WEBVTT - How does Testicular Torsion occur?

0:00:01.190 --> 0:00:05.369
<v Speaker 1>Now Health Matters with Daniel Martin. Welcome into Health Matters

0:00:05.380 --> 0:00:08.228
<v Speaker 1>right here on CN 8938. Many of you, many of

0:00:08.239 --> 0:00:12.369
<v Speaker 1>you have been sharing this article and leaving comments of

0:00:12.380 --> 0:00:18.600
<v Speaker 1>concern and wondering about the medical condition known as testicular torsion.

0:00:18.610 --> 0:00:22.549
<v Speaker 1>You would have read about the doctor suspended after misdiagnosing.

0:00:22.770 --> 0:00:26.809
<v Speaker 1>Um the condition in a young boy initially treating what

0:00:26.819 --> 0:00:29.700
<v Speaker 1>the doctor thought was maybe an infection.

0:00:30.290 --> 0:00:32.029
<v Speaker 1>And then it resulted in the fact that this boy

0:00:32.040 --> 0:00:35.799
<v Speaker 1>had to undergo surgery to remove his left testes and

0:00:35.810 --> 0:00:38.889
<v Speaker 1>this was after this delayed diagnosis of testicular torsion. It's

0:00:38.900 --> 0:00:39.909
<v Speaker 1>an emergency condition.

0:00:40.659 --> 0:00:42.098
<v Speaker 1>I want to learn more about it

0:00:42.840 --> 0:00:45.909
<v Speaker 1>who it could affect how you can figure out for

0:00:45.918 --> 0:00:49.299
<v Speaker 1>yourself and whether like this one, like I, I need

0:00:49.310 --> 0:00:52.200
<v Speaker 1>a second opinion here. I don't think this doctor is right.

0:00:52.209 --> 0:00:55.319
<v Speaker 1>I'm pretty sure it could be something like testicular torsion.

0:00:55.540 --> 0:00:58.669
<v Speaker 1>Let's discuss the health matter itself. Dr Jay Lim is

0:00:58.680 --> 0:01:00.919
<v Speaker 1>back on the show. He is a urologist at a

0:01:00.930 --> 0:01:03.979
<v Speaker 1>Pan Asia Surgery Group. Dr Lim, thank you so much

0:01:03.990 --> 0:01:04.610
<v Speaker 1>for coming back.

0:01:05.039 --> 0:01:08.499
<v Speaker 2>No worries, Daniel. Always great to be back here again.

0:01:08.628 --> 0:01:08.708
<v Speaker 1>I

0:01:08.749 --> 0:01:12.859
<v Speaker 1>understand you recently had some experience with this, didn't you?

0:01:13.540 --> 0:01:17.139
<v Speaker 2>I actually do because in fact, it's actually quite a

0:01:17.150 --> 0:01:20.800
<v Speaker 2>quite common occurrence. It's one of these things that neurologists

0:01:20.809 --> 0:01:23.899
<v Speaker 2>must look out for and we constantly think about it

0:01:23.910 --> 0:01:27.889
<v Speaker 2>any time. And every time we see a young gentleman

0:01:27.900 --> 0:01:31.639
<v Speaker 2>that comes in complaining of pain in the

0:01:31.745 --> 0:01:36.125
<v Speaker 2>scrotum region, that's always what we worry about. And in fact,

0:01:36.135 --> 0:01:39.375
<v Speaker 2>there are some characteristics that we look at it and

0:01:39.385 --> 0:01:43.164
<v Speaker 2>the recent case that I actually got involved in generally

0:01:43.175 --> 0:01:47.305
<v Speaker 2>happens at where testicular caution most commonly happened. And which

0:01:47.315 --> 0:01:50.964
<v Speaker 2>is basically two main periods. The first period actually is

0:01:50.974 --> 0:01:54.264
<v Speaker 2>actually when you just born, that's actually the most common

0:01:54.275 --> 0:01:56.565
<v Speaker 2>cause is you actually see testicular torsion.

0:01:56.910 --> 0:02:01.129
<v Speaker 2>The other peak that we commonly see is just around

0:02:01.139 --> 0:02:04.989
<v Speaker 2>after the age of puberty. So any young gentleman that

0:02:05.000 --> 0:02:09.410
<v Speaker 2>comes in below the age of 20 or even 20

0:02:09.419 --> 0:02:11.970
<v Speaker 2>in their twenties, I would actually think about whether this

0:02:11.979 --> 0:02:16.320
<v Speaker 2>is a torsion, the numbers are out there. About one

0:02:16.330 --> 0:02:20.209
<v Speaker 2>in 4000 male can actually have a torsion. It is

0:02:20.220 --> 0:02:22.288
<v Speaker 2>not as common as appendicitis for sure.

0:02:22.945 --> 0:02:25.884
<v Speaker 2>But if you are a young teenage boy that comes

0:02:25.895 --> 0:02:28.595
<v Speaker 2>into my clinic, in fact, it's probably one of the

0:02:28.604 --> 0:02:30.913
<v Speaker 2>first things that we are trained to actually think of,

0:02:30.925 --> 0:02:33.323
<v Speaker 2>which is whether this is a case of torsion, we

0:02:33.335 --> 0:02:34.353
<v Speaker 2>are dealing with what

0:02:34.365 --> 0:02:37.125
<v Speaker 1>is happening exactly what's getting twisted and why is it

0:02:37.163 --> 0:02:38.524
<v Speaker 1>a medical emergency?

0:02:39.029 --> 0:02:42.300
<v Speaker 2>Right. So what you can think about portion. Um The

0:02:42.309 --> 0:02:44.830
<v Speaker 2>way to look at it is basically test, this is

0:02:44.839 --> 0:02:47.679
<v Speaker 2>like any organ in the body. You need blood supply,

0:02:47.690 --> 0:02:50.699
<v Speaker 2>you need good blood supply. And imagine basically if I

0:02:50.710 --> 0:02:52.639
<v Speaker 2>take my finger out here and I put in a very,

0:02:52.649 --> 0:02:54.669
<v Speaker 2>very tight rubber band and I ask you to hold

0:02:54.679 --> 0:02:58.279
<v Speaker 2>a rubber band for around 4 to 6 hours. It

0:02:58.288 --> 0:02:58.410
<v Speaker 2>need

0:02:58.524 --> 0:03:01.163
<v Speaker 2>actually the 1st 5, 10 minutes might be bearable. But

0:03:01.175 --> 0:03:04.134
<v Speaker 2>as condition as they go by the blood flow gets

0:03:04.145 --> 0:03:07.604
<v Speaker 2>a bit impinged and you start turning blue. And after that,

0:03:07.615 --> 0:03:10.615
<v Speaker 2>it starts looking very tender and it gets swollen and

0:03:10.625 --> 0:03:13.705
<v Speaker 2>all that stuff. That's essentially what's happening to the test

0:03:13.714 --> 0:03:16.865
<v Speaker 2>is because the test is only got one major blood

0:03:16.875 --> 0:03:18.145
<v Speaker 2>vessel that goes in

0:03:18.460 --> 0:03:22.259
<v Speaker 2>when you torsion. A test is what you're doing is

0:03:22.270 --> 0:03:27.089
<v Speaker 2>basically twisting the torsion within the scrotum bit more and more.

0:03:27.100 --> 0:03:31.049
<v Speaker 2>And we talk about 360 to degrees torsion or even

0:03:31.059 --> 0:03:34.759
<v Speaker 2>580 degrees to or whatever many rounds that you can get.

0:03:34.979 --> 0:03:38.220
<v Speaker 2>So imagine basically having an organ that's basically

0:03:38.375 --> 0:03:41.914
<v Speaker 2>wheeze out his blood supply. That's what's to and how

0:03:41.925 --> 0:03:47.964
<v Speaker 2>basically it can present as an immense pain usually. Um,

0:03:47.975 --> 0:03:50.604
<v Speaker 2>so bad that he actually induces a bit of nausea

0:03:50.615 --> 0:03:53.445
<v Speaker 2>and vomiting. So it's a very, very, not uncommon to

0:03:53.455 --> 0:03:56.395
<v Speaker 2>actually see them coming in. We're looking very, very sick

0:03:56.404 --> 0:03:58.315
<v Speaker 2>in a huge amount of pain.

0:03:58.559 --> 0:04:02.559
<v Speaker 2>The key to this diagnosis is that you need to

0:04:02.570 --> 0:04:07.100
<v Speaker 2>make sure you got diagnosis within 4 to 8 hours

0:04:07.110 --> 0:04:10.500
<v Speaker 2>depending on what age group you are. That's right. Imagine

0:04:10.509 --> 0:04:12.740
<v Speaker 2>if you basically cross the line of 6 to 8

0:04:12.750 --> 0:04:15.220
<v Speaker 2>hours for male or even 4 to 6 hours in

0:04:15.229 --> 0:04:18.539
<v Speaker 2>younger boys, then there is not much I can do

0:04:18.549 --> 0:04:20.738
<v Speaker 2>to reverse the damage that's already done

0:04:21.260 --> 0:04:23.329
<v Speaker 1>because of that blood loss, because of the torture that

0:04:23.339 --> 0:04:25.299
<v Speaker 1>results in a blood loss. The organ is loss,

0:04:25.309 --> 0:04:28.769
<v Speaker 2>right? Yes, the organ is lost and it's irreversible damage.

0:04:28.779 --> 0:04:32.640
<v Speaker 2>Of course, you can come to a hospital in certain cases,

0:04:32.649 --> 0:04:35.649
<v Speaker 2>they come to hospital too late and we can always

0:04:35.660 --> 0:04:39.279
<v Speaker 2>try to say for selfish to test this. But as

0:04:39.290 --> 0:04:42.200
<v Speaker 2>times go by, you can imagine that the salvage weight

0:04:42.209 --> 0:04:44.839
<v Speaker 2>becomes less and less and less and less as they,

0:04:44.850 --> 0:04:46.440
<v Speaker 2>as the hours go by. Obviously,

0:04:46.450 --> 0:04:49.959
<v Speaker 1>pain has been endured. It's very uncomfortable, it's painful and,

0:04:50.220 --> 0:04:52.539
<v Speaker 1>and to go through that is one thing and, and

0:04:52.549 --> 0:04:54.440
<v Speaker 1>let's say you have to go through the loss and

0:04:54.450 --> 0:04:57.760
<v Speaker 1>the removal of one testee. What is the health implication

0:04:57.980 --> 0:04:58.380
<v Speaker 1>of

0:04:58.390 --> 0:04:58.799
<v Speaker 1>that

0:05:00.160 --> 0:05:02.750
<v Speaker 2>in? I suppose the good way to look at it

0:05:02.760 --> 0:05:06.130
<v Speaker 2>is there's always an implication, nobody likes to lose an

0:05:06.140 --> 0:05:08.669
<v Speaker 2>organ regardless of the situation.

0:05:09.000 --> 0:05:12.820
<v Speaker 2>Um But it depends on what age group that you

0:05:12.829 --> 0:05:16.010
<v Speaker 2>are we are talking about. Uh if it's basically a

0:05:16.019 --> 0:05:19.230
<v Speaker 2>young boy before the marriage, age of marriage, then the

0:05:19.238 --> 0:05:23.309
<v Speaker 2>issue of fertility will come into play. But the good

0:05:23.320 --> 0:05:26.019
<v Speaker 2>thing about how we are made, God actually gave us

0:05:26.029 --> 0:05:29.070
<v Speaker 2>a spare. So technically, with only one functioning test, this

0:05:29.079 --> 0:05:30.140
<v Speaker 2>is actually enough

0:05:30.675 --> 0:05:34.626
<v Speaker 2>to actually give us enough hormones to actually go on

0:05:34.635 --> 0:05:37.865
<v Speaker 2>with life because the test is itself uh needs to

0:05:37.876 --> 0:05:40.876
<v Speaker 2>basically come up with testosterone, which is the male hormone.

0:05:41.115 --> 0:05:44.515
<v Speaker 2>So one test is enough to actually generate enough testosterone

0:05:44.565 --> 0:05:49.145
<v Speaker 2>and is actually good enough to actually uh produce enough

0:05:49.156 --> 0:05:51.476
<v Speaker 2>sperm for reproduction in

0:05:51.582 --> 0:05:55.361
<v Speaker 2>future. But you can imagine the psychological impact of a

0:05:55.372 --> 0:06:00.380
<v Speaker 2>young boy or young teenager walking around. Basically, they knew

0:06:00.391 --> 0:06:03.462
<v Speaker 2>what happened. They might have a lot of stress or

0:06:03.471 --> 0:06:08.880
<v Speaker 2>mental disturbances from, you know, walking around with one less organ. Now, naturally,

0:06:08.891 --> 0:06:11.832
<v Speaker 2>if you are in the age whereby you are trying

0:06:11.842 --> 0:06:12.802
<v Speaker 2>to start a family,

0:06:13.070 --> 0:06:17.549
<v Speaker 2>then the implications are somewhat different. And the the fertility,

0:06:17.559 --> 0:06:21.589
<v Speaker 2>if the remaining test is is normal, then great, the

0:06:21.600 --> 0:06:25.260
<v Speaker 2>chances of you conceiving probably is not that badly damaged.

0:06:25.269 --> 0:06:28.190
<v Speaker 2>But let's say if you had a previous accident on

0:06:28.200 --> 0:06:30.979
<v Speaker 2>the remaining test is before or you have some previous

0:06:30.988 --> 0:06:34.809
<v Speaker 2>conditions that affect the facility, then naturally that

0:06:34.920 --> 0:06:39.178
<v Speaker 2>person's chances of having a baby would go down as

0:06:39.190 --> 0:06:41.690
<v Speaker 2>a result of that damage. And of course, if you're

0:06:41.700 --> 0:06:44.558
<v Speaker 2>in your fifties and sixties, which yes, they occur in

0:06:44.570 --> 0:06:47.458
<v Speaker 2>that age group do very, very rare, right in the

0:06:47.470 --> 0:06:51.079
<v Speaker 2>older generation. And obviously, the impact may not be that

0:06:51.089 --> 0:06:54.789
<v Speaker 2>bad as long as the hormonal functions can be taken

0:06:54.799 --> 0:06:56.660
<v Speaker 2>up by the remaining testes,

0:06:57.190 --> 0:06:59.390
<v Speaker 1>that's good to know, at least in that regard. But

0:06:59.399 --> 0:07:02.570
<v Speaker 1>like you said, the psychological impact is worth bearing in

0:07:02.579 --> 0:07:06.079
<v Speaker 1>mind as well that I've heard about, I mean, other

0:07:06.089 --> 0:07:07.399
<v Speaker 1>implants that exist.

0:07:08.269 --> 0:07:13.359
<v Speaker 2>So in the unfortunate situation that you have to have

0:07:13.369 --> 0:07:14.820
<v Speaker 2>one test is removed and in

0:07:15.170 --> 0:07:19.140
<v Speaker 2>situations like trauma or accidents or torsion, you lost one

0:07:19.149 --> 0:07:23.450
<v Speaker 2>test is they are actually implants that we can actually

0:07:23.459 --> 0:07:25.959
<v Speaker 2>put into, um, back into the quater. And if you

0:07:25.970 --> 0:07:28.929
<v Speaker 2>were to look on the website and that's basically an architect,

0:07:29.040 --> 0:07:33.029
<v Speaker 2>architect do meter, what it does is that basically it,

0:07:33.589 --> 0:07:35.920
<v Speaker 2>there's a whole string of implants and you can look

0:07:35.929 --> 0:07:38.670
<v Speaker 2>at what is the appropriate size. I know one funny

0:07:38.679 --> 0:07:41.640
<v Speaker 2>thing aside as boys, basically, everybody wants to go for

0:07:41.649 --> 0:07:42.359
<v Speaker 2>the bigger size

0:07:43.049 --> 0:07:44.459
<v Speaker 1>you should go for that matches

0:07:44.470 --> 0:07:45.170
<v Speaker 1>folks.

0:07:45.359 --> 0:07:47.600
<v Speaker 2>That is absolutely right. So we try to match up

0:07:47.609 --> 0:07:50.609
<v Speaker 2>the contralateral side of the remaining test is and we

0:07:50.619 --> 0:07:54.049
<v Speaker 2>figure out what size works best for you and in surgery,

0:07:54.059 --> 0:07:57.890
<v Speaker 2>we actually replace it so that it's basically giving

0:07:57.975 --> 0:08:00.605
<v Speaker 2>the patients or in this case, the young gentleman a

0:08:00.614 --> 0:08:02.894
<v Speaker 2>bit of a psychological support.

0:08:03.005 --> 0:08:06.484
<v Speaker 1>It's an implant that helps in terms of the appearance factor,

0:08:06.524 --> 0:08:08.855
<v Speaker 1>but it doesn't replace the functional aspects in

0:08:08.864 --> 0:08:09.325
<v Speaker 1>any way,

0:08:09.415 --> 0:08:13.565
<v Speaker 2>doesn't it just a plastic model that's long lasting and

0:08:13.575 --> 0:08:14.684
<v Speaker 2>it's appropriate sized.

0:08:14.695 --> 0:08:16.855
<v Speaker 1>Got it, I think just as we end off. I

0:08:16.864 --> 0:08:20.434
<v Speaker 1>think it goes to question what caused the torsion to

0:08:20.445 --> 0:08:22.234
<v Speaker 1>happen and how do we prevent this?

0:08:23.369 --> 0:08:29.690
<v Speaker 2>In many cases, torsion occurs because of some uh congenital

0:08:29.700 --> 0:08:34.190
<v Speaker 2>uh anatomical abnormalities. Um As I mentioned to you just now,

0:08:34.200 --> 0:08:37.000
<v Speaker 2>there are two periods as torsion is still can occur

0:08:37.309 --> 0:08:41.069
<v Speaker 2>in um young babies. We call it the prenatal or

0:08:41.080 --> 0:08:46.119
<v Speaker 2>perinatal ages. It's basically due to uh extra virginal torsion

0:08:46.130 --> 0:08:49.179
<v Speaker 2>that happens when the test is actually gets got into

0:08:49.190 --> 0:08:52.119
<v Speaker 2>the scrotum just as it was better get into the

0:08:52.130 --> 0:08:52.689
<v Speaker 2>scrotum

0:08:52.919 --> 0:08:55.469
<v Speaker 2>and it torch and the whole blood vessel is torn.

0:08:55.900 --> 0:08:58.780
<v Speaker 2>Um That is actually the most common reason as to

0:08:58.789 --> 0:09:02.320
<v Speaker 2>why it taught in babies. But for young teenagers, it's

0:09:02.330 --> 0:09:07.819
<v Speaker 2>mostly an extra or intra virginal torsion caused by an

0:09:07.830 --> 0:09:12.820
<v Speaker 2>anatomical variation called the vow clapper uh anatomy. So what

0:09:12.830 --> 0:09:16.359
<v Speaker 2>happens is imagine having a t uh attack

0:09:16.455 --> 0:09:19.314
<v Speaker 2>is supposed to be fixed on about 3 to 4

0:09:19.325 --> 0:09:22.983
<v Speaker 2>parts of the uh of the of the scrotum is

0:09:22.994 --> 0:09:25.195
<v Speaker 2>supposed to be fixed to it so that it actually

0:09:25.205 --> 0:09:29.364
<v Speaker 2>prevents turning in a bell clapper deformity. The test itself

0:09:29.375 --> 0:09:33.784
<v Speaker 2>actually are allowed to move a bit more than usual. Therefore,

0:09:33.794 --> 0:09:37.835
<v Speaker 2>in situations where they suddenly undergo puberty, they start twisting

0:09:38.224 --> 0:09:39.934
<v Speaker 2>and turning and you get into the

0:09:39.989 --> 0:09:42.909
<v Speaker 2>this situation. So it will be fairly different depending on

0:09:42.919 --> 0:09:45.250
<v Speaker 2>what kind of age group. But the treatment is all

0:09:45.260 --> 0:09:48.109
<v Speaker 2>the same. It is a surgical emergency. You need to

0:09:48.119 --> 0:09:50.570
<v Speaker 2>get to the hospital as soon as you can. In

0:09:50.580 --> 0:09:54.530
<v Speaker 2>the last situation that I had. This young gentleman, young boy,

0:09:54.539 --> 0:09:56.809
<v Speaker 2>12 years old came in, he was woken up in

0:09:56.820 --> 0:10:00.330
<v Speaker 2>the middle of the night mom got him into emergency very,

0:10:00.340 --> 0:10:03.440
<v Speaker 2>very quickly. And by 8 a.m.

0:10:03.525 --> 0:10:05.744
<v Speaker 2>he came in through around 4 a.m. by 8 a.m.

0:10:05.755 --> 0:10:10.054
<v Speaker 2>operations already done and he got immediately better because the

0:10:10.065 --> 0:10:12.064
<v Speaker 2>blood flow has been restored.

0:10:12.354 --> 0:10:16.484
<v Speaker 1>My gosh, so it's not due to trauma, sporting activity,

0:10:16.494 --> 0:10:18.145
<v Speaker 1>tight underwear. None of that,

0:10:18.455 --> 0:10:21.344
<v Speaker 2>none of that. None of that is just an anatomical

0:10:21.354 --> 0:10:23.505
<v Speaker 2>variation abnormality that can

0:10:23.515 --> 0:10:23.984
<v Speaker 2>occur.

0:10:24.195 --> 0:10:26.093
<v Speaker 1>That's good to know as well. So really time is

0:10:26.104 --> 0:10:26.944
<v Speaker 1>of the essence here.

0:10:27.299 --> 0:10:29.299
<v Speaker 1>Yes, it is. In fact. So the minute you feel

0:10:29.309 --> 0:10:32.419
<v Speaker 1>that very strong pain and it's centered in the scroll term,

0:10:32.429 --> 0:10:33.348
<v Speaker 1>you will feel it centered

0:10:33.359 --> 0:10:33.570
<v Speaker 1>there.

0:10:33.739 --> 0:10:37.080
<v Speaker 2>Yes, it's so painful that you want to basically feel

0:10:37.090 --> 0:10:39.549
<v Speaker 2>like vomiting. You feel nauseous. You can't stand up no

0:10:39.559 --> 0:10:44.099
<v Speaker 2>matter what you do points to the right spot. And

0:10:44.109 --> 0:10:46.520
<v Speaker 2>if that's the case, if in doubt, I will also

0:10:46.530 --> 0:10:49.479
<v Speaker 2>suggest you get seek help at the first possible time

0:10:49.520 --> 0:10:51.289
<v Speaker 2>so that you can have it looked at and

0:10:51.299 --> 0:10:52.919
<v Speaker 1>this is definitely an A&amp;E kind of situation.

0:10:53.015 --> 0:10:53.745
<v Speaker 2>Oh, it's

0:10:53.755 --> 0:10:56.895
<v Speaker 2>definitely an A&amp;E you've got time is of essence here.

0:10:56.905 --> 0:11:00.056
<v Speaker 2>We're talking about 4 to 8 hours. You want to

0:11:00.065 --> 0:11:03.476
<v Speaker 2>be able to get into the problem and taught it

0:11:03.486 --> 0:11:05.306
<v Speaker 2>as soon as you can. So this is one of

0:11:05.315 --> 0:11:08.955
<v Speaker 2>those few medical emergencies that you see me jumping around in,

0:11:08.966 --> 0:11:12.866
<v Speaker 2>in emergency department. Usually I'm quite chill and everything's gonna

0:11:12.875 --> 0:11:15.255
<v Speaker 2>take a while and so on and so forth. Except

0:11:15.265 --> 0:11:17.875
<v Speaker 2>for torsion, I really would want to get into theaters

0:11:17.885 --> 0:11:18.635
<v Speaker 2>as soon as I can

0:11:18.731 --> 0:11:20.932
<v Speaker 2>so much so that I even start pushing the patients

0:11:20.942 --> 0:11:24.791
<v Speaker 2>to the, to the operating theater myself that has happened before.

0:11:25.062 --> 0:11:28.221
<v Speaker 2>And it is this situation that you can really make

0:11:28.231 --> 0:11:30.521
<v Speaker 2>a difference if you get there on time at the

0:11:30.530 --> 0:11:31.101
<v Speaker 2>right place.

0:11:31.242 --> 0:11:32.151
<v Speaker 1>Valuable

0:11:32.160 --> 0:11:34.221
<v Speaker 1>valuable advice. Doctor Lim could have done it without you.

0:11:34.231 --> 0:11:35.752
<v Speaker 1>Thank you so much for coming on the show. No

0:11:35.761 --> 0:11:37.721
<v Speaker 2>problem, Daniel. Always a pleasure. Doctor

0:11:37.731 --> 0:11:40.481
<v Speaker 1>J Lim there who's a urologist out of Pan Asia

0:11:40.492 --> 0:11:44.341
<v Speaker 1>surgery group. I'm Daniel Martin and this is health matters

0:11:50.119 --> 0:11:53.700
<v Speaker 1>before making any decisions based on the information in our program.

0:11:53.710 --> 0:11:55.699
<v Speaker 1>Please consult a medical professional.