April 21, 2026 • 41 mins
- Listen Saturday mornings at 8 as Dr. Msonthi Levine discusses medical issues and takes your calls on News Talk 560 KLVI. Dr Levine is board certified in Internal Medicine and Geriatrics. His office is located at 3080 Milam in Beaumont, Texas. He can be reached at 409-347-3621.
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Speaker 1 (00:00):
All right, Southeast Sex is InteLnet Radio listeners, Welcome to
the edition of the Doctor Levine Medical Hour. I'm your
weekly hosts Arkorlovine, coming to you live from the studios
of KOVI here in Bone, my Texas, taking your phone calls,
helping you answer questions about how to stay alive as
long as possible, be as healthy as possible, limit your
interaction with the healthcare world, and stay at home and
(00:22):
enjoy your life, and limit the number of times you
have to go to the hospital of the doctor's office,
and try and limit the number of meds that you
take right all the medications that are available now, which
some of them are very very good for you and
you need them, but try to limit them as much
as possible. Phone lines are open eight nine to six
k LVII one eight hundred and three to three zero KOVII.
(00:46):
We would love to talk with your two way radio
answer some of your questions so that we can figure
out what works best for you and your family, as
it is truly confusing out there, even for doctors and
healthcare professionals. It's a lot of misinformation, a lot of suggestions,
(01:07):
recommendations flying around all the time. Which one do I believe,
which one don't I believe. Yeah, it can get pretty intense.
But certainly the one thing that I want to emphasize
is you have to do the basics correctly. And if
you listen to my show, you understand some of that.
(01:29):
I mentioned that typically as frequently as possible, just because
it needs to be understood that you got to know, eat, write,
and stay physically active, and that cannot be fixed or
replaced by taking some simple over the counter dietary supplement
(01:53):
once a day, twice to day, whatever the case may be.
You still have to do your part, and it's more
so as you get old. When you're younger, you can
get away a little bit with that, but you have
to do your part, no question. And one thing that
we've talked about over the years and that we promote
on the show is just what we call knowing your numbers.
(02:14):
And it's getting easy and easier to monitor how your
body is functioning in terms of your blood pressure or
your heart rate, are how fast your heart is beating
or if it's beating irregularly, And it also goes with
(02:35):
your sugar. They have now these what they call CGM
sensors continuous glucose monitors sensors that allow you to check
your blood sugars as frequently as possible. I want to say,
because you wear a censor there in your arm and
it communicates with your phone. Most everyone has a smartphone.
(02:59):
Now that simple technology allows this device to communicate with
another device so that you can see real time what
your sugar is doing. And the studies so far involving
this CGM device indicate that the knowledge of knowing what
(03:22):
your blood sugar is as it pertains to its relationship
to certain food items really really helps you control your
blood sugar. Just knowing what your blood sugar is when
you eat this or drink that allows you to be
smarter obviously, right, that makes sense about what's good for you,
(03:43):
what's not so good for you, And just seeing that
sugar spike with certain food items reminds you that maybe
this is not the one for you. Remember that everyone's
system is different, so two diabetics could maybe tolerate different
and food items, and knowing that with the CGM is
(04:05):
one way to do that. I think there are a
few different companies out there that have CGM and insurance companies.
Our most insurance companies are stepping on board with paying
for the CGM so that you can use yours to
monitor your sugar. And the technology has gotten better such
(04:25):
that there's pretty simple introductory to wearing it and exchanging it.
And I think adhesiveness on a lot of these cgms
is better because that was one big complaint when they
first hit the markets that they fall off a lot
or they get bumped off. Obviously it's man made, right,
(04:47):
so there's always potential for the device to not function
as well as possible with your phone. You know, our
computers can be in terms of them talking to each other.
But again they've been working on this year after years,
because they've been off about four or five years and
maybe a little bit longer, and it's getting easy and easier.
There's tons of videos and how to set up these devices.
(05:12):
So if you do have diabetes one are two, you
should entertain getting one of these devices. I mean, in
my experience working with my patients, it really does allow
them to smarten up in terms of what works and
what does in terms of eating and drinking, so that
they can go through their process of elimination in terms
(05:34):
of foods and beverages that spike their sugar. So It's
a great idea, and certainly if you have diabetes, it's
one that you want to try and get on. Another
new development with the management diabetes is certainly these injectibles
that work very well to help you control your appetite
(05:55):
throughout the day, so that food noise that is with
us all the time does not get to the best
of you, and you won't find yourself going to the
refrigerator or the cabinets or the pantry sort of getting
all these comfort foods and these snack foods just to
(06:17):
eat something to put in your mouth. It's the food
noise is so loud, so you can very comfortably go
throughout the day without eating solid food. Certainly want you
to stay hydrated, and that's something else you have to
be careful with because of all of the sugary beverages
and bottled beverages that we have out there, a lot
(06:41):
of times they contain calories and that can sometimes defeat
the purpose of what you're trying to accomplish in terms
of weight loss, So you have to try and prioritize
beverages with no calories. I think the thing that I
typically promote is water, coffee, tea, and there's a lot
(07:02):
of flavored teas, flavored coffees, and you can also learn
how to flavor your water without adding calories to the mixture,
because a lot of times, even with a surgery like
a gastric bypass or a gastric sleeve, a patient sometimes
(07:23):
will struggle with their weight because they are consuming their
calories in a liquid form. Right, there's a lot of
liquid beverages out there with a lot of calories, and
you've seen maybe some commercials for these beverages. These are
like Insureance Boost when these are really designed for patients
(07:43):
who have, for whatever reasons, severe limitations with their food consumption,
beverage consumption. Maybe they have severe anorexia, meaning they just
don't want to eat. We get in to these issues
a lot when you get metabolic disease, is cancers, sometimes dementia,
sometimes adverse traction medications. It really robs you of your
(08:08):
desire to eat and so again you start losing a
significant amount of weight. But with that comes to nutritional
deficiencies that can really impact the way your body functions.
And so these supplemental typically moderate a high calorie liquid
beverages Boost and Sure have come out on the market
(08:29):
been out for many years, and it's really designed for
that population, not really designed for general consumption. At least,
I don't have a lot of patients that just drink
it just to drink it, although I'm sure they're beople
out there do that. But again, other than solid food,
you have to be aware that you can drink a
(08:50):
lot of your calories, and we do see that a lot,
and patients decide to be better at their diet, they
sort of eliminate or get rid of all of the
foods that can generate obesity, But then they're still drinking
things like juice or gatorade. That's another big one. I
grew up drinking that as well, great beverage, but again,
(09:13):
most gatorades just have too much sugar in them for
daily consumption. You really have to limit that. And all
of the other sports beverages out there, all of the
energy beverages out there, Again, a lot of times you
have to be aware of the ingredients. Most of the
time they contain caffeine or sugar or other irritating substances.
(09:36):
So a lot of times, yeah, it's not considered a
healthy beverage, and so it falls back on this water
coffee tea trio. But yes, it's boring mixed in with
all these other exciting beverages with the packaging that they
have and the story that you see on TV or
your phone in terms of if you drink this, this
(09:57):
is what should happen to you. Look at what all
these other people are doing with this beverage. Don't you
want to be like that too?
Speaker 2 (10:03):
Right?
Speaker 1 (10:04):
I remember the when I was growing up that Michael
Jordan was more popular. That was a be like Mike campaign.
I can't remember what they were drinking. Maybe it was
gator and I can't remember that, but anyway, that was
sort of the idea. And that's how marketing is in general.
It's just sort of if you eat this substance, drink
(10:25):
this substance, then you're going to be more like this
person that you see on TV. But everyone is different.
You have to be careful about those beverages and consuming that.
So the continuous glul cos monitor does allow you to
very freely decide and determine what is good for your systems.
(10:47):
So if you don't have one, certainly go out and
talk with the healthcare provider about getting one of those decks.
Com D ExCom is one version of that. We had
the Freestyle lead v Bray is another version of that.
I think those are the two most popular. I think
there might be another company out there that has the CGM.
(11:08):
Doesn't matter which one you get, but certainly get one
of them and start taking that and see what works
for you and what doesn't. Phone lines are open eight
nine to six kV I won one hundred three three
zero kov I. We'll be back in two minutes. All right,
(11:30):
welcome back to Dography Medical. Our phone lines are open.
Eight nine to six kV I won one hundred and
three to three zero kov I. Talking about CGM glucose
continuous glucose monitors sort of the new thing to do
if you have diabetes are if you just curious about
your blood sugar and what it does. These advices are
out there on the market. It's getting easier to know
(11:52):
your numbers. One other option that has been becoming more
and more popular or is the bill to you to
check your heart rate and see if your heart is
bouncing around, if it's irregular or not. With these watches
as well as with phones that allow you to sort
of check your pulse. And I want to say that
(12:14):
there's some watches coming out that can also check your
blood pressure. I think that would be just totally awesome. Again,
sort of unintrusive. You're just sort of wearing these devices
and they're sort of keeping up with what the human
body is doing. More so as you get older again,
because as you get older, unfortunately, aging process kicks in
(12:36):
and the body just becomes more chaotic and more likely
to break down. Just like any other machine that you have, right,
the older the machine, the more likely it is to
break down. The human body is no different. So these
are some strategies that you can implement to try and
stay on top of if something is happening with your
(12:56):
body breaking down. Measuring your heart rate, measuring your polls,
measuring your blood pressure. That you have to do it
multiple times a day, but periodically, just to see what's
going on, so you can try and stay on top
of things. Because certain conditions like atre fibillation, which is
(13:17):
this irregular, chaotic heartbeat that we see a lot of
every day in the hospital as well as the office,
the biggest risk factor for the development of ature fibrillation
is getting older, just getting older by itself, and again
we have to respect the aging process because it is
an active, real process, and no, patients don't like hearing that,
(13:40):
but it truly is. Your body is changing as you
get older, no question, and making you more vulnerable to
disease and illness. I mean, there's just a thousand ways
or a thousand things that can happen, and they will
a lot of times. Working in the hospital as I do,
I have this conversation all the time. Patients want to
(14:02):
know what happened, like what did I do? How did
I cause this? Or how do I prevent this in
the future. And again a lot of times there is
really no it just the fact that I'm sorry, but
you know, you're eighty four, and at eighty four, these
are the things that tend to start happening just naturally,
just because the body is eighty four years old. It's
(14:23):
older than someone who's in their twenties, and we have
to kind of respect that process that's in the background.
And so a lot of metabolic and cardiovascular derangements start
to happen, such as atrial fibrillation, which I think if
you're in your sixties seventies, you've probably heard of it,
just because it's so common. A lot of your friends,
(14:44):
family have had an episode, maybe they've been hospitalized for it.
They now have some cardiac procedures that are available for
atrial fibrillation to cure the atrial fibrillation so that you
don't have to take a lot of medications. There's also
another procedure called a watchman watch Watchman device that's basically
(15:11):
a device that's put actually in the heart to prevent
clots that form when you're having hrifibrillation, because the chaoticness
of the heartbeat tends to cause turbulent blood flow. And
when the blood is turbulent and tends to form blood
clots little pebbles of blood boulders or blood rocks, if
(15:32):
you will, that can then be ejected from the heart
and travel in the vascular highway until it finds a
resting point. And when it does find a resting point,
it blocks blood from flowing forward wherever the resting point is.
A lot of times it happens in the brain. That
is what causes a stroke and roma. These strokes are
(15:55):
pretty big. We call these schemic strokes where there's no
old blood flow or lack of blood flow. That's what
we call a schemia. That's a term we use that's normally.
The ideology of all heart attacks is there's a boulder
of blood that develops in a blood vessel that feeds
the heart, and so the heart muscle cannot get blood flow,
(16:17):
and so there's an a schemic episode and the muscle
starts to die in terms of a heart attack, and
the brain, the brain cells start to die, and because
of that, you start developing symptoms from brain death if
you will, And normally you get some characteristic symptoms like
(16:38):
loss of vision or change in vision, maybe some numbness
and tingling of your hands and legs, can't walk, can't talk,
that sometimes a decreased level of consciousness because these strokes
tend to be pretty big, with these atrial fibrillation induced strokes,
because a lot of times facians don't know they have
(17:00):
fibrillation because sometimes, h your fibrillation is silent. It's quiet,
meaning you have it and you don't know, which is
why these monitoring devices are so cool. I mean, I
think it's just something we should start promoting for patients
sixty five and above because the risk starts to climb
exponentially that you know, you just need to get yourself
(17:22):
a blood pressure monitor, maybe ACGM monitor. Certainly if it
involves just wearing a watch, that will be fine, or
interacting with the smartphone. I always love to see my
elderly patients interacting with smartphones because sometimes that can be challenging,
as memory loss and comprehension and just processing new information
(17:45):
can be a stretch when you get older, as the
brain starts to shrink, as the connection start to become
a little bit more chaotic and not as strong, and
the ability for the brain to utilize new information start
to client device like a smartphone can be kind of
challenging for most ely patients. But as far as I know,
(18:07):
these apps that involve the phone and checking your heart
right and your pulse are pretty straightforward, and most ely
patients have family members that a little bit more savvy
with the use of these devices in these phones and
can assist them with managing working with these phones and
working with these apps, which again can be very informative
(18:30):
and very useful to help you monitor your system so
that you can find out yourself or discover yourself if
you have at your fibillation, because a lot of times,
as we know, it kind of kicks off and it
becomes what we call paroxysmal. It kind of comes and goes,
comes and goes, comes and goes, and then it can
(18:51):
sometimes turn into a chronic thing. And that's a lot.
I pick up a lot of atre fibrillation there in
the office just listening to patients. Hearts are even doing
ekg's and they feel fine, there's nothing wrong. Maybe they're
just there for checkup, and boom, we find it just
like that. But wearing these wristbands and getting these apps
(19:14):
for you if you're sixty five and above, having someone
check you out so that they can help you manage
that can allow us to detect these cardiac irregularities sooner
rather than later, just like with breast I'm sorry. With
cancer screening, we don't screen for all cancers, but certainly
it's a part of your healthcare provider's position. When you
(19:39):
go in for your routine visit, whether it be a
nurse practitioner or a medical doctor, you should you should
be figuring out what screening tests you need to try
and stay up on that and turn particular cancer screening. Again,
we don't do all cancers, but do a few of them,
(20:00):
the high yield ones like breast cancer, colon prostate. We're
into lung cancer screening as well for high risk individuals.
Those are individuals who've smoked for an extensive period of time,
typically twenty thirty years of smoking a pack of cigarettes
(20:21):
once a day that puts them that increased risk. I'll
be honest with you, I've sort of lowered my threshold
a lot, just because you know, that's sort of a
target audience. But certainly there's probably some patients who maybe
didn't smoke that many cigarettes today, maybe they smoked a
half a pack a day, but they're still at risk
for getting these this cancer just because they're exposure to tobacco.
(20:45):
And so lung cancer screening has become a part of
my routine and a part of a lot of doctor's routines,
again trying to discover these cancers in more of a
stage one just because the outcomes are typically a lot
better the the cancer volume, the cancer exposure is normally lowers,
so that the treatment plan is really not as toxic,
(21:07):
not as harsh, doesn't cause as much damage during the
treatment phase, which again the treatment of most cancers has
become more tolerable for most patients, meaning they can a
lot of times resume going back to work, or if
they have to be out, maybe it's for a short
period of time. Doesn't cause a lot of collateral issues
(21:29):
in terms of harming other healthy tissue beds and other
tissue areas. Like some of the old chemotherapy agents used
to do things have gotten a lot cleaner and the
treatment plan is more effective, so that again, staying up
with your cancer screenings is very important. You go into
(21:50):
your doctor's office. For us, we have a little sheet
there in the rooms where patients are sitting. They can
kind of review the sheet and see if they need
to order any of these tests. Because with all, even
though everyone has the best intentions, just so many things
get in the way of setting up these screening tests, right.
The scheduling of these screening tests can be a problem.
(22:13):
Just you know, we talk about it, you agree to it,
we schedule it, we send a referral, and then something happens,
right either on your end or the wherever the referral
is going, something happens, and then a year goes by
and you've not had your test. So it is some
sort of shared decision or share responsibility to go in
talk to your healthcare provider about where you're at with
(22:36):
your cancer screening, so that you can be sure and
stay up on this. And then like I said, yes,
if you have diabetes, get your CGM, and then yeah,
if you're sixty five and above, Really I would really
promote getting one of these smart watches or getting an
app on your phone and starting to check your pulse,
your blood pressure and just how regular or irregular or
(22:57):
hardest beating so that you can get your healthcare provider
and follow up on that. As if you do follow
up with the heart doctor. They're getting more and more
monitoring equipment where you just sort of wear device and
it's communicating with some other location and if something abnormal
is being found, they're alerting the cardiologists, they're alerting the
(23:19):
provider that's responsible for you. Maybe have to be hospitalized,
maybe have to can change your medicine, come into a visit. Again.
Just trying to be as preventive as possible is the
way we're going so that we can keep you out
of the hospital and just stay up there, just stay
up with your disease process anyway. Phone lines are open
eight nine to six Kalvy one one hundred three three
(23:41):
zero Kalvy I'll be back in two minutes. All right,
welcome back to Doctably Medical. Our phone lines are open
eight nine six kylvy I one one hundred three three
(24:02):
zero kilva. Talking about monitoring yourself and how that's normally
a good idea to help your health care provider out.
You know, a lot can happen in between doctor visits. Yes,
you have been to your doctor or your health care
provider every four or five months, and at the time
you go in, everything looks good, your lap work looks good,
(24:24):
your blood pressure looks good, and hey, you're great, You're happy.
But hey, a lot of things can happen in between visits.
I mean, how many times do you hear, Yeah, I
just went to my doctor two weeks ago, and now
I'm in the hospital. You know, it's not a guarantee
of success, but certainly we encourage patients to go in,
especially the more medical problems. You have to go and
(24:44):
just kind of get a little check up, look over
your labs, look over your meds, just do some vital
signs and sort of review kind of where you are
in terms of your cancer screening and all of your
other screening and if anything, other tests need to be
done between your net visit. But we do have a
lot of patients that really have no medical issues. They
may go to the doctor once a year, which is fine.
(25:07):
But again, because there's now all of these monitoring devices
out there, we do encourage patients to engage and get
one of these devices to help monitor yourself. One thing
that has changed recently the new guidelines have come out
with cholesterol management. We talk about cholesterol a little bit
because it is a big risk factor for cardiovascal disease,
(25:28):
for the plaque formation in your blood vessels. And just
since I've been a physician for over twenty years, the
targets of cholesterol levels for each patient or individual patients
has just gotten more strict, tighter, and they want the
levels to be lower and lower and lower. I guess
(25:51):
the latest research does indicate that keeping the cholesterol controlled,
and especially what we call high risk patients. These are
patients maybe we've already had a cardiovascal event or they
have a lot of risk factors for cardiovascular events. They
want the cholesterol levels to be even lower, even the
(26:13):
what they call LDL that's the bad cholesterol, right. You
hear about that all the time, to be less than
fifty five. It used to be less than one hundred,
and it was seventy, and then now it's fifty five.
So they want the LDL cholesterol to be even lower.
And these are really for high risk patients, not the
average person, but certainly the more risk factors you have,
(26:34):
they just want that thing low and low and lower.
These are the latest skylines came out of maybe a
month ago. You can talk to your healthcare provider about
your level of risk and where you are and what
sort of medicines you need to be on. And certainly,
in my experience what that means for a lot of
(26:55):
patients is unfortunately they might have to be on two
medics for cholesterol. Remember that your number of medications can
get a little bit busy depending on the medical problems
you have, because there's multiple medicines for one disease such
as hypertension, diabetes, and now cholesterol. And when I came out,
(27:18):
there were maybe one or two medications for cholesterol. We
had the old niosin which you know, caused a lot
of flushing problems, so you really couldn't escalate the dose
just because you could never get over that issue of
the flushing issue with the Niosin and niaspan, and we
tried all sorts of strategies and it just wasn't that effective,
(27:42):
to be honest with you, very dirty drug, but it's
all we had. Statins were on the market, like the
zokore lipitorre provostat, and they were on the market at
that time. They were kind of brand new and a
torvostat and kind of hit the scene when I was
in when I was in medical residency and when I
(28:03):
first became a physician, torvest stat and was just hitting
the scene. Lipitour For all the others that don't know
who a torvistat is. It's now sort of a common
name in most households, such as also Crest Store and receuvistatin.
But these medicines sort of issued a new era of
cholesterol management because there were once a day drugs. They
(28:25):
for the most part very strong and help us control
the cholesterol and keep it down, but they normally had
limitations in their strength. Right if we could do the
maximum dose of the medication, and just wasn't getting that
cholesterol down to where we wanted to get it down to.
(28:46):
And we were still sort of struggling to get the
cholesterol managed the way we want to, even though they
were on the medicines that were chosen for them, and
statins have had their issues with drug drug interactions as
well as advert reaction. If you've ever taken the drug before,
you know sometimes you can have a bump in your
liver function test. You sometimes get some muscle injury, or
(29:10):
you feel fatigued, you feel achy, tired, and a host
of other physical symptoms that happens with these statins and
cholesterol medications. The big concern initially was it's irritation on
the liver, and I remember when they first hit the scene,
doctors were being asked to check the liver function every
three to four months while we started the cholesterol medication
(29:33):
such as the statin category like zok core lipatre at
least for a year to make sure that it wasn't
irritating the liver. And then as we started using these
drugs more and more, we realize it's pretty safe, it's
not really causing a lot of liver issues, and we
kind of relax those recommendations, although I still see in
some patients that it does irritate their liver and we
(29:56):
have to stop the medication. Maybe reduce it, maybe tried
every other day, every three days, things like that. Even
with the muscle eggs and the fatigue issues that can
come along with statins, we still see that as well.
These are normally reversible issues. These are not life threatening issues,
very irritating issues that normally go away once you stop
(30:18):
the medication. But now we have a few other classes
of cholesterol medicines that in combination typically will allow us
to get that cholesterol level down if you are a
high risk patient to a fifty five on your LDL again,
which is considered the bad cholesterol because it's sometimes hard
(30:39):
to do with one product alone, like the statin. For
I would say maybe forty percent of patients, the statin
alone will be enough, But if you're a high risk
patient trying to get down fifty five, you're going to
need two or even three cholesterol medications to do that. Now,
one category of medicines that has become very was these
(31:00):
PCSK nine inhibitors, you know them as REPATHA. It's a
injection that you take every two weeks. This stuff is strong,
it's effective, and man, it slams that LDL down. And
in my opinion, if you can get your hands on
that REPATHA and you get and take the stat and
(31:21):
you'll be done. That LDL will be flat almost be zero.
We have Darwin from Orange.
Speaker 2 (31:27):
How can we help you, Yes, sir doctor Levine, I
was wondering if you could discuss this peel Liscentaprio. My
doctor put me on it. And here's an example. I
was at Walmart and when I started taking these peels.
Here a couple of weeks ago, I was in Walmart
(31:48):
and it seemed like my eyes had actually like when
you have them dilated. And I thought, I said, you know,
I don't think this is good for me. So I
got myself off of it, and I did call them,
but could you please discuss that listener prill And now
(32:08):
I'm going to hang up and listen.
Speaker 1 (32:10):
All right, Darwin, We appreciate that. Brother. Las Centyprill is
a blood pressure medicine that belongs to a very common
category of blood pressure medicines called ace inhibitors ACE, and
they have been around for ages. Ever since I've been
in the medical world. ACE inhibitors have been involved with
(32:33):
being prescribed by a lot of doctors for the management
of hypertension. They're also used for the management of a
condition called heart failure as well as chronic kidney disease,
primarily for diabetic patients, and these are very popular drugs.
ACE inhibitors and ACE inhibitors is just a receptor in
(32:58):
the cardiovascular system, the ACE receptor, and this ACE inhibitor
blocks that receptor and in doing so it helps manage
blood pressure. And there's a lot of ACE receptors, they're
in the human body, and these medications work very well
to help manage these cardiovascular issues. And the good thing
(33:21):
about ACE and hitters right now is that they are
generic and they're normally very inexpensive. We talk about four
or five dollars for a whole month, so very very
popular drugs. But again with any drug, they have their
adverse reaction issues. And the adverse reaction issues that I
(33:42):
see a lot of times a couple, it's two main ones.
Anything can happen, right as this color mentioned, some change
in vision, some blurry vision, that could be your adverse reaction.
Anything is possible. When you get to the pharmacis you
get that long book of possible adverse reaction? Does everybody
to read that note? But the two that I see
(34:03):
one is a chronic cough when you start taking the drug,
and it could even happen a year after being on
the last center PRO. You just get this little naggy
cough that bothers you all day long, and people look
at you funny. Now because we're post COVID, they want
to know if you're gonna infect them or not. So
this chronic, little naggy cough happens. And also you can
(34:26):
get this episode of swelling of your lip or your tongue.
We call that angioedema. These are the two adverse reactions
that I see all the time that I don't really
like to see that, and a lot of times that's
one reason that I don't like to prescribe the ACE inhibitors.
So I personally, as a physician, don't prescribe ACE inhibitors
(34:49):
anymore just because of those two nasty little side effects.
And I just didn't find it to be a very
strong medication again in my use of the medicaid, even
though most healthcare providers are taught to utilize these medications
just because they are effective, most of them once a day,
and the medical literature does support their use in terms
(35:11):
of it helping control hypertension, helping it to control or
manage heart failure as well as helping to control chronic
kidney disease. Now, newer drugs have hit the market, which
is why ACE inhibitives have sort of been left in
the dust, to be honest with you, But they still
are popular because they're cheap, they work, they're once a day,
(35:34):
a lot of healthcare providers are familiar with them, They're
readily available, and so there are some advantages to being
placed on an ACE inhibitor. But another class of medication
called ARBs arb angiotensen receptor blockers is what I use primarily.
You know them as low sartan or all me sartan
(35:55):
or ben a car. Those medications I primarily use myself personally,
and they have less risk of the angioedema or swelling
episode and typically do not cause cough, and typically are
stronger medications as far as I'm concerned based on my experience,
So I don't really have any of my patients on that.
(36:19):
If they come to me on the ac nimbert, I
don't necessarily change it. I'll leave them on, especially if
they're tolerating it. But if anything happens a blurry vision
episode like that, happened to you, then I'll just quickly
get them off of it and go a different direction
with an ARB or angiotenson receptor blocker, which again they
(36:39):
they've been out for a longer time as well, and
they normally are inexpensive once a day, very very strong,
very very effective, and so I normally go with those
versus an ACE inhibitor. But don't feel like the ACE
nimber is a bad thing for you. It's a good drug.
But you just always have to be on the lookout
and the patient did the right thing. If you take
any prescribed medication and you take it and something physically
(37:02):
happens to you, certainly by all means you can discontinue
the drug, but you need to get back with your
healthcare provider, let them know about it, or seek medical
attention the same day, just so that they are aware
and see if they can change you to something else,
because if you stop your medicine for a medical disease
that you have, you normally need to replace it with
(37:22):
something else. So you've got to have your provide involved.
Phone lines are opening on six Kalvy. I want to
hundred three three zero kov. I'll be back on my
last break. All right, welcome back to Doclam Medical Hour.
Phone lines are opening on six KLV. I want to
hundred three three zero ko v I at the end
(37:43):
of the show. Remember if there's a topic you'd like
me to talk about, as inhibitors, medications, procedures, et cetera,
give the office a call three four seven three sixty
two one. That's URYO code four oh nine. Or you
can call the radio station. Leave that message with him
and we'll discuss that top. Just to clarify with the
ACE inhibitors, haven't used that those medications in a while.
(38:07):
They basically are medications that reduce hormonal production of a
medicine called angio tensin, which causes constriction of the blood vessels.
That's sort of how it works. It's a what they
call angio Tenson receptor blocker. That's the ARB. The ACE
inhibitor is one that prevents a hormone from being produced
(38:31):
in your blood system. ACE inhibitor angiotensen converting enzyme inhibitor.
That's where they get the name ACE ACE. So I
just wanted to clarify that it's more of a hormone
blocker versus a receptor blocker. But in essence, Yeah, it's
preventing receptors from interacting with certain hormones. But nonetheless it's
(38:53):
a good drug, and if your doctor prescribes it to
your health care provider prescribes it to you, certainly take
the drug if that's what they recommend for you. I'm
just not a big fan of ACE inhibitors because of
my experience with as nimbers. I love the ARBs ANGI
tensor receptor blockers, you know them as all me sartan
or benacar a. Those sartan prescribed in a lot of
(39:14):
combination medicines with diuretics and the hydrochlorothisi. It's a very
very common, popular category of blood pressure medicines. But no
matter what you're prescribed, there's potential for adverse reaction by
whomever prescribes it, so you always have to be on
the lookout for that, and they we have tried to
involve patients and educating them on this to always been
(39:36):
a lookout for that. And if you are taking prescription trucks,
just try to monitor your blood periodically every four months,
six months, that sort of thing. Make sure you're tolerating
the drug. Okay, Sometimes these as hibbits. RBS can cause
things like high potassium levels if you do have some
kidney dysfunction, so you always have to check on that.
(40:00):
And then, as I've mentioned throughout the show, if you
are sixty five and above, I'm really really working with
patients in that category. I really really encourage patients to
start monitoring themselves just because a lot of chaos starts
to get generated as you get older, and it's getting
easier to do that with all the smart watches and
the phones. If you have a mother or father and
(40:23):
you're trying to figure out what's a good gift for them,
maybe their birthday is coming up, celebrations come up. These
are great devices that you can give your elderly parents
to help them monitor themselves. A lot of times you
can do it yourself. Maybe you can get a message
if something happens. This also goes with these METI alert
buttons that go around their neck or their wrists. Having
(40:47):
those those are great, great options. A lot of them
monitoring equipment out there very inexpensive where you can have
this and monitor your elderly patients. So a lot of
good options out there to kind of help your health
providers do on top of things, especially if you have
a lot of medications and you have a lot of
cardiovascal disease, monitoring yourself in between visits can be very
(41:09):
helpful and also try and prevent you from having to
be hospitalized for acute medical crisis, which a lot of
times because as you get older, you're not as strong.
When a crisis happened, sometimes it can be a little
overwhelming to the human body and it's sometimes difficult to
get out of the hospital. So we want to try
(41:31):
and prevent as much as possible. That includes eating a
healthy diet, staying away from those sugary beverages, those lovely
sugary beverages, and getting a little exercise right walking around
the block or just walking on a trip mail anyway,
thank you for joining for the edition of this show.
Remember don't drink or drive, eat some vegetables, and we'll
(41:53):
see you guys next week. Take care,
All right, Southeast Sex is InteLnet Radio listeners, Welcome to
the edition of the Doctor Levine Medical Hour. I'm your
weekly hosts Arkorlovine, coming to you live from the studios
of KOVI here in Bone, my Texas, taking your phone calls,
helping you answer questions about how to stay alive as
long as possible, be as healthy as possible, limit your
interaction with the healthcare world, and stay at home and
(00:22):
enjoy your life, and limit the number of times you
have to go to the hospital of the doctor's office,
and try and limit the number of meds that you
take right all the medications that are available now, which
some of them are very very good for you and
you need them, but try to limit them as much
as possible. Phone lines are open eight nine to six
k LVII one eight hundred and three to three zero KOVII.
(00:46):
We would love to talk with your two way radio
answer some of your questions so that we can figure
out what works best for you and your family, as
it is truly confusing out there, even for doctors and
healthcare professionals. It's a lot of misinformation, a lot of suggestions,
(01:07):
recommendations flying around all the time. Which one do I believe,
which one don't I believe. Yeah, it can get pretty intense.
But certainly the one thing that I want to emphasize
is you have to do the basics correctly. And if
you listen to my show, you understand some of that.
(01:29):
I mentioned that typically as frequently as possible, just because
it needs to be understood that you got to know, eat, write,
and stay physically active, and that cannot be fixed or
replaced by taking some simple over the counter dietary supplement
(01:53):
once a day, twice to day, whatever the case may be.
You still have to do your part, and it's more
so as you get old. When you're younger, you can
get away a little bit with that, but you have
to do your part, no question. And one thing that
we've talked about over the years and that we promote
on the show is just what we call knowing your numbers.
(02:14):
And it's getting easy and easier to monitor how your
body is functioning in terms of your blood pressure or
your heart rate, are how fast your heart is beating
or if it's beating irregularly, And it also goes with
(02:35):
your sugar. They have now these what they call CGM
sensors continuous glucose monitors sensors that allow you to check
your blood sugars as frequently as possible. I want to say,
because you wear a censor there in your arm and
it communicates with your phone. Most everyone has a smartphone.
(02:59):
Now that simple technology allows this device to communicate with
another device so that you can see real time what
your sugar is doing. And the studies so far involving
this CGM device indicate that the knowledge of knowing what
(03:22):
your blood sugar is as it pertains to its relationship
to certain food items really really helps you control your
blood sugar. Just knowing what your blood sugar is when
you eat this or drink that allows you to be
smarter obviously, right, that makes sense about what's good for you,
(03:43):
what's not so good for you, And just seeing that
sugar spike with certain food items reminds you that maybe
this is not the one for you. Remember that everyone's
system is different, so two diabetics could maybe tolerate different
and food items, and knowing that with the CGM is
(04:05):
one way to do that. I think there are a
few different companies out there that have CGM and insurance companies.
Our most insurance companies are stepping on board with paying
for the CGM so that you can use yours to
monitor your sugar. And the technology has gotten better such
(04:25):
that there's pretty simple introductory to wearing it and exchanging it.
And I think adhesiveness on a lot of these cgms
is better because that was one big complaint when they
first hit the markets that they fall off a lot
or they get bumped off. Obviously it's man made, right,
(04:47):
so there's always potential for the device to not function
as well as possible with your phone. You know, our
computers can be in terms of them talking to each other.
But again they've been working on this year after years,
because they've been off about four or five years and
maybe a little bit longer, and it's getting easy and easier.
There's tons of videos and how to set up these devices.
(05:12):
So if you do have diabetes one are two, you
should entertain getting one of these devices. I mean, in
my experience working with my patients, it really does allow
them to smarten up in terms of what works and
what does in terms of eating and drinking, so that
they can go through their process of elimination in terms
(05:34):
of foods and beverages that spike their sugar. So It's
a great idea, and certainly if you have diabetes, it's
one that you want to try and get on. Another
new development with the management diabetes is certainly these injectibles
that work very well to help you control your appetite
(05:55):
throughout the day, so that food noise that is with
us all the time does not get to the best
of you, and you won't find yourself going to the
refrigerator or the cabinets or the pantry sort of getting
all these comfort foods and these snack foods just to
(06:17):
eat something to put in your mouth. It's the food
noise is so loud, so you can very comfortably go
throughout the day without eating solid food. Certainly want you
to stay hydrated, and that's something else you have to
be careful with because of all of the sugary beverages
and bottled beverages that we have out there, a lot
(06:41):
of times they contain calories and that can sometimes defeat
the purpose of what you're trying to accomplish in terms
of weight loss, So you have to try and prioritize
beverages with no calories. I think the thing that I
typically promote is water, coffee, tea, and there's a lot
(07:02):
of flavored teas, flavored coffees, and you can also learn
how to flavor your water without adding calories to the mixture,
because a lot of times, even with a surgery like
a gastric bypass or a gastric sleeve, a patient sometimes
(07:23):
will struggle with their weight because they are consuming their
calories in a liquid form. Right, there's a lot of
liquid beverages out there with a lot of calories, and
you've seen maybe some commercials for these beverages. These are
like Insureance Boost when these are really designed for patients
(07:43):
who have, for whatever reasons, severe limitations with their food consumption,
beverage consumption. Maybe they have severe anorexia, meaning they just
don't want to eat. We get in to these issues
a lot when you get metabolic disease, is cancers, sometimes dementia,
sometimes adverse traction medications. It really robs you of your
(08:08):
desire to eat and so again you start losing a
significant amount of weight. But with that comes to nutritional
deficiencies that can really impact the way your body functions.
And so these supplemental typically moderate a high calorie liquid
beverages Boost and Sure have come out on the market
(08:29):
been out for many years, and it's really designed for
that population, not really designed for general consumption. At least,
I don't have a lot of patients that just drink
it just to drink it, although I'm sure they're beople
out there do that. But again, other than solid food,
you have to be aware that you can drink a
(08:50):
lot of your calories, and we do see that a lot,
and patients decide to be better at their diet, they
sort of eliminate or get rid of all of the
foods that can generate obesity, But then they're still drinking
things like juice or gatorade. That's another big one. I
grew up drinking that as well, great beverage, but again,
(09:13):
most gatorades just have too much sugar in them for
daily consumption. You really have to limit that. And all
of the other sports beverages out there, all of the
energy beverages out there, Again, a lot of times you
have to be aware of the ingredients. Most of the
time they contain caffeine or sugar or other irritating substances.
(09:36):
So a lot of times, yeah, it's not considered a
healthy beverage, and so it falls back on this water
coffee tea trio. But yes, it's boring mixed in with
all these other exciting beverages with the packaging that they
have and the story that you see on TV or
your phone in terms of if you drink this, this
(09:57):
is what should happen to you. Look at what all
these other people are doing with this beverage. Don't you
want to be like that too?
Speaker 2 (10:03):
Right?
Speaker 1 (10:04):
I remember the when I was growing up that Michael
Jordan was more popular. That was a be like Mike campaign.
I can't remember what they were drinking. Maybe it was
gator and I can't remember that, but anyway, that was
sort of the idea. And that's how marketing is in general.
It's just sort of if you eat this substance, drink
(10:25):
this substance, then you're going to be more like this
person that you see on TV. But everyone is different.
You have to be careful about those beverages and consuming that.
So the continuous glul cos monitor does allow you to
very freely decide and determine what is good for your systems.
(10:47):
So if you don't have one, certainly go out and
talk with the healthcare provider about getting one of those decks.
Com D ExCom is one version of that. We had
the Freestyle lead v Bray is another version of that.
I think those are the two most popular. I think
there might be another company out there that has the CGM.
(11:08):
Doesn't matter which one you get, but certainly get one
of them and start taking that and see what works
for you and what doesn't. Phone lines are open eight
nine to six kV I won one hundred three three
zero kov I. We'll be back in two minutes. All right,
(11:30):
welcome back to Dography Medical. Our phone lines are open.
Eight nine to six kV I won one hundred and
three to three zero kov I. Talking about CGM glucose
continuous glucose monitors sort of the new thing to do
if you have diabetes are if you just curious about
your blood sugar and what it does. These advices are
out there on the market. It's getting easier to know
(11:52):
your numbers. One other option that has been becoming more
and more popular or is the bill to you to
check your heart rate and see if your heart is
bouncing around, if it's irregular or not. With these watches
as well as with phones that allow you to sort
of check your pulse. And I want to say that
(12:14):
there's some watches coming out that can also check your
blood pressure. I think that would be just totally awesome. Again,
sort of unintrusive. You're just sort of wearing these devices
and they're sort of keeping up with what the human
body is doing. More so as you get older again,
because as you get older, unfortunately, aging process kicks in
(12:36):
and the body just becomes more chaotic and more likely
to break down. Just like any other machine that you have, right,
the older the machine, the more likely it is to
break down. The human body is no different. So these
are some strategies that you can implement to try and
stay on top of if something is happening with your
(12:56):
body breaking down. Measuring your heart rate, measuring your polls,
measuring your blood pressure. That you have to do it
multiple times a day, but periodically, just to see what's
going on, so you can try and stay on top
of things. Because certain conditions like atre fibillation, which is
(13:17):
this irregular, chaotic heartbeat that we see a lot of
every day in the hospital as well as the office,
the biggest risk factor for the development of ature fibrillation
is getting older, just getting older by itself, and again
we have to respect the aging process because it is
an active, real process, and no, patients don't like hearing that,
(13:40):
but it truly is. Your body is changing as you
get older, no question, and making you more vulnerable to
disease and illness. I mean, there's just a thousand ways
or a thousand things that can happen, and they will
a lot of times. Working in the hospital as I do,
I have this conversation all the time. Patients want to
(14:02):
know what happened, like what did I do? How did
I cause this? Or how do I prevent this in
the future. And again a lot of times there is
really no it just the fact that I'm sorry, but
you know, you're eighty four, and at eighty four, these
are the things that tend to start happening just naturally,
just because the body is eighty four years old. It's
(14:23):
older than someone who's in their twenties, and we have
to kind of respect that process that's in the background.
And so a lot of metabolic and cardiovascular derangements start
to happen, such as atrial fibrillation, which I think if
you're in your sixties seventies, you've probably heard of it,
just because it's so common. A lot of your friends,
(14:44):
family have had an episode, maybe they've been hospitalized for it.
They now have some cardiac procedures that are available for
atrial fibrillation to cure the atrial fibrillation so that you
don't have to take a lot of medications. There's also
another procedure called a watchman watch Watchman device that's basically
(15:11):
a device that's put actually in the heart to prevent
clots that form when you're having hrifibrillation, because the chaoticness
of the heartbeat tends to cause turbulent blood flow. And
when the blood is turbulent and tends to form blood
clots little pebbles of blood boulders or blood rocks, if
(15:32):
you will, that can then be ejected from the heart
and travel in the vascular highway until it finds a
resting point. And when it does find a resting point,
it blocks blood from flowing forward wherever the resting point is.
A lot of times it happens in the brain. That
is what causes a stroke and roma. These strokes are
(15:55):
pretty big. We call these schemic strokes where there's no
old blood flow or lack of blood flow. That's what
we call a schemia. That's a term we use that's normally.
The ideology of all heart attacks is there's a boulder
of blood that develops in a blood vessel that feeds
the heart, and so the heart muscle cannot get blood flow,
(16:17):
and so there's an a schemic episode and the muscle
starts to die in terms of a heart attack, and
the brain, the brain cells start to die, and because
of that, you start developing symptoms from brain death if
you will, And normally you get some characteristic symptoms like
(16:38):
loss of vision or change in vision, maybe some numbness
and tingling of your hands and legs, can't walk, can't talk,
that sometimes a decreased level of consciousness because these strokes
tend to be pretty big, with these atrial fibrillation induced strokes,
because a lot of times facians don't know they have
(17:00):
fibrillation because sometimes, h your fibrillation is silent. It's quiet,
meaning you have it and you don't know, which is
why these monitoring devices are so cool. I mean, I
think it's just something we should start promoting for patients
sixty five and above because the risk starts to climb
exponentially that you know, you just need to get yourself
(17:22):
a blood pressure monitor, maybe ACGM monitor. Certainly if it
involves just wearing a watch, that will be fine, or
interacting with the smartphone. I always love to see my
elderly patients interacting with smartphones because sometimes that can be challenging,
as memory loss and comprehension and just processing new information
(17:45):
can be a stretch when you get older, as the
brain starts to shrink, as the connection start to become
a little bit more chaotic and not as strong, and
the ability for the brain to utilize new information start
to client device like a smartphone can be kind of
challenging for most ely patients. But as far as I know,
(18:07):
these apps that involve the phone and checking your heart
right and your pulse are pretty straightforward, and most ely
patients have family members that a little bit more savvy
with the use of these devices in these phones and
can assist them with managing working with these phones and
working with these apps, which again can be very informative
(18:30):
and very useful to help you monitor your system so
that you can find out yourself or discover yourself if
you have at your fibillation, because a lot of times,
as we know, it kind of kicks off and it
becomes what we call paroxysmal. It kind of comes and goes,
comes and goes, comes and goes, and then it can
(18:51):
sometimes turn into a chronic thing. And that's a lot.
I pick up a lot of atre fibrillation there in
the office just listening to patients. Hearts are even doing
ekg's and they feel fine, there's nothing wrong. Maybe they're
just there for checkup, and boom, we find it just
like that. But wearing these wristbands and getting these apps
(19:14):
for you if you're sixty five and above, having someone
check you out so that they can help you manage
that can allow us to detect these cardiac irregularities sooner
rather than later, just like with breast I'm sorry. With
cancer screening, we don't screen for all cancers, but certainly
it's a part of your healthcare provider's position. When you
(19:39):
go in for your routine visit, whether it be a
nurse practitioner or a medical doctor, you should you should
be figuring out what screening tests you need to try
and stay up on that and turn particular cancer screening. Again,
we don't do all cancers, but do a few of them,
(20:00):
the high yield ones like breast cancer, colon prostate. We're
into lung cancer screening as well for high risk individuals.
Those are individuals who've smoked for an extensive period of time,
typically twenty thirty years of smoking a pack of cigarettes
(20:21):
once a day that puts them that increased risk. I'll
be honest with you, I've sort of lowered my threshold
a lot, just because you know, that's sort of a
target audience. But certainly there's probably some patients who maybe
didn't smoke that many cigarettes today, maybe they smoked a
half a pack a day, but they're still at risk
for getting these this cancer just because they're exposure to tobacco.
(20:45):
And so lung cancer screening has become a part of
my routine and a part of a lot of doctor's routines,
again trying to discover these cancers in more of a
stage one just because the outcomes are typically a lot
better the the cancer volume, the cancer exposure is normally lowers,
so that the treatment plan is really not as toxic,
(21:07):
not as harsh, doesn't cause as much damage during the
treatment phase, which again the treatment of most cancers has
become more tolerable for most patients, meaning they can a
lot of times resume going back to work, or if
they have to be out, maybe it's for a short
period of time. Doesn't cause a lot of collateral issues
(21:29):
in terms of harming other healthy tissue beds and other
tissue areas. Like some of the old chemotherapy agents used
to do things have gotten a lot cleaner and the
treatment plan is more effective, so that again, staying up
with your cancer screenings is very important. You go into
(21:50):
your doctor's office. For us, we have a little sheet
there in the rooms where patients are sitting. They can
kind of review the sheet and see if they need
to order any of these tests. Because with all, even
though everyone has the best intentions, just so many things
get in the way of setting up these screening tests, right.
The scheduling of these screening tests can be a problem.
(22:13):
Just you know, we talk about it, you agree to it,
we schedule it, we send a referral, and then something happens,
right either on your end or the wherever the referral
is going, something happens, and then a year goes by
and you've not had your test. So it is some
sort of shared decision or share responsibility to go in
talk to your healthcare provider about where you're at with
(22:36):
your cancer screening, so that you can be sure and
stay up on this. And then like I said, yes,
if you have diabetes, get your CGM, and then yeah,
if you're sixty five and above, Really I would really
promote getting one of these smart watches or getting an
app on your phone and starting to check your pulse,
your blood pressure and just how regular or irregular or
(22:57):
hardest beating so that you can get your healthcare provider
and follow up on that. As if you do follow
up with the heart doctor. They're getting more and more
monitoring equipment where you just sort of wear device and
it's communicating with some other location and if something abnormal
is being found, they're alerting the cardiologists, they're alerting the
(23:19):
provider that's responsible for you. Maybe have to be hospitalized,
maybe have to can change your medicine, come into a visit. Again.
Just trying to be as preventive as possible is the
way we're going so that we can keep you out
of the hospital and just stay up there, just stay
up with your disease process anyway. Phone lines are open
eight nine to six Kalvy one one hundred three three
(23:41):
zero Kalvy I'll be back in two minutes. All right,
welcome back to Doctably Medical. Our phone lines are open
eight nine six kylvy I one one hundred three three
(24:02):
zero kilva. Talking about monitoring yourself and how that's normally
a good idea to help your health care provider out.
You know, a lot can happen in between doctor visits. Yes,
you have been to your doctor or your health care
provider every four or five months, and at the time
you go in, everything looks good, your lap work looks good,
(24:24):
your blood pressure looks good, and hey, you're great, You're happy.
But hey, a lot of things can happen in between visits.
I mean, how many times do you hear, Yeah, I
just went to my doctor two weeks ago, and now
I'm in the hospital. You know, it's not a guarantee
of success, but certainly we encourage patients to go in,
especially the more medical problems. You have to go and
(24:44):
just kind of get a little check up, look over
your labs, look over your meds, just do some vital
signs and sort of review kind of where you are
in terms of your cancer screening and all of your
other screening and if anything, other tests need to be
done between your net visit. But we do have a
lot of patients that really have no medical issues. They
may go to the doctor once a year, which is fine.
(25:07):
But again, because there's now all of these monitoring devices
out there, we do encourage patients to engage and get
one of these devices to help monitor yourself. One thing
that has changed recently the new guidelines have come out
with cholesterol management. We talk about cholesterol a little bit
because it is a big risk factor for cardiovascal disease,
(25:28):
for the plaque formation in your blood vessels. And just
since I've been a physician for over twenty years, the
targets of cholesterol levels for each patient or individual patients
has just gotten more strict, tighter, and they want the
levels to be lower and lower and lower. I guess
(25:51):
the latest research does indicate that keeping the cholesterol controlled,
and especially what we call high risk patients. These are
patients maybe we've already had a cardiovascal event or they
have a lot of risk factors for cardiovascular events. They
want the cholesterol levels to be even lower, even the
(26:13):
what they call LDL that's the bad cholesterol, right. You
hear about that all the time, to be less than
fifty five. It used to be less than one hundred,
and it was seventy, and then now it's fifty five.
So they want the LDL cholesterol to be even lower.
And these are really for high risk patients, not the
average person, but certainly the more risk factors you have,
(26:34):
they just want that thing low and low and lower.
These are the latest skylines came out of maybe a
month ago. You can talk to your healthcare provider about
your level of risk and where you are and what
sort of medicines you need to be on. And certainly,
in my experience what that means for a lot of
(26:55):
patients is unfortunately they might have to be on two
medics for cholesterol. Remember that your number of medications can
get a little bit busy depending on the medical problems
you have, because there's multiple medicines for one disease such
as hypertension, diabetes, and now cholesterol. And when I came out,
(27:18):
there were maybe one or two medications for cholesterol. We
had the old niosin which you know, caused a lot
of flushing problems, so you really couldn't escalate the dose
just because you could never get over that issue of
the flushing issue with the Niosin and niaspan, and we
tried all sorts of strategies and it just wasn't that effective,
(27:42):
to be honest with you, very dirty drug, but it's
all we had. Statins were on the market, like the
zokore lipitorre provostat, and they were on the market at
that time. They were kind of brand new and a
torvostat and kind of hit the scene when I was
in when I was in medical residency and when I
(28:03):
first became a physician, torvest stat and was just hitting
the scene. Lipitour For all the others that don't know
who a torvistat is. It's now sort of a common
name in most households, such as also Crest Store and receuvistatin.
But these medicines sort of issued a new era of
cholesterol management because there were once a day drugs. They
(28:25):
for the most part very strong and help us control
the cholesterol and keep it down, but they normally had
limitations in their strength. Right if we could do the
maximum dose of the medication, and just wasn't getting that
cholesterol down to where we wanted to get it down to.
(28:46):
And we were still sort of struggling to get the
cholesterol managed the way we want to, even though they
were on the medicines that were chosen for them, and
statins have had their issues with drug drug interactions as
well as advert reaction. If you've ever taken the drug before,
you know sometimes you can have a bump in your
liver function test. You sometimes get some muscle injury, or
(29:10):
you feel fatigued, you feel achy, tired, and a host
of other physical symptoms that happens with these statins and
cholesterol medications. The big concern initially was it's irritation on
the liver, and I remember when they first hit the scene,
doctors were being asked to check the liver function every
three to four months while we started the cholesterol medication
(29:33):
such as the statin category like zok core lipatre at
least for a year to make sure that it wasn't
irritating the liver. And then as we started using these
drugs more and more, we realize it's pretty safe, it's
not really causing a lot of liver issues, and we
kind of relax those recommendations, although I still see in
some patients that it does irritate their liver and we
(29:56):
have to stop the medication. Maybe reduce it, maybe tried
every other day, every three days, things like that. Even
with the muscle eggs and the fatigue issues that can
come along with statins, we still see that as well.
These are normally reversible issues. These are not life threatening issues,
very irritating issues that normally go away once you stop
(30:18):
the medication. But now we have a few other classes
of cholesterol medicines that in combination typically will allow us
to get that cholesterol level down if you are a
high risk patient to a fifty five on your LDL again,
which is considered the bad cholesterol because it's sometimes hard
(30:39):
to do with one product alone, like the statin. For
I would say maybe forty percent of patients, the statin
alone will be enough, But if you're a high risk
patient trying to get down fifty five, you're going to
need two or even three cholesterol medications to do that. Now,
one category of medicines that has become very was these
(31:00):
PCSK nine inhibitors, you know them as REPATHA. It's a
injection that you take every two weeks. This stuff is strong,
it's effective, and man, it slams that LDL down. And
in my opinion, if you can get your hands on
that REPATHA and you get and take the stat and
(31:21):
you'll be done. That LDL will be flat almost be zero.
We have Darwin from Orange.
Speaker 2 (31:27):
How can we help you, Yes, sir doctor Levine, I
was wondering if you could discuss this peel Liscentaprio. My
doctor put me on it. And here's an example. I
was at Walmart and when I started taking these peels.
Here a couple of weeks ago, I was in Walmart
(31:48):
and it seemed like my eyes had actually like when
you have them dilated. And I thought, I said, you know,
I don't think this is good for me. So I
got myself off of it, and I did call them,
but could you please discuss that listener prill And now
(32:08):
I'm going to hang up and listen.
Speaker 1 (32:10):
All right, Darwin, We appreciate that. Brother. Las Centyprill is
a blood pressure medicine that belongs to a very common
category of blood pressure medicines called ace inhibitors ACE, and
they have been around for ages. Ever since I've been
in the medical world. ACE inhibitors have been involved with
(32:33):
being prescribed by a lot of doctors for the management
of hypertension. They're also used for the management of a
condition called heart failure as well as chronic kidney disease,
primarily for diabetic patients, and these are very popular drugs.
ACE inhibitors and ACE inhibitors is just a receptor in
(32:58):
the cardiovascular system, the ACE receptor, and this ACE inhibitor
blocks that receptor and in doing so it helps manage
blood pressure. And there's a lot of ACE receptors, they're
in the human body, and these medications work very well
to help manage these cardiovascular issues. And the good thing
(33:21):
about ACE and hitters right now is that they are
generic and they're normally very inexpensive. We talk about four
or five dollars for a whole month, so very very
popular drugs. But again with any drug, they have their
adverse reaction issues. And the adverse reaction issues that I
(33:42):
see a lot of times a couple, it's two main ones.
Anything can happen, right as this color mentioned, some change
in vision, some blurry vision, that could be your adverse reaction.
Anything is possible. When you get to the pharmacis you
get that long book of possible adverse reaction? Does everybody
to read that note? But the two that I see
(34:03):
one is a chronic cough when you start taking the drug,
and it could even happen a year after being on
the last center PRO. You just get this little naggy
cough that bothers you all day long, and people look
at you funny. Now because we're post COVID, they want
to know if you're gonna infect them or not. So
this chronic, little naggy cough happens. And also you can
(34:26):
get this episode of swelling of your lip or your tongue.
We call that angioedema. These are the two adverse reactions
that I see all the time that I don't really
like to see that, and a lot of times that's
one reason that I don't like to prescribe the ACE inhibitors.
So I personally, as a physician, don't prescribe ACE inhibitors
(34:49):
anymore just because of those two nasty little side effects.
And I just didn't find it to be a very
strong medication again in my use of the medicaid, even
though most healthcare providers are taught to utilize these medications
just because they are effective, most of them once a day,
and the medical literature does support their use in terms
(35:11):
of it helping control hypertension, helping it to control or
manage heart failure as well as helping to control chronic
kidney disease. Now, newer drugs have hit the market, which
is why ACE inhibitives have sort of been left in
the dust, to be honest with you, But they still
are popular because they're cheap, they work, they're once a day,
(35:34):
a lot of healthcare providers are familiar with them, They're
readily available, and so there are some advantages to being
placed on an ACE inhibitor. But another class of medication
called ARBs arb angiotensen receptor blockers is what I use primarily.
You know them as low sartan or all me sartan
(35:55):
or ben a car. Those medications I primarily use myself personally,
and they have less risk of the angioedema or swelling
episode and typically do not cause cough, and typically are
stronger medications as far as I'm concerned based on my experience,
So I don't really have any of my patients on that.
(36:19):
If they come to me on the ac nimbert, I
don't necessarily change it. I'll leave them on, especially if
they're tolerating it. But if anything happens a blurry vision
episode like that, happened to you, then I'll just quickly
get them off of it and go a different direction
with an ARB or angiotenson receptor blocker, which again they
(36:39):
they've been out for a longer time as well, and
they normally are inexpensive once a day, very very strong,
very very effective, and so I normally go with those
versus an ACE inhibitor. But don't feel like the ACE
nimber is a bad thing for you. It's a good drug.
But you just always have to be on the lookout
and the patient did the right thing. If you take
any prescribed medication and you take it and something physically
(37:02):
happens to you, certainly by all means you can discontinue
the drug, but you need to get back with your
healthcare provider, let them know about it, or seek medical
attention the same day, just so that they are aware
and see if they can change you to something else,
because if you stop your medicine for a medical disease
that you have, you normally need to replace it with
(37:22):
something else. So you've got to have your provide involved.
Phone lines are opening on six Kalvy. I want to
hundred three three zero kov. I'll be back on my
last break. All right, welcome back to Doclam Medical Hour.
Phone lines are opening on six KLV. I want to
hundred three three zero ko v I at the end
(37:43):
of the show. Remember if there's a topic you'd like
me to talk about, as inhibitors, medications, procedures, et cetera,
give the office a call three four seven three sixty
two one. That's URYO code four oh nine. Or you
can call the radio station. Leave that message with him
and we'll discuss that top. Just to clarify with the
ACE inhibitors, haven't used that those medications in a while.
(38:07):
They basically are medications that reduce hormonal production of a
medicine called angio tensin, which causes constriction of the blood vessels.
That's sort of how it works. It's a what they
call angio Tenson receptor blocker. That's the ARB. The ACE
inhibitor is one that prevents a hormone from being produced
(38:31):
in your blood system. ACE inhibitor angiotensen converting enzyme inhibitor.
That's where they get the name ACE ACE. So I
just wanted to clarify that it's more of a hormone
blocker versus a receptor blocker. But in essence, Yeah, it's
preventing receptors from interacting with certain hormones. But nonetheless it's
(38:53):
a good drug, and if your doctor prescribes it to
your health care provider prescribes it to you, certainly take
the drug if that's what they recommend for you. I'm
just not a big fan of ACE inhibitors because of
my experience with as nimbers. I love the ARBs ANGI
tensor receptor blockers, you know them as all me sartan
or benacar a. Those sartan prescribed in a lot of
(39:14):
combination medicines with diuretics and the hydrochlorothisi. It's a very
very common, popular category of blood pressure medicines. But no
matter what you're prescribed, there's potential for adverse reaction by
whomever prescribes it, so you always have to be on
the lookout for that, and they we have tried to
involve patients and educating them on this to always been
(39:36):
a lookout for that. And if you are taking prescription trucks,
just try to monitor your blood periodically every four months,
six months, that sort of thing. Make sure you're tolerating
the drug. Okay, Sometimes these as hibbits. RBS can cause
things like high potassium levels if you do have some
kidney dysfunction, so you always have to check on that.
(40:00):
And then, as I've mentioned throughout the show, if you
are sixty five and above, I'm really really working with
patients in that category. I really really encourage patients to
start monitoring themselves just because a lot of chaos starts
to get generated as you get older, and it's getting
easier to do that with all the smart watches and
the phones. If you have a mother or father and
(40:23):
you're trying to figure out what's a good gift for them,
maybe their birthday is coming up, celebrations come up. These
are great devices that you can give your elderly parents
to help them monitor themselves. A lot of times you
can do it yourself. Maybe you can get a message
if something happens. This also goes with these METI alert
buttons that go around their neck or their wrists. Having
(40:47):
those those are great, great options. A lot of them
monitoring equipment out there very inexpensive where you can have
this and monitor your elderly patients. So a lot of
good options out there to kind of help your health
providers do on top of things, especially if you have
a lot of medications and you have a lot of
cardiovascal disease, monitoring yourself in between visits can be very
(41:09):
helpful and also try and prevent you from having to
be hospitalized for acute medical crisis, which a lot of
times because as you get older, you're not as strong.
When a crisis happened, sometimes it can be a little
overwhelming to the human body and it's sometimes difficult to
get out of the hospital. So we want to try
(41:31):
and prevent as much as possible. That includes eating a
healthy diet, staying away from those sugary beverages, those lovely
sugary beverages, and getting a little exercise right walking around
the block or just walking on a trip mail anyway,
thank you for joining for the edition of this show.
Remember don't drink or drive, eat some vegetables, and we'll
(41:53):
see you guys next week. Take care,
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