Ep. 28: Paralyzer

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Welcome to M4 Medicine, mystery,
mayhem, and sometimes murder.

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I'm Andrea Marciano and RN with
35 years of experience across

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various fields.
From direct patient care in

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hospitals to home health,
geriatrics, and injury medicine,

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I face life, death, and
everything in between.

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And I'm Crystal Miller and RN
with 13 1/2 years of experience.

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My work spans home health,
Hospice, emergency care,

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geriatrics, and occupational
health.

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From the chaos of trauma based
quiet moments with patients,

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I've seen stories that defy
explanations.

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We've been friends for over 25
years and as nurses we've shared

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countless stories that have left
us and our families speechless.

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Now we're bringing those stories
and many more to you in

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medicine, mystery, mayhem, and
sometimes murder.

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Each week, we'll uncover cases
that challenge the boundaries of

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medicine, sharing the human
stories behind the science.

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From puzzling medical mysteries
to shocking real life crimes,

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we'll bring you stories that'll
leave you questioning everything

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you thought you knew while.
We're both experiencing these

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nurses.
We want to make it clear we're

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not here to give medical advice.
This podcast is about

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storytelling, education and
exploration, not diagnosing or

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treating medical conditions.
This is medicine, mystery,

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mayhem, and sometimes murder.
Let's dive in.

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Hey, Crystal, how are you doing?
I'm.

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Doing great.
How are you?

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I'm very well.
Thank you.

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You got anything exciting to
talk about?

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Anything's come up recently.
Well, I had an exciting driving

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experience.
I went to Utah to see my kids

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and my parents, my siblings, and
we go through Kansas and

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Colorado and Wyoming to get
there from Oklahoma.

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And driving on the way back, we
actually had a snowstorm in

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Kansas.
And it was actually barely a

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snowstorm because there was just
a little snow, but there was so

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much wind that it was blowing
the snow off the drifts.

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And so it was only about 50
yards, maybe.

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Oh that's no fun.
And with white hard to see

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edges.
Yeah, exactly.

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So we were driving along going
about 60 mph probably and all of

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a sudden there's a car in front
of a truck in front of me and

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Holly Scouts car stopped.
Oh my gosh.

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I honked my horn which I meant
to turn on my hazards but in my

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think I honked my horn instead.
I turned on my hazards and

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swerved around it on the left.
It was in the left lane, swerved

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around it on the left and just
missed it.

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And then Odyssey was right
behind me.

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She also she saw me swerve so
she swerved and just missed it

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and then we both stopped.
Had to get our adrenaline to

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calm down and then the guy just
drove off.

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Odyssey thinks that he actually
came off the other side going

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opposite direction and spun into
our into our lane on the on the

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opposite highway.
So it was wild though.

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Like it, I mean, it was turned
sideways, so like the passenger

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side door was facing us and it
was just the closest call ever.

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And in the snow and in low
visibility, it was like a

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miracle that we got around it.
Frankly, Oh my gosh.

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Well, back in the day, I used to
travel from California to Utah

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to go to school and I would come
through in the winter time and I

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didn't drive back and forth that
many times in the winter because

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it really is very dangerous,
especially going over the

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passes.
Donner Pass, not fun, but

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friendly.
And there's a reason people got

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stuck and started eating their
friends and family.

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But that's another story.
Another podcast.

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I was one time coming and it was
after, after the Christmas

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holidays and I was, I can't
remember exactly how far I was,

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but I hit some black ice and
spun off the road.

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Well, excuse, pardon me.
I slid off the road and then I

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spun and I counted 12
revolutions there in the medium.

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Just I, that's how many I
counted.

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I don't know if that's how many
actually happened.

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If there.
I think there may have been more

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because I think by the time I
thought of counting, I was

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already doing it a few times.
And I had a friend who was

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traveling with me and he had
been asleep.

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He woke up as we were coming out
of the last revolution and he's

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really disoriented.
I mean, just waking up and also

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coming out into a spin.
I didn't feel like we were going

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to die because we were out of
traffic, but it was not

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comfortable.
And I was, you know, I doing all

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the things I was breaking and
turning, but I think was helping

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because obviously it wouldn't,
but I still felt like I had to

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be doing something.
I was pulling the emergency

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brake and back in the day when
we had them and and so as we

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came out, he started to get out
of the car and I saw that he was

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still seat belted.
So he was confused to the point

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that that made sense to him, but
it wasn't a good idea.

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So I said get back in.
He looked at me and he did.

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And he shut the door.
And just as he shut the door, we

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were hit from behind.
Oh my gosh.

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Yeah, and I was riding in my
favorite car ever, 1977 Toyota

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Celica.
It looked like a Mustang and it

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was made of real metal back in
the day.

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I think that if we had gotten
hit and his head was outside the

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door he would have at least been
injured if not killed after the

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other.
The guy came came off and hit us

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and he said we got out and he
said I hit some black ice I'm

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really sorry.
And I looked and there was

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little damage to my car because
it was real metal but his was

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kind of scrunched because his
was a newer car.

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And I said listen let's trade
information and get the heck out

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of here because I came off you
came off doesn't mean anyone

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else is going to stay on the
road back here.

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So I'm going and he said no we
have to wait for police.

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I said Nope, Nope, Nope, Nope.
I so I got on.

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I got back on the freeway and
traveled on and as I went I saw

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that there was no other spot for
about 30 miles that didn't have

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a cement barricade between the
lanes and about two miles up the

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road.
Someone had probably done what I

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had done and they were in a
Suburban.

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They had flipped over and the
top of the vehicle was crushed

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down to the door frames.
Oh my gosh.

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And I thought that could have
been us.

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I had.
I had settled down because

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really nothing terrible
happened.

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And when I saw that again, I had
to pull off at the next exit, I

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was so freaked out because I
knew that could have been us.

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There was another car that was
driving with us, another set of

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friends in another car, and we
all pulled off because we were

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watching each other.
I think we even had little

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walkie talkies or radios or
something.

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And because back in the day, you
know, no cell phone.

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So I said I'm getting off the
road.

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And we went off the road and we
all jumped out and everybody

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hugged each other.
And.

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They said did you see that?
You didn't?

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All that was when we went off.
All it was was sand.

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It was just a lot of stretch of
sand between the lanes and I

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have no idea why that was there.
But like you said, it was

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basically a miracle that we went
off there and everything was OK.

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Nobody got hurt.
The insurance has ended up

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covering the small amount of
damage I had, but it it could

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have been so much worse.
And there was good visibility.

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That wasn't the problem.
It just was black ice and black

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guy says, you know, is
invisible.

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Yeah.
And there's just nothing to do.

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People will kind of by habit
slam on brakes, which is the

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very worst person thing a person
can do.

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And I didn't do that because it
hit and I went off and I never

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even had time on the freeway to
do something.

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I just slid off and had no idea.
So this person that may have

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done similar sort of thing,
could they have come across from

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the other side?
Like was there no barrier?

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There, yeah, no.
And and Ash, who was in

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Odyssey's car, saw the skid mark
the the spin marks in the grass

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and the knees.
You know, probably did the same

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thing I did, just wasn't as
lucky and came across and

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hopefully they never got hit by
anybody that is so.

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Scary.
It's crazy.

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And it's interesting because for
I, I sent Odyssey when she was

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15 with her learner's permit to
a defensive driving course

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called Driver's Edge in Las
Vegas.

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And I, I didn't send any of the
other kids.

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And I think it was a cost.
No, 'cause it's free.

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I don't remember why I didn't
send any of the other kids, but

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I did end up sending Odyssey and
they teach all of these high

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hazard reactions.
So it's, it's on the Motor

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Speedway there and in Vegas and
like they have them go through

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an oil slick and they teach them
how to go through snow.

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And you know, when you start
slipping, you do this.

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And so she actually had another
point in the same trip where she

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was behind us and I noticed that
she started that she started

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slipping, you know, so she
didn't have control of the car.

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And so I slowed way, way down
because this was like worse,

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this was like 5 foot visibility
at this point.

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And so I slowed down.
We went really slow for the next

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probably 15 miles, but she, she
lost and gained control probably

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4 times in that time.
And just like it was really, it

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was.
And she of course was like, I'm

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so glad I took that driver's
edge training.

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So hey, I think it still exists.
So if you want to teach your

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kids high hazard training?
Nope.

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Driving skills?
Driver's Edge in Las Vegas.

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If it still exists and it's
free, you just have to get there

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and have a place to stay I
guess.

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Wow, yeah, that's that's huge.
I remember when I was living in

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Utah, every winter I would go
out somewhere that had no real

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barriers, like a big parking lot
or something that was empty.

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And I just practice.
I'd go and I'd push the brakes

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and start to spin and practice
getting the feel of it again.

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Because after the short summer
times, after four or five

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months, it's easy to forget how
to respond.

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And I mean I would just.
Cry and drive really slowly.

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That sounds like a good coping
mechanism.

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I actually preferred my method
but and I did send my kids out

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that way too because I said if
you just face it and you

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remember get that muscle memory
back you'll be fine.

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But if you don't and just drive
and cry, then you may not have

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as easy a time.
I don't do that anymore.

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For the record, I've I've, I've
learned the skill of driving in

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the snow now I just don't like
it.

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I do not like it, but.
No, I have come to realize I

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like heavy, heavy, heavy rain
much less.

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Because the.
Heavy, heavy rain.

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The lines are invisible.
Yeah.

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I I.
I think my scariest, I think my

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scariest driving experience was
heavy, heavy rain at the point

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of the mountain in Utah.
Yeah, it's all like, yeah, my in

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a storm we had not long ago, the
visibility was so low and there

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was a semi truck that that was
near me and kept shooting my

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window with water.
I slowed down as much as I could

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and then all of a sudden I
realized that I was not in my

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lane because I couldn't see the
lines.

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Anyway, that was harrowing.
Well, that's probably enough of

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that.
However, a little bit into our

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topic today.
Well.

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That's fun.
Yes, and you'll see why in a

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minute.
At first you probably will say

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what?
No, it doesn't, but it does a

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little bit.
Anyway, today we're talking

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about periodic paralysis.
Have you ever heard?

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That I have not.
I hadn't either, and I'm going

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to, from here on out, call it
pee pee because periodic

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paralysis is kind of a tongue
twister.

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Yeah, I can imagine.
This pee Pee is a rare group of

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genetic disorders that causes
sudden, temporary episodes of

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muscle weakness, stiffness, or
paralysis.

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It's triggered by factors like
exercise, stress, cold.

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Those are the things that segued
into it, just in case you're

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wondering whether.
Yes.

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Or high carbohydrate meals.
They then have abnormal

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potassium levels.
Oh wow, I know it's like what?

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I'll tell you more about this of
course, but.

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We'll see you later, that's all.
Thanks for listening.

226
00:12:13,200 --> 00:12:20,440
This to me was just fascinating
because it's so intense the the

227
00:12:20,440 --> 00:12:23,760
situation anyway, so I'll tell
you my sources.

228
00:12:23,800 --> 00:12:28,240
My sources were Sears, Cedars
Sinai Organization, and in their

229
00:12:28,240 --> 00:12:30,840
health library they had some
information about this.

230
00:12:30,840 --> 00:12:34,160
National Institute of Health had
a couple of articles and and

231
00:12:34,160 --> 00:12:37,720
studies I read about this.
Mayo Clinic had some

232
00:12:37,720 --> 00:12:41,760
information, the Cleveland
Clinic also, interestingly, the

233
00:12:41,760 --> 00:12:45,520
medical dystrophyassociation.org
had some interesting information

234
00:12:45,520 --> 00:12:49,480
about periodic paralysis.
And you'll, you'll see why that

235
00:12:49,480 --> 00:12:53,040
is in a little bit, that it is
kind of an overlap for MDA

236
00:12:53,160 --> 00:12:57,280
muscular dystrophy, well, a
association, but for the

237
00:12:57,280 --> 00:13:03,080
muscular dystrophy situation.
So what is periodic paralysis or

238
00:13:03,080 --> 00:13:06,720
PP?
It's a rare genetic disorder,

239
00:13:06,960 --> 00:13:11,000
which is really good because if
it wasn't rare, this could be a

240
00:13:11,000 --> 00:13:15,120
much bigger problem because it
is huge and it causes sudden

241
00:13:15,120 --> 00:13:17,960
attacks of short term muscle
weakness, stiffness or

242
00:13:17,960 --> 00:13:20,080
paralysis.
Now, this is one of the things

243
00:13:20,080 --> 00:13:23,240
that differentiates it from
things like muscular dystrophy

244
00:13:23,240 --> 00:13:25,720
or Lou Gehrig's or other things
like that.

245
00:13:25,720 --> 00:13:28,600
And it is not progressive
mostly.

246
00:13:29,080 --> 00:13:33,120
OK.
Some it it itself is not

247
00:13:33,120 --> 00:13:37,240
progressive, but sometimes the
effects of what happens will

248
00:13:37,240 --> 00:13:39,560
cause progressive problems.
You see what I mean?

249
00:13:40,040 --> 00:13:44,480
It's not that it's guaranteed to
progress, but some of the side

250
00:13:44,480 --> 00:13:48,200
effects become progressive if
that makes sure all right.

251
00:13:49,000 --> 00:13:53,040
And these attacks may affect the
whole body or just one or two

252
00:13:53,040 --> 00:13:56,760
limbs.
Sometimes it's on one side

253
00:13:56,760 --> 00:14:00,720
unilateral or sometimes it's
bilateral and they're not

254
00:14:00,720 --> 00:14:06,320
totally sure why it shows up
that way in in people.

255
00:14:06,880 --> 00:14:10,640
Some of the conditions, it's
broken down into a few segments

256
00:14:10,640 --> 00:14:17,240
and some of them are called by
names or things that relate to

257
00:14:17,600 --> 00:14:19,680
whether the unilateral,
bilateral, but we'll talk a

258
00:14:19,680 --> 00:14:23,240
little bit more about that too.
So there are several different

259
00:14:23,240 --> 00:14:27,560
forms, but they all involve
defects in the ion channels.

260
00:14:28,120 --> 00:14:31,000
Do you remember what that is?
Is that the calcium, potassium

261
00:14:31,000 --> 00:14:32,880
exchange?
You're a genius.

262
00:14:34,200 --> 00:14:38,800
Yes, these are gateways that
lead charged minerals, ions such

263
00:14:38,800 --> 00:14:42,800
as sodium and potassium, and
calcium is one of them in and

264
00:14:42,800 --> 00:14:45,560
out of the cells.
Now the reason that's important

265
00:14:45,560 --> 00:14:50,960
is because these ions are very,
very responsible for things

266
00:14:50,960 --> 00:14:55,000
especially related to muscle.
And you can have problems with

267
00:14:55,000 --> 00:15:00,320
calcium, which can cause heart
issues are palpitations and

268
00:15:00,320 --> 00:15:02,760
potassium can as well.
The thing that most of us think

269
00:15:02,760 --> 00:15:06,880
of when we think of low sodium,
potassium or calcium is muscle

270
00:15:06,880 --> 00:15:10,080
cramps because again, it affects
the muscles.

271
00:15:10,360 --> 00:15:12,400
And so people will say, well,
you had muscle cramps, you

272
00:15:12,400 --> 00:15:16,040
should have a banana or you have
muscle cramps, you should you

273
00:15:16,040 --> 00:15:17,960
should have something with
calcium and drink a glass of

274
00:15:17,960 --> 00:15:20,600
milk or things like that.
Technically it's true.

275
00:15:20,760 --> 00:15:22,920
It may not translate quite as
easily as that.

276
00:15:23,160 --> 00:15:26,400
All the bananas do really a lot.
And that actually can be a

277
00:15:26,400 --> 00:15:29,960
problem because sometimes my
mother had an issue with high

278
00:15:29,960 --> 00:15:32,200
potassium because she was eating
a banana every day.

279
00:15:32,400 --> 00:15:35,240
So something about her body
wasn't screening the extra

280
00:15:35,240 --> 00:15:38,480
potassium and so she started
having heart palpitations.

281
00:15:38,480 --> 00:15:40,600
So that can be a problem on that
side.

282
00:15:40,960 --> 00:15:45,200
So our bodies as you, I don't
know if you remember the the

283
00:15:45,200 --> 00:15:47,640
teeter totter when they talked
about these channels.

284
00:15:48,160 --> 00:15:50,200
And if you have too much, it's
not going to work.

285
00:15:50,200 --> 00:15:51,840
And if you have too little, it's
not going to work.

286
00:15:52,160 --> 00:15:55,360
And I always remember the teeter
totter, even if I don't remember

287
00:15:55,440 --> 00:15:59,360
why it was important.
But but like I said, these flow

288
00:15:59,360 --> 00:16:03,880
of ions are part of how the
muscles work, and in PP the ion

289
00:16:03,880 --> 00:16:07,480
channels sometimes fail and so
the muscles don't work

290
00:16:07,480 --> 00:16:11,440
correctly.
Now most forms of PP involve

291
00:16:11,440 --> 00:16:15,760
hypokalemia, and that's when
blood potassium levels are too

292
00:16:15,760 --> 00:16:18,840
low.
Some of them do hyperkalemia,

293
00:16:18,840 --> 00:16:21,560
which is when some of the
potassium is too high.

294
00:16:22,040 --> 00:16:25,360
So I want to point out really
quick for our listeners that it

295
00:16:25,360 --> 00:16:28,880
may sound strange that high
potassium is called hyperkalemia

296
00:16:28,880 --> 00:16:31,440
and low potassium is called
hypokalemia.

297
00:16:31,800 --> 00:16:34,960
But I want you to remember
potassium is K on the periodic

298
00:16:34,960 --> 00:16:36,880
table, and that's because of
kalemia.

299
00:16:36,880 --> 00:16:40,960
KALEMIAI mean that's where
kalemia comes from or vice

300
00:16:40,960 --> 00:16:42,520
versa, whatever.
But I just wanted to point that

301
00:16:42,520 --> 00:16:45,640
out because when I before I went
to nursing school, if you said

302
00:16:45,640 --> 00:16:47,720
hyperkalemia, I would have
assumed you met calcium.

303
00:16:49,560 --> 00:16:51,320
Oh, yeah.
OK, so good.

304
00:16:51,320 --> 00:16:55,080
Thank you.
And so yes, cholimia is, is

305
00:16:55,080 --> 00:16:59,440
potassium calcemia is the
calcium good?

306
00:16:59,600 --> 00:17:02,800
OK, thank you.
And but most of them, like I

307
00:17:02,800 --> 00:17:05,319
say, is where the blood
potassium levels are too lows,

308
00:17:05,680 --> 00:17:10,040
too lows too low.
And a lot of us will have

309
00:17:10,040 --> 00:17:14,839
symptoms if our our potassium or
calcium are too low or too high,

310
00:17:14,839 --> 00:17:17,160
as I mentioned related to my
mom's episode.

311
00:17:17,599 --> 00:17:24,640
And our potassium level should
be at least three.

312
00:17:24,800 --> 00:17:29,760
But the normal range is
considered 3.6 to 5.2 millimoles

313
00:17:29,760 --> 00:17:32,720
per liter.
Usually we'll look at labs and

314
00:17:32,920 --> 00:17:36,120
it'll say millimoles or whatever
the unit is.

315
00:17:36,120 --> 00:17:39,520
We're sure when we read labs at
least I as a nurse look at it

316
00:17:39,520 --> 00:17:42,400
go, OK, 3.6 to 5.2, cool, we're
good.

317
00:17:42,880 --> 00:17:44,000
Me too.
I personally.

318
00:17:44,480 --> 00:17:47,920
Hear if it's millimoles or it's
decibels or decibels.

319
00:17:47,920 --> 00:17:52,280
Inches or.
When I come and and we're a

320
00:17:52,320 --> 00:17:53,880
better nurse perhaps I would
care.

321
00:17:53,880 --> 00:17:56,800
But what I needed to know is
where the numbers fall and

322
00:17:56,800 --> 00:18:01,960
people 3.6 is the normal of the
low and at three people can

323
00:18:01,960 --> 00:18:04,360
start having significant
symptoms, which is interesting

324
00:18:04,360 --> 00:18:09,920
to me because from the normal is
.6 millimoles, which doesn't

325
00:18:09,920 --> 00:18:12,160
seem like a lot.
But when you're only going up to

326
00:18:12,160 --> 00:18:15,720
three, I can see how a .6 can
make a really big difference.

327
00:18:15,880 --> 00:18:19,080
As we discussed, potassium is
vital for nerve and muscle

328
00:18:19,080 --> 00:18:20,680
function.
And heart function.

329
00:18:21,160 --> 00:18:21,960
Right.
Exactly.

330
00:18:21,960 --> 00:18:24,680
Because heart is a muscle.
Yeah, Yeah, yes.

331
00:18:24,840 --> 00:18:26,520
And we'll talk a little bit more
about that.

332
00:18:26,520 --> 00:18:29,640
And one form of this PP that is
significantly more dangerous

333
00:18:29,640 --> 00:18:35,040
than the others because of that.
And this potassium problem will

334
00:18:35,320 --> 00:18:38,280
feed into what you were just
saying, can lead to paralysis,

335
00:18:38,280 --> 00:18:41,400
respiratory failure or cardiac
arrest with chronic deficiency,

336
00:18:41,760 --> 00:18:44,400
increasing the risk for high
blood pressure, kidney stones

337
00:18:44,400 --> 00:18:50,600
and bone loss.
And and so it feels like, how

338
00:18:50,600 --> 00:18:52,240
could this make such a
difference?

339
00:18:52,960 --> 00:18:55,680
And do I have to get potassium
in other ways?

340
00:18:56,320 --> 00:19:00,120
Well the short answer is people
who have a air quote normal

341
00:19:00,120 --> 00:19:02,040
system should regulate on their
own.

342
00:19:02,720 --> 00:19:05,920
We should with just regular
eating be OK.

343
00:19:06,200 --> 00:19:07,800
You know we want to avoid those
highs.

344
00:19:07,800 --> 00:19:10,480
Like mom was doing a banana
every day and sometimes she had

345
00:19:10,480 --> 00:19:14,600
two bananas a day that just put
her system too high with

346
00:19:14,600 --> 00:19:17,680
potassium.
Now if every one of us ate 2

347
00:19:17,680 --> 00:19:20,280
bananas every day for the rest
of our lives where we have

348
00:19:20,280 --> 00:19:23,200
problems, maybe, maybe not.
Depends on our symptoms.

349
00:19:23,760 --> 00:19:26,240
I don't think I could eat 2
bananas every single day for the

350
00:19:26,240 --> 00:19:32,520
rest of my life for tears.
But our body systems, typically,

351
00:19:32,520 --> 00:19:36,840
if they're working properly, can
adjust and regulate by letting

352
00:19:36,840 --> 00:19:40,480
more or less of these ions into
our cells.

353
00:19:40,600 --> 00:19:42,760
We'll talk a little bit more
about this later, but sometimes

354
00:19:42,760 --> 00:19:47,280
cells will burst for reasons
that may or may not be related

355
00:19:47,280 --> 00:19:49,640
to anything specific.
Sometimes when they die, they

356
00:19:49,640 --> 00:19:52,440
burst.
And some things can cause cell

357
00:19:52,440 --> 00:19:54,480
death more than other things.
We won't go into that today

358
00:19:54,480 --> 00:19:56,120
because that's another whole
podcast.

359
00:19:56,640 --> 00:20:00,840
But when there's too much
potassium that has left, or

360
00:20:00,840 --> 00:20:03,720
calcium or sodium has left the
cells.

361
00:20:04,200 --> 00:20:07,120
Then they're not available for
proper cell function and

362
00:20:07,120 --> 00:20:09,840
especially in the muscle areas,
this can have a huge impact.

363
00:20:10,520 --> 00:20:13,720
Now just for general
information, this PP attacks,

364
00:20:14,000 --> 00:20:18,040
these attacks can start in
childhood or adulthood and when

365
00:20:18,040 --> 00:20:20,960
it starts can help determine
which one this is.

366
00:20:21,280 --> 00:20:24,160
But again, remembering this is a
very rare condition and I'll

367
00:20:24,160 --> 00:20:26,920
talk about how many people get
it in a minute.

368
00:20:27,320 --> 00:20:32,520
But one of the things to know is
these episodes happen after

369
00:20:32,640 --> 00:20:34,960
certain types of trigger
triggers in most people.

370
00:20:35,080 --> 00:20:38,960
And they may happen after
someone works out hard and then

371
00:20:38,960 --> 00:20:41,800
while they're resting, they can
have a problem.

372
00:20:42,240 --> 00:20:44,160
The symptoms may be mild or
severe.

373
00:20:44,320 --> 00:20:46,280
They may last for minutes or
days.

374
00:20:47,400 --> 00:20:50,920
It's all over the board, which
then, as we'll talk about later,

375
00:20:51,240 --> 00:20:55,720
be so difficult with diagnosis.
It can look like a lot of other

376
00:20:55,720 --> 00:20:57,840
stuff.
This speaks to me saying that it

377
00:20:57,840 --> 00:21:02,560
is not a degenerative type
disease, but this is something

378
00:21:02,560 --> 00:21:04,720
important to know.
It may slowly get worse over

379
00:21:04,720 --> 00:21:08,760
time, but it doesn't have to.
But it's more because of those

380
00:21:08,760 --> 00:21:10,240
side effects that I was talking
about.

381
00:21:10,760 --> 00:21:15,560
The hypokalemia may not get
worse, but because of things

382
00:21:15,560 --> 00:21:17,840
being damaged, the person make
it worse.

383
00:21:18,080 --> 00:21:22,080
Does that make sense?
Yeah, it is a differentiation.

384
00:21:22,400 --> 00:21:24,040
Differentiation.
Thank you.

385
00:21:24,040 --> 00:21:27,720
That wasn't right.
Big words, mouth got stuck.

386
00:21:28,440 --> 00:21:33,560
But it is a difference because
some things do progress and some

387
00:21:33,560 --> 00:21:35,840
things just get worse because of
side effects.

388
00:21:36,120 --> 00:21:38,800
The frequency of these attacks
tend to decrease this

389
00:21:38,800 --> 00:21:43,720
individual's age, which is good.
And it makes me wonder if

390
00:21:43,720 --> 00:21:47,680
there's anything about puberty,
anything about puberty that

391
00:21:47,680 --> 00:21:49,520
might change, because I know
there's a couple of seizure

392
00:21:49,520 --> 00:21:53,840
disorders that when people go
through puberty, they stop, and

393
00:21:53,840 --> 00:21:58,000
I don't know if they're related.
Yeah, I've had three kids

394
00:21:58,000 --> 00:22:02,760
outgrow seizures actually.
So I'm I am very familiar with

395
00:22:02,760 --> 00:22:05,400
that.
So it makes me wonder if these

396
00:22:05,400 --> 00:22:09,840
things are somehow linked, but I
don't know.

397
00:22:09,880 --> 00:22:12,960
I didn't, I didn't look into
that because that would also be

398
00:22:12,960 --> 00:22:16,680
another podcast.
There is one case of one of

399
00:22:16,680 --> 00:22:20,760
these PP types and it's called
Thyrotoxic and we'll talk a

400
00:22:20,760 --> 00:22:23,000
little bit more in detail about
that in a minute.

401
00:22:23,280 --> 00:22:26,560
And that usually is on set after
the age of 20.

402
00:22:27,160 --> 00:22:32,440
Interestingly, most thyroid
abnormalities are manifesting

403
00:22:32,440 --> 00:22:35,080
after the age of 20.
Not mine.

404
00:22:36,720 --> 00:22:40,080
Most there are outliers on both
sides.

405
00:22:41,400 --> 00:22:46,200
The difference of this paralysis
versus other types of things

406
00:22:46,200 --> 00:22:51,520
like Guillain Barre or you've
got some types that are probably

407
00:22:51,520 --> 00:22:57,640
in the paralysis realm like
trigeminal neuralgia, which can

408
00:22:57,640 --> 00:23:02,480
cause some paralysis.
But this type, right, those are

409
00:23:02,480 --> 00:23:05,280
not in this category because
they're not thyroid related.

410
00:23:06,520 --> 00:23:09,680
And like I say, the most
constant triggers are the rest

411
00:23:09,680 --> 00:23:12,840
that following strenuous
activity and consumption of

412
00:23:12,840 --> 00:23:16,280
carbohydrate rich meals.
The reason is these triggers

413
00:23:16,280 --> 00:23:20,440
increase plasm, plasma
epinephrine or insulin level.

414
00:23:20,440 --> 00:23:22,760
So you eat a lot of
carbohydrates, your insulin goes

415
00:23:22,760 --> 00:23:26,920
up and that shifts that
intercellular ionic transfer

416
00:23:26,920 --> 00:23:31,440
that we were talking about and
it takes more potassium and it

417
00:23:31,440 --> 00:23:35,600
lowers the serum potassium
levels which then enter enters

418
00:23:35,600 --> 00:23:38,720
the episode.
So the serum potassium goes down

419
00:23:38,720 --> 00:23:42,720
because these other things are
going up and these heavy carb

420
00:23:42,720 --> 00:23:45,080
meals and I don't know how
heavy.

421
00:23:45,080 --> 00:23:48,800
They didn't really say like you
eat a whole container of

422
00:23:48,800 --> 00:23:50,680
spaghetti, is that the load?
I don't.

423
00:23:50,680 --> 00:23:54,720
Know right, Right.
It does appear that many people

424
00:23:55,000 --> 00:23:59,400
who have this have different
levels of tolerance and again,

425
00:23:59,400 --> 00:24:03,240
it's a rare thing so there's not
tons and tons of people to to

426
00:24:03,240 --> 00:24:05,320
look at.
But that shift at the

427
00:24:05,320 --> 00:24:09,280
intracellular shift is really
interesting to me and how it can

428
00:24:09,800 --> 00:24:11,840
trigger pretty fast.
But then you look at things like

429
00:24:11,840 --> 00:24:16,880
diabetes and insulin and sugar
levels can alternate pretty fast

430
00:24:16,880 --> 00:24:21,240
too And sometimes depending on
how air quote fragile a person

431
00:24:21,240 --> 00:24:23,800
is will depend on how fast these
transfers occur.

432
00:24:24,120 --> 00:24:27,760
Now that's true in this, the
thing about hypo PP as well,

433
00:24:28,120 --> 00:24:31,640
because different people have
different tolerance levels,

434
00:24:31,640 --> 00:24:34,760
which is the one thing that I
realized during all of the

435
00:24:34,760 --> 00:24:37,040
research I did is that
everybody's different.

436
00:24:38,160 --> 00:24:41,320
There are some general
guidelines, but there are some

437
00:24:41,320 --> 00:24:44,880
things that are similar.
And like I say, the less

438
00:24:44,880 --> 00:24:48,600
consistent triggers that we were
talking about earlier about the

439
00:24:48,600 --> 00:24:52,120
car accident, stress and cold is
excitement.

440
00:24:52,120 --> 00:24:54,560
So if someone has extreme
excitement because they're there

441
00:24:54,560 --> 00:25:00,600
goes that adrenaline or stress,
fear, cold temperatures, high

442
00:25:00,600 --> 00:25:03,000
sodium intake, because as you
can see, that would change those

443
00:25:03,000 --> 00:25:06,520
pathways too.
And alcohol consumption or

444
00:25:06,520 --> 00:25:10,760
anesthesia, those are things
that can trigger these events,

445
00:25:11,760 --> 00:25:15,280
but they are less common.
Attacks vary widely.

446
00:25:15,280 --> 00:25:19,640
Some have once a week, once a
lifetime, several times a week.

447
00:25:19,840 --> 00:25:22,760
It doesn't seem to matter.
Even if there were seven people

448
00:25:23,080 --> 00:25:27,360
that had the same type of hypo
PP, they may have two totally

449
00:25:27,360 --> 00:25:30,320
different presentations.
This is the one thing I've seen

450
00:25:30,320 --> 00:25:34,280
about women versus men.
Women tend to that is good.

451
00:25:34,280 --> 00:25:38,760
I mean, women tend to have fewer
attacks than men.

452
00:25:38,920 --> 00:25:45,160
One thing we have less of,
right, and of course I'm not

453
00:25:45,160 --> 00:25:47,520
making light of people having
attacks, but really one thing

454
00:25:47,520 --> 00:25:50,360
I've ever seen that women have
less than men and they don't

455
00:25:50,480 --> 00:25:53,160
really know why that is either.
In the research that I did, they

456
00:25:53,160 --> 00:25:56,400
didn't really seem to have any
particular reason.

457
00:25:56,800 --> 00:26:00,040
If I were a person that had
this, I feel like it would be

458
00:26:00,040 --> 00:26:04,040
super stressful because if I'm a
person who doesn't know if it's

459
00:26:04,040 --> 00:26:08,640
going to be attacked for
minutes, days or weeks, I don't

460
00:26:08,640 --> 00:26:10,680
know how a person could get
along.

461
00:26:10,800 --> 00:26:14,240
Function.
Yeah, Yeah, sometimes it's mild,

462
00:26:14,240 --> 00:26:18,680
like they just have generalized
muscle weakness and they have

463
00:26:18,680 --> 00:26:21,680
more pronounced involvement of
proximal, which is the near the

464
00:26:21,680 --> 00:26:24,840
body than distal muscles which
is away from the body.

465
00:26:24,840 --> 00:26:28,560
So like fingertips are less
affected than upper body or

466
00:26:28,560 --> 00:26:30,400
upper arms.
You see what I mean?

467
00:26:30,760 --> 00:26:33,240
Severe involvement of these
muscles can be life threatening.

468
00:26:33,240 --> 00:26:34,560
And we'll talk about that in a
minute.

469
00:26:34,560 --> 00:26:39,480
Because when we think about, I
think we forget how many of our

470
00:26:39,480 --> 00:26:44,960
systems are run by muscle
contractions like the heart, Big

471
00:26:44,960 --> 00:26:48,120
1.
And I feel like people may not

472
00:26:48,120 --> 00:26:51,280
realize how many of the body
systems are at least facilitated

473
00:26:51,520 --> 00:26:54,200
by muscles, even if they aren't
run by it.

474
00:26:54,200 --> 00:26:56,520
Because if you think about the
lungs, the lungs aren't a

475
00:26:56,520 --> 00:26:58,640
muscle, but the diaphragm is,
right?

476
00:26:58,640 --> 00:27:01,520
The diaphragm is what helps open
and close the lungs.

477
00:27:02,040 --> 00:27:03,920
Right.
So if your diaphragm is

478
00:27:04,520 --> 00:27:06,920
paralyzed, that's going to be a
problem.

479
00:27:07,240 --> 00:27:09,200
That's Yep, that seems like a
problem.

480
00:27:10,000 --> 00:27:12,520
Yeah, yeah.
This is part of the general

481
00:27:12,520 --> 00:27:14,400
overview and I'm going to go
deeper into some of them.

482
00:27:14,400 --> 00:27:17,280
But during one of these attacks,
whether it's a muscle weakness

483
00:27:17,280 --> 00:27:22,360
or a complete paralysis during a
physical exam, the muscle

484
00:27:22,360 --> 00:27:25,760
weakness is accompanied by
hyporeflexia, which is a

485
00:27:25,760 --> 00:27:28,920
decreased or absent reflex
response in your muscles.

486
00:27:29,360 --> 00:27:33,360
And if it's completely gone,
it's called araflexia.

487
00:27:33,800 --> 00:27:37,320
And that's when somebody, not
just somebody, when a doctor or

488
00:27:37,320 --> 00:27:41,560
someone with a reflex hammer,
just somebody comes out, you,

489
00:27:41,600 --> 00:27:43,600
anybody.
But when they use the reflex

490
00:27:43,600 --> 00:27:47,480
hammer and there's no response,
where is typically, typically a

491
00:27:47,480 --> 00:27:51,160
response behind the elbows,
behind the knees, behind the

492
00:27:51,240 --> 00:27:54,240
ankles, things like that.
If there is no response or

493
00:27:54,240 --> 00:27:56,200
decreased response, this can be
a symptom.

494
00:27:56,200 --> 00:27:58,200
It can be a symptom of other
stuff too, but it's one of the

495
00:27:58,200 --> 00:28:00,720
things that they watch for.
But actually in front of the

496
00:28:00,720 --> 00:28:02,440
knees.
But they do behind as well.

497
00:28:02,480 --> 00:28:04,480
But yeah, you're right.
They do in front and behind.

498
00:28:04,680 --> 00:28:06,480
You're right.
I've never had behind done, only

499
00:28:06,480 --> 00:28:08,720
in front.
I feel ripped off in a more in a

500
00:28:08,720 --> 00:28:11,240
more complete neurological exam.
They'll do more of them.

501
00:28:11,720 --> 00:28:15,080
And I was just envisioning an
exam I witnessed the other day.

502
00:28:15,080 --> 00:28:21,080
But and what's interesting to me
is many patients report

503
00:28:21,320 --> 00:28:26,160
porodromal or early symptoms
such as fatigue, paresthesia,

504
00:28:26,160 --> 00:28:28,840
which can be some numbness and
behavioral changes shortly

505
00:28:28,840 --> 00:28:31,480
before the episode.
The brain man.

506
00:28:31,920 --> 00:28:35,600
Right.
And maybe this is something that

507
00:28:35,600 --> 00:28:38,840
if people do get these, I kind
of was thinking of it like an

508
00:28:38,840 --> 00:28:42,880
aura with a migraine to see
things or my vision would change

509
00:28:42,880 --> 00:28:46,080
or or something would happen.
And so I knew it was coming and

510
00:28:46,080 --> 00:28:49,560
if I can put some caffeine and
ibuprofen on board fast enough,

511
00:28:49,880 --> 00:28:52,720
it wouldn't happen.
So I feel like people that have

512
00:28:52,720 --> 00:28:56,680
these early symptoms could
really lessen the effects

513
00:28:56,680 --> 00:28:59,200
because they will do what it
takes, like increasing their

514
00:28:59,200 --> 00:29:03,360
potassium or decreasing them if
they have the one more rare

515
00:29:03,360 --> 00:29:04,920
type.
That's to me.

516
00:29:04,960 --> 00:29:06,600
Behavior changes.
That's wild.

517
00:29:06,600 --> 00:29:10,480
Like, Oh no, mom's suddenly
being really nitpicky.

518
00:29:10,480 --> 00:29:12,240
I think she's going to be
paralyzed soon.

519
00:29:12,720 --> 00:29:16,320
Exactly and exactly too.
When you look at people who

520
00:29:16,320 --> 00:29:21,080
become hangry, many of them are
hypo or low blood sugar episodes

521
00:29:21,480 --> 00:29:26,560
because our bodies, while they
have a lot of give, there's some

522
00:29:26,560 --> 00:29:28,560
parts of our systems that are
very tight.

523
00:29:28,560 --> 00:29:31,920
They have very little
differences that it can tolerate

524
00:29:31,920 --> 00:29:33,640
before something starts to go
wrong.

525
00:29:33,920 --> 00:29:37,160
I just think sometimes of how
many systems in our bodies have

526
00:29:37,160 --> 00:29:41,280
to be working at every moment in
time for us to do.

527
00:29:41,320 --> 00:29:44,280
Yeah, I agree.
Anything primarily stay alive.

528
00:29:45,120 --> 00:29:47,480
It's crazy how much of our body
is autonomous.

529
00:29:47,480 --> 00:29:51,040
Also, we don't have to think
about it functioning.

530
00:29:51,320 --> 00:29:56,360
Really what we do think about is
not even necessarily any sort of

531
00:29:56,360 --> 00:29:58,920
function because it's like I am
going to pick up my phone,

532
00:29:58,920 --> 00:30:00,800
right?
But I didn't think about I'm

533
00:30:00,800 --> 00:30:02,840
going to take my hand, I'm going
to out stretch my fingers.

534
00:30:02,840 --> 00:30:05,800
I'm going to place it down on
the phone, then I'm going to in

535
00:30:05,800 --> 00:30:07,960
stretch my fingers I would say.
And then I'm going to.

536
00:30:07,960 --> 00:30:09,640
Lift my hand.
Like we don't think of that,

537
00:30:09,640 --> 00:30:10,600
right?
We're just like, I'm going to

538
00:30:10,600 --> 00:30:13,040
pick up my phone and then our
body picks up our phone.

539
00:30:13,280 --> 00:30:15,080
It's fascinating.
It's fascinating.

540
00:30:15,080 --> 00:30:17,640
There's a lot going on in our
bodies, that's for sure.

541
00:30:18,080 --> 00:30:20,920
Well, there is.
And I always think of the fact

542
00:30:20,920 --> 00:30:23,760
we're just your example.
I'm going to reach out and touch

543
00:30:23,760 --> 00:30:25,480
it.
Well, I've reached out the right

544
00:30:25,480 --> 00:30:28,840
amount of degrees.
I've put my arm in the correct

545
00:30:28,880 --> 00:30:33,120
angle and positioning and I have
done all of these things

546
00:30:33,120 --> 00:30:35,400
without, like you said, even
thinking about it.

547
00:30:35,640 --> 00:30:38,840
I'm, I just reached for this.
I could not solve this math

548
00:30:38,840 --> 00:30:42,600
problem in my in any way what it
took for me to get there in a

549
00:30:42,600 --> 00:30:45,600
math sentence.
But other people can.

550
00:30:45,600 --> 00:30:47,800
I can't, nor do I want to, but I
just.

551
00:30:47,840 --> 00:30:50,160
Yeah.
But my brain in the meantime has

552
00:30:50,160 --> 00:30:53,120
done all the things it took to
create lifting or moving

553
00:30:53,120 --> 00:30:57,120
something and every bit of what
happened there.

554
00:30:57,480 --> 00:31:01,040
So I think when we do things
like forget or become

555
00:31:01,040 --> 00:31:03,080
distracted, we just get to
remember all the things our

556
00:31:03,080 --> 00:31:04,880
brain does correctly, not those
things.

557
00:31:05,080 --> 00:31:09,480
Yeah, exactly.
And one of the things, back to

558
00:31:09,480 --> 00:31:12,600
our topic, one of the things
that individuals have with the

559
00:31:12,600 --> 00:31:16,840
Hypo PP is they have mild muscle
weakness between attacks.

560
00:31:16,840 --> 00:31:20,040
So some they'll have their
attacks and then between them

561
00:31:20,040 --> 00:31:23,120
sometimes they'll have mild
muscle weakness and that can

562
00:31:23,120 --> 00:31:28,560
improve with mild exercise.
So I feel like maybe this is

563
00:31:28,560 --> 00:31:32,880
hypothesis by Andrea, but I
wonder if that's moving some of

564
00:31:33,200 --> 00:31:37,040
the muscle strands so that it
can balance out those hypo or

565
00:31:37,040 --> 00:31:41,720
hyperkalemic cells.
I that's my theory and I only

566
00:31:41,720 --> 00:31:45,920
just thought of it.
I did 0 research about that so

567
00:31:46,000 --> 00:31:49,680
if I'm wrong and people are
experts at hypo PP please.

568
00:31:49,760 --> 00:31:53,640
Forgive me.
But like I said, there are some

569
00:31:53,640 --> 00:31:57,920
main forms of pee pee.
The most common is the

570
00:31:57,920 --> 00:31:59,800
hypoclimic.
We've been talking about the low

571
00:31:59,800 --> 00:32:05,120
potassium, and that is, like I
said, the most common.

572
00:32:05,240 --> 00:32:10,320
Now get this, This is the list
of things that can trigger.

573
00:32:10,320 --> 00:32:12,720
We talked about a couple of
these already, but we talked

574
00:32:12,720 --> 00:32:16,320
about heavy exercise and food
with lots of sugars and

575
00:32:16,320 --> 00:32:22,280
starches, licorice, stress, cold
temperatures and some medicines.

576
00:32:22,800 --> 00:32:24,840
Now you may be wondering about
licorice.

577
00:32:25,560 --> 00:32:27,360
Yes, I am wondering about
licorice.

578
00:32:28,560 --> 00:32:32,040
That was I licorice.
I mean, it's on the list.

579
00:32:32,040 --> 00:32:34,360
Licorice.
How is that a thing?

580
00:32:34,480 --> 00:32:40,760
Well I'm glad you asked because
licorice can cause hypokalemia

581
00:32:41,160 --> 00:32:47,920
because of its active compound
glycer cyreazine, which I may be

582
00:32:47,920 --> 00:32:52,680
pronouncing incorrectly, but it
blocks an enzyme which is listed

583
00:32:52,680 --> 00:32:57,600
here. 11 BHSD 2 Where you of?
Course, of course, we're talking

584
00:32:57,600 --> 00:33:02,840
about black licorice, correct?
Yes, yes, because red licorice

585
00:33:02,840 --> 00:33:06,040
is not I, it's not truly
licorice, but thank you for

586
00:33:06,040 --> 00:33:09,080
clarifying.
So black licorice and if you

587
00:33:09,080 --> 00:33:10,520
want to look at that enzyme, go
ahead.

588
00:33:10,960 --> 00:33:14,600
But it blocks an enzyme in the
kidneys that normally

589
00:33:14,600 --> 00:33:17,800
inactivates cortisol.
OK, So when I was reading this,

590
00:33:17,960 --> 00:33:21,880
wait, cortisol.
So that's interesting and it

591
00:33:21,880 --> 00:33:22,800
leads.
Hormone.

592
00:33:23,280 --> 00:33:25,760
Right.
It leads to excess active

593
00:33:25,760 --> 00:33:29,000
cortisol.
This build up of cortisol

594
00:33:29,200 --> 00:33:34,200
excessively activates
mineralocorticoid receptors.

595
00:33:34,200 --> 00:33:35,120
My.
Goodness.

596
00:33:35,240 --> 00:33:41,440
Mimicking high aldosterone then
causes the kidneys to excrete

597
00:33:41,520 --> 00:33:43,840
too much potassium and retain
sodium.

598
00:33:44,280 --> 00:33:46,920
Wow.
That results in low potassium

599
00:33:47,240 --> 00:33:51,880
and high blood pressure.
So I'm good, but wow.

600
00:33:52,400 --> 00:33:55,360
You're also good because it
rarely causes PP.

601
00:33:55,400 --> 00:33:57,800
Only 40 cases have ever been
described.

602
00:33:58,520 --> 00:34:01,520
Wow.
But I thought, Oh my gosh, And

603
00:34:01,520 --> 00:34:06,000
how did it if there were 40
cases?

604
00:34:06,200 --> 00:34:11,960
No idea.
However, it was a thing and has

605
00:34:11,960 --> 00:34:13,880
been a thing.
And actually, we're going to

606
00:34:13,880 --> 00:34:17,280
talk about some case studies
where it was a thing, which to

607
00:34:17,280 --> 00:34:19,639
me is wild because I've eaten
black.

608
00:34:19,719 --> 00:34:23,120
I do like black licorice.
I don't think I've ever eaten

609
00:34:23,120 --> 00:34:28,360
enough to get to this level of
having all activating compounds.

610
00:34:28,360 --> 00:34:31,639
Dumping all your kidneys kidneys
dumping all your potassium from

611
00:34:31,639 --> 00:34:34,840
your.
Kidneys Exactly exactly so when

612
00:34:34,840 --> 00:34:37,480
I read the licorice I, I
immediately had to go down a

613
00:34:37,480 --> 00:34:38,719
rabbit hole for that for a
second I'm.

614
00:34:38,840 --> 00:34:45,040
Sure I I would too I think.
Anyway, hypo PP is a rare and I

615
00:34:45,040 --> 00:34:47,280
keep saying rare because I want
people to understand it really

616
00:34:47,280 --> 00:34:52,600
is very rare and it's one person
per 100,000 people.

617
00:34:52,840 --> 00:34:55,000
OK.
So that's pretty rare.

618
00:34:55,280 --> 00:34:57,960
You're the one of the 100,000.
It doesn't feel rare as most

619
00:34:57,960 --> 00:35:00,440
disorders that it doesn't feel
rare when you're one that has

620
00:35:00,480 --> 00:35:02,920
it.
But that to me was comforting

621
00:35:03,360 --> 00:35:05,920
and I would probably know by now
if I had it.

622
00:35:06,320 --> 00:35:12,200
And yeah, yeah, probably one of
the other things to know is that

623
00:35:12,200 --> 00:35:15,720
when the serum potassium levels
drop below 3, like we talked

624
00:35:15,720 --> 00:35:20,680
about affected fibers, the
muscle fibers develop sustained

625
00:35:20,680 --> 00:35:23,800
depolarization.
Now the way muscles work is by

626
00:35:23,800 --> 00:35:27,960
polarizing and unpolarizing, but
the, and that's why the ions

627
00:35:27,960 --> 00:35:30,840
that have charges are important
because it changes the

628
00:35:30,840 --> 00:35:34,880
polarization.
Now these fibers, when they're

629
00:35:34,880 --> 00:35:39,240
depolarized, cannot relax or
tighten.

630
00:35:39,240 --> 00:35:42,640
They can't do their their
movements, so they're

631
00:35:42,640 --> 00:35:45,440
electrically inexcitable.
They just can't be changed.

632
00:35:45,600 --> 00:35:49,040
Normal fibers undergo
hyperpolarization in response to

633
00:35:49,040 --> 00:35:51,840
a drop in serum potassium.
So if you and I had more

634
00:35:51,840 --> 00:35:55,040
potassium than we needed, ours
would be hyperpolarized, which

635
00:35:55,040 --> 00:35:58,320
would then 'cause some of those
spasms and things we think of

636
00:35:58,640 --> 00:36:02,480
with potassium, which is
interesting because I know that

637
00:36:02,480 --> 00:36:04,440
I've had cramps.
I've thought about take, I've

638
00:36:04,440 --> 00:36:07,560
eaten a banana, which actually
is kind of contraindicated

639
00:36:07,920 --> 00:36:11,920
because if mine is probably
already hyperpolarized.

640
00:36:11,920 --> 00:36:15,320
So that's another whole thing.
But then it shifts the ions and

641
00:36:15,320 --> 00:36:17,600
there's all kinds of stuff that
goes on behind the scenes, which

642
00:36:17,600 --> 00:36:21,600
is shocking to me.
And so instead of being ready to

643
00:36:21,600 --> 00:36:24,600
go, their muscles are not ready
to go.

644
00:36:24,600 --> 00:36:26,600
They don't, they just don't
respond.

645
00:36:26,720 --> 00:36:32,760
The types of hypo PP have been
both familial and acquired.

646
00:36:33,160 --> 00:36:36,880
So many of these conditions are
genetic.

647
00:36:36,880 --> 00:36:39,040
They've carried on through the
family lines.

648
00:36:39,280 --> 00:36:44,360
This hypo PP does not always,
more typically it does the not.

649
00:36:44,600 --> 00:36:49,480
But there are some types that
occurs from other sorts of

650
00:36:49,480 --> 00:36:51,160
conditions, which we'll talk
about in a minute.

651
00:36:51,160 --> 00:36:55,560
But mostly there's a mutation in
the skeletal muscle calcium

652
00:36:55,600 --> 00:36:59,080
channel gene, which I won't even
try to say because it's a big,

653
00:36:59,720 --> 00:37:03,440
it's a big one thing.
It's the one that helps work on

654
00:37:03,440 --> 00:37:05,680
the regulation of all these
muscle ion channels.

655
00:37:06,160 --> 00:37:10,160
The mutations disrupt the normal
flow of electric current through

656
00:37:10,520 --> 00:37:12,960
the voltage sensor domain of the
ion channel.

657
00:37:13,240 --> 00:37:15,520
And there is actually a voltage
sensor.

658
00:37:15,760 --> 00:37:19,880
It's not quite like what we use
in our electrical processing,

659
00:37:19,880 --> 00:37:23,120
but it's it's the sensor that
tells whether the ions need to

660
00:37:23,120 --> 00:37:25,240
charge or become positive or
negative.

661
00:37:25,960 --> 00:37:27,960
And I just don't even know how
well this works.

662
00:37:28,480 --> 00:37:31,600
And I figured it out again, no
idea.

663
00:37:31,800 --> 00:37:35,120
Yeah, it is wild.
The bottom line is this causes

664
00:37:35,120 --> 00:37:38,000
what's called flaccid paralysis,
which just basically means the

665
00:37:38,000 --> 00:37:41,800
muscles can't move and.
That's bad.

666
00:37:42,320 --> 00:37:46,560
Yeah, that seems bad.
I think that that moving muscles

667
00:37:46,560 --> 00:37:49,680
are a good thing.
I really feel that way too for

668
00:37:49,960 --> 00:37:53,000
we are caring professionals
though, so take our word for it.

669
00:37:54,840 --> 00:38:01,400
We know now that things working
are good, and the most important

670
00:38:01,400 --> 00:38:06,560
thing in this hypo PP is prompt
diagnosis and treatment.

671
00:38:06,920 --> 00:38:09,120
And that can be a challenge
which we'll talk about in a

672
00:38:09,120 --> 00:38:13,960
little bit, because if it's not
promptly identified, some other

673
00:38:13,960 --> 00:38:16,960
things can happen which can
cause some morbidity.

674
00:38:16,960 --> 00:38:21,800
They can cause death because it
leads to the cascading chain of

675
00:38:21,800 --> 00:38:27,120
events which can be fatal.
Again, that part of it is not

676
00:38:27,120 --> 00:38:29,560
that common.
Usually people have some time

677
00:38:29,560 --> 00:38:31,360
once they started to develop
some things.

678
00:38:31,640 --> 00:38:35,040
The good news is, if a person is
paralyzed, they usually go for

679
00:38:35,040 --> 00:38:37,560
care.
They don't even ignore it.

680
00:38:37,560 --> 00:38:39,920
Oh femor gosh, you know I can't.
Oh, this is awesome.

681
00:38:40,720 --> 00:38:41,680
That's weird.
I'll watch TV.

682
00:38:43,040 --> 00:38:46,480
And most people will go get some
care, which is is good because

683
00:38:46,480 --> 00:38:48,960
it does facilitate an earlier
diagnosis.

684
00:38:48,960 --> 00:38:50,800
Then a lot of things will sit
around going well.

685
00:38:50,800 --> 00:38:52,920
It's probably not that bad, not
much fell off.

686
00:38:54,000 --> 00:38:56,120
Right.
Wait, am I having a heart

687
00:38:56,120 --> 00:38:58,680
attack?
I can see a little bit.

688
00:38:59,160 --> 00:39:02,560
Yeah, it's probably indigestion.
I have a funny story about that

689
00:39:02,560 --> 00:39:04,680
actually.
As you know, and I don't think

690
00:39:04,680 --> 00:39:07,960
our listeners know, but I, I
used to have SVT or Supra

691
00:39:08,320 --> 00:39:11,760
ventricular tachycardia, which
means your heart just beats

692
00:39:11,760 --> 00:39:14,720
really, really fast because it's
getting sent electrical signals

693
00:39:14,720 --> 00:39:16,200
that it's not supposed to be
getting.

694
00:39:16,360 --> 00:39:19,760
And what happens is normally you
have a sinus node on your heart

695
00:39:19,760 --> 00:39:22,680
that sends out the signals and
that's what supposed to send out

696
00:39:22,680 --> 00:39:24,240
the signals.
But your your heart starts

697
00:39:24,600 --> 00:39:27,800
sending out signals from other
parts of the of the heart and so

698
00:39:27,800 --> 00:39:30,560
it gets confused.
Anyway, Long story short, my

699
00:39:30,640 --> 00:39:34,720
heart rate when I was in SVT was
300 beats per minute, which as

700
00:39:34,720 --> 00:39:38,120
you can imagine is very very
fast and very very frightening

701
00:39:38,120 --> 00:39:41,160
and.
Very. 1st and very unpleasant so

702
00:39:41,160 --> 00:39:46,160
the first time I was in SVTI was
driving and it's when it starts

703
00:39:46,160 --> 00:39:51,280
it's starts feeling like like
heart palpitations, but then it

704
00:39:51,280 --> 00:39:55,760
just gets worse and I don't even
know how to describe what worse

705
00:39:55,760 --> 00:40:00,000
is other than like my fingertips
started to hurt and then I was

706
00:40:00,560 --> 00:40:04,200
having a hard time like catching
my breath or yeah I mean it's

707
00:40:04,200 --> 00:40:06,680
just kind of hard to describe so
I pulled over into a gas station

708
00:40:06,680 --> 00:40:11,000
before it got really bad but
then as I was as I was sitting

709
00:40:11,000 --> 00:40:13,920
in the car it got it was getting
worse so I got out of the car

710
00:40:13,920 --> 00:40:15,760
turns out standing up makes it
worse worse.

711
00:40:16,000 --> 00:40:19,000
So then I laid down in the back
of the car and the whole this is

712
00:40:19,000 --> 00:40:21,600
the funny part of the story.
The whole time I'm thinking to

713
00:40:21,600 --> 00:40:23,880
myself.
Am I having a heart attack?

714
00:40:24,120 --> 00:40:27,160
And I don't want to call 911
because it will be so

715
00:40:27,160 --> 00:40:29,920
embarrassing to have an
ambulance come to this parking

716
00:40:29,920 --> 00:40:34,640
lot.
And I marvel that in that

717
00:40:34,640 --> 00:40:37,840
moment, I really was saying I
would rather die than be

718
00:40:37,840 --> 00:40:39,800
embarrassed in a stupid.
Gas.

719
00:40:39,800 --> 00:40:43,080
Station parking lot, it's and
I'm a nurse and I was a nurse at

720
00:40:43,080 --> 00:40:47,360
that time, but there was just,
again, obviously it wasn't a

721
00:40:47,360 --> 00:40:50,880
heart attack and I did call 911
and I did get it treated.

722
00:40:50,880 --> 00:40:53,560
I ended up having another
episode before I got it treated

723
00:40:53,560 --> 00:40:57,040
and that was equally as scary
and horrifying and terrible and

724
00:40:57,440 --> 00:41:00,800
fast. 300 beats per minute.
But yeah, it's so it's there are

725
00:41:00,800 --> 00:41:03,200
people, myself included, I don't
think I would be this.

726
00:41:03,200 --> 00:41:04,440
I don't know.
I don't even know.

727
00:41:04,440 --> 00:41:05,600
I don't know if I'd be the same
way.

728
00:41:05,600 --> 00:41:09,200
But there are people, myself
included, who will go wait and

729
00:41:09,200 --> 00:41:11,600
see.
Right, right.

730
00:41:11,600 --> 00:41:15,360
I had a patient come into the
clinic I was working at who had

731
00:41:15,360 --> 00:41:17,560
called me.
I was just a triage nurse and I

732
00:41:17,560 --> 00:41:18,760
was on the telephones at the
moment.

733
00:41:18,760 --> 00:41:21,640
He called me and he said I think
I'm having a heart attack and

734
00:41:21,640 --> 00:41:25,880
911, this is how old I am. 911
system was newly available and I

735
00:41:25,880 --> 00:41:28,560
said call 911, don't be on the
phone with me.

736
00:41:28,920 --> 00:41:31,280
And he said, well, if I'm not
having a heart attack, it'd be

737
00:41:31,280 --> 00:41:33,320
really embarrassing to have
someone come to the office.

738
00:41:33,920 --> 00:41:36,360
I'm like, dude, and if you are
having a heart attack, it might

739
00:41:36,360 --> 00:41:39,280
save your life.
He wouldn't tell me who he was.

740
00:41:39,280 --> 00:41:41,280
And we didn't have reverse
directory or anything.

741
00:41:41,280 --> 00:41:43,280
And I had no idea who it was.
And he hung up.

742
00:41:44,120 --> 00:41:46,840
And then I'm like, Oh my gosh,
he's going to go die.

743
00:41:47,280 --> 00:41:50,240
Well, then about half an hour
later, I didn't put this

744
00:41:50,240 --> 00:41:52,800
together until a little while
later, about half an hour later,

745
00:41:52,800 --> 00:41:56,720
this guy came in and he had
checked in and said he was

746
00:41:56,720 --> 00:41:59,960
having abdominal pain, he was
nauseous and things like that.

747
00:42:00,160 --> 00:42:02,920
Turned out it was the same guy.
And then he came in and he was

748
00:42:02,920 --> 00:42:04,520
having a heart attack.
Oh, wow.

749
00:42:04,840 --> 00:42:06,400
And we found out later he was
the same guy.

750
00:42:06,400 --> 00:42:08,280
But we didn't know it then
because like I said, there's

751
00:42:08,280 --> 00:42:11,160
half an hour between.
Why the heck would he come to an

752
00:42:11,160 --> 00:42:12,880
urgent care clinic and not the
ER?

753
00:42:13,000 --> 00:42:15,320
Because the ER was only down the
road, for heaven's sakes.

754
00:42:15,680 --> 00:42:18,040
But anyway, blah, blah, blah.
But that was the thing.

755
00:42:18,040 --> 00:42:20,080
I would be embarrassed if it's
not this.

756
00:42:20,280 --> 00:42:21,280
Yeah.
So what?

757
00:42:21,400 --> 00:42:23,240
Yeah.
Better than dead?

758
00:42:23,920 --> 00:42:27,400
I know it's, that's what I mean.
Like I said, I did finally

759
00:42:27,400 --> 00:42:30,880
actually Odyssey called 911
because I was incapacitated, but

760
00:42:31,640 --> 00:42:34,680
EMS eventually came.
But I just, it just, I still

761
00:42:34,680 --> 00:42:39,000
marvel at the fact that I'd
rather be dead than embarrassed.

762
00:42:39,000 --> 00:42:41,200
I can't imagine that's actually
true, right?

763
00:42:41,200 --> 00:42:45,520
Like in my rational mind.
But that's what I was allegedly

764
00:42:45,520 --> 00:42:48,360
supposedly thinking at that
time, you know, because it could

765
00:42:48,360 --> 00:42:49,960
have been a heart attack, Who
knows?

766
00:42:50,000 --> 00:42:52,600
I don't know.
I don't know what SVT I do now,

767
00:42:52,600 --> 00:42:54,280
but I didn't know what SVT felt
like.

768
00:42:54,880 --> 00:42:57,960
Well, in your defense, when the
heart is acting inappropriately,

769
00:42:57,960 --> 00:42:59,720
there's less oxygen going to the
brain.

770
00:43:00,240 --> 00:43:02,640
That's true.
So maybe the decision making in

771
00:43:02,640 --> 00:43:05,600
that moment is reduced because
there's less oxygen in the

772
00:43:05,600 --> 00:43:07,040
brain.
But still, it's true.

773
00:43:07,320 --> 00:43:09,640
The embarrassed thing is, is a
common thought.

774
00:43:09,640 --> 00:43:12,520
I've heard people say it a lot
of times when they've come into

775
00:43:12,520 --> 00:43:16,080
the to urgent care or when I was
working in the hospital and they

776
00:43:16,080 --> 00:43:17,840
had come in after they've been
through the ER.

777
00:43:17,840 --> 00:43:20,600
They said, well, you know,
anyway, yeah, it's wild.

778
00:43:20,960 --> 00:43:23,200
It's important to get care
immediately if you think

779
00:43:23,200 --> 00:43:27,640
something's going on because
better better early than too

780
00:43:27,640 --> 00:43:29,200
late.
Yep, I agree.

781
00:43:29,280 --> 00:43:32,400
Again, back to our topic.
Thanks for the examples though.

782
00:43:32,480 --> 00:43:36,240
So hypocalemic PP often starts
in late high childhood or teen

783
00:43:36,240 --> 00:43:39,720
years.
The average is between 5 and 35

784
00:43:39,720 --> 00:43:42,480
years of age.
Oh my gosh, imagine being a 5

785
00:43:42,480 --> 00:43:45,200
year old and all of a sudden
you're paralyzed and you don't

786
00:43:45,200 --> 00:43:47,520
know why.
Or the parent of a 5 year old.

787
00:43:47,520 --> 00:43:49,760
Or the parent of a 5 year old.
Yeah, for sure.

788
00:43:50,200 --> 00:43:52,400
However, that gap to me was
amazing.

789
00:43:52,400 --> 00:43:55,760
Five years.
The average age is between.

790
00:43:55,760 --> 00:43:57,360
Is that even an average?
I was just going.

791
00:43:57,560 --> 00:43:58,760
To say, can you call that an
average?

792
00:43:59,400 --> 00:44:02,480
So I don't know, but that's what
the information said when I was

793
00:44:02,480 --> 00:44:05,640
researching it.
And attacks of the skeletal

794
00:44:05,640 --> 00:44:08,480
muscle weakness may last again
from a couple hours to a day.

795
00:44:08,800 --> 00:44:10,960
These tend to happen at night or
in the morning.

796
00:44:10,960 --> 00:44:13,480
Which brings me back to the
thought when they were saying it

797
00:44:13,480 --> 00:44:15,920
can happen after heavier
exercise, the rest period.

798
00:44:16,200 --> 00:44:20,120
So that seems to be the case.
They may not be able to move it

799
00:44:20,240 --> 00:44:22,400
all during the most severe
episodes.

800
00:44:23,600 --> 00:44:27,240
That would be so scary, and I'll
tell you something about that in

801
00:44:27,240 --> 00:44:29,800
a minute.
But after age 50, it may cause

802
00:44:29,800 --> 00:44:32,680
permanent weakness that slowly
gets worse, especially in hips

803
00:44:32,680 --> 00:44:36,440
and thighs.
And again, the condition itself

804
00:44:36,440 --> 00:44:41,000
is not progressive, but the
damage it causes can become

805
00:44:41,000 --> 00:44:44,720
progressive.
And one of the things that

806
00:44:45,400 --> 00:44:49,040
removes it from like I said, the
ALS or Lou Gehrig's or things

807
00:44:49,040 --> 00:44:53,280
like that.
Now my partner Max had gown

808
00:44:53,280 --> 00:44:58,560
beret and he woke up 1 morning
not really able to move his feet

809
00:44:58,560 --> 00:45:02,120
and legs quite right.
And he he thought, well, that's

810
00:45:02,120 --> 00:45:05,840
weird as we do and and
continued.

811
00:45:05,840 --> 00:45:10,120
And by the time he called the
ambulance, it didn't take that

812
00:45:10,120 --> 00:45:12,320
long.
It had only taken about an hour

813
00:45:12,480 --> 00:45:14,840
or so until he really couldn't
move.

814
00:45:14,920 --> 00:45:17,080
And it was getting progressed.
It was progressing much more

815
00:45:17,080 --> 00:45:20,400
quickly.
And he was in the hospital for,

816
00:45:20,520 --> 00:45:22,360
I think he said he was in the
hospital for two weeks and then

817
00:45:22,360 --> 00:45:24,760
he had to go to rehab because he
had to learn how to walk again

818
00:45:24,760 --> 00:45:27,200
because it became to the point
that he was paralyzed to his

819
00:45:27,200 --> 00:45:28,800
neck.
Did he get a tick bite?

820
00:45:28,800 --> 00:45:33,840
How'd he get young Beret?
He still doesn't know and

821
00:45:33,840 --> 00:45:37,320
because of it he can't take some
of the immunizations because of

822
00:45:37,320 --> 00:45:41,480
the inactive ingredients that
can cause a flare in a virus.

823
00:45:41,800 --> 00:45:44,720
The Andre is a virus and some
things can flare it.

824
00:45:44,720 --> 00:45:49,720
He can't take the flu shot.
He can't take a couple other

825
00:45:49,720 --> 00:45:52,360
things that have too much active
virus.

826
00:45:52,360 --> 00:45:54,080
I guess in it is the problem.
Yikes.

827
00:45:54,880 --> 00:45:57,360
But the one thing that is
different about that is this is

828
00:45:57,360 --> 00:46:01,400
not periodic.
That was an event and he is more

829
00:46:01,400 --> 00:46:04,520
susceptible to it in the future,
but he doesn't necessarily ever

830
00:46:04,520 --> 00:46:06,640
have to have another event.
Wow.

831
00:46:07,200 --> 00:46:11,720
And the these are periodic.
So you might have one and then

832
00:46:12,040 --> 00:46:16,080
as they mentioned, maybe not
ever again or in a few weeks or

833
00:46:16,080 --> 00:46:20,120
in a few years or or whatever.
And that again to me would be so

834
00:46:20,120 --> 00:46:22,000
scary because you just don't
know.

835
00:46:22,440 --> 00:46:23,720
It could, everything could be
fine.

836
00:46:23,920 --> 00:46:28,600
The good news, I guess is that
if it starts, it usually starts

837
00:46:28,880 --> 00:46:31,040
with weakness and then
progresses on.

838
00:46:31,560 --> 00:46:34,720
But say I'm driving.
That start feeling, my thought

839
00:46:34,720 --> 00:46:36,880
from the very beginning is
somebody driving?

840
00:46:37,360 --> 00:46:40,120
Yeah.
And I don't think that it would

841
00:46:40,120 --> 00:46:44,680
be the same as epilepsy or
something because they have to

842
00:46:44,680 --> 00:46:47,080
pass a certain period of time
and there can be controlled by

843
00:46:47,080 --> 00:46:50,960
medication in order to drive if
they've had a seizure after.

844
00:46:51,200 --> 00:46:53,160
I think it's a six month time
frame, is that right?

845
00:46:53,160 --> 00:46:56,360
I can't quite remember.
But it's a year.

846
00:46:56,760 --> 00:46:58,400
Is it a year you?
Have to you have to be a year

847
00:46:58,400 --> 00:47:01,480
without seizures medication
free.

848
00:47:01,480 --> 00:47:04,640
Torin just went through it.
So it has to be medication free?

849
00:47:05,360 --> 00:47:07,520
Oh I thought it could be
controlled with medication.

850
00:47:07,520 --> 00:47:09,600
I think it's three years
controlled with medication.

851
00:47:09,760 --> 00:47:12,200
Oh, and that's a huge impact on
life.

852
00:47:12,200 --> 00:47:16,680
I have someone I know who had
had had seizures, had just

853
00:47:16,680 --> 00:47:20,800
passed the window of
everything's OK and had a

854
00:47:20,800 --> 00:47:23,200
seizure.
No.

855
00:47:23,200 --> 00:47:25,240
And now she can't drive again.
Yeah.

856
00:47:25,640 --> 00:47:29,200
And she's devastated because as
an adult it affects every

857
00:47:29,200 --> 00:47:32,160
blasted part of her life to be
able to drive and get herself

858
00:47:32,160 --> 00:47:34,600
around and her dependency on
others.

859
00:47:34,600 --> 00:47:39,600
Now is is back and she has no
not adult adult children, but

860
00:47:39,600 --> 00:47:42,840
driving age children who she
can't go anywhere without them.

861
00:47:43,640 --> 00:47:46,280
Yeah, Holly and I were just
talking about this.

862
00:47:46,440 --> 00:47:48,160
Yeah, Holly and I were just
talking about the same sort of

863
00:47:48,160 --> 00:47:49,640
thing.
Obviously I don't have seizures,

864
00:47:49,640 --> 00:47:54,120
but knock on wood, but when I
had my hip replacement before,

865
00:47:54,200 --> 00:47:56,440
before I had my hip replacement.
And then after I had my hip

866
00:47:56,440 --> 00:47:59,840
replacement, I was dependent on
my adult and driving age

867
00:47:59,840 --> 00:48:04,200
children and even little things
like like we would go to a

868
00:48:04,200 --> 00:48:06,920
seafood buffet and they would
have to go get my food for me,

869
00:48:06,920 --> 00:48:09,720
right.
Like, and, and it it because

870
00:48:09,800 --> 00:48:13,320
it's not just frustrating for,
we'll say the patient or the,

871
00:48:13,680 --> 00:48:15,560
you know, it's frustrating for
all those people too.

872
00:48:15,560 --> 00:48:17,920
Those kids don't want to have to
take their mom grocery shopping

873
00:48:17,920 --> 00:48:19,640
every time, you know what I
mean?

874
00:48:19,920 --> 00:48:24,520
And kudos that they do.
And you know, like, but it's

875
00:48:24,520 --> 00:48:27,080
just, yeah, that sucks.
That's what I'm saying.

876
00:48:27,520 --> 00:48:29,760
It does.
And fortunately now there are a

877
00:48:29,760 --> 00:48:33,600
lot more things that like
DoorDash, Instacart and all of

878
00:48:33,600 --> 00:48:36,280
the things that people get stuff
brought to them.

879
00:48:36,280 --> 00:48:38,240
But still it's there.
It's always there.

880
00:48:39,360 --> 00:48:42,120
And then now we've gone through
one type of this.

881
00:48:42,120 --> 00:48:43,600
We probably ought to move along
a little bit.

882
00:48:45,440 --> 00:48:48,280
There's another PP that we had
alluded to.

883
00:48:48,280 --> 00:48:53,040
It's hyperkalemic which is the
high potassium and this may

884
00:48:53,040 --> 00:48:57,960
cause attacks and the triggers
may include heavy exercise,

885
00:48:58,760 --> 00:49:02,960
fasting, stress, cold and some
medicines which are similar.

886
00:49:02,960 --> 00:49:05,040
Fasting one was interesting to
me.

887
00:49:05,240 --> 00:49:08,920
Yeah, I would think and your
testing would go down if you

888
00:49:08,920 --> 00:49:12,240
were fasting?
I would think so too, but we get

889
00:49:12,240 --> 00:49:15,400
to remember that these people
have their gates, their ion

890
00:49:15,400 --> 00:49:17,800
gates, if you will, which is
really what it's called as an

891
00:49:17,800 --> 00:49:19,840
ion gate.
But it's, it sounds like it's a

892
00:49:19,840 --> 00:49:22,880
made-up thing, but the ion gates
are not working properly.

893
00:49:23,200 --> 00:49:27,040
So they let out too much or not
enough potassium, sodium,

894
00:49:27,040 --> 00:49:28,840
calcium.
In this case we're talking about

895
00:49:28,840 --> 00:49:33,160
the potassium and the symptoms
for the hyperkalemic.

896
00:49:33,160 --> 00:49:36,680
The high potassium include
weakness in the arms, legs,

897
00:49:36,680 --> 00:49:40,640
shoulders and back, muscle
stiffness which is myotonia and

898
00:49:40,640 --> 00:49:43,360
attacks Usually asked minute to
hours with normal strength

899
00:49:43,360 --> 00:49:46,080
between episodes.
Be thinking to yourself, doesn't

900
00:49:46,080 --> 00:49:48,400
this sound very same?
Yeah, except for the minutes to

901
00:49:48,400 --> 00:49:51,560
hours as opposed to months or
whatever the.

902
00:49:51,800 --> 00:49:55,760
Yeah, or days, right.
And again, diagnosing can be

903
00:49:55,760 --> 00:49:58,560
really a challenge, especially
because it's considered fairly

904
00:49:58,560 --> 00:50:02,560
rare and hyperkalemic PP often
starts by the age of 10.

905
00:50:02,720 --> 00:50:05,720
These attacks of skeletal muscle
weakness last an average of 30

906
00:50:05,720 --> 00:50:07,720
minutes to four hours like we're
talking about.

907
00:50:07,800 --> 00:50:11,200
So it's shorter and that's good,
and still no bueno.

908
00:50:11,920 --> 00:50:15,000
Yeah, it's I would not like to
be paralyzed for four hours

909
00:50:15,000 --> 00:50:15,960
even.
No, I don't.

910
00:50:16,240 --> 00:50:17,840
Think I'd like to be paralyzed
for 5 minutes.

911
00:50:17,840 --> 00:50:18,600
What am I?
What?

912
00:50:18,600 --> 00:50:20,320
Am I really There's no time
frame?

913
00:50:20,360 --> 00:50:23,120
I would like to be, but then we
have some paralysis which we are

914
00:50:23,120 --> 00:50:25,960
planning an episode on another
time, right?

915
00:50:26,400 --> 00:50:30,520
The attacks tend to be frequent
but less severe than other PP

916
00:50:30,520 --> 00:50:32,360
form.
So they may have them more

917
00:50:32,360 --> 00:50:35,400
often, but they're less severe,
which in some ways seems to me

918
00:50:35,400 --> 00:50:37,920
would be more like disrupting.
Yeah.

919
00:50:38,360 --> 00:50:42,080
True, as people get older, they
may have fewer attacks, but they

920
00:50:42,080 --> 00:50:44,800
also might have permanent muscle
damage that slowly gets worse.

921
00:50:44,920 --> 00:50:48,040
Again, not because of the
hyperkalemia, but because the

922
00:50:48,040 --> 00:50:52,040
results of the hyperkalemia.
There's another kind called

923
00:50:52,200 --> 00:50:57,440
Thyro Toxic PP and this is a
little bit clarified in its

924
00:50:57,440 --> 00:51:00,360
name, but it's high levels of
thyroid hormone that might cause

925
00:51:00,360 --> 00:51:02,600
attacks.
Thyroid related problems are

926
00:51:02,680 --> 00:51:05,960
also usually present.
Other triggers may include

927
00:51:06,520 --> 00:51:09,960
exercise, meals with lots of
carbohydrates, and stress.

928
00:51:10,760 --> 00:51:12,080
Wild.
Yeah.

929
00:51:12,320 --> 00:51:16,040
And this form appears mostly in
men, especially of those in

930
00:51:16,040 --> 00:51:19,440
Asian backgrounds.
One of the things, yeah, the

931
00:51:19,440 --> 00:51:22,440
predominance of male versus
female is 9 to 1.

932
00:51:22,720 --> 00:51:26,840
So for every one female, there's
nine males that have had this

933
00:51:26,880 --> 00:51:31,040
issue and and familial cases,
which is the ones that run in

934
00:51:31,040 --> 00:51:34,720
family exhibit an autosomal
dominant inheritance pattern,

935
00:51:34,840 --> 00:51:40,400
which means it comes through
with the woman dominant gene is

936
00:51:40,400 --> 00:51:42,960
the way I understand it.
It manifests normally with

937
00:51:42,960 --> 00:51:48,080
milder clinical expression and
attack rates in women compared

938
00:51:48,080 --> 00:51:53,800
to men, meaning women again have
less severity and it's less

939
00:51:53,800 --> 00:51:56,880
common.
It tends to start between 20 and

940
00:51:56,880 --> 00:52:00,280
40 years of age.
The attacks happen anywhere

941
00:52:00,280 --> 00:52:02,440
between a few times a year to a
few times a week.

942
00:52:02,480 --> 00:52:04,440
Again can last from hours to
days.

943
00:52:04,640 --> 00:52:07,600
And they also may have the
thyroid latest symptoms such as

944
00:52:07,600 --> 00:52:10,800
anxiety, sweating, weight loss
and an abnormal feeling of the

945
00:52:10,800 --> 00:52:14,720
heartbeat like palpitations.
Some people with thyroid toxic

946
00:52:14,720 --> 00:52:17,440
PP don't have symptoms of
thyroid disease, especially

947
00:52:17,440 --> 00:52:19,160
early on.
So this is another thing where

948
00:52:19,160 --> 00:52:24,160
it itself hasn't progressed, but
the thyroid problems may have

949
00:52:24,160 --> 00:52:26,240
progressed, which makes this
worse.

950
00:52:26,400 --> 00:52:30,680
And some of those other symptoms
will come up for people, like I

951
00:52:30,680 --> 00:52:34,040
say, the thyroid symptoms, and
sometimes that is how they

952
00:52:34,040 --> 00:52:36,560
identified as those thyroid
symptoms, like the sweating,

953
00:52:36,560 --> 00:52:38,400
anxiety, weight loss and
palpitations.

954
00:52:39,160 --> 00:52:42,760
And the final one that we're
going to talk about, there are a

955
00:52:42,760 --> 00:52:45,720
couple other kind of outliers,
but these are the main ones.

956
00:52:45,960 --> 00:52:49,440
But this is called Anderson
Towall syndrome, and this is

957
00:52:49,440 --> 00:52:52,040
named because of the people who
discovered it, as is common in

958
00:52:52,040 --> 00:52:56,200
these sorts of things.
This also is a shift in the

959
00:52:56,200 --> 00:53:00,560
potassium levels and triggers
may include guess what.

960
00:53:02,360 --> 00:53:04,120
Exercise, stress, and
carbohydrates.

961
00:53:04,760 --> 00:53:10,080
Well, certain medications,
exercise and stress, which makes

962
00:53:10,080 --> 00:53:12,320
sense to me really, because
you've got those.

963
00:53:12,440 --> 00:53:15,640
We talked all about the cortisol
shift and all of that, and that

964
00:53:15,640 --> 00:53:18,400
makes sense because things are
in motion, things are moving.

965
00:53:18,480 --> 00:53:23,880
Those gates are going to get
rusty and and not work properly

966
00:53:24,200 --> 00:53:26,560
and certain medications, like I
say, can happen.

967
00:53:26,840 --> 00:53:30,200
And with this form of pee pee,
this is the only form of pee pee

968
00:53:30,480 --> 00:53:33,360
that they have a certain set of
physical features.

969
00:53:33,520 --> 00:53:37,480
It includes a broad forehead,
widely spaced eyes, low set ears

970
00:53:37,480 --> 00:53:42,320
and a small chin.
And right, they have the genetic

971
00:53:42,320 --> 00:53:45,360
defect that can cause these.
And some of the other physical

972
00:53:45,360 --> 00:53:50,120
things are like I said, it's
called microganathia, which is

973
00:53:50,120 --> 00:53:51,880
the undersize or under belt low
jaw.

974
00:53:52,160 --> 00:53:54,840
And it's people you see that
have most of us have our, our

975
00:53:54,840 --> 00:53:56,760
chin will point out a little
bit.

976
00:53:57,120 --> 00:54:00,480
It'll be a little bit outside of
our jaw.

977
00:54:00,560 --> 00:54:03,440
It'll be pokey, if you will.
I don't even know how to it'll

978
00:54:03,440 --> 00:54:05,400
protrude a.
Little it'll protrude in a

979
00:54:05,440 --> 00:54:07,160
profile.
Right there you go.

980
00:54:07,160 --> 00:54:10,680
Thank you.
And people with this syndrome,

981
00:54:11,120 --> 00:54:13,440
their chin is almost not even
there.

982
00:54:13,440 --> 00:54:15,800
It just sort of from the.
Like Mitch McConnell.

983
00:54:15,880 --> 00:54:17,480
Oh, does he have that
congressman?

984
00:54:17,960 --> 00:54:19,040
Oh, OK.
Maybe.

985
00:54:19,040 --> 00:54:21,840
I don't know if he would be
actually diagnosed with it, but

986
00:54:21,840 --> 00:54:23,200
maybe.
But it's I mean.

987
00:54:23,200 --> 00:54:25,920
Just the chin.
I don't know about that I'm.

988
00:54:26,680 --> 00:54:31,760
Not diagnosing him but what's
interesting is in profile I've

989
00:54:31,760 --> 00:54:36,080
seen it in people that have, but
in profile they have just their

990
00:54:36,080 --> 00:54:37,800
lip and then goes down at an
angle.

991
00:54:37,800 --> 00:54:41,280
There's no protuberance.
What's that disorder where

992
00:54:41,280 --> 00:54:44,120
people are, They look really old
and they get old really their

993
00:54:44,120 --> 00:54:48,960
bodies accelerate syndrome.
No, that's not the real thing.

994
00:54:49,160 --> 00:54:51,800
Anyway, it doesn't matter.
But they have this

995
00:54:52,120 --> 00:54:58,200
underdeveloped jaw and they have
clinodiactyly of the 5th digit,

996
00:54:58,360 --> 00:55:01,920
which is where the finger cursed
sideways most often link little

997
00:55:01,920 --> 00:55:06,120
finger bending towards the ring
finger and it's got an

998
00:55:06,200 --> 00:55:10,280
abnormally shaped bone.
And then they also can have the

999
00:55:10,280 --> 00:55:13,480
syndactyl, which is a condition
where two or more fingers are

1000
00:55:13,480 --> 00:55:15,760
webbed.
So they have a variety potential

1001
00:55:15,760 --> 00:55:19,880
of a variety of physical
attributes that will be telltale

1002
00:55:19,880 --> 00:55:23,680
because of this condition and
the the genetic disorder.

1003
00:55:24,040 --> 00:55:26,720
They also tend to have scoliosis
in short stature.

1004
00:55:26,800 --> 00:55:29,600
These mutations are in the ion
channel.

1005
00:55:29,600 --> 00:55:33,040
So they they start mutated more
than some of the others.

1006
00:55:33,040 --> 00:55:36,120
It sounds like from what I was
reading, those multiple systemic

1007
00:55:36,240 --> 00:55:40,960
systemic issues, this is is the
one that is the most dangerous

1008
00:55:41,400 --> 00:55:46,040
because it causes more problems
with cardiac rhythm disturbances

1009
00:55:46,160 --> 00:55:49,240
it can cause.
That itself can be huge.

1010
00:55:49,600 --> 00:55:54,680
And they're saying that Graves'
disease is the most common cause

1011
00:55:54,680 --> 00:55:58,440
of the thyrotoxic condition.
If you've ever seen anyone with

1012
00:55:58,440 --> 00:56:00,800
Graves' disease, they are the
ones that have the buggy eyes

1013
00:56:00,800 --> 00:56:03,880
sometimes.
So this can fall into that.

1014
00:56:03,880 --> 00:56:09,160
Graves' disease is not hypo PP,
but Graves' disease can trigger

1015
00:56:09,240 --> 00:56:11,760
hypo PP.
It's the cause of it in some

1016
00:56:11,760 --> 00:56:14,000
cases.
It also has a greater incidence

1017
00:56:14,000 --> 00:56:16,760
among men, although
hyperthyroidism is more

1018
00:56:16,760 --> 00:56:20,200
frequently diagnosed in women.
So the incidence of this

1019
00:56:20,360 --> 00:56:24,880
hyperthyroidism is more frequent
in women, and the hypo is more

1020
00:56:24,880 --> 00:56:27,600
frequent in men.
Just for the record, Graves'

1021
00:56:27,600 --> 00:56:31,040
disease is more common.
Excuse me?

1022
00:56:31,040 --> 00:56:34,480
Graves' disease is an autoimmune
disorder or the immune system

1023
00:56:34,760 --> 00:56:38,280
mistakenly attacks the thyroid
gland, causing it to over

1024
00:56:38,280 --> 00:56:41,120
produce thyroid hormones.
So that graved.

1025
00:56:41,120 --> 00:56:45,440
With so is Hashimoto's thyroid
toxicosis, which is what I have.

1026
00:56:45,480 --> 00:56:48,440
I was actually diagnosed with
graved disease incorrectly and

1027
00:56:48,440 --> 00:56:51,600
then that diagnosis was fixed to
Hashimoto's.

1028
00:56:51,640 --> 00:56:53,720
But yeah, also an autoimmune
disease that attacks the

1029
00:56:53,720 --> 00:56:55,320
thyroid.
So thanks a lot buddy.

1030
00:56:55,960 --> 00:56:59,760
Yeah, well, and you go back to
like we were talking about

1031
00:56:59,760 --> 00:57:03,000
before, there were so many
things that have to happen every

1032
00:57:03,000 --> 00:57:05,360
single moment for a body to
correctly.

1033
00:57:05,360 --> 00:57:08,880
It's amazing most of us don't
have so many more syndromes and.

1034
00:57:08,880 --> 00:57:10,680
Conditions or Yeah.
Yeah, right.

1035
00:57:11,080 --> 00:57:14,160
And actually, sometimes I wonder
if the people who are air quotes

1036
00:57:14,320 --> 00:57:20,400
normal are really the outliers.
Yeah, maybe like, well, that was

1037
00:57:20,400 --> 00:57:21,000
normal.
Yeah.

1038
00:57:21,000 --> 00:57:23,960
But really it wasn't, I don't
know, back to what we were

1039
00:57:23,960 --> 00:57:26,800
talking about.
Most of these PPS affect the

1040
00:57:26,800 --> 00:57:32,320
skeletal muscles, right?
And again, the heart muscle for

1041
00:57:32,320 --> 00:57:36,560
Anderson Twalley is the most
problematic and the most life

1042
00:57:36,560 --> 00:57:40,880
threatening and it Anderson
Twalley syndrome is a group of

1043
00:57:40,880 --> 00:57:45,160
diseases and they're inherited
myopathies or myopathies.

1044
00:57:45,880 --> 00:57:48,480
Different people pronounce it
differently, but anyway, same

1045
00:57:48,480 --> 00:57:50,240
word.
And it causes problems with the

1046
00:57:50,240 --> 00:57:52,520
tone and contraction of the
skeletal muscles.

1047
00:57:52,520 --> 00:57:56,200
And that is obviously a problem.
And the disease has onset in

1048
00:57:56,200 --> 00:58:00,200
childhood or adolescence and
starts before 18 is slowly

1049
00:58:00,200 --> 00:58:02,120
progressive.
This is The only exception to

1050
00:58:02,120 --> 00:58:04,800
the progressive nature.
The the Anderson trolley is

1051
00:58:04,800 --> 00:58:07,000
progressive itself.
That's why I kept making that

1052
00:58:07,000 --> 00:58:10,720
differentiation before, because
the other one is not the others

1053
00:58:10,720 --> 00:58:13,040
are not.
This one is with these physical

1054
00:58:13,040 --> 00:58:16,880
manifestations is probably the
easiest to diagnose too, because

1055
00:58:16,880 --> 00:58:19,880
it's more obvious other people
don't have physical

1056
00:58:20,120 --> 00:58:23,680
manifestations and permanent
weakness may occur with age.

1057
00:58:23,960 --> 00:58:25,840
Men and women are affected
equally.

1058
00:58:25,920 --> 00:58:32,080
The attack lasts from 1 to 36
hours each time, right?

1059
00:58:32,920 --> 00:58:35,000
Yeah.
So as a deeper dive, all of

1060
00:58:35,000 --> 00:58:38,000
these forms of PPE have genetic
problems.

1061
00:58:38,360 --> 00:58:44,960
Each one has some genetic defect
that causes this syndrome.

1062
00:58:45,120 --> 00:58:49,720
If you will exclusively
attacking the ion channel areas

1063
00:58:49,720 --> 00:58:53,560
that control the mineral
transfer in our muscle cells.

1064
00:58:53,600 --> 00:58:54,880
Talk a little bit more about
that.

1065
00:58:54,880 --> 00:58:58,160
Each muscle cell has a covering
or membrane that keeps the

1066
00:58:58,160 --> 00:58:59,960
inside of the cell protected,
right?

1067
00:59:00,360 --> 00:59:03,000
Because it has to keep stuff in
there.

1068
00:59:03,240 --> 00:59:06,880
And when your nerves tell your
muscles to contract, it sends a

1069
00:59:06,880 --> 00:59:09,600
chemical signal to the gate.
We've been talking about the ion

1070
00:59:09,600 --> 00:59:13,440
gate that allows the sodium ions
to flow into the cell, and the

1071
00:59:13,440 --> 00:59:16,360
rush of charged ions change the
electrical charge inside the

1072
00:59:16,360 --> 00:59:18,160
cell.
And I just have this little

1073
00:59:18,160 --> 00:59:20,360
picture of this in my mind.
Oh, everything's changing.

1074
00:59:20,360 --> 00:59:23,760
Yay.
And it causes a wave of current

1075
00:59:23,760 --> 00:59:25,920
that runs through the muscle
fiber, right?

1076
00:59:26,240 --> 00:59:29,800
So you can see that sodium goes
in waves, come, gets the muscle

1077
00:59:29,800 --> 00:59:33,400
fiber moving, and then calcium
ions pour out of the sacs in the

1078
00:59:33,400 --> 00:59:36,000
cells that make the muscle
fibers contract.

1079
00:59:36,080 --> 00:59:39,680
Again, that charge of those ions
is huge because the correct

1080
00:59:39,680 --> 00:59:42,400
charge has to be in the correct
place at the correct time.

1081
00:59:42,440 --> 00:59:46,600
And when these sodium, I mean,
excuse me, when these ion gates

1082
00:59:47,000 --> 00:59:50,400
are not working properly, even a
little bit of problem can cause

1083
00:59:50,400 --> 00:59:54,440
a real a real difficulty.
So calcium ions have poured out

1084
00:59:54,440 --> 00:59:57,480
of the sacs in the cells to make
the fibers contract and then the

1085
00:59:57,480 --> 01:00:01,880
potassium channels open sending
potassium ions out of the cell

1086
01:00:02,120 --> 01:00:05,080
and it causes it to contract.
So you've got.

1087
01:00:05,560 --> 01:00:09,160
All of these things happening
all of the time and we don't

1088
01:00:09,160 --> 01:00:11,800
move muscles 1 cell at a time
either.

1089
01:00:12,160 --> 01:00:15,360
This is happening on probably
the level of thousands at the

1090
01:00:15,360 --> 01:00:17,360
same moment.
I'm sitting here because I've

1091
01:00:17,360 --> 01:00:22,240
got an Italian last name and
when we do that we move all the

1092
01:00:22,240 --> 01:00:25,200
time and thousands and thousands
of contractions are happening.

1093
01:00:25,200 --> 01:00:28,640
You think about sitting up when
I'm using my core muscles, such

1094
01:00:28,640 --> 01:00:32,600
as they are they all of these
muscles are moving all the time.

1095
01:00:32,600 --> 01:00:35,680
Any little teeny contraption,
all of these activities, these

1096
01:00:35,680 --> 01:00:39,040
are going to happen.
So if you can see that NPP, the

1097
01:00:39,040 --> 01:00:43,440
ion channels have flaws that
disrupt the process, the cells

1098
01:00:43,440 --> 01:00:47,520
then either don't contract or
don't relax in the right way in

1099
01:00:47,640 --> 01:00:50,520
response to the nurse signals.
So the nurse signals could be

1100
01:00:50,520 --> 01:00:54,600
correct, but the gates aren't.
So the nurse saying, hey, hey,

1101
01:00:54,600 --> 01:00:58,000
over here, let's do this.
And the gates cannot or they

1102
01:00:58,000 --> 01:01:02,000
cannot completely, which is why
sometimes the action that occurs

1103
01:01:02,000 --> 01:01:05,640
is just a weakness and other
times it's a complete paralysis

1104
01:01:05,960 --> 01:01:08,720
because the nerves are saying
open the gates and the gates

1105
01:01:08,720 --> 01:01:12,000
just don't do anything.
That means that they're flaccid

1106
01:01:12,000 --> 01:01:14,160
or unable to move.
And that's where it can be such

1107
01:01:14,160 --> 01:01:17,040
a problem.
And then ultimately, because

1108
01:01:17,040 --> 01:01:20,400
they do end this problem, this
flaccidity ends.

1109
01:01:20,720 --> 01:01:24,600
That means the ion gates are
opening, even just a little bit.

1110
01:01:24,680 --> 01:01:26,080
So now, finally, things are
worked.

1111
01:01:26,120 --> 01:01:29,440
So many of these defects, like
say, can cause the PP, but they

1112
01:01:29,440 --> 01:01:31,920
always affect the sodium,
calcium and potassium ion

1113
01:01:31,920 --> 01:01:33,560
channels.
That's just how it works.

1114
01:01:33,960 --> 01:01:37,960
There are many unidentified
defects in the PP chain.

1115
01:01:38,000 --> 01:01:43,760
It shows that in most cases, PP
is able to be contracted even if

1116
01:01:43,760 --> 01:01:45,440
just one parent has the
condition.

1117
01:01:45,800 --> 01:01:49,560
And that is a lot because
usually there has to be a higher

1118
01:01:49,560 --> 01:01:52,040
concentration or both parents
have to have it or it'll skip

1119
01:01:52,040 --> 01:01:53,320
generations or something like
that.

1120
01:01:53,320 --> 01:01:55,280
But only one of the parents has
to have it.

1121
01:01:55,320 --> 01:01:58,280
And that unfortunately can be a
big problem.

1122
01:01:58,360 --> 01:02:01,800
Some of the symptoms we've
talked about a little bit, but

1123
01:02:02,080 --> 01:02:06,960
are attacks and muscle, excuse
me, attacks of muscle weakness

1124
01:02:06,960 --> 01:02:10,880
that last minutes today's and
muscle pain and muscles after

1125
01:02:11,400 --> 01:02:13,920
exercising again because those
channels aren't working

1126
01:02:13,920 --> 01:02:15,320
correctly.
So you're going to have a build

1127
01:02:15,320 --> 01:02:19,560
up probably of calcium that will
cause the pain because it's

1128
01:02:19,560 --> 01:02:23,320
usually calcium release and
build up that causes muscle pain

1129
01:02:23,320 --> 01:02:26,120
after a person's worked out and
we all can get that.

1130
01:02:26,680 --> 01:02:30,400
However, ours will release as
the gates open and things move

1131
01:02:30,400 --> 01:02:34,000
in and out again.
Muscle cramping and feeling

1132
01:02:34,000 --> 01:02:38,200
tingles like tingly fingers or
tingles in other parts of the

1133
01:02:38,200 --> 01:02:40,160
body.
The final symptom that was

1134
01:02:40,160 --> 01:02:44,160
listed in this this general just
overview is permanent weakness,

1135
01:02:44,160 --> 01:02:47,640
but that's mostly later in life.
It's differentiated by the exact

1136
01:02:47,640 --> 01:02:51,680
gene that's affected.
And the way that it's identified

1137
01:02:52,000 --> 01:02:55,800
is blood test for potassium
levels during an attack or even

1138
01:02:55,800 --> 01:02:59,440
just after an attack because
it'll still be either elevated

1139
01:02:59,440 --> 01:03:01,440
or super low.
Other blood tests to measure

1140
01:03:01,440 --> 01:03:05,560
levels of other minerals and
blood gases and genetic blood

1141
01:03:05,560 --> 01:03:09,840
tests for known PP defects.
And that would be if suddenly a

1142
01:03:09,840 --> 01:03:14,000
person has a weakness or
paralysis that shows up that

1143
01:03:14,080 --> 01:03:15,680
someone else in the family has
had.

1144
01:03:15,680 --> 01:03:18,040
So they'll do some genetic
testing at that point nerve

1145
01:03:18,040 --> 01:03:22,800
conduction studies and EMG's
will do to be done to check

1146
01:03:22,800 --> 01:03:25,480
activity, muscular activity in
the in the areas.

1147
01:03:25,640 --> 01:03:29,480
Also an ECG to check electrical
activity of the heart, because

1148
01:03:29,480 --> 01:03:32,800
obviously you can be paralyzed
in your legs and you're like,

1149
01:03:32,800 --> 01:03:35,120
well, that's a bummer.
But if you're paralyzed in your

1150
01:03:35,120 --> 01:03:38,440
heart, that's a big bummer.
Yeah.

1151
01:03:38,560 --> 01:03:40,400
And that has to be checked
immediately.

1152
01:03:40,720 --> 01:03:43,920
Yeah, of course.
Things have to be reversed and

1153
01:03:43,920 --> 01:03:46,800
assisted for that right away.
Also, they'll check levels of

1154
01:03:46,800 --> 01:03:51,000
thyroid hormones and most people
if they go, if they start having

1155
01:03:51,000 --> 01:03:53,400
some of these problems, if it's
significant enough, they should

1156
01:03:53,520 --> 01:03:56,200
probably take themselves to the
ER by themselves.

1157
01:03:56,200 --> 01:03:59,040
I mean, not should as I'm
recommending this.

1158
01:03:59,040 --> 01:04:02,160
They, they mostly do go to the
ER.

1159
01:04:02,360 --> 01:04:05,000
Some people if they have the
lower level, just the weakness

1160
01:04:05,000 --> 01:04:07,760
will go to the primary care
providers and then we'll

1161
01:04:07,760 --> 01:04:10,520
probably moved be moved along to
neurologist and then go down

1162
01:04:10,520 --> 01:04:13,840
that pathway before things are
identified because it can look

1163
01:04:13,840 --> 01:04:17,520
like some other stuff.
The treatment for these folks is

1164
01:04:17,520 --> 01:04:20,320
to closely control potassium
intake through diet and

1165
01:04:20,320 --> 01:04:23,880
supplements.
That's a really big a big part

1166
01:04:23,880 --> 01:04:26,560
of it.
Sometimes they get IV potassium

1167
01:04:26,560 --> 01:04:30,640
treatments if this, the symptoms
are severe from hypocalimate PP,

1168
01:04:31,000 --> 01:04:39,040
low potassium control
carbohydrates in the diet and

1169
01:04:39,040 --> 01:04:41,240
what's interesting is
carbohydrates come in so many

1170
01:04:41,240 --> 01:04:43,240
forms.
So that seems to me that would

1171
01:04:43,240 --> 01:04:46,480
be quite a challenge, but vital
for the folks that are affected

1172
01:04:46,480 --> 01:04:48,560
by this.
Honestly, probably vital for

1173
01:04:48,560 --> 01:04:50,720
most of us, but we don't have
that much feedback.

1174
01:04:50,720 --> 01:04:52,440
Usually.
The biggest thing is controlling

1175
01:04:52,440 --> 01:04:55,440
those carbohydrates also control
thyroid function.

1176
01:04:55,440 --> 01:04:58,840
If they have thyroid toxic PP,
then they're going to be on

1177
01:04:58,840 --> 01:05:01,880
thyroid assisting medications,
whatever that looks like for

1178
01:05:01,880 --> 01:05:04,520
them and their condition.
A lot of people are recommended

1179
01:05:04,520 --> 01:05:09,440
to get help from nutritionist to
support those diet pieces

1180
01:05:09,480 --> 01:05:12,840
because it's easy to be unclear
about what is exactly a

1181
01:05:12,840 --> 01:05:15,760
carbohydrate, how they show up
in things where they can affect

1182
01:05:16,600 --> 01:05:19,680
person and the other minerals.
What does have potassium,

1183
01:05:19,840 --> 01:05:22,680
calcium and sodium.
Most people I think are familiar

1184
01:05:22,680 --> 01:05:25,480
with sodium, but there's a lot
of what people call hidden

1185
01:05:25,480 --> 01:05:28,360
sodium, especially in the
American diet and especially

1186
01:05:28,360 --> 01:05:31,680
packaged things.
I would expect that people that

1187
01:05:31,680 --> 01:05:35,440
are what I say, considered
fragile air quotes, that those

1188
01:05:35,440 --> 01:05:39,000
are people that are not very
easily controlled will have more

1189
01:05:39,600 --> 01:05:41,720
little nuances to their
treatment.

1190
01:05:41,800 --> 01:05:44,160
There are some medications that
can help.

1191
01:05:44,240 --> 01:05:47,880
Some of them are diuretics which
cause increased urination

1192
01:05:47,880 --> 01:05:52,600
because if they pull potassium
out of the body, they'll use a

1193
01:05:52,600 --> 01:05:54,400
diuretic to that out through the
kidneys.

1194
01:05:54,400 --> 01:05:57,080
That reminds me of nursing
school and learning about

1195
01:05:57,440 --> 01:06:02,240
potassium sparing diuretics and
potassium leaking diuretics.

1196
01:06:03,400 --> 01:06:08,080
Exactly which is how our body
processes it back again to me

1197
01:06:08,080 --> 01:06:09,960
being shocked at how people
figure this out.

1198
01:06:09,960 --> 01:06:14,080
I just don't even Yeah, true.
How on earth and what's funny is

1199
01:06:14,080 --> 01:06:17,400
it does just say talking about
potassium spurring or diuretics

1200
01:06:18,840 --> 01:06:21,600
and then certain types of
anesthesia can be a problem

1201
01:06:21,600 --> 01:06:23,320
because of possible
complications.

1202
01:06:23,640 --> 01:06:27,160
Sometimes people with the
Anderson quali have to use heart

1203
01:06:27,160 --> 01:06:30,880
medicine or pacemaker and.
I figured they probably would.

1204
01:06:30,920 --> 01:06:33,320
I mean, you can't just have your
heart stop, you know?

1205
01:06:34,320 --> 01:06:37,080
They don't work.
Out well contradicated to life

1206
01:06:37,640 --> 01:06:42,200
it's true and once they know it
they I'm sure have very close

1207
01:06:42,200 --> 01:06:45,880
cardiac observation and
treatments for that.

1208
01:06:46,200 --> 01:06:50,760
Because like anything it's on a
spectrum where it's sometimes

1209
01:06:50,760 --> 01:06:52,520
really bad, sometimes not so
bad.

1210
01:06:52,520 --> 01:06:56,600
Some of the people with Anderson
Tuoli don't have heart issues,

1211
01:06:56,600 --> 01:06:58,520
but most of them do from what I
read.

1212
01:06:58,920 --> 01:07:02,640
Their advice to limit exposure
to triggers, to keep exercise to

1213
01:07:02,640 --> 01:07:06,280
a moderate level, not get super,
don't run a triathlon.

1214
01:07:06,280 --> 01:07:08,680
You know what is it?
Whatever is moderate for them.

1215
01:07:08,880 --> 01:07:11,200
And that's probably something
that takes some time to figure

1216
01:07:11,200 --> 01:07:13,200
out exactly.
There are some medications that

1217
01:07:13,200 --> 01:07:17,120
affect the electrolyte balance
we talked about using related to

1218
01:07:17,120 --> 01:07:21,920
urine output with diuretic.
Sometimes that helps and other

1219
01:07:21,920 --> 01:07:23,800
times it doesn't.
It just depends on the

1220
01:07:23,800 --> 01:07:27,120
particular part of the disorder.
Now, dear listeners, we've gone

1221
01:07:27,120 --> 01:07:31,360
over our hour, which is what we
usually record for, and we've

1222
01:07:31,360 --> 01:07:34,000
got some case studies.
So if you want to listen a

1223
01:07:34,000 --> 01:07:36,480
little bit longer, listen to the
case studies.

1224
01:07:36,480 --> 01:07:38,960
Otherwise, we'll catch you on
the next episode.

1225
01:07:39,600 --> 01:07:41,600
Yay.
Now for those who are still

1226
01:07:41,600 --> 01:07:44,400
here, there's some police
studies that I wanted to

1227
01:07:44,400 --> 01:07:47,000
discuss.
The first case study, and I'm

1228
01:07:47,000 --> 01:07:50,240
going to read these because
paraphrasing them will just be

1229
01:07:50,240 --> 01:07:53,880
difficult.
The first case study is a 36

1230
01:07:53,880 --> 01:07:57,040
year old male patient with no
prior medical history presented

1231
01:07:57,040 --> 01:07:59,920
to the emergency department with
weaknesses, upper and lower

1232
01:07:59,920 --> 01:08:02,760
limbs and have been ongoing for
one day.

1233
01:08:03,520 --> 01:08:06,960
No complaints of double vision,
no difficulty with swallowing or

1234
01:08:06,960 --> 01:08:09,880
incontinence, and no history of
trauma were reported.

1235
01:08:10,520 --> 01:08:12,440
He had no significant family
history.

1236
01:08:12,920 --> 01:08:16,000
Upon physical examination, the
patient was found to be alert

1237
01:08:16,000 --> 01:08:19,399
and oriented with a power of two
out of five in the lower limbs

1238
01:08:19,399 --> 01:08:21,080
and three out of five in the
upper limbs.

1239
01:08:21,680 --> 01:08:24,960
They were slightly decreased
reflexes in all limbs, but no

1240
01:08:24,960 --> 01:08:28,240
significant findings otherwise.
Initial lab tests showed an

1241
01:08:28,240 --> 01:08:32,840
increase in white blood cells, a
low potassium level of 2.5, a

1242
01:08:33,279 --> 01:08:40,000
high thyroid stimulating
hormone, THS TSH of 6.1 and a

1243
01:08:40,000 --> 01:08:44,240
low a low and a couple other
labs that don't appear to be

1244
01:08:44,240 --> 01:08:46,080
related.
That's my comment there.

1245
01:08:46,520 --> 01:08:49,399
Based on these findings, the
patient was admitted for

1246
01:08:49,399 --> 01:08:52,200
investigation and treatment of
hypoclimic paralysis.

1247
01:08:52,600 --> 01:08:55,160
During his admission, he was
started on a potassium infusion

1248
01:08:55,160 --> 01:08:58,960
of 40 millimoles over 4 hours
and 50 milligrams of

1249
01:08:59,200 --> 01:09:02,240
levothyroxine.
That's a thyroid medication.

1250
01:09:02,720 --> 01:09:05,720
Further investigations showed a
high titer of anti

1251
01:09:06,000 --> 01:09:11,279
thyroglobulin.
Sorry about that pronunciation

1252
01:09:13,040 --> 01:09:16,319
after two days.
Two days after his admission, he

1253
01:09:16,319 --> 01:09:19,279
was diagnosed with
hypothyroidism and hypoclimic

1254
01:09:19,279 --> 01:09:25,200
paralysis, and he was discharged
on levothyroxine and magnesium

1255
01:09:25,200 --> 01:09:29,680
hydroxide and potassium
chloride, all of that to

1256
01:09:29,680 --> 01:09:32,240
maintain his levels.
And of course, he was referred

1257
01:09:32,240 --> 01:09:34,640
for follow up in the clinic and
genetic testing.

1258
01:09:35,439 --> 01:09:38,439
But it turns out for this case,
they noted genetic testing was

1259
01:09:38,439 --> 01:09:41,200
not done to due to the patient's
financial issues.

1260
01:09:42,720 --> 01:09:45,439
Yeah, no kidding.
So the thing that for this case,

1261
01:09:46,160 --> 01:09:50,160
what was amazing to me and, and
I guess emergency rooms are more

1262
01:09:50,160 --> 01:09:55,240
familiar with this than I am,
but they thought of the fact

1263
01:09:55,240 --> 01:09:59,400
that it was a hypoclimic
paralysis almost from the get go

1264
01:09:59,400 --> 01:10:02,120
it seemed like.
And that low potassium of 2.5.

1265
01:10:02,120 --> 01:10:05,320
Remember normal is 3.6, I think
it was 5.6.

1266
01:10:05,920 --> 01:10:08,680
But I think this is five.
I think anything over 5 is bad.

1267
01:10:08,920 --> 01:10:12,120
Is it OK?
But 2.5 is quite low and like we

1268
01:10:12,120 --> 01:10:15,960
talked about before, when the
range is so short, any change is

1269
01:10:15,960 --> 01:10:17,960
significant.
And this was a big change.

1270
01:10:18,520 --> 01:10:21,560
So they noticed right away.
But he had had no complaints, no

1271
01:10:21,560 --> 01:10:24,960
prior prior problems and he was
36 when this happened.

1272
01:10:25,720 --> 01:10:28,760
Wow, and that would be wild.
Yeah, it would.

1273
01:10:29,120 --> 01:10:33,480
Now the second case, this guy
was a 27 year old man with no

1274
01:10:33,480 --> 01:10:36,360
prior medical history presented
to the emergency department

1275
01:10:36,360 --> 01:10:39,160
complaining of muscle weakness
which had lasted for one day.

1276
01:10:39,800 --> 01:10:43,280
He did not exhibit any other
symptoms such as slurred speech,

1277
01:10:43,560 --> 01:10:46,680
double vision, headache, trauma,
palpitations, or excessive

1278
01:10:46,680 --> 01:10:48,080
sweating.
He had none of those.

1279
01:10:48,480 --> 01:10:51,760
This was his first episode and
there was no significant family

1280
01:10:51,760 --> 01:10:55,680
history.
Physical exam reviewed GOSH

1281
01:10:56,000 --> 01:10:58,640
words.
Physical examination revealed a

1282
01:10:58,640 --> 01:11:01,560
power of two out of five in his
upper limbs and three out of

1283
01:11:01,560 --> 01:11:05,800
five in his lower limbs,
according to testing, and then

1284
01:11:05,800 --> 01:11:08,680
accompanied by decreased
reflexes throughout his body.

1285
01:11:09,400 --> 01:11:11,840
No significant abnormalities
were discovered in other

1286
01:11:11,840 --> 01:11:15,440
systems.
Initial lab test results showed

1287
01:11:15,440 --> 01:11:20,320
an elevated white blood cell
count, low potassium 2.1.

1288
01:11:20,760 --> 01:11:22,440
Wow.
And.

1289
01:11:22,440 --> 01:11:24,520
White blood cell count, huh?
Right.

1290
01:11:24,520 --> 01:11:26,400
And that's been consistent for
last two, right?

1291
01:11:27,080 --> 01:11:28,760
Yeah.
And they don't address that.

1292
01:11:28,760 --> 01:11:32,000
They didn't address that at all
in any of the things I was

1293
01:11:32,000 --> 01:11:33,720
reading.
Although if you think about

1294
01:11:33,720 --> 01:11:36,760
Graves' disease, that's an
autoimmune disease that attacks

1295
01:11:36,760 --> 01:11:39,120
the thyroid.
So I wonder if part of this may

1296
01:11:39,120 --> 01:11:41,640
be autoimmune.
I would that white blood cell

1297
01:11:41,640 --> 01:11:43,120
increase.
No one's ever said that.

1298
01:11:43,120 --> 01:11:48,280
That's another theory by Andrea.
He also had a TSH of 0.2.

1299
01:11:48,320 --> 01:11:51,320
He was admitted for further
investigation and management of

1300
01:11:51,320 --> 01:11:55,320
periodic paralysis highs caused
by hypokalemia with

1301
01:11:55,320 --> 01:12:00,840
hyperthyroidism, so he had low
potassium and high thyroid

1302
01:12:00,840 --> 01:12:04,480
activity.
Yeah, a TSH of .2 is low.

1303
01:12:05,080 --> 01:12:06,760
Yeah.
He was given potassium

1304
01:12:06,760 --> 01:12:10,640
replacement therapy and during
his stay has revealed a high

1305
01:12:10,640 --> 01:12:15,480
titer of anti thyroid, thyroid
globulin antibodies.

1306
01:12:15,960 --> 01:12:18,480
Thank you.
And he was started on

1307
01:12:19,600 --> 01:12:25,440
carbamazole twice a day and I
looked that one up.

1308
01:12:25,520 --> 01:12:29,880
It's used to treat overactive
thyroid, the carbon muscle.

1309
01:12:30,120 --> 01:12:32,600
After a couple of days of from
his admission, he was discharged

1310
01:12:32,600 --> 01:12:34,960
and referred to outpatient
department for follow up and

1311
01:12:34,960 --> 01:12:38,640
genetic testing.
Again, not done due to financial

1312
01:12:38,640 --> 01:12:41,200
issues.
I thought that was interesting

1313
01:12:41,200 --> 01:12:42,920
that both of them mentioned
that.

1314
01:12:43,240 --> 01:12:45,200
Yeah, I agree.
But genetic testing is

1315
01:12:45,200 --> 01:12:46,920
expensive.
But it seems to me, well, the

1316
01:12:46,920 --> 01:12:50,280
only time at that point that it
would matter is for having

1317
01:12:50,280 --> 01:12:52,720
children, right?
And this kid was 26.

1318
01:12:52,720 --> 01:12:56,200
The other one was 36 or no,
excuse me, he was 27.

1319
01:12:56,680 --> 01:13:00,720
All right, third case, a 37 year
old male patient with a known

1320
01:13:00,720 --> 01:13:05,480
history of grave disease and
positive TRAB thyropropen

1321
01:13:06,040 --> 01:13:11,080
receptor antibodies had not
taken his carbamazole, which is

1322
01:13:11,080 --> 01:13:14,280
the overactive thyroid stuff.
So Graves' disease, he's

1323
01:13:14,280 --> 01:13:17,200
supposed to be taking
carbamazole for his overactive

1324
01:13:17,200 --> 01:13:20,200
thyroid, but he hadn't been
taking the medication for more

1325
01:13:20,200 --> 01:13:22,960
than a month.
Again, a lot of people, it says

1326
01:13:22,960 --> 01:13:24,880
something about this later, but
a lot of people change their

1327
01:13:24,880 --> 01:13:26,960
medications because they can't
afford them.

1328
01:13:27,280 --> 01:13:28,400
Yeah.
Yeah.

1329
01:13:28,840 --> 01:13:32,520
At any rate, we won't judge that
now, but we will later be

1330
01:13:32,760 --> 01:13:35,160
presented with lower limb
weakness that prevented him from

1331
01:13:35,160 --> 01:13:37,840
walking or standing.
He had no history of headache,

1332
01:13:37,840 --> 01:13:40,440
fever, decrease or loss of
consciousness.

1333
01:13:40,440 --> 01:13:43,320
He had no bowel or bladder
incontinence or recent

1334
01:13:43,320 --> 01:13:45,840
infections.
He had no significant family

1335
01:13:45,840 --> 01:13:48,080
history.
And if you remember people who

1336
01:13:48,080 --> 01:13:52,560
have this have had some of them
have had family history of this

1337
01:13:52,880 --> 01:13:55,320
disorder, but this guy hadn't
either.

1338
01:13:55,360 --> 01:13:59,680
His initial vital showed a pulse
of 108 8, which is elevated of

1339
01:13:59,680 --> 01:14:03,200
course.
Blood pressure of 127 / 68, not

1340
01:14:03,200 --> 01:14:05,360
bad.
Initial examination showed a

1341
01:14:05,360 --> 01:14:08,000
power of three out of five in
the lower limbs and normal power

1342
01:14:08,000 --> 01:14:11,440
in the upper limbs.
No other significant findings

1343
01:14:11,440 --> 01:14:14,120
were found.
Initial labs showed a potassium

1344
01:14:14,120 --> 01:14:21,400
of two and he had TSH was
severely decreased as well.

1345
01:14:21,520 --> 01:14:25,040
He had a couple other things
that were not totally related,

1346
01:14:25,040 --> 01:14:28,480
but he had no other findings
that were related in the in the

1347
01:14:28,480 --> 01:14:30,920
blood draws.
As a result, he was admitted for

1348
01:14:30,920 --> 01:14:35,120
management investigation as the
case of periodic paralysis with

1349
01:14:35,240 --> 01:14:37,920
thyroid toxicosis.
He was starting on IV of

1350
01:14:37,920 --> 01:14:41,920
potassium replacement and he
start he was started on

1351
01:14:42,000 --> 01:14:45,320
Propralonol which is a beta
blocker to slow his heart rate

1352
01:14:45,600 --> 01:14:48,040
and it also works to decrease
blood pressure, which in his

1353
01:14:48,040 --> 01:14:49,920
case he didn't need blood
pressure but needing his heart

1354
01:14:49,920 --> 01:14:54,160
rate slowed because if you
remember it was 108 and then the

1355
01:14:54,160 --> 01:14:59,000
carbamazole then his testing
later the calcium was our

1356
01:14:59,000 --> 01:15:02,160
potassium was corrected to 4.4.
So after he was given these

1357
01:15:02,160 --> 01:15:05,880
things, his potassium went up to
a normal range and his weakness

1358
01:15:05,880 --> 01:15:09,000
improved. 3 days after
admission, he was discharged on

1359
01:15:09,000 --> 01:15:13,160
propolinol and carbamazole and
referred to the outpatient

1360
01:15:13,160 --> 01:15:16,520
department for follow up.
Genetic testing was not done due

1361
01:15:16,520 --> 01:15:18,160
to the patient's financial
issues.

1362
01:15:19,240 --> 01:15:21,760
I hate it.
The fact that they mentioned

1363
01:15:21,760 --> 01:15:24,640
that every single time, it means
a lot to me.

1364
01:15:24,960 --> 01:15:29,400
And I believe that part had come
from the Mayo Clinic #4 is a

1365
01:15:29,400 --> 01:15:31,600
report of a licorice consumption
case.

1366
01:15:32,760 --> 01:15:37,960
I know I wanted to cover this.
So this is a 36 year old

1367
01:15:37,960 --> 01:15:41,200
previously healthy Palestinian
man from Eastern Jerusalem

1368
01:15:41,200 --> 01:15:43,520
presented to the emergency
department with a four day

1369
01:15:43,520 --> 01:15:47,800
history of rapidly progressive
limb weakness, bilateral

1370
01:15:47,800 --> 01:15:50,840
parasis, which is partial
paralysis or muscle weakness.

1371
01:15:50,840 --> 01:15:54,600
So he had either one or both of
those, first developed his legs

1372
01:15:54,600 --> 01:15:58,480
and hands, progressed to his
arms, thighs and torso and

1373
01:15:58,480 --> 01:16:00,360
caused extreme difficulty in
walking.

1374
01:16:00,840 --> 01:16:03,800
On the day of admission he had
difficulty sitting up or raising

1375
01:16:03,800 --> 01:16:07,040
his hands from the bed.
Now this is Andrea talking.

1376
01:16:07,400 --> 01:16:10,400
At first blush I would start
thinking Gan Beret because of

1377
01:16:10,400 --> 01:16:16,400
the of the progression.
However, I'm incorrect on

1378
01:16:16,400 --> 01:16:19,560
examination the laying down
patient because he could not sit

1379
01:16:19,560 --> 01:16:21,680
up.
He was unable to move was but

1380
01:16:21,680 --> 01:16:25,080
was fully alert, cognizant and a
febrile so we had no

1381
01:16:25,080 --> 01:16:28,120
temperature.
He had mild hypertension or

1382
01:16:28,120 --> 01:16:33,280
blood pressure which was 150 /
100 which sounds a little more

1383
01:16:33,280 --> 01:16:36,040
than mild to me.
Yeah, especially that, that

1384
01:16:36,040 --> 01:16:39,240
diastolic or low, low bottom
number, right, That's a high

1385
01:16:39,720 --> 01:16:41,160
number for that.
Yes.

1386
01:16:41,160 --> 01:16:45,280
And for note to listeners who
are unaware of this, the closer

1387
01:16:45,280 --> 01:16:49,000
the number, so like 150 to 100,
the closer those numbers are to

1388
01:16:49,000 --> 01:16:51,200
each other, the more dangerous
it is, right?

1389
01:16:51,280 --> 01:16:55,680
Because that means that the,
well, we'll go into that another

1390
01:16:55,680 --> 01:16:57,000
time.
But anyway, it's more dangerous.

1391
01:16:57,400 --> 01:17:01,200
And his neurological examination
revealed several bilateral,

1392
01:17:01,480 --> 01:17:04,320
excuse me, severe bilateral
weakness to the proximal and

1393
01:17:04,320 --> 01:17:07,400
distal muscles.
Now, if you remember, it often

1394
01:17:07,400 --> 01:17:09,840
is only the proximal but not the
distal muscles.

1395
01:17:09,840 --> 01:17:12,400
So the ones closest to the body,
but not the far ones away.

1396
01:17:12,520 --> 01:17:14,760
One of the things I think that
may have made this different for

1397
01:17:14,760 --> 01:17:17,160
him is that it had been a few
days.

1398
01:17:17,200 --> 01:17:20,040
So he's progressed pretty far
with this problem.

1399
01:17:20,040 --> 01:17:23,800
All four limbs were affected and
it was by bilateral so both

1400
01:17:23,800 --> 01:17:27,760
sides.
He also had absent patellar

1401
01:17:27,760 --> 01:17:30,680
which is knee, ankle and triceps
reflexes.

1402
01:17:30,680 --> 01:17:32,600
They were absent.
Wow.

1403
01:17:33,200 --> 01:17:35,600
And his plantar.
The foot reflexes were

1404
01:17:35,600 --> 01:17:37,560
incorrect.
It was flexor instead of

1405
01:17:37,560 --> 01:17:39,160
extensor.
I know he's getting bad.

1406
01:17:39,280 --> 01:17:43,000
The patient had no evidence of
meningeal cranial nerve or

1407
01:17:43,000 --> 01:17:45,760
central nervous system
involvement, which to translate

1408
01:17:45,760 --> 01:17:50,280
is basically like he didn't have
meningitis or or brain injury at

1409
01:17:50,280 --> 01:17:53,760
this point.
He had no sphincter disturbance,

1410
01:17:53,760 --> 01:17:56,800
so he had not been caught in a
bowel, hadn't had muscle wasting

1411
01:17:56,800 --> 01:18:00,480
or muscle tenderness.
The laboratory studies were done

1412
01:18:00,520 --> 01:18:06,560
and he had a lumbar puncture,
chest imaging, CT and all of

1413
01:18:06,560 --> 01:18:12,520
that showed no abnormalities.
However, he had in his ECG had

1414
01:18:12,520 --> 01:18:16,960
mildly elongated QT interval,
which is an abnormal pattern

1415
01:18:16,960 --> 01:18:21,160
which can be deadly.
And he had severe hypokalemia.

1416
01:18:21,160 --> 01:18:27,200
Potassium, as we said, is 1.7.
So he's getting really, really

1417
01:18:27,200 --> 01:18:30,040
low.
He also had elevated creatinine

1418
01:18:30,040 --> 01:18:33,760
level of 800.
And creatinine can indicate

1419
01:18:34,160 --> 01:18:37,440
muscle wasting and damage, among
other things, but that's one of

1420
01:18:37,440 --> 01:18:39,880
the things.
Now his weight was stable, he

1421
01:18:39,880 --> 01:18:42,520
had consumed A balanced diet,
and he didn't have diarrhea,

1422
01:18:42,520 --> 01:18:45,920
excessive sweating or symptoms
of hyperthyroidism, Cushing's

1423
01:18:45,920 --> 01:18:49,800
syndrome or things like that.
And he had no previous episodes

1424
01:18:49,800 --> 01:18:53,440
of muscular weakness or personal
or family history of any of

1425
01:18:53,440 --> 01:18:56,640
these things.
He denied the use of licorice

1426
01:18:56,640 --> 01:18:59,720
chewing tobacco, which can have
some licorice properties in it

1427
01:19:00,080 --> 01:19:02,920
and prescribed over the counter
natural herbal medications or

1428
01:19:02,920 --> 01:19:06,240
abusive drugs, alcohol or
laxatives and had no risk for

1429
01:19:06,240 --> 01:19:13,520
human immunity, HIV.
And they ask these things and

1430
01:19:13,520 --> 01:19:16,200
these things can be related
because of some of the side

1431
01:19:16,200 --> 01:19:19,640
effects of some of these these
herbal things over the counter

1432
01:19:19,840 --> 01:19:22,240
stuff.
People think that things like

1433
01:19:22,320 --> 01:19:25,440
laxatives can be harmless, but
they cannot because I mean, they

1434
01:19:25,440 --> 01:19:28,440
can be very damaging because
they can cause a dumping, as it

1435
01:19:28,440 --> 01:19:32,160
were of enzymes and potassium,
sodium and calcium are some of

1436
01:19:32,160 --> 01:19:34,440
the things that they dumped the
most because our body doesn't

1437
01:19:34,440 --> 01:19:38,240
have time to absorb them.
And then he had a 24 hour urine

1438
01:19:38,240 --> 01:19:42,960
study which revealed high
urinary excretion, which can

1439
01:19:42,960 --> 01:19:47,960
indicate some kidney issues.
And he just all of this was

1440
01:19:47,960 --> 01:19:49,960
going on.
They just weren't sure what was

1441
01:19:49,960 --> 01:19:52,840
happening.
But he was given a large dose of

1442
01:19:52,840 --> 01:19:56,040
intravenous and oral potassium,
which resulted in the

1443
01:19:56,040 --> 01:19:59,120
normalization of the serum
potassium and creatinine levels

1444
01:19:59,400 --> 01:20:03,000
after three days.
It took three days to get normal

1445
01:20:03,440 --> 01:20:06,880
and then he during that three
day time frame had complete

1446
01:20:06,880 --> 01:20:09,080
restoration of muscle strength
and motor reflexes.

1447
01:20:09,080 --> 01:20:11,680
He was gradually weaned from all
the potassium supplements and

1448
01:20:11,680 --> 01:20:14,040
his electrolyte levels remain
stable and normal throughout the

1449
01:20:14,040 --> 01:20:17,160
rest of his hospitalization.
So he isn't presenting as some

1450
01:20:17,160 --> 01:20:19,480
of these other folks have.
A little bit, but not

1451
01:20:19,480 --> 01:20:22,320
completely.
Well, it turns out that upon

1452
01:20:22,320 --> 01:20:25,320
further questioning, he admitted
that during the previous year,

1453
01:20:25,320 --> 01:20:28,040
he and his three sons had
consumed half a bag of licorice

1454
01:20:28,040 --> 01:20:30,120
candy daily.
Oh my gosh.

1455
01:20:30,280 --> 01:20:33,680
Yeah, so half a half a bag each
one of them had.

1456
01:20:33,680 --> 01:20:35,680
I mean, they'd all consume that
daily.

1457
01:20:35,680 --> 01:20:38,040
So that's a lot.
He also noticed that during the

1458
01:20:38,040 --> 01:20:40,680
two weeks before his admission,
he drank large amounts of tea

1459
01:20:40,680 --> 01:20:43,800
prepared from an extract
purchased at a E Jerusalem

1460
01:20:44,000 --> 01:20:47,320
popular.
It's called the SUS House SUS.

1461
01:20:47,600 --> 01:20:50,280
And then house is specialized in
the production of licorice,

1462
01:20:50,280 --> 01:20:54,360
sweetened tea, and SUS is Arab
slang for licorice.

1463
01:20:54,960 --> 01:20:58,560
Now, one of the things that the
investigating people noted is

1464
01:20:58,560 --> 01:21:02,920
that because they didn't know
what the slang was, they didn't

1465
01:21:03,160 --> 01:21:07,440
understand what he had had,
which may have resulted in

1466
01:21:07,440 --> 01:21:10,520
delayed diagnosis because he had
said that he had gone to the

1467
01:21:10,520 --> 01:21:12,840
suss house, but they didn't
understand what that meant.

1468
01:21:13,080 --> 01:21:16,240
And I don't know if these people
had been American doctors

1469
01:21:16,240 --> 01:21:20,320
treating them in Jerusalem or or
what, but that slang was a

1470
01:21:20,320 --> 01:21:22,440
problem.
They estimated that the patient

1471
01:21:22,440 --> 01:21:26,640
consumed an additional 100
milligrams of this glyceraic

1472
01:21:26,920 --> 01:21:31,000
acid with the T, which
aggravated as hypoclenia and

1473
01:21:31,000 --> 01:21:34,360
resulted in the development of
the progressive life threatening

1474
01:21:34,360 --> 01:21:38,360
paralysis.
And if you remember all of his

1475
01:21:38,360 --> 01:21:42,200
heart numbers or is his ECG and
stuff was all a mess, too.

1476
01:21:42,240 --> 01:21:44,920
Yeah, yeah.
Now, his children who did not

1477
01:21:44,920 --> 01:21:47,360
drink the tea remained
asymptomatic.

1478
01:21:47,360 --> 01:21:49,480
And they had been helping meet
the licorice, but they didn't

1479
01:21:49,480 --> 01:21:51,160
have the tea.
So the tea must have pushed him

1480
01:21:51,160 --> 01:21:53,720
over the top.
And it's probably good because

1481
01:21:53,720 --> 01:21:57,360
these kids are are obviously
younger and potentially quite

1482
01:21:57,360 --> 01:21:59,440
young.
I don't know for sure, but that

1483
01:21:59,440 --> 01:22:02,880
could have been huge for them,
probably deadly if they had more

1484
01:22:02,880 --> 01:22:05,800
of that going on.
He was discharged after 10 days

1485
01:22:05,800 --> 01:22:10,560
of hospitalization with strict
rules to avoid licorice and

1486
01:22:10,560 --> 01:22:14,240
licorice flavored products.
At an 18 month follow up, he was

1487
01:22:14,720 --> 01:22:17,640
all normal, everything's fine.
He was free of residual

1488
01:22:17,640 --> 01:22:19,600
weakness.
But Can you imagine death by

1489
01:22:19,600 --> 01:22:22,960
licorice?
No, that is, that's wild.

1490
01:22:23,720 --> 01:22:25,960
Wild all the time.
But this is wild world.

1491
01:22:26,480 --> 01:22:29,400
It is a wild world.
I have two more quick cases.

1492
01:22:29,400 --> 01:22:32,720
This next one is a 46 year old
man who has a history of

1493
01:22:32,720 --> 01:22:35,720
autoimmune hypothyroidism and
currently it was on

1494
01:22:35,720 --> 01:22:40,280
levothyroxine and presented with
sudden symmetrical weakness in

1495
01:22:40,280 --> 01:22:42,880
both his legs.
After working in hot weather, he

1496
01:22:42,880 --> 01:22:45,600
was unable to stand or walk.
He had experienced similar

1497
01:22:45,600 --> 01:22:48,840
symptoms twice before.
He had no fever, trauma, back

1498
01:22:48,840 --> 01:22:52,080
pain or autonomic involvement.
His initial vital signs were

1499
01:22:52,080 --> 01:22:54,880
normal and his examination
revealed muscle power, three out

1500
01:22:54,880 --> 01:22:56,960
of five and all limbs with
hypotonia.

1501
01:22:57,080 --> 01:23:00,520
Hyporeflexia which means the
tone was low and the reflexes

1502
01:23:00,520 --> 01:23:02,440
were low.
There were no significant

1503
01:23:02,440 --> 01:23:05,520
findings in the other systems.
His initial investigation showed

1504
01:23:05,560 --> 01:23:09,560
elevated creatinine and a low
potassium of 2.1.

1505
01:23:09,600 --> 01:23:13,920
His TSH was elevated.
The patient was admitted as a

1506
01:23:13,920 --> 01:23:20,520
case of hypoclimic pre erotic
paralysis due to type 1 RTA and

1507
01:23:20,600 --> 01:23:23,080
I did not look that up.
I'm not sure what that means,

1508
01:23:23,080 --> 01:23:25,360
I'm sorry.
And acute kidney injury from

1509
01:23:25,360 --> 01:23:29,480
heat exhaustion and was started
on levothyroxine and IV

1510
01:23:29,520 --> 01:23:31,960
potassium replacement IV fluids
for management.

1511
01:23:31,960 --> 01:23:35,520
After two days of treatment, the
potassium was corrected and the

1512
01:23:35,520 --> 01:23:38,240
weakness improved significantly
along with the creatinine level.

1513
01:23:38,640 --> 01:23:40,920
Due to these improvements, the
patient was discharged on the

1514
01:23:40,920 --> 01:23:43,280
third day and referred to the
outpatient department for follow

1515
01:23:43,280 --> 01:23:46,600
up and genetic testing was not
done due to the patient's

1516
01:23:46,600 --> 01:23:49,440
financial issues.
So this was a little bit

1517
01:23:49,440 --> 01:23:52,760
different because he was the one
out in the heat doing all of

1518
01:23:52,760 --> 01:23:55,280
this stuff.
Again, he was 46, so he was

1519
01:23:55,320 --> 01:23:59,560
older, but he also had known
hypothyroidism, right?

1520
01:23:59,560 --> 01:24:02,600
So he was at risk already.
The power, muscle power that

1521
01:24:02,600 --> 01:24:04,240
they're talking about is fairly
significant.

1522
01:24:04,240 --> 01:24:06,840
Three out of five, four out of
five, two out of five.

1523
01:24:07,160 --> 01:24:08,920
This is pretty, pretty strong
weakness.

1524
01:24:09,280 --> 01:24:11,400
The final case I'm going to
bring up, although there are a

1525
01:24:11,400 --> 01:24:15,560
bunch more, I tried to limit it.
A 27 year old male patient with

1526
01:24:15,560 --> 01:24:17,680
no prior medical history
presented with progressive

1527
01:24:17,680 --> 01:24:20,720
weakness in his upper and lower
limbs that persisted for two

1528
01:24:20,720 --> 01:24:22,480
days.
He didn't have a fever,

1529
01:24:22,480 --> 01:24:24,880
headache, trauma, recent
infection, or incontinence.

1530
01:24:25,320 --> 01:24:27,080
There was no significant family
history.

1531
01:24:27,320 --> 01:24:29,920
His vitals were normal and he
was alert and oriented.

1532
01:24:30,200 --> 01:24:32,880
However, he had a power of three
out of five in both upper and

1533
01:24:32,880 --> 01:24:35,840
lower limbs and his cranial
nerves were normal, while other

1534
01:24:35,840 --> 01:24:40,560
systems showed no abnormalities.
So there was just nothing coming

1535
01:24:40,560 --> 01:24:42,920
up.
They did lab investigations and

1536
01:24:42,920 --> 01:24:46,360
it reviewed potassium of 2.5,
but there were no other

1537
01:24:46,360 --> 01:24:49,560
significant findings.
The patient was admitted to ICU

1538
01:24:49,560 --> 01:24:52,120
for monitoring, management and
further investigation as a case

1539
01:24:52,120 --> 01:24:57,200
of hypokalemic paralysis.
He received 20 milligrams of IV

1540
01:24:57,400 --> 01:25:01,520
potassium and magnesium sulfate,
and the next day his potassium

1541
01:25:01,520 --> 01:25:05,840
levels had improved to 5.2 and
his weakness has decided.

1542
01:25:05,920 --> 01:25:09,240
Consequently, he was transported
to the medical ward for the lab

1543
01:25:09,240 --> 01:25:11,360
test showed an aldosterone
level.

1544
01:25:11,360 --> 01:25:14,880
Do you remember that from before
it was 119?

1545
01:25:15,160 --> 01:25:19,200
I don't have the averages on
that but they did measure it and

1546
01:25:19,200 --> 01:25:23,120
TSH of 3.38.
After two days the patient was

1547
01:25:23,120 --> 01:25:25,280
discharged, referred to the
outpatient department for follow

1548
01:25:25,280 --> 01:25:28,560
up and genetic testing was not
done due to patient financial

1549
01:25:28,560 --> 01:25:31,160
issues.
I never did see one that said it

1550
01:25:31,160 --> 01:25:32,240
was done.
Nope.

1551
01:25:32,920 --> 01:25:35,720
But the fact that they bring it
up every time means to me that

1552
01:25:35,720 --> 01:25:39,440
it was significant to them and
to me, but it was.

1553
01:25:39,680 --> 01:25:42,160
It was really interesting.
Those are the cases.

1554
01:25:42,160 --> 01:25:45,080
There were a lot more, but those
are the ones I grabbed because

1555
01:25:45,080 --> 01:25:47,720
they showed some very variation
in the process.

1556
01:25:48,200 --> 01:25:50,880
And again, this is a fairly rare
condition.

1557
01:25:51,200 --> 01:25:54,800
I'm very impressed that these
providers discovered it

1558
01:25:54,800 --> 01:25:59,080
apparently quite quickly.
I don't know how many times a

1559
01:25:59,240 --> 01:26:02,600
hospital or ER will come up with
this, but I think it is fairly

1560
01:26:02,600 --> 01:26:07,040
common to check potassium levels
and other electrolytes, calcium

1561
01:26:07,040 --> 01:26:10,200
and all of that, just to see
where people are, blood sugars

1562
01:26:10,200 --> 01:26:12,160
and all that.
I'm pretty sure all of that is

1563
01:26:12,160 --> 01:26:15,800
quite common.
This is just such an interesting

1564
01:26:16,040 --> 01:26:20,080
condition and scary.
So scary.

1565
01:26:20,640 --> 01:26:23,800
Very scary.
To be weak, I can understand

1566
01:26:23,800 --> 01:26:26,360
having weakness for a couple of
days and not really go rushing

1567
01:26:26,360 --> 01:26:29,360
out, but I certainly cannot
understand having a paralysis

1568
01:26:29,360 --> 01:26:31,160
and waiting four days for it to
progress.

1569
01:26:31,400 --> 01:26:35,000
Like licorice toxicity.
I'm like, Oh my gosh, I would be

1570
01:26:35,000 --> 01:26:37,280
rushing right in.
And like I said, this is one of

1571
01:26:37,280 --> 01:26:41,360
those things that people I think
do tend to get treatment faster

1572
01:26:41,920 --> 01:26:44,320
then they might with other types
of symptoms.

1573
01:26:44,320 --> 01:26:47,640
So I'm glad about that.
It's this condition I've never

1574
01:26:47,640 --> 01:26:51,320
heard of before and it was
really fun to research.

1575
01:26:52,120 --> 01:26:52,880
That's awesome.
Thank you.

1576
01:26:53,360 --> 01:26:55,280
You're welcome.
All right, If you've made it

1577
01:26:55,280 --> 01:26:57,920
this far, clearly you like a
little mayhem with your

1578
01:26:57,920 --> 01:27:00,000
medicine.
Or you just enjoy hearing us

1579
01:27:00,000 --> 01:27:01,840
ramble about weird medical
mysteries.

1580
01:27:02,160 --> 01:27:03,720
Either way, we'd love you for
it.

1581
01:27:03,920 --> 01:27:06,600
So hit that follow or subscribe
button wherever you're

1582
01:27:06,600 --> 01:27:08,520
listening.
And toss us a rating or review

1583
01:27:08,520 --> 01:27:11,560
while you're at it.
Helps other curious weirdos find

1584
01:27:11,560 --> 01:27:14,240
the show.
And we know there are a lot of

1585
01:27:14,240 --> 01:27:16,360
you out there.
Oh so many.

1586
01:27:16,640 --> 01:27:18,760
Come join the chaos.
Thanks for listening to

1587
01:27:18,760 --> 01:27:21,880
Medicine, Mystery, mayhem, and
sometimes Murder.

1588
01:27:22,440 --> 01:27:25,000
Do you have an idea for an
episode of this podcast?

1589
01:27:25,400 --> 01:27:28,280
Just want to say hi?
You can get in touch with us at

1590
01:27:28,360 --> 01:27:33,040
our M4 pod.
That's OURM

1591
01:27:33,120 --> 01:27:39,560
thenumberfourpod@gmail.com.
We read every e-mail, and

1592
01:27:39,560 --> 01:27:42,880
sometimes we even respond just
like real professionals.

1593
01:27:43,040 --> 01:27:47,440
Because we are.
Old friends with new twists and

1594
01:27:47,440 --> 01:27:49,000
lots of body bags.