbladder you make the gi track seems so elegant it is beautiful really in its own way if you you want to connect your small intestine your gallbladder your liver and the pancreas and they're all connected through a little intricate series of tubes and ducts and those empty out into the small intestine and you know in response to eating there's uh these things are releasing uh

enzymes and bile into your GI system to help you digest your food. Now, the sphincter of ODI is a relatively poorly, in my opinion, I'm sure there's some ERCP interventionalists who will write in talking about, you know, how they do understand very well. But I think it's a relatively poorly understood sphincter there. It's a thriving part of my listenership. The ERCP. You don't need that kind of toxicity in your life. You gotta shake that. Anyway, go ahead.

And sometimes if this sphincter doesn't work right, we think it can cause some problems called syncope.

sphincter of ODI dysfunction. And that can cause people to have like, it's a really confusing thing because it can cause a lot of pain. And sometimes there are different variations of it. There is a sphincter of ODI dysfunction where there's no lab abnormalities. We've ruled out everything, but the story seems suggestive of sphincter of ODI dysfunction. And we think that might be it. And then sometimes it can cause some lab abnormalities and it becomes very tricky.

A big part of the problem is we don't have great treatments for this. As of now, one of the few things that we can do is to do what's called an ERCP, endoscopic retrograde cholangiopancreatography. It's a big fancy, it's nice, right? Practice that. And you go in with a scope into the mouth, into the esophagus, into the stomach, into the small intestine, and you try to get in there and you make a little cut in the sphincter. And that we hope will help.

Sometimes it does, but the problem is it's also very likely to cause pancreatitis and it could be severe. So it is, it's a bad news situation. That's why I did not pick it because I find it to be problematic. I don't.

I don't enjoy that because when patients have it, we don't as of now have great treatments for it. Gotcha. Okay. And there's even some people who aren't even sure it exists completely, you know, forms of it. Like if we don't have some proof, it's hard to know. And there are some people who say you could do manometry. You could...

put a balloon into the duct and measure the manometry and how hard it's squeezing. But I don't know how great that test is. It's not fantastic. And that can also cause problems. So that's why it's not high on my list. But I do love the name sphincter of Odi. Yeah, that's a good name. I'm sure there was some Dr. Odi or something that came up with that. Yeah, with Garfield, with Dr. Garfield. And they did great work in the 80s on lasagna. Yeah.

And, uh, the, um, uh, but I think that the running the risk of like severe abdominal pain that like, that there's no, you know, yeah. I, so I feel very justified in my selection. Yeah.

All right. That's enough of that sphincter that we don't understand completely. So what do you got? Well, turnabout is fair play. You take something I love. I take something that you love. I was afraid you were going to do this. Yeah, I wasn't going to. You made me. You made me do this. I'm going to take what I assume is the major sphincter muscle in the eye, the sphincter pupillae, which I hope I'm saying right. Yep.

located in the iris. Yes. Am I also right about that? Yes, the iris. It controls the size of the pupil by constricting it in response to bright light or parasympathetic function. Correct. And it helps regulate the light that comes in. So I feel like what you're going to tell me is that you can live without it. You can wear like big sunglasses or you could probably get by without it. But it does seem like

annoying a real nuisance to have to do that it would be and that was going to be my next pick if you didn't go there but it's it's the only sphincter in the eye so it's very it's like our pride and joy as far as sphincters go only one sphincter that's it we got lame and you know the iris is one of those things like is that you is you don't

really appreciate it until it's not working correctly. Yes. And, you know, doing the majority of my time, I do a ton of cataract surgery, right? As a lot of ophthalmologists do. And one of the lessons from my mentor in residency was whatever you do, do not mess with the iris. Because if that, if you start, if you have damage to the iris, because you can damage it during cataract surgery, you damage the iris, it can cause lots of problems if you have

transillumination of the iris. Basically, you lose the pigment behind the iris. You get these transillumination defects because the point of the iris is to modulate the amount of light that comes into the eye. Yeah, like a camera lens, right? Yeah, exactly. So if you have too much light coming in the eye,

then you're going to have glare issues you're going to have incredible light sensitivity if you have too little light coming into the eye then obviously you're not going to see that well in dim lighting conditions because you won't be able to open the pupil as well that's not as much of a problem as too much light coming in um because there's a lot more diseases that can cause that kind of problem so if you don't have your your pupil sphincter muscle which

which is what, yeah, you're right. It constricts the people down. Then you're going to have way too much light coming into the eye. You're going to, you're going to want to live in a very Northern climate because, uh, you want the, the, you want, uh, you know, overcast, like honestly, Portland, Oregon, Seattle, Washington would be great place for you because you just places where you don't get a lot of sunshine.

Uh, because if you're in the middle of summer, bright light, your pupil, you will not be able to constrict your pupil. You're pretty much going to be, you'll be able, your pupil will be able to dilate because you still have a dilator muscle that opens the pupil, but you won't be able to constrict it down. And so, uh, you're going to be, it's going to be tough in bright light. So dark sunglasses, like a radiologist. So.

So if it does dilate, then will it just stay dilated forever or will it eventually tire out and come back down? Yeah, because you'll have unopposed dilation. You won't have the constrictor muscle. So yeah, I think you'll probably... I have no idea because I've never seen a patient that didn't have any of that constrictor muscle. Actually, patients...

have aniridia just don't have an iris but that's a slightly different thing so yeah i think you will have you'll you'll be fairly dilated like a good five six millimeters which is a pretty large pupil have you ever heard this theory about why pirates actually might have had eye patches um i'm about to hear it yeah so this is an actual theory because wait hold on let's before you get this is let's tease this let's take a break we'll come back and we'll hear we'll hear you it'd be a

Hey, Kristen. Yeah.

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All right, back with Kaveh Hoda as my co-host here. So, Kaveh, tell us about the pirate theory. Why do pirates wear patches? Okay, so I think this is fascinating. So, you know, a lot of times we are...

impression of pirates, it's hard to know what's real and what's from movies. And the eye patch is one of those things. It's like you assume it's because they've been in so many fights that they've lost an eye or something. But there's another theory, and that is that a lot of these sailors had to work between being on the top in the light on the deck where there's out in the sun, and then going down into the bowels of the ship where it's dark. There's not a lot of light at all. They didn't have electricity. And so they would just

flip to the other eye. Oh. So they could just use the other eye that was already in the dark and it was already ready for it. And they could just alternate back and forth between the two. And now, again, I mean,

I mean, I think we're pulling a lot of this out of our butt. But I think it's a really interesting concept. Interesting and totally unnecessary because for a normal eye, you adapt very quickly. I mean, they did a lot of things back then that don't make a lot. I mean, there's a lot. Honestly, it probably just was because it looks cool. I mean, snake plissken? Come on. Although it's really hard to be a badass with...

with a patch in real life it's really hard to do there was in the second one where he's like playing basketball I don't know if you ever watched the escape from LA I did not see LA it's not great but there is a scene where he has to like he has to shoot baskets to do it and

it. And when they like, and Kurt Russell was actually a basketball player in high school and college. He's very good at the game. And I watched this behind the scenes take where he had to do this and it took so long because it's so hard to shoot hoops with one eye. Very challenging. Anyways, well, I mean, that's a patch story. Well, a lot of people also think that whenever you have only one eye that you have no depth perception, which is actually not true.

You do, you suffer, you don't have as good a depth perception as you normally would with two eyes, obviously, because there's binocular depth perception, but you do have monocular clues. Like if you look with one eye, you can tell if one object is in front of another object, right? You have monocular, so you can drive with one eye, you're like testing it, right? I don't know how much depth you can get in your tiny little...

recording studio there slash guest room but it's like it looks like i think the wall might be just six inches behind you touch it but but you do have monocular clues but yeah that would be that'd be very challenging to do something that has to require a lot of hand-eye coordination like like playing playing hoops yeah all right yeah fair all right so so i think i think well that's enough sphincter talk i think we've we've built teams uh so you have internal anal sphincter mm-hmm

The lower esophageal sphincter. Yeah. The ileocecal valve. Yep. And the iris. Yeah. That's a good team. Yeah. Well, you let me go first. I know. I know. So I have external anal, external urethral. Man, I'm going to be doing... I'm just constantly doing... A lot of work. I'm just like...

Constantly I can't even hold down a steady job I'm too busy just doing kegels I don't know it's a good argument to be made for it though I got the sphincter of Odie And then Oh I have one more pick You're right So my last pick Because I just don't know Any more sphincters I'm going to just go with the Pyloric valve Yeah okay

I'll take, I'll accept. Yeah, because I just, I like this, the name of it. It's pyloric. It's strong. Yeah. And I do. Sounds like a war fought in the Middle Ages, the pyloric wars. Yeah. And I feel like you'd probably get a lot of diarrhea if you didn't have it. Yeah. Oh, yeah. You're going to, it's really bad if you don't have a functioning pylorus. Yeah, no, it's a good call. Very good call. Pylorus. You don't have a pylorus. I'll tell you all about the incisora next.

I like that you pulled out pupillae. You made me do that. I didn't want to do that. You think I want to do that? I don't want to do that. You made me. All right. So I want the listeners to, who do you think has the best, will have the best life with the assortment of sphincters? I am really curious to see what happens with these responses, actually. I usually try not to read, like, you know, comments on YouTube. I'll let you know. No, this one I'm willing to do. I'm going to check it out. Yeah.

Yeah, for sure. Um, all right. I want to do one more thing with you, uh, before we wrap up and that's, uh, we did talk about the pit a little bit more. Absolutely. So I was on a recent episode with you on your podcast. Um, we were talking about the pit. I'd only seen three episodes at that point. I have now seen the entire, I basically went after we recorded, I ended up binging the rest of the season. Um, that shows amazing. Yeah. First of all. Yeah. Incredible. And my God, what a shift.

Yeah, I mean, it's a little bit over the top, but yeah. Okay, so I have just a couple thoughts. One is kind of a problem I have with it is the...

the abilities of the med student and like first day interns. Yeah. Yeah. Like they're doing incredible things. They're doing, they're doing a ton of stuff. The biggest problem I have, and I'm going to, by the way, this is a spoiler alert. Okay. For, for people who haven't seen it, who don't want to be spoiled, you know, just, you can stop listening for a few minutes here. Um,

The, the, the, the, I forgot her name. The intern that, that, um, uh, told on, um, about, about the, he's stealing the medications. Half Filipino speaks Tagalog. Yes. Yes. So she's a, she's like a first day. This is like our first day of internship. Yeah. All right. If that was me first day, I'm just trying to survive. Yeah. Like how on earth is she have like the capacity to,

to be paying attention to the, the, the, the speaking habits and the, the, all the little nuances to, to come up with this theory that this intern, this resident,

is stealing medication. Like I would just be, I'm flying by the seat of my pants. I'm just surviving. How, how the wherewithal to like, to be able to like do that on your first day on that shift seemed a little bit unbelievable. There's a lot, there's a lot of that in the show. Yeah, yeah, exactly. I mean, we,

made very clear. We both admire the show. We both like it very much. It's a great show. It should be watched. They should also hire us to not only be consultants, but to also come in as guest starring roles as bickering gastroenterologists and ophthalmologists. Oh, Dr. Santos. Dr. Santos. That was the name of the intern. But there is a lot of...

of this where it's like they remember how Michael Weber on the House of Pod was talking to us about how you have to have these plot devices to move things forward. I mean, she's kind of there as this plot device to do two things. One, kind of be a foil because she's kind of a jerk and she's kind of like it's kind of an interesting character in that way because she's like she's nuanced and she has like

Part of you does not like it because she gives everyone these nicknames that nobody likes and nobody wants them. She's a bit grating. Yeah, yeah. She hoists them on people and it's a little bit abrasive in that way. And then also because you're kind of rude, they make you really like this one resident a lot who then she comes into a lot of conflict with and she ends up being right about the drug use. And it does...

it is kind of just there to help bring that story out. Because, you know, I think Noel Wiley really wanted to bring that doctor's abuse and medication, which I hope is not that common, but, you know, we've talked about it on our show. I'm sure you probably talked about it on your show, too. It can certainly happen. So I think that's... I think that she was there really for that purpose. And it kind of doesn't make that much sense when you think about it, just like you said. And again, the fact that she...

got the, the one thing that was nice is when she orders the BiPAP on the patient who shouldn't have had the BiPAP. I forget they had like the pneumothorax. You know, that was a nice teaching point. It also shows that they're not perfect, that like they did make some mistakes. That was nice. But yeah, there's a lot of that where you're just like, after you watch it, you're kind of like sit back and you're like,

That didn't make that much sense, did it? It just didn't. Most of the stuff did make sense. I wanted to ask, though, what would a gastroenterologist abuse? Octreotide? Oh, man, that stuff's good. Octreotide.

That's good stuff. Yeah. Timolol for me. I just, you know, really, you know, we have narcotics. Oh, you do? Yeah. I mean, we, we, we use, we use sedation for, you know, procedures. I mean, well, it's usually like the anesthesiologist or the giving it, but you know, um, it's there in the room. Uh, are you, we're, we're really getting the fiber go down a dark path. Some of that fiber. Are you hoarding? Are you hoarding a go lightly?

You know, one day I'll be able to weaponize it against people. I'll find a way. Flip it in. No, I did lose a bet though once with a nephrologist friend and I did have to drink cola.

And that's, yeah, it's not fun. I know what it's like for my patients. I mean, that's the hardest part of our procedure. I think we talked about this before, is the prep you have to do for a colonoscopy. It is brutal. It does not taste good. My recommendation for your listeners who have an upcoming colonoscopy, remember to keep the drink as cool or cold as possible. Good tip. Now, here's why that works. Like, you've seen those beer commercials where they're

Where they're like, if it's cold, the can, the mountains on the can turn blue. It's like so dumb, right? It's like the one thing that we, the consumer, have control over is the temperature of which we keep our drinks, right? They know that their beer tastes so bad that if you can keep it cold, if they can incentivize you to make it colder, it'll be more palatable. It's the same thing with the nasty stuff you have to drink for colonoscopy. Keep it cold.

Keep it cold. Good to know. Okay. And wet wipes. Wet wipes. Because it's alarming. I thought about this recently. It's alarming how quickly my first colonoscopy is going to be coming up. Soaring around the corner. I'm trying to talk myself into it being a positive experience. It is. Oh, the hardest part's the prep. Yeah. It's going to be all downhill. Yeah. Almost literally from there. It's going to be real easy.

All right. Real quick. Let's do, let's do, I want to know where the pit, um, factors into like your top medical shows that you've seen. So what do you got? So I don't watch a lot of medical shows for one, for two reasons. One, either they, you know, I'm trying to get away from that and I want something different and I want, you know, you're the only, this

This is the truth. You're the only medical podcast I listen to. Like, I just don't listen to a lot of medical podcasts. Oh, I appreciate that. Yeah. You listened for Lady Glock and Flecken, though, I'm sure. Well, I mean, you guys are an amazing combo, so that's why I love it. So that's one of the reasons. But then the other reason is if I do watch it and it's nonsense, then I get mad. It annoys me. So most of what I like, it's not for the medicine itself. Pitt makes it on there for being medically accurate.

you know, most part with a small nitpicks that we have. Um, and it understands the, the,

the medical crisis that our healthcare workers are under. And it brings that to light and it does an amazing job of that. And Noah Wiley is great. So I've been very happy with that show. So that's on the list. It won't be number one for me though. Okay. Number one, should I say number one for last? Go, go, go five to one. Okay. So it, number five is a tie between, um, St. Elsewhere and Doogie Howser. Hmm. That's,

That's a little bit before my time. So I don't, well, seeing elsewhere was definitely before my time, but I, you know, I saw reruns of it and it was medically included or medically sort of related. And I, and I watched a couple episodes, didn't watch a lot, watch a couple episodes, thought it was like entertaining writing, good actors, uh,

I could already tell. So, but I didn't watch a lot of it. So, you know, Doogie Howser, I did watch a little bit more of, uh, medically speaking, not incredibly accurate, but it's a fun story. It's like, you know, whatever. It's like, there's nothing in the rule book that says a golden retriever can't play basketball. It's like fun in that regards, you know? What were you, what were you doing when you were 12? Are you going to medical school? Probably not. No.

No, much less so. He was like 12 years old then. He was a pre-k drive. I remember he couldn't drive at the time. That's right. All right, what's next? So then number four...

is one that I think might surprise you, and it's Nip Tuck. Oh, that was on my list! Yeah, is it right? Yeah, yeah! It was over the top, it was silly, ridiculous. Right, you know what I'm saying? It was nuts and stupid, and there was no part of me that was like, this is not medically accurate, because I'm like, they're not even trying. It's absurd. That's a show I don't think I would watch now if it came out, because that was one of the first medical shows I ever watched. So I just, I wasn't

as in tune to like what a medical show should be and so this it just seemed so it was on cable so it was you know it was like they you know it was blood and guts and all kinds of stuff so it was like sexy yeah yeah yeah jump the shark every other episode from the crazy there was like nuts weird absolutely nuts storylines that like yeah um okay so then for me third would be mash okay

And just because it was on constantly, like I remember that being on the TV all the time. Reruns were always playing. It was funny. It was the first time that like,

It's funny because it's so different from the movie. The movie was good, but the show was very different. But it kind of like showed Doctors as like fun, a little bit counterculture, kind of a little punk rock. They were like, you know, they're out there helping people, helping both sides, not trying to be cops about it. They were like trying to just do what's right and what's

their Hippocratic oath told them to do. And it was for the large part funny. It was weird having a laugh track. It was kind of bothered me. I'm like, why is there an audience laughing in the middle of like Korea? It didn't make any sense. Good point. But that song, you know what the lyrics of that song are? The lyrics are suicide is painless. It brings on many changes. I'm not making that up. People can Google it and they can hear that. Yeah.

Anyways, so you have so much random knowledge. This is too much. One may argue too much. What's number two? So number two is the pit.

Yeah. Okay. That's where it falls in for me. And number one, I think you, you, you can guess, right? Scrubs. ER. Scrubs. No. ER doesn't make the list. ER doesn't make your list? Scrubs. I didn't even watch it. I couldn't watch it. I wasn't that into it. Scrubs, number one, it gets the, the pathos of training so, so down. And it's like, it was fun to watch. It's fun. Even if you're not,

in medicine because of the humor, the banter and the friendships. And it felt, it felt so real at the same time. I really enjoyed that. Here's my five. I'll just go through them real quick. So Nip Tuck five house for, I love house. I it's, it's the most ridiculous show in the world, but I just absolutely love it. Uh, pits three for me, ER two scrubs one. And, uh, honorable mention to the scene in, um, the TV show one tree Hill, uh,

Season six, episode 18. It was called Searching for Home, where a dog eats a human heart transplant that was intended for one of the main characters. I've seen that in clips. I've seen that in Instagram. Can I add an honorable mention? Sure. The show Lost. I think they did a pretty good job with their medical stuff in the show.

Not just because one of the main characters was a surgeon, but there would be like, there's a point where someone gets injured and he didn't know it was a crush injury. And that changed the way he treated the patient. And because of that, like the patient ended up dying and he ended up being really mad when Boone died. Anyways, that I thought that...

I thought they did a good job. And actually in the back, there's a scene with Ben from the others. And in the back, I noticed in his like wall of books was the Marino ICU book, that blue ICU book. That was like one of my favorite books of all time. And I love that book. And I was like, that's dope. Somebody knows what they're doing on this show. Well, um,

I think we both have, those are some great, great, uh, great shows at the pit guys. Check out the pit. If you haven't seen it yet, please go watch it. Um, the whole thing, it's just, it's wild, wild show. And I hope they do the night shift. I think it'd be fun to see the night shift. Um, uh, so that's it. Kaveh, you did great. It's like, it's almost as if you have your own podcast. I don't know. You know, I'll never, I'll never be, I am basically the

If you ordered Glock and Fleckens off of Timu, you would get me. That's kind of what you're going to get. It's sort of, you'll like recognize it. Yeah. It doesn't work quite as well, but that's, if you, if you, if you like it, then you might enjoy our podcast, the House of Pod.

Well, you definitely check that out. The House of Pod. I've been on there a couple of times and I hope you invite me back sometime soon. Oh, man. I'd love to have you on. You're obviously one of my favorites. Every time we talk about medical shows and movies, it's fun. Yeah. Oh, I love it. We're going to keep doing that with Michael Weber. I think that's a lot of fun. All right. Well, thanks for joining us. Thank you. Thanks so much to Kaveh Hoda for filling in for Lady Glockenfleckin today. Let me know what you thought of the episode. Did you like the sphincter draft?

Are there any other drafts we can have for human body parts? I'd love to hear what you think. Email us, knockknockhigh at human-content.com. Visit us on our social media platforms. You can hang out with us in the Human Content Podcast family on Instagram or on TikTok at humancontentpods.

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That's right. Milo is getting, I feel like he's getting worse eyesight. Maybe he's just slowing down because he's getting a little bit older. I don't know. I don't, maybe I should learn some dog ophthalmology or find a dog ophthalmologist. They seem like they'd be hard to come by.

But anyway, thanks for the comment. Also, full video episodes are up every week again on our YouTube channel at Glock and Plekans. We also have a Patreon, lots of cool perks, bonus episodes, react to medical shows and movies. Hang out with other members of the Knock Knock High community. Early entry episode access, interact with Q&A, live stream events, much more. Patreon.com slash Glock and Plekan or go to GlockandPleka.com.

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and Sean A.D. Patreon roulette, random shout, someone on the emergency medicine tier, Ashley K. Thanks for being a patron, and thank you all for listening. We are your hosts, or I guess I am your host, Will Flannery, also known as Dr. Glockenpluckin. Lady Glockenpluckin is going to be back next week, I promise. Our executive producers are Will Flannery, Kristen Flannery, Aaron Corny, Rob Goldman, and Sean D. Brick. Editor and engineer, producer of music is by Omer Bensvi. To learn about 99 High's program, disclaimer, next policy, submission, verification, licensing terms, hip release terms,

You can go to GlockofLego.com or reach out to us, knock, knock, hi, at human-content.com with questions, concerns, or fun medical puns. Knock, knock, hi, it's a human content production. Knock, knock, goodbye. Hey, Kristen, am I a good multitasker?

Sure. I don't believe you. Oh. That was not very convincing. No? That's okay. I fully admit I'm not the best at it. And the problem is physicians have to do a lot of multitasking. Yeah, that is a problem. Like I'm sitting there, I talk to the patient, I hear all the things, synthesize all the information, come up with a diagnosis, sometimes order medications, and then maybe that has an interaction with a different medication. You got to like figure that out.

you know, what can help though? What? Microsoft dragon copilot. Yeah, this is great. You don't have to, you can just use dragon copilot like in your workflow. You can access information right at the point of care, right there with the patient. And like, if I wanted to look up a code, a diagnostic code for the encounter, I can use dragon copilot. It's it. I can look up drug, drug interactions. There's, there's, and,

an endless number of applications that you can use Dragon Copilot for. That's true. Very true. I think it's good for you as a patient, too. Yeah, I mean... Because it's streamlined. It's streamlined. And you get accurate information more quickly. Yes, exactly. You're taking the words right out of my mouth. To learn more about Microsoft Dragon Copilot, visit aka.ms slash knock knock hot.

Again, that's aka.ms slash knock, knock, hi. You've been caught, Denton.