Terminal lucidity; pneumonic plague; rabies on the rise

[music] Coming up on the program, it's our spooky spectacular monthly medical roundtable for Halloween. Then our experts answer your questions. Support for What's Health Got to Do With It is provided in part by the American Academy of Neurology Research Program. Every gift helps researchers move closer to critical cures for brain disorders. 100% funds brain research. Learn more at brainhealth.com/donate. And by Norellis, a leading neuroscience company focused on the development and commercialization of therapeutics or the treatment of epilepsy and other neurologic disorders. The company's unique drug portfolios strive to address unmet needs in patient care. Learn more at norellis.com. Hi, I'm Dr. Joe Servan, a practicing neurologist, professor of health care administration and policy. And this is what's health got to do with it, where we explore where and how health care intersects with your life, hoping you get the medical answers you need. It's our monthly medical roundtable and October has brought us a collection of health headlines that sound like they belong in a Halloween horror movie. Measles outbreaks in Pennsylvania and New York. A spike in rabies cases. And wait, is the plague making a comeback? Not everything is frightening. We're going to also look at promising research suggesting the HPV vaccine may help prevent premature births. A controversial hepatitis B vaccine trial that's raising serious ethical questions and the mysterious phenomenon of terminal lucidity when people nearing the end of life suddenly seem to regain mental clarity. And don't worry, no tricks, just a few treats from our medical experts. Then our experts are going to answer your questions. Joining us for today's roundtable are all vets. Dr. Jen Coward, she is our Princess Leia for today's episode. She's a primary care physician, she's a hospice internist over at Mayo Clinic in Rochester, Minnesota. Dr. Coward, welcome. Glad to be back, Joe. It's good to have you back. We have Dr. Jose Posas, who is also in a Star Wars themed approach for today. He is a practicing neurologist at the University of Virginia, hint for those wondering what he's dressed as. This is the way. Dr. Posas, welcome. Thanks for having me. You bet. Last but not least, it's our other Dr. Seuss, Dr. Donna G. Ivory, author, podcast host OBGYN. She is in our cat in the hat mode for today. Dr. Ivory, welcome. Thank you so much, Joe. And happy Halloween. Happy Halloween. We're going to get started with probably an all-seriousness, one of the scariest of the topics. And that has to do with searching measles cases. I can't believe here we are talking about this. In Pennsylvania and New York declared a state emergency specifically New York did. The number of cases has increased. We have seen more than 1,000 reported cases in the state of Pennsylvania, with at least five deaths at the time of this taping. While neighboring New York state declared a state of emergency by governor Kathy Hoekle there. This is a disease we declared eliminated the United States back in 2000 and yet we are seeing the worst resurgence in decades. Dr. Coward, here's a question that I know I've asked a few times. I'll just ask it one more time. How did we get here? So measles was considered eradicated in the United States in the 90s and was so for over 20 years by virtue of the fact of the measles vaccine creation, which was released in the 1960s. It was initially released as a single shot series and then with a bit of an increase in cases in the late 80s. This second dose was recommended for school childrens now our recommendation vaccine program for measles is two doses following that measles rates fell to almost undetectable cases that were found in the United States for the next 20 years were really folks who contracted it elsewhere. Where measles rates remain very high in other parts of the world, it is spread person to person unless we eradicated it worldwide, we will not ever fully get rid of it in the United States. So what's happening now over the last few years that measles rates are higher. Unfortunately measles vaccine rates have fallen. I think parents were very reassured that rates were so low they no longer felt that their children were at risk and so many parents started declining this vaccine. They ended up with decreasing vaccination rates for school children that tends to cluster in areas of population so it's not evenly spread everywhere that everyone has the same vaccine rate. So there's populations across the US where there's clusters of unvaccinated folks and those are populations that are at the highest risk of contracting the measles. Long story short lower vaccine rates higher percentages of folks who are unvaccinated in the United States and then this has not been eradicated worldwide so it can travel from folks who have visited other countries they bring it back. And then unfortunately it's very infectious very contagious and the folks are at the highest risk are of course those were unvaccinated and the youngest of our population are at the even highest risk. So looking at the cases in Minnesota where we're not currently experiencing that kind of public health emergency but we do have at least two outbreaks that have been declared the vast majority of the folks affected are very young over one third are under the age of five. We have only about 1% of the cases are in folks have been vaccinated so 99% of the cases in the US have been unvaccinated. Now why do we care you know if it's just a rash and a you know just one of those seasonal childhood things you know why do we care so bad. So my mother actually was born before the vaccine was available and she still remembers having measles that she was stuck in her house for several weeks missed school. The light hurt her eyes she could barely move because she was so fatigue you know she remembers this is very pivotal moment in her childhood that their house had a quarantine sign on the door and it was a really big deal. Her sister was born 10 years after and was in the cohort one of the first groups to get the vaccine and that their family was really excited to be able to get this vaccine because the illness was so serious for her. And she didn't have some of the most serious consequences so we know there are rare but very dangerous risks of measles infection like acute and cephalitis so for my neurologists on the call and cephalitis being swelling of the brain. If anybody's a pit fan the child who has the measles on the pit he has in cephalitis he's severely ill he's shown to be intubated he's critically ill it's a really sad thing to watch. And no one wants her child to go through that so even if it's a rare outcome no one wants their kid that sick we do know that there have been five deaths so far this year from this current measles outbreak. Of those five deaths three were infants they were too young to get vaccinated one was an 18 year old and one was a 40 year old so these are young people who had their whole lives in front of them who unfortunately lost those lives to the measles. So it's a very serious illness it makes people really sick even if they don't suffer the more serious consequences and unfortunately a few people have lost their lives to the illness this year so it is very spooky go. Thank you and I just remind everyone please get vaccinated if you have not we're going to pivot to another topic that also one that I did not expect to be chatting about in a headline and that has to do with animal rabies cases that spiked this past summer. The CDC has issued a health alert network advisory warning that animal rabies activity and human exposures have increased significantly across the country this summer prompting the agency to urge clinicians in the public to take the threat more seriously. rabies is almost always fatal once symptoms begin but entirely preventable if post exposure vaccination is administered promptly after bites it's an important warning to avoid contact with sick acting wildlife Dr. Posas most people think of rabies and something that only happens in other countries or in old movies. How serious is this you know the risk of rabies here in the US is actually fairly low because of the mandates on rabies vaccination. Usually for domesticated animals one of the big risk factors though are non domesticated animals right in the main risks are bats skunks raccoons and foxes oh my so these are the main animals CDC warns us about and if anyone has been in contact in the form of a bite or a scratch it's not just the teeth that can get you it's the claws to you know the advice is seek medical care sooner than later. Not to get too spooky with it but three and four Americans live in a community where these animals carry rabies again rabid dogs rabid cats very low percentages if they have appropriate veterinary care because of the vaccination schedules that are mandated folks who go into the wilderness especially folks who are in higher contact activities like spelunking camping or hunting should consider pre exposure vaccination with their local expert other folks who work in the veterinary world. as in vet texts and veterinarians, that is another group of people who would think about and animal control folks should think about that pre-exposure vaccination as well. The big word in this advisory here, though, is act promptly, so go quickly. I'm going to pivot to yet one more topic as we're kind of making our pass through headlines here, and here's one on a very positive end, Dr. Ivory. I'm going to point this one at you. There was a nice study we have been talking about vaccines with measles. We've been talking about getting post-exposure vaccination with rabies, but here's a third one, a nice positive one. It was found that in a study that mothers who were vaccinated against the HPV virus before pregnancy were less likely to give birth prematurely. Can you at least explain to us what HPV is and why is that vaccine given and what the study means? So HPV is human papaloma virus. It is an extremely common virus. It's been around for thousands of years, so nothing new there. What we do know is almost 100% of cervical cancers have HPV types associated with it. And so the notion of doing something to prevent cervical cancer, beyond just what had been surveillance with pap smears and treating pre-cancer as early cancer as changes, how could we prevent that from ever happening if we know all the exposures are due to HPV? So that was the impetus behind the vaccines. The worrisome HPV types are types 16 and 18, which are 70% of cervical cancers. And then we have some other high risk types, which are 31, 33, 45, 52, and 58. We also have two types associated with genital wards, which are 6 at 11. So the impetus is to vaccinate against the most common types that are creating sexually transmitted disease, cervical disease, leading to cervical cancer, and genital wards. And that has been very successful. The study in question was done in Sweden, and they actually saw statistical significance in reducing the rate of severe prematureity, routine mild prematureity, premature rupture of membranes, and two other factors associated with early birth in women who were vaccinated before the age of 17. So they were very clear on looking at before 17 vaccination versus after 17 vaccination. And all of them being vaccinated before pregnancy compared to their age group and the location in the country of women who were unvaccinated. And these were all moms who were delivering for the first time. So it was a nice study. What we know is that HPV infection has passed with onset of intercourse, and a significant number of women are exposed with their first or second or early sexual activity. We think that then leads to chronic inflammation. We used to think that all the things we did to address abnormal pap smears had a lot to do with preterm delivery, and it does. But we also are now starting to think that it's the inflammatory process that is to some degree either weakening the significance of the cervix staying closed or initiating additional prostaglandins that lead to increased and early labor in pregnancy. So bringing down the risk of HPV, bringing down the percentage of women exposed to HPV infection seems to be associated in a statistical manner, especially if they're vaccinated before 17 years of age. It really brings down the risk of preterm labor, preterm delivery, preterm rupture of membranes, and that is really a good sign. That's more than we bargained for when we talked about the HPV vaccine. And it's interesting in this study. They only did the quadrivalent vaccine that is against 6 and 8 and 16 and 18. Now everyone is really gone to the nine-valent vaccine, which covers those other high risk types. So I'm excited to see what the improvement in premature birth is after everyone goes to a nine-valent vaccine. But it's very, very, very promising information. I love it. And we're going to take a short break. When we come back, we're going to ask that question, is the plague making a comeback? We'll be right back. , we'll be right back. Welcome back. I'm Dr. Joseph and this is what's how it got to do with it. If you're just joining us, it is our Halloween spectacular monthly medical roundtable for the month of October. Well, just in time for Halloween, a disease straight out of Medieval history actually made headlines. Following reports of a possible plague-related death in a Russian laboratory, it sounds like the opening scene of a movie. The CDC's monitoring travelers from the region, Russian officials dispute that the plague caused the death and the CDC says the risk to Americans is extremely low. But the story raises an interesting question. Could the plague ever make a comeback? Dr. Coward just remind everyone, I know I can't believe we're having this discussion in 2026. What exactly is the plague and does it still pose a threat? The plague is a naturally occurring infection. It's commonly called the bubonic plague because the large lymph nodes that gets swollen with this or called buboes, this did produce what we know as the black death, which was a major outbreak of bubonic plague in Europe in Medieval times that killed many, many, many people this focus of much literature around that time. It is spread by vermin and specifically fleas on rats and mice. And so we do see from time to time low levels of naturally occurring plague in the Western United States. So I found a news report that there was a death in Santa Fe, New Mexico in June of this year that she was the first human case in New Mexico this year. Unfortunately, she did pass away. So they reminded everyone that this is a bacterial disease. It's carried by rodents and it is present. And so that if you have any contact with wildlife who appear ill or with wildlife, you have flea bites and symptoms that are consistent with plague and you live in endemic areas who seek care. And they have some great advice for folks. So in in those areas where it's endemic, I think people are are somewhat aware that plague could be existing in rats and some of the wildlife. Now, why this was a case of concern from Russia is that this researcher who died of some type of pneumonia, the official story from Russia is that they did not identify a plague in this person, but that this person did work in a research laboratory where they were researching your cineapestus, which is the bacteria that causes the plague and that this person had a severe pneumonia. So that raised lots of questions and concerns. Could this have been pneumonic plague? So plague that is a bacteria. So if it infects your lungs, we then call it pneumonic plague. pneumonic plague is a very serious complication of plague with a high mortality rate. And there have long been publications from academic environments as well as the government that there is a rare but real possibility of bioterrorism using aerosolized plague that would cause widespread outbreaks of pneumonic plague. It takes a few days to get sick. You don't get sick immediately. And then once you start coughing, you could infect lots of people. So again, very rare risk. But if you go to OSHA website and other government websites, they game this out. They figure out what would be due if we encounter a bioterrorism event with aerosolized plague. Plague is treatable with antibiotics. So especially for bubonic plague, appropriate antibiotic therapy reduces mortality from 40 to 60 percent untreated down into well into single digits. In one study, it was around 4 percent. So antibiotics are very effective. If you believe that you have been exposed to plague, because you were outside and there were rats running around. And you think you got flea bites. And now you have a fever, go to your doctor, tell him that you're at risk for plague. And they can institute appropriate antibiotics. It's very treatable. So I don't think we should write this second, all the panicking and stockpiling, leave a floxist and because oh no, we might have a pneumonic plague outbreak. But it is important to recognize that the United States government has long had plans in place for various bio-weapons, including plague. And it could be very serious if, again, in that very rare circumstances, we're used in that way. At least that's reassuring for this holiday weekend. I appreciate that. We're going to move to yet another topic. This one, even I had to take a pause when I read this one. This has to do with a hepatitis B vaccine study that was condemned as unethical from a Danish university, a controversial CDC-funded study in Guinea, Bissau, has received approval from a Danish university despite international criticism. Evidently, the study would enroll 14,000 newborns, give half the hepatitis B vaccine at birth, while the others would follow the country's current vaccination schedule, which does not include it. Critics argue that withholding a proven life-saving vaccine raises serious ethical questions. It still needs to be approved by the government. I believe it isn't, Dr. Ivory. Why is giving the hepatitis B vaccine immediately after birth so important? And what happened if you delay it? I mean, this is stuff I thought we had settled. There's a lot to be said about whether it's settled and whether it's available. And so that's really part of the problem. So when we talk about hepatitis B, one of the issues with hepatitis B is that number one, it is fairly easily transmissible with exposure to bodily fluids. And there is what we call vertical transmission. So moms with hepatitis B have a significant risk of passing on that hepatitis B to their newborn during the process of birth. So I think it's very important that we talk about the risk of the newborn getting hepatitis B before some other time of vaccination. What we know about hepatitis B is maybe upward of 20 to 25% of people who get chronic hepatitis B infection will go on to liver damage and cirrhosis and die from liver disease. So Guinea Bessau has one of the highest rates of hepatitis B in this entire population. It's important to look at this study. Now, you know, my first thought was, oh my God, what have we, you know, Tuskegee didn't end until 1972. That's my lifetime. I was a lot during that time frame. And so the notion of a study like this for what was quoted as we have a window of opportunity to understand the differences between the vaccinated and unvaccinated newborns does not hold water and really does not meet an appropriate ethical standard. The government of Guinea Bessau has formally stated that they do not approve of the study and they're gonna put it on hold. So we will see. But I think it's important to also look at what the study is saying. The study is studying giving a newborn vaccination versus the current schedule which the first vaccination starts at six weeks. So six weeks, 10 weeks, 14 weeks of age. So it is not a vaccine or no vaccine study. It's the timing of the first dose. Guinea Bessau just initiated hepatitis B vaccinations for children in 2008. So they haven't even had 20 years of vaccinating children in a population that has a significant risk of chronic hepatitis B and subsequent liver failure in death. So I still personally and professionally feel like this is unethical because the government is already planning to initiate newborn vaccination starting in 2028. So the notion of let's rush in and do a study so we can take this window of opportunity is more than problematic. And the University of South Denmark, I think should really be ashamed of itself. But let's be honest, it's being funded by the CDC in the U.S. Department of Health and Human Services. And that is the more shameful factor because we have the history of the Tuskegee experiment. Which started as a six month observational study in 1932 before penicillin. And I didn't know that until today, to be honest. It was only supposed to run six months for observational purposes because the type of treatments available were arsenic or mercury or bidsmith and all those things were extremely toxic. The treatment might have killed people as much as the syphilis itself. But the study continued to be extended even once penicillin was available in 1943. And penicillin was withheld from those participants through 1972. And that's just horrendous. It's a crime. So I don't think that we should look at this as just, oh, it's just a mild study, we need information with, I don't know that we don't have this information. And the government of Guinea Basel, I would hope we'll stand by their guns and not go forward with this type of study. - Dr. Ivory, thank you for clarifying that. I know this is such a complicated topic and this has been very wonderful for you to kind of give us that insight. We're gonna go to yet a very different topic. We're gonna pivot to a medical mystery that is particularly appropriate for this holiday, for Halloween to some level. So a recent Washington Post article describes a remarkable phenomenon in people with advanced Alzheimer's disease and other dementias. After months or even years of being unable to recognize loved ones or communicate, some patients suddenly experience moments of extraordinary clarity. They recognize family members speak coherently and sometimes they have meaningful conversations only to slip back into silence. Scientists call this paradoxical lucidity or terminal lucidity if it happens near death. Researchers are studying whether these episodes offer clue about how memories and cognitive abilities might remain accessible even in severely damaged or diseased brains. Dr. Post's, I can tell you, I actually remember this with my own father-in-law sitting there in the room. He had a Louis body dementia and suddenly he said something totally lucid, totally clear and then went back into it when I was trying to follow up. What do you think is happening during these moments? - Joe, let me first off connect with you and say I'm sorry that junior family had to deal with that devastating neurologic disease. I will say, and this is the levity part of the discussion, other than being a reasonable name for a neurology progressive metal band, terminal lucidity can be seen across various forms of dementia and other devastating neurologic diseases, not just dementia's. There was a scientific article that came out that looked at over 6,000 patients around 2500 were observed to have terminal lucidity, which is surprisingly high at close to about 44%. So what are we looking at here? Is this about neuronal network activity or reactivity? Is this a surge or dumping of neurotransmitters from neurons that are no longer trying to maintain survival that rather shift to function and sort of like one last dying burst or is it somewhere in between? We don't know the data as to why, but I think that there is enough mystery here to keep us interested in this human condition where we can all come together as humankind and think about the magical mysterious ways of the human mind and spirit and brain and how all that intersects. I mean, this instills a sense of wonder and respect it made personally. Dr. Postes to the family members who struggle with watching their family members and then you have this moment where they come back. Well, how can family members make of those moments? Because it can sometimes confuse folks that maybe something's improving or changing. Can you speak to that piece of it? - Yeah, I mean, I hate to say that this can bring false hope. What I would like to pivot that and say is that this may not give us an answer for an individual person or family struggle with a terminal neurologic diagnosis. But I think this should, again, instill and inspire an awe in the public to try to think about funding neuroscience research so we can look at this more. I think this gives us interesting windows that we don't have full comprehension as to how the human brain works when certain that a biolic or a neurodegenerative conditions are met. But I think with further due diligence, we can figure this out and figure out ways to build upon this and not necessarily extend life but extend quality of life, which I think is the big picture here. How do we make sure that the moments that are left with our loved ones are high quality moments? - Last question on this topic. Do you think that there's a kind of a fundamental scientific question here? And I think you kind of alluded to it in your first answer. if someone is able to do that does this mean that these These diseases are suppressing brain activity as opposed to destroying brain activity that it kind of could give us a glimpse as to a new approach. Before I say be me up, Scotty, I'm going to preface this by saying there's a little bit of a sci-fi answer. And yes, I know that I have probably upset the fans of one of those two major franchises of Nerddom, but that's okay. The idea here is we know, for example, in studies that look at transcranial magnetic stimulation, if you turn down the side of the brain that had the stroke, then people can actually regain some function in terms of improvement of the phasia, meaning there are people who have a stroke who have difficulty speaking, it's not turning up the signal on the side that does the speaking, it's turning down the dysfunction on the other side. So meaning, are there compensatory things that the human brain does that we don't quite understand, which may be getting in our own way of what we would consider functional? And that's a fascinating enough question that I think we as a society should dream about explore, think about as we move into the final frontier or other frontiers. I love what a poetic way to kind of in that part of the segment. Up next our experts are going to answer your questions. Only treats, no tricks, coming up next. [Music] [Music] [Music] Welcome back, I'm Dr. Joe Servin and this is what's health got to do with it. If you're just joining us, we are in the throes of our Halloween spectacular monthly medical round table and our producer Stacy Bennett, she joins us now with questions for our experts from our listeners. Happy Halloween Stacy. Happy Halloween Dr. Joe. All right, what do you have in your pumpkin goodie bag? A good one for sure. This comes from Frank who lives in Yonkers, which is near Sleepy Hollow in New York. Ah, okay. He says, Dr. Joe, I love a good haunted house, but last Halloween, one of those jump scares nearly gave me a heart attack. What got me wondering, can someone actually be frightened enough to trigger a real heart attack or dangerous heart rhythm? And are there people who should think twice before walking into a haunted house? Dr. Coward or Princess Leia, whichever alter ego here, help us out. It's an interesting question. I think it's actually a good one. What do you think is some of those haunted houses? They are freaky. All right, so I'm just going to say I'm not a fan of haunted houses or jump scares. So I'm not going to be the one over there. But if that is your thing and you enjoy it, then you probably enjoy that adrenaline spike that you get same from riding a roller coaster. So I, the little research actually found a American Heart Association article from few years ago where they reviewed this question around Halloween. Is it okay if I have heart disease to go to a haunted house or could I have a heart attack from fear? So they said it is a conditional yes, but extraordinarily unlikely from Halloween hijinks as they put it. So essentially what they're saying is that there are states of severe adrenaline stress, either physical stress or emotional stress that could put extra strain on a heart that already has heart disease could create the symptoms that lead to a particularly ischemia, the heart not getting enough blood flow could trigger a heart attack. But they point out that these are often situations that we can't prepare for. Some kind of terrible car accident, for example, finding a loved one deceased unexpectedly, the kind of just horrible things that no one can prepare themselves for. So again, rare, thankfully, and I hope you never have to experience any of those. But those are more dangerous adrenaline surges because we can't prepare for it a last longer. They're not just a quick on and off and they can produce not only adrenaline stress and fast heart rate that could cause blood flow mismatch and acute ischemia, but could also cause what we call tacatubos cardiomyopathy or broken heart syndrome where actually the heart behaves as if it's had ischemia, but in fact, the vessels are fine. We see this sometimes in the hospital from people who've been critically ill for other things. They've had sepsis or other illnesses and then have heart failure and we can treat them through that and get them better. Now, in terms of a haunted house, back to that one, so if you're going to a haunted house, you're preparing yourself that there will be jump scares. And so yes, you will jump, you will scream, but probably you'll calm down pretty quickly because you knew it was coming. You knew that, okay, I'm, look, I'm rounding a corner, something's probably going to jump out at me. So you're going to jump, but then you're going to calm down. So you're able to prepare for those things. So it's much less likely to produce that kind of severe adrenaline stress on the body that you'd be expecting. So that said, if you have stable heart disease, no active symptoms, and you love a haunted house, I would say it's probably okay to go for it, monitor your symptoms if it gets to be too much, of course, leave. If you have unstable heart disease where your heart's not in great shape anyway, you're having lots of symptoms, there's other things going on, you're probably not well enough to want to go to that haunted house, might not be the thing for you this year, but I would say for most people, if that's your jam, go for it, I will be somewhere else noted from Princess Leia. All right, Stacy, what else do we have? From San Antonio, Texas, Sophia says, my family celebrates Dia de los Muertos every year by putting up photographs of relatives we've lost and sharing stories about them. What amazes me is that I can barely remember what I had for dinner last Tuesday, but I can still remember my grandmother's voice, the smell of her cooking, and the things she said to me when I was a little girl. Why do some memories stay with us so vividly while others disappear? And can remembering someone actually help us cope with grief? Dr. Postus, this is actually, I'm going to say a beautiful question, and I don't say that every day, but can you kind of help answer that question for Sophia? I completely am with her on this. Sophia Mancanta es la pregunta, right? I love this question. The emotional weight of memory helps it borrow deeper into our memory centers and skip the parts of the brain that scan for day-to-day meaning. To say it another way, this pathway is called the limbic pathway. It is an ancient pathway that we have kept from our evolution from vertebrate ancestors. Basically because it associates social bonding, fear, and parental care as part of our survival as a species. This is the same currency that keeps prairie dogs in a group that keeps cats huddled on a cold night, that keeps our dogs bonded with us throughout our familial seasons. So those slightly different, you know, the pet example I gave, they have similar symptoms, birds due to, so dogs, cats, and birds tend to have similar type of limbic system where there's the social aid fear to try to protect the group, the social group that is important here. Stimulating those limbic pathways or the limbic system can help on cope with grief because it helps change the neurotransmitters in the brain that help us build circuits that help deal with these deeply moving emotional moments in our lives. So if we can associate our grief rather than just raw pain and more of, I'm bonding with the people that are also left and care deeply about this person who I've lost or, or this event that has caused me grief, I think that's the way it can help cope with grief. I love that question. Thank you. Again, Stacy, what else do we have? This one comes from Lori in Sanford, Florida, she says, I know this sounds like something out of a Halloween horror movie, but I've heard that some women actually eat their placenta after giving birth. Some even have turned it into pills. Is this really a thing? Are there any proven health benefits or could eating your own placenta actually be dangerous? Dada, I'm going to just let you answer this because I don't think I can handle the truth here. So go, I just wanted to lay it out for us. If you all only knew, there are these placenta pill capsule kits on TikTok so you can dry your own placenta and put it into pills and be able to ingest it over the first couple of weeks. Now, number one, the placenta look. like liver. They say it tastes like liver. So who am I to judge? If they like it, I love it. But let's be very, very clear. When we talk about some of these things, number one, the placenta is not coming from a sterile environment on its way out. You know, if there's no entry to an infection, that's one thing. But boy, let me tell you, there are all kinds of secretions and solid material and whatnot sitting there on the way out. And so the notion of cleanliness is important. But then that's why you're supposed to cook it. Now, having said that, when we talk about post-partum depression and post-partum mood disorders, there is some indication that the sudden large drop in progesterone levels is what's triggering that. And the hormones of pregnancy are generated from the tissues in the placenta. So there is some level of a hormonal infusion by placental tissue. So maybe we need to take that guinea basal study money and put it into if you're going to eat your placenta, let's check your hormone levels afterwards and whatnot and see what happens. So all of that to say, most of the crazy things out there have some smidgen of either historical habits. If you look at some animal species, they eat the placenta after birth. So what is it? It's calories. It is iron. It is minerals. There are, you know, the things needed to replenish the blood supply and heavy blood loss. I mean, we we laugh and I'm still pooping and I never inquired about taking my placenta home and eating it at any level. But when we talk about some of those things, there are some grains of truth and some interesting aspects of science for us to look at and potentially explore because there are some answers there. Yes, I think we have adequately answered that. Wow, is all I have to say. A stacey next question. This is from Jennifer and Salem, Oregon. She says every Halloween, my kids come home with enough candy to keep a dentist and business for years. Between sugar, artificial colors and the occasional stomach ache, I wonder how worried parents should really be. Is eating a mountain of candy in one night actually dangerous? Dr. Cowart, help us understand about the dangers of eating too much candy Halloween night. Science studies everything and apparently some researchers from the American Chemical Society, I believe it was, looked at this question a few years ago. They went on Good Morning America. There were some articles that they posted on this and the question they looked at is, what would be a truly toxic dose of Halloween-sized candy and what would actually cause like a cute toxicity where you have so much sugar in your bloodstream that it would disrupt your natural fluid status that you could actually not just have a little stomach ache, but that you could really make yourself ill, even death. How much sugar, how much candy would I need to eat to die? So this is in pharmacogenomics, pharmacokinetics, we call this the lethal dose 50, LD 50, you know, basically what would be a lethal dose in 50% of the population? When they came out with a formula, you multiply the weight in pounds times 13.5 and you divide that by a number for the type of candy. So the average 40-pound Kindergartener, little Kindergartener, you know, pre-K. When I calculated this out and I did the fun-sized candy bar calculation, I got 58 fun-sized candy bars essentially in one sitting to be a truly toxic level. That doesn't mean 58 over the course of a lifetime, it means like in one night you sit down and you just ingest 58 and this is for a little tiny Kindergarten. In terms of candy corn for the candy corn calculation, this would be 360 pieces of candy corn. So if you're keeping an eye on what your kid is eating and they're eating something less, then 58 fun-sized candy bars are that equivalent. Maybe they're had 10 and they're really excited and hyper and you give them some water and then they feel better. They might get a little tummy ache, they might have a sugar crash, yes, they need to brush your teeth afterwards, but very likely they're not going to have any other ill effects, they just might not feel that great. Now if we eat 10 candy bars every day, that's a lot of artificial sugars and things to be ingesting that might increase our risk of metabolic syndrome and diabetes. And to everyone out there, please don't do that at home. Don't sit down and try our calculations to prove us wrong. Just listen to the good advice from Dr. Coward. Stay see what else do we have. Kaden from Fountain Hills, Arizona says, "I'm curious about some of the unexpected ways that COVID-19 pandemic is still affecting us. I've read that working from home and spending less time with others may be taking a toll on our mental health. As physicians, are you seeing lasting effects of the pandemic that nobody anticipated? And are there ways our patients' lives have changed that we're only beginning to understand?" All right, Dr. Post, this is an interesting question about kind of like, I mean, one of the miserable memories we all have with regards to COVID and the way it impacted us. This is kind of a tricky space of societal neurology, right? Like, how do we as a species interact at that level? This is less individual one-on-one person, right? We have mirror neurons within our brains that are really built for social groups and social environments, right? If there are no other humans to mirror, are we really using the parts of the brain with the mirror neuron reside? And if we don't use it, do we lose it, right? I mean, that's one of those really tricky questions, especially as we start to age. The other side of that question is, are we actually biologically hardwired to sustain the crush of mirror neuron use that it would take to live and work in some of the most popular cities on the planet? Places like Tokyo, Japan, New York City, downtown Francisco, et cetera, et cetera, et cetera. The list goes on, maybe not, but as a medical and scientific community, we don't have record of what happened from a neurological, sociological, and biological intersection when the industrial revolution occurred and drove humans to cities, right? We just don't know. It might be worth watching what happens to us at that unique intersection, again, neurology and sociology, when communicable disease might push us back out to tightly locked environments, but I would say that that is a spooky thought. Fair enough, Stacey. I think we have time for one more question. From Philadelphia, Vincent says, "Yo, doctor Joe, here in Philly, Rocky Balboa is practically family. I've always noticed that Sylvester Stallone has had the distinctive crooked smile and slightly slurred speech. I heard it has something to do with a facial nerve injury when he was born because of four steps. How common is a nerve injury to the baby from delivery?" "Dr. Ivory actually Stallone and his new bio just wrote about this fact that that's how his famous slur is from his mother's delivery. How common is that?" "Believer not is more common than you think. When we talk about four steps delivery, four steps delivery is used to be 5, 6, 7 percent of deliveries and now it's 0.98 percent of vaginal deliveries. So the numbers are down a lot. Most in facial nerve injuries were occurring with four steps deliveries and that rate was 8.8 injuries for every 1,000 four steps. That's not that uncommon." Now the good part is that the majority of those, the overwhelming majority of those, resolved within the first month, four to five weeks of life without any treatment or intervention. Even the mild to moderate ones. So it's more common. It's actually rare for facial nerve palsy to extend that long past delivery. But four steps injuries can, on occasion, be pretty severe. I actually have a cut on my cheek from a four steps injury because I was the neighborhood four steps. So four steps were not 1,000 percent benign but they were far more useful during the days when a C-section almost meant certain death from infection or was not readily available. And as the technology and refinement of how we handle abnormal births improves, we see that four steps are falling by the wayside. And they should because people aren't trained to use them anymore. And if you're not trained to use them, four steps are dangerous in your hands. And I was trained to use them but I would not put four steps on anybody because I don't do it enough to stay good at it. And the proficiency is important because placement can mean the difference between an injury, a laceration or even a skull fracture. Now, facial nerve injuries have not disappeared because maybe 20 percent of facial nerve injuries are not associated with four steps delivery. They're just associated with a vaginal delivery. And it's because the cheek or the jaw has been compressed on the sacral promontory and the mom's pelvis. And so it's a pressure injury under those circumstances. But again, most of those injuries, the overwhelming majority resolve in 45 weeks of life with no known sequelae. So no side effects going forward. - Thank you so very much. And I wanna thank our incredible panel. They got into costumes just for this. So we had Dr. Donna G. Ivory. She was also our cat in the hat. Donna, thank you so much for joining us as always. - Oh, always. And you know, I'm trying to bring the chaos whenever I can. (laughing) - Love it. We had Dr. Jose the Mandalorian poses who joined us as well. He's at the University of Virginia. Thanks so much for joining us, Dr. Posis. - This is the way. (laughing) - And last but not least, we have Dr. Jennifer Princess Leia, a coward who joined us up from Rochester, Minnesota. Thanks so much, Jennifer, for all your insight here. - Thanks, Joe. We're gonna be part of the rebellion. - You've been, (laughing) well, that is our program for today. We hope you've enjoyed our show. And if you've missed anything, you can listen to the full episode at wjct.org and on your favorite podcast app. Thanks to all of our guests. Stacey Bennett is our executive producer. Rady Korm is our director, Isabella Casapal, is our associate producer. Kaden Collins is our researcher. If you have questions about this or any topic, let us know by calling us at 904-358-6362. Email us at [email protected] or tag me on social media at J.Servin. I'm Dr. Joe Servin and you're listening to what's health got to do with it from WJCT Studios in Jacksonville, Florida. Until then, thank you for listening. And until next time, stay healthy, keep in touch, and salute. Happy Halloween and Dia de los Muertos. - Support for what's health got to do with it is provided in part by the American Academy of Neurology Research Program. This year, one gift can change what's possible for brain research. The program funs scientists working on new treatments for brain disorders. And the American Brain Foundation invests in today's science to discover tomorrow's cures. Discover how we find and fund the researchers working to make those cures possible at americanbrainfoundation.org. (upbeat music) (upbeat music)