They Told Her It Was Just A Wine Headache (w/Dr. Kathy Travnicek)

– What up, fam? It’s your boy, ZDoggMD, welcome to the show. This is going live to supporters because I love my supporter tribe. Thank you for subscribing. You get this stuff first completely uncensored. We’ll decide whether to censor it for the main audience when we put it out. The way we do it now is we go live to supporters. We get your comments. We interact with you and then, we go to a podcast in a couple days. So, that’s out to the world and then to the main page for everybody to watch via web posts, YouTube, all that. But, getting it here first means you get your questions answered. Today, we have a crazy story. This is insane. So you guys all remember Dr. Kathy Travnicek from three previous episodes that she’s been on. She is a physical med and rehab doc right here in Las Vegas, specializes in pain. So we’ve done shows on Dilaudid. We’ve done shows on running ultramarathons and crazy endurance sports. And we’ve done shows on, you know should physicians be packing guns, all kinds of crazy topics. Kathy T. is our go to person. But something crazy happened in the last few months. I got a text from Kathy T. and she’s like, I’m in the hospital and you’ll never believe what happened. So, she’s here today to talk about what happened because it is a cautionary tale for all of us. Kathy T., welcome to the show!

– Well, hello.

– How are you? You look good, girl!

– I, well, I’m fully recovered 100% good and I’m exercising again.

– The thing is like you almost died and yet, here you are. You just got back from Egypt. You’re going to Toronto to speak. You’re on the circuit talking about pain management and things like this. But the thing is, you almost died. And when I got that text from you, I remember just going, oh my gosh, what? And just start at the beginning of what happened? And walk us through it because it is insane.

– It really is insane. And I would’ve never thought that it would happen. So, I’m at Hubert Keller’s birthday party. Okay–

– Oh wow. a surprise birthday party.

– Big chef guy?

– Yeah. And I’m hanging out talking. I’d been there for about eight hours. Actually, before I went, that morning, I ran 18 miles.

– You know, just a morning run, 18 miles.

– Morning, easy run. So, you guys who don’t know, Kathy’s like a serious endurance athlete. So she is crazy. You’ve climbed Everest a couple times?

– In my dreams, but yes.

– Oh, nice.

– Yeah .

– Nice, nice.

– So go on. So you’re at Keller’s party.

– Yeah and before I’d went there, at one o’ clock, I’d had some lunch. So I go to the party around two and around 9:00 PM I’m talking and hanging out. I had not had that much to drink that day. I’d had maybe a glass or two of wine and I had some food. I got a severe, like sudden severe headache and it started in the back of my head and it radiated to the front. It felt like electric lightning. I remember going, ow, ow. I was talking to someone and they said, you know are you okay? And I’m like, yeah, I’m fine. Because in my mind, I thought this will go away. And it just kept shooting and I said, I’ll be right back. I went and I sat down with my friends who were with me there and I said, hey guys, I got a really bad headache. They said, are you okay? Are you okay? In my mind, I’m always, okay, yeah, I’m fine. I’m fine, I’m fine. Then, I felt sick. So I went to one of the back bathrooms. I went in the bathroom, locked the door and had nausea and vomiting in the bathroom for about 20 minutes. And as I’m throwing up and laying on the floor feeling sick, I’m kind of like what is this? I’m probably dehydrated, maybe I have a virus. Because I had thrown up my lunch, which I’d eaten at one o’ clock, it’s now 9:00 PM. So in my mind, I had some virus, so I’m thinking, I have to get home, how am I gonna get home, I can’t drive like this.

– Are you still having the headache? The crazy–

– Severe headache.

– Have you ever had anything like this?

– Never had a headache ever in my life, period, never. Never had a headache. And so I get up about, it was about 20, 30 minutes later, I get up and I walk out. And I feel, I’m convincing myself that I’m okay, I’m gonna drive home and I’m just gonna sleep this off.

– Wow. And this is at Keller’s party?

– This is at Keller’s party.

– And let me just recap–

– And I didn’t want to tell anybody because of where I was at.

– Oh my gosh.

– I pretended I was totally fine because I was embarrassed, I didn’t want to cause a scene.

– Oh my gosh. You know this running 18 miles in the morning, that’s not unusual for you.

– No, I run 18 to 20 miles every Sunday.

– That’s crazy.

– Thank you.

– And also awesome.

– Yeah.

– So, at this point, you’re embarrassed. You’re like, I’m just gonna get home, walk it off, sleep it off, all that.

– Yep, yep, so I drive home. I didn’t have any other symptoms. The drunk feeling went away. I didn’t really feel drunk but the severe headache was there. I’d made sure not to drive interstate so I drove the side roads home and I pulled over every mile or two to throw up.

– Oh my God. And I would wait and then I drove to the house, parked and went upstairs, got in bed and laid down and thought, okay, good, I’m safe. I’m at home. I’ll be fine. I’ll sleep a few hours, I’ll go to work in the morning. This will be fine. And as the night went on, I got some sleep, but the nausea and vomiting resolved and the headache got worse.

– Wow. And, you know as a pain management specialist, I’m going through how bad is the headache, how bad could this really be? What is this on the pain scale? Because you know when I’m explaining to patients who, you know they come in, they circle their whole body, they write 20 plus–

– Right. and I’m like, hey, let’s talk about what a 10 out of 10 is. You’re getting mauled by a bear. You’ve been hit by a car and it’s dragging you down the road. You know all these ideas of what 10 out of 10 pain is. When I thought about those, no, it’s not really a 10. It’s, I don’t know, it’s moderate pain. It’s pretty bad, but I can get up. I walked around and drove home and I was thinking about the ultras. There were a few ultras that were very, very painful and I’m like well it’s definitely not that. So I was trying to put it in context of my experiences of how bad the pain was. So I rationalized it wasn’t that bad, it was gonna be okay.

– We’re really good at rationalizing as doctors, right.

– Yeah.

– And we’re good at going into work when we’re sick.

– Yeah.

– We’re good at sucking it up. We’re good at all of those things and nurses are even better at it.

– Yeah, 100%. So I realized I needed to go to the ER in the morning when I stood up out of bed and everything went white and I had a severe headache and I fell back in bed. So I said okay, that was bad. Now I can’t function so now I’m gonna go to the ER. This is ER status now. But the pain in my mind I thought you know, I can handle this. I kept telling myself I’m tougher than this, I can handle this. It’s not that bad.

– And you have a trained mind because you’re running ultras and doing these extreme things that require mind over body.

– Yes, yes, you’re working through a lot of pain or it’s a lot of mental tasking. So I had called my neighbor, who had incidentally had an ischemic stroke six months earlier and I’d help him with his dog and stuff so he took my dog, Yogi, and he drove me to the hospital. I remember, you know it’s Vegas in June so it’s very sunny and I remember it being very bright and I had my sunglasses on. But it’s Vegas in June and everybody has photophobia, right? So I didn’t really recognize it as a symptom until I got into the hospital because then it was like kind of a hard to see things. So the first hospital I went to–

– No names, please.

– No names, no names. Perfect, there was nobody in the waiting room. I got right in, triaged right away. And I at this point, sorry I forgot to mention, when I was at my house I was taking my vitals, I was doing a physical exam on myself. I was like maybe I blew a C23 disc and I’m like doing neck tenderness. I’m seriously doing diagnostic triaging at my house.

– Well of course you are.

– Yeah.

– Yeah, of course you are. Because I mean I would do the same thing. I’ve done that.

– Yeah, my meningeal signs, the whole thing. And I had nuchal rigidity at this point. I couldn’t move my head because I got a severe headache.

– Wow!

– So I’m sitting in the chair and I’m looking up at the PA like this because I can’t look up, my eyes are going up. So I explain to her the story. I said yes, I have a severe headache. I don’t have a history of headache, this is completely new. I tell her the story but what she heard was I was at a party, I had a glass of wine, and now I have a headache. That’s all she heard. So she looks at me and says, after I tell her the whole story–

– And she’s seeing a young woman.

– Yes, young woman, blonde, Vegas, whatever. But I can’t move my head and she still says to me oh, sounds like a wine headache. We’ll give you the migraine cocktail and we’ll send you home. And the fire that just boiled, I was fucking pissed. I was so pissed because first of all I’m a pain management physician. I wouldn’t be in the ER for a fucking wine headache, okay. And I’ve had wine in my day, I’ve never gotten a headache from it. Two, I run ultras, and I said this to her. I said I’m a pain management physician. I have to assess pain everyday. Two, I run ultras. I’m running 50 mile races all the time. And number three, I wouldn’t be in the fucking ER with a wine headache. Get me the doctor now. Like that’s all I said. And I couldn’t look at her like at that point I’d looked down so I don’t know what her reaction was. All I know is she was gone and I was in the back and I was talking to the ER doctor right away.

– Wow, holy shit!

– So had I not advocated for myself or had I not kept rationalizing I was okay, which I had been doing the 12 hours before, I would have probably got the cocktail and sent home and then who knows what would have happened.

– And you know, I can tell you right now what that PA was thinking is here’s a fucking great example of how doctors are the worst fucking patients.

– Yep.

– Like she thinks she knows everything, she’s talking down to me even though she can’t make eye contact with me. This and this and this, that’s what she’s thinking.

– Yeah, but I told her, I can not move my head to look up at you. And she said, do you have any neck tenderness. And I remember saying no, I’ve done the exam. I did all my physical exam stuff at home. I can’t move my head, I have nuchal rigidity. It hurts, the headache’s severe, my neurological exam is normal. I’m showing her my reflex and yeah.

– And you’re afebrile, right?

– Completely. I had checked my temperature at home. I was monitoring my pulse at home. But still for some reason in my mind I had a virus. I had an early meningitis or something because in my mind I was looking at everything that had happened and trying to figure out from what happened that day what this could be but bleed never crossed my mind.

– Common things happen commonly so you’re thinking it’s a viral meningitis, some kind of viral, another viral syndrome with headache. You’ve never had anything like this and you’ve been through a lot of stuff.

– Yeah.

– Oh, my God. And you know, did they do any labs or anything off the bat?

– Yeah, so I was right when they took me back there was a nurse who was on her computer facing away from me and she says what do you want for pain? This is actually the first thing that happened. And I said well, just IV Tylenol will be fine. I don’t really want anything else. She said we don’t have IV Tylenol but we have Toradol and morphine so which one do you want? And I said don’t give me the morphine, I don’t want that. I’ll just take the Toradol. Because again, I’m not thinking I have a bleed. I’m completely, it’s viral. I’ll get some antibiotics or I’ll get some treatment and I’ll be out of here.

– Wow.

– So she almost gives it to me and then says you know what, let me check with the doctor first. And so she went to the back and he said no, I’m ruling out a head bleed. So she came back and said I can’t give you any blood thinning medications because we are ruling out bleed. And that’s at that point I’m like oh, it ain’t that but that’s okay. So —

– It’s funny. How many patients have come into the Emergency Department like first of all I don’t want the morphine, fucking give me IV Tylenol? Who says that?

– Yeah, I do.

– Nobody, except for Kathy T. because you know why? Because Kathy T. has years of experience managing pain. Now this is what really fucking chaps my hide is that there’s so many patients who are effectively dependent on opioids who think that IV Tylenol is a joke and this and this and this and that’s not how you manage pain and they are so fucking wrong.

– Yeah.

– But that’s all right. That’s another subject.

– I actually learned that. So I learned how powerful Tylenol was as a pain management tool in my internship at University of Nevada Reno. We would have elderly patients come in with hip fractures and they couldn’t tolerate the opiates and we would give them Tylenol scheduled and they would do fine.

– They do fine.

– They do fine. You don’t need an opiate for that. And I learned that in internship and I’ve carried that with me throughout my entire career.

– See we trained at different times. You know what I learned at internship? That we’re under treating pain and that narcotics don’t lead to addiction in people who have any pain of any sort. Fucking bullshit.

– Yeah, it’s crazy. It’s crazy.

– So back to you in the emergency room having the worst headache, the first headache, of your life. The first headache–

– The very first.

– of your life. Forget about worst. Nuchal rigidity, your neck is stiff, you’ve sent the PA out, the doctor’s here. And sometimes a doctor’s worse than anybody else.

– He was fantastic.

– That’s awesome.

– The ER doctor was fantastic. He took me seriously and he said, the first thing he said was I don’t think you have meningitis. I’ve seen a lot of meningitis cases even early. You just, something else is going on. So he had a feeling it was something else, he just didn’t know what. So had the labs, had the CT head, and the whole time I’m there I’m just observing the ER, watching patients, trying to just distract myself. And I refused any pain medication while I was there. I was just I don’t need it, I can tolerate this. Because the headache would pulsate and then it would crescendo and spike and then it would decrescendo.

– Wow.

– So I was just paying attention to the headache and my heart rate and the physiological mechanisms that were happening. And then they called my name and they brought me back and they give me a gown. They said you need to put this on. They started to put the EKG lubes on, we need to hook you up, we need to monitor you. And I said, oh shit.

– Oh wow.

– Then I got scared.

– Yeah, yeah, yeah.

– Then I got scared and I went blank. When I went blank I couldn’t think of what it could be. You’re panicked, you’re scared, you’re vulnerable. You turn into 100% patient, there’s no doctor there. Like I’m not being a doctor now. Now I’m just a vulnerable patient. And I got in bed and the doctor came in with a nurse and they both grabbed my had and I’m thinking I have cancer. I didn’t, you know when they come in and do that–

– That’s where your mind jumped to, to cancer?

– That’s where my mind jumped because I’m just scared. So there’s no rational thought, you’re just scared. So he said you know I can’t believe I’m saying this to you but you have a subarachnoid hemorrhage and it’s not that small and we need to transfer you to the Level 1 trauma center here in town. You’re probably gonna need a neurosurgical procedure.

– Wow.

– And I just started bawling.

– Oh, my God.

– And that’s when I lost it. And that’s when I texted you because I knew where I was going. I’m like you need to come see me in the hospital.

– Yeah, yeah, yeah, yeah.

– And then my parents and other people that I’m close with. Made sure my dog was okay. And then texted the guy who dropped me off who had a stroke. I had told him oh, I’ll just get some antibiotics or I’ll get some fluids or something. I’ll be fine. You’ll come pick me up in an hour. And I texted him, I’m like, I actually had a stroke.

– Holy crap!

– So then it got real I had a stroke. And I’m in my 30s and I had a stroke.

– That is unbelievable. When I got the text from you my jaw had dropped. And immediately I talked to my wife who actually does a lot of neuroradiology at night and I think we ended up looking at your films. But we’re cutting ahead. The hospital you were transferring to was the right answer so everything was being done correctly.

– Correct.

– And oh my gosh, man. And you’re kind of alone in Vegas, right. Or do you have–

– Yeah, I’m alone and my parents are in Mississippi and then my boyfriend is in LA. I have friends all over the country and I do have friends here but in terms of direct family nobody’s here. So I was just telling people to come travel in and then everybody that I knew who was a neurosurgeon I would call. And I couldn’t text very well because the screen of the light was causing, I was having that photosensitivity.

– Even that much light?

– Yeah. And then when I was crying uncontrollably I couldn’t call people. I had to wait for that to go away before I could make a phone call.

– I love how you, that was a condition that I suffered from for a minute where I was crying uncontrollably. I needed to wait for that to resolve.

– Yeah, that resolved and then I made a phone call.

– Oh, man. I’m just glad you’re alive to laugh about it now and to talk about it and to spread the word. So at this point you probably got… So tell me, keep going with the story because this is something everybody needs to hear. Because first of all, young people get strokes. Second of all, we deny women’s symptoms all the time. It’s a wine headache, come on, fucking come on. Number next, okay, how do we manage this now and how did it happen? Everybody’s got the questions. We’re all on the edge of our seats. Tell us the story.

– Okay. So I get transferred to UMC right away in an ambulance and that ride wouldn’t have been so bad had it not been for all of the bumps. Every time I hit a bump I was like ow. And then it would go down. And the guys, they were trying to tell stories to distract me and they–

– The EMS guys.

– Yeah, and anytime we would hit it and say oh, they’d be like, we have morphine, we have morphine. And I said, I don’t want the morphine. Because it would spike to a 10, it would be severe but then it would come down. It would go down to more of a moderate level. So I could tolerate a few seconds of a 10 out of 10 and so I didn’t want the mediation. So we get to UMC, I get into the ER, which that ER is packed like balls to the wall.

– Yeah, that ER is cra!

– It’s crazy.

– We’ve shot videos in that ER.

– It’s crazy, it’s crazy.

– That’s where we shot Readmission.

– So two of my friends in town came to the ER to be with me and they were scared. Like they were full on scared .

– In the Emergency Department.

– In the Emergency Department at UMC. It was great, that was a funniest part. I’m trying to calm them down. In my own ER room.

– Right. I’ve been in that position. Yeah, wow.

– It was so funny. And the nurse was fantastic, the ER doctor was fantastic. The initial process there was great, they were great. The funny thing is so the ER doctor, they go through the medical history and ask you about your medications. The nurse comes through and does the same thing, asks you your medications. And then is when I had realized I was gonna be admitted and so the pharmacists comes in and he asks my home medications. I’ve got two home medications and I had like four or five. Then there was somebody else who asked me, maybe he was a resident. So four people and they were never even ordered. Not that that’s huge but think about it, you have four people coming in doing a job and I’ve got the ER doctor putting it in, and then I’ve got the nurse checking it, and then I’m being transferred to the neuro ICU, the resident’s supposed to check that, and the pharmacist is supposed to check it, and they were all missed. I mean for patients who are complicated I thought, how often does this happen?

– Every single fucking day.

– It’s crazy.

– It’s crazy because we don’t have a system, we have chaos. We don’t have a process, we have a bunch of parallel processes all competing with each other. We don’t do it right in the hospital at all. And I’ll tell you this as a hospital specialist, it is a fucking shit show most of the time in every, every organization.

– And I was shocked because I thought these are not high level meds. I got two meds, it’s not a big deal. So but while I was in the ER I got the CTA. Now when I got the CTA it had been about 16 to 18 hours after the initial headache. This is me after I’d gone back and kind of wrote all this down. Later on after I recovered I wrote the history down. So I’m realizing that now it was about 16 to 18 hours. And as I’m transferring from one bed to the other bed in the CTA room I got this severe sacral pain. And it wasn’t low back pain it was sacral and it outlined my sacrum. And it was so bad it took my breath away. It was worse than the headache. And I thought okay, yeah, the headache’s not a 10, that’s a 10. And I remember sitting there and I gasped and the CT Tech said, are you okay. Yeah, yeah, yeah, I’m fine. You know me. Yeah, yeah, I’m fine, just some sacral pain, it’s fine. And I remember thinking, oh shit, what is that? I don’t know what that is. And it was not from bedrest because I had only been laying in a bed for a few hours. It couldn’t have been bedrest and it wasn’t my low back either. So get the CTA–

– It’s a CTA angiogram so they’re outlining the vessels in your brain.

– Yes, yes. And boy is it weird getting that contrast.

– Tell me about that because a lot of people say this but no one tells the patient, except for the great techs.

– Yes, nobody told me except the tech. So I get in there and he says, it’s gonna be hot, it’s gonna be uncomfortable, it’s gonna spread throughout your body and it’s gonna feel like you have to urinate. And I thought oh yeah, that’s not a big deal, whatever. It’s really uncomfortable and it started in my arm when he put in the contrast, and it went up and it spread into my head and my face to where my mouth felt hot. And I opened my mouth because I was like ahh–

– You’re gonna breathe fire.

– To get the heat out because it felt so hot. And then it went down my body, it felt like I had to urinate, and then it was over. But I thought, I don’t want to do that again. That’s not fun.

– How interesting, you never hear that.

– So I was trying to ask people, you know when you start asking people very detailed questions that are physics really questions like why do I feel hot? Oh, it’s the ion movements.

– Nobody has a fucking clue, right.

– Yeah, yeah, yeah. And at that point I was like good enough for me. I was so tired and just kind of burnt out, it’s fine. That was pretty funny.

– Yeah, that’s pretty good.

– So I get up into the neuro ICU and this is when I realized I miss the days of paper charts.

– Tell me why, this is interesting.

– So I’m in the ICU and I hadn’t had fluids and I knew I’d had that contrast and I knew I was getting another femoral angio through a femoral approach.

– Tell the people who don’t know why contrast and not getting fluids is a thing, is a bad problem.

– Kidney failure.

– Yeah, one of the complications of IV contrast.

– Yeah, and it’s not uncommon. So I’m thinking okay, I’m dehydrated. I haven’t had anything to drink. I just had a contrast scan and they told me they were gonna order fluids. They didn’t order fluids or they did and then I got transferred before I got them. So now I’m in the ICU and the nurse is fantastic. The nurses in the neuro ICU are fantastic.

– Oh hell yeah.

– So I’m telling her I really need IV fluids. You can starve me for 10 days, I don’t care. I need IV fluids. And I can see the doctors rounding with their little computer thing.

– WOWs, workstation on wheels.

– Yeah, anyways.

– I miss the day when we could call ’em COWs.

– Why can’t you call ’em COWs?

– Apparently a patient overheard residents talking about their COW and they thought that they were talking about the patient because the patient was obese. And so in the infinite wisdom of management they’re like uh, from henceforth shalt it be written that we shall call them WOWs, workstation on wheels, instead of computers on wheels, which is what they are.

– Oh, my God, that’s awesome.

– So the residents got the COWs.

– The COWs, okay. So I see the COW, the WOW, and I remember saying to her, can you just pop over there and tell them that I haven’t had fluids. I’m gonna have a another contrast. All they need to do is order some fluids, that’s all I need. I don’t want to complain about anything else, I just want some fluids. And she went there and told them and then she went there and told them this is over a few hours I didn’t get the fluid order. And I remember thinking remember back in the day when you could just call the nurse when you were rounding on another floor and say hey, you know what, I forgot to write that fluid order. Or they’ll call you, hey, this patient needs fluids. Sure, go ahead do this, set this up. I’ll come by and I’ll sign it in a little bit. So I’d write it down that I gave that verbal order. They’d write it in the chart, verbal order, and the fluids would have got hung. And I sat there and waited because it needed to be put in the fucking computer.

– You know what, fuck the computer.

– Yeah, exactly.

– And the thing is we’ve trained our staff so much to be dependent on the computer that when it fails it’s downtime orders and everyone panics man. But I’ll tell you, when I worked at Stanford and we had EPIC then I would cross the bay because we would rotate to Washington Hospital and Fremont Community Hospital. There was nothing, it was paper charts to start with and just read only version of EPIC. Oh, my God it was great. And you know what, we were 100% more collegial. We had a doctor’s lounge. The nurses and us were all friends. We would talk to each other.

– Yes.

– It was fucking great.

– Yes. And people now are relying too much on the computer and I realized that during my stay in the ICU because I had, there was an ICU attending. I only saw him once and he didn’t really do anything. It was really neurology would come in and then I had neurosurgery and then because UMC has this continuity of care, the Internal Medicine doctor that I was gonna be transferred to on the floor eventually would come and see me. So I would have four doctors and I had a few different residents who rarely identified themselves or what service they were on. And they weren’t talking to each other. So there was no team work. And one would come in and tell me this is the plan and then someone else would come in the room and tell me a different plan. And at one point I thought, thank God I’m alert and oriented because I’m a make my own plan. So I talked to the neurosurgeon and then I talked to a bunch of my neurosurgery friends and they all had a same plan, they were all on the same page, and I said, this is what we’re gonna do. Neurosurgery says we’re gonna do this, this, and this, and we’re gonna do this, this, and this. So if the ICU resident came in and said, oh we’re gonna discharge you today, out. Go talk to neurosurgery. Like I can’t do that. Then neurology would come and say well we think we’re gonna discharge you tomorrow, maybe the day after. We’ll do CTA as an outpatient. And I just said look, I can’t, there’s so many different opinions here. Please talk to neurosurgery, please. We’re just gonna do what neurosurgery says because they are taking this very seriously because you can miss an aneurysm on the first angio. Yeah, go ahead.

– No, I want to ask you this because what did the angio show because I think people are asking what was it? Was it an aneurysm? What was it?

– So my CTA was negative and when the resident came in the room his response was, your CTA is negative and that’s kind of weird. That’s how that was relayed to me.

– So you had a bleed on your standard CT non-con. Is that what they saw?

– Yeah, so they saw a subarachnoid hemorrhage on the CT. The CTA was negative.

– So they didn’t see anything bleeding from a vessel. No aneurysm, right.

– Then they said we need to do an angio femoral approach the next day. So I was scheduled with interventional radiology. I went in Monday morning at 9 AM, I got that on Tuesday morning 9 AM.

– Got it.

– And it was negative. And at that time, so my baseline heart rate, this is another thing, my baseline heart rate is in the 40s and my blood pressure baseline is 90 over 60 consistently.

– Right, because you’re an athlete, an endurance athlete.

– So my initial, when I was first hospitalized, my blood pressure was like 120s over 80s and my heart rate was like 60, 70, so it’s a little bit higher.

– High for you, yeah.

– Yeah, high for me. So when I went to have my first angio, they were able to give me a little bit of Versed to relax me for the angio. I remember being relaxed and they have to walk you through it. And then you have to either the tech or the radiologist says to hold your breath, so you hold your breath. They shoot the contrast and they take the pictures. And you can feel the contrast in each blood vessel of your brain.

– Wow.

– It’s fascinating, it’s fascinating.

– And you’re also kind of doped out a little on Versed.

– Yeah, so the first angio I was a little relaxed but I was awake and aware and I could feel it but I was okay with it. The second angio all my vitals had gone back to normal. So my baseline heart rate was like 43 I think when I went down there and 90 over 60 and nobody wanted to give me any sedation.

– Because they were treating the numbers–

– They were treating the numbers. So they don’t, in the hospital everyone’s so used to treating sick patients, they don’t know how to treat healthy patients. And so–

– Definitely true.

– And they really didn’t want to give me any sedation and I said I’m about to have this angio with no sedation, let’s do this. Like I don’t have a choice, let’s do it. And it wasn’t painful. You don’t really need an opiate for this procedure. If I were to tell physicians, even patients, you don’t need fentanyl, you don’t need an opiate, you need the Versed. I had significant anxiety because I could kind of feel that coil and I was like oh, oh, oh, oh.

– Wow, wow.

– Yeah, yeah, and then everything’s more intense. The contrast is more intense when they’re like hold your breath, , whoa.

– Man.

– Yeah, it was way more intense, but you could, whatever. You know I got through it.

– Yeah, but you’re you.

– Yeah, I mean a regular patient would need Versed for that procedure. Yeah, 100%. It was negative.

– Wow.

– So the response I got from the neurologist is that we don’t know why you bled, we don’t know what this is. What did he say? The chance of this happening to you is like getting hit by lightning. The chance of it ever happening again is probably getting hit by lightning twice so live your life, go do your thing. But I still didn’t have what it was, what a diagnosis was. I’m like well how can you say that if you don’t know what the is?

– And you had a subarachnoid bleed without a source.

– Yeah, without an aneurysm. When you look at stroke, 87% are ischemic and the other 13% are subarachnoid hemorrhage. And then when you just take the subarachnoid hemorrhage, maybe 85% is an aneurysm bleed, whether trauma, ruptured aneurysm. And then the other 10% is non-aneurysm subarachnoid hemorrhage and that’s what I had. So the working diagnosis is perimesencephalic subarachnoid hemorrhage. Say that five times fast.

– Perimesencephalic subarachnoid hemorrhage. That’s what my wife called it when she saw your stuff. She was like oh yes, we see this. And I was like huh because as a hospitalist I’m like como?

– Yeah, I never heard of it. It was a first time I’d ever heard of it. So the neurosurgeon was the one who came in and said you had a perimesencephalic subarachnoid hemorrhage. We don’t know why people have this. It could be an arterial venous bleed. It’s thought to be more to have a venous source but we don’t know. But patients do very well. There’s no long-term risk. You can go back to living your life, doing your thing. So there’s no limitations.

– So it was like an anomaly that happened.

– Yes.

– And you’re not doing lines of coke and smoking crack and doing meth.

– Now by the way, I was not tested for that. So let’s talk about that.

– Let’s talk about that. Oh, Kathy T. is a local doctor in town. We’ll give her a pass, treat her as a VIP. Funny, you got all the negative effects of being a physician patient.

– Unfortunately, yes.

– Being a woman, being blonde, living in Vegas.

– Yeah, I mean it varied by provider in terms of the judgment or the treatment that I got so probably that first PA I was just some little white, blonde girl in Vegas who was drunk and just needed a cocktail. A migraine cocktail, not a real cocktail.

– One of the few times white people get treated worse.

– Yeah, yeah for sure. White bias.

– Right, right.

– And then the other times I think I was treated differently because I was a physician. But physicians have substance use disorders and physicians, I mean cocaine and methamphetamines in Nevada are coming back as the number one abused substances, even more than heroine. And so when someone comes in with any type of head bleed, you should be testing for substances that cause any of those things. And cocaine is known to cause subarachnoid hemorrhage.

– Yeah, of course. But the first thing I thought.

– And I wouldn’t have been offended.

– I know, when I read your story I was like, did I not know Kathy was a coke abuser.

– I don’t like to tell people.

– I know, neither do I. I just snort it and then pretend I didn’t. But no I mean you have to treat your patients as if you would treat any other patient. And that’s the problem with the VIP syndrome, that’s the problem with physicians. And again, you were a victim of all these biases. What if that were the case, they would have missed that.

– Yeah. The other thing that was interesting is for the pain management throughout the hospitalization stay was interesting. So people push opiates more than I was, I was surprised to be honest. So they would ask what my pain score was and I would say look, let’s say it’s a moderate pain, I’ll give it a five, six at baseline and then it would crescendo to a 10 and then it would come back down. But it would be there a few seconds and come down and I kept telling myself you know what, I can tolerate this. But at night it got pretty bad and they kept telling me we don’t have any pain medication for this. You have to take an opiate. An opiate’s the only thing that works.

– Wow.

– That’s it. And I hadn’t looked up, I had photophobia at the time but I did this later. But I hadn’t looked up the guidelines for pain management of subarachnoid hemorrhage. And I couldn’t initially because I couldn’t read the computer screen. My mom had come at this time, she’d brought my computer in but I couldn’t look at the screen. So I remember one night it was particularly bad and I had trouble sleeping and I thought let me just try a little fentanyl, just give me a little bit. And one reason they use fentanyl is it has a lower hypotensive effect and that’s why they give the fentanyl. So I got a dose of it and I remember sitting there sometime later just feeling sedated and tired but the pain was still there. It didn’t do anything. And I just thought, this stuff doesn’t work. And when you have opiates in a situation where you need to monitor for neurological compromise it’s not really the best medication to use. So I told the nurse once I was the next morning, I said take it off my med list. I don’t want it on my med list, I’m not gonna take it, it didn’t work. It sedated me and it could alter my neurological exam and I don’t want another $100,000 work up for a stroke I didn’t have.

– Wow, holy shit man. It’s so rare in these interviews where I’m just sitting here like this the whole time. Like just getting schooled. This is amazing. You know we did a show with a dude out of Yale who was talking about subcutaneous opioid protocol.

– Yes, is saw that, that was cool.

– And it’s interesting because we do in the hospital create a lot of problems. Because what if they had given you like just repeated opioids, you’re getting the buzz without any–

– Without any pain relief.

– And the next thing you know you’re out on the pills and the next thing you know you’re doing heroine.

– Yep, and nobody did, that’s the other thing, nobody did any type of opiate risk assessment or addiction assessment. So nobody asked me if I had a history of addiction to any substance or if I had abused any substance in the past. No one had asked if I had a family history of addiction. Now sure, you walk in and they’ll say, what’s your family history? Uh, my mom, you think immediately like my mom has diabetes and high blood pressure, whatever it is, and then you move on. But I’ve learned in my practice you have to specifically ask about addiction because patient’s don’t identify that as a medical disorder. They will not tell you. So you have to ask, have you ever used a substance. And I don’t use legality as a judge point.

– You don’t say an illegal substance, right.

– Legal, illegal, it doesn’t matter. It doesn’t matter. I mean people are addicted to food. Look at the obesity epidemic. Sugar’s legal, people are addicted to it. So legality has nothing to do with addiction. So I would specifically ask do you have a personal history with addiction? Do you have a personal history of using substances that alter your mind that you have a problem with? Do you have a family history of any addiction to anything? I just open the flood gates. Gambling, food, nicotine, alcohol. And they’ll tell you but if you don’t specifically ask I’ve never had a patient just tell me their father was an alcoholic in their family medical history unless I ask specifically. And that never happened in my stay. And when you look at all the opiate risk tools for who’s at risk for addiction, nobody asked me any of those specific questions. So they would never know. So the question to me was why you’re encouraging opiates for what I later found out, later on when I Googled, I literally did a Google search and then did a PubMed search on what the guidelines were for pain management in subarachnoid hemorrhage. There are none because nothing works.

– Wow.

– Yeah. Opiates don’t work, they don’t work. Yeah. And I would read some of these websites, opiates are the only pain reliever. Give fentanyl, give fentanyl, but there would be no citation for where they got that data from. It was just like you should do this but I couldn’t find the literature supporting it.

– Right.

– Because there is none.

– You know Kathy it’s crazy because when this all happened I think a couple of weeks had gone by, you’d been discharged, you were doing okay, the crisis was over, the acute crisis–

– I think I had had my MRI. I had to have a repeat MRI to make sure that when the blood was gone there wasn’t a tumor.

– Right, so how did that go?

– Fine, normal.

– Good. And I remember you reached out and you were like there’s a lot of shit that went fucking crazy that your audience needs to know about. And I said yeah, it sounds like it. And then you sent a typed thing because you were like I need to type this up before I forget.

– It took me a few days and I had to think and go back.

– I still have it and it is 90% more detailed and more angry because I think you were truly traumatized by this experience at the time.

– At the time I was. Now I’m still just mad about the wine headache. That really pisses me off still, that’s the main thing. Because it affected my entire stay because I was worried I was gonna be judged, because I had been judged in my first encounter. So every time someone came in the room I made sure that wasn’t, I really tried to make it a point not to be judged. So I knew about asshole doctors as patients. I wasn’t gonna be an asshole. I tried to be nice. I also knew that people, I just really tried to make it easy because I was afraid of being judged because I had been judged. And it could have cost me. It could have cost other patients. So when you look at young patients who present with stroke, and classically for my type of stroke it’s severe, worst headache of your life, nausea, vomiting. You can get meningeal signs and you can get photophobia but mostly it’s severe headache, nausea, vomiting.

– And that’s all it is and that could be mixed up with a lot of things.

– Exactly. So when I went and looked at some of the numbers in terms of stroke, the rates for ischemic stroke are increasing in patients aged 30 to 40 because of obesity and diabetes and hypertension. But in my non-aneurysm type stroke where we don’t know the risk factors. There aren’t really any risk factors, it’s just a random event. Those types of strokes are not increasing.

– I see.

– And so when a young patient comes in you still have stroke is still in your differential diagnosis. You still have to think about it, it’s got to be on that list because ischemic stroke is going up in the population and you will see young patients with stroke. And there was an article I was reading in the New York Times where they quoted a study that showed that one in seven patients that are younger that present with stroke are misdiagnosed.

– I think I saw that article and we actually did a show on a UCLA study about young people with stroke and then we made a video, Can’t Feel My Face, a parody of The Weeknd’s, trying to recognize the FAST acronym. And now it’s even BE FAST. Balance, I forget what the E is now. They always add acronyms. Well someone will have to school me on this. But the bottom line is it’s a real thing in young people. I don’t know if I ever told you this story, this is nothing like what you went through and yet a parallel track where it was minor but could have been the end of my life. And it was simply I’m sitting there with Josh.O, we’re running turntables, it was like three or four years ago. And I’m typing on the computer, and this again what’s it like when a physician becomes a patient. And there’s a shame component because what you said about how you were judged for the wine headache, let’s not minimize that. It tainted the entire stay for you because you know there’s a component of shame or judgment. We all as humans feel that. And think about our poor patients who come in and maybe they’re addicted to crack cocaine–

– Yeah, they get judged all the time.

– They get judged all the time.

– Yeah, it’s not a disease. They’re crazy, get ’em out.

– That’s right and in the beginning, you don’t think that taints their stay, right.

– 100%.

– We’re biased on every level for everything against physicians because of the VIP syndrome, there’s racial bias, there’s socioeconomic bias, there’s substance abuse and legal bias, how do we treat our jail patients, all these other things, because we’re not perfect, we’re humans. We can’t blame people for this but we have to institute institutional structures that help us do better. That’s why I think certain protocols, certain processes, certain repeatable steps would have prevented some of the missed things that might have happened.

– Yeah, absolutely. I mean I teach this even to patients when they come into me with a compliant. I have a it’s called a differential diagnosis. We practice medicine based on probabilities. So you have a list of probabilities, you have a list of possibilities and what our job is to do is to figure out what the diagnosis is but we have to work through this. So I tell patients it may be this, it may be this. This is what we’re gonna do to try and figure this out. So I try to educate my patients on that because I have had some patients say I went to this doctor and they misdiagnosed me so I just left. Wait a minute, wait a minute, wait a minute. Maybe they did but did they have a list of things that it could be that they were working through? Sometimes we don’t get it right the first time, I get it.

– Yeah, that’s why we’re–

– A differential diagnosis is there. It’s not this is what you have, bye.

– So Andy Reid says balance and the BE stands for balance and eyes, vision changes. Which makes perfect sense.

– Yeah and I had, does photophobia account for vision changes?

– Yeah, I would think so, I would think so. Now the other thing I would say, so we were talking about protocols. I’ll say to the defense of UMC Hospital, they’re probably the best hospital in town and I’ve seen the same–

– Oh yeah. I still had good care by most of them.

– But the thing is what happened to you happens at the best academic medical centers around the country and it’s this discohesion, competing processes–

– They’re on the computer, they think other people are reading their note and they don’t have to communicate. That’s a problem.

– We call that electronic silos.

– Oh, it’s terrible.

– And we put it in our rap song, EHR State of Mind, for that very reason that they are horrible. It used to be we talked to each other. So that’s the other thing. And then working as a team that’s cohesive instead of these separate elements always trying to turf and bump and well we’re gonna discharge, no we’re gonna discharge. What you did was you took an advocacy role and said listen no, we’re gonna do what the quarterback says. And in this case with this disease it’s the neurosurgeon.

– It’s neurosurgery.

– It’s neurosurgery. It’s not the intern, it’s not this. That’s brilliant so that’s a lesson for people for self-advocacy in the hospital. We will you and I will do a show in the future about how to advocate for yourself when you’re in the hospital. I think it’s a great topic. And that’ll be out for the muggles. Now getting back to what happened to me because this is all about me, Kathy.

– Of course.

– Yes, you’re a superhero athlete, yes, you’re an amazing pain doc and a tremendous teacher and I’m humbled in your presence, honestly. It’s amazing to sit here and listen to you but hear about me.

– Let’s do it.

– I’m sitting here, I’m typing on the computer and I suddenly have a visual defect. So I can not see the words on the page. And I’m looking at it, now at this point I’m 39 or 40.

– And your first thought’s probably, how much coffee did I have today. That’s what I would have thought.

– Exactly, I’m like rubbing my eyes. And I’m sitting with Josh and we’re both working on trying to get turntable of the ground and it’s 110 degrees outside. It’s maybe my first or second Vegas summer. Maybe my first Vegas summer. I’m coming from the Bay Area and I’m like man this is weird. And then finally I’m like, Josh, is my computer screwed up. I slide it over and he’s like no, it’s fine. He reads it to me and I’m like, I can’t read a single word on this. It’s all rubbish. And then things started getting weirder. So all of my peripheral vision started to get kind of hazy and I started seeing the words kind of moving and getting this feeling of disengagement like something’s not right. Like the tunnel is closing and I’ve never felt this in my life. I’m like holy shit. No headache, no nothing. So at this point I turn to Josh and I go, Josh.O, I don’t want to frighten you, I’m a 40-year-old man. And at this point I didn’t realize that I had this clotting predisposition that I had done 23 & Me and found out I have Factor 5 leiden and heterozygous and prothrombin 20210A heterozygous. So if I had known that I would have gone to the ER right away.

– When you’re done with this story I want to ask you a question about 23 & Me.

– Oh, totally, totally, totally. It’s a good conversation. So at this point I’m just a youngish guy who has no family history of anything, I’m a physician, and I’m going through the differential in my head. My head is foggy.

– Right, so you don’t get the full differential because you’re not 100%. I did the same thing.

– I’m not 100%. Isn’t it weird and you’re sitting there going okay, I hope I’m not missing anything because even at my best I’m pretty developmentally delayed. And now I’m really at a disadvantage and I’m with a guy who’s 23 who knows nothing about medicine. So in strange town with no support except for the family’s off somewhere. So I start going okay, Josh, I need you to Google for me in a doctor way. So I need you to Google visual field disturbance, no headache. And he does that and he comes up with some images and I can now see only out of the corner of my vision. My macular vision is bad. So I look out of the corner and it shows exactly what I’m starting to see which is a fortification spectra. Which is a scintillating sort of thing like this with distortion all around it. And it’s in both eyes. I close my eyes, I see it in both eyes. When I close my eyes I still see it. And at this point I’m like this sounds lik a migraine aura but I have no headache and I’ve never had migraines. And I go okay, listen Josh, this is the thing. I am going to self-diagnosis myself right now with the nuance that migraine aura without headache.

– So did you go to the ER and get a migraine cocktail?

– The aura’s set, a little of that lala. No, I told them I said if I stop being able to speak, if I look weak, if I’m not able to stand, if there’s anything else wrong with me, you are responsible for calling 9-1-1. And he goes, you could see this kid, he’s 23. His eyes get really big and he’s like this doctor is telling me that there’s a chance that he’s gonna have to call 9-1-1. So now suddenly all eyes are on me. And I’m like, just give me a few minutes. I’m gonna sit here, give me a water, and I’m watching it happen and I’m like oh, this is like I remember from the textbook. And then it evolves out and I start to get better and then a little mild headache right frontal temporal and the whole thing lasted about an hour and it was done.

– Wow.

– And I tell you if I were a muggle, I would have gone to the ER and it would have been the right answer. Right now in retrospect it was. I’ve had them since then maybe two or three times and it has to do probably with, I talked to a neurology buddy at UCSF, high heat, low humidity environments for the first time often can trigger that in some patients migraines with visual symptoms. So for me that’s probably what it was.

– So is that why you’re moving?

– That’s why I’m moving, yeah. You know what though, Kathy T.?

– What?

– We’re gonna still have you on the show though all the time.

– Okay, thanks.

– Because I’m still gonna be back in Vegas quite a bit and we’re keeping the studio.

– Yeah, the studio is amazing.

– And so don’t you fret, Kathy T. Vegas is still near and dear to my heart. But yeah, so the bottom line is we need to be better patients but see the thing is if you hadn’t advocated as a physician things could have gotten ugly. And you might have gotten a test that wasn’t necessary that then led to iatrogenic complications that then led to real problems. So it’s scary.

– It really is, it really is scary. And after I was, the last thing that happened. There were two more things that happened in terms of medications. So when I was on the step down unit, that sacral pain got worse.

– Yeah, tell me about that sacral pain, yeah. We never followed up on that.

– So the headache started getting better and the sacral pain got worse and it would come very randomly. And at one point I got up in the morning and I wasn’t allowed to exercise for about a month or two so I was doing like leg swings, range of motion exercises and I’m standing there and I go to walk around the unit and thank God I was right by my bed. It came on and it was so severe I had to get in bed. I almost fell down because the pain was so bad. And I thought okay, I got to ask about this again. So I called a neurosurgery friend because I’m like I’m not asking the, I can’t, neurology, I had asked neurology. They, I don’t know what that is. I don’t know what it is. The Internal Medicine asked neurology. It’s just punt, punt, punt, they just would punt it to somebody else and then it would get punted again. So my neurosurgery friend said oh, I know exactly what that is. He said probably what happened is the blood products have descended to the lower sacral sac and that’s why it’s pulsating and it’s just causing pain down there. So that will resolve.

– Holy fucking shit.

– So I was pissed, why didn’t I think of that.

– Well because you’re not a neurosurgeon.

– That but it makes so much sense. And it pulsated like my headache had pulsated.

– Because blood vessels that are beating are squeezing the blood products.

– Yes, yes.

– Holy crap.

– It was just very bizarre that it outlined, like it perfectly outlined my sacrum. It was the bizarrest thing ever.

– Is that the way the cecal sac is just shaped? I don’t even know, I don’t know the amount any more.

– So it comes around the spinal cord and then it ends around S1, S2, in that lower sacral area. And so I think, just because I had a little bit down that was pulling there, and that’s why it just affected the sacral root in the sacral area.

– And some of that pain may even be referred. I mean you never know whether it’s kind of deep pain.

– And nothing really helped. So at that point I thought I need something for this because this is bad. But again I didn’t want and opiate. By this time my photophobia had gone away so now I’m on doing my PubMed searches on pain management for meningeal pain and I look up Gabapentin. I’m like Gabapentin would be great for this. And the Internal Medicine doctor didn’t want to write me any medications until he cleared it with neurology because he didn’t feel comfortable. Totally respectable, I get it. So I said okay, I’m gonna bill a Level 4 pain management consult. I’m gonna do my own pain management. So I go through, I go look up Gabapentin and it actually was recently approved for safety in bleeds. In any type of head bleeds you can use Gabapentin safely. That came out in like 2014, 2015. So I’m like okay, check, safe. Next, now what dose should I start myself at? So I thought I’ll just start at what I would start it in a patient my age. So I told the nurse, I said call the doctor and have him write 300 mg of Gabapentin in the morning and then two 300s at night. Let me start with one. I’ll take two if I need it. Let’s just see. And she says okay. So she calls the Internal Medicine doctor who refuses to do it, calls the neurologist. So I don’t hear back for maybe a day. Because I was in the hospital for eight days so it was like two days later that the Internal Medicine doctor comes in and he says I’m sorry, I didn’t want to write anything. I had to clear it with neurology. Neurology said it was okay. I said oh yeah, I know it’s okay. I can send you the data that they did that this is safe to use in bleeding. And he said, I’ll just write whatever you want. Then they ended up writing it so I took it. It ended up helping, I could sleep. So I took the Gabapentin at night, which really helped me sleep which did help just overall.

– You did your own pain consult.

– I did my own consult.

– See this is the thing, the instinct on the part of the team is to be defensive about that. Oh, fuck.

– No, they weren’t defensive at all, which was nice.

– That’s good.

– But I’m sure they would have.

– If it were me I would have been defensive.

– Yeah, you would have been like shut up.

– Yeah, like oh great. Actually that’s not true because when you have a specialist. So Kathy T. is a pain specialist. So it’s one thing if you’re a psychiatrist and you’re like I want Dilaudid for my–

– I need Xanax.

– Right, right. And then you’re like well hmm, physician treat thyself with thy drugs and become thy addict. Sorry, suffer from they addiction.

– Yeah, thank you.

– Thank you. So you had a question for me about 23 & Me.

– Okay. So my 23 & Me when I did it came back, it was like stellar. So what I wanted to do is send it to my insurance company for a discount. I’m gonna take exception with this and I’ll tell you why. Because mine was fucked up and if my insurance company, if there are pre-existing conditions, even though I’ve had no clots, nothing, they’re gonna look at the fact that I have a 75% lifetime probability of having a DVT based on studies that are squirrely and then they’re gonna say you’re uninsurable. So it’s a double-edged sword.

– So whenever you have some type of health, well I looked up perimesencephalic stroke and future outcomes. And on the stroke AHA website they did a study on this because patients were being denied health insurance and life insurance.

– Based on a previous stroke.

– Yes, based on a previous stroke. So it is published in the stroke journal that patients with perimesencephalic stroke do well, have little to no risk of re-bleeding, and have no change in their life expectancy. So we should not be judged or penalized by physicians, life, and health insurances.

– I fucking love it.

– Thank God they published that.

– That’s so good.

– It’s amazing.

– Because you know it’s come up.

– Yeah, and unfortunately in medicine now we have to think this way and we have to publish shit like that.

– Yeah, yeah. God bless us sometimes.

– I know. Sometimes we do okay stuff.

– And I hate us sometimes. Sometime we do okay and sometimes we are so fallible and I want to be replaced by a computer.

– Some days I’m like computers.

– By the way, I want to thank Kathy T. for a specific gift that she gave me. She always comes bearing gifts and today’s gift is this. I was hoping for a battle of wits with you but you appear to be unarmed. And this was specifically aimed at you, every single anti-vaxxer that I’m looking at. So thank you. By the way, we did the whole show on how anti-vax memes are just the dumbest–

– The memes.

– The memes, oh, that’s right.

– I call ’em memes.

– Yeah, Kathy T. on our first show she’s like isn’t it memes? Like you did not know the pronunciation of meme because why would you.

– And even when you corrected me, I was like it’s a meme.

– It’s a meme. You know what I think it’s la meme choix in French, it’s the same thing. the more things change, the more they stay the same.

– Exactly.

– And memes have stayed the same for too long with anti-vaxxers. They are dumb.

– Yeah.

– Kathy T., any parting words? Should we take some comments? Hit me with the parting words.

– Parting words are there are a lot of people who your life could end at any moment. You don’t know how much time you have here.

– This is getting dark.

– Actually no, I mean I think that you really have to analyze what you’re doing and if you’re happy. If you have a bucket list, if there are things you want to do and you haven’t done them, if you’re unhappy with something you’re doing and you need to make a change, do it now because you really don’t know how much time you have left. So make the most of the time you do have.

– Damn. I mean living in the moment, me? Hell nah. I’m always living three seconds behind girl.

– I’m in yesterday.

– I’m still living in this moment. Hey guys, what’s going on. Anyways man, I got to say. The comments are mostly like uh, so there’s no much to read here. I just got to say this, I am so glad that you’re alive, that you are well.

– Thanks, me too, thank you.

– I’m so glad that you could come out of this and teach us about everything that’s wrong and right. And also I think you’re gonna save a life because someone’s gonna have the symptom and is gonna go in and be like I remember Kathy T. talking about this and I’m not gonna miss it. Dude, so grateful to you.

– Oh, thank you.

– So grateful. So looking forward to hanging out in the future and having you back on the show.

– Ahh, thank you.

– And I still think that guest host that like ZDogg and Kathy T, kind of like Regis and Kathy Lee–

– We should, I thought about that like I’ll have a glass of wine.

– Of course you will. And then they’ll accuse you of having a wine headache.

– Yeah, and then I’ll be a drunkard.

– It always struck me that Regis was the alcoholic. Hey, what’s going on? I don’t know, hey, give me another. What’s this, water? No, it’s vodka. Ah, Kathy T., thanks again. ZPac, I want to thank you for being with us. Supporters thank you so much. Sign up as a supporter if you haven’t. If your seeing this on the replay, please share it with people you care about. Spread the word. And we out, peace! Do we need a thumbnail Tom Hyniver.

– Do it!

– Okay, we look over here, Kathy T. And we kind of make a face like the thumbnail face. Like duck face, both of us duck face.

– Wait, am I looking here?

– No, at that little camera up there, yeah.

– Okay.

– Right in the lens and you make a little duck face.