Sep 14, 2021

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Scot: Troy was out of town, so I was not able to call Troy with a medical issue that I had.

Troy: Oh, no.

Scot: Yeah. I mean, you were on vacation. I wasn't going to bother you.

Troy: Thanks.

Scot: I mean, I more or less knew the answer, but I thought it might be an interesting topic. And I think maybe we can learn something, especially if you have kids, or if this happens to you. So I swallowed a crown last week.

Troy: So a crown from your tooth? This was not a toy from a Burger King meal.

Scot: No.

Troy: A child's meal. This was a crown that popped off your tooth and you swallowed it?

Scot: Yeah. So I'm just eating a sandwich, and then the next thing I know, I've got this raw nub of a tooth in my mouth. I'm like, "What happened?" And I check around in my mouth and the food, and it's not there.

Mitch: What was in that sandwich to knock a crown off?

Scot: I don't know. This particular crown has been problematic. I don't know if it was made right. I've had to have it glued on a couple of times.

Mitch: Geez.

Scot: So, anyway, I swallowed this crown. Now, the first thing I think . . . Do you guys want to guess what the first thing I think is?

Troy: The first thing I would think is, "Now I'm going to have to sift through my poop for the next four days to find this stupid crown."

Scot: Yes. Right.

Troy: That would be my first thought. I would not be concerned about this crown being in my stomach. I would be concerned about what's going to now have to happen over the next four days, depending how frequently you have bowel movements.

Scot: Yeah, because I wanted to retrieve that. Crowns aren't cheap. They're kind of expensive, right?

Troy: Like a thousand bucks, aren't they?

Scot: What's that? A thousand? I don't know.

Troy: They cost a lot, yeah. To make a crown is not cheap.

Scot: I mean, they take time to make it. That's going to be two trips minimum to the dentist, one to get the mold and then the other to install it. So I'm like, "All right. So I wonder, first of all, when do I need to start worrying? Is today's bowel movement going to be something I need to worry about, or . . ."

Troy: "Is this the one?"

Scot: Yeah. Or do I need to wait a little bit? So I started doing some work on the internet. And we've talked in the past about, is it a concern? When should you be concerned when you swallow things?

Troy: Yeah. So were you concerned about that? Were you concerned about it causing problems in your intestines, or was it more just like, "I've got to sift through my poop"?

Scot: Yeah. I mean, from what I've learned from you, unless it's got some sharp edges, or it's really, really big, if it can make it down your throat and it's got smooth edges, you're probably going to be okay and just pass it if you're an adult.

Troy: Yeah. I love that you took that. Really, if it's wider than three centimeters, or longer than five centimeters, or it's sharp . . .

Scot: Can we talk about this in inches? I mean, what country do you think we're in?

Troy: If it's wider than 2 inches or longer than 3.5 inches . . .

Scot: Better.

Troy: . . . that's when you get concerned.

Scot: That's a pretty big object.

Troy: That's pretty big. Or if it's sharp. If it's big, it's not going to get past your stomach. You've got the pylorus there, which leads out of the stomach into the duodenum, the small intestines, all that. So if it can't get past that, it's going to block it. So that's the problem. But yeah, a crown, that's really small. You're fine.

Scot: So clarify something. I could theoretically swallow something that is too big to pass from my stomach into my small intestine?

Troy: Oh, for sure.

Scot: Okay. So the throat is not the limiting factor here, unfortunately?

Troy: It's not the throat. No. It's the stomach going into the small intestine. And on a regular basis . . . not super regular, but it's not uncommon for me to see people who intentionally swallow items, adults who intentionally swallow items, and then we have to call the GI doctors in because it meets one of those criteria, and they have to go in and fish it out. It's just sitting in their stomach waiting to block things up. But you were fine with your tooth. That's not a big deal.

Scot: So, anyway, during this kind of search, I found out some interesting fun facts, and then we're going to get back to what a recovery effort looks like in a situation like this. When you start thinking about . . .

Troy: I've got to ask you this, Scot. Did you really want to put a crown back in your mouth that has . . .

Mitch: That's what I was going to say.

Troy: . . . gone through your small intestines and large intestines that you pulled out of your poop? I mean, is it worth the money saved? I don't know. I'm curious where this is going.

Scot: Yeah. I've always wanted to have the name "stinky tooth," so maybe, the nickname.

Troy: Rot Mouth?

Scot: All right. So a couple of little fun facts that I found. This was kind of interesting as I'm doing the search. So there have been a lot of studies looking at coins. If you swallow a coin, how long does that take to pass? And the range is anywhere from 3.1 to 5.8 days, average of about 4 days to pass a coin. There was actually a group of pediatricians that did an experiment where six of them swallowed a small LEGO head.

Troy: Oh, boy. This is good.

Scot: Because kids . . . And this was actually published in the "Journal of Pediatrics and Child Health."

Troy: Oh, I love it.

Scot: Yeah. They swallowed these little, small round LEGO heads, and they wanted to find out how long it took to pass through their systems. Obviously, pediatricians would have an interest in that because of kids. So they kept a daily diary of their bowel movements, and they recorded these little details, like the texture that could potentially impact the toy's . . .

Troy: Oh, that's awesome.

Scot: . . . travel time through their systems. By the way, they called that the SHAT scale.

Troy: Love it.

Scot: They had to rate their turd's qualities on the SHAT scale, which stood for Stool Hardness and Transit.

Troy: So good. That might be the best scale acronym I've heard. I've got to start using that.

Mitch: Who are these scientists?

Scot: This was a group of internationally renowned pediatricians, is who this was.

Mitch: They're just choking down some LEGOs, and then . . .

Scot: Yeah, and then sifting through their own. And then the other thing is when they recovered it, they call that their FART, which was the Found and Retrieved Time score, their FART score.

Troy: I love it.

Scot: Anyway, LEGO heads, there was a range of 1.14 to 3.04 days, with the average being of 1.71. The women pediatricians passed it faster than the men. Why? I don't know. And one of the pediatricians never found his LEGO head after a week.

Troy: Oh, wow.

Scot: So it could have been he didn't pass it. It could have been he missed it.

Troy: Probably missed it.

Scot: So, anyway, those LEGO heads went through faster than a penny. Why would you say that is, Dr. Madsen? It took a penny four days. The average was 1.71 on the LEGO heads.

Troy: Well, imagine a penny in a stream and imagine a LEGO in a stream.

Scot: Sure.

Troy: That's my theory.

Scot: A round LEGO head versus a flat penny.

Troy: Yeah. It's like having the wind at your sails with a LEGO. You've got more stuff pushing. You've got more surface area for it to push than a penny, which can maybe just sit there and stuff moves around it. I don't know. That's my theory.

Mitch: Is that the twist? Does Scot have a bunch of LEGOs for us to swallow?

Troy: Is this where we're going now?

Scot: Yes.

Troy: Please, no, Scot. Please, no. I'm still traumatized by the cooking stuff. Don't make me do this.

Scot: I like to think in holistic terms on the show. We dealt with cooking, which is in. We're going to deal with the out now.

Troy: And then we'll evaluate our own transit times.

Scot: So, anyway, back to the crown. So then I started thinking about, strategically, from a practical standpoint, how do you recover it? And this is when I actually wanted to call you, because I'm like, "I could take some laxatives and whatnot." But then it's just under the bottom of a muddy, yucky bowl.

Troy: So let me get this right. You wanted to call me. I wish you had, now that you're telling me this story. I wish I had not been on vacation. But you wanted to call me to ask me how you should sift through your poop to find your crown?

Scot: Yeah. I wanted some ideas.

Troy: As if I, number one, regularly counsel people on this, or, number two, do it myself?

Scot: It's possible. So I did a quick internet search, and it was really kind of surprisingly difficult to find on Google how to do this from a practical standpoint. And then finally I did. And this is another interesting thing. You can see how one person's idea can travel on the internet, because I found the exact same idea on numerous different websites almost verbatim, all these websites almost claiming it as their own.

Troy: Let me tell you what I would have told you, Scot, and I'm curious if this coincides with what you found. If you would have called me, I would have said to poop into a colander, like one of those strainers that you would use for spaghetti or something. Poop into that. Stick it . . .

Scot: "Hey, honey, where's the colander?"

Troy: "Can you get the colander?" Put it in the shower and then take a showerhead, especially if you've got one with a handle on it, with hot water, and just soak that thing, and let that poop break down and run out of it. And then the tooth would stay in there. That would be my advice. It limits the amount of time you spend touching the poop and sifting through it, which sounds absolutely disgusting. So that's what I would have told you.

Mitch: Have you suggested this before? That seemed like a very quick answer. Have you just thought about this hypothetically?

Troy: Neither, Mitch. I can't say I've ever thought about how to do this. If Scot had called me, that's what I would have said. To me, this makes the most sense. I'm not touching it and taking a fork or something and . . . That's what I'm trying to imagine. Would you take a fork or something, and push on it, and see if it hits something? I don't know. It sounds awful.

Scot: So there were a couple of suggestions I saw that talked about that theory. I didn't want to spoil any of our kitchen utensils, so that was out for me.

Troy: The colander theory? You're talking about the one I came up with?

Scot: Yeah.

Troy: Oh, okay.

Mitch: The Madsen Colander Technique.

Scot: You've been wanting to get something named after you. Maybe that's it, the Madsen Colander Technique for recovering stuff you swallowed.

Troy: It's called the MC Poop, the Madsen Colander Poop . . . the MC Poop Technique.

Scot: Yeah. And then you could do some research papers on this, because I think you're right. I think minimizing the actual touching, and the time, and where is that going to go after you're done is key to this process. That was what was in my mind, too.

I like your idea better. But I was thinking a colander is better because it's got fewer holes. I was thinking a strainer, one of those wire mesh strainers, or a screen. "Hey, Honey, why are you taking the screens off the window?" "Don't worry about it."

Troy: "Don't mind me. Just doing a thorough cleaning of the screens."

Scot: The other idea that was out there was you get a solid bucket, like something you can sit on, and for the next few days, you poop in that bucket. And then you take two plastic knives and you just mash it up until you find what you're looking for.

Troy: That sounds horrible.

Scot: Yeah, it does.

Troy: That's bad. That sounds horrible, because that's too much . . . for a knife to hit it, you've got to be cutting every quarter inch through that thing to . . .

Scot: Oh, you're cutting and mashing, is what you're doing. You're not just cutting.

Troy: Yeah, I don't like that.

Scot: And then you've got dirty knives afterwards and a dirty bucket.

Troy: It sounds messy.

Scot: One guy actually in some comments said he didn't do that, but he put newspaper on the bathroom floor.

Troy: No. Definitely colander technique. Definitely go with the MC Poop Technique.

Scot: So how dangerous is that if you start colandering your poop? I mean, it's gross, yes. Could you get sick from that?

Troy: If you are at the same time perhaps eating one of our candy bars or granola bars that we made, if you have one of those on the side and you're reaching for that. I think as long as you're not touching your face or your mouth, you're fine, and you wash your hands after.

Scot: Got you.

Troy: But it just sounds disgusting.

Scot: And then the other thing is, after you get it out, then your point was a lot of comments, is like, "Sure, if it's a gold one, maybe, because I'll get the gold value back. But I don't know that I want that in my mouth." And people were like, "Well, make a bleach mixture of blah-blah-blah. And then when you take it to the dentist, they'll . . ."

Troy: Yeah, sterilize it.

Scot: "They'll sterilize it too." I don't know if I took it to the dentist, if I told the dentist where it came from, if he would even put it back in your mouth.

Troy: Yeah, I would not tell anyone that story.

Scot: So, anyway, I chose not to try to recover.

Troy: So, end of the story, you did not do either one? You were just so turned off, you said, "No way"?

Scot: Yeah. I just decided that wasn't worth it.

Troy: I probably would have done the same thing, honestly. I would have said, "Well, got to get a new crown made." I mean, it's going to cost you . . . I don't know how much the crown itself costs. Maybe it's like $500, but it's . . .

Scot: I guess I'll find out.

Troy: I guess you'll find out, unfortunately.

Scot: Yeah. So is there a chance that something like a crown could stay in your stomach, or is it pretty good chance it's going to pass through?

Troy: It's going to pass. It's small enough. It's not going to have an issue.

Scot: Mitch, would you have tried to recover?

Mitch: Not at all. No. The rabbit hole of internet research you did and everything just would not have even entered my mind. It would have been like, "Call up the dentist and be like, 'Hey, I need a new one immediately.'"

Troy: It's like, "I'm out."

Scot: Troy, would you have considered doing it for a moment?

Troy: I would have considered it for a moment. Absolutely. But then as I thought through the logistics of it, and I thought through using the colander and all that kind of stuff, which would probably be my go-to, I probably would have said, "It's not worth it."

Scot: And how did you propose getting it into the colander?

Troy: Just poop straight into it. Sit on the toilet seat, hold it under you, and poop straight into it. I mean, how else are you going to do it?

Mitch: It's got me thinking of . . . Our colander is one of those that you can pull the sides out, and it fits across the sink.

Troy: Oh, that's awesome.

Mitch: So we'd just do one of those, and then into the . . .

Troy: That would be ideal.

Scot: So you're just pooping straight into the colander, not with it in the toilet or anything?

Troy: So, basically, if you had Mitch's colander, it'd be ideal. But most of these have two handles on them. You could sit down on the toilet seat so it feels natural for you. You could still hold on to those two handles. I mean, you could even drop that colander into the toilet bowl. Who cares if it's all wet?

Mitch: That's true.

Troy: You could just drop it in there.

Scot: Then it's like panning for gold.

Troy: It's like panning for gold. You've got to pull it out because then I think you really need to put it in the shower, and you've got to have hot water because that's going to dissolve stuff most easily. I think then you put in the shower, you just turn that hot water on, you just leave it on, let it run, walk away, come back in 15 minutes, hopefully everything is down the drain, and you've got whatever is going to stay there is going to be there.

So, again, if you did have corn on the cob, or ate peanuts, you might see some relics there. We'll refer to that as fool's gold, but eventually you would probably find what you need, whether it's the tooth or whatever else you're searching for, or some valuable penny you swallowed, or whatever.

Scot: All right. Well, I hope we've learned some lessons from this. Lesson 1, if you swallow something, you know when to be concerned or when not to be concerned. It depends on the size and it depends on the sharpness, when you would want to go to the ER. We have an "ER or Not" at where Dr. Madsen talks about that if you want to get more details on that.

This is for adults too. So I don't know kids. I would imagine all that stuff is smaller, and it's probably a little different for kids. I mean, you're not a pediatric ER doc, so you probably don't know either, do you, Dr. Madsen?

Troy: It's all pretty similar for kids. The big thing with kids . . . a lot of things you see with kids is coins. They will swallow coins, and you have to be really careful there because they may breathe it in their lungs. You may see a coin in their mouth and then it's gone. They may breathe it in. It gets stuck in their trachea, or it gets stuck in the esophagus. You can just search on the internet and find these cool X-rays of this coin just sitting stuck in their esophagus. So that's not an uncommon thing in kids.

Scot: Even with this crown, it said, "Make sure that you swallowed it and that you didn't breathe it into your lungs." Can you breathe it into your lungs? Is that a thing?

Troy: Sure. I mean, if it somehow popped off as . . . Let's say you're exercising and taking a deep breath. But you would know it's there. You would want to cough it out. I will tell you your crown is not in your lungs right now. Don't worry about that.

Scot: Okay.

Troy: Yeah, you would feel it. It would irritate it like nothing else. You would want to cough it out. If it's stuck in your esophagus, you're going to feel it too. It's going to be hard to swallow. You're just going to have this feeling in your throat like something is stuck there. You'll know it's there. But those are big things to watch out for.

Scot: Nonfood items that meet the size requirements Dr. Madsen threw out that are smooth and that aren't dangerous, otherwise, like button batteries, if anybody swallows a button battery, ER. Do not pass Go. Go straight to the ER.

Troy: Yeah. And that's a big issue with kids too. Those button batteries can cause erosion through the esophagus and all kinds of issues. And those size measurements I gave you, those are going to be smaller in kids. There, you're going to be a little more cautious. But the sharp thing, that's one of those things. If it's sharp, it's got to come out, if you can get to it.

Scot: So, anyway, there's my crown story. I'm going to the dentist today, actually. I'm going to ask the dentist if they would have put the crown back on if I'd have brought it in. I'm going to ask them if they've ever encountered this before.

Troy: Well, Scot, since you told this story, I have to tell just quickly my favorite story from residency.

Scot: All right.

Troy: We had someone who came in and said they swallowed a pencil. So the resident and the attending physician are asking, "Well, okay, do we really trust him?" Kind of said, "He may have some ulterior motives with this." There were some other circumstances.

So they asked, "Would a pencil show up on an X-ray?" So they had the great idea, "Let's tape a pencil to this guy's back. We're going to shoot an X-ray of the stomach, including the chest. And if the pencil on his back shows up on the X-ray, but we cannot see the pencil in his stomach, we'll know that we could see it if it was there, and we'll know he didn't swallow it."

So they take him over to the X-ray. They tape a pencil to his back. They go to shoot the X-ray. The guy reaches on his back, pulls the pencil off and swallows it. And on the X-ray, they see two pencils.

So they got their answer, but have fun explaining that to the GI doctor when you call him and you say, "Hey, I've got a guy with two pencils in his stomach you need to come and fish out." They say, "Why does he have two pencils?" "Well . . ."

Scot: "One was him. One was us."

Troy: "One was us." Yep.

Scot: All right. Well, thanks for listening to the "Sideshow." Next week, back online with an episode we're really excited about. We're going to talk to a listener, Brett, about a condition he was diagnosed with called fatty liver disease. I think we're going to tentatively call this episode, "Hey, whose liver are you calling fat?" We'll find out what that diagnosis means, which more and more people are getting this diagnosis, and what you can do about it. Is it exercise? Is it diet? Listener Brett on the next "Who Cares About Men's Health."

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