January 27, 2025 • 41 mins
- Listen Saturday mornings at 8 as Dr. Msonthi Levine discusses medical issues and takes your calls on News Talk 560 KLVI. Dr Levine is board certified in Internal Medicine and Geriatrics. His office is located at 3080 Milam in Beaumont, Texas. He can be reached at 409-347-3621.
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Episode Transcript
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Speaker 1 (00:00):
All right, Internet radio listeners Southeast Texas, Good morning and
welcome to the edition of the Doctor Levine Medical Hour.
This is your regular host, Doctor Levine. Welcome to the
edition of the show. Happy New Year, as we're deep
into January, it's almost February. I mean, look how fast
that went by the new year. Thank you for joining
(00:23):
for the show. Did everybody enjoy that snow in the
past couple of days wasn't that different and it wasn't
a change of what we normally experienced. It was fun.
I hope everybody enjoyed that. It was so beautiful to
look at the snow on the ground, so peaceful walking
out there with all the snow on the ground and
(00:44):
talking on my patients. Seems like everybody had some fun
when they were just interacting with this, So that was great.
Speaker 2 (00:51):
So hopefully you had a great time for the past.
Speaker 1 (00:55):
It almost felt like a holiday weekend, right because Southeast
Sex was kind of closed down for a couple of days.
Most jobs were closed and most businesses were closed, so
you're just kind of hanging out at the house almost
like another Christmas.
Speaker 3 (01:10):
Right.
Speaker 1 (01:10):
I had one patient who felt like, hey man, this
feels so much like Christmas started playing.
Speaker 2 (01:16):
Christmas means got his house. Just because of the.
Speaker 1 (01:19):
Snow and the ambiance, if you will. It was just
very festive and holidayish, so they take advantage of that.
But man, that was fun, and it wasn't really terribly disruptive.
I remember I guess five six years maybe it was
five years ago, four years ago, when we had that
(01:42):
cold freeze and it lasted several days, and man, it
was a mess just with all the pipes busting and
all the headache that came with snow and freezing. That
Texas was not used to power outages. That was another
thing forgot about. That seems like that was not supposed
(02:03):
to happen. I think people get excited when they know
it's going to snow, but man, that time, a lot
of bad things are happening with ice and cold, and
we're just ready for it to go away. So it
just lasted a couple of days and then it was gone.
I mean, I think that was perfect. I know in
some areas of the country it lasts for weeks a week,
(02:26):
it just snowing every day, And my god, could you
imagine having to shovel out of that every day to
get to work. And in some areas that's what they do.
They don't shut down, they keep going. Phone lines are
open eight nine to six. Kova I won in one
hundred and three three zero kova I. Give us a
call and let's talk about anything that pertaining to your health,
(02:52):
make it less confusing, help you understand better what maybe
is the right thing to do. We're here for you,
try to get you some information for you, are your family.
If you're having a physical symptom that doesn't seem to
want to go away, and maybe you want to know
(03:12):
kind of what it is, because that's always a big
concern when you get a physical symptom. It's new, you
feel it, and you just want some answers as to
what's causing that. And that can sometimes cause a lot
of angst and a lot of concern, and we're here
to try and help you to figure out what that is. Vaccines,
(03:34):
we're still promoting those. Flu season is winding down, but
nonetheless all the other vaccines that we promote, pneumonia, shingles, covid, RSV,
viral respiratory infections, which things are winding down at this point,
(03:56):
flu season and all that, but you know, we see
these things year round, we get the big spike in
the wintertime. And yesterday we had our taping of the
asdoc section segment. I should say, as you may or
may not know, we've been doing that segment for many years,
(04:16):
ever since I got back here in Southeast Sexes, and
we had our taping yesterday, so I thought i'd talk
about some of the topics that came up on that.
One question that was interesting was having cold feet at
nighttime when you go to bed. I know patients come
in with that complaint often is their feet are cold,
(04:40):
and they want to know if that represents poor circulation,
poor circulation or better known as pad RPVD, whicheveryone you prefer.
I think most people know it as pad peripheral arterial disease.
Speaker 3 (05:00):
Right.
Speaker 1 (05:00):
That's when the blood vessels that feed the lower extremities
your legs, your feed start to develop a lot of
plaque plaque, and the blood flow is sluggish, and so yes,
you're not getting as much blood float into the extremity
(05:22):
or the foot. And yes, that makes sense that if
your blood is not flowing well, then it could generate
some sensation of cold temperature, like they just they feel cold,
and when you touch them, they're cold. And does that
always represent peripheral arterial disease? In my experience it does not.
(05:46):
In my experience, it does not represent that, but can.
And the one thing that we always want to make
patients aware of is that you know, if you feel that,
just go and get it checked out, right, because the
workup is kind of simple and non invasive to figure
(06:08):
out if you do have p A D. And again,
just to reiterate, there's two blood vessels in the human
plus three kind of two and a half. I put
it that way, vessels in your body that allow blood
and fluid to navigate itself through your system, to get
(06:31):
to the cells, to feed the cells and eliminate waste
from cellular activity. So you have your artery, you have
your capillary, and you have your vein.
Speaker 2 (06:45):
That's about it.
Speaker 1 (06:46):
That comprises the vascular system. And the most common or
biggest problem in our country right is arterial vascular disease.
And again, that's the blood vessel that transports blood from
the heart, starting from the heart area to a particular
(07:10):
specific organ site that's the artery. And normally that artery
is under pressure because the heart is beating, it's generating
the pressure and that's what normally generates that pulse PU
L s E that you can feel when you touch
either your neck or your wrist, you can feel that
(07:32):
pulse that's normally the arterial pulse. And the blood flows
through that particular conduit to a particular vital organ, and
as it transitions through the cell, there is a capillary system,
which anatomically is different.
Speaker 2 (07:53):
It allows the.
Speaker 1 (07:55):
Blood and the cell, whichever cell that is, whether it
be a heart cell or over cell or a nerve cell,
that's sort of the transition zone where things can I guess,
if you will, sort of like a train station. Nutrients
can get on and nutrients can get off or get out.
Speaker 2 (08:15):
Of the cell.
Speaker 1 (08:16):
So oxygen and nutrition and sugar can get into the
cell at the capillary level, and all of the cellul
activity that occurs again because we're sort of like a
little engine that's running all the time, electrical engine, if
you will, these byproducts then get out of the cell
(08:39):
in the capillary area, and then as it leaves the
capillar area, it goes to the venus system, which is
considered a low pressure system because the capillary system kind
of slows down that pressure and blunts some of that
pressure from the arterial side, and the venus side is
(09:01):
what we call a low pressure system. And the blood
vessel or condoit is not as muscular. It's still a
complex blood vessel. Like the artery. It's a very complex
blood vessel. It's interacting with a lot of things that
are happening in the blood system. But the vein again
(09:23):
brings blood back to the central part of your body,
the heart, the lung so that it can dump all
of those toxins and all those bioproducts and get cleaned up.
Speaker 2 (09:37):
So it goes to that liver, which is like a
big scrubber of the blood.
Speaker 1 (09:42):
It allows us to sort of eliminate toxins and deal
with all sorts of havoc in the bloodstream. The liver
neutralizes that. Then as it passes through the livery goes
back to the heart through the lungs, gets more oxygen,
It dumps that carbon dioxide out, you breathe out, and
then the whole cycle starts over again. It's it's called
(10:05):
a closed circuit our closed circuit cycle right the blood system.
But things like hypertension, high cholesterol, high sugar, that's America.
It tends to generate plaque in the arterial wall of
(10:25):
the artery and all of the inflammatory activities that Americans
engage in. Right, We've talked about that before, and a
lot of experts are raising the alarm that a lot
of the foods and beverages don't forget beverages.
Speaker 2 (10:43):
We love those beverages. Right.
Speaker 1 (10:45):
When I grew up, the supermarkets were just not as big, Right,
they were small. You had a lot of mom and
pop grocery shows everywhere, and you know, you had a
few choices of beverages. Right, But you guys know what
I'm talking about. You go to go to the convenience stores.
I mean those things are huge and monsters. I mean
(11:09):
it's a whole wall, the whole store. I mean the
back wall is just full of all these beverages. It's amazing.
I mean they look good too. And but you know,
these beverages, a lot of experts are saying are containing
substances that, if you drink on a regular basis, can
(11:31):
generate inflammation, generate weight gain, and inflammation adds to the
development of plaque p L a q U E in
the artery, and plaque over time makes it more narrow.
Speaker 2 (11:47):
For blood to flow.
Speaker 1 (11:48):
It makes it more of a diseased artery such that
it is unhealthy. It's more prone to forming clots, it's
more prone to eat. It does not act in a
healthy way to the cardiovascular system. So it just becomes
a diseased part of your body. And that's when you
(12:10):
start having physical symptoms related to the progression of the plaque,
as well as a chronic inflammation. You know, eating and
drinking certain things that generate inflammation. You guys all know
what I'm talking about, right, Sugar, Right, you eat a
lot of that sugar, You drink a lot of that sugar.
The body, as experts are clearly documenting, the body human
(12:37):
body reacts negatively to that when it gets exposed to
all that sugar every day, NonStop, just all the time,
no break. And you've heard me talk on this show
recently that you know, at the end of the day,
the bottom line is, you know, we just eat too
(12:58):
much in this country. Not that you're trying to be
a bad person, but we just we don't have to
eat as much as we do. I mean, we eat
a lot, we snack a lot. There's all these products
to snack and eat on and we engage in that.
But the impact of that is your body is getting
exposed to all these carbs and sugars and starches and
(13:20):
energy all the time.
Speaker 2 (13:22):
Doesn't get a break. And I think, why should say.
Speaker 1 (13:25):
I know, based on my understanding, my own personal experience
and talking with the experts, that the body is okay
with not being exposed to foods and beverages every few hours,
like you've got to give it a break. We call
that fasting FASTI NNG and that's a popular way to
(13:49):
lose weight these days. A lot of people are into
that right now as the new year gets kicking, and
they want to look pretty. They want their skin to
look good, and they want to get into those old clothes,
and they want that joint pain to go away, and
they want to be less short of breath and want
to have more energy. They want to feel younger again.
Most of the time, you got to get that weight
down because the bigger you get, the more inflamed your
(14:13):
body is, and the more things are going to slow down.
You talk to guys about fatigue all the time, low
T low testosphone, even guys in their forties. I mean
for all of us guys, I mean our test housecone
will decrease or decline over time. That's natural aging process, right,
I talk about that all the time. But being overweight,
(14:36):
being inactive, eating a lot of inflammatory foods and beverages,
that test housphone goes down faster and more prematurely and earlier,
and so you get those physical symptoms related to that.
But back to PAD, those risk factors high pertension, high lestero,
(15:00):
high bloopressure, and I forgot the big monster in the room.
You guys probab already know which when it is right,
that's right. Tobacco smoking, dipping. Any exposure to tobacco PVD
is there, man, I mean it ramps it up. I
see the worst PAD and smokers, I mean the worst.
(15:23):
I mean terrible. At an early age, I mean young
people forties, fifties already, the blood vessels are just torn up.
You know, they need stints, they need bypass, they need
blood thinners, and then they get put on blood thinners,
and then they come in bleeding and then they need
blood transfusions and scopes and all these things that sort
(15:48):
of come from the fact that you got to now
be on these medicines because all that plaque in your
blood vessels from these risk factors that we talk about,
but in my pin, smoke is at the top list.
I mean it's huge, huge, huge, huge, And I would
say again, I'm been in the game over twenty years.
(16:11):
Smoking and its impact on the human body was not
really impressed upon me as a resident or when I
was training, just it wasn't talked about.
Speaker 2 (16:23):
And so.
Speaker 1 (16:25):
You get out and you train. When you finish your
training and you start interacting with your patients, you kind
of know it's something you shouldn't do, but you know
it doesn't really mean that much too until you see
the impact of smoking on patients in their lives. I
mean they come in with the big mis the big strokes,
(16:46):
the smokers, and it doesn't make you a bad person.
Speaker 2 (16:50):
It's a hard habit to break. And we're here to help.
Speaker 1 (16:52):
Your phone on to open eight nine to six kV
I one hundred three three zero o kVA.
Speaker 2 (16:56):
I'll be back in two minutes.
Speaker 1 (17:09):
All right, welcome back to dock of your medical Our
phone lines are open eight nine six kV I one
hundred and three three zero k l v I.
Speaker 2 (17:15):
Happy New Year to you.
Speaker 1 (17:17):
We have Carolyn from Baytown.
Speaker 2 (17:20):
How can we help you.
Speaker 3 (17:22):
Yes, I would like to have you talk about osteoporosis
and the treatments of my prolia reclassed and then the
pails and stuff that they had before the heavy other
injection and infusion.
Speaker 1 (17:39):
All right, Carolyn, we can do that. Do you have
any other questions?
Speaker 3 (17:44):
No, that's it all right, app shake your opinion on
some of them. Okay, Oh, thank you so much.
Speaker 1 (17:51):
Absolutely happy to you to you callen osteoporosis. You know,
it doesn't come up a lot on this show, and
I'm sorry about that. Again, if there's any topic that
you guys would like me to talk about, just let
me know. The show is for you and we want
you to certainly be engaged and interested in what we
have to say. Osteoporosis it's a big term, big, a
(18:13):
lot of letters, but basically it means thinning of the
bone structure. And we kind of think of this as
a female problem, but guys can have osteoporosis as well. Again,
I talk a lot about aging on this show, and
I do that because it's a real process in our
(18:34):
human body.
Speaker 2 (18:35):
It's real.
Speaker 1 (18:37):
Okay, just we age, we get older, and you have
to understand that that Again, if you want to be healthy,
you want to stay out of the hospital, You want
to stay alive as long as possible. You have to
invest more time into your health as you get older.
It's just you can't. It's not automatic anymore. You're not young,
and there's just all these diseases and illnesses and elements
(19:01):
that we accrue as we get older.
Speaker 2 (19:06):
It's part of the process.
Speaker 1 (19:07):
To be honest with you, if you stay alive to
your eighties nineties, more than likely, yes, there will be
some physical problem that you develop, just because modern medicine,
including vaccines, as well as other advancements such as the
treatment of cancer, the diagnoses of cancer, the treatment of
cardiovascal disease, the diagnosis of cardiovascal disease, just our hygiene
(19:33):
in this country, antibiotics, all this stuff has allowed our
population to live longer. Well, when the longer you live,
you know, again, the body is engineered to at some
point expire. We can't defeat that, and I think everybody
understands that. So the longer you live, you're going to
(19:56):
accrue some sort of typically hive chance, some sort of
medical issue. You just want to keep it to a minimum.
Osteoporosis is one of those, as I say, age related
diseases that most ladies get again just because of their
physical makeup, their hormonal levels, their activity level, but guys
(20:17):
can get it too, And for most of the people
that have osteoporosis, yes it's an age related thing. But
there are diseases that cause osteoporosis. I know a couple
of those diseases. One that's popular, are common. It's just
the use of steroids like pretnozone, solur meadrildex of methisone.
(20:40):
There are a lot of indications for the use of
chronic steroid usage in the population for chronic diseases, and
one of the impacts of steroids is osteoporosis. And then
number two, there are metabolic diseases that impact the levels
of vitamin D as well as calcium that can impact
(21:04):
the bone structure. Those are more rare but can happen.
And I don't have a lot of exposure to those diseases.
Maybe an interchronologists would, but they happen sometimes. But the
main things I see frostposis is age and then steroid
induced those that comprises the big part of it. And
(21:24):
then there's a like I said a metabolg disease called
primary hyperthyroidism. You know, your thyroid sort of sits on
the front of your neck and it sort of looks
like an h and you have the two upper parts
two lower parts, and in that general area you have
a little gland called the parathyroid gland, which is involved
(21:46):
with calcium regulation.
Speaker 2 (21:48):
And if the.
Speaker 1 (21:49):
Parathoric gland goes crazy, you can either have a high
calcium or a low calcium. So with osteoporosis, when the
calcium level gets on your blood, the parathyroglan is basically
stealing calcium away from the bones because it's hyper and
it's malfunctioning in a hyper state, and over time it
(22:13):
takes calcium away from your bone, and that does not
allow your bone structure to be as strong as possile.
You can't make new bone as well or as efficiently
because it needs calcium to make bone. It's almost like concrete.
There's components of concrete. You know, you have the actual
concrete and you have the steel that goes in between
(22:36):
the concrete to give it rigidness. But you have to
mix concrete with water and all this stuff. Well, just
think of a component of that was eliminated are not
there as much as it should. It would be very
weak concrete and be brittle and break easy. The bone
is no different. There's a metabolic process that's happening all
(22:59):
the time to keep your bones as strong as possible.
But as you age, that process breaks down and it
tends to lead to weak bones, brittle bones, porous bones
in the sense, and very easy to fracture, or what
(23:19):
we call spontaneous fractures.
Speaker 2 (23:22):
Believe it or not.
Speaker 1 (23:24):
Getting out of bed, jumping, stepping, bending, picking up things.
These are common activities you engage in every day, believe
it or not.
Speaker 2 (23:34):
That puts a.
Speaker 1 (23:35):
Little strain on your muscular scalar system, and for the
most part, nothing's going to happen. But when you get osteoporosis,
those same activities, bending, picking up things, falling, you can
fracture your bone. And yes, you're doctor Levine did have
(23:57):
a fall in the snow walking out of the garage,
and I was when I walked down, I'm like, okay,
I'm gonna be real careful, I'm not gonna fall, and man,
one little slip boom.
Speaker 2 (24:11):
I was down.
Speaker 1 (24:13):
It was fast too. Thank god, it didn't break anything.
But man, I went down fast, you know, those cartoons
were anyway, that's very We saw some fractures during the winter.
We always see them. Patients going outside and they slip
and fall in the ice and they fracture a hip fracture, pelvis. Well,
(24:34):
ostioprosis certainly increased the risk of those sort of fractures,
but also increase the risk of spontaneous fractures, meaning you
turned over in bed to reposition yourself and crack, you
get a fracture.
Speaker 2 (24:48):
We see that that's what osbirosis does.
Speaker 1 (24:50):
There's a big awareness foster process now right since I've
been to doctor, there's just been a big awareness of
oster prosis. So most ladies, again it's kind of considered
ladies problem, but men can get it too, not as common.
So we do a test called a bone density test,
(25:11):
which is a painless, simple, easy test to do, typically
by a bone density machine. And some doctors have these
machines in their offices, but most of the time they're
at freestanding X ray businesses, or it's at a major
hospital such as Baptist and you go in, you lay
(25:33):
on the table, they do the scan, you get up,
you go home. I mean, it's very, very easy. It's
like was that it? But the screening guidelines right now
in this country tell me as a doctor that certainly
I should be looking out foster process and I should
be screening for it in certain patient populations. And at
the age of sixty five, most ladies deserve to start
(25:56):
looking foster process. And again we do this bone density
and if it's positive, then we offer medications. And this
was the original question of this caller. My god, I
took a long time answer this question. I'm just trying
to give you the background. I give you the oversight
of osteoporosis. We offer these medications and when I first
(26:19):
came out, Yes, this class of medications that we use
now called bysphosphonates better known as fossamax or alindrinate. Those
are the two that I know and that I've used
over the years. I haven't had to use more in
the bisphosphinate category. Have been out for many years. And
(26:40):
originally it was once a day, but now it's like
once a week. There was a once a month version,
but the caller was more interested in these injections, which
again I talked about the metabolic system that makes bone
and breaks down bone. Again, natural process and homeostasis. You
(27:01):
heard that term before. That process of breaking down bone
recreating bone is supposed to be imbalanced, meaning at the
end of the day, even though that process is going on,
your bones stay strong. But osteoporosis, the process menopause, age, steroids,
(27:22):
parathyroid problems, the process starts to favor bone loss, and
so you just lose that thickness of the bone gets
very brittle, weak, not strong. And the medicines they've come
out with basically blunt or block that process in various
ways to slow down the bone breakdown so that the
(27:44):
bodies regenerative properties can catch up with the loss. That's
basically what's happening. And just like hypertension, we have sort
of these different classes of these meds. This posphinates is
one of those classes and was probably still the most
popular version because it's been around for a long time.
(28:06):
It's a tablet. You take it once a week because
you know, it's pretty simple, straightforward. But the call I
was talking about these injections and infusions. I think one
of them is IV that you can get to help
with your osteoporosis. One of the other brand names for
(28:26):
that is called prolia, which is every every six months injection.
That works pretty well, but I again, I don't have
to go to that one. Often a lot of times
spaces have side effects to the bisfoscinates, like the actinelle
(28:48):
or the fossom x. The big one is just gastrointestinal upset.
They take it and they get a lot of heartburn,
and sometimes it can interact with other medications and so
so that can be an issue. When these medicines first
came out, again when I was a younger doctor, they
didn't want you to use it if patients had acid
(29:09):
reflux or had gash in tests and problems. They had
a lot of extreme caution. They had all these instructions.
You have to take it in the morning, you got
to drink water, don't go, don't lay down, all these
things to help the medicine be absorbed better and to
reduce the impact of the side effect of the medication.
(29:29):
But still a lot of people got around that and
still use these bis fascinates, act to el fosso x, elindronate.
Speaker 2 (29:37):
They're cheap.
Speaker 1 (29:38):
Now the infusions and the injections tend to be more expensive,
a little bit more cumbersome, Right, you got it? A
lot of times go to infusion center to get that done.
But it can happen, right, you can get it done,
and it's not every day, no, it's not only every
(29:59):
six months once a year.
Speaker 2 (30:01):
With these other.
Speaker 1 (30:02):
Infusions and injections, and again, it just like anything, it
just depends on what the doctor's trying to compet it's
an option, but just because it it's an injection, it's
an infusion, you know, doesn't mean that's the right thing
for you. Just depends on the indication and what we're
trying to do. For most people with generic osteoporosis, no problems.
(30:23):
I think most doctors are still sticking with the tablets.
It's just easier, been around for a long time, jeep,
and we can resolve that issue. But if there's some
secondary problem that's happening, then we start going to these
injections and these infusions, and again they work very well
(30:44):
to blunt the breakdown of bone so that the risk
of spontaneous fractures is low. And if you do have
some sort of trauma, which goes up as we get older,
right because of falls, you're less likely to break bone.
So expense comes into play as well. A lot of
(31:04):
people don't like injections, like it's once it's in, it's in,
you know, that's it's going to do what it's gonna do,
a lot of people don't like that, and they don't
have control over the medication. It's it's new stuff. It's strong.
The side effects I read about it, and so there's
some limitations with that as well, but just more options
available for patients to have ostroporosis. So they're all good
(31:27):
products and they all have their side effect issues to
deal with. But I think most people start the tablets,
and then tablets don't work, they go to the infusions
like prolia is one of those for tao. Is another
one fo r TEO. That's another one, different class of
(31:49):
anti absorptive medication for the reduction of bone loss for TAO,
which I haven't used much.
Speaker 2 (32:00):
And then a new one just came out. I'm blinking
on the name.
Speaker 1 (32:02):
Rep was just in the office last week talking about
that one. So all good. Just talk with your doctor
and see which one is right. A few phone lines
open eight nine to six S three zero, Okay, I
be back in two minutes. All right, Welcome back to Acay.
(32:30):
Maclar Michael from Pasadena, how can we help you?
Speaker 4 (32:34):
Oh, good morning, and thank you for taking my call.
Speaker 2 (32:37):
Yes, sir, I.
Speaker 4 (32:40):
Went to see a back doctor uh in Webster, and
he recommended physical therapy for curved back. If it's got
a name, start with a cake, try something or other. Yes,
and uh, he recommended a physical therapy and I asked
(33:03):
them if they had a specialist for that, and he
recommended doctor Francis, doctor Richard Francis, and he has an
office in Beaumont and in bel Air, Texas, which is
(33:23):
off Southwest Freeway across Houston from Pasadena. And I just
wondered if you knew of him, and as he highly recommended, Yeah.
Speaker 1 (33:37):
Doctor France has actually been operating for a long time.
He does have office here in south east Texas. I
am familiar with him. Yes, he is regarded as a
very very good, excellent neurosurgeon and has been been around
for a while.
Speaker 2 (33:50):
So yeah, he knows what he's doing.
Speaker 4 (33:53):
Okay, I'm going to try the physical therapy, but I'm
gonna the doctor that I saw is a good doctor,
but he said he doesn't specialize in the curvatures of
the back, and so okay, well, thank you very much,
(34:21):
and your topic on the bones and backbone. That's very good.
Speaker 1 (34:26):
I appreciate you, all right, brother, I appreciate it. Happy
to you tell you. Yes, a little back pain. Our
caller having problems with that. Remember that again. Aging we
talked about osteoporos is age related. Primary osteoarthritis or degenerative
joint disease is also, in my opinion, age related as well,
(34:47):
and for some of us can generate some muscular scalar complaints,
back pain being the number one cause of that, and
sometimes it can be severe.
Speaker 2 (34:59):
The DJD the process.
Speaker 1 (35:01):
And that then causes what we call stenosis, where there's
narrowing of the structures, whether the bone structure is sort
of encroaching or putting pressure on the nerves, which is
there to protect starts putting pressure on those nerves, and
then that generates symptoms such as pain, cramping, tightness in
(35:23):
the back, numbness, tingling, weakness, And it's from the spinal
sypnosis and generative joint disease. And our patient is having
some cayphosis, which is a medical term we use to
describe when the spine sort of bends forward like a
c There is some normal curvature in the spine, but
(35:45):
that curvature when it becomes more excessive as a result
of osteoporosis, which is probably why this patient was calling
the vertebrae, which is part of the spine. Those little
parts of the spine that are stacked on top of
each other, they are called vertebrae, and we have multiple
(36:06):
vertebraes and the cervical, thoracic lumbar spine.
Speaker 2 (36:10):
Well, anyway, that.
Speaker 1 (36:11):
Vertebrae structure starts to flatten as a result of osteoporosis.
It bends, it flattens, it cracks, almost like if it
was pressed down. But again, the osteoporosis process can generate
this because of the pressure of gravity and things like
I said, walking, bending, picking up things, it puts pressure
(36:33):
on that spine and if you have weak bones and
it just basically flattens it. And as it flattens, you
start to.
Speaker 2 (36:42):
Lean forward.
Speaker 1 (36:44):
You can kind of see that you're not straight up,
You're more forward when you walk. That's kaiphosis, and we
normally see that in severe osteoporosis is what we see.
What we see most of the time in ladies. You
see that in elderly patients as they walk and you
kind of notice their leaning forward. Sometimes it's so severe
they can't even look up, sort of looking down because
(37:06):
the spine has just sort of curved and bent forward
because of the weakness. Sometimes that's more congenital. A lot
of times again it's a degenitive process. And yes we
do see cayphosis and men unrelated to osteoporosis, but related
to that aging.
Speaker 2 (37:24):
Process that we talk about.
Speaker 1 (37:26):
And you know, as a back surgeon, you don't really
want to operate on weak bones, you know, because putting
in screws and plates and all that the bone structure
is weak, then the surgery may not take It may
lose its position, you know, the screw might come out,
the plate might loosen up, and certainly the blood flow
(37:50):
may not be where it is, the protection from infection
may not be where it is, so it can get infected.
I mean, it can really turn into a big mess.
In my experience, back surgeons tend to be very conservative
with patients, you know, seventy and above. They just it's
a high risk patient typically, and they a lot of
(38:11):
times will say, hey, it's not much I can do,
or it's not much I want to do. You can
go down the street and talk to this other guy
see if he wants to do it. Some doctors are
more skilled at working with high risk patients and they'll
take on the operation. But certainly take your time and
don't jump to it because once you open that back
up it can be a mess. Phone lines opening nine
(38:31):
six kvy. I want a hundred through three to zero
O ky ov. I'll be back in two minutes. All right,
welcome back to doctor me a medical our phone lines
open an six kV. I want one hundred three to
three zero ok lv I.
Speaker 2 (38:52):
Happy New Year to you.
Speaker 1 (38:55):
Almost at the end of the show, I want to
thank all the college and listeners. Time goes fast, so
super fast. But talking about peripheral arterial disease, wanted to
conclude that again, if you're a smoker, please stop as
as soon.
Speaker 2 (39:09):
As you can.
Speaker 1 (39:09):
We have products available to help with that. Most smokers
need something to help them stop smoking. The two products
that have been out which are used by a lot
of practitioners chantis as well as well, butrian that may
not work for you, but it is an option. And
then they have all of these sort of nicotine replacement
products over the counter that you can go and get now.
(39:34):
But I do strongly strow encourage you if you are smoking,
please stop. It's just a terrible, terrible habit. It just
causes so much premature cardiovastar disease. It increases the risk
of cancer terribly, chronic lung disease terrible. So we need
you to work on that. But if your feed are cold, yeah,
(39:55):
go to your primary care doctor and get an ultrasound
of your arteries and just check see if your circulation
is good. But a lot of people just have cold
feet and it just feel cold. You cold, But the
circulation is fine, the labs are fine, although the X
rays are fine. It's just, yeah, your feet get cold
(40:16):
in the evening, and most of the time I just
tell people you just gotta dress warmer, you know, put
some socks on, get underneath the blanket. But there's not
really a medication for them unless we found a disease.
Sometimes diabetic neuropathy or any other forms of neuropathy can
make the feet feel cold as well, and certainly treating
(40:37):
the sugar can help with that, But otherwise we conservatively
manage that there's not really a medication to just sort
of make your feet feel less cold. But you just
want to make sure and check those things out. And
I'll tell you that if you don't smoke, and you
don't have hot sugar or high cholesterol, it's highly unlikely
(41:01):
you'll ever develop any plaque in your life.
Speaker 2 (41:04):
That's significant.
Speaker 1 (41:05):
I mean, I see patients in their eighties nineties with
some plaque development, but again that's part of the aging process.
In my opinion, it's normally not severe. The blood has
sort of rerouted itself. They don't have any symptoms. That's
more of an age thing and nothing they really did wrong.
(41:26):
But yes, the older we get sometimes, yes we have
to deal with these physical issues that come up, but
most of the time you can manage them very well.
And it all starts with what you eat and what
you drink. And we want you to focus on that.
Eat more vegetables, eat less sugar, and be physically active.
(41:50):
That could be a brisk walk or peling a bicycle.
We'll see y'all next week. Happy New Year, Thank you
for listening.
Speaker 2 (41:56):
God bless
All right, Internet radio listeners Southeast Texas, Good morning and
welcome to the edition of the Doctor Levine Medical Hour.
This is your regular host, Doctor Levine. Welcome to the
edition of the show. Happy New Year, as we're deep
into January, it's almost February. I mean, look how fast
that went by the new year. Thank you for joining
(00:23):
for the show. Did everybody enjoy that snow in the
past couple of days wasn't that different and it wasn't
a change of what we normally experienced. It was fun.
I hope everybody enjoyed that. It was so beautiful to
look at the snow on the ground, so peaceful walking
out there with all the snow on the ground and
(00:44):
talking on my patients. Seems like everybody had some fun
when they were just interacting with this, So that was great.
Speaker 2 (00:51):
So hopefully you had a great time for the past.
Speaker 1 (00:55):
It almost felt like a holiday weekend, right because Southeast
Sex was kind of closed down for a couple of days.
Most jobs were closed and most businesses were closed, so
you're just kind of hanging out at the house almost
like another Christmas.
Speaker 3 (01:10):
Right.
Speaker 1 (01:10):
I had one patient who felt like, hey man, this
feels so much like Christmas started playing.
Speaker 2 (01:16):
Christmas means got his house. Just because of the.
Speaker 1 (01:19):
Snow and the ambiance, if you will. It was just
very festive and holidayish, so they take advantage of that.
But man, that was fun, and it wasn't really terribly disruptive.
I remember I guess five six years maybe it was
five years ago, four years ago, when we had that
(01:42):
cold freeze and it lasted several days, and man, it
was a mess just with all the pipes busting and
all the headache that came with snow and freezing. That
Texas was not used to power outages. That was another
thing forgot about. That seems like that was not supposed
(02:03):
to happen. I think people get excited when they know
it's going to snow, but man, that time, a lot
of bad things are happening with ice and cold, and
we're just ready for it to go away. So it
just lasted a couple of days and then it was gone.
I mean, I think that was perfect. I know in
some areas of the country it lasts for weeks a week,
(02:26):
it just snowing every day, And my god, could you
imagine having to shovel out of that every day to
get to work. And in some areas that's what they do.
They don't shut down, they keep going. Phone lines are
open eight nine to six. Kova I won in one
hundred and three three zero kova I. Give us a
call and let's talk about anything that pertaining to your health,
(02:52):
make it less confusing, help you understand better what maybe
is the right thing to do. We're here for you,
try to get you some information for you, are your family.
If you're having a physical symptom that doesn't seem to
want to go away, and maybe you want to know
(03:12):
kind of what it is, because that's always a big
concern when you get a physical symptom. It's new, you
feel it, and you just want some answers as to
what's causing that. And that can sometimes cause a lot
of angst and a lot of concern, and we're here
to try and help you to figure out what that is. Vaccines,
(03:34):
we're still promoting those. Flu season is winding down, but
nonetheless all the other vaccines that we promote, pneumonia, shingles, covid, RSV,
viral respiratory infections, which things are winding down at this point,
(03:56):
flu season and all that, but you know, we see
these things year round, we get the big spike in
the wintertime. And yesterday we had our taping of the
asdoc section segment. I should say, as you may or
may not know, we've been doing that segment for many years,
(04:16):
ever since I got back here in Southeast Sexes, and
we had our taping yesterday, so I thought i'd talk
about some of the topics that came up on that.
One question that was interesting was having cold feet at
nighttime when you go to bed. I know patients come
in with that complaint often is their feet are cold,
(04:40):
and they want to know if that represents poor circulation,
poor circulation or better known as pad RPVD, whicheveryone you prefer.
I think most people know it as pad peripheral arterial disease.
Speaker 3 (05:00):
Right.
Speaker 1 (05:00):
That's when the blood vessels that feed the lower extremities
your legs, your feed start to develop a lot of
plaque plaque, and the blood flow is sluggish, and so yes,
you're not getting as much blood float into the extremity
(05:22):
or the foot. And yes, that makes sense that if
your blood is not flowing well, then it could generate
some sensation of cold temperature, like they just they feel cold,
and when you touch them, they're cold. And does that
always represent peripheral arterial disease? In my experience it does not.
(05:46):
In my experience, it does not represent that, but can.
And the one thing that we always want to make
patients aware of is that you know, if you feel that,
just go and get it checked out, right, because the
workup is kind of simple and non invasive to figure
(06:08):
out if you do have p A D. And again,
just to reiterate, there's two blood vessels in the human
plus three kind of two and a half. I put
it that way, vessels in your body that allow blood
and fluid to navigate itself through your system, to get
(06:31):
to the cells, to feed the cells and eliminate waste
from cellular activity. So you have your artery, you have
your capillary, and you have your vein.
Speaker 2 (06:45):
That's about it.
Speaker 1 (06:46):
That comprises the vascular system. And the most common or
biggest problem in our country right is arterial vascular disease.
And again, that's the blood vessel that transports blood from
the heart, starting from the heart area to a particular
(07:10):
specific organ site that's the artery. And normally that artery
is under pressure because the heart is beating, it's generating
the pressure and that's what normally generates that pulse PU
L s E that you can feel when you touch
either your neck or your wrist, you can feel that
(07:32):
pulse that's normally the arterial pulse. And the blood flows
through that particular conduit to a particular vital organ, and
as it transitions through the cell, there is a capillary system,
which anatomically is different.
Speaker 2 (07:53):
It allows the.
Speaker 1 (07:55):
Blood and the cell, whichever cell that is, whether it
be a heart cell or over cell or a nerve cell,
that's sort of the transition zone where things can I guess,
if you will, sort of like a train station. Nutrients
can get on and nutrients can get off or get out.
Speaker 2 (08:15):
Of the cell.
Speaker 1 (08:16):
So oxygen and nutrition and sugar can get into the
cell at the capillary level, and all of the cellul
activity that occurs again because we're sort of like a
little engine that's running all the time, electrical engine, if
you will, these byproducts then get out of the cell
(08:39):
in the capillary area, and then as it leaves the
capillar area, it goes to the venus system, which is
considered a low pressure system because the capillary system kind
of slows down that pressure and blunts some of that
pressure from the arterial side, and the venus side is
(09:01):
what we call a low pressure system. And the blood
vessel or condoit is not as muscular. It's still a
complex blood vessel. Like the artery. It's a very complex
blood vessel. It's interacting with a lot of things that
are happening in the blood system. But the vein again
(09:23):
brings blood back to the central part of your body,
the heart, the lung so that it can dump all
of those toxins and all those bioproducts and get cleaned up.
Speaker 2 (09:37):
So it goes to that liver, which is like a
big scrubber of the blood.
Speaker 1 (09:42):
It allows us to sort of eliminate toxins and deal
with all sorts of havoc in the bloodstream. The liver
neutralizes that. Then as it passes through the livery goes
back to the heart through the lungs, gets more oxygen,
It dumps that carbon dioxide out, you breathe out, and
then the whole cycle starts over again. It's it's called
(10:05):
a closed circuit our closed circuit cycle right the blood system.
But things like hypertension, high cholesterol, high sugar, that's America.
It tends to generate plaque in the arterial wall of
(10:25):
the artery and all of the inflammatory activities that Americans
engage in. Right, We've talked about that before, and a
lot of experts are raising the alarm that a lot
of the foods and beverages don't forget beverages.
Speaker 2 (10:43):
We love those beverages. Right.
Speaker 1 (10:45):
When I grew up, the supermarkets were just not as big, Right,
they were small. You had a lot of mom and
pop grocery shows everywhere, and you know, you had a
few choices of beverages. Right, But you guys know what
I'm talking about. You go to go to the convenience stores.
I mean those things are huge and monsters. I mean
(11:09):
it's a whole wall, the whole store. I mean the
back wall is just full of all these beverages. It's amazing.
I mean they look good too. And but you know,
these beverages, a lot of experts are saying are containing
substances that, if you drink on a regular basis, can
(11:31):
generate inflammation, generate weight gain, and inflammation adds to the
development of plaque p L a q U E in
the artery, and plaque over time makes it more narrow.
Speaker 2 (11:47):
For blood to flow.
Speaker 1 (11:48):
It makes it more of a diseased artery such that
it is unhealthy. It's more prone to forming clots, it's
more prone to eat. It does not act in a
healthy way to the cardiovascular system. So it just becomes
a diseased part of your body. And that's when you
(12:10):
start having physical symptoms related to the progression of the plaque,
as well as a chronic inflammation. You know, eating and
drinking certain things that generate inflammation. You guys all know
what I'm talking about, right, Sugar, Right, you eat a
lot of that sugar, You drink a lot of that sugar.
The body, as experts are clearly documenting, the body human
(12:37):
body reacts negatively to that when it gets exposed to
all that sugar every day, NonStop, just all the time,
no break. And you've heard me talk on this show
recently that you know, at the end of the day,
the bottom line is, you know, we just eat too
(12:58):
much in this country. Not that you're trying to be
a bad person, but we just we don't have to
eat as much as we do. I mean, we eat
a lot, we snack a lot. There's all these products
to snack and eat on and we engage in that.
But the impact of that is your body is getting
exposed to all these carbs and sugars and starches and
(13:20):
energy all the time.
Speaker 2 (13:22):
Doesn't get a break. And I think, why should say.
Speaker 1 (13:25):
I know, based on my understanding, my own personal experience
and talking with the experts, that the body is okay
with not being exposed to foods and beverages every few hours,
like you've got to give it a break. We call
that fasting FASTI NNG and that's a popular way to
(13:49):
lose weight these days. A lot of people are into
that right now as the new year gets kicking, and
they want to look pretty. They want their skin to
look good, and they want to get into those old clothes,
and they want that joint pain to go away, and
they want to be less short of breath and want
to have more energy. They want to feel younger again.
Most of the time, you got to get that weight
down because the bigger you get, the more inflamed your
(14:13):
body is, and the more things are going to slow down.
You talk to guys about fatigue all the time, low
T low testosphone, even guys in their forties. I mean
for all of us guys, I mean our test housecone
will decrease or decline over time. That's natural aging process, right,
I talk about that all the time. But being overweight,
(14:36):
being inactive, eating a lot of inflammatory foods and beverages,
that test housphone goes down faster and more prematurely and earlier,
and so you get those physical symptoms related to that.
But back to PAD, those risk factors high pertension, high lestero,
(15:00):
high bloopressure, and I forgot the big monster in the room.
You guys probab already know which when it is right,
that's right. Tobacco smoking, dipping. Any exposure to tobacco PVD
is there, man, I mean it ramps it up. I
see the worst PAD and smokers, I mean the worst.
(15:23):
I mean terrible. At an early age, I mean young
people forties, fifties already, the blood vessels are just torn up.
You know, they need stints, they need bypass, they need
blood thinners, and then they get put on blood thinners,
and then they come in bleeding and then they need
blood transfusions and scopes and all these things that sort
(15:48):
of come from the fact that you got to now
be on these medicines because all that plaque in your
blood vessels from these risk factors that we talk about,
but in my pin, smoke is at the top list.
I mean it's huge, huge, huge, huge, And I would
say again, I'm been in the game over twenty years.
(16:11):
Smoking and its impact on the human body was not
really impressed upon me as a resident or when I
was training, just it wasn't talked about.
Speaker 2 (16:23):
And so.
Speaker 1 (16:25):
You get out and you train. When you finish your
training and you start interacting with your patients, you kind
of know it's something you shouldn't do, but you know
it doesn't really mean that much too until you see
the impact of smoking on patients in their lives. I
mean they come in with the big mis the big strokes,
(16:46):
the smokers, and it doesn't make you a bad person.
Speaker 2 (16:50):
It's a hard habit to break. And we're here to help.
Speaker 1 (16:52):
Your phone on to open eight nine to six kV
I one hundred three three zero o kVA.
Speaker 2 (16:56):
I'll be back in two minutes.
Speaker 1 (17:09):
All right, welcome back to dock of your medical Our
phone lines are open eight nine six kV I one
hundred and three three zero k l v I.
Speaker 2 (17:15):
Happy New Year to you.
Speaker 1 (17:17):
We have Carolyn from Baytown.
Speaker 2 (17:20):
How can we help you.
Speaker 3 (17:22):
Yes, I would like to have you talk about osteoporosis
and the treatments of my prolia reclassed and then the
pails and stuff that they had before the heavy other
injection and infusion.
Speaker 1 (17:39):
All right, Carolyn, we can do that. Do you have
any other questions?
Speaker 3 (17:44):
No, that's it all right, app shake your opinion on
some of them. Okay, Oh, thank you so much.
Speaker 1 (17:51):
Absolutely happy to you to you callen osteoporosis. You know,
it doesn't come up a lot on this show, and
I'm sorry about that. Again, if there's any topic that
you guys would like me to talk about, just let
me know. The show is for you and we want
you to certainly be engaged and interested in what we
have to say. Osteoporosis it's a big term, big, a
(18:13):
lot of letters, but basically it means thinning of the
bone structure. And we kind of think of this as
a female problem, but guys can have osteoporosis as well. Again,
I talk a lot about aging on this show, and
I do that because it's a real process in our
(18:34):
human body.
Speaker 2 (18:35):
It's real.
Speaker 1 (18:37):
Okay, just we age, we get older, and you have
to understand that that Again, if you want to be healthy,
you want to stay out of the hospital, You want
to stay alive as long as possible. You have to
invest more time into your health as you get older.
It's just you can't. It's not automatic anymore. You're not young,
and there's just all these diseases and illnesses and elements
(19:01):
that we accrue as we get older.
Speaker 2 (19:06):
It's part of the process.
Speaker 1 (19:07):
To be honest with you, if you stay alive to
your eighties nineties, more than likely, yes, there will be
some physical problem that you develop, just because modern medicine,
including vaccines, as well as other advancements such as the
treatment of cancer, the diagnoses of cancer, the treatment of
cardiovascal disease, the diagnosis of cardiovascal disease, just our hygiene
(19:33):
in this country, antibiotics, all this stuff has allowed our
population to live longer. Well, when the longer you live,
you know, again, the body is engineered to at some
point expire. We can't defeat that, and I think everybody
understands that. So the longer you live, you're going to
(19:56):
accrue some sort of typically hive chance, some sort of
medical issue. You just want to keep it to a minimum.
Osteoporosis is one of those, as I say, age related
diseases that most ladies get again just because of their
physical makeup, their hormonal levels, their activity level, but guys
(20:17):
can get it too, And for most of the people
that have osteoporosis, yes it's an age related thing. But
there are diseases that cause osteoporosis. I know a couple
of those diseases. One that's popular, are common. It's just
the use of steroids like pretnozone, solur meadrildex of methisone.
(20:40):
There are a lot of indications for the use of
chronic steroid usage in the population for chronic diseases, and
one of the impacts of steroids is osteoporosis. And then
number two, there are metabolic diseases that impact the levels
of vitamin D as well as calcium that can impact
(21:04):
the bone structure. Those are more rare but can happen.
And I don't have a lot of exposure to those diseases.
Maybe an interchronologists would, but they happen sometimes. But the
main things I see frostposis is age and then steroid
induced those that comprises the big part of it. And
(21:24):
then there's a like I said a metabolg disease called
primary hyperthyroidism. You know, your thyroid sort of sits on
the front of your neck and it sort of looks
like an h and you have the two upper parts
two lower parts, and in that general area you have
a little gland called the parathyroid gland, which is involved
(21:46):
with calcium regulation.
Speaker 2 (21:48):
And if the.
Speaker 1 (21:49):
Parathoric gland goes crazy, you can either have a high
calcium or a low calcium. So with osteoporosis, when the
calcium level gets on your blood, the parathyroglan is basically
stealing calcium away from the bones because it's hyper and
it's malfunctioning in a hyper state, and over time it
(22:13):
takes calcium away from your bone, and that does not
allow your bone structure to be as strong as possile.
You can't make new bone as well or as efficiently
because it needs calcium to make bone. It's almost like concrete.
There's components of concrete. You know, you have the actual
concrete and you have the steel that goes in between
(22:36):
the concrete to give it rigidness. But you have to
mix concrete with water and all this stuff. Well, just
think of a component of that was eliminated are not
there as much as it should. It would be very
weak concrete and be brittle and break easy. The bone
is no different. There's a metabolic process that's happening all
(22:59):
the time to keep your bones as strong as possible.
But as you age, that process breaks down and it
tends to lead to weak bones, brittle bones, porous bones
in the sense, and very easy to fracture, or what
(23:19):
we call spontaneous fractures.
Speaker 2 (23:22):
Believe it or not.
Speaker 1 (23:24):
Getting out of bed, jumping, stepping, bending, picking up things.
These are common activities you engage in every day, believe
it or not.
Speaker 2 (23:34):
That puts a.
Speaker 1 (23:35):
Little strain on your muscular scalar system, and for the
most part, nothing's going to happen. But when you get osteoporosis,
those same activities, bending, picking up things, falling, you can
fracture your bone. And yes, you're doctor Levine did have
(23:57):
a fall in the snow walking out of the garage,
and I was when I walked down, I'm like, okay,
I'm gonna be real careful, I'm not gonna fall, and man,
one little slip boom.
Speaker 2 (24:11):
I was down.
Speaker 1 (24:13):
It was fast too. Thank god, it didn't break anything.
But man, I went down fast, you know, those cartoons
were anyway, that's very We saw some fractures during the winter.
We always see them. Patients going outside and they slip
and fall in the ice and they fracture a hip fracture, pelvis. Well,
(24:34):
ostioprosis certainly increased the risk of those sort of fractures,
but also increase the risk of spontaneous fractures, meaning you
turned over in bed to reposition yourself and crack, you
get a fracture.
Speaker 2 (24:48):
We see that that's what osbirosis does.
Speaker 1 (24:50):
There's a big awareness foster process now right since I've
been to doctor, there's just been a big awareness of
oster prosis. So most ladies, again it's kind of considered
ladies problem, but men can get it too, not as common.
So we do a test called a bone density test,
(25:11):
which is a painless, simple, easy test to do, typically
by a bone density machine. And some doctors have these
machines in their offices, but most of the time they're
at freestanding X ray businesses, or it's at a major
hospital such as Baptist and you go in, you lay
(25:33):
on the table, they do the scan, you get up,
you go home. I mean, it's very, very easy. It's
like was that it? But the screening guidelines right now
in this country tell me as a doctor that certainly
I should be looking out foster process and I should
be screening for it in certain patient populations. And at
the age of sixty five, most ladies deserve to start
(25:56):
looking foster process. And again we do this bone density
and if it's positive, then we offer medications. And this
was the original question of this caller. My god, I
took a long time answer this question. I'm just trying
to give you the background. I give you the oversight
of osteoporosis. We offer these medications and when I first
(26:19):
came out, Yes, this class of medications that we use
now called bysphosphonates better known as fossamax or alindrinate. Those
are the two that I know and that I've used
over the years. I haven't had to use more in
the bisphosphinate category. Have been out for many years. And
(26:40):
originally it was once a day, but now it's like
once a week. There was a once a month version,
but the caller was more interested in these injections, which
again I talked about the metabolic system that makes bone
and breaks down bone. Again, natural process and homeostasis. You
(27:01):
heard that term before. That process of breaking down bone
recreating bone is supposed to be imbalanced, meaning at the
end of the day, even though that process is going on,
your bones stay strong. But osteoporosis, the process menopause, age, steroids,
(27:22):
parathyroid problems, the process starts to favor bone loss, and
so you just lose that thickness of the bone gets
very brittle, weak, not strong. And the medicines they've come
out with basically blunt or block that process in various
ways to slow down the bone breakdown so that the
(27:44):
bodies regenerative properties can catch up with the loss. That's
basically what's happening. And just like hypertension, we have sort
of these different classes of these meds. This posphinates is
one of those classes and was probably still the most
popular version because it's been around for a long time.
(28:06):
It's a tablet. You take it once a week because
you know, it's pretty simple, straightforward. But the call I
was talking about these injections and infusions. I think one
of them is IV that you can get to help
with your osteoporosis. One of the other brand names for
(28:26):
that is called prolia, which is every every six months injection.
That works pretty well, but I again, I don't have
to go to that one. Often a lot of times
spaces have side effects to the bisfoscinates, like the actinelle
(28:48):
or the fossom x. The big one is just gastrointestinal upset.
They take it and they get a lot of heartburn,
and sometimes it can interact with other medications and so
so that can be an issue. When these medicines first
came out, again when I was a younger doctor, they
didn't want you to use it if patients had acid
(29:09):
reflux or had gash in tests and problems. They had
a lot of extreme caution. They had all these instructions.
You have to take it in the morning, you got
to drink water, don't go, don't lay down, all these
things to help the medicine be absorbed better and to
reduce the impact of the side effect of the medication.
(29:29):
But still a lot of people got around that and
still use these bis fascinates, act to el fosso x, elindronate.
Speaker 2 (29:37):
They're cheap.
Speaker 1 (29:38):
Now the infusions and the injections tend to be more expensive,
a little bit more cumbersome, Right, you got it? A
lot of times go to infusion center to get that done.
But it can happen, right, you can get it done,
and it's not every day, no, it's not only every
(29:59):
six months once a year.
Speaker 2 (30:01):
With these other.
Speaker 1 (30:02):
Infusions and injections, and again, it just like anything, it
just depends on what the doctor's trying to compet it's
an option, but just because it it's an injection, it's
an infusion, you know, doesn't mean that's the right thing
for you. Just depends on the indication and what we're
trying to do. For most people with generic osteoporosis, no problems.
(30:23):
I think most doctors are still sticking with the tablets.
It's just easier, been around for a long time, jeep,
and we can resolve that issue. But if there's some
secondary problem that's happening, then we start going to these
injections and these infusions, and again they work very well
(30:44):
to blunt the breakdown of bone so that the risk
of spontaneous fractures is low. And if you do have
some sort of trauma, which goes up as we get older,
right because of falls, you're less likely to break bone.
So expense comes into play as well. A lot of
(31:04):
people don't like injections, like it's once it's in, it's in,
you know, that's it's going to do what it's gonna do,
a lot of people don't like that, and they don't
have control over the medication. It's it's new stuff. It's strong.
The side effects I read about it, and so there's
some limitations with that as well, but just more options
available for patients to have ostroporosis. So they're all good
(31:27):
products and they all have their side effect issues to
deal with. But I think most people start the tablets,
and then tablets don't work, they go to the infusions
like prolia is one of those for tao. Is another
one fo r TEO. That's another one, different class of
(31:49):
anti absorptive medication for the reduction of bone loss for TAO,
which I haven't used much.
Speaker 2 (32:00):
And then a new one just came out. I'm blinking
on the name.
Speaker 1 (32:02):
Rep was just in the office last week talking about
that one. So all good. Just talk with your doctor
and see which one is right. A few phone lines
open eight nine to six S three zero, Okay, I
be back in two minutes. All right, Welcome back to Acay.
(32:30):
Maclar Michael from Pasadena, how can we help you?
Speaker 4 (32:34):
Oh, good morning, and thank you for taking my call.
Speaker 2 (32:37):
Yes, sir, I.
Speaker 4 (32:40):
Went to see a back doctor uh in Webster, and
he recommended physical therapy for curved back. If it's got
a name, start with a cake, try something or other. Yes,
and uh, he recommended a physical therapy and I asked
(33:03):
them if they had a specialist for that, and he
recommended doctor Francis, doctor Richard Francis, and he has an
office in Beaumont and in bel Air, Texas, which is
(33:23):
off Southwest Freeway across Houston from Pasadena. And I just
wondered if you knew of him, and as he highly recommended, Yeah.
Speaker 1 (33:37):
Doctor France has actually been operating for a long time.
He does have office here in south east Texas. I
am familiar with him. Yes, he is regarded as a
very very good, excellent neurosurgeon and has been been around
for a while.
Speaker 2 (33:50):
So yeah, he knows what he's doing.
Speaker 4 (33:53):
Okay, I'm going to try the physical therapy, but I'm
gonna the doctor that I saw is a good doctor,
but he said he doesn't specialize in the curvatures of
the back, and so okay, well, thank you very much,
(34:21):
and your topic on the bones and backbone. That's very good.
Speaker 1 (34:26):
I appreciate you, all right, brother, I appreciate it. Happy
to you tell you. Yes, a little back pain. Our
caller having problems with that. Remember that again. Aging we
talked about osteoporos is age related. Primary osteoarthritis or degenerative
joint disease is also, in my opinion, age related as well,
(34:47):
and for some of us can generate some muscular scalar complaints,
back pain being the number one cause of that, and
sometimes it can be severe.
Speaker 2 (34:59):
The DJD the process.
Speaker 1 (35:01):
And that then causes what we call stenosis, where there's
narrowing of the structures, whether the bone structure is sort
of encroaching or putting pressure on the nerves, which is
there to protect starts putting pressure on those nerves, and
then that generates symptoms such as pain, cramping, tightness in
(35:23):
the back, numbness, tingling, weakness, And it's from the spinal
sypnosis and generative joint disease. And our patient is having
some cayphosis, which is a medical term we use to
describe when the spine sort of bends forward like a
c There is some normal curvature in the spine, but
(35:45):
that curvature when it becomes more excessive as a result
of osteoporosis, which is probably why this patient was calling
the vertebrae, which is part of the spine. Those little
parts of the spine that are stacked on top of
each other, they are called vertebrae, and we have multiple
(36:06):
vertebraes and the cervical, thoracic lumbar spine.
Speaker 2 (36:10):
Well, anyway, that.
Speaker 1 (36:11):
Vertebrae structure starts to flatten as a result of osteoporosis.
It bends, it flattens, it cracks, almost like if it
was pressed down. But again, the osteoporosis process can generate
this because of the pressure of gravity and things like
I said, walking, bending, picking up things, it puts pressure
(36:33):
on that spine and if you have weak bones and
it just basically flattens it. And as it flattens, you
start to.
Speaker 2 (36:42):
Lean forward.
Speaker 1 (36:44):
You can kind of see that you're not straight up,
You're more forward when you walk. That's kaiphosis, and we
normally see that in severe osteoporosis is what we see.
What we see most of the time in ladies. You
see that in elderly patients as they walk and you
kind of notice their leaning forward. Sometimes it's so severe
they can't even look up, sort of looking down because
(37:06):
the spine has just sort of curved and bent forward
because of the weakness. Sometimes that's more congenital. A lot
of times again it's a degenitive process. And yes we
do see cayphosis and men unrelated to osteoporosis, but related
to that aging.
Speaker 2 (37:24):
Process that we talk about.
Speaker 1 (37:26):
And you know, as a back surgeon, you don't really
want to operate on weak bones, you know, because putting
in screws and plates and all that the bone structure
is weak, then the surgery may not take It may
lose its position, you know, the screw might come out,
the plate might loosen up, and certainly the blood flow
(37:50):
may not be where it is, the protection from infection
may not be where it is, so it can get infected.
I mean, it can really turn into a big mess.
In my experience, back surgeons tend to be very conservative
with patients, you know, seventy and above. They just it's
a high risk patient typically, and they a lot of
(38:11):
times will say, hey, it's not much I can do,
or it's not much I want to do. You can
go down the street and talk to this other guy
see if he wants to do it. Some doctors are
more skilled at working with high risk patients and they'll
take on the operation. But certainly take your time and
don't jump to it because once you open that back
up it can be a mess. Phone lines opening nine
(38:31):
six kvy. I want a hundred through three to zero
O ky ov. I'll be back in two minutes. All right,
welcome back to doctor me a medical our phone lines
open an six kV. I want one hundred three to
three zero ok lv I.
Speaker 2 (38:52):
Happy New Year to you.
Speaker 1 (38:55):
Almost at the end of the show, I want to
thank all the college and listeners. Time goes fast, so
super fast. But talking about peripheral arterial disease, wanted to
conclude that again, if you're a smoker, please stop as
as soon.
Speaker 2 (39:09):
As you can.
Speaker 1 (39:09):
We have products available to help with that. Most smokers
need something to help them stop smoking. The two products
that have been out which are used by a lot
of practitioners chantis as well as well, butrian that may
not work for you, but it is an option. And
then they have all of these sort of nicotine replacement
products over the counter that you can go and get now.
(39:34):
But I do strongly strow encourage you if you are smoking,
please stop. It's just a terrible, terrible habit. It just
causes so much premature cardiovastar disease. It increases the risk
of cancer terribly, chronic lung disease terrible. So we need
you to work on that. But if your feed are cold, yeah,
(39:55):
go to your primary care doctor and get an ultrasound
of your arteries and just check see if your circulation
is good. But a lot of people just have cold
feet and it just feel cold. You cold, But the
circulation is fine, the labs are fine, although the X
rays are fine. It's just, yeah, your feet get cold
(40:16):
in the evening, and most of the time I just
tell people you just gotta dress warmer, you know, put
some socks on, get underneath the blanket. But there's not
really a medication for them unless we found a disease.
Sometimes diabetic neuropathy or any other forms of neuropathy can
make the feet feel cold as well, and certainly treating
(40:37):
the sugar can help with that, But otherwise we conservatively
manage that there's not really a medication to just sort
of make your feet feel less cold. But you just
want to make sure and check those things out. And
I'll tell you that if you don't smoke, and you
don't have hot sugar or high cholesterol, it's highly unlikely
(41:01):
you'll ever develop any plaque in your life.
Speaker 2 (41:04):
That's significant.
Speaker 1 (41:05):
I mean, I see patients in their eighties nineties with
some plaque development, but again that's part of the aging process.
In my opinion, it's normally not severe. The blood has
sort of rerouted itself. They don't have any symptoms. That's
more of an age thing and nothing they really did wrong.
(41:26):
But yes, the older we get sometimes, yes we have
to deal with these physical issues that come up, but
most of the time you can manage them very well.
And it all starts with what you eat and what
you drink. And we want you to focus on that.
Eat more vegetables, eat less sugar, and be physically active.
(41:50):
That could be a brisk walk or peling a bicycle.
We'll see y'all next week. Happy New Year, Thank you
for listening.
Speaker 2 (41:56):
God bless
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