welcome back I'm Dr Reena Malik urologist and pelvic surgeon and today I'm reacting to an episode of the resident the title of the episode is run Dr run and I'm told I've actually never watched this episode but that there is a little bit of a surprise related to sexual health during the episode so we're going to watch together and hopefully you guys will learn something along the way you work where did you show up your rectum this time the first time that that you had extracted an object from from the colon of an adult or male yes all right so guys this actually does happen quite a bit people do stick things up their rectum and they get stuck and so this is a real problem because it requires often um if it gets really stuck and you can't extract it through endoscopic means using like using a colonoscopy or a sigmoidoscopy basically a scope to obtain the item sometimes it means that you actually have to have surgery meaning they have to open your abdomen and then open the colon to retrieve the object so please use objects that are used for anal play because they often have a flared base or some sort of mechanism where they will not get sucked up into the rectum and you will be able to retrieve them safely please do not use household items all right back to it it's nice to see you again York and this was beloved mother Devon fi has told me sad with her thank you for your care of him don't mention it I have the same problem you know a day without asba is a day I long for well we're so glad that we could help with his asba and Conrad is where's in case so my name well I took a tble York and I were out for a walk on the Belt Line and can we stop foring do you have any har where are they going and they're seeing the doctor in the hallway yeah okay I'm going to order nioc cardog and expedite X-ray on your foot okay fine by me right so yes so this gentleman is the same one who is putting stuff in his rectum who now brought his mother to the emergency room now it's very common for people who do these sorts of things to not share them with their loved ones because they're embarrassed right and that's super normal and we as doctors take an oath right we cannot disclose your private personal information without your consent so if you come to the doctor and tell us for example that you caught um an STD because you were cheating on your partner I can't go tell your partner that you were cheating on them in fact if I did that I would be violating hipa and could get in a lot of trouble and so in general you can feel rest assured that whatever issue you're having is between you and your doctor it's not going to get shared with anyone else and it's definitely not going to get shared with your personal loved ones you have a fifth minute TSO fracture in your foot but the good news is it's it's non-surgical yeah but that echocardiogram is not so good let's keep this train moving lying in the bed your aoic valve has classified and thickened resulting in critical aoic senosis it's an urgent need of replacement how urgent does it require general anesthesia it does a close friend of mine went under and when he woke he was a different man he couldn't even recognize his own family yeah she's right General inesia can trigger dementia in the Cocoon crowd now there is another option it's uh UNS surgical you interested yes don't have the surgery and die hey this you man watch it buddy Dr Austin is just being honest but I would rather die than go through life being demented and confused I still got to go to my belly dancing classes I like hway sidebar now emergency sorry my so yeah we actually do see this there are some studies about general anesthesia affecting cognitive function particularly in elderly patients now I'm not privy to the data in terms of like how up to- dat it is but it is something to consider and discuss with your anesthesiologist before getting an anesthetic awake what do you mean awake awake meaning not you do that it just scares me when I had surgery surgery for what Yori Mom it wasn't a big deal isn't safe yes and just Regional anesthesia I'm in mama I'm in would you listen to me Mr man I'm sure you are God's gift to medicine but you mind your p's and q's in the O if I hear anything to the contrary I will wield my pen like a mighty sword ask PES I was thinking about something else when you were talking but don't bother repeating it I really don't care I am going to save my mother's life you're welcome so you've got the valve issue asthma varicose veins the recent cataract surgery any other medical history which you know about well that is anything YY honey give us a minute well we don't have secrets mother no no honey I just one moment sweee okay well he has secs close the door I have um the little SE the little sea you mean big sea cancer no clamidia we call it the little C in my retirement community yeah you do all right guys chamy or the little CA in this case is becoming very common in nursing homes and in elderly patients in fact data shows that it has doubled from the last 10 years so if you look at the data actually between 2007 and 2017 we've seen double the rate of chyia in patients over 65 and this is for a lot of different reasons one we now have people living in nursing homes where they're all together and they're not afraid of pregnancy right they're well beyond the years of reprod uction women cannot get pregnant two men have medications that can help them obtain erection so people who would maybe have difficulty getting an erection or sustaining an erection that they can use for penetrative intercourse can now have a sustained erection number three a lot of women are using vaginal hormones which I wish more women were using but uh they're using vaginal hormones which allows the vaginal tissues to remain elastic continue making good lubricant which also makes having sex less uncomfortable able and lastly older people haven't had sex ed in decades they may not have even thought of sexually transmitted diseases for a long time cuz very often they've been in monogamous relationships for quite some time and then one partner passes and now they're finally dating new people and having sex with other partners and so these things do happen all right so she G the surgery what's up in what you care for some music oh yes how nice Tom Jones is F I love Tom Jon Dr Oka for timeout please Ivon AOA Evans correct actually that's Aurora Dr CH you got to roll the middle R Spanish I'm not Spanish but like April 4th 1942 way to make her feel com my boyfriend thinks I was born in 47 she he was born in 45 but you know men they prefer younger women he is not loving the I'm not going to feel much I mean I know I'm not going to feel pain but you know what you are going to feel Miss Evans she's has good is new when the surgery is complete how does that sound that sounds wonderful just wonderful okay so in surgery very often patients are wheeled to the operating room awake and that's unless you have like a specific area where patients are put to sleep and then wheed to the operating room most surgical centers or hospitals have everyone get put to sleep in the operating room so you go in awake and it's very sort of scary because you've got um all these new things in the room it's a very sterile environment as it should be there's lights above your head you're kind of vulnerable um people are doing things like maybe putting IVs in or putting a mask on you and so it can be very unnerving and so it's very important for everyone to make the patient feel super comfortable very often you'll see people holding the patient's hand while they get put to sleep just really kind of calming them through the process and this is not calming at all so I get it that he's a little bit annoyed that he has to operate on someone awake you became a surgeon to help patients and I don't know why people think it's okay for surgeons to have a poor bedside manner it is completely possible to be an excellent surgeon and have a good bedside manner so I don't see why people get away with treating people like this sorry so sorry or three ran over this one's a doozy huh my gr gr had gyia and hey hey ch and Banger they're helping goers HP like rabbit is a wick are you blind illiterate or both the sign on the window says awake surgery in progress she made a mistake move on you giving orders now I'm giving advice son it's happening what's happening sure I said put her under all right so one you know it's really unprofessional to be talking about patients like that in the operating room even if they're asleep so we you know keep a very professional atmosphere in the operating room we don't talk negatively about our patients and so this is really unprofessional whether she's awake or not to doing any sort of awake Regional anesthetic for any sort of surgery and you can absolutely do an endovascular surgery with regional anesthesia and the patient can remain awake so if someone decides to have a surgery awake and there are issues with the surgery you can at times need to sort of change your surgical plan now I can't speak to this particular surgery in general but if we're doing a surgery on someone and either they can't tolerate it awake or the regional anesthesia is not working we can sometimes change to do a general anesthetic but of course the patient has to consent to it so she specifically said she didn't want to go to sleep now if it's a matter of life and death that's something that probably you should discuss with the patient so you would need consent from the patient EXP explicitly to be able to go under anesthesia especially if she says originally that she didn't want to because then you'd be putting her to sleep under without her consent so it' be important to have the discussion if you are worried that it may require at some point the patient to go under if there's a complication that's a discussion you have beforehand so we often will you know take consent for blood products even when we think it's very unlikely that we'll need to transfuse somebody under anesthesia because they can't give consent but under emergency situations if we haven't had that discussion of course it goes to the doctor's uh decision to decide what is in the best interest for the safety of the patient PS M push get Dr noan in here why he's a traa surgeon by m clear sign for the theed a TR surgeon when there is no traa I'm here let's going on what do we got is this Tom Jones you know this is Tom Jones uh am I needed for this surgery no you are not needed for this surgery Dr Nolan but your colleagues need to lay eyes on someone who gets it someone who listens who learns and who understands what is like to let your emotions get the best of you just shut your mouth this is unfortunate I believe it was n who said that many are still served your purpose and get out okay guys this makes no sense it looks like the patient is coding they're cardover verting the patient so they're using paddles to try to cardiovert the patient the surgeon is sitting in the back of the room with his arms crossed having a temper tantrum like that doesn't even make sense and then he calls another colleague in just to make an example like one that is so unprofessional two that's not only wasting everyone's time in the operating room where you're not focused on the patient but two you're also wasting that surgeons time where they could be doing something else and saving someone else's life this guy's a trauma surgeon he's probably taking care of traumas all day long that come in from the emergency room that need his attention immediately so this is just wildly inaccurate tell me about this man that you're very close to you met him there he is bring it in for the real thing all right big thank you you're all right by me thank you York F let's get you home yeah yeah all right just get my flowers don't forget them it's clear you've chosen the right profession young man thank you Yorkie why is there a syrup bottle up your blond was pulled up the wrong why Evans why is his what I'm so sorry in TR organ it's okay I have chyia first of all why is he even opening up another patient's chart while he's sitting in the room of the mother like it makes no sense and why is the X-ray all of a sudden there like this is not accurate at any like he has no reason to look at that x-ray he has no reason the patient's not in the hospital so was he doing it purposefully so the mother would see it I mean again total violation of privacy here and none of this is accurate and then that ending is just very awkward right like I don't know I don't talk to my mother about things like this the ending was like totally weird I mean if my mother had chyia I really don't want to know about it to be quite honest with you okay let's talk a little bit about chlamydia so you know chlamydia is a disease that is often undiagnosed in fact 70% of women are asymptomatic when they get chlamydia and 50 % of men are asymptomatic so symptoms when they do occur in women can be abnormal vaginal discharge pain with urination so often it can be confused for a urinary tract infection they can have abnormal bleeding between periods or they can even have pelvic pain now again because often times they don't present with symptoms people can go undiagnosed and this is why Chia can spread so rapidly particularly in populations where they're not looking for it so we talk a lot about it for young people to get screened to get checked but often times older patients are less likely to get screen cuz they're not getting pop smears regularly and they're not getting evaluated by their doctor for sexually transmitted infections they're getting evaluated for high blood pressure and diabetes and heart conditions so it's really important that if you are an older person having unprotected sex with a partner make sure that you're both tested for sex R transmitted infections you're both treated so if one of you is positive for chedia you both need to be treated the other issue is that if you're exposed to sexually transmitted diseases as an elderly person you're more likely to get the infection and this is because of a couple things particularly as you age your immunity decreases so for both genders you're going to have less immunity also as women age they go through the genital urinary syndrome of menopause and through that their tissues become less elastic they become thinner and more Frable or fragile so they can more easily get Cuts or lacerations and so when you have a cut you're more likely to get a bacteria from somebody else when you're having sexual intercourse and it's important to know that chyia does not only pass from vaginal penetrative sex it can pass through oral sex or anal sex as well or if you touch an infected genital and get some secretions and then rub your eyeball you can also get affected so it's really important to always kind of use protection no matter what type of sex you're having and wash your hands after having sex the other thing that women can do to reduce their risk of getting a sexually transmitted infection is by using lubricant I've had a whole video about lubricant so you can check that one out but basically there's three different types of lubricant water-based oilbased and silicone based water-based evaporates quickly so you'll need to reapply and oilbased and silicone based last a little bit longer so you can experiment with those and figure out what you like if you're using condoms as you should do not use oil-based lubricants because they can break down the condom now in terms of um other things if you are suffering from thinning vaginal tissue dryness discomfort I strongly encourage talk to your doctor about getting vaginal estrogen therapy it is very very safe it does not cause breast cancer endometrial cancer or anything like that because it's very local meaning it just gets absorbed in the local tissues and very little amounts get absorbed systemically so it's very very safe and you can can use it from now until death do your part and remember so if you are having new onset pain new discharge pain with urination abnormal bleeding please see your doctor and get screen for sex transmitted infections chyia ganara are very very common and the testing is so easy it's usually a swab of the area or a urine test and so you can get those done and it can be very very helpful in preventing progression of the disease pain discomfort and spreading of the condition as well if you guys are looking for a urologist in the Newport Beach area I'm happy to see you please make an appointment at ralik md.com slapp appointments it's very easy to make an appointment and I would love to have you as one of my patients and if you are enjoying my content please make sure to subscribe and share this Channel with your friends if you enjoyed this reaction video you will probably enjoy my reaction video to end just like that where Harry has retrograde ejaculation so make sure you check that one out and as always remember to take care of yourself because you are worth it