1 00:00:23,333 --> 00:00:25,773 [doctor] You were riding your bike and you hit a pothole, is that correct? 2 00:00:25,802 --> 00:00:26,772 [woman] Yeah. 3 00:00:26,803 --> 00:00:28,973 [doctor] That is a long handle. 4 00:00:29,005 --> 00:00:30,345 And that’s stuck in her leg. 5 00:00:30,373 --> 00:00:31,773 [woman moaning in pain] 6 00:00:31,808 --> 00:00:34,308 [woman 2] The pain was so bad that I was laying on the floor. 7 00:00:34,344 --> 00:00:36,514 [doctor 2] Oh, what is that? 8 00:00:36,546 --> 00:00:39,116 Something’s going on and we have to figure it out. 9 00:00:39,149 --> 00:00:41,979 [coughing] 10 00:00:42,018 --> 00:00:43,548 I have these really bad tonsil stones. 11 00:00:45,689 --> 00:00:47,619 - [choking] - [man] There you go. 12 00:00:47,657 --> 00:00:51,027 [doctor 3] I had a lady who apparently has a fake nail in her ear. 13 00:00:51,061 --> 00:00:52,391 Sorry. 14 00:00:52,429 --> 00:00:55,159 I think we’ve all played Operation when we were little kids. 15 00:00:55,198 --> 00:00:56,828 [woman] Ah! Did you get it? 16 00:00:56,866 --> 00:00:58,436 [assistant] It’s really stuck in there. 17 00:01:09,412 --> 00:01:10,882 [Dr. Larry] My name is Dr. Larry Melleck. 18 00:01:10,914 --> 00:01:13,254 I’ve been practicing for over 40 years. 19 00:01:13,283 --> 00:01:17,083 Pediatrics, emergency medicine and board certified in all three of those. 20 00:01:17,120 --> 00:01:19,890 What I really love about this job is the stimulation, 21 00:01:19,923 --> 00:01:23,093 like the challenge, I like being at the top of my game. 22 00:01:25,028 --> 00:01:29,608 In my career, I’ve seen just a spectrum of different types of penetrating injuries. 23 00:01:29,633 --> 00:01:32,833 But I think one of the more dramatic ones that I’ve ever seen 24 00:01:32,869 --> 00:01:35,669 was a teenager who presented in the emergency department 25 00:01:35,705 --> 00:01:38,375 with a bike brake handle stuck in her leg. 26 00:01:38,408 --> 00:01:42,318 It was the entire bike brake handle that was buried into her leg. 27 00:01:43,980 --> 00:01:46,780 So, you were riding your bike and you hit a pothole, is that correct? 28 00:01:47,784 --> 00:01:48,954 How old are you? 29 00:01:49,786 --> 00:01:50,656 15? 30 00:01:52,922 --> 00:01:56,722 My name is Jasmine Hay. I’m in the United States Army. 31 00:01:56,760 --> 00:01:59,890 So, I was in Aiken, South Carolina with my friend. 32 00:01:59,929 --> 00:02:03,359 We decided that we were gonna go ride bikes around the neighborhood. 33 00:02:03,400 --> 00:02:05,200 So, she was like, "Oh," you know, "let’s race." 34 00:02:05,235 --> 00:02:06,475 So, I was like, "Okay." 35 00:02:06,503 --> 00:02:09,973 So, we’re racing. She turns off. 36 00:02:10,006 --> 00:02:12,316 So I go to look and like, "Where she at?" 37 00:02:12,342 --> 00:02:14,812 So, I turn around, like, turn my whole body. 38 00:02:14,844 --> 00:02:16,414 And I hit the pothole. 39 00:02:17,580 --> 00:02:18,680 I blackout. 40 00:02:19,349 --> 00:02:20,949 I was like, "Oh, my goodness." 41 00:02:20,984 --> 00:02:24,624 And I see like, half of the bicycle brake 42 00:02:24,654 --> 00:02:26,594 inside of my leg. 43 00:02:26,623 --> 00:02:28,323 There was these people that were out there 44 00:02:28,358 --> 00:02:29,968 and they seen the whole thing. 45 00:02:29,993 --> 00:02:32,433 They’re like, "Oh! That’s deep!" 46 00:02:32,462 --> 00:02:34,492 So, when the ambulance finally come, 47 00:02:34,531 --> 00:02:36,961 they couldn’t take the whole bike to the hospital. 48 00:02:37,000 --> 00:02:40,070 So they got a saw to cut me from the bike. 49 00:02:40,103 --> 00:02:42,503 So, I’m getting burnt from the sparks from the saw. 50 00:02:42,539 --> 00:02:43,769 I’m screaming. 51 00:02:43,807 --> 00:02:46,247 Finally, they got me disconnected from the bike 52 00:02:46,276 --> 00:02:47,776 and put in me in the ambulance. 53 00:02:47,811 --> 00:02:49,511 [sirens blare] 54 00:02:49,546 --> 00:02:51,446 [Jasmine] So, we’re on the highway. 55 00:02:51,481 --> 00:02:53,181 So, I’m feeling every bump. 56 00:02:53,983 --> 00:02:55,183 My leg is like, 57 00:02:55,819 --> 00:02:56,779 it’s throbbing. 58 00:02:59,289 --> 00:03:00,949 [Dr. Larry] I’m just giving her a tourniquet. 59 00:03:00,990 --> 00:03:02,460 - [man 2] Okay. - [Dr. Larry] Just in case we need it. 60 00:03:02,492 --> 00:03:03,762 [man 2] In case it starts to bleed. 61 00:03:03,793 --> 00:03:05,963 [Dr. Larry] I walk in the room and I see Jasmine, 62 00:03:05,995 --> 00:03:08,535 and surprisingly, she’s very calm. 63 00:03:08,565 --> 00:03:11,605 I mean, right here, sartorius just cut on from here... 64 00:03:11,634 --> 00:03:12,834 all the way to there. 65 00:03:12,869 --> 00:03:15,129 That’s gonna be our challenge today, is to get that out. 66 00:03:16,506 --> 00:03:18,276 As I’m looking at this, 67 00:03:18,308 --> 00:03:20,018 what’s racing through my brain here is like, 68 00:03:20,043 --> 00:03:22,013 "That is a long handle, 69 00:03:22,045 --> 00:03:23,685 and that’s buried in her leg. 70 00:03:25,148 --> 00:03:26,888 If I pull that out, 71 00:03:26,916 --> 00:03:31,186 and it’s ruptured a major vein or a major artery, 72 00:03:31,221 --> 00:03:33,821 am I just gonna see a spurt of blood coming out 73 00:03:33,857 --> 00:03:35,297 and she starts to hemorrhage?" 74 00:03:35,325 --> 00:03:38,395 Right under the sartorius is where the SFA lies. 75 00:03:38,428 --> 00:03:41,298 If this goes medially towards it 76 00:03:41,331 --> 00:03:42,831 that could hit the SFA vessel. 77 00:03:42,866 --> 00:03:44,736 It does go laterally, we got an X-ray. 78 00:03:44,768 --> 00:03:46,578 - [man 2] Yeah. - [Dr. Larry] And it shows it’s pretty superficial. 79 00:03:46,603 --> 00:03:48,743 [Jasmine] They’re trying to figure if I need to go to surgery, 80 00:03:48,772 --> 00:03:50,902 they’re trying to figure out if they can just pull it straight out. 81 00:03:50,940 --> 00:03:53,340 They’re trying to figure out all these things because looking at it, 82 00:03:53,376 --> 00:03:54,576 it just looks bad. 83 00:03:55,912 --> 00:03:57,842 I was like, "Well, can y’all put me to sleep?" 84 00:03:57,881 --> 00:04:00,411 He’s like, "No, it’s a possibility you could bleed out." 85 00:04:00,450 --> 00:04:02,550 That’s not what you wanna hear at 15. 86 00:04:02,585 --> 00:04:05,595 [Dr. Larry] Once there’s a foreign body that’s impaled the skin, 87 00:04:05,622 --> 00:04:07,552 the body’s gonna react to that. 88 00:04:07,590 --> 00:04:10,060 Those foreign bodies bring along with them bacteria 89 00:04:10,093 --> 00:04:12,393 that can actually cause serious infections 90 00:04:12,428 --> 00:04:15,358 and bacteria that gets into the bloodstream causes shock. 91 00:04:15,398 --> 00:04:17,598 [Jasmine moaning in pain] 92 00:04:17,634 --> 00:04:19,204 [Dr. Larry] Jasmine’s hurting. 93 00:04:19,235 --> 00:04:23,245 I’ve got my child life specialist who are helping out trying to distract her. 94 00:04:24,908 --> 00:04:26,448 I’m used to managing pain. 95 00:04:26,476 --> 00:04:31,186 But to hear Jasmine crying and frightened just kinds of tears me up inside. 96 00:04:31,214 --> 00:04:32,714 [Jasmine moaning in pain] 97 00:04:32,749 --> 00:04:35,719 Part of the brake handle had actually clamped on to the skin. 98 00:04:35,752 --> 00:04:38,752 [Jasmine] They were pulling my skin along with the brake. 99 00:04:38,788 --> 00:04:40,888 [Jasmine moaning in pain] 100 00:04:40,924 --> 00:04:42,464 And that’s when I started screaming. 101 00:04:42,492 --> 00:04:45,262 - [Jasmine moaning in pain] - [Dr. Larry] It’s caught on the skin there. 102 00:04:45,295 --> 00:04:47,065 I feel everything. 103 00:04:47,096 --> 00:04:49,406 [Dr. Larry] I’m gonna give some lidocaine for the skin. 104 00:04:49,432 --> 00:04:52,432 It’s become obvious we have to deal with the pain. 105 00:04:52,468 --> 00:04:54,628 We had to provide additional anesthesia. 106 00:04:56,139 --> 00:04:59,469 Because of my concerns about the potential damage 107 00:04:59,509 --> 00:05:01,109 that this may have caused, 108 00:05:01,144 --> 00:05:02,884 I consult my colleagues 109 00:05:02,912 --> 00:05:05,452 to have them come and assist with the removal of this foreign body 110 00:05:05,481 --> 00:05:09,151 in the event of some obvious complication as we pull it out. 111 00:05:14,691 --> 00:05:17,221 - There we go. - [woman] Nice and easy. It’s gone. 112 00:05:17,260 --> 00:05:19,660 [Dr. Larry] Once we remove the brake handle and open that up, 113 00:05:19,696 --> 00:05:21,136 it came out very easily. 114 00:05:21,164 --> 00:05:23,364 And then, I just had like, this huge hole 115 00:05:23,833 --> 00:05:24,833 in my leg. 116 00:05:24,868 --> 00:05:26,108 Like, it was big. 117 00:05:26,135 --> 00:05:27,575 [man 2] That didn’t go in the vessels. 118 00:05:27,604 --> 00:05:28,974 [Dr. Larry] Yeah, she is lucky. 119 00:05:30,206 --> 00:05:31,976 Thank you. Good job. 120 00:05:32,008 --> 00:05:33,278 - [man 2] I’m just gonna wash it out. - Yeah. 121 00:05:33,309 --> 00:05:34,469 So we’ll irrigate that. 122 00:05:34,510 --> 00:05:38,280 My goal is, do minimal damage and let her heal quickly. 123 00:05:38,314 --> 00:05:40,514 [Jasmine] I was like, just beyond happy. 124 00:05:40,550 --> 00:05:42,010 Beyond grateful for them. 125 00:05:44,354 --> 00:05:46,694 I’d say it took probably about like, six months 126 00:05:46,723 --> 00:05:49,463 for me to finally like, heal it altogether. 127 00:05:49,492 --> 00:05:52,532 And then, now I just got an indentation on my leg 128 00:05:52,562 --> 00:05:54,832 that everybody asks if I got shot 129 00:05:54,864 --> 00:05:57,764 because it looks like a bullet mark in my leg. 130 00:05:57,800 --> 00:05:58,660 [sighs] So, yeah. 131 00:05:58,701 --> 00:06:00,671 Now, I have not rode a bike since. 132 00:06:00,703 --> 00:06:03,473 I will not touch a bike. Will not look at a bike. 133 00:06:04,040 --> 00:06:04,870 No. 134 00:06:08,912 --> 00:06:12,312 [siren blaring] 135 00:06:12,348 --> 00:06:14,048 My name’s Kayla Shiflett, 136 00:06:14,083 --> 00:06:16,683 and I live in Anniston, Alabama. 137 00:06:16,719 --> 00:06:18,949 So, I was 12 weeks pregnant 138 00:06:18,988 --> 00:06:21,118 and my baby was fine. 139 00:06:21,157 --> 00:06:22,867 I had a okay pregnancy. 140 00:06:22,892 --> 00:06:25,162 And then, I felt some pressure. 141 00:06:25,194 --> 00:06:26,694 And then it got worse and worse. 142 00:06:26,729 --> 00:06:29,799 And then one day, it got so bad 143 00:06:29,832 --> 00:06:33,832 that I was throwing up, it was just so painful. 144 00:06:33,870 --> 00:06:36,640 I really thought that I needed to go to the hospital. 145 00:06:36,673 --> 00:06:38,203 I really thought that I was having a miscarriage, 146 00:06:38,241 --> 00:06:39,741 but I wasn’t bleeding. 147 00:06:39,776 --> 00:06:41,876 When I got to the emergency room, 148 00:06:41,911 --> 00:06:44,381 the pain was so bad that I was laying on the floor. 149 00:06:46,215 --> 00:06:47,585 [man] All right, here we go. 150 00:06:49,552 --> 00:06:51,222 My name is George Crawford. 151 00:06:51,254 --> 00:06:53,994 I am a board certified general surgeon 152 00:06:54,023 --> 00:06:57,023 and I’ve been practicing for 20 years. 153 00:06:57,060 --> 00:07:00,060 After talking to Kayla’s OB, 154 00:07:00,096 --> 00:07:02,406 we decided to get her prepped for surgery. 155 00:07:02,432 --> 00:07:05,362 The biggest concern is, she had appendicitis. 156 00:07:05,401 --> 00:07:08,171 Appendicitis can not only be dangerous to the mother, 157 00:07:08,204 --> 00:07:11,044 it can be dangerous to her unborn child. 158 00:07:11,074 --> 00:07:14,874 You can see on this ultrasound of the child, 159 00:07:14,911 --> 00:07:16,781 that there’s blood flow in the uterus, 160 00:07:16,813 --> 00:07:18,713 there’s blood flow outside the uterus. 161 00:07:18,748 --> 00:07:21,418 So, it looks like the baby is fine. 162 00:07:21,451 --> 00:07:23,781 What we are now thinking is 163 00:07:23,820 --> 00:07:26,290 if this is either the appendix, 164 00:07:26,322 --> 00:07:29,692 or something going on with the ovary. 165 00:07:29,726 --> 00:07:31,896 [Kayla] It was really scary because my doctor said, 166 00:07:31,928 --> 00:07:35,238 "We really gotta do this quickly because if your appendix ruptures, 167 00:07:35,264 --> 00:07:37,264 it’s your life and your baby’s life." 168 00:07:39,002 --> 00:07:41,702 So in her situation, it was deemed an emergency. 169 00:07:41,738 --> 00:07:44,078 So, instead of meeting her in the emergency room, 170 00:07:44,107 --> 00:07:45,917 she was asleep in the operating room. 171 00:07:45,942 --> 00:07:48,942 And five minutes later, we were getting her taken care of. 172 00:07:48,978 --> 00:07:50,608 - Grasper, please. - [nurse] Yes, sir. 173 00:07:50,646 --> 00:07:53,656 [Dr. George] Is this an ovarian problem or is this appendicitis? 174 00:07:53,683 --> 00:07:58,123 Appendicitis is the most common non-obstetrical surgery 175 00:07:58,154 --> 00:07:59,994 that we see in pregnant women. 176 00:08:01,257 --> 00:08:02,497 All right. Let’s get it done. 177 00:08:08,798 --> 00:08:09,838 There we go. 178 00:08:12,602 --> 00:08:14,502 So, stuck my scopes in, 179 00:08:14,537 --> 00:08:16,077 start looking around. 180 00:08:16,105 --> 00:08:18,775 And it’s obviously not her appendix. 181 00:08:18,808 --> 00:08:20,918 Her appendix is normal. It’s kind of flopping right there. It’s like, 182 00:08:20,943 --> 00:08:23,183 "Hey," waving at you, "it’s not me, it’s somebody else." 183 00:08:25,782 --> 00:08:28,012 Oh, what is that? 184 00:08:28,051 --> 00:08:30,681 But off to the side, you see this huge mass. 185 00:08:30,720 --> 00:08:33,450 Something’s going on, and we have to figure it out. 186 00:08:34,323 --> 00:08:35,393 Oh, wow. 187 00:08:35,425 --> 00:08:37,695 So this is a real bigger problem than I thought. 188 00:08:56,846 --> 00:09:00,056 [Dr. George] Oh, what is that? 189 00:09:00,083 --> 00:09:02,583 Kayla comes in with right lower quadrant abdominal pain. 190 00:09:02,618 --> 00:09:04,278 We take her to the operating room 191 00:09:04,320 --> 00:09:06,290 expecting to find appendicitis, 192 00:09:06,322 --> 00:09:08,652 and we find something completely different. 193 00:09:11,260 --> 00:09:13,390 When we get in there, we find something stuck 194 00:09:13,429 --> 00:09:15,559 on her abdominal wall on that right side. 195 00:09:15,598 --> 00:09:18,128 There’s really not supposed to be anything over there. 196 00:09:18,167 --> 00:09:19,507 We gotta get it out. 197 00:09:19,535 --> 00:09:22,175 It looks like she’s probably gonna have what’s called a teratoma. 198 00:09:24,640 --> 00:09:27,140 A teratoma is just one of these cells 199 00:09:27,176 --> 00:09:29,916 that had gotten stuck in the ovary, and over time, 200 00:09:29,946 --> 00:09:32,086 it’s slowly grown with the patient. 201 00:09:32,115 --> 00:09:35,415 The reason she’s having pain is because it’s just twisted a little bit 202 00:09:35,451 --> 00:09:37,681 and it didn’t have a good blood supply. 203 00:09:37,720 --> 00:09:40,420 The appendix looks normal so I know that’s not the problem. 204 00:09:40,456 --> 00:09:43,126 But kind of out of the side of my eye, I see 205 00:09:43,159 --> 00:09:45,189 the ovary is big and purple. 206 00:09:45,228 --> 00:09:46,998 And it’s not supposed to be that color. 207 00:09:47,029 --> 00:09:49,459 So, I know that that’s a problem. 208 00:09:49,499 --> 00:09:51,929 This thing doesn’t have natural blood supply. 209 00:09:51,968 --> 00:09:55,508 So, that death of tissue is what causes pain. 210 00:09:55,538 --> 00:09:57,648 And then we end up having to take it out. 211 00:09:57,673 --> 00:10:00,973 The mass was so big that it twisted the ovary 212 00:10:01,010 --> 00:10:03,180 and she was losing blood supply to it. 213 00:10:03,212 --> 00:10:04,982 So, that’s why she was having the pain 214 00:10:05,014 --> 00:10:07,114 because she’s not having blood supply to her ovary. 215 00:10:07,150 --> 00:10:10,650 And I know that it’s something that we have to take out at this time, 216 00:10:10,686 --> 00:10:14,456 because if you wait, the ovary dies, 217 00:10:14,490 --> 00:10:16,190 she can get septic from that, 218 00:10:16,225 --> 00:10:17,425 and then the baby dies. 219 00:10:17,460 --> 00:10:21,330 So, now I gotta figure out how to take the teratoma out 220 00:10:21,364 --> 00:10:23,764 without injuring the baby. 221 00:10:25,501 --> 00:10:27,071 There we go. 222 00:10:27,103 --> 00:10:29,173 Brenda, make sure they get suction set up, please. 223 00:10:35,578 --> 00:10:37,518 As soon as I open it up, 224 00:10:37,547 --> 00:10:40,587 you can see a lot of the fluid starting to leak out. 225 00:10:40,616 --> 00:10:42,826 It’s not toxic, it’s not infected. 226 00:10:42,852 --> 00:10:44,922 So, we’re not worried about her getting sick from it. 227 00:10:44,954 --> 00:10:48,754 But what we will do is make sure we get as much as we can suctioned out. 228 00:10:48,791 --> 00:10:50,761 A teratoma is a tumor 229 00:10:50,793 --> 00:10:53,493 that can have anything in it. 230 00:10:53,529 --> 00:10:56,699 When we say ’anything’, it can have bone, hair, 231 00:10:56,732 --> 00:10:58,262 skin, teeth. 232 00:10:58,301 --> 00:11:01,971 It can have functioning organs or part of functioning organs. 233 00:11:08,277 --> 00:11:11,687 We have to get all of the content 234 00:11:11,714 --> 00:11:14,014 from the teratoma suctioned out of her 235 00:11:14,050 --> 00:11:16,420 because if we leave something in, 236 00:11:16,452 --> 00:11:18,022 then the mother can get sick, 237 00:11:18,054 --> 00:11:20,054 and then, the baby gets threatened, 238 00:11:20,089 --> 00:11:21,819 and it’s not a successful operation. 239 00:11:24,060 --> 00:11:27,430 So we’ll suction out the content, put it in a bag, 240 00:11:27,463 --> 00:11:30,503 and hopefully be able to squeeze it out through one of these incisions. 241 00:11:31,834 --> 00:11:33,974 And what it looks like, 242 00:11:34,003 --> 00:11:36,803 is she’s gonna have a little bit of hair in here, 243 00:11:36,839 --> 00:11:38,539 and maybe a little bit of bone. 244 00:11:38,574 --> 00:11:40,444 Because I can feel something hard. 245 00:11:42,245 --> 00:11:44,415 Now, when I’m taking it out, I do make a hole in it, 246 00:11:44,447 --> 00:11:46,457 and you can see hair sticking out of it. 247 00:11:46,482 --> 00:11:48,582 So, once you see the hair sticking out of the mass, 248 00:11:48,618 --> 00:11:49,828 you know it’s a teratoma. 249 00:11:57,860 --> 00:11:59,890 So what we’re trying to do now 250 00:11:59,929 --> 00:12:02,799 is just peel the teratoma 251 00:12:02,832 --> 00:12:05,162 away from her normal ovary. 252 00:12:10,339 --> 00:12:12,639 What this does is gives her the opportunity 253 00:12:12,675 --> 00:12:15,315 to have a successful pregnancy 254 00:12:15,344 --> 00:12:16,644 after this child. 255 00:12:17,847 --> 00:12:20,587 So hopefully, we can get all this stuff out 256 00:12:20,616 --> 00:12:22,656 and it just makes it easier for her in the future. 257 00:12:23,653 --> 00:12:25,383 There we go. It’s coming apart now. 258 00:12:27,690 --> 00:12:31,460 Okay, so I’mma go ahead and suction out all of this fluid content, 259 00:12:31,494 --> 00:12:34,194 get all of this tissue in the bag. 260 00:12:34,230 --> 00:12:37,730 And hopefully, I’ll be able to get it out through one of these incisions. 261 00:12:53,749 --> 00:12:54,579 There we go. 262 00:13:01,524 --> 00:13:02,864 That’ll be it. 263 00:13:02,892 --> 00:13:05,392 We’re able to get it out through a pretty small incision. 264 00:13:06,262 --> 00:13:07,492 All right, let’s see. 265 00:13:07,530 --> 00:13:08,690 Put it in here. 266 00:13:08,731 --> 00:13:10,531 And some pickups. 267 00:13:10,566 --> 00:13:12,506 All right, guys. I think we’re done here. 268 00:13:12,535 --> 00:13:14,105 Looks like there’s no bleeding. 269 00:13:15,204 --> 00:13:19,144 You can have anything in a teratoma. 270 00:13:19,175 --> 00:13:21,245 So, it’s kind of like a present when you find one, 271 00:13:21,277 --> 00:13:22,987 because the first thing you wanna do 272 00:13:23,012 --> 00:13:25,482 is open it up and see what’s in it. 273 00:13:25,514 --> 00:13:27,914 So, when I open it up, I was like, "Oh? 274 00:13:27,950 --> 00:13:30,420 Okay, that’s a tooth." 275 00:13:30,453 --> 00:13:33,193 And then, there was another tooth. And there was bone. 276 00:13:33,222 --> 00:13:36,392 And it was just kind of like, "Okay. So this is a real teratoma." 277 00:13:36,425 --> 00:13:39,265 This was kind of the one we read about in medical textbooks. 278 00:13:39,295 --> 00:13:40,565 Oh, it’s pretty cool. 279 00:13:40,596 --> 00:13:43,436 There’s also a little bit of hair in it. 280 00:13:43,466 --> 00:13:46,236 But this one’s pretty cool ’cause you don’t see them too often, 281 00:13:46,268 --> 00:13:47,498 with a tooth. 282 00:13:47,536 --> 00:13:50,506 And you can see that’s firmly attached to this hair, 283 00:13:50,539 --> 00:13:51,939 where it’s not coming off. 284 00:13:51,974 --> 00:13:53,574 That one actually has ridges. 285 00:13:53,609 --> 00:13:55,609 So, it has roots and everything. 286 00:13:55,644 --> 00:13:56,914 So, that is one good tooth. 287 00:13:56,946 --> 00:13:58,386 And there’s some other. 288 00:13:58,414 --> 00:14:00,384 There is like molar or something back here. 289 00:14:00,416 --> 00:14:02,386 One of them is actually stuck in the jaw. 290 00:14:02,418 --> 00:14:04,428 I didn’t expect to find a teratoma. 291 00:14:04,453 --> 00:14:07,523 What I was thinking that we would find is an appendicitis. 292 00:14:07,556 --> 00:14:09,026 But in this case, 293 00:14:09,058 --> 00:14:10,928 I pulled teeth out of some lady’s belly. 294 00:14:10,960 --> 00:14:12,360 So, it was actually pretty cool. 295 00:14:12,395 --> 00:14:14,195 Teeth? Ugh, gross. 296 00:14:14,230 --> 00:14:15,160 It was so gross. 297 00:14:15,197 --> 00:14:17,137 So, like, my first impression was that, 298 00:14:17,166 --> 00:14:20,106 "Okay, was that like, a baby that didn’t form right?" 299 00:14:20,136 --> 00:14:21,476 Or like, what happened? 300 00:14:21,504 --> 00:14:24,074 But Dr. Crawford actually explained it to me 301 00:14:24,106 --> 00:14:27,376 that like, really just like, one of my eggs just went haywire 302 00:14:27,410 --> 00:14:31,280 and formed this teratoma, just started making baby parts. 303 00:14:31,313 --> 00:14:33,783 [Dr. George] Initially when she came into the emergency room, 304 00:14:33,816 --> 00:14:35,956 he was worried that she was having a miscarriage. 305 00:14:35,985 --> 00:14:38,625 It works out that she wasn’t, which is fantastic. 306 00:14:38,654 --> 00:14:40,794 And this child can go on to grow 307 00:14:40,823 --> 00:14:44,463 without any problems, and hopefully, she’ll have a healthy, safe delivery. 308 00:14:44,493 --> 00:14:47,393 I’m glad that we got this out of her and it’s not stuck in there anymore. 309 00:14:47,430 --> 00:14:48,290 She should be good. 310 00:14:50,933 --> 00:14:54,103 [assistant] I had a lady who apparently had a fake nail in her ear. 311 00:14:54,136 --> 00:14:57,976 If she moves, there’s potential to damage her ear. 312 00:14:58,007 --> 00:14:59,617 - Sorry. - [woman moans] 313 00:14:59,642 --> 00:15:02,342 [assistant] I think we’ve all played Operation when we were little kids. 314 00:15:02,378 --> 00:15:03,988 You know, when it get that buzzer going... 315 00:15:04,013 --> 00:15:05,083 [woman winces] 316 00:15:05,114 --> 00:15:06,954 [assistant] ...the intensity that that evoked. 317 00:15:06,982 --> 00:15:08,582 And that’s not even real. 318 00:15:08,617 --> 00:15:10,157 [woman] Ah, did you get it? 319 00:15:30,039 --> 00:15:31,869 [phone rings] 320 00:15:31,907 --> 00:15:33,317 [Crystal] Hey, this is Crystal Gay. 321 00:15:33,342 --> 00:15:36,112 I’ll get that prescription sent into your pharmacy. 322 00:15:36,145 --> 00:15:38,385 I’m Crystal Gay. I’m a physician assistant 323 00:15:38,414 --> 00:15:40,984 at Ear, Nose and Throat Institute in Atlanta, Georgia. 324 00:15:41,016 --> 00:15:43,856 The PA is pretty much the backbone of the operation. 325 00:15:43,886 --> 00:15:46,026 We see patients just like they do, 326 00:15:46,055 --> 00:15:48,625 um, treat just like they do, prescriptions. 327 00:15:48,657 --> 00:15:51,667 I communicate very well with my patients and, 328 00:15:51,694 --> 00:15:53,564 I mean, they know a lot about me and I just... 329 00:15:53,596 --> 00:15:54,866 I’m an open book to them. 330 00:15:54,897 --> 00:15:57,737 And if they have something I’ve had, I relate that to them. 331 00:15:57,766 --> 00:16:00,906 So, if they’re happy with their visit, now, that just makes your day. 332 00:16:00,936 --> 00:16:03,206 All right. Thank you. Have a good weekend. Bye. 333 00:16:05,374 --> 00:16:07,074 So, we have a patient coming in 334 00:16:07,109 --> 00:16:10,209 that apparently has a nail in her ear. 335 00:16:10,246 --> 00:16:12,986 I don’t know what kind of nail, I don’t know how long it’s been in there, 336 00:16:13,015 --> 00:16:14,555 I don’t know how it got in there. 337 00:16:15,518 --> 00:16:17,058 So, we’ll see. 338 00:16:17,086 --> 00:16:18,556 - Hi! - [patient] Hi. 339 00:16:18,587 --> 00:16:20,557 - [Crystal] How are you today? - Good. 340 00:16:20,589 --> 00:16:23,419 So, tell me what’s going on? What brings you in to see us today? 341 00:16:23,459 --> 00:16:27,429 Yesterday, I was trying to scratch my ear with this little finger of mine... 342 00:16:27,463 --> 00:16:28,293 Mm-hm. 343 00:16:29,865 --> 00:16:32,835 part of a nail, half of it, like, a little bit of it, 344 00:16:32,868 --> 00:16:34,068 - went inside my ear. - Okay. 345 00:16:34,103 --> 00:16:36,003 And did you try to get it out yourself? 346 00:16:36,038 --> 00:16:37,198 I did try. 347 00:16:37,239 --> 00:16:40,339 At night, I put some oil and slept on the same side. 348 00:16:40,376 --> 00:16:42,016 - [Crystal] Mmm-hmm. - But I don’t think it came out. 349 00:16:42,044 --> 00:16:44,214 Okay, is it hurting or does it feel full? 350 00:16:44,246 --> 00:16:46,056 It feels kind of a little full 351 00:16:46,081 --> 00:16:48,781 and I can tell there’s something going on in my ear. Like... 352 00:16:48,817 --> 00:16:51,557 [Crystal] Okay. Well, let’s take a look. 353 00:16:51,587 --> 00:16:54,227 I actually don’t think I’ve seen a fingernail before. 354 00:16:54,256 --> 00:16:56,866 I mean, it makes sense if you’re scratching your ear and you have 355 00:16:56,892 --> 00:16:59,762 the fake nails that it can come off and pop off 356 00:16:59,795 --> 00:17:01,135 in your ear if you’re really getting at it. 357 00:17:01,163 --> 00:17:02,063 Yep. 358 00:17:02,665 --> 00:17:04,435 I can see it’s in there. 359 00:17:04,466 --> 00:17:06,036 It doesn’t look like a fingernail, 360 00:17:06,068 --> 00:17:07,268 but you can definitely see it. 361 00:17:07,303 --> 00:17:09,233 Let me see if I can see it on my other camera 362 00:17:09,271 --> 00:17:10,641 so you can see it too. 363 00:17:23,285 --> 00:17:24,385 [Crystal] Okay. 364 00:17:24,420 --> 00:17:26,590 - [Mary] Can you see it? - [Crystal] Yeah. 365 00:17:26,622 --> 00:17:29,052 I called my friend, she’s like, "Oh, when you go home, 366 00:17:29,091 --> 00:17:31,561 just put oil and sleep on the same side." 367 00:17:31,594 --> 00:17:33,094 [Crystal] Okay, look in the phone. 368 00:17:33,128 --> 00:17:36,428 So, I slept on the same side. But you know how when you’re in a deep sleep, 369 00:17:36,465 --> 00:17:40,635 I think I must’ve turned on the other side and it went way deep inside. 370 00:17:40,669 --> 00:17:41,969 [Crystal] Yeah, you can see it. 371 00:17:42,004 --> 00:17:43,844 It’s taken up the whole ear canal. 372 00:17:43,872 --> 00:17:45,502 It’s like a tongue. 373 00:17:45,541 --> 00:17:48,011 So, to remove foreign objects, 374 00:17:48,043 --> 00:17:50,143 most of the time we use an operating microscope. 375 00:17:50,179 --> 00:17:52,849 And we can use forceps, 376 00:17:52,881 --> 00:17:54,451 we can irrigate some things, 377 00:17:54,483 --> 00:17:55,913 and then, we have suction. 378 00:17:55,951 --> 00:17:59,591 So we can suction pus, or a foreign body, 379 00:17:59,622 --> 00:18:00,852 or wax out of the ears. 380 00:18:05,628 --> 00:18:09,668 - It’s gonna be a little tender coming out. - [winces in pain] 381 00:18:10,899 --> 00:18:13,669 So, I have to really concentrate at this point. 382 00:18:13,702 --> 00:18:17,972 And be intentional about every decision that I make. 383 00:18:18,007 --> 00:18:19,007 If she moves, 384 00:18:19,575 --> 00:18:21,015 flinches, coughs, 385 00:18:21,043 --> 00:18:23,513 even just... just jerks a little bit, 386 00:18:23,545 --> 00:18:26,155 there’s potential to damage her ear, 387 00:18:26,181 --> 00:18:28,111 scratch the ear canal and then it bleeds. 388 00:18:28,150 --> 00:18:30,020 And the ear canal bleeds like crazy. 389 00:18:30,052 --> 00:18:32,682 There’s potential to perforate her eardrum, 390 00:18:32,721 --> 00:18:34,551 which also hurts and bleeds. 391 00:18:34,590 --> 00:18:36,660 [wincing] 392 00:18:36,692 --> 00:18:38,792 - Ah! - [Crystal] Sorry. 393 00:18:38,827 --> 00:18:41,497 I think we’ve all played Operation when we were little kids 394 00:18:41,530 --> 00:18:44,030 and the intensity that that evoked... 395 00:18:44,066 --> 00:18:45,136 [groans] 396 00:18:45,167 --> 00:18:47,907 ...you know, you don’t wanna get that buzzer going. 397 00:18:47,936 --> 00:18:49,746 And that’s not even real, 398 00:18:49,772 --> 00:18:51,302 and you’re, you know, stressed out about it. 399 00:18:51,340 --> 00:18:53,910 So, this is much bigger scale. 400 00:18:53,942 --> 00:18:55,012 Very serious. 401 00:18:55,044 --> 00:18:57,914 - Okay. Almost got it. - [Mary wincing] 402 00:18:58,547 --> 00:19:00,017 You didn’t get it? 403 00:19:00,049 --> 00:19:02,079 [Crystal] Well, yeah. It came closer to me, 404 00:19:02,117 --> 00:19:03,457 - but I gotta grab it. - [groans] 405 00:19:04,920 --> 00:19:07,990 So, I would try to grab it and I had a really good hold of it, 406 00:19:08,023 --> 00:19:09,323 and I thought it was gonna come out. 407 00:19:09,358 --> 00:19:10,728 But then, it wouldn’t come out. 408 00:19:10,759 --> 00:19:13,659 The lacquer that was actually on top of the nail, 409 00:19:13,696 --> 00:19:15,766 when I grabbed it, it was just going through that lacquer. 410 00:19:15,798 --> 00:19:17,168 So, it was like just pinching it, 411 00:19:17,199 --> 00:19:18,459 it wasn’t grabbing it. 412 00:19:19,868 --> 00:19:22,728 - Oof! - Think if you can turn your head this way right there. 413 00:19:22,771 --> 00:19:24,841 - [Mary sighs] Did you get it? - [Crystal] Not yet. 414 00:19:24,873 --> 00:19:26,873 [Mary groaning] 415 00:19:28,410 --> 00:19:29,740 [Crystal] It’s really... 416 00:19:29,778 --> 00:19:33,178 - Did you get it? - [chuckles] No, I’ll let you know when I get it. 417 00:19:33,215 --> 00:19:36,555 It’s really stuck in there. You went pretty deep. 418 00:19:36,585 --> 00:19:38,385 The ear canal is super sensitive. 419 00:19:38,420 --> 00:19:40,120 I’m just gonna take a look. 420 00:19:40,155 --> 00:19:43,225 And if you touch it, it’s easy to bleed. 421 00:19:43,258 --> 00:19:44,618 [Mary] Is it even moving? 422 00:19:44,660 --> 00:19:45,860 [Crystal] Yeah, I can grab it. 423 00:19:45,894 --> 00:19:48,294 It’s just not wanting to come out because it’s stuck. 424 00:19:48,330 --> 00:19:51,060 You have to be very careful because if you scrape it or scratch it, 425 00:19:51,100 --> 00:19:52,430 it’s gonna hurt. 426 00:19:52,468 --> 00:19:55,738 And then people are gonna jerk and that’s... You don’t want that. 427 00:19:55,771 --> 00:19:58,441 The only thinking that I do that makes adults cry is 428 00:19:58,474 --> 00:20:00,544 really anything that has to do with the ear canal. 429 00:20:00,576 --> 00:20:02,946 - [Mary] Did you get it? - [Crystal] No. 430 00:20:02,978 --> 00:20:06,108 So, I’m trying to get a better view. 431 00:20:11,353 --> 00:20:14,493 Okay. I think I know what it’s doing here. 432 00:20:15,524 --> 00:20:16,964 Gosh. 433 00:20:16,992 --> 00:20:18,692 - [sighs] - [Tori] You okay, Mary? 434 00:20:20,295 --> 00:20:21,495 [Crystal] Oh, come on. 435 00:20:21,530 --> 00:20:23,330 - [Mary winces] - [Crystal sighs] 436 00:20:23,365 --> 00:20:24,705 You don’t have any, um... 437 00:20:26,268 --> 00:20:30,438 You just feel like some drum’s hitting your ears. 438 00:20:30,472 --> 00:20:33,472 [Crystal] The alligator’s literally just eating through the nail. 439 00:20:33,509 --> 00:20:35,709 It’s like cutting through it. 440 00:20:38,380 --> 00:20:39,310 [Crystal] Yeah. 441 00:20:40,215 --> 00:20:41,785 Or Cetacaine, whatever we have. 442 00:20:45,721 --> 00:20:48,121 [Crystal] If I’m not able to get this thing out, 443 00:20:48,157 --> 00:20:50,527 then it’s gonna be inflamed, it’s gonna get worse. 444 00:20:50,559 --> 00:20:53,489 We’re gonna have to, most likely, get her into the operating room and remove it, 445 00:20:53,529 --> 00:20:57,359 uh, surgically. Which, I’m really hoping we don’t have to go that route today. 446 00:20:59,535 --> 00:21:01,035 All right. Little spray, okay? 447 00:21:02,204 --> 00:21:04,944 It’s a numbing agent. But it’s pretty strong. 448 00:21:04,973 --> 00:21:06,773 It works pretty quick too. 449 00:21:06,809 --> 00:21:08,369 Okay, I’m not trying to pull it out. 450 00:21:08,410 --> 00:21:10,910 I’m just looking and seeing if I can move it around a little bit. 451 00:21:16,351 --> 00:21:18,321 Can you tell if it’s numbed up a little? 452 00:21:18,353 --> 00:21:20,853 [Mary] Whatever you’re using, it’s not gripping it. 453 00:21:20,889 --> 00:21:23,889 [Crystal] No, I’m not trying to grip it, I’m trying to move it. 454 00:21:23,926 --> 00:21:25,896 It looks like it’s loose. It looks like it wants to just 455 00:21:25,928 --> 00:21:28,168 be grabbed and brought out. 456 00:21:28,197 --> 00:21:29,967 So, I tried twisting it around. 457 00:21:29,998 --> 00:21:32,028 And twisted it and it started to come out. 458 00:21:33,569 --> 00:21:35,169 [clears throat] 459 00:21:35,204 --> 00:21:37,304 I was getting really excited and then it stopped again. 460 00:21:37,339 --> 00:21:38,399 Okay. Forceps. 461 00:21:46,849 --> 00:21:49,879 It was nerve-racking for a little bit. It was really stuck. 462 00:21:55,390 --> 00:21:56,220 Got it. 463 00:21:57,125 --> 00:21:58,765 [sighs] Oh, gosh. 464 00:21:58,794 --> 00:22:00,694 [Crystal] So, I had to move it around so I could get 465 00:22:00,729 --> 00:22:02,689 more of the actual nail. 466 00:22:02,731 --> 00:22:05,431 And pull it and twist it around and pull it out. 467 00:22:05,467 --> 00:22:07,337 So that was a little painful but um, 468 00:22:07,369 --> 00:22:09,429 the ear canal is super duper tender. 469 00:22:10,739 --> 00:22:11,599 [Mary] Yeah, but... 470 00:22:13,542 --> 00:22:14,372 [Mary] Yeah. 471 00:22:19,114 --> 00:22:22,414 [Crystal] You can see the, um, eardrum now, like... 472 00:22:22,451 --> 00:22:25,181 so you can tell the difference in what you were looking at before and now. 473 00:22:25,220 --> 00:22:26,280 [Mary sighs] Oh, Jesus. 474 00:22:26,321 --> 00:22:28,051 Will I put the nails again? 475 00:22:28,090 --> 00:22:30,690 [all laugh] 476 00:22:30,726 --> 00:22:33,436 [Mary] I can’t believe it. It happened so quick. 477 00:22:33,462 --> 00:22:36,432 [Crystal] It was really stuck in there. I thought it would be a lot easier. 478 00:22:36,465 --> 00:22:38,805 I don’t know if I need to keep this or just trash it. 479 00:22:38,834 --> 00:22:40,074 [Crystal and Tori laugh] 480 00:22:40,102 --> 00:22:42,032 I know, it’s a souvenir. Do you want to keep the souvenir? 481 00:22:42,070 --> 00:22:42,900 [Mary] No. 482 00:22:50,979 --> 00:22:53,779 - Thank you so much. You saved my life. - [Crystal] You’re welcome. 483 00:22:53,815 --> 00:22:55,485 - You’re welcome. - [Mary] Thanks. 484 00:22:55,517 --> 00:22:57,487 Somebody is really happy, it makes me really happy 485 00:22:57,519 --> 00:22:59,119 because that’s what we’re here for. 486 00:22:59,154 --> 00:23:02,654 You don’t wanna go to work and not feel like you’ve helped anybody all day long. 487 00:23:02,691 --> 00:23:04,621 - [Mary] Thank you so much. - [Crystal] You’re welcome. 488 00:23:10,999 --> 00:23:13,329 [Dr. George] You know, the nice part about general surgery is 489 00:23:13,368 --> 00:23:15,268 it’s always full of surprises. 490 00:23:15,304 --> 00:23:19,244 I remember a case where I treated a lady that had been 491 00:23:19,274 --> 00:23:21,944 involved in a accident 15 years earlier 492 00:23:21,977 --> 00:23:24,017 and she had a bullet stuck in her back. 493 00:23:38,694 --> 00:23:41,534 My name is Erica Miles and I’m a certified nursing assistant. 494 00:23:42,030 --> 00:23:44,600 Um, back in 2005, 495 00:23:44,633 --> 00:23:47,373 when I was in high school, after a football game, 496 00:23:47,402 --> 00:23:49,632 my friends and I were waiting on our rides. 497 00:23:49,671 --> 00:23:52,371 And we end up being innocent bystanders 498 00:23:52,407 --> 00:23:55,477 caught in the middle of two groups of people shooting at each other. 499 00:23:59,348 --> 00:24:01,288 I end up getting shot in the back. 500 00:24:01,316 --> 00:24:03,186 I felt the burning sensation. 501 00:24:03,218 --> 00:24:05,848 They said that it was too close to my spine at the time. 502 00:24:05,887 --> 00:24:07,957 And they didn’t wanna take it out. 503 00:24:07,990 --> 00:24:11,290 [Dr. George] As long as it’s not in a vessel or a joint, 504 00:24:11,326 --> 00:24:13,236 we usually leave them alone and take them out when they 505 00:24:13,261 --> 00:24:15,161 either cause pain or discomfort. 506 00:24:15,197 --> 00:24:17,307 People get shot all the time and we never remove bullets. 507 00:24:17,332 --> 00:24:18,502 That’s kind of a TV thing. 508 00:24:18,533 --> 00:24:20,303 We leave all bullets in, 509 00:24:20,335 --> 00:24:23,345 unless they are stuck in a vessel or a joint. 510 00:24:23,372 --> 00:24:27,372 The reason why is, we usually will cause a bigger problem 511 00:24:27,409 --> 00:24:29,139 going in to get it. 512 00:24:29,177 --> 00:24:31,817 The body will get rid of it on its own, 513 00:24:31,847 --> 00:24:33,887 the majority of the time. 514 00:24:33,915 --> 00:24:36,215 The problem is, when it gets to the surface, 515 00:24:36,251 --> 00:24:37,921 that’s when it starts to cause pain. 516 00:24:39,254 --> 00:24:40,694 In her, 517 00:24:40,722 --> 00:24:43,522 this started causing significant amount of pain. 518 00:24:44,459 --> 00:24:46,219 So we decided to take it out. 519 00:24:47,596 --> 00:24:50,066 I never felt it moving throughout the years 520 00:24:50,098 --> 00:24:51,658 in my back. Um... 521 00:24:51,700 --> 00:24:54,330 Never thought about it. It never bothered me 522 00:24:54,369 --> 00:24:58,169 until the night I felt it on the surface of my skin 523 00:24:58,206 --> 00:24:59,706 and I knew that’s what it was. 524 00:24:59,741 --> 00:25:03,381 I was actually scared ’cause I knew that shouldn’t have been in that place, 525 00:25:03,412 --> 00:25:05,442 it was at the top portion of my back, 526 00:25:05,480 --> 00:25:07,710 and it moved down to the lower portion. 527 00:25:07,749 --> 00:25:09,179 So I was scared. 528 00:25:09,217 --> 00:25:12,887 [Dr. George] Once you cut it open, you can see the cavity already here. 529 00:25:12,921 --> 00:25:15,091 Because they body’s been trying to get rid of it. 530 00:25:15,123 --> 00:25:18,693 Over my entire career, I’ve probably seen 531 00:25:18,727 --> 00:25:21,797 maybe 300-500 gunshot wounds. 532 00:25:21,830 --> 00:25:24,230 And of those, the strangest one 533 00:25:24,266 --> 00:25:26,066 was a gentlemen that got shot in the head. 534 00:25:26,101 --> 00:25:29,101 He had a bullet in the middle of his brain 535 00:25:29,137 --> 00:25:32,647 and had a little bit of blood leaking out of the hole. 536 00:25:32,674 --> 00:25:35,114 We were trying to decide when we were taking him to the operating room, 537 00:25:35,143 --> 00:25:37,583 do an emergency craniotomy, all this other stuff. 538 00:25:37,612 --> 00:25:39,482 And over the next couple of hours, 539 00:25:39,514 --> 00:25:41,314 he woke up, he was doing fine. 540 00:25:41,349 --> 00:25:42,179 So we left it. 541 00:25:42,851 --> 00:25:43,681 So... 542 00:25:45,087 --> 00:25:46,157 That’s it. 543 00:25:48,356 --> 00:25:49,896 That’s a bullet extraction. 544 00:25:49,925 --> 00:25:51,895 Looks more like a 9... 545 00:25:51,927 --> 00:25:55,137 Not anything big like a .40 caliber. 546 00:25:55,163 --> 00:25:58,763 - Unlike the movies, we don’t have... - [woman] Mmm-hmm. 547 00:25:58,800 --> 00:25:59,860 [Dr. George] Um... 548 00:26:00,769 --> 00:26:02,329 a metal basin to drop it in. 549 00:26:06,274 --> 00:26:08,744 - [chuckling] That has the same effect. - [woman chuckling] 550 00:26:08,777 --> 00:26:10,117 [Dr. George] But yeah. That’s a bullet. 551 00:26:12,547 --> 00:26:14,657 After the surgery, the recovery was fine. 552 00:26:14,683 --> 00:26:17,483 Um, I didn’t have any issues or concerns. 553 00:26:17,519 --> 00:26:19,149 I healed like normal. 554 00:26:19,721 --> 00:26:21,151 I was okay. 555 00:26:21,189 --> 00:26:23,659 [Dr. George] So, what we are gonna do, we’re gonna put one stitch in it, 556 00:26:23,692 --> 00:26:25,922 just to help the healing process. 557 00:26:25,961 --> 00:26:28,791 But as far as closing the hole up, 558 00:26:28,830 --> 00:26:31,100 we traditionally just let them close up on their own. 559 00:26:31,133 --> 00:26:32,003 You have like, a... 560 00:26:33,201 --> 00:26:34,401 small stitch maybe. 561 00:26:39,841 --> 00:26:41,871 I’m so grateful for Dr. Crawford. 562 00:26:41,910 --> 00:26:44,680 I’m just glad that I wasn’t in any pain 563 00:26:44,713 --> 00:26:46,753 and I’m just glad that the bullet was out of my back. 564 00:26:49,417 --> 00:26:51,857 Like, I start coughing and stuff because I’ll start gagging on something. 565 00:26:51,887 --> 00:26:55,297 And these little white things kept coming out. Like, hard balls. 566 00:26:55,323 --> 00:26:57,323 They smell like Sulphur and like, just ick. 567 00:26:57,359 --> 00:26:58,819 [PA] All right. Let’ see these things. 568 00:26:58,860 --> 00:27:02,830 - They look... - [gagging] Sorry. [chuckles] 569 00:27:02,864 --> 00:27:05,904 Ear wax and the removal of ear wax is an art form. 570 00:27:05,934 --> 00:27:07,204 Got a little wax in there. 571 00:27:07,235 --> 00:27:08,905 Not all wax is the same. 572 00:27:08,937 --> 00:27:10,877 [PA 2] There we go. Look at that! 573 00:27:10,906 --> 00:27:12,046 My head feels lighter. 574 00:27:12,073 --> 00:27:13,873 [Crystal] It can be like, that long. 575 00:27:13,909 --> 00:27:17,439 [woman] Walk around like I’m cute and that is just like, ew. 576 00:27:32,260 --> 00:27:34,430 [assistant] You can have a seat right here and then... 577 00:27:34,462 --> 00:27:37,062 I’m Destiny Moon. My tonsils are like, 578 00:27:37,098 --> 00:27:39,228 a bajillion sizes bigger than they should be. 579 00:27:39,267 --> 00:27:41,407 And I have a super bad gag reflex. 580 00:27:41,436 --> 00:27:43,746 Like, I start coughing and stuff because I’ll start gagging on something, 581 00:27:43,772 --> 00:27:45,872 and these little white things kept coming out. 582 00:27:45,907 --> 00:27:47,647 Like, hard balls. 583 00:27:47,676 --> 00:27:49,776 They smell like Sulphur and like, just ick. 584 00:27:49,811 --> 00:27:52,711 So, I was googling it and found out that they were tonsil stones. 585 00:27:52,747 --> 00:27:55,917 The most I’ve ever had come out of my throat was like, 15-ish. 586 00:27:55,951 --> 00:27:58,621 I don’t know if you’ve ever seen the aquarium, like, pebble stones, 587 00:27:58,653 --> 00:28:00,293 like in fish tanks, it’s like that. 588 00:28:00,322 --> 00:28:02,292 And it’s awful. 589 00:28:02,324 --> 00:28:03,764 [knocking] 590 00:28:03,792 --> 00:28:05,592 [PA] Hello, how are you? 591 00:28:05,627 --> 00:28:07,167 - Destiny, right? - [Destiny] Yeah. 592 00:28:07,195 --> 00:28:08,835 [Mark] I’m Mark. Nice to meet you. 593 00:28:08,863 --> 00:28:10,663 So, what’s going on with you today? 594 00:28:10,699 --> 00:28:13,429 Um, my family doctor said that I needed to come up here 595 00:28:13,468 --> 00:28:15,268 ’cause I have these really bad tonsil stones. 596 00:28:15,303 --> 00:28:16,973 And that I needed to get them checked out. 597 00:28:17,005 --> 00:28:19,405 Do they cause you any problems? Do they hurt? 598 00:28:19,441 --> 00:28:22,471 - I can’t swallow water without choking. Like, bad. - [Mark] Okay. 599 00:28:22,510 --> 00:28:24,410 All right. How long has this been going on for? 600 00:28:24,446 --> 00:28:26,246 My entire life. But it started getting really, really bad 601 00:28:26,281 --> 00:28:28,081 when I was pregnant with my son, 602 00:28:28,116 --> 00:28:30,586 - who’s now three. [chuckles] - [Mark chuckles] 603 00:28:30,619 --> 00:28:34,119 Do they cause you any other issues like pain, bad breath 604 00:28:34,155 --> 00:28:36,995 - things like that at all? - [Destiny] Probably. [laughs] 605 00:28:37,025 --> 00:28:38,295 - The bad breath, I’m assuming. - [Mark] Okay. 606 00:28:38,326 --> 00:28:40,166 The tonsil stones smell when they come out. 607 00:28:40,195 --> 00:28:43,165 - So, I’m just assuming. - [Mark] Yes, unfortunately they do smell very bad. 608 00:28:43,198 --> 00:28:45,438 Crypts are like holes in the tonsils. 609 00:28:45,467 --> 00:28:48,307 Uh, kind of like if you think about how the moon looks. 610 00:28:48,336 --> 00:28:50,806 And then the holes, they produce keratin, 611 00:28:50,839 --> 00:28:53,769 and then that, you know, the epithelial cells, 612 00:28:53,808 --> 00:28:57,708 bacteria, just debris, kind of mixes together and forms those little stones. 613 00:28:57,746 --> 00:28:59,946 And then they stick in there until you pop them out. 614 00:28:59,981 --> 00:29:04,621 Tonsil stones can be anywhere from a size of a grain of sand to... 615 00:29:04,653 --> 00:29:07,493 I’ve seen some tonsil stones about the size of a pinky nail. 616 00:29:07,522 --> 00:29:08,592 So, pretty large. 617 00:29:09,324 --> 00:29:10,864 [chuckles] 618 00:29:10,892 --> 00:29:13,222 All right. You can go ahead and remove your mask if you’re fine with that. 619 00:29:13,261 --> 00:29:14,831 Worst case scenario is, 620 00:29:14,863 --> 00:29:17,063 the definitive treatment is to remove the tonsils. 621 00:29:17,098 --> 00:29:20,028 And unfortunately, that’s not a pleasant procedure. 622 00:29:20,068 --> 00:29:23,408 You have a little bit of a deviated septum but your nose otherwise looks great. 623 00:29:23,438 --> 00:29:25,008 All right, let’s see these things. 624 00:29:25,040 --> 00:29:26,640 Big ah. Look right up here for me. 625 00:29:26,675 --> 00:29:30,645 So about three plus tonsils and definitely very cryptic. 626 00:29:30,679 --> 00:29:32,739 - You can see the holes in the tonsils. - Sorry. 627 00:29:32,781 --> 00:29:35,081 - [Mark] Do you have a bad gag reflex? - Yes, awful. 628 00:29:35,116 --> 00:29:37,886 [Mark] Then what I’m gonna do is, I’m gonna spray some stuff in your throat. 629 00:29:37,919 --> 00:29:40,819 - It’ll numb it up and blunt the gag reflex. - [Destiny] Okay. 630 00:29:40,855 --> 00:29:43,225 - [Mark] Unfortunately, it tastes really bad. - Ugh. 631 00:29:44,893 --> 00:29:48,333 - Understatement. [laughs] - [Mark laughs] Yes. 632 00:29:48,363 --> 00:29:50,263 All right. Let’s see if we can do this. 633 00:29:50,298 --> 00:29:53,328 So, look up here, just a little bit. Just like that. 634 00:29:53,368 --> 00:29:56,438 So, you can see one right over here on the left side. 635 00:29:56,471 --> 00:29:58,901 - Oh, yes. Oh, you’re fine. You’re fine. - [gags] Sorry. 636 00:29:58,940 --> 00:30:00,770 - [Mark] It’s normal. - [gags] 637 00:30:00,809 --> 00:30:02,709 [Mark] There’s one small one. 638 00:30:03,545 --> 00:30:04,885 - You good? - Ah! 639 00:30:04,913 --> 00:30:07,153 Oh, sorry. [laughs] 640 00:30:07,749 --> 00:30:10,379 [coughing] 641 00:30:10,418 --> 00:30:12,918 - [gags] Oh, sorry. - [Mark] Look at this. 642 00:30:12,954 --> 00:30:15,724 All right, so I’m gonna turn this way, just a little bit. 643 00:30:15,757 --> 00:30:19,567 - [gags] Sorry. - [both laugh] 644 00:30:19,594 --> 00:30:21,064 - Told you it was really bad. - [Mark] No, it’s okay. 645 00:30:21,096 --> 00:30:24,236 Tonsil stones have a very foul smell. 646 00:30:25,166 --> 00:30:27,536 Similar to a dead animal. 647 00:30:27,569 --> 00:30:28,669 [laughs] Like roadkill. 648 00:30:30,105 --> 00:30:31,545 They’re not pleasant. 649 00:30:31,573 --> 00:30:33,403 - Oh, goodness. - Smells bad. 650 00:30:34,676 --> 00:30:36,046 [laughs] 651 00:30:36,077 --> 00:30:37,587 So, with tonsils like yours, 652 00:30:37,612 --> 00:30:40,812 the only good treatment is gonna be just removing your tonsils. 653 00:30:40,849 --> 00:30:44,319 - Now, it’s not a fun surgery. So, fair warning. - [Destiny] Yeah. 654 00:30:44,352 --> 00:30:46,482 Destiny came in with tonsil stones. 655 00:30:46,521 --> 00:30:49,091 Unfortunately, no way to fix this problem 656 00:30:49,124 --> 00:30:51,624 without just taking the tonsils out at this point. 657 00:30:51,659 --> 00:30:53,259 Certainly should help the swallowing 658 00:30:53,294 --> 00:30:54,894 and the discomfort back there as you have. 659 00:30:54,929 --> 00:30:57,599 But the good news is, you won’t ever have a tonsil stone again. 660 00:30:58,767 --> 00:31:02,007 She’ll suffer for 10-14 days to get it out. 661 00:31:02,036 --> 00:31:05,576 So when someone is willing to do that, you know it’s probably significant enough. 662 00:31:05,607 --> 00:31:07,417 In the long run, it’s usually worth it for them. 663 00:31:07,442 --> 00:31:09,972 - No tonsils, no tonsil stones. - [both laugh] 664 00:31:17,285 --> 00:31:18,825 Hello! 665 00:31:18,853 --> 00:31:22,693 I’m Lynn Guan and I’m a physician assistant at the ENT Institute. 666 00:31:22,724 --> 00:31:24,924 - Good morning, Ms. Moralski. - [Ms. Moralski] Hello, how are you? 667 00:31:24,959 --> 00:31:26,689 - [Lynn] Good. How are you? - [Ms. Moralski] I’m good. 668 00:31:26,728 --> 00:31:30,608 Even though I specialize in all things ear, nose and throat related, 669 00:31:30,632 --> 00:31:34,172 I find myself spending a lot of time looking in people’s ears. 670 00:31:34,202 --> 00:31:36,432 All right, so what’s going on today? 671 00:31:36,471 --> 00:31:38,001 [Ms. Moralski] Oh, well. I had a little... 672 00:31:38,673 --> 00:31:39,943 Little problem hearing. 673 00:31:39,974 --> 00:31:42,674 I don’t know what it’s, you know, what it’s about, whatever. 674 00:31:42,710 --> 00:31:44,840 And I thought I should come in, have it checked out. 675 00:31:44,879 --> 00:31:46,679 [Lynn] All right. Well, let’s take a look inside. 676 00:31:46,714 --> 00:31:51,284 Everyday at the ENT Institute, I see something that’s stuck in patients ears 677 00:31:51,319 --> 00:31:54,189 Most of the time, it’s wax. 678 00:31:54,222 --> 00:31:58,492 - So, this side has quite a lot of wax in here. - [Ms. Moralski] Okay. 679 00:31:58,526 --> 00:32:02,696 I’d say I probably see a little under a 100 ear wax cases a month. 680 00:32:02,730 --> 00:32:05,900 So, the wax is a bit hard on this side. 681 00:32:05,934 --> 00:32:09,534 She had just a harder, more firm type of ear wax. 682 00:32:09,571 --> 00:32:12,871 So I used a tool we call an alligator forcep 683 00:32:12,907 --> 00:32:15,417 to gently peel away the layers of the wax 684 00:32:15,443 --> 00:32:17,243 from the side of the ear canal. 685 00:32:17,278 --> 00:32:18,808 You ready to see this piece? 686 00:32:18,847 --> 00:32:20,887 - [Ms. Moralski] Uh, yeah. I guess. - [both chuckle] 687 00:32:20,915 --> 00:32:23,555 - [Lynn] So, here’s what we have! - [Ms. Moralski] Oh, my gosh! 688 00:32:23,585 --> 00:32:26,685 - [Lynn] Look at this here. So, that’s a good one there. - [Ms. Moralski] Oh, wow. 689 00:32:26,721 --> 00:32:28,651 - Wow. - [Lynn chuckles] So this is what came out of your ear. 690 00:32:28,690 --> 00:32:31,590 - So, you can see just how long it’s been there. - Yeah, no wonder I can’t hear. 691 00:32:31,626 --> 00:32:33,496 - By how hard it is. Can you hear better now? - [laughs] Yeah. 692 00:32:33,528 --> 00:32:35,668 - Yeah, I really can. It’s amazing. - [Lynn] Good. 693 00:32:35,697 --> 00:32:37,337 [Ms. Moralski] Wow. 694 00:32:37,365 --> 00:32:40,235 Ear wax and removal of ear wax is an artform. 695 00:32:40,268 --> 00:32:41,578 You got a little wax in there. 696 00:32:41,603 --> 00:32:43,203 Not all wax is the same. 697 00:32:43,238 --> 00:32:45,248 We’re gonna get it out for you. 698 00:32:46,474 --> 00:32:48,514 Does that feel a little bit more open? 699 00:32:48,543 --> 00:32:49,643 [man] No, it feels good. 700 00:32:49,677 --> 00:32:52,587 [woman] No wonder sometimes he has selective hearing. 701 00:32:52,614 --> 00:32:56,754 With regard to ear wax, it’s something that’s genetically determined. 702 00:32:56,784 --> 00:32:58,584 And I always jokingly say, 703 00:32:58,620 --> 00:33:00,420 "It’s another thing you can blame on your mother." 704 00:33:00,455 --> 00:33:02,495 They are really, completely clogged. 705 00:33:03,925 --> 00:33:05,325 The motherlode. Here we go. 706 00:33:05,760 --> 00:33:06,890 There we go? 707 00:33:06,928 --> 00:33:09,368 That’s like a hole in one, to get it out in one piece. 708 00:33:09,397 --> 00:33:11,407 - [woman] Hi, Crystal. Nice to meet you. - [Crystal] Nice to meet you. 709 00:33:11,432 --> 00:33:13,432 So, tell me what’s been going on with your ear. 710 00:33:13,468 --> 00:33:15,808 So when I first started doing ENT, 711 00:33:15,837 --> 00:33:19,047 I guess I really didn’t realize that there was gonna be ear wax, 712 00:33:19,073 --> 00:33:22,473 and it was a little off-putting. 713 00:33:22,510 --> 00:33:24,440 Okay. Got a big bit out. 714 00:33:24,479 --> 00:33:26,609 - But there’s more. - [woman] Oh, my God! 715 00:33:27,282 --> 00:33:28,882 That is crazy. 716 00:33:28,917 --> 00:33:31,957 If you’ve never had it cleaned out, and you’re used to the way your ears feel 717 00:33:31,986 --> 00:33:33,356 when they’re full, 718 00:33:33,388 --> 00:33:35,958 you don’t know that there’s a problem until you are about deaf. 719 00:33:35,990 --> 00:33:38,820 - More of the same. - [woman] Oh, my goodness. 720 00:33:38,860 --> 00:33:40,260 What in the world? 721 00:33:41,296 --> 00:33:42,136 [Crystal] There. 722 00:33:42,664 --> 00:33:44,664 [woman] Oh, ew. 723 00:33:44,699 --> 00:33:46,059 - [chuckles] - [Crystal] Huh. 724 00:33:46,100 --> 00:33:48,430 [woman] Oh, my God. I walk around like I’m cute, 725 00:33:48,469 --> 00:33:51,239 - and that is just like, ew. - [Crystal laughing] 726 00:33:51,272 --> 00:33:54,012 Everybody is like, [sighs]. 727 00:33:54,042 --> 00:33:55,842 Oh, my God, I feel so much better. 728 00:33:55,877 --> 00:33:58,847 It’s like a weight lifted off. Like, I’m telling you, 729 00:33:58,880 --> 00:33:59,840 say something. 730 00:33:59,881 --> 00:34:03,251 [all laughing] 731 00:34:03,284 --> 00:34:06,084 Some of it can be really thick. 732 00:34:06,120 --> 00:34:07,990 This was wax out of that one ear. 733 00:34:09,390 --> 00:34:11,660 Sometimes it smells. 734 00:34:11,693 --> 00:34:14,093 [Dr. Daniel] There was a gentleman with an ear infection 735 00:34:14,128 --> 00:34:17,498 and I could smell his ear from the doorway. 736 00:34:17,532 --> 00:34:19,002 - You see that wax? - Yes. 737 00:34:19,033 --> 00:34:20,473 [Dr. Daniel] Okay, we’re gonna clean that out. 738 00:34:20,501 --> 00:34:25,301 It’s not uncommon to pull out a huge piece in one sitting. 739 00:34:25,340 --> 00:34:27,140 [Lynn] Here we go, look at that! 740 00:34:27,175 --> 00:34:29,615 - [man] Wow, my head feels lighter. - Does it feel lighter? 741 00:34:29,644 --> 00:34:31,514 It can be like, that long, 742 00:34:31,546 --> 00:34:33,086 and that thick. 743 00:34:34,382 --> 00:34:37,152 And it’s just like, oh, wow. 744 00:34:37,185 --> 00:34:39,355 - [man] Wow. - [Lynn] So, this is the big old guy 745 00:34:39,387 --> 00:34:40,757 that came out of your ear. 746 00:34:42,590 --> 00:34:46,190 - So there’s more of that pulled out over here. - [man] Oh, wow. 747 00:34:48,229 --> 00:34:51,659 [Dr. Daniel] She is packed full of ear wax. 748 00:34:51,699 --> 00:34:54,399 I actually had a guy, had to see him every six weeks. 749 00:34:54,435 --> 00:34:55,375 Really. 750 00:34:55,403 --> 00:34:57,243 We called him the candlestick-maker. 751 00:34:57,271 --> 00:34:58,971 [laughs] 752 00:34:59,007 --> 00:35:01,217 Oh, your... clean as a whistle. 753 00:35:01,242 --> 00:35:05,982 I know you guys all wonder what happens to everything that goes through that suction 754 00:35:06,014 --> 00:35:07,354 and through that mysterious tube, 755 00:35:07,382 --> 00:35:09,752 but it all goes into a cannister. 756 00:35:09,784 --> 00:35:12,424 It is full of all kinds of loveliness. 757 00:35:12,453 --> 00:35:15,253 [Lynn] Everything from ear wax, drainage, 758 00:35:15,289 --> 00:35:18,419 fungus, bacteria, blood, 759 00:35:18,459 --> 00:35:19,689 all that good stuff. 760 00:35:23,965 --> 00:35:26,835 - [choking] - [nurse] Gotta relax. 761 00:35:26,868 --> 00:35:28,638 Open your eyes. 762 00:35:39,547 --> 00:35:42,057 [nurse] So, in this bag, they’ll put your shoes and your 763 00:35:42,083 --> 00:35:44,553 gown goes on like this. 764 00:35:44,585 --> 00:35:46,455 [Destiny] I’m here to get my tonsils taken out 765 00:35:46,487 --> 00:35:49,457 and deal with the tonsil stones that are building in the back of my throat. 766 00:35:49,490 --> 00:35:52,190 It’s nerve-wracking and I’m stressed out, nervous. 767 00:35:52,226 --> 00:35:53,966 I just want to get the surgery over with 768 00:35:53,995 --> 00:35:56,235 because the tonsils are awful. 769 00:35:56,264 --> 00:35:58,434 - [doctor] Destiny? I love that name. - Yes. 770 00:35:58,466 --> 00:36:01,036 - It’s fantastic. But I love the hair more. - [chuckles] 771 00:36:01,069 --> 00:36:03,429 I’m Dr. Jeffery Gallups. I’m the Medical Director of 772 00:36:03,471 --> 00:36:05,371 the Ear, Nose and Throat Institute. 773 00:36:05,406 --> 00:36:07,776 One of the most anxious times for a patient 774 00:36:07,809 --> 00:36:10,369 is that morning, that day of surgery. 775 00:36:10,411 --> 00:36:12,911 So, I always try to lighten the mood a little bit. 776 00:36:12,947 --> 00:36:16,217 - You have much pain from it? - Yeah. A lot of discomfort at least. 777 00:36:16,250 --> 00:36:17,720 Well, that’s gonna be gone. [clicks fingers] 778 00:36:17,752 --> 00:36:19,982 Everyone knows someone that’s had a tonsillectomy. 779 00:36:20,021 --> 00:36:22,121 And you think, "Oh, it’s a fairly benign procedure." 780 00:36:22,156 --> 00:36:24,626 But it has its own complications. 781 00:36:24,659 --> 00:36:28,489 So we wanna be very selective about why we’re doing this. 782 00:36:28,529 --> 00:36:30,559 Dr. Bovenkerk’s taking care of you today. 783 00:36:30,598 --> 00:36:32,598 I’ll be in the room but not performing the surgery. 784 00:36:32,633 --> 00:36:35,133 - I’m excited for you. Great to meet you. - Yeah, awesome. Thank you. 785 00:36:35,169 --> 00:36:37,839 The number one complication of a tonsillectomy is bleeding. 786 00:36:37,872 --> 00:36:39,672 One of the other complications 787 00:36:39,707 --> 00:36:41,577 is when you take tonsils out, 788 00:36:41,609 --> 00:36:43,509 sometimes it creates more swelling 789 00:36:43,544 --> 00:36:46,284 than the tonsils created at the time. 790 00:36:46,314 --> 00:36:47,784 Now, this is temporary, 791 00:36:47,815 --> 00:36:50,515 but if you have that, then you could suffocate. 792 00:36:51,719 --> 00:36:53,519 [Dr. Stephen] Hello, hello, Destiny. 793 00:36:53,554 --> 00:36:55,254 Hi! Dr. Bovenkerk. 794 00:36:55,289 --> 00:36:57,619 Nice to meet you. 795 00:36:57,658 --> 00:36:59,918 [nurse] This is just oxygen. We’ll have you start taking those nice, 796 00:36:59,961 --> 00:37:01,591 deep breaths in and out. 797 00:37:01,629 --> 00:37:04,299 Put your chin up towards the ceiling for me, perfect. 798 00:37:04,332 --> 00:37:06,302 You’ve been on any vacations lately? 799 00:37:06,334 --> 00:37:08,004 No, need one. 800 00:37:08,035 --> 00:37:09,305 [nurse] You need one? Okay. 801 00:37:09,337 --> 00:37:11,447 - [Dr. Stephen] Well, you’re gonna get one now. - [nurse] Yep. 802 00:37:11,472 --> 00:37:15,172 [Dr. Stephen] Starting the medication now to help you drift off to Gatlinburg. 803 00:37:15,209 --> 00:37:16,869 [Destiny chuckles] 804 00:37:16,911 --> 00:37:17,911 [Dr. Stephen] Enjoy that nap. 805 00:37:23,551 --> 00:37:26,281 This is a MacGyver retractor. 806 00:37:26,320 --> 00:37:30,320 It does a really good job of keeping the mouth nice and open. 807 00:37:30,358 --> 00:37:32,668 My tonsils, they’ve always been a problem. 808 00:37:32,693 --> 00:37:34,893 I’m super excited to get the surgery over with. 809 00:37:34,929 --> 00:37:37,629 And I’m really hoping that we can get it out today. 810 00:37:37,665 --> 00:37:40,035 [Dr. Jeffery] Look at that. Oh, yeah. 811 00:37:40,067 --> 00:37:42,377 Plenty to grasp on to there. 812 00:37:42,403 --> 00:37:43,303 [Dr Stephen] I agree. 813 00:37:43,337 --> 00:37:45,207 Tonsils can be very deceiving. 814 00:37:45,239 --> 00:37:47,669 So when I looked in her mouth, it was huge. 815 00:37:47,708 --> 00:37:49,408 And inflamed. 816 00:37:49,443 --> 00:37:51,643 Looks like they’ve been bleeding. 817 00:37:51,679 --> 00:37:53,039 You know, they’re just raw. 818 00:37:53,080 --> 00:37:55,750 That is a really good indicator 819 00:37:55,783 --> 00:37:59,323 for somebody who needs their tonsils removed. 820 00:37:59,353 --> 00:38:03,223 [De. Stephen] So, she has cryptic tonsils with those crypts and crevices. 821 00:38:03,257 --> 00:38:05,267 And they’re enlarged as well. 822 00:38:05,293 --> 00:38:08,363 In the tonsil itself, are called crypts. 823 00:38:08,396 --> 00:38:11,436 And it’s where food has been pushed 824 00:38:11,465 --> 00:38:14,175 into these little holes in the tonsils. 825 00:38:14,202 --> 00:38:16,502 And after a while, they become thick. 826 00:38:16,537 --> 00:38:18,777 Kind of like sand on the beach. 827 00:38:18,806 --> 00:38:21,076 Then after that, they become stones. 828 00:38:21,108 --> 00:38:24,008 I’ve seen stones as this big. 829 00:38:24,045 --> 00:38:25,445 Look like a spearhead. 830 00:38:25,479 --> 00:38:27,409 In fact, I still have that one in my desk drawer. 831 00:38:30,117 --> 00:38:33,127 [Dr. Stephen] We’re gonna put a catheter into the nose, 832 00:38:33,154 --> 00:38:36,624 gives me a little better exposure of the tonsils. 833 00:38:36,657 --> 00:38:40,067 We can start to see these white-ish, yellow-ish particles here. 834 00:38:40,094 --> 00:38:42,034 Those are the tonsil stones. 835 00:38:42,063 --> 00:38:45,463 Sometimes they are the size of garbanzo beans. 836 00:38:45,499 --> 00:38:48,099 [Dr. Jeffery] The next thing is, retract the tonsil. 837 00:38:48,135 --> 00:38:50,035 It’s against the side of the wall of the throat. 838 00:38:50,071 --> 00:38:51,741 So, we want to stretch it, 839 00:38:51,772 --> 00:38:54,172 so that we can really cut it off. 840 00:39:01,315 --> 00:39:04,785 And it seals the vessels as it removes the tonsil. 841 00:39:04,819 --> 00:39:07,949 You know, it’s like cutting through butter with a hot knife. 842 00:39:15,263 --> 00:39:18,333 [Dr. Stephen] So, this is her right tonsil. 843 00:39:18,366 --> 00:39:22,906 Quite a few of those little tonsil stones right on the surface here. 844 00:39:22,937 --> 00:39:25,607 You can go ahead and pass that. 845 00:39:25,640 --> 00:39:29,010 And we’ll get to work on the left tonsil. 846 00:39:47,495 --> 00:39:49,635 And the left tonsil. 847 00:39:50,298 --> 00:39:52,708 Really enlarged tonsils. 848 00:39:53,501 --> 00:39:55,931 One of the scariest times is 849 00:39:55,970 --> 00:39:58,640 when they remove the tube that assists them 850 00:39:58,673 --> 00:39:59,773 to keep the airway open. 851 00:39:59,807 --> 00:40:02,477 The surgeon many times suctions the stomach. 852 00:40:02,510 --> 00:40:05,340 [instrument blowing] 853 00:40:08,349 --> 00:40:13,019 Because after you take the tube out of the throat from surgery, 854 00:40:13,054 --> 00:40:15,894 if they were to vomit or cough, 855 00:40:15,923 --> 00:40:17,793 and their stomach’s full of fluid, 856 00:40:17,825 --> 00:40:20,835 they will cough that up and potentially aspirate it, 857 00:40:20,861 --> 00:40:22,791 or suck it back into their lungs. 858 00:40:22,830 --> 00:40:25,400 And then you’ve got a real emergency. 859 00:40:25,433 --> 00:40:26,833 [Dr. Stephen] And that is it. 860 00:40:27,668 --> 00:40:28,968 [Dr. Jeffery] Fantastic. 861 00:40:29,003 --> 00:40:30,633 [nurse] Destiny? 862 00:40:30,671 --> 00:40:32,071 Destiny, you’re all done. 863 00:40:32,106 --> 00:40:34,446 [gurgling] 864 00:40:39,046 --> 00:40:42,316 - [coughing] - [Dr. Jeffery] There you go. Cough it up. 865 00:40:42,350 --> 00:40:45,020 [nurse] Destiny, you’re just waking up, okay? 866 00:40:45,052 --> 00:40:46,422 [Destiny coughing] 867 00:40:46,454 --> 00:40:48,824 [nurse 2] Hey, Destiny. Can you open your eyes? 868 00:40:48,856 --> 00:40:51,096 As you can see, she’s trying to fight this back a little bit. 869 00:40:51,125 --> 00:40:53,925 Won’t open her eyes, she’s not responding to them. 870 00:40:53,961 --> 00:40:56,061 You know, she’s biting a little bit on the tube. 871 00:40:56,097 --> 00:40:59,737 They’re trying to get this out and she’s totally unaware any of this at this point. 872 00:41:03,637 --> 00:41:05,777 [coughing] 873 00:41:05,806 --> 00:41:07,376 - [nurse 1] Here we go. - [nurse 2] Try to relax. 874 00:41:07,408 --> 00:41:09,248 - Okay? - [Dr. Jeffery] Perfect. 875 00:41:11,145 --> 00:41:12,615 Welcome back. 876 00:41:12,646 --> 00:41:15,356 It’s hard for me to not put myself in their position 877 00:41:15,383 --> 00:41:18,123 ’cause I had my tonsils out when I was a kid and I still remember it. 878 00:41:18,152 --> 00:41:21,452 She’s gonna wake up. She’s gonna have a very sore throat. 879 00:41:21,489 --> 00:41:23,049 She’s gonna be groggy. 880 00:41:23,090 --> 00:41:24,960 But after the grogginess goes away, 881 00:41:24,992 --> 00:41:27,792 it’s gonna be the worst sore throat she’s ever had. 882 00:41:27,828 --> 00:41:29,458 But it’s gonna cure the problem. 883 00:41:31,098 --> 00:41:33,898 [Destiny] I’m way too excited, ’cause I just want everything to be better. 884 00:41:33,934 --> 00:41:36,604 And I might actually be able to like, eat food and 885 00:41:36,637 --> 00:41:39,047 enjoy food again. That would be super great. 886 00:41:39,073 --> 00:41:40,403 [laughs] 887 00:41:43,277 --> 00:41:46,117 [chuckling] Fish hooks are a nemesis for patients. 888 00:41:48,015 --> 00:41:50,055 She has a bead stuck in her ear. 889 00:41:50,084 --> 00:41:53,524 A bead of a beanbag. So I tried to get it out. 890 00:41:54,588 --> 00:41:55,718 Could it be popcorn? 891 00:41:55,756 --> 00:41:58,596 [mother] Popcorn in her ear? 892 00:41:58,626 --> 00:42:00,626 No! It’s a bead. 893 00:42:00,661 --> 00:42:02,591 Pop, there’s goes the nail. 894 00:42:02,630 --> 00:42:05,900 [] I’ve seen a few nail gun injuries like this. 895 00:42:05,933 --> 00:42:09,403 You can see it’s actually in there pretty good. 896 00:42:09,437 --> 00:42:14,317 You could hear it rip though a little bit of tendon or tissue. 897 00:42:14,341 --> 00:42:17,611 [Dr. Daniel] He just has a ball of sort of jelly mucus that’s just 898 00:42:17,645 --> 00:42:19,585 stuck there and it’s just never gonna come out, 899 00:42:19,613 --> 00:42:20,983 unless we remove it. 900 00:42:21,015 --> 00:42:22,955 - [machine whirring] - Here we go. Wow. 901 00:42:22,983 --> 00:42:23,853 That is just... 902 00:42:25,953 --> 00:42:27,793 That is just cool, look at that. 903 00:42:27,822 --> 00:42:29,452 There is this pleasant lady 904 00:42:29,490 --> 00:42:32,690 she’s got a huge stiletto heel 905 00:42:32,726 --> 00:42:34,996 stuck smack into her face.