February 20, 2025 • 45 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
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:28):
The pen, the building, the berth outstay back to the post,
to the days, the bud, to future, the pages that
(00:51):
the nasty stay internast.
Speaker 2 (00:53):
He was saying, bring in a mass between.
Speaker 1 (00:55):
Dug to the stay in the nasty, Stay in the nasty,
in the back, in the back of the bay.
Speaker 3 (01:18):
All right, welcome to South these Texas Internet radio listeners.
This is Doctor Levine, Doctor Levine Medical. Are welcome to
another edition of this show. We always love that you
listen and pay attention and tune in. But give us
a call so we can have a conversation and I
can answer a question and see if we can help
(01:40):
you understand what it's going to take for you to
stay alive longer and be as healthy as possible as
you stay alive. Who wants to be sick in the
doctor's office taking a bunch of tablets? How can you
avoid that? Right out of the hospital and keep your
(02:02):
doctor visits to a minimum maybe once a year. Right,
The annual visit phone lines are open eight nine six
kV I one one hundred and three to three zero
klv I. We are here every Saturday between eight and
nine at the studios of klv I. Hear in Beaumont,
Texas Live Radio. Yes it's live. It still is live,
(02:25):
no recordings, and hopefully having a wonderful Saturday morning. Weather
outside is really really muggy, heavy and not so bright.
So not such great weather this morning. And as you know,
end of February, beginning of March, it gets real tripolar.
(02:49):
As I would like to say, you know, you get
some spring weather, you get some winter weather, you get
some summer rain. I mean, it's just all over the place,
says the true winter season kind of sputters out, as
you guys or gals may or may not know. I
love the winner. It's normally the time of year that
(03:11):
I like weather wise, because the summer is just it's
too hot here in this area. My god, it's so heavy.
But give us a call so we can talk about
you and maybe answer some questions for you, because it
is confusing out there every day. Trying to get you
(03:31):
some answers and help things seem easier and more oriented
to what you are doing. We had our taping of
ASCIDOC yesterday, so I thought I would mention some of
those topics that we had on ASCIDOC yesterday, and one
(03:54):
had to do with whether or not this whole lifestyle
thing makes a difference.
Speaker 1 (04:00):
Right.
Speaker 3 (04:01):
The callers was pretty much saying, Hey, I just wanted
to know. You know, I know a guy, right, they
always have this threact. I know a guy that lived
to be in their nineties and they ate bacon every day, right,
and it could be anything different. Right. They smoked cigarettes
(04:23):
every day, they drank every day, they were overweghed, you
know things like that. Right, all these the stuff that
we tell you don't do, don't do, don't do, don't do.
And I know that sometimes it's very easy to just
turn that off and to ignore that. With all the
(04:45):
dues and don'ts out there, the list is very, very long.
My wife and I you know, at the end of
the day, just about as we settle down before we
go to bed, we have our favorite websites that we
like to go to. And I'm just listening to her
(05:08):
go through her cycle of her websites and just all
the advice that is out there by different people, different
entities about all just about everything, and it all seems
sort of stressful information or a crisis situation that you
(05:29):
got to do this right now, something bad's going to
happen to you. And I can just understand how irritating
that can be, and just the desire to just sort
of turn it off because after a while, just just
too much. You know, you have to be able to
get out of your house and wake up every day
(05:50):
and just be you right and do what you like
and enjoy the time you have left on this earth.
And I have this conversation a lot with patients, just
the balance of your lifestyle, meaning the holidays come through,
(06:10):
you go on a trip like a cruise. A lot
of my patients are, they're going cruises. They might go
in two or three cruises a week. I'm sorry, a year.
That would be good, right, going two or three cruises
a week, but no two or three cruises a year.
You know, I grew up watching The Love Boat, right,
(06:31):
and at that time that was sort of a luxury
to go on a cruise, very expensive and really out
of reach for the average American. But now with the
way cruises are, I mean, they're very affordable and people
are going on multiple cruises per year and normally there
(06:52):
are five to seven day cruises. Sort of a period
of gluttony, if you will, just because the way that
the ships are engineered and I mean everything is on
the ship. I mean it's a city, right, you know, entertainment, shopping, eating, drinking,
(07:13):
outside activities, it's all in the ship. You don't really
even have to leave the ship. And it's got more
affordable so that you can bring your whole family grow.
I mean a lot of my patients say they plan
these family trips and group trips, you know, the girls
or the guys. Mainly girls. Guys are homebodies, right, they
(07:33):
just want to stay at home, go in their man cave,
hang out and do whatever they do, make wood or
make things, or have these hobbies, work on old cars,
stuff like that. But females normally are adventurous and they
want to go somewhere. So a cruise is one thing
(07:53):
that they do but don't normally. When you're on the cruise,
you know, it's just all this food, all these drink
and just very excessive sort of exposure and experience, which
is fine for a few days and then come back
home and tieden up. So you know the question of
you know, does lifestyle really matter? You know, because hey, man,
(08:14):
I know a guy that ate bacon every day and
he got into his nineties. I mean, you guys are
always talking about don't eat bacon and it's going to
kill you. But I know someone who ate bacon. Oh,
I know someone who smoked a cigar every day or whatever.
And I get that periodically from patients, almost like I
(08:39):
really don't want to listen to what you're telling me.
I really don't want to change my ways. And as
proof of that, I know somebody who is doing that
and they're still alive. So I'm gonna just kind of
keep doing what I want to do, which is fine, right,
which is it's fine. The landscape as it pertains to
(09:04):
the healthcare industry at this point and its relationship with
the patient has changed drastically, even during my tenure as
a healthcare provider, it has changed. And the way it
is now is that, you know, doctors, healthcare professionals are
(09:25):
pretty much in sort of this advisory position, meaning whatever
decision is made at the end of the day is
more of a shared decision, right. You've heard that term before,
shared decision making and what that means is and this
(09:47):
was sort of before my time as well. The relationship
between the doctor and the patient, it used to be
very paternalistic relationship. Your doctor told you to do this,
and you did it. You didn't really question anything about
what the doctor said. He just did it. It's the
truth and he said it, and that's what's going to happen.
(10:10):
But those days are sort of over with, and it's
not necessarily a bad thing. I enjoy the fact that
patients understand more what's going on and they're looking more
into their own health, which might mean looking at their
labs and their X rays. I mean, it makes total
(10:33):
sense to me and I'm totally fine with it. As
a healthcare provider, it and honestly makes my job easier.
We still have patients that sort of our old school
and the doctor or healthcare provider, nurse practition physician assistant
is sort of in charge of everything and they have
(10:56):
complete trust in that healthcare provider and whatever that healthcare
provider recommends, they'll do. We still have that brand of
patients around, but we have sort of the new brand
that wants more of an interactive relationship and they want
to be informed of their results and just sort of
(11:19):
more engaged, which again I think when a patient is
more engaged, it's the outcomes are a lot better, whether
it be in the hospital or whether it be in
the office, the outcomes are better in my opinion, And
so going back to lifestyle, it's fine if to me,
(11:40):
if a patient wants to challenge the idea or the
understanding of what it takes to get to eighty or
ninety years old healthy, let's have a discussion. You know,
I have some concerns. I know someone who is not
doing that in their living. What do you got to
say about that? I have proof, And my answer to
(12:07):
that is, you know, you can always find that person.
You can always find that person who defies the odds
and they push through and they make it to eighty
and ninety engaging in those habits that are considered high risk.
And that's really what it's all about, is risk factor evaluation.
(12:30):
What is your risk high are low risk? Not that
it's going to happen one hundred percent, No, what's the risk?
And lifestyle In my opinion, even at this point in
my career over twenty years of doctoring and talking with patients,
(12:52):
is paramount to your risk of getting sick, ending up
in the hospital and having to take a sack of
meds MDS MEDS. Lifestyle is what I should say. It
is the biggest factor in determining your risk and the
(13:15):
biggest factor in determining the chances of you getting sick
or ill as you get older. It is lifestyle. There
is no question. It is unquestionable to me. This is
what I see every day. I work every day every
day in the hospital. In my office, I'm talking to
(13:39):
patients all day long. Every day. I see what they do,
I hear what they do, I see what foods they eat,
what beverages they drink. And it's very clear to me
the relationship between what you do every day, what you
eat every day, what you drink every day, and your
(14:02):
chances of ending up in the hospital, your chances of
getting a cancer. It is real and there is no
questioning as far as I'm concerned, the relationship. But yes,
every now and then there will be a person who
defies person or persons that defies the odds. They get
(14:27):
to eight or ninety and they didn't pay their dues,
if you will, right, we have a lot of patients
that they don't want to do cancer screening. I mean
I get that a lot in my office, and I
don't want to be screened for colon cancer. I don't
want to be screened for prospect cancer. I don't want labs,
I don't want this, I don't want that, and hey,
(14:48):
they get to eighty ninety, nothing happens to them. They
defied the odds, no question. Every day. But I also
see every day patients that they don't go to primary
care physicians, they don't get testing, they don't get LAP,
and they come down with stage four cancer cancer everywhere
(15:13):
at presentation. Just all the time. I see that, and
it's a little confusing because for most of the patients,
just maybe a yearly visit to a healthcare provider just
to get a quick idea of maybe some things I
(15:33):
should be doing or some things I should have to do,
you know, you don't have to go to the doctor
every day, maybe once a year, and just what is
the latest understanding, what are the latest recommendations about what
I should be doing to keep myself healthy, keep my
family healthy, and prevent some things or find some things
(15:57):
early so that there's more that can be done and
I don't end up suffering unnecessarily with all of these complications.
I mean, we talk about breast cancer all the time.
There's a huge awareness in our country about breast cancer.
But still but still we find ladies coming in with
(16:22):
stage four metastatic breast cancer, we still see it same things.
Still see stage four colon cancer coming in, no follow up,
no doctor visits, no nothing, still come in like that.
So we even though we've sort of made some of
this stuff more convenient, because a lot of that has
(16:45):
to do with convenience, right, it's a lot of work
sometimes to get these screening tests done. And again we've
worked over the years the medical community to try and
make it as easy as possible, such as this new
way of colon cancer screening. I remember, guys, gals, we
(17:05):
now start at the age of forty five. Right, forty five,
we're now starting the screen for colon cancer. Or if
it runs in your family and someone maybe had colon
cancer diagnosed in their thirties or their forties, then we
start a little bit earlier in that family. But for
(17:27):
the most visits forty five. That little box that comes
to your house. I mean, how convenient is that? That
is the most convenient? Right, You don't have to necessarily
drink all that solution, take a whole day off from
work and get exposed to sedatives and a procedure which
sometimes things go wrong. To in those procedures. I mean,
(17:49):
they're cranking those colonoscopies out every day and just about
nothing happens. Mostly the percentage is very low. But you know,
listen to my show, there's always a little grimlin bug
running around just terrorizing us, and something happens periodically that
(18:11):
you got to deal with. So these these stool kits
are pretty good in terms of making more convenient. What
I'm really waiting for because number one, cardiovast disease is
still king in our country in terms of what we
die from. Number two is cancer. What I'm still waiting
(18:34):
for from the cancer world, because you know, cancer research
is my god, It's very robust. They're pumping out stuff
all the time. A lot of people are researching cancer,
a lot of smart people. What I'm waiting for is
for some sort of profile, some sort of cancer profile,
(18:57):
are our sort of collection of cancer blood test that
we can order very easily that are sensitive to the
development of cancer, because again, cancer is basically hyper cellular
activity among other things with cancer, but it's a it's
(19:21):
it's a cell cancer that is wherever the cancer is,
whether it be your brain or your pancreas or your kidney.
The cells that sort of make up the structure of
that make up the structure of that particular organ start
to grow very abnormally at a more rapid rate, and
(19:45):
the cell that's made the inside components are very abnormal.
It's like an ugly cell. It's an abnormal So it's
a it's a it's a villain. It's sort of a
foreign alien cell, if you will. So it doesn't behave normally.
It behaves very aggressively, and because it's alive, it's certainly
(20:10):
got some sort of presence in your bloodstream. It starts
to sort of emit or should say, there are proteins
that sort of start to happen are circulating your bloodstream
that with modern technology, this is my dream or expectation
(20:30):
that we will be able to test your blood and
just see if it's floating around in your system, sort
of like the PSA prostate specific eenigen for prostate cancer
is sort of a in a category of what we
call a tumor marker. You've heard those terms before. PSA.
There's also C one nineteen CEA. You've heard of these
(20:55):
acronyms before. I'm surprised they're not more on market right
now that are available to healthcare providers to sort of screen.
That's a screening profile for process cancer, you know, because
we don't screen for all cancers. Some patients come down
with the dreaded pancreatic cancer or the dreaded renal cell
(21:15):
carcino that's kidney cancer. And because of these cancers are
in the abdominal cavity, which is sort of in the
middle part of your your body, your torso, and there's
so much room for that cancer to grow. Most of
time it has to get big before it starts to
cause problems, and by that time, you know, it's only
stage four. Hey, Leonard from Houston, how can we help you?
Speaker 4 (21:40):
About a month ago, my doctor switched me from met
Foreman to Farsiga and now I'm getting numbers one thirty one,
one one twenty four completely acceptable numbers to me. How
does far Sega work differently than met Foreman.
Speaker 3 (21:56):
Yeah, that's a little challenge for me learnon and thank
you for that. Es good question. I think you called
a few weeks ago. Met Forman is the old medicase
has been around for so so many years. As you know,
diabetes is a very complex endocrine abnormality. That generates a
(22:19):
lot of metabolic derangements that at the end of the
day generate this sort of hot sugar in your bloodstream.
And for type twos I'm talking about and sort of
this resistance to the chemical insulin which is made by
the pancreas. So a lot of organs are involved with
(22:40):
type two diabetes and just sort of this dysregulation the pancreas,
the liver, and your muscle cells, your brain cells. There's
sort of this irregularity with all these organs. So the
pharmacy of companies are targeting several different chemical pathways that
(23:00):
lead to diabetes. They're targeting these pathways to block or
slow down, or blunt or augment these abnormalities. So met
Foreman primarily works on the liver and sort of helps
decrease the production of sugar that is dumped into your
(23:20):
bloodstream when you have type two diabetes, which is why
some people come to us and they say, I haven't
eaten anything and my sugar is still high. And that's
because for some patients type two diabetes, their body still
pumps out sugar and dumps it in the bloodstream. So
metformant helps with sort of liver glucose of liver sugar production.
(23:45):
Far Sega belongs to a category of medicines called SGLT
two inhibitors, which is a chemical pathway primarily in the kidney,
and in bl locking that pathway, it allows the kidney
to dump sugar or prevents reabsorption of sugar because a
(24:07):
lot of times when you have sugar floating around in
your bloodstream, when it gets to your kidney, if there's
a lot of sugar in the blood, the kidney sort
of dumps that sugar out, which is a lot of
times when the sugar is how you urinate a lot.
That's one of the signs and symptoms of hyperglycemia. It's
just urinating a lot because the kidneys are dumping all
(24:29):
that sugar, but some of it's reabsorbed as well by
the kidney. So the SELT two inhibitors are Farsiga, jaradians,
and volcana. They sort of work at the kidney level
to block the reabsorption of sugar so that it does
(24:49):
not get reabsorbed and so it's eliminated out of your body.
And in doing that it helps bring your sugar down
because almost like once the sugar gets in your system,
it's sort of they is locked into your system so
that the farsiga is an outlet for the sugar to
dump out and be eliminated, and that will allow your
(25:10):
sugar count to start coming down. And in doing that, Leonard, yes,
it might start to cause you to urinate more, and
it behaves almost like a diuretic. You know, diuretics as
LASiS or ferosamide or demodex or torsomide or hydrochlor thixide
(25:31):
or diazide chlorthalidone. These are some diuretics we use all
the time. And diuretics again work at the kidney level,
blocking these normal pathways that the kidney uses to balance
fluid balance, and so these when you take these medicines,
they go to the kidney and they sort of block
these pathways, so the kidney cannot reabsorb this fluid in
(25:53):
the dumps and so you urinate. But there's different areas
in the kidney where the medicines work. So that's why
sometimes you can be on two diuretics, so three diuretics
at the same time, because they're working at different areas
in the kidney to get rid of the fluid. The
kidney is a very complex structure, but we know a
lot about the kidney. So the thing the way we
(26:15):
approach type two diabetes right now compared to when I
first came out, is now we have more medicines at
different targets along the way that if used in combination,
it can shut it down. I mean it can really
shut type two diabetes down because you have multiple areas
(26:36):
that you're targeting every day to just sort of balance
this metabolic derangement out. So I would say our ability
to help patients with type two diabetes has grown significantly
over the years because we now have better products on
the market and we for the most part, can get
(26:58):
a higher percentage if our patients took goal with the
use of these combinations of medications. I'm not saying it's
one hundred percent, because I don't think it ever will
be one hundred percent, but it's approaching a high percentage.
Seventy eighty percent of our patients can be well controlled
with all these medicines, the SCLT two class, Farsiga and
(27:22):
Vocatta Chardians in my opinion, or blockbuster medications. They work
extremely well. And when I came out of medical training,
med Foreman was the drug of choice to start most
of your patients on. It is now more, in my opinion,
it is now more of a second or third line
(27:42):
medication to start your patients on. What's first line in
my opinion are these SGLT two inhibitors as well as
the GOLP one class. This is what you know is
Ozimpic by Durion Victoza, what Govi Munjaro Rybelsi's. These are
(28:02):
those injectable medicines that are now available to you. So
for me, when I have a type two diabetic, I'm
trying to get them on Farsiga as well as injectables
day one, met Foreman later. So that's roughly how they work.
Speaker 5 (28:21):
Any questions, So bottom line, met Foreman works on.
Speaker 4 (28:28):
The liver deliver and far Sega works on the kidney.
Correct Is there wa against taking met Foreman and Farsiega together.
Speaker 3 (28:39):
No, not at all. It's a good combination. There's actually
there's there's pharmaceutical companies have combined both of those medications
already and they have some of those products out there
on the market. Where you have a met forman and
an sgl T two inhibitor. I've forgotten some of the
(29:00):
names because they're brand names. And I don't I don't
know that I've used them all the time. But yeah,
that's that's a great combination.
Speaker 4 (29:09):
Okay, well, I think I'll try it. And you know,
is there is there a day if I go with
met for form and farsiga, Is there a number that
I don't want to go below.
Speaker 3 (29:25):
Blood sugar number? Yes, we normally want to keep the
level above sixty. Less than sixty, it starts irritating the
nervous system. And that that's the main thing that happens, Leonard,
when your sugar goes low, right because the brain, the
brain cells, their primary energy is sugar. They need You
(29:51):
need to have sugar in your bloodstream because that's what
that's how the brain works. It uses sugar in the brain.
So when your sugar level falls less than sixty, typically
the amount of sugar getting to your brain is significantly
reduced and you can pass out, you can lose consciousness
because of low sugar. We see it all the time
(30:13):
because you know a lot of diabetics out there and
some are in insulin and they're on four or five meds.
They forgot to eat and then that sugar will just
boom go right below sixty. Very rapidly pass out because I.
Speaker 4 (30:28):
Have had that problem in the past. I went out
and I bought some of those sugar pills and now
I carry them. You know, I haven't needed them in
a year.
Speaker 3 (30:38):
And that's the thing about the pharmaceutical world is every normally,
when when they have new medicines on the market, the
medicines are safer and really they have less comf they
have less side effects, easier to use, more effective. So
some of the older diabetes medicines you had that issue,
(31:00):
but the newer stuff is unlikely to cause that low
sugar issue.
Speaker 5 (31:09):
Anything else, Leonyard, if I start with the metaform, and again,
is there a danger sign I should be looking for.
Speaker 4 (31:17):
That I'm over medicated.
Speaker 3 (31:21):
I mean, I think low sugar would be the main thing.
But you know, anything that is possible when you start
combining medicines. You know, all of that. Those irritating symptoms,
you know, nausea, vomiting, headache, weakness, rashes, you know, those
are sort of these mild adverse reaction issues and normally
(31:42):
they're reversible once you stop the medication and go away
in a day or two. All right, Leonard, it's good
to talk to you. Always appreciate your phone call phone
lines or open eight nine six kvy. I want to
hundred three three zero o kov. I'll be back in
two minutes.
Speaker 4 (32:04):
H m hm h.
Speaker 3 (32:17):
M all right, welcome back to talk to me, Matag.
Our phones are open eight nine six kvy. I want
to hnd you three three zero kilov. We have John
from Beaumont. How can we help you?
Speaker 2 (32:32):
Yeah, I have a heart question for you. The uh
they say, I've got a little blockage in my arteries
and what I'm a schedule for a bypass operation? What
is better the bypass? Getting the bypasses are the stints?
And then I understand that you're gonna have to I'm
(32:55):
gonna have to have be on blood thinners. And how
long do you have to be on blood thinners after
a bypass?
Speaker 4 (33:03):
Man?
Speaker 3 (33:03):
John? Those are awesome questions. I guess you studied last night.
But you know, these are questions that come up often,
and the medical community has constant conversations about which is
better stints or bypassed. And there are certain situations that
(33:26):
come up where it's sort of clear or they've decided
for the time being that which one is better for you,
whether bypass or stints, and this is not something I
do every day. The cardiologist and the heart surgeons are
in the position of answering this question every day. But
a couple of things. I do know for a fact
(33:48):
that normally, in terms of bypass, it's better to do
bypass if your main artery what we call the left
main artery, has a significant stenosis, are narrowing from plaque,
and you have diabetes, So you go in with chest
(34:09):
pain you have diabetes, they do the cath and the
main arter which they call the left main if that
is severely narrow ninety nine percent that diabetics do better
with a bypass. You also do better with the bypass
if you have multiple vessels that are severely narrow which
(34:33):
they call three vessel disease, which if you look at
the circulation of the heart, there's three main blood vessels
that sort of feed the heart. So if all those
pathways have severe narrowing when they go in and do
their cath, then they normally recommend bypass. Other than that,
(34:53):
it's sort of up to the cardiologist looking at your
anatomy to decide if bypass or stints are better. Normally,
if it's just one blood vessel. It's not your left
main you're not diabetic, you have some blood vessel, norw
and go go ahead and stint it again, just to
reiterate the Probably the literature may have been updated about
(35:18):
which is better bypassed or stint, But this is my
current understanding of sort of that decision making. Most of
the time, it's, you know, the doctor's experience, whether it
be the cardiologists or the surgeon, it's going to be
their experience that kind of dictates a lot of that stuff.
Even though the official guidelines might say one thing or
(35:39):
the other, it's normally the doctor's experience that tells them
what to do, meaning they sort of have been exposed
to a lot of outcomes a lot of patients in
terms of well, I did this dur in this situation
and this is what happened, or I did something else
and this is what happened. So they remember all that
stuff so that when another page comes along with similar situation,
(36:03):
they know, based on their experience that it's probably better
to do one thing or the other in terms of
bypass versus stinning. And this is a constant conversation between
the two worlds, the cardiologists and the surgeons, right, cardiologists
do the stinting, the surgeons do the bypass. I mean,
(36:23):
obviously they don't want to go in there if they
don't have to. It's a big operation, a lot of risk,
for a lot of things to go wrong. So Norman,
when they pull the trigger, they feel very confident that, hey,
this is going to benefit the patient better than stints.
But the stint world, the technology behind stints, the engineering
the medicines, they're pretty good too, right, And it's getting
(36:47):
to a point where maybe stinning is the best way
to go as well. But again, I don't do this
for a living. In terms of the blood thinners, yes,
after bypass, in my experience, it's normally going to be
an aspirin or one of these other platelet medicines which
(37:07):
we know as plavix are clo pedigrill are the are
two of them. So plavix an aspirin are just asking
by itself or plavix by itself. Again, it's up to
the heart doctor to determine which one is going to
benefit you the best. There's a lot of different factors
that go into that, and normally, if you have bypass,
(37:28):
you're going to have to take some sort of what
we call blood dinner for the rest of your life,
and again up to the heart doctor to decide that
that could change from year to year. It just depends
on you as a patient. How many risk factors you have,
which your anatomy looks like kind of determines that. But
(37:49):
normally asked when our plavix, it's normally when you get
these stints that you need to medicines that you have
to take for at least six months to a year
because that stint is foreign and the body knows that,
and a lot of times it can attack the stint,
and attacking the stint, it causes another blood clot and
(38:13):
when that happens, you get another heart attack. So that's
a big thing in the cardiology world. When you get
a stint, a lot of times they'll tell you, they'll
print it on your chest, they'll give you all this paperwork.
Do not stop these blood thinners unless I tell you to.
Don't let anybody else tell you to stop them either,
because it's so critical because that happens. Sometimes you get
(38:36):
a stint and then two weeks later something happens, you
stop your mads and then you have another heart attack.
Bypass is not like that bypass. Like I say, normally
can have an aspirin or a plavix and you might
have to stop it. It'll be okay for the most part.
But these stints are in your blood vessels. They're foreign.
It's almost like a transplant, right. Your body reacts to it,
(38:59):
and so you need those two blood thinners to prevent
you from forming these clots. And it's only for like
I say, six months a year. They've been trying to
lessen the amount of time you have to take both
these blood thinners because guess what, blood thener's caused you
to bleed. It's a very common scenario that happens every
day in the hospital. You come in with your heart
attack one week and then two weeks later you're in
(39:21):
the hospital for bleeding. We see it every day. So
they're trying to shorten the period where you have to
be on these blood thinners so that your risk of
bleeding is lesser and so you don't come in with bleeding.
So hopefully that helps you out.
Speaker 4 (39:37):
John, that helped a lot.
Speaker 2 (39:39):
I have a lot of sure and appreciate the in
So all.
Speaker 3 (39:43):
Right, bro, they have a good day. We're going on
a second break. Phone ones open eight down six scalovy
I won one hundred three three zero Kovy. I'll be
back in two minutes. All right, welcome back to doctor
(40:11):
Vie and Medical. Our phone lines are open A nine
to six K one one hundred and three three zero
kov I appreciate all the callers, and yes, all these
medical decisions that doctors make every day, dance bypass meds two,
meds one med. You know, it's just what we do
all day long, and we certainly enjoy doing it. And
the medical literature is always changing because sometimes new information
(40:37):
comes out about certain diseases or medicines and maybe they're
doing something else in a different region of the world,
not necessarily the United States, but overseas, and it works
better for our patients. It's easier, it's more effective, except
whatever it is. And that's what I love so much
about the profession, just sort of constant evolvement, changing of
(41:01):
our ideas about how we do things. And even as
I was talking earlier in the show about shared information
with the patient, and that's a big shift in healthcare delivery,
is bringing in the patient to be more involved and
share with the decisions and the understanding of what we're doing.
(41:24):
And I'd certainly have no problem with that amount of
money that the average person spends on their healthcare insurance.
They should be involved and should know what's going on.
You're spending in a large amount of your heart earned money,
and you should know what is going on with your
body and why you're taking medications and what they're for,
(41:45):
and getting your test results and making sure you're getting
your screening tests on time. And as I would started
with the show, there's always a few of those that
pushed through and defy the odds and question whether or
not do I really need to eat vegetables? Do I
(42:07):
really need to do that? Do I really need to
prioritize drinking water? Because I know a guy or girl
that doesn't do that, and they're driving and they have
no they don't take any medicine, they don't go to
the doctor, and they're doing fine. You know, we always
try to find that one person that gives us proof
(42:27):
that all those doctors don't know what they're talking about.
It's all hooplile, they're making it up. I can do
whatever I want, I can eat whatever I want. Well,
if that's the way you want to live your life.
Then certainly it's your choice. And again, doctors are just
there to try and help advise you on the current
understanding of what works and what doesn't work. And it
(42:50):
can change, no question. But based on what I've seen
over the past twenty years talking to patients in the
office in the hospital, man to me, it's clear I
see it every day, just sort of this strong relationship
about what you're eating and drinking and your chances of
(43:11):
becoming ill and again cardiovascal disease. Can's just the two
biggest issues, which in my opinion, are very preventable, but
you certainly have to invest more time into doing that
as you get older and as I mentioned, forty years old,
sort of when the body starts to get into that
(43:33):
auto shutdown mode, right, I talk about that. I use
that term because it's sort of programmed into us when
we're born. The cells stop working, they're not as robust,
they don't heal very well, so it leaves our body
vulnerable for all sorts of ailments to start happening to us.
(43:53):
And again, the things that you're eating influence that dramatically,
Like sugar, we talk about that all the time, as
well as eating processed foods, in my opinion, tend to
generate more disease and illness. So try to eat cleaner
(44:13):
and try to drink more water and stay away from
the sugar every single day. I still have a lot
of my patients consuming sugary beverages every day. And yes,
I do find patients in their sixties seventies drinking sugary
beverages every day. Because a lot of experts are claiming
that Alzheimer's, they're starting to call it a type three
(44:36):
diabetic because they're trying to are there getting to understand
that high sugar are spikes and sugar are detrimental to
your nervous system. It makes sense to me, makes complete
sense to me. And trying to prioritize reducing your exposure
to starches and sugar so that you don't get these
(44:57):
spikes and not doing getting the spikes, you don't flame
your body and then just start injuring your nervous system,
including the brain, and in doing that, less chance of
diabet I'm sorry, dementia, which is the third or fourth
major problem in our country that kills us. So huge
cardiovascular risk factors for dementia, so work on that. Thank
(45:20):
you for joining us on the edition of the show
Don't Drink and drive. Drink some water. We'll see you
guys next week. Take care.
The pen, the building, the berth outstay back to the post,
to the days, the bud, to future, the pages that
(00:51):
the nasty stay internast.
Speaker 2 (00:53):
He was saying, bring in a mass between.
Speaker 1 (00:55):
Dug to the stay in the nasty, Stay in the nasty,
in the back, in the back of the bay.
Speaker 3 (01:18):
All right, welcome to South these Texas Internet radio listeners.
This is Doctor Levine, Doctor Levine Medical. Are welcome to
another edition of this show. We always love that you
listen and pay attention and tune in. But give us
a call so we can have a conversation and I
can answer a question and see if we can help
(01:40):
you understand what it's going to take for you to
stay alive longer and be as healthy as possible as
you stay alive. Who wants to be sick in the
doctor's office taking a bunch of tablets? How can you
avoid that? Right out of the hospital and keep your
(02:02):
doctor visits to a minimum maybe once a year. Right,
The annual visit phone lines are open eight nine six
kV I one one hundred and three to three zero
klv I. We are here every Saturday between eight and
nine at the studios of klv I. Hear in Beaumont,
Texas Live Radio. Yes it's live. It still is live,
(02:25):
no recordings, and hopefully having a wonderful Saturday morning. Weather
outside is really really muggy, heavy and not so bright.
So not such great weather this morning. And as you know,
end of February, beginning of March, it gets real tripolar.
(02:49):
As I would like to say, you know, you get
some spring weather, you get some winter weather, you get
some summer rain. I mean, it's just all over the place,
says the true winter season kind of sputters out, as
you guys or gals may or may not know. I
love the winner. It's normally the time of year that
(03:11):
I like weather wise, because the summer is just it's
too hot here in this area. My god, it's so heavy.
But give us a call so we can talk about
you and maybe answer some questions for you, because it
is confusing out there every day. Trying to get you
(03:31):
some answers and help things seem easier and more oriented
to what you are doing. We had our taping of
ASCIDOC yesterday, so I thought I would mention some of
those topics that we had on ASCIDOC yesterday, and one
(03:54):
had to do with whether or not this whole lifestyle
thing makes a difference.
Speaker 1 (04:00):
Right.
Speaker 3 (04:01):
The callers was pretty much saying, Hey, I just wanted
to know. You know, I know a guy, right, they
always have this threact. I know a guy that lived
to be in their nineties and they ate bacon every day, right,
and it could be anything different. Right. They smoked cigarettes
(04:23):
every day, they drank every day, they were overweghed, you
know things like that. Right, all these the stuff that
we tell you don't do, don't do, don't do, don't do.
And I know that sometimes it's very easy to just
turn that off and to ignore that. With all the
(04:45):
dues and don'ts out there, the list is very, very long.
My wife and I you know, at the end of
the day, just about as we settle down before we
go to bed, we have our favorite websites that we
like to go to. And I'm just listening to her
(05:08):
go through her cycle of her websites and just all
the advice that is out there by different people, different
entities about all just about everything, and it all seems
sort of stressful information or a crisis situation that you
(05:29):
got to do this right now, something bad's going to
happen to you. And I can just understand how irritating
that can be, and just the desire to just sort
of turn it off because after a while, just just
too much. You know, you have to be able to
get out of your house and wake up every day
(05:50):
and just be you right and do what you like
and enjoy the time you have left on this earth.
And I have this conversation a lot with patients, just
the balance of your lifestyle, meaning the holidays come through,
(06:10):
you go on a trip like a cruise. A lot
of my patients are, they're going cruises. They might go
in two or three cruises a week. I'm sorry, a year.
That would be good, right, going two or three cruises
a week, but no two or three cruises a year.
You know, I grew up watching The Love Boat, right,
(06:31):
and at that time that was sort of a luxury
to go on a cruise, very expensive and really out
of reach for the average American. But now with the
way cruises are, I mean, they're very affordable and people
are going on multiple cruises per year and normally there
(06:52):
are five to seven day cruises. Sort of a period
of gluttony, if you will, just because the way that
the ships are engineered and I mean everything is on
the ship. I mean it's a city, right, you know, entertainment, shopping, eating, drinking,
(07:13):
outside activities, it's all in the ship. You don't really
even have to leave the ship. And it's got more
affordable so that you can bring your whole family grow.
I mean a lot of my patients say they plan
these family trips and group trips, you know, the girls
or the guys. Mainly girls. Guys are homebodies, right, they
(07:33):
just want to stay at home, go in their man cave,
hang out and do whatever they do, make wood or
make things, or have these hobbies, work on old cars,
stuff like that. But females normally are adventurous and they
want to go somewhere. So a cruise is one thing
(07:53):
that they do but don't normally. When you're on the cruise,
you know, it's just all this food, all these drink
and just very excessive sort of exposure and experience, which
is fine for a few days and then come back
home and tieden up. So you know the question of
you know, does lifestyle really matter? You know, because hey, man,
(08:14):
I know a guy that ate bacon every day and
he got into his nineties. I mean, you guys are
always talking about don't eat bacon and it's going to
kill you. But I know someone who ate bacon. Oh,
I know someone who smoked a cigar every day or whatever.
And I get that periodically from patients, almost like I
(08:39):
really don't want to listen to what you're telling me.
I really don't want to change my ways. And as
proof of that, I know somebody who is doing that
and they're still alive. So I'm gonna just kind of
keep doing what I want to do, which is fine, right,
which is it's fine. The landscape as it pertains to
(09:04):
the healthcare industry at this point and its relationship with
the patient has changed drastically, even during my tenure as
a healthcare provider, it has changed. And the way it
is now is that, you know, doctors, healthcare professionals are
(09:25):
pretty much in sort of this advisory position, meaning whatever
decision is made at the end of the day is
more of a shared decision, right. You've heard that term before,
shared decision making and what that means is and this
(09:47):
was sort of before my time as well. The relationship
between the doctor and the patient, it used to be
very paternalistic relationship. Your doctor told you to do this,
and you did it. You didn't really question anything about
what the doctor said. He just did it. It's the
truth and he said it, and that's what's going to happen.
(10:10):
But those days are sort of over with, and it's
not necessarily a bad thing. I enjoy the fact that
patients understand more what's going on and they're looking more
into their own health, which might mean looking at their
labs and their X rays. I mean, it makes total
(10:33):
sense to me and I'm totally fine with it. As
a healthcare provider, it and honestly makes my job easier.
We still have patients that sort of our old school
and the doctor or healthcare provider, nurse practition physician assistant
is sort of in charge of everything and they have
(10:56):
complete trust in that healthcare provider and whatever that healthcare
provider recommends, they'll do. We still have that brand of
patients around, but we have sort of the new brand
that wants more of an interactive relationship and they want
to be informed of their results and just sort of
(11:19):
more engaged, which again I think when a patient is
more engaged, it's the outcomes are a lot better, whether
it be in the hospital or whether it be in
the office, the outcomes are better in my opinion, And
so going back to lifestyle, it's fine if to me,
(11:40):
if a patient wants to challenge the idea or the
understanding of what it takes to get to eighty or
ninety years old healthy, let's have a discussion. You know,
I have some concerns. I know someone who is not
doing that in their living. What do you got to
say about that? I have proof, And my answer to
(12:07):
that is, you know, you can always find that person.
You can always find that person who defies the odds
and they push through and they make it to eighty
and ninety engaging in those habits that are considered high risk.
And that's really what it's all about, is risk factor evaluation.
(12:30):
What is your risk high are low risk? Not that
it's going to happen one hundred percent, No, what's the risk?
And lifestyle In my opinion, even at this point in
my career over twenty years of doctoring and talking with patients,
(12:52):
is paramount to your risk of getting sick, ending up
in the hospital and having to take a sack of
meds MDS MEDS. Lifestyle is what I should say. It
is the biggest factor in determining your risk and the
(13:15):
biggest factor in determining the chances of you getting sick
or ill as you get older. It is lifestyle. There
is no question. It is unquestionable to me. This is
what I see every day. I work every day every
day in the hospital. In my office, I'm talking to
(13:39):
patients all day long. Every day. I see what they do,
I hear what they do, I see what foods they eat,
what beverages they drink. And it's very clear to me
the relationship between what you do every day, what you
eat every day, what you drink every day, and your
(14:02):
chances of ending up in the hospital, your chances of
getting a cancer. It is real and there is no
questioning as far as I'm concerned, the relationship. But yes,
every now and then there will be a person who
defies person or persons that defies the odds. They get
(14:27):
to eight or ninety and they didn't pay their dues,
if you will, right, we have a lot of patients
that they don't want to do cancer screening. I mean
I get that a lot in my office, and I
don't want to be screened for colon cancer. I don't
want to be screened for prospect cancer. I don't want labs,
I don't want this, I don't want that, and hey,
(14:48):
they get to eighty ninety, nothing happens to them. They
defied the odds, no question. Every day. But I also
see every day patients that they don't go to primary
care physicians, they don't get testing, they don't get LAP,
and they come down with stage four cancer cancer everywhere
(15:13):
at presentation. Just all the time. I see that, and
it's a little confusing because for most of the patients,
just maybe a yearly visit to a healthcare provider just
to get a quick idea of maybe some things I
(15:33):
should be doing or some things I should have to do,
you know, you don't have to go to the doctor
every day, maybe once a year, and just what is
the latest understanding, what are the latest recommendations about what
I should be doing to keep myself healthy, keep my
family healthy, and prevent some things or find some things
(15:57):
early so that there's more that can be done and
I don't end up suffering unnecessarily with all of these complications.
I mean, we talk about breast cancer all the time.
There's a huge awareness in our country about breast cancer.
But still but still we find ladies coming in with
(16:22):
stage four metastatic breast cancer, we still see it same things.
Still see stage four colon cancer coming in, no follow up,
no doctor visits, no nothing, still come in like that.
So we even though we've sort of made some of
this stuff more convenient, because a lot of that has
(16:45):
to do with convenience, right, it's a lot of work
sometimes to get these screening tests done. And again we've
worked over the years the medical community to try and
make it as easy as possible, such as this new
way of colon cancer screening. I remember, guys, gals, we
(17:05):
now start at the age of forty five. Right, forty five,
we're now starting the screen for colon cancer. Or if
it runs in your family and someone maybe had colon
cancer diagnosed in their thirties or their forties, then we
start a little bit earlier in that family. But for
(17:27):
the most visits forty five. That little box that comes
to your house. I mean, how convenient is that? That
is the most convenient? Right, You don't have to necessarily
drink all that solution, take a whole day off from
work and get exposed to sedatives and a procedure which
sometimes things go wrong. To in those procedures. I mean,
(17:49):
they're cranking those colonoscopies out every day and just about
nothing happens. Mostly the percentage is very low. But you know,
listen to my show, there's always a little grimlin bug
running around just terrorizing us, and something happens periodically that
(18:11):
you got to deal with. So these these stool kits
are pretty good in terms of making more convenient. What
I'm really waiting for because number one, cardiovast disease is
still king in our country in terms of what we
die from. Number two is cancer. What I'm still waiting
(18:34):
for from the cancer world, because you know, cancer research
is my god, It's very robust. They're pumping out stuff
all the time. A lot of people are researching cancer,
a lot of smart people. What I'm waiting for is
for some sort of profile, some sort of cancer profile,
(18:57):
are our sort of collection of cancer blood test that
we can order very easily that are sensitive to the
development of cancer, because again, cancer is basically hyper cellular
activity among other things with cancer, but it's a it's
(19:21):
it's a cell cancer that is wherever the cancer is,
whether it be your brain or your pancreas or your kidney.
The cells that sort of make up the structure of
that make up the structure of that particular organ start
to grow very abnormally at a more rapid rate, and
(19:45):
the cell that's made the inside components are very abnormal.
It's like an ugly cell. It's an abnormal So it's
a it's a it's a villain. It's sort of a
foreign alien cell, if you will. So it doesn't behave normally.
It behaves very aggressively, and because it's alive, it's certainly
(20:10):
got some sort of presence in your bloodstream. It starts
to sort of emit or should say, there are proteins
that sort of start to happen are circulating your bloodstream
that with modern technology, this is my dream or expectation
(20:30):
that we will be able to test your blood and
just see if it's floating around in your system, sort
of like the PSA prostate specific eenigen for prostate cancer
is sort of a in a category of what we
call a tumor marker. You've heard those terms before. PSA.
There's also C one nineteen CEA. You've heard of these
(20:55):
acronyms before. I'm surprised they're not more on market right
now that are available to healthcare providers to sort of screen.
That's a screening profile for process cancer, you know, because
we don't screen for all cancers. Some patients come down
with the dreaded pancreatic cancer or the dreaded renal cell
(21:15):
carcino that's kidney cancer. And because of these cancers are
in the abdominal cavity, which is sort of in the
middle part of your your body, your torso, and there's
so much room for that cancer to grow. Most of
time it has to get big before it starts to
cause problems, and by that time, you know, it's only
stage four. Hey, Leonard from Houston, how can we help you?
Speaker 4 (21:40):
About a month ago, my doctor switched me from met
Foreman to Farsiga and now I'm getting numbers one thirty one,
one one twenty four completely acceptable numbers to me. How
does far Sega work differently than met Foreman.
Speaker 3 (21:56):
Yeah, that's a little challenge for me learnon and thank
you for that. Es good question. I think you called
a few weeks ago. Met Forman is the old medicase
has been around for so so many years. As you know,
diabetes is a very complex endocrine abnormality. That generates a
(22:19):
lot of metabolic derangements that at the end of the
day generate this sort of hot sugar in your bloodstream.
And for type twos I'm talking about and sort of
this resistance to the chemical insulin which is made by
the pancreas. So a lot of organs are involved with
(22:40):
type two diabetes and just sort of this dysregulation the pancreas,
the liver, and your muscle cells, your brain cells. There's
sort of this irregularity with all these organs. So the
pharmacy of companies are targeting several different chemical pathways that
(23:00):
lead to diabetes. They're targeting these pathways to block or
slow down, or blunt or augment these abnormalities. So met
Foreman primarily works on the liver and sort of helps
decrease the production of sugar that is dumped into your
(23:20):
bloodstream when you have type two diabetes, which is why
some people come to us and they say, I haven't
eaten anything and my sugar is still high. And that's
because for some patients type two diabetes, their body still
pumps out sugar and dumps it in the bloodstream. So
metformant helps with sort of liver glucose of liver sugar production.
(23:45):
Far Sega belongs to a category of medicines called SGLT
two inhibitors, which is a chemical pathway primarily in the kidney,
and in bl locking that pathway, it allows the kidney
to dump sugar or prevents reabsorption of sugar because a
(24:07):
lot of times when you have sugar floating around in
your bloodstream, when it gets to your kidney, if there's
a lot of sugar in the blood, the kidney sort
of dumps that sugar out, which is a lot of
times when the sugar is how you urinate a lot.
That's one of the signs and symptoms of hyperglycemia. It's
just urinating a lot because the kidneys are dumping all
(24:29):
that sugar, but some of it's reabsorbed as well by
the kidney. So the SELT two inhibitors are Farsiga, jaradians,
and volcana. They sort of work at the kidney level
to block the reabsorption of sugar so that it does
(24:49):
not get reabsorbed and so it's eliminated out of your body.
And in doing that it helps bring your sugar down
because almost like once the sugar gets in your system,
it's sort of they is locked into your system so
that the farsiga is an outlet for the sugar to
dump out and be eliminated, and that will allow your
(25:10):
sugar count to start coming down. And in doing that, Leonard, yes,
it might start to cause you to urinate more, and
it behaves almost like a diuretic. You know, diuretics as
LASiS or ferosamide or demodex or torsomide or hydrochlor thixide
(25:31):
or diazide chlorthalidone. These are some diuretics we use all
the time. And diuretics again work at the kidney level,
blocking these normal pathways that the kidney uses to balance
fluid balance, and so these when you take these medicines,
they go to the kidney and they sort of block
these pathways, so the kidney cannot reabsorb this fluid in
(25:53):
the dumps and so you urinate. But there's different areas
in the kidney where the medicines work. So that's why
sometimes you can be on two diuretics, so three diuretics
at the same time, because they're working at different areas
in the kidney to get rid of the fluid. The
kidney is a very complex structure, but we know a
lot about the kidney. So the thing the way we
(26:15):
approach type two diabetes right now compared to when I
first came out, is now we have more medicines at
different targets along the way that if used in combination,
it can shut it down. I mean it can really
shut type two diabetes down because you have multiple areas
(26:36):
that you're targeting every day to just sort of balance
this metabolic derangement out. So I would say our ability
to help patients with type two diabetes has grown significantly
over the years because we now have better products on
the market and we for the most part, can get
(26:58):
a higher percentage if our patients took goal with the
use of these combinations of medications. I'm not saying it's
one hundred percent, because I don't think it ever will
be one hundred percent, but it's approaching a high percentage.
Seventy eighty percent of our patients can be well controlled
with all these medicines, the SCLT two class, Farsiga and
(27:22):
Vocatta Chardians in my opinion, or blockbuster medications. They work
extremely well. And when I came out of medical training,
med Foreman was the drug of choice to start most
of your patients on. It is now more, in my opinion,
it is now more of a second or third line
(27:42):
medication to start your patients on. What's first line in
my opinion are these SGLT two inhibitors as well as
the GOLP one class. This is what you know is
Ozimpic by Durion Victoza, what Govi Munjaro Rybelsi's. These are
(28:02):
those injectable medicines that are now available to you. So
for me, when I have a type two diabetic, I'm
trying to get them on Farsiga as well as injectables
day one, met Foreman later. So that's roughly how they work.
Speaker 5 (28:21):
Any questions, So bottom line, met Foreman works on.
Speaker 4 (28:28):
The liver deliver and far Sega works on the kidney.
Correct Is there wa against taking met Foreman and Farsiega together.
Speaker 3 (28:39):
No, not at all. It's a good combination. There's actually
there's there's pharmaceutical companies have combined both of those medications
already and they have some of those products out there
on the market. Where you have a met forman and
an sgl T two inhibitor. I've forgotten some of the
(29:00):
names because they're brand names. And I don't I don't
know that I've used them all the time. But yeah,
that's that's a great combination.
Speaker 4 (29:09):
Okay, well, I think I'll try it. And you know,
is there is there a day if I go with
met for form and farsiga, Is there a number that
I don't want to go below.
Speaker 3 (29:25):
Blood sugar number? Yes, we normally want to keep the
level above sixty. Less than sixty, it starts irritating the
nervous system. And that that's the main thing that happens, Leonard,
when your sugar goes low, right because the brain, the
brain cells, their primary energy is sugar. They need You
(29:51):
need to have sugar in your bloodstream because that's what
that's how the brain works. It uses sugar in the brain.
So when your sugar level falls less than sixty, typically
the amount of sugar getting to your brain is significantly
reduced and you can pass out, you can lose consciousness
because of low sugar. We see it all the time
(30:13):
because you know a lot of diabetics out there and
some are in insulin and they're on four or five meds.
They forgot to eat and then that sugar will just
boom go right below sixty. Very rapidly pass out because I.
Speaker 4 (30:28):
Have had that problem in the past. I went out
and I bought some of those sugar pills and now
I carry them. You know, I haven't needed them in
a year.
Speaker 3 (30:38):
And that's the thing about the pharmaceutical world is every normally,
when when they have new medicines on the market, the
medicines are safer and really they have less comf they
have less side effects, easier to use, more effective. So
some of the older diabetes medicines you had that issue,
(31:00):
but the newer stuff is unlikely to cause that low
sugar issue.
Speaker 5 (31:09):
Anything else, Leonyard, if I start with the metaform, and again,
is there a danger sign I should be looking for.
Speaker 4 (31:17):
That I'm over medicated.
Speaker 3 (31:21):
I mean, I think low sugar would be the main thing.
But you know, anything that is possible when you start
combining medicines. You know, all of that. Those irritating symptoms,
you know, nausea, vomiting, headache, weakness, rashes, you know, those
are sort of these mild adverse reaction issues and normally
(31:42):
they're reversible once you stop the medication and go away
in a day or two. All right, Leonard, it's good
to talk to you. Always appreciate your phone call phone
lines or open eight nine six kvy. I want to
hundred three three zero o kov. I'll be back in
two minutes.
Speaker 4 (32:04):
H m hm h.
Speaker 3 (32:17):
M all right, welcome back to talk to me, Matag.
Our phones are open eight nine six kvy. I want
to hnd you three three zero kilov. We have John
from Beaumont. How can we help you?
Speaker 2 (32:32):
Yeah, I have a heart question for you. The uh
they say, I've got a little blockage in my arteries
and what I'm a schedule for a bypass operation? What
is better the bypass? Getting the bypasses are the stints?
And then I understand that you're gonna have to I'm
(32:55):
gonna have to have be on blood thinners. And how
long do you have to be on blood thinners after
a bypass?
Speaker 4 (33:03):
Man?
Speaker 3 (33:03):
John? Those are awesome questions. I guess you studied last night.
But you know, these are questions that come up often,
and the medical community has constant conversations about which is
better stints or bypassed. And there are certain situations that
(33:26):
come up where it's sort of clear or they've decided
for the time being that which one is better for you,
whether bypass or stints, and this is not something I
do every day. The cardiologist and the heart surgeons are
in the position of answering this question every day. But
a couple of things. I do know for a fact
(33:48):
that normally, in terms of bypass, it's better to do
bypass if your main artery what we call the left
main artery, has a significant stenosis, are narrowing from plaque,
and you have diabetes, So you go in with chest
(34:09):
pain you have diabetes, they do the cath and the
main arter which they call the left main if that
is severely narrow ninety nine percent that diabetics do better
with a bypass. You also do better with the bypass
if you have multiple vessels that are severely narrow which
(34:33):
they call three vessel disease, which if you look at
the circulation of the heart, there's three main blood vessels
that sort of feed the heart. So if all those
pathways have severe narrowing when they go in and do
their cath, then they normally recommend bypass. Other than that,
(34:53):
it's sort of up to the cardiologist looking at your
anatomy to decide if bypass or stints are better. Normally,
if it's just one blood vessel. It's not your left
main you're not diabetic, you have some blood vessel, norw
and go go ahead and stint it again, just to
reiterate the Probably the literature may have been updated about
(35:18):
which is better bypassed or stint, But this is my
current understanding of sort of that decision making. Most of
the time, it's, you know, the doctor's experience, whether it
be the cardiologists or the surgeon, it's going to be
their experience that kind of dictates a lot of that stuff.
Even though the official guidelines might say one thing or
(35:39):
the other, it's normally the doctor's experience that tells them
what to do, meaning they sort of have been exposed
to a lot of outcomes a lot of patients in
terms of well, I did this dur in this situation
and this is what happened, or I did something else
and this is what happened. So they remember all that
stuff so that when another page comes along with similar situation,
(36:03):
they know, based on their experience that it's probably better
to do one thing or the other in terms of
bypass versus stinning. And this is a constant conversation between
the two worlds, the cardiologists and the surgeons, right, cardiologists
do the stinting, the surgeons do the bypass. I mean,
(36:23):
obviously they don't want to go in there if they
don't have to. It's a big operation, a lot of risk,
for a lot of things to go wrong. So Norman,
when they pull the trigger, they feel very confident that, hey,
this is going to benefit the patient better than stints.
But the stint world, the technology behind stints, the engineering
the medicines, they're pretty good too, right, And it's getting
(36:47):
to a point where maybe stinning is the best way
to go as well. But again, I don't do this
for a living. In terms of the blood thinners, yes,
after bypass, in my experience, it's normally going to be
an aspirin or one of these other platelet medicines which
(37:07):
we know as plavix are clo pedigrill are the are
two of them. So plavix an aspirin are just asking
by itself or plavix by itself. Again, it's up to
the heart doctor to determine which one is going to
benefit you the best. There's a lot of different factors
that go into that, and normally, if you have bypass,
(37:28):
you're going to have to take some sort of what
we call blood dinner for the rest of your life,
and again up to the heart doctor to decide that
that could change from year to year. It just depends
on you as a patient. How many risk factors you have,
which your anatomy looks like kind of determines that. But
(37:49):
normally asked when our plavix, it's normally when you get
these stints that you need to medicines that you have
to take for at least six months to a year
because that stint is foreign and the body knows that,
and a lot of times it can attack the stint,
and attacking the stint, it causes another blood clot and
(38:13):
when that happens, you get another heart attack. So that's
a big thing in the cardiology world. When you get
a stint, a lot of times they'll tell you, they'll
print it on your chest, they'll give you all this paperwork.
Do not stop these blood thinners unless I tell you to.
Don't let anybody else tell you to stop them either,
because it's so critical because that happens. Sometimes you get
(38:36):
a stint and then two weeks later something happens, you
stop your mads and then you have another heart attack.
Bypass is not like that bypass. Like I say, normally
can have an aspirin or a plavix and you might
have to stop it. It'll be okay for the most part.
But these stints are in your blood vessels. They're foreign.
It's almost like a transplant, right. Your body reacts to it,
(38:59):
and so you need those two blood thinners to prevent
you from forming these clots. And it's only for like
I say, six months a year. They've been trying to
lessen the amount of time you have to take both
these blood thinners because guess what, blood thener's caused you
to bleed. It's a very common scenario that happens every
day in the hospital. You come in with your heart
attack one week and then two weeks later you're in
(39:21):
the hospital for bleeding. We see it every day. So
they're trying to shorten the period where you have to
be on these blood thinners so that your risk of
bleeding is lesser and so you don't come in with bleeding.
So hopefully that helps you out.
Speaker 4 (39:37):
John, that helped a lot.
Speaker 2 (39:39):
I have a lot of sure and appreciate the in
So all.
Speaker 3 (39:43):
Right, bro, they have a good day. We're going on
a second break. Phone ones open eight down six scalovy
I won one hundred three three zero Kovy. I'll be
back in two minutes. All right, welcome back to doctor
(40:11):
Vie and Medical. Our phone lines are open A nine
to six K one one hundred and three three zero
kov I appreciate all the callers, and yes, all these
medical decisions that doctors make every day, dance bypass meds two,
meds one med. You know, it's just what we do
all day long, and we certainly enjoy doing it. And
the medical literature is always changing because sometimes new information
(40:37):
comes out about certain diseases or medicines and maybe they're
doing something else in a different region of the world,
not necessarily the United States, but overseas, and it works
better for our patients. It's easier, it's more effective, except
whatever it is. And that's what I love so much
about the profession, just sort of constant evolvement, changing of
(41:01):
our ideas about how we do things. And even as
I was talking earlier in the show about shared information
with the patient, and that's a big shift in healthcare delivery,
is bringing in the patient to be more involved and
share with the decisions and the understanding of what we're doing.
(41:24):
And I'd certainly have no problem with that amount of
money that the average person spends on their healthcare insurance.
They should be involved and should know what's going on.
You're spending in a large amount of your heart earned money,
and you should know what is going on with your
body and why you're taking medications and what they're for,
(41:45):
and getting your test results and making sure you're getting
your screening tests on time. And as I would started
with the show, there's always a few of those that
pushed through and defy the odds and question whether or
not do I really need to eat vegetables? Do I
(42:07):
really need to do that? Do I really need to
prioritize drinking water? Because I know a guy or girl
that doesn't do that, and they're driving and they have
no they don't take any medicine, they don't go to
the doctor, and they're doing fine. You know, we always
try to find that one person that gives us proof
(42:27):
that all those doctors don't know what they're talking about.
It's all hooplile, they're making it up. I can do
whatever I want, I can eat whatever I want. Well,
if that's the way you want to live your life.
Then certainly it's your choice. And again, doctors are just
there to try and help advise you on the current
understanding of what works and what doesn't work. And it
(42:50):
can change, no question. But based on what I've seen
over the past twenty years talking to patients in the
office in the hospital, man to me, it's clear I
see it every day, just sort of this strong relationship
about what you're eating and drinking and your chances of
(43:11):
becoming ill and again cardiovascal disease. Can's just the two
biggest issues, which in my opinion, are very preventable, but
you certainly have to invest more time into doing that
as you get older and as I mentioned, forty years old,
sort of when the body starts to get into that
(43:33):
auto shutdown mode, right, I talk about that. I use
that term because it's sort of programmed into us when
we're born. The cells stop working, they're not as robust,
they don't heal very well, so it leaves our body
vulnerable for all sorts of ailments to start happening to us.
(43:53):
And again, the things that you're eating influence that dramatically,
Like sugar, we talk about that all the time, as
well as eating processed foods, in my opinion, tend to
generate more disease and illness. So try to eat cleaner
(44:13):
and try to drink more water and stay away from
the sugar every single day. I still have a lot
of my patients consuming sugary beverages every day. And yes,
I do find patients in their sixties seventies drinking sugary
beverages every day. Because a lot of experts are claiming
that Alzheimer's, they're starting to call it a type three
(44:36):
diabetic because they're trying to are there getting to understand
that high sugar are spikes and sugar are detrimental to
your nervous system. It makes sense to me, makes complete
sense to me. And trying to prioritize reducing your exposure
to starches and sugar so that you don't get these
(44:57):
spikes and not doing getting the spikes, you don't flame
your body and then just start injuring your nervous system,
including the brain, and in doing that, less chance of
diabet I'm sorry, dementia, which is the third or fourth
major problem in our country that kills us. So huge
cardiovascular risk factors for dementia, so work on that. Thank
(45:20):
you for joining us on the edition of the show
Don't Drink and drive. Drink some water. We'll see you
guys next week. Take care.
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