[doctor] You were riding your bike and you hit a pothole, is that correct?
[woman] Yeah.
[doctor] That is a long handle.
And that’s stuck in her leg.
[woman moaning in pain]
[woman 2] The pain was so bad that I was laying on the floor.
[doctor 2] Oh, what is that?
Something’s going on and we have to figure it out.
[coughing]
I have these really bad tonsil stones.
- [choking] - [man] There you go.
[doctor 3] I had a lady who apparently has a fake nail in her ear.
Sorry.
I think we’ve all played Operation when we were little kids.
[woman] Ah! Did you get it?
[assistant] It’s really stuck in there.
[Dr. Larry] My name is Dr. Larry Melleck.
I’ve been practicing for over 40 years.
Pediatrics, emergency medicine and board certified in all three of those.
What I really love about this job is the stimulation,
like the challenge, I like being at the top of my game.
In my career, I’ve seen just a spectrum of different types of penetrating injuries.
But I think one of the more dramatic ones that I’ve ever seen
was a teenager who presented in the emergency department
with a bike brake handle stuck in her leg.
It was the entire bike brake handle that was buried into her leg.
So, you were riding your bike and you hit a pothole, is that correct?
How old are you?
15?
My name is Jasmine Hay. I’m in the United States Army.
So, I was in Aiken, South Carolina with my friend.
We decided that we were gonna go ride bikes around the neighborhood.
So, she was like, "Oh," you know, "let’s race."
So, I was like, "Okay."
So, we’re racing. She turns off.
So I go to look and like, "Where she at?"
So, I turn around, like, turn my whole body.
And I hit the pothole.
I blackout.
I was like, "Oh, my goodness."
And I see like, half of the bicycle brake
inside of my leg.
There was these people that were out there
and they seen the whole thing.
They’re like, "Oh! That’s deep!"
So, when the ambulance finally come,
they couldn’t take the whole bike to the hospital.
So they got a saw to cut me from the bike.
So, I’m getting burnt from the sparks from the saw.
I’m screaming.
Finally, they got me disconnected from the bike
and put in me in the ambulance.
[sirens blare]
[Jasmine] So, we’re on the highway.
So, I’m feeling every bump.
My leg is like,
it’s throbbing.
[Dr. Larry] I’m just giving her a tourniquet.
- [man 2] Okay. - [Dr. Larry] Just in case we need it.
[man 2] In case it starts to bleed.
[Dr. Larry] I walk in the room and I see Jasmine,
and surprisingly, she’s very calm.
I mean, right here, sartorius just cut on from here...
all the way to there.
That’s gonna be our challenge today, is to get that out.
As I’m looking at this,
what’s racing through my brain here is like,
"That is a long handle,
and that’s buried in her leg.
If I pull that out,
and it’s ruptured a major vein or a major artery,
am I just gonna see a spurt of blood coming out
and she starts to hemorrhage?"
Right under the sartorius is where the SFA lies.
If this goes medially towards it
that could hit the SFA vessel.
It does go laterally, we got an X-ray.
- [man 2] Yeah. - [Dr. Larry] And it shows it’s pretty superficial.
[Jasmine] They’re trying to figure if I need to go to surgery,
they’re trying to figure out if they can just pull it straight out.
They’re trying to figure out all these things because looking at it,
it just looks bad.
I was like, "Well, can y’all put me to sleep?"
He’s like, "No, it’s a possibility you could bleed out."
That’s not what you wanna hear at 15.
[Dr. Larry] Once there’s a foreign body that’s impaled the skin,
the body’s gonna react to that.
Those foreign bodies bring along with them bacteria
that can actually cause serious infections
and bacteria that gets into the bloodstream causes shock.
[Jasmine moaning in pain]
[Dr. Larry] Jasmine’s hurting.
I’ve got my child life specialist who are helping out trying to distract her.
I’m used to managing pain.
But to hear Jasmine crying and frightened just kinds of tears me up inside.
[Jasmine moaning in pain]
Part of the brake handle had actually clamped on to the skin.
[Jasmine] They were pulling my skin along with the brake.
[Jasmine moaning in pain]
And that’s when I started screaming.
- [Jasmine moaning in pain] - [Dr. Larry] It’s caught on the skin there.
I feel everything.
[Dr. Larry] I’m gonna give some lidocaine for the skin.
It’s become obvious we have to deal with the pain.
We had to provide additional anesthesia.
Because of my concerns about the potential damage
that this may have caused,
I consult my colleagues
to have them come and assist with the removal of this foreign body
in the event of some obvious complication as we pull it out.
- There we go. - [woman] Nice and easy. It’s gone.
[Dr. Larry] Once we remove the brake handle and open that up,
it came out very easily.
And then, I just had like, this huge hole
in my leg.
Like, it was big.
[man 2] That didn’t go in the vessels.
[Dr. Larry] Yeah, she is lucky.
Thank you. Good job.
- [man 2] I’m just gonna wash it out. - Yeah.
So we’ll irrigate that.
My goal is, do minimal damage and let her heal quickly.
[Jasmine] I was like, just beyond happy.
Beyond grateful for them.
I’d say it took probably about like, six months
for me to finally like, heal it altogether.
And then, now I just got an indentation on my leg
that everybody asks if I got shot
because it looks like a bullet mark in my leg.
[sighs] So, yeah.
Now, I have not rode a bike since.
I will not touch a bike. Will not look at a bike.
No.
[siren blaring]
My name’s Kayla Shiflett,
and I live in Anniston, Alabama.
So, I was 12 weeks pregnant
and my baby was fine.
I had a okay pregnancy.
And then, I felt some pressure.
And then it got worse and worse.
And then one day, it got so bad
that I was throwing up, it was just so painful.
I really thought that I needed to go to the hospital.
I really thought that I was having a miscarriage,
but I wasn’t bleeding.
When I got to the emergency room,
the pain was so bad that I was laying on the floor.
[man] All right, here we go.
My name is George Crawford.
I am a board certified general surgeon
and I’ve been practicing for 20 years.
After talking to Kayla’s OB,
we decided to get her prepped for surgery.
The biggest concern is, she had appendicitis.
Appendicitis can not only be dangerous to the mother,
it can be dangerous to her unborn child.
You can see on this ultrasound of the child,
that there’s blood flow in the uterus,
there’s blood flow outside the uterus.
So, it looks like the baby is fine.
What we are now thinking is
if this is either the appendix,
or something going on with the ovary.
[Kayla] It was really scary because my doctor said,
"We really gotta do this quickly because if your appendix ruptures,
it’s your life and your baby’s life."
So in her situation, it was deemed an emergency.
So, instead of meeting her in the emergency room,
she was asleep in the operating room.
And five minutes later, we were getting her taken care of.
- Grasper, please. - [nurse] Yes, sir.
[Dr. George] Is this an ovarian problem or is this appendicitis?
Appendicitis is the most common non-obstetrical surgery
that we see in pregnant women.
All right. Let’s get it done.
There we go.
So, stuck my scopes in,
start looking around.
And it’s obviously not her appendix.
Her appendix is normal. It’s kind of flopping right there. It’s like,
"Hey," waving at you, "it’s not me, it’s somebody else."
Oh, what is that?
But off to the side, you see this huge mass.
Something’s going on, and we have to figure it out.
Oh, wow.
So this is a real bigger problem than I thought.
[Dr. George] Oh, what is that?
Kayla comes in with right lower quadrant abdominal pain.
We take her to the operating room
expecting to find appendicitis,
and we find something completely different.
When we get in there, we find something stuck
on her abdominal wall on that right side.
There’s really not supposed to be anything over there.
We gotta get it out.
It looks like she’s probably gonna have what’s called a teratoma.
A teratoma is just one of these cells
that had gotten stuck in the ovary, and over time,
it’s slowly grown with the patient.
The reason she’s having pain is because it’s just twisted a little bit
and it didn’t have a good blood supply.
The appendix looks normal so I know that’s not the problem.
But kind of out of the side of my eye, I see
the ovary is big and purple.
And it’s not supposed to be that color.
So, I know that that’s a problem.
This thing doesn’t have natural blood supply.
So, that death of tissue is what causes pain.
And then we end up having to take it out.
The mass was so big that it twisted the ovary
and she was losing blood supply to it.
So, that’s why she was having the pain
because she’s not having blood supply to her ovary.
And I know that it’s something that we have to take out at this time,
because if you wait, the ovary dies,
she can get septic from that,
and then the baby dies.
So, now I gotta figure out how to take the teratoma out
without injuring the baby.
There we go.
Brenda, make sure they get suction set up, please.
As soon as I open it up,
you can see a lot of the fluid starting to leak out.
It’s not toxic, it’s not infected.
So, we’re not worried about her getting sick from it.
But what we will do is make sure we get as much as we can suctioned out.
A teratoma is a tumor
that can have anything in it.
When we say ’anything’, it can have bone, hair,
skin, teeth.
It can have functioning organs or part of functioning organs.
We have to get all of the content
from the teratoma suctioned out of her
because if we leave something in,
then the mother can get sick,
and then, the baby gets threatened,
and it’s not a successful operation.
So we’ll suction out the content, put it in a bag,
and hopefully be able to squeeze it out through one of these incisions.
And what it looks like,
is she’s gonna have a little bit of hair in here,
and maybe a little bit of bone.
Because I can feel something hard.
Now, when I’m taking it out, I do make a hole in it,
and you can see hair sticking out of it.
So, once you see the hair sticking out of the mass,
you know it’s a teratoma.
So what we’re trying to do now
is just peel the teratoma
away from her normal ovary.
What this does is gives her the opportunity
to have a successful pregnancy
after this child.
So hopefully, we can get all this stuff out
and it just makes it easier for her in the future.
There we go. It’s coming apart now.
Okay, so I’mma go ahead and suction out all of this fluid content,
get all of this tissue in the bag.
And hopefully, I’ll be able to get it out through one of these incisions.
There we go.
That’ll be it.
We’re able to get it out through a pretty small incision.
All right, let’s see.
Put it in here.
And some pickups.
All right, guys. I think we’re done here.
Looks like there’s no bleeding.
You can have anything in a teratoma.
So, it’s kind of like a present when you find one,
because the first thing you wanna do
is open it up and see what’s in it.
So, when I open it up, I was like, "Oh?
Okay, that’s a tooth."
And then, there was another tooth. And there was bone.
And it was just kind of like, "Okay. So this is a real teratoma."
This was kind of the one we read about in medical textbooks.
Oh, it’s pretty cool.
There’s also a little bit of hair in it.
But this one’s pretty cool ’cause you don’t see them too often,
with a tooth.
And you can see that’s firmly attached to this hair,
where it’s not coming off.
That one actually has ridges.
So, it has roots and everything.
So, that is one good tooth.
And there’s some other.
There is like molar or something back here.
One of them is actually stuck in the jaw.
I didn’t expect to find a teratoma.
What I was thinking that we would find is an appendicitis.
But in this case,
I pulled teeth out of some lady’s belly.
So, it was actually pretty cool.
Teeth? Ugh, gross.
It was so gross.
So, like, my first impression was that,
"Okay, was that like, a baby that didn’t form right?"
Or like, what happened?
But Dr. Crawford actually explained it to me
that like, really just like, one of my eggs just went haywire
and formed this teratoma, just started making baby parts.
[Dr. George] Initially when she came into the emergency room,
he was worried that she was having a miscarriage.
It works out that she wasn’t, which is fantastic.
And this child can go on to grow
without any problems, and hopefully, she’ll have a healthy, safe delivery.
I’m glad that we got this out of her and it’s not stuck in there anymore.
She should be good.
[assistant] I had a lady who apparently had a fake nail in her ear.
If she moves, there’s potential to damage her ear.
- Sorry. - [woman moans]
[assistant] I think we’ve all played Operation when we were little kids.
You know, when it get that buzzer going...
[woman winces]
[assistant] ...the intensity that that evoked.
And that’s not even real.
[woman] Ah, did you get it?
[phone rings]
[Crystal] Hey, this is Crystal Gay.
I’ll get that prescription sent into your pharmacy.
I’m Crystal Gay. I’m a physician assistant
at Ear, Nose and Throat Institute in Atlanta, Georgia.
The PA is pretty much the backbone of the operation.
We see patients just like they do,
um, treat just like they do, prescriptions.
I communicate very well with my patients and,
I mean, they know a lot about me and I just...
I’m an open book to them.
And if they have something I’ve had, I relate that to them.
So, if they’re happy with their visit, now, that just makes your day.
All right. Thank you. Have a good weekend. Bye.
So, we have a patient coming in
that apparently has a nail in her ear.
I don’t know what kind of nail, I don’t know how long it’s been in there,
I don’t know how it got in there.
So, we’ll see.
- Hi! - [patient] Hi.
- [Crystal] How are you today? - Good.
So, tell me what’s going on? What brings you in to see us today?
Yesterday, I was trying to scratch my ear with this little finger of mine...
Mm-hm.
part of a nail, half of it, like, a little bit of it,
- went inside my ear. - Okay.
And did you try to get it out yourself?
I did try.
At night, I put some oil and slept on the same side.
- [Crystal] Mmm-hmm. - But I don’t think it came out.
Okay, is it hurting or does it feel full?
It feels kind of a little full
and I can tell there’s something going on in my ear. Like...
[Crystal] Okay. Well, let’s take a look.
I actually don’t think I’ve seen a fingernail before.
I mean, it makes sense if you’re scratching your ear and you have
the fake nails that it can come off and pop off
in your ear if you’re really getting at it.
Yep.
I can see it’s in there.
It doesn’t look like a fingernail,
but you can definitely see it.
Let me see if I can see it on my other camera
so you can see it too.
[Crystal] Okay.
- [Mary] Can you see it? - [Crystal] Yeah.
I called my friend, she’s like, "Oh, when you go home,
just put oil and sleep on the same side."
[Crystal] Okay, look in the phone.
So, I slept on the same side. But you know how when you’re in a deep sleep,
I think I must’ve turned on the other side and it went way deep inside.
[Crystal] Yeah, you can see it.
It’s taken up the whole ear canal.
It’s like a tongue.
So, to remove foreign objects,
most of the time we use an operating microscope.
And we can use forceps,
we can irrigate some things,
and then, we have suction.
So we can suction pus, or a foreign body,
or wax out of the ears.
- It’s gonna be a little tender coming out. - [winces in pain]
So, I have to really concentrate at this point.
And be intentional about every decision that I make.
If she moves,
flinches, coughs,
even just... just jerks a little bit,
there’s potential to damage her ear,
scratch the ear canal and then it bleeds.
And the ear canal bleeds like crazy.
There’s potential to perforate her eardrum,
which also hurts and bleeds.
[wincing]
- Ah! - [Crystal] Sorry.
I think we’ve all played Operation when we were little kids
and the intensity that that evoked...
[groans]
...you know, you don’t wanna get that buzzer going.
And that’s not even real,
and you’re, you know, stressed out about it.
So, this is much bigger scale.
Very serious.
- Okay. Almost got it. - [Mary wincing]
You didn’t get it?
[Crystal] Well, yeah. It came closer to me,
- but I gotta grab it. - [groans]
So, I would try to grab it and I had a really good hold of it,
and I thought it was gonna come out.
But then, it wouldn’t come out.
The lacquer that was actually on top of the nail,
when I grabbed it, it was just going through that lacquer.
So, it was like just pinching it,
it wasn’t grabbing it.
- Oof! - Think if you can turn your head this way right there.
- [Mary sighs] Did you get it? - [Crystal] Not yet.
[Mary groaning]
[Crystal] It’s really...
- Did you get it? - [chuckles] No, I’ll let you know when I get it.
It’s really stuck in there. You went pretty deep.
The ear canal is super sensitive.
I’m just gonna take a look.
And if you touch it, it’s easy to bleed.
[Mary] Is it even moving?
[Crystal] Yeah, I can grab it.
It’s just not wanting to come out because it’s stuck.
You have to be very careful because if you scrape it or scratch it,
it’s gonna hurt.
And then people are gonna jerk and that’s... You don’t want that.
The only thinking that I do that makes adults cry is
really anything that has to do with the ear canal.
- [Mary] Did you get it? - [Crystal] No.
So, I’m trying to get a better view.
Okay. I think I know what it’s doing here.
Gosh.
- [sighs] - [Tori] You okay, Mary?
[Crystal] Oh, come on.
- [Mary winces] - [Crystal sighs]
You don’t have any, um...
You just feel like some drum’s hitting your ears.
[Crystal] The alligator’s literally just eating through the nail.
It’s like cutting through it.
[Crystal] Yeah.
Or Cetacaine, whatever we have.
[Crystal] If I’m not able to get this thing out,
then it’s gonna be inflamed, it’s gonna get worse.
We’re gonna have to, most likely, get her into the operating room and remove it,
uh, surgically. Which, I’m really hoping we don’t have to go that route today.
All right. Little spray, okay?
It’s a numbing agent. But it’s pretty strong.
It works pretty quick too.
Okay, I’m not trying to pull it out.
I’m just looking and seeing if I can move it around a little bit.
Can you tell if it’s numbed up a little?
[Mary] Whatever you’re using, it’s not gripping it.
[Crystal] No, I’m not trying to grip it, I’m trying to move it.
It looks like it’s loose. It looks like it wants to just
be grabbed and brought out.
So, I tried twisting it around.
And twisted it and it started to come out.
[clears throat]
I was getting really excited and then it stopped again.
Okay. Forceps.
It was nerve-racking for a little bit. It was really stuck.
Got it.
[sighs] Oh, gosh.
[Crystal] So, I had to move it around so I could get
more of the actual nail.
And pull it and twist it around and pull it out.
So that was a little painful but um,
the ear canal is super duper tender.
[Mary] Yeah, but...
[Mary] Yeah.
[Crystal] You can see the, um, eardrum now, like...
so you can tell the difference in what you were looking at before and now.
[Mary sighs] Oh, Jesus.
Will I put the nails again?
[all laugh]
[Mary] I can’t believe it. It happened so quick.
[Crystal] It was really stuck in there. I thought it would be a lot easier.
I don’t know if I need to keep this or just trash it.
[Crystal and Tori laugh]
I know, it’s a souvenir. Do you want to keep the souvenir?
[Mary] No.
- Thank you so much. You saved my life. - [Crystal] You’re welcome.
- You’re welcome. - [Mary] Thanks.
Somebody is really happy, it makes me really happy
because that’s what we’re here for.
You don’t wanna go to work and not feel like you’ve helped anybody all day long.
- [Mary] Thank you so much. - [Crystal] You’re welcome.
[Dr. George] You know, the nice part about general surgery is
it’s always full of surprises.
I remember a case where I treated a lady that had been
involved in a accident 15 years earlier
and she had a bullet stuck in her back.
My name is Erica Miles and I’m a certified nursing assistant.
Um, back in 2005,
when I was in high school, after a football game,
my friends and I were waiting on our rides.
And we end up being innocent bystanders
caught in the middle of two groups of people shooting at each other.
I end up getting shot in the back.
I felt the burning sensation.
They said that it was too close to my spine at the time.
And they didn’t wanna take it out.
[Dr. George] As long as it’s not in a vessel or a joint,
we usually leave them alone and take them out when they
either cause pain or discomfort.
People get shot all the time and we never remove bullets.
That’s kind of a TV thing.
We leave all bullets in,
unless they are stuck in a vessel or a joint.
The reason why is, we usually will cause a bigger problem
going in to get it.
The body will get rid of it on its own,
the majority of the time.
The problem is, when it gets to the surface,
that’s when it starts to cause pain.
In her,
this started causing significant amount of pain.
So we decided to take it out.
I never felt it moving throughout the years
in my back. Um...
Never thought about it. It never bothered me
until the night I felt it on the surface of my skin
and I knew that’s what it was.
I was actually scared ’cause I knew that shouldn’t have been in that place,
it was at the top portion of my back,
and it moved down to the lower portion.
So I was scared.
[Dr. George] Once you cut it open, you can see the cavity already here.
Because they body’s been trying to get rid of it.
Over my entire career, I’ve probably seen
maybe 300-500 gunshot wounds.
And of those, the strangest one
was a gentlemen that got shot in the head.
He had a bullet in the middle of his brain
and had a little bit of blood leaking out of the hole.
We were trying to decide when we were taking him to the operating room,
do an emergency craniotomy, all this other stuff.
And over the next couple of hours,
he woke up, he was doing fine.
So we left it.
So...
That’s it.
That’s a bullet extraction.
Looks more like a 9...
Not anything big like a .40 caliber.
- Unlike the movies, we don’t have... - [woman] Mmm-hmm.
[Dr. George] Um...
a metal basin to drop it in.
- [chuckling] That has the same effect. - [woman chuckling]
[Dr. George] But yeah. That’s a bullet.
After the surgery, the recovery was fine.
Um, I didn’t have any issues or concerns.
I healed like normal.
I was okay.
[Dr. George] So, what we are gonna do, we’re gonna put one stitch in it,
just to help the healing process.
But as far as closing the hole up,
we traditionally just let them close up on their own.
You have like, a...
small stitch maybe.
I’m so grateful for Dr. Crawford.
I’m just glad that I wasn’t in any pain
and I’m just glad that the bullet was out of my back.
Like, I start coughing and stuff because I’ll start gagging on something.
And these little white things kept coming out. Like, hard balls.
They smell like Sulphur and like, just ick.
[PA] All right. Let’ see these things.
- They look... - [gagging] Sorry. [chuckles]
Ear wax and the removal of ear wax is an art form.
Got a little wax in there.
Not all wax is the same.
[PA 2] There we go. Look at that!
My head feels lighter.
[Crystal] It can be like, that long.
[woman] Walk around like I’m cute and that is just like, ew.
[assistant] You can have a seat right here and then...
I’m Destiny Moon. My tonsils are like,
a bajillion sizes bigger than they should be.
And I have a super bad gag reflex.
Like, I start coughing and stuff because I’ll start gagging on something,
and these little white things kept coming out.
Like, hard balls.
They smell like Sulphur and like, just ick.
So, I was googling it and found out that they were tonsil stones.
The most I’ve ever had come out of my throat was like, 15-ish.
I don’t know if you’ve ever seen the aquarium, like, pebble stones,
like in fish tanks, it’s like that.
And it’s awful.
[knocking]
[PA] Hello, how are you?
- Destiny, right? - [Destiny] Yeah.
[Mark] I’m Mark. Nice to meet you.
So, what’s going on with you today?
Um, my family doctor said that I needed to come up here
’cause I have these really bad tonsil stones.
And that I needed to get them checked out.
Do they cause you any problems? Do they hurt?
- I can’t swallow water without choking. Like, bad. - [Mark] Okay.
All right. How long has this been going on for?
My entire life. But it started getting really, really bad
when I was pregnant with my son,
- who’s now three. [chuckles] - [Mark chuckles]
Do they cause you any other issues like pain, bad breath
- things like that at all? - [Destiny] Probably. [laughs]
- The bad breath, I’m assuming. - [Mark] Okay.
The tonsil stones smell when they come out.
- So, I’m just assuming. - [Mark] Yes, unfortunately they do smell very bad.
Crypts are like holes in the tonsils.
Uh, kind of like if you think about how the moon looks.
And then the holes, they produce keratin,
and then that, you know, the epithelial cells,
bacteria, just debris, kind of mixes together and forms those little stones.
And then they stick in there until you pop them out.
Tonsil stones can be anywhere from a size of a grain of sand to...
I’ve seen some tonsil stones about the size of a pinky nail.
So, pretty large.
[chuckles]
All right. You can go ahead and remove your mask if you’re fine with that.
Worst case scenario is,
the definitive treatment is to remove the tonsils.
And unfortunately, that’s not a pleasant procedure.
You have a little bit of a deviated septum but your nose otherwise looks great.
All right, let’s see these things.
Big ah. Look right up here for me.
So about three plus tonsils and definitely very cryptic.
- You can see the holes in the tonsils. - Sorry.
- [Mark] Do you have a bad gag reflex? - Yes, awful.
[Mark] Then what I’m gonna do is, I’m gonna spray some stuff in your throat.
- It’ll numb it up and blunt the gag reflex. - [Destiny] Okay.
- [Mark] Unfortunately, it tastes really bad. - Ugh.
- Understatement. [laughs] - [Mark laughs] Yes.
All right. Let’s see if we can do this.
So, look up here, just a little bit. Just like that.
So, you can see one right over here on the left side.
- Oh, yes. Oh, you’re fine. You’re fine. - [gags] Sorry.
- [Mark] It’s normal. - [gags]
[Mark] There’s one small one.
- You good? - Ah!
Oh, sorry. [laughs]
[coughing]
- [gags] Oh, sorry. - [Mark] Look at this.
All right, so I’m gonna turn this way, just a little bit.
- [gags] Sorry. - [both laugh]
- Told you it was really bad. - [Mark] No, it’s okay.
Tonsil stones have a very foul smell.
Similar to a dead animal.
[laughs] Like roadkill.
They’re not pleasant.
- Oh, goodness. - Smells bad.
[laughs]
So, with tonsils like yours,
the only good treatment is gonna be just removing your tonsils.
- Now, it’s not a fun surgery. So, fair warning. - [Destiny] Yeah.
Destiny came in with tonsil stones.
Unfortunately, no way to fix this problem
without just taking the tonsils out at this point.
Certainly should help the swallowing
and the discomfort back there as you have.
But the good news is, you won’t ever have a tonsil stone again.
She’ll suffer for 10-14 days to get it out.
So when someone is willing to do that, you know it’s probably significant enough.
In the long run, it’s usually worth it for them.
- No tonsils, no tonsil stones. - [both laugh]
Hello!
I’m Lynn Guan and I’m a physician assistant at the ENT Institute.
- Good morning, Ms. Moralski. - [Ms. Moralski] Hello, how are you?
- [Lynn] Good. How are you? - [Ms. Moralski] I’m good.
Even though I specialize in all things ear, nose and throat related,
I find myself spending a lot of time looking in people’s ears.
All right, so what’s going on today?
[Ms. Moralski] Oh, well. I had a little...
Little problem hearing.
I don’t know what it’s, you know, what it’s about, whatever.
And I thought I should come in, have it checked out.
[Lynn] All right. Well, let’s take a look inside.
Everyday at the ENT Institute, I see something that’s stuck in patients ears
Most of the time, it’s wax.
- So, this side has quite a lot of wax in here. - [Ms. Moralski] Okay.
I’d say I probably see a little under a 100 ear wax cases a month.
So, the wax is a bit hard on this side.
She had just a harder, more firm type of ear wax.
So I used a tool we call an alligator forcep
to gently peel away the layers of the wax
from the side of the ear canal.
You ready to see this piece?
- [Ms. Moralski] Uh, yeah. I guess. - [both chuckle]
- [Lynn] So, here’s what we have! - [Ms. Moralski] Oh, my gosh!
- [Lynn] Look at this here. So, that’s a good one there. - [Ms. Moralski] Oh, wow.
- Wow. - [Lynn chuckles] So this is what came out of your ear.
- So, you can see just how long it’s been there. - Yeah, no wonder I can’t hear.
- By how hard it is. Can you hear better now? - [laughs] Yeah.
- Yeah, I really can. It’s amazing. - [Lynn] Good.
[Ms. Moralski] Wow.
Ear wax and removal of ear wax is an artform.
You got a little wax in there.
Not all wax is the same.
We’re gonna get it out for you.
Does that feel a little bit more open?
[man] No, it feels good.
[woman] No wonder sometimes he has selective hearing.
With regard to ear wax, it’s something that’s genetically determined.
And I always jokingly say,
"It’s another thing you can blame on your mother."
They are really, completely clogged.
The motherlode. Here we go.
There we go?
That’s like a hole in one, to get it out in one piece.
- [woman] Hi, Crystal. Nice to meet you. - [Crystal] Nice to meet you.
So, tell me what’s been going on with your ear.
So when I first started doing ENT,
I guess I really didn’t realize that there was gonna be ear wax,
and it was a little off-putting.
Okay. Got a big bit out.
- But there’s more. - [woman] Oh, my God!
That is crazy.
If you’ve never had it cleaned out, and you’re used to the way your ears feel
when they’re full,
you don’t know that there’s a problem until you are about deaf.
- More of the same. - [woman] Oh, my goodness.
What in the world?
[Crystal] There.
[woman] Oh, ew.
- [chuckles] - [Crystal] Huh.
[woman] Oh, my God. I walk around like I’m cute,
- and that is just like, ew. - [Crystal laughing]
Everybody is like, [sighs].
Oh, my God, I feel so much better.
It’s like a weight lifted off. Like, I’m telling you,
say something.
[all laughing]
Some of it can be really thick.
This was wax out of that one ear.
Sometimes it smells.
[Dr. Daniel] There was a gentleman with an ear infection
and I could smell his ear from the doorway.
- You see that wax? - Yes.
[Dr. Daniel] Okay, we’re gonna clean that out.
It’s not uncommon to pull out a huge piece in one sitting.
[Lynn] Here we go, look at that!
- [man] Wow, my head feels lighter. - Does it feel lighter?
It can be like, that long,
and that thick.
And it’s just like, oh, wow.
- [man] Wow. - [Lynn] So, this is the big old guy
that came out of your ear.
- So there’s more of that pulled out over here. - [man] Oh, wow.
[Dr. Daniel] She is packed full of ear wax.
I actually had a guy, had to see him every six weeks.
Really.
We called him the candlestick-maker.
[laughs]
Oh, your... clean as a whistle.
I know you guys all wonder what happens to everything that goes through that suction
and through that mysterious tube,
but it all goes into a cannister.
It is full of all kinds of loveliness.
[Lynn] Everything from ear wax, drainage,
fungus, bacteria, blood,
all that good stuff.
- [choking] - [nurse] Gotta relax.
Open your eyes.
[nurse] So, in this bag, they’ll put your shoes and your
gown goes on like this.
[Destiny] I’m here to get my tonsils taken out
and deal with the tonsil stones that are building in the back of my throat.
It’s nerve-wracking and I’m stressed out, nervous.
I just want to get the surgery over with
because the tonsils are awful.
- [doctor] Destiny? I love that name. - Yes.
- It’s fantastic. But I love the hair more. - [chuckles]
I’m Dr. Jeffery Gallups. I’m the Medical Director of
the Ear, Nose and Throat Institute.
One of the most anxious times for a patient
is that morning, that day of surgery.
So, I always try to lighten the mood a little bit.
- You have much pain from it? - Yeah. A lot of discomfort at least.
Well, that’s gonna be gone. [clicks fingers]
Everyone knows someone that’s had a tonsillectomy.
And you think, "Oh, it’s a fairly benign procedure."
But it has its own complications.
So we wanna be very selective about why we’re doing this.
Dr. Bovenkerk’s taking care of you today.
I’ll be in the room but not performing the surgery.
- I’m excited for you. Great to meet you. - Yeah, awesome. Thank you.
The number one complication of a tonsillectomy is bleeding.
One of the other complications
is when you take tonsils out,
sometimes it creates more swelling
than the tonsils created at the time.
Now, this is temporary,
but if you have that, then you could suffocate.
[Dr. Stephen] Hello, hello, Destiny.
Hi! Dr. Bovenkerk.
Nice to meet you.
[nurse] This is just oxygen. We’ll have you start taking those nice,
deep breaths in and out.
Put your chin up towards the ceiling for me, perfect.
You’ve been on any vacations lately?
No, need one.
[nurse] You need one? Okay.
- [Dr. Stephen] Well, you’re gonna get one now. - [nurse] Yep.
[Dr. Stephen] Starting the medication now to help you drift off to Gatlinburg.
[Destiny chuckles]
[Dr. Stephen] Enjoy that nap.
This is a MacGyver retractor.
It does a really good job of keeping the mouth nice and open.
My tonsils, they’ve always been a problem.
I’m super excited to get the surgery over with.
And I’m really hoping that we can get it out today.
[Dr. Jeffery] Look at that. Oh, yeah.
Plenty to grasp on to there.
[Dr Stephen] I agree.
Tonsils can be very deceiving.
So when I looked in her mouth, it was huge.
And inflamed.
Looks like they’ve been bleeding.
You know, they’re just raw.
That is a really good indicator
for somebody who needs their tonsils removed.
[De. Stephen] So, she has cryptic tonsils with those crypts and crevices.
And they’re enlarged as well.
In the tonsil itself, are called crypts.
And it’s where food has been pushed
into these little holes in the tonsils.
And after a while, they become thick.
Kind of like sand on the beach.
Then after that, they become stones.
I’ve seen stones as this big.
Look like a spearhead.
In fact, I still have that one in my desk drawer.
[Dr. Stephen] We’re gonna put a catheter into the nose,
gives me a little better exposure of the tonsils.
We can start to see these white-ish, yellow-ish particles here.
Those are the tonsil stones.
Sometimes they are the size of garbanzo beans.
[Dr. Jeffery] The next thing is, retract the tonsil.
It’s against the side of the wall of the throat.
So, we want to stretch it,
so that we can really cut it off.
And it seals the vessels as it removes the tonsil.
You know, it’s like cutting through butter with a hot knife.
[Dr. Stephen] So, this is her right tonsil.
Quite a few of those little tonsil stones right on the surface here.
You can go ahead and pass that.
And we’ll get to work on the left tonsil.
And the left tonsil.
Really enlarged tonsils.
One of the scariest times is
when they remove the tube that assists them
to keep the airway open.
The surgeon many times suctions the stomach.
[instrument blowing]
Because after you take the tube out of the throat from surgery,
if they were to vomit or cough,
and their stomach’s full of fluid,
they will cough that up and potentially aspirate it,
or suck it back into their lungs.
And then you’ve got a real emergency.
[Dr. Stephen] And that is it.
[Dr. Jeffery] Fantastic.
[nurse] Destiny?
Destiny, you’re all done.
[gurgling]
- [coughing] - [Dr. Jeffery] There you go. Cough it up.
[nurse] Destiny, you’re just waking up, okay?
[Destiny coughing]
[nurse 2] Hey, Destiny. Can you open your eyes?
As you can see, she’s trying to fight this back a little bit.
Won’t open her eyes, she’s not responding to them.
You know, she’s biting a little bit on the tube.
They’re trying to get this out and she’s totally unaware any of this at this point.
[coughing]
- [nurse 1] Here we go. - [nurse 2] Try to relax.
- Okay? - [Dr. Jeffery] Perfect.
Welcome back.
It’s hard for me to not put myself in their position
’cause I had my tonsils out when I was a kid and I still remember it.
She’s gonna wake up. She’s gonna have a very sore throat.
She’s gonna be groggy.
But after the grogginess goes away,
it’s gonna be the worst sore throat she’s ever had.
But it’s gonna cure the problem.
[Destiny] I’m way too excited, ’cause I just want everything to be better.
And I might actually be able to like, eat food and
enjoy food again. That would be super great.
[laughs]
[chuckling] Fish hooks are a nemesis for patients.
She has a bead stuck in her ear.
A bead of a beanbag. So I tried to get it out.
Could it be popcorn?
[mother] Popcorn in her ear?
No! It’s a bead.
Pop, there’s goes the nail.
[] I’ve seen a few nail gun injuries like this.
You can see it’s actually in there pretty good.
You could hear it rip though a little bit of tendon or tissue.
[Dr. Daniel] He just has a ball of sort of jelly mucus that’s just
stuck there and it’s just never gonna come out,
unless we remove it.
- [machine whirring] - Here we go. Wow.
That is just...
That is just cool, look at that.
There is this pleasant lady
she’s got a huge stiletto heel
stuck smack into her face.