October 20, 2025 • 43 mins
- Listen Saturday mornings at 8 as Dr. Msonthi Levine discusses medical issues and takes your calls on News Talk 560 KLVI. Dr Levine is board certified in Internal Medicine and Geriatrics. His office is located at 3080 Milam in Beaumont, Texas. He can be reached at 409-347-3621.
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Episode Transcript
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Speaker 1 (00:00):
All right, welcome South East Texas Internet radio listeners. This
(00:03):
is your weekly host, Doctor Levine on the Doctor Levine
and Medical Hour. We are here at the series of
klv I here in Beaumont, Texas, cross street from Park
Demo answering your phone calls about healthcare and medicine. Trying
to stay alive as long as possible and as healthy
as possible so that you're unlikely to have to go
(00:23):
to the hospital and be hospitalized, and keep your doctor
visits to a minimum, so we know how pleasant those are.
But we'll try to answer some questions for you get
some information. We know how complicated it is out there,
so give us a call. Phone lines to open eight
nine to six kV I one one hundred three three
(00:46):
zero klv I. Weather. It's pretty good outside today. The
heat wave seems to be over. We're heading entire winter
holiday months. Normally more enjoyable weather during this time. I'm
not sure if it's going to snow this year, but
we've had some snow a little bit limited over the years.
(01:07):
But this is the normally time where we really really
prioritize thus vaccinations just because we get those respiratory infections
big time. During this time of year, and we like
to promote these vaccines and we've talked about that before
and how good they are for you, and a lot
(01:28):
of people are concerned about their immune system and how
to keep it healthy, how to boost it, and vaccines,
in my opinion, is one way to do that. Certainly,
have to do your part with your lifestyle. We talk
about that often, but because it is so critical, it
(01:49):
is so important, you got to do your part as
you get older. It's not automatic anymore like it used
to be when you're young. Got to put that time
in and make sure that you're treating your body as
well as possible, just so that, yes, if you do
get sick, you're stronger and you have more endurance versus
(02:14):
if you're not so healthy. There's more monitoring equipment out there,
with the sugar monitors, the blood pressure monitors, the heart
rate monitors. You can really sort of put yourself in
a position where you're kind of up with that and
making sure you're doing everything you can to stay out
of trouble. And even if you are going to the
(02:37):
doctor on a regular basis, you are doing your part.
You do have your monitoring equipment, you can still have issues,
but try to stay ahead of the game. Just like
with cancer screening, we don't talk enough about that, but
it's an opportunity for someone to again find something sooner
(02:58):
rather than later, colon cancer being a perfect example of that.
We still we still have patients coming into the hospital
that for whatever reason just didn't get a primary, doesn't
go to a primary, they don't get the screening tests
(03:19):
that they deserve, and they come in with sort of
this advanced stage of cancer cancers that we're focusing on.
Remember that, unfortunately, we don't screen for all cancers. We
have about four that we are constantly kind of screening
for looking at, but we're unfortunately still getting patients with
(03:40):
what we call stage four. You know, cancers have stages, right,
It helps the oncologists, those are the cancer specialists sort
of figure out how aggressive it is and what sort
of treatment plan they can give for you. Normally stage
four is considered one that has advanced significantly or in
different sites. Remember that the way the cancer world is
(04:05):
categorized as you have a cancer cell that starts at
some point and they call that the primary cancer. You
know where it started, or what is the cancer cell
that kicked off everything, whether it be liver cancer, pancreas cancer,
(04:26):
lung cancer, breast cancer. It normally starts at a primary point,
so we normally call that the primary cancer. And if
it leaves that primary area and then goes somewhere else,
then we call that metastatic, meaning it's traveled. It's now
(04:48):
left the original spot and it has embedded itself into
another location such as the brain, or the spine or
the liver. We see that a lot with colon cancer.
The cancer starts in the colon, but because of the
behavior of the cancer and the way the body is engineered,
(05:13):
that colon cancer will leave there and go right to
the liver, and we call that metastatic. And normally we
will give that a stage four category, which means it's
advanced and it's systemic. If you will again, if you
can find the cancer in its original location, you know
(05:35):
it's not too big and it hasn't spread. It's more
of a stage one and normally stage one cancers, if
they're found, normally are easier to treat, normally a cure,
and you can normally not have to suffer any significant
(05:56):
adverse reaction from the treatment, and your prognosis is good,
Stage four being less, but still even like I said,
with colon cancer, if you're going to your doctor getting
your screening, you should not have any stage four issues.
I mean, sometimes it catches you off guard, meaning cancer
can present at a very young age, maybe in a
(06:19):
family that doesn't have any cancer. Patient really has no
symptoms until it pops up. We see that as well,
but I guess I'm talking about the patients that are
in their fifties, sixties and hadn't really gone in and
hadn't gotten checked out. Remember, colon cancer screening now is
easier than it was years ago. When I came out
(06:43):
of residency, we were doing what they call flex SIGs
flax sig and just stands for flexible sigmoidoscopy, which is
the instrument that they used to look for colon cancers.
We unfortunately again had to learn but when when I
(07:05):
was coming out, the flex sigmatoscopy would only look at
half of the colon because that's where most of the
colon cancers were occurring. And then we sort of found
out through research that there are certain cancers that end
up beyond that area that we were looking. So people
(07:28):
were getting their flex sigmatoscopy screening exams and then still
coming down and cancer, and we just couldn't understand that.
But then we figured out, yes, we had to look
at the entire colon. So the standard became just the
colonoscopy where they used their scopes and they looked at
the entire colon and depending on your age and your
(07:52):
family history and what they found on the original scope,
that would sort of dictate how frequent you would get
these scopes and how soon you had to start, et cetera,
et cetera. But it's cumbersome to have to get a colonoscopy, right.
You have to drink that solution the night before. You
(08:13):
have to a lot of times be chaperone or you
need someone to take you because there's some slight sedation
that they use for the colonoscopy, and it would pretty
much take you, you know, most of the morning or
the evening to get that done, so you would have
to miss work. I mean, it was a big I
(08:34):
shouldn't say big, but it was a significant commitment that
a lot of people couldn't do it. I mean it
was it was hard to fit that in their schedule,
or they didn't want to have an instrument placed there,
or they didn't they have a problem with sedation, or
maybe they're on blood thinners and they can't stop their blood.
I mean, just the list of possible interferences was a
(08:58):
lot higher. So even though maybe they have Blue Cross
Blue Shield, they go to their doctor, they would be
offered the colonoscopy. They wouldn't do it for various reasons.
So year after year, no colonoscopy, and then boom, get
diagnosed with like a stage three or stage four colon
cancer because they didn't engage with those screening intervals that
(09:21):
have been recommended to them. But now it's gotten easier. There's,
like I say, a stool kit that can come to
your house. Most people have seen commercials on TV called
colon Guard, somewhat controversial if you talk with gaserentrologists that
they do sort of are concerned about those screening app
(09:45):
screening tests at the stool kits, but again the most
of the medical organizations have endorsed them. Something I use
in my practice and so far, knock on wood, everything
has worked out. Okay, We've had several people that basically
have had some positive tests and they eventually get to colonoscopy,
(10:06):
and most of the time they have polyps that they
find no cancer. That's been my experience, but you may
have other practitioners that have had other experiences. But bottom
line is that is convenient. It gets you in the
door to get your screening accomplished without a colonoscopy. And again,
these are ones that we're using for low risk patients,
(10:29):
which means you have no family history, you have no symptoms,
and you're just at forty five right, because that's when
we start screening. Now, we used to start at fifty.
Now for the average person was starting at forty five. Again,
research was finding out that we were still missing a
(10:49):
significant portion of those patients, so we had to drop
the age down the forty five because it used to
be fifty. Now, if it runs in your family, you
might start screening at the age of thirty or even forty,
just depends on your family issues. So strong family history
normally you would start sooner. You know, if it was
(11:10):
your mother, your dad, or brother or sister, that tends
to mean that's a strong genetic linkage and we probably
just lay some eyes on you a lot sooner, so
we would get you in sooner to start your screening
and try and find that sooner. So because at this point,
(11:31):
if you get a stage one or stage two, a
lot of times it can be surgically removed and that's
a cure. Are sometimes you have to undergo some chemo
with the surgery, but the chemo now is very well tolerated.
A lot of times patients can continue to go to work.
(11:52):
It's not that toxic like a lot of the chemo
medicines were back in the day. I mean, they've gotten
a lot better. It's amazing the amount of research and
the interest in cancer treatment has advanced the treatment of cancer.
I mean, they're a lot of times putting people in
(12:12):
remission with minimal adverse reaction. I think that was the
issue years ago, is man that the medicines were just
so harsh that that was something separate. Yes you have cancer,
but now you have to undergo this very toxic, harsh
sort of treatment. Just a lot of adverse physical problems.
(12:34):
I mean, we still see them, but I don't think.
I'm not a cancer doctor, but I help manage cancer
patients in the hospital, and just from what I'm seeing
that the adverse reaction issues normally just you know, maybe
some gasher intestinal, maybe neurological issues and certainly infections, just
(12:57):
because there's sort of this interplay with chemo on your
immune system and your metabolic system, and it can certainly
increase your risk of infection. A lot of times you're
not eating the same you're getting exposed to needles, and
you have this cancer, and so it's just a lot
of tension in your body at the time you get
diagnosed and the treatment and so a lot of physical
(13:21):
elements can happen in that situation. But certainly want to
get your screening in and colon cancer is one of those.
So now they have those stool kits very convenient comes
to your house. It's all sort of digital, meaning your
communication with the processing center. They can track it, you
(13:42):
can track it, you get your results, they remind you
when you need another one. I mean, it's really gotten
super convenient. That's what we try to do with vaccines.
You know that we have them in the doctor's offices,
we have them at the pharmacy, which a lot of
people are going to the pharmacy because a lot of
US Americans unfortunately have prescription medication. So we're at the pharmacy.
(14:06):
It's convenient. We just kind of get it in and
go home again. We want to increase compliance as much
as possible, and so this is the time we normally
will focus on that during the winter because all the
winter infections viruses that we do see during this time.
So if you're off today and you're hanging out, like
what can I do, go get your vaccine and help
(14:27):
you and your family out anyway. Phone lines are open
eight nine six kV I one hundred three three zero kVA.
Speaker 2 (14:33):
I'll be back in two minutes. All right, Welcome back
to the dark Waion Medical.
Speaker 1 (14:47):
Our phone lines are open eight nine six k v
I one hundred three three zero kill y. I'd love
to hear from you. One complaint I get a lot
in the office is weakness. I feel weak. I don't
feel strong anymore. I'm tired. Something is happening to me.
I don't have that vigor and strength and endurance that
(15:10):
I once had. What is wrong? Weakness? Seems like maybe
all of us get that periodically, but it is a complaint,
a physical complaint that I hear often several times a day,
and trying to figure that out can be extremely challenging
for most healthcare professionals who get that complaint of just weakness.
(15:34):
Don't feel good. I'm not strong, and that's pretty much
all you get in terms of complaint, I just don't
feel strong. So it's always been some time sort of
talking about some of the causes of weakness that I
see as healthcare professional over twenty years of service. And
(15:54):
most of the time we start off with just basic
labs and basic X rays that that most doctors do
in their offices a CBC and checking your kidney function, thyroids, electrolytes,
your bone marrow function, thyroid profile, cholesterol, check your urine
(16:16):
as well. This is a pretty basic screening starting point
for most physical complaints. And then with some X rays
would throw that in as well. Chest X ray just
look at your chest and depending on your physical and
your family history and any other associated symptoms that go
(16:37):
along with the weakness, I might do a cat scan
of your abdomen and for guys, for girls, might do
some hormone levels as well, again because both of us
men women can have some lowering of the natural hormone levels.
(16:57):
The testosterone estrogen sometimes just not make you feel very well,
so menopause male menopause, however you want to call it,
low t that stuff happens, and guys get it to
normally in their deeper ages, but we are finding some
men that do have low tea issues in their forties,
(17:19):
which is a little premature, but we do see it
so normally. That's sort of my approach. If someone comes
in with we can just sort of get a nice
screening evaluation, check all those different areas and see if
anything pops up. One thing that we always have to
(17:39):
be concerned about again because of the use of pharmaceutical medication,
is the medications that you're taking. So a lot of
times I will just look at the medication peruse of
medicines and see if there's anything that pops up. Just
about any medication that's prescribed to you can at some
point generate a little fatigue issue us or some lack
(18:01):
of energy, you know, especially our blood pressure medications, cholesterol meds,
if you have anxiety depression, you're taking antidepressant anti anxiety medications.
If you have chronic pain and you're taking various pain
medication such as gabapentin or lyrica or even the narcotic
(18:25):
based pain medication, again the combination can sort of sap
your strength and we have to spend some time trying
to de escalate, as we say, some of the medications
to see if that will increase your energy or not. Again,
a lot of times you need these medications to help
fight some other chronic medical problem, and it's difficult. Meaning
(18:51):
you can't be on five ten medications a day and
expect to fill one hundred percent.
Speaker 2 (18:58):
I just.
Speaker 1 (19:00):
You can't believe that. You can't buy that. That's a
fantasy to think that you take ten medications and you're
supposed to feel wonderful and great and strong and healthy.
I mean, we try to achieve that. The pharmaceutical companies
try to give us medications that are neutral, meaning that
we prescribe the medicine. You take it, but you don't
(19:23):
feel like you're taking a medicine. Those are some of
the older medicines I was talking about chemotherapy in the
cancer world. That's what they're trying to achieve all the time,
is you get cancered. They give you medicine and you
feel neutral, like nothing is happening. You're getting this medicine.
It's attacking the cancer, but it's not doing anything else.
You don't lose your hair, your appetite's fine, you feel strong,
(19:46):
you go to work every day. I mean, that's what
we're trying to achieve with newer and newer medications that
come out all the time, you know, sort of once
a day medicine, simple dosing, no collateral issues. But again,
if you're taking ten medications every day, it's going to
be hard to feel just completely normal just because of
(20:09):
the interaction issues that come along with taking a lot
of medications. But again I always focus on that and
see if we can change something, reduce something. Again, over
the years, I would say I try to limit the
number of medicines that I will prescribe to a patient,
(20:29):
especially if there's several things going on in the visit
and I'm starting maybe two medicines, three medicines. It makes
me uncomfortable, and a lot of times I will recommend
to not start the medicines all in the same day
and maybe start one today, wait several days and start
the next one, and then so forth and so on,
(20:51):
just so we can remain oriented about what is happening,
just because if something does happen, we want to have
some orientation or ability to say, yes, it's that medication
that make me feel tired and fatigued. So again that's
sort of my approach with that. But other things that
(21:12):
can cause fatigue that you should be on the lookout
for as thyroid disorders, which again most doctors who are
primary care doctors and even in the er, they're doing
this now, checking the thyroid levels to make sure that
the thyroid profile is stable. That's a very easy fix
(21:34):
for fatigue if the thyroid is low and you just
need some thyroid replacement, it's very simple, it's very easy
to dose that. You don't necessarily have to go to
a thyroid specialist when it comes to that, but that's
certainly something you should check. And then your kidney function. Again,
as your kidneys stop working, as they stop clearing the
(21:55):
toxins in your bloodstream, it will start to generate a
sense of fatigue in your body. Just your muscles may
be hurt, you just don't have the endurance you used
to have. You might start getting some nausea and just
loss of appetite, but again that can normally be picked
up with just routine blood work when it comes to that.
(22:16):
Any electrolyte problems such as a high calcium, a low calcium,
a high sodium, a low sodium, a high phosphorus, low potassium,
high potassium, So a lot of electrolyte problems come into play,
especially if you're taking medications that can generate some fatigue
(22:38):
and loss of strength whenever you start taking these medications. Again,
that can be picked up very easily with the blood work.
But cancers sort of on a cancer theme today, but
cancers can sometimes just cause fatigue. You know, I just
don't feel good, something's off, My energy is down, especially
(23:00):
if you're fifty and above. I'm sort of always on
the lookout for that, just because that's a lot of
times when most of our cancers start happening, not all,
but some, I mean, breast cancer can happen soon. I mean,
any cancer can happen sooner than the normal range of cancers. Again,
most of the time we're screening, it's just for the
general population, and we have data for the sort of
(23:24):
low risk of general population. But cancers do run in families.
There's genetic abitimalodies that increase your risk of cancer. This
is something you should know talking with your mother, your father,
brothers and sisters in terms of what runs in your family.
That's always good information just so you know what sort
of genetic predisposition you have, so that you can let
(23:45):
your provider know, you can educate yourself about maybe some
things you should be looking out for. It doesn't mean
you're going to necessarily get it. It's that it's guaranteed,
but certainly your risk is a little higher, and maybe
you can live your life a little bit different and
you can go into your provider and just sort of
(24:06):
engage in the screening process, the surveillance process, so that
you're picking up on this stuff so that again you
can catch you out of stage one versus the stage four.
And again our cancer doctors have gotten really good. Even
with stage four man, they're hitting some home runs in
terms of getting that cooled off and getting patients in
(24:29):
remission and just getting them on sort of on a
surveillance schedule. Well maybe they go on every six months
every year and just really never miss a beat when
it comes to that. So it's gotten to that point,
but certainly with the fatigue issues, so many different possibilities
that yeah, we start with sort of blood X rays,
(24:51):
review of your medications, and I would say for me,
maybe with that at first visit, second visit, probably seventy
eighty percent of the time I can kind of nail
it down in the general ballpark in terms of what
is causing that. We can kind of come to a
conclusion about why maybe you're not feeling your best and
(25:14):
try and adjust whatever it is we found, or maybe
we did find something on the X rays. Like I say, cancers,
it's just why do a chest X ray? Maybe sometimes
I do a cat scan again looking So many cancers
hide in the abdominal cavity. That's what we call sort
of your torso. A lot of organs in there, a
lot of them gash intestinal, but you have the reproductive organs,
(25:35):
you have your kidneys. Any or all of those organs
can potentially develop cancer. Set's why a lot of times
I'll throw in a cat scan if someone is fatigued.
I'm just looking throw out my little fishing net and
see what I get back and kind of go from there.
But there are cases where all that's kind of normal.
(25:56):
I don't really see anything on the on the medications
and paces. Still, Hey, I don't feel good. Phone lines
JO open eight nine six klv I one one hundred
three three zero klv. I'll be back in two minutes.
(26:18):
All right, Welcome back to the dark wav metagal phone
lines are open eight nine six k kelv I won
one hundred three three zero Kova talking about lack of
energy and fatigue. Just don't feel good, My energy is gone.
We did list a few common causes of that, electrolyte problems,
(26:39):
kidney failure, thyroid anemia. Forgot about that one that's super common.
Just your HGB or your hemoglobin is low. And again
you have to understand maybe why this is. There are
a lot of diseases that can cause anemia, thyroid disorders,
kidney disorders, but you know blood disorders, blood cancers can
(27:03):
cause anemia. But a very common cause that that is
just bleeding internally. And that's because again, cardiovascular disease is
our number one problem, and how do we treat that.
We treat that with blood thinners. And when your blood
is not working one hundred percent in terms of its
(27:24):
ability to form clots, it tends to bleed spontaneously. Maybe
you know someone who has bruising on their arms, or
maybe you've taken aspen once a day for a while,
or you've had a heart attack or stroke and now
you're on blood thinners and you start getting all this
bruising everywhere, and that's just bleeding in your skin, but
the same thing that's happening in your gas intestinal system
(27:48):
and you can't see it, and so it's just sort
of in the background, silently bleeding. And because you are
losing blood technically, is what that is going on. If
you're losing enough that your body can keep up with it,
then yes, your hemoglobin will start to go down and
your body feels that because you need a certain level
(28:11):
of hemoglobin in your body for your body to work efficiently.
From a hemoglobin, its primary purpose is to sort of
carry oxygen to all of the organs that require oxygen,
and if there's a decreased oxygen carrying capacity is what
they kind of call that, then your body will sort
of pick up on that and it'll start to cause
(28:32):
fatigue and you go in and get your blood work.
The CBC complete blood count that's part of most general
examinations will be low, and a lot of times the
healthcare provider will need to investigate that why is the
hemoglobe and low? Why are you anemic? So that can
be a small workup or a big workup. It just
(28:53):
kind of depends, but there is sort of a standard
approach to it. Sometimes you might have to go get
to go see a blood special or a gas neurologist,
because the most common cause of bleeding, our anemia from
bleeding is the gasro intestinal systems. So a lot of
times you have to go get your colonoscopy. They have
(29:14):
to look in the upper portion of your gasro intestinal system.
We call that an upper endoscopy. And we have intestines
sort of in the middle, the small intestines, which can
bleed as well. If you're uncuminin, you're on plavix, you're
un brilenta, your aspirin, your eloquiz a relto prodox. I mean,
we have this whole line of blood in as we're
(29:38):
using now again because plaque development is sort of the
most common issue in our country. Just as we get old,
those blood vessels fill up with the build up of
all the years of the sugars and the starches and
the smoking and the sugar and the blood pressure, you know,
just irritating to the nervous system, I'm sorry, cardiovascular system.
(30:03):
And so yeah, most people are in bloodthins and that
hemoglobin drops and man, you feel tired, You feel tired.
So but Normally a CBC can pick up on that
quite easily. But a lot of times the lab is
fairly normal. The x rays they look okay, nothing terrible,
(30:24):
but patients are still like, I stin't feel good, I'm off,
And a couple other things that I've found is lack
of sleep. Lack of proper sleep is the reason for that.
You're not getting your rest and so you feel tired.
That makes sense, right. Have you ever tried to stay
up twenty four hours? Man? I used to do that
(30:45):
all the time when I was in medical school. I
mean I could do it then, but I felt terrible.
And that's when I was young, and I'm like late twenties,
early thirties. You could do some stuff like that and
even go take a test, stay up all night, go
to sleep, go take a test. I mean, you were
just so wired up, you were so nervous, scared that
(31:07):
you were going to forget something, and you have this
three hour test. You stayed up throughout the night. It
was insane, but I did it. I couldn't do it now,
there's no way. I mean just your body hurts so much. Anyway, Yeah,
you lay down, go to bed, close your eyes, and
then you might wake up the next morning four or
five yas. Yeah, you feel terrible, your your body is achy,
(31:29):
is tired. You feel like you could go right back
to bed, and a lot of times you need to.
But a lot of times it's because you have a
sleeping disorder. And the most common sleeping disorder in our
country is called obstructive sleep apnea OSA for short. Why
is that the most common? I'm sure somebody can answer
(31:52):
that class class. Yes, because we're dealing with obesity in
our country. Everybody's overweight big, right, You're heavier than your
frame normally is designed to carry. A lot of that
weight goes to that neck. That's why you can tell
when someone's thin, right, you see, you haven't seen a
(32:13):
friend in a long time. You can look right at
the neck. Is the neck big or is it skinny?
So a lot of that excessive weight that we're carrying
goes right to the neck and inside the neck the
oral fairings as we call that. And again, as all
of us sleep, our muscles relax, we go into sort
(32:34):
of a semi paralyzed state in the deeper stages of sleep.
I mean, we're asleep, we can't sense it, but the
muscles relax, and it's the throat area sort of collapses
on itself a little bit. And if you have a
lot of that excessive tissue, just the amount of area
that the air can flow through is significantly reduced. You
(32:56):
would call it stenosis or narrowing. And that can sometimes
be very disruptive to your breathing to the point that
you stop breathing. A lot of spouses see their loved
ones doing this every night and they have to wake
them up just because they stop breathing or the breathing
is the story is so loud that you can hear it.
(33:18):
It's very disruptive. But all that is is sleep apnea.
And I've advised all of my listeners if your body
mass index is thirty or above against simple calculation weight
over height, you can do it on your computer or
your smartphone. You can use a calculator whatever, but they
have these little formulas or apps you can download. If
(33:40):
you're being my body mass index is what that stands
for B and is thirty or above, go get a
sleeping study and the cool thing. And again, healthcare is
getting so convenient, so twenty four hours, so just righting
your face at all times you used to have to
go to a sleep lab. You don't have to do it.
(34:01):
You can do it at your house. Most healthcare providers
have the ability these appliances that you can just wear
at home. You get your sleep study at your house
and your own bed, simple to use, and the doctors
can download that information very quickly and while you have it,
and then you get your machine. Normally we treat obstructive
(34:24):
sleep apping with a SEEPAP machine, continuous positive airway pressure,
little bitty device quiet. The appliances that you would put
on your face, that has come a long way as well.
Used to be very cumbersome patients than like them. Now
they're easier to use, they're better to fit on the face.
(34:44):
You just put it on, press go and boom. You're
ready to go and you can get yourself a full
night's rest. And a lot of people are like, oh
my god, I can't believe how I feel. I'm just
ready to go. I'm ready to attack, to wheel my
energy's back. That is something that it doesn't normally generate
any lab abnormalities, doesn't generate any sort of X ray problems.
(35:09):
You just don't feel good. It's because you're not sleeping,
so that's always something to check. And again you just
have to see what your body habit as is. Most
people know that when they're overweight and just go get screened.
Very I mean, I have a few patients coming, like,
I think I have sleep app and I need a test.
(35:30):
But I think there's a lot of undiagnosed sleep apnea
out there. Spouses know their loved ones have it, but
just don't know that it's important. And you know, you're busy,
you got a lot of distractions, and we don't talk
a lot about sleep apnea. It's it's you know, we
hear about cancer and we hear about vaccines, but we don't.
(35:53):
I mean, it's just so much to know. I mean,
which one am I going to think about? First? Second, third, fourth?
I mean I can't do everything, but certainly, yes, sleep
apnea is if you're heavy, if you're overweight, you should
be getting screened for this. Go into your healthcare provider,
Hey what about sleep apnea? Should I be screened for this?
(36:15):
Because again it's easy to do at your home. And again,
if your body cannot rest, your body cannot heal, body
cannot heal, your body starts getting sick and there's a
lot of physical symptoms of sleep appening. The most one
is just fatigue. I just don't feel good, and most
(36:35):
people push through it. Right, they got time to be
sitting in Doc Levine's office for two three hours waiting
on him, you know, and he gotta go to work.
I got to pay the bills. I get it. But certainly,
hopefully if you are tired, go get your sleep study.
Make sure you're doing okay. Fond on to open eight
nine six klv I one one hundred and three to
three zero kio v. I will be on our last break.
(36:57):
Be back in two minutes. All right, welcome back to
the doctable metagal phone lines to open eight nine six
kov I one hundred and three to three zero. Okova.
I hear chatting about weakness and fatigue. You're tired, your
(37:18):
energy is down. What is wrong? I want to feel better.
We went through some of the common causes of that.
Certainly is something you should look into if you start
feeling that way, because normally a reversible problem can be found.
Sometimes it's hard to fix fatigue. We do have patients
(37:38):
that suffer chronic fatigue. That is a true phenomenon. It
is a true diagnosis chronic fatigue syndrome. These patients tend
to have very limited ability to function like normal folks
every day. A lot of times they can't even hold
a job. This is a real thing and super frustrating,
(38:02):
just because again, the ability to make that doc nesis
can be challenging. There's no agreeance about how to fix
it a lot of times in the medical world, so
depending on which practitioner you're going to, you might get
different medications. We don't have like a fatigue medicine where
you know, we can give you this tablet and then voila,
(38:24):
you get better again. Go through the discovery process of
the X rays of labs, review your meds. Make sure
you don't have sleep apnea, right, make sure you don't
have cancer, I mean, go through all that. Make sure
don't have an infection, a rooumatological disease, right, I didn't
really mention that, but stuff like lupus and room arthritis.
(38:48):
There are these sort of autoimmune inflammatory diseases that can
just kind of make you feel run down. So after
all that's done, everything's negative, but still patients are left
with a sense of fatigue. They can't hardly function that's frustrating,
and the medical world has not figured out what is
the cause of that either chronic fatigue syndrome. So a
(39:11):
lot of people are also secondarily diagnosed with fibromyalgia, which
is again a medical term that means that you have
sort of these diffuse muscle aches and muscle pains just
in your arm, your torso, your leg. You know, you
just feel sick and super super frustrating for the patient
(39:32):
as well as a practitioner again because we don't have
good ability to fix or evaluate what is the reason
for that. After all the blood and X rays and
the visits with all these subspecialists, they're sort of left
still with not being able to function, still with pain,
still with fatigue. You know, it's something that hopefully you
(39:57):
don't get just because there's no bopsy for chronic f
I mean, they may have gone through bopsies again to
try and find something, but there is no bops that says, ah,
we got the reason for your fatigue, and patients are
sort of left with trying to just figure out how
to make myself feel better. And certainly that's someone that
probably is on a few different medications to help them
(40:20):
sleep because fatigue chronicityque can cause depression, so a lot
of times we have to put them on antidepressants and
they may have tried a lot of different modality's probably
seen five or six practitioners just trying to figure it out.
So hopefully that doesn't happen to you, but it is
a real thing, chronic fatigue and the association with fibromagia.
(40:45):
And I've been a doc over twenty years. I don't
know that we've gotten better at making that diagnosis or
treating that disease in terms of someone gets diagnosed with
that and then they go to a doctor and then
booms three months, six months or back to where they were.
(41:06):
Maybe we've gotten a little bit better, but we're still
struggling to kind of figure that one out. And the
most you can do as a patient is certainly utilize
the healthcare system to come to a sort of understanding
about what it is or what it's not, because a
lot of this is just making sure you don't have
(41:27):
certain identifiable diseases as I've mentioned a few of those,
and then you just sort of left with this physical presence.
I mean, the sky's the limit in terms of the
things that you can try whether it be hormones or acupuncture,
or dietary supplements or certain exercises, certain foods. There's a
lot of testimonials from patients and people who've had these
(41:51):
diseases and how they've responded to it, whether they start
eating a certain type of diet or they sleep a
certain way. I mean a lot of stuff. It's sort
of wide open out there. So hopefully that doesn't plague you,
because you know, we're good at certain things. Cardiovas disease, cancer,
(42:11):
we're pretty good at that stuff, and we have a
lot of medicines, a lot of people are familiar with it,
and we can a lot of times are very successful
at treating those diseases. But chronic fatigue, we're not the
best at that, and hopefully that does not bother you
as a pace. Anyway, we appreciate all the listeners. No
callers this week. It's okay. I had fun talking with
(42:34):
you guys, trying to share some of this information. Don't
drink and drive, Eat a cucumber. We'll see you guys
next week. Take care,
All right, welcome South East Texas Internet radio listeners. This
(00:03):
is your weekly host, Doctor Levine on the Doctor Levine
and Medical Hour. We are here at the series of
klv I here in Beaumont, Texas, cross street from Park
Demo answering your phone calls about healthcare and medicine. Trying
to stay alive as long as possible and as healthy
as possible so that you're unlikely to have to go
(00:23):
to the hospital and be hospitalized, and keep your doctor
visits to a minimum, so we know how pleasant those are.
But we'll try to answer some questions for you get
some information. We know how complicated it is out there,
so give us a call. Phone lines to open eight
nine to six kV I one one hundred three three
(00:46):
zero klv I. Weather. It's pretty good outside today. The
heat wave seems to be over. We're heading entire winter
holiday months. Normally more enjoyable weather during this time. I'm
not sure if it's going to snow this year, but
we've had some snow a little bit limited over the years.
(01:07):
But this is the normally time where we really really
prioritize thus vaccinations just because we get those respiratory infections
big time. During this time of year, and we like
to promote these vaccines and we've talked about that before
and how good they are for you, and a lot
(01:28):
of people are concerned about their immune system and how
to keep it healthy, how to boost it, and vaccines,
in my opinion, is one way to do that. Certainly,
have to do your part with your lifestyle. We talk
about that often, but because it is so critical, it
(01:49):
is so important, you got to do your part as
you get older. It's not automatic anymore like it used
to be when you're young. Got to put that time
in and make sure that you're treating your body as
well as possible, just so that, yes, if you do
get sick, you're stronger and you have more endurance versus
(02:14):
if you're not so healthy. There's more monitoring equipment out there,
with the sugar monitors, the blood pressure monitors, the heart
rate monitors. You can really sort of put yourself in
a position where you're kind of up with that and
making sure you're doing everything you can to stay out
of trouble. And even if you are going to the
(02:37):
doctor on a regular basis, you are doing your part.
You do have your monitoring equipment, you can still have issues,
but try to stay ahead of the game. Just like
with cancer screening, we don't talk enough about that, but
it's an opportunity for someone to again find something sooner
(02:58):
rather than later, colon cancer being a perfect example of that.
We still we still have patients coming into the hospital
that for whatever reason just didn't get a primary, doesn't
go to a primary, they don't get the screening tests
(03:19):
that they deserve, and they come in with sort of
this advanced stage of cancer cancers that we're focusing on.
Remember that, unfortunately, we don't screen for all cancers. We
have about four that we are constantly kind of screening
for looking at, but we're unfortunately still getting patients with
(03:40):
what we call stage four. You know, cancers have stages, right,
It helps the oncologists, those are the cancer specialists sort
of figure out how aggressive it is and what sort
of treatment plan they can give for you. Normally stage
four is considered one that has advanced significantly or in
different sites. Remember that the way the cancer world is
(04:05):
categorized as you have a cancer cell that starts at
some point and they call that the primary cancer. You
know where it started, or what is the cancer cell
that kicked off everything, whether it be liver cancer, pancreas cancer,
(04:26):
lung cancer, breast cancer. It normally starts at a primary point,
so we normally call that the primary cancer. And if
it leaves that primary area and then goes somewhere else,
then we call that metastatic, meaning it's traveled. It's now
(04:48):
left the original spot and it has embedded itself into
another location such as the brain, or the spine or
the liver. We see that a lot with colon cancer.
The cancer starts in the colon, but because of the
behavior of the cancer and the way the body is engineered,
(05:13):
that colon cancer will leave there and go right to
the liver, and we call that metastatic. And normally we
will give that a stage four category, which means it's
advanced and it's systemic. If you will again, if you
can find the cancer in its original location, you know
(05:35):
it's not too big and it hasn't spread. It's more
of a stage one and normally stage one cancers, if
they're found, normally are easier to treat, normally a cure,
and you can normally not have to suffer any significant
(05:56):
adverse reaction from the treatment, and your prognosis is good,
Stage four being less, but still even like I said,
with colon cancer, if you're going to your doctor getting
your screening, you should not have any stage four issues.
I mean, sometimes it catches you off guard, meaning cancer
can present at a very young age, maybe in a
(06:19):
family that doesn't have any cancer. Patient really has no
symptoms until it pops up. We see that as well,
but I guess I'm talking about the patients that are
in their fifties, sixties and hadn't really gone in and
hadn't gotten checked out. Remember, colon cancer screening now is
easier than it was years ago. When I came out
(06:43):
of residency, we were doing what they call flex SIGs
flax sig and just stands for flexible sigmoidoscopy, which is
the instrument that they used to look for colon cancers.
We unfortunately again had to learn but when when I
(07:05):
was coming out, the flex sigmatoscopy would only look at
half of the colon because that's where most of the
colon cancers were occurring. And then we sort of found
out through research that there are certain cancers that end
up beyond that area that we were looking. So people
(07:28):
were getting their flex sigmatoscopy screening exams and then still
coming down and cancer, and we just couldn't understand that.
But then we figured out, yes, we had to look
at the entire colon. So the standard became just the
colonoscopy where they used their scopes and they looked at
the entire colon and depending on your age and your
(07:52):
family history and what they found on the original scope,
that would sort of dictate how frequent you would get
these scopes and how soon you had to start, et cetera,
et cetera. But it's cumbersome to have to get a colonoscopy, right.
You have to drink that solution the night before. You
(08:13):
have to a lot of times be chaperone or you
need someone to take you because there's some slight sedation
that they use for the colonoscopy, and it would pretty
much take you, you know, most of the morning or
the evening to get that done, so you would have
to miss work. I mean, it was a big I
(08:34):
shouldn't say big, but it was a significant commitment that
a lot of people couldn't do it. I mean it
was it was hard to fit that in their schedule,
or they didn't want to have an instrument placed there,
or they didn't they have a problem with sedation, or
maybe they're on blood thinners and they can't stop their blood.
I mean, just the list of possible interferences was a
(08:58):
lot higher. So even though maybe they have Blue Cross
Blue Shield, they go to their doctor, they would be
offered the colonoscopy. They wouldn't do it for various reasons.
So year after year, no colonoscopy, and then boom, get
diagnosed with like a stage three or stage four colon
cancer because they didn't engage with those screening intervals that
(09:21):
have been recommended to them. But now it's gotten easier. There's,
like I say, a stool kit that can come to
your house. Most people have seen commercials on TV called
colon Guard, somewhat controversial if you talk with gaserentrologists that
they do sort of are concerned about those screening app
(09:45):
screening tests at the stool kits, but again the most
of the medical organizations have endorsed them. Something I use
in my practice and so far, knock on wood, everything
has worked out. Okay, We've had several people that basically
have had some positive tests and they eventually get to colonoscopy,
(10:06):
and most of the time they have polyps that they
find no cancer. That's been my experience, but you may
have other practitioners that have had other experiences. But bottom
line is that is convenient. It gets you in the
door to get your screening accomplished without a colonoscopy. And again,
these are ones that we're using for low risk patients,
(10:29):
which means you have no family history, you have no symptoms,
and you're just at forty five right, because that's when
we start screening. Now, we used to start at fifty.
Now for the average person was starting at forty five. Again,
research was finding out that we were still missing a
(10:49):
significant portion of those patients, so we had to drop
the age down the forty five because it used to
be fifty. Now, if it runs in your family, you
might start screening at the age of thirty or even forty,
just depends on your family issues. So strong family history
normally you would start sooner. You know, if it was
(11:10):
your mother, your dad, or brother or sister, that tends
to mean that's a strong genetic linkage and we probably
just lay some eyes on you a lot sooner, so
we would get you in sooner to start your screening
and try and find that sooner. So because at this point,
(11:31):
if you get a stage one or stage two, a
lot of times it can be surgically removed and that's
a cure. Are sometimes you have to undergo some chemo
with the surgery, but the chemo now is very well tolerated.
A lot of times patients can continue to go to work.
(11:52):
It's not that toxic like a lot of the chemo
medicines were back in the day. I mean, they've gotten
a lot better. It's amazing the amount of research and
the interest in cancer treatment has advanced the treatment of cancer.
I mean, they're a lot of times putting people in
(12:12):
remission with minimal adverse reaction. I think that was the
issue years ago, is man that the medicines were just
so harsh that that was something separate. Yes you have cancer,
but now you have to undergo this very toxic, harsh
sort of treatment. Just a lot of adverse physical problems.
(12:34):
I mean, we still see them, but I don't think.
I'm not a cancer doctor, but I help manage cancer
patients in the hospital, and just from what I'm seeing
that the adverse reaction issues normally just you know, maybe
some gasher intestinal, maybe neurological issues and certainly infections, just
(12:57):
because there's sort of this interplay with chemo on your
immune system and your metabolic system, and it can certainly
increase your risk of infection. A lot of times you're
not eating the same you're getting exposed to needles, and
you have this cancer, and so it's just a lot
of tension in your body at the time you get
diagnosed and the treatment and so a lot of physical
(13:21):
elements can happen in that situation. But certainly want to
get your screening in and colon cancer is one of those.
So now they have those stool kits very convenient comes
to your house. It's all sort of digital, meaning your
communication with the processing center. They can track it, you
(13:42):
can track it, you get your results, they remind you
when you need another one. I mean, it's really gotten
super convenient. That's what we try to do with vaccines.
You know that we have them in the doctor's offices,
we have them at the pharmacy, which a lot of
people are going to the pharmacy because a lot of
US Americans unfortunately have prescription medication. So we're at the pharmacy.
(14:06):
It's convenient. We just kind of get it in and
go home again. We want to increase compliance as much
as possible, and so this is the time we normally
will focus on that during the winter because all the
winter infections viruses that we do see during this time.
So if you're off today and you're hanging out, like
what can I do, go get your vaccine and help
(14:27):
you and your family out anyway. Phone lines are open
eight nine six kV I one hundred three three zero kVA.
Speaker 2 (14:33):
I'll be back in two minutes. All right, Welcome back
to the dark Waion Medical.
Speaker 1 (14:47):
Our phone lines are open eight nine six k v
I one hundred three three zero kill y. I'd love
to hear from you. One complaint I get a lot
in the office is weakness. I feel weak. I don't
feel strong anymore. I'm tired. Something is happening to me.
I don't have that vigor and strength and endurance that
(15:10):
I once had. What is wrong? Weakness? Seems like maybe
all of us get that periodically, but it is a complaint,
a physical complaint that I hear often several times a day,
and trying to figure that out can be extremely challenging
for most healthcare professionals who get that complaint of just weakness.
(15:34):
Don't feel good. I'm not strong, and that's pretty much
all you get in terms of complaint, I just don't
feel strong. So it's always been some time sort of
talking about some of the causes of weakness that I
see as healthcare professional over twenty years of service. And
(15:54):
most of the time we start off with just basic
labs and basic X rays that that most doctors do
in their offices a CBC and checking your kidney function, thyroids, electrolytes,
your bone marrow function, thyroid profile, cholesterol, check your urine
(16:16):
as well. This is a pretty basic screening starting point
for most physical complaints. And then with some X rays
would throw that in as well. Chest X ray just
look at your chest and depending on your physical and
your family history and any other associated symptoms that go
(16:37):
along with the weakness, I might do a cat scan
of your abdomen and for guys, for girls, might do
some hormone levels as well, again because both of us
men women can have some lowering of the natural hormone levels.
(16:57):
The testosterone estrogen sometimes just not make you feel very well,
so menopause male menopause, however you want to call it,
low t that stuff happens, and guys get it to
normally in their deeper ages, but we are finding some
men that do have low tea issues in their forties,
(17:19):
which is a little premature, but we do see it
so normally. That's sort of my approach. If someone comes
in with we can just sort of get a nice
screening evaluation, check all those different areas and see if
anything pops up. One thing that we always have to
(17:39):
be concerned about again because of the use of pharmaceutical medication,
is the medications that you're taking. So a lot of
times I will just look at the medication peruse of
medicines and see if there's anything that pops up. Just
about any medication that's prescribed to you can at some
point generate a little fatigue issue us or some lack
(18:01):
of energy, you know, especially our blood pressure medications, cholesterol meds,
if you have anxiety depression, you're taking antidepressant anti anxiety medications.
If you have chronic pain and you're taking various pain
medication such as gabapentin or lyrica or even the narcotic
(18:25):
based pain medication, again the combination can sort of sap
your strength and we have to spend some time trying
to de escalate, as we say, some of the medications
to see if that will increase your energy or not. Again,
a lot of times you need these medications to help
fight some other chronic medical problem, and it's difficult. Meaning
(18:51):
you can't be on five ten medications a day and
expect to fill one hundred percent.
Speaker 2 (18:58):
I just.
Speaker 1 (19:00):
You can't believe that. You can't buy that. That's a
fantasy to think that you take ten medications and you're
supposed to feel wonderful and great and strong and healthy.
I mean, we try to achieve that. The pharmaceutical companies
try to give us medications that are neutral, meaning that
we prescribe the medicine. You take it, but you don't
(19:23):
feel like you're taking a medicine. Those are some of
the older medicines I was talking about chemotherapy in the
cancer world. That's what they're trying to achieve all the time,
is you get cancered. They give you medicine and you
feel neutral, like nothing is happening. You're getting this medicine.
It's attacking the cancer, but it's not doing anything else.
You don't lose your hair, your appetite's fine, you feel strong,
(19:46):
you go to work every day. I mean, that's what
we're trying to achieve with newer and newer medications that
come out all the time, you know, sort of once
a day medicine, simple dosing, no collateral issues. But again,
if you're taking ten medications every day, it's going to
be hard to feel just completely normal just because of
(20:09):
the interaction issues that come along with taking a lot
of medications. But again I always focus on that and
see if we can change something, reduce something. Again, over
the years, I would say I try to limit the
number of medicines that I will prescribe to a patient,
(20:29):
especially if there's several things going on in the visit
and I'm starting maybe two medicines, three medicines. It makes
me uncomfortable, and a lot of times I will recommend
to not start the medicines all in the same day
and maybe start one today, wait several days and start
the next one, and then so forth and so on,
(20:51):
just so we can remain oriented about what is happening,
just because if something does happen, we want to have
some orientation or ability to say, yes, it's that medication
that make me feel tired and fatigued. So again that's
sort of my approach with that. But other things that
(21:12):
can cause fatigue that you should be on the lookout
for as thyroid disorders, which again most doctors who are
primary care doctors and even in the er, they're doing
this now, checking the thyroid levels to make sure that
the thyroid profile is stable. That's a very easy fix
(21:34):
for fatigue if the thyroid is low and you just
need some thyroid replacement, it's very simple, it's very easy
to dose that. You don't necessarily have to go to
a thyroid specialist when it comes to that, but that's
certainly something you should check. And then your kidney function. Again,
as your kidneys stop working, as they stop clearing the
(21:55):
toxins in your bloodstream, it will start to generate a
sense of fatigue in your body. Just your muscles may
be hurt, you just don't have the endurance you used
to have. You might start getting some nausea and just
loss of appetite, but again that can normally be picked
up with just routine blood work when it comes to that.
(22:16):
Any electrolyte problems such as a high calcium, a low calcium,
a high sodium, a low sodium, a high phosphorus, low potassium,
high potassium, So a lot of electrolyte problems come into play,
especially if you're taking medications that can generate some fatigue
(22:38):
and loss of strength whenever you start taking these medications. Again,
that can be picked up very easily with the blood work.
But cancers sort of on a cancer theme today, but
cancers can sometimes just cause fatigue. You know, I just
don't feel good, something's off, My energy is down, especially
(23:00):
if you're fifty and above. I'm sort of always on
the lookout for that, just because that's a lot of
times when most of our cancers start happening, not all,
but some, I mean, breast cancer can happen soon. I mean,
any cancer can happen sooner than the normal range of cancers. Again,
most of the time we're screening, it's just for the
general population, and we have data for the sort of
(23:24):
low risk of general population. But cancers do run in families.
There's genetic abitimalodies that increase your risk of cancer. This
is something you should know talking with your mother, your father,
brothers and sisters in terms of what runs in your family.
That's always good information just so you know what sort
of genetic predisposition you have, so that you can let
(23:45):
your provider know, you can educate yourself about maybe some
things you should be looking out for. It doesn't mean
you're going to necessarily get it. It's that it's guaranteed,
but certainly your risk is a little higher, and maybe
you can live your life a little bit different and
you can go into your provider and just sort of
(24:06):
engage in the screening process, the surveillance process, so that
you're picking up on this stuff so that again you
can catch you out of stage one versus the stage four.
And again our cancer doctors have gotten really good. Even
with stage four man, they're hitting some home runs in
terms of getting that cooled off and getting patients in
(24:29):
remission and just getting them on sort of on a
surveillance schedule. Well maybe they go on every six months
every year and just really never miss a beat when
it comes to that. So it's gotten to that point,
but certainly with the fatigue issues, so many different possibilities
that yeah, we start with sort of blood X rays,
(24:51):
review of your medications, and I would say for me,
maybe with that at first visit, second visit, probably seventy
eighty percent of the time I can kind of nail
it down in the general ballpark in terms of what
is causing that. We can kind of come to a
conclusion about why maybe you're not feeling your best and
(25:14):
try and adjust whatever it is we found, or maybe
we did find something on the X rays. Like I say, cancers,
it's just why do a chest X ray? Maybe sometimes
I do a cat scan again looking So many cancers
hide in the abdominal cavity. That's what we call sort
of your torso. A lot of organs in there, a
lot of them gash intestinal, but you have the reproductive organs,
(25:35):
you have your kidneys. Any or all of those organs
can potentially develop cancer. Set's why a lot of times
I'll throw in a cat scan if someone is fatigued.
I'm just looking throw out my little fishing net and
see what I get back and kind of go from there.
But there are cases where all that's kind of normal.
(25:56):
I don't really see anything on the on the medications
and paces. Still, Hey, I don't feel good. Phone lines
JO open eight nine six klv I one one hundred
three three zero klv. I'll be back in two minutes.
(26:18):
All right, Welcome back to the dark wav metagal phone
lines are open eight nine six k kelv I won
one hundred three three zero Kova talking about lack of
energy and fatigue. Just don't feel good, My energy is gone.
We did list a few common causes of that, electrolyte problems,
(26:39):
kidney failure, thyroid anemia. Forgot about that one that's super common.
Just your HGB or your hemoglobin is low. And again
you have to understand maybe why this is. There are
a lot of diseases that can cause anemia, thyroid disorders,
kidney disorders, but you know blood disorders, blood cancers can
(27:03):
cause anemia. But a very common cause that that is
just bleeding internally. And that's because again, cardiovascular disease is
our number one problem, and how do we treat that.
We treat that with blood thinners. And when your blood
is not working one hundred percent in terms of its
(27:24):
ability to form clots, it tends to bleed spontaneously. Maybe
you know someone who has bruising on their arms, or
maybe you've taken aspen once a day for a while,
or you've had a heart attack or stroke and now
you're on blood thinners and you start getting all this
bruising everywhere, and that's just bleeding in your skin, but
the same thing that's happening in your gas intestinal system
(27:48):
and you can't see it, and so it's just sort
of in the background, silently bleeding. And because you are
losing blood technically, is what that is going on. If
you're losing enough that your body can keep up with it,
then yes, your hemoglobin will start to go down and
your body feels that because you need a certain level
(28:11):
of hemoglobin in your body for your body to work efficiently.
From a hemoglobin, its primary purpose is to sort of
carry oxygen to all of the organs that require oxygen,
and if there's a decreased oxygen carrying capacity is what
they kind of call that, then your body will sort
of pick up on that and it'll start to cause
(28:32):
fatigue and you go in and get your blood work.
The CBC complete blood count that's part of most general
examinations will be low, and a lot of times the
healthcare provider will need to investigate that why is the
hemoglobe and low? Why are you anemic? So that can
be a small workup or a big workup. It just
(28:53):
kind of depends, but there is sort of a standard
approach to it. Sometimes you might have to go get
to go see a blood special or a gas neurologist,
because the most common cause of bleeding, our anemia from
bleeding is the gasro intestinal systems. So a lot of
times you have to go get your colonoscopy. They have
(29:14):
to look in the upper portion of your gasro intestinal system.
We call that an upper endoscopy. And we have intestines
sort of in the middle, the small intestines, which can
bleed as well. If you're uncuminin, you're on plavix, you're
un brilenta, your aspirin, your eloquiz a relto prodox. I mean,
we have this whole line of blood in as we're
(29:38):
using now again because plaque development is sort of the
most common issue in our country. Just as we get old,
those blood vessels fill up with the build up of
all the years of the sugars and the starches and
the smoking and the sugar and the blood pressure, you know,
just irritating to the nervous system, I'm sorry, cardiovascular system.
(30:03):
And so yeah, most people are in bloodthins and that
hemoglobin drops and man, you feel tired, You feel tired.
So but Normally a CBC can pick up on that
quite easily. But a lot of times the lab is
fairly normal. The x rays they look okay, nothing terrible,
(30:24):
but patients are still like, I stin't feel good, I'm off,
And a couple other things that I've found is lack
of sleep. Lack of proper sleep is the reason for that.
You're not getting your rest and so you feel tired.
That makes sense, right. Have you ever tried to stay
up twenty four hours? Man? I used to do that
(30:45):
all the time when I was in medical school. I
mean I could do it then, but I felt terrible.
And that's when I was young, and I'm like late twenties,
early thirties. You could do some stuff like that and
even go take a test, stay up all night, go
to sleep, go take a test. I mean, you were
just so wired up, you were so nervous, scared that
(31:07):
you were going to forget something, and you have this
three hour test. You stayed up throughout the night. It
was insane, but I did it. I couldn't do it now,
there's no way. I mean just your body hurts so much. Anyway, Yeah,
you lay down, go to bed, close your eyes, and
then you might wake up the next morning four or
five yas. Yeah, you feel terrible, your your body is achy,
(31:29):
is tired. You feel like you could go right back
to bed, and a lot of times you need to.
But a lot of times it's because you have a
sleeping disorder. And the most common sleeping disorder in our
country is called obstructive sleep apnea OSA for short. Why
is that the most common? I'm sure somebody can answer
(31:52):
that class class. Yes, because we're dealing with obesity in
our country. Everybody's overweight big, right, You're heavier than your
frame normally is designed to carry. A lot of that
weight goes to that neck. That's why you can tell
when someone's thin, right, you see, you haven't seen a
(32:13):
friend in a long time. You can look right at
the neck. Is the neck big or is it skinny?
So a lot of that excessive weight that we're carrying
goes right to the neck and inside the neck the
oral fairings as we call that. And again, as all
of us sleep, our muscles relax, we go into sort
(32:34):
of a semi paralyzed state in the deeper stages of sleep.
I mean, we're asleep, we can't sense it, but the
muscles relax, and it's the throat area sort of collapses
on itself a little bit. And if you have a
lot of that excessive tissue, just the amount of area
that the air can flow through is significantly reduced. You
(32:56):
would call it stenosis or narrowing. And that can sometimes
be very disruptive to your breathing to the point that
you stop breathing. A lot of spouses see their loved
ones doing this every night and they have to wake
them up just because they stop breathing or the breathing
is the story is so loud that you can hear it.
(33:18):
It's very disruptive. But all that is is sleep apnea.
And I've advised all of my listeners if your body
mass index is thirty or above against simple calculation weight
over height, you can do it on your computer or
your smartphone. You can use a calculator whatever, but they
have these little formulas or apps you can download. If
(33:40):
you're being my body mass index is what that stands
for B and is thirty or above, go get a
sleeping study and the cool thing. And again, healthcare is
getting so convenient, so twenty four hours, so just righting
your face at all times you used to have to
go to a sleep lab. You don't have to do it.
(34:01):
You can do it at your house. Most healthcare providers
have the ability these appliances that you can just wear
at home. You get your sleep study at your house
and your own bed, simple to use, and the doctors
can download that information very quickly and while you have it,
and then you get your machine. Normally we treat obstructive
(34:24):
sleep apping with a SEEPAP machine, continuous positive airway pressure,
little bitty device quiet. The appliances that you would put
on your face, that has come a long way as well.
Used to be very cumbersome patients than like them. Now
they're easier to use, they're better to fit on the face.
(34:44):
You just put it on, press go and boom. You're
ready to go and you can get yourself a full
night's rest. And a lot of people are like, oh
my god, I can't believe how I feel. I'm just
ready to go. I'm ready to attack, to wheel my
energy's back. That is something that it doesn't normally generate
any lab abnormalities, doesn't generate any sort of X ray problems.
(35:09):
You just don't feel good. It's because you're not sleeping,
so that's always something to check. And again you just
have to see what your body habit as is. Most
people know that when they're overweight and just go get screened.
Very I mean, I have a few patients coming, like,
I think I have sleep app and I need a test.
(35:30):
But I think there's a lot of undiagnosed sleep apnea
out there. Spouses know their loved ones have it, but
just don't know that it's important. And you know, you're busy,
you got a lot of distractions, and we don't talk
a lot about sleep apnea. It's it's you know, we
hear about cancer and we hear about vaccines, but we don't.
(35:53):
I mean, it's just so much to know. I mean,
which one am I going to think about? First? Second, third, fourth?
I mean I can't do everything, but certainly, yes, sleep
apnea is if you're heavy, if you're overweight, you should
be getting screened for this. Go into your healthcare provider,
Hey what about sleep apnea? Should I be screened for this?
(36:15):
Because again it's easy to do at your home. And again,
if your body cannot rest, your body cannot heal, body
cannot heal, your body starts getting sick and there's a
lot of physical symptoms of sleep appening. The most one
is just fatigue. I just don't feel good, and most
(36:35):
people push through it. Right, they got time to be
sitting in Doc Levine's office for two three hours waiting
on him, you know, and he gotta go to work.
I got to pay the bills. I get it. But certainly,
hopefully if you are tired, go get your sleep study.
Make sure you're doing okay. Fond on to open eight
nine six klv I one one hundred and three to
three zero kio v. I will be on our last break.
(36:57):
Be back in two minutes. All right, welcome back to
the doctable metagal phone lines to open eight nine six
kov I one hundred and three to three zero. Okova.
I hear chatting about weakness and fatigue. You're tired, your
(37:18):
energy is down. What is wrong? I want to feel better.
We went through some of the common causes of that.
Certainly is something you should look into if you start
feeling that way, because normally a reversible problem can be found.
Sometimes it's hard to fix fatigue. We do have patients
(37:38):
that suffer chronic fatigue. That is a true phenomenon. It
is a true diagnosis chronic fatigue syndrome. These patients tend
to have very limited ability to function like normal folks
every day. A lot of times they can't even hold
a job. This is a real thing and super frustrating,
(38:02):
just because again, the ability to make that doc nesis
can be challenging. There's no agreeance about how to fix
it a lot of times in the medical world, so
depending on which practitioner you're going to, you might get
different medications. We don't have like a fatigue medicine where
you know, we can give you this tablet and then voila,
(38:24):
you get better again. Go through the discovery process of
the X rays of labs, review your meds. Make sure
you don't have sleep apnea, right, make sure you don't
have cancer, I mean, go through all that. Make sure
don't have an infection, a rooumatological disease, right, I didn't
really mention that, but stuff like lupus and room arthritis.
(38:48):
There are these sort of autoimmune inflammatory diseases that can
just kind of make you feel run down. So after
all that's done, everything's negative, but still patients are left
with a sense of fatigue. They can't hardly function that's frustrating,
and the medical world has not figured out what is
the cause of that either chronic fatigue syndrome. So a
(39:11):
lot of people are also secondarily diagnosed with fibromyalgia, which
is again a medical term that means that you have
sort of these diffuse muscle aches and muscle pains just
in your arm, your torso, your leg. You know, you
just feel sick and super super frustrating for the patient
(39:32):
as well as a practitioner again because we don't have
good ability to fix or evaluate what is the reason
for that. After all the blood and X rays and
the visits with all these subspecialists, they're sort of left
still with not being able to function, still with pain,
still with fatigue. You know, it's something that hopefully you
(39:57):
don't get just because there's no bopsy for chronic f
I mean, they may have gone through bopsies again to
try and find something, but there is no bops that says, ah,
we got the reason for your fatigue, and patients are
sort of left with trying to just figure out how
to make myself feel better. And certainly that's someone that
probably is on a few different medications to help them
(40:20):
sleep because fatigue chronicityque can cause depression, so a lot
of times we have to put them on antidepressants and
they may have tried a lot of different modality's probably
seen five or six practitioners just trying to figure it out.
So hopefully that doesn't happen to you, but it is
a real thing, chronic fatigue and the association with fibromagia.
(40:45):
And I've been a doc over twenty years. I don't
know that we've gotten better at making that diagnosis or
treating that disease in terms of someone gets diagnosed with
that and then they go to a doctor and then
booms three months, six months or back to where they were.
(41:06):
Maybe we've gotten a little bit better, but we're still
struggling to kind of figure that one out. And the
most you can do as a patient is certainly utilize
the healthcare system to come to a sort of understanding
about what it is or what it's not, because a
lot of this is just making sure you don't have
(41:27):
certain identifiable diseases as I've mentioned a few of those,
and then you just sort of left with this physical presence.
I mean, the sky's the limit in terms of the
things that you can try whether it be hormones or acupuncture,
or dietary supplements or certain exercises, certain foods. There's a
lot of testimonials from patients and people who've had these
(41:51):
diseases and how they've responded to it, whether they start
eating a certain type of diet or they sleep a
certain way. I mean a lot of stuff. It's sort
of wide open out there. So hopefully that doesn't plague you,
because you know, we're good at certain things. Cardiovas disease, cancer,
(42:11):
we're pretty good at that stuff, and we have a
lot of medicines, a lot of people are familiar with it,
and we can a lot of times are very successful
at treating those diseases. But chronic fatigue, we're not the
best at that, and hopefully that does not bother you
as a pace. Anyway, we appreciate all the listeners. No
callers this week. It's okay. I had fun talking with
(42:34):
you guys, trying to share some of this information. Don't
drink and drive, Eat a cucumber. We'll see you guys
next week. Take care,
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