- 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.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
All right, welcome South East Sex's Internet radio listeners. This
is doctor Levine. You're a weekly host of the Doctor
Levine Medical Hour, coming to you live from the studios
of k LVII in Beaumont, Texas, cross the street from
the Big Parkdale Mall, taking your phone calls, answering questions
about health care and medicine to try and make things
(00:22):
easier for you to understand about your healthier family's health,
and just to figure out what's right and what's wrong
as it pertains to your health. We hear a lot
about health every day, all sorts of suggestions about what
to do and how to do it, what to drink,
what not to drink, what to avoid. Man, the list
(00:43):
is very long. It seems like you need to go
to school and get a degree to figure out what
it is so you can understand all this information that
you're getting. The Information Highway as they call it, more
and more information directly getting to the consumer, even before
(01:05):
it gets to your healthcare professional. And a lot of
that information is unfiltered and as or I should say,
is being presented by a lot of what, as they say, influencers,
people that maybe have a they're great orators they know
(01:26):
how to produce a show, they know how to say
certain buzzwords to get your attention, But what are their
credentials are there? What's their background? We know a lot
of times know that, but nonetheless they're making strong recommendations
about what's good for you, what's not so good for you.
(01:50):
They don't necessarily give us that information when we look
on our YouTube or wherever you go for your little
pockets of information. All these folks that are out there talking,
So you've got to be careful and maybe talk with
someone you trust, or talk with someone that you know
has credentials behind their name. They've been in the game
(02:12):
for a long time. Like myself. Not that I'm saying
I'm the best or brightest, but i feel like I'm
putting my time in and I'm out there every day
talking to you guys and trying to help you. I'm
in the hospitals, I'm in office, I mean every day,
every day. And you get a certain insight into really
(02:36):
what's true and what's not so true when you expose
yourself to the healthcare industry in all of its glorious,
beautiful ways. So I feel like I have a little
insight and maybe can help point in the right direction.
So that's the genesis of the show. And again, if
there's something that you would like for me to talk about,
(02:57):
please let us know. Wants you interested and we want
to make it worthwhile. We just have an hour or
less than an hour, as you know, with those doctor
visits and those healthcare provider visits might be ten minutes.
That's all you get with your provider. Even though you
drove for thirty minutes, you sat in the waiting room
(03:18):
for another thirty minutes, forty five minutes, and all you
got was ten lousy minutes with your provider. I mean,
how good is that? So phone lines open eight nine
six kVA. I won one hundred and three three zero okyov.
I would love to hear from you. Weather is pretty
(03:39):
good today and this is not really vaccine time, but
go get your vaccines. We always recommend that. But one
thing we see year round, I mean year round, is
joint pain and back pain. Right. I think everyone has
had some pain in their joints before, right, whether it
(04:01):
be your foot or your ankle, or your neck, or
your shoulders, your wrists, your fingers. Chest. Yeah, you have
joints in your chest that can hurt as well, but
joint pain. Thought we'd spend all the time talking about
that because that's a very frequent common complaint coming into
(04:26):
the doctor's office. Is my lower back hurts. That's my
kidneys are hurting. That's what I hear my patients come in,
My kidneys are hurting. I love that. It's cute, But
just so you know, most of the time, when you
have real kidney disease, real kidney problems, there is no
(04:46):
pain in my experience, no pain whatsoever. You could have
a very large cancerous lesion on your liver sitting there,
a very large tumor sitting there, there's no pain associated
with it. It's just the way the kidney is designed
and the way the kidney is what we call enervated,
(05:10):
meaning how the nervous system works on the kidney. It
just doesn't have a lot of nerve endings. So most
of the time kidney problems really have no pain. Now,
some people will get kidney stones, which that can cause
some pain, some severe pain, some labor pain. As they say,
(05:32):
you know, ladies will always claim that they don't know
what it's like to deliver a child, that labor pain, right,
and guys have to kind of sit back and take
that one. But if you've ever had a kidney stone,
that's on the level are higher than labor pain, I'll
tell you. Also, another type of pain that tends to
(05:53):
generate a lot of pain is nerve pain, like when
the nerve gets pinched. Are Yeah, when it gets injured,
that is painful as well. But certainly this kidney stone
pain is not necessarily in the kidney. It's typically in
the what we call uryter, which is a vessel or
(06:18):
a tube that normally carries the urine from the kidney
to the bladder. It's fairly long, it's a it looks
like a string, but nonetheless it's a vessel that carries
your urine from the kidney to the bladder. And that's
where most kidney stones form, is in the uryter, and
(06:43):
that has a significant amount of pain sensor, so that
when a stone gets in the urter and it starts
irritating the edge of the urret, man, the pain is intense.
We have Carl from Wallaceville. How can we help you today?
How you doing today?
Speaker 2 (07:00):
Doctor?
Speaker 1 (07:01):
Doing good?
Speaker 3 (07:03):
I got a quick question and I had just to
give you a little background. I went in I had
a heart scan plus done on me not too long ago,
and I had a calcium short came back over seven
hundred uh in three different spots, and I followed up
with a cardios which now with the within the last
(07:25):
year and a half, I've had two nuclear stress tests
and he's fixing the schedule of me for an echo
and at two stress testes.
Speaker 4 (07:36):
That they did in imaging, he said he didn't see
any concern them at this time as far as any
blockages or how accurate is the nuclear stress test with
an echo on really detecting the the blood flow.
Speaker 3 (07:55):
Around where it's you know, supposed to be going and everything.
Speaker 1 (07:58):
I'm just kind of curious about that. Yeah, Carl, great question,
And we appreciate that those are what we call non
invasive cardiac stimulation tests, and I'm surprised we don't do
more of them, just because we all know cardiovascal disease
is the number one killer in our country and a
(08:18):
lot of Americans are suffering with risk factors that cause
heart disease. To me, it seems like we should be
doing more of these stress tests, But you know, who's
going to pay for it, Who's got the time? We
would really have to change how we did those tests
just because we just don't have enough cardiologists to go
around to do those tests. They are normally the ones
(08:40):
who monitor and interpret those tests. So we would probably
have to bring that down to the primary care level
if we truly wanted to expand that to more people.
But nonetheless, the ultrasound of the heart, which is ultrasound
technology has been out for many years, got and a
lot better. It's cheaper, but it's what they consider non
(09:04):
invasive and does not expose you to radiation, which things
like cat scans and MRIs do. So it's a very simple, quick, easy,
sort of cheap way to just look at your heart.
Because the idea is that if you have circulation problems,
your heart's going to beat differently, it's not going to
look normal, and the cardiologists are trained to pick up
(09:26):
those changes almost like an EKG. You go to your day.
Speaker 3 (09:30):
It's just kind of like the nuclear stress test you're
talking about, or.
Speaker 1 (09:33):
No, that's separate, that's separate. So normally when you go
to a heart doctor and you say, hey, I'm concerned
about my heart, I want to check up, they're going
to do an ultrasound again, I mean why not. I mean,
just let's look at the heart, let's see what it
looks like. That makes sense. And then the nuclear stress
test is nuclear medicine's been around for a very long
(09:53):
time as well. The best way really to stress your heart, Carl,
is to get on a treadmill and walk very rapidly
at an incline. That's a test that doctors still do
in their offices. But they didn't put me on a treadmill.
Speaker 3 (10:12):
They elected to, I guess, inject me with the medication
to make your heart beat real fast.
Speaker 1 (10:20):
Correct, yes, yes, correct, So that is the second best
way to determine that. And they do that because just
a lot of patients cannot do a treadmill test for
various reasons, whether it be they're out of shape, or
they're overweight, they have joint problems, there's a lot of
reasons for that. But yes, the nuclear medicine version is
(10:43):
a is the second best way to determine if there
is any narrowing or stenosis of circulation. And the idea
is that if your heart muscle is under stress and
there is a narrowing of any of the hypes or
blood vessels that feed the heart, muscle, then it's going
(11:04):
to show up on this scan that they do, and
they basically inject you with a nuclear medicine that lights
up on the scan. And the idea is if there's
reduced blood flow, then it will not light up and
they can see that on the scan, so the areas
will look dark whereas when they should light up. So
(11:24):
if your heart has proper blood flow, then the heart
lights up, but if there is reduced blood flow, are
no blood flow, then it's going to be dark. It's
going to be black, and then they will know there's
an area there, there's a problem there. Then they will
recommend to you what they call an angiogram, where they
inject more dye into your blood vessels, not nuclear medicine,
(11:47):
but a radio radiographic dye, and then they will be
able to actually visualize all your blood vessels.
Speaker 3 (11:55):
Like I was saying. They so I'm self pay and
I found it very It was the test, the nuclear
stress test was, you know, five hundred and sixty dollars
that they charged, which I thought sounded pretty reasonable to me.
And uh, and then they have the echo, which they're
going to be doing here in a couple of weeks.
(12:18):
I mean, I schedule these tests at the same time,
so they just said they'd like to see an echo too,
And I mean at that test is like two hundred
and sixty five dollars I think that they do in
the UH in the cardiologist's office.
Speaker 1 (12:32):
So yeah, I mean that's a standard cardiac workup ultrasound
EKG and a nuclear medicine test. That's sort of a
standard cardiac assessment. So if yours are completely normal, I
would feel really good that I'm good for right now
in terms of my cardiac out that would feel great.
Speaker 3 (12:55):
And I've got you know, I've got diabetes and it
you know, it's a factor, and I just I'm just
trying to stay on top of it because I want
They have me on a of course, I'm on a
stat and forlorn my cholesterol, but they also put me
my bad cholesterol was normal, but they've given me something
another pill. I'm not sure what it is, but it
(13:16):
actually cuts that number in half.
Speaker 2 (13:19):
So m hmm.
Speaker 1 (13:20):
Oh, absolutely, And I think that was a great idea
on your behalf to look into that and check into that.
And that's what I mean when I first started this
answer is there should be more testing in my opinion
in this country, because you have diabetes, you have high potential,
you have high cholesterol, Hey why not let's do a
(13:41):
stress test in your heart. But that would really increase
the number of people getting these tests on a regular
basis to an astronomical level, and we just in my opinion,
don't have the manpower to do that. So it really
have to come down to a primary care level where
we could do that, which it's not requires some space
last training. Not that primary care doctors couldn't do it.
(14:04):
Maybe just introduce that into their medical education, but so
far that has not changed. So I appreciate the fact
that you've done that on your behalf is to just
make sure you're doing okay. I think that's a great idea.
They also have the calcium scoring test. Have you heard
of that one? Or was that offered to you as well?
(14:28):
Did you did you? Were you offered a calcium scoring test?
Speaker 3 (14:34):
That was a self ordered test that I did through Methodist.
It's very inexpensive. Anybody can do it. It's like two
hundred and fifty dollars and you know, Methodist Hospital will
take you in and they do cat scan and they
(14:54):
do they also do the ultrasound the check all your
your vessel like you're around your heart, neck, feet and
stuff like that. I mean it's a bar basically.
Speaker 1 (15:07):
So yeah, absolutely, this ultrasound sort of testing has been
around for a long time. That was a program called
Life Share that would go to small communities. They would
go to churches, things of that nature, and they would
offer sort of an ultrasound screening of targeted blood vessel
(15:30):
areas like your karate, your heart, your kidney, your lower extremities.
And they've been out there for a long time doing
that for a feed, you know, three hundred dollars, four
hundred dollars something. It's something very affordable again, just to
get an assessment of your vascular health, which is not
a bad idea, especially if you have risk factors. So
I agree with that one too. So yeah, I think
(15:52):
the accuracy and the specificity of those tests is very high,
which is why they do them. Now. Are other patients
that have negative tests like that and then have a
heart attack in two weeks, Yes, I've seen that, but
for the most part, no, that doesn't happen. And again,
you should feel confident that your vascular and Kardak health
(16:15):
is good, right, now since these tests were negative, and
just keep banging out the sugar control, blood pressure, cholesterol control,
and do the basic things and you should be okay. Again.
A lot of times we see these failures with patients
just because the risk factors were not being properly controlled
until it led to that. Now, we do have people
(16:38):
that they do everything they're supposed to, they eat right,
they exercise, and they still have problems. That happens. But
it's really in the minority for most patients is the
risk factors are not being controlled for various reasons. It's
hard out there, and so they have an event like
a heart attack or a stroke, something of that nature.
(16:58):
But no, Carl, I think that's a great idea what
you did.
Speaker 3 (17:02):
Okay, Well, I appreciate your time. All right, brother, you
have a good uh Memorial Day weekend.
Speaker 1 (17:08):
I'm gonna try all right, buddy, take care and well
appreciate Carl's phone call. Phone lines are open eight nine
six KALV I won one hundred three three zero, okay
if you I'll be back in two minutes. All right,
(17:36):
welcome back to the DOCTA ME Medical. Our phone line
to open eight non six kf yeah, one one hundred
three three zero O k o ya I talking about
stress tests and ultra sounds. That we don't really talk
a lot about that, which is terrible. We should be
talking about that more often, just because that is the
big problem in our country, right is cardio vascular disease.
(17:58):
You know this, The blood vessels get clogged with plaque,
just like that plumbing in your house this year after year,
just that build up in those pipes. And you know
when the water starts flowing poorly, things start backing up. Man.
The human body is the same. Just like when the
blood is not flowing, you start getting congested, right, you've
(18:19):
had you've heard the term congestive heart failure. Or when
you get swollen and your ankles start getting puffy, you're
gaining weight, you get short of bread to get that
fluid in your lungs. That's when the blood ain't flowing. Yeah,
Marie from Beaumont, how can we help you? Marie? You're alive?
(18:39):
How can we help you? What's your question for us today?
Speaker 5 (18:44):
Yes, I was wondering if you could talk about an
elevated pair of thyroid hormone test and see what some
of the problems that could be related to that.
Speaker 1 (18:57):
Yeah, thank you for that question. I would get a
lot of intercarin questions on the show. But the parathyroid, Yeah,
that's a little bit little organ that sits at the
edges of your thyroid. Your thyroid sits just above your
voice box at the front part of your neck, and
(19:18):
it has four corners and at these little the corners
of the thyroid are what they call a para thyroids
normally small, circular, and my understanding is their main purpose
is to regulate calcium levels such that if your calcium
levels typically go high, and we check that on routine
(19:41):
blood work when you go into the emergency department monoritare,
or you want just some routine blood work. Calcium is
one of the electrolytes that we do monitor on a
normal blood panel. Normally we start thinking about para thyroid
if the calcium is either high or low, right, because
(20:05):
it regulates calcium levels. Primarily, the parathyroid is a problem
when the calcium level is high. That's what it does
mainly is cause if it's going to have a problem,
it's going to cause a high level. We call that
hyper calcemia. So normal calcium level is about eight to ten.
(20:29):
So normally, when you get a hyper parathyroid organ or gland,
it's going to make your calcium level go above ten
point five typically, and under normal circumstances, it again communicates
with the human body and it keeps the calcium level
(20:50):
at a sort of steady level. But sometimes it can
become hyper and it generates a high calcium level, normally
a or even sometimes twelve, So that's very easily picked
up on a routine blood test. Most of the time
it's silent, meaning you probably wouldn't know you have a hyperparathyroid,
(21:15):
just because when the calcium level does get a little
bit high, your body is able to tolerate that for
the most part, such that you don't feel any symptoms. Normally,
as a calcium level starts to climb into the twelve thirteen,
fourteen fifteen, that's normally when the body gets irritated and
(21:36):
you start to develop toxicity symptoms related to hyper calcemia.
That could be kidney stones, that could be what we
call osteoporosis. When your bones get really weak, you can
get confusion, you can get a lot of joint pain,
you can become very dehydrated and have a very low
(21:57):
blood pressure. You can get cardiac arrhythmias, whether it be
very slow, very fast, or irregular, your muscle pain. So
these are some of the issues that come about. When
your calcium level is a bit more high. Again, at
a level of eleven or so, not much is going
(22:17):
to happen to you, and it's probably something that's going
to be picked up on routine blood work. So most
healthcare providers at my level, when they see the calcium
level high, that is one of the diseases that they
look into. Normally, what we have to do is order
what we call a PTH level parathyroid hormone level. We
(22:39):
order that and what should happen is if the calcium
level is high for other reasons, because there's other things
that can cause a high calcium level, and they teach
us what those things are. Cancer would probably be the
next biggest cause of that in my experience. But we
order this parathyroid hormone LIE level to see what is
(23:01):
going on with the parathyroid, and normally in hyperparathyroid, the
level is high, right, so we check it the level
is high, we know then that probably the cause of
the hypercalcemia is a hyperparathyroid The way to confirm that
is to do a parathyroid uptake scan. That's a nuclear
(23:25):
medicine test that's strongly done by the radiologists. And we
order that test and you go in. They inject your
vein with some material that is supposed to concentrate there
in the parathyroid gland, and when it's very hyper it
absorbs that material very rapidly and such that when they
(23:48):
do the scan, it lights up, sort of like the
nuclear medicine test of the heart. When the blood is flowing,
that radioactive chemical gets to where it's supposed to go
and it sits there and it lights up. Take a
picture of that particular organ. Boom, everything lights up. When
there's no flow or it's not hyperactive, then it does
(24:12):
not absorb that chemical and it's dark. And that's sort
of what the radiologists see. It's either going to be
light or it's going to be dark. So most of
the time with a hyperparathyroid gland, again there's about four
of them. They sit on the corners of the thyroid.
I'd say the thyroid looks like an H is how
I think of a thyroid glan, A big one, a
(24:32):
big H A puffy h if you will, And at
each corner of the age they have these little glands
sitting there helping regulate calcium levels, so that parathyroid scan
uptake scan would be would light up, it would be
a positive test. We would get that back and then
(24:53):
depending on the calcium level, you can just sort of
follow it and monitor the patient. But certainly if they
start having more symptoms, like I say, the calcium level
starts getting into the twelve thirteen range, they start getting
physical symptoms like kidney stones, are severe osteoporosis, our severe
joint pain, or they start getting into cardiac issues, then
(25:18):
it's time to take it out. So for most people
who have hyper parathyroid issues, we basically just monitor them
and we can monitor them for several years and nothing happens,
just as long as their calcim levels sort of stay
in that high eleven low eleven range. Sometimes it'll go
(25:40):
up to twelve twelve point two, but it'll come back down.
We can repeat it in a week two weeks and
it'll be back down. It sort of goes up and down,
but it is abnormal, but it's not irritating the human
body yet. So studies have shown that we can just
sort of monitor these patients that have sort of a
higher level of calcium but not so super high. We
(26:03):
can monitor them. But when they start getting more physical symptoms,
that's when we normally send them to a surgeon who
removes these glands because that's the treatment for it. And
once you remove the glands, then the hyper thyroid or
hyperparathyroid state then goes away. Calcium level tends to return
(26:23):
to normal. But in my experience, most patients have this disease,
they never get surgery and we just monitor them for
many years. You know, certainly we do bone density tests.
We they start having kidney stones, that's a different picture.
Normally we can say, hey, you start to have a
(26:44):
lot of problems, we need to take these glans out.
And that's the thing is that there's not a lot
here in South throught Sex. It's not a lot of
those surgeons. So most of the time you have to
go to a Galveston or Baytown or Houston to find
a next surgeon that takes those parathis our glands out.
Sometimes you can find what they call a general surgeon
who has been trained and has been taught to do that,
(27:07):
but that's very uncommon. Normally you'd have to be sent
to sort of a specialist who does that all the time.
And again, just Southeast Texas small market most of the time,
you just don't have those type of surgeons available where
you can make an appointment and go and see them.
Normally you have to go outside of Southeast Texas and
(27:28):
find that surgeon. But it's so good. Houston's just an
hour and ten minutes away. That's not bad. Just make
a day out of it. Anyway. Hopefully that answers your
questions about hyperparroate that right. Wow, we don't get a
lot of intercrin questions, so that was good. Hopefully that
helps you. If night gifts call back. Phone lines to
open eight nine to six kV out win one hundred
and three to three zero KOF. I'll be back in
two minutes. All right, welcome back to stock William Well.
(28:00):
Our phone lines open eight nine six kof at one
hundred and three to three zero okof. Leonard from Houston,
what's up, buddy.
Speaker 2 (28:09):
I've burned my foot. About it about six weeks ago.
I've been to the foot doctor three times now. The
first time he was an hour and a half late.
Second time an hour twenty and store time hour and
fifteen minutes late for the appointment. Is there a standard
that doctors are supposed to adhere to on time limits.
Speaker 1 (28:33):
Leonard, I love that question. Yeah, there is no agreed
upon time limit as it pertains to visits or time management, no, sir,
But certainly that is a part of being a professional provider,
is time management, No question. We don't want patients waiting
(28:54):
longer than they need to. Just Unfortunately, Leonard, when you
start seeing a lot of patients throughout the day, like
any mature health care provider will be exposed to, time
just becomes very limited. Things come up throughout the day
that push your schedule around, and these are just unavoidable things. Now,
(29:15):
some doctors are more punctual than others, no question. They
structure their days so that they can make those appointments
faster that they don't have their patients waiting longer. So, yes,
some doctors are a bit more sloppy as it pertains
time management versus others. But we don't want you waiting
(29:36):
longer than you have to. I think for me as
a healthcare provider, primary care provider, you know we don't
want you waiting longer than twenty thirty minutes. But unfortunately,
as the day bills up, I mean, the time starts
to slip away from you and it could be forty
five minutes wait or an hour wait before we can
(29:56):
get to you. And it's not that we're sitting around
doing nothing. Do things start happening throughout the day that
you have to address these issues, whether it be phone
calls or a patient's visit takes a long time just
because there's multiple problems going on, but not just a surgeon,
so they have to perform operations typically throughout the day.
They normally have surgery day, and the surgery might go long,
(30:22):
or maybe they couldn't get the surgery at the time
that it was schedule, and so that's going to push
the whole day back. Just things like that, maybe they're
going to two three different facilities and they have to
make all those rounds before they get to the office. Traffic,
all that stuff. But I agree that it is a
long time to wait, and we're sorry that you have
(30:45):
to wait. My wife and I have talked about this
issue in healthcare. Just the time commitment to going to
the primary care resasient's office is something we all need
to work on. And the insurance companies are looking at
this as well and asking patients about their time at
their primary care Decisions office, how much time you sat there,
(31:06):
how much time you spent with the provider. I'm assuming
that there will be some changes with that coming, and
I'm fine with it. It's just that there's so much
time in a day, and there's so many providers.
Speaker 4 (31:21):
And.
Speaker 1 (31:23):
Yeah, you might have to wait. Things like the virtual
platforms where you're at home with a computer interface, with
the phone interface and you have a scheduled time with
a provider, that might be the best option. I see.
If you don't want to wait for provider, you can
schedule it at seven o'clock in the morning six o'clock
(31:45):
in the evening. It's more convenient for you because when
you're talking about an office and you have these confined
office hours, you get into more of that sitting around.
So it's not that we don't we don't prioritize it.
We hate when patients have to sit, but just sometimes
a day gets busy. Leonard, I apologize about that. Good question, though.
Speaker 2 (32:08):
Are my only real options to live with it or
replace him?
Speaker 1 (32:13):
Yeah, that's up to you. That's really up to you.
I think that again, like I said, some offices and
some doctors are better at their time management than others.
And if that's really important to you your time, then yeah,
you might want to find another practitioner and see if
you have the same experience. What I would do, Leonard
(32:34):
Number one is let your provider know, say, hey, I
noticed on my past three visits that I had to
wait a long time. Is there anything you can do
to change that? Or is that just going to be
routine here? I'm just trying to figure it out. I
don't particularly like sitting here for almost two hours. I mean,
(32:56):
I like you as a practitioner. You did a good
job of my but I'm just concerned. I have a
question for you. Can you help me understand that something
like that? Just have an honest relationship with the provider,
and depending on that answer, yeah, you might need to
find another doctor. Some doctors get offended by a patient
(33:19):
asking them stuff like that, So it all depends on
what you want to do. But if your time is
that critical then and the doctor doesn't really answer the
way you like, or you don't particularly like the way
he answers, the yeah, you might need to find another provider.
But I just want to warn you that these same
(33:41):
time pressures that your podiatris is under, all offices are
under that same pressure every day. Hospitals ers. Scheduling is
a big part of what happens every day in all
these institutions. And yes it is prioritized, but just things
come up all the time that might push that time around.
(34:02):
I have patients in the hospital that they might be
in the er for eight hours, twenty four hours, you know,
waiting for bed. They might be in the hospital waiting
around for a test of some type for hours, not eating,
not drinking, just because the time gets away from the schedule.
(34:22):
So it happens. But it's up to you if you
want to go through the pain.
Speaker 2 (34:27):
Of one more appointment, I'll go. And if he's a
and wait a half an hour, more than half an hour, right,
I'll just stet up and leave.
Speaker 1 (34:37):
There you go. That's a solution for me.
Speaker 2 (34:40):
It's a matter of respect. If I can be on time,
he can.
Speaker 1 (34:42):
Be on time. Absolutely, brother, I get it. Yeah, it's
it's it's your it's your guy, yes, sir, absolutely, Leonard.
And yeah, I mean, if you listen to my show,
it's a great question, right, and I don't like it
any more than anybody else. And if you're a patient, mind, yes,
sometimes you have to sit there for an hour before
(35:04):
I get to you. But again, I'm not twiddling my thumbs.
It's just things are coming up, and it pushes the
whole day back. There's paperwork, there's phone calls that primary
care doctors are responsible for throughout the day. Maybe you
get a couple of new patients in their new patient
visits take a longer time. Maybe a visit that was
(35:25):
supposed to be quick turns out to be a long visit.
I mean, so forth and so on, all of these
uncontrolled variables that come up and start eating up the day.
But I would agree that there's just some doctors are
better at time management than others. I will say that,
not that they're bad surgeons are bad doctors, meaning in
(35:48):
terms of the decisions they make, the medicines they give you.
They may be excellent clinicians in terms of being able
to diagnose you, you're up to date with all your screenings,
you're on the best goal directed medications, or they performed
a life threatening surgery for you and saved your life.
But their time management might be terrible. We do see that,
(36:10):
and it's up to the patient to decide what they
want to do about that situation. I always say, at
least give your practitioner that includes me, give your practitioner
an opportunity to try and change that, or let them
know that it's bothering you and you would like something
(36:31):
to happen. Sometimes what I tell patients, if their patient
of mine, is maybe make your visit like the first
visit of the shift, because normally, at the beginning of
the shift we can sort of get the patients in
and out pretty quickly. But as you start getting into
the middle of this shift, you start the time starts
(36:54):
to expand. And that's sort of just because you're dealing
with the patients you had, and then you're trying to
get the patient that you have done, and then the
patients that are coming in later are coming in, and
so it starts to get bogged down in the middle
of the shift. And most offices such that you're more
likely to not have to wait if you're the first
(37:15):
or second patient of this shift. Most offices have a
morning shift and an evening shift. There's some offices that
are just they go throughout the day, right, there's no
lunch break. That's odd though, right because staff, once I
think it's legal, you have to give them sort of
a thirty minute break an hour break for lunch. And
depending on how some offices are set up, maybe there's
(37:37):
some overlap where office members take off for lunch at
different times so that there's always someone available to take
care of patients. Such that office opens at eight, it
closes at five, and then just run it through for
those several hours. But most offices sort of take a
lunch twelve to one. And again if you want to
(37:58):
be that first patient where you don't have to sit
normally at the beginning of the shift, so eight o'clock
would be your appointment, or one o'clock in the evening
ship would be your appointment, so you don't have to wait.
That's something I tell patients all the time. Maybe why
don't you try that. Just be sure you're one of
the first or second patients to be seen, because normally
in the middle it starts to get bogged down. Phone
lines are open eight andine six kalvy, I want one
(38:20):
hundred three three zero kill Yeah, I'll be back in
two minutes and welcome back to Doctor Medical. Our phone
lines are open eight nine to six kV I won
eight hundred three to three zero kov I had great
question Leonard time management waiting at the doctor's office. I
(38:43):
mentioned that periodic on this show, and I'm gonna tell you,
I mean most of these healthcare facilities they work on
that all the time. I know, especially in the er,
that that's a big area where there's a lot of
sitting around waiting. There's some long waits, you know, in
(39:04):
the waiting room when you get to the back. And
I'm telling you they are working on these strategies all
the time to try and speed things up. But there's
just these unforeseen roadblocks that happen in the day. Whether
it be your surgeon's office, your primary care psition's office,
minor cares, just all these places where you're going, there
(39:28):
are roadblocks that come up. But everyone handles it differently
in terms of if they want to try a different practitioner,
because that could be dangerous as well. You know, you're
with a doctor, everything is going well and they're making
the right decisions for you, and other than having to
sit for thirty minutes an hour, everything is great. You
(39:50):
like the staff, you get your meds on time. It's
very convenient for you. Maybe the office is right down
the street. Maybe you have just a good re relationship
with your provider. But yeah, you have to wait. You know,
it's risky to get up and say, you know what,
I don't want to wait, that it's disrespectful. I'm going
to go to a different doctor. It's risky just because again,
(40:12):
the same time pressures that that office has, they everybody
has that, And again you just have to prioritize what's
most important to you and your provider, that relationship, but
what's the least important. Everyone decides differently. For our friend,
good friend Leonard, hey man, it's important, it's disrespectful. I
(40:34):
got to find someone else. And patients leave our office
as well, And it could be for those exact same reasons.
We're tired of waiting for doctor Lavine to show up.
I've been here for an hour every time I come here.
It's just to wait, wait, wait, I get it, I understand.
But on our end, it's not that we're trying to
make you wait. Just there's so many office staff members
(40:56):
you can hire this when you start seeing a lot
of patients, there's a lot of responsibility that happens every day.
It's it's a hard balance to achieve and most offices
are trying to achieve that balance. You get an office
staff member that decides to resign or they don't show up.
I mean, that's a huge, huge hit to a small
(41:18):
healthcare professional's office, even for these big giant facilities, when
employees come and go and you got to retrain them
and who's going to do that job now, just very disruptive,
but that impacts the time that you have to maybe
wait for that practitioner to show up. But it is
(41:38):
something that we get introduced to in medical training in
terms of time management. Just yeah, I agree with Leonard
being disrespectful for the patient having them wait. It is disrespectful,
but again not intentional, just trying to get through the
day and make sure you're doing everything and being thorough
with all the paperwork that we have now, all the
(42:00):
documentation you see, most health can providers have these computers
and we're tapping away. That eats into your time as well,
and it's just getting worse and worse as it pertains
to that aspect of it. Just all the documentation that
you have to do with one single visit. The insurance
companies want more and more, and the computer industry is
helping out making more efficient. But still, let's say your
(42:22):
computer system goes down. Oh my god, that's huge. Anyway,
we want to thank all the listeners and the callers
to the Doctaby Medical Hour again. If there's a topic
you want me to discuss, please let me know we
can do that. Talk about a little about parathyroid glands,
well indocren question. That was good and refreshing. But enjoy
your Memorial Day weekend. Don't drink and drive, eat some
(42:43):
vegetable drinks and water and we'll see you guys next week.
Take care,
All right, welcome South East Sex's Internet radio listeners. This
is doctor Levine. You're a weekly host of the Doctor
Levine Medical Hour, coming to you live from the studios
of k LVII in Beaumont, Texas, cross the street from
the Big Parkdale Mall, taking your phone calls, answering questions
about health care and medicine to try and make things
(00:22):
easier for you to understand about your healthier family's health,
and just to figure out what's right and what's wrong
as it pertains to your health. We hear a lot
about health every day, all sorts of suggestions about what
to do and how to do it, what to drink,
what not to drink, what to avoid. Man, the list
(00:43):
is very long. It seems like you need to go
to school and get a degree to figure out what
it is so you can understand all this information that
you're getting. The Information Highway as they call it, more
and more information directly getting to the consumer, even before
(01:05):
it gets to your healthcare professional. And a lot of
that information is unfiltered and as or I should say,
is being presented by a lot of what, as they say, influencers,
people that maybe have a they're great orators they know
(01:26):
how to produce a show, they know how to say
certain buzzwords to get your attention, But what are their
credentials are there? What's their background? We know a lot
of times know that, but nonetheless they're making strong recommendations
about what's good for you, what's not so good for you.
(01:50):
They don't necessarily give us that information when we look
on our YouTube or wherever you go for your little
pockets of information. All these folks that are out there talking,
So you've got to be careful and maybe talk with
someone you trust, or talk with someone that you know
has credentials behind their name. They've been in the game
(02:12):
for a long time. Like myself. Not that I'm saying
I'm the best or brightest, but i feel like I'm
putting my time in and I'm out there every day
talking to you guys and trying to help you. I'm
in the hospitals, I'm in office, I mean every day,
every day. And you get a certain insight into really
(02:36):
what's true and what's not so true when you expose
yourself to the healthcare industry in all of its glorious,
beautiful ways. So I feel like I have a little
insight and maybe can help point in the right direction.
So that's the genesis of the show. And again, if
there's something that you would like for me to talk about,
(02:57):
please let us know. Wants you interested and we want
to make it worthwhile. We just have an hour or
less than an hour, as you know, with those doctor
visits and those healthcare provider visits might be ten minutes.
That's all you get with your provider. Even though you
drove for thirty minutes, you sat in the waiting room
(03:18):
for another thirty minutes, forty five minutes, and all you
got was ten lousy minutes with your provider. I mean,
how good is that? So phone lines open eight nine
six kVA. I won one hundred and three three zero okyov.
I would love to hear from you. Weather is pretty
(03:39):
good today and this is not really vaccine time, but
go get your vaccines. We always recommend that. But one
thing we see year round, I mean year round, is
joint pain and back pain. Right. I think everyone has
had some pain in their joints before, right, whether it
(04:01):
be your foot or your ankle, or your neck, or
your shoulders, your wrists, your fingers. Chest. Yeah, you have
joints in your chest that can hurt as well, but
joint pain. Thought we'd spend all the time talking about
that because that's a very frequent common complaint coming into
(04:26):
the doctor's office. Is my lower back hurts. That's my
kidneys are hurting. That's what I hear my patients come in,
My kidneys are hurting. I love that. It's cute, But
just so you know, most of the time, when you
have real kidney disease, real kidney problems, there is no
(04:46):
pain in my experience, no pain whatsoever. You could have
a very large cancerous lesion on your liver sitting there,
a very large tumor sitting there, there's no pain associated
with it. It's just the way the kidney is designed
and the way the kidney is what we call enervated,
(05:10):
meaning how the nervous system works on the kidney. It
just doesn't have a lot of nerve endings. So most
of the time kidney problems really have no pain. Now,
some people will get kidney stones, which that can cause
some pain, some severe pain, some labor pain. As they say,
(05:32):
you know, ladies will always claim that they don't know
what it's like to deliver a child, that labor pain, right,
and guys have to kind of sit back and take
that one. But if you've ever had a kidney stone,
that's on the level are higher than labor pain, I'll
tell you. Also, another type of pain that tends to
(05:53):
generate a lot of pain is nerve pain, like when
the nerve gets pinched. Are Yeah, when it gets injured,
that is painful as well. But certainly this kidney stone
pain is not necessarily in the kidney. It's typically in
the what we call uryter, which is a vessel or
(06:18):
a tube that normally carries the urine from the kidney
to the bladder. It's fairly long, it's a it looks
like a string, but nonetheless it's a vessel that carries
your urine from the kidney to the bladder. And that's
where most kidney stones form, is in the uryter, and
(06:43):
that has a significant amount of pain sensor, so that
when a stone gets in the urter and it starts
irritating the edge of the urret, man, the pain is intense.
We have Carl from Wallaceville. How can we help you today?
How you doing today?
Speaker 2 (07:00):
Doctor?
Speaker 1 (07:01):
Doing good?
Speaker 3 (07:03):
I got a quick question and I had just to
give you a little background. I went in I had
a heart scan plus done on me not too long ago,
and I had a calcium short came back over seven
hundred uh in three different spots, and I followed up
with a cardios which now with the within the last
(07:25):
year and a half, I've had two nuclear stress tests
and he's fixing the schedule of me for an echo
and at two stress testes.
Speaker 4 (07:36):
That they did in imaging, he said he didn't see
any concern them at this time as far as any
blockages or how accurate is the nuclear stress test with
an echo on really detecting the the blood flow.
Speaker 3 (07:55):
Around where it's you know, supposed to be going and everything.
Speaker 1 (07:58):
I'm just kind of curious about that. Yeah, Carl, great question,
And we appreciate that those are what we call non
invasive cardiac stimulation tests, and I'm surprised we don't do
more of them, just because we all know cardiovascal disease
is the number one killer in our country and a
(08:18):
lot of Americans are suffering with risk factors that cause
heart disease. To me, it seems like we should be
doing more of these stress tests, But you know, who's
going to pay for it, Who's got the time? We
would really have to change how we did those tests
just because we just don't have enough cardiologists to go
around to do those tests. They are normally the ones
(08:40):
who monitor and interpret those tests. So we would probably
have to bring that down to the primary care level
if we truly wanted to expand that to more people.
But nonetheless, the ultrasound of the heart, which is ultrasound
technology has been out for many years, got and a
lot better. It's cheaper, but it's what they consider non
(09:04):
invasive and does not expose you to radiation, which things
like cat scans and MRIs do. So it's a very simple, quick, easy,
sort of cheap way to just look at your heart.
Because the idea is that if you have circulation problems,
your heart's going to beat differently, it's not going to
look normal, and the cardiologists are trained to pick up
(09:26):
those changes almost like an EKG. You go to your day.
Speaker 3 (09:30):
It's just kind of like the nuclear stress test you're
talking about, or.
Speaker 1 (09:33):
No, that's separate, that's separate. So normally when you go
to a heart doctor and you say, hey, I'm concerned
about my heart, I want to check up, they're going
to do an ultrasound again, I mean why not. I mean,
just let's look at the heart, let's see what it
looks like. That makes sense. And then the nuclear stress
test is nuclear medicine's been around for a very long
(09:53):
time as well. The best way really to stress your heart, Carl,
is to get on a treadmill and walk very rapidly
at an incline. That's a test that doctors still do
in their offices. But they didn't put me on a treadmill.
Speaker 3 (10:12):
They elected to, I guess, inject me with the medication
to make your heart beat real fast.
Speaker 1 (10:20):
Correct, yes, yes, correct, So that is the second best
way to determine that. And they do that because just
a lot of patients cannot do a treadmill test for
various reasons, whether it be they're out of shape, or
they're overweight, they have joint problems, there's a lot of
reasons for that. But yes, the nuclear medicine version is
(10:43):
a is the second best way to determine if there
is any narrowing or stenosis of circulation. And the idea
is that if your heart muscle is under stress and
there is a narrowing of any of the hypes or
blood vessels that feed the heart, muscle, then it's going
(11:04):
to show up on this scan that they do, and
they basically inject you with a nuclear medicine that lights
up on the scan. And the idea is if there's
reduced blood flow, then it will not light up and
they can see that on the scan, so the areas
will look dark whereas when they should light up. So
(11:24):
if your heart has proper blood flow, then the heart
lights up, but if there is reduced blood flow, are
no blood flow, then it's going to be dark. It's
going to be black, and then they will know there's
an area there, there's a problem there. Then they will
recommend to you what they call an angiogram, where they
inject more dye into your blood vessels, not nuclear medicine,
(11:47):
but a radio radiographic dye, and then they will be
able to actually visualize all your blood vessels.
Speaker 3 (11:55):
Like I was saying. They so I'm self pay and
I found it very It was the test, the nuclear
stress test was, you know, five hundred and sixty dollars
that they charged, which I thought sounded pretty reasonable to me.
And uh, and then they have the echo, which they're
going to be doing here in a couple of weeks.
(12:18):
I mean, I schedule these tests at the same time,
so they just said they'd like to see an echo too,
And I mean at that test is like two hundred
and sixty five dollars I think that they do in
the UH in the cardiologist's office.
Speaker 1 (12:32):
So yeah, I mean that's a standard cardiac workup ultrasound
EKG and a nuclear medicine test. That's sort of a
standard cardiac assessment. So if yours are completely normal, I
would feel really good that I'm good for right now
in terms of my cardiac out that would feel great.
Speaker 3 (12:55):
And I've got you know, I've got diabetes and it
you know, it's a factor, and I just I'm just
trying to stay on top of it because I want
They have me on a of course, I'm on a
stat and forlorn my cholesterol, but they also put me
my bad cholesterol was normal, but they've given me something
another pill. I'm not sure what it is, but it
(13:16):
actually cuts that number in half.
Speaker 2 (13:19):
So m hmm.
Speaker 1 (13:20):
Oh, absolutely, And I think that was a great idea
on your behalf to look into that and check into that.
And that's what I mean when I first started this
answer is there should be more testing in my opinion
in this country, because you have diabetes, you have high potential,
you have high cholesterol, Hey why not let's do a
(13:41):
stress test in your heart. But that would really increase
the number of people getting these tests on a regular
basis to an astronomical level, and we just in my opinion,
don't have the manpower to do that. So it really
have to come down to a primary care level where
we could do that, which it's not requires some space
last training. Not that primary care doctors couldn't do it.
(14:04):
Maybe just introduce that into their medical education, but so
far that has not changed. So I appreciate the fact
that you've done that on your behalf is to just
make sure you're doing okay. I think that's a great idea.
They also have the calcium scoring test. Have you heard
of that one? Or was that offered to you as well?
(14:28):
Did you did you? Were you offered a calcium scoring test?
Speaker 3 (14:34):
That was a self ordered test that I did through Methodist.
It's very inexpensive. Anybody can do it. It's like two
hundred and fifty dollars and you know, Methodist Hospital will
take you in and they do cat scan and they
(14:54):
do they also do the ultrasound the check all your
your vessel like you're around your heart, neck, feet and
stuff like that. I mean it's a bar basically.
Speaker 1 (15:07):
So yeah, absolutely, this ultrasound sort of testing has been
around for a long time. That was a program called
Life Share that would go to small communities. They would
go to churches, things of that nature, and they would
offer sort of an ultrasound screening of targeted blood vessel
(15:30):
areas like your karate, your heart, your kidney, your lower extremities.
And they've been out there for a long time doing
that for a feed, you know, three hundred dollars, four
hundred dollars something. It's something very affordable again, just to
get an assessment of your vascular health, which is not
a bad idea, especially if you have risk factors. So
I agree with that one too. So yeah, I think
(15:52):
the accuracy and the specificity of those tests is very high,
which is why they do them. Now. Are other patients
that have negative tests like that and then have a
heart attack in two weeks, Yes, I've seen that, but
for the most part, no, that doesn't happen. And again,
you should feel confident that your vascular and Kardak health
(16:15):
is good, right, now since these tests were negative, and
just keep banging out the sugar control, blood pressure, cholesterol control,
and do the basic things and you should be okay. Again.
A lot of times we see these failures with patients
just because the risk factors were not being properly controlled
until it led to that. Now, we do have people
(16:38):
that they do everything they're supposed to, they eat right,
they exercise, and they still have problems. That happens. But
it's really in the minority for most patients is the
risk factors are not being controlled for various reasons. It's
hard out there, and so they have an event like
a heart attack or a stroke, something of that nature.
(16:58):
But no, Carl, I think that's a great idea what
you did.
Speaker 3 (17:02):
Okay, Well, I appreciate your time. All right, brother, you
have a good uh Memorial Day weekend.
Speaker 1 (17:08):
I'm gonna try all right, buddy, take care and well
appreciate Carl's phone call. Phone lines are open eight nine
six KALV I won one hundred three three zero, okay
if you I'll be back in two minutes. All right,
(17:36):
welcome back to the DOCTA ME Medical. Our phone line
to open eight non six kf yeah, one one hundred
three three zero O k o ya I talking about
stress tests and ultra sounds. That we don't really talk
a lot about that, which is terrible. We should be
talking about that more often, just because that is the
big problem in our country, right is cardio vascular disease.
(17:58):
You know this, The blood vessels get clogged with plaque,
just like that plumbing in your house this year after year,
just that build up in those pipes. And you know
when the water starts flowing poorly, things start backing up. Man.
The human body is the same. Just like when the
blood is not flowing, you start getting congested, right, you've
(18:19):
had you've heard the term congestive heart failure. Or when
you get swollen and your ankles start getting puffy, you're
gaining weight, you get short of bread to get that
fluid in your lungs. That's when the blood ain't flowing. Yeah,
Marie from Beaumont, how can we help you? Marie? You're alive?
(18:39):
How can we help you? What's your question for us today?
Speaker 5 (18:44):
Yes, I was wondering if you could talk about an
elevated pair of thyroid hormone test and see what some
of the problems that could be related to that.
Speaker 1 (18:57):
Yeah, thank you for that question. I would get a
lot of intercarin questions on the show. But the parathyroid, Yeah,
that's a little bit little organ that sits at the
edges of your thyroid. Your thyroid sits just above your
voice box at the front part of your neck, and
(19:18):
it has four corners and at these little the corners
of the thyroid are what they call a para thyroids
normally small, circular, and my understanding is their main purpose
is to regulate calcium levels such that if your calcium
levels typically go high, and we check that on routine
(19:41):
blood work when you go into the emergency department monoritare,
or you want just some routine blood work. Calcium is
one of the electrolytes that we do monitor on a
normal blood panel. Normally we start thinking about para thyroid
if the calcium is either high or low, right, because
(20:05):
it regulates calcium levels. Primarily, the parathyroid is a problem
when the calcium level is high. That's what it does
mainly is cause if it's going to have a problem,
it's going to cause a high level. We call that
hyper calcemia. So normal calcium level is about eight to ten.
(20:29):
So normally, when you get a hyper parathyroid organ or gland,
it's going to make your calcium level go above ten
point five typically, and under normal circumstances, it again communicates
with the human body and it keeps the calcium level
(20:50):
at a sort of steady level. But sometimes it can
become hyper and it generates a high calcium level, normally
a or even sometimes twelve, So that's very easily picked
up on a routine blood test. Most of the time
it's silent, meaning you probably wouldn't know you have a hyperparathyroid,
(21:15):
just because when the calcium level does get a little
bit high, your body is able to tolerate that for
the most part, such that you don't feel any symptoms. Normally,
as a calcium level starts to climb into the twelve thirteen,
fourteen fifteen, that's normally when the body gets irritated and
(21:36):
you start to develop toxicity symptoms related to hyper calcemia.
That could be kidney stones, that could be what we
call osteoporosis. When your bones get really weak, you can
get confusion, you can get a lot of joint pain,
you can become very dehydrated and have a very low
(21:57):
blood pressure. You can get cardiac arrhythmias, whether it be
very slow, very fast, or irregular, your muscle pain. So
these are some of the issues that come about. When
your calcium level is a bit more high. Again, at
a level of eleven or so, not much is going
(22:17):
to happen to you, and it's probably something that's going
to be picked up on routine blood work. So most
healthcare providers at my level, when they see the calcium
level high, that is one of the diseases that they
look into. Normally, what we have to do is order
what we call a PTH level parathyroid hormone level. We
(22:39):
order that and what should happen is if the calcium
level is high for other reasons, because there's other things
that can cause a high calcium level, and they teach
us what those things are. Cancer would probably be the
next biggest cause of that in my experience. But we
order this parathyroid hormone LIE level to see what is
(23:01):
going on with the parathyroid, and normally in hyperparathyroid, the
level is high, right, so we check it the level
is high, we know then that probably the cause of
the hypercalcemia is a hyperparathyroid The way to confirm that
is to do a parathyroid uptake scan. That's a nuclear
(23:25):
medicine test that's strongly done by the radiologists. And we
order that test and you go in. They inject your
vein with some material that is supposed to concentrate there
in the parathyroid gland, and when it's very hyper it
absorbs that material very rapidly and such that when they
(23:48):
do the scan, it lights up, sort of like the
nuclear medicine test of the heart. When the blood is flowing,
that radioactive chemical gets to where it's supposed to go
and it sits there and it lights up. Take a
picture of that particular organ. Boom, everything lights up. When
there's no flow or it's not hyperactive, then it does
(24:12):
not absorb that chemical and it's dark. And that's sort
of what the radiologists see. It's either going to be
light or it's going to be dark. So most of
the time with a hyperparathyroid gland, again there's about four
of them. They sit on the corners of the thyroid.
I'd say the thyroid looks like an H is how
I think of a thyroid glan, A big one, a
(24:32):
big H A puffy h if you will, And at
each corner of the age they have these little glands
sitting there helping regulate calcium levels, so that parathyroid scan
uptake scan would be would light up, it would be
a positive test. We would get that back and then
(24:53):
depending on the calcium level, you can just sort of
follow it and monitor the patient. But certainly if they
start having more symptoms, like I say, the calcium level
starts getting into the twelve thirteen range, they start getting
physical symptoms like kidney stones, are severe osteoporosis, our severe
joint pain, or they start getting into cardiac issues, then
(25:18):
it's time to take it out. So for most people
who have hyper parathyroid issues, we basically just monitor them
and we can monitor them for several years and nothing happens,
just as long as their calcim levels sort of stay
in that high eleven low eleven range. Sometimes it'll go
(25:40):
up to twelve twelve point two, but it'll come back down.
We can repeat it in a week two weeks and
it'll be back down. It sort of goes up and down,
but it is abnormal, but it's not irritating the human
body yet. So studies have shown that we can just
sort of monitor these patients that have sort of a
higher level of calcium but not so super high. We
(26:03):
can monitor them. But when they start getting more physical symptoms,
that's when we normally send them to a surgeon who
removes these glands because that's the treatment for it. And
once you remove the glands, then the hyper thyroid or
hyperparathyroid state then goes away. Calcium level tends to return
(26:23):
to normal. But in my experience, most patients have this disease,
they never get surgery and we just monitor them for
many years. You know, certainly we do bone density tests.
We they start having kidney stones, that's a different picture.
Normally we can say, hey, you start to have a
(26:44):
lot of problems, we need to take these glans out.
And that's the thing is that there's not a lot
here in South throught Sex. It's not a lot of
those surgeons. So most of the time you have to
go to a Galveston or Baytown or Houston to find
a next surgeon that takes those parathis our glands out.
Sometimes you can find what they call a general surgeon
who has been trained and has been taught to do that,
(27:07):
but that's very uncommon. Normally you'd have to be sent
to sort of a specialist who does that all the time.
And again, just Southeast Texas small market most of the time,
you just don't have those type of surgeons available where
you can make an appointment and go and see them.
Normally you have to go outside of Southeast Texas and
(27:28):
find that surgeon. But it's so good. Houston's just an
hour and ten minutes away. That's not bad. Just make
a day out of it. Anyway. Hopefully that answers your
questions about hyperparroate that right. Wow, we don't get a
lot of intercrin questions, so that was good. Hopefully that
helps you. If night gifts call back. Phone lines to
open eight nine to six kV out win one hundred
and three to three zero KOF. I'll be back in
two minutes. All right, welcome back to stock William Well.
(28:00):
Our phone lines open eight nine six kof at one
hundred and three to three zero okof. Leonard from Houston,
what's up, buddy.
Speaker 2 (28:09):
I've burned my foot. About it about six weeks ago.
I've been to the foot doctor three times now. The
first time he was an hour and a half late.
Second time an hour twenty and store time hour and
fifteen minutes late for the appointment. Is there a standard
that doctors are supposed to adhere to on time limits.
Speaker 1 (28:33):
Leonard, I love that question. Yeah, there is no agreed
upon time limit as it pertains to visits or time management, no, sir,
But certainly that is a part of being a professional provider,
is time management, No question. We don't want patients waiting
(28:54):
longer than they need to. Just Unfortunately, Leonard, when you
start seeing a lot of patients throughout the day, like
any mature health care provider will be exposed to, time
just becomes very limited. Things come up throughout the day
that push your schedule around, and these are just unavoidable things. Now,
(29:15):
some doctors are more punctual than others, no question. They
structure their days so that they can make those appointments
faster that they don't have their patients waiting longer. So, yes,
some doctors are a bit more sloppy as it pertains
time management versus others. But we don't want you waiting
(29:36):
longer than you have to. I think for me as
a healthcare provider, primary care provider, you know we don't
want you waiting longer than twenty thirty minutes. But unfortunately,
as the day bills up, I mean, the time starts
to slip away from you and it could be forty
five minutes wait or an hour wait before we can
(29:56):
get to you. And it's not that we're sitting around
doing nothing. Do things start happening throughout the day that
you have to address these issues, whether it be phone
calls or a patient's visit takes a long time just
because there's multiple problems going on, but not just a surgeon,
so they have to perform operations typically throughout the day.
They normally have surgery day, and the surgery might go long,
(30:22):
or maybe they couldn't get the surgery at the time
that it was schedule, and so that's going to push
the whole day back. Just things like that, maybe they're
going to two three different facilities and they have to
make all those rounds before they get to the office. Traffic,
all that stuff. But I agree that it is a
long time to wait, and we're sorry that you have
(30:45):
to wait. My wife and I have talked about this
issue in healthcare. Just the time commitment to going to
the primary care resasient's office is something we all need
to work on. And the insurance companies are looking at
this as well and asking patients about their time at
their primary care Decisions office, how much time you sat there,
(31:06):
how much time you spent with the provider. I'm assuming
that there will be some changes with that coming, and
I'm fine with it. It's just that there's so much
time in a day, and there's so many providers.
Speaker 4 (31:21):
And.
Speaker 1 (31:23):
Yeah, you might have to wait. Things like the virtual
platforms where you're at home with a computer interface, with
the phone interface and you have a scheduled time with
a provider, that might be the best option. I see.
If you don't want to wait for provider, you can
schedule it at seven o'clock in the morning six o'clock
(31:45):
in the evening. It's more convenient for you because when
you're talking about an office and you have these confined
office hours, you get into more of that sitting around.
So it's not that we don't we don't prioritize it.
We hate when patients have to sit, but just sometimes
a day gets busy. Leonard, I apologize about that. Good question, though.
Speaker 2 (32:08):
Are my only real options to live with it or
replace him?
Speaker 1 (32:13):
Yeah, that's up to you. That's really up to you.
I think that again, like I said, some offices and
some doctors are better at their time management than others.
And if that's really important to you your time, then yeah,
you might want to find another practitioner and see if
you have the same experience. What I would do, Leonard
(32:34):
Number one is let your provider know, say, hey, I
noticed on my past three visits that I had to
wait a long time. Is there anything you can do
to change that? Or is that just going to be
routine here? I'm just trying to figure it out. I
don't particularly like sitting here for almost two hours. I mean,
(32:56):
I like you as a practitioner. You did a good
job of my but I'm just concerned. I have a
question for you. Can you help me understand that something
like that? Just have an honest relationship with the provider,
and depending on that answer, yeah, you might need to
find another doctor. Some doctors get offended by a patient
(33:19):
asking them stuff like that, So it all depends on
what you want to do. But if your time is
that critical then and the doctor doesn't really answer the
way you like, or you don't particularly like the way
he answers, the yeah, you might need to find another provider.
But I just want to warn you that these same
(33:41):
time pressures that your podiatris is under, all offices are
under that same pressure every day. Hospitals ers. Scheduling is
a big part of what happens every day in all
these institutions. And yes it is prioritized, but just things
come up all the time that might push that time around.
(34:02):
I have patients in the hospital that they might be
in the er for eight hours, twenty four hours, you know,
waiting for bed. They might be in the hospital waiting
around for a test of some type for hours, not eating,
not drinking, just because the time gets away from the schedule.
(34:22):
So it happens. But it's up to you if you
want to go through the pain.
Speaker 2 (34:27):
Of one more appointment, I'll go. And if he's a
and wait a half an hour, more than half an hour, right,
I'll just stet up and leave.
Speaker 1 (34:37):
There you go. That's a solution for me.
Speaker 2 (34:40):
It's a matter of respect. If I can be on time,
he can.
Speaker 1 (34:42):
Be on time. Absolutely, brother, I get it. Yeah, it's
it's it's your it's your guy, yes, sir, absolutely, Leonard.
And yeah, I mean, if you listen to my show,
it's a great question, right, and I don't like it
any more than anybody else. And if you're a patient, mind, yes,
sometimes you have to sit there for an hour before
(35:04):
I get to you. But again, I'm not twiddling my thumbs.
It's just things are coming up, and it pushes the
whole day back. There's paperwork, there's phone calls that primary
care doctors are responsible for throughout the day. Maybe you
get a couple of new patients in their new patient
visits take a longer time. Maybe a visit that was
(35:25):
supposed to be quick turns out to be a long visit.
I mean, so forth and so on, all of these
uncontrolled variables that come up and start eating up the day.
But I would agree that there's just some doctors are
better at time management than others. I will say that,
not that they're bad surgeons are bad doctors, meaning in
(35:48):
terms of the decisions they make, the medicines they give you.
They may be excellent clinicians in terms of being able
to diagnose you, you're up to date with all your screenings,
you're on the best goal directed medications, or they performed
a life threatening surgery for you and saved your life.
But their time management might be terrible. We do see that,
(36:10):
and it's up to the patient to decide what they
want to do about that situation. I always say, at
least give your practitioner that includes me, give your practitioner
an opportunity to try and change that, or let them
know that it's bothering you and you would like something
(36:31):
to happen. Sometimes what I tell patients, if their patient
of mine, is maybe make your visit like the first
visit of the shift, because normally, at the beginning of
the shift we can sort of get the patients in
and out pretty quickly. But as you start getting into
the middle of this shift, you start the time starts
(36:54):
to expand. And that's sort of just because you're dealing
with the patients you had, and then you're trying to
get the patient that you have done, and then the
patients that are coming in later are coming in, and
so it starts to get bogged down in the middle
of the shift. And most offices such that you're more
likely to not have to wait if you're the first
(37:15):
or second patient of this shift. Most offices have a
morning shift and an evening shift. There's some offices that
are just they go throughout the day, right, there's no
lunch break. That's odd though, right because staff, once I
think it's legal, you have to give them sort of
a thirty minute break an hour break for lunch. And
depending on how some offices are set up, maybe there's
(37:37):
some overlap where office members take off for lunch at
different times so that there's always someone available to take
care of patients. Such that office opens at eight, it
closes at five, and then just run it through for
those several hours. But most offices sort of take a
lunch twelve to one. And again if you want to
(37:58):
be that first patient where you don't have to sit
normally at the beginning of the shift, so eight o'clock
would be your appointment, or one o'clock in the evening
ship would be your appointment, so you don't have to wait.
That's something I tell patients all the time. Maybe why
don't you try that. Just be sure you're one of
the first or second patients to be seen, because normally
in the middle it starts to get bogged down. Phone
lines are open eight andine six kalvy, I want one
(38:20):
hundred three three zero kill Yeah, I'll be back in
two minutes and welcome back to Doctor Medical. Our phone
lines are open eight nine to six kV I won
eight hundred three to three zero kov I had great
question Leonard time management waiting at the doctor's office. I
(38:43):
mentioned that periodic on this show, and I'm gonna tell you,
I mean most of these healthcare facilities they work on
that all the time. I know, especially in the er,
that that's a big area where there's a lot of
sitting around waiting. There's some long waits, you know, in
(39:04):
the waiting room when you get to the back. And
I'm telling you they are working on these strategies all
the time to try and speed things up. But there's
just these unforeseen roadblocks that happen in the day. Whether
it be your surgeon's office, your primary care psition's office,
minor cares, just all these places where you're going, there
(39:28):
are roadblocks that come up. But everyone handles it differently
in terms of if they want to try a different practitioner,
because that could be dangerous as well. You know, you're
with a doctor, everything is going well and they're making
the right decisions for you, and other than having to
sit for thirty minutes an hour, everything is great. You
(39:50):
like the staff, you get your meds on time. It's
very convenient for you. Maybe the office is right down
the street. Maybe you have just a good re relationship
with your provider. But yeah, you have to wait. You know,
it's risky to get up and say, you know what,
I don't want to wait, that it's disrespectful. I'm going
to go to a different doctor. It's risky just because again,
(40:12):
the same time pressures that that office has, they everybody
has that, And again you just have to prioritize what's
most important to you and your provider, that relationship, but
what's the least important. Everyone decides differently. For our friend,
good friend Leonard, hey man, it's important, it's disrespectful. I
(40:34):
got to find someone else. And patients leave our office
as well, And it could be for those exact same reasons.
We're tired of waiting for doctor Lavine to show up.
I've been here for an hour every time I come here.
It's just to wait, wait, wait, I get it, I understand.
But on our end, it's not that we're trying to
make you wait. Just there's so many office staff members
(40:56):
you can hire this when you start seeing a lot
of patients, there's a lot of responsibility that happens every day.
It's it's a hard balance to achieve and most offices
are trying to achieve that balance. You get an office
staff member that decides to resign or they don't show up.
I mean, that's a huge, huge hit to a small
(41:18):
healthcare professional's office, even for these big giant facilities, when
employees come and go and you got to retrain them
and who's going to do that job now, just very disruptive,
but that impacts the time that you have to maybe
wait for that practitioner to show up. But it is
(41:38):
something that we get introduced to in medical training in
terms of time management. Just yeah, I agree with Leonard
being disrespectful for the patient having them wait. It is disrespectful,
but again not intentional, just trying to get through the
day and make sure you're doing everything and being thorough
with all the paperwork that we have now, all the
(42:00):
documentation you see, most health can providers have these computers
and we're tapping away. That eats into your time as well,
and it's just getting worse and worse as it pertains
to that aspect of it. Just all the documentation that
you have to do with one single visit. The insurance
companies want more and more, and the computer industry is
helping out making more efficient. But still, let's say your
(42:22):
computer system goes down. Oh my god, that's huge. Anyway,
we want to thank all the listeners and the callers
to the Doctaby Medical Hour again. If there's a topic
you want me to discuss, please let me know we
can do that. Talk about a little about parathyroid glands,
well indocren question. That was good and refreshing. But enjoy
your Memorial Day weekend. Don't drink and drive, eat some
(42:43):
vegetable drinks and water and we'll see you guys next week.
Take care,
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
24/7 News: The Latest
The latest news in 4 minutes updated every hour, every day.
Crime Junkie
Does hearing about a true crime case always leave you scouring the internet for the truth behind the story? Dive into your next mystery with Crime Junkie. Every Monday, join your host Ashley Flowers as she unravels all the details of infamous and underreported true crime cases with her best friend Brit Prawat. From cold cases to missing persons and heroes in our community who seek justice, Crime Junkie is your destination for theories and stories you won’t hear anywhere else. Whether you're a seasoned true crime enthusiast or new to the genre, you'll find yourself on the edge of your seat awaiting a new episode every Monday. If you can never get enough true crime... Congratulations, you’ve found your people. Follow to join a community of Crime Junkies! Crime Junkie is presented by audiochuck Media Company.