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Speaker 1: Since it is Wednesday, eight thirty, we go to Jim Keeney.

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Speaker 1: As always, doctor Jim McKinney, chief medical officer for Dignity

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Speaker 1: Saint Mary Medical Center in Long Beach, also a board

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Speaker 1: certified member of the er World and killing people. But

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Speaker 1: I always say that, Jim, we had a question before

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Speaker 1: we are going through the topics, and that is, I

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Speaker 1: don't know if you heard about this crazy ass congresswoman

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Speaker 1: from Illinois about dead fetuses in our water supply when

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Speaker 1: people have an abortion, you know, a self abortion with

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Speaker 1: meta metaphis prone or whatever the hell that's called. Anyway,

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Speaker 1: the question came up about medical waste and what happens

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Speaker 1: in the hospital with the medical waste.

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Speaker 2: You know, they put the stuff in those little red boxes.

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Speaker 2: What do you do with all that?

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Speaker 3: Oh boy, that is a complicated question. You know, it's

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Speaker 3: it's highly regulated. So what happens is, you know, regulatory

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Speaker 3: bodies in the in the county or the city will

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Speaker 3: come and actually follow a trash truck to the trash

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Speaker 3: dump and check to see if there's anything inappropriate being

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Speaker 3: sent to UH to the dump because all the all

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Speaker 3: the special trash, anything like with human waste or toxic

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Speaker 3: materials or say chemotherapy or even down to batteries. You know,

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Speaker 3: you can't dispose of those in the public waste system.

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Speaker 3: So uh that we have different special wastes for all

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Speaker 3: those different things. When you throw something away in the hospital,

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Speaker 3: you have to think about five different buckets that you

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Speaker 3: may have to throw it in.

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Speaker 2: So where does it go? I mean, yeah, you know,

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Speaker 2: I mean there's the needles that have.

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Speaker 1: Been used, you know, the bandages, uh, you know, the

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Speaker 1: people that are really sick and have gotten chemo.

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Speaker 2: Where's all that stuff go?

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Speaker 3: So a lot of it go those to get incinerated.

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Speaker 3: So there's companies that will take that away for us

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Speaker 3: and then incinerate it so that it's no longer you know,

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Speaker 3: toxic or no longer infectious. And then for you know,

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Speaker 3: things like needles and stuff like that. You know that

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Speaker 3: we have a disposal company that takes care of all

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Speaker 3: those sharps and you know, so there's specialties for every

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Speaker 3: single type of trash, you know, including just like you're

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Speaker 3: not supposed to throw away people aren't supposed to throw

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Speaker 3: away batteries either in their normal trash. It's supposed to

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Speaker 3: dispose of them properly, but especially lithium batteries. But you

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Speaker 3: know a lot of people I think do just throw

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Speaker 3: them in the trash?

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Speaker 1: Okay, because and the reason I bring that up because

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Speaker 1: Amy had that question, what do you do with the waste?

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Speaker 1: And so are there special places where for example, needles,

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Speaker 1: those aren't incinerated because that's hard to do and they

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Speaker 1: go wearing special dumps special locations.

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Speaker 3: Yeah, I think they probably, you know, you do something,

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Speaker 3: you know, like melted down or crush it or whatever.

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Speaker 3: Actually I don't you're a good question. I don't know

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Speaker 3: what happens after they take it away. I just know

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Speaker 3: that we can't throw it in the trash and we

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Speaker 3: have to give it to somebody to do something special

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Speaker 3: with it.

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Speaker 2: Okay, fair enough, you know what I want to take Colin.

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Speaker 1: I'm gonna take an early break here, okay, because we're

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Speaker 1: going to come back and there's something very special around

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Speaker 1: the world, and that is Tuberculosis Day as we celebrate TB.

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Speaker 2: Day all over the world.

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Speaker 1: And I have a couple of questions to ask Jim

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Speaker 1: about that.

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Speaker 2: Neil, you're giving me.

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Speaker 4: The weird quick Amy sent me information that said they

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Speaker 4: autoclave that stuff, so it would be similar to SANATAI.

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Speaker 4: So the needles and the sharps and stuff looks like

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Speaker 4: they autoclave it before they deconstruct or dispose of it.

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Speaker 2: That makes sense. So under heat.

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Speaker 3: Interesting, I'm going to go to work today and look

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Speaker 3: that up and find out what happens after the needles

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Speaker 3: leave the hospital.

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Speaker 4: So autoclave is just heat and pressure, right, Jim.

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Speaker 3: Yeah, that's what it is. But you know that doesn't

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Speaker 3: it doesn't make sense because we don't reuse the needles,

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Speaker 3: so you know, to auto cleaving is kind of a fussy,

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Speaker 3: detailed process that we do for things that we're going

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Speaker 3: to use in surgery for example, or stuff like that.

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Speaker 4: But tattooing as well. When I used to tattoo, Yeah,

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Speaker 4: autoclip to sanitize everything, all.

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Speaker 2: Right, World TB Day.

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Speaker 1: And the reason that I am so interested in that

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Speaker 1: is my mother was a lab tech at All of

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Speaker 1: You Medical Center in the fifties and when it was

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Speaker 1: a TB sanitarium and very few people know that. Well,

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Speaker 1: of course now it's the general hospital, but it was

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Speaker 1: a sanitarium for tuberculosis and it ended up having three

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Speaker 1: patients when it switched over. And the other reason I'm

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Speaker 1: interested in the World TB Day is much like many

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Speaker 1: hospitals around the country yours. Also, the first hundred people

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Speaker 1: that show up get a free TB infection.

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Speaker 2: Is that right?

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Speaker 3: Not true, Bill, not true, But it is true that

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Speaker 3: a lot of hospitals started as TV sanitariums. The same

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Speaker 3: thing with uc Irvine. It was a TV sanitarium initially.

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Speaker 3: So yeah, yesterday was World TB Day. It was March

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Speaker 3: twenty fourth, because that's the day in eighteen eighty two

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Speaker 3: that Robert Koch announced that he discovered mycobacterium tuberculosis, which

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Speaker 3: was the cause of tuberculosis, and it's still to this

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Speaker 3: day a massive disease. We're talking about two billion people

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Speaker 3: in the world affected. One out of every four people

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Speaker 3: in the world have tuberculosis. They're infected with it, but

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Speaker 3: most are in what we call latent stage. So the

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Speaker 3: bacteria is just laying dormant in your body and at

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Speaker 3: some point it becomes activated. That's how most TV cases occur,

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Speaker 3: as a latent TV turns into active TV. So why

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Speaker 3: is there a place where it belongs?

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Speaker 2: Why are there so few TV cases reported? Because that's

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Speaker 2: not a big deal here.

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Speaker 1: We don't hear much about tuberculosis here in the States, right.

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Speaker 3: So it's a huge disease burden as far as how

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Speaker 3: many people are infected, but how many people are symptomatic,

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Speaker 3: and you're only contagious when you're symptomatic, it's only a

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Speaker 3: small number. So ten percent of those people will convert

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Speaker 3: to being active TV. So the point here is you

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Speaker 3: can have a big impact on this disease and how

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Speaker 3: it progresses by learning that you have latent TV early.

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Speaker 3: And the only way to do that, because there's no

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Speaker 3: symptoms at all, you have to get a test for tuberculosis.

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Speaker 3: There's that little bubble like they inject into your skin

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Speaker 3: is one way to do it. That's the cheap, easy way.

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Speaker 3: And then a very expensive test called the inquantiferon test

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Speaker 3: is a blood test that will tell you whether you

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Speaker 3: have latent TV or not. And then if you do

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Speaker 3: get diagnosed, you can treat it. It's just one to

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Speaker 3: two drugs for three to four months. That sounds like

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Speaker 3: a lot, but compared to when it goes active of

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Speaker 3: you're talking about minimum for drugs to start, minimum six

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Speaker 3: months and as long as two years of treatment if

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Speaker 3: it becomes active.

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Speaker 1: Okay, the people that go to dry hot places, which

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Speaker 1: is traditionally before the antibiotics were kicking in.

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Speaker 2: Does that help? Is there anything? Is there any truth

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Speaker 2: to that?

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Speaker 3: Not for tuberculosis, but what people they'd send tuberculosis for

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Speaker 3: is up to high altitude. If you're at a high

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Speaker 3: altitude and the oxygen levels lower, tuberculos is very sensitive

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Speaker 3: to oxygen content, So you send people up to the

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Speaker 3: high altitude place and the bacteria had struggles to grow,

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Speaker 3: struggles to stay alive in the lungs.

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Speaker 2: How often did you see active TV cases in the er?

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Speaker 3: You know, pretty rare that we see an active TV case,

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Speaker 3: just like you're saying, But you know, as far as

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Speaker 3: people testing positive and then having to be treated for it,

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Speaker 3: that's common.

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Speaker 1: So the bottom line, if you test and there are

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Speaker 1: there are certain jobs where you have to test for TB,

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Speaker 1: especially in the medical world the UH, if you are positive,

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Speaker 1: you automatically go into the antibiotic phase where you have

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Speaker 1: to be treated.

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Speaker 3: Correct. So if you test positive, then the first thing

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Speaker 3: is you want to decide is this really latent TB

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Speaker 3: or do you have an early stage of active TV

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Speaker 3: and you didn't know it. So typically you'll get a

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Speaker 3: chest X ray, you know, we'll look and see if

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Speaker 3: you actually have active TB. If you do, then we

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Speaker 3: have to do the active TV treatment. If you don't,

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Speaker 3: then yeah, we get the nice simple latent tbment for

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Speaker 3: a few months. Again not contagious at that stage, so

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Speaker 3: you can keep working if you you know, work in

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Speaker 3: a hospital, you can keep you know, being exposed to

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Speaker 3: your family members, and you don't have to worry about

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Speaker 3: infecting them. And by treating it, you don't worry now

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Speaker 3: that you're going to become active and start infecting people.

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Speaker 3: You know, a lot of times you're infectious before you

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Speaker 3: have significant symptoms because it's just a a dry cough something,

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Speaker 3: you know. The early stages are a very dry cough,

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Speaker 3: so it doesn't seem anything but annoying for a long time,

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Speaker 3: and then when it doesn't go away, you finally get

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Speaker 3: a chest ticks ray and realize, oh my gosh, I

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Speaker 3: have active TV and I've been doing it for months.

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Speaker 4: Hey, doc, is is TB what they used to call

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Speaker 4: the consumption?

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Speaker 3: Yeah, they used to call it galloping consumption. That's before

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Speaker 3: they knew what caused it, right, we didn't know what

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Speaker 3: caused it. It looked almost the patients look like cancer

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Speaker 3: patients because it drained so much energy out of their body,

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Speaker 3: they lose it on a weight, they become really gaunt,

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Speaker 3: and they just look like they're suffering from cancer. So

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Speaker 3: it literally consumes your body from the inside out.

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Speaker 1: Doc Holiday okay, the Okay Okay Corral had consumption, died

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Speaker 1: of it. And so I you everget asked out on Jeopardy,

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Speaker 1: you're going to have you have a winning answer.

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Speaker 2: All right, Jim, we'll talk again next week. You have

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Speaker 2: a good one, all right.

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Speaker 3: Take care