Search for tag: "pigworms"

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Scot: It's "Who Cares About Men's Health, the Sideshow." My name is Scot Singpiel. I'm here with Dr. Troy Madsen.

Troy: Hey, Scot.

Scot: He is the MD, I bring the BS. And we also have producer Mitch.

Mitch: Hey.

Scot: All right. Today, pig worms is the show or subtitled "Swallow Your Pride, Not the Undercooked Pork."

Troy: I'm so intrigued already, Scot.

Scot: Are you intrigued?

Troy: I am intrigued. I'm a little grossed out already too, but I'm intrigued.

Scot: Mitch, how are you doing so far with this?

Mitch: I just got a mystery invite to this recording that just said pig worms.

Scot: Pig worms.

Mitch: I'm excited to hear whatever's about to come out this conversation.

Scot: I know that Troy probably knows the answer to this question so I'll throw this at you, Mitch. Do you know why you're not supposed to eat raw or undercooked pork?

Mitch: I always assumed there was some disease connected to it, because I know like you got salmonella when you have undercooked chicken and I assumed that there was something with pork. I don't know what exactly it is.

Scot: Troy, what's the difference between like salmonella and what happens when you eat undercooked pork?

Troy: Well, there are two different diseases for sure. So pork, I'm thinking of trichinosis. Is that what you're getting at?

Scot: One is a bacteria, right?

Troy: Right. One is a bacteria, one is a parasite.

Scot: Which is just a nice way of saying . . .

Troy: Worms. You've got worms.

Scot: All right. So here's the story. And then where this is eventually going to go is just how to have a conversation with your doctor, because this was a very frustrating journey for me on a lot of different levels. And I think maybe we can pull a lesson out of this for other conditions other than if you ingest undercooked pork and have pig worms.

Troy: I think there's going to be a lot the lessons from this, Scot, but why don't you go on. We need to hear what happened first.

Scot: All right. So when it comes to trichinosis, which is caused by eating raw or undercooked pork, not so much here in the industrialized world anymore because the FDA and there are regulations in place to prevent this from happening, but you know, it can happen.

And it also can happen from eating wild game. So if you're a hunter and eat wild game and it's undercooked or raw, then you can also possibly get trichinosis, which is a parasite, which is a worm called trichinella.

And the internet is equal parts unconcerned about this disease and also terrifying and inconsistent. The other thing the internet is heavy on prevention. So right up front, if you get a piece of pork that looks undercooked, it should be white inside or raw, don't eat it. Send it back, don't mess around with it.

Troy: That's the first rule of thumb, yeah.

Scot: My wife and I were on vacation. We went to a restaurant. I hardly ever get the pork. I decided to get the pork and it comes out and I cut into it and it looks kind of pink, like pinker than I think pork should be. So I'm like, "Eh, does this look okay?" My wife's a vegetarian so she's like, it looks maybe a little . . .

Troy: She's like it looks it's disgusting.

Scot: Yeah. Looks a little raw but I don't know. So I have two kind of fatal flaws. Well, I've got a lot of fatal character flaws, but two that apply to this story. Number one is I don't like to look stupid. Number two is that I don't like to be a bother. So I'm in the restaurant.

Troy: You didn't want to make a scene. You didn't want to call the waiter and be like, "My pork's undercooked. Please take it back." You didn't want to be that guy.

Scot: Every time I've ever had an interaction with a waiter about the quality or the condition of the food, it's just never turned out me feeling good about it.

Troy: So this is your background coming into this. Like, you know, they're not going to, you know, or they're going to spit on your food or something.

Scot: Yeah. Or the other thing is I'm afraid I'm going to call them over and just be like, "Oh, I'm sorry, sir. That's how good pork is cooked."

Troy: That's how we do it here.

Scot: Right. Like, you rube.

Troy: That's how we cook it in South Dakota.

Scot: We were in Washington but actually we were in Idaho. You, rube, don't, you know, you're supposed to cook pork this way now. You know, in Boise, Idaho, that's what I'm afraid of. That's how little confidence I have in myself. Like the fine culinary practices of Boise, Idaho, I don't want to be insulted by those.

So I go on the internet and I look up and apparently the FDA has said that you could actually cook pork now at a lower temperature and medium rare is okay. Now I found this on a few different websites. So I take a couple bites of the, what I assume to be the medium-rare part. And then as I'm cutting into this a little bit more, it's starting to look more like how I would expect pork to look cooked. It didn't look overcooked, but it did not look like what I had just eaten.

So I waved the waiter over and I say, "Yeah, I'm sorry to bother you. I think that maybe this might be undercooked," and I turned my plate and he looks at, and he goes, "Oh my gosh."

Troy: Oh no. That was the response from the waiter. Oh, wow. And how many bites had you had at that point?

Scot: I'm not sure. Maybe a couple of that section. Possibly three. I mean, not a ton.

Troy: Okay. This is of the section where he's looking. As you're chewing on it, was it pretty squishy?

Scot: Yeah, it was.

Troy: But you just kept eating it.

Scot: Let me take another side.

Troy: This is how it's cooked in Boise.

Scot: So he says, of course, you won't be paying for that. Take the potatoes off your plate. I'm going to take this back to the kitchen. So he scoots it back to the kitchen. He comes back a few minutes later and he's like, "I've showed it to our sous chef, I've showed it to our manager, you will not be paying for that meal. We'll go ahead and going to cover your flight of your beer tasters there. You get 10% of our brewpub. Just don't sue us, please." No, he didn't say that.

Troy: Don't sue us.

Scot: But this reaction led me to believe that this was the deal.

Troy: That you would pay the price.

Scot: Yeah. So anyway, go ahead and open up the picture that I sent you.

Mitch: What am I looking at here?

Scot: Is that medium-rare or is that uncooked?

Mitch: Scot. Scot, what did you do? Why did you eat this?

Troy: Was it a dark restaurant? Could you not see what you were eating?

Scot: That's pretty raw, isn't it?

Troy: That looks like pan-seared tuna. Essentially. Seriously. It looks like pan-seared tuna, where they take the tuna, they throw it in the pan, and heats it up on the outside. The center of it is raw. I mean, that's like, that's definitely not cooked.

Scot: So I think the picture, I don't know, maybe. Our perceptions are such weird things. But anyway that's pretty raw is what I've come to the conclusion.

Troy: That's raw.

Scot: So anyway, so I start looking up trichinosis and this is where I run into the equal parts, unconcerned, terrifying, and inconsistent. So CDC says one to two days abdominal symptoms. Oh, by the way, hey Troy, do you know how the life cycle of a trichinosis, trichinella or do you want me to explain that?

Troy: You are the expert now, Scot. I'll say I know that it will reproduce in your liver and it works away in your muscles.

Scot: I didn't know that. Okay. Well, I knew the muscles part. I didn't know that it was via the liver. You eat this piece of raw meat that has these little, basically worm eggs in them that have this very hard coating on them. When you digest that, your stomach acids dissolves away the coating so then the worm can come out and be born.

Then the worms, I think they eat through your muscle, or somehow they get into your lower, they get into your intestinal system. So they get out of the stomach and into the intestinal system. Trigger warning, the worms then have sex, and then they have these little larva that go out into your muscle and then they embed themselves in your muscle. And then they do the same thing, they form this little thing around them, and then they wait there until they get their next opportunity to be digested and be born again.

Troy: I love Scot that you had to say, you can't say the worms reproduce, you have to give people this image of worms having sex in your intestines and making their worm babies that are then making their home in your muscles.

Scot: In your muscles.

Mitch: Gross.

Troy: Regardless.

Scot: So anyway.

Troy: Yeah. It's yeah. It's not good.

Scot: There's a couple of places here where you can start having symptoms from what I've understood. Place number one is when the little worms are freed in your stomach and they move into your intestines. You can have abdominal symptoms, that sort of thing. CDC says that can take one to two days.

I went to the Mayo Clinic's website. They said that that could take . . . well, they really didn't say when the initial symptoms happen. They say later signs could be a week after infection. Minnesota Department of Health, they say a few days after eating, you can have nausea, vomiting, diarrhea, fever, fatigue, abdominal pain. And I'm assuming that that's when they're actually coming out of the little worm protective coating into your stomach. I'm assuming that's when the nausea and stuff happens.

And then later on, when they move into your bloodstream and in your muscle, that's when your fever chills, weakness, muscle, and joint pain can start happening. At least that's how I've interpreted it from what the Minnesota Department of Health said.

All right. So I ate this Thursday night. Six days later, Wednesday at 3:30, I break out into a terrible sweat out of nowhere. I get incredibly nauseous out of nowhere. I go into the bathroom. I'm hovering. You know this one, I'm hovering above the toilet seat just waiting for something to happen for about 10 minutes. I am.

Troy: Which part of your body is hovering?

Scot: My mouth, my mouth.

Troy: I was like, what are we doing here? Yeah. Okay. So you're getting ready to throw up.

Scot: I'm sweating terribly.

Troy: So the diarrhea has not hit yet, but you feel like you're going to throw up.

Scot: Ten minutes later, instead of throwing up, it was diarrhea. We transitioned to that. Then the cold sweat goes away, and I'm cool for about 15 to 20 minutes. And then the chills come and it's 100 degrees outside and I am shivering and have goosebumps. Muscle pain, joint pain start developing, headaches starts developing. It is almost impossible for me to move around. I'm so weak at this point.

Troy: That sounds miserable.

Scot: It was miserable. And so I've done a lot of research on this. I'm kind of like, eh. And the part about being, when should you be concerned is a little tricky on the internet too, because some places say most cases are going to be mild. You're not even going to have any symptoms. If you've got more of a kind of mild to heavier infestation, then you might have started having symptoms, but a lot of these sites just kind of tell you, well, either call your doctor. They don't really tell you what to talk to your doctor about, or, you know, it's just going to run its course, which isn't very satisfying to me.

Troy: Especially when you think about them then burrowing into your muscles.

Scot: And these long-term. So they're saying, the Minnesota Department of Health website says after they move into your bloodstream and embedded in the muscle, you can have headaches, fever, chills, weakness, joint pain that can last for months.

So I call a virtual urgent care, talk to the physician, tell them exactly what happened. And their solution was, well, just, you know, kind of wait it out. Over the next four or five days, you should get better. If you start having severe abdominal pain, which I was not having, I just had nausea, then you should, you know, go to the ER.

So that was that solution, which I wasn't really cool with because I don't want to have worms continuingly to have sex in my stomach till my immune system takes care of it if there's actually something else that can be done.

The other tricky thing, Mitch, about trichinosis is there no . . .

Troy: I don't know if worms have sex though, Scot. I think they reproduce, but this image you've got I think that's very disturbing.

Mitch: That is what you had been focusing on is whether or not they reproduced sexually or asexually. All the disgusting, like upsetting, churning things that have been happening over the last five minutes, you're like, "Hmm. Scot, I think you actually got that point wrong about like the reproductive systems."

Troy: Yeah. I think there might be a different process. Anyway, go on. Go on.

Scot: And this might be the disconnect between regular people and MDs, Troy. I don't know.

Troy: There you go. We will dispute the details of their reproductive process.

Scot: At a later date.

Troy: At a later date, exactly.

Scot: But I just want it to be known for the record.

Troy: For the record.

Scot: No, so, I mean, I don't want this to continue to happen. Okay, so I think I was saying there's not really a good diagnostic. And it's even a little unclear on that. The diagnostic is kind of a secondary diagnostic. Meaning if you have these worms in your stomach. And from a couple of the websites I read, it's not even effective until the two to four weeks after you've eaten the pork. So here I am six days in, I need to wait two weeks to find out if this is what I've got?

So, you know, just to let my immune system take care of it, I wasn't digging especially if there's pills out there that you can take. So there are. So not being happy with that answer, I contact a second physician who after hearing my symptoms, I have a little cough while I'm talking to the second physician because I'm drinking ginger ale, which this particular ginger ale, for whatever reason, when you breathe it in before you take a drink would make you cough.

So now I'm getting a COVID test because they think it's COVID. So now I'm getting a COVID test because I mean, I get it, cases of trichinosis are so rare in industrialized countries.

Troy: Yeah. Common are common.

Scot: This particular physician saying, well, the Delta variant does have some gastrointestinal type of symptoms. You've got the fever, you got this. Their contention was it was six days since I ate whatever it was I ate and food poisoning takes, you know, it happens faster than that, which was frustrating to me because I . . .

Troy: Standard food poisoning.

Scot: Yes, exactly. Because I had a fever, I just felt like they weren't understanding, you know, what trichinella do. What was going on in my stomach, how long it takes for this process to happen. That was the delayed part of this process. So now I'm getting a COVID test, which, you know, disrupts my life.

Now my wife can't go into work for two days until I get the results. Comes back negative. So finally I contact a third physician and I finally had the conversation I wish I would have had initially, which was from what I understand, these symptoms are right on time for developing trichinosis. What's the downside to taking this medication I've read about?

And the side effects and the symptoms that might potentially come on for me taking it was pretty low. So for me, just having peace of mind that I've done something to at least try to get rid of this infestation in my stomach, I don't know if it was. Like, that's the other thing too. It could have been all of those things. Those symptoms are so just kind of generic. It could have been COVID, it could have been food poisoning, it could have been something I ate that day and didn't realize it.

Troy: It could have been a virus you picked up, but you're right. That's the hard thing. It makes sense that this could be the cause of it. It's certainly possible. There are a lot of other things it could be, but the downside of not doing something about this is that potentially, you know, it could be that it resolves on its own and it's not an issue, but it also could cause some longer-term problems as well. So yeah, your concerns are definitely well-founded.

Scot: So I think that kind of leads into this conversation about how to have a conversation with your doctor. Because my first doctor, I was very focused on telling them the symptoms, trying to be very specific about the time frames, that sort of thing. I left that conversation feeling like I wasn't heard.

The second one, I felt that left that conversation feeling like I was kind of steered off in another direction, which delayed doing what I wanted to do in the first place but didn't either have the words or hadn't gotten to the point in my journey where I was able to communicate that until I got to the third physician, which was, you know, a few days after that.

So Troy, how should we be having conversations with our doctors? And like the other thing too, is I'd done a lot of research within that first physician. I just felt like they weren't really interested in hearing about what I had learned. And I think part of it is because trichinosis is so rare. I don't know if there's a tremendously good understanding of it. And maybe that's a really egotistical assumption on my part. I don't know.

Troy: It's not egotistical. And that's the challenge, something like this, you know, and this kind of thing happens all the time. Where you have a specific concern, but you don't want to come out and say, this is my concern and say, well, this happened and this happened.

And, you know, as a physician, I may come to my own assumptions and certainly, common things being common. The first thing he says, well, it's probably just a viral thing or maybe it's COVID or something like that.

But with something like this, you at that moment may know more about this disease than your physician does because you've done tons of reading. And obviously, you used very reputable sites so you had great resources you were looking up and it may just be who you're talking to isn't really familiar with it. This is a rare thing, but again, as you really look into it, is something that definitely could be a possibility with what happened.

So I think it's really important when you talk to your doctor about these kinds of things, if that's your specific concern, just say it upfront. Just say, hey, I had raw meat. I'm concerned about trichinosis, and just be honest about what your concerns are. And I think that's very helpful.

And then as a physician, I then like to approach it, again, like kind of the shared decision-making, where I think physicians are receiving more training on this, where it's kind of like, hey yeah, you know, these are my thoughts. I think that it's less likely, but this is how we treat it. I don't see a lot of downside to treatment. I'm okay with doing this if this is what you want to do. And then I'll say the alternative would be to give it a week and just see if your symptoms resolve. What would you like to do?

And I do that a lot in the ER, I do it when I'm concerned about abdominal pain sometimes with CT scans. And while there's the risk of radiation, these are my concerns. We could do a CT, we could give it 12 to 24 hours, but I think, you know, some people come in and say, hey, I am just really concerned. I have appendicitis. And I say, well, these are my thoughts. I think your risk is about, you know, 2% based on your symptoms. If you want to CT, we can do it. And I say, you know, we could wait.

But again, I think the point here is just be upfront about what your concerns are. And, you know, you'd hate to have to do that where it's sometimes referred to as doctor shopping, where you're jumping from one doctor to the other until you find the answer you want, but sometimes you kind of have to get a second opinion. And there's no problem with that. With trying to talk to someone else or finding a different resource, whether it's going to the emergency department or your primary care doctor or whatever it may be to really try and put you at either peace of mind or to get the testing you feel like you need to have done.

Scot: I think peace of mind, that was an important part for me. It was just this peace of mind. And I actually did find an article that said one of the things about getting this type of thing is just that thought, that visual image that I had of what's happening inside your body, like that, just gave me chills, you know, thinking about those sorts of things. Not only, you know, the potential long-term downsides, which again, I realize are pretty rare in a already pretty rare sort of occurrence of something here, you know, in the United States and trichinosis.

Troy: But they're rare in part because people know to cook the meat. Like, that was rare. That meat was rare. So that's part of it too. They know to cook the meat and that was raw meat. I mean, that's something.

Scot: I think it's also rare because a lot of times people don't even get symptoms. Although I did have another friend of mine say, you know, it can be rare because they actually go to point of, you know, processing for pork meat and they test to see if this is a problem and that's where they're seeing whether or not it's an issue.

Mitch: One of the things I just, Troy, when I was hearing that, is that one of the things that I think I fall into a lot is whenever I go and I've done my research and I think I know what's going on when I get in front of the doctor, I have a hard time finding that, like that line between, oh, hey, I'm trying to advocate for myself and oh no, I'm crazy. Like I'm a hypochondriac, I've self-diagnosed, I'm not the professional, I need to trust them.

And so I guess for me, it's very good I guess, to hear that, you know, there is occasionally an appreciation for someone who's done their research and can kind of come forward and say, here's what I'm concerned about.

Troy: And I really appreciate it when people do that, because then it's kind of like and I'll ask them. Sometimes when I'm just I'm kind of sensing that from them, they're leading towards something, I'll just ask them like, "What's your concern?"

And even if they don't tell me that, I will say, well, these are my concerns. This is what I want to test for. Did you have any other concerns? Like what other things were on your mind? What brought you in today?

And I think it's helpful, but, and you can frame it exactly like you said, Mitch. You can say, "Hey, I'm not the expert. I recognize that everything on the internet is not accurate, but this is what happened. This is what I read. What do you think?" And just lay it out there.

And you have to realize as well, that certainly, yeah, as physicians, we have a lot of training, but you know, we may not consider everything. And I always appreciate when people bring those things up. And I may say, "Wow, I didn't think about that. That's a great point. Thanks for bringing that to my attention. Yeah, let's test for that."

Scot: I think another thing that I'd like you to talk about here, and I might be using the wrong word, but physicians use a differential diagnosis, right?

Troy: Yes.

Scot: So if you take a look at what are the chances that this person in of me, and maybe I'm mixing my things here, you know, it has this particular thing.

So sometimes that can be blinding to physicians, and I think understanding how physicians think can be useful for people like Mitch and myself to maybe understand, you know, why recommendations might be made that, you know, that we don't quite want or that don't address our direct concerns.

Like, for example, with my trichinosis, it's a pretty rare thing that's going to happen, and it's pretty rare that it's ever going to be a problem. So then they start looking for other potential things.

Troy: And you can take a couple of approaches with this whole differential diagnosis. And all that means is I come up in my mind with the things I think this could possibly be. And I'll move things up and down that list based on their likelihood. But the big thing I try and do as well is weigh the seriousness of each of those things.

So, Scot, if you come to the ER with chest pain, you know, I'll say, well, you know, here's a guy who's otherwise healthy. Is he having a heart attack? Probably not. But then say in my mind, "Am I comfortable saying that his likelihood of having a heart attack is less than 1%?" And if I can't say yes to that, then I say, "I need to do some testing."

So even though the heart attack is probably way down there on that list of likelihood or list a probability, maybe I think your odds are 5%. And I think the odds that you have, you know, like some inflammation in your chest wall is more like 30%. Still the more serious things you got to focus on those things and make sure you can rule those out.

So the differential diagnosis is interesting because yeah, there are a lot of things you could say you had, that are probably not as serious, but the trichinosis piece of it is definitely a concern and it's a serious thing and it could lead to long-term issues.

And so that's where I think, you know, it's important to make sure you highlight those things as you talk to your doctor and say, yeah, I know this is less likely, but I read a lot about it. I'm really concerned about what the long-term implications of this could be.

And so I think that then can help them in terms of raising that and not just saying, yeah, it's less likely. Yeah, it is less likely, but it's also a serious thing and it should probably be addressed.

Mitch: So Scot, like after I guess going from doctor to doctor and eventually really advocating for yourself, do you feel better now? Did you get the treatment that you wanted, that kind of peace of mind that you were looking for?

Scot: Yes, I did. Finally, the last physician I talked to, I just like I said, basically said, what are the downsides to taking to the pills is going to stop the worm sex? And the doctor said . . .

Mitch: You got it treated. Like you have treatment because even if there's like Troy said there is less than 1% of a chance that that is happening, that grosses me out so bad.

Troy: So you get the prescription, you took the pills, you're feeling all right.

Scot: Yeah. Yeah. I feel all right. It said that you could have some symptoms from taking the pills, then that's probably, you know, the death and destruction happening. It could pause that. So I was actually looking forward to those symptoms, which I never really got, but yeah, I feel a lot better. I have a much more of a peace of mind.

My body is back to functioning normally on all accounts, so, yeah, I feel much better about the whole thing. And who knows, it still might be happening, but all right. Well, I think this was a good conversation. I know I learned a lot from the experience. Everything from trying to find a reliable information on the internet is a little frustrating, then trying to communicate with a physician based on that unreliable information you find on the internet.

Like I was going to reliable sources, but it was just kind of pieces and bits and no consistency, and some places would leave some stuff out.

I liked a couple of things that you said, Troy, and I think this speaks to you to your concern too, Mitch, and I'd love to hear your thoughts. It's kind of like tell them what your real concern is, why it's your real concern, what you would like to do. Acknowledge that you did do some research and that, you know, you don't know what you don't know, and you might be missing some stuff. So help me as a physician fill in the blanks of what I might not be catching on to.

One of the things you said that I love Troy was I know that this is a small chance that this might be what it is, but I would just really feel better if there was something we could do about it. Can we discuss what those are, the upsides and downsides? I think that's huge upsides and downsides.

And then this shared decision-making, you know, hopefully, you can find a physician that's open to that. If they're not, I don't quite know how you negotiate that on a communication standpoint, other than just continue to advocate for yourself, acknowledge what the physician is saying and contrast that with what you feel and think. I don't know. Mitch, any other thoughts?

Mitch: Well, I really appreciate just having some of the language to kind of approach that kind of shared decision-making because the last thing I want to do, and I think my real hesitancy is like, I show up, I did my research on the internet. Like, let me tell you what I think is going on. And I'm really afraid of that. I'm really afraid of being disrespectful, especially to someone who is the one that is going to help me get better.

So by having this kind of terminology of like, hi, this is what I'm concerned about. That's really, I mean, that gives me a strategy that I can apply moving forward.

Troy: And it's that simple. Just say, this is what I'm concerned about. I recognize I'm not the expert. I know the internet isn't always reliable, but I've done some reading, and help me understand if I should be concerned about this, or if you feel differently. I think if you frame it that way, people will be very open to having that discussion with you and really helping address your concern. Either really helping to explain it to you a little bit differently where you feel comfortable or pursuing whatever diagnosis or treatment is necessary there.

Scot: Hopefully, this conversation has helped somebody that might be suffering from hopefully something other than eating undercooked or raw pork. Hopefully, you make a better decision than I do.

Troy: I was going to say let's hope so. So two lessons from this. Number one, talk to your doctor. Number two, cook your food. Number three, refrigerate your food. Three lessons from this.

Mitch: Send it back. If it's gross, send it back.

Troy: If it's gross, send it back. Don't be ashamed. Do not eat the worm larvae, send it back. And Scot, we can have a conversation another time about how I faced a similar situation and paid the price, but we'll save that for later.

Scot: All right, there you go. We'll hear Troy's story some other day. Thanks for listening. Do us a favor, if you enjoyed this or think, you know, somebody else that might enjoy it, let them know, tell them about the podcast, help us get one more listener. In real life would be the best, whenever you're talking about podcasts, what your favorite ones are, or on social media would be great too.

Just a reminder, we have three different kinds of shows here. First of all, we have shows about the "Core Four." Those are the four things everybody should concentrate on to be healthy now and in the future. That is your diet, your exercise, your sleep, your emotional health, and the plus one more is you should know your genetics.

So we have episodes that talk just about that help you get better at that, help you understand that. We have men's health essentials, which are those things that affect and impact us men in particular that you should know about so you can remain healthy.

And then we've got the sideshow where like today there could be some valuable information in it. It's just a little bit more loose, not quite as focused.

Thank you for listening. If you ever want to get ahold of us, you can do so. So easy. Go to hello@thescoperadio.com. You can call us at 601-55-SCOPE and leave a message. You can go to facebook.com/whocaresmenshealth, always to get ahold of us and let us know what you're thinking, what you want to talk about, what you want to hear about. And thanks for listening and thanks for caring about men's health. Scot and worms out.