Episode Notes

Episode summary

Guest info and links

The host Margaret Killjoy can be found on twitter @magpiekilljoy or instagram at @margaretkilljoy.

This show is published by Strangers in A Tangled Wilderness. We can be found at Tangled Wilderness You can support the show on Patreon.

Referenced Texts:

> Fitzpatrick's Dermatology, 9e > Taylor and Kelly's Dermatology for Skin of Color, 2e > Sanford Guide To Anti-Microbials > UpToDate: > UpToDate – Evidence-based Clinical Decision Support | Wolters Kluwer > Where there is no Doctor:Books and Resources - Hesperian Health GuidesHesperian Health Guides > CDC > American Academy of Orthopedic Surgeons >

Transcript

Max on Taking Care of Medical Needs

Margaret 00:15 Hello, and welcome to Live Like The Wold Is Dying, your podcast for what feels like the end times. I'm your host Margaret killjoy. I use she or they pronouns. And this week I'm talking to another medical practitioner. I'm talking to a nurse practitioner named Max, who is going to talk about how to access medical care when medical care doesn't want to give you access to medical care. And we'll be talking about the different ways that people source medications, and we'll be talking about the different diagnostic tools and kind of talk about what you can do to learn how to be your own doctor. Yeah, I hope you enjoy it. This podcast as a proud member of the Channel Zero network of anarchists podcasts. And here's a jingle from another show on the network. Ba-da-da-dah-dah-da.

Channel Zero Jingle

Margaret 02:18 Okay, so if you could introduce yourself with your name, your pronouns, and then I guess a little bit of your background as relates to the kind of stuff we're going to be talking about today.

Max 02:27 Sure, my name is Max, I use he/him pronouns. I'm a medical provider, technically, I'm a nurse practitioner with a degree in family health care. I've been working in health care for about 15 years on the, on the East Coast, first doing primary care and working with LGBTQ+ folks, and now mostly doing HIV care in an infectious diseases environment.

Margaret 02:56 Okay, so the reason I wanted to have you on the show is I wanted to talk about, I guess you could say like DIY allopathic health care, or maybe rather like accessing allopathic medical care without access to the allopathic medical system. And, I was wondering if you could kind of give a brief introduction to that, and also explain what allopathy is, for anyone who's listening who's not familiar with that term?

Max 03:21 Sure. Allopathic is the word I think I'm going to use to describe the medical world I work in, I think about it, like how people talk about Western medicine. But I feel like there are so many different contributions to what we think of as Western medicine, from all over the world historically, and currently that it seems kind of like a dumb term. And I sort of reached out to some friends of mine who are in other kinds of health care, outside of this sort of what we think of as like this health care model and was like, "What's the best terminology?" and they're like, "Oh, "allopathic", that's what you should use," you know, and so I think, "all right, that's what I'm going to use for this." And for me, I think a lot about expertise, right? Like someone could learn to work on a bicycle outside of ever having to learn necessarily in a shop or in a school. And they could learn to work on their bicycle super super well, and they could learn to start working on other people's bicycles. And they could go on the internet and they could diagnose problems with bicycles and they could you know, become the person who lives next door who's really really good at fixing everybody's bicycles. And ultimately with experience that person can be an expert in bicycles right? That's that's something we allow people and there's something about allopathic medicine that just doesn't allow for that expertise outside of really rigid model, outside of schooling outside...it it police's its borders. So like, if you want to go and look something up about your own health care on the internet, the things that you find are are terrible, even the things that are supposed to be reliable, like something like Medscape or something like that, you know, it's like every, "Oh, you have a sore throat," you look up sore throat, and it gives you every possible thing that could ever possibly have ever caused a sore throat, including some kind of cancer, right

Margaret 05:16 Yeah like if you look up, yeah.

Max 05:17 Yeah. And if you...but if you look up how to fix a flat, there's not disclaimers about "Oh, you might cut off your tongue while fixing a flat, or run yourself over, or wear a helmet." You know, it's this...it's like, matter of fact, you're allowed to access the information. And I think that there's...it's a big problem when it comes to health care. And...

Margaret 05:29 Well everyone has bicycles, but only some people have bodies.

Max 05:42 No, no one has bodies. No one...

Margaret 05:44 Yeah. But everyone has a bicycle. So it makes sense.

Max 05:47 Everyone has a bicycle. Yeah.

Margaret 05:49 Yeah. Sorry, I cut you off. Please continue.

Max 05:51 No, it's fine. Makes total sense. I, I, I also think too, about a lot of the, you know, I think one of the things I think about in your show is that idea of like, you know, the prepper, and the fallout shelter, or like the little green anarchists like how that's not necessarily like a sustainable model in the, in the tradition, like, because we need each other, right. And I think one of the things that we need about each other is that we need all of each other. And I think this idea of being able to just go and live on the mountaintop and survive on your own is deeply ablest and assumes a lot about bodies and what bodies need and what people need to keep their bodies healthy.

Margaret 06:29 Yeah, and it doesn't take into account that like even able-bodied people aren't always perpetually able-bodied, you know, like, speaking as someone who currently lives alone on a mountaintop...you know, I think about it a lot, right? Like, I'm like, if I fall on the ice, my dog isn't going for help. You know, and like, I could probably only do what I do with access to a cell phone. You know, like, realistically, I mean, sure people successfully live alone for long periods of time, without access to any of that, but people also unsuccessfully live alone without access to other people, too. So I agree with you. I am....Yeah, we do need each other even even, even when you choose to be mostly isolated, which actually come any kind of crisis. I'm not making this about me, I just got really self conscious thinking about the mountain top thing. You know, come any kind of crisis, I immediately don't want to be alone anymore. Like, be...living alone only make sense in the context of the entire, like, social infrastructure that we have set up, you know?

Max 07:34 Oh, for sure. Oh, for sure. And it's like, as soon as you get a little bit hurt, and you're laying on the ground, and you're like, "Why did I do that thing that I just did that got me a little bit hurt?" you're like, "Will I be hurt forever. Will anybody findfind my corpse.

Margaret 07:51 Okay, so, so and then. So, you're someone who does have access to a lot of the, you know, traditional allopathic medical world, right. And and what you're saying is that it's something that people can become more competent as individuals, whether they're, like specializing, or whether they're just like Jack-of-all-trades-ing their, you know, their health care. What does that...what does that look like? What are good places to start, either in the current context, or in a, you know, a crisis context in which we might be detached from social infrastructure? Like, what what should people learn?

Max 08:28 I'm definitely not in the working in any kind of realm of right now, like, emergency, right? So this definitely isn't the like, 'how to, you know, stop somebody from bleeding and excessively' or...

Margaret 08:41 We have that episode, actually, so.

Max 08:43 Exactly, yeah. No, I've listened to it. And it was great. Um, but it's sort of more like, how do we access these things, so that so that people can become experts outside of a traditional model, right? And so I think about things like, like, sort of big three big things as like reliable sources, right? Where can you look up information and actually get information without being told that you're gonna, that you have cancer when you just have a sore throat, right. And, and then you have access to diagnostic tools, and things that help make diagnostics, and things that help sort of lay it out. And then because that's something that you...we use all the time. And then the final thing I think about is, and also in in that realm of tools, is medications, right? Like how do we get medicine? You know, like this, like medicine in pill form, medicine in injectable form, like how do we get those things outside of a doctor model? And then the final thing is just like, what makes someone an expert is experience. But so the big things I'm going to talk about, like are like what I'd like to talk about, I guess is sources, and tools. Tools, and in the sense of tools I think, you know, diagnostics, manuals and things like that, but diagnostic tools and, and medicines. Okay, so

Margaret 10:09 This is exciting, I want to know these things, and then I'm going to ask you about fish antibiotics afterwards.

Max 10:13 And then in the very most fundamental level, I think that everyone in the whole world who...should have a little index card that they keep on their person that says, you know, their name and emergency contact, what they're allergic to, if they have any medical conditions, if they take any medications, you know. It...or make, you know, or make that if you live with someone who's older, if you live with someone who's house bound, if you live with someone who's particularly vulnerable, help them do that, make them for that for them, and just have that on hand. Because that just simplifies every process.

Margaret 10:50 I, I really liked that idea. And then like maybe people who have access to whoever in your neighborhood has a lamination machine, you know, make laminated cards for everyone. No, that makes sense. It's one of the questions I get the most, you know, because the traditional, as you kind of mentioned, the traditional prepper space is very ableist, and very focused on people who are not marginalized by society. And, and so a lot of people are like, well, you know, "I need a thyroid pill every day, or I'll die," or, you know, or "I don't want to go off antidepressants, I'd rather die," or, you know, whatever these things are. And I don't usually have good solid answers. So that was actually why when you reached out, I was so excited to talk to you. So I guess, do you want to start with sources? What are good sources, obviously, WebMD and Wikipedia, but...

Max 11:41 I have a ton as they do about ways of sort of amassing medication, so we'll get to that.

Margaret 11:46 Okay, cool. Yeah, yeah.

Max 11:47 So, sources was like the first thing. If you can get health insurance right now. And I mean that in like...there are sometimes ways to get it. Like if you can access a lower income clinic, or you know, someone who's a social worker, or does case management, they can help you often get, like state assistance health insurance. And like if you're super sick, and you have a complex issue that would might involve...like, if you have a broken bone, or you worried that you might have legit pneumonia, you can absolutely always give fake information at an emergency room. Just be savvy about it...

Margaret 12:24 Right, and obviously only do this....

Max 12:25 And if you have to get hospitalised...

Margaret 12:27 Oh no, obviously, we're talking about fiction in this particular context, as we would never advocate for you to break the law, but yeah.

Max 12:31 Yeah, absolutely fiction. Yeah, absolutely fiction and in...

Margaret 12:33 In a post apocalyptic society that looks exactly like our current society. This is what you could tell.

Max 12:37 Yeah, that's what we're, that's what we're talking about. And the only way to talk, you know, and in said society too, if you end up in a in a hospitalized situation, and you're what they consider to be indigent. They know they can't get blood from a stone. So they'll often sort of retroactively sign people up for medical coverage to cover that. This is all of course, assuming that someone is documented so I don't want to, I don't want to assume that. So that's on the baseline. But, so things that you could do diagnostic wise, right, we can learn and people can learn how to do physical exams. But I'm a big fan of, of, of some sources that people can access, there's this book called "Where There Is No Doctor", and everyone and their mother should ownthis book. You can get free PDFs of it, and tons and tons of languages, tons and tons and tons and tons of languages. And it is an incredibly useful thing. People should just get it for each other for like birthday presents, you know, and it pretty much shows you how to like diagnose and treat a wide variety of illnesses, even with explicit medication instruction. And it's just, it's just a really, really, really, really useful tool. There's also this thing, this online thing that most healthcare people have access to called "Up To Date." And if you know anyone in healthcare, and you know, in an in an in an alternate reality, where people can share things like you know, logins and things like that, you know, someone who might be willing to share that, you can use Up To Date to diagnose and treat everything. And what it is, is it's, it's, it's staffed by medical people who create, you know, pages about different illnesses, about different things that you might encounter, and gives you all the most quote unquote, "up to date" well referenced literature about whatever it is, you know, and they kind of grade like, "Okay, we give this a Grade A, we give this a Grade B" in terms of like, okay, this is a good intervention or not. And you it's, it's, I look at it all day long, and I've been doing healthcare for a long time. Another possible thing that one could do if one was in like a collective of people was you could all go in on it have an Up To Date.

Margaret 15:06 How much does it cost? Or do you need to provide like medical license? Or?

Max 15:09 I've not had to, to sign up for it? I mean, and I think it's, I think it's very worth it. But I think it's also like one of those kinds of things like, you know, a lot of subscription services where somebody's got login. And there's no way to sort of misuse it, you know.

Margaret 15:29 it just, it drives me crazy how like, this exists, and that we can't access it. Like, I mean, obviously, some people can. And that's, that's wonderful. And I'm sure there's reasons or whatever, but it's just, it's very frustrating the idea that, like, we're all stuck with WebMD, you know, whereas like, actual doctors are able to like...it's not that they just magically know, all this information, you know, I mean, I've been going to a friend of mine for years as like my primary medical provider, basically. As soon as he started going to med school, you know, he just started answering everyone's medical questions for the community that he was in. And, you know, yeah, he spends all of his day like reading and stuff like that, and keeping up to date...it is a very clever name...about all this stuff. And it's amazing how much it changes. I don't know. I don't know, I sorry, I just got really frustrated, think about how that that exists, and I can't immediately access it, and I'm stuck, like, using things telling me I'll die of cancer.

Max 16:30 And it's, it's...that's kind of one of the things I mean, like what else? What else? Where else? Is it so difficult maybe to to access, actual legitimate, you know, resources, if you have a friend, like who's in health care, and they're associated with a university or like a major hospital system, there are also sometimes these biomedical libraries online? Well, of course, there are there are biomedical libraries online, sorry. And, you know, you can look up to the very most current research on things papers wise, you know, and that's a fantastic, fantastic resource. If you know anybody with a login, who's...or is...who is a medical student, or even just a student period, most of them have an online acc... online access to really, really good current research. And ways of guiding care. And so that's another great tool. So you can actually be doing, you know, very, very current, you know, well documented smart health care for people, because they're these things exist. These these documents, these research papers, exist, we just, it's the access, right? It's, it's the access like 100%. Let's see....

Margaret 17:56 I mean, it's, it's ivory tower shit, it's like, it's the same as like, whenever I'm trying to research history. There's all kinds of papers written by historians, and they're all locked up behind these academic paywalls. And I basically have to like bug my friends in the academy being like, "Hey, can you pull this paper?" Or like, write the author's directly and be like, "Hey, you're the only person who's written about the blue spectacles worn by the nihilists in 1860s. Russia, can you tell me why they were blue? Can you just give me the paper?" You know, and I don't know. Sorry, as an aside, it just irritates me. I don't like this ivory tower thing.

Max 18:28 It's ridiculous. It's so ridiculous. And you know, but it really, I think, probably a lot of people are only probably a couple of degrees, like, away from someone who might have one of these log-ons...logins. So I think we should just pressure the hell out of our friends and colleagues, and make sure that they you know, distribute...

Margaret 18:48 Yeah.

Max 18:49 equitably, equitably. The...one of the things I really use a lot is like dermatology guides. So if you have a bunch of friends and you want to go in on a little like Biomedical Library, you know, you know if you know someone who ever went to nursing school or anything like that, ask them if they have, you know, things like anatomy books and things like that. But if you can get Derm books, they're great. There's one called "Fitzpatrick's Dermatology". And it's just like the tome, and has, it has tons of color pictures, if you get an outdated one, just know that some of the recommendations in terms of things like antibiotics might be outdated, but...but what the rash is, and what it what it is, you know, is not...it hasn't changed. That book, though, has...centers I think white skin considerably. There's a book called "Taylor And Kelly's Dermatology For Skin Of Color" that's much much better in terms of, obviously, skin of color. It's very, very good book as well. The problem with both of these books is that they're not cheap. So it's totally worth finding old copies. But then again, just remembering that, you know, the "how to treat things" might have changed.

Margaret 20:11 Okay, so the diagnostics are good, but the treatment...

Max 20:15 Yeah, but the "what to do" has changed.

Margaret 20:17 But once you diagnose it, then you can reference Up To Date or whatever to figure out a better....

Max 20:23 Absolutely. And just in terms of rashes, you know, rashes kind of can all look like each other, too. So that's that problem with rashes.

Margaret 20:30 I mean, to be honest, like to just admit to everyone the main thing I've been going to medical care provider for many years, I, you know, i was a squatter, and I live in a van, I live in a cabin was was like, "Hey, what's this rash?"

Max 20:43 What's this rash!

Margaret 20:44 And usually the answer is shower more, and...

Max 20:48 Dirt rash.

Margaret 20:50 Yeah, and like, I think, ended up having to put anti-dandruff shampoo on various parts of my body at various points, and like leave it there for 10 minutes. Anyway, now that you all know more about me, then you need to...dermatology that that makes sense.

Max 21:09 I love getting to tell patients to shower less that sometimes happens with eczema,

Margaret 21:13 Oh, interesting. I haven't had that problem. I'm looking forward to having that problem.

Max 21:24 So there's a thing called the "Sanford Guide To Anti-Microbials". They're little bitty books, if you can get a very, very up to date one, or like, like, current one. Sorry. That's a really useful thing. They're teeny. The CDC website is really, really useful when it comes to all manner of things like travel exposures, bacterial and viral illnesses, their STD stuff is great, their PrEP stuff, which is like a pre-exposure prophylaxis for HIV, their PrEP guidelines are great and super, super accessible. And that's just free and available, and you just look it up. But just instead of looking at the...look at the "For Providers", you know, always just click on "For Providers." And then I really like the American Academy of Orthopedic Surgeon website when it comes to like certain exercises for bones and joints. And then let's see, a lot of schools and universities will just have like"best practice guidelines, which are just the best ways to...like algorithms for diagnosing things. And then there's some, like online videos, there's this place I used to work....They... I used to refer a lot of my patients at this one practice to this place called Excel PT, Physical Therapy, and I love them because they have tons and tons and tons of free physical therapy videos on their website that are really really good. Like they're legitimate physical therapy exercises that people can go through and be put through. And I just really liked them because I feel like, I don't know it's not just a printout. It's...they're actually putting someone's body through the motions. They have them right up there and there's not like 50,000 disclaimers, like you're gonna...I don't know, I really I think they're super, super valuable. And I use them a lot with patients of mine who are uninsured who can't go to physical therapy. So, that's some of my...those are like my manuals, I love manuals anyways, in all manner of things.

Margaret 23:37 Yeah, that's like the...sometimes people come over my house are sort of disappointed because I'm a fiction writer, and most of my shelves are just like...if I see a manual for how to do something at a used bookstore, I'll buy it.

Max 23:47 Oh my gosh, totally. Every time.

Margaret 23:51 I really don't see the world where I'm trapping small game. I just don't see it happening. I've been vegan for 20 some years, but...

Max 23:59 I got this really good. It's like a guide. It's exactly that. I have to remember the name. I'll have to tell you later. We can cut this out of there.

Margaret 24:07 Naw, we should leave that part in.

Max 24:10 It's like a hunter-trapper manual. It's so good.

Margaret 24:14 Good. Will we be able to put in the show notes all of the... wil you be able to send me the list and I could put this in top of the show note, so you don't have to dig through the trans, transcription to find these again. Anyone who's listening they'll be in the top of the show notes.

Max 24:27 Absolutely. I will send you all of my, all of my bits and bobs. And then, I guess after after that comes to me like, diagnostic tools in terms of like physical things in like, you know everybody if you you know [have a] blood pressure cuff, pulse oximeter and stethoscope. Right. But you can use...if you get a microscope and you have slides...like a decent student microscope, you can actually diagnose a fair number of things. You know, if you can, you can learn how to Gram stain so you can figure out, you know a lot about bacteria.

Margaret 25:08 What kind of stuff can you successfully diagnose yourself with this kind of thing.

Max 25:12 Like with a microscope, for instance?

Margaret 25:14 Yeah.

Margaret 25:16 You can diagnose like a yeast infection or a fungal infection. If you have a microscope and something called potassium hydroxide, you can like...Trichomoniasis is like an STD. You can absolutely see Tric, like swim on a microscope slide. Um, you can, you know, if you look at a slide and there's like loss of white blood cells, and then also like little 'cock-eyes' , sometimes you can diagnose certain kinds of STDs. And then yeah, with a microscope slide and some some pH paper, you can diagnose bacterial vaginosis, yeast infections and Trichomoniasis for sure. For sure.

Margaret 26:08 That's cool.

Max 26:09 And then, yeah, it's really cool actually. It's fantastic. And it's old school and, you know, people miss things. And sometimes things don't look like how they should but there's tons of information about that online

Margaret 26:22 There's a question and probably, you probably can't,but a friend of mine in med school saw his own chromosomes. And I assume that's more than a microscope.

Max 26:33 Yeah, no. But, you know, a student microscope is going to be kind of more like bigger, bigger cells, things swimming across, you know, little fungal things that are growing. That kind of stuff.

Margaret 26:46 Okay.

Max 26:48 And then if you can get access to urine dipsticks, so which you can actually buy, I think just, I mean, I even I think I looked them up on Amazon, which I shouldn't have. But I did, just to see how easy they were to get, because there are in medical offices. They just have to be kept like in the little...they have to be kept in their little container that they're in because they have to be kept dark. But, those can be used to diagnose, you know, a urinary tract infection. And if there's sort of three things, or if there's little two major things going on on them, you know, if you see something like an increase in the white blood cells that are on the little strip, and you see something called leuk leukocyte, esterase, or leuk esterase, or nitrites on there, those things pretty much are indicative of of a UTI. So if someone has recurrent UTIs, they can actually like pee on a strip and be like, you know, this is this is legit, this just this isn't just me feeling like dehydrated or having coffee, too much coffee bladder or something like that. So it's kind of really useful. Also, if someone just has a ton of glucose on there, that you know, that's like a diabetes diagnosis. So that can be really useful. Having a glucometer is really useful, which tests their blood sugar levels because it can test to see if someone, you know if someone in somebody's community is diabetic, and they get too low or too high, or just in general, if you have someone that's not faring super hot, you can check their their blood glucose levels. The problem with glucometers is they're maddeningly proprietary. So you get them and like there's strips and there's the little finger stick things and they all go with the one has the ones and so it's really obnoxious because it's not like you can super easy cobble together a little glucometer setup.

Margaret 28:44 That's basically to rip off diabetic people.

Max 28:47 Oh, completely. It's just all...it's the dum dum dum dum, dum dum. You know, pregnancy tests. There's home HIV tests. Now we've got COVID test. Apparently, mine's coming from the government. I just finished and I just got it back a negative rapid covid just like two seconds before this. I was feeling kind of rundown. Yeah, I was feeling kind of rundown. So I was like, I should do this before I see my kiddo tomorrow. Yeah. And then now more and more, you can just order lab work for yourself. And I think it's really useful to know what you're going into before doing something like that. And all these things I'm talking about, you know, it should be for really big like, "I think I might have an STD," you know, or like, I think, you know, there's something, something isn't right with this very specific thing. But a lot of these sort of like LabCorp and Quest Diagnostics and things you can actually just go on and order your own tests. It's not cheap, but...

Margaret 29:52 I went and got a bunch from Let's Get Checked. And I'm a little bit squeamish around blood and it was like, "Oh, it's a finger prick and I can handle a finger prick." What they don't tell you is that it's a finger prick and then milk the blood out of your finger.

Max 30:05 Oh, I hate that, the word milking.

Margaret 30:08 Yeah, and I literally couldn't do it. I like, tried. And then I was like making someone help me. And then they were like getting really stressed out because I was kind of freaking out of them. And I couldn't do it. So I have like, a fair amount of expensive tests sitting and waiting for me to figure out how to, and then, you know, I like I talked to them, and they're like, "Oh, you just got to make sure you take a shower first, and that you're all warmed up so that you can like..." and I'm like, "I will not milk blood from my finger." So I have...my squeamishness prevents me from accessing certain amongst these tests.

Max 30:48 Well, some of them, you can order yourself and actually just bring to the lab. And they'll actually do a blood draw for you. So I learned that from...

Margaret 30:57 Okay, okay.

Max 30:58 Yeah. But they're not always, you know, I think the cost is always kind of an issue at the end of the day with some of these things.

Margaret 31:08 Yeah, I like the idea that someone in like, someone in your crew can have a microscope and at least tell you if you have Tric.

Max 31:15 Yeah, for sure. For sure. Especially if you know, the symptoms, and the and the test match up. Yeah, possibly all labs may be able to be ordered. But the thing is, I'm a big fan of like, not going looking for things unless there's an actual... I don't know, unless someone's having a problem in that they feel like it means that something has changed from their baseline to such a degree that it's causing them...like, things aren't going well.

Margaret 31:48 Yeah.

Max 31:48 You know? And if something I always tell people, if something's been there on your body for a long time, and it's unchanged, it's probably not anything. You know, like, it's probably just a... it's probably just your variation on a theme, or it's some kind of weird little cyst that's just always gonna be there. And if if it's causing sort of psychological distress, distress, or something, that's totally fine. Like, we can deal with it. But if it's not changing or getting worse or anything, it's probably nothing. That...nothing worrisome. It might be something but it's not going to be something worrisome.

Margaret 32:23 Yeah.

Max 32:24 Yeah.

Margaret 32:25 You mentioned also in diagnostic tools, like physical exams, like, what are the kinds of physical exams that we should be learning how to administer on ourselves and our friends?

Max 32:35 Well, I think just sort of knowing what your body is like, like know, from the get-go, like not to be totally "to our bodies, ourselves," but I think there's something really good about knowing what's there. You know, and, like self exams are good in terms of people think about, like, you know, chest self exams, testicular self exams, those kinds of things. I think if someone really wants to pursue be... you know, knowing about other people's bodies, you know, knowing knowing what, what to listen for, would you listen at someone's heart and things like that are important things, you know, to know. But I think just having kind of a sense of oneself and like, "Oh, something isn't right. Something really isn't right," is is kind of the most important part when it comes to physical exams.

Margaret 33:25 So just knowing your baseline basically, and knowing...

Max 33:27 Knowing your baseline and knowing when something wildly deviates from your baseline.

Margaret 33:33 Okay. Which of course always says the fun, like aging thing where you're like, Oh, that's a new spot.

Max 33:38 Oh, yeah, totally. Or that hurts so much.

Margaret 33:41 Oh, actually, okay here's a diagnostic question: What should I look for? What should 'one' look for when they look at moles? To try and figure out whether or not they're worrisome?

Max 33:52 Is it? Is it new? Is it irregular? Like very irregular. Not like a nice little round, nice, like continuous border, but does it look raggedy? Right? Is it, is it kind of just like a different pigmentation from your skin color? Or is it like, like really black? Or is it like, going to bleed easy? Is it kind of bumpity all over as opposed to kind of a continuous smooth thing? In my experience, things that are worrisome that turn out to be cancer, things look worrisome. They look really different. Usually. Not always, but usually, you know, you see something and you're like, "What is that?" That's not something that's been on your body before. And again, if it's something that's unchanged, really, mostly it's been there for a long time. It's not doing anything. It's just chillin with you.

Margaret 34:55 So, one of the things I want to ask about, that you talked about briefly before we before we started recording is, is access to medications. Obviously, medications are something that it's, you know, there's there's probably two types of answers to this question or almost two questions. And one of them would be like, "What can you gain access to in a situation where law is no longer a thing?" Versus "What can you gain access to within the existing society?" Like, how can you gain access to different things? And those are maybe related questions, and maybe not, but I'm curious.

Max 35:31 I think they're related. I think I need to preface it, okay. Something that's really important to me is anti-microbial stewardship. And it's, it's up there with, you know, all kinds of stewardship, right, like Earth stewardship, meaning like, we have access to drugs that treat microbes. We have overuse to them as a society, right. And now we have these things called multi-drug-resistant organisms. And the way we prevent more of that is not is by not taking medicine that we don't need. Okay. And by taking medicine, that makes sense for the organism. So that's my only little caveat that I'm putting out there.

Margaret 36:18 No, that's interesting. The way of phrasing it as like, part of stewardship makes a lot of sense. Like, so what's involved in...I mean, like, you know, I remember, was a kid, we'd all be like, "Oh, don't use antimicrobial soap, or you'll make everything worse," you know, and I don't know, that was us being like, proud about being dirty, or whether that was legitimate and, like, like, so what else is involved? I mean, there's also the like, you know, always complete your round of antibiotics, so that you like, actually destroy it versus like, you know, almost killing it having come back worse, but like, what are...

Max 36:53 That's kind of changed a little, they've actually shortend a lot of courses.

Margaret 36:55 Oh, interesting.

Max 36:56 Yeah. You know, it used to be these sort of like long drawn out courses. We just want to make sure that someone's using the right, right drug for the right critter, right. And that we're not just taking medicine because we don't feel good. Because, there's a lot of things that may make people not feel good, that doesn't even have anti whatever's towards it, like anti-microbials. Because it might not be bacterial it might be viral, there might not be anything to do for it. You know, like the vast majority of of those, those two, three weeks, sort of sinusitis, doom, "I'm so sick, and I'm never going to be a well person." That's all viral illnesses, you know, there's not anything we can really do for them. If it's multi-symptom, like that, like runny nose, and yucky eyes, and a cough, and chest, and I mean pre-COVID virus, right? Viruses present a lot similarly to each other. Right. And viral illnesses make us kind of have viral illnesses, which are usually multi-symptom. And a lot of viruses, we just kind of have to suck it up and do the soup and neti pot and be miserable for a while.

Margaret 38:15 Okay.

Max 38:16 But so that, you know, we can target anti-microbials like anti-biotics like specifically to certain to certain things, because we can diagnose them pretty specifically with certain tools, or, you know, we kind of really know that these symptoms always kind of equal "this" or whatever. But it's just something good to keep in mind going into things. I mean, everybody does dumb things. And everybody...sometimes I have definitely...many times I've written prescriptions for things that I wasn't 100% sure of, because I want to make someone well, and we don't have access to all the diagnostics and...

Margaret 38:56 Right. So it's just your best guess or whatever.

Max 38:59 Yeah. But, not everybody should be taking azithromycin if they feel bad, ya know? But so I think that's my only thing going into things. It's just, you know, we should be we should be conscientious of these things. Um, because we only, you know, we have the potential to create total havoc when it comes to critters, right. I mean, yeah. I guess I think about accessing medications or anything. So, where do you get medications in the world, right, if you don't have like a provider or prescriber? So, most medicines, if they're like a tablet form, do not readily expire. So most medication...

Margaret 39:50 I've heard the efficacy drops a little bit.

Max 39:53 Maybe, maybe a little, but it takes a lot for the efficacy to drop, drop, drop. I mean, I guess Have you opened up an old thing of meds and it just looked very, very strange? Maybe...but if it's still there, most of the time, most medications, they just don't have the money to keep studying them out and out and out and out and out expiration wise and they get to the point where they're like, "It's probably not expired..." Certain...like tetracycline, maybe it causes a dangerous situation. So, stay away from old tetracycline and Ranitidine.

Margaret 40:32 And that's an anti-biotic?

Max 40:34 Oh, yeah, so tetracycline is the antibiotic. And that, that could be dangerous if, if it's old, theoretically, but it's not prescribed, like all that anymore. And Ranitidine, which is like a stomach med that's been taken off the market, it's an antacid style medication, it has some cancer causing compounds that could have occurred, that most things like if they're a tablet, they don't expire. Like it's completely reasonable to hoard medication.

Margaret 41:05 Okay, is there a way to get the doctor to give you like, longer prescriptions? Like I've heard that like, sometimes people struggle to be like, I want my ADHD meds more, you know, and people are like, nervous to give larger best perscriptions or whatever.

Max 41:21 That's tricky because they're control...sometimes they're controlled. And I think with controlled meds, providers are super squeamish.

Margaret 41:28 Okay. Okay.

Max 41:29 Which sucks. But, some meds just keeping them you know, just if you have them in your house, and, you know, maybe you didn't take them, as long as it's not liquid medicine or emergency medicine. So, if it's like an epi pen, or insulin, you want those things to stay, obviously, like, you don't want them to be expired.

Margaret 41:52 Okay.

Max 41:53 But you know, but inhalers seem to be okay. And I always just say, if you have like old meds, antibiotics, et cetera, keep them. Someone may need them. Right? Do you have a relative that's passed from this mortal coil or whatever, and you know, you're cleaning out their space? Maybe there's something that they might have that someone needs?

Max 42:18 You know, I shouldn't I mean, this is like that...my pharmacist friend is going to roll over in her not grave, but like, but we're always told not to tell people this, but we're talking about, you know, access, if someone doesn't have access to medicine that they need, you know, how do we get them access to medication. So this is sort of talking about, like, you know, worst case scenario, but, and then I always think about, you know, if someone, if you got a prescription of something, say, and you took it, and it gave you a rash all over, and the doctor said, "Don't take it anymore, you're allergic to it," or you're like, "Oh, I threw up and I never took that, again," save it, because that's almost a full course of the medicine. It's probably the you know...which is fantastic. You know, if you if you were taking something for something like, like for HIV, and you were on anti-retrovirals, and you switched regimens, because you were cured... like wanted to take something new, save your old meds. So, because as long as you're not resistant to your old meds, your previous med regimen still works. And you could go back to it, and you could save yourself, like a couple months of heartache if something went down.

Margaret 42:18 Yeah.

Margaret 43:34 Okay. So theoretically. This is okay...Wait, no, I don't want to give terrible medical advice on this show. Nevermind.

Max 43:44 I'm not trying to either. That's, why I'm like..."ahhhh!"

Margaret 43:48 Because I'm like, well, how could someone get a backstock of you know, someone who's HIV positive and wants to have access to their medication, despite disruptions in supply chains, and whatever. I dunno people can figure that out themselves.

Max 43:59 You know, I think about this all the time, I think about this all the time, do you have a friend that would be willing to get meds prescribed for them? Even if they you know, do you have a friend with insurance that would be willing to, to say that they had X, Y and Z in the low stakes way? I mean, it starts to become high stakes if controlled substances are involved. Right? That's when things become dangerous for everyone involved. And you know, could be...

Max 44:02 And that would be stuff like painkillers, Ritalin. I forget the name of the larger...SSRIs.

Max 44:39 Not SSRIs.

Margaret 44:41 Oh really, okay.

Max 44:42 But benzodiazepines...

Margaret 44:45 Oh, that's what I was thinking of, benzos. I dont' take medication.

Max 44:48 Yeah, I think that you know, you have to you have to go and and, you know, get special scripts for and things. Those are the things that they...

Margaret 44:56 The stuff with street value, basically. The stuff that's fun to take.

Max 44:58 Exactly. Those are the things sprays thick eyebrows. Yeah, yeah. And, and, you know, and there's a lot of surveillance of, you know, but if if if you're someone who needs thyroid medication to live, you know, and you have someone, you know, if you have access to other ways of getting your same medication, you know, that's not a medicine that's necessarily going to raise eyebrows or some of the medications can be very expensive. Sometimes, you know, people can ask their providers to give them 90 day supplies of things. I...you know, I think we try to do that all the time. And I think a lot of people who do have chronic health conditions are very savvy about pre planning.

Margaret 45:47 Okay.

Max 45:47 When it comes to medications, otherwise, you can't go anywhere.

Margaret 45:50 Yeah. So so what else? How else does one access medications?

Max 45:56 I think I talked about partners like if you if you have a partner or a friend who has health insurance, and you don't. And then if you know, anyone who's traveling to countries with pharmacies that don't require prescriptions. So there's a you know, handfuls of countries where one can just go into a pharmacy and just purchase medication.

Margaret 46:15 And is this something that's like, like, what's the legality of taking like, let's not let's, let's pretend like we're not taking other controlled substances, let's talk thyroid pills or whatever, right? If I, if I go to a country where I can just get thyroid pills over the counter, I actually don't know whether you can get thyroid pills over the counter or whether they require Medicare? Is this a good example?

Max 46:34 It's a great example. Okay, let's talk about levothyroxine. Can you go in to a pharmacy in some countries and just buy it? Yes. Do you have someone in your life that needs it desperately? Maybe? Go and get it.

Margaret 46:46 What? What's the law about bringing it back into the country, something that requires a medication [perscription] in another country, and in this country?

Max 46:54 So I can't speak specifically to any law, but it's not something that I've ever heard of penalized.

Margaret 46:59 Okay.

Max 47:00 Because again, it's not, it does...There's not a control piece there.

Max 47:04 Okay. And again, we're not telling anyone to break any laws, and people should make their own decisions. And if it turns out that this stuff is illegal, that would also map to being morally wrong, because obviously, the laws of our society are just and worth valuing.

Margaret 47:04 Right.

Max 47:04 It's not a scam. It's not a, you know, I think if you set up like a capitalist, Super Buyers Club kind of concept thing where, you know, you're bringing levothyroxine back into the United States and selling it for I don't know, I would be like, you're pretty savvy, but you know, that I don't think it would be...I mean, otherwise, I think if you're just bringing back amounts, that makes sense for like, a person, a single person to use, I don't think there would be any surveillance of that at all.

Max 47:50 Especially when it comes to people's health.

Margaret 47:52 Yeah, totally.

Max 47:54 And you know, some countries, some countries have i