August 30, 2025 • 41 mins
- Listen Saturday mornings at 8 as Dr. Msonthi Levine discusses medical issues and takes your calls on News Talk 560 KLVI. Dr Levine is board certified in Internal Medicine and Geriatrics. His office is located at 3080 Milam in Beaumont, Texas. He can be reached at 409-347-3621.
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Episode Transcript
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Speaker 1 (00:00):
All right, Internet, ready to listen. Southeast Texas Welcome, Welcome
to another edition of the Doctor Levine Medical Hour. I'm
your host, Doctor Levine Live from the Suitors of kov I.
Hear in bo my texts, taking your phone calls, answering questions,
trying to help you stay alive as long as possible
and as healthy as possible. Our phone lines are open
(00:22):
eight nine to six klv I or one in one
hundred and three to three zero kov I. We love
hearing from you and talking with you and answering your
questions and trying to help you clarify what it is
the best thing for you and your family to stay
alive as long as possible, and just to figure out
what to do and what not to do, and what's
(00:43):
the best advice that someone might have for it. There's
so much information flowing out there, it's difficult to determine
who's right and who's wrong and what you should listen to.
More so than when when I first became a physician.
Just so much influence, and it does generate a lot
(01:06):
of confusion, just because a lot of times the messaging
is contradictory and you need some orientation. So that's where
your healthcare professionals come into play just to kind of
help you figure that out. And that's why we hear
sometimes with these doctor visits and these healthcare professional visits,
(01:28):
it's quick, you sit a lot, you wait a long time,
but actually when you get in to see the practition,
it's very quick. Can be frustrating. So hey, we have
this Saturday program and we can talk for an hour
or less and trying to get you fixed out. Hopefully
you're having a wonderful Saturday morning. I am whether it
(01:50):
is kind of overcast, not the most beautiful day, but
thankfully no hurricanes. As you know, we're in hurricanes season,
and this is normally when we start getting a lot
of activity out in the Gulf. So we my wife
and I normally will start watching the Weather Channel and
(02:12):
seeing what's brewing out there. We've been through several hurricanes
in the past several years. You know, hopefully we won't
have to worry about that this year, and God bless
anyone who has to go through that. Mica. Florida's one
state that seems to get a lot. Louisiana, man, we're
always inundated with these hurricanes. So hopefully no hurricanes this year.
(02:40):
The summer has gone by pretty fast. Schools back in
our guests last week, London Bryant, who's in high school.
You know, we forgot to mention that this is our
first year of being a ninth grader being in high school.
If everyone could remember those days a freshman in high school.
Go right, you got out of junior high. Now you're
(03:02):
in high school and you're the low man on the
totem pole or low woman on the totem pole, female,
and you have this new system, and it can just
be real scary. So we wish her well, and I
hope that the year goes by farewell. And we'll appreciate
(03:23):
everyone listening to her last week as she gave us
a rundown of her summer, which again, man, it went
by so quick. Even for me hadn't really been able
to experience that heat. You know, most of the time,
I'm indoors most of the day in the office or
a hospital or in my car, so not really outdoors
as much, man, But that heat is out there, and
(03:44):
we did see our share of heat related illnesses or
heat related injury, which again, the body is a machine
and it likes to operate within a certain temperature range,
just like a car, or just like any other mechanical machine.
You want to keep the temperature sort of within a
(04:07):
certain range, and when it falls outside those ranges, it
normally causes some sort of metabolic derangement or the machine
just doesn't work as efficiently. It doesn't work as well,
and most people know that they don't feel very well.
And most of the time when the temperature is high,
(04:28):
that's normally what we get into for most patients, a
elevated temperature anything about one hundred point five are above.
And the thermometers have gotten a little bit easier to use.
We remember the one that you stick in the mouth,
and then there's an ear thermometer. We remember the COVID
(04:49):
pandemic with all of the forehead thermometers that you guys
had to go through. I had to go through just
to enter a building. The accuracy of though, I'm not
quite sure, but man, we were blowing them up during
COVID just a very quick, fast, easy way to detect
(05:10):
potentially someone's acurate temperature. I don't know, man, it was
crazy doing. Then you know the temperature gun. You don't
remember that they pointed to your forehead to get your
temperature before you get walk in anywhere, get your permission,
your slip. You had to go through questions, and you
had to get your temperature checked, and I mean you
(05:31):
had to wait in line just to get in, and
if you had a temperature you had to couldn't get in.
I mean, all that stuff, man, I'm so glad that's
behind us. Brings up the point of we're getting now
that we're leaving in our summer, we're getting into ourn winter,
and so we normally start getting into our vaccines, are
(05:52):
really pushing vaccines just because respiratory viruses tend to become
more prevalent during the winter months. There's some theories as
to why that happened, but nonetheless we see it every
single year. We see it throughout the year, but normally
in the winter, starting roughly in October, November, December, then
(06:17):
in January February. Those are sort of our respiratory months
where the hospitals just fill up inundate it with the
respiratory illnesses and infections, and then as the spring and
summer come into play, it kind of dies down where
we see the respiratory problems. But it's just not at
(06:40):
the volume of doing the winter and that's when we
start promoting our vaccines. Now, as a healthcare professional primary
care physician, it is sort of our duty to promote
them every single visit, and that should be a part
of your experience when you go to your primary care
(07:02):
physician or healthcare professional. Certainly a couple of different tasks
that should be prioritized every time you interact with them. Again,
the system has gotten better with trying to introduce sort
of some routine into that visit. Again, when I hit
the scene over twenty years ago, a private practice was
(07:24):
really a personal experience. Is because doctor A was really
different from doctor B. To be honest with, even though
your diseases were the same, you sort of got a
different approach from doctor A versus doctor B. And it's
going to be hard to completely have a carbon copy
(07:45):
of doctor A and doctor B when you have that experience,
even though that's where the healthcare world is trying to get.
Like when you go into Burger Place A and Burger
Place B. They are the same company and you're trying
to get the same sort of experience from this location
versus that location. It's still kind of hard. We have
(08:08):
that issue with certain other entities, Like some people get
frustrated with pharmacies. They call this pharmacy. They have a
hard time sort of getting their meds and just callbacks
and stuff like that, so they try a different one
and they might have better luck with that same thing
with doctors' offices. Right, So they're trying to sort of
(08:29):
introduce some regularity so that some basic things that you
should be getting no matter where you're going. And one
of those is the prioritization of vaccines and importance of that.
The healthcare world believes heavily in these vaccines, and we're
going to keep promoting them. Although we know it's controversial.
That's not going anywhere. This is America, right. That's what
(08:51):
we love about this country so much that we can
argue about it. We can come to the table and
try and figure out what's the best and what's the
right thing, open argument, open discussion. That's why we love
the country. It's never going anywhere. It keeps everyone safe.
That's why we do it. So we don't have one
(09:13):
compliance even though we like that. Carry from needle and
how can we help you, Hi?
Speaker 2 (09:20):
My question was I've seen a doctor in Beaumont for TMJ,
my jaw was clicking and popping, and you know, he
gave me a splint and that pretty much fixed it.
But you know, I still have pain that you know,
it kind of comes and goes. I'm wondering what should
I do.
Speaker 1 (09:40):
Well A lot of times with a TMJ temporal mandibular
joint disease. I mean, I hadn't said that in a
long time, but it's basically a joint issue, and just
like a knee or back, or a neck or elbow,
it can a lot of times generates inflammation and that
(10:01):
joint just because of the disease process of what causes TMJ.
I'm not the world's expert on that one, but nonetheless,
pain can be a part of that experience. And if
the application that your dentist gave you doesn't completely take
the pain away, certainly you can always reach back out
(10:21):
to that practitioner and let them know you're still experiencing
some discomfort to see what they recommend. Most of the time,
we would go to some anti inflammatory medications because a
lot of times the joint is inflamed just because of
the joint itself and because it's not perfect, it sort
(10:41):
of injures the joint slightly, which is what the mouthpiece
is there to do. It's just sort of the realignment
joints space so that it doesn't injure the joint. But
nonetheless pain can be a part of it. So we
normally go with things like talalnol or motor and advil
that you can take to help that, but some practitioners
are a little bit more aggressive. You can do injections
(11:04):
in that area as far as I know, to help
with this comfort. Sometimes there's different mouthpieces, sizes, shapes that
might again align the joint space better when you go
to sleep. So certainly I would reach back out to
your practitioner and see particularly what they would like to
do to try and to alleviate the pain. We always
(11:26):
try to make the pain go away one hundred percent,
but sometimes the goal is to reduce the pain by
sixty percent or eighty percent, just so it's not as severe.
But I think that would be a good way to
approach that some over the counter in inflammatories and then
talk with your healthcare provider who is working with you
on your TMJ.
Speaker 2 (11:49):
Okay, all right, thank you, yes, ma'am.
Speaker 1 (11:51):
I appreciate the phone call. And yeah, you know, the
idea of reassessment. You have to get a comfortable with that,
and I've gotten comfortable with that over the years as
a healthcare pro healthcare provider is the idea of getting reassessed.
(12:12):
I know that's maybe kind of frustrating for health care
I'm sorry patients. They sort of want the answer on
the first day. And for the most part, any health
care provider that you go to, you probably will get
the right answer the first time you go there. But
(12:35):
it is sort of common that your symptoms will not
go away completely. They might get worse, or they might change,
and you have to have an open mind to get reassessed.
Not necessarily upset about it, but just understanding the simple
fact that there's only so many symptoms that a healthcare
(12:56):
provider has to work with, right and there's about and
it's about ten of them that we sort of circulate
every single day with no matter who you are or
where you are in this world, it's about ten key
medical complaints physical complaints that we kind of work with
throughout the day. And every disease known a man can
(13:20):
start off with one or combination of those sort of
ten physical complaints and the physician or the healthcare pravoted
nurse practrician physician assistant. They have to gather more information,
normally vital signs or maybe what your physical examination may be,
the results of X rays and labs to try and
(13:42):
figure that out. But I can tell you after being
a healthcare provider for over twenty years, man, it's not
always clear what is actually the cause of a patients symptoms.
We might have a few ideas, and we might want
to monitor or a patient I observe a patient, whether
it be at a hospital, even at home, and see
(14:05):
what happens over the next few days, the next few hours. Again,
if we think it's critical, we normally will hospitalize and
hook you up to all sorts of monitors and do
all sorts of blood work, and maybe have some other
doctors see you to try and get to the bottom
of what's wrong with you and get you some answers
as soon as possible, because we certainly know how fearful
(14:29):
that is and how anxiety provoking that is is to
have a physical symptom and the expert that you're working with,
that you spoke to, that should know what's wrong with you,
doesn't know what's wrong with you and they tell you that,
I mean, where do you go from there? Right, it's
just sort of an my god, what do I do?
(14:49):
I mean, I'm scared, I'm nervous, and they don't even
know what's wrong with me. I mean, what are my options?
So yeah, I mean doctors would love to and healthcare
providers would love to be able to just freely, easily,
quickly tell you exactly what the problem is. But man,
(15:10):
it's it's tough out there every single day trying to
do that again high majority of the time. Yeah, we
have that answer, we know what it is, and we're
going to do this and this and that. You're going
to get better and like real nice, predictable stuff. You know,
you have some abdominal pain, you go to your X ray.
I'm sorry, you're er, they do X ray. You have
(15:30):
a penicitis. Man, that's easy, right, But think about chest pain.
Think about abdomina pain or shortness of breath, or headaches
or confusion, which we see a lot of that every
single day. I mean, that's a lot of different diseases
that can cause that, and sometimes it takes a while
to figure that out. But I want to encourage all
(15:52):
the listeners to get reassessed if you're not better, if
your symptoms do not go away, just have an open
mind to say, hey, I need to either get back
to the original practitioner, which is what I advise most
of the time, just because the practitioner sort of knows
those symptoms, they've maybe already done a few other things.
(16:16):
They already kind of have in mind what they might
want to do if you come back, or a different
medicine that they might want to use or referral or
X ray or work up if you come back, if
you go to a different one, you might kind of
have to start over. Behave Sometimes that's what you need
to do. It's kind of tricky. It is kind of tricky,
But if you have confidence in the original practitioner, by
(16:38):
all means, go to that. Go back to that practitioner.
Have am not better, this is new, this medicine's not working,
and let them kind of rework it again. Nothing is
wrong with that. Just the sharing of information can be limited.
We see this a lot in the hospital where patients
are sick, they're vomiting, they have pain, they're altered there, paired,
(17:00):
they're by themselves. Doctors, nurses come in, Hey, what's wrong
with you? What happened? You can't remember that stuff when
you're in pain and you're throwing up and you got
a headache and you're you can't see out of one
it's not thinking clearly, right, and so you're what you
(17:21):
tell the practition might be very limited. You might not
be in the right frame of mind and want to
give a history in terms of what happened. So the
practitioners don't have a whole lot to work with. But again,
your wife is there, your your husband is there, maybe
a family member who is there, and they're more they're
not in pain, right, they can really give the history
(17:43):
because that happens a lot of times. We're going Initially
they're by themselves and we get what we can and
that's it. And then an hour later to ours, somebody
shows up a witness, right, just like a crime scene,
a witness shows up and we get more information. Then okay,
well let's do this, let's do that. I mean, that's
(18:03):
how that works in the healthcare world. And the same
thing with any sort of physical element that you have.
You have to go get reassessed and have an open mind. Yes,
even if it means if you're in the hospital. I
hear this all the time in the hospital. I do
hospital work from back to this hospital when just before
we discharge patients patients like that. I don't want to
(18:24):
have to come back. I don't want to have to
come back to the hospital. Be sure before you discharge me.
I don't want to have to come back. And I
know it's super frustrating right to have to get back
to the er and be processed and wait, Oh my god,
who wants to do They gotta wait in the R
for hours and hours. Even though just so you guys know,
(18:47):
I mean, all hospitals in this country work on their
system to more efficiently processed patients coming through the R.
It's just that man, in the heat of the day,
they are get hammered. I mean hammered with acute complaints
and serious acute complaints. I mean things that are life threatening.
(19:11):
I mean they're just getting bombarded simultaneously. They could have
someone having a massive heart attack, a massive stroke, and
dying all in the same room, you know. And yeah,
I mean it's hard to get everybody addressed in a
timely fashion when things are hopping like that. Gotta be
(19:34):
understanding in that situation. So I know that it's like, no,
I don't want to have to go to that process again.
So before you let me go, let's make sure everything
is good. And you know, most doctors try to get
that done, and for the most part, we do, but
you know, it's not perfect. We can't line it up
all the time. Just something's gonna happen. You get worse.
(19:55):
Medicine doesn't work. I mean that's just built into it, unfortunately.
And yes, you have to come back to the hospital,
even if it's within six hours, twelve hours a day,
two days, and we will see it. We just can't
guarantee success like that, and you have to get reassessed,
same thing in the doctor's office, you know, and get better.
Get back to that doctor and let them know. See
(20:17):
this a lot with skin diseases, they go to the
dermatologists the cream didn't work, that this didn't work, and
then they're frustrated and they're like, what do I do.
We'll go back to your skin doctor. Yeah, let them know.
See what else they want to want to do. I mean,
we have to go through this process of elimination, and
sometimes it can take a long time, but that's the
(20:38):
way it works. Phone lines are open eight nine six kV.
I want one hundred three three zero kov. I'll be
back in two minutes. All right, welcome back to Docta
V Medical. Our phone lines to open eight nine to
six KLV. I won one hundred three three zero Kova.
We have Mark from East Texas. How can we help you?
Speaker 2 (21:03):
The drug iloquist? Has it been around just a short
time or a relatively long time with an established track record?
What is it design to treat? And how well does
it accomplish that mission? Is it a relatively mild drug
(21:23):
or is it a powerful drug? Well powerful side effects?
And relatively speaking, how is it? How expensive is it?
We all I'll hang up and listen.
Speaker 1 (21:41):
All right, Mark, I appreciate that East Texas. All right, eloquists. Yes,
it is a great drug. It belongs to a category
of blood thinners, which we call anti coagulant blood thinners,
which is different from anti platelet medication, which you know
(22:04):
is aspirin or clo pedigrill are relentive. I think most
people are familiar with cuminin or warfarin, which again is
an anticoagulant, which is what eloquist is. Eloquis belongs to
a new category of blood thinners called direct oral anticoagulants
(22:26):
or DOAC for short DOAC, and they have been around
for several years I would say at least ten, maybe
a little bit longer, and they are a very powerful
class of medications, absolutely, and we do use them a
lot in this country just because cardiovascal disease is still
(22:51):
the biggest issue in our country and the formation of
blood clots, which we call thrombus are imbali, is extremely
common because of cardiovascal disease in this country. And one
of the central ways we treat cardiovascal disease in this
(23:12):
country is to prescribe either a anti coagulant such as
eloquist or an anti platelet such as aspirin or clo
pedigral are better known as plavix. And again that's just
because as we all get older, and I shared this
realization with a lot of patients every single day, you
(23:34):
have to respect the aging process. It is real. It
is a program that we all have that at a
certain age, normally about forty, things just sort of start
shutting down and becoming a little bit more chaotic in haywire,
and they don't work as efficiently efficiently, and the humantological system,
(23:58):
the blood system that is there to protect us, starts
getting a little haywire and becoming a little bit more
imbalanced and more prone to form blood clots, which is
why it's super common as you get older. If you
probably talk to your friend or your family, someone else
(24:18):
has already had a blood clot episode, which you might
call a stroke or a heart attack, or what we
call a pulmonary imblice or a DVT or deep vein thrombosis,
which is normally when these anticoagulants are going to be
prescribed to you when you get a thrombus like that,
(24:43):
And before the category of doas DOAC, which is what
Eloquist is a part of, it was really only warfrin
or kuminin or jentavin was another name, j A n
tv E n rat poison. That's what a lot of
people used to call it. That was the drug of choice.
(25:05):
That was really the only drug available to patients who
suffered a thrombotic event, whether it be a DVT or
a pulmonary emblas or some other thraumbas somewhere in some
other arterial tree, maybe a clot in their leg. We
see that a lot with smokers. War friend Kumitin was
(25:28):
the only thing available. The problem with that is that
it was so chaotic of a drug that it had
a very narrow therapeutic window. It's what the medical world
calls that, meaning you had to sort of keep it
the level within a certain narrow range of what we
will call therapeutic level, and it was very easy to
(25:52):
get it out of that therapeutic level, whether it was
below the therapeutic level or above the therapeutic level. When
it's above the therapeutic level, you tend to have spontaneous bleeding,
meaning you can just be walking along and then boom,
you just spring a leak. Right, And there's certain locations
(26:13):
that the body likes to leak when they're own blood thinners.
A few of them would be the gash room teslina system.
That's probably the most common is the gash room intestinal system,
which is what prompts a lot of people to have
to go into the hospital is they start bleeding. They
were in the hospital maybe a month ago, two months ago,
(26:34):
a week ago, two days ago, right, and they got
put on blood thinners by doctor Levine because they had
a thrombotic event. And then two days from now, they're
in the restroom and they go to restroom, there's nothing
but blood in the toilet. We see that all the time.
Are they urinating blood? Right? Or you start getting those nasty,
(26:59):
ugly bruises on your arm that people just love to see, right, Like,
what is going on? Are you getting beat up at home?
Speaker 2 (27:08):
Right?
Speaker 1 (27:09):
I mean I have these conversations. I'd swear to God
to you. Yeah, so war when coomanin terrible, terrible in
terms of its ability to predict that therapeutic windows. So
people bled a lot. And when you bleed, I mean
a lot of things, serious, bad things can happen. And
I forgot the infamous bleeding in your brain. We used
(27:31):
to see that a ton. Someone is on kuminin they
had a DVT maybe a month ago, they got put
on Koman and then now they come in they're confused,
I mean, and it happens rapidly they start bleeding in
their brain. I mean, who seen that? So thank god?
(27:52):
The pharmaceutic company came out with this new category of
drugs Eloquists Doxa as well as the Relato. These are
the three medicines in this sort of new category of
anti quagons, which are more stable. You don't have to
check your blood. Everyone knows, right, all the listeners they
(28:14):
remember having to go to the Kuminin clinic, right every
week every two weeks, and you had to increase this
and stop this and start that and up and down
with this kumitin. I mean it was a major, major
headache and it could impact your lifestyle, right, I mean
you had to work, but then you had to go
to the Kumin clinic and you had to go get
(28:35):
this new dose of medicines and you had to remember
it and you take two this day and then one
another day, and you had to hold this and stop that,
and then you couldn't eat green lettuce and you couldn't
eat nothing with green You couldn't. I mean, just oh
my god, just for this one drug. But then doas
Doac came into play. Eloquist changed it all, changed it all, right.
(29:03):
I mean, people still bleed on these medicines, but a
whole lot less. In my experience, we have less of
these catastrophic bleeds. In my experience, you can still bleed.
Patients still come in bleeding, but not at the frequency
and the severity that they did when Kuminin was the
(29:23):
only player on the field, and Kuminin is still out
there and people are still taking Kuminin or warfaring, But
this new category doax or eloquists change the game. And
if you have had an event, this is the drug
of choice that most doctors are reaching for, especially when
(29:43):
you've had a DVT or a pulmonary imblice. Those are
pretty much the two big categories that patients get placed
on these blood thinners. Also in other categories if you
have a condition called atrial fibrillation, which is in my opinion,
the most common cardiac irregularity as you get older. We
(30:05):
see this stuff every single day in the hospital, in
the office. The issue with agri of fibrillation is it's
chaotic cardiac activity. And when the blood, the blood is flowing, well,
the heart is pumping the blood. I mean it's flowing
like a stream. I mean it's rapid, it's flowing. But
(30:26):
if the heart function becomes chaotic or it slows down,
the blood can flow and it gets sticky and it
tends to generate thrombus blood clots right, and a blood
clot can leave the heart and travel anywhere. We call
that an embalus pomonary embulsces get it and it can
(30:48):
block blood flow in a certain location, primarily the brain,
but it can be the foot, it can be your lung,
it can be your kidney. Primarily the brain is the
one that we that we're concerned about it and cause
a big stroke. So most of the time when you
get diagnosed with hrual fibrillation, you have to be put
on a blood thinner. It used to be Kumitin. So
(31:10):
you get diagnosed at h fribllation, you get put on Kumitin.
Now you got to go to Kumanin clinic. You gotta
take all these meds and just this huge production. Now
it's sort of been dumbed down. You don't have to
do all that stuff anymore, and it's more stable. Phone
lines are open eight nine six kalv i one hundred
three three zero kov I'll be back in two minutes.
(31:33):
All right, welcome back to doctor Vimnaga. Our phone lines
are open eight nine to six kalva one one hundred
three three zero ko Yah Talking about eloquist which is
a Anarqui. Great question. By the way, we appreciate that
it is a anti coagulant which is different from an
anti platelet. You know that them as aspirin, plavix, clo, pedigrill, brilenta,
(31:59):
which again, if you think about it, cardiovascusease number one
problem in our country, cancer number two, number three, I
can't remember. I think maybe Alzheimer's could be another disease.
But this is what keeps the doctors busy all day
dealing with these two diseases, and the way we treat
that is with blood thinners. So the pharmaceutical world has
(32:23):
introduced newer blood thinners and this Eloquists are class of
dough acts. You're familiar with gop one, right, that's a
diabetes as z infic, right. But another term do acts,
direct oral anticoagulants is what eloquist belongs to.
Speaker 2 (32:41):
Man.
Speaker 1 (32:42):
These have revolutionized the prescribing for these particular thrombotic events
which most of us are at risk for as we
get older. Just getting older all by itself is a
big risk factor for forming clots. Just getting old again,
the blood doesn't work as well, the heart doesn't work
(33:03):
as well. The most of us, because of our diet
and our habits, are going to have some plaque in
our blood vessel system just like plumbing just gets that
build up just from years of use. So all of
these factors sort of promote that. But if you're sedentary,
(33:24):
meaning you sit a lot, if you have certain medical diseases,
heart failure is one big risk factor for clots. Kidney
failure is another big risk factor for clots. In what
feeds into heart and kidney failure high pertension, diabetes, high cholesterol, band, overweight,
(33:47):
ban inactive, you know, just that American lifestyle unfortunately leads
to the formation of clots. And we see these clots
in our hospital every single day. We see them in
office every single day. You have to be on the
lookout because they're out there and patients are getting placed
on these medications. Are they affordable? I think that was
(34:08):
another question our caller had. It depends, I think depending
on some patients. If you have no insurance, yeah, they
can be real high, really really high. I mean just
out of reach in my opinion, you know, five six
hundred dollars a month, I mean crazy numbers. But a
(34:30):
lot of times if you have insurance with Medicare or
wish my wife was here, we can go over that.
They pay for that stuff, They make it affordable. They
subsidize expense. And the pharmaceutical company themselves still has programs
out there where if you have a certain card which
they normally give to the provider, they have them in
(34:51):
their offices. Typically they'll give you like a month for free,
or they'll take so much money off of the bents
of the drug so that maybe it'll drop the price
of your personal cost of the drug down to a
more affordable range. Again, but it's so varied out there.
(35:11):
I hear these stories all day long from patients. Now,
depending on your insurance, the time of year, and the
pharmacy you go to, and sometimes even the doctor's office
you go to, those are four variables that a lot
of times you don't kind of control that can impact
(35:33):
the ultimate cost of the drug. Meaning you can call
this one pharmacy with this same drug, same doctor's office,
you get this price. You go across the street to
a different pharmacy, same prescription, same doctor's office, different price.
I see that. So that's why a lot of times
(35:55):
when patients come out, hey it's too expensive, I say,
try different pharmacy. Go to three different pharmacies, and a
lot of times you would get different pricing. Call your
insurance company. That's one thing that I ask of my
patients all the time, just because most primary care physicians'
offices do not have this staff are the time, unfortunately,
(36:18):
to make all these phone calls, with all these issues
every single day that comes up, with all these products, referrals, meds,
prior authorizations. It's too much. It's overwhelming for any doctor's
office to be able to do that. I mean I
would have to I would have to hire five more
people in order for us to do all of that
(36:40):
for patients, so unfortunate. A lot of times at our
office we ask patients to help us out and make
some of those phone calls and talk to your insurance
company and say, hey, if eloquist is too expensive, which
one do they pay for? Because normally, if you have
the diagnosis, they'll pay for one of them, Prodoxa, eloquist osorrelto.
(37:00):
But a lot of times I don't know, they don't
give us that service, that platform where I can go
to some website and say, okay, your insurance will pay
for this. This is going to be the expense. I
don't really have that website to go to. As a doctor.
We just maybe like Zerelto, We like eloquist, We prescribe
it and boom off to the races, and then the
journey starts for you. Right, phone lines are open eight
(37:22):
nine c's kV I won one hundred through three zero kaloviyah,
last break, be right back, all right, welcome back to
the doctoraviing medical hour. Excuse me clearing my Throat's our last,
Like man, time goes about so quickly. I want to
thank all of the callers as well as the listeners. Remember,
if there's a topic that you like me to discuss,
you can call the station, can call my office four
(37:43):
nine three four seven three six two one, and we
can talk about the top you like to discuss. We
had some fun talking about eloquists. Are do acts which
you don't talk about a lot. We should talk about
it more often. New class of blood dinners, very strong,
extremely effective. Still can bleed, but the risk is a
(38:06):
lot lower than an old friend kumitin or war friend,
and sometimes can be as very expensive and a lot
of times, working with your insurance company or even the
pharmaceutical company, you can go to their website, you can
get that price down to a more affordable range. And yes,
once you start taking these medications, if you just take
(38:28):
the medication, you should not have another thrambas experience. And
again understand that the number one problem in our country
is cardio vascal disease, which the formation of thrambas is
a part of that. So most of you listen to
this show will probably be put on some form of
(38:49):
an anti platelet like as from plavix or an anticoagulant
eloquis zerelto at some point in your life. Again, that
is what happened to most Americans. Some cardiovascular disease will
impact you. Again because we like ultra processed foods, we
(39:09):
like consuming sugary beverages, and we like consuming a lot
of ultra processed starches and sugars. That is our diet.
That is what we like. That's the way we live.
And I've told you over and over again it is
your lifestyle that impacts your health. The most number one
(39:33):
eating a proper diet, right, Yes, it's cumbersome. Yes, eating
vegetables might be a little bit more expensive, time consuming
because there's no preservatives. You gotta eat it. It's fresh.
Frozen is not terrible. That's a good alternative, but certainly
you have to do your part at know, going to
(39:54):
your vitamin store, getting your vitamins off the internet, at
your little super Man pack or your female pack, and
you've got several different vitamins. You're gonna swallow them every morning.
That that's going to compensate for being overweight. That the
fact that you're still drinking sugary beverages, you're still eating
(40:17):
ultra processed foods, you're not exercising, you're smoking, you're drinking
a lot of alcohol. It's just going to overcome that.
It's a fantasy. It is a straight up fantasy, and
I don't want you to be like that. I want
you to know the truth. And the truth is you
got to eat right and compliment that with a little exercise,
(40:41):
which does not have to be high intensity. It can
be as simple as walking in your neighborhood. Getting a bicycle,
doesn't even have to be an expensive bicycle, a cheap
bicycle and pedaling or getting on some treadmill which they're
more affordable now, and just walking on it for twenty minutes,
not even every day, maybe three times a week. But
(41:06):
at the end of the day, eat some vegetables, limit
your sugar, and that's pretty much all you have to do,
and you ever now and then go to the doctor
just to say hello. I want to thank all the
callers and the listeners. Remember don't drink and drive and
eat a cucumber. God bless. We'll see you next week.
All right, Internet, ready to listen. Southeast Texas Welcome, Welcome
to another edition of the Doctor Levine Medical Hour. I'm
your host, Doctor Levine Live from the Suitors of kov I.
Hear in bo my texts, taking your phone calls, answering questions,
trying to help you stay alive as long as possible
and as healthy as possible. Our phone lines are open
(00:22):
eight nine to six klv I or one in one
hundred and three to three zero kov I. We love
hearing from you and talking with you and answering your
questions and trying to help you clarify what it is
the best thing for you and your family to stay
alive as long as possible, and just to figure out
what to do and what not to do, and what's
(00:43):
the best advice that someone might have for it. There's
so much information flowing out there, it's difficult to determine
who's right and who's wrong and what you should listen to.
More so than when when I first became a physician.
Just so much influence, and it does generate a lot
(01:06):
of confusion, just because a lot of times the messaging
is contradictory and you need some orientation. So that's where
your healthcare professionals come into play just to kind of
help you figure that out. And that's why we hear
sometimes with these doctor visits and these healthcare professional visits,
(01:28):
it's quick, you sit a lot, you wait a long time,
but actually when you get in to see the practition,
it's very quick. Can be frustrating. So hey, we have
this Saturday program and we can talk for an hour
or less and trying to get you fixed out. Hopefully
you're having a wonderful Saturday morning. I am whether it
(01:50):
is kind of overcast, not the most beautiful day, but
thankfully no hurricanes. As you know, we're in hurricanes season,
and this is normally when we start getting a lot
of activity out in the Gulf. So we my wife
and I normally will start watching the Weather Channel and
(02:12):
seeing what's brewing out there. We've been through several hurricanes
in the past several years. You know, hopefully we won't
have to worry about that this year, and God bless
anyone who has to go through that. Mica. Florida's one
state that seems to get a lot. Louisiana, man, we're
always inundated with these hurricanes. So hopefully no hurricanes this year.
(02:40):
The summer has gone by pretty fast. Schools back in
our guests last week, London Bryant, who's in high school.
You know, we forgot to mention that this is our
first year of being a ninth grader being in high school.
If everyone could remember those days a freshman in high school.
Go right, you got out of junior high. Now you're
(03:02):
in high school and you're the low man on the
totem pole or low woman on the totem pole, female,
and you have this new system, and it can just
be real scary. So we wish her well, and I
hope that the year goes by farewell. And we'll appreciate
(03:23):
everyone listening to her last week as she gave us
a rundown of her summer, which again, man, it went
by so quick. Even for me hadn't really been able
to experience that heat. You know, most of the time,
I'm indoors most of the day in the office or
a hospital or in my car, so not really outdoors
as much, man, But that heat is out there, and
(03:44):
we did see our share of heat related illnesses or
heat related injury, which again, the body is a machine
and it likes to operate within a certain temperature range,
just like a car, or just like any other mechanical machine.
You want to keep the temperature sort of within a
(04:07):
certain range, and when it falls outside those ranges, it
normally causes some sort of metabolic derangement or the machine
just doesn't work as efficiently. It doesn't work as well,
and most people know that they don't feel very well.
And most of the time when the temperature is high,
(04:28):
that's normally what we get into for most patients, a
elevated temperature anything about one hundred point five are above.
And the thermometers have gotten a little bit easier to use.
We remember the one that you stick in the mouth,
and then there's an ear thermometer. We remember the COVID
(04:49):
pandemic with all of the forehead thermometers that you guys
had to go through. I had to go through just
to enter a building. The accuracy of though, I'm not
quite sure, but man, we were blowing them up during
COVID just a very quick, fast, easy way to detect
(05:10):
potentially someone's acurate temperature. I don't know, man, it was
crazy doing. Then you know the temperature gun. You don't
remember that they pointed to your forehead to get your
temperature before you get walk in anywhere, get your permission,
your slip. You had to go through questions, and you
had to get your temperature checked, and I mean you
(05:31):
had to wait in line just to get in, and
if you had a temperature you had to couldn't get in.
I mean, all that stuff, man, I'm so glad that's
behind us. Brings up the point of we're getting now
that we're leaving in our summer, we're getting into ourn winter,
and so we normally start getting into our vaccines, are
(05:52):
really pushing vaccines just because respiratory viruses tend to become
more prevalent during the winter months. There's some theories as
to why that happened, but nonetheless we see it every
single year. We see it throughout the year, but normally
in the winter, starting roughly in October, November, December, then
(06:17):
in January February. Those are sort of our respiratory months
where the hospitals just fill up inundate it with the
respiratory illnesses and infections, and then as the spring and
summer come into play, it kind of dies down where
we see the respiratory problems. But it's just not at
(06:40):
the volume of doing the winter and that's when we
start promoting our vaccines. Now, as a healthcare professional primary
care physician, it is sort of our duty to promote
them every single visit, and that should be a part
of your experience when you go to your primary care
(07:02):
physician or healthcare professional. Certainly a couple of different tasks
that should be prioritized every time you interact with them. Again,
the system has gotten better with trying to introduce sort
of some routine into that visit. Again, when I hit
the scene over twenty years ago, a private practice was
(07:24):
really a personal experience. Is because doctor A was really
different from doctor B. To be honest with, even though
your diseases were the same, you sort of got a
different approach from doctor A versus doctor B. And it's
going to be hard to completely have a carbon copy
(07:45):
of doctor A and doctor B when you have that experience,
even though that's where the healthcare world is trying to get.
Like when you go into Burger Place A and Burger
Place B. They are the same company and you're trying
to get the same sort of experience from this location
versus that location. It's still kind of hard. We have
(08:08):
that issue with certain other entities, Like some people get
frustrated with pharmacies. They call this pharmacy. They have a
hard time sort of getting their meds and just callbacks
and stuff like that, so they try a different one
and they might have better luck with that same thing
with doctors' offices. Right, So they're trying to sort of
(08:29):
introduce some regularity so that some basic things that you
should be getting no matter where you're going. And one
of those is the prioritization of vaccines and importance of that.
The healthcare world believes heavily in these vaccines, and we're
going to keep promoting them. Although we know it's controversial.
That's not going anywhere. This is America, right. That's what
(08:51):
we love about this country so much that we can
argue about it. We can come to the table and
try and figure out what's the best and what's the
right thing, open argument, open discussion. That's why we love
the country. It's never going anywhere. It keeps everyone safe.
That's why we do it. So we don't have one
(09:13):
compliance even though we like that. Carry from needle and
how can we help you, Hi?
Speaker 2 (09:20):
My question was I've seen a doctor in Beaumont for TMJ,
my jaw was clicking and popping, and you know, he
gave me a splint and that pretty much fixed it.
But you know, I still have pain that you know,
it kind of comes and goes. I'm wondering what should
I do.
Speaker 1 (09:40):
Well A lot of times with a TMJ temporal mandibular
joint disease. I mean, I hadn't said that in a
long time, but it's basically a joint issue, and just
like a knee or back, or a neck or elbow,
it can a lot of times generates inflammation and that
(10:01):
joint just because of the disease process of what causes TMJ.
I'm not the world's expert on that one, but nonetheless,
pain can be a part of that experience. And if
the application that your dentist gave you doesn't completely take
the pain away, certainly you can always reach back out
(10:21):
to that practitioner and let them know you're still experiencing
some discomfort to see what they recommend. Most of the time,
we would go to some anti inflammatory medications because a
lot of times the joint is inflamed just because of
the joint itself and because it's not perfect, it sort
(10:41):
of injures the joint slightly, which is what the mouthpiece
is there to do. It's just sort of the realignment
joints space so that it doesn't injure the joint. But
nonetheless pain can be a part of it. So we
normally go with things like talalnol or motor and advil
that you can take to help that, but some practitioners
are a little bit more aggressive. You can do injections
(11:04):
in that area as far as I know, to help
with this comfort. Sometimes there's different mouthpieces, sizes, shapes that
might again align the joint space better when you go
to sleep. So certainly I would reach back out to
your practitioner and see particularly what they would like to
do to try and to alleviate the pain. We always
(11:26):
try to make the pain go away one hundred percent,
but sometimes the goal is to reduce the pain by
sixty percent or eighty percent, just so it's not as severe.
But I think that would be a good way to
approach that some over the counter in inflammatories and then
talk with your healthcare provider who is working with you
on your TMJ.
Speaker 2 (11:49):
Okay, all right, thank you, yes, ma'am.
Speaker 1 (11:51):
I appreciate the phone call. And yeah, you know, the
idea of reassessment. You have to get a comfortable with that,
and I've gotten comfortable with that over the years as
a healthcare pro healthcare provider is the idea of getting reassessed.
(12:12):
I know that's maybe kind of frustrating for health care
I'm sorry patients. They sort of want the answer on
the first day. And for the most part, any health
care provider that you go to, you probably will get
the right answer the first time you go there. But
(12:35):
it is sort of common that your symptoms will not
go away completely. They might get worse, or they might change,
and you have to have an open mind to get reassessed.
Not necessarily upset about it, but just understanding the simple
fact that there's only so many symptoms that a healthcare
(12:56):
provider has to work with, right and there's about and
it's about ten of them that we sort of circulate
every single day with no matter who you are or
where you are in this world, it's about ten key
medical complaints physical complaints that we kind of work with
throughout the day. And every disease known a man can
(13:20):
start off with one or combination of those sort of
ten physical complaints and the physician or the healthcare pravoted
nurse practrician physician assistant. They have to gather more information,
normally vital signs or maybe what your physical examination may be,
the results of X rays and labs to try and
(13:42):
figure that out. But I can tell you after being
a healthcare provider for over twenty years, man, it's not
always clear what is actually the cause of a patients symptoms.
We might have a few ideas, and we might want
to monitor or a patient I observe a patient, whether
it be at a hospital, even at home, and see
(14:05):
what happens over the next few days, the next few hours. Again,
if we think it's critical, we normally will hospitalize and
hook you up to all sorts of monitors and do
all sorts of blood work, and maybe have some other
doctors see you to try and get to the bottom
of what's wrong with you and get you some answers
as soon as possible, because we certainly know how fearful
(14:29):
that is and how anxiety provoking that is is to
have a physical symptom and the expert that you're working with,
that you spoke to, that should know what's wrong with you,
doesn't know what's wrong with you and they tell you that,
I mean, where do you go from there? Right, it's
just sort of an my god, what do I do?
(14:49):
I mean, I'm scared, I'm nervous, and they don't even
know what's wrong with me. I mean, what are my options?
So yeah, I mean doctors would love to and healthcare
providers would love to be able to just freely, easily,
quickly tell you exactly what the problem is. But man,
(15:10):
it's it's tough out there every single day trying to
do that again high majority of the time. Yeah, we
have that answer, we know what it is, and we're
going to do this and this and that. You're going
to get better and like real nice, predictable stuff. You know,
you have some abdominal pain, you go to your X ray.
I'm sorry, you're er, they do X ray. You have
(15:30):
a penicitis. Man, that's easy, right, But think about chest pain.
Think about abdomina pain or shortness of breath, or headaches
or confusion, which we see a lot of that every
single day. I mean, that's a lot of different diseases
that can cause that, and sometimes it takes a while
to figure that out. But I want to encourage all
(15:52):
the listeners to get reassessed if you're not better, if
your symptoms do not go away, just have an open
mind to say, hey, I need to either get back
to the original practitioner, which is what I advise most
of the time, just because the practitioner sort of knows
those symptoms, they've maybe already done a few other things.
(16:16):
They already kind of have in mind what they might
want to do if you come back, or a different
medicine that they might want to use or referral or
X ray or work up if you come back, if
you go to a different one, you might kind of
have to start over. Behave Sometimes that's what you need
to do. It's kind of tricky. It is kind of tricky,
But if you have confidence in the original practitioner, by
(16:38):
all means, go to that. Go back to that practitioner.
Have am not better, this is new, this medicine's not working,
and let them kind of rework it again. Nothing is
wrong with that. Just the sharing of information can be limited.
We see this a lot in the hospital where patients
are sick, they're vomiting, they have pain, they're altered there, paired,
(17:00):
they're by themselves. Doctors, nurses come in, Hey, what's wrong
with you? What happened? You can't remember that stuff when
you're in pain and you're throwing up and you got
a headache and you're you can't see out of one
it's not thinking clearly, right, and so you're what you
(17:21):
tell the practition might be very limited. You might not
be in the right frame of mind and want to
give a history in terms of what happened. So the
practitioners don't have a whole lot to work with. But again,
your wife is there, your your husband is there, maybe
a family member who is there, and they're more they're
not in pain, right, they can really give the history
(17:43):
because that happens a lot of times. We're going Initially
they're by themselves and we get what we can and
that's it. And then an hour later to ours, somebody
shows up a witness, right, just like a crime scene,
a witness shows up and we get more information. Then okay,
well let's do this, let's do that. I mean, that's
(18:03):
how that works in the healthcare world. And the same
thing with any sort of physical element that you have.
You have to go get reassessed and have an open mind. Yes,
even if it means if you're in the hospital. I
hear this all the time in the hospital. I do
hospital work from back to this hospital when just before
we discharge patients patients like that. I don't want to
(18:24):
have to come back. I don't want to have to
come back to the hospital. Be sure before you discharge me.
I don't want to have to come back. And I
know it's super frustrating right to have to get back
to the er and be processed and wait, Oh my god,
who wants to do They gotta wait in the R
for hours and hours. Even though just so you guys know,
(18:47):
I mean, all hospitals in this country work on their
system to more efficiently processed patients coming through the R.
It's just that man, in the heat of the day,
they are get hammered. I mean hammered with acute complaints
and serious acute complaints. I mean things that are life threatening.
(19:11):
I mean they're just getting bombarded simultaneously. They could have
someone having a massive heart attack, a massive stroke, and
dying all in the same room, you know. And yeah,
I mean it's hard to get everybody addressed in a
timely fashion when things are hopping like that. Gotta be
(19:34):
understanding in that situation. So I know that it's like, no,
I don't want to have to go to that process again.
So before you let me go, let's make sure everything
is good. And you know, most doctors try to get
that done, and for the most part, we do, but
you know, it's not perfect. We can't line it up
all the time. Just something's gonna happen. You get worse.
(19:55):
Medicine doesn't work. I mean that's just built into it, unfortunately.
And yes, you have to come back to the hospital,
even if it's within six hours, twelve hours a day,
two days, and we will see it. We just can't
guarantee success like that, and you have to get reassessed,
same thing in the doctor's office, you know, and get better.
Get back to that doctor and let them know. See
(20:17):
this a lot with skin diseases, they go to the
dermatologists the cream didn't work, that this didn't work, and
then they're frustrated and they're like, what do I do.
We'll go back to your skin doctor. Yeah, let them know.
See what else they want to want to do. I mean,
we have to go through this process of elimination, and
sometimes it can take a long time, but that's the
(20:38):
way it works. Phone lines are open eight nine six kV.
I want one hundred three three zero kov. I'll be
back in two minutes. All right, welcome back to Docta
V Medical. Our phone lines to open eight nine to
six KLV. I won one hundred three three zero Kova.
We have Mark from East Texas. How can we help you?
Speaker 2 (21:03):
The drug iloquist? Has it been around just a short
time or a relatively long time with an established track record?
What is it design to treat? And how well does
it accomplish that mission? Is it a relatively mild drug
(21:23):
or is it a powerful drug? Well powerful side effects?
And relatively speaking, how is it? How expensive is it?
We all I'll hang up and listen.
Speaker 1 (21:41):
All right, Mark, I appreciate that East Texas. All right, eloquists. Yes,
it is a great drug. It belongs to a category
of blood thinners, which we call anti coagulant blood thinners,
which is different from anti platelet medication, which you know
(22:04):
is aspirin or clo pedigrill are relentive. I think most
people are familiar with cuminin or warfarin, which again is
an anticoagulant, which is what eloquist is. Eloquis belongs to
a new category of blood thinners called direct oral anticoagulants
(22:26):
or DOAC for short DOAC, and they have been around
for several years I would say at least ten, maybe
a little bit longer, and they are a very powerful
class of medications, absolutely, and we do use them a
lot in this country just because cardiovascal disease is still
(22:51):
the biggest issue in our country and the formation of
blood clots, which we call thrombus are imbali, is extremely
common because of cardiovascal disease in this country. And one
of the central ways we treat cardiovascal disease in this
(23:12):
country is to prescribe either a anti coagulant such as
eloquist or an anti platelet such as aspirin or clo
pedigral are better known as plavix. And again that's just
because as we all get older, and I shared this
realization with a lot of patients every single day, you
(23:34):
have to respect the aging process. It is real. It
is a program that we all have that at a
certain age, normally about forty, things just sort of start
shutting down and becoming a little bit more chaotic in haywire,
and they don't work as efficiently efficiently, and the humantological system,
(23:58):
the blood system that is there to protect us, starts
getting a little haywire and becoming a little bit more
imbalanced and more prone to form blood clots, which is
why it's super common as you get older. If you
probably talk to your friend or your family, someone else
(24:18):
has already had a blood clot episode, which you might
call a stroke or a heart attack, or what we
call a pulmonary imblice or a DVT or deep vein thrombosis,
which is normally when these anticoagulants are going to be
prescribed to you when you get a thrombus like that,
(24:43):
And before the category of doas DOAC, which is what
Eloquist is a part of, it was really only warfrin
or kuminin or jentavin was another name, j A n
tv E n rat poison. That's what a lot of
people used to call it. That was the drug of choice.
(25:05):
That was really the only drug available to patients who
suffered a thrombotic event, whether it be a DVT or
a pulmonary emblas or some other thraumbas somewhere in some
other arterial tree, maybe a clot in their leg. We
see that a lot with smokers. War friend Kumitin was
(25:28):
the only thing available. The problem with that is that
it was so chaotic of a drug that it had
a very narrow therapeutic window. It's what the medical world
calls that, meaning you had to sort of keep it
the level within a certain narrow range of what we
will call therapeutic level, and it was very easy to
(25:52):
get it out of that therapeutic level, whether it was
below the therapeutic level or above the therapeutic level. When
it's above the therapeutic level, you tend to have spontaneous bleeding,
meaning you can just be walking along and then boom,
you just spring a leak. Right, And there's certain locations
(26:13):
that the body likes to leak when they're own blood thinners.
A few of them would be the gash room teslina system.
That's probably the most common is the gash room intestinal system,
which is what prompts a lot of people to have
to go into the hospital is they start bleeding. They
were in the hospital maybe a month ago, two months ago,
(26:34):
a week ago, two days ago, right, and they got
put on blood thinners by doctor Levine because they had
a thrombotic event. And then two days from now, they're
in the restroom and they go to restroom, there's nothing
but blood in the toilet. We see that all the time.
Are they urinating blood? Right? Or you start getting those nasty,
(26:59):
ugly bruises on your arm that people just love to see, right, Like,
what is going on? Are you getting beat up at home?
Speaker 2 (27:08):
Right?
Speaker 1 (27:09):
I mean I have these conversations. I'd swear to God
to you. Yeah, so war when coomanin terrible, terrible in
terms of its ability to predict that therapeutic windows. So
people bled a lot. And when you bleed, I mean
a lot of things, serious, bad things can happen. And
I forgot the infamous bleeding in your brain. We used
(27:31):
to see that a ton. Someone is on kuminin they
had a DVT maybe a month ago, they got put
on Koman and then now they come in they're confused,
I mean, and it happens rapidly they start bleeding in
their brain. I mean, who seen that? So thank god?
(27:52):
The pharmaceutic company came out with this new category of
drugs Eloquists Doxa as well as the Relato. These are
the three medicines in this sort of new category of
anti quagons, which are more stable. You don't have to
check your blood. Everyone knows, right, all the listeners they
(28:14):
remember having to go to the Kuminin clinic, right every
week every two weeks, and you had to increase this
and stop this and start that and up and down
with this kumitin. I mean it was a major, major
headache and it could impact your lifestyle, right, I mean
you had to work, but then you had to go
to the Kumin clinic and you had to go get
(28:35):
this new dose of medicines and you had to remember
it and you take two this day and then one
another day, and you had to hold this and stop that,
and then you couldn't eat green lettuce and you couldn't
eat nothing with green You couldn't. I mean, just oh
my god, just for this one drug. But then doas
Doac came into play. Eloquist changed it all, changed it all, right.
(29:03):
I mean, people still bleed on these medicines, but a
whole lot less. In my experience, we have less of
these catastrophic bleeds. In my experience, you can still bleed.
Patients still come in bleeding, but not at the frequency
and the severity that they did when Kuminin was the
(29:23):
only player on the field, and Kuminin is still out
there and people are still taking Kuminin or warfaring, But
this new category doax or eloquists change the game. And
if you have had an event, this is the drug
of choice that most doctors are reaching for, especially when
(29:43):
you've had a DVT or a pulmonary imblice. Those are
pretty much the two big categories that patients get placed
on these blood thinners. Also in other categories if you
have a condition called atrial fibrillation, which is in my opinion,
the most common cardiac irregularity as you get older. We
(30:05):
see this stuff every single day in the hospital, in
the office. The issue with agri of fibrillation is it's
chaotic cardiac activity. And when the blood, the blood is flowing, well,
the heart is pumping the blood. I mean it's flowing
like a stream. I mean it's rapid, it's flowing. But
(30:26):
if the heart function becomes chaotic or it slows down,
the blood can flow and it gets sticky and it
tends to generate thrombus blood clots right, and a blood
clot can leave the heart and travel anywhere. We call
that an embalus pomonary embulsces get it and it can
(30:48):
block blood flow in a certain location, primarily the brain,
but it can be the foot, it can be your lung,
it can be your kidney. Primarily the brain is the
one that we that we're concerned about it and cause
a big stroke. So most of the time when you
get diagnosed with hrual fibrillation, you have to be put
on a blood thinner. It used to be Kumitin. So
(31:10):
you get diagnosed at h fribllation, you get put on Kumitin.
Now you got to go to Kumanin clinic. You gotta
take all these meds and just this huge production. Now
it's sort of been dumbed down. You don't have to
do all that stuff anymore, and it's more stable. Phone
lines are open eight nine six kalv i one hundred
three three zero kov I'll be back in two minutes.
(31:33):
All right, welcome back to doctor Vimnaga. Our phone lines
are open eight nine to six kalva one one hundred
three three zero ko Yah Talking about eloquist which is
a Anarqui. Great question. By the way, we appreciate that
it is a anti coagulant which is different from an
anti platelet. You know that them as aspirin, plavix, clo, pedigrill, brilenta,
(31:59):
which again, if you think about it, cardiovascusease number one
problem in our country, cancer number two, number three, I
can't remember. I think maybe Alzheimer's could be another disease.
But this is what keeps the doctors busy all day
dealing with these two diseases, and the way we treat
that is with blood thinners. So the pharmaceutical world has
(32:23):
introduced newer blood thinners and this Eloquists are class of
dough acts. You're familiar with gop one, right, that's a
diabetes as z infic, right. But another term do acts,
direct oral anticoagulants is what eloquist belongs to.
Speaker 2 (32:41):
Man.
Speaker 1 (32:42):
These have revolutionized the prescribing for these particular thrombotic events
which most of us are at risk for as we
get older. Just getting older all by itself is a
big risk factor for forming clots. Just getting old again,
the blood doesn't work as well, the heart doesn't work
(33:03):
as well. The most of us, because of our diet
and our habits, are going to have some plaque in
our blood vessel system just like plumbing just gets that
build up just from years of use. So all of
these factors sort of promote that. But if you're sedentary,
(33:24):
meaning you sit a lot, if you have certain medical diseases,
heart failure is one big risk factor for clots. Kidney
failure is another big risk factor for clots. In what
feeds into heart and kidney failure high pertension, diabetes, high cholesterol, band, overweight,
(33:47):
ban inactive, you know, just that American lifestyle unfortunately leads
to the formation of clots. And we see these clots
in our hospital every single day. We see them in
office every single day. You have to be on the
lookout because they're out there and patients are getting placed
on these medications. Are they affordable? I think that was
(34:08):
another question our caller had. It depends, I think depending
on some patients. If you have no insurance, yeah, they
can be real high, really really high. I mean just
out of reach in my opinion, you know, five six
hundred dollars a month, I mean crazy numbers. But a
(34:30):
lot of times if you have insurance with Medicare or
wish my wife was here, we can go over that.
They pay for that stuff, They make it affordable. They
subsidize expense. And the pharmaceutical company themselves still has programs
out there where if you have a certain card which
they normally give to the provider, they have them in
(34:51):
their offices. Typically they'll give you like a month for free,
or they'll take so much money off of the bents
of the drug so that maybe it'll drop the price
of your personal cost of the drug down to a
more affordable range. Again, but it's so varied out there.
(35:11):
I hear these stories all day long from patients. Now,
depending on your insurance, the time of year, and the
pharmacy you go to, and sometimes even the doctor's office
you go to, those are four variables that a lot
of times you don't kind of control that can impact
(35:33):
the ultimate cost of the drug. Meaning you can call
this one pharmacy with this same drug, same doctor's office,
you get this price. You go across the street to
a different pharmacy, same prescription, same doctor's office, different price.
I see that. So that's why a lot of times
(35:55):
when patients come out, hey it's too expensive, I say,
try different pharmacy. Go to three different pharmacies, and a
lot of times you would get different pricing. Call your
insurance company. That's one thing that I ask of my
patients all the time, just because most primary care physicians'
offices do not have this staff are the time, unfortunately,
(36:18):
to make all these phone calls, with all these issues
every single day that comes up, with all these products, referrals, meds,
prior authorizations. It's too much. It's overwhelming for any doctor's
office to be able to do that. I mean I
would have to I would have to hire five more
people in order for us to do all of that
(36:40):
for patients, so unfortunate. A lot of times at our
office we ask patients to help us out and make
some of those phone calls and talk to your insurance
company and say, hey, if eloquist is too expensive, which
one do they pay for? Because normally, if you have
the diagnosis, they'll pay for one of them, Prodoxa, eloquist osorrelto.
(37:00):
But a lot of times I don't know, they don't
give us that service, that platform where I can go
to some website and say, okay, your insurance will pay
for this. This is going to be the expense. I
don't really have that website to go to. As a doctor.
We just maybe like Zerelto, We like eloquist, We prescribe
it and boom off to the races, and then the
journey starts for you. Right, phone lines are open eight
(37:22):
nine c's kV I won one hundred through three zero kaloviyah,
last break, be right back, all right, welcome back to
the doctoraviing medical hour. Excuse me clearing my Throat's our last,
Like man, time goes about so quickly. I want to
thank all of the callers as well as the listeners. Remember,
if there's a topic that you like me to discuss,
you can call the station, can call my office four
(37:43):
nine three four seven three six two one, and we
can talk about the top you like to discuss. We
had some fun talking about eloquists. Are do acts which
you don't talk about a lot. We should talk about
it more often. New class of blood dinners, very strong,
extremely effective. Still can bleed, but the risk is a
(38:06):
lot lower than an old friend kumitin or war friend,
and sometimes can be as very expensive and a lot
of times, working with your insurance company or even the
pharmaceutical company, you can go to their website, you can
get that price down to a more affordable range. And yes,
once you start taking these medications, if you just take
(38:28):
the medication, you should not have another thrambas experience. And
again understand that the number one problem in our country
is cardio vascal disease, which the formation of thrambas is
a part of that. So most of you listen to
this show will probably be put on some form of
(38:49):
an anti platelet like as from plavix or an anticoagulant
eloquis zerelto at some point in your life. Again, that
is what happened to most Americans. Some cardiovascular disease will
impact you. Again because we like ultra processed foods, we
(39:09):
like consuming sugary beverages, and we like consuming a lot
of ultra processed starches and sugars. That is our diet.
That is what we like. That's the way we live.
And I've told you over and over again it is
your lifestyle that impacts your health. The most number one
(39:33):
eating a proper diet, right, Yes, it's cumbersome. Yes, eating
vegetables might be a little bit more expensive, time consuming
because there's no preservatives. You gotta eat it. It's fresh.
Frozen is not terrible. That's a good alternative, but certainly
you have to do your part at know, going to
(39:54):
your vitamin store, getting your vitamins off the internet, at
your little super Man pack or your female pack, and
you've got several different vitamins. You're gonna swallow them every morning.
That that's going to compensate for being overweight. That the
fact that you're still drinking sugary beverages, you're still eating
(40:17):
ultra processed foods, you're not exercising, you're smoking, you're drinking
a lot of alcohol. It's just going to overcome that.
It's a fantasy. It is a straight up fantasy, and
I don't want you to be like that. I want
you to know the truth. And the truth is you
got to eat right and compliment that with a little exercise,
(40:41):
which does not have to be high intensity. It can
be as simple as walking in your neighborhood. Getting a bicycle,
doesn't even have to be an expensive bicycle, a cheap
bicycle and pedaling or getting on some treadmill which they're
more affordable now, and just walking on it for twenty minutes,
not even every day, maybe three times a week. But
(41:06):
at the end of the day, eat some vegetables, limit
your sugar, and that's pretty much all you have to do,
and you ever now and then go to the doctor
just to say hello. I want to thank all the
callers and the listeners. Remember don't drink and drive and
eat a cucumber. God bless. We'll see you next week.
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