November 18, 2024 • 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, South East Texas and't it ready? Listeners, Welcome
to another edition of the Doctoravine Medical Hour. Thank you
for joining me this morning. I am normally here every
Saturday between eight and nine taking your phone calls, answering
questions about healthcare and medicine and your health and stay
alive longer as much as possible, because it is confusing
(00:22):
out there to try and figure out what's good for you,
and what's good with your family, and what's the best
options for you. We have a lot of options in
this country. It's the best country in the world, but
it can be confusing with all these choices. Which one
is the best one, which one is not so good?
So we're here to try and help you get you
(00:44):
some answers and answer some of your questions. Phone lines
are open eight nine six.
Speaker 2 (00:50):
Kelby I won one hundred three three zero, Kyovie.
Speaker 1 (00:52):
I would love hearing from you, so I give us
Carl got a whole hour at the beginning of the show.
Don't wait to the end of the show run out
of time and it feels like a doctor visit.
Speaker 2 (01:04):
So we're trying to avoid.
Speaker 1 (01:05):
That so that we have a lot of time to
discuss and chat as it pertains to your physical issue.
Weather is good, wintery. I really would like more cold weather.
I think we're a little bit pasted due it's still
kind of warm in my opinion. Thanksgiving us around the
(01:28):
corner in a couple of weeks, and it really would
be nice to have some really good cold weather to
help us out with that. So hopefully talk with Greg
and two we can do about that. But as you know,
this is our respiratory season. We see our huge bike
in respiratory cases with the coughing and congestion, and a
(01:53):
lot of that has to do with respiratory viruses. Yes, viruses,
not bacteria, although bacteria can and cause respiratory infection. So again,
as we always highlight get those vaccines right, they're getting
easier to get and there's more available to you, and
(02:14):
it can get a little confusing to figure out which
ones you need. But certainly if you're six to five
and above, are you have a lot of medical issues,
we certainly want you to get as many as possible
to sort of protect yourself from these infections. And again
just reiterate and say it over and over again. You
(02:35):
can still get the organism to infect you, but if
your body's immune system is primed and is ready to
defend itself against certain common organisms, then that's how's supposed
to work.
Speaker 2 (02:53):
And in the process.
Speaker 1 (02:55):
Of keeping it very mild and not severe so that
you have to in the hospital for several days, maybe
on a breathing machine, we're trying to keep it at
bay and keep it mouth so you can sort of
keep going. Because again, aging you know this, you hear
(03:16):
this a lot on my show, but it seems like
there is sort of a misunderstanding about that.
Speaker 2 (03:22):
Basically, a lot of your vital.
Speaker 1 (03:24):
Organ systems don't work as well because of that process.
And when you get sick like that with a pneumonia
or a covid or a flu, you need those systems
to work in conjunction as a system to defend itself,
and a lot of times as we get older, those
systems just don't work as well, so you're more vulnerable
(03:46):
to having a more severe illness in a more severe case.
Speaker 2 (03:50):
So help yourself out with that.
Speaker 1 (03:54):
And you know, we talk a lot about just your
lifestyle and what you can do to stay healthy. And again,
it's for me gotten more simple to understand what is
going on and why there's a problem, and you certainly
have to do your part as you get older.
Speaker 2 (04:12):
When you're young, you.
Speaker 1 (04:13):
Can sort of be automatic and sort of not think
about it and kind of do whatever you want to do.
But unfortunately, as we get older again because that aging process,
you have to do more if you want to be
healthy and stay out of the doctor's office, stay out
of the hospitals, not have to take ten or fifteen medications.
(04:38):
And it all starts every day with what you're putting
in your mouth and what you're drinking, and what's your
activity level like all that stuff sort of impacts the
vital systems, and again that most important immune system. It
tends to respond very positively to actually sizing, and certainly
(05:01):
we're trying to limit the consumption of sugars and starches
as those two items tend to generate some issue with
your weight.
Speaker 3 (05:12):
And Hello, yes, doctor, we have Danny and Lumberton, and
just to explain, we're having a little phone issue. I
can hear with the doctors having a little trouble hearing
the phone, so I'm going to relay the questions. Danny
and Lumberton has a six bulging disc. They've been trying
to relieve some of that with some shots directly into
the disc. He's a due for another set of them,
(05:34):
and his question is is there any long term effects
from continuing to have these shots into a bulging disc
to relieve the pain.
Speaker 1 (05:44):
Well, thank you for that question, Jim, and thank you
for that question, Danny. Very common issue in our country,
herniated discs in the lower back, which we call the
lumbar spine. I would say every day in my office,
I'm probably getting two of our three patients coming in
(06:06):
with complaints of low back pain. We have various terms
that we use to describe low back pain. One common
term is called door salgia, and it just basically means
sort of a discomfort, pain, tightness in the lower back
region and super super common in our country for various reasons.
Speaker 2 (06:31):
You may know.
Speaker 1 (06:31):
Some of those reasons. Number one, we're getting older, are
we're able to get to our deeper seventies eighties, And
the muscular skeletal system, which includes the lower back, the
lumbar spine, but also it would include our knees and
our shoulders, our neck, they wear out and that process
(06:55):
is called degenerative joint disease and the coming arthritic problem.
That's causing that. It's called osteoarthritis. And yes, there are
other arthritic diseases that require special attention and special medications.
Speaker 2 (07:17):
Those would be things like rheumatoid.
Speaker 1 (07:20):
Arthritis, our gout are loopus. A lot of people are
familiar with loopus. So these are very common arthritic diseases
that have evolved to have specialized medications that can sort
of control the progression of those diseases very well. Normally
you have to get into a rheumatologist to be properly
(07:45):
diagnosed and get on these specialized medications. But for primary
osteoarthritis or primary degenitive joint disease again which can affect
the lower back like the lumbar spine, most primary care
doctors are managing that. Now, if the degenerative joint disease
(08:06):
is of a moderate to severe form, then yes, you
probably have as a part of your anatomy herniated discs.
That's part of the whole wearing out process of the
lower spine. Hernated discs. And what happens when these well,
let's back up. The discs are sort of these cushiony,
(08:31):
flexible rubber like material that sort of sits in between
the bone structure, the bony spine, if you will, to
sort of help provide some absorption and some flexibility with
your spine, sort of like a shock absorber, if you will,
on a car. And as you know, with time, the
(08:56):
inside are the components of the shock absorber can wear
out such that now the disc is not so flexible,
it's more rigid, It dries out more, it cracks, and
when there's a crack or a fissure in the material
or the structure of the disk, the inside portion herniates.
Speaker 2 (09:22):
It oozes out, if you will.
Speaker 1 (09:25):
And when that inside material is able to escape the
actual structure of the disk, it herniates. Because of the
anatomy of the back and its relationship with the nervous system,
So the bones and the herniated disk and the nervous system,
they're all sort of tightly woven in there, and they're
(09:49):
all very close to each other. It starts to put
pressure on the surrounding nerves. And that's most of the
time when patients it alerted to the fact that they
have hernated discs. You can probably assume that if you're
in your fifties sixty seventies, you do have herniated disks. Already,
(10:11):
but it's not enough herniation to cause any problems a
lot of times, so you don't really know it's there
until you start getting symptoms. And most symptoms would be
yes that back tightness, or waking up one morning and
your leg is on fire.
Speaker 2 (10:28):
Are your leg hurts?
Speaker 1 (10:30):
A lot of times the pain starts sort of at
the upper back, and it sort of travels down the
backside of your butt and on the side of your
leg and sort of to the front of your thigh
and just down to your foot. That's sort of the
trajectory that this sort of pain syndrome has a lot
of times when that nerve down there has pressure on
(10:52):
it from the herniated material from the disk, and so
it puts pressure on a couple of those nerves there,
and so most patients come in with just this horrific.
Speaker 2 (11:04):
Back pain, butt pain.
Speaker 1 (11:08):
You have pain on the side of your thigh and
it just sort of travels down your thigh in the front,
down the front of.
Speaker 2 (11:15):
Your leg, and to your foot.
Speaker 1 (11:17):
Sometimes the presentation is the foot first and then the
butts later, but it's very classic presentation. But sometimes it's
just hey, my back hurts and it won't go away,
and it can get pretty severe where you can't even
stand up, you can't even walk, because when you do that,
more pressure gets put on the nerve and you start
having severe symptoms. And I have patients coming in with
(11:41):
in wheelchairs because they can't walk and they have to
be transported to an er again because they can't stand
up straight. When they do that, it just makes the
pain more severe. So these herniated disks and then putting
pressure on these nerves, which when all that happens and
you have the symptoms, we call that ridiculuopathy is the
(12:02):
term that we use. More specifically, we call it lumbar
ridiculo opity because it's being generated in the lumbar spine,
and initially or immediately, we don't go to injections on
day one directly into the spine. That's more of something
that happens maybe in a couple of weeks or a
month after the symptoms have started. Most of the practitioners
(12:28):
that are doing the what we call epidural injections, which
is where the injection or the medicine is put in
the epidural space of the.
Speaker 2 (12:39):
Central nervous system.
Speaker 1 (12:40):
This is where a lot of times the nerves are
and so we're just trying to deaden the nerves so
that it's not sending that pain signal to the brain.
And most of the time these doctors pain specialists, sometimes
interventional radiologists, but primary Elliot's pain medicine specialists who've learned
(13:03):
how to do these techniques, you know, doing these separadual injections.
Sometimes anesthesiologists do that, but they use specialized extra equipment
to visualize exactly where they're going in and they just
sort of inject normally steroid and pain medication right sort
of at the sight of the pressure point where the
(13:25):
hernae disk is on the nerve, generating that pressure again
just to kind of deaden it so that all that
inflammation that has been generated by the pressure is sort
of tampered down, and ideas that doing those injections will
help cool that off and you have less pain. What
(13:46):
are the long term complications of that? The pain specialists
and the practitioners that perform these procedures are trying to
walk a tight rope as it pertains of these injections.
As far as I know, my current understanding of that
is you can only get so many per year, and
in doing so, that cuts down on the potential complication
(14:10):
of injecting your spine with a steroid and a pain medication.
And my current understanding is that is about three. So
most people go through a series of three injections, normally
separated by a few weeks, maybe one per month if needed.
Speaker 2 (14:29):
So if one.
Speaker 1 (14:30):
Injection does it, then that's all you need. But sometimes
patients have to go to three injections, and sometimes even
after that third injection, patients still have pain. So that
is unfortunate, but that does happen in my experience, I
don't see any long term complications in doing that procedure.
(14:52):
I have not had any exposure to that. I've not
had any patients who've had any poor outcomes as it
relates to long term complications from the epidural injections. So
my answer to that is, I don't think there's any
I mean, obviously there's always potentially something that can happen
(15:14):
to you. I mean, they are injecting as something into
your body, so anything is possible. But they're performing these
procedures a lot, and I just don't hear a lot
of issues from patients who've had epidual injections.
Speaker 2 (15:30):
In the past.
Speaker 1 (15:31):
I think the one thing that I hear often is
that sometimes they just don't work.
Speaker 2 (15:36):
They've had three and they're.
Speaker 1 (15:38):
Still in pain, and maybe they shouldn't have done the
injection because they're no better.
Speaker 2 (15:45):
But it's still a viable.
Speaker 1 (15:48):
Option when it comes to treating door salgia or acute
low back pain from my hernity disk and what we
collectively call a pinched nerve from the hernic disk, the
epidual injections are very commonly used, and again, I think
there's a there's a higher enough percentage of patients to
(16:09):
actually respond to these injections, which is why it's offered.
We hear this a lot with the well any medicine
that we prescribe. You know, patients come in because you know,
they saw something, they heard something, somebody told them something
about this product, and they're not quite sure if they
want to use it. And that's sort of the thing
you have to understand. Let's take, for example, of the zimpic,
(16:31):
which is very popular right now with the weight loss issues.
You're starting to hear some rumblings, oh, it causes this,
it causes that, et cetera. You know, that's all fine,
and you have to understand that no medicine is free
of any injury or adverse reaction, but the percentage of
that happening is extremely low because I mean it makes sense, right,
(16:54):
if it was truly out there causing all this horm
how could it be so popular. Because it would just
sort of of really get around that this medicine is
causing a lot of harm. Practitioners would stop prescribing it.
They would stop recommending it for sure, and probably because
of all the surveillance that happens with any prescription medication,
if it was sort of starting to generate a lot
(17:16):
of adverse reaction, they would start looking at it and
probably put it off the market or make it not available.
Speaker 2 (17:21):
I mean something like that. So epidual injections, if.
Speaker 1 (17:24):
I had a little back pain, it's certainly something I
would still only consider because of my experience with that.
It's a good option. It's a relatively safe option. I
don't know of any significant long term complications that have
been described to me, so I would say go ahead
and do it.
Speaker 2 (17:40):
You know I had this.
Speaker 1 (17:42):
You know, doctors are sort of in a position every
day where we're just trying to help patients make these decisions.
Right for us, A lot of times they're simple because
we're answering these questions all the time and we have
a better position and a better understanding of all this.
But you know, I talk about vaccines all the time.
(18:02):
But I did have one patient yesterday that asked me
if she should take the flu vaccine because last time
she took it she passed out. This a long time ago,
but she was willing to try it again, you know,
because it had been several years. And as you know,
vaccine technology has come a long way.
Speaker 2 (18:21):
It's a lot better.
Speaker 1 (18:23):
And that's how it is with the pharmacy industry in general,
is all these medicines that they're putting out normally are cleaner.
Speaker 2 (18:32):
Less side effects.
Speaker 1 (18:34):
Just they go in, do what they're supposed to do
and they get out of there. Just more precision with
the medicine and the dynamics of how the medicine works.
Speaker 2 (18:43):
And she asked me.
Speaker 1 (18:46):
You know, hey, I passed out before and I was
told never to take the vaccine again.
Speaker 2 (18:51):
What do you think?
Speaker 1 (18:52):
And we sort of he heard about it and laughed
about it, but my final recommendation is to not take it.
I didn't I certainly didn't want her to pass out again.
And she was relatively healthy. She didn't really have a
lot of chronic medical issues that we talk about, and
I just felt like the risk was too high, so
(19:16):
I recommend it to not take it.
Speaker 2 (19:18):
So there you go.
Speaker 1 (19:19):
You know, I'm open minded, and I just don't push vaccines.
If someone's having problems with it, I understand that, Hey,
it's probably not for you. The chance is too high.
Let's not do it. We don't want to cause any harm.
So that's always the position of most are all healthcare professionals.
We want to give you something that helps you and
doesn't cause harm, but we can never guarantee that. So
(19:42):
phone lines are open eight nine to six klvy I
won one hundred and three to three zero OKV. I'll be
back in two minutes. All right, welcome back to talk
(20:10):
with me Metical. Our phone line to open eight nine
to six kalf I one hundred and three to three
zero kov. I would love to hear from and give
us a call talking about low back pain, darsalgia, and
just that low back pain that we all sometimes get.
Especially in the winter time. We start seeing a lot
of uptick with muscular skeletal complaints. Something about the well
(20:34):
I wouldn't say it's that cold, but it gets colder
here in this part of the country is time of year.
I would like it to be less less less warm.
But anyway, you start getting a lot of joint complaints,
and back pain is one of them. For the most part,
when patients get any sort of muscle skeletal complaint, most
(20:55):
people kind of have access to the over the counter
products that are very helpful because most any healthcare professional,
if you come in with a muscular skeletal complaint, I
ET joint pain, they normally start off with the class
of medicines called insets N SAIDs. They stands for nonsteroidal
(21:17):
anti inflammatory drug and you know them as motrin, advil, alive, ibuprofen,
and a proxy and these are very very good. Aspirin
forgot about that one. I know we think of aspirin
as sort of more of a cardiac medication, more of
a blood dinner, and it does have that property, but
(21:40):
normally at the eighty one milligram dosage, which we call
children's dose or child's dose, an adult dose being a
three to twenty five milligram dose has more of a anti
inflammatory effect. And there's been ongoing controversy with these over
the years in terms of what's the proper dose for
(22:04):
cardiac disease, and I think eighty one is still king
ki NNG, But there are some doctors who recommend three
twenty five once a day to help with preventing cardiovascular events,
which for most of us is an a schemic event,
meaning a blood clot has formed in some artery are
(22:28):
some vein primarily arterial again from plaque development and from
low level chronic inflammation, as well as hypertension, high cholesterol,
and high sugar. These are all irritating factors to the
lining of the blood vessel the artery, which we call
(22:51):
the indo thelium, which is alive and well and when
we're young and as we get older, that endothelium sort
of has its own aging process and tends to promote
the development of these clots, which we call throng by
or imbalie, and they reduce blood flow, They stop blood
(23:15):
flow to certain arterial locations, and that's where we sort
of get our cardiovascular events. And aspin has been tossed
around for a long time and I like to use it,
but as it pertains to back pain, it can be
used for back pain because it is an an inflammatory.
Talinaw is also good for that. It's a blockbuster medication
(23:40):
as well. It's over the counter and it comes in
a few different forms over the counter. But certainly that's
a good pain medication and relatively safe to be used.
I know we hear a lot about talinaw and liver
disease and whether it can affect your liver, which it can,
so you kind of have to be a bit more
(24:01):
careful with talanol in my opinion as it pertains to
your liver and my understanding right now, the safest amount
you can take of talanol is four thousand milligrams in
a twenty four hour period, a lot of talanol, and
that can be safely used in that time frame four
(24:22):
thousand milligrams of talanol.
Speaker 2 (24:26):
If you have chronic liver disease.
Speaker 1 (24:28):
Let's say, liver curosis, or you have some you have
maybe active hepatitis, something along those lines, they tend to
decrease that level down to two thousand milligrams, certainly under
the advisement of your healthcare professional to talk about the
risks and benefits of that. But as far as I know,
if the liver disease is stable and it's not decompensated
(24:52):
liver problems. That some talanol over the counter would be safe,
but at a lower dose two thousand milligrams. I hear
Jim on the line.
Speaker 3 (25:03):
Yes, indeed, Jeff from Needle and it's an interesting question.
He was a gardening, got a little cut on his finger,
got infected, and he's lost some strength in his arm.
The doctor has treated him for several months and said
it may be rosegarden disease, and he's just wondering more
(25:23):
about that, some sort of infection from being in the garden.
Speaker 2 (25:28):
Yeah, Jim, thank you for that. Questions. I don't think
I've been asked that question in a while, or maybe never,
maybe never.
Speaker 1 (25:37):
So that's why I love being a doctor and coming
on the show. You do get some exposure to some
more rare questions. Doctors are like anybody else. We certainly
see certain diseases every day and answer certain questions every day,
so we get very comfortable with that. We get pretty
good at it answering these questions. But rosegarden disease. Have
(26:00):
read about it when I was studying for my boards,
or maybe I had a conversation at one time back
in training. But certainly it's not a disease that I
see all the time. But yeah, in general, working in
a flower bed are working with plants. Yes, there is
some inherent infectious injury component to that, just with all
(26:26):
the different bacteria and organisms in soil and those that
are attached to plants such as fungi and parasites.
Speaker 2 (26:36):
Yeah.
Speaker 1 (26:36):
Sometimes if I know, rose bushes have thorns on them
and they sort of can injure the skin and cut
the skin, making these little micro injuries, and it basically
disturbs the skin barrier. Remember, the skin is our most
important barrier other than the lining of the gassero intestinal system.
That's how organisms and other foreign mai get inside our
(27:01):
system is getting through these barriers. So inside your GI
tract is a barrier. Outside it's the skin. But if
there's any sort of break in that barrier, then microorganisms
that around all the time can very quickly get into
your system and cause active infection or irritation or inflammation.
So I can just imagine a garden with all of
(27:26):
the organisms that are surrounded are involved in a garden
bed that if you get a break in your skin
dealing with the roses then you can certainly get an
infection with one of these various organisms, and I would
just assume in general that that's sort of the name
that they give that soft tissue or skin infection that
(27:48):
you get if you're working in rose bushes, and then
you subsequently get a hand infection or arm infection, which
for most of the time is going to look red,
it's going to be swollen, it's going to have some
pain to it, and maybe some drainage which we a
lot of times we call pus that a lot of
times will generate those symptoms. And there's various antibiotics that
(28:11):
we use that normally work very well to treat the
active infection, but again some patients require a second course
or third course. Sometimes infection is a more severe infection
and it requires hospitalization or it can require maybe some
(28:34):
minor surgery by the appropriate surgeon to treat the infection
that they see. And yes, things like diabetes, being older,
chronic medical problems, certain chronic medications can interfere with the
healing process, can interfere with the immune system, which again
(28:55):
can sort of keep this sort of active infection going
a festering or not being completely controlled because of all
these extenuating circumstances, and you might find yourself a month,
six weeks later, still kind of battling this particular problem
which is sort of started off as a bacterial or
(29:15):
parasitic or fungal infection of the soft tissue of the finger.
But then you have all these extenuating circumstances that feed
into it, and one thing can lead to another, and
you can find yourself, like I say, sometime later, still
battling it.
Speaker 2 (29:30):
So I would say.
Speaker 1 (29:32):
Rosegarden disease or rose garden syndrome, in my opinion, would
just generally be acute infection brought on by all the
different organisms that are on roses that are in the
soil of a typical plant bed, and then getting the
(29:52):
soft tissue, the organisms get into the soft tissue and
cause an active infection. That would be my general understanding
of what rosegarden syndrome or rose garden disease is just
basically an infection of the soft tissue brought on by
the I guess resident organisms that you might see in
(30:13):
a flower bed or a rose bush. And yeah, just unfortunate.
Sometimes it can last a long time. Now he's saying
there were he underwent several rounds of antibiotics. Again, the
best way to figure out what's the right antibiotic is
to get a culture of the organism. A lot of
(30:37):
times that can be difficult, and practitioners are sort of
medicating blindly, if you will.
Speaker 2 (30:44):
We sort of know in general.
Speaker 1 (30:46):
Which organisms should be present. Let's say, if you get
a lung infection, or even sully lightis a lot of
people suffer from sellitis to get that redness and that
pain in their arm or their thigh or their left
we don't actually get a culture most of the time,
but we know.
Speaker 2 (31:05):
In general the.
Speaker 1 (31:07):
Organisms that normally cause that high percentage of the time,
and so we have several antibotic choices that we can use.
Same thing for respiratory infections, same thing for urine air
tract infections. Although that's a bit easier to try and
get a urine culture in that situation, we normally can
get that performed. But a lot of these infections that
(31:29):
we treat, it's difficult to get an actual culture and
identify the organism. But we have obviously medical literature, we
have resources we can go to that give us a
really good idea about which antibotics should be effective, and
that's sort of how we choose the antabotic for you.
But sometimes they don't work, and we normally will switch
(31:53):
to a different antibiotics again that should work. But if
you're on your third course of a different antibiotic, a
lot of times I will try to get the involvement
of an infection specialist.
Speaker 2 (32:07):
These are doctors that.
Speaker 1 (32:08):
Study organisms and study infections, and they help us a
lot in choosing the right antibiotic, whether it be ivy
or po and sometimes choosing the length of the antibiotic course.
You know, most of the time, patients are familiar with
taking antibiotic maybe for five days a week, maybe even
(32:28):
two weeks, but there are situations that come up where
you have to take the antibiotic for four weeks, six weeks, forever.
So we have those patients that have those sort of diseases.
So if you're on your third course, I would say
that this is a more complicated situation and we'll probably
try to get you to an infection doctor. You know,
(32:50):
because if it's involving your extremities your finger, those are
very tight structures, meaning if you see a cross section
of your finger, there's a lot of there's a lot
of things packed into that finger, that digit that once
you get an infection, it can just sort of affect
and destroy all that the nerves, the blood vessel, the bone,
the connective tissue. It can go pretty fast, and a
(33:12):
lot of times the only way to deal with that
is to amputate it, because just time is of the
essence in those situations, and you don't want to play
around with infections of your digits because again, sometimes it
can cause some.
Speaker 2 (33:26):
Pretty rapid destruction of those structures, and.
Speaker 1 (33:29):
The only way to deal with is just to cut
that little digit off, that section off and sort of
sew it up. So sometimes people have to do that
with just common routine infections. But certainly three courses sounds
a little long to me, and probably just to make
sure I'm doing my part as a practitioner, probably get
another doctor involved to kind of help us out. Phone
(33:51):
lines are open eight nine to six KALVA one hundred
three three zero KALVY. I'll be back in two minutes.
Speaker 3 (34:12):
And doctor Leonard in Houston has a question. He'd like
to lose twenty pounds wonders if there are any pills,
are injectables you could recommend to lose twenty pounds.
Speaker 1 (34:24):
We appreciate that Gemen. We appreciate Leonard Carling hadn't heard
from in a while. But Leonard, and I think, has
type two diabetes. If this is the same Leonard from Houston,
and the awesome thing about that situation, if there is
anything awesome about having diabetes. But these new medications that
(34:46):
have on the market right now that are diabetic medications
that belong to a certain class, I think most people
know them as a zimpic, but there's several medicines in
that class category. I should say one of the adverse,
shouldn't say adverse. One of the actions of the medication
(35:08):
is basically to kind of slow down your bowel function.
That's that's how this class works. G l P one
agonist is the technical term of the class of medications.
Again O zimpic, trulicity, Wygovi, Munjaro, ry Belsi's there's a
(35:29):
couple other ones that have in these class. And this
medicine has been out for a long time, I would
say nine years at least, and I don't I don't
quite know why it took this long for this medication
to sort of be prioritized as it pertains to wait.
But certainly, if Leonard were a patient of mine and
(35:53):
he was wanting to lose weight, he has type two diabetes,
that's one of the medicines that I would prioritize for him,
probably get him on that medication in its various forms,
to try and get his way down, because again, in
slowing down the bile function, it basically allows us to
go several hours without eating because our say tidy is satisfied,
(36:18):
meaning we don't feel hungry. And that's the issue in
this country, and I've talked about this before, is that
we're sort of all told that you have to eat
three times a day like that's a normal thing. And
my message to all my listeners is that I think
that is excessive in today's world. With the amount of
(36:44):
energy that we have to expend every day to stay alive,
it's not that much. We're not really physically active anymore
in this country for various reasons, and so we don't
need to necessarily spend a lot of time eating a
lot of food, which is basically just for calories so
that our bodies will work. Our bodies are a machine.
We need fuel, and food is our fuel to work.
Speaker 2 (37:09):
But we don't.
Speaker 1 (37:10):
We don't really need a lot of fuel every day
to function, So eating three times a day, in my opinion,
is excessive. You know, you don't need to wake up
and eat breakfast and then lunch and then dinner. And
most of us just kind of hanging out, sitting around,
maybe riding in a vehicle or sitting at a desk,
or we're just not doing a lot physically, and so
(37:32):
we don't really need to eat a lot. But again,
we're kind of a conditioned in this country to do that, right.
But when you ask someone, well, don't eat, just eat
once a day, right, Mentally, that can be challenging. It
can be tough to go all day without eating. And
this medication, of this class of medications ozempic wygovi, munjarro, trulicity.
(37:57):
There's a couple other ones. Again I keep forgetting sex
send that's another one. Ripe Elsa's. When you take these medications,
it is easier to go several hours without eating, you
feel comfortable. It's you don't get this angry sensation when
you go all day without eating. How you just sort
of get irritated and are nerved up and you just
(38:19):
want to choose something you want to swallow something, You
want that sensation to go away because it is a
little bit uncomfortable. So with all the food around us
all the time, very easy to access, again, a lot
of times the food that's not good for us is cheap,
it's packaged, it's ready to go, and it's filled with
(38:41):
all the things that we love to taste, right, the
flavors and the sensations, and they sort of know all
this stuff right and put it in front of us
just hey, they're own businesses, provide food, and so we
eat it. You know, it all helps or it all works.
Speaker 2 (38:55):
But again, when you're.
Speaker 1 (38:56):
Trying to lose way, you have to figure out a
way to not do that. These medicines are very good,
so Leonard I would certainly try and get you on
one of those medications. Phonons are opening one six kV
I want one hundred three three zero kalf last break
be back in two minutes. My mind now goes by
(39:28):
so fast. Phoneons are opening unc kV I one hundred
three three zero KLF. I just only have a couple
of minutes left in the show. We'll always want to
thank that listeners and the callers every week and again
if there's some topic that you would like me to discuss,
certainly let me know. We certainly want the program to
(39:50):
be enjoyable and informative to you. Again, just trying to
get your answers to some of your commonly asked questions
and to make this thing a little bit easier for you.
I'm not here to say that it's always easy to
give your answers, because a lot of times it is difficult.
We do see a lot of our listeners in the
(40:12):
hospital with a lot of physical complaints, and man, we
just we're doing everything we can. We just can't get
those answers to you. And as I mentioned to my
patients all the time in the hospital, we would love
to just very easily hand these diagnoses to you. You know,
they're the right diagnoses. Everything's going to work out and
(40:33):
there's going to be a victory party at the end
of the day. But just unfortunate that's not the way
it is. Even despite being in a modern hospital with
getting all the modern tests and seeing all the specialized doctors.
Just sometimes we just the answers don't come as easily
as we would like, and you know that's part of
the way it is. Sometimes and it is unfortunate, but
(40:56):
we try to keep those cases to a minimum. So
if there's anything that you want me to discuss, you know,
let us know. We'd more than happy to dive into that.
Most of the topics that I talk about are common
topics that I see every day that may be of
interest while I'm interacting with my patients. Why I love
(41:18):
my job is letting our people talking with me and
them letting me into their lives and sharing some of
their secrets and their issues with them. So just a
lot of interesting things that people are doing and going through,
and I just want to thank all of my patients
(41:38):
and my practice and all the listeners for allowing me
to do that.
Speaker 2 (41:41):
It is a privilege and I know that, and we'll try.
Speaker 1 (41:46):
Again my best to give you the best answer that
I can based on my experience. I'm a practitioner, been
doing it for over twenty years, and I'm always learning
new things about just medicines and the way to prescribe
medication is truly a very very enjoyable profession. And I
(42:06):
know a lot of patients when they come in and
visit with me, they're like, Hey, you doing, Okay, Hi
you doing? Because they want to make sure their practitioners okay,
they're gonna be with it. So I appreciate those questions
as well. But again at the end of the day,
this is the winter time respiratory time, so go get
those vaccines, and we always see our respiratory rises, So
(42:31):
get in with your practitioner sooner rather than later. The
healthcare community certainly has better access on the weekends and
at nights if you start getting that cough and chess congestion,
especially if you have chronic medical problems like a COPD
or CHF or diabees a lot of times, if you
can get on top of that on day one, day two,
you can stay out of the hospital rather than letting
(42:54):
it just persist and get stronger and more severe. Again,
because you want to do what you can to keep
it to a minimum, you know, go in and get
checked out and get on the appropriate medication, and try
to stay out at the hospital as much as possible.
So we again enjoy all of the callers and the listeners. Remember,
(43:16):
we want you to drink that water, and we want
you to exercise a little bit, and again, don't have
to do it every day. We're talking about ten or
twenty minutes of some physical activity, walking a triapmill, pelling
a bicycle, jumpin.
Speaker 2 (43:30):
Jacks, push ups, sit ups.
Speaker 1 (43:32):
That stuff still works, right, But it doesn't mean you
can have a big pizza and eat whatever you want
if you're exercising.
Speaker 2 (43:38):
We'll see you next week. Take care,
All right, South East Texas and't it ready? Listeners, Welcome
to another edition of the Doctoravine Medical Hour. Thank you
for joining me this morning. I am normally here every
Saturday between eight and nine taking your phone calls, answering
questions about healthcare and medicine and your health and stay
alive longer as much as possible, because it is confusing
(00:22):
out there to try and figure out what's good for you,
and what's good with your family, and what's the best
options for you. We have a lot of options in
this country. It's the best country in the world, but
it can be confusing with all these choices. Which one
is the best one, which one is not so good?
So we're here to try and help you get you
(00:44):
some answers and answer some of your questions. Phone lines
are open eight nine six.
Speaker 2 (00:50):
Kelby I won one hundred three three zero, Kyovie.
Speaker 1 (00:52):
I would love hearing from you, so I give us
Carl got a whole hour at the beginning of the show.
Don't wait to the end of the show run out
of time and it feels like a doctor visit.
Speaker 2 (01:04):
So we're trying to avoid.
Speaker 1 (01:05):
That so that we have a lot of time to
discuss and chat as it pertains to your physical issue.
Weather is good, wintery. I really would like more cold weather.
I think we're a little bit pasted due it's still
kind of warm in my opinion. Thanksgiving us around the
(01:28):
corner in a couple of weeks, and it really would
be nice to have some really good cold weather to
help us out with that. So hopefully talk with Greg
and two we can do about that. But as you know,
this is our respiratory season. We see our huge bike
in respiratory cases with the coughing and congestion, and a
(01:53):
lot of that has to do with respiratory viruses. Yes, viruses,
not bacteria, although bacteria can and cause respiratory infection. So again,
as we always highlight get those vaccines right, they're getting
easier to get and there's more available to you, and
(02:14):
it can get a little confusing to figure out which
ones you need. But certainly if you're six to five
and above, are you have a lot of medical issues,
we certainly want you to get as many as possible
to sort of protect yourself from these infections. And again
just reiterate and say it over and over again. You
(02:35):
can still get the organism to infect you, but if
your body's immune system is primed and is ready to
defend itself against certain common organisms, then that's how's supposed
to work.
Speaker 2 (02:53):
And in the process.
Speaker 1 (02:55):
Of keeping it very mild and not severe so that
you have to in the hospital for several days, maybe
on a breathing machine, we're trying to keep it at
bay and keep it mouth so you can sort of
keep going. Because again, aging you know this, you hear
(03:16):
this a lot on my show, but it seems like
there is sort of a misunderstanding about that.
Speaker 2 (03:22):
Basically, a lot of your vital.
Speaker 1 (03:24):
Organ systems don't work as well because of that process.
And when you get sick like that with a pneumonia
or a covid or a flu, you need those systems
to work in conjunction as a system to defend itself,
and a lot of times as we get older, those
systems just don't work as well, so you're more vulnerable
(03:46):
to having a more severe illness in a more severe case.
Speaker 2 (03:50):
So help yourself out with that.
Speaker 1 (03:54):
And you know, we talk a lot about just your
lifestyle and what you can do to stay healthy. And again,
it's for me gotten more simple to understand what is
going on and why there's a problem, and you certainly
have to do your part as you get older.
Speaker 2 (04:12):
When you're young, you.
Speaker 1 (04:13):
Can sort of be automatic and sort of not think
about it and kind of do whatever you want to do.
But unfortunately, as we get older again because that aging process,
you have to do more if you want to be
healthy and stay out of the doctor's office, stay out
of the hospitals, not have to take ten or fifteen medications.
(04:38):
And it all starts every day with what you're putting
in your mouth and what you're drinking, and what's your
activity level like all that stuff sort of impacts the
vital systems, and again that most important immune system. It
tends to respond very positively to actually sizing, and certainly
(05:01):
we're trying to limit the consumption of sugars and starches
as those two items tend to generate some issue with
your weight.
Speaker 3 (05:12):
And Hello, yes, doctor, we have Danny and Lumberton, and
just to explain, we're having a little phone issue. I
can hear with the doctors having a little trouble hearing
the phone, so I'm going to relay the questions. Danny
and Lumberton has a six bulging disc. They've been trying
to relieve some of that with some shots directly into
the disc. He's a due for another set of them,
(05:34):
and his question is is there any long term effects
from continuing to have these shots into a bulging disc
to relieve the pain.
Speaker 1 (05:44):
Well, thank you for that question, Jim, and thank you
for that question, Danny. Very common issue in our country,
herniated discs in the lower back, which we call the
lumbar spine. I would say every day in my office,
I'm probably getting two of our three patients coming in
(06:06):
with complaints of low back pain. We have various terms
that we use to describe low back pain. One common
term is called door salgia, and it just basically means
sort of a discomfort, pain, tightness in the lower back
region and super super common in our country for various reasons.
Speaker 2 (06:31):
You may know.
Speaker 1 (06:31):
Some of those reasons. Number one, we're getting older, are
we're able to get to our deeper seventies eighties, And
the muscular skeletal system, which includes the lower back, the
lumbar spine, but also it would include our knees and
our shoulders, our neck, they wear out and that process
(06:55):
is called degenerative joint disease and the coming arthritic problem.
That's causing that. It's called osteoarthritis. And yes, there are
other arthritic diseases that require special attention and special medications.
Speaker 2 (07:17):
Those would be things like rheumatoid.
Speaker 1 (07:20):
Arthritis, our gout are loopus. A lot of people are
familiar with loopus. So these are very common arthritic diseases
that have evolved to have specialized medications that can sort
of control the progression of those diseases very well. Normally
you have to get into a rheumatologist to be properly
(07:45):
diagnosed and get on these specialized medications. But for primary
osteoarthritis or primary degenitive joint disease again which can affect
the lower back like the lumbar spine, most primary care
doctors are managing that. Now, if the degenerative joint disease
(08:06):
is of a moderate to severe form, then yes, you
probably have as a part of your anatomy herniated discs.
That's part of the whole wearing out process of the
lower spine. Hernated discs. And what happens when these well,
let's back up. The discs are sort of these cushiony,
(08:31):
flexible rubber like material that sort of sits in between
the bone structure, the bony spine, if you will, to
sort of help provide some absorption and some flexibility with
your spine, sort of like a shock absorber, if you will,
on a car. And as you know, with time, the
(08:56):
inside are the components of the shock absorber can wear
out such that now the disc is not so flexible,
it's more rigid, It dries out more, it cracks, and
when there's a crack or a fissure in the material
or the structure of the disk, the inside portion herniates.
Speaker 2 (09:22):
It oozes out, if you will.
Speaker 1 (09:25):
And when that inside material is able to escape the
actual structure of the disk, it herniates. Because of the
anatomy of the back and its relationship with the nervous system,
So the bones and the herniated disk and the nervous system,
they're all sort of tightly woven in there, and they're
(09:49):
all very close to each other. It starts to put
pressure on the surrounding nerves. And that's most of the
time when patients it alerted to the fact that they
have hernated discs. You can probably assume that if you're
in your fifties sixty seventies, you do have herniated disks. Already,
(10:11):
but it's not enough herniation to cause any problems a
lot of times, so you don't really know it's there
until you start getting symptoms. And most symptoms would be
yes that back tightness, or waking up one morning and
your leg is on fire.
Speaker 2 (10:28):
Are your leg hurts?
Speaker 1 (10:30):
A lot of times the pain starts sort of at
the upper back, and it sort of travels down the
backside of your butt and on the side of your
leg and sort of to the front of your thigh
and just down to your foot. That's sort of the
trajectory that this sort of pain syndrome has a lot
of times when that nerve down there has pressure on
(10:52):
it from the herniated material from the disk, and so
it puts pressure on a couple of those nerves there,
and so most patients come in with just this horrific.
Speaker 2 (11:04):
Back pain, butt pain.
Speaker 1 (11:08):
You have pain on the side of your thigh and
it just sort of travels down your thigh in the front,
down the front of.
Speaker 2 (11:15):
Your leg, and to your foot.
Speaker 1 (11:17):
Sometimes the presentation is the foot first and then the
butts later, but it's very classic presentation. But sometimes it's
just hey, my back hurts and it won't go away,
and it can get pretty severe where you can't even
stand up, you can't even walk, because when you do that,
more pressure gets put on the nerve and you start
having severe symptoms. And I have patients coming in with
(11:41):
in wheelchairs because they can't walk and they have to
be transported to an er again because they can't stand
up straight. When they do that, it just makes the
pain more severe. So these herniated disks and then putting
pressure on these nerves, which when all that happens and
you have the symptoms, we call that ridiculuopathy is the
(12:02):
term that we use. More specifically, we call it lumbar
ridiculo opity because it's being generated in the lumbar spine,
and initially or immediately, we don't go to injections on
day one directly into the spine. That's more of something
that happens maybe in a couple of weeks or a
month after the symptoms have started. Most of the practitioners
(12:28):
that are doing the what we call epidural injections, which
is where the injection or the medicine is put in
the epidural space of the.
Speaker 2 (12:39):
Central nervous system.
Speaker 1 (12:40):
This is where a lot of times the nerves are
and so we're just trying to deaden the nerves so
that it's not sending that pain signal to the brain.
And most of the time these doctors pain specialists, sometimes
interventional radiologists, but primary Elliot's pain medicine specialists who've learned
(13:03):
how to do these techniques, you know, doing these separadual injections.
Sometimes anesthesiologists do that, but they use specialized extra equipment
to visualize exactly where they're going in and they just
sort of inject normally steroid and pain medication right sort
of at the sight of the pressure point where the
(13:25):
hernae disk is on the nerve, generating that pressure again
just to kind of deaden it so that all that
inflammation that has been generated by the pressure is sort
of tampered down, and ideas that doing those injections will
help cool that off and you have less pain. What
(13:46):
are the long term complications of that? The pain specialists
and the practitioners that perform these procedures are trying to
walk a tight rope as it pertains of these injections.
As far as I know, my current understanding of that
is you can only get so many per year, and
in doing so, that cuts down on the potential complication
(14:10):
of injecting your spine with a steroid and a pain medication.
And my current understanding is that is about three. So
most people go through a series of three injections, normally
separated by a few weeks, maybe one per month if needed.
Speaker 2 (14:29):
So if one.
Speaker 1 (14:30):
Injection does it, then that's all you need. But sometimes
patients have to go to three injections, and sometimes even
after that third injection, patients still have pain. So that
is unfortunate, but that does happen in my experience, I
don't see any long term complications in doing that procedure.
(14:52):
I have not had any exposure to that. I've not
had any patients who've had any poor outcomes as it
relates to long term complications from the epidural injections. So
my answer to that is, I don't think there's any
I mean, obviously there's always potentially something that can happen
(15:14):
to you. I mean, they are injecting as something into
your body, so anything is possible. But they're performing these
procedures a lot, and I just don't hear a lot
of issues from patients who've had epidual injections.
Speaker 2 (15:30):
In the past.
Speaker 1 (15:31):
I think the one thing that I hear often is
that sometimes they just don't work.
Speaker 2 (15:36):
They've had three and they're.
Speaker 1 (15:38):
Still in pain, and maybe they shouldn't have done the
injection because they're no better.
Speaker 2 (15:45):
But it's still a viable.
Speaker 1 (15:48):
Option when it comes to treating door salgia or acute
low back pain from my hernity disk and what we
collectively call a pinched nerve from the hernic disk, the
epidual injections are very commonly used, and again, I think
there's a there's a higher enough percentage of patients to
(16:09):
actually respond to these injections, which is why it's offered.
We hear this a lot with the well any medicine
that we prescribe. You know, patients come in because you know,
they saw something, they heard something, somebody told them something
about this product, and they're not quite sure if they
want to use it. And that's sort of the thing
you have to understand. Let's take, for example, of the zimpic,
(16:31):
which is very popular right now with the weight loss issues.
You're starting to hear some rumblings, oh, it causes this,
it causes that, et cetera. You know, that's all fine,
and you have to understand that no medicine is free
of any injury or adverse reaction, but the percentage of
that happening is extremely low because I mean it makes sense, right,
(16:54):
if it was truly out there causing all this horm
how could it be so popular. Because it would just
sort of of really get around that this medicine is
causing a lot of harm. Practitioners would stop prescribing it.
They would stop recommending it for sure, and probably because
of all the surveillance that happens with any prescription medication,
if it was sort of starting to generate a lot
(17:16):
of adverse reaction, they would start looking at it and
probably put it off the market or make it not available.
Speaker 2 (17:21):
I mean something like that. So epidual injections, if.
Speaker 1 (17:24):
I had a little back pain, it's certainly something I
would still only consider because of my experience with that.
It's a good option. It's a relatively safe option. I
don't know of any significant long term complications that have
been described to me, so I would say go ahead
and do it.
Speaker 2 (17:40):
You know I had this.
Speaker 1 (17:42):
You know, doctors are sort of in a position every
day where we're just trying to help patients make these decisions.
Right for us, A lot of times they're simple because
we're answering these questions all the time and we have
a better position and a better understanding of all this.
But you know, I talk about vaccines all the time.
(18:02):
But I did have one patient yesterday that asked me
if she should take the flu vaccine because last time
she took it she passed out. This a long time ago,
but she was willing to try it again, you know,
because it had been several years. And as you know,
vaccine technology has come a long way.
Speaker 2 (18:21):
It's a lot better.
Speaker 1 (18:23):
And that's how it is with the pharmacy industry in general,
is all these medicines that they're putting out normally are cleaner.
Speaker 2 (18:32):
Less side effects.
Speaker 1 (18:34):
Just they go in, do what they're supposed to do
and they get out of there. Just more precision with
the medicine and the dynamics of how the medicine works.
Speaker 2 (18:43):
And she asked me.
Speaker 1 (18:46):
You know, hey, I passed out before and I was
told never to take the vaccine again.
Speaker 2 (18:51):
What do you think?
Speaker 1 (18:52):
And we sort of he heard about it and laughed
about it, but my final recommendation is to not take it.
I didn't I certainly didn't want her to pass out again.
And she was relatively healthy. She didn't really have a
lot of chronic medical issues that we talk about, and
I just felt like the risk was too high, so
(19:16):
I recommend it to not take it.
Speaker 2 (19:18):
So there you go.
Speaker 1 (19:19):
You know, I'm open minded, and I just don't push vaccines.
If someone's having problems with it, I understand that, Hey,
it's probably not for you. The chance is too high.
Let's not do it. We don't want to cause any harm.
So that's always the position of most are all healthcare professionals.
We want to give you something that helps you and
doesn't cause harm, but we can never guarantee that. So
(19:42):
phone lines are open eight nine to six klvy I
won one hundred and three to three zero OKV. I'll be
back in two minutes. All right, welcome back to talk
(20:10):
with me Metical. Our phone line to open eight nine
to six kalf I one hundred and three to three
zero kov. I would love to hear from and give
us a call talking about low back pain, darsalgia, and
just that low back pain that we all sometimes get.
Especially in the winter time. We start seeing a lot
of uptick with muscular skeletal complaints. Something about the well
(20:34):
I wouldn't say it's that cold, but it gets colder
here in this part of the country is time of year.
I would like it to be less less less warm.
But anyway, you start getting a lot of joint complaints,
and back pain is one of them. For the most part,
when patients get any sort of muscle skeletal complaint, most
(20:55):
people kind of have access to the over the counter
products that are very helpful because most any healthcare professional,
if you come in with a muscular skeletal complaint, I
ET joint pain, they normally start off with the class
of medicines called insets N SAIDs. They stands for nonsteroidal
(21:17):
anti inflammatory drug and you know them as motrin, advil, alive, ibuprofen,
and a proxy and these are very very good. Aspirin
forgot about that one. I know we think of aspirin
as sort of more of a cardiac medication, more of
a blood dinner, and it does have that property, but
(21:40):
normally at the eighty one milligram dosage, which we call
children's dose or child's dose, an adult dose being a
three to twenty five milligram dose has more of a anti
inflammatory effect. And there's been ongoing controversy with these over
the years in terms of what's the proper dose for
(22:04):
cardiac disease, and I think eighty one is still king
ki NNG, But there are some doctors who recommend three
twenty five once a day to help with preventing cardiovascular events,
which for most of us is an a schemic event,
meaning a blood clot has formed in some artery are
(22:28):
some vein primarily arterial again from plaque development and from
low level chronic inflammation, as well as hypertension, high cholesterol,
and high sugar. These are all irritating factors to the
lining of the blood vessel the artery, which we call
(22:51):
the indo thelium, which is alive and well and when
we're young and as we get older, that endothelium sort
of has its own aging process and tends to promote
the development of these clots, which we call throng by
or imbalie, and they reduce blood flow, They stop blood
(23:15):
flow to certain arterial locations, and that's where we sort
of get our cardiovascular events. And aspin has been tossed
around for a long time and I like to use it,
but as it pertains to back pain, it can be
used for back pain because it is an an inflammatory.
Talinaw is also good for that. It's a blockbuster medication
(23:40):
as well. It's over the counter and it comes in
a few different forms over the counter. But certainly that's
a good pain medication and relatively safe to be used.
I know we hear a lot about talinaw and liver
disease and whether it can affect your liver, which it can,
so you kind of have to be a bit more
(24:01):
careful with talanol in my opinion as it pertains to
your liver and my understanding right now, the safest amount
you can take of talanol is four thousand milligrams in
a twenty four hour period, a lot of talanol, and
that can be safely used in that time frame four
(24:22):
thousand milligrams of talanol.
Speaker 2 (24:26):
If you have chronic liver disease.
Speaker 1 (24:28):
Let's say, liver curosis, or you have some you have
maybe active hepatitis, something along those lines, they tend to
decrease that level down to two thousand milligrams, certainly under
the advisement of your healthcare professional to talk about the
risks and benefits of that. But as far as I know,
if the liver disease is stable and it's not decompensated
(24:52):
liver problems. That some talanol over the counter would be safe,
but at a lower dose two thousand milligrams. I hear
Jim on the line.
Speaker 3 (25:03):
Yes, indeed, Jeff from Needle and it's an interesting question.
He was a gardening, got a little cut on his finger,
got infected, and he's lost some strength in his arm.
The doctor has treated him for several months and said
it may be rosegarden disease, and he's just wondering more
(25:23):
about that, some sort of infection from being in the garden.
Speaker 2 (25:28):
Yeah, Jim, thank you for that. Questions. I don't think
I've been asked that question in a while, or maybe never,
maybe never.
Speaker 1 (25:37):
So that's why I love being a doctor and coming
on the show. You do get some exposure to some
more rare questions. Doctors are like anybody else. We certainly
see certain diseases every day and answer certain questions every day,
so we get very comfortable with that. We get pretty
good at it answering these questions. But rosegarden disease. Have
(26:00):
read about it when I was studying for my boards,
or maybe I had a conversation at one time back
in training. But certainly it's not a disease that I
see all the time. But yeah, in general, working in
a flower bed are working with plants. Yes, there is
some inherent infectious injury component to that, just with all
(26:26):
the different bacteria and organisms in soil and those that
are attached to plants such as fungi and parasites.
Speaker 2 (26:36):
Yeah.
Speaker 1 (26:36):
Sometimes if I know, rose bushes have thorns on them
and they sort of can injure the skin and cut
the skin, making these little micro injuries, and it basically
disturbs the skin barrier. Remember, the skin is our most
important barrier other than the lining of the gassero intestinal system.
That's how organisms and other foreign mai get inside our
(27:01):
system is getting through these barriers. So inside your GI
tract is a barrier. Outside it's the skin. But if
there's any sort of break in that barrier, then microorganisms
that around all the time can very quickly get into
your system and cause active infection or irritation or inflammation.
So I can just imagine a garden with all of
(27:26):
the organisms that are surrounded are involved in a garden
bed that if you get a break in your skin
dealing with the roses then you can certainly get an
infection with one of these various organisms, and I would
just assume in general that that's sort of the name
that they give that soft tissue or skin infection that
(27:48):
you get if you're working in rose bushes, and then
you subsequently get a hand infection or arm infection, which
for most of the time is going to look red,
it's going to be swollen, it's going to have some
pain to it, and maybe some drainage which we a
lot of times we call pus that a lot of
times will generate those symptoms. And there's various antibiotics that
(28:11):
we use that normally work very well to treat the
active infection, but again some patients require a second course
or third course. Sometimes infection is a more severe infection
and it requires hospitalization or it can require maybe some
(28:34):
minor surgery by the appropriate surgeon to treat the infection
that they see. And yes, things like diabetes, being older,
chronic medical problems, certain chronic medications can interfere with the
healing process, can interfere with the immune system, which again
(28:55):
can sort of keep this sort of active infection going
a festering or not being completely controlled because of all
these extenuating circumstances, and you might find yourself a month,
six weeks later, still kind of battling this particular problem
which is sort of started off as a bacterial or
(29:15):
parasitic or fungal infection of the soft tissue of the finger.
But then you have all these extenuating circumstances that feed
into it, and one thing can lead to another, and
you can find yourself, like I say, sometime later, still
battling it.
Speaker 2 (29:30):
So I would say.
Speaker 1 (29:32):
Rosegarden disease or rose garden syndrome, in my opinion, would
just generally be acute infection brought on by all the
different organisms that are on roses that are in the
soil of a typical plant bed, and then getting the
(29:52):
soft tissue, the organisms get into the soft tissue and
cause an active infection. That would be my general understanding
of what rosegarden syndrome or rose garden disease is just
basically an infection of the soft tissue brought on by
the I guess resident organisms that you might see in
(30:13):
a flower bed or a rose bush. And yeah, just unfortunate.
Sometimes it can last a long time. Now he's saying
there were he underwent several rounds of antibiotics. Again, the
best way to figure out what's the right antibiotic is
to get a culture of the organism. A lot of
(30:37):
times that can be difficult, and practitioners are sort of
medicating blindly, if you will.
Speaker 2 (30:44):
We sort of know in general.
Speaker 1 (30:46):
Which organisms should be present. Let's say, if you get
a lung infection, or even sully lightis a lot of
people suffer from sellitis to get that redness and that
pain in their arm or their thigh or their left
we don't actually get a culture most of the time,
but we know.
Speaker 2 (31:05):
In general the.
Speaker 1 (31:07):
Organisms that normally cause that high percentage of the time,
and so we have several antibotic choices that we can use.
Same thing for respiratory infections, same thing for urine air
tract infections. Although that's a bit easier to try and
get a urine culture in that situation, we normally can
get that performed. But a lot of these infections that
(31:29):
we treat, it's difficult to get an actual culture and
identify the organism. But we have obviously medical literature, we
have resources we can go to that give us a
really good idea about which antibotics should be effective, and
that's sort of how we choose the antabotic for you.
But sometimes they don't work, and we normally will switch
(31:53):
to a different antibiotics again that should work. But if
you're on your third course of a different antibiotic, a
lot of times I will try to get the involvement
of an infection specialist.
Speaker 2 (32:07):
These are doctors that.
Speaker 1 (32:08):
Study organisms and study infections, and they help us a
lot in choosing the right antibiotic, whether it be ivy
or po and sometimes choosing the length of the antibiotic course.
You know, most of the time, patients are familiar with
taking antibiotic maybe for five days a week, maybe even
(32:28):
two weeks, but there are situations that come up where
you have to take the antibiotic for four weeks, six weeks, forever.
So we have those patients that have those sort of diseases.
So if you're on your third course, I would say
that this is a more complicated situation and we'll probably
try to get you to an infection doctor. You know,
(32:50):
because if it's involving your extremities your finger, those are
very tight structures, meaning if you see a cross section
of your finger, there's a lot of there's a lot
of things packed into that finger, that digit that once
you get an infection, it can just sort of affect
and destroy all that the nerves, the blood vessel, the bone,
the connective tissue. It can go pretty fast, and a
(33:12):
lot of times the only way to deal with that
is to amputate it, because just time is of the
essence in those situations, and you don't want to play
around with infections of your digits because again, sometimes it
can cause some.
Speaker 2 (33:26):
Pretty rapid destruction of those structures, and.
Speaker 1 (33:29):
The only way to deal with is just to cut
that little digit off, that section off and sort of
sew it up. So sometimes people have to do that
with just common routine infections. But certainly three courses sounds
a little long to me, and probably just to make
sure I'm doing my part as a practitioner, probably get
another doctor involved to kind of help us out. Phone
(33:51):
lines are open eight nine to six KALVA one hundred
three three zero KALVY. I'll be back in two minutes.
Speaker 3 (34:12):
And doctor Leonard in Houston has a question. He'd like
to lose twenty pounds wonders if there are any pills,
are injectables you could recommend to lose twenty pounds.
Speaker 1 (34:24):
We appreciate that Gemen. We appreciate Leonard Carling hadn't heard
from in a while. But Leonard, and I think, has
type two diabetes. If this is the same Leonard from Houston,
and the awesome thing about that situation, if there is
anything awesome about having diabetes. But these new medications that
(34:46):
have on the market right now that are diabetic medications
that belong to a certain class, I think most people
know them as a zimpic, but there's several medicines in
that class category. I should say one of the adverse,
shouldn't say adverse. One of the actions of the medication
(35:08):
is basically to kind of slow down your bowel function.
That's that's how this class works. G l P one
agonist is the technical term of the class of medications.
Again O zimpic, trulicity, Wygovi, Munjaro, ry Belsi's there's a
(35:29):
couple other ones that have in these class. And this
medicine has been out for a long time, I would
say nine years at least, and I don't I don't
quite know why it took this long for this medication
to sort of be prioritized as it pertains to wait.
But certainly, if Leonard were a patient of mine and
(35:53):
he was wanting to lose weight, he has type two diabetes,
that's one of the medicines that I would prioritize for him,
probably get him on that medication in its various forms,
to try and get his way down, because again, in
slowing down the bile function, it basically allows us to
go several hours without eating because our say tidy is satisfied,
(36:18):
meaning we don't feel hungry. And that's the issue in
this country, and I've talked about this before, is that
we're sort of all told that you have to eat
three times a day like that's a normal thing. And
my message to all my listeners is that I think
that is excessive in today's world. With the amount of
(36:44):
energy that we have to expend every day to stay alive,
it's not that much. We're not really physically active anymore
in this country for various reasons, and so we don't
need to necessarily spend a lot of time eating a
lot of food, which is basically just for calories so
that our bodies will work. Our bodies are a machine.
We need fuel, and food is our fuel to work.
Speaker 2 (37:09):
But we don't.
Speaker 1 (37:10):
We don't really need a lot of fuel every day
to function, So eating three times a day, in my opinion,
is excessive. You know, you don't need to wake up
and eat breakfast and then lunch and then dinner. And
most of us just kind of hanging out, sitting around,
maybe riding in a vehicle or sitting at a desk,
or we're just not doing a lot physically, and so
(37:32):
we don't really need to eat a lot. But again,
we're kind of a conditioned in this country to do that, right.
But when you ask someone, well, don't eat, just eat
once a day, right, Mentally, that can be challenging. It
can be tough to go all day without eating. And
this medication, of this class of medications ozempic wygovi, munjarro, trulicity.
(37:57):
There's a couple other ones. Again I keep forgetting sex
send that's another one. Ripe Elsa's. When you take these medications,
it is easier to go several hours without eating, you
feel comfortable. It's you don't get this angry sensation when
you go all day without eating. How you just sort
of get irritated and are nerved up and you just
(38:19):
want to choose something you want to swallow something, You
want that sensation to go away because it is a
little bit uncomfortable. So with all the food around us
all the time, very easy to access, again, a lot
of times the food that's not good for us is cheap,
it's packaged, it's ready to go, and it's filled with
(38:41):
all the things that we love to taste, right, the
flavors and the sensations, and they sort of know all
this stuff right and put it in front of us
just hey, they're own businesses, provide food, and so we
eat it. You know, it all helps or it all works.
Speaker 2 (38:55):
But again, when you're.
Speaker 1 (38:56):
Trying to lose way, you have to figure out a
way to not do that. These medicines are very good,
so Leonard I would certainly try and get you on
one of those medications. Phonons are opening one six kV
I want one hundred three three zero kalf last break
be back in two minutes. My mind now goes by
(39:28):
so fast. Phoneons are opening unc kV I one hundred
three three zero KLF. I just only have a couple
of minutes left in the show. We'll always want to
thank that listeners and the callers every week and again
if there's some topic that you would like me to discuss,
certainly let me know. We certainly want the program to
(39:50):
be enjoyable and informative to you. Again, just trying to
get your answers to some of your commonly asked questions
and to make this thing a little bit easier for you.
I'm not here to say that it's always easy to
give your answers, because a lot of times it is difficult.
We do see a lot of our listeners in the
(40:12):
hospital with a lot of physical complaints, and man, we
just we're doing everything we can. We just can't get
those answers to you. And as I mentioned to my
patients all the time in the hospital, we would love
to just very easily hand these diagnoses to you. You know,
they're the right diagnoses. Everything's going to work out and
(40:33):
there's going to be a victory party at the end
of the day. But just unfortunate that's not the way
it is. Even despite being in a modern hospital with
getting all the modern tests and seeing all the specialized doctors.
Just sometimes we just the answers don't come as easily
as we would like, and you know that's part of
the way it is. Sometimes and it is unfortunate, but
(40:56):
we try to keep those cases to a minimum. So
if there's anything that you want me to discuss, you know,
let us know. We'd more than happy to dive into that.
Most of the topics that I talk about are common
topics that I see every day that may be of
interest while I'm interacting with my patients. Why I love
(41:18):
my job is letting our people talking with me and
them letting me into their lives and sharing some of
their secrets and their issues with them. So just a
lot of interesting things that people are doing and going through,
and I just want to thank all of my patients
(41:38):
and my practice and all the listeners for allowing me
to do that.
Speaker 2 (41:41):
It is a privilege and I know that, and we'll try.
Speaker 1 (41:46):
Again my best to give you the best answer that
I can based on my experience. I'm a practitioner, been
doing it for over twenty years, and I'm always learning
new things about just medicines and the way to prescribe
medication is truly a very very enjoyable profession. And I
(42:06):
know a lot of patients when they come in and
visit with me, they're like, Hey, you doing, Okay, Hi
you doing? Because they want to make sure their practitioners okay,
they're gonna be with it. So I appreciate those questions
as well. But again at the end of the day,
this is the winter time respiratory time, so go get
those vaccines, and we always see our respiratory rises, So
(42:31):
get in with your practitioner sooner rather than later. The
healthcare community certainly has better access on the weekends and
at nights if you start getting that cough and chess congestion,
especially if you have chronic medical problems like a COPD
or CHF or diabees a lot of times, if you
can get on top of that on day one, day two,
you can stay out of the hospital rather than letting
(42:54):
it just persist and get stronger and more severe. Again,
because you want to do what you can to keep
it to a minimum, you know, go in and get
checked out and get on the appropriate medication, and try
to stay out at the hospital as much as possible.
So we again enjoy all of the callers and the listeners. Remember,
(43:16):
we want you to drink that water, and we want
you to exercise a little bit, and again, don't have
to do it every day. We're talking about ten or
twenty minutes of some physical activity, walking a triapmill, pelling
a bicycle, jumpin.
Speaker 2 (43:30):
Jacks, push ups, sit ups.
Speaker 1 (43:32):
That stuff still works, right, But it doesn't mean you
can have a big pizza and eat whatever you want
if you're exercising.
Speaker 2 (43:38):
We'll see you next week. Take care,
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