February 7, 2026 • 43 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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Speaker 1 (00:00):
All right.
Speaker 2 (00:01):
Welcome Internet radio listeners Southeast Texas, Welcome, Welcome, Welcome to
another edition of the Doctor Lavine in Medical Hour. I'm
your host's weekly host, Doctor Levine, coming to you live
from the series of Kovi I here in Beaumont, Texas,
across the tree from Parkdale Mall, taking your phone calls,
trying to help you figure out how to stay alive
(00:21):
longer and live a healthier life. Not in the doctor's
offices all day long, or carrying a sack of prescription
medications that sucks your money away from you. God, the
prices of medicine's terrible. We need to work on that.
But anyway, phone lines are open eight nine to six
(00:42):
KLV at one one hundred and three to three zero.
Kova I gave us a call. This is two way radio.
We love to hear from you so that we can
help you figure out what's good for you it's not
so good for you. There's a lot of controversy out
there about what is the right thing to eat drink.
You're trying to boot your immune system. You're trying to
(01:02):
prevent the onset of dementia, that memory loss. Right, Maybe
I've forgotten a few things, and it starts to creep
in that maybe you're developing dementia. How do I reduce
that or prevent that. There's some conversation out there about that,
so we can kind of discuss that, So give us
(01:23):
a buzz. It's at the beginning of the show, so
we have all this time an hour, you know how
quickly it goes by, So we really would like to
share that with you at the beginning of the show
and have some good discussions about that. So give us
a buzz. We'd love to hear from you AnyWho. As
(01:43):
you know, sometimes we try to get guests on this show.
It can be difficult. It's Saturday morning and it's the weekend.
People are just busy and have a lot of things
to do, run errands, etc. And it's tough to get
some guests. But every now and then we do have
some host I'm sorry, some guests on the show. And
(02:04):
we have a frequent guest here this morning that likes
to come to this show and sort of share her
thoughts about her side of the story and the other
side of medicine. As you know, I practice medicine, but
there's also this sort of business administrative side of medicine
that we just can't get away from that really grows
(02:25):
and grows and grows each and every year, gets more technical,
there's more issues that we have to deal with as
it retains the business side. So it's always a good
day when this guest comes. So we can talk about
the business side because it is very impactful to the
practice of medications in terms of which medicines you get,
(02:46):
what doctors you go to, what hospitals you go to,
what tests you get. I mean, it's impactful. We got
to at least come to realize that, and certainly choices
that you make can impact how things develop. So once
again we'd like to welcome missus Levigne to the show.
How are you doing this morning?
Speaker 3 (03:04):
I'm wonderful. Good morning. How are you?
Speaker 2 (03:07):
I think I'm good?
Speaker 1 (03:08):
Good?
Speaker 2 (03:09):
How about your night? Short? It was long too well.
Speaker 4 (03:13):
I went to bed at midnight. I think you went
crazy before dark, which was exciting.
Speaker 2 (03:19):
Yeah. I took a little nap yesterday. I had a
little stomach upset yesterday. I don't know what that came.
Speaker 3 (03:24):
Doctors get sick.
Speaker 2 (03:27):
No, Yeah, we're machines. Yeah, we're machines. Just plug us
in and re charge our battery and unplug us and
make us go out and work all day. We never
get sick. Well, of course doctors get sick. That's absolutely right.
So I sick a little nap yesterday. But yeah, you've
been quite busy this past week. And again we'll appreciate
(03:49):
you coming on the show and sharing your thoughts with
the audience to see what is going on with the
office and just some highlights of the office. So this
is the beginning of the year, and so there's always
these issues with insurance plan. You chose deductibles. What else?
(04:12):
There's a couple other terms that are insurances, say agand
co insurance, co insurance, deductibles. Can you switch? Can you
not switch? What's the latest on that? Anything new for
twenty twenty six from the insurance industry that you think
would be a good highlight, a good subject matter that
(04:32):
maybe the patients or the audience would love to hear
about or discuss. Anything from your standpoint, same old, same
old stuff.
Speaker 4 (04:41):
I think anything is new, and we haven't been in
the year long enough to figure out all the surprises
that they have for us. So as we move along,
maybe after we get out of the first quarter of
the year, we'll understand some changes, but I don't see
any this far.
Speaker 3 (04:57):
I mean I don't.
Speaker 4 (04:58):
We haven't came across to you, to be honest with you.
They seem to be all the same.
Speaker 2 (05:04):
All right, So so far it's about the same. There's
been no new snaffoos. And the insurance industry.
Speaker 3 (05:10):
Deductibles go up just a little.
Speaker 4 (05:12):
Bit normally, what's a little bit twenty thirty dollars.
Speaker 3 (05:17):
That's kind of the trend.
Speaker 2 (05:18):
Not terrible.
Speaker 3 (05:20):
Cost of medicines go up.
Speaker 4 (05:22):
Excuse me. Patients get older, they get sicker. I mean,
it's just kind of like the cost of living goes up,
you know, it follows that same trend.
Speaker 2 (05:31):
Yeah, one thing you say, the cost of medicines goes up.
It's just a subject matter we don't really get into
a lot, but man, it's it's really something that we
probably should start prioritizing and tackle at some point, just
because these are good medications for patients and they really
work and they can really control the disease process whatever
(05:54):
that is. But one area of interest is these sort
of weight loss medicines, these GLP one agonists as we
call them. The companies including what go vis zep Bound.
There's another one out there. Munjaro are really trying to
reduce the cost of a cash price, if you will,
(06:19):
just because these are blockbuster medications and we still have
little weight loss program right that involves some generic semiglue tide.
How's that been going.
Speaker 3 (06:31):
It's good.
Speaker 4 (06:31):
I mean, we've had patients that have been very successful
on it. We have we can get other weight loss
medications now they're a little bit more expensive. So if patients, sorry.
Speaker 2 (06:43):
You don't be afraid of the mic.
Speaker 3 (06:45):
I'm not afraid of the mic.
Speaker 4 (06:47):
God, it wouldn't be sitting two inches from it.
Speaker 2 (06:52):
We want to be sure to hear you, okay, Well,
because you spit in a lot of well, I think
interesting knowledge, we want the people to hear it.
Speaker 4 (07:00):
I think I have a soft spoken voice and so
it's kind of hard to hear me. So, you know,
we have we have a second medication that has came
on board for us. It's a little bit more expensive,
so that if patients have been on the weight loss
program for a while and they're not responding to it,
we can switch them over. And it is Manjaro and
(07:22):
so so far no one's wanted to switch. They're happy
with what we're doing. But there is you know, a
second choice if if that's where the patient gets and
wants to do that. So, you know, I think it's
I think it's nice to watch the patients lose weight.
They get super excited, their clothes fit better, they feel better,
and you just kind of watch that trend from the
(07:42):
day that. Yeah, but you know, they it's not a
real fast process, but it's fast enough, you know, because
you don't want to lose weight quickly because then you
gain it back quickly, so you want it to be slow.
And then we try to also teach them about their
eating habits. It's not just about putting medication in your
body and all of a sudden, six months later you're thin.
(08:04):
You have to learn how to eat inner thinner. You
have to learn how to eat, what to do, move
a little, do a little exercise, gain some muscle mass.
Speaker 2 (08:12):
A little bit.
Speaker 3 (08:14):
Yeah, well, what what's that mean a little bit?
Speaker 2 (08:18):
Well, if you're my number one fan, I will totally
and if you listen to this show, you did. I
think if you listen to the show, what I try
to tell all the listeners is that the exercise that
helps you with your health really does not involve a
lot of time. It does not have to involve a
(08:39):
lot of time. Again, exercising is advertised to the American
people as a type of exercise that requires a gym membership.
It sometimes requires a trainer, someone who the wardrobe. A wardrobe.
Absolutely got to wear the right clothing, shoes. Yeah, yes,
you need equipment to do this. So all of these desires,
(09:04):
all of these requirements are basically, in my opinion, obstacles
to actually exercising on a regular basis, just because the
average person is not going to go out and buy
a whole bunch of gear, or they don't have the things. Yeah,
they don't have the money.
Speaker 4 (09:19):
For training iPods, and you have to have music and
you have to have a device you can listen to.
Speaker 2 (09:25):
All that on, all these necessary items just to get
some benefit from exercising, and it's untrue in my opinion.
Exercising can be just walking in your neighborhood or walking
in your house. A lot of this home equipment has
gotten very inexpensive. It's something you can get from Walmart
(09:47):
or you can buy online where you can put it
in your house. And if you talk about your health
and investment your health, as I've tried to mention talk
about my retirees a lot. I love talking about them.
They're so excited.
Speaker 3 (09:59):
About Wait, you talk to me and I'm your retire.
Speaker 2 (10:02):
We talk about it all the time. But I love
talking to out retirees because they're so excited about just
being able to do whatever they want to do and
spend time focusing on them since they've spent thirty plus
years focusing on someone else or sacrificing for some other person,
(10:25):
and now all of a sudden they have the ability
to focus on them. And it just makes sense that
if you now are in this position and you want
to enjoy the next fifteen, maybe twenty years of your life, man,
your health is so critical and you have to figure
out a strategy to prioritize your health. And we want
(10:45):
to try and keep the obstacles to a minimum. And
as it pertains to exercise, we just want to reassure
patients and just help them understand that the exercising that
requires to be healthy does it's not that hard. It
does not have to be painful a painful experience, which
is why a lot of people don't like to exercise
(11:06):
just because it's advertised as it's got to be painful.
You have to just sweat and you have to push
your body to the limit and just have to draw
all this stuff right in order to get the benefit
out of it, which is, in my opinion, incompletely wrong.
Just walking around your house or walking in your house
can be exercise. We just want you to get up
(11:27):
and move around. We don't want you to sit around
in the couch all day doing nothing. We want you
to stay physically active. And again, walking on a treadmill
for fifteen to twenty minutes two three times a week
is plenty. Now, if you want to do more, that's fine,
but this amount of exercise is it's fine. So it does.
Speaker 3 (11:50):
Routine, huh. I enjoyed my little routine.
Speaker 2 (11:53):
Yeah, you've mixed it up over the years.
Speaker 3 (11:55):
It's nothing serious.
Speaker 4 (11:56):
I mean I just ride a stationary bike and do
some crunches and some sit ups on a ball and
about forty five minutes and it goes by fast and
I enjoy it, you know, look forward to it.
Speaker 2 (12:11):
And you can listen to music if you want. You
can't have a television on.
Speaker 4 (12:15):
I have to listen to a lot during the day.
So I like peace and quiet works for.
Speaker 2 (12:20):
Me and most people say the same thing after they
finish exercising, it feel energetic. It just helps with their
circulation system, it helps with their bowl function. That becomes
the issue as people get older. Just I think that's always.
Speaker 4 (12:34):
An issue with women, though women seem to have that
more than men.
Speaker 3 (12:37):
What about issues.
Speaker 2 (12:42):
I haven't seen that. Maybe I know that females tend
to talk about their physical problems more than guys. I
think guys culturally tend to try and keep all of
that to their chest and don't complain about it. It's
like a guid thing, you know. They want to be
considered tough and resilient. I'm strong and I don't complain
(13:04):
a lot. That's just sort of a cultural thing. But
they could be suffering constipation, but they're not going to
tell you. They don't want to seem like they're weak
and complaining and that sort of thing. That's a mindset
that guys typically have versus females. They tend to be
more open with that. They want to get better, and
they don't mind sharing that information with the doctor. They
(13:25):
want they just want to get better, right, So I
think it's just a guid thing. I think they're suffering
it as well. And a few of them, yes, we'll
mention that, but most of them know they're going to
try and figure something out at home. Which again, for constipation,
there's a lot of things over the counter that helps
with that, but we do have some prescription medication available
if you do have constipation, and it is a very
(13:48):
very common physical issue as one gets older. And the
good thing is that the pharmacutical company has supplied us
with things. But the product over the counter that works
for it was called maryl Line, which is a great,
great product. You can take it long term. It's a powder.
You mix it in your coffee or your tea or whatever
you drink. Can you just drink it two or three
(14:09):
times a day. It doesn't taste, yeah, there's no there's
no taste to it. It's not chalky, it's it's very
well tolerated. It's a great product.
Speaker 3 (14:18):
There's a meta musial.
Speaker 2 (14:20):
Yeah, that's that's the old school version, so still a version. Yeah,
it is. It's an option. And that's the wonderful thing
about this country. You go to the store and you
have twenty thousand options for just about every item that
you might be looking at. I mean, it's just insane.
Sometimes overwhelming, but yeah, meta Musa has been there. Metamusa
is just sort of a synthetic fiber that is on
(14:43):
the market. It comes in a lot of different forms.
I think traditionally comes in that powder, but I think
they have it in some other different forms as well.
I think they have some chocolate squares or something.
Speaker 3 (14:52):
Do they still make xlax?
Speaker 2 (14:55):
I think so. I'm sure. I'm sure. I just haven't
heard any patients intion it recently, but I'm sure it's
out there.
Speaker 4 (15:03):
We have to run to the pharmacy and look for
it and see if it's still there.
Speaker 2 (15:09):
Yeah, you know, that will be an interesting topic, is
just the history of the pharmaceutical industry in terms of
what has been available to the American public prescription wise
and over the counter wise, in terms of what medicines
we've used, what medical therapeutics we've used over the years
to treat all these various ailments. Now that it's such
(15:30):
a robust industry, I mean you look at the pharmacies now,
they're popping up everywhere and they're huge, they're long doors,
long lines. Yes, so all these products that are available,
and then don't forget about the Internet and the web,
how you can just get on your computer and look
up all these items and somebody is selling it everywhere
or somewhere like x lax and things like that. Well,
(15:52):
you don't need a prescription, you can buy it yourself.
Which again, as a prescriber for over twenty years, I
have gotten more into that, you know, as a product
that's over the counter. Then I try to encourage that
just because getting it. We've talked about that, right, getting
a prescription from a doctor's office can be so tough. Right,
why is that? What in your experience, Why do you
(16:14):
think it's so tough to get that prescription when it
should be pretty.
Speaker 3 (16:18):
Easy a new prescription?
Speaker 2 (16:20):
Why any prescription it can be kind of hard.
Speaker 4 (16:22):
Well, there's a lot of work behind prescriptions because we
have to as a as an office and as a team.
When someone calls in for a refill, we have to
make sure that we are the one that prescribed it.
Because some patients go to other physicians, like their gas stroginy.
Speaker 2 (16:36):
No that that's bad, No, no.
Speaker 3 (16:38):
No, no.
Speaker 4 (16:38):
They have a team of doctors mm hmm, so they'll
call in and so we you know, patient safety is
going to be number one, So you always have to
think about that, you know, is what they're asking for,
Is that what they need, or is that what their
neighbor thinks they need, or their friend or their children,
or so they're asking for a prescription, we have to
make sure that it's safe. We have to make sure
(17:01):
that what they're asking for applies to the issue that
they're having. We also have to look at their other
medications to see if there's contra indications that they're going
to be safe for each other. We have to make
sure that if it's a medication that they're already taking
and they ask for a prescription or a refill, we
(17:22):
have to make sure it's time to make sure they're
taking it correctly. Are they asking for it too early?
Is it too late? So there's a lot of work
that goes behind refills. It's not just opening up your
computer and sending something off. That's a very irresponsible thing
to do as their healthcare advocate, and we just want
(17:44):
to make sure that it's the right thing for the patient.
And then if it comes down to it, if our
staff is not comfortable, then that's going to be a
visit that they have to see you. Because at the
end of the day, we don't want to harm the
patient by just giving them what they want, because you know,
a lot of a lot of medical patients interfere with
blood pressure, medications, antibiotics. You know, you have to stop
(18:06):
certain medications in order to start an antibiotic. And that's
really over our knowledge base, not our knowledge base, but
more of that's a doctor patient.
Speaker 2 (18:17):
Visit, doctor patient visit. With a prescription, yes, a good
topic as well as prior authorizations are pas as we
call them, something that we can talk about. On the
next segment, we have Pam from Beoma. How can we
help you?
Speaker 5 (18:33):
Good morning, doctor Levin, and this lebne so good to
hear this morning. While we're speaking on the conversation on constipation,
I would like to know for taking through softness, how
could it be that we can take one a day
(18:54):
or twice.
Speaker 2 (18:55):
A day stool softeners? Yes, sir, you want to know
if you can take one a day or twice a day.
Speaker 5 (19:03):
Yes, sir.
Speaker 2 (19:04):
I think most stool softeners can be taken as frequently
as you needed. I think if it's requiring you to
take two or three a day every day, probably might
be a little excessive. But stool softeners seem to be
a very benign product, and some patients do take them
(19:26):
on a regular basis. I think overall, we've gotten away
from stool softeners and we like this product, as I mentioned,
called me relax. It's safer, it's very neutral. Steel softwares
can sometimes generate its own issues, so I think in
terms of safety and what's effective, this Marilax powder, which
comes in a purple container typically is what most physicians
(19:50):
are recommending these days. Steel softwares were very popular back
in the day before these newer products hit the market.
So I would say, if you were my patient and
you're suffering from constipation and the subject came up, I
would probably recommend transitioning to this powder Merlax. Are there
some other prescription medicines that we use which tend not
(20:11):
to be too expensive that I would recommend you take.
But if you want to stay with the stool softwires,
you're not having any problems. I don't see any problem
with that. And yes, normally one or two a day
is what the standard dose is.
Speaker 4 (20:23):
And also try to increase the fiber in your diet.
Speaker 3 (20:26):
That would be a good.
Speaker 5 (20:27):
Okay, vegetables, Okay, thank you so much.
Speaker 1 (20:31):
I was on.
Speaker 5 (20:35):
The medication of this for trying to think what it
is mid Barman. And I know they say that the
met barman usually you know, help you go.
Speaker 2 (20:48):
But that's right.
Speaker 5 (20:49):
For some reason it caused me to be constipated. I
spoke with my doctor concerned in this matter. But I
will try to increase my fiber again, and I take
like the protein bars. But for some reason, I just
have a problem with the constipation. But I am active,
I walk up pretty much. But it's just one of
(21:11):
those things that I have a little problem with it.
Speaker 3 (21:14):
If you drink a lot of water.
Speaker 5 (21:16):
Oh, yes, ma'am, Yes, ma'am.
Speaker 2 (21:19):
Well, very good. Yeah, it sometimes this becomes an issue,
and the diet is the most important impact of that.
So increasing fiber withol me, eating again more vegetables, nuts
and seeds, whole grains like quinwa, flag seed, millet, barley,
old meal would be another way to increase the fiber
(21:40):
in your diet. There's a whole list of things that
you can do. Can look that up and then yes,
staying well hydrated with water and physical activity, no questions. Okay,
that increases function, yes, ma'am.
Speaker 5 (21:53):
All right.
Speaker 1 (21:54):
It's so good to talk with you all this morning.
Speaker 5 (21:55):
I have a good day.
Speaker 3 (21:56):
Thank you so kindly, have a wonderful weekend.
Speaker 2 (21:58):
Appreciate that. Constipation absolutely big big topic. Phone unch open
eight nine six kalv I one one hundred three three
zero kalv I'll be back in two minutes. All right,
(22:28):
welcome back to doctav matagcour phone lines are open eight
nine six kal v I one hundred three three zero
k o v I. He's sitting here chatting with Missus
Levigne about various topics, including constipation, which is an extremely
common issue as we get older. Maybe not a sexy
thing to talk about, but certainly it can be very
(22:48):
impactful to you whenever you have that. And again it's
the beginning of the new year, and there are topics
that come up at the beginning of the year. On
the administrative side, prior authorizations are PA for short, which
is this process that normally a medical office has to
go through in order to get a medication approved. Typically
(23:13):
the newer medications that hit the market. We've talked about
these GLP one agonists, but there's new medicines coming out
all the time, typically a bit more expensive, but normally
a better product in terms of treating the disease illness.
It's a product that healthcare professionals get introduced to and
we'd like to utilize just because they're they're better, right,
I mean, that's the way things work. We want to
(23:35):
use products that are good for the patients, are better,
easy to use, less side effects, more effective, et cetera,
et cetera. And normally the newer medications are like that.
But just this expense issue and the pharmaceutical world as
well as the insurance will kind of battle with this.
But there's this process called prior authorization. What does that mean?
Speaker 3 (23:57):
Prior authorism?
Speaker 2 (23:58):
Expert person of there, you got your headphones?
Speaker 4 (24:02):
You got to think so I may have some difficulty,
but I'm working with it.
Speaker 2 (24:07):
So you just change it out.
Speaker 4 (24:08):
Yeah, but I'm having to hold this little thing because
it keeps keeps going in and out.
Speaker 2 (24:13):
I going to get you a new set of earphones
and have your own personal earphones that we can have
for you. But what is pro authorization? We hear that term.
Are the patients here that term?
Speaker 4 (24:26):
So that term means that pro authorization? So what happens
the whole process of that is you come in to
see your provider. They want you to have a certain medicine.
That certain medicine is usually new on the market or
been on the market a couple of years and requires
a pro authorization because there's other things that have been
on the market way longer that are much cheaper, and
(24:49):
insurance companies would rather you go that route. But if
the provider believes that, you know, hey, you do need
this medicine, let's do the pro authorization. It's just paperwork
proving to the insurance companies that you've been taking those
other class medications and then your body has not responded
to them as well, so it's called failed treatment, and
(25:11):
you have to have failed treatment two or three times
and then they'll consider paying for it. And once you
have your prior authorization in place, it's good for like
a year, and it's a little bit of work behind it.
And you asked me earlier if I had seen anything
that had changed. That is one of the things that
I have seen that have changed. A lot of patients.
(25:32):
Formularies have changed, which is requiring a lot of prior authorizations,
and we put a new platform in place through clinicals
that kind of lets us know that while you're prescribing,
we can see that and you've probably seen something different
on your screen.
Speaker 2 (25:46):
Maybe, Yeah, we've got to update or upgrade this past week.
More busy, more information on the screen.
Speaker 4 (25:54):
Well, the cool thing is when the I mean we
know the po So the old way is we would
faxit it, we would send it over through EAT scripts
to the pharmacy. The pharmacy would then at some point
send us the pro authorization. This medication requires a prior authorisation.
There's a website or a couple of websites that we
utilize that we go to that helps us process that authorization.
(26:17):
Now it's integrated into e clinicals so that when you
prescribe it, it prompts us prior authorization is needed, and
we can do it in the computer, send the clinical
note and normally have the answer before the patient leaves,
which is leaps and bounds of positive from what it
used to be, and normally the patient can pick up
(26:39):
their medication that same day to where the old way
it was maybe two or three days later.
Speaker 2 (26:45):
HM. Improvement with technology, Yeah, it's wow. I didn't know that. Yeah,
I think that's a good improvement. Yeah, to the system,
because yeah, it was a very cumbersome process, right, just
a lot of back and forth. Time can assuming right.
That was the big thing for healthcare professionalist office, primary
care physician's office is time just because it eats up
(27:08):
or gobbles up your day as an office doing all
of these PA's for multiple people, right, just because it's
not one person, it's probably several people that require PA
for a particular product. So it's a time consuming issue
and sort of limiting to some degree. It's difficult to
accomplish all the pas in one day or two days,
(27:30):
and people are sort of sitting waiting for their products
to be delivered to them. So it's a deterrent basically
for providers. For patients, it's a deterrent, right. Oh, I
know it's going to take a long time. Forget about it.
Let me just stick with the old product. So integrating
it with the EMR or our EMR which is called
(27:52):
e Clinicals, which we've had since we've pretty much opened
the office. There's multiple ones out there. We've been very
happy with it.
Speaker 4 (27:59):
We had to get a couple of months without an EMR.
I you remember that we didn't have very many patients
in those days.
Speaker 2 (28:04):
Yeah, that's not terrible. So we've been using it ever
since and it's a great product, and now that it's
integrating to the system, absolutely it'll speed that whole process up,
become less of a deterrent. And again trying to get
patients on these norm medications which typically work. Now sometimes
it is not necessarily a failure. It's just that doctors
(28:26):
think it's more effective. Right, Maybe the disease is not
being controlled the way we wanted to for various reasons,
and we just want to try a new product out right,
and we feel like that this product is better. It's
normally going to be a once a day, it has
less side effects. Maybe it's stronger, but without the side
effect issues.
Speaker 3 (28:47):
I think it's easier.
Speaker 4 (28:48):
It breaks down in the body easier, it's more friendly
to your liver and kidneys and.
Speaker 2 (28:52):
Yeah, all that stuff. Absolutely, and having to take it
once a day versus multiple times a day. We know
that if patients having to take a medicine two three
times a day, that it's going to be difficult to
be compliant with that drug versus a drug that's once
a day or once a week, once a month.
Speaker 4 (29:12):
There was so many medications back in my day, and
I haven't practiced nursing in a really long time, even
though I.
Speaker 3 (29:17):
Practice every day.
Speaker 2 (29:19):
I'd love to see you back out of the floor.
Speaker 3 (29:21):
So you know you remember it.
Speaker 4 (29:27):
As long as you love taking care of I may
be a little rusty.
Speaker 3 (29:31):
But I would pull it together.
Speaker 2 (29:33):
It's changed well.
Speaker 3 (29:34):
Whatever, Oh my god.
Speaker 2 (29:35):
So much paperwork and just all the ins and outs
that they applied to the nursing staff. God bless them
and thank you for all nurses that are in the
hospital and all the nurses out them. Man, they have
a tough job and I really feel sorry for them
sometimes because of the pressures that they put on the
(29:58):
nursing staff. So yes, that's where we met. Was a
floor nurse and a very good floor nurse and took
care of a lot of critical patients because you are
good at managing critical topics and having to juggle all
these topics in your brain and just getting the job
(30:19):
done and not panicking and just doing what needs to
be done. You were very good at that, which is
why you're good at your job now. Just a big
problem solver and managing all this information that's flowing through
your brain and processing it and then spitting it out.
Speaker 3 (30:35):
Spitting out an answer.
Speaker 2 (30:37):
Yes, a solution, Yes, problem solver, right, that's what most
healthcare professionals are doing all day. It's this problem solving
and a lot of it's routine. But there are things
that come up that you were not trained to do,
and you were not really trained to be a medical admin.
You weren't trained to do that, right, No, it wasn't
(30:57):
a part of your training as a nurse. No, I
to run an office, a medical office. But you do
it very well and you've learned a lot. And yeah,
these prior authorizations are are were, according to you, a
cumbersome process, but now it seems like it's more straightforward
(31:17):
and it's easy. It's sort of integrated into our system
and allows us to get these products to patients a
lot faster than before.
Speaker 4 (31:26):
And at the end of a prization, it just means
that you pay your regular copay, that you pay for
everything else without that pro authorization. That that thirty day
supply of medication could be eighteen hundred to two thousand dollars.
Speaker 3 (31:40):
It's crazy.
Speaker 4 (31:42):
So we you know, we have a person in our office, Kayla,
who does all of our pro authorizations, and she likes
to keep it centrally located so she can keep up
with it. Because it's a lot, and she foughts extremely
hard and normally gets her pro authorizations approved and the
patients are happy.
Speaker 3 (31:58):
But also on her screen.
Speaker 4 (32:00):
And on your screen, you know when if you've noticed,
it'll tell you that this medication requires a prior authorization
and it'll bring up medications that are in that same.
Speaker 3 (32:10):
Class that are much cheaper. Did you have you seen that?
Or no you haven't.
Speaker 2 (32:14):
No, I haven't had a chance to look at the
new update at length.
Speaker 4 (32:18):
Well this was before the update. But okay, anyway, Kayla
can show you on Monday. I think you'll enjoy it.
I don't think it'll make you make a different decision,
because you're going to make what you what's best for
the patient.
Speaker 2 (32:30):
So so it prompts the staff they see a warning
or a signal it lights up or how does that work?
Speaker 3 (32:38):
Well, when you when you pursue.
Speaker 2 (32:39):
This is our system, another EMR could operate totally differently.
Speaker 4 (32:44):
When you prescribe a medication, it'll say, it'll prompt an
alert that it requires a prior authorization, and that alert
goes to Kayla.
Speaker 3 (32:53):
Yeah, that alert goes to Kayla.
Speaker 4 (32:56):
She normally mae it, Well, don't spend so too much
time thinking about it.
Speaker 3 (33:00):
I'll show you on Monday.
Speaker 2 (33:01):
Okay, phone lines are open eight one six kalfy. I
won one hundred three to three zero kalfy. I'll be
back in two minutes. All right, Welcome back to the
Dokahoum Medical. Our phone lines are open eight nine to
six kov. I want one hundred three three zero kofa
(33:21):
chatting with Missus Levigne about various topics. We are spending
a little bit of time talking about prior authorization, just
sort of that little naggy process that you have to
go through when you want to get a medication that
maybe was advertised to you, maybe you took it before
and it worked and now you need another prescription. You
have to go through that process. In the past, it's
(33:44):
just been a big deterrence. Just steps you have to
go through, normally very time consuming for any medical office staff,
which basically just creates stall and you know, just creates
a lot of uh, just tens and as it pertains
to getting the medication, getting a medicine prescription, medicine should
be pretty easy, considering electronic medical records and the computer
(34:08):
systems and phones and websites and just everybody's on the grid.
You should be able to just push a number or
push a button and then boom, your medicine shows up
at your doorstep. Wouldn't that be awesome? I mean you
can order from Amazon and get a product to your
door within twenty four forty eight hours. I mean, that's
it's crazy, incredible technology. Why can't I get my prescription
(34:32):
like that? What is so hard about it? Right? I've
been taking the same medicine for the longest time. I
just need a refill and I've done my best. Nobody's
picking up my phone, calls you. Now I got a prioritization.
I filled it two weeks ago. Now I can't. That's
another topic right there. What about the actual refilling part
(34:54):
of it. It's it's a little complicated, right. Can you
just for us system of refilling medicines? I guess if
you could explain that very quickly, just I know, patients
call like how I need a refieling like, no, you
got to come in. Well you can't get your medicines.
Can you kind of briefly explain our system or why
(35:15):
do you feel like that's necessary? Or what's the genesis
of that system? Because I know a lot of patients
like why why do I have to come see you?
I just saw you.
Speaker 4 (35:24):
So there's there's several reasons why it's not difficult to
get a medication from our office.
Speaker 2 (35:30):
If you're can be a case, if.
Speaker 4 (35:32):
You're a compliant patient. So you've made all of your visits,
you've you've done all the things that you're supposed to
be doing.
Speaker 3 (35:39):
You need to refeel.
Speaker 4 (35:40):
You've got to you You see us regularly, you keep
your appointments, you take your medicines on time, you ask
for them on time. We send you know, we send
your refill right away. It becomes a problem when it
becomes a problem you haven't been to see us. And
if few months, several months, you've skipped your appointments, canceled
(36:04):
your appointments.
Speaker 2 (36:05):
Sometimes a good reason, for good reason's happened.
Speaker 4 (36:08):
Yes, absolutely, but we need to see you. I mean
we need to reevaluate you for this medication.
Speaker 2 (36:16):
Now, this topic comes up a lot. Does the insurance
company put excuse me, put pressure on us to see
the patients on a regular basis?
Speaker 4 (36:23):
Yes, because we have a lot of paperwork. You mentioned
paperwork to be a paperless office, We have a lot
of paperwork that we have to report to the insurance
companies on your behalf, when you had your colonoscopy, when
you had your mammogram, if you're on a stat and
is your blood pressure controlled, do you have an A
one C And it's just on and on and on
(36:46):
and so every visit we gather this information. Because it's
so much information, we can't gather it in one visit.
The patient would be.
Speaker 3 (36:54):
There all day.
Speaker 4 (36:54):
You would be there all day with one patient, So
we gather this inform. We know what we need to
report to them on a yearly basis, and we gather
this information throughout the year. We normally see our patients
every three months, especially if you're Medicare or if you're
sixty five or older, just because there's a lot going
(37:15):
on with you and it can't be done in one visit,
So we gather that information and we report it every
single time the patient comes in. We report the information,
excuse me, and by the end of the year we're
normally done. The one thing that is the hardest measure
to meet out of all the quality measures is compliance
(37:36):
with medication. That is the most and it's triple weighted,
and that is.
Speaker 2 (37:41):
Means it's important very important.
Speaker 4 (37:43):
And it's triple weighted for the patient, meaning that it's
critical that they pick it up and take it on time.
Speaker 2 (37:52):
Because it helps control the disease process. We're trying to
keep everyone out of the hospital, as I've mentioned to
you before, and we want to slow the progression of
the disease down. And research has been very positive that
when you take your medications on a regular basis, that
(38:13):
the disease is control and it doesn't get worse. I mean,
that's what Primary cares all about, is prevention. At least
that's our goal, and one of the central components of
that is, yes, taking that medication on a regular basis
and certainly going to your doctor and making sure you're
getting the medication on a regular basis is. Key phone
(38:33):
lines are open eight on six kal Yeah, won one
hundred three three zero ko Via.
Speaker 6 (38:37):
I'll be back on our last break.
Speaker 2 (38:48):
All right, welcome back to the doc Levine and Metal.
Our phone lines are open eight one six kal of
yeat one hundred three three zero Okyov Yeah. Chatting with
Missus Lavigne and coming to the end of the show. Remember,
if there's a topic that you like when to talk about,
you can call this show. You can call my office
three four seven three six two one four nine area
code and drop off that topic. Would be more than happy.
Speaker 3 (39:09):
Do you remember a little secret?
Speaker 2 (39:10):
Tomber No, a secret to the phone number.
Speaker 4 (39:17):
So if you can't remember four zero nine three four
seven three six two.
Speaker 3 (39:22):
One was it?
Speaker 2 (39:23):
Was it like doctor one or something? Yes?
Speaker 3 (39:25):
Doc one, Doc one?
Speaker 2 (39:27):
Awesome, Hey Leonard from Houston. What's up, buddy?
Speaker 1 (39:32):
I have diabetes? Here I get remember a little blood
sugar numbers? Uh? Sixty two, sixty seven, seventy one. Is
there anything I could do to prevent low blood sugar numbers?
Speaker 2 (39:44):
Well, I think most of the time, as it pertains
to type two diabetics, if you're starting to get little
blood sugar readings, then a lot of times we look
at your med list and see if there's maybe something
that we can adjust or discontinue. Our goal is to
get patients off of medications if they have type two diabetes.
So a lot of times patients will make the necessary
(40:05):
changes in their lifestyle and the sugar levels just don't
go up and they don't need medication. So the first
sign of that is a sugar star getting pretty low.
So that would be my first recommendation to you is
to try and reduce the number of medicines you take,
or stop the medicine that you're taking, and see what happens.
Certainly you do that with the advice and the advisement
(40:26):
of your prescribing doctor.
Speaker 1 (40:30):
I went to him and he cut my forest of
mine in half instead of taking it every day, and
now I take it Monday, Wednesday, Fridays, and it's it's
been too soon as to you know, see if it's
doing any good. But all hand, I'm saying it's gonna
it hasn't done any good, but it's only been a
couple of days.
Speaker 2 (40:50):
Well, ferosomite is not a diabetic medication and.
Speaker 3 (40:53):
Does not it's a diabetic Yeah.
Speaker 2 (40:56):
It does not affect your blood sugar, so I don't
I don't think that would impact your blood anyway.
Speaker 1 (41:02):
Okay, Yeah, So what do I do about low blood sugars?
Speaker 2 (41:06):
Again, if you're not taking any medications that would cause
your blood sugars to go low, do you have any
symptoms when your blood sugar is in the sixties?
Speaker 1 (41:15):
Uh, shaky, sweaty, just don't feel good. I take a
couple of glucos pills and I'm openly and a half
an hour.
Speaker 2 (41:25):
Yes. So do you do you take any medication to
cause a low blood sugar?
Speaker 1 (41:30):
Well, I take blood, sure, I play, I take diabetic medicines.
Speaker 2 (41:34):
Yeah, so that would be the first thing. It's just
to cut back on the number of diabetic medications that
you're taking, and probably the sugar will go up or
are prevented from going down like that.
Speaker 1 (41:46):
Okay, I'll give it a try.
Speaker 4 (41:48):
Obviously, see your provider and let him instruct you on that.
Speaker 1 (41:52):
Yes, I did any take me off furs or cut
my first half.
Speaker 2 (41:58):
Well, just call him back and say, hey, I've talking
about my diabetes.
Speaker 4 (42:01):
Now, yeah, let's talk about my blood sugars.
Speaker 2 (42:05):
Yes, all right, Leonard, we appreciate that. So diuretic lay
sticks doesn't affect blood sugar, but if you're diabetic, your
sugar starts going low. The first thing to do is
to look at those meds and like which one can
I stop any last words, missus Levine, you don't come
that often to make sure that.
Speaker 3 (42:26):
You're hanging out with you there.
Speaker 2 (42:28):
Yeah, you can come anytime, give any time, that's no problem.
But thank you for joining us today. There's always a
lot going on on the admin side. It's good to
note that the prior authorization system may be speeding up,
so that's good for the listeners and feeding.
Speaker 3 (42:45):
Up for our office. You can speak for other offices.
Speaker 2 (42:47):
And yes, you do have to come into the doctor's
office to get your medication refills. We want to see,
we want to talk about what's going on. Make sure
that we try and do everything we can to keep
you out of the hospital and taking your medications. Being
complying it is a part of that process. Thank you
for joining me from the list of the show. We'll
see you next week. Don't drink and drive. God bless
All right.
Speaker 2 (00:01):
Welcome Internet radio listeners Southeast Texas, Welcome, Welcome, Welcome to
another edition of the Doctor Lavine in Medical Hour. I'm
your host's weekly host, Doctor Levine, coming to you live
from the series of Kovi I here in Beaumont, Texas,
across the tree from Parkdale Mall, taking your phone calls,
trying to help you figure out how to stay alive
(00:21):
longer and live a healthier life. Not in the doctor's
offices all day long, or carrying a sack of prescription
medications that sucks your money away from you. God, the
prices of medicine's terrible. We need to work on that.
But anyway, phone lines are open eight nine to six
(00:42):
KLV at one one hundred and three to three zero.
Kova I gave us a call. This is two way radio.
We love to hear from you so that we can
help you figure out what's good for you it's not
so good for you. There's a lot of controversy out
there about what is the right thing to eat drink.
You're trying to boot your immune system. You're trying to
(01:02):
prevent the onset of dementia, that memory loss. Right, Maybe
I've forgotten a few things, and it starts to creep
in that maybe you're developing dementia. How do I reduce
that or prevent that. There's some conversation out there about that,
so we can kind of discuss that, So give us
(01:23):
a buzz. It's at the beginning of the show, so
we have all this time an hour, you know how
quickly it goes by, So we really would like to
share that with you at the beginning of the show
and have some good discussions about that. So give us
a buzz. We'd love to hear from you AnyWho. As
(01:43):
you know, sometimes we try to get guests on this show.
It can be difficult. It's Saturday morning and it's the weekend.
People are just busy and have a lot of things
to do, run errands, etc. And it's tough to get
some guests. But every now and then we do have
some host I'm sorry, some guests on the show. And
(02:04):
we have a frequent guest here this morning that likes
to come to this show and sort of share her
thoughts about her side of the story and the other
side of medicine. As you know, I practice medicine, but
there's also this sort of business administrative side of medicine
that we just can't get away from that really grows
(02:25):
and grows and grows each and every year, gets more technical,
there's more issues that we have to deal with as
it retains the business side. So it's always a good
day when this guest comes. So we can talk about
the business side because it is very impactful to the
practice of medications in terms of which medicines you get,
(02:46):
what doctors you go to, what hospitals you go to,
what tests you get. I mean, it's impactful. We got
to at least come to realize that, and certainly choices
that you make can impact how things develop. So once
again we'd like to welcome missus Levigne to the show.
How are you doing this morning?
Speaker 3 (03:04):
I'm wonderful. Good morning. How are you?
Speaker 2 (03:07):
I think I'm good?
Speaker 1 (03:08):
Good?
Speaker 2 (03:09):
How about your night? Short? It was long too well.
Speaker 4 (03:13):
I went to bed at midnight. I think you went
crazy before dark, which was exciting.
Speaker 2 (03:19):
Yeah. I took a little nap yesterday. I had a
little stomach upset yesterday. I don't know what that came.
Speaker 3 (03:24):
Doctors get sick.
Speaker 2 (03:27):
No, Yeah, we're machines. Yeah, we're machines. Just plug us
in and re charge our battery and unplug us and
make us go out and work all day. We never
get sick. Well, of course doctors get sick. That's absolutely right.
So I sick a little nap yesterday. But yeah, you've
been quite busy this past week. And again we'll appreciate
(03:49):
you coming on the show and sharing your thoughts with
the audience to see what is going on with the
office and just some highlights of the office. So this
is the beginning of the year, and so there's always
these issues with insurance plan. You chose deductibles. What else?
(04:12):
There's a couple other terms that are insurances, say agand
co insurance, co insurance, deductibles. Can you switch? Can you
not switch? What's the latest on that? Anything new for
twenty twenty six from the insurance industry that you think
would be a good highlight, a good subject matter that
(04:32):
maybe the patients or the audience would love to hear
about or discuss. Anything from your standpoint, same old, same
old stuff.
Speaker 4 (04:41):
I think anything is new, and we haven't been in
the year long enough to figure out all the surprises
that they have for us. So as we move along,
maybe after we get out of the first quarter of
the year, we'll understand some changes, but I don't see
any this far.
Speaker 3 (04:57):
I mean I don't.
Speaker 4 (04:58):
We haven't came across to you, to be honest with you.
They seem to be all the same.
Speaker 2 (05:04):
All right, So so far it's about the same. There's
been no new snaffoos. And the insurance industry.
Speaker 3 (05:10):
Deductibles go up just a little.
Speaker 4 (05:12):
Bit normally, what's a little bit twenty thirty dollars.
Speaker 3 (05:17):
That's kind of the trend.
Speaker 2 (05:18):
Not terrible.
Speaker 3 (05:20):
Cost of medicines go up.
Speaker 4 (05:22):
Excuse me. Patients get older, they get sicker. I mean,
it's just kind of like the cost of living goes up,
you know, it follows that same trend.
Speaker 2 (05:31):
Yeah, one thing you say, the cost of medicines goes up.
It's just a subject matter we don't really get into
a lot, but man, it's it's really something that we
probably should start prioritizing and tackle at some point, just
because these are good medications for patients and they really
work and they can really control the disease process whatever
(05:54):
that is. But one area of interest is these sort
of weight loss medicines, these GLP one agonists as we
call them. The companies including what go vis zep Bound.
There's another one out there. Munjaro are really trying to
reduce the cost of a cash price, if you will,
(06:19):
just because these are blockbuster medications and we still have
little weight loss program right that involves some generic semiglue tide.
How's that been going.
Speaker 3 (06:31):
It's good.
Speaker 4 (06:31):
I mean, we've had patients that have been very successful
on it. We have we can get other weight loss
medications now they're a little bit more expensive. So if patients, sorry.
Speaker 2 (06:43):
You don't be afraid of the mic.
Speaker 3 (06:45):
I'm not afraid of the mic.
Speaker 4 (06:47):
God, it wouldn't be sitting two inches from it.
Speaker 2 (06:52):
We want to be sure to hear you, okay, Well,
because you spit in a lot of well, I think
interesting knowledge, we want the people to hear it.
Speaker 4 (07:00):
I think I have a soft spoken voice and so
it's kind of hard to hear me. So, you know,
we have we have a second medication that has came
on board for us. It's a little bit more expensive,
so that if patients have been on the weight loss
program for a while and they're not responding to it,
we can switch them over. And it is Manjaro and
(07:22):
so so far no one's wanted to switch. They're happy
with what we're doing. But there is you know, a
second choice if if that's where the patient gets and
wants to do that. So, you know, I think it's
I think it's nice to watch the patients lose weight.
They get super excited, their clothes fit better, they feel better,
and you just kind of watch that trend from the
(07:42):
day that. Yeah, but you know, they it's not a
real fast process, but it's fast enough, you know, because
you don't want to lose weight quickly because then you
gain it back quickly, so you want it to be slow.
And then we try to also teach them about their
eating habits. It's not just about putting medication in your
body and all of a sudden, six months later you're thin.
(08:04):
You have to learn how to eat inner thinner. You
have to learn how to eat, what to do, move
a little, do a little exercise, gain some muscle mass.
Speaker 2 (08:12):
A little bit.
Speaker 3 (08:14):
Yeah, well, what what's that mean a little bit?
Speaker 2 (08:18):
Well, if you're my number one fan, I will totally
and if you listen to this show, you did. I
think if you listen to the show, what I try
to tell all the listeners is that the exercise that
helps you with your health really does not involve a
lot of time. It does not have to involve a
(08:39):
lot of time. Again, exercising is advertised to the American
people as a type of exercise that requires a gym membership.
It sometimes requires a trainer, someone who the wardrobe. A wardrobe.
Absolutely got to wear the right clothing, shoes. Yeah, yes,
you need equipment to do this. So all of these desires,
(09:04):
all of these requirements are basically, in my opinion, obstacles
to actually exercising on a regular basis, just because the
average person is not going to go out and buy
a whole bunch of gear, or they don't have the things. Yeah,
they don't have the money.
Speaker 4 (09:19):
For training iPods, and you have to have music and
you have to have a device you can listen to.
Speaker 2 (09:25):
All that on, all these necessary items just to get
some benefit from exercising, and it's untrue in my opinion.
Exercising can be just walking in your neighborhood or walking
in your house. A lot of this home equipment has
gotten very inexpensive. It's something you can get from Walmart
(09:47):
or you can buy online where you can put it
in your house. And if you talk about your health
and investment your health, as I've tried to mention talk
about my retirees a lot. I love talking about them.
They're so excited.
Speaker 3 (09:59):
About Wait, you talk to me and I'm your retire.
Speaker 2 (10:02):
We talk about it all the time. But I love
talking to out retirees because they're so excited about just
being able to do whatever they want to do and
spend time focusing on them since they've spent thirty plus
years focusing on someone else or sacrificing for some other person,
(10:25):
and now all of a sudden they have the ability
to focus on them. And it just makes sense that
if you now are in this position and you want
to enjoy the next fifteen, maybe twenty years of your life, man,
your health is so critical and you have to figure
out a strategy to prioritize your health. And we want
(10:45):
to try and keep the obstacles to a minimum. And
as it pertains to exercise, we just want to reassure
patients and just help them understand that the exercising that
requires to be healthy does it's not that hard. It
does not have to be painful a painful experience, which
is why a lot of people don't like to exercise
(11:06):
just because it's advertised as it's got to be painful.
You have to just sweat and you have to push
your body to the limit and just have to draw
all this stuff right in order to get the benefit
out of it, which is, in my opinion, incompletely wrong.
Just walking around your house or walking in your house
can be exercise. We just want you to get up
(11:27):
and move around. We don't want you to sit around
in the couch all day doing nothing. We want you
to stay physically active. And again, walking on a treadmill
for fifteen to twenty minutes two three times a week
is plenty. Now, if you want to do more, that's fine,
but this amount of exercise is it's fine. So it does.
Speaker 3 (11:50):
Routine, huh. I enjoyed my little routine.
Speaker 2 (11:53):
Yeah, you've mixed it up over the years.
Speaker 3 (11:55):
It's nothing serious.
Speaker 4 (11:56):
I mean I just ride a stationary bike and do
some crunches and some sit ups on a ball and
about forty five minutes and it goes by fast and
I enjoy it, you know, look forward to it.
Speaker 2 (12:11):
And you can listen to music if you want. You
can't have a television on.
Speaker 4 (12:15):
I have to listen to a lot during the day.
So I like peace and quiet works for.
Speaker 2 (12:20):
Me and most people say the same thing after they
finish exercising, it feel energetic. It just helps with their
circulation system, it helps with their bowl function. That becomes
the issue as people get older. Just I think that's always.
Speaker 4 (12:34):
An issue with women, though women seem to have that
more than men.
Speaker 3 (12:37):
What about issues.
Speaker 2 (12:42):
I haven't seen that. Maybe I know that females tend
to talk about their physical problems more than guys. I
think guys culturally tend to try and keep all of
that to their chest and don't complain about it. It's
like a guid thing, you know. They want to be
considered tough and resilient. I'm strong and I don't complain
(13:04):
a lot. That's just sort of a cultural thing. But
they could be suffering constipation, but they're not going to
tell you. They don't want to seem like they're weak
and complaining and that sort of thing. That's a mindset
that guys typically have versus females. They tend to be
more open with that. They want to get better, and
they don't mind sharing that information with the doctor. They
(13:25):
want they just want to get better, right, So I
think it's just a guid thing. I think they're suffering
it as well. And a few of them, yes, we'll
mention that, but most of them know they're going to
try and figure something out at home. Which again, for constipation,
there's a lot of things over the counter that helps
with that, but we do have some prescription medication available
if you do have constipation, and it is a very
(13:48):
very common physical issue as one gets older. And the
good thing is that the pharmacutical company has supplied us
with things. But the product over the counter that works
for it was called maryl Line, which is a great,
great product. You can take it long term. It's a powder.
You mix it in your coffee or your tea or whatever
you drink. Can you just drink it two or three
(14:09):
times a day. It doesn't taste, yeah, there's no there's
no taste to it. It's not chalky, it's it's very
well tolerated. It's a great product.
Speaker 3 (14:18):
There's a meta musial.
Speaker 2 (14:20):
Yeah, that's that's the old school version, so still a version. Yeah,
it is. It's an option. And that's the wonderful thing
about this country. You go to the store and you
have twenty thousand options for just about every item that
you might be looking at. I mean, it's just insane.
Sometimes overwhelming, but yeah, meta Musa has been there. Metamusa
is just sort of a synthetic fiber that is on
(14:43):
the market. It comes in a lot of different forms.
I think traditionally comes in that powder, but I think
they have it in some other different forms as well.
I think they have some chocolate squares or something.
Speaker 3 (14:52):
Do they still make xlax?
Speaker 2 (14:55):
I think so. I'm sure. I'm sure. I just haven't
heard any patients intion it recently, but I'm sure it's
out there.
Speaker 4 (15:03):
We have to run to the pharmacy and look for
it and see if it's still there.
Speaker 2 (15:09):
Yeah, you know, that will be an interesting topic, is
just the history of the pharmaceutical industry in terms of
what has been available to the American public prescription wise
and over the counter wise, in terms of what medicines
we've used, what medical therapeutics we've used over the years
to treat all these various ailments. Now that it's such
(15:30):
a robust industry, I mean you look at the pharmacies now,
they're popping up everywhere and they're huge, they're long doors,
long lines. Yes, so all these products that are available,
and then don't forget about the Internet and the web,
how you can just get on your computer and look
up all these items and somebody is selling it everywhere
or somewhere like x lax and things like that. Well,
(15:52):
you don't need a prescription, you can buy it yourself.
Which again, as a prescriber for over twenty years, I
have gotten more into that, you know, as a product
that's over the counter. Then I try to encourage that
just because getting it. We've talked about that, right, getting
a prescription from a doctor's office can be so tough. Right,
why is that? What in your experience, Why do you
(16:14):
think it's so tough to get that prescription when it
should be pretty.
Speaker 3 (16:18):
Easy a new prescription?
Speaker 2 (16:20):
Why any prescription it can be kind of hard.
Speaker 4 (16:22):
Well, there's a lot of work behind prescriptions because we
have to as a as an office and as a team.
When someone calls in for a refill, we have to
make sure that we are the one that prescribed it.
Because some patients go to other physicians, like their gas stroginy.
Speaker 2 (16:36):
No that that's bad, No, no.
Speaker 3 (16:38):
No, no.
Speaker 4 (16:38):
They have a team of doctors mm hmm, so they'll
call in and so we you know, patient safety is
going to be number one, So you always have to
think about that, you know, is what they're asking for,
Is that what they need, or is that what their
neighbor thinks they need, or their friend or their children,
or so they're asking for a prescription, we have to
make sure that it's safe. We have to make sure
(17:01):
that what they're asking for applies to the issue that
they're having. We also have to look at their other
medications to see if there's contra indications that they're going
to be safe for each other. We have to make
sure that if it's a medication that they're already taking
and they ask for a prescription or a refill, we
(17:22):
have to make sure it's time to make sure they're
taking it correctly. Are they asking for it too early?
Is it too late? So there's a lot of work
that goes behind refills. It's not just opening up your
computer and sending something off. That's a very irresponsible thing
to do as their healthcare advocate, and we just want
(17:44):
to make sure that it's the right thing for the patient.
And then if it comes down to it, if our
staff is not comfortable, then that's going to be a
visit that they have to see you. Because at the
end of the day, we don't want to harm the
patient by just giving them what they want, because you know,
a lot of a lot of medical patients interfere with
blood pressure, medications, antibiotics. You know, you have to stop
(18:06):
certain medications in order to start an antibiotic. And that's
really over our knowledge base, not our knowledge base, but
more of that's a doctor patient.
Speaker 2 (18:17):
Visit, doctor patient visit. With a prescription, yes, a good
topic as well as prior authorizations are pas as we
call them, something that we can talk about. On the
next segment, we have Pam from Beoma. How can we
help you?
Speaker 5 (18:33):
Good morning, doctor Levin, and this lebne so good to
hear this morning. While we're speaking on the conversation on constipation,
I would like to know for taking through softness, how
could it be that we can take one a day
(18:54):
or twice.
Speaker 2 (18:55):
A day stool softeners? Yes, sir, you want to know
if you can take one a day or twice a day.
Speaker 5 (19:03):
Yes, sir.
Speaker 2 (19:04):
I think most stool softeners can be taken as frequently
as you needed. I think if it's requiring you to
take two or three a day every day, probably might
be a little excessive. But stool softeners seem to be
a very benign product, and some patients do take them
(19:26):
on a regular basis. I think overall, we've gotten away
from stool softeners and we like this product, as I mentioned,
called me relax. It's safer, it's very neutral. Steel softwares
can sometimes generate its own issues, so I think in
terms of safety and what's effective, this Marilax powder, which
comes in a purple container typically is what most physicians
(19:50):
are recommending these days. Steel softwares were very popular back
in the day before these newer products hit the market.
So I would say, if you were my patient and
you're suffering from constipation and the subject came up, I
would probably recommend transitioning to this powder Merlax. Are there
some other prescription medicines that we use which tend not
(20:11):
to be too expensive that I would recommend you take.
But if you want to stay with the stool softwires,
you're not having any problems. I don't see any problem
with that. And yes, normally one or two a day
is what the standard dose is.
Speaker 4 (20:23):
And also try to increase the fiber in your diet.
Speaker 3 (20:26):
That would be a good.
Speaker 5 (20:27):
Okay, vegetables, Okay, thank you so much.
Speaker 1 (20:31):
I was on.
Speaker 5 (20:35):
The medication of this for trying to think what it
is mid Barman. And I know they say that the
met barman usually you know, help you go.
Speaker 2 (20:48):
But that's right.
Speaker 5 (20:49):
For some reason it caused me to be constipated. I
spoke with my doctor concerned in this matter. But I
will try to increase my fiber again, and I take
like the protein bars. But for some reason, I just
have a problem with the constipation. But I am active,
I walk up pretty much. But it's just one of
(21:11):
those things that I have a little problem with it.
Speaker 3 (21:14):
If you drink a lot of water.
Speaker 5 (21:16):
Oh, yes, ma'am, Yes, ma'am.
Speaker 2 (21:19):
Well, very good. Yeah, it sometimes this becomes an issue,
and the diet is the most important impact of that.
So increasing fiber withol me, eating again more vegetables, nuts
and seeds, whole grains like quinwa, flag seed, millet, barley,
old meal would be another way to increase the fiber
(21:40):
in your diet. There's a whole list of things that
you can do. Can look that up and then yes,
staying well hydrated with water and physical activity, no questions. Okay,
that increases function, yes, ma'am.
Speaker 5 (21:53):
All right.
Speaker 1 (21:54):
It's so good to talk with you all this morning.
Speaker 5 (21:55):
I have a good day.
Speaker 3 (21:56):
Thank you so kindly, have a wonderful weekend.
Speaker 2 (21:58):
Appreciate that. Constipation absolutely big big topic. Phone unch open
eight nine six kalv I one one hundred three three
zero kalv I'll be back in two minutes. All right,
(22:28):
welcome back to doctav matagcour phone lines are open eight
nine six kal v I one hundred three three zero
k o v I. He's sitting here chatting with Missus
Levigne about various topics, including constipation, which is an extremely
common issue as we get older. Maybe not a sexy
thing to talk about, but certainly it can be very
(22:48):
impactful to you whenever you have that. And again it's
the beginning of the new year, and there are topics
that come up at the beginning of the year. On
the administrative side, prior authorizations are PA for short, which
is this process that normally a medical office has to
go through in order to get a medication approved. Typically
(23:13):
the newer medications that hit the market. We've talked about
these GLP one agonists, but there's new medicines coming out
all the time, typically a bit more expensive, but normally
a better product in terms of treating the disease illness.
It's a product that healthcare professionals get introduced to and
we'd like to utilize just because they're they're better, right,
I mean, that's the way things work. We want to
(23:35):
use products that are good for the patients, are better,
easy to use, less side effects, more effective, et cetera,
et cetera. And normally the newer medications are like that.
But just this expense issue and the pharmaceutical world as
well as the insurance will kind of battle with this.
But there's this process called prior authorization. What does that mean?
Speaker 3 (23:57):
Prior authorism?
Speaker 2 (23:58):
Expert person of there, you got your headphones?
Speaker 4 (24:02):
You got to think so I may have some difficulty,
but I'm working with it.
Speaker 2 (24:07):
So you just change it out.
Speaker 4 (24:08):
Yeah, but I'm having to hold this little thing because
it keeps keeps going in and out.
Speaker 2 (24:13):
I going to get you a new set of earphones
and have your own personal earphones that we can have
for you. But what is pro authorization? We hear that term.
Are the patients here that term?
Speaker 4 (24:26):
So that term means that pro authorization? So what happens
the whole process of that is you come in to
see your provider. They want you to have a certain medicine.
That certain medicine is usually new on the market or
been on the market a couple of years and requires
a pro authorization because there's other things that have been
on the market way longer that are much cheaper, and
(24:49):
insurance companies would rather you go that route. But if
the provider believes that, you know, hey, you do need
this medicine, let's do the pro authorization. It's just paperwork
proving to the insurance companies that you've been taking those
other class medications and then your body has not responded
to them as well, so it's called failed treatment, and
(25:11):
you have to have failed treatment two or three times
and then they'll consider paying for it. And once you
have your prior authorization in place, it's good for like
a year, and it's a little bit of work behind it.
And you asked me earlier if I had seen anything
that had changed. That is one of the things that
I have seen that have changed. A lot of patients.
(25:32):
Formularies have changed, which is requiring a lot of prior authorizations,
and we put a new platform in place through clinicals
that kind of lets us know that while you're prescribing,
we can see that and you've probably seen something different
on your screen.
Speaker 2 (25:46):
Maybe, Yeah, we've got to update or upgrade this past week.
More busy, more information on the screen.
Speaker 4 (25:54):
Well, the cool thing is when the I mean we
know the po So the old way is we would
faxit it, we would send it over through EAT scripts
to the pharmacy. The pharmacy would then at some point
send us the pro authorization. This medication requires a prior authorisation.
There's a website or a couple of websites that we
utilize that we go to that helps us process that authorization.
(26:17):
Now it's integrated into e clinicals so that when you
prescribe it, it prompts us prior authorization is needed, and
we can do it in the computer, send the clinical
note and normally have the answer before the patient leaves,
which is leaps and bounds of positive from what it
used to be, and normally the patient can pick up
(26:39):
their medication that same day to where the old way
it was maybe two or three days later.
Speaker 2 (26:45):
HM. Improvement with technology, Yeah, it's wow. I didn't know that. Yeah,
I think that's a good improvement. Yeah, to the system,
because yeah, it was a very cumbersome process, right, just
a lot of back and forth. Time can assuming right.
That was the big thing for healthcare professionalist office, primary
care physician's office is time just because it eats up
(27:08):
or gobbles up your day as an office doing all
of these PA's for multiple people, right, just because it's
not one person, it's probably several people that require PA
for a particular product. So it's a time consuming issue
and sort of limiting to some degree. It's difficult to
accomplish all the pas in one day or two days,
(27:30):
and people are sort of sitting waiting for their products
to be delivered to them. So it's a deterrent basically
for providers. For patients, it's a deterrent, right. Oh, I
know it's going to take a long time. Forget about it.
Let me just stick with the old product. So integrating
it with the EMR or our EMR which is called
(27:52):
e Clinicals, which we've had since we've pretty much opened
the office. There's multiple ones out there. We've been very
happy with it.
Speaker 4 (27:59):
We had to get a couple of months without an EMR.
I you remember that we didn't have very many patients
in those days.
Speaker 2 (28:04):
Yeah, that's not terrible. So we've been using it ever
since and it's a great product, and now that it's
integrating to the system, absolutely it'll speed that whole process up,
become less of a deterrent. And again trying to get
patients on these norm medications which typically work. Now sometimes
it is not necessarily a failure. It's just that doctors
(28:26):
think it's more effective. Right, Maybe the disease is not
being controlled the way we wanted to for various reasons,
and we just want to try a new product out right,
and we feel like that this product is better. It's
normally going to be a once a day, it has
less side effects. Maybe it's stronger, but without the side
effect issues.
Speaker 3 (28:47):
I think it's easier.
Speaker 4 (28:48):
It breaks down in the body easier, it's more friendly
to your liver and kidneys and.
Speaker 2 (28:52):
Yeah, all that stuff. Absolutely, and having to take it
once a day versus multiple times a day. We know
that if patients having to take a medicine two three
times a day, that it's going to be difficult to
be compliant with that drug versus a drug that's once
a day or once a week, once a month.
Speaker 4 (29:12):
There was so many medications back in my day, and
I haven't practiced nursing in a really long time, even
though I.
Speaker 3 (29:17):
Practice every day.
Speaker 2 (29:19):
I'd love to see you back out of the floor.
Speaker 3 (29:21):
So you know you remember it.
Speaker 4 (29:27):
As long as you love taking care of I may
be a little rusty.
Speaker 3 (29:31):
But I would pull it together.
Speaker 2 (29:33):
It's changed well.
Speaker 3 (29:34):
Whatever, Oh my god.
Speaker 2 (29:35):
So much paperwork and just all the ins and outs
that they applied to the nursing staff. God bless them
and thank you for all nurses that are in the
hospital and all the nurses out them. Man, they have
a tough job and I really feel sorry for them
sometimes because of the pressures that they put on the
(29:58):
nursing staff. So yes, that's where we met. Was a
floor nurse and a very good floor nurse and took
care of a lot of critical patients because you are
good at managing critical topics and having to juggle all
these topics in your brain and just getting the job
(30:19):
done and not panicking and just doing what needs to
be done. You were very good at that, which is
why you're good at your job now. Just a big
problem solver and managing all this information that's flowing through
your brain and processing it and then spitting it out.
Speaker 3 (30:35):
Spitting out an answer.
Speaker 2 (30:37):
Yes, a solution, Yes, problem solver, right, that's what most
healthcare professionals are doing all day. It's this problem solving
and a lot of it's routine. But there are things
that come up that you were not trained to do,
and you were not really trained to be a medical admin.
You weren't trained to do that, right, No, it wasn't
(30:57):
a part of your training as a nurse. No, I
to run an office, a medical office. But you do
it very well and you've learned a lot. And yeah,
these prior authorizations are are were, according to you, a
cumbersome process, but now it seems like it's more straightforward
(31:17):
and it's easy. It's sort of integrated into our system
and allows us to get these products to patients a
lot faster than before.
Speaker 4 (31:26):
And at the end of a prization, it just means
that you pay your regular copay, that you pay for
everything else without that pro authorization. That that thirty day
supply of medication could be eighteen hundred to two thousand dollars.
Speaker 3 (31:40):
It's crazy.
Speaker 4 (31:42):
So we you know, we have a person in our office, Kayla,
who does all of our pro authorizations, and she likes
to keep it centrally located so she can keep up
with it. Because it's a lot, and she foughts extremely
hard and normally gets her pro authorizations approved and the
patients are happy.
Speaker 3 (31:58):
But also on her screen.
Speaker 4 (32:00):
And on your screen, you know when if you've noticed,
it'll tell you that this medication requires a prior authorization
and it'll bring up medications that are in that same.
Speaker 3 (32:10):
Class that are much cheaper. Did you have you seen that?
Or no you haven't.
Speaker 2 (32:14):
No, I haven't had a chance to look at the
new update at length.
Speaker 4 (32:18):
Well this was before the update. But okay, anyway, Kayla
can show you on Monday. I think you'll enjoy it.
I don't think it'll make you make a different decision,
because you're going to make what you what's best for
the patient.
Speaker 2 (32:30):
So so it prompts the staff they see a warning
or a signal it lights up or how does that work?
Speaker 3 (32:38):
Well, when you when you pursue.
Speaker 2 (32:39):
This is our system, another EMR could operate totally differently.
Speaker 4 (32:44):
When you prescribe a medication, it'll say, it'll prompt an
alert that it requires a prior authorization, and that alert
goes to Kayla.
Speaker 3 (32:53):
Yeah, that alert goes to Kayla.
Speaker 4 (32:56):
She normally mae it, Well, don't spend so too much
time thinking about it.
Speaker 3 (33:00):
I'll show you on Monday.
Speaker 2 (33:01):
Okay, phone lines are open eight one six kalfy. I
won one hundred three to three zero kalfy. I'll be
back in two minutes. All right, Welcome back to the
Dokahoum Medical. Our phone lines are open eight nine to
six kov. I want one hundred three three zero kofa
(33:21):
chatting with Missus Levigne about various topics. We are spending
a little bit of time talking about prior authorization, just
sort of that little naggy process that you have to
go through when you want to get a medication that
maybe was advertised to you, maybe you took it before
and it worked and now you need another prescription. You
have to go through that process. In the past, it's
(33:44):
just been a big deterrence. Just steps you have to
go through, normally very time consuming for any medical office staff,
which basically just creates stall and you know, just creates
a lot of uh, just tens and as it pertains
to getting the medication, getting a medicine prescription, medicine should
be pretty easy, considering electronic medical records and the computer
(34:08):
systems and phones and websites and just everybody's on the grid.
You should be able to just push a number or
push a button and then boom, your medicine shows up
at your doorstep. Wouldn't that be awesome? I mean you
can order from Amazon and get a product to your
door within twenty four forty eight hours. I mean, that's
it's crazy, incredible technology. Why can't I get my prescription
(34:32):
like that? What is so hard about it? Right? I've
been taking the same medicine for the longest time. I
just need a refill and I've done my best. Nobody's
picking up my phone, calls you. Now I got a prioritization.
I filled it two weeks ago. Now I can't. That's
another topic right there. What about the actual refilling part
(34:54):
of it. It's it's a little complicated, right. Can you
just for us system of refilling medicines? I guess if
you could explain that very quickly, just I know, patients
call like how I need a refieling like, no, you
got to come in. Well you can't get your medicines.
Can you kind of briefly explain our system or why
(35:15):
do you feel like that's necessary? Or what's the genesis
of that system? Because I know a lot of patients
like why why do I have to come see you?
I just saw you.
Speaker 4 (35:24):
So there's there's several reasons why it's not difficult to
get a medication from our office.
Speaker 2 (35:30):
If you're can be a case, if.
Speaker 4 (35:32):
You're a compliant patient. So you've made all of your visits,
you've you've done all the things that you're supposed to
be doing.
Speaker 3 (35:39):
You need to refeel.
Speaker 4 (35:40):
You've got to you You see us regularly, you keep
your appointments, you take your medicines on time, you ask
for them on time. We send you know, we send
your refill right away. It becomes a problem when it
becomes a problem you haven't been to see us. And
if few months, several months, you've skipped your appointments, canceled
(36:04):
your appointments.
Speaker 2 (36:05):
Sometimes a good reason, for good reason's happened.
Speaker 4 (36:08):
Yes, absolutely, but we need to see you. I mean
we need to reevaluate you for this medication.
Speaker 2 (36:16):
Now, this topic comes up a lot. Does the insurance
company put excuse me, put pressure on us to see
the patients on a regular basis?
Speaker 4 (36:23):
Yes, because we have a lot of paperwork. You mentioned
paperwork to be a paperless office, We have a lot
of paperwork that we have to report to the insurance
companies on your behalf, when you had your colonoscopy, when
you had your mammogram, if you're on a stat and
is your blood pressure controlled, do you have an A
one C And it's just on and on and on
(36:46):
and so every visit we gather this information. Because it's
so much information, we can't gather it in one visit.
The patient would be.
Speaker 3 (36:54):
There all day.
Speaker 4 (36:54):
You would be there all day with one patient, So
we gather this inform. We know what we need to
report to them on a yearly basis, and we gather
this information throughout the year. We normally see our patients
every three months, especially if you're Medicare or if you're
sixty five or older, just because there's a lot going
(37:15):
on with you and it can't be done in one visit,
So we gather that information and we report it every
single time the patient comes in. We report the information,
excuse me, and by the end of the year we're
normally done. The one thing that is the hardest measure
to meet out of all the quality measures is compliance
(37:36):
with medication. That is the most and it's triple weighted,
and that is.
Speaker 2 (37:41):
Means it's important very important.
Speaker 4 (37:43):
And it's triple weighted for the patient, meaning that it's
critical that they pick it up and take it on time.
Speaker 2 (37:52):
Because it helps control the disease process. We're trying to
keep everyone out of the hospital, as I've mentioned to
you before, and we want to slow the progression of
the disease down. And research has been very positive that
when you take your medications on a regular basis, that
(38:13):
the disease is control and it doesn't get worse. I mean,
that's what Primary cares all about, is prevention. At least
that's our goal, and one of the central components of
that is, yes, taking that medication on a regular basis
and certainly going to your doctor and making sure you're
getting the medication on a regular basis is. Key phone
(38:33):
lines are open eight on six kal Yeah, won one
hundred three three zero ko Via.
Speaker 6 (38:37):
I'll be back on our last break.
Speaker 2 (38:48):
All right, welcome back to the doc Levine and Metal.
Our phone lines are open eight one six kal of
yeat one hundred three three zero Okyov Yeah. Chatting with
Missus Lavigne and coming to the end of the show. Remember,
if there's a topic that you like when to talk about,
you can call this show. You can call my office
three four seven three six two one four nine area
code and drop off that topic. Would be more than happy.
Speaker 3 (39:09):
Do you remember a little secret?
Speaker 2 (39:10):
Tomber No, a secret to the phone number.
Speaker 4 (39:17):
So if you can't remember four zero nine three four
seven three six two.
Speaker 3 (39:22):
One was it?
Speaker 2 (39:23):
Was it like doctor one or something? Yes?
Speaker 3 (39:25):
Doc one, Doc one?
Speaker 2 (39:27):
Awesome, Hey Leonard from Houston. What's up, buddy?
Speaker 1 (39:32):
I have diabetes? Here I get remember a little blood
sugar numbers? Uh? Sixty two, sixty seven, seventy one. Is
there anything I could do to prevent low blood sugar numbers?
Speaker 2 (39:44):
Well, I think most of the time, as it pertains
to type two diabetics, if you're starting to get little
blood sugar readings, then a lot of times we look
at your med list and see if there's maybe something
that we can adjust or discontinue. Our goal is to
get patients off of medications if they have type two diabetes.
So a lot of times patients will make the necessary
(40:05):
changes in their lifestyle and the sugar levels just don't
go up and they don't need medication. So the first
sign of that is a sugar star getting pretty low.
So that would be my first recommendation to you is
to try and reduce the number of medicines you take,
or stop the medicine that you're taking, and see what happens.
Certainly you do that with the advice and the advisement
(40:26):
of your prescribing doctor.
Speaker 1 (40:30):
I went to him and he cut my forest of
mine in half instead of taking it every day, and
now I take it Monday, Wednesday, Fridays, and it's it's
been too soon as to you know, see if it's
doing any good. But all hand, I'm saying it's gonna
it hasn't done any good, but it's only been a
couple of days.
Speaker 2 (40:50):
Well, ferosomite is not a diabetic medication and.
Speaker 3 (40:53):
Does not it's a diabetic Yeah.
Speaker 2 (40:56):
It does not affect your blood sugar, so I don't
I don't think that would impact your blood anyway.
Speaker 1 (41:02):
Okay, Yeah, So what do I do about low blood sugars?
Speaker 2 (41:06):
Again, if you're not taking any medications that would cause
your blood sugars to go low, do you have any
symptoms when your blood sugar is in the sixties?
Speaker 1 (41:15):
Uh, shaky, sweaty, just don't feel good. I take a
couple of glucos pills and I'm openly and a half
an hour.
Speaker 2 (41:25):
Yes. So do you do you take any medication to
cause a low blood sugar?
Speaker 1 (41:30):
Well, I take blood, sure, I play, I take diabetic medicines.
Speaker 2 (41:34):
Yeah, so that would be the first thing. It's just
to cut back on the number of diabetic medications that
you're taking, and probably the sugar will go up or
are prevented from going down like that.
Speaker 1 (41:46):
Okay, I'll give it a try.
Speaker 4 (41:48):
Obviously, see your provider and let him instruct you on that.
Speaker 1 (41:52):
Yes, I did any take me off furs or cut
my first half.
Speaker 2 (41:58):
Well, just call him back and say, hey, I've talking
about my diabetes.
Speaker 4 (42:01):
Now, yeah, let's talk about my blood sugars.
Speaker 2 (42:05):
Yes, all right, Leonard, we appreciate that. So diuretic lay
sticks doesn't affect blood sugar, but if you're diabetic, your
sugar starts going low. The first thing to do is
to look at those meds and like which one can
I stop any last words, missus Levine, you don't come
that often to make sure that.
Speaker 3 (42:26):
You're hanging out with you there.
Speaker 2 (42:28):
Yeah, you can come anytime, give any time, that's no problem.
But thank you for joining us today. There's always a
lot going on on the admin side. It's good to
note that the prior authorization system may be speeding up,
so that's good for the listeners and feeding.
Speaker 3 (42:45):
Up for our office. You can speak for other offices.
Speaker 2 (42:47):
And yes, you do have to come into the doctor's
office to get your medication refills. We want to see,
we want to talk about what's going on. Make sure
that we try and do everything we can to keep
you out of the hospital and taking your medications. Being
complying it is a part of that process. Thank you
for joining me from the list of the show. We'll
see you next week. Don't drink and drive. God bless
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