In this episode, Dr. Obadan and Dr. Merritt discuss the critical role of patient-doctor relationships in pain medicine and the intersection with addiction medicine. They offer practical tips for managing chronic pain and emphasize the importance of diet and physical activity. The role of dietitians in pain management is also explored.
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Episode Transcript
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(00:02):
Hello, everyone.
Thank you for joining us again today.
My name is Dakota Amaka Obadan, also known asDoctor.
D.
D.
I'm the CEO and founder of a younger self MDmedical clinic, health and wellness located in
Kennesaw, Georgia.
We help Adults at risk prevent and treatmedical conditions like diabetes, high blood
pressure, and chronic kidney disease in aslittle as 90 days so that they can go into
(00:27):
leave healthier, health, happier, and longerlives.
And today, I have the amazing doctor Sarametek.
Hello?
Thank
you for joining me, Doctor Merrick.
Could you introduce yourself to our audiencehere, please?
Absolutely.
My name is Sarah Merritt.
I'm a physician, anesthesiologist, and I'm alsoboard certified in, pain medicine, and
(00:53):
addiction medicine.
That is amazing.
And she is the CEO and founder of a huge painmedicine practice.
Tell us some more about it.
Yeah.
So my practice is called LifeStream HealthCenter.
We are located in Bowie, Maryland, which is inPrince George's County.
(01:14):
The practice has been around for 15 years orso.
I actually, purchased it from, anotheranesthesiologist who had, practiced in the area
for many years.
And he was in poor health and actually passed,but, so the practice was not at its current
size.
(01:35):
But it's, has been in operation for some years,and we have, you know, my 1st day was January
1st 2014, probably.
And then I, I bought the practice in 2016.
And and I have patients in the practice thatI've seen since January of 2014 at this point
now in 2023.
(01:55):
So we're coming up on, you know, some of thesepeople I've known for 8 or 9 years that are,
that are my my product aid patients.
That's amazing.
And she's been growing it and growing it andtaking care of all these patients.
And giving them all this great outcome.
So, you know, so one thing I like to, ask myguests on the show is to kind of Tell us a
(02:16):
little bit about what you do, why you do, whatyou do, you know, how you got here.
Yeah.
And and why why pay medicine, I mean, whypaying, an addiction medicine?
Yeah.
Yeah.
So I, I act I actually got interested in painmedicine because I had a mentor who was a pain
(02:37):
doctor.
Had a mentor named who's a pain doctor.
And she, as I came into the program, we werepaired up.
And so I was paired up with this woman.
Her Pamela Vic, and, Doctor Vic was like, youdon't yet know it yet, but you wanna be a pain
doctor.
Okay.
You know, I'm just I'm just leaving the school.
(02:58):
Reading your mind.
He's reading my mind.
Yeah.
I'm like, okay.
But really, you know, in terms of the longevityof a career, you know, I think the idea I
matched to anesthesia and the idea around,like, taking late call and overnights and all
of this that was gonna be needed to be, like,at a partnership level and a practice.
(03:21):
You know, I had concerns with how sustainablethat would be over decades.
And
so what I saw in pain medicine was anopportunity to You know, the the hours part
certainly was appealing, but, you know, whatreally got me was in the OR, you really have no
longitudinal relationships.
Right?
So you put people to sleep, and then you, like,never see them again.
(03:44):
And maybe if you're really thorough, you callthem afterward, or you follow-up the next day,
but you don't even know, like, what happens tothese people.
And, like, did I really train all this time to,like, have so little involvement in people's
outcomes.
And not that, or anesthesia isn't superimportant and and at its best, we do, you know,
(04:05):
we do have systems following up and and seeingthat.
But but on an individual basis, for theindividual doctor, it's hard to follow those
cases because that's not your role.
Yeah.
And so what I really enjoyed about painmedicine was kind of that getting to know your
patients, helping people progress over time,and seeing, you know, improvement and impact,
(04:27):
over time with patients.
And and when you've helped a patient who hassignificant chronic pain, very often, you've
helped them with their worst problem.
Oh, yes.
I mean, pain is, like, is debilitating is oneof the chronic medical conditions.
It's Yes.
You know, it it is it's terrible.
I mean, being able to alleviate their pain,puts improves their quality of life
(04:51):
significantly.
That's right.
That's right.
Yeah.
Yeah.
Yeah.
For sure.
Yeah.
So it's really a great opportunity to have a aan important impact in the the lives of our
patients.
And then I got interested in addictionmedicine, really because, like, once you treat
patients with pain, you know, sometimes wewrite controlled substance medications to help
(05:14):
with pain.
And so we also have people that may develop aproblem taking controlled substance medications
or people who are taking more than prescribed.
And and then how do you parse that out?
You know, what is what is pain?
What is a where, you know, is there some line,or is there some
right for you?
Yeah.
(05:35):
Trying to come to understand that.
So I I got interested in in those questionsand, you know, just really saw an opportunity,
because around the time that I acquired thepractice, there really weren't there really
weren't doctors, in my local area at that timein, like, 2016 that we're prescribing, like,
(06:00):
Suboxone or buprenorphine for addiction.
And not that many that were certainly doing itunder addiction, excuse me, doing it under
insurance.
And so
what there was at that time was you know, ifyou had an opioid problem, you were gonna pay
cash to go see a doctor.
And, you know, even if even if your insuranceshould cover this treatment.
(06:24):
And that just didn't seem right to me, youknow, from a justice point of view, I guess.
And and really, like, How messed up is that forsociety?
You know, are we incentivizing people to, like,think about selling their medicine?
Right?
Like, like, as a doctor who I want to be partof that, like, absolutely not.
You know?
And so I, got interested in being able toprovide that service, and we started kind of a
(06:47):
service line in our practice treating patientsfor opioid use disorder, around that time.
That is amazing.
That is so impactful.
Oh, my dog is growling.
She has a tennis ball under the chair.
So sorry about that.
Oh, is that was I thought I was of info.
Yeah.
I think if you hear interesting noises, that's,that's what it is.
(07:07):
What kind of dog is it?
Oh, I love German I love big dogs.
Like, I just don't understand the idea ofpeople who have dogs going with the really
small, like, you know, I mean, I, yeah, do you.
Like, I feel like if you wanna if you if I wasto get a pet, I would get a big dog.
(07:29):
He's great.
You know?
But, yeah, let's let's Let me go back to our.
Yeah.
Hi.
Yeah.
Yeah.
But, oh, like, can can we see her?
Is she Let's see.
You too.
Just came over.
Oh.
I what's her name?
Hinger.
Inger.
Hey, Inger.
(07:50):
She's like, getting my ball.
Sorry.
Well, taking your mom, I wait for you for acouple of minutes.
Okay?
Well, with this, it's very important to askedabout opioid use disorders and addiction
medicine because this is very important in thisday and age.
And, you know, what you were talking aboutjustice is really relevant, you know, with the
disparities.
Are you seeing any of that?
(08:11):
The health disparities in the in theethnicities and the races?
Yes.
For sure.
I mean, I think I see just a lot of impact, Iguess, of, you know, social determinants of
health.
I think that's the other kind of Buzz word.
Right?
And so Right.
You know, certainly in society, you know, thereare people who are disadvantaged because of
(08:32):
their race or education, etcetera.
And and then it sets up a stream of thingspotentially with health outcomes, right, that
Yeah.
With lower levels of education, people, youknow, certainly is one socioeconomic status.
You know, those are are particular riskfactors.
(08:54):
But
then separate from that, yeah, certainly thereare, you know, differences sometimes in terms
of of race that we have a harder time, youknow, getting our our hands around.
But now that the insurance is covering a lot soI was going back to what you said earlier about
initially when it was purely just cash based.
So now that the insurance is covering, a lot ofall the stuff.
(09:15):
And they've I think they've even made somerecent changes and, made some more physicians.
They go prescribe this new medication.
Right?
So
it makes it more accessible.
Yeah.
I can
prescribe, and it is more accessible.
And then I'm located in Maryland.
You know, Maryland has a good, Medicaidexpansion, right, not every state, used
(09:40):
Medicaid expansion dollars from the federalgovernment, the Affordable Care Act, and in
Maryland, we have good Medicaid expansion, andand we pay pretty well for Medicaid services,
actually, which I think is not normal.
Like, not every state does that.
And so it's actually, It's good for patients,because certainly Maryland has its share of
(10:01):
opioid problems.
Yeah.
And Baltimore, historically has has had aheroin problem even when the rest of the US did
not.
But Maryland, you know, does do, I would say, apretty good job of trying to support substance,
sup support services for people with substanceuse disorders.
(10:23):
For for medical treatment.
That's amazing.
Well, that's good.
Well, thanks for sharing that.
So So, for my audience, I typically like to askmy guest to share 3 practical tips Yep.
Or action steps to take, you know, how whatwhat are the three steps that you would
recommend for people with?
(10:45):
Yes.
So for for people with chronic pain, I thinkthe typical app action steps that I would think
about would be, you know, what can they do toto better their own health I would think about,
of course, seeing their seeing their healthcaredoctors, seeing their provider, consulting a
(11:05):
healthcare profession to identify the source ofthe pain.
Right?
So
Right.
But he has a chronic painful condition, youknow, do they have a clear diagnosis of of what
it is?
I think that's where, you know, that's kind ofwhere treatment starts is understanding the
problem, and really your physicians in the bestposition to know that.
(11:26):
Yeah.
I mean, for me as a nephrologist, many of mypatients, there's a noise.
Did you hear that?
Oh, I think isn't the dog?
Oh, I just needed it.
Sorry.
Oh, okay.
Many many of my patients have chronic pain.
From, you know, the ones who are already ondialysis, you know, or if they have some skin
(11:48):
conditions like cowsy can latch, or, you know,many of them have, like, end stage, peripheral
vascular disease, or they may have, like,cossifications from their bone disease, causing
bone pains.
Do do you got to come across some of thesepatients?
In your clinic?
(12:08):
For sure.
For sure.
Yeah, and so we have a variety of patients whohave pain.
And sometimes it's unclear you know, whatexactly the cause is also.
Right?
Mhmm.
Mhmm.
Yeah.
Sometimes sometimes we're not sure.
But then that's hopefully part of the workup.
Right?
If a patient comes to see me, sometimes theythey may already have a diagnosis, the way they
(12:30):
know, like, oh, I have osteoarthritis of my hipor, Right.
Like that.
You know, they may already know or it or it maybe unclear.
Yeah.
We're speaking about, you know, my my long termpatients and the practice.
You know, some of these folks, if they are aredoing well, you know, they don't come and see
me, but then they show up every now and thenwhen they have a setback, for instance.
(12:52):
So I I saw a woman this week who's, eighty fiveyears Obadan, and she has, had intermittent
injections for back pain.
She's had a medial patch block recently for,axial low back pain.
It's a a particular injection that's beenreally helpful, for her in the past.
(13:13):
And but but as she was here, you know, we wehad to kind of, re examine her and relook at
the situation and make sure, you know, well, isthis what we think is going on?
Or or is it your hip because she's also hadsome significant hip arthritis.
So Oh, okay.
For for us, that's kind of how has showed uplately, you know, in terms of finding that
(13:34):
right diagnosis is just needing to re examinepatients and even just kinda keeping an open
mind.
But I think you're right that, you know, thereare these many manifestations of other, I
guess, systemic diseases.
Right?
Like, if you mentioned, calcium deposits andthings like that where your, some of your renal
(13:54):
patients or, patients with significant, othersick systemic illnesses may have pain related
manifestations,
as well.
So the first step the first practical tip,which I think said, it's very important.
Definitely get involved, get involved with yourdoctors.
Don't just stay home and stop self diagnosingand self medicating.
(14:15):
Yeah.
Yeah.
Not a good plan.
Extensper.
Mhmm.
Not a good plan at all.
Not a good plan?
That's right.
That's right.
Yeah.
And in fact, I saw a referral, this weekinterestingly of a a nephrology patient.
Who had some significant, hip osteoarthritis,and she was saying she had actually gotten my
(14:36):
name from someone at her dialysis center.
That, you know, as they start, you know, as asyou go regularly, right, that you might have a
relationship with people that work there ortheir patients that you see.
And and that was kind of how she had had cameacross my name.
And she, this was a patient with with HIPAAurothritis and so we were working together on a
(14:58):
plan to, deal with her hip pain.
Yeah.
That's amazing.
Yeah.
Well, thank you.
And so so they get to they get to see thephysician.
And do you have, like, some so what's the nextstep?
What's the other tip?
Like, what are the some of the I know that thisis something a lot of my audience would like to
know.
Non you know, medical ways to manage pain.
(15:21):
Yeah.
Natural way.
Well, I was gonna say numb number 2 is Yeah.
I would actually say is engage in physicalactivity, which I think is counterintuitive or
doesn't
to it.
It is comprehensive because, hey, I'm in pain.
I am in pain.
All I wanna do is just sit down and lay there.
(15:42):
Do anything.
That's right.
Yeah.
Yeah.
And so, it's hard, you know, it's hard to, helppatients understand this, that, you know, and I
talk about it, I guess, in a variety of waysand and it may depend on the patient what,
like, ultimately kind of resonates with them,but, the body is sort of a a use it or lose it
(16:07):
type of of thing.
And so there's that aspect that I think peopleunderstand that bodies in motion tend to stay
in
motion.
Mhmm.
And so being as active as possible, whateverthat looks like for you, And I'll tend to,
like, use a little contrasting when speakingwith patients like, hey.
We don't we're not expecting you to run amarathon.
But even just that daily walk to the mailbox,you know, could you do that a couple of times?
(16:34):
You
know, doing some easy stretches in a chair,taking, you know, taking a walk with the dog if
that's within your abilities.
And and it depends on the patient.
Sure, like, what is, what is realistic.
I'm a big fan of physical therapy.
And so, I I will write patients for physicaltherapy, you know, as long as they're getting
(16:58):
improvements, and and that may be a long time,especially if have a long way to go, it may
require, you know, a good bit of of therapy toget them moving more.
Right.
Right.
So I think, you know, being as active aspossible, whatever that looks like for the
(17:18):
individual, oh, and I know what I was gonna sayin terms of physical therapy, in addition, for
some patients, if land based physical therapyis is too stressful or too much for their, for
their joints.
Some patients with significant adiposity.
It may be really to move and walk very far,sometimes water based PT or aquatic physical
(17:43):
therapy can be really good.
I'm a I'm a big fan.
I'm a big fan of Aquas Zumba, but
Oh, that sounds fun.
Oh, you never heard of it?
Oh, my goodness.
Like, I personally have indulged in aqua Zumba.
It is amazing.
Yes.
You know, you're you're in the pool.
You're swimming, and you're dancing and doingall the jumping in.
(18:05):
Yeah.
A lot of movement to the beat, you know, to thereally nice music.
And if you have a great tractor as I did, acouple of years ago after I had my my third
child and really wanted to lose weight,
Yeah.
That was some, you know, it was fun.
It was fun, and I moved a lot.
And there were a lot of people who had panicpain that went to pull with me at the same
(18:29):
time.
And they found it really easy because, youknow, of the it's, weight bare.
It's it's, weightless.
Exactly.
So whatever pain you're having in your joints,the water kind of makes you float on it, and
then you're able to move and So, yeah, I waswaiting for you to just say that because I have
personally experienced that, and it is amazing.
(18:50):
Yeah.
Yeah.
It really is.
Yeah.
And I think I think it's and it can be part ofa progression for people.
And so, you know, initially starting in thewater, moving those joints, getting getting
better range of motion, being able to, youknow, walk in the water, etcetera.
(19:11):
And then that can turn into you know, doingmore on land over some time.
And I would say, you know, I I have a patientthat I can think of who has a significant spine
fusion through, like, most of her cervical andthoracic spine is just fused.
And, she is, maintains a healthy weight.
(19:34):
But but her exercises, she goes to the pool andshe just walks.
And it's, you know, she calls it water walkingand she finds it.
And she's not overweight, but she finds thatit's just much gentler on her joints, on her
body.
Yeah.
Right.
Right.
Yeah.
And it's good.
Is is that because of the weight of the thingsthat they used to fuse has spines or what?
(19:56):
Yeah.
It's a good question.
I think, and it may also depend even on thepool that you're in very often.
Some of those, pools that are, designed foraquatic therapy or aqua classes, you know, they
may be a little bit warmed also.
And so while they are cooler than your bodytemperature, you know, they're warm that
(20:17):
they're soothing in some way.
Yeah.
Yeah.
Is that just like a temperature effect that'sthat's generally pleasant?
And then I think, yeah, just less less stresson the joints overall.
And and yeah, the spine, of course, is is partof that.
That's amazing.
How about some foods?
Are there some foods that can help with painmanagement?
(20:38):
So what kind of
Yeah.
I
mean, non inflammatory diet, for sure, but, youknow.
Yes.
Are there any specific kinds of Do you know ofany diet that has a lot of, like, analgesic
properties?
I read somewhere one time or or so that,peppers have the some elements, but I don't
(20:59):
know if it's something that you'd generallyprescribe to you Right.
Be a patient Yeah.
Like, capsaicin maybe is
the Exactly.
Cap Sacin.
Yeah.
Right.
Right.
Right.
Yeah.
I haven't pres there's I haven't prescribedthat.
I mean, it's certain only topically, there'sgood data for capsaicin topically.
So for patients with neuropathy, particularlydiabetic peripheral neuropathy, but other types
(21:21):
too, to use capsaicin, the dilute that'savailable at the pharmacy, you know, is 0.25%.
Excuse me.
0.025 percent.
So so pretty gentle.
And that can help with nerve pain.
It's actually a little uncomfortable initiallyto apply.
(21:42):
But then once it once the treatments occur, itcan become more tolerable over time, and then
it often can, reverse some of the pain ofneuropathy.
We shouldn't advise our patients to go andstart loading up on all the puppets.
Right?
No.
Don't do that.
Right?
Don't don't do that.
(22:02):
I think really just an anti inflammatory dietis is what we'll hear, talked about for better
pain management and, for that probably hasindividual properties that might be different
for different people.
But, certainly, something that's maybe closelyresembling the Mediterranean diet and not
(22:23):
resembling the standard American diet.
Right?
And I eat standard American diet stuff fromtime to time, but, you know, I think it's
really
Once it's okay.
Yeah.
No judges.
No joke.
I think I think it's really a matter of reallytrying to be conscious, you know, of of one's
(22:43):
eating each meal of the day.
And, you know, if if patients have some someweight to lose, then then the diet discussion
can also be part of that.
But, yeah, I think incorporating, healthy fatslike, olive oil, avocado oil, some of these
things to cooking, etcetera, you know, that,these healthy fats are better for, myelin,
(23:09):
which is the nerve covering of the brain and,the nerve.
So supporting those things with with thesehealthy fats and not with, like, you know,
trans fats or the the ones that are generatedfrom frying foods.
There are some people that will feel betterwith, a diet that's lower in dairy.
(23:30):
So some for some people, dairy causesinflammation and and that's been associated
with pain in some studies.
So there are some studies that one of mymentors did, in rats back in the day and
looking at rats that got a soy diet versus ratsthat got a whey based casein diet, and you give
the same rats, the same nerve injury, and thedairy rats do worse.
(23:56):
And so, you know, again, I don't know that, youknow, that's totally applicable to humans
necessarily, but that in addition to, you know,anecdotal evidence that, you know, there are
some patients that have had benefit fromcutting out, dairy.
I think that can be inflammatory for somepeople.
And and really, you know, dairy is delicious,but but not really necessary, you know, in in
(24:22):
our in our diets.
It's not an essential.
Especially after a certain age, a lot of peoplebecome lactose tolerance as we go older.
That's right.
Yeah.
So, mhmm.
And I
think, you know, we kind of love our cheese onthings, but but really, it's an addition of,
like, fat and calorie it's not adding a lot ofnutritional value.
And so maybe instead of also, like, what not toeat, if we can also focus on maybe what to eat,
(24:46):
you know, and and focusing on vegetables, meatsthat are that are lean, and more vegetables.
And some free.
Yes.
Yes.
Yes.
Yes.
Yes.
You know,
and Michael Colin is famous for having said,you know, eat food, mostly plants, not too
much.
(25:06):
And I think that encapsulates a lot of thingsalso.
So a mostly plants if you're if you're leaningheavy on that.
I also have some patients that have done welleliminating gluten from their diet.
Don't think that's necessary for everyone, butI do have quite a number of patients either
with we've maybe as a medical professional, youare familiar, of course, with celiac disease,
(25:30):
but then there's also this thing called nonceliac gluten sensitivity.
And there are a lot of, a fair number ofpeople, maybe more than we've realized in the
past that have some of this type of problemwhere they may have just inflammation or
discomfort related to ingestion of gluten andand cutting it out can make a difference, in
terms of pain.
(25:50):
When they say you are, what you eat, theyweren't joking.
You know?
Yeah.
Yeah.
Yeah.
It's true.
It's true.
Yeah.
So I think, you know, we've had kind of areductionist view of calories that, you know,
oh, well, you just need, you know, these manycalories to fill your body.
But I think really shifting that and andthinking of food as fuel and what do you want
(26:15):
to fuel with and and we should focus onvegetables and you know, lean lean healthy
protein sources.
Keep a healthy diet, people.
This is helpful, even for pain.
Yeah.
It is.
Yeah.
And and so and is that a third tip of what wewhat we're kind of talking about the non the
(26:36):
non the natural, you know, non medicine.
So the natural ways.
Yeah.
I think that was the
I think being active is making diverse at somepoint.
And then
Other stuff, might be the 3rd point.
Yeah.
Other stuff, including, yeah, diet, because Ithink diets big enough to be its own point.
(26:57):
Diodes is big.
It's really big.
Like, everything that we've just talked about,you know, we could go we'll get So do you often
send your patients to go to dietitians to,like, get their whole meal plan figured out and
stuff like that?
I probably should.
I I do not do that super regularly.
I do have a a PA in my practice who, who, likesto do some dietary counseling.
(27:21):
So she's not a dietitian, but she Yeah.
Certification from the Institute for FunctionalMedicine.
And she's
an
elimination diet work.
And so I actually did it myself, just so Iwould know what this was that we were offering
to patients.
And, did, like, the 6 week elimination diet ofeliminating gluten and dairy and all kinds of
(27:43):
things.
And
Really?
Did you notice any?
I haven't gone back.
I mean, I I eat I would say I eat some, gluten.
I eat some, dairy, but I no longer think ofmyself as just like, oh, I eat every thing,
which is kinda how I used to think of myself.
And now I now I kind of have have modified myhabits, and and I feel better.
(28:04):
And
at the time, I was just having, you know,personally, I was just having some, like,
bloating sensation and was really looking I waslooking to address that and then to make I
understood the program that we had.
And it did help.
That's amazing.
Oh, no.
Thank you for sharing that with us.
So Oh, the last part that were coming wereapproaching the last segment of our podcast,
(28:26):
which is like, share something interesting thathappened to you recently, or something that
made you feel empowered.
Oh, something that I mean,
you're maybe doing power, and my goodness.
Yeah.
Something interesting.
It doesn't it doesn't have to have make youfeel like, you know, if you're not into the
whole empowerment, feminism, But, you know,people tend to want to hear something
(28:51):
uplifting.
Yeah.
Or something interesting.
No.
I I I'm just, like, super fortunate, honestly.
I I feel I was just thinking about some of our,you know, challenges on the one hand you know,
in the business.
And, but but, no, I'm I'm really just superfortunate and to have a a great team in my
(29:13):
office and to have, a great family.
And I'm just, you know, I'm just super blessed.
And, I think that, you know, I want to workhard to help the community and and help other
people to live their best lives.
That's so sweet.
Well, I hope you will come back for anotherepisode with us in the future.
(29:37):
This was really good.
This was really amazing.
And how can our audience find you?
I know you're in Maryland.
I'm in Georgia, but If people were around theMaryland area and wanted to work with you, how
can people find you?
Yeah.
So we're at, life stream health center dot comis our website.
You can send us a message from there.
(29:58):
We're also on facebook, facebook.com/livestreamHealth Center.
And we're on Instagram as live stream H.
C.
And, yeah, I would love to connect peoplethere.
Our YouTube channel actually too is live streamhealth center, and we have a series of live
broadcast.
And so, check out the YouTube channel and underthose, live headings, we've got a lot of
(30:23):
different, education on different topics ashealth topics as they intersect with pain.
This this has been amazing.
And you can find me at younger selfmd.com andwe're currently accepting patients.
Our phone number is 404-566-4623.
Thank you so much for joining us.
(30:45):
And stay tuned for the next, episode and, ourmystery guests.
Find out who I missed your yes is gonna be.
Thank you so much, Doctor Sarah.
This was so good.
Glad to be here.
Thank
Hello, everyone.
Thank you for joining us again today.
My name is Dakota Amaka Obadan, also known asDoctor.
D.
D.
I'm the CEO and founder of a younger self MDmedical clinic, health and wellness located in
Kennesaw, Georgia.
We help Adults at risk prevent and treatmedical conditions like diabetes, high blood
pressure, and chronic kidney disease in aslittle as 90 days so that they can go into
(00:27):
leave healthier, health, happier, and longerlives.
And today, I have the amazing doctor Sarametek.
Hello?
Thank
you for joining me, Doctor Merrick.
Could you introduce yourself to our audiencehere, please?
Absolutely.
My name is Sarah Merritt.
I'm a physician, anesthesiologist, and I'm alsoboard certified in, pain medicine, and
(00:53):
addiction medicine.
That is amazing.
And she is the CEO and founder of a huge painmedicine practice.
Tell us some more about it.
Yeah.
So my practice is called LifeStream HealthCenter.
We are located in Bowie, Maryland, which is inPrince George's County.
(01:14):
The practice has been around for 15 years orso.
I actually, purchased it from, anotheranesthesiologist who had, practiced in the area
for many years.
And he was in poor health and actually passed,but, so the practice was not at its current
size.
(01:35):
But it's, has been in operation for some years,and we have, you know, my 1st day was January
1st 2014, probably.
And then I, I bought the practice in 2016.
And and I have patients in the practice thatI've seen since January of 2014 at this point
now in 2023.
(01:55):
So we're coming up on, you know, some of thesepeople I've known for 8 or 9 years that are,
that are my my product aid patients.
That's amazing.
And she's been growing it and growing it andtaking care of all these patients.
And giving them all this great outcome.
So, you know, so one thing I like to, ask myguests on the show is to kind of Tell us a
(02:16):
little bit about what you do, why you do, whatyou do, you know, how you got here.
Yeah.
And and why why pay medicine, I mean, whypaying, an addiction medicine?
Yeah.
Yeah.
So I, I act I actually got interested in painmedicine because I had a mentor who was a pain
(02:37):
doctor.
Had a mentor named who's a pain doctor.
And she, as I came into the program, we werepaired up.
And so I was paired up with this woman.
Her Pamela Vic, and, Doctor Vic was like, youdon't yet know it yet, but you wanna be a pain
doctor.
Okay.
You know, I'm just I'm just leaving the school.
(02:58):
Reading your mind.
He's reading my mind.
Yeah.
I'm like, okay.
But really, you know, in terms of the longevityof a career, you know, I think the idea I
matched to anesthesia and the idea around,like, taking late call and overnights and all
of this that was gonna be needed to be, like,at a partnership level and a practice.
(03:21):
You know, I had concerns with how sustainablethat would be over decades.
And
so what I saw in pain medicine was anopportunity to You know, the the hours part
certainly was appealing, but, you know, whatreally got me was in the OR, you really have no
longitudinal relationships.
Right?
So you put people to sleep, and then you, like,never see them again.
(03:44):
And maybe if you're really thorough, you callthem afterward, or you follow-up the next day,
but you don't even know, like, what happens tothese people.
And, like, did I really train all this time to,like, have so little involvement in people's
outcomes.
And not that, or anesthesia isn't superimportant and and at its best, we do, you know,
(04:05):
we do have systems following up and and seeingthat.
But but on an individual basis, for theindividual doctor, it's hard to follow those
cases because that's not your role.
Yeah.
And so what I really enjoyed about painmedicine was kind of that getting to know your
patients, helping people progress over time,and seeing, you know, improvement and impact,
(04:27):
over time with patients.
And and when you've helped a patient who hassignificant chronic pain, very often, you've
helped them with their worst problem.
Oh, yes.
I mean, pain is, like, is debilitating is oneof the chronic medical conditions.
It's Yes.
You know, it it is it's terrible.
I mean, being able to alleviate their pain,puts improves their quality of life
(04:51):
significantly.
That's right.
That's right.
Yeah.
Yeah.
Yeah.
For sure.
Yeah.
So it's really a great opportunity to have a aan important impact in the the lives of our
patients.
And then I got interested in addictionmedicine, really because, like, once you treat
patients with pain, you know, sometimes wewrite controlled substance medications to help
(05:14):
with pain.
And so we also have people that may develop aproblem taking controlled substance medications
or people who are taking more than prescribed.
And and then how do you parse that out?
You know, what is what is pain?
What is a where, you know, is there some line,or is there some
right for you?
Yeah.
(05:35):
Trying to come to understand that.
So I I got interested in in those questionsand, you know, just really saw an opportunity,
because around the time that I acquired thepractice, there really weren't there really
weren't doctors, in my local area at that timein, like, 2016 that we're prescribing, like,
(06:00):
Suboxone or buprenorphine for addiction.
And not that many that were certainly doing itunder addiction, excuse me, doing it under
insurance.
And so
what there was at that time was you know, ifyou had an opioid problem, you were gonna pay
cash to go see a doctor.
And, you know, even if even if your insuranceshould cover this treatment.
(06:24):
And that just didn't seem right to me, youknow, from a justice point of view, I guess.
And and really, like, How messed up is that forsociety?
You know, are we incentivizing people to, like,think about selling their medicine?
Right?
Like, like, as a doctor who I want to be partof that, like, absolutely not.
You know?
And so I, got interested in being able toprovide that service, and we started kind of a
(06:47):
service line in our practice treating patientsfor opioid use disorder, around that time.
That is amazing.
That is so impactful.
Oh, my dog is growling.
She has a tennis ball under the chair.
So sorry about that.
Oh, is that was I thought I was of info.
Yeah.
I think if you hear interesting noises, that's,that's what it is.
(07:07):
What kind of dog is it?
Oh, I love German I love big dogs.
Like, I just don't understand the idea ofpeople who have dogs going with the really
small, like, you know, I mean, I, yeah, do you.
Like, I feel like if you wanna if you if I wasto get a pet, I would get a big dog.
(07:29):
He's great.
You know?
But, yeah, let's let's Let me go back to our.
Yeah.
Hi.
Yeah.
Yeah.
But, oh, like, can can we see her?
Is she Let's see.
You too.
Just came over.
Oh.
I what's her name?
Hinger.
Inger.
Hey, Inger.
(07:50):
She's like, getting my ball.
Sorry.
Well, taking your mom, I wait for you for acouple of minutes.
Okay?
Well, with this, it's very important to askedabout opioid use disorders and addiction
medicine because this is very important in thisday and age.
And, you know, what you were talking aboutjustice is really relevant, you know, with the
disparities.
Are you seeing any of that?
(08:11):
The health disparities in the in theethnicities and the races?
Yes.
For sure.
I mean, I think I see just a lot of impact, Iguess, of, you know, social determinants of
health.
I think that's the other kind of Buzz word.
Right?
And so Right.
You know, certainly in society, you know, thereare people who are disadvantaged because of
(08:32):
their race or education, etcetera.
And and then it sets up a stream of thingspotentially with health outcomes, right, that
Yeah.
With lower levels of education, people, youknow, certainly is one socioeconomic status.
You know, those are are particular riskfactors.
(08:54):
But
then separate from that, yeah, certainly thereare, you know, differences sometimes in terms
of of race that we have a harder time, youknow, getting our our hands around.
But now that the insurance is covering a lot soI was going back to what you said earlier about
initially when it was purely just cash based.
So now that the insurance is covering, a lot ofall the stuff.
(09:15):
And they've I think they've even made somerecent changes and, made some more physicians.
They go prescribe this new medication.
Right?
So
it makes it more accessible.
Yeah.
I can
prescribe, and it is more accessible.
And then I'm located in Maryland.
You know, Maryland has a good, Medicaidexpansion, right, not every state, used
(09:40):
Medicaid expansion dollars from the federalgovernment, the Affordable Care Act, and in
Maryland, we have good Medicaid expansion, andand we pay pretty well for Medicaid services,
actually, which I think is not normal.
Like, not every state does that.
And so it's actually, It's good for patients,because certainly Maryland has its share of
(10:01):
opioid problems.
Yeah.
And Baltimore, historically has has had aheroin problem even when the rest of the US did
not.
But Maryland, you know, does do, I would say, apretty good job of trying to support substance,
sup support services for people with substanceuse disorders.
(10:23):
For for medical treatment.
That's amazing.
Well, that's good.
Well, thanks for sharing that.
So So, for my audience, I typically like to askmy guest to share 3 practical tips Yep.
Or action steps to take, you know, how whatwhat are the three steps that you would
recommend for people with?
(10:45):
Yes.
So for for people with chronic pain, I thinkthe typical app action steps that I would think
about would be, you know, what can they do toto better their own health I would think about,
of course, seeing their seeing their healthcaredoctors, seeing their provider, consulting a
(11:05):
healthcare profession to identify the source ofthe pain.
Right?
So
Right.
But he has a chronic painful condition, youknow, do they have a clear diagnosis of of what
it is?
I think that's where, you know, that's kind ofwhere treatment starts is understanding the
problem, and really your physicians in the bestposition to know that.
(11:26):
Yeah.
I mean, for me as a nephrologist, many of mypatients, there's a noise.
Did you hear that?
Oh, I think isn't the dog?
Oh, I just needed it.
Sorry.
Oh, okay.
Many many of my patients have chronic pain.
From, you know, the ones who are already ondialysis, you know, or if they have some skin
(11:48):
conditions like cowsy can latch, or, you know,many of them have, like, end stage, peripheral
vascular disease, or they may have, like,cossifications from their bone disease, causing
bone pains.
Do do you got to come across some of thesepatients?
In your clinic?
(12:08):
For sure.
For sure.
Yeah, and so we have a variety of patients whohave pain.
And sometimes it's unclear you know, whatexactly the cause is also.
Right?
Mhmm.
Mhmm.
Yeah.
Sometimes sometimes we're not sure.
But then that's hopefully part of the workup.
Right?
If a patient comes to see me, sometimes theythey may already have a diagnosis, the way they
(12:30):
know, like, oh, I have osteoarthritis of my hipor, Right.
Like that.
You know, they may already know or it or it maybe unclear.
Yeah.
We're speaking about, you know, my my long termpatients and the practice.
You know, some of these folks, if they are aredoing well, you know, they don't come and see
me, but then they show up every now and thenwhen they have a setback, for instance.
(12:52):
So I I saw a woman this week who's, eighty fiveyears Obadan, and she has, had intermittent
injections for back pain.
She's had a medial patch block recently for,axial low back pain.
It's a a particular injection that's beenreally helpful, for her in the past.
(13:13):
And but but as she was here, you know, we wehad to kind of, re examine her and relook at
the situation and make sure, you know, well, isthis what we think is going on?
Or or is it your hip because she's also hadsome significant hip arthritis.
So Oh, okay.
For for us, that's kind of how has showed uplately, you know, in terms of finding that
(13:34):
right diagnosis is just needing to re examinepatients and even just kinda keeping an open
mind.
But I think you're right that, you know, thereare these many manifestations of other, I
guess, systemic diseases.
Right?
Like, if you mentioned, calcium deposits andthings like that where your, some of your renal
(13:54):
patients or, patients with significant, othersick systemic illnesses may have pain related
manifestations,
as well.
So the first step the first practical tip,which I think said, it's very important.
Definitely get involved, get involved with yourdoctors.
Don't just stay home and stop self diagnosingand self medicating.
(14:15):
Yeah.
Yeah.
Not a good plan.
Extensper.
Mhmm.
Not a good plan at all.
Not a good plan?
That's right.
That's right.
Yeah.
And in fact, I saw a referral, this weekinterestingly of a a nephrology patient.
Who had some significant, hip osteoarthritis,and she was saying she had actually gotten my
(14:36):
name from someone at her dialysis center.
That, you know, as they start, you know, as asyou go regularly, right, that you might have a
relationship with people that work there ortheir patients that you see.
And and that was kind of how she had had cameacross my name.
And she, this was a patient with with HIPAAurothritis and so we were working together on a
(14:58):
plan to, deal with her hip pain.
Yeah.
That's amazing.
Yeah.
Well, thank you.
And so so they get to they get to see thephysician.
And do you have, like, some so what's the nextstep?
What's the other tip?
Like, what are the some of the I know that thisis something a lot of my audience would like to
know.
Non you know, medical ways to manage pain.
(15:21):
Yeah.
Natural way.
Well, I was gonna say numb number 2 is Yeah.
I would actually say is engage in physicalactivity, which I think is counterintuitive or
doesn't
to it.
It is comprehensive because, hey, I'm in pain.
I am in pain.
All I wanna do is just sit down and lay there.
(15:42):
Do anything.
That's right.
Yeah.
Yeah.
And so, it's hard, you know, it's hard to, helppatients understand this, that, you know, and I
talk about it, I guess, in a variety of waysand and it may depend on the patient what,
like, ultimately kind of resonates with them,but, the body is sort of a a use it or lose it
(16:07):
type of of thing.
And so there's that aspect that I think peopleunderstand that bodies in motion tend to stay
in
motion.
Mhmm.
And so being as active as possible, whateverthat looks like for you, And I'll tend to,
like, use a little contrasting when speakingwith patients like, hey.
We don't we're not expecting you to run amarathon.
But even just that daily walk to the mailbox,you know, could you do that a couple of times?
(16:34):
You
know, doing some easy stretches in a chair,taking, you know, taking a walk with the dog if
that's within your abilities.
And and it depends on the patient.
Sure, like, what is, what is realistic.
I'm a big fan of physical therapy.
And so, I I will write patients for physicaltherapy, you know, as long as they're getting
(16:58):
improvements, and and that may be a long time,especially if have a long way to go, it may
require, you know, a good bit of of therapy toget them moving more.
Right.
Right.
So I think, you know, being as active aspossible, whatever that looks like for the
(17:18):
individual, oh, and I know what I was gonna sayin terms of physical therapy, in addition, for
some patients, if land based physical therapyis is too stressful or too much for their, for
their joints.
Some patients with significant adiposity.
It may be really to move and walk very far,sometimes water based PT or aquatic physical
(17:43):
therapy can be really good.
I'm a I'm a big fan.
I'm a big fan of Aquas Zumba, but
Oh, that sounds fun.
Oh, you never heard of it?
Oh, my goodness.
Like, I personally have indulged in aqua Zumba.
It is amazing.
Yes.
You know, you're you're in the pool.
You're swimming, and you're dancing and doingall the jumping in.
(18:05):
Yeah.
A lot of movement to the beat, you know, to thereally nice music.
And if you have a great tractor as I did, acouple of years ago after I had my my third
child and really wanted to lose weight,
Yeah.
That was some, you know, it was fun.
It was fun, and I moved a lot.
And there were a lot of people who had panicpain that went to pull with me at the same
(18:29):
time.
And they found it really easy because, youknow, of the it's, weight bare.
It's it's, weightless.
Exactly.
So whatever pain you're having in your joints,the water kind of makes you float on it, and
then you're able to move and So, yeah, I waswaiting for you to just say that because I have
personally experienced that, and it is amazing.
(18:50):
Yeah.
Yeah.
It really is.
Yeah.
And I think I think it's and it can be part ofa progression for people.
And so, you know, initially starting in thewater, moving those joints, getting getting
better range of motion, being able to, youknow, walk in the water, etcetera.
(19:11):
And then that can turn into you know, doingmore on land over some time.
And I would say, you know, I I have a patientthat I can think of who has a significant spine
fusion through, like, most of her cervical andthoracic spine is just fused.
And, she is, maintains a healthy weight.
(19:34):
But but her exercises, she goes to the pool andshe just walks.
And it's, you know, she calls it water walkingand she finds it.
And she's not overweight, but she finds thatit's just much gentler on her joints, on her
body.
Yeah.
Right.
Right.
Yeah.
And it's good.
Is is that because of the weight of the thingsthat they used to fuse has spines or what?
(19:56):
Yeah.
It's a good question.
I think, and it may also depend even on thepool that you're in very often.
Some of those, pools that are, designed foraquatic therapy or aqua classes, you know, they
may be a little bit warmed also.
And so while they are cooler than your bodytemperature, you know, they're warm that
(20:17):
they're soothing in some way.
Yeah.
Yeah.
Is that just like a temperature effect that'sthat's generally pleasant?
And then I think, yeah, just less less stresson the joints overall.
And and yeah, the spine, of course, is is partof that.
That's amazing.
How about some foods?
Are there some foods that can help with painmanagement?
(20:38):
So what kind of
Yeah.
I
mean, non inflammatory diet, for sure, but, youknow.
Yes.
Are there any specific kinds of Do you know ofany diet that has a lot of, like, analgesic
properties?
I read somewhere one time or or so that,peppers have the some elements, but I don't
(20:59):
know if it's something that you'd generallyprescribe to you Right.
Be a patient Yeah.
Like, capsaicin maybe is
the Exactly.
Cap Sacin.
Yeah.
Right.
Right.
Right.
Yeah.
I haven't pres there's I haven't prescribedthat.
I mean, it's certain only topically, there'sgood data for capsaicin topically.
So for patients with neuropathy, particularlydiabetic peripheral neuropathy, but other types
(21:21):
too, to use capsaicin, the dilute that'savailable at the pharmacy, you know, is 0.25%.
Excuse me.
0.025 percent.
So so pretty gentle.
And that can help with nerve pain.
It's actually a little uncomfortable initiallyto apply.
(21:42):
But then once it once the treatments occur, itcan become more tolerable over time, and then
it often can, reverse some of the pain ofneuropathy.
We shouldn't advise our patients to go andstart loading up on all the puppets.
Right?
No.
Don't do that.
Right?
Don't don't do that.
(22:02):
I think really just an anti inflammatory dietis is what we'll hear, talked about for better
pain management and, for that probably hasindividual properties that might be different
for different people.
But, certainly, something that's maybe closelyresembling the Mediterranean diet and not
(22:23):
resembling the standard American diet.
Right?
And I eat standard American diet stuff fromtime to time, but, you know, I think it's
really
Once it's okay.
Yeah.
No judges.
No joke.
I think I think it's really a matter of reallytrying to be conscious, you know, of of one's
(22:43):
eating each meal of the day.
And, you know, if if patients have some someweight to lose, then then the diet discussion
can also be part of that.
But, yeah, I think incorporating, healthy fatslike, olive oil, avocado oil, some of these
things to cooking, etcetera, you know, that,these healthy fats are better for, myelin,
(23:09):
which is the nerve covering of the brain and,the nerve.
So supporting those things with with thesehealthy fats and not with, like, you know,
trans fats or the the ones that are generatedfrom frying foods.
There are some people that will feel betterwith, a diet that's lower in dairy.
(23:30):
So some for some people, dairy causesinflammation and and that's been associated
with pain in some studies.
So there are some studies that one of mymentors did, in rats back in the day and
looking at rats that got a soy diet versus ratsthat got a whey based casein diet, and you give
the same rats, the same nerve injury, and thedairy rats do worse.
(23:56):
And so, you know, again, I don't know that, youknow, that's totally applicable to humans
necessarily, but that in addition to, you know,anecdotal evidence that, you know, there are
some patients that have had benefit fromcutting out, dairy.
I think that can be inflammatory for somepeople.
And and really, you know, dairy is delicious,but but not really necessary, you know, in in
(24:22):
our in our diets.
It's not an essential.
Especially after a certain age, a lot of peoplebecome lactose tolerance as we go older.
That's right.
Yeah.
So, mhmm.
And I
think, you know, we kind of love our cheese onthings, but but really, it's an addition of,
like, fat and calorie it's not adding a lot ofnutritional value.
And so maybe instead of also, like, what not toeat, if we can also focus on maybe what to eat,
(24:46):
you know, and and focusing on vegetables, meatsthat are that are lean, and more vegetables.
And some free.
Yes.
Yes.
Yes.
Yes.
Yes.
You know,
and Michael Colin is famous for having said,you know, eat food, mostly plants, not too
much.
(25:06):
And I think that encapsulates a lot of thingsalso.
So a mostly plants if you're if you're leaningheavy on that.
I also have some patients that have done welleliminating gluten from their diet.
Don't think that's necessary for everyone, butI do have quite a number of patients either
with we've maybe as a medical professional, youare familiar, of course, with celiac disease,
(25:30):
but then there's also this thing called nonceliac gluten sensitivity.
And there are a lot of, a fair number ofpeople, maybe more than we've realized in the
past that have some of this type of problemwhere they may have just inflammation or
discomfort related to ingestion of gluten andand cutting it out can make a difference, in
terms of pain.
(25:50):
When they say you are, what you eat, theyweren't joking.
You know?
Yeah.
Yeah.
Yeah.
It's true.
It's true.
Yeah.
So I think, you know, we've had kind of areductionist view of calories that, you know,
oh, well, you just need, you know, these manycalories to fill your body.
But I think really shifting that and andthinking of food as fuel and what do you want
(26:15):
to fuel with and and we should focus onvegetables and you know, lean lean healthy
protein sources.
Keep a healthy diet, people.
This is helpful, even for pain.
Yeah.
It is.
Yeah.
And and so and is that a third tip of what wewhat we're kind of talking about the non the
(26:36):
non the natural, you know, non medicine.
So the natural ways.
Yeah.
I think that was the
I think being active is making diverse at somepoint.
And then
Other stuff, might be the 3rd point.
Yeah.
Other stuff, including, yeah, diet, because Ithink diets big enough to be its own point.
(26:57):
Diodes is big.
It's really big.
Like, everything that we've just talked about,you know, we could go we'll get So do you often
send your patients to go to dietitians to,like, get their whole meal plan figured out and
stuff like that?
I probably should.
I I do not do that super regularly.
I do have a a PA in my practice who, who, likesto do some dietary counseling.
(27:21):
So she's not a dietitian, but she Yeah.
Certification from the Institute for FunctionalMedicine.
And she's
an
elimination diet work.
And so I actually did it myself, just so Iwould know what this was that we were offering
to patients.
And, did, like, the 6 week elimination diet ofeliminating gluten and dairy and all kinds of
(27:43):
things.
And
Really?
Did you notice any?
I haven't gone back.
I mean, I I eat I would say I eat some, gluten.
I eat some, dairy, but I no longer think ofmyself as just like, oh, I eat every thing,
which is kinda how I used to think of myself.
And now I now I kind of have have modified myhabits, and and I feel better.
(28:04):
And
at the time, I was just having, you know,personally, I was just having some, like,
bloating sensation and was really looking I waslooking to address that and then to make I
understood the program that we had.
And it did help.
That's amazing.
Oh, no.
Thank you for sharing that with us.
So Oh, the last part that were coming wereapproaching the last segment of our podcast,
(28:26):
which is like, share something interesting thathappened to you recently, or something that
made you feel empowered.
Oh, something that I mean,
you're maybe doing power, and my goodness.
Yeah.
Something interesting.
It doesn't it doesn't have to have make youfeel like, you know, if you're not into the
whole empowerment, feminism, But, you know,people tend to want to hear something
(28:51):
uplifting.
Yeah.
Or something interesting.
No.
I I I'm just, like, super fortunate, honestly.
I I feel I was just thinking about some of our,you know, challenges on the one hand you know,
in the business.
And, but but, no, I'm I'm really just superfortunate and to have a a great team in my
(29:13):
office and to have, a great family.
And I'm just, you know, I'm just super blessed.
And, I think that, you know, I want to workhard to help the community and and help other
people to live their best lives.
That's so sweet.
Well, I hope you will come back for anotherepisode with us in the future.
(29:37):
This was really good.
This was really amazing.
And how can our audience find you?
I know you're in Maryland.
I'm in Georgia, but If people were around theMaryland area and wanted to work with you, how
can people find you?
Yeah.
So we're at, life stream health center dot comis our website.
You can send us a message from there.
(29:58):
We're also on facebook, facebook.com/livestreamHealth Center.
And we're on Instagram as live stream H.
C.
And, yeah, I would love to connect peoplethere.
Our YouTube channel actually too is live streamhealth center, and we have a series of live
broadcast.
And so, check out the YouTube channel and underthose, live headings, we've got a lot of
(30:23):
different, education on different topics ashealth topics as they intersect with pain.
This this has been amazing.
And you can find me at younger selfmd.com andwe're currently accepting patients.
Our phone number is 404-566-4623.
Thank you so much for joining us.
(30:45):
And stay tuned for the next, episode and, ourmystery guests.
Find out who I missed your yes is gonna be.
Thank you so much, Doctor Sarah.
This was so good.
Glad to be here.
Thank
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